Effective - 28 Aug 2018
190.147. Behavioral health patients — temporary hold, when — memorandum of understanding, contents — physical restraints, use of. — *1. An emergency medical technician paramedic (EMT-P) may make a good faith determination that such behavioral health patients who present a likelihood of serious harm to themselves or others, as the term "likelihood of serious harm" is defined under section 632.005, or who are significantly incapacitated by alcohol or drugs shall be placed into a temporary hold for the sole purpose of transport to the nearest appropriate facility; provided that, such determination shall be made in cooperation with at least one other EMT-P or other health care professional involved in the transport. Once in a temporary hold, the patient shall be treated with humane care in a manner that preserves human dignity, consistent with applicable federal regulations and nationally recognized guidelines regarding the appropriate use of temporary holds and restraints in medical transport. Prior to making such a determination:
(1) The EMT-P shall** have completed a standard crisis intervention training course as endorsed and developed by the state EMS medical director's advisory committee;
(2) The EMT-P shall** have been authorized by his or her*** ground or air ambulance service's administration and medical director under subsection 3 of section 190.103; and
(3) The EMT-P's**** ground or air ambulance service has developed and adopted standardized triage, treatment, and transport protocols under subsection 3 of section 190.103, which address the challenge of treating and transporting such patients. Provided:
(a) That such protocols shall be reviewed and approved by the state EMS medical director's advisory committee; and
(b) That such protocols shall direct the EMT-P regarding the proper use of patient restraint and coordination with area law enforcement; and
(c) Patient restraint protocols shall be based upon current applicable national guidelines.
2. In any instance in which a good faith determination for a temporary hold of a patient has been made, such hold shall be made in a clinically appropriate and adequately justified manner, and shall be documented and attested to in writing. The writing shall be retained by the ambulance service and included as part of the patient's medical file.
3. EMT-Ps who have made a good faith decision for a temporary hold of a patient as authorized by this section shall no longer have to rely on the common law doctrine of implied consent and therefore shall not be civilly liable for a good faith determination made in accordance with this section and shall not have waived any sovereign immunity defense, official immunity defense, or Missouri public duty doctrine defense if employed at the time of the good faith determination by a government employer.
4. Any ground or air ambulance service that adopts the authority and protocols provided for by this section shall have a memorandum of understanding with applicable local law enforcement agencies in order to achieve a collaborative and coordinated response to patients displaying symptoms of either a likelihood of serious harm to themselves or others or significant incapacitation by alcohol or drugs, which require a crisis intervention response. The memorandum of understanding shall include, but not be limited to, the following:
(1) Administrative oversight, including coordination between ambulance services and law enforcement agencies;
(2) Patient restraint techniques and coordination of agency responses to situations in which patient restraint may be required;
(3) Field interaction between paramedics and law enforcement, including patient destination and transportation; and
(4) Coordination of program quality assurance.
5. The physical restraint of a patient by an emergency medical technician under the authority of this section shall be permitted only in order to provide for the safety of bystanders, the patient, or emergency personnel due to an imminent or immediate danger, or upon approval by local medical control through direct communications. Restraint shall also be permitted through cooperation with on-scene law enforcement officers. All incidents involving patient restraint used under the authority of this section shall be reviewed by the ambulance service physician medical director.
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(L. 2018 H.B. 1355 merged with S.B. 870)
*This subsection contains language from both H.B. 1355 and S.B. 870, 2018; however, the order of the language differs from H.B. 1355.
**Word "Who" appears in original rolls of H.B. 1355, 2018.
***Word "their" appears in original rolls of H.B. 1355, 2018.
****Word "Whose" appears in original rolls of H.B. 1355, 2018.
Structure Missouri Revised Statutes
Title XII - Public Health and Welfare
Chapter 190 - Emergency Services
Section 190.020 - Public hearing, notice — costs, how paid.
Section 190.025 - Petitions — consolidation, when — amended, how.
Section 190.030 - Sufficiency of petition, county commission to determine.
Section 190.035 - Notice of election, contents.
Section 190.040 - Form of ballot — effect of passage on tax rate — fund created — refunds, when.
Section 190.041 - Tax levy for central dispatching service, when, amount — funds kept separate.
Section 190.043 - Increase in tax rate without voter approval, when, amount.
Section 190.045 - Returns of election, where filed — effect of.
Section 190.051 - Change in number of board members, when — ballot language.
Section 190.052 - Board member must live in his district — vacancies, how filled.
Section 190.053 - Educational training required for board of directors — failure to attend.
Section 190.056 - Recall of directors, procedure.
Section 190.060 - Powers of district.
Section 190.065 - Bonds, issuance of — election, form of ballot.
Section 190.070 - Annexation, petition for — hearing — election, form of ballot.
Section 190.074 - Collection of taxes — levy — procedure.
Section 190.075 - Records, what and how kept.
Section 190.080 - Donated property — title, how taken.
Section 190.085 - Failure to approve bonds, effect of — dissolution — funds, how rebated.
Section 190.094 - Minimum ambulance staffing — volunteer defined.
Section 190.100 - Definitions.
Section 190.102 - Regional EMS advisory committees.
Section 190.104 - Pediatric emergency medical services system.
Section 190.107 - Contracts for mutual aid services.
Section 190.108 - Air ambulance licenses — sale or transfer of ownership, notice required.
Section 190.109 - Ground ambulance license.
Section 190.111 - Inspection limitation — effect of sale or transfer on a license.
Section 190.120 - Insurance, what coverage required — policy provisions required — term of policy.
Section 190.131 - Certification of training entities.
Section 190.133 - Emergency medical response agency license.
Section 190.134 - Dispatch agency, requirements.
Section 190.142 - Emergency medical technician license — rules.
Section 190.144 - Immunity from liability, when.
Section 190.146 - Lapse of license, request to return to active status, procedure.
Section 190.160 - Renewals of licenses, requirements.
Section 190.165 - Suspension or revocation of licenses, grounds for — procedure.
Section 190.171 - Aggrieved party may seek review by administrative hearing commission.
Section 190.173 - Confidentiality of information.
Section 190.175 - Records to be maintained by licensee.
Section 190.176 - Data collection system.
Section 190.180 - Penalty for violation.
Section 190.185 - Rules and regulations, department to adopt — procedure.
Section 190.190 - Time to comply granted existing equipment and personnel.
Section 190.200 - Public information and education.
Section 190.205 - Insurers' duties.
Section 190.243 - Transportation to trauma, STEMI, or stroke centers or hospitals, how authorized.
Section 190.248 - Investigations of allegations of violations, completed when — access to records.
Section 190.255 - Naloxone, first responder may administer, when — definition.
Section 190.265 - Helipads, hospitals not required to have fencing or barriers.
Section 190.270 - Citation of law.
Section 190.275 - Definitions.
Section 190.286 - Inapplicability to certain out-of-state businesses.
Section 190.290 - Definitions.
Section 190.300 - Definitions.
Section 190.306 - Dissolution of emergency telephone service not required, when (Christian County).
Section 190.315 - Contract for service authorized.
Section 190.320 - Election — ballot form.
Section 190.328 - Election of board, Christian and Scott counties, when — terms.
Section 190.329 - Election of board, exceptions, when — terms.
Section 190.334 - Performance and fiscal audits authorized.
Section 190.336 - Recall, board members subject to — procedure.
Section 190.340 - Emergency services board, officers duties, rules and regulations.
Section 190.355 - Use of existing resources required.
Section 190.400 - Definitions — interoperability service agreements, what agencies.
Section 190.420 - Fund established.
Section 190.470 - Alternate consolidation — petition, election — board appointed, requirements.
Section 190.475 - Centralized database to be maintained, updates.
Section 190.500 - Temporary license — qualified health care professions — declared emergency.
Section 190.525 - Definitions.
Section 190.534 - Violations, penalty — attorney general to have concurrent jurisdiction.
Section 190.537 - Rulemaking authority.
Section 190.550 - Schedule of fees established, rules — collection and deposit.
Section 190.600 - Citation of act — definitions.
Section 190.606 - Immunity from liability, what persons and entities.
Section 190.609 - Order effective, when — limitations of order.
Section 190.618 - Rules — rulemaking authority.
Section 190.621 - Penalty for concealing or falsifying an order.
Section 190.800 - Imposition of tax — definitions.
Section 190.803 - Formula for tax based on gross receipts — challenge of validity of rules.
Section 190.806 - Record-keeping requirements, confidentiality.
Section 190.812 - Determination of tax final, when — timely protest permitted.
Section 190.815 - Rulemaking authority.
Section 190.818 - Remittance of tax — fund created, use of moneys.
Section 190.821 - Tax period — failure to pay, delinquency, enforcement procedures.
Section 190.824 - Tax-exempt status of ambulance service not affected.
Section 190.827 - Payments to ambulance services, when.
Section 190.830 - Federal financial participation required.
Section 190.833 - No tax imposed prior to effective date.
Section 190.836 - Rules requirements, authority.
Section 190.839 - Expiration date.
Section 190.840 - Nonseverability clause.
Section 190.900 - REPLICA enacted — definitions.
Section 190.903 - Home state licensure.
Section 190.906 - Compact privilege to practice.
Section 190.909 - Conditions of practice in a remote state.
Section 190.912 - Relationship to emergency management assistance compact.
Section 190.915 - Veterans, service members separating from active duty military, and their spouses.
Section 190.918 - Adverse actions.
Section 190.921 - Additional powers invested in a member state's EMS authority.
Section 190.924 - Establishment of the interstate commission for EMS personnel practice.
Section 190.927 - Coordinated database.
Section 190.933 - Oversight, dispute resolution, and enforcement.