What is a System of Care and Why Are They Important

Welcome back again to the South Carolina Bureau of EMS contribution area of this edition of Carolina Fire Rescue EMS Magazine. As we gear up for what is promising to be another very hot summer season, I urge you to stay hydrated, eat right, get enough rest, and LOOK OUT FOR EACH OTHER! If you, your EMS partner, or member of your engine crew is getting overheated; STOP everything and re-evaluate the situation. Heat stress and stroke can come on quickly and can be deadly. If you’re lucky you may just end up with the world’s most painful leg cramps. Be safe. Be smart. 


What are Statutes and Regulations?

Many times we gather here at the Bureau of EMS and Trauma to discuss issues of the day. We go over current projects, grants, investigations and a myriad of other items. One topic that seems to always creep into the conversation is “Why don’t people know their statutes and regulations?”

Of course, this is an over-generalization; many of you out there in EMS land are ultra-familiar with both statutes and regulations and you follow them to the “T” every day you operate. The bureau staff is pointing more to those that seemingly — or oftentimes admittedly — have no idea about what rules they are supposed to follow or why. When we interview someone during an investigation, we nearly always ask if they know what Title 44-61 is or Regulation 61-7. So often we are treated to a blank stare and a mumbled “No, ma’am.”

As the bureau chief I know that daily our field personnel, regulatory staff, training and certification personnel educate the EMS community on a regular basis on the laws and regulations pertaining to EMS; I see and hear it constantly. I thought perhaps an article in this issue may reach a few more of you and maybe you can share it with your colleagues.

We will focus this article strictly on what laws and regulations pertain to EMS. We will not go into disciplinary or corrective actions, fines, or how laws and regulations are passed; I don’t have enough paper in all the printers on this whole floor to explain those processes. Let’s focus on entry level education into what “rules” you need to follow as EMS providers.    

What is Title 44-61?

The 1976 South Carolina Code of Laws is updated every Legislative session; currently they are on Act number 143 of the 2018 Session. Sessions are two years long, and this January we will begin another two-year cycle. The Code of Laws is broken down in to 63 “Titles” and they run from Trade and Commerce, to motor vehicles, to health, etc. Health is Title 44, and within Title 44 there are 137 “chapters” which range from birth defects, to the violent sexual predator act, to EMS related chapters. The main chapter that covers us is of course 44-61 “Emergency Medical Services.” There are other chapters that most certainly pertain to your job, and you should have a look at them as well. Chapter 1, DHEC; Chap 4, Emergency Health Powers; Chap 30 Healthcare Professional Compliance Act; Chap 75 Athletic Trainers; Chap 76, AED’s, Chap 78 EMS DNR; Chap 99 Insect Sting Emergency Treatment Act (yes that’s real), etc. etc.

There are many of them that regulate what and how you do business. We’ll concentrate again on 44-61, EMS. Within the Act are Titles, within the Titles there are Articles, and within the Articles are Sections. Sound complicated? It’s not. 

Articles break down the EMS Act by sections. There are four articles in 44-61 and I bet you’re familiar with most of them. First is EMS, then EMS for Children, Trauma Care Systems, and finally Stroke System of Care. Each article generally starts with definitions, then it adds a requirement for some type of oversight or advisory council, and then gets to the meat of the law. Section 44-61 provide very general mandates for the bureau to follow when regulating EMS in South Carolina. It tells us to license agencies, EMTs, permit vehicles, regulate the education of EMTs, and what types of things we as a bureau can define as misconduct as well as a ton of other things.

What it does not do is tell us “how” to perform these functions. The “how” comes from the authority given within most statutes for DHEC to “promulgate regulations and develop standards in order to carry out the provisions of this act.” The act also grants the Bureau of EMS the authority to enforce the act, regulations and standards as developed.

One fact that is often misunderstood is that neither the bureau nor the agency can make changes to the statute. The act is the set of rules by which the legislature authorizes us to perform our duties. We cannot change what we do, only the legislature can. One example that is often heard is “Why doesn’t the bureau regulate emergency medical responders?” The act currently tells us that we may regulate only those defined as emergency medical technicians: “(12) “Emergency medical technician” (EMT) when used in general terms for emergency medical personnel, means an individual possessing a valid EMT, advanced EMT (AEMT), or paramedic certificate issued by the State pursuant to the provisions of this article.”

Note there is no mention of EMR’s in that definition. We cannot add them, nor can we remove another level if we chose to do so. We must license and regulate that which we have authority. Would it be as easy as to add the language “and Emergency Medical Responders” to the definition, basically, yes, but those few words could take years to implement. Easy to write, harder to institute. Where we have the “how to do business” is within our regulations.

What is Regulation 61-7? 

Now we get into the longer more detailed processes of “how” do we license EMTs and agencies or what is required to obtain such licensure, what is needed to be a training center, what misconduct means and how we can go about correcting the misconduct that has occurred.

The regulations are much more detailed and longer in length than the actual statute. The act is barely four pages long; the regulation is 67 pages in length. In a nutshell, as an example, the act tells the BEMS to permit ambulances, the regulation tells you how big the stripe should be, where the stars of life go, what equipment has to be on it and how many people are needed to operate it during any given time. There are 14 sections within the regulation — no need to list them all — but they include regulations on ePCRs, personnel, misconduct, air-medical services, etc. Grab the regulations and read through them.

They are filled with little known fun facts about how you need to do business. If you read through them, I promise you will learn something new. If you HONESTLY do not, send me an email and I’ll buy you an ice cream next time we run into each other! Let’s close out this edition with just a few fun facts, shall we?

Title 44-61 and Regulation 61-7
Facts YOU should know

Section 44-61-70.

The department has the authority to suspend a license pending an investigation. We don’t often do this, but it does happen on occasion when the facts seemingly provide a vivid picture of the actual event(s) that lead to the investigation and we feel the safety of the public may be in jeopardy if the agency is allowed to continue to operate. Some of the things we can suspend or revoke a license for?

  1. Allowed uncertified personnel to perform patient care
  2. Falsified required forms or paperwork as required by the department
  3. Failed to maintain required equipment as evidenced by past compliance history
  4. Failed to maintain a medical control physician
  5. Failed to maintain equipment in working order and others

How about Section 44-61-110?

“No grant in aid funds can be made to any counties or municipalities not in compliance with the EMS act” Really good reason to stay in compliance, right?

How about some Regulation
61-7 tidbits?

These are always fun. Do you know the minimum number of EMTs an agency can have on a roster and still be licensed? That’d be five. (Section 404(B)). Did you know if you wreck an ambulance and it’s out of service for more than two weeks, or the windshield gets replaced on a routine issue, you are supposed to return the old permit to the bureau and have a new one issued?  (Section 501(F))

Every permitted ambulance must have two sun visors, two working windshield wipers (and washers), and two exterior mirrors.  (Section 600(H)5-7) I’ll finish with a big one that we often see as a violation and have had to do some corrective actions on. How long do you have to enter your ePCRs into your records management system (RMS)? That’s right! You have 24 hours from the call to enter it and 72 hours from the call to upload it to the EMS Performance Improvement Center. And yes, this is not only in regulation, it is in statute too in order for us to submit data nationally and contribute to the world body of knowledge in EMS.

There are many ins, outs, ups, downs and caveats in the laws and regulations that govern EMS in South Carolina. You can better prepare yourself professionally and personally if you take the time to familiarize yourself with them on your next couple shifts and potentially avoid a pitfall of some rule or regulation you “didn’t know about” because much like “I didn’t see the speed zone sign,” ignorance is not an excuse when it comes to a violation of the law in our world either.

A copy of the EMS Statute can be found on the South Carolina Legislatures website at: https://www.scstatehouse.gov/code/t44c061.php and a copy of the most current version of Regulation 61-7 can be found at: A copy of the EMS Statute can be found on the South Carolina Legislatures website at: https://www.scstatehouse.gov/code/t44c061.php and a copy of the most current version of Regulation 61-7 can be found at: https://www.scdhec.gov/Agency/docs/health-regs/61-7.pdf.

Take a minute to read them over, then try to stump your friends with some of your new found knowledge, it’ll be worth it, I swear

Rob Wronski is the South Carolina Department of Health and Environmental Control (SC DHEC) Bureau Chief of EMS. He has served in many roles since becoming a firefighter paramedic in 1991, culminating with his selection as Chief of EMS for the state where he has served for nearly three years. He has held several executive positions including Assistant Chief of the St. Andrews Fire Department in Charleston, Medical Officer of the Mt. Pleasant Fire Department, and a Shift Commander in the Beach Park (IL) Fire Department. His experience includes working in fire-based EMS, including ALS and BLS first response as well as fire based and county based ALS transport.

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