ESHB 2110
SignedHouse
Specialty care transports
Concerning personnel for ambulance service interfacility specialty care transports.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill updates Washington’s ambulance service regulations to improve access to interfacility specialty care transports during workforce shortages. It allows registered nurses with appropriate training to lead certain high-acuity patient transfers when paramedics or EMT-certified nurses are unavailable, and expands options for rural ambulance services to use untrained drivers under strict safeguards.
- Clarifies the definition of 'specialty care transport' to include care by physicians, registered nurses with appropriate competencies, or specially trained paramedics.
- Allows registered nurses (RNs) to serve as the sole medical provider on an ambulance for interfacility specialty care transports—*if* certain conditions are met: (1) at least one certified emergency medical service provider is present, (2) the RN has required competencies, (3) no paramedic or RN with EMT certification is available from the sending hospital or ambulance service.
- Expands flexibility for rural ambulance services to use untrained drivers (age 18+) under strict conditions: background check, valid license, must be accompanied by a nondriving emergency medical technician, and no medical care beyond their training level.
- Reaffirms that ambulances must have at least one certified emergency medical technician (EMT) in attendance, with specific command and location requirements for EMTs in multi-EMT crews.
- Updates definitions in RCW 18.73.030 to clarify terms like 'interfacility transport', 'specialty care transport', and 'stretcher' for consistency and clarity.
Who is affected
- Rural ambulance services — Ambulance services in rural areas may use untrained drivers under strict conditions, potentially expanding staffing flexibility where qualified personnel are scarce.
- Hospitals and health systems — Hospitals and health systems may rely more on registered nurses (RNs) for specialty care transports when paramedics or RNs with EMT certification are unavailable, affecting staffing decisions and interfacility transfer logistics.
- Registered nurses — Registered nurses who meet specific competencies may now legally serve as primary medical personnel during certain interfacility specialty care transports, expanding their scope in emergency transport settings.
- Patients requiring interfacility specialty care transports — Patients needing high-acuity transfers between facilities may experience more timely or appropriate transport options when workforce shortages would otherwise delay care.
Pro/Con Analysis
Potential Benefits (5)
Allowing RNs to serve as sole medical providers on interfacility specialty care transports when paramedics and EMT-certified RNs are unavailable directly addresses workforce shortages and may reduce delays in high-acuity transfers—especially for patients needing time-sensitive care like stroke or trauma. This expands access to timely specialty care and may reduce preventable morbidity/mortality.
HealthcarePeopleRef: Sec. 3(3)Expanding rural ambulance staffing flexibility by permitting untrained drivers (under strict safeguards) helps sustain service in areas with acute workforce shortages, reducing or preventing service gaps that would otherwise leave rural patients without transport options.
Public SafetyPeopleRef: Sec. 3(2)Formally recognizing RNs with appropriate competencies as qualified providers for specialty care transports expands the pool of qualified personnel, enabling hospitals and ambulance services to better match patient needs with available staff—particularly helpful in regions with paramedic shortages.
HealthcarePeopleRef: Sec. 2(22)Clarifying definitions (e.g., 'interfacility transport', 'specialty care transport', 'stretcher') reduces regulatory confusion and improves compliance consistency across ambulance services, especially for smaller or newer providers who may struggle with ambiguous statutory language.
HealthcarePeopleRef: Sec. 2(16)-(23)The bill may increase demand for RNs with specialty care competencies (e.g., critical care, flight medicine), potentially creating new career pathways and retention incentives for nurses—though this benefit is likely limited to those already in or near the specialty care workforce.
Business & EmploymentRef: Sec. 2(22)
Potential Concerns (5)
The bill reaffirms that every ambulance must have at least one certified EMT in attendance, with command responsibilities clearly assigned (e.g., nondriving EMT in multi-EMT crews). This strengthens baseline safety standards by ensuring medical personnel with standardized training are always present and accountable for patient care during transport.
Public SafetyRef: Sec. 3(1)(a)The bill maintains the requirement that ambulance drivers must have at least an advance first aid certificate unless two EMTs are present — preserving a baseline of emergency response capability for drivers in standard urban/suburban operations.
Public SafetyRef: Sec. 3(1)(b)Allowing untrained drivers in rural ambulances—even under strict safeguards—introduces a modest safety risk: while the driver doesn’t provide care, they are present in the patient compartment and may inadvertently interfere with care or compromise scene safety during high-stress situations. The background check and EMT accompaniment mitigate but do not eliminate this risk.
Public SafetyPeopleRef: Sec. 3(2)The bill’s requirement that the sending hospital must lack a registered nurse with EMT certification before an RN without EMT certification can serve as primary provider prevents overuse of the new authority and preserves continuity of care protocols where EMT-certified RNs are available.
HealthcareRef: Sec. 3(3)(d)Clarifying 'specialty care transport' to explicitly include RNs with appropriate competencies (alongside physicians and specially trained paramedics) reduces regulatory ambiguity and supports consistent application of care standards across regions.
HealthcareRef: Sec. 2(22)
Who Is Most Affected
Rural ambulance services gain staffing flexibility to maintain service continuity in areas with severe workforce shortages, reducing service gaps and potential patient abandonment. However, they must absorb administrative burden (e.g., background checks, documentation) and may face liability concerns if untrained drivers are involved.
Hospitals and health systems benefit from greater flexibility in staffing interfacility transfers, potentially reducing delays and improving patient flow. However, they must ensure RNs meet competency requirements and may face increased coordination complexity.
Registered nurses with appropriate competencies gain expanded legal authority to lead specialty care transports, potentially increasing job satisfaction and career mobility. However, this also increases liability exposure and requires additional training/certification maintenance.
Patients requiring high-acuity interfacility transfers benefit from faster, more appropriate transport options when workforce shortages would otherwise delay care—especially in rural or underserved regions. However, those in areas where untrained drivers are used may face slightly elevated safety risks during transport.