Commissioner Margret R. Cooke
Massachusetts Department of Public Health
250 Washington St.
Boston, MA 02108

Delivered Electronically

Re: 105 CMR 170.000: Emergency Medical Services System

Dear Commissioner Cooke,

On behalf of the 351 cities and towns of the Commonwealth, the Massachusetts Municipal Association appreciates the opportunity to offer comments as the Department of Public Health holds a hearing and receives input on proposed amendments to 105 CMR 170: Emergency Medical Services System.

Emergency medical services (EMS) personnel are unique health care providers, needing to be ready 24/7 to respond to each and every call within eight minutes. EMS is an essential service provided in every city and town throughout the Commonwealth, with very different service delivery circumstances in each community. Uniform regulatory changes within this complex and varied system can easily miss the mark, and impose unintentionally infeasible and counterproductive requirements on a large number of municipalities and providers. We believe this is the case with the proposed changes offered by 105 CMR 170.

The MMA has significant concerns regarding the pending draft, which would disrupt the already overstressed EMS system in the Commonwealth. We know the pandemic is not over, and the demands on our emergency medical services system have grown exponentially. Cities, towns, and EMS service providers need a regulatory framework that provides the flexibility necessary to deploy time and resources in a manner that supports our first responders and provides adequate and effective service to residents across the Commonwealth.

The proposed changes would place unnecessary and unaffordable administrative and financial burdens on ambulance services, including emergency medical service providers. Because cities and towns operate under state laws that cap municipal revenues and resources, the implementation of overly burdensome and costly mandates would force the reduction of other essential services, creating significant problems for residents and taxpayers. Therefore, we respectfully urge DPH to rescind the current proposed regulatory changes and work with the MMA and other stakeholders on key issues and priorities for future regulatory review by the Department.

In particular, we raise two significant issues of concern. The proposed language in 170.345 would require that patient care reports be transmitted to or left at the hospital prior to EMS personnel leaving. Current practice enables ambulance personnel to submit reports after departure, so that personnel can be swiftly redeployed to ensure effective response times to subsequent calls. The proposed delay in departure after delivering patients to hospitals would present significant operational risks for emergency medical services, and make it much more difficult to meet expected call response times. This would impact all municipalities, particularly in rural areas. Further, in 170.305, new staffing definitions would present significant challenges, especially for an already understaffed workforce. This would directly impact service and likely create additional costs for cities and towns, forcing cutbacks in other public services.

We commend the comments and recommendations submitted by the Massachusetts Ambulance Association, the Fire Chiefs Association of Massachusetts, and other interested stakeholders. These expert practitioners are raising similar concerns regarding the proposed changes and the expected negative impacts on EMS and public safety that would result.

Thank you again for holding this public hearing and for considering the comments outlined above. If you have any questions, or wish to receive additional details, please do not hesitate to contact MMA Legislative Director Dave Koffman at or 617-426-7272, ext. 122, at any time.


Geoffrey C. Beckwith
MMA Executive Director & CEO

Secretary Marylou Sudders, Executive Office of Health and Human Services