This bill amends existing Washington law (chapter 18.73 RCW) by adding legislative findings, updating definitions used in the chapter, and changing minimum staffing, training, and procedural standards for ambulance operations and interfacility specialty care transports. It amends RCW 18.73.030 (definitions) and RCW 18.73.150 (ambulance personnel requirements) to establish these changes. The personnel and procedural changes require every ambulance to operate with sufficient personnel including at least one emergency medical technician (EMT) meeting standards set by the secretary of health. If two or more EMTs are present, a nondriving medical technician is in command and must be in the patient compartment attending the patient. Drivers must hold at least an advance first aid certificate recognized by the secretary unless two certified EMTs are on board. With department approval, certain rural volunteer or municipal services may use an otherwise untrained driver under specific conditions (age, background check, valid license, accompaniment by a nondriving EMT, and limits on care provided). The bill also allows a registered nurse who is not EMT-certified to serve as sufficient personnel for interfacility specialty care transports if specified conditions are met (at least one EMT on board; the RN has appropriate competencies; no paramedic is available to respond; and the sending hospital has no RN with EMT certification available). Additional requirements for such RNs include following the sending or receiving physician’s medical direction, working within the RN scope consistent with State Board of Nursing standards, and confirmation by the sending hospital that the RN is familiar with ambulance equipment and supplies before transport. The bill adds or clarifies multiple definitions (for example, advanced life support, basic life support, aid service, ambulance, specialty care transport, prehospital patient care protocols, and others) and identifies affected entities, including the Department of Health and its secretary, the State Board of Nursing, regional and local EMS and trauma care councils, emergency communication centers, EMS medical program directors, ambulance and aid services, organ transport services, hospitals, and emergency services supervisory organizations. These are procedural and standards changes to licensing, staffing, and transport practices; the extracted text does not mention changes to criminal penalties. The provided excerpts end with Sec. 3 and cite several cross-referenced statutes, and other parts of the bill, fiscal details, or implementation provisions may exist but are not included here.

If enacted, the bill will require every ambulance to have enough crew to meet patient needs and at least one certified EMT on board, make a nondriving EMT the on‑scene leader when two or more EMTs are present, and generally require drivers to hold an advance first aid certificate unless two EMTs are riding. It also creates a limited option for some rural volunteer or municipal services to use a driver without medical training if the department approves and strict conditions are met, and it allows a registered nurse who lacks EMT certification to staff certain interfacility specialty transports when an EMT is on board, a paramedic is unavailable, and the sending hospital confirms the nurse’s competencies and familiarity with ambulance equipment. The people and organizations most affected are ambulance services (including volunteer and municipal units), EMTs, ambulance drivers, registered nurses used for specialty transfers, hospitals that send patients, the Department of Health, and regional EMS councils and medical program directors. Expect changes in who can be assigned to drives and patient care, new or expanded training, certification, background check, and documentation duties, and potential operational flexibility for rural systems to make timely transfers; costs and liability exposure may shift to services that need to meet the new personnel, training, and approval requirements. The bill cites several external rules and statutes for standards but does not include full implementation details or any fiscal provisions here, so some practical effects (like exact training costs or oversight procedures) remain unclear.