Policy

Interstate Pediatric Transport Standardization Act

An Act to provide for a coordinated national Emergency Medical Services program and the establishment of interfacility pediatric transport standards in interstate commerce to reduce delays in care for critically ill and injured children.

 

Be it enacted by the Senate and House of Representatives of the United States in Congress assembled, that Congress hereby declares that the purpose of this Act is to reduce delays in patient care resulting from interstate inter-facility medical transport crew configuration discrepancies. Therefore, Congress determines that it is necessary to establish interfacility transport standards for emergency medical service crews, vehicles, and equipment in interstate commerce; and to undertake and support necessary research and development.

Section 1. Short Title.

This Act may be cited as the Interstate Pediatric Transport Standardization Act of 2025.

Section 2. Declaration of Purpose.

To that end, it is the policy of Congress to:

  • Provide for a coordinated national effort to improve the timeliness, safety, and quality of pediatric medical transports conducted in interstate commerce;

  • Establish minimum federal standards for personnel, vehicles, and equipment used in the interfacility transport of pediatric patients;

  • Encourage the development and application of specialized technologies and workforce models in pediatric emergency medical services;

  • Support research, demonstration projects, and data collection related to pediatric interfacility transport systems.

Section 3. Authority.

(a) The Secretary of Transportation, acting through the National Highway Traffic Safety Administration (NHTSA), is authorized and directed to prescribe and enforce such rules and regulations as may be necessary to carry out the purposes of this Act.

(b) Nothing in this Act shall be construed to apply to pediatric medical transports occurring wholly within the boundaries of a single state.

Section 4. Rulemaking and Implementation.

(a) Within 18 months of the date of enactment of this Act, the Secretary shall initiate rulemaking proceedings to:

  • Establish minimum standards for crew composition, licensure classification, and credentialing requirements for interstate pediatric interfacility transport;

  • Establish minimum equipment and vehicle specifications for ambulances engaged in such pediatric transports.

(b) In developing such standards, the Secretary is authorized to consult with the Department of Health and Human Services, professional medical, nursing, and EMS associations, and state regulatory bodies.

Section 5. Research and Evaluation.

The Secretary is further authorized to conduct or support research, data collection, and evaluation concerning—

  • The development of a national registry of interfacility medical transports.

  • Clinical outcomes and care delays associated with interstate pediatric interfacility transfers;

  • Models of pediatric transport staffing and credentialing;

  • The impact of state regulatory variability on the availability and quality of pediatric interfacility transport.

Section 6. Appropriations.

Such sums as may be necessary to carry out the provisions of this Act are hereby authorized to be appropriated.

The language of the authorizing legislation above mirrors the National Traffic and Motor Vehicle Safety Act of 1966. Just as that law was broad enough for the then Secretary of Commerce to shape the agency and its rules, so too NHTSA should have the ability to determine the design of inter-facility transport. The language should be narrow enough to exclude medical transport conducted within one state’s boundary.

Proposed NHTSA Rule Summary

[Proposed Rule Summary for Publication in the Federal Register]

Department of Transportation – National Highway Traffic Safety Administration (NHTSA)

Notice of Proposed Rulemaking (NPRM)

Establishment of Interstate Interfacility Medical Transport Classification Standards

Docket No. [to be assigned]

 

AGENCY: National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation.

ACTION: Notice of proposed rulemaking.

Summary:

The National Highway Traffic Safety Administration (NHTSA) is proposing the establishment of a standardized classification system for personnel conducting interfacility medical transports in interstate commerce. This rule is intended to reduce delays in patient care resulting from inconsistent crew qualifications and equipment standards across state lines. The proposed framework mirrors the structure of the Commercial Driver’s License (CDL) system and categorizes personnel by level of training and certification. The rule would apply only to medical transports that originate in one state and terminate in another.

DATES: Comments must be received no later than [60 days from publication date].

ADDRESSES: Comments may be submitted via the Federal eRulemaking Portal at [www.regulations.gov].

FOR FURTHER INFORMATION CONTACT:

[Name], Office of Emergency Medical Services, NHTSA, U.S. Department of Transportation, [contact info].

Supplementary Information:

I. BACKGROUND

Interfacility transport of critically ill and injured patients between healthcare facilities often requires traversing state lines. Currently, disparate state licensure requirements and inconsistent recognition of professional certifications may result in delays, refusals, or downgrading of care during these transports. The absence of a national standard limits operational efficiency, endangers patients, and imposes burdens on highly specialized transport teams.

II. PURPOSE AND SCOPE

This proposed rule establishes minimum personnel classification standards for medical transport conducted in interstate commerce only. It does not affect intrastate transports or the existing authority of state EMS agencies.

III. PROPOSED CLASSIFICATION FRAMEWORK

The proposed system consists of three primary classes:

  • Class A – Critical Care Transport (CCT)

    Personnel qualified to care for critically ill patients with complex equipment needs.

    Subcategories:

    • A-1: Physician (Critical Care/Emergency Medicine/Anesthesiology)

    • A-2: Registered Nurse with CFRN, CTRN plus CCRN-P/N or RNC-NIC plus C-NPT

    • A-3: Respiratory Therapist with NPS and C-NPT

    • A-4: Paramedic with FP-C or CCP-C and C-NPT

  • Class B – Advanced Life Support (ALS)

    Personnel authorized to administer medications, perform airway management, and provide ALS care without advanced ventilation or invasive monitoring.

    Subcategories:

    • B-1 to B-4: Physician, RN, RT, or Paramedic with basic licensure

    • C-1: EMT-Intermediate or AEMT

    • C-2: EMT-Basic

  • Class C – Basic Life Support (BLS)

    Personnel qualified for non-invasive transport services.

    Subcategories:

    • C-1: EMT-Intermediate or AEMT

    • C-2: EMT-Basic

IV. RECOGNITION AND RECIPROCITY

Providers will be granted federal recognition under the classification system based on state licensure and nationally accepted certifications. States will not be required to issue new credentials but must verify existing personnel qualifications to ensure compliance. All personnel operating in interstate medical transport must be assigned to a class by their home state EMS authority.

 

V. VEHICLE REQUIREMENTS

Each interfacility transport vehicle must be staffed according to the highest class of care being provided during the transport. For example, a Class A interfacility transport must include at least one Class A-certified provider.

 

VI. RESEARCH AND IMPLEMENTATION TIMELINE

NHTSA proposes a two-year implementation window following adoption of the final rule. The agency will provide technical assistance, model state protocols, and pilot project funding.

Authority:

This rule is issued under the authority of 49 U.S.C. §§ 30101, 30117, and 31136, and pursuant to the Interfacility Medical Transport Standardization Act of 2025.