Bill Text: OH HB567 | 2009-2010 | 128th General Assembly | Introduced
Bill Title: To provide for recognition of hospital primary stroke centers and establishment of protocols for emergency triage, treatment, and transport of stroke patients.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2010-08-09 - To Health [HB567 Detail]
Download: Ohio-2009-HB567-Introduced.html
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Representative Boyd
| To amend sections 3701.901, 3701.903, 4742.03, | 1 |
| 4765.10, 4765.16, and 4765.40 and to enact | 2 |
| sections 3701.908, 3701.909, 3727.11, 4765.44, and | 3 |
| 4765.441 of the Revised Code to provide for | 4 |
| recognition of hospital primary stroke centers and | 5 |
| establishment of protocols for emergency triage, | 6 |
| treatment, and transport of stroke patients. | 7 |
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
| Section 1. That sections 3701.901, 3701.903, 4742.03, | 8 |
| 4765.10, 4765.16, and 4765.40 be amended and sections 3701.908, | 9 |
| 3701.909, 3727.11, 4765.44, and 4765.441 of the Revised Code be | 10 |
| enacted to read as follows: | 11 |
| Sec. 3701.901. (A) The membership of the council on stroke | 12 |
| prevention and education shall consist of one representative of | 13 |
| each of the following: | 14 |
| (1) Brain injury association of Ohio; | 15 |
| (2) Ohio academy of family physicians; | 16 |
| (3) American college of emergency physicians Ohio chapter; | 17 |
| (4) Ohio chapter of the American college of cardiology; | 18 |
| (5) Ohio state neurosurgical society; | 19 |
| (6) Ohio heart and vascular research foundation; | 20 |
| (7) Ohio geriatrics society; | 21 |
| (8) Ohio nurses association; | 22 |
| (9) Ohio association of rehabilitation facilities; | 23 |
| (10) Ohio hospital association; | 24 |
| (11) Northeast Ohio stroke association; | 25 |
| (12) American heart association Ohio valley affiliate; | 26 |
| (13) American association of retired persons Ohio office; | 27 |
| (14) Ohio department of health; | 28 |
| (15) Ohio commission on minority health; | 29 |
| (16) Ohio state medical association; | 30 |
| (17) Ohio osteopathic association; | 31 |
| (18) Ohio physical therapy association; | 32 |
| (19) A university research facility in Ohio specializing in | 33 |
| biotechnology; | 34 |
| (20) A health insuring corporation, as defined in section | 35 |
| 1751.01 of the Revised Code; | 36 |
| (21) A small employer, as defined in section 3924.01 of the | 37 |
| Revised Code; | 38 |
| (22) An employer that provides health benefits to its | 39 |
| employees through a self-insurance program, as defined in section | 40 |
| 3959.01 of the Revised Code; | 41 |
| (23) Cleveland clinic. | 42 |
| (B) The director of health shall appoint the members of the | 43 |
| council. The director shall request from each entity listed in | 44 |
| division (A) of this section a list of three persons qualified to | 45 |
| serve as members of the council. In making appointments to the | 46 |
| council, the director shall select one member from the list | 47 |
| submitted by each entity. If the director does not receive a list | 48 |
| from an entity not later than sixty days after making a request, | 49 |
| the director shall appoint a member to serve as the representative | 50 |
| of that entity. The director shall appoint as members of the | 51 |
| council no fewer than six persons who are authorized under Chapter | 52 |
| 4731. of the Revised Code to practice medicine and surgery or | 53 |
| osteopathic medicine and surgery. | 54 |
| (C) The director of health shall appoint the chair and | 55 |
| vice-chair of the council from among its members. | 56 |
| Sec. 3701.903. (A) The council on stroke prevention and | 57 |
| education shall, to the extent funds are available, do all of the | 58 |
| following: | 59 |
| (1) Develop and implement a comprehensive statewide public | 60 |
| education program on stroke prevention, targeted to high-risk | 61 |
| populations and to geographic areas where there is a high | 62 |
| incidence of stroke, including information developed or compiled | 63 |
| by the council on all of the following: | 64 |
| (a) Healthy lifestyle practices that reduce the risk of | 65 |
| stroke; | 66 |
| (b) Signs and symptoms of stroke and action to be taken when | 67 |
| signs occur; | 68 |
| (c) Determinants of high-quality health care for stroke; | 69 |
| (d) Other information the council considers appropriate for | 70 |
| inclusion in the public education program. | 71 |
| (2) Develop or compile for primary care physicians | 72 |
| recommendations that address risk factors for stroke, appropriate | 73 |
| screening for risk factors, early signs of stroke, and treatment | 74 |
| strategies; | 75 |
| (3) Develop or compile for physicians and emergency health | 76 |
| care providers recommendations on the initial treatment of stroke; | 77 |
| (4) Develop or compile for physicians and other health care | 78 |
| providers recommendations on the long-term treatment of stroke; | 79 |
| (5) Develop or compile for physicians, long-term care | 80 |
| providers, and rehabilitation providers recommendations on | 81 |
| rehabilitation of stroke patients; | 82 |
| (6) Encourage hospitals registered with the department of | 83 |
| health under section 3701.07 of the Revised Code and emergency | 84 |
| medical service organizations, as defined in section 4765.01 of | 85 |
| the Revised Code, to share data and methods of improving the | 86 |
| quality of care provided stroke patients; | 87 |
| (7) Facilitate the analysis of stroke care treatment and | 88 |
| communication of treatment results among hospitals and emergency | 89 |
| medical service organizations; | 90 |
| (8) Advise the department of health on the collection of | 91 |
| additional data that would assist in development of an effective | 92 |
| system of stroke care in this state; | 93 |
| (9) Make recommendations regarding the data on treatment of | 94 |
| stroke patients to be provided under division (B) of section | 95 |
| 3701.908 of the Revised Code by hospitals and emergency medical | 96 |
| service organizations to the department of health; | 97 |
| (10) Make recommendations to the state board of emergency | 98 |
| medical services in accordance with division (B)(3) of section | 99 |
| 4765.44 of the Revised Code on choice of hospitals when a patient | 100 |
| is transported by an emergency medical service organization; | 101 |
| (11) Take other actions consistent with the purpose of the | 102 |
| council to ensure that the public and health care providers are | 103 |
| informed with regard to the most effective treatment strategies | 104 |
| for stroke prevention and treatment. | 105 |
| (B) The council may use information developed or made | 106 |
| available by other public or private entities to meet the | 107 |
| requirements of division (A) of this section. | 108 |
| (C) The department of health shall make information developed | 109 |
| or compiled by the council under this section available to the | 110 |
| public and disseminate to the appropriate persons the | 111 |
| recommendations developed or compiled by the council. | 112 |
| Sec. 3701.908. (A) As used in this section, "emergency | 113 |
| medical service organization" has the same meaning as in section | 114 |
| 4765.01 of the Revised Code. | 115 |
| (B) Each hospital and each emergency medical service | 116 |
| organization shall, in accordance with recommendations made by the | 117 |
| council on stroke prevention and education under section 3701.903 | 118 |
| of the Revised Code, provide to the department of health data | 119 |
| requested by the department on the treatment of stroke patients | 120 |
| served by the hospital or emergency medical service organization. | 121 |
| This data is not a public record under section 149.43 of the | 122 |
| Revised Code but may be released in aggregate or statistical form. | 123 |
| (C) Not later than June 1, 2012, and each first day of June | 124 |
| thereafter, the department of health shall release a report | 125 |
| summarizing the data provided under division (B) of this section. | 126 |
| The report shall be submitted to the speaker of the house of | 127 |
| representatives, president of the senate, and governor. The report | 128 |
| shall also be posted on the department's web site. | 129 |
| Sec. 3701.909. (A) As used in this section: | 130 |
| (1) "Telestroke" means the use of interactive video | 131 |
| conferencing technology for the purpose of expanding expertise in | 132 |
| stroke care among an electronically integrated network of | 133 |
| hospitals. | 134 |
| (2) "Primary stroke center" means a hospital recognized as a | 135 |
| primary stroke center by the department of health under section | 136 |
| 3727.11 of the Revised Code, or, if no hospitals have been | 137 |
| recognized under that section, a hospital that holds a certificate | 138 |
| of distinction for primary stroke centers issued by the joint | 139 |
| commission or accreditation by the health care facilities | 140 |
| accreditation program as a primary stroke center. | 141 |
| (3) "Hospital" means a hospital registered with the | 142 |
| department of health under section 3701.07 of the Revised Code. | 143 |
| (B) The council on stroke prevention and education shall make | 144 |
| recommendations in accordance with division (C) of this section | 145 |
| regarding the establishment of an effective system of stroke care, | 146 |
| paying particular attention to the establishment of an effective | 147 |
| system in the rural areas of this state. | 148 |
| (C) Not later than twelve months after the effective date of | 149 |
| this section, the council on stroke prevention and education shall | 150 |
| submit recommendations to the public health council on the | 151 |
| establishment of an effective system of stroke care in this state. | 152 |
| The recommendations shall be made in consultation with the | 153 |
| department of health and the state board of emergency medical | 154 |
| services and include all of the following: | 155 |
| (1) Procedures for coordination and communication between | 156 |
| primary stroke centers and hospitals that are not primary stroke | 157 |
| centers; | 158 |
| (2) Support services necessary to ensure that all residents | 159 |
| of this state have access to effective and efficient stroke care; | 160 |
| (3) Implementation strategies for a telestroke network in | 161 |
| this state under which primary stroke centers communicate with | 162 |
| hospitals that are not primary stroke centers and hospitals that | 163 |
| are not primary stroke centers communicate with primary stroke | 164 |
| centers; | 165 |
| (4) Methods to indicate whether a hospital is participating | 166 |
| in a telestroke network. | 167 |
| (D) Not later than twelve months after the council on stroke | 168 |
| prevention and education submits its recommendations under | 169 |
| division (C) of this section, the department of health shall | 170 |
| adopt, in accordance with Chapter 119. of the Revised Code, rules | 171 |
| that implement those recommendations. | 172 |
| Sec. 3727.11. (A) The department of health shall recognize | 173 |
| as a primary stroke center any hospital that meets all of the | 174 |
| following criteria: | 175 |
| (1) Holds either of the following: | 176 |
| (a) A certificate of distinction for primary stroke centers | 177 |
| issued by the joint commission; | 178 |
| (b) Accreditation as a primary stroke center by the health | 179 |
| care facilities accreditation program. | 180 |
| (2) Maintains the requirements for certification or | 181 |
| accreditation; | 182 |
| (3) Cooperates with the state board of emergency medical | 183 |
| services in the establishment of protocols for assessment, | 184 |
| treatment, and transport of stroke patients in accordance with the | 185 |
| stroke assessment and protocol tool established under section | 186 |
| 4765.44 of the Revised Code. | 187 |
| (B) A hospital shall not use the term "primary stroke center" | 188 |
| or otherwise hold itself out as a primary stroke center unless it | 189 |
| has been recognized as such under division (A) of this section. | 190 |
| (C) In accordance with the notice and hearing requirements of | 191 |
| Chapter 119. of the Revised Code, the department may suspend or | 192 |
| revoke a hospital's recognition as a primary stroke center if the | 193 |
| department determines that the hospital no longer meets all the | 194 |
| criteria of division (A) of this section. | 195 |
| (D) Not later than June 1, 2011, and every June 1 thereafter, | 196 |
| the department shall compile and send to each hospital and the | 197 |
| medical director and cooperating physician advisory board of each | 198 |
| emergency medical service organization, as defined in section | 199 |
| 4765.01 of the Revised Code, a list of hospitals recognized as | 200 |
| primary stroke centers under this section. The department shall | 201 |
| post the list on its web site. | 202 |
| (E) Nothing in this section shall limit or prohibit the | 203 |
| services provided by a hospital if that hospital is authorized to | 204 |
| provide such services. | 205 |
| (F) The department may adopt rules for administration of this | 206 |
| section. The rules shall be adopted under Chapter 119. of the | 207 |
| Revised Code. | 208 |
| Sec. 4742.03. (A) A person may obtain certification as an | 209 |
| emergency service telecommunicator by successfully completing a | 210 |
| basic course of emergency service telecommunicator training that | 211 |
| is conducted by the state board of education under section 4742.02 | 212 |
| of the Revised Code. The basic course of emergency service | 213 |
| telecommunicator training shall include, but not be limited to, | 214 |
| both of the following: | 215 |
| (1) At least forty hours of instruction or training, at least | 216 |
| one hour of which is in the assessment and treatment of stroke | 217 |
| patients; | 218 |
| (2) Instructional or training units in all of the following | 219 |
| subjects: | 220 |
| (a) The role of the emergency service telecommunicator; | 221 |
| (b) Effective communication skills; | 222 |
| (c) Emergency service telecommunicator liability; | 223 |
| (d) Telephone techniques; | 224 |
| (e) Requirements of the "Americans With Disabilities Act of | 225 |
| 1990," 104 Stat. 327, 42 U.S.C. 12101, as amended, that pertain to | 226 |
| emergency service telecommunicators; | 227 |
| (f) Handling hysterical and suicidal callers; | 228 |
| (g) Law enforcement terminology; | 229 |
| (h) Fire service terminology; | 230 |
| (i) Emergency medical service terminology; | 231 |
| (j) Emergency call processing guides for law enforcement; | 232 |
| (k) Emergency call processing guides for fire service; | 233 |
| (l) Emergency call processing guides for emergency medical | 234 |
| service; | 235 |
| (m) Radio broadcast techniques; | 236 |
| (n) Disaster planning; | 237 |
| (o) Police officer survival, fire or emergency medical | 238 |
| service scene safety, or both police officer survival and fire or | 239 |
| emergency medical service scene safety; | 240 |
| (p) Assessment and treatment of stroke patients. | 241 |
| (B) A person may maintain certification as an emergency | 242 |
| service telecommunicator by successfully completing at least eight | 243 |
| hours of continuing education coursework in emergency service | 244 |
| telecommunicator training during each two-year period after a | 245 |
| person first obtains the certification referred to in division (A) | 246 |
| of this section. The continuing education coursework shall consist | 247 |
| of review and advanced training and instruction in the subjects | 248 |
| listed in division (A)(2) of this section. | 249 |
| (C) If a person successfully completes the basic course of | 250 |
| emergency service telecommunicator training described in division | 251 |
| (A) of this section, the state board of education or a designee of | 252 |
| the board shall certify the person's successful completion. The | 253 |
| board shall send a copy of the certification to the person and to | 254 |
| the emergency service provider by whom the person is employed. | 255 |
| If a person successfully completes the continuing education | 256 |
| coursework described in division (B) of this section, the state | 257 |
| board of education or a designee of the board shall certify the | 258 |
| person's successful completion. The board shall send a copy of the | 259 |
| certification to the person and to the emergency service provider | 260 |
| by whom the person is employed. | 261 |
| Sec. 4765.10. (A) The state board of emergency medical | 262 |
| services shall do all of the following: | 263 |
| (1) Administer and enforce the provisions of this chapter and | 264 |
| the rules adopted under it; | 265 |
| (2) Approve, in accordance with procedures established in | 266 |
| rules adopted under section 4765.11 of the Revised Code, | 267 |
| examinations that demonstrate competence to have a certificate to | 268 |
| practice renewed without completing a continuing education | 269 |
| program; | 270 |
| (3) Advise applicants for state or federal emergency medical | 271 |
| services funds, review and comment on applications for these | 272 |
| funds, and approve the use of all state and federal funds | 273 |
| designated solely for emergency medical service programs unless | 274 |
| federal law requires another state agency to approve the use of | 275 |
| all such federal funds; | 276 |
| (4) Serve as a statewide clearinghouse for discussion, | 277 |
| inquiry, and complaints concerning emergency medical services; | 278 |
| (5) Make recommendations to the general assembly on | 279 |
| legislation to improve the delivery of emergency medical services; | 280 |
| (6) Maintain a toll-free long distance telephone number | 281 |
| through which it shall respond to questions about emergency | 282 |
| medical services; | 283 |
| (7) Work with appropriate state offices in coordinating the | 284 |
| training of firefighters and emergency medical service personnel. | 285 |
| Other state offices that are involved in the training of | 286 |
| firefighters or emergency medical service personnel shall | 287 |
| cooperate with the board and its committees and subcommittees to | 288 |
| achieve this goal. | 289 |
| (8) Provide a liaison to the state emergency operation center | 290 |
| during those periods when a disaster, as defined in section | 291 |
| 5502.21 of the Revised Code, has occurred in this state and the | 292 |
| governor has declared an emergency as defined in that section. | 293 |
| (9) Post all of the following on the board's web site: | 294 |
| (a) A list of the hospitals recognized as primary stroke | 295 |
| centers by the department of health under section 3727.11 of the | 296 |
| Revised Code; | 297 |
| (b) The standardized stroke assessment and protocol tool | 298 |
| adopted under section 4765.44 of the Revised Code. | 299 |
| (B) The board may do any of the following: | 300 |
| (1) Investigate complaints concerning emergency medical | 301 |
| services and emergency medical service organizations as it | 302 |
| determines necessary; | 303 |
| (2) Enter into reciprocal agreements with other states that | 304 |
| have standards for accreditation of emergency medical services | 305 |
| training programs and for certification of first responders, | 306 |
| EMTs-basic, EMTs-I, paramedics, firefighters, or fire safety | 307 |
| inspectors that are substantially similar to those established | 308 |
| under this chapter and the rules adopted under it; | 309 |
| (3) Establish a statewide public information system and | 310 |
| public education programs regarding emergency medical services; | 311 |
| (4) Establish an injury prevention program. | 312 |
| Sec. 4765.16. (A) All courses offered through an emergency | 313 |
| medical services training program or an emergency medical services | 314 |
| continuing education program, other than ambulance driving, shall | 315 |
| be developed under the direction of a physician who specializes in | 316 |
| emergency medicine. Each course that deals with trauma care shall | 317 |
| be developed in consultation with a physician who specializes in | 318 |
| trauma surgery. Except as specified by the state board of | 319 |
| emergency medical services pursuant to rules adopted under section | 320 |
| 4765.11 of the Revised Code, each course offered through a | 321 |
| training program or continuing education program shall be taught | 322 |
| by a person who holds the appropriate certificate to teach issued | 323 |
| under section 4765.23 of the Revised Code. | 324 |
| (B) A training program for first responders shall meet the | 325 |
| standards established in rules adopted by the board under section | 326 |
| 4765.11 of the Revised Code. The program shall include at least | 327 |
| one hour of training or instruction in the assessment and | 328 |
| treatment of stroke patients and courses in both of the following | 329 |
| areas for at least the number of hours established by the board's | 330 |
| rules: | 331 |
| (1) Emergency victim care; | 332 |
| (2) Reading and interpreting a trauma victim's vital signs. | 333 |
| (C) A training program for emergency medical | 334 |
| technicians-basic shall meet the standards established in rules | 335 |
| adopted by the board under section 4765.11 of the Revised Code. | 336 |
| The program shall include at least one hour of training or | 337 |
| instruction in the assessment and treatment of stroke patients and | 338 |
| courses in each of the following areas for at least the number of | 339 |
| hours established by the board's rules: | 340 |
| (1) Emergency victim care; | 341 |
| (2) Reading and interpreting a trauma victim's vital signs; | 342 |
| (3) Triage protocols for adult and pediatric trauma victims; | 343 |
| (4) In-hospital training; | 344 |
| (5) Clinical training; | 345 |
| (6) Training as an ambulance driver. | 346 |
| Each operator of a training program for emergency medical | 347 |
| technicians-basic shall allow any pupil in the twelfth grade in a | 348 |
| secondary school who is at least seventeen years old and who | 349 |
| otherwise meets the requirements for admission into such a | 350 |
| training program to be admitted to and complete the program and, | 351 |
| as part of the training, to ride in an ambulance with emergency | 352 |
| medical technicians-basic, emergency medical | 353 |
| technicians-intermediate, and emergency medical | 354 |
| technicians-paramedic. Each emergency medical service organization | 355 |
| shall allow pupils participating in training programs to ride in | 356 |
| an ambulance with emergency medical technicians-basic, advanced | 357 |
| emergency medical technicians-intermediate, and emergency medical | 358 |
| technicians-paramedic. | 359 |
| (D) A training program for emergency medical | 360 |
| technicians-intermediate shall meet the standards established in | 361 |
| rules adopted by the board under section 4765.11 of the Revised | 362 |
| Code. The program shall include, or require as a prerequisite, the | 363 |
| training specified in division (C) of this section and courses in | 364 |
| each of the following areas for at least the number of hours | 365 |
| established by the board's rules: | 366 |
| (1) Recognizing symptoms of life-threatening allergic | 367 |
| reactions and in calculating proper dosage levels and | 368 |
| administering injections of epinephrine to persons who suffer | 369 |
| life-threatening allergic reactions, conducted in accordance with | 370 |
| rules adopted by the board under section 4765.11 of the Revised | 371 |
| Code; | 372 |
| (2) Venous access procedures; | 373 |
| (3) Cardiac monitoring and electrical interventions to | 374 |
| support or correct the cardiac function. | 375 |
| (E) A training program for emergency medical | 376 |
| technicians-paramedic shall meet the standards established in | 377 |
| rules adopted by the board under section 4765.11 of the Revised | 378 |
| Code. The program shall include, or require as a prerequisite, the | 379 |
| training specified in divisions (C) and (D) of this section and | 380 |
| courses in each of the following areas for at least the number of | 381 |
| hours established by the board's rules: | 382 |
| (1) Medical terminology; | 383 |
| (2) Venous access procedures; | 384 |
| (3) Airway procedures; | 385 |
| (4) Patient assessment and triage; | 386 |
| (5) Acute cardiac care, including administration of | 387 |
| parenteral injections, electrical interventions, and other | 388 |
| emergency medical services; | 389 |
| (6) Emergency and trauma victim care beyond that required | 390 |
| under division (C) of this section; | 391 |
| (7) Clinical training beyond that required under division (C) | 392 |
| of this section. | 393 |
| (F) A continuing education program for first responders, | 394 |
| EMTs-basic, EMTs-I, or paramedics shall meet the standards | 395 |
| established in rules adopted by the board under section 4765.11 of | 396 |
| the Revised Code. A continuing education program shall include | 397 |
| instruction and training in subjects established by the board's | 398 |
| rules for at least the number of hours established by the board's | 399 |
| rules. | 400 |
| Sec. 4765.40. (A)(1) Not later than two years after | 401 |
| 402 | |
| of emergency medical services shall adopt rules under section | 403 |
| 4765.11 of the Revised Code establishing written protocols for the | 404 |
| triage of adult and pediatric trauma victims. The rules shall | 405 |
| define adult and pediatric trauma in a manner that is consistent | 406 |
| with section 4765.01 of the Revised Code, minimizes overtriage and | 407 |
| undertriage, and emphasizes the special needs of pediatric and | 408 |
| geriatric trauma patients. | 409 |
| (2) The state triage protocols adopted under division (A) of | 410 |
| this section shall require a trauma victim to be transported | 411 |
| directly to an adult or pediatric trauma center that is qualified | 412 |
| to provide appropriate adult or pediatric trauma care, unless one | 413 |
| or more of the following exceptions applies: | 414 |
| (a) It is medically necessary to transport the victim to | 415 |
| another hospital for initial assessment and stabilization before | 416 |
| transfer to an adult or pediatric trauma center; | 417 |
| (b) It is unsafe or medically inappropriate to transport the | 418 |
| victim directly to an adult or pediatric trauma center due to | 419 |
| adverse weather or ground conditions or excessive transport time; | 420 |
| (c) Transporting the victim to an adult or pediatric trauma | 421 |
| center would cause a shortage of local emergency medical service | 422 |
| resources; | 423 |
| (d) No appropriate adult or pediatric trauma center is able | 424 |
| to receive and provide adult or pediatric trauma care to the | 425 |
| trauma victim without undue delay; | 426 |
| (e) Before transport of a patient begins, the patient | 427 |
| requests to be taken to a particular hospital that is not a trauma | 428 |
| center or, if the patient is less than eighteen years of age or is | 429 |
| not able to communicate, such a request is made by an adult member | 430 |
| of the patient's family or a legal representative of the patient; | 431 |
| (f) The victim is subject to the transportation requirements | 432 |
| of the stroke assessment and protocol tool adopted under section | 433 |
| 4765.44 of the Revised Code. | 434 |
| (3)(a) The state triage protocols adopted under division (A) | 435 |
| of this section shall require trauma patients to be transported to | 436 |
| an adult or pediatric trauma center that is able to provide | 437 |
| appropriate adult or pediatric trauma care, but shall not require | 438 |
| a trauma patient to be transported to a particular trauma center. | 439 |
| The state triage protocols shall establish one or more procedures | 440 |
| for evaluating whether an injury victim requires or would benefit | 441 |
| from adult or pediatric trauma care, which procedures shall be | 442 |
| applied by emergency medical service personnel based on the | 443 |
| patient's medical needs. In developing state trauma triage | 444 |
| protocols, the board shall consider relevant model triage rules | 445 |
| and shall consult with the commission on minority health, regional | 446 |
| directors, regional physician advisory boards, and appropriate | 447 |
| medical, hospital, and emergency medical service organizations. | 448 |
| (b) Before the joint committee on agency rule review | 449 |
| considers state triage protocols for trauma victims proposed by | 450 |
| the state board of emergency medical services, or amendments | 451 |
| thereto, the board shall send a copy of the proposal to the Ohio | 452 |
| chapter of the American college of emergency physicians, the Ohio | 453 |
| chapter of the American college of surgeons, the Ohio chapter of | 454 |
| the American academy of pediatrics, OHA: the association for | 455 |
| hospitals and health systems, the Ohio osteopathic association, | 456 |
| and the association of Ohio children's hospitals and shall hold a | 457 |
| public hearing at which it must consider the appropriateness of | 458 |
| the protocols to minimize overtriage and undertriage of trauma | 459 |
| victims. | 460 |
| (c) The board shall provide copies of the state triage | 461 |
| protocols, and amendments to the protocols, to each emergency | 462 |
| medical service organization, regional director, regional | 463 |
| physician advisory board, certified emergency medical service | 464 |
| instructor, and person who regularly provides medical direction to | 465 |
| emergency medical service personnel in the state; to each medical | 466 |
| service organization in other jurisdictions that regularly provide | 467 |
| emergency medical services in this state; and to others upon | 468 |
| request. | 469 |
| (B)(1) The state board of emergency medical services shall | 470 |
| approve regional protocols for the triage of adult and pediatric | 471 |
| trauma victims, and amendments to such protocols, that are | 472 |
| submitted to the board as provided in division (B)(2) of this | 473 |
| section and provide a level of adult and pediatric trauma care | 474 |
| comparable to the state triage protocols adopted under division | 475 |
| (A) of this section. The board shall not otherwise approve | 476 |
| regional triage protocols for trauma victims. The board shall not | 477 |
| approve regional triage protocols for regions that overlap and | 478 |
| shall resolve any such disputes by apportioning the overlapping | 479 |
| territory among appropriate regions in a manner that best serves | 480 |
| the medical needs of the residents of that territory. The trauma | 481 |
| committee of the board shall have reasonable opportunity to review | 482 |
| and comment on regional triage protocols and amendments to such | 483 |
| protocols before the board approves or disapproves them. | 484 |
| (2) Regional protocols for the triage of adult and pediatric | 485 |
| trauma victims, and amendments to such protocols, shall be | 486 |
| submitted in writing to the state board of emergency medical | 487 |
| services by the regional physician advisory board or regional | 488 |
| director, as appropriate, that serves a majority of the population | 489 |
| in the region in which the protocols apply. Prior to submitting | 490 |
| regional triage protocols, or an amendment to such protocols, to | 491 |
| the state board of emergency medical services, a regional | 492 |
| physician advisory board or regional director shall consult with | 493 |
| each of the following that regularly serves the region in which | 494 |
| the protocols apply: | 495 |
| (a) Other regional physician advisory boards and regional | 496 |
| directors; | 497 |
| (b) Hospitals that operate an emergency facility; | 498 |
| (c) Adult and pediatric trauma centers; | 499 |
| (d) Professional societies of physicians who specialize in | 500 |
| adult or pediatric emergency medicine or adult or pediatric trauma | 501 |
| surgery; | 502 |
| (e) Professional societies of nurses who specialize in adult | 503 |
| or pediatric emergency nursing or adult or pediatric trauma | 504 |
| surgery; | 505 |
| (f) Professional associations or labor organizations of | 506 |
| emergency medical service personnel; | 507 |
| (g) Emergency medical service organizations and medical | 508 |
| directors of such organizations; | 509 |
| (h) Certified emergency medical service instructors. | 510 |
| (3) Regional protocols for the triage of adult and pediatric | 511 |
| trauma victims approved under division (B)(2) of this section | 512 |
| shall require patients to be transported to a trauma center that | 513 |
| is able to provide an appropriate level of adult or pediatric | 514 |
| trauma care; shall not discriminate among trauma centers for | 515 |
| reasons not related to a patient's medical needs; shall seek to | 516 |
| minimize undertriage and overtriage; may include any of the | 517 |
| exceptions in division (A)(2) of this section; and supersede the | 518 |
| state triage protocols adopted under division (A) of this section | 519 |
| in the region in which the regional protocols apply. | 520 |
| (4) Upon approval of regional protocols for the triage of | 521 |
| adult and pediatric trauma victims under division (B)(2) of this | 522 |
| section, or an amendment to such protocols, the state board of | 523 |
| emergency medical services shall provide written notice of the | 524 |
| approval and a copy of the protocols or amendment to each entity | 525 |
| in the region in which the protocols apply to which the board is | 526 |
| required to send a copy of the state triage protocols adopted | 527 |
| under division (A) of this section. | 528 |
| (C)(1) The state board of emergency medical services shall | 529 |
| review the state triage protocols adopted under division (A) of | 530 |
| this section at least every three years to determine if they are | 531 |
| causing overtriage or undertriage of trauma patients, and shall | 532 |
| modify them as necessary to minimize overtriage and undertriage. | 533 |
| (2) Each regional physician advisory board or regional | 534 |
| director that has had regional triage protocols approved under | 535 |
| division (B)(2) of this section shall review the protocols at | 536 |
| least every three years to determine if they are causing | 537 |
| overtriage or undertriage of trauma patients and shall submit an | 538 |
| appropriate amendment to the state board, as provided in division | 539 |
| (B) of this section, as necessary to minimize overtriage and | 540 |
| undertriage. The state board shall approve the amendment if it | 541 |
| will reduce overtriage or undertriage while complying with | 542 |
| division (B) of this section, and shall not otherwise approve the | 543 |
| amendment. | 544 |
| (D) No provider of emergency medical services or person who | 545 |
| provides medical direction to emergency medical service personnel | 546 |
| in this state shall fail to comply with the state triage protocols | 547 |
| adopted under division (A) of this section or applicable regional | 548 |
| triage protocols approved under division (B)(2) of this section. | 549 |
| (E) The state board of emergency medical services shall adopt | 550 |
| rules under section 4765.11 of the Revised Code that provide for | 551 |
| enforcement of the state triage protocols adopted under division | 552 |
| (A) of this section and regional triage protocols approved under | 553 |
| division (B)(2) of this section, and for education regarding those | 554 |
| protocols for emergency medical service organizations and | 555 |
| personnel, regional directors and regional physician advisory | 556 |
| boards, emergency medical service instructors, and persons who | 557 |
| regularly provide medical direction to emergency medical service | 558 |
| personnel in this state. | 559 |
| Sec. 4765.44. (A) As used in this section: | 560 |
| (1) "Primary stroke center" means a hospital recognized by | 561 |
| the department of health as a primary stroke center under section | 562 |
| 3727.11 of the Revised Code, or, if no hospitals have been | 563 |
| recognized under that section, a hospital that holds a certificate | 564 |
| of distinction for primary stroke centers issued by the joint | 565 |
| commission or accreditation by the health care facilities | 566 |
| accreditation program as a primary stroke center. | 567 |
| (2) "Telestroke network" has the same meaning as in section | 568 |
| 3701.909 of the Revised Code. | 569 |
| (B) Not later than twelve months after the effective date of | 570 |
| this section, the state board of emergency medical services, in | 571 |
| cooperation with the department of health and primary stroke | 572 |
| centers, shall establish a stroke assessment and protocol tool. | 573 |
| The tool shall do all of the following: | 574 |
| (1) Comply with nationally recognized standards for the | 575 |
| assessment of stroke patients; | 576 |
| (2) Detail the best practices for the assessment, treatment, | 577 |
| and transport of stroke patients by an emergency medical | 578 |
| technician-basic, emergency medical technician-intermediate, or | 579 |
| paramedic; | 580 |
| (3) Establish, in accordance with recommendations of the | 581 |
| council on stroke prevention and education made under division | 582 |
| (A)(10) of section 3701.903 of the Revised Code, regional plans | 583 |
| for triage and transport of stroke patients. | 584 |
| (C) The regional plans established under division (B) of this | 585 |
| section shall do both of the following: | 586 |
| (1) Specify the distances at which a patient is to be | 587 |
| transported to a primary stroke center or hospital participating | 588 |
| in a telestroke network rather than the nearest hospital; | 589 |
| (2) In the case of two hospitals or primary stroke centers | 590 |
| that are within one mile of each other, provide that the | 591 |
| preferences of the patient be followed. For patients who do not | 592 |
| express a preference or are unable to express a preference, the | 593 |
| plans shall provide for an equitable and sequential distribution | 594 |
| of patients between the hospitals. | 595 |
| Sec. 4765.441. (A) The state board of emergency medical | 596 |
| services shall provide a copy of the stroke assessment and | 597 |
| protocol tool established under section 4765.44 of the Revised | 598 |
| Code to the medical director and cooperating physician advisory | 599 |
| board of each emergency medical service organization, and to each | 600 |
| emergency medical technician-basic, emergency medical | 601 |
| technician-intermediate, and emergency medical | 602 |
| technician-paramedic. An EMT-basic, EMT-I, or paramedic shall | 603 |
| perform emergency medical services the EMT-basic, EMT-I, or | 604 |
| paramedic is authorized to provide in accordance with the stroke | 605 |
| assessment and protocol tool. | 606 |
| (B) The board and the department of health shall post the | 607 |
| assessment and protocol tool on their web sites. | 608 |
| (C) The board may adopt rules necessary for administration of | 609 |
| this section and section 4765.44 of the Revised Code. The rules | 610 |
| shall be adopted under Chapter 119. of the Revised Code. | 611 |
| Section 2. That existing sections 3701.901, 3701.903, | 612 |
| 4742.03, 4765.10, 4765.16, and 4765.40 of the Revised Code are | 613 |
| hereby repealed. | 614 |
