Bill Text: OH HB427 | 2011-2012 | 129th General Assembly | Introduced

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Bill Title: To replace the Council on Stroke Prevention and Education with the Stroke System of Care Task Force; to provide for state recognition of hospitals that are primary stroke centers; to require establishment of protocols for emergency triage, treatment, and transport of stroke patients; and to require the Department of Health to maintain a stroke data registry and a statewide system for stroke response and treatment.

Spectrum: Moderate Partisan Bill (Democrat 13-2)

Status: (Introduced - Dead) 2012-01-25 - To Health & Aging [HB427 Detail]

Download: Ohio-2011-HB427-Introduced.html

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As Introduced

129th General Assembly Regular Session 2011-2012

H. B. No. 427

Representatives Boyd, Gardner 

Cosponsors: Representatives Barnes, Lundy, Murray, Garland, Ashford, Ramos, Goyal, Letson, Reece, Yuko, Antonio, Landis, Fende 

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A BILL

To amend sections 3701.90, 3701.901, 3701.902,

1

3701.903, 3701.904, 3701.907, 4742.03, 4765.10,

2

4765.16, and 4765.40; to enact sections 3701.908,

3

3701.909, 3727.11, 3727.111, 4765.44, and 4765.45;

4

and to repeal sections 3701.905 and 3701.906 of

5

the Revised Code to replace the Council on Stroke

6

Prevention and Education with the Stroke System of

7

Care Task Force; to provide for state recognition

8

of hospitals that are primary stroke centers; to

9

require establishment of protocols for emergency

10

triage, treatment, and transport of stroke

11

patients; and to require the Department of Health

12

to maintain a stroke data registry and a statewide

13

system for stroke response and treatment.

14

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 3701.90, 3701.901, 3701.902,	15
3701.903, 3701.904, 3701.907, 4742.03, 4765.10, 4765.16, and	16
4765.40 be amended and sections 3701.908, 3701.909, 3727.11,	17
3727.111, 4765.44, and 4765.45 of the Revised Code be enacted to	18
read as follows:	19

Sec. 3701.90.  There is hereby created in the department of	20
health the council on stroke prevention and educationstroke	21
system of care task force to address matters of triage, treatment,	22
and transport of patients who may experience acute stroke. The	23
department shall, to the extent funds are available, provide	24
office space and staff assistance for the counciltask force.	25

Sec. 3701.901.  (A) The membership of the council on stroke	26
prevention and education shall consist of one representative of	27
each of the following:	28

(1) Brain injury association of Ohio;

29

(2) Ohio academy of family physicians;

30

(3) American college of emergency physicians Ohio chapter;

31

(4) Ohio chapter of the American college of cardiology;

32

(5) Ohio state neurosurgical society;

33

(6) Ohio heart and vascular research foundation;

34

(7) Ohio geriatrics society;

35

(8) Ohio nurses association;

36

(9) Ohio association of rehabilitation facilities;

37

(10) Ohio hospital association;

38

(11) Northeast Ohio stroke association;

39

(12) American heart association Ohio valley affiliate;

40

(13) American association of retired persons Ohio office;

41

(14) Ohio department of health;

42

(15) Ohio commission on minority health;

43

(16) Ohio state medical association;

44

(17) Ohio osteopathic association;

45

(18) Ohio physical therapy association;

46

(19) A university research facility in Ohio specializing in	47
biotechnology;	48

(20) A health insuring corporation, as defined in section	49
1751.01 of the Revised Code;	50

(21) A small employer, as defined in section 3924.01 of the	51
Revised Code;	52

(22) An employer that provides health benefits to its	53
employees through a self-insurance program, as defined in section	54
3959.01 of the Revised Code.	55

(B) The director of health shall appoint the members of the	56
council. The director shall request from each entity listed in	57
division (A) of this section a list of three persons qualified to	58
serve as members of the council. In making appointments to the	59
council, the director shall select one member from the list	60
submitted by each entity. If the director does not receive a list	61
from an entity not later than sixty days after making a request,	62
the director shall appoint a member to serve as the representative	63
of that entity. The director shall appoint as members of the	64
council no fewer than six personsstroke system of care task	65
force. The task force shall include all of the following:	66

(1) Representatives from the department of health;

67

(2) Representatives from the state board of emergency medical	68
services;	69

(3) Representatives from the American stroke association;

70

(4) Representatives from primary stroke centers;

71

(5) Representatives from rural hospitals;

72

(6) Persons who are authorized under Chapter 4731. of the	73
Revised Code to practice medicine and surgery or osteopathic	74
medicine and surgery;	75

(7) Providers of emergency medical services, as defined in	76
section 4765.01 of the Revised Code.	77

(C)(B) The director of health shall appoint the chair	78
chairperson and vice-chairvice-chairperson of the counciltask	79
force from among its members.	80

Sec. 3701.902. Members of the council on stroke prevention	81
and educationstroke system of care task force shall serve without	82
compensation, but shall, to the extent funds are available, be	83
reimbursed by the department of health for the actual and	84
necessary expenses they incur in the performance of their official	85
duties. A member may serve until a replacement is appointed by the	86
director of health. Replacement members shall be appointed in the	87
same manner as the initial members.	88

Sec. 3701.903.  (A) The council on stroke prevention and	89
educationstroke system of care task force shall, to the extent	90
funds are available, do all of the following:	91

(1) Develop and implement a comprehensive statewide public	92
education program on stroke prevention, targeted to high-risk	93
populations and to geographic areas where there is a high	94
incidence of stroke, including information developed or compiled	95
by the council on all of the following:	96

(a) Healthy lifestyle practices that reduce the risk of	97
stroke;	98

(b) Signs and symptoms of stroke and action to be taken when	99
signs occur;	100

(c) Determinants of high-quality health care for stroke;

101

(d) Other information the council considers appropriate for	102
inclusion in the public education program.	103

(2) Develop or compile for primary care physicians	104
recommendations that address risk factors for stroke, appropriate	105
screening for risk factors, early signs of stroke, and treatment	106
strategies;	107

(3) Develop or compile for physicians and emergency health	108
care providers recommendations on the initial treatment of stroke;	109

(4) Develop or compile for physicians and other health care	110
providers recommendations on the long-term treatment of stroke;	111

(5) Develop or compile for physicians, long-term care	112
providers, and rehabilitation providers recommendations on	113
rehabilitation of stroke patients;	114

(6)Encourage hospitals registered with the department of	115
health under section 3701.07 of the Revised Code and emergency	116
medical service organizations, as defined in section 4765.01 of	117
the Revised Code, to share information and methods of improving	118
the quality of care provided to stroke patients;	119

(2) Facilitate the analysis of stroke treatment and	120
coordination of care;	121

(3) Facilitate the communication of treatment results among	122
hospitals and emergency medical service organizations;	123

(4) Advise the department of health on the collection of	124
information that would assist in development of an effective	125
system of stroke care in this state;	126

(5) Take other actions consistent with the purpose of the	127
counciltask force to ensure that the public and health care	128
providers are informed with regard to the most effective treatment	129
strategies for stroke prevention and treatment.	130

(B) The counciltask force may use information developed or	131
made available by other public or private entities to meet the	132
requirements of division (A) of this section.	133

(C) The department of health shall make information developed	134
or compiled by the counciltask force available to the public and	135
disseminate to the appropriate persons the recommendations	136
developed or compiled by the counciltask force.	137

Sec. 3701.904. (A) The council on stroke prevention and	138
educationstroke system of care task force shall meet at the call	139
of the chair to conduct its official business.	140

(B) A majority of the voting members of the counciltask	141
force constitutes a quorum. The counciltask force may take action	142
only by affirmative vote of a majority of a quorum.	143

Sec. 3701.907.  The council on stroke prevention and	144
educationstroke system of care task force is exempt from the	145
requirements of section 101.84not subject to sections 101.82 to	146
101.87 of the Revised Code.	147

Sec. 3701.908.  (A) As used in this section, "emergency	148
medical service organization" has the same meaning as in section	149
4765.01 of the Revised Code.	150

(B)(1) Each of the following entities shall provide to the	151
department of health information requested by the department on	152
the treatment of stroke patients served by the entity:	153

(a) A hospital recognized under section 3727.11 of the	154
Revised Code as a primary stroke center;	155

(b) A hospital recognized under section 3727.111 of the	156
Revised Code as an acute stroke-capable center, if the department	157
has implemented a recognition system under that section;	158

(c) A hospital other than a hospital described in division	159
(B)(1)(a) or (b) of this section;	160

(d) An emergency medical service organization;

161

(e) Any other entity from which the department requests	162
information regarding the treatment of stroke patients served by	163
the entity.	164

(2) The requested information shall be provided in a manner	165
that aligns with the stroke consensus metrics developed and	166
approved by the American heart association, American stroke	167
association, the United States centers for disease control and	168
prevention, and the joint commission.	169

(3) To the greatest extent possible, the department shall	170
coordinate with national voluntary health organizations involved	171
in stroke quality improvement to avoid duplication and redundancy	172
in the collection of the information.	173

(C) The department shall develop and maintain a stroke data	174
registry and include in the registry the information collected	175
under division (B) of this section. The registry shall be	176
developed and maintained by using the stroke registry guidelines	177
established by either of the following:	178

(1) The American heart association;

179

(2) Another organization acceptable to the department that	180
has established stroke registry guidelines with standards for	181
maintaining confidentiality of information that are no less secure	182
than the confidentiality standards included in the American heart	183
association's guidelines.	184

(D) Information provided or maintained under this section	185
that is protected health information pursuant to section 3701.17	186
of the Revised Code shall be released only in accordance with that	187
section. Information that does not identify an individual may be	188
released in summary, statistical, or aggregate form.	189

(E) The department shall adopt rules as it considers	190
necessary to implement and administer this section. The rules	191
shall be adopted in accordance with Chapter 119. of the Revised	192
Code.	193

Sec. 3701.909.  (A) As used in this section, "telemedicine	194
services" means the delivery of health care services through the	195
use of interactive audio, video, and other electronic media used	196
for the purpose of diagnosis, consultation, or treatment of acute	197
stroke.	198

(B)(1) The stroke system of care task force shall develop	199
recommendations regarding the establishment under this section of	200
a statewide system for stroke response and treatment. The task	201
force shall update its recommendations at least every two years.	202

In developing its recommendations, the task force shall pay	203
particular attention to the establishment of an effective system	204
for stroke response and treatment in the rural areas of the state.	205
The recommendations shall be developed in consultation with the	206
state board of emergency medical services.	207

(2) The task force's recommendations shall include all of the	208
following:	209

(a) Procedures for coordination and communication between	210
hospitals that are recognized under section 3727.11 of the Revised	211
Code as primary stroke centers and hospitals that are not	212
recognized as primary stroke centers;	213

(b) A plan for achieving continuous improvement in the	214
quality of care provided under the statewide system for stroke	215
response and treatment established under division (C) of this	216
section;	217

(c) Strategies for use of telemedicine services in this state	218
for inter-hospital communication between hospitals that are	219
recognized under section 3727.11 of the Revised Code as primary	220
stroke centers and hospitals that are not recognized as primary	221
stroke centers.	222

(3) The task force shall submit its recommendations to the	223
department of health, the governor, and, in accordance with	224
section 101.68 of the Revised Code, the general assembly.	225

(C)(1) Based on the task force's recommendations, the	226
department shall establish a statewide system for stroke response	227
and treatment. The department may take any actions it considers	228
necessary to maintain an effective system for stroke response and	229
treatment in this state.	230

(2) As part of the system, the department shall post both of	231
the following on its internet web site and shall update the posted	232
information on at least an annual basis:	233

(a) The list compiled under section 3727.11 of the Revised	234
Code identifying the hospitals that are recognized under that	235
section as primary stroke centers;	236

(b) The standardized stroke assessment and protocol tool	237
established under section 4765.44 of the Revised Code.	238

(D) The department shall adopt rules as it considers	239
necessary to implement and administer this section. The rules	240
shall be adopted in accordance with Chapter 119. of the Revised	241
Code.	242

Sec. 3727.11.  (A) The department of health shall recognize	243
as a primary stroke center any hospital that holds certification	244
or accreditation as a primary stroke center issued by any of the	245
following:	246

(1) The joint commission;

247

(2) The healthcare facilities accreditation program;

248

(3) Another entity acceptable to the department that is	249
nationally recognized and provides certification or accreditation	250
of primary stroke centers.	251

(B) A hospital shall not use the phrase "primary stroke	252
center" or otherwise hold itself out as a primary stroke center	253
unless it is recognized as a primary stroke center under this	254
section.	255

(C) The department may suspend or revoke its recognition of a	256
hospital as a primary stroke center if the department determines	257
that the hospital no longer holds certification or accreditation	258
that meets the requirements of division (A) of this section or has	259
not maintained the requirements to hold the certification or	260
accreditation. The department's action shall be taken pursuant to	261
an adjudication conducted in accordance with Chapter 119. of the	262
Revised Code.	263

(D) Annually, not later than the first day of December, the	264
department shall compile a list of hospitals recognized as primary	265
stroke centers.	266

(E) Nothing in this section limits the services provided by a	267
hospital, or prohibits a hospital from providing services, if that	268
hospital is authorized to provide such services.	269

(F) The department may adopt rules as necessary to implement	270
and administer this section. The rules shall be adopted in	271
accordance with Chapter 119. of the Revised Code.	272

Sec. 3727.111.  The department of health may establish a	273
program for recognition of hospitals as acute stroke-capable	274
centers. The program shall be administered in the same manner as	275
the department's recognition of primary stroke centers under	276
section 3727.11 of the Revised Code.	277

The program may be established as entities acceptable to the	278
department begin issuing accreditation of hospitals as acute	279
stroke-capable centers. The department may consider an entity	280
acceptable only if the entity is nationally recognized and uses	281
evidence-based standards for issuing its accreditation.	282

The department may adopt rules as it considers necessary to	283
implement and administer this section. The rules shall be adopted	284
in accordance with Chapter 119. of the Revised Code.	285

Sec. 4742.03.  (A) A person may obtain certification as an	286
emergency service telecommunicator by successfully completing a	287
basic course of emergency service telecommunicator training that	288
is conducted by the state board of education under section 4742.02	289
of the Revised Code. The basic course of emergency service	290
telecommunicator training shall include, but not be limited to,	291
both of the following:	292

(1) At least forty hours of instruction or training;

293

(2) Instructional or training units in all of the following	294
subjects:	295

(a) The role of the emergency service telecommunicator;

296

(b) Effective communication skills;

297

(c) Emergency service telecommunicator liability;

298

(d) Telephone techniques;

299

(e) Requirements of the "Americans With Disabilities Act of	300
1990," 104 Stat. 327, 42 U.S.C. 12101, as amended, that pertain to	301
emergency service telecommunicators;	302

(f) Handling hysterical and suicidal callers;

303

(g) Law enforcement terminology;

304

(h) Fire service terminology;

305

(i) Emergency medical service terminology;

306

(j) Emergency call processing guides for law enforcement;

307

(k) Emergency call processing guides for fire service;

308

(l) Emergency call processing guides for emergency medical	309
service;	310

(m) Radio broadcast techniques;

311

(n) Disaster planning;

312

(o) Police officer survival, fire or emergency medical	313
service scene safety, or both police officer survival and fire or	314
emergency medical service scene safety;	315

(p) Assessment and treatment of stroke patients.

316

(B) A person may maintain certification as an emergency	317
service telecommunicator by successfully completing at least eight	318
hours of continuing education coursework in emergency service	319
telecommunicator training during each two-year period after a	320
person first obtains the certification referred to in division (A)	321
of this section. The continuing education coursework shall consist	322
of review and advanced training and instruction in the subjects	323
listed in division (A)(2) of this section.	324

(C) If a person successfully completes the basic course of	325
emergency service telecommunicator training described in division	326
(A) of this section, the state board of education or a designee of	327
the board shall certify the person's successful completion. The	328
board shall send a copy of the certification to the person and to	329
the emergency service provider by whom the person is employed.	330

If a person successfully completes the continuing education	331
coursework described in division (B) of this section, the state	332
board of education or a designee of the board shall certify the	333
person's successful completion. The board shall send a copy of the	334
certification to the person and to the emergency service provider	335
by whom the person is employed.	336

Sec. 4765.10.  (A) The state board of emergency medical	337
services shall do all of the following:	338

(1) Administer and enforce the provisions of this chapter and	339
the rules adopted under it;	340

(2) Approve, in accordance with procedures established in	341
rules adopted under section 4765.11 of the Revised Code,	342
examinations that demonstrate competence to have a certificate to	343
practice renewed without completing a continuing education	344
program;	345

(3) Advise applicants for state or federal emergency medical	346
services funds, review and comment on applications for these	347
funds, and approve the use of all state and federal funds	348
designated solely for emergency medical service programs unless	349
federal law requires another state agency to approve the use of	350
all such federal funds;	351

(4) Serve as a statewide clearinghouse for discussion,	352
inquiry, and complaints concerning emergency medical services;	353

(5) Make recommendations to the general assembly on	354
legislation to improve the delivery of emergency medical services;	355

(6) Maintain a toll-free long distance telephone number	356
through which it shall respond to questions about emergency	357
medical services;	358

(7) Work with appropriate state offices in coordinating the	359
training of firefighters and emergency medical service personnel.	360
Other state offices that are involved in the training of	361
firefighters or emergency medical service personnel shall	362
cooperate with the board and its committees and subcommittees to	363
achieve this goal.	364

(8) Provide a liaison to the state emergency operation center	365
during those periods when a disaster, as defined in section	366
5502.21 of the Revised Code, has occurred in this state and the	367
governor has declared an emergency as defined in that section;	368

(9) Post both of the following on the board's internet web	369
site and update the posted information on at least an annual	370
basis:	371

(a) The list compiled under section 3727.11 of the Revised	372
Code identifying the hospitals that are recognized under that	373
section as primary stroke centers;	374

(b) The standardized stroke assessment and protocol tool	375
established under section 4765.44 of the Revised Code.	376

(10) Not later than the first day of December each year,	377
provide to each emergency medical service organization an	378
electronic or paper copy of the information posted on the board's	379
web site under division (A)(9) of this section.	380

(B) The board may do any of the following:

381

(1) Investigate complaints concerning emergency medical	382
services and emergency medical service organizations as it	383
determines necessary;	384

(2) Enter into reciprocal agreements with other states that	385
have standards for accreditation of emergency medical services	386
training programs and for certification of first responders,	387
EMTs-basic, EMTs-I, paramedics, firefighters, or fire safety	388
inspectors that are substantially similar to those established	389
under this chapter and the rules adopted under it;	390

(3) Establish a statewide public information system and	391
public education programs regarding emergency medical services;	392

(4) Establish an injury prevention program.

393

Sec. 4765.16.  (A) All courses offered through an emergency	394
medical services training program or an emergency medical services	395
continuing education program, other than ambulance driving, shall	396
be developed under the direction of a physician who specializes in	397
emergency medicine. Each course that deals with trauma care shall	398
be developed in consultation with a physician who specializes in	399
trauma surgery. Except as specified by the state board of	400
emergency medical services pursuant to rules adopted under section	401
4765.11 of the Revised Code, each course offered through a	402
training program or continuing education program shall be taught	403
by a person who holds the appropriate certificate to teach issued	404
under section 4765.23 of the Revised Code.	405

(B) A training program for first responders shall meet the	406
standards established in rules adopted by the board under section	407
4765.11 of the Revised Code. The program shall include courses	408
training in both of the following areas for at least the number of	409
hours established by the board's rules:	410

(1) Emergency victim care;

411

(2) Reading and interpreting a trauma victim's vital signs.

412

(C) A training program for emergency medical	413
technicians-basic shall meet the standards established in rules	414
adopted by the board under section 4765.11 of the Revised Code.	415
The program shall include coursestraining in each of the	416
following areas for at least the number of hours established by	417
the board's rules:	418

(1) Emergency victim care;

419

(2) Reading and interpreting a trauma victim's vital signs;

420

(3) Triage protocols for adult and pediatric trauma victims;

421

(4) In-hospital training;

422

(5) Clinical training;

423

(6) Training as an ambulance driver;

424

(7) Training in the assessment and treatment of stroke	425
patients.	426

Each operator of a training program for emergency medical	427
technicians-basic shall allow any pupil in the twelfth grade in a	428
secondary school who is at least seventeen years old and who	429
otherwise meets the requirements for admission into such a	430
training program to be admitted to and complete the program and,	431
as part of the training, to ride in an ambulance with emergency	432
medical technicians-basic, emergency medical	433
technicians-intermediate, and emergency medical	434
technicians-paramedic. Each emergency medical service organization	435
shall allow pupils participating in training programs to ride in	436
an ambulance with emergency medical technicians-basic, advanced	437
emergency medical technicians-intermediate, and emergency medical	438
technicians-paramedic.	439

(D) A training program for emergency medical	440
technicians-intermediate shall meet the standards established in	441
rules adopted by the board under section 4765.11 of the Revised	442
Code. The program shall include, or require as a prerequisite, the	443
training specified in division (C) of this section and courses	444
training in each of the following areas for at least the number of	445
hours established by the board's rules:	446

(1) Recognizing symptoms of life-threatening allergic	447
reactions and in calculating proper dosage levels and	448
administering injections of epinephrine to persons who suffer	449
life-threatening allergic reactions, conducted in accordance with	450
rules adopted by the board under section 4765.11 of the Revised	451
Code;	452

(2) Venous access procedures;

453

(3) Cardiac monitoring and electrical interventions to	454
support or correct the cardiac function.	455

(E) A training program for emergency medical	456
technicians-paramedic shall meet the standards established in	457
rules adopted by the board under section 4765.11 of the Revised	458
Code. The program shall include, or require as a prerequisite, the	459
training specified in divisions (C) and (D) of this section and	460
coursestraining in each of the following areas for at least the	461
number of hours established by the board's rules:	462

(1) Medical terminology;

463

(2) Venous access procedures;

464

(3) Airway procedures;

465

(4) Patient assessment and triage;

466

(5) Acute cardiac care, including administration of	467
parenteral injections, electrical interventions, and other	468
emergency medical services;	469

(6) Emergency and trauma victim care beyond that required	470
under division (C) of this section;	471

(7) Clinical training beyond that required under division (C)	472
of this section.	473

(F) A continuing education program for first responders,	474
EMTs-basic, EMTs-I, or paramedics shall meet the standards	475
established in rules adopted by the board under section 4765.11 of	476
the Revised Code. A continuing education program shall include	477
instruction and training in subjects established by the board's	478
rules for at least the number of hours established by the board's	479
rules.	480

Sec. 4765.40.  (A)(1) Not later than two years after the	481
effective date of this amendment, theThe state board of emergency	482
medical services shall adopt rules under section 4765.11 of the	483
Revised Code establishing written protocols for the triage of	484
adult and pediatric trauma victims. The rules shall define adult	485
and pediatric trauma in a manner that is consistent with section	486
4765.01 of the Revised Code, minimizes overtriage and undertriage,	487
and emphasizes the special needs of pediatric and geriatric trauma	488
patients.	489

(2) The state triage protocols adopted under division (A) of	490
this section shall require a trauma victim to be transported	491
directly to an adult or pediatric trauma center that is qualified	492
to provide appropriate adult or pediatric trauma care, unless one	493
or more of the following exceptions applies:	494

(a) It is medically necessary to transport the victim to	495
another hospital for initial assessment and stabilization before	496
transfer to an adult or pediatric trauma center;	497

(b) It is unsafe or medically inappropriate to transport the	498
victim directly to an adult or pediatric trauma center due to	499
adverse weather or ground conditions or excessive transport time;	500

(c) Transporting the victim to an adult or pediatric trauma	501
center would cause a shortage of local emergency medical service	502
resources;	503

(d) No appropriate adult or pediatric trauma center is able	504
to receive and provide adult or pediatric trauma care to the	505
trauma victim without undue delay;	506

(e) Before transport of a patient begins, the patient	507
requests to be taken to a particular hospital that is not a trauma	508
center or, if the patient is less than eighteen years of age or is	509
not able to communicate, such a request is made by an adult member	510
of the patient's family or a legal representative of the patient;	511

(f) The victim is subject to the transportation requirements	512
of the standardized stroke assessment and protocol tool	513
established under section 4765.44 of the Revised Code.	514

(3)(a) The state triage protocols adopted under division (A)	515
of this section shall require trauma patients to be transported to	516
an adult or pediatric trauma center that is able to provide	517
appropriate adult or pediatric trauma care, but shall not require	518
a trauma patient to be transported to a particular trauma center.	519
The state triage protocols shall establish one or more procedures	520
for evaluating whether an injury victim requires or would benefit	521
from adult or pediatric trauma care, which procedures shall be	522
applied by emergency medical service personnel based on the	523
patient's medical needs. In developing state trauma triage	524
protocols, the board shall consider relevant model triage rules	525
and shall consult with the commission on minority health, regional	526
directors, regional physician advisory boards, and appropriate	527
medical, hospital, and emergency medical service organizations.	528

(b) Before the joint committee on agency rule review	529
considers state triage protocols for trauma victims proposed by	530
the state board of emergency medical services, or amendments	531
thereto, the board shall send a copy of the proposal to the Ohio	532
chapter of the American college of emergency physicians, the Ohio	533
chapter of the American college of surgeons, the Ohio chapter of	534
the American academy of pediatrics, OHA: the association for	535
hospitals and health systems, the Ohio osteopathic association,	536
and the association of Ohio children's hospitals and shall hold a	537
public hearing at which it must consider the appropriateness of	538
the protocols to minimize overtriage and undertriage of trauma	539
victims.	540

(c) The board shall provide copies of the state triage	541
protocols, and amendments to the protocols, to each emergency	542
medical service organization, regional director, regional	543
physician advisory board, certified emergency medical service	544
instructor, and person who regularly provides medical direction to	545
emergency medical service personnel in the state; to each medical	546
service organization in other jurisdictions that regularly provide	547
emergency medical services in this state; and to others upon	548
request.	549

(B)(1) The state board of emergency medical services shall	550
approve regional protocols for the triage of adult and pediatric	551
trauma victims, and amendments to such protocols, that are	552
submitted to the board as provided in division (B)(2) of this	553
section and provide a level of adult and pediatric trauma care	554
comparable to the state triage protocols adopted under division	555
(A) of this section. The board shall not otherwise approve	556
regional triage protocols for trauma victims. The board shall not	557
approve regional triage protocols for regions that overlap and	558
shall resolve any such disputes by apportioning the overlapping	559
territory among appropriate regions in a manner that best serves	560
the medical needs of the residents of that territory. The trauma	561
committee of the board shall have reasonable opportunity to review	562
and comment on regional triage protocols and amendments to such	563
protocols before the board approves or disapproves them.	564

(2) Regional protocols for the triage of adult and pediatric	565
trauma victims, and amendments to such protocols, shall be	566
submitted in writing to the state board of emergency medical	567
services by the regional physician advisory board or regional	568
director, as appropriate, that serves a majority of the population	569
in the region in which the protocols apply. Prior to submitting	570
regional triage protocols, or an amendment to such protocols, to	571
the state board of emergency medical services, a regional	572
physician advisory board or regional director shall consult with	573
each of the following that regularly serves the region in which	574
the protocols apply:	575

(a) Other regional physician advisory boards and regional	576
directors;	577

(b) Hospitals that operate an emergency facility;

578

(c) Adult and pediatric trauma centers;

579

(d) Professional societies of physicians who specialize in	580
adult or pediatric emergency medicine or adult or pediatric trauma	581
surgery;	582

(e) Professional societies of nurses who specialize in adult	583
or pediatric emergency nursing or adult or pediatric trauma	584
surgery;	585

(f) Professional associations or labor organizations of	586
emergency medical service personnel;	587

(g) Emergency medical service organizations and medical	588
directors of such organizations;	589

(h) Certified emergency medical service instructors.

590

(3) Regional protocols for the triage of adult and pediatric	591
trauma victims approved under division (B)(2) of this section	592
shall require patients to be transported to a trauma center that	593
is able to provide an appropriate level of adult or pediatric	594
trauma care; shall not discriminate among trauma centers for	595
reasons not related to a patient's medical needs; shall seek to	596
minimize undertriage and overtriage; may include any of the	597
exceptions in division (A)(2) of this section; and supersede the	598
state triage protocols adopted under division (A) of this section	599
in the region in which the regional protocols apply.	600

(4) Upon approval of regional protocols for the triage of	601
adult and pediatric trauma victims under division (B)(2) of this	602
section, or an amendment to such protocols, the state board of	603
emergency medical services shall provide written notice of the	604
approval and a copy of the protocols or amendment to each entity	605
in the region in which the protocols apply to which the board is	606
required to send a copy of the state triage protocols adopted	607
under division (A) of this section.	608

(C)(1) The state board of emergency medical services shall	609
review the state triage protocols adopted under division (A) of	610
this section at least every three years to determine if they are	611
causing overtriage or undertriage of trauma patients, and shall	612
modify them as necessary to minimize overtriage and undertriage.	613

(2) Each regional physician advisory board or regional	614
director that has had regional triage protocols approved under	615
division (B)(2) of this section shall review the protocols at	616
least every three years to determine if they are causing	617
overtriage or undertriage of trauma patients and shall submit an	618
appropriate amendment to the state board, as provided in division	619
(B) of this section, as necessary to minimize overtriage and	620
undertriage. The state board shall approve the amendment if it	621
will reduce overtriage or undertriage while complying with	622
division (B) of this section, and shall not otherwise approve the	623
amendment.	624

(D) No provider of emergency medical services or person who	625
provides medical direction to emergency medical service personnel	626
in this state shall fail to comply with the state triage protocols	627
adopted under division (A) of this section or applicable regional	628
triage protocols approved under division (B)(2) of this section.	629

(E) The state board of emergency medical services shall adopt	630
rules under section 4765.11 of the Revised Code that provide for	631
enforcement of the state triage protocols adopted under division	632
(A) of this section and regional triage protocols approved under	633
division (B)(2) of this section, and for education regarding those	634
protocols for emergency medical service organizations and	635
personnel, regional directors and regional physician advisory	636
boards, emergency medical service instructors, and persons who	637
regularly provide medical direction to emergency medical service	638
personnel in this state.	639

Sec. 4765.44.  (A) The state board of emergency medical	640
services shall establish a standardized stroke assessment and	641
protocol tool. The board shall update the standardized tool at	642
intervals the board considers necessary.	643

The standardized tool shall be established, and any updates	644
made, in consultation with the department of health and hospitals	645
that are recognized under section 3727.11 of the Revised Code as	646
primary stroke centers.	647

The standardized tool shall comply with nationally recognized	648
standards for the assessment of stroke patients.	649

(B) The board shall provide a copy of the standardized tool	650
to the medical director and cooperating physician advisory board	651
of each emergency medical service organization, and to each	652
emergency medical technician-basic, emergency medical	653
technician-intermediate, and emergency medical	654
technician-paramedic. The copy may be provided electronically or	655
by any other means.	656

An EMT-basic, EMT-I, or paramedic shall perform emergency	657
medical services the EMT-basic, EMT-I, or paramedic is authorized	658
to provide in accordance with the stroke assessment and protocol	659
tool.	660

(C) The board may adopt rules under section 4765.11 of the	661
Revised Code as the board considers necessary for the	662
implementation and administration of this section.	663

Sec. 4765.45.  The state board of emergency medical services,	664
in consultation with the stroke system of care task force created	665
under section 3701.90 of the Revised Code, shall establish	666
prehospital care protocols related to the assessment, treatment,	667
and transport of stroke patients by emergency medical	668
technicians-basic, emergency medical technicians-intermediate, and	669
paramedics in this state. The protocols shall include regional	670
transport plans for the triage and transport of stroke patients to	671
the closest, most appropriate facility.	672

Section 2.  That existing sections 3701.90, 3701.901,	673
3701.902, 3701.903, 3701.904, 3701.907, 4742.03, 4765.10, 4765.16,	674
and 4765.40 and sections 3701.905 and 3701.906 of the Revised Code	675
are hereby repealed.	676

Section 3.  With respect to the implementation of this act,	677
all of the following apply:	678

(A) The initial rules for implementation of a stroke data	679
registry under section 3701.908 of the Revised Code, as enacted by	680
this act, shall be adopted by the Department of Health not later	681
than one year after the effective date of this act.	682

(B)(1) The Stroke System of Care Task Force's initial	683
recommendations under section 3701.909 of the Revised Code, as	684
enacted by this act, for establishment of a statewide system for	685
stroke response and treatment shall be submitted to the	686
Department, Governor, and General Assembly not later than one year	687
after the effective date of this act.	688

(2) The rules for implementation and administration of	689
section 3701.909 of the Revised Code, as enacted by this act,	690
shall be adopted by the Department not later than one year after	691
it receives the Task Force's initial recommendations.	692

(3) The Task Force shall issue its first update of its	693
recommendations regarding the statewide system for stroke response	694
and treatment not later than two years after it issues its initial	695
recommendations.	696

(C)(1) Not later than December 1, 2012, the Department shall	697
implement the system for recognition of hospitals as primary	698
stroke centers required by section 3727.11 of the Revised Code, as	699
enacted by this act, compile the first list of recognized primary	700
stroke centers as required by that section, and post the list on	701
the Department's internet web site as required by section 3701.909	702
of the Revised Code, as enacted by this act.	703

(2) Until the Department of Health has implemented section	704
3727.11 of the Revised Code, as enacted by this act, any provision	705
of this act that requires consultation with hospitals recognized	706
under that section as primary stroke centers is deemed to refer to	707
any hospital that holds current, valid certification or	708
accreditation as a primary stroke center from the Joint Commission	709
or the Healthcare Facilities Accreditation Program.	710

(D) Not later than one year after the effective date of this	711
act, the State Board of Emergency Medical Services shall establish	712
the initial standardized stroke assessment and protocol tool, as	713
required by section 4765.44 of the Revised Code, as enacted by	714
this act.	715