CS/HB 1033

1	A bill to be entitled
2	An act relating to emergency cardiology services;
3	providing legislative findings; providing definitions;
4	requiring the Department of Health to develop sample
5	assessment criteria relating to cardiac triage and
6	disseminate the information by a certain date; requiring
7	medical directors of licensed emergency medical services
8	providers to submit or develop and implement certain
9	protocols and plans; providing requirements for the
10	protocols; requiring the department to develop and provide
11	support, recommendations, and training for the
12	identification of patients with acute STEMI; requiring
13	certain assessment criteria; requiring the department to
14	conduct a survey of licensed emergency medical services
15	providers and report its findings to certain stakeholders;
16	requiring the department to assist in identifying and
17	providing to emergency medical services providers
18	opportunities and resources to secure appropriate
19	equipment for identifying STEMI; requiring the department
20	to meet with stakeholders; providing a date for emergency
21	medical services providers to comply with the act;
22	authorizing medical directors of emergency medical service
23	providers to determine appropriate transport destinations
24	for patients; requiring the adoption of rules by the
25	department; requiring licensed hospitals to participate in
26	the coordination of a local STEMI system of care;
27	requiring submission of timed documentation data to
28	specified entities; providing rulemaking authority;
29	providing an effective date.
30
31	WHEREAS, every year, approximately 24,000 people in this
32	state suffer a life-threatening heart attack known as a STEMI,
33	one-third of whom die within 24 hours after the attack, and
34	WHEREAS, fewer than 20 percent of heart attack victims
35	receive emergency reperfusion to open blocked arteries, and
36	WHEREAS, studies have shown that individuals suffering a
37	life-threatening heart attack have better outcomes if they
38	receive emergency reperfusion, and
39	WHEREAS, studies have shown that percutaneous coronary
40	intervention or PCI is the optimum treatment for a patient
41	suffering from an ST-elevated myocardial infarction or STEMI
42	heart attack, and
43	WHEREAS, studies have shown that opening a blocked coronary
44	artery using emergency PCI within recommended timeframes can
45	effectively prevent or significantly minimize permanent damage
46	caused by a heart attack, and
47	WHEREAS, even fewer patients receive the procedure within
48	the timeframe recommended by the American Heart Association, and
49	WHEREAS, damage to the heart muscle can result in death,
50	congestive heart failure, atrial fibrillation, and other chronic
51	diseases of the heart, and
52	WHEREAS, organizations such as the American Heart
53	Association, the American College of Cardiology, and the Florida
54	College of Emergency Physicians recommend deploying protocols
55	and systems to help ensure that people suffering from a life-
56	threatening heart attack receive the latest evidence-based care,
57	such as timely reperfusion and emergency PCI, within recommended
58	timeframes, and
59	WHEREAS, Florida's system of trauma services and system of
60	emergency stroke treatment have dramatically improved the care
61	provided for individuals suffering from a traumatic injury or a
62	stroke, and
63	WHEREAS, a localized emergency cardiac system can help
64	ensure that people suffering from a life-threatening heart
65	attack will receive the latest evidence-based care within
66	recommended timeframes, NOW, THEREFORE,
67
68	Be It Enacted by the Legislature of the State of Florida:
69
70	Section 1.  Emergency medical services providers; triage
71	and transportation of victims of an acute ST-elevation
72	myocardial infarction; definitions.--
73	(1)(a)  The Legislature finds that rapid identification and
74	treatment of serious heart attacks, known as ST-elevation
75	myocardial infarction or STEMI, can significantly improve
76	outcomes by reducing death and disability by rapidly restoring
77	blood flow to the heart in accordance with the latest evidence-
78	based standards.
79	(b)  The Legislature further finds that a strong emergency
80	system to support survival from life-threatening heart attacks
81	is needed in this state in order to treat victims in a timely
82	manner and to improve outcomes and the overall care of heart
83	attack victims.
84	(c)  Therefore, the Legislature directs all local emergency
85	medical providers and hospitals to establish a STEMI system of
86	care to help improve outcomes for individuals suffering from a
87	life-threatening heart attack.
88	(2)  As used in this section, the term:
89	(a)  "Agency" means the Agency for Health Care
90	Administration.
91	(b)  "Department" means the Department of Health.
92	(c)  "Percutaneous coronary intervention center" means a
93	provider of adult interventional cardiology services licensed by
94	the agency under s. 408.0361, Florida Statutes.
95	(d)  "STEMI system of care" means a local agreement between
96	emergency medical service providers and local hospitals to
97	deliver patients identified as having an ST-elevation myocardial
98	infarction to appropriate medical facilities.
99	(3)  The department shall develop sample assessment
100	criteria relating to cardiac triage. The department must post
101	this sample assessment criteria on its website and provide a
102	copy of the assessment criteria to each licensed emergency
103	medical services provider and medical director of emergency
104	medical services by July 1, 2010. Each licensed provider of
105	emergency medical services licensed under chapter 401, Florida
106	Statutes, is required to submit existing cardiac triage
107	protocols or to develop assessment criteria relating to cardiac
108	triage which specifically addresses transportation and treatment
109	plans for acute STEMI patients.
110	(4)  The medical director of each licensed emergency
111	medical services provider shall submit and implement existing
112	protocols or develop and implement protocols for the assessment,
113	treatment, and transportation of cardiac patients and employ
114	those protocols to assess, treat, and transport patients having
115	a STEMI to the most appropriate hospital. These protocols must
116	include use of a community plan to address the transport of
117	cardiac patients to appropriate facilities in a manner that
118	addresses community-specific resources and needs. The plan must
119	also address a data-sharing agreement between hospitals and
120	emergency medical service providers.
121	(5)  The department shall develop and provide to each
122	licensed emergency medical services provider and medical
123	director of emergency medical services technical support,
124	equipment recommendations, and necessary training
125	recommendations for the effective identification of patients who
126	are having an acute STEMI. The department shall base the sample
127	assessment criteria relating to cardiac triage on the most
128	recent version of an advanced cardiovascular life support chest
129	pain algorithm for prehospital assessment, triage, and treatment
130	of patients suspected of having a STEMI that uses evidence-based
131	guidelines such as those developed by the American Heart
132	Association or a substantially similar program. The department
133	shall conduct a biennial survey of all applicable licensed
134	emergency medical services providers to develop an inventory of
135	their equipment and identify their equipment needs, training
136	requirements, and performance regarding the practical
137	application of protocols and the identification of an acute
138	STEMI in the field. The department shall report its survey
139	findings and provide a copy of the survey to emergency medical
140	services providers, directors of emergency medical services, the
141	Emergency Medical Services Advisory Council, and other
142	stakeholders.
143	(6)  The department shall assist in identifying and
144	providing all licensed emergency medical services providers with
145	opportunities, partnerships, and resources for securing
146	appropriate equipment for identifying STEMI in the field. These
147	sources may include the Emergency Medical Services Grant Trust
148	Fund pursuant to part II of chapter 401, Florida Statutes.
149	(7)  After implementation of the assessment criteria, local
150	STEMI systems are encouraged to meet semiannually to assess
151	quality improvement measures.
152	(8)  After implementation of the assessment criteria, the
153	department shall convene stakeholders at least once a year, if
154	necessary, to facilitate the sharing of experiences and best
155	practices. The best practices shall be made available on the
156	department's website. These meetings may take place at one of
157	the annual meetings of emergency medical services providers, by
158	teleconference, by web conference, or by using other methods
159	appropriate to distribute and share information.
160	(9)  Each emergency medical services provider licensed
161	under chapter 401, Florida Statutes, must comply with this
162	section by July 1, 2010.
163	(10)  Medical directors of emergency medical service
164	providers shall determine the most appropriate transport
165	destinations for suspected STEMI patients.
166	(11)  The department shall adopt rules necessary to
167	administer this section.
168	Section 2.  (1)  Any hospital licensed under chapter 395,
169	Florida Statutes, must participate in coordinating a local STEMI
170	system of care.
171	(2)  Participants should include, but need not be limited
172	to, hospitals, primary percutaneous coronary intervention
173	centers with or without open-heart centers onsite, those
174	facilities designated as chest pain centers, and those hospitals
175	not equipped to provide services related to percutaneous
176	coronary intervention.
177	(3)  The hospital portion of a STEMI system of care shall
178	submit detailed, timed documentation of each step in the patient
179	care process to the American College of Cardiology-National
180	Cardiovascular Data Registry in accordance with the timetables
181	and procedures established by the registry for 100 percent of
182	all STEMI patients. All data shall be reported using the
183	specific data elements, definitions, and transmission format as
184	set forth by the American College of Cardiology-National
185	Cardiovascular Data Registry. Hospital reports shall include,
186	but not be limited to, door to reperfusion time, door to cardiac
187	catheterization laboratory time, emergency department arrival
188	time, and emergency department exit time. Medical directors
189	shall have access to the American College of Cardiology-National
190	Cardiovascular Data Registry to access data on the treatment of
191	their patients for the exclusive use of quality improvement of
192	the entire STEMI system within 30 days after patient discharge.
193	(4)  Hospitals shall provide a copy of the reporting data
194	to the emergency medical services director for each suspected
195	STEMI patient treated by their respective emergency medical
196	services team.
197	Section 3.  The Department of Health and the Agency for
198	Health Care Administration are authorized to adopt rules to
199	implement the data sharing authorized by this act.
200	Section 4.  This act shall take effect July 1, 2009.

CODING: Words stricken are deletions; words underlined are additions.