HB 1033

1	A bill to be entitled
2	An act relating to emergency cardiology services; creating
3	s. 395.1042, F.S.; providing definitions; requiring the
4	Agency for Health Care Administration to post and update a
5	list of percutaneous coronary intervention centers on its
6	Internet website; requiring the Department of Health to
7	send a list of such centers to emergency medical services
8	providers and emergency medical services directors in the
9	state; directing the department to develop and distribute
10	sample cardiac triage assessment criteria and post it on
11	its Internet website; providing for licensed emergency
12	medical services providers to use similar assessment
13	criteria; requiring the director of each emergency medical
14	services provider to develop and use certain specified
15	protocols; providing additional duties of the department
16	relating to support, training, and equipment; requiring
17	the department to conduct a biennial survey; requiring a
18	report; providing for stakeholder meetings; requiring the
19	agency to direct certain hospitals to participate in local
20	ST elevated myocardial infarction (STEMI) systems of care;
21	requiring documentation of the patient care process to be
22	submitted to the medical director; requiring compliance by
23	a certain date; providing an effective date.
24
25	WHEREAS, every year, approximately 24,000 people in this
26	state suffer a life-threatening heart attack, one-third of whom
27	die within 24 hours after the attack, and
28	WHEREAS, fewer than 20 percent of heart attack victims
29	receive emergency angioplasty to open blocked arteries, and
30	WHEREAS, studies have shown that individuals suffering a
31	life-threatening heart attack have better outcomes if they
32	receive emergency reperfusion, and
33	WHEREAS, studies have shown that percutaneous coronary
34	intervention (PCI) is the optimum treatment for a patient
35	suffering from an ST elevated myocardial infarction (STEMI)
36	heart attack, and
37	WHEREAS, studies have shown that opening a blocked coronary
38	artery with emergency PCI within recommended timeframes can
39	effectively prevent or significantly minimize permanent damage
40	to the heart, and
41	WHEREAS, even fewer patients receive the procedure within
42	the timeframe recommended by the American Heart Association, and
43	WHEREAS, damage to the heart muscle can result in death,
44	congestive heart failure, atrial fibrillation, and other chronic
45	diseases of the heart, and
46	WHEREAS, organizations such as the American Heart
47	Association, the American College of Cardiology, and the Florida
48	College of Emergency Physicians recommend deploying protocols
49	and systems to help ensure that people suffering from a life-
50	threatening heart attack receive the latest evidence-based care,
51	such as timely reperfusion or emergency PCI, within recommended
52	timeframes, and
53	WHEREAS, Florida's trauma services system and emergency
54	stroke treatment system have dramatically improved the care
55	provided for individuals suffering from a traumatic injury or a
56	stroke, and
57	WHEREAS, a localized emergency cardiac system can help
58	people suffering from a life-threatening heart attack receive
59	the latest evidence-based care within recommended timeframes,
60	and
61	WHEREAS, rapid identification and treatment of a STEMI
62	heart attack can significantly improve outcomes by reducing
63	death and disability by rapidly restoring blood flow to the
64	heart, and
65	WHEREAS, a strong emergency response system is needed in
66	communities throughout our state in order to treat heart attack
67	victims in a timely manner and to improve the overall care of
68	those victims, and
69	WHEREAS, the Legislature strongly encourages local
70	emergency medical service providers to establish a STEMI system
71	of care to help improve outcomes for individuals who have
72	survived a life-threatening heart attack, NOW, THEREFORE,
73
74	Be It Enacted by the Legislature of the State of Florida:
75
76	Section 1.  Section 395.1042, Florida Statutes, is created
77	to read:
78	395.1042  Emergency medical services providers; cardiac
79	assessment criteria and protocols.--
80	(1)  As used in this section, the term:
81	(a)  "Percutaneous coronary intervention center" or "PCI
82	center" means a provider of adult interventional cardiology
83	services licensed by the agency under s. 408.0361.
84	(b)  "STEMI" means an ST elevation myocardial infarction.
85	(c)  "STEMI system of care" means a local agreement between
86	emergency medical service providers and local hospitals to
87	deliver identified STEMI patients to appropriate medical
88	facilities.
89	(2)  By December 1, 2009, and by June 1 of each year
90	thereafter, the agency shall post on its Internet website a list
91	of PCI centers licensed by the agency.
92	(3)  By June 1, 2010, or 6 months after the agency adopts a
93	rule governing certification of PCI centers under s.
94	408.036(3)(o), whichever is later, and by June 1 of each year
95	thereafter, the department shall send a list of the names and
96	addresses of each PCI center licensed by the agency to each
97	licensed emergency medical services provider and emergency
98	medical services director in the state.
99	(4)  The department shall develop sample cardiac triage
100	assessment criteria, post the criteria on its Internet website,
101	and provide a copy of the criteria to each licensed emergency
102	medical services provider and emergency medical services
103	director no later than July 1, 2010. Each licensed medical
104	services provider is encouraged to use cardiac triage assessment
105	criteria that are substantially similar to the sample cardiac
106	triage assessment criteria provided by the department under this
107	subsection.
108	(5)  The medical director of each licensed emergency
109	medical services provider shall develop and implement
110	assessment, treatment, and transportation protocols for cardiac
111	patients and employ those protocols to assess, treat, and
112	transport STEMI patients to the most appropriate hospital. Such
113	protocols shall include use of a community plan to address
114	transport of cardiac patients to appropriate facilities in a
115	manner that addresses community-specific resources and needs.
116	(6)  The department shall develop and provide technical
117	support, equipment recommendations, and necessary training for
118	effective identification of acute STEMI patients to each
119	licensed emergency medical services provider and emergency
120	medical services director. The department shall use the American
121	Heart Association's advanced cardiovascular life support chest
122	pain algorithm for prehospital assessment, triage, and treatment
123	of patients with suspected STEMI, a substantially similar
124	program, or a program with evidence-based guidelines as a model
125	for its sample cardiac triage assessment criteria. The
126	department shall conduct a biennial survey of all applicable
127	licensed emergency medical services providers to develop an
128	inventory of their equipment and identify their equipment needs,
129	training requirements, and performance regarding the practical
130	application of protocols and the identification of acute STEMI
131	in the field. The department shall report its survey findings
132	and provide a copy of the survey to emergency medical services
133	providers, emergency medical services directors, the Emergency
134	Medical Services Advisory Council, and other stakeholders.
135	(7)  The department is encouraged to identify and provide
136	opportunities, partnerships, and resources to secure appropriate
137	equipment for identification of STEMI in the field to all
138	licensed emergency medical service providers.
139	(8)  After implementation of the assessment criteria, the
140	department shall convene stakeholders at least once a year, if
141	necessary, to facilitate the sharing of experiences and best
142	practices. The best practices shall be made available on the
143	department's Internet website.
144	(9)  The agency shall direct all hospitals licensed under
145	this chapter to participate in the coordination of local STEMI
146	systems of care.
147	(a)  Participants in a STEMI system of care shall include,
148	but not be limited to, hospitals with primary PCI centers, with
149	or without open-heart surgery programs on site, stand-alone PCI
150	centers, and hospitals that are not equipped with PCI centers.
151	(b)  The hospital portion of the STEMI system of care shall
152	include detailed documentation of the time at which each step of
153	the patient care process occurred. This information shall be
154	submitted to the medical director of emergency medical services
155	for the purpose of quality improvement.
156	(10)  Each emergency medical services provider licensed
157	under chapter 401 shall comply with this section by July 1,
158	2010, or 6 months after the date it receives the list of PCI
159	centers sent pursuant to subsection (4), whichever is later.
160	Section 2.  This act shall take effect July 1, 2009.

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