CS/CS/HB 1033

1	A bill to be entitled
2	An act relating to cardiology services; creating s.
3	395.3042, F.S.; requiring emergency medical services
4	providers to transport certain cardiac patients to the
5	most appropriate facility and specify a facility
6	preference; providing legislative findings; providing
7	definitions; requiring medical directors of emergency
8	medical services providers to develop and implement
9	certain protocols for assessment, treatment, and
10	transportation of cardiac patients; providing an
11	exemption; requiring the Department of Health to identify
12	and provide to emergency medical services providers
13	opportunities and resources to secure appropriate
14	equipment for the identification of certain cardiac
15	patients; authorizing medical directors to determine
16	appropriate transport locations for patients; requiring
17	participation by certain hospitals; requiring notice of
18	changes; requiring hospitals to report certain data;
19	providing a timeframe for emergency medical services
20	providers to comply with the act; providing for
21	rulemaking; providing an effective date.
22
23	WHEREAS, every year, approximately 24,000 people in this
24	state suffer a type of life-threatening heart attack known as an
25	ST-Elevation Myocardial Infarction (STEMI), one-third of whom
26	die within 24 hours after the attack, and
27	WHEREAS, fewer than 20 percent of heart attack victims
28	receive emergency reperfusion to open blocked arteries, and
29	WHEREAS, studies have shown that individuals suffering a
30	life-threatening heart attack known as an ST-Elevation
31	Myocardial Infarction or STEMI have better outcomes if they
32	receive emergency reperfusion, and
33	WHEREAS, studies have shown that percutaneous coronary
34	intervention (PCI) is currently the optimum treatment for a
35	patient suffering from a STEMI heart attack, and
36	WHEREAS, studies have shown that opening a blocked coronary
37	artery using emergency PCI within recommended timeframes can
38	effectively prevent or significantly minimize permanent damage
39	to the heart caused by a heart attack, and
40	WHEREAS, even fewer patients receive the procedure within
41	the timeframe recommended by the American Heart Association and
42	the American College of Cardiology, and
43	WHEREAS, damage to the heart muscle can result in death,
44	congestive heart failure, arterial fibrillation, and other
45	chronic 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 and emergency PCI, within recommended
52	timeframes, and
53	WHEREAS, Florida's system of trauma services and system of
54	emergency stroke treatment have dramatically improved the care
55	provided for individuals suffering from a traumatic injury or a
56	stroke, and
57	WHEREAS, emergency medical services (EMS) personnel often
58	have a unique opportunity to identify STEMI patients through
59	training, appropriate equipment use, and quality assurance
60	programs and can impact their outcome by following protocols
61	that specify appropriate destination selection, and
62	WHEREAS, cooperative relationships between EMS agencies and
63	medical facilities are necessary to provide a systematic
64	continuum of care for STEMI patients that ensures that they will
65	receive the latest evidence-based care within recommended
66	timeframes, NOW, THEREFORE,
67
68	Be It Enacted by the Legislature of the State of Florida:
69
70	Section 1.  Section 395.3042, Florida Statutes, is created
71	to read:
72	395.3042  Emergency medical services providers; triage and
73	transportation of victims of an acute ST-elevation myocardial
74	infarction; legislative findings; definitions.--Emergency
75	medical services providers shall provide triage and
76	transportation to victims of an acute ST-elevation myocardial
77	infarction to the most appropriate medical facility with a
78	specific preference to medical facilities with a percutaneous
79	coronary intervention center or those medical centers certified
80	as chest pain centers by the Society of Chest Pain Centers.
81	(1)(a)  The Legislature finds that rapid identification and
82	treatment of serious heart attacks, known as ST-elevation
83	myocardial infarction, or STEMI, can significantly improve
84	outcomes by reducing death and disability by rapidly restoring
85	blood flow to the heart in accordance with the latest evidence-
86	based standards.
87	(b)  The Legislature further finds that a strong emergency
88	system to support survival from life-threatening heart attacks
89	is needed in this state in order to treat victims in a timely
90	manner and to improve outcomes and the overall care of heart
91	attack victims.
92	(c)  Therefore, the Legislature directs all local emergency
93	medical services providers and medical facilities to work
94	together to establish local STEMI systems of care to help
95	improve outcomes for individuals suffering from this life-
96	threatening heart attack.
97	(2)  As used in this section, the term:
98	(a)  "Local" means, at a minimum, a functional area defined
99	by an emergency medical services provider and the medical
100	facilities to which it routinely transports STEMI and other
101	patients with medical complaints.
102	(b)  "Percutaneous coronary intervention center" means a
103	provider of adult interventional cardiology services licensed by
104	the agency under s. 408.0361 that provides 24-hour-a-day
105	availability of services for acute STEMI patients.
106	(c)  "STEMI system of care" means a local agreement between
107	emergency medical service providers and local hospitals to
108	deliver patients identified as having an ST-elevation myocardial
109	infarction to appropriate medical facilities.
110	(3)  The medical director of each licensed emergency
111	medical services provider shall establish protocols for the
112	assessment, treatment, destination selection, and transportation
113	of suspected cardiac patients. These protocols must specify
114	destination selection criteria for suspected STEMI patients.
115	Emergency medical services providers that only provide
116	nonemergency ambulance transportation and do not provide first
117	response services are exempt from the requirements of this
118	section.
119	(4)  The medical director of each licensed emergency
120	medical services provider shall determine which medical
121	facilities are the most appropriate destinations for suspected
122	STEMI patients, taking local resources into consideration.
123	(5)  The department shall assist in identifying and
124	providing all licensed emergency medical service providers with
125	opportunities, partnerships, and resources for securing
126	appropriate equipment for identifying a suspected STEMI patient.
127	These sources may include the Emergency Medical Services Grant
128	program established under ss. 401.101-401.121.
129	(6)  A facility licensed under chapter 395 which routinely
130	cares for adult acute cardiac patients shall agree to
131	participate and cooperate with each medical director of an
132	emergency medical services provider to ensure establishment of
133	local protocols for STEMI patient assessment, treatment, and
134	destination selection.
135	(7)(a)  Any local medical facility whose status changes
136	regarding percutaneous coronary intervention service
137	availability is required to notify the medical director or
138	medical directors of the local emergency medical services
139	provider whether the changes are permanent or temporary. This
140	notification must be made prior to the change, if possible, and
141	must occur immediately if the facility can no longer provide the
142	service to an immediately incoming suspected STEMI patient.
143	(b)  An emergency medical services provider and its medical
144	directors shall be held harmless if such notification has not
145	been provided or if insufficient notice has been provided such
146	that the medical director of the emergency medical services
147	provider could not take measures to prevent the transportation
148	of a suspected STEMI patient to the facility during the period
149	of status change.
150	(8)(a)  All receiving hospitals shall report data on all
151	suspected STEMI patients to the medical director of the
152	respective emergency medical services provider for that patient.
153	Reports shall be delivered to the medical director no later than
154	30 days after the time when the patient was discharged,
155	transferred, or died.
156	(b)  For suspected STEMI patients, the data reported to the
157	medical director of the emergency medical services provider
158	shall include, but are not limited to:
159	1.  Patient name.
160	2.  Date of transport.
161	3.  Patient date of birth.
162	4.  Emergency medical services provider incident or run
163	number.
164	5.  Emergency department arrival time.
165	6.  Emergency department exit time.
166	7.  Name of facility, if transferred, and time of
167	departure.
168	8.  Medical therapy delivered to patient and time
169	administered.
170	9.  Cathertization laboratory arrival time.
171	10.  Medical reason if percutaneous coronary intervention
172	was not used or was contraindicated.
173	11.  Femoral access time.
174	12.  Cross lesion time.
175	13.  Admission.
176	14.  Survival outcome.
177	(9)  The department shall adopt rules necessary to
178	administer the provisions of this section relating to emergency
179	medical services providers. The department and the agency are
180	authorized to create rules to implement the data sharing
181	required by this section.
182	(10)  Each emergency medical services provider licensed
183	under chapter 401 must comply with this section by July 1, 2010.
184	Section 2.  This act shall take effect July 1, 2009.

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