Florida Senate - 2009 SB 1938
By Senator Constantine
22-00811-09 20091938__
1 A bill to be entitled
2 An act relating to cardiology services; providing
3 legislative findings; providing definitions; requiring
4 the Agency for Health Care Administration to post a
5 list of percutaneous coronary intervention centers on
6 its website; requiring the Department of Health to
7 send a list of names and addresses of percutaneous
8 coronary intervention centers to directors and
9 providers for emergency medical services; requiring
10 the department to develop sample assessment criteria
11 relating to cardiac triage on its website; encouraging
12 providers of medical services to use the sample
13 assessment criteria relating to cardiac triage;
14 requiring each medical director of an emergency
15 medical services provider to develop and implement
16 certain protocols for cardiac patients; providing
17 requirements for the protocols; requiring the
18 department to develop and provide technical support,
19 equipment recommendations, and training for
20 identification of patients having ST-elevation
21 myocardial infarction; requiring the department to
22 base the sample assessment criteria relating to
23 cardiac triage on specified programs; requiring the
24 department to conduct a survey of licensed emergency
25 medical services providers and report its findings to
26 certain stakeholders; encouraging the department to
27 identify and provide to emergency medical services
28 providers opportunities and resources to secure
29 appropriate equipment for the identification of ST
30 elevation myocardial infarction; requiring the
31 department to meet with stakeholders; providing a
32 timeframe for emergency medical services providers to
33 comply with the act; authorizing medical directors to
34 determine appropriate transport locations for
35 patients; requiring the department to adopt rules;
36 requiring the agency to direct hospitals to
37 participate in coordinating a local STEMI system of
38 care; providing requirements for documentation of time
39 for the process of patient care for the hospital
40 portion of the STEMI system of care; redesignating the
41 Office of Trauma within the department to the Office
42 of Trauma/STEMI; providing an effective date.
43
44 WHEREAS, every year, approximately 24,000 people in this
45 state suffer a life-threatening heart attack, one-third of whom
46 die within 24 hours after the attack, and
47 WHEREAS, fewer than 20 percent of heart attack victims
48 receive emergency reperfusion to open blocked arteries, and
49 WHEREAS, studies have shown that individuals suffering a
50 life-threatening heart attack have better outcomes if they
51 receive emergency reperfusion, and
52 WHEREAS, studies have shown that percutaneous coronary
53 intervention or PCI is the optimum treatment for a patient
54 suffering from a ST-elevated myocardial infarction or STEMI
55 heart attack, and
56 WHEREAS, studies have shown that opening a blocked coronary
57 artery using emergency PCI within recommended timeframes can
58 effectively prevent or significantly minimize permanent damage
59 caused by a heart attack to the heart, and
60 WHEREAS, even fewer patients receive the procedure within
61 the timeframe recommended by the American Heart Association, and
62 WHEREAS, damage to the heart muscle can result in death,
63 congestive heart failure, atrial fibrillation, and other chronic
64 diseases of the heart, and
65 WHEREAS, organizations such as the American Heart
66 Association, the American College of Cardiology, and the Florida
67 College of Emergency Physicians recommend deploying protocols
68 and systems to help ensure that people suffering from a life
69 threatening heart attack receive the latest evidence-based care,
70 such as timely reperfusion and emergency PCI, within recommended
71 timeframes, and
72 WHEREAS, Florida's system of trauma services and system of
73 emergency stroke treatment have dramatically improved the care
74 provided for individuals suffering from a traumatic injury or a
75 stroke, and
76 WHEREAS, a localized emergency cardiac system can help
77 ensure that people suffering from a life-threatening heart
78 attack will receive the latest evidence-based care within
79 recommended timeframes, NOW, THEREFORE,
80
81 Be It Enacted by the Legislature of the State of Florida:
82
83 Section 1. Emergency medical services providers; triage and
84 transportation of victims of ST-elevation myocardial infarction
85 to a percutaneous coronary intervention center; definitions.—
86 (1)(a) The Legislature finds that rapid identification and
87 treatment of serious heart attacks, known as ST-elevation
88 myocardial infarction or STEMI, can significantly improve
89 outcomes by reducing death and disability by rapidly restoring
90 blood flow to the heart in accordance with the latest evidence
91 based standards.
92 (b) The Legislature further finds that a strong emergency
93 system to support survival from life-threatening heart attacks
94 is needed in this state in order to treat victims in a timely
95 manner and to improve the overall care of heart attack victims.
96 (c) Therefore, the Legislature strongly encourages local
97 emergency medical providers to establish a STEMI system of care
98 to help improve outcomes for individuals suffering from a life
99 threatening heart attack.
100 (2) As used in this section, the term:
101 (a) “Agency” means the Agency for Health Care
102 Administration.
103 (b) “Department” means the Department of Health.
104 (c) “STEMI system of care” means a local agreement between
105 emergency medical service providers and local hospitals to
106 deliver patients identified as having ST-elevated myocardial
107 infarction to appropriate medical facilities.
108 (d) “Percutaneous coronary intervention center” means a
109 provider of adult interventional cardiology services licensed by
110 the agency under s. 408.0361, Florida Statutes.
111 (3) By December 1, 2009, and by June 1 of each year
112 thereafter, the agency shall post on its website a list of the
113 percutaneous coronary intervention centers licensed by the
114 agency.
115 (4) By June 1, 2010, or 6 months after the agency adopts a
116 rule governing the certification of percutaneous coronary
117 intervention centers under s. 408.036(3)(o), Florida Statutes,
118 whichever occurs later, and by June 1 of each year thereafter,
119 the department shall send a list of the names and addresses of
120 each percutaneous coronary intervention center that is licensed
121 by the agency to each licensed emergency medical services
122 provider and director of emergency medical services in the
123 state.
124 (5) The department shall develop sample assessment criteria
125 relating to cardiac triage. The department must post this sample
126 assessment criteria on its website and provide a copy of the
127 assessment criteria to each licensed emergency medical services
128 provider and director of emergency medical services by July 1,
129 2010. Each licensed provider of medical services is encouraged
130 to use assessment criteria relating to cardiac triage which are
131 substantially similar to the sample assessment criteria relating
132 to cardiac triage provided by the department under this
133 subsection.
134 (6) The medical director of each licensed emergency medical
135 services provider shall develop and implement protocols for the
136 assessment, treatment, and transportation of cardiac patients
137 and employ those protocols to assess, treat, and transport
138 patients having ST-elevation myocardial infarction to the most
139 appropriate hospital. These protocols must include use of a
140 community plan to address the transport of cardiac patients to
141 appropriate facilities in a manner that addresses community
142 specific resources and needs.
143 (7) The department shall develop and provide to each
144 licensed emergency medical services provider and director of
145 emergency medical services technical support, equipment
146 recommendations, and necessary training for the effective
147 identification of patients who have acute ST-elevation
148 myocardial infarction. The department shall base the sample
149 assessment criteria relating to cardiac triage on the American
150 Heart Association's advanced cardiovascular life support chest
151 pain algorithm for prehospital assessment, triage, and treatment
152 of patients suspected of having ST-elevation myocardial
153 infarction, a substantially similar program, or a program that
154 uses evidence-based guidelines. The department shall conduct a
155 biennial survey of all applicable licensed emergency medical
156 services providers to develop an inventory of their equipment
157 and identify their equipment needs, training requirements, and
158 performance regarding the practical application of protocols and
159 the identification of acute ST-elevation myocardial infarction
160 in the field. The department shall report its survey findings
161 and provide a copy of the survey to emergency medical services
162 providers, directors of emergency medical services, the
163 Emergency Medical Services Advisory Council, and other
164 stakeholders.
165 (8) The department is encouraged to identify and provide to
166 all licensed emergency medical service providers opportunities,
167 partnerships, and resources for securing appropriate equipment
168 for identifying ST-elevation myocardial infarction in the field.
169 (9) After implementation of the assessment criteria, the
170 department shall convene stakeholders at least once a year, if
171 necessary, to facilitate the sharing of experiences and best
172 practices. The best practices shall be made available on the
173 department's website.
174 (10) Each emergency medical services provider licensed
175 under chapter 401, Florida Statutes, must comply with this
176 section by July 1, 2010, or 6 months after the date it receives
177 the list of percutaneous coronary intervention centers sent
178 pursuant to subsection (4), whichever occurs later.
179 (11) Medical directors may determine appropriate transport
180 locations for patients.
181 (12) The department shall adopt rules necessary to
182 administer this section.
183 Section 2. (1) The agency shall direct each hospital
184 licensed under chapter 395, Florida Statutes, to participate in
185 coordinating a local STEMI system of care.
186 (2) Participants may include, but need not be limited to,
187 hospitals, primary percutaneous coronary intervention centers
188 with and without open-heart centers onsite, stand-alone
189 percutaneous coronary intervention centers, and those hospitals
190 not equipped to provide services related to percutaneous
191 coronary intervention.
192 (3) The hospital portion of a STEMI system of care shall
193 deliver detailed, time-stamped documentation of each step in the
194 patient-care process to the medical director of emergency
195 medical services for quality-improvement purposes.
196 Section 3. The Department of Health shall redesignate the
197 Office of Trauma within the Department of Health to the Office
198 of Trauma/STEMI.
199 Section 4. This act shall take effect July 1, 2009.