Florida Senate - 2010 SB 1822
By Senator Bennett
1 A bill to be entitled
2 An act relating to cardiology services; requiring
3 emergency medical services providers to transport
4 certain cardiac patients to the most appropriate
5 facility and specify a facility preference; providing
6 legislative findings; providing definitions; requiring
7 medical directors of emergency medical services
8 providers to develop and implement certain protocols
9 for assessment, treatment, and transportation of
10 cardiac patients; providing an exemption; requiring
11 the Department of Health to assist in identifying and
12 providing to emergency medical services providers
13 opportunities and resources to secure appropriate
14 equipment for the identification of certain cardiac
15 patients; requiring certain facilities to participate
16 and cooperate with each medical director of an
17 emergency medical services provider to ensure
18 establishment of certain protocols for assessment,
19 treatment, and transportation of cardiac patients;
20 requiring a local medical facility to notify the
21 medical director of the local emergency medical
22 services provider of its change in status; providing
23 that an emergency medical service provider and its
24 medical directors are held harmless if there is no
25 notice or insufficient notice; requiring hospitals to
26 report certain data; providing for rulemaking;
27 providing a timeframe for emergency medical services
28 providers to comply with the act; providing an
29 effective date.
31 WHEREAS, every year, approximately 24,000 people in this
32 state suffer a type of life-threatening heart attack known as an
33 ST-Elevation Myocardial Infarction or STEMI, one-third of whom
34 die within 24 hours after the attack, and
35 WHEREAS, fewer than 20 percent of heart attack victims
36 receive emergency reperfusion to open blocked arteries, and
37 WHEREAS, studies have shown that individuals suffering a
38 life-threatening, STEMI heart attack have better outcomes if
39 they receive emergency reperfusion, and
40 WHEREAS, studies have shown that percutaneous coronary
41 intervention (PCI) is currently the optimum treatment for a
42 patient suffering from a STEMI 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 to the heart 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 the American College of Cardiology, and
50 WHEREAS, damage to the heart muscle can result in death,
51 congestive heart failure, arterial fibrillation, and other
52 chronic diseases of the heart, and
53 WHEREAS, organizations such as the American Heart
54 Association, the American College of Cardiology, and the Florida
55 College of Emergency Physicians recommend deploying protocols
56 and systems to help ensure that people suffering from a life
57 threatening heart attack receive the latest evidence-based care,
58 such as timely reperfusion and emergency PCI, within recommended
59 timeframes, and
60 WHEREAS, Florida’s system of trauma services and system of
61 emergency stroke treatment have dramatically improved the care
62 provided for individuals suffering from a traumatic injury or a
63 stroke, and
64 WHEREAS, emergency medical services (EMS) personnel often
65 have a unique opportunity to identify STEMI patients through
66 training, appropriate equipment use, and quality assurance
67 programs and can affect their outcome by following protocols
68 that specify appropriate destination selection, and
69 WHEREAS, cooperative relationships between EMS agencies and
70 medical facilities are necessary in order to provide a
71 systematic continuum of care for STEMI patients which ensures
72 that they will receive the latest evidence-based care within
73 recommended timeframes, NOW, THEREFORE,
75 Be It Enacted by the Legislature of the State of Florida:
77 Section 1. Emergency medical services providers; triage and
78 transportation of victims of an acute ST-elevation myocardial
79 infarction; legislative findings; definitions.—Emergency medical
80 services providers shall provide triage and transportation for
81 victims of an acute ST-elevation myocardial infarction to the
82 most appropriate medical facility, with a specific preference
83 given to medical facilities that have a percutaneous coronary
84 intervention center or those medical centers certified as chest
85 pain centers by the Society of Chest Pain Centers.
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 following life-threatening heart
94 attacks is needed in this state in order to treat victims in a
95 timely manner and to improve outcomes and the overall care of
96 heart attack victims.
97 (c) Therefore, the Legislature directs all local emergency
98 medical services providers and medical facilities to work
99 together to establish local STEMI systems of care to help
100 improve outcomes for individuals suffering from this life
101 threatening heart attack.
102 (2) As used in this section, the term:
103 (a) “Local” means, at a minimum, a functional area defined
104 by an emergency medical services provider and the medical
105 facilities to which it routinely transports STEMI and other
106 patients who have medical complaints.
107 (b) “Percutaneous coronary intervention center” means a
108 provider of adult interventional cardiology services licensed by
109 the Agency for Health Care Administration under s. 408.0361,
110 Florida Statutes, which provides daily, 24-hour availability of
111 services for acute STEMI patients.
112 (3) The medical director of each licensed emergency medical
113 services provider shall establish protocols for the assessment,
114 treatment, destination selection, and transportation of
115 suspected cardiac patients. These protocols must specify
116 destination-selection criteria for suspected STEMI patients.
117 Emergency medical services providers that provide only
118 nonemergency ambulance transportation and that do not provide
119 first response services are exempt from the requirements of this
121 (4) The medical director of each licensed emergency medical
122 services provider shall determine which medical facilities are
123 the most appropriate destinations for suspected STEMI patients,
124 taking local resources into consideration.
125 (5) The Department of Health shall assist in identifying
126 and providing all licensed emergency medical service providers
127 with opportunities, partnerships, and resources for securing
128 appropriate equipment for identifying a suspected STEMI patient.
129 These sources may include the Emergency Medical Services Grant
130 program established under ss. 401.101-401.121, Florida Statutes.
131 (6) A facility licensed under chapter 395, Florida
132 Statutes, which routinely cares for adult acute cardiac patients
133 shall agree to participate and cooperate with each medical
134 director of an emergency medical services provider to ensure
135 establishment of local protocols for STEMI patient assessment,
136 treatment, and destination selection.
137 (7)(a) If a local medical facility’s status changes
138 regarding the availability of its percutaneous coronary
139 intervention service, the facility shall notify the medical
140 director or medical directors of the local emergency medical
141 services provider whether the changes are permanent or
142 temporary. This notification shall be made before the change, if
143 possible, and shall occur immediately if the facility can no
144 longer provide the service to an immediately incoming suspected
145 STEMI patient.
146 (b) An emergency medical services provider and its medical
147 directors shall be held harmless if such notification has not
148 been provided or if insufficient notice has been provided such
149 that the medical director of the emergency medical services
150 provider could not take measures to prevent the transportation
151 of a suspected STEMI patient to the facility during the period
152 of status change.
153 (8)(a) All receiving hospitals shall report data on each
154 suspected STEMI patient to the medical director of the
155 respective emergency medical services provider for that patient.
156 Reports shall be delivered to the medical director no later than
157 30 days after the time when the patient was discharged,
158 transferred, or died.
159 (b) For suspected STEMI patients, the data reported to the
160 medical director of the emergency medical services provider
161 shall include, but are not limited to:
162 1. Patient name.
163 2. Date of transport.
164 3. Patient date of birth.
165 4. Emergency medical services provider incident or run
167 5. Emergency department arrival time.
168 6. Emergency department exit time.
169 7. Name of facility, if transferred, and time of departure.
170 8. Medical therapy delivered to patient and time
172 9. Cathertization laboratory arrival time.
173 10. Medical reason if percutaneous coronary intervention
174 was not used or was contraindicated.
175 11. Arterial access time.
176 12. Cross lesion time.
177 13. Admission.
178 14. Survival outcome.
179 (9) The Department of Health shall adopt rules necessary to
180 administer the provisions of this section relating to emergency
181 medical services providers. The department and the Agency for
182 Health Care Administration may adopt rules to administer the
183 data sharing required by this section.
184 (10) Each emergency medical services provider licensed
185 under chapter 401, Florida Statutes, shall comply with this
186 section by July 1, 2011.
187 Section 2. This act shall take effect July 1, 2010.