January 18, 2021
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       Florida Senate - 2010                                    SB 1822
       By Senator Bennett
       21-00714-10                                           20101822__
    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
  120  section.
  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
  166  number.
  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
  171  administered.
  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.

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