As Introduced

129th General Assembly
Regular Session
2011-2012
H. B. No. 427


Representatives Boyd, Gardner 

Cosponsors: Representatives Barnes, Lundy, Murray, Garland, Ashford, Ramos, Goyal, Letson, Reece, Yuko, Antonio, Landis, Fende 

A BILL
To amend sections 3701.90, 3701.901, 3701.902, 1
3701.903, 3701.904, 3701.907, 4742.03, 4765.10, 2
4765.16, and 4765.40; to enact sections 3701.908, 3
3701.909, 3727.11, 3727.111, 4765.44, and 4765.45; 4
and to repeal sections 3701.905 and 3701.906 of 5
the Revised Code to replace the Council on Stroke 6
Prevention and Education with the Stroke System of 7
Care Task Force; to provide for state recognition 8
of hospitals that are primary stroke centers; to 9
require establishment of protocols for emergency 10
triage, treatment, and transport of stroke 11
patients; and to require the Department of Health 12
to maintain a stroke data registry and a statewide 13
system for stroke response and treatment.14


BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

       Section 1. That sections 3701.90, 3701.901, 3701.902, 15
3701.903, 3701.904, 3701.907, 4742.03, 4765.10, 4765.16, and 16
4765.40 be amended and sections 3701.908, 3701.909, 3727.11, 17
3727.111, 4765.44, and 4765.45 of the Revised Code be enacted to 18
read as follows:19

       Sec. 3701.90.  There is hereby created in the department of 20
health the council on stroke prevention and educationstroke 21
system of care task force to address matters of triage, treatment, 22
and transport of patients who may experience acute stroke. The 23
department shall, to the extent funds are available, provide 24
office space and staff assistance for the counciltask force.25

       Sec. 3701.901.  (A) The membership of the council on stroke 26
prevention and education shall consist of one representative of 27
each of the following:28

       (1) Brain injury association of Ohio;29

       (2) Ohio academy of family physicians;30

       (3) American college of emergency physicians Ohio chapter;31

       (4) Ohio chapter of the American college of cardiology;32

       (5) Ohio state neurosurgical society;33

       (6) Ohio heart and vascular research foundation;34

       (7) Ohio geriatrics society;35

       (8) Ohio nurses association;36

       (9) Ohio association of rehabilitation facilities;37

       (10) Ohio hospital association;38

       (11) Northeast Ohio stroke association;39

       (12) American heart association Ohio valley affiliate;40

       (13) American association of retired persons Ohio office;41

       (14) Ohio department of health;42

       (15) Ohio commission on minority health;43

       (16) Ohio state medical association;44

       (17) Ohio osteopathic association;45

       (18) Ohio physical therapy association;46

       (19) A university research facility in Ohio specializing in 47
biotechnology;48

       (20) A health insuring corporation, as defined in section 49
1751.01 of the Revised Code;50

       (21) A small employer, as defined in section 3924.01 of the 51
Revised Code;52

       (22) An employer that provides health benefits to its 53
employees through a self-insurance program, as defined in section 54
3959.01 of the Revised Code.55

       (B) The director of health shall appoint the members of the 56
council. The director shall request from each entity listed in 57
division (A) of this section a list of three persons qualified to 58
serve as members of the council. In making appointments to the 59
council, the director shall select one member from the list 60
submitted by each entity. If the director does not receive a list 61
from an entity not later than sixty days after making a request, 62
the director shall appoint a member to serve as the representative 63
of that entity. The director shall appoint as members of the 64
council no fewer than six personsstroke system of care task 65
force. The task force shall include all of the following:66

       (1) Representatives from the department of health;67

       (2) Representatives from the state board of emergency medical 68
services;69

       (3) Representatives from the American stroke association;70

       (4) Representatives from primary stroke centers;71

       (5) Representatives from rural hospitals;72

       (6) Persons who are authorized under Chapter 4731. of the 73
Revised Code to practice medicine and surgery or osteopathic 74
medicine and surgery;75

       (7) Providers of emergency medical services, as defined in 76
section 4765.01 of the Revised Code.77

       (C)(B) The director of health shall appoint the chair78
chairperson and vice-chairvice-chairperson of the counciltask 79
force from among its members.80

       Sec. 3701.902. Members of the council on stroke prevention 81
and educationstroke system of care task force shall serve without 82
compensation, but shall, to the extent funds are available, be 83
reimbursed by the department of health for the actual and 84
necessary expenses they incur in the performance of their official 85
duties. A member may serve until a replacement is appointed by the 86
director of health. Replacement members shall be appointed in the 87
same manner as the initial members.88

       Sec. 3701.903.  (A) The council on stroke prevention and 89
educationstroke system of care task force shall, to the extent 90
funds are available, do all of the following:91

       (1) Develop and implement a comprehensive statewide public 92
education program on stroke prevention, targeted to high-risk 93
populations and to geographic areas where there is a high 94
incidence of stroke, including information developed or compiled 95
by the council on all of the following:96

       (a) Healthy lifestyle practices that reduce the risk of 97
stroke;98

       (b) Signs and symptoms of stroke and action to be taken when 99
signs occur;100

       (c) Determinants of high-quality health care for stroke;101

       (d) Other information the council considers appropriate for 102
inclusion in the public education program.103

       (2) Develop or compile for primary care physicians 104
recommendations that address risk factors for stroke, appropriate 105
screening for risk factors, early signs of stroke, and treatment 106
strategies;107

       (3) Develop or compile for physicians and emergency health 108
care providers recommendations on the initial treatment of stroke;109

       (4) Develop or compile for physicians and other health care 110
providers recommendations on the long-term treatment of stroke;111

       (5) Develop or compile for physicians, long-term care 112
providers, and rehabilitation providers recommendations on 113
rehabilitation of stroke patients;114

       (6)Encourage hospitals registered with the department of 115
health under section 3701.07 of the Revised Code and emergency 116
medical service organizations, as defined in section 4765.01 of 117
the Revised Code, to share information and methods of improving 118
the quality of care provided to stroke patients;119

       (2) Facilitate the analysis of stroke treatment and 120
coordination of care;121

       (3) Facilitate the communication of treatment results among 122
hospitals and emergency medical service organizations;123

       (4) Advise the department of health on the collection of 124
information that would assist in development of an effective 125
system of stroke care in this state;126

       (5) Take other actions consistent with the purpose of the 127
counciltask force to ensure that the public and health care 128
providers are informed with regard to the most effective treatment129
strategies for stroke prevention and treatment.130

       (B) The counciltask force may use information developed or 131
made available by other public or private entities to meet the 132
requirements of division (A) of this section.133

       (C) The department of health shall make information developed 134
or compiled by the counciltask force available to the public and 135
disseminate to the appropriate persons the recommendations 136
developed or compiled by the counciltask force.137

       Sec. 3701.904. (A) The council on stroke prevention and 138
educationstroke system of care task force shall meet at the call 139
of the chair to conduct its official business.140

       (B) A majority of the voting members of the counciltask 141
force constitutes a quorum. The counciltask force may take action 142
only by affirmative vote of a majority of a quorum.143

       Sec. 3701.907.  The council on stroke prevention and 144
educationstroke system of care task force is exempt from the 145
requirements of section 101.84not subject to sections 101.82 to 146
101.87 of the Revised Code.147

       Sec. 3701.908.  (A) As used in this section, "emergency 148
medical service organization" has the same meaning as in section 149
4765.01 of the Revised Code.150

       (B)(1) Each of the following entities shall provide to the 151
department of health information requested by the department on 152
the treatment of stroke patients served by the entity:153

       (a) A hospital recognized under section 3727.11 of the 154
Revised Code as a primary stroke center;155

       (b) A hospital recognized under section 3727.111 of the 156
Revised Code as an acute stroke-capable center, if the department 157
has implemented a recognition system under that section;158

       (c) A hospital other than a hospital described in division 159
(B)(1)(a) or (b) of this section;160

       (d) An emergency medical service organization;161

       (e) Any other entity from which the department requests 162
information regarding the treatment of stroke patients served by 163
the entity.164

       (2) The requested information shall be provided in a manner 165
that aligns with the stroke consensus metrics developed and 166
approved by the American heart association, American stroke 167
association, the United States centers for disease control and 168
prevention, and the joint commission.169

       (3) To the greatest extent possible, the department shall 170
coordinate with national voluntary health organizations involved 171
in stroke quality improvement to avoid duplication and redundancy 172
in the collection of the information.173

       (C) The department shall develop and maintain a stroke data 174
registry and include in the registry the information collected 175
under division (B) of this section. The registry shall be 176
developed and maintained by using the stroke registry guidelines 177
established by either of the following:178

       (1) The American heart association;179

       (2) Another organization acceptable to the department that 180
has established stroke registry guidelines with standards for 181
maintaining confidentiality of information that are no less secure 182
than the confidentiality standards included in the American heart 183
association's guidelines.184

       (D) Information provided or maintained under this section 185
that is protected health information pursuant to section 3701.17 186
of the Revised Code shall be released only in accordance with that 187
section. Information that does not identify an individual may be 188
released in summary, statistical, or aggregate form.189

       (E) The department shall adopt rules as it considers 190
necessary to implement and administer this section. The rules 191
shall be adopted in accordance with Chapter 119. of the Revised 192
Code.193

       Sec. 3701.909.  (A) As used in this section, "telemedicine 194
services" means the delivery of health care services through the 195
use of interactive audio, video, and other electronic media used 196
for the purpose of diagnosis, consultation, or treatment of acute 197
stroke.198

       (B)(1) The stroke system of care task force shall develop 199
recommendations regarding the establishment under this section of 200
a statewide system for stroke response and treatment. The task 201
force shall update its recommendations at least every two years.202

       In developing its recommendations, the task force shall pay 203
particular attention to the establishment of an effective system 204
for stroke response and treatment in the rural areas of the state. 205
The recommendations shall be developed in consultation with the 206
state board of emergency medical services.207

       (2) The task force's recommendations shall include all of the 208
following:209

       (a) Procedures for coordination and communication between 210
hospitals that are recognized under section 3727.11 of the Revised 211
Code as primary stroke centers and hospitals that are not 212
recognized as primary stroke centers;213

       (b) A plan for achieving continuous improvement in the 214
quality of care provided under the statewide system for stroke 215
response and treatment established under division (C) of this 216
section;217

       (c) Strategies for use of telemedicine services in this state 218
for inter-hospital communication between hospitals that are 219
recognized under section 3727.11 of the Revised Code as primary 220
stroke centers and hospitals that are not recognized as primary 221
stroke centers.222

       (3) The task force shall submit its recommendations to the 223
department of health, the governor, and, in accordance with 224
section 101.68 of the Revised Code, the general assembly.225

       (C)(1) Based on the task force's recommendations, the 226
department shall establish a statewide system for stroke response 227
and treatment. The department may take any actions it considers 228
necessary to maintain an effective system for stroke response and 229
treatment in this state.230

       (2) As part of the system, the department shall post both of 231
the following on its internet web site and shall update the posted 232
information on at least an annual basis:233

       (a) The list compiled under section 3727.11 of the Revised 234
Code identifying the hospitals that are recognized under that 235
section as primary stroke centers; 236

       (b) The standardized stroke assessment and protocol tool 237
established under section 4765.44 of the Revised Code.238

       (D) The department shall adopt rules as it considers 239
necessary to implement and administer this section. The rules 240
shall be adopted in accordance with Chapter 119. of the Revised 241
Code.242

       Sec. 3727.11.  (A) The department of health shall recognize 243
as a primary stroke center any hospital that holds certification 244
or accreditation as a primary stroke center issued by any of the 245
following:246

       (1) The joint commission;247

       (2) The healthcare facilities accreditation program;248

       (3) Another entity acceptable to the department that is 249
nationally recognized and provides certification or accreditation 250
of primary stroke centers.251

       (B) A hospital shall not use the phrase "primary stroke 252
center" or otherwise hold itself out as a primary stroke center 253
unless it is recognized as a primary stroke center under this 254
section.255

       (C) The department may suspend or revoke its recognition of a 256
hospital as a primary stroke center if the department determines 257
that the hospital no longer holds certification or accreditation 258
that meets the requirements of division (A) of this section or has 259
not maintained the requirements to hold the certification or 260
accreditation. The department's action shall be taken pursuant to 261
an adjudication conducted in accordance with Chapter 119. of the 262
Revised Code.263

       (D) Annually, not later than the first day of December, the 264
department shall compile a list of hospitals recognized as primary 265
stroke centers.266

       (E) Nothing in this section limits the services provided by a 267
hospital, or prohibits a hospital from providing services, if that 268
hospital is authorized to provide such services.269

       (F) The department may adopt rules as necessary to implement 270
and administer this section. The rules shall be adopted in 271
accordance with Chapter 119. of the Revised Code.272

       Sec. 3727.111.  The department of health may establish a 273
program for recognition of hospitals as acute stroke-capable 274
centers. The program shall be administered in the same manner as 275
the department's recognition of primary stroke centers under 276
section 3727.11 of the Revised Code.277

       The program may be established as entities acceptable to the 278
department begin issuing accreditation of hospitals as acute 279
stroke-capable centers. The department may consider an entity 280
acceptable only if the entity is nationally recognized and uses 281
evidence-based standards for issuing its accreditation.282

       The department may adopt rules as it considers necessary to 283
implement and administer this section. The rules shall be adopted 284
in accordance with Chapter 119. of the Revised Code.285

       Sec. 4742.03.  (A) A person may obtain certification as an 286
emergency service telecommunicator by successfully completing a 287
basic course of emergency service telecommunicator training that 288
is conducted by the state board of education under section 4742.02 289
of the Revised Code. The basic course of emergency service 290
telecommunicator training shall include, but not be limited to, 291
both of the following:292

       (1) At least forty hours of instruction or training;293

       (2) Instructional or training units in all of the following 294
subjects:295

       (a) The role of the emergency service telecommunicator;296

       (b) Effective communication skills;297

       (c) Emergency service telecommunicator liability;298

       (d) Telephone techniques;299

       (e) Requirements of the "Americans With Disabilities Act of 300
1990," 104 Stat. 327, 42 U.S.C. 12101, as amended, that pertain to 301
emergency service telecommunicators;302

       (f) Handling hysterical and suicidal callers;303

       (g) Law enforcement terminology;304

       (h) Fire service terminology;305

       (i) Emergency medical service terminology;306

       (j) Emergency call processing guides for law enforcement;307

       (k) Emergency call processing guides for fire service;308

       (l) Emergency call processing guides for emergency medical 309
service;310

       (m) Radio broadcast techniques;311

       (n) Disaster planning;312

       (o) Police officer survival, fire or emergency medical 313
service scene safety, or both police officer survival and fire or 314
emergency medical service scene safety;315

       (p) Assessment and treatment of stroke patients.316

       (B) A person may maintain certification as an emergency 317
service telecommunicator by successfully completing at least eight 318
hours of continuing education coursework in emergency service 319
telecommunicator training during each two-year period after a 320
person first obtains the certification referred to in division (A) 321
of this section. The continuing education coursework shall consist 322
of review and advanced training and instruction in the subjects 323
listed in division (A)(2) of this section.324

       (C) If a person successfully completes the basic course of 325
emergency service telecommunicator training described in division 326
(A) of this section, the state board of education or a designee of 327
the board shall certify the person's successful completion. The 328
board shall send a copy of the certification to the person and to 329
the emergency service provider by whom the person is employed.330

       If a person successfully completes the continuing education 331
coursework described in division (B) of this section, the state 332
board of education or a designee of the board shall certify the 333
person's successful completion. The board shall send a copy of the 334
certification to the person and to the emergency service provider 335
by whom the person is employed.336

       Sec. 4765.10.  (A) The state board of emergency medical 337
services shall do all of the following:338

       (1) Administer and enforce the provisions of this chapter and 339
the rules adopted under it;340

       (2) Approve, in accordance with procedures established in 341
rules adopted under section 4765.11 of the Revised Code, 342
examinations that demonstrate competence to have a certificate to 343
practice renewed without completing a continuing education 344
program;345

       (3) Advise applicants for state or federal emergency medical 346
services funds, review and comment on applications for these 347
funds, and approve the use of all state and federal funds 348
designated solely for emergency medical service programs unless 349
federal law requires another state agency to approve the use of 350
all such federal funds;351

       (4) Serve as a statewide clearinghouse for discussion, 352
inquiry, and complaints concerning emergency medical services;353

       (5) Make recommendations to the general assembly on 354
legislation to improve the delivery of emergency medical services;355

       (6) Maintain a toll-free long distance telephone number 356
through which it shall respond to questions about emergency 357
medical services;358

       (7) Work with appropriate state offices in coordinating the 359
training of firefighters and emergency medical service personnel. 360
Other state offices that are involved in the training of 361
firefighters or emergency medical service personnel shall 362
cooperate with the board and its committees and subcommittees to 363
achieve this goal.364

       (8) Provide a liaison to the state emergency operation center 365
during those periods when a disaster, as defined in section 366
5502.21 of the Revised Code, has occurred in this state and the 367
governor has declared an emergency as defined in that section;368

       (9) Post both of the following on the board's internet web 369
site and update the posted information on at least an annual 370
basis:371

       (a) The list compiled under section 3727.11 of the Revised 372
Code identifying the hospitals that are recognized under that 373
section as primary stroke centers;374

       (b) The standardized stroke assessment and protocol tool 375
established under section 4765.44 of the Revised Code.376

       (10) Not later than the first day of December each year, 377
provide to each emergency medical service organization an 378
electronic or paper copy of the information posted on the board's 379
web site under division (A)(9) of this section.380

       (B) The board may do any of the following:381

       (1) Investigate complaints concerning emergency medical 382
services and emergency medical service organizations as it 383
determines necessary;384

       (2) Enter into reciprocal agreements with other states that 385
have standards for accreditation of emergency medical services 386
training programs and for certification of first responders, 387
EMTs-basic, EMTs-I, paramedics, firefighters, or fire safety 388
inspectors that are substantially similar to those established 389
under this chapter and the rules adopted under it;390

       (3) Establish a statewide public information system and 391
public education programs regarding emergency medical services;392

       (4) Establish an injury prevention program.393

       Sec. 4765.16.  (A) All courses offered through an emergency 394
medical services training program or an emergency medical services 395
continuing education program, other than ambulance driving, shall 396
be developed under the direction of a physician who specializes in 397
emergency medicine. Each course that deals with trauma care shall 398
be developed in consultation with a physician who specializes in 399
trauma surgery. Except as specified by the state board of 400
emergency medical services pursuant to rules adopted under section 401
4765.11 of the Revised Code, each course offered through a 402
training program or continuing education program shall be taught 403
by a person who holds the appropriate certificate to teach issued 404
under section 4765.23 of the Revised Code.405

       (B) A training program for first responders shall meet the 406
standards established in rules adopted by the board under section 407
4765.11 of the Revised Code. The program shall include courses408
training in both of the following areas for at least the number of 409
hours established by the board's rules:410

       (1) Emergency victim care;411

       (2) Reading and interpreting a trauma victim's vital signs.412

       (C) A training program for emergency medical 413
technicians-basic shall meet the standards established in rules 414
adopted by the board under section 4765.11 of the Revised Code. 415
The program shall include coursestraining in each of the 416
following areas for at least the number of hours established by 417
the board's rules:418

       (1) Emergency victim care;419

       (2) Reading and interpreting a trauma victim's vital signs;420

       (3) Triage protocols for adult and pediatric trauma victims;421

       (4) In-hospital training;422

       (5) Clinical training;423

       (6) Training as an ambulance driver;424

       (7) Training in the assessment and treatment of stroke 425
patients.426

       Each operator of a training program for emergency medical 427
technicians-basic shall allow any pupil in the twelfth grade in a 428
secondary school who is at least seventeen years old and who 429
otherwise meets the requirements for admission into such a 430
training program to be admitted to and complete the program and, 431
as part of the training, to ride in an ambulance with emergency 432
medical technicians-basic, emergency medical 433
technicians-intermediate, and emergency medical 434
technicians-paramedic. Each emergency medical service organization 435
shall allow pupils participating in training programs to ride in 436
an ambulance with emergency medical technicians-basic, advanced 437
emergency medical technicians-intermediate, and emergency medical 438
technicians-paramedic.439

       (D) A training program for emergency medical 440
technicians-intermediate shall meet the standards established in 441
rules adopted by the board under section 4765.11 of the Revised 442
Code. The program shall include, or require as a prerequisite, the 443
training specified in division (C) of this section and courses444
training in each of the following areas for at least the number of 445
hours established by the board's rules:446

       (1) Recognizing symptoms of life-threatening allergic 447
reactions and in calculating proper dosage levels and 448
administering injections of epinephrine to persons who suffer 449
life-threatening allergic reactions, conducted in accordance with 450
rules adopted by the board under section 4765.11 of the Revised 451
Code;452

       (2) Venous access procedures;453

       (3) Cardiac monitoring and electrical interventions to 454
support or correct the cardiac function.455

       (E) A training program for emergency medical 456
technicians-paramedic shall meet the standards established in 457
rules adopted by the board under section 4765.11 of the Revised 458
Code. The program shall include, or require as a prerequisite, the 459
training specified in divisions (C) and (D) of this section and 460
coursestraining in each of the following areas for at least the 461
number of hours established by the board's rules:462

       (1) Medical terminology;463

       (2) Venous access procedures;464

       (3) Airway procedures;465

       (4) Patient assessment and triage;466

       (5) Acute cardiac care, including administration of 467
parenteral injections, electrical interventions, and other 468
emergency medical services;469

       (6) Emergency and trauma victim care beyond that required 470
under division (C) of this section;471

       (7) Clinical training beyond that required under division (C) 472
of this section.473

       (F) A continuing education program for first responders, 474
EMTs-basic, EMTs-I, or paramedics shall meet the standards 475
established in rules adopted by the board under section 4765.11 of 476
the Revised Code. A continuing education program shall include 477
instruction and training in subjects established by the board's 478
rules for at least the number of hours established by the board's 479
rules.480

       Sec. 4765.40.  (A)(1) Not later than two years after the 481
effective date of this amendment, theThe state board of emergency 482
medical services shall adopt rules under section 4765.11 of the 483
Revised Code establishing written protocols for the triage of 484
adult and pediatric trauma victims. The rules shall define adult 485
and pediatric trauma in a manner that is consistent with section 486
4765.01 of the Revised Code, minimizes overtriage and undertriage, 487
and emphasizes the special needs of pediatric and geriatric trauma 488
patients.489

       (2) The state triage protocols adopted under division (A) of 490
this section shall require a trauma victim to be transported 491
directly to an adult or pediatric trauma center that is qualified 492
to provide appropriate adult or pediatric trauma care, unless one 493
or more of the following exceptions applies:494

       (a) It is medically necessary to transport the victim to 495
another hospital for initial assessment and stabilization before 496
transfer to an adult or pediatric trauma center;497

       (b) It is unsafe or medically inappropriate to transport the 498
victim directly to an adult or pediatric trauma center due to 499
adverse weather or ground conditions or excessive transport time;500

       (c) Transporting the victim to an adult or pediatric trauma 501
center would cause a shortage of local emergency medical service 502
resources;503

       (d) No appropriate adult or pediatric trauma center is able 504
to receive and provide adult or pediatric trauma care to the 505
trauma victim without undue delay;506

       (e) Before transport of a patient begins, the patient 507
requests to be taken to a particular hospital that is not a trauma 508
center or, if the patient is less than eighteen years of age or is 509
not able to communicate, such a request is made by an adult member 510
of the patient's family or a legal representative of the patient;511

       (f) The victim is subject to the transportation requirements 512
of the standardized stroke assessment and protocol tool 513
established under section 4765.44 of the Revised Code.514

       (3)(a) The state triage protocols adopted under division (A) 515
of this section shall require trauma patients to be transported to 516
an adult or pediatric trauma center that is able to provide 517
appropriate adult or pediatric trauma care, but shall not require 518
a trauma patient to be transported to a particular trauma center. 519
The state triage protocols shall establish one or more procedures 520
for evaluating whether an injury victim requires or would benefit 521
from adult or pediatric trauma care, which procedures shall be 522
applied by emergency medical service personnel based on the 523
patient's medical needs. In developing state trauma triage 524
protocols, the board shall consider relevant model triage rules 525
and shall consult with the commission on minority health, regional 526
directors, regional physician advisory boards, and appropriate 527
medical, hospital, and emergency medical service organizations.528

       (b) Before the joint committee on agency rule review 529
considers state triage protocols for trauma victims proposed by 530
the state board of emergency medical services, or amendments 531
thereto, the board shall send a copy of the proposal to the Ohio 532
chapter of the American college of emergency physicians, the Ohio 533
chapter of the American college of surgeons, the Ohio chapter of 534
the American academy of pediatrics, OHA: the association for 535
hospitals and health systems, the Ohio osteopathic association, 536
and the association of Ohio children's hospitals and shall hold a 537
public hearing at which it must consider the appropriateness of 538
the protocols to minimize overtriage and undertriage of trauma 539
victims.540

       (c) The board shall provide copies of the state triage 541
protocols, and amendments to the protocols, to each emergency 542
medical service organization, regional director, regional 543
physician advisory board, certified emergency medical service 544
instructor, and person who regularly provides medical direction to 545
emergency medical service personnel in the state; to each medical 546
service organization in other jurisdictions that regularly provide 547
emergency medical services in this state; and to others upon 548
request.549

       (B)(1) The state board of emergency medical services shall 550
approve regional protocols for the triage of adult and pediatric 551
trauma victims, and amendments to such protocols, that are 552
submitted to the board as provided in division (B)(2) of this 553
section and provide a level of adult and pediatric trauma care 554
comparable to the state triage protocols adopted under division 555
(A) of this section. The board shall not otherwise approve 556
regional triage protocols for trauma victims. The board shall not 557
approve regional triage protocols for regions that overlap and 558
shall resolve any such disputes by apportioning the overlapping 559
territory among appropriate regions in a manner that best serves 560
the medical needs of the residents of that territory. The trauma 561
committee of the board shall have reasonable opportunity to review 562
and comment on regional triage protocols and amendments to such 563
protocols before the board approves or disapproves them.564

       (2) Regional protocols for the triage of adult and pediatric 565
trauma victims, and amendments to such protocols, shall be 566
submitted in writing to the state board of emergency medical 567
services by the regional physician advisory board or regional 568
director, as appropriate, that serves a majority of the population 569
in the region in which the protocols apply. Prior to submitting 570
regional triage protocols, or an amendment to such protocols, to 571
the state board of emergency medical services, a regional 572
physician advisory board or regional director shall consult with 573
each of the following that regularly serves the region in which 574
the protocols apply:575

       (a) Other regional physician advisory boards and regional 576
directors;577

       (b) Hospitals that operate an emergency facility;578

       (c) Adult and pediatric trauma centers;579

       (d) Professional societies of physicians who specialize in 580
adult or pediatric emergency medicine or adult or pediatric trauma 581
surgery;582

       (e) Professional societies of nurses who specialize in adult 583
or pediatric emergency nursing or adult or pediatric trauma 584
surgery;585

       (f) Professional associations or labor organizations of 586
emergency medical service personnel;587

       (g) Emergency medical service organizations and medical 588
directors of such organizations;589

       (h) Certified emergency medical service instructors.590

       (3) Regional protocols for the triage of adult and pediatric 591
trauma victims approved under division (B)(2) of this section 592
shall require patients to be transported to a trauma center that 593
is able to provide an appropriate level of adult or pediatric 594
trauma care; shall not discriminate among trauma centers for 595
reasons not related to a patient's medical needs; shall seek to 596
minimize undertriage and overtriage; may include any of the 597
exceptions in division (A)(2) of this section; and supersede the 598
state triage protocols adopted under division (A) of this section 599
in the region in which the regional protocols apply.600

       (4) Upon approval of regional protocols for the triage of 601
adult and pediatric trauma victims under division (B)(2) of this 602
section, or an amendment to such protocols, the state board of 603
emergency medical services shall provide written notice of the 604
approval and a copy of the protocols or amendment to each entity 605
in the region in which the protocols apply to which the board is 606
required to send a copy of the state triage protocols adopted 607
under division (A) of this section.608

       (C)(1) The state board of emergency medical services shall 609
review the state triage protocols adopted under division (A) of 610
this section at least every three years to determine if they are 611
causing overtriage or undertriage of trauma patients, and shall 612
modify them as necessary to minimize overtriage and undertriage.613

       (2) Each regional physician advisory board or regional 614
director that has had regional triage protocols approved under 615
division (B)(2) of this section shall review the protocols at 616
least every three years to determine if they are causing 617
overtriage or undertriage of trauma patients and shall submit an 618
appropriate amendment to the state board, as provided in division 619
(B) of this section, as necessary to minimize overtriage and 620
undertriage. The state board shall approve the amendment if it 621
will reduce overtriage or undertriage while complying with 622
division (B) of this section, and shall not otherwise approve the 623
amendment.624

       (D) No provider of emergency medical services or person who 625
provides medical direction to emergency medical service personnel 626
in this state shall fail to comply with the state triage protocols 627
adopted under division (A) of this section or applicable regional 628
triage protocols approved under division (B)(2) of this section.629

       (E) The state board of emergency medical services shall adopt 630
rules under section 4765.11 of the Revised Code that provide for 631
enforcement of the state triage protocols adopted under division 632
(A) of this section and regional triage protocols approved under 633
division (B)(2) of this section, and for education regarding those 634
protocols for emergency medical service organizations and 635
personnel, regional directors and regional physician advisory 636
boards, emergency medical service instructors, and persons who 637
regularly provide medical direction to emergency medical service 638
personnel in this state.639

       Sec. 4765.44.  (A) The state board of emergency medical 640
services shall establish a standardized stroke assessment and 641
protocol tool. The board shall update the standardized tool at 642
intervals the board considers necessary.643

       The standardized tool shall be established, and any updates 644
made, in consultation with the department of health and hospitals 645
that are recognized under section 3727.11 of the Revised Code as 646
primary stroke centers.647

       The standardized tool shall comply with nationally recognized 648
standards for the assessment of stroke patients.649

       (B) The board shall provide a copy of the standardized tool 650
to the medical director and cooperating physician advisory board 651
of each emergency medical service organization, and to each 652
emergency medical technician-basic, emergency medical 653
technician-intermediate, and emergency medical 654
technician-paramedic. The copy may be provided electronically or 655
by any other means.656

       An EMT-basic, EMT-I, or paramedic shall perform emergency 657
medical services the EMT-basic, EMT-I, or paramedic is authorized 658
to provide in accordance with the stroke assessment and protocol 659
tool.660

       (C) The board may adopt rules under section 4765.11 of the 661
Revised Code as the board considers necessary for the 662
implementation and administration of this section.663

       Sec. 4765.45.  The state board of emergency medical services, 664
in consultation with the stroke system of care task force created 665
under section 3701.90 of the Revised Code, shall establish 666
prehospital care protocols related to the assessment, treatment, 667
and transport of stroke patients by emergency medical 668
technicians-basic, emergency medical technicians-intermediate, and 669
paramedics in this state. The protocols shall include regional 670
transport plans for the triage and transport of stroke patients to 671
the closest, most appropriate facility.672

       Section 2.  That existing sections 3701.90, 3701.901, 673
3701.902, 3701.903, 3701.904, 3701.907, 4742.03, 4765.10, 4765.16, 674
and 4765.40 and sections 3701.905 and 3701.906 of the Revised Code 675
are hereby repealed.676

       Section 3.  With respect to the implementation of this act, 677
all of the following apply:678

       (A) The initial rules for implementation of a stroke data 679
registry under section 3701.908 of the Revised Code, as enacted by 680
this act, shall be adopted by the Department of Health not later 681
than one year after the effective date of this act.682

       (B)(1) The Stroke System of Care Task Force's initial 683
recommendations under section 3701.909 of the Revised Code, as 684
enacted by this act, for establishment of a statewide system for 685
stroke response and treatment shall be submitted to the 686
Department, Governor, and General Assembly not later than one year 687
after the effective date of this act.688

       (2) The rules for implementation and administration of 689
section 3701.909 of the Revised Code, as enacted by this act, 690
shall be adopted by the Department not later than one year after 691
it receives the Task Force's initial recommendations.692

       (3) The Task Force shall issue its first update of its 693
recommendations regarding the statewide system for stroke response 694
and treatment not later than two years after it issues its initial 695
recommendations.696

       (C)(1) Not later than December 1, 2012, the Department shall 697
implement the system for recognition of hospitals as primary 698
stroke centers required by section 3727.11 of the Revised Code, as 699
enacted by this act, compile the first list of recognized primary 700
stroke centers as required by that section, and post the list on 701
the Department's internet web site as required by section 3701.909 702
of the Revised Code, as enacted by this act.703

       (2) Until the Department of Health has implemented section 704
3727.11 of the Revised Code, as enacted by this act, any provision 705
of this act that requires consultation with hospitals recognized 706
under that section as primary stroke centers is deemed to refer to 707
any hospital that holds current, valid certification or 708
accreditation as a primary stroke center from the Joint Commission 709
or the Healthcare Facilities Accreditation Program.710

       (D) Not later than one year after the effective date of this 711
act, the State Board of Emergency Medical Services shall establish 712
the initial standardized stroke assessment and protocol tool, as 713
required by section 4765.44 of the Revised Code, as enacted by 714
this act.715