To amend sections 4742.03, 4765.10, 4765.16, and 4765.40 and to enact sections 3701.908, 3701.909, 3701.9010, 3727.11, and 4765.44 of the Revised Code to provide for designation of hospital primary stroke centers and establishment of protocols for emergency triage, treatment, and transport of stroke patients.

Section 1. That sections 4742.03, 4765.10, 4765.16, and 4765.40 be amended and sections 3701.908, 3701.909, 3701.9010, 3727.11, and 4765.44 of the Revised Code be enacted to read as follows:

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

(B) The department of health shall maintain a stroke care database and compile, evaluate, and disseminate statistics on stroke treatment and treatment results in this state. The performance metrics used for the database shall be consistent with those developed and approved by the American heart association, centers for disease control and prevention, and the joint commission. The department shall use the "get with the guidelines" stroke program capacity assessment tool for the evaluation of any data collected in the database or a similar assessment tool if that assessment tool ceases to be available.

(C) To the extent possible, the department shall do all of the following in completing its duties under division (B) of this section:

(1) Coordinate with the council of stroke prevention and education established under section 3701.90 of the Revised Code and national voluntary health organizations involved in stroke treatment quality improvement to avoid duplication and redundancy of data collection and evaluation;

(2) Encourage hospitals and emergency medical service organizations to share data and methods on ways to improve the quality of care provided to stroke patients;

(3) Facilitate the analysis of stroke care treatment and communication of treatment results among hospitals and emergency medical service organizations.

(D) Each hospital and each emergency medical service organization shall provide to the department of health data requested by the department on the treatment of stroke patients served by the hospital or emergency medical service organization. This data is not a public record under section 149.43 of the Revised Code but may be released in analytical or statistical form.

(E) Not later than June 1, 2012, and each first day of June thereafter, the department of health shall release a report summarizing the data in the database established under division (B) of this section. The report shall be submitted to the speaker of the house of representatives, president of the senate, and governor. The report shall also be posted on the department's web site.

Sec. 3701.909.  The department of health shall approve a stroke assessment and protocol tool submitted for the purposes described in division (C) of section 4765.44 of the Revised Code if the assessment and protocol tool meets the requirements of division (B) of that section.

Sec. 3701.9010.  (A) There is hereby established the stroke system of care task force. The task force shall make recommendations in accordance with division (D) of this section regarding the establishment of an effective system of stroke care, paying particular attention to the establishment of an effective system in the rural areas of the state.

(B) The task force shall be composed of the following individuals, who shall be appointed to the task force not later than the effective date of this section:

(1) The director of health;

(2) The director of the department of public safety, or the director's designee;

(3) A representative of the American stroke association appointed by the American stroke association;

(4) Two representatives of hospitals that, on the effective date of this section, hold certificates of distinction for primary stroke centers issued by the joint commission, appointed by the director of health;

(5) Two representatives of hospitals, one of which shall be a hospital located in a rural county, appointed by the Ohio hospital association;

(6) Three physicians, two appointed by the Ohio state medical association and one by the national association of EMS physicians;

(7) Two representatives of emergency medical service providers, appointed by the Ohio association of emergency medical services.

(C) Vacancies shall be filled in the manner provided for original appointments. Members of the task force shall serve without compensation, except to the extent that serving on the task force is part of their regular duties of employment, but shall be reimbursed for their actual and necessary expenses.

The department of health shall provide administrative support to the task force.

(D) Not later than six months after the effective date of this section, the task force shall submit recommendations to the department of health on the establishment of an effective stroke system of care in this state. The task force may consult with the council on stroke prevention and education, established under section 3701.90 of the Revised Code. The recommendations shall include all of the following:

(1) Protocols for triage, stabilization, and appropriate routing of stroke patients by emergency medical service providers, including protocols for rural areas of the state;

(2) Procedures for coordination and communication between hospitals designated primary stroke centers under section 3727.11 of the Revised Code and hospitals not so designated;

(3) Support services necessary to ensure that all residents of this state have access to effective and efficient stroke care.

On submission of its recommendations, the task force is abolished.

(E) Not later than six months after the task force submits its recommendations under division (D) of this section, the department of health shall adopt, in accordance with Chapter 119. of the Revised Code, rules that implement the recommendations.

Sec. 3727.11.  (A) The department of health shall designate as a primary stroke center any hospital that meets all of the following criteria:

(1) Holds a certificate of distinction for primary stroke centers issued by the joint commission;

(2) Maintains the requirements for certification;

(3) Cooperates with the state board of emergency medical services in the establishment of protocols for assessment, treatment, and transport of stroke patients in accordance with the stroke assessment and protocol tool established under section 4765.44 of the Revised Code.

(B) A hospital shall not use the term "primary stroke center" or otherwise hold itself out as a primary stroke center unless it has been designated as such under division (A) of this section.

(C) In accordance with the notice and hearing requirements of Chapter 119. of the Revised Code, the department may suspend or revoke a hospital's designation as a primary stroke center if the department determines that the hospital no longer meets all the criteria of division (A) of this section.

(D) Not later than June 1, 2011, and every June 1 thereafter, the department shall compile and send to each hospital and the medical director and cooperating physician advisory board of each emergency medical service organization, as defined in section 4765.01 of the Revised Code, a list of hospitals designated primary stroke centers under this section. The department shall post the list on its web site.

(E) Nothing in this section shall limit or prohibit the services provided by a hospital if that hospital is authorized to provide such services.

(F) The department may adopt rules for administration of this section. Any such rules shall be adopted under Chapter 119. of the Revised Code.

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

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

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

(a) The role of the emergency service telecommunicator;

(b) Effective communication skills;

(c) Emergency service telecommunicator liability;

(d) Telephone techniques;

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

(f) Handling hysterical and suicidal callers;

(g) Law enforcement terminology;

(h) Fire service terminology;

(i) Emergency medical service terminology;

(j) Emergency call processing guides for law enforcement;

(k) Emergency call processing guides for fire service;

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

(m) Radio broadcast techniques;

(n) Disaster planning;

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

(p) Assessment and treatment of stroke patients.

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

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

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

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

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

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

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

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

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

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

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

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

(9) Post all of the following on the board's web site:

(a) A list of the hospitals designated as primary stroke centers by the department of health under section 3727.11 of the Revised Code;

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

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

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

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

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

(4) Establish an injury prevention program.

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

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

(1) Emergency victim care;

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

(3) Assessment and treatment of stroke patients.

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

(1) Emergency victim care;

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

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

(4) In-hospital training;

(5) Clinical training;

(6) Training as an ambulance driver;

(7) Assessment and treatment of stroke patients.

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

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

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

(2) Venous access procedures;

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

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

(1) Medical terminology;

(2) Venous access procedures;

(3) Airway procedures;

(4) Patient assessment and triage;

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

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

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

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

Sec. 4765.40.  (A)(1) Not later than two years after the effective date of this amendment November 3, 2000, the state board of emergency medical services shall adopt rules under section 4765.11 of the Revised Code establishing written protocols for the triage of adult and pediatric trauma victims. The rules shall define adult and pediatric trauma in a manner that is consistent with section 4765.01 of the Revised Code, minimizes overtriage and undertriage, and emphasizes the special needs of pediatric and geriatric trauma patients.

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

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

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

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

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

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

(f) The victim is subject to the transportation requirements of the stroke assessment and protocol tool adopted under section 4765.44 of the Revised Code.

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

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

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

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

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

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

(b) Hospitals that operate an emergency facility;

(c) Adult and pediatric trauma centers;

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

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

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

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

(h) Certified emergency medical service instructors.

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

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

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

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

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

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

Sec. 4765.44.  (A) As used in this section, "primary stroke center" means a hospital designated by the department of health as a primary stroke center under section 3727.11 of the Revised Code, or, if no hospitals have been designated under that section, a hospital that holds a certificate of distinction for primary stroke centers issued by the joint commission.

(B) Not later than six months after the effective date of this section, the state board of emergency medical services, in cooperation with the department of health and primary stroke centers, shall establish a stroke assessment and protocol tool. The tool shall:

(1) Comply with nationally recognized standards for the assessment of stroke patients;

(2) Detail the best practices for the assessment, treatment, and transport of stroke patients by an emergency medical technician-basic, emergency medical technician-intermediate, or paramedic;

(3) Establish regional plans for triage and transport of stroke patients to the closest primary stroke centers, that can be reached in not more than sixty minutes.

(C) The board shall provide a copy of the stroke assessment and protocol tool established under division (B) of this section to the medical director and cooperating physician advisory board of each emergency medical service organization, and to each EMT-basic, EMT-I, and paramedic. An EMT-basic, EMT-I, or paramedic shall perform emergency medical services the EMT-basic, EMT-I, or paramedic is authorized to provide in accordance with the stroke assessment and protocol tool or with a stroke assessment and protocol tool approved by the department of health under section 3701.909 of the Revised Code that meets the requirements of division (B) of this section.

(D) The board and the department of health shall post the assessment and protocol tool on their web sites.

(E) The board may adopt rules necessary for administration of this section. The rules shall be adopted under Chapter 119. of the Revised Code.

Section 2.  That existing sections 4742.03, 4765.10, 4765.16, and 4765.40 of the Revised Code are hereby repealed.