To amend sections 3701.901, 3701.903, 4742.03, 4765.10, 4765.16, and 4765.40 and to enact sections 3701.908, 3701.909, 3727.11, 4765.44, and 4765.441 of the Revised Code to provide for recognition of hospital primary stroke centers and establishment of protocols for emergency triage, treatment, and transport of stroke patients.

Section 1. That sections 3701.901, 3701.903, 4742.03, 4765.10, 4765.16, and 4765.40 be amended and sections 3701.908, 3701.909, 3727.11, 4765.44, and 4765.441 of the Revised Code be enacted to read as follows:

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

(1) Brain injury association of Ohio;

(2) Ohio academy of family physicians;

(3) American college of emergency physicians Ohio chapter;

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

(5) Ohio state neurosurgical society;

(6) Ohio heart and vascular research foundation;

(7) Ohio geriatrics society;

(8) Ohio nurses association;

(9) Ohio association of rehabilitation facilities;

(10) Ohio hospital association;

(11) Northeast Ohio stroke association;

(12) American heart association Ohio valley affiliate;

(13) American association of retired persons Ohio office;

(14) Ohio department of health;

(15) Ohio commission on minority health;

(16) Ohio state medical association;

(17) Ohio osteopathic association;

(18) Ohio physical therapy association;

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

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

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

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

(23) Cleveland clinic.

(B) The director of health shall appoint the members of the council. The director shall request from each entity listed in division (A) of this section a list of three persons qualified to serve as members of the council. In making appointments to the council, the director shall select one member from the list submitted by each entity. If the director does not receive a list from an entity not later than sixty days after making a request, the director shall appoint a member to serve as the representative of that entity. The director shall appoint as members of the council no fewer than six persons who are authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.

(C) The director of health shall appoint the chair and vice-chair of the council from among its members.

Sec. 3701.903.  (A) The council on stroke prevention and education shall, to the extent funds are available, do all of the following:

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

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

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

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

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

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

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

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

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

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

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

(8) Advise the department of health on the collection of additional data that would assist in development of an effective system of stroke care in this state;

(9) Make recommendations regarding the data on treatment of stroke patients to be provided under division (B) of section 3701.908 of the Revised Code by hospitals and emergency medical service organizations to the department of health;

(10) Make recommendations to the state board of emergency medical services in accordance with division (B)(3) of section 4765.44 of the Revised Code on choice of hospitals when a patient is transported by an emergency medical service organization;

(11) Take other actions consistent with the purpose of the council to ensure that the public and health care providers are informed with regard to the most effective treatment strategies for stroke prevention and treatment.

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

(C) The department of health shall make information developed or compiled by the council under this section available to the public and disseminate to the appropriate persons the recommendations developed or compiled by the council.

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) Each hospital and each emergency medical service organization shall, in accordance with recommendations made by the council on stroke prevention and education under section 3701.903 of the Revised Code, 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 aggregate or statistical form.

(C) Not later than June 1, 2012, and each first day of June thereafter, the department of health shall release a report summarizing the data provided 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.  (A) As used in this section:

(1) "Telestroke" means the use of interactive video conferencing technology for the purpose of expanding expertise in stroke care among an electronically integrated network of hospitals.

(2) "Primary stroke center" means a hospital recognized as a primary stroke center by the department of health under section 3727.11 of the Revised Code, or, if no hospitals have been recognized under that section, a hospital that holds a certificate of distinction for primary stroke centers issued by the joint commission or accreditation by the health care facilities accreditation program as a primary stroke center.

(3) "Hospital" means a hospital registered with the department of health under section 3701.07 of the Revised Code.

(B) The council on stroke prevention and education shall make recommendations in accordance with division (C) 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 this state.

(C) Not later than twelve months after the effective date of this section, the council on stroke prevention and education shall submit recommendations to the public health council on the establishment of an effective system of stroke care in this state. The recommendations shall be made in consultation with the department of health and the state board of emergency medical services and include all of the following:

(1) Procedures for coordination and communication between primary stroke centers and hospitals that are not primary stroke centers;

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

(3) Implementation strategies for a telestroke network in this state under which primary stroke centers communicate with hospitals that are not primary stroke centers and hospitals that are not primary stroke centers communicate with primary stroke centers;

(4) Methods to indicate whether a hospital is participating in a telestroke network.

(D) Not later than twelve months after the council on stroke prevention and education submits its recommendations under division (C) of this section, the department of health shall adopt, in accordance with Chapter 119. of the Revised Code, rules that implement those recommendations.

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

(1) Holds either of the following:

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

(b) Accreditation as a primary stroke center by the health care facilities accreditation program.

(2) Maintains the requirements for certification or accreditation;

(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 recognized 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 recognition 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 recognized as 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. The 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, at least one hour of which is in the assessment and treatment of stroke patients;

(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 recognized 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 at least one hour of training or instruction in the assessment and treatment of stroke patients and courses in both 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.

(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 at least one hour of training or instruction in the assessment and treatment of stroke patients and 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.

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:

(1) "Primary stroke center" means a hospital recognized by the department of health as a primary stroke center under section 3727.11 of the Revised Code, or, if no hospitals have been recognized under that section, a hospital that holds a certificate of distinction for primary stroke centers issued by the joint commission or accreditation by the health care facilities accreditation program as a primary stroke center.

(2) "Telestroke network" has the same meaning as in section 3701.909 of the Revised Code.

(B) Not later than twelve 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 do all of the following:

(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, in accordance with recommendations of the council on stroke prevention and education made under division (A)(10) of section 3701.903 of the Revised Code, regional plans for triage and transport of stroke patients.

(C) The regional plans established under division (B) of this section shall do both of the following:

(1) Specify the distances at which a patient is to be transported to a primary stroke center or hospital participating in a telestroke network rather than the nearest hospital;

(2) In the case of two hospitals or primary stroke centers that are within one mile of each other, provide that the preferences of the patient be followed. For patients who do not express a preference or are unable to express a preference, the plans shall provide for an equitable and sequential distribution of patients between the hospitals.

Sec. 4765.441. (A) The state board of emergency medical services shall provide a copy of the stroke assessment and protocol tool established under section 4765.44 of the Revised Code to the medical director and cooperating physician advisory board of each emergency medical service organization, and to each emergency medical technician-basic, emergency medical technician-intermediate, and emergency medical technician-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.

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

(C) The board may adopt rules necessary for administration of this section and section 4765.44 of the Revised Code. The rules shall be adopted under Chapter 119. of the Revised Code.

Section 2.  That existing sections 3701.901, 3701.903, 4742.03, 4765.10, 4765.16, and 4765.40 of the Revised Code are hereby repealed.