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H. B. No. 427 As IntroducedAs Introduced
129th General Assembly | Regular Session | 2011-2012 |
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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,
3701.903, 3701.904, 3701.907, 4742.03, 4765.10,
4765.16, and 4765.40; to enact sections 3701.908,
3701.909, 3727.11, 3727.111, 4765.44, and 4765.45;
and to repeal sections 3701.905 and 3701.906 of
the Revised Code to replace the Council on Stroke
Prevention and Education with the Stroke System of
Care Task Force; to provide for state recognition
of hospitals that are primary stroke centers; to
require establishment of protocols for emergency
triage, treatment, and transport of stroke
patients; and to require the Department of Health
to maintain a stroke data registry and a statewide
system for stroke response and treatment.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 3701.90, 3701.901, 3701.902,
3701.903, 3701.904, 3701.907, 4742.03, 4765.10, 4765.16, and
4765.40 be amended and sections 3701.908, 3701.909, 3727.11,
3727.111, 4765.44, and 4765.45 of the Revised Code be enacted to
read as follows:
Sec. 3701.90. There is hereby created in the department of
health the council on stroke prevention and education stroke
system of care task force to address matters of triage, treatment,
and transport of patients who may experience acute stroke. The
department shall, to the extent funds are available, provide
office space and staff assistance for the council task force.
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.
(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 stroke system of care task
force. The task force shall include all of the following:
(1) Representatives from the department of health;
(2) Representatives from the state board of emergency medical
services;
(3) Representatives from the American stroke association;
(4) Representatives from primary stroke centers;
(5) Representatives from rural hospitals;
(6) Persons
who are authorized under Chapter 4731. of the
Revised Code to practice medicine and surgery or osteopathic
medicine and surgery;
(7) Providers of emergency medical services, as defined in
section 4765.01 of the Revised Code.
(C)(B) The director of health shall appoint the chair
chairperson and
vice-chair vice-chairperson of the council task
force from among its members.
Sec. 3701.902. Members of the council on stroke prevention
and education stroke system of care task force shall serve without
compensation, but shall, to the extent funds are available, be
reimbursed by the department of health for the actual and
necessary expenses they incur in the performance of their official
duties. A member may serve until a replacement is appointed by the
director of health. Replacement members shall be appointed in the
same manner as the initial members.
Sec. 3701.903. (A) The council on stroke prevention and
education stroke system of care task force 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 information and methods of improving
the quality of care provided to stroke patients;
(2) Facilitate the analysis of stroke treatment and
coordination of care;
(3) Facilitate the communication of treatment results among
hospitals and emergency medical service organizations;
(4) Advise the department of health on the collection of
information that would assist in development of an effective
system of stroke care in this state;
(5) Take other actions consistent with the purpose of the
council task force 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 task force 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 task force available to the public and
disseminate to the appropriate persons the recommendations
developed or compiled by the council task force.
Sec. 3701.904. (A) The council on stroke prevention and
education stroke system of care task force shall meet at the call
of the chair to conduct its official business.
(B) A majority of the voting members of the
council
task
force constitutes a quorum. The council task force may take action
only by affirmative vote of a majority of a quorum.
Sec. 3701.907. The council on stroke prevention and
education stroke system of care task force is
exempt from the
requirements of section 101.84 not subject to sections 101.82 to
101.87 of the Revised Code.
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)(1) Each of the following entities shall provide to the
department of health information requested by the department on
the treatment of stroke patients served by the entity:
(a) A hospital recognized under section 3727.11 of the
Revised Code as a primary stroke center;
(b) A hospital recognized under section 3727.111 of the
Revised Code as an acute stroke-capable center, if the department
has implemented a recognition system under that section;
(c) A hospital other than a hospital described in division
(B)(1)(a) or (b) of this section;
(d) An emergency medical service organization;
(e) Any other entity from which the department requests
information regarding the treatment of stroke patients served by
the entity.
(2) The requested information shall be provided in a manner
that aligns with the stroke consensus metrics developed and
approved by the American heart association, American stroke
association, the United States centers for disease control and
prevention, and the joint commission.
(3) To the greatest extent possible, the department shall
coordinate with national voluntary health organizations involved
in stroke quality improvement to avoid duplication and redundancy
in the collection of the information.
(C) The department shall develop and maintain a stroke data
registry and include in the registry the information collected
under division (B) of this section. The registry shall be
developed and maintained by using the stroke registry guidelines
established by either of the following:
(1) The American heart association;
(2) Another organization acceptable to the department that
has established stroke registry guidelines with standards for
maintaining confidentiality of information that are no less secure
than the confidentiality standards included in the American heart
association's guidelines.
(D) Information provided or maintained under this section
that is protected health information pursuant to section 3701.17
of the Revised Code shall be released only in accordance with that
section. Information that does not identify an individual may be
released in summary, statistical, or aggregate form.
(E) The department shall adopt rules as it considers
necessary to implement and administer this section. The rules
shall be adopted in accordance with Chapter 119. of the Revised
Code.
Sec. 3701.909. (A) As used in this section, "telemedicine
services" means the delivery of health care services through the
use of interactive audio, video, and other electronic media used
for the purpose of diagnosis, consultation, or treatment of acute
stroke.
(B)(1) The stroke system of care task force shall develop
recommendations regarding the establishment under this section of
a statewide system for stroke response and treatment. The task
force shall update its recommendations at least every two years.
In developing its recommendations, the task force shall pay
particular attention to the establishment of an effective system
for stroke response and treatment in the rural areas of the state.
The recommendations shall be developed in consultation with the
state board of emergency medical services.
(2) The task force's recommendations shall include all of the
following:
(a) Procedures for coordination and communication between
hospitals that are recognized under section 3727.11 of the Revised
Code as primary stroke centers and hospitals that are not
recognized as primary stroke centers;
(b) A plan for achieving continuous improvement in the
quality of care provided under the statewide system for stroke
response and treatment established under division (C) of this
section;
(c) Strategies for use of telemedicine services in this state
for inter-hospital communication between hospitals that are
recognized under section 3727.11 of the Revised Code as primary
stroke centers and hospitals that are not recognized as primary
stroke centers.
(3) The task force shall submit its recommendations to the
department of health, the governor, and, in accordance with
section 101.68 of the Revised Code, the general assembly.
(C)(1) Based on the task force's recommendations, the
department shall establish a statewide system for stroke response
and treatment. The department may take any actions it considers
necessary to maintain an effective system for stroke response and
treatment in this state.
(2) As part of the system, the department shall post both of
the following on its internet web site and shall update the posted
information on at least an annual basis:
(a) The list compiled under section 3727.11 of the Revised
Code identifying the hospitals that are recognized under that
section as primary stroke centers;
(b) The standardized stroke assessment and protocol tool
established under section 4765.44 of the Revised Code.
(D) The department shall adopt rules as it considers
necessary to implement and administer this section. The rules
shall be adopted in accordance with Chapter 119. of the Revised
Code.
Sec. 3727.11. (A) The department of health shall recognize
as a primary stroke center any hospital that holds certification
or accreditation as a primary stroke center issued by any of the
following:
(1) The joint commission;
(2) The healthcare facilities accreditation program;
(3) Another entity acceptable to the department that is
nationally recognized and provides certification or accreditation
of primary stroke centers.
(B) A hospital shall not use the phrase "primary stroke
center" or otherwise hold itself out as a primary stroke center
unless it is recognized as a primary stroke center under this
section.
(C) The department may suspend or revoke its recognition of a
hospital as a primary stroke center if the department determines
that the hospital no longer holds certification or accreditation
that meets the requirements of division (A) of this section or has
not maintained the requirements to hold the certification or
accreditation. The department's action shall be taken pursuant to
an adjudication conducted in accordance with Chapter 119. of the
Revised Code.
(D) Annually, not later than the first day of December, the
department shall compile a list of hospitals recognized as primary
stroke centers.
(E) Nothing in this section limits the services provided by a
hospital, or prohibits a hospital from providing services, if that
hospital is authorized to provide such services.
(F) The department may adopt rules as necessary to implement
and administer this section. The rules shall be adopted in
accordance with Chapter 119. of the Revised Code.
Sec. 3727.111. The department of health may establish a
program for recognition of hospitals as acute stroke-capable
centers. The program shall be administered in the same manner as
the department's recognition of primary stroke centers under
section 3727.11 of the Revised Code.
The program may be established as entities acceptable to the
department begin issuing accreditation of hospitals as acute
stroke-capable centers. The department may consider an entity
acceptable only if the entity is nationally recognized and uses
evidence-based standards for issuing its accreditation.
The department may adopt rules as it considers necessary to
implement and administer this section. The rules shall be adopted
in accordance with 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;
(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 both of the following on the board's internet web
site and update the posted information on at least an annual
basis:
(a) The list compiled under section 3727.11 of the Revised
Code identifying the hospitals that are recognized under that
section as primary stroke centers;
(b) The standardized stroke assessment and protocol tool
established under section 4765.44 of the Revised Code.
(10) Not later than the first day of December each year,
provide to each emergency medical service organization an
electronic or paper copy of the information posted on the board's
web site under division (A)(9) of this section.
(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
training 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
courses training 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;
(6) Training as an ambulance driver;
(7) Training in the 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
training 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 training in each of the following areas for at least the
number of hours established by the board's rules:
(2) Venous access 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, the 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 standardized stroke assessment and protocol tool
established 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) The state board of emergency medical
services shall establish a standardized stroke assessment and
protocol tool. The board shall update the standardized tool at
intervals the board considers necessary.
The standardized tool shall be established, and any updates
made, in consultation with the department of health and hospitals
that are recognized under section 3727.11 of the Revised Code as
primary stroke centers.
The standardized tool shall comply with nationally recognized
standards for the assessment of stroke patients.
(B) The board shall provide a copy of the standardized tool
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. The copy may be provided electronically or
by any other means.
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.
(C) The board may adopt rules under section 4765.11 of the
Revised Code as the board considers necessary for the
implementation and administration of this section.
Sec. 4765.45. The state board of emergency medical services,
in consultation with the stroke system of care task force created
under section 3701.90 of the Revised Code, shall establish
prehospital care protocols related to the assessment, treatment,
and transport of stroke patients by emergency medical
technicians-basic, emergency medical technicians-intermediate, and
paramedics in this state. The protocols shall include regional
transport plans for the triage and transport of stroke patients to
the closest, most appropriate facility.
Section 2. That existing sections 3701.90, 3701.901,
3701.902, 3701.903, 3701.904, 3701.907, 4742.03, 4765.10, 4765.16,
and 4765.40 and sections 3701.905 and 3701.906 of the Revised Code
are hereby repealed.
Section 3. With respect to the implementation of this act,
all of the following apply:
(A) The initial rules for implementation of a stroke data
registry under section 3701.908 of the Revised Code, as enacted by
this act, shall be adopted by the Department of Health not later
than one year after the effective date of this act.
(B)(1) The Stroke System of Care Task Force's initial
recommendations under section 3701.909 of the Revised Code, as
enacted by this act, for establishment of a statewide system for
stroke response and treatment shall be submitted to the
Department, Governor, and General Assembly not later than one year
after the effective date of this act.
(2) The rules for implementation and administration of
section 3701.909 of the Revised Code, as enacted by this act,
shall be adopted by the Department not later than one year after
it receives the Task Force's initial recommendations.
(3) The Task Force shall issue its first update of its
recommendations regarding the statewide system for stroke response
and treatment not later than two years after it issues its initial
recommendations.
(C)(1) Not later than December 1, 2012, the Department shall
implement the system for recognition of hospitals as primary
stroke centers required by section 3727.11 of the Revised Code, as
enacted by this act, compile the first list of recognized primary
stroke centers as required by that section, and post the list on
the Department's internet web site as required by section 3701.909
of the Revised Code, as enacted by this act.
(2) Until the Department of Health has implemented section
3727.11 of the Revised Code, as enacted by this act, any provision
of this act that requires consultation with hospitals recognized
under that section as primary stroke centers is deemed to refer to
any hospital that holds current, valid certification or
accreditation as a primary stroke center from the Joint Commission
or the Healthcare Facilities Accreditation Program.
(D) Not later than one year after the effective date of this
act, the State Board of Emergency Medical Services shall establish
the initial standardized stroke assessment and protocol tool, as
required by section 4765.44 of the Revised Code, as enacted by
this act.
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