Trauma Care System.  The Department of Health (DOH) oversees the state emergency medical services and trauma care system along with regional emergency medical services and trauma care councils.  DOH has established minimum standards for level I, II, III, IV, and V trauma care services.  A facility wishing to be authorized to provide such services must request an appropriate designation from DOH.
 
The Emergency Medical Services and Trauma Care Steering Committee (Steering Committee) advises DOH regarding emergency medical services and trauma care needs, reviews regional emergency medical services and trauma care plans, recommends changes to DOH before it adopts the plans, and reviews and recommends modification to administrative rules for emergency services and trauma care.

In 2006, the Steering Committee created an Emergency Cardiac and Stroke Work Group (Work Group) to evaluate and make recommendations regarding emergency cardiac and stroke care in Washington.  In 2008, the Work Group issued a report containing recommendations including the establishment of a statewide comprehensive and coordinated system of cardiac and stroke care that includes prevention and public education, data collection, standards for prehospital, hospital, and rehabilitative care, and verification of hospital capabilities.
 
The Emergency Cardiac and Stroke Care System.  DOH must endeavor to enhance and support an emergency cardiac and stroke care system through:

• encouraging medical hospitals to voluntarily self-identify cardiac and stroke capabilities, indicating which level of cardiac and stroke service the hospital provides;
• giving a hospital deemed status and designating it as a primary stroke center if it holds a certification of distinction for primary stroke centers issued by the Joint Commission; and
• adopting cardiac and stroke prehospital patient care protocols, patient care procedures, and triage tools, consistent with the guiding principles and recommendations of the Work Group.

 
A hospital in the system must participate in:

• quality improvement activities; and
• a national, state, or local data collection system that measures cardiac and stroke system performance from patient onset of symptoms to treatment or intervention.

DOH must contract with an independent party for an evaluation of the state's current system response for cardiac and stroke emergencies and submit a report of findings and recommendations to the Legislature by October 1, 2023.  The evaluation must contain:

• an assessment of the existing system of care for cardiac and stroke care delivery;
• an analysis of the current state of quality data collection, its deficiencies, the reasons for deficiencies, and the feasibility and value of registries to monitor and improve cardiac and stroke care and outcomes;
• an analysis of potential benefits of establishing a statewide cardiac and stroke steering committee to monitor the provision of cardiac and stroke care and prioritize improvement initiatives; and
• recommendations to support a cardiac and stroke care system for Washington State.

 
The assessment of the existing system of care for cardiac and stroke care delivery must consider a review of the emergency medical system; current gaps in resources such as equipment and training for emergency medical service providers; and hospital and system capacity including treatment resource availability with particular attention to critical access and rural hospitals.

 
DOH must seek input and guidance from representatives of the following groups:

• a statewide medical association;
• a statewide organization of emergency physicians;
• a statewide hospital association;
• a representative of critical access hospitals;
• a statewide for-profit ambulance association;
• a statewide public emergency medical response organization;
• county and city governments actively engaged in providing emergency response;
• the American Heart Association; and
• the emergency cardiac and stroke technical advisory committee.

PRO:  Timely coordinated experts response can mean the difference between life and death.  This bill provides a critical needs assessment of our state wide emergency stroke and cardiac care system and it is an important step to ensure a strong and dedicated response for statewide cardiac and stroke.  Currently, there is no well-coordinated system of care and no clear understanding of gaps in services or resources.  We need to have personnel that are trained and well-equipped.  We need to know the best practices for treating patients and which hospital to transport the patient.  This bill will give us the information needed to help improve our stroke and cardiac care system and to understand our strengths and weaknesses.
 
OTHER:  Heart disease and stroke are the leading cause of mortality in Washington State.  This bill would aid our ability to understand how we can improve as a system for cardiac and stroke care here in Washington.  A comprehensive assessment will provide the state with a roadmap for the infrastructure and investment needed to improve care.  There are some concerns that the data collection and submission may present significant challenges to rural hospitals.  A full evaluation of the cost and opportunities will allow the state to better target and identify gaps in our system.