Legislature(2025 - 2026)ADAMS 519
04/07/2025 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Adjourn | |
| Start | |
| HB48 | |
| HB17 | |
| HB27 |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 48 | TELECONFERENCED | |
| += | HB 17 | TELECONFERENCED | |
| + | HB 27 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 27
"An Act relating to medical care for major
emergencies."
2:21:23 PM
REPRESENTATIVE GENEVIEVE MINA, SPONSOR, introduced the bill
by reading from prepared remarks:
Thank you for hearing HB 27, Major Medical Emergencies
The goal of HB 27 is to modernize Alaska's system for
Emergency Medical Services (EMS) by including strokes
and heart attacks.
Why bring the bill forward?
I introduced this in the last legislature after convos
with physicians and EMS providers who identified a gap
in Alaska's EMS system.
Background
In the 1960s, with high rates of injuries and deaths
from car accidents, public health leaders and
policymakers developed America's EMS system to focus
on pre-hospital care.
A strong EMS system, rather than just the ER care, is
important for preventing lives through the "Golden
Hour," a crucial amount of time to ensure that someone
after a traumatic injury could avoid death by getting
to the "right person, to the right place, at the right
time. As part of this movement, the state created the
Alaska Office of EMS. The office developed Alaska's
trauma system of care in the 90s by coordinating
public and private agencies, funding agencies through
pass-through grants, and developing training and
protocols.
What is a system of care?
It is creating a network for phases of stroke care
between prehospital care, transport, treatment to
home, and supporting hospitals and clinics. They also
designate certified trauma centers, ensuring that
hospitals meet state and national standards for
different levels of trauma. Modern EMS and the focus
on the "golden hour" has evolved beyond trauma.
Issue: We have no system of care for other time-
sensitive, medical emergencies, specifically strokes
and heart attacks.
In 2022, 744 Alaskans died from trauma, 217 died from
strokes, and 510 died from cardiovascular disease
(such as a heart attack). Alaska has unique challenges
in meeting "Golden Hour" due to rural Alaska and
transportation issues, and standardizing best
practices between clinics, hospitals, and EMS
providers. There are now best practices and improved
technology for STEMIs and strokes, as well as stroke
centers and STEMI centers - but no one is coordinating
Alaska's hospitals, provider organizations, and
communities on improving their care.
What does HB 27 do?
HB 27 is very straightforward: it expands the Office
of EMS' powers to replicate Alaska's trauma system of
care, allowing the office to create a system of care
for strokes and for heart attacks. Additionally, it
allows EMS to replicate trauma designation process for
strokes and STEMIs. At least 41 states have (or are
finalizing) regional or statewide protocols that
ensure patients experiencing a critical stroke such as
ELVO are transported directly to Level 1 stroke
centers.
Impacts:
The improvements in the trauma system of care reduced
transfer time to meet the "Golden Hour." It improved
outcomes where every single minute meant the
difference between walking out of the hospital the
next day or requiring 24 hour 7 day a week 24/7 care.
Other improvements on outcomes focused on data
collection and improving technology to transmit
screenings and other technology between clinics and
hospital. In addition, it will result in cost savings
for the state by ensuring people receive the right
care at the right time and preventing more drastic
health outcomes.
In Closing we cannot change when a patient arrives to
a hospital. But we can improve the workflow to
diagnose a case and make the decision-making process
more efficient. b. HB 27 updates Alaska's EMS system
and ensures that our state reflects modern EMS
standards so that Alaskans experiencing a stroke or
heart attack get to the "right person, to the right
place, at the right time.
2:26:29 PM
Co-Chair Foster wanted the committee to hear from invited
testimony.
BRIAN WEBB, SELF, ANCHORAGE, shared that he was a paramedic
for over 47 years. He related that minutes mattered for
trauma and medical emergencies and Emergency Medical
Services (EMS) mut quickly respond and determine the
correct facility to transport the patient. He pointed out
that a statewide system was lacking for medical
emergencies. There were no data registries, few facility
designations, nor standardized protocols. The bill provided
the structure necessary for better prevention, decisions,
and outcomes. Since the passage of HB-168 [Trauma Care
Centers/Fund, Chapter 98 SLA 10, 06/21/2010] in 2010, which
established trauma centers and a trauma care fund, Alaska
EMS had been better equipped to make critical transport
decisions. The results enhanced our training and skills and
enabled us to deliver trauma patients to the most
appropriate facility and saved lives. The legislation
addressed a critical gap in the treatment of major medical
emergencies, particularly heart attacks and strokes, by
offering a system of registry, standards, and voluntary
facility registration. In addition, the legislation
identified resource gaps, improved transport planning, and
opened doors for planning partnerships improving the
delivery of care by EMS. The voluntary facility designation
not only benefitted hospitals it resulted in better
outcomes and lowers death rates and disabilities. The
bill's costs were minimal compared to the long term costs
of disability and preventable deaths, which created
significant saving "downstream."
2:29:32 PM
LUCY HE, NEUROSURGEON, PROVIDENCE AND ALASKA REGIONAL
HOSPITALS, ANCHORAGE, offered her testimony. She explained
that Alaska was one of the few remaining states lacking any
funding for time sensitive emergencies. The success of such
programs elsewhere in the United States (US) with
limitations such as that existed in Alaska had been
demonstrated. The incidence of stroke in Alaska was the
same as in the Southeastern US but Alaska had very limited
resources. The resources for stroke recovery and prevention
remained significantly underfunded and the main limitation
was identifying the patients as early as possible in the
field and creating a coordinated and efficient system of
transfer. She continued that without guidance from the
Department of Health (DOH) and the resources to track the
data the state could not improve its response. She observed
that the Alaska native population was prone to aneurism
ruptures. However, there was no data regarding patient care
remaining in or leaving the state in those instances. The
state's most recent report on stroke care in Alaska was
published in 2019 referencing 2016 data. She reported that
DOH acknowledged that there was a significant gap in data.
She continued that DOH along with the Alaska Stroke
Coalition collaborated on acquiring Coverdell Grants [Paul
Coverdell Forensic Science Improvement Grants Program (the
Coverdell program)]. The grants were denied because the
state lacked a formalized system for tracking stroke care.
The state needed additional resources and funding in order
to evolve a program. She emphasized the importance of rapid
correct diagnosis and intervention due to insufficient
recovery, outpatient, and therapy resources. She offered a
statistic that by 2030 the global economic impact of
strokes would reach $1 trillion. She stressed the
importance of treatment, prevention, and decreasing stroke
risk. She urged support for the bill.
2:33:32 PM
Representative Johnson thought that the bill was a good
idea. She encouraged DOH to look to vacant positions to
reduce the cost of the bill versus adding a position. She
noted that the fiscal note added a range 20 position.
GENE WISEMAN, SECTION CHIEF, RURAL AND COMMUNITY HEALTH,
DEPARTMENT OF PUBLIC HEALTH, ANCHORAGE, asked for
Representative Johnson to repeat the question.
Representative Johnson obliged and reiterated the question.
Mr. Wiseman deferred the answer to a colleague in DOH.
Representative Mina answered that it was a good question.
She communicated that in discussions with the department,
she discovered that there was a gap in statute concerning
the state's system of care. She determined that there was a
need from the state's health professionals. She wanted to
help address filling the one position through a vacancy.
2:36:59 PM
Representative Bynum wanted a better understanding how the
bill would improve care in the state. He noted that in many
communities there were limited places where emergency
victims could go. In those instances where there was one
regional hospital, the patient would be evaluated a flown
out to another facility if necessary. He wondered how
adding a position at the state level would accomplish the
goal of the bill and inquired about the position's
workload.
Representative Mina responded that the legislation was
about improving the EMS system overall and especially for
rural communities that would benefit the most. She deferred
further answer to Mr. Webb who had worked closely with
Alaska's EMS system. She also suggested that Dr. He address
the specific gaps in stroke care and how a system of care
would benefit responders and providers. Representative
Bynum repeated the question. He was trying to understand
how creating the position would create benefits to remote
communities who were trained at the local level on
addressing strokes and heart attacks that he believed
received a "high focus" with rural responders. In addition,
was the bill focused on places with large populations in
the state.
2:41:12 PM
Mr. Wiseman replied that the position would replicate DOH's
trauma systems. He elaborated that under Rural Community
Health Systems the office of EMS and the trauma unit were
paired together. The Trauma systems unit had two employees;
one managed the Trauma Registry data base. The data base
manager convened committees of hospital subject matter
experts and from the EMS system to build the coordinated
care approach. The hospitals voluntarily entered their data
into the registry to create a statewide overview and track
patients and outcomes better. The trauma systems unit only
had two employees who were extremely busy and one
additional employee to track additional data would be
necessary. Additionally, coordinating the committees and
site visits for certification was time consuming. The
objective was to analyze the data for care coordination at
a systems of care state level approach. He emphasized the
amount of work necessary to produce a systemic change.
Representative Galvin referenced that 41 other states had
the same proposed coordinated approach. She asked how other
states approached implementing the system. She wondered
whether hospitals had a coordinated approach or if it was
truly best accomplished through the state. Representative
Mina deferred to Dr. He who had experience in setting up
the coordinated approach.
2:45:32 PM
Dr. He responded that Hawaii was the best example of an EMS
statewide system that utilized both via a Hawaii Statewide
Stroke coalition that brought together most hospital
clinicians. The state tracked stroke data in coordination
with the stroke coalition. She described why both was
necessary. She indicated that as a clinician, she and other
clinicians reviewed cases of transfers which helped to
determine the outcomes and what worked best or did not work
at one facility or another and decided who provided better
interventions for specific issues. She relayed an example
from Hawaii of coordinated state and hospital data and how
it determined the best interventions to help shorten
transport time to the right facility. She offered that the
data helped Hawaii EMS in recognizing how long transport
times were and how to shorten it. She elucidated that it
was outside Alaska hospital purview to mandate they
examine the efficiency of patient transport and would be
unable to manifest changes unless statewide protocols were
in place. She emphasized that coordination between the
state and hospitals was essential. She shared that in
states with successful EMS systems they had both a DOH
tracking system and the clinical providers that worked
together to integrate what was happening in the field and
identifying the gaps. She discussed issues with sharing
stroke imaging statewide and believed that state
involvement could help find a better solution. The success
in improving stroke care with the proposed paradigm was
dependent on the state and clinicians working together to
improve patient care and outcomes.
2:49:17 PM
Co-Chair Josephson wanted to understand the "Golden Hour"
concept better. He understood that time was of the essence
for stoke victims for the administration of reverse
clotting agents for a successful recovery. He wondered
whether part of the bill was to try to get reverse clotting
agents to people in the field in small rural areas. He
asked whether the bill only entailed coordination or would
there be a component for training and providing new medical
treatment opportunities in smaller hospitals.
Representative Mina replied that supplying clot busting
drugs and medical services was different than coordination
and providing training. She deferred the answer to Mr.
Webb.
Co-Chair Foster noted that Mr. Webb was no longer online.
Representative Mina requested hearing from Mr. Wiseman.
Mr. Wiseman asked for clarification on the question. Co-
Chair Josephson understood elements of the bill. He asked
if another element of the legislation was to get treatment
modalities in rural areas for rapid response and better
outcomes for the patient. Mr. Wiseman answered that the
golden hour timeframes were different for stroke and heart
attacks. He spoke to enhanced training for pre-hospital
providers for heart attack recognition and mitigation. He
elaborated that it was not the same for stroke, which
needed imaging to determine the cause. The statewide
coordinated training would be developed for heart attacks
and strokes to ensure the right determination under
protocol for where a patient should be sent for trauma care
and treatment. He provided an example regarding a stroke
victim in a rural community where pre-hospital providers
would determine the right hospital to medivac the patient
to.
2:55:56 PM
Co-Chair Josephson asked if the training and coordination
would be with sub-regional clinics and clinics in villages.
Mr. Wiseman responded in the affirmative. The coordinating
committees would set baseline protocols and there would be
associated training to support austere clinics in rural
settings to respond appropriately. However, he was unsure
whether a stroke patient could be handled in a community
like Dutch Harbor. He deferred further answer to Dr. He.
Dr. He relayed that she agreed with Mr. Wiseman. She shared
from personal experience that in the prior summer there
were several patients that experienced massive strokes on
cruise ships. She focused on one patient where the cruise
ship responders identified the problem and wanted to get
the patient to the closest hospital for administration of
clot busting drugs. The medication must be administered
within four and one half hours after the event. The EMS
providers on the scene recognized that the patient might
need additional intervention known as a clot retrieval,
which was only done in Anchorage. The patient was
transferred to a hospital in Southeast Alaska and received
imaging and clot busting medication in time. However, the
imaging also showed the patient was a candidate for clot
intervention. The patient had to wait for yet another
flight crew to be transferred, which led to a significant
delay. She concluded that coordinating and improving
efficient transfers and consistency of care mattered the
most utilizing the most efficient process by which to
triage and determine the appropriate facility. She noted
that the situation was a classic example and the tracked
data, if in place, could provide solutions by looking at it
in a larger context and identifying patterns. She suggested
that one solution could utilize "on hold" medivac services.
She exemplified another case where a stroke patient needing
clot intervention was transferred 3 times over 13 hours.
The delay was significant because 2 million brain cells die
per minute. Even cutting the time in half could produce a
better outcome for the patient. She emphasized that for
patients in rural areas coordination mattered much more
than in urban areas.
3:00:54 PM
Representative Stapp hypothesized a scenario where someone
had a heart attack in Unakleet and was not transferred to
Norton Sound Health Corporation in Nome but was transported
directly to Anchorage. He could not understand why someone
would be diverted to a rural health clinic prior to going
to Anchorage regarding a major medical emergency. He shared
from personal experience working with a dozen Alaska Native
health corporations that major emergencies were always
transferred directly to Anchorage due to the corporations
lacking the necessary trauma level care. He was not opposed
to the bill, but he was confused how it would achieve the
outcome because it was a voluntary program. He asked how
the program would be effective.
Representative Mina answered that it would need to be
determined which hospital to send a patient directly to
Anchorage to. If there was not a standard protocol, there
would be a great reliance on the provider in the rural
community where the emergency happened, they and might not
have the same training as a licensed EMS professional. The
standard of care helped provide more direction for rural
areas where there was no coordination to know which
specific Anchorage hospital was appropriate. Representative
Mina addressed his concerns regarding the voluntary element
of the bill. She communicated that there was difference
between each provider having its own internal protocols
versus having the providers working with each other on
where to transfer patients. She deferred to Mr. Wiseman to
speak to creating a standard system of care versus none at
all.
3:05:23 PM
Mr. Wiseman responded that the statute was set up for the
trauma system in a way the voluntary nature spoke to the
hospitals themselves.He expounded that whether they
wanted to participate and become certified as a Level IV to
Level II trauma center was a voluntary program in the
state. The department determined that carrying the same
voluntary nature to a stroke or heart attack center would
replicate for the EMS program as well. The vast majority of
hospitals had become trauma centers over the years on a
voluntary basis. The hospitals increased their in-house
training and capabilities to meet the trauma center
standard.
Representative Stapp asked Dr. He whether regional Native
Health corporations could currently treat a heart attack or
stroke. Dr. He answered that it depended. She related that
they had the diagnostic imaging capabilities and clot
busting medicines, but for higher level intervention the
patient had to be transported to Anchorage. An EKG could be
tested or sent easily but stroke imaging could not be
transferred quickly. She elaborated that the EMS crew
determined whether the patient had to transfer directly to
Anchorage, and it was not necessary for every shore
patient. Even if a facility had clot busting medications,
the patient needed to be at an ICU level of nursing care
according to current standards and had to transfer
somewhere else after they were administered the clot
busting drugs. Most of the small clinics do not have the
ability. She described further complications with strokes
and clot busting drugs and pointed to the varied issues
that arise. Representative Stapp asked who would make the
decision as to where victims were transferred. He wondered
who would have the standardized information to decide. He
experienced that currently responders erred on the side of
caution and sent the patient directly to a major hospital.
Dr. He responded that the EMS first responder would be the
most appropriate person to make the call. She furthered
that other symptoms make it difficult to delineate a stroke
in the field, like hallucinations making appear it was
substance issues. Therefore, training and resources for
pre-hospital staff would be very helpful. Lacking the
tracking data regarding patients with strokes, gaps could
be identified and more efficient decisions regarding care
could be made.
3:12:24 PM
Representative Stapp asked if the data would be available
after the fact through the Heath Information Exchange (HIE)
after the fact. DR. He responded in the negative.
Mr. Wiseman reviewed the published fiscal impact note from
DOH (FN 1(DOH) appropriated to Public Health for Emergency
Response. He reported that the $240.6 thousand was to
accomplish the objectives of the bill that would require
one additional full time position in the trauma systems
unit within the Division of Public Health. The position
would support coordination of multiple stakeholder
committees to build a process. Additionally, funding for
(Information Technology) IT systems enhancements will be
required to implement tracking and reporting of heart
attack and stroke.
Co-Chair Foster interjected that the fund sources were;
Federal Receipts at $28.9 thousand and G/F match in UGF was
$211.7 totaling $240.6 thousand.
Representative Bynum described that in Southeast Alaska a
patient requiring major medical care was automatically
flown out. He voiced that there were already systems in
place that accomplished getting someone to care. He asked
what the reach of regulatory components would be given the
fact that the healthcare institutions were already heavily
regulated. He cited AS 18.08.200 (14) and noted that it
currently read, "immediate medical surgical intervention or
treatment to prevent death or permanent disability." He
inquired how the current definition did not meet the
requirement for heart attack or stroke.
Representative Mina replied that there was a difference
between regulations and creating guidance and protocols for
the best standards of care for the state's EMS system. She
voiced that the authority for DOH to create the standard of
care would not exist without the inclusion of heart attack
or stroke in the definition in statute. She deferred to Mr.
Wiseman to speak to the current authority of the Office of
EMS and haw it related to regulations for healthcare
facilities and why the current statute did not include
heart attack or stroke.
3:18:15 PM
Mr. Wiseman answered that in the current statute AS 18.08
related to EMS and trauma care. He indicated that trauma
care was added in 2010, because a system of care needed to
be developed and focus on a system of care. It gave the
department a higher level of authority to focus on the
issue of trauma care systems. He spoke to the importance of
data and how the system was built on the data viewed from a
high level and the provider committee process to establish
the standards. The current set of EMS standards focused on
the pre-hospital level of care. He announced that DOH's
authority to establish the EMS systems of care approach was
currently non-existent as the original statute was not
sufficient to develop a trauma system prior to its
inclusion in 2010. He spoke to coordination regarding
cruise ship passengers. He offered that the Coast Guard had
to lift approximately 219 patients off the ships to
transfer them to care and they needed to be involved as
well as private providers. He voiced that currently there
was no statewide approach.
Representative Johnson commented that she would like to see
some letters of support from stakeholders other than from
paramedics, LifeMed Alaska, LLC or EMS providers who would
be directly impacted. She guessed that there might be a
protocol in place already. She thought it might become a
mandatory system for providers. She was not sure how it
would impact insurance companies. She voiced that she
wanted to hear from someone in the other body who had
medical experience. She hoped for more information in
general.
3:23:34 PM
Representative Jimmie described how medical emergencies
were handled in the remote part of Alaska she lived in.
Ultimately, some were evacuated through LifeMed. She was
aware from experience that the LifeMed responders made the
treatment decisions.
Representative Tomaszewski asked how many specialty
hospitals were in Alaska.
Mr. Wiseman replied that there were 15 level 4 trauma
centers, 1 level 3 trauma center, and 2 level 2 trauma
centers in the state. He was unable to answer what level of
specialty care was available in receiving centers.
Representative Tomaszewski pointed to the sponsor statement
and wondered whether the hospital had adopted the national
criteria for EMS system of care. He read from the sponsor
statement: "HB 27 will ensure that the receiving specialty
hospitals meet DOH-adopted national criteria for being a
voluntary stroke or heart attack center." He asked whether
DOH had adopted the national criteria. Mr. Wiseman replied
that the national criteria DOH had adopted was from the
American College of Surgeons, which established the current
system of care and provided credential for facilities. He
elucidated that there were other national accrediting
bodies that a hospital could participate in. Representative
Tomaszewski stated that the objective of the bill was to
establish criterion that all hospitals in the state follow
so everyone was "on the same page." Mr. Wiseman responded
in the affirmative and added that it depended on if the
hospital voluntarily wanted the certification to become a
stroke or heart attack center. The department would
identify the national entity that would be used to
establish the standards. Representative Tomaszewski
inquired what the outcome of volunteering to be a specialty
hospital would mean for the facility. Mr. Wiseman replied
that he was unsure what the financial impact on the
hospital to obtain the certification was. The certification
would help the patient be directed to the right provider
for care. Representative Tomaszewski asked if there were
any hospitals in the state that had adopted the national
criteria to be a heart attack or stroke center. Mr. Wiseman
deferred the answer to Dr. He. The department did not
currently track the information.
3:30:40 PM
Representative Bynum noted that the current statute
required trauma care. He inquired whether DOH was already
doing all it wanted for stroke and heart attack and was
doing all it wanted for all other traumas except for stroke
and heart attack.
Representative Mina replied that the state did have a
robust system of trauma care but lacked a robust system of
care for heart attacks and strokes. She asked Mr. Wiseman
to confirm her statement.
Mr. Wiseman asked for the question to be repeated.
Representative Bynum complied. Mr. Wiseman responded in the
affirmative. He elaborated that in the trauma system there
was a statewide trauma registry that almost every hospital
participated in and entered its data so outcomes could be
tracked. The trauma systems review committee had published
several guidelines for certain types of trauma and
protocols were produced statewide.
HB 27 was HEARD and HELD in committee for further
consideration.
Co-Chair Foster discussed future meetings.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 27 Letters of Support 03.17.25.pdf |
HFIN 4/7/2025 1:30:00 PM |
HB 27 |
| HB 27 Sectional Analysis Ver. N 03.17.25.pdf |
HFIN 4/7/2025 1:30:00 PM |
HB 27 |
| HB 27 Sponsor Statement Ver. N 03.17.25.pdf |
HFIN 4/7/2025 1:30:00 PM |
HB 27 |