HB 27-MEDICAL MAJOR EMERGENCIES  4:07:32 PM REPRESENTATIVE MEARS announced that the next order of business would be HOUSE BILL NO. 27, "An Act relating to medical care for major emergencies." 4:07:43 PM CHAIR MINA, as prime sponsor of HB 27, gave the sponsor statement [included in the committee file], which read as follows [original punctuation provided]: A coordinated statewide system of care enhances the chance of survival in life-threatening, time-critical emergencies in adults and children. Trauma and specific medical emergencies addressed within this system ensure that Alaskans receive care from the "right person, at the right place, at the right time." Trauma, strokes, and heart attacks represent the leading causes of death in Alaska. In 2022 alone, 744 Alaskans died from trauma, 217 died from strokes, and 510 died from died from cardiovascular disease such as a heart attack. By enabling a statewide systems of care approach for major emergencies, death rates caused by these time-sensitive emergencies can improve. Importantly, these are conditions for which interventions exist that can markedly alter their otherwise dismal prognoses. HB 27 seeks to expand the scope of the Section of Rural and Community Health Systems within the Department of Health to include strokes and severe heart attacks in: • Developing training programs for ambulance and first responder services on a standardized protocol. • Communicating the urgency of the patient's condition to the local receiving hospital or clinic. • Assist in establishing statewide guidelines, helping physicians and advanced practice practitioners determine if local treatment is appropriate or to expedite transport to the suitable treatment facility. This legislation also focuses on expanding AS 18.08.010 and AS 18.08.200, allowing the Department of Health (DOH) to replicate those systems and processes that have improved trauma care and apply those principles to stroke and severe heart attacks. With the success of the Trauma Center program, HB 27 will ensure that the receiving specialty hospitals meet DOH-adopted national criteria for being a voluntary stroke or heart attack center. It also establishes a registry specific to these major emergencies, a means to measure outcomes, and guide changes that will inevitably be needed. The overall goal of HB 27 is that a trauma, cardiac, or stroke patient returns home as a functional member of the community and embraces life changes that will improve their future health. 4:12:35 PM KATY GIORGIO, Staff, Representative Genevieve Mina, Alaska State Legislature, on behalf of Representative Mina, prime sponsor of HB 27, gave the sectional analysis [included in the committee file], which read as follows [original punctuation provided]: Section 1. Amends AS 18.08.010  Section 1, subsections 1-3 adds "major emergencies" to the existing emergency medical services (EMS) system. Currently, only trauma care appears in statute, and the addition of "major emergencies" will allow the Department of Health (DOH) to include time-sensitive emergencies such as heart attacks and strokes to their EMS review system. Section 1, subsection 4, addresses the trauma center designation status for hospitals and clinics and gives the statutory authority for DOH to adopt criteria for those health centers to represent themselves as being capable of treating major emergencies. Section 2. Amends AS 18.08.200 by adding a new  paragraph:  This is the definition section for the chapter, and "major emergency" is added and defined as heart attack and stroke. 4:13:37 PM REPRESENTATIVE MEARS invited committee questions. 4:13:52 PM REPRESENTATIVE RUFFRIDGE said he understood why heart attack and stroke were chosen as major medical emergencies, as they are clear options. He then cited the current statutory definition of medical care as "services utilized in responding to a perceived need for medical care to prevent loss of life". He questioned the need to define major emergency as being just two types of medical situations. CHAIR MINA replied, "My understanding is that what we have in statute for the duties and responsibilities of the Office of EMS is only situated to what is in statute. And so, to be able to clearly define the different instances of major medical emergencies, like strokes and heart attacks, I think we do have to put that in statute clearly." That said, she deferred to Gene Wiseman. 4:15:39 PM GENE WISEMAN, Chief, Section of Rural and Community Health Systems, Division of Public Health, Department of Health (DOH), noted that AS [18.08.010] specifies "trauma" [in relation to emergency medical services]. He stated, "At the time of the writing of that statute, trauma had known outcome for coordinated care." He spoke about the finite timeframes related to heart attack and stroke "that require a higher level of system coordination to occur." He offered further details. REPRESENTATIVE RUFFRIDGE summarized that Mr. Wiseman had said that because trauma care is specifically defined, then major emergencies also must be specifically defined, which led him to ask whether the statute could be broadened by replacing "trauma care" and "major emergencies" with "plan and deliver emergency medical services". MR. WISEMAN responded that EMS responds to all emergencies. He indicated that the statute facilitates the building of a system of care that encompasses trauma, stroke, and heart attack. This requires collaboration, subject experts, and monitoring. He offered examples. He concluded, "Without it being in there, ... potentially, it doesn't allow us ... that focus on the collaboration." 4:22:08 PM REPRESENTATIVE GRAY proffered that HB 27 is more of a "clean-up bill," because it is proposing to put into statute "that which we are already do." He remarked that he knows no one in the field of medicine who will say, "Well, now that it's in statute, we'll start taking strokes and heart attacks seriously." That, he emphasized, has already been happening for decades. 4:23:26 PM REPRESENTATIVE MEARS announced that HB 27 was held over.