                                 CODE OF VIRGINIA

STATEWIDE EMERGENCY MEDICAL SERVICES PLAN; TRAUMA TRIAGE PLAN; STROKE TRIAGE
PLAN (§ 32.1-111.3)

A. The Board of Health shall develop a Statewide Emergency Medical Services Plan
that shall provide for a comprehensive, coordinated, emergency medical services
system in the Commonwealth and shall review, update, and publish the Plan
triennially, making such revisions as may be necessary to improve the
effectiveness and efficiency of the Commonwealth&#8217;s emergency medical
services system. The Plan shall incorporate the regional emergency medical
services plans prepared by the regional emergency medical services councils
pursuant to § 32.1-111.4:2. Publishing through electronic means and posting on
the Department website shall satisfy the publication requirement. The objectives
of such Plan and the emergency medical services system shall include the
following:

   1. Establishing a comprehensive statewide emergency medical services system,
   incorporating facilities, transportation, manpower, communications, and other
   components as integral parts of a unified system that will serve to improve
   the delivery of emergency medical services and thereby decrease morbidity,
   hospitalization, disability, and mortality;

   2. Reducing the time period between the identification of an acutely ill or
   injured patient and the definitive treatment;

   3. Increasing the accessibility of high quality emergency medical services to
   all citizens of Virginia;

   4. Promoting continuing improvement in system components including ground,
   water, and air transportation; communications; hospital emergency departments
   and other emergency medical care facilities; health care provider training and
   health care service delivery; and consumer health information and education;

   5. Ensuring performance improvement of the emergency medical services system
   and emergency medical services and care delivered on scene, in transit, in
   hospital emergency departments, and within the hospital environment;

   6. Working with professional medical organizations, hospitals, and other
   public and private agencies in developing approaches whereby the many persons
   who are presently using the existing emergency department for routine,
   nonurgent, primary medical care will be served more appropriately and
   economically;

   7. Conducting, promoting, and encouraging programs of education and training
   designed to upgrade the knowledge and skills of emergency medical services
   personnel, including expanding the availability of paramedic and advanced life
   support training throughout the Commonwealth with particular emphasis on
   regions underserved by emergency medical services personnel having such skills
   and training;

   8. Consulting with and reviewing, with agencies and organizations, the
   development of applications to governmental or other sources for grants or
   other funding to support emergency medical services programs;

   9. Establishing a statewide air medical evacuation system which shall be
   developed by the Department of Health in coordination with the Department of
   State Police and other appropriate state agencies;

   10. Establishing and maintaining a process for designation of appropriate
   hospitals as trauma centers, certified stroke centers, and specialty care
   centers based on an applicable national evaluation system;

   11. Maintaining a comprehensive emergency medical services patient care data
   collection and performance improvement system pursuant to Article 3.1 (&#xA7;
   32.1-116.1 et seq.);

   12. Collecting data and information and preparing reports for the sole purpose
   of the designation and verification of trauma centers and other specialty care
   centers pursuant to this section. All data and information collected shall
   remain confidential and shall be exempt from the provisions of the Virginia
   Freedom of Information Act (&#xA7; 2.2-3700 et seq.);

   13. Establishing and maintaining a process for crisis intervention and peer
   support services for emergency medical services personnel and public safety
   personnel, including statewide availability and accreditation of critical
   incident stress management or peer support teams and personnel. Such
   accreditation standards shall include a requirement that a peer support team
   be headed by a Virginia-licensed clinical psychologist, Virginia-licensed
   psychiatrist, Virginia-licensed clinical social worker, or Virginia-licensed
   professional counselor, who has at least five years of experience as a mental
   health consultant working directly with emergency medical services personnel
   or public safety personnel;

   14. Establishing a statewide program of emergency medical services for
   children to provide coordination and support for emergency pediatric care,
   availability of pediatric emergency medical care equipment, and pediatric
   training of health care providers;

   15. Establishing and supporting a statewide system of health and medical
   emergency response teams, including emergency medical services disaster task
   forces, coordination teams, disaster medical assistance teams, and other
   support teams that shall assist local emergency medical services agencies at
   their request during mass casualty, disaster, or whenever local resources are
   overwhelmed;

   16. Establishing and maintaining a program to improve dispatching of emergency
   medical services personnel and vehicles, including establishment of and
   support for emergency medical services dispatch training, accreditation of 911
   dispatch centers, and public safety answering points;

   17. Identifying and establishing best practices for managing and operating
   emergency medical services agencies, improving and managing emergency medical
   services response times, and disseminating such information to the appropriate
   persons and entities;

   18. Ensuring that the Department of Criminal Justice Services and the Virginia
   Criminal Injuries Compensation Fund shall be contacted immediately to deploy
   assistance in the event there are victims as defined in &#xA7; 19.2-11.01, and
   that the Department of Criminal Justice Services and the Virginia Criminal
   Injuries Compensation Fund become the lead coordinating agencies for those
   individuals determined to be victims; and

   19. Maintaining current contact information for both the Department of
   Criminal Justice Services and the Virginia Criminal Injuries Compensation
   Fund.

B. The Board of Health shall also develop and maintain as a component of the
Emergency Medical Services Plan a statewide prehospital and interhospital Trauma
Triage Plan designed to promote rapid access for pediatric and adult trauma
patients to appropriate, organized trauma care through the publication and
regular updating of information on resources for trauma care and generally
accepted criteria for trauma triage and appropriate transfer. The Trauma Triage
Plan shall include:

   1. A strategy for maintaining the statewide Trauma Triage Plan through
   development of regional trauma triage plans that take into account the
   region&#8217;s geographic variations and trauma care capabilities and
   resources, including hospitals designated as trauma centers pursuant to
   subsection A and inclusion of such regional plans in the statewide Trauma
   Triage Plan. The regional trauma triage plans shall be reviewed triennially.
   Plans should ensure that the Department of Criminal Justice Services and the
   Virginia Criminal Injuries Compensation Fund shall be contacted immediately to
   deploy assistance in the event there are victims as defined in &#xA7;
   19.2-11.01, and that the Department of Criminal Justice Services and the
   Virginia Criminal Injuries Compensation Fund become the lead coordinating
   agencies for those individuals determined to be victims; and maintain current
   contact information for both the Department of Criminal Justice Services and
   the Virginia Criminal Injuries Compensation Fund.

   2. A uniform set of proposed criteria for prehospital and interhospital triage
   and transport of trauma patients developed by the Advisory Board, in
   consultation with the Virginia Chapter of the American College of Surgeons,
   the Virginia College of Emergency Physicians, the Virginia Hospital and
   Healthcare Association, and prehospital care providers. The Advisory Board may
   revise such criteria from time to time to incorporate accepted changes in
   medical practice or to respond to needs indicated by analyses of data on
   patient outcomes. Such criteria shall be used as a guide and resource for
   health care providers and are not intended to establish, in and of themselves,
   standards of care or to abrogate the requirements of &#xA7; 8.01-581.20. A
   decision by a health care provider to deviate from the criteria shall not
   constitute negligence per se.

   3. A performance improvement program for monitoring the quality of emergency
   medical services and trauma services, consistent with other components of the
   Emergency Medical Services Plan. The program shall provide for collection and
   analysis of data on emergency medical and trauma services from existing
   validated sources, including the emergency medical services patient care
   information system, pursuant to Article 3.1 (&#xA7; 32.1-116.1 et seq.), the
   Patient Level Data System, and mortality data. The Advisory Board shall review
   and analyze such data on a quarterly basis and report its findings to the
   Commissioner. The Advisory Board may execute these duties through a committee
   composed of persons having expertise in critical care issues and
   representatives of emergency medical services providers. The program for
   monitoring and reporting the results of emergency medical services and trauma
   services data analysis shall be the sole means of encouraging and promoting
   compliance with the trauma triage criteria.
   				The Commissioner shall report aggregate findings of the analysis annually
   to each regional emergency medical services council. The report shall be
   available to the public and shall identify, minimally, as defined in the
   statewide plan, the frequency of (i) incorrect triage in comparison to the
   total number of trauma patients delivered to a hospital prior to pronouncement
   of death and (ii) incorrect interfacility transfer for each region.
   				The Advisory Board or its designee shall ensure that each hospital
   director or emergency medical services agency chief is informed of any
   incorrect interfacility transfer or triage, as defined in the statewide Trauma
   Triage Plan, specific to the hospital or agency and shall give the hospital or
   agency an opportunity to correct any facts on which such determination is
   based, if the hospital or agency asserts that such facts are inaccurate. The
   findings of the report shall be used to improve the Trauma Triage Plan,
   including triage, and transport and trauma center designation criteria.
   				The Commissioner shall ensure the confidentiality of patient information,
   in accordance with &#xA7; 32.1-116.2. Such data or information in the
   possession of or transmitted to the Commissioner, the Advisory Board, any
   committee acting on behalf of the Advisory Board, any hospital or prehospital
   care provider, any regional emergency medical services council, emergency
   medical services agency that holds a valid license issued by the Commissioner,
   or group or committee established to monitor the quality of emergency medical
   services or trauma services pursuant to this subdivision, or any other person
   shall be privileged and shall not be disclosed or obtained by legal discovery
   proceedings, unless a circuit court, after a hearing and for good cause shown
   arising from extraordinary circumstances, orders disclosure of such data.

C. The Board shall also develop and maintain as a component of the Statewide
Emergency Medical Services Plan a statewide prehospital and interhospital Stroke
Triage Plan designed to promote rapid access for stroke patients to appropriate,
organized stroke care through the publication and regular updating of
information on resources for stroke care and generally accepted criteria for
stroke triage and appropriate transfer. The Stroke Triage Plan shall include:

   1. A strategy for maintaining the statewide Stroke Triage Plan through
   development of regional stroke triage plans that take into account the
   region&#8217;s geographic variations and stroke care capabilities and
   resources, including hospitals designated as comprehensive stroke centers,
   primary stroke centers, primary stroke centers with supplementary levels of
   stroke care distinction, and acute stroke-ready hospitals through
   certification by the Joint Commission, DNV Healthcare, the American Heart
   Association, or a comparable process consistent with the recommendations of
   the Brain Attack Coalition, and inclusion of such regional plans in the
   statewide Stroke Triage Plan. The regional stroke triage plans shall be
   reviewed triennially.

   2. A uniform set of proposed criteria for prehospital and interhospital triage
   and transport of stroke patients developed by the Advisory Board, in
   consultation with the American Stroke Association, the Virginia College of
   Emergency Physicians, the Virginia Hospital and Healthcare Association, and
   prehospital care providers. The Board may revise such criteria from time to
   time to incorporate accepted changes in medical practice or to respond to
   needs indicated by analyses of data on patient outcomes. Such criteria shall
   be used as a guide and resource for health care providers and are not intended
   to establish, in and of themselves, standards of care or to abrogate the
   requirements of &#xA7; 8.01-581.20. A decision by a health care provider to
   deviate from the criteria shall not constitute negligence per se.

D. Whenever any state-owned aircraft, vehicle, or other form of conveyance is
utilized under the provisions of this section, an appropriate amount not to
exceed the actual costs of operation may be charged by the agency having
administrative control of such aircraft, vehicle, or other form of conveyance.

HISTORY: 1996, c. 899; 1997, c. 321; 1998, c. 317; 1999, c. 1000; 2005, cc. 632,
686; 2006, c. 412; 2007, c. 15; 2008, cc. 66, 567; 2009, cc. 222, 269; 2012, c.
418; 2014, c. 320; 2015, cc. 502, 503; 2017, c. 609; 2018, cc. 103, 109.