SECTION 1.  Chapter 111 of the General Laws, as appearing in the 2014 Official Edition, is hereby amended, after section 51J, by inserting the following new section:-

“Section 51K. All regional EMS councils, as defined in chapter 111C, §1, shall establish, in collaboration with the department, pre-hospital care protocols, related to the assessment, treatment and transport of stroke patients by licensed emergency medical services providers in this state.  Such protocols shall include point of entry criteria and plans for the triage and transport of stroke patients who may have an emergent large vessel occlusion, to the closest facility that offers advanced neuroendovascular treatment within a specified timeframe of onset of symptoms.  

In determining such protocols for the assessment, treatment and transport of stroke patients by licensed emergency medical services providers in this state, the following should be considered:

(i) The capability of an emergency-receiving facility that does not provide neuroendovascular care to stabilize a patient suspected, based on clinical severity, of having an emergent large vessel occlusion stroke before initiating a transfer directly to a stroke center that provides neuroendovascular treatment;

(ii) The distance and duration of transport by EMS, including consideration of crossing state lines, with the understanding that the direct transport of a patient suspected of having an emergent large vessel occlusion to a neuroendovascular center should be prioritized.

If direct transport of a patient suspected of having an emergent large vessel occlusion involves aircraft to take the patient out of their local region, the preferred destination should be a facility that offers neuroendovascular treatment. If the patient is initially taken by EMS to a facility that does not offer neuroendovascular treatment, and computed tomography angiograph confirms an emergent large vessel occlusion, the patient shall be transferred to a facility offering neuroendovascular treatment.  If the facility where the patient is initially taken by EMS does not have a computed tomography angiography available, the patient shall be transported to a facility offering neuroendovascular treatment.

For purposes of this section, hospitals offering neuroendovascular treatment shall mean “facilities with the capabilities to properly assess, diagnose using advanced imaging devices, and treat stroke patients with complex cases of ischemic stroke, including emergent large vessel occlusion caused by the loss of blood supply to a part of the brain, or hemorrhagic stroke, caused by bleeding into a part of the brain, and requiring immediate treatment at a facility with a trained team of neurointerventional surgeons, vascular neurologists and assisting medical personnel, and the ability to perform a mechanical thrombectomy 24 hours per day, seven days per week to treat the stroke.”  The department shall identify facilities that meet the criteria set forth in this act as facilities that offer neuroendovascular treatment.