Time-sensitive emergencies

AN ACT Relating to improving system outcomes for time-sensitive 1
emergencies through data-driven continuous quality improvement; 2
amending RCW 70.168.090 and 70.168.150; and creating a new section.3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:4
NEW SECTION. Sec. 1. The legislature intends to:5
(1) Implement the recommendations of the emergency cardiac and 6
stroke system assessment directed by chapter 58, Laws of 2022 to 7
support efforts to improve emergency cardiac and stroke care in 8
Washington and reduce death and disability resulting from cardiac and 9
stroke events. This includes developing an inclusive system of 10
optimal cardiac and stroke care throughout the continuum of care 11
delivery. Coordinated health care delivery systems require ongoing 12
levels of oversight, evidence-based inputs, coordination, and 13
evaluation of performance. Accordingly, the legislature intends that 14
the department has the responsibility for oversight and coordination 15
of the statewide cardiac and stroke system of care; and16
(2) Establish a single statewide data repository for time-17
sensitive emergencies, including stroke events, cardiac events such 18
as heart attack and sudden cardiac arrest, and trauma events, such as 19
traumatic brain injury. The data repository shall be established by 20
maintaining the existing reporting requirements under the trauma 21
H-2621.1
HOUSE BILL 2232
State of Washington 69th Legislature 2026 Regular Session
By Representatives Parshley, Ryu, Reed, Zahn, Macri, and Fosse
Prefiled 12/31/25. Read first time 01/12/26. Referred to Committee
on Health Care & Wellness.
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registry and adding new data sets related to stroke events and 1
cardiac events. The result will provide a data repository that is 2
able to analyze data on the incidence, severity, and causes of 3
cardiac, stroke, and trauma events. In addition, the data repository 4
will have the capacity to interact with the statewide electronic 5
emergency medical services data system to provide complete 6
information about the status of the time-sensitive emergency response 7
system in Washington. 8
Sec. 2. RCW 70.168.090 and 2019 c 314 s 19 are each amended to 9
read as follows: 10
(1)(((a) By July 1991 )) Until January 1, 2031, when the time-11
sensitive emergencies data repository is established under subsection 12
(2) of this section , the department shall ((establish)) maintain a 13
statewide data registry to collect and analyze data on the incidence, 14
severity, and causes of trauma, including traumatic brain injury. The 15
department shall collect additional data on traumatic brain injury 16
should additional data requirements be enacted by the legislature. 17
The registry shall be used to improve the availability and delivery 18
of prehospital and hospital trauma care services. Specific data 19
elements of the registry shall be defined by rule by the department. 20
To the extent possible, the department shall coordinate data 21
collection from hospitals for the trauma registry with the health 22
care data system authorized in chapter 70.170 RCW. Every hospital, 23
facility, or health care provider authorized to provide level I, II, 24
III, IV, or V trauma care services, level I, II, or III pediatric 25
trauma care services, level I, level I-pediatric, II, or III trauma-26
related rehabilitative services, and prehospital trauma-related 27
services in the state shall furnish data to the registry. All other 28
hospitals and prehospital providers shall furnish trauma data as 29
required by the department by rule. 30
(((b) The department may respond to requests for data and other 31
information from the registry for special studies and analysis 32
consistent with requirements for confidentiality of patient and 33
quality assurance records. The department may require requestors to 34
pay any or all of the reasonable costs associated with such requests 35
that might be approved.))36
(2)(a) By January 1, 2031, the department shall establish the 37
statewide time-sensitive emergencies data repository to collect and 38
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analyze data on the incidence, severity, and causes of time-sensitive 1
emergencies. 2
(b) The time-sensitive emergencies data repository shall consist 3
of data elements identified by the department in rule as relevant to 4
assessing the timeliness of the care delivered to patients 5
experiencing time-sensitive emergencies and evaluating performance on 6
nationally recognized measures, the delivery of care, and patient 7
outcomes, including:8
(i) A data set related to trauma events, including traumatic 9
brain injury;10
(ii) A data set related to cardiac events, such as heart attack 11
and sudden cardiac arrest; and12
(iii) A data set related to stroke events.13
(c) Beginning January 1, 2031, on a quarterly basis and in a 14
format approved by the department:15
(i) Every hospital, facility, or health care provider authorized 16
to provide level I, II, III, IV, or V trauma care services, level I, 17
II, or III pediatric trauma care services, level I, level I-18
pediatric, II, or III trauma-related rehabilitative services, and 19
prehospital trauma-related services must submit to the data 20
repository those data required under (b)(i) of this subsection (2);21
(ii) Every hospital authorized by the department to provide 22
specialized emergency cardiac care must submit to the data repository 23
those data required under (b)(ii) of this subsection (2); and24
(iii) Every hospital authorized by the department to provide 25
specialized emergency stroke care shall submit to the data repository 26
those data required under (b)(iii) of this subsection (2).27
(d)(i) The department shall establish a data validation process 28
for the statewide time-sensitive emergencies data repository and 29
implement a plan for continuous data quality improvement.30
(ii) The department may minimize the creation of new reporting 31
requirements by using existing data sources and coordinating with 32
state and national organizations involved in time-sensitive emergency 33
services quality improvement. The department may enter into any 34
necessary data-sharing agreements for this purpose.35
(e) The department shall provide technical assistance to 36
ambulance and aid services, hospitals, including critical access 37
hospitals, and emergency care regional partners.38
(f)(i) Beginning July 1, 2033, and annually thereafter, the 39
department shall provide a summary report of the data collected 40
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pursuant to this subsection (2) and an analysis of the statewide 1
progress toward improving quality of care and patient outcomes. The 2
department shall report all data in aggregate form and post the data 3
on the department's website. 4
(ii) The 2033 report must include an analysis of data collected 5
and recommendations regarding whether on-site verification of 6
hospitals' adherence to cardiac and stroke systems of care is needed 7
to improve citizens' access to safe, timely, evidence-based care for 8
stroke, acute coronary syndrome, and cardiac arrest.9
(3) The department must establish a statewide electronic 10
emergency medical services data system and adopt rules requiring 11
licensed ambulance and aid services to report and furnish patient 12
encounter data to the electronic emergency medical services data 13
system. The data system must be used to improve the availability and 14
delivery of prehospital emergency medical services. The department 15
must establish in rule the specific data elements of the data system 16
and secure transport methods for data. The data collected must 17
include data on suspected drug overdoses for the purposes of 18
including, but not limited to, identifying individuals to engage 19
substance use disorder peer professionals, patient navigators, 20
outreach workers, and other professionals as appropriate to prevent 21
further overdoses and to induct into treatment and provide other 22
needed supports as may be available. 23
(((3))) (4) In each emergency medical services and trauma care 24
planning and service region, a regional emergency medical services 25
and trauma care systems quality assurance program shall be 26
established by those facilities authorized to provide levels I, II, 27
and III trauma care services. The systems quality assurance program 28
shall evaluate trauma care delivery, patient care outcomes, and 29
compliance with the requirements of this chapter. The systems quality 30
assurance program ((may)) shall also evaluate emergency cardiac and 31
stroke care delivery. The emergency medical services medical program 32
director and all other health care providers and facilities who 33
provide trauma and emergency cardiac and stroke care services within 34
the region shall be invited to participate in the regional emergency 35
medical services and trauma care quality assurance program.36
(((4))) (5) The department shall:37
(a) Establish and implement a plan for achieving continuous 38
quality improvement in the care provided under the time-sensitive 39
emergencies data repository. The department shall develop and 40
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implement the statewide plan using the time-sensitive emergencies 1
data repository, the statewide electronic emergency medical services 2
data system, and other data sources available to the department;3
(b) Establish a system performance oversight process using data 4
from the statewide time-sensitive emergencies data repository;5
(c) Analyze data concerning time-sensitive emergency response and 6
treatment and identify areas in need of improvement;7
(d) Provide quarterly reports on system performance and quality 8
of care measures to the emergency cardiac and stroke technical 9
advisory committee and the hospital technical advisory committee of 10
the emergency medical services and trauma care steering committee;11
(e) Provide recommendations to the emergency medical services and 12
trauma care steering committee for the improvement of time-sensitive 13
emergency services in the state;14
(f) Provide aggregate time-sensitive emergencies care feedback to 15
participating ambulance and aid services, trauma regions, and 16
hospitals to improve performance on care and system coordination;17
(g) Use data from the statewide time-sensitive emergencies data 18
repository to further the development of cardiac, stroke, and trauma 19
system standards and education; and20
(h) Identify and disseminate interventions to improve time-21
sensitive emergency care in prehospital and hospital settings and in 22
local and regional systems of care.23
(6) The department may respond to requests for data and other 24
information from the trauma registry established in subsection (1) of 25
this section, the statewide time-sensitive emergencies data 26
repository established in subsection (2) of this section, and the 27
statewide electronic emergency medical services data system 28
established in subsection (3) of this section for special studies, 29
public health activities, and analysis consistent with requirements 30
for confidentiality of patient and quality assurance records. The 31
department may require requestors to pay any or all of the reasonable 32
costs associated with such requests that might be approved.33
(7) Data elements related to the identification of individual 34
patient's, provider's , and facility's care outcomes shall be 35
confidential, shall be exempt from ((RCW 42.56.030 through 42.56.570 36
and 42.17.350 through 42.17.450)) chapter 42.56 RCW, and shall not be 37
subject to discovery by subpoena or admissible as evidence.38
(((5))) (8) Patient care quality assurance proceedings, records, 39
and reports developed pursuant to this section are confidential, 40
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exempt from chapter 42.56 RCW, and are not subject to discovery by 1
subpoena or admissible as evidence in any civil action, except, after 2
in camera review, pursuant to a court order which provides for the 3
protection of sensitive information of interested parties including 4
the department: (a) In actions arising out of the department's 5
designation of a hospital or health care facility pursuant to RCW 6
70.168.070; (b) in actions arising out of the department's revocation 7
or suspension of designation status of a hospital or health care 8
facility under RCW 70.168.070; (c) in actions arising out of the 9
department's licensing or verification of an ambulance or aid service 10
pursuant to RCW 18.73.030 or 70.168.080; (d) in actions arising out 11
of the certification of a medical program director pursuant to RCW 12
18.71.212; or (e) in actions arising out of the restriction or 13
revocation of the clinical or staff privileges of a health care 14
provider as defined in RCW 7.70.020 (1) and (2), subject to any 15
further restrictions on disclosure in RCW 4.24.250 that may apply. 16
Information that identifies individual patients shall not be publicly 17
disclosed without the patient's consent. 18
(9) The department may contract with a single entity to develop 19
and administer the statewide time-sensitive emergencies data 20
repository established under subsection (2) of this section. The 21
department shall conduct a competitive procurement to select an 22
entity to develop and administer the time-sensitive emergencies data 23
repository.24
(10) Within funds appropriated for this specific purpose, the 25
department shall assist critical access hospitals and rural hospitals 26
with their platforms to meet the department's data collection 27
requirement and support prehospital services, particularly in rural 28
areas, in acquiring improved equipment and additional personnel 29
training for the treatment of patients experiencing a cardiac, 30
stroke, or trauma event.31
(11) Within funds appropriated for this specific purpose, the 32
department shall conduct public education of the signs and symptoms 33
of heart attack and stroke and the lifesaving benefits of calling 911 34
and seeking immediate treatment.35
(12) For purposes of this section, "time-sensitive emergency" 36
means a medical condition for which rapid assessment, intervention, 37
and coordinated transport to an appropriate facility are critical to 38
improving patient outcomes and reducing the risk of death or 39
permanent disability. Time-sensitive emergencies include stroke 40
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events, cardiac events, such as heart attack and sudden cardiac 1
arrest, and trauma events, including traumatic brain injury.2
Sec. 3. RCW 70.168.150 and 2010 c 52 s 3 are each amended to 3
read as follows: 4
(1) By January 1, 2011, the department shall endeavor to enhance 5
and support an emergency cardiac and stroke care system through:6
(a) Encouraging hospitals to voluntarily self-identify cardiac 7
and stroke capabilities, indicating which level of cardiac and stroke 8
service the facility provides. Hospital levels must be defined by the 9
previous work of the emergency cardiac and stroke technical advisory 10
committee and must follow the guiding principles and recommendations 11
of the emergency cardiac and stroke work group report;12
(b) Giving a hospital "deemed status" and designating it as a 13
primary stroke center if it has received a certification of 14
distinction for primary stroke centers issued by the nonprofit 15
organization known as the joint commission. When available, a 16
hospital shall demonstrate its cardiac or stroke level through 17
external, national certifying organizations, including, but not 18
limited to, primary stroke center certification by the joint 19
commission; and 20
(c) Within the current authority of the department, adopting 21
cardiac and stroke prehospital patient care protocols, patient care 22
procedures, and triage tools, consistent with the guiding principles 23
and recommendations of the emergency cardiac and stroke work group 24
report. 25
(2) A hospital that voluntarily participates in the system:26
(a) Shall participate in internal, as well as regional, quality 27
improvement activities; 28
(b) Shall participate in a national, state, or local data 29
collection system that measures cardiac and stroke system performance 30
from patient onset of symptoms to treatment or intervention, and 31
includes, at a minimum, the nationally recognized consensus measures 32
for stroke. Beginning January 1, 2031, hospitals that participate in 33
the system shall submit data to the time-sensitive emergencies data 34
repository; and 35
(c) May advertise participation in the system, but may not claim 36
a verified certification level unless verified by an external, 37
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nationally recognized, evidence-based certifying body as provided in 1
subsection (1)(b) of this section. 2
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