[Congressional Record Volume 147, Number 109 (Tuesday, July 31, 2001)]
[Senate]
[Pages S8469-S8474]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. KENNEDY (for himself, Mr. Frist Mr. Dodd, Mr. Hutchinson, 
        Mr. Jeffords, Ms. Collins, Mr. Bingaman, Mr. Edwards, Mrs. 
        Murray, and Mr. Sessions):
  S. 1274. A bill to amend the Public Health Service Act to provide 
programs for the prevention, treatment, and rehabilitation of stroke; 
to the Committee on Health, Education, Labor, and Pensions.
                                 1_____
                                 
      By Mr. FRIST (for himself, Mr. Kennedy, Mr. Jeffords, Mr. 
        Hutchinson, Mr. Dodd, Ms. Collins, Mr. Bingaman, Mr. Feingold, 
        Mrs. Murray, Mr. Edwards, and Mr. Corzine):
  S. 1275. A bill to amend the Public Health Service Act to provide 
grants for public access defibrillation programs and public access 
defibrillation demonstration projects, and for other purposes; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. FRIST. Mr. President, I rise today with Senator Kennedy to 
introduce two pieces of legislation, the STOP Stroke Act and the 
Community Access to Emergency Defibrillation Act. These bills represent 
our next step in the battle against cardiac arrest and stroke and are 
critical to increasing access to timely, quality health care.
  The first bill we are introducing today focuses attention on stroke, 
the third leading cause of death and the leading cause of serious, 
long-term disability in the United States, through the implementation 
of a prevention and education campaign, the development of the Paul 
Coverdell Stroke Registry and Clearinghouse, and the provision of 
grants for statewide stroke care systems and for medical professional 
development. The untimely death of Senator Paul Coverdell points to the 
need to provide more comprehensive stroke care and to learn more about 
providing better quality care to the more than 700,000 Americans who 
experience a stroke each year. Our first step in doing so is the 
introduction of the Stroke Treatment and Ongoing Prevention Act (STOP 
Stroke Act).
  One of the most significant factors that affects stroke survival 
rates is the speed with which one obtains access to health care 
services. About 47 percent of stroke deaths occur out of the hospital. 
Many patients do not recognize the signs of a stroke and attribute the 
common symptoms, such as dizziness, loss of balance, confusion, severe 
headache or numbness, to other less severe ailments. To increase 
awareness of this public health problem, the Secretary of Health and 
Human Services will implement a national, multimedia campaign to 
promote stroke prevention and encourage those with the symptoms of 
stroke to seek immediate treatment. This crucial legislation also 
provides for special programs to target high risk populations. For the 
professional community, continuing education grants are included to 
train physicians in

[[Page S8470]]

newly-developed diagnostic approaches, technologies, and therapies for 
prevention and treatment of stroke. With a more informed public and up-
to-date physicians, our ability to combat the devastating effects of a 
stroke will be enhanced.
  The Paul Coverdell National Acute Stroke Registry and Clearinghouse, 
authorized in the STOP Stroke Act, establish mechanisms for the 
collection, analysis, and dissemination of valuable information about 
best practices relating to stroke care and the development of stroke 
care systems. In order to facilitate the process of implementing 
statewide stroke prevention, treatment, and rehabilitation systems that 
reflect the research gathered by the Registry and Clearinghouse, grants 
will be made available to States that will ensure that stroke patients 
have access to quality care.
  These legislative efforts have already proved successful. Lives are 
being saved. We can do more.
  Therefore, we are moving today to expand on these successes by 
introducing the Community Access to Emergency Defibrillation Act. This 
important legislation will provide $50 million for communities to 
establish public access defibrillation programs that will train 
emergency medical personnel, purchase AEDs for placement in public 
areas, ensure proper maintenance of defibrillators, and evaluate the 
effectiveness of the program.
  Each year, over 250,000 Americans suffer sudden cardiac arrest. 
Sudden cardiac arrest is a common cause of death during which the heart 
suddenly stops functioning. Most frequently, cardiac arrest occurs when 
the electrical impulses that regulate the heart become rapid, 
ventricular tachycardia, or chaotic, ventricular fibrillation, causing 
the heart to stop beating altogether. As a result, the individual 
collapses, stops breathing and has no pulse. Often, the heart can be 
shocked back into a normal rhythm with the aid of a defibrillator. This 
is exactly what happened when I resuscitated a patient using 
cardiopulmonary resuscitation, CPR, and electrical cardioversion in the 
Dirksen Senate Office Building in 1995.
  When a person goes into cardiac arrest, time is of the essence. 
Without defibrillation, his or her chances of survival decrease by 
about 10 percent with every minute that passes. Thus, having an 
automated external defibrillator, AED, accessible is not only 
important, but also could save lives. AEDs are portable, lightweight, 
easy to use, and are becoming an essential part of administering first 
aid to victims of sudden cardiac arrest.
  We have seen that in places where AEDs are readily available, 
survival rates can increase by 20-30 percent. In some settings, 
survival rates have even reached 70 percent. Therefore, Congress has 
taken several important steps to increase access to AEDs over the past 
two Congresses.
  In the 105th Congress, I authored the Aviation Medical Assistance 
Act. This bill directed the Federal Aviation Administration to decide 
whether to require AEDs on aircraft and in airports. As a result of 
this law, many airlines now carry AEDs on board, and some airports have 
placed AEDs in their terminals. At Chicago O'Hare, just four months 
after AEDs were placed in that airport, four victims were resuscitated 
using the publicly available AEDs.
  In the last Congress, we passed two important bills expanding the 
availability of AEDs: the Cardiac Arrest Survival Act and the Rural 
Access to Emergency Devices Act. Respectively, these bills address the 
placement of automated external defibrillators, AEDs, in Federal 
buildings and provide liability protection to persons or organizations 
who use AEDs, as well as grants to community partnerships to enable 
them to purchase AEDs. The bills also provide defibrillator and basic 
life support training.
  I am pleased to introduce these important pieces of legislation and I 
look forward to their ultimate enactment into law. I want to thank my 
colleague, Senator Kennedy, for his work on these life saving 
proposals.
  Mr. KENNEDY. Mr. President, it is a privilege to join my colleague, 
Senator Frist, to introduce the Stroke Treatment and Ongoing Prevention 
Act. Stroke is a cruel affliction that takes the lives and blights the 
health of millions of Americans. Senator Frist and I have worked 
closely on legislation to establish new initiatives to reduce the grim 
toll taken by stroke, and I commend him for his leadership. We are 
joined in proposing this important legislation by our colleagues on the 
Health Committee, Senators Dodd, Hutchinson, Jeffords, Collins, 
Bingaman, Edwards, and Murray. The STOP Stroke Act is also supported by 
a broad coalition of organizations representing patients and the health 
care community.
  Stroke is a national tragedy that leaves no American community 
unscarred.
  Stroke is the third leading cause of death in the United States. 
Every minute of every day, somewhere in America, a person suffers a 
stroke. Every three minutes, a person dies from one. Strokes take the 
lives of nearly 160,000 Americans each year. Even for those who survive 
an attack, stroke can have devastating consequences. Over half of all 
stroke survivors are left with a disability.
  Since few Americans recognize the symptoms of stroke, crucial hours 
are often lost before patients receive medical care. The average time 
between the onset of symptoms and medical treatment is a shocking 13 
hours. Emergency medical technicians are often not taught how to 
recognize and manage the symptoms of stroke. Rapid administration of 
clot-dissolving drugs can dramatically improve the outcome of stroke, 
yet fewer than 3 percent of stroke patients now receive such 
medication. If this lifesaving medication were delivered promptly to 
all stroke patients, as many as 90,000 Americans could be spared the 
disabling aftermath of stroke.
  Even in hospitals, stroke patients often do not receive the care that 
could save their lives. Treatment of patients by specially trained 
health care providers increases survival and reduces disability due to 
stroke, but a neurologist is the attending physician for only about one 
in ten stroke patients. To save lives, reduce disabilities and improve 
the quality of stroke care, the Stroke Treatment and Ongoing 
Prevention, STOP Stroke, Act authorizes important public health 
initiatives to help patients with symptoms of stroke receive timely and 
effective care.
  The Act establishes a grant program for States to implement systems 
of stroke care that will give health professionals the equipment and 
training they need to treat this disorder. The initial point of contact 
between a stroke patient and medical care is usually an emergency 
medical technician. Grants authorized by the Act may be used to train 
emergency medical personnel to provide more effective care to stroke 
patients in the crucial first few moments after an attack.
  The Act provides important new resources for States to improve the 
standard of care given to stroke patients in hospitals. The legislation 
will assist States in increasing the quality of stroke care available 
in rural hospitals through improvements in telemedicine.
  The Act directs the Secretary of Health and Human Services to conduct 
a national media campaign to inform the public about the symptoms of 
stroke, so that patients receive prompt medical care. The bill also 
creates the Paul Coverdell Stroke Registry and Clearinghouse, which 
will collect data about the care of stroke patients and assist in the 
development of more effective treatments.
  Finally, the STOP Stroke Act establishes continuing education 
programs for medical professionals in the use of new techniques for the 
prevention and treatment of stroke.
  These important new initiatives can make a difference in the lives of 
the thousands of American who suffer a stroke every year. For patients 
experiencing a stroke, even a few minutes' delay in receiving treatment 
can make the difference between healthy survival and disability or 
death. The Act will help make certain that those precious minutes are 
not wasted.
  Increased public information on the symptoms of stroke will help 
stroke patients and their families know to seek medical care promptly. 
Better training of emergency medical personnel will help ensure that 
stroke patients receive lifesaving medications when they are most 
effective. Improved systems of stroke care will help patients receive 
the quality treatment

[[Page S8471]]

needed to save lives and reduce disability.
  This legislation can make a real difference to every community in 
America, and I urge my colleagues to join Senator Frist and myself in 
supporting the STOP Stroke Act.
  I ask unanimous consent that additional material and letters of 
support relating to this bill be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

        The Stroke Treatment and Ongoing Prevention Act of 2001


                  background and need for legislation

       Stoke is the third leading cause of death in the United 
     States, claiming the life of one American every three and a 
     half minutes. Those who survive stroke are often disabled and 
     have extensive health care needs. The economic cost of stroke 
     is staggering. The United States spends over $30 billion each 
     year on caring for persons who have experienced stroke.
       Prompt treatment of patients experiencing stroke can save 
     lives and reduce disability, yet thousands of stroke patients 
     do not receive proper therapy during the crucial window of 
     time when it is most effective. Rapid administration of clot-
     dissolving drugs can dramatically improve the outcome of 
     stroke, yet fewer than 3 percent of stroke patients now 
     receive such medication. Treatment of patients by specially 
     trained health care providers increases survival and reduces 
     disability due to stroke, but a neurologist is the attending 
     physician for only about one in ten stroke patients. Most 
     Americans cannot identify the signs of stroke and even 
     emergency medical technicians are often not taught how to 
     recognize and manage its symptoms. Even in hospitals, stroke 
     patients often do not receive the care that could save their 
     lives. To saves lives, reduce disability and improve the 
     quality of stroke care, the Stroke Treatment and Ongoing 
     Prevention, STOP Stroke, Act authorizes the following 
     important public health initiatives.
     Stroke prevention and education campaign
       The STOP Stroke Act provides $40 million, fiscal year 2002, 
     for the Secretary to carry out a national, multi-media 
     awareness campaign to promote stroke prevention and encourage 
     stroke patients to seek immediate treatment. The campaign 
     will be tested for effectiveness in targeting populations at 
     high risk for stroke, including women, senior citizens, and 
     African-Americans. Alternative campaigns will be designed for 
     unique communities, including those in the nation's ``Stoke 
     belt,'' a region with a particularly high rate of stroke 
     incidence and mortality.
     Paul Coverdell Stroke Registry and Clearinghouse
       The STOP Stroke Act authorizes the Paul Coverdell Stroke 
     Registry and Clearinghouse to collect data about the care of 
     acute stroke patients and foster the development of effective 
     stroke care systems. The clearinghouse will serve as a 
     resource for States seeking to design and implement their own 
     stroke care systems by collecting, analyzing and 
     disseminating information on the efforts of other communities 
     to establish similar systems. Special consideration will be 
     given to the unique needs of rural facilities and those 
     facilities with inadequate resources for providing quality 
     services for stroke patients. The Secretary is also 
     authorized to conduct and support research on stroke care. 
     Where suitable research has already been conducted, the 
     Secretary is charged with disseminating this research to 
     increase its effectiveness in improving stroke care.
     Grants for statewide stroke care systems
       The Secretary will award grants to States to develop and 
     implement statewide stroke prevention, treatment, and 
     rehabilitation systems. These systems must ensure that stroke 
     patients in the State have access to quality care. The 
     Secretary is also authorized to award planning grants to 
     States to assist them in developing statewide stroke care 
     systems. Each State that receives a grant will: implement 
     curricula for training emergency medical services personnel 
     to provide pre-hospital care to stroke patients; curricula 
     may be modeled after a curriculum developed by the Secretary; 
     have the option of identifying acute stroke centers, 
     comprehensive stroke treatment centers, and/or stroke 
     rehabilitation centers; set standards of care and other 
     requirements for facilities providing services to stroke 
     patients; specify procedures to evaluate the statewide stroke 
     care system; and collect and analyze data from each facility 
     providing care to stroke patients in the State to improve the 
     quality of stroke care provided in that State.
       The Act authorizes this grant program at $50 million for 
     fiscal year 2002, $75 million for fiscal years 2003 and 2004, 
     $100 million for fiscal year 2005, and $125 million for 
     fiscal year 2006.
     Medical professional development
       The STOP Stroke Act provides grant authority to the 
     Secretary for public and non-profit entities to develop and 
     implement continuing education programs in the use of new 
     diagnostic approaches, technologies, and therapies for the 
     prevention and treatment of stroke. Grant recipients must 
     have a plan for evaluation of activities carried out with the 
     funding. The Secretary must ensure that any grants awarded 
     are distributed equitably among the regions of the United 
     States and between urban and rural populations.
     Secretary's role
       In addition to carrying out the national education 
     campaign, operating the clearinghouse and registry, and 
     awarding grants to States, the Secretary will: develop 
     standards of care for stroke patients that may be taken into 
     consideration by States applying for grants; develop a model 
     curriculum that States may adopt for emergency medical 
     personnel; develop a model plan for designing and 
     implementing stroke care systems, taking into consideration 
     the unique needs of varying communities; report to Congress 
     on the implementation of the Act in participating States.
       In carrying out the STOP Stroke Act, the Secretary will 
     consult widely with those having expert knowledge of the 
     needs of patients with stroke.


                            KEY STROKE FACTS

     The devastating effects of stroke
       There are roughly 700,000-750,000 strokes in the U.S. each 
     year.
       Stroke is the 3rd leading cause of death in the U.S.
       Almost 160,000 Americans die each year from stroke.
       Every minute in the U.S., an individual experiences a 
     stroke. Every 3.3 minutes an individual dies from one.
       Over the course of a lifetime, four out of every five 
     families in the U.S. will be touched by stroke.
       Roughly 1/3 of stroke survivors have another one within 
     five years.
       Currently, there are four million Americans living with the 
     effects of stroke.
       15 percent to 30 percent of stroke survivors are 
     permanently disabled. 55 percent of stroke survivors have 
     some level of disability.
       40 percent of these patients feel they can no longer visit 
     people; almost 70 percent report that they cannot read; 50 
     percent need day-hospital services; 40 percent need home 
     help; 40 percent have a visiting nurse; and 14 percent need 
     Meals on Wheels.
       22 percent of men and 25 percent of women who have an 
     initial stroke die within one year.
     The staggering costs of stroke
       Stroke costs the U.S. $30 billion each year.
       The average cost per patient for the first 90 days 
     following a stroke is $15,000.
       The lifetime costs of stroke exceed $90,000 per patient for 
     ischemic stroke and over $225,000 per patient for 
     subarachnoid hemorrhage.
     Improvements can be made
       When a stroke unit was first established at Mercy General 
     Hospital in Sacramento, CA in December of 1990, the average 
     length of stay for a Medicare stroke patient in the immediate 
     care setting was 7 days and total hospital charges per 
     patient were $14,076. By June of 1994, the average length of 
     stay was 4.6 days and the charges per patient were $10,740. 
     Overall, in the three and a half years during which the 
     stroke unit was in operation, Mercy General's charges to 
     Medicare for stroke patients declined $1,621,296.
       In a national survey of acute stroke teams ASTs, Duke 
     University researchers found that the majority of ASTs cost 
     only $0-$5,000, far less than the average cost for 
     hospitalization of stroke patients.


       Stroke patients often do not receive effective treatments

       Nationally, only 2 percent to 3 percent of patients with 
     stroke are being treated with the clot-busting drug, tPA.
       In the year following FDA approval of tPA, it was 
     determined that only 1.5 percent of patients who might have 
     been candidates for tPA therapy actually received it.
       In a study of North Carolina's stroke treatment facilities, 
     66 percent of hospitals did not have stroke protocols and 82 
     percent did not have rapid identification for patients 
     experiencing acute stroke.
       A recent study of Cleveland, OH found that only 1.8 percent 
     of area patients with ischemic stroke received tPA.
       In a 1995 study of the Reading, Ohio Emergency Medical 
     Services System EMS, almost half of all stroke patients who 
     went through the MES system were dispatched as having 
     something other than stroke and a quarter of all patients 
     identified as having stroke by paramedics were later 
     discovered to have another cause for their illness.
       Out of 1000 hours of training for paramedics in Cincinnati, 
     only 1 percent is devoted to recognition and management of 
     acute stroke.
       A 1993 study of patients who had a stroke while they were 
     inpatient found a median delay between stroke recognition and 
     neurological evaluation of 2.5 hours.
       Neurologists are the attending physicians for only 11 
     percent of acute stroke patients.


              public awareness of stroke symptoms is poor

       In a 1989 survey by the American Heart Association of 500 
     San Francisco residents, 65 percent of those surveyed were 
     unable to correctly identify any of the early stroke warning 
     signs when given a list of symptoms.
       In a national survey conducted by the American Heart 
     Association, 29 percent of respondents could not name the 
     brain as the site of a stroke and only 44 percent identified 
     weakness or loss of feeling in an arm or leg as a symptom of 
     stroke.
       The International Stroke Trial found that only 4 percent of 
     the 19,000 patients studied presented within 3 hours of 
     symptom onset only 16 percent presented within 6 hours.

[[Page S8472]]

                               tPA facts

       A seminal NIH study found an 11 to 13 percent increase in 
     the number of tPA-treated patients exhibiting minimal or no 
     neurological deficits or disabilities compared with placebo 
     treated patients.
       That same study reported a 30 to 55 percent relative 
     improvement in clinical outcome for tPA-treated patients 
     compared with placebo-treated patients.


     NATIONAL ORGANIZATIONS SUPPORTING THE STOP STROKE ACT OF 2001

     American Academy of Neurology
     American Academy of Physical Medicine and Rehabilitation
     American Association of Neurological Surgeons
     American College of Chest Physicians
     American College of Emergency Physicians
     American College of Preventive Medicine
     American Heart Association/American Stroke Association
     American Physical Therapy Association
     American Society of Interventional and Therapeutic 
         Neuroradiology
     American Society of Neuroradiology
     Association of American Medical Colleges
     Association of State and Territorial Chronic Disease Program 
         Directors
     Association of State and Territorial Directors of Health 
         Promotion and Public Health Education
     Boston Scientific
     Brain Injury Association
     Congress of Neurological Surgeons
     Emergency Nurses Association
     Genentech, Inc.
     National Association of Public Hospitals and Health Systems
     National Stroke Association
     North American Society of Pacing and Electrophysiology
     Partnership for Prevention
     Society of Cardiovascular and Interventional Radiology
     Stroke Belt Consortium
     The Brain Attack Coalition which is made up of the following 
         advocacy organizations:
     American Academy of Neurology
     American Association of Neurological Surgeons
     American Association of Neuroscience Nurses
     American College of Emergency Physicians
     American Heart Association/American Stroke Association
     American Society of Neuroradiology
     National Stroke Association
     Stroke Belt Consortium
                                  ____



                                   American Heart Association,

                                        Dallas, TX, July 20, 2001.
     Hon. Edward Kennedy,
     U.S. Senate,
     Washington, DC.
       Dear Chairman Kennedy: On behalf of the American Heart 
     Association, our American Stroke Association division and our 
     more than 22.5 million volunteers and supporters, thank you 
     for leading the fight against stroke--the nation's third 
     leading cause of death.
       It has been our privilege to work with you and your staff 
     to draft the Stroke Treatment and Ongoing Prevention Act 
     (STOP Stroke Act). This vital legislation will help raise 
     public awareness about stroke and dramatically improve our 
     nation's stroke care. More specifically, the legislation will 
     conduct a national stroke education campaign; provide 
     critical resources for states to implement statewide stroke 
     care systems; establish a clearinghouse to support 
     communities aiming to improve stroke care; offer medical 
     professional development programs in new stroke therapies; 
     and conduct valuable stroke care research.
       Stroke touches the lives of almost all Americans. Today, 
     4.5 million Americans are stroke survivors, and as many as 30 
     percent of them are permanently disabled, requiring extensive 
     and costly care. In Massachusetts alone, stroke kills more 
     than 3,300 people every year. Unfortunately, most Americans 
     know very little about this disease. On average, stroke 
     patients wait 22 hours after the one set of symptoms before 
     receiving medical care. In addition, many health are 
     facilities are not equipped to treat stroke aggressively like 
     other medical emergencies.
       Your legislation helps build upon our successful stroke 
     programs. In 1998, the American Hearth Association launched a 
     bold initiative--Operation Stroke--to improve stroke care in 
     targeted communities across the country by strengthening the 
     stroke ``Chain of Survival.'' The Chain is a series of events 
     that must occur to improve stroke care and includes rapid 
     public recognition and reaction to stroke warning signs; 
     rapid assessment and pre-hospital care; rapid hospital 
     transport; and rapid diagnosis and treatment.
       The STOP Stroke Act will help ensure that the stroke Chain 
     of Survival is strong in every community across the nation 
     and that every stroke patient has access to quality care. We 
     strongly support this legislation and look forward to 
     continuing to work with you and Senator Frist to fight this 
     devastating disease. Thank you again for your leadership and 
     vision!
           Sincerely,
     Lawrence B. Sadwin,
       Chairman of the Board.
     David P. Faxon, M.D.,
       President.
                                  ____



                                  National Stroke Association,

                                     Englewood, CO, March 8, 2001.
     Hon. Edward Kennedy,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senator Kennedy: I am writing on behalf of the 
     national Stroke Association (NSA) to express our strong 
     commitment to helping you bring attention to, and secure 
     passage of, the ``Stroke Treatment and Ongoing Prevention Act 
     of 2001'' (the ``STOP Stroke Act'').
       NSA is a leading independent, national nonprofit 
     organization which dedicates 100 percent of its resources to 
     stroke including prevention, treatment, rehabilitation, 
     research, advocacy and support for stroke survivors and their 
     families. Our mission is to reduce the incidence and impact 
     of stroke--the number one cause of adult disability and 3rd 
     leading cause of death in America.
       NSA believes that your proposed legislation is historic--
     never before has comprehensive legislation been introduced to 
     address this misunderstood public health problem. In fact, 
     stroke has not been given the level of attention, focus or 
     resources commensurate with the terrible toll it takes on 
     Americans in both human and economic terms. We are grateful 
     for your leadership in bringing this issue to the top of the 
     public health agenda.
       The STOP Stroke Act clearly recognizes an urgent need to 
     build more effective systems of patient care and to increase 
     public awareness about stroke. We are hopeful that the Stroke 
     Prevention and Education Campaign which it authorizes will go 
     a long way toward disseminating the most accurate and timely 
     information regarding stroke prevention and the importance of 
     prompt treatment. NSA is encouraged that the state grant 
     program will facilitate the establishment of a comprehensive 
     network of stroke centers to reduce the overwhelming 
     disparity in personnel, technology, and other resources and 
     target assistance to some of the smaller, less advanced 
     facilities. We also believe that the research program is a 
     necessary component of the STOP Stroke Act in order to assess 
     and monitor barriers to access to stroke prevention, 
     treatment, and rehabilitation services, and to ultimately 
     raise the standard of care for those at risk, suffering or 
     recovering from stroke.
       Over the past few months NSA has convened leaders in 
     medicine, nursing, rehabilitation, healthcare, business, and 
     advocacy to work with your staff on developing this important 
     legislation. NSA is pleased to have contributed its ideas and 
     expertise on this critical health issue. We look forward to 
     working in partnership with you and your colleagues on 
     getting the legislation passed by Congress.
       Please count on us to work with you in any way possible to 
     ensure we STOP stroke.
           Sincerely,
                                                   Patti Shwayder,
     Executive Director/CEO.
                                  ____

         American Association of Neurological Surgeons; Congress 
           of Neurological Surgeons,
                                    Washington, DC, March 5, 2001.
     Hon. Ted Kennedy,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Kennedy: The American Association of 
     Neurological Surgeons (AANS) and the Congress of Neurological 
     Surgeons (CNS), representing over 4,500 neurosurgeons in the 
     United States, thank you for your leadership and vision in 
     crafting the ``STOP Stroke Act (Stroke Treatment and Ongoing 
     Prevention Act) of 2001.'' We strongly endorse this bill and 
     pledge to work with you to ensure its passage. Your 
     legislation would not only educate the public about the 
     burden of stroke and stroke-related disability, but would 
     encourage states to develop stroke planning systems through 
     the matching grant concept.
       Stroke is the nation's third leading cause of death and is 
     the leading cause of disability in our country creating a 
     huge human and financial burden associated with this disease. 
     The advances in research and treatment related to stroke over 
     the last decade have been truly remarkable. For example, 
     surgical techniques such as carotid endarterectomy have been 
     proven effective and saved lives. Also, the discovery of 
     therapeutic drugs that can be administered within three hours 
     of the onset of a stroke have allowed many survivors to 
     recover in a way that was impossible to imagine in even 
     recent years.
       What was once viewed as an untreatable and devastating 
     disease has the potential to become as commonly treatable as 
     heart attacks if appropriate resources are directed to the 
     problem. Senator Kennedy, your legislation will allow all 
     Americans to take advantage of these rapid advances in stroke 
     treatment and prevention.
       Once again, we strongly endorse this legislation. On behalf 
     of all neurosurgeons and the patients we serve, thank you for 
     your leadership on this issue. Please feel free to contact us 
     should you need further assistance.
           Sincerely,
     Stewart B. Dunsker, MD,
       President, American Association of Neurological Surgeons.
     Issam A. Awad, MD,
       President, Congress of Neurological Surgeons.

[[Page S8473]]

     
                                  ____
                                    National Association of Public


                                 Hospitals and Health Systems,

                                   Washington, DC, March 22, 2001.
     Hon. Edward M. Kennedy,
     U.S. Senate,
     Washington, DC.
       Dear Senator Kennedy: I am writing on behalf of the 
     National Association of Public Hospitals & Health Systems 
     (NAPH) to express our support for the ``STOP Stroke Act of 
     2001,'' legislation to help states improve the level of 
     stroke care that is offered to patients and to improve public 
     education about the importance of seeking early emergency 
     care to combat the effects of stroke.
       NAPH represents more than 100 of America's metropolitan 
     area safety net hospitals and health systems. The mission of 
     NAPH members is to provide health care services to all 
     individuals, regardless of insurance status or ability to 
     pay. More than 54 percent of the patients served by NAPH 
     systems are either Medicaid recipients or Medicare 
     beneficiaries; another 28 percent are uninsured.
       We applaud your efforts to raise public awareness about the 
     signs and symptoms of this pernicious disease and to assure 
     that all Americans--including our nation's poorest and most 
     vulnerable--have access to state-of-the-art stroke treatment. 
     In particular, we are pleased that your legislation would:
       Establish a grant program to provide funding to states--
     with a particular focus on raising the level of stroke 
     treatment in underserved areas--to assure that all patients 
     have access to high-quality stroke care;
       Ensure that all appropriate medical personnel are provided 
     access to training in newly developed approaches for 
     preventing and treating stroke;
       Authorize a national public awareness campaign to educate 
     Americans about the signs and symptoms of stroke and the 
     importance of seeking emergency treatment as soon as symptoms 
     occur; and,
       Create a comprehensive research program to identify best 
     practices, barriers to care, health disparities, and to 
     measure the effectiveness of public awareness efforts.
       NAPH has long supported efforts to assure that all 
     Americans are afforded access to the highest quality health 
     care services and most current technology that is available. 
     Indeed, it is critical that facilities that provide acute 
     care services to stroke patients have the resources necessary 
     to assure patients access to a minimum standard of stroke 
     care. Unfortunately, uncompensated care costs and high rates 
     of uninsured patients often make it difficult for safety net 
     providers to dedicate sufficient resources to meet these 
     goals.
       We are pleased that your legislation, through its state 
     grants program, attempts to direct additional resources 
     toward the providers that are most in need of updating their 
     stroke care systems. We urge you to consider amending your 
     legislation to allow local government and safety net 
     providers to participate directly in this grants program. 
     Allowing public hospitals and other safety net providers who 
     seek to improve their stroke care infrastructure to apply for 
     these grants will go a long way toward assuring that the 
     providers most in need of these resources get access to them.
       As the American population ages and promising discoveries 
     are being made to improve the early detection and treatment 
     of stroke, it is becoming increasingly important that 
     additional resources be directed at stroke awareness, 
     prevention and treatment programs. And, as federal funds are 
     provided, it is critical that all of our citizens, in 
     particular those who frequently slip through the cracks, are 
     given access to the best available stroke-related 
     specialists, diagnostic equipment and life-saving treatments 
     and therapies.
       We thank you for your ongoing leadership in developing 
     legislation to preserve and improve our nation's public 
     health systems and the healthy care safety net. We look 
     forward to working with you further to develop solutions to 
     the problems of our nation's poor and uninsured.
           Sincerely,
                                                    Larry S. Gage,
     President.
                                  ____



                                   Partnership for Prevention,

                                   Washington, DC, March 16, 2001.
     Re Stroke Treatment and Ongoing Prevention Act of 2001.

     Hon. Edward Kennedy,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Kennedy: We commend the introduction of the 
     Stroke Treatment and Ongoing Prevention Act of 2001 (STOP 
     Stroke Act). As you well know, stroke is the third leading 
     cause of death in the United States, a principal cause of 
     cardiovascular disease death, and a major cause of disability 
     for Americans.
       The STOP Stroke Act creates a framework for the nation to 
     begin systematically addressing some important tertiary 
     stroke prevention issues, namely timely diagnosis and 
     treatment. We concur that much more can and should be done to 
     ensure stroke patients are treated according to clinical 
     guidelines based on up-to-date scientific evidence.
       Investing in primary and secondary prevention is the best 
     strategy for stopping stroke. Hypertension is the top 
     contributor to stroke, followed by heart disease, diabetes, 
     and cigarette smoking. According to the National Institutes 
     of Health and the Centers for Disease Control and Prevention 
     (CDC), prevention of stroke requires addressing the critical 
     risk factors.
       To prevent or delay hypertension, experts at both agencies 
     recommend community-based interventions that promote healthy 
     diets, regular physical activity, tobacco cessation, and 
     limited alcohol intake. The Public Health Service's clinical 
     guidelines on treating tobacco use and dependence is another 
     resource to help Americans kick the habit. Lifestyle 
     modifications for hypertension prevention not only contribute 
     to overall cardiovascular health, but also reduce risk 
     factors associated with other chronic diseases (e.g., 
     obesity, diabetes, and cancer).
       A second essential step is to improve management of 
     hypertension once it develops. Recent studies indicate 
     effective hypertension treatment can cut stroke incidence and 
     fatality rates by at least a third. To advance hypertension 
     treatment, we must invest in disease management systems that 
     enable health care providers to prescribe the most effective 
     therapies and assist patients with pharmacological regimens 
     and healthy lifestyles.
       The main prevention components in the STOP Stroke Act 
     (i.e., the proposed research program and national stroke 
     awareness campaign) should be coordinated with--and even 
     integrated into--the CDc comprehensive cardiovascular disease 
     program. Involving nearly every state, this program offers an 
     integrated network that is addressing the underlying causes 
     of stroke and other cardiovascular diseases.
       Partnership welcomes the STOP Stroke Act and its intent to 
     address stroke, a serious health problem. We also encourage 
     strengthened primary and secondary prevention policies to 
     protect health before strokes happen.
           Sincerely yours,
                                               Ashley B. Coffield,
     President.
                                  ____



                                       Brain Attack Coalition,

                                        Bethesda, MD, May 7, 2001.
     Hon. Edward M. Kennedy,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Kennedy: The Brain Attack Coalition is a group 
     of professional, voluntary and governmental organizations 
     dedicated to reducing the occurrence, disabilities and death 
     associated with stroke.
       Stroke is our nations third leading cause of death and the 
     leading cause of adult long-term disability. Recent advances 
     in stroke treatment can lead to improved outcomes if stroke 
     patients are treated shortly after symptom onset. Currently 
     only two to three percent of stroke patients who are 
     candidates for thrombolytic therapy receive it. This must be 
     remedied.
       We urgently need to educate the public about stroke 
     symptoms and the importance of seeking medical attention 
     immediately. We also need to provide training to medical 
     personnel in the new approaches for treating and preventing 
     stroke. The Stroke Treatment and Ongoing Prevention Act of 
     2001 (STOP Stroke Act) is designed to address these issues 
     and to establish a grant program to provide funding to states 
     to help ensure that stroke patients in each state have access 
     to high-quality stroke care.
       The members of the Brain Attack Coalition strongly support 
     the STOP Stroke Act and hope for prompt enactment of this 
     legislation. Please not that the National Institute of 
     Neurological Disorders and Stroke and the Centers for Disease 
     Control and Prevention are not included in this endorsement 
     because the Administration has not taken a position on the 
     legislation.
           Sincerely,
                                          Michael D. Walker, M.D.,
     Chair, Brain Attack Coalition.
                                  ____

                                                 American Physical


                                          Therapy Association,

                                    Alexandria, VA, June 13, 2001.
     Hon. Edward Kennedy,
     U.S. Senate,
     Washington, DC.
       Dear Senator Kennedy: I am writing to express the strong 
     support of the American Physical Therapy Association (APTA) 
     for the ``Stroke Treatment and Ongoing Prevention Act of 
     2001,'' which you plan to introduce soon.
       As you know, stroke is the third leading cause of death in 
     the United States, and is one of the leading causes of adult 
     disability. APTA believes your legislation is critical to 
     establishing a comprehensive system for stroke prevention, 
     treatment and rehabilitation in the United States. We 
     appreciate your modification to the legislation to highlight 
     the important role physical therapists play in stroke 
     prevention and rehabilitation.
       Every day, physical therapists across the nation help 
     approximately 1 million people alleviate pain, prevent the 
     onset and progression of impairment, functional limitation, 
     disability, or changes in physical function and health status 
     resulting from injury, disease, or other causes. Essential 
     participants in the health care delivery system, physical 
     therapists assume leadership roles in rehabilitation 
     services, prevention and health maintenance programs. They 
     also play important roles in developing health care policy 
     and appropriate standards for the various elements of 
     physical therapists practice to ensure availability, 
     accessibility, and excellence in the delivery of physical 
     therapy services.
       Again, thank you for your leadership on this issue. Please 
     call upon APTA to assist in the passage of this important 
     legislation.
           Sincerely,
                                                Ben F. Massey, PT,
                                                        President.


[[Page S8474]]


  Mr. KENNEDY. Mr. President, today Senator Frist and I are introducing 
the ``Community Access to Emergency Defibrillation Act of 2001.''
  Every 2 minutes, sudden cardiac arrest strikes down another person. 
Cardiac arrest can strike at any time without any warning. Without 
rapid intervention, is unavoidable.
  One thousand people will die today from cardiac arrest, and 200,000 
people will lose their lives this year to this devastating disease. The 
good news is that we know that 90 percent of cardiac arrest victims can 
be saved, if immediate access is available to an automated external 
defibrillator, an AED.
  We could save thousands of lives every year if AEDs are available in 
every public building. Yet few communities have programs to make this 
technology widely accessible.
  That is why Senator Frist and I today are introducing the ``Community 
AED Act''. Its goal is to provide funding for programs to increase 
access to emergency defibrillation. It will place AEDs in public areas 
like schools, workplaces, community centers, and other locations where 
people gather. It will provide training to use and maintain the 
devices, and funding for coordination with emergency medical personnel.
  Furthermore, it also funds the development of community-based 
projects to enhance AED access and place them in unique settings where 
access is more difficult to achieve. Our bill also emphasizes 
monitoring cardiac arrest in children and putting AEDs in schools--so 
that we can also deal with cardiac arrest when it affects our youth.
  Sudden cardiac arrest is a tragedy for families all across America. 
Communities that have already implemented programs to increase public 
access to AEDs--like the extremely successful ``First Responder 
Defibrillator Program'' in Boston--have been able to achieve survival 
rates of up to 50 percent. That's 100,000 lives that we can save each 
year if every community implements a program like this one. This bill 
will enable communities to save lives in public buildings, in 
workplaces, and in schools all across the nation, and I urge you to 
stand with Senator Frist and I in support of this legislation--
legislation that will have a lifesaving impact on us all.
  I ask unanimous consent that a bill summary for the ``Community 
Access to Emergency Defibrillation Act of 2001'' be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

      The Community Access to Emergency Defibrillation Act of 2001


                  background and Need for Legislation

       Cardiac arrest is not a heart attack--it is instant heart 
     paralysis for which defibrillation is the only effective 
     treatment. Every minute that passes after a cardiac arrest, a 
     person's chance of surviving decreases by 10 percent. Cardiac 
     arrest takes a tremendous toll on the American public; each 
     year, it kills over 220,000 people.
       The good news is that 90 percent of cardiac arrest victims 
     who are treated with a defibrillator within one minute of 
     arrest can be saved. In addition, cardiac arrest victims who 
     are treated with CPR within four minutes and defibrillation 
     within ten minutes have up to a 40 percent chance of 
     survival. However, few communities have programs to make 
     emergency defibrillation widely accessible to cardiac arrest 
     victims. Communities that have implemented public access 
     programs have achieved average survival rates for out-of-
     hospital cardiac arrest as high as 50 percent.
       Automated external defibrillators, AEDs, have a 95 percent 
     success rate in terminating ventricular fibrillation. Wide 
     use of defibrillators could save as many as 50,000 lives 
     nationally each year, yet fewer than half of the nation's 
     ambulance services, 10-15 percent of emergency service fire 
     units, and less than 1 percent of police vehicles are 
     equipped with AEDs.
       The Community Access to Emergency Defibrillation, Community 
     AED Act, provides for the following public health initiatives 
     to increase public awareness of emergency defibrillation and 
     to expand public access to lifesaving AEDs:
     Community Grants Program to establish comprehensive 
         initiatives to increase public access to AEDs
       The Community AED Act provides $50 million for communities 
     to establish public access defibrillation programs. 
     Communities receiving these grants will: train local 
     emergency medical services personnel to administer immediate 
     care, including CPR and automated external defibrillation, to 
     cardiac arrest victims; purchase and place automated external 
     defibrillators in public places where cardiac arrests are 
     likely to occur; train personnel in places with 
     defibrillators to use them properly and administer CPR to 
     cardiac arrest victims; inform local emergency medical 
     services personnel, including dispatchers, about the location 
     of defibrillators in their community; train members of the 
     public in CPR and automated external defibrillation; ensure 
     proper maintenance and testing of defibrillators in the 
     community; encourage private companies in the community to 
     purchase automated external defibrillators and train 
     employees in CPR and emergency defibrillation; and collect 
     data to evaluate the effectiveness of the program in 
     decreasing the out-of-hospital cardiac arrest survival 
     rate in the community.
     Community demonstration projects to develop innovative AED 
         access programs
       The Community AED Act provides $5 million for community-
     based demonstration projects. Grantees will develop 
     innovative approaches to maximize community access to 
     automated external defibrillation and provide emergency 
     defibrillation to cardiac arrest victims in unique settings. 
     Communities receiving these grants must meet many of the same 
     requirements for equipment maintenance, public information, 
     and data collection included in the larger grants program.
     National Clearinghouse to promote AED access in schools
       The Community AED Act provides for a national information 
     clearinghouse to provide information to increase public 
     awareness and promote access to defibrillators in schools. 
     This center will also establish a database for information on 
     sudden cardiac arrest in youth and will provide assistance to 
     communities wishing to develop screening programs for at risk 
     youth.
       The Community AED Act is supported by these and other 
     leading health care organizations:
       American Heart Association; American Red Cross; Agilent 
     Technologies; American College of Emergency Physicians'; 
     Cardiac Science; Citizen CPR Foundation; Congressional Fire 
     Services Institute; Medical Device Manufacturers Association; 
     Medical Research Laboratories, Inc.; Medtronic; MeetingMed: 
     National Center for Early Defibrillation; National Emergency 
     Medical Services Academy; National Fire Protection 
     Association; National SAFE KIDS Compaign; National Volunteer 
     Fire Council; and Survivalink.
                                 ______