BILL NUMBER: AB 559 CHAPTERED 10/03/01 CHAPTER 458 FILED WITH SECRETARY OF STATE OCTOBER 3, 2001 APPROVED BY GOVERNOR OCTOBER 2, 2001 PASSED THE SENATE AUGUST 27, 2001 PASSED THE ASSEMBLY JUNE 6, 2001 AMENDED IN ASSEMBLY JUNE 4, 2001 INTRODUCED BY Assembly Member Wiggins FEBRUARY 21, 2001 An act to add Section 4119.2 to the Business and Professions Code, to add Section 49414 to the Education Code, and to add Section 1797.197 to the Health and Safety Code, relating to emergency medical services. LEGISLATIVE COUNSEL'S DIGEST AB 559, Wiggins. Emergency medical services. (1) Existing law authorizes a pharmacy to furnish a dangerous drug or dangerous device to a licensed health care facility for storage in a specified manner. This bill would authorize a pharmacy to furnish epinephrine auto-injectors to a school district or county office of education if certain conditions are met. The bill would require the school district or county office of education to maintain records regarding the acquisition and disposition of epinephrine auto-injectors furnished by the pharmacy for a period of 3 years from the date the records were created. (2) Under existing law, the governing board of any school district is required to give diligent care to the health and physical development of pupils, and may employ properly certified persons for that work. This bill would authorize a school district or county office of education to provide emergency epinephrine auto-injectors to trained personnel, and would authorize the trained personnel to utilize those epinephrine auto-injectors to provide emergency medical aid to persons suffering from an anaphylactic reaction. The bill would expressly authorize each public and private elementary and secondary school in the state to voluntarily determine whether or not to make emergency epinephrine auto-injectors and trained personnel available at its school and to designate one or more school personnel to receive prescribed training regarding epinephrine auto-injectors from individuals in specified positions. The bill would require the Superintendent of Public Instruction to establish minimum standards of training for the administration of epinephrine auto-injectors and to consult with the State Department of Health Services, organizations, and providers with expertise in administering epinephrine auto-injectors and administering medication in a school environment in developing those standards. The bill would authorize school nurses or, if the school does not have a school nurse, a person who has received training regarding epinephrine auto-injectors, to obtain prescriptions for epinephrine auto-injectors from individuals in certain positions and to immediately administer an epinephrine auto-injector under certain circumstances. The bill would require those individuals to initiate emergency medical services or other appropriate medical followup in accordance with written training materials. The bill would also require any school district or county office of education electing to utilize epinephrine auto-injectors for emergency medical aid to create a plan to address specified issues. (3) Existing law requires the Emergency Medical Services Authority to develop planning and implementation guidelines for emergency medical service systems which address, among other things, manpower and training. Existing law requires the authority to adopt rules and regulations as may be reasonable and proper to enable the authority to exercise its powers and perform its duties. This bill would require the authority to establish training and standards for all prehospital emergency care personnel regarding the characteristics and method of assessment and treatment of anaphylactic reactions and the use of epinephrine, and to promulgate regulations therefor. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 4119.2 is added to the Business and Professions Code, to read: 4119.2. (a) Notwithstanding any other provision of law, a pharmacy may furnish epinephrine auto-injectors to a school district or county office of education pursuant to Section 49414 of the Education Code if all of the following are met: (1) The epinephrine auto-injectors are furnished exclusively for use at a school district site or county office of education. (2) A physician and surgeon provides a written order that specifies the quantity of epinephrine auto-injectors to be furnished. (b) Records regarding the acquisition and disposition of epinephrine auto-injectors furnished pursuant to subdivision (a) shall be maintained by both the school district or county office of education for a period of three years from the date the records were created. The school district or county office of education shall be responsible for monitoring the supply of auto-injectors and assuring the destruction of expired auto-injectors. SEC. 2. Section 49414 is added to the Education Code, to read: 49414. (a) A school district or county office of education may provide emergency epinephrine auto-injectors to trained personnel, and trained personnel may utilize those epinephrine auto-injectors to provide emergency medical aid to persons suffering from an anaphylactic reaction. Any school district or county office of education choosing to exercise the authority provided under this subdivision shall not receive state funds specifically for the purposes of this subdivision. (b) For purposes of this section, the following terms have the following meaning: (1) "Anaphylaxis" means a potentially life-threatening hypersensitivity to a substance. (A) Symptoms of anaphylaxis may include shortness of breath, wheezing, difficulty breathing, difficulty talking or swallowing, hives, itching, swelling, shock, or asthma. (B) Causes of anaphylaxis may include, but are not limited to, an insect sting, food allergy, drug reaction, and exercise. (2) "Epinephrine auto-injector" means a disposable drug delivery system with a spring-activated concealed needle that is designed for emergency administration of epinephrine to provide rapid, convenient first aid for persons suffering a potentially fatal reaction to anaphylaxis. (c) Each public and private elementary and secondary school in the state may voluntarily determine whether or not to make emergency epinephrine auto-injectors and trained personnel available at its school. In making this determination, a school shall evaluate the emergency medical response time to the school and determine whether initiating emergency medical services is an acceptable alternative to epinephrine auto-injectors and trained personnel. Any school choosing to exercise the authority provided under this subdivision shall not receive state funds specifically for the purposes of this subdivision. (d) Each public and private elementary and secondary school in the state may designate one or more school personnel on a voluntary basis to receive initial and annual refresher training, based on the standards developed pursuant to subdivision (e), regarding the storage and emergency use of an epinephrine auto-injector from the school nurse or other qualified person designated by the school district physician, the medical director of the local health department, or the local emergency medical services director. Any school choosing to exercise the authority provided under this subdivision shall not receive state funds specifically for the purposes of this subdivision. (e) (1) The Superintendent of Public Instruction shall establish minimum standards of training for the administration of epinephrine auto-injectors that satisfy the requirements in paragraph (2). For purposes of this subdivision, the Superintendent of Public Instruction shall consult with organizations and providers with expertise in administering epinephrine auto-injectors and administering medication in a school environment, including, but not limited to, the State Department of Health Services, the Emergency Medical Services Authority, the American Academy of Allergy, Asthma, and Immunology, the California School Nurses Organization, the California Medical Association, the American Academy of Pediatrics, and others. (2) Training established pursuant to this subdivision shall include all of the following: (A) Techniques for recognizing symptoms of anaphylaxis. (B) Standards and procedures for the storage and emergency use of epinephrine auto-injectors. (C) Emergency follow-up procedures, including calling the emergency 911 phone number and contacting, if possible, the pupil's parent and physician. (D) Instruction and certification in cardiopulmonary resuscitation. (E) Written materials covering the information required under this subdivision. (3) A school shall retain for reference the written materials prepared under subparagraph (E) of paragraph (2). (f) A school nurse, or if the school does not have a school nurse, a person who has received training pursuant to subdivision (d), may do the following: (1) Obtain from the school district physician, the medical director of the local health department, or the local emergency medical services director a prescription for epinephrine auto-injectors. (2) Immediately administer an epinephrine auto-injector to a person exhibiting potentially life-threatening symptoms of anaphylaxis at school or a school activity when a physician is not immediately available. (g) A person who has received training as set forth in subdivision (d) or a school nurse shall initiate emergency medical services or other appropriate medical follow up in accordance with the training materials retained pursuant to paragraph (3) of subdivision (e). (h) Any school district or county office of education electing to utilize epinephrine auto-injectors for emergency medical aid shall create a plan to address all of the following issues: (1) Designation of the individual or individuals who will provide the training pursuant to subdivision (d). (2) Designation of the school district physician, the medical director of the local health department, or the local emergency medical services director that the school district or county office of education will consult for the prescription for epinephrine auto-injectors pursuant to paragraph (1) of subdivision (f). (3) Documentation as to which individual, the school nurse or other trained person pursuant to subdivision (f), in the school district or county office of education will obtain the prescription from the physician and the medication from a pharmacist. (4) Documentation as to where the medication is stored and how the medication will be made readily available in case of an emergency. SEC. 3. Section 1797.197 is added to the Health and Safety Code, to read: 1797.197. The authority shall establish training and standards for all prehospital emergency care personnel, as defined pursuant to paragraph (2) of subdivision (a) of Section 1797.189, regarding the characteristics and method of assessment and treatment of anaphylactic reactions and the use epinephrine. The authority shall promulgate regulations regarding these matters for use by all prehospital emergency care personnel.