BILL ANALYSIS
SENATE JUDICIARY COMMITTEE
Senator Ellen M. Corbett, Chair
2009-2010 Regular Session
AB 1312
Assemblymember Swanson
As Amended June 17, 2009
Hearing Date: July 14, 2009
Health and Safety Code
SK:jd
SUBJECT
Defibrillators
DESCRIPTION
This bill would make the current requirements for health studios
to purchase, maintain, and train staff in the use of automatic
external defibrillators (AEDs) applicable to amusement parks and
golf courses. This bill would revise the sunset date on this
requirement from July 1, 2012 to July 1, 2014.
BACKGROUND
An AED is a medical device which is used to administer an
electric shock through the chest wall to the heart after someone
suffers cardiac arrest. Built-in computers assess the patient's
heart rhythm, determine whether the person is in cardiac arrest,
and signal whether to administer the shock. Audible cues guide
the user through the process.
In 1999, the Legislature passed and the Governor signed SB 911
(Figueroa, Ch. 163, Stats. 1999) which created a qualified
immunity from civil liability for trained persons who use AEDs
in good faith and without compensation when rendering emergency
care or treatment at the scene of an emergency. The immunity
does not apply in cases of personal injury or wrongful death
resulting from gross negligence or willful or wanton misconduct.
AB 2041 (Vargas, Ch. 718, Stats. 2002) expanded this immunity
by repealing the training requirements and also relaxing the
requirement that building owners must ensure that expected AED
users complete training as a condition of immunity. AB 2041 was
enacted with a five-year sunset which was extended another five
(more)
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years to January 1, 2013 by AB 2083 (Vargas, Ch. 85, Stats.
2006).
In 2005, AB 1507 (Pavley, Ch. 431, Stats. 2005) was enacted to
require health studios, beginning July 1, 2007, to acquire,
maintain, and train personnel in the use of AEDs. AB 1507
specifically applied most of the AB 2041 provisions to health
studios but made the acquisition of AEDs mandatory rather than
voluntary until July 1, 2012.
This bill would extend the sunset date on the current
requirement that health studios purchase, maintain, and train
staff in the use of AEDs until July 1, 2014. The bill would
also add amusement parks and golf courses to the statute,
thereby requiring those entities to acquire and maintain AEDs
and to train staff in how to use the devices.
CHANGES TO EXISTING LAW
Existing law requires health studios, beginning July 1, 2007, to
acquire an AED and to maintain, and train personnel in the use
of that AED. These requirements sunset on July 1, 2012.
(Health & Saf. Code Secs. 104113(a)(1), (2).)
Existing law provides that on or after July 1, 2012 a health
studio that elects to continue the installation of an AED shall
maintain and train personnel in the use of an AED and shall not
be liable for civil damages resulting from the use, attempted
use, or nonuse of an AED. (Health & Saf. Code Sec.
104113(a)(3).)
Existing law requires a health studio to do all of the
following:
a. Comply with all regulations governing the placement of
an AED.
b. Ensure that the AED is maintained and regularly tested,
as specified.
c. Ensure that the AED is checked for readiness after each
use and at least once every 30 days if the AED has not been
used in the preceding 30 days. Records of these checks
must be maintained.
d. Ensure that any person who renders emergency care or
treatment on a person in cardiac arrest by using an AED
activates the emergency services system as soon as possible
and reports any use of the AED to the licensed physician
and local EMS agency.
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e. For every AED acquired, up to five units, no less than
one employee per AED shall complete a training course in
AED use. After the first five AEDs are acquired, for each
additional five AEDs acquired a minimum of one employee
shall be trained.
f. Acquirers of AEDs shall have trained employees who
should be available to respond to an emergency that may
involve the use of an AED during normal operating hours.
Acquirers of AEDs may need to train additional employees to
assure that a trained employee is available at all times.
g. Have a written plan that describes the procedures to be
followed in the event of an emergency that may involve the
use of an AED. (Health & Saf. Code Sec. 104113(e).)
Existing law provides for immunity from liability as follows:
a. An employee of a health studio who renders emergency
care or treatment is not liable for civil damages resulting
from the use, attempted use, or nonuse of an AED.
b. When an employee uses, does not use, or attempts to use
an AED to render emergency care or treatment, the members
of the board of directors of a facility are not liable for
civil damages resulting from any act or omission in
rendering the care or treatment, including the use or
nonuse of the AED.
c. When an employee of a health studio renders emergency
care or treatment using an AED, the owners, managers,
employees, or otherwise responsible authorities of the
facility are not liable for civil damages resulting from
any act or omission in the course of rendering that care or
treatment, provided the facility has fully complied with
existing law requiring testing and staffing, as described
above.
d. These provisions of immunity from liability do not apply
in the case of personal injury or wrongful death that
results from gross negligence or willful or wanton
misconduct on the part of the person who uses, attempts to
use, or maliciously fails to use an AED to render emergency
care or treatment. (Health & Saf. Code Secs. 104113(b),
(c), (d), (f).)
This bill would add amusement parks and golf courses to the
above statute, making those two entities subject to all of the
above-described provisions.
This bill would impose a requirement for health studios to
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install AEDs until January 1, 2014, and, as of that date, would
repeal the requirement for installation of AEDs and the
associated immunity for their use or non-use.
This bill would require that records be maintained for two years
after the AED is checked for readiness.
This bill would extend the sunset date on the above statute to
July 1, 2014.
This bill would define "amusement parks" to mean any area where
amusement park rides are inspected pursuant to the Labor Code,
as specified.
COMMENT
1. Stated need for the bill
The author writes that this bill addresses the following two
deficiencies in current law: "Provisions governing AEDs at
health clubs are set to expire. 2) Provisions regarding
placement of AEDs ought to be broadened to include other
high-incidence locations of heart attacks."
2. The importance of getting help fast
In the case of sudden cardiac arrest (SCA), every second counts:
there is a ten percent reduction in survival for every minute
delay in response. It has been said "few life threatening
emergencies are as time sensitive as SCA," and the American
Heart Association recommends that the optimal response time from
collapse of the victim to on-scene arrival of the AED with a
trained rescuer is three minutes.
According to the Sudden Cardiac Arrest Association, "[i]t is
essential that defibrillation be administered immediately
following the cardiac arrest. If the heart does not return to a
regular rhythm within 5-7 minutes, this fibrillation could be
fatal. If defibrillated within the first minute of collapse,
the victim's chances for survival are close to 90 percent. . .
. If [defibrillation] is delayed by more than 10 minutes, the
chance of survival in adults is less than 5 percent."
Under this bill, both golf courses and amusement parks would be
required to install and maintain an AED and train personnel in
the use of that AED. Because both sites cover large areas the
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issue of AED placement is critical. Although the statute does
not require that a specified number of AEDs be installed,
experts such as the American Heart Association recommend that
organizations "[c]onsider placing more than one AED at a
location that covers a large area . . . while there's no
research that indicates a recommended coverage area for an AED,
. . . achieving a 3-minute response time should be the primary
guide to making placement decisions." In addition, it should be
noted that the three-minute response time must take into account
the time to get to the AED and the time to get back to the
victim. As a result, golf courses and amusement parks should
consider installing AEDs in multiple locations, as it may not be
sufficient to install an AED in the clubhouse alone.
3. The importance of having trained responders on hand
The American Heart Association emphasizes that it is important
that the person who is responsible for using the AED be trained
in CPR and in how to use the AED, explaining:
If AEDs are so easy to use, why do people need formal training
in how to use them? An AED operator must know how to
recognize the signs of a sudden cardiac arrest, when to
activate the EMS system, and how to do CPR. It's also
important for operators to receive formal training on the AED
model they will use so that they become familiar with the
device and are able to successfully operate it in an
emergency. Training also teaches the operator how to avoid
potentially hazardous situations.
The National Center for Early Defibrillation also indicates that
simply installing AEDs is not enough, stating "[i]t is important
to identify a medical director, develop an on-site AED response
plan, train designated responders and conduct periodic AED
response drills." (Emphasis added.)
This bill would require golf courses and amusement parks to
train personnel in the use of installed AEDs. Existing law,
currently applicable only to health clubs, requires acquirers of
AEDs to have trained employees who should be available to
respond to an emergency that may involve the use of an AED
during normal operating hours. The statute also provides that
acquirers of AEDs may need to train additional employees to
assure that a trained employee is available at all times. Under
this bill, golf courses and amusement parks would be subject to
these requirements.
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4. AEDs are not foolproof
AEDs are said to be "foolproof," but manufacturers have recalled
some AEDs recently. In April 2009 the maker of the Zoll AED
Plus issued a Class 1 recall, the most serious type of recall
that involves situations in which there is a reasonable
probability that use of the product will cause serious injury or
death. In the case of the Zoll AED Plus, at least two patients
died following incidents when the device failed to deliver a
shock. Subsequent tests determined that faulty battery test
software failed to detect defective batteries, and it was later
found that additional malfunctions had occurred, resulting in
one more death.
Over 14,000 AED 10 and MRL Jumpstart defibrillators were
recalled in March 2009 after 39 reports of incidents, including
two deaths. In this case, the company alerted consumers to the
following potential problems with the defective AED: low-energy
shock, electromagnetic noise interference, unexpected shutdown
during use, blown fuse, loss of voice prompts, and shutdown in
cold temperatures.
Another Class 1 recall was issued on September 11, 2008 for
LifePak CR Plus AEDs made by Physio Control, Inc. The AED was
determined to be defective because the shock button was covered
and not visible so that responders were unable to administer the
shock.
5. AED placement in golf courses and amusement parks
Sudden cardiac arrest often occurs in active, outwardly healthy
people. Indeed, strenuous exercise has been shown to be a
trigger for sudden cardiac arrest. The National Center for
Early Defibrillation asserts that the risk of sudden cardiac
arrest during exercise is significantly higher than at times of
no exertion.
Experts who have studied "public access defibrillation" suggest
that placing AEDs in public places with the highest incidence of
cardiac arrest will help to maximize their usefulness and
potentially increase survival rates from cardiac arrest. A
study published in 1998 for the American Heart Association
attempted to determine the optimal placement in public places of
AEDs. That study, which focused on certain cardiac arrests in
Seattle and King County, found the higher incidence location
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categories to be: (1) international airport (Seattle-Tacoma
International Airport); (2) county jail; (3) large shopping
mall; (4) public sports venue; (5) industrial site; (6) golf
course; (7) shelter; (8) ferries/train terminal; (9) health
club/gym; and (10) community/senior center. (Becker et al,
"Public Locations of Cardiac Arrest: Implications for Public
Access Defibrillation," Circulation, 1998.)
Although golf courses had an average, for the group, incidence
per site, they were second only to the airport for actual number
of cardiac arrests (23 over five years; the airport had 35 in
the same period). An October 2009 article in Golf Digest
entitled "Saving lives on the golf course: Join the battle
against golf's deadliest enemy: sudden cardiac arrest" explains
why golf courses have a higher-incidence of cardiac arrests:
Why are golfers at such high risk? Dr. Edward A. Palank, a
cardiologist in Naples, Fla., cites three reasons:
* The age of the average golfer correlates with the population
most at risk. (The average age of a sudden-cardiac- arrest
victim is 65, though many who are stricken are in their 30s
and 40s.)
* Heart attacks are most likely to occur between 6 and 11
a.m., precisely when most golfers are out on the course.
* Golfers spend from four to six hours a day on the course,
often several times a week, which simply means, says Palank,
"Things are going to happen."
In the case of amusement parks, an often-cited 2007 study in
Germany found that modern roller coasters "can make the heart
race up to 155 beats a minute and spur dangerous changes to
heart rhythm in some people." (Los Angeles Times, "Modern
coasters carry risky thrills for hearts," August 15, 2007.) In
some cases, the roller coasters gave riders "a stomach
plummeting 6 g's of gravity force, equivalent to that
experienced by astronauts." (Daily Herald, "Roller coasters may
be too much for heart to handle," June 25, 2007.) As a result,
experts recommend that people with heart conditions and high
blood pressure should not ride roller coasters. In several
cases, there have been tragic consequences for riders. In 2005,
a four-year old boy died after a ride on "Mission Space" and in
another case a 73-year old man was unresponsive after riding
"Space Mountain." In both cases, the riders suffered from heart
conditions.
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In November 2007, Disneyland Resort and Walt Disney World Resort
announced the installation of 250 AEDs (50 at Disneyland and 200
at Walt Disney World) which followed the 2003 installation of
600 AEDs at the resorts. A press release announcing the
installation stated that more than 5,000 staff had been trained
in the use of AEDs and an additional 500 would be trained in the
upcoming year. At the time, Disney also indicated that AEDs
installed at its resorts might have already saved as many as 40
lives. (Orlando Sentinel, "Bad heart, lack of AED blamed in
death at Disney," December 21, 2007.)
6. Immunity provisions
Under existing law, employees of health studios are not liable
for civil damages resulting from the use, attempted use, or
nonuse of an AED when they are rendering emergency care or
treatment. Similarly, when that employee renders emergency care
or treatment the owners, managers, employees, or otherwise
responsible authorities of the facility are not liable for civil
damages that result from any act or omission in the course of
rendering that care or treatment. This protection is available
to the facility as long as it has fully complied with existing
conditions concerning testing and staffing.
Those conditions require that the entity maintain and regularly
test the AED and check it for readiness after each use and at
least once every 30 days if the device has not been used in the
previous 30 days. Existing law also sets a minimum level of
trained employees by providing that for up to five installed
AEDs, the entity shall have no less than one employee who is
trained in the use of the AEDs. If more than five AEDs are
installed, the entity is required to train a minimum of one
additional employee for each five additional AEDs installed.
Finally, the entity must have trained employees who are capable
of responding to an emergency during normal business hours and
may need to train additional employees to assure that a trained
employee is available at all times. All of these requirements
are conditions for the immunity from liability under existing
law and under this bill.
However, none of the protections from liability apply in the
case of personal injury or wrongful death that results from
gross negligence or willful or wanton misconduct on the part of
the person who uses, attempts to use, or maliciously fails to
use the AED to provide emergency care or treatment.
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Under this bill, golf course and amusement park employees,
owners, managers, or otherwise responsible authorities would
receive these protections from liability provided that any
ensuing harm did not result from gross negligence or willful or
wanton misconduct.
7. Sunset date; effect on immunity; necessary amendments
Existing law requires health studios to install an AED on their
premises and grants them a qualified immunity for the use, or
nonuse, of those devices. While that requirement sunsets on
July 1, 2012, existing law provides that studios may continue to
install AEDs and enjoy the same qualified immunity after that
date.
This bill would revise those provisions by removing the July 1,
2012 sunset, and, instead, sunset the entire section on AEDs on
January 1, 2014. As a result, this bill would impose a
requirement for health studios to install AEDs until January 1,
2014, and, as of that date, repeal not only the requirement for
installation of AEDs, but also the associated immunity for their
use or non-use.
The author has indicated that this is not his intent. As a
result, the bill should be amended to provide that the qualified
immunity would continue after January 1, 2014.
Support : American Red Cross; California Professional
Firefighters; City of Sacramento
Opposition : None Known
HISTORY
Source : Author
Related Pending Legislation : AB 142 (Hayashi) would address
staffing issues related to health studios that are available for
use 24 hours per day, but are not staffed during that entire
time. This bill is pending in this committee.
Prior Legislation : See Background.
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Prior Vote :
Assembly Judiciary Committee (Ayes 10, Noes 0)
Assembly Floor (Ayes 77, Noes 0)
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