BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 704
AUTHOR: Fong
INTRODUCED: February 21, 2013
HEARING DATE: July 3, 2013
CONSULTANT: Marchand
SUBJECT : Emergency medical services: military experience.
SUMMARY : Requires Emergency Medical Services Authority to
develop and adopt regulations to accept the education, training
and practical experience that an applicant received as a member
of the armed forces toward the qualifications and requirements
for certification as an EMT-I or EMT-II, or licensure as an
EMT-P.
Existing law:
1.Establishes the Emergency Medical Services Authority (EMSA)
within the California Health and Human Services Agency, and
requires the director of EMSA to be a physician appointed by
the Governor.
2.Requires EMSA, among other things, to develop planning and
implementation guidelines for emergency medical services
systems which address specified components, including manpower
and training, communications, transportation, system
organization and management, data collection and evaluation,
and disaster response.
3.Establishes the EMS Commission within the California Health
and Human Services Agency, composed of 18 members appointed by
the Governor, the Speaker of the Assembly, and the Senate
Committee on Rules to represent specified entities,
professions and associations.
4.Requires the EMS Commission to review and approve regulations,
standards and guidelines to be developed by EMSA for
implementation of the EMS System and the Prehospital Emergency
Medical Care Personnel Act.
5.Defines "Emergency Medical Technician-I" or "EMT-I" as an
individual trained in all facets of basic life support, as
specified. Defines an "Emergency Medical Technician-II,"
"EMT-II," "Advanced Emergency Medical Technician," or
Continued---
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"Advanced EMT" as an EMT-I with additional training in limited
advanced life support according to specified standards. Both
EMT-Is and EMT-IIs are certified at the local level.
6.Defines "Emergency Medical Technician-Paramedic," "EMT-P,"
"paramedic" or "mobile intensive care paramedic" means an
individual whose scope of practice includes the ability to
provide advanced life support, as specified, including
administering specified medications. EMT-Ps are licensed and
regulated at the state level through EMSA.
This bill:
1.Requires EMSA to develop, and after approval by the EMS
Commission, adopt regulations to accept, upon presentation of
satisfactory evidence by an applicant for certification as an
EMT-I or EMT-II, or licensure as an EMT-P, the education,
training and practical experience completed by an applicant as
a member of the United States Armed Forces, the United States
Military Reserve, the National Guard of any state, or the
Naval Militia of any state toward the qualifications and
requirements for certification or licensure.
2.Requires EMSA, in developing the above regulations related to
requirements for certification as an EMT-II, to deem an
applicant for EMT-II certification with military experience
equivalent to EMT-I certification as certified as an EMT-I
unless EMSA determines that the education, training or
practical experience is not sufficiently comparable to
existing standards.
3.Prohibits EMSA, in developing the above regulations related to
requirements for licensure as an EMT-P, from requiring an
applicant for EMT-P licensure with military experience
equivalent to relevant course work to complete duplicative
requirements unless EMSA determines that the education,
training, or practical experience is not sufficiently
comparable to existing standards.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, initial and ongoing costs to EMSA of approximately
$100,000 annually for staff to develop regulations and provide
program assistance once regulations are adopted.
PRIOR VOTES :
Assembly Business, Professions and Consumer Protection:13- 0
Assembly Veterans Affairs: 10- 0
AB 704 | Page
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Assembly Appropriations: 17- 0
Assembly Floor: 75- 0
COMMENTS :
1.Author's statement. Upon exiting military service, our
nation's recent veterans face a higher unemployment rate than
their civilian counterparts. Many veterans are unable to
transfer their military training and experience into
marketable job skills for civilian careers. This should not
be a problem for veterans who served as medics given the
high-quality education and experience they obtained in the
military. Unfortunately, California does not offer credit for
this specialized background towards civilian licensure.
Veterans with medical training make up the second largest
specialty in the military and cannot transfer their training
and experience towards an EMT or paramedic licensure, despite
similarities in the training and experience of comparable
positions, such as a combat medic. As a result, these veterans
must re-take courses which they have already taken, costing
them additional time and money.
AB 704 will allow these veterans to use their training and
experiences as credit towards paramedic licensure, and
streamline veterans with equivalent experience to fill
much-needed jobs in the healthcare field.
2.Report on Military Health Personnel. In 2008, the UCSF Center
for Health Professions published a report entitled, "US
Military and California Health Personnel: Select Comparisons."
As this report noted, California faces workforce shortages and
geographic mal-distribution in many of the health care
professions, and that one potential pool of health care
workers includes former military personnel returning from
active duty or retiring with years available for service in
the civilian labor force.
As one example, the Army's Health Care Specialist provides
patient assessment, teaching, emergency care and nursing care.
Individuals may be overqualified for positions in the civilian
sector as EMTs but, unless they have an M6 Practical Nurse
Additional Skill Identifier, they would not be close to
qualifying as a Licensed Vocational Nurse in California.
According to the report, the Navy's Independent Duty Corpsmen
are highly trained individuals with clinical and management
AB 704 | Page 4
skills that enable them to work with indirect supervision
providing care and administering programs, departments or
clinics. Their skills are rarely known or appreciated in the
civilian sector, although they could make significant
contributions to civilian health care.
The report stated that several differences exist between the
military and civilian sectors regarding how health care
workers are educated, trained, certified and regulated. These
differences can sometimes make it all but impossible for an
individual to make a smooth transition from the military to a
comparable civilian position. In many instances, civilian
health education programs and state professional boards'
licensing criteria do not always give full credit for the
health care provider education, training and experience one
may have received in the military. Because of the state-based
authority to set health care professions' scopes of practice,
the practice acts vary tremendously from state to state for
some professions. The US military is exempt from this system
and has developed its own occupations and training programs
based on need. This results in occupations and skill sets that
do not match up exactly.
3.Current EMT regulations. Current regulations allow military
education, training and experience to serve as credit towards
EMT licensure. All levels of EMT licensure (EMT-I, EMT-II, and
EMT-P) allow medical training units of a branch of the Armed
Forces or Coast Guard to serve as eligible EMT training
programs. However, an individual may obtain certification as
an EMT-1 if he/she can provide documented evidence of
successful completion of an emergency medical services
training program of the Armed Forces within the preceding two
years that meets national EMS Education Standards. This does
not apply to EMT-2 or EMT-P level licensure.
4.Prior legislation. AB 1588 (Atkins), Chapter 742, Statutes of
2012, required boards under the Department of Consumer Affairs
(DCA) to waive professional license renewal fees, continuing
education requirements, and other renewal requirements as
determined by the licensing board, for any licensee or
registrant called to active duty.
AB 1976 (Logue) of 2012 would have required healing arts boards
within DCA, as well as professional licensure programs within
the Department of Public Health, to accept military training
towards licensure requirements, as applicable, and requires
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boards that accredit schools to ensure schools have procedures
in place to accept military training. AB 1976 was held on the
Assembly Appropriations suspense file.
AB 1932 (Gorell) of 2012 would have required healing arts boards
within DCA to issue a written report to the California
Department of Veterans Affairs detailing the methods of
evaluating the education, training, and experience obtained in
military service and whether that education, training and
experience is applicable to the boards' requirements for
licensure. AB 1932 was passed by the Assembly, but was not
referred to a Senate Policy Committee.
SB 1646 (Rogers), Chapter 987, Statutes of 1994, required
licensing boards under DCA to promulgate regulations to
evaluate and credit military education, training, and
experience in meeting licensure requirements, if the military
education, training, and experience are applicable to the
profession.
5.Support. The United State Department of Defense State Liaison
Office (DOD) states that one of its highest priority issues
this year is working with states to facilitate service members
receiving credit for military education, training, and
experience when applying for a state licensure when
transitioning out of the military. DOD states that the policy
in this bill will be helpful to some of those transitioning
service members in obtaining these medical licenses and
finding work. The California Association of County Veterans
Service Officers and the Vietnam Veterans of American -
California State Council agree that California should
recognize veterans' skills and training received while serving
in the armed forces and allow these skills to be transferrable
to certification or licensure in similar civilian positions.
The California State Firefighters' Association (CSFA) states
that one out of every five veterans becomes unemployed upon
their return home, and that a large portion of unemployed
veterans were medics in the service. CSFA states that these
medics are not allowed to use their military training to
supplant any of the training required to become a licensed
emergency medical services provider, and that this is an
egregious oversight that should be remedied. The American
Federation of State, County and Municipal Employees states
that it supports this legislation because it provides multiple
career pathways for this important field, as well as assists
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veterans with transitioning into civilian life more easily.
The Association of California Healthcare Districts writes in
support that the majority of California's healthcare districts
are located in rural areas, and many have a difficult time
recruiting qualified individuals into their workforce. By
increasing the prospective workforce, healthcare districts
will be able to offer their communities increased patient
care.
SUPPORT AND OPPOSITION :
Support: American Federation of State, County and Municipal
Employees, AFL-CIO
Association of California Healthcare Districts
California Association of County Veterans Service
Officers
California State Firefighters' Association
United States Department of Defense
Vietnam Veterans of America - California State Council
Oppose: None received
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