BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 535
AUTHOR: Nielsen
INTRODUCED: February 21, 2013
HEARING DATE: April 10, 2013
CONSULTANT: Marchand
SUBJECT : Commission on Emergency Medical Services.
SUMMARY : Requires the Speaker of the Assembly to appoint one
air ambulance representative from a list of the three names
submitted by the California Association of Air Medical Services,
in addition to the 18 existing appointed representatives to the
Emergency Medical Services (EMS) Commission, for a total of 19
members.
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.Establishes the Emergency Medical Air Transportation Act,
which imposes an additional $4 on every Vehicle Code violation
to augment Medi-Cal reimbursement rates for medical air
transportation services. The penalties provision sunsets on
Continued---
SB 535 | Page 2
July 1, 2016, and the Emergency Medical Air Transportation Act
sunsets on January 1, 2018.
This bill: Requires the Speaker of the Assembly to appoint one
air ambulance representative from a list of the three names
submitted by the California Association of Air Medical Services,
in addition to the 18 existing appointed representatives to the
EMS Commission, for a total of 19 members.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. Air medical service providers are based
all over California. Often a base will cover a 100 mile radius
which could include a few counties. Each helicopter usually
includes a pilot, a paramedic or EMT and a nurse. Based on
this scenario, these providers are regulated by several
entities. First, as an air carrier, they are regulated by the
Federal Aviation Authority (FAA). As an EMS provider, they are
regulated by the state and the local EMS authority. In
addition, the pilot is regulated by the FAA and the paramedic
or EMT is regulated by the state and local EMS authority. The
nurse is regulated by the Board of registered nursing. Lastly,
the landing zones are regulated by the FAA and the California
Department of Transportation.
The primary role of the Commission is to review and approve
regulations, standards, and guidelines developed by the
California EMS Authority. The Commission also advises the
Authority with regard to communications, medical equipment,
training personnel, facilities and other components of an
emergency medical services system. However, Air Ambulance
providers do not currently have a voice on this Commission. As
the Commission reviews various regulations that effect
emergency service providers, there are times when air services
are included in these discussions. Because air ambulance
providers are regulated by multiple federal, state and local
agencies it is important that these providers are able to
clarify how a proposed regulation will affect the provision of
air services in the state.
2.Composition of the EMS Commission. Under existing law, the
EMS Commission is composed of the following appointments:
SB 535 | Page
3
--------------------------------------------------------------
|Type |Representing |Appointed |
| | |by |
|----------------------+----------------------------+----------|
|Physician whose |California Chapter of the |Senate |
|practice is emergency |American College of | |
|medicine |Emergency Physicians | |
|----------------------+----------------------------+----------|
|Physician who is |American Board of Emergency |Assembly |
|board certified in |Medicine | |
|emergency medicine | | |
|----------------------+----------------------------+----------|
|Physician who is a |American College of |Assembly |
|trauma surgeon |Surgeons | |
|----------------------+----------------------------+----------|
|Physician |California Medical |Senate |
| |Association | |
|----------------------+----------------------------+----------|
|County Health Officer |California Conference of |Governor |
| |Local Health Officers | |
|----------------------+----------------------------+----------|
|Registered nurse who |Emergency Nurses |Governor |
|is a mobile intensive |Association | |
|care nurse | | |
|----------------------+----------------------------+----------|
|Paramedic or EMT-II, |California Rescue and |Senate |
|who is not a peace |Paramedic Association | |
|officer | | |
|----------------------+----------------------------+----------|
|Private emergency |California Ambulance |Assembly |
|services provider |Association | |
|----------------------+----------------------------+----------|
|Fire management |California Fire Chiefs |Governor |
| |Association | |
|----------------------+----------------------------+----------|
|Hospital |California Hospital |Governor |
|administrator |Association | |
|----------------------+----------------------------+----------|
|Paramedic or EMT-II |California Peace Officers' |Governor |
|who is also a full |Association | |
|time peace officer | | |
|----------------------+----------------------------+----------|
|Public member |Rural area |Governor |
|----------------------+----------------------------+----------|
SB 535 | Page 4
|Public member |Non-specific |Governor |
|----------------------+----------------------------+----------|
|Local Emergency |Emergency Medical Services |Governor |
|Medical Services |Administrators' Association | |
|Agency administrator |of CA | |
|----------------------+----------------------------+----------|
|Medical director of a |Emergency Medical Directors |Governor |
|local EMS agency |Association of California | |
|----------------------+----------------------------+----------|
|Type |Representing |Appointed |
| | |by |
|----------------------+----------------------------+----------|
|Firefighter |California State |Governor |
| |Firefighters' Association | |
|----------------------+----------------------------+----------|
|Employee of CAL-FIRE |California Professional |Governor |
| |Firefighters | |
|----------------------+----------------------------+----------|
|Employee of a city, |California Professional |Governor |
|county, or special |Firefighters | |
|district providing | | |
|fire protection | | |
--------------------------------------------------------------
3.Prior legislation. AB 2394 (Nielsen) of 2012 was
substantially similar to this bill. AB 2394 was referred to
Assembly Health Committee, but did not have a hearing.
AB 2173 (Beall), Chapter 547, Statutes of 2010, established the
Emergency Medical Air Transportation Act, which imposed an
additional $4 on every Vehicle Code violation to augment
Medi-Cal reimbursement rates for medical air transportation
services. This penalties provision sunsets on July 1, 2016,
and the entire bill sunsets on January 1, 2018.
SB 997 (Ridley-Thomas), Chapter 275, Statutes of 2008, added two
members to the EMS Commission: one employee of CAL-FIRE, and
one employee of a city, county or special district that
provides fire protection. Both of these added members are
appointed by the Governor from a list of names provided by the
California Professional Firefighters.
AB 2917 (Torrico), Chapter 274, Statutes of 2008, required EMSA
to establish and maintain a statewide registry of the status
of emergency medical technician (EMT) licenses and
certificates, to be used by certifying entities, and required
SB 535 | Page
5
EMSA to develop standards, guidelines and regulations for
certification of specified EMTs.
4.Support. This bill is sponsored by the California Association
of Air Medical Services (CAAMS), which states that this
additional member will provide the appropriate representation
of this segment of the EMS community at the EMS Commission.
According to CAAMS, air medical providers are not represented
on the EMS Commission, but are a key provider of emergency
medical services. By adding an air medical representative,
these providers will have an opportunity to provide their
perspective.
5.Opposition. The California State Sheriffs' Association (CSSA)
opposes this bill, stating that the revision of the EMS
Commission's membership could create policies and procedures
that would be detrimental to local government and the law
enforcement community. For example, limiting fire and sheriff
medical transport capabilities and the scope of the type of
aircraft local fire and sheriffs fly for rescue. In some
counties, CSSA states that these additional member companies
are not part of the local emergency service plan as fire and
sheriffs handle rescue and transport, and adding them to the
EMS Commission could create policies that work against local
rescue efforts.
The Los Angeles County Sheriff's Department (LACSD) also opposes
this bill, stating that in Los Angeles County, the Los Angeles
County Fire Department, the City of Los Angeles Fire
Department and the LACSD handles all of the rescues and
related air transports. LACSD's Air Rescue 5 program rescue
helicopter has saved thousands of lives and is a critical part
of our region-wide emergency medical plan. LACSD states that
while it is true that private air ambulance members are not
represented on the EMS Commission specifically, there is no
member of a public agency that specifically provides air
rescue and transport either. LACSD states that it does not
believe that the private air ambulance providers should be
placed on the EMS Commission. However, if the Legislature
feels compelled to add a member of the private air ambulance
providers, they should also add a member from a public agency
that provides emergency air transport.
SUPPORT AND OPPOSITION :
Support: California Association of Air Medical Services
SB 535 | Page 6
(sponsor)
Oppose: California State Sheriffs' Association
Los Angeles County Sheriff's Department
San Bernardino County Sheriff's Office
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