BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 669| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: SB 669 Author: Huff (R) Amended: 5/28/13 Vote: 21 SENATE HEALTH COMMITTEE : 8-0, 4/17/13 AYES: Hernandez, Anderson, Beall, De León, DeSaulnier, Monning, Nielsen, Wolk NO VOTE RECORDED: Pavley SENATE JUDICIARY COMMITTEE : 7-0, 4/30/13 AYES: Evans, Walters, Anderson, Corbett, Jackson, Leno, Monning SENATE APPROPRIATIONS COMMITTEE : 7-0, 5/23/13 AYES: De León, Walters, Gaines, Hill, Lara, Padilla, Steinberg SUBJECT : Emergency medical care: epinephrine auto-injectors SOURCE : Conference of California Bar Association DIGEST : This bill (1) authorizes a trained pre-hospital emergency medical care person, first responder, or lay rescuer to obtain and use epinephrine auto-injectors to render emergency care to another person, pursuant to specified requirements, and grants them qualified immunity from liability, as specified, unless their conduct in rendering emergency care is grossly negligent; (2) provides immunity to specified entities that are authorized to train these persons in the emergency administration of epinephrine auto-injectors for any civil damages alleged to result from those training requirements or CONTINUED SB 669 Page 2 standards; and (3) among other things, provides minimal training requirements and requires that the Emergency Medical Services Authority (EMSA) establish and approve authorized training providers and minimum standards for training and the use and administration of epinephrine auto-injectors. ANALYSIS : Existing law: 1. Permits a school district or county office of education to provide emergency epinephrine auto-injectors to trained personnel, and permits trained personnel to utilize these epinephrine auto-injectors to provide emergency medical aid to persons suffering from an anaphylactic reaction. 2. Permits each elementary and secondary school to designate one or more school personnel on a voluntary basis to receive initial and annual refresher training, based on standards developed by the Superintendent of Public Instruction in consultation with organizations with expertise, including the EMSA. 3. Permits a school nurse, or if the school does not have a nurse then the person who has received the training, to 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. 4. Permits a school nurse, or if the school does not have a nurse then the person who has received the training, to 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. 5. Provides civil liability immunity, with certain restrictions, to persons who complete a basic cardiopulmonary resuscitation course and who, in good faith, renders emergency cardiopulmonary resuscitation at the scene of an emergency. 6. Provides civil liability immunity to any person who, in good faith and not for compensation, renders emergency care or CONTINUED SB 669 Page 3 treatment by the use of an automated external defibrillator at the scene of an emergency. Specifies that the protections in this bill do not apply in the case of personal injury or wrongful death that result from the gross negligence or willful or wanton misconduct of the person who renders emergency care by the use of an automated external defibrillator. 7. Provides civil liability immunity, as part of a pilot project in seven counties, to a person who administers an opioid antagonist, who is not otherwise licensed to do so, in an emergency without fee if the person has received specified training. Sunsets this provision on January 1, 2016. 8. Establishes the EMSA within the California Health and Human Services Agency, and 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. 9. Defines pre-hospital emergency medical personnel as any of the following: authorized registered nurse or mobile intensive care nurse, emergency medical technician (EMT)-I EMT-II, EMT-paramedic, lifeguard, firefighter, or peace officer, as defined, or a physician who provides pre-hospital emergency medical care or rescue services. This bill: 1. Authorizes a pre-hospital emergency medical care person, first responder, or lay rescuer to use an epinephrine auto-injector to render emergency care to another person, as specified. 2. Requires the EMSA to establish and approve authorized training providers and minimum standards for training and the use and administration of epinephrine auto-injectors. Permits EMSA to designate existing training standards. 3. Clarifies these provisions do not apply to a school district or county office of education, or its personnel, that provides and utilizes epinephrine auto-injectors to provide CONTINUED SB 669 Page 4 emergency medical care, as specified. 4. Clarifies that these provisions do not limit or restrict the ability of pre-hospital emergency medical care personnel, under any other statute or regulation, to administer epinephrine, or to require additional training or certification, beyond what is already required. 5. Authorizes a pharmacy to dispense epinephrine auto-injectors to a pre-hospital emergency medical care person, first responder, or lay rescuer for the purpose of rendering emergency care in accordance with these provisions. 6. Provides that a pre-hospital emergency medical care person, first responder, or lay rescuer who administers an epinephrine auto-injector, in good faith and not for compensation, to another person who appears to be experiencing anaphylaxis at the scene of an emergency situation is not liable for any civil damages resulting from his/her acts or omissions in administering the epinephrine auto-injector, if that person has complied with specified certification and training requirements and standards, except as specified. 7. Provides immunity to a local agency, entity of state or local government, or other public or private organization that sponsors, authorizes, supports, finances, or supervises the training of those persons, or develops standards, for civil damages alleged to result from those training programs or standards, except as specified. Background Anaphylaxis . According to the National Institutes of Health, anaphylaxis is a severe, whole-body allergic reaction to a chemical that has become an allergen. After being exposed to a substance such as bee sting venom, the person's immune system becomes sensitized to it. When the person is exposed to that allergen again, an allergic reaction may occur. This causes the airways to tighten and leads to other symptoms. Anaphylaxis can occur in response to any allergen. Anaphylaxis is life-threatening and can occur at any time. Risks include a history of any type of allergic reaction. CONTINUED SB 669 Page 5 Epinephrine auto-injector . An epinephrine auto-injector is a medical device used to deliver a measured dose of epinephrine (also known as adrenaline) using auto-injector technology, most frequently for the treatment of acute allergic reactions to avoid or treat the onset of anaphylaxis. The EpiPen (and the version for smaller children, the EpiPen Jr.) are commonly used epinephrine auto-injectors. The devices are intended to be injected into the middle of the outer thigh, and patients are directed not to inject the device into a vein, buttock, fingers, toes, hands or feet. Prior legislation AB 559 (Wiggins, Chapter 458, Statutes of 2001), established provisions of law that permit a school district or county office of education to provide emergency epinephrine auto-injectors to trained personnel, and permit trained personnel to utilize these epinephrine auto-injectors to provide emergency medical aid to persons suffering from an anaphylactic reaction at a school or during a school activity. FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes Local: Yes According to the Senate Appropriations Committee: One-time costs of $450,000 for the adoption and amendment of regulations by the EMSA(General Fund). Ongoing costs of $250,000 for training and oversight by the EMSA (General Fund). SUPPORT : (Verified 5/23/13) Conference of California Bar Associations (source) California Hospital Association California Medical Association Food Allergy Research and Education ARGUMENTS IN SUPPORT : This bill is sponsored by the Conference of California Bar Associations (CCBA), representing more than 25 metropolitan, regional and specialty bar associations. CCBA states that like almost all states, CONTINUED SB 669 Page 6 California has responded to the dangers of anaphylaxis in our schools by enacting legislation to permit school districts or county offices of education to provide emergency epinephrine auto-injectors to trained personnel, and to permit those personnel to utilize these auto-injectors to provide emergency medical aid to students suffering from an anaphylactic reaction. CCBA states that this bill would enable California to join a growing group of states that provide training in the proper use of epinephrine auto-injectors and which makes these auto-injectors available by prescription to individuals who have successfully completed the training. This bill is supported by the California Hospital Association (CHA), which states that death from anaphylaxis remains a real and widespread problem. Currently, anaphylaxis leads to 500-1,000 deaths per 2.4 million in the United States. While mortality rates have decreased, the incidence of anaphylaxis appears to be increasing from 20 per 100,000 per year in the 1980s to 50 per 100,000 in the 1990s. CHA states that there is no effective treatment to prevent anaphylactic cardiac arrest in the community unless the victim has an epinephrine auto-injector and is able to self-administer the injection before losing consciousness. JL:d 5/28/13 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED