BILL ANALYSIS Ó
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UNFINISHED BUSINESS
Bill No: SB 669
Author: Huff (R), et al.
Amended: 7/3/13
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
SENATE FLOOR : 38-0, 5/29/13
AYES: Anderson, Beall, Berryhill, Block, Calderon, Cannella,
Corbett, Correa, De León, DeSaulnier, Emmerson, Evans, Fuller,
Gaines, Galgiani, Hancock, Hernandez, Hill, Hueso, Huff,
Jackson, Lara, Leno, Lieu, Liu, Monning, Nielsen, Padilla,
Pavley, Price, Roth, Steinberg, Torres, Walters, Wolk, Wright,
Wyland, Yee
NO VOTE RECORDED: Knight, Vacancy
ASSEMBLY FLOOR : 77-0, 9/9/13 - See last page for vote
SUBJECT : Emergency medical care: epinephrine auto-injectors
SOURCE : Conference of California Bar Associations
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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) 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; (3) authorizes the
director of the EMSA to deny, suspend, or revoke any approval or
place any approved training provider on probation upon a finding
by the director of an imminent threat to public health and
safety, as prescribed; (4) creates the Specialized First Aid
Training Program Approval Fund (Fund), and requires the EMSA to
assess a fee, to be deposited into the fund, to cover the
reasonable costs incurred by the EMSA for the ongoing review and
approval of training and certification; and (5) requires
epinephrine auto-injectors obtained by pre-hospital emergency
medical care personnel to be used only when functioning outside
the course of the person's occupational duties, or as a
volunteer, as specified.
Assembly Amendments (1) authorize the director of the EMSA to
deny, suspend, or revoke any approval or place any approved
training provider on probation upon a finding by the director of
an imminent threat to public health and safety, as prescribed,
(2) create the Fund, and require the EMSA to assess a fee, to be
deposited into the Fund, to cover the reasonable costs incurred
by the EMSA for the ongoing review and approval of training and
certification, (3) require epinephrine auto-injectors obtained
by prehospital emergency medical care personnel to be used only
when functioning outside the course of the person's occupational
duties, or as a volunteer, as specified, and (4) make other
technical changes.
ANALYSIS :
Existing law:
1. Permits a school district or county office of education to
provide emergency epinephrine auto-injectors to trained
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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
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
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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, 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. Authorizes the director of the EMSA authority to deny,
suspend, or revoke any approval or place any approved
training provider on probation upon a finding by the director
of an imminent threat to public health and safety, as
prescribed.
4. Creates the Fund, and requires the authority to assess a fee,
to be deposited into the fund, to cover the reasonable costs
incurred by the authority for the ongoing review and approval
of training and certification.
5. 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
emergency medical care, as specified.
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6. 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.
7. 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.
8. Requires epinephrine auto-injectors obtained by pre-hospital
emergency medical care personnel to be used only when
functioning outside the course of the person's occupational
duties, or as a volunteer, as specified.
9. 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.
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.
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
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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 : (Per Assembly Judiciary Committee analysis of
8/13/13) (Unable to reverify)
Conference of California Bar Associations (source)
American Academy of Pediatrics
Association of Regional Center Agencies
California Advocates, Inc.
California Association of Joint Powers Authorities
California Hospital Association
California Medical Association
Civil Justice Association of America
Civil Justice Association of California
Food Allergy Research and Education
Hospital Corporation of America
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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,
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.
ASSEMBLY FLOOR : 77-0, 9/9/13
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley,
Dahle, Daly, Dickinson, Eggman, Fong, Fox, Frazier, Beth
Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gorell, Gray,
Grove, Hagman, Hall, Harkey, Roger Hernández, Holden, Jones,
Jones-Sawyer, Levine, Linder, Logue, Lowenthal, Maienschein,
Mansoor, Medina, Melendez, Mitchell, Morrell, Mullin,
Muratsuchi, Nazarian, Nestande, Olsen, Pan, Patterson, Perea,
V. Manuel Pérez, Quirk, Quirk-Silva, Rendon, Salas, Skinner,
Stone, Ting, Wagner, Waldron, Weber, Wieckowski, Wilk,
Williams, Yamada, John A. Pérez
NO VOTE RECORDED: Donnelly, Vacancy, Vacancy
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JL:AL:d 9/9/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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