BILL ANALYSIS Ó
AB 319
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Date of Hearing: April 22, 2015
ASSEMBLY COMMITTEE ON EDUCATION
Patrick O'Donnell, Chair
AB 319
(Rodriguez) - As Introduced February 13, 2015
SUBJECT: Pupil instruction: cardiopulmonary resuscitation
SUMMARY: Requires that school districts and charter schools
provide instruction on performing cardiopulmonary resuscitation
(CPR) and the use of an automated external defibrillator (AED)
to students in grades 9-12 as part of a course required for
graduation. Specifically, this bill:
1)Makes findings and declarations regarding the importance of
CPR.
2)Requires, by changing a voluntary section to a mandate, that
schools or school districts provide first aid and CPR training
to students and employees.
3)Requires that school districts and charter schools provide to
students in grades 9-12 instruction on performing CPR and the
use of an AED as part of a physical education course or
another course required for graduation.
4)Requires the instruction to include:
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a) An instructional program developed by the American Heart
Association or the American Red Cross, or one that is
nationally recognized and based on the most current
national evidence-based emergency care guidelines on those
topics
b) Training on the psychomotor skills (defined as hands-on
and cognitive) necessary to perform CPR. Permits students
receiving online instruction to be exempt from performing
hands-on practice
c) General information on the use and importance of an AED.
States that the physical presence of an AED in the
classroom is not required
1)Allows instruction to be provided by a person who is certified
in CPR who is any of the following:
a) A licensed health care provider
b) An emergency medical technician
c) A peace officer
d) A firefighter
e) A teacher
1)States that a teacher shall not be required to be certified in
CPR to facilitate, provide, or oversee instruction for
training, provided that the training does not provide CPR
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certification.
2)States that, if it is in accordance with the laws, rules, or
regulations governing his or her profession, a person who
provides this instruction may apply the hours spent performing
instruction toward fulfilling professional community service
requirements.
3)States that the governing board of a school district or the
governing body of a charter school may adopt regulations to
implement this section.
EXISTING LAW:
1)Establishes high school graduation requirements, including two
years of physical education, and permits school districts to
establish graduation requirements which exceed those of the
state. Existing law does not require a health course for
graduation.
2)Allows school districts to offer a comprehensive course of
study on first aid and CPR and requires that it be based on
standards that are at least equivalent to the standards
currently used by the American Red Cross or the American Heart
Association.
3)Requires, through the adopted course of study, that schools
provide instruction at the appropriate grade levels on
personal and public safety and accident prevention, including
emergency first aid instruction, instruction in hemorrhage
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control, treatment for poisoning, resuscitation techniques,
and CPR when appropriate equipment is available.
4)States (Civil Code § 1714.2) that no person certified to teach
CPR by the American Red Cross or the American Heart
Association, and no local agency, entity of state or local
government, or other public or private organization which
sponsors, authorizes, supports, finances, or supervises the
training of citizens in cardiopulmonary resuscitation can be
held liable for any civil damages alleged to result from such
training programs.
5)States (Civil Code § 1714.21) that a person or entity who
provides CPR and AED training to a person who renders
emergency care is not liable for any civil damages resulting
from any acts or omissions of the person rendering the
emergency care.
6)Requires (Health and Safety Code § 1797.196) that when an AED
is placed in a public or private K-12 school, the principal
follow specified posting and notice requirements, and
designate trained employees to be available to respond to an
emergency that may involve the use of an AED during normal
operating hours.
FISCAL EFFECT: This bill has been keyed a state-mandated local
program by the Office of Legislative Counsel.
COMMENTS:
Need for the bill. The author's office states, "Sudden cardiac
arrest is one of the most lethal public health threats in the
United States, and sadly only ten percent of people who suffer
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cardiac arrest outside the hospital survive. If no CPR is
provided or no defibrillation occurs within 3 to 5 minutes of
collapse, the chances of survival drop. Effective bystander CPR
provided immediately after sudden cardiac arrest can double or
triple a victim's chance of survival. Alarmingly, 70 percent of
Americans may feel helpless to act during a cardiac emergency
because they do not know how to perform CPR and only 32 percent
of cardiac arrest victims get CPR from a bystander.
CPR training is sensible and affordable and can easily fit into
existing classes. In fact, instruction in CPR and AED is part of
the existing Health curriculum framework and content standards.
AB 319 seeks to expand upon this current policy and ensure that
every high school student in California receives this important,
life-saving training."
What is "Hands Only" CPR training? This bill requires that
students receive training in a method of CPR known as
"Hands-Only CPR." Hands-on CPR is conventional CPR without
mouth-to-mouth resuscitation. According to the American Heart
Association, Hands-Only CPR has been shown to be as effective as
conventional CPR for sudden cardiac arrest at home, at work or
in public.
Hands-only CPR involves two steps when a teen or adult
collapses: 1) calling 9-1-1, and 2) pushing hard on the center
of the person's chest at the rate of 100 compressions per minute
- roughly the same as the beat in the Bee Gees 1977 hit song
"Stayin' Alive." For infants, children, victims of drowning or
drug overdose, and people who collapse due to breathing
problems, the American Heart Association still recommends CPR
with compression and breaths.
The American Red Cross and the American Heart Association offer
a "CPR for Students" course which involves 30 minutes of
instruction. The author expects that schools would meet the
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requirements of this bill by offering that course.
Health disparities in CPR training and bystander use. A 2013
study published in the Journal of the American Medical
Association found wide disparities in CPR training, and that
residents of the communities most in need of training are the
least likely to be trained. The study, which examined national
training rates, found that counties with the lowest rates of CPR
training were more likely to have a higher proportion of African
American and Latino residents, more likely to have a lower
median household income, and were more likely to be rural (where
it may take longer for emergency personnel to arrive).
Other research has demonstrated that low income individuals and
African Americans are significantly less likely to receive
bystander CPR when they experience sudden cardiac arrest, and
that people who experience such an event in predominantly
African American, low income neighborhoods are the least likely
of all groups to receive bystander CPR treatment. This study
attributed this disparity in CPR use to low rates of training in
those in communities.
CPR/AED graduation requirements in 21 other states. According
to the American Heart Association, twenty one other states have
adopted CPR training as a high school graduation requirement,
totaling about 1.2 million trained high school graduates per
year. Among the larger states are Texas, Georgia, Virginia,
North Carolina, and New Jersey.
Most states which require instruction to be provided in a
required class have given districts between two and three years
"lead time" for implementation, or when requiring completion of
training by individual students, have made the requirement
effective with a future incoming class of 9th graders.
As written, this bill would become effective half-way through
the 2015-16 academic year. Based on the experience of other
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states, as well and the resources required to implement such a
requirement, staff recommends that the bill be amended to push
back the effective dates of these requirements to the 2017-18
academic year.
Local capacity to provide training. Approximately 400,000
students graduate from California high schools each year. Under
the requirements of this bill, each one would receive CPR/AED
training through a class they must take to graduate. This
raises a question regarding the capacity of school districts to
provide the instruction at sufficient scale to serve this number
of students annually.
This bill allows teachers who are not certified in CPR/AED to
provide this instruction, provided that they use the materials
produced by The American Red Cross or American Heart
Association, or equivalent, and that the training is not for the
purpose of certifying students. All other providers would need
to be certified. Since the teachers of courses in which this
instruction would occur (most likely Health or Physical
Education) would not be required to be certified, it would
appear that it is possible to instruct all students. Since the
training could be completed in as little as 30 minutes sometime
over the course of four years of instruction, it would not
appear to place an undue burden on instructional time.
CPR (but not AED) training in state health standards and
curriculum frameworks. CPR instruction is part of the state's
health content standards and corresponding curriculum framework.
The 2008 standards include: "Describing procedures for
emergency care and lifesaving, including CPR, first aid, and
control of bleeding." Neither the standards of framework mention
use of an AED. As the author notes, this does not mean that all
students receive this instruction, as not all districts require
a health course for graduation, and compliance with the
standards is not mandatory.
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Placentia-Yorba Linda Unified School District makes hands-only
CPR training part of course required for graduation. After the
tragic loss of two high school students in 2006 and 2014 to
sudden cardiac arrest, the Placentia-Yorba Linda Unified School
District in 2015 became the first known district in the state to
make 'hands only" CPR/AED instruction part of a course required
for high school graduation. The district has provided this
instruction to all 9th grade students through a locally-required
health course and purchased CPR Anytime kits, which include
manikins, for use in the program. Equipment for four high
schools with an enrollment of approximately 8,000 students
(total enrollment, not graduating class) required an expenditure
of approximately $10,000 by the district, $8000 of which was
paid for by privately-raised funds. The district expects these
kits to last at least five years before needing replacement.
Recommended amendments. To meet the author's intent and provide
clarity, staff recommends the following amendments:
1) Staff recommends that this bill be amended to strike
Section 1 of this bill. This section of the bill requires,
by changing the section from voluntary to mandatory, that
schools train students and employees in first aid and CPR.
The author indicates that his intent is to make CPR/AED
training part of a course required for graduation (as other
provisions of this bill do), not require training for staff
in CPR and first aid.
2) Staff recommends that this bill be amended to allow
certified instructors from non-profit organizations such as
the American Red Cross and the American Heart Association
to provide the training required by this bill.
3) Staff recommends a clarifying amendment which would
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specify that the instruction could be provided in a course
required to meet either state graduation requirements or
locally-adopted graduation requirements. This would
clarify that in addition to courses required by the state
for graduation, the instruction could be provided in a
health or other course which a school district has made a
local graduation requirement.
4) Staff recommends that the bill be amended to strike
references to online instruction, to clarify that "hands
on" training is required.
5) As noted above, staff recommends that the bill be
amended to push back the effective dates of these
requirements to the 2017-18 academic year.
Previous legislation. AB 2217 (Melendez, Chapter 812, Statutes
of 2014), authorizes a public school to solicit and receive
non-state funds to acquire and maintain an AED, and provides
that school districts and their employees are not liable for
civil damages resulting from certain uses of an AED.
AB 939 (Melendez) of the 2013-14 Session would have stated the
intent of the Legislature to encourage all public schools to
acquire and maintain at least one AED, and would have authorized
a public school to solicit and receive non-state funds to
acquire and maintain an AED. This bill died in the Senate
Appropriations Committee.
SB 1346 (Lowenthal, Chapter 71, Statutes of 2012), extended
indefinitely, the minimum training standards and immunity from
civil damages in connection with the use of AEDs. This measure
was not heard by the Assembly Education Committee.
SB 63 (Price) of the 2011-12 Session would have required all
public high schools to acquire and maintain at least one AED.
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This bill died in the Senate Appropriations Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
American Heart Association (sponsor)
American Red Cross (sponsor)
Alameda County Board of Supervisors
American College of Emergency Physicians, California Chapter
California Ambulance Association
California Hospital Association
California Professional Firefighters
Derrick Faison Foundation
Emergency Nurses Association of California
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Eric Paredes Save a Life Foundation
Placentia-Yorba Linda Unified School District
Travis R. Roy Sudden Cardiac Arrest Fund
1 individual
Opposition
CSAC Excess Insurance Authority (unless amended)
1 individual
Analysis Prepared by:Tanya Lieberman / ED. / (916) 319-2087