BILL ANALYSIS                                                                                                                                                                                                    Ó

          |SENATE RULES COMMITTEE            |                       AB 1223|
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                                   THIRD READING 

          Bill No:  AB 1223
          Author:   O'Donnell (D)
          Amended:  6/30/15 in Senate
          Vote:     21  

           SENATE HEALTH COMMITTEE:  6-0, 7/8/15
           AYES:  Hernandez, Hall, Monning, Pan, Roth, Wolk
           NO VOTE RECORDED:  Nguyen, Mitchell, Nielsen


           ASSEMBLY FLOOR:  76-0, 5/26/15 (Consent) - See last page for  

           SUBJECT:   Emergency medical services: ambulance transportation

          SOURCE:    California Fire Chiefs Association

          DIGEST:   This bill requires the Emergency Medical Services  
          Authority (EMSA) to adopt a statewide standard methodology for  
          the calculation and reporting by a Local Emergency Medical  
          Services Agency (LEMSA) of ambulance patient offload time, and  
          permits a LEMSA to adopt policies and procedures for calculating  
          and reporting ambulance patient offload time using the statewide  
          methodology adopted by EMSA. This bill requires, if a LEMSA  
          adopts a policy for calculating and reporting ambulance patient  
          offload time, to establish criteria for the reporting of, and  
          quality assurance follow-up for, a "nonstandard patient offload  



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          Existing law:

          1)Establishes EMSA, which is responsible for the coordination  
            and integration of all state activities concerning emergency  
            medical services (EMS), including the establishment of minimum  
            standards, policies, and procedures. 

          2)Requires EMSA, utilizing regional and local information, to  
            assess each EMS area or the system's service area for the  
            purpose of determining the need for additional emergency  
            services, and the coordination and effectiveness of EMS.

          3)Requires EMSA to develop planning and implementation  
            guidelines for EMS systems which address specified components,  
            including communications, system organization and management,  
            and data collection and evaluation.

          4)Authorizes counties to develop an EMS program and designate a  
            LEMSA responsible for planning and implementing an EMS system,  
            which includes day-to-day EMS system operations.  

          This bill:

          1)Requires EMSA to develop, and after approval by the Commission  
            on EMS, adopt a statewide standard methodology for the  
            calculation and reporting by a LEMSA of ambulance patient  
            offload time, using input from stakeholders, including, but  
            not limited to, hospitals, LEMSAs, and public and private EMS  

          2)Defines "ambulance patient offload time" as the interval  
            between the arrival of an ambulance patient at an emergency  
            department, and the time that the patient is transferred to an  
            emergency department gurney, bed, chair, or other acceptable  
            location and the emergency departments assumes responsibility  
            for care of the patient.

          3)Permits a LEMSA to adopt policies and procedures for  
            calculating and reporting ambulance patient offload time, and  
            requires a LEMSA that adopts these policies and procedures to  
            do all of the following:

             a)   Use the statewide standard methodology for calculating  
               and reporting patient offload time developed by EMSA  


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               pursuant to this bill; and,

             b)   Establish criteria for the reporting of, and quality  
               assurance follow-up for, a "nonstandard patient offload  
               time," as defined in this bill. 

          4)Defines "nonstandard patient offload time" as an offload time  
            that exceeds a period of time designated in the criteria  
            established by the LEMSA, but excludes from this definition  
            instances in which the offload times exceeds the designated  
            period of time due to acts of God, natural disasters, or  
            manmade disasters.

          1)Author's statement.  According to the author, when someone is  
            picked up by an ambulance, they are taken to a hospital  
            emergency department. Once the patient is in the ambulance the  
            EMS crew becomes responsible for their care until they are  
            signed over to hospital staff. Patients who are suffering from  
            a serious medical condition are quickly admitted into the  
            hospital, but that is often not the case with patients with  
            minor issues, who have to wait for a hospital bed to become  
            available. A national study found that patient offload times  
            had more than doubled since 2006, from 25 minutes to 45  
            minutes. Offload times in some parts of California can be much  
            longer. EMSA reports that 13 of the states' 33 LEMSAs  
            identified the problem of ambulance patient offload times as  
            an issue. These 13 agencies serve 70% of the state's  
            population. While some individual counties and hospitals have  
            taken actions to alleviate the issue there has been no  
            uniform, statewide, or comprehensive attempts to solve the  
            problem of patient offload times or even define it. Without a  
            common vocabulary when discussing this issue the state can't  
            begin to identify the problem let alone devise remedies. 

          2)Background and creation of toolkit to address offload delays.  
            In 2013, the California Hospital Association and EMSA created  
            the Ambulance Patient Offload Delay Collaborative to analyze  
            and develop solutions for the offload delays that were  
            increasing pressure on both hospitals and ambulance providers.  
            The goals of this collaborative were to: a) develop  
            standardized language, definitions, metrics and reporting  
            opportunities for ambulance patient throughput; b) identify  


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            ways to reduce delays and improve transfer times; and, c)  
            assist local jurisdictions in developing processes and  
            sustainable goals to reduce the incidence of ambulance patient  
            offload delays. In a national study involving 200 cities,  
            including some in California, the national average wait time  
            for handing off ambulance patients has doubled from 20 minutes  
            in 2006 to more than 45 minutes. Through survey research, the  
            collaborative learned that the offload delay problem in  
            California is not uniform or consistently reported. Of the 124  
            hospitals that responded to the survey, 74 (or 60%) said that  
            offload delays were "neutral" or "not significant," which was  
            consistent with what 19 out of 33 LEMSAs (58%) reported as  
            well. In contrast, 45 hospitals and 13 LEMSAs reported that  
            offload delays were "extremely significant," "very  
            significant," or "somewhat significant." However, those 13  
            LEMSAs reporting a problem represent regions that include 70%  
            of California's population. 

            As a result of this collaborative effort, in August of 2014  
            the Toolkit to Reduce Ambulance Patient Offload Delays in the  
            Emergency Department (Toolkit) was published by the California  
            Hospital Association.  The Toolkit includes definitions,  
            process guidelines and strategies to be considered to evaluate  
            current practices and develop specific process improvements at  
            the local level. The theme of the Toolkit was that local EMS  
            systems and hospitals are unique, and that collaborative  
            problem solving should be used to identify and solve problems  
            locally. However, the Toolkit did identify three key factors  
            for success, starting with improving the emergency department  
            intake process, followed by continuous quality improvement  
            measures, and hospital and LEMSA collaboration.

          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   No

          SUPPORT:   (Verified8/18/15)

          California Fire Chiefs Association (source)
          California Ambulance Association
          California Professional Firefighters
          California State Firefighters' Association
          City of Culver City


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          League of California Cities
          Long Beach Firefighters Association, Local 372
          Paramedics Plus
          United Firefighters of Los Angeles City, Local 112

          OPPOSITION:   (Verified8/18/15)

          California Hospital Association
          Corona Regional Medical Center
          Parkview Community Hospital Medical Center

          ARGUMENTS IN SUPPORT:     According to the author, this bill is  
          sponsored by the California Fire Chiefs Association (CFCA),  
          which states in support that hospital emergency departments are  
          more crowded and busier than ever, which means that EMS  
          responders are spending more of their time waiting to offload  
          patients at emergency departments than fulfilling their primary  
          duty of responding to emergency calls. CFCA states that this  
          bill seeks to help alleviate these issues by requiring EMSA to  
          develop a methodology for determining an acceptable amount of  
          time for EMS crews to offload their patients at emergency  
          departments. The California Ambulance Association (CAA) states  
          that it supports this bill because it believes that it will  
          ultimately result in cost savings to the EMS system. According  
          to CAA, patient offload time has been a significant problem for  
          ambulance providers. CAA agrees that a crucial first step in  
          dealing with this issue is to properly identify and define  
          metrics to measure the issue. The California Professional  
          Firefighters states in support that this bill represents a good  
          first step toward the development of standards to expedite the  
          transfer of care between ambulance personnel and the emergency  
          department staff of a general acute care hospital and mitigate  
          delays in returning ambulances and pre-hospital care personnel  
          to the EMS system. Paramedics Plus states in support that a five  
          minute wait time reduction in Alameda County equates to one 24  
          hour ambulance deployment per day back into the 911 EMS system.

          ARGUMENTS IN OPPOSITION:     The California Hospital Association  
          (CHA) states in opposition that numerous issues contribute to  
          ambulance patient offload delays and emergency department  


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          crowding, and that hospitals are not the main problem. According  
          to CHA, excess demand for emergency services, for the most part,  
          is beyond both hospitals and EMS providers to exclusively solve.  
          CHA states that standardization of ambulance patient offload  
          delay methodology is a laudable goal, however, it does not  
          address the individual local needs of each LEMSA and neighboring  
          hospitals to solve problems with their existing resources.  
          Finally, CHA states that the Ambulance Patient Offload Delay  
          initiative has been operating for more than two years with many  
          regional collaboratives already working collectively and  
          cooperatively to solve this issue, and that legislation is  
          unnecessary. According to CHA, one local area has discovered  
          that offload delays are a product of their counties' massive  
          population growth with increased Medi-Cal patients seeking care  
          in the area emergency departments, while another area showed  
          that delays were attributable to the EMS crews restocking and  
          completing their paperwork. CHA states that legislation that  
          requires measurements that will be used in a retaliatory manner  
          against hospitals is unfair and unnecessary.

          ASSEMBLY FLOOR:  76-0, 5/26/15
          AYES:  Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bonilla,  
            Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau,  
            Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd,  
            Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia,  
            Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray,  
            Grove, Hadley, Roger Hernández, Holden, Irwin, Jones,  
            Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,  
            Maienschein, Mayes, McCarty, Medina, Melendez, Mullin,  
            Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,  
            Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,  
            Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,  
            Wilk, Williams, Wood, Atkins
          NO VOTE RECORDED:  Bloom, Chávez, Harper, Mathis

          Prepared by:Vince Marchand / HEALTH / 
          8/19/15 20:42:59

                                   ****  END  ****



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