BILL ANALYSIS Ó
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|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
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 76-0, 5/26/15 (Consent) - See last page for
vote
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
time."
ANALYSIS:
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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
providers.
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.
Comments
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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