BILL ANALYSIS                                                                                                                                                                                                    



                                                                    AB 1223


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          CONCURRENCE IN SENATE AMENDMENTS


          AB  
          1223 (O'Donnell)


          As Amended  June 30, 2015


          Majority vote


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          |ASSEMBLY:  | 76-0 | (May 26,      |SENATE: |38-0  | (August 31,     |
          |           |      |2015)          |        |      |2015)            |
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          Original Committee Reference:  HEALTH


          SUMMARY:  Requires the Emergency Medical Services Authority  
          (EMSA) to develop, using input from stakeholders, a statewide  
          standard methodology for the calculation and reporting of  
          patient offload time by local emergency medical services (EMS)  
          agencies.  Defines "ambulance patient offload time" as the  
          interval between the arrival of a patient transported by  
          ambulance at an emergency department (ED) and the time that the  
          ED assumes responsibility for care of the patient.  Allows a  
          local EMS agency to adopt policies and procedures for  
          calculating and reporting ambulance patient offload time, as  
          specified.  Requires, if a local EMS agency 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."


          The Senate amendments define "nonstandard patient offload time"  
          as an offload time that exceeds a period of time designated in  








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          the criteria established by the local EMS agency, but excludes  
          from this definition instances in which the offload times exceed  
          the designated period of time due to acts of God, natural  
          disasters, or manmade disasters.


          FISCAL EFFECT:  According to the Senate Appropriations  
          Committee, pursuant to Senate Rule 28.8, negligible state costs.


          COMMENTS:  According to the author this bill provides a  
          definition for the term "ambulance patient offload time" and  
          requires EMSA to create a methodology that local EMS agencies  
          may use to create a policy for the measurement and reporting of  
          ambulance patient offload time appropriate for their region.   
          The author states this methodology will be devised using  
          stakeholder input and flexible enough to meet the unique needs  
          of each of the state's 33 local EMS agencies.  The author argues  
          that delays in patient offload time are becoming more of a  
          problem than currently exists.  A crucial first step in dealing  
          with this issue is to properly identify and define what the  
          issue is.  The author concludes, this bill creates a common  
          definition and a standard way of measuring the problem across  
          the state, while allowing for the collection of the data needed  
          address it.


          The California Fire Chiefs Association (CFCA), sponsor of this  
          bill, writes in support that current law requires EMS providers  
          when responding to 9-1-1 calls to deliver their patients to  
          licensed EDs.  CFCA states that patients suffering from serious  
          medical conditions and those with only minor issues go through  
          the same process and are delivered to the same type of facility;  
          at the same time EDs are busier than ever, this means that EMS  
          responders are spending more time waiting to offload patients at  
          EDs and this bill seeks to help alleviate this problem by  
          requiring the adoption of a methodology to keep track of wait  
          times.  CFCA indicates that it is vital that as EDs and EMS  
          providers take on a larger role in our healthcare system that  
          state statutory and regulatory frameworks are updated to reflect  
          reality.  The California Professional Firefighters (CPF) also  
          write in support that this bill will establish an important  








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          first step in defining "wall time" within the context of  
          reducing or altogether eliminating wall time in our EMS system.   
          CPF further writes that while a patient waits to be admitted to  
          the hospital, EMS personnel responsible for his or her care  
          cannot respond to other emergency calls while waiting to  
          transfer the patient.  According to CPF, not only does this  
          prevent a patient from receiving appropriate and immediate care,  
          it poses a public safety risk by having fewer qualified EMS  
          personnel available to respond to other emergencies.


          The Riverside County Regional Medical Center and the Urban  
          Counties Caucus both write in opposition to the prior version of  
          this bill, that although reducing ambulance waiting times is an  
          important issue, local EMS agencies are currently working on a  
          project to try and address one facet of this issue and suggest a  
          local solution over a statewide construct, which may not work in  
          all counties.


          Analysis Prepared by:                                             
                          Patty Rodgers / HEALTH / (916) 319-2097  FN:  
          0001370