BILL ANALYSIS Ó
AB 1719
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Date of Hearing: April 6, 2016
ASSEMBLY COMMITTEE ON EDUCATION
Patrick O'Donnell, Chair
AB 1719
(Rodriguez) - As Amended March 16, 2016
SUBJECT: Pupil instruction: cardiopulmonary resuscitation
SUMMARY: Requires school districts and charter schools serving
students in grades 9-12 to offer instruction in cardiopulmonary
resuscitation (CPR) as part of a required course. Specifically,
this bill:
1)Requires, commencing with the 2017-18 school year, the
governing board bodies of school districts and charter schools
which offer instruction in grades 9-12, to provide instruction
on performing CPR in a required course.
2)Requires that this instruction include both of the following:
a) an instructional program based on national
evidence-based emergency cardiovascular care guidelines for
the performance of CPR, such as those developed by the
American Heart Association or the American Red Cross
training for students relative to the psychomotor skills
necessary to perform CPR.
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b) Defines "psychomotor skills" as skills that students are
required to perform as hands-on practice to support
cognitive learning
3)Requires, before the start of the 2017-18 school year, the
California Department of Education (CDE) to provide guidance
on how to implement the requirements of the bill, including
the individuals who may provide instruction.
4)States that the CDE may consider an individual in any of the
following categories to provide instruction:
a) a licensed health care provider
b) an emergency medical technician
c) a peace officer
d) a firefighter
e) a teacher
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f) an instructor certified to teach CPR by the American Red
Cross or the American Heart Association, or an instructor
certified to teach an instructional program that is
nationally recognized and based on national evidence-based
emergency cardiovascular care guidelines for the
performance of CPR
g) any other provider of instruction in performing CPR, as
determined by the CDE
1)Encourages the providing of general information on the use and
importance of an automated external defibrillator (AED).
States that the physical presence of an AED in the classroom
is not required.
2)States that the governing board of a school district or the
governing body of a charter school may adopt regulations to
implement the requirements of the bill.
3)Encourages the governing board of a school district or the
governing body of a charter school providing instruction in
performing CPR or information on the use of an AED to use the
most cost-effective means possible to implement that
requirement.
4)States that the act shall not be construed to require the
governing board of a school district or the governing body of
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a charter school to make any purchases, including purchasing
an AED.
5)States that an entity providing, or overseeing the provision
of, instruction in performing CPR or information on the use of
an AED pursuant to this section may be exempt from civil
liability, as applicable and except as specified.
6)Adds CPR to the adopted course of study in personal and public
safety and accident control in elementary and secondary
grades.
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 Health curriculum framework and content standards. AB 1719
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" or "compression-only" CPR training?
Hands-only CPR, also known as compression-only 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. Research
indicates that this is due to a better willingness to start CPR
by bystanders, a low quality of mouth-to-mouth ventilation, and
a detrimental effect of too-long interruptions of chest
compressions during ventilation.
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 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.
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The author indicates that instruction in hands-only CPR would be
sufficient to meet the requirements of this bill, but this is
not indicated by the current language of the measure. Staff
recommends that this bill be amended to state that instruction
in compression-only CPR meets the instructional requirements of
the bill.
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 high school graduation requirements in other states.
According to the American Heart Association, twenty six other
states have adopted CPR training as a high school graduation
requirement. Among the larger states are Texas, New York,
Virginia, North Carolina, Georgia, 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
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effective with a future incoming class of 9th graders. Under
the current requirements of the bill, which will become
effective on January 1, 2017, the CDE would have to provide
guidance, and schools would have to be prepared to provide
instruction, by the beginning of the 2017-18 school year. As
this does not appear to provide enough time for implementation,
staff recommends that the bill be amended to make the
requirements of the bill effective for the 2018-19 school year.
Staff also recommends clarifying amendments stating that 1) the
required course in which CPR instruction is to take place is a
course offered in any of grades 9-12, and 2) change
"regulations" to "policies" which could be adopted by school
boards in implementing the requirements of the bill.
Local capacity and instructional time required to provide
training. Approximately 400,000 students graduate from
California high schools each year. Under the requirements of
this bill, students would receive instruction in CPR in a course
they are required to take. This raises a question regarding the
capacity of school districts - both in terms of instructors and
instructional time - to meet the requirements of the bill.
This bill requires the CDE to provide guidance on how to
implement the requirements of the bill, including who may
provide instruction, and states that the CDE may consider
specified individuals, including health care providers,
emergency medical technicians, peace officers and firefighters,
teachers, and CPR instructors.
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
requirements of this bill by offering that course. Since the
training could be completed in as little as 30 minutes sometime
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over the course of four years of instruction, it would not
appear to place an undue burden on instructional time for
individual students.
CPR training in state health standards and curriculum framework.
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."
As the author notes, this does not mean that all students
receive instruction in CPR, as not all districts require a
health course for graduation, and compliance with the standards
is not mandatory. Neither the standards nor the framework
mention use of an AED.
The current health framework is out of date and not aligned to
the state's 2008 health content standards. The CDE had been
preparing a revision of the framework, with expected adoption by
the State Board of Education in 2013, when in 2009 all work on
framework revisions was suspended due to state budget shortfalls
resulting from the economic recession. Last year the CDE
submitted a budget change proposal for the continuous funding of
the work of the Instructional Quality Commission (which develops
the frameworks) which was not included in the 2016-17 Governor's
Budget. The CDE has resubmitted this proposal.
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
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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.
According to the American Heart Association, in 2015 the San
Francisco Unified School District also announced that it would
make CPR training a graduation requirement commencing in the
2015-16 school year.
Amendments regarding liability. The author intends to adopt
amendments in this Committee which would require that teachers
who instruct students in providing CPR using an instructional
program based on national evidence-based emergency
cardiovascular care guidelines for the performance of CPR not be
liable for any civil damages resulting from any acts or
omissions of those students when they render emergency care.
Issues of liability are outside of the jurisdiction of this
Committee, so staff recommends the adoption of these amendments
and that a "do pass as amended" motion on this bill include a
referral to the Committee on Rules" for re-referral to the
appropriate policy committee.
Related legislation. AB 1639 (Maienschein) of this Session, as
heard by this Committee, establishes the Sudden Cardiac Arrest
Prevention Act; requires the CDE to make available specified
guidelines and materials on sudden cardiac arrest; requires
pupils and parents to sign informational materials before
athletic participation; requires training of coaches; and sets
requirements for action in the event a pupil experiences
specified symptoms. This bill is pending in the Assembly
Judiciary Committee.
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AB 319 (Rodriguez) of this Session would have required school
districts and charter schools to provide instruction on
performing CPR and the use of an AED to students in grades 9-12
as part of a course required for graduation. This bill was held
in the Assembly Appropriations Committee.
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.
This bill died in the Senate Appropriations Committee.
REGISTERED SUPPORT / OPPOSITION:
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Support
American Heart Association (co-sponsor)
American Red Cross (co-sponsor)
American Medical Response
American Medical Society for Sports Medicine
American Stroke Association
Association of California Healthcare Districts
California Association for Health, Physical Education,
Recreation and Dance
California Chapter of the American College of Emergency
Physicians
California School Nurses Organization
City of San Jose Councilmember Ash Kalra
City of San Diego Councilmember Marti Emerald
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Dignity Health
El Camino Children & Family Services, Inc. Board of Directors
Montebello Unified School District
Olivia's Heart Project
Racing Hearts
Santa Clara Unified School District
Numerous individuals
Opposition
None received
Analysis Prepared by:Tanya Lieberman / ED. / (916) 319-2087
AB 1719
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