BILL ANALYSIS Ó
AB 1719
Page 1
Date of Hearing: April 19, 2016
ASSEMBLY COMMITTEE ON JUDICIARY
Mark Stone, Chair
AB 1719
(Rodriguez) - As Amended April 11, 2016
As Proposed to be Amended
SUBJECT: PUPIL INSTRUCTION: CARDIOPULMONARY RESUSCITATION
KEY ISSUE: should school districts and public employees who
facilitate instruction on compression-only CPR in high schools
be immune from any civil damages alleged to result from the acts
or omissions of an individual who received such instruction?
SYNOPSIS
Sudden cardiac arrest is a leading cause of death in the United
States. According to the American Heart Association, there are
between approximately 236,000 and 325,000 out-of-hospital
incidents of sudden cardiac arrest in the United States each
year. Survival rates (defined as being discharged alive from
the hospital) vary widely by region, but the overall average
rate of survival is estimated to be 7.6 percent to 7.9 percent.
However, effective bystander CPR provided immediately after
sudden cardiac arrest can double or triple the likelihood that a
victim will survive. The odds of surviving sudden cardiac
arrest are 2.4 times higher for those who received any form of
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bystander CPR with or without ventilation.
Existing law, in order to encourage qualified individuals to
instruct citizens in CPR, provides certified instructors with
immunity from liability for any civil damages alleged to result
from the acts or omissions of the persons they train to perform
CPR. In order to encourage training and use of emergency CPR,
this bill, as proposed to be amended, requires compression-only
CPR training as a standard part of high school curriculum. It
also provides immunity to school districts, public employees
that facilitate instruction of students in compression-only CPR
or use of an AED pursuant to the bill. This bill does not
affect the certification requirement for instructors, or the
training requirement for rescuers in current law that apply to
regular CPR. The author and sponsors of this bill assert that
such training is not necessary for compression-only CPR, which
can be taught by video and volunteer (non-certified)
instructors. The author and sponsors reasonably argue that
compression-only CPR instruction in schools should not be
subject to such rigorous training and certification requirements
of regular CPR. In response to an inquiry from this Committee
about whether there are any known cases of injuries attributable
to compression-only CPR, the author and sponsors say they are
unaware of even a single case. However, they have many examples
of students who have saved lives by performing compression-only
CPR after receiving instruction in schools.
This bill recently passed the Education Committee by a vote of
6-0 (with one Member not voting). It is co-sponsored by the
American Heart Association and the American Red Cross. It is
supported by a large number of education and health
organizations and has no opposition.
SUMMARY: Requires compression-only CPR training as a standard
part of high school curriculum and provides immunity to school
districts, public employees that facilitate instruction of
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students in compression-only CPR or use of an AED pursuant to
the bill. Specifically, this bill:
1)Provides that, commencing with the 2018-19 school year, the
governing board of a school district, and the governing body
of a charter school, offering instruction to pupils in grades
9 to 12, inclusive, shall provide instruction in performing
compression-only cardiopulmonary resuscitation (CPR) as part
of a required high school curriculum and requires the
instruction to include both of the following:
a) An instructional program based on national
evidence-based emergency cardiovascular care guidelines for
the performance of compression-only CPR, such as those
developed by the American Heart Association or the American
Red Cross.
b) Instruction to pupils relative to the psychomotor skills
necessary to perform compression-only CPR.
1)Requires that before the commencement of the 2017-18 school
year, the California Department of Education to provide
guidance on how to implement this section, including, but not
limited to, who may provide instruction pursuant to this
section.
2)Encourages the governing board of a school district or the
governing body of a charter school to provide to pupils
general information on the use and importance of an automated
external defibrillator (AED) and specifies that the physical
presence of an AED in the classroom is not required.
3)Provides that no local agency, entity of state or local
government, or other public or private organization that
sponsors, authorizes, supports, finances, or supervises the
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instruction of students in compression-only CPR or use of an
AED shall be liable for any civil damages alleged to result
from the acts or omissions of an individual who received such
instruction.
4)Provides that a public employee who facilitates instruction of
students in compression-only CPR or use of an AED pursuant to
this section shall not be liable for any civil damages alleged
to result from the acts or omissions of an individual who
received such instruction.
5)Provides that the bill shall not be construed to grant
immunity from civil damages to any person who provides or
facilitates instruction of students in compression-only CPR or
use of an AED in a manner that constitutes gross negligence or
willful or wanton misconduct.
EXISTING LAW:
1)Provides that everyone is responsible, not only for the result
of his or her willful acts, but also for an injury occasioned
to another by his or her want of ordinary care or skill in the
management of his or her property or person, except so far as
the latter has, willfully or by want of ordinary care, brought
the injury upon himself or herself. (Civil Code Section 1714
(a).)
2)Provides that a person who in good faith, and not for
compensation, renders emergency medical or nonmedical care at
the scene of an emergency shall not be liable for any civil
damages resulting from any act or omission. (Health and
Safety Code Section 1799.102 (a).)
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3)Provides that a public employee is not liable for an injury
resulting from his act or omission where the act or omission
was the result of the exercise of the discretion vested in
him, whether or not such discretion was abused. (Government
Code Section 820.2.)
4)Provides that any person who has completed a basic
cardiopulmonary resuscitation course that complies with the
standards adopted by the American Heart Association or the
American Red Cross for cardiopulmonary resuscitation and
emergency cardiac care, and who, in good faith, renders
emergency cardiopulmonary resuscitation at the scene of an
emergency shall not be liable for any civil damages as a
result of any acts or omissions by such person rendering the
emergency care. (Civil Code Section 1714.2 (a).)
5)Provides that 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 shall be
liable for any civil damages alleged to result from such
training programs. (Civil Code Section 1714.2 (c).)
FISCAL EFFECT: As currently in print this bill is keyed fiscal.
COMMENTS: Sudden cardiac arrest is a leading cause of death in
the United States. According to the American Heart Association,
there are between approximately 236,000 and 325,000
out-of-hospital incidents of sudden cardiac arrest in the United
States each year. Survival rates (defined as being discharged
alive from the hospital) vary widely by region, but the overall
average survival rate is estimated to be only 7.6 percent to 7.9
percent.
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Sudden cardiac arrest (SCA) occurs when electrical impulses in
the heart become rapid or chaotic, which causes the heart to
suddenly stop beating. Within a few seconds, the victim's heart
stops beating; blood stops circulating; oxygen stops flowing to
the brain; and the victim stops breathing. If no CPR is
provided (or no defibrillation occurs) within 3 to 5 minutes of
the incident, the chances of survival drop significantly.
However, effective bystander CPR provided immediately after
sudden cardiac arrest can double or triple the likelihood of the
victim's survival. According to one study, the odds of a
favorable 30-day neurological outcome associated for out of
hospital SCA victims was 2.4 times higher for those who received
any form of bystander CPR with or without ventilation. (Cave et
al, AHA Circulation (2011), Importance of Training in
Cardiopulmonary Resuscitation and Automated External
Defibrillation in Schools: A Science Advisory From the American
Heart Association, Vol. 123: pp 691-706.
http://circ.ahajournals.org/ ) Unfortunately, approximately 70
percent of Americans feel helpless to act during a cardiac
emergency because they do not know how to perform CPR. (Ibid.)
How Compression-only CPR and its Training Programs Differ from
Regular CPR. Compression-only CPR is CPR without mouth-to-mouth
resuscitation. According to the author and co-sponsors, it is
an easy-to-learn method of CPR that has been proven to be, as
mentioned above, as effective as conventional CPR.
Compression-only CPR training is much more simple and easy to
learn than regular CPR. According to materials provided by the
author and co-sponsors, it can be delivered in one of three
ways: traditional instructor-led courses, traditional peer-led
courses, and video-based, self-directed training. And a live
instructor is not required.
A facilitator is typically present when self-directed
video-based training is used in a group setting. These methods
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have been compared in the literature. Peer-led and video-based
training have been shown to be at least as effective as
traditional instructor-led courses. All 3 methods have been
successfully implemented in schools.
Skills testing can be performed by a skills evaluator (as is
assumed in this example) or by use of an authorized
computerized manikin system. . . . Some advantages have been
noted for peer-led and videobased training that are worth
consideration when planning a school program. Peer-led
training generally reduces the demand for instructors, which
can simplify logistics and reduce costs. Likewise,
self-directed video-based training eliminates the need for CPR
instructors. Some of these programs, such as the video-based
training kit . . . have the additional advantage of a short
training time (22 minutes) and can be used at home by others.
Nevertheless, instruction on the technique to perform
compression-only CPR is important. According to the American
Heart Association:
The quality, depth, and rate of compressions and the duration
of interruptions to compressions have a direct impact on
outcome of cardiac arrest. . . . Performance of high-quality
chest compressions should therefore be the core psychomotor
skill taught in any CPR training program, with emphasis on
correct depth and rate, full chest recoil, and minimal
interruptions in compressions. When teaching hands-only CPR
for adults who have suddenly collapsed, providing high-quality
chest compressions is the only psychomotor skill that needs to
be taught.
Compression-only CPR, according to the author and sponsors, is
also far less intimidating for bystanders to perform in an
emergency. According to the American Heart Association, those
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who have not been trained in CPR within the last five years
stated that they would be more likely to perform
compression-only CPR than conventional CPR for an adult who
collapses suddenly. (Cave et al, supra.)
Experience with Compression-only CPR in California Schools. The
Placentia Yorba Linda Unified School District became the first
school district in California to require compression-only CPR
training in high school after a 17 year-old student at a
district high school suffered sudden cardiac arrest at tennis
practice and died. The district has provided this instruction
to all 9th grade students through a locally-required health
course and has purchased CPR Anytime kits, which include
manikins. Compression-only CPR (with AED instruction) is
required for high school graduation for all students in the
district.
In 2015, the San Francisco Unified School District began
requiring CPR instruction for all high school students. The San
Francisco Fire Department has partnered with the district to
provide instruction to the students free of charge for the first
three years. According to the author and sponsors, 27 states
have passed legislation to teach some form of CPR instruction in
high schools.
Immunity Provisions for Volunteers who Provide Emergency Medical
Care in Schools. Existing state law provides qualified immunity
to school personnel who volunteer to be trained to administer
emergency medical assistance in some circumstances. It also
requires the employers of these volunteers - a school district,
county office of education, or charter school -to provide them
with legal defense and indemnification for any and all civil
liability associated with providing emergency medical care. For
example, school personnel who agree to be trained to use an
epinephrine auto-injector (Education Code Section 49414 (j));
epilepsy anti-seizure medication (Education Code Section 49414.7
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(i)); or an automated external defibrillator (AED) (Education
Code Section 49417 (b)) have immunity from civil liability for
the administration of emergency medical assistance, as well as
the right to defense by the employer; and the right to
indemnification. The only exceptions (which makes the immunity
"qualified") are cases in which personal injury or wrongful
death results from gross negligence or willful or wanton
misconduct on the part of the person who uses, attempts to use,
or maliciously fails to render emergency care or treatment.
(See, for example, Education Code Section 49417 (d).) The
rationale for these provisions in the Education Code is
presumably to encourage volunteers, who otherwise are not
required to provide medical care, to be trained and provide care
when needed.
This is similar to the rationale in the Civil Code for providing
immunity to persons who are not otherwise required to provide
training, be trained, or administer CPR. Such immunity is
intended to "encourage citizens to participate in emergency
medical services training programs and to render emergency
medical services to fellow citizens" (Civil Code Section 1714.2
(a)).
CPR Immunity Provisions in Current Law Differ From the Immunity
Provisions in this bill Because "Training" Programs are
Different. Existing law, in order to encourage qualified
individuals to instruct citizens in CPR, provides certified
instructors with immunity from liability for any civil damages
alleged to result from the acts or omissions of the persons they
train to perform CPR. (Civil Code Section 1714.2 (d).)
Likewise, any person who has completed a basic CPR course and
who, in good faith and not for compensation, renders emergency
CPR at the scene of an emergency is immune from liability for
any civil damages as a result of doing so. (Civil Code 1714.2
(a).) The Legislature clearly intended for individuals who
perform CPR to be fully and competently trained, at least in
order to have qualified immunity for doing so.
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This bill does not affect the certification requirement for
instructors, or the training requirement for rescuers in current
law that apply to regular CPR in Civil Code Section 1714.2,
above. The author and sponsors of this bill assert that such
training is not necessary for compression-only CPR, which can be
taught by video and volunteer (non-certified) instructors, so
compression-only CPR instruction in schools should not be
subject to such rigorous training and certification
requirements.
In response to an inquiry from this Committee about whether
there are any known cases of injuries attributable to
compression-only CPR, the author and sponsors say they are
unaware of even a single case. However, they have many examples
of students who have saved lives by performing CPR after
receiving instruction in schools. For example:
Washington Teens Save Stranger by Giving CPR. On April 15,
2015 in Tulalip, Washington, Hailey Enick and Jasmine Daniels
sprang into action after they came across an unconscious man
in a McDonald's parking lot. When the girls arrived, they saw
that no one had started chest compressions. The high school
freshman had recently learned CPR in their health class. They
took turns doing the compressions until EMTs arrived and saved
his life. The EMTs said if they hadn't started chest
compressions the man would not have survived.
( http://abcnews.go.com/Health/washington-teens-save-stranger-gi
ving-cpr/story?id=30227460 )
Missouri Teen Credited With Saving Baby's Life at Wal-Mart.
On November 17, 2014 in Missouri, while shopping in Walmart,
17 year-old Abby Snodgrass saw a crowd gather around a mother
whose infant had stopped breathing. No one else knew CPR, so
Abby pushed through the onlookers and performed it herself.
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She learned CPR in her health class in high school. The local
fire chief said had it not been for Abby's bravery, the baby
may not have survived.
( http://ktla.com/2014/11/17/missouri-teen-credited-with-saving-
babys-life-at-wal-mart/ )
Teens give girl life-saving CPR on school bus. On March 21,
2016 in Gwinnett County, Georgia, Ismael Olvera and Rebecca
Goodrich, both high school students, saved Ismael's 15
year-old sister's life after she stopped breathing on a school
bus. Ismael and Rebecca did chest compressions along with
mouth-to-mouth resuscitation. They continued CPR until
paramedics arrived. Gwinnett County school officials shared
the story as an example of the importance of CPR.
( http://www.ajc.com/news/news/local-education/teens-give-girl-l
ife-saving-cpr-on-school-bus/nqp62/ )
Student learns CPR at airport, saves fellow student 2 days
later. On April 8, 2015, college student Matt Lickenbrock
saved the life of a fellow student who had collapsed when he
performed CPR on the other student. He had learned hands-only
CPR two days earlier from a kiosk at the Dallas/Fort Worth
International Airport during a three-hour layover there. He
practiced for about 10 to 15 minutes until he got a perfect
score. Two days later at school he was able to use his skills
to save a life.
( http://wishtv.com/2016/03/10/student-learns-cpr-at-airport-sav
es-fellow-student-2-days-later/ )
Forestville teen saves dad's life. On October 2014, 13
year-old Lewis Griffith of Forestville, California, saved the
life of his father, Steve Griffith, after he suffered a heart
attack. He used compression-only CPR, a technique he learned
from a class at Forestville Academy. He learned CPR in his
P.E. class. He said he knew to put one hand on top of the
other and aim for the center of his dad's chest. He began
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pushing down to the beat of the old disco favorite "Stayin'
Alive" and didn't stop until Forestville firefighters arrived
and took over. (
http://www.pressdemocrat.com/news/2904853-181/forestville-teen-
saves-dads-life )
Given the distinction between compression-only CPR and regular
CPR, and the lack of evidence that anyone has ever been injured
as a result of a person performing, or attempting to perform
compression-only CPR (and considering the life-saving potential
demonstrated by the examples, above), it seems reasonable to
have different immunity provisions for the two types of CPR. As
proposed to be amended, this bill will offer "qualified
immunity" (which does not immunize against gross negligence, or
wanton and willful misconduct) to the following: (1) government
agencies and non-profit organizations that instruct students in
compression-only CPR, and (2) public employees who facilitate
instruction in compression-only CPR. These provisions appear to
adequately protect the public from the risk of injury, while
promoting the public policy of widespread and effective
compression-only CPR training.
Any Issue of Liability for Students who Perform Compression-only
CPR is Fully Addressed by the "Good Samaritan" Law. In 2009,
California adopted a so-called "Good Samaritan" statute. (The
term refers to the parable in the Gospel of Luke about the
"lowly" Samaritan who came to the aid of a stranger left for
dead while supposedly more upstanding citizens ignored the cries
of the dying man.) California's Good Samaritan statute (Health
& Safety Code Section 1799.102) grants qualified immunity to any
person who renders medical or non-medical aid in an emergency,
so long as that person acts in good faith and not for
compensation, and so long as that person's conduct is not
grossly negligent or willful or wanton.
It is difficult to imagine a situation in which a person who was
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instructed in the use of compression-only CPR, as envisioned by
this bill would have any liability for performing, attempting,
or failing to perform compression-only CPR on a person
experiencing sudden cardiac arrest. Given the likelihood of the
person dying without any medical intervention, it is virtually
impossible to imagine a scenario in which a lay rescuer could
even theoretically be liable for his or her performance or
non-performance of chest compressions. But if such an unlikely
situation were to hypothetically arise, the lay rescuer would be
protected from liability under the Good Samaritan statute.
Given the fact that Health & Safety Code Section 1799.102
provides immunity from liability, an express immunity provision
for student rescuers is unnecessary. Considering that this bill
deals only with the issue of compression-only CPR instructional
programs in schools, an express immunity provision for students
seems inappropriate.
Author's Proposed Amendments. In order to clarify that the
provisions of the bill only apply to compression-only CPR,
prevent confusion over the issue of whether CPR instructors need
to be certified in order to instruct students on
compression-only CPR, and specify the individuals who are
protected from liability for damages alleged to result from
compression-only CPR instruction, the author has agreed to the
following amendments:
1)Strike out SECTION ONE in its entirety
2)Amend SECTION THREE as follows:
51225.6. (a) Commencing with the 2018-19 school year, the
governing board of a school district, and the governing body
of a charter school, offering instruction to pupils in grades
9 to 12, inclusive, shall provide instruction in performing
compression-only cardiopulmonary resuscitation (CPR) as part
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of a course offered in any of grades 9 to 12, inclusive, that
is required pursuant to this article. This instruction may
consist solely of instruction in compression-only CPR and
shall include both of the following:
(1) An instructional program based on national evidence-based
emergency cardiovascular care guidelines for the performance
of compression-only CPR, such as those developed by the
American Heart Association or the American Red Cross.
(2) Training for Instruction to pupils relative to the
psychomotor skills necessary to perform compression-only CPR.
For purposes of this paragraph, "psychomotor skills" means
skills that pupils are required to perform as hands-on
practice to support cognitive learning.
(b) Before the commencement of the 2017-18 school year, the
department shall provide guidance on how to implement this
section, including, but not limited to, who may provide
instruction pursuant to this section. The department may
consider an individual in any of the following categories to
provide instruction:
(1) A health care provider licensed pursuant to Division 2
(commencing with Section 500) of the Business and Professions
Code, the Osteopathic Initiative Act, as set forth in Chapter
8 (commencing with Section 3600) of Division 2 of the
Business and Professions Code, or the Chiropractic Initiative
Act, as set forth in Chapter 2 (commencing with Section 1000)
of Division 2 of the Business and Professions Code.
(2) A person certified pursuant to the Emergency Medical
Services System and the Prehospital Emergency Medical Care
Personnel Act (Division 2.5 (commencing with Section 1797) of
the Health and Safety Code).
(3) A peace officer, as defined in Section 830 of the Penal
Code.
(4) A firefighter, defined as any regularly employed and paid
officer, employee, or member of a fire department or fire
protection or firefighting agency of the State of California,
a city, a county, a city and county, a district, or other
public or municipal corporation or political subdivision of
this state or member of an emergency reserve unit of a
volunteer fire department or fire protection district.
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(5) A teacher.
(6) 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.
(7) Any other provider of instruction in performing CPR.
(c) The governing board of a school district or the
governing body of a charter school is encouraged to provide
to pupils general information on the use and importance of an
automated external defibrillator (AED). The physical presence
of an AED in the classroom is not required.
(d) The governing board of a school district or the governing
body of a charter school may adopt policies to implement this
section.
(e) (1) The governing board of a school district or the
governing body of a charter school providing instruction in
performing compression-only CPR or information on the use of
an AED pursuant to this section is encouraged to use the most
cost-effective means possible to implement that requirement.
(2) This section shall not be construed to require the
governing board of a school district or the governing body of
a charter school to make any purchases, including, but not
limited to, purchasing an AED.
(f) 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, pursuant to
Section 1714.2 or 1714.21 of the Civil Code, respectively.
(1) No local agency, entity of state or local government, or
other public or private organization that sponsors,
authorizes, supports, finances, or supervises the instruction
of students in compression-only CPR or the use of an AED
shall be liable for any civil damages alleged to result from
the acts or omissions of an individual who received such
instruction.
(2) A public employee who facilitates instruction of students
in compression-only CPR or the use of an AED pursuant to this
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section shall not be liable for any civil damages alleged to
result from the acts or omissions of an individual who
received such instruction.
(3) This section shall not be construed to grant immunity
from civil damages to any person who provides or facilitates
instruction of students in compression-only CPR or the use
of an AED in a manner that constitutes gross negligence or
willful or wanton misconduct.
RECENT SIMILAR LEGISLATION: AB 319 (Rodriguez, 2015) 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 not heard by this Committee and was held in the
Assembly Appropriations Committee.
AB 939 (Melendez, 2013) 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.
AB 1639 (Maienschein) provides additional information, training,
and emergency intervention protocols at schools in order to
reduce the risk of sudden cardiac arrest (SCA) among students,
specifically requiring coaches to remove athletes with symptoms
of SCA from competition. Passed by this Committee and in
Assembly Appropriations.
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.
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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:
Support
American Heart Association (co-sponsor)
American Red Cross (co-sponsor)
California Chapter of the American College of Emergency
Physicians (CA-ACEP)
American Academy of Pediatrics
American Medical Response
American Medical Society for Sports Medicine
Ash Kalra, Councilmember, City of San Jose
Association of California Healthcare Districts
California Association for Health, Physical
Education, Recreation and Dance
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California Ambulance Association
California School Boards Association
California Society of Respiratory Care
Dignity Health
El Camino Children and Family Services
Learn for Morgan Foundation
Los Angeles Unified School District
Marti Emerald, Council President Pro Tem, City of San Diego
Mitchell Englander, Councilmember, Los Angeles City Council
Montebello Unified School District
Olivia's Heart Project
Racing Hearts
San Francisco Fire Department
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Santa Clara Unified School District
Numerous Individuals
Opposition
None on file
Analysis Prepared by:Alison Merrilees / JUD. / (916) 319-2334