BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON EDUCATION
                              Senator Carol Liu, Chair
                                2015 - 2016  Regular 

          Bill No:             AB 1719             
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          |Author:    |Rodriguez                                            |
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          |Version:   |April 21, 2016                             Hearing   |
          |           |Date:    June 15, 2016                               |
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          |Urgency:   |No                     |Fiscal:    |Yes              |
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          |Consultant:|Lenin DelCastillo                                    |
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          Subject:  Pupil instruction:  cardiopulmonary resuscitation

          
          NOTE:  This bill has been referred to the Committees on  
          Education and Judiciary.  A "do pass" motion should include  
          referral to the Committee on Judiciary.

            SUMMARY
          
          This bill requires school districts and charter schools serving  
          students in grades 9-12 to offer instruction in compression-only  
          cardiopulmonary resuscitation (CPR) as part of a required  
          course, commencing in the 2018-19 school year.   

           
            BACKGROUND
          
          Existing law:

             1)   Establishes high school graduation requirements,  
               including three years in English, two years in math, and  
               two years of physical education, and permits school  
               districts to establish graduation requirements which exceed  
               those required by the state.  (Education Code § 51225.3)  


             2)   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  







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               hemorrhage control, treatment for poisoning, resuscitation  
               techniques, and CPR when appropriate equipment is  
               available.  (Education Code § 51202)


             3)   Provides 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.  (Civil Code § 1714.2)


             4)   Provides that a person or entity who provides CPR  
               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.  
               (Civil Code § 1714.21)





            ANALYSIS
          
          This bill:


             1)   Requires, starting with the 2018-19 school year, school  
               districts and charter schools to provide instruction in  
               compression-only cardiopulmonary resuscitation (CPR) as  
               part of an existing course for grades 9-12. Specifically,  
               this bill:  


             2)   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  








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                    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.  Defines "psychomotor skills" as  
                    skills that pupils are required to perform as hands-on  
                    practice to support cognitive learning.


             1)   Requires the California Department of Education (CDE),  
               prior to the beginning of the 2017-18 school year, to  
               provide guidance on how to implement the instructional  
               requirements of this bill, including, but not limited to,  
               who may provide instruction.


             2)   Encourages school districts and charter schools to  
               provide pupils general information on the use and  
               importance of an automated external defibrillator (AED).   
               Specifies that the physical presence of an AED in the  
               classroom is not required.


             3)   Provides that a school district or charter school may  
               adopt policies to implement the requirements of the bill.


             4)   Encourages a school district or charter school to use  
               the most cost-effective means possible to implement these  
               requirements. 


             5)   Provides that a local agency, entity of state or local  
               government, or other public or private organization that  
               sponsors, authorizes, supports, finances, or supervises the  
               instruction of pupils, or an employee who provides or  
               facilitates instruction in compression-only CPR or the use  
               of an AED, shall not be held liable for any civil damages  
               alleged to result from the acts or omissions of an  
               individual who received such instruction.    










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             6)   Specifies that this liability does not grant immunity  
               from civil damages to any person who provides or  
               facilitates the instruction of pupils in compression-only  
               CPR or the use of an AED in a manner that constitutes gross  
               negligence or willful or wanton misconduct. 


          



          STAFF COMMENTS
          
             1)   Need for the bill.  The author's office indicates that  
               "sudden cardiac arrest is one of the most lethal public  
               health threats in the United States, and sadly only 10% of  
               people who suffer cardiac arrest outside the hospital  
               survive.  If no cardiopulmonary resuscitation (CPR) is  
               provided or no defibrillation occurs within three to five  
               minutes of collapse, the chances of survival drop.   
               Effective bystander only CPR provided immediately after  
               sudden cardiac arrest can double or triple a victim's  
               chance of survival.  Alarmingly, 70% of Americans may feel  
               helpless to act during a cardiac emergency because they do  
               not know how to perform only cardiopulmonary resuscitation  
               (CPR) and only 32% 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 automated external defibrillators (AED) is part of  
               the existing curriculum framework found in the Health  
               Education Content Standards for public schools.   AB 1719  
               seeks to expand upon this current policy and ensure that  
               every high school student in California receives this  
               important, life-saving training."

             2)   Compression-only CPR training?  Compression-only CPR is  
               conventional CPR without mouth-to-mouth resuscitation.   
               According to the American Heart Association,  
               compression-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 lengthy  
               interruptions of chest compressions during ventilation.   








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               Compression-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.  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. 

             3)   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."  However, existing law does not  
               require a health course for graduation so not all students  
               receive instruction in CPR.  

             4)   Impact on core academic courses?  Notwithstanding the  
               benefits that may result, by requiring school districts and  
               charter schools to offer the instruction as part of a  
               required course, this bill could have the effect of taking  
               away valuable instructional time from a core academic  
               course and/or high school graduation requirement.   
               Additionally, the bill does not specify whether the  
               instruction would be offered annually for all students or  
               only on a one-time basis.  However, the sponsors of this  
               measure, the American Red Cross and the American Heart  
               Association/American Stroke Association indicate that the  
               required instruction would only take approximately 30  
               minutes of class time.  To help mitigate the potential  
               negative impact on the state required courses for  
               graduation and provide additional flexibility, staff  
               recommends an amendment that specifies that the instruction  
               could also be provided as part of a locally required course  
               and that a student only needs to receive the instruction  
               once during his or her tenure in high school.  

             5)   Fiscal impact.  According to the Assembly Appropriations  
               Committee, this bill would result in Proposition 98/GF  
               state mandated costs, potentially in the low millions,  
               starting in 2017-18, for school districts to provide  
               instruction in compression-only cardiopulmonary  
               resuscitation (CPR) to students in grades 9-12.  Actual  
               costs will vary depending on how a district chooses to  








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               implement the provisions of the bill. Charter schools will  
               also incur costs to implement the requirements of the bill;  
               however, charter schools are not eligible for mandate  
               reimbursement. 

          School districts may have access to instruction through in-kind  
          donations from community partners, such as hospitals or fire  
          departments. Other districts may need to provide instruction  
          using existing district staff who will need time to review  
          online training videos and prepare lesson plans.  San Francisco  
          Unified School District (SFUSD), for example, was able to  
          provide training through an in-kind donation from the local fire  
          department, however; according to SFUSD, the district dedicated  
          approximately $68,000 towards their hands-on CPR program. There  
          are 420 school districts that serve students in grades 9-12. If  
          one-fourth of these districts needed to make an investment  
          similar to SFUSD, statewide costs would be approximately $7.1  
          million. 

          There would also be General Fund administrative costs to  
          California Department of Education (CDE) of approximately  
          $32,000 to provide guidance documents and provide technical  
          assistance to districts and charter schools. 

             6)   Related legislation.

               AB 1639 (Maienschein, 2016) establishes the Sudden Cardiac  
               Arrest Prevention Act and requires the CDE to make  
               available specified guidelines and materials on sudden  
               cardiac arrest.  This bill is scheduled to be heard by this  
               Committee on June 29, 2016.

               AB 319 (Rodriguez, 2015) required school districts and  
               charter schools to provide instruction on performing CPR  
               and the use of an automated External Defibrillator (AED) to  
               students in grades 9-12 as part of a course required for  
               graduation.  This measure failed passage in the Assembly  
               Appropriations Committee.  

               AB 2217 (Melendez, Chapter 812, Statutes of 2014)  
               authorizes a 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. 








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          SUPPORT
          
          American Heart Association/American Stroke Association
          American Red Cross
          Association of California Healthcare Districts
          California Association for Health, Physical Education,  
          Recreation and Dance
          City of Los Angeles
          Service Employees International Union

            OPPOSITION
           
           None received.

                                      -- END --