BILL ANALYSIS Ó
AB 1827
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Date of Hearing: April 12, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 1827
(Kim) - As Amended March 16, 2016
SUBJECT: Emergency medical services: mobile field hospitals.
SUMMARY: Appropriates $2 million from the General Fund (GF) to
the Office of Emergency Services (OES) for the purpose of
providing maintenance and upkeep of one or more mobile field
hospitals (MFHs) to be ready and available within 72 hours in
the event of a natural disaster or other mass casualty incident.
EXISTING LAW:
1)Establishes OES in the office of the Governor and makes it
responsible for emergency and disaster response services for
natural, technological, or manmade disasters and emergencies.
2)Establishes the Emergency Medical Services Administration
(EMSA) in the Health and Human Services Agency to administer a
statewide system of coordinated emergency medical care, injury
prevention, and disaster medical response.
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FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, Californians
need to be prepared and protected in the event of a
particularly strong natural disaster or other catastrophic
emergency. We have facilities warehoused and collecting dust
that could be used to save lives. The state should make full
use of these MFHs and restore the ability for them to be
mobilized and treat disaster victims within 72 hours of a
catastrophic emergency. According to the California Office of
Statewide Health Planning and Development, over 75% of
California's hospitals are located in areas of high earthquake
potential. The U.S. Geological Survey calculates that between
April 1, 2015 and April 1, 2018 there is an 85% probability of
a magnitude '5' or greater earthquake hitting the greater Los
Angeles area. Earthquakes can cripple acute care hospitals
and until 2020, the first deadline for acute care hospitals to
withstand a strong earthquake, there is a deadly gap in
state-level disaster preparedness and response.
2)BACKGROUND.
a) Historical Background. According to EMSA, in 2007, the
state purchased three MFHs with the intent to replace or
augment acute hospital care capacity during catastrophic
emergencies. AB 1811 (Laird), Chapter 48, Statutes of
2006, which amended the Budget Act of 2006, authorized the
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purchase of the three MFHs at an initial GF cost of $18.3
million. Additionally, $1.7 million GF was authorized in FY
2006-07 to provide for ongoing costs associated with
program staff, storage, maintenance and readiness. These
ongoing funds were eliminated in FY 2011-12. The MFHs have
been deployed three times for exercises, but never for a
response to a real event.
b) Deployment Capabilities. Each MFH can be deployed as a
200-bed acute care facility that includes: 20 bed
Emergency Department; two Operating Room stations; 20
Intensive Care Unit beds; 10 Reverse Isolation beds; 170
medical-surgical ward beds; digital X-Ray; point of care
laboratory testing; Pharmacy; cascade oxygen system to
generate and refill oxygen tanks; 130 ventilators; and, a
30' x 50' climate controlled supply warehouse and staff
quarters for 150. Power is provided by up to eight diesel
generators, depending on the number of modules used. Each
MFH could be deployed as one integrated facility or in
smaller modules of 50, 100, or 150 beds. If divided into
smaller units, each would not have the same capabilities.
The shelf life for the MFHs' infrastructure items is a
minimum of 20 years; the current age is eight years.
c) Operational Status. Currently, all three MFHs are
stored in the Sacramento area in delayed deployment status
and cannot be mobilized in time to treat patients during
the initial phase of a response. Until June 30, 2015, one
MFH was maintained with ongoing biomedical equipment
maintenance for a target deployment time of one week. If
the other MFHs were needed in the event of a disaster, they
would require additional maintenance and recertification of
all biomedical equipment, which would require an estimated
minimum of 30 days before deployment.
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d) Program Costs. The cost estimates provided by EMSA and
outlined below are to restore one MFH to rapid deployment
condition and status. These are point-in-time estimates
and are based on past contracts.
i) Storage. To store one MFH requires 15,000-20,000
sq. ft. of clean storage space where biomedical equipment
maintenance can be performed. The facility requires a
forklift for movement of boxes to access the equipment
for maintenance and to move the generators outside to be
run once per month. Warehouse space for one MFH is
estimated to cost between $175,000 to $250,000 per year
if stored in Southern California. There are no
additional costs to store one hospital in Sacramento at
EMSA Station 1.
ii) Transportation. To move one MFH by ground, the
requirements are as follows: three 42' box trucks and
eighteen 42' flatbed trucks. The cost varies by
distance.
iii) Maintenance. To maintain one MFH a maintenance
contract would include: 24/7/365 logistical support,
setup teams immediately available for deployment,
maintenance of all support services contracts, and
ongoing maintenance and replacement of equipment beyond
its service life, including biomedical, batteries,
generators, medical supplies, shelters, and other items.
Some equipment needs replacement, as it is beyond its
service life. The maintenance for one MFH is estimated
to cost between $825,000 and $900,000 per year.
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3)SUPPORT. Supporters of this bill argue that MFHs have a long
and proven record providing critical life-saving facilities
during emergencies. Appropriating $2 million to maintain
these valuable emergency medical assets is critical.
4)OPPOSITION. The California Ambulance Association argues that
OES has no statutory authority to provide medical care during
a disaster. Such authority rests with EMSA and the Health and
Welfare Agency. Furthermore, OES has no experience in
operating a MFH or overseeing emergency medical services.
Thus, OES is the wrong agency to receive funds for the
operation and maintenance of MFHs.
5)RELATED LEGISLATION. AB 1528 (Rodriguez) appropriates $2
million from the GF to the EMSA to provide maintenance and
upkeep of MFH within the MFH Program. AB 1528 is scheduled to
be heard by the Assembly Health Committee on April 12, 2016.
6)PREVIOUS LEGISLATION. AB 355 (Cooley) of 2013 would have
appropriated $1 million from the GF to EMSA to continue the
MFH Program. AB 355 was held on the Senate Appropriations
Committee Suspense File.
REGISTERED SUPPORT / OPPOSITION:
Support
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California Fire Chiefs Association
Fire Districts Association of California
Opposition
California Ambulance Association
Analysis Prepared by:John Gilman / HEALTH / (916) 319-2097