BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 658|
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UNFINISHED BUSINESS
Bill No: SB 658
Author: Hill (D), et al.
Amended: 6/15/15
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 4/8/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE JUDICIARY COMMITTEE: 7-0, 5/12/15
AYES: Jackson, Moorlach, Anderson, Hertzberg, Leno, Monning,
Wieckowski
SENATE FLOOR: 39-0, 5/22/15
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Hall, Hancock,
Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno,
Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Moorlach,
Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Runner, Stone,
Vidak, Wieckowski, Wolk
ASSEMBLY FLOOR: 79-0, 8/20/15 - See last page for vote
SUBJECT: Automated external defibrillators
SOURCE: Author
DIGEST: This bill repeals or reduces various requirements
relating to persons or entities who acquire automated external
defibrillators (AEDs), including repealing requirements that
employees complete training, and reducing the inspection
requirements from once every 30 days to once every 90 days.
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Assembly Amendments 1) delete a requirement that the principle
of a public or private K-12 school designate the trained
employees who are required to be available to respond to an
emergency involving the use of an AED during normal operating
hours; and 2) revise a provision of existing law that governs
the placement of AEDs in public or private K-12 schools, by
requiring school administrators and staff to annually receive
information that describes sudden cardiac arrest, the school's
emergency response plan, and the proper use of an AED, rather
than a brochure approved by the American Heart Association or
the American Red Cross that just describes the proper use of an
AED, and by ensuring that instructions posted next to every AED
are in 14-point type.
ANALYSIS:
Existing law:
1)Provides, in the Civil Code, immunity from civil liability for
the acts or omissions of any person who, in good faith and not
for compensation, renders emergency care or treatment by the
use of an AED at the scene of an emergency.
2)Provides, in the Civil Code, immunity from civil liability for
any acts or omissions in the rendering of emergency care by
the use of an AED for a person or entity that acquires an AED
for emergency use, if that person or entity has complied with
certain specified requirements in the Health and Safety Code.
3)Provides, in the Civil Code, immunity from civil liability for
a physician who is involved with the placement of an AED, and
any person or entity responsible for the site where an AED is
located, if that physician, person or entity has complied with
all of the requirements in specified provisions of the Health
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and Safety Code that apply to that physician, person or
entity.
4)Provides, in the Health and Safety Code, immunity from civil
liability for a person or entity that acquires an AED for any
acts or omissions in the rendering of emergency care if that
person or entity meets various requirements, including:
a) Ensures that the AED is checked for readiness after each
use and at least once every 30 days;
b) Ensures that any person who renders emergency care or
treatment by using an AED activates the emergency medical
services system as soon as possible and reports the use to
the licensed physician and to the local Emergency Medical
Services (EMS) agency;
c) Ensures that for every AED unit acquired up to five
units, no less than one employee per AED unit, and one
employee for every additional five units, complete a
training course in cardiopulmonary resuscitation (CPR) and
AED use, as specified.
d) Ensure that tenants in a building where an AED is placed
receive a brochure describing the proper use of an AED and
are notified once a year of the location of AEDs.
e) Permits the Emergency Medical Services Authority (EMSA)
to establish minimum standards for the training and use of
AEDs.
This bill:
1)Recasts a provision of law in the Civil Code that provides
immunity from civil liability to a physician who is involved
with the placement of an AED, and any person or entity
responsible for the site where an AED is located, if that
physician, person, or entity has met certain specified
requirements, by narrowing the immunity to only physicians or
other healthcare professionals and by deleting the requirement
that conditions this immunity on meeting certain requirements,
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thereby making this civil liability protection unconditional.
2)Repeals a provision in the Health and Safety Code that
provides immunity from civil liability to a person or entity
who acquires an AED if that person or entity meets certain
requirements, and instead revises this provision to require
persons or entities who acquire an AED to meet a reduced set
of requirements (the reductions are described in #3 below).
3)Repeals, or in some cases revises, certain requirements for
persons or entities that acquire AEDs, as follows:
a) Repeals the requirement that for every AED unit acquired
up to five units, no less than one employee per AED unit,
and one employee for every additional five units, complete
a training course in CPR and AED use that complies with
regulations adopted by EMSA.
b) Repeals a requirement that acquirers of AED units have
trained employees who should be available to respond to an
emergency that may involve the use of an AED unit during
normal operating hours, and instead requires the building
owner to offer a demonstration once a year to at least one
person associated with the building.
c) Repeals the requirement that there be a written plan
that describes the procedures to be followed in the event
of an emergency that may involve the use of an AED, and
that this plan include immediate notification of 911 and
trained office personnel at the start of AED procedures.
d) Repeals the requirement that the AED be checked for
readiness after each use and at least once every 30 days if
the AED has not been used in the preceding 30 days, and
instead requires a visual inspection at least every 90 days
for potential issues such as a blinking light or other
obvious defects.
e) Repeals the requirement that the person or entity who
acquired an AED ensure that any person who renders
emergency care or treatment on a person in cardiac arrest
by using an AED activate the emergency medical services
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system as soon as possible, and reports any use of the AED
to the licensed physician and to the local EMS agency.
f) Repeals the requirement that building owners where an
AED is placed ensure that tenants annually receive a
brochure, approved by the American Heart Association or
American Red Cross, which describes the proper use of an
AED, and instead requires that that similar information is
posted next to any installed AED, and that tenants are
notified of the location of AED units at least once a year.
g) Revises the requirement that an agent of the local EMS
agency be notified of the existence, location and type of
AED acquired by requiring this notification to be done by
the person or entity who acquired the AED, rather than the
existing law requirement that this notification be done by
the person or entity that supplied the AED.
h) Only requires the AED to be maintained and annually
tested according to the operation and maintenance
guidelines set forth by the manufacturer, and repeals the
additional requirements that the maintenance and testing
also comply with guidelines set forth by the American Heart
Association, the American Red Cross, and according to any
applicable rules and regulations set forth by the
governmental authority under the federal Food and Drug
Administration (FDA) and any other applicable state and
federal authority.
4)Specifies that a medical director or other physician is not
required to be involved in the acquisition or placement of an
AED.
5)Specifies that the requirements relating to persons or
entities acquiring AEDs do not apply to licensed hospitals or
skilled nursing facilities.
6)Revises a provision of existing law that governs the placement
of AEDs in public or private K-12 schools, by requiring school
administrators and staff to annually receive information that
describes sudden cardiac arrest, the school's emergency
response plan, and the proper use of an AED, rather than a
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brochure approved by the American Heart Association or the
American Red Cross that just describes the proper use of an
AED, and by ensuring that instructions posted next to every
AED are in 14-point type.
7)Deletes a requirement that the principle of a public or
private K-12 school designate the trained employees who are
required to be available to respond to an emergency involving
the use of an AED during normal operating hours.
8)Specifies that the provision of existing law governing the
placement of AEDs in public or private K-12 schools does not
prohibit a school employee or other person from rendering aid
with an AED.
Comments:
1)Author's statement. According to the author, this bill
increases the likelihood that AEDs will be installed in
buildings throughout the state by reducing outdated
requirements imposed on building owners who voluntarily
install AEDs. Sudden cardiac arrest kills nearly 1,000 people
per day in the US and ends the lives of 350,000 people
annually. It can happen to anyone, anytime, anywhere and at
any age. The single most effective intervention during sudden
cardiac arrest is the use of an AED which can safely restore
the heart's normal rhythm. A study by Johns Hopkins University
found that Good Samaritan access to AEDs doubles survival from
sudden heart attack. Researchers found - in real-life,
emergency situations - that use of AEDs by random bystanders
more than doubled survival rates among victims felled by a
sudden heart stoppage due to a heart attack or errant heart
rhythm.
2)American Heart Association. According to the American Heart
Association (AHA), each year in the U.S., there are
approximately 359,400 Emergency Medical Services
(EMS)-assessed cardiac arrests outside of a hospital setting
and on average, less than 10 percent of victims survive. Early
defibrillation, along with CPR, is the only way to restore the
victim's heart rhythm to normal in a lot of cases of cardiac
arrest. For every minute that passes without CPR and
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defibrillation, however, the chances of survival decrease by 7
to 10 percent. The 2013 Update of AHA's Heart Disease and
Stroke Statistics shows that 23 percent of out-of-hospital
cardiac arrests are "shockable" arrhythmias, or those that
respond to a shock from an AED, making AEDs in public places
highly valuable. Yet, AHA states there are not enough AEDs and
persons trained to use them and perform CPR. Communities with
comprehensive AED programs that include CPR and AED training
have achieved survival rates of nearly 40 percent for cardiac
arrest victims. AHA states on its website that it supports
placing AEDs in targeted public areas such as sports arenas,
gate communities, office complexes, doctor's offices, shopping
malls, etc. When AEDs are placed in the community or a
business or facility, AHA strongly encourages that they be
part of a defibrillation program which includes notification
to the local EMS office when an AED is acquired, that a
licensed physician or medical authority provides medical
oversight to ensure quality control, and that persons
responsible for using the AED are trained in CPR and how to
use an AED.
3)EMSA Regulations. In 1990, EMSA adopted a package of
regulations entitled "Lay Rescuer Automated External
Defibrillator Regulations." These regulations predate the
civil immunity provisions that this bill revises, which were
first enacted in 1999. Much of the regulations were
incorporated into the later-enacted Health and Safety Code
requirements that are being repealed or revised by this bill,
including the employee training requirements and the
requirement that the AED be checked every 30 days. However,
these regulations also include a requirement that any agency,
business, organization or individual who purchases an AED for
use in a medical emergency (an AED Service Provider) must have
a physician medical director who is required to be involved in
developing an internal emergency response plan and who is
responsible for ensuring compliance with training,
notification and maintenance requirements. This bill includes
a provision that specifies that a medical director or other
physician is not required to be involved in the placement of
an AED.
4)CDC report on public access defibrillation. The Centers for
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Disease Control and Prevention (CDC) published an article in
2010 that reviewed state laws on public access defibrillation
(PAD) policies, and the extent to which 13 PAD program
elements, based on AHA recommendations, were mandated in each
state. These 13 elements range from targeted AED site
placement, CPR and AED training of anticipated rescuers,
maintenance and testing, coordination with emergency medical
services and oversight by medical professionals, and liability
protection. The article concluded that PAD programs in many
states are at risk of failure because critical elements such
as maintenance, medical oversight, EMS notification, and
continuous quality improvement are not required. The article
recommended that policy makers consider strengthening PAD
policies by enacting laws that require strategic placement of
AEDs in high-risk locations or mandatory PAD registries that
are coordinated with local EMS and dispatch centers.
California was identified as one of the states with the
highest rate of adoption of the 13 PAD elements, although no
state had mandated all 13 elements. The article stated that
because it only analyzed the extent to which states had
enacted specific PAD elements, it was unable to associate
cardiac arrest survival rates with the strength of a state
policy, and stated that further research is needed to identify
the most effective PAD policies for increasing AED use by lay
persons and improving survival rates.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:NoLocal: No
SUPPORT: (Verified8/21/15)
American Heart Association
American Red Cross
Association of California Healthcare Districts
Building Owners and Managers Association of California
California Ambulance Association
California Apartment Association
California Business Properties Association
California Chamber of Commerce
California Hospital Association
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California Retailers Association
California State Firefighters' Association
California State Sheriffs' Association
Civil Justice Association of California
Commercial Real Estate Development Association, NAIOP of
California
El Camino Hospital
International Council of Shopping Centers
Lucile Packard Children's Hospital
Philips
Pulse Point Foundation
Santa Clara County Board of Supervisors
Santa Clara County Fire Chiefs' Association
Silicon Valley Leadership Group
Stanford Health Care
OPPOSITION: (Verified8/21/15)
Rescue Training Institute
ARGUMENTS IN SUPPORT: Philips, a maker of AEDs, states in
support that California's current AED liability requirements are
onerous, outdated, and do not reflect the current capabilities
of AEDs in the marketplace. Building owners and those
responsible for sites where AEDs are located are therefore
dissuaded from purchasing and placed AEDs, out of fear they will
not be granted immunity from civil liability. The California
State Sheriffs' Association states in support that by
eliminating outdated and burdensome requirements that must be
met to confer protection from liability, the Legislature could
encourage wider access to AEDs and increase their life-saving
capacity. The California Business Properties Association, the
Building Owners and Managers Association of California, the
Commercial Real Estate Development Association, and the
International Council of Shopping Centers jointly write in
support that existing law may have made sense over a decade ago,
but due to evolving technology and ease of AED use, have since
become an anachronism and are an impediment to installation. The
California Chamber of Commerce notes in support that this bill
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still holds a manufacturer, developer, installer, or distributor
liable for potential product defects or performance, and that
this bill continues to mandate that any person or entity that
acquires an AED notify the local EMS agency of its placement as
well as ensure that the AED is regularly maintained and tested.
The American Heart Association states in support that while it
believes that requirements in current law are important, it
knows that sudden cardiac arrest is 100 percent fatal if not
treated quickly.
ARGUMENTS IN OPPOSITION: This bill is opposed by the Rescue
Training Institute, which states that it is not a good approach
to providing CPR and AED in the community by expecting a
non-trained employee or bystander to retrieve, deploy, apply and
utilize the AED to safely defibrillate a patient in sudden
cardiac arrest. Only through approved national training programs
can one learn how to confidently and competently perform CPR and
utilize an AED. The Rescue Training Institute also opposes the
repeal of the monthly inspection requirement and the requirement
that the AED be checked after each use.
ASSEMBLY FLOOR: 79-0, 8/20/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Cooley, Cooper, Dababneh, Dahle, Daly,
Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,
Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,
Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,
Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen,
Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Chu
Prepared by:Vince Marchand / HEALTH /
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8/21/15 10:03:48
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