BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K Alquist, Chair
BILL NO: AB 1272
A
AUTHOR: Hill
B
AMENDED: June 2, 2010
HEARING DATE: June 9, 2010
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CONSULTANT:
2
Tadeo
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SUBJECT
Emergency medical services: trauma center: helicopter
landing pad
SUMMARY
Requires a local government to consult with the local
Emergency Medical Services (EMS) agency regarding the
benefits of air ambulance access for the local EMS system
prior to disapproving a proposed helipad/heliport facility.
Provides a hospital or trauma center not less than 90 days
to prepare and provide an independent report that describes
the health and safety impacts to the local community and
larger region of the proposed heliport/helipad, prior to
the local government disapproving a proposed
helipad/heliport facility.
CHANGES TO EXISTING LAW
Existing law:
Establishes the Emergency Medical Services Authority (EMSA)
under the Emergency Medical Services System and the
Prehospital Emergency Medical Care Personnel Act (EMS Act)
and requires it to develop guidelines for local emergency
Continued---
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medical services systems which address, among other
components, transportation, system organization and
management, and disaster response.
Requires EMSA to adopt regulations that provide specific
requirements for the care of trauma cases and ensures that
the trauma care system is fully coordinated with all
elements of the existing emergency medical services system.
Authorizes each county to develop an emergency medical
services program, and requires each county developing such
a program to designate a local EMS agency (LEMSA).
Allows a LEMSA to implement a trauma care system in
accordance with minimum standards set forth in EMSA
regulations. A LEMSA must also develop and submit a trauma
care system plan to the EMSA prior to implementing a
system.
Permits a county, upon the recommendation of the LEMSA, to
adopt ordinances governing the transport of patients who
are receiving care in the field from prehospital emergency
medical personnel, when the patients meet specific criteria
for trauma, burn, or pediatric care adopted by the LEMSA.
Prohibits the EMS Act from being construed as restricting
the use of a helicopter of the California Highway Patrol
(CHP) for missions which the CHP determines are in the best
interests of the people of the State of California.
Prohibits, under the State Aeronautics Act, a political
subdivision, or any person, from submitting any application
for the construction of a new airport to any local,
regional,
state, or federal agency unless the plan for construction
is first approved by the board of supervisors of the
county, or the city council of the city, in which the
airport is to be located, and unless the plan is submitted
to the airport land use commission, and acted upon by that
commission in accordance as specified.
Permits a county board of supervisors or a city council to
delegate responsibility for the approval of a construction
plan of new helicopter landing and takeoff areas to the
county or city planning agency.
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Requires every city and county to adopt a general plan with
seven mandatory elements: land use, circulation, housing,
conservation, open space, noise, and safety. Except for
the housing elements, existing law does not require cities
and counties to regularly revise their general plans.
Cities and counties' major land use decisions --
subdivisions, zoning, public works projects, use permits --
must be consistent with their general plans. Development
decisions must carry out and not obstruct a general plan's
policies.
This bill:
Prohibits a city, county, or city and county from
disapproving an application for a permit to build a
heliport/helipad upon the property of a general acute care
hospital until after the city, county, or city and county
consults with the LEMSA regarding the benefits of air
ambulance access for the local EMS system.
Provides a hospital applicant with not less than 90 days to
prepare and provide the city, county, or city and county
with an independent report that describes the health and
safety impacts of the proposed heliport/helipad. Requires
the city, county, or city and county to discuss the
findings of the report in an open meeting before it takes
action on the application, if the applicant provides the
independent report.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
The author states that, under current law, there is no
requirement that local governments take health and safety
factors into consideration when deciding on proposed
helipad/heliport facilities at hospitals or trauma centers.
The author adds that patient survival rates are
significantly improved with the utilization of air
ambulance services. Rural communities and high traffic
zones depend on this form of transportation to immediately
deliver a patient to the appropriate care center.
Additionally, many rural hospitals utilize air ambulance
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services to deliver patients to tertiary care centers that
can appropriately treat them when the rural hospital does
not have the service available, for example, in the case of
a high-risk pregnancy or cardiac event. The author contends
that AB 1272 would improve emergency medical air transport
by including health and safety considerations into the
local debate regarding proposed helipad/heliport
facilities.
Trauma and the "golden hour"
A trauma patient is a seriously injured person who requires
timely diagnosis and treatment of actual or potential
injuries by a multidisciplinary team of health care
professionals, supported by the appropriate resources, to
diminish or eliminate the risk of death or permanent
disability.
Trauma is the third leading cause of death in the United
States and the leading cause of death for people between
ages 1 through 44, regardless of gender, race, or economic
status. Patients with traumatic injuries have better
chances of survival if they receive specialized trauma care
within the first hour after injury, the "golden hour." In
trauma care, the "golden hour" is the brief window of time
in which the lives of a majority of critically injured
trauma patients can be saved if appropriate treatment is
provided. The golden hour provides 60 minutes from the
moment of injury to call 911, dispatch an ambulance,
transport the victim to a trauma center, and perform the
necessary, life-saving intervention. However, not everyone
lives near a trauma center and not all traumatic injuries
occur near a trauma center. Air ambulances can cut the
time it takes to transport patients with life-threatening
injuries to trauma centers.
Trauma care systems
A trauma system is an organized, coordinated system in a
defined geographic area that delivers the full range of
emergency and trauma care services to injured patients and
is integrated with the local medical and public health
systems.
The state is divided into 31 LEMSAs, including 24
single-county and 7 multi-county LEMSAs. LEMSAs plan,
implement and manage local trauma systems based upon state
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regulations, but are not mandated to develop trauma
systems. Local trauma plans are submitted to EMSA for
review and approval. The plans must outline the elements
of the local trauma systems, including the number and level
of trauma centers and destinations, but do not necessarily
address inter-county needs. According to a 2006 EMSA
evaluation on California statewide trauma planning, 28 of
the 31 LEMSAs have approved trauma plans, which are in
varying stages of implementation, and one has a plan in
process.
LEMSAs may designate trauma centers that meet state trauma
regulation requirements. There are currently 65 designated
trauma centers throughout the state. Initial transport to
a trauma center is considered part of the emergency
response, but transport from one trauma center to the other
is not.
Trauma center designations include Levels I though IV and
Pediatric Levels I and II. Level I and II (including
pediatric trauma centers) have the greatest number of
specialty personnel, services, and resources. Level I
trauma centers are also research and teaching facilities.
Level III trauma centers provide surgical service for
patients with less critical injuries who do not need
immediate surgery. Level IV trauma centers generally
provide initial stabilization of trauma patients with
secondary transfer to a higher level of trauma center care
when appropriate. Five of the sixty-five trauma centers do
not have a helipad to receive air transported trauma
victims.
Although there are trauma centers throughout the state,
access to trauma centers in many areas, including the North
Coast, Central Valley, and East Sierra areas is extremely
limited resulting in long transport times, even by air, of
one to three hours from the time of injury.
According to the 2006 EMSA evaluation on California
statewide trauma planning, difficulties exist in obtaining
trauma care, particularly in rural California due to
limited access and transportation issues. The majority of
trauma patients are transported to trauma centers by ground
ambulance; however, air transport is necessary in rural
areas where there are extended transport times to the
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closest trauma center. The use of air transportation has
inherent limitations, such as capacity, weather and
availability.
According to the evaluation, geographic areas with gaps in
trauma service include the North Coast, Central California,
and the Central Coast area. The evaluation further adds
that, transfer of the patient to a trauma center requires
either the use of limited air transport resources or a
secondary transfer, which can result in a delay in
receiving care. Additionally, these transports remove
patients from their community and family support as well as
place additional burdens on the receiving trauma center
that is already serving its own community.
The evaluation also reports that Los Angeles County, with a
mature trauma system, due to financial difficulties, no
longer has a designated trauma center located in the highly
populated San Gabriel Valley, and trauma patients are air
transported to trauma centers outside the geographic area.
Hospitals that are not trauma centers
According to OSHPD data, in 2006 there were 454 licensed
general acute care hospitals, of which 300 had a
comprehensive or basic emergency department, and 39 had a
standby emergency department. There are currently 138
hospitals with a helicopter landing pad permit from
CalTrans, but only 36 percent of the hospitals with such a
permit operate trauma centers.
Emergency service helicopters, helipads and heliports
Emergency service helicopters transport critically injured
people to hospitals when ground transportation is
impractical. Based on protocols established by the LEMSA,
prehospital personnel may decide to transport critically
injured patients by air to trauma centers.
To install a helipad, a trauma center must obtain a state
heliport permit from the State Department of
Transportation's Division of Aeronautics. Caltrans
requires a permit applicant to provide site and design
plans and documentation showing that the construction plans
have been approved by a local government, acted upon by an
airport land use commission (ALUC), and complies with
California Environmental Quality Act and Federal Aviation
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Administration regulations. If the proposed helipad is
attached to the trauma center building, such as the roof,
the trauma center also needs to have its construction plans
approved by the Office of Statewide Health Planning and
Development (OSHPD), which is the state agency that
oversees hospitals' compliance with building safety
standards. To obtain a Caltrans heliport site permit,
hospitals must specifically provide the following:
Two copies of scaled drawings of the heliport and
adjoining areas;
Topographic map that shows the location of the
approach surfaces relative to the heliport;
Local area map or drawing depicting the heliport
and the location of schools, places of public
gathering, and residential areas within 1,000 feet of
the center of a proposed heliport;
Documentation of approval of the plan for
construction by either the board of supervisors of the
county or the city council of the city (as
appropriate) in which the heliport is to be located;
Documentation of action by the Airport Land Use
Commission of the county in which the heliport is to
be located (as appropriate);
Documentation of compliance with the California
Environmental Quality Act;
Documentation showing ownership of the heliport;
and,
A Federal Aviation Administration Airspace
Determination regarding the heliport.
SB 1141 (Margett), Chapter 289, Statutes of 2008, repeals
the authority of EMSA and LEMSAs to regulate public
aircraft that conduct emergency medical and search and
rescue missions.
SB 266 (Romero) of 2005 would have required the EMSA to
establish a trauma care advisory committee as specified,
and require the committee to develop a statewide trauma
care plan, present the plan to EMSA, and provide the plan
to the Legislature along with the EMSA's comments by
January 1, 2007. This bill was vetoed by the Governor. In
his veto message, he directed EMSA to complete its
statewide trauma care plan.
Arguments in support
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The California Hospital Association (CHA) states that in
some communities throughout California, hospitals have been
unable to secure a permit for a helipad through their local
governing board. CHA adds that in some cases local
neighbors concerns about the noise have taken precedent
over the public health needs of the community and of the
patients that need helicopter transport for specialized
medical needs. CHA contends that this bill ensures the
public health and trauma care needs of the community are
considered when a permit is requested for a hospital
helipad.
Arguments in opposition
The American Planning Association, California Chapter APA),
and the League of California Cities (LCC) state that AB
1272 ignores the fact that the current decision-making
process for local agencies is founded on the premise of
notice and due process. APA and LCC add that the notice,
environmental review, and public hearing requirements for
each decision provide plenty of opportunity for key
interests to share reviews and provide information about
the need for a project.
Opponents of AB 1272 state that there are already local
procedures for making decisions about the construction and
operation of helipads and heliports, which include CEQA,
Caltrans and OSHPD protections. Opponents contend that
this bill is not needed because no trauma center helipad
has been rejected by a local government in 20 years.
PRIOR ACTIONS
Based on a previous version of the bill:
Assembly Transportation 14-0
Assembly Health 19-0
Assembly Floor 77-0
COMMENTS
1. Referral back to Rules Committee. Should this bill
pass the Health Committee, Rules Committee has asked that
it be referred back to Rules Committee to consider requests
from the Local Government and Environmental Quality
Committees to hear the bill.
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2. As drafted AB 1272 may not be workable. A city, county
or city and county would not know if a permit to build a
heliport or helipad will be disapproved until the vote has
taken place. Therefore the bill's prohibition against a
permit disapproval by a city, county, or city and county
until after a consultation with a local EMSA has taken
place and a hospital has had 90 days for an independent
report, may be unworkable.
A more workable means of achieving the author's intent that
the benefits of air ambulance and the health and safety
impacts of the proposed helipad or heliport be taken into
consideration when deciding whether to grant such a permit,
would be to require the city, county, or city and county to
consult with the hospital and the LEMSA prior to taking
action on the permit application and to require the LEMSA
to provide information regarding the benefits to the local
EMS system.
Suggested amendments:
Strike Page 2, lines 1-10, and Page 3, lines 4-13, and add:
SECTION 1. Section 65097 is added to the Government Code,
to read:
65097. A city, county, or city and county shall, upon
receiving an application for a permit resulting in the
construction or operation of a heliport or helipad on the
property of a general acute care hospital, notify the
hospital and the local EMS agency of the date, time and
place of the hearing.
The city, county or city and county shall consult with
representatives of the hospital before the hearing
regarding the impacts on availability and accessibility of
emergency and trauma care services in the designated area,
and health and safety effects of the proposed heliport or
helipad.
The city, county or city and county shall consult with the
local EMS agency regarding the benefits of air ambulance
access for the local EMS system.
The city, county, or city and county shall consider any
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written comments by the hospital and the local EMS agency
at the hearing.
As used in this section, "local EMS agency" means a local
EMS agency as defined in Section 1797.94 of the Health and
Safety Code.
SEC. 2. Section 1797.259 is added to the Health and Safety
Code to read:
After receiving notice pursuant to Section 65097 of the
Government Code, the local EMS agency shall provide
information to the city, county or city and county
regarding the benefits of air ambulance access for the
local EMS system.
The local EMS may prepare a report, consult with
representatives of the city, county, or city and county,
provide written comments, and/or appear at the hearing
regarding the proposed construction or operation of a
heliport or helipad.
POSITIONS
Support: Alameda County Board of Supervisors
American Federation of State, County and
Municipal Employees
California Ambulance Association
California Association of Air Medical
Services
California Hospital Association
California Medical Association
California Shock Trauma Air Rescue
Emergency Medical Services Administrators'
Association of California
Emergency Nurses Association
Oppose: American Planning Association, California Chapter
Coalition for San Francisco Neighborhoods
League of California Cities
One individual
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