BILL ANALYSIS �
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1245
A
AUTHOR: Williams
B
AMENDED: June 22, 2011
HEARING DATE: June 29, 2011
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CONSULTANT:
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Tadeo
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SUBJECT
Emergency medical services
SUMMARY
Authorizes the Emergency Medical Services Authority
(Authority) to adopt regulations for state approval of
standards for an emergency medical responder (EMR) training
course that meets or exceeds national guidelines, as
specified.
CHANGES TO EXISTING LAW
Existing law:
Establishes the Authority (also referred to as EMSA), which
is responsible for the coordination and integration of all
state activities concerning emergency medical services
(EMS), including the establishment of minimum standards,
policies, and procedures.
Authorizes counties to develop an EMS program and designate
a Local Emergency Medical Services Agency (LEMSA)
responsible for planning and implementing an EMS system,
which includes day-to-day EMS system operations.
Continued---
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Establishes a 16-member EMS Commission within the
California Health and Human Services Agency, specifies its
membership and appointing authorities, and defines its
duties to include reviewing regulations, standards, and
guidelines developed by the Authority; advising the
Authority on a data collection system; advising the
director of the Authority regarding various aspects of the
EMS system; and making recommendations for further
development of EMS.
Requires the Authority to create emergency medical
technician (EMT) certification, recertification,
disciplinary standards, and to maintain a central registry
of EMTs. Requires all EMTs to submit fingerprints for a
state and federal level Criminal Offender Record
Information (CORI) search, as specified.
Defines a pre-hospital emergency care person or personnel
as an authorized registered nurse or mobile intensive care
nurse, EMT-I, EMT-II, EMT-paramedic, lifeguard,
firefighter, or police officer, as specified, or a
physician and surgeon who provides pre-hospital care or
rescue services.
Defines fire service personnel to include, but not be
limited to, a firefighter or pre-hospital emergency medical
worker employed by a state or local agency.
Establishes an Emergency Response Training Advisory
Committee under the Office of Emergency Services and
requires the Authority to establish training standards that
include curriculum content recommended by this committee to
address the training needs of those identified as first
responders, among other responsibilities.
Requires all ocean, public beach, and public swimming pool
lifeguards and all firefighters, except those whose duties
are primarily clerical or administrative, to be trained to
administer first aid and pulmonary resuscitation (CPR).
Requires this training to meet standards prescribed by the
Authority.
Requires all peace officers, except those whose duties are
primarily clerical or administrative, to be trained to
administer first aid and CPR. Requires this training to
meet standards prescribed by the Authority, in consultation
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with the Commission on Peace Officers Standards and
Training.
This bill:
Authorizes the Authority to adopt regulations for the state
approval of standards for an EMR training course that meets
or exceeds the United States Department of Transportation's
EMR Instructional Guidelines.
Provides that the bill does not authorize an EMR
independent scope of practice, license, or certification,
nor does it authorize a new category of EMS personnel.
Provides that this bill shall not be construed to prohibit
a public safety agency that provides training to its
personnel from administering training programs developed
and delivered pursuant to specified laws and regulations,
as they read on January 1, 2011.
FISCAL IMPACT
According to the Assembly Appropriations Committee analysis
of AB 1245, this bill would result in minor and absorbable
costs to the Authority to develop regulations if the
Authority chooses to use the authority granted in this
bill.
BACKGROUND AND DISCUSSION
According to the author, the Authority is currently in the
process of developing regulations for a new EMR
certification course. However, there is no indication that
a background check will be part of the approved course.
The author argues that all EMRs, whether professional or
volunteer, should be held to the same standards in
providing EMS to the public. The author states that AB
1245 allows the Authority to continue to develop the EMR
regulations, while prohibiting new guidelines from
conferring a new EMR scope of practice. The author
contends that once the new regulations are adopted, the
Authority will need to come back to the Legislature for
permission to classify EMR as a new recognized
first-responder category, with their own scope of practice,
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and at that time, the state can require a background check
to be part of the regulations if it has not already been
included.
California's EMS system
California operates on a two-tiered EMS system. The
Authority is the lead agency and centralized resource to
oversee emergency and disaster medical services. The
Authority is charged with providing leadership in
developing and implementing local EMS systems throughout
California, and in setting standards for the training and
scope of practice of various levels of EMS personnel.
California has 32 local EMS systems that provide EMS for
California's 58 counties. (Seven regional EMS systems
comprised of 33 counties and 25 single-county agencies
provide the services.) Regional systems are usually
comprised of small, rural, less-populated counties, and
single-county systems generally exist in the larger and
more urban counties.
Pre-hospital emergency medical care personnel
The Authority develops and implements regulations that set
training standards and the scope of practice for emergency
medical personnel, including EMT-Basic (EMT-B or EMT,
previously EMT-I), Advanced EMTs (AEMT) (previously
EMT-IIs), paramedics, mobile intensive care nurses,
firefighters, peace officers, and lifeguards. EMTs and
AEMTs are initially certified by a LEMSA according to
guidelines and regulations developed by the Authority,
including criminal background checks. The responsibility
for disciplinary investigations, suspensions and
revocations is shared by the LEMSAs, ambulance service
employers licensed by the California Highway Patrol, and
fire and public safety agencies.
National EMS scope of practice model
Paralleling the state's attempts towards uniformity,
consistency, and integration, the National EMS Scope of
Practice Model is part of the National Highway Traffic
Safety Administration (NHTSA) and the Health Resources and
Services Administration implementation of the EMS Agenda
for the Future. According to the NHTSA, it is part of an
integrated, interdependent system, to maximize efficiency,
consistency of instructional quality, and student
competence. According to the NHTSA website, states
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following the National EMS Scope of Practice Model as
closely as possible will increase the consistency of the
nomenclature and competencies of EMS personnel nationwide,
facilitate reciprocity, improve professional mobility, and
enhance the name recognition and public understanding of
EMS.
The National EMS Scope of Practice Model defines and
describes four levels of EMS licensure: EMR, EMT, AEMT, and
paramedic. New Authority regulations took effect January
14, 2011, transitioning the category of EMT-II to AEMT.
Among other changes, the new regulations expanded the scope
of practice and requires a transition by July 1, 2013, to
the use of written and skills examination by the National
Registry of EMTs in place of one administered by a local
training program or a LEMSA.
State efforts pertaining to EMRs
At the March 23, 2011, meeting of the EMS Commission, the
acting director of the Authority reported that an EMR Task
Force had been convened to revise the Public Safety First
Aid Regulations, adopt a scope of practice for the Public
Safety First Aid providers, adopt the EMR as a level of EMS
responder, and adopt the training requirements and scope of
practice for EMRs. It was further reported that the Task
Force recommended removing EMR from the Public Safety First
Aid Chapter of Regulations and placing it in its own
chapter of regulations. The purpose was to separate the
focus on public safety first-aid requirements from the EMR
requirements. The director further reported that the new
EMR regulations will be similar to the EMT regulations with
respect to training program approval requirements and will
include a scope of practice consistent with the National
EMS Scope of Practice Model. The Authority is not
proposing to require certification or criminal background
checks for the EMR, due to the lack of statutory authority.
According to NHTSA, the primary focus of the EMR is to
initiate immediate lifesaving care to critical patients who
access the emergency medical system. This individual
possesses the basic knowledge and skills necessary to
provide lifesaving interventions while awaiting additional
EMS response and to assist higher level personnel at the
scene and during transport. EMRs function as part of a
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comprehensive EMS response, under medical oversight. EMRs
perform basic interventions with minimal equipment.
Criminal Offender Record Information (CORI)
Training, certification, and discipline remain at the local
level for EMTs and AEMTs. As of July 1, 2010, state law
(AB 2917) requires every EMT candidate and certificate
holder to submit finger prints for a criminal offender
record information search including the reporting of any
subsequent arrests. Approximately 70 agencies have
authority to certify EMTs. Certifying agencies and
employers investigate and verify any information that is
reported from the CORI search and must verify in writing to
the authority that nothing in the CORI search precludes the
individual from obtaining certification. Regulations
adopted in June, 2010 by the Authority provide that all
certifying entities, other than a LEMSA, must advise an
applicant if anything in the CORI search indicates conduct
that would be cause for disciplinary action and that the
applicant must apply directly to the medical director of
the LEMSA for certification. The regulations prescribe the
process for EMT and AEMT disciplinary action generally.
They also specify the process for an applicant who has been
directed to apply to the medical director. The regulations
list nine circumstances under which the medical director
must deny or revoke certification, such as a person who is
on parole or probation for any felony, has been convicted
within the preceding five years of any theft related
misdemeanor or had been convicted of murder, attempted
murder, or murder for hire. In addition, the regulations
provide for circumstances that are within the medical
Director's discretion such as certain offenses relating to
controlled substances.
Prior legislation
AB 2917 (Torrico), Chapter 274, Statutes of 2008, requires
the Authority to establish a statewide EMT registry and to
develop standards, guidelines, and regulations for
certification of EMTs and required all EMTs to have a
criminal background check. Establishes rules for EMT
certification and discipline and for the investigation of
conduct that threatens public health and safety.
SB 997 (Ridley-Thomas), Chapter 275, Statutes of 2008 adds
to the Emergency Medical Services Commission (Commission)
two members, one who is an employee of the Department of
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Forestry and Fire Protection (CAL FIRE) and one who is an
employee of a city, county, or special district that
provides fire protection, each appointed by the governor
from lists of three names provided by the California
Professional Firefighters. Requires one Commission member
to be a member of the California Firemen's Association by
deleting the California Professional Firefighters from the
list of two organizations from which one Commission member
must be selected.
SB 1533 (Ashburn) of 2008, similar to AB 941 (Torrico) of
2007, would have required the Authority to maintain a
centralized system for monitoring and tracing EMT-I and
EMT-II certification status and EMT-P licensure status to
be used by employers and local EMS agencies as part of the
background check process. The hearing for this bill in
Senate Health Committee was cancelled at the request of the
author.
SB 583 (Ridley-Thomas) of 2007, almost identical to 2554
(Ridley-Thomas) of 2006, would have limited the
disciplinary actions LEMSAs can take against EMTs employed
by public safety agencies and would have established an
alternative system. The bill would have required the
Authority to develop specified procedures for review of EMT
discipline and would have authorized LEMSAs to confirm or
impose EMT disciplinary actions. This bill was held in
Senate Appropriations Committee.
SB 254 (Ashburn) of 2007 would have, commencing January 1,
2009, required the Authority to be responsible for
establishing statewide standards for EMT-Is and IIs and,
along with LEMSAs to be jointly responsible for the
implementation and enforcement of statewide licensure and
licensure renewal and discipline. Would have required
applicants for EMT-I and II licensure to have a state and
federal criminal history background check; would have also
required the Authority to develop and implement an alcohol
and drug diversion program for EMT-I, II, and paramedic
license holders. The hearing for this bill in the Senate
Health Committee was cancelled at the request of the
author.
AB 941 (Torrico) of 2007 would have required the Authority
to maintain a central registry for certified EMTs and to
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adopt specified regulations for disciplining EMTs. Would
have required employers of EMTs to investigate/discipline
certified employees and authorized review of employer
actions by local or state authority. This bill was vetoed
by the Governor.
AB 220 (Bass), Chapter 591, Statutes of 2007, enacts the
Firefighters Procedural Bill of Rights Act, to mirror the
Public Safety Officers Procedural Bill of Rights Act that
is applicable to public safety officers.
SB 1811 (Romero) of 2006 would have made changes relating
to training for EMTs.
This bill was held in Senate Health Committee.
AB 2554 (Ridley-Thomas) of 2006, almost identical to SB 583
(Ridley-Thomas) of 2007, was vetoed by the Governor for
putting public safety at risk by limiting the authority of
LEMSA to take disciplinary action against EMTs, and for
being in direct conflict with California's health care
licensure system that requires independent medical
oversight of licensed and certified professionals. This
bill was vetoed by the Governor.
Arguments in support:
The California Professional Firefighters (CPF), the sponsor
of AB 1245, states that all emergency responder training
courses should reflect similar, if not the same, standards
and belong to the same community of other medical
professionals who train to provide this essential public
duty. CPF contends that AB 1245 provides a clarification
of the law needed to enable the authority to move forward
in developing a specified EMR training course and while not
adding them as a another practitioner in the EMS system,
and instead allowing further action by the Legislature on
how to best structure an EMR scope of practice.
Arguments in opposition:
The San Joaquin County Board of Supervisors (San Joaquin
County) argues that AB 1245 would eliminate EMR
certification programs created by LEMSAs. San Joaquin
County states that it developed an EMR program over 20
years ago to address the needs of volunteer fire
departments and local law enforcement agencies, which do
not have the resources to implement an EMT standard for
their personnel. San Joaquin County further argues that AB
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1245 will force these agencies to lower their delivery of
EMS to basic first aid, and prohibit 61 firefighters and
sheriff's deputies certified as EMRs in San Joaquin County
from providing life-saving skills such as administering
oxygen and using a bag-valve mask device to assist an
unconscious patient with breathing.
The North Coast EMS argues that AB 1245 would nullify state
EMR regulations currently under development and eliminate
existing EMR programs throughout the state which have been
in existence for decades, often serving rural areas as a
less expensive and more accessible alternative to EMT-I
training.
The California Center for Rural Policy states that AB 1245
will essentially kill or postpone the process underway at
the Authority to implement new EMR regulations and instead
suggests that a more comprehensive process be conducted by
the Authority over the next year, with strong rural
volunteer representation, to evaluate the EMR program and
all related issues.
The Emergency Medical Services Administrator's Association
of California (EMSAAC)
states that AB 1245 is related to a new EMR training and
initially contained a provision to include a background
check which it supports. Since this language has been
removed, EMSAAC is no longer supports the bill. EMSAAC
argues that all emergency responders who have access to an
individual's home, property and medical information should
be properly screened for any relevant criminal history.
PRIOR ACTIONS
Assembly Health: 18- 0
Assembly Appropriations:17- 0
Assembly Floor: 75- 0
COMMENTS
1. Should there be an independent scope of practice for an
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EMR? The practice of approving EMR training programs
locally occurs in some areas of the state, although it is
not a position which is recognized by the state, making it
difficult for the Authority to provide statewide standards
and regulations. Many agencies that provide EMS employ
personnel that receive the EMR training described in AB
1245, but are not employed as EMRs, per se, and rather are
certified or licensed under another category. While AB
1245 does not create the EMR as a type of first responder
with its own scope of practice, or impede on the ability of
the Authority to continue to work on developing regulations
pertaining to an EMR course of instruction, it is unclear
whether it impedes the ability of a local agency to use
pre-hospital emergency workers who effectively function in
an EMR capacity.
A suggested amendment would be to clarify that pre-hospital
emergency workers can continue to provide EMR services
while regulations are being adopted for state approval of
standards.
On lines 10 - 17, amend as follows:
(b) This section shall not be construed to prohibit the
Department of the California Highway Patrol, Cal-Fire, or
any other public safety agency that provides training to
its law enforcement or firefighting personnel, from
administering training programs , or providing subsequent
services pursuant to these programs, developed and
delivered pursuant to Section 1797.182 or 1797.183, and
Sections 100015, 100018, and 100020 of Title 22 of the
California Code of Regulations, as those regulations read
and programs existed on January 1, 2011,
POSITIONS
Support: California Professional Firefighters (sponsor)
Oppose:California Center for Rural Policy at Humboldt State
University
Crescent City Volunteers Fire Department
Crescent Firefighter's Association
East Bay Community Law Center
Emergency Medical Services Administrator's
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Association of California
Farmington Fire Protection District
North Coast Emergency Medical Services
San Joaquin County Board of Supervisors
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