BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AB 1245|
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THIRD READING
Bill No: AB 1245
Author: Williams (D)
Amended: 7/11/11 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 7-0, 6/29/11
AYES: Hernandez, Strickland, Alquist, Anderson, Blakeslee,
De Le�n, DeSaulnier
NO VOTE RECORDED: Rubio, Wolk
SENATE APPROPRIATIONS COMMITTEE : 8-0, 8/15/11
AYES: Kehoe, Walters, Alquist, Emmerson, Lieu, Pavley,
Price, Steinberg
NO VOTE RECORDED: Runner
ASSEMBLY FLOOR : 75-0, 5/26/11 (Consent) - See last page
for vote
SUBJECT : Emergency medical services
SOURCE : California Professional Firefighters
DIGEST : This bill authorizes the Emergency Medical
Services EMSA to adopt regulations for state approval of
standards for an emergency medical responder training
course that meets or exceeds national guidelines, as
specified.
ANALYSIS :
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Existing law :
1. Establishes the Emergency Medical Services EMSA (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.
2. 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.
3. 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 EMSA; advising the EMSA
on a data collection system; advising the director of
the EMSA regarding various aspects of the EMS system;
and making recommendations for further development of
EMS.
4. Requires the EMSA to create emergency medical technician
(EMT) certification, recertification, disciplinary
standards, and to maintain a central registry of EMTs.
5. Requires all EMTs to submit fingerprints for a state and
federal level Criminal Offender Record Information
search, as specified.
6. 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.
7. 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.
8. Establishes an Emergency Response Training Advisory
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Committee under the Office of Emergency Services and
requires the EMSA 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.
9. 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.
10.Requires this training to meet standards prescribed by
the EMSA.
11.Requires all peace officers, except those whose duties
are primarily clerical or administrative, to be trained
to administer first aid and pulmonary resuscitation.
12.Requires this training to meet standards prescribed by
the EMSA, in consultation with the Commission on Peace
Officers Standards and Training.
This bill :
1. Authorizes the EMSA 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.
2. 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.
3. 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 or prohibit personnel of these agencies from
providing services that were the subject of these
training programs, as they read on January 1, 2011.
Background
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California's EMS system . California operates on a
two-tiered EMS system. The EMSA is the lead agency and
centralized resource to oversee emergency and disaster
medical services. The EMSA 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 EMSA
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 EMSA, 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
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,
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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 EMSA 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
EMSA 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 EMSA is not proposing to
require certification or criminal background checks for the
EMR, due to the lack of statutory EMSA.
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
comprehensive EMS response, under medical oversight. EMRs
perform basic interventions with minimal equipment.
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FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13
2013-14 Fund
EMSA regulations minor and
absorbableGeneral
SUPPORT : (Verified 8/16/11)
California Professional Firefighters (source)
OPPOSITION : (Verified 8/16/11)
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 Association of
California
Farmington Fire Protection District
North Coast Emergency Medical Services
San Joaquin County Board of Supervisors
ARGUMENTS IN SUPPORT : The California Professional
Firefighters (CPF), the sponsor of this bill, 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 this
bill provides a clarification of the law needed to enable
the EMSA 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
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Supervisors (San Joaquin County) argues that this bill
eliminates 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
this bill 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 this bill nullifies 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 this
bill will essentially kill or postpone the process underway
at the EMSA to implement new EMR regulations and instead
suggests that a more comprehensive process be conducted by
the EMSA 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 this bill 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.
ASSEMBLY FLOOR :
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall, Bill
Berryhill, Block, Blumenfield, Bonilla, Bradford,
Brownley, Buchanan, Butler, Charles Calderon, Carter,
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Chesbro, Conway, Cook, Dickinson, Donnelly, Eng, Feuer,
Fletcher, Fong, Fuentes, Furutani, Beth Gaines, Galgiani,
Garrick, Gatto, Gordon, Grove, Hagman, Halderman, Hall,
Harkey, Hayashi, Roger Hern�ndez, Hill, Huber, Hueso,
Huffman, Jeffries, Knight, Lara, Logue, Bonnie Lowenthal,
Ma, Mansoor, Mendoza, Miller, Mitchell, Monning, Morrell,
Nestande, Nielsen, Norby, Olsen, Pan, Perea, V. Manuel
P�rez, Portantino, Silva, Skinner, Smyth, Solorio,
Swanson, Torres, Valadao, Wagner, Wieckowski, Williams,
Yamada, John A. P�rez
NO VOTE RECORDED: Campos, Cedillo, Davis, Gorell, Jones
CTW:do 8/16/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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