Existing law requires a school district, charter school, or private school that elects to offer an athletic program to comply with certain requirements relating to pupil safety, including, among other things, removing an athlete who is suspected of sustaining a concussion or head injury from an athletic activity.

This bill would create the Eric Paredes Sudden Cardiac Arrest Prevention Act and would require the State Department of Education to post on its Internet Web site guidelines, videos, and an information sheet on sudden cardiac arrest symptoms and warning signs, and other relevant materials relating to sudden cardiac arrest. The bill would require a pupil in any public school, including a charter school, or private school that elects to conduct athletic activities, and the pupils parent or guardian, to sign and return an acknowledgment of receipt of an information sheet on sudden cardiac arrest symptoms and warning signs each school year before the pupil participates in an athletic activity, as specified. The bill would require an athletic director, coach, athletic trainer, or authorized person, as defined, to remove from participation a pupil who passes out or faints while participating in or immediately following an athletic activity, and would require a coach of an athletic activity to complete a sudden cardiac arrest training course every other school year. The bill would impose penalties, on and after July 1, 2019, for a violation of the provision requiring a coach to complete a sudden cardiac arrest training course, as specified. The bill would make the acts provisions operative on July 1, 2017.

Existing law requires a school district, charter school, or private school that elects to offer an athletic program to comply with certain requirements relating to pupil safety, including, among other things, removing an athlete who is suspected of sustaining a concussion or head injury from an athletic activity.

This bill would create the Eric Paredes Sudden Cardiac Arrest Prevention Act and would require the State Department of Education to post on its Internet Web site guidelines, videos, and an information sheet on sudden cardiac arrest symptoms and warning signs, and other relevant materials relating to sudden cardiac arrest. The bill would require a pupil in any public school, including a charter school, or private school that elects to conduct athletic activities, and the pupils parent or guardian, to sign and return an acknowledgment of receipt of an information sheet on sudden cardiac arrest symptoms and warning signs each school year before the pupil participates in an athletic activity, as specified. The bill would require an athletic director, coach, athletic trainer, or authorized person, as defined, to remove from participation a pupil who passes out or faints while participating in or immediately following an athletic activity, and would require a coach of an athletic activity to complete a sudden cardiac arrest training course every other school year. The bill would impose penalties, on and after July 1, 2019, for a violation of the provision requiring a coach to complete a sudden cardiac arrest training course, as specified. The bill would make the acts provisions operative on July 1, 2017.

Existing law requires a school district, charter school, or private school that elects to offer an athletic program to comply with certain requirements relating to pupil safety, including, among other things, removing an athlete who is suspected of sustaining a concussion or head injury from an athletic activity.

This bill would create the Eric Paredes Sudden Cardiac Arrest Prevention Act and would require the State Department of Education to post on its Internet Web site guidelines, videos, and an information sheet on sudden cardiac arrest symptoms and warning signs, and other relevant materials relating to sudden cardiac arrest. The bill would require a pupil in any public school, including a charter school, or private school that elects to conduct athletic activities, and the pupils parent or guardian, to sign and return an acknowledgment of receipt of an information sheet on sudden cardiac arrest symptoms and warning signs each school year before the pupil participates in an athletic activity, as specified. The bill would require an athletic director, coach, or athletic trainer athletic trainer, or authorized person, as defined, to remove from participation a pupil who passes out or faints while participating in or immediately following an athletic activity, and would require a coach of an athletic activity to complete a sudden cardiac arrest training course every other school year. The bill would impose penalties, on and after July 1, 2019, for a violation of the provision requiring a coach to complete a sudden cardiac arrest training course, as specified. The bill would make the acts provisions operative on July 1, 2017.

Existing law requires a school district, charter school, or private school that elects to offer an athletic program to comply with certain requirements relating to pupil safety, including, among other things, removing an athlete who is suspected of sustaining a concussion or head injury from an athletic activity.

This bill would create the Eric Paredes Sudden Cardiac Arrest Prevention Act and would require the State Department of Education to post on its Internet Web site guidelines, videos, and an information sheet on sudden cardiac arrest symptoms and warning signs, and other relevant materials relating to sudden cardiac arrest. The bill would require a pupil in any public school, including a charter school, or private school that elects to conduct athletic activities, and the pupils parent or guardian, to sign and return an acknowledgment of receipt of an information sheet on sudden cardiac arrest symptoms and warning signs each school year before the pupil participates in an athletic activity, as specified. The bill would require an athletic director, coach, or athletic trainer to remove from participation a pupil who passes out or faints while participating in or immediately following an athletic activity, and would require a coach of an athletic activity to complete a sudden cardiac arrest training course every other school year. The bill would impose penalties, on and after July 1, 2019, for a violation of the provision requiring a coach to complete a sudden cardiac arrest training course, as specified. The bill would make the acts provisions operative on July 1, 2017.

Existing law requires a school district, charter school, or private school that elects to offer an athletic program to comply with certain requirements relating to pupil safety, including, among other things, removing an athlete who is suspected of sustaining a concussion or head injury from an athletic activity.

This bill would create the Sudden Cardiac Arrest Prevention Act and would require the State Department of Education to post on its Internet Web site guidelines, videos, and an information sheet on sudden cardiac arrest symptoms and warning signs, and other relevant materials relating to sudden cardiac arrest. The bill would require a pupil in any public school, including a charter school, or private school that elects to conduct athletic activities, and the pupils parent or guardian, to sign and return an acknowledgment of receipt of an information sheet on sudden cardiac arrest symptoms and warning signs each school year before the pupil participates in an athletic activity, as specified. The bill would require an athletic director, coach, or athletic trainer to remove from participation a pupil who passes out or faints while participating in or immediately following an athletic activity, and would require a coach of an athletic activity to complete a sudden cardiac arrest training course every other school year. The bill would impose penalties, on and after July 1, 2019, for a violation of the provision requiring a coach to complete a sudden cardiac arrest training course, as specified. The bill would make the acts provisions operative on July 1, 2017.

Existing law requires a school district, charter school, or private school that elects to offer an athletic program to comply with certain requirements relating to pupil safety, including, among other things, removing an athlete who is suspected of sustaining a concussion or head injury from an athletic activity.

This bill would create the Sudden Cardiac Arrest Prevention Act and would require the State Department of Education to develop guidelines post on its Internet Web site guidelines, videos, and an information sheet on sudden cardiac arrest symptoms and warning signs, and other relevant materials relating to sudden cardiac arrest, and to post the information on the departments Internet Web site. arrest. The bill would require a pupil in any public school, including a charter school, or private school that elects to conduct athletic activities, and the pupils parent or guardian, to sign and return an acknowledgment of receipt of an information sheet on sudden cardiac arrest symptoms and warning signs each school year before the pupil participates in an athletic activity. activity, as specified. The bill would require an athletic director, coach, or athletic trainer to remove from participation a pupil who passes out or faints while participating in or immediately following an athletic activity, and would require a coach of an athletic activity to complete a sudden cardiac arrest training course every other school year. The bill would impose penalties, on and after July 1, 2019, for a violation of the provision requiring removal of a pupil from an athletic activity and the provision requiring a coach to complete a sudden cardiac arrest training course, as specified. The bill would make the acts provisions operative on July 1, 2017.

Existing law requires a school district, charter school, or private school that elects to offer an athletic program to comply with certain requirements relating to pupil safety, including, among other things, removing an athlete who is suspected of sustaining a concussion or head injury from an athletic activity.

This bill would create the Sudden Cardiac Arrest Prevention Act and would require the State Department of Education to develop guidelines and an information sheet on sudden cardiac arrest symptoms and warning signs, and other relevant materials relating to sudden cardiac arrest, and to post the information on the departments Internet Web site. The bill would require a pupil in any public school, including a charter school, or private school that elects to conduct athletic activities activities, and the pupils parent or guardian, to sign and return an acknowledgment of receipt of an information sheet on sudden cardiac arrest symptoms and warning signs each school year before participating the pupil participates in an athletic activity. The bill would require an athletic director, coach, or athletic trainer to remove from participation a pupil who passes out or faints while participating in or immediately following an athletic activity, and would require a coach of an athletic activity to complete a sudden cardiac arrest training course each every other school year. The bill would impose penalties, on and after July 1, 2019, for a violation of the provision requiring removal of a pupil from an athletic activity and the provision requiring a coach to complete a sudden cardiac arrest training course, as specified. The bill would make the acts provisions operative on July 1, 2017.

Existing law requires a school district, charter school, or private school that elects to offer an athletic program to comply with certain requirements relating to pupil safety, including, among other things, removing an athlete who is suspected of sustaining a concussion or head injury from an athletic activity.

This bill would create the Sudden Cardiac Arrest Prevention Act and would require the State Department of Education to develop guidelines an information sheet on sudden cardiac arrest symptoms and warning signs, and other relevant materials relating to sudden cardiac arrest, and to post the information on the departments Internet Web site. The bill would require a pupil in any public school, including a charter school, or private school that elects to conduct athletic activities to sign and return an acknowledgment of receipt of an information sheet on sudden cardiac arrest symptoms and warning signs each school year before participating in an athletic activity. The bill would require an athletic director, coach, or athletic trainer to remove a pupil who passes out or faints while participating or immediately following an athletic activity, and would require a coach of an athletic activity to complete a sudden cardiac arrest training course each school year. The bill would impose penalties, on and after July 1, 2019, for a violation of the provision requiring removal of a pupil from an athletic activity and the provision requiring a coach to complete a sudden cardiac arrest training course, as specified. The bill would make the acts provisions operative on July 1, 2017.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1639

Author:(Maienschein)

As Amended Ver:August 15, 2016

Majority vote

Original Committee Reference: ED.

SUMMARY: Establishes the Eric Paredes Sudden Cardiac Arrest Prevention Act; requires the California Department of Education (CDE) to make available specified guidelines and materials on sudden cardiac arrest (SCA); requires pupils and parents to sign informational materials before athletic participation; requires training of coaches; and sets requirements for action in the event a pupil experiences specified symptoms. Specifically, this bill:

1. Establishes the following definitions:
   1. "Athletic activity" means the following:
      1. Interscholastic athletics;
      2. An athletic contest or competition, other than interscholastic athletics, sponsored by a school, including cheerleading, club-sponsored sport activities;
      3. Noncompetitive cheerleading sponsored by a school; and,
      4. Practices, interscholastic practices and scrimmages for activities listed under i) through iii) above.
   2. "Authorized person" means an employee, volunteer, or contractor authorized to provide health or medical services to pupil athletes.
   3. "School" means a public school, including a charter school, or a private school that elects to conduct athletic activities.
2. Requires the CDE to develop and post on its Internet Web site guidelines and an information sheet on specified SCA symptoms, risks and warning signs.
3. Requires the materials to be developed using relevant materials and training videos used by the Eric Paredes Save a Live Foundation, the California Interscholastic Federation (CIF) and the National Federation of High Schools (NFHS).
4. Encourages school districts and schools to post these materials on their Internet Web sites.
5. Requires a pupil and the pupil's parent or guardian to sign an acknowledgment of receipt and review of the information sheet developed by the CDE every year before participation in an athletic activity.
6. Authorizes schools to hold informational meetings on SCA before each athletic season.
7. Requires removal from activity any pupil who passes out or faints while participating in or immediately after athletic activity, or who is known to have done so, by an athletic trainer, coach, athletic director or authorized person.
8. Authorizes an athletic trainer or authorized person to remove a pupil from participation if the pupil experiences specified symptoms the trainer reasonably believes are cardiac related. Requires, in the absence of a trainer or authorized person, a coach observing symptoms of SCA in a pupil to notify a parent or guardian, so that that parent or guardian can determine what treatment, if any, the pupil should seek.
9. Prohibits a pupil who has been removed from activity for SCA symptoms from returning to participation until evaluated and cleared to participate in writing by an appropriate medical professional.
10. Requires biennial SCA training for coaches; and, specifies a coach is ineligible to coach an activity until the training is complete.
11. Requires, beginning July 1, 2019, suspension of coaches for not undergoing the yearly training.
12. Limits a coach's civil liability for his or her action or inaction under the Act, other than acting in a grossly negligent or reckless manner.
13. Encourages the sponsors of youth athletic activities to follow the guidelines in the Act.
14. Makes the Act operative on July 1, 2017.

The Senate amendments define "authorized person" to mean an employee, volunteer, or contractor authorized to provide health or medical services to pupil athletes.

EXISTING LAW:

1. Limits full-contact practices, as defined, for high school and middle school football and urges CIF adoption of rules to implement such guidelines. (Education Code (EC) Section 35179.5)
2. Requires an athlete suspected of sustaining a concussion or head injury during athletic activity to be removed from that activity and not be permitted to return until evaluated and cleared by a licensed health care provider; urges the CIF to develop rules and protocols to implement this; and requires athletes and parents to receive, sign and return a head injury information sheet annually before practice or competition. Excludes the requirements from athletic activities during the regular schoolday or as part of a physical education course. (EC Section 49475)
3. Requires a high school sports coach to complete educational programs developed by his or her school district and the CIF that meet specified guidelines. (EC Section 49032)

FISCAL EFFECT: According to the Senate Appropriations Committee, the CDE estimates one-time costs of $85,000 General Fund to post required information on its website. Significant local costs for schools that elect to conduct athletic activities to comply with the bill's requirements. These activities are unlikely to be deemed a state reimbursable mandate since the bill's requirements are based upon a school's decision to conduct athletic activities. See staff comments.

COMMENTS: This bill requires dispersion of informational materials on SCA, and notification for student athletes and their parents, in order to build awareness of the possible precursors to SCA. This bill also requires training for coaches and establishes procedures to be followed in the event of SCA symptoms...

Existing law involving athletic activities. California has established laws regulating athletic activities and requirements for coaches, including limiting the number football full-contact practices and requiring coaches to attend a coaching education program. This bill is similar to requirements on concussions among students in interscholastic sports, which were established following increasing awareness of the dangers of head injuries. Current law requires a graduated return-to-play protocol for those pupils who have had a concussion or head injury diagnosed by a licensed health care provider. These rules are for schools with an interscholastic sports program and do not specify penalties for violations.

Purpose of the bill. The author's office states that "Sudden Cardiac Arrest (SCA) has emerged as a leading cause of death among people under age 25. According to the American Heart Association, SCA affects nearly 10,000 youth per year." The author's office also states that 72% of those who have suffered SCA experienced prior symptoms but did not recognize them as warning signs. The sponsor of this bill, the Eric Paredes Save a Life Foundation, seeks to make more people aware of these warning signs, in the hopes that it will provide the opportunity to prevent fatal cardiac events.

Eric Paredes, for whom the sponsor organization was named, was a young athlete who died from a sudden cardiac arrest while at home. Eric's parents hope to use the story of their son's death, and those of other young athletes, to bring attention to heart screening and possible warning signs they say could save the lives of other children. The Foundation has worked extensively to produce and distribute information on SCA, and to promote training videos for coaches.

Supporters consider this bill a first effort in preventing future deaths through information and risk assessment. One supporter, Heartfelt Cardiac Projects, states, "This bill is an inaugural step in educating youth, parents and coaches about the potential warning signs and risk factors of sudden cardiac arrest and about the cardiac chain of survival that could save a life."

Similar requirements under CIF. The CIF, working with a panel of medical professionals, established policies related to SCA which went into effect in 2015. These policies cover most students playing interscholastic sports, including 1,600 schools with 1.8 million students. CIF added SCA information to their existing training requirements for coaches. The CIF also added protocols similar to those in this bill. They include removal from athletic activity after a pupil passes out or faints during or right after activity, with a medical clearance required to return to activity. Similarly, pupils must be cleared if they are held out for exhibiting signs or symptoms associated with SCA. The policy requires a pupil and his or her parent or guardian to receive and sign a Sudden Cardiac Information sheet each year. The sponsors feel an information sheet serves the purpose of educating pupils and parents regarding symptoms that might otherwise be ignored.

Given that the CIF implemented coaching training rules and a protocol for SCA in 2015, many of the informational and care guidelines in this bill already apply to the great majority of student athletes.

Analysis Prepared by: Chelsea Kelley / ED. / (916) 319-2087 FN: 0004194

 THIRD READING  

Bill No: AB 1639

Author:

:

Vote:

SENATE EDUCATION COMMITTEE: 9-0, 6/29/16

AYES: Liu, Block, Hancock, Huff, Leyva, Mendoza, Monning, Pan, Vidak

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/11/16

AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen

ASSEMBLY FLOOR: 76-0, 4/28/16 (Consent) - See last page for vote

SUBJECT:

SOURCE: Eric Paredes Save A Life Foundation

DIGEST: This bill, beginning July 1, 2017, establishes a return-to-play protocol for students who pass out or faint during an athletic activity, requires coaches to complete a sudden cardiac arrest training course, and requires schools to retain a copy of a sudden cardiac arrest information sheet before a student participates in an athletic activity.

ANALYSIS:

Existing law:

1. Requires a school district, charter school, or private school that elects to offer an athletic program to comply with all of the following:
   
   1. Immediately removed from the athletic activity for the remainder of the day an athlete who is suspected of sustaining a concussion or head injury.
      
   2. Prohibits the athlete from returning to the athletic activity until he or she is evaluated and provided written clearance by a licensed health care provider.
      
   3. Requires the athlete, if the health care provider determines a concussion or head injury was sustained, to complete a graduated return-to-play protocol of at least seven days in duration.
      
   4. Requires a concussion and head injury information sheet to be signed and returned by the athlete and the parent annually before the athlete initiates practice or competition. (Education Code § 49475)
      
2. States legislative intent that high school athletic coaches complete training regarding the identification of and appropriate response to concussions, among other things. (EC § 35179.1)

This bill:

Return-to-play protocol

1. Requires that a student who passes out or faints while participating in or immediately following an athletic activity, or who is known to have passed out or fainted while participating in or immediately following an athletic activity, be removed from participation at that time by the athletic director, coach, athletic trainer, or authorized person.
2. Authorizes an athletic trainer or authorized person to remove from participation a student who exhibits unexplained shortness of breath, chest pains, dizziness, racing heart rate, or extreme fatigue during an athletic activity, if the athletic trainer or authorized person reasonably believes that the symptoms are cardiac related.
3. Prohibits a student who is removed from play from being permitted to return to an athletic activity until the student is evaluated and cleared to return in writing by a physician and surgeon, or a nurse practitioner or physician assistant, as specified.
4. Requires, in the absence of an athletic trainer or authorized person, any coach who observes any of the symptoms of sudden cardiac arrest to notify the parent so that the parent can determine what treatment, if any, the student should seek.
   
5. Exempts from these protocols athletic activities during the regular schoolday or as part of a physical education course unless it constitutes a practice, interscholastic practice, or scrimmage.
   

Training

1. Requires coaches, by July 1, 2019, prior to coaching an athletic activity, to complete the sudden cardiac arrest training course using the information posted on the California Department of Education’s (CDE’s) Web site.
   
2. Requires coaches to retake the training course every two years.
   
3. Prohibits a coach from being eligible to coach an athletic activity until the coach completes the training course.
   
4. Requires that a coach who does not receive the training, by July 1, 2019, be subject to suspension from coaching any athletic activity until completion of the required training.
   

Sudden cardiac arrest information sheet

1. Requires, annually before a student participates in an athletic activity governed by the California Interscholastic Federation (CIF), the school to collect and retain a copy of the sudden cardiac arrest information sheet required by the CIF for that student.
   
2. Requires, before a student participates in an athletic activity not governed by the CIF, the student and the student’s parent to sign and return to the school an acknowledgment of receipt and review of the information sheet posted on the CDE’s Web site.
   

Posting of guidelines and information

1. Requires the CDE to post on its Web site guidelines, videos, and an information sheet on sudden cardiac arrest symptoms and warning signs, and other relevant materials to inform and educate students and parents, and to train coaches about the nature and warning signs, including the risks associated with continuing to play or practice after experiencing fainting or seizures during exercise, unexplained shortness of breath, chest pains, dizziness, racing heart rate, or extreme fatigue.
   
2. Authorizes materials to include but not be limited to, those developed or used for sudden cardiac arrest education and coaches training by the National Federation of High School Associations, the Eric Paredes Save A Life Foundation, or the CIF.
   
3. Encourages schools and school districts to post the information and materials on their Web sites to give students, parents, and coaches ready access to the information.
   

Miscellaneous

1. Provides that this bill is to become effective on July 1, 2017.
   
2. Authorizes a school to hold an informational meeting before the start of each athletic season for all ages of competitors regarding the symptoms and warning signs of sudden cardiac arrest. This bill authorizes the meetings to include physicians, pediatric cardiologists, athletic trainers, and authorized persons, in addition to students, parents, coaches and other school officials.
   
3. Encourages the sponsors of youth athletic activities to follow the guidelines specified in this bill.
   
4. Defines “athletic activity” to include all of the following:
   
   1. Interscholastic athletics.
      
   2. An athletic contest or competition, other than interscholastic athletics, that is sponsored by a school including cheerleading and club-sponsored sports activities.
      
   3. Non-competitive cheerleading that is sponsored by a school.
      
   4. Practices, interscholastic practice, and scrimmages for all of the activities listed above.
      
5. Defines “authorized person” as an employee, volunteer, or contractor authorized to provide health or medical services to student athletes.
   
6. Defines “school” as a public school, including a charter school, or private school that elects to conduct athletic activities.

Comments

Existing CIF bylaw. The CIF governs competitive athletics in grades 9-12, and had adopted a bylaw that mirrors the return-to-play protocol and information sheet requirements contained in this bill. This bill essentially extends the CIF bylaw to athletic activities at schools that are not governed by CIF, as well as requiring all coaches to receive training and the posting of information on the Web site of the CDE.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

According to the Senate Appropriations Committee:

• The CDE estimates one-time costs of $85,000 General Fund to post required information on its Web site.
• Significant local costs for schools that elect to conduct athletic activities to comply with the bill’s requirements. These activities are unlikely to be deemed a state reimbursable mandate since this bill’s requirements are based upon a school’s decision to conduct athletic activities.

SUPPORT: (Verified 8/12/16)

Eric Paredes Save A Life Foundation (source)

OPPOSITION: (Verified 8/12/16)

None received

ASSEMBLY FLOOR: 76-0, 4/28/16

AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, 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, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon

NO VOTE RECORDED: Chávez, Daly, Mathis, Olsen

Prepared by:

8/15/16 20:10:05

**** END ****

SENATE COMMITTEE ON

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 1639 (Maienschein) - Pupil health: The Eric Paredes Sudden Cardiac Arrest Prevention Act

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on August 11, 2016

Bill Summary:

This bill, beginning July 1, 2017, establishes a return-to-play protocol for students who pass out or faint during an athletic activity; requires coaches to complete a sudden cardiac arrest training course; and requires the California Department of Education (CDE) to post specified information on its website related to sudden cardiac arrest.

Fiscal Impact:

• The CDE estimates one-time costs of $85,000 General Fund to post required information on its website.
• Significant local costs for schools that elect to conduct athletic activities to comply with the bill’s requirements. These activities are unlikely to be deemed a state reimbursable mandate since the bill’s requirements are based upon a school’s decision to conduct athletic activities. See staff comments.

Author Amendments:

• Establishes a definition for an “authorized person” to mean an employee, volunteer, or contractor authorized to provide health and medical services to pupil athletes.
• Includes authorized persons in return-to-play protocols.

-- END --

SENATE COMMITTEE ON

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 1639 (Maienschein) - Pupil health: The Eric Paredes Sudden Cardiac Arrest Prevention Act

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

This bill, beginning July 1, 2017, establishes a return-to-play protocol for students who pass out or faint during an athletic activity; requires coaches to complete a sudden cardiac arrest training course; and requires the California Department of Education (CDE) to post specified information on its website related to sudden cardiac arrest.

Fiscal Impact:

• The CDE estimates one-time costs of $85,000 General Fund to post required information on its website.
• Significant local costs for schools that elect to conduct athletic activities to comply with the bill’s requirements. These activities are unlikely to be deemed a state reimbursable mandate since the bill’s requirements are based upon a school’s decision to conduct athletic activities. See staff comments.

Background:

Existing law:

• Establishes similar requirements regarding concussion and head injuries as this bill does for sudden cardiac arrest symptoms. Specifically, it requires a school district, charter school, or private school that elects to offer an athletic program to comply with all of the following:
  • Immediately remove from the athletic activity for the remainder of the day an athlete who is suspected of sustaining a concussion or head injury.
  • Prohibits the athlete from returning to the athletic activity until he or she is evaluated and provided written clearance by a licensed health care provider.
  • Requires the athlete, if the health care provider determines a concussion or head injury was sustained, to complete a graduated return-to-play protocol of at least seven days in duration.
  • Requires a concussion and head injury information sheet to be signed and returned by the athlete and the parent annually before the athlete initiates practice or competition. (Education Code § 49475)
    
• States legislative intent that high school athletic coaches complete training regarding the identification of and appropriate response to concussions, among other things. (EC § 35179.1)
  
• Requires the principal of a school, when an automated external defibrillator (AED) is placed in a public or private K–12 school, to ensure that the school administrators and staff annually receive information that describes sudden cardiac arrest, the school’s emergency response plan, and the proper use of an AED. (Health & Safety Code § 1797.196)

Proposed Law:

This bill establishes the Eric Paredes Sudden Cardiac Arrest Prevention Act beginning July 1, 2017. It requires the CDE to post on its website guidelines, videos, and an information sheet on sudden cardiac arrest symptoms and warning signs, and other relevant materials to inform and educate students and parents, and to train coaches about the warning signs of sudden cardiac arrest. Schools and school districts are encouraged to post this information on their websites as well.

This bill establishes the following requirements for schools that elect to conduct athletic activities:

• Before a student participates in an athletic activity governed by the California Interscholastic Federation (CIF), the school must collect and retain a copy of the sudden cardiac arrest information sheet required by the CIF for that student.
• Before a student participates in an athletic activity not governed by the CIF, the student and the parent or guardian are required to sign and return to the student’s school an acknowledgement of receipt and review of the information posted online by the CDE.
• Requires a student who passes out, or is known to have passed out, while participating in or following an athletic activity, to be removed from participation at that time by the athletic director, coach, or athletic trainer.
• Authorizes a student who exhibits any of the other symptoms of sudden cardiac arrest during athletic activity to be removed from participation, as specified.
• If an athletic trainer is absent, any coach that observes these signs is required to notify the parent or guardian of the student so that they can determine any treatment necessary.
• A student who is removed from play is prohibited from being allowed to participate in an athletic activity until the student is evaluated and cleared in writing by any of the specified healthcare providers to return to participate.
• A coach is required, before being able to coach an athletic activity, to complete the sudden cardiac arrest training course posted online by the CDE and is required to retake the course every two years.

Related Legislation:

AB 1719 (Rodriguez, 2016) requires school districts and charter schools serving students in grades 9 through 12 to offer instruction in compression-only cardiopulmonary resuscitation as part of a required course, commencing in the 2018-19 school year. AB 1719 is pending in this committee.

Staff Comments:

This bill codifies recent CIF bylaws regarding the sudden cardiac arrest return-to-play protocol, the information sheet requirement, and the coaches’ training requirements contained in this bill. Since the CIF governs competitive athletics in grades 9 through 12, high schools may already be in compliance with these requirements. This bill essentially extends the CIF bylaw to athletic activities at schools that are not governed by CIF, including athletic activities in the younger grades.

The requirement to sign and return an acknowledgement of receipt and review of the information posted online by CDE is not currently required by CIF and therefore a requirement that schools would have to implement if they conduct athletic activities not governed by the CIF. This bill may also necessitate additional training to ensure all appropriate staff are aware of the requirements in this bill.

-- END --

SENATE COMMITTEE ON EDUCATION

Senator Carol Liu, Chair

2015 - 2016 Regular

Bill No:

Subject:

SUMMARY

This bill, beginning July 1, 2017, establishes a return-to-play protocol for students who pass out or faint during an athletic activity, requires coaches to complete a sudden cardiac arrest training course, and requires schools to retain a copy of a sudden cardiac arrest information sheet before a student participates in an athletic activity.

BACKGROUND

Existing law:

1. Requires a school district, charter school, or private school that elects to offer an athletic program to comply with all of the following:
   
   1. Immediately removed from the athletic activity for the remainder of the day an athlete who is suspected of sustaining a concussion or head injury.
      
   2. Prohibits the athlete from returning to the athletic activity until he or she is evaluated and provided written clearance by a licensed health care provider.
      
   3. Requires the athlete, if the health care provider determines a concussion or head injury was sustained, to complete a graduated return-to-play protocol of at least seven days in duration.
      
   4. Requires a concussion and head injury information sheet to be signed and returned by the athlete and the parent annually before the athlete initiates practice or competition. (Education Code § 49475)
      
2. States legislative intent that high school athletic coaches complete training regarding the identification of and appropriate response to concussions, among other things. (EC § 35179.1)
   
3. Authorizes a public school to solicit and receive non-state funds to acquire and maintain an automated external defibrillator (AED), and requires these funds to be used only to acquire and maintain an AED and to provide training to school employees regarding use of an AED. (EC § 49417)
   
4. Requires the principal of a school, when an automated external defibrillator (AED) is placed in a public or private K–12 school, to ensure that the school administrators and staff annually receive information that describes sudden cardiac arrest, the school’s emergency response plan, and the proper use of an AED. Existing law requires the principal to ensure that instructions, in no less than 14-point type, on how to use the AED are posted next to every AED. Existing law also requires the principal to, at least annually, notify school employees as to the location of all AED units on the campus. (Health & Safety Code § 1797.196)

ANALYSIS

This bill, beginning July 1, 2017, establishes the Eric Paredes Sudden Cardiac Arrest Prevention Act that includes a return-to-play protocol for students who pass out or faint during an athletic activity, requires coaches to complete a sudden cardiac arrest training course, and requires schools to retain a copy of a sudden cardiac arrest information sheet before a student participates in an athletic activity. Specifically, this bill:

Return-to-play protocol

1. Requires that a student who passes out or faints while participating in or immediately following an athletic activity, or who is known to have passed out or fainted while participating in or immediately following an athletic activity, be removed from participation at that time by the athletic director, coach or athletic trainer.
   
2. Authorizes an athletic trainer to remove from participation a student who exhibits unexplained shortness of breath, chest pains, dizziness, racing heart rate, or extreme fatigue during an athletic activity, if the athletic trainer reasonably believes that the symptoms are cardiac related.
   
3. Prohibits a student who is removed from play from being permitted to return to an athletic activity until the student is evaluated and cleared to return in writing by a physician and surgeon, or a nurse practitioner or physician assistant, as specified.
   
4. Requires, in the absence of an athletic trainer, any coach who observes any of the symptoms of sudden cardiac arrest to notify the parent so that the parent can determine what treatment, if any, the student should seek.
   
5. Exempts from these protocols athletic activities during the regular schoolday or as part of a physical education course unless it constitutes a practice, interscholastic practice, or scrimmage.
   

Training

1. Requires coaches, by July 1, 2019, prior to coaching an athletic activity, to complete the sudden cardiac arrest training course using the information posted on the California Department of Education’s (CDE’s) Web site.
   
2. Requires coaches to retake the training course every two years.
   
3. Prohibits a coach from being eligible to coach an athletic activity until the coach completes the training course.
   
4. Requires that a coach who does not receive the training, by July 1 2019, be subject to suspension from coaching any athletic activity until completion of the required training.
   

Sudden cardiac arrest information sheet

1. Requires, annually before a student participates in an athletic activity governed by the California Interscholastic Federation (CIF), the school to collect and retain a copy of the sudden cardiac arrest information sheet required by the CIF for that student.
   
2. Requires, before a student participates in an athletic activity not governed by the CIF, the student and the student’s parent to sign and return to the school an acknowledgment of receipt and review of the information sheet posted on the California Department of Education’s (CDE’s) Web site.
   

Posting of guidelines and information

1. Requires the CDE to post on its Web site guidelines, videos, and an information sheet on sudden cardiac arrest symptoms and warning signs, and other relevant materials to inform and educate students and parents, and to train coaches about the nature and warning signs, including the risks associated with continuing to play or practice after experiencing fainting or seizures during exercise, unexplained shortness of breath, chest pains, dizziness, racing heart rate, or extreme fatigue.
   
2. Authorizes materials to include but not be limited to, those developed or used for sudden cardiac arrest education and coaches training by the National Federation of High School Associations, the Eric Paredes Save A Life Foundation, or the California Interscholastic Federation.
   
3. Encourages schools and school districts to post the information and materials on their Web sites to give students, parents, and coaches ready access to the information.
   

Miscellaneous

1. Provides that this bill is to become effective on July 1, 2017.
   
2. Authorizes a school to hold an informational meeting before the start of each athletic season for all ages of competitors regarding the symptoms and warning signs of sudden cardiac arrest. This bill authorizes the meetings to include physicians, pediatric cardiologists, and athletic trainers, in addition to students, parents, coaches and other school officials.
   
3. Encourages the sponsors of youth athletic activities to follow the guidelines specified in this bill.
   
4. Defines “athletic activity” to include all of the following:
   
   1. Interscholastic athletics.
      
   2. An athletic contest or competition, other than interscholastic athletics, that is sponsored by a school including cheerleading and club-sponsored sports activities.
      
   3. Non-competitive cheerleading that is sponsored by a school.
      
   4. Practices, interscholastic practice, and scrimmages for all of the activities listed above.
      
5. Defines “school” as a public school, including a charter school, or private school that elects to conduct athletic activities.

STAFF COMMENTS

1. Need for the bill. According to the author, “Currently, there are no statutes or regulations in California regarding sudden cardiac arrest (SCA). Only last year did the California Interscholastic Federation (CIF) adopt policies regarding SCA. The issue is that involvement in the CIF is not mandatory and their policies therefore do not cover every student athlete in the state. SCA claims the lives of thousands of kids annually. Of the people that suffered from SCA, 72% were reported to have at least one of the symptoms that went largely unrecognized. In California, there is a lack of education about the symptoms of the leading cause of death on school campuses.”
   
2. Existing California Interscholastic Federation bylaw. The California Interscholastic Federation (CIF) governs competitive athletics in grades 9-12, and had adopted a bylaw that mirrors the return-to-play protocol and information sheet requirements contained in this bill. This bill essentially extends the CIF bylaw to athletic activities at schools that are not governed by CIF, as well as requiring all coaches to receive training and the posting of information on the Web site of the California Department of Education (CDE).
   
3. Fiscal impact. According to the Assembly Appropriations Committee, this bill imposes General Fund administrative costs to CDE of approximately $85,000 to post guidelines, videos, and an information sheet on symptoms of sudden cardiac arrest. The CDE will also develop an online training for coaches in consultation with health stakeholder, as specified in the bill.
   
4. Related legislation. AB 1719 (Rodriguez, 2016) requires school districts and charter schools serving students in grades 9-12 to offer instruction in

compression-only cardiopulmonary resuscitation as part of a required course, commencing in the 2018-19 school year. AB 1719 is pending in the Senate Judiciary Committee.

SUPPORT

American Red Cross

Association of California School Administrators

California Interscholastic Federation

California School Boards Association

California School Nurses Organization

California State PTA

Los Angeles Unified School District

OPPOSITION

None received.

-- END --

Date of Hearing: April 20, 2016

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 1639

Author:(Maienschein) – As Amended Ver:April 7, 2016

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill establishes the Sudden Cardiac Arrest Prevention Act, effective July 1, 2017, to provide additional information, training, and emergency intervention protocols at public and private schools in order to reduce the risk of sudden cardiac arrest (SCA) among students. Specifically, this bill:

Top of Form

1. Requires the California Department of Education (CDE) to post online, guidelines, videos, and an information sheet on SCA symptoms and warning signs, and other relevant materials to inform and educate pupils and parents, and to train coaches about the nature and warning signs of SCA.
2. Specifies materials posted online by CDE may include those developed or used for SCA education and coaches training by the National Federation of High School Associations, the Eric Paredes Save A Life Foundation, or the California Interscholastic Federation. Encourages public and private schools and school districts to post this information on their individual websites.
3. Annually requires each school, before a student participates in an athletic activity governed by the California Interscholastic Federation (CIF), to collect and retain a copy of the SCA information sheet required by the CIF for that pupil. For students that participate in an athletic activity not governed by the CIF, the student and the student's parent or guardian is required to sign and return to the pupil’s school an acknowledgment of receipt and review of the information sheet posted on the CDE's website.
4. Authorizes a school to hold an informational meeting before the start of each athletic season for all ages of competitors regarding the symptoms and warning signs of sudden cardiac arrest.
5. Requires a student who passes out or faints while participating in or immediately following an athletic activity, or who is known to have passed out or fainted while participating in or immediately following an athletic activity, to be removed from participation at that time by the athletic director, coach, or athletic trainer.
6. Authorizes an athletic trainer to remove a student from athletic participation if the student exhibits any of the other symptoms of SCA during an athletic activity, if the athletic trainer reasonably believes that the symptoms are cardiac related. In the absence of an athletic trainer, any coach who observes any of the symptoms of SCA is required to notify the parent or guardian so that they can determine what treatment, if any, the student should seek.
7. Prohibits a student who is removed from an athletic activity, as specified, from returning to participate in the activity until the pupil is evaluated and cleared to return by a physician and surgeon, or a nurse practitioner or physician assistant.
8. Specifies the requirement of this bill do not apply to a pupil engaging in an athletic activity during the regular schoolday or as part of a physical education course unless it constitutes a practice, interscholastic practice, or scrimmage.
9. Requires an athletic coach to complete the SCA training course, developed pursuant to this bill, and retake the training course every two years thereafter. A coach is not eligible to coach an athletic activity until they complete this training course. Starting July 1, 2019, a coach that violates this requirement is subject to suspension from coaching any athletic activity until training is completed.
10. Encourages sponsors of youth athletic activities to follow the guidelines of this bill.

FISCAL EFFECT:

General Fund administrative costs to the California Department of Education (CDE), of approximately $85,000 to post guidelines, videos, and an information sheet on SCA symptoms. The CDE will also develop an online training for coaches in consultation with health stakeholder, as specified in the bill.

COMMENTS:

1. Purpose. According to the American Heart Association, SCA affects nearly 10,000 youth per year. SCA is not a heart attack. It is an abnormality in the heart’s electrical system or structure that abruptly stops the heartbeat. The author’s office states that 72 percent of those who have suffered SCA experienced prior symptoms but did not recognize them as warning signs. SCA is 60% more likely to occur during physical activity and athletes are at greater risk. The sponsor of this bill, the Eric Paredes Save a Life Foundation, seeks to make more people aware of these warning signs, in the hopes that it will provide the opportunity to prevent fatal cardiac events.
2. Background. The California Interscholastic Federation (CIF) governs competitive athletics in grades 9-12. The CIF is comprised of 10 Section across the State; each Section has a governing body that, among other things, adopts rules and regulations in addition to those promulgated by the State CIF.

The safety protocols established by this bill are similar to safety protocols for concussions in interscholastic sports. Current law requires the removal of “an athlete who is suspected of sustaining a concussion or head injury in an athletic activity from the athletic activity for the remainder of the day.” It also provides similar protocols for allowing the student to return to athletic activity. Unlike this bill, however, there is no penalty on coaches (or other school personnel) for non-compliance.

This bill codifies similar CIF policies on SCA that went into effect in 2015. These policies cover most students playing interscholastic sports, including 1,600 schools with 1.8 million students. The CIF rules, however, do not apply to the other (non-CIF) activities covered by this bill: athletic contests or competitions, other than interscholastic athletics, that is sponsored by a school, including cheerleading and club-sponsored sports activities; noncompetitive cheerleading that is sponsored by a school.

Analysis Prepared by: Misty Feusahrens / APPR. / (916) 319-2081

Date of Hearing: April 5, 2016

ASSEMBLY COMMITTEE ON JUDICIARY

Mark Stone, Chair

ABPCA Bill Id:AB 1639

Author:(Maienschein) – As Amended Ver:March 29, 2016

PROPOSED CONSENT (As Proposed to be Amended)

SUBJECT: PUPIL HEALTH: SUDDEN CARDIAC ARREST PREVENTION ACT

KEY ISSUE: SHOULD ATHLETIC DIRECTORS, COACHES, AND ATHLETIC TRAINERS BE REQUIRED TO IMMEDIATELY REMOVE A PUPIL WHO PASSES OUT OR FAINTS WHILE PARTICIPATING IN A SCHOOL-SPONSORED ATHLETIC ACTIVITY FROM THE ACTIVITY, AND PROHIBIT THE PUPIL FROM RETURNING TO THE ACTIVITY, UNTIL CLEARED BY A MEDICAL PROFESSIONAL?

SYNOPSIS

According to the author, “Sudden Cardiac Arrest (SCA) has emerged as a leading cause of death among people under age 25. According to the American Heart Association, SCA affects nearly 10,000 youth per year.” The author’s office also states that 72 percent of those who have suffered SCA experienced prior symptoms but did not recognize them as warning signs. The sponsor of this bill, the Eric Paredes Save a Life Foundation, seeks to make more people aware of these warning signs, in the hopes that it will provide the opportunity to prevent fatal cardiac events. California has existing laws that regulate athletic activities and requirements for coaches, including limits on the number of football full-contact practices and requirements for coaches to attend a coaching education program. The safety protocols established by this bill are similar to safety protocols for concussions in interscholastic sports, which were established following increasing awareness of the dangers of head injuries. For the reasons discussed in the analysis, the author has reasonably agreed to remove the immunity provision from the bill. The author also proposes a clarifying amendment to specify which medical providers are able to provide clearance to a student’s return to play. This non-controversial bill is supported by numerous heart health advocacy organizations, as well as diverse groups such as the Association of California School Administrators; California School Nurses Organization; California State PTA; and the Consumer Attorneys of California. It has no known opposition.

SUMMARY: Seeks to provide additional information, training, and emergency intervention protocols at schools in order to reduce the risk of sudden cardiac arrest (SCA) among students. Specifically, this bill, in its provisions most relevant to this Committee:

1. Requires the California Department of Education (Department) to post on its Internet Web site guidelines, videos, and an information sheet on SCA symptoms and warning signs, and other relevant materials to inform and educate pupils and parents, and to train coaches about the nature and warning signs of sudden cardiac arrest, including the risks associated with continuing to play or practice after experiencing fainting or seizures during exercise, unexplained shortness of breath, chest pains, dizziness, racing heart rate, or extreme fatigue.
2. Requires that a pupil who passes out or faints while participating in or immediately following an athletic activity, or who is known to have passed out or fainted while participating in or immediately following an athletic activity, shall be removed from participation at that time by the athletic director, coach, or athletic trainer.
3. Provides that a pupil who exhibits any of the other symptoms of sudden cardiac arrest, described in 1), above, during an athletic activity, may be removed from participation by an athletic trainer, if the athletic trainer reasonably believes that the symptoms are cardiac related.
4. Requires, in the absence of an athletic trainer, any coach who observes any of the symptoms of sudden cardiac arrest to notify the parent or guardian of the pupil so that the parent or guardian can determine what treatment, if any, the pupil should seek.
5. Prohibits a pupil who is removed from play pursuant to 2) or 3), above, from participating in an athletic activity until the pupil is evaluated and cleared to return to participate in writing by a licensed health care provider.
6. Requires a coach of an athletic activity to complete the sudden cardiac arrest training course and to retake the training course every two years thereafter.
7. Provides that a coach of an athletic activity shall not be eligible to coach an athletic activity until the coach completes the training course required in 6), above.
8. Provides that, on and after July 1, 2019, a coach who violates the training requirements in 6), above is subject to suspension from coaching any athletic activity until completion of the required training.
9. Defines two relevant terms:
10. “Athletic activity” (defined to include interscholastic athletics; an athletic contest or competition, other than interscholastic athletics, that is sponsored by a school, including cheerleading and club-sponsored sports activities; noncompetitive cheerleading that is sponsored by a school; practices, interscholastic practices, and scrimmages for all of the activities listed above).
11. “School” (a public school, including a charter school, or private school that elects to conduct athletic activities).
12. Makes this article operative on July 1, 2017.

EXISTING LAW:

1. Provides that everyone is responsible, not only for the result of his or her willful acts, but also for an injury occasioned to another by his or her want of ordinary care or skill in the management of his or her property or person, except so far as the latter has, willfully or by want of ordinary care, brought the injury upon himself or herself. (Civil Code Section 1714 (a).)
2. Requires a school district, charter school, or private school that elects to offer an athletic program, to comply with both of the following:
   1. Immediately remove an athlete who is suspected of sustaining a concussion or head injury in an athletic activity from the athletic activity for the remainder of the day and do the following:
      1. Not allow the athlete to return to the athletic activity until he or she is evaluated by a “licensed health care provider” (defined as a “licensed health care provider who is trained in the management of concussions and is acting within the scope of his or her practice”).
      2. Not allow the athlete to return to the athletic activity until he or she receives written clearance to return to the athletic activity from a licensed health care provider.
      3. Ensure that any athlete who sustained a concussion or a head injury also complete a graduated return-to-play protocol of no less than seven days in duration under the supervision of a licensed health care provider.
   2. On a yearly basis, require a concussion and head injury information sheet to be signed and returned by the athlete and the athlete’s parent or guardian before the athlete initiates practice or competition. (Education Code Section 49475. All further statutory references are to this code, unless otherwise indicated.)
3. Requires a school district, county office of education, or charter school to ensure that each employee who volunteers to be trained and to provide emergency medical assistance with an epinephrine auto-injector (epi-pen) and to provide the volunteer with legal defense and indemnification for any and all civil liability associated with use of the device. (Section 49414 (j).)
4. Requires that a school district, county office of education, or charter school which elects to allow employees who volunteer to be trained and provide emergency medical assistance with epilepsy anti-seizure medication, to provide the volunteer with legal defense and indemnification for any and all civil liability associated with use of the medication. (Section 49414.7 (i).)
5. Provides that an employee of a school district who volunteers to be trained and renders emergency care or treatment through the use, attempted use, or nonuse of an automated external defibrillator (AED) at the scene of an emergency is not liable for any civil damages resulting from any act or omission in the rendering of the emergency care or treatment. (Section 49417 (b).)
6. Provides that if a public school or school district complies with the requirements for training and installation of an AED on its premises, the public school or school district shall not be liable for any civil damages resulting from any act or omission in the rendering of the emergency care or treatment with the AED. (Section 49417 (c).)
7. Exempts from the provisions of 5), and 6), above, any case in which personal injury or wrongful death results from gross negligence or willful or wanton misconduct on the part of the person who uses, attempts to use, or maliciously fails to use an AED to render emergency care or treatment. (Section 49417 (d).)

FISCAL EFFECT: As currently in print this bill is keyed fiscal.

COMMENTS: According to the author, “Sudden Cardiac Arrest (SCA) has emerged as a leading cause of death among people under age 25. According to the American Heart Association, SCA affects nearly 10,000 youth per year.” The author’s office also states that 72 percent of those who have suffered SCA experienced prior symptoms but did not recognize them as warning signs. The sponsor of this bill, the Eric Paredes Save a Life Foundation, seeks to make more people aware of these warning signs, in the hopes that it will provide the opportunity to prevent fatal cardiac events.

Eric Paredes, for whom the sponsor organization was named, was a young athlete who died from a sudden cardiac arrest while at home. Eric’s parents hope to use the story of their son’s death, and those of other young athletes, to bring attention to heart screening and possible warning signs they say could save the lives of other children. The Foundation has worked extensively to produce and distribute information on SCA, and to promote training videos for coaches.

Existing Safety Standards for Risky Athletic Activities and Penalties for Noncompliance. California has existing laws that regulate athletic activities and requirements for coaches, including limits on the number of football full-contact practices and requirements for coaches to attend a coaching education program. The safety protocols established by this bill are similar to safety protocols for concussions in interscholastic sports, which were established following increasing awareness of the dangers of head injuries. Current law requires the removal of “an athlete who is suspected of sustaining a concussion or head injury in an athletic activity from the athletic activity for the remainder of the day.” (Section 49475.) It also requires the school district, charter school, or private school to do the following: not allow the athlete to return to the athletic activity until he or she is evaluated by a “licensed health care provider” (defined as a “licensed health care provider who is trained in the management of concussions and is acting within the scope of his or her practice”); not allow the athlete to return to the athletic activity until he or she receives written clearance to return to the athletic activity from a licensed health care provider; ensure that any athlete who sustained a concussion or a head injury also complete a graduated return-to-play protocol of no less than seven days in duration under the supervision of a licensed health care provider. (Ibid.) There is no penalty on coaches (or other school personnel) for non-compliance and no immunity for school personnel who act (or do not act) pursuant to the law.

The CIF, working with a panel of medical professionals, established policies related to SCA which went into effect in 2015. These policies cover most students playing interscholastic sports, including 1,600 schools with 1.8 million students. CIF added SCA information to their existing training requirements for coaches. The CIF also added protocols similar to those in this bill. They include removal from athletic activity after a pupil passes out or faints during or right after activity, with a medical clearance required to return to activity. Similarly, pupils must be cleared if they are held out for exhibiting signs or symptoms associated with SCA. The policy requires a pupil and his or her parent or guardian to receive and sign a Sudden Cardiac Information sheet each year. Given that the CIF implemented coaching training rules and a protocol for SCA in 2015, many of the informational and care guidelines in this bill already apply to the great majority of student athletes. However, the CIF rules do not apply to the other (non-CIF) activities covered by this bill: athletic contests or competitions, other than interscholastic athletics, that is sponsored by a school, including cheerleading and club-sponsored sports activities; noncompetitive cheerleading that is sponsored by a school.

As originally in print, this bill contained sanctions for coaches who did not follow the guidelines for removal of a student and allowing such a student to return to play. As recently amended (in the Assembly Education Committee), those penalties were removed from the bill. According to that Committee’s analysis:

The CIF protocol on SCA does not contain sanctions. According to the CIF, coaches are employees of the school district, not the CIF. Existing law for concussions also do not contain sanctions. While current law on coaches speaks of the need for coaches to be trained in safety, including cardiopulmonary resuscitation requirements, it is silent on punishments for noncompliance in any area.

Immunity Provisions for Volunteers who Provide Emergency Medical Care in Schools. Existing state law provides qualified immunity to school personnel who volunteer to be trained to administer emergency medical assistance in some circumstances. It also requires the employers of these volunteers - a school district, county office of education, or charter school –to provide them with legal defense and indemnification for any and all civil liability associated with providing emergency medical care. For example, school personnel who agree to be trained to use an epinephrine auto-injector (Section 49414 (j)); epilepsy anti-seizure medication (Section 49414.7 (i)); or an automated external defibrillator (AED) (Section 49417 (b)) have immunity from civil liability for the administration of emergency medical assistance, as well as the right to defense by the employer; and the right to indemnification. The only exceptions (which makes the immunity “qualified”) are cases in which personal injury or wrongful death results from gross negligence or willful or wanton misconduct on the part of the person who uses, attempts to use, or maliciously fails to render emergency care or treatment.

The rationale for these provisions in the Education Code is presumably to encourage volunteers, who otherwise would have no duty to be trained or to provide emergency medical care, to do so. This is similar to the rationale in the Civil Code for providing immunity to persons who are trained to administer CPR. Such immunity is intended to “encourage citizens to participate in emergency medical services training programs and to render emergency medical services to fellow citizens” (Civil Code Section 1714.2 (a).)

The same rationale does not apply to the provisions of this bill, which require coaches (as well as athletic directors and athletic trainers) to intervene when a student-athlete shows symptoms of SCA. However, as explained below, such provisions are unnecessary and superfluous, at least for coaches, athletic directors, and athletic trainers who are public employees, because those employees are already immune for discretionary decisions (such as whether or not to remove an athlete from competition). Therefore, it does not seem reasonable or necessary to provide them with additional express immunity for doing (or not doing) so.

General Governmental Immunity for Coaches (and Other Public Employees). In general, a civil action against a public employee is not possible when the damages are caused by an act or omission of the employee while exercising the discretion vested in the employee.  (Government Code Section 820.2.)  In fact, “public employees are immune for their discretionary acts, even those which constitute breaches of actionable duty, unless a statute otherwise provides. … This … can only be achieved by a clear indication of legislative intent that statutory immunity is withheld or withdrawn in the particular case” [Citation deleted]. (Conn v. Western Placer Unified School Dist. (2010) 186 Cal.App.4th 1163, 1179.) An employee is required to "indemnify the public entity" only in instances where the employee acted outside the scope of his employment or "acted with actual fraud, corruption, or malice." (Connelly v. State (1970) 3 Cal.App.3d 744, 750 [84 Cal.Rptr. 257].) A discretionary act is one that calls for the exercise of judgment (i.e., discretion), weighing of evidence and consideration of advantages and disadvantages of making a decision or taking action, such as a board’s decision whether or not a worker is permanently disabled and therefore unable to return to work (Masters v. San Bernardino County Employees Retirement Assn. (1995) 32 Cal.App.4th 30, 46-47); or a social service worker’s investigation regarding the suitability of prospective adoptive parents (Ronald S. v. County of San Diego (1993) 16 Cal. App. 4th 887, 897).

The type of decisions that would have to be made under the provisions of this bill – whether the pupil passed out or fainted during or immediately after an athletic activity; whether the pupil exhibits any symptoms of SCA during an athletic activity; whether the symptoms are cardiac related; whether to notify the parent or guardian – involve judgment calls that are typical of those made by school personnel, especially coaches. They are also very similar to the discretionary decisions that are made regarding student athletes who obtain concussions. A court would almost certainly consider them to be “discretionary act” for purposes of the immunity provisions in Government Code Section 820.2. Therefore, additional express immunity is not necessary for athletic directors, coaches, or athletic trainers.

Duty of Care – Coaches Engaged in Coaching. While a school athletic coach has a duty of care to a student-athlete, “because a significant part of an instructor’s or coach’s role is to challenge or ‘push’ a student or athlete to advance his or her skill level and to undertake more difficult tasks, and because the fulfillment of such a role could be improperly chilled by too stringent a standard of potential legal liability,” coaches can engage in somewhat more risky behavior without breaching that duty. (Kahn v. East Side Union High School Dist. (2003) 31 Cal. 4th 990, 996.) “A sports instructor may be found to have breached a duty of care to a student or athlete only if the instructor intentionally injures the student or engages in conduct that is reckless in the sense that it is “totally outside the range of the ordinary activity” [citation omitted] involved in teaching or coaching the sport.” (Ibid.)

But naturally, this special permissive standard for athletic coaches, allowing them to push students to engage in what would otherwise be dangerous activities only applies when they are – as the Kahn court observed - “involved in teaching or coaching the sport.” If a coach were also an English teacher, he or she is held to the same standard of care as other teachers when teaching. The status of a coach would not allow the teacher to encourage students to engage in inherently risky behavior in the classroom under the guise of “pushing” students to undertake more difficult tasks by advancing their skill level. The same is also true of a coach acting as a coach, but engaging in activities other than encouraging students to advance their skills, such as observing whether or not a student athlete exhibits the signs and symptoms of SCA, or whether or not the student fainted during or immediately after an athletic activity. In those cases, the coach would have a regular duty of care, rather than the relaxed version of that duty.

This bill does not seek to address the role of the coach while pushing a student-athlete to take chances and try new activities or risky maneuvers to develop the athlete’s skills. Rather, this bill requires coaches to get training and to pull an athlete out of the game or practice if he or she passes out, faints, or shows signs of cardiac arrest.  Therefore, the coach would have a regular duty of care towards the student. Any coach who did not remove a pupil from competition after the pupil passed out or showed signs of cardiac arrest would likely be deemed reckless or grossly negligent by a judge or jury, regardless of the provisions of this bill.

Author’s Amendments to Address Committee’s Concerns Regarding Immunity Provision. Unlike state law regarding school responsibilities to comply with the concussion protocol, this bill, as currently in print, includes an immunity provision providing that a “coach shall not be exposed to civil liability for his or her action or inaction” in compliance with the bill, “unless the coach is found to have acted in a grossly negligent manner.” For a number of reasons, this immunity provision is unnecessary and unreasonable. First, it is inconsistent with other state laws that provide immunity to school personnel whose job descriptions do not require them to engage in emergency medical assistance, but who volunteer to be trained to administer such assistance in some circumstances. The same rationale does not apply to the provisions of this bill, which require coaches (as well as athletic directors and athletic trainers) to intervene when a student-athlete shows symptoms of SCA. Second, such immunity is unnecessary and superfluous, at least for coaches, athletic directors, and athletic trainers who are public employees, because those employees are already immune for discretionary decisions (such as whether or not to remove an athlete from competition). Third, schools and school personnel have complete immunity for activities held off campus. For all of the above reasons, the author has reasonably agreed to remove the immunity provision in 33487 (b) from the bill.

Medical Professionals Authorized to Clear Athlete for Return to Play. Like Section 49475 (regarding athletes who are suspected of sustaining a concussion or head injury in an athletic activity) on which this bill appears to be modeled, this bill uses the term “licensed health care provider” in describing the medical professional who is required to examine the pupil before he or she can be allowed to return to the athletic activity. However, unlike Section 49475, this bill does not define that term. In order to clarify who is required to perform the medical evaluation, the author proposes the following amendment:

On Page 4, at line 9: delete “appropriate medical professional” and insert the following:

a physician and surgeon, or a nurse practitioner or physician assistant practicing in accordance with standardized procedures or protocols developed and approved by the supervising physician and surgeon and the nurse practitioner or physician assistant.

ARGUMENTS IN SUPPORT: Supporters consider this bill a first effort in preventing future deaths through information and risk assessment. One supporter, Heartfelt Cardiac Projects, states:

This bill is an inaugural step in educating youth, parents and coaches about the potential warning signs and risk factors of sudden cardiac arrest and about the cardiac chain of survival that could save a life.

REGISTERED SUPPORT / OPPOSITION:

Support

Eric Paredes Save a Life Foundation (sponsor)

American Academy of Pediatrics, California

American Heart Association/American Stroke Association

Association of California School Administrators

California School Nurses Organization

California State PTA

Children’s Cardiology of the Bay Area, inc.

Children’s Cardiomyopathy Foundation

Consumer Attorneys of California

Heartfelt Cardiac Projects

Los Angeles Unified School District

Mike Whitmarsh Memorial Foundation

No More Broken Hearts

Olivia’s Heart Project

San Diego City Councilmember Chris Cate

San Diego City Councilmember Mark Kersey

San Diego County Supervisor Ron Roberts

Saving Hearts Foundation

SDSU Circle K

Sequoia Union High School District

Sudden Cardiac Arrest Association

Travis R. Roy Sudden Cardiac Arrest Fund

VIA Heart Project

Numerous individuals

Opposition

None on file

Concerns – request for amendment

California Academy of Physician Assistants

Analysis Prepared by: Alison Merrilees / JUD. / (916) 319-2334

Date of Hearing: March 16, 2016

ASSEMBLY COMMITTEE ON EDUCATION

Patrick O'Donnell, Chair

ABPCA Bill Id:AB 1639 (

Author:Maienschein) – As Amended on Ver:March 9, 2016

[Note: This bill is double-referred to the Judiciary Committee and will be heard by that Committee as it relates to issues under its jurisdiction.]

SUBJECT: Pupil health: Sudden Cardiac Arrest Prevention Act

SUMMARY: Establishes the Sudden Cardiac Arrest Prevention Act; requires the California Department of Education (CDE) to make available specified guidelines and materials on sudden cardiac arrest (SCA); requires pupils and parents to sign informational materials before athletic participation; requires training of coaches; and sets requirements for action in the event a pupil experiences specified symptoms. Specifically, this bill:

1. Establishes the following definitions:
   1. “Athletic activity” means the following:
      1. Interscholastic athletics;
      2. An athletic contest or competition, other than interscholastic athletics, sponsored by or associated with a school, including cheerleading, club-sponsored sport activities and sports activities sponsored by school-affiliated organizations;
      3. Noncompetitive cheerleading sponsored by or associated with a school; and,
      4. Practices and scrimmages for activities listed under i) through iii).
   2. “School” means a public school, including a charter school, or a private school with athletic activities.
2. Requires the CDE to develop and post on its Internet Web site guidelines and an information sheet on specified SCA symptoms, risks and warning signs.
3. Requires the materials to be developed using relevant materials and training videos used by the Eric Paredes Save a Live Foundation, the California Interscholastic Federation (CIF) and the National Federation of High Schools (NFHS).
4. Encourages school districts and schools to post these materials on their Internet Web sites.
5. Requires a pupil and the pupil’s parent or guardian to sign an acknowledgment of receipt and review of the information sheet developed by the CDE every year before participation in an athletic activity.
6. Authorizes schools to hold informational meetings on SCA before each athletic season.
7. Requires removal from activity any pupil who passes out or faints while participating in or immediately after athletic activity, or who is known to have done so, by an athletic trainer, coach or athletic director.
8. Authorizes an athletic trainer to remove a pupil from participation if the pupil experiences specified symptoms the trainer reasonably believes are cardiac related. Requires, in the absence of a trainer, a coach observing symptoms of SCA in a pupil to notify a parent or guardian, so that that parent or guardian can determine what treatment, if any, the pupil should seek.
9. Prohibits a pupil who has been removed from activity for SCA symptoms from returning to participation until evaluated and cleared to participate in writing by an appropriate medical professional.
10. Requires biennial SCA training for coaches.
11. Requires, beginning July 1, 2019, suspension of coaches for not removing from activity a pupil who has fainted or passed out, or for not undergoing the yearly training. Requires a coach to be suspended for the remainder of a season, for a first violation; for the remainder of the season and the next season, for a second violation; and permanent suspension from coaching any athletic activity, for a third violation.
12. Limits a coach’s civil liability for his or her action or inaction under the Act, other than acting in a grossly negligent or reckless manner.
13. Encourages the sponsors of youth athletic activities to follow the guidelines in the Act.
14. Makes the Act operative on July 1, 2017.

EXISTING LAW:

1. Limits full-contact practices, as defined, for high school and middle school football and urges CIF adoption of rules to implement such guidelines. (Education Code (EC) Section 35179.5)
2. Requires an athlete suspected of sustaining a concussion or head injury during athletic activity to be removed from that activity and not be permitted to return until evaluated and cleared by a licensed health care provider; urges the CIF to develop rules and protocols to implement this; and requires athletes and parents to receive, sign and return a head injury information sheet annually before practice or competition. Excludes the requirements from athletic activities during the regular schoolday or as part of a physical education course. (EC Section 49475)
3. Requires a high school sports coach to complete educational programs developed by his or her school district and the CIF that meet specified guidelines. (EC Section 49032)
4. Authorizes a school district or school to provide comprehensive instruction in first aid or cardiopulmonary resuscitation. (EC Section 49413)

FISCAL EFFECT: Unknown

COMMENTS: This bill requires dispersion of informational materials on SCA, and notification for student athletes and their parents, in order to build awareness of the possible precursors to SCA. This bill also requires training for coaches, establishes procedures to be followed in the event of SCA symptoms, and sets penalties for not following the procedures.

Existing law involving athletic activities. California has established laws regulating athletic activities and requirements for coaches, including limiting the number football full-contact practices and requiring coaches to attend a coaching education program. This bill is similar to requirements on concussions among students in interscholastic sports, which were established following increasing awareness of the dangers of head injuries. Current law requires a graduated return-to-play protocol for those pupils who have had a concussion or head injury diagnosed by a licensed health care provider. These rules are for schools with an interscholastic sports program and do not specify penalties for violations.

Purpose of the bill. The author’s office states that “Sudden Cardiac Arrest (SCA) has emerged as a leading cause of death among people under age 25. According to the American Heart Association, SCA affects nearly 10,000 youth per year.” The author’s office also states that 72 percent of those who have suffered SCA experienced prior symptoms but did not recognize them as warning signs. The sponsor of this bill, the Eric Paredes Save a Life Foundation, seeks to make more people aware of these warning signs, in the hopes that it will provide the opportunity to prevent fatal cardiac events.

Eric Paredes, for whom the sponsor organization was named, was a young athlete who died from a sudden cardiac arrest while at home. Eric’s parents hope to use the story of their son’s death, and those of other young athletes, to bring attention to heart screening and possible warning signs they say could save the lives of other children. The Foundation has worked extensively to produce and distribute information on SCA, and to promote training videos for coaches.

Supporters consider this bill a first effort in preventing future deaths through information and risk assessment. One supporter, Heartfelt Cardiac Projects, states, “This bill is an inaugural step in educating youth, parents and coaches about the potential warning signs and risk factors of sudden cardiac arrest and about the cardiac chain of survival that could save a life.”

Similar requirements under CIF. The CIF, working with a panel of medical professionals, established policies related to SCA which went into effect in 2015. These policies cover most students playing interscholastic sports, including 1,600 schools with 1.8 million students. CIF added SCA information to their existing training requirements for coaches. The CIF also added protocols similar to those in this bill. They include removal from athletic activity after a pupil passes out or faints during or right after activity, with a medical clearance required to return to activity. Similarly, pupils must be cleared if they are held out for exhibiting signs or symptoms associated with SCA. The policy requires a pupil and his or her parent or guardian to receive and sign a Sudden Cardiac Information sheet each year. The sponsors feel an information sheet serves the purpose of educating pupils and parents regarding symptoms that might otherwise be ignored.

Given that the CIF implemented coaching training rules and a protocol for SCA in 2015, many of the informational and care guidelines in this bill already apply to the great majority of student athletes. To add another form for these same students seems duplicative. The sponsor would like to extend these guidelines to cover children in all grades and all school-sponsored sports, with coach training required, including at an elementary level, every two years. As written, the bill appears to include any athletic activity occurring at a school, including independent club sports using school facilities and elementary school “field day” type competitions. Ideally, the sponsors have said, they would like every child screened, as SCA does not affect only athletes.

Penalties. This bill’s sponsors believe sanctions are needed to provide an incentive for coaches to follow the guidelines when they conflict with a desire to win. The CIF protocol on SCA does not contain sanctions. According to the CIF, coaches are employees of the school district, not the CIF. Existing law for concussions also do not contain sanctions. While current law on coaches speaks of the need for coaches to be trained in safety, including cardiopulmonary resuscitation requirements, it is silent on punishments for noncompliance in any area.

Unintended consequence? Cardiologists writing in the American Heart Association publication, “Circulation”, have noted that the number of specifically athletic sudden cardiac deaths among young people is “relatively small, with (about) 100 to 150 competitive deaths during sports in the United States annually.” These cardiologists also suggested that “significant gaps in evidence exist related to effectiveness of preventing sudden death in the athlete with preparticipation screening strategies.” The publication raised concern as to whether screening could inappropriately lead to students becoming less active – a known health risk.

Committee amendments:

1. Because the definition of athletic activity is broad and somewhat unspecific, staff recommends that Section 33281(a)(2) be amended to more narrowly define athletic activity. This definition should include those activities sponsored by a school, but exclude those activities “associated with a school” or “sponsored by school-affiliated organizations.” The Committee may consider further focusing the bill’s requirements on schools with an athletic program.
2. Staff recommends that Section 33482(a) be amended to delete the requirement that the CDE be required to develop materials and to clarify that CDE is simply required to post specified informational material on its Web site.
3. To avoid duplication of notices, staff recommends that Section 33483 be amended to require, for athletic activities governed by CIF, that schools retain a copy of each signed SCA information sheet required by CIF; and that a pupil and parent or guardian participating in a sport not governed by CIF be required to sign and return to the school an acknowledgement of receipt and review of the information material made available on the CDE’s website.
4. Staff recommends adding language consistent with that currently applied to concussion protection, stating, “This section does not apply to an athlete engaging in an athletic activity during the regular schoolday or as part of a physical education course required pursuant to subdivision (d) of Section 51220.” (Physical education requirements)
5. Staff recommends changing, in Section 33485, “appropriate medical professional” to “licensed health care provider” to be more specific and consistent with concussion protections.
6. Staff recommends amending Section 33487 to delete penalties for violating Section 33485 and, for violations of Section 33486, to require suspension of a coach until completion of required training. The Committee may also consider striking Section 33487(b) with this amendment.

Related legislation. AB 1719 (Rodriguez), pending in this Committee, requires high school students to receive instruction in cardiopulmonary resuscitation and the use of an automated external defibrillator as part of a course required for graduation. A similar bill by this author was held in the Appropriations Committee suspense file in 2015.

AB 2182 (Mullin), pending in this Committee, requires neurocognitive testing, as defined, for any pupil participating in interscholastic athletics before competitions have taken place and after any head injury. The bill also requires collecting and maintaining data on injuries, with reporting to the appropriate county office of education for compilation and retention.

REGISTERED SUPPORT / OPPOSITION:

Support

Eric Paredes Save a Life Foundation (sponsor)

American Academy of Pediatrics, California

Children’s Cardiomyopathy Foundation

Heartfelt Cardiac Projects

Mike Whitmarsh Memorial Foundation

Olivia’s Heart Project

San Diego City Councilmember Chris Cate

San Diego City Councilmember Mark Kersey

San Diego County Supervisor Ron Roberts

Travis R. Roy Sudden Cardiac Arrest Fund

Numerous individuals

Opposition

None on file

Analysis Prepared by: Carlos Alcala and Sophia Kwong Kim / ED. / (916) 319-2087