Existing law establishes the Office of Emergency Medical Services Authority in the Health and Welfare Agency to administer a statewide system of coordinated emergency medical care, injury prevention, and disaster medical response. in the office of the Governor and makes the office responsible for the states emergency and disaster response services for natural, technological, or manmade disasters and emergencies. Existing law authorizes the purchase of mobile field hospitals.

This bill would express the intent of the Legislature to establish funding for make an appropriation of $2,000,000 from the General Fund to the Office of Emergency Services for the purpose of providing maintenance and upkeep of one or more mobile field hospital to hospitals that would be ready and available within 72 hours to assist local communities in the event of a natural disaster or other mass casualty incidents. incident. The bill would make related findings and declarations.

Existing law establishes the Emergency Medical Services Authority in the Health and Welfare Agency to administer a statewide system of coordinated emergency medical care, injury prevention, and disaster medical response.

This bill would express the intent of the Legislature to establish funding for one mobile field hospital to be ready and available within 72 hours to assist local communities in the event of a natural disaster or other mass casualty incidents.

Date of Hearing: April 12, 2016

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 1827

Author:(Kim) – As Amended Ver:March 16, 2016

SUBJECT: Emergency medical services: mobile field hospitals.

SUMMARY: Appropriates $2 million from the General Fund (GF) to the Office of Emergency Services (OES) for the purpose of providing maintenance and upkeep of one or more mobile field hospitals (MFHs) to be ready and available within 72 hours in the event of a natural disaster or other mass casualty incident.

EXISTING LAW:

1. Establishes OES in the office of the Governor and makes it responsible for emergency and disaster response services for natural, technological, or manmade disasters and emergencies.
   
2. Establishes the Emergency Medical Services Administration (EMSA) in the Health and Human Services Agency to administer a statewide system of coordinated emergency medical care, injury prevention, and disaster medical response.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, Californians need to be prepared and protected in the event of a particularly strong natural disaster or other catastrophic emergency. We have facilities warehoused and collecting dust that could be used to save lives. The state should make full use of these MFHs and restore the ability for them to be mobilized and treat disaster victims within 72 hours of a catastrophic emergency. According to the California Office of Statewide Health Planning and Development, over 75% of California’s hospitals are located in areas of high earthquake potential. The U.S. Geological Survey calculates that between April 1, 2015 and April 1, 2018 there is an 85% probability of a magnitude ‘5’ or greater earthquake hitting the greater Los Angeles area. Earthquakes can cripple acute care hospitals and until 2020, the first deadline for acute care hospitals to withstand a strong earthquake, there is a deadly gap in state-level disaster preparedness and response.
2. BACKGROUND.
   1. Historical Background. According to EMSA, in 2007, the state purchased three MFHs with the intent to replace or augment acute hospital care capacity during catastrophic emergencies. AB 1811 (Laird), Chapter 48, Statutes of 2006, which amended the Budget Act of 2006, authorized the purchase of the three MFHs at an initial GF cost of $18.3 million. Additionally, $1.7 million GF was authorized in FY 2006-07 to provide for ongoing costs associated with program staff, storage, maintenance and readiness. These ongoing funds were eliminated in FY 2011-12. The MFHs have been deployed three times for exercises, but never for a response to a real event.
      
   2. Deployment Capabilities. Each MFH can be deployed as a 200-bed acute care facility that includes: 20 bed Emergency Department; two Operating Room stations; 20 Intensive Care Unit beds; 10 Reverse Isolation beds; 170 medical-surgical ward beds; digital X-Ray; point of care laboratory testing; Pharmacy; cascade oxygen system to generate and refill oxygen tanks; 130 ventilators; and, a 30’ x 50’ climate controlled supply warehouse and staff quarters for 150. Power is provided by up to eight diesel generators, depending on the number of modules used. Each MFH could be deployed as one integrated facility or in smaller modules of 50, 100, or 150 beds. If divided into smaller units, each would not have the same capabilities. The shelf life for the MFHs’ infrastructure items is a minimum of 20 years; the current age is eight years.
   3. Operational Status. Currently, all three MFHs are stored in the Sacramento area in delayed deployment status and cannot be mobilized in time to treat patients during the initial phase of a response. Until June 30, 2015, one MFH was maintained with ongoing biomedical equipment maintenance for a target deployment time of one week. If the other MFHs were needed in the event of a disaster, they would require additional maintenance and recertification of all biomedical equipment, which would require an estimated minimum of 30 days before deployment.
   4. Program Costs. The cost estimates provided by EMSA and outlined below are to restore one MFH to rapid deployment condition and status. These are point-in-time estimates and are based on past contracts.
      1. Storage. To store one MFH requires 15,000-20,000 sq. ft. of clean storage space where biomedical equipment maintenance can be performed. The facility requires a forklift for movement of boxes to access the equipment for maintenance and to move the generators outside to be run once per month. Warehouse space for one MFH is estimated to cost between $175,000 to $250,000 per year if stored in Southern California. There are no additional costs to store one hospital in Sacramento at EMSA Station 1.
         
      2. Transportation. To move one MFH by ground, the requirements are as follows: three 42’ box trucks and eighteen 42’ flatbed trucks. The cost varies by distance.
         
      3. Maintenance. To maintain one MFH a maintenance contract would include: 24/7/365 logistical support, setup teams immediately available for deployment, maintenance of all support services contracts, and ongoing maintenance and replacement of equipment beyond its service life, including biomedical, batteries, generators, medical supplies, shelters, and other items. Some equipment needs replacement, as it is beyond its service life. The maintenance for one MFH is estimated to cost between $825,000 and $900,000 per year.
3. SUPPORT. Supporters of this bill argue that MFHs have a long and proven record providing critical life-saving facilities during emergencies. Appropriating $2 million to maintain these valuable emergency medical assets is critical.
   
4. OPPOSITION. The California Ambulance Association argues that OES has no statutory authority to provide medical care during a disaster. Such authority rests with EMSA and the Health and Welfare Agency. Furthermore, OES has no experience in operating a MFH or overseeing emergency medical services. Thus, OES is the wrong agency to receive funds for the operation and maintenance of MFHs.
   
5. RELATED LEGISLATION. AB 1528 (Rodriguez) appropriates $2 million from the GF to the EMSA to provide maintenance and upkeep of MFH within the MFH Program. AB 1528 is scheduled to be heard by the Assembly Health Committee on April 12, 2016.
   
6. PREVIOUS LEGISLATION. AB 355 (Cooley) of 2013 would have appropriated $1 million from the GF to EMSA to continue the MFH Program. AB 355 was held on the Senate Appropriations Committee Suspense File.

REGISTERED SUPPORT / OPPOSITION:

Support

California Fire Chiefs Association

Fire Districts Association of California

Opposition

California Ambulance Association

Analysis Prepared by: John Gilman / HEALTH / (916) 319-2097