Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, establishes the Emergency Medical Services Authority and provides for the certification of emergency medical personnel, as specified. The authority is responsible for the coordination and integration of all statewide activities concerning emergency medical services.

This bill would require the authority to establish training standards and licensing reciprocity procedures for out-of-state fire and paramedic personnel who are requested through the California Disaster and Civil Defense Master Mutual Aid Agreement to render aid in this state on a temporary basis during a declared state of emergency.

The California Emergency Services Act authorizes the Governor to enter into reciprocal aid agreements or compacts, mutual aid plans, or other interstate arrangements for the protection of life and property with other states and the federal government, either on a statewide basis or a political subdivision basis.

This bill would authorize a mutual aid agreement to provide for temporary training and licensing reciprocity for out-of-state fire and paramedic personnel who render aid in this state during a declared state of emergency.

 THIRD READING  

Bill No: AB 2102

Author:

:

Vote:

SENATE HEALTH COMMITTEE: 9-0, 6/27/18

AYES: Pan, Nguyen, Beall, Hernandez, Leyva, Mitchell, Monning, Nielsen, Roth

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/16/18

AYES: Portantino, Bates, Beall, Bradford, Hill, Nielsen, Wiener

ASSEMBLY FLOOR: 73-0, 5/17/18 (Consent) - See last page for vote

SUBJECT:

SOURCE: Author

DIGEST:

This bill requires the Emergency Medical Services Authority to establish training standards and licensing reciprocity procedures for out-of-state paramedic personnel who are requested through the California Disaster and Civil Defense Master Mutual Aid Agreement to render aid on a temporary basis during a declared state of emergency pursuant to the California Emergency Services Act, as specified.

ANALYSIS:

Existing law:

1. Establishes the Emergency Medical Services Authority (EMSA), which is responsible for the coordination and integration of all state activities concerning emergency medical services (EMS), including the establishment of minimum standards, policies, and procedures. [HSC §1797.100, et seq.]
2. Authorizes counties to develop an EMS program and designate a local EMS agency (LEMSA) responsible for planning and implementing an EMS system, which includes day-to-day EMS system operations. [HSC §1797.200, et seq.]
3. Requires every LEMSA to have a licensed physician as medical director to provide medical control and to assure medical accountability throughout the planning, implementation, and evaluation of the EMS system. [HSC §1797.202]
4. Establishes an 18-member Commission on EMS, within the California Health and Human Services Agency. Defines the duties of the Commission to include reviewing regulations, standards, and guidelines developed by EMSA; advising EMSA on a data collection system; advise on emergency facilities and services, emergency communications, medical equipment, personnel training, and various aspects of the EMS system; and, to make recommendations for further development of the EMS system. [HSC §1799, et seq.]
5. Requires the Commission on EMS to review and approve regulations, standards and guidelines to be developed by EMSA for implementation of the EMS system and the Prehospital Emergency Medical Care Personnel Act. [HSC §1799.50]
6. Defines "Emergency Medical Technician-I" or "EMT-I" as an individual trained in all facets of basic life support, as specified. Defines an "Emergency Medical Technician-II," "EMT-II," "Advanced Emergency Medical Technician," or "Advanced EMT" as an EMT-I with additional training in limited advanced life support according to specified standards. Both EMT-Is and EMT-IIs are certified at the local level. [HSC §1797.80 and §1797.82]
7. Defines "Emergency Medical Technician-Paramedic," "EMT-P," "paramedic" or "mobile intensive care paramedic" as an individual whose scope of practice includes the ability to provide advanced life support, as specified, including administering specified medications. EMT-Ps are licensed and regulated at the state level through EMSA. [HSC §1797.84]
8. Establishes the California Emergency Services Act, which provides the Governor with broad powers to declare local and state emergencies, and to coordinate all emergency services functions for the mitigation of the effects of an emergency in California. [GOV §8550, et seq.]

This bill requires EMSA to establish training standards and licensing reciprocity procedures for out-of-state paramedic personnel who are requested through the California Disaster and Civil Defense Master Mutual Aid Agreement to render aid on a temporary basis during a declared state of emergency pursuant to the California Emergency Services Act, as specified.

Comments

1. Author’s statement. According to the author, in 2017, California experienced the largest documented wildfire in its history through Ventura and Santa Barbara Counties, spanning over 280,000 acres. This event, the Thomas Fire, destroyed over 1,000 structures, damaged another 280, injured two firefighters, and killed one firefighter and one civilian. This bill streamlines the process of recognizing out-of-state paramedic personnel who have been called into California to assist with disaster relief by tasking EMSA to establish uniform procedures to more easily recognize these out-of-state personnel to provide medical care.
2. EMS Personnel Mutual Aid Compendium. EMSA publishes the EMS Personnel Mutual Aid Compendium (Compendium) “to clarify the existing laws and regulations pertaining to when and under what conditions a paramedic, EMT, or Advanced EMT, whether licensed or certified inside or outside California, may legally function in their respective EMS classification during transport, mutual aid, and disasters in California.” According to the Compendium, the rules for out-of-state licensed or certified EMS personnel are the same regardless of whether for daily response and transport needs or in response to a declared disaster. An out-of-state paramedic is permitted to temporarily practice in California on a mutual aid response, on routine patient transports from out of state into California, or during a special event, provided all of the following conditions are met:
   1. They are in possession of a valid paramedic license or certificate issued by another state or country;
   2. They are approved by the medical director of the LEMSA to practice in the jurisdiction of that LEMSA;
   3. They utilize the scope of practice as defined by the jurisdiction with whom they are licensed or certified; and,
   4. They observe any limits placed on their scope of practice by the local medical director, should the local medical director exercise that option.

While this bill only applies to paramedics, the rule is similar for EMTs. There is no provision in statute or regulation for non-California Advanced EMTs to temporarily practice in California.

1. Current mutual aid process. According to EMSA, the current mutual aid intake process provides for tracking of out-of-state EMS personnel and allows LEMSAs to best appropriate the skills of those individuals to the needs within their system during an emergency. Upon arrival, EMS personnel deployed into California on a mutual aid request are rostered by the medical group supervisor who then faxes or communicates the completed list to the LEMSA where the incident is located. The roster includes the individual's name, certification/licensure level (EMT, Advanced EMT, and paramedic), certification/license number, and certification/license issuing agency. This identifies the individual, their license or certification, and associates them with a state licensing body. The LEMSA medical director then grants limited recognition to practice in that LEMSA's jurisdiction in California. Limited recognition is valid until the individual leaves the state or the LEMSA's jurisdiction. If the individual is deployed to another LEMSA's jurisdiction, the individual will go through the same rostering process to practice there. California is divided into 33 LEMSAs, each with a designated medical director. Current law grants the responsibility for medical control and medical accountability to each LEMSA medical director. Therefore, the LEMSA medical director must be the one to grant the recognition.
   
   According to the author, because each medical director can impose varying restrictions on the scope of practice of a paramedic who came from out-of-state, if the paramedic crosses a county line they will have to adjust to that county’s directions. The author argues that during the Thomas Fire, Cal Fire medical team leaders were subjected to an additional 20 hours of administrative work to ensure that the firefighter/paramedics from out-of-state could be cleared to use their medical training, and that more can be done to expedite this process.
2. Mutual aid within California. Unlike EMTs and Advanced EMTs, which are certified at the local level by LEMSAs, paramedics are licensed by EMSA. However, in addition to state licensure, paramedics are required to have “local accreditation” by a LEMSA in order to practice as a paramedic within that jurisdiction. During a mutual aid call, a California-licensed paramedic can practice anywhere in California if they are accredited by an LEMSA, and if they are affiliated with an EMS provider agency (such as a fire department or an ambulance company) that is approved by the LEMSA where they are accredited. They also have to stay within the scope of practice established by the LEMSA with whom they are accredited. In essence, the difference between mutual aid provided by an out-of-state paramedic, versus mutual aid provided by a paramedic from a different county in California, is that a California paramedic is affiliated with an EMS provider as their employer, which has also been approved by their LEMSA. It provides a second layer of oversight when traveling to other jurisdictions in the state. Without an in-state, LEMSA-approved provider, an out-of-state paramedic is forced to get approval from each individual LEMSA when traveling between jurisdictions in the state.
3. California Emergency Services Act and the Master Mutual Aid Agreement. The California Emergency Services Act is the body of law governing what happens during one of the three types of emergencies that can be declared by the Governor: a state of war emergency, a state of emergency, or a local emergency. Among the many powers at the Governor’s disposal during a state of emergency or a state of war emergency is the ability to suspend any statute or regulation where the Governor determines that strict compliance with any statute or regulation would in any way prevent, hinder, or delay the mitigation of the effects of the emergency.
   
   The California Disaster and Civil Defense Master Mutual Aid Agreement (MMAA), referenced in this bill, is an agreement between the state, counties, cities and other political subdivisions, originally entered into in 1950, signed by Governor Earl Warren. According to the MMAA, in order to aid and assist each other in the event that a disaster should occur, “it is necessary and desirable that a cooperative agreement be executed for the interchange of such mutual aid on a local, countywide, regional, statewide, and interstate basis.” The MMAA states that each party agrees to furnish resources and facilities and to render services to each and every other party to prevent and combat any type of disaster in accordance with duly adopted mutual aid operational plans. The MMA goes on to state that “it is expressly understood that when and as the State of California enters into mutual aid agreements with other states and the Federal Government, the parties to this agreement shall abide by such mutual aid agreements in accordance with the law.”
4. Policy comment. This bill requires EMSA to develop “training standards and license reciprocity” for out-of-state paramedics who are providing mutual aid during an emergency. If the goal is to simplify the ability of a paramedic who is already licensed in another state to practice across various LEMSA jurisdictions during an emergency, developing “training standards” does not seem like the right approach. With regard to license reciprocity, there are already specific state regulations that permit out-of-state paramedics to provide mutual aid. As the author notes, because it is subject to approval by each LEMSA’s medical director, this can make it difficult to move quickly from one county to another, but a process does exist.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

According to the Senate Appropriations Committee, the Emergency Medical Services Authority estimates:

$143,0000 (General Fund) in fiscal year 2018-19 and $136,000 (General Fund) annually thereafter for one associate governmental program analyst to research mutual aid agreements, conduct rulemaking process, and monitor individuals on mutual aid requests.

SUPPORT: (Verified 8/15/18)

None received

OPPOSITION: (Verified 8/15/18)

None received

ASSEMBLY FLOOR: 73-0, 5/17/18

AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bonta, Brough, Burke, Caballero, Calderon, Carrillo, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Mullin, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Rodriguez, Rubio, Salas, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

NO VOTE RECORDED: Cristina Garcia, Melendez, Muratsuchi, Santiago, Steinorth

Prepared by:

8/18/18 14:22:38

**** END ****

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2017 - 2018 Regular Session

AB 2102 (Rodriguez) - State of emergency: out-of-state aid: reciprocity

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

Bill Summary:

Requires the Emergency Medical Services Authority (EMSA) to establish training standards and licensing reciprocity procedures for out-of-state paramedic personnel who are requested through the California Disaster and Civil Defense Master Mutual Aid Agreement to render aid on a temporary basis during a declared state of emergency pursuant to the California Emergency Services Act, as specified.

Fiscal Impact:

The Emergency Medical Services Authority estimates:

$143,0000 (General Fund) in fiscal year 2018-19 and $136,000 (General Fund) annually thereafter for one associate governmental program analyst to research mutual aid agreements, conduct rulemaking process, and monitor individuals on mutual aid requests.

Background: The Emergency Medical Services Authority (EMSA) is responsible for the coordination and integration of all state activities concerning emergency medical services (EMS), including the establishment of minimum standards, policies, and procedures, and oversight of the state’s 33 local EMS agencies (LEMSAs). The California Emergency Services Act is the body of law governing what happens during one of the three types of Governor-declared emergencies: a state of war emergency, a state of emergency, or a local emergency. The California Disaster and Civil Defense Master Mutual Aid Agreement (MMAA), referenced in this bill, is an agreement between the state, counties, cities and other political subdivisions, originally entered into in 1950, signed by Governor Earl Warren. According to the MMAA, in order to aid and assist each other in the event that a disaster should occur.

An out-of-state paramedic is permitted to temporarily practice in California on a mutual aid response, on routine patient transports from out of state into California, or during a special event, provided all of the following conditions are met:

• They possess a valid paramedic license or certificate issued by another state or country;
• They are approved by the medical director of the LEMSA to practice in the jurisdiction of that LEMSA;
• They utilize the scope of practice as defined by the jurisdiction with whom they are licensed or certified; and,
• They observe any limits placed on their scope of practice by the local medical director, should the local medical director exercise that option.

The current mutual aid intake process provides for tracking of out-of-state EMS personnel and allows LEMSAs to best appropriate the skills of those individuals to the needs within their system during an emergency. Upon arrival, EMS personnel deployed into California on a mutual aid request are rostered by the medical group supervisor who then faxes or communicates the completed list to the LEMSA where the incident is located. The roster includes the individual's name, certification/licensure level (EMT, Advanced EMT, and paramedic), certification/license number, and certification/license issuing agency. This identifies the individual, their license or certification, and associates them with a state licensing body. The LEMSA medical director then grants limited recognition to practice in that LEMSA's jurisdiction in California. Limited recognition is valid until the individual leaves the state or the LEMSA's jurisdiction. If the individual is deployed to another LEMSA's jurisdiction, the individual will go through the same rostering process to practice there.

Each of California’s 33 LEMSAs has a designated medical director. Current law imparts medical control and medical accountability to each LEMSA medical director. Therefore, the LEMSA medical director must be the one to grant the recognition.

Proposed Law:

Assembly Bill 2102 requires EMSA to establish training standards and licensing reciprocity procedures for out-of-state paramedic personnel who are requested through the California Disaster and Civil Defense Master Mutual Aid Agreement to render aid on a temporary basis during a declared state of emergency.

Related Legislation:

The Legislature has deliberated similar proposals, including:

• AB 2333 (Wood) establishes a behavioral health deputy director within the Office of Emergency Services to ensure individuals have access to necessary mental and behavioral health services and supports in the aftermath of a natural disaster or declaration of a state of emergency. AB 2233 is pending consideration in this committee.
• AB 2380 (Aguiar-Curry) requires the Governor’s Office of Emergency Services, in collaboration with the Department of Forestry and Fire Protection, to develop standards and regulations for any privately contracted private fire prevention resources operating in the state. AB 2233 is pending consideration in this committee.

Staff Comments:

Existing state regulations permit out-of-state paramedics, subject to LEMSA medical director approval, to provide mutual aid. According to the author, during the Thomas Fire, Cal Fire medical team leaders were subjected to an additional 20 hours of administrative work to ensure that the firefighter/paramedics from out-of-state could be cleared to use their medical training.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: AB 2102

SUBJECT: State of emergency: out-of-state aid: reciprocity

SUMMARY:

Requires the Emergency Medical Services Authority to establish training standards and licensing reciprocity procedures for out-of-state paramedic personnel who are requested through the California Disaster and Civil Defense Master Mutual Aid Agreement to render aid on a temporary basis during a declared state of emergency pursuant to the California Emergency Services Act, as specified.

Existing law:

1. Establishes the Emergency Medical Services Authority (EMSA), which is responsible for the coordination and integration of all state activities concerning emergency medical services (EMS), including the establishment of minimum standards, policies, and procedures. [HSC §1797.100, et seq.]
2. Authorizes counties to develop an EMS program and designate a local EMS agency (LEMSA) responsible for planning and implementing an EMS system, which includes day-to-day EMS system operations. [HSC §1797.200, et seq.]
3. Requires every LEMSA to have a licensed physician as medical director to provide medical control and to assure medical accountability throughout the planning, implementation, and evaluation of the EMS system. [HSC §1797.202]
4. Establishes an 18-member Commission on EMS, within the California Health and Human Services Agency. Defines the duties of the Commission to include reviewing regulations, standards, and guidelines developed by EMSA; advising EMSA on a data collection system; advise on emergency facilities and services, emergency communications, medical equipment, personnel training, and various aspects of the EMS system; and, to make recommendations for further development of the EMS system. [HSC §1799, et seq.]
5. Requires the Commission on EMS to review and approve regulations, standards and guidelines to be developed by EMSA for implementation of the EMS system and the Prehospital Emergency Medical Care Personnel Act. [HSC §1799.50]
6. Defines "Emergency Medical Technician-I" or "EMT-I" as an individual trained in all facets of basic life support, as specified. Defines an "Emergency Medical Technician-II," "EMT-II," "Advanced Emergency Medical Technician," or "Advanced EMT" as an EMT-I with additional training in limited advanced life support according to specified standards. Both EMT-Is and EMT-IIs are certified at the local level. [HSC §1797.80 and §1797.82]
7. Defines "Emergency Medical Technician-Paramedic," "EMT-P," "paramedic" or "mobile intensive care paramedic" as an individual whose scope of practice includes the ability to provide advanced life support, as specified, including administering specified medications. EMT-Ps are licensed and regulated at the state level through EMSA. [HSC §1797.84]
8. Establishes the California Emergency Services Act, which provides the Governor with broad powers to declare local and state emergencies, and to coordinate all emergency services functions for the mitigation of the effects of an emergency in California. [GOV §8550, et seq.]

This bill: Requires EMSA to establish training standards and licensing reciprocity procedures for out-of-state paramedic personnel who are requested through the California Disaster and Civil Defense Master Mutual Aid Agreement to render aid on a temporary basis during a declared state of emergency pursuant to the California Emergency Services Act, as specified.

FISCAL EFFECT:

According to the Assembly Appropriations Committee:

1. Staff costs in the range of $140,000 General Fund (GF) for one to two years to research mutual aid agreements and conduct the rulemaking process for training and reciprocity standards.
2. Ongoing GF costs for monitoring and enforcement are likely to be in a similar range if EMSA is required to monitor individuals arriving in California on mutual aid requests.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, in 2017, California experienced the largest documented wildfire in its history through Ventura and Santa Barbara Counties, spanning over 280,000 acres. This event, the Thomas Fire, destroyed over 1,000 structures, damaged another 280, injured two firefighters, and killed one firefighter and one civilian. This bill streamlines the process of recognizing out-of-state paramedic personnel who have been called into California to assist with disaster relief by tasking EMSA to establish uniform procedures to more easily recognize these out-of-state personnel to provide medical care.
2. EMS Personnel Mutual Aid Compendium. EMSA publishes the EMS Personnel Mutual Aid Compendium (Compendium) “to clarify the existing laws and regulations pertaining to when and under what conditions a paramedic, EMT, or Advanced EMT, whether licensed or certified inside or outside California, may legally function in their respective EMS classification during transport, mutual aid, and disasters in California.” According to the Compendium, the rules for out-of-state licensed or certified EMS personnel are the same regardless of whether for daily response and transport needs or in response to a declared disaster. An out-of-state paramedic is permitted to temporarily practice in California on a mutual aid response, on routine patient transports from out of state into California, or during a special event, provided all of the following conditions are met:
   1. They are in possession of a valid paramedic license or certificate issued by another state or country;
   2. They are approved by the medical director of the LEMSA to practice in the jurisdiction of that LEMSA;
   3. They utilize the scope of practice as defined by the jurisdiction with whom they are licensed or certified; and,
   4. They observe any limits placed on their scope of practice by the local medical director, should the local medical director exercise that option.

While this bill only applies to paramedics, the rule is similar for EMTs. There is no provision in statute or regulation for non-California Advanced EMTs to temporarily practice in California.

1. Current mutual aid process. According to EMSA, the current mutual aid intake process provides for tracking of out-of-state EMS personnel and allows LEMSAs to best appropriate the skills of those individuals to the needs within their system during an emergency. Upon arrival, EMS personnel deployed into California on a mutual aid request are rostered by the medical group supervisor who then faxes or communicates the completed list to the LEMSA where the incident is located. The roster includes the individual's name, certification/licensure level (EMT, Advanced EMT, and paramedic), certification/license number, and certification/license issuing agency. This identifies the individual, their license or certification, and associates them with a state licensing body. The LEMSA medical director then grants limited recognition to practice in that LEMSA's jurisdiction in California. Limited recognition is valid until the individual leaves the state or the LEMSA's jurisdiction. If the individual is deployed to another LEMSA's jurisdiction, the individual will go through the same rostering process to practice there. California is divided into 33 LEMSAs, each with a designated medical director. Current law grants the responsibility for medical control and medical accountability to each LEMSA medical director. Therefore, the LEMSA medical director must be the one to grant the recognition.
   
   According to the author, because each medical director can impose varying restrictions on the scope of practice of a paramedic who came from out-of-state, if the paramedic crosses a county line they will have to adjust to that county’s directions. The author argues that during the Thomas Fire, Cal Fire medical team leaders were subjected to an additional 20 hours of administrative work to ensure that the firefighter/paramedics from out-of-state could be cleared to use their medical training, and that more can be done to expedite this process.
2. Mutual aid within California. Unlike EMTs and Advanced EMTs, which are certified at the local level by LEMSAs, paramedics are licensed by EMSA. However, in addition to state licensure, paramedics are required to have “local accreditation” by a LEMSA in order to practice as a paramedic within that jurisdiction. During a mutual aid call, a California-licensed paramedic can practice anywhere in California if they are accredited by an LEMSA, and if they are affiliated with an EMS provider agency (such as a fire department or an ambulance company) that is approved by the LEMSA where they are accredited. They also have to stay within the scope of practice established by the LEMSA with whom they are accredited. In essence, the difference between mutual aid provided by an out-of-state paramedic, versus mutual aid provided by a paramedic from a different county in California, is that a California paramedic is affiliated with an EMS provider as their employer, which has also been approved by their LEMSA. It provides a second layer of oversight when traveling to other jurisdictions in the state. Without an in-state, LEMSA-approved provider, an out-of-state paramedic is forced to get approval from each individual LEMSA when traveling between jurisdictions in the state.
3. California Emergency Services Act and the Master Mutual Aid Agreement. The California Emergency Services Act is the body of law governing what happens during one of the three types of emergencies that can be declared by the Governor: a state of war emergency, a state of emergency, or a local emergency. Among the many powers at the Governor’s disposal during a state of emergency or a state of war emergency is the ability to suspend any statute or regulation where the Governor determines that strict compliance with any statute or regulation would in any way prevent, hinder, or delay the mitigation of the effects of the emergency.
   
   The California Disaster and Civil Defense Master Mutual Aid Agreement (MMAA), referenced in this bill, is an agreement between the state, counties, cities and other political subdivisions, originally entered into in 1950, signed by Governor Earl Warren. According to the MMAA, in order to aid and assist each other in the event that a disaster should occur, “it is necessary and desirable that a cooperative agreement be executed for the interchange of such mutual aid on a local, countywide, regional, statewide, and interstate basis.” The MMAA states that each party agrees to furnish resources and facilities and to render services to each and every other party to prevent and combat any type of disaster in accordance with duly adopted mutual aid operational plans. The MMA goes on to state that “it is expressly understood that when and as the State of California enters into mutual aid agreements with other states and the Federal Government, the parties to this agreement shall abide by such mutual aid agreements in accordance with the law.”
4. Related legislation. AB 2333 (Wood) establishes a behavioral health deputy director within the Office of Emergency Services to ensure individuals have access to necessary mental and behavioral health services and supports in the aftermath of a natural disaster or declaration of a state of emergency. AB 2333 is set for hearing on June 27, 2018 in this Committee.
   
   AB 2380 (Aguiar-Curry) requires the Governor’s Office of Emergency Services, in collaboration with the Department of Forestry and Fire Protection, to develop standards and regulations for any privately contracted private fire prevention resources operating in the state. AB 2380 is set for hearing on June 26, 2018 in the Senate Natural Resources and Water Committee.
5. Policy comment. This bill requires EMSA to develop “training standards and license reciprocity” for out-of-state paramedics who are providing mutual aid during an emergency. If the goal is to simplify the ability of a paramedic who is already licensed in another state to practice across various LEMSA jurisdictions during an emergency, developing “training standards” does not seem like the right approach. With regard to license reciprocity, there are already specific state regulations that permit out-of-state paramedics to provide mutual aid. As the author notes, because it is subject to approval by each LEMSA’s medical director, this can make it difficult to move quickly from one county to another, but a process does exist.

SUPPORT AND OPPOSITION:

Support: None received

Oppose: None received

-- END --

Date of Hearing: May 9, 2018

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 2102

Author:(Rodriguez) – As Amended Ver:March 23, 2018

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

SUMMARY:

This bill requires the Emergency Medical Services Authority (EMSA) to establish training standards and licensing reciprocity procedures for out-of-state fire and paramedic personnel who render aid in California on a temporary basis during a declared state of emergency.

FISCAL EFFECT:

1. Staff costs in the range of $140,000 GF for one to two years to research mutual aid agreements and conduct the rulemaking process for training and reciprocity standards.
2. Ongoing GF costs for monitoring and enforcement are likely to be in a similar range if EMSA is required to monitor individuals arriving in California on mutual aid requests.

COMMENTS:

1. Purpose. According to the author, this bill streamlines recognition for out-of-state fire and paramedic personnel by requiring EMSA to establish procedures to identify qualified personnel. This bill was inspired by shortcomings noted in the reciprocity process during recent wildfires.
2. Background. Mutual aid is the sharing of resources in which similar organizations assist each other during emergencies and day-to-day operations. Currently, upon arrival, EMS personnel deployed into California on a mutual aid request are approved at the local level. A local EMS agency (LEMSA) medical director grants limited recognition to practice in that LEMSA’s jurisdiction, which is valid until the individual leaves the state or the LEMSA's jurisdiction. If the individual is deployed to another LEMSA’s jurisdiction, the individual will go through the same rostering process to practice there. This bill would require EMSA to establish statewide standards.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 24, 2018

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2102

Author:(Rodriguez) – As Amended Ver:March 23, 2018

SUBJECT: State of emergency: out-of-state aid: reciprocity.

SUMMARY: Requires the Emergency Medical Services Authority (EMSA) to establish training standards and licensing reciprocity procedures for out-of-state fire and paramedic personnel who render aid in this state on a temporary basis during a declared state of emergency.

EXISTING LAW:

1. Establishes EMSA and grants EMSA the authority, utilizing regional and local information, to assess each emergency medical services (EMS) area for the purpose of determining the need for additional EMS services, coordination of EMS, and the effectiveness of EMS. Requires EMSA to develop planning and implementation guidelines for EMS systems which address the following components:
   1. Workforce and training;
   2. Communications;
   3. Transportation;
   4. Assessment of hospitals and critical care centers;
   5. System organization and management;
   6. Data collection and evaluation;
   7. Public information and education; and,
   8. Disaster response.
2. Requires EMSA to provide technical assistance to existing agencies, counties, and cities for the purpose of developing the components of EMS systems, and requires EMSA to adopt rules and regulations as may be reasonable and proper, and to enable EMSA to perform its duties.
3. Authorizes counties to develop EMS programs. Requires counties developing a program to designate a local EMS agency (LEMSA). Requires the LEMSA to be the county health department, an agency established and operated by the county, an entity with which the county contracts for the purposes of local EMS administration, or a joint powers agency created for the administration of EMS by agreement between counties or cities and counties.
4. Requires every LEMSA to have a full- or part-time licensed physician and surgeon as medical director, who has substantial experience in the practice of emergency medicine to provide medical control and to assure medical accountability throughout the planning, implementation and evaluation of the EMS system. Authorizes EMSA to waive this requirement if it places undue hardship on the county or counties.
5. Requires LEMSAs, using state minimum standards, to establish policies and procedures approved by the medical director of the LEMSA to assure medical control of the EMS system, and allows the policies and procedures approved by the medical director to require basic life support emergency medical transportation services to meet any medical control requirements including dispatch, patient destination policies, patient care guidelines, and quality assurance requirements.
6. Requires EMSA, in cooperation with the Office of Emergency Services (OES) to respond to any medical disaster by mobilizing and coordinating EMS mutual aid resources to mitigate health problems. Requires EMSA to coordinate, through LEMSAs, medical and hospital disaster preparedness with other local, state, and federal agencies and departments having a responsibility relating to disaster response, and to assist OES in the preparation of the EMS component of the State Emergency Plan.
7. Authorizes the EMSA Director and the State Public Health Officer to jointly appoint a regional disaster medical and health coordinator for each mutual aid region of the state. Requires a regional medical and health coordinator to be either a county health officer, a county coordination of emergency services, a LEMSA administrator, or a medical director of a LEMSA.
8. Authorizes, in the event of a major disaster which results in the proclamation of emergency by the Governor, and the need to deliver medical or public and environmental health mutual aid to the area affected by the disaster, a regional disaster medical and health coordinator in a region unaffected by the disaster to coordinate the acquisition of requested mutual aid resources from the jurisdictions in the region.

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

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, in 2017, California experienced the largest documented wildfire in its history throughout Ventura and Santa Barbara Counties, spanning over 280,000 acres. This event, the Thomas Fire, destroyed more than 1,000 structures, damaged another 280, injured two firefighters, and killed one firefighter and one civilian. The author states that this bill streamlines the process of recognizing out-of-state fire and paramedic personnel who have been called into the state to assist with disaster relief by requiring EMSA to establish procedures to more easily identify qualified out-of-state personnel to provide medical care.
2. BACKGROUND.
   1. State Emergency Plan. The State of California Emergency Plan (SEP) describes how response to natural or human-caused emergencies occurs in California. The SEP is a requirement of the California Emergency Services Act, and describes methods for conducting emergency operations, the process for rendering mutual aid, emergency services of government agencies, how resources are mobilized, how the public is informed, and how continuity of government is maintained during an emergency.
   2. Mutual aid/Reciprocity. In the event of an emergency or disaster, it is customary for nearby jurisdictions unaffected by the disaster to render aid. In general, mutual aid is the concept of resource sharing in which similar organizations assist each other during emergencies and day-to-day operations. EMSA's EMS Personnel Mutual Aid Compendium specifies that mutual aid includes the following:
      1. Auto/Instant Aid: includes agreements between two or more jurisdictions where the nearest available resource is dispatched to an emergency irrespective of jurisdictional boundaries or where two or more agencies are automatically dispatched simultaneously to predetermined types of emergencies. This type of mutual aid agreement is typically utilized on a day-to-day basis;
      2. Mutual Aid: includes agreements between two or more jurisdictions to provide assistance across jurisdictional boundaries, when requested, as a result of the circumstances of an emergency exceeding local resources; and,
      3. Disaster Assistance: which is similar to mutual aid but are requests for assistance in the event that a disaster overwhelms local resources. These requests may be under existing mutual aid agreements or the result of unforeseen needs arising from a particularly large-scale disaster.
   3. Scope of practice during mutual aid. The rules for California licensed/certified EMS personnel are the same regardless of whether the duties involve daily response and transport needs (including auto/instant aid, mutual aide, inter-facility transport and aero-medical transport) or in response to a declared disaster or major wildfire. Paramedics and advanced emergency medical technicians (EMTs) are authorized to utilize their approved scope of practice anywhere in California during a mutual aid call provided they have a valid license or certificate, are accredited by a LEMSA, are affiliated with an advanced life support provider that is approved by the LEMSA with whom they are accredited, and that they utilized the scope of practice as defined by the policies and procedures of the LEMSA with whom they are accredited, which for paramedics also includes an "Out-of-County Response" Policy.

An out-of-state paramedic may temporarily practice in California provided all of the following conditions are met:

• • 1. They are in possession of a valid paramedic license/certificate issued by another state or country;
    2. They are approved by the medical director of the LEMSA to practice in jurisdiction of the LEMSA;
    3. They may utilize the scope of practice as defined by the jurisdiction with whom they are licensed/certified; and,
    4. They will observe any limits placed on their scope of practice by the LEMSA director, should the local medical director exercise that option.

There is no requirement for an out-of-state paramedic to be affiliated with an approved advanced life support provider. Additionally, there is no provision in either statute or regulations for non-California Advanced EMTs to temporarily practice in California. Out-of-state EMTs may temporarily practice in California if all of the following conditions are met:

• • 1. They are either a Nationally Registered EMT or are in possession of a valid EMT license/certificate issues by any branch of the Armed forces, the National Park Service, the Bureau of Land Management, or the U.S. Forest Service;
    2. They are approved by the medical director of the LEMSA to practice in the jurisdiction of the LEMSA;
    3. They may utilize the scope of practice defined by the jurisdiction with whom they are licensed/certified; and,
    4. They will observe any limits placed on their scope of practice by the local medical director, should the local medical director exercise that option.

This existing process for granting temporary recognition of out-of-state paramedic personnel during times of mutual aid ensures that these paramedics are properly certified, and oriented to local resources, such as trauma centers, and operate in accordance with and under the medical control of the LEMSA medical director.

1. RELATED LEGISLATION.
   1. AB 2333 (Wood) establishes a behavioral health deputy director within the Office of Emergency Services to ensure individuals have access to necessary mental and behavioral health services and supports in the aftermath of a natural disaster or declaration of a state of emergency. AB 2333 is pending a hearing in the Assembly Health Committee.
   2. AB 2380 (Aguiar-Curry) requires the Governor’s Office of Emergency Services (Cal OES), in collaboration with the Department of Forestry and Fire Protection (Cal FIRE), to develop standards and regulations for any privately contracted private fire prevention resources (private fire resource) operating in the state. AB 2380 is pending a hearing in the Assembly Natural Resources Committee.
2. PREVIOUS LEGISLATION. AB 2917 (Torrico), Chapter 274, Statutes of 2007, requires EMSA to establish a statewide EMT registry and to develop standards, guidelines, and regulations for certification of specified EMTs. AB 2917 also establishes rules for EMT certification and discipline and for investigation of any conduct which threatens public health and safety, as defined.
3. POLICY COMMENT. As currently drafted this bill does not appear to be necessary because LEMSAs already have an existing process to allow out-of-state paramedics to practice in California during times of mutual aid, which was developed in collaboration with EMSA.

REGISTERED SUPPORT / OPPOSITION:

Support
None on file.

Opposition
None on file.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097