CONSENT  

Bill No: AB 379

Author: Maienschein (D), et al.

Amended: 4/1/19 in Assembly

Vote: 21

SENATE HEALTH COMMITTEE: 8-0, 7/10/19

AYES: Pan, Stone, Lena Gonzalez, Hurtado, Leyva, Mitchell, Monning, Rubio

NO VOTE RECORDED: Grove

ASSEMBLY FLOOR: 77-0, 5/2/19 - See last page for vote

SUBJECT: Youth athletics: concussion and sudden cardiac arrest prevention protocols

SOURCE: California Athletic Trainers Association

Eric Paredes Save a Life Foundation

DIGEST:

1. This bill adds “an athlete who has passed out or fainted” to existing law that prohibits an athlete from returning to athletic activity until being evaluated and cleared by a health care provider. Requires the athlete, if the health care provider suspects that the athlete has a cardiac condition that puts the athlete at risk for sudden cardiac arrest or other heart-related issues, to remain under the care of the healthcare provider to pursue followup testing until the athlete is cleared to play.

ANALYSIS:

Existing law:

1. Requires youth sports organizations to immediately remove an athlete, who is suspected of sustaining a concussion or other head injury, from an athletic activity for the remainder of the day. Prohibits the athlete from being permitted to return to any athletic activity until he or she is evaluated by a licensed health care provider and receives written clearance to return to athletic activity. Requires the athlete, if the health care provider determines that the athlete sustained a concussion or other head injury, to complete a graduated return-to-play protocol of at least seven days in duration under the supervision of a health care provider. [HSC §124235(a)(1)]
2. Requires youth sports organizations, if an athlete who is 17 years of age or younger has been removed from athletic activity due to a suspected concussion, to notify the athlete’s parent or guardian of the time and date of the injury, the symptoms observed, and any treatment provided for the injury. [HSC §124235(a)(2)]
3. Requires youth sports organizations, on a yearly basis, to give a concussion and head injury information sheet to each athlete. Requires the information sheet to be signed and returned by the athlete and, if the athlete is 17 years or younger, also be signed by the athlete’s parent or guardian, before the athlete initiates practice or competition. [HSC §124235(a)(3)]
4. Requires youth sports organizations to offer concussion and head injury education, or related educational materials, or both, to each of its coaches and administrators on a yearly basis. Requires coaches and administrators to be required to successfully complete the concussion and head injury education at least once, either online or in person, before supervising an athlete in an activity of the youth sports organization. [HSC §124235(a)(4)]
5. Defines “youth sports organization” to mean an organization, business, nonprofit entity, or a local governmental agency that sponsors or conducts amateur sports competitions, training, camps, or clubs in which persons 17 years of age or younger participate in: baseball; basketball; bicycle motocross (BMX); boxing; competitive cheerleading; diving; equestrian activities; field hockey; football; full contact martial arts; gymnastics; ice hockey; lacrosse; parkour; rodeo; roller derby; rugby; skateboarding; skiing; soccer; softball; surfing; swimming; synchronized swimming; volleyball; water polo; or, wrestling. [HSC §124235(b)(4)]

This bill:

1. Adds “an athlete who has passed out or fainted” to existing law that prohibits an athlete from returning to athletic activity until being evaluated and cleared by a health care provider. Requires the athlete, if the health care provider suspects that the athlete has a cardiac condition that puts the athlete at risk for sudden cardiac arrest (SCA) or other heart-related issues, to remain under the care of the healthcare provider to pursue followup testing until the athlete is cleared to play.
2. Adds an athlete who is 17 years of age or younger and has been removed from athletic activity due to fainting or another suspected cardiac condition, to the parent notification requirements in 2) of existing law above. Requires, if the athlete is six years of age or younger, only the signature of the athlete’s parent or guardian to be required on the notification forms for concussions and cardiac conditions. Requires, if the athlete is 18 years of age or older, only the signature of the athlete to be required on the notification forms for both conditions.
3. Adds “sudden cardiac arrest prevention” to existing law containing coach and administrator education requirements. Places these education requirements on referees, umpires, or other game officials. Requires youth sports organizations to post education information online, or to provide educational materials to athletes and parents, or both.
4. Requires “sudden cardiac arrest prevention education and educational materials” and a “sudden cardiac arrest information sheet” to include, at a minimum, information relating to:
   1. Cardiac conditions and their potential consequences;
   2. The signs and symptoms of SCA;
   3. Best practices for removal of an athlete from an athletic activity after fainting or a suspected cardiac condition is observed;
   4. Steps for returning an athlete to an athletic activity after the athlete faints or experiences a cardiac condition; and,
   5. What to do in the event of a cardiac emergency: including calling 911, performing hands-only cardiopulmonary resuscitation (CPR), and using an automated external defibrillator (AED) if it is available.
5. Deletes references to the 27 specific sports in the definition of “youth sports organization.” Makes other technical, clarifying changes.

Comments

1. Author’s statement. According to the author, the statistics around SCA in youth are astounding. SCA is the number one killer of student athletes and contributes to the number two medical cause of death among youth under 25. The National Center for Catastrophic Sport Injury Research stated that more athletes die from a cardiac arrest than from incurring injuries while playing sports. One in 300 youth has an undetected condition that puts them at risk. The American Heart Association has reported up to 16,000 youth stricken annually. An American Board of Family Medicine Study noted that 72% of youth who suffered from SCA were reported by their parents to have had at least one symptom before the event—they just didn’t recognize it as life threatening. Once SCA strikes, survival is less than 10% because bystanders are not prepared to respond to a cardiac emergency, which is critical given every minute delayed in treating an SCA victim decreases their chance of survival by 10%, and the average for emergency medical services to arrive on scene is seven to 14 minutes. Given the precedent set by current law mandating concussion protocol in both school and community sports programs, although SCA is the number one killer of student athletes, this bill pays necessary attention to a missing standard in youth sports safety.
2. SCA. According to the National Heart, Blood, and Lung Institute, SCA is a condition in which the heart suddenly and unexpectedly stops beating, and usually causes death if it's not treated within minutes. SCA is not the same as a heart attack. A heart attack is when blood flow to the heart is blocked, and SCA is when the heart malfunctions and suddenly stops beating unexpectedly. A heart attack is a “circulation” problem and sudden cardiac arrest is an “electrical” problem. However, SCA can happen after or during recovery from a heart attack. Ventricular fibrillation (v-fib), a type of arrhythmia, causes most SCAs. During v-fib, the heart's lower chambers don't beat normally, and instead quiver very rapidly and irregularly and little or no blood is pumped to the body. Other problems with the heart's electrical system can also cause SCA. For example, SCA can occur if the rate of the heart's electrical signals becomes very slow and stops. SCA also can occur if the heart muscle doesn't respond to the heart's electrical signals. Coronary heart disease or coronary artery disease; severe physical stress; certain inherited disorders; and structural changes in the heart can also cause SCA.
3. SCA in athletes. According to the American College of Cardiology (ACC), when playing sports, an athlete’s heart is working faster and pumping harder. Adrenaline is pumped throughout the body, and the heart needs more oxygen than normal. Dehydration, fever or changes in electrolytes can also play a part. In people whose hearts are not normal to begin with, these extra stresses can sometimes trigger the electrical system of the heart and cause SCA. While rare, SCA is the leading medical cause of death in young athletes. ACC states that warning signs during exercise include passing out, dizziness, chest pain, shortness of breath, and seizures. According to a study published in December 2017, a loss of consciousness in athletes during sports activity is usually not immediately recognized as SCA and time is wasted by checking breathing and body movement. Immediate CPR and defibrillation with an AED should be initiated if an athlete is experiencing SCA. Without defibrillation, the probability of surviving declines by 10% per minute.

Related/Prior Legislation

AB 2007 (McCarty, Chapter 516, Statutes of 2016) established requirements for youth sports organizations to remove an athlete who is suspected of sustaining a concussion or other head injury until he or she is evaluated and cleared by a licensed health care provider.

FISCAL EFFECT: Appropriation: No Fiscal Com.: No Local: No

SUPPORT: (Verified 7/16/19)

California Athletic Trainers Association (co-source)

Eric Paredes Save a Life Foundation (co-source)

American Academy of Pediatrics, California

Association of California School Administrators

Bear Valley Middle School

Boys and Girls Club of San Dieguito

California Association for Health, Physical Education, Recreation & Dance

California Orthopaedic Association

California State PTA

Cardiac Science Corporation

Children’s Cardiomyopathy Foundation

City of Culver City

City of San Diego

Consumers Attorneys of California

County of San Diego Second District Supervisor, Dianne Jacob

Coyote Valley Band of Pomo Indians

Habematolel Pomo of Upper Lake

Heartbeat of Champions Foundation

Institute for Public Health

LA Galaxy San Diego

Los Angeles Mayor, Eric Garcetti

Los Angeles Unified School District

Mechoopda Indian Tribe of Chico Rancheria

Olivia’s Heart Project

Parent Heart Watch

Revive Solutions Inc.

San Diego State University, Institute of Public Health

Saving Hearts Foundation

Sudden Cardiac Arrest Association – San Diego

Sudden Cardiac Arrest Foundation

Travis R. Roy Sudden Cardiac Arrest Fund

Via Heart Project

Four Individuals

OPPOSITION: (Verified 7/16/19)

None received

ARGUMENTS IN SUPPORT: Supporters write that SCA has emerged as a recurring cause of death among people under age 25. According to the American Heart Association, SCA affects between 7,000 to 16,000 youth per year. In fact, studies show that 1 in 300 youth has an undetected heart condition. Many children and their parents are unaware they have a potentially fatal heart abnormality until it is too late. In fact, 72% of those who suffered an SCA were reported to experience prior symptoms but did not recognize them as life threatening. The National Center for Catastrophic Sport Injury Research cites that more athletes die from sudden cardiac arrest than from any other sport-related trauma. Further, coaches, parents, referees and players are oftentimes unprepared to act when SCA strikes. It is vital for an SCA victim to be in the presence of people who are prepared to respond to a cardiac emergency because 92% of SCA victims will die if not treated within minutes. Knowing the Cardiac Chain of Survival—call 911, start hands-only CPR, use the nearest AED—can mean the difference between life and death.

ASSEMBLY FLOOR: 77-0, 5/2/19

AYES: Aguiar-Curry, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

NO VOTE RECORDED: Arambula, Mullin, Quirk

Prepared by: Melanie Moreno / HEALTH / (916) 651-4111

8/9/19 9:20:05

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: AB 379

SUBJECT: Youth athletics: concussion and sudden cardiac arrest prevention protocols

SUMMARY:

1. Adds “an athlete who has passed out or fainted” to existing law that prohibits an athlete from returning to athletic activity until being evaluated and cleared by a health care provider. Requires the athlete, if the health care provider suspects that the athlete has a cardiac condition that puts the athlete at risk for sudden cardiac arrest or other heart-related issues, to remain under the care of the healthcare provider to pursue follow up testing until the athlete is cleared to play.

Existing law:

1. Requires youth sports organizations to immediately remove an athlete, who is suspected of sustaining a concussion or other head injury, from an athletic activity for the remainder of the day. Prohibits the athlete from being permitted to return to any athletic activity until he or she is evaluated by a licensed health care provider and receives written clearance to return to athletic activity. Requires the athlete, if the health care provider determines that the athlete sustained a concussion or other head injury, to complete a graduated return-to-play protocol of at least seven days in duration under the supervision of a health care provider. [HSC §124235(a)(1)]
2. Requires youth sports organizations, if an athlete who is 17 years of age or younger has been removed from athletic activity due to a suspected concussion, to notify the athlete’s parent or guardian of the time and date of the injury, the symptoms observed, and any treatment provided for the injury. [HSC §124235(a)(2)]
3. Requires youth sports organizations, on a yearly basis, to give a concussion and head injury information sheet to each athlete. Requires the information sheet to be signed and returned by the athlete and, if the athlete is 17 years or younger, also be signed by the athlete’s parent or guardian, before the athlete initiates practice or competition. [HSC §124235(a)(3)]
4. Requires youth sports organizations to offer concussion and head injury education, or related educational materials, or both, to each of its coaches and administrators on a yearly basis. Requires coaches and administrators to be required to successfully complete the concussion and head injury education at least once, either online or in person, before supervising an athlete in an activity of the youth sports organization. [HSC §124235(a)(4)]
5. Defines “youth sports organization” to mean an organization, business, nonprofit entity, or a local governmental agency that sponsors or conducts amateur sports competitions, training, camps, or clubs in which persons 17 years of age or younger participate in: baseball; basketball; bicycle motocross (BMX); boxing; competitive cheerleading; diving; equestrian activities; field hockey; football; full contact martial arts; gymnastics; ice hockey; lacrosse; parkour; rodeo; roller derby; rugby; skateboarding; skiing; soccer; softball; surfing; swimming; synchronized swimming; volleyball; water polo; or, wrestling. [HSC §124235(b)(4)]

This bill:

1. Adds “an athlete who has passed out or fainted” to existing law that prohibits an athlete from returning to athletic activity until being evaluated and cleared by a health care provider. Requires the athlete, if the health care provider suspects that the athlete has a cardiac condition that puts the athlete at risk for sudden cardiac arrest (SCA) or other heart-related issues, to remain under the care of the healthcare provider to pursue followup testing until the athlete is cleared to play.
2. Adds an athlete who is 17 years of age or younger and has been removed from athletic activity due to fainting or another suspected cardiac condition, to the parent notification requirements in 2) of existing law above. Requires, if the athlete is six years of age or younger, only the signature of the athlete’s parent or guardian to be required on the notification forms for concussions and cardiac conditions. Requires, if the athlete is 18 years of age or older, only the signature of the athlete to be required on the notification forms for both conditions.
3. Adds “sudden cardiac arrest prevention” to existing law containing coach and administrator education requirements. Places these education requirements on referees, umpires, or other game officials. Requires youth sports organizations to post education information online, or to provide educational materials to athletes and parents, or both.
4. Requires “sudden cardiac arrest prevention education and educational materials” and a “sudden cardiac arrest information sheet” to include, at a minimum, information relating to:
   1. Cardiac conditions and their potential consequences;
   2. The signs and symptoms of SCA;
   3. Best practices for removal of an athlete from an athletic activity after fainting or a suspected cardiac condition is observed;
   4. Steps for returning an athlete to an athletic activity after the athlete faints or experiences a cardiac condition; and,
   5. What to do in the event of a cardiac emergency: including calling 911, performing hands-only CPR, and using an automated external defibrillator (AED) if it is available.
5. Deletes references to the 27 specific sports in the definition of “youth sports organization.” Makes other technical, clarifying changes.

FISCAL EFFECT:

This bill is keyed non-fiscal.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, the statistics around SCA in youth are astounding. SCA is the number one killer of student athletes and contributes to the number two medical cause of death among youth under 25. The National Center for Catastrophic Sport Injury Research stated that more athletes die from a cardiac arrest than from incurring injuries while playing sports. One in 300 youth has an undetected condition that puts them at risk. The American Heart Association has reported up to 16,000 youth stricken annually. An American Board of Family Medicine Study noted that 72% of youth who suffered from SCA were reported by their parents to have had at least one symptom before the event—they just didn’t recognize it as life threatening. Once SCA strikes, survival is less than 10% because bystanders are not prepared to respond to a cardiac emergency, which is critical given every minute delayed in treating an SCA victim decreases their chance of survival by 10%, and the average for EMS to arrive on scene is seven to 14 minutes. Given the precedent set by current law mandating concussion protocol in both school and community sports programs, although SCA is the number one killer of student athletes, this bill pays necessary attention to a missing standard in youth sports safety.
2. Background. According to the National Heart, Blood, and Lung Institute, SCA is a condition in which the heart suddenly and unexpectedly stops beating, and usually causes death if it's not treated within minutes. SCA is not the same as a heart attack. A heart attack is when blood flow to the heart is blocked, and SCA is when the heart malfunctions and suddenly stops beating unexpectedly. A heart attack is a “circulation” problem and sudden cardiac arrest is an “electrical” problem. However, SCA can happen after or during recovery from a heart attack. Ventricular fibrillation (v-fib), a type of arrhythmia, causes most SCAs. During v-fib, the heart's lower chambers don't beat normally, and instead quiver very rapidly and irregularly and little or no blood is pumped to the body. Other problems with the heart's electrical system can also cause SCA. For example, SCA can occur if the rate of the heart's electrical signals becomes very slow and stops. SCA also can occur if the heart muscle doesn't respond to the heart's electrical signals. Coronary heart disease or coronary artery disease; severe physical stress; certain inherited disorders; and structural changes in the heart can also cause SCA.
3. SCA in athletes. According to the American College of Cardiology (ACC), when playing sports, an athlete’s heart is working faster and pumping harder. Adrenaline is pumped throughout the body, and the heart needs more oxygen than normal. Dehydration, fever or changes in electrolytes can also play a part. In people whose hearts are not normal to begin with, these extra stresses can sometimes trigger the electrical system of the heart and cause SCA. While rare, SCA is the leading medical cause of death in young athletes. ACC states that warning signs during exercise include passing out, dizziness, chest pain, shortness of breath, and seizures. According to a study published in December 2017, a loss of consciousness in athletes during sports activity is usually not immediately recognized as SCA and time is wasted by checking breathing and body movement. Immediate cardiopulmonary resuscitation (CPR) and defibrillation with an AED should be initiated if an athlete is experiencing SCA. Without defibrillation, the probability of surviving declines by 10% per minute.
4. Related legislation. AB 1 (Cooper) establishes certain requirements on youth football, including limiting full-contact practices to 30 minutes per day, and no more than two days per week, and requires an emergency medical technician or higher-level medical professional to be present during all games, and one independent non-rostered individual to be present at all practice locations with the authority to evaluate and remove any youth tackle football participant from practice who exhibits an injury. AB 1 passed by a vote of 9-0 when it was heard in this Committee on June 27, 2019.
5. Prior legislation. AB 2007 (McCarty Chapter 516, Statutes of 2016) establishes requirements for youth sports organizations to remove an athlete who is suspected of sustaining a concussion or other head injury until he or she is evaluated and cleared by a licensed health care provider.
6. Support. Supporters write that SCA has emerged as a recurring cause of death among people under age 25. According to the American Heart Association, SCA affects between 7,000 to 16,000 youth per year. In fact, studies show that 1 in 300 youth has an undetected heart condition. Many children and their parents are unaware they have a potentially fatal heart abnormality until it is too late. In fact, 72% of those who suffered an SCA were reported to experience prior symptoms but did not recognize them as life threatening. The National Center for Catastrophic Sport Injury Research cites that more athletes die from sudden cardiac arrest than from any other sport-related trauma. Further, coaches, parents, referees and players are oftentimes unprepared to act when SCA strikes. It is vital for an SCA victim to be in the presence of people who are prepared to respond to a cardiac emergency because 92% of SCA victims will die if not treated within minutes. Knowing the Cardiac Chain of Survival—call 911, start hands-only CPR, use the nearest AED—can mean the difference between life and death.

SUPPORT AND OPPOSITION:

Support: California Athletic Trainers Association (co-sponsor)

Eric Paredes Save a Life Foundation (co-sponsor)

American Academy of Pediatrics, California

Association of California School Administrators

Bear Valley Middle School

Boys and Girls Club of San Dieguito

California Association for Health, Physical Education, Recreation & Dance

California Orthopaedic Association

California State PTA

Cardiac Science Corporation

Children’s Cardiomyopathy Foundation

City of Culver City

City of San Diego

Consumers Attorneys of California

County of San Diego Second District Supervisor, Dianne Jacob

Coyote Valley Band of Pomo Indians

Habematolel Pomo of Upper Lake

Heartbeat of Champions Foundation

Institute for Public Health

LA Galaxy San Diego

Los Angeles Mayor, Eric Garcetti

Los Angeles Unified School District

Mechoopda Indian Tribe of Chico Rancheria

Olivia’s Heart Project

Parent Heart Watch

Revive Solutions Inc.

San Diego State University, Institute of Public Health

Saving Hearts Foundation

Sudden Cardiac Arrest Association – San Diego

Sudden Cardiac Arrest Foundation

Travis R. Roy Sudden Cardiac Arrest Fund

Via Heart Project

Four Individuals

Oppose: None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 379

Author:(Maienschein)

As Amended Ver:April 1, 2019

Majority vote

SUMMARY:

The bill would add similar protocols relating to sudden cardiac arrest prevention to the concussion protocols imposed on youth sports organizations under existing law, and would delete designation of 27 covered sports from the definition of youth sports organization for purposes of this provision, thus expanding the scope of covered youth sports organizations.

Major Provisions

States that an athlete who is suspected of sustaining a concussion or other head injury, or who has passed out or fainted, in an athletic activity shall be immediately removed from the athletic activity for the remainder of the day, and shall not be permitted to return to any athletic activity until the athlete is evaluated by a licensed healthcare provider.

Further provides that the athlete shall not be permitted to return to athletic activity until the athlete receives written clearance to return to athletic activity from a licensed healthcare provider, as specified.

Requires, on a yearly basis, the youth sports organization shall give both a concussion and head injury and a sudden cardiac arrest information sheet to each athlete, as provided.

Provides that on a yearly basis, the youth sports organization shall offer and specified personnel shall complete, concussion and head injury and sudden cardiac arrest prevention education, or related educational materials, or both, to each coach, administrator, and referee, umpire, or other game official of the youth sports organization, as specified.

Expands the definition of "Licensed healthcare provider" to include a licensed healthcare provider who is trained in the evaluation and management of cardiac conditions and is acting within the scope of that provider's practice for evaluation and management of sudden cardiac arrest, fainting, and shortness of breath.

Defines "Youth sports organization" to mean an organization, business, nonprofit entity, or a local governmental agency that sponsors or conducts amateur sports competitions, training, camps, or clubs in which persons 17 years of age or younger participate and deletes the list of sports covered under current law.

COMMENTS:

Please see the policy committee analysis for a full discussion of the measure.

According to the Author:

According to the Author, "The statistics around Sudden Cardiac Arrest (SCA) in youth are astounding. SCA is the number one killer of student athletes and contributes to the number two medical cause of death among youth under 25. The National Center for Catastrophic Sport Injury Research stated that more athletes die from a cardiac arrest than from incurring injuries while playing sports. One in 300 youth has an undetected condition that puts them at risk. The American Heart Association has reported up to 16,000 youth stricken annually. An American Board of Family Medicine Study noted that 72% of youth who suffered from SCA were reported by their parents to have had at least one symptom before the event—they just didn't recognize it as life threatening. Once SCA strikes, survival is less than 10% because bystanders are not prepared to respond to a cardiac emergency, which is critical given every minute delayed in treating an SCA victim decreases their change of survival by 10%, and the average for [Emergency Medical Services] to arrive on scene is seven to 14 minutes."

Arguments in Support:

The Sudden Cardiac Arrest Foundation note, "Current law and regulations require youth sports organizations to remove an athlete from an athletic activity who is suspected of sustaining a concussion or head injury. Parents and youth annually review information about the dangers of concussion and head injury, and coaches complete a concussion and head injury course. AB 379 would require the same protocols used for concussions in youth and high school sports to be used when a youth or high school athlete appears to be suffering from SCA related symptoms."

Arguments in Opposition:

There is no opposition on file.

FISCAL COMMENTS:

This bill is keyed non-fiscal by the Legislative Counsel.

VOTES:

ASM ARTS, ENTERTAINMENT, SPORTS, TOURISM, AND INTERNET MEDIA: 7-0-0

YES: Chu, Diep, Chiu, Choi, Friedman, Kamlager-Dove, Nazarian

UPDATED:

VERSION: April 1, 2019

CONSULTANT: Dana Mitchell / A.,E.,S.,T., & I.M. / (916) 319-3450 FN: 0000239

Date of Hearing: April 23, 2019

ASSEMBLY COMMITTEE ON ARTS, ENTERTAINMENT, SPORTS, TOURISM, AND INTERNET MEDIA

Kansen Chu, Chair

ABPCA Bill Id:AB 379 (

Author:Maienschein) – As Amended Ver:April 1, 2019

SUBJECT: Youth athletics: concussion and sudden cardiac arrest prevention protocols.

SUMMARY: The bill would add similar protocols relating to sudden cardiac arrest prevention to the concussion protocols imposed on youth sports organizations under existing law, and would delete designation of 27 covered sports from the definition of youth sports organization for purposes of this provision, thus expanding the scope of covered youth sports organizations.

Specifically, this bill:

1. States that an athlete who is suspected of sustaining a concussion or other head injury, or who has passed out or fainted, in an athletic activity shall be immediately removed from the athletic activity for the remainder of the day, and shall not be permitted to return to any athletic activity until the athlete is evaluated by a licensed healthcare provider.
2. Further provides that the athlete shall not be permitted to return to athletic activity until the athlete receives written clearance to return to athletic activity from a licensed healthcare provider.
   1. If the licensed healthcare provider determines that the athlete sustained a concussion or other head injury, the athlete shall also complete a graduated return-to-play protocol of no less than seven days in duration under the supervision of a licensed healthcare provider.
   2. If the licensed healthcare provider suspects that the athlete has a cardiac condition that puts the athlete at risk for sudden cardiac arrest or other heart-related issues, the athlete shall remain under the care of the licensed healthcare provider to pursue follow up testing until the athlete is cleared to play.
3. Requires, on a yearly basis, the youth sports organization shall give both a concussion and head injury and a sudden cardiac arrest information sheet to each athlete. The information sheet shall be signed and returned by the athlete and, if the athlete is 17 years of age or younger, shall also be signed by the athlete’s parent or guardian, before the athlete initiates practice or competition, except athletes under six years of age who need not sign in addition to their parents.
4. Provides that on a yearly basis, the youth sports organization shall offer concussion and head injury and sudden cardiac arrest prevention education, or related educational materials, or both, to each coach, administrator, and referee, umpire, or other game official of the youth sports organization.
5. Additionally provides that the youth sports organization shall require each coach, administrator, and referee, umpire, or other game official of the youth sports organization to successfully complete the concussion and head injury and sudden cardiac arrest prevention education, as specified, at least once, either online or in person, before supervising an athlete in an activity of the youth sports organization, and post related information, as specified, or provide educational materials to athletes and parents, or both.
6. In addition the youth sports organization shall identify procedures to ensure compliance with the requirements for providing concussion and head injury and sudden cardiac arrest prevention education and a concussion and head injury and sudden cardiac arrest prevention information sheet, as specified.
7. Expands the definition of “Licensed healthcare provider” to mean either of the following:
   1. A licensed healthcare provider who is trained in the evaluation and management of concussions and is acting within the scope of the provider’s practice for evaluation and management of concussions or other head injuries.
   2. A licensed healthcare provider who is trained in the evaluation and management of cardiac conditions and is acting within the scope of that provider’s practice for evaluation and management of sudden cardiac arrest, fainting, and shortness of breath.
8. Declares “Sudden cardiac arrest prevention education and educational materials” and a “sudden cardiac arrest information sheet” shall, at a minimum, include information relating to all of the following:
   1. Cardiac conditions and their potential consequences.
   2. The signs and symptoms of sudden cardiac arrest.
   3. Best practices for removal of an athlete from an athletic activity after fainting or a suspected cardiac condition is observed.
   4. Steps for returning an athlete to an athletic activity after the athlete faints or experiences a cardiac condition.
   5. What to do in the event of a cardiac emergency: this shall include calling 911, performing hands-only CPR, and using an automated external defibrillator (AED) if it is available.
9. Defines “Youth sports organization” to mean an organization, business, nonprofit entity, or a local governmental agency that sponsors or conducts amateur sports competitions, training, camps, or clubs in which persons 17 years of age or younger participate and deletes the list of sports covered under current law.
10. Contains technical and conforming provisions.

EXISTING LAW:

Requires a youth sports organization that elects to offer an athletic program to comply with all of the following:

1. Require an athlete who is suspected of sustaining a concussion or other head injury in an athletic activity to be immediately removed from the athletic activity for the remainder of the day, and not permitted to return to any athletic activity until he or she is evaluated by a licensed health care provider;
2. Prohibit the athlete from returning to athletic activity until he or she receives written clearance to return to athletic activity from a licensed health care provider;
3. Require, if the licensed health care provider determines that the athlete sustained a concussion or other head injury, the athlete to 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;
4. Require if an athlete who is 17 years of age or younger has been removed from athletic activity due to a suspected concussion, the youth sports organization to notify a parent or guardian of that athlete of the time and date of the injury, the symptoms observed, and any treatment provided to that athlete for the injury;
5. Require on a yearly basis, the youth sports organization to give a concussion and head injury information sheet to each athlete;
6. Require the information sheet to be signed and returned by the athlete and, if the athlete is 17 years of age or younger, to also be signed by the athlete’s parent or guardian, before the athlete initiates practice or competition;
7. Permit the information sheet to be sent and returned through an electronic medium including, but not necessarily limited to, fax or electronic mail;
8. Require each coach and administrator to be required to successfully complete the concussion and head injury education offered at least once, either online or in person, before supervising an athlete in an activity of the youth sports organization;
9. Require on a yearly basis, the youth sports organization to offer concussion and head injury education, or related educational materials, or both, to each coach and administrator of the youth sports organization; and,
10. Require the youth sports organization to identify both of the following:
    1. An individual within the organization who is responsible for ensuring compliance by the organization with the requirements for providing concussion and head injury education contained in paragraph 8 above; and,
    2. Procedures to ensure compliance with the athlete removal provisions and the return-to-play protocol required pursuant to paragraphs 1-3 above.
11. Establishes definitions including that a “youth sports organization” means an organization, business, nonprofit entity, or a local governmental agency that sponsors or conducts amateur sports competitions, training, camps, or clubs in which persons 17 years of age or younger participate in any of the following sports:

Baseball; Basketball; Bicycle motocross; Boxing; Competitive cheerleading; Full Contact Martial Arts; Diving; Equestrian activities; Field hockey; Football; Gymnastics; Ice hockey; Lacrosse; Parkour; Rodeo; Roller derby; Rugby; Skateboarding; Skiing; Soccer; Softball; Surfing; Volleyball; Water polo; and, Wrestling.

1. Defines “licensed health care provider” as a licensed health care provider who is trained in the evaluation and management of concussions and is acting within the scope of his or her practice.
2. Requires this bill to apply to all persons participating in the activities of a youth sports organization, irrespective of their ages. Prohibits anything in this bill from being construed to prohibit a youth sports organization, or any other appropriate entity, from adopting and enforcing rules intended to provide a higher standard of safety for athletes than the standard established under this bill.

FISCAL EFFECT: This bill has been keyed as non-fiscal by the Legislative Counsel.

COMMENTS:

1. Author and supporters stated need for legislation: recreational sports account for the majority of youth athletics and are deserving of SCA health and safety protection. According to the Author, “The statistics around Sudden Cardiac Arrest (SCA) in youth are astounding. SCA is the number one killer of student athletes and contributes to the number two medical cause of death among youth under 25. The National Center for Catastrophic Sport Injury Research stated that more athletes die from a cardiac arrest than from incurring injuries while playing sports. One in 300 youth has an undetected condition that puts them at risk. The American Heart Association has reported up to 16,000 youth stricken annually. An American Board of Family Medicine Study noted that 72% of youth who suffered from SCA were reported by their parents to have had at least one symptom before the event—they just didn’t recognize it as life threatening. Once SCA strikes, survival is less than 10% because bystanders are not prepared to respond to a cardiac emergency, which is critical given every minute delayed in treating an SCA victim decreases their change of survival by 10%, and the average for EMS to arrive on scene is seven to 14 minutes.

“AB 1639 – The Eric Paredes Sudden Cardiac Arrest Prevention Act — was California’s first legislation attempting to mitigate this gap in youth heart safety by focusing on school-sponsored athletic activities (because SCA is also the leading cause of death on school campuses.) But consider the number of youth who participate in sports programs outside of school. National studies from the Sports and Fitness Industry Association (SFIA) and the D'Youville's Center for Research on Physical Activity, Sport & Health (CRPASH) show between 21.47 million kids (ages 6 to 17) and 28.7 million kids (ages 8 to 17) respectively participate in youth sports. Meanwhile, the National Federation of High Schools reports 7,980,886 high school student athletes, with 10% in California (808,557). Extrapolating 10% of the national statistics above, there are between 2.1 and 2.8 million California youth age 6 to 17 playing sports. That means that the current SCA prevention protocol now mandated in school-sponsored athletic activities is missing the majority of young athletes in our state. Given the precedent set by current law mandating concussion protocol in both school and community sports programs, although SCA is the number one killer of student athletes, AB 379 pays necessary attention to a missing standard in youth sports safety.”

The LA Galaxy San Diego add in their support, “Youth participating in sports are particularly susceptible to SCA, making SCA the #1 killer of student athletes. The National Center for Catastrophic Sport Injury Research cites that more athletes die from sudden cardiac arrest than from any other sport-related trauma. Further, coaches, parents, referees and players are oftentimes unprepared to act when SCA strikes. 92% of SCA victims will die if not treated within minutes. Thus, it is vital for an SCA victim to be in the presence of people who are prepared to respond to a cardiac emergency. Knowing the Cardiac Chain of Survival—call 911, start hands-only CPR, use the nearest automated external defibrillator (AED)—can mean the difference between life and death.”

Finally, the Sudden Cardiac Arrest Foundation note, Current law and regulations require youth sports organizations to remove an athlete from an athletic activity who is suspected of sustaining a concussion or head injury. Parents and youth annually review information about the dangers of concussion and head injury, and coaches complete a concussion and head injury course. AB 379 would require the same protocols used for concussions in youth and high school sports to be used when a youth or high school athlete appears to be suffering from SCA related symptoms.”

1. Prior related legislation
   1. AB 2007 (McCarty), Chapter 516, Statutes of 2016, requires amateur youth sports organizations to adopt concussion treatment and recognition protocols similar to those in existing law for student athletes in 27 designated sports, as specified. Would also require youth sports organizations to develop return-to-play protocols, and provide yearly concussion and head injury information sheets and education, as provided.
   2. AB 1639 (Mainschein), Chapter 792, Statutes of 2016, established the Eric Paredes Sudden Cardiac Arrest Prevention Act that requires the California Department of Education (CDE) to make available specified guidelines and materials on sudden cardiac arrest (SCA): pupils and parents to sign informational materials before athletic participation; training of coaches; and set requirements for action in the event a pupil experiences specified symptoms.
   3. AB 2182 (Mullin) of 2016, would create a baseline neurocognitive testing pilot program for concussion and head injury, as defined, applying to students playing interscholastic sports, as provided, and requires specified schools to collect, maintain and report on traumatic brain injuries sustained by any pupil during athletic competition. Status: Vetoed
   4. AB 2127 (Cooley), Chapter 165, Statutes of 2014, among other things, limits full-contact practices for high school and middle school football teams for concussion and head injury prevention, and requires that a return-to-play protocol after concussion or head injury be no less than seven days in duration.
   5. AB 588 (Fox), Chapter 423, Statutes of 2013, applies existing law relating to students who sustain, or are suspecting of sustaining, a concussion during a school-sponsored athletic activity to charter schools and private schools.
   6. AB 1451 (Hayashi), Chapter 173, Statutes of 2012, includes a basic understanding of the signs and symptoms of concussions and the appropriate response to concussions within the HSCET, administered by school districts.
   7. AB 1449 (Hayashi) of 2012, would have required the SPI to develop and make available a sample concussion and head injury information sheet for use by school districts. That measure was held in the Assembly Education Committee.
   8. AB 25 (Hayashi), Chapter 465, Statutes of 2011, requires a school district that elects to offer athletic programs to immediately remove an athlete who is suspected of sustaining a concussion or head injury during that activity; prohibits the return of the athlete to that activity until he or she is evaluated by, and receives written clearance from, a licensed health care provider; requires, on a yearly basis, 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’s initiating practice or competition.
   9. AB 1646 (Hayashi) of 2010, would have required training for coaches to be able to identify symptoms of head and neck injury. That measure was held in the Assembly Appropriations Committee Suspense file.
   10. AB 1893 (Hayashi) of 2010, would have required all high school spirit activities coaches to have valid certification in CPR and first aid, including an understanding of signs, symptoms, and appropriate emergency action steps regarding potentially catastrophic injury, including but not limited to, head and neck injury and concussion. Pupils participating in this activity who experience or show signs of trauma or other injury must obtain a release from the treating provider before resuming these activities. That measure was held in the Assembly Education Committee
   11. AB 533 (Hayashi) of 2009, would have required training for coaches to be able to identify symptoms of head and neck injury. That measure was held in the Assembly Appropriations Committee Suspense file.

REGISTERED SUPPORT / OPPOSITION:

Support

Association of California School Administrators
Bear Valley Middle School
Boys and Girls Clubs of San Dieguito
California Association for Health, Physical Education, Recreation & Dance
California Athletic Trainers Association
California Orthopedic Association
California State PTA
Cardiac Science Corporation
Children's Cardiomyopathy Foundation
City of Beverly Hills, Council Member Lili Bosse
City of Culver City
Consumer Attorneys of California
Council President Pro Tem Barbara Bry, City of San Diego
County of San Diego Second District Supervisor Dianne Jacob
Coyote Valley Band of Pomo Indians
Eric Paredes Save A Life Foundation
Habematolel Pomo of Upper Lake
Heartbeat of Champions Foundation
Institute for Public Health
La Galaxy San Diego
Los Angeles Unified School District
Mayor Eric Garcetti, City of Los Angeles
Mechoopda Indian Tribe of Chico Rancheria
Middletown Rancheria
Olivia's Heart Project
Parent Heart Watch
Revive Solutions Inc.
Saving Hearts Foundation
Sudden Cardiac Arrest Association - San Diego
Sudden Cardiac Arrest Foundation
Travis R. Roy Sudden Cardiac Arrest Fund
Via Heart Project

11 individuals

Opposition

There is no opposition on file.

Analysis Prepared by: Dana Mitchell / A.,E.,S.,T., & I.M. / (916) 319-3450