Existing law requires the Emergency Medical Services Authority to develop planning and implementation guidelines that address designated components for emergency medical services systems.

This bill would require the authority to develop standards, on or before January 1, 2027, for personal protective equipment for ambulance personnel and to update the standards on or before January 1, 2032, and every 5 years thereafter.

Existing law requires the Emergency Medical Services Authority to develop planning and implementation guidelines that address designated components for emergency medical services systems.

This bill would require the authority to develop standards, on or before January 1, 2027, for personal protective equipment for ambulance personnel and to update the standards on or before January 1, 2032, and every 5 years thereafter.

GOVERNOR'S VETO

GV Bill Id:AB 1792

Author:(Rodriguez)

As Enrolled Ver:August 31, 2024

2/3 vote

SUMMARY

Requires the Emergency Medical Services Authority (EMSA) to, on or before January 1, 2027, develop standards for personal protective equipment (PPE) for ambulance personnel, and to update those standards on a regular basis, as specified.

Major Provisions:

1. Requires EMSA to, on or before January 1, 2027, develop standards for personal protective equipment (PPE) for ambulance personnel.
2. Requires EMSA to update the standards on or before January 1, 2032, and every five years thereafter.

Governor's Veto Message

This bill would require the Emergency Medical Services Authority (EMSA) to develop personal protective equipment (PPE) standards specifically for ambulance personnel by January 1, 2027.

I support efforts to protect and maximize the safety of our state's life-saving emergency responders. However, current law already requires employers to evaluate workplace hazards and provide all necessary PPE and training to employees. Requiring EMSA to set new, separate standards for PPE used by ambulance personnel could create a conflict between these new standards and existing regulations promulgated and enforced by The Division of Occupational Safety and Health (Cal/OSHA).

COMMENTS

Personal Protective Equipment (PPE) is defined by the Occupational Safety and Health Administration (OSHA) as "equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses. These injuries and illnesses may result from contact with chemical, radiological, physical, electrical, mechanical, or other workplace hazards." PPE for EMS personnel may include items such as gloves, hearing and eye protection, hard hats, chemical resistant, hooded clothing, skin-covering garments, sturdy footwear and footwear covers, flashlights, and respirators. According to the Centers for Disease Control and Prevention (CDC), the highest risks to EMS worker safety are 1) motion-related injuries, including straining muscles and falling; 2) exposure to hazardous biological and environmental materials; 3) motor vehicle incidents; and 4) violence and assaults. PPE can reduce workplace injury in nearly all categories, from sturdy and nonslip footwear preventing falls to skin and eye protection from blood and bodily fluids.

EMS workers face evolving hazards: In 2001, the response effort to the 9/11 terrorist attacks highlighted the need for EMTs to have accessible and maintained reserves of 'all-hazard' PPE. First responders were dispatched to the scene with inadequate environmental PPE – like hard hats and respirators - and a dearth of training on how to stay safe in such a multi-hazard event. The equipment that was available lacked interoperability, with pieces from various brands and vendors that didn't necessarily work well together, and workers struggled with inadequate fit and poor maintenance, such as hard hats and respirators. In the wake of the attack, the California Emergency Medical Services Authority (EMSA) established and released updated PPE standards in 2006. These standards set uniform statewide standards to maximize mutual aid interoperability and keep first responders prepared to stay safe in a wide variety of response environments and scenarios.

Since then, the COVID-19 pandemic brought on unprecedented public health challenges. Additionally, violence against EMS workers has increased in recent years. According to the Centers for Disease Control and Prevention, 2,000 EMS workers experience violence or assault each year at work. In 2017, 3,500 incidents of injury among EMS workers were caused by violence, comprising of 17% of all injuries. In 2008, that number was just 2,100, 10% of all injuries.

In light of the ever-changing EMS landscape, this bill seeks to ensure that PPE standards for EMS workers are brought up to date and kept up to date statewide in the future.

The Emergency Medical Services Authority: This bill gives the responsibility of setting PPE standards to EMSA, the organization which authored the 2006 standards. EMSA provides statewide oversight for the 33 local emergency medical services agencies, which together form the state's pre-hospital emergency medical system. EMSA's existing responsibilities include developing the planning and implementation guidelines for EMS systems. Components of this include training, communication, system organization and management, and disaster response. Committee staff notes that adding worker safety standards to this list appears appropriate. 

No existing laws: Keeping EMS PPE standards up to date is currently an unlegislated space. The closest related industry which requires the regular update of PPE standards is firefighting, which was mandated by AB 2146 (Skinner) in 2014. Similar to AB 1792, AB 2146 tasks a committee of industry experts to evaluate whether current PPE standards can be improved and recommend updates every five years. AB 2146 used the National Fire Protection Association, an international nonprofit organization which develops new safety standards for firefighters every five years, as the source of new improvements for the state committee to consider adopting. AB 1792 gives EMSA discretion to develop standards and updates as they see fit.

According to the Author

"The California Emergency Medical Services Authority (EMSA) published guidelines for minimum PPE for ambulance workers, which must be provided to all ambulance workers (public, private, emergency, and non-emergency). These include items such as hard hats, eye and hearing protection, gloves, and flashlights. The guidelines have not been updated since their publication in 2006. As EMS workers face new challenges on the job and threats to their safety, it is important that the state continue to evaluate the appropriate PPE that should be provided to ambulance personnel."

Arguments in Support

The International Association of EMTs and Paramedics (IAEP) writes in support, "PPE guidelines for all statewide ambulance personnel have remained untouched for nearly 20 years; given all that we have learned from the COVID-19 pandemic, changing environmental and social landscape, and the advancement of medicine in those two decades, updating these guidelines and establishing formal PPE standards for EMS providers will ensure that dedicated workers who respond to medical emergencies are properly protected in the course of their work."

The American Federation of State, County and Municipal Employees (AFSCME) writes in support, "The COVID-19 Pandemic showed how dangerous it is for the state to not have a vast supply of high-quality PPE for ambulance personnel. A 2020 study found that COVID-19 infection rates among healthcare workers would have been much lower if the state had enough proper PPE available… While the state took steps during the height of the pandemic to make sure that there was enough PPE for a public health…, the quality of this PPE for ambulance personnel is thus far unregulated by law. Assembly Bill 1792 seeks to resolve this by requiring the Emergency Management Services Authority to develop standards for the PPE used by ambulance personnel."

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Committee on Appropriations, this bill incurs "ongoing costs of approximately $174,000 to EMSA for an additional staff position to engage stakeholders, research and develop PPE standards, analyze the effectiveness of adopted standards, and update the standards every five years (General Fund (GF)). For additional context, EMSA notes that a similar requirement tasking the Department of Industrial Relations (DIR) with establishing and updating PPE standards for firefighters necessitated the support of three staff positions."

VOTES

ASM EMERGENCY MANAGEMENT: 7-0-1

YES: Rodriguez, Arambula, Boerner, Calderon, Wendy Carrillo, Davies, Waldron

ABS, ABST OR NV: Bennett

ASM APPROPRIATIONS: 15-0-0

YES: Wicks, Sanchez, Arambula, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Grayson, Haney, Hart, Jim Patterson, Pellerin, Ta, Villapudua

ASSEMBLY FLOOR: 73-0-7

YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

ABS, ABST OR NV: Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis, Luz Rivas

UPDATED

VERSION: August 31, 2024

CONSULTANT: Ryan Fleming / E.M. / (916) 319-3802 FN: 0005124

 THIRD READING  

Bill No: AB 1792

Author: Rodriguez (D)

Introduced: 1/4/24

Vote: 21

SENATE HEALTH COMMITTEE: 11-0, 6/5/24

AYES: Roth, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Smallwood-Cuevas, Wiener

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/15/24

AYES: Caballero, Jones, Ashby, Becker, Bradford, Seyarto, Wahab

ASSEMBLY FLOOR: 73-0, 5/21/24 - See last page for vote

SUBJECT: Emergency medical services: personal protective equipment

SOURCE: Author

DIGEST:

This bill requires the Emergency Medical Services Authority to develop standards for personal protective equipment for ambulance personnel by January 1, 2027, and to update those standards every five years.

ANALYSIS:

Existing law:

1. Establishes the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act (EMS Act) to provide for a statewide system for EMS, and establishes the Emergency Medical Services Authority (EMSA), which is responsible for the coordination and integration of all state activities concerning EMS, including the establishment of minimum standards, policies, and procedures. [HSC §1797, et seq.]
2. Requires the California Department of Public Health (CDPH) and the Office of Emergency Services, in coordination with other state agencies, to establish a Personal Protective Equipment (PPE) stockpile, upon appropriation and as necessary, to establish guidelines for procurement, management, and distribution of PPE from CDPH. [HSC §131021]
3. Establishes a PPE Advisory Committee consisting of specified representatives to make recommendations to the Office of Emergency Services and CDPH necessary to develop the guidelines established in 2) above. [HSC §131021(f)]
4. Establishes general industry safety orders, promulgated by the California Occupational Health Standards Board (OSHA Standards Board), to provide guidance for employers and employees alike, in order to secure safety in places of employment. Among these general industry safety orders are a set of orders for PPE for firefighters. [8 CCR §3200 et seq., §3401 et seq.]
5. Requires the OSHA Standards Board, beginning July 1, 2018, and every five years thereafter, to complete a comprehensive review of all revisions to National Fire Protection Association standards pertaining to PPE covered by the general industry safety orders in specified regulations pertaining to PPE requirements for firefighters, and to consider modifying these safety orders to maintain alignment of the safety orders with the applicable National Fire Protection Association standards. [LAB §147.4]
6. Requires employers to assess their workplace to determine if hazards are present or are likely to be present that would necessitate the use of PPE. Further requires that an employer record which workplace was assessed, what person certified the assessment and the date of the assessment. [8 CCR §3380(f)(1)]
7. Requires an employer who has determined that a workplace contains hazards to provide training for their employees including when PPE is necessary, what PPE is necessary, how to properly adjust and wear PPE, the limitations of PPE and the proper care, useful life and proper disposal method for the PPE. [8 CCR §3380(f)(4)]
8. Requires each of the following types of employers to provide all safeguards, including provision of PPE, respirators, training, and medical services, at no cost to the employee, at a reasonable time and place for the employee, and during the employee's working hours:
   1. Hospitals;
   2. Skilled nursing facilities;
   3. Clinics, medical offices, and other outpatient medical facilities;
   4. Facilities where high hazard procedures are performed;
   5. Home health care;
   6. Long term health care facilities and hospices;
   7. Medical outreach services;
   8. Paramedic and emergency medical services including these services when provided by firefighters and other emergency responders; and,
   9. Medical transport. [8 CCR §5199]

This bill requires EMSA, by January 1, 2027, to develop standards for PPE for ambulance personnel, and to update the standards by January 1, 2032, and every five years thereafter.

Comments

1. Author’s statement. According to the author, “EMSA published guidelines for minimum PPE for ambulance workers, which must be provided to all ambulance workers (public, private, emergency, and non-emergency). These include items such as hard hats, eye and hearing protection, gloves, and flashlights. The guidelines have not been updated since their publication in 2006. As EMS workers face new challenges on the job and threats to their safety, it is important that the state continue to evaluate the appropriate PPE that should be provided to ambulance personnel.”
2. Existing EMSA guidelines on PPE. In June 2005, after forming a committee at the suggestion of the EMS Commission, EMSA published “Minimum Personal Protective Equipment for Ambulance Personnel in California Guidelines.” This document noted that the working environment for all first responders changed following the terrorist events of September 11, 2001, which demonstrated shortfalls in first responder preparedness such as unavailability of PPE. Additionally, there were issues of inadequate prescription, fit, use, and maintenance of various PPE. The Guidelines that were developed were intended to ensure, at a minimum, that each of the various items were available for every person working on an ambulance, whether worn, on the ambulance unit, or available at headquarters. Among other items, these include hard hats, eye protection and hearing protection for the head; a set of barrier garments, such as “white Tyvek,” on the ambulance, and a set of hooded, chemical-resistant clothing available at headquarters; an N-100 mask, or N-95 masks; an Escape Hood; plus, various routine equipment such as a flashlight, folding knife, glass punch, and a personal communication device. For extended operations equipment, the Guidelines recommended a “go pack,” or mission-ready backpack or duffel bag for response operations during a potential extended, or weapons of mass destruction event, which include equipment for an individual’s self-sustainment for 72 hours.
3. OSHA Standards Board has adopted specific PPE requirements for firefighters. Among other duties, the OSHA Standards Board promulgates “general industry safety orders” for various types of employment for the guidance of employers. Every employer is required to provide their supervisory staff with a copy of these orders to ensure that each supervisor is familiar with those sections pertaining to the operations under their supervision. One set of these general industry safety orders is for PPE for firefighters. These orders cover purchase quality standards; selection, inspection, and maintenance; and identifies various types of protective equipment. Additionally, PPE specific to structural fires as well as wildland firefighting is covered. While there is no set of general industry safety orders specific to ambulance providers that delineate the specifics of their PPE, existing law still requires ambulance employers to provide PPE to their employees, and there are general industry safety orders for PPE that apply wherever a hazard assessment determines PPE is necessary.

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

According to the Senate Appropriations Committee, EMSA estimates ongoing General Fund costs of $174,000 to develop standards for PPE for ambulance personnel and to update the standards through regulations every five years. The EMSA also indicates potential cost implications for public EMS providers and various state agencies that operate as EMS providers within the state’s EMS system

SUPPORT: (Verified 8/15/24)

American Federation of State, County, and Municipal Employees California

California Fire Chiefs Association

Fire Districts Association of California

International Association of EMTs and Paramedics

United Steelworkers District 12

OPPOSITION: (Verified 8/15/24)

None received

ARGUMENTS IN SUPPORT: The International Association of EMTs and Paramedics write in support that PPE guidelines for all statewide ambulance personnel have remained untouched for nearly 20 years; given all that we have learned from the COVID-19 pandemic, changing environmental and social landscape, and the advancement of medicine in those two decades, updating these guidelines and establishing formal PPE standards for EMS providers will ensure that dedicated workers who respond to medical emergencies are properly protected in the course of their work. The American Federation of State, County and Municipal Employees write in support that the COVID-19 pandemic showed how dangerous it is for the state to not have a vast supply of high-quality PPE for ambulance personnel. While the state took steps during the height of the pandemic to make sure that there was enough PPE for a public health crisis, the quality of this PPE for ambulance personnel is thus far unregulated by law. This bill seeks to resolve this by requiring EMSA to develop standards for the PPE used by ambulance personnel.

ASSEMBLY FLOOR: 73-0, 5/21/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis, Luz Rivas

Prepared by: Vincent D. Marchand / HEALTH / (916) 651-4111

8/18/24 8:50:54

**** END ****

SENATE COMMITTEE ON

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

AB 1792 (Rodriguez) - Emergency medical services: personal protective equipment

Bill Summary:

AB 1792 would require the Emergency Medical Services Authority (EMSA) to develop standards for personal protective equipment (PPE) for ambulance personnel by January 1, 2027, and to update those standards every five years.

Fiscal Impact:

The EMSA estimates ongoing General Fund costs of $174,000 to develop standards for PPE for ambulance personnel and to update the standards through regulations every five years. The EMSA also indicates potential cost implications for public emergency medical services (EMS) providers and various state agencies that operate as EMS providers within the state’s EMS system.

Background:

Among other duties, the California Occupational Safety and Health Standards Board promulgates “general industry safety orders” for various types of employment for the guidance of employers. Every employer is required to provide their supervisory staff with a copy of these orders to ensure that each supervisor is familiar with those sections pertaining to the operations under their supervision. One set of these general industry safety orders is for PPE for firefighters. These orders cover purchase quality standards; selection, inspection, and maintenance; and identification of various types of protective equipment. Additionally, PPE specific to structural fires as well as wildland firefighting is covered.

There is no set of general industry safety orders specific to ambulance providers that delineate the specifics of their PPE. However, existing law still requires ambulance employers to provide PPE to their employees and there are general industry safety orders for PPE that apply wherever a hazard assessment determines PPE is necessary.

In June 2005, EMSA published “Minimum Personal Protective Equipment for Ambulance Personnel in California Guidelines.” However, the guidelines have not been updated.

Proposed Law:

AB 1792 would require EMSA, by January 1, 2027, to develop standards for PPE for ambulance personnel, and to update the standards by January 1, 2032 and every five years thereafter.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Richard Roth, Chair

BILL NO: AB 1792

SUBJECT: Emergency medical services: personal protective equipment

SUMMARY:

Requires the Emergency Medical Services Authority to develop standards for personal protective equipment for ambulance personnel by January 1, 2027, and to update those standards every five years.

Existing law:

1. Establishes the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act (EMS Act) to provide for a statewide system for EMS, and establishes the Emergency Medical Services Authority (EMSA), which is responsible for the coordination and integration of all state activities concerning EMS, including the establishment of minimum standards, policies, and procedures. [HSC §1797, et seq.]
2. Requires the California Department of Public Health (CDPH) and the Office of Emergency Services, in coordination with other state agencies, to establish a Personal Protective Equipment (PPE) stockpile, upon appropriation and as necessary, to establish guidelines for procurement, management, and distribution of PPE from CDPH. [HSC §131021]
3. Establishes a PPE Advisory Committee consisting of specified representatives to make recommendations to the Office of Emergency Services and CDPH necessary to develop the guidelines established in 2) above. [HSC §131021(f)]
4. Establishes general industry safety orders, promulgated by the California Occupational Health Standards Board (OSHA Standards Board), to provide guidance for employers and employees alike, in order to secure safety in places of employment. Among these general industry safety orders are a set of orders for PPE for firefighters. [8 CCR §3200 et seq., §3401 et seq.]
5. Requires the OSHA Standards Board, beginning July 1, 2018, and every five years thereafter, to complete a comprehensive review of all revisions to National Fire Protection Association standards pertaining to PPE covered by the general industry safety orders in specified regulations pertaining to PPE requirements for firefighters, and to consider modifying these safety orders to maintain alignment of the safety orders with the applicable National Fire Protection Association standards. [LAB §147.4]
6. Requires employers to assess their workplace to determine if hazards are present or are likely to be present that would necessitate the use of PPE. Further requires that an employer record which workplace was assessed, what person certified the assessment and the date of the assessment. [8 CCR §3380(f)(1)]
7. Requires an employer who has determined that a workplace contains hazards to provide training for their employees including when PPE is necessary, what PPE is necessary, how to properly adjust and wear PPE, the limitations of PPE and the proper care, useful life and proper disposal method for the PPE. [8 CCR §3380(f)(4)]
8. Requires each of the following types of employers to provide all safeguards, including provision of PPE, respirators, training, and medical services, at no cost to the employee, at a reasonable time and place for the employee, and during the employee's working hours:
   1. Hospitals;
   2. Skilled nursing facilities;
   3. Clinics, medical offices, and other outpatient medical facilities;
   4. Facilities where high hazard procedures are performed;
   5. Home health care;
   6. Long term health care facilities and hospices;
   7. Medical outreach services;
   8. Paramedic and emergency medical services including these services when provided by firefighters and other emergency responders; and,
   9. Medical transport. [8 CCR §5199]

This bill: Requires EMSA, by January 1, 2027, to develop standards for PPE for ambulance personnel, and to update the standards by January 1, 2032, and every five years thereafter.

FISCAL EFFECT:

According to the Assembly Committee on Appropriations, this bill incurs ongoing costs of approximately $174,000 to EMSA for an additional staff position to engage stakeholders, research and develop PPE standards, analyze the effectiveness of adopted standards, and update the standards every five years (General Fund). For additional context, EMSA notes that a similar requirement tasking the Department of Industrial Relations with establishing and updating PPE standards for firefighters necessitated the support of three staff positions.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, EMSA published guidelines for minimum PPE for ambulance workers, which must be provided to all ambulance workers (public, private, emergency, and non-emergency). These include items such as hard hats, eye and hearing protection, gloves, and flashlights. The guidelines have not been updated since their publication in 2006. As EMS workers face new challenges on the job and threats to their safety, it is important that the state continue to evaluate the appropriate PPE that should be provided to ambulance personnel.
2. Existing EMSA guidelines on PPE. In June 2005, after forming a committee at the suggestion of the EMS Commission, EMSA published “Minimum Personal Protective Equipment for Ambulance Personnel in California Guidelines.” This document noted that the working environment for all first responders changed following the terrorist events of September 11, 2001, which demonstrated shortfalls in first responder preparedness such as unavailability of PPE. Additionally, there were issues of inadequate prescription, fit, use, and maintenance of various PPE. The Guidelines that were developed were intended to ensure, at a minimum, that each of the various items were available for every person working on an ambulance, whether worn, on the ambulance unit, or available at headquarters. Among other items, these include hard hats, eye protection and hearing protection for the head; a set of barrier garments, such as “white Tyvek,” on the ambulance, and a set of hooded, chemical-resistant clothing available at headquarters; an N-100 mask, or N-95 masks; an Escape Hood; plus, various routine equipment such as a flashlight, folding knife, glass punch, and a personal communication device. For extended operations equipment, the Guidelines recommended a “go pack,” or mission-ready backpack or duffel bag for response operations during a potential extended, or weapons of mass destruction event, which include equipment for an individual’s self-sustainment for 72 hours.
3. OSHA Standards Board has adopted specific PPE requirements for firefighters. Among other duties, the OSHA Standards Board promulgates “general industry safety orders” for various types of employment for the guidance of employers. Every employer is required to provide their supervisory staff with a copy of these orders to ensure that each supervisor is familiar with those sections pertaining to the operations under their supervision. One set of these general industry safety orders is for PPE for firefighters. These orders cover purchase quality standards; selection, inspection, and maintenance; and identifies various types of protective equipment. Additionally, PPE specific to structural fires as well as wildland firefighting is covered. While there is no set of general industry safety orders specific to ambulance providers that delineate the specifics of their PPE, existing law still requires ambulance employers to provide PPE to their employees, and there are general industry safety orders for PPE that apply wherever a hazard assessment determines PPE is necessary.
4. Prior legislation. AB 73 (Robert Rivas, Chapter 322, Statutes of 2021) revised provisions of law requiring the state to establish a PPE stockpile for pandemic or other health emergencies, by also including wildfire smoke events as a type of emergency for which a PPE stockpile would be required; adds agricultural workers to the definition of “essential workers” for purposes of access to the PPE stockpile; and requires wildfire smoke safety training for agricultural employees to be in a language and manner readily understandable by employees.

SB 275 (Pan and Leyva, Chapter 301, Statutes of 2020) requires CDPH and the Office of Emergency Services to establish a PPE stockpile, and required certain health care employers, including hospitals and skilled nursing facilities, to maintain an inventory of PPE at least sufficient for 45 days of surge consumption, effective on January 1, 2023, or one year after regulations are adopted defining 45 days of surge consumption, whichever is later.

AB 2092 (Rodriguez of 2020) would have required private EMS ambulance employers to establish a voluntary PPE program that allows emergency ambulance employees to purchase multithread body protective gear using an employer-funded stipend. AB 2092 was vetoed by Governor Newsom, who stated that this bill would hold employers responsible for only part of the multithread body protective gear, which conflicts with longstanding law requiring employers to furnish and provide safety devices and safeguards necessary to protect their employers, and that it is unclear how these provisions would effectively contribute toward that goal.

AB 2537 (Rodriguez, Chapter 313, Statutes of 2020) required employers of workers in a general acute care hospital to supply employees providing patient care with necessary PPE, and to require an employer to maintain a three month supply of specified equipment.


AB 2146 (Skinner, Chapter 811, Statutes of 2014) required the Department of Industrial Relations to convene an advisory committee to evaluate whether changes are needed to align specified safety orders related to minimum requirements for personal protective clothing and equipment for firefighters with the applicable and most recently promulgated standards of the National Fire Protection Association. AB 2146 required the advisory committee to present its findings and recommendations to the OSHA Standards Board to render a decision regarding the adoption of changes to these safety orders, and required the OSHA Standards Board to complete a comprehensive review of all revisions to National Fire Protection Association standards pertaining to PPE, and to consider modifying existing safety orders no later than July 1, of the subsequent year.

1. Support. The International Association of EMTs and Paramedics write in support that PPE guidelines for all statewide ambulance personnel have remained untouched for nearly 20 years; given all that we have learned from the COVID-19 pandemic, changing environmental and social landscape, and the advancement of medicine in those two decades, updating these guidelines and establishing formal PPE standards for EMS providers will ensure that dedicated workers who respond to medical emergencies are properly protected in the course of their work. The American Federation of State, County and Municipal Employees write in support that the COVID-19 pandemic showed how dangerous it is for the state to not have a vast supply of high-quality PPE for ambulance personnel. While the state took steps during the height of the pandemic to make sure that there was enough PPE for a public health crisis, the quality of this PPE for ambulance personnel is thus far unregulated by law. This bill seeks to resolve this by requiring EMSA to develop standards for the PPE used by ambulance personnel.

SUPPORT AND OPPOSITION:

Support: American Federation of State, County, and Municipal Employees California

International Association of EMTs and Paramedics

Oppose: None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 1792

Author:(Rodriguez)

As Introduced Ver:January 4, 2024

Majority vote

SUMMARY

Requires the Emergency Medical Services Authority (EMSA) to, on or before January 1, 2027, develop standards for personal protective equipment (PPE) for ambulance personnel, and to update those standards on a regular basis, as specified.

Major Provisions

1. Requires EMSA to, on or before January 1, 2027, develop standards for personal protective equipment (PPE) for ambulance personnel.
2. Requires EMSA to update the standards on or before January 1, 2032, and every five years thereafter.

COMMENTS

Personal Protective Equipment (PPE) is defined by the Occupational Safety and Health Administration (OSHA) as "equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses. These injuries and illnesses may result from contact with chemical, radiological, physical, electrical, mechanical, or other workplace hazards." PPE for EMS personnel may include items such as gloves, hearing and eye protection, hard hats, chemical resistant, hooded clothing, skin-covering garments, sturdy footwear and footwear covers, flashlights, and respirators. According to the Centers for Disease Control and Prevention (CDC), the highest risks to EMS worker safety are 1) motion-related injuries, including straining muscles and falling; 2) exposure to hazardous biological and environmental materials; 3) motor vehicle incidents; and 4) violence and assaults. PPE can reduce workplace injury in nearly all categories, from sturdy and nonslip footwear preventing falls to skin and eye protection from blood and bodily fluids.

EMS workers face evolving hazards: In 2001, the response effort to the 9/11 terrorist attacks highlighted the need for EMTs to have accessible and maintained reserves of 'all-hazard' PPE. First responders were dispatched to the scene with inadequate environmental PPE – like hard hats and respirators - and a dearth of training on how to stay safe in such a multi-hazard event. The equipment that was available lacked interoperability, with pieces from various brands and vendors that didn't necessarily work well together, and workers struggled with inadequate fit and poor maintenance, such as hard hats and respirators. In the wake of the attack, the California Emergency Medical Services Authority (EMSA) established and released updated PPE standards in 2006. These standards set uniform statewide standards to maximize mutual aid interoperability and keep first responders prepared to stay safe in a wide variety of response environments and scenarios.

Since then, the COVID-19 pandemic brought on unprecedented public health challenges. Additionally, violence against EMS workers has increased in recent years. According to the Centers for Disease Control and Prevention, 2,000 EMS workers experience violence or assault each year at work. In 2017, 3,500 incidents of injury among EMS workers were caused by violence, comprising of 17% of all injuries. In 2008, that number was just 2,100, 10% of all injuries.

In light of the ever-changing EMS landscape, this bill seeks to ensure that PPE standards for EMS workers are brought up to date and kept up to date statewide in the future.

The Emergency Medical Services Authority: This bill gives the responsibility of setting PPE standards to EMSA, the organization which authored the 2006 standards. EMSA provides statewide oversight for the 33 local emergency medical services agencies, which together form the state's pre-hospital emergency medical system. EMSA's existing responsibilities include developing the planning and implementation guidelines for EMS systems. Components of this include training, communication, system organization and management, and disaster response. Committee staff notes that adding worker safety standards to this list appears appropriate.

No existing laws: Keeping EMS PPE standards up to date is currently an unlegislated space. The closest related industry which requires the regular update of PPE standards is firefighting, which was mandated by AB 2146 (Skinner), Chapter 811, Statutes of 2014. Similar to AB 1792, AB 2146 tasks a committee of industry experts to evaluate whether current PPE standards can be improved and recommend updates every five years. AB 2146 used the National Fire Protection Association, an international nonprofit organization which develops new safety standards for firefighters every five years, as the source of new improvements for the state committee to consider adopting. AB 1792 gives EMSA discretion to develop standards and updates as they see fit.

According to the Author

"The California Emergency Medical Services Authority (EMSA) published guidelines for minimum PPE for ambulance workers, which must be provided to all ambulance workers (public, private, emergency, and non-emergency). These include items such as hard hats, eye and hearing protection, gloves, and flashlights. The guidelines have not been updated since their publication in 2006. As EMS workers face new challenges on the job and threats to their safety, it is important that the state continue to evaluate the appropriate PPE that should be provided to ambulance personnel."

Arguments in Support

The International Association of EMTs and Paramedics (IAEP) writes in support, "PPE guidelines for all statewide ambulance personnel have remained untouched for nearly 20 years; given all that we have learned from the COVID-19 pandemic, changing environmental and social landscape, and the advancement of medicine in those two decades, updating these guidelines and establishing formal PPE standards for EMS providers will ensure that dedicated workers who respond to medical emergencies are properly protected in the course of their work."

The American Federation of State, County and Municipal Employees (AFSCME) writes in support, "The COVID-19 Pandemic showed how dangerous it is for the state to not have a vast supply of high-quality PPE for ambulance personnel. A 2020 study found that COVID-19 infection rates among healthcare workers would have been much lower if the state had enough proper PPE available… While the state took steps during the height of the pandemic to make sure that there was enough PPE for a public health…, the quality of this PPE for ambulance personnel is thus far unregulated by law. Assembly Bill 1792 seeks to resolve this by requiring the Emergency Management Services Authority to develop standards for the PPE used by ambulance personnel."

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Committee on Appropriations, this bill incurs "ongoing costs of approximately $174,000 to EMSA for an additional staff position to engage stakeholders, research and develop PPE standards, analyze the effectiveness of adopted standards, and update the standards every five years (General Fund (GF)). For additional context, EMSA notes that a similar requirement tasking the Department of Industrial Relations (DIR) with establishing and updating PPE standards for firefighters necessitated the support of three staff positions."

VOTES

ASM EMERGENCY MANAGEMENT: 7-0-1

YES: Rodriguez, Arambula, Boerner, Calderon, Wendy Carrillo, Davies, Waldron

ABS, ABST OR NV: Bennett

ASM APPROPRIATIONS: 15-0-0

YES: Wicks, Sanchez, Arambula, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Grayson, Haney, Hart, Jim Patterson, Pellerin, Ta, Villapudua

UPDATED

VERSION: January 4, 2024

CONSULTANT: Sarina Patel / E.M. / (916) 319-3802 FN: 0003049

Date of Hearing: April 24, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 1792

Author:(Rodriguez) – As Introduced Ver:January 4, 2024

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

SUMMARY:

This bill requires, by January 1, 2027, the Emergency Medical Services Authority (EMSA) to develop personal protective equipment (PPE) standards for ambulance personnel.

EMSA must update those standards by January 1, 2032, and every five years thereafter.

FISCAL EFFECT:

Ongoing costs of approximately $174,000 to EMSA for an additional staff position to engage stakeholders, research and develop PPE standards, analyze the effectiveness of adopted standards, and update the standards every five years (General Fund (GF)). For additional context, EMSA notes that a similar requirement tasking the Department of Industrial Relations (DIR) with establishing and updating PPE standards for firefighters necessitated the support of three staff positions.

According to the Legislative Analyst’s Office, the GF faces a structural deficit in the tens of billions of dollars over the next several fiscal years.

COMMENTS:

1. Purpose. According to the author:

[EMSA] published guidelines for minimum PPE for ambulance workers, which must be provided to all ambulance workers (public, private, emergency, and non-emergency). These include items such as hard hats, eye and hearing protection, gloves, and flashlights. The guidelines have not been updated since their publication in 2006. As [emergency medical services (EMS)] workers face new challenges on the job and threats to their safety, it is important that the state continue to evaluate the appropriate PPE that should be provided to ambulance personnel.

This bill supported by the International Association of EMTs and Paramedics and the American Federation of State, County, and Municipal Employees.

1. EMS Hazards. EMSA developed uniform PPE standards for EMS workers in 2006 to maximize mutual aid interoperability and keep first responders safe in a wide variety of response environments and scenarios. Since then, however, the COVID-19 pandemic has presented unprecedented public health challenges, and violence against EMS workers is increasing. According to the Centers for Disease Control and Prevention, 2,000 EMS workers experience violence or assault each year at work. This bill requires EMSA to develop PPE standards for ambulance personnel by January 1, 2027, and update those standards every five years. However, unlike PPE standards enforced by the Division of Occupational Safety and Health, it is unclear whether this bill’s PPE standards developed by EMSA would be mandatory.
2. Prior Legislation. AB 2146 (Skinner), Chapter 811, Statutes of 2014, required DIR to convene an advisory committee to evaluate whether changes were needed to align safety orders regarding PPE for firefighters with standards promulgated by the National Fire Protection Association (NFPA). AB 2146 required the Occupational Safety and Health Standards Board (OSHSB) to decide whether to adopt any proposed changes, and also requires OSHSB to review subsequent revisions to NFPA standards every five years to determine whether corresponding updates should be made to safety orders.

AB 7 (Rodriguez), of the 2021-22 Legislative Session, would have required private emergency ambulance providers to provide readily available, multi-threat body protective gear to an emergency ambulance employee upon request. AB 7 was vetoed by the Governor, who stated:

Current law already imposes an affirmative obligation on employers to evaluate workplace hazards and provide all necessary [PPE] at no cost to employees regardless of whether the PPE is requested by the employee.

I support efforts to maximize the safety of all of California’s life-saving EMS personnel and encourage proponents of this bill to work within the current regulatory structure to provide the evidence demonstrating that multi-threat body protective gear is necessary for all EMTs.

AB 2092 (Rodriguez), of the 2019-20 Legislative Session, would have required private emergency ambulance providers to establish a voluntary PPE program that allowed employees to purchase multi-threat body protective gear using an employer-funded stipend. AB 2092 was vetoed by the Governor.

Analysis Prepared by: Irene Ho / APPR. / (916) 319-2081

Date of Hearing: April 8, 2024

ASSEMBLY COMMITTEE ON EMERGENCY MANAGEMENT

Freddie Rodriguez, Chair

ABPCA Bill Id:AB 1792 (

Author:Rodriguez) – As Introduced Ver:January 4, 2024

SUBJECT: Emergency medical services: personal protective equipment

SUMMARY: Requires the Emergency Medical Services Authority to, on or before January 1, 2027, develop standards for personal protective equipment (PPE) for ambulance personnel, and to update those standards on a regular basis, as specified. Specifically, this bill:

1. Requires EMSA to, on or before January 1, 2027, develop standards for personal protective equipment (PPE) for ambulance personnel.
2. Requires EMSA to update the standards on or before January 1, 2032, and every five years thereafter.

EXISTING LAW:

1. Establishes the Emergency Medical Services Authority (EMSA), under the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, which is responsible for the coordination of various state activities concerning emergency medical services. (Health and Safety Code Section 1797)

2. Requires, among other things, EMSA to develop planning and implementation guidelines for EMS systems which address components including manpower and training, transportation, system organization and management, and disaster management. (Health and Safety Code Section 1797.103)

1. Provides each county may develop an emergency medical services program. Each county developing such a program shall designate a local EMS agency which shall 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 emergency medical services administration, or a joint powers agency created for the administration of emergency medical services by agreement between counties or cities and counties, as specified. (Health and Safety Code 1797.200)
2. Establishes the Commission on Emergency Medical Services and assigns to it duties including: reviewing and approving regulations, standards, and guidelines; advising the director with regard to communications, medical equipment, training personnel, facilities, and other components of an emergency medical services system; utilizing technical advisory panels as needed to assist in developing standards for emergency medical services (Health and Safety Code 1799.0-1799.56)
3. Requires that every local EMS agency shall plan, implement, and evaluate an emergency medical services system, in accordance with the provisions of this part, consisting of an organized pattern of readiness and response services based on public and private agreements and operational procedures. (Health and Safety Code 1797.204)
4. Requires EMSA to cooperate with the Office of Emergency Services to respond to any medical disaster by mobilizing and coordinating emergency medical services mutual aid resources to mitigate health problems. (Health and Safety Code 1797.150)
5. Requires EMSA to coordinate, through local EMS agencies, medical and hospital disaster preparedness with other local, state, and federal agencies and departments having a responsibility relating to disaster response, and assist the Office of Emergency Services in the preparation of the emergency medical services component of the State Emergency Plan as defined in Section 8560 of the Government Code. (Health and Safety Code 1797.151)

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

COMMENTS:

Purpose of the bill: According to the author, “The California Emergency Medical Services Authority (EMSA) published guidelines for minimum PPE for ambulance workers, which must be provided to all ambulance workers (public, private, emergency, and non-emergency). These include items such as hard hats, eye and hearing protection, gloves, and flashlights. The guidelines have not been updated since their publication in 2006. As EMS workers face new challenges on the job and threats to their safety, it is important that the state continue to evaluate the appropriate PPE that should be provided to ambulance personnel.”

Equity Impact: According to the author, “In my 30 years as an EMS worker, I served anyone who needed help, regardless of their means. Being able to keep myself safe ensured I could go out again and again to help the next patient. PPE is a vital requirement for EMS workers to continue doing the good that they do serving the community, and as times change, it is important that the standards we maintain for the safety of our EMS workers adapt, too.”

Background:

Personal Protective Equipment (PPE) is defined by the Occupational Safety and Health Administration (OSHA) as “equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses. These injuries and illnesses may result from contact with chemical, radiological, physical, electrical, mechanical, or other workplace hazards.” PPE for EMS personnel may include items such as gloves, hearing and eye protection, hard hats, chemical resistant, hooded clothing, skin-covering garments, sturdy footwear and footwear covers, flashlights, and respirators. According to the Centers for Disease Control and Prevention (CDC), the highest risks to EMS worker safety are 1) motion-related injuries, including straining muscles and falling; 2) exposure to hazardous biological and environmental materials; 3) motor vehicle incidents; and 4) violence and assaults. PPE can reduce workplace injury in nearly all categories, from sturdy and nonslip footwear preventing falls to skin and eye protection from blood and bodily fluids.

EMS workers face evolving hazards: In 2001, the response effort to the 9/11 terrorist attacks highlighted the need for EMTS to have accessible and maintained reserves of ‘all-hazard’ PPE. First responders were dispatched to the scene with inadequate environmental PPE – like hard hats and respirators - and a dearth of training on how to stay safe in such a multi-hazard event. The equipment that was available lacked interoperability, with pieces from various brands and vendors that didn’t necessarily work well together, and workers struggled with inadequate fit and poor maintenance, such as hard hats and respirators. In the wake of the attack, the California Emergency Medical Services Authority (EMSA) established and released updated PPE standards in 2006. These standards set uniform statewide standards to maximize mutual aid interoperability and keep first responders prepared to stay safe in a wide variety of response environments and scenarios.

Since then, the COVID-19 pandemic brought on unprecedented public health challenges. Additionally, violence against EMS workers has increased in recent years. According to the Centers for Disease Control and Prevention, 2,000 EMS workers experience violence or assault each year at work. In 2017, 3,500 incidents of injury among EMS workers were caused by violence, comprising of 17% of all injuries. In 2008, that number was just 2,100, 10% of all injuries.

In light of the ever-changing EMS landscape, this bill seeks to ensure that PPE standards for EMS workers are brought up to date and kept up to date statewide in the future.

The Emergency Medical Services Authority: This bill gives the responsibility of setting PPE standards to EMSA, the organization which authored the 2006 standards. EMSA provides statewide oversight for the 33 local emergency medical services agencies, which together form the state’s pre-hospital emergency medical system. EMSA’s existing responsibilities include developing the planning and implementation guidelines for EMS systems. Components of this include training, communication, system organization and management, and disaster response. Committee staff notes that adding worker safety standards to this list appears appropriate. 

No existing laws: Keeping EMS PPE standards up to date is currently an unlegislated space. The closest related industry which requires the regular update of PPE standards is firefighting, which was mandated by AB 2146 (Skinner) in 2014. Similar to AB 1792, AB 2146 tasks a committee of industry experts to evaluate whether current PPE standards can be improved and recommend updates every five years. AB 2146 used the National Fire Protection Association, an international nonprofit organization which develops new safety standards for firefighters every five years, as the source of new improvements for the state committee to consider adopting. AB 1792 gives EMSA discretion to develop standards and updates as they see fit.

Arguments in support: The International Association of EMTs and Paramedics write in support, “PPE guidelines for all statewide ambulance personnel have remained untouched for nearly 20 years; given all that we have learned from the COVID-19 pandemic, changing environmental and social landscape, and the advancement of medicine in those two decades, updating these guidelines and establishing formal PPE standards for EMS providers will ensure that dedicated workers who respond to medical emergencies are properly protected in the course of their work.”

The American Federation of State, County and Municipal Employees write in support, “The COVID-19 Pandemic showed how dangerous it is for the state to not have a vast supply of high-quality PPE for ambulance personnel. A 2020 study found that COVID-19 infection rates among healthcare workers would have been much lower if the state had enough proper PPE available… While the state took steps during the height of the pandemic to make sure that there was enough PPE for a public health…, the quality of this PPE for ambulance personnel is thus far unregulated by law. Assembly Bill 1792 seeks to resolve this by requiring the Emergency Management Services Authority to develop standards for the PPE used by ambulance personnel.”

Arguments in opposition: None on file.

RELATED AND PRIOR LEGISLATION:

• SB 409 (Kehoe) Chapter 26, Statutes of 2006. This bill appropriated $7 million dollars to provide PPE to firefighter EMTs and ambulance personnel whose agencies could not obtain funding by other means.
• AB 2146 (Skinner) Chapter 811, Statutes of 2014. This bill requires the PPE standards for firefighters to be comprehensively reviewed and updated as needed every five years.
• AB 2537 (Rodriguez) Chapter 313, Statutes of 2020. This bill requires employers of workers in a general acute care hospital to supply employees providing patient care with necessary PPE, and to ensure that the employees use the PPE supplied to them. The bill further requires that an employer maintain a 3 month supply of specified equipment.
• SB 275 (Pan and Leyva) Chapter 301, Statues of 2020. This bill mandated the creation of a PPE stockpile that could supply health care and essential workers for 90 days in a health emergency.
• AB 2092 (Rodriguez) of the 2019-2020 Session. This bill attempted to require emergency ambulance providers to establish a voluntary PPE program that would allow ambulance employees to purchase subsidized multi-threat bulletproof body protective gear, pursuant to an employer-funded stipend. It authorized an employee to voluntarily participate in a PPE program and to wear the PPE while on duty. (Vetoed by the governor.)
• AB 579 (Flora) Chapter 520, Statutes of 2021. This bill expands the purchasing authority of Cal FIRE to include buying PPE from both the Prison Industry Authority, which many state agencies are required to prioritize, and private entities as needed, so as not to deprive firefighters in the state of the quality and quantity of PPE they require.
• AB 805 (Maienschein) of the 2021-2022 Session. This bill attempted to require regional medical coordinators to release regular reports on their distribution of PPE and for those reports to be made public on the Cal OES website. It also defined what constitutes PPE. (Held in Assembly Appropriations.)

REGISTERED SUPPORT / OPPOSITION:

Support

AFSCME CA
International Association of EMTs and Paramedics

Opposition

None on file.

Analysis Prepared by: Sarina Patel / E.M. / (916) 319-3802