Existing law, the California Emergency Services Act, authorizes use of the Emergency Alert System to inform the public of local, state, and national emergencies. Existing law authorizes a law enforcement agency to request the Department of the California Highway Patrol to activate a Feather Alert, as defined, if the law enforcement agency determines that specified criteria are satisfied with respect to an endangered indigenous person who has been reported missing under unexplained or suspicious circumstances. Existing law requires the department, if it concurs that those specified requirements are met, to activate a Feather Alert within the appropriate geographical area requested by the investigating law enforcement agency and to assist the agency by disseminating specified alert messages and signs. Existing law requires the department to create and submit a report to the Governors office and the Legislature that includes an evaluation of the Feather Alert, as specified.

This bill would require the department, in consultation with specified groups including tribal nations, to develop policies and procedures providing instruction specifying how a law enforcement agency and certain entities involved in emergency warnings are required to proceed after a missing person has been reported to a law enforcement agency, as defined, and prescribed conditions are met. The bill would require those policies and procedures to include, among other things, procedures for the transfer of information regarding the missing person and the circumstances surrounding the missing persons disappearance, as specified.

This bill would require the department to respond to a law enforcement agencys or tribes request to activate a Feather Alert within 48 hours of receiving the request. The bill would require the department to take reasonable steps to confirm that a report from a missing persons family members is not an attempt to locate an indigenous person who is intentionally avoiding or evading abuse, as specified. If the department declines to activate a Feather Alert, the bill would require it to provide written notice to the requesting law enforcement agency or tribe, as specified.

This bill would revise the conditions under which a law enforcement agency or tribe may request the department to activate a Feather Alert. In this regard, the bill would authorize the agency or tribe to make that request if the law enforcement agency determines a Feather Alert would be an effective tool in the investigation of missing and murdered indigenous persons. To make that determination, the bill would require a law enforcement agency to consider prescribed factors, including, among other things, that the agency or tribe believes that the person is in danger and is missing under specified circumstances. The bill would require a law enforcement agency to make that determination within 24 hours following the initial report being made to the agency and would authorize a tribe to directly request the department to activate a Feather Alert if the law enforcement agency does not make a determination within 24 hours. By creating a new duty for local law enforcement agencies, this bill would impose a state-mandated local program.

This bill would revise the reporting requirement described above to require the department to work with law enforcement agencies and tribal nations to create the report and to submit the report no later than January 1, 2027. The bill would require the report to include information on the efficacy and advantages of the Feather Alert, including, but not limited to, statistical data on the number of cases closed and the number of cases that remain open, and the impact of the Feather Alert on other alert programs.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law, the California Emergency Services Act, authorizes use of the Emergency Alert System to inform the public of local, state, and national emergencies. Existing law authorizes a law enforcement agency to request the Department of the California Highway Patrol to activate a Feather Alert, as defined, if the law enforcement agency determines that specified criteria are satisfied with respect to an endangered indigenous person who has been reported missing under unexplained or suspicious circumstances. Existing law requires the department, if it concurs that those specified requirements are met, to activate a Feather Alert within the appropriate geographical area requested by the investigating law enforcement agency and to assist the agency by disseminating specified alert messages and signs. Existing law requires the department to create and submit a report to the Governors office and the Legislature that includes an evaluation of the Feather Alert, as specified.

This bill would require the department, in consultation with specified groups including tribal nations, to develop policies and procedures providing instruction specifying how a law enforcement agency and certain entities involved in emergency warnings are required to proceed after a missing person has been reported to a law enforcement agency, as defined, and prescribed conditions are met. The bill would require those policies and procedures to include, among other things, procedures for the transfer of information regarding the missing person and the circumstances surrounding the missing persons disappearance, as specified.

This bill would require the department to respond to a law enforcement agencys or tribes request to activate a Feather Alert within 48 hours of receiving the request. The bill would require the department to take reasonable steps to confirm that a report from a missing persons family members is not an attempt to locate an indigenous person who is intentionally avoiding or evading abuse, as specified. If the department declines to activate a Feather Alert, the bill would require it to provide written notice to the requesting law enforcement agency or tribe, as specified.

This bill would revise the conditions under which a law enforcement agency or tribe may request the department to activate a Feather Alert. In this regard, the bill would authorize the agency or tribe to make that request if the law enforcement agency determines a Feather Alert would be an effective tool in the investigation of missing and murdered indigenous persons. To make that determination, the bill would require a law enforcement agency to consider prescribed factors, including, among other things, that the agency or tribe believes that the person is in danger and is missing under specified circumstances. The bill would require a law enforcement agency to make that determination within 24 hours following the initial report being made to the agency and would authorize a tribe to directly request the department to activate a Feather Alert if the law enforcement agency does not make a determination within 24 hours. By creating a new duty for local law enforcement agencies, this bill would impose a state-mandated local program.

This bill would revise the reporting requirement described above to require the department to work with law enforcement agencies and tribal nations to create the report and to submit the report no later than January 1, 2027. The bill would require the report to include information on the efficacy and advantages of the Feather Alert, including, but not limited to, statistical data on the number of cases closed and the number of cases that remain open, and the impact of the Feather Alert on other alert programs.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, governs local emergency medical services (EMS) systems. The act establishes the Emergency Medical Services Authority (authority), which is responsible for the coordination and integration of all emergency medical services. Existing law authorizes each county to develop an emergency medical services program and requires a county that does so to designate a local EMS agency (LEMSA). Existing law makes a violation of the act or regulations adopted pursuant to the act punishable as a misdemeanor.

Existing law requires the authority to develop planning and implementation guidelines for emergency medical services systems that address specified components, including the assessment of hospital and critical care centers and data collection and evaluation.

This bill would require the authority to develop planning and implementation guidelines for response times and exemptions. This bill would require the authority to develop a statewide standard methodology for calculation and reporting by a LEMSA of response times for emergency ambulance service providers. The bill would require the authority to ensure the guidelines include a list of specified standardized terminology for a LEMSA to use when granting exemptions or when modifying original response time data for required public reporting of 911 response time. The

Upon the authority adopting a statewide standard, this bill would require a LEMSA to adopt policies and procedures for calculating and reporting of response times. The bill would require a LEMSA to report emergency ambulance services provider response times to the authority in a data dispatch form, as specified. The bill would require an emergency ambulance services provider to report response times to the LEMSA that has jurisdiction over the provider. The bill would require the LEMSA to post emergency ambulance services provider response times monthly on the LEMSAs internet website in specified formats.

Existing law authorizes a LEMSA to adopt policies and procedures for calculating and reporting ambulance patient offload times.

This bill would make adoption of those policies and procedures mandatory.

Existing law requires a LEMSA to annually submit an EMS plan for the EMS area to the authority according to systems, standards, and guidelines established by the authority.

This bill would require a LEMSA to include in an EMS plan the LEMSAs annual budget, a list of administrative exemptions and a list of administrative modifications relating to response time that were approved by the LEMSA, and any exemptions granted by the LEMSA in the previous calendar year. The bill would require a LEMSA to make its plan accessible on its internet website, and would require the authority to make each EMS plan submitted to the authority accessible on the authoritys internet website, as specified. The bill would require a LEMSA to use the above-described standardized terminology developed by the authority to the extent possible.

Because the bill would create new requirements within the act, thereby expanding the scope of an existing crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, governs local emergency medical services (EMS) systems. The act establishes the Emergency Medical Services Authority (authority), which is responsible for the coordination and integration of all emergency medical services. Existing law authorizes each county to develop an emergency medical services program and requires a county that does so to designate a local EMS agency (LEMSA). Existing law makes a violation of the act or regulations adopted pursuant to the act punishable as a misdemeanor.

Existing law requires the authority to develop planning and implementation guidelines for emergency medical services systems that address specified components, including the assessment of hospital and critical care centers and data collection and evaluation.

This bill would require the authority to develop planning and implementation guidelines for response times and exemptions. This bill would require the authority to develop a statewide standard methodology for calculation and reporting by a LEMSA of response times for emergency ambulance service providers. The bill would require the authority to ensure the guidelines include a list of specified standardized terminology for a LEMSA to use when granting exemptions or when modifying original response time data for required public reporting of 911 response time. The bill would require a LEMSA to report emergency ambulance services provider response times to the authority in a data dispatch form, as specified. The bill would require an emergency ambulance services provider to report response times to the LEMSA that has jurisdiction over the provider. The bill would require the LEMSA to post emergency ambulance services provider response times monthly on the LEMSAs internet website in specified formats.

Existing law authorizes a LEMSA to adopt policies and procedures for calculating and reporting ambulance patient offload times.

This bill would make adoption of those policies and procedures mandatory.

Existing law requires a LEMSA to annually submit an EMS plan for the EMS area to the authority according to systems, standards, and guidelines established by the authority.

This bill would require a LEMSA to include in an EMS plan the LEMSAs annual budget, a list of administrative exemptions and a list of administrative modifications relating to response time that were approved by the LEMSA, and any exemptions granted by the LEMSA in the previous calendar year. The bill would require a LEMSA to make its plan accessible on its internet website, and would require the authority to make each EMS plan submitted to the authority accessible on the authoritys internet website, as specified. The bill would require a LEMSA to use the above-described standardized terminology developed by the authority to the extent possible.

Because the bill would create new requirements within the act, thereby expanding the scope of an existing crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, governs local emergency medical services (EMS) systems. The act establishes the Emergency Medical Services Authority (authority), which is responsible for the coordination and integration of all emergency medical services. Existing law authorizes each county to develop an emergency medical services program and requires a county that does so to designate a local EMS agency (LEMSA). Existing law authorizes a LEMSA to create exclusive operating areas in the development of a local EMS plan. Existing law makes a violation of the act or regulations adopted pursuant to the act punishable as a misdemeanor.

Existing law requires the authority to develop planning and implementation guidelines for emergency medical services systems that address specified components, including the assessment of hospital and critical care centers and data collection and evaluation.

This bill would require the authority to develop planning and implementation guidelines for response times and exemptions. This bill would require the authority to develop a statewide standard methodology for calculation and reporting by a LEMSA of response times for emergency ambulance service providers operating in exclusive operating areas. providers. The bill would require the authority to ensure the guidelines include a list of specified standardized terminology for a LEMSA to use when granting exemptions or when modifying original response time data for required public reporting of 911 response time. The bill would require a LEMSA to report emergency ambulance services provider response times to the authority in a data dispatch form, as specified. The bill would require an emergency ambulance services provider to report response times to the LEMSA that has jurisdiction over the provider. The bill would require the LEMSA to post emergency ambulance services provider response times monthly on the LEMSAs internet website in specified formats.

Existing law authorizes a LEMSA to adopt policies and procedures for calculating and reporting ambulance patient offload times.

This bill would make adoption of those policies and procedures mandatory.

Existing law requires a LEMSA to annually submit an EMS plan for the EMS area to the authority according to systems, standards, and guidelines established by the authority.

This bill would require a LEMSA to include in an EMS plan the LEMSAs annual budget, a list of administrative exemptions and a list of administrative modifications relating to response time that were approved by the LEMSA, and any exemptions granted by the LEMSA in the previous calendar year. The bill would require a LEMSA to make its plan accessible on its internet website, and would require the authority to make each EMS plan submitted to the authority accessible on the authoritys internet website, as specified. The bill would require a LEMSA to use the above-described standardized terminology developed by the authority to the extent possible.

Because the bill would create new requirements within the act, thereby expanding the scope of an existing crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, governs local emergency medical services (EMS) systems. The act establishes the Emergency Medical Services Authority (authority), which is responsible for the coordination and integration of all emergency medical services. Existing law authorizes each county to develop an emergency medical services program and requires a county that does so to designate a local EMS agency (LEMSA). Existing law authorizes a LEMSA to create exclusive operating areas in the development of a local EMS plan. Existing law makes a violation of the act or regulations adopted pursuant to the act punishable as a misdemeanor.

Existing law requires the authority to develop planning and implementation guidelines for emergency medical services systems that address specified components, including the assessment of hospital and critical care centers and data collection and evaluation.

This bill would require the authority to develop planning and implementation guidelines for response times. times and exemptions. This bill would require the authority to develop a statewide standard methodology for calculation and reporting by a LEMSA of response time. times for emergency ambulance service providers operating in exclusive operating areas. The bill would require the authority to ensure the guidelines include a list of specified standardized terminology for a LEMSA to use when granting exemptions or when modifying original response time data for public and contractual required public reporting of 911 response time. The bill would require a LEMSA to report contracted emergency ambulance services provider response times to the authority in a data dispatch form, as specified. The bill would require a noncontracted ambulance an emergency ambulance services provider to report response times to the LEMSA that has jurisdiction over the provider. The bill would require the LEMSA to post contracted and noncontracted emergency ambulance services provider response times monthly on the LEMSAs internet website in specified formats.

Existing law authorizes a LEMSA to adopt policies and procedures for calculating and reporting ambulance patient offload times.

This bill would make adoption of those policies and procedures mandatory.

Existing law requires a LEMSA to annually submit an EMS plan for the EMS area to the authority according to systems, standards, and guidelines established by the authority.

This bill would require a LEMSA to include in an EMS plan the LEMSAs annual budget, a list of administrative exemptions and a list of administrative modifications relating to response time that were approved by the LEMSA, and any exemptions granted by the LEMSA in the previous calendar year. The bill would require a LEMSA to make its plan accessible on its internet website, and would require the authority to make each EMS plan submitted to the authority accessible on the authoritys internet website, as specified. The bill would require a LEMSA to use the above-described standardized terminology developed by the authority to the extent possible.

Because the bill would create new requirements within the act, thereby expanding the scope of an existing crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, governs local emergency medical services (EMS) systems. The act establishes the Emergency Medical Services Authority (authority), which is responsible for the coordination and integration of all emergency medical services. Existing law authorizes each county to develop an emergency medical services program and requires a county that does so to designate a local EMS agency (LEMSA). Existing law makes a violation of the act or regulations adopted pursuant to the act punishable as a misdemeanor.

Existing law requires the authority to develop planning and implementation guidelines for emergency medical services systems that address specified components, including the assessment of hospital and critical care centers and data collection and evaluation.

This bill would require the authority to develop planning and implementation guidelines for response times. This bill would require the authority to develop a statewide standard methodology for calculation and reporting by a LEMSA of response time. The bill would require the authority to ensure the guidelines include a list of specified standardized terminology for a LEMSA to use when granting exemptions or when modifying original response time data for public and contractual reporting of 911 response time. The bill would require a LEMSA to report contracted provider response times to the authority in a data dispatch form, as specified. The bill would require a noncontracted ambulance provider to report response times to the LEMSA that has jurisdiction over the provider. The bill would require the LEMSA to post contracted and noncontracted provider response times monthly on the LEMSAs internet website in specified formats.

Existing law authorizes a LEMSA to adopt policies and procedures for calculating and reporting ambulance patient offload times.

This bill would make adoption of those policies and procedures mandatory.

Existing law requires a LEMSA to annually submit an EMS plan for the EMS area to the authority according to systems, standards, and guidelines established by the authority.

This bill would require a LEMSA to include in an EMS plan the LEMSAs annual budget, a list of administrative exemptions and a list of administrative modifications relating to response time that were approved by the LEMSA, and any exemptions granted by the LEMSA in the previous calendar year. The bill would require a LEMSA to make its plan accessible on its internet website, and would require the authority to make each EMS plan submitted to the authority accessible on the authoritys internet website, as specified. The bill would require a LEMSA to use the above-described standardized terminology developed by the authority to the extent possible.

Because the bill would create new requirements within the act, thereby expanding the scope of an existing crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 2348

Author:(Ramos)

As Amended Ver:August 28, 2024

Majority vote

SUMMARY

This bill requires the California Highway Patrol (CHP) to develop policies and procedures on how a Feather Alert (Alert) is activated, authorizes specified entities to directly request Alert activations, expands the criteria for determining whether to request and activate an Alert, outlines how decisions about activations are communicated, and establishes timelines for Alert Activation decisions and, if necessary, the proceeding activations.

Senate Amendments

Strikes the entire bill's text and adds the following:

1. Requires CHP, in consultation with tribal nations, the Department of Justice, and other law enforcement stakeholders, as specified, to develop policies and procedures for how law enforcement, alert broadcasters, and any intermediate entities may activate the Alert, as specified.
2. Authorizes law enforcement agencies or tribal nations to directly request CHP to activate the Alert.
3. Requires CHP to respond to a law enforcement or tribe request for Alert activation within 48 hours and, when declining an activation, provide the requesting entity a written notice, as specified.
4. Requires CHP to make all reasonable efforts to locate the missing person, as specified, and take reasonable steps to ensure the reported missing person is not intentionally avoiding abuse, as specified.
5. Requires law enforcement to make a determination as to whether a missing person report meets the requirement to issue a Feather Alert within 24 hours
6. Authorizes a Tribe of California, when law enforcement does not make a determination within 24 hours, to directly request a Feather Alert activation from CHP.

COMMENTS

Gut and Amend with Language from AB 1863: This bill is now nearly identical to AB 1863 (Ramos) of this session, with exceptions noted below. AB 1863 was passed by both houses but, according to the author's office, requires the following changes before becoming statute:

1. Requires law enforcement to make a determination as to whether a missing person report meets the requirement to issue a Feather Alert within 24 hours
2. Authorizes a Tribe of California, when law enforcement does not make a determination within 24 hours, to directly request a Feather Alert activation from CHP.

Equity Impact: According to the author's staff, "The bill will directly impact California tribes, and allow them to find their missing people faster and potentially bring them home safely."

California Alert Systems: The first alert system developed in California was "Amber Alert," which authorized law enforcement agencies to use digital messaging on overhead roadway signs to assist in recovery efforts for child abduction cases. After a successful implementation, the state developed the "Blue Alert" and the "Silver Alert" notification systems. The "Blue Alert" system provides for public notification when a law enforcement officer is attacked, and the "Silver Alert" notification system provides for public notification when either 1) a person age 65 years or older or 2) a person who is developmentally disabled or cognitively impaired is missing. In January 2023, CHP launched the Feather Alert System to aid in locating involuntarily abducted or kidnapped Indigenous people. In January 2023, CHP also re-launched the Yellow Alert system to aid in apprehending an individual involved in a hit-and-run crash that caused a death. Each of the above systems are reflected in current statute. As of January 2024, the Endangered Missing Advisory (EMA) Alert Program was codified to issue and coordinate alerts with respect to a person who is at risk, developmentally disabled, or cognitively impaired, or who has been abducted.

This bill makes changes to the existing Feather Alert System.

Missing and Murdered Indigenous Women and People (MMIWP): California has the largest population of Indigenous people compared to any other state. In 2020, the Sovereign Bodies Institute published a report identifying 165 MMIWP and Two Spirit cases reported throughout California. As of 2020, these results identified California as the state with the fifth highest number of cases.

The National Institute of Justice 2016 report made the following findings:

1. 84% of American Indian/Alaska Native women (1.5 million people) experience violence in their lifetimes
2. 67% were concerned for their own safety, and
3. 41% had been physically injured from physical violence by intimate partners, stalking, and sexual violence.

It is important to note that, due to underreporting, racial misclassification, and prejudice, these statistics likely do not reflect the true number of cases.

According to the Author

"Missing and Murdered Indigenous Persons is at an all time high in the State of California. This crisis has been plaguing California tribes for generations, and progress has been slow to solve this. In 2022, I introduced AB 1314, the Feather Alert, the first of its kind law in the nation which was ultimately signed into law. However, since the passing of the bill, tribes and advocates have experienced difficulty in utilizing this law, citing roadblocks from law enforcement and from the State. AB 1863 would make fixes to established law, in the hopes of finding our loved ones and bring them home."

Arguments in Support

None on file.

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Committee on Appropriations:

1. Absorbable costs to CHP to develop Feather Alert procedures and issue a significant increase in Feather Alerts pursuant to the expanded alert criteria. CHP notes that the magnitude of costs is dependent on how many Feather Alert requests are received. In 2023, CHP handled 263 alert activations for missing and wanted persons, but only one was a Feather Alert. However, thus far, in 2024, CHP has activated three Feather Alerts. Given the year-over-year increase in alert activations and the proposed expansion to the scope of the alert, CHP anticipates activating approximately 40 or more Feather Alerts per year.
2. Minor and absorbable costs to DOJ to consult with CHP on Feather Alert procedures.

VOTES:

ASM EMERGENCY MANAGEMENT: 7-0-1

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

ABS, ABST OR NV: Bennett

ASM HEALTH: 16-0-0

YES: Bonta, Waldron, Aguiar-Curry, Arambula, Wendy Carrillo, Flora, Haney, Jones-Sawyer, Maienschein, McCarty, Joe Patterson, Rodriguez, Sanchez, Santiago, Schiavo, Weber

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: 71-0-9

YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, 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, Robert Rivas

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

UPDATED

VERSION: August 28, 2024

CONSULTANT: Ryan Fleming/ E.M. / (916) 319-3802 FN: 0005019

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

AB 2348 (Ramos) - California Emergency Services Act: notification systems: Feather Alert

Bill Summary:

AB 2348 authorizes tribes and local law enforcement agencies to request CHP to activate the Feather Alert, as specified.

Fiscal Impact:

• Unknown, potentially significant ongoing state costs (Motor Vehicle Account) to the California Highway Patrol (CHP). CHP indicates that the fiscal impact will largely depend on the number of Feather Alert requests received and the number of alerts the department must directly determine as actual missing persons cases. In 2023, CHP handled 263 alert activations across all missing and wanted person alerts. In that same year, the first year of the Feather Alert being in effect, only one Feather Alert was activated. So far, in 2024, CHP has activated five Feather Alerts. Given the year-over-year increase in activations and the proposed expansion of CHP responsibilities in the legislation, the department anticipates a continued increase in Feather Alert requests and subsequent activations as well as an overall increase in workload. While it is challenging to estimate the resulting increase in workload due to the uncertainties surrounding the impact of the revised standards and processes, a rise in overall requests and direct requests to the CHP is anticipated. This, along with the data collection and analysis required for mandated legislative reporting, will necessitate the addition of one officer position at an estimated cost of approximately $300,000 for the first year, and $282,000 for each subsequent year. The increased responsibilities may also impact field staffing, potentially leading to the need for one to five additional officer positions, with costs ranging from hundreds of thousands to several million dollars, depending on the extent of the increased workload that materializes. (See Staff Comments)
  
• Unknown, ongoing costs (General Fund, local funds) for local law enforcement agencies to make the required determinations regarding Feather Alert activations. By creating a new duty for local law enforcement agencies, this bill would impose a state-mandated local program.

Background:

The America's Missing: Broadcast Emergency Response (AMBER) Alert was California’s first alert system to help find missing persons, allowing CHP to activate the Emergency Alert System in certain cases when a child under the age of 17 or individual with a proven mental or physical disability has been abducted and is in imminent danger of serious bodily injury or death. Subsequent alert systems for public notification now include the Blue Alert when a law enforcement officer is attacked; the Silver Alert when a person age 65 or older or a person with developmental disabilities or cognitive impairment is missing; the Feather Alert when an indigenous person is abducted or kidnapped; the Ebony Alert for the disappearance of a Black person; and, the Yellow Alert to aid in apprehending a person involved in a hit-and-run crash causing death.

In 2022, the Feather Alert was established to aid in location of an Indigenous person who has been abducted or kidnapped. According to the Yurok Tribe, early implementation of the Feather Alert has exposed gaps in how the system works. This bill modifies and clarifies how and when a Feather Alert is activated.

Proposed Law:

• Requires CHP, in consultation with tribes and law enforcement, to develop policies and procedures for how law enforcement, alert broadcasters, and any intermediate entities may activate the Feather Alert.
• Defines “Tribe” or “Tribe of California” as a Native American tribe located in California that is on the contact list maintained by the Native American Heritage Commission, as specified.
• Authorizes local law enforcement agencies and tribal nations to directly request CHP to activate the Feather Alert, as specified.
• Requires law enforcement agencies to make a determination as to whether to request CHP to activate Feather Alert within 24 hours of an initial report being made to the agency, as specified.
  
• Provides that, if the law enforcement agency does not make a determination within 24 hours, then the tribe may directly request CHP to activate a Feather Alert.
• Requires CHP to respond to a law enforcement or tribe request for a Feather Alert activation within 48 hours and, when declining an activation, provide the requesting entity a written notice, as specified.
• Requires CHP to make all reasonable efforts to locate the missing person, as specified, and take reasonable steps to ensure the reported missing person is not intentionally avoiding abuse, as specified.

Related Legislation:

• AB 1314 (Ramos), Statutes of 2022, Chapter 476, established the Feather Alert.
• AB 1863 (Ramos) is substantially similar to this bill. AB 1863 was enrolled and presented to the Governor on August 19, 2024. This bill, which was gutted and amended on the Senate Floor on August 28, 2024, would include all of the changes proposed by AB 1863, and additionally includes a 24-hour requirement for law enforcement to make a determination as to whether a missing person report meets the requirement to issue a Feather alert, and clarifies that, if the determination is not made within 24 hours, a tribe can directly request CHP to activate a Feather Alert.

Staff Comments:

In its analysis of the Governor’s proposed 2024-25 Budget, the Legislative Analyst’s Office noted that the Motor Vehicle Account is expected to fully exhaust its reserves and become insolvent in 2025-26. Specifically, the administration projects expenditures will exceed available resources by roughly $140 million in 2025-26. Absent actions to address the Motor Vehicle Account fund condition, approving any new proposals that would increase Motor Vehicle Account expenditures would exacerbate the structural imbalance and hasten the insolvency timeline.

-- END --

 THIRD READING  

Bill No: AB 2348

Author: Ramos (D)

Amended: 8/28/24 in Senate

Vote: 21

SENATE PUBLIC SAFETY COMMITTEE: 5-0, 8/29/24

AYES: Wahab, Seyarto, Bradford, Skinner, Wiener

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/30/24

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

ASSEMBLY FLOOR: Not relevant

SUBJECT: California Emergency Services Act: notification systems: Feather Alert

SOURCE: Author

DIGEST:

This bill revises the changes proposed by AB 1863 (Ramos 2024) to include a 24-hour requirement for law enforcement to make a determination as to whether a missing person report meets the requirement to issue a Feather alert, and if the determination is not made within 24 hours, a Tribe of California can make a request to issue the alert directly to CHP.

ANALYSIS:

Senate Floor Amendments of 8/28/24, gutted and amended to include the 24-hour requirement mentioned above in the digest.

Existing law:

1. Authorizes the CHP to activate a “Feather Alert” upon request by a law enforcement agency and the following requirements are met:
2. The missing person is an indigenous woman or an indigenous person;
3. The investigating law enforcement agency has utilized available and tribal resources;
4. The law enforcement agency determines that the person has gone missing under unexplained or suspicious circumstances;
5. The law enforcement agency determines that the person is in danger because of age, health, mental or physical disability, environment or weather conditions, that the person is in the company of potentially dangerous person, or there are other factors that indicate that the person might be in peril; and,
6. There is information available that, if disseminated to the public could assist in the safe recovery of the missing person. (Gov. Code § 8594.13 (c).)
7. Provides that if the CHP determines that the conditions for the activation of a “Feather Alert” are met, it shall activate the alert in the appropriate geographical area requested by the investigating law enforcement agency. (Gov. Code § 8594. 13 (b) (1).
8. States that the CHP may use a changeable message system if the law enforcement determines that a vehicle was used in the incident and there is specific identifying information about the vehicle. (Gov. Code § 8594.13 (b) (4).
9. Defines “Feather Alert” as an activation system designed to issue and coordinate alerts with endangered or indigenous people, specifically indigenous women, who are reported missing under unexplained or suspicious circumstances. (Gov. Code § 8594.13 (a).)
10. Provides that the CHP shall create and submit a report to the Governor’s office and the Legislature that includes an evaluation of the Feather Alert, including the efficacy, the advantages, and the impact of other alert programs. The CHP shall submit the report to the Governor’s office and the Legislature no later than January 1, 2027. (Gov. Code § 8594.13 (d).
11. States that if an abduction has been reported to a law enforcement agency and the agency determines that a child 17 years of age or younger, or an individual with a proven mental or physical disability, has been abducted and is in imminent danger of serious bodily injury or death and there is information available that, if disseminated to the general public, could assist in the safe recovery of the victim, the agency, through a person authorized to activate the Emergency Alert System (EAS), shall request the activation of the EAS within the appropriate local area. (Gov. Code, § 8594 (a).)
12. Provides that CHP in consultation with the Department of Justice, as well as a representative from the California State Sheriffs' Association (CSSA), the California Police Chiefs' Association and the California Police Officers' Association shall develop policies and procedures providing instructions specifying how law enforcement agencies, broadcasters participating in the EAS, and where appropriate, other supplemental warning systems, shall proceed after qualifying abduction has been reported to a law enforcement agency. (Gov. Code, § 8594 (b).)
13. Defines a “Blue Alert” as a quick response system designed to issue and coordinate alerts following an attack upon a law enforcement officer, as specified. (Gov. Code, § 8594.5, (a).)
14. Provides that in addition to the circumstances described under existing law relating to "Amber Alerts", upon the request of an authorized person at a law enforcement agency that is investigating an offense, the CHP shall activate the EAS and issue a blue alert if all of the following conditions are met:
15. A law enforcement officer has been killed, suffers serious bodily injury, or is assaulted with a deadly weapon, and the suspect has fled the scene of the offense;
16. A law enforcement agency investigating the offense has determined that the suspect poses an imminent threat to the public or other law enforcement personnel;
17. A detailed description of the suspect’s vehicle or license plate is available for broadcast;
18. Public dissemination of available information may help avert further harm or accelerate apprehension of the suspect; and,
19. The CHP has been designated to use the federally authorized EAS for the issuance of blue alerts. (Gov. Code, § 8594.5 (b).)
20. Provides that the "Blue Alert" system incorporates a variety of notification resources and developing technologies that may be tailored to the circumstances and geography of the underlying attack. The blue alert system shall utilize the state-controlled Emergency Digital Information System, (EDIS) local digital signs, focused text, or other technologies, as appropriate, in addition to the federal EAS, if authorized and under conditions permitted by the federal government. (Gov. Code, § 8594.5 (c).)
21. Defines a "Silver Alert" as a notification system, that can be activated as specified, and is designed to issue and coordinate alerts with respect to a person 65 years of age or older who is reported missing. (Gov. Code, § 8594.10 (a)).
22. Provides that if a person is reported missing to a law enforcement agency, and that agency determines that specified requirements are met, the agency may request the CHP to activate a "Silver Alert". If the CHP concurs that the specified requirements are met, it shall activate a "Silver Alert" within the geographical area requested by the investigating law enforcement agency. (Gov. Code § 8594.10. (c).)
23. States that a law enforcement agency may request a "Silver Alert" be activated if that agency determines that all of the following conditions are met in regard to the investigation of the missing person:
24. The missing person is 65 years of age or older;
25. The investigating law enforcement agency has utilized all available local resources;
26. The law enforcement agency determines that that the person has gone missing under unexplained or suspicious circumstances;
27. The law enforcement agency believes that the person is in danger because of age, health, mental or physical disability, environment or weather conditions, that the person is in the company of a potentially dangerous person, or there are other factors indicating that the person may be in peril; and,
28. There is information available that, if disseminated to the public, could assist in the safe recovery of the missing person. (Gov. Code § 8594.10 (c).)
29. Requires the CHP to create and submit a report to the Governor’s office and the Legislature by January 1, 2027 that includes an evaluation of the Feather Alert, including the efficacy, the advantages, and the impact to other alert programs. (Gov. Code § 8594.13 (d).)
30. Defines sexual battery as the touching of an intimate part of another person, if the touching is against the will of the person touched, and is for the specific purpose of sexual arousal, sexual gratification, or sexual abuse and punishes the act by imprisonment in the county jail not exceeding 6 months and a fine of up to $1,000. (Pen. Code, § 243.4, subd. (d).)
31. Provides that any person who willfully inflicts corporal injury resulting in a traumatic condition upon a victim, as described, is guilty of a felony. Provides that the punishment is imprisonment in the state prison for two, three, or four years, or in a county jail for not more than one year, or by a fine of up to $6,000, or by both that fine and imprisonment. (Pen. Code, § 273.5, subd. (a).)
32. Provides that the above penalty applies if the victim is or was one or more of the following:
33. The offender’s spouse or former spouse.
34. The offender’s cohabitant or former cohabitant.
35. The offender’s fiancé or fiancée, or someone with whom the offender has, or previously had, an engagement or dating relationship, as defined.
36. The mother or father of the offender’s child. (Pen. Code, § 273.5, subd. (b).)

This bill:

1. Requires a law enforcement agency to make a determination as to whether a missing person report meets the requirements for a Feather Alert to be issued within 24 hours of receiving the initial report.
2. Clarifies that if the law enforcement agency does not make a determination within 24 hours, a Tribe of California may make the request to issue a Feather Alert directly to CHP.

Background

Murdered or Missing Indigenous Persons (MMIP) in California and the U.S. The problem of MMIP reaches across state lines. In 2018, the Urban Indian Health Institute (UIHI) published a study addressing MMIP titled Missing and Murdered Indigenous Women & Girls, A snapshot of date from 71 urban cities in the United States. (Available at: https://www.uihi.org/wp-content/uploads/2018/11/Missing-and-Murdered-Indigenous-Women-and-Girls-Report.pdf [as of Mar. 26, 2024].) They state in part, “the National Crime Information Center reports that, in 2016, there were 5,712 reports of missing American Indian and Alaska Native women and girls, though the US Department of Justice’s federal missing persons database, NamUs, only logged 116 cases.” (Missing and Murdered Indigenous Women & Girls, supra, at p. 2.) The lack of information, underreporting, and misinformation on MMIPs leads to various discrepancies as to how local, state, and federal agencies responds to this ongoing crisis. The UIHI tried, repeatedly, to gather information from various sources including, but not limited to, law enforcement agencies, state and national databases, and media coverage regarding MMIP. Some sources either did not respond or found it to laborious to produce or provide information for MMIP.

In their report, the UIHI states, “As demonstrated by the findings of this study, reasons for the lack of quality data include underreporting, racial misclassification, poor relationships between law enforcement and American Indian and Alaska Native communities, poor record-keeping protocols, institutional racism in the media, and a lack of substantive relationships between journalists and American Indian and Alaska Native communities. In an effort to collect as much case data as possible and to be able to compare the five data sources used, UIHI collected data from Freedom of Information Act (FOIA) requests to law enforcement agencies, state and national missing persons databases, searches of local and regional news media online archives, public social media posts, and direct contact with family and community members who volunteered information on missing or murdered loved ones.” (Missing and Murdered Indigenous Women & Girls, supra, at p. 4.)

According to a memo produced by the Yurok Tribe in Partnership with Strong Hearted Native Women’s Coalition, provided to this committee by the author, Recommendations for Federal and State Leaders Addressing the Crisis of Missing and Murdered Indigenous People, “California has over 109 federally recognized native tribes, and has the largest population of Native Americans of any state in the United States and the fifth largest caseload of Missing and Murdered Indigenous People (MMIP).” The report gives direct insight into the needs of indigenous groups who live and reside in California. The memo makes recommendations specifically for California, including the creation of a Red Ribbon Panel to address MMIP.

This bill seeks to refine the existing system in California that is responsible for locating missing indigenous persons by better specifying the conditions required to activate a Feather Alert and providing more transparency when activation requests are denied. By creating standardized policies among various levels of law enforcement agencies and tribal nations, this bill would increase understanding of the system and allow improved collaboration among the agencies responsible for locating missing persons. This bill would also produce more data regarding missing indigenous persons and the impact that the Feather Alert on finding missing indigenous persons. When considering that there is a clear lack of data in this space, this bill could potentially provide much needed information.

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

SUPPORT: (Verified 8/30/24)

None received

OPPOSITION: (Verified 8/30/24)

None received

Prepared by: John Duncan / PUB. S. /

8/30/24 17:27:01

**** END ****

 THIRD READING  

Bill No: AB 2348

Author: Rodriguez (D)

Amended: 8/23/24 in Senate

Vote: 21

SENATE HEALTH COMMITTEE: 10-0, 6/12/24

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

NO VOTE RECORDED: Smallwood-Cuevas

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

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

ASSEMBLY FLOOR: 71-0, 5/21/24 - See last page for vote

SUBJECT: Emergency medical services

SOURCE: Author

DIGEST:

This bill revises the changes proposed by AB 1863 (Ramos 2024) to include a 24-hour requirement for law enforcement to make a determination as to whether a missing person report meets the requirement to issue a Feather alert, and if the determination is not made within 24 hours, a Tribe of California can make a request to issue the alert directly to CHP.

Senate Floor Amendments of 8/23/24, gutted and amended to include the 24-hour requirement mentioned above in the digest.

ANALYSIS:

Existing law:

1. Authorizes the CHP to activate a “Feather Alert” upon request by a law enforcement agency and the following requirements are met:
2. The missing person is an indigenous woman or an indigenous person;
3. The investigating law enforcement agency has utilized available and tribal resources;
4. The law enforcement agency determines that the person has gone missing under unexplained or suspicious circumstances;
5. The law enforcement agency determines that the person is in danger because of age, health, mental or physical disability, environment or weather conditions, that the person is in the company of potentially dangerous person, or there are other factors that indicate that the person might be in peril; and,
6. There is information available that, if disseminated to the public could assist in the safe recovery of the missing person. (Gov. Code § 8594.13 (c).)
7. Provides that if the CHP determines that the conditions for the activation of a “Feather Alert” are met, it shall activate the alert in the appropriate geographical area requested by the investigating law enforcement agency. (Gov. Code § 8594. 13 (b) (1).
8. States that the CHP may use a changeable message system if the law enforcement determines that a vehicle was used in the incident and there is specific identifying information about the vehicle. (Gov. Code § 8594.13 (b) (4).
9. Defines “Feather Alert” as an activation system designed to issue and coordinate alerts with endangered or indigenous people, specifically indigenous women, who are reported missing under unexplained or suspicious circumstances. (Gov. Code § 8594.13 (a).)
10. Provides that the CHP shall create and submit a report to the Governor’s office and the Legislature that includes an evaluation of the Feather Alert, including the efficacy, the advantages, and the impact of other alert programs. The CHP shall submit the report to the Governor’s office and the Legislature no later than January 1, 2027. (Gov. Code § 8594.13 (d).
11. States that if an abduction has been reported to a law enforcement agency and the agency determines that a child 17 years of age or younger, or an individual with a proven mental or physical disability, has been abducted and is in imminent danger of serious bodily injury or death and there is information available that, if disseminated to the general public, could assist in the safe recovery of the victim, the agency, through a person authorized to activate the Emergency Alert System (EAS), shall request the activation of the EAS within the appropriate local area. (Gov. Code, § 8594 (a).)
12. Provides that CHP in consultation with the Department of Justice, as well as a representative from the California State Sheriffs' Association (CSSA), the California Police Chiefs' Association and the California Police Officers' Association shall develop policies and procedures providing instructions specifying how law enforcement agencies, broadcasters participating in the EAS, and where appropriate, other supplemental warning systems, shall proceed after qualifying abduction has been reported to a law enforcement agency. (Gov. Code, § 8594 (b).)
13. Defines a “Blue Alert” as a quick response system designed to issue and coordinate alerts following an attack upon a law enforcement officer, as specified. (Gov. Code, § 8594.5, (a).)
14. Provides that in addition to the circumstances described under existing law relating to "Amber Alerts", upon the request of an authorized person at a law enforcement agency that is investigating an offense, the CHP shall activate the EAS and issue a blue alert if all of the following conditions are met:
15. A law enforcement officer has been killed, suffers serious bodily injury, or is assaulted with a deadly weapon, and the suspect has fled the scene of the offense;
16. A law enforcement agency investigating the offense has determined that the suspect poses an imminent threat to the public or other law enforcement personnel;
17. A detailed description of the suspect’s vehicle or license plate is available for broadcast;
18. Public dissemination of available information may help avert further harm or accelerate apprehension of the suspect; and,
19. The CHP has been designated to use the federally authorized EAS for the issuance of blue alerts. (Gov. Code, § 8594.5 (b).)
20. Provides that the "Blue Alert" system incorporates a variety of notification resources and developing technologies that may be tailored to the circumstances and geography of the underlying attack. The blue alert system shall utilize the state-controlled Emergency Digital Information System, (EDIS) local digital signs, focused text, or other technologies, as appropriate, in addition to the federal EAS, if authorized and under conditions permitted by the federal government. (Gov. Code, § 8594.5 (c).)
21. Defines a "Silver Alert" as a notification system, that can be activated as specified, and is designed to issue and coordinate alerts with respect to a person 65 years of age or older who is reported missing. (Gov. Code, § 8594.10 (a)).
22. Provides that if a person is reported missing to a law enforcement agency, and that agency determines that specified requirements are met, the agency may request the CHP to activate a "Silver Alert". If the CHP concurs that the specified requirements are met, it shall activate a "Silver Alert" within the geographical area requested by the investigating law enforcement agency. (Gov. Code § 8594.10. (c).)
23. States that a law enforcement agency may request a "Silver Alert" be activated if that agency determines that all of the following conditions are met in regard to the investigation of the missing person:
24. The missing person is 65 years of age or older;
25. The investigating law enforcement agency has utilized all available local resources;
26. The law enforcement agency determines that that the person has gone missing under unexplained or suspicious circumstances;
27. The law enforcement agency believes that the person is in danger because of age, health, mental or physical disability, environment or weather conditions, that the person is in the company of a potentially dangerous person, or there are other factors indicating that the person may be in peril; and,
28. There is information available that, if disseminated to the public, could assist in the safe recovery of the missing person. (Gov. Code § 8594.10 (c).)
29. Requires the CHP to create and submit a report to the Governor’s office and the Legislature by January 1, 2027 that includes an evaluation of the Feather Alert, including the efficacy, the advantages, and the impact to other alert programs. (Gov. Code § 8594.13 (d).)
30. Defines sexual battery as the touching of an intimate part of another person, if the touching is against the will of the person touched, and is for the specific purpose of sexual arousal, sexual gratification, or sexual abuse and punishes the act by imprisonment in the county jail not exceeding 6 months and a fine of up to $1,000. (Pen. Code, § 243.4, subd. (d).)
31. Provides that any person who willfully inflicts corporal injury resulting in a traumatic condition upon a victim, as described, is guilty of a felony. Provides that the punishment is imprisonment in the state prison for two, three, or four years, or in a county jail for not more than one year, or by a fine of up to $6,000, or by both that fine and imprisonment. (Pen. Code, § 273.5, subd. (a).)
32. Provides that the above penalty applies if the victim is or was one or more of the following:
33. The offender’s spouse or former spouse.
34. The offender’s cohabitant or former cohabitant.
35. The offender’s fiancé or fiancée, or someone with whom the offender has, or previously had, an engagement or dating relationship, as defined.
36. The mother or father of the offender’s child. (Pen. Code, § 273.5, subd. (b).)

This bill:

1. Requires a law enforcement agency to make a determination as to whether a missing person report meets the requirements for a Feather Alert to be issued within 24 hours of receiving the initial report.
2. Clarifies that if the law enforcement agency does not make a determination within 24 hours, a Tribe of California may make the request to issue a Feather Alert directly to CHP.

Murdered or Missing Indigenous Persons (MMIP) in California and the U.S. The problem of MMIP reaches across state lines. In 2018, the Urban Indian Health Institute (UIHI) published a study addressing MMIP titled Missing and Murdered Indigenous Women & Girls, A snapshot of date from 71 urban cities in the United States. (Available at: https://www.uihi.org/wp-content/uploads/2018/11/Missing-and-Murdered-Indigenous-Women-and-Girls-Report.pdf [as of Mar. 26, 2024].) They state in part, “the National Crime Information Center reports that, in 2016, there were 5,712 reports of missing American Indian and Alaska Native women and girls, though the US Department of Justice’s federal missing persons database, NamUs, only logged 116 cases.” (Missing and Murdered Indigenous Women & Girls, supra, at p. 2.) The lack of information, underreporting, and misinformation on MMIPs leads to various discrepancies as to how local, state, and federal agencies responds to this ongoing crisis.

The UIHI tried, repeatedly, to gather information from various sources including, but not limited to, law enforcement agencies, state and national databases, and media coverage regarding MMIP. Some sources either did not respond or found it to laborious to produce or provide information for MMIP.

In their report, the UIHI states, “As demonstrated by the findings of this study, reasons for the lack of quality data include underreporting, racial misclassification, poor relationships between law enforcement and American Indian and Alaska Native communities, poor record-keeping protocols, institutional racism in the media, and a lack of substantive relationships between journalists and American Indian and Alaska Native communities. In an effort to collect as much case data as possible and to be able to compare the five data sources used, UIHI collected data from Freedom of Information Act (FOIA) requests to law enforcement agencies, state and national missing persons databases, searches of local and regional news media online archives, public social media posts, and direct contact with family and community members who volunteered information on missing or murdered loved ones.” (Missing and Murdered Indigenous Women & Girls, supra, at p. 4.)

According to a memo produced by the Yurok Tribe in Partnership with Strong Hearted Native Women’s Coalition, provided to this committee by the author, Recommendations for Federal and State Leaders Addressing the Crisis of Missing and Murdered Indigenous People, “California has over 109 federally recognized native tribes, and has the largest population of Native Americans of any state in the United States and the fifth largest caseload of Missing and Murdered Indigenous People (MMIP).” The report gives direct insight into the needs of indigenous groups who live and reside in California. The memo makes recommendations specifically for California, including the creation of a Red Ribbon Panel to address MMIP.

This bill seeks to refine the existing system in California that is responsible for locating missing indigenous persons by better specifying the conditions required to activate a Feather Alert and providing more transparency when activation requests are denied. By creating standardized policies among various levels of law enforcement agencies and tribal nations, this bill would increase understanding of the system and allow improved collaboration among the agencies responsible for locating missing persons. This bill would also produce more data regarding missing indigenous persons and the impact that the Feather Alert on finding missing indigenous persons. When considering that there is a clear lack of data in this space, this bill could potentially provide much needed information.

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

SUPPORT: (Verified 8/23/24)

None received

OPPOSITION: (Verified 8/23/24)

None received

ASSEMBLY FLOOR: 71-0, 5/21/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, 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, Robert Rivas

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

Prepared by: John Duncan / PUB. S. /

8/27/24 20:59:48

**** END ****

 THIRD READING  

Bill No: AB 2348

Author: Rodriguez (D)

Amended: 6/17/24 in Senate

Vote: 21

SENATE HEALTH COMMITTEE: 10-0, 6/12/24

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

NO VOTE RECORDED: Smallwood-Cuevas

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

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

ASSEMBLY FLOOR: 71-0, 5/21/24 - See last page for vote

SUBJECT: Emergency medical services

SOURCE: Author

DIGEST:

This bill requires the Emergency Medical Services Authority to develop and adopt a standard methodology for the calculation and reporting of ambulance response times for all emergency ambulance services. Requires local Emergency Medical Services (EMS) agencies to adopt policies and procedures for calculating and reporting response times for emergency ambulance services providers based on the statewide standard.

ANALYSIS:

Existing law:

1. Establishes the Warren-911-Emergency Assistance Act, which requires every public agency to operate a telephone service, which automatically connects a person dialing the digits “911” to an established public safety answering point. Defines “public agency” to include the state, any city or county, or any public district that provides or has authority to provide firefighting, policy, ambulance, or other emergency services. Prohibits public agencies from delegating or subcontracting 911 dispatch services to a private entity, with limited exceptions for contracts that existed prior to the law that prohibited private entities from providing 911 dispatch. [GOV §53100, et seq.]
2. Requires every 911 system to include police, firefighting, and emergency medical and ambulance services. Requires every 911 system, in those areas in which a public safety agency provides ambulance emergency services, to include such public safety agencies. Permits 911 systems to incorporate private ambulance services. [GOV §53110]
3. 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.]
4. Establishes an 18-member Commission on EMS, within the California Health and Human Services Agency. Defines the duties of the Commission to include reviewing regulations, standards, and guidelines developed by EMSA; advising EMSA on a data collection system; advising on emergency facilities and services, emergency communications, medical equipment, personnel training, and various aspects of the EMS system; and, making recommendations for further development of the EMS system. [HSC §1799, et seq.]
5. Requires EMSA to develop, and after approval by the Commission on EMS, adopt a statewide standard methodology for the calculation and reporting by a local EMS agency (LEMSA) of ambulance patient offload time (APOT), using input from stakeholders, including, but not limited to, hospitals, LEMSAs, and public and private EMS providers. [HSC §1797.120]
6. Requires EMSA to develop planning and implementation guidelines for EMS systems, which address the following components: manpower and training; communications; transportation; assessment of hospitals and critical care centers; system organization and management; data collection and evaluation; public information and education; and, disaster response. [HSC §1797.103]
7. Requires EMSA to receive plans for the implementation of EMS systems from LEMSAs, and to permit a LEMSA to implement a plan, unless EMSA determines that the plan does not effectively meet the needs of the persons served or is not consistent with applicable guidelines or regulations established by EMSA. Permits a LEMSA to appeal a determination to the Commission on EMS. [HSC §1797.105]
8. Requires LEMSAs to annually submit an EMS plan for their area to EMSA, according to EMS Systems, Standards, and Guidelines established by EMSA. [HSC §1797.254]

This bill:

1. Requires EMSA to develop, and after approval by the Commission on EMS, adopt a standard methodology for the calculation and reporting of ambulance response times for all emergency ambulance services, in addition to the existing requirement that EMSA adopt a methodology for calculating and reporting APOT. Requires the standard methodology adopted by EMSA for calculating and reporting both emergency ambulance response time and APOT to use a fractal reporting formal report that includes, at a minimum, a 90^th percentile benchmark.
2. Defines, for purposes of this bill, “response time” to mean the interval between the point in time when the address or location is received by the responding EMS provider’s dispatch center and the point in time that the transporting ambulance unit arrives at the provided address or location.
3. Requires EMSA, in developing the statewide standard for reporting ambulance response times, to include a list of standardized terminology for LEMSAs to use when granting exemptions or modifying original response time data for any publicly reported 911 response times. Requires the list of standardized terminology to include common reasons for granting exemptions from 911 response times in the various EMS areas of the state. Additionally, requires the list of standardized terminology to include the following:
   1. “Cancelled calls” means an EMS response in which the responding unit is notified and begins the response, but the response is terminated prior to the responding EMS unit arrival on scene using predefined objective criteria;
   2. “Do not count” means an EMS response generated within the computer-aided dispatch (CAD) incident data that, upon review, does not satisfy the criteria for an EMS response that is subject to compliance monitoring using predefined objective criteria;
   3. “Exemption” means an EMS response where the incident data is administratively excluded from the CAD data used to calculate response interval compliance using predefined objective criteria; and,
   4. “Time correction” means an EMS response where defined points in time in the CAD incident data are administratively modified from the original CAD incident data using predefined objective criteria.
4. Requires LEMSAs, upon EMSA adopting a statewide standard, to adopt policies and procedures for calculating and reporting response times for emergency ambulance services providers, and to use the statewide standard methodology for calculating and reporting response times developed by EMSA pursuant to this bill.
5. Requires LEMSAs, when establishing response time compliance requirements, to weigh the risk to the safety of the responding crew and public against the severity of the medical emergency when determining what level of response and time allotment to require from an emergency ambulance services provider.
6. Requires the response time reporting by a LEMSA to include data from all emergency ambulance services providers where the aggregate annual transport volume of all emergency ambulance transports within for all exclusive operating areas exceeds 7,500 transports per calendar year within their jurisdiction. Specifies that this bill does not prohibit a LEMSA from reporting response interval compliance from emergency ambulance services providers that do not satisfy this transport volume requirement.
7. Requires LEMSAs to report emergency ambulance services provider response times to EMSA in a form that is consistent with the California Emergency Medical Services Information System (CEMSIS) and the National Emergency Medical Services Information System (NEMSIS) standards, including:
   1. The point in time that the dispatch center receives the EMS call;
   2. The point in time that the EMS provider’s dispatch center, that is responsible for directly dispatching the ambulance unit, receives EMS caller data from a public agency dispatch center;
   3. The point in time that the responding ambulance unit is notified of EMS caller data by dispatch;
   4. The point in time that the ambulance unit is en route;
   5. The point in time that the ambulance unit arrives on scene; and,
   6. The emergency medical dispatch code at which the call was dispatched and any upgrades or downgrades, if applicable.
8. Requires a LEMSA to make response times publicly available monthly on the LEMSA’s website both in raw form and on a 90^th percentile fractal compliance scale. Defines “raw form” to mean the response time prior to administrative exemptions or modification.
9. Requires an emergency ambulance services provider to report response times to the LEMSA that has jurisdiction over the provider in the manner described in 7) above. Requires a LEMSA to include on its website the response times provided to the LEMSA by an emergency ambulance services provider. Requires the LEMSA to publish data no more than 60 calendar days after the last day of the monthly reporting period.
10. Specifies that the provisions of this bill do not apply to calls that do not originate in the 911 system.
11. Requires each LEMSA to include in their required annual EMS plan the list of administrative exemptions approved by the LEMSA, if any, relating to 911 response time performance standards; the list of administrative modifications relating to reported response time performance standards approved by the LEMSA, if any; and, any exemptions from meeting 911 response times granted by the LEMSA in the previous calendar year. Requires LEMSAs to utilize the standardized terms established by EMSA pursuant to this bill to the extent possible.
12. Requires local EMS agencies, as part of the requirement to annually submit an EMS plan to EMSA, to include the local EMS agency’s budget, and requires EMSA to approve or request changes to the proposed plans within 90 days of receipt.
13. Requires local EMS agencies to make their annual plans accessible on their website within 30 days of approval by EMSA, and requires EMSA to make each local EMS agency plan submitted to them accessible on EMSA’s internet website as well.

Comments

1. Author’s statement. According to the author, LEMSAs are responsible for planning, coordinating, and improving local emergency and medical response systems. LEMSAs primarily work to organize prehospital services. Their plans provide policies for system organization and management, staffing and training, communication, response and transportation for emergency services, facilities and critical care, data collection and system evaluation, public information and education, disaster medical response, and more. By requiring LEMSAs and EMSA to post approved plans on their websites, we can increase transparency for policymakers, stakeholders, and residents who want to see how emergency management officials are planning for response and care. Additionally, requiring ambulance providers to report publically and to EMSA their 911 response times, and having LEMSAs make public their budgets and exemptions for not meeting 911 response time standards, we can see what may be hindering emergency response, in either planning, response, or simply unpredictable circumstances. This transparency and additional data will help EMSA and LEMSAs in their EMS planning and quality improvement efforts.
2. EMSA draft regulations on local EMS systems. One provision of this bill requires EMSA to approve, or seek changes to, the local EMS area plans that are required to be submitted to EMSA annually for approval within 90 days of receipt. These local EMS plans are supposed to be based on EMS Systems, Standards, and Guidelines that EMSA is required to establish. EMSA developed several guidance documents in 1985 that were revised over the years, but they were never formally adopted as regulations. In 2019, the California Fire Chiefs Association challenged these guidelines as underground regulations. In response, EMSA certified that it would not use or enforce the documents, and subsequently began the process of promulgating regulations. In October of 2019, EMSA released draft regulations to adopt standards, policies, and procedures for the planning and implementation of local EMS systems. Many areas of the EMS Act would be affected by these regulations, including the competitive process a LEMSA would have to follow in order to create an exclusive operating area. Among the many provisions proposed to govern the bidding process, these regulations proposed to explicitly prohibit subcontracting the primary provision of ambulance services by the bidder. The controversy over this subcontracting issue contributed to a decision by EMSA in August 2020 not to proceed with these regulations. This issue also led to the passage of AB 389 (Grayson, Chapter 460, Statutes of 2021), which gave statutory authority for fire agencies to subcontract with private ambulance services. The guidance documents that LEMSAs have historically relied upon to develop their EMS plans can no longer be enforced due to the challenge that they were underground regulations. Consequently, LEMSAs are currently in a gray area of using the old guidance documents despite EMSA’s inability to enforce them, since nothing else has been adopted to replace them. EMSA is continuing to meet with stakeholders to develop a new regulatory package to provide standards, policies and procedures for local EMS systems, and is targeting a final implementation timeline of June 2025. At the March 2024 Commission on EMS meeting, EMSA stated that it was in the final stages of approval for a workgroup with partners on draft language.
3. Background on 911 response times and exemptions. There is no requirement in state law or regulations that first response or ambulance transport meet minimum 911 response times. In most local EMS areas, it is fire departments who arrive first to medical emergencies. But there is no universal or enforceable standard that fire departments respond to medical emergencies, or how fast fire departments are required to arrive at the scene of a medical emergency. As part of the EMS planning, a LEMSA may establish ambulance response times as part of a competitive process in creating an exclusive operating area (EOA). In practice, this approach to EMS planning has led to the imposition of response time standards for private ambulance companies in EOA agreements with LEMSAs, while public fire department-based providers have no LEMSA or external response time requirements. Many LEMSAs use the guidelines established by the National Fire Protection Association (NFPA) to compare response time performance between contracted EOA ambulance services and fire departments. The NFPA response guidelines are as follows:
   1. Dispatch time for medical emergencies: 90 seconds for 90% of the calls (the time it takes for a 911 operator at a dispatch center to relay the call to a provider with the address/location);
   2. Turnout time: 60 seconds for 90% of calls (the time it takes from when the call comes to a provider for the crew to get into the vehicle and leave the station); and,
   3. Travel time: four minutes for 90% of calls for basic life support, and nine minutes for 90% of calls for advanced life support (meaning, a licensed paramedic is part of the crew rather than just an emergency medical technician for basic life support).

LEMSA agreements with response time requirements generally have a set of agreed upon “exemptions” from response time standards for occurrences outside the control of the provider. Examples of recognized exemptions include, but are not limited to, adverse weather such as fog or heavy rain, unexpected road closures, and notably when ambulances are captured at emergency departments waiting to transfer patients for care (APOT delays).

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

According to Senate Appropriations Committee, EMSA estimates General Fund costs, likely high hundreds of thousands to a low million, for state administration.

SUPPORT: (Verified 8/15/24)

American Medical Response
California Fire Chiefs Association
Fire Districts Association of California

OPPOSITION: (Verified 8/15/24)

None received

ARGUMENTS IN SUPPORT: The California Fire Chiefs Association and the Fire Districts Association of California write in support that this bill is a step forward in ensuring there is transparency in the planning processes for California’s emergency care. Under this bill, EMSA would be required to develop a standardized list of exemptions that LEMSAs give to their contract ambulance providers and LEMSAs would be required to report any such granted exemptions as part of their annual plans. This bill would also require ambulance providers to report their 911 response times so that the public and policymakers have a clear picture of emergency response times in the state. American Medical Response states in support that for decades, many agencies have only reported average response times, which is not an accurate depiction of a provider’s true performance. This bill would bring the state closer to informing the public of what actual response times look like.

ASSEMBLY FLOOR: 71-0, 5/21/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, 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, Robert Rivas

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

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

8/18/24 9:07:36

**** END ****

SENATE COMMITTEE ON

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

AB 2348 (Rodriguez) - Emergency medical services

Bill Summary:

AB 2348 would require the Emergency Medical Services Authority (EMSA) to develop and adopt a statewide standard methodology for the calculation and reporting of response times for all emergency ambulance services.

Fiscal Impact:

EMSA estimates General Fund costs, likely high hundreds of thousands to a low million, for state administration.

Background:

Current law establishes the Emergency Medical Services (EMS) System and the Prehospital Emergency Medical Care Personnel Act to provide for a statewide system for EMS and establishes the EMSA which is responsible for the coordination and integration of all state activities concerning EMS. Current law authorizes counties to develop an EMS program and to designate a local EMS agency (LEMSA) responsible for planning and implementing an EMS system. Current law requires LEMSAs to annually submit an EMS plan for their area to EMSA, according to EMS Systems, Standards, and Guidelines established by EMSA.

There is no requirement in state law or regulations that first response or ambulance transport meet minimum 911 response times. In most local EMS areas, it is fire departments who arrive first to medical emergencies. But there is no universal or enforceable standard that fire departments respond to medical emergencies, or how fast fire departments are required to arrive at the scene of a medical emergency. As part of the EMS planning, a LEMSA may establish ambulance response times as part of a competitive process in creating an exclusive operating area (EOA). In practice, this approach to EMS planning has led to the imposition of response time standards for private ambulance companies in EOA agreements with LEMSAs, while public fire department-based providers have no LEMSA or external response time requirements. Many LEMSAs use the guidelines established by the National Fire Protection Association (NFPA) to compare response time performance between contracted EOA ambulance services and fire departments.

Current law requires EMSA to develop a statewide standard methodology for the calculation and reporting by a LEMSA of ambulance patient offload time (APOT). APOT is defined as the interval between the arrival of an ambulance patient at an emergency department, and the time that the patient is transferred to an emergency department gurney, bed, chair, or other acceptable location and the emergency department assumes responsibility for care of the patient. Current law authorizes a LEMSA to adopt policies and procedures for calculating and reporting APOT. Current law requires, by no later than July 1, 2024, every LEMSA to develop a standard not to exceed 30 minutes, 90 percent of the time, for APOT and report the adopted time to EMSA.

Proposed Law:

Specific provisions of the bill would:

• Require, rather than authorize, LEMSAs to adopt policies and procedures for calculating and reporting APOT.
• Require EMSA to develop, and after approval by the Commission on EMS, adopt a statewide standard methodology for the calculation and reporting by a LEMSA of response times for all emergency ambulance services, as specified.
• Require, upon EMSA adopting a statewide standard, LEMSAs to adopt policies and procedures for calculating and reporting response times for emergency ambulance services providers, as specified.
• Require an emergency ambulance services provider to report response times to the LEMSA that has jurisdiction over the provider, as specified.
• Require LEMSAs, as part of the existing requirement to annually submit an EMS plan to EMSA, to include the local EMS agency’s budget and additional information regarding response times, as specified; and require EMSA to approve or request changes to the proposed plans within 90 days of receipt.

Related Legislation:

AB 379 (Rodriguez, 2023) would have required EMSA to develop a list of standardized terminology for LEMSAs to use when granting exemptions for 911 response times and added requirements to the annual LEMSA plans. The bill was held on the suspense file in this committee.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Richard Roth, Chair

BILL NO: AB 2348

SUBJECT: Emergency medical services

SUMMARY:

Requires the Emergency Medical Services Authority to develop and adopt a standard methodology for the calculation and reporting of ambulance response times for all emergency ambulance services. Requires local Emergency Medical Services (EMS) agencies to adopt policies and procedures for calculating and reporting response times for emergency ambulance services providers based on the statewide standard.

Existing law:

1. Establishes the Warren-911-Emergency Assistance Act, which requires every public agency to operate a telephone service, which automatically connects a person dialing the digits “911” to an established public safety answering point. Defines “public agency” to include the state, any city or county, or any public district that provides or has authority to provide firefighting, policy, ambulance, or other emergency services. Prohibits public agencies from delegating or subcontracting 911 dispatch services to a private entity, with limited exceptions for contracts that existed prior to the law that prohibited private entities from providing 911 dispatch. [GOV §53100, et seq.]
2. Requires every 911 system to include police, firefighting, and emergency medical and ambulance services. Requires every 911 system, in those areas in which a public safety agency provides ambulance emergency services, to include such public safety agencies. Permits 911 systems to incorporate private ambulance services. [GOV §53110]
3. 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.]
4. Establishes an 18-member Commission on EMS, within the California Health and Human Services Agency. Defines the duties of the Commission to include reviewing regulations, standards, and guidelines developed by EMSA; advising EMSA on a data collection system; advising on emergency facilities and services, emergency communications, medical equipment, personnel training, and various aspects of the EMS system; and, making recommendations for further development of the EMS system. [HSC §1799, et seq.]
5. Requires EMSA to develop, and after approval by the Commission on EMS, adopt a statewide standard methodology for the calculation and reporting by a local EMS agency (LEMSA) of ambulance patient offload time (APOT), using input from stakeholders, including, but not limited to, hospitals, LEMSAs, and public and private EMS providers. [HSC §1797.120]
6. Defines APOT as the interval between the arrival of an ambulance patient at an emergency department, and the time that the patient is transferred to an emergency department gurney, bed, chair, or other acceptable location and the emergency departments assumes responsibility for care of the patient. [HSC §1797.120]
7. Requires, by July 1, 2024, every LEMSA to develop an APOT standard not to exceed 30 minutes, 90% of the time, and report the adopted time to EMSA. [HSC §1797.120.5(b)]
   
8. Requires EMSA to develop planning and implementation guidelines for EMS systems, which address the following components: manpower and training; communications; transportation; assessment of hospitals and critical care centers; system organization and management; data collection and evaluation; public information and education; and, disaster response. [HSC §1797.103]
9. Requires EMSA to receive plans for the implementation of EMS systems from LEMSAs, and to permit a LEMSA to implement a plan, unless EMSA determines that the plan does not effectively meet the needs of the persons served or is not consistent with applicable guidelines or regulations established by EMSA. Permits a LEMSA to appeal a determination to the Commission on EMS. [HSC §1797.105]
10. Requires LEMSAs to annually submit an EMS plan for their area to EMSA, according to EMS Systems, Standards, and Guidelines established by EMSA. [HSC §1797.254]

This bill:

1. Requires EMSA to develop, and after approval by the Commission on EMS, adopt a standard methodology for the calculation and reporting of ambulance response times for all emergency ambulance services, in addition to the existing requirement that EMSA adopt a methodology for calculating and reporting APOT. Requires the standard methodology adopted by EMSA for calculating and reporting both emergency ambulance response time and APOT to use a fractal reporting formal report that includes, at a minimum, a 90^th percentile benchmark.
2. Defines, for purposes of this bill, “response time” to mean the interval between the point in time when the address or location is received by the responding EMS provider’s dispatch center and the point in time that the transporting ambulance unit arrives at the provided address or location.
3. Requires EMSA, in developing the statewide standard for reporting ambulance response times, to include a list of standardized terminology for LEMSAs to use when granting exemptions or modifying original response time data for any publicly reported 911 response times. Requires the list of standardized terminology to include common reasons for granting exemptions from 911 response times in the various EMS areas of the state. Additionally, requires the list of standardized terminology to include the following:
   1. “Cancelled calls” means an EMS response in which the responding unit is notified and begins the response, but the response is terminated prior to the responding EMS unit arrival on scene using predefined objective criteria;
   2. “Do not count” means an EMS response generated within the computer-aided dispatch (CAD) incident data that, upon review, does not satisfy the criteria for an EMS response that is subject to compliance monitoring using predefined objective criteria;
   3. “Exemption” means an EMS response where the incident data is administratively excluded from the CAD data used to calculate response interval compliance using predefined objective criteria; and,
   4. “Time correction” means an EMS response where defined points in time in the CAD incident data are administratively modified from the original CAD incident data using predefined objective criteria.
4. Requires LEMSAs to adopt policies and procedures for calculating and reporting response times for emergency ambulance services providers, and to use the statewide standard methodology for calculating and reporting response times developed by EMSA pursuant to this bill.
5. Requires LEMSAs, when establishing response time compliance requirements, to weigh the risk to the safety of the responding crew and public against the severity of the medical emergency when determining what level of response and time allotment to require from an emergency ambulance services provider.
6. Requires the response time reporting by a LEMSA to include data from all emergency ambulance services providers where the aggregate annual transport volume of all emergency ambulance transports within for all exclusive operating areas exceeds 7,500 transports per calendar year within their jurisdiction. Specifies that this bill does not prohibit a LEMSA from reporting response interval compliance from emergency ambulance services providers that do not satisfy this transport volume requirement.
7. Requires LEMSAs to report emergency ambulance services provider response times to EMSA in a data dispatch form that is consistent with the California Emergency Medical Services Information System (CEMSIS) and the National Emergency Medical Services Information System (NEMSIS) standards, including:
   1. The point in time that the public safety agency dispatch center receives the EMS call;
   2. The point in time that the EMS provider’s dispatch center, that is responsible for directly dispatching the ambulance unit, receives EMS caller data from a public agency dispatch center;
   3. The point in time that the responding ambulance unit is notified of EMS caller data by dispatch;
   4. The point in time that the ambulance unit is en route;
   5. The point in time that the ambulance unit arrives on scene; and,
   6. The emergency medical dispatch code at which the call was dispatched and any upgrades or downgrades, if applicable.
8. Requires a LEMSA to make response times publicly available monthly on the LEMSA’s website both in raw form and on a 90^th percentile fractal compliance scale. Defines “raw form” to mean the response time prior to administrative exemptions or modification.
9. Requires an emergency ambulance services provider to report response times to the LEMSA that has jurisdiction over the provider in the manner described in 7) above. Requires a LEMSA to include on its website the response times provided to the LEMSA by an emergency ambulance services provider. Requires the LEMSA to publish data no more than 60 calendar days after the last day of the monthly reporting period.
10. Specifies that the provisions of this bill do not apply to calls that do not originate in the 911 system.
11. Requires each LEMSA to include in their required annual EMS plan the list of administrative exemptions approved by the LEMSA, if any, relating to 911 response time performance standards; the list of administrative modifications relating to reported response time performance standards approved by the LEMSA, if any; and, any exemptions from meeting 911 response times granted by the LEMSA in the previous calendar year. Requires LEMSAs to utilize the standardized terms established by EMSA pursuant to this bill to the extent possible.
12. Specifies that this bill does not prohibit a LEMSA from granting exemptions that do not use the terminology established by EMSA when the reason for granting the exemption does not meet the definition of a term established by EMSA. Additionally, this bill does not prohibit a LEMSA, when using standardized terminology to grant exemptions from 911 response times, from including additional information or rationales when granting exemptions.
13. Requires local EMS agencies, as part of the requirement to annually submit an EMS plan to EMSA, to include the local EMS agency’s budget, and requires EMSA to approve or request changes to the proposed plans within 90 days of receipt.
14. Requires local EMS agencies to make their annual plans accessible on their website within 30 days of approval by EMSA, and requires EMSA to make each local EMS agency plan submitted to them accessible on EMSA’s internet website as well.

FISCAL EFFECT:

According to the Assembly Committee on Appropriations, costs in the high hundreds of thousands of dollars to EMSA to develop guidelines and a statewide standard methodology for calculating and reporting response times, work with LEMSAs to implement those guidelines and methodologies, review a LEMSA’s EMS plan within the specified amount of time, and post LEMSA EMS plans to EMSA’s website (General Fund (GF)).

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, LEMSAs are responsible for planning, coordinating, and improving local emergency and medical response systems. LEMSAs primarily work to organize prehospital services. Their plans provide policies for system organization and management, staffing and training, communication, response and transportation for emergency services, facilities and critical care, data collection and system evaluation, public information and education, disaster medical response, and more. By requiring LEMSAs and EMSA to post approved plans on their websites, we can increase transparency for policymakers, stakeholders, and residents who want to see how emergency management officials are planning for response and care. Additionally, requiring ambulance providers to report publically and to EMSA their 911 response times, and having LEMSAs make public their budgets and exemptions for not meeting 911 response time standards, we can see what may be hindering emergency response, in either planning, response, or simply unpredictable circumstances. This transparency and additional data will help EMSA and LEMSAs in their EMS planning and quality improvement efforts.
2. EMSA draft regulations on local EMS systems. One provision of this bill requires EMSA to approve, or seek changes to, the local EMS area plans that are required to be submitted to EMSA annually for approval within 90 days of receipt. These local EMS plans are supposed to be based on EMS Systems, Standards, and Guidelines that EMSA is required to establish. EMSA developed several guidance documents in 1985 that were revised over the years, but they were never formally adopted as regulations. In 2019, the California Fire Chiefs Association challenged these guidelines as underground regulations. In response, EMSA certified that it would not use or enforce the documents, and subsequently began the process of promulgating regulations. In October of 2019, EMSA released draft regulations to adopt standards, policies, and procedures for the planning and implementation of local EMS systems. Many areas of the EMS Act would be affected by these regulations, including the competitive process a LEMSA would have to follow in order to create an exclusive operating area. Among the many provisions proposed to govern the bidding process, these regulations proposed to explicitly prohibit subcontracting the primary provision of ambulance services by the bidder. The controversy over this subcontracting issue contributed to a decision by EMSA in August 2020 not to proceed with these regulations. This issue also led to the passage of AB 389 (Grayson, Chapter 460, Statutes of 2021), which gave statutory authority for fire agencies to subcontract with private ambulance services. The guidance documents that LEMSAs have historically relied upon to develop their EMS plans can no longer be enforced due to the challenge that they were underground regulations. Consequently, LEMSAs are currently in a gray area of using the old guidance documents despite EMSA’s inability to enforce them, since nothing else has been adopted to replace them. EMSA is continuing to meet with stakeholders to develop a new regulatory package to provide standards, policies and procedures for local EMS systems, and is targeting a final implementation timeline of June 2025. At the March 2024 Commission on EMS meeting, EMSA stated that it was in the final stages of approval for a workgroup with partners on draft language.

1. Background on 911 response times and exemptions. There is no requirement in state law or regulations that first response or ambulance transport meet minimum 911 response times. In most local EMS areas, it is fire departments who arrive first to medical emergencies. But there is no universal or enforceable standard that fire departments respond to medical emergencies, or how fast fire departments are required to arrive at the scene of a medical emergency. As part of the EMS planning, a LEMSA may establish ambulance response times as part of a competitive process in creating an exclusive operating area (EOA). In practice, this approach to EMS planning has led to the imposition of response time standards for private ambulance companies in EOA agreements with LEMSAs, while public fire department-based providers have no LEMSA or external response time requirements. Many LEMSAs use the guidelines established by the National Fire Protection Association (NFPA) to compare response time performance between contracted EOA ambulance services and fire departments. The NFPA response guidelines are as follows:
   1. Dispatch time for medical emergencies: 90 seconds for 90% of the calls (the time it takes for a 911 operator at a dispatch center to relay the call to a provider with the address/location);
   2. Turnout time: 60 seconds for 90% of calls (the time it takes from when the call comes to a provider for the crew to get into the vehicle and leave the station); and,
   3. Travel time: four minutes for 90% of calls for basic life support, and nine minutes for 90% of calls for advanced life support (meaning, a licensed paramedic is part of the crew rather than just an emergency medical technician for basic life support).

LEMSA agreements with response time requirements generally have a set of agreed upon “exemptions” from response time standards for occurrences outside the control of the provider. Examples of recognized exemptions include, but are not limited to, adverse weather such as fog or heavy rain, unexpected road closures, and notably when ambulances are captured at emergency departments waiting to transfer patients for care (APOT delays).

1. APOT reporting. Pursuant to AB 1223 (O’Donnell, Chapter 379, Statutes of 2015), EMSA developed standardized methods for data collection and reporting of APOT, and approved these standards in December of 2016. These APOT reporting standards established two reporting metrics (APOT-1 and APOT-2). APOT-1 is a measure of how many minutes it took to transfer care of 90% of the patients in the report (i.e., if there were 100 patients in a given APOT report, and they were sorted from the shortest APOT to the longest, the APOT-1 measure would be how long it took to transfer the 90^th patient). APOT-2 is a measure of the percentage of ambulance patients with an APOT within a 20-minute target, and the percentage that exceeded that target in reference to 60, 120, and 180-minute intervals. These reports are required to be stratified by hospitals, with the number of patients transported to each hospital to provide context for the hospital reports. The reports are to be on a quarterly basis.
   
   Initially, APOT reporting was voluntary, but subsequent legislation (AB 2961, O’Donnell, Chapter 656, Statutes of 2018) requires a LEMSA to report APOT to EMSA on a quarterly basis. AB 2961 also requires EMSA to calculate APOT by jurisdiction and by each facility within a jurisdiction, and to report this data to the Commission on EMS twice per year. According to a report on APOT delays, in December 2020, for purposes of evaluating APOT across the state, EMSA determined, in collaboration with EMS stakeholders, that 20 minutes is the maximum time any Californian transported to a hospital by ambulance should ever wait at any emergency department in the state before being transferred to a hospital bed. However, many LEMSAs established a standard offload time of 30 minutes. EMSA estimated in this report that statewide, an average of 28.26% of all transports exceeded 20 minutes. The report identified that the problem was severe in Sacramento, Los Angeles, and Alameda counties, but was not a problem in Napa, Marin, Ventura, San Mateo, or Santa Barbara counties. Looking at more recent data (from 2022), many hospitals in severe areas are regularly scoring over an hour in APOT-1 (the time it takes to transfer care for the 90^th percentile patient). For example, in the Sacramento area for the month of October 2022: Kaiser Permanente in South Sacramento had 1498 offloads, and APOT-1 was 1:08:35; Mercy San Juan Medical Center had 1505 offloads, and APOT-1 was 1:29:34; Sutter Medical Center had 1386 offloads, and APOT-1 was 1:14:04; and, UC Davis Medical Center had 1310 offloads, and APOT-1 was 0:53:23.
   
   In response to these lengthy APOT times, AB 40 (Rodriguez, Chapter 793, Statutes of 2023) was enacted last year to require LEMSAs to adopt an APOT standard, not to exceed 30 minutes, 90% of the time, starting on July 1 of this year. AB 40 further requires a hospital to develop an APOT reduction protocol to facilitate a rapid reduction in APOT to the adopted standard when the standard has been exceeded for one month. When a hospital has exceeded the adopted APOT standard for the preceding month, EMSA is required to report the exceedance to the LEMSA, which is required to alert all emergency medical services providers in their jurisdiction, direct the hospital to implement the APOT reduction protocol, and host bi-weekly calls with relevant hospital administrators and other stakeholders.
   
2. Background on CEMSIS and capturing APOT data. According to EMSA, the California Emergency Medical Services Information System (CEMSIS) is a demonstration project for improving EMS data analysis across California. CEMSIS offers a secure, centralized data system for collecting data about individual EMS requests, patients treated at hospitals, and EMS provider organizations. CEMSIS uses the National Emergency Medical Services Information System (NEMSIS) standard for how patient care information resulting from a 911 call for emergency assistance is collected. EMSA states that all of California’s 34 LEMSAs currently send a variety of local data collections to CEMSIS, and in return, these local agencies gain access to digital tools for running comprehensive reports on their own data at no cost. According to EMSA, it uses the data to develop and coordinate high quality emergency medical care in California through activities such as healthcare quality programs that monitor patient care outcomes, agency collaboration across jurisdictional boundaries, and public health surveillance.
   
3. Related legislation. AB 1792 (Rodriguez) requires EMSA to develop standards for personal protective equipment for ambulance personnel by January 1, 2027, and to update those standards every five years. AB 1792 is set for hearing on June 17, 2024 in the Senate Appropriations Committee.
   
   AB 1168 (Bennett) provides the City of Oxnard, notwithstanding City of Oxnard v. County of Ventura, the right to administer or contract for prehospital EMS, establishes a process to determine who will provide prehospital EMS to the remaining portion of the exclusive operating area if the City of Oxnard exercises its right to provide prehospital EMS in the City, and clarifies going forward that a city or fire district providing prehospital EMS that enters into a joint powers of authority agreement (JPA) with a county will retain its rights to administer prehospital EMS if the city or fire district withdraws from the JPA. AB 1168 is pending on the Senate Floor.
   
   AB 1843 (Rodriguez) increases, from 10 to 20, the number of employer-paid employee assistance program treatments per issue for every emergency ambulance employee, adds post-traumatic stress disorder to the definition of issue, and requires the provision of peer support services upon an employee’s request. AB 1843 is set for hearing on June 19, 2024 in this Committee.
   
   AB 2859 (Patterson) authorizes an EMS provider to establish a peer support and crisis referral program to provide a network of peer representatives available to aid fellow employees on emotional or professional issues. AB 2859 is set for hearing on June 19, 2024 in this Committee.
   
4. Prior legislation. AB 379 (Rodriguez of 2023) requires LEMSAs to post their annual plans that are approved by EMSA on their website, and requires these plans to include the LEMSA’s annual budget and any exemptions from meeting 911 response times. Requires EMSA to develop a standardized list of exemptions from meeting 911 response times. AB 379 was held on the Senate Appropriations Committee suspense file.

AB 40 (Rodriguez, Chapter 793, Statutes of 2023) requires LEMSAs to adopt an APOT standard, not to exceed 30 minutes, 90% of the time. Requires a hospital to develop an APOT reduction protocol to facilitate a rapid reduction in APOT to the adopted standard when the standard has been exceeded for one month.

AB 716 (Boerner, Chapter 454, Statutes of 2023) limits the amount a health plan enrollee, insured, or uninsured person who receives services from a ground ambulance provider has to pay for services, prohibits the ground ambulance provider from billing more than the specified amount, and requires the health plan or insurer to directly reimburse a ground ambulance provider according to authorized reimbursement amounts, as specified.

AB 389 (Grayson, Chapter 460, Statutes of 2021) permits a county to contract for emergency ambulance services with a fire agency that will provide those services, in whole or in part, through a written subcontract with a private ambulance service; and permits a fire agency to enter into a written subcontract with a private ambulance service for the purpose of contracting with a county.

AB 1544 (Gipson and Gloria, Chapter 138, Statutes of 2020) enacted the Community Paramedicine or Triage to Alternate Destination Act of 2019, which permits local emergency medical services agencies, with approval by EMSA, to develop programs to provide community paramedic or triage to alternate destination services in one of the following specialties: providing directly observed tuberculosis therapy; providing case management services to frequent emergency medical services users; providing hospice services to treat patients in their homes; and, providing patients with transport to an alternate destination, which can either be an authorized mental health facility, or an authorized sobering center. Sunsets the provisions of this bill on January 1, 2024.

SB 438 (Hertzberg, Chapter 389, Statutes of 2019) prohibited a public agency from entering into a contract for 911 call processing regarding the dispatch of emergency response resources unless the contract is with another public agency, with specified exceptions.

AB 2961 (O’Donnell, Chapter 656, Statutes of 2018) requires a LEMSA to report APOT to EMSA on a quarterly basis, and requires EMSA to calculate APOT by jurisdiction and by each facility within a jurisdiction, and report this data to the Commission on EMS twice per year, and to submit a report to the Legislature by December 1, 2020.

AB 1223 (O’Donnell, Chapter 379, Statutes of 2015) required EMSA to adopt a statewide standard methodology for the calculation and reporting by a LEMSA of APOT, and permits LEMSAs to adopt policies and procedures for calculating and reporting APOT using the statewide methodology.

AB 1129 (Burke, Chapter 377, Statutes of 2015) requires an emergency medical care provider, when submitting data to a LEMSA, to use an electronic health record system that is compatible with specified standards, and that includes those data elements that are required by the LEMSA.

AB 503 (Rodriguez, Chapter 362, Statutes of 2015) authorizes health facilities to release patient-identifiable medical information to an EMS provider and LEMSA when specific data elements are requested for the purpose of quality assessment and improvement.

1. Support. The California Fire Chiefs Association and the Fire Districts Association of California write in support that this bill is a step forward in ensuring there is transparency in the planning processes for California’s emergency care. Under this bill, EMSA would be required to develop a standardized list of exemptions that LEMSAs give to their contract ambulance providers and LEMSAs would be required to report any such granted exemptions as part of their annual plans. This bill would also require ambulance providers to report their 911 response times so that the public and policymakers have a clear picture of emergency response times in the state. American Medical Response states in support that for decades, many agencies have only reported average response times, which is not an accurate depiction of a provider’s true performance. This bill would bring the state closer to informing the public of what actual response times look like.
2. Suggested amendments.
   1. Because this bill requires a LEMSA to adopt policies and procedures for calculating and reporting ambulance response times that are based on the statewide standard that this bill requires EMSA to adopt, this bill should make clear that EMSA has to adopt the standard before the LEMSA is required to adopt policies and procedures. On Page 5, line 18, the bill should be amended as follows:
      
      1797.235 (a) A Upon the adoption of a statewide standard by the authority, a local EMS Agency shall adopt policies and procedures for calculating and reporting of response times…
   2. Beginning on Page 6, line 38 and continuing to Page 7 through line 6, subdivisions (j) and (k) of Section 1797.235 contain language that is a verbatim duplicate of subdivisions (c) and (d) of Section 1797.255 on the top of Page 8. According to the author’s office, the duplication was unintentional and the language was only intended to be in Section 1797.255, so those two subdivisions in the other code section should be deleted.
   3. The definition of “cancelled calls” on Page 4, lines 10-13, should be clarified as follows:
      
      “Cancelled calls” means an EMS response in which the responding unit is notified and beings the response, but the response is terminated prior to the responding to the EMS unit arrival on scene using predefined objective criteria.

SUPPORT AND OPPOSITION:

Support: American Medical Response
California Fire Chiefs Association
Fire Districts Association of California

Oppose: None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 2348

Author:(Rodriguez)

As Amended Ver:April 25, 2024

Majority vote

SUMMARY

This bill would require the California Emergency Medical Services Authority (EMSA) and Local Emergency Medical Services Agencies (LEMSAs) to engage in a number of planning and reporting actions to increase transparency and improve emergency response.

Major Provisions

1) Requires EMSA to develop planning and implementation guidelines for response times and exemptions.

2) Requires EMSA to develop a statewide standard methodology for calculation and reporting by a LEMSA of response times for emergency ambulance providers operating in exclusive operating areas.

3) Requires EMSA to ensure guidelines include a list of specified standardized terminology for a LEMSA to use when granting exemptions or when adjusting original response time data for reporting of 911 response times.

4) Requires LEMSAs to report emergency ambulance services provider response times to the authority in a data dispatch form, as specified.

5) Requires emergency ambulance services providers to report response times to their LEMSA.

6) Requires LEMSAs to post emergency ambulance services provider response times monthly on the LEMSA’s internet website, as specified.

7) Requires LEMSAs to adopt policies and procedures for calculating and reporting ambulance patient offload times.

8) Requires LEMSAs to include in their annual EMS plan submitted to EMSA the LEMSA’s annual budget and a list of exemptions, as specified, to response time standards or goals established by the LEMSA.

9) Requires EMSA to develop guidelines for LEMSAs to report response times and exemptions using standardized terminology for the terms: cancelled calls; do not count; exemption; and time correction, as specified.

10) Requires LEMSAs and EMSA to make annual EMS plans accessible on their respective internet websites, as specified.

COMMENTS

EMSA, LEMSAs and Hospital Emergency Departments: EMSA provides statewide oversight for the 34 local emergency medical services agencies or LEMSAs. Together they form the state’s pre-hospital emergency medical system. The pre-hospital emergency medical system and hospital emergency departments operate as separate and distinct entities, but are linked through policies, procedures and regulations. Collectively, these entities provide effective patient care from the initial notification of an emergency and response in the field to the time the EMS provider drops off the patient at the emergency department and returns to the community, while the patient receives evaluation, care and hospitalization, if needed.

EMSA’s Annual Report on Effectiveness of EMS Systems: EMSA is mandated to annually report on the effectiveness of EMS systems and related impact on death and disability (HSC

1797.121). HSC 1797.103 (f) further identifies that one of the required elements of an EMS system is data collection and evaluation. EMSA meets these mandates by collecting data from the LEMSAs.

LEMSAs and EMS Medical Directors: Medical directors of each LEMSA, along with other interested EMS medical directors, make up the EMS Medical Directors Association of California (EMDAC). EMDAC supports and guides the various agencies and makes recommendations to the California EMS Authority about policy, legislation and scope of practice issues. In an effort to improve the quality of EMS care in our state, EMDAC has endeavored to create evidence-based recommendations for EMS protocols. Those recommendations and previous reviews are intended to assist medical directors of the various LEMSAs to develop high quality, evidence-based protocols.

EMDAC Recommended Response Time Intervals: Some LEMSAs use the following Response Call Intervals, as recommended by EMDAC, as benchmarks:

(a) Basic Life Support with AED on scene – 5 minutes from time of first ring at primary Public Safety Answering Point (PSAP) to vehicle arrival at the scene with the wheels stopped.

(b) Advanced Life Support – 10 minutes from time of first ring at primary PSAP to vehicle arrival at the scene with the wheels stopped.

(c) Patient Transport Vehicle – 12 minutes from time of first ring at primary PSAP to vehicle arrival at the scene with the wheels stopped.

Across EMS, response times are used as a process indicator to assess emergency medical services provider’s performance across the country. Response times are objective, quantifiable, and easily understood by the public and policy makers.

According to the Author

LEMSAs are responsible for planning, coordinating, and improving local emergency and medical response systems. LEMSAs primarily work to organize prehospital services. Their plans provide policies for system organization and management, staffing and training, communication, response and transportation for emergency services, facilities and critical care, data collection and system evaluation, public information and education, disaster medical response, and more.

By requiring LEMSAs and EMSA to post approved plans on their websites, we can increase transparency for policymakers, stakeholders, and residents who want to see how emergency management officials are planning for response and care. Additionally, requiring ambulance providers to report publically and to EMSA their 911 response times, and having LEMSAs make public their budgets and exemptions for not meeting 911 response time standards, we can see what may be hindering emergency response, either in planning, response, or simply unpredictable circumstances. This transparency and additional data will help EMSA and LEMSAs in their EMS planning and quality improvement efforts.

Arguments in Support

The California Fire Chiefs Association and Fire Districts Association of California write in support, "AB 2348 is a step forward in insuring that there is transparency in the planning processes for Californians’ emergency care. EMSA would be required to develop a standardized list of exemptions that LEMSAs give to their contracted ambulance providers and LEMSAs would be required to report any such granted exemptions as part of their annual plans. AB 2348 would also require that both EMSA and LEMSAs publish annual plans on their websites, an already commonplace practice that ensures transparency for the public."

American Medical Response (AMR) writes in support, "This bill would bring the state closer to informing the public of what actual response times look like. This bill will establish in statute the national standard of response time measurement. For decades many agencies have only reported average response times, which is not an accurate depiction of a provider’s true performance.

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Committee on Appropriations, "Costs in the high hundreds of thousands of dollars to EMSA to develop guidelines and a statewide standard methodology for calculating and reporting response times, work with LEMSAs to implement those guidelines and methodologies, review a LEMSA’s EMS plan within the specified amount of time, and post LEMSA EMS plans to EMSA’s website (General Fund (GF))."

VOTES

ASM EMERGENCY MANAGEMENT: 7-0-1

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

ABS, ABST OR NV: Bennett

ASM HEALTH: 16-0-0

YES: Bonta, Waldron, Aguiar-Curry, Arambula, Wendy Carrillo, Flora, Haney, Jones-Sawyer, Maienschein, McCarty, Joe Patterson, Rodriguez, Sanchez, Santiago, Schiavo, Weber

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: April 25, 2024

CONSULTANT: Mike Dayton / E.M. / (916) 319-3802 FN: 0003053

Date of Hearing: May 8, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 2348

Author:(Rodriguez) – As Amended Ver:April 25, 2024

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

SUMMARY:

This bill requires the Emergency Medical Services Authority (EMSA) to develop planning and implementation guidelines for emergency medical system (EMS) response times.

Specifically, this bill:

1. Requires the planning and implementation guidelines for EMS systems developed by EMSA to additionally cover response times and exemptions and data quality improvement. The guidelines for response times and exemptions must include certain requirements, such as a list of standardized terminology for a local EMS agency (LEMSA) to use.
2. Requires EMSA to develop a statewide standard methodology for calculating and reporting emergency ambulance service provider response times.
3. Requires, instead of authorizes as in current law, a LEMSA to adopt policies and procedures for calculating and reporting ambulance patient offload times (APOTs).
4. Requires a LEMSA to adopt policies and procedures to calculate and report response times using the statewide standard methodology and report response times to EMSA in a data dispatch form. A provider must report response times to the LEMSA with jurisdiction over the provider and the LEMSA must post monthly provider response time data in a specified format on the LEMSA’s website.
5. Requires a LEMSA to include its annual budget and the list of approved response time exemptions in the LEMSA’s EMS plan submitted to EMSA. EMSA must approve or request changes to the LEMSA’s EMS plan within 90 days of receipt. The LEMSA must make its EMS plan accessible on its website within 30 days of EMSA approval and each EMS plan submitted to EMSA must also be accessible on EMSA’s website.

FISCAL EFFECT:

Costs in the high hundreds of thousands of dollars to EMSA to develop guidelines and a statewide standard methodology for calculating and reporting response times, work with LEMSAs to implement those guidelines and methodologies, review a LEMSA’s EMS plan within the specified amount of time, and post LEMSA EMS plans to EMSA’s website (General Fund (GF)).

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:

By requiring LEMSAs and EMSA to post approved plans on their websites, we can increase transparency for policymakers, stakeholders, and residents who want to see how emergency management officials are planning for response and care. Additionally, requiring ambulance providers to report publically and to EMSA their 911 response times, and having LEMSAs make public their budgets and exemptions for not meeting 911 response time standards, we can see what may be hindering emergency response, either in planning, response, or simply unpredictable circumstances. This transparency and additional data will help EMSA and LEMSAs in their EMS planning and quality improvement efforts.

This bill is supported by American Medical Response – an emergency medical services company – and fire chief and district associations.

1. LEMSAs. California has 34 LEMSAs (single county or multi-county regions), each with an EMS system and plan. Essential functions performed by LEMSAs include coordinating prehospital and hospital services, certifying EMS field personnel, developing medical treatment protocols for local EMS service providers, and designating trauma centers.

Existing law requires EMSA to adopt a statewide standard methodology for calculation of APOT and allows a LEMSA to adopt policies and procedures to calculate and report APOT using the statewide standard methodology. This bill requires a LEMSA to adopt such policies and procedures. This bill also requires EMSA to develop a statewide standard methodology for calculating and reporting emergency ambulance service provider response times and exemptions to meeting specified response times, which a LEMSA must use to report response times to EMSA and on the LEMSA’s website.

Existing law requires a LEMSA to annually submit its EMS plan to EMSA for approval. This bill requires EMSA to approve or request changes to the LEMSA’s EMS plan within 90 days of receipt and requires each LEMSA to make its annually updated EMS plan accessible on its website within 30 days of approval by EMSA, which must also post the plan online in that timeframe.

1. Related Legislation. AB 379 (Rodriguez), among other provisions, contains similar provisions to this bill, such as requiring EMSA to develop standard terminology for 911 response time exemptions, requiring a LEMSA to adopt policies and procedures for calculating and reporting APOTs, and requiring a LEMSA to include its annual budget with its EMS plan submission and post plans online. AB 379 was held on the Senate Appropriations Committee’s suspense file.

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

Date of Hearing: April 23, 2024

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 2348

Author:(Rodriguez) – As Amended Ver:April 1, 2024

SUBJECT: Emergency medical services.

SUMMARY: Requires a local emergency medical services authority (LEMSA) to adopt policies and procedures for calculating and reporting ambulance patient offload times. Requires the Emergency Medical Services Authority (EMSA), to develop a statewide standard methodology for the calculation and reporting by a LEMSA, of response times for emergency ambulance services, and exemptions to those required times, provided in exclusive operating areas (EOAs), as defined. Specifically, this bill:

1. Adds a requirement for EMSA to develop planning and implementation guidelines for response and transportation, including response times and exemptions, as well as quality improvement and disaster medical response.
2. Requires EMSA to develop, using input from stakeholders, including, but not limited to, hospitals, LEMSAs, and public and private emergency medical services (EMS) providers, and, after approval by the Emergency Medical Services Commission (Commission) described in 6) of existing law below, a statewide standard methodology for the calculation and reporting by a LEMSA of contract ambulance response time response times for emergency ambulance services provided in EOAs and ambulance patient offload time.
3. Requires a LEMSA to adopt policies and procedures for calculating and reporting response times, as defined, for emergency ambulance services providers operating under an EOA.
4. Defines, for purposes of this bill, “response time” to means the interval between the point in time when the address or location is received by the responding EMS provider’s dispatch center and the point in time that the transporting ambulance unit arrives at the provided address or location.
   
5. Requires EMSA to ensure the EMS system planning and implementation guidelines for response times comply with all of the following requirements:
   1. Include a list of standardized terminology for LEMSAs to use when granting exemptions or when modifying original response time data for any publicly reported 911 response times required by this bill. Requires the list of standardized terminology to include the following terms and definitions:
      1. “Cancelled calls” means an EMS response in which the responding unit is notified and begins the response, but the response is terminated prior to responding to the EMS unit arrival on scene using predefined objective criteria;
      2. “Do not count” means an EMS response generated within the computer-aided dispatch (CAD) incident data that, upon review, does not satisfy the criteria for an EMS response that is subject to compliance monitoring using predefined objective criteria;
      3. “Exemption” means an EMS response where the incident data is administratively excluded from the CAD data used to calculate response interval compliance using predefined objective criteria; and,
      4. “Time correction” means an EMS response where defined points in time in the CAD incident data are administratively modified from the original CAD incident data using predefined objective criteria.
         
   2. Requires the list of standardized terminology described in a) above to include common reasons for granting exemptions from 911 response times in the various emergency medical services areas of the state.
      
6. Requires a LEMSA to adopt policies and procedures for calculating and reporting ambulance patient offload time (APOT).
   
7. Requires a LEMSA to use the statewide standard methodology for calculating and reporting response interval performance developed by EMSA pursuant to 2) above.
   
8. Requires a LEMSA, when establishing response time compliance requirements, to weigh the risk to the safety of the responding crew and public against the severity of the medical emergency when determining what level of response and time allotment to require from an emergency ambulance services provider.
   
9. Requires LEMSA response times reporting to include data from all emergency ambulance services providers operating in EOAs where the annual transport volume of all emergency ambulance transports within an exclusive operating area exceeds 10,000 transports per calendar year within their jurisdiction.
10. Requires a LEMSA to report emergency ambulance services provider response times to EMSA in a data dispatch form that is consistent with the California Emergency Medical Services Information System (CEMSIS) and the National Emergency Medical Services Information System (NEMSIS) standards, as specified by EMSA, including with the following:
    1. The point in time that the public safety agency dispatch center receives the EMS call;
    2. The point in time that the EMS provider’s dispatch center that is responsible for directly dispatching the ambulance unit receives EMS caller data from a public agency dispatch center;
    3. The point in time that the responding ambulance unit is notified of EMS caller data by dispatch;
    4. The point in time that the ambulance unit is en route; and,
    5. The point in time that the ambulance unit arrives on scene.
       
11. Requires a LEMSA to make response times publicly available monthly on the LEMSA internet website both in raw form and on a 90th percentile fractal compliance scale. Defines for purposes of this provision, “raw form” to mean the response time prior to administrative exemptions or modification.
12. Requires the LEMSA to include on the LEMSA’s internet website the response times provided to the LEMSA by an emergency ambulance services provider.
13. Defines, for purposes of 10) above, “EMS caller data” to mean the address or location of the emergency.
14. Requires an emergency ambulance services provider to report response times to the LEMSA that has jurisdiction over the provider.
    
15. Specifies that this bill does not apply to calls not originating in the 911 system and does not prohibit a LEMSA from reporting response interval compliance from emergency ambulance services providers that are not in an EOA.
    
16. Specifies that this bill does not prohibit LEMSAs from granting exemptions that do not use the terminology established by EMSA when the reason for granting the exemption does not meet the definition of a term established by EMSA, and does not prohibit a LEMSA, when utilizing standardized terminology to grant exemptions from 911 response times, from including additional information or rationales when granting exemptions.
    
17. Requires a LEMSA annual EMS plan to include the LEMSAs annual budget.
    
18. Requires EMSA to approve or request changes to a LEMSAs proposed plans within 90 calendar days of receipt.
    
19. Requires a LEMSA to make the plan accessible on the agency’s internet website within 30 calendar days of approval by EMSA.
    
20. Requires EMSA to make each LEMSAs plan submitted to EMSA accessible on the EMSA’s internet website within 30 calendar days of approval by EMSA.
    
21. Requires a LEMSA to include in the annual EMS plan all of the following:
    1. The list of administrative exemptions approved by the local EMS agency, if any, relating to 911 response time performance standards;
    2. The list of administrative modifications relating to reported response time performance standards approved by the LEMSA, if any; and,
    3. Any exemptions from meeting 911 response times granted by the LEMSA in the previous calendar year.
       

EXISTING LAW:

1. Establishes EMSA, which is responsible for the coordination and integration of all state activities concerning EMS, including the establishment of minimum standards, policies, and procedures. [Health and Safety Code (HSC) §179.100]
   
2. Requires EMSA, utilizing regional and local information, to assess each EMS area or the system’s service area for the purpose of determining the need for additional emergency services, and the coordination and effectiveness of EMS. Requires EMSA to develop planning and implementation guidelines for EMS systems which address specified components, including communications, system organization and management, and data collection and evaluation. [HSC §179.102]
   
3. Authorizes counties to develop an EMS program and designate a LEMSA responsible for planning and implementing an EMS system, which includes day-to-day EMS system operations. [HSC §1797.200]
   
4. Requires, upon the request of a city or fire district that contracted for or provided, as of June 1, 1980, prehospital EMS, a county to enter into a written agreement with the city or fire district regarding the provision of prehospital EMS for that city or fire district. Requires, until such time that an agreement is reached, prehospital EMS to be continued at not less than the existing level, and the administration of prehospital EMS by cities and fire districts presently providing such services to be retained by those cities and fire districts, except the level of prehospital EMS may be reduced where the city council, or the governing body of a fire district, pursuant to a public hearing, determines that the reduction is necessary. [HSC § 1797.201]
   
5. Authorizes a LEMSA to create one or more exclusive operating areas (EOAs) in the development of a local plan, if a competitive process is utilized to select the provider or providers of the services pursuant to the plan. Specifies that no competitive process is required if the LEMSA develops or implements a local plan that continues the use of existing providers operating within a local EMS area in the manner and scope in which the services have been provided without interruption since January 1, 1981. Requires a LEMSA which elects to create one or more EOAs in the development of a local plan to develop and submit for approval to EMSA, as part of the local EMS plan, its competitive process for selecting providers and determining the scope of their operations. Requires this plan to include provisions for a competitive process held at periodic intervals. [HSC §1797.224.]
6. Establishes the 18-member Commission, within the California Health and Human Services Agency. Defines the duties of the Commission to include reviewing regulations, standards, and guidelines developed by EMSA; advising EMSA on a data collection system; advising on emergency facilities and services, emergency communications, medical equipment, personnel training, and various aspects of the EMS system; and, to make recommendations for further development of the EMS system. [HSC §1799 and 1799.2]
   
7. Requires EMSA, by no later than December 31, 2024, to develop and implement a CEMSIS requirement for an electronic signature for use between the emergency department (ED) medical personnel at a receiving hospital and the Emergency Medical Technician, Advanced Emergency Medical Technician, or Emergency Medical Technician-Paramedic that captures the points in time when the ambulance arrives at the hospital ED bay and when transfer of care is executed for documentation of APOT, as defined. Requires the signature to be collected when physical transfer of the patient occurs and the report is given to hospital staff and to note ambulance arrival time at the hospital. Requires, by no later than July 1, 2024, every LEMSA to develop a standard not to exceed 30 minutes, 90% of the time, for APOT and report the adopted time to the authority. [HSC § 1797.120.5.(a)]
   
8. Defines APOT as the interval between the arrival of an ambulance patient at an ED and the time that the patient is transferred to an ED gurney, bed, chair, or other acceptable location and the ED assumes responsibility for care of the patient. [HSC § 1797.120.]
   
9. Defines “response time” to mean the interval between the point in time when the address or location is received by the responding EMS provider’s dispatch center and the point in time that the transporting ambulance unit arrives at the provided address or location. [Ibid.]
   

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

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, LEMSAs are responsible for planning, coordinating, and improving local emergency and medical response systems. LEMSAs primarily work to organize prehospital services. Their plans provide policies for system organization and management, staffing and training, communication, response and transportation for emergency services, facilities and critical care, data collection and system evaluation, public information and education, disaster medical response, and more. The author states that by requiring LEMSAs and EMSA to post approved plans on their websites, we can increase transparency for policymakers, stakeholders, and residents who want to see how emergency management officials are planning for response and care. Additionally, requiring ambulance providers to report publicly and to EMSA their 911 response times, and having LEMSAs make public their budgets and exemptions for not meeting 911 response time standards, we can see what may be hindering emergency response, either in planning, response, or simply unpredictable circumstances. The author concludes that this transparency and additional data will help EMSA and LEMSAs in their EMS planning and quality improvement efforts.
   
2. BACKGROUND. EMSA is the lead agency and centralized resource to oversee emergency and disaster medical services. Day-to-day EMS system management is the responsibility of the local and regional LEMSAs. California has 34 LEMSA systems that provide EMS for California's 58 counties. Regional systems are usually comprised of small, more rural, less-populated counties and single-county systems generally exist in the larger and more urban counties. There are seven regional EMS agencies comprised of 32 counties and 26 single-county LEMSAs. Both single and multi-county LEMSAs develop and submit five-year EMS plans and annual updates to EMSA for a local EMS system according to the state system standards and guidelines. The purpose of the local EMS plans is to meet community EMS needs through the effective utilization of local resources. Between 2019 and June 2022, there were 33 LEMSAs. In July 2022, Stanislaus County separated from Mountain-Valley EMS (a multi-county LEMSA) bringing the total number of LEMSAs to 34.
   
   The EMS Act comprehensively regulates emergency medical care in California. Enacted in 1980, the Act provides for the creation of emergency medical procedures and protocols, certification of emergency medical personnel, and coordination of emergency responses by fire departments, ambulance services, hospitals, specialty care centers, and other providers within the local EMS system. HSC §1797.201 (Section 201), generally known as “201 rights,” was added late in the legislative process that led to the passage of the EMS Act. Section 201 was included to address concerns some cities expressed about the EMS Act’s potential impact on their authority to continue providing EMS programs they had previously started in their cities.
   1. Creation of EOAs. Health and Safety Code §1797.224 permits a local EMS agency to create one or more EOAs for emergency services, including ambulance transport, when developing an EMS plan, if a competitive process is utilized to select the provider or providers of the services pursuant to the plan (although no competitive process is required if the plan continues the use of existing providers operating without interruption since January 1, 1981). When a LEMSA elects to create an exclusive operating area, it is required to submit for approval to EMSA, as part of the local EMS plan, its competitive process for selecting providers and determining the scope of their operations. The plan is also required to include provisions for a competitive process to be held at periodic intervals.
      
      This bill requires response time reporting by EMS providers operating in an EOA.
      
   2. Annual reports. EMSA is mandated to annually report on the effectiveness of EMS systems and related impact on death and disability. State law further identifies that one of the required elements of an EMS system is data collection and evaluation. EMSA meets these mandates by collecting data from the LEMSAs.

According to EMSA, “data collected serves to provide an image of the EMS system, the number and types of patients being cared for, and the EMS and hospital institutions and individuals who are providing that care. As more data becomes available to the EMSA, that image will sharpen. As the reliability of the data improves, answers to questions about the quality of the care provided to EMS patients will be possible. And finally, EMSA’s concurrent effort to integrate EMS data with existing data streams drawn from the spectrum of medical care using Health Information Exchange promises to answer questions about the impact of EMS care on patient outcomes. EMSA’s converging data objectives will, together, allow California to at last measure the value that EMS adds to the health care system.”

c) Emergency Medical Directors Association of California (EMDAC) Recommended Response Time Intervals. Some LEMSAs use the following Response Call Intervals, as recommended by EMDAC, as benchmarks:

• • 1. Basic Life Support with AED on scene – 5 minutes from time of first ring at primary Public Safety Answering Point (PSAP) to vehicle arrival at the scene with the wheels stopped;
    2. Advanced Life Support – 10 minutes from time of first ring at primary PSAP to vehicle arrival at the scene with the wheels stopped; and,
    3. Patient Transport Vehicle – 12 minutes from time of first ring at primary PSAP to vehicle arrival at the scene with the wheels stopped.

Across EMS, response times are used as a process indicator to assess emergency medical services provider’s performance across the country. Response times are objective, quantifiable, and easily understood by the public and policy makers.

d) Quality Improvement (QI). QI in EMS is the intentional process of making system-level changes in clinical processes with a continuous reassessment to improve the delivery of high-quality prehospital care. Effective QI programs are transparent; both administration and clinical staff understand the goals and methods of any ongoing quality improvement project. QI programs often use Key Performance Indicators (KPIs) to measure ongoing clinical performance, identify areas for improvement, and assess the impact of process changes. EMS systems generally build their KPIs on clinical evidence, a perceived system deficit, or an operational need. The goal of QI is to develop a high-reliability organization that operates in a relatively error-free state over a long period of time.

e) NEMSIS and CEMSIS. NEMSIS was formed in 2001 by the National Association of State EMS Directors, in conjunction with the National Highway Traffic Safety Administration and the Trauma/EMS Systems program of the Health Resources and Services Administration’s Maternal and Child Health Bureau, in order to develop a national EMS database. NEMSIS is the national repository that will be used to potentially store EMS data from every state in the nation, and was developed to help states collect more standardized elements to allow submission to the national database.

CEMSIS is a demonstration project for improving EMS data analysis across California. CEMSIS offers a secure, centralized data system for collecting data about individual EMS requests, patients treated at hospitals, and EMS provider organizations. CEMSIS uses the NEMSIS standard for how patient care information resulting from a 911 call for emergency assistance is collected. Thirty-three of California’s 34 LEMSAs currently send a variety of local data collections to CEMSIS on a voluntary basis, and in return, these local agencies gain access to digital tools for running comprehensive reports on their own data at no cost.

f) Importance of Response Times. Emergency medical services (EMS) provide critical prehospital care, and disparities in response times to time-sensitive conditions, such as cardiac arrest, may contribute to disparities in patient outcomes. A 2018 Journal of the American Medical Association study, “Association Between Income and Ambulance Response Time in Cardiac Arrest,” demonstrates that total EMS time for cardiac arrest incidents is longer and that a lower proportion of 911 calls meets national ambulance response time benchmarks in low-income compared with high-income neighborhoods. The study found a persistent and significant time difference between high-income and low-income zip codes, even after controlling for common EMS system demand indicators, such as weekday and time of day to account for traffic. The findings are particularly concerning given the time sensitivity of conditions like cardiac arrest in which the heart has ceased functioning and immediate medical care is required to restore function and circulation. Patients with cardiac arrest from the poorest neighborhoods had longer EMS times that were less likely to meet national benchmarks compared with those from the wealthiest neighborhoods, which may lead to increased disparities in the delivery of prehospital care over time.

The author states that the data generated by this bill should contribute to LEMSA and EMSA QI programs.

1. SUPPORT. The California Fire Chiefs Association (CalChiefs) and the Fire Districts Association of California (FDAC), support this bill and state that it would require EMSA and LEMSAs to engage in a number of planning and reporting actions to increase transparency and improve emergency response. EMSA would be required to develop a standardized list of exemptions that LEMSAs give to their contracted ambulance providers and LEMSAs would be required to report any such granted exemptions as part of their annual plans. This bill would also require that both EMSA and LEMSAs publish annual plans on their websites, an already commonplace practice that ensures transparency for the public. CalChiefs and FDAC conclude that this bill would also require ambulance providers to report their 911 response times so that the public and policymakers have a clear picture of emergency response in the state.
   
2. RELATED LEGISLATION. AB 2973 (Hart) authorizes a county board of supervisors or the governing body of an entity or a LEMSA to provide or support the provision of EMS to persons located within the county. Requires a county board of supervisors or a LEMSA to adopt a written policy setting forth requirements for an emergency ambulance services provider in order to enter into a contract with a provider for emergency ambulance services. AB 2973 is pending in the Assembly Health Committee.
3. PREVIOUS LEGISLATION. AB 379 (Rodriguez) of 2023 was substantially similar to this bill. AB 379 was held in Senate Appropriations.
   
4. DOUBLE REFERRAL. This bill is double referred, it passed the Assembly Committee on Emergency Management with a vote of 7-0 on April 8, 2024.
   
5. SUGGESTED AMENDMENT. As currently drafted this bill only requires reporting of response times in EOAs. The Committee may wish to amend this bill to apply to all EMS service providers, whether they are in an EOA or not.
   

REGISTERED SUPPORT / OPPOSITION:

Support

California Fire Chiefs Association
Fire Districts Association of California
Global Medical Response

Opposition

None on file.

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

Date of Hearing: April 23, 2024

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 2348

Author:(Rodriguez) – As Amended Ver:April 1, 2024

SUBJECT: Emergency medical services.

SUMMARY: Requires a local emergency medical services authority (LEMSA) to adopt policies and procedures for calculating and reporting ambulance patient offload times. Requires the Emergency Medical Services Authority (EMSA), to develop a statewide standard methodology for the calculation and reporting by a LEMSA, of response times for emergency ambulance services, and exemptions to those required times, provided in exclusive operating areas (EOAs), as defined. Specifically, this bill:

1. Adds a requirement for EMSA to develop planning and implementation guidelines for response and transportation, including response times and exemptions, as well as quality improvement and disaster medical response.
2. Requires EMSA to develop, using input from stakeholders, including, but not limited to, hospitals, LEMSAs, and public and private emergency medical services (EMS) providers, and, after approval by the Emergency Medical Services Commission (Commission) described in 6) of existing law below, a statewide standard methodology for the calculation and reporting by a LEMSA of contract ambulance response time response times for emergency ambulance services provided in EOAs and ambulance patient offload time.
3. Requires a LEMSA to adopt policies and procedures for calculating and reporting response times, as defined, for emergency ambulance services providers operating under an EOA.
4. Defines, for purposes of this bill, “response time” to means the interval between the point in time when the address or location is received by the responding EMS provider’s dispatch center and the point in time that the transporting ambulance unit arrives at the provided address or location.
   
5. Requires EMSA to ensure the EMS system planning and implementation guidelines for response times comply with all of the following requirements:
   1. Include a list of standardized terminology for LEMSAs to use when granting exemptions or when modifying original response time data for any publicly reported 911 response times required by this bill. Requires the list of standardized terminology to include the following terms and definitions:
      1. “Cancelled calls” means an EMS response in which the responding unit is notified and begins the response, but the response is terminated prior to responding to the EMS unit arrival on scene using predefined objective criteria;
      2. “Do not count” means an EMS response generated within the computer-aided dispatch (CAD) incident data that, upon review, does not satisfy the criteria for an EMS response that is subject to compliance monitoring using predefined objective criteria;
      3. “Exemption” means an EMS response where the incident data is administratively excluded from the CAD data used to calculate response interval compliance using predefined objective criteria; and,
      4. “Time correction” means an EMS response where defined points in time in the CAD incident data are administratively modified from the original CAD incident data using predefined objective criteria.
         
   2. Requires the list of standardized terminology described in a) above to include common reasons for granting exemptions from 911 response times in the various emergency medical services areas of the state.
      
6. Requires a LEMSA to adopt policies and procedures for calculating and reporting ambulance patient offload time (APOT).
   
7. Requires a LEMSA to use the statewide standard methodology for calculating and reporting response interval performance developed by EMSA pursuant to 2) above.
   
8. Requires a LEMSA, when establishing response time compliance requirements, to weigh the risk to the safety of the responding crew and public against the severity of the medical emergency when determining what level of response and time allotment to require from an emergency ambulance services provider.
   
9. Requires LEMSA response times reporting to include data from all emergency ambulance services providers operating in EOAs where the annual transport volume of all emergency ambulance transports within an exclusive operating area exceeds 10,000 transports per calendar year within their jurisdiction.
10. Requires a LEMSA to report emergency ambulance services provider response times to EMSA in a data dispatch form that is consistent with the California Emergency Medical Services Information System (CEMSIS) and the National Emergency Medical Services Information System (NEMSIS) standards, as specified by EMSA, including with the following:
    1. The point in time that the public safety agency dispatch center receives the EMS call;
    2. The point in time that the EMS provider’s dispatch center that is responsible for directly dispatching the ambulance unit receives EMS caller data from a public agency dispatch center;
    3. The point in time that the responding ambulance unit is notified of EMS caller data by dispatch;
    4. The point in time that the ambulance unit is en route; and,
    5. The point in time that the ambulance unit arrives on scene.
       
11. Requires a LEMSA to make response times publicly available monthly on the LEMSA internet website both in raw form and on a 90th percentile fractal compliance scale. Defines for purposes of this provision, “raw form” to mean the response time prior to administrative exemptions or modification.
12. Requires the LEMSA to include on the LEMSA’s internet website the response times provided to the LEMSA by an emergency ambulance services provider.
13. Defines, for purposes of 10) above, “EMS caller data” to mean the address or location of the emergency.
14. Requires an emergency ambulance services provider to report response times to the LEMSA that has jurisdiction over the provider.
    
15. Specifies that this bill does not apply to calls not originating in the 911 system and does not prohibit a LEMSA from reporting response interval compliance from emergency ambulance services providers that are not in an EOA.
    
16. Specifies that this bill does not prohibit LEMSAs from granting exemptions that do not use the terminology established by EMSA when the reason for granting the exemption does not meet the definition of a term established by EMSA, and does not prohibit a LEMSA, when utilizing standardized terminology to grant exemptions from 911 response times, from including additional information or rationales when granting exemptions.
    
17. Requires a LEMSA annual EMS plan to include the LEMSAs annual budget.
    
18. Requires EMSA to approve or request changes to a LEMSAs proposed plans within 90 calendar days of receipt.
    
19. Requires a LEMSA to make the plan accessible on the agency’s internet website within 30 calendar days of approval by EMSA.
    
20. Requires EMSA to make each LEMSAs plan submitted to EMSA accessible on the EMSA’s internet website within 30 calendar days of approval by EMSA.
    
21. Requires a LEMSA to include in the annual EMS plan all of the following:
    1. The list of administrative exemptions approved by the local EMS agency, if any, relating to 911 response time performance standards;
    2. The list of administrative modifications relating to reported response time performance standards approved by the LEMSA, if any; and,
    3. Any exemptions from meeting 911 response times granted by the LEMSA in the previous calendar year.
       

EXISTING LAW:

1. Establishes EMSA, which is responsible for the coordination and integration of all state activities concerning EMS, including the establishment of minimum standards, policies, and procedures. [Health and Safety Code (HSC) §179.100]
   
2. Requires EMSA, utilizing regional and local information, to assess each EMS area or the system’s service area for the purpose of determining the need for additional emergency services, and the coordination and effectiveness of EMS. Requires EMSA to develop planning and implementation guidelines for EMS systems which address specified components, including communications, system organization and management, and data collection and evaluation. [HSC §179.102]
   
3. Authorizes counties to develop an EMS program and designate a LEMSA responsible for planning and implementing an EMS system, which includes day-to-day EMS system operations. [HSC §1797.200]
   
4. Requires, upon the request of a city or fire district that contracted for or provided, as of June 1, 1980, prehospital EMS, a county to enter into a written agreement with the city or fire district regarding the provision of prehospital EMS for that city or fire district. Requires, until such time that an agreement is reached, prehospital EMS to be continued at not less than the existing level, and the administration of prehospital EMS by cities and fire districts presently providing such services to be retained by those cities and fire districts, except the level of prehospital EMS may be reduced where the city council, or the governing body of a fire district, pursuant to a public hearing, determines that the reduction is necessary. [HSC § 1797.201]
   
5. Authorizes a LEMSA to create one or more exclusive operating areas (EOAs) in the development of a local plan, if a competitive process is utilized to select the provider or providers of the services pursuant to the plan. Specifies that no competitive process is required if the LEMSA develops or implements a local plan that continues the use of existing providers operating within a local EMS area in the manner and scope in which the services have been provided without interruption since January 1, 1981. Requires a LEMSA which elects to create one or more EOAs in the development of a local plan to develop and submit for approval to EMSA, as part of the local EMS plan, its competitive process for selecting providers and determining the scope of their operations. Requires this plan to include provisions for a competitive process held at periodic intervals. [HSC §1797.224.]
6. Establishes the 18-member Commission, within the California Health and Human Services Agency. Defines the duties of the Commission to include reviewing regulations, standards, and guidelines developed by EMSA; advising EMSA on a data collection system; advising on emergency facilities and services, emergency communications, medical equipment, personnel training, and various aspects of the EMS system; and, to make recommendations for further development of the EMS system. [HSC §1799 and 1799.2]
   
7. Requires EMSA, by no later than December 31, 2024, to develop and implement a CEMSIS requirement for an electronic signature for use between the emergency department (ED) medical personnel at a receiving hospital and the Emergency Medical Technician, Advanced Emergency Medical Technician, or Emergency Medical Technician-Paramedic that captures the points in time when the ambulance arrives at the hospital ED bay and when transfer of care is executed for documentation of APOT, as defined. Requires the signature to be collected when physical transfer of the patient occurs and the report is given to hospital staff and to note ambulance arrival time at the hospital. Requires, by no later than July 1, 2024, every LEMSA to develop a standard not to exceed 30 minutes, 90% of the time, for APOT and report the adopted time to the authority. [HSC § 1797.120.5.(a)]
   
8. Defines APOT as the interval between the arrival of an ambulance patient at an ED and the time that the patient is transferred to an ED gurney, bed, chair, or other acceptable location and the ED assumes responsibility for care of the patient. [HSC § 1797.120.]
   
9. Defines “response time” to mean the interval between the point in time when the address or location is received by the responding EMS provider’s dispatch center and the point in time that the transporting ambulance unit arrives at the provided address or location. [Ibid.]
   

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

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, LEMSAs are responsible for planning, coordinating, and improving local emergency and medical response systems. LEMSAs primarily work to organize prehospital services. Their plans provide policies for system organization and management, staffing and training, communication, response and transportation for emergency services, facilities and critical care, data collection and system evaluation, public information and education, disaster medical response, and more. The author states that by requiring LEMSAs and EMSA to post approved plans on their websites, we can increase transparency for policymakers, stakeholders, and residents who want to see how emergency management officials are planning for response and care. Additionally, requiring ambulance providers to report publicly and to EMSA their 911 response times, and having LEMSAs make public their budgets and exemptions for not meeting 911 response time standards, we can see what may be hindering emergency response, either in planning, response, or simply unpredictable circumstances. The author concludes that this transparency and additional data will help EMSA and LEMSAs in their EMS planning and quality improvement efforts.
   
2. BACKGROUND. EMSA is the lead agency and centralized resource to oversee emergency and disaster medical services. Day-to-day EMS system management is the responsibility of the local and regional LEMSAs. California has 34 LEMSA systems that provide EMS for California's 58 counties. Regional systems are usually comprised of small, more rural, less-populated counties and single-county systems generally exist in the larger and more urban counties. There are seven regional EMS agencies comprised of 32 counties and 26 single-county LEMSAs. Both single and multi-county LEMSAs develop and submit five-year EMS plans and annual updates to EMSA for a local EMS system according to the state system standards and guidelines. The purpose of the local EMS plans is to meet community EMS needs through the effective utilization of local resources. Between 2019 and June 2022, there were 33 LEMSAs. In July 2022, Stanislaus County separated from Mountain-Valley EMS (a multi-county LEMSA) bringing the total number of LEMSAs to 34.
   
   The EMS Act comprehensively regulates emergency medical care in California. Enacted in 1980, the Act provides for the creation of emergency medical procedures and protocols, certification of emergency medical personnel, and coordination of emergency responses by fire departments, ambulance services, hospitals, specialty care centers, and other providers within the local EMS system. HSC §1797.201 (Section 201), generally known as “201 rights,” was added late in the legislative process that led to the passage of the EMS Act. Section 201 was included to address concerns some cities expressed about the EMS Act’s potential impact on their authority to continue providing EMS programs they had previously started in their cities.
   1. Creation of EOAs. Health and Safety Code §1797.224 permits a local EMS agency to create one or more EOAs for emergency services, including ambulance transport, when developing an EMS plan, if a competitive process is utilized to select the provider or providers of the services pursuant to the plan (although no competitive process is required if the plan continues the use of existing providers operating without interruption since January 1, 1981). When a LEMSA elects to create an exclusive operating area, it is required to submit for approval to EMSA, as part of the local EMS plan, its competitive process for selecting providers and determining the scope of their operations. The plan is also required to include provisions for a competitive process to be held at periodic intervals.
      
      This bill requires response time reporting by EMS providers operating in an EOA.
      
   2. Annual reports. EMSA is mandated to annually report on the effectiveness of EMS systems and related impact on death and disability. State law further identifies that one of the required elements of an EMS system is data collection and evaluation. EMSA meets these mandates by collecting data from the LEMSAs.

According to EMSA, “data collected serves to provide an image of the EMS system, the number and types of patients being cared for, and the EMS and hospital institutions and individuals who are providing that care. As more data becomes available to the EMSA, that image will sharpen. As the reliability of the data improves, answers to questions about the quality of the care provided to EMS patients will be possible. And finally, EMSA’s concurrent effort to integrate EMS data with existing data streams drawn from the spectrum of medical care using Health Information Exchange promises to answer questions about the impact of EMS care on patient outcomes. EMSA’s converging data objectives will, together, allow California to at last measure the value that EMS adds to the health care system.”

c) Emergency Medical Directors Association of California (EMDAC) Recommended Response Time Intervals. Some LEMSAs use the following Response Call Intervals, as recommended by EMDAC, as benchmarks:

• • 1. Basic Life Support with AED on scene – 5 minutes from time of first ring at primary Public Safety Answering Point (PSAP) to vehicle arrival at the scene with the wheels stopped;
    2. Advanced Life Support – 10 minutes from time of first ring at primary PSAP to vehicle arrival at the scene with the wheels stopped; and,
    3. Patient Transport Vehicle – 12 minutes from time of first ring at primary PSAP to vehicle arrival at the scene with the wheels stopped.

Across EMS, response times are used as a process indicator to assess emergency medical services provider’s performance across the country. Response times are objective, quantifiable, and easily understood by the public and policy makers.

d) Quality Improvement (QI). QI in EMS is the intentional process of making system-level changes in clinical processes with a continuous reassessment to improve the delivery of high-quality prehospital care. Effective QI programs are transparent; both administration and clinical staff understand the goals and methods of any ongoing quality improvement project. QI programs often use Key Performance Indicators (KPIs) to measure ongoing clinical performance, identify areas for improvement, and assess the impact of process changes. EMS systems generally build their KPIs on clinical evidence, a perceived system deficit, or an operational need. The goal of QI is to develop a high-reliability organization that operates in a relatively error-free state over a long period of time.

e) NEMSIS and CEMSIS. NEMSIS was formed in 2001 by the National Association of State EMS Directors, in conjunction with the National Highway Traffic Safety Administration and the Trauma/EMS Systems program of the Health Resources and Services Administration’s Maternal and Child Health Bureau, in order to develop a national EMS database. NEMSIS is the national repository that will be used to potentially store EMS data from every state in the nation, and was developed to help states collect more standardized elements to allow submission to the national database.

CEMSIS is a demonstration project for improving EMS data analysis across California. CEMSIS offers a secure, centralized data system for collecting data about individual EMS requests, patients treated at hospitals, and EMS provider organizations. CEMSIS uses the NEMSIS standard for how patient care information resulting from a 911 call for emergency assistance is collected. Thirty-three of California’s 34 LEMSAs currently send a variety of local data collections to CEMSIS on a voluntary basis, and in return, these local agencies gain access to digital tools for running comprehensive reports on their own data at no cost.

f) Importance of Response Times. Emergency medical services (EMS) provide critical prehospital care, and disparities in response times to time-sensitive conditions, such as cardiac arrest, may contribute to disparities in patient outcomes. A 2018 Journal of the American Medical Association study, “Association Between Income and Ambulance Response Time in Cardiac Arrest,” demonstrates that total EMS time for cardiac arrest incidents is longer and that a lower proportion of 911 calls meets national ambulance response time benchmarks in low-income compared with high-income neighborhoods. The study found a persistent and significant time difference between high-income and low-income zip codes, even after controlling for common EMS system demand indicators, such as weekday and time of day to account for traffic. The findings are particularly concerning given the time sensitivity of conditions like cardiac arrest in which the heart has ceased functioning and immediate medical care is required to restore function and circulation. Patients with cardiac arrest from the poorest neighborhoods had longer EMS times that were less likely to meet national benchmarks compared with those from the wealthiest neighborhoods, which may lead to increased disparities in the delivery of prehospital care over time.

The author states that the data generated by this bill should contribute to LEMSA and EMSA QI programs.

1. SUPPORT. The California Fire Chiefs Association (CalChiefs) and the Fire Districts Association of California (FDAC), support this bill and state that it would require EMSA and LEMSAs to engage in a number of planning and reporting actions to increase transparency and improve emergency response. EMSA would be required to develop a standardized list of exemptions that LEMSAs give to their contracted ambulance providers and LEMSAs would be required to report any such granted exemptions as part of their annual plans. This bill would also require that both EMSA and LEMSAs publish annual plans on their websites, an already commonplace practice that ensures transparency for the public. CalChiefs and FDAC conclude that this bill would also require ambulance providers to report their 911 response times so that the public and policymakers have a clear picture of emergency response in the state.
   
2. RELATED LEGISLATION. AB 2973 (Hart) authorizes a county board of supervisors or the governing body of an entity or a LEMSA to provide or support the provision of EMS to persons located within the county. Requires a county board of supervisors or a LEMSA to adopt a written policy setting forth requirements for an emergency ambulance services provider in order to enter into a contract with a provider for emergency ambulance services. AB 2973 is pending in the Assembly Health Committee.
3. PREVIOUS LEGISLATION. AB 379 (Rodriguez) of 2023 was substantially similar to this bill. AB 379 was held in Senate Appropriations.
   
4. DOUBLE REFERRAL. This bill is double referred, it passed the Assembly Committee on Emergency Management with a vote of 7-0 on April 8, 2024.
   
5. SUGGESTED AMENDMENT. As currently drafted this bill only requires reporting of response times in EOAs. The Committee may wish to amend this bill to apply to all EMS service providers, whether they are in an EOA or not.
   

REGISTERED SUPPORT / OPPOSITION:

Support

California Fire Chiefs Association (cosponsor)
Fire Districts Association of California (cosponsor)
Global Medical Response

Opposition

None on file

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

Date of Hearing: April 8, 2024

ASSEMBLY COMMITTEE ON EMERGENCY MANAGEMENT

Freddie Rodriguez, Chair

ABPCA Bill Id:AB 2348 (

Author:Rodriguez) – As Amended Ver:April 1, 2024

SUBJECT: Emergency medical services

SUMMARY: AB 2348 would require the California Emergency Medical Services Authority (EMSA) and Local Emergency Medical Services Agencies (LEMSAs) to engage in a number of planning and reporting actions to increase transparency and improve emergency response. Specifically, this bill:

1. Requires EMSA to develop planning and implementation guidelines for response times and exemptions.
2. Requires EMSA to develop a statewide standard methodology for calculation and reporting by a LEMSA of response times for emergency ambulance providers operating in exclusive operating areas.
3. Requires EMSA to ensure guidelines include a list of specified standardized terminology for a LEMSA to use when granting exemptions or when adjusting original response time data for reporting of 911 response times.
4. Requires LEMSAs to report emergency ambulance services provider response times to the authority in a data dispatch form, as specified.
5. Requires emergency ambulance services providers to report response times to their LEMSA.
6. Requires LEMSAs to post emergency ambulance services provider response times monthly on the LEMSA’s internet website, as specified.
7. Requires LEMSAs to adopt policies and procedures for calculating and reporting ambulance patient offload times.
8. Requires LEMSAs to include in their annual EMS plan submitted to EMSA the LEMSA’s annual budget and a list of exemptions, as specified, to response time standards or goals established by the LEMSA.
9. Requires EMSA to develop guidelines for LEMSAs to report response times and exemptions using standardized terminology for the terms: cancelled calls; do not count; exemption; and time correction, as specified.
10. Requires LEMSAs and EMSA to make annual EMS plans accessible on their respective internet websites, as specified.

EXISTING LAW:

1. Establishes the Emergency Medical Services Authority, 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, provide technical assistance to existing agencies, counties, and cities for the purpose of developing the components of EMS systems, and receive plans for the implementation of EMS and trauma care systems from local EMS agencies. (Health and Safety Code Section 1797.103-105)
3. Provides each county may develop an emergency medical services program. Each county developing such a program shall designate a local EMS agency (LEMSA) 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)
4. Allows LEMSAs to create one or more exclusive operating areas in the development of a local EMS plan, if a competitive process is utilized to select the provider or providers of the services pursuant to the plan. No competitive process is required if the local EMS agency develops or implements a local plan that continues the use of existing providers operating within a local EMS area in the manner and scope in which the services have been provided without interruption since January 1, 1981. (Health and Safety Code 1797.224)
5. Requires EMSA to develop and adopt, as specified, a statewide standard methodology for the calculation and reporting by a local EMS agency of ambulance patient offload time (APOT) and defines “APOT” as the interval between the arrival of an ambulance patient at an emergency department and the time that the patient is transferred to an emergency department gurney, bed, chair, or other acceptable location and the emergency department assumes responsibility for care of the patient. (Health and Safety Code 1797.120)
6. Authorizes LEMSAs to adopt policies and procedures for calculating and reporting ambulance patient offload times. (Health and Safety Code Section 1797.225)
7. Requires LEMSAs that do adopt policies for calculating and reporting ambulance patient offload times to transmit such data quarterly to EMSA, as specified. (Health and Safety Code Section 1797.228)
8. Requires LEMSAs to annually submit an EMS plan to EMSA in accordance with specified standards and guidelines. (Health and Safety Code Section 1797.254)

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

COMMENTS:

Purpose of the bill: According to the author, “LEMSAs are responsible for planning, coordinating, and improving local emergency and medical response systems. LEMSAs primarily work to organize prehospital services. Their plans provide policies for system organization and management, staffing and training, communication, response and transportation for emergency services, facilities and critical care, data collection and system evaluation, public information and education, disaster medical response, and more.

By requiring LEMSAs and EMSA to post approved plans on their websites, we can increase transparency for policymakers, stakeholders, and residents who want to see how emergency management officials are planning for response and care. Additionally, requiring ambulance providers to report publically and to EMSA their 911 response times, and having LEMSAs make public their budgets and exemptions for not meeting 911 response time standards, we can see what may be hindering emergency response, either in planning, response, or simply unpredictable circumstances. This transparency and additional data will help EMSA and LEMSAs in their EMS planning and quality improvement efforts.”

Equity Impact: According to the author’s staff, “this bill is designed to enhance patient outcomes by providing EMS Administrators, Medical Directors, and EMSA with additional data for their quality improvement programs and operational plans. Enhanced patient outcomes will benefits the most frequent users of 911 emergency medical services, which are often some of the most socioeconomically distressed individuals in our communities.”

EMSA, LEMSAs and Hospital Emergency Departments: EMSA provides statewide oversight for the 33 local emergency medical services agencies or LEMSAs. Together they form the state’s pre-hospital emergency medical system. The pre-hospital emergency medical system and hospital emergency departments operate as separate and distinct entities, but are linked through policies, procedures and regulations. Collectively, these entities provide effective patient care from the initial notification of an emergency and response in the field to the time the EMS provider drops off the patient at the emergency department and returns to the community, while the patient receives evaluation, care and hospitalization, if needed.

EMSA’s Annual Report on Effectiveness of EMS Systems: EMSA is mandated to annually report on the effectiveness of EMS systems and related impact on death and disability (HSC

1797.121). HSC 1797.103 (f) further identifies that one of the required elements of an EMS system is data collection and evaluation. EMSA meets these mandates by collecting data from the LEMSAs.

According to EMSA, “data collected serves to provide an image of the EMS system, the number and types of patients being cared for, and the EMS and hospital institutions and individuals who are providing that care. As more data becomes available to the EMSA, that image will sharpen. As the reliability of the data improves, answers to questions about the quality of the care provided to EMS patients will be possible. And finally, the EMS Authority’s concurrent effort to integrate EMS data with existing data streams drawn from the spectrum of medical care using Health Information Exchange (HIE) promises to answer questions about the impact of EMS care on patient outcomes. EMSA’s converging data objectives will, together, allow California to at last measure the value that EMS adds to the health care system.”

LEMSAs and EMS Medical Directors: Medical directors of each LEMSA, along with other interested EMS medical directors, make up the EMS Medical Directors Association of California (EMDAC). EMDAC supports and guides the various agencies and makes recommendations to the California EMS Authority about policy, legislation and scope of practice issues. In an effort to improve the quality of EMS care in our state, EMDAC has endeavored to create evidence-based recommendations for EMS protocols. Those recommendations and previous reviews are intended to assist medical directors of the various LEMSAs to develop high quality, evidence-based protocols.

EMDAC Recommended Response Time Intervals: Some LEMSAs use the following Response Call Intervals, as recommended by EMDAC, as benchmarks:

(a) Basic Life Support with AED on scene – 5 minutes from time of first ring at primary Public Safety Answering Point (PSAP) to vehicle arrival at the scene with the wheels stopped.

(b) Advanced Life Support – 10 minutes from time of first ring at primary PSAP to vehicle arrival at the scene with the wheels stopped.

(c) Patient Transport Vehicle – 12 minutes from time of first ring at primary PSAP to vehicle arrival at the scene with the wheels stopped.

Across EMS, response times are used as a process indicator to assess emergency medical services provider’s performance across the country. Response times are objective, quantifiable, and easily understood by the public and policy makers.

Quality Improvement (QI): QI in EMS is the intentional process of making system-level changes in clinical processes with a continuous reassessment to improve the delivery of high-quality prehospital care. Effective QI programs are transparent; both administration and clinical staff understand the goals and methods of any ongoing quality improvement project. Quality improvement programs often use Key Performance Indicators (KPIs) to measure ongoing clinical performance, identify areas for improvement, and assess the impact of process changes. EMS systems should build their KPIs on clinical evidence, a perceived system deficit, or an operational need. The goal of QI is to develop a high-reliability organization that operates in a relatively error-free state over a long period of time. The data generated by this bill, should contribute to LEMSA and EMSA QI programs.

Additionally, many EMS organizations elect to use the Institute of Healthcare Improvement Model of improvement: the Plan-Do-Study-Act (PDSA) cycle. Effective PDSA cycles should be organized with staff involved in all aspects of the process being improved. For example, a PDSA cycle with an aim to improve cardiac arrest survival should include field paramedics as well as staff from the medical director's office, administration, and logistics personnel. Having additional data on response times and exemptions will contribute to these efforts.

Arguments in support: American Medical Response (AMR) writes in support, “This bill would bring the state closer to informing the public of what actual response times look like. This bill will establish in statute the national standard of response time measurement. For decades many agencies have only reported average response times, which is not an accurate depiction of a provider’s true performance. This data will also allow the state to more accurately apply response time policies and requirements that do not unnecessarily place our employees or the public at risk by eliminating requirements that all 911 calls, regardless of the severity of the injury or illness, require high risk code 3 responses.”

Double referral: Should this bill be approved, it will be referred to the Assembly Committee on Health.

Related legislation: AB 2973 (Hart) of this Session. Provides County Boards of Supervisors with four policy options to provide EMS services, as specified. (Set to be heard in Assembly Committee on Emergency Management on April 8, 2024)

AB 379 (Rodriguez) of this Session. Requires LEMSAs to adopt policies and procedures for calculating and reporting ambulance patient offload times, as specified. (Held in Assembly Committee on Appropriations)

AB 1168 (Bennett) of this Session. Would overturn existing “Oxnard” decision, and instead requires a city or fire district that contracted for, or provided, as of June 1, 1980, prehospital EMS, to be deemed to retain its authorities regarding, and administration of, the prehospital EMS when a city or fire district enters into an agreement with a county for the joint exercise of powers regarding prehospital EMS, or ceased to contract for, provide, or administer prehospital EMS as a result of a judicial finding, or contracts with a county to provide prehospital EMS in areas outside of that city or fire district. (Senate Inactive File)

Prior legislation: AB 40 (Rodriguez), Chapter 793, Statutes of 2023. Requires the Emergency Medical Services Authority (EMSA) to, among other things, to adopt emergency regulations to develop an electronic signature for use between emergency department and emergency medical personnel, a statewide 30 minute standard for patient offload times, and an audit tool to improve the accuracy of such data.

AB 389 (Grayson), Chapter 460, Statutes of 2021. Authorizes a county to contract for emergency ambulance services with a fire protection district that is governed by the county’s board of supervisors and provides those services, in whole or in part, through a written subcontract with a private ambulance service, and authorizes a fire protection district to enter into a written subcontract with a private ambulance service for these purposes.

AB 1770 (Rodriguez) of the 2021-2022 Session. Would have required the Emergency Medical Services Authority (EMSA), in collaboration with the California Office of Emergency Services (Cal OES), California Department of Public Health (CDPH), and other entities as specified, to establish several policies to reduce ambulance patient offload delays and protect patients from unnecessary and life-threatening impacts to their overall health outcomes. (Died in the Assembly Health Committee)

AB 1229 (Rodriguez) of the 2021-2022 Session. Would have required the Director of the California Emergency Services Authority (EMSA) to establish a task force to address ambulance patient offload delays. (Held in the Assembly Committee on Appropriations.)

AB 1544 (Gipson), Chapter 138, Statutes of 2020. Established the Community Paramedicine or Triage to Alternate Destination Act of 2020, which permits LEMSAs, with approval by the EMSA, to develop programs to provide community paramedic or triage to alternate destination services, as specified.

AB 2961 (O’Donnell), Chapter 656, Statutes of 2018. Requires a local EMS agency to submit quarterly data to EMSA. Also required EMSA to submit a report to the Legislature on ambulance patient offload time and recommendations to reduce or eliminate ambulance patient offload time.

AB 503 (Rodriguez), Chapter 362, Statutes of 2015. Authorizes health facilities to release patient-identifiable medical information to an EMS provider and LEMSA when specific data elements are requested for the purpose of quality assessment and improvement.

AB 1129 (Burke), Chapter 377, Statutes of 2015, requires an emergency medical care provider, when submitting data to a LEMSA, to use an electronic health record system that is compatible with specified standards, and that includes those data elements that are required by the LEMSA.

AB 1223 (O’Donnell), Chapter 379, Statutes of 2015. Authorizes a local EMS agency to adopt policies and procedures relating to ambulance patient offload time, as defined. Requires the authority to develop a statewide standard methodology for the calculation and reporting by a local EMS agency of ambulance patient offload time.

REGISTERED SUPPORT / OPPOSITION:

Support

American Medical Response

Opposition

None on file.

Analysis Prepared by: Mike Dayton / E.M. / (916) 319-3802