Existing law establishes the Office of Emergency Services within the office of the Governor. Existing law makes the office responsible for the states emergency and disaster response services for natural, technological, or man-made disasters and emergencies, including responsibility for activities necessary to prevent, respond to, recover from, and mitigate the effects of emergencies and disasters to people and property.

Existing law, the Warren-911-Emergency Assistance Act, requires every local public agency, as defined, to have an emergency communication system and requires the digits 911 to be the primary emergency telephone number within the system. Existing law requires the office, with the advice and assistance of the Attorney General, to coordinate the implementation of systems, to assist local public agencies and local public safety agencies in obtaining financial help to establish emergency telephone service, and to aid agencies in the formulation of concepts, methods, and procedures that will improve the operation of those systems and that will increase cooperation between public safety agencies.

This bill would establish the 911 Public Education Campaign, to be administered by the office in collaboration with the State 911 Advisory Board, as specified, for the purpose of educating the public on when it is appropriate to call 911 for assistance. The bill would include in the goals of the campaign, among others, reducing the number of unnecessary calls to 911 call centers and reducing delays in the 911 system caused by nonemergency calls being placed. The bill would require the campaign to give local public agencies the ability to tailor the message of the campaign, focus on social media, and be distributed to the public via local public agency channels.

Existing law establishes the Office of Emergency Services within the office of the Governor. Existing law makes the office responsible for the states emergency and disaster response services for natural, technological, or man-made disasters and emergencies, including responsibility for activities necessary to prevent, respond to, recover from, and mitigate the effects of emergencies and disasters to people and property.

Existing law, the Warren-911-Emergency Assistance Act, requires every local public agency, as defined, to have an emergency communication system and requires the digits 911 to be the primary emergency telephone number within the system. Existing law requires the office, with the advice and assistance of the Attorney General, to coordinate the implementation of systems, to assist local public agencies and local public safety agencies in obtaining financial help to establish emergency telephone service, and to aid agencies in the formulation of concepts, methods, and procedures that will improve the operation of those systems and that will increase cooperation between public safety agencies.

This bill would establish the 911 Public Education Campaign, to be administered by the office, office in collaboration with the State 911 Advisory Board, as specified, for the purpose of educating the public on when it is appropriate to call 911 for assistance. The bill would include in the goals of the campaign, among others, reducing the number of unnecessary calls to 911 call centers and reducing delays in the 911 system caused by nonemergency calls being placed. The bill would require the campaign to give local public agencies the ability to tailor the message of the campaign, focus on social media, and be distributed to the public via local public agency channels.

Existing law establishes the Office of Emergency Services within the office of the Governor. Existing law makes the office responsible for the states emergency and disaster response services for natural, technological, or man-made disasters and emergencies, including responsibility for activities necessary to prevent, respond to, recover from, and mitigate the effects of emergencies and disasters to people and property.

Existing law, the Warren-911-Emergency Assistance Act, requires every local public agency, as defined, to have an emergency communication system and requires the digits 911 to be the primary emergency telephone number within the system. Existing law requires the office, with the advice and assistance of the Attorney General, to coordinate the implementation of systems, to assist local public agencies and local public safety agencies in obtaining financial help to establish emergency telephone service, and to aid agencies in the formulation of concepts, methods, and procedures that will improve the operation of those systems and that will increase cooperation between public safety agencies.

This bill would establish the 911 Public Education Campaign, to be administered by the office, for the purpose of educating the public on when it is appropriate to call 911 for assistance. The bill would include in the goals of the campaign, among others, reducing the number of unnecessary calls to 911 call centers and reducing delays in the 911 system caused by nonemergency calls being placed. The bill would authorize the office to use federal preparedness grant funds or funds appropriated by the Legislature for these purposes to implement these provisions.

Existing law establishes the Office of Emergency Services within the office of the Governor. Existing law makes the office responsible for the states emergency and disaster response services for natural, technological, or man-made disasters and emergencies, including responsibility for activities necessary to prevent, respond to, recover from, and mitigate the effects of emergencies and disasters to people and property.

Existing law, the Warren-911-Emergency Assistance Act, requires every local public agency, as defined, to have an emergency communication system and requires the digits 911 to be the primary emergency telephone number within the system. Existing law requires the office, with the advice and assistance of the Attorney General, to coordinate the implementation of systems, to assist local public agencies and local public safety agencies in obtaining financial help to establish emergency telephone service, and to aid agencies in the formulation of concepts, methods, and procedures that will improve the operation of those systems and that will increase cooperation between public safety agencies.

This bill would establish the 911 Public Education Campaign, to be administered by the office, for the purpose of educating the public on when it is appropriate to call 911 for assistance. The bill would include in the goals of the campaign, among others, reducing the number of unnecessary calls to 911 call centers and reducing delays in the 911 system caused by nonemergency calls being placed. The bill would authorize the office to use federal preparedness grant funds or funds appropriated by the Legislature for these purposes to implement these provisions.

Existing law establishes the Office of Emergency Services within the office of the Governor. Existing law makes the office responsible for the states emergency and disaster response services for natural, technological, or man-made disasters and emergencies, including responsibility for activities necessary to prevent, respond to, recover from, and mitigate the effects of emergencies and disasters to people and property.

Existing law, the Warren-911-Emergency Assistance Act, requires every local public agency, as defined, to have an emergency communication system and requires the digits 911 to be the primary emergency telephone number within the system. Existing law requires the office, with the advice and assistance of the Attorney General, to coordinate the implementation of systems, to assist local public agencies and local public safety agencies in obtaining financial help to establish emergency telephone service, and to aid agencies in the formulation of concepts, methods, and procedures that will improve the operation of those systems and that will increase cooperation between public safety agencies.

This bill would establish the 911 Public Education Campaign, to be administered by the office, for the purpose of educating the public on when it is appropriate to call 911 for assistance. The bill would include in the goals of the campaign, among others, reducing the number of unnecessary calls to 911 call centers and reducing delays in the 911 system caused by nonemergency calls being placed. The bill would authorize the office to use federal preparedness grant funds or funds appropriated by the Legislature for these purposes to implement these provisions.

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

AB 296 (Rodriguez) - Office of Emergency Services: 9-1-1 Public Education Campaign

Bill Summary:

AB 296 establishes the 911 Public Education Campaign to educate the public on when it is appropriate to call 911 for assistance and tasks the Office of Emergency Services (OES) with administering the program.

Fiscal Impact:

OES estimates costs ranging between $15 million to $20 million to administer the campaign (General Fund).

Background:

The 911 system was designed to provide a universal, easy-to-remember number for people to reach police, fire, or emergency medical assistance from any phone in any location. While people may generally know to call 911 in an emergency, many people are not sure of what actually constitutes an emergency worth calling for. Too often, requests to 911 do not involve a true emergency, which overloads the 911 system with non-emergency calls. Many 911 call centers follow protocols that guide callers through a sequence of questions to quickly obtain information necessary for dispatching the right responders to the right location. Call-takers may also provide instructions about what to do until help arrives. Even though protocols are designed to help call-takers reassure callers and take charge of the situation, the experience can be stressful for a 911 caller who is not accustomed to dealing with emergencies.

With over 450 total call centers, known as public safety answering points (PSAPs), California’s 911 system is the nation’s largest. California’s PSAPs receive around 26 million total calls per year, with over 80% of those coming from mobile phones.

Proposed Law:

• Establishes the 911 Public Education Campaign and tasks OES with administering the program to educate the public on when it is appropriate to call 911 for assistance. Requires the campaign to:
  • Give local public safety agencies the ability to tailor a message that fits their parameters for distribution.
  • Focus on social media over radio and to the exclusion of television.
  • Be distributed to the public via local public agency channels as determined by the local public agency.
• Requires OES to collaborate with the State 911 Advisory Board in overseeing the campaign and requires the Board to assist OES in creating messaging about the campaign.
• States the goals of the campaign are to: raise public awareness about when it is appropriate to call 911 and other 911 alternatives; and to reduce the number of unnecessary calls to 911 call centers, delays in the 911 system caused by nonemergency calls, and the frequency of first responder resources being held or delayed due to inappropriate 911 calls.
• States legislative findings and declarations.

Related Legislation:

AB 2976 (Committee on Emergency Management, 2022) was substantially similar to this bill, and would have established the 911 Public Education Campaign, administered by OES, to educate the public on when it is appropriate to call 911 for assistance. AB 2976 was held on the Assembly Appropriations Committee Suspense File.

Staff Comments:

Actual costs of the program and for OES to administer the campaign required in this bill will be commensurate with the scope of the campaign and the extent OES would assist local public safety agencies in educating the public. These activities may include conducting trainings, coordinating public outreach, responding to public inquires, creating tools and other messaging, overseeing program implementation, and providing other technical assistance as needed. To the extent OES would be heavily involved in the administration of the campaign, the total fiscal impact of the bill will likely be on the upper end of the estimate provided by OES.

For comparison, the author has previously requested a one-time $50 million General Fund appropriation in the 2022-23 Budget for implementation of AB 2976. OES would have required at least five percent of allocated program funds for administration costs for either ongoing staff positions or limited-term contracts to manage the campaign. This bill does not include attached funding.

-- END --

SENATE COMMITTEE ON GOVERNMENTAL ORGANIZATION

Senator Bill Dodd

Chair

2023 - 2024 Regular

Bill No: AB Hearing Date: 7/11/2023

SUBJECT:

DIGEST: This bill establishes the 911 Public Education Campaign, to be administered by the Office of Emergency Services (OES), for the purposes of educating the public on when it is appropriate to call 911 for assistance, as specified.

ANALYSIS:

Existing law:

1. Establishes OES, within the office of the Governor, and makes it responsible for the state’s emergency and disaster response services for natural, technological, or man-made disasters and emergencies, including responsibility for activities necessary to prevent, respond to, recover from, and mitigate the effects of emergencies and disasters to people and property.
2. The Warren-911-Emergency Assistance Act requires every local public agency to have an emergency communication system and requires the digits “911” to be the primary emergency telephone number within the system.
3. Requires OES, with the advice and assistance of the Attorney General (AG), to coordinate the implementation of systems, to assist local public agencies and local public safety agencies in obtaining financial help to establish emergency telephone service, and to aid agencies in the formulation of concepts, methods, and procedures that will improve the operation of those systems and that will increase cooperation between public safety agencies.
4. Establishes the State 911 Advisory Board to advise OES, as specified, and to conduct a hearing on any conflict between a local public agency and OES, as specified.
5. Authorizes every local public agency to establish a nonemergency telephone system utilizing “311” as the nonemergency telephone number within the system.
6. Designates, under the National Suicide Hotline Designation Act, the three-digit telephone number “988” as the universal number within the United States for the purpose of the national suicide prevention and mental health crisis hotline system operating through the National Suicide Prevention Lifeline (NSPL) maintained by the Assistant Secretary for Mental Health and Substance Abuse and the Veterans Crisis Line Maintained by the Secretary of Veterans Affairs.

This bill:

1. Establishes the 911 Public Education Campaign, to be administered by OES, for the purposes of educating the public on when it is appropriate to call 911 for assistance.
2. Provides that the goals of the 911 Public Education Campaign include all of the following:
   1. Raise public awareness about when to call and when not to call 911, and about alternatives to 911, including but not limited to, the 988 hotline, police nonemergency numbers, and other alternatives where appropriate.
   2. Reduce the number of unnecessary calls to 911 call centers.
   3. Reduce delays in the 911 system caused by nonemergency 911 calls being placed.
   4. Reduce the frequency of first responder resources being held or delayed at hospital emergency departments as a result of inappropriate 911 calls.
3. Requires the 911 Public Education Campaign to do all of the following:
   1. Give local public safety agencies the ability to tailor a message that fits their parameters for distribution.
   2. Focus on social media over radio and to the exclusion of television.
   3. Be distributed to the public via local public agency channels as determined by the local public agency.
4. Requires OES to collaborate with the State 911 Advisory Board in overseeing the campaign.
5. Requires the State 911 Advisory Board to assist OES in creating messaging about the campaign.
6. Includes Legislative findings and declarations related to 911 emergency services.

Background

Author Statement. According to the author’s office, “911 is routinely called inappropriately, and COVID only exacerbated the problem. During the pandemic, Californians experienced surges in demands for COVID-19 testing and vaccinations, extended wait times for emergency care at hospitals, and increases in 9-1-1 EMS response time intervals. As a result of surges in demand for emergency medical services, hospital emergency departments were overcrowded and paramedics and EMTs experienced unduly long wall times. The public will benefit from shorter wait times for emergency services when dispatchers can quickly and efficiently answer their call and dispatch services, without having to spend time explaining to another caller why their call isn’t appropriate for 911.

Further, “last year, the Assembly Committee on Emergency Management held an oversight hearing on wall times. One of the recommendations from this hearing was to educate the public on when it is appropriate to call 9-1-1 for assistance, as there were many instances of the public calling 9-1-1 centers for non-urgent matters.”

911 System. The 911 system was designed to provide a universal, easy-to-remember number for people to reach police, fire, or emergency medical assistance from any phone in any location. Today, people communicate in ways that the designers of the original 911 system could not have envisioned: wireless phones, text and video messages, social media, Internet Protocol (IP)-enabled devices, and more.

While people may generally know to call 911 in an emergency, many people are not sure of what actually constitutes an emergency worth calling for. Too often, requests to 911 do not involve a true emergency, which overloads the 911 system with non-emergency calls. Many 911 call centers follow protocols that guide callers through a sequence of questions to quickly obtain information necessary for dispatching the right responders to the right location. Call-takers may also provide instructions about what to do until help arrives. Even though protocols are designed to help call-takers reassure callers and take charge of the situation, the experience can be stressful for a 911 caller who is not accustomed to dealing with emergencies.

With over 450 total call centers, known as public safety answering points (PSAPs), California’s 911 system is the nation’s largest. California’s PSAPs receive around 26 million total calls per year, with over 80% of those coming from mobile phones. Research demonstrates that most calls are not related to a crime in progress, but still elicit a police response. As a result police are increasingly deployed to address complex problems outside their training such as mental health crises and homelessness.

California State 911 Advisory Board. The California State 911 Advisory Board, within OES, was established to promote communication between PSAPs and the California 911 Emergency Communications Office. Additionally, the 911 Advisory Board works to advise on matters pertaining to policies, technical and operational standards, training standards, budget, funding, proposed projects, and expediting the rollout of Enhanced 911 Phase II technology, among other things.

National Suicide Hotline Designation Act of 2020. The National Suicide Hotline Designation Act of 2020 (NSHD) designated 988 as the new three-digit number for the national suicide prevention and mental health crisis hotline. Specifically, the NSHD requires the Federal Communication Commission (FCC) to designate 988 as the universal telephone number for a national suicide prevention and mental health crisis hotline, which operates through the NSPL Network.

To adequately fund the 988 system, the NSHD authorizes states to impose a fee on access lines for providing 988 related services. In the California Emergency Telephone User Surcharge Act, an access line is defined as a wireline communication service (landline), a wireless communication service line (cell phones), and Voice Over Internet Protocol (VoIP). Revenue from the fees must be held in a designated account to be spent only in support of 988 services, and the FCC must submit an annual report on state administration of these fees. The fees may only be spent on (1) ensuring the efficient and effective routing of calls made to the 988 suicide prevention and mental health crisis hotline to an appropriate crisis center; (2) personnel; and, (3) the provision of acute mental health crisis outreach and stabilization by directly responding to the 988 national suicide prevention and mental health crisis hotline.

In California, AB 988 (Bauer-Kahan, Chapter 747, Statute of 2022) implemented the NSHD. Under the bill, OES collects a surcharge for the 988 Fund and the 988 hotline and the 988 hotline is administered by the (CHHSA). The bill also required CHHSA to create a set of recommendations to support the five-year implementation plan for the 988 hotline by December 31, 2023.

State Nonemergency Telephone System. Every local public agency in California is authorized to establish a nonemergency telephone system utilizing the digits 311. The availability of a 311 nonemergency telephone number was intended to reduce the number of unnecessary calls to the 911 system. Existing law requires the nonemergency 311 system to be designed to provide a system similar to the 911 selective routing system, whereby the location of the initial call is determined to provide a coordinated uniform delivery system to meet the specified requirements of each local jurisdiction.

911 Public Education Campaign. This bill establishes, and requires OES to administer, the 911 Public Education Campaign to educate the public on when it is appropriate to call 911 for assistance. The bill’s stated goals include raising public awareness of when to call and when not to call 911 – and about alternatives to 911, including, but not limited to, the 988 hotline, police nonemergency numbers, and other alternatives where appropriate. Additionally, goals include reducing the number of unnecessary calls to 911 call centers, reducing delays in the 911 system caused by nonemergency 911 calls, and reducing the frequency of first responder resources being held or delayed at hospital emergency departments as a result of inappropriate 911 calls.

This bill requires the 911 Public Education Campaign to allow local public safety agencies to craft messages that are appropriate for their specific situations and requirements. Additionally, the campaign is designed to mainly use social media for distributing these messages, specifically favoring it over radio and entirely excluding television. Finally, these messages will be shared with the public through various local public agency channels, the specifics of which will be decided by each individual agency. This bill requires OES to collaborate with the 911 Advisory Board in overseeing the campaign, while the 911 Advisory Board will aide in the development of campaign messaging.

This bill does not include any attached funding, however the author has previously requested a $50 million one-time general fund appropriation in the 2022-23 state budget to establish the campaign.

Prior/Related Legislation

AB 40 (Rodriguez, 2023) requires the Emergency Medical Services Authority (EMSA) to develop a system for an electronic signature for use between the emergency department and an Emergency Medical Technician (EMT) or Paramedic that captures the points in time when a hospital receives notification of ambulance arrival and when transfer of care is executed for documentation of ambulance patient offload time. (Pending in the Senate Health Committee)

AB 988 (Mathis, 2023) requires an entity receiving funds from the 988 State Suicide and Behavioral Health Crisis Services Fund to report on the number of individuals served who self-identified as veterans or active military personnel, if known. (Pending in the Senate Appropriations Committee)

AB 1276 (McKinnor, 2023) requires the University of California at Davis Health (UC Davis Health), in collaboration with specified state entities, to establish a program for the receipt and collection of “911” emergency call and dispatch data to complete a study for the purpose of improving emergency response services systems. (Held on the Assembly Appropriations Committee Suspense File)

AB 988 (Bauer-Kahan, Chapter 747, Statutes of 2022) established the 988 Crisis Hotline Center for the purpose of connecting individuals experiencing a mental health crisis with suicide prevention and mental health services, as specified. Additionally, the bill required OES to require an entity seeking funds from the 988 Fund to annually file an expenditure and outcomes report, as specified.

AB 1770 (Rodriguez, 2022) would have required EMSA, in collaboration with OES, the Department of Public Health, 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, as specified. (Never heard in the Assembly Health Committee)

AB 2976 (Committee on Emergency Management, 2022) was substantially similar to this bill, and would have established the 911 Public Education Campaign, administered by OES, to educate the public on when it is appropriate to call 911 for assistance. (Held on the Assembly Appropriations Committee Suspense File)

AB 1229 (Rodriguez, 2021) would have required the director of EMSA to appoint and convene an advisory task force to evaluate ambulance patient offload delays due to the COVID-19 pandemic, as specified, and recommend technologies to help emergency medical services systems improve response times. (Held on the Assembly Appropriations Committee Suspense File)

AB 669 (Hertzberg, Chapter 731, Statutes of 022) authorized local public agencies to establish a 311 non-emergency telephone system, as specified.

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

SUPPORT:

California Chapter of the National Emergency Number Association (Source)

Association of California Healthcare Districts

Association of Public-Safety Communications Officials – Northern

Association of Public-Safety Communications Officials – SoCal

California Chapter of the National Emergency Number Association

California Emergency Nurses Association

California Fire Chiefs Association

California Hospital Association

California Special Districts Association

California State Sheriffs’ Association

City of Long Beach

Fire Districts Association of California

Peace Officers Research Association

Riverside County Sheriff’s Office

OPPOSITION:

None received

ARGUMENTS IN SUPPORT: In support of the bill, the California Chapter of National Emergency Number Association writes that, “[w]tih limited resources, unde5rstaffed dispatch centers (resulting in getting placed on hold when calling 9-1-1), and the advent of Next Generation 9-1-1 which will allow text and video to 9-1-1, it is past time for another public education campaign on the proper use of the 9-1-1 system. When 9-1-1 is inappropriately used for non-emergency purposes, it can cause significant challenges to getting resources to where they are most needed in the community. Additionally, the problems multiply throughout the first responder system, taking limited resources offline, causing increased wall times at local medical facilities, and overwhelming resources such as emergency rooms or urgent care centers.”

ASSEMBLY THIRD READING

ATR Bill Id:AB 296

Author:(Rodriguez)

As Amended Ver:May 18, 2023

Majority vote

SUMMARY

Would establish the 911 Public Education Campaign, to be administered by the California Office of Emergency Services (Cal OES), for the purpose of educating the public on when it is appropriate to call 911 for assistance.

Major Provisions

Would establish the 911 Public Education Campaign, to be administered by the Cal OES, for the purpose of educating the public on when it is appropriate to call 911 for assistance

1. Specifies the goals of the campaign to include all of the following:
2. Raise public awareness of when to call and when not to call 9-1-1.
3. Reduce the number of unnecessary calls to 911 call centers.
4. Reduce delays in the 911 system caused by nonemergency 911 calls being placed.
   1. Reduce the frequency of first responder resources being held or delayed at hospital emergency departments as a result of inappropriate 911 calls.

COMMENTS

Equity Impact: According to the author's office. "An effective 911 public education campaign should be mindful of and help mitigate the systemic inequities in emergency medical services."

Background: California has one of the nation's largest 911 systems with over 440 total call centers, or public safety answering points (PSAPs), to handle its 9-1-1 calls. Cal OES's Public Safety Communication Division is responsible for administering the state’s 911 emergency system.

California also has many PSAPs that are provided through partnership with PlantCML, the leading provider of mission critical communication systems. According to Cal OES, PlantCML provides a suite of end-to-end solutions for more than 3,400 PSAPs across the nation, with nearly 350 of those sites being located in the State of California.

Transform 911, a project led by the University of Chicago Health Lab, recently referenced an analysis of 9-1-1 calls to the largest public communication centers in the country. They found that the most common calls pertained to minor traffic concerns, followed by non-crime administrative or information requests and accidental calls or hang-ups. This organization also states that the tremendous volume and diversity of 9-1-1 calls has placed a considerable burden on emergency communications centers, which, coupled with other challenges such as staffing and extended wall times, may severely diminish capacity to respond to calls for service.

The National 911 Program explains that, generally speaking, people are aware that they should call 911 in an emergency, but are less aware of the circumstances in which they should not call 911. This can become an issue when many requests to 911 do not involve true emergencies, thus overloading the 911 system. They also express that there is a growing need for targeted and well-coordinated public education efforts about how to use 911 appropriately.

According to the Author

9-1-1 is routinely called inappropriately, and COVID only exacerbated the problem. During the pandemic, Californians experienced surges in demands for COVID-19 testing and vaccinations, extended wait times for emergency care at hospitals, and increases in 9-1-1 EMS response time intervals. As a result of surges in demand for emergency medical services, hospital emergency departments were overcrowded and paramedics and EMTs experienced unduly long wall times. The public will benefit from shorter wait times for emergency services when dispatchers can quickly and efficiently answer their call and dispatch services, without having to spend time explaining to another caller why their call isn't appropriate for 911. Last year, the Assembly Committee on Emergency Management held an oversight hearing on wall times. One of the recommendations from this hearing was to educate the public on when it is appropriate to call 9-1-1 for assistance, as there were many instances of the public calling 9-1-1 centers for non-urgent matters.

Arguments in Support

The California Chapter of the National Emergency Number Association (CLANENA) writes in support, "On behalf of the CALNENA, we are pleased to work with you and sponsor your AB 296, a measure that would establish the 911 Public Education Campaign, to be administered by CalOES, for the purpose of educating the public on when it is appropriate to call 9-1-1 for assistance. With limited resources, understaffed dispatch centers (resulting in getting placed on hold when calling 9-1-1), and the advent of Next Generation 9-1-1 which will allow text and video to 9-1-1, it is past time for another public education campaign on the proper use of the 9-1-1 system. When 9-1-1 is inappropriately used for non-emergency purposes, it can cause significant challenges to getting resources to where they are most needed in the community."

The California Hospital Association writes in support, "A campaign to educate the public on when it is appropriate to call 911 would promote proper use of the emergency services delivery system and reduce the number of non-emergency calls to 911. This is crucial at a time when patient volume in hospital emergency departments has increased more than 40% in the past seven years, especially considering that as many as three-fourths of patients who arrive by ambulance have relatively minor needs."

The California State Sheriffs' Association adds, "Having an available and robust emergency call system is vital to protecting our communities. Ensuring the public is aware of the appropriate times to call and when not to call 911 will reduce the number of unnecessary calls to 911 call centers, reduce delays in the 911 system caused by nonemergency 911 calls being placed, and reduce the frequency of first responder resources being held or delayed at hospital emergency departments as a result of inappropriate 911 calls."

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Committee on Appropriations, "Ongoing General Fund (GF) cost pressures to appropriate an unknown, but potentially significant, amount, likely in the low millions of dollars, to OES to administer the public education campaign. OES would likely incur staffing costs, as well as costs to execute the campaign’s educational materials and marketing placements."

VOTES

ASM EMERGENCY MANAGEMENT: 7-0-0

YES: Rodriguez, Waldron, Aguiar-Curry, Alvarez, Calderon, Megan Dahle, Schiavo

ASM COMMUNICATIONS AND CONVEYANCE: 13-0-0

YES: Boerner Horvath, Jim Patterson, Connolly, Davies, Holden, Hoover, Low, Maienschein, Papan, Luz Rivas, Rodriguez, Schiavo, Weber

ASM APPROPRIATIONS: 11-0-5

YES: Holden, Bryan, Calderon, Wendy Carrillo, Mike Fong, Hart, Lowenthal, Papan, Pellerin, Weber, Ortega

ABS, ABST OR NV: Megan Dahle, Dixon, Mathis, Robert Rivas, Sanchez

UPDATED

VERSION: May 18, 2023

CONSULTANT: Mike Dayton / E.M. / (916) 319-3802 FN: 0000903

Date of Hearing: May 10, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

ABPCA Bill Id:AB 296

Author:(Rodriguez) – As Amended Ver:April 26, 2023

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

SUMMARY:

This bill establishes the 911 Public Education Campaign administered by the Office of Emergency Services (OES) to educate the public on when it is appropriate to call 911 for assistance.

This bill authorizes OES to use federal preparedness grant funds or funds appropriated by the Legislature for this campaign to implement the campaign.

FISCAL EFFECT:

General Fund (GF) cost pressures to appropriate an unknown, but potentially significant, amount to OES to administer the public education campaign. The author previously requested a $50 million one-time GF appropriation in the 2022-23 state budget to establish this campaign.

OES generally notes that federal preparedness grant funds are already specified for existing uses. OES also generally notes it would utilize five percent of allocated program funds for administrative costs. Thus, depending on the nature of funds allocated, OES would either require ongoing staff positions or enter into a short-term contract to manage the campaign.

COMMENTS:

1. Purpose. According to the author, this bill stems from the Assembly Committee on Emergency Management’s 2022 oversight hearing on wall time, or ambulance patient offload time, which is the interval of time between when the patient arrives at the hospital and is transferred into the hospital’s care. The author notes “One of the recommendations from this hearing was to educate the public on when it is appropriate to call 9-1-1 for assistance, as there were many instances of the public calling 9-1-1 centers for non-urgent matters.”
2. When to Call 911. According to the National 911 Program, people are aware that they should call 911 in an emergency, but are less aware of the circumstances in which they should not call 911. Aside from emergency calls, common calls to 911 pertain to minor traffic concerns, non-crime administrative or information requests, and accidental calls or hang-ups. This bill requires OES to launch a public education campaign regarding when to call 911. However, since this bill’s focus, in part, stems from the desire to reduce wall times, requiring the California Emergency Medical Services Authority (EMSA) to lead the campaign may be a better fit.
3. Related Legislation. AB 40 (Rodriguez) requires, by March 1, 2024, EMSA to develop a public education campaign with local public health departments related to the use of 911 service and other tools for access to care, amongst many other provisions. AB 40 is pending hearing in this committee.
4. Prior Legislation. AB 2976 (Committee on Emergency Management), of the 2021-22 Legislative Session, was substantially similar to this bill. AB 2976 was held on this committee’s suspense file.

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

Date of Hearing: April 19, 2023

ASSEMBLY COMMITTEE ON COMMUNICATIONS AND CONVEYANCE

Tasha Boerner Horvath, Chair

ABPCA Bill Id:AB 296 (

Author:Rodriguez) – As Introduced Ver:January 26, 2023

SUBJECT: Office of Emergency Services: 9-1-1 Public Education Campaign

SUMMARY: Would establish the 911 Public Education Campaign, to be administered by the California Office of Emergency Services (Cal OES), for the purpose of educating the public on when it is appropriate to call 911 for assistance. Specifically, this bill:

1. Would establish the 911 Public Education Campaign, to be administered by the Cal OES, for the purpose of educating the public on when it is appropriate to call 911 for assistance
2. Specifies the goals of the campaign to include all of the following:
3. Raise public awareness of when to call and when not to call 9-1-1.
4. Reduce the number of unnecessary calls to 911 call centers.
5. Reduce delays in the 911 system caused by nonemergency 911 calls being placed.
6. Reduce the frequency of first responder resources being held or delayed at hospital emergency departments as a result of inappropriate 911 calls.
7. Authorizes the office to use federal preparedness grant funds appropriated by the Legislature for these purposes to implement these provisions.

EXISTING LAW:

1. Under the California Emergency Services Act, establishes the California Office of Emergency Services (Cal OES) within the office of the Governor for the purpose of mitigating the effects of natural, manmade, or war-caused emergencies. (Government Code § 8550)
2. Requires Cal OES to develop a plan and timeline of target dates for the testing, implementation, and operation of a Next Generation 911 emergency communication system, including text to 9-1-1 service, throughout California. (Government Code § 53121)
3. Establishes the 9-1-1 Emergency Assistance Act, which establishes the number “911” as the primary emergency telephone number for use in this state for any person calling the telephone number “9-1-1” seeking police, fire, medical, and other emergency services. (Government Code § 53100)
4. Establishes the State Emergency Telephone Number Account (SETNA) and requires the funds to be only be used for specified purposes. (Revenue & Taxation Code § 41136)

FISCAL EFFECT: Unknown.

COMMENTS:

1. Purpose of the bill. The purpose of this bill is to establish a statewide education campaign to inform the public on the proper use of 911. According to the author, “911 is routinely called inappropriately, and COVID only exacerbated the problem. During the pandemic, Californians experienced surges in demands for COVID-19 testing and vaccinations, extended wait times for emergency care at hospitals, and increases in 9-1-1 EMS response time intervals. As a result of surges in demand for emergency medical services, hospital emergency departments were overcrowded and paramedics and EMTs experienced unduly long wall times.”
2. Research suggests some callers do not use 911 as intended. Transform 911, a project led by the University of Chicago Health Lab, recently published a report^[1] of 911 calls to the largest public communication centers in the country. They found that the most common calls pertained to minor traffic concerns, followed by non-crime administrative or information requests and accidental calls or hang-ups. This organization also states that the tremendous volume and diversity of 911 calls has placed a considerable burden on emergency communications centers, which, coupled with other challenges such as staffing and extended wall times, may severely diminish capacity to respond to calls for service.

The National 911 Program explains that, generally speaking, people are aware that they should call 911 in an emergency, but are less aware of the circumstances in which they should not call 911. This can become an issue when many requests to 911 do not involve emergencies with an immediate threat to life or welfare, thus overloading the 911 system. The report expresses that there is a growing need for targeted and well-coordinated public education efforts about how to use 911 appropriately.

1. The public would benefit from more information about alternatives to 911. The primary goal of the educational campaign this bill provides is to reduce unnecessary calls to 911, and in turn increase response times for first responders. One way to reduce calls to 911 is to provide alternatives, and alternatives to 911 already exist for non-emergency and non-criminal purposes. Alternative hotlines include three-digit dialing resources for non-emergency issues and municipal services (311), community-based health and human services referrals (211), and the newly established National Suicide Prevention Lifeline (988). Alternative resources to 911 for crisis issues also include helplines for domestic violence support, runaway youth, and human trafficking. However, for alternative hotlines to work effectively, the public needs to know about them, use them, and have sufficient satisfaction with the quality of the response received that they use them again. While the focus of this is to educate the public on the appropriate use of 911, part of that education could be informing the public about the alternatives. Utilizing alternatives to 911 would benefit the 911 system because it has the potential to divert calls to more appropriate first-responders or other civic-services.
2. No source of funding identified. This bill does not identify a source of funding for the program. There are several potential funding sources including federal grant funds, state general funds, or existing state special funds for the 911 program. The special funds for the 911 program are collected from telephone user surcharges and held within the State Emergency Telephone Number Account (SETNA). While the jurisdiction of this committee is not to analyze the fiscal or budgetary implications of this bill, it’s worth noting that using SETNA funds for educational purposes is not explicitly authorized under existing law. As such, the author should be advised that statutory changes not currently proposed by this bill would likely be necessary to utilize SETNA funds to implement this bill. Nonetheless, SETNA funds are not the only funds that could be available.
3. Committee Amendments. In order to better inform the public on alternatives to 911, which in turn would likely help achieve the objective of this bill, the Chair recommends amending the bill to require the educational campaign to additionally inform the public about alternatives to 911, including the 988 hotline.
4. Related Legislation.
   1. AB 40 (Rodriguez), of this session, would codify several recommendations of the EMSA Ambulance Patient Offload Time Committee. The bill is pending in the Assembly Committee on Emergency Management.
   2. AB 1276 (McKinnor), of this session, would require the University of California at Davis Health (UC Davis Health) to establish a program for the receipt and collection of “911” emergency call and dispatch data, in order to complete an analysis of the data for the purpose of improving emergency response services systems, as specified. (Set to be heard by the Assembly Committee on Health on April 11, 2023.)

REGISTERED SUPPORT / OPPOSITION:

Support

California Fire Chiefs Association
California Hospital Association
California Public-safety Radio Association
California State Sheriffs' Association
Emergency Nurses Association, California State Council
Fire Districts Association of California
Northern California Association of Public-safety Communications Professionals
Riverside County Sheriff's Office
The California Chapter of The National Emergency Number Association (CALNENA)

Opposition

None on file

Analysis Prepared by: Emilio Perez / C. & C. / (916) 319-2637

1. Transforming 911 Report. 2022. TRANSFORM911, The University of Chicago Health Lab. https://www.transform911.org/resource-hub/transforming-911-report/ ↑

Date of Hearing: March 27, 2023

ASSEMBLY COMMITTEE ON EMERGENCY MANAGEMENT

Freddie Rodriguez, Chair

ABPCA Bill Id:AB 296 (

Author:Rodriguez) – As Introduced Ver:January 26, 2023

SUBJECT: Office of Emergency Services: 9-1-1 Public Education Campaign

SUMMARY: Would establish the 911 Public Education Campaign, to be administered by the California Office of Emergency Services (Cal OES), for the purpose of educating the public on when it is appropriate to call 911 for assistance. Specifically, this bill:

1. Would establish the 911 Public Education Campaign, to be administered by the Cal OES, for the purpose of educating the public on when it is appropriate to call 911 for assistance
2. Specifies the goals of the campaign to include all of the following:

(a) Raise public awareness of when to call and when not to call 9-1-1.

(b) Reduce the number of unnecessary calls to 911 call centers.

(c) Reduce delays in the 911 system caused by nonemergency 911 calls being placed.

(d) Reduce the frequency of first responder resources being held or delayed at hospital emergency departments as a result of inappropriate 911 calls.

1. Authorizes the office to use federal preparedness grant funds appropriated by the Legislature for these purposes to implement these provisions.

EXISTING LAW:

1. Under the California Emergency Services Act, establishes the California Office of Emergency Services (Cal OES) within the office of the Governor for the purpose of mitigating the effects of natural, manmade, or war-caused emergencies. (Government Code 8550)
2. Requires Cal OES to develop a plan and timeline of target dates for the testing, implementation, and operation of a Next Generation 911 emergency communication system, including text to 9-1-1 service, throughout California. (Government Code 53121)
3. Establishes the 9-1-1 Emergency Assistance Act, which establishes the number “911” as the primary emergency telephone number for use in this state for any person calling the telephone number “9-1-1” seeking police, fire, medical, and other emergency services. (Government Code 53100)

FISCAL EFFECT: Unknown.

COMMENTS:

Purpose of the bill: According to the author, “911 is routinely called inappropriately, and COVID only exacerbated the problem. During the pandemic, Californians experienced surges in demands for COVID-19 testing and vaccinations, extended wait times for emergency care at hospitals, and increases in 9-1-1 EMS response time intervals. As a result of surges in demand for emergency medical services, hospital emergency departments were overcrowded and paramedics and EMTs experienced unduly long wall times.”

The author continued, “The public will benefit from shorter wait times for emergency services when dispatchers can quickly and efficiently answer their call and dispatch services, without having to spend time explaining to another caller why their call isn’t appropriate for 911.”

“Last year, the Assembly Committee on Emergency Management held an oversight hearing on wall times. One of the recommendations from this hearing was to educate the public on when it is appropriate to call 9-1-1 for assistance, as there were many instances of the public calling 9-1-1 centers for non-urgent matters,” concluded the author.

Equity Impact: According to the author’s office. “An effective 911 public education campaign should be mindful of and help mitigate the systemic inequities in emergency medical services.”

Background: California has one of the nation’s largest 911 systems with over 440 total call centers, or public safety answering points (PSAPs), to handle its 9-1-1 calls. Cal OES’s Public Safety Communication Division is responsible for administering the state’s 911 emergency system.

California also has many PSAPs that are provided through partnership with PlantCML, the leading provider of mission critical communication systems. According to Cal OES, PlantCML provides a suite of end-to-end solutions for more than 3,400 PSAPs across the nation, with nearly 350 of those sites being located in the State of California.

Transform 911, a project led by the University of Chicago Health Lab, recently referenced an analysis of 9-1-1 calls to the largest public communication centers in the country. They found that the most common calls pertained to minor traffic concerns, followed by non-crime administrative or information requests and accidental calls or hang-ups. This organization also states that the tremendous volume and diversity of 9-1-1 calls has placed a considerable burden on emergency communications centers, which, coupled with other challenges such as staffing and extended wall times, may severely diminish capacity to respond to calls for service.

The National 911 Program explains that, generally speaking, people are aware that they should call 911 in an emergency, but are less aware of the circumstances in which they should not call 911. This can become an issue when many requests to 911 do not involve true emergencies, thus overloading the 911 system. They also express that there is a growing need for targeted and well-coordinated public education efforts about how to use 911 appropriately.

Calling 9-1-1: Prior to the widespread adoption of mobile phones, 9-1-1 emergency calls were made primarily on landlines. Calls from landlines would be routed to a PSAP and the dispatcher would dispatch emergency services to the location accordingly. As mobile phones were introduced, mobile 9-1-1 calls were originally routed to a California Highway Patrol (CHP) dispatch because most early mobile phones were in cars. At the time, the assumption was that calls made from a mobile phone were primarily to reporting issues on roadways. As mobile phones became more common, and the use of landlines decreased, more 9-1-1 calls were being made from mobile phones then landlines.

According to the National Emergency Number Association (NENA), an estimated 240 million 9-1-1 calls are made nationally each year, with many areas having at least 80 percent of the calls made from a wireless device. Calls made from a wireless device are now routed to a cell tower that determines the appropriate PSAP. They further explain how in areas serviced by enhanced 9-1-1, the call is selectively routed to the proper PSAP for the caller’s location, and the PSAP has equipment and database information that display the caller’s phone number and address to the call taker. NENA quantifies that 93% of counties with 9-1-1 coverage have this enhanced 9-1-1 for callers. However, the term “enhanced 9-1-1” is not synonymous with wireless 9-1-1.

Next Generation 9-1-1 (NG9-1-1): Since most 9-1-1 systems were originally built using analog rather than digital technologies, public safety answering points (PSAPs) across the country need to be upgraded to a digital or Internet Protocol (IP)-based 9-1-1 system, commonly referred to as Next Generation 9-1-1 (NG9-1-1). The success and reliability of 9-1-1 will be greatly improved with the implementation of NG9-1-1, as it will enhance emergency number services to create a faster, more resilient system that allows voice, photos, videos and text messages to flow seamlessly from the public to the 9-1-1 network.

NG9-1-1 will also improve PSAP ability to help manage call overload, natural disasters, and transferring of 9-1-1 calls and proper jurisdictional responses based on location tracking. While the technology to implement these new IP-based 9-1-1 systems is available now, the transition to NG9-1-1 will involve much more than just new computer hardware and software. Implementing NG9-1-1 in states and counties nationwide will require the coordination of a variety of emergency communication, public safety, legislative and governing entities.

9-1-1 and the Emergency Medical Services System: Current delays in in the 9-1-1 system are partially caused by non-emergency calls being placed, holding critical first responder resources at hospital emergency rooms for hours (referred to a “wall times” or Patient Offload Delay Times). The issue of extended wall times is not new to our state; it is something that has been going on for decades. Unfortunately, the COVID-19 pandemic has exacerbated the ongoing issue even further. Last year, the Assembly Committee on Emergency Management held an oversight hearing on the issue of extended wall times. One of the recommendations from this hearing was to educate the public on when it is appropriate to call 9-1-1 for assistance, as there were many instances of the public calling 9-1-1 centers for non-urgent matters.

Emergency Medical Service Authority’s (EMSA) Ambulance Patient Offload Time (APOT) Committee Report: The APOT Committee was established on November 1, 2021 for key stakeholders across the state to provide advisory recommendations to the California Department of Public Health (CDPH) and the EMSA on how best to mitigate ambulance patient offload delays (APOD). The mission of the APOT Committee is to develop advisory recommendations, including legislative or regulatory changes that will assist in the preservation of the Hospital and Emergency Medical Services (EMS) system.

The committee sought to protect California’s healthcare consumers through the identification and sharing of successful pre-hospital and hospital system efficiencies that reduce or eliminate APOD in the transfer of care from EMS providers to receiving hospital emergency clinicians.

According to EMSA, the purpose of the APOT Committee was for committee members to provide recommendations to inform potential future actions for the mitigation of APOD beyond twenty (20) minutes. EMSA established June 30, 2022, for completion of the committee’s work, and the committee members voted on June 29, 2022. One of the recommendations approved by the APOT Task Force was based on the need for community education, “The state and local public health departments should provide education to the public/beneficiaries related to use of the 911 system and other tools at for access to care. This should include public service announcements and educational material.”

Arguments in support: The California Chapter of the National Emergency Number Association (CLANENA) writes in support, “On behalf of the CALNENA, we are pleased to work with you and sponsor your AB 296, a measure that would establish the 911 Public Education Campaign, to be administered by CalOES, for the purpose of educating the public on when it is appropriate to call 9-1-1 for assistance. With limited resources, understaffed dispatch centers (resulting in getting placed on hold when calling 9-1-1), and the advent of Next Generation 9-1-1 which will allow text and video to 9-1-1, it is past time for another public education campaign on the proper use of the 9-1-1 system. When 9-1-1 is inappropriately used for non-emergency purposes, it can cause significant challenges to getting resources to where they are most needed in the community.”

The California Hospital Association writes in support, “A campaign to educate the public on when it is appropriate to call 911 would promote proper use of the emergency services delivery system and reduce the number of non-emergency calls to 911. This is crucial at a time when patient volume in hospital emergency departments has increased more than 40% in the past seven years, especially considering that as many as three-fourths of patients who arrive by ambulance have relatively minor needs.”

The California State Sheriffs’ Association adds, “Having an available and robust emergency call system is vital to protecting our communities. Ensuring the public is aware of the appropriate times to call and when not to call 911 will reduce the number of unnecessary calls to 911 call centers, reduce delays in the 911 system caused by nonemergency 911 calls being placed, and reduce the frequency of first responder resources being held or delayed at hospital emergency departments as a result of inappropriate 911 calls.”

Double Referral: Should the Emergency Management Committee approve this bill, it will be referred to the Assembly Committee on Communications and Conveyance.

Related legislation: AB 40 (Rodriguez) of this Session. Would codify several recommendations of the EMSA Ambulance Patient Offload Time Committee. (Set to be heard by the Assembly Committee on Emergency Management on March 27, 2023.

AB 988 (Mathis) of this Session. Would require an entity seeking moneys from the 911 fund to also include the number of individuals who used the service and identified as veterans or active military personnel in its annual expenditure and outcomes report. (Referred to the Assembly Committee on Communications and Conveyance.)

AB 1276 (McKinnor) of this Session. Would require the University of California at Davis Health (UC Davis Health) to establish a program for the receipt and collection of “911” emergency call and dispatch data, in order to complete an analysis of the data for the purpose of improving emergency response services systems, as specified. (Set to be heard by the Assembly Committee on Health on April 11, 2023.)

Prior legislation: AB 988 (Bauer-Kahan) of the 2021-2022 Session. Requires the California Health and Human Services Agency (CHHSA) to appoint and convene a state 988 policy advisory group (AG) to advise CHHSA on the implementation and administration of the five-year implementation plan for the 988 Suicide Prevention System. Requires the Office of Emergency Services (OES) to appoint a 988 system director and convene an advisory board (Board) to guide how 988 is implemented and made interoperable with 911, including the creation of a new surcharge for 988 to fund the crisis services. (Chapter 747, Statutes of 2022.)

AB 2976 (Committee on Emergency Management) of the 2021-2022 Session. Would have established the 911 Public Education Campaign, to be administered by the Governor’s Office of Emergency Services (Cal OES), for the purpose of educating the public on when it is appropriate to call 911 for assistance. (Held in the Assembly Committee on Appropriations.)

AB 911 (Rodriguez) of the 2019-2020 Session. Requires OES to conduct a study on the feasibility of developing a statewide system, as specified, and submit a report of the results to the Legislature and the State 911 Advisory Board by January 1, 2021. (Chapter 686, Statues of 2019.)

REGISTERED SUPPORT / OPPOSITION:

Support

CALNENA (Sponsor)

Association of California Healthcare Districts

California Emergency Nurses Association

California Fire Chiefs Association

California Hospital Association

California State Sheriffs’ Association

Fire Districts Association of California

Riverside County Sheriff’s Office

Opposition

None on file.

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

Date of Hearing: March 27, 2023

ASSEMBLY COMMITTEE ON EMERGENCY MANAGEMENT

Freddie Rodriguez, Chair

ABPCA Bill Id:AB 296 (

Author:Rodriguez) – As Introduced Ver:January 26, 2023

SUBJECT: Office of Emergency Services: 9-1-1 Public Education Campaign

SUMMARY: Would establish the 911 Public Education Campaign, to be administered by the California Office of Emergency Services (Cal OES), for the purpose of educating the public on when it is appropriate to call 911 for assistance. Specifically, this bill:

1. Would establish the 911 Public Education Campaign, to be administered by the Cal OES, for the purpose of educating the public on when it is appropriate to call 911 for assistance
2. Specifies the goals of the campaign to include all of the following:

(a) Raise public awareness of when to call and when not to call 9-1-1.

(b) Reduce the number of unnecessary calls to 911 call centers.

(c) Reduce delays in the 911 system caused by nonemergency 911 calls being placed.

(d) Reduce the frequency of first responder resources being held or delayed at hospital emergency departments as a result of inappropriate 911 calls.

1. Authorizes the office to use federal preparedness grant funds appropriated by the Legislature for these purposes to implement these provisions.

EXISTING LAW:

1. Under the California Emergency Services Act, establishes the California Office of Emergency Services (Cal OES) within the office of the Governor for the purpose of mitigating the effects of natural, manmade, or war-caused emergencies. (Government Code 8550)
2. Requires Cal OES to develop a plan and timeline of target dates for the testing, implementation, and operation of a Next Generation 911 emergency communication system, including text to 9-1-1 service, throughout California. (Government Code 53121)
3. Establishes the 9-1-1 Emergency Assistance Act, which establishes the number “911” as the primary emergency telephone number for use in this state for any person calling the telephone number “9-1-1” seeking police, fire, medical, and other emergency services. (Government Code 53100)

FISCAL EFFECT: Unknown.

COMMENTS:

Purpose of the bill: According to the author, “911 is routinely called inappropriately, and COVID only exacerbated the problem. During the pandemic, Californians experienced surges in demands for COVID-19 testing and vaccinations, extended wait times for emergency care at hospitals, and increases in 9-1-1 EMS response time intervals. As a result of surges in demand for emergency medical services, hospital emergency departments were overcrowded and paramedics and EMTs experienced unduly long wall times.”

The author continued, “The public will benefit from shorter wait times for emergency services when dispatchers can quickly and efficiently answer their call and dispatch services, without having to spend time explaining to another caller why their call isn’t appropriate for 911.”

“Last year, the Assembly Committee on Emergency Management held an oversight hearing on wall times. One of the recommendations from this hearing was to educate the public on when it is appropriate to call 9-1-1 for assistance, as there were many instances of the public calling 9-1-1 centers for non-urgent matters,” concluded the author.

Equity Impact: According to the author’s office. “An effective 911 public education campaign should be mindful of and help mitigate the systemic inequities in emergency medical services.”

Background: California has one of the nation’s largest 911 systems with over 440 total call centers, or public safety answering points (PSAPs), to handle its 9-1-1 calls. Cal OES’s Public Safety Communication Division is responsible for administering the state’s 911 emergency system.

California also has many PSAPs that are provided through partnership with PlantCML, the leading provider of mission critical communication systems. According to Cal OES, PlantCML provides a suite of end-to-end solutions for more than 3,400 PSAPs across the nation, with nearly 350 of those sites being located in the State of California.

Transform 911, a project led by the University of Chicago Health Lab, recently referenced an analysis of 9-1-1 calls to the largest public communication centers in the country. They found that the most common calls pertained to minor traffic concerns, followed by non-crime administrative or information requests and accidental calls or hang-ups. This organization also states that the tremendous volume and diversity of 9-1-1 calls has placed a considerable burden on emergency communications centers, which, coupled with other challenges such as staffing and extended wall times, may severely diminish capacity to respond to calls for service.

The National 911 Program explains that, generally speaking, people are aware that they should call 911 in an emergency, but are less aware of the circumstances in which they should not call 911. This can become an issue when many requests to 911 do not involve true emergencies, thus overloading the 911 system. They also express that there is a growing need for targeted and well-coordinated public education efforts about how to use 911 appropriately.

Calling 9-1-1: Prior to the widespread adoption of mobile phones, 9-1-1 emergency calls were made primarily on landlines. Calls from landlines would be routed to a PSAP and the dispatcher would dispatch emergency services to the location accordingly. As mobile phones were introduced, mobile 9-1-1 calls were originally routed to a California Highway Patrol (CHP) dispatch because most early mobile phones were in cars. At the time, the assumption was that calls made from a mobile phone were primarily to reporting issues on roadways. As mobile phones became more common, and the use of landlines decreased, more 9-1-1 calls were being made from mobile phones then landlines.

According to the National Emergency Number Association (NENA), an estimated 240 million 9-1-1 calls are made nationally each year, with many areas having at least 80 percent of the calls made from a wireless device. Calls made from a wireless device are now routed to a cell tower that determines the appropriate PSAP. They further explain how in areas serviced by enhanced 9-1-1, the call is selectively routed to the proper PSAP for the caller’s location, and the PSAP has equipment and database information that display the caller’s phone number and address to the call taker. NENA quantifies that 93% of counties with 9-1-1 coverage have this enhanced 9-1-1 for callers. However, the term “enhanced 9-1-1” is not synonymous with wireless 9-1-1.

Next Generation 9-1-1 (NG9-1-1): Since most 9-1-1 systems were originally built using analog rather than digital technologies, public safety answering points (PSAPs) across the country need to be upgraded to a digital or Internet Protocol (IP)-based 9-1-1 system, commonly referred to as Next Generation 9-1-1 (NG9-1-1). The success and reliability of 9-1-1 will be greatly improved with the implementation of NG9-1-1, as it will enhance emergency number services to create a faster, more resilient system that allows voice, photos, videos and text messages to flow seamlessly from the public to the 9-1-1 network.

NG9-1-1 will also improve PSAP ability to help manage call overload, natural disasters, and transferring of 9-1-1 calls and proper jurisdictional responses based on location tracking. While the technology to implement these new IP-based 9-1-1 systems is available now, the transition to NG9-1-1 will involve much more than just new computer hardware and software. Implementing NG9-1-1 in states and counties nationwide will require the coordination of a variety of emergency communication, public safety, legislative and governing entities.

9-1-1 and the Emergency Medical Services System: Current delays in in the 9-1-1 system are partially caused by non-emergency calls being placed, holding critical first responder resources at hospital emergency rooms for hours (referred to a “wall times” or Patient Offload Delay Times). The issue of extended wall times is not new to our state; it is something that has been going on for decades. Unfortunately, the COVID-19 pandemic has exacerbated the ongoing issue even further. Last year, the Assembly Committee on Emergency Management held an oversight hearing on the issue of extended wall times. One of the recommendations from this hearing was to educate the public on when it is appropriate to call 9-1-1 for assistance, as there were many instances of the public calling 9-1-1 centers for non-urgent matters.

Emergency Medical Service Authority’s (EMSA) Ambulance Patient Offload Time (APOT) Committee Report: The APOT Committee was established on November 1, 2021 for key stakeholders across the state to provide advisory recommendations to the California Department of Public Health (CDPH) and the EMSA on how best to mitigate ambulance patient offload delays (APOD). The mission of the APOT Committee is to develop advisory recommendations, including legislative or regulatory changes that will assist in the preservation of the Hospital and Emergency Medical Services (EMS) system.

The committee sought to protect California’s healthcare consumers through the identification and sharing of successful pre-hospital and hospital system efficiencies that reduce or eliminate APOD in the transfer of care from EMS providers to receiving hospital emergency clinicians.

According to EMSA, the purpose of the APOT Committee was for committee members to provide recommendations to inform potential future actions for the mitigation of APOD beyond twenty (20) minutes. EMSA established June 30, 2022, for completion of the committee’s work, and the committee members voted on June 29, 2022. One of the recommendations approved by the APOT Task Force was based on the need for community education, “The state and local public health departments should provide education to the public/beneficiaries related to use of the 911 system and other tools at for access to care. This should include public service announcements and educational material.”

Arguments in support: The California Chapter of the National Emergency Number Association (CLANENA) writes in support, “On behalf of the CALNENA, we are pleased to work with you and sponsor your AB 296, a measure that would establish the 911 Public Education Campaign, to be administered by CalOES, for the purpose of educating the public on when it is appropriate to call 9-1-1 for assistance. With limited resources, understaffed dispatch centers (resulting in getting placed on hold when calling 9-1-1), and the advent of Next Generation 9-1-1 which will allow text and video to 9-1-1, it is past time for another public education campaign on the proper use of the 9-1-1 system. When 9-1-1 is inappropriately used for non-emergency purposes, it can cause significant challenges to getting resources to where they are most needed in the community.”

The California Hospital Association writes in support, “A campaign to educate the public on when it is appropriate to call 911 would promote proper use of the emergency services delivery system and reduce the number of non-emergency calls to 911. This is crucial at a time when patient volume in hospital emergency departments has increased more than 40% in the past seven years, especially considering that as many as three-fourths of patients who arrive by ambulance have relatively minor needs.”

The California State Sheriffs’ Association adds, “Having an available and robust emergency call system is vital to protecting our communities. Ensuring the public is aware of the appropriate times to call and when not to call 911 will reduce the number of unnecessary calls to 911 call centers, reduce delays in the 911 system caused by nonemergency 911 calls being placed, and reduce the frequency of first responder resources being held or delayed at hospital emergency departments as a result of inappropriate 911 calls.”

Double Referral: Should the Emergency Management Committee approve this bill, it will be referred to the Assembly Committee on Communications and Conveyance.

Related legislation: AB 40 (Rodriguez) of this Session. Would codify several recommendations of the EMSA Ambulance Patient Offload Time Committee. (Set to be heard by the Assembly Committee on Emergency Management on March 27, 2023.

AB 988 (Mathis) of this Session. Would require an entity seeking moneys from the 911 fund to also include the number of individuals who used the service and identified as veterans or active military personnel in its annual expenditure and outcomes report. (Referred to the Assembly Committee on Communications and Conveyance.)

AB 1276 (McKinnor) of this Session. Would require the University of California at Davis Health (UC Davis Health) to establish a program for the receipt and collection of “911” emergency call and dispatch data, in order to complete an analysis of the data for the purpose of improving emergency response services systems, as specified. (Set to be heard by the Assembly Committee on Health on April 11, 2023.)

Prior legislation: AB 988 (Bauer-Kahan) of the 2021-2022 Session. Requires the California Health and Human Services Agency (CHHSA) to appoint and convene a state 988 policy advisory group (AG) to advise CHHSA on the implementation and administration of the five-year implementation plan for the 988 Suicide Prevention System. Requires the Office of Emergency Services (OES) to appoint a 988 system director and convene an advisory board (Board) to guide how 988 is implemented and made interoperable with 911, including the creation of a new surcharge for 988 to fund the crisis services. (Chapter 747, Statutes of 2022.)

AB 2976 (Committee on Emergency Management) of the 2021-2022 Session. Would have established the 911 Public Education Campaign, to be administered by the Governor’s Office of Emergency Services (Cal OES), for the purpose of educating the public on when it is appropriate to call 911 for assistance. (Held in the Assembly Committee on Appropriations.)

AB 911 (Rodriguez) of the 2019-2020 Session. Requires OES to conduct a study on the feasibility of developing a statewide system, as specified, and submit a report of the results to the Legislature and the State 911 Advisory Board by January 1, 2021. (Chapter 686, Statues of 2019.)

REGISTERED SUPPORT / OPPOSITION:

Support

CALNENA (Sponsor)

Association of California Healthcare Districts

California Emergency Nurses Association

California Hospital Association

California State Sheriffs’ Association

Riverside County Sheriff’s Office

Opposition

None on file.

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