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AB-1770 Ambulance patient offload time.(2021-2022)

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Date Published: 03/24/2022 09:00 PM
AB1770:v98#DOCUMENT

Revised  April 05, 2022
Amended  IN  Assembly  March 24, 2022

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 1770

Introduced by Assembly Member Rodriguez
(Coauthors: Assembly Members Cooley and Seyarto)

February 02, 2022

An act to amend Section 1797.123 of of, and to add Section 1797.1201 to, the Health and Safety Code, relating to emergency medical services.


LEGISLATIVE COUNSEL'S DIGEST


AB 1770, as amended, Rodriguez. Ambulance patient offload time.
Existing law requires the Emergency Medical Services Authority to develop, using input from stakeholders and after approval by the Commission on Emergency Medical Services, and adopt a statewide standard methodology for the calculation and reporting by a local emergency medical services (EMS) agency of ambulance patient offload time (APOT). Existing law 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.
Existing law requires the authority to report twice per year to the commission the APOT by local EMS agency jurisdiction and by each facility in that jurisdiction.
This bill would instead require the authority to report the APOT data to the commission every 6 months.
The bill would, subject to an appropriation, require the authority to take certain actions in collaboration with the Office of Emergency Services and the State Department of Public Health, for the purpose of reducing ambulance patient offload delays, protecting patients from unnecessary and life-threatening impacts to their overall health outcomes, and preparing for surges in demand for emergency medical services.
Under the bill, those actions would include, among others, implementing a public education campaign, supporting staffing of EMS providers and additional resources for physical assets, issuing clear guidelines relating to triage and care, creating an expedited mechanism for a local EMS agency to obtain approval from the authority to implement alternate destination policies, designating urgent care overflow facilities that could serve as surge capacity for hospitals, and establishing policies relating to use of available fire department resources, telehealth, EMS-initiated refusal, assessment, and referral, as specified.
The bill would also require the authority to develop policies to allow for the safe and efficient transfer of patients from emergency departments to nonhospital facilities, and would require the State Department of Public Health and the State Department of Health Care Services to engage local health departments with skilled nursing facilities and community behavioral health providers, at the election of those local health departments.
The bill would require the authority to implement a specified set of those actions on or before July 1, 2023.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1797.1201 is added to the Health and Safety Code, immediately following Section 1797.120, to read:

1797.1201.
 (a) This section shall be implemented, subject to an appropriation by the Legislature, for the purpose of reducing ambulance patient offload delays, protecting patients from unnecessary and life-threatening impacts to their overall health outcomes, and preparing for surges in demand for emergency medical services.
(b) The authority, in collaboration with the Office of Emergency Services and the State Department of Public Health, shall do all of the following:
(1) Develop and implement a public education campaign to communicate with and educate the public on the use of the EMS system.
(2) Support staffing of EMS providers and additional resources for physical assets, including, but not limited to, hospital-appropriate gurneys and oxygen, that are necessary to care for patients awaiting acceptance to the emergency department, for augmentation of hospital personnel to care for those patients, and for overflow surge facilities. It is the intent of the Legislature, if a future appropriation is made for the purpose of implementing this section, that the appropriation include twenty million dollars ($20,000,000) for the purpose of implementing this paragraph.
(3) Issue clear guidelines to direct the ability for one member of EMS provider personnel to provide care for up to four patients who meet clear acuity protocols established by the authority, and directions to local EMS agencies and hospitals to support efficient triage and transfer of care from EMS provider personnel to hospital personnel.
(4) Create an expedited mechanism for a local EMS agency to obtain approval from the authority to implement alternate destination policies, educate local EMS agencies about this flexibility, and direct local EMS agencies to work with fire departments and public and private EMS providers, at the election of those departments and providers, in the delivery of emergency medical services.
(5) Preidentify and designate urgent care overflow facilities that could serve as surge capacity for hospitals. Overflow facilities shall be strategically located throughout the state to allow for safe and efficient EMS transport of low acuity patients to these locations. The authority shall issue clear medical protocols to allow EMS provider personnel to triage a patient and transport them to the surge urgent care locations.
(6) Establish policies to facilitate use of available fire department resources throughout the state, at the election of those departments, to respond to requests for in-county and out-of-county mutual aid requests. These policies shall incorporate fire departments with mobile integrated health services and those that can provide additional EMS resources.
(7) Establish policies and systems to facilitate increased use of telehealth in the field.
(8) Establish a clear set of statewide policy and protocol for EMS-initiated refusal to allow for enhanced field decisionmaking, and establish a statewide policy for assessment and referral that local jurisdictions can implement.
(9) Develop implementation policies to allow for the safe and efficient transfer of patients from emergency departments to nonhospital facilities. Upon development of these policies, the State Department of Public Health and the State Department of Health Care Services shall engage local health departments with skilled nursing facilities, as defined in Section 1250, and community behavioral health providers, at the election of those local health departments.
(c) The authority shall implement paragraphs (3) to (9), inclusive, of subdivision (b) on or before July 1, 2023.

SECTION 1.SEC. 2.

 Section 1797.123 of the Health and Safety Code is amended to read:

1797.123.
 (a) Upon receipt of data reported by a local EMS agency to the authority pursuant to Section 1797.228, the authority shall calculate ambulance patient offload time by local EMS agency jurisdiction and by each facility in a local EMS agency jurisdiction.
(b) The authority shall report every six months to the Commission on Emergency Medical Services the ambulance patient offload time by local EMS agency jurisdiction and by each facility in a local EMS agency jurisdiction.
(c) On or before December 1, 2020, the authority, in collaboration with local EMS agencies, shall submit a report to the Legislature on ambulance patient offload time and recommendations to reduce or eliminate ambulance patient offload time. The report shall be submitted in compliance with Section 9795 of the Government Code.

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REVISIONS:
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