Memo to CFCA Members Regarding AB 40 Implementation and Compliance

TO:  All California Fire Agencies
FR:  CPF President Brian K. Rice and CFCA President Brian Fennessy
RE:  AB 40 (Rodriguez/2023) Implementation: APOT ePCR Compliance
DATE:  August 19, 2025

As you know, our organizations have worked together to respond to the ambulance patients offload time (AOPT) challenges we are experiencing at hospitals across the State. As the Emergency Medical Services Authority (EMSA) has moved to implement AB 40 (Rodrguez/2023), we must do our part to meet the data standard promulgated in regulation. By aligning our practices with AB 40 and the associated data protocols, we uphold our mission to deliver equitable, person‑centered emergency care when seconds truly count.

We respectfully request that all agencies update their practices to ensure data consistency and compliance with AB 40. 

While ambulance transport providers are those who we are requesting update their ePCRs most directly, we also ask that non-transport agencies who may regularly have fire department paramedics ride on a BLS ambulance also update their ePCR to ensure consistent data collection. If a non-transport paramedic rides to assist a transport paramedic, we recommend they collaborate with the transfer crew to enter the accurate data in the field when the transfer occurs, assuming that the non-transport medic may leave the emergency room prior to the transfer of care. 

On June 18, 2025, the Emergency Medical Services (EMS) Commission voted and approved the emergency regulations for Chapter 1. Delivering Equitable and Person-Centered Care: Article 1.2 Ambulance Patient Offload Time. These regulations were approved by OAL and took effect on June 23, 2025. 

According to the emergency regulations Article 6 § 100006.01:

An EMS transport provider agency shall: (a) No later than 60 days from the effective date of these regulations, collect an electronic signature within the ePCR (NEMSIS element eOther.19) from emergency department medical personnel at the point of transfer of care for each patient transported to a GACH emergency department.

Per the technical specification for APOT-1 noted in regulations, the following NEMSIS data elements shall be collected and reported to calculate APOT:

• eTimes.11 – “Arrival of an ambulance patient at an emergency department ambulance bay” - values are logical and present
  
• eTimes.12 - “Destination Patient Transfer of Care Date/Time” - values are logical and present and shall be linked to the hospital staff’s signature provided at the moment of transfer of care, and shall be assigned the indicated values from the specification sheet listed in Chapter 1, Article 1.2:  
  
  • eOther.12 – “Type of Person Signing” Value shall be recorded as – 4512005 “Healthcare Provider”
    
  • eOther.13 – “Signature Reason” Value shall be recorded as – 45130074 “Transfer of Patient Care” 
    
  • eOther.15 – “Signature Status” Value shall be recorded as – 4515031 “Signed”
    
  • eOther.19 – “Signature Date Time” Value – is logical and present – should match eTimes.12
    

As a reminder, this signature should be collected at the time that the emergency department assumes responsibility (meaning a patient report has been given to ED medical personnel) and patient care is transferred to an emergency department gurney, bed, chair, or other acceptable location.

It is critical that every EMS Provider implement and utilize these NEMSIS data elements as part of their ePCR for the capture of verifiable APOT data. It is equally important that the data we report is in alignment with the regulatory data standard, leaving no room for dispute or misinterpretation by partner healthcare facilities regarding the accuracy of APOT metrics.

The Emergency Medical Services Authority (EMSA) has established a webpage (www.emsa.ca.gov/apot) with resources related to AB 40 Implementation and compliance.  EMSA staff are available to assist your organization in meeting these new documentation requirements.  Inquiries and requests for support can be made to APOT@emsa.ca.gov.  Please engage EMSA for any technical questions or inquiries.  

Please update your ePCR workflows to capture the required NEMSIS elements and ensure ED staff signatures at the moment of transfer of care. Coordinate with your LEMSA and partner hospitals to understand local APOT standards and protocols. Accurate, timely data will be critical both for compliance and for improving patient flow across the system.

Thank you for your consideration of this request. We collectively see a real opportunity to leverage AB 40 and its implementation to reduce ambulance patient offload times, allowing us to better serve our communities.