AB 645 directs public safety agencies that process 911 calls for medical emergencies to provide callers with prearrival medical instructions for urgent, life‑threatening situations. The statute establishes a baseline set of required instruction topics and lets local systems implement those instructions through existing medical control structures.
The change pushes more immediate, bystander‑directed care into the dispatch window—a shift with potential to improve outcomes in overdose, cardiac arrest, choking, severe bleeding, and childbirth. It also creates new operational responsibilities for 911 centers and for local EMS medical directors who must review and approve the instructions.
At a Glance
What It Does
The bill requires public safety agencies that handle 911 medical calls to provide prearrival medical instructions to callers and gives agencies the option to contract with another agency to meet that duty. Agencies must implement instructions consistent with their medical protocols and local medical control.
Who It Affects
Primary targets are public safety answering points (PSAPs) and any agency that processes 911 medical calls, plus local EMS agencies and their medical directors who must approve the instructions. Dispatch training providers, software vendors for emergency dispatch protocols, and counties that fund PSAPs will also feel the impact.
Why It Matters
Standardizing a minimum instruction set moves critical interventions earlier—potentially saving lives—while imposing training, protocol‑approval, and QA requirements on locally run dispatch centers. For compliance officers and EMS administrators, this converts an often‑informal practice into an enforceable obligation.
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What This Bill Actually Does
AB 645 adds Section 1797.161 to the Health and Safety Code and creates a floor for what a 911 caller must be able to receive, in verbal form, before responders arrive. The statute lists six topic areas that dispatchers must be able to cover with callers: airway and choking guidance for infants, children and adults; AED and CPR instructions for children and adults; childbirth assistance; bleeding control and hemorrhage management; administration of epinephrine with an auto‑injector for suspected anaphylaxis; and administration of naloxone for suspected opioid overdoses.
A public safety agency may meet the new requirement directly or by contracting with another public safety agency that already provides prearrival instructions. Whatever path is chosen, the instructions must receive approval from the local EMS agency medical director and be implemented consistent with the agency’s medical protocols and procedures.
The bill expressly references subdivisions (c) and (d) of Section 1797.223 for the medical‑director approval process, tying the new obligation to existing local medical control rules.The statute includes several operational carve‑outs. Agencies that already offer emergency medical dispatch or other approved prearrival instructions do not have to revise policies if those instructions have received local medical‑director approval.
An agency that dispatches only peace officers to a scene is not treated as providing call processing services for emergency medical response under this section. The bill also states that it does not limit the Emergency Medical Services Authority’s existing regulatory powers over dispatcher training and emergency medical dispatch guidelines.Finally, the measure addresses the fiscal and legal framing: because the requirement expands duties carried out by local public safety agencies, it is identified as creating a state‑mandated local program.
The bill contains the usual constitutional language about reimbursement—declaring no reimbursement is required for costs arising solely from changes in criminal definitions or penalties and preserving the Commission on State Mandates process for any other mandated costs.
The Five Things You Need to Know
Deadline: PSAPs that provide medical call processing must be able to provide the required prearrival instructions beginning January 1, 2027.
Required topics: the law specifies six minimum instruction areas—airway/choking (all ages), AED/CPR (children and adults), childbirth, bleeding control, epinephrine auto‑injector for anaphylaxis, and naloxone for suspected opioid overdose.
Medical‑director approval: all prearrival instructions must be approved by the local EMS agency medical director under the approval framework in Section 1797.223.
Compliance path: an agency may comply by providing the instructions itself or by contracting with another public safety agency that already provides prearrival medical instruction.
Fiscal/legal framing: the bill is treated as imposing a state‑mandated local program and includes standard provisions about reimbursement and the Commission on State Mandates review for any mandated costs.
Section-by-Section Breakdown
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Minimum required prearrival instruction topics
This subdivision lists the six topic areas that every 911 call processor providing medical call processing must be prepared to instruct on. Practically, that means dispatch centers must adopt scripts or protocols that allow a dispatcher to walk a caller through airway/choking maneuvers, CPR/AED steps, childbirth assistance, hemorrhage control, epinephrine auto‑injector use, and naloxone administration. The wording creates a statutory floor: local systems can add more topics, but cannot offer less.
Allows contracting to satisfy duties
This short clause permits a public safety agency to meet the statute’s requirements by contracting with another agency that already provides prearrival medical instruction. That creates a compliance alternative for small or rural PSAPs that lack bandwidth to run full programs, but it also introduces interagency contract and oversight issues—who trains, audits, and ultimately bears liability if instructions are deficient.
Requires local medical‑director approval
The statute ties content and implementation to local medical control by requiring approval from the local EMS agency medical director, referencing procedures in Section 1797.223(c) and (d). That anchors dispatcher scripts to existing medical protocols and gives medical directors explicit gatekeeper authority over what dispatchers may instruct callers to do.
Exemptions and limits on scope
Subdivision (d) says agencies already providing approved prearrival instruction need not update policies simply because the statute exists, avoiding retroactive disruption for compliant systems. Subdivision (e) clarifies that an agency that only dispatches peace officers does not count as providing medical call processing under this section—even if officers may later render first aid—so the statute targets entities whose primary function includes medical call triage.
Relationship to existing authority and reimbursement framing
The bill confirms it does not limit the EMS Authority’s rulemaking power over emergency medical dispatch and dispatcher training. Section 2 frames the fiscal/legal treatment: the measure is characterized as creating a state‑mandated local program, includes the constitutional statement about no reimbursement for costs tied strictly to criminal law changes, and preserves the Commission on State Mandates process for any other mandated costs. That combination matters for counties and cities budgeting for implementation.
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Who Benefits
- Bystanders and callers: Receiving standardized, dispatcher‑guided instructions can increase the chance that immediate, life‑saving steps (CPR, naloxone administration, bleeding control, safe childbirth assistance) are performed before EMS arrival.
- Overdose victims and families: The explicit requirement to provide naloxone guidance increases the likelihood of timely reversal interventions in opioid overdose situations, especially where bystanders have access to naloxone.
- Rural and long‑response jurisdictions: Areas with longer ambulance response times stand to gain most from dispatcher‑directed interventions that bridge the gap until EMS arrives.
- Hospitals and EMS systems: Better early intervention can reduce the severity of cases arriving to definitive care, potentially lowering downstream resource use and improving outcomes.
Who Bears the Cost
- Public safety answering points (PSAPs) and dispatch centers: They must adopt protocols, train staff, add QA, and potentially buy or update software to deliver and document prearrival instructions.
- Local EMS agencies and medical directors: Medical directors will spend time reviewing and approving instruction sets and maintaining oversight, which consumes medical control resources.
- County and municipal budgets: Local governments that fund PSAPs may face new operational and training costs; while the bill references mandate rules, local agencies should expect implementation expenses.
- Contracted provider agencies and vendors: Agencies hired to supply prearrival instruction capacity and the vendors that supply EMD (emergency medical dispatch) software will need to revise content, training modules, and reporting features.
Key Issues
The Core Tension
The bill forces a trade‑off between two legitimate priorities: maximizing immediate, bystander‑guided life‑saving actions through standardized dispatch instructions, and avoiding an unfunded, uneven operational burden on local 911 centers and medical directors that could produce variable quality and potential liability exposure. The statute favors saving lives earlier in the chain of care, but it leaves unanswered whether and how all jurisdictions will secure the training, oversight, and funding needed to do that reliably.
Implementation hinges on medical‑director review and local protocols, which preserves local control but guarantees variability in what callers actually hear across jurisdictions. That variability creates an evidence and equity challenge: outcomes will depend on how well local medical directors write, approve, and enforce dispatch protocols, and on local investments in dispatcher training and QA.
Smaller or underfunded PSAPs risk delivering substantially different instructions than well‑resourced centers, even though the statute sets a minimum topic list.
Operationally, the statute raises liability and practical questions. Requiring dispatchers to coach hands‑on interventions (epinephrine or naloxone administration, airway maneuvers, bleeding control) increases reliance on dispatcher judgment, audio clarity, and caller capability.
The bill ties content approval to medical directors, which helps manage clinical risk, but it does not create a statewide training standard or dedicated funding stream, leaving local agencies to determine training hours, competency checks, and documentation practices. Finally, the contracting option helps small centers comply but introduces intergovernmental oversight complexity—who audits the contractor, and how are responsibilities allocated when an adverse outcome occurs?
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