SB 221-CPR CURRICULUM  4:11:00 PM CHAIR TOBIN reconvened the meeting and announced the consideration of SENATE BILL NO. 221 "An Act relating to cardiopulmonary resuscitation education in public schools; relating to the duties of the Department of Education and Early Development; and providing for an effective date." 4:11:33 PM SENATOR ELVI GRAY-JACKSON, District G, Alaska State Legislature, Juneau, Alaska, speaking as sponsor of SB 221 provided the following sponsor statement: [Original punctuation provided.] Sponsor Statement   Senate Bill 221   CPR CURRICULUM  Sudden Cardiac Arrest is a leading cause of death in the USbut bystander CPR can double or triple the survival rate. Senate Bill 221 seeks to enhance the quality of health education within our state's public school system. This focuses on equipping our students with the knowledge and skills necessary to increase the number of CPR-trained bystanders. By enacting this legislation, we prioritize the health and well-being of our youth, empowering them with the knowledge and skills to make informed decisions and respond effectively in emergency situations, potentially saving lives within their communities. By integrating CPR education into the school curriculum, we are promoting a culture of preparedness and responsiveness to emergencies. Requiring schools to teach CPR ensures that all students, regardless of socioeconomic status or geographic location, have access to this vital life- saving skill. 4:13:19 PM LUMA DIAZ, Staff, Senator Elvi Gray-Jackson, Alaska State Legislature, Juneau, Alaska, gave a presentation on SB 221 to discuss what the bill does. She moved to slide 2 and discussed the following: What is CPR? Importance of Early CPR  • Cardiopulmonary Resuscitation is a first aid technique to help people who suffer a cardiac arrest (their heart stops beating). • It involves doing chest compressions. • Aids in the circulation of oxygenated blood around the body to maintain the brain and vital organs until advance medical help arrives. • If performed immediately, CPR can double or triple a victim's chances of survival. 4:14:08 PM MS. DIAZ moved to slide 3 and provided background on other states that have passed bills similar to SB 221: [Original punctuation provided.] A little background    • Currently 40 states have a bill that requires students to have CPR training before graduating high school. • Alabama passed a similar bill in 1984. • Florida was the last state to adopt a similar bill in 2021. 4:14:28 PM MS. DIAZ moved to slide 4: [Original punctuation provided.] TRAINED STUDENTS SAVE LIVES    • Sudden Cardiac Arrest is a leading cause of death in the USbut bystander CPR can double or triple the survival rate. • Training students in CPR requires minimal investment in time and cost. According to the latest science, trainees can achieve acceptable levels of CPR skills proficiency in 30 minutes or less. • Pierson High School in Sag Harbor, NY began its CPR program in 1994. Amazingly, at least 16 lives have been saved so far because these students used their CPR skills in the real world! 4:15:09 PM MS. DIAZ moved to slide 5: [Original punctuation provided.] What does SB 221 do? • It will require schools to develop and implement curricula to instruct public school students on hands-only cardiopulmonary resuscitation (CPR). • The curricula must : • Be based on current national, evidence-based emergency cardiovascular care guidelines for cardiopulmonary resuscitation. • Incorporate hands-on practice in addition to cognitive learning. • Include instruction in the appropriate use of an AED (automated external defibrillator), which may be taught using video or other means if in-person instruction is not available. 4:16:00 PM MS. DIAZ provided the following sectional analysis for SB 221: [Original punctuation provided.] Sectional Analysis for SB 221   CPR Curriculum  Section 1: Amends AS 14.30.360(a) by deleting Cardiopulmonary Resuscitation (CPR) from the program curricula in this section. Section 2: Amends AS 14.30 by adding a new section, Sec. 14.30.363 Cardiopulmonary Resuscitation Education to establish the curricula details and responsibilities of the Department of Education and Early Development. Section 3: Sets an effective date of August 25, 2025. 4:16:51 PM CHAIR TOBIN asked how many districts already offer CPR training and whether they follow the proposed legislation. She also inquired if there is any data on how many districts currently provide this training in their schools. 4:17:16 PM SENATOR GRAY-JACKSON stated that while current statute encourages CPR training, SB 221 would make it a requirement. She added that she would provide the committee with information on how many districts teach CPR training to students. 4:17:29 PM MS. DIAZ stated that many schools already encourage CPR and similar trainings. She mentioned meeting a teacher in Juneau who included CPR in a life skills program. However, she emphasized the importance of having this requirement in statute to ensure that every school can provide CPR training to all students. 4:18:05 PM SENATOR KIEHL asked about the structure of the CPR requirement in SB 221. He noted that while the numbered list [on slide 5] requires the curriculum to follow current national evidence- based guidelines, the paragraph specifies hands-only CPR. He questioned why hands-only CPR is specified, given that the guidelines changed only 10 to 15 years ago. He suggested it might be better to align strictly with the best evidence-based practices, allowing flexibility as guidelines evolve. 4:18:52 PM SENATOR GRAY-JACKSON deferred the question, asking that Chief Schrage answer it. 4:19:10 PM CHAIR TOBIN referred to SB 221, page 2, line 5, which mentions a person holding a current pulmonary resuscitation instructor certificate. She asked if this section of the bill allows for individuals with outside expertise to volunteer their time in schools. SENATOR GRAY-JACKSON deferred the question. 4:19:49 PM MS. DIAZ clarified that the SB 221 allows anyone with a certified qualification to train students in CPR, which could include teachers, administrative staff, or certified volunteers. She mentioned being in contact with fire department personnel, paramedics, and Emergency Medical Services (EMS), who have previously volunteered their time to teach hands-only CPR in schools. She emphasized that the intent of SB 221 is to ensure that anyone trained in CPR can provide this training to students. 4:20:55 PM CHAIR TOBIN announced invited testimony for SB 221. 4:21:15 PM DOUGLAS SCHRAGE, Chief, Anchorage Fire Department, Anchorage, Alaska, stated that he was present to provide information and express strong support for SB 221, emphasizing the goal of improving the survivability of sudden cardiac arrest. He highlighted that sudden cardiac arrest is often a survivable condition and noted that approximately 1,100 Alaskans die each year from heart disease, with many deaths preventable through early Cardiopulmonary Resuscitation (CPR). He explained that hands-only CPR maintains oxygen flow to vital organs until Emergency Medical Services (EMS) arrives and is most effective when initiated immediately by a bystander. 4:22:11 PM MR. SCHRAGE addressed questions about hands-only CPR, stating that it is supported by scientific evidence, particularly in situations where EMS response is within 15 minutes. He noted that hands-only CPR is often more effective because people are more willing to perform it and it better circulates oxygen without the interruptions caused by mouth-to-mouth. He acknowledged that for longer periods, additional oxygen would eventually be needed but emphasized the effectiveness of hands- only CPR in the critical early minutes. MR. SCHRAGE stressed that improving survival from cardiac arrest is a community-wide effort, not just the responsibility of emergency services. He pointed out that the best emergency systems still require time to arrive, while permanent brain damage can occur within four minutes of a cardiac event. He called for more community members to be trained in CPR and for more automated external defibrillators (AEDs) to be available in public spaces. 4:24:15 PM MR. SCHRAGE argued that SB 221 could significantly improve survival rates in Alaskan communities by equipping youth with life-saving skills. He noted that current public education efforts are insufficient, while hands-only CPR training is straightforward, cost-effective, and can be implemented with minimal resources. He provided an example of successfully teaching CPR to a group of 40 people in 20 minutes. He added that while certification through the American Heart Association or American Red Cross is desirable, it is not required under SB 221. He concluded by urging support for SB 221, citing its profound potential impact relative to its modest investment. 4:25:44 PM CHAIR TOBIN noted that many young students might babysit or care for younger siblings. She asked whether the 20-minute CPR training given to Rotary members included infant CPR and whether this type of training might also be available to students in schools. 4:26:06 PM MR. SCHRAGE responded that he did not include infant Cardiopulmonary Resuscitation (CPR) in the training. He explained that infant CPR requires a different, more specialized skill set, which is very valuable for people in environments with infants and children, and he recommended certification for those scenarios. However, he emphasized that the main focus is on addressing sudden cardiac arrest in adults, where the greatest number of lives can be saved. He noted that while cardiac arrest in infants does occur, it is relatively rare, and the strategy is to train as many people as possible to perform CPR on adults. 4:27:43 PM JAMIE MORGAN, Senior Region Lead, State Government Relations, American Heart Association, Dallas, Texas, stated that each year more than 350,000 people experience cardiac arrest outside of a hospital, with only one in ten surviving due to receiving timely Cardiopulmonary Resuscitation (CPR). She noted that in 2008, the American Heart Association released a scientific advisory promoting hands-only CPR as the standard response for adult sudden cardiac arrest. She explained that cardiac arrest is caused by an electrical malfunction in the heart, unlike a heart attack, and nearly 90 percent of those who experience it outside of a hospital do not survive. MS. MORGAN emphasized the importance of training students in hands-only CPR to improve survival rates, noting that 70 percent of out-of-hospital cardiac arrests happen at home. Early training could foster a culture of action and improve survival rates. She explained that hands-only CPR instruction can be delivered within a single class period, using resources such as sample curricula, first aid e-books, streaming videos, and mannequins for practice. 4:29:56 PM MS. MORGAN shared a story highlighting the importance of bystander CPR, involving J.R. Lewis of KTVF in Fairbanks, whose 15-year-old son suffered a cardiac arrest but survived because bystanders knew CPR. This experience led Lewis to raise awareness about CPR, which he promotes in his newscasts. She also noted that since 2018, more than 40 states have passed laws requiring CPR training before high school graduation, while Alaska remains among the few without such a requirement. MS. MORGAN urged support for SB 221, stating that teaching students hands-only CPR could save thousands of lives by equipping communities with lifesavers who can provide immediate assistance until first responders arrive. She emphasized that now is the time to act, with the American Heart Association encouraging support for SB 221. 4:31:16 PM KELLY MANNING, Deputy Director, Innovation and Education Excellence, Department of Education and Early Development (DEED), Juneau, Alaska, paraphrased DEED's fiscal note for SB 221, OMB component 2796, dated February 29, 2024: [Original punctuation provided.] This bill removes cardiopulmonary resuscitation (CPR) from AS 14.30.360(a) as recommended content for physical health and personal safety instruction and adds a new section AS 14.30.363 that requires CPR be provided in public schools using curricula developed by the Department of Education and Early Development (DEED) at grade levels determined by DEED. This fiscal note assumes that DEED will create the CPR curriculum and identify which grade levels are appropriate for instruction. This fiscal note contains the following one-time expenses: 1) $400.0 for a facilitator to convene 20 qualified medical providers with educational expertise for their participation in the development of a K-12 CPR curriculum, including stipends, travel, and facilitation fees; 2) $100.0 First Year certification training for certified trainers (includes cost for a facilitator and travel for certified trainers); and 3) $6.0 for legal fees to implement the necessary regulation changes. This fiscal note contains the following annual expenses: 1) $30.0 for printed materials; 2) $10.0 for supplies (cleaning supplies, gloves, etc. as identified by the curriculum); 3) $35.0 CPR/AED kits ($55.50 (whole dollars) per kit - which supports 15 students, approximately 635 kits are needed); 4) $375.0 Annual Curriculum training (2-3 staff per district, depending on district size, up to 165 per year this includes stipends, travel, materials and supplies); 5) $75.0 annual certified trainer certification training (facilitator, travel for trainers, materials, and supplies.). 4:34:50 PM MS. MANNING continued her overview of fiscal note OMB component 2796: It should be noted, after consultation with the Division of Risk Management, there is concern regarding the high liability exposure for DEED developing the CPR curriculum for Alaskan School districts. CPR curriculum should be developed and taught by CPR certified instructors. If CPR is taught to school students by non-certified parties and something goes terribly wrong during the course of one of those students' providing CPR, the school district, or DEED, may be held liable for negligent and improper instruction. This fiscal note contains the following bi-annual expenses: 1) $150.00 for a facilitator to convene 15 qualified medical providers with educational expertise for their participation in a review of curriculum against CDC guidelines every two years, including stipends and facilitation fees. (Can be conducted virtually) 4:35:59 PM SENATOR KIEHL stated that he understood Ms. Manning was not part of Risk Management but asked if she could clarify their perspective on the potential liability. He noted that this situation seems to align with the definition of discretionary function immunity for a sovereign and inquired what possible liabilities might be involved. 4:36:17 PM MS. MANNING explained that Risk Management highlighted concerns related to the department developing medical instruction. As noted in the fiscal note, the potential liability stems not from the inherent nature of CPR instruction itself, but from the department developing a unique curriculum. The concern is that if any issues arose with the department-developed curriculum, liability could be a factor. She noted that existing curricula, which have already undergone extensive vetting processes, might mitigate such concerns better than a newly developed one. She added that this was not her area of expertise. 4:37:03 PM SENATOR KIEHL expressed skepticism about the liability concern, noting that the State of Alaska regularly develops curricula and standards across various domains. He pointed out that the department also establishes standards for building safety, despite the existence of codes, and could provide numerous similar examples. He argued that this situation falls under discretionary function immunity as defined by the Federal Tort Claims Act and Alaska Supreme Court [Tort Claims Act] 4:37:37 PM SENATOR GRAY-JACKSON thanked Senator Kiehl for his knowledge and stated her staff would share who will develop the curriculum. 4:38:11 PM MS. DIAZ stated Senator Gray-Jackson's office was in contact with DEED regarding the fiscal note. She said there are many fire departments, EMS, and paramedics, ready to volunteer and eager to collaborate in developing the curriculum. This means that the responsibility for creating the curriculum would not fall entirely on the department. She emphasized that there are already numerous resources available for building the curriculum, which should be straightforward since SB 221 focuses only on hands-only CPR. She mentioned a meeting with DEED and expressed hope in finding ways to adjust the fiscal note to reflect potential cost savings. 4:39:09 PM SENATOR BJORKMAN inquired how educators or school personnel would put SB 221 into practice and what it would look like in a school environment. 4:39:41 PM MS. MANNING replied that SB 221, as structured, leaves the implementation largely at the discretion of each district. The department is tasked with identifying the grades where CPR training will occur and setting standards. If the curriculum development changes, the department would adjust accordingly, but districts would retain autonomy in deciding how to implement it. She noted that districts have various options for employing CPR training, and some already do so. The department would provide support and technical assistance to help districts explore different approaches, recognizing that there are multiple ways to incorporate CPR training effectively. 4:41:02 PM SENATOR BJORKMAN expressed appreciation for the potential range and variety in implementation approaches. He referenced Chief Schrage's comment that it took only 30 minutes to teach CPR to the Rotary Club. However, he noted that the fiscal note, which involves convening large groups, implies that the Department of Education and Early Development (DEED) has a more expansive vision for this program. He asked specifically what DEED envisions teachers will be instructing students regarding CPR. 4:41:44 PM MS. MANNING explained that the fiscal note is based on the language in SB 221, Section 2, which states that the department shall develop the curriculum. If the language changes, as Senator Gray-Jackson suggested, the department would reconsider its approach to the curriculum. The fiscal note reflects the requirement for DEED to develop the curriculum, which accounts for much of the projected cost. If DEED is not responsible for developing it, a different approach could be adopted. She stated that if DEED develops the curriculum, it will need to be created effectively according to national standards for CPR instruction, which drives the majority of the expenses. Additionally, DEED would need to train individuals on how to use the new curriculum, which is what the fiscal note is focused on. Once districts are trained, DEED would prepare a certified facilitator who could then meet district needs according to the curriculum developed by the group of experts. 4:42:54 PM SENATOR GRAY-JACKSON commented that she would have SB 221 amended once it is determined who will be responsible for developing the curriculum if it is not the department. 4:43:23 PM SENATOR TOBIN opened public testimony on SB 221. 4:43:39 PM JAMES WHITE, representing self, Juneau, Alaska, testified in support of SB 221. He shared his experiences teaching Cardiopulmonary Resuscitation (CPR) to students and emphasized the importance of having an educated population ready to respond to cardiac emergencies. He spoke about losing his father-in-law to an asthma-induced cardiac arrest in 2018, which taught him that every second is crucial in such situations. He noted that 70 percent of Americans are still hesitant to perform CPR due to lack of training and pointed out that for every minute without chest compressions, a person can lose up to 10 percent of brain function. Immediate CPR more than doubles survival odds and greatly reduces the risk of brain damage or lasting harm. MR. WHITE incorporated the American Heart Association's hands- only CPR curriculum into the life skills course he was teaching, and for the past five years, he has used this curriculum to teach students how to respond to cardiac arrest by performing CPR and using an Automated External Defibrillator (AED) when available. He described his experiences as both engaging and rewarding. 4:45:06 PM MR. WHITE shared specific success stories, including one in December 2021 where a student saved his father's life by performing hands-only CPR after a cardiac arrest. The student credited his quick and effective response to the training he received in class just weeks prior. Another similar incident occurred in February 2023, when a student saved her mother's life after a cardiac arrest at their Juneau home, again attributing her successful response to the CPR lessons learned in class. 4:45:55 PM MR. WHITE highlighted the value of empowering students with practical, life-saving skills like CPR, which benefit both the students and the broader community. He expressed regret that in December 2023, the life skills course was cut due to lack of funding, eliminating CPR training opportunities for students in his district. He urged support for increased Base Student Allocation (BSA) funding to ensure teachers can continue providing CPR education in schools, emphasizing that the decision to empower students to save lives is now in the hands of the policymakers. 4:46:42 PM SCOTT WELLMAN, M.D., representing self, Anchorage, Alaska, testified in support of SB 221 and is the medical director at Providence Alaska Children's Hospital. He shared a story about a patient he met last August, a generally healthy and active 15- year-old from western Alaska. While playing basketball, the teenager suddenly felt strange and collapsed. A bystander provided Cardiopulmonary Resuscitation (CPR) until medics arrived five minutes later and found an unstable heart rhythm. A defibrillator was used to restore the normal rhythm. The teenager took some time to recover but ultimately had an excellent outcome, thanks to the bystander who knew CPR. He noted that the patient's mother wanted this story shared, and he emphasized its importance. Although remarkable, he said the story was not unique, as he has seen other patients with similar experiences. 4:47:57 PM DR. WELLMAN noted that while students can potentially save peers, CPR is more often used to save adults in their homes or communities, where 70 to 75 percent of cardiac arrests occur. He highlighted that having someone at home capable of responding to an emergency can make all the difference. He also mentioned that CPR has financial benefits, as survivors who receive CPR early tend to recover faster, leave the hospital sooner, and return to the workforce. He acknowledged that he did not have the exact figures but believed this factor was crucial for consideration. DR. WELLMAN emphasized that CPR is an essential life skill, expressing happiness at hearing that it was taught in middle schools earlier. He noted that the benefits extend beyond saving lives, including building self-confidence among students. Given that over 40 other states have already implemented CPR training in schools, he urged that Alaska make CPR training a part of school curricula across the state. 4:49:23 PM LINDA IRELAND, D.O., representing self, Anchorage, Alaska, testified in support of SB 221. She said she is a practicing cardiologist and president of the Alaska Heart and Vascular Institute in Anchorage, as well as the current governor of the Alaska Chapter of the American College of Cardiology, She emphasized that requiring the Department of Education to implement CPR education statewide is crucial for student and community safety. She noted that cardiac arrest can happen anywhere, with 70 percent of cases occurring at home, and stressed that knowing CPR can mean the difference between life and death. Drawing from her 20 years of cardiology experience in Alaska, she shared that she has seen many instances where delayed CPR led to severe incapacity or death, cases that could have been prevented if CPR had been administered immediately. She argued that educating students is a powerful way to save lives, as empowering youth with CPR skills will have long- lasting benefits for individuals and communities. She added that the resources and training for hands-only CPR are widely available and cost-effective. 4:50:38 PM DR. IRELAND also shared her recent partnership with the Boys and Girls Club, where she has begun teaching hands-only CPR, with plans to continue these efforts in remote areas of Alaska this summer, funded by a grant from the American College of Cardiology. She urged that with the support of SB 221, every student could graduate with the ability to respond effectively in an emergency. In conclusion, she encouraged the committee to pass SB 221, highlighting that over 40 states have already integrated CPR training into school curricula. She stressed that advancing this legislation will allow Alaska to join those states in equipping students to act decisively in emergencies, thereby saving lives and strengthening communities. 4:51:40 PM BRIAN WEBB, representing self, Anchorage, Alaska, testified in support of SB 221. He said he has been an Alaskan EMS professional since 1978 and educator since 1984. He stressed that delayed EMS response times and lack of bystander CPR are major challenges, with each minute of cardiac arrest reducing survival chances by 10 percent. He noted Alaska remains among the few states without mandatory school CPR training, despite past attempts since 2005. 4:52:25 PM MR. WEBB emphasized that CPR certification isn't required gaining skills is key, and effective training can be done in 30 minutes or less using low-cost programs and available mannequins. He highlighted community support efforts from Ketchikan, Kodiak, and Prince of Wales Island, and shared a success story from Juneau where a student saved his father's life using school CPR training and noted over 15 instances in the lower forty-eight states where students saved lives. He urged support for SB 221 to save lives across Alaska. 4:53:51 PM TYLER BELK, representing self, Anchorage, Alaska, testified in support of SB 221. He said he is a firefighter paramedic with the Anchorage Fire Department and Executive Board member of the International Association of Firefighters Local 1264. He stated that CPR is a life-saving skill anyone can learn and has witnessed its impact firsthand through community members performing CPR before paramedics arrive. He emphasized that SB 221 provides a valuable opportunity to educate young people in the community in this critical skill. He shared personal stories, including finding a seven-year-old performing CPR on their father, underscoring the importance of this training. He expressed his full support for SB 221 and opined that his union members also support SB 221. 4:55:41 PM FORREST KUIPER, representing self, Fairbanks, Alaska, testified in support of SB 221 and is the President of the Alaska Fire Chiefs Association. He said he is the president of the Alaska Fire Chiefs Association and emphasized the importance of incorporating CPR training into high school curricula statewide. He noted that Alaska's vast landscape creates unique emergency response challenges, where seconds can determine life or death, particularly in remote areas. He highlighted that CPR empowers individuals to provide life-saving interventions until professional help arrives. He cited three incidents in the last 60 days in the University Fire Service area where bystander CPR, combined with early advanced interventions, led to successful resuscitations. He credited these outcomes to quick bystander actions. He urged support for SB 221, stressing that integrating CPR training in schools would empower youth, improve emergency response across Alaska, and ensure a safer future. 4:58:11 PM GERALD VOSS, representing self, Juneau, Alaska, testified in support of SB 221. He expressed strong support for teaching CPR at a young age, noting that he has used CPR to save lives while working in the airlines. He questioned why the resources and expertise of fire departments couldn't be leveraged to train both teachers and students, potentially reducing costs. He also asked if defibrillators are available in high schools and whether teachers would be trained to use them if needed. He reiterated his support for teaching CPR to children. 4:59:08 PM CHAIR TOBIN closed public testimony on SB 221. 4:59:18 PM CHAIR TOBIN held SB 221 in committee.