California Lifeguards and Title 22

The State of California Code of Regulations has a section on first aid standards for public safety personnel, including lifeguards, police and fire, commonly referred to as Title 22.

It requires first aid training beyond the first aid required for a Red Cross lifeguard certification, but not as many hours as Emergency Response. It requires Cardiopulmonary Resuscitation instruction to the same level as does the Red Cross lifeguard certification: Cardiopulmonary Resuscitation for the Professional Rescuer (CPRFPR).

A copy of the regulation is below. The notes below are for my students to consider.

Note that in section 100017 a time limit of one year for completion of the training is given. Many local pools I know of are intrepreting this to mean that their seasonal lifeguards need not have this training. But some of these guards are rehired summer after summer, so these pools could be in trouble if an accident leads to a lawsuit.

Note also that in sections 100010, 100011, 100012, 100014, etc. the persons who need the training are described as employed and paid. Volunteers are not mentioned, except volunteer fire fighters, but the training could be wise for volunteer lifeguards such as Scout leaders or volunteers at swim races.

As of 2007, the Santa Clara Valley Chapter of the Red Cross offered First Aid for Public Safety Personnel, and described it as suitable for “Lifeguards, Security Officers and Company Responders” The class had a prerequisite of a current (within one year) CPRFPR certification. This class cost $155 and took 16 hours. It included oxygen and bloodborne pathogens requirements for responders, which some local lifeguard classes include as a part pf their lifeguard classes.

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June 2000

California Code of Regulations

Title 22. Social Security

Division 9. Prehospital Emergency Medical Services

Chapter 1.5. First Aid Standards for Public Safety Personnel

Article 1. Definitions

§ 100005. Automated External Defibrillator or AED.

“Automated External Defibrillator or AED” means an external defibrillator capable of cardiac
rhythm analysis which will charge and deliver a shock either automatically or by user interaction
after electronically detecting and assessing ventricular fibrillation or rapid ventricular
tachycardia.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.52,
1797.182 and 1797.183, Health and Safety Code; and Section 13518, Penal Code.
1

§ 100006. Public Safety AED Service Provider

“Public Safety AED Service Provider” means an agency, or organization which is responsible
for, and is approved to operate, an AED.

NOTE: Authority cited: Section 1797.107, 1797.182 and 1797.183, Health and Safety Code.
Reference: Sections 1797.182 and 1797.183, Health and Safety Code and Section 13518, Penal
Code.

§ 100007. Cardiopulmonary Resuscitation.

“Cardiopulmonary resuscitation” or “CPR” means establishing and maintaining an open airway,
ensuring adequate respiration either spontaneously or by use of rescue breathing, and ensuring
adequate circulation either spontaneously or by means of closed chest cardiac compression,
according to standards promulgated by the American Heart Association and/or the American Red
Cross.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.182
and 1797.183, Health and Safety Code; and Section 13518, Penal Code.

§ 100008. Firefighter

“Firefighter” means any regularly employed and paid officer, employee or member of a fire
department or fire protection or firefighting agency of the State of California, or any city, county,
city and county, district or other public or municipal corporation or political subdivision of
California or any member of an emergency reserve unit of a volunteer fire department or fire
protection district.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Section 1797.182,
Health and Safety Code.

§ 100009. First Aid.

“First aid” means the recognition of and immediate care for injury or sudden illness, including
medical emergencies, prior to the availability of medical care by licensed or certified health care
professionals.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.182
and 1797.183, Health and Safety Code; and Section 13518, Penal Code.

§ 100010. Lifeguard.

“Lifeguard” means any regularly employed and paid officer, employee, or member of a public
aquatic safety department or marine safety agency of the State of California, or any city, county,
city and county, district or other public or municipal corporation or political subdivision of
California.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Section 1797.182,
Health and Safety Code.

§ 100011. Peace Officer.

“Peace officer” means any city police officer, sheriff, deputy sheriff, peace officer member of
the California Highway Patrol, marshal or deputy marshal or police officer of a district
authorized by statute to maintain a police department or other peace officer required by law to
complete the training specified in this Chapter.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Section 1797.183,
Health and Safety Code; and Section 13518, Penal Code.

§ 100012. Primarily Clerical or Administrative.

“Primarily clerical or administrative” means the performance of clerical or administrative duties
for ninety percent (90%) or more of the time worked within each pay period.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.182
and 1797.183, Health and Safety Code; and Section 13518, Penal Code.

§ 100013. Qualified Instructor.

“Qualified instructor” is a trained individual who shall be certified to teach first aid and/or CPR
by the approving authority specified in Section 100026 of this Chapter.
Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.182
and 1797.183, Health and Safety Code; and Section 13518, Penal Code.

§ 100014. Regularly Employed.

“Regularly employed” means being given wages, salary, or other remuneration for the
performance of those duties normally carried out by lifeguards, firefighters, or peace officers.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.182
and 1797.183, Health and Safety Code.

Article 2. General Training Provisions

§ 100015. Application and Scope.

Except those whose duties are primarily clerical or administrative, the following regularly
employed public safety personnel shall be trained to administer first aid, and cardiopulmonary
resuscitation, according to the standards set forth in this Chapter:

(a) lifeguard;

(b) firefighter;

(c) peace officer.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.182
and 1797.183, Health and Safety Code; and Section 13518, Penal Code.

§ 100016. Training Programs In Operation.

Training programs in operation prior to the effective date of these regulations shall submit
evidence of compliance with this Chapter to the appropriate approving Authority as specified in
Section 100026 of this Chapter within six (6) months after the effective date of these regulations.
Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.182
and 1797.183, Health and Safety Code; and Section 13518, Penal Code.

§ 100017. Time Limitation for Initial Training.

The initial training requirements specified in this Chapter shall be satisfactorily completed
within one (1) year from the effective date of the individual’s initial employment and, whenever
possible, prior to assumption of regular duty in one of the personnel categories set forth in
Section 100016 of this Chapter.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.182
and 1797.183, Health and Safety Code; and Section 13518, Penal Code.

Article 3. Training Standards

§ 100018. Scope of Course.

(a) The initial course of instruction shall at a minimum consist of not less than fifteen (15)
hours in first aid and six (6) hours in cardiopulmonary resuscitation.

(b) The course of instruction shall include, but need not be limited to, the following scope of
course which shall prepare personnel specified in Section 100016 of this Chapter to recognize the
injury or illness of the individual and render assistance:

(1) Emergency action principles which describe the basic problems of decision making in first
aid;

(2) First aid for medical emergencies, including sudden illnesses;

(3) Cardiac and respiratory emergencies, including cardiac and/or respiratory failures in victims
of all ages;

(4) First aid for traumatic injuries including wounds, and life threatening bleeding;

(5) First aid for specific injuries, including care for specific injuries to different parts of the
body;

(6) Bandaging, including materials and guidelines used in bandaging;

(7) First aid for environmental emergencies including burns, heat and chemical burns, electrical
emergencies and exposure to radiation, or climatic changes;

(8) First aid for injuries to bones, muscles, and joints;

(9) Emergency rescue and transfer;

(10) First aid for obstetrical emergencies.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.182
and 1797.183, Health and Safety Code; and Section 13518, Penal Code.

§ 100019. Required Topics.

The content of the training course shall include at least the following topics and shall be skill-
oriented:

(a) Examination and assessment of the victim;

(b) Orientation to the EMS system;

(c) Suspected heart attack or stroke;

(d) Fainting, convulsions, and/or suspected drug abuse;

(e) Heat exhaustion, heat stroke, hypothermia and frost bite;

(f) Mouth to mouth breathing and care for choking victims whether conscious or unconscious;

(g) Types of wounds and control of bleeding;

(h) Shock, and its causes, infection and closed wounds;

(i) Eye, face, scalp, jaw and ear injuries;

(j) Injuries of the head, neck, back, trunk, arms and legs;

(k) Exposure to toxic substances;

(l) Bites and stings by snakes, marine life and insects;

(m) Bandaging techniques, first aid kits and supplies;

(n) Determination of the severity of burns, including first, second, and third degree burns;

(o) Fractures, both open and closed, splinting, and care for fractures, sprains, strains and
dislocated joints;

(p) Techniques of cardiopulmonary resuscitation; and

(q) Obstetrical emergencies.

Note: Authority cited: Section: 1797.107, Health and Safety Code. Reference: Sections 1797.182
and 1797.183, Health and Safety Code; and Section 13518, Penal Code.

§ 100020. Optional Skill.

(a) In addition to the activities authorized by Section 100019 of this Chapter, public safety
personnel may perform AED when authorized by a public safety AED service provider.

(1) Training for the AED shall consist of not less than four (4) hours and shall include the
following topics and skills:

(A) Proper use, maintenance and periodic inspection of the AED.

(B) The importance of cardiopulmonary resuscitation (CPR), defibrillation, advanced life
support (ALS), adequate airway care, and internal emergency response system, if applicable.

(C) Overview of the EMS system, the local EMS system’s medical control policies,
9-1-1 access, and interaction with EMS personnel.

(D) Assessment of an unconscious patient, to include evaluation of airway, breathing, and
circulation to determine cardiac arrest.

(E) Information relating to AED safety precautions to enable the individual to administer a
shock without jeopardizing the safety of the patient or rescuers or other nearby persons.

(F) Recognition that an electrical shock has been delivered to the patient and that the
defibrillator is no longer charged.

(G) Rapid, accurate assessment of the patient’s post-shock status.

(H) The appropriate continuation of care following a successful defibrillation.

(b) In order to be authorized to utilize the defibrillator, an individual shall pass a written and
skills examination with a pre-established standard, which tests the ability to assess and manage
the specified conditions listed in subsection (a) of this section.

(c) A local EMS agency that approves public safety AED service providers shall:

(1) Approve and monitor training programs including refresher training within its jurisdiction
to assure compliance with this Chapter.

(2) Approve the written and skills exam required for AED training course completion

(3) Develop policies and procedures for approval of AED instructors by the local EMS agency
medical director. To be authorized to instruct public safety personnel in the use of an AED, an
AED instructor shall either:

(A) Complete an American Red Cross or American Heart Association recognized instructor
course (or equivalent) including instruction and training in the use of an AED, or

(B) Be approved by the local EMS agency director and meet the following requirements:

1. Be AED accredited or able to show competency in the proper utilization of an AED, and

2. Be able to demonstrate competency in adult teaching methodologies.

(4) Establish policies and procedures for medical control pursuant to Section 1798 of the
Health and Safety Code.

(5) Establish policies and procedures for the approval and designation of public safety AED
service provider(s) which will include requirements that public safety AED service providers
have policies and procedures, approved by the local EMS agency medical director, to

(A) provide orientation of AED accredited personnel to the AED,

(B) ensure continued competency of AED accredited personnel, and

(C) collect and report data to the local EMS agency, pursuant to Section 100021.

(6) Establish policies and procedures to collect, maintain and evaluate patient care records.

(7) Report annually to the EMS Authority on: 38

(A) The total number of patients, defibrillated; , who were discharged from the hospital alive,
and

(B) The data collected by public safety AED service providers pursuant to Section 100021 of
this chapter.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.52,
1797.58, 1797.74, 1797.90, 1797.175, 1797.176, 1797.182, 1797.183, 1798, 1798.2, 1798.4,
1798.100, 1798.102 and 1797.104, Health and Safety Code; and Section 13518, Penal Code. 67

§Section 100021. Public Safety AED Service Provider

A public safety AED service provider is an agency or organization that employs individuals as
defined in Section 100015, and who obtain AEDs for the purpose of providing AED services to
the general public.

(a) A public safety AED service provider shall be approved by the local EMS agency, or in the
case of state or federal agencies, the EMS Authority, prior to beginning service. In order to
receive and maintain AED service provider approval, a public safety AED service provider shall
ensure compliance with the requirements of this Chapter.

(b) Public safety AED service provider approval may be revoked or suspended for failure to
maintain the requirements of this section.
(c) A public safety AED service provider applicant shall be approved if they meet and provide
the following:

(1) Provide orientation of AED authorized personnel to the AED;

(2) Ensure maintenance of AED equipment;

(3) Ensure initial training and continued competency of AED authorized personnel;

(4) Collect and report to the local EMS agency where the defibrillation occurred, as required by
the local EMS agency but no less than annually, data that includes, but is not limited to:

(A) The number of patients with sudden cardiac arrest receiving CPR prior to arrival of
emergency medical care.

(B) The total number of patients on whom defibrillatory shocks were administered, witnessed
(seen or heard) and not witnessed; and

(C) The number of these persons who suffered a witnessed cardiac arrest whose initial
monitored rhythm was ventricular tachycardia or ventricular fibrillation.

(5) Authorize personnel and maintain a listing of all public safety AED service provider
authorized personnel and provide upon request to the local EMS agency or the EMS Authority.

(c) An approved public safety AED service provider and their authorized personnel shall be
recognized statewide.

NOTE: Authority cited: Section 1797.107, 1797.182 and 1797.183, Health and Safety Code.
Reference: Sections 1797.182 and 1797.183, Health and Safety Code and Section 13518, Penal
Code.

§ 100022. Testing.

(a) The course of instruction shall include a written and skills examination which tests the
ability to assess and manage all the conditions listed in Sections 100018 and 100019 of this
Chapter.

(b) A passing standard shall be established by the training agency before administration of the
examination.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.182
and 1797.183, Health and Safety Code; and Section 13518, Penal Code. 78

§ 100023. Training Instructor Requirements.

(a) Training in first aid and CPR for the personnel specified in Section 100016 of this Chapter
shall be conducted by an instructor who is:

(1) Proficient in the skills taught; and

(2) qualified to teach by education and/or experience.

(b) Determination of the instructor’s qualifications shall be the responsibility of the agency
whose training program has been approved by the Authority pursuant to Section 100026 of this
Chapter.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.182
and 1797.183, Health and Safety Code; and Section 13518, Penal Code.

§ 100024. Validation of Course Completion.

(a) Each trainee who successfully completes an approved course of instruction and successfully
passes a proficiency test shall be given written verification to that effect by the institution,
organization or agency which provides the instruction.

(b) Employing agencies which provide approved courses of instruction to their employees need
not provide individual written verification but shall maintain a record of the names of trainees
and the date(s) on which training courses have been completed for at least three (3) years.

(c) Such training records shall be made available for inspection by the local EMS agency upon
request.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.182
and 1797.183, Health and Safety Code; and Section 13518, Penal Code.

§ 100025. Retraining Requirements.

(a) The retraining requirements of this Chapter shall be satisfied by successful completion of
either:

(1) An approved retraining course which includes a review of the topics and demonstration of
skills prescribed in this Chapter and which consists of no less than twelve (12) hours; or

(2) A competency based written and skills pretest of the topics and skills prescribed in this
Chapter with the following restrictions:

(A) That appropriate retraining be provided on those topics indicated necessary by the pretest,
in addition to any new developments in first aid and CPR;

(B) A final test be provided covering those topics included in the retraining for those persons
failing to pass the pretest; and

(C) The hours for the retraining may be reduced to those hours needed to cover the topics
indicated necessary by the pretest.

(b) The entire retraining course or pretest may be offered yearly by the training agency, but in
no event shall the retraining course or pretest be offered less than once every three (3) years.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.182
and 1797.183, Health and Safety Code; and Section 13518, Penal Code.

Article 4. Training Approval Options

§ 100026. Approved Courses.

The training requirements of this Chapter may be satisfied by successfully completing any one
of the following course options as determined by the employing agency:

(a) A course in first aid, including CPR, developed and/or authorized by the Fire Service
Training Program of the Office of the State Fire Marshal and approved by the EMS Authority; or

(b) A course in first aid, including CPR, authorized by the Commission on Peace Officer’s
Standards and Training (POST) and approved by the EMS Authority; or

(c) A course in first aid, including CPR, developed and authorized by the California
Department of Parks and Recreation and approved by the EMS Authority; or

(d) A course in first aid, including CPR, developed and authorized by the California
Department of Forestry and Fire Protection and approved by the EMS Authority; or

(e) A course in first aid, including CPR, developed and authorized by the Department of the
California Highway Patrol and approved by the EMS Authority; or

(f) A course in first aid, including CPR, sponsored and/or approved by the American Red
Cross; or

(g) A course in first aid sponsored and/or approved by the American Red Cross and a course in
CPR sponsored and/or approved by the American Heart Association; or

(h) The U.S. Department of Transportation’s first responder course which includes first aid
practices and CPR approved by the local EMS agency; or

(i) A course in first aid and/or CPR equivalent to the standards of the American Red Cross
and/or American Heart Association and approved by the local EMS agency; or

(j) An EMT-I course which has been approved pursuant to Chapter 2 of this division; or

(k) An EMT-II course which has been approved pursuant to Chapter 3 of this division; or

(l) An EMT-P course which has been approved pursuant to Chapter 4 of this division.

Note: Authority cited: Section 1797.107, Health and Safety Code. Reference: Sections 1797.182
and 1797.183, Health and Safety Code; and Section 13518, Penal Code.