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TO BE PUBLISHED IN THE OFFICIAL REPORTS 

OFFICE OF THE ATTORNEY GENERAL 

State of California 

DANIEL E. LUNGREN 

Attorney General 

______________________________________

OPINION :

: No. 98-806

of :

: November 17, 1998

DANIEL E. LUNGREN :

Attorney General :

:

CLAYTON P. ROCHE :

Deputy Attorney General :

:

______________________________________________________________________

 THE HONORABLE MIKE THOMPSON, MEMBER OF THE CALIFORNIA STATE

SENATE, has requested an opinion on the following question:

 Does a county board of supervisors or the county emergency medical services agency have

the authority to designate the location of trauma facilities in the county? 

CONCLUSION

 The county emergency medical services agency, and not the county board of supervisors,

has the authority to designate the location of trauma facilities in the county. 

ANALYSIS

 In 1980 the Legislature enacted a comprehensive statutory scheme, the Emergency Medical

Services System and the Prehospital Emergency Medical Care Personnel Act (Health & Saf. Code, §§

1797-1799.207; "Act") Footnote No. 1 to establish a statewide system for providing emergency medical

services to those in need thereof. (Valley Medical Transport, Inc. v. Apple Valley Fire Protection Dist.

(1998) 17 Cal.4th 747, 754; County of San Bernardino v. City of San Bernardino (1997) 15 Cal.4th 909,

914-916.) The Act is administered by the Emergency Medical Services Authority ("Authority") at the state

level (§ 1797.1) and by an emergency medical service agency ("EMS agency") at the local county level (§

1797.200). Section 1797.200 provides:

 "Each county may develop an emergency medical services program. Each county

developing such a program shall designate a local EMS agency which shall be the county health

department, an agency established and operated by the county, an entity with which the county

contracts for the purposes of local emergency medical services administration, or a joint powers

agency created for the administration of emergency medical services . . . ."
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 The question presented for resolution concerns whether a county board of supervisors or the

local EMS agency is responsible under the terms of the Act for selecting the location of necessary trauma

facilities. We conclude that the EMS agency has the sole statutory obligation.

 Section 1798.165 specifically controls the siting of trauma facilities. It states:

 "(a) Local emergency medical services agencies may designate trauma facilities as

part of their trauma care system pursuant to the regulations promulgated by the authority.

 "(b) The health facility shall only be designated to provide the level of trauma care

and services for which it is qualified and which is included within the system implemented by

the agency.

 "(c) No health care provider shall use the terms 'trauma facility,' 'trauma hospital,'

'trauma center,' 'trauma care provider,' 'trauma vehicle,' or similar terminology in its signs or

advertisements, or in printed materials and information it furnishes to the general public, unless

the use is authorized by the local EMS agency." (Italics added.)

Subdivision (b) of section 1798.160 defines a "trauma facility" as follows:

 "'Trauma facility' means a health facility, as defined by regulation, which is capable

of treating one or more types of potentially seriously injured persons and which has been

designated as part of the regional trauma care system by the local EMS agency. A facility may

be a trauma facility for one or more services, as designated by the local EMS agency." (Italics

added.)

 The regulations adopted by the Authority (Cal. Code Regs., tit. 22, §§ 100000.1-100334)

Footnote No. 2 in administering the Act refer to trauma facilities as "trauma centers" (Reg. 100250),

classifying them as "Level 1" (Reg. 100260), "Level II" ( Reg. 100261), or "Level III" (Reg. 100262). A

trauma center is "a licensed general acute care hospital which has been designated as a Level I, II, or III

trauma center by the local EMS Agency in accordance with this chapter." (Reg. 100250.) Regulation 100254,

subdivision (j) states: "No health care facility shall advertise in any manner or otherwise hold themselves out

to be a trauma center unless they have been so designated by the local EMS Agency, in accordance with this

Chapter." The local EMS agency is required under the Authority's regulations to "designate a single trauma

center of the highest level possible" within a given service area. (Reg. 100255, subd. (b)(3).)

 It is apparent that the Act and implementing regulations require the local EMS agency,

rather than the county board of supervisors, to designate trauma facilities. It is evident that medical

knowledge is necessary to make such determinations. (See Regs. 100260-100262.) A designation is not a

local issue to be resolved politically, but instead is a medical decision to be made by medically trained

officials in carrying out the Act's purposes of providing "the state with a statewide system for emergency

medical services." (§ 1797.1; see also § 1797.5; Memorial Hospital Assn. v. Randol (1995) 38 Cal.App.4th

1300, 1310 [when requiring a determination to be made by the local EMS agency, which has a physician as

its medical director, the Legislature indicates that it wants the decision to be "a professional, not a political

determination"].)

 Both the language of the Act and its implementing regulations, as well as the legislative

purposes to be served, require the local EMS agency to designate the location of all trauma facilities based

upon medical factors, not political considerations.

 We conclude that the county EMS agency, and not the county board of supervisors, has the

authority to designate the location of trauma facilities in the county. 
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Footnote No. 1

All references hereafter to the Health and Safety Code are by section number only. 

Footnote No. 2

All references hereafter to title 22 of the California Code of Regulations are by regulation number only.