SACRAMENTO, CA - April 4, 2026 - The Fitiger engineering and product safety team has released a benchmarking brief examining how California's AB 645 may affect airway-emergency readiness planning for public safety agencies, schools, and other high-occupancy environments.
California's AB 645 requires, by January 1, 2027, that a public safety agency providing 911 call processing services for emergency medical response deliver prearrival medical instructions to callers requiring medical assistance. The bill text specifically includes airway and choking medical instructions for infants, children, and adults, along with CPR, childbirth, bleeding control, epinephrine auto-injector use for suspected anaphylaxis, and naloxone for suspected narcotics overdose. The law also requires those instructions to be approved by the local EMS agency medical director and implemented consistently with the public safety agency's adopted medical protocols and procedures.
For Fitiger, the engineering significance of AB 645 is not limited to dispatcher scripts. The bill highlights a broader operational question: how quickly a bystander can move from recognition to usable action when professional responders are still minutes away. In airway emergencies, that interval is shaped by instruction clarity, scene layout, available tools, and whether the caller can follow a sequence without confusion under stress.
The benchmarking brief focuses on the relationship between prearrival guidance and second-line readiness. The FDA's current framework places suction anti-choking devices in a Class II category intended for use as a second-line treatment after established choking rescue protocols have been attempted without success. Under that federal position, prearrival medical instructions do not replace first-line action. They clarify the sequence around it.
Fitiger's analysis identifies three operational issues that California agencies and institutional planners may need to evaluate more closely as the 2027 implementation date approaches. The first is instruction design: whether a time-sensitive airway sequence can be communicated clearly to a lay responder over the phone. The second is device and resource reach: whether the caller or a nearby responder can access the next step without losing the scene. The third is protocol alignment: whether local guidance preserves established first-line choking response while defining what happens if standard measures do not resolve the obstruction.
Human factors data make that readiness question more concrete. In published simulated-use testing, lay responders using a simple suction sequence averaged 36.6 seconds to operate the device,
while a more complex catheter-based approach averaged about 50.4 seconds. A 14-second difference does not sound dramatic on paper. In an airway emergency, it sits inside the exact interval when the caller is trying to follow instructions under stress, often before EMS arrives.
That timing gap is especially relevant in distributed and rural settings. California's statewide response picture is uneven, and some communities operate with longer EMS intervals than dense urban corridors. A bystander who can move from recognition to usable second-line action in a tightly compressed sequence does not replace professional care. The shorter sequence helps fill part of the prearrival gap while responders are still en route.
The company said AB 645 is especially relevant in large campuses, rural areas, distributed school settings, and multi-building environments where the interval before on-scene professional care may be longer and the first effective response still depends on bystanders. In those settings, prearrival medical instructions become part of the physical rescue pathway, not just a communication layer.
'AB 645 shifts part of the airway-readiness conversation into the dispatch window,' said the Fitiger Engineering and Product Safety Team. 'The critical question is no longer only what equipment is on site. It is whether the sequence between recognition, instruction, reach, and intervention still holds while professional responders are en route.'
As California agencies continue implementation work ahead of January 1, 2027, Fitiger said it will keep publishing technical resources around airway-emergency workflow design, second-line readiness, human factors, and bystander usability under pressure.
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Resources
California AB 645 chaptered text
