California Proposition 11, Ambulance Employees Paid On-Call Breaks, Training, and Mental Health Services Initiative (2018)

California Proposition 11, the Ambulance Employees Paid On-Call Breaks, Training, and Mental Health Services Initiative, is on the ballot in California as an initiated state statute on November 6, 2018.


What would this ballot initiative change about ambulance operations?

Proposition 11 would allow ambulance providers to require workers to remain on-call (reachable by a portable communications device) during meal and rest breaks. The measure would require ambulance providers to pay workers at their regular rate during breaks, not make workers take a meal break during the first or last hour of a shift, and space multiple meal breaks during a shift by at least two hours. If a worker is contacted during a meal or rest break, the initiative would mandate that the interrupted break not be counted towards the breaks the worker is required to receive. The measure would require ambulance providers to manage staffing levels sufficient to provide employees with the required breaks.
The initiative would require ambulance providers to provide ambulance employees, such as paramedics and EMTs, with training related to active shooters and multiple casualties, natural disasters, violence prevention, and mental health. The initiative would also require ambulance providers to provide workers up to 10 paid mental health services per year and, for employers who provide health insurance, health insurance plans that offer long-term mental health services.

Why was this ballot initiative proposed?

In December 2016, the California Supreme Court ruled in Augustus v. ABM Security Services that employer-required on-call rest breaks violated state labor law. According to the state Supreme Court, state labor law mandates that rest breaks must be considered off-duty and uninterruptable, including in the event of an emergency. Although Augustus specifically applied to private security guards, the California Legislative Analyst noted that on-call break practices among EMTs and paramedics are similar to that of private security guards. The analyst's office also noted that several lawsuits alleging break violations under Augustus had been brought against ambulance providers and remained unresolved. If Augustus was applied to ambulance employees, EMTs and paramedics would need to go off-duty during their meal and rest breaks. Ambulance providers, according to the analyst's office, would need to hire about 25 percent more ambulance crews to meet the requirements of Augustus. The ballot initiative would amend state labor law to allow EMTs and paramedics to be on-call during breaks and require employers to pay workers at their regular rates during breaks.

Who is behind the campaigns surrounding the ballot initiative?

Californians for Emergency Preparedness and Safety is leading the campaign in support of the ballot initiative. The committee had raised $21.90 million. American Medical Response, the country's largest medical transportation firm, was the sole donor to the committee. There were no committees registered to oppose the ballot initiative.

Ballot Title

The official ballot title is as follows:

“Requires Private-Sector Emergency Ambulance Employees to Remain on Call During Work Breaks. Changes Other Conditions of Employment. Initiative Statute.”

Text of the measure

Ballot summary

The official ballot summary is as follows:

  • Makes labor law entitling hourly employees to take work breaks for meals and rest, without being on-call, inapplicable to private-sector emergency ambulance employees. Regulates timing of meal breaks for these employees.
  • Eliminates employers’ liability—in actions pending on or after October 25, 2017—for violations of existing law regarding work breaks. Requires employers to provide training regarding certain emergency incidents, violence prevention, and mental health and wellness.
  • Requires employers to provide employees certain mental-health services.