Advocates and caregiver press Pennsylvania committee to require dementia training for EMS; ambulance group urges regulation instead

HARRISBURG — The House Aging & Older Adult Services Committee heard divided testimony on HB 2435 as advocates and a caregiver urged lawmakers to require baseline dementia-care training for emergency medical services personnel while the Ambulance Association of Pennsylvania recommended relying on existing national standards and Department of Health regulation.

Chairwoman Representative Maureen Madden opened the hearing by noting last session’s bipartisan Act 111 of 2024 and introducing HB 2435, which she and Rep. Kyle Mullins sponsored to establish initial and continuing dementia-care training for EMS. "As this population continues to grow," Madden said, "we cannot afford to risk a poor encounter with our first responders system here in the Commonwealth."

Michael Galvan, director of government relations for the Alzheimer’s Association in Pennsylvania, testified in support of the bill. He said EMS already encounters people living with Alzheimer’s and other dementias frequently and that HB 2435 would "codify into law" critical training topics so they remain part of required education. Galvan cited Commonwealth figures he gave in testimony ("more than 282,000 Pennsylvanians aged 65 or older" living with Alzheimer’s or related dementias), said dementia patients have high emergency-department use as he reported it, and said Pennsylvania’s Medicaid costs for Alzheimer’s care total "$4,400,000,000 annually" as he framed it. Galvan listed curriculum topics the bill would require, including recognizing behavioral symptoms, communication strategies, addressing behavioral symptoms during emergency care, identifying and reporting abuse or neglect, and protocols for contacting caregivers when someone is found wandering. "This bill is about giving the best care and treatment for our loved ones, their caregivers, and our first responders," Galvan said.

Jenny Catchings, state advocacy manager for the Association for Frontotemporal Degeneration, said FTD often affects people younger than typical Alzheimer’s patients and may present with disinhibition or impulsivity that responders could mistake for intoxication or psychiatric illness. "When caregivers report positive experiences, the stories sound similar; when they report negative experiences, they sound chaotic," Catchings said, arguing consistent, high-quality training would reduce those harmful misinterpretations.

Amy Bruglia, a Cambria County caregiver who provided an account of her husband’s care, urged lawmakers to pass the bill. Bruglia described calling 911 when her husband became aggressive, police and EMS arriving, EMS excluding her from communication despite her role as primary caregiver, her husband fleeing into the street and nearly being struck by a car, and subsequent restraint and removal of clothing in an emergency room where staff and security remarks alarmed her. "This experience represents a systemic failure of how we care for individuals living with dementia," Bruglia said. She told the committee she believed HB 2435 could have prevented the traumatic sequence.

The Ambulance Association of Pennsylvania, represented by Don Derunas (legislative committee chair and board member), urged caution about a statutory mandate. Derunas acknowledged the importance of training but said the 2021 National Highway Traffic Safety Administration (NHTSA) National EMS Education Standards integrate dementia-related competencies across geriatrics, behavioral emergencies and related topics rather than isolating them. "Existing curricula already address identification of altered mental status, adapting assessments for geriatric populations, and communication with caregivers," he testified, and he warned that a disease-specific statutory requirement could open precedent pressure for many other conditions and risk overburdening training systems.

Committee members questioned witnesses about practical implementation. Rep. John Schlegel and Rep. Eric Nelson asked whether elements of dementia care already exist in EMS training and how a new requirement would fit into existing hour blocks for EMT education. Galvan said some basic dementia content is present under behavioral health or geriatric modules but that HB 2435 seeks to secure a stable, specialized curriculum so dementia topics are not dropped during future priority reviews. When asked about costs, Galvan said other states that have enacted similar requirements reported minimal costs and that existing curricula or shared modules (Ohio was cited as an example) could be incorporated rather than adding burdensome hours.

Derunas said the Ambulance Association has no objection to better education but prefers regulatory routes—through the Department of Health, the Pennsylvania Emergency Health Services Council and the state advisory processes—rather than adding statute. He also described operational realities: responders often arrive after dispatch reports "altered mental status," which requires ruling out causes such as hypoglycemia, trauma or other medical conditions before concluding dementia is the cause.

No vote or formal action occurred at the hearing. The committee adjourned after follow-up questions and statements of intent to continue working with stakeholders.

What’s next: Committee members said they intended to continue coordination with the Department of Health, advocacy groups and EMS stakeholders; the transcript does not record a committee vote or a scheduled markup date.