Big Bear Lake Municipal Code Ch. 5.08 Ambulances

Unless otherwise stated, words and terms are defined as follows:

A. "Advanced life support (ALS) or limited advanced life support (LALS) ambulance" means an ambulance which has additional equipment and supplies as specified by the health officer.

B. "Ambulance" means any privately or publicly owned vehicle or boat specially designed, constructed, modified, equipped, arranged, maintained and operated for the sole purpose of transporting sick, injured, wounded, invalid, expectant mother, convalescent or otherwise incapacitated persons.

C. "Ambulance attendant" means a qualified person acting as an attendant on an ambulance responding to an emergency call and who occupies the patient compartment while transporting any individual in apparent need of medical attention.

D. "Ambulance service" means any private or public organization, individual or agency which operates one or more ambulances, or other medical transportation means.

E. "Ambulance service operator" means any person or agency who operates an ambulance service.

F. "Basic life support (BLS) ambulance" means an ambulance which has equipment and supplies as specified by Title 13, California Administrative Code.

G. "Class of service" means the level or levels of complexity of field emergency medical services that may be provided by a permittee, and will be specified as basic life support provided by EMT-IA personnel conforming to California Health and Safety Code, Section 1760(f), full advanced life support provided by California licensed physician or by paramedics and mobile intensive care nurses certified by the health officer under California Health and Safety Code, Section 1481, or limited advanced life support provided by EMT-II personnel authorized under Health and Safety Code, Sections 429.73 or 1760(f).

H. "Council" means the city council of Big Bear Lake, California.

I. "Department" means the public health department of the city.

J. "Driver" means a qualified person who operates an ambulance, as specified in Section 31.0818(a) of this chapter.

K. "Emergency call" means a request for the dispatch of an ambulance to transport or provide other assistance for a person who apparently has a sudden or unforeseen need of medical attention.

L. "Emergency medical technician-II ambulance (EMT-IIA)" means a state-certified person authorized to provide limited advanced life support (LALS) under Health and Safety Code, Sections 429.73 or 1760(f).

M. "Emergency service" means the functions performed in response to an emergency call.

N. "Mobile intensive care (MIC) paramedic" means a person specially trained in the provision of emergency cardiac and noncardiac care appropriately certified by the health officer.

O. "Mobile intensive care (MIC) nurse" means a nurse who has been certified by the health officer as qualified in the provision of emergency cardiac and noncardiac care in the issuance of emergency instructions to MIC paramedics.

P. "Patient" means a sick, injured, wounded, invalid, expectant mother, convalescent or otherwise incapacitated person.

Q. "Permittee" means any ambulance services which possess a current permit granted by the council to provide an ambulance service within a specific permit area in the city.

R. "Person" means any individual, firm, corporation, association, agency or group, or combination acting as a unit.

(Ord. 82-72 § 1(part), 1982)

A. Required. It is unlawful for any person, either as owner, agency or otherwise, to operate, conduct, advertise, or otherwise engage in or profess to be engaged in the business or service of the transportation of patients upon the streets or any public way or place in the city, except in conformance with a valid permit to do so issued by the department.

B. Exceptions. The equipment and personnel standards specified in this chapter apply to all ambulance agencies; however, the licensing and permit requirements shall not apply to:

1. Publicly owned ambulances;

2. Vehicles operated as ambulances at the request of local authorities during any "state of war emergency," duly proclaimed "state of emergency" or "local emergency," as defined in the California Emergency Services Act (Chapter 7 of Division 1 of Title 2 of the Government Code), as amended; or

3. Ambulances based in adjoining states operating in the border areas of the city under terms of a letter of agreement between the department and appropriate regulatory agencies within the adjacent state.

(Ord. 82-72 § 1(part), 1982)

Permit fees shall be those specified in the County Code Section 16.0213A(a)(5). All permits shall be issued to expire on June 30th of each year, and the annual fee therefor may be prorated on a quarterly basis for the first year. Permit fees may be waived by the city council if public need and necessity requires it for nonprofit agencies supported by public subscription.

(Ord. 82-72 § 1(part), 1982)

A. Procedure and Information Required. Prerequisites to the issuance of a permit or renewal of a permit for an applicant shall include the filing with the department an application in writing on a form to be furnished by the department, which shall provide the following minimum information:

1. Name and description of applicant;

2. Business address and residence address of record of the applicant;

3. Trade or firm name, or DBA as recorded;

4. If a corporation, a joint venture or a partnership or limited partnership, the names of all partners, or the names of corporate officers, their permanent addresses and their percentage of participation in the business;

5. A statement of facts showing the experience of the applicant in the operation of an ambulance service and that the applicant is qualified to render efficient twenty-four-hour ambulance service. A photocopy of the license issued by the commissioner of the California Highway Patrol to privately owned ambulances (in accordance with Section 2501, California Vehicle Code and Title 13, California Administrative Code) shall be provided to the department prior to the start of ambulance operations;

6. The geographical boundary of the territory or designation of the service area for which the permit is requested;

7. The class or classes of service which the applicant proposes to provide;

8. A statement in renewal applications that the applicant owns or has under his control required equipment to adequately conduct an ambulance service in the territory or service area for which he is applying, which meet the requirements established by the California Vehicle Code, and that the applicant owns or has access to suitable and safe facilities for maintaining his ambulance service in a clean and sanitary condition. When an initial application is submitted, a statement that the applicant will own, or will have under his control required equipment to adequately conduct an ambulance service in the territory or service area for which he is applying, which meet the requirements established by the California Vehicle Code, and that the applicant will own or will have access to suitable and safe facilities for maintaining his ambulance service in a clean and sanitary condition;

9. A list for renewal applications amended as required during the year for any changed, substituted, loaned or leased vehicles, giving a complete description of each ambulance vehicle operated by the applicant, covering a list of the internal equipment carried by each ambulance, including the patient capacity thereof, and a copy of the most recent Ambulance Inspection Report issued by the California Highway Patrol for each vehicle. When an initial application is submitted, a list, amended as required during the year for any changed, substituted, loaned or leased vehicles, giving a complete description of each ambulance vehicle to be operated by the applicant, covering a list of the internal equipment carried by each ambulance, including the patient capability thereof, and a copy of the most recent Ambulance Inspection Report issued by the California Highway Patrol for each vehicle shall be provided to the department prior to the start of ambulance operation;

10. An affirmation for renewal applications that each permitted ambulance and its appurtenances conform to all applicable provisions of this chapter, the California Vehicle Code, the California Administrative Code, and any other state or city applicable directive. When an initial application is submitted, an affirmation that each permitted ambulance and its appurtenances conform to all applicable provisions of this chapter, the California Vehicle Code, the California Administrative Code, and any other state or city applicable directive shall be provided to the department prior to the start of ambulance operations;

11. A statement for renewal applications that the applicant employs sufficient personnel adequately trained and available to deliver ambulance services of good quality at all times in the applicant's proposed territory or service area. When an initial application is submitted, a statement that the applicant will employ sufficient personnel adequately trained and available to deliver ambulance services of good quality at all times in the applicant's proposed territory or service area;

12. A list for renewal applications, amended as required during the year for any personnel changes, giving a description of the level of training for each ambulance employee, and a copy of each certificate or license issued by the state and city establishing qualifications of such personnel in ambulance operations. When an initial application is submitted, a list, amended as required during the year for any personnel changes, giving description of the level of training for each ambulance employee and a copy of each certificate or license issued by the state and city establishing qualifications of such personnel in ambulance operations shall be provided to the department prior to start of ambulance operation;

13. A schedule of rates, including any special rates, to be charged by the permittee for ambulance services;

14. A statement that shows to the satisfaction of the department that the issuance of a permit is in the public interest and there is a need for a permit to be issued, in that there is a requirement for ambulance service which can be legally serviced by the applicant;

15. A statement signed by the applicant that as a condition of the county's issuing a permit, applicant agrees to appear and defend all actions against the city arising out of the exercise of the permit, and shall indemnify and save the city, its officers, and employees and agents harmless of and from all claims, demands, actions or causes of actions of every kind and description resulting directly or indirectly, arising out of, or in any way connected with exercise of this permit; and

16. Such other facts or information as the department may require.

(Ord. 82-72 § 1(part), 1982)

Upon receipt of a completed application, the health officer shall conduct an investigation to determine if the public health, safety, welfare, convenience and necessity require the granting of an original or additional permit for the ambulance service area for which the application has been made and shall further determine if the applicant meets all requirements of this chapter. Upon completion of his investigation, the health officer shall recommend to the city council that a permit be granted or denied for the ambulance service area. No permit shall be issued by the health officer until the city council has determined that the public health, safety, welfare, convenience and necessity require the granting of such permit for the particular ambulance service area.

(Ord. 82-72 § 1(part), 1982)

A. The city council may order the issuance of a permit to conduct an ambulance service in a specified area upon finding that the public health, safety, welfare, convenience and necessity require the availability of such ambulance service and that the applicant meets all requirements of this chapter.

B. The city council may order the denial of a permit on the ground of infeasibility. Whenever a new application is filed under the provisions of this chapter for a permit to provide ambulance service in the city where services already exist, the council, after due investigation, may find and determine, as a matter of fact, that there does not exist in the area sufficient potential need for ambulance service to justify the granting of an additional separate and distinct permit for use within that ambulance service area. Predicated on such findings, the city council may deny the application for permit on the grounds that the granting of such new permit is not economically or financially feasible and not in the public interest and welfare.

C. The city council may order the denial or revocation of a permit if the applicant or any partner, officer or director thereof:

1. Was previously the holder of a permit issued under the ordinance which permit has been revoked or not reissued and the terms or conditions of the suspension have not been fulfilled or corrected;

2. Is committing any act, which, if committed by any permittee, would be grounds for the suspension or revocation of a permit issued pursuant to this chapter;

3. Has committed any act involving dishonesty, fraud, or deceit whereby another is injured or where the applicant has benefited;

4. Has acted in the capacity of a permitted person or firm under this chapter without having a permit therefore;

5. Has entered a plea of guilty to, or been found guilty of, or been convicted of a felony, or a crime involving moral turpitude, and the time for appeal has elapsed or the judgment of conviction has been affirmed on appeal, irrespective of an order granting probation following such conviction suspending the imposition of sentence, or of a subsequent order under the provisions of Section 1203.4 of the Penal Code allowing such person to withdraw his plea of guilty and to enter a plea of not guilty, or setting aside the plea or verdict of guilty, or dismissing the accusation of information.

D. Bonding of Applicant. Before any permit is issued under the provisions of this chapter, the council shall require the applicant as a condition to the issuance of the permit to post with the clerk of the council a surety bond in the sum of two thousand five hundred dollars or a surety bond in the same amount furnished by a corporation authorized to do business in the state, payable to the city. The bond shall be conditioned upon the full and faithful performance by the permittee of his obligations under the applicable provision of this chapter and shall be kept in full force and effect by the permittee throughout the life of the permit and all renewals thereof. The council, upon recommendation of the department, from time to time may by resolution establish such additional or lower bond requirement for individual permittees as may be deemed necessary in the event it is determined the foregoing bond requirements constitute insufficient or more than sufficient protection to the city, as the case may be. The bond requirement may be waived by the city council if public need and necessity require it.

E. Liability Insurance. The permittee shall obtain and keep in force during the term of the permit public liability and bodily injury insurance issued by a company authorized to do business in the state, insuring the owner, and also naming the city as an additional insured of such ambulance against loss by reason of injury or damage that may result to persons or property from negligent operation of defective construction of such ambulance or from violation of this chapter or of any other law of the state or the United States. The policy shall be in the sum of not less than two hundred thousand dollars for personal injury to or death of any one person in any single accident; and the limits of each such vehicle shall not be less than one hundred thousand dollars for damages to or destruction of property in any one accident. Workers compensation insurance shall be carried covering all employees of the permit holder. Before the health officer issues a permit, copies of the policies or certificates evidencing such policies shall be filed with the department. All policies shall contain a provision requiring a thirty-day notice to be given to the department prior to cancellation, modification or reduction in limits. The amounts of public liability insurance for bodily injury and property damage shall be subject to review and adjustment at the council's option.

(Ord. 82-72 § 1 (part), 1982)

The permit shall specify the dates of issuance and of expiration, the geographical limits of the territory within which the permittee may provide ambulance service, the number of ambulance units to be used by the permittee, the class or classes of service to be provided, and any special conditions regarding communication, equipment, personnel, rates for special services, or waiver of requirements deemed appropriate by the health officer.

(Ord. 82-72 § 1(part), 1982)

Upon request by the permittee, the health officer may amend the conditions specified in a permit if he finds such changes in substantial compliance with the provisions of this chapter. Such amendment shall not affect the expiration date of the existing permit, nor shall it authorize a change in ownership from that specified in the original permit.

(Ord. 82-72 § 1(part), 1982)

Permits shall be renewed annually by the health officer upon application of the permittee, if the permit holder proposes no substantial change in the content of the permit, and if the health officer determines that the permit holder has during the period of the expiring permit operated in conformity with the provisions of this chapter and the rules and regulations of the department, and that he is capable of continuing operation in conformity with the rules and regulations of the department.

(Ord. 82-72 § 1(part), 1982)

The health officer, after conducting a hearing, shall be empowered to suspend or revoke the permit issued under the provisions of this chapter to operate an ambulance service, when it has been found after investigation that the permittee or any partner, officer or director:

A. Violates any section of this chapter or any rules or regulations that are promulgated by the department, which relate to his permit activities;

B. Is convicted of any felony;

C. Is convicted of any misdemeanor involving moral turpitude;

D. Is convicted of any offense relating to the use, sale, possession, or transportation of narcotics or habit-forming drugs;

E. Commits any act involving dishonesty, fraud or deceit whereby another is injured, or whereby the permittee has benefited, or any act involving moral turpitude;

F. Has misrepresented a material fact in obtaining a permit, or is no longer adhering to the conditions specified in his application;

G. Aids or abets an unlicensed or uncertified person to evade the provisions of this chapter;

H. Fails to make and keep records showing his transactions as a permittee, or fails to have such records available for inspection by the health officer or his duly authorized representative for a period of not less than three years after completion of any transaction to which the records refer, or refuses to comply with a written request of the health officer or make such record available for inspection;

I. Accepts an emergency call when either unable or unwilling to provide the requested service or fails to inform the person requesting such service of any delay and fails to obtain the consent of such person before causing an ambulance to respond from a location more distant than the one to which the request was directed.

(Ord. 82-72 § 1 (part), 1982)

A. In the event of a change in ownership of any kind or nature, any interruption of service of more than twenty-four hours duration, or any substantial change in the ambulance service, which causes, or threatens to cause, the ambulance service to be carried out differently than specified in the current operating permit, the permittee shall notify the health officer immediately in writing, stating the facts of such change.

B. Upon request by the permittee, the health officer may grant a temporary variance in writing from the condition specified in the original permit if he finds that such change is in substantial compliance with the provisions of this chapter. If the health officer finds that such change is not in substantial compliance with this chapter, he may suspend, revoke or amend the permit by written notice. In all cases when a change of ownership occurs in an ambulance service, an application for new permit shall be filed with the department within thirty days. In no case shall any temporary variance be valid for more than sixty days without written approval of the city council.

(Ord. 82-72 § 1(part), 1982)

A. If the renewal of a permit is denied by the health officer or if the health officer suspends or revokes a permit, the permittee shall be given written notice specifying not only the action taken, but in the event of a suspension or revocation, the effective date thereof. Such notification shall be by registered or certified mail.

B. The permittee shall, upon written request, be entitled to a hearing before the health officer. The permittee's request for a hearing shall be made within ten days of receiving the notice of denial, revocation or suspension. The permittee shall then be afforded a hearing prior to the effective dates of denial, suspension or revocation. The health officer may, after such hearing, affirm, modify or set aside the original decision. The health officer shall notify all public safety agencies, city communications departments and all hospitals in the respective permit area if the permit renewal is denied or if a permit is suspended or revoked.

C. If the health officer denies the renewal of or suspends or revokes a permit, the permittee shall have the right to demand a hearing by the city council. A request for a hearing shall be made in writing to the clerk of the council within fifteen calendar days following the denial, suspension or revocation of the permit. Upon receipt of a written request, the clerk of the council shall set the matter for hearing on a date not more than sixty days following receipt of the written request and give notice to the appellant and the health officer of the date set for the hearing. At the hearing, the council shall hear the appellant, the health officer, and any other interested persons who may present evidence relevant to the decision of the health officer. Within thirty days following the conclusion of the hearing, the council shall issue its order, whether or not the permit should be issued or the suspension or revocation sustained.

(Ord. 82-72 § 1(part), 1982)

Each ambulance service operator shall provide emergency ambulance service (of the class or classes specified in his permit) on a continuous twenty-four hours per day basis, excluding acts of God or labor disputes. If for any reason an operator stops providing the prescribed class or classes of ambulance service on a continuous twenty-four hours per day basis, he shall immediately stop any advertisement of emergency services which have been discontinued and immediately notify the health officer.

(Ord. 82-72 § 1(part), 1982)

No ambulance operator shall, but for the exceptions below, provide ambulance service for ambulance calls originating within the city outside the territorial limits fixed in the permit issued to him.

A. Exceptions. A permittee may provide service for ambulance calls outside the territorial limits fixed in the permit issued to him:

1. Upon request by any law enforcement or governmental agency having jurisdiction;

2. Upon request of any person for emergency ambulance service when an ambulance is not immediately available in the permit area from which the request originates;

3. Upon request of a permittee in an adjoining service area/zone, when such permittee does not have an ambulance immediately available in the permit area from which a request originates, and when ambulance services is immediately required;

4. To provide ambulance service to any person who is a resident within permittee's ambulance service area/zone when such person is a member of a plan operated by a permittee who provides ambulance service to plan members for a fixed period, without cost or at reduced cost, upon payment of a subscription fee, in compliance with California Welfare and Institution Code, Chapter 2.2, Article 1;

5. To provide ambulance service to a person who originally used permittee's service for ambulance transportation to a destination outside of permittee's service area;

6. To provide medically required specialized transportation services not immediately available for a patient in another permit area/zone.

(Ord. 82-72 § 1(part), 1982)

Each ambulance service operating in the city shall establish and maintain radio contact with a central point designated by the city and its local base of operation where technically feasible. Radio procedures prescribed in the city communications manual shall be utilized.

(Ord. 82-72 § 1(part), 1982)

Each ambulance service receiving an emergency ambulance request from a private person in its service area shall dispatch an ambulance in compliance with the procedures identified in Title 13, California Administrative Code. If an ambulance is not available for immediate dispatch, the procedures identified in Title 13, California Administrative Code, shall be complied with.

(Ord. 82-72 § 1(part), 1982)

Ambulances shall be maintained at all times in good mechanical repair and in a clean and sanitary condition.

A. Minimum Requirement. All ambulances shall be equipped with all safety and emergency equipment required for ambulances by the California Vehicle Code and the California Administrative Code and administrative rules of the health officer as the same are now written or hereafter amended.

B. ALS and LALS Ambulance Equipment. In addition to the regular ambulance equipment and supplies, the ALS and LALS ambulances shall also be equipped as required by administrative rules of the health officer.

C. Maintenance of Emergency Equipment and Supplies. Dressings, bandaging, instruments and other medical supplies used for care and treatment of patients will be protected so they are sterile when ready for use. Provisions shall be made to assure autoclaving or resterilization of emergency equipment when required.

(Ord. 82-72 § 1(part), 1982)

A. Every person who operates an ambulance within the city, while responding to emergency calls, shall comply with the requirements in the California Administrative Code for ambulance drivers. The driver of an ambulance shall be trained and competent in the proper use of all emergency equipment required by this chapter. The driver shall also hold a certificate as an Emergency Medical Technician IA (EMT-IA), unless the ambulance service operator has been specifically exempted from this requirement by the city council.

B. Ambulance Attendant. An ambulance attendant shall be trained and competent in the proper use of all emergency equipment required by this chapter, and shall hold the required certification as an EMT-IA. If the vehicle is being used as an ALS or LALS ambulance, at least one attendant shall hold a certificate as an MIC paramedic issued by the health officer for ALS ambulances or a certificate as an EMT-IIA for LALS ambulances.

C. Attendant Required. Each ambulance being operated within the city, in response to an emergency call, shall be staffed by both a driver and attendant, unless the ambulance service operator has been exempted. The attendant of an ambulance responding to an emergency call shall occupy the patient compartment while transporting any person in apparent need of medical attention. An ambulance driver or ambulance attendant who is a California licensed physician or an MIC nurse certified by the health officer shall be exempt from the emergency medical training requirement of this section. This section shall not apply during any "state of emergency," or "local emergency" as defined in the Government Code of the state.

(Ord. 82-72 § 1(part), 1982)

No ambulance shall charge more than the following rates for ambulance service.

A. One Patient. The schedule of maximum rates that may be charged for ambulance service for one patient shall be as set by resolution adopted by the city council. The rate schedule is incorporated herein by reference, and is on file in the office of the clerk of the city council as provided in subsection G of this section.

B. Two or More Patients.

1. Each additional stretcher or gurney patient carried at the same time may be charged the full base rate for response to the call and half the mileage rate.

2. Each additional sit-up patient shall be charged half the base rate for response to the call and half the mileage rate.

C. For group loads from the same origin to the same destination, permittee shall divide the total mileage rate equally among all the patients, and if all the patients are sit-up patients, he shall also divide the total base rate equally among the patients.

D. No charge shall be made for uninjured or well persons who accompany a patient.

E. All rates are to be computed from the time the ambulance arrives for hire until the ambulance is discharged by the patient or his representative, attending physician, or emergency receiving facility.

F. A schedule of rates, including rates for special services, shall be posted in a conspicuous place within each ambulance.

G. The schedule of maximum rates for ambulance service shall be subject to amendment by resolution of the city council. The clerk of the council shall mail a copy of any such resolution adopted by the council to each permittee and the new schedule of maximum rates shall be effective thirty days after the adoption of the resolution by the city council. Three copies of the maximum rates as established by resolution shall be on file in the office of the clerk of the city council.

H. Proposed rates for special services, or proposed changes in such rates shall be submitted to the health officer for review. Such rates shall be approved by that officer before becoming a part of any permit and before being charged by any permittee. The health officer shall approve proposed rates for special services, or proposed changes in such rates, if he finds that such rates are reasonable in relationship to the cost of providing the special services. The decision of the health officer to approve or disapprove special rates may be appealed to the city council in the same manner as provided in Section 5.08.120.

(Ord. 82-72 § 1(part), 1982)

An ambulance based and properly licensed outside the city shall be authorized to transport a patient to or through the city, but shall not be authorized to transport patients originating in the city, except under the conditions of Section 5.08.020. In order to maintain proper medical support, communications will be maintained with the ambulance dispatch center for the area. ALS ambulances will establish and maintain communications with and medical control from a base station in conformance with the rules of the health officer.

(Ord. 82-72 § 1 (part), 1982)

The health officer may authorize a temporary operating permit to an ambulance service based and properly licensed by the California Highway Patrol outside the city up to thirty days for special activities. Such temporary operating permit shall conform to the requirements of Section 5.08.070 and shall contain such additional conditions and restrictions that the health officer deems appropriate for the operation.

(Ord. 82-72 § 1(part), 1982)

During any "state of war emergency," "state of emergency," or "local emergency," as defined in the California Emergency Services Act (Chapter 7 of Division 1 of Title 2 of the Government Code), as amended, each ambulance service operator shall provide equipment, facilities and personnel as required by the health officer.

(Ord. 82-72 § 1(part), 1982)

Whenever the health officer or his designate determines that ambulance resources within the city are inadequate to respond to a city emergency disaster, a request for emergency ambulance mutual aid may be made to any health officer or his designate within the Inland Counties Emergency Medical Authority Region, as required. Whenever the health officer or his designate receives a request involving emergency ambulance mutual aid from any health officer or his designate within the Inland Counties Emergency Medical Authority Region, such resources shall be provided as are available.

(Ord. 82-72 § 1(part), 1982)

Any user or subscriber to an ambulance service contending that he has been required to pay an excessive charge for service or that he has received unsatisfactory services may file a written complaint with the department setting forth such allegations. The department shall notify the ambulance service of such complaint, and shall investigate the matter to determine the validity of the complaint. If the complaint is determined to be valid, the department shall take reasonable and proper actions to secure compliance with the conditions of this chapter.

(Ord. 82-72 § 1(part), 1982)

A. The department shall make all necessary and reasonable rules and regulations subject to the approval of the council, covering ambulance service operation, ambulance equipment, maintenance vehicles, ambulance personnel, and for the effective and reasonable administration of this chapter.

B. The department shall inspect the records, facilities, vehicles, equipment and methods of operation whenever such inspections are deemed necessary.

(Ord. 82-72 § 1 (part), 1982)

All provisions of this chapter shall be enforced by the health department unless otherwise provided.

(Ord. 82-72 § 1(part), 1982)