Calaveras County Municipal Code Ch. 5.26 Ambulance Ordinance of Calaveras County

The ordinance codified in this chapter establishes and prescribes measures for the regulation of ambulance services within the county. It shall be known as the "Ambulance Ordinance of Calaveras County."

(Ord. 2866 (part), 2005).

California Code of Regulations, Title 22, Division 9, Section 100173(b):

An approved EMT-P service provider shall have a written agreement with the Local EMS Agency in order to participate in the advanced life support program and comply with all applicable State regulations and local policies and procedures, including a mechanism to assure compliance. (California Health and Safety Code Sections 1797, et seq., including Section 1798.100, and 1798.102.)

(Ord. 2866 (part), 2005).

A. Defines the process required for authorization and provision of ambulance services within the county of Calaveras;

B. Sets minimum standards for ambulance services to facilitate the orderly and lawful operation of the local emergency medical services system pursuant to the provisions of Health and Safety Code Sections 1797 et seq.;

C. Allows for the coordination of emergency ambulance services through a system of dispatch procedures;

D. Establishes a mechanism to create and maintain exclusive operating areas for ambulance services in Calaveras County pursuant to California Health and Safety Code Sections 1797.85 and 1797.224;

E. Eliminates competition by preventing an ambulance service, not party to local ambulance provider agreements, from encroaching upon established exclusive operating areas;

F. Allows for the orderly provision of ambulance services during those interim periods when exclusive ambulance operating areas may revert back to nonexclusive.

(Ord. 2866 (part), 2005).

A. This chapter does not apply to EMS aircraft operations.

B. This chapter does not apply to business operations that Calaveras County based ground ambulance providers may conduct outside of Calaveras County.

(Ord. 2866 (part), 2005).

Unless otherwise specifically provided or required by the context, the following terms shall apply to this chapter with the following meanings:

"Advanced life support (ALS)" means special services designed to provide definitive prehospital emergency medical care, including, but not limited to, cardiopulmonary resuscitation, cardiac monitoring, cardiac defibrillation, advanced airway management, intravenous therapy, administration of specified drugs and other medicinal preparations, and other specified techniques and procedures administered by authorized personnel under the direct supervision of a base hospital as part of a local EMS system at the scene of an emergency, during transport to an acute care hospital, during interfacility transfer, and while in the emergency department of an acute care hospital until responsibility is assumed by the emergency or other medical staff of that hospital. [H&S Code Section 1797.52]

"Ambulance" means a vehicle specially constructed, modified or equipped and used for the purpose of transporting sick, injured, convalescent, infirm, or otherwise incapacitated persons [CAC Title 13, Section 1100.2]. The term "ambulance" does not apply to the nonemergency transportation of persons confined to wheelchairs, but does apply to vehicles utilized for the nonemergency transportation of persons confined to gurneys.

"Ambulance provider" means a person, firm, partnership, corporation, or other organization which furnishes or offers to furnish ambulance service within Calaveras County.

"Ambulance provider agreement" means an agreement between the local EMS agency and an ambulance provider which stipulates conditions under which the provider shall provide ambulance services within the county.

"Ambulance response zone" means the area that is identified as the primary response area for an ambulance provider pursuant to an ambulance provider agreement with the local EMS agency.

"Ambulance service" means the activity, business or service, for hire, profit, or otherwise, of transporting one or more persons by ambulance on, or, in any of the streets, roads, highways, alleys, or any public way or place in this county, including the provision of emergency or nonemergency, ALS or BLS services, and interfacility transfer services.

"Ambulance station" means the premises (including living quarters) located within an ambulance response zone from which the ambulance provider renders service to that zone.

"Authorized EMS dispatch center" means a dispatch center authorized by the local EMS agency for dispatch of ambulance services within Calaveras County.

"Basic life support" or "BLS" means emergency first aid and cardiopulmonary resuscitation procedures which, as a minimum, include recognizing respiratory and cardiac arrest and starting the proper application of cardiopulmonary resuscitation to maintain life without invasive techniques until the victim may be transported or until advanced life support is available. [H&S Code Section 1797.60]

"Emergency ambulance services" means all services that require the use of an ambulance, including, but not limited to, advanced life support, basic life support, interfacility patient transfers, or critical care transports originating within Calaveras County.

"Emergency call" means a condition or situation in which an individual has a need for immediate medical attention, or where the potential for such need is perceived by public safety personnel or emergency medical personnel at the scene of an emergency, or dispatch personnel at an authorized EMS dispatch center. This includes ambulance requests (other than from an acute care facility) wherein the ambulance is requested for a condition that requires an immediate ambulance response.

"Emergency medical technician," "paramedic" or "EMT-P" means a licensed individual whose scope of practice to provide advanced life support is according to standards prescribed in Title 22 of the California Code of Regulations, Division 9, Chapter 4.

"Emergency medical technician-I" or "EMT-I" means an individual who has been certified by the EMT-1 certifying authority and trained in all facets of basic life support to perform the scope of practice described in Title 22 of the California Code of Regulations, Chapter 2, Article 2, Section 100063.

"EMS aircraft" means and includes air ambulances and all categories of rescue aircraft, as defined in the California Code of Regulations, Title 22, Division 9, Chapter 8. "Exclusive operating area" or "EOA" means an ambulance response zone, the number and boundary of which are approved by the board of supervisors and identified in the transportation plan of the local EMS agency for Calaveras County.

"Local emergency medical services agency (local EMS agency)" means an emergency medical services agency designated by the Calaveras County board of supervisors pursuant to Section 1797.200, Division 2.5 of the California Health and Safety Code.

"Posting" is the term used to denote when an ambulance provider is directed by the authorized EMS dispatch center to position an ambulance in a location in the county per the posting plan approved by the local EMS agency in consultation with the EMSOC operational advisory subcommittee.

(Ord. 2866 (part), 2005).

A. Ambulance Provider Agreement Requirement.

1. Ambulance providers in Calaveras County are required to have an ambulance provider agreement with the local EMS agency to meet minimum standards for ambulance services to facilitate the orderly and lawful operation of the local emergency medical services system pursuant to the provisions of Health and Safety Code Sections 1797 et seq.

2. No person (either as owner, agent or otherwise) shall furnish, operate, conduct, maintain or otherwise engage in or advertise, offer or profess to engage in the provision of ambulance service in Calaveras County unless the person or entity has executed a currently valid ambulance provider's agreement with the local EMS agency for Calaveras County.

B. Ambulance Provider Agreement Requirement Exception. Ambulance providers are not required to have an ambulance provider agreement if they only provide the following services:

1. Transport persons into Calaveras County from a location outside Calaveras County;

2. Transport persons through Calaveras County to a destination outside the county; or

3. Provide ambulance services at the request of any county-authorized EMS dispatch center or at the request of any law enforcement or fire protection agency during any "state of war emergency," "state of emergency" or "local emergency," as defined in Government Code Section 8558 or during any situation when the local EMS agency director determines that adequate emergency ambulance service will not be available from existing county providers.

C. Exclusive Operating Areas. The local EMS agency shall establish and maintain, through a competitive bid process pursuant to Health and Safety Code Section 1797.224 and state EMS authority guidelines, exclusive operating areas for ambulance services in Calaveras County. The number and boundaries of these EOAs, and any revisions to these boundaries, shall be recommended by the local EMS agency and approved by the board of supervisors.

D. Nonexclusive Operating Areas.

1. Interim Ambulance Provider Agreement Application Process. In the event that an exclusive operating area temporarily reverts back to a nonexclusive operating area, the process for all applicants interested in providing ambulance services within Calaveras County is as follows:

a. Applicant requests an application from the local EMS agency.

b. Applicant submits completed application to the local EMS agency.

c. The local EMS agency determines within ninety days of receipt of a completed application whether to issue or decline to issue an ambulance provider agreement to applicant.

d. If the local EMS agency determines that the applicant meets all minimum requirements, the applicant shall sign an ambulance provider agreement with the local EMS agency per Section 5.26.060(A)(1) of this chapter.

E. Appeal From Denial of Issuance of a Nonexclusive Ambulance Agreement. If the local EMS agency declines to issue a nonexclusive ambulance provider agreement to applicant, or if an agreement cannot be reached between the applicant and the local EMS agency, and a satisfactory resolution is not achieved at the conclusion of the appeal process established by the local EMS agency, the applicant may file an appeal within thirty days with the board of supervisors of Calaveras County. A hearing on the request shall be scheduled within ninety days from the receipt of a written request for an appeal hearing. The hearing may be held before a hearing officer designated by the board of supervisors. The decision of the board of supervisors or their designated hearing officer rendered pursuant to this hearing shall be final.

F. Variances and Temporary Agreements.

1. The local EMS agency director may grant a variance from the terms of this chapter if he or she finds such action is necessary to protect the public health, safety, or welfare. Such action may include the issuance of temporary ambulance agreements. Such variances or temporary agreements shall remain in effect for the period indicated by the local EMS agency director but not to exceed one hundred eighty days.

2. The local EMS agency may temporarily authorize an ambulance provider based outside the county and properly licensed by the California Highway Patrol to provide on-site ambulance service for up to three days (which may be renewed) for special events. Such authorization shall be contingent upon adherence to conditions and restrictions specified by local EMS agency policies and procedures.

G. Agreement Term. The maximum ambulance provider agreement term allowed shall be five years. Agreement renewals may be allowed, but not to exceed a total agreement term of ten years.

(Ord. 2866 (part), 2005).

The following are minimum ambulance service standards to be included in all ambulance provider agreements with ambulance providers in Calaveras County:

A. Ambulance Response Standards. The minimum standard for emergency ambulance response to an emergency call shall be one ambulance equipped and staffed per local EMS agency policy. No ambulance in Calaveras County shall be equipped at less than BLS levels, or be staffed with fewer than two EMT-1s.

B. Response to Private Requests. Upon receipt of a private request for emergency ambulance services, the ambulance provider shall transfer the requesting party to the authorized EMS dispatch center.

C. Dispatch Standards. Ambulance providers and authorized EMS dispatch center shall abide by the posting plan approved by the local EMS agency and implemented by the authorized EMS dispatch center, and ambulances shall only respond to requests for ambulance services when approved by the authorized EMS dispatch center.

D. Ambulance Station Requirement. Ambulance providers, that are authorized to provide ambulance services within an ambulance response zone, shall maintain an ambulance station within that zone.

(Ord. 2866 (part), 2005).

A. Dispatch protocols, policies and procedures, including those for handling of private calls shall meet the standards established by the local EMS agency. The county-authorized EMS dispatch agency shall be responsible for directing ambulances to respond to emergency calls and posting locations under a plan approved by the local EMS agency.

B. All requests for ambulance services shall be coordinated by the authorized EMS dispatch agency. No ambulance provider shall respond to a request for ambulance services without prior authorization of the authorized EMS dispatch agency. Upon receipt of a request for emergency ambulance services via a private line, ambulance providers shall transfer the caller to the authorized EMS dispatch agency. Criteria to define the specific types of ambulance service requests received via private line that must be transferred to the authorized EMS dispatch agency shall be defined by the local EMS agency.

(Ord. 2866 (part), 2005).

Any person, firm or corporation violating the provision of this title or the rules and regulations promulgated hereunder is guilty of an infraction, punishable by a fine not exceeding five hundred dollars. A person, firm, or corporation that violates the provisions of Section 5.26.060(A) of this chapter shall be deemed to be guilty of a separate infraction for each day, or portion thereof, during which the violation continues. These penalties are not intended to, and shall not preclude or preempt any criminal penalties provided by state law.

(Ord. 2866 (part), 2005).

The remedies and penalties provided for violations of the provisions of this chapter or the rules promulgated hereunder are cumulative. Election of one remedy does not preclude election of another, including any such civil law remedies as may be available.

(Ord. 2866 (part), 2005).

Unless expressly agreed in writing, the county of Calaveras and its officers and employees shall not be liable for any ambulance service costs or charges associated with compliance under this chapter or the rules and regulations promulgated hereunder.

(Ord. 2866 (part), 2005).