Inyo County Municipal Code Ch. 7.56 Emergency Medical Services

The purpose of this chapter is to regulate local control of those items delegated local responsibilities by the state of California in a manner provided by this chapter or by local policies, procedures and protocols developed by the local emergency medical services director and to enhance the local emergency medical service system by providing access for basic life support, limited advanced life support and advanced life support to operate in the county. Nothing in this chapter shall be construed, and no subsequent rules, regulations, policies, procedures or protocols will be made or adopted by the local emergency medical services agency to imply or institute any requirement for any prehospital care personnel to be advanced life support certified or to require that any ambulance providing service will be required to upgrade their ambulance or to be required to hire advanced life support personnel. This chapter does not preclude any rule or law in Title 13 or 22 of the California Code of Regulations and the California Vehicle Code, the California Health and Safety Code, or any other applicable laws.

(Ord. 879 § 4, 1990)

Unless otherwise specified, words and terms are as follows:

"Advanced life support (ALS) ambulance"

means an ambulance which has the basic equipment set forth in Title 13 of the California Code of Regulations as well as additional equipment and supplies as specified by the local EMS agency.

"Ambulance"

means any privately or publicly owned motor vehicle, aircraft, boat, or snowmobile operated and/or especially designed, constructed, modified, equipped, or arranged and maintained for the purpose of transporting sick, injured, wounded, invalid, expectant mother, convalescent, or otherwise incapacitated persons.

"Ambulance attendant"

means a qualified person acting as an attendant on an ambulance who is responsible for the care of any patient and who occupies the patient compartment.

"Ambulance service" or "medical transportation service"

means any private or public organization, individual, or agency which operates one or more ambulances.

"Ambulance service operator"

means any person or agency who operates an ambulance service.

"Base hospital"

means a hospital or hospitals which, upon designation by the local emergency medical services agency and with a written contractual agreement with the local emergency medical services agency, is responsible for directing the advanced life support system assigned to it or them by the local emergency medical services agency.

"Basic life support"

means emergency first aid and cardiopulmonary resuscitation procedures which, as a minimum, include recognizing respiratory and cardiac arrest and starting the proper applications of cardiopulmonary resuscitation to maintain life without invasive techniques until the victim may be transported.

"Basic life support ambulance"

means an ambulance that has equipment and supplies as specified by Title 13, California Code of Regulations.

"Board"

means the Inyo County board of supervisors.

"Certificate"

means a specific document issued to an individual denoting competence in the named area of prehospital service.

"Control"

means the dispatch center in Independence, known as "Independence Control" and the dispatch center in Bishop known as "Bishop Two."

"Department"

means the Inyo County department of health services.

"Driver"

means a person currently California licensed to drive an ambulance.

"Emergency call"

means a request for the dispatch of an ambulance to transport or provide other assistance for a person apparently having a sudden unforeseen need of medical attention.

"Emergency medical services"

means the services needed to provide urgent medical care in 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 emergency medical personnel, a public safety agency or, with respect to interfacility transfers, qualified medical personnel of the transferring facility. Any transportation needs pursuant to a request for an emergency ambulance operating under a permit issued by the Commissioner of the California Highway Patrol or the attendance of certified emergency medical personnel or licensed medical personnel shall be deemed the providing of emergency medical services.

"Emergency medical technician I" or "EMT I"

means an individual trained in all facets of basic life support according to standards prescribed by Division 2.5 of the Health and Safety Code and the local EMS agency, and who has a valid certificate. This definition shall include EMT I and EMT IA.

"Emergency medical technician II" or "EMT II"

means an EMT I with additional training in limited advanced life support according to the standards prescribed by this chapter and who has a valid certificate issued to them by the local emergency medical services agency.

"Emergency medical technician - Paramedic"

means a person specially trained and certified to provide advanced life support according to standards prescribed by Division 2.5 of the Health and Safety Code and who has a valid certificate and accredited by the local EMS agency.

"Exclusive operating areas"

means specific geographic areas of the county designated in the emergency medical services plan for the county and authorized by Sections 1797.6, 1797.85 and 1797.224 of the Health and Safety Code.

"Level of service"

means the type of emergency medical services that may be provided by a permittee, and will be specified as basic life support, limited advanced life support and advanced life support provided by personnel certified as specified in Division 2.5 of the California Health and Safety Code and Title 22, Division 9 of the California Code of Regulations.

"Limited advanced life support"

means a special service designed to provide pre-hospital emergency medical care limited to techniques and procedures that exceed basic life support but are less than advanced life support and are those procedures specified pursuant to Health and Safety Code Section 1797.171.

"Local emergency medical services agency" or "local EMS agency"

means the agency, department or office having primary responsibility for administration of emergency medical services in a county and which is designated pursuant to Health and Safety Code, Chapter 4 (commencing with Section 1797.200).

"Mobile intensive care nurse (MICN)"

means a registered nurse who is functioning pursuant to Section 2725 of the Business and Professions Code and who has been authorized by the medical director of the local EMS agency as qualified to provide pre-hospital advanced life support or to issue instructions to pre-hospital emergency medical care personnel within an EMS system according to standardized procedures developed by the local EMS agency consistent with statewide guidelines established by the authority. Nothing in this section shall be deemed to abridge or restrict the duties or functions of a registered nurse or mobile intensive care nurse as otherwise provided by law.

"Nonexclusive operating areas"

means those areas of the county defined geographically but not designated in the EMS plan for the county as exclusive operating areas.

"Patient"

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

"Permittee"

means any ambulance service which has been granted a permit by the county board of supervisors upon authorization of the local EMS agency to operate an ambulance service within a specific permit area of the county.

"Person"

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

"Special events"

means any situation where a previously announced event places a grouping or gathering of people in one general locale sufficient in number, or subject to activity that creates the need to have one or more ambulances at the site.

(Ord. 879 § 4, 1990)

It is unlawful for any person, either as owner, agent 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 of the county, without possessing a valid permit to do so issued by the board.

(Ord. 879 § 4, 1990)

The licensing and permit requirements shall not apply to:

A. 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 Government Code; or

B. Ambulances based in adjoining states or counties operating in the border areas of the county, provided they are appropriately certified by their state or county and permitted to do so by the local EMS agency; or

C. Ambulances bringing patients from outside, into or through the county, provided they are appropriately certified by their state or county and that appropriate continuation of all agreements have been made.

(Ord. 879 § 4, 1990)

The board of supervisors, by resolution, shall set the charge for permit fees.

(Ord. 879 § 4, 1990)

A. All ambulance service permits and renewals thereof shall specify the territory within which the permittee may provide ambulance service, and no ambulance operator shall, but for the expectations below, provide ambulance service for ambulance calls originating within the county outside the territorial limits fixed in the permit issued to him. The territory so specified in any such permit will be assigned by the board of supervisors, and may be modified by same if such modification is found to be necessary for the efficient conduct of ambulance service and for the welfare and safety of the residents in the territory involved after an investigation completed by the county.

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

1. Upon dispatching for emergency service when an ambulance is not immediately available in the permit area from which the request originated;

2. To provide return ambulance service to a person that originally used permittee's service for ambulance transportation to a destination outside of permittee's service area.

(Ord. 879 § 4, 1990)

Prerequisites to the issuance of a permit or renewal of a permit for an applicant shall require the filing with the department an application in writing on a form to be furnished by the county and must comply with all provisions of the transportation component of the EMS plan.

(Ord. 879 § 4, 1990)

A. Upon the receipt of a completed application, the county, through the health department, 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 for which the application has been made, and shall further determine if the applicant meets all requirements of this chapter and obtains the authorization, if required, from the local EMS agency. Upon completion of its investigation, the county health department shall advise the board of supervisors and recommend either issuance or denial of the permit for the ambulance service.

B. The board of supervisors may issue a permit to conduct an ambulance service in a specified area upon finding that all requirements of this chapter are met.

C. The board of supervisors may deny a permit if all requirements of this chapter are not met, or if the applicant or any partner, officer or director thereof:

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

2. Has committed any act which would be grounds for the 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 therefor;

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 a 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.

(Ord. 879 § 4, 1990)

Permits shall be reviewed annually by the county, if the county determines that the permit holder has during the period of operation conformed with the provisions of this chapter and the rules and regulations of the department and that he or she is capable of continuing operation in conformity with the rules and regulations of the department. The term of an authorization to provide emergency medical services in any given area shall be for an initial term of five years. Procedure for renewal of permits will be the same as that described in Section 7.56.070 above.

(Ord. 879 § 4, 1990)

The department, through the county board of supervisors after conducting a hearing, shall be empowered to 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 rules or regulations that are promulgated by the EMS agency) which relates 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 or her transactions as a permittee, or fails to have such records available for inspection by the health officer or 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 to make such records available for inspection;

I. Accepts an emergency call when either unable to or unwilling to provide the requested service;

J. Fails to inform the hospital that he is unable to complete a prearranged nonemergency transfer;

K. Fails to respond to an emergency call from control.

(Ord. 879 § 4, 1990)

A. In the event that an operating area is for any reason without ambulance service, the board of supervisors authorizes the county health officer to grant a conditional operating permit for a period not to exceed eighteen months. In order to obtain a permanent operating permit, the conditional operator shall be required to comply with all provisions of the transportation component of the Inyo County EMS plan.

B. In the event of a change of ownership of any kind or nature, or any interruption of service of more than twenty-four hours' duration, or any substantial change in staffing or equipment of the ambulance service, which causes the ambulance service to be carried out differently than specified in the current operating permit, the permittee shall notify the county immediately in writing, stating the facts of such change. The county may grant a temporary variance from the condition specified in the original permit if they find that such change is in substantial compliance with the provisions of this chapter. If the county finds that such change is not in substantial compliance with this chapter, it may revoke the permit. In all cases when a change of ownership occurs in an ambulance service, an application for a new permit shall be filed with the county within thirty days. In no case shall any temporary variance be valid for more than sixty days without written approval of the county.

(Ord. 879 § 4, 1990; Ord. 1297 § 1, 2023)

If the original request for a permit or the renewal of a permit be denied by the EMS agency, or if the EMS agency revokes a permit, the permittee shall have the right to a hearing by the board of supervisors. A request for a hearing shall be made in writing to the clerk of the board within fifteen calendar days following the denial or revocation of the permit. Upon receipt of a written request, the clerk of the board 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 EMS agency of the date set for the hearing. At the hearing, the board shall hear the appellant, the EMS agency and any other interested persons who may present evidence relevant to the decision of the EMS agency. Within thirty days following the conclusion of the hearing the board shall issue its recommendations whether or not the permit should be issued or the revocation sustained. The permittee will not retain the permit during the appeal process unless the EMS agency finds no harm in his or her doing so.

(Ord. 879 § 4, 1990)

The permittee shall obtain and keep in force during the term of said permit public liability and bodily injury insurance, maintained at a level set by the board of supervisors, issued by a company authorized to do business in the state of California, insuring the owner, and also naming the county and the local EMS agency 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 or defective construction of such ambulances, or from violation of this chapter or of any other law of the state of California, or the United States, and shall be in accordance with the California Vehicle Code, Title 13. Such policy shall include a provision prohibiting cancellation of the policy except upon thirty days' prior written notice to the county. The certification of insurance shall be delivered to the county prior to time of application for the permit.

(Ord. 879 § 4, 1990)

Each ambulance service operator shall provide service on a continuous twenty-four-hour per day basis. If for any reason an operator stops service on a continuous twenty-four-hour per day basis, he or she shall immediately stop any advertisement of emergency services which have been discontinued, and shall immediately notify the control centers and the EMS agency by telephone and letter of the facts of such change.

(Ord. 879 § 4, 1990)

Procedures prescribed in the local EMS agency communications policy will be utilized for use of the radio.

(Ord. 879 § 4, 1990)

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

A. Minimum Equipment. The basic life support ambulance shall be equipped with all safety and emergency equipment required for ambulances by the California Vehicle Code and the California Code of Regulations.

B. Limited Advanced Life Support (LALS) Ambulance Equipment. In addition to the basic life support ambulance equipment and supplies, the limited advanced life support ambulance shall also be equipped as required by the local EMS agency.

C. Advanced Life Support (ALS) Ambulance Equipment. In addition to the basic life support ambulance equipment and supplies, the advance life support ambulance shall be equipped as required by the local EMS agency.

(Ord. 879 § 4, 1990)

A. Every person who operates an ambulance within the county while responding to emergency calls shall comply with the requirements in the California Code of Regulations and the Health and Safety Code for ambulance drivers. The driver shall also hold a certificate as an Emergency Medical Technician IA, or Emergency Medical Technician II or a Paramedic (except as allowed in Title 13, California Code of Regulations and Vehicle Code).

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 certificate as an EMT IA. If the vehicle is being used as a LALS ambulance, at least one attendant shall hold a certificate as an EMT II issued by the EMS agency. If the vehicle is being used as an ALS ambulance, then at least one attendant shall hold the required certificate as a paramedic.

C. Attendant Required. Each ambulance being operated within the county in response to an emergency call shall be staffed by both a driver and an attendant, unless the ambulance service operator has been exempted by the state. The attendant on an ambulance when transporting any patient shall occupy the patient compartment of the ambulance. This section shall not apply during any "state of emergency" or "local emergency" as defined in the Government Code of the state of California.

(Ord. 879 § 4, 1990)

The local emergency medical services agency will develop, implement and evaluate BLS, LALS and ALS procedures and protocols.

(Ord. 879 § 4, 1990)

The local EMS agency is responsible for certification of all EMT I, EMT II, and paramedics and for approving all training programs as stated in the California Health and Safety Code.

(Ord. 879 § 4, 1990)

A. The local emergency medical services agency shall make all necessary and reasonable rules and regulations concerning ambulance service operation, ambulance equipment, ambulance vehicles and ambulance personnel, for the effective and reasonable administration of this chapter.

B. The county shall inspect the records, facilities, vehicles, equipment and methods of operation whenever such inspections are deemed necessary, or required by state law.

C. The local EMS agency may place on probation any certificate holder, or revoke or suspend any certificate issued under the provisions of this chapter for any of the following:

1. Fraud in the procurement of any certification under this chapter;

2. Gross negligence;

3. Repeated negligent acts;

4. Incompetence;

5. The commission of any fraudulent, dishonest or corrupt act which is substantially related to the qualifications, functions and duties of pre-hospital personnel;

6. Conviction of any crime which is substantially related to the qualifications, functions and duties of prehospital personnel. The record of conviction or certified copy thereof shall be conclusive evidence of such conviction;

7. Violating or attempting to violate directly or indirectly or assisting in or abetting the violation of, or conspiring to violate, any provision of this chapter or the regulations promulgated by the EMS agency pertaining to pre-hospital personnel;

8. Violating or attempting to violate any federal or state statute or regulation which regulates narcotics, dangerous drugs or controlled substances;

9. Addiction to the excessive use of, or the misuse of alcoholic beverages, narcotics, dangerous drugs or controlled substances;

10. Functioning outside the supervision of medical control in the field care system operating at the local level, except as authorized by any other license or certification;

11. Demonstration of irrational behavior or occurrence of a physical disability to the extent that a reasonable and prudent person would have reasonable cause to believe that the ability to perform the duties normally expected may be impaired.

(Ord. 879 § 4, 1990)

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 inadequate services may file a written complaint with the county setting forth such allegations. The county will investigate the allegations and take reasonable and proper actions to secure compliance with the conditions of this chapter and subsequently promulgated policies, procedures and protocols. Complaints directed to other agencies shall be directed to the county.

(Ord. 879 § 4, 1990)

The board of supervisors, by resolution, shall set maximum rates allowable to be charged in Inyo County.

(Ord. 879 § 4, 1990)

During any state of war emergency, state of emergency or local emergency, as defined in the Government Code of the state, each ambulance service operator shall provide equipment, facilities and personnel as required by the EMS agency. Whenever the health officer or his designee determines that ambulance resources within the county are inadequate to respond to a county emergency/disaster, a request for emergency ambulance mutual aid may be made to any other county health officer or his designee. Whenever the county health officer or his designee receives a request involving emergency ambulance mutual aid from another county health officer or his designee, such resources shall be provided as are available.

(Ord. 879 § 4, 1990)

The Inyo County board of supervisors will call together an emergency medical care committee for local input and assistance in preparation of policies, procedures and protocols pursuant to this chapter as required by law.

(Ord. 879 § 4, 1990)