Napa County Municipal Code Art. V Operational Requirements

A. Each ambulance permittee, at its sole cost and expense, shall obtain, maintain, and comply with all county insurance coverage(s) and requirements. Types of insurance coverage include Commercial General Liability, Commercial or Business Automobile Liability, Workers' Compensation and Employers Liability, Professional Liability/Errors and Omissions, and Endorsements and Conditions. Required limits of insurance may be obtained from Napa County Health and Human Services, Public Health Division.

B. Lack of coverage as required at any time shall automatically suspend the Certificate of Operation. Failure of the permittee to notify the county of lack of coverage for any reason shall be deemed a violation of regulation subject to fine.

C. As a condition of being issued a permit, permittee shall be required to indemnify and hold harmless the county from any and all claims or actions for property damage, personal injury, sickness, disease, caused by the permittee's acts or omissions and will pay any and all judgment decrees, costs, attorney's fees which may be rendered against the county, its directors, officers, agents, employees and volunteers in any and all such actions or proceedings.

(Ord. No. 1464, § 1, 12-8-2020)

Each permittee shall provide the county with information in reference to any pending action or unpaid judgments or liens against the permittee, and the notice of the transactions or acts giving rise to the judgments or liens. The permittee shall notify the county in writing of the actions within one week of the notification from the levying agency. The reported information will be reviewed by the county who will make a determination regarding the effect this information will have on the agency's ability to provide continuous service in accordance with this division.

(Ord. No. 1464, § 1, 12-8-2020)

A. Permittee shall maintain sufficient ambulances, operational procedures and personnel, with valid certifications and licenses to meet performance standards and permit specifications.

B. Permittee shall follow the county's LEMSA's policies.

C. Permittee and their personnel shall follow the regulations of the California Vehicle Code and the California Code of Regulations, Title 13, Motor Vehicles.

D. Permittee shall maintain supervisory or management personnel, available on a twenty-four hour basis on-site or on-call, authorized to make operational decisions, direct personnel and commit resources for use.

E. Permittee shall maintain a Quality Management program and perform quality assurance activities in accordance with Sections 8.70.070 and 8.70.071 of this ordinance.

F. Permittee shall ensure that all management, supervisory, dispatch and field personnel maintain knowledge and familiarity with multi-casualty and mass-casualty incident medical operations, staging, and incident command structure.

(Ord. No. 1464, § 1, 12-8-2020)

A. Each ambulance shall be equipped according to the standard vehicle safety and equipment requirements of the California Vehicle Code and the California Code of Regulations, Title 13, Motor Vehicles.

B. Each ambulance shall carry a photocopy or original current vehicle registration, current insurance identification, current CHP ambulance identification card (or CHP inspection report valid for thirty days after an initial inspection), and current county issued Ambulance Permit.

C. Each ambulance shall carry standard patient carrying fixtures and restraints necessary for the comfort and safety of patients.

D. Each ambulance shall be equipped with no less than the standardized equipment and supplies as established according to the LEMSA's Equipment and Supply Specifications policy for the level of service provided. CCT ambulances shall be equipped according to the LEMSA's CCT policy.

E. Permittee shall maintain its vehicles, equipment, and supplies in a clean, sanitary, and safe mechanical condition at all times.

(Ord. No. 1464, § 1, 12-8-2020)

A. No person, firm, partnership, corporation or other organization, except as identified in subsection (C) of Section 8.70.004, shall operate or cause an ambulance to be operated in Napa County unless an Ambulance Permit has been issued for that ambulance in accordance with this ordinance.

B. The LEMSA shall inspect each ambulance for which it receives an application to ensure compliance with this ordinance and the LEMSA's policies, protocols, and regulations as they pertain to the ambulance service applied for, according to the provisions of Section 8.70.043.

C. The annual inspection for permit renewal shall be based on the list of ambulances submitted by the permittee.

D. The permittee shall be notified in a timely manner of the results of the inspection and any corrective action required if an ambulance fails the inspection.

E. Upon passage of the ambulance inspection, the county shall issue an Ambulance Permit or renewal of the permit, to the permittee.

F. The ambulance inspection will be for all equipment identified in the LEMSA's policies, which has not been inspected by the CHP under the California Code of Regulations, Title 13, Motor Vehicles, Division 2, Chapter 5, Article 1, Sections 1103 and 1103.2.

(Ord. No. 1464, § 1, 12-8-2020)

Each ambulance shall have a radio for establishing and maintaining radio contact with county Dispatch and county hospitals as prescribed by the county and in compliance with Federal Communication Commission regulations.

(Ord. No. 1464, § 1, 12-8-2020)

A. At the time of initial application, and if subsequently changed, permittee shall provide the county with pictures or a description of the permittee's specific color scheme and design of its ambulances.

B. The color scheme and design shall not imitate or conflict with any other color scheme of other permittees authorized by this ordinance in a manner that is misleading or would tend to deceive the public.

(Ord. No. 1464, § 1, 12-8-2020)

A. Each BLS ambulance shall be staffed with a minimum of two California certified EMTs. Paramedics licensed in California may also staff BLS ambulances but may not utilize the paramedic scope of practice. CCT ambulances shall be staffed according to the LEMSA's CCT policy.

B. BLS Surge Ambulances may be staffed with one California certified EMT and one sworn public safety representative, trained at a minimum level of Public Safety First Aid (PSFA), if two California certified EMTs are not immediately available.

(Ord. No. 1464, § 1, 12-8-2020)

A. All personnel while on duty must carry all applicable certificates and permittee identification, and comply with the LEMSA Administrative Policy and Field Treatment Guideline Manual.

B. All EMT and paramedic personnel who operate ambulances and critical care transport units must have a current California driver's license, California ambulance driver's certificate, and a medical examiner's certificate.

C. Permittee's EMT personnel assigned to provide BLS service under this ordinance must meet the minimum qualifications:

1. EMTs must hold current, valid EMT certification in the State of California.

2. EMTs shall be certified in cardiopulmonary resuscitation (CPR/AED) according to the policies of the LEMSA and State of California.

3. EMTs assigned to provide CCT driver/assistant service must meet the additional qualifications specified in the county's CCT policy.

D. Permittee's paramedic personnel assigned to provide CCT service under this ordinance must meet the minimum qualifications:

1. Paramedics must hold current, valid paramedic licensure in the State of California.

2. Paramedics shall be accredited by the LEMSA and hold current and valid ALS certifications.

3. Paramedics assigned to provide CCT patient care must meet the additional qualifications specified in the LEMSA's CCT policy.

E. Permittee's registered nurse (RN) personnel assigned to provide CCT service under this ordinance must meet the minimum qualifications specified in the LEMSA's CCT policy.

F. Public Safety First Aid (PSFA) personnel assigned to provide BLS service under this ordinance must meet the minimum qualifications:

1. PSFAs must possess a valid certificate or written verification of course completion by an approved training institution.

2. PSFAs shall be certified in cardiopulmonary resuscitation (CPR/AED) according to the policies of the LEMSA and State of California.

G. All drivers must complete an Emergency Vehicle Operation Course (EVOC) driver training course, or its equivalent.

H. The permittee shall retain on file at all times, copies of all current and valid licenses, certifications, and/or accreditations of all emergency medical personnel performing services under this ordinance.

(Ord. No. 1464, § 1, 12-8-2020)

Ambulance companies shall maintain personnel standards that include orientation to the LEMSA Administrative Policy and Field Treatment Guideline Manual, special training (as deemed necessary by the EMS Medical Director), uniforms and appearances, safety apparel, identification, driver training, work-hour scheduling limitations, with due consideration for collective bargaining agreements and/or State and Federal regulations where they apply.

(Ord. No. 1464, § 1, 12-8-2020)

All ambulance personnel are to provide patient care in accordance with the LEMSA Administrative Policy and Field Treatment Guideline Manual and as directed by standing or specific orders issued by the EMS Medical Director, or his or her designee.

(Ord. No. 1464, § 1, 12-8-2020)

A. Permittee shall supply and maintain standardized personal protective equipment and supplies to ensure safety and readiness, according to Cal/OSHA guidelines.

B. Permittee shall ensure that all personnel receive training in all available equipment, including fit testing, according to Cal/OSHA guidelines.

(Ord. No. 1464, § 1, 12-8-2020)

Ambulance company stations within Napa County shall meet the minimum standards in Section 8 of the Federal Housing Authority, and include an EMS bulletin board, provisions for storage, and protection of ambulance(s). Stations shall comply with all applicable zoning, building, and occupational health and safety regulations.

(Ord. No. 1464, § 1, 12-8-2020)

The permittee, unless holding a contract to provide emergency service only, shall be approved by the county prior to beginning service.

(Ord. No. 1464, § 1, 12-8-2020)

A. Any private call requesting service for a life threatening emergency or a call requiring ALS level care where ALS care is timely, appropriate and available shall be immediately referred to the 9-1-1 emergency operators.

B. If a BLS ambulance responds to a patient who appears to have a medical emergency, the crew shall call 9-1-1 and request a 9-1-1 response, and render appropriate care within their scope of practice until the ALS ambulance is on-scene.

C. Permittee shall dispatch an ambulance to a non-emergency BLS call within a reasonable amount of time and notify the caller of the ambulance's estimated time of arrival. If the unit is delayed more than fifteen minutes from its estimated time of arrival the permittee shall notify the caller of the delay with the new estimated arrival time. The exception to this is for calls that have been prescheduled except for the notification of delay requirement.

D. The permittee or their employees shall report any response to a non-emergency request for ambulance service that is responded to by a unit not permitted, staffed or equipped at the appropriate service level to the county EMS Agency on an Unusual Occurrence form within ten days of the incident.

(Ord. No. 1464, § 1, 12-8-2020)

Each ambulance company providing service under this ordinance shall assign at least one person or an agency to be responsible for receiving calls and dispatching ambulances. The permittee shall have a Dispatcher Training Program that includes prioritizing tasks including, but not limited to, call intake, unit assignment, documentation and reporting; communication equipment; and compliance with the LEMSA Administrative Policy and Field Treatment Guideline Manual covering ambulance service operation, ambulance transport, equipment, ambulance personnel, and standards of dispatch. Dispatchers shall be certified in CPR/AED.

(Ord. No. 1464, § 1, 12-8-2020)

Ambulance companies are hereby prohibited from engaging in the following activities:

A. Permitting the operation of an ambulance in any manner contrary to the provisions of this ordinance or contrary to any applicable statue, rule, or regulation.

B. Responding to a call when not requested to respond to that call by an individual requesting that service or the appropriate dispatch center.

C. Causing or allowing its ambulances to respond to an emergency call location without first receiving a specific request from a Napa County approved dispatch center.

D. Providing ALS service without being authorized by the county to provide such service.

E. Providing CCT services without possessing a current and valid CCT Certificate of Operation and associated Ambulance Permit(s).

(Ord. No. 1464, § 1, 12-8-2020)

A. No person or organization shall announce, advertise, offer, or in any way claim that it provides non-emergency ambulance service unless it possesses a current, valid ALS, BLS or CCT ambulance Certificate of Operation.

B. No person or organization shall announce, advertise, offer, or in any way claim that it provides emergency service unless it has been approved as an emergency provider by the county.

C. Any use of a telephone number on an ambulance for non-emergency ambulance service shall include the phrase "FOR EMERGENCIES, CALL 9-1-1" in capital letters that are at least as big as the letters used for the telephone number.

(Ord. No. 1464, § 1, 12-8-2020)

A. The permittee shall submit their service charges and rates to the county with their application for a Certificate of Operation with each renewal. Any change to the service charges and rates must be reported to the county at least fifteen days prior to such changes.

B. All service charges and rates must be defined in sufficient detail so as to be understandable to the public. A list of all ambulance rates will be posted on the county website for public viewing. At least annually, the county will notify local healthcare providers, including hospitals and long-term care facilities of current ambulance rates.

C. The county reserves the option, with board approval, to set maximum allowable rates for ambulance services.

(Ord. No. 1464, § 1, 12-8-2020)

The permittee shall, at the start of each calendar year, submit to the county, in an electronic form, a list of all EMTs, paramedics, and PSFA personnel employed along with their certificate or license numbers. In addition, the permittee shall notify the county within thirty days of any EMTs and/or paramedics who have been newly hired, terminated, retired, or have quit their employment.

(Ord. No. 1464, § 1, 12-8-2020)