Nevada County Municipal Code Ch. 2 Regulation of Medical Transportation Services

The purpose of this Section is to enact formal policies and regulations for licensing and regulating the operation of medical transportation services with the County of Nevada, to protect the public by assuring that medical transportation services operate safely and to assure that adequate medical transportation services will be provided in all areas of the County.

(Ord. 2530. (10/24/2023))

The following terms are defined as set forth below for the purposes of this Section:

A. Advanced Life Support (ALS) means special services designed to provide definitive pre-hospital 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 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 inter-facility 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.

B. Agency Vehicle means a vehicle, which responds to an emergency, the attendants of which may treat but not transport patients and is operated and equipped at the ALS level by a provider agency under a permit issued pursuant to this Section.

C. Ambulance means a vehicle, permitted by the local EMS Agency, specially constructed, modified, equipped, and used for the purpose of transportation of sick, injured, convalescent, infirm, or otherwise incapacitated persons who may require measures to prevent loss of life or worsening of a traumatic injury or illness, or have sudden need of medical attention.

D. Ambulance Service means the operation of any ambulance within the County of Nevada.

E. Applicant means any person, organization, or service provider who applies for a permit under this Section.

F. Basic Life Support (BLS) means emergency first aid and cardiopulmonary resuscitation procedures which, at 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.

G. Board means the Governing Board of Directors of the local EMS Agency.

H. County means The County of Nevada, California and its agencies, departments, committees, boards and commissions.

I. Department of Public Health means the Nevada County Department of Public Health.

J. Emergency Medical Services Subcommittee (EMSS) means the Nevada County subcommittee of the Nevada County Operational Area Emergency Services Council established pursuant to Cal. Health & Safety § 1797.270.

K. Emergency Medical Services means the services utilized in responding to a medical emergency.

L. Equipment means the equipment required in an ambulance, air ambulance or agency vehicle pursuant to this Section and equipment standards established by the local EMS Agency.

M. Local EMS Agency means the agency, department, or office having primary responsibility for administration of emergency medical services in the County of Nevada or local EMS Agency or region.

N. Medical Transport Vehicle means a vehicle, not an ambulance, specifically constructed, modified, equipped, or arranged to accommodate a stretcher or wheelchair and operated for the purpose of transporting sick, injured, convalescent, infirmed, or otherwise incapacitated persons not requiring urgent transportation.

O. Patient means an individual who is sick, injured, wounded, or otherwise incapacitated or helpless and who may be transported in an ambulance, air ambulance or medical transport vehicle.

P. Permit means the document authorized/issued by the local EMS Agency on behalf of the Board which issues a permit for a service to provide emergency care and/or medical transportation in the County of Nevada.

Q. Permittee means a person who holds a permit.

R. Person means an individual, trust, firm, partnership, association, corporation or public entity.

S. Pilot means a person who is certified as a commercial pilot by the Federal Aviation Administration.

T. Public Entity Service means a service which is provided primarily as a public service by an agency of local government.

U. Reports means records upon such forms as may be provided or prescribed by the local EMS Agency concerning the dispatch, emergency care, or transportation of any patient within or beyond the limits of Nevada County. Such reports shall be available for inspection at any reasonable time and copies of such records shall be filed upon written request of the local EMS Agency within two (2) working days.

V. Service means the operation of an ambulance, air ambulance, agency or medical transport vehicle to provide medical care or patient transportation within the County of Nevada.

W. State means the State of California.

X. Station means a facility from which an ambulance, air ambulance or medical transport vehicle is operated.

Y. Substation means a subsidiary facility from which an ambulance, air ambulance or medical transport vehicle is operated.

Z. Transfer means the movement of a patient by ambulance, air ambulance or medical transport vehicle, from one hospital to another hospital, a medical facility, a home or other location.

AA. Transport means the movement of a patient by ambulance, air ambulance or medical transport vehicle.

BB. Volunteer means an individual who:

1. Acts as a driver or attendant of an ambulance or medical transport vehicle;

2. Does not receive more than fifty percent (50%) of their annual income from the EMS provider that is claiming volunteer status.

CC. Volunteer Service means a service which:

1. Transports patients without compensation, other than reimbursements to defray the actual expenses of providing such service and;

2. Is either wholly or partly subsidized or otherwise operated under the auspices of some governmental or public agency, body or group, or any industrial or nonprofit corporation and;

3. Uses volunteers.

(Ord. 2530. (10/24/2023))

A. Except as provided in this Section, no person may furnish, operate, conduct, maintain, advertise or otherwise be engaged in, or profess to operate an ambulance, air ambulance or medical transport vehicle within the County of Nevada unless they hold a valid permit authorized/issued by the local EMS Agency pursuant to this Section.

B. A permit will be issued only when the permittee is in compliance with all applicable Federal, State, and County codes and regulations, and County policies and procedures.

C. For the purpose of determining whether a service meets the requirements of this Section, the local EMS Agency may require the following information:

1. Location of storage, supply, or re-supply of drugs and controlled substances;

2. Station or substation location;

3. Location of business as listed on any business license;

4. Advertised business location, telephone number, and mailing address;

5. Site to which on-call employees respond when a request for service is received;

6. Location of back-up equipment supply or re-supply; and

7. Any additional information that may be required by the County or local EMS Agency.

D. Whenever a service based outside the County of Nevada, but within the State of California, initiates a transport within the County of Nevada must hold a valid permit as described in this Section, unless otherwise exempted in this Section.

E. No permit is required if a valid provisional permit, issued by the local EMS Agency, to operate pursuant to Section 6.02.050, exists.

F. A service permitted in accordance with this Section must provide emergency care to and transport any emergency patient regardless of the patient's ability to pay.

G. No permittee, under this Section shall cause or allow its ambulances, or air ambulances to respond to a location without receiving a specific request for that response, unless otherwise exempt.

(Ord. 2530. (10/24/2023))

A. Application for a permit must be made upon forms prescribed by the local EMS Agency in accordance with this Section. The local EMS Agency, after receipt of the completed application shall:

1. Confirm the applicant's approval as an ALS provider;

2. Cause an investigation to be made of the applicant, the applicant's proposed service and the information contained on the application and;

3. Upon completion of the investigation, either issue the permit or reject the application in writing on any grounds prescribed in this Section. The written rejection must set forth the reasons therefor and must notify the applicant of their right to appeal per Section 6.02.210.

B. In accordance with the provision of this Section, the local EMS Agency shall prepare an application form and shall require each applicant to furnish information as it deems necessary to determine the applicant's ability to meet the requirements of this Section.

C. The applicant must provide proof of insurance coverage as required by Section 6.02.110.

D. The applicant must provide a statement of financial worth of the proposed ambulance service.

E. When the applicant is a firm or corporation, the officers, owners and managers shall provide their fingerprints for the purpose of identification and criminal background screening.

F. A permit expires on July 1, following the date of issuance, and must be renewed before that date. A renewal application must be submitted at least thirty (30) days prior to the permit expiration date with the same requirements, limitations, terms and conditions applicable to issuance of a permit. A modified application form approved by the local EMS Agency shall be used for renewal applications for a permit.

G. The local EMS Agency shall not approve an application for operation unless that application is in compliance with the policies of the local EMS Agency. The application shall include, at a minimum, a description of:

1. The name, current address, and certification level of the attendants who the service proposes to utilize;

2. How the service or agency proposes that its attendants will comply with requirements under this Section for continuing training and periodic certification;

3. Communications and 24-hour dispatch capabilities, including recording of telephone and radio communications of the service, recording maintenance and retrieval system, response times and the protocols used for dispatching the service;

4. How the equipment, supplies and drugs which the service uses on each BLS, ALS, or medical transport unit comply with local EMS Agency policy; ambulances or air ambulances shall be removed from service if the unavailability of supplies/drugs interferes with the delivery of clinically necessary patient care.

5. How the service or agency proposes to maintain adequate medical records on the treatment of patients, and a general description of their internal quality assurance process and the individuals responsible;

6. The name of each base hospital to which patients will be transported;

7. The staffing necessary for the number of units to be operated by the service;

8. The service's plan for drug storage, supply and re-supply, including procedures to meet Federal, State and local requirements;

9. The service's plan for handling and disposal of biohazardous materials;

10. The service's plan for Infection Control and;

11. The service's plan for the Incident Command System (ICS), and disaster training, equipment and supplies;

12. The schedule of proposed rates under which applicant will operate. Such rates may be based on a flat rate, or zone basis, time, mileage, or special service, or a combination thereof.

(Ord. 2530. (10/24/2023))

A. The local EMS Agency may authorize/issue a provisional permit to operate an ambulance, air ambulance, or medical transportation service which is limited as to time, place and purpose, based on public need.

B. No provisional permit may be issued for a period of time longer than six (6) months.

C. A provisional permit may be authorized for reissue at the discretion of the local EMS Agency, but in no case may more than one (1) reissue be made.

D. A provisional permit may be issued when the applicant is deemed by the local EMS Agency Medical Director to be ineligible for a regular permit because of an inability to meet, in the opinion of the local EMS Agency, any requirement of this Section and the service is deemed necessary for the safety of the public and not detrimental to patient care.

(Ord. 2530. (10/24/2023))

A. Any permit or provisional permit issued pursuant to this Section shall be prominently displayed in the principal place of business of the permittee and shall not be altered or defaced in any way. If any official entry on any such permit is defaced, removed, obliterated or altered in any way, the permit shall be rendered immediately null and void and of no force and effect whatever.

B. No permit issued pursuant to this Section is transferable.

C. Each permitted vehicle shall display the issued permit decal in plain sight on each vehicle in the area deemed appropriate by the local EMS Agency.

(Ord. 2530. (10/24/2023))

A. The local EMS Agency may refuse to issue a permit for one (1) or more of the following reasons:

1. Failure to provide a complete application or a determination by the local EMS Agency that the applicant fails to meet the requirements of this Section;

2. If the provider's owners, officers and managers have previously had an applicable permit revoked or the status is directly at issue, which effects its present ability to serve;

3. If the provider's owners, officers and managers have a criminal record, as verified by the FBI and/or the Criminal Intelligence and Investigation, which is substantially related to the qualifications, functions, and duties of operating a service;

4. If there is reasonable cause to believe that the provider's owners, officers and managers will not provide emergency medical services or medical transport in a manner that will promote the health and general welfare of persons within the County who may need to utilize the applicant's proposed services;

5. If the provider's owners, officers and managers do not have the required equipment for the units;

6. If the provider's owners, officers and managers have not demonstrated, utilizing standard accounting practices and principles, sufficient financial stability or capitalization of a service to assure that the service will be run in an efficient and business-like manner for a period of at least one (1) year or cannot meet the insurance requirements in Section 6.02.110;

7. If the provider's owners, officers and managers propose to operate a service within a service area where another ambulance service or entity has been granted an exclusive operating area;

8. If the applicant for a permit to operate an air ambulance does not meet the Federal Aviation Rules for certification under FAR Part 91 or Part 135, or both, as published in the Federal Register, January 1, 1985, as may be amended from time to time;

9. If the provider's owners, officers and managers commit fraud or deception in the completion of the application and/or;

10. Failure to comply with all applicable Federal, State and County codes and regulations and local EMS Agency policies/procedures.

B. If an application for a permit to operate a service, or an endorsement authorizing services at the ALS level is denied by the local EMS Agency for failure to meet the requirements of this Section, the applicant shall be notified by personal service or by certified mail within ten (10) working days of that fact, stating the reason or reasons therefore and the applicant's right of appeal as provided for in this Section. No right of appeal exists if the permit is denied pursuant to the provisions of this Section.

(Ord. 2530. (10/24/2023))

Receipt of business license issued by any local governmental entity does not constitute a permit to operate an ambulance or medical transport service until a permit as required by this Section has been authorized/issued by the local EMS Agency.

(Ord. 2530. (10/24/2023))

A. Any unit, unless exempt, in order to be placed into service, must be inspected by the California Highway Patrol and the local EMS Agency and must have a current "Statement of Safe Operating Condition" issued by the California Highway Patrol to determine if it complies with this Section.

B. Each unit must be maintained in a safe operating condition, including all engine parts, body parts, and all other operating parts and equipment used in and on the unit. (Note: In this connection the local EMS Agency shall periodically, and at least annually, require each permittee to certify that they have had inspected every unit under their control and supervision and that, in the opinion of a professional mechanic, the unit is in safe operating condition. Successful completion of an annual California Highway Patrol Ambulance Inspection is acceptable. A written copy of this certificate shall be submitted to the local EMS Agency within ten (10) days of the inspection.) In the case of an air ambulance, maintenance must be in accordance with Federal Aviation Rules Parts 43, 91 and 135 as applicable.

C. Each ambulance shall be equipped with at least one (1) primary mobile two-way radio capable of establishing and maintaining communication with the base hospital on the UHF designated MED NET 1-10 frequencies and the local fire authority. Each ambulance shall also be equipped with at least one (1) portable back up communication device (cellular telephone is acceptable). All communications equipment must meet manufacturer's specifications for power, output and antenna.

D. Units shall be equipped with such lights, sirens, and special marking to designate it as an ambulance as are required by the regulations of the California Highway Patrol covering operation and equipment of ambulances used for emergency services.

E. Every unit operated in the County of Nevada shall currently comply with all applicable laws and local ordinances relating to health, sanitation and safety.

F. Relatives of a patient and other persons may ride in an ambulance or medical transport vehicle at the discretion of the attendant(s). Restraints for utilization by each passenger riding in an ambulance or medical transport vehicle must be available in ambulances or medical transport vehicles. Attendants shall require that all persons utilize such restraints.

G. An ambulance service or entity granted an exclusive operating area as part of the local EMS Agency plan, may adopt dispatch protocols and procedures which must be approved by the local EMS Agency.

(Ord. 2530. (10/24/2023))

A. In addition to any other requirements contained herein, no service may utilize a driver or pilot to operate a unit unless:

1. They are familiar with the geographic area of the organization's service area;

2. They have adequate knowledge of all the hospitals within the organization's service area;

3. They can operate a two-way radio; and

4. They can drive a unit under emergency conditions.

The service provider shall keep on file confirmation of demonstrated knowledge/ability of A.1—4, signed by the employee and management.

B. Each service or agency must provide written notice to the local EMS Agency within ten (10) days of any change in units unless an alternate plan has been approved by the local EMS Agency.

C. Services may utilize only those drivers and attendants who are appropriately licensed, certified and accredited by California and/or the local EMS Agency.

D. Every advanced life support transport unit when in operation must be staffed, at a minimum, by two (2) personnel, one (1) of whom must be State licensed and locally accredited as an EMT-P and one (1) of whom must be certified in the State of California as an EMT-I.

E. Every Basic Life Support transport unit when in operation must be staffed, at a minimum, by two (2) personnel, both of whom must be certified in the State of California as an EMT-I.

F. An agency vehicle approved at the ALS level must have at least one (1) California licensed and locally accredited EMT-P.

G. An operational air ALS unit should be staffed by two (2) EMT-P's or two (2) registered nurses and, as a minimum, must be staffed by no fewer than one (1) EMT-P or authorized registered nurse and one (1) EMT-I.

H. No person, service or agency shall be out of compliance with Cal. Gov't Code § 8355, in matters relating to providing a drug-free workplace.

I. Air ambulance attendants used by a service must have training in aeromedical physiology, aircraft safety, emergency aeromedical procedures, and any other specialized training required by the local EMS Agency based on current Association of Air Medical Services (AAMS) national standards.

(Ord. 2530. (10/24/2023))

A. The permittee shall obtain and keep in force during the term of said permit the following insurance coverage issued by a company authorized to do business in the State of California. The required insurance coverage may be revised as deemed necessary by the local EMS Agency, Nevada County Risk Manager or the County Administrative Officer.

1. Comprehensive General Liability Insurance to include coverage for bodily injury, property damage, blanket contractual, and personal injury.

2. Workers' Compensation Insurance for Statutory Compensation Coverage.

3. Comprehensive Auto Liability, combined Single Limit Bodily Injury and Property Damage; minimum coverage for medical transport vehicles and coverage for all permittees must include owned auto, non-owned auto, hired auto, and cross liability or severability of interest clause in policy.

4. Professional Liability for all employees providing service. Error or omission and failing to render professional services coverage, and minimum limits for medical transport vehicles and all other permittees.

B. Said insurance shall contain coverage expressly recognizing the indemnification obligations assumed by the ambulance business or applicant in accordance with this Section but shall not be construed to limit in any manner the amount of ambulance business or applicant's liability thereunder; providing further, where permitted by the carrier, said insurance shall expressly name County and local EMS Agency, its governing board, agents, officers and employees as additional insured.

C. Said insurance shall not be subject to cancellation or reduction without sixty (60) days prior written notice to County and local EMS Agency. The insurance carrier shall serve written notice to the Nevada County Risk Manager and local EMS Agency.

D. Each unit placed in operation shall be included within the scope of the required insurance coverage and limits and shall be operated pursuant to the permit issued in accordance with this Section.

E. Certificate(s) of insurance satisfactory to the County of Nevada Risk Manager and local EMS Agency must be approved before ambulance service commences.

F. The provisions of this Section regarding liability insurance do not apply to services provided by the State of California or its departments, divisions or agencies.

G. Upon receipt of any notice of cancellation or non-renewal of an insurance policy, the County of Nevada Risk Manager or local EMS Agency shall either:

(1) Confirm that the provider immediately reinstates insurance coverage prior to cancellation;

(2) In the absence of substitute provider coverage, order the permittee to cease service in the County of Nevada and to surrender any permit issued pursuant to this Section;

(3) See that the insurance is reinstated at the provider's expense; or

(4) Obtain substitute provider coverage until the matter is resolved at provider's expense.

(Ord. 2530. (10/24/2023))

A. All services must adhere to the local EMS Agency equipment inventory list.

B. All medical equipment and supplies on an agency vehicle must be stored to promote security and protection from the elements.

(Ord. 2530. (10/24/2023))

A. Each ground ambulance unit placed in service after July 1, 1991, must, when purchased, be configured to meet the mechanical and electrical standards established by the United States Department of Transportation in its specifications designated Docket KKK-A-1822, as amended from time to time.

B. In addition to meeting the requirements in this Section, ALS units must, where noted:

1. Have space as required by Docket KKK-A-1822, as amended from time to time;

2. Have additional shelf and other storage space sufficient for controlled substances, including locked storage in accordance with Section 6.02.160;

3. Have proper storage of other medical equipment and supplies to prevent patient injury in transit; and

4. Have a system which will control temperature adequately to maintain the integrity of the medical supplies and drugs as well as the health and safety of the patients and attendants.

(Ord. 2530. (10/24/2023))

A. Every station and substation used in a commercial or public entity service must meet the following requirements:

1. Local Building, Fire, Health, Sanitation and CalOSHA Codes;

2. Every station and substation must be properly located to permit any ambulance operating therefrom rapid and safe egress to a main thoroughfare;

3. Every station and substation must have adequate off-street parking space for all units operating therefrom;

4. Every station shall be in compliance with all applicable OSHA and ADA requirements;

5. Every station and substation must be in clean and sanitary condition and have suitable sleeping quarters for attendants who are scheduled to work a 24-hour shift which are private and separate from operational areas.

B. Every station and substation shall be inspected prior to the issuance of any permit and, thereafter, shall be inspected at least once yearly by County Risk Manager or local EMS Agency for the purpose of determining whether or not the station or substation is in compliance with this Section and any other Nevada County Department of Public Health regulations.

(Ord. 2530. (10/24/2023))

An air ambulance must, in addition to other requirements in this Section, comply with local EMS Agency policies and procedures.

(Ord. 2530. (10/24/2023))

All administration, supply, re-supply, documentation, storage and security measures and destruction of drugs, controlled substances and hypodermic devices must be in compliance with all laws and regulations of the State and Federal government, Federal and State pharmacy regulations and the local EMS Agency. As used in this Section, drugs and controlled substances have the meaning ascribed to them in State Board of Pharmacy Regulations. Any provider agency that stockpiles drugs shall have a medical director and/or a clinical pharmacist.

(Ord. 2530. (10/24/2023))

A. Any change in a service's ambulance fleet must be filed by the permittee with the local EMS Agency within ten (10) days of its occurrence.

B. Each service shall submit such additional operational information as required by local EMS Agency within ten (10) days.

C. Whenever a unit is involved in a crash and/or experiences mechanical problems resulting in a mission failure, the local EMS Agency shall be notified immediately.

D. Any alleged violation of this Section must be reported by the service provider, to the local EMS Agency.

(Ord. 2530. (10/24/2023))

A. The local EMS Agency shall inspect, or cause to be inspected, every unit before it is placed into use, and annually thereafter. Such inspections do not duplicate, and shall not be in lieu of, inspections performed or required by the California Highway Patrol.

B. After inspection, a written report shall be prepared indicating every violation or omission of any requirements, standards or provisions contained in this Section with respect to the unit inspected. The report shall set a time period for correction of each violation or omission. A copy of the report shall be given to the permittee of the service concerned.

C. In addition to the routine inspections required in this Section, the County and/or local EMS Agency may make unannounced non-routine inspections of any ambulance, air ambulance or medical transport vehicle, station or substation regulated hereunder, for the purpose of determining whether or not any aspect of a service subject to this Section is, or is not, in compliance with this Section. A written report shall be prepared pursuant to Subsection 6.02.220(B).

(Ord. 2530. (10/24/2023))

A. Enforcement of this Section is the primary responsibility of the local EMS Agency.

B. An appeal process is established by the local EMS Agency.

(Ord. 2530. (10/24/2023))

A. A person exhibits unprofessional conduct if they fail to maintain that standard of performance, exercise that degree of skill, care, diligence and expertise, or manifests that professional demeanor and attitude which is ordinarily exercised and possessed by other persons in similar positions in California. Unprofessional conduct includes, without limitation:

1. The use of obscene, abusive, slanderous or threatening language;

2. The use of unreasonable force which unnecessarily increases or inflicts pain upon a patient;

3. Conviction of an offense, a diversion status, a nolo contendere guilty plea if the acts involved have a direct bearing on entrusting the person to serve the public;

4. Disclosing the contents of examinations for certification or re-certification;

5. Violation of the confidentiality of health records except as allowed or required by law or regulation;

6. Possessing, diverting or using medical supplies, equipment or drugs for personal or unauthorized use; and

7. Possession of any firearms or other weapons while on duty or engaged in the performance of pre-hospital care duties per local EMS Agency policy.

B. All incidents listed above shall be reported to the Local EMS Agency.

(Ord. 2530. (10/24/2023))

An appeal process shall be established and administered by the local EMS Agency. Providers shall be provided with a copy of this appeal process.

(Ord. 2530. (10/24/2023))

A. Any permit may be revoked after inspection by the local EMS Agency, the service provider to whom the permit or endorsement was issued does not comply fully with this Section within a reasonable period of time after receiving any request or order of the local EMS Agency to do so. "Reasonable period of time" as used herein, is that period of time necessary to take immediate action with due regard for the public interest and for the ordering of necessary supplies and/or parts.

B. If a permit or endorsement to operate a service is suspended or revoked, the local EMS Agency may request that the business licensing authorities immediately institute proceedings to revoke any business license or permit issued to the person operating the service.

C. If an exclusive operating area is granted, the permits of existing ambulance services within the exclusive operating area not granted such exclusive operating area or not determined to be part of an entity granted such exclusive operating area, shall be revoked upon written notice of the local EMS Agency. Such notice shall indicate the date and time when the permit is revoked.

(Ord. 2530. (10/24/2023))

A. The local EMS Agency may take any immediate disciplinary action set forth in Sections 6.02.220 and 6.02.230 when the local EMS Agency has reason to believe that a permitted service has violated any section of this Code, or any applicable statute, regulation or code.

B. Written notice will be furnished to the permittee specifying the reasons for the proposed disciplinary action and informing the permittee of their right to file an appeal with the local EMS Agency as required by Section 6.02.210; except that such hearing, if the permit is revoked for the reasons stated in Section 6.02.210, shall not delay any immediate suspension ordered by the local EMS Agency.

C. A Notice of Revocation or Suspension issued in accordance with Section 6.02.240 may state that the effective date of the revocation or suspension is:

1. Immediate if the local EMS Agency has determined through investigation that such suspension or revocation is in the best interest of the public or;

2. Stayed pending formal appeal and review of the proposed action.

D. Any ambulance or medical transport service who is served a notice of proposed suspension or revocation, other than under Section 6.02.110, for insurance issues, or Section 6.02.240, Notice of Violation, has ten working days from the date of the notice to appeal that action in writing to the local EMS Agency. Upon receipt of the appeal, the County or local EMS Agency shall conduct an appeal hearing. In case of immediate suspension or revocation, the decision of the local EMS Agency is final.

(Ord. 2530. (10/24/2023))

A. Whenever the local EMS Agency has reasonable cause to believe that any section of these regulations other than Section 6.02.110, concerning insurance coverage, has been violated, the local EMS Agency shall cause written notice to be served upon the person or persons responsible for the alleged violation. Such notice shall be sent to the person or person's address of record and a copy to the employer of record.

B. The notice shall specify:

1. The Section or Sections of this Code alleged to be violated;

2. The facts alleged to constitute the violation; and

3. An order to take corrective action within a specified time.

C. Such an order becomes final unless, within ten (10) working days from the date of the notice, it is appealed in writing to the local EMS Agency. Upon receipt of an appeal, the local EMS Agency shall refer it to the appeal process.

D. Failure to comply with a Notice of Violation shall result in the issue being referred to the local EMS Agency.

(Ord. 2530. (10/24/2023))

A. Complaints regarding alleged violations of this Section shall be made in writing. The local EMS Agency may require the complainant to specify:

1. The Section alleged to have been violated;

2. The date, time and location of the alleged violation;

3. The person and/or service involved and;

4. The circumstances or details which support the allegation of a violation.

B. The complainant may be requested to personally present additional information to substantiate the complaint.

C. Based upon information obtained from the complainant, the local EMS Agency shall make a determination whether to proceed with the investigation and to set a priority for conducting the investigation.

D. The person and service alleged to be in violation shall be notified by the local EMS Agency.

E. The complaint investigation may include a review of any applicable records, tapes, personal statements, affidavits or other items deemed relevant by the local EMS Agency. A summary report detailing the findings of the investigation shall be prepared.

F. At the conclusion of the investigation, the complainant shall be afforded the opportunity to receive copies of all appropriate documents associated with the complaint investigation.

G. The local EMS Agency shall determine if permit suspension or other any disciplinary action should be taken at any time during the complaint investigation process.

H. When the local EMS Agency is separate from County of Nevada Government, complaints received by the Nevada County Public Health Director that are potential violations of Cal. Health & Safety Code § 1798.200, shall be referred to the local EMS Agency for necessary action.

(Ord. 2530. (10/24/2023))

Except as otherwise provided herein, every service must be in compliance with this Section within ninety (90) days after its adoption by the County of Nevada Board of Supervisors.

(Ord. 2530. (10/24/2023))

The following shall be exempt from the provisions of this Section:

1. The occasional (not to exceed twice annually unless previously authorized by the local EMS Agency) use of a vehicle or aircraft not ordinarily used in the business of transporting persons who are sick or injured when an authorized form of approved medical transportation is not available in a critical care situation;

2. A vehicle or aircraft not ordinarily used in case of a major catastrophe or emergency, when services with permits are insufficient to render the services required;

3. Persons rendering service as attendants or air attendants in case of a major catastrophe or emergency when permitted attendants cannot be secured;

4. An ambulance or medical transport vehicle based and properly permitted outside the County shall be authorized to transport a patient to or through the County but shall not be authorized to transport patients originating in the County;

5. Volunteer attendants based outside the County of Nevada;

6. Units owned and operated by search and rescue organizations chartered by the State as corporations not for profit or compensation, or otherwise existing as nonprofit associations which are not regularly used to transport patients except as part of rescue operations; or

7. Units owned and operated by an agency of the United States Government or the State of California.

(Ord. 2530. (10/24/2023))

The following miscellaneous provisions on the operation of units within the County of Nevada apply with respect to any permit:

1. No one within the County of Nevada may operate a medical transportation service in violation of this Section.

2. Personnel records of all certified or permitted personnel are confidential and may only be made available to the person who is the subject of the records, the local EMS Agency, or as provided by law. Investigation of personnel complaints shall be coordinated with the local EMS Agency.

3. A registered nurse employed by a service is subject to this Section. Any violation of this Section by a registered nurse may result in investigation by the local EMS Agency and possible referral to the California State Board of Registered Nurses.

4. It is the responsibility of the employer of record to forward any notice issued under this Section to a person or persons in their employ, which is undeliverable to the address of record, to that person or persons at their next work shift.

5. Public entity services and ambulance services shall demonstrate availability of mutual and/or automatic aid agreements, with adjacent ambulance service areas, which ensure dispatch of the nearest appropriate ambulance. Mutual and/or automatic aid agreements must be reviewed by the Nevada County Operational Area Emergency Services Council and the local EMS Agency.

(Ord. 2530. (10/24/2023))

A. Permit applicants of high-risk and/or high-exposure events will be required to notify, in writing, the Office of Emergency Services (OES), the responsible law enforcement agency and the responsible fire protection agency thirty (30) days prior to the event and have County of Nevada permitted ambulances with appropriate personnel and equipment present. Notification shall include:

1. Nature of the event;

2. Anticipated attendance;

3. Nature of the crowd;

4. Geography and physical characteristics of the event site;

5. Use of alcoholic beverages;

6. Use of fireworks or other pyrotechnics;

7. Amplified sound system; and

8. Additional information pertinent to the event.

The OES shall notify appropriate law and fire agencies upon receipt of the event notification.

B. All permit applicants for special events expecting 2,500 participants and/or attendees shall submit appropriate medical plans, in a format established by the County, for approval by the County Public Health Officer, or their designee. Public health and sanitation plans shall be submitted for approval to the Nevada County Public Health Officer, or their designee. A copy of each of those plans shall be submitted to the responsible local law enforcement and fire protection authorities.

C. Guidelines for the public health plans will be promulgated and approved by the Public Health Officer, or their designee, and guidelines for medical plans will be promulgated and approved by the County.

(Ord. 2530. (10/24/2023))

A. The Board of Supervisors may adopt procedures for reviewing and regulating ambulance rates in the County. If regulated, ambulance permittees shall not charge more than the rates adopted by the Board of Supervisors. Alternatively, the Board of Supervisors may allow the marketplace to set rates subject to subsections B and D of this Section.

B. No charge shall be made for transporting uninjured or well persons who accompany a patient to an emergency care facility.

C. If regulated, the schedule of rates may be adjusted by the Board of Supervisors upon the receipt of a permittee request addressed to the Clerk of the Board of Supervisors. Upon request by the Board of Supervisors, the local EMS agency shall submit a written report and recommendation to the Board of Supervisors within thirty (30) calendar days of the request. If rates are regulated, the Board of Supervisors shall conduct a public hearing regarding the requested rate increase.

D. Any rate change, even those approved by the Board of Supervisors, as applicable, shall be effective thirty (30) days from the date of approval, if by the Board of Supervisors, and first publication, as a display public notice, in a daily newspaper of general circulation within the County at least two (2) times and not less than five (5) calendar days apart.

E. Current rate categories and charges shall be posted at each permittee's place of business.

(Ord. 2530. (10/24/2023))

A. Each ambulance provider participating in the transfer of patients with an ambulance will conform to all laws, rules and regulations, including but not limited to, set forth in the California Health and Safety Code and local EMS Agency policies applicable to inter-facility transfer of patients, and pursuant to any formal transfer agreements, including mutual aid agreements, between transferring and receiving facilities involved.

B. Treatment performed by ambulance personnel for the patient in transport, shall be provided with appropriate medical care, including personnel and equipment, according to the California Health and Safety Code and applicable local EMS Agency policies.

(Ord. 2530. (10/24/2023))

A. Each permittee shall make ambulances available, when resources allow, to the Nevada County Office of Emergency Services during times of disaster or large scale system emergencies in accordance with the Multi-Casualty Incident Plan. Ambulances shall report to a designated staging area via radio for direction. A designated dispatch center shall coordinate all dispatch functions for said ambulances during the event. All ambulances shall remain under the control of the Incident Commander until released.

B. Permittee shall make every effort to call in off-duty personnel to staff additional ambulances as necessary to meet system demands.

C. Permittee shall have on file with the Nevada County Office of Emergency Services and local EMS Agency, its disaster response and personnel call-back plan.

D. All management and field personnel of permittee shall follow the guidelines and directions of the OES Region IV Multi-Casualty Incident Plan and the Nevada County Emergency Action Plan during the incident.

E. At least once a year, permittee shall participate in an interagency organized disaster exercise. All of permittee's costs associated with their participation in the disaster exercise shall be the sole responsibility of the permittee.

(Ord. 2530. (10/24/2023))

A. No person or service may represent, advertise or imply that it is authorized to provide ambulance or medical transport services unless the service has a current, valid permit issued by the local EMS Agency.

B. No service or agency may use EMT-Ps and/or registered nurses unless the service or agency has a current, valid permit issued by the local EMS Agency and the service operates in accordance with all provisions of this Section.

C. No person, service or agency shall be out of compliance with Cal. Gov't Code § 855, in matters relating to providing a drug-free workplace.