Sonoma County Municipal Code Art. V Medical and EMS Systems Control

(a) The LEMSA medical director shall, in consultation with medical care providers and in conformance with accepted medical and administrative practices and state law, develop and implement policies and procedures for basic and advanced life support services within the EMS system. These policies and procedures shall include, but not be limited to, patient evaluation and treatment and EMS system operation and evaluation.

(b) LEMSA policies and procedures shall be developed in the following manner:

(1) LEMSA policies will routinely be reviewed and revised as needed. Suggestions for new policies or revisions will be considered from any interested agency or individual.

(2) LEMSA will create draft policy.

(3) The draft policy shall be made available to county EMCC members and all stakeholders, for a sixty-day external comment period. Extension of the public comment period can occur as needed to ensure adequate participation.

(4) All draft policies approved for external review shall be published on the LEMSA website.

(5) After the close of the external review period, the policy author will review and make appropriate revisions to the draft policy.

(6) The revised draft policy will be re-submitted to LEMSA staff for final review. If necessary, an internal or external workshop will be scheduled to discuss the proposed policy.

(7) Approved policies shall be distributed to EMCC members and posted on the LEMSA website at least thirty (30) days prior to the effective date.

(c) Special Memoranda.

(1) The LEMSA medical director may issue EMS special memoranda to address immediate issues that require temporary or interim guidance

(2) EMS special memoranda have the same force as policy or treatment guidelines but are limited in duration to one (1) year

(3) Interim guidance within special memos must be subject to formal policy development or revision to remain in effect as properly promulgated regulation.

(d) Following final adoption of a policy or procedure, any EMS system provider agency affected by the policy may request a hearing as provided in Section 28-21 of this chapter.

(Ord. No. 6294, § I, 11-12-2019)

(a) The LEMSA may establish one or more exclusive operating areas (EOAs), as defined in Health and Safety Code section 1797.85. Such EOAs may be awarded either without a competitive process (a "non-competitive EOA") or pursuant to a competitive process (a "competitive EOA"), provided that in either case the requirements of Health and Safety Code section 1797.224 are met.

(b) An EMS entity granted an EOA shall enter into an agreement with the county (an "EOA agreement") setting forth the terms on which the EMS entity (and/or any approved subcontractor) shall provide services within the EOA, including the level and type of ambulance services covered by the EOA agreement.

(c) No EMS entity shall render any type or level of services considered exclusive within an EOA, unless the EMS entity has entered into an EOA agreement with the county to provide such services or acting as a subcontractor of an EMS entity with such an agreement.

(d) Nothing in this chapter or in any rule or regulation enacted by the county shall be construed as requiring the county to establish either a competitive or non-competitive EOA.

(e) Nothing in this section shall limit the ability of a city, special district or the county from operating as a non-transport EMS entity within their jurisdictions, consistent with applicable law and LEMSA policy.

(f) Competitive process shall include the following steps:

(1) The LEMSA shall develop the request for proposal document.

(2) Notice of the competitive process shall be mailed prior to the time set for submission of all proposals, to each current ambulance service operator in the County, to all EMCC members and any other interested parties who have requested in writing to the LEMSA.

(3) A pre-bid conference will be held for qualified bidders. Only bidders who attend this public conference will be able to submit proposals. Any proposal received after the time set for submission shall not be considered.

(4) An evaluation committee chosen by the department director or designee shall review, rate and rank all proposals based on objective criteria approved by the department. Such committee shall, at minimum, have representation including a Physician with experience in the acute emergency department setting and a working knowledge of prehospital emergency care, a local EMS agency administrator, a fire services officer from an agency that provides ALS transport services, a county-level administrative officer, a certified public accountant with health systems knowledge. Evaluation committee members shall be selected from entities outside of Sonoma County.

(g) Following the competitive process, the department director will submit a written report and recommendation to the board of supervisors who will approve or disapprove any proposed contract with the winning bidder.

(h) In selecting an exclusive provider under this chapter, the LEMSA shall consider the comparative value of competing proposals, including the consideration of:

(1) The quality of the service to be provided;

(2) The level of service to be provided;

(3) The rates charged to the public for services provided;

(4) The cost, if any, to the county, cities or district

(5) Documented evidence of ability to work effectively with local agencies;

(6) Evidence of expertise, capability and capacity to provide for or arrange for ambulance services as described in the RFP";

(7) The financial stability of service to be provided;

(8) The effect proposers' wages, benefits, shift schedules and expected productivity will have on proposers' ability to attract and retain experienced personnel, especially the existing employed paramedics and EMTs in Sonoma County. Wage and benefit packages should encourage personnel to remain with the system to reduce the turnover rate and increase the expertise and experience available through the incumbent workforce.

(9) Specification of Exclusive Operating Areas.

(i) All ambulance service contracts shall specify the area within which the operator may provide ambulance services.

(j) No ambulance service operator may provide ambulance service for requests originating outside the area designated in the contract unless requested to do so by EMS dispatch or under provisions outlined in written mutual aid agreements.

(k) Effect of Chapter on Exclusive Operating Areas. This chapter is not intended to supersede or otherwise modify the performance standards set forth in any agreement between the county of Sonoma and the recipient of any EOA. This section is intended to be consistent with and to carry out the purposes of the Act (and in particular sections 1797.85) and to assist the department in carrying out its functions as the designated LEMSA. Except as provided in state law, nothing in this section is intended to limit the authority of the board of supervisors, including, but not limited to, the authority to enter into contracts.

(Ord. No. 6294, § I, 11-12-2019)