Yuba County Municipal Code Ch. 6.05 Ambulances

(Repealed and Reenacted by Ord. No. 1338)

Footnotes:

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State Law reference— Emergency Medical Services System and the Prehospital Emergency Medical Care Act, Health and Safety Code § 1797 et seq.; local emergency medical services agencies, Health and Safety Code § 1979.200 et seq.

The purpose and intent of this Chapter is to enact formal policies and regulations implementing and supplementing the current provisions of, including but not limited to, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act (Health and Safety Code § 1797 et seq.) Health and Safety Code § 13862; CCR Title 13, Div. 2, Ch. 5, Art. 1, (CCR § 1100 et seq.), California Highway Patrol Ambulance Drivers Handbook, and Local EMS Agency policies, to permit and regulate the operation of ambulance services and other medical transport systems within Yuba County. Nothing contained in this Chapter shall be construed to permit a deviation from the minimum standards set forth in State statutes and regulations and nothing contained in this Chapter shall require duplication of certification or accreditation.

(Prior Code, § 6.05.000; Ord. No. 1338)

Definitions, as stated in the laws, regulations, and policies listed in Section 6.05.010 apply to this Chapter. In addition, the following definitions are used in this Chapter, unless the context otherwise requires, the words and terms contained in Section 6.05.010 have the meanings ascribed to them in those Sections.

(1) 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 direct supervision of a base hospital as part of a Local EMS system at the scene of an emergency, during transport to an acute care hospital, during 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.

State Law reference— Similar provisions, Health and Safety Code § 1797.52.

(2) 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 LALS or ALS level pursuant to this Chapter.

(3) Ambulance means a vehicle specially constructed, modified, equipped, or arranged and operated for the urgent 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.

(4) Applicant means any person, organization, or service provider who applies for a permit under this Chapter.

(5) 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.

(6) Board means the Board of Supervisors of the County of Yuba.

(7) Commercial Ambulance Service means the operation of any ambulance for profit within Yuba County.

(8) County means the County of Yuba.

(9) Department of Health and Human Services means the Yuba County Health and Human Services Department.

(10) Emergency Medical Care Committee (EMCC ) means the Bi-County Committee established pursuant to Health and Safety Code § 1797.270.

(11) Emergency Medical Services means the services utilized in responding to a medical emergency.

State Law reference— Similar provisions, Health and Safety Code § 1797.72.

(12) Equipment means the equipment required in an ambulance, air ambulance or agency vehicle pursuant to this Chapter and equipment standards established by the Local EMS Agency.

(13) First responder means a person who provides the initial response to an emergency.

(14) Limited Advanced Life Support (LALS) means 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 § 1797.171.

(15) Local EMS Agency means the agency, department, or office having primary responsibility for administration of emergency medical services in a County or region and which is designated pursuant to Health and Safety Code Div. 2.5, Ch. 4 (Health and Safety Code § 1797.200 et seq.). At the time of the writing of this Chapter, Yuba County participates in a Joint Powers Agency (Sierra-Sacramento Valley EMS Agency) with four other counties, pursuant to the provisions of Government Code Title 1, Div. 7, Ch. 5 (Government Code § 6500 et seq.).

(16) 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, infirm, or otherwise incapacitated persons not requiring urgent ambulance transportation.

(17) 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 or is cared for at the scene of an emergency by a certified or accredited attendant or a public provider agency, or who dies following the commencement of such transportation.

(18) Permit means the document authorized and issued by the County on behalf of the Board which issues a permit for a service to provide emergency care and/or medical transportation in Yuba County.

(19) Permittee means a person who holds a permit.

(20) Person means an individual, trust, firm, partnership, association, corporation, or public entity.

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

(22) Public entity service means a service which is provided primarily as a public service by an agency of local government.

(23) Reports means accurate 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 Yuba County. Such reports shall be available, pursuant to policies of the Local EMS Agency, for inspection at any reasonable time and copies of such records shall be filed upon written request of the Local EMS Agency within two working days.

(24) Service means the operation of an ambulance, air ambulance, agency or medical transport vehicle to provide medical care or patient transportation within Yuba County.

(25) State means the State of California.

(26) Station means an approved facility from which a unit is operated.

(27) Substation means an approved subsidiary facility from which a unit is operated.

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

(29) Transport means the movement of a patient by ambulance, air ambulance or medical transport vehicle from the scene of an emergency or dispatch to a hospital.

(30) Unit means an ambulance, air ambulance, agency vehicle or any medical transport vehicle.

(31) Volunteer means an individual who:

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

b. Does not receive more than 50 percent of his/her annual employment income from the EMS provider that is claiming volunteer status.

(32) Volunteer service means a service which:

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

b. 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 non-profit corporation; and

c. Uses volunteers.

(Prior Code, § 6.05.010; Ord. No. 1338)

(a) No person may furnish, operate, conduct, maintain, advertise or otherwise be engaged in, or profess to be engaged in business as an ambulance, air ambulance or medical transport vehicle unless a valid permit has been authorized and issued by the County where the County is the actor or licensing 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) Criminal action may be taken against an applicant who knowingly provides false information on the permit application.

(d) For the purpose of determining whether a service meets the requirements of Section 6.05.020 through Section 6.05.020(c) the County may require the following information:

(1) The number of patients transported by the service originating or terminating within Yuba County;

(2) Location of storage, supply, or resupply of drugs, dangerous drugs, and controlled substances;

(3) Station or substation location;

(4) Location of business as listed on any business license;

(5) Advertised business location, telephone number, and mailing address;

(6) Site to which on-call employees respond when a request for service is received;

(7) Location of back-up equipment supply or resupply; and

(8) Any additional pertinent information that may be required by the County.

(e) Whenever a service based outside Yuba County, but within the State of California, enters into a written agreement or contract for the provision of service with any medical care facility or medical organization based within Yuba County, it must hold a valid permit as described in Section 6.05.020, unless otherwise exempted in this Chapter. Public Entity, Automatic and Mutual Aid Agreements are exempt from this Section.

(f) No permit is required if the County has authorized/issued a provisional permit to operate a service pursuant to Section 6.05.070 of this Chapter.

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

(h) No permittee, under this Chapter shall cause or allow its units to respond to a location without receiving a specific official request for that response.

(Prior Code, § 6.05.020; Ord. No. 1338)

(a) Application for a permit must be made upon forms prescribed by the County in accordance with this Chapter. The County, after receipt of the completed application shall:

(1) Confirm the applicant's approval as a LALS or ALS provider;

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

(3) Upon completion of the investigation, either issue the permit or reject the application in writing on any grounds prescribed in this Chapter. The written rejection must set forth the reasons therefore and must notify the applicant of his right to appeal.

(b) In accordance with Section 6.05.060(a), the County 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 Chapter.

(c) The applicant must provide proof of insurance coverage as required by Section 6.05.180 of this Chapter.

(d) 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 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 County shall be used for renewal applications for a permit.

(e) The County 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, which the service proposes to utilize;

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

(3) Communications and 24-hour dispatch capabilities, including, a 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) The equipment, supplies and drugs which the service uses on each BLS, ALS, LALS or medical transport unit must comply with Local EMS Agency Policy;

(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 and the signature of an authorized representative of each hospital;

(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 resupply;

(9) The service's plan for handling and disposal of bio-hazardous 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.

(Prior Code, § 6.05.060; Ord. No. 1338)

(a) The County may authorize and issue a provisional permit to operate an ambulance, air ambulance, or medical transport, 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 months.

(c) A provisional permit may be authorized for renewal at the discretion of the County, but in no case may more than one renewal be made.

(d) A provisional permit may be issued when the applicant is deemed by the County to be ineligible for a regular permit because of an inability to meet, in the opinion of the County, any requirement of this Chapter and the service is deemed necessary for the convenience and safety of the public to be served thereby.

(Prior Code, § 6.05.070; Ord. No. 1338)

(a) Any permit or provisional permit issued pursuant to this Chapter 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 Chapter is transferable.

(Prior Code, § 6.05.080; Ord. No. 1338)

(a) The County may refuse to issue a permit for one or more of the following reasons:

(1) Failure to provide a complete application or a determination by the County that the applicant fails to meet the requirements of this Chapter;

(2) If the applicant has previously had an applicable permit revoked or the status of an applicable permit is directly at issue, and effects the applicant's present ability to provide the proposed services;

(3) If the applicant has a criminal or health record which reasonably indicates she/he would be unlikely to properly accept the responsibilities of operating a service;

(4) If there is reasonable cause to believe that the applicant 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 applicant does not have the required equipment for its units;

(6) If the applicant has 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 year or cannot meet the insurance requirements of Section 6.05.180;

(7) If the applicant proposes 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 Federal Aviation Regulations - Part 91 or Part 135, or both, as published in the Federal Register, January 1, 1985, as may be amended from time to time; and/or

(9) 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 LALS or ALS level is denied by the County for failure to meet the requirements of this Chapter, the applicant shall be notified by personal service or by certified mail within ten working days of that fact, stating the reason or reasons therefore and the applicant's right of appeal as provided for in this Chapter. No right of appeal exists if the permit is denied pursuant to Section 6.05.090(a)(1), (2), (6), (7), (8), and (9).

(Prior Code, § 6.05.090; Ord. No. 1338)

Receipt of a 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 Chapter has been authorized/issued by the County.

(Prior Code, § 6.05.100; Ord. No. 1338)

(a) Any permit may be revoked or suspended by the County if, after inspection by the Local EMS Agency, the person to whom the permit or endorsement was issued does not comply fully with this Chapter within a reasonable period of time after receiving any request or order of the Local EMS Agency to do so. "Reasonable" 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 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 County. Such notice shall indicate the date and time when the permit is revoked.

(c) If a permit or endorsement to operate a service is suspended or revoked, the County may request that the business licensing authorities immediately institute proceedings to revoke any business license or permit issued to the person operating the service.

(Prior Code, § 6.05.120; Ord. No. 1338)

(a) The County may take any disciplinary action set forth in this Section 6.05.130(d), and Section 6.05.120 when the County has reason to believe that a permitted service has violated any Section of this Chapter, or any applicable State 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 her/his right to file an appeal with the County as required by Section 6.05.140; except that such hearing may not be requested if the permit is revoked for the reasons stated in Section 6.05.120(b).

(c) A notice of revocation or suspension issued in accordance with Section 6.05.131(c), may state that the effective date of the revocation or suspension is:

(1) Immediate if the County 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 emergency ambulance or medical transport service which is served a disciplinary action, other than under Section 6.05.131, has ten working days from the date of the notice to appeal that action in writing to the County. Upon receipt of the appeal, the County shall conduct an appeal hearing. In case of immediate suspension or revocation, the decision of the County is final.

(e) Failure to request an appeal according to the time period prescribed in this Section shall be deemed to be an admission that the suspension or revocation order is well founded and precludes administrative or judicial review.

(Prior Code, § 6.05.130; Ord. No. 1338)

(a) Whenever the County has reasonable cause to believe that any Section of these regulations has been violated, the County 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 Chapter 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 working days from the date of the notice, it is appealed in writing to the County. Upon receipt of an appeal, the County 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 administrative hearing process.

(Prior Code, § 6.05.131; Ord. No. 1338)

(a) Complaints regarding alleged violations of this Chapter shall be made in writing. The County may require the complainant to specify:

(1) The Section of the Chapter 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 County 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 County.

(e) The complaint investigation may include a review of any applicable records, tapes, personal statements, affidavits or other items deemed relevant by the County. 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 documents associated with the complaint investigation.

(g) The County shall determine if any disciplinary action should be taken at any time during the complaint investigation process.

(h) When the Local EMS Agency is separate from Yuba County Government, complaints received by the Yuba County Health and Human Services Department that are potential violations by persons licensed or certified by the Local EMS Agency, shall be referred to the Local EMS for necessary action in accordance with Health and Safety Code §§ 1798.200—1798.209.

(Prior Code, § 6.05.140; Ord. No. 1338)

Except as otherwise provided herein, every service must be in compliance with this Chapter within 90 days after ordinance approval by the Board of Supervisors of the County of Yuba.

(Prior Code, § 6.05.150; Ord. No. 1338)

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

(1) The occasional 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 life/death situation;

(2) A vehicle or aircraft not ordinarily used as a unit 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 patient to or through the County but shall not be authorized to transport patients originating in the County;

(5) A volunteer ambulance service is being operated from a location, station or headquarters outside of Yuba County, does not conduct the majority of its business within the boundaries of Yuba County, and the patients transported by said service are: Picked up at a point outside the boundaries of Yuba County and transported to a medical facility within Yuba County;

(6) Volunteer units based outside Yuba County, except that any such unit receiving a patient within Yuba County for transport to a location within Yuba County shall comply with the provisions of the Chapter;

(7) Volunteer County attendants based outside Yuba County;

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

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

(Prior Code, § 6.05.160; Ord. No. 1338)

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

(1) No County, city or other political subdivision within Yuba County may operate a service in violation of this Chapter;

(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, and the Local EMS Agency, or as provided by law;

(3) A registered nurse employed by a service is subject to this Chapter. Any violation of this Chapter 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 Chapter to a person or persons in their employ, which is undeliverable to the address of record, to the person or persons at their next work shift;

(5) Medical transport vehicles will carry portable oxygen to supplement patients whose own oxygen supply may run out and will also carry a first aid kit, as determined by the Local EMS Agency;

(6) Public entity 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 and filed with the County; or

(7) Emergency ambulance services shall participate with adjacent ambulance service areas in mutual and/or automatic aid agreements, which are approved by the County.

(Prior Code, § 6.05.161; Ord. No. 1338)

(a) Events with high-risk and high-exposure will be required to have Yuba County permitted ambulances with advanced life support services present. Criteria used to evaluate the need for ambulances with advanced life support services will include:

(1) Nature of the event, including but not limited to the change of injury to participants or observers;

(2) Anticipated attendance;

(3) Nature of the crowd; and

(4) Geography, including the distances of the event from the nearest hospital, and physical characteristics of the event site.

(b) All permit applicants for special events expecting 50 participants and/or attendees shall submit appropriate medical plans, in a format established by the County, for approval by the County. Public health plans shall be submitted for approval to the Yuba County Public Health Officer. A copy of each of those plans shall be submitted to the Yuba County Office of Emergency Services.

(c) Guidelines for the public health plans will be promulgated and approved by the Public Health Officer and guidelines for medical plans will be promulgated and approved by the County.

(Prior Code, § 6.05.162; Ord. No. 1338)

Without limiting the permittee's indemnification of the County and Local EMS Agency, the permittee shall provide and maintain at its own expense, the following insurance coverage and provisions:

(1) Prior to the commencement of services, the permittee shall provide certificates of insurance certifying that all coverages as required herein have been obtained and remain in force at such time as the permit is valid. Any required endorsement shall either be attached to the certificate or certified as issued on the certificate. All certificates of insurance shall be sent to the following address:

Yuba County Risk Manager

915 - 8th Street, Suite 113

Marysville, California 95901

Permittee shall not commence services until it has obtained all insurance required and certificates of insurance have been provided to County and Local EMS Agency. All certificates of insurance shall provide that the County and Local EMS Agency will receive 30 days prior written notice of cancellation or major modification before the expiration date.

(2) General liability insurance requirements. Comprehensive General Liability Insurance or Commercial General liability for bodily injury (including death), personal injury and property damage which provides limits of not less than $3,000,000.00 each occurrence and written on an occurrence basis. Each type of insurance shall include coverage for premises/operations, products/completed operations and personal injury. General liability insurance coverage shall include the following endorsements:

a. Additional insured endorsement: Insurance afforded by this policy shall also apply to the County of Yuba, and members of the Board of Supervisors of the County of Yuba, the officers, agents, and employees of the County of Yuba, individually and collectively, as additional insured.

b. Primary insurance endorsement: Insurance afforded by the additional insured endorsement shall apply as primary insurance, and other insurance maintained by the County of Yuba, its officers, agents and employees shall be excess only and not contributing with insurance provided under this policy.

c. Notice of cancellation or change of coverage endorsement: Insurance provided by this policy shall not be cancelled or changed so as to no longer meet the specified County insurance requirements without 30 days' prior written notice of such cancellation or change being delivered to the County of Yuba at the address to which the certificate of insurance is sent as specified above.

d. Severability of interest endorsement: Insurance provided by this policy shall apply separately to each insured who is seeking coverage or against whom a claim is made or a suit is brought, except with respect to the policy's limits of liability.

e. The endorsements required by Section 6.05.180(2)b, c, and d above, are not required if the policy provides for these provisions without endorsement.

(3) Automobile liability insurance requirements. For bodily injury (including death) and property damage, which provides total limits of not less than $3,000,000.00 combined single limit per occurrence applicable to each unit placed in operation by permittee.

(4) Workers' Compensation and Employers' Liability Insurance with statutory California Workers Compensation coverage and Employers' Liability coverage of not less than $1,000,000.00 per occurrence for all employees engaged in services or operations under this permit.

(5) Professional Liability Insurance in an amount of not less than $3,000,000.00 and written on an occurrence basis:

a. If coverage is written on a claims-made basis, such policy shall provide that:

1. The policy retroactive data coincides with or precedes permittee's commencement of service (including subsequent policies purchased as renewals or replacements).

2. If the policy is terminated for any reason during the term of this permit, permittee shall purchase a replacement policy with a retroactive date coinciding with or preceding, the retroactive date of the terminating policy, or shall purchase an extended reporting provision of at least two years to report claims arising from work performed in connection with this agreement and a replacement policy with a retroactive date coinciding with or preceding the expiration date of the terminating policy.

3. If this permit is terminated or not renewed, permittee shall maintain the policy in effect on the date of termination or non-renewal for a period of not less than two years therefrom. If that policy is terminated for any reason during the two-year period, permittee shall purchase an extended reporting provision at least covering the balance of the two-year period to report claims arising from services performed in connection with this permit, or a replacement policy with a retroactive date coinciding with or preceding the retroactive date of the terminating policy.

(6) Each unit placed in operation by the permittee shall be included within the required insurance coverage and limits.

(7) Upon receipt of any notice or cancellation or non-renewal of an insurance policy, the County and/or the Local EMS Agency shall either:

a. Confirm the that permittee immediately reinstates insurance coverage prior to cancellation;

b. Procure substitute permittee coverage and order the permittee to cease service in Yuba County and to surrender any permit issued pursuant to this Chapter;

c. See that the insurance is reinstated at the permittee's expense; or

d. Obtain substitute permittee coverage until the matter is resolved at permittee's expense.

(8) Indemnification. permittee will agree to indemnify, defend (upon County's written request), protect, and hold harmless the County and County's officers, employees, and agents against all liabilities, claims, demands, damages, and costs (including attorney's fees and litigation costs through final appeal) to the extent that they arise from acts or omissions by the permittee or the permittee's officers, employees, or agents. Permittee's obligation under this Section covers, but is not limited to, liabilities, claims, demands, damages, and costs arising from injury to, or death of, any person and from damage to, or destruction of, any property as used in this Section.

a. "Property" is to be interpreted expansively and includes, but is not limited to, the environment, permittee's and County's real and personal property, and the personal property of County's tenants; and

b. "Person" is to be interpreted expansively and inclusively but is not limited to permittee's officers, employees, agents, material men and suppliers, and County's officers, employees, agents, and tenants.

(9) Permittee's obligation under this Section shall survive the termination of this permit.

(10) The Board of Supervisors upon the written request of the permittee may waive in part, or in whole, any of the insurance requirements.

(Prior Code, § 6.05.180; Ord. No. 1338)

(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.

(Prior Code, § 6.05.181; Ord. No. 1338)

• Requirements for interior configuration, design and dimensions of ground units.

(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 at Docket KKK-A-1822, as amended from time to time.

(b) In addition to meeting the requirements in Section 6.05.181 and Section 6.05.182 and Section 6.05.185, 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 6.05.185;

(3) Have proper storage of other medical equipment and supplies to prevent patient injury in transit and to meet approved procedures for management of patients; 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.

(Prior Code, § 6.05.182; Ord. No. 1338)

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

(1) Local building and fire codes;

(2) The station must be a structure with a system to communicate with each ambulance operating from the station or substation and have adequate sanitary storage space for equipment and material to be used in the operation of the service;

(3) The substation must be capable of communication with a central dispatch facility with both a primary and a secondary two-way communication system;

(4) Every station and substation must be properly located to permit any ambulance operating from there rapid and safe egress to a main thoroughfare;

(5) Every station and substation must have adequate off street parking space for all units operating therefrom;

(6) Every station, unless the service participates in a central dispatch facility approved by the County, must be attended by a dispatcher on a 24-hour basis;

(7) Every station shall be in compliance with all applicable Occupational Safety and Health Appeals (OSHA) rules and requirements;

(8) 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 the Local EMS Agency for the purpose of determining whether or not the station or substation is in compliance with this Chapter and any other Yuba County regulations.

(Prior Code, § 6.05.183; Ord. No. 1338)

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

(Prior Code, § 6.05.184; Ord. No. 1338)

All administration, supply, resupply, documentation, storage and security measures and destruction of drugs, dangerous drugs, controlled substances and hypodermic devices must be in compliance with all laws and regulations of the State and Federal Government and the Local EMS Agency. As used in this Section, drugs, dangerous 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.

(Prior Code, § 6.05.185; Ord. No. 1338)

(a) An additional unit, unless exempt, in order to be placed into service, must have a current "statement of safe operating condition" and must be inspected by the California Highway Patrol and the Local EMS Agency to determine if it complies with this Chapter.

(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 County shall periodically, and at least annually, require each permittee to certify that she/he has inspected every unit under his control and supervision and that, in the opinion of a professional master 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 County within ten 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 one primary mobile two-way radio and at least one portable back up communication device capable of establishing and maintaining communication with the base hospital on the MED NET 1-10 frequencies. Back up communication with a cellular telephone is acceptable. All communications equipment must meet manufacturers' specifications for power, output and antenna.

(d) Units must have printed at a minimum on the front and rear thereof, or in the case of an aircraft, on a sign in the window of the aircraft, the unit number and name of the service. The reflective lettering for such identification shall be at least four inches in height.

(e) Every unit operated in Yuba County shall be in a clean and sanitary condition subject to such sanitary standards as are prescribed by the County.

(f) Relatives of a patient and other persons may ride in an ambulance or medical transport vehicle at the discretion of the attendant(s). Three point restraints for utilization by each passenger riding in an ambulance or medical transport vehicle must be available in ambulances or medical transport vehicles purchased after the effective date of this Chapter.

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

(Prior Code, § 6.05.190; Ord. No. 1338)

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

(1) He/she is familiar with the geographic area of the organization's service area;

(2) He/she has adequate knowledge of all the hospitals within the organization's service area;

(3) He/she can operate a two-way radio; and

(4) He/she can drive a unit under emergency conditions.

(b) Each service or agency must provide written notice to the County within ten days of any change in personnel or units unless an alternate plan has been approved by the County.

(c) Services may utilize only those drivers and attendants who are appropriately licensed, certified and accredited.

(d) Every Advanced Life Support transport unit when in operation must be staffed, at a minimum, by two personnel, one of whom must be locally accredited as an Emergency Medical Technician-Paramedic (EMT-P) and one of whom must be certified as an EMT-IA, unless exempt.

(e) Every Limited Advanced Life Support transport unit when in operation must be staffed, at a minimum, by two personnel, one of whom must be locally certified at the limited advanced life support level and one of whom must be certified as an EMT-IA, unless exempt.

(f) Every Basic Life Support transport unit when in operation must be staffed, at a minimum, by two personnel, both of whom must be certified as an EMT-IA, unless granted a waiver from the California Highway Patrol (13 CCR § 1108 and Vehicle Code § 2512).

(g) An agency vehicle endorsed at the LALS level must have at least one individual locally certified as an EMT-II, or if endorsed at the ALS level, one locally accredited EMT-P.

(h) All providers are responsible to implement reasonable employee shift schedules to avoid problems of sleep deprivation, fatigue, and incompetent performance.

(i) An operational air ALS unit should be staffed by two EMT-Ps or two registered nurses and, at a minimum, must be staffed by no fewer than one EMT-P or authorized registered nurse and one EMT-IA.

(j) Services must insure that their attendants are free of physical defects or diseases which may impair their ability to attend to patients. No person, service or agency shall be out of compliance with Government Code § 8355, in matters relating to providing a drug-free workplace.

(k) 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.

(l) Drivers and attendants utilized on medical transport vehicles shall be at least 18 years of age, shall hold a current certificate in level C basic cardiac life support from the American Heart Association or American Red Cross, and first aid from the American Red Cross, and shall demonstrate compliance with all applicable State and local laws and regulations.

(Prior Code, § 6.05.200; Ord. No. 1338)

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

(b) Each service shall submit operational information as required by the County or the Local EMS Agency.

(c) Run report/patient care record must be completed, as required by the Local EMS Agency, by an attendant whenever a unit responds to a request for patient care, including dry runs.

(1) Patient care information submitted to the Local EMS Agency is confidential but may be used for quality assurance.

(2) The hospital copy of the patient care record must be completed and submitted to the receiving medical facility as specified in Local EMS Agency policy.

(3) The patient care record prepared by a service shall be the EMS Response Form, ambulance run form or a form approved by the Local EMS Agency.

(d) Whenever a unit is involved in a crash and/or experiences mechanical problems resulting in a mission failure, the County shall be notified immediately.

(e) Any alleged violation of this Chapter must be reported to the County.

(Prior Code, § 6.05.210; Ord. No. 1338)

(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 Chapter 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 Section 6.05.211, the Local EMS Agency may make unannounced non-routine inspections of any unit, attendant, volunteer, pilot or air attendant, station or substation regulated hereunder, for the purpose of determining whether or not any aspect of a service subject to this Chapter is, or is not, in compliance with this Chapter. A written report shall be prepared and forwarded to the Board of Supervisors.

(Prior Code, § 6.05.211; Ord. No. 1338)

(a) Enforcement of this Chapter is the primary responsibility of the County.

(b) An appeal process shall be established by the County.

(Prior Code, § 6.05.212; Ord. No. 1338)

A person exhibits unprofessional conduct if he/she fails 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 recertification;

(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/or

(7) Possession of any firearms or other weapons while on duty or engaged in the performance of prehospital care duties, unless authorized by law.

(Prior Code, § 6.05.213; Ord. No. 1338)

An administrative/appeal process shall be established and administered by the County.

(Prior Code, § 6.05.214; Ord. No. 1338)

(a) The Board of Supervisors of the County of Yuba may adopt procedures for reviewing proposed ambulance rates in the County. Ambulance permittees shall not charge more than the standard rates adopted by the Board of Supervisors or their designated representative.

(b) The Board of Supervisors reserves the right to deny any requests for rate increases from ambulance service providers.

(c) Requests for increases in ambulance rates are to be submitted in writing, along with supporting documentation, to the Board of Supervisors. The requested rate increases will be effective 60 days after the proposal is received at the office of the Clerk of the Board of Supervisors, unless the Board of Supervisors determines that the need for the requested rate is not substantiated by the documentation, or that the proposed rates are more than the standard rates of the industry for the service area. In those instances where the requested rates are not acceptable, the Board of Supervisors shall conduct a public hearing regarding the rate increase.

(d) No charge shall be made for transporting uninjured or well persons who accompany a patient when these persons are not treated at an emergency care facility.

(e) Current rate categories and charges shall be posted at each permittees place of business.

(Prior Code, § 6.05.220; Ord. No. 1338)

(a) Each ambulance provider participating in the transfer of patients with an ambulance will conform to all laws, rules and regulations set forth in the Health and Safety Code and Local EMS Agency policies applicable to inter-facility transfer of patients, and pursuant to any formal transfer agreements between transferring and receiving facilities involved.

(b) Treatment performed by an ambulance service for the patient in transport, shall be provided with appropriate medical care, including personnel and equipment, according to the Health and Safety Code and applicable Local EMS Agency policies.

(Prior Code, § 6.05.230; Ord. No. 1338)

(a) Each permittee shall make ambulances available to the County during times of disaster or large scale system emergencies in accordance with the Multi-Casualty Incident Plan. Ambulances shall report to a County-designated dispatch center via radio for direction. The designated dispatch center shall coordinate all dispatch functions for said ambulances during the event. All ambulances shall remain under the control of the County 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 County and the Yuba County Office of Emergency Services, its disaster response and personnel call-back plan.

(d) All management and field personnel of permittee shall follow the guidelines and directions of the Yuba County Multi-Casualty Incident Plan during the event.

(e) At least once a year, permittee shall participate in a County-organized disaster exercise by providing staff and equipment as necessary to meet the exercise objectives. All of permittee's costs associated with their participation in the disaster exercise shall be the sole responsibility of the permittee.

(Prior Code, § 6.05.240; Ord. No. 1338)

Should any section, paragraph, sentence, clause or phrase of this Chapter be declared unconstitutional or invalid, for any reason, the remainder of the Chapter shall not be affected thereby.

(Prior Code, § 6.05.250; Ord. No. 1338)

(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 authorization for operation from the County.

(b) No service or agency may use EMT-IIs, EMT-Ps and/or registered nurses unless the service or agency has a current permit authorized by the County and the service operates in accordance with all provisions of this Chapter.

(c) No person may operate a unit within Yuba County unless the unit meets the following operation standards:

(1) No unit may be dispatched unless it is fully operational; and

(2) The unit at the time it is in use or on call contains equipment and supplies such as are applicable for any specific unit and specified in Sections 6.05.181, 6.05.182 and 6.05.184, whichever may be applicable.

(d) No person may operate any unit while under the influence of any intoxicating liquor or controlled substance or any drugs that impair the ability to carryout responsibilities.

(e) No unit may be dispatched with any soiled, dirty or contaminated bandages, dressings, bedding, materials or equipment contained in the patient compartment, unless properly bagged.

(f) No person, service or agency shall be out of compliance with Government Code § 8355, in matters relating to providing a drug-free workplace.

(Prior Code, § 6.05.260; Ord. No. 1338)