HomeMy WebLinkAboutItem 6.3 MuniCode Med Svcs
CITY CLERK
File # D~~@]-[(Q][Q]
AGENDA STATEMENT
CITY COUNCIL MEETING DATE: April 15, 2008
SUBJECT:
ATTACHMENTS:
RECOMMENDATION:/'J Aft
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FINANCIAL STATEMENT:
DESCRIPTION:
Backeround
PUBLIC HEARING: Ordinance Adding Chapter 4.36 (Emergency
Medical Services) to Dublin Municipal Code.
Report Prepared by Joni Pattillo, Assistant City Manager; David
Rocha, Deputy Chief, Alameda County Fire Department; and Steve
Muzio, City Attorney's Office
1.
Ordinance Adding Chapter 4.36, relating to Emergency
Medical Services, to the Dublin Municipal Code.
Chapter 6.114 - Alameda County Emergency Medical
Services Ambulance Ordinance
2.
Receive Staff presentation;
Open public hearing;
Receive public testimony;
Close public hearing and deliberate;
Waive reading and INTRODUCE the Ordinance Adding
Chapter 4.36, relating to Emergency Medical Services, to the
Dublin Municipal Code (Attachment 1).
There is no cost associated with the adoption of this ordinance. In
the event that an emergency medical services provider is established
in Dublin, the City would receive the proceeds from any fines levied
against that provider.
Non-911 ambulance services, Basic Life Support and Critical Care Transport, have been unregulated and
have been operating without emergency medical service oversight. This has led to problems with
employee and customer complaints and equipment issues over which the Alameda County Emergency
Medical Services Agency (County EMSA) has no authority. Currently, these ambulance providers are
under no obligation to provide disaster relief assistance, may not have medically trained supervisors, and
may not have appropriate quality control procedures, and there is no requirement that their ambulances or
employees comply with County EMSA policies. County EMSA currently has no right to conduct
ambulance inspections.
COPY TO:
JP- Emergency Medical Services StalT Report; 114.1015
Page 1 of3
(0.2;-
ITEM NO.
The County EMSA is the Local EMS Agency (LEMSA) designated to plan, implement and evaluate the
local Emergency Medical Services System of Alameda County. The County EMSA maintains contracts
with first responder agencies to provide 911 ambulance services, but has no authority over non-911
ambulance providers. There are eight non-911 ambulance companies currently operating in the county,
with several more making plans to start services in the near future. At this time, none of the established
companies is based in Dublin.
In order to establish a comprehensive system of administration and oversight of non-911 ambulance
services, the Board of Supervisors of the County of Alameda recently adopted an ordinance adding
Chapter 6.114 to the County General Ordinance Code. Section 6.114.030 of the new Chapter provides
that, upon adoption by a city of the ordinance, the County shall "have enforcement powers within that
city." The proposed Ordinance would add a new Chapter to the Dublin Municipal Code requiring any
emergency medical service provider based or operating within the City to comply with the requirements
imposed by Chapter 6.114 of the County General Ordinance Code.
Ambulance Service Certification and Ambulance Permits
The County ordinance contains provisions regarding the issuance of a certificate of operation for
ambulance service and ambulance permits based on operational requirements and standards. County
EMSA will develop operational requirements and standards with which all certified and permitted
providers must comply. The certification and permitting standards include provisions related to
ambulance inspections, insurance coverage, communication standards, quality management, disaster
operations, and special event stand-by.
The County EMSA will provide administrative oversight of many aspects of non-911 ambulance service
including: policies, procedures and protocols, response time standards for non-emergency responses in
each area of the County, identification of required clinical or operational reports and dispatch records,
personnel requirements, equipment requirements, vehicle requirements, other clinical, operational, and
dispatch standards, clinical and operational data reports, special event stand-by, and emergency and
disaster operations.
Enforcement
The County ordinance includes an enforcement section which provides that the County EMSA has the
right to inspect the records, facilities, equipment, supplies, personnel and methods operation of permittees.
The section also provides that any user of a permitted ambulance service may file a written complaint with
the County which the County will investigate. In the event that any inspection or investigation results in a
finding that the permittee is in violation of the provisions of the ordinance, the County may suspend or
revoke the company's certificate of operation. Moreover, the County EMSA may impose fines on
permittees for, among other things; failure to comply with the ordinance's reporting provisions or the
equipment, vehicle. and personnel standards. (In the event that a fine is levied against an ambulance
company based in Dublin, the fines shall be disbursed to the City.) Finally, any violation of the County
ordinance may also be charged as a misdemeanor.
Page 2 of3
Impact of Ordinance on City
Because there are no emergency medical service providers currently based in the City, adoption of this
ordinance will only impact service providers who operate within the City. Thus, in the event that a
customer complaint occurs based on events that took place within Dublin, the County EMSA would have
the jurisdiction to investigate the complaint and, where appropriate, sanction the provider involved in the
incident. In the event that an emergency medical service provider establishes a place of business within
the City, the County EMSA will have the authority to regulate the provider through its certification and
licensing procedures.
The City will benefit from the development of an emergency and disaster response, mass casualty, or
special event service that can fully utilize ambulances from all ambulance companies within Alameda
County. Dublin residents will be assured of regulated ambulance service in which quality will be
consistent from company to company through medical oversight and ambulance inspections as well as
uniform safety, medical, and training standards.
RECOMMENDATION
Staff recommends that the City Council: 1) receive Staff presentation; 2) open public hearing; 3) receive
public testimony; 4) close public hearing and deliberate; 5) waive reading and INTRODUCE the
Ordinance Adding Chapter 4.36, relating to Emergency Medical Services, to the Dublin Municipal Code
(Attachment 1).
Page 3 of3
ORDINANCE NO.
AN ORDINANCE OF THE CITY OF DUBLIN
ADDING CHAPTER 4.36 TO THE DUBLIN MUNICIPAL CODE
RELATING TO EMERGENCY MEDICAL SERVICES
The City Council of the City of Dublin does hereby ordain as follows:
Section 1. Chapter 4.36 shall be added to the Dublin Municipal Code to read as follows:
Chapter 4.36
EMERGENCY MEDICAL SERVICES
Sections:
4.36.010
4.36.020
4.36.030
Definitions.
Compliance with County Ordinance Code required.
City Liability.
4.36.010 Definition.
For the purposes of this chapter, the following words shall have the following meanings:
"Basic Life Support Ambulance Service" or "BLS" means the service performed in response
to a non-emergency call. Specifically, first aid and cardiopulmonary resuscitation (CPR)
procedures that, at a minimum, include recognizing respiratory and cardiac arrest and starting the
proper application of an automatic external defibrillator (AED) and CPR to maintain life without
invasive techniques until the victim may be transported or until advanced life support is
available.
"Critical Care Transport" or "CCT" means any emergency or non-emergency transport of a
patient where the skill level required in the care of that patient during transport requires, or may
require, care within the CCT-Paramedic or CCT-RN scope of practice.
4.36.020 Compliance with County Ordinance Code required.
Every company based in the City of Dublin which provides Basic Life Support Ambulance
Service or Critical Care Transport, and every company which provides Basic Life Support
Ambulance Service or Critical Care Transport within the City of Dublin shall comply with the
provisions of Chapter 6.114 of Title 6 of the Ordinance Code of the County of Alameda, as it is
now and as it may be amended in the future.
4.36.030 City Liability.
ATTACHMENT 1
Unless expressly agreed in writing, the City of Dublin and its officers and employees shall not
be liable for any costs or charges associated with compliance with this Chapter or the rules or
regulations promulgated hereunder.
Section 2. Severability. The provisions of this Ordinance are severable and if any
provision, clause, sentence, word or part thereof is held illegal, invalid, unconstitutional, or
inapplicable to any person or circumstances, such illegality, invalidity, unconstitutionality, or
inapplicability shall not affect or impair any ofthe remaining provisions, clauses, sentences,
sections, words or parts thereof of the ordinance or their applicability to other persons or
circumstances.
Section 3. Effective Date. This Ordinance shall take effect and be enforced thirty
(30) days following its adoption.
Section 4. Posting. The City Clerk of the City of Dublin shall cause this Ordinance
to be posted in at least three (3) public places in the City of Dublin in accordance with Section
36933 of the Government Code of the State of California.
PASSED, APPROVED AND ADOPTED this _ day of
,2008.
AYES:
NOES:
ABSENT:
ABSTAIN:
Janet Lockhart, Mayor
ATTEST:
Carolyn Parkinson, Interim City Clerk
ALAMEDA COUNTY EMERGENCY MEDICAL SERVICES AMBULANCE ORDIANCE
Chapter 6.114
Sections:
6.114.010
6.114.020
6.114.030
6.114.040
Article I. General Provisions
Title.
Purpose.
Authority within the county and cities.
Ordinance administration.
Article II. Definitions
6.114.050 Generally.
6.114.060
6.114.070
6.114.080
6.114.090
6.114.100
6.114.11 0
Article III. Certificate of Operation and Permits
Ambulance services.
Certificate of operation and permits required.
Certificate of operation and permit process.
Changes to operations.
Adding ambulances.
Renewal of certificate of operation.
Article IV. Fees
6.114.120 Fees
6.114.130
6.114.140
6.114.150
6.114.160
6.114.170
6.114.180
6.114.190
6.114.200
6.114.210
6.114.220
6.114.230
6.114.240
6.114.250
6.114.260
6.114.270
6.114.280
6.114.290
6.114.300
6.114.310
6.114.320
Article V. Operational Requirements
Hold harmless and liability insurance agreement.
Financial responsibility.
General performance standards.
Ambulance compliance.
Ambulance inspection and permit process.
Ambulance communication capacity.
Ambulance color scheme and design.
Ambulance staffing.
Ambulance personnel qualifications.
Personnel standards.
Medical control.
Personal protective equipment.
Ambulance station standards.
Service level.
Response standards.
Dispatch.
Prohibitions.
Advertising.
Service charges and rates.
System status updates.
ATTACHMENT 2
6.114.330
6.114.340
6.114.350
6.114.360
6.114.370
6.114.380
6.114.390
6.114.400
6.114.410
6.114.420
6.114.430
6.114.440
6.114.450
6.114.460
6.114.470
6.114.480
6.114.490
Article VI. Enforcement
Investigations and inspections.
Consumer complaints.
Penalties.
Notice issuan ces.
Hearings.
Appeals.
Emergency action.
Decision.
Article VII. Quality Management
Quality management program.
CCT continuous quality improvement plan.
Article VIII. Miscellaneous provisions
Exemptions.
Medical direction.
EMS special event notification.
Emergency and disaster operations.
Clinical experience program.
County liability.
Separability.
2
, /-.'..il u\!~K.l Eil:) to Form
;1~:bHAR NIE, County Counsel
ORDINANCE NO.
8y
AN ORDINANCE ADDING CHAPTER 6.114 TO TI LE 6
OF 'THE ORDINANCE CODE OF 'THE COUNTY OF A
RELATING TO EMERGENCY MEDICAL SERVICES'
The Board of Supervisors of the County of Alameda ordains as follows:
SECTION I
FINDINGS
WHEREAS, pursuant to Division 2.5 of the Health and Safety Code, Section
1797.200, et seq., the County of Alameda has designated the Alameda County
Emergency Medical Services District (COUNTY) to be the local Emergency Medical
Services (EMS) Agency for the purpose of the administration of local EMS services;
and
WHEREAS, Division 2.5 of the Health and Safety Code Sections 1797.224 and
1797.85 allows the COUNTY to create Exclusive Operating Areas to restrict
operations to one or more providers of emergency ambulance services and
Advanced Life Support (ALS) services in the development of an emergency medical
services plan; and
WHEREAS, providers of 9-1-1 ALS emergency ambulance service are regulated
through contracts; and .
WHEREAS, emergency and non-emergency Critical Care Transport services, and
emergency and non-emergency Basic Life Support transport services have been
unregulated;
Now therefore, the COUNTY has developed this Ambulance Ordinance.
SECTION II
AMENDMENT OF ORDINANCE CODE
Chapter 6.114 is added to Title 6 of the Ordinance Code of the County of Alameda to
read as follows:
ARTICLE I
GENERAL PROVISIONS
6.114.010
TITLE
1 The numbering of the text (Le., 6.114.010, etc.) may change when it is placed in the Ordinance Code.
The ordinance will be in Chapter 6 of the Ordiance Code, but the articles may be numbered differently.
3
This ordinance shall be known as the "Alameda County Emergency Medical
Services Ambulance Ordinance."
6.114.020
PURPOSE
The purposes of this ordinance are to:
(A) Establish formal policies and regulations for issuing certificates and permits, and
regulating the operation of ground am bulance services in Alameda County;
(B) Protect the public by assuring that ambulances operate safely and meet certain
minimum levels and standards of equipment, staffing, and mechanical reliability;
(C) Allow for adequate, appropriate, and efficient ambulance services in all areas of
Alameda County;
(D) Allow for the orderly and lawful operation of a local em ergency and non-
emergency medical services system pursuant to the provisions of Health and
Safety Code Section 1797 et seq.; and
(E) Allow for all ambulance services to be a part of the County EMS system with the
necessary training, policies, procedures, and com munication systems.
6.114.030
AUTHORITY WITHIN THE COUNTY AND CITIES
(A) Upon adoption by the County Board of Supervisors, the ordinance shall apply
within the county's unincorporated areas and to ambulance companies that
transport i ntracounty but do not have a physical business location within the
county.
(B) Upon adoption by a city of the or dinance, the COUNTY shall have enforcement
powers within that city. However, lack of adoption of all or part of this ordinance
by a city shall not be interpreted as limiting any authority granted to the COUNTY
by Division 2.5 of the California Health and Safety Code and the Californi a Code
of Regulations, Title 22, Division 9.
6.114.040
ORDINANCE ADMINISTRATION
(A) The COUNTY shall be responsible for the administration of this ordinance, and
shall make necessary and reasonable policies, procedures, and/or protocols for
the effective and reasonable administration of this ordinance. These policies,
procedures, and/or protocols shall be codified in the COUNTY's Field Manual
and Administration Manual and shall include, but not be limited to:
(1) Response time standards for non-emergency responses in each area of the
cou nty
(2) Identification of required clinical or operational reports and dispatch records
(3) Personnel requirements
(4) Equipment requirements
(5) Vehicle requirements
(6) Other clinical, operational, and dispatch standards
4
(7) Clinical and operational data reports
(8) Special event stand-by
(9) Emergency and disaster operations
(B) All references herein to COUN TY policies and medical orders/direction by the
EMS Medical Director shall be interpreted as referring to the current version and
all subsequent additions/deletions to such policies and regulations.
ARTICLE II
DEFINITIONS
6.114.050
GEN ERALL Y
Unless otherwise specifically provided, or required by the context, the following terms
have the meanings set forth in this chapter.
(A) 9-1-1 AMBULANCE SERVICE
"9-1-1 Ambulance Service" means a private company or a County fire department
first responder ALS provider with a contract to provide 9-1-1 emergency ambulance
service.
(B) 9-1-1 EMERGENCY CALL
"9-1-1 Emergency call" means a 9-1-1 request for an am bulance to transport or
assist persons in apparent sudden need of medical attention; or an am bulance
transport that is initially classified as a non-emergency call that becomes a 9-1-1
emergency call due to a change in the patient's medical condition; or a medical
emergency, as determined by a physician, to transport blood, or any therapeutic
device, accessory to such device, or tissue or organ for transplant.
(C) ADVANCED LIFE SUPPORT AMBULANCE SERVICE
"Advanced Life Support Ambulance Service" or "ALS" means the service performed
in response a 9-1-1 emergency call which, due to the patient's medical condition,
requires care at the paramedic level of service. This service is provided under
contract at a 9-1-1 service level. This includes transportation of a patient, regardless
of a presumption of death of the patient, or transportation of a body for the purpose
of making an anatomi cal gift, as provided in Section 12811, Vehicle Code, and the
Uniform Anatomical Gift Act, Health and Safety Code sections 7150 et seq.
(D) AMBULANCE
"Ambulance" means a ground transportation vehicle certified by the California
Highway Patrol (CHP) that is specially constructed, modified or equipped and used
for the purpose of transporting sick, injured, convalescent, infirm, or otherwise
incapacitated persons and staffed with no less than two EMT-1s. "Ambulance" does
not include the transportation of persons in a Gurney or Wheelchair Van as defined
in this section.
(E) AMBULANCE PERMIT
5
"Ambulance Permit" means the document and/or decal issued by the COUNTY for
each ambulance conforming to the requirements of these regulations, which is
owned or controlled by a person holding a Certificate of Operation.
(F) AMBULANCE PROVIDER
"Ambulance provider" means a person, firm, partnership, corporation or other
organization, which furnishes or offers to furnish ambulance service.
(G) AMBULANCE SERVICE
"Ambulance service" means the activity, business or service, for hire, profit or
otherwise, of transporting one or more persons by an ambulance certified by the
CHP on or in any of the streets, roads, highways, alleys, or any public way or place
in this County.
(H) BASIC LIFE SUPPORT AMBULANCE SERVICE
"Basic Life Support Ambulance Service" or "BLS" means the service performed in
response to a non-emergency call. Specifically, first aid and cardiopulmonary
resuscitation (CPR) procedures that as a mi nimum, includes recognizing respiratory
and cardiac arrest and starting the proper application of an automatic external
defibrillator (AED) and CPR to maintain life without invasive techni ques until the
victim may be transported or until advanced life support is available.
(I) CERTIFICATE OF OPERATION
"Certificate of Operation" means the document iss ued by the COUN TY to a
PERMITTEE that has met the requirements to operate an ambulance service in
Alameda County. Certificates of Operation wi II be issued for BLS and CCT levels of
service.
(J) COUNTY
"COUNTY" means the Alameda County Emergency Medical Services District (EMS).
(K) COUNTY COMMUNICATIONS CENTER
"County Communications Center" means the County of Alameda Emergency
Operations Center (EOC).
(L) COUNTY DISPATCH
"County Dispatch" means the COUNTY designated Public Safety Answering Point
dispatch center(s).
(M) COUNTY POLICIES
"County Policies" means the policies and regulations as defined in the COU NTY's
Administrative Manual and Field Manual.
(N) CRITICAL CARE TRANSPORT
"Critical Care Transport or "CCT" means any emergency or non-emergency transport
of a patient where the skill level required in the care of that patient during transport
requires, or may require, care within the CCT-Paramedic or CCT -RN scope of
practice.
(0) CRITICAL CARE TRANSPORT POLICIES
6
"Critical Care Transport Policies" means the policies and regulations as defined in
the COUNTY's Administrative Manual and Field Manual.
(P) EMERGENCY MEDICAL TECHNICIAN
"Emergency Medical Technician," or "EMT," "EMT-1" or "EMT-B" means an individual
trained and certified in basic life support care in accordance with the provisions
contained in the California Code of Regulations, Title 22, Division 9, Chapter 2, et
seq.
(Q) EMERGENCY MEDICAL TECHNICIAN - PARAMEDIC
"Emergency Medical Technician - Paramedic," or "EMT-P" or "paramedic" means an
individual trained and licensed in advanced life support car e in accordance with the
provisions contained in the California Code of Regulations, Title 22, Division 9,
Chapter 4, et seq. and accredited by the COUNTY.
(R) EXCLUSIVE OPERATING AREA
"Exclusive Operating Area" or "EOA" means an EMS area or sub area as defined by
the COUNTY, which restricts operations to one or more ambulance providers.
(S) FIRST RESPONDER ALS
"First Responder ALS" means a unit staffed and equipped with a minimum of one
California State licensed and Alameda County accredited paramedic capable of
providing ALS at scenes of medical emergencies.
(T) GURNEY VAN TRANSPORT
"Gurney Van Transport" means any vehicle specially constructed, modified or
equipped and/or used for the purpose of transporting patients who cann ot travel in
an upright, sitting position and for whom the need for any medical care, treatment or
procedure is not required, likely, or foreseeable.
(U) NON-EMERGENCY CALL
"Non-emergency call" means a request for an ambulance to transport or assist
persons that would not constitute a 9-1-1 emergency call.
(V) PARAMEDIC
""Paramedic," Emergency Medical Technician - Paramedic," or "EMT-P" means an
individual trained and licensed in advanced life support car e in accordance with the
provisions contained in the California Code of Regulations, Title 22, Division 9,
Chapter 4, et seq. and accredited by the COUNTY.
(W) PERMITTEE
"PERMITTEE" means a person, firm, partnership, corporation or other organization
to whom a Certificate of Operation and Am bulance permit(s) have been issued for
purposes of operating an ambulance service.
(X) PERSONAL PROTECTIVE EQUIPMENT - PPE
"Personal Protective Equipment" or "PPE" means the minimum equipment, supplies,
and personal protective equipment - per responder - to ensure safety and
readiness.
(Y) SPECIAL EVENT
7
"Special event" means a designated event, including, but not limited to street fairs,
concerts, sporting events, contests. or other events that place a grouping or
gathering of people in one g enerallocale sufficient in num ber, or subject to activity
that creates the need to have one or more ambulances pre-positioned at the event.
(Z) WHEELCHAIR VAN TRANSPORT
"Wheelchair Van Transport" means any vehicle specially constructed, modified or
equipped and/or used for the purpose of transporting patients in wheelchairs for
whom the need for any medical care, treatment or procedure is not required, likely,
or foreseeable.
ARTICLE III
CERTIFICATE OF OPERATION AND PERMITS
6.114.060
AMBULANCE SERVICES
(A) Advanced Life Support (ALS) emergency ambulance services shall only be
provided under a 9-1-1 contract with the COUNTY under provisions of the Health
& Safety Code 1797.200.201, and 224.
(B) Basic Life Support (BLS) emergency and non-emergency transport service shall
be provided under the provisions of this ordinance.
(C) Critical Care Transport (CCT) ALS emergency and non-emergency transport
service, either CCT-P or CCT-RN, shall be provided under the provisions of this
ordinance and the COUNTY's CCT and Administrative policies.
(D) Nothing in this ordinance shall be construed as regulating the clinical work of
Registered Nurses (RN) working in a CCT -RN ambulance.
6.114.070
CERTIFICATE OF OPERATION AND PERMITS REQUIRED
(A) No person (either as owner, agent or otherwise) shall furnish, operate, conduct,
maintain or otherwise engage in or advertise, offer or profess to engage in
ambulance service within Alameda County unless the pers on holds (and is
entitled to hold) a currently valid ambulance Certificate of Operation issued by
the COUNTY.
(B) No person (either as owner, agent or otherwise) shall furnish and operate an
ambulance.unless that ambulance has a currently valid Ambulance Permit issued
by the COUNTY.
(C) Gurney and Wheelchair Van Transport providers are not required to hold an
ambulance Certificate of Operation.
(0) No Certificate of Operation or Ambulance Permit is required for the delivery into
Alameda County of persons picked up outside the County boundaries. No
Certificate of Operation or Ambulance Permit is required for specialized teams
(e.g. CCT and neonatal intensive care unit teams) that are permitted by another
8
emergency medical services agency and tha t pick up patients in Alameda County
for transportation to an acute care hospital based outside of the County.
(E) Exclusive Operating Areas:
The COUNTY has not established Exclusive Operating Areas (EOA) for BLS, and/or
CCT emergency and/or non-emergency transport, but retains its option to do so in
the future.
6.114.080
CERTIFICATE OF OPERATION AND PERMIT PROCESS
(A) Application forms for an ambulance service Certificate of Operation shall be
supplied by the COUNTY.
(B) The applicant should be a licensed CHP ambulance service prior to submitting
an application.
(C) Required data: Each applicant who desir es an ambulance service Certificate of
Operation shall submit the following on, or as attachments, with their application:
(1) The names and addresses of the applicant(s), registered owner(s),
partner(s), officer(s), director(s) and controlling shareholder(s), hereafter
called "applicant";
(2) The name under which the applicant has engag ed, does, or proposes to
engage in ambulance service;
(3) The ambulance service level requested - BLS, CCT, or both;
(4) A statement specifying whether the applic ant has provided ambulance
service in Alameda Cou nty prior to the establishment of this or dinance, a nd if
so, what type and fo r how long;
(5) A statement specifying whether the applicant has previously operated an
ambulance company outs ide of Alameda County, and if so, unde r what
name, what type, where and for how long;
(6) A copy of a current CHP Emergency Ambulance Non- Transferable License;
(7) An assets and liabilities statement or a letter prepared by a certified public
accountant showing proof of financial solvency;
(8) A copy of the business Ii cense for the city in whi ch the applicant is doing
business;
(9) A statement of the legal history of the applicant, including criminal and civil
convictions;
(10) A statement specifying the education, training, and experience of the
applicant in the care and transportation of patients;
(11) A statement that the applicant will abide by the regulations of the
California Vehicle Code and the California Code or Regulations, Title 13,
Motor Vehicles;
(12) A statement that the applicant owns or has under his control, in good
mechanical condition, required equipment to consistently provide quality
ambulance service in the area for which he is applying, and that the applicant
owns or has access to suitable facil ities for maintaining equipment in a clean
and sanitary condition;
9
(13) A statement that the applicant understands and will comply with the
COUNTY's Staffing, and Equipment and Supply Specifications policies
regarding equipment carried in each ambulance, including AEDs;
(14) A list of the actual number of ambulances and for each: the make and
model, year, the vehicle identification number (VIN), State vehicle license
number and proof of current Department of Motor Vehicle registration, and
proof of California Highway Patrol Ambulance Inspection Report and
Ambulance Identifi cation Certificate;
(15) A statement that the applicant understands and will comply with the
ambulance inspection process, including the required fees.
(16) A statement that the applicant has or will have sufficient personnel
adequately trained and available to deliver ambulance service of good quality
at all times, including copies of their certifications/licenses;
(17) A statement of the applicant's training and orientation programs for
EMT-1s and/or paramedics, and dispatchers;
(18) A description of the number and type, frequency and private line
codes of the vehicle's radios, and if used, phone numbers of the vehicle's
cellular phones;
(19) A description of the company's program for maintenance of the
vehicles;
(20) A description and photo/image of the company's logo and color
scheme to be used to designate the ambulances of the applicant;
(21) The number of ambulances to be deployed on each shift;
(22) A description of the locations from which ambulance services will be
offered, noting the hours of oper ation and phone numbers;
(23) Evidence of insurance coverage compliance under section 6.114.130;
(24) A Certificate of Consent to Self Insure issued by the California State
Director of Industrial Relations, or a Certificate of Workman's Compensation
Insurance;
(25) A Quality Management program as specified in section 6.114.410;
(26) A Disaster Response Plan as specified in section 6.114.460;
(27) All service charges and rates to be charged, showing compliance with
any maximum charges established by the County;
(28) The application fee for a Certificate of Operation as set forth in the
COUNTY's Administration Manual;
(29) In a separate payment, the Ambulance Inspection fee for each
ambulance to be inspected as set forth in the COUNTY's Administration
Manual. This fee may be returned if the PERMITTEE does not meet the basic
requirements of section 6.114.080 (C) and ambulances are not inspected.
(30) If applying for a CCT Certificate of Operation, copies of all pape rwork
for interfacility transport as identified in the COUNTY's CCT and
Administrative policies.
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(31) Any other information the COUNTY deems necessary for
determination of compliance with this division.
(D) Within sixty (60) days of receipt of a complete application an d the required fee,
the COUNTY shall determine a - h (below) or if an extension is necessary:
(1) Whether the applicant is a licensed CHP ambulance service, and
(2) Whether the applicant meets the requirements of this ordinance and of other
applicable laws, ordinances, and regulations; and
(3) Whether the applicant is able to provi de the requested service, and
(4) Whether the applicant has knowingly made a false statement of fact in such
application, and
(5) Whether the applicant has knowingly fai led to disclose facts pertinent to the
application process, and
(6) Whether the applicant was prev iously a provider of ambulance service prior
to the establishm ent of this ordinance, which has not bee n renewed by the
CHP, and
(7) Whether the applicant was previously a holder of a Certificate of Operation
issued under this chapter, which has been revoked or not renewed based on
the provisions of this ordinance, and
(8) Whether the applicant's vehicles, equipment, and appurtenances, including
radios, are in good working order and the ambulances pass an inspection,
according to the provisions of section 6.114.160 - 170.
(E) Approval or denial:
(1) If it is determined that the applicant does not meet all requirements
within this division, then the COUNTY shall deny the application and
notify the applicant in wr iting by certified mail of the receipt of the
application.
(2) If it is determined that the applicant meets all requirements within this
division, the COUNTY shall approve the application and issue a
Certificate of Operation and, upon a positive inspection, appropr iate
Ambulance Permits.
(F) Appeal from denial of issuance: Whenever the COUNTY denies an application
for a permit, the applicant may request a hearing on the denial at which the
applicant will have the burden of proof. The appeal will be made to the Board of
Supervisors according to the provi sions of section 6.114.110.
(G) Decisions-finality: The decision of the COUNTY rendered pursuant to this
chapter shall be final, unless appealed to the Board of Supervisors within thirty
(30) days after such decision is rendered in writing, and notice of the same is
given to the applicant by certified mail.
(H) Term:
(1) Certificates of Operation shall be valid for two years from the date of
issuance.
(2) Certificates of Operation shall be continued upon conditions of section
6.114.370 unless earlier suspended, revoked or terminated for cause.
11
(3) Notice of intent to discontinue service: A PERMITTEE providing ambulance
service may discontinue such services only after providing sixty (60) days
notice in writing of intent to discontinue services to the COUNTY or upon
mutual written agreement.
(I) Existing ambulance companies:
(1) Within sixty (60) days of the effective date of the ordinance codified in this
ordinance, non 9-1-1 ambulance companies that have been continuously
providing ambulance services shall apply for a Certificate of Operation and
Ambulance Permits. The COUNTY shall issue or deny a Certificate of
Operation to each existing company, based on their ability to meet the
requirements as set forth in this ordinance. The fees for the initial Certificate
of Operation and Ambulance Permits for existing companies shall be the fee
set for new applicants.
(2) The COUNTY may issue a provisional sixty (60) day Certificate of Operation
to an existing non 9-1-1 ambulance company to allow for required ambulance
inspections. Upon a satisfactory completion of the inspections, the provisional
status will be made permanent.
(J) Transfer of Certificate of Operation or Ambulance Permit: Application for transfer
of any PERMITTEE's Certificate of Operation shall be subject to the same terms,
conditions, and requirements as if the application were for an original certificate.
No ambulance permit shall be transferred to another person(s), or company or
corporation, except upon prior approval of the COUNTY.
6.114.090
CHANGES TO OPERATIONS
The PERMITTEE shall notify the COUNTY about changes to business location and
phone numbers; ambulance stations and phone numbers; hours of operations;
service charges and rates; insurance coverage; and changes to applicant(s),
registered owner(s), partner(s), officer(s), director(s) and controlling shareholder(s)
on file; within fifteen (15) days of such changes.
6.114.100
ADDING AMBULANCES
If a PERMITTEE desires to include additional ambulance units under its Certificate of
Operation, the PERMITTEE shall submit a vehicle description form for each
additional unit and provide the designated fee per unit to the COUNTY, and schedule
an ambulance inspection. The term of the Ambulance Permit for additional
authorized units shall run concurrently with the last authorized permit period. The fee
paid for each additional unit will be prorated according to the amount of time
remaining during the last authorized permit period. Prorating will be based on the
number of quarters left in the permit period.
6.114.110
RENEWAL OF CERTIFICATE OF OPERATION
(A) Applicants for renewal of an ambulance service Certificate of Operation under
this ordinance shall file with the COUNTY an application in writing, which shall
include information required in section 6.114.080 (C). A renewal fee shall
accompany the application for renewal. Renewal applications may be submitted
ninety (90) days prior to the expiration date but no later than forty-five (45) days
prior to the expiration date.
(8) Late renewal applications received less than forty-five (45) days prior to the
12
expiration of the Certificate of Operation shall pay an additional twenty percent
(20%) of all fees due.
(C) All ambulances specified by the PERMITTEE shall be inspected and have their
permits renewed in accordance with the prov isions of section 6.114.170,
Ambulance Inspection and Permit Process. The issuance of a renewed
Certificate of Operation shall be based on all ambulances having been inspected.
(D) Renewal of a Certificate of Operation shall require conformance with all
requirements of this division as upon issuance of an initial certificate. Nothing in
this division shall be construed as requiring the granting of a certificate upon
expiration of a previous certificate, and the burden of proof respecting
compliance with all the requirements for a period and of entitlement of a
certificate shall remain at all times with the applicant for renewal.
(E) An ambulance provider shall submit, with their renewal application, a financial
statement of its business activ ities or a letter showing proof of financial solvency,
prepared by a certified public accountant. Renewal of a certificate is contingent
upon proof of financial solvency with in the proper time frames.
ARTICLE IV
FEES
6.114.120
FEES
(A) An application for an initial ambulance Certificate of Operation shall be
accompanied by payment of an application fee a nd Ambulance Inspection fees
as defined in COU NTY policies. The Ambulance Inspection fee may be returned
if the PERMITTEE does not meet the basic requirements of section 6.114 .080(C)
and ambulances are not inspected.
(B) An application for renewal of an ambulance Certificate of Operation shall be
accompanied by payment of fees as defined in COUNTY policies.
(C) The Board of Supervisors shall set the fees by resolution. The fees shall not
exceed the reasonable cost of administering and enforci ng this ordinance as
determined by the Board of Supervisors.
ARTICLE V
OPERATIONAL REQUIREMENTS
6.114.130
HOLD HARMLESS AND LIABILITY INSURANCE AGREEMENT
(A) Each ambulance PERMITTEE, at its sole cost and expense, shall obtain,
maintain, and comply with all County insurance coverage(s) and requirements.
Types of insurance coverage include Com mercial General Liability, Commercial
or Business Automobile Liabil ity, Worker's Compensation and Em ployers
Liability, Professional Liability/Errors & Omissions, and Endorsements and
Conditions.
13
(B) Lack of coverage as required at any time shall automatically suspend the
Certificate of Operation. Failure of the PERMITTEE to notify the COUNTY of lack
of coverage for any reason shall be deemed a violation of regulation subject to
fine.
(C) As a condition of being issued a permit, PERMITTEE shall be required to
indemnify and hold harmless the County of Alameda from any and all claims or
actions for property damage, personal injury, sickness, disease, caused by the
PERMITTEE's acts or omissions and will pay any and all judgment decrees,
costs, attorney's fees which may be rendered against the County of Alam eda, its
directors, officers, agents, employees and volunteers in any and all such actions
or proceedings.
6.114.140
FINANCIAL RESPONSIBILITY
Each PERMITTEE shall provide the COUNTY with information in reference to any
pending action or unpaid judgm ents or liens against the PERMITTEE, and the notice
of the transactions or acts giving rise to the judgments or liens. The PERMITTEE
shall notify the COUNTY in writing of the actions within one (1) week of the
notification from the levying agency. The reported information will be reviewed by the
COUNTY who will make a determination regarding the effect this information will
have on the agency's ability to provide continuous service in accordance with this
division.
6.114.1 50
GENERAL PERFORMANCE STANDARDS
(A) PERMITTEE shall maintain sufficient ambulances, operational procedures and
personnel, with valid certifications and licenses to meet performance standards
and permit specifications.
(B) PERMITTEE shall follow the COUNTY's policies.
(C) PERMITTEE and their personnel shall follow the regulations of the California
Vehicle Code and the California Code or Regulations, Title 13, Motor Vehicles.
(0) PERMITTEE shall maintain supervisory or management personnel, avai lable on
a twenty-four (24) hour basis on site or on-call, authorized to make operational
decisions, direct personnel and commit resources for use.
(E) PERMITTEE shall maintain a Quality Managem ent program and perform quality
assurance activities in accordance with article VII of this ordinance.
(F) PERMITTEE shall maintain a Disaster Response Plan that includes a pers onnel
call-back plan for disasters and mass casualty incidents in accordance with
section 6.114.460 of this ordinance.
(G) PERMITTEE shall ensure that all management, supervisory, dispatch and field
personnel maintain knowledge and fa miliarity with multi-casualty and mass
casualty incident medical operations, staging, and incident command structure.
6.114.160
AMBULANCE COMPLIANCE
(A) Each ambulance shall be equipped according to the standard vehicle safety and
equipment requirements of the California Vehicle Code and the California Code
or Regulations, Title 13, Motor Vehicles.
(8) Each ambulance shall carry a photocopy or original current vehicle registration,
14
current insurance identification, current CHP ambulance identification card (or
CHP Inspection report valid for 30 days after an initial inspection), and current
COUNTY issued ambulance permit.
(C) Each ambulance shall carry standard patient carrying fixtures and restraints
necessary for the comfort and safety of patients.
(D) Each ambulance shall be equipped with no less than the standardized equipment
and supplies as established according to the COUNTY's Equipment and Supply
Specifications policy for the level of service provided. CCT ambulances shall be
equipped according to the COUNT Y's Critical Care Transport policy.
(E) PERMITTEE shall maintain its vehicles, equipment, and sup plies in a clean,
sanitary, and safe mechanical condition at all times.
6.114.170
AMBULANCE INSPECTION AND PERMIT PROCESS
(A) No person, firm, partnership, corporation or other organization, except as
identified in section 6.11 4.070, shall operate or cause an ambulance to be
operated In Alam eda County unless an ambulance per mit has been issued for
that ambulance in accordance wi th these regulations.
(B) The COUNTY shall inspect each ambulance for which it receives an application
to ensure compliance with this ordinance and the COUNTY's policies, protocols,
and regulations as they pertain to the ambulance service applied for, according
to the provisions of section 6.114.160 - 170.
(C) The bi-annual inspection for permit renewal shall be based on the list of
ambulances submitted by the PERMITTEE.
(D) The PERMITTEE shall be notified in a tim ely manner of the results of the
inspection and any corrective action required if an ambulance fails the inspection.
(E) Upon passage of the ambulance inspection, the COUNT Y shall issue an
ambulance permit or renewal of the perm it, to the PERMITTEE.
(F) The ambulance inspection will be for all equipment identified in the COUNTY's
policies, which has not been inspected by the CH P under the California Code of
Regulations, Title 13, Vehicle Code, Division 2, Chapter 2, Article 1, sections
1103and 1103.2.
6.114.180
AMBULANCE COMMUNICATION CAPABILITY
Each ambulance shall have a radio for establishing and maintaining radio contact
with County Dispatch and county hospitals as prescribed by the COUNTY and in
compliance with F.C .C. regulations.
6.114.190
AMBULANCE COLOR SCHEME AND DESIGN
(A) At the time of initial application, PERMITTEE shall request a specific color
scheme and design and, upon approval by the COUNTY, shall apply such color
scheme and design to each ambulance receiving an ambulance permit.
(B) The color scheme and design shall not imitate or conflict with any other color
scheme authorized by this ordinance in a manner that is misleading or would
tend to deceive the public.
(C) No sign, letter, color, appliance or thing of decorative or distinguishing nature
15
shall be attached or applied to any am bulance unless it has first been approved
in the color scheme authorized for each ambulance company.
6.114.200
AMBULANCE STAFFING
Each BLS ambulance shall be staffed with a minimum of two (2) California certified
EMT-1s. Paramedics licensed in California may also staff BLS ambulances but may
not utilize the paramedic scope of practice. CCT ambulances shall be staffed
according to the COUNTY's CCT policy.
6.114.210
AMBULANCE PERSONNEL QUALIFICATIONS
(A) All personnel while on duty must carry all applicable certificates and PERMITTEE
identification, and comply with the COUNTY's policies and procedures.
(B) All EMT and paramedic personnel must have a current driver's license,
ambulance driver's certificate, and a medical examiner's certificate. EMTs hired
to solely provide patient care duties are exempt from this requirement. In these
cases, the PERM ITTEE is required to inform the COUNTY of these personnel
and of any changes to their work status.
(C) PERMITTEE's EMT personnel assigned to provide BLS service under this
ordinance must meet the minimum qualifications:
(1) EMTs must hold current, valid EMT certification in the State of California.
(2) EMTs shall be certified in cardiopulmonary resuscitation (CPR/AED)
according to the policies of the COU NTY and State.
(3) EMTs assigned to provide CCT driver/assistant service must meet the
additional qualifications specified in the COUNTY's CCT policy.
(0) PERMITTEE's paramedic personnel assigned to provide CCT service under this
ordinance must meet the minimum qualifications:
(1) Paramedics must hold current, valid paramedic licensure in the State of
California.
(2) Paramedics shall be accredited by the COU NTY and hold current and valid
ALS certifications.
(3) Paramedics assigned to provide CCT patient care must meet the additional
qualifications specified in the COUNTY's CCT policy.
(E) PERMITTEE's registered nurse (RN) personnel assigned to provide CCT service
under this ordinance must meet the minimum qualifications specified in the
COUNTY's CCT policy.
(F) All drivers must completed an Emergency Vehicle Operation Course (EVOC)
driver training course, or its equivalent, related to responding to calls for
emergency medical service that includes, but is not lim ited to, the followi ng
didactic and practical components: legal aspects of the emergency ambulance
operation, the practice of defensive driving, accident avoidance, pr inciples of
vehicle control, routine vehicle safety checks, breaking and stopping,
acceleration, and steering.
(G) The PERMITTEE shall retain on file at all times, copies of all current and valid
licenses, certifications, and/or accreditations of all emergency medical personnel
16
performing services under this ordinance.
6.114.220
PERSONNEL STANDARDS
Ambulance companies shall maintain personnel standards that include orientation to
the COUNTY policies and procedures, special training (as deemed necessary by the
EMS Medical Director), uniforms and appearances, safety apparel, identification,
driver training, work-hour scheduling limitations, with due consideration for collective
bargaining agreements and/or State and Federal regulations where they apply.
6.114.230
MEDICAL CONTROL
All ambulance personnel are to provide patient care in accordance with the
COUNTY's policies and as directed by standing or specific orders issued by the EMS
Medical Director, or his or her designee.
6.114.240
PERSONAL PROTECTIVE EQUIPMENT
(1) PERMITTEE shall supply and maintain standardized personal protective
equipment and supplies to ensure safety and readiness, according to Cal/OSHA
guidelines.
(2) PERMITTEE shall ensure that all personnel receive training in all available
equipment, including fit testing, according to Cal /OSHA guidelines.
6.114.250
AMBULANCE STATION STANDARDS
Ambulance company stations shall meet the minimum standards in Section 8 of the
Federal Housing Authority, and include an EM S bulletin board, provisions for
storage, and protection of ambulance(s). Stations shall comply with all applicable
zoning, building, and occupational he alth and safety regulations.
6.114.260
SERVICE LEVEL
The PERMITTEE, unless holding a contract to provi de 9-1-1 emergency service
only, shall be approved by the COUN. TY prior to beginning service.
6.114.270
RESPONSE STANDARDS
(A) Any private call of a life threatening nature or a call requiring ALS level care
where ALS care is timely, appropriate and available shall be immediately referred
to the 9-1-1 emergency operators.
(8) If an ambulance responds to a patient who appears to have a medical
emergency, the crew shall call 9-1-1 and request a 9-1-1 response, and render
appropriate care within their scope of practice until the ALS ambulance is on-
scene.
(C) PERMITTEE shall dispatch an ambulance to a non-emergency BLS call within
fifteen (15) minutes unless the caller is immediately advised of a delay in
respond ing to the call or the unavailabil ity of an ambulance. The exception to this
is for calls that have been prescheduled.
(D) PERM ITTEE shall provide prompt transportation of the patient to the most
appropriate medical facility, licensed, equipped, and staffed to meet the needs of
the patient in accordance with applicable laws, rules, regulations, and policies.
17
(E) The PERMITTEE or their employees shall report any response to a non-
emergency request for ambulance service that is responded to by a unit not
staffed and equipped at the appropriate service level to the COU NTY on an
Unusual Occurrence form within ten (10) days of the incident.
6.114.280
DISPATCH
(A) Each ambulance company providing service under this ordinance shall assign at
least one person or an agency to be responsible for receiving calls and
dispatching ambulances. The PERMITTEE shall have a Dispatcher Training
Program that includes prioritizing tasks including, but not limited to, call intake,
unit assignment, crew utilization and computer input; documentation and
reporting; communication equipment; and compliance with the COUNTY's
policies, procedures, and/or protocols covering ambulance service operation,
ambulance transport, equipment, ambulance personnel, and standards of
dispatch. Dispatchers shall be certified in CPR/AED.
(B) Each PERMITTEE ambulance dispatch center shall have access to ReddiNet for
the purpose of county system status updates.
6.114.290
PROHIBITIONS
Ambulance companies are hereby prohibited from engaging in the following
activities:
(A) Permitting the operation of an ambulance in any manner contrary to the
provisions of this ordinance or contrary to any applicable statue, rule, or
regulation.
(B) Responding to a call when not requested to respond to that call by an individual
requesting that service or the appropriate dispatch center.
(C) Causing or allowing its ambulances to respond to a 9-1-1 emergency call location
without first receiving a specific request from an Alameda County approved
dispatch center.
(D) Providing ALS service without being authorized by the COUNTY to provide such
service.
(E) Providing Critical Care Transport services without possessing a current and valid
Critical Care Transport Certificate of Operation and associated ambulance
permit(s).
6.114.300
ADVERTISING
(A) No person or organization shall announce, advertise, offer, or in any way claim
that it provides non-9-1-1 ambulance service unless it possesses a current, valid,
BLS or CCT ambulance Certificate of Operation.
(B) No person or organization shall announce, advertise, offer, or in any way claim
that it provides emergency 9-1-1 service unless it has been approved as an
emergency 9-1-1 provider by the COUNTY.
(C) Any use of a telephone n umber on an am bulance for non-emergency ambulance
service shall include the phrase "FOR EMERGENCIES, CALL 9-1-1" in capital
letters that are at least as big as the letters used for the telephone number.
18
6.114.310
SERVICE CHARGES & RATES
The PERMITTEE shall submit their service charges and rates to the COUNTY with
their application for a Certificate of Operation and with each renewal. All service
charges and rates must be defined in sufficient detail so as to be understandable to
the public. The COUN TY reserves the option, with Board of Supervisor approval, to
set base rates for ambulance calls.
6.114.320
SYSTEM STATUS UPDATES
(A) The PERMITTEE shall annually submit a system update to the COUNTY. The
update shall identify:
(1) Ambulance station locations.
(2) Posting locations.
(3) The number of ambulances normally available for response by time of day
and day of week, with any seasona I variations.
(B) The PERMITTEE shall, at the start of each calendar year, submit to the
COUNTY, in an electronic form, a list of all EMTs and paramedics employed
along with their certificate or license numbers. In addition, the PERMITTEE shall
notify the COUNTY within thirty (30) days of any EMTs and/or paramedics who
have been newly hired, terminated, retired, or have quit their em ployment.
ARTICLE VI
ENFORCEMENT
6.114.330
INVESTIGATIONS AND INSPECTIONS
(A) The COUNTY shall have the right to ins pect the records, facilities, equipment,
supplies, personnel, and methods of operation of the PERMITTEE whenever the
COUNTY deems such inspection necessary.
(B) The PERMITTEE shall cooperate with the COUNTY, in any investigations of
possible violations of this section and shall make all dispatch logs and similar
dispatch records, including tape recordings, available for inspection and copying
at reasonable times at the PERMITTEE's regular place of business. All tape
recordings shall remain available for a minimum of sixty (60) days from the date
the recording was made.
(C) The PERMITTEE shall allow the COUNTY to inspect, on a pre-announced or
unannounced basis, all ambulances used to provide ambulance service. The
inspections should be held, whenever possible, during normal business hours at
the ambulance operations center. The purpose of such inspections is to
determine if the ambulance and its equipm ent and suppli es are in good work ing
order, properly maintained and equ ipped for the provision of ambulance service
for which it is permitted. The ambulance inspection will be for all equipment
identified in the COUNT Y's policies, which has not been inspected by the CH P
under the California Code of Regulations, Title 13, Vehicle Code, Division 2,
Chapter 2, Article 1, sections 1103 and 1103.2.
19
(D) At the request of the COUNTY, the ambulance provider shall submit self-
inspections of all ambulances on the COUNTY's Ambulance Self-Inspection
form.
(E) The PERMITTEE shall inform the COUNTY of any suspension and/or revocation
of their California Highway Patrol Ambulance Service License, or Vehicle
Certificate, or Authorized Emergency Vehicle Permit for any of their support
vehicle(s).
6.114.340 CONSUMER COMPLAINTS
(A) Any user of a permitted ambulanceservice contending that he/she received
unsatisfactory service(s) may file a written complaint with the COUNTY. Such
written complaint(s) shall set forth the allegations. The COUNTY shall notify the
PERMITTEE of the complaint and provide the PERMITTEE with information
about the complaint.
(B) The COUNTY shall conduct an investigation of the allegation(s) in the written
complaint to determine the validity of said allegation(s). If the allegation(s) are
found to be valid, the COUNTY shall take actions to secure compliance with the
provisions of this chapter and any establi shed ambulance regul ations.
(C) If the COUNTY is unable to secure compliance, it will initiate action to penalize,
suspend or revoke the Certificate of Operation.
6.114.350
PENAL TIES
(A) The COUNTY may suspend or revoke an ambulance company's Certificate of
Operation for:
(1) Violating any provis ion, regulation, law, s tate or federal standards or
ordinances; or
(2) Failure to make and retain records showing its operations in any area
covered by this ordinance, incl uding but not limited to dispatching, response,
personnel, vehicles, medical treatment or billing, or failure to make such
records available for inspection by the COUNTY; or
(3) Accepting an emergency or non-emergency call when it is either unable or
unwilling to provide the requested service, or fails to inform the person
requesting such service of any delay, and fails to obtain consent of such
person before causing an ambulance to respond from a location more distant
than the one to which the request was directed; or
(4) Failure to pay any fine issued pursuant to this section within thirty (30)
business days.
(B) Suspension is not a condition precedent to revocation.
(C) Fines:
(1) Fines may be issued by the COU NTY for:
(a) Failure to provide required cI inical or operational reports, including
dispatch records;
(b) Failure to comply with requirements for personnel, equipment, and
vehicles;
20
(c) Failure to comply with any other section of this ordinance or any
regulation adopted pursuant to this ordinance
(2) Exceptions shall be granted for records destroyed by fi re, explosion, or theft
beyond the reasonable contr 01 of the PERMITTEE; a declaration of local,
state, or federal emergency impacting the PERMITTEE'S resources; and/or
acts of God.
(3) Failure to remit amount of fine levied within thirty (30) days of resolution of
appeal to the Board of Supervisors may result in revocation of the
Certification of Operati on.
(D) Violations:
(1) Except as otherwise provided, any PERMITTEE who violates any provision of
this ordinance shall be guilty of a misdemeanor as provided under section
1.12.010 of the Alameda Cou nty Code.
(2) A PERM ITTEE who violates provisions of this ordinance shall be subject to a
fine:
(a) Not exceeding two hundred dollars ($200.00) for a first violation.
(b) Not exceeding four hundred dollars ($400.00) for a second violation of the
same section.
(c) Not exceeding six hundred dollars ($600.00) for each additional violation
within one (1) year of the same section.
(4) A violation period is defined as each day or portion thereof that a
PERMITTEE is in violation of this ordinance.
(5) The COUNTY or designee is hereby authorized to institute and pursue, in the
name of the county, pursuant to the provisions of section 25132 of the
Government code, civil actions for the recovery of fines for violations of this
ordinance.
(6) Payment of any fine herein shall not relieve the PERMITTEE from the
responsibility of correcting the violation.
(7) The fines paid under the administration of this ordinance shall be disbursed
by the COUNTY to the city in which the ambulance com pany is based.
6.114.360
NOTICE ISSUANCES
Before any suspension or revocation, the COUN TY shall give written notice to the
PERMITTEE specifying why such action is contemplated and giving the PE RMITTEE
a reasonable period of time (not less than five (5) nor more than fifteen (15) business
days) to comply with the provisions in question or to show cause against suspension
or revocation and setting a date for hearing thereon.
6.114.370
HEARINGS
(A) If an applicant for a Certificate of Operation or an Ambulance Permit or a
PERMITEE is dissatisfied with any of the actions taken by the COUNT Y, he/she
may request an administrative hearing.
(B) The request for an adm inistrative hearing must be filed within ninety (90) days of
the date of the notice.
21
(C) The hearing shall be held at an agency office. The agency shall mail to the
claimant a written notice of the tim e and place of the hearing no less than five
days prior to the hearing.
(D) Hearings conducted pursuant to this chapter shall be conducted before a Hear ing
Officer designated by the COUNTY. All hearings shall be electronic tape-
recorded. Hearings need not be conducted according to the California Code of
Evidence. Hearsay evidence may be used for the purpose of supplementing or
explaining any direct evidence, but sha II not be sufficient in itself to support a
finding unless it woul d be admissible over objection in civil actions in courts of
competent jurisdiction in this state. Any relevant evidence shall be admitted if it is
the type of evidence on which reasonable persons are accustomed to rely in the
conduct of serious affairs, regardless of the existence of any com mon law or
statutory rule which might make improper the admission of such evidence over
objection in civil actions in courts of competent jurisdiction in this state. Irrelevant
and unduly repetitious evidence shall be excluded. The parties shall equally bear
the expense of the Hearing Officer and the cost of the hearing. Each party shall
bear its own expense.
(E) At the hearing, the COUN TY has the burden of proof and may present evidence
as to why such action sh ould be taken and to answer the evidence presented by
the PERMITTEE.
6.114.380
APPEALS
The PERMITTEE may file a written appeal with the Board of Supervisors within ten
(10) days of receipt of the issuance of the COU NTY's written decision by certified
mail. A copy of the written appeal must al so be served to the COU NTY either in
person or by certified return receipt mai I within ten (10) days of receipt of the
issuance of the COUNTY's written decision by certified mail. Appeals will be heard at
a regularly scheduled Board of Supervisors meeting. The Board of Supervisor's
decision shall be final.
6.114.390
EMERGENCY ACTION
The COUNTY may reduce the period of time for compliance under a suspension or
revocation notice to no less than tw enty-four (24) hours and set the matter for
hearing immediately upon expiration of the period when the COUNTY makes written
preliminary findings that such action is necessary to protect the public health, safety
and welfare. When, as a result of such an emergency proceeding, a permit is
suspended or revoked, the PERMITTEE may request an additional hearing at which
the PERMITTEE will have the burden of establishing renewed com pliance justifying
reinstatement of the permit. Such additional hearings will be commenced within five
(5) days of the PERMITTEE's request. The request for, or the scheduling of, an
additional heari ng shall not stay operation of the suspensio n or revocation order.
6.114.400
DECISION
At the conclusion of the hearings, the Hearing Officer or the Board shall promptly
prepare a written determination of the issues presented and the proposed findings. A
copy of the decision sha II be served on the parties by certified return receipt mail.
Service of the decision shall be deemed complete at the time deposited in the mail.
22
ARTICLE VII
QUALITY MANAGEMENT
6.114.410
QUALITY MANAGEMENT PROGRAM
To ensure that ambul ances are operating in the best interest of the public health and
safety, and that ambulance com panies are utilizing properly trained staff, each
PERMITTEE will be required to have a quality management program that:
(A) Utilizes a physician, RN, or paramedic with experience in quality management to
direct and coordinate quality improvement activities (exceptions to this may be
made on an individual basis by the COUN TY).
(B) Reviews patient care provided by their employees.
(C) Meets the requirements of the State Em ergency Medical Services Authority's
Quality Improvement Program contained in the California Code of Regulations,
Title 22, Division 9.
(D) Identifies problems or issues regarding patient care and proposes solutions for
corrective action.
(E) Participates in the COU NTY's collection of data regardi ng quality of patient care.
(F) Includes disciplinary procedures to be used when appropriate.
(0) Maintains a radio recording of all calls for anibulance services requested, all
dispatch instructions given, and all communications between the dispatch center
and the ambulance unit until the am bulance run is completed. Recordings must
be stored for a period of at least sixty (60) days.
(H) Ensures that all drivers have completed an Emergency Vehicle Operation Course
(EVOC) driver training course, or its equivalent, related to responding to calls for
emergency medical service that includes, but is not lim ited to, the followi ng
didactic and practical components: legal aspects of the emergency ambulance
operation, the practice of defensive driving, accident avoidance, principles of
vehicle control, routine vehicle safety checks, breaking and stopping,
acceleration, and steering.
(I) Requires the use of the COUNTY's designated Prehospital Care Report, the
Unusual Occurrence form, and/or other approved reports that include all required
data elements for all emergency medical and those runs and refusal of service
against medical advice.
(1) Requires staff to attend, at no expense to the COU NTY, EMS Orientation, and
other education and training pr ograms as may be reasonably requested by the
COUNTY.
(K) Is consistent with the COUNTY's Quality Assurance/Quality Improvement Plan.
(L) PERMITTEES, or a designated em ployee(s), shall actively participate on any
committees, at the request of the COUNTY, to provide for continued system
performance.
(M)Documentation outlining the quality management program is to be submitted to
the COUNTY as part of the ambulance service permit application process.
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6.114.420
CCT CONTINUOUS QUALITY IMPROVEMENT PLAN
Critical Care Transport ambulance com panies are additionally responsible for
submitting a Continuous Quality Improvement plan according to the specifications in
the COUNTY's CCT policy.
ARTICLE VIII
MISCELLANEOUS PROVISIONS
6.114.430
EXEMPTIONS
(A) When county officials have deter mined that adequa te emergency ambulance
service will not be available from existing ambulance providers, this ordinance
may be waived at the request of any County Communications Center or at the
request of any law enforcement or fire protection agency during any "state of war
emergency," "state of emergency," or "local emergency" as defined in
Government Code Section 8558 or dur ing any period (not over thirty (30) days,
but renewable every thirty (30) days).
(B) This ordinance shall not prevent any peace officer as described in the California
Code or Regulations, Title 13, Motor Vehicles 11 07(a)(2) or public safety
personnel as defined in COUNTY policies, from arranging for the transportation
of an individual in need of emergency medical care when no am bulance with an
appropriate ambulance service permit is available and such transportation is
required immediately for the preservation of life or to avoid substantial
impairment of the person to be transported.
6.114.440
MEDICAL DIRECTION
All EMT and paramedic personnel working in Alameda County are required to
provide patient care in accordance with medical care policies, procedures and
protocols promulgated by the EMS medical director.
6.114.450
EMS SPECIAL EVENT NOTIFICATION
PERMITTEEs providing special event standby coverage shall comply with the
COUNTY's Special Event policy and complete an EM S Special Event Notification
form. This form shall be submitted to the COUNTY for approval at least seven (7)
days prior to the beginning of the coverage. Non COUNTY approved transport
providers shall pay a Special Event Non-Emergency Ambulance Permit fee. The
COUNTY may impose conditions on the approval of the request, which are
necessary to ensure the safety of the public, including, but not limited to, notification
of the local public safety jurisdiction, county communications, and appropriate 9-1-1
first responder providers. This provision shall help to ensure that adequate and
integrated emergency medical services are available to the public and event
participants. Any unauthorized standby service provided by a private EMS service
may result in a fine, permit suspension or revocation.
6.114.460
EMERGENCY AND DISASTER OPERATIONS
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(A) In the events of a disaster or mass casualty incident, the a bility of the emergency
ALS ambulance providers to provide necessary prehospital emergency
ambulance care and transportation may be disrupted or be inadequate for the
number of casualties. It is necessary; therefore, that all ambulances permitted in
Alameda County be avai lable to assist disaster or mass casualty medical needs
when there is a disaster or mass casualty incident. In the events of a disaster or
mass casualty incident, the COUNTY will determine the amount of assistance
needed, determine accessible acceptable ambulance staffing and configuration,
and may authorize the dispatch of any ambulance as permitted by law. Each
service shall make available, and place into service, all permitted units at the
request of the COUNTY. The COUNTY shall coordinate all medical mutual aid
requests through the County Centralized Emergency Medical Dispatch, the
medical mutual aid system, and the County Health Officer when applicable.
(B) The PERMITTEE shall have on file with the COU NTY, its Disaster Response
Plan which includes a personnel call-back plan.
(C) All management and field personnel of the PE RMITTEE shall follow the
COUNTY's Multi Casualty Incident (MCI) Plan Policy during an MC I.
(D) The COUNTY may assist the PERMITTEE in seeking reimbursement for its costs
from any disaster relief monies. The COUNTY shall have no financial
responsibility for these costs or charges.
(E) When requested by the COUNTY, the PERMITTEE shall participate in a
COUNTY organized disaster exercise by sending one fully staffed am bulance
with a minimum ninety (90) day notice from the COUNTY. All costs associated
with their participation in the disaster exercise shall be the sole res ponsibility of
the PERMITTEE.
6.114.470
CLINICAL EXPERIENCE PROGRAM
All BLS ambulance companies, in business m ore than one year, shall work with the
COUNTY to develop and maintain a program that provides clinical experience to
students enrolled in E MT training programs approved by the COUNTY.
6.114.480
COUNTY LIABILITY
Unless expressly agreed in writing, the COUN TY and the County of Alam eda and its
officers and employees shall not be liable for any PERMITTEE costs or charges
associated with compliance under this ordinance or the rules or regulations
promulgated hereunder.
6.114.490 SEPARABILITY
If any chapter, section, or subsection, sentence, clause, phrase, or portion of this
ordinance are for any reason held invalid or unconstitutional by any court of
competent judgment, such portion shall be deemed a separ ate, distinct and
independent provision and shall not affect the val idity of the rem aining porti ons
hereof.
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SECTION III
EFFECTIVE DATE
1. This ordinance shall take effect and be in force thirty (30) days from and after the
date of passage.
2. Before the expiration of fifteen (15) days after its passage it shall be published
once with the names of the members voting for and against the same in the Inter-City
Express, a newspaper published in the County of Alameda.
Adopted by the Board of Supervisors of the County of Alameda, State of California, on
__' 2007 by the following called vote:
AYES:
NOES;
EXCUSED:
SCOTT HAGGERTY
President of the Board of Supervisors
County of Alameda, State of California
ATTEST: CRYSTAL K. HISHIDA, Clerk
of the Board of Supervisors, County of Alameda
By
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