HomeMy WebLinkAbout3065.
~ Ordinance No. 3065
2 BUTTE COUNTY EMERGENCY MEDZCAL RESPONSE ORDTNANCE
3 The Board ot Supervisors o~ the County of Butte ardains as
4 ~ol.laws :
5 Section ~. Tit1e Pur oses
6 The EMRO shall be known as the "Emergency Medical Response
7 Ordinance {EMR~} of Butte County."
8 The purpose of the EMRO is to prtivide for the public safety
9 and wel.fare o~ Butte County citizens in the use o~ emergency
~b ambulance and other pre-h~spital care resources tharough the
~.1 establishment af effective standards for the operation, equip~nent
~.2 and p~rsannel o~ pre-hospital emergency care services. The EMRO
13 does nat app].y to wheelchair vans, gurney cars or simil.ar non-
14 emergency vehicles ar operations or to vehicles not requiring an
15 emergency vehicle per~nit from the California Highway Patrol. The
1.6 EMRO shall be 1.iberally construed for the accomplishment of these
17 purposes.
18 The ENlRO is not intended to supplant, over].ap, or interfere
19 with existing EMS regulations established under the Califarnia EMS
20 Act and the operati.onai standards established by the local EMS
2~ Agency, promu~.gated pu~suant t~ Division 2.5 of the Health and
22 Safety Code. However, in the case of a conf3.ict and where the
23 EMRO calls tor a high~r l.evel a~ service, the EMR~ sha~l prevail.
24 Noth~ng in the EMRO shall be limited by an ambulance service's
25 base hospital agreement. Nothing in the EMRO sha11 limit a base
26 hospital from impos~ng standards higher than those provided in the
27 EMRO; hawever, the base haspita~. must apply those standards
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uniformly ta a1.1 permittees under agreemant.
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1 The County of Butte has and will continue to uti~ize
2 geographic ambulance service areas for the provision of emergency
3 medical services.
4 Any person selected by the Health Officer to assist in any
5 investigation~ inspection or analysis pursuant to sections 7, 8, or
6 9 shal~ have na financial, nor personal stake in the outcome, but
7 shall be objective and disinterested.
8 The Caunty a~ Butte expresses the right to recognize and
9 establish exclusive operating areas in accordance with Health and
1d Safety Code Sections 1797.85 and 1797.22~ for the pravision of
21 emergency medica~ serv~ces and to designata exclusive operators
12 within those areas.
~3 section 2. Definitions
14 The EMRO incorporates the definit~ons set ~orth ~n Health and
15 Sa~~ty Code Section 1797.5d et seq. Add~tional definitians are set
16 forth in th~s section. In the case af any conf~ict, the specific
17 definitions set ~orth in this section shall be controlling.
18 A. Ambulance-An "ambuZance" is a vehicle specaally
19 constructed, moditied, equipped ar arranged and operated for the
20 purpose of urgent transp~rtation af sick, injured, convalescent,
21 in~irm, or othe~wise incapacitated persons.
22 B. Ambu~ance Attendant-An "ambulance attendant" i5 an
23 indiv~dual who is certified by the Health O~ficer as an EMT IA and
24 who is responsible for the care and t~ansportation af incapacitated
25 persons in an amb~lance.
26 C. Ambulance Service-An "ambulance service" is a private or
27 public arganization, entity, firm or agency which provides advanced
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1 lite suppart ambulance service.
2 D. Attendant Driver-An "attendant driver" is a person who is
3 qualifiad as an "ambulance attendant" and a driver af an ambulance.
4 E. Emerqency Calls-A request for an ambulance to transport or
5 assist persons in apparent sudden need of ~edica~ attention; or, in
6 a medical emergency, as determined by a physician, to transport
7 blood, any therapeutic device, accessory to such device, or tissue
8 ar organ for transplant.
9 F. EMD-An "~MD" is a person traa.ned and certi.fied as an
~.o emergency medical dispataher.
Z1. G. EMCC-"EMCC" means the Emergency Medical Care Committee of
12 Butte County estab~ished pursuant to Health and Safety Code Section
7.3 1797.270.
14 H. Ambulance Service Area(s)-An "ambulance service area(s)"
15 means th~ area{s) designated by the Health Officer for the
16 provision a~ emergency ~-eda.cal se~vices. The map depicting and
17 defining the geographic se~vice areas shal~ be avai~.able from the
18 Health Ofticer.
19 I. Health Dfficer-"H~alth Officer" means the Butte County
20 Health Officer or designated Health Department or other Department
21 staff.
22 J. Permittee-A "permittee" is an ambulance serv~ce aperatinq
23 under a vaiid permit issued pursuant to the EMRO.
24 K. Person-A "pers~n" is an individual, f~rm, partnership,
25 assaciation, carparation, co~npany, graup of individuals acting
25 togethe~ for a comman purpose, or any organization of any kind,
27 including any governmental agency other than the United States.
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3
l. L. Service-"Service" is an "Ambulance Service."
2 Section 3. Service Permit Re uirements
3 Except as provided in Section 4, it shal~. be unlawful far a
4 person to operate, canduct, ~aintain, advertise, or engage in an
5 ambulance service unless that persan has first app~ied for and
6 obtains and ho~ds a current valid service perma.t issu~d by the
7 Health O~ficer pursuant to the EMRO.
8 A permit wi~]. be issued only when the permittee is in
9 compla.ance with a11. app~icable Federa~, State, and County codes and
10 regulati~ns, and Laca~. EMS Agency policy and proceduares.
11 5ection 4. Permit Exem tions
1.2 No Butte Caunty permit for ambulance service sha11 be required
~.3 in the fol~owing cases:
14 a. A vehicle not ordinarily used as an emergency unit in the
15 case o~ a major catastrophe ar emergency when services
1& with permits are insuffici~nt ta render the services
17 required.
18 b. Persons rendering such services as attendants in case af
19 a major catastrophe, including but not limited to a
20 declaratian of a local state of emergency, o~ emergency
21 when permitted attendants can not be secured.
22 c. An ambulance or medica]. transport vehicle based and
23 properly permitted outside of the County shall be
24 authorized to transp~rt a patient to ar through the
25 County but shall not be authorized to transport patients
26 orig~.nating in the County, except as provided in Section
27 4(a}, and except in cases requiring a transport team
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1 configuration provided by ~acilities and centers outside
2 the County.
3 Section 5. A lication far Ambulance Service Permit: Initial and
4 Renewal
5 (a) Each application f~r a permit ar renewal shal~ be
6 accompanied by a reasonable applicatian fee. This~fee shall cover
7 the costs of annual inspection of services and adminis~ration costs
8 for processing this permit. Application ~or A~bulance Service
9 Permits hereunder sha~1 be made ~n such forms as ~ay be prescribed
1Q by the Health Officer and shall contain:
11 1. The name and address of the applicant and o~ th~
~~ registered and legal owners ot the ambulance or
~3 ambu~anc~s.
14 2. The geographic ambulance service area for which the
~~ permit is requested.
15 3. The trade or other fict3tious name, if any, under
17 which the applicant do~s business and proposes to
Zg do business. If the applicant is a copartnership,
19 the names and addresses of the ca-partners shall be
2p listed. Yf the applicant is a corporation, the
21 applicant shai~ list the names and addresses ot all
22 corporate ofEicers, directors, managing employees
23 and any stockholder ar stockholders who own five
Z4 percent of the issued stock of the applicant
25 corporation.
26 4. The app~icant's experience in praviding ambulance
27 serv~ce.
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1 5. A description of each ambulance, including the
2 make, madel, year of manutacture, motor and chassis
3 number; current state license numbe~; the length of
4 time the ambulance has been in use; maintenance and
5 replacement p~an for each ambulance; the co~or
6 scheme and insignia of the ambulance(s), name,
7 monogram or ather distinguishing charaateristics to
8 be used to designate applicant's ambulance or
9 amb~lances.
14 6. Street address of the ambu~ance service and its
11 te~~phane number and description of the location or
12 locations fr~m which each ambulance shall operate,
13 Each app~icant shall demonstrate campliance with
1~ any land use and/~r zoning requirements f~r each
15 location.
Z6 7. Cosnmunieations and 24-hour dispatch abilities,
17 including: recording of telephane and radio
18 cammunications of the service, recording
I9 maintenance and retrieval system, response times
20 and the protocals used far dispatching the service.
2~ 8. The equipment, supplies and drugs which the
22 applicant proposes to use on each ambulance.
23 9. How the applicant proposes to maintain adequate
24 medical records on the treatment of patients, and a
25 generai description of their internal quality
25 assurance process and the individuals responsibZe.
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1 ~0. The organizati~n, manpawer and staffing necessary
2 for continuous operation o~ the units to be
3 op~rated by the applicant.
4 11. The applicant's plan for drug starage, supply and
5 re-supply.
6 12. The applicant's plan for handling and disposal o~
~ bio-hazardous materials.
8 13. The applicant's plan for infection control.
9 14. The applicant's plan for incident command system
1p and disaster training, equ~pment and supplies.
1~ ~5. Verification that the applicant has prepared and
12 does have in place a current plan as required by
~3 C~l OSHA.
14 16. Base Station Agreement for medical cantrol with
15 written endarsement by a Base Haspital (at a
16 locatian approved by the Health Of£icer), the Base
~~ Hospital Emergency Physician group, and the
~g gove~ning EMS Agency.
19 17. Such other infa~mati~n as the Health Of~icer shail
2p deem reasanably necessary to fairly determ~ne
21 compliance with the requirements v~ the EMR~.
22 (b} Any new provider af ambulance service who submits a
23 perm~t application sha~l submit documentation demonstrating how
24 that service w ill improve the existing level o~ pre-hospita~ care,
25 wiil improv~ response times ta emergency calls, and any other
26 information deemed necessary by the Health Officer. The Hea~th
27 Officer shal~ review the documentation and shall conduct an
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1 investigat~on ta determine whether the applicant meets ali the
2~equirements of the EMRO. The Health Officer Shalli in addition,
3 conduct an investigation ta determine whether the new pr~posed
4 service, if permitted, would enhance the public health, welfare and
5 convenience. If the Health Ofticer determines that the new service
6 would adverse~y effect the public health, welfare and cvnvenience,
7 the application may be denied. The denial may be appealed
8 utilizing the procedures set torth in Sectians 7(h) and (i) of the
9 EMRO.
10 (c) The p~rmit expires one year fr~m the date of issuance and
I1 must be renewed prior to expiration. A renewal applicant must
12 submit a completed renewal application at least thirty days pri.dr
13 to the permit expiration date. The renewa~ checklist or outline
14 shali be ~nade availabie by the Health O£ficer.
15 {d} Any permit issued pursuant ta the EMRO shall be
16 prominently displayed in the p~inca.ple place of business of the
17 applicant and sha~~ not be altered or defaced in any way. If any
18 offa.cial entry on any such permit is defaced, re~noved, obliterated,
19 or altered in any way, the permit shall be rendered immediately
20 null and v~id and of na ~orce and effect.
21 (e) No permit issued pursuant to the EMRO is transferable.
22 Section 6. A lication for Service Permit and Renewal: Pracessin
23 and Investi ation b Health O~ficer
24 {a} All permit applications and renewals shall be submitted
25 to the Hea~th O~ficer. The Health Officer shall assign the
26 application ar renewal to one ar more designee(s) for review and
27 investigatian. The Hea~.th Of~icer sha1.1 direct the review and
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1 znvestigation, The designe~(s} shal~ review, investigate and
2 report, in writing, to the Health Ofticer. The Health Officer
3 shall review the investigation, consu~t with the d~signee(s) and
4 may order further investigatian.
5 (b) The Health 4fficer shall, within thirty days after
6 receipt of an applicatian for an ambulance service permit, and
7 after investigation, issue a permit upon the follaw~ng findings:
8 1. That the Health Off icer has considered the impact the
9 service wi~l have on the existing system in ~egards to
10 emergency medica~ care, cast o~ services, and any other
11 issues relative to the integrity ot the existing system.
~2 2. That the applicant or its responsible managing employee
13 is adequately trained and experienced in the field of
1~ ambulance services.
~5 3. That each ambulance wi~~ be sta£fed by at least two
16 persans, one o~ wham is a fully accredited EMT-P {at
17 least) and the other an EMT-Z (at Ieast).
~8 4. That neithar the applicant nor any co-partner or managing
19 e~ployee thereo~ is registered as a sex offender under
24 the provisions of Penal Cade Sectian 290.
23 5. That the applicant or any co-partner or managing employee
22 thereof affirms that he neither habitually nor
23 e~cessively ~ses, used, nor is addicted ta the use of
24 narcotics or dangeraus drugs nor has been convicted of
25 any affense relating to the use, sale, possessian or
26 transportatian of narcotics, mood or mind al~tering or
27 habit form~ng drugs.
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1 6. That the appiicant ar any co-partner or manaqing emp~oyee
2 thereof aftirms that he is nat a habitual user of
3 intoxicating beverages to excess.
4 7. The appiicant ar any ca-partner or managing employee
5 thereaf within the three year period immediately
6 preceding the application has nat be~n under suspension,
7 revacation, ar probation by the Department o~ Motar
8 Vehicles for cause involving the saf~ operation a~ a
9 motor vehicle and has not been convicted of any of the
10 following offenses:
ii (i} Failure to stop and render azd in an accident
12 involving injury or d~ath;
13 (ii} Driving whiie intoxicated;
14 (iii) Reckless Driving
15 8. That the applicant a~ any co-partner or managing
16 employee thereof has not been convicted of any o~fense
17 punishable as a felany in the State of California and has
~8 not been canvicted of the crime of theft af either degree
19 within the ten year period immediately proceeding the
20 app~ication.
21 9. The app].icant or any co-partner or manag~.ng employee
22 thereof does not have any undisclosed f inancial interest
23 ~.n more than ane ambulance company op~rating within Butte
24 Caunty.
25 10. That each ambulance owned or operated by the applicant
2b has been certified by the Cal.i~ornia Highway Patro3. as in
27 comp~iance with the regulations pertaining to ambulances
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1 and camplies with the pravisions of th~ EMRO.
2 li. That tha local EMS agency has cert~fied th~ applicant's
3 compliance with aI~ applicable regulations, standards,
4 and requirements.
5 12. That th~ applicant has signed the Statement af Intended
6 Compliance with the regulations set forth in Sections 10,
7 11, 1.2, 15 and 16.
8 (c) No approva].by any local governmental entity may be given
9 to any application for a business license ar any other ].icense ar
10 permit ta operate an ambu~ance or medica7. transport service unless
11 a permit as requi~ed by the EMRO has been issued by the Health
12 Off icer.
13 (d) An app~ication for renewal af any permit shall be
14 pracessed by the Hea~th Offi.cer in the sa~ne manner as an origi.nal
1~ application fo~ a permit and denia~ shall be subject to the same
16 procedures as denial. af an or~.ginal application.
17 (e} In the event of a den~.al ~f a permit app~icatian by the
18 Health Officer, the procedure set forth in Section 7 sha11 be
19 fo~lowed and utilized.
24 Sectian 7. Vioiations znvesti ations and Penalties
21 (a) This secti.on pertains only ta permits issued by Butte
22 County. Any alleged violations of the EMRO will be reported to the
23 Health Of~icer who will notify appropriate health aare and public
24 safety agencies.
25 (b) A permit issued hereunder for an ambulance service may be
26 revoked or suspended by the Health O~~ice~ for any vialation af
27 the terms o~ the EMRO, or ~or any good cause related to the public
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1 health, safety and we~tare, or in the event af conduct af the
2 permittee which would be graunds for denial of an applicativn for
3 sueh a permit.
4 (c) Zn the event that it appears to the Health Officer that
5 an application for a p~rm~t should be denied or that a previously
6 issued permit should be suspended or revoked or that a fine or
7 other penalty shauld be imposed, the Hea~th Officer shall natify
8 the applicant or permittee to appear before him and t~ show cause
9 why such permit should not be denied, suspended, or revoked or why
10 such fine or ather pena~.ty should not be imposed. The Health
11 Officer shall provide the applicant or permittee ten (10) days
12 written notice of such hea~ing.
13 Written noti.ca will be ~urnishad to the permittee specifying
14 the reason(s) for the proposed intended acti~n and in~~rming the
1.5 permittee of his right to request a hearing before the Health
16 Off icer.
17 Said notice shali state the ground or reason for the proposed
18 denial, revocation, fine or other pena~ty in clear and concise
19 terms . At saa.d hearing, the applicant ar perrr-ittee ~ay present
20 evidence and arguments in response to the Health Officer.
21 The applicant or permittee ~nay be represent~d by counsel at
22 said hearing; however, the lack of counse]. shall nat be a ground
23 for continuing the hearing unless gaod cause is shown.
24 In the event that the Health O~ficer determines that the
25 continued aperation of the service poses an immediate threat to
26 pulalic health and safety, the Health Officer may immediately
27 suspend operation o~ the service. The i.nvestigatian and hear~.ng
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1 process wi11 follow such action.
2 (d) The Health Officer may designata one or more persans to
3 investigate the allegat~on(s) . The Health O~ficer shall direct the
4~.nvestigation and sha~~. receive a written report from the
5 designee{s). The Health Officer shalZ review the investi.gation,
6 consult with the designee(s) and order further investigation if
7 necessary.
8 (e} No service whose p~rmit has been suspended or revoked may
9 operate after the receipt of the notice af suspension or
1.o revocati~n.
~1 {f} The suspension or revocation may lae immediate if the
12 Health Officer has determined through investigatian that such
13 suspens~.on oar revocatian i.s in the best interest of the public.
14 {g) The Health Of~icer shall set f~rth the intended action
15 within and as part of the noti.ce of de~ial, revocation, suspension
1.6 fine or other penal.ty. The actions which may be noticed and
17 i~nposed by the Health Officer include, but are nat l.imited to, the
18 following:
1.9 ~.. A letter af reprimand
20 2. Fines ~or willful and/ar continued violations in the
21 amount of two hundred and fi~ty do~lars ($250) per day
22 3. Suspension or revocation af the service permit for any
23 subseq~ent viol.ation
24 4. Issuance of a citati.on for violatian of the EMRD with a
25 fine up to one thousand dol~.ars ($1,000) per day of
26 vi.alation.
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1 (h) Within ten days after receipt of the intended action by
2 the Health Of~icer, the applicant ar permittee may appeal said
3 decision by ~iling a request f~r appeal with the Health officer.
4 The intended action of the Health Of~icer sha11 be implemented if
5 no timely appeal is filed. This request sha11 state the ground(s)
6 far appeal in cl~ar and concise language. Upon receipt, the Health
7 Officer shall transmit this notice to the Glerk of the Board of
8 Supe~visors. Upon receipt of such request, the clerk shall present
9 the matter to the Baard of Supervisors at its naxt meeting. At
1.0 such ~neeting, the Baard of Supervisors shall set the matter for a
1.1 hearing within sixty (60) days thereafter. The Board of
12 Supervisors, at its disc~etian, may refer the appeal to an
13 independent referee who sha11 hear the matter and ~ender a
14 reeommendation to the Board for its cansideration.
15 (i} At such appea~ hearing, the Board af Supervisors, and/or
16 the app~inted referee, shall fu11y hear all parties to the appeal
17 and render its decisian thereupan to either sustain the decisi.on Qf
18 the Hea~th O~f icer, reverse the decision o~ the Health Officer, or
19 modify the decisian af the Health Officer, based upon the submitted
20 evidence. The decision of the Board of Supervisors shall be
21 final.
22 (j) Upon suspension, revocation or terminatian of an
23 ambulance service permit, the permittee shall cease aperatians as
2~4 such and na ather person shall a11ow the permittee to continue
Z5 operat~ons.
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27 ///
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1 Sectian 8. Tns ecti~ns.
2 (a) The Hea~th Dfficer sha~l inspect, or cause ta be
3 inspected, ~very ambulance befor~ it is placed into use and
4 annually thereatter. The Health ~ff icer may assign such inspection
5 to a designee(s). The Health ~ff~cer shall direct such inspection
6 and review th~ report, consult with the designee(s) and may arder
7 further inspection. Such inspections do not duplicate, and shall
8 nat be in lieu af, inspections performed or required by the
9 California Highway Patrol.
10 (b) Aft~r inspection, a written report shall be prepared
11 indicating every v~alation or omissi~n of any requirement,
12 standa~d, or provision contained in the EMRO with respect to the
13 ambulance ~nspect~d. The report shall set a t~me period for
~4 correctian of each vioiatian or omission. A copy o~ the report
~5 shall be given to the permittee of the service concerned.
16 {c} In addition to the routine inspections required in
17 subsectian (a), the Health Officer and/or designee may, at any time
18 and in his/their sale discretion, ~ake non-routine inspections of
19 any unit, station ar sub-stati~n regulated hereunder for the
20 purposes of determining whether ~r not any aspect of the service
21 subject ta the EMRO is, ar is not, in compliance with the EMRO. A
22 written report shall be prepared p~rsuant to subsection {b).
23 Section 9. Compla_ints.
24 (a) Complaints regarding alleged violation of the EMRO shall
25 be documented as fallows:
2~ 1. Section of the EMRO alleged to have been violated.
27 2. The time, date, and lacat~on af alleged violatian.
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~ 3. The person and/or serviae involved.
2 4. The circumstances or detazls which support the
3 al~egations of a violation.
4 5. Names, addresses and telephona numbers of percip~ent and
5 substantiating witnesses.
5 (b) The Health O~~icer may assign the investigation of the
7 complaint to a designee(s). The Health 4fficer shall direat the
8 investigatian and sha~l receive a written rep~rt f~om the
9 desig~ee. The Health O~ficer shall review the w~itten repo~t and
1~ confer with th~ designee(s) and may order further investigat~on.
11 (c) The complainant may be required ta personally present
12 additional information to substantiate the complaint.
13 (d) The persan or service alleged ta be in vialation shall be
14 natified by the Health Depart~ent ot the c~mplaint and shall be
15 afforded the opportunity to receive copies of documents associated
1& with the complaint investigation.
~7 (e) The complaint investigation ~ay include a review o~ any
18 applicable records, tapes, personal stateanents or affidavits or
19 oth~r items deemed relevant by the Heal.th Of~icer. A summary
20 report detailing the tindings of the investigation sha11 be
21 prepared.
22 {f) The Hea~.th Officer shall determine if any actidn should
23 be taken at any time during the complaint investigation process.
24 Any action by the Health Offi.cer sha1.1 be presented pursuant to the
25 procedures set forth in Section 7, with the permittee afforded the
26 review procedures of that same sectian.
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1.6
~ Section 14.
2(a) Operat~ons, Standards and Procedures, Equipment and Response
3 T~mes.
4 (1} In order to be placed into service, each a~bulance ~ust
5 be currently approved by the Cali~ornia Highway Patrol and the
6 Health Department, pursuant to the EMRO.
7 (2) Each ambulance must be maintained in a safe operating
8 condition, including a11 engine parts, body parts, and ai~
9 other operating parts, and equipment used in and ~n the unit.
10 {3) Each ambulance must be affixed on each side and the rear
11 thereof the unit designatian assigned by the Health Of~icer
12 and name of the service. The lettering for such
13 identiticat~on shall be at least four inches in height. The
~4 assigned unit designation shall a1s~ be affixed to the
15 ambulance top and shall be at least 24 inches in height.
16 (4) Every ambulance aperated in Butte County shall be in a
17 clean and sanitary condition subject to the sanitary standards
18 as are prescribed by the H~alth Officer.
19 (b} Communicatian E u~. ment Each ambulance sha1~ lae equipped with
20 at least the ~ollowinq communication equipment:
22 (1) Standardized UHF/Mobile radio providing at least eight
22 channels with fixed unit lacated in patient compartment of
23 vehicle.
24 (2) VHF 16 Channe~ (minimum) radio with Butte County
25 recommended frequencies.
26 (3) At least ane portable UHF radio.
27 Additional coinmunicatians equipment requirements may be
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1 estab~ished by the Local Emergency Medical Services Agency.
2 (c) Reauired Persannel
3 (1} The se~vice must maintain sutficient sta~f to ensure 24
4 hour dispatch capability.
5 (2} No serv~ce wil~ allow either ambulance attendants or
6 drive~s to work more than 72 hours consecut~vely. If a service
7 allows its attendants or drivers to work 72 hours consecutively it
8 is prohibited by this ordinance to do so m~re than one time per
9 consecutive thirty (3p) day period. During any shift longer than
10 24 hours, ambulance drivers and attendants shall per~orm only pre-
il hospital care a~d sha11 have no other duties.
12 (3) In additian to any ather r~qu~rements contained herein,
13 no service may utilize a driver to operate a unit unless:
14 (a) He or she is fam~liar with the geog~aphic area of
15 the organization's service area;
15 (b) He or she has adequate knowledge of all the
l~ hospita~s within the arganizatian's servace area;
18 (c} He or she can operate a twa way radio; and,
19 (d) He or she can drive a unit under emergency
20 canditions.
21 (4) Each service must provide written notice to the Hea~th
22 Officer of any change in personnel or ambu~ances, within ten {10)
23 days after such change, unless an a~ternate plan has been appraved
24 by the Health Officer.
25 (5) Services may uti~ize on~y those drivers and attendants
26 who a~e appropriately licensed, certi~ied and accredited.
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1 (6) When in operatian every ambulance ~ust be sta~fed, at a
2 minimum, by twa personnel, one of whom must be locally accredited
3 as an EMT-P (at least} and one of which must be locally certified
4 as an EMT-TA {at least),
5 (7} Services must ensure to the best of the~r ability that
6 their attendants are free of physical defects or diseases which may
7 either endanger their patients or impair their abil~ty to attend ta
8 patients.
9 (d) Insurance Re uirements.
1p (1) Each ambulance service shal.l obtain and keep in force
11 during the term af such permit the fallawing caverage issued by a
12 company authorized to da business in the State of Califarnia.
~.3 Required insurance coverage may be revised as deemed necessary by
14 the Health O~ficer.
15 (a) Comprehensive general liability insurance to
16 include caverage for bodily injury, property
17 damage, blanket contract~al, and personal injury.
lg Minimum limits of liability wi11 be at ].east one
39 million dollars ($1~00O,OOp) per accurrence,
~p combined single limit laodi~y injury and praperty
~~ damage.
22 (b) Work~r~s Compensation Insurance policies shall be
23 carried covering all employees of the permit
z~ holder.
25 (c} Compreh~nsive motor vehic~.e liability at a minimum
26 of one million dollars ($1,000,000) per occurrence,
27 combined single limit bodil.y injury and property
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~ damage. The coverage for all permittees must
2 inc~ude owned motor vehicle, non-owned motor
3 vehicle, hir~d motor vehicle, and cross-liability
4 or severability of interest clause in policy.
5 (d) Pro~essional liability ~or all emp~ayees providing
~ service. Error and amission and failing to render
~ p~afessional services coverage. Minimum lim~ts
g shall be at least $~,OD0,4~0.
9 (2) 5aid insurance shall contain coverage expressly
10 recognizing the indemnification obligations assumed by the
11 ambulance services or applicant in accardance with the EMR~, but
12 shall not be canstrued t~ l~mit in any manner the amount of an
~3 ambulanca service's or applicant's liabiiity thereunder. Further,
1~ where permitted by the carrier, said insurance eoverages described
~5 above shall expressly name the County o~ Butte, ~ts Board o~
16 Superviso~si agents, officers and employees as additional insureds.
~7 (3) Said insurance sha11 not be subject to cancellation or
18 reduction without sixty (6b) days prior written notice to the
19 Health Officer.
20 (4) Each ambulance p~aced in operation by the servic~ shal~
22 be ~.ncluded within the scope o~ the requ~red insurance coverage and
22 limits.
23 (5) Certificates of insurance satisfactory to the Health
24 O£ficer must be approved be~ore ambulance service commences.
25 (6) Upon receipt of any notice af cancellation or non-renewal
26 of an insurance policy, the Health Officer may immediately arder
27 the permittee to cease service in Butte County and to surrender any
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1 permit issued pursuant to the EMRO, Noth~ng contained harein
2 prohibits the permittee from requesting the Hearing B~ard to review
3 the action af the Hea~th Officer and/or petitioning the Hearinq
4 Board to reinstate the permit.
5 {e) Vehic~e Eauipment.
6 (1} All ambulances must have, equipment as specified in the
7 Butt~ Caunty Ambulance Vehicle Equipment List.
8 (2) A11 medical equipment and supplies on ambulances must b~
9 stared pursuant ta County-approved medical control policies.
10 (~) Requirements fo~ Interior Confiauration, Design__and Dimension
11 of Ambulances.
12 Each ambulance must:
13 (1) Contain at least 300 cubic feet of space.
14 (2) Have additianal shelf and other storag~ space su~ficient
15 for cantrolled substances including locked storage in
16 accordance with Section 1~.
17 (3) Have proper storage of other medical equipment and
18 supplies ta prevent patient injury in transit and ta meet
19 approved procedures for management of patients.
20 (4} Hav~ systems which will.contro].temperature adequately to
21 maintain the integrity of the medical supp~ies and drugs
22 as well as the health and sa~ety of the patients and
23 attendants.
24 (g) Maintenance Proqra~n. Each ambulance, at a mini~num, sha11 be
25 maintained in accordance with a~aintenance and repl.acement plan
26 approved by the Health Officer. I~ addition, at 1.50, ~00 miles,
27 each amlaulance will be removed trom operatian and inspected by an
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~ ASE Certified Master Mechanic. The ambulance may be placed back
2 into serviae only when the mechanic certifies that the ambulance
3 complies with the Butte County ambulance operation speci~~cations.
4(h) Re uired E ui ment Reserve. Each provider is to maintain a
5 minimum backup reserve af one fuily stocked and Qperational ALS
6 ambulance for each regularly staffed ALS ambulance. These
7 ambulances must norma~ly be based in Butte County and readi~y
8 available ~or immediate use. These ambulanaes would be used for
9 high volume periods, standbys, and backup far transfers and
10 maintenance.
11 (i) Res onse Time Criter~a. Each ambulance service shall meet or
12 exceed the following response time criteria: eight minutes
13 response time or less 900 of the time far emergency 911 cal~s,
~4 within the urban areas af the County as established by the Health
15 Officer. The Health O~ficer may provide for exceptians to this
16 crite~ia with approval by the Board of Supervisors.
17 {j) Dispatchina, Each ambulance service in Butte Caunty shall be
18 required t~ adhere to the fo~lowing dispatching requirements:
19 1. Twenty four hour dispatching with medically trained
20 personnel (minimum level to be an EMD).
21 2. Have ~adio equipment sufficient to permit cammunicat~on
22 (1) with all ambulances operated by the service; and (2) permitting
23 com~nunication with the service~s lacal and county public service
24 answering po~nts.
25 3. Phane lines with five outside line capability.
26 4. Back-up pawer system with an autamatic start ar immediate
27 access to an alternative dispatching sourc~.
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1 5. A~1 CHP guidelines.
2 (k) Station Requirements.
3 (1} Every station and sub-station used by an ambulance
4 service must meet the following requirements:
5 (a) Co~piiance with applicable building, fire, zoning
6 and land us~ codes and r~gulations;
7 (b) Adequate sanitary storage space for equipment and
8 materials to be used in the operation of the service;
g (c} Cammunication capability with a central dispatch
10 facility with both a primary and secondary communication
11 system;
12 (d} Fraperly ~ocated to permit any ambulance operating
~3 there~rom rapid and safe egress to a main tharoughfare;
14 {e) Adequate off-street parking space for al~ units
15 operat~ng therefrom;
16 (f) Attended by an EM~ on a twenty ~our hour basis,
17 unless the service participates in a central dispatch
18 facility approved by the health officer;
19 (g) At least one additional clean uniform for each on
20 duty staff inember.
21 (h} Remain in a clean and sanitary conditian and have
22 suitab~~ sleeping qua~ters, and an on site restr~om
23 facility.
24 (i} Maintain c~.ean, sanitary and safe food preparation
25 and storage facilities.
26 (2y ~very station and sub-station shall be inspected priar to
27 the issuance af any permit and, thereafte~, shall be inspected at
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1 least once yearly by the Health O~ficer or his designee{s) for the
2 purpase of determining whether or nat the station dr sub-station is
3 in campliance with the EMRO and any other Health Department
4 regulations.
5 Section 11 Drugs, Danaerous Drugs and Controlled Substances.
6 A~l administration, supply, re-supply, documentation, storaqe
7 and security measures and destruction of drugs, dangeraus drugs,
8 c~ntrolled substances and hypodermic devices must be in compliance
9 with all laws and regu~ations of the state and federal government
10 and the local EMS agency. As used in this section, dr~gs,
11 dangerous drugs and controlled substances have the meaning ascribed
12 ta them in the State Board of Pharmacy Ragulations.
13 Section 12. Ambulance Service: Re uired Re orts and Records.
14 (a) A repart ~f each a~bulance ~aii shall be maintained by
15 the service and shall include require record keeping per CHP and
16 Local EMS Ag~ncy requirements. One copy of the above shall
17 accompany patient's records, and ane copy shall be ~iled with
18 ambulance company.
~9 (b) The provisians of sub-s~ctian (a) of this section sha11
20 apply with equal force where patients die before being so
2~ t~ansparted ther~in ar at anytime prior to the acceptance of the
22 patient into the respansi.bility o~ the hospita~. or medical or other
23 autharity if the pat~ent is still under the care or responsibility
24 of the ambu~anca.
25 (c} Records kept by any service pursuant to state regulations
26 shail, during regular business hours, be apen to inspection by the
27 Health Offa.cer or his designated representative upon req~test.
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1 Section 13. Fees.
2 A non-refundable application ~ee recommended by the Health
3 Officer and approved by the Board ~f Supervisors must accompany an
4 application far a permit. A renewal fee recommended by the Health
5 Officer and appraved by the Board o~ Supervisors must aacompany any
5 applicatian for renewal or permit.
7 Section 1~4. Changes In Owne~ship and Transfers.
8 The Health Officer shall be notitied o~ any change in
9~wnership o~ a permitted ambulance service and shall have the
10 discretion ta terminate the permit and require a new application,
11 or partian thereof, and new permit.
1.2 Section 15. Rul.es and Re ulations.
~.3 The Health Officer is hereby authorized to issue rul.es and
I4 regulations prescribing and defining the duties and pr~cedures to
15 he observed and compla.ed with by an ambu].ance service and by
1.6 drivers and attendants, which rules and regu~atians and any
17 amendments thereof sha~.~ be subject to approval by the Board of
18 Supervisors. Such ru].es and regulations shall include, but not be
19 3.imited to: (1) The Butte County Ambulance Vehicle Equipment
20 List; {2) The Butte County Ambulance Maintenance Pragram, and (3)
21 The Butte County Ambul.ance Operati~n Standards. Such r'ules and
22 regulations and amendments thereto, when appraved by the Board ot
23 Supervisors by resalution and filed with the Health Department,
24 shal~ const~.tute enfarceable provisions of the EMRO and violati.ons
25 thereaf sha~.l be subject to the penalty pravisions of the EMR~.
26 Copies o~ said rules and reguiations and ar~y amendments thereof
27 shall be delivered to each ambu~ance service the time the permit is
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1 issued.
2 Sectian 16. Su lemental Re ulations.
3 The pravisions o~ the EMRO shall be deemed as supplementa~ to
4 the provisians of any other pert~nent laws or ordinances of the
5 county.
6 Sectian z7.
7 The Health Officer shall have the suthority to suspend all or
8 part af the EMRO in the case of a~ocal emergency or catastrophe.
9 The susp~ns~on shall be withdrawn as soon as is pract~cab~e.
~0 Section ~S. Severability.
11 Should any section, paragraph, sentence, clause or phrase af
~2 the EMR4 be declared illegal, unconstitutional ar inval~d, for any
13 reason, th~ remainder shall nat be affected thereby.
14 PASSED AND ADOPTED by the Board of Supervisors of the County
15 of Butte, State of Califo~nia, on the 27~h day of
~6 Apr~l ~ 1993~ by the folloWing votB:
17 AYES: Superv~sozs Meyer, Dolan, McLaughlin, ~homas and Chair Houx
18 NOES : None
~.9 ABSENT : None ~ I
r
20 NOT VOTING: None ~'"' ,
21 Y AN HO X, Chair af he
Butte County Board af Supervisors
22 ATTEST:
23 JOHN S. BLACKLOCK
Oft~c and C1 k of the Board
24
By
25 ~
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