HomeMy WebLinkAboutC07-144 Colorado Emergency Medical ServicesEXHIBIT A
EMERGENCY MEDICAL SERVICES
AMBULANCE LICENSING STANDARDS
ARTICLE I. AUTHORITY, PURPOSE AND INTENT
A. These Regulations are adopted pursuant to the authority granted the Board of County
Commissioners under the Colorado Emergency Medical Services Act, Section 25-3.5-101, et
seq., C.R.S.
B. The purpose of these Regulations is to set forth the requirements for the inspection,
licensure and operation of ambulance services, ambulance personnel and ambulance vehicles
operating in the County pursuant to the Colorado Emergency Medical Services Act; establish the
structure and authority for regulatory oversight; and provide for the development and
implementation of high-quality ambulance services for the County.
C. The Board reserves the right to amend these Regulations, and any other individual
conditions of licensing as applied to any particular license, as needed in keeping with its
legislative function and in order to implement the policy of the State of Colorado that the
regulation and control of ambulance licenses is in the exclusive purview of the Boards of County
Commissioners. The Board may grant a variance from the terms of these Regulations if the
Board finds such action is necessary to protect the public health, safety, or welfare.
D. Nothing in these Regulations shall be construed to create a cause of action or civil
liability remedy in any person. These Regulations shall not be construed to create a duty to any
third party where no such duty otherwise existed. It is the express intention of the Board that any
third party receiving services or benefits under these Regulations shall be deemed to be an
incidental beneficiary only.
E. If any of the provisions of these Regulations are determined to be invalid, such
determination shall not affect the remaining provisions of these Regulations.
ARTICLE II. DEFINITIONS
1. Ambulance: Any public or privately owned land vehicle especially constructed or
modified and equipped, intended to be used, and maintained or operated by, ambulance
services for the transportation upon the roads, streets and highways of this state, of
individuals who are sick, injured, or otherwise incapacitated or helpless.
2. Ambulance Service: The furnishing, operating, conducting, maintaining, advertising, or
otherwise engaging in or professing to be engaged in the transportation of patients by
ambulance. Taken in context, the person so engaged or professing to be so engaged and the
vehicles used for the emergency transportation of persons injured at a mine are excluded
from this definition when the personnel utilized in the operation of said vehicles are
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subject to the mandatory safety standard of the Federal Mine Safety and Health
Administration, or its successor agency.
3. Ambulance Transport Agency: Any public agency, volunteer organization or
commercial enterprise licensed as an ambulance service by the Board of County
Commissioners of any Colorado county, sometimes referred to herein as a "licensed
ambulance service."
4. Ambulance -advanced life support: A vehicle equipped in accordance with Section
12.9.3 of the rules pertaining to Emergency Medical Services, 6CCR1015-3, and operated
by an ambulance service authorizing the vehicle to be used to provide ambulance service
limited to the scope of practice of the Emergency Medical Technician -Intermediate or
Emergency Medical Technician -Paramedic as defined in the Colorado Board of Medical
Examiners rules, 3 CCR 713-6, Rule 500, Sections 5 and 6.
5. Ambulance -basic life support: A vehicle equipped in accordance with Section 12.9.2 of
the rules pertaining to Emergency Medical Services, 6CCR1015-3, and operated by an
ambulance service authorizing the vehicle to be used to provide ambulance service limited
to the scope of practice of the Emergency Medical Technician -Basic as defined in the
Colorado Board of Medical Examiners rules, 3 CCR 713-6, Rule 500, Section 4.
6. Authorized Representative: The Public Health Manager, as designated by the Director of
the Eagle County Department of Health and Human Services. This individual is
responsible for coordinating the licensure of ambulances and the administration of these
regulations.
7. Based: An ambulance service headquartered, having a substation, office ambulance post
or other permanent location in a county.
8. Board: Means the Board of County Commissioners for Eagle County.
9. Board of Medical Examiners Rules: Rules adopted by the Board of Medical Examiners
which establish responsibilities of Medical Directors and all authorized acts of Emergency
Medical Technicians.
10. Council: State Emergency Medical and Trauma Services Advisory Council (SEMTAC)
11. County: Eagle County
12. Department: Colorado Department of Public Health & Environment (CDPHE)
13. Director: The Director of the Eagle County Department of Health
14. Disaster Aid: In the event of an all hazards event, including but not limited to air
transport crash, terrorist attack, natural disaster earthquake, ambulances may be called
upon by another jurisdiction or county in which they are not licensed to serve, to provide
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emergency support. No formal contracts or mutual aid agreements for assistance or
additional licenses are needed for this type of disaster response during a catastrophic event.
15. Emergency: Actual or self -perceived event which threatens life, limb or well-being of
an individual in such a manner that immediate medical care is needed.
16. Emergency Call: A real or self -perceived event where the EMS system is accessed by
the 9-1-1 emergency access number or its local equivalent, or an interfacility transfer
where the patient's health or well-being could be compromised if the patient is held at the
originating facility indefinitely.
17. Emergency Facility: A general hospital, trauma center, or free-standing emergency
facility with an emergency department staffed twenty-four (24) hours a day, seven (7) days
per week, with a licensed physician; or an emergency medical outpatient facility staffed
twenty-four (24) hours a day, seven (7) days per week with a licensed physician or
registered nurse with direct medical supervision by a licensed physician; or an emergency
facility with a licensed physician who responds on an on-call basis.
18. Emergency Medical Technician: An individual who holds a valid Emergency Medical
Technician's certificate issued by the Colorado Department of Public Health and
Environment. The three classes of emergency medical technicians as follows:
a. Emergency Medical Technician -Basic (EMT -B): An individual who holds a current and
valid Emergency Medical Technician -Basic certificate issued by the Department.
b. Emergency Medical Technician -Intermediate (EMT -I): An individual who holds a
current and valid Emergency Medical Technician -Intermediate certificate issued by the
Department.
c. Emergency Medical Technician -Paramedic (EMT -P): An individual who holds a current
and valid Emergency Medical Technician -Paramedic certificate issued by the Department.
19. Graduate EMT -Intermediate: An individual who has successfully completed a
Department recognized Emergency Medical Technician -Intermediate training course but
has not yet successfully completed the certification requirements set forth in these rules.
20. Graduate EMT -Paramedic: An individual who has successfully completed a
Department recognized Emergency Medical Technician -Paramedic training course but has
not yet successfully completed the certification requirements set forth in these rules.
21. License: The authorization issued by the appropriate authority to operate an ambulance
service in the County. The license may not be assigned, sold or otherwise transferred.
22. Licensee: The legal entity that has been issued a license by the appropriate authority to
provide ambulance service in the County.
23. Medical Director: A physician who holds an active Colorado Medical License, who
establishes protocols and standing orders for medical acts performed by Department
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certified EMTs of a prehospital EMS service agency who is specifically identified as being
responsible to assure the competency of the performance of those acts by such department -
certified EMTs as described in the physicians medical continuous quality improvement
program. Any reference to a "physician advisor" in the state EMS rules or in the Board of
Medical Examiners previously adopted rules shall apply to a "Medical Director" as defined
in these rules.
24. Medical quality improvement program: A process consistent with the Colorado Board
of Medical Examiners rules, 3 CCR 713-6, Rule 500, Section 3.2 (b), used to objectively,
systemically and continuously monitor, assess and improve the quality and appropriateness
of care provided by the medical care providers operating on an ambulance service.
25. Mutual Aid: A written, contractual agreement between two licensees to supplement
services in each other's response districts. A mutual aid agreement does not exempt an
Ambulance from the licensing requirements of the local government within which mutual
aid is provided.
26. Patient: Means any individual, who is sick, injured, has experienced a traumatic injury,
or is in need of immediate professional medical attention and who has been treated.
27. Patient Care Report: A medical record of an encounter between any patient and a
provider of medical care.
28. Permit: The authorization issued by the governing body of a local government with
respect to an ambulance used or to be used to provide ambulance service in this state. The
permit may not be assigned, sold or otherwise transferred.
29. Quick Response Teams: Provides initial care to a patient prior to the arrival of an
ambulance.
30. Rescue Unit: Any organized group chartered by this state as a corporation not for profit
or otherwise existing as a nonprofit organization whose purpose is the search for and the
rescue of lost or injured persons and includes, but is not limited to, such groups as search
and rescue, mountain rescue, ski patrols, (either volunteer or professional), law
enforcement posses, civil defense units, or other organizations of governmental
designation responsible for search and rescue.
31. "Service Area" means the geographic area of the County where an ambulance service
provides services. Boundaries for service areas may be defined by customary practice or
legally established by a Special District or other political subdivision.
32. To Operate in Eagle County: The providing of Ambulance service or transport of
patients within the boundaries of Eagle County.
ARTICLE III: REGULATIONS
A. Ambulance Service License Required: No person or agency, public or private, shall transport
a patient from any point within the County in an ambulance, to any point within or outside the
County unless that person or agency holds a valid license and permits issued by the County,
except as provided in subsection III.C. of these Regulations.
B. Ambulance Permit: No ambulance shall be operated within the County unless a permit has
been issued as hereinafter provided.
C. Exceptions to Licensing and Permits Required: The provisions of the licensing and permit
paragraphs, (A) and (B) above, shall not apply to the following:
1. Vehicles used by other agencies including quick response teams and rescue units that
do not routinely transport patients and are only used to transport patients for extrication
from areas inaccessible to a permitted ambulance. Vehicles used in this capacity may
only transport patients to the closest practical point for access to a permitted ambulance
or hospital.
2. Vehicles, including ambulances from another jurisdiction, used during a major
catastrophe or mass casualty incident when permitted ambulances are insufficient.
3. An ambulance service that does not transport patients from points originating in Eagle
County, or transporting a patient originating outside the borders of Eagle County.
4. Vehicles used or designated for the scheduled transportation of convalescent patients,
individuals with disabilities, or persons who would not be expected to require skilled
treatment or care while in the vehicle.
5. Vehicles used solely for the transportation of intoxicated persons or persons
incapacitated by alcohol as defined in Section 25-1-302, C.R.S. (2006), but who are not
otherwise disabled or seriously injured and who would not be expected to require skilled
treatment or care while in the vehicle.
6. Vehicles used for the transportation of persons injured at a mine when the personnel
used on the vehicles are subject to the mandatory safety standards of the Federal Mine
Safety and Health Administration, or its successor agency.
7. Ambulances operated by a department or an agency of the federal government,
originating from a federal reservation for the purpose of responding to, or transporting
patients under federal responsibility.
8. Ambulances duly licensed by another jurisdiction providing services in Eagle County
pursuant to a mutual aid or automatic aid agreement with an ambulance service licensed
in Eagle County or otherwise summoned to assist by an ambulance service licensed in
Eagle County.
D. Ambulance Crew Members Required: No patient shall be transported in an ambulance which
is operating in the County unless the ambulance is staffed by a crew consisting of at least one
emergency vehicle operator and one Emergency Medical Technician, except under extraordinary
circumstances pursuant to C.R.S. § 25-3.5-202.
E. Medical Director Required: All ambulance services shall have a single medical director
meeting the requirements established by the Colorado Board of Medical Examiners to supervise
the medical acts of all personnel on the ambulance service pursuant to 3 CCR 713-6, Rule 500,
or its successor. The medical director shall be notified in writing by the Board, or their
authorized representative, of any violations of these Regulations by the ambulance service or
alleged complaints or violations by individual medical providers operating on an ambulance
service. The Board shall be informed within five (5) business days, in writing, of any changes in
medical director during the term of the ambulance service license. The Medical Director shall
attest to his or her willingness to provide medical oversight and a medical continuous quality
improvement for the ambulance service in writing.
F. Insurance:
1. No ambulance service shall operate in the County unless it is covered by workers'
compensation insurance, commercial or comprehensive general liability insurance,
complying motor vehicle liability insurance, medical malpractice or professional liability
insurance, and other insurance policies as may be required by law, in amounts that meet
or exceed limits specified in the Workers' Compensation Act, the Governmental
Immunity Act, the Motor Vehicle Financial Responsibility Act, or other applicable
statutes, furnished by an insurance carrier appropriately licensed to write such policies in
Colorado. Every insurance policy required shall provide for continuing liability
thereunder to the full amount, not withstanding any recovery thereon, that the liability of
the insured shall not be affected by the insolvency or bankruptcy of the insured and that
the insurance company will not be relieved from liability on account of nonpayment of
premiums, failure to renew the ambulance service license, or any act or omission of the
insured unless the policy is canceled, terminated or revoked with appropriate written
notification as required in these Regulations.
2. In addition to the coverage described above, each ambulance service shall
maintain insurance coverage for each and every ambulance owned, operated or leased by
the ambulance service providing coverage for injury or death of persons in accidents
resulting from any cause for which the owner of the ambulance should be liable on
account of any liability imposed on him by law, regardless of whether the ambulance was
being operated by the owner, his agent or lessee, or any other person, and coverage as
against damage to the property of another, including personal property, under like
circumstances, in the following minimum amounts:
Public Liability and Bodily Injury:
Each Person $1,000,000
Each Accident $2,000,000
Property Damage:
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Each Accident $1,000,000
Professional Liability:
Each Person $1,000,000
Each Accident $2,000,000
3. The County shall be notified, in writing, thirty (30) days prior to any cancellation,
termination, revocation or other material change in coverage.
4. Proof of insurance shall be filed with the County with the application for an
ambulance service license as required in these Regulations.
5. A certificate of insurance, with the County named as certificate holder, shall
indicate the vehicles covered by the policy, type of insurance, policy number(s), policy
effective date and expiration date and amount of coverage. Notification of any changes
in insurance, including vehicles covered under the policy, shall be made to the County in
writing, and a new certificate of insurance forwarded to the Board within thirty (30) days
of the changes.
6. Each ambulance service shall provide written notice to all personnel regarding the
amount of professional liability insurance the ambulance service carries. Ambulance
service must attest to and provide if requested, documentation regarding the process used
to inform ambulance staff of the amount of professional liability insurance carried by the
service.
7. The Board may require reasonable additional coverage and proof of insurance at
any time it deems necessary to promote the public health, safety and welfare.
G. Standards:
1. Ambulance Specifications:
a. Ambulances permitted by the County prior to the effective date of these
Regulations may continue to be used as ambulances provided that they continue
to meet minimum standards for suitability, construction and general condition as
determined by the Board.
b. Each ambulance shall clearly display permanent markings on both sides
showing the name of the ambulance service under which they are licensed.
C. Each ambulance shall be maintained at all times in a safe operating
condition and in compliance with Colorado motor vehicle statutes, rules or
regulations. At the time of application for permit the ambulance service shall
submit to the County a certificate prepared by a qualified mechanic certifying the
ambulance is in a safe operating condition.
2. Ambulance Equipment: Each ambulance shall contain minimal required
equipment listed in the Department's rules pertaining to Emergency Medical Services, 6
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CCR 1015-3, Section 12.9 Minimum Equipment Requirements. Further, each ambulance
shall be outfitted with the following equipment:
a. Audible and visual warning devices and any special markings to designate
it as an ambulance as required by statute for authorized emergency vehicles.
b. Safe tires and, in addition, approved snow tires or chains when weather
conditions demand.
C. Appropriate protective occupant restraints for the vehicle operator and
any other ambulance personnel.
d. Appropriate protective occupant restraints for patients, accompanying
family members or other persons being transported.
e. The minimum required equipment for a Basic Life Support ambulance
shall be as listed in the current edition of the State Board of Health Rules
Pertaining to Emergency Medical Services, 6 CCR 1015-3, or its successor.
f. The minimum required equipment for an Advanced Life Support
ambulance shall be as listed in the current edition of the State Board of Health
Rules Pertaining to Emergency Medical Services, 6 CCR 1015-3, or its successor.
3. Inspections:
a. The designee of Eagle County Department of Health and Human Services
shall inspect any and all ambulances owned, leased, or operated by a licensed
ambulance service annually, or more often if required by the Board, to assure
compliance with applicable rules and regulations. Inspections may be performed
at any time. Any inspection shall be for the purpose of determining that each
vehicle is being properly maintained and contains the equipment specified in
these Regulations. Maintenance records shall be made immediately available
upon the County inspector's request. Such inspections shall be in addition to
other safety or motor vehicle inspections required under Colorado law.
b. Any inspection necessary for application or renewal must be completed
prior to the acceptance of the application or renewal application.
C. New vehicles shall be inspected prior to the vehicle being operated and
used in the course of providing emergency medical services.
c. It is the responsibility of the ambulance service operator to have each
vehicle inspected prior to licensing. An appointment must be made in advance to
the performance of an inspection.
4. General Regulations:
a. All ambulance services shall have an ongoing medical continuous quality
improvement program consistent with the requirements established by the
Colorado Board of Medical Examiners pursuant to 3 CCR 713-6, Rule 500, 3.2, b,
or its successor.
b. Each ambulance service licensed in the County shall complete a patient
care report and transmit said records to CDPHE in the prescribed method by July
0 2007, including the minimum prehospital care data set described in 6 CCR
1015-3 Section 11, or its successor, for each patient assessed and each call
received.
C. Each ambulance service licensed in the County shall complete and submit
an agency profile to the Colorado Department of Public Health and Environment
pursuant to 6 CCR 1015-3, Section 12, on an annual basis.
d. All personnel shall be readily identifiable as to their ambulance service
and level of training at the scene of a call and while treating a patient.
e. The medical director for each ambulance service shall establish
destination guidelines that conform to state and regional requirements, generally
accepted standards of medical care for patients transported by ambulance or as
otherwise mandated by rule, regulation or statute
f. Any ambulance service using the radio frequencies licensed to, or
operated by, the Eagle County Communications Center for agree to abide by
Federal Communications Commission regulations and operating procedures or
other usage requirements established by the Eagle County Communications
Center.
g. The Board shall be authorized to promulgate and enforce such additional
rules and regulations as it deems necessary to provide for quality emergency
medical services and insure compliance with Colorado law and any resolution
adopted by the Board, which regulate the operation and licensing of ambulance
services in the County.
h. All ambulance services licensed by the County are required to agree to and
comply with all provisions of these Regulations, or any amendments thereto, any
other conditions pertinent to the license reasonably imposed by the Board, all
rules, regulations and plans developed by the Central Mountains RETAC and
adopted by the County and all applicable provisions of Federal, State and local
laws, rules and regulations in order to maintain licensure. The Board may also
consider medical practices that deviate significantly from accepted standards of
care and business practices that pose a risk to the public health, safety and welfare
as a violation of these Regulations.
ARTICLE IV- LICENSES AND PERMITS
E
A. Application for Ambulance Service License: An application for an ambulance service
license shall be submitted to the County and shall contain the following information, supporting
documents and application fees:
1. Type of license: BLS ambulance service or ALS ambulance service. The type of license
will describe the maximum level of service that could be provided at any time by the
ambulance service.
2. The name, address and telephone number(s) of the owner of each ambulance.
3. The name, address and telephone number(s) of the person applying for the license,
hereinafter referred to as the applicant.
4. The name, address and telephone number(s) of the person who will be in charge of the
operation of the ambulance service.
5. If the owner of an ambulance or the applicant is a partnership, the name and address of
each partner. If the owner of an ambulance or the applicant is a corporation, the name and
address of each stockholder owning ten percent (10%) or more of the outstanding stock of
each such corporation and the name and address of each director of the corporation. If the
owner of an ambulance or the applicant is a government, the name and address of each
member of the governing board.
6. The trade or other name, if any, under which the applicant does business or proposes to do
business.
7. A completed ambulance vehicle permit application for every ambulance to be used by the
applicant in providing service in the County.
8. The location and description of the place or places from which it is intended to operate the
ambulance service.
9. For a new application, certificates of inspection or other documentation that the physical
inspection of the ambulances, equipment and location of the applicant has been completed
and the ambulance(s), equipment and location(s) were found to be in compliance with the
provisions of these Regulations.
10. The area to be served by the ambulance service.
11. The name, address and telephone number(s) of the ambulance service medical director.
12. Attestation by the medical director of willingness to provide medical oversight and a
medical continuous quality improvement program for the ambulance service.
13. For a new license application, a service plan demonstrating the need for services to be
provided, pro forma income statements, balance sheets, bank records or other financial
information as may be reasonably requested by the Board sufficient to demonstrate the
ambulance service's ability to operate and respond within the area to be served.
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14. For a renewal license application, an income statement, balance sheet and other financial
information for the last fiscal year sufficient to demonstrate the ambulance service's ability
to continue operations and respond within the area to be served.
15. Certificates of insurance as required by these Regulations.
17. The following shall be available for inspection:
a. The list of all emergency personnel who may be called upon to respond to an
emergency with the ambulance service. This list shall include the following information:
i. complete name, address, and date of birth.
ii. the current training level.
b. The ambulance service shall maintain documentation for all emergency personnel who
may be called upon to respond to an emergency with the ambulance service
demonstrating their qualifications. The documentation shall include the following
information:
i. a copy of a current Colorado Emergency Medical Technician certificate, or a First
Responder course completion certificate; Cardiopulmonary Resuscitation card issued
a nationally -recognized training program; and an Advanced Cardiac Life Support
card issued by a nationally -recognized training program, if applicable; ii. copy of a
valid Colorado driver's license.
c. A complete copy of the ambulance service's medical treatment protocols. A copy
shall be provided to the Board upon request.
B. Issuance of a New Ambulance Service License: Upon receipt of a complete application for a
license to provide ambulance services, the Board shall review the application, the applicant's
record and hold a public hearing to allow input from interested parties. No license shall be
granted unless the application demonstrates complete compliance with this resolution and
applicable laws. Each license shall be granted by resolution of the Board and shall be valid for a
period of twelve (12) months following the date of issue providing that the ambulance service
personnel, vehicle(s), equipment, and location comply with the requirements of these
Regulations.
C. Renewal of Ambulance Service License: Unless revoked by the Board, any license issued by
the County may be renewed by submitting to the County Department of Health and Human
Services a completed application for renewal containing the required information, necessary
supporting documents and application fees. Application for renewal shall be filed annually, but
not less than thirty (30) days before the date the license expires. If re-application is not received
at least thirty (30) days prior to license expiration, County shall issue a temporary suspension
notice and the applicant shall cease operation until license is reissued. If re-application is
received, license will not be suspended pending administration and completion of the renewal
process.
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D. Issuance of a Renewal Ambulance Service License: License renewals shall be issued
administratively unless the County Department of Health and Human Services or the applicant
requests a full hearing. Then the process shall be as follows:
The Board shall review the application, the applicant's record and hold a public hearing
to allow input from interested parties. A license renewal shall be granted by resolution of
the Board and shall be valid for a period of twelve (12) months following the date of
issue providing that the ambulance service personnel, vehicle(s), equipment, and location
comply with the requirements of these Regulations.
E. Ambulance Vehicle Permits: Permits shall be issued administratively. An application for an
ambulance permit shall be submitted to the Eagle County Department of Health and Human
Services and shall contain the following information, supporting documents and application fees,
if any:
1. Type of permit: BLS ambulance or ALS ambulance. The type of permit will describe the
maximum level of service that could be provided at any time by that vehicle and appropriate
staff.
2. The name, address and telephone number(s) of the owner of the ambulance.
3. The name, address and telephone number(s) of the person applying for the license,
hereinafter referred to as the applicant.
4. The trade or other name, if any, under which the applicant does business or proposes to do
business.
5. A description of the ambulance, including make, model, year of manufacture, vehicle
identification number, Colorado license plate number for the current year, the length of time
the vehicle has been in use, and the color scheme, insignia, name, monogram, and other
distinguishing characteristics used to designate the vehicle.
6. Certificate of inspection or other documentation that the physical inspection of the
ambulance equipment has been completed and the ambulance and equipment were found to
be in compliance with the provisions of these Regulations.
7. Certificate of inspection by a qualified mechanic.
F. Issuance of Ambulance Vehicle Permits: The County Department of Health and Human
Services shall review the application. An ambulance vehicle permit shall be valid for a period of
twelve (12) months following the date of issue or the remaining term of the applicant's
ambulance service license providing that the vehicle and equipment comply with the
requirements of these Regulations.
G. Transfer of License or Permits: No license or permit issued by the County shall be sold,
assigned, or otherwise transferred.
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H. Change of Ownership: Change of ownership shall require a new application license and
payment of license fees. Any sale or exchange of stock in excess of twenty-five percent (25%)
of the total outstanding stock of a corporation to anyone other than an existing stockholder at the
time of the original issuance of license shall be deemed a change of ownership for the purpose of
these Regulations. Any change of ownership of any transfer of stock ownership of ten percent
(10%) or more shall be reported in writing to the County Department of Health and Human
Services within thirty (30) days of such change or transfer.
I. ReciprocitX:
1. The Eagle County Department of Health and Human Services may issue an
ambulance service license and ambulance permit(s) to an ambulance service licensed by
another Colorado county upon a finding that the requirements in the county are
substantially equivalent, and the ambulance service agrees to comply in full with these
Regulations. An ambulance service license and ambulance permit(s) may be issued by
completing the application requirements and payment of the appropriate fee, if any, as
specified in these Regulations.
2. Based on the finding that the requirements of Pitkin County are substantially
equivalent to the requirements of Eagle County, Ambulance service providers not
licensed by Eagle County, but who are licensed by and in good standing with Pitkin
County, may operate within those portions of the Basalt and Rural Fire Protection District
that are within the jurisdiction of Eagle County.
J. Service Area: No ambulance service may operate within the County for the express
purpose of providing only inter -facility transports without written consent from the Ambulance
District they serve and must agree to take an equivalent proportion of Emergency Calls
generating from the 9-1-1 center in the area served. This does not apply to provisions as set forth
in Article III (C) of this resolution.
ARTICLE V: COMPLAINTS
A. Origination of Complaints: Alleged violation of these Regulations by a licensed ambulance
service, individual medical providers on a licensed ambulance service, or of an ambulance
service operating in the County without a license, may be made in writing by any party and
addressed to the Board, or by the Board on its own initiative. Any individual bringing a matter
of medical competency to the Board shall waive the right of patient confidentiality as a condition
of complaint submission and subsequent investigation. If any legal action is filed against a
licensed ambulance service in a court of the United States, the State of Colorado or any of its
political subdivisions, the licensee shall notify the Board within ten (10) business days. A
violation of these Regulations shall not be presumed based on the allegation. In the event that a
judgment is entered against the licensee, the licensee shall file a copy of the findings of fact,
conclusions of law and order of the court with the Board within ten (10) business days. If an
action against an ambulance service license is undertaken by another jurisdiction, the licensee
shall notify the Board within ten (10) business days. A violation of these Regulations shall not
be presumed based on the action. If the action results in a suspension or revocation of the
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ambulance service license by another jurisdiction, the licensee shall file a copy of the record of
the adverse action with the Board within ten (10) business days.
B. Validation of Complaints: The Board, or its designee, shall complete an initial review of the
complaint, judgment or adverse action within five (5) business days to determine if it constitutes
a violation of these Regulations and has sufficient foundation to warrant a complete
investigation. Any apparent violation of these Regulations having sufficient factual basis shall
be fully investigated by the Board. Allegations of violations outside the purview of the Board
shall be returned to the complainant for referral to the appropriate authority or jurisdiction. The
Board shall notify the complainant in writing if the allegation lacks sufficient basis to warrant
investigation. The Board shall notify the licensee in writing if a judgment or adverse action filed
with the Board does not constitute a violation of these Regulations.
C. Investigation of Complaints: The Board shall notify the complainant in writing that the
allegation is sufficient to warrant a full investigation. Upon initiation of a full investigation, the
Board shall notify the ambulance service and the medical director for the ambulance service of
the alleged violation in writing. The Board shall commence action against the ambulance service
or unlicensed ambulance service if the allegation is determined to be a violation of these
Regulations or, at its discretion, may provide a reasonable period of time for the licensee to cure
any violation or to implement corrective measures to bring the licensee's business activities into
conformance with these Regulations before commencing action to suspend or revoke a license or
permit. The Board may forego further hearing or action against the license or permit upon
confirmation that the licensee has cured the violation and satisfied any conditions reasonably
imposed by the Board. The Board shall notify the complainant in writing if an investigation
determines that the allegation fails to constitute a violation of these Regulations or that the
licensee has cured the violation.
ARTICLE VI: PROCEDURES FOR REVOCATION OR SUSPENSION
A. The Board may, on its own initiative or upon written complaint made by any party,
temporarily suspend, suspend for a definite period, or revoke any license or permit issued
pursuant to these Regulations upon a determination that a violation of these Regulations by a
licensed ambulance service or by individual medical providers on a licensed ambulance service
has occurred.
B. Temporary Suspension: Without prior notice to the licensee and upon determination that a
violation that poses immediate threat to the public health, safety and welfare has occurred, the
Board may temporarily suspend any license or permit. Such temporary suspension shall be
effective upon delivery of written notice to the licensed ambulance service by the Board. No
temporary suspension shall be valid for more than thirty (30) days or until a final decision by the
Board concerning suspension or revocation, whichever period is longer. Any written notice of
temporary suspension shall also provide notice of the time, date, and place of a hearing before
the Board to consider the suspension or revocation of the license. Except upon written consent
of the licensee, the hearing shall be held not more than ten (10) business days following the
effective date of the temporary suspension. The Board shall secure an equal level of service to
the area that was covered by the suspension and fund the provision of EMS to maintain adequate
coverage based on the traditional service provided during the suspension.
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C. Suspension for Definite Period or Revocation of License: Following notice to the licensee
and a public hearing at which the licensee shall be afforded an opportunity to be heard, the Board
may suspend or revoke any license or permit. Any suspension or revocation shall require a
finding by the Board of a violation of these Regulations based upon the evidence presented at the
hearing. Suspension shall be for a specific and definite period of time not to exceed any
remaining current license period. The County shall bear the burden of proof of a violation
justifying any suspension or revocation of a license or permit. Issuance of a temporary
suspension shall not be a prerequisite to the conduct of a hearing to consider the suspension or
revocation of a license or permit. The Board shall secure an equal level of service to the area
that was covered by the suspension and fund the provision of EMS to maintain adequate
coverage based on the traditional service provided during the suspension.
D. Hearings: All suspension or revocation hearings shall be open to the public and shall be
conducted in accordance with the Colorado Open Meetings Act. The Board shall be authorized
to administer oaths and issue subpoenas to require the attendance of witnesses and the production
of papers, books, and records necessary to the determination of any issue at any hearing.
E. Surrender of License or Permit: Following receipt of a written notice of suspension or
revocation, the licensee shall surrender and deliver its license and all ambulance permits to the
Board within forty-eight (48) hours.
F. Notices: Any notice issued pursuant to these Regulations shall be made in writing and
provided to the licensee and the medical director at the address listed in the application for
license. The Board shall use its best efforts to immediately notify in writing any
communications center, and notify within three (3) business days any first response agencies,
mutual aid agencies, local law enforcement agencies, hospitals and medical directors of any
suspension or revocation. The Board may send notice to the County Emergency Medical
Services Council, Regional Emergency Medical and Trauma Services Advisory Council
Coordinator, Colorado Board of Medical Examiners, Colorado Department of Public Health and
Environment or other interested parties; provided, however, that such notice shall not entitle
these parties to a right to participate in any hearing concerning suspension or revocation of a
license.
ARTICLE VII: MISCELLANEOUS PROVISIONS
A. Use of sirens and Emergency Equipment: All emergency equipment and warning
devises shall be used in accordance with all Colorado traffic statutes, local ordinances and rules
and regulations.
B. Severability: If any of the provisions of these regulations are determined to be invalid,
such determination shall not affect the remaining provisions of these regulations.
C. Remedies: These regulations create no third -party beneficiaries and no private
remedies for the breach of any provision of these regulations. The penalties set forth herein are
the sole and exclusive penalties and remedies for the breach of any provisions of these
regulations.
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Dated: CJ • �S• QS1
Clerk of the B6ard of
Commissioners
EAGLE C
BY AND;
16
4TY, STATE OF COLORADO
OUGH ITS BOARD OF
SIONERS
Menconi, Chairman
