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HomeMy WebLinkAboutR90-111 ambulance certification standardsCommissioner moved adoption of the following Resolution: BOARD OF COUNTY COMMISSIONERS COUNTY OF EAGLE, STATE OF COLORADO RESOLUTION NO. 90--hi AMBULANCE CERTIFICATION STANDARDS AND APPOINTMENT OF EMERGENCY MEDICAL SERVICES COUNCIL MEMBERS WHEREAS, the General Assembly of the State of Colorado enacted the Colorado Emergency Medical Services Act, C.R.S. § 25 -3.5 -101 et sec.; and WHEREAS, the Act requires that the Board of County Commissioners of each county adopt certain standards, requirements and procedures for providing emergency medical services within each county; and WHEREAS, the Act authorizes the Board of County Commissioners of each county to license and regulate ambulances, ambulance services and emergency services personnel; and WHEREAS, the Board desires to reappoint members to the Emergency Medical Services Council ( "EMS Council ") and to adopt Eagle County Ambulance Services Regulations; and WHEREAS, the terms and conditions of this Resolution are intended to reaffirm Eagle County's commitment to and implementation of the General Assembly's declaration that it is in the public interest to provide available, coordinated, quality, sufficient and reliable emergency medical services to the state's residents. The orderly certification of ambulances and ambulance services within the County assists in the development of the emergency medical services system within the County and assists in the prevention of premature mortality and the reduction of the morbidity that arises from critical injuries, exposure to poisonous substances and illnesses. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF THE COUNTY OF EAGLE, STATE OF COLORADO: THAT, the Board hereby appoints the following members to the EMS Council, with future vacancies, additions and deletions to be approved in accordance with the By Laws: Vail Valley Medical Center All Fire Departments Vail Ski Patrol Colorado State Patrol All Police Departments Western Eagle County Ambulance Dist. Eagle County Ambulance Search & Rescue 911 -Vail Eagle County Sheriff's Office Colorado Mountain College Physician Advisor to Council Red Cross Jane Brandes Kraige Kenney Brian McCartney Sgt. Rick Donner Phil Biersdorfer Norm Brown Lyn Morgan Ralph Thomas Ken Hughey Ken Wilson Jim Olsen Dr. Bill Bevan Carol Mulson THAT, the Board hereby adopts Ambulance Certification Standards in the form as set forth in Exhibit "A" attached hereto and made a part hereof by this reference. THAT, the Board finds, determines and declares that this Resolution is necessary for the public health, safety and welfare of the citizens of the County of Eagle, State of Colorado. MOVED, READ AND ADOPTED by the Board of County Commissioners of the County of Eagle, State of Colorado, at its regular meeting held the day of %6 u ,- H,,6 e- , 1990. ��� COUNTY OF EAGLE, STATE OF COLORADO, By and Through Its ATTEST: BOARD OF COUNTY COMMISSIONERS By B: Clerk to the B a of County Commissioners Commissioner A=te seconded adoption of the foregoing resolution. The roll having been called, the vote was as follows: Commissioner George A. Gates Q Commissioner Donald H. Welch Commissioner Richard L. Gustafson Gi i This Resolution passed by _2.,L ,,,uote of the Board of County Commissioners of the County of Eagle, State of Colorado. EMERGENCY MEDICAL SERVICES AMBULANCE CERTIFICATION STANDARDS ARTICLE I: Definitions A. "Act" means the Colorado Emergency Medical Services Act, C.R.S. § 25 -3.5 -101 et sec. B. "Advanced Life Support Ambulance" means an Ambulance, which in addition to meeting the basic requirements for Equipment, must have on the Ambulance the equipment and medications as required by the physician advisor's protocol, and operating with Advanced Life Support Personnel. C. "Advanced Life Support Personnel" means a minimum of one state certified Emergency Medical Technician — Paramedic /EMT —P, or an Emergency Medical Technician — Intermediate /EMT —I, or a registered nurse with Advanced Cardiac Life Support certification, or a physician with Advanced Cardiac Life Support certification, or a Paramedic or EMT -I serving as a trainee or graduate prior to state certification; and a driver with a valid Colorado driver's license and current Colorado state certified Emergency Medical Tech nician - Basic /E MT- B certification. D. "Ambulance" means any privately or publicly owned land vehicle, especially con- structed or modified and equipped, intended to be used and maintained or operated for the transportation of Patients upon the streets and highways in the County. E. "Ambulance Driver" means any person who holds a valid Colorado driver's license and meets the requirements necessary for the operation of a Basic Life Support Ambulance, as defined below. F. "Ambulance Permit" means the authorization issued by the Director and approved by the Board with respect to an Ambulance used or to be used to provide Ambulance Service in the County (hereinafter "Permit "). G. "Ambulance Service" means the furnishing, operating, conducting, maintaining, advertising, or otherwise engaging in or professing to be engaged in the transpor- tation of Patients by Ambulance. Taken in context, it also means the person so engaged or professing to be so engaged. The person 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 subject to the mandatory safety standards of the Federal Mine Safety and Health Administration, or its successor agency. H. "Ambulance Transport" means the transportation of Patients originating in the County by Ambulances licensed by the County. —1— I. "Based" means an Ambulance headquartered in or having a substation or office or a permanent station in the County, and whose primary response area is dedicated to transporting Patients originating in the County. J. "Basic Life Support Ambulance" means an Ambulance that meets the requirements for Equipment as established by the Board and is manned by at least two (including the driver) Emergency Medical Tech nician— Basic /EMT —B currently certified by the State of Colorado. The EMT who acts as the driver shall hold a valid Colorado driver's license. K. "Board" means the Board of County Commissioners of the County of Eagle, State of Colorado. L. "County" means the County of Eagle, State of Colorado. M. "Director" means the individual responsible for licensure and enforcement of resolutions of Ambulance Service within the County. N. "Emergency" means any 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. O. "Emergency Call" means those situations requiring the use of sirens and red lights for the purpose of clearing traffic. P. "Emergency Facility" means a general hospital 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. Q. "Emergency Medical Technician — Basic /EMT —B" means an individual who holds a valid Emergency Medical Tech nician — Basic /EMT —B certificate issued by the Colorado Department of Health, EMS Division. R. "Emergency Medical Technician — Intermediate /EMT -1" means an individual who holds a valid Emergency Medical Technician — Intermediate /EMT -1 certificate issued by the Colorado Department of Health, EMS Division. S. "Emergency Medical Technician — Paramedic /EMT —P" means an individual who holds a valid Emergency Medical Technician — Paramedic /EMT —P certificate issued by the Colorado Department of Health, EMS Division. T. "EMS Council" means the Eagle County Emergency Medical Services Council. U. "Equipment" means the equipment and supplies designated by the August 195:) ACS Bulletin, as established by the State Advisory Council on Emergency Medical Services and approved by the State Board of Health, or as from time to time defined by the Board. —2— V. "License" means the authorization issued by the Board to operate an Ambulance Service in the County. W. "Licensee" means the person or entity that has been issued a License by the Board to provide Ambulance Service in the County. X. "Patient" means any individual who is sick, injured or otherwise incapacitated, helpless or in need of medical assistance. Y. "Physician Advisor" means a physician who establishes protocols or medical acts performed by EMT — Basics, EMT — Intermediates, EMT — Paramedics, and /or non — emergency medical vehicle operators of a pre — hospital emergency medical care service agency, and who is specifically identified as being responsible to assure the competency of the performance of the acts by such EMT — Basics, EMT — Intermediate, EMT — Paramedics, and /or non — emergency medical vehicle operators. A Physician Advisor shall meet all qualifications as outlined in the "RULES DEFINING THE DUTIES AND RESPONSIBILITIES OF EMERGENCY MEDICAL SERVICE PHYSICIAN ADVISORS AND THE AUTHORIZED MEDICAL ACTS OF EMERGENCY MEDICAL TECHNICIANS AND PARAMEDICS" (3 —CCR- 713 -6) of the "ACTS ALLOWED" published and approved in September 1987 by the EMS Division of the Colorado Department of Health. Z. "Proof of Ambulance Validation" means a copy of the valid Ambulance Permit for the particular Ambulance in which it is carried, placed in a readily accessible place in each Ambulance. The Proof of Ambulance Validation shall indicate the date of validation and shall be provided by the Director. AA. "To Operate In Eagle County" means the providing of Ambulance Service or the transport of Patients within the boundaries of the County. BB. "Trainee Graduate Paramedic" means an individual who has successfully completed a Colorado Department of Health approved paramedic training course (Prior to January 1, 1990) and who is employed or otherwise serving in a practical field training program under the medical supervision of that organization's Physician Advisor. ARTICLE II: Ambulance Certification Regulations A. Ambulance Service License Required No person, partnership, corporation or other entity (including local governments) shall provide or operate an Ambulance Service, publicly or privately, in the County using any Ambulance based in the County, unless that person or entity holds a valid License to do so issued by the Board. B. Proof of Ambulance Validation No Ambulance shall transport Patients, when transport originates in the County, unless it meets County Ambulance licensing requirements and carries a current Ambulance Permit. C. Advanced Life Support Ambulances When an Ambulance Service operates or charges as a paramedic or Advanced Life Support Ambulance Service, the manning must comply with the definition of Advanced Life Support Ambulance. —3— D. Basic Life Support Ambulance. Any Ambulance manned and operating as a Basic Life Support Ambulance Service shall in no way advertise, display or claim to be an Advanced Life Support Ambulance unless it is licensed as such. E. Ambulance Crew Members. No Patient shall be transported in an Ambulance which is based in the County unless there are two (2) or more properly qualified persons in the Ambulance. F. Ambulance Permit. No Ambulance based in the County shall be operated within the County unless a Permit has been issued and a copy thereof is being carried in the Ambulance, as herein provided. All Ambulances shall bear evidence that its Equipment meets or is equivalent to the minimum requirements set forth in the minimum Equipment list established by the Board. G. Exceptions to Licensing and Permits Required The provisions of the licensing and Permit paragraphs set forth herein shall not apply to the following: 1. The exceptional emergency use of a privately or publicly owned vehicle, including search and rescue unit vehicles, or aircraft not ordinarily used in the formal act of transporting Patients; 2. A vehicle rendering services as an Ambulance in case of a major catastro- phe or emergency when Ambulances with Permits based in the localities of the catastrophe or emergency are insufficient to render the services required; 3. Vehicles used or designed for the scheduled transportation of convalescent patients, handicapped individuals, or persons who would not be expected to require skilled treatment or care while in the vehicle; 4. Ambulances based outside the state which are transporting a Patient in Colorado; 5. Vehicles used solely for the transportation of intoxicated persons or persons incapacitated by alcohol as defined in C.R.S. § 25 -1 -301, but who would not be expected to require skilled treatment or care while in the vehicle. H. Insurance. No ambulance shall operate in the County unless it is covered by insurance as set forth in this paragraph. 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 vehicle should be liable on account of any liability imposed on it by law, regardless of whether the Ambulance was being driven 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 amounts: Statutory Worker's Compensation Insurance —4— 2. I Public Liability and Property Damage /Bodily Injury Each Person $150,000 Each Occurrence $400,000 Property Damage: Each Person $150,000 Each Occurrence $400,000 Professional Liability Coverage: Each Person $150,000 Each Occurrence $400,000 a. Proof of insurance shall be filed with the Board or the Director, along with the application for an Ambulance Service License as required in these regulations. Every insurance policy required shall contain provisions for continuing liability thereunder to the full amount thereof, 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 until a policy is revoked, the insurance company will not be relieved from liability on account of nonpayment of premiums, failure to renew License at the appropriate time, or any act or omission of the named insured. At any time said insurance is required to be renewed, proof of the renewal shall be provided to the Board or the Director. The motor vehicle insurance shall be a complying policy as defined in C.R.S. § 10-4 -703. b. A certificate of insurance, with the Board named on the certificate holders copy, shall indicate the vehicles covered by the policy, type of insurance (vehicle, professional liability, etc.), policy number(s), policy effective date, policy expiration date, amount of coverage, and contain a provisions that thirty (30) days prior written notice of any cancellation or termination or revocation of said insurance policy shall be given to the Board and the Director. C. Any changes in the status of vehicles listed on the certificate of insurance during the licensing cycle shall be noted on a new certificate of insurance and forwarded to the Board or the Director within thirty (30) days of the changes. d. Written notification to the Board or the Director of any changes in insurance shall be made within thirty (30) days of such changes, to be followed with a certificate of insurance as outlined herein. The Board may require additional proof of insurance at any time needed in order to promote the health, safety and welfare of the inhabitants of the County. —5— e. Ambulances must prove, as part of the application procedure, that the necessary vehicular liability insurance is in place in accordance with C.R.S. 10-4 -703, Motor Vehicle "No Fault" Insurance. This requirement includes certain required coverages described in C.R.S. 10 -4 -706 and is tempered by the provisions of the Governmental Immunity Act (C.R.S. 24- 10-101 et sec.) in the case of a local government ambulance provider. Ambulance Specification Ground vehicles obtained, licensed and placed in use as Ambulances shall at the minimum, meet the guidelines as from time to time es- tablished by the State EMS Advisory Council. Variances of the above - mentioned specifications may be granted at the discretion of the Director, as approved by the Board. All Ambulances shall have the name of the Ambulance Service clearly visible on the vehicle. J. Ambulance Equipment. Each Ambulance shall contain, at the minimum, the Equipment and supplies designated by the August 1983 ACS Bulletin, as established by the State Advisory Council on Emergency Medical Services and approved by the State Board of Health, or as from time to time defined by the Board. The Equipment shall be maintained in good working order. 2. Each Ambulance shall also contain, subject to the same terms and conditions, the following: a. Emergency lighting and audible warning equipment which complies with Colorado state law for emergency vehicles. b. Safe tires and, in addition, adequate snow tires or chains when weather conditions demand. C. The capability for two -way radio communications with a dispatcher and with one or more emergency facility. d. Safety belts or other restraining devices for each Patient and all personnel. e. A functioning fire extinguisher with current annual inspection of the all purpose dry chemical type, ABC, and of the size as specified on the Equipment list. K. Inspections. The Board, through the Director, shall appoint and direct inspectors to inspect each Ambulance to be issued a Permit under a valid licence in the County once a year, or more often, if required by the Board. Such inspection shall determine that each Ambulance is being properly maintained and contains the Equipment specified in these Regulations. Maintenance records shall be made immediately available upon the Director's request. Such inspections shall be in addition to other safety or motor vehicle inspections required by law and shall not excuse compliance with any other applicable law. The Permit for each Ambulance L. shall be carried in that Ambulance and made available for inspection by the Board, its representatives or any law enforcement official. General Reoulations. 1. The Director shall be authorized to promulgate and enforce such rules and regulations as deemed 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. 2. All Ambulances shall deliver Patients to the licensed Emergency Facility of the Patient's choosing, or as directed by the Patient's physician or member of the Patient's immediate family, provided however, when the Patient's condition is determined to be emergent, the Ambulance Service shall deliver the Patient to the closest licensed Emergency Facility, or the facility as designated by the Physician Advisor. In all cases where a preference is not expressed, the Ambulance Service should deliver the Patient to the nearest appropriate licensed Emergency Facility. For the public good, in the case of Ambulances owned by public entities, previously defined boundaries of an Ambulance Service area and its delivery destination may override the Patient's choice. 3. No licensed Ambulance Service shall operate from locations other than those on file with the Director nor shall such licensed Ambulance Service abandon said location without prior notification to the Director. 4. Each Ambulance Service shall make available information concerning the transportation of Patients as specified by the Director, at the Director's request. 5. All Ambulance Services based in the County must have a Physician Advisor designated in writing. The Physician Advisor and the board of directors of the Ambulance Service shall be notified in writing by the Board or the Director of any violations of these regulations. The Ambulance Service also has an affirmative duty to notify the Director of any violations which can not be rectified immediately. 6. To the extent that an Ambulance Service based in Eagle County is subject to the ambulance certification standards of another Colorado county, it shall be the affirmative duty of the Ambulance Service to comply with said standards and provide proof of compliance to the Director. 7. An Ambulance Service operating in this County must comply with all applicable County and municipal ordinances and regulations. 8. All County licensed Ambulance Services must utilize the statewide emergency medical services uniform pre — hospital care reporting system operated by the Colorado Department of Health, EMS Division. —7— 9. The Ambulance Service is solely responsible for confirming that its personnel are properly and lawfully certified for the position(s) held within the Ambulance Service's organization. ARTICLE III: Ambulance Licenses A. Application for Ambulance Service Licenses and Ambulance Permits An application for an Ambulance Service License and Ambulance Permit shall be submitted through the Director to the Board and shall be in the form and contain the information and necessary supporting documents as prescribed by the Director from time to time. B. Licensing Fees. Licenses, Permits and renewals shall require the payment of fees in amounts, not to exceed $100, to be determined by the Director from time to time. The Board hereby waives payment of such fees for Ambulance Services operated by municipalities or special districts. C. Time of Application. Original applications must be filed prior to operation. Renewal applications shall be made at least thirty (30) days prior to the expiration of the existing Permit. Updated applications resulting from changes or additions must be filed within thirty (30) days of the change or addition. D. Issuance of Ambulance Service Licenses and Vehicle Permits Upon receipt of an application for a vehicle Permit and License to provide Ambulance Service, the Director shall review the application and the applicant's record. The Director may recommend to the Board that a resolution be passed to issue the applicant a License to operate an Ambulance Service and issue a Permit for each Ambulance passing inspection, both of which shall be valid for a period of twelve (12) months following the date of issue providing that: 1. The Ambulance Service staff, vehicle, Equipment and location comply with the requirements of these regulations; and 2. The Ambulance Service personnel are certified or possess at least the minimum qualifications set forth in these regulations. E. Ambulance Service License and Vehicle Permit Renewal Any License or Permit granted pursuant to the terms of these regulations, unless revoked by the Board, may be renewed by filing an application for renewal in the form as prescribed by the Director. Renewal applications shall be filed annually, but not less than thirty (30) days before the date the License or Permit expires. Renewal notices shall be sent by the Director to all persons and entities who currently hold a License or Permit sixty (60) days prior to expiration. However, failure to receive such notice shall not release the Permit or License holder from its responsibility for renewal of the License or Permit. If re— application is not received at least thirty (30) days prior to expiration and applicant's License or Permit expires, applicant shall cease operation until the License or Permit is reissued. 2. The procedure for approval or disapproval of applications for renewal shall be the same as for new applications. M J F. Transfer of License or Permit. No License or Permit issued by the Board shall be sold, assigned or otherwise transferred. G. Change of Ownership. Change of ownership shall require a new application and License. ARTICLE IV: Revocation and or Suspension of Permits and Licenses — Procedures and Hearings A. The Board may on its own motion or on complaint, after investigation and /or public hearing at which the Licensee shall be afforded an opportunity to be heard, suspend or revoke any License or Permit issued by the Board pursuant to these regulations and in accordance with any rules and regulations promulgated by the Director in accordance herewith. B. If appropriate, the Licensee or Permit holder shall be given the opportunity to cure any defect giving rise to violation of the licensing and permitting requirements, in the discretion of the Director. C. The Licensee shall receive written notification of any temporary suspension and a hearing shall be held no later than ten (10) days after such temporary suspension. After such hearing, the Board may suspend or revoke any License or Permit issued pursuant to these regulations for any portion or the remainder of its duration. At the end of such period, the person or entity whose License or Permit was suspended or revoked may apply for a new License or Permit as in the case of an original application. D. After a second violation or failure to comply, the Board of County Commissioners may permanently revoke the License or Permit. Suspension or revocation may result from the violation of: 1. Any provision of these regulations; 2. Any law of the State of Colorado or any ordinance or regulation of any municipality of the County (and any evidence of such violation may be considered by the Board); and /or 3. Any rules and regulations promulgated pursuant to these regulations. E. All hearings before the Board shall be public and every vote and official act of the Board shall be public. The Board has the power to administer oaths and issue sub- poenas to require the presence of persons and the production of documentation necessary to the determination of any issue at any hearing which the Board is authorized to conduct hereunder. F. Written notice of temporary suspension or revocation as well as any required notice of a hearing shall be given by certified mail, return receipt requested, to the Licensee or Permit holder at the address contained in its application and shall be effective upon mailing. —9— G. Any License or Permit may be temporarily suspended by the Board pending the prosecution, investigation or public hearing for good cause. A temporary suspen- sion shall not exceed thirty (30) days and a hearing shall be held no later than ten (10) days after such temporary suspension. H. The following practices shall be unlawful and may be grounds for a suspension or revocation of a License or Permit: Willful and deliberate failure to respond to any call in the absence of good cause shown. 2. Willful and deliberate failure to transport a Patient when required by the nature of the injury. 3. Administering unnecessary treatment or supplies to a Patient for the purpose of increasing the Patient's bill. 4. Administration of any substance considered a drug or intravenous fluid unless under direct order of a physician, either present or by radio or telephone, except as permitted by protocol. 5. Call jumping, which is defined as a response to a call for ambulance service by an Ambulance Service with the knowledge that another Ambulance Service has been notified to respond to the call or is actually responding to the call. 6. Conduct which constitutes a significant threat to the health or safety of the Patient. ARTICLE V: Miscellaneous A. Use of Sirens and Emergency Equipment 1. All emergency equipment and warning devises shall be used in accordance with all Colorado traffic statutes, rules and regulations. 2. When operating an Ambulance with red lights and siren, local law enforce- ment officials shall be notified, and neighboring jurisdictions shall also be notified prior to entering those jurisdiction. B. Negligence not Presumed: Action Necessary in the event of Legal Proceedings 1. In any legal action against a Licensee or Permit holder in which it is alleged that plaintiff's injury, illness or incapacity was aggravated by, or was otherwise injured by the negligence of the Licensee or Permit holder, no negligence shall be presumed because of such allegations. —10— 2. If a judgment is entered against a Licensee or Permit holder it shall, within thirty (30) days, file a copy of such finds and corresponding Order of the Court with the Board. The Board shall take note of such judgment for purposes of investigation and take appropriate action if there appears to be any violation of these regulations, rules and regulations promulgated pursuant hereto, or of any Colorado law or ordinance or regulation of any municipality in the County. 3. The Licensee or Permit holder shall notify the Director of any legal action pending against it. C. Violations; Penalties. Any person who violated any provisions of C.R.S. § 25 -3.5- 301 et seq. commits a class 3 misdemeanor, and shall be punished as provided in C.R.S. § 18 -1 -106. D. Remedies. These Regulations create no private remedy 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 provision of these regulations. E. No Cause of Action against the County. Failure to enforce any provision of these Regulations, or any other act of omission or commissions relating hereto, shall not subject the County, the Board, the Director or any of their respective agencies, employees, representatives or independent contractors to any liability what so ever. F. Severability. If any of the provisions of these Regulations promulgated hereunder are determined to be invalid, such determination shall not affect the remaining provisions of the Regulations. —11—