HomeMy WebLinkAboutR20-011 Ambulance Licensing Standards Commissioner W-A-4-41Z—I2— moved
adoption of the following Resolution:
BOARD OF COUNTY COMMISSIONERS
COUNTY OF EAGLE, STATE OF COLORADO
RESOLUTION NO 2020- 0
A RESOLUTION CONCERNING AMBULANCE LICENSING STANDARDS
WHEREAS,the General Assembly of Colorado enacted the Colorado Emergency
Medical and Trauma Services Act, C.R.S. § 25-3.5-101 et seq.; and
WHEREAS,the Act requires the Board of County Commissioners (the "Board") to
adopt by resolution rules and regulations governing licensing ambulance services and emergency
services personnel; and
WHEREAS,the Board has previously adopted ambulance licensing standards including
via Resolutions 2007-052 and 2015-56; and
WHEREAS,the Board now wishes to supersede the previously-adopted ambulance
licensing standards with those attached hereto as Exhibit A.
NOW, THEREFORE,BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISIONERS OF THE COUNTY OF EAGLE, STATE OF COLORADO:
THAT,the Board hereby adopts the Emergency Medical Services Ambulance Licensing
Standards attached hereto as Exhibit A, which supersede any and all ambulance licensing
standards previously adopted by the Board.
THAT,the Board finds that this Resolution is necessary for the public health, safety, and
welfare of the citizens of the County of Eagle, State of Colorado.
[Signature Page to Follow]
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MOVED, READ,AND ADOPTED by the Board of County Commissioners of the County
of Eagle, State of Colorado,at its regular meeting held the IV-day of February, 2020.
COUNTY OF EAGLE, STATE OF
COLORADO, By and Through Its
BOARD OF COUNTY COMMISSIONERS
srosi\or
ATT .T:
'lo the Board of .thy andler-Henry
County Commissioners Chair
IV CIA 3
J ne McQueeney
Commissioner
Matt Sc -.2--
Commissioner
Commissioner 1440 seconded adoption of the foregoing resolution. The roll
having been called, the vote was as follows:
Commissioner Chandler-Henry 4.14
Commissioner McQueeney
Commissioner Scherr
This resolution passed by 1 vote of the Board of County Commissioners of
the County of Eagle, State of Colorado
EXHIBIT A
EMERGENCY MEDICAL SERVICES
AMBULANCE LICENSING STANDARDS
ARTICLE I: AUTHORITY,PURPOSE AND INTENT
A. These Standards are adopted pursuant to the authority granted the Board of County
Commissioners ("Board") under the Colorado Emergency Medical Services Act, Section 25-3.5-
101, et seq., C.R.S. ("EMS Act"), and Section 30-11-107(1)(q), C.R.S. The Board finds that the
emergency transportation of sick, injured, or otherwise incapacitated or helpless persons is a
matter closely affecting the public interest and welfare and declares that it is in the best interest
of the public health, safety and welfare, and in accordance with the law, that these Standards be
adopted.
B. The purpose of these Standards is to set forth the requirements for the inspection,
licensure, and operation of ambulance services, ambulance personnel, and ambulance vehicles
operating in Eagle County pursuant to the EMS Act.
C. Nothing in these Standards shall be construed to create a cause of action or civil remedy in
any party. These Standards shall not be construed to create a duty to any party where no such
duty otherwise existed. It is the,express intent of the Board that any party receiving services or
benefits under these Standards' h&ll be deemed to be an incidental beneficiary only.
D. If any of the provisions of these Standards are determined to be invalid, such
determination shall not affect the remaining provisions of these Standards.
ARTICLE II: DEFINITIONS
Where indicated, certain terms used in these Standards are defined in Colorado State Board of
Health Rules pertaining to Emergency Medical Services: 6 CCR 1015.3 Chapter 1 Section 2 and
Chapter 4 Section 2.
Other Definitions:
A. "Accredited": means any licensed ambulance service that holds a valid certificate of
accreditation from the Commission of Accreditation of Ambulance Services (CAAS) or the
Commission on Accreditation of Medical Transport Systems (CAMTS).
B. "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."
C. "Ambulance —advanced life support": A vehicle equipped in accordance with Chapter 4
Section 3.4.2 of the rules pertaining to Emergency Medical Services, 6 CCR 1015-3, 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 by the Emergency Medical Practice
Advisory Council (EMPAC) in Chapter 2, 6 CCR 1015-3.
D. "Ambulance — basic life support": A vehicle equipped in accordance with Chapter 4
Section 3.4.2 of the rules pertaining to Emergency Medical Services, 6 CCR 1015-3, 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
by the Emergency Medical Practice Advisory Council (EMPAC) in Chapter 2, 6 CCR 1015-3.
E. "Authorized Representative": The Public Health Manager, as designated by the Director
of Eagle County Public Health and Environment. This individual is responsible for coordinating
the licensure of ambulances and the administration of these standards.
F. "Based": An ambulance service headquartered, having a substation, office ambulance
post or other location in the county.
G. "Board": Means the Board of County Commissioners for Eagle County.
H. "Council": State Emergency Medical and Trauma Services Advisory Council (SEMTAC)
I. "County": Eagle County
J. "Department": Colorado Department of Public Health&Environment(CDPHE).
K. "Director": The Director of Eagle County Public Health and Environment.
L. "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 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.
M. "Emergency": Actual or self-perceived event that threatens life, limb or well-being of an
individual in such a manner that immediate medical care is needed.
N. "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.
0. "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
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direct medical supervision by a licensed physician; or an emergency facility with a licensed
physician who responds on an on-call basis.
P. "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.
Q. "Licensee": The legal entity that has been issued a license by the appropriate authority to
provide ambulance service in the County.
R. "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.
S. "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.
T. "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.
U. "To Operate in Eagle County": The providing of Ambulance service or transport of
patients within the boundaries of Eagle County.
ARTICLE III: APPLICABILITY
A. County License and Permit Required. Unless excepted pursuant to subsection B,
below, all ambulance services operating within Eagle County require a county license and all
ambulances operating within Eagle County require a county permit.
B. Exceptions to Requirements for Licenses and Permits. Licenses and permits are not
required for 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, and is 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 in an emergency to assist by an ambulance service
licensed in Eagle County.
C. Penalty for non-compliance: Ambulance agencies that operate in the county in violation
of any provision herein are subject to revocation and suspension as set forth in Article V herein.
Additionally, failure to operate in the county without a valid license is a class 3 misdemeanor
pursuant to C.R.S. §25-3.5-306.
ARTICLE IV: LICENSES AND PERMITS
A. Ambulance Service License Type: The County recognizes 2 forms of licensure for
ambulance services operating within Eagle County:
1. Class A License: An unrestricted license for an ambulance service that is
approved under subsection(B)(3), below.
2. Class B License: A restricted license for an ambulance service that is approved
under subsection (B)(4), below.
B. Processes and Criteria for Ambulance Service Licenses
1. Service Area. The Board finds that in order to protect the health,public safety and
welfare of the citizens and visitors to the county that duplication of services within areas served
by existing licensed providers should be avoided. The Board desires mutual cooperation and
coordination among providers.
2. Application Standards. All ambulance services wishing to operate in Eagle
County must submit an application for an ambulance service license to the County. All
applications must contain the following information, supporting documents, and application fees:
a. Type of license, either 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.
b. The name, address and telephone number(s) of the owner of each ambulance.
c. The name, address and telephone number(s) of the person applying for the
license, hereinafter referred to as the applicant.
d. The name, address and telephone number(s) of the person who will be in
charge of the operation of the ambulance service.
e. Accreditation certificate and type of accreditation including date of renewal
and last inspection by accrediting body.
f. 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.
g. The trade or other name, if any, under which the applicant does business or
proposes to do business.
h. Completed ambulance vehicle permit application for every ambulance to be
used by the applicant in providing service in the County.
i. The location and description of the place or places from which it is intended to
operate the ambulance service or a copy of the District boundaries if applicant
is a Title 32 Special District.
j. 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
Standards.
k. The area to be served by the ambulance service.
1. The name, address and telephone number(s) of the ambulance service medical
director.
m. Attestation by the medical director of willingness to provide medical oversight
and a medical continuous quality improvement program for the ambulance
service.
n. 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
sufficient to demonstrate the ambulance service's ability to operate and
respond within the area to be served.
o. 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.
p. Certificates of insurance as required by these Standards.
3. Issuance of a Class A License. Upon receipt of a complete application for a Class
A license to provide ambulance services,the Board, or its designee, shall review the application
and the applicant's record. For purposes of these Standards,the Eagle County Public Health
shall be the Board's designee for the holding hearings and issuing licenses. Notwithstanding the
foregoing, the Board may determine to hear any new license application upon notice to its
designee.No license shall be granted unless the application demonstrates complete compliance
with all requirements of these Standards, supplies adequate documentation on need for the
service, 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 Standards.
a. Approval Processes. Services may be granted a license under subsection (b)or
(c),below. Notwithstanding, no license will be granted unless the applicant
demonstrates that the service will provide an overall advantage to the
residents of Eagle County in terms of ensuring quality and cost-effective
ambulance service.
b. Review and Hearing. The Board may find after a public hearing to allow input
from interested parties that, in its discretion, a Class A License is appropriate
after considering the level of compliance of the proposed service with the
following, along with any other information it deems relevant in determining
to grant a Class A license:
i. The boundaries of the area to be served;
ii. The efforts toward coordination and any resulting
cooperative agreements with existing providers within the
area to be served;
iii. The sufficient existing or projected need for additional
service in the proposed area to be served and the proposed
impacts to existing providers;
iv. Whether the proposed ambulance service is capable of
providing economical and sufficient service to the proposed
area that enhances the overall cohesive provision of
services in Eagle County;
v. The proposed service to be provided, including what
proportion of Emergency Calls generating from the 9-1-1
center and interfacility transports in the area are to be
.made; and
vi. Whether the Application Standards in Article IV(B)(2)
have been met.
c. Reciprocity
i. Eagle County Public Health and Environment may issue a
Class A ambulance service license and ambulance permits
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 Standards.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
Standards.
ii. Based on the Board's 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 obtain a license
to operate within those portions of the Roaring Fork Fire
Authority that are within the jurisdiction of Eagle County.
4. Issuance of a Class B License
a. Administratively Approved Licenses.
Special Service Limited License. The Eagle Public Health
Department may administratively issue a Class B license
upon demonstration that the operator provides a specialty
service that the local licensee cannot provide within the
scope of practice of the service per waivers or Chapter 2 of
6 CCR 1015-3.
ii. Standby and Special Event Limited License. The Eagle
County Health Department may administratively issue a
Class B license to operate for a specific time period for
special event or standby coverage for an entity that meets
the criteria for licensure and files an application with the
Eagle County Public Health and Environment no later than
thirty(30) days prior to event. Due to the expedited review
of such limited licenses,the county shall assess an
additional fee for issuing such license.
iii. Requirements for Limited License Holders. A Limited
License holder shall comply with all requirements,
including the requirements for inspections, contained
within these Standards. The provider must demonstrate that
it:
I. Substantially meets these Standards;
II. Is licensed in another jurisdiction with
adequate licensing standards in the
discretion of Eagle County;
III. Is accredited by the CAAS; or
IV. Can otherwise perform the service in a
manner at least equivalent to the
Standards contained herein.
b. Conditions on Class B Licenses.
Class B licensees shall transport less than 25 patients per
calendar year or provide standby service less than 5 times
per year. If a Class B licensee exceeds these limits, they
must apply for a Class A License and are subject to all
restrictions and requirements for Class A licensing.
ii. The licensee must be licensed and in good standing in
another county in the State of Colorado.
iii. The licensee is subject to inspection at the discretion of the
Eagle County Department of Health.
5. Renewal and Issuance of Ambulance Service License.
a. Renewal. Unless revoked by the Board, any license issued by the County
may be renewed by submitting to Eagle County Public Health and
Environment 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, the County
shall issue a temporary suspension notice and the applicant shall cease
operation until license is reissued. If re-application is timely received,
license will not be suspended pending administration and completion of
the renewal process.
b. Issuance. License renewals shall be issued administratively unless
Eagle County Public Health and Environment or the applicant requests a
full hearing. The Board shall review the application,the applicant's record
and hold a public hearing to allow input from interested parties. 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 Standards.
C. Processes and Criteria for Ambulance Vehicle Permits. Ambulance Vehicle Permits
will be issued administratively.
1. Applications. An application for an ambulance permit shall be submitted to Eagle
County Public Health and Environment and must contain the following
information, supporting documents and application fees, if any:
a. 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.
b. The name, address and telephone number(s) of the owner of the
ambulance.
c. The name, address and telephone number(s) of the person applying for the
license, hereinafter referred to as the applicant.
d. The trade or other name, if any, under which the applicant does business
or proposes to do business.
e. A description or photographs 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.
f. 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 Standards.
g. Certificate of inspection by a qualified mechanic.
2. Issuance. Eagle County Public Health and Environment 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 Standards.
D. Transfer of License or Permits.No license or permit issued by the County shall be sold,
assigned, or otherwise transferred.
E. Change of Ownership. A change of ownership requires 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 Standards. Any change of ownership of any transfer of stock ownership of ten percent
(10%) or more shall be reported in writing to Eagle County Public Health and Environment
within thirty(30)days of such change or transfer.
ARTICLE V: REGULATIONS
A. Ambulance Service License Required. No person shall provide ambulance service,
publicly or privately, in Eagle County unless that person or firm holds a valid license or unless
exempt pursuant to these Standards.
B. Ambulance Crew Members. No patient shall be transported in an ambulance operating
in the County unless the ambulance is staffed by a person certified as an EMS Provider as
defined in the Rules Pertaining to EMS Education and Certification at 6 CCR 1015-3, Chapter
One. The minimum requirement for the ambulance driver shall be a valid driver's license.
C. Ambulance Equipment. Each ambulance shall contain all equipment, as adopted by the
agency, which includes the minimum equipment requirements established by the Colorado
Department of Public Health and Environment 6 CCR 1015-3 Chapter Four, Section Nine.
Equipment must be kept in good working order at all times.
D. Ambulance Permit. No ambulance shall be operated within the County unless a permit
has been issued as provided herein. This includes operations including, without limitation,
responding to 911 calls, standby for special events and interfacility transports from any health
facility, free standing emergency department, skilled nursing facility, long term care facility,
clinic or urgent care. Health facilities are defined in 6 CCR 1011-1 Chapters Two — Twenty-
five.
E. Ambulance Specifications. Ambulances permitted by the County prior to the effective
date of these Standards 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. For all ambulances:
1. Each ambulance shall clearly display permanent markings on both sides showing
the name of the ambulance service under which they are licensed.
2. Each ambulance shall be maintained at all times in a safe operating condition and
in compliance with Colorado motor vehicle statutes, rules or Standards. 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.
F. General Requirements.
1. All ambulance services shall have an ongoing medical continuous quality
improvement program consistent with the requirements established by the
Department 6 CCR 1015-3 Chapter Two or its successor.
2. Each ambulance service licensed in the County shall complete a patient care
report and transmit said records to CDPHE in the prescribed method including the
minimum prehospital care data set described in 6 CCR 1015-3 Chapter Three, or
its successor, for each patient assessed and each call received.
3. Each ambulance service licensed in the County shall complete and submit an
agency profile to the Department per 6 CCR 1015-3 Chapter Three, or its
successor, on an annual basis.
4. 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.
5. 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.
6. All ambulance services licensed by the County are required to agree to and
comply with all provisions of these Standards, or any amendments thereto, any
other conditions pertinent to the license reasonably imposed by the Board, all
rules, Standards 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 Standards 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 Standards.
G. 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 of thereunder to the full amount,
notwithstanding 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 of omission
of the insured unless the policy is canceled, terminated or revoked with
appropriate written notification as required in these Standards.
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:
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. Proof of insurance
shall be filed with the County with the application for an ambulance service
license as required in these Standards. 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 with thirty (30) days of the
changes.
4. Each ambulance service shall provide written notice to all personnel regarding the
amount of professional liability insurance the ambulance service carries.
Ambulance services 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.
5. 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. The
requirements herein may be satisfied through an umbrella policy acceptable to
Eagle County containing equivalent or greater amounts.
H. Inspections Required.
1. The designee of Eagle County Public Health and Environment will 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 Standards. 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 Standards.
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.
2. Any inspection necessary for application or renewal must be completed prior to
the acceptance of the application or renewal application.
3. New vehicles shall be inspected prior to the vehicle being operated and used in
the course of providing emergency medical services.
4. 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.
5. Inspections may be waived if the service is accredited and the determination is
made that an inspection need not occur. This does not waive the right of the
county to inspect any vehicle, records or service at any time.
Inspection Items. The following shall be available for inspection:
1. Personnel List. The ambulance service shall maintain a list of all emergency
personnel who may be called upon to respond to an emergency with the
ambulance service. This list shall include complete name, address, date of birth,
and current training level.
2. Personnel Qualifications. 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 a copy of a current Colorado Emergency Medical Technician
certificate, Colorado Paramedic certificate or license, or a First Responder course
completion certificate; Cardiopulmonary Resuscitation card issued a nationally-
recognized training program; an Advanced Cardiac Life Support card issued by a
nationally-recognized training program, if applicable; and a copy of a valid
Colorado driver's license.
3. Protocols. Complete copy of the ambulance service's medical treatment protocols.
A copy shall be provided to the Board upon request.
4. Accredited Agencies. If the ambulance agency is accredited, they shall supply the
certificate and have available any findings or deficiencies from last inspection by
the accrediting body. If the licensee is in good standing, there shall not be an
inspection by Eagle County Public Health and Environment unless it is
determined that such inspection take place.
J. Medical Direction. All ambulance services shall have a medical director meeting the
requirements established by 6 CCR 1015-3 Chapter Two. The medical director shall be
notified in writing by the Board, or their authorized representative, of any violations of
these Standards 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.
K. Standby and special event coverage. No person or agency, private or public, shall
transport a patient from any point within Colorado in an ambulance unless that person or
agency holds a valid license and permits issued by the county where the service is based
and where the patient originates. Accordingly, no ambulance agency may operate for
the sole purposes of providing event standby or special event coverage in the County
without a limited license permit to operate for the time period expressed in the
application.
ARTICLE VI: COMPLAINTS
A. Origination of Complaints: Alleged violation of these Standards by a licensed or
unlicensed 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 Standards 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 Standards shall not be presumed based on the action. If the action results in a suspension or
revocation of the 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 Standards and has sufficient foundation to warrant a complete
investigation. Any apparent violation of these Standards 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 Standards.
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
Standards 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 Standards 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 Standards or that the licensee
has cured the violation. If an unlicensed ambulance service or vehicle is found to be operating in
the county, the Board may also report them to the county in which they are licensed and to the
Department.
ARTICLE VII: 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 Standards upon a determination that a violation of these Standards 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 a determination
that a violation that poses an 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.
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 Standards 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 Standards 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 VIII: MISCELLANEOUS PROVISIONS
A. Severability. If any provision of these Standards is found by a court of competent
jurisdiction to be invalid, the remaining provisions of the Standards shall continue in full force
and effect.
B. No Third Party Beneficiary. Nothing in these Standards shall be construed to create a
cause of action and/or civil liability remedy in any person. These Standards 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
Standards shall he deemed to be an incidental beneficiary only.
C. Amendment. The Board reserves the right to amend these Standards, and to impose any
individual conditions of licensing to any license as needed to protect health, safety, and welfare;
in keeping with the Board's legislative function; and in order to implement the policy of the State
of Colorado that the regulation and control or ambulance licenses is in the exclusive purview of
the Board