Ordinance No. 2575 (Word Version)

ORDINANCE NO. 2575

AN ORDINANCE CREATING SECTIONS 12-12 THROUGH 12-20 OF ORDINANCE NO. 2575 PROVIDING FOR AMBULANCE SERVICES IN THE CITY OF GRAND JUNCTION.

WHEREAS, the City Council for the City of Grand Junction finds that an efficient Emergency Services Systems dedicated to the provision of emergency intervention to the City of Grand Junction is necessary and important, and

WHEREAS, the Fire Department maintains emergency response units and personnel throughout the City, the Grand Junction Rural Fire Protection District and areas of Mesa County covered by mutual aid agreements, and

WHEREAS, the City desires to ensure the continued quality and availability of emergency medical response and transportation of patients who require emergent care, consistent with good health and safety practices;

NOW, THEREFORE, IT IS HEREBY ORDAINED BY THE CITY COUNCIL OF THE CITY OF GRAND JUNCTION, COLORADO THAT:

12-12 Sec. 1. Purpose: The purposes of this chapter are to:

1. Enact formal policies and regulations for licensing and regulating the operation of ambulances;

2. Protect the public by assuring that ambulances operate safely;

3. Protect the public from unsafe and unsanitary operation of ambulances;

4. Allow for adequate emergency ambulance service and nonemergency ambulance services in all areas of the City; and

5. Allow for the orderly and lawful operation of a local emergency medical services system.

Sec. 2. Exemptions:

1. This division shall not apply to:

a. Vehicles operated as ambulances and to persons engaged in ambulance service where ambulance services are rendered at the request of any law enforcement or fire protection agency during any state of war emergency, state emergency or disaster or local emergency or disaster or during nay period when the City determines that adequate emergency ambulance service is not available from existing permittees.

b. This chapter shall not prevent any peace officer, fire fighter or physician licensed to practice medicine in this state from arranging for the transportation of an individual in need of emergency medical care when no ambulance with an appropriate ambulance service permit is available and such transportation is required immediately for the preservation of life or to avoid substantial impairment of the patient's physical or mental condition.

Sec. 3. Standard Operating Procedures Manual:

The City Council shall adopt, by resolution, a Standard Operating Procedures Manual. The Fire Chief may amend or add to these procedures as may be necessary from time to time to carry out the intent of said Standard Operating Procedures. One certified copy of such Manual, with the most recent amendments, shall be filed with the City Clerk. Additional copies shall be kept in the office of the Fire Chief for review by the general public. Ambulance permittees shall receive one copy of the Standard Operating Procedures Manual. The Standard Operating Procedures Manual shall have the force and effect of law with respect to all ambulance operators, drivers and attendants.

Sec. 4. Ambulance Station Location:

1. All new ambulance station locations shall be approved by the Fire Chief or his designee prior to commencing operations.

2. Each ambulance station shall be equipped with all communication equipment as required by the Standard Operating Procedures Manual, adopted pursuant to 12-12 Sec. 3 of this Ordinance.

12-13 General Definitions:

Unless otherwise specifically provided, or required by the context, the following terms have the meanings set forth:

Ambulance: A vehicle specially constructed, modified or equipped and used for the purpose of transporting sick, injured, convalescent, infirm or otherwise incapacitated persons. Ambulance does not include the non-emergency transportation of persons confined to wheelchairs.

Ambulance Service: The furnishing, operation, conduct as, maintaining, advertising or otherwise engaging in or professing to be engaged in the transportation of patients by ambulance. Also including, but not limited to the person so engaged or professing to be so engaged.

Ambulance Service Permit: Is written authorization by the City to an ambulance service to provide ambulance service within the City.

Ambulance Station: The premises (including living quarters) located within the City from which the ambulance service provides service.

Base Hospital: The source of direct medical communications with and responsible for the supervision of the field emergency care performance by emergency medical technicians, emergency medical technician intermediates, and or paramedics.

Basic Life Support (BLS): Pre-hospital medical intervention delivered by emergency medical technicians. Field patients care providing basic treatment and stabilization of ill or injured patients.

Designated Dispatch Center: The Grand Junction Regional Communication Center which is responsible for 9-1-1 Emergency Services Telecommunications and who dispatches emergency personnel and equipment.

Emergency Call: (Also may be referred to as an emergent call) is a request for an ambulance to transport or assist persons in apparent sudden need of medical attention or in medical emergency, or to transport blood or any therapeutic device, accessory to such device, tissue or organ.

Emergency Medical Services (EMS): Any actual or self-perceived event which threatens life, limb or well-being of an individual in such a manner that a need for immediate medical care is created. Medical services provider means any agency that provides a medical service or medical treatment, at either BLS level or ALS level and or provides transportation of patients. Emergency medical services also includes the transportation of a patient, regardless of the presumption of death, or transportation of a body for the purpose of masking an anatomical gift.

Emergency Medical Technician Intermediate: Means certified technician between the level of Paramedic and EMT-B. This classification is not to be equated to that of paramedic, nor is it comparable to an EMT-B.

Emergency Response List: Is the official list maintained by the designated dispatch center of permittees who possess an emergency ambulance service permit.

Grand Junction City Council: A body politic serving as the governing body of and for the City of Grand Junction.

License: Means authorization issued by the Board of County Commissioners to operate an ambulance service, publicly or privately within Mesa County, Colorado.

Non-Emergency call: (Also may be referred to as Non-emergent) refers to calls which require routine medical services in conjunction with transportation, e.g., patient transfer from hospital to nursing home.

Physician Advisor: A physician (M.D. or D.O.) currently licensed by the State of Colorado, who establishes protocols for medical acts performed by emergency medical services personnel and who is specifically designated and responsible to assure the competency of the performance of those acts by EMS personnel, in accordance with applicable rules of the Colorado Board of Medical Examiners.

Private Call: Is any call received by the ambulance service directly from a private party requesting services.

12-13 Sec. 1. Permits Required:

No person (either as owner, agent or otherwise) shall furnish, operate, conduct, maintain or otherwise engage in or advertise, offer or profess to engage in ambulance service unless the person holds (and is entitled to hold) a currently valid ambulance service permit. No permit is required for ambulance services that are transporting patients to or through the City which do not have their principal service area in Mesa County.

Sec. 2. Application Form:

Each application for an ambulance service permit shall be made on the form required by the Fire Chief or his designee.

Sec. 3. Application Information:

1. Each applicant who desires an ambulance service permit shall submit the following information:

a. The name(s) and address(es) of the applicant(s), registered owner(s), partner(s), officer(s), director(s) and controlling shareholder(s) if a corporation, sole proprietorship or partnership.

b. The name under which the applicant does or proposed to do business.

c. A description of each ambulance including the make, model, year of manufacture, vehicle identification number and color scheme, insignia and other distinguishing characteristics of the vehicle.

d. A statement that the applicant owns or has under his control, in good operating condition, required equipment to consistently provide ambulance service and that the applicant owns or has access to suitable facilities for maintaining his equipment in a clean and sanitary condition.

e. A description of the company's program for maintenance of its vehicles.

f. A description of the number and type, frequency and line codes of the vehicles radios.

g. A description of the location (s) from which ambulance services will be provided.

h. A list, amended as required during the year for any personnel changes, giving the name and a description of the training for each ambulance attendant and driver and a copy of each certificate or license held establishing the qualifications of the ambulance personnel.

i. A description of the company's training and orientation programs for all attendants, dispatchers, drivers and the provisions for continuing education of the advanced life support personnel.

j. All service charges and rate structure of the company.

k. The number of advance life support units deployed on each shift.

l. Evidence of insurance coverage as required by the State of Colorado and this Ordinance.

m. The applicant may be required to submit such other information as the Fire Chief or his designee deems necessary for compliance with this section.

Sec. 4. Application Investigation:

Upon receipt of a completed application and the required fee, the Fire Chief or his designee, shall make or cause to be made an investigation to determine if:

1. The applicant meets the requirements of this Ordinance and other applicable laws and regulations, and

2. That the radio equipment listed by the applicant is in good working order and is integrated with the existing communications system.

Sec. 5. Issuance:

Within ninety (90) days of receipt of an application, the Fire Chief or his designee, shall make a determination on (1) whether the applicant meets all requirements of this Ordinance and (2) whether the public health, safety and welfare require the granting of the permit. In making such determination the Fire Chief or his designee, shall consider, among other things, the demand and necessity for ambulance service, whether the applicant is able to provide service, whether the applicant has knowingly made false statements of fact in his applicant and whether under this Ordinance the applicant was previously a holder of a permit issued under this Ordinance which has been revoked or not renewed based on violations of the law, this ordinance or otherwise.

Sec. 6. Denial:

If it is determined that the applicant does not meet all requirements of this ordinance, then the Fire Chief or his designee shall deny the application and notify the applicant in writing within ninety (90) days of receipt of the application.

Sec. 7. Appeal From Denial of Issuance:

Whenever the Fire Chief or his designee denies an application the applicant may request a hearing before the City Council at which the applicant will have the opportunity to appeal the decision of denial. The appeal hearing shall be scheduled within thirty (30) days of the applicant's written request for said hearing.

Sec. 8. Finality of Decision:

The decision of the Fire Chief or his designee rendered pursuant to this application process shall be final unless appealed to the City Council within thirty (30) days after a decision is rendered in writing and notice is given to an applicant by certified mail.

Sec. 9. Term:

Permits shall be continued upon payment of the annual renewal fee unless earlier suspended, revoked or terminated.

Sec. 10. Existing Ambulance Service Application:

Within sixty (60) days of the effective date of this Ordinance, the ambulance companies that have been continuously operating for a minimum of 180 days prior to the effective date of this Ordinance, may apply for and obtain an Ambulance Service Permit. The Fire Chief or his designee shall issue or deny a permit to each existing company within sixty (60) days of receipt of an application for such permit based upon their ability to meet the requirements as set forth in this Ordinance. The fee for the initial permit for existing companies shall be the fee set for new applicants.

Sec. 11. Change of Information:

The applicant and or permittee shall report to the Fire Chief or his designee any change in the information required in 12-13 Sec. 3 within ten (10) days of the effective date of the change.

Sec. 12. Transfer of Permit:

No permit shall be transferred to another person except upon prior approval of the Fire Chief or his designee. Application for transfer of any permit shall be subject to the same terms, conditions, and requirements as if the application were for a new permit.

Sec. 13. Renewal of Permit:

Permittees shall annually file an application for renewal on a form furnished by the Fire Chief or his designee, which forms shall include information required by 12-13 Sec. 3. The renewal application shall be accompanied by a renewal fee.

12-14 Fees

The City Council shall set all fees by resolution. The fees shall not exceed the reasonable cost of administrating this Ordinance and providing for the orderly provision of emergency medical services.

12-15 Personnel and Equipment Standards

Sec. 1. Any ambulance driver utilized by a permittee shall be at least eighteen (18) years of age, shall be trained and competent in the proper use of all emergency ambulance equipment, shall hold current certification as an Emergency Medical Technician B and shall demonstrate compliance with all applicable laws and regulations.

Sec. 2. The permittee shall provide a minimum of one (1) paramedic, trained and competent in current ALS paramedic techniques for ALS equipped ambulances. Each permittee shall provide a minimum of one (1) ALS staffed and equipped ambulance and one (1) ALS equipped ambulance, twenty four hours per day. Each permittee shall provide and operate a minimum of one (1) backup ambulance. The backup ambulance shall be ALS equipped and shall respond in the event of mechanical failure of the primary ALS unit.

Sec. 3. Every ambulance driver, attendant, EMT or paramedic utilized by a permittee shall hold a certificate from the State of Colorado or an otherwise accredited training program indicating successful completion of their respective training.

Sec. 4. Each person providing ambulance service subject to permit under this Ordinance shall staff each ambulance with required minimum personnel who shall wear clean uniforms, be neat and comply with the Standard Operating Procedure requirements of this Ordinance.

Sec. 5. Each permittee shall provide and maintain, at it's own expense, a communication system meeting the requirements of the Fire Chief, or his designee, and the Standard Operating Procedures promulgated under this Ordinance.

Sec. 6. Each permittee providing ambulance service under this Ordinance shall assign at least one person to be responsible for receiving calls and dispatching ambulances for non-emergency calls. Permittees shall provide such services on a twenty-four (24) hour basis and shall train the dispatcher, in accordance with a curriculum developed by the Fire Chief or his designee, to be able to operate radios and handle calls according to established protocols.

12-16 Vehicle Compliance

Sec. 1. Every ambulance shall be authorized and inspected by the Fire Chief or his designee and shall meet the requirements of this Ordinance and all other applicable City, County and State laws, rules and regulations.

Sec. 2. The permittee shall allow the Fire Chief or his designee to inspect, on a preannounced or unannounced basis, all ambulances used to provide ambulance service. The inspection should be held, whenever possible, during normal business hours. The purpose of such inspections may include, but shall not be limited to, determining if:

1. the ambulances are properly maintained and equipped for the provision of ambulance service pursuant to Standard Operating Procedures;

2. the description of the ambulances required by 12-13 are accurate;

3. the ambulances contain radios that are in good working order and that the radios are of correct and compatible frequencies with the emergency medical communications system in accordance with the Standard Operating Procedures Manual.

12-17 Permit Suspension or Revocation

Sec. 1. The Fire Chief or his designee may suspend or revoke an ambulance service permit for failure to comply and maintain compliance with, or for violation of, any applicable provisions, standards or requirements of State law or this Ordinance or of any regulations promulgated hereunder. The Fire Chief or his designee may suspend or revoke a permit if (1) the permittee fails to make and retain records showing its non-emergent/private call dispatches or (2) the permittee accepts an emergency call when it is either unable or unwilling to provide the requested service or fails to inform the person requesting service of any delay and fails to obtain the consent of such person before causing an ambulance to respond from a location more distant than the one to which the request for service was directed. Suspension is not a condition precedent to revocation.

Sec. 2. Before suspension or revocation, the Fire Chief or his designee shall give written notice by United States mail, postage prepaid, return receipt requested, to the permittee specifying why such action is contemplated and giving the permittee a reasonable time (not less than seven (7) or more than thirty (30) days) to comply with the provisions in question or to show cause against suspension or revocation and setting a hearing thereon.

Sec. 3. At the hearing the Fire Chief or his designee has the burden of proof and may present evidence as to why action should be taken and to answer the evidence presented by the permittee.

Sec. 4. The Fire Chief may reduce the period of time for compliance under a suspension or revocation notice to no less than twenty-four (24) hours and s et the matter for hearing immediately upon expiration of twenty-four (24) hours when the Fire Chief or his designee makes written preliminary findings that such action is necessary to protect the health, safety and welfare. When as a result of such an emergency proceeding a permit is suspended or revoked the permittee will have the burden of establishing renewed compliance justifying reinstatement of the permit. Such additional hearing will be commenced within five (5) days of the permittees request. The request for, or the scheduling of an additional hearing shall not stay the operation of the suspension or revocation order.

Sec. 5. In hearings conducted pursuant to this Ordinance evidence must be relevant, noncumulative and of such nature as to be reliable. As far as practicable the hearing shall be controlled by the Colorado Rules of Evidence and the Colorado Rules of Civil Procedure.

Sec. 6. Hearings conducted pursuant to this Ordinance shall be conducted before a hearing officer designated by the City Manager. The hearing officer may issue subpoenas for the production of documents or the attendance of witnesses. The hearing officer shall keep a record of the proceedings either by electronic or stenographic means. At the conclusion of the hearing, the hearing officer shall promptly prepare a written summary of the evidence and findings and conclusions for consideration by the Fire Chief or his designee. The parties shall equally bear the expenses of the hearing officer and the cost of the hearing. Each party shall bear its own expenses and costs.

Sec. 7. The hearing officer shall issue a written decision within thirty (30) days of the conclusion of the hearing.

12-18 Miscellaneous

Sec. 1. Renewal of an ambulance service permit shall require conformance with all requirements of this Ordinance as upon issuance of an initial permit. Nothing in this paragraph or otherwise contained in this Ordinance shall be construed as requiring the granting of a permit upon expiration of a previous permit and the burden of proof respecting compliance with all the requirements of entitlement to a permit shall remain at all times with the applicant for renewal.

Sec. 2. No ambulance service permittee under this Ordinance shall announce, advertise, offer or in any way claim that:

1. it provides emergency ambulance service unless it possesses a current and valid ambulance service permit and

2. is staffed and provides paramedic service level care for emergency response calls.

Sec. 3. The permittee shall obtain and keep in force during the term of said ambulance service permit, comprehensive automobile liability insurance and professional liability insurance issued by a company licensed to do business in the State of Colorado, insuring the owner against loss by reason of injury or damage that may result to persons or property from negligent operation or defective construction of such ambulance, or damage that may result to persons or property from violation of this Ordinance or any other law of the State of Colorado or of the United States. The comprehensive liability policy shall be in the sum of not less than one million dollars ($1,000,000.) for combined single limit bodily injury and property damage. Workers Compensation Insurance shall be carried covering all employees of the permit holder. Before a permit is issued, copies of policies or certificates evidencing such policies, shall be filed with the Fire Chief or his designee. All polices shall contain a provision requiring thirty (30) day notice to be given to the Fire Chief or his designee prior to cancellation, modification or reduction in the limits of coverage. Required policies of insurance shall contain an endorsement naming the City as an additional insured. The required policy(ies) of insurance shall provide that the City is indemnified, defended and held harmless from and against all costs, expenses and liability arising out of, or based upon, any and all property damage or damages for personal injury, including death, which results or is claimed to have resulted from any act or omission on the part of the ambulance service provider or the ambulance service providers agents or employees.

Sec. 4.

1. An ambulance service provider shall provide the Fire Chief or his designee with any information in reference to any pending legal action or judgment, unpaid judgment or lien(s) against the ambulance service provider and notice of the transactions or acts giving rise to said legal action, judgment or lien(s). The ambulance service provider shall notify the Fire Chief or his designee, in writing, or said legal action, judgment or liens within one (1) week of the date served or notified. The information will be reviewed by the Fire Chief or his designee who will make a determination regarding the effect, if any, on the ambulance service providers ability to provide service in accordance with the requirements of this Ordinance.

Sec. 5.

1. Each ambulance service provider shall establish an ambulance station which is so located as to provide the minimum response time, considering traffic, street patterns and other ambulance station locations. All locations shall be approved by the Fire Chief or his designee and shall comply with all applicable zoning and building regulations and shall be maintained in a safe and sanitary condition.

2. The Fire Chief or his designee shall inspect the facilities, equipment and methods of operation of each ambulance service permittee.

12-19 Response

Sec. 1. No ambulance service permittee under this division shall cause or allow its ambulance(s) to respond to a location without first receiving a specific request for such service at that location. Ambulance service permittees shall cooperate with the Fire Chief or his designee, in any investigations of possible violations of this section and shall make all logs and records available for inspection and copying at reasonable times at the permittees place of business.

Sec. 2. When responding to a dispatched emergency call the ambulance service provider shall comply with the request of the patient for a desired hospital, or the request of the on scene paramedic if trauma protocols apply, regarding transportation of the injured or ill party.

Sec. 3. Ambulance service providers response to private calls must be consistent with the medical condition or injury(ies) of the patient.

Sec. 4. The ambulance service providers are aware that not all EMS scenes are without danger of some type. The provider shall use prudent judgment in determining the safety of the scene if it is the first responding unit. The provider is under no obligation, and no obligation is created by the terms of this Ordinance or the operating procedures promulgated hereunder, to enter a scene that is determined to be unreasonably dangerous. The provider agrees to standby, at a safe distance, until the scene has been secured by another agency.

12-20 Regulation

Sec. 1. The Fire Chief or his designee shall make necessary and reasonable rules and regulations covering ambulance service, ambulance equipment, ambulance personnel and dispatch standards for the effective and reasonable administration of this Ordinance. Prior to adoption, said regulations shall be submitted to the Physician Advisor for his comments and concurrence.

Sec. 2. If any provisions of this Ordinance or the regulations promulgated hereunder, is held to be invalid such invalidity shall not affect other provisions or application of this Ordinance which can be given effect without the invalid provision(s), and to this end the provisions of this Ordinance and the regulations promulgated hereunder, are declared to be severable.

PASSED AND ADOPTED this 20th day of May, 1992.

Attest:

NAME

____________________

President of the Council

Theresa F. Martinez

____________________

Acting City Clerk

I HEREBY CERTIFY that the foregoing Ordinance, being Ordinance No. 2575, was introduced, read, and ordered published by the City Council of the City of Grand Junction, Colorado, at a regular meeting of said body held on the 6th day of May, 1992, and that the same was published in The Daily Sentinel, a newspaper published and in general circulation in said City, at least ten days before its final passage.

IN WITNESS WHEREOF, I have hereunto set may hand and affixed the official seal of said City this 21st day of May, 1992.

Theresa F. Martinez

____________________

Theresa F. Martinez, CMC

Acting City Clerk

Published: May 8, 1992

Published: May 22, 1992

Effective: June 21, 1992

MANUAL OF AMBULANCE OPERATIONS

1. RECITALS

2. DEFINITIONS

3. SERVICES

3.1.1. Geographic area

3.1.2. Services Provided

3.2. Communications

3.3. Quality Control

3.4. Operations and Equipment

3.5. Documentation

3.6. Staffing

3.7. Disaster Assistance

3.8. Supply Restock

4. ADDITIONAL PROVISIONS

4.1. Insurance

4.1.1. General Liability and Malpractice

4.2. Worker's Compensation

4.3. Indemnification

4.4. Independent Contractor

4.5. Charges for Service Rendered

4.6. Permit Termination

5. PERFORMANCE STANDARDS

5.1. Paramedic Manning Levels

5.2. Agency Interaction

5.3. Downgrading Patient Care

5.4. Unprofessional Communications

5.6. Supply Replacement

5.7. Appeal/Review Process

6. CONCLUSION

1. RECITALS

The Fire Department is one of the agencies involved in an Emergency Services System dedicated to the provision of emergency intervention to a portion of Mesa County, Colorado, including the City of Grand Junction and the Grand Junction Rural Fire Protection District. The Fire Department maintains emergency response units and personnel throughout the City of Grand Junction, the Grand Junction Rural Fire Protection District, and for areas of Mesa County covered by mutual agreements. Ambulance service permittees desire to provide emergency response and transportation of emergent patients who require emergent care. In order to provide emergency service under the terms of the Colorado Emergency Medical Services Act, Article 3.5 of Title 25, Colorado Revised Statutes, and to provide quality emergency medical care for patients, consistent with good health and safety practices, the Ambulance Service Permittees are required by Ordinance to perform their service in accordance with the regulations contained herein.

2. DEFINITIONS

Advanced Life Support (ALS): Pre-hospital medical intervention delivered by paramedics utilizing invasive medical procedures, under protocol and physician direction, for the field stabilization of ill or injured patients. If a paramedic is unavailable, an EMT-I, under physician direction and on protocols may be used to perform advanced life support.

Ambulance Service Permit: Is written authorization by the City to an ambulance service to provide ambulance service within the City.

Ambulance Station: The premises (including living quarters) located within the City from which the ambulance service provides service.

Basic Life Support (BLS): Pre-hospital medical intervention delivered by emergency medical technicians. Field patients care providing basic treatment and stabilization of ill or injured patients.

Designated Dispatch Center: The Grand Junction Regional Communication Center which is responsible for 9-1-1 Emergency Services Telecommunications and who dispatches emergency personnel and equipment.

Emergency Medical Technician Intermediate: Means certified technician between the level of Paramedic and EMT-B. This person must also be on protocols with the Physician Advisor. Intermediates (EMT-I) may perform invasive procedures above that of an Emergency Medical Technician Basic (EMT-B) for ill or injured patients with direct physician orders and within state guidelines for emergency medical technician-intermediate. This classification is not to be equated to that of Paramedic, nor is it comparable to an EMT-B.

Emergency Response List: Is the official list maintained by the designated dispatch center of permittees who possess an emergency ambulance service permit.

Grand Junction City Council: A body politic serving as the governing body of and for the City of Grand Junction.

License: Means authorization issued by the Board of County Commissioners to operate an ambulance service, publicly or privately within Mesa County, Colorado.

Medical Control: A planned approach to the provision of Advance Life Support Services in a pre-hospital setting. Under this approach Advanced Life Support (ALS) personnel are viewed as surrogates of a designated base hospital and it's physician advisor, regardless of employer-employee relationships.

Private Call: Is any call received by the ambulance service directly from a private party requesting services.

Vehicle Permit: Means the authorization issued by the Board of County Commissioners to own, operate and maintain an ambulance used or to be used to provide ambulance services in Mesa County.

3. SERVICES

3.1.1. Geographic Area of Responsibility

Ambulance service permittees will respond to calls originating and occurring within:

- City of Grand Junction

- Grand Junction Rural Fire Protection District

- Mutual Aid Fire Districts

- Unincorporated Areas (areas serviced by the City not otherwise serviced by Emergency Medical Services Providers).

3.1.2. Services Provided

1. Each ambulance service permittee is required to provide a minimum of three 24 hour ambulances.

2. Ambulance service permittees will provide a minimum of one (1) paramedic staffed, ALS equipped ambulance available for 9-1-1 emergency calls one hundred percent (100%), of the time, twenty-four hours per day and one (1) BLS/EMT-I Ambulance for scheduled routine transfers during normal business hours and weekends if needed. Ambulance service permittees will maintain a minimum of one (1) backup ambulance. The backup ambulance shall be ALS equipped and shall respond in the event of mechanical failure of either of the two primary units. The Grand Junction Fire Department will respond paramedics to be utilized in emergency medical service and will release patient(s) only to permitted, paramedics staffed, ambulance service providers.

3. The Fire Department agrees that permitted ambulance service providers will be called to provide ambulance service whenever the Fire Department receives a request for such services from persons in the City of Grand Junction, Grand Junction Rural Fire Protection District, or areas covered by a mutual aid agreement between the Fire Department and other agencies or Fire Departments and unincorporated areas serviced by the Fire Department.

4. The Fire Department EMS personnel may ride to the hospital with the ambulance service permittee when patient condition requires.

5. The ambulance service provider will honor the patient's request for hospital preference and will make a reasonable effort to determine any preference. Should the patient or family fail to select a hospital, and the patient's destination is not affected by certain predetermined conditions, specified through local transportation or standard of care protocols, the paramedic will contact the hospital of destination, and that hospital shall decide if they wish to receive the patient.

6. The ambulance service provider will at emergency scenes responded to by any law enforcement agency or the Fire Department, allow the agency or department to reasonably control ambulance usage and activities, within the guidelines of an incident command system. This includes the use of helicopter ambulances.

7. The ambulance service provider will assist the Fire Department and serve the citizens of the areas outlined herein. Should any providers service prove to be inadequate, the ambulance service permit may be suspended or terminated pursuant to Ordinance No. 2575.

3.2. Communications

1. The Grand Junction Regional Communication Center, also known as the Designated Dispatch Center, receives calls for emergency services through a 9-1-1 telecommunications system. Dispatch initiates activity for the Grand Junction Police and Fire Department as well as the Mesa County Sheriffs Office.

2. The Designated Dispatch Center will receive calls for emergency services and will activate appropriate resources, including but not limited to permitted ambulance service providers, through a tone out system and/or verbal radio communication. Ambulance service providers dispatched via the Designated Dispatch Center will restrict communication with the Designated Dispatch Center to communication contemplated under the terms of this Standard Operating Procedure Manual.

3. The ambulance service providers will provide and maintain, at their own expense, a communication system meeting the requirements of the Fire Department. The Fire Department will assign a frequency to the ambulance service providers for use in a toned dispatch system.

4. The ambulance service providers will be charged a fee for all calls received by the Designated Dispatch Center for calls that do not involve the Grand Junction Fire Department or do not require an emergency response. Charges will be set by the Designated Dispatch Center. The ambulance service providers will maintain private telephone lines and dispatch capability for private calls. All charges are to be paid within thirty (30) days of billing.

5. The first arriving paramedic on an emergency medical call shall determine the level of response for all and or additional incoming units. If no paramedic is on scene, then the Grand Junction Fire Department Paramedic will determine the level of response for responding units.

6. The ambulance service provider will immediately notify dispatch of non-availability. The ambulance service provider shall not wait until they are toned out for this notification of non-availability. Failure to notify of non-availability may be cause for termination of permit.

7. The ambulance service provider will have their unit enroute within two (2) minutes from the time of dispatch. If unable to respond the ambulance service provider shall immediately notify dispatch of their status.

8. The ambulance service provider will have their unit on the scene within ten (10) minutes. If the ambulance service provider anticipates a longer response time, then the responding ambulance service provider shall immediately notify the Designated Dispatch Center by radio of their delayed response time. It is understood that unusual circumstances can happen and produce response times that exceed the aforementioned standards. These shall include, but not be limited to, unusual weather, natural disaster, or unusual periods of very high demand upon the system. Safety of the ambulance service providers and others using the streets and highways is paramount.

9. The ambulance service provider shall use prudent judgment in determining the safety of the scene if it is the first responding unit. The ambulance service provider is under no obligation, and no obligation is created by the terms of this Standard Operation Procedure Manual, to enter a scene that is determined to be unreasonably dangerous. The ambulance service provider shall standby, at a safe distance, until the scene has been secured by another agency.

10. The ambulance service provider shall not have conversations with or ask dispatchers to answer questions or complaints about the emergency medical dispatch system. All complaints about dispatch services shall be submitted in writing to the Fire Chief or his designee.

3.3 Quality Control

1. The Fire Chief or his designee is required by Ordinance to protect the health and safety of the Community by promulgation regulations for and of ambulance service providers. The regulations contained in this Standard Operating Procedures Manual are written quality assurances of the service provider.

2. Adequate clinical performance, under the terms of this manual, is defined by expert opinions of trained individuals rendering sound professional judgement, in a reasonable manner, and is mandated under State and local regulations and practice protocols.

3. Representatives of the Fire Department and the ambulance service providers will periodically review random EMS calls for overall efficiency and effectiveness. All phases of the call will be reviewed and the results documented and filed. Discrepancies in clinical performance will be identified, reviewed and appropriate corrective actions will be taken.

4. Complaints involving ambulance service providers will be brought to the attention of the Physician Advisor. Medical advice, comment and review from the Physician Advisor will be included as an integral part of any discrepancy involving medical control and will be included in the appropriate report. Should the complaint be substantiated, the ambulance service provider will be required to correct the discrepancy in accordance with the requirements of Ordinance No. 2575 or the ambulance service provider may be subject to suspension or revocation of it's permit.

3.4. Operation and Equipment:

1. The ambulance service providers when operating emergency vehicles, shall operate the vehicle in a safe and prudent manner in compliance with all State Statutes and City Ordinances relating to the operation of emergency vehicles.

2. All ambulances will be equipped with all required essential items pursuant to C.R.S. 25-3.5-301, Colorado Board of Health and State EMS Rules. All such equipment will be maintained in safe operable and reliable condition. The Fire Department, as an express condition of permit issuance, has the right to inspect all vehicles and equipment for compliance.

3. Ambulances shall have current Vehicle Permits if utilized for the transportation of patients. Permits are required by CRS 25-3.5-301 and are to be obtained annually through the local health department designee.

4. All ambulances the ambulance service provider utilizes in Emergency Medical Services shall not be smaller than the smallest ambulance operated by the Fire Department. This standard applies to the patient treatment compartment of the vehicle.

5. Vehicular Liability insurance will be carried by the company in accordance with the provisions of Ordinance No. 2575 or the requirements set forth in CRS 25-3.5-303 whichever is more stringent.

6. Radios and radio frequencies.

3.5. Documentation

1. Patient records and call logs will be promptly made and accurately kept and maintained. Documentation will be thorough, concise and legible. Copies of the patient trip report will be made available to the hospital of destination and to the Area Emergency Medical Services Office for medical control by the Physician Advisor.

2. Documentation standards are addressed in CRS 25-3.5-501 and 502. Said standards are incorporated herein by references as if fully set forth.

3.6. Staffing.

1. All ambulance service provider personnel will meet all certification requirements for the State of Colorado outlined in CRS 25-3.5-201. Said standards are incorporated herein by reference as if fully set forth.

2. The Emergency Medical Technician-Basic will be the minimum level of certification utilized by the ambulance service provider for patient care and transportation.

3. All practicing paramedic personnel will maintain current protocol status as required by the State of Colorado, the Board and the Physician Advisor. EMT-I personnel not on protocols shall be considered as EMT-B.

3.7. Disaster Assistance

1. Ambulance service providers shall cooperate with the Fire Department in rendering emergency assistance during disaster incidents.

2. At the scene of any disaster, the ambulance service provider's personnel shall perform under the direction of the Fire or Police agency in command and in accordance with local disaster protocols.

3. Ambulance service providers will participate in periodic disaster and mass casualty drill, per year, as a terms of their permit.

4. ADDITIONAL PROVISIONS

4.1. Insurance

4.1.1. General Liability and Malpractice

1. The ambulance service provider shall obtain and maintain at all times insurance coverage, from a carrier acceptable to the Fire Chief or his designee, insuring for general liability, professional error/malpractice and property damage claims arising from any operation or activity of the Company, it's agents, or employees.

Minimum coverages shall be: Not less than $1,000,000.00 for combined single limit bodily injury, death or property damage.

2. The ambulance service provider shall further furnish the Fire Chief or his designee a Certificate(s) of Insurance, evidencing at least the minimum coverages established in paragraph 1 above and in accordance with the requirements of Ordinance No. 2575. Any and all policies of insurance shall contain a provision that in the event of cancellation, for any reason whatsoever, the Fire Chief or his designee will be notified thirty (30) days prior the date of cancellation.

4.2. Worker's Compensation

1. The ambulance service provider shall provide the Fire Chief or his designee with a list of all of employees of the Company working as ambulance drivers and attendants. The ambulance service provider shall further provide the Fire Chief or his designee, with evidence of insurance coverage for Worker's Compensation for each employee.

4.3. Indemnification

1. The ambulance service provider shall indemnify and hold harmless the City of Grand Junction, the Grand Junction Fire Department and it's agents and employees from and against all claims, damages, losses, and expenses, including attorney's fees, arising out of or resulting from the performance by the ambulance service provider of the services specified in this Standard Operating Procedures Manual, any act or omission caused or claimed to be caused by the ambulance service provider or it's subcontractors.

4.4. Independent Contractor Status

1. The ambulance service provider shall function under the provisions of Ordinance No. 2575 and the resulting regulations, as an independent contractor and in no capacity as an agent or employee of the City of Grand Junction.

4.5. Charges for Service Rendered

1. The ambulance service provider will follow established Federal and/or State guidelines for fees and rates. The ambulance service provider further agrees that it will not charge patients for calls when no ground transport is involved.

2. The ambulance service provider will supply to the Fire Chief or his designee a fee schedule.

3. Fees may be adjusted within established Federal and/or State guidelines.

4. The ambulance service provider shall not charge the patient or insurance company an extra fee for the use of a Fire Department Paramedic.

4.6. Permit Termination

1. See, Ordinance 12-17 Sections 1-7

2. Failure of the Ambulance Service Permittee to operate in a manner which meets the most restrictive of all State, County and City laws and regulations regarding the operation of an Emergency Medical Services System will be grounds for termination or suspension. The Ambulance Service Permittee will not be required to operated under conditions more restrictive than those pertaining to the Fire Department personnel and equipment.

3. Failure to notify dispatch of non-availability is a violation of these regulations and is cause for termination of the service permit.

4. The ambulance service provider shall provide that all citizen complaints arising from services provided will be documented and a copy sent to the Fire Department E.M.S. Coordinator.

5. PERFORMANCE STANDARDS

5.1. Paramedic Manning Levels

1. The ambulance service permittee shall maintain one (1) paramedic on protocols, available to the system one hundred percent (100%) of the time.

2. Utilization of a Fire Department paramedic for transport will be determined by patient condition and will be in accord with the terms of treatment and transportation protocols.

5.2. Agency Interaction

1. Ambulance service permittees shall participate in Fire Department sponsored E.M.S. Training.

5.3. Downgrading Patient Care

1. The Fire Department and the Company agree to follow the Physician Advisor Protocols for the transfer of patient care from the level of paramedic to the level of E.M.T.-I. and/or E.M.T.-B.

5.4. Unprofessional Communications

1. Ambulance service provider personnel shall not communicate privileged information concerning the field actions, patients, calls, incidents or the performance of the Department or the ambulance service provider personnel to persons who have no right to know of such privileged information. Any and all disclosures are subject to professional medical ethics disclosure laws, guidelines, rules and regulations. Any reported known incidents of this type of communication shall be documented and appropriate corrective action taken by the Department or the Company.

2. Allegations or misconduct shall be submitted in writing to the Fire Chief or his designee and shall be signed by the party making the allegation. Copies of the allegation will be forwarded to the responsible agency. An investigation shall occur of each and every such allegation and any and all action(s) taken concerning the allegation(s) shall be documented and filed with the Fire Chief or his designee. Inappropriate behavior by ambulance service provider personnel, will be, in the sole discretion of the Fire Chief or his designee, grounds for immediate termination of the ambulance service permit issued to the offending ambulance service provider.

5.4. Appeal/Review Process

see Sections 12-17 for appeal right

6. CONCLUSION

1. These standard operating procedures are continuing obligations with the force and effect of law. The procedures may change from time to time to address any changed conditions or may add conditions or requirements which will ensure continued quality patient care.

2. Any amendments, modifications or deletions to these procedures are the responsibility of the ambulance service provider. Failure to adhere to or act in accordance with the operating procedures herein may result in suspension, revocation or termination of authority to operate or of any permit issued and may result in civil and or criminal liability.