(a) The emergency and non-emergency transportation of sick, disabled or injured persons is a matter closely affecting the public interest and welfare, it is the policy of the Board of Supervisors of San Diego County to see that persons requiring ground or air ambulance, critical care, and non-emergency medical transportation services receive such services, and that such services are reasonably available and accessible to persons within the County; and
(b) Every Emergency Medical Services aircraft (EMS aircraft), ground ambulance, critical care transport, and non-emergency medical transport vehicle that serves persons in the unincorporated areas of San Diego County shall meet certain minimum levels and standards of equipment, staffing and mechanical reliability.
(Added by Ord. No. 8192 (N.S.), effective 2-4-93; amended by Ord. No. 8787 (N.S.), effective 4-29-97; amended by Ord. No. 9668 (N.S.), effective 8-14-04; amended by Ord. No. 10274 (N.S.), effective 8-29-13; amended by Ord. No. 10927 (N.S.), effective 1-10-25)
(a) This Division shall not apply to vehicles operated as EMS aircraft, ground ambulances, critical care transport vehicles, and non-emergency medical transport vehicles, or to persons engaged in providing service where ambulance, critical care transport, and non-emergency medical transport services are rendered at the request of any County communications center or at the request of any law enforcement or fire protection agency during any "state of war emergency", "state of emergency", or "local emergency" as defined in California Government Code section 8558 or during any period (not over 30 days, but renewable every 30 days) when the Board of Supervisors or the Chief Administrative Officer or his or her designee has determined that adequate emergency ambulance service, critical care transport service, or non-emergency medical transport services will not be available from existing permittees.
(b) This Division shall not apply to EMS aircraft, ground ambulances, critical care transport vehicles, or non-emergency medical transport vehicles and to persons engaged in the transport of patients where the transport initiated outside San Diego County boundaries for transport into the County.
(c) This Division does not apply to EMS aircraft, ground ambulances, critical care transport vehicles, or non-emergency medical transport vehicles operating solely within an incorporated area.
(d) Not for profit agencies, volunteer public safety agencies, or agencies permitted by another governmental entity shall not be required to pay the fees imposed by Section 610.601 of this Division. All other portions of this Division shall apply.
(e) Agencies of the United States Government operating air or ground ambulances are exempted from all portions of this Division.
(f) Governmental agencies operating air or ground ambulances twenty-four hours per day staffed with full time paid employees shall be exempted from the application process identified in Sections 610.201 through 610.211 and 610.401 through 610.411, as well as the fees imposed by Section 610.601 of this Division. All other portions of this Division shall apply.
(Added by Ord. No. 8192 (N.S.), effective 2-4-93; amended by Ord. No. 8270 (N.S.), effective 6-29-93; amended by Ord. No. 8276 (N.S.), effective 8-19-93; amended by Ord. No. 8787 (N.S.), effective 4-29-97; amended by Ord. No. 9668 (N.S.), effective 8-14-04; amended by Ord. No. 10274 (N.S.), effective 8-29-13; amended by Ord. No. 10927 (N.S.), effective 1-10-25)
Unless otherwise specifically provided, the following terms as used in this Division are defined as follows:
(a) Advanced Life Support. "Advanced Life Support" (ALS) means special services designed to provide definitive prehospital emergency medical care, including, but not limited to, cardiopulmonary resuscitation, cardiac monitoring, cardiac defibrillation, advanced airway management, intravenous therapy, administration of specified drugs and other medicinal preparations, and other specified techniques and procedures administered by authorized personnel under the direct supervision of a base hospital as part of a local EMS system at the scene of an emergency, during transport to an acute care hospital, during interfacility transfer, and while in the emergency department of an acute care hospital until responsibility is assumed by the emergency physician or other medical staff of that hospital, as cited in Section 1797.52 of the Health and Safety Code.
(b) Advanced Life Support Rescue Aircraft. "Advanced Life Support Rescue Aircraft," (ALS Rescue Aircraft) means a rescue aircraft whose medical flight crew has at a minimum one attendant certified or licensed in advanced life support.
(c) Air Ambulance. "Air Ambulance" means any rotor aircraft specially constructed, modified or equipped, and used for the primary purposes of responding to emergency calls and transporting critically ill or injured patients whose medical flight crew has at a minimum two (2) attendants certified or licensed in advanced life support, one of which is a Registered Nurse (RN).
(1) Air Ambulance Providers permitted to respond to prehospital scene locations shall be identified as Primary Response Air Ambulances.
(2) Interfacility Air Ambulances are aircraft configured and staffed as Air Ambulances and engaged in the transport of the sick and injured between licensed health care facilities with licensed heliports.
(d) Air Ambulance Service. "Air Ambulance Service" means an air transportation service that utilizes air ambulances.
(e) Air Rescue Service. "Air Rescue Service" means an air service used for emergencies, including search and rescue.
(f) Air Rescue or Air Ambulance Service Provider. "Air Rescue or Air Ambulance Service Provider" means the individual or group that owns and/or operates an air ambulance or air rescue service.
(g) Ambulance. "Ambulance" generally refers to a "Ground Ambulance" which is any vehicle specially constructed, modified or equipped and used for the purpose of transporting sick, injured, disabled, convalescent, infirm, or otherwise incapacitated persons, including vehicles used for critical care transport. "Ambulance" does not include a gurney van or a non-medical transport vehicle designed for the transportation of persons who are wheelchair users.
(h) Ambulance Attendant. "Ambulance Attendant" means a person who is at a minimum certified as an Emergency Medical Technician (EMT) whose primary duty is to care for the sick, injured or disabled persons.
(i) Ambulance Driver. "Ambulance Driver" means a person properly licensed by the State of California as an ambulance driver and who is at a minimum certified as an Emergency Medical Technician (EMT).
(j) Ambulance Provider. "Ambulance Provider" means a person, firm, partnership, corporation, municipality, government agency or other organization which furnishes or offers to furnish ambulance service to the public, its employees, visitors and/or residents of San Diego County. "Ambulance Provider" includes all organizations that provide or operate an ambulance on private property whether or not required to do so by local, state or federal law and/or regulation.
(k) Ambulance Provider's Permit. "Ambulance Provider's Permit" means written authorization by the County to provide emergency or non-emergency ambulance service within the County.
(l) Ambulance Service. "Ambulance Service" means the activity, business or service for hire, profit, or otherwise, of being prepared for, responding to requests for and/or transporting one or more persons by ambulance on or in any of the streets, roads, highways, alleys, or any public way or place in the unincorporated areas of the County. "Ambulance Service" includes all organizations that provide or operate an ambulance on private property whether or not required to do so by local, state or federal law and/or regulation.
(m) Authorizing EMS Agency. "Authorizing EMS Agency" means the County of San Diego Emergency Medical Services (EMS) Office which approves utilization of specific EMS aircraft within its jurisdiction.
(n) Auxiliary Rescue Aircraft. "Auxiliary Rescue Aircraft" means a rescue aircraft which does not have a medical flight crew, or whose medical flight crew does not meet the minimum requirements of a BLS rescue aircraft.
(o) Basic Life Support. "Basic Life Support" (BLS) means those procedures and skills contained in the EMT scope of practice listed in California Code of Regulations, Title 22, Division 9, Chapter 2.
(p) Basic Life Support Rescue Aircraft. "Basic Life Support Rescue Aircraft" (BLS Rescue Aircraft) means a rescue aircraft whose medical flight crew has at a minimum one attendant certified as an EMT with at least eight (8) hours of hospital clinical training, and whose field/clinical experience specified in the California Code of Regulations, Title 22, Division 9, Chapter 2 is in the air medical transport of patients.
(q) Classifying Emergency Medical Services Agency. "Classifying Emergency Medical Services Agency" (Classifying EMS Agency) means the agency, which categorizes the EMS aircraft into groups. This shall be the local EMS agency in the jurisdiction of origin, except for aircraft operated by the California Highway Patrol, the California Department of Forestry or the California National Guard, which shall be classified by the EMS Authority.
(r) Code I, II, or III Calls.
(1) Code I - Any non-emergency transportation of patients without the use of lights and sirens.
(2) Code II - An emergency where time is critical, requiring immediate response by the Ambulance Provider, without the use of lights and sirens.
(3) Code III - An emergency requiring immediate response, whether to or from the scene, with the use of lights and sirens to deliver critical care to patients threatened by loss of life or limb. Such responses involve emergency ALS ambulances responding to 911 requests. BLS or CCT ambulance with such a response shall notify the emergency ambulance provider holding rights to the Exclusive Operating Area (EOA) within which the pathway to and/or address resides.
(s) Critical Care Transport. "Critical Care Transport" (CCT) means any non-911 requested emergency or non-emergency transport of a patient from one health care facility or acute care facility to another where the skill level required in the care of that patient during transport exceeds the basic life support, Emergency Medical Technician (EMT) level and scope of training.
(t) Critical Care Transport Provider. "Critical Care Transport Provider" (CCT Provider) means a person, firm, partnership, corporation, municipality, government agency or other organization which furnishes or offers to furnish critical care transport.
(u) Critical Care Transport Provider's Permit. "Critical Care Transport (CCT) Provider's Permit" means written authorization by the County to provide emergency or non-emergency critical care transport within the County. Critical Care Providers may be employed or contracted by Transport Providers.
(v) Designated Dispatch Center. "Designated Dispatch Center" means an agency that has been designated by the County of San Diego EMS Office for the purpose of coordinating air ambulance or rescue aircraft response to the scene of a medical emergency within the jurisdiction of the local EMS agency.
(w) Emergency Call. "Emergency Call" means a request for an ambulance to transport or assist persons in apparent sudden need of medical attention; or, an ambulance transport that is initially classified as a non-emergency call that becomes an emergency call due to a change in the patient's medical condition; or, in a medical emergency, as determined by a physician, to transport blood, or any therapeutic device, accessory to such device, or tissue or organ for transplant.
(x) Emergency Medical Technician. "Emergency Medical Technician" (EMT) means an individual trained in all facets of basic life support and who has a valid certificate, in accordance with the provisions contained in Title 22, California Code of Regulations, Division 9, Chapter 2, et seq.
(y) Emergency Medical Services Aircraft. "Emergency Medical Services Aircraft" means an aircraft utilized for the purpose of prehospital emergency patient response and transport. EMS aircraft includes air ambulances and all categories of rescue aircraft.
(z) Emergency Service. "Emergency Service" means the service performed in response to an emergency call. Emergency service also includes transportation of a patient, regardless of a presumption of death of the patient, or transportation of a body for the purpose of making an anatomical gift, as provided in Section 12811 of the California Vehicle Code, and the California Uniform Anatomical Gift Act.
(aa) Gurney Van Transport. "Gurney Van Transport" means any vehicle specially constructed, modified or equipped and/or used for the purpose of transporting patients who cannot travel in an upright, sitting position and for whom the need for any medical care, treatment or procedure other than pre-established devices solely maintained by the patient is not required, likely or foreseeable.
(bb) Jurisdiction of Origin. "Jurisdiction of Origin" means the local EMS jurisdiction within which the authorized air ambulance or rescue aircraft is operationally based.
(cc) Medical Flight Crew. "Medical Flight Crew" means the individual(s), excluding the pilot, specifically assigned to care for the patient during aircraft transport.
(dd) Non-emergency Call. "Non-emergency Call" means an ambulance call for a purpose other than an emergency.
(ee) Non-Emergency Medical Transport Provider. "Non-Emergency Medical Transport Provider" means any person, firm, partnership, corporation, municipality, government agency or other organization which furnishes or offers to furnish non emergency medical transport service.
(ff) Non-emergency Medical Transport Provider's Permit. "Non-emergency Medical Transport Provider's Permit" means written authorization by the County to provide non-emergency medical transport service.
(gg) Non-Emergency Medical Transport Service. "Non-Emergency Medical Transport Service" means the activity, business or service, for hire, profit, or otherwise, of being prepared for, responding to requests for and/or transporting for medical purposes one or more persons by gurney van, or wheelchair van on or in any of the streets, roads, highways, alleys or any public way or place in the unincorporated areas of the County.
(hh) Non-emergency Medical Vehicles. "Non-emergency Medical Vehicles" means any vehicle which has been specially constructed, modified, or equipped and/or used for the purpose of transporting clients either for profit or non-profit, who are wheelchair users or bed confined under the following categories:
(1) hospitals
(2) convalescent homes
(3) retirement homes
(4) all homes receiving funding for the board and care of residents living in those homes
(5) non-emergency medical transport providers
(6) nutrition centers
(7) senior citizens
(8) any other like social service categories not regulated by the California Highway Patrol, Metropolitan Transit System.
(ii) Paramedic. "Paramedic" means an individual whose scope of practice is to provide advanced life support as according to the standards prescribed by Title 22, California Code of Regulations, Division 9, Chapter 4, et seq., who has a valid license pursuant to that division, and is accredited by the Medical Director of the County of San Diego EMS Office.
(jj) Permit Officer. "Permit Officer" means the EMS Administrator of the County of San Diego EMS Office or his/her designee.
(kk) Primary Response Air Ambulance. "Primary Response Air Ambulance" means air ambulances permitted to respond to prehospital scene locations. This rotor aircraft has been specifically constructed, modified or equipped as an air ambulance, permitted by the County of San Diego EMS Officefor the primary purposes of responding to emergency calls and/or transporting critically ill or injured patient(s). Primary Response Air Ambulances shall be authorized to routinely respond to medical emergencies in the field at the request of public safety or other designated officials.
(ll) Private Call. "Private Call" means any call for services that is received by an ambulance provider other than through the 9-1-1 system.
(mm) Rescue Aircraft. "Rescue Aircraft" means an aircraft whose usual function is not prehospital emergency patient transport but which may be utilized, in compliance with local EMS policy, for prehospital emergency patient transport when use of an air or ground ambulance is inappropriate or unavailable. Rescue aircraft includes ALS rescue aircraft, BLS rescue aircraft and Auxiliary rescue aircraft.
(nn) Special Events. "Special Events" means any event, including, but not limited to concerts, sporting events or contests, and other events that place a grouping or gathering of people in one general locale sufficient in number, or subject to activity that creates the need to have one or more ambulances pre-positioned at the event. Ambulances at these events shall be permitted by the County of San Diego with an Emergency Medical Transport Permit.
(oo) Vehicle Permit. "Vehicle Permit" means a permit decal or certificate issued by the Permit Officer indicating that an ambulance or other permitted vehicle has passed inspection according to the standards established herein. This permit is required for each vehicle operated in addition to the ambulance operator's permit.
(Added by Ord. No. 8192 (N.S.), effective 2-4-93; amended by Ord. No. 8572 (N.S.), effective 9-14-95; amended by Ord. No. 8787 (N.S.), effective 4-29-97; amended by Ord. No. 9668 (N.S.), effective 8-14-04; amended by Ord. No. 10274 (N.S.), effective 8-29-13; amended by Ord. No. 10927 (N.S.), effective 1-10-25)
Cross reference(s)--Definitions, § 12.101 et seq.