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(a) “Agency vehicle” means a vehicle which responds to an emergency, the attendants of which may treat but not transport patients, and is operated at the BLS or ALS level by a provider agency under a permit issued pursuant to this chapter.
(b) “Ambulance” means a privately or publicly owned vehicle especially designed, constructed, modified, equipped, arranged, maintained and operated for the sole purpose of transporting sick, injured, infirm, convalescent, or otherwise incapacitated persons, and expectant mothers.
(c) “Ambulance dispatch center” means any entity that dispatches ambulances in response to a request for service through any means of communication.
(d) “Ambulance service provider” means any person or entity who, for monetary, public services, or other consideration, transports in one or more air or ground ambulances providing any class of service, one or more persons needing medical attention or services from any location within the County.
(e) “Ambulance service provider permit” means a permit issued by LEMSA in accordance with LEMSA policy authorizing the holder to act as an ambulance service provider within the County.
(f) “Ambulance permit” means the ambulance service provider has been granted a permit by the LEMSA to engage in a business or service in which ambulances are operated.
(g) “Applicant” means any person, organization, or service provider who applies for a permit under this chapter.
(h) “Board” means the Yolo County Board of Supervisors.
(i) “Class of service” means the level or levels of complexity of field emergency medical services that may be provided by the permittee and/or certified persons. These are:
(1) “First responder” means a person who provides the initial response to an emergency.
(2) “Emergency medical responder (EMR) level of care” is by a person who has completed a state-approved EMR course that meets or exceeds national EMS education standards for EMR and functions within the state and LEMSA approved scope of practice.
(3) “Basic life support (BLS)” as defined in Health and Safety Code section 1797.60 provided at the EMT scope of practice level, as defined in Health and Safety Code section 17919.80.
(4) “Advanced life support (ALS)” as defined in Health and Safety Code section 1797.56 provided by a paramedic as defined in Health and Safety Code section 1797.84.
(5) “Critical care transport (CCT)” a level of care during transport which exceeds the paramedic scope of practice requiring a higher level of health care licensure.
(j) “County” means the County of Yolo.
(k) “Critical care transport (CCT) services”, which shall be for "Specialty Care Transport" as defined in 42 CFR 414.605.
(l) “Department” means County of Yolo Department of Health and Human Services Agency.
(m) “Emergency Medical Services” or “EMS” means medical services performed in response to an emergency call.
(n) “EOA” means “exclusive operating area” as defined in Health and Safety Code section 1797.85 and in Section 4-6.309 below.
(o) “EMS aircraft services” means any aircraft services utilized for the purpose of prehospital emergency patient respond and transport. EMS aircraft includes air ambulances and all categories of rescue aircraft as defined in Title 22.
(p) “EMS dispatch” means the dispatch center designated by the LEMSA for the dispatch of EMS responders to emergency calls.
(q) “EMS entity” means a public or private organization of any type providing ambulance services within the County.
(r) “EMS system” means a specifically organized arrangement which provides for the personnel, facilities, and equipment for the effective coordinated delivery of medical care services under emergency conditions, as described in Health and Safety Code section 1797 and 1798.
(s) “Equipment” means the equipment required inventory set forth by the LEMSA for any ambulance, air-ambulance or agency vehicle pursuant to this chapter.
(t) “Inter-facility Transportation (IFT)” is defined as transportation between licensed health care facilities such as:
(1) Cancer hospitals;
(2) Children's hospitals;
(3) Critical access hospitals;
(4) Inpatient acute care hospitals;
(5) Rehabilitation hospitals;
(6) Sole community hospitals;
(7) Psychiatric hospitals;
(8) Skilled nursing facilities.
(u) “LEMSA” means the Local EMS Agency established by the County, designated by the Board pursuant to Health and Safety Code section 1797 et seq.
(v) “Maddy EMS Fund” references funding available through Health and Safety Code section 1797.98 which compensates health care providers for emergency medical services for individuals who do not have health insurance and cannot afford to pay for emergency care and for the discretionary EMS purposes.
(w) “Medical transport vehicle” means a vehicle, not an ambulance, specifically constructed, modified, equipped, or arranged to accommodate a stretcher or wheelchair and operated for the purpose of transporting sick, injured, convalescent, infirm, or otherwise incapacitated persons not requiring urgent transportation.
(x) “Patient” means a person who is sick, injured, wounded, or otherwise incapacitated or helpless and who may be transported in an ambulance, air-ambulance or medical transport vehicle, or is cared for at the scene of an emergency by a certified or accredited attendant or a public provider agency, or who dies following the commencement of such transportation.
(y) “Permittee” means a person who holds a permit.
(z) “Provider authorization” means an agreement between an EMS entity and the LEMSA specifying terms and conditions for the provisions of EMS including but not limited to class of service to be provided, LEMSA approval for optional scope of practice, participation in LEMSA data and quality improvement activities and/or performance standards.
(aa) “Public entity service” means a service which is provided primarily as a public service by an agency of local government.
(bb) “Station” means an approved facility from which a unit is operated.
(cc) “Substation” means an approved subsidiary facility from which a unit is operated.
(dd) “Service” means the operation of an ambulance, air-ambulance, agency vehicle, or medical transport vehicle to provide medical care or patient transportation within Yolo County.
(ee) “Transfer” means the movement of a patient by ambulance, air-ambulance, or medical transport vehicle from one hospital to another hospital, a medical facility, a home or other location.
(ff) “Transport” means the movement of a patient by ambulance or air ambulance from the scene of an emergency to a hospital.
(gg) Unit means an ambulance, air-ambulance, agency vehicle, or any medical transport vehicle.
(hh) “Volunteer” means a person who:
(1) Acts as a driver or attendant; and
(2) Does not receive more than fifty (50%) percent of his or her annual employment income from the EMS provider that is claiming volunteer status.
(ii) “Volunteer service” means a service which:
(1) Transports patients without compensation, other than reimbursements to defray the actual expenses of providing such service;
(2) It is either wholly or partly subsidized or otherwise operated under the auspices of some governmental or public agency, body or group, or any industrial or non-profit corporation; and
(3) Uses volunteers. (§ 1, Ord. 1515, eff. December 19, 2019)
Except as provided in Section 4-6.1901, no person may furnish, operate, conduct, maintain, advertise or otherwise be engaged in, or profess to be engaged in business as an ambulance, air-ambulance, or medical transport vehicle within Yolo County unless he or she holds a valid permit issued by the LEMSA pursuant to this chapter.
A permit will be issued only when the permittee is in compliance with all applicable federal, state, and County codes and regulations, and LEMSA application, policies and procedures. Permittees, unless holding a contract with Yolo County to provide emergency medical service only, shall be approved by the county prior to beginning service.
Criminal action may be taken against an applicant who knowingly provides false information on the permit application. (§ 1, Ord. 1515, eff. December 19, 2019)
All EMS entities operating in the County shall be authorized by the LEMSA in accordance with the requirements of this chapter and any federal or state law or regulation governing EMS.
Authorization shall consist of provider authorization and, if indicated for the type of EMS entity, an ambulance provider permit.
Provider authorizations shall be issued in accordance with LEMSA provider authorization policy.
Ambulance service provider permits shall be issued in accordance with LEMSA ambulance service permit policy. (§ 1, Ord. 1515, eff. December 19, 2019)
(a) Any entity (either as an owner, agent or otherwise) who wishes to furnish, operate, conduct, maintain, or otherwise engage in, or offer, or profess to engage in providing ambulance service in the County shall have a valid ambulance service provider permit in accordance with the LEMSA system plan and EMS policies, procedures, and guidelines.
(b) Permit requirements shall apply to providers of air and ground ambulances, including BLS, ALS, IFT and CCT vehicles with the following exceptions:
(1) No permit is required of an ambulance service provider engaged in the transport of patients where the transport is initiated outside county boundaries for transport into the County.
(2) No permit is required of an ambulance service provider responding to a request from the EMS administrator or designee to calls arising from a declared multi-casualty incident (MCI) or declared disaster.
(3) No permit is required for specialized teams including, but not limited to: neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) teams that are permitted by another EMS agency and that pick up patients within the County for transportation to an acute care, tertiary, or quaternary care hospital located outside of the County, unless also responding to other services within the 9-1-1 system or inter-facility calls.
(c) Non-transport ALS. Any person, either as owner, agency, or otherwise, or any agency, who wishes to furnish, operate, conduct, maintain, or otherwise engage in, offer, or profess to engage in, or offer ALS non-transport services within the County, shall have a current valid non-transport ALS provider contract in accordance with the LEMSA's EMS system plan and EMS protocols, policies, and guidelines.
(d) An application for an initial ambulance Certificate of Operation shall be accompanied by payment of an application fee and an ambulance inspection fee. These fees are established by resolution of the Board of Supervisors, are listed in the Yolo County EMS Agency Fee Schedule and shall not exceed the reasonable cost of administering and enforcing this chapter. If the fees are not paid within thirty (30) days of permit issuance, the provider's permit will be considered suspended and the provider shall not provide the related service(s) within the County until the fees are paid in full. If the fees are not paid within ninety (90) days, the permit will be considered expired and a new application must be submitted to the LEMSA. Failed ambulance inspections will require a new inspection fee prior to the re-inspection of that ambulance. Exceptions to this section may be granted by the LEMSA. (§ 1, Ord. 1515, eff. December 19, 2019)
(a) Any EMS entity providing ambulance service, BLS, ALS, CCT or other EMS services requiring LEMSA authorization in the County, shall secure an ambulance service permit from the LEMSA specifying terms and conditions for the provision of EMS including, but not limited to, class of service to be provided, LEMSA approval for optional scope of practice, participation in LEMSA data and quality improvement activities and applicable performance standards as defined in LEMSA policies, procedures and guidelines.
(b) Provider authorizations shall not apply to cities or fire districts providing prehospital emergency medical services subject to and in accordance with Health and Safety Code section 1797.201. Such agencies providing services under section 1797.201 shall nonetheless be subject to LEMSA medical control and applicable performance standards as defined in LEMSA policies, procedures and guidelines. Compliance of City and Fire District prehospital emergency service providers with LEMSA medical control and applicable performance standards pursuant to LEMSA policies, procedures and guidelines shall not evidence or constitute an "agreement" with such City and Fire Districts for purposes of section 1797.201, and nothing in this chapter may be so construed. Nothing in this chapter is intended to affect or may be construed to affect in any way the rights and obligations of City and Fire District prehospital emergency service providers pursuant to section 1797.201. Nothing in this chapter is intended to affect or may be construed to affect the eligibility of City and Fire District prehospital emergency service providers to enter exclusive operating agreements under Health and Safety Code section 1797.224.
(c) Permit application.
(1) Applicants for an ambulance service permit or non-transporting ALS provider permit shall complete the LEMSA application process, which includes:
A. A LEMSA ambulance service provider permit application.
B. Provide a detailed description of company logo, color scheme used to designate the ambulance and attach a photo image.
C. A list of each ambulance including the following: make, model, year, mileage, VIN and license plate number.
D. Description of the company's program for vehicle maintenance.
E. Description of the company's vehicle radio/communication capabilities.
F. Copies of California Highway Patrol (CHP) inspection reports for each vehicle.
G. Portfolio of the company's experience and training in the transportation and care of patients.
H. List of employee's name and certification level with issued and expiration dates (EMT, paramedic, registered nurse, etc.).
I. Description of the company's training and orientation program for EMS personnel.
J. Applicants shall submit their planned work schedule for employees, including scheduled breaks and related staffing levels,
K. ePCR system description which is NEMSIS compliant.
L. A letter stating the willingness to share data with the LEMSA and participate in the Clinical Quality Improvement (CQI) process.
M. Current copy of the company's business license(s) and/or permits required by state law and regulations,
N. Recent financial statement (revenue, expenditures, balance sheet) stating total assets and liabilities.
O. Providing all transport and mileage billing rates.
P. Current insurance face sheet for: general liability for vehicle operation, comprehensive medical liability, workers compensation.
1. For general and comprehensive medical liability, the County shall be named as a co-insured. A valid certificate to self-insure from State of California Director of Industrial Relations is acceptable for workers compensation insurance. (§ 1, Ord. 1515, eff. December 19, 2019)
(a) Upon receipt of a completed application, the LEMSA shall conduct an inspection of the permit requester, including the applicant, any partner, officer, director, company and its ownership, to determine if there are any concerns related to the health, safety and welfare of the public. The inspection includes each vehicle, and its equipment and premises. A vehicle inspection fee is required per vehicle and the fee is approved by the board of supervisors. This required inspection shall be in addition to any other safety or motor vehicle inspections required or made under state, federal or local law.
(b) After the LEMSA has completed its inspection, it may issue the permit to be valid for a period of up to one year. The permit sticker must be placed on the window of the rear driver window of each permitted vehicle.
(c) Failed ambulance inspections will require a new inspection fee prior to the re-inspection of that ambulance. (§ 1, Ord. 1515, eff. December 19, 2019)
(a) Permits shall be renewed annually by the LEMSA upon application of the permittee if the LEMSA determines the permit holder has within the operating period of the expiring permit, acted in conformity with this chapter and the protocols and polices of the LEMSA.
(b) Applicants for permit renewal must be made at least thirty (30) days prior to the expiration date of the existing permit. The renewal fee must be included with the application for renewal. (§ 1, Ord. 1515, eff. December 19, 2019)
(a) The LEMSA may deny an ambulance services provider permit for any of the following reasons:
(1) Lack of approval by the LEMSA;
(2) Failure to provide a complete application or a determination by the LEMSA that the applicant fails to meet the requirements of this chapter;
(3) If the applicant has previously had an applicable permit or license revoked or the status is directly at issue, which affects the applicant's present ability to serve;
(4) If the applicant has a criminal or health record which reasonably indicates that the applicant would be unlikely to properly accept the responsibilities of operating a service;
(5) If there is reasonable cause to believe that the applicant will not provide emergency medical services or medical transport in a manner that will promote the health and general welfare of persons within the County who may need to utilize the applicant's proposed services;
(6) If the applicant does not have the required equipment for its units;
(7) If the applicant has not demonstrated, utilizing standard accounting practices and principles, sufficient financial stability or capitalization of a service to assure that the service will be run in an efficient and business-like manner for a period of at least one year or cannot meet the insurance requirements of Section 4-6.700 et seq.;
(8) If the applicant proposes to operate a service within a service area where another ambulance service or entity has been granted an exclusive operating area;
(9) Failure to comply with all applicable federal, state and county codes and regulations and LEMSA policies and procedures. (§ 1, Ord. 1515, eff. December 19, 2019)
The LEMSA may, and is authorized to, suspend or revoke any permit issued under this chapter for failure of a permittee to comply and to maintain compliance with, or for violation of the requirements of this chapter, or any other applicable laws or ordinances or regulations, or LEMSA policies, procedures, or protocols promulgated thereunder. (§ 1, Ord. 1515, eff. December 19, 2019)
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