Alachua County Board of County Commissioners ORDINANCE 93-9

Transcription

1 Alachua County Board of County Commissioners ORDINANCE 93-9 AN ORDINANCE REPEALING EMERGENCY ORDINANCE 92-28, ORDINANCE AND SECTIONS THROUGH OF ARTICLE II OF CHAPTER 52 OF THE ALACHUA COUNTY CODE OF ORDINANCES, RELATING TO MEDICAL TRANSPORTATION SERVICES; ENACTING A NEW ARTICLE II RELATING TO EMERGENCY MEDICAL SERVICES; PROVIDING A SHORT TITLE; PROVIDING FOR DEFINITIONS; PROVIDING FOR APPLICABILITY WITHIN THE INCORPORATED AND UNINCORPORATED AREAS OF ALACHUA COUNTY; PROVIDING FOR A MEDICAL ADVISORY BOARD; PROVIDING THAT A CERTIFICATE IS REQUIRED FOR SERVICE PROVIDERS; PROVIDING FOR A PRIMARY PRE-HOSPITAL CARE PROVIDERj PROVIDING FOR EXEMPTIONS; PROVIDING FOR APPLICATION FOR CERTIFICATE; PROVIDING FOR INVESTIGATION OF APPLICATION: PROVIDING FOR HEARINGS AND NOTICES; PROVIDING FOR FORM AND CONTENT OF CERTIFICATE; PROVIDING FOR TRANSFER OR ASSIGNMENT OF CERTIFICATE; PROVIDING FOR REVOCATION, MODIFICATION f OR SUSPENSION OF CERTIFICATE; PROVIDING FOR OBEDIENCE TO TRAFFIC LAWS, ORDINANCES, AND REGULATIONS; PROVIDING FOR GENERAL OPERATING REGULATIONS; PROVIDING FOR A CENTRAL PLACE OF BUSINESS; PROVIDING FOR A SCHEDULE OF RATES TO BE CHARGED FOR SERVICES; PROVIDING FOR OPERATOR'S INSURANCE; PROVIDING FOR QUALIFICATIONS OF DRIVERS; PROVIDING FOR CONDUCT OF EMPLOYEES; PROVIDING FOR SANITATION AND MAINTENANCE OF TRANSPORT VEHICLES i PROVIDING REQUIREMENTS RELATED TO PASSENGERS IN EMERGENCY TRANSPORT VEHICLES; PROVIDING FOR REGULATION OF FIRST RESPONSE PROVIDERS; PROVIDING FOR REGULATION OF NON-EMERGENCY TRANSPORT PROVIDERS; PROVIDING FOR ADMINISTRATION AND ENFORCEMENT OF ORDINANCE; PROVIDING FOR PENALTY FOR VIOLATION OF ORDINANCE; PROVIDING FOR REPEAL; PROVIDING FOR SEVERABILITY; PROVIDING AN EFFECTIVE DATE. WHEREAS, Alachua County, as a charter county, may exercise all power not inconsistent with general law or special law approved by the electorate; and, WHEREAS, Chapter 401, Florida Statutes, has established a state policy directive to Alachua County to develop a Comprehensive Emergency Medical Services System and to regulate competition in the private emergency medical services sector; and, -1-

2 WHEREAS, the Board of County Commissioners has determined that regulation and active supervision of emergency medical pre-hospital services is essential to the public health, safety, and welfare of the citizens of Alachua County; and, WHEREAS, as a result of such determination, the Board of County Commissioners commission.ed a task force to study the emergency medical services system in Alachua County; and, WHEREAS, as a result of its study, the Emergency Medical Services Special Task Force has determined that certain deficiencies do exist in various components of the emergency medical services system and has made recommendations to the Board of County Commissioners of ways to improve the operation and delivery of emergency medical services for the benefit of the citizens; and, WHEREAS, the Emergency Medical Service Task Force Study indicates that past emergency medical service fiscal policies were inadequate to provide long-term fiscal control and financial stability and, as a result, the emergency medical service system has grown excessively dependent upon local tax support for its continuing operations; and, WHEREAS, the Board of County Commissioners has determined that it is in the best interest of the public health, safety, and welfare, from a medical point of view, to have a single Primary Pre-hospital Care Provider within Alachua County; and, -2-

3 WHEREAS, the Board of County Commissioners has determined that it is in the best interest of the public health, safety, and welfare to require that ambulance service be provided at the advanced life support service level; NOW, THEREFORE, BE IT ORDAINED BY THE BOARD OF COUNTY COMMISSIONERS OF ALACHUA COUNTY, FLORIDA: 20 and Sections through of Article II of Chapter 52 of the Alachua County Code of Ordinances are hereby repealed. A new Article II, consisting of the following sections as set forth below is hereby adopted. Section 2. Short Title. This ordinance shall be known and cited as the "Alachua County Emergency Medical Services Act fj Section 3. Definitions. For the purpose of this ordinance, certain terms or words used herein shall be interpreted to mean the following unless another meaning is plainly intended. The word "shall" is mandatory, the word "may" is permissive. a. "Advanced life support" means treatment of life-threatening medical emergencies through the use of basic life support and advanced techniques such as endotracheal intubation, the administration of drugs, intravenous fluids, telemetry, cardiac monitoring, and cardiac defibrillation, by a qualified person pursuant to Chapter 401, Florida Statutes. Section 1. Emergency Ordinance 92-28, Ordinance

4 b. "Advanced life support service" means any emergency medical transport or non-transport service which uses advanced life support techniques as defined in this ordinance and Chapter 401, Florida Statutes. c. "Advanced life support service license" means ailyauthorizati6h to provide advanced life support service pursuant to the provisions of this ordinance and Chapter 401, Florida Statutes. d. "Air ambulance" means any fixed wing or rotary wing aircraft used for, or intended to be used for, air transportation of sick or injured persons who may need medical attention during transport. e. "Ambulance" means any privately or publicly owned land vehicle that is designed, constructed, reconstructed, maintained, equipped, or operated for, and is used for, or intended to be used for land transportation of sick or injured persons who are in need of medical attention during transport and/or who must be transported on a stretcher. f. "Ambulance driver" means any person who meets the requirements of Chapter 401, Florida Statutes, and Section 20 of this ordinance. g. "Applicant" means any person who may make application for a certificate of public convenience and necessity as hereinafter described. -4-

5 h. "Assistant medical director" means a licensed physician contracted with or employed with a secondary prehospital care provider or first response provider to provide continuing education, quality assurance, and medical administration assistance. The assistant medical director must be authorized by the system medical director. i. "Basic life support" means treatment of lifethreatening medical emergencies by a qualified person through the use of techniques such as patient assessment, basic cardiopulmonary resuscitation, splinting, obstetrical assistance, bandaging, administration of oxygen, application of medical anti-shock trousers, and other techniques that an emergency medical technician is authorized to do pursuant to Chapter 401, Florida Statutes. j. "Board" means the Board of County Commissioners of Alachua County, Florida. k. "Certificate" means a certificate of public convenience and necessity as issued by the Board. 1. "Certification" means any authorization issued pursuant to the provisions of this ordinance or Chapter 401, Florida Statutes, to a person to act in a capacity regulated by this ordinance or Chapter 401, Florida Statutes. m. "County" means all incorporated and unincorporated areas within the territorial limits of Alachua County, Florida. n. "Department" means the Department of Health and Rehabilitative Services. -5-

6 o. "Emergency medical dispatch" means the authorized system of taking a request for emergency response of an ambulance and prioritizing (triaging) that request with the other requests taken in that same time period, and providing prearrival instruction, as authorized by the system medical director, and notifying the appropriate unit or agency within one (1) minute, ninety (90) per cent of the time. The only time dispatch may be delayed on an emergency call is during a system overload. p. "Emergency response time" means the time calculated from when the call-taker answers the call requiring medical services to the time the medical arrives on the scene. q. "EMS" means emergency medical services. r. "Emergency medical technician (EMT) " means any person who is trained in basic life support and who is certified by the department to perform such procedures in emergency situations. s. "EMT-D" means a first response agency trained and authorized by the system medical director to utilize a semiautomatic external defibrillator for the purpose of detecting the presence of ventricular fibrillation and delivering the appropriate charge and counter-shock(s). -6-

7 t. "First responder" means a first response agency trained in the treatment of life-threatening emergencies through the use of basic techniques such as cardiopulmonary resuscitation, splinting, obstetrical assistance, bandaging, and other techniques as qualified and authorized by the system medical director. u. "First response provider" means any fire department dispatched to any emergency call for the purpose of providing non-transport first responder, basic life support, and/or EMT-D, medical care to the sick and injured. This provision does not pertain to the response of a fire department for the purpose of rescue or fire operations. v. "Inter-hospital transfer" means the ambulance transportation of a patient between two facilities licensed under Chapter 395 or Chapter 400, Florida Statutes, pursuant to this ordinance or Chapter 401, Florida Statutes. w. "Inspection officer" means the official designated by the county manager to be responsible for review and inspection of all certificate holders and/or applicants for certificates. x. "Medical advisory board" means the advisory board established herein as responsible for conducting investigations of complaints, problems, or concerns pertaining to this ordinance and providing a report and recommendations to the county manager or his or her designee, the board of county commissioners, or the system medical director, as appropriate. -7-

8 In addition, this advisory board will assist with the development and monitoring of the system standard of care protocols. y. "Non-emergency transport provider" means any person authorized by the county to provide medically related transportation of persons who do not require medical treatment or monitoring during transport. z. "Patient" means an individual who is ill, sick, injured, wounded, or incapacitated, and who is in need off or is at risk of needing, medical care or assessment during transportation to or from a health care facility, and who is or should be transported in a reclining position. aa. "Off-line medical direction" means medical direction by established medical care protocols when on-line medical direction is not available. abo "On-line medical direction" means medical direction by an appropriate physician, which may include, but shall not be limited tof a medical facility physician, an emergency department physician, an on-scene physician, or the system medical director. ac. "Neonatal ambulance provider" means any person licensed by the department and authorized by the countyf as provided herein to conduct critical neonatal transports. A written agreement that determines pre-hospital neonatal response and transport protocol shall be developed by the Primary Prehospital Care Provider and the Neonatal Ambulance Providerf and shall be approved by the System Medical Director. ad. "Operator" means any person owning or acting as -8-

9 ,. agent for the owner of any business or service which furnishes, operates, conducts, maintains, advertises, engages in, proposes to engage in, or professes to engage in a business or service that offers emergency medical service. ae. "Air ambulance provider" means any service licensed as an air ambulance by the department to conduct emergency medical patient transports in a pre-hospital or interfacility air ambulance. An air ambulance provider may operate ALS ground vehicles only as an adjunct to air ambulance patient transports. af. "Person" means and includes an individual, firm, corporation, association, partnership, or governmental entity. ago "Paramedic" means a person certified by the department and the system medical director to perform basic and advanced life support, pursuant to the provisions of this ordinance or Chapter 401, Florida Statutes. ah. "Permit" means any authorization issued pursuant to the provisions of Chapter 401, Florida Statutes, for a vehicle to be operated as a transport or a non-transport vehicle providing advanced life support services. ai. "Physician" means a practitioner licensed under the provisions of Chapter 458 or Chapter 459, Florida Statutes. aj. "Primary pre-hospital care provider" means the single county-authorized person responsible for the provision of county-wide advanced life support ambulance service. provider must be licensed by the State of Florida. Such This provider -9-

10 coordinates all components necessary to ensure an effective and systematic delivery of emergency medical services. Such provider shall have, as a minimum, advanced life support service capability available to all emergency and non-emergency medical service requests. ak. "Seconda.rY pre -hospi tal ca.re provider" means the county-authorized person or persons responsible for provision of non-transport advanced life support emergency medical response only upon request of the primary pre-hospital care provider. al. am. "State" means the State of Florida. "System" means those persons in the county who are authorized by the county to perform first responder, basic life support, EMT-D, and/or advanced life support. an. "System medical direction" means the physician supervision of the medical performance of the system emergency medical technicians, paramedics, and others, pursuant to rules of the department. This may be accomplished by on-line and/or offline medical direction. ao. "System medical director" means a licensed physician contracted with or employed by the board to provide system-wide medical direction pursuant to the provisions of this ordinance and the rules of the department. ap. "System overload" means the occurrence of more emergency calls than available ambulances to respond, resulting in a delay in dispatch and response of an ambulance. -10-

11 aq. "System standard of care" means the written body of standards, policies, and protocols governing all clinical aspects of the emergency medical services system that is approved by the system medical director and the medical advisory board, and which is developed and periodically updated. A.s used iii tllis c6fleext,"syseem staildard of care lf is a comprehensive term, including: (1) "Input standards", which include, but are not limited to, personnel certification requirements, in-service training requirements, equipment specifications, on-board inventory requirements, and other requirements that the system must fulfill before receipt of a request for service; (2) "Performance standards", which include, but are not limited to, priority dispatching protocols and prearrival instructions, medical protocols, response time standards, protocols governing authority for on-scene control of patient care, and other performance specifications describing how the system should behave upon receipt of a request for service; and, (3) "Outcome standards", which include, but are not limited to, target survival rates for certain narrowly defined presenting problems or presumptive diagnoses, such as witnessed cardiac arrests involving patients whose medical histories meet defined criteria. Outcome standards are results the system intends to achieve by meeting its input and performance standards. -11-

12 Section 4. Applicability. This ordinance shall apply within the incorporated and unincorporated areas of Alachua County. Section 5. Medical Advisory Board. There is hereby established a medical advisory board which shall be responsible fbrcohducting investigation of complaints, problems, or concerns pertaining to this ordinance and providing reports and recommendations to the county manager, the board, or the system medical director, as appropriate. The advisory board shall also assist in the development and monitoring of the system standard of care protocols. Members of the advisory board shall be appointed by resolution of the board of county commissioners and shall consist of, but not be limited to, the following: the emergency department medical director for each hospital within Alachua County, a physician from the Alachua County Medical Society, a general surgeon, a cardiologist, and a pediatrician, which physicians must practice in Alachua County. Section 6. Certificate Required. Subject to the provisions of Sections 24 and 25 hereof, as of the effective date of this ordinance, no person shall advertise or engage in, or otherwise provide any of the following services within Alachua County without first obtaining a certificate of public convenience and necessity from the board: primary pre-hospital care provider, secondary pre-hospital care provider, air ambulance provider, neonatal ambulance provider, first response provider, and non-emergency transport provider. The certificate required hereunder shall not relieve any person from the -12-

13 requirement of securing any other license required by state law. Section 7. Primary Pre-hospital Care Provider. Primary pre-hospital care provider services shall be provided within Alachua County by a single person, whether a private or public entity, provided such person shall be licensed by the state as an advanced life support provider and shall hold a certificate as provided for in this ordinance. Section 8. Exemptions. The following are exempt from the provisions of this ordinance: a. A vehicle rendering services as an ambulance in the event of a major catastrophe or emergency when ambulances with permits based in the locality of the catastrophe or emergency are incapacitated or insufficient in number to render the services needed. b. Any ambulance based outside the Alachua County, except that any such ambulance receiving a person within the county for transport to a location within the county shall comply with the provisions of this ordinance. c. Any ambulance owned and operated by the federal government. d. Any organization or person that provides wheelchair transport services if: (1) The service is a public bus system. (2) The service is a public or private school bus system whose major business is that of transporting school children to and from school or school-related activities. e. Any hospital or medical facility utilizing its -13-

14 own land vehicles in transporting to or from its hospital or its medical facility, provided the hospital does not charge a fee for this service. Section 9. Application for Certificate. Every application for a certificate as required under this ordinance shall be on a form provided by the board and shall be signed a.nd sworn to by the applicant and contain the following information: a. The name and business address of the owner or operator of the proposed service. b. The name under which the applicant will operate. c. A list of the names and addresses of all officers, directors, and shareholders of applicant, and the name and address of the registered agent and registered office for service of process. d. The territory which the applicant desires to serve. e. The type of service the applicant wishes to provide using the following applicable terms: (1) Primary pre-hospital care provider. (2) Secondary pre-hospital care provider. (3) Air ambulance provider. (4) Neonatal ambulance provider. (5) First response provider. (a) First responder. (b) Basic life support. (c) EMT-D. -14-

15 (6) Non-emergency transport provider. f. The location and description of each place from which applicant's service is intended to operate. g. A description of each vehicle to be used in the applicant's business or service, including: the make; model; year of manufacture; mileage; and vehicle identification number (VIN); state or federal aviation registration number where applicable; the size and gross weight of each vehicle; and the color scheme, insignia, name, monogram, or other distinguishing characteristics to be used to designate the applicant's vehicle or vehicles. h. The names and addresses of at least three (3) residents of the county as references. i. An agreement by the applicant to file, in the event that the application is approved and the certificate is granted, and prior to the effective date of the certificate, copies of public liability, property damage, and malpractice insurance in such amounts as the board may require, which insurance shall be at least the minimal amount and types of insurance as required by state law. All insurance policies shall provide for a thirty- (30) day cancellation notice to the board. j. An agreement by the applicant to file, in the event that the application is approved and the certificate is granted, and prior to the effective date of the certificate, a copy of standard operating procedures which shall include all general and/or special instructions to personnel as to the exact nature of their duties, and, when applicable, under what condi- -15-

16 tions and to whom and how emergency care shall be rendered. Such standard operating procedures shall be reviewed and approved by the medical advisory board and the system medical director prior to the initiation of services. The applicant shall agree to abide by the system standard of care as defined in Section 3.aq herein and as developed and approved by the system medical director and the medical advisory board. k. A statement certifying that the applicant will provide continuous service on a twenty-four (24) hour per day, seven (7) days a week basis. This statement shall not be required for non-emergency transport providers. 1. A rate schedule for services. m. Proof that the applicant has met, as appropriate, the requirements of Chapter 401, Florida Statutes. n. Such other information as the board shall deem reasonable and necessary to a fair determination of compliance with this ordinance. Section 10. Investigation of Application. Upon receipt of an application for any certificate under this ordinance, the board shall cause an investigation to be made of the financial ability of the applicant to render safe and comfortable service and to maintain or replace equipment for such service; the financial responsibility of the applicant to maintain insurance for the payment of personal injury, death, and property damage claims; and of such other pertinent facts which the board shall deem relevant in determining the fitness of the applicant to assume the occupation of an operator. The -16-

17 inspection officer shall inspect all applicants for compliance with requirements of Chapter 401, Florida Statutes, and the requirements of this ordinance. Section 11. Hearings and Notices. a. Upon the filing of an application for a certificate, the board shall give notice to all existing operators serving any part of the area proposed to be served by the applicant. Such notice shall contain a brief summary of the subject matter of the application, including the type of service proposed, the geographical area to be served, and other information as may be pertinent. Any operator notified as provided herein, may file with the board and serve upon the applicant a formal protest specifying objections to the issuance of a certificate within thirty (30) days after mailing of the notice by the board. b. Within ninety (90) days after mailing of the notice as provided herein, the board shall grant, grant with modifications or such conditions that the board may deem necessary or proper in the public interest, or deny the application for a certificate. c. In determining whether such certificate shall be granted, the board may consider the following: (1) Whether existing emergency medical transportation services are adequate to meet reasonable public needs. (2) The financial ability of the applicant to furnish continuous and uninterrupted service at the times -17-

18 required therefor, and to meet the financial obligations of the service which the applicant proposes to perform. (3) The effect on existing medical transportation facilities and services of all kinds and, particularly, whether the granting of such certificate will or may seriously impair essential public service as provided by existing service operators. (4) The qualifications of the applicant to properly perform the proposed service and to conform to the provisions of this ordinance. (5) Any objections received from operators who were provided notice of the application as set out herein. (6) Any of the matters set out in Section 9 of this ordinance. Section 12. Form and Content of Certificate. a. Every certificate issued under this ordinance shall state the service territory authorized, the minimum requirements for the motor vehicles to be used in the provision of such service, and such conditions and limitations as the board may deem necessary for protecting the public interest. b. All certificates and any and all renewals thereof shall be valid for a period of two (2) years from the -18-

19 date issued, unless earlier revoked, modified, or suspended. c. The board shall consider issuing renewals of existing certificates by following the same process as identified herein concerning applications for original certificates. d. The inspection officer shall inspect each primary pre-hospital care provider, secondary pre-hospital care provider, first responder provider, neonatal ambulance provider, non-emergency transport provider, and air ambulance provider, which shall include an examination or review of each emergency medical service vehicle, transport vehicle, equipment, personnel, records, premises, and operational procedures, at reasonable times, no more than quarterly, no less than annually, or whenever such inspection is deemed necessary by the board and prior to issuing a certificate or renewing a certificate. The periodic inspection required hereunder shall be in addition to other state inspections required under general law, and shall not interfere with patient care. e. If the board determines not to renew a certificate, within thirty (30) days of the expiration of the certificate, it shall notify the holder in writing of its intended action and the reasons for that action. f. In time of emergency, certificate boundaries may be extended or services duplicated in the same geographic area at the discretion of the inspection officer or the system medical director at the request of a certificate holder within an area needing assistance for a temporary period of thirty (30) days. Permanent changes may be made only for the purpose of -19-

20 changing boundaries between two agencies and shall require board approval. Section 13. Transfer or Assignment. No certificate issued under this ordinance shall be assigned or transferred by the person to whom it is issued, except upon prior approval of the board of si1en assignment or transfer. Such approval shall be granted in the same manner and subject to the same application requirements and procedures as original applications for certificates. Any majority transfer of shares of stock or interest of any person or operator so as to cause a change in the directors, officers, majority stockholders, or managers of such person or operator shall be deemed a transfer or assignment as contemplated by this ordinance shall be subject to the same rules and regulations as any other transfer or assignment. Section 14. Revocation, Modification, or Suspension of Certificates; Grounds. a. Every certificate issued under this ordinance shall be subject to revocation, modification, or suspension by the board when it shall appear that: (1) The operator has failed or neglected to render all services authorized by the certificate without reasonable cause. (2) The operator has been convicted of or pled nolo contendere to a felony or to any criminal offense involving moral turpitude. (3) The certificate was obtained by an application in which any material fact was omitted or falsely stated. -20-

21 (4) The operator has permitted any vehicle to be operated in violation of the laws of the state or this ordinance, which violation resulted in a conviction of the driver or operator of the vehicle of a misdemeanor in the second degree or greater. {S)The operator ha:spermieteaa: person topro~ vide service under the certificate without such person possessing the appropriate license, certificate, or permit as required by this ordinance and Chapter 401, Florida Statutes. (6) The operator has failed to comply with any of the provisions of this ordinance, Chapter 401, Florida Statutes, or Chapter 10D-66, Florida Administrative Code. (7) The operator, or his or her agents, or employees have demanded money or compensation for services other than at the rates established and prescribed under this ordinance. (8) The operator has knowingly allowed his or her agents or employees to violate the provisions of this ordinance, Chapter 401, Florida Statutes, or Chapter 10D-66, Florida Administrative Code. (9) Or other good cause. b. Proceedings for investigation and recommendation of revocation, modification, or suspension of a certificate, and any hearing to be held based upon this investigation, shall be undertaken by the medical advisory board. All complaints shall be investigated within fifteen (15) days and a report thereon made to the board, together with findings and -21-

22 recommendations. If revocation, modification, or suspension of any certificate appears warranted, the board, through the county manager's office, shall give written notice to the operator holding the certificate that the same will be considered for possible revocation, modification, or suspension at a specific board meeting, provided. the date of such rneeeing shall not be earlier than fifteen (15) days from the date of the notice. The board shall, thereupon, undertake to consider the complaint and either revoke, modify, or suspend the certificate or dismiss the complaint. Section 15. Obedience to Traffic Laws, Ordinances, and Regulations. a. The driver of an ambulance responding to an emergency medical call or transporting a patient may exercise the privileges set forth in this section subject to the conditions stated and only when such driver has reasonable grounds to believe that an emergency in fact exists requiring the exercise of such privileges. Subject to these conditions, the driver of an ambulance may: (1) Park or stop the ambulance, irrespective of the otherwise applicable provisions of law, ordinances, and regulations. (2) Proceed past a red stop signal or stop sign, but only after slowing down and/or stopping as may be necessary for safe operation. (3) Exceed the maximum speed limits permitted so long as life and property are not endangered. -22-

23 (4) Except when the situation involves a stopped school bus with flashing red lights, disregard laws, ordinances, and regulations governing direction of movement or turning in specified direction so long as life and property are not endangered. b. The privileges herein grantedstiall a.pply only when such ambulance is making use of appropriate warning signals meeting the requirements of this ordinance and Chapter 401, Florida Statutes. c. The foregoing provisions shall not relieve the driver of an ambulance from the duty to drive with due regard for the safety of all persons, nor shall such provisions protect the driver from the consequences of his or her reckless disregard for the safety of others. Section 16. General Operating Regulations. All certificate holders and operators shall comply with, and ensure that their agents and employees comply with, the following regulations: a. Every certificate holder, except for nonemergency transport providers, shall be required at all times to operate a sufficient number of vehicles to meet the normal daily demand for the service and to prevent frequent system overloads. A pre-hospital air ambulance service certificate holder shall utilize every reasonable effort to minimize its out-of-service times due to mechanical failure. b. Every call for emergency medical service shall be answered promptly. Emergency medical dispatch utilizing the -23-

24 medical priority dispatch system will be the accepted standard of emergency medical call-taking in Alachua County. All certificate holders, other than non-emergency transport providers, shall have dispatch policies and procedures that shall be subject to review by the medical advisory board. Persons requesting emergency medical services Shall be respondeat.o ana t.ransported without being subjected to unreasonable delays. All certificate holders, other than non-emergency transport providers, shall conform to the response time standards established by the medical advisory board. c. Each advanced life support vehicle shall have, in addition to its driver, an attendant who is cleared by the system medical director, who shall continuously attend the patient during transport. All vehicles shall be staffed in compliance with Chapter 401, Florida Statutes, and Chapter 10D- 66, Florida Administrative Code. d. Every certificate holder shall maintain a daily record upon which shall be recorded the place of origin, the time of call, the time of dispatch, the time of arrival at scene, time left for destination, time of arrival at destination, and charges for each trip made, and such other operating and patient information as may be required by the state. Every certificate holder shall retain and preserve all daily logs for at least two (2) years and such logs shall be available for inspection by the inspection officer or the medical advisory board upon reasonable request. Falsification of a record shall be grounds for revocation, modification, or suspension of a certificate. Advanced -24-

25 life support services shall record and keep patient medical records in accordance with Chapter 401, Florida Statutes, and Chapter 10D-66, Florida Administrative Code, and any other applicable state laws. Patient report forms shall be approved by the medical advisory board. e. Each ambulance shall be suitable for transportation of persons requesting service and shall meet the appropriate safety, sanitation, and maintenance standards. Every vehicle shall possess an appropriate communications system linking the vehicle with the operator's central place of business in addition to conformance with the State of Florida Division of Communications requirements for licensed EMS vehicles. Emergency medical services communications channel assignments will be determined by the primary pre-hospital care provider and all vehicles responding to an incident for EMS purposes will operate on the same radio channel as assigned by the primary pre-hospital provider's emergency medical communications center. Each vehicle shall conform in all respects to the most recent applicable design criteria as required by Chapter 401, Florida Statutes, and Chapter 10D-66, Florida Administrative Code. f. Each vehicle licensed by the department shall, at all times, carry the minimum equipment as required by Chapter 401, Florida Statutes, and Chapter 10D-66, Florida Administrative Code. All vehicles not licensed by the department shall carry, at all times, the minimum equipment as required by the system medical director. -25-

26 g. Each vehicle assigned as an advanced life support unit shall have all equipment in proper working order in order to allow a paramedic to render advanced life support service. h. The system medical director is responsible for the development of written medical care protocols that determine the minimum level of medical care that each provider may deliver without direct on-line communication with a physician. Section 17. Central Place of Business. operator shall maintain a central place of business. Each Each operator shall keep and make available at his or her central place of business such daily business records that are required for inspection by the inspection officer or the medical advisory board. Each operator shall file with the board as part of his or her application, and keep current with the board, his or her central place of business address and telephone number. Section 18. Rates. All persons granted certificates hereunder shall file with the board a schedule of the rates to be charged for services rendered during treatment and/or transportation in a service vehicle. Such rate schedule shall be filed as part of the application for a certificate. All rates are subject to board approval and a rate schedule may be implemented only after approval by resolution of the board. Only those rates shown on a rate schedule approved by the board shall be charged and collected by the operator. Every vehicle shall have a rate card available, which card shall state the date the charges were approved by the board. Air ambulance providers -26-

27 shall be exempt from rate schedule approval by the Board but will file current rate schedules as required herein. Section 19. Operator's Insurance. Every operator, throughout the term of his or her certificate and any renewal thereof, shall carry and maintain insurance as described in subsect.i.on9.i nereof. Section 20. Drivers. a. Each certificate holder is responsible for ensuring that his or her service's vehicles are driven by trained, experienced, and otherwise qualified personnel. b. No person shall drive an emergency service vehicle unless that person: (1) Is eighteen (18) years of age or older. (2) Certifies under oath that he or she is not addicted to alcohol or any controlled substance. (3) Certifies under oath that he or she is free from any physical or mental defect or disease that might impair his or her ability to drive. (4) Has not, within the past three (3) years, been convicted of reckless driving, or driving under the influence of alcohol or controlled substances, and has not had a driver's license suspended pursuant to Florida law. (5) Possesses a valid Type "D" or chauffeur's license. (6) Possesses a valid Florida emergency medical technician or paramedic certificate while driving an ambulance. -27-

28 (7) Is trained in the safe operation of emergency vehicles and has completed an emergency vehicle operator's course or the reasonable equivalent as approved by the department, provided that this requirement shall apply only to a driver of a land vehicle. ( S) Fogsesges, fore i ther fixed wing air ambu ~ lances or emergency medical helicopters, the appropriate commercial pilot's license for the category of aircraft being utilized and, for fixed wing aircraft, the appropriate instrument rating and, if applicable, the appropriate marine certificate. Section 21. Conduct of Employees. No operator, service attendant, or driver registered hereunder, or employee thereof, shall: a. Failor refuse to promptly transport or attend any sick or injured person after responding to a call. b. Demand or receive compensation other than that established and prescribed as provided in Section 18 hereof, or fail to give a receipt for monies received. c. Give or allow rebate, commission, discount, or any reduced rate not provided in the approved rate schedule. d. At any time, induce or seek to induce any person engaging an ambulance to patronize or retain the services of any hospital, convalescent home, mortuary, cemetery, attorney, accident investigator, nurse, medical doctor, or other service occupation or profession. -28-

29 e. Fail to keep his or her person clean and presentable when on duty, or fail to wear a clean, presentable uniform, when reasonable, distinctive of the organization he or she represents. f. At any time, use abusive or obscene language or fail to conduct himself or herself in a professional manner. g. At any time, release a patient from his or her care until he or she is assured that some person of an equal or higher level of training is available to receive such patient. h. At any time, use a siren or flashing red light unless on an emergency call and/or in an emergency situation. i. Smoke or use any tobacco product while driving an ambulance carrying a patient or when attending a patient. j. At any time, administer treatment to any patient or fail to administer any treatment which is not within the prescribed bounds of his or her training, or covered by standing orders or at the direction of an attending physician, or which would not be considered what any reasonable person would administer under the same or similar circumstances. k. Fail to record on the daily record as authorized by the system medical director, the refusal of service by a patient. Section 22. Sanitation and Maintenance. All emergency medical transportation vehicles shall: a. Have interior equipment which is smooth and easily cleaned. b. Have interior lights which function properly. -29-

30 c. Be free of hazards, including, but not limited to, uneven and slippery floors and sharp edges. d. Be free of dents and rust which interfere with the safe operation of the vehicle. e. At all times, meet the requirements of Chapter 4t>l, Florida Statutes. f. Have all equipment in passenger compartment safely and adequately secured. g. Have all doors, latches, and handles in proper working order. h. Have clean blankets, linen, or disposable sheets for each patient when used to transport stretcher patients. i. Have storage compartments for soiled linens when used to transport stretcher patients. Section 23. Passengers/Ambulance. No person shall be aboard an ambulance when engaged in emergency or routine medical calls, except the following: a. The driver and attendants. b. Patients. c. Family or friends of patient or patients, at the driver's discretion. -30-

31 d. Physicians. e. Other persons authorized by the licensing authority, including trainees, other emergency medical technicians, emergency department nursing personnel, and others having the right to observe and/or participate in this portion of the emergency services system. Section 24. Regulation of First Response Providers. Within eighteen (18) months after the effective date of this ordinance, no person shall provide or offer first response provider services within Alachua County without a certificate issued in accordance with this ordinance. First response provider certificates may be issued at either of the following levels of clinical capability. a. First responder. b. Basic life support. c. EMT-D. First response provider certificates require the prior approval of the medical director. Each first response provider shall be medically supervised, during the term of its certificate, by the system medical director. Section 25. Regulation of Non-emergency Transport Providers. Within twelve (12) months after the effective date of this ordinance, no person shall provide non-emergency transport services within Alachua County without a certificate issued in accordance with this ordinance. -31-

32 In addition to the requirements of Section 9 of this ordinance, non-emergency transport providers shall ensure that their transportation vehicles: a. Have interior equipment that is smooth and easily cleaned. b. Have interior lights in the transport compartment that function properly. c. Are free of dents and rust that would interfere with the safe operation of the vehicle. d. Have appropriate markings that clearly identify the intended use of the vehicle. e. Have a functioning heating and air conditioning system that adequately heats and cools the transport compartment. f. Have all doors, latches, and handles in proper working order. g. Have securing devices to ensure wheelchairs and stretchers are fastened securely during transport. Safety restraint devices are required for all passengers. h. Are staffed with a minimum of one (1) licensed driver who is currently certified in cardiopulmonary resuscitation. i. All vehicles must have a two-way radio system or cellular telephone service which shall access their central place of business. -32-

33 Section 26. Administration and Enforcement of Ordinance. The responsibility of the administration and review of the provisions of this ordinance is vested in the inspection officer. The inspection officer will determine the time interval for correcting all infractions. Failure to comply by the certificate-hotd-er wilt re-sultin a report to the medical advisory board for further action and recommendation. Section 27. Penalty. Any person violating this ordinance shall be guilty of a misdemeanor and, in addition to any other penalty provided herein, shall be subject to the penalty set forth in Section (1), Florida Statutes. Section 28. Severability. It is the declared intent of the Board of County Commissioners that, if any section, subsection, sentence, clause, phrase, or provision of this ordinance is held invalid or unconstitutional by a court of competent jurisdiction, such invalidity or unconstitutionality shall not be so construed as to render invalid or unconstitutional the remaining provisions of this ordinance. Section 29. Repealing Clause. Emergency Ordinance 92-28, Ordinance 92-20, and Sections through of the Alachua County Code of Ordinance are hereby repealed and all other ordinances or portions thereof in conflict herewith are, to the extent of such conflict, hereby repealed. -33-

34 Section 30. Effective Date. A certified copy of this ordinance shall be filed with the Department of State by the Clerk of the Board of County Commissioners within ten (10) days after enactment by the Board of County Commissioners, and shall take effect upon receipt of official acknowledgment from that office that the same has been filed , i 1arch A.. D, DULY ADOPTED in regular session, this ~~ day of BOARD OF COUNTY COMMISSIONERS OF ALACHUA COUNTY, FLORIDA By:?~~~ Penelope Wheat, Chalrman J APPROVED AS TO FORM (SEAL) ECTNESS -34-