Chapter 8.32
REGULATORY STANDARDS FOR EMERGENCY SERVICES
Sections:
8.32.010 Purpose.
8.32.020 Definitions.
8.32.030 Exclusive ambulance service provider.
8.32.035 Administration.
8.32.045 System standard of care—Medical program director’s duties.
8.32.055 System standard of care—Upgrades—Conditions.
8.32.065 System standard of care—Contractor upgrades—Review required.
8.32.100 Prohibited activities.
8.32.110 Violation—Penalty.
8.32.120 Exemptions to chapter provisions.
8.32.130 EMS administrative board—Authority.
8.32.140 Administrative rules.
8.32.145 Enforcement—Liability limitations.
8.32.010 Purpose.
It is the purpose of this chapter:
A. To establish oversight and regulatory standards for the provision of ambulance and emergency medical services which supplement and exceed the standards of Chapters 18.73 and 70.168 RCW and the regulations adopted thereunder;
B. To promote state-of-the-art clinical quality of EMS care with reasonable, reliable response-time standards, and with the goal of furnishing the best possible chance of survival, without disability or preventable complication, to each EMS patient;
C. To provide a method to develop specific performance standards, adequate review, and medical protocols for such services; and
D. To establish a uniform EMS ordinance which may be adopted by other general purpose governmental units which wish to take advantage of a uniform standard of care in recognition of the role of the medical facilities and health care community as regional providers of primary, secondary, and tertiary medical care. (Ord. 03-010 § 1, 2003: Ord. 95-772 § 1, 1995)
8.32.020 Definitions.
Unless a different meaning is plainly required by the context, words and phrases used in this chapter shall have the meanings attributed to them in RCW 18.73.030 or in this section; provided, that in case of any conflict, this chapter shall control.
“Ambulance patient” means any patient being transported to or from a health care facility in a reclining position.
“Ambulance service” means the transport of ambulance patients by any person to or from a health care facility or between health care facilities.
“Ambulance service contractor” means the entity which is under contract with Clark County EMS District No. 2 to provide ambulance services.
“Board” means the Clark County board of commissioners.
“Cities” means the cities of Battle Ground, La Center, and Vancouver, Washington which have adopted the uniform EMS ordinance and entered into the EMS interlocal cooperation agreement.
“County” means Clark County, Washington.
“CRESA” means the Clark regional emergency services agency.
“District” means Clark County Emergency Medical Services District No. 2 established by ordinance pursuant to RCW 36.32.480.
“Emergency medical services administrative board,” “EMS board,” or “EMSAB” means the board established pursuant to this chapter and the EMS interlocal cooperation agreement to provide EMS administrative and financial oversight functions.
“EMS interlocal cooperation agreement” means the agreement entered into between the cities, the county, and the district pursuant to Chapter 39.34 RCW in part to effectuate the enforcement of this chapter.
“Loaded miles” means the ambulance transport of a patient from site of pick up to destination.
“Medical call-taker” means a person in the employ of or acting under the control of a private or public agency who receives and responds to calls requesting emergency medical services and administers emergency medical dispatch protocols approved by the medical program director.
“Medical program director” or “director” means the medical program director for Clark County certified by the Secretary of the Department of Health pursuant to Chapter 18.71 RCW.
“Medical protocol” means any diagnosis-specific or problem-oriented written statement of standard procedures promulgated pursuant to state or local law or regulation for prehospital care for a given clinical condition.
“On-line medical control physician” means a physician who gives direction to ambulance or other EMS personnel through direct voice contact or other communication media as required by applicable medical protocols.
“Patient” means any person who is injured, sick, incapacitated, or otherwise found by the medical program director to require emergency medical services.
“Person” means an individual, partnership, company, association, corporation (governmental or private) or any other legal entity including any receiver, trustee, assignee or similar representative.
“Regulated service area” means the combined area of the unincorporated area of Clark County plus the corporate limits of the cities and all other general purpose jurisdictions which have adopted the uniform EMS ordinance and entered into the EMS interlocal cooperation agreement.
“Response time zones” means those geographic areas designated as urban, suburban, rural and wilderness by the EMS administrative board and in the EMS administrative rules adopted pursuant to this chapter.
“System standard of care” or “standard of care” means the combined compilation of all standards for prehospital medical care including but not limited to priority dispatching protocols; pre-arrival instruction protocols; medical protocols (i.e., first responders and ambulances); protocols for selecting destination hospitals; standards for certification of prehospital care personnel (i.e., medical call-takers, first responders, EMTs and on-line medical control physicians); standards for permits (i.e., ambulances, first responder units, helicopter rescue units, and special-use mobile intensive care services); response time standards; standards governing on-board medical equipment and supplies; and standards for licensure of ambulance services and first responder agencies. The standard of care shall serve as both a regulatory and contractual standard of care and performance.
“Uniform EMS ordinance” or “ordinance” means the ordinance codified in this chapter and all substantially identical ordinances adopted by general purpose governmental jurisdictions which are also parties to the EMS interlocal cooperation agreement. (Ord. 03-010 § 2, 2003: Ord. 95-772 § 2, 1995)
8.32.030 Exclusive ambulance service provider.
Except as provided for in BGMC 8.32.120, no person or entity shall provide ambulance service for either emergency and nonemergency transport of ambulance patients unless under contract to do so with the district. (Ord. 03-010 § 3, 2003: Ord. 95-772 § 3, 1995)
8.32.035 Administration.
Clark County shall be the agent of the city to enforce and administer this chapter and shall establish a budget for the support of such activities; provided, that any criminal prosecution as defined in BGMC 8.32.110 shall be instituted by the affected jurisdiction. The specific responsibilities of Clark County as the regulatory administrator shall be described as described by the EMS interlocal cooperation agreement. (Ord. 03-010 § 9, 2003)
8.32.045 System standard of care—Medical program director’s duties.
The county, as administrator, shall contract with the medical program director to perform the following duties and responsibilities:
A. To prescribe and periodically revise the standard of care for EMS services so as to supplement or exceed the standards set by state law and regulations;
B. To appoint and receive recommendations from such standing and ad hoc advisory committees as may be appropriate to secure broad-based input for improving the standard of care, with membership on such committees which may include emergency medical service providers such as physicians, nurses and paramedics; public and private emergency response and planning agency personnel; and consumers of emergency medical services; provided, there shall be appointed at minimum one standing advisory committee composed of representatives from public and private EMS providers;
C. To provide recommendation to the appropriate state authority related to the issuance, renewal, suspension, revocation or restriction of the licenses, certifications and permits provided for by this chapter, subject to appeal or review as prescribed by this chapter and not inconsistent with state law;
D. To establish and maintain a system of clinical and response-time monitoring, medical control and medical audit designed to detect and correct deviations from the standard of care which reduce the level of patient care, to identify and correct deficiencies in the system standard of care itself, and advance the practice of prehospital medicine through clinical research. (Ord. 03-010 § 10, 2003)
8.32.055 System standard of care—Upgrades—Conditions.
Upgrades to the system standard of care may be periodically proposed by the medical program director, after input from any appropriate ad hoc or standing advisory committees established pursuant to this chapter. The medical program director shall notify the city and all affected holders of licenses, permits and certifications of the proposed upgrade not less than thirty days prior to the date scheduled for its implementation. The affected persons or entities may submit a statement of financial impact to the director documenting their projected actual and reasonable costs of implementing and maintaining such upgrade and the impact of such costs on the fees, if any, they charge for their services or the amount of local government funding for such services. The financial impact statement shall be submitted in a format approved by the medical program director. If no financial impact statements are submitted or if the statements submitted show that the proposed upgrade can be implemented without an increase in fees to consumers or an increase in local government subsidy, the upgrade shall be implemented as scheduled. If financial impact statements are submitted by the ambulance service contractor to show that the upgrade will result in increased fees to consumers or increased local government subsidies, the proposed upgrade shall be referred to the EMS administrative board for review. If financial impact statements are submitted by other affected holders of licenses, permits and certifications to show that the upgrade will result in increased fees to consumers or increased local government subsidies, the impact statements shall be referred to the medical program director for consideration in adopting the upgrade. (Ord. 03-010 § 11, 2003)
8.32.065 System standard of care—Contractor upgrades—Review required.
Upon receipt of a proposal for an upgrade in the system standard of care which is alleged to result in a cost or subsidy increase to the ambulance contractor, the EMS administrative board shall schedule a hearing within thirty days of receipt to determine the probable financial impact of the proposed upgrade and review its importance to the provision of quality prehospital medicine. The medical program director, the city, the county and the ambulance service contractor shall be given not less than five days’ prior notice of the hearing and shall have the opportunity to present evidence and argument at the hearing. The EMS administrative board shall approve, modify, or deny the proposed upgrade subject to confirmation by the district, and give notice of its decision to the city, county, and ambulance service contractor; provided, that no proposed upgrade shall be modified by the EMS administrative board without the approval of the medical program director. The upgrade so approved or modified shall become effective thirty days after notice of the decision of the EMS administrative board, unless prior to the expiration of such time the district gives notice to the EMS administrative board of its election to review the upgrade. The district shall schedule a hearing before the board on the upgrade within thirty days of its notice of election and shall give the medical program director, the cities, and ambulance contractor not less than five days’ prior notice of the hearing and the opportunity to present evidence and argument at such hearing. The district may approve, modify or deny the upgrade; provided, that the upgrade shall not be modified without approval of the medical program director. The written decision of the board on the upgrade shall be final and conclusive unless review is sought in a court of competent jurisdiction within ten days of the board’s written decision. (Ord. 03-010 § 12, 2003)
8.32.100 Prohibited activities.
Except as provided in BGMC 8.32.120, it shall be unlawful for any person including any ambulance service, its agents or employees to intentionally, knowingly, or recklessly:
A. Make a false statement of a material fact, or omit disclosure of a material fact, in any application for a license, certification, or permit required by this chapter;
B. Perform the services of or allow the performance of first responder, EMT or trainee activities by any first responder, EMT or trainee who suffers a suspension, revocation or termination of certification by the Department of Health;
C. Solicit the performance of ambulance services or the transport of an ambulance patient by any person not licensed or certified under this chapter or by use of any vehicle or equipment for which a permit is not in effect under this chapter;
D. Perform the services of a first responder or EMT unless in full conformity with state law, this chapter and the standard of care established hereunder;
E. Provide private ambulance service unless under contract to do so with the district or authorized by Clark regional emergency services agency in time of emergency;
F. If licensed hereunder, fail or refuse to immediately advise Clark regional emergency services agency of receipt of a request for emergency medical assistance;
G. Falsify, deface or obliterate any license, certificate or permit required under this chapter;
H. Transport an ambulance patient in any vehicle other than an ambulance, except as provided in RCW 18.73.170;
I. Advertise on a vehicle a level of services not being provided by that particular vehicle. The level of service must be available anytime that vehicle is available for service; provided, that this chapter shall not be construed to require level of service advertising on vehicles;
J. Wear any badge or device similar to the badge traditionally worn by police or fire personnel while serving on or with an ambulance providing emergency medical transportation within the county unless such ambulance is owned or controlled by a public safety agency and the personnel are employees of the agency;
K. Deny or delay emergency ambulance or other EMS service to any person on account of possible inability to pay, race, creed, religion, age, sex, national origin, physical or mental disability, place of residence, financial condition, presence or absence of medical insurance coverage; provided, that it shall not be a violation of this chapter for ambulance personnel to obtain at the time of service information required for effective billing, to comply with state or federal regulations pertaining to patient care and transport, or to comply with special benefit eligibility procedures established by medical insurers or medical service providers;
L. Charge for any service, equipment or supplies not provided to the patient. (Ord. 03-010 § 4, 2003: Ord. 95-772 § 10, 1995)
8.32.110 Violation—Penalty.
Misdemeanor. Violation of this chapter is a misdemeanor punishable upon conviction by not more than one year in jail and/or a fine not to exceed five thousand dollars. (Ord. 95-772 § 11, 1995)
8.32.120 Exemptions to chapter provisions.
This chapter shall not apply to:
A. Vehicles being used to render temporary assistance in the case of a public catastrophe or emergency when licensed ambulances are not available or cannot meet overwhelming demand;
B. Vehicles owned or controlled by the United States government;
C. Vehicles operated only on private property or within the confines of institutional grounds;
D. Persons providing wholly volunteer emergency transportation or emergency medical services without compensation or the expectation of compensation on an unplanned and nonregular basis;
E. Vehicles or aircraft responding at the request of an ambulance service provider licensed under this chapter pursuant to a mutual aid agreement approved by the medical program director;
F. Persons or vehicles providing ambulance service for patient transports originating outside the regulated service area or nonstop patient transports through the regulated service area;
G. All air transport services (fixed and rotary wing) approved by the medical program director used for the medical transport purposes;
H. Persons or vehicles providing non-911 ambulance service for intercounty patient transports originating inside the regulated service area in excess of thirty loaded miles. (Ord. 03-010 § 5, 2003: Ord. 95-772 § 12, 1995)
8.32.130 EMS administrative board—Authority.
The county shall appoint four of the five members of an EMS administrative board. The fifth member shall be appointed by the four county appointees to the EMS administrative board. The EMS administrative board shall advise on matters pertaining to EMS contracting and system-wide financial stability and carry out administrative duties as specified in this chapter and by the ambulance services contract, and the EMS interlocal cooperation agreement.
A. The EMS administrative board shall consist of five persons, none of whom shall be elected officials, who shall consist of the following:
1. One with expertise in the field of health care administration;
2. One with expertise in business and finance;
3. One with expertise in law;
4. One with expertise in the fields of health care administration or business;
5. One person chosen by the four county appointees to the EMS administrative board.
B. Appointments shall be for three years. The EMS administrative board shall elect such officers and adopt such bylaws as appropriate for orderly conduct of business.
C. The EMS administrative board, as provided in the EMS interlocal agreement, shall:
1. Develop and administer an ambulance procurement process for the contract service area of EMS District No. 2, subject to confirmation by the district;
2. Conduct ongoing ambulance contract administration and oversight;
3. Review and comment on changes in EMS system structure and financing;
4. Review upgrades in the system standard of care which will result in major cost increases, subject to confirmation by the district;
5. Perform such other duties as are prescribed by the EMS interlocal cooperation agreement. (Ord. 03-010 § 6, 2003: Ord. 95-772 § 13, 1995)
8.32.140 Administrative rules.
A. Adoption. The medical program director may adopt, amend and repeal administrative rules deemed necessary to achieve the purposes of establishing system standards of care. Such rules shall include, but are not limited to:
1. Procedures for licensing ambulance services;
2. Procedures for obtaining EMS vehicle permits;
3. Minimum EMS vehicle and equipment levels;
4. Minimum staffing levels;
5. Minimum response time standards.
B. Notification Requirements. In promulgating or amending these rules, the medical program director shall provide for reasonable notice to and opportunity for comment by affected agencies and persons. (Ord. 03-010 § 7, 2003: Ord. 95-772 § 14, 1995)
8.32.145 Enforcement—Liability limitations.
Nothing in this chapter is intended to create a cause of action or claim against the city or its officials, employees or agents running to specific individuals. Any duty created by this chapter is a general duty running in favor of the public. Nothing in this chapter shall be construed to make the city liable for the costs of ambulance or EMS services. (Ord. 03-010 § 13, 2003)