Chapter 10.47
Emergency Medical Transport

Sections:

10.47.010 Purpose.

10.47.020 No Duty Created.

10.47.030 Definitions.

10.47.040 City of Spokane EMS Board.

10.47.050 Permit.

10.47.060 Insurance.

10.47.070 Medical Emergencies.

10.47.080 Patient Care and Transfer.

10.47.090 Communications.

10.47.100 Contacts for Responsibility.

10.47.110 Advertising.

10.47.120 Telephone Numbers.

10.47.130 Appearance.

10.47.140 Enforcement.

10.47.150 Penalties.

10.47.160 Severability.

10.47.170 Additional Enforcement.

10.47.180 Liberal Construction.

10.47.190 Effective Date.

10.47.010 Purpose.

The purpose of this chapter is to regulate the emergency medical treatment of injured, ill or disabled persons and their emergency transport in ground and air ambulances. It does not apply to or regulate non-emergency patient transport.

This chapter is enacted as an exercise of the police power and is to be construed for the protection of the general public health, safety and welfare. It is intended to supplement and exceed the standards for ambulances and emergency services set forth in RCW chapters 18.71 and 18.73 to the extent possible.

[Ord. C32548 § 1; Passed: 12/20/1999]

10.47.020 No Duty Created.

No particular duty, relationship, liability or obligation of the City or any official to any particular individual, group or entity shall be deemed created because of this chapter or because of any action or inaction pursuant to its provisions or authority.

[Ord. C32548 § 2; Passed: 12/20/1999]

10.47.030 Definitions.

A.  “Ambulance” means a ground or air vehicle designed and used to transport the ill or injured and to provide personnel, facilities, and equipment to treat patients before and during transportation.

B.  “Emergency transport” means an ambulance transport of a person on an emergency basis to an appropriate medical facility for immediate treatment.

C.  “Non-emergency transport” means planned transport of a person in a medically stable condition on a non-emergency basis.

[Ord. C32548 § 3; Passed: 12/20/1999]

10.47.040 City of Spokane EMS Board.

There is hereby created the City of Spokane EMS board comprised of:

One fire service executive designated by the Inland Empire fire chiefs’ association;

Executive director of the Spokane County medical society;

Spokane County medical program director;

Deputy director, Spokane City/County department of emergency management;

One member of the executive board of the East Region EMS council;

The City of Spokane EMS board shall assure compliance with the provisions of this chapter and have other duties and responsibilities as provided herein or as may hereinafter be delegated by the Spokane city council.

[Ord. C32548 § 4; Passed: 12/20/1999]

10.47.050 Permit.

A.  Permit Required. No person may operate an ambulance within the City of Spokane without first obtaining a permit from the City with the endorsement of the Spokane County EMS Council. An application for a license must be submitted to Spokane County EMS Council, contain documentation provided by the provisions of this chapter and be signed by the person and certified as true under penalty of perjury.

B.  Requirements. No permit is issued unless the applicant has:

1.   fulfilled all the requirements of the laws of the State of Washington applicable to ambulance services, including but not limited to RCW chapters 18.71, 18.73 and 71.168 and WAC chapters 246-976 and 248-17, and subsequent amendments or revisions thereto;

2.   met all requirements of this chapter; and

3.   filed proof of insurance coverage as required by this chapter.

C.  Validity. A permit is valid for two years beginning July 1st, if application is made between March 1st and April 30th. Permits issued pursuant to applications made at other times of the year will be issued within three months of the application date and be valid until the second July 1st after the date of issue.

D.  Exemptions. A permit is not required for ambulance(s):

1.   entering the City of Spokane for the purpose of transporting patients to or through it; or

2.   pressed into service for transportation of patients in major emergencies or disasters; or

3.   based and posted inside of the City for the purpose of providing service to border areas or outside the city.

E.  Fee. The permit fee is twenty-five dollars.

F.  Transfer. A permit issued under this section may not be assigned or transferred. It shall be invalid upon change of ambulance ownership.

[Ord. C32548 § 5; Passed: 12/20/1999]

10.47.060 Insurance.

A.  Workers Compensation. The ambulance company must obtain and maintain Worker’s Compensation Insurance for the benefit of its employees required to be insured by the laws of the State of Washington.

B.  Liability. The ambulance company must obtain and maintain occurrence form liability insurance with a minimum of three million dollars combined single-limit coverage for both bodily injury and property damage under vehicle liability, general comprehensive liability, and contract liability insurance coverage.

C.  Professional Liability. The ambulance company must obtain and maintain professional liability insurance in the minimum amount of five million dollars per person for any certified individual providing medical care.

D.  Liability Policy Requirements. The above-referenced liability insurance policies must:

1.   provide for thirty days’ notice to the City by the insurer in the event any policy, or portion thereof, is canceled, or the coverage under the policy is reduced, or the policy is not renewed; and

2.   be primary and not excess or contributing.

E.  Insurance Companies. Certificate(s) evidencing such coverage(s) shall be provided to the City. Insurance companies must be licensed under the laws of the State of Washington and have a Best rating of “A.”

[Ord. C32548 § 6; Passed: 12/20/1999]

10.47.070 Medical Emergencies.

The provisions of the section are in keeping with the “tiered response” principles adopted by the Spokane County EMS Council for securing the immediate response by the appropriate emergency medical service (EMS) provider to any medical emergency incident and to assure incident management and control.

A.  Primary EMS Responder. The Spokane fire department is designated as and will be the primary EMS responder for the City of Spokane.

B.  Incident Command and Control. The “primary EMS responder,” as defined in subsection (A) of this section, is responsible for and will have incident command and control for all EMS incidents in its jurisdiction. Ambulance personnel shall operate within the incident command framework.

C.  Notice Medical Emergency to Fire Service Dispatch. When an ambulance company receives a request for an ambulance to respond to any medical emergency from any source other than Spokane City/County fire service dispatch (CCC) or the Spokane fire department, the ambulance company shall immediately, coincident with its response, provide Spokane City/County fire service dispatch (CCC) with all available information as to the nature and location of the emergency.

D.  Ambulance Response. An ambulance may not respond to a medical emergency incident unless called to respond by Spokane City/County fire service dispatch (CCC) or direct telephone call as provided for in subsection (C) of this section.

E.  Monitoring Frequencies. No person may monitor emergency service radio frequencies to ascertain emergency medical incident locations for the purpose of responding.

[Ord. C32548 § 7; Passed: 12/20/1999]

10.47.080 Patient Care and Transfer.

The procedure for patient care at an incident and for the transfer of care of such person(s) is as follows:

A.  Medical Command at the Scene.

1.   Fire Personnel on Scene First. Upon arrival on the scene of a medical emergency where patient care is being provided by fire protection district personnel, the ambulance crew seeks out the officer or paramedic in command of the incident. Fire personnel remain in charge of the incident in accordance state law. Fire personnel remain in charge of patient care until it is specifically relinquished to the ambulance personnel.

2.   Ambulance Crew Scene First. Where the ambulance company has arrived first on the scene of a medical emergency, the officer in charge of the subsequently arriving Spokane fire department unit seeks out the ambulance attendant in charge for a report on the condition of the patient, any treatment that may have been provided, and any other necessary information. Following this transfer of information, the fire officer may assume command of the incident and utilize fire resources to assist patient care to the extent possible.

3.   Order of Authority. Patient care at an incident is subject to the following ascending order of authority:

a.   first responder,

b.   emergency Medical Technician (first arriving, either fire or private),

c.   paramedic or flight nurse (first arriving, either fire or private),

d.   physician,

e.   ALS (Advanced Life Support) supervising physician,

f.   medical program director.

B.  Patient Care Procedures and Protocols. Patient care procedures and protocols shall comply with the Spokane County pre-hospital patient care procedures and protocols established by the Spokane County EMS council, East Region trauma council, and Spokane County medical program director. Concerns about patient care procedures, including compliance, should be referred to the Spokane County EMS council.

C.  Patient Transfer. Loading of patients into the ambulance is under the direction of ambulance company personnel. The ambulance company assumes responsibility for patient care from fire personnel in accordance with subsection (A)(1) of this section, except that advance life support patient care may remain the responsibility of the Advance Life Support personnel providing the patient care if such ALS provider accompany the patient during transport. Should the condition of a patient or the number of patients necessitate more than the ambulance company’s personnel in the patient compartment to appropriately treat the patient(s), the ambulance company and the fire officer shall mutually determine if the Spokane fire department will provide additional personnel to assist with patient care en route to the hospital.

D.  Selection of Hospital. The order of priority in transporting patients to hospitals shall be consistent with patient care procedures as established by the Spokane County EMS Council.

[Ord. C32548 § 8; Passed: 12/20/1999]

10.47.090 Communications.

A.  Dispatch Center Requirements. An ambulance company must provide staffed dispatch twenty-four hours per day. Staffing may be accomplished by the ambulance company or by contract with another agency. All dispatchers must be trained and certified in “Emergency Medical Dispatch” or a Washington State DOH-approved equivalent. Ambulance service dispatch centers must have speed-dial telephone lines to all level 3 or higher designated trauma centers in Spokane County. Direct-connect telephone lines to fire and law enforcement emergency dispatch centers are to be provided at no cost to the city.

B.  Radio Communications. An ambulance company must have, and provide with its permit application, a radio communications plan meeting all FCC permit and licensing requirements. All ambulance company radio frequencies and permission to access them must be provided to the Spokane fire department.

C.  Recordings. An ambulance company shall record all of its dispatch telephone and radio traffic with a recorder providing a simultaneous date and time track. All recordings shall be retained for a minimum period of ninety days. Recordings shall be made available to the City of Spokane EMS board upon request.

[Ord. C32548 § 9; Passed: 12/20/1999]

10.47.100 Contacts for Responsibility.

An ambulance company appoints a representative to act as a liaison for this chapter and for receipt of any notices. The representative designates a person to act as authorized designee in case of absence or other circumstance where the appointed representative may be unavailable.

[Ord. C32548 § 10; Passed: 12/20/1999]

10.47.110 Advertising.

A.  All advertising or other solicitation for business by an ambulance company shall emphasize in a conspicuous manner that its primary business is not to provide rapid initial response or advanced field life support to medical emergencies and is designed solely to transport those persons whose physical impairments render it impractical to use a regular common carrier or taxi service.

B.  An ambulance company may not use the name “Spokane fire department” in any advertising.

[Ord. C32548 § 11; Passed: 12/20/1999]

10.47.120 Telephone Numbers.

A.  9-1-1.

1.   “9-1-1” is the public telephone number for all emergencies, including medical emergencies of all types, in the City of Spokane.

2.   Any telephone stickers distributed by an ambulance company to non-EMS providers will show “9-l-1” as the only emergency telephone number for medical emergencies.

3.   Ambulance vehicles must show “9-1-1” as the emergency telephone number. “9-1-1” shall be prominently shown on both sides and the rear of the ambulance, more prominent and observable, and in larger lettering than any seven-digit number displayed.

B.  Seven-Digit Number. An ambulance company advertising a seven-digit number shall affirmatively state, in lettering as prominent as the number, that it is a non-emergency telephone number.

[Ord. C32548 § 12; Passed: 12/20/1999]

10.47.130 Appearance.

Neither ambulance color schemes nor uniforms may represent or resemble those of the Spokane fire department.

[Ord. C32548 § 13; Passed: 12/20/1999]

10.47.140 Enforcement.

A.  In addition to or as an alternative to enforcement provisions in this chapter, the operating permit issued under this chapter may be suspended or revoked for noncompliance or violation of any requirement of this chapter. The City of Spokane EMS board has the authority and responsibility to take enforcement action as provided by this section. Any complaint of noncompliance or violation of this chapter shall be made in writing to the City of Spokane EMS board by delivery to the Spokane County medical program director. Upon receipt of a complaint, the program director gives notice to the ambulance company that it is the subject of the complaint, together with a copy of the complaint, a citation of the section of this chapter that has been allegedly violated, and a request for an answer or response within ten calendar days.

B.  If, based upon the complaint and the response, or in the event that no response is received, the City of Spokane EMS board finds that the complaint has probable substance, a hearing will be called for the determination of the facts. The operating permit may be suspended pending the results of the hearing if the City of Spokane EMS board determines that the areas of noncompliance are potentially life threatening. The hearing will be called for a time no more than twenty calendar days after receipt of the ambulance company’s written response to the complaint or thirty calendar days after notice of the complaint is given to the ambulance company, whichever is sooner.

C.  The hearing is before the City of Spokane EMS board and limited to ascertaining the facts specifically related to the alleged noncompliance or violation of this chapter. The hearing is recorded. All related communications recordings shall be provided by the ambulance company. Within five calendar days of the conclusion of the hearing, the City of Spokane EMS board may:

1.   dismiss the complaint; or

2.   if the ambulance company is found in noncompliance or violation, either:

a.   reprimand the ambulance company, or

b.   suspend or revoke the operating permit of the ambulance company, and

c.   order remedial or corrective action to be taken as deemed appropriate.

D.  The ambulance company may appeal the decision or enforcement action of the City of Spokane EMS board to the Spokane city council. An appeal must be submitted to the city clerk within five calendar days of the written decision of the City of Spokane EMS board. The written appeal must set forth in detail the basis of the appeal. All appeals are considered by the city council at a public hearing. The appeal hearing shall be scheduled by the city clerk at the next open hearing date after receipt of the appeal which affords ten days’ notice to the appellant. The clerk shall give ten days’ notice to the appellant and the City of Spokane EMS board of the hearing date. All appeals shall be based upon a written transcript of the hearing before the City of Spokane EMS board as well as any documents submitted to the City of Spokane EMS board. The council will allow fifteen minutes to the appellant and the City of Spokane EMS board to address the appeal. No new testimony will be allowed. The council shall render a written decision within fourteen calendar days of its hearing. The council may affirm, overturn or remand the decision of the City of Spokane EMS board. Any decision of the city council may be appealed to a court of competent jurisdiction within thirty days of its written decision. The city clerk shall mail by certified mail, return receipt requested, a copy of the written decision to the appellant.

[Ord. C32548 § 14; Passed: 12/20/1999]

10.47.150 Penalties.

Any person who violates any provisions of this chapter is guilty of a misdemeanor and upon conviction shall be punished by imprisonment in the city/county jail for a maximum term fixed by the court of not more than ninety days or by a fine in an amount fixed by the court of not more than one thousand dollars, or both such imprisonment and fine. Each day that a violation is permitted to exist constitutes a separate offense.

[Ord. C32548 § 15; Passed: 12/20/1999]

10.47.160 Severability.

If any section, subsection, sentence of clause of this chapter is for any reason held to be invalid, such decision shall not affect the validity of the remaining provisions of this chapter.

[Ord. C32548 § 16; Passed: 12/20/1999]

10.47.170 Additional Enforcement.

The remedies found in this chapter are not exclusive and the City may seek any other legal or equitable relief; including but not limited to, enjoining an act or practice that constitutes or will constitute a violation of the provisions of this chapter.

[Ord. C32548 § 17; Passed: 12/20/1999]

10.47.180 Liberal Construction.

This chapter shall be deemed to be an exercise of the police power of City of Spokane to preserve the public health, safety and welfare, and its provisions shall be liberally construed for the accomplishment of that purpose.

[Ord. C32548 § 18; Passed: 12/20/1999]

10.47.190 Effective Date.

The effective date of the ordinance codified in this chapter is January 19, 2000. All ambulance companies affected shall be in full compliance with the provisions and requirements of this chapter within ninety calendar days after the date of enactment.

[Ord. C32548 § 19; Passed: 12/20/1999]