Chapter 5.35


5.35.010    Title.

5.35.020    Purpose.

5.35.030    Definitions.

5.35.040    Local Emergency Medical Services Agency.

5.35.050    Service provider permits.

5.35.060    Exclusive operating area.

5.35.070    Fees.

5.35.080    Emergency medical vehicle markings.

5.35.090    Driver and attendant requirements.

5.35.100    Mutual aid.

5.35.110    Emergency and disaster operations.

5.35.120    Documentation.

5.35.130    Interfacility transportation.

5.35.140    Unauthorized response.

5.35.010 Title.

This chapter shall be known as the Emergency Medical Services (EMS) Ordinance of Santa Cruz County. [Ord. 5310 § 5, 2019; Ord. 5252 § 2, 2017].

5.35.020 Purpose.

It is the purpose of this chapter to provide for the public health, safety and welfare in the use of ambulance and other prehospital emergency care resources by setting effective standards for the operation, equipment and personnel of ground ambulance and air ambulance services.

It is also the purpose of this chapter to provide the LEMSA the authority and direction to provide management of emergency medical services within the County in conformance with California Health and Safety Code Sections 1797 et seq. and 1443, California Welfare and Institution Code Section 17000, California Vehicle Code Section 2512. [Ord. 5310 § 5, 2019; Ord. 5252 § 2, 2017].

5.35.030 Definitions.

For the purpose of this chapter, certain words and phrases shall be construed as herein set forth, unless it is apparent from the context that a different meaning is intended. These definitions are meant only to supplement and not to supplant the definitions set forth in Division 2.5 of the California Health and Safety Code.

(A)    “Advanced life support” (ALS) means special services designed to provide definitive prehospital emergency medical care, including, but not limited to, cardiopulmonary resuscitation, cardiac monitoring, cardiac defibrillation, advanced airway management, intravenous therapy, administration of specified drugs and other medicinal preparations, and other specified techniques and procedures administered by authorized personnel under the direct supervision of a base hospital as part of a local EMS system at the scene of an emergency, during transport to an acute care hospital, during interfacility transport and while in the emergency department of an acute care hospital until responsibility is assumed by the emergency or other medical staff of that hospital. See also “Class of service.”

(B)    “Ambulance” means any privately or publicly owned vehicle, including aircraft, specially designed, or constructed, modified, equipped, arranged, maintained, and operated for the purpose of transporting sick, injured, wounded, invalid, convalescent or otherwise incapacitated persons, and expectant mothers.

(C)    “Ambulance service provider” means any person or entity who, for monetary or other consideration, or as a public service, or as incidental to any other occupation, transports in one or more ambulances persons needing medical services.

(D)    “Ambulance service provider permit” means a permit issued by the LEMSA, in accordance with LEMSA policy, authorizing the holder to act as an ambulance service provider within the County.

(E)    “Base hospital” means one of a limited number of hospitals which, upon designation by the LEMSA, and upon the completion of a written contractual agreement with the LEMSA, is responsible for directing the ALS system or limited ALS system and prehospital care systems as directed by the LEMSA.

(F)    “Basic life support” (BLS) means emergency first aid and cardiopulmonary resuscitation medical care procedures which, at a minimum, include recognizing respiratory and cardiac arrest and starting proper application of cardiopulmonary resuscitation to maintain life without invasive techniques, unless authorized by State law or regulation, until the victim may be transported or until ALS medical care is available. See also “Class of service.”

(G)    “Class of service” means the level or levels of complexity of care that may be provided by the permittee and/or certified person, for example, basic life support (BLS); advanced life support (ALS); or critical care transport (CCT).

(H)    “Critical care transport” (CCT) means any entity or person who transports a patient in circumstances where the skill level required in the care of that patient during transport exceeds the BLS and ALS scope of practice.

(I)    “Emergency call” means a request for dispatch of an ambulance to any occurrence or situation outside a hospital that involves injury, illness, or disability requiring immediate medical services.

(J)    “Emergency medical services” (EMS) means a system of services performed in response to an emergency medical call or in response to service requests made according to other critical care programs identified by the County.

(K)    “EMS system” means a specifically organized arrangement which provides for the personnel, facilities, and equipment for the effective and coordinated delivery of medical care services under emergency conditions.

(L)    “Exclusive operating area” (EOA) means an EMS area or subarea defined by the emergency medical services plan for which a LEMSA, upon the recommendation of a county, restricts operations to one or more emergency ambulance services or providers of limited ALS or ALS. The authority for the creation of a local EOA is established under California Health and Safety Code Section 1797.224.

(M)    “Local EMS agency” (LEMSA) means the agency, department, or office having primary responsibility for administration of EMS in the County, and which has been established in accordance with California Health and Safety Code Section 1797.200 et seq.

(N)    “Nontransport ALS provider” means any privately or publicly owned organization operated for purpose of providing nontransport ALS care to sick, injured, wounded, invalid, convalescent, or otherwise incapacitated persons, and expectant mothers.

(O)    “Nontransport ALS provider permit” means a permit issued by the LEMSA, in accordance with LEMSA policy, authorizing the holder to act as a nontransport ALS service provider within the County.

(P)    “Patient” means any person encountered by prehospital personnel who demonstrates any known or suspected illness or injury, or who is involved in an event with significant mechanism that could cause illness or injury, or who requests care or evaluation.

(Q)    “Permittee” means a service provider which has been granted a permit by the LEMSA to engage in a business or service in which ambulances are operated or nontransport ALS service is provided. [Ord. 5310 § 5, 2019; Ord. 5252 § 2, 2017].

5.35.040 Local Emergency Medical Services Agency.

(A)    Designation of EMS Agency. The Santa Cruz County Local Emergency Medical Services Agency (LEMSA) is designated as the EMS agency for Santa Cruz County, whose authority is provided for in California Health and Safety Code Section 1797.200.

(B)    Duties of EMS Agency. The LEMSA shall develop and implement protocols, policies, and guidelines setting forth minimum requirements for the permitting and operation of ground and air EMS providers for the purpose of providing the organization and resources required to maintain an EMS system that meets the health and safety needs of the general public of the County. [Ord. 5310 § 5, 2019; Ord. 5252 § 2, 2017].

5.35.050 Service provider permits.

(A)    Permit Required. No person, either as owner, agent, or otherwise, may furnish, operate, conduct, maintain, or otherwise engage in, or offer, or profess to engage in, providing ambulance service within the County without a current valid ambulance service provider permit.

(1)    Permit requirements shall apply to providers of air and ground ambulances, including BLS, ALS, CCT, and interfacility transportation (IFT) vehicles, with the following exceptions:

(a)    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.

(b)    No permit is required of an ambulance service provider responding to calls arising from a declared multi-casualty incident (MCI) or declared disaster.

(c)    No permit is required of an ambulance service provider owned by a municipality who is a subcontractor to an EOA contractor, as specified in SCCC 5.35.060, or of an ambulance operated by the State or Federal government.

(d)    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 service calls within the 9-1-1 system or to interfacility calls.

(2)    Nontransport ALS. With the exception of an ALS nontransport service operating as an approved EOA subcontractor under SCCC 5.35.060, any person, either as owner, agent, 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 nontransport service within the County shall have a current valid nontransport ALS provider permit in accordance with EMS protocols, policies, and guidelines.

(B)    Time of Permit Validity. All permits shall be valid for one year (July 1st to June 30th), or a portion of the year after issuance, and all permits shall expire on June 30th. In order to continue operations after June 30th, permit holders must follow the permit renewal process set forth in subsection (G) of this section.

(C)    Permit Fees. Permit holders shall pay permit fees as set forth in the County’s Unified Fee Schedule. If the fees are not paid within 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 180 days, the permit will be considered expired and a new application must be submitted to the LEMSA. Exceptions to this section may be granted by the LEMSA.

(D)    Permit Application. Applicants for an ambulance service permit or a nontransport ALS provider permit shall complete the LEMSA application process as defined by LEMSA policy.

(E)    Investigation of Permit Application.

(1)    Upon receipt of a completed application, the LEMSA shall conduct an initial investigation of the permit requester, including the applicant, any partner, officer, director, company and its ownership, to determine if there are concerns related to the health, safety, and welfare of the public. The investigation may include an inspection of each vehicle, and its equipment and premises. This required inspection shall be in addition to any other safety or motor vehicle inspections required or made under State, Federal, or local law.

(2)    The LEMSA may issue the permit if, after investigation, it finds:

(a)    Each vehicle, its required equipment, and the premises designated in the application comply with State and County standards;

(b)    The applicant is a responsible and proper person or entity to provide emergency medical services;

(c)    Only properly licensed and certified drivers, attendants, or other appropriate personnel are employed in such capacities; and

(d)    All the requirements of this chapter and all other applicable laws, regulations and policies have been met.

(F)    Insurance Requirements. No permit shall be issued under this chapter, nor shall such permit be valid after issuance, nor shall any vehicle be operated within any area of the County unless there is at all times in force and effect insurance coverage, issued by an insurance company licensed to do business in the State of California, for each and every vehicle owned or operated by or for the applicant or permittee, providing for all sums the applicant or permittee legally must pay as damages due to bodily injury or property damage caused by an accident and resulting from ownership, maintenance or use of a vehicle. The minimum liability limits on each such vehicle shall not be less than what is required by LEMSA policy for combined single limit coverage.

(G)    Permit Renewal.

(1)    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 policies of the LEMSA.

(2)    Applications for permit renewal must be made at least 30 days prior to the expiration date of the existing permit. The renewal fee must be included with the application for renewal.

(H)    Permit Denial. The LEMSA may deny an ambulance services provider permit for any of the following reasons:

(1)    The permit application was incomplete.

(2)    The applicant was previously the holder of a permit or license issued under this chapter which has been revoked or not reissued, and the terms or conditions of the suspension have not been fulfilled or corrected.

(3)    The applicant is committing any act which, if committed by any permittee, would be grounds for the suspension or revocation of a permit issued pursuant to this chapter.

(4)    The applicant has acted in the capacity of a permitted person or firm under this chapter without having a valid permit. Persons or firms acting in the capacity of a permitted person or firm under this chapter without having a valid permit shall be subject to a fine as noted in the County’s Unified Fee Schedule.

(5)    The applicant has entered a plea of guilty to, no contest to, or has been found guilty of a felony or a crime involving moral turpitude or fraud.

(6)    The applicant has failed to meet the requirements of applicable Federal, State, or County laws or regulations, or any of the provisions of this chapter.

(I)    Permit Suspension and Revocation.

(1)    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.

(2)    If there is an immediate threat to the health and safety of the public from continued operations, the suspension shall result in immediate cessation of the permittee’s operations within the County.

(J)    Contact Person. Permit holders shall assign at least one person at all times to be responsible for receiving calls or inquiries. The ‘24/7’ contact information for this person shall be continuously updated and made available to the LEMSA Administrator or their designee. [Ord. 5310 § 5, 2019; Ord. 5252 § 2, 2017. Formerly §§ 5.36.060 – 5.35.110 and 5.35.210].

5.35.060 Exclusive operating area.

(A)    The LEMSA may establish one or more exclusive operating area(s) (EOA), which may be awarded either without a competitive process (“noncompetitive EOA”), or pursuant to a competitive process (“competitive EOA”); provided, that any competitive process has been submitted to and approved by the California State Emergency Medical Services Agency, in accordance with California Health and Safety Code Section 1797.224.

(B)    An ambulance service provider or nontransport ALS provider that is granted a permit under an EOA shall enter into an agreement with the County (an “EOA agreement”) setting forth the terms on which the provider shall provide services within the EOA, including the level, type, and fees for services covered by the EOA.

(C)    Nothing in this chapter, or in any rule or regulation enacted by the County, shall be construed as requiring the County to establish either a competitive EOA or noncompetitive EOA. [Ord. 5310 § 5, 2019; Ord. 5252 § 2, 2017. Formerly 5.35.120].

5.35.070 Fees.

Fees related to the administration of this chapter shall be set by resolution of the Board of Supervisors. Such fees include, but are not limited to: ambulance service provider permits; nontransport ALS provider permits; EOA contract monitoring; submission to a request for proposals (RFP) for contracted services; contract award from an RFP; and operation of a base hospital, or of a receiving healthcare facility, or specialty center such as for trauma, stroke, or cardiac care. The LEMSA has discretion to reduce or waive fees to advance the purposes of this chapter. [Ord. 5310 § 5, 2019; Ord. 5252 § 2, 2017. Formerly 5.35.130].

5.35.080 Emergency medical vehicle markings.

All emergency vehicle markings must be authorized in writing by the LEMSA. [Ord. 5310 § 5, 2019; Ord. 5252 § 2, 2017. Formerly 5.35.140].

5.35.090 Driver and attendant requirements.

(A)    There shall be at least one appropriately trained and certified or licensed driver and one appropriately trained and certified or licensed attendant in each ambulance when in use as such, pursuant to this chapter, or as described in LEMSA policies and procedures.

(B)    Fire service vehicles that are not ambulances shall be staffed as required by their agency. Fire service ambulances shall be staffed as required by LEMSA policies and procedures.

(C)    Aircraft ambulances shall be staffed with a minimum of one appropriately trained and licensed pilot and a minimum of one appropriately trained and certified or licensed attendant. [Ord. 5310 § 5, 2019; Ord. 5252 § 2, 2017. Formerly 5.35.150].

5.35.100 Mutual aid.

(A)    All permit holders are required to be part of the County mutual aid system and respond to mutual aid requests when they have available resources.

(B)    Ambulances responding into the County as mutual aid are not required to have an ambulance service provider’s permit, and are expected to conform to EMS system ordinances, policies, and procedures established by the LEMSA where they are normally based. [Ord. 5310 § 5, 2019; Ord. 5252 § 2, 2017. Formerly 5.35.160].

5.35.110 Emergency and disaster operations.

During any “state of war emergency,” “state of emergency” or “local emergency” as defined in the California Government Code Section 8550 et seq., each permit holder shall provide equipment, facilities, personnel, and other services as required by the LEMSA. [Ord. 5310 § 5, 2019; Ord. 5252 § 2, 2017. Formerly 5.35.170].

5.35.120 Documentation.

All providers are required to document, via the process approved by the LEMSA, all incident and patient contacts, as defined by LEMSA policy for data submission requirements. This includes requests received through the emergency 9-1-1 system as well as through any other dispatch center via any alternate telephone numbers or communication systems. All non-EOA providers are required to 1) obtain approval of the patient care reporting mechanism they plan to use; and 2) submit all responses and patient contacts, as defined by LEMSA policy for data submission requirements. This section applies to all providers of any type who respond to calls for service within Santa Cruz County, regardless of requirement for permit, excluding ambulance services responding to calls arising from a declared MCI or declared disaster. [Ord. 5310 § 5, 2019; Ord. 5252 § 2, 2017. Formerly 5.35.180].

5.35.130 Interfacility transportation.

Permit holders may offer interfacility transportation (IFT) services unless restricted by an EOA agreement. These services are intended for the scheduled or nonurgent transportation of patients where the origination is from and/or to a medical facility. Any non-EOA provider offering IFT services shall not accept any ambulance transport request of an emergent (prehospital) nature from a location not considered to be a medical facility. Every request for service shall be evaluated using dispatch protocols approved by the LEMSA Medical Director, and any calls determined to be emergent, based on LEMSA policies, must be referred to the 9-1-1 system for the appropriate response. [Ord. 5310 § 5, 2019; Ord. 5252 § 2, 2017. Formerly 5.35.190].

5.35.140 Unauthorized response.

No permit holder shall cause or allow its ambulance(s) to respond to a location without receiving a specific request for such service at that location. [Ord. 5310 § 5, 2019; Ord. 5252 § 2, 2017. Formerly 5.35.200].