Chapter 5.10 EMERGENCY MEDICAL SERVICES

A. The Josephine County Board of Commissioners hereby determines that the health, safety, and general welfare of the citizens of Josephine County requires that ambulance services be regulated so as to provide prompt, effective, efficient and safe service.

B. This chapter authorizes Josephine County to provide regulations that may be more stringent than those adopted by the State Health Division.

C. This chapter is authorized by ORS 682.031, 682.062, OAR 333-260-0000 et seq., Josephine County Home Rule Charter, Chapter II, and other applicable law. [Ord. 2013-007 § 2.]

5.10.030 Policy and purpose.

The Board of Commissioners finds:

A. That pursuant to ORS 682.062, Josephine County has developed and adopted a plan relating to the need for, and coordination of, ambulance services, and to establish ambulance service areas consistent with the plan to provide efficient and effective ambulance services; that plan has been approved by the Oregon Health Authority.

B. That this chapter establishes ambulance service areas and the methods for selecting ambulance providers for each service area, and establishes the Emergency Medical Services Board. This article and Article II JCC, known as the Josephine County Ambulance Service Area Plan (ASA Plan), make up the complete plan for emergency ambulance service for Josephine County.

C. That the previously enacted ordinances, 89-20, 90-2 and 91-8, should be and hereby are repealed and replaced by this chapter. [Ord. 2013-007 § 3.]

5.10.040 Definitions.

Unless specifically defined herein to have a different meaning, the words and phrases in this chapter shall have the meaning provided in ORS Chapter 682 and OAR Chapter 333, Divisions 250 (ambulance service licensing), 255 (ambulance licensing), 260 (County Ambulance Service Area Plan), and 265 (licensing people) as those statutes and rules existed on March 1, 2012, and as they may be later amended.

Other specific definitions include:

“Board” or “BCC” means the Josephine County Board of Commissioners.

“Emergency Medical Services Board” or “EMSB” means the advisory committee that provides advice to the Board on matters relating to the ambulance service area, the provision of ambulance services, regulation of its providers, and all related matters. [Ord. 2013-007 § 4.]

5.10.050 Exemptions.

The provisions of the chapter and rules adopted pursuant thereto do not apply to:

A. U.S. Government. Vehicles owned or operated by the United States Government or under contract to an agency of the United States Government.

B. Public Catastrophe. Vehicles being used to render temporary assistance in case of a major catastrophe or emergency with which the licensed ambulances of the County are unable to cope, or when directed to be used to render temporary assistance by the individual in charge of the scene of an accident or emergency.

C. Institutional Vehicles. Vehicles operated solely on private property or within the confines of institutional grounds, whether or not the incidental crossing of any public street, road or highway serving the property or grounds is involved.

D. Out of County Vehicles. Vehicles operating from a business location, office or headquarters outside the County, that are transporting a patient from an area outside the County to a health care facility within the County, or vehicles which are passing through without a destination in the County.

E. Person with Exempt Vehicle. Any person who drives or who attends a patient transported in a vehicle under subsection (A) or (D) of this section.

F. Doctors and Nurses. Any physician or registered nurse who by state or federal license is authorized to attend patients insofar as their acts are within the scope of activities authorized by their license. [Ord. 2013-007 § 5.]

5.10.060 Powers of the Board of County Commissioners.

The BCC has the authority to create, assign and reassign ambulance service areas (ASAs) within Josephine County in compliance with ORS 682.062 et seq. Josephine County has implemented a four-tiered emergency medical services system comprised of the components listed in subsection (A) of this section:

A. Ambulance Service Areas.

1. The BCC, which has ultimate responsibility and legislative authority regarding matters relating to the provision of emergency medical services;

2. The Administrator, who is designated by order of the BCC to administer this chapter;

3. The Emergency Medical Services Board (EMSB), created as an advisory board to monitor the providers’ performance against the terms of the County contract and the standards set forth in the Josephine County EMS chapter, rules and ASA Plan, as well as other local, state and federal rules and laws;

4. The assigned and licensed provider.

B. Rules and Licenses. The BCC shall have the authority to approve rules and to take action concerning licenses in accordance with the provisions of this chapter.

C. Emergency Rules. The BCC may adopt emergency rules. When the BCC finds that immediate action is required, the BCC may adopt emergency rules without notice. Such rules shall expire automatically 120 days after their adoption by the BCC.

D. Other Powers. The BCC shall also have the authority to:

1. Convene the EMSB;

2. Audit records to assure compliance with this chapter;

3. Perform all other acts necessary to implement and enforce the provisions of this chapter;

4. Perform any act necessary to ensure that ambulance service providers comply with all applicable provisions of federal and state law and administrative rules, as well as local ordinances and rules.

E. Administration. The BCC shall appoint an Administrator. The Administrator, under the supervision of the BCC and with assistance of the EMSB, shall be responsible for the administration of this chapter. To carry out the duties imposed by this chapter, the Administrator, or persons authorized by the Administrator, is hereby authorized to enter on the premises of any service provider regulated by this chapter at reasonable times and in a reasonable manner to determine compliance with this chapter and regulations promulgated pursuant thereto. The Administrator shall also have access to records pertaining to ambulance service operations of any person regulated by this chapter. These records shall be made available within five working days to the Administrator at the person’s place of business, or copies made and provided as requested by the Administrator. [Ord. 2013-007 § 6.]

5.10.070 Emergency Medical Services Board.

The Emergency Medical Services Board (EMSB) is a board created by this chapter with the following composition, duties and responsibilities:

A. The EMSB is an advisory board consisting of not fewer than nine nor more than 11 members. Members shall be appointed by the BCC for three-year terms with the following conditions:

1. Initial terms shall be one, two or three years being determined by order of original appointment. The terms of office shall be staggered with one-third of the members appointed each year.

2. The EMSB shall choose its own Chair. The terms of the Chair and Vice-Chair shall be for one year with the ability to be reelected.

3. The EMSB shall meet quarterly or when called upon by its Chair or Vice-Chair or as called by the Administrator. The Chair or any two members of the EMSB may call an emergency meeting with 24 hours’ notice to other members of the EMSB.

B. A majority vote of members present at an official meeting is required to pass motions.

C. A quorum consisting of a majority of appointed members will be required to conduct an official meeting.

D. EMSB meetings are subject to the Oregon public meetings and public records laws as set out in ORS Chapter 192.

E. The EMSB shall include members representing the following:

1. One member representing the Josephine County Sheriff’s Office;

2. One member representing the Josephine County Fire Defense Board;

3. One member representing the Grants Pass Department of Public Safety;

4. One 9-1-1 Public Safety Answering Point (PSAP) representative;

5. One Health Care/Emergency Department physician;

6. One member representing the Rogue Community College (RCC) Emergency Services Department;

7. The Director or Administrator of the Josephine County Public Health Department;

8. One representative of each contracted ambulance service provider; and

9. Two members representing the general public.

F. Ex Officio Members. The Board of County Commissioners’ liaison to the County Health Department may serve as an ex officio member of the EMSB; the BCC may appoint other County employees or officials to serve as ex officio members.

G. Members shall be appointed by and serve at the pleasure of the BCC. The EMSB may appoint or approve designation of alternates to serve in the absence of persons appointed to the EMSB. A designated alternate attending a meeting in the place of a regularly appointed member shall have the right to vote in the place of the absent member.

H. EMSB members are public officers and are therefore required to comply with the provisions of ORS Chapter 244 and OAR Chapter 199.

I. The EMSB shall have the following powers and duties:

1. Review and make recommendations to the Administrator regarding all applications for assignment of ASAs, including initial license, amendment to a license, or renewal of a license.

2. Provide for ongoing input to the Administrator from pre-hospital care consumers, providers and the medical community.

3. Under the direction of the Administrator, periodically review the performance of ambulance service providers within Josephine County.

4. Periodically review the Josephine County ASA Plan, emergency medical services chapter and make recommendations to the Administrator including, but not limited to:

a. Reviewing standards established in the Plan and make recommendations regarding improvement and/or new standards;

b. Monitor coordination between emergency medical service resources;

c. Review dispatch procedures and compliance;

d. Review the effectiveness and efficiency of the ASA boundaries; and

e. Review and make recommendations to the BCC concerning the establishment of administrative rules.

J. The EMSB will review the ASA Plan as required by ORS Chapter 682, OAR Chapter 333 or by direction from the BCC. The EMSB will review this chapter, the EMS Rules and the needs of the community for possible recommended revisions and/or amendments. The Administrator and the BCC maintain ultimate authority in terms of assignment, reassignment, and/or revocation of licenses. [Ord. 2013-007 § 7.]

5.10.080 Adoption of rules – Rule-making generally.

The BCC may, on its own motion, or upon written recommendation from the EMSB, adopt, amend, or repeal administrative rules deemed necessary to achieve the purposes of, and further implement, this chapter. Such rules may be adopted as provided for in this chapter. Rules adopted pursuant to the provisions of this chapter shall have the force of law.

A. Prior to adoption, amendment or repeal of any rule the BCC shall:

1. Make copies of the notice of intended rule-making available to the public. Such notice shall be made at least 30 days prior to the intended action;

2. Send notice of the intended rule-making to the EMSB prior to intended action;

3. Send notice to every person, city, or district that has notified the County in writing of its desire to be consulted.

B. The adoption, amendment, or repeal of a rule by the BCC need not be based upon or supported by an evidentiary record. [Ord. 2013-007 § 8.]

5.10.090 Ambulance service area adjustment.

For the efficient and effective provision of ambulance service in accordance with the Josephine County ASA Plan, the ambulance service areas shown on the map in JCC 5.10.280 as Exhibit “A” are hereby adopted as the ASAs for Josephine County as defined in ORS 682.062 et seq. and OAR 333-260-0000 et seq.

A. The BCC, after notice to the affected ASAs provider and by the adoption of an order, may adjust the boundaries of that ASA(s) from time to time as necessary to provide efficient and effective ambulance service.

B. Persons may petition for changes in ASAs; however, the petitioner must demonstrate how these changes will provide for more efficient or effective ambulance services to the public than already exist as defined in ORS 682.062 et seq. and OAR 333-260-0000 et seq.

1. Effectiveness of service is demonstrated by complying with requirements for boundaries, coordination and service standards.

2. Efficiency of service is demonstrated by selecting an ambulance provider that will meet the effectiveness standards of the Plan at a reasonable cost to the consumer.

C. In addition, the petitioner must either demonstrate that the call volume of all ASAs is sufficient to financially support the level of service required or else demonstrate financial soundness of the proposal through other income sources and comply with other provisions for selection.

D. Further rules shall be drafted so as to avoid, to the extent practicable, restrictions on free entry into the marketplace and shall provide a mechanism for re-designation to accommodate new licensees or expansions. The rules shall provide for ASAs meeting the requirements as defined in ORS 682.062 et seq. and OAR 333-260-0000 et seq. [Ord. 2013-007 § 9.]

5.10.100 Assignment of ambulance service areas.

A. No person shall provide ambulance service in Josephine County unless the BCC has issued a license and assigned an ASA to that person pursuant to this section.

B. Any person desiring to provide ambulance service within Josephine County shall submit an application to be assigned an ASA during a defined and advertised application period. The application shall be submitted to the BCC. Applications shall be reviewed by the EMSB created by this chapter, which shall recommend the assignment of ASAs to the BCC. The assignment of the ASA shall be made by an order of the BCC.

C. An application required by subsection (B) of this section shall be submitted by the applicant in the manner prescribed by this chapter and rules and shall include the following:

1. The name and address of the person applying for the assignment of an ASA.

2. The ASA the person desires to service and the location from which ambulance services will be provided.

3. A list of vehicles to be used in providing ambulance services including year, make and model and verification that each vehicle is licensed as a basic life support and/or advanced life support ambulance by the State of Oregon.

4. A list of personnel to be used in providing ambulance service and their current emergency medical technician or paramedic license number.

5. A statement that all equipment and supplies in each ambulance comply with all applicable standards set by the Public Health Division of the Oregon Department of Human Services.

6. Proof of financial ability to operate, including but not limited to audits, profit and loss statements, tax returns, references and government reports.

7. A statement of experience in providing ambulance services; together with a statement of ability to comply with the requirements of service in the Josephine County ambulance service area.

8. Any licensing and inspection fees.

9. Any additional information requested by the Josephine County EMSB or BCC.

D. Each application shall be reviewed for the applicant’s conformity with the requirements of Oregon law for providing ambulance services, the specific criteria of the Josephine County ASA Plan and the need for efficient and effective ambulance service within Josephine County. This shall include but not be limited to:

1. Equipment Inspection. At any time after receipt of a license application, or request for license amendment or renewal, the BCC or designee may inspect and test all vehicles and equipment and inspect all proposed vehicle location sites.

2. Approval Criteria. Any application must document that (a) by addition of the proposed service, the overall service to the County will be improved, considering effectiveness, efficiency, and cost, and (b) the proposed service meets all requirements set forth in this chapter and the rules adopted pursuant to it.

3. Recommendation by the EMSB. The EMSB shall review and investigate each application and shall make a written report to the BCC with its recommendation as to (a) the ability of the applicant to meet the requirements for a license, and (b) whether the applicant should be granted a license.

E. The BCC may award a license upon finding that the applicant has met all requirements of applicable state and federal law and administrative rules, this chapter and the rules adopted pursuant to this chapter.

F. The assignment of the initial ASA license shall be valid from the date of issuance until June 30th of the third calendar year following issuance. Thereafter, the assignment of ASAs may be renewed for additional five-year terms commencing on the first day of July pursuant to subsection (G) of this section and subject to the provisions for suspension or revocation as set forth in JCC 5.10.130, and to the provisions for discontinuance in subsection (I) of this section.

G. Not less than 180 days prior to the expiration of the assignment of an ASA, any person desiring the renewal of an assignment or a new assignment of an ASA shall submit an application to be assigned an ASA. The application shall include the information required by subsection (C) of this section, except that applications for renewal need only provide such information necessary to bring the original application up to date. The review of the application and assignment of the ASA shall be in accordance with this section.

H. The ambulance/EMS operator shall provide at least 180 days’ written notice to the BCC prior to terminating service.

I. A licensee shall notify the Josephine County 9-1-1 Agency through the 9-1-1 Center and Public Health Administrator immediately if for any reason said licensee becomes unable to provide emergency ambulance service within its ASA.

J. In the event that a person assigned an ASA discontinues service before the expiration of the assignment, the BCC shall set a time by which applications must be submitted for reassignment of the ASA. The review of the applications and assignment of the ASA shall be for the remainder of the term unless otherwise specified by the BCC.

K. Not less than 15 days prior to any date when the applications for the assignment of an ASA are due, notice of such application due date shall be posted in three public places and published at least once in a newspaper of general circulation in Josephine County.

L. The applicant or licensee may submit an amended application and an amended license may be issued for the balance of the original or renewed license period. [Ord. 2013-007 § 10.]

5.10.110 Duties of ambulance service provider.

Upon assignment of an ASA to a person, the person providing ambulance service:

A. Shall immediately file with the BCC and EMSB a current list of all fees charged for rendering service. No change may be made in such fees unless authorized by the BCC and EMSB upon written application by the provider. The provider shall file a statement of fees each year during the life of the provider’s contract with the County.

B. Shall maintain on file, and make available upon request of the BCC or EMSB, a current roster of personnel who will be operating under the ambulance provider’s employ and/or control. This roster must include the following information: (1) full name, (2) level of certification or licensure and (3) license or certification number.

C. Shall maintain and make available, upon request of the BCC, all records required by federal, state and local laws and administrative rules.

D. Shall employ only: (1) emergency medical technicians or paramedics who are certified or licensed or hold provisional license or certification by the Oregon State Health Authority and who meet the requirements of rules adopted pursuant to this chapter, or (2) substitute personnel as authorized by: (a) the Oregon State Health Authority or the Oregon State Board of Medical Examiners, and (b) this chapter, or rules adopted thereunder.

E. Shall enlist, at the provider’s expense, the services of a supervising physician who meets the requirements of the state Board of Medical Examiners for supervising physicians.

F. Shall make available, upon request, written information to the public concerning all rate information.

G. Shall render emergency medical services 24 hours a day, seven days a week, during every week.

H. Pre-hospital medical services and ambulance transportation shall be provided to all persons in the service area without regard to race, color, creed, gender, marital status, sexual orientation, national origin, or ability to pay.

I. Shall submit to the County, prior to approval of a County license, proof of all insurance required by rules adopted pursuant to this chapter.

J. Shall notify the County within 10 working days of any changes in material information that would adversely affect response time or service contained in the license application, related materials, or license.

K. Shall enter into and maintain in effect mutual aid agreements with emergency medical service providers in adjoining counties.

L. All employees, agents, associates and managers or directors of any person or entity providing emergency medical services shall at all times comply with all applicable federal, state, and local laws, statutes, and administrative rules, including those laws, statutes and rules relating to the equipment and supply of vehicles and the licensing and fitness of personnel. [Ord. 2013-007 § 11.]

5.10.120 Prohibited activities.

A. Operational Prohibitions.

1. Services. It shall be unlawful for any person to do business or operate an ambulance in Josephine County without having a license issued by Josephine County to operate such ambulance(s) or ambulance service.

2. Ambulances. No person shall operate a vehicle as an ambulance that is not equipped, operated, and attended by personnel as required by ORS Chapter 682 and OAR Chapter 333, as well as any rules adopted by Josephine County.

B. Related Prohibitions. No ambulance operator, ambulance service provider, or said operator’s or providers’ employee, agent or representative shall:

1. False Statements. Make a false statement of a material fact, or omit disclosure of a material fact, in an application for a license or in any matter relating directly to the provision of emergency medical services.

2. Overcharging. Charge for services not performed, make duplicate charges for the same service, or charge rates exceeding those on file with BCC.

3. Unauthorized Services. Perform emergency medical services unless authorized by this chapter and the rules adopted pursuant to this chapter. This prohibition does not apply when:

a. The response is for supplemental or mutual aid;

b. An Incident Commander requests additional assistance in response to a multiple casualty incident.

4. Transfer of Assignment. Assignment of an ASA may be made only with the written application to and approval of the BCC. The BCC shall determine the process for assignment of an area or selection of a new provider. The application shall be reviewed in accordance with the provisions of this chapter.

5. Failure to Notify. Fail or refuse to promptly inform the 9-1-1 Center of receipt of a request for emergency medical assistance or when a licensee’s ambulance(s) becomes unavailable to respond to dispatch orders.

6. Violating Responses. Respond by ambulance to an emergency call in violation of this chapter or rules adopted pursuant to this chapter.

7. Nonresponse. Fail or refuse to respond to a dispatch from the 9-1-1 Center or other authorized dispatch center when an ambulance subject to the call is available for service.

8. Falsifying Licenses, Etc. Intentionally falsify, deface, or obliterate any license or certificate required under this chapter.

9. Violation of Law. Violate any federal, state, County, or municipal law, or any rule adopted pursuant to those laws. [Ord. 2013-007 § 12.]

5.10.130 Suspension or revocation of assignment.

A. Upon a recommendation by the EMSB, or upon its own motion, the BCC may suspend or revoke the assignment of an ASA upon finding that the holder thereof has:

1. Willfully violated provisions of this chapter, the Josephine County ASA Plan or Administrative Rules, or provisions of state or federal laws and regulations; or

2. Materially misrepresented facts or information given in the application for the assignment of an ASA, or as part of the review of the performance of the service furnished by the provider.

B. In lieu of the suspension or revocation of the assignment of the ASA, the BCC may order that the violation be corrected and make the suspension or revocation contingent upon compliance with the order within the period of time stated therein. Notice of the BCC action shall be provided to the holder of the assignment which shall specify the violation, the action necessary to correct the violation and the date by which the action must be taken. The holder of the assignment shall notify the BCC of action taken. If the holder of the assignment fails to take corrective action within the time required, the BCC shall notify the holder that the assignment is suspended or revoked upon receipt of the notice. [Ord. 2013-007 § 13.]

5.10.140 Appeals.

A person receiving a notice of the assignment, denial, suspension, revocation, or contingent suspension, or revocation of an ASA may request a hearing before the BCC by filing with the BCC a written request for a hearing within 14 days of the decision, setting forth the reasons for the hearing and the issues proposed to be reviewed. The filing of a hearing request shall stay the action pending the hearing and final determination by the BCC unless the BCC makes a written finding that prompt implementation of the decision is required due to an immediate hazard to the public’s safety. The BCC shall set a time and place for a hearing within 14 days of the filing date of the hearing request. The hearing shall be de novo on the record or a full de novo hearing, as determined by the BCC. Within 14 days after the conclusion of the hearing, the BCC shall affirm, reverse, or modify its original decision. [Ord. 2013-007 § 14.]

5.10.150 Penalties.

A. In addition to any other procedures and remedies provided for by law, violations of this chapter or rules adopted pursuant to this chapter shall be punishable by a fine not to exceed $5,000 per violation.

B. Violators may be cited and prosecuted: (1) pursuant to Josephine County citation procedures; or (2) by civil suit in the appropriate court; or (3) by criminal charges where appropriate, or (4) in any other manner provided by law.

C. Notwithstanding other provisions regarding enforcement of this chapter, the County or any affected person may initiate a civil suit to remedy the violation, seeking injunctive or declaratory relief.

D. Notwithstanding subsections (A) through (C) of this section, the County or any affected party is also entitled to pursue any other legal remedy provided by applicable law. [Ord. 2013-007 § 15.]

5.10.160 Nuisance.

In addition to penalties provided by JCC 5.10.150, violation of any of the provisions of this chapter is declared to be a nuisance and may be regarded as such in all actions, suits and proceedings. Pursuant to the provisions of ORS Chapter 682 and OAR Chapter 333, this chapter shall be enforceable by the Health Authority of the State of Oregon, Department of Human Resources. In addition, Josephine County may undertake any appropriate action to enforce the provisions of this chapter and the administrative rules adopted pursuant to this chapter. [Ord. 2013-007 § 16.]

5.10.170 State standards.

Nothing in this chapter, or the rules adopted pursuant to it, shall be construed to establish requirements for ambulance service lower than those established, now or hereafter, by the State of Oregon or the rules adopted by the Oregon Health Division. [Ord. 2013-007 § 17.]

5.10.180 Delegation.

The BCC may delegate any or all of its functions under this chapter or rules adopted hereunder to the EMSB or any other entity deemed suitable by the BCC. Decisions of such delegation shall be final unless and until reversed by the BCC. [Ord. 2013-007 § 18.]

5.10.190 Dispatch exemption.

Nothing in this chapter or in the ASA Plan is intended to prohibit a 9-1-1 agency from dispatching any other initial responder to the scene of a medical emergency, in addition to dispatching an emergency ambulance service provider. [Ord. 2013-007 § 19.]

Article II. Ambulance Service Area Plan (ASA Plan)

5.10.200 Certification by Board of County Commissioners.

The undersigned of the Plan codified in this article hereby certify, pursuant to OAR 333-260-0030(2) that:

A. Each subject or item contained in the Plan codified in this article has been addressed and considered in the adoption of this Plan by this governing body.

B. In the judgment of this governing body, the ambulance service areas established in the Plan provide for the efficient and effective provision of ambulance services.

C. To the extent that they are applicable, the County has complied with the provisions of ORS Chapter 682 and with existing local ordinances and rules. [Order 2013-043.]

5.10.210 Overview of Josephine County.

Josephine County is located in southwestern Oregon. The County is bounded on the east by Jackson County, on the south by California, on the west by Curry County and on the north by Douglas County. According to information from the State of Oregon, Josephine County is approximately 1,641 square miles in size. The County’s population was reported to be 82,713 as of the 2010 census. A large percentage of the population is concentrated in and around the incorporated cities, with the largely rural areas of the County more thinly populated.

Grants Pass, the County seat, had a population of 34,553 as of 2010, and the only other incorporated city, Cave Junction, had a population of approximately 1,750. The principal industries in Josephine County are tourism, recreation, forest products, electronics and software. Josephine County is largely mountainous, rugged terrain. The average annual precipitation is 32.31 inches, with an average temperature of 39.9 degrees in January and 71.6 degrees in July. [Order 2013-043.]

5.10.220 Definitions.

Some of the following definitions refer to Oregon Revised Statutes (ORS) and to Oregon Administrative Rules (OAR). All such references are to the text and context of the statutes and rules as they exist on March 1, 2012.

“Address and Consider” has the meaning imparted to the term by ORS 682.062.

“Administrator” means the person designated by the Josephine County Board of Commissioners to administer the Josephine County Ambulance Service Ordinance, Administrative Rules and Ambulance Service Area Plan.

“Ambulance” or “Ambulance Vehicle” means any privately or publicly owned motor vehicle, aircraft, or marine craft operated by a division-licensed ambulance service and that is regularly provided or offered to be provided for the emergency and nonemergency transportation of persons suffering from illness, injury or disability.

“Ambulance Service” means any individual, partnership, corporation, association, governmental agency or other entity that holds an authority-issued ambulance service license to provide emergency and nonemergency care and transportation to sick, injured or disabled persons.

“Ambulance Service Area (ASA)” means a geographic area which is served by one ambulance service provider, and may include all or a portion of Josephine County, or all or portions of two or more contiguous counties.

“Ambulance Service Area Plan (Plan)” means this written document, which outlines a process for establishing a County emergency medical services system. This Plan addresses the need for and coordination of ambulance services by establishing ambulance service areas for the entire County and by meeting the other requirements of the Oregon Administrative Rules.

“Ambulance Service Provider” means a licensed ambulance service that responds to 9-1-1 dispatched calls or provides prearranged nonemergency transfers or emergency or nonemergency interfacility transfers.

“Authority” means the Emergency Medical Services Board and Trauma Systems Program of the Oregon Health Authority.

“Emergency Care” means the performance of acts or procedures under emergency conditions in the observation, care and counsel of persons who are ill or injured or who have disabilities; in the administration of care or medications as prescribed by a licensed physician, insofar as any of these acts is based upon knowledge and application of the principles of biological, physical and social science as required by a complete course utilizing an approved curriculum in prehospital emergency care. However, “emergency care” does not include acts of medical diagnosis or prescription of therapeutic or corrective measures.

“Emergency Medical Responder” means a person who is licensed by the Authority as an Emergency Medical Responder.

“Emergency Medical Service (EMS)” means those prehospital functions and services whose purpose it is to prepare for and respond to medical and traumatic emergencies, including rescue and ambulance services patient care, communications and evaluation.

“Emergency Medical Services Board (EMSB)” means the advisory board created by the Josephine-County Board of Commissioners, and whose purpose it is to review the standards and rules governing the performance and functions of medical service providers and to make recommendations to the Josephine County Public Health Administrator and to the Josephine County Board of Commissioners relating to the performance of such providers.

“Emergency Medical Services Medical Director” means a supervising physician who is a medical or osteopathic physician licensed under ORS Chapter 677, actively registered and in good standing with the Oregon Medical Board, who provides direction of emergency or nonemergency care provided by emergency medical responders.

“Emergency Medical Technician (EMT)” means a person who is licensed by the Authority as an emergency medical technician.

“EMT Basic” has the same meaning as emergency medical technician.

“EMT Intermediate” means a person who is licensed by the Authority as an EMT intermediate.

“EMT Paramedic” has the same meaning as paramedic.

“Frontier” means the areas within the ASA designated as such on the maps in JCC 5.10.280, Exhibits 1 through 3.

“License” means those documents issued by the Oregon Health Authority to the owner of an ambulance service and ambulance, when the service and ambulance are found to be in compliance with the applicable provisions of the Oregon Revised Statutes (ORS) and the Oregon Administrative Rules (OAR).

“Nonemergency Care” means the performance of acts or procedures on a patient who is not expected to die, become permanently disabled or suffer permanent harm within the next 24 hours including but not limited to observation, care and counsel of a patient and administration of medications prescribed by a licensed physician, insofar as any of those acts are based upon knowledge and application of the principles of biological, physical and social science and are performed in accordance with scope of practice rules adopted by the Oregon Medical Board in the course of providing prehospital care as defined in this chapter.

“Notification Time” means the length of time between the initial receipt of a request for emergency medical service by either a provider or an emergency dispatch center and the notification of all responding emergency medical service personnel.

“Owner” means the person having all incidents of ownership in an ambulance service or an ambulance vehicle. Where the incidents of ownership are in different persons, “owner” means that person, other than a security interest holder or lessor, entitled to the possession of an ambulance vehicle or operation of an ambulance service under a security agreement or a lease for a term of 10 or more successive days.

“Paramedic” means a person who is licensed by the Authority as a paramedic.

“Patient” means an ill, injured or disabled person who may be transported in an ambulance.

“Person” means any individual, corporation, association, firm, partnership, joint stock company, or any other type of entity or group of individuals acting together for a common purpose of organization of any kind and includes any receiver, trustee, assignee or similar representative thereof.

“Prehospital Care” means that care rendered by emergency medical technicians as an incident of the operation of an ambulance as defined by ORS Chapter 682 and that care rendered by emergency medical technicians as incidents of other public safety duties, and includes, but is not limited to, “emergency care” as defined by ORS Chapter 682.

“Provider” means any public, private or volunteer person or entity providing emergency medical service.

“Public Safety Answering Point (PSAP)” means a 24-hour communication facility established as an answering location for 9-1-1 calls originating within a given service area.

“Response Time” means the length of time between the notification of each provider and the arrival of that provider’s emergency medical service unit(s) at the scene.

“Stretcher Car” means any vehicle configured or used to carry a patient in a reclining position, less than 30 degrees, without a person other than the driver attending to the patient, or with a person in attendance who is not certified by the State of Oregon as an EMT. The use of stretcher cars is prohibited in Josephine County.

“System Response Time” means the total elapsed time between the time the public safety answering point receives the call and the time the appropriate provider unit(s) arrive at the scene. [Order 2013-043.]

5.10.230 Boundaries.

Josephine County contains two ambulance service areas (ASAs). The boundaries of each area are set by this ASA Plan and will not change during the initial term of the contract with the EMS provider(s). The geographical boundaries of Josephine County are set forth in ORS 201.170 and are adopted and incorporated herein for the purposes of this Plan. The Oregon Blue Book statewide reference portrays Josephine County as containing approximately 1,641 square miles.

A. ASA Narrative Descriptions.

1. Ambulance Service Area 1 contains approximately 913 square miles.

2. ASA 1 contains the communities of Selma, Kerby, O’Brien, Takilma, and the incorporated city of Cave Junction. The boundaries of ASA 1 are portrayed on the map in JCC 5.10.280. The boundaries are described as follows:

The western boundary of ASA 1 is the Curry County Line, township 35S to township 41S, range 9 to range 11. The northern boundary is township 35S, range 11 diagonally down to township 36S, range 9. The eastern boundary is township 36S range 9 down to township 41S, range 5. The southern boundary is the California state line, township 41S, range 5 to range 10.

3. Ambulance Service Area 2 contains approximately 728 square miles.

4. ASA 2 contains the communities of Galice, Hugo, Leland, Merlin, Murphy, Sunny Valley, Wilderville, Williams, Wolf Creek, Wonder, and the incorporated city of Grants Pass. The boundaries of ASA 2 are portrayed on the map in JCC 5.10.280. The boundaries are described as follows:

The western boundary of ASA 2 is the Curry County line from township 32S range 9 to township 35S range 10. The northern boundary is the Douglas County line from township 32S range 9 to township 33S range 5. The eastern boundary is the Jackson County line from township 33S range 4 to township 41S range 4. The southern boundary is the California state line, township 41S, range 4 to range 5.

B. ASA Maps Showing Response Time Zones. The map in JCC 5.10.280 shows the differing zones for “system response times,” as that term has been defined herein. The map in JCC 5.10.280 shows the boundaries for the fire districts and the two incorporated cities in Josephine County. The 9-1-1 agency serves the entire county, along with the Sheriff’s Office emergency dispatch lines.

C. Alternatives Considered to Reduce Response Times. Josephine County is largely rural; much of the County consists of rugged, mountainous terrain with limited vehicular access. Even in settled areas, there may be unimproved roadways that pose difficult problems for vehicles other than those designed for off-road use. The large geographic area, with thinly settled areas outside the incorporated cities, together with poorly maintained or unimproved roadways, pose significant difficulties for emergency response teams. The County has attempted to overcome these difficulties by designating two ambulance service areas with response times in each area geared to the unique characteristics of that area. These measures are the result of the County’s determination to adapt contractual and logistical considerations to the geographic and economic realities of Josephine County, and by doing so, to provide the best possible emergency medical services at the most reasonable cost. It is the opinion of the governing body of the County that vigilant oversight and cooperative attempts to solve problems as they arise will avoid critical failures of service. To that end, the County will continually monitor all aspects of provider performance, including response times. The review of response time performance will necessarily take into consideration the characteristics of each ASA, including the distance traveled and the existing road conditions at the time of the response. For example, accelerated growth in the southern area of the City of Grants Pass, across the Rogue River from the older sections of the city, has created potential bottlenecks for traffic on the three existing bridges spanning the river. Those conditions must be considered in any evaluation of response times in ASA 2 involving a transit of the bridges. [Order 2013-043.]

5.10.240 System elements.

A. 9-1-1 Dispatched Calls. Josephine County has one primary public safety answering point; the 9-1-1 Agency. The 9-1-1 Agency has contracted with the City of Grants Pass to provide dispatching services for fire and EMS agencies. The Josephine County Sheriff’s Office (JCSO) is a secondary PSAP, receiving transferred calls from the 9-1-1 center for Sheriff’s Office response only. Calls requiring mutual response from both JCSO and EMS will be coordinated between the two centers.

B. Prearranged Nonemergency Transfers and Interfacility Transfers. Through the implementation of this Plan, Josephine County intends to undertake measures to address and consider the individual provision of nonemergency and scheduled transfer services within the County. The governing body of Josephine County is of the opinion that the safety of the citizens of the County requires adequate monitoring of any medically-oriented transportation services, both emergency and nonemergency. The Josephine County Board of Commissioners may, in the future, adopt regulations and ordinances to ensure that all such transportation providers comply with the highest standards of care and performance in order to ensure the safety of the citizens of the County. The Board of Commissioners will address and consider all factors to determine whether it is in the best interests of the citizens of Josephine County to continue the current practice of authorizing the emergency medical service provider to provide nonemergency transfer services. The Board of Commissioners may adopt additional regulations if it appears to be necessary to do so.

C. Notification and Response Times. Josephine County ASA ambulance service provider response times, as defined in this Plan, are depicted on the time zone map in JCC 5.10.280. Providers will be required to meet response time requirements in at least 90 percent of calls for service. Each response time zone has a designated maximum allowable response time. The urban zone response time limit is eight minutes. Response time for the suburban zone is 15 minutes. For the more remote areas included in the rural zone the response time is 30 minutes, and for the most difficult and remote areas in the frontier zone the response time is two hours. Running of response times stops with the arrival at the scene of the first appropriately equipped ambulance provider unit. All ambulance providers will provide periodic reports showing response time success and failures. The County reserves the right to require additional reports as the County deems necessary. In addition, the County may adopt policies, ordinances, or administrative rules providing for liquidated damages or for enforcement of response time requirements by imposition of penalties, in the event of failure by one or more providers to meet response time requirements.

Each provider may request an exception to the response time requirements for a specified individual call on the basis of identified criteria. Those criteria include, but are not necessarily limited to, such factors as difficulty in determining the correct address, either because of inadequate information at the scene, or language barriers that impair communication efficiency. Other factors may include adverse weather conditions, adverse road conditions, including traffic loads due to traffic accidents or to weather or road conditions, multiple incidents with multiple patients at more than one incident scene, an unsafe scene that presents significant risk to medical responders, and the presence of hazardous materials at the scene that require additional preparation and equipment. Each request for an exception to the response time requirements for a particular call must be made to the Administrator within 30 days of the dispatch time for that call, and each such request must include a specific description of the reasons or criteria justifying the exception. Every call, including those for which an exception is requested, must be included in the response time reports. For those calls for which an exception has been requested, the response time reports must indicate that the exception was requested, and whether the request was granted or denied.

D. Level of Care. Every ambulance and ambulance service operating in Josephine County must maintain current licensing with the Oregon Health Authority. Equipment and supplies for vehicles must meet or exceed the requirements and standards set out in the Oregon Administrative Rules and the Josephine County Administrative Rules, as well as those in this Plan.

Ambulance service providers in Josephine County are not permitted to subcontract performance of any EMS duty, service or obligation. Ambulance service providers are permitted to enter into mutual aid agreements with ambulance service providers in other counties so long as the Josephine County ambulance service provider notifies the EMS Board and Josephine County Public Health Administrator of that fact. Mutual aid agreements must be reduced to writing, and the provider must give a copy of the written agreement to the EMS Board and the Josephine County Public Health Administrator.

E. Personnel. Every ambulance operated in Josephine County must be certified and properly equipped and staffed to meet one of three levels of care recognized by the Oregon State Administrative Rules and Oregon Revised Statutes. For advanced life support ambulances, at least one person staffing the ambulance must be licensed at the paramedic level, and the other person must be licensed at least at the EMT level. For intermediate life support ambulances, at least one person staffing the ambulance must be licensed at the EMT intermediate level, and the other person must be licensed at least at the EMT level. For basic life support ambulances, both persons staffing the ambulance must be licensed at the EMT level. All licenses for ambulance personnel must be current; every ambulance operated in Josephine County must be staffed at all times by two properly qualified persons with current licenses.

Persons staffing an ambulance in Josephine County must not have consumed alcoholic beverages of any type within eight hours of the start of their duty shift. Personnel staffing ambulances in Josephine County must not be taking any medication that interferes with or impairs their ability to provide proper patient care or their ability to operate motor vehicles and other equipment.

F. Medical Supervision. All emergency medical service providers must be supervised by an EMS medical director. The EMS medical director must be licensed in the State of Oregon as either a medical doctor (MD) or a doctor of osteopathic medicine (DO) and must be Oregon Medical Board certified and in good standing. In addition, the EMS medical director must have been approved to act in that capacity by the Oregon Medical Board. The EMS provider may employ a properly qualified person as its own medical director. In any case, the medical director must meet at least once in each calendar year with the EMS Board, and must be available to provide advice, direction and supervision when needed.

G. Medical Resource Hospital. The designated medical resource hospital for Josephine County is Three Rivers Community Hospital located in Grants Pass. Other medical facilities may be called upon to provide advice, services or other aid as circumstances require. Other medical facilities may be called upon as needed.

H. Patient Care Equipment. All patient care equipment must be maintained to meet all of the applicable standards set out in the Oregon Administrative Rules, including but not limited to OAR Chapter 333, Division 255. All such equipment must also meet all applicable statutory requirements, and the requirements of currently accepted medical practice. Each ambulance service provider shall maintain a complete list of equipment for each ambulance operated by the provider. Each list shall be available to the Josephine County Board of Commissioners, the Administrator, or a designated representative upon request.

I. Ambulance Vehicles. Each ambulance operated by the provider shall be constructed and maintained in compliance with all applicable state and federal standards, including but not limited to OAR Chapter 333, Division 255. All ambulance vehicles operated by the provider must be properly licensed by the Oregon Health Authority. Each provider shall furnish to the Administrator an up-to-date list of all ambulance vehicles operated by the provider. In no case shall any provider operate an ambulance vehicle having in excess of 200,000 miles on the chassis, unless the provider requests and receives an exception to this requirement. Any such request and the response to the request must be in writing.

J. Training. All persons staffing ambulance vehicles must be properly licensed by the Oregon Health Authority and the Oregon Department of Transportation and must maintain current licensing as required by statute and administrative rule. All licenses and certificates, as required by statute and administrative rule, must be maintained in current, up-to-date status by participation in training and education programs approved by or acceptable to Oregon Health Division and Oregon Department of Transportation.

K. Quality Improvement. The Josephine County Board of Commissioners and the Josephine County Public Health Department staff recognize the critical importance of providing high quality medical care and assistance. In order to accomplish that recognized goal Josephine County has undertaken the task of drafting revised administrative rules governing emergency medical services and the providers of those services. The rules will provide for effective administrative oversight and for the effective resolution of complaints from the public related to emergency medical services. All ambulance service providers will be subjected to periodic review of their performance in order to assure that the interests of the public are being served.

1. Structure. Under the terms of the draft ordinance governing emergency medical services, the Board of County Commissioners anticipates the recreation of the Emergency Medical Services Board, EMSB, composed of the following representatives:

a. One member representing the Josephine County Sheriff’s Office.

b. One member representing the Josephine County Fire Defense Board.

c. One member representing Grants Pass Department of Public Safety.

d. One 9-1-1 Public Safety Answering Point (PSAP) representative.

e. One hospital-based or emergency department physician or designee.

f. One member representing the Rogue Community College (RCC) Medical Training staff.

g. The Director/Administrator of the Josephine County Public Health Department.

h. One representative of each contracted ambulance service provider.

i. Two members at large, representing the general public.

2. Process. The primary purpose of the EMSB is to monitor and oversee the performance of all ambulance service providers. The EMSB will formulate and make recommendations to the Josephine County Public Health Department; the Josephine County Public Health Department will either act on those recommendations or relay them to the Board of Commissioners for further action. In addition, the EMSB will evaluate the necessity of drafting a quality assurance program to ensure that provider performance is maintained at the highest practical level. If the EMSB determines that such a program is called for, it will produce a draft program for approval by the Josephine County Board of Health. In addition to its periodic review of ambulance service provider performance, the EMSB will receive and review every complaint relating to prehospital medical care and emergency medical services provision.

3. Problem Resolution. Reports of problems related to dispatch functions or deviation from protocol by emergency medical service provider personnel will be referred to the dispatch supervisor or the medical director. If the complaint indicates that the contract provider is failing or has failed to comply with the requirements of the contract, rules or this Plan, the EMSB will refer the report to the Administrator of the Josephine County Public Health Department.

4. Sanctions for Noncompliant Personnel or Ambulance Service Providers. Upon a recommendation by the Administrator of the Josephine County Public Health Department, by the EMSB, or upon its own motion, the Board of Commissioners may suspend or revoke the assignment of an ambulance service area if the Board of Commissioners finds that the provider has willfully violated the provisions of a County rule or ordinance, the provisions of this Plan or the provisions of a state or federal statute or administrative rule. The Board of Commissioners may suspend or revoke the assignment of an ASA upon a finding that the provider misrepresented material facts or information in an application for assignment of an ASA or in the process of review of a complaint or in the process of a periodic review of performance. In lieu of suspension or revocation, the Board of Commissioners may order the provider to remedy or correct the violation within a time set by the Board of Commissioners. In any action upon a complaint or review, the EMSB shall provide written notice to the provider of the action anticipated and allow the provider a reasonable opportunity to respond to the notice. In any contemplated action, any member of the EMSB who has or who appears to have a conflict of interest shall declare the conflict or apparent conflict and shall take no part in the supervision, review, revocation or resolution process.

In addition to suspension or revocation, the Board of Commissioners may assess monetary penalties against a noncompliant provider or against a noncompliant person employed by or associated with a provider. Such penalties may not exceed $500.00 per day for each offense or failure to comply. Nothing in this Plan is intended to or should be construed as limiting the rights of Josephine County to pursue actions in court, either at law or in equity, against any person or entity for any violation either in contract or otherwise. [Order 2013-043.]

5.10.250 Coordination.

A. Entity That Will Administer the ASA Plan. The Josephine County Board of Commissioners has authority under the provisions of state statutes (ORS 682.031 et seq.,) to create and assign ambulance service areas and to create a plan to govern the assignment of ASAs to individual providers. The Board of Commissioners has authority to revise the ASA Plan as may be necessary. Under the provisions of the ASA Plan for Josephine County, the EMSB will administer the ASA Plan subject to the oversight of the Josephine County Public Health Department and the Board of Commissioners.

In order to fulfill its role the EMSB will meet at least once in each calendar quarter; in addition to its regularly scheduled meetings the EMSB will meet to consider complaints as to the performance of providers or personnel involved in the provisions of emergency medical services or prehospital medical care. The EMSB will provide a written report of its activities to the Josephine County Board of Health and to the Board of Commissioners.

B. Complaint Review Process. Complaints relating to emergency medical services shall be in writing; all such complaints shall be referred to the EMSB for review and resolution. The EMSB may conduct investigations and make recommendations to the Board of Commissioners and to the Administrator of the Josephine County Public Health Department to resolve ongoing difficulties related to the provision of emergency medical services.

C. Mutual Aid Agreements. If more than one ambulance service provider is under contract and assigned to an ambulance service area, each provider shall enter into a written mutual aid agreement with all other ambulance service providers in Josephine County and each provider shall supply a copy of the agreement to the EMSB. Each provider in Josephine County shall enter into a mutual aid agreement with ambulance service providers in adjoining counties and supply copies of all such agreements to the EMSB. If any mutual aid agreement is amended, canceled, not renewed, or altered in any aspect, all of the Josephine County ambulance service providers signatory to the agreement shall immediately notify the EMSB in writing of the change. All mutual aid agreements shall be reviewed by EMSB annually.

All requests for mutual aid under an agreement shall be made through the appropriate dispatch center.

D. Disaster Response. First responding EMS providers are expected to evaluate every multiple-victim incident to determine whether the magnitude requires extraordinary response. Requests for such response will be made through the appropriate dispatch center. EMS providers will participate in coordinated response training with other agencies, including the Josephine County Sheriff’s Office.

1. County Resources Other Than Ambulances. Any requests for additional responders will be made through the appropriate dispatch center. Josephine County Emergency Management Division will be notified immediately of any incident that requires action on their part, or that requires participation by search and rescue. Emergency management personnel are responsible for coordinating all responses of additional resources.

2. Out of County Resources. In the event that resources from adjacent counties are needed in order to provide medical services during a disaster, a request for those resources will be made through the appropriate dispatch center.

3. Mass Casualty Incident Management Plan. Josephine County Public Health Department officials, in cooperation with law enforcement officials, will coordinate to create a policy and documented plan to allocate available resources to deal with any incident that creates or could create large numbers of casualties.

4. Response to Terrorism. In the event that a terrorist act results in the creation of large numbers of casualties, the ambulance service provider will cooperate with law enforcement agencies to manage the event, provide necessary medical care to the victims, and provide whatever aid is available to search for victims and provide them with medical care. Medical responders are not expected to enter any area that is subject to hostile action. Law enforcement agencies are expected to coordinate their activities by assigning an incident commander to any large event. All medical responders, including out-of-county resources responding under the provisions of a mutual aid agreement, are expected to coordinate with the designated incident commander to provide needed care. Specific response tactics and allocation of resources are detailed in the Josephine County Emergency Operations Plan and the Josephine County Public Health Department Continuity of Operations Plan.

E. Personnel and Equipment Resources. All resources are described in the Josephine County Emergency Operations Plan and the Josephine County Public Health Department Continuity of Operations Plan. Each EMS provider will be required to participate in county-wide planning for coordinated response in the event of catastrophic emergencies.

F. Emergency Communications and System Access.

1. Telephone Access. The Josephine County 9-1-1 Center is located in Grants Pass and is the primary public safety answering point. The Josephine County Sheriff’s Office has a separate dispatch center but does not dispatch medical responders. Anyone who has access to telephone services will have access to the Josephine County 9-1-1 Center by dialing 9-1-1. Upon receipt of a request, all emergency responders including fire and ambulance with the sole exception of the Josephine County Sheriff’s Office patrol deputies are dispatched by the Josephine County 9-1-1 Center in Grants Pass.

2. Dispatch Procedures. The dispatcher will alert appropriate personnel within two minutes of receipt by dispatch of a medical call. The dispatcher will inform the first responders of the location of the incident, the nature of the incident, and provide any other pertinent information. EMS personnel shall inform the dispatcher immediately when the responding unit is in-service, when the unit in en route to the incident location, when it arrives at the incident location, when it begins transportation of patient(s) and when it arrives at the receiving medical facility.

3. Radio System. The PSAP center restricts access to authorized personnel only. The facility must meet all standards set by the state fire marshal. The dispatch center must maintain radio consoles capable of direct communication with all first response agencies dispatched by the dispatch center, and must maintain radio logs that comply with all standards for form and content set by the Federal Communications Commission and by the Oregon Revised Statutes. The dispatch center must be equipped with an emergency power source capable of providing electric power for all functions of the dispatch center facility.

Each ambulance service provider must maintain in each ambulance vehicle a multichannel radio capable of reception and transmission, with sufficient power to allow radio communication with dispatchers, medical facilities, emergency medical services providers and mutual aid units from other counties.

For each incident and each request for service, the highest level of ambulance staffing available at the time will be dispatched. Other responders such as fire or law enforcement will be dispatched as required.

4. Emergency Medical Services Dispatcher Training. All Josephine County primary PSAP dispatchers must successfully complete an emergency medical dispatch (EMD) training course as approved by the Oregon Emergency Management Division and the Oregon Department of Public Safety Standards and Training and must recertify annually. All dispatchers are encouraged to continue training by attending any class, course, or program that enhances their skills.

E. Personnel and Equipment Resources. All resources are described in the Josephine County Emergency Operations Plan and the Josephine County Public Health Department Continuity of Operations Plan. Each EMS provider will be required to participate in County-wide planning for coordinated response in the event of catastrophic emergencies.

F. Emergency Communications and System Access.

2. Dispatch Procedures. The dispatcher will alert appropriate personnel within two minutes of receipt by dispatch of a medical call. The dispatcher will inform the first responders of the location of the incident, the nature of the incident, and provide any other pertinent information. EMS personnel shall inform the dispatcher immediately when the responding unit is in service, when the unit in en route to the incident location, when it arrives at the incident location, when it begins transportation of patient(s) and when it arrives at the receiving medical facility.

3. Radio System. The PSAP center restricts access to authorized personnel only. The facility must meet all standards set by the State Fire Marshal. The dispatch center must maintain radio consoles capable of direct communication with all first response agencies dispatched by the dispatch center, and must maintain radio logs that comply with all standards for form and content set by the Federal Communications Commission and by the Oregon Revised Statutes. The dispatch center must be equipped with an emergency power source capable of providing electric power for all functions of the dispatch center facility.

Each ambulance service provider must maintain in each ambulance vehicle a multi-channel radio capable of reception and transmission, with sufficient power to allow radio communication with dispatchers, medical facilities, emergency medical services providers and mutual aid units from other counties.

5.10.260 Provider selection.

A. Initial Assignment. On the date this Plan is implemented, the Josephine County Board of Commissioners shall provide public notice that the current provider(s) of emergency medical transport services shall continue to do so in their assigned ambulance service areas within the County, conditioned upon the ability and willingness of the provider to comply with the requirements of this Plan and the rules, statutes, and ordinances that govern the provision of emergency medical services. If a current provider wishes to continue in an assigned ASA but is currently not in compliance with these requirements, the provider shall be allowed a period of 180 days within which to achieve complete compliance. If the provider does so, the provider shall be allowed to continue; if the provider is unable to achieve compliance, the ASA shall be opened for reassignment to another provider. The EMSB will determine whether a provider is in compliance with the requirements.

B. Reassignment. In the event that reassignment of an ASA becomes necessary, the EMSB will make a written recommendation to the Board of Commissioners indicating which provider should be permitted to assume the responsibilities and obligations of providing services in that ASA.

C. Application for an ASA. In response to an invitation to bid, request for proposals, or request for qualifications, any qualified and licensed entity or person may apply for assignment to an ASA in Josephine County. All such applications must comply with the requirements of the invitation or request issued by the County, and must comply with all County contracting rules. All applications for assignment to an ASA must be made in writing to the EMSB; the application must contain all documents demonstrating the current abilities of the applicant to fulfill all obligations involved in providing emergency medical services, including, but not limited to, the number of vehicles, their equipment, and the number of qualified and licensed staff members, with accompanying documented proof. EMSB will evaluate all applicants and make a written recommendation to the Board of Commissioners.

D. Notification of Vacating an MA. A provider that has been assigned an ASA must provide a constant level of service in compliance with the requirements of this Plan, the federal and state statutes and local ordinances, and administrative rules. A provider that cannot continue to provide the necessary level of service must notify EMSB in writing of the provider’s inability immediately; if the provider intends to vacate its assigned ASA, it must notify EMSB of that fact in writing no less than 90 days prior to the date it intends to vacate.

E. Maintaining Level of Service. In the event that EMSB determines that no fully qualified provider is available, the EMSB will notify the Board of Commissioners, in writing, of that determination. The Board of Commissioners or the EMSB may apply to the Oregon State Health Authority for a variance or exemption as provided by ORS 682.079 or other applicable statute or rule.

F. Role of County at End of Contract Term. The Board of Commissioners, on its own motion or at the request of one or more of the ambulance service providers, may choose to extend an existing contract with an ambulance service provider or allow the contract to expire and begin a formal selection process. In addition, the Board of Commissioners may cooperate with the existing provider to modify the existing contract and extend it as modified without beginning a formal selection process. Nothing in this section is intended to limit the authority of the Board of Commissioners to make decisions, negotiate contracts, or otherwise act in accordance with the functions of their office as provided by statute, rule or Charter. The Board of Commissioners may use a formal selection process consisting of an invitation to bid, a request for proposals, or a request for qualifications, or any other process or combination that complies with County rules and ordinances as well as state and federal statutes and rules. [Order 2013-043.]

5.10.270 Josephine County ordinance and administrative rules.

The Josephine County Board of Commissioners shall adopt an ambulance service area ordinance. The ordinance shall include criteria for administering the Ambulance Service Area Plan, limiting ambulance services that may operate in the County, setting the terms of ambulance franchise for the County, providing for enforcement, preventing interruption of service, setting out the duties of the ambulance service providers assigned to an ASA, providing for monitoring levels of service, complaint resolution and an appeals process, and establishing membership and duties of the Emergency Medical Services Board. The Board of Commissioners shall also adopt administrative rules governing the oversight of service providers. [Order 2013-043.]

5.10.280 Exhibits.

A. Exhibit 1 – Map portraying the boundaries of ASA 1 and ASA 2.

B. Exhibit 2 – Map showing the response time zones.

C. Exhibit 3 – Map depicting boundaries for fire districts and incorporated cities.

[Order 2013-043.]

Article III. Administrative Rules

5.10.290 Authority and application of rules.

A. The Josephine County Board of County Commissioners finds that the County is authorized to regulate emergency and nonemergency ambulance transport services within Josephine County. This authority is derived from ORS 221.485 through 221.495, 682.031, 682.062, OAR 333-260-0000 et seq., Josephine County Home Rule Charter Chapter 11, and other applicable law. The purpose of these rules is to establish effective regulation of such services in order to provide prompt, safe, effective and efficient medical transport services for the citizens of Josephine County.

B. It is unlawful for any person or entity to operate or allow to be operated any ambulance within Josephine County without a license to do so issued by the Board of County Commissioners.

C. These rules, upon adoption by the Board of County Commissioners, have the force of law. [Order 2013-043.]

5.10.300 Area of application.

A. Josephine County has developed and adopted an ambulance service area plan pursuant to state law; that plan has been approved by the Oregon State Health Authority. Under the provisions of the Josephine County ASA Plan, the County contains two ambulance service areas. The descriptions and depictions of those areas contained in the ASA Plan, and the Plan itself, are adopted and incorporated by the order codified in this chapter. The ASA Plan is attached to these rules in the order codified in this chapter as Exhibit 1. The two ambulance service areas include all of Josephine County.

B. The Board of County Commissioners has adopted Ordinance 2013-007, the Emergency Medical Services Ordinance. That ordinance, the ASA Plan, and these rules constitute the complete structure for regulation and enforcement relating to the provision of emergency medical transport services in Josephine County. [Order 2013-043.]

5.10.310 Medical direction.

A. Oregon state law prohibits emergency medical technicians or paramedics from providing patient care or treatment without written authorization and standing orders from a supervising physician. Any provider authorized by Josephine County to provide emergency medical services in the County must retain, at the provider’s own expense, a supervising physician fully licensed in Oregon as either an M.D. or D.O.

B. The services provided by the supervising physician shall be as described in OAR 847-035-0025 and other applicable rules and laws, as such rules and laws may be amended. [Order 2013-043.]

5.10.320 Emergency medical dispatch.

Josephine County retains rule-making authority for all matters related to emergency medical services, including communications. The County may, from time to time, adopt or amend administrative rules governing communications procedures, equipment, and dispatch protocol. [Order 2013-043.]

5.10.330 Provider types – Emergency ambulance.

A. One emergency medical transport provider will be licensed for each of the two ambulance service areas in Josephine County. At the option of the Board of County Commissioners, the same provider may be licensed for both of the Ambulance Service Areas. Every provider licensed by Josephine County must be fully licensed by the State of Oregon and must at all times comply fully with all federal, state, and local statutes, ordinances and administrative rules.

B. No person or entity may operate, advertise or otherwise engage in the provision of emergency medical transport services within Josephine County unless the person or entity is licensed to do so by the County. The prohibitions in this section do not apply to:

1. Vehicles owned or operated by the United States government or under contract to the United States government.

2. Vehicles being used to render temporary assistance in the event of a major catastrophe or emergency with which the licensed ambulances of the County are unable to cope, or when directed to be used to render temporary assistance by the individual in charge of the scene of an accident or emergency.

3. Vehicles being operated solely on private property or within the confines of institutional grounds, whether or not the incidental crossing of any street, road or highway serving the grounds is involved.

4. Vehicles operating from a business location, office or headquarters outside Josephine County that are transporting a patient from an area outside the County to a health care facility within the County; vehicles that are passing through without a destination in the County, or vehicles that are transporting a patient from a hospital at the hospital’s request.

5. Persons who drive or attend a patient transported in a vehicle under subsections (B)(1) through (4) of this section.

6. A physician or registered nurse who by state or federal license is authorized to attend patients insofar as their actions are within the scope of activities authorized by their license. [Order 2013-043.]

5.10.340 Nonemergency ambulance.

Providers of nonemergency medical transport services are subject to the same requirements as the providers of emergency medical transport services and must be licensed by the State and the County in order to provide any services. A licensed provider of emergency medical services is also required to perform nonemergency medical care, as that term is defined in the Josephine County Ambulance Service Area Plan, codified in JCC 5.10.220. [Order 2013-043.]

5.10.350 Level of care – Advanced life support (ALS).

“Advanced Life Support” means out-of-hospital emergency care that encompasses procedures, treatments, and techniques that are within the EMT-paramedic scope of practice described in OAR 847-035-0030 and that are authorized by the supervising physician. [Order 2013-043.]

5.10.360 Provider requirements.

A. Each provider of emergency medical services in Josephine County must be properly licensed, fully insured, and fully in compliance at all times with all applicable federal, state and local statutes, ordinances, and administrative rules. It is the responsibility of the provider to be informed at all times of changes in laws or rules relating to the provision of emergency medical services. It is the intent of the Josephine County Board of Commissioners that these rules are intended to supplement, rather than replace, the requirements of federal and state administrative rules. Nothing in these rules is intended to relieve any provider of any obligation, responsibility or requirement imposed by federal or state statute or administrative rule.

1. At a minimum, each provider will have on duty and available for dispatch two ambulances in Ambulance Service Area 2, and one ambulance in Ambulance Service Area 1, 24 hours a day, seven days a week, including weekends and holidays.

2. Every ambulance must be staffed with at least two fully licensed EMTs, at least one of whom must be licensed as a paramedic. If only one of the persons staffing an ambulance is licensed as a paramedic, the paramedic must be in attendance with the patient during transport if the patient requires ALS care.

3. Every ambulance must carry the equipment described in OAR 333-255-0000, et seq., and all equipment and supplies must be replenished or replaced at the first opportunity after use. In addition, each ambulance must at all times carry all the medications and equipment necessary to follow the standing orders or scope of practice as authorized by the supervising physician.

4. All ambulances must be maintained in clean condition, with the interior being cleaned thoroughly after each use if possible.

5. All equipment must be stored safely, so that it is protected from contamination but is readily accessible.

6. Linens must be clean, and must be changed after each use.

7. Reusable equipment must be cleaned after each use. Cleaning shall be accomplished in accordance with commonly accepted medical practice, and shall include sterilization when such practice requires it.

8. All equipment except for disposable items must be constructed so as to withstand repeated cleaning and the normal stress of ambulance operations.

9. Equipment that is intended for single use only shall not be reused and shall be disposed of according to commonly accepted medical practice.

B. Every person staffing an ambulance or in any other way providing out-of-hospital emergency medical care is required to wear a standardized uniform in a style or form specified by the employing agency. The uniform must display the name of the agency. Uniforms must be clean, and must be free of excessive wear. The uniform must be free of blood, dirt, and bodily materials. Reasonable exceptions shall be made for uniforms soiled during the course of providing service so long as the uniform is reasonably clean and is changed at the first opportunity.

C. Every person staffing an ambulance or providing out-of-hospital emergency medical care must display the person’s level of licensure or certification and the person’s first or last name. The display must be apparent on the outer garment of the work uniform. Reasonable exceptions may be made for attire necessary to protect the responder from injury or illness, such as hazmat suits. Employees of a provider who respond to a scene while they are not on duty shall make reasonable efforts to comply with the uniform and identification requirements.

D. No person may work as a staff person on an ambulance in any capacity if the person has consumed any alcoholic beverage within eight hours of the start of the person’s shift. No person may work as a staff person on an ambulance in any capacity if the person is impaired to any degree by the ingestion of alcoholic beverage or the ingestion or other use of any drug, medication or other substance.

E. Every provider shall have in place a program to screen for drug and alcohol use, both pre-employment and for-cause. Every applicant for employment shall be tested for drug and alcohol use. The provider shall file with the Board of County Commissioners, the County Health Department, and the EMSB a copy of the testing/screening program.

F. Every provider shall have in place a program for criminal background checks. The provider shall subject every applicant for employment to a thorough background check for criminal activity and driving offenses. No person may work as a staff person on an ambulance if the person has a felony conviction, or a misdemeanor conviction involving violence, dishonesty or moral turpitude. No person may work as a staff person on an ambulance unless the person has a valid Oregon driver’s license permitting the person to do that work.

G. Upon request from the BCC or from the County Health Department Administrator, each provider shall conduct a drug and alcohol screen for any individual employee, and/or a criminal background check for any individual employee, and shall furnish the results of such checks or tests to the requesting authority.

H. Every provider shall make every effort and take every step necessary to ensure that all of the provider’s employees treat all patients with courtesy and respect and render the highest level of medically competent care.

I. Every provider shall enter into and maintain mutual assistance agreements with all of the providers of emergency medical services in all counties adjoining Josephine County.

J. Every provider shall complete a patient care form (PCF) for each instance as required by the Documentation of Care Protocol, OAR 333-250-0045, as amended. The PCF must contain all of the data points required by the Oregon Prehospital Care Database. Ambulance personnel shall complete and return the PCF before the end of the duty shift.

K. Ambulance personnel must prepare a pre-hospital care worksheet and leave it with the appropriate hospital staff before departing the emergency department. [Order 2013-043.]

5.10.370 Physician supervision.

A. Each provider shall select and appoint a supervising physician at the provider’s cost. The supervising physician must be a physician licensed in Oregon to practice medicine, either as an M.D. or as a D.O., and board certified in Oregon in emergency medicine.

B. The supervising physician shall perform the functions described in ORS 682.245(4) and OAR 847-035-0025. The supervising physician shall issue, review and maintain standing orders for patient care that incorporate treatments that are within the scope of practice for each level of licensure or certification for EMTs, first responders and paramedics.

C. The supervising physician shall review the standing orders at least once each year. A copy of the standing orders dated within the current year and signed by the supervising physician must be available in every ambulance operated by every provider.

D. Each provider shall create and maintain a program to control the storage, security, and administration of controlled substances. The provider’s controlled substance program must comply with applicable federal and state statutes and administrative rules and with the supervising physician standing orders. [Order 2013-043.]

5.10.380 Equipment and vehicle requirements.

A. Every ambulance shall carry all of the equipment and supplies required by Oregon Administrative Rules, including but not limited to, OAR 333-255-0000 et seq. In addition, every ambulance shall carry all of the equipment, supplies and medications necessary to execute their standing orders and scope of practice.

B. Ambulance vehicles must be maintained in a safe and mechanically sound condition, with regularly scheduled maintenance. Each ambulance must be properly licensed by the Oregon Health Authority. Each ambulance must carry safety equipment as required by federal and state laws and administrative rules.

C. No ambulance vehicle may be operated in Josephine County if the vehicle has more than 200,000 miles on the chassis. Any exception to this requirement must be requested in writing, with supporting documentation. [Order 2013-043.]

5.10.390 Reportable incidents/actions.

A. Every provider of ambulance services shall adopt and implement an incident reporting system in addition to patient care reporting. The incident reporting system shall be used to report any event that places patient safety in jeopardy or that represents a failure to provide care at or above the commonly accepted medical standard. At a minimum, each employee and each provider must report to the Oregon Health Authority and to the Josephine County Health Department and the Josephine County Board of County Commissioners the following, within 10 days if the occurrence of the event:

1. Any conviction of a misdemeanor or a felony.

2. Any arrest for a felony.

3. Any restriction placed on a scope of practice of the license holder.

4. Any legal action being filed against the license holder alleging misconduct or medical malpractice.

5. Any physical disability that affects the ability of the license holder to perform all of the duties at the level of the license.

6. Any change in mental health that may affect a license holder’s ability to perform the duties of an emergency medical services provider.

B. Failure to report any of the events described in this section as required may serve as the basis for suspension or disqualification to provide emergency medical services in Josephine County. Without regard to whether the Oregon Health Authority has or will investigate a failure to report any of these events, the Josephine County Board of County Commissioners may, on its own authority and at its sole discretion, initiate its own investigation into the event.

C. Reportable incidents include, in addition to those listed in subsection (A) of this section, the following, which must be reported within 10 days of the event:

1. A commendable action by any health care provider.

2. Any event in which an ambulance or any other vehicle operated by an emergency medical services provider, is damaged or disabled or is involved in a traffic accident. The term traffic accident includes but is not limited to a collision with another vehicle, an object, or a person.

3. Any mechanical failure of a vehicle with a patient on board if the failure delays service or requires the response of another vehicle to continue service.

4. Failure of any equipment used to load or secure the patient.

5. Any observed deviation from treatment protocol.

6. Questionable care by any health care provider.

D. Any emergency medical service provider who has reasonable cause to believe that any other EMS provider has engaged in any conduct prohibited by law or administrative rule; dishonorable or unprofessional conduct; dishonesty or medical malpractice; or any other conduct that is likely to harm patients or is likely to call into question the capability of the ambulance service provider to conduct itself in accordance with established medical practice, shall report that fact within 10 days of the event. The report shall be made to both the Oregon Health Authority and to the Josephine County Board of Commissioners.

E. It is the intent of the Josephine County Board of Commissioners that the reports described in this section be considered part of the process of quality improvement or quality assurance, and that such reports be protected from public disclosure to the extent provided by ORS 41.675 and 41.685 and applicable public records laws. In all events, all providers must comply with all federal and state reporting requirements, including but not limited to OAR 333-265-0080. [Order 2013-043.]

5.10.400 Fee schedule, insurance and record requirements.

A. Every provider of ambulance services shall establish and file with the Josephine County Board of Commissioners, through the County Health Department, a schedule of fees charged for its service. No provider may charge or assess a fee that is not included on the fee schedule filed with the County. Upon being selected as a provider for the County, the provider shall file the fee schedule with the County. The Board of County Commissioners, or its designee, shall review the fee schedule at least once every year. No increase in fees charged may be made unless such an increase is approved the Board of County Commissioners in writing.

B. The Board of County Commissioners is aware that schedules of fees may be proprietary in nature and that the disclosure of such fee schedules may adversely affect a provider’s ability to do business. If the provider wishes to keep its fee schedule confidential, the provider may make a written request for non-disclosure to the Board of County Commissioners, supported by substantial evidence to justify the request. If the Board of County Commissioners approves the request, the fee schedule may be kept confidential to the extent provided by state and federal law.

C. Each provider shall maintain vehicle liability insurance, comprehensive general liability insurance and professional liability errors and omissions insurance in limits of not less than $3,000,000 combined single limit per occurrence and $3,000,000 in the aggregate.

D. With the exception of professional liability insurance, every policy shall include Josephine County as a named additional insured. Each policy must include provisions specifying that the term “Josephine County” includes all authorities, boards, bureaus, commissions, divisions, departments, districts, and offices of Josephine County and the individual members, employees and agents thereof in their official capacities. Any lapse of coverage shall be considered a material breach of the contract with the County. In the event that federal or state laws create a risk not currently covered, the provider shall obtain riders or additional policies providing additional coverage. All insurance policies shall be evidenced by certificates of insurance which shall be delivered to the County prior to commencing operations under a contract. Each policy and each certificate shall contain a requirement that written notice of any cancellation or revocation of coverage must be provided to the County by certified mail at least 30 days in advance of the date of such cancellation or revocation.

E. The provider is solely liable for workers’ compensation insurance coverage. Each provider must furnish the County with written proof of workers’ compensation coverage and registration with the Oregon State Unemployment Compensation Commission.

F. Each provider must maintain adequate records of all transports. Transport records must include, at a minimum, the names of all ambulance personnel involved in the transport, the name and address of the patient, the location of the pickup and the destination, the date and time of the pickup, the origin of the dispatch call, and the reason for the pickup. These records must be maintained for at least 10 years or for the period specified in OAR 333-250-0045, whichever is greater.

G. Each provider must maintain adequate records of vehicle maintenance. The records must reflect dates and mileage of preventive maintenance, the nature and extent of any repairs or equipment replacements, and the names of the persons performing the maintenance. These records must be kept on file for each vehicle and must be available for inspection at the provider’s business office. Vehicle maintenance records must be kept for seven years, or for the period specified in OAR 333-250-0043, whichever is greater. [Order 2013-043.]

5.10.410 Contracting for emergency ambulance service – Contract terms and structure.

A. The Josephine County Board of Commissioners finds that the franchising or licensing of emergency ambulance services is the most reasonable and most effective regulatory mechanism for coordinating and promoting the efficient and effective provision of emergency ambulance services within the County. The Board of County Commissioners further finds that the County has the authority to regulate the provision of emergency ambulance services under ORS 221.485 through 221.495, 682.031, 682.062, OAR 333-260-0000 et seq., Josephine County Home Rule Charter Chapter 11, and other applicable law.

B. After selecting a provider of emergency ambulance services, the County will enter into a written contract with the provider. The written contract will serve as the exclusive franchise and license to operate emergency ambulance services in the County. No person or entity may operate emergency ambulance services, attempt to provide such services, or advertise the provision of such services without holding a written contract authorizing the provision of such services. [Order 2013-043.]

5.10.420 Selection process.

A. If for any reason the County elects not to renew an existing contract with a provider of emergency ambulance services, the County will follow a selection process to select a new or different provider. That process will comply with the County’s own public contracting rules as well as with state law and state administrative rules related to public contracting. In order to select a provider, the County will prepare, through its legal counsel, a request for proposal (RFP). The RFP will be subject to approval by the Board of County Commissioners and will include, at a minimum:

1. The minimum set of credentials and experience in order to qualify to submit a proposal.

2. Specific maximum response times.

3. Performance expectations and remedies for breach.

4. Bid evaluation process.

5. Sufficient information to allow bidders to prepare ambulance service proposals.

B. The RFP will require bidders to submit, at a minimum:

1. Qualifying information, including but not limited to, the experience and ability of the bidder to provide the necessary services and references that establish the bidder’s qualifications.

2. A complete description and history of the organizational structure of the bidder, including any associations, affiliations, parent or subsidiary entities, and a complete history of claims against the bidder within the last five years.

3. The financial structure of the bidder, with references establishing the bidder’s financial stability.

4. A complete list of all vehicles currently used by the bidder for the provision of ambulance service, their ages, the mileage, and a summary of service records including history of damage from collision.

5. A complete list of all personnel to be employed in the provision of ambulance services in Josephine County, together with the licensing or certification documentation for each employee, a brief summary of the work history or experience for each employee, and the rates of compensation for each employee.

6. A complete rate schedule showing all charges made or anticipated for service and equipment or supplies.

7. A statement of insurance coverage, showing types of coverage and policy limits for each type.

8. Authorization for the County or its designee to conduct investigations into the history, background, and financial stability of the bidder and the criminal history of its employees.

9. A statement of the bidders ability and willingness to comply with response time requirements.

10. A statement describing how the bidder will attempt to improve services.

11. Any other information that the Board of County Commissioners or legal counsel may determine is necessary or appropriate to aid in the bid evaluation process.

C. The Board of County Commissioners, advised by the County Health Department Administrator and legal counsel, will evaluate the proposals submitted. Based upon its evaluation the BCC may select a provider and assign the provider one or both of the ambulance service areas contained in Josephine County. Once selected, the provider will enter into a contractual agreement with the County to provide ambulance services in one or both ASAs. [Order 2013-043.]

5.10.430 Default, revocation and vacating ambulance service areas.

A. A designated ambulance service provider may be found in default of the ambulance service area contract for any one or more of the following:

1. Supplying false or misleading information in connection with the bidding process, or supplying information so incomplete as to be misleading.

2. Supplying or submitting to the County false or misleading information in connection with the provision of contract services, or supplying or submitting information so incomplete as to be misleading.

3. Failing to operate the ambulance service in substantial compliance with federal, state, and county laws, ordinances and administrative rules; failing to operate the ambulance service in substantial compliance with the terms of the contract.

4. Supplying or submitting false or misleading information to any state or federal agency in connection with the performance or provision of ambulance services.

5. Suspension or revocation of any license or certificate issued by the State of Oregon or the United States, including licenses or certificates of employees.

6. Voluntary or involuntary filing of bankruptcy, an assignment for the benefit of creditors, or the appointment of a trustee.

7. Failure to maintain equipment in compliance with the standards required by state and federal law and the generally accepted standards of ambulance service operators.

8. Failure to respond to a call for service. For the purposes of this subsection, “failure to respond” means that the appropriate ambulance vehicle, with appropriate staff, is not en route to the location of the call within 10 minutes for an emergency call and 20 minutes for a nonemergency call. The failure to respond will not be considered a default if the circumstances that led to the failure were beyond the control of the provider and the provider has taken reasonable steps to ensure against future failures.

9. Failure to respond to an emergency call within the designated ASA location, if the failure is caused by factors not beyond the control of the provider and occurs more than twice in any seven-day period.

10. Any disciplinary action instituted by any federal or state authority or agency against the providing entity, its officers, agents, employees or associates.

11. Failure to notify the County immediately in the event any legal action is filed against the provider within the State of Oregon.

12. Any condition, occurrence or situation that may adversely affect the provider’s ability to perform its obligations under the contract. It is the provider’s duty to keep the County completely informed as to the ability of the provider to perform its obligations. Failure to do so is a material breach.

B. If the County determines that a breach of the contract terms has occurred or is about to occur, the Board of County Commissioners shall notify the provider of the determination and allow the provider an opportunity to either remedy the breach or to explain why the event does not constitute a breach of the contract. The notification to the provider shall be in writing and shall allow 10 days for the provider to respond. If the provider does not respond the County may begin the process to replace the provider with another service provider. If the provider does respond the County may make an informal determination as to whether a breach has occurred. If the provider requests a formal hearing, the Board of County Commissioners shall conduct a hearing within 10 days of the written request by the provider and shall make its determination based on the evidence presented at the hearing. The provider shall have the right to be represented by counsel at the hearing; at all hearings, whether the provider is represented by counsel or not, County legal counsel shall represent the County.

C. In the event that the Board of County Commissioners determines that the ambulance service provider has breached the contract and that the breach requires immediate termination, the BCC may:

1. Immediately either suspend or terminate the contract with the provider, and

2. Immediately contract for temporary services with another provider.

D. In the event of an emergency action that requires immediate termination, the BCC may act to enter into an agreement for temporary services without regard to the normal procurement process. The authority for emergency contracting for ambulance services is provided by ORS 279A.015 and ORS 279B.080.

E. In the event that the BCC undertakes emergency action to suspend or terminate a contract and appoint an alternate or temporary provider, the suspended or terminated provider is entitled to a hearing as provided in subsection (B) of this section. The BCC may act to appoint or designate another provider immediately, whether the suspended or terminated provider requests a hearing or not. [Order 2013-043.]

5.10.440 Level of service.

The Board of County Commissioners recognizes that the provision of prompt, effective and efficient ambulance service is a necessary function. The citizens of Josephine County have a right to expect such services. In the event that the Board of County Commissioners finds that for any reason, a provider has become unable or unfit to provide ambulance services for the County, the BCC may immediately designate another provider to operate ambulances services in the County on a temporary basis, pending the selection of a permanent provider. [Order 2013-043.]

5.10.450 Changes by Board of County Commissioners.

A. The Board of County Commissioners reserves the right to change ambulance provider selection procedures and provider standards of performance. The Board may take whatever steps are necessary to ensure the continuation of ambulance services in the County, including but not limited to temporary contracts with providers from other counties.

B. The BCC may, in order to assure uninterrupted ambulance services to the citizens of the County, immediately suspend or terminate a contract with a provider. Such action will be communicated to the provider by delivery of written notification by certified mail to the provider’s local business address and to its corporate home office, if different. If possible, the same written communication will be hand delivered to the provider’s local office.

C. Upon delivery of the notification described in this section, the County’s contract with the provider is either suspended or terminated, effective as of the delivery, and the County is required to contract with an alternative or temporary provider as soon as possible. [Order 2013-043.]

5.10.460 Emergency medical services operations – Dispatch and response times.

A. Each provider is required to comply with response time requirements as specified in the Ambulance Service Area Plan. Repeated failure to comply with specified response times is a breach of contractual obligations and may be the basis for fines, penalties, or termination of the contract.

B. For purposes of determining adequacy of response time, the time ends when the first appropriately staffed and equipped ambulance vehicle arrives on scene. If the ambulance is ordered to stop at a staging area, the time ends upon arrival at the staging area.

C. All providers must keep accurate records reflecting all times relevant to a determination of the response time for each call for service. All such records must be made available to the County upon request. [Order 2013-043.]

5.10.470 Mutual aid agreements.

A. Each ambulance service provider in Josephine County shall enter into and maintain written mutual aid agreements with every other ambulance service provider in Josephine County. Each agreement must specify the mutual duties and obligations of each of the providers. Each provider shall send a copy of the written agreement to the Board of County Commissioners or the Board’s designee.

B. Each ambulance service provider in Josephine County shall enter into and maintain written mutual aid agreements with all emergency medical service providers in each county adjoining Josephine County. Each agreement must specify the mutual duties and obligations of each of the providers. Each provider in Josephine County shall send a copy of each written agreement to the Board of County Commissioners or the Board’s designee. [Order 2013-043.]

5.10.480 Disaster operations.

A. Josephine County has adopted an Emergency Operations Plan. Medical first responders are responsible for the evaluation of each incident to determine whether higher level response is necessary.

B. All ambulance service providers are required to participate in and comply with the response methods set out in the Emergency Operations Plan, and to cooperate with other agencies as a part of the response. Whenever possible, ambulance service personnel will participate in training with other agencies to prepare for disaster response operations. The Josephine County Emergency Manager is the contact person for the Board of County Commissioners and the first source of information on disaster operations in the County. [Order 2013-043.]

5.10.490 Trauma system plan.

A. Josephine County participates in the Oregon State Trauma Program. Josephine County is part of Area Trauma Advisory Board 5 (ATAB 5). Emergency medical service providers in Josephine County must comply with the plans, rules and statutes relating to the Oregon Trauma System.

B. Each ambulance service provider in Josephine County shall actively participate in the ATAB 5 proceedings to the extent possible, and shall send at least one representative to each scheduled ATAB 5 meeting. [Order 2013-043.]

5.10.500 Administration.

A. The Josephine County Board of County Commissioners will administer and oversee the regulation of ambulance service providers in the County. The Board of County Commissioners may designate the Director of the County Public Health Department to participate in, or to assume responsibility for, administration and oversight. In any event, the Board of County Commissioners is the ultimate authority for oversight.

B. The BCC envisions a collaborative oversight process that involves all of the EMS Board members. Nevertheless, the Board of County Commissioners retains and reserves the right to adopt and implement additional administrative rules as circumstances may require. [Order 2013-043.]

5.10.510 Licenses and applications.

A. An application for a license to operate an ambulance service in Josephine County shall consist of the response to the request for proposals made by the County, or to any other invitation made by the County. Such response shall include, at a minimum, the information listed in JCC 5.10.420, as well as any other information or documentation required by the Board of County Commissioners.

B. At the time of application, the applicant will designate one person as the authorized agent and contact person for all future communication related to the application. The designation must include complete authorization for the designated person to act on behalf of the applicant.

C. Upon being selected to operate ambulance services in the County, the applicant will enter into a written contract with the County. The contract shall contain a statement that it is an exclusive license to operate ambulance services in the assigned ambulance service area. [Order 2013-043.]

5.10.520 Inspections.

A. All ambulance service providers are required to comply with all federal and state requirements relating to the mechanical condition of ambulance vehicles, their cleanliness and suitability for service, the equipment and supplies carried in the vehicles, and the education, training, experience and general fitness for service of the personnel staffing the vehicles. In addition to any inspection protocol required or recommended by federal or state law or rules, each ambulance service provider in Josephine County shall be inspected by representatives of the County Public Health Department at least once per year during the life of the contract. Health Department officials or representatives are authorized to demand access to vehicles, buildings, and documents including but not limited to written papers, electronically stored documents, emails, and any other recorded information, for the purpose of conducting an inspection or to ascertain compliance with federal, state or local laws or rules. Health Department representatives may conduct inspections without any prior notification to the provider.

B. In the event that any aspect of the operation of an ambulance service provider is found by inspection to be not within the requirements of federal, state or local laws or rules; or below the standards required by commonly accepted medical practice, the provider will be given a reasonable amount of time to remedy the condition. In no case will the time be greater than 30 days. If the condition is one that, in the view of the inspecting officials, creates an imminent risk of harm, the inspecting official shall immediately notify the Board of County Commissioners and the Director of the Josephine County Public Health Department. In that event, the BCC or the Health Department Director may require immediate remedy of the condition, and may suspend the provider’s license to operate until the remedy is complete.

C. The inspecting official shall make a written report of the findings from the inspection and file the report with the Director of the County Public Health Department. In the event the inspecting official or officials believe that immediate action is required, the Director shall be notified immediately. In any event, the written report shall be filed with the Director within 10 days of the date of the inspection. [Order 2013-043.]

5.10.530 Ownership and management changes.

A. The contract to operate ambulance services in Josephine County is specific to the provider. It is a license to operate and it cannot be transferred or assigned; the obligations of the provider cannot be delegated.

B. In the event that the provider is acquired by or merges with another entity, the County must receive written notification in advance of the intended merger or acquisition at least 30 days before the effective date of the acquisition or merger. If there are substantial factors that require confidentiality, the County must receive written notification of the request for confidentiality with the notice of the intended merger or acquisition. The Board of County Commissioners will, upon receiving notification, determine whether or not it is in the best interests of the County to allow the new entity to continue with the contract to provide ambulance services. That determination will be reflected in an order adopted and entered by the BCC. [Order 2013-043.]

5.10.540 Suspension, revocation and denial.

A. The right to operate ambulance services in Josephine County is conditional. The Board of County Commissioners may suspend or revoke the license to do so upon a determination that the provider is unfit to continue to operate. The BCC may deny an application to operate ambulance services upon a determination that the operator in unfit to operate or for any failure to comply with the application requirements.

B. If the BCC determines that a provider currently under contract with the County is unfit to continue to provide services, the BCC shall notify the provider of that determination, in writing, by both certified and regular mail. The notice must set forth specifically the facts upon which the BCC made its determination. The provider shall have 10 days from the date the provider receives the notice to request a hearing. The request for a hearing must be in writing and must be delivered to the BCC within 10 days from the date the provider received the notice.

C. If the provider does not request a hearing, the BCC shall immediately begin the process of finding another provider to operate ambulance services in the County. As soon as another provider has been engaged, the BCC shall rescind, cancel and nullify the contract with the original provider and shall adopt and enter an order prohibiting that provider from operating ambulance services in the County.

D. If the provider does request a hearing, the BCC shall conduct a formal hearing within 10 days from the date the provider delivered the request for a hearing to the BCC. The hearing shall be a full and formal hearing, at which the provider may be represented by legal counsel. The County will be represented by County legal counsel whether the provider is represented or not.

E. After completion of the hearing, the BCC may take the matter under advisement, but shall issue its final determination within 10 days of the date the hearing terminated. After conducting a full and fair hearing, the BCC may take no action at all, may issue a written warning that the provider has failed to provide the level of service that is required, may suspend the license to operate ambulance services in the County, or may terminate the contract, thereby revoking the license to operate. Nothing in these rules does or is intended to abrogate the right of the provider to seek judicial review under ORS Chapter 34 or other applicable law. [Order 2013-043.]

5.10.550 Procedures for acting on complaints.

A. Each provider shall create, implement and maintain an effective system for dealing with consumer complaints. It is the intent of the Josephine County Board of County Commissioners that every ambulance service provider conduct its business so as to provide the best possible medical care; at the same time, the BCC expects that every provider will treat every patient and every member of the public with dignity and respect. Every complaint from the public about the conduct of medical provider staff, treatment, driving, or other subject, shall be recorded, investigated, and acted upon.

B. Each provider shall maintain a record of all complaints received; the record shall include the name of the complainant, if available, how the complaint was received, how the matter was investigated, and what action was taken. The record of complaints shall be made available to the BCC or its designee upon request. [Order 2013-043.]

5.10.560 Compliance with laws and rules.

A. Nothing in these rules does or is intended to relieve the provider of the necessity to comply with all federal and state statutes, administrative rules, local ordinances, and other applicable laws and regulations.

B. Failure of a provider to comply with all applicable laws and rules may constitute a breach of the contract between the provider and the County. Each alleged failure will be evaluated to determine the extent and severity of the failure. In the event that any federal or state government entity informs the provider that the provider has violated or failed to comply with any statute, law, rule or regulation, the provider must immediately inform the County of that fact and provide the County with a copy of the letter, email, or other communication sent by the government entity.

C. Upon receiving information that a provider has violated one or more of these rules or any federal or state law, statute, rule or regulation, the Board of County Commissioners may undertake an investigation or may appoint a designee to investigate the circumstances of the reported violation. The investigator shall make a written report to the BCC after completing a thorough investigation into all the circumstances of the incident. The BCC shall review the report and determine whether any further action is necessary; if further action is indicated, the BCC may notify the provider of that fact, upon which the provider may request a hearing as provided in these rules. [Order 2013-043.]

5.10.570 Violations.

A. If the BCC determines or a provider admits that the provider has violated one or more of these rules or any federal or state law, statute, rule or regulation the BCC may impose penalties in accordance with the provisions of the Emergency Medical Services Ordinance, Josephine County Ordinance 2013-007.

B. The penalties available to the BCC to be imposed upon a provider include warnings, written warnings, fines and monetary penalties, temporary suspension of the license to operate, and revocation of the license to operate. No penalty shall be imposed without first affording the provider an opportunity to be heard and to present evidence in its defense. [Order 2013-043.]