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HomeMy WebLinkAboutAgenda - 02-02-2010 - 6aORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: February 2, 2010 Action Agenda Item No. (p -(~ SUBJECT: Second Reading: Amendments to the EMS Franchise Agreement entitled "An Ordinance Regulating Emergency Medical, First Responder and Rescue Service and Granting of Franchise and Contracts to the Operators In the County of Oran e" DEPARTMENTS: Emergency Services County Attorney PUBLIC HEARING: (Y/N) No ATTACHMENT(S): Proposed Amendments to "An Ordinance Regulating Emergency Medical, First Responder and Rescue Service and Granting of Franchise and Contracts to the Operators In the County of Orange" INFORMATION CONTACT: Frank Montes de Oca, Emergency Services, 245-6100 Annette M. Moore, Staff Attorney, 245-2317 PURPOSE: To consider on second reading approving amendments to the EMS Franchise Ordinance entitled, "An Ordinance Regulating Ambulance and Emergency Medical, First Responder and Rescue Services and Granting of Franchise and Contracts to the Operators In the County of Orange." BACKGROUND: On May 1, 1981 Orange County enacted its first EMS Franchise Ordinance, "An Ordinance Regulating the Operation of Ambulance Services and the Administration of Emergency Medical Assistance in Orange County, North Carolina" (EMS Franchise Ordinance). On April 20, 1993, Orange County repealed the original EM;S .Franchise Ordinance and enacted the current ordinance entitled, "An Ordinance Regulating Ambulance and Emergency Medical, First Responder and Rescue Services and Granting oi` Franchise and Contracts to the Operators In the County of Orange." Since 1993, the EMS Franchise Ordinance has not been updated with any statutory or regulatory changes'. In the inltervening years and especially since the events of September 11, 2001 there have been changes in both state law and regulations as well as the practices, policies, procedures, terminology„ and the responsibilities placed on the County by both state and federal government governincl the services provided by the EMS Franchise Ordinance. The amendments update the EMS Franchise Ordinance making it consistent with the existing authority mandated to the County by state law and regulations including, but not limited to, the following: 1. North Carolina General Statutes Chapter 131 E, Articlle 7 2. North Carolina General Statutes Chapter 143, Article 56 3. North Carolina General Statutes section 153A-250 ~ In January 2009, extensive revisions were made to l0A NCAC 13P .0101 et se;q. 4. North Carolina Administrative Code, 10A NCAC 13P .0101 et seq. 2 The Board at its meeting on January 21, 2010 voted 6-1 to approve the amendments to the EMS Franchise Ordinance. North Carolina General Statute §153A-45 provides that in order for an ordinance to be adopted on its first reading it "must receive the approval of all the members of the board of commissioners. If the ordinance is approved by a majority of those voting but not by all the members of the board... it shall be considered at the next regular meeting of the board." The history of Board actions on these amendments to this Ordinance is as follows: • This matter first came before the Board on December 7, 2009, the Board voted to delay the item. Prior to the meeting, both the Orange County Rescue Squad ("OCRs") and South Orange Rescue Squad's ("SORB") attorneys were given a copy of the amendments to the EMS Franchise Ordinance. OCRs came before the Board at the December 7, 2009 meeting and presented a letter in opposition to the amendments. Specifically, OCRs was opposed to the composition of the EMS Advisory Committee and the due process provided in the Ordinance. The attorney for SORB had no concerns about either the EMS Advisory Committee or the due process requirements. The Board asked the County Attorney to review the letter presented by OCRs prior to acting on the Ordinance. Response: The County Attorney's Office reviewed the letter and found that both the EMS Advisory Committee and the due process provisions provided by the Ordinance comported to the requirements of due process under both the federal and state constitutions. On January 21, 2010, these amendments were brought before the Board, the Board voted 6-1 to approve the amendments to the Ordinance. Fire Chiefs from several volunteer fire departments raised concerns about not having input into the changes to the Ordinance and questioned how the amendments to the Ordinance would affect them. OCRs again indicated it opposed the amendments to the Ordinance for the same reasons they indicated on December 7, 2009 and SORB spoke in favor of the proposed amendments to the Ordinance. The Board expressed concerns about the fire departments' position and the composition of the Emergency Medical Service Advisory Committee and EMS Peer Review Committee. Response: At the Board's December 7th meeting staff from the County Attorney`s office indicated the amendments to the EMS Franchise Ordinance did not require volunteer fire departments to be permitted a franchise to provide services that are considered fire fighting services. The volunteer fire departments are not in the business of providing the services governed by the Ordinance. There was no change recommended to require fire departments to have a franchise. The volunteer fire departments contract with the County to provide fire fighting and fire prevention service in the County. Fire fighting services necessarily include both first/medical responder and extrication services, which are incidental to their obligations and specifically referenced in their existing contracts. However, the North Carolina Administrative Code provides that County governments shall establish an EMS System that has among other things: o A defined scope of practice for all EMS personnel functioning in the EMS system; o Written policies and procedures describing dispatch, coordination and oversight of all responders that provide EMS care; o Written policies and procedures for the EMS System's EMS Care data for the daily and on-going management of all EMS System resources; o A written continuing education program for all credentialed EMS personnel, developed and modified based on feedback from system EMS Care data, review and evaluation of patient outcomes and quality management peer review that follow the guidelines of the US DOT NHTSA First Responder Refresher "National Standard Curriculum" for medical responder personnel; and o Written policies and procedures to address management of the EMS System,2 The Department of Health and Human Services may deny, suspend or revoke the approval of an EMS System for failure to comply with the requirements set forth above.3 EMS Systems are also required to have the following components to assure medical oversight of the system: a medical director, written protocols for adult and pediatric patients, and emergency medical dispatch system, an EMS Peer Review Committee whose membership is defined in G.S. 131 E-155(6b) and written procedures for EMS personnel to obtain on-line medical direction.4 Both the state statute and the North Carolina Administrative Code continue to require the County provide oversight of personnel performing responders services within the EMS system. So while fire departments are not required to have a franchise under the Ordinance, state law and regulations do require that personnel who are first/medical responders be credentialed and comply with the policies, practices and protocols of the EMS system. There were no substantive amendments to the sections governing EMS personnel (See Section VII, Standards for Personnel). The Emergency Medical Services Advisory Committee ("Committee") is not a citizens' advisory board; it is a technical advisory board. The proposed members of the Committee, through their positions either as employees of Orange County or through services contracted with the County have the medical responsibility either to the Board of County Commissioners, the Office of EMS, the North Carolina Medical Board or the Board of Health to oversee the medical health of persons within this EMS system. They are credentialed and have the educational, technical and experiential background to recommend, make and implement system wide medical improvements in the EMS System necessary to ensure a high quality, high functioning medical care. The only proposed enforcement responsibility of the Committee is to review stays of franchises. And after hearing evidence the Committee may ether remove the stay, provide a recommendation for corrective action or forward a recommendation to the Board of County Commissioners- for termination or suspension of the franchise. This does not in any way change what is currently or has been required of fire departments within Orange County. FINANCIAL IMPACT: None z See l0A NCAC 13P .0201. s l0A NCAC 13P .0701(1)(1) a l0A NCAC 13P.0401 4 RECOMMENDATION(S): The Manager recommends that the Board adopt on Second Reading the amendments to "An Ordinance Regulating Ambulance and Emergency Medical, First Responder and Rescue Services and Granting of Franchise and Contracts to the Operators In the County of Orange" effective and authorize the Chair to sign the EMS Franchise Ordinance as amended. The amendments to the EMS Franchise Ordinance will be effective upon signature by the Chair. ~~.~~ ~b1©-C~1 ~, 5 AN ORDINANCE REGULATING AMBULANCE, EMERGENCY MEDICAL, FIRST REPSPONDER AND RESCUE SERVICE AND GRANTING OF FRANCHISE AND CONTRACTS TO THE OPERATOR IN THE COUNTY OF ORANGE An ordinance governing the granting of franchises for emergency services and other prehospital emergency medical services, the County of Orange Board of Commissioners do ordain the following: SECTION I. DEFINITIONS Unless the context otherwise requires, the following definitions shall apply to the interpretation and enforcement of this Ordinance: 1.1 Ambulance. The term "ambulance" means any privately or publicly owned motor vehicle, aircraft, or vessel that is specifically designed, constructed, or modified and equipped and is intended to be used for and is maintained or operated for the transportation on the streets or highways, waterways, or airways of this State of persons who are sick, injured, wounded, or otherwise incapacitated or helpless. 1.2 Ambulance Provider. The term "ambulance provider" means an individual, firm, corporation, or association who engages or professes to engage in the business or services of transporting patients in an ambulance. 1.3 Approved. The term "approved" shall mean approved by the North Carolina Medical Care Commission pursuant to the Tatter's rules and regulations promulgated under N.C.G.S. 143E-165. 1.4 Advisory Committee or Committee. The term "Advisory Committee" or "Committee" shall mean the Orange County Emergency Medical Services Committee which is the advisory committee designated by the Board of County Commissioners with respect to emergency medical services in Orange County. 1.5 Contract. The term "contract" shall mean the instrument by which both parties agree to the terms of operation of the service to be provided. 1.6 Convalescent Transportation Services. The term "convalescent transportation service" shall mean the operation of an ambulance for any purpose other than transporting emergency or emergent patients. 1.7 County. The term "County" shall mean Orange County and its Board of Commissioners or their designated representative(s). 1.8 Emergency. The term "emergency" or "emergency transportation services" shall mean the use of a service, its equipment and personnel to provide medical care, rescue, andlor transportation of a patient who is in need of immediate rescue or medical treatment in Page 1 of 18 6 order to prevent loss of life or further aggravation of physiological or psychological illness or injury. 1.9 Emergency Management System or EMS. Emergency Management System or "EMS" shall mean a coordinated arrangement of local resources under the authority of the Emergency Services Director (including all agencies, personnel, equipment, and facilities) organized to respond to medical emergencies and integrated with other health care providers and networks including public health, community health monitoring activities, and special needs populations. 1.10 Emergency Medical Dispatcher or Telecommunicator. The term "emergency medical dispatcher" of "telecommunicator" shall mean an emergency telecommunicator who has completed educational requirements and been credentialed by the Department of Health and Human Services as an emergency medical dispatcher and who is available to receive requests for emergency services, to dispatch emergency services, and to advise local law enforcement agencies, fire departments, rescue squads, first or medical responder units and emergency medical services and facilities of any existing or threatened emergency. 1.11 Emergency Medical Services. "Emergency Medical Services" means services rendered by emergency medical services personnel in responding to improve the health and wellness of the community and to address the individual's need for emergency medical care within the scope of practice as defined by the North Carolina Medical Board, in accordance with G.S. 143-514, and the Orange County Medical Director in order to prevent loss of life or further aggravation of physiological or psychological illness or injury. 1.12 Emergency Medical Services Instructor. "Emergency Medical Services Instructor" means an individual who has completed educational requirements approved by the Department of Health and Human Services and has been credentialed by that Department as an emergency medical services instructor. 1.13 Emergency Medical Services Peer Review Committee. Emergency Medical Service Peer Review Committee means a panel composed of EMS program representatives responsible for analyzing patient care data and outcome measures to evaluate the ongoing quality of patient care, system performance, and medical direction within the EMS system. The committee may include physicians, nurses, EMS personnel, medical facility personnel and county government staff as determined by the Emergency Services Director in consultation with the County Medical Director. 1.15 Emergency Medical Technician (EMT). The term "emergency medical technician" means an individual who has completed a training program in emergency medical care that has been approved for legal recognition by the North Carolina Department of Health and Human Services, in accordance with rules promulgated by the Medical Care Commission, has been .certified as an EMT by the State of North Carolina Office of Emergency Medical Services, and approved by the County Medical Director to perform services as an EMT in the Orange County EMS system. Page 2 of 18 7 1.16. Emergency Medical Technician - Intermediate. The term "emergency medical technician -intermediate" means an individual who has completed a training program in emergency medical care at the intermediate level that has been approved for legal recognition by the North Carolina Department of Health and Human Services, in accordance with• rules promulgated by the Medical Care Commission, has been certified as an EMT -Intermediate by the State of North Carolina Office of Emergency Medical Services, and approved by the County Medical Director to perform services at the EMT- Intermediate level in the Orange County EMS system. 1.17. Emergency Medical Technician -Paramedic. The term "emergency medical technician - paramedic" means an individual who has completed a training program in emergency medical care at the paramedic level that has been approved for legal recognition by the North Carolina Department of Health and Human Services, in accordance with rules promulgated by the Medical Care Commission, has been certified as anEMT-Paramedic by the State of North Carolina Office of Emergency Medical Services, and approved by the County Medical Director to perform services as anEMT-Paramedic in the Orange County EMS. system.. 1.18. Emergency Services Director. The term shall mean the person designated by the Orange County Board of Commissioners to manage the overall Emergency Management System in Orange County. 1.19 First Responder. The term "first responder" shall mean an organization with personnel trained in emergency medical care that is dispatched to the scene of a medical emergency for the primary purpose of providing emergency medical assistance to a patient until the ambulance and additional medical aid arrives. 1.20 Franchise. The term "franchise" shall mean a permit issued by the County to a person for the operation of am ambulance service, rescue squad or first responder unit. 1.21 Franchisee. The term "franchisee" shall mean any person having been issued a franchise by the County for the operation of an ambulance service, rescue squad or first responder unit. 1.22. License. The term "license" shall mean any driver's license or permit to operate a motor vehicle issued under or granted by the laws of the State of North Carolina. 1.23. Medical Responder. "Medical Responder" shall mean an individual who has completed an educational program in emergency medical care and first aid approved and credentialed by the Department of Health and Human Services as a medical responder and the Orange County Medical Director to operate in Orange County EMS. 1.24. Medical Director. "Medical Director" shall mean the physician appointed, either directly or by written delegation, by the County and have the responsibilities as provide by l0A NCAC 13P .0403 and l0A NCAC 13P .0404. The County may, in addition, appoint an Page 3 of 18 8 assistant medical director. The medical director and the assistant medical director shall meet the criteria defined in the "North Carolina College of Emergency Physicians: Standards of Medical Oversight and Data Collection," which is incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. 1.25. Non-Emergency Transportation Services. The term "non-emergency transportation service" shall mean the operation of an ambulance for any purpose other than transporting emergency or emergent patients. 1.26 Operation Protocols. "Operation Protocols" shall mean the administrative policies and procedures of EMS that provides guidance for the day-to-day operations of the system. 1.27 Operator. The term "operator" shall mean a person in actual physical control of an ambulance or rescue service vehicle which is in motion or which has the engine running. 1.28 Owner. The term "owner" shall man any person or entity who owns an ambulance or provides a service covered by this Ordinance. 1.29 Patient. The term "patient" shall mean an individual who is sick, injured, wounded, or otherwise incapacitated or helpless such that the need for some medical assistance might be anticipated while being transported to or from a medical facility. 1.30 Person. The term "person" shall mean any individual, firm, partnership, association, corporation, company, group of individuals acting together for a common purpose, or organization of any kind, including any governmental agency other than the United States. 1.31 Practical Examination. "Practical Examination means a test where an applicant for credentialing as an emergency medical technician, or medical responder, emergency medical technician -intermediate, or emergency medical technician -paramedic demonstrates the ability to perform specified emergency medical care skills. 1.32 Rescue. The term "rescue" shall mean the removal of individuals facing external, non- medical, and non-patient related peril to areas of relative safety. 1.33 Rescue Squad or Rescue Unit. The term "rescue squad" or "rescue unit" shall mean a group of individuals who are not necessarily trained in emergency medical services, fire fighting, or law enforcement, but who expose themselves to an external, non-medical, and non-patient related peril to effect the removal of individuals facing the same type of peril to areas of relative safety. 1.34 Secondary Ambulance Provider. The term "secondary ambulance provider" shall mean the system of personnel and equipment meeting the same criteria as a primary ambulance provider, but not normally dispatched on first call response. 1.35 Service. The term "service" shall mean the same as owner. Page 4 of 18 9 1.36 Treatment Protocols. "Treatment Protocols" shall mean a document approved by the medical director and the Office of Emergency Medical Service specifying the diagnostic procedures, treatment procedures, medication administration, and patient-care-related policies that shall be completed by emergency service personnel based upon the assessment of the patient. 1.37 Victim. The term "victim" shall mean any patient or potential patient that is entrapped, entangled pinned, fallen, suspended, or otherwise in need of rescue services. SECTION II. FRANCHISE REQUIRED 2.1 No person either as owner, agent or otherwise, shall furnish, operate, conduct, maintain, advertise, or otherwise be engaged in or profess to be engaged in the business or service of emergency medical service, emergency, emergent and/or non-emergency transportation of patients within the County of Orange unless the person holds a valid EMS Provider License and a valid permit for each ambulance used in such business or service issued by the North Carolina Department of Health and Human Services, Office of Emergency Medical Service, and has been granted a franchise for the operation of such business or services by the County pursuant to this Ordinance. 2.2 No person shall drive an ambulance, attend a patient in one, or permit one to be operated when transporting a patient within the County of Orange unless he or she holds a currently valid North Carolina Operator's License, a currently valid certificate as an EMT (Emergency Medical Technician), EMT-I (Emergency Medical Technician - Intermediate), EMT-P Emergency Medical Technician - Paramedic) or Medical Responder issued by the North Carolina Department of Health and Human Services, and has been approved by the Orange County Medical Director to provide such service in Orange County. 2.3 No person either as owner, agent or otherwise, shall furnish, operate, conduct, maintain, advertise, or otherwise be engaged in or profess to be engaged in the business or service of providing rescue services, medical responder services or first responder services unless they have been granted a franchise for the operation of such business or service by the County pursuant to this Ordinance. 2.4 No franchise shall be required for: a. Any entity operated from a location or headquarter outside of the County of Orange in order to transport patients who are picked up beyond the limits of the County of Orange, to facilities located within the County of Orange, or to pick up patients within the County of Orange for transporting to locations outside the County of Orange; but no such entity shall be used to pick up patients within the County of Orange for transporting to locations within the County of Orange or other locations unless it is rendering assistance to a franchised ambulance service in the case of a major catastrophe or mutual aid. Page5of18 10 b. Ambulances owned and operated by an agency of the County, the State of North Carolina, or of the United States. SECTION III. APPLICATION FOR AMBULANCE FRANCHISE 3.1 Application for a franchise to operate ambulances, emergency or convalescent, in the County of Orange shall be made by the ambulance provider upon such forms as may be prepared or prescribed by the County and shall include, but are not limited to, the following: a. The name and address of the ambulance provider and of the owner of the ambulance(s). b. The trade or other fictitious names, if any, under which the applicant does business, along with a certified copy of an assumed name certificate stating such name or articles of incorporation stating such name. c. A resume of the training and experience of the applicant in the transportation and care of patients. d. A full description of the type and level of service to be provided including the location of the place or places from which it is intended to operate, the manner in which the public will be able to obtain assistance and how the vehicle will be dispatched. A financial statement of the applicant as the same pertains to the operations in the County of Orange, said financial statements to be in such forms and in such detail as may be required by the County. e. A list of radio frequencies the applicant is authorized to operate on, and a copy of the FCC license(s) in the name of the person providing the service. f. A description of the applicant's capability to provide twenty-four hour coverage, seven days per week for the district covered by the franchise applied for, and an accurate estimate of the minimum and maximum times for a response to calls within such district. g. A copy of the written plan detailing how the applicant will furnish credentialed personnel and a current roster of all credentialed personnel with a list of their credentials. h. A copy of the applicant's written operational protocols for the management of equipment, supplies and medications. Any information the County shall deem reasonably necessary for a fair determination of the capability of the applicant to provide ambulance services in Page 6 of 18 11 the County of Orange in accordance with the requirements of state laws and the provisions of these regulations. SECTION IV. APPLICATION FOR MEDICAL OR FIRST RESPONDER 4.1 Application for a franchise to operate as medical or first responders in the County of Orange shall be made by the provider upon such forms as may be prepared or prescribed by the County and shall include, but not be limited to the following: a. The name and address of the provider and the owner of the service. b. The trade or other fictitious names, if any, under which the applicant does business, along with a certified copy of an assumed name certificate stating such name or articles of incorporation stating such name. c. A resume of the training and experience of the applicant in the treatment and care of patients. d. A full description of the type and level of service to be provided including the location of the place or places from which it is intended to operate, the manner in which the public will be able to obtain assistance and how the vehicle will be dispatched. A financial statement of the applicant as the same pertains to the operations in the County of Orange, said financial statements to be in such forms an in such detail. as may be required by the County. A current financial statement provided by a fire department, volunteer or otherwise, operating within the County which has been provided to the County as part of the County budget process shall satisfy this financial statement requirement. e. A list of radio frequencies the applicant is authorized to operate on, and a copy of the FCC license(s) in the name of the person providing the service, unless included as part of a fire department radio system. f. A copy of the written plan detailing how the applicant will furnish credentialed personnel and a current roster of all credentialed personnel with a list of their credentials. g. A copy of the applicant's written operational protocols for the management of equipment, supplies and medications. h. A description of the applicant's capability to provide coverage for the district covered by the franchise applied for, and an accurate estimate of the minimum and maximum times for a response to calls within such district. i. Any information the County shall deem reasonably necessary for a fair determination of the capability of the applicant to provide medical or first Page 7 of 18 12 responder services in the County of Orange in accordance with the requirements of state laws and the provisions of these regulations. SECTION V. APPLICATION FOR RESCUE SERVICES 5.1 Application for a franchise to provide rescue services in the County of Orange Shall be made by the provider upon such forms as may be prepared or prescribed by the County and shall include, but are not be limited to the following: a. The name and address of the provider and of the owner of the service(s). b. The trade or other fictitious names, if any, under which the applicant does business, along with a certified copy of an assumed name certificate stating such name or articles of incorporation stating such name. c. A resume of the training and experience of the applicant in the rescue of victims. d. A full description of the type and level of service to be provided including the location of the place or places from which it is intended to operate, the manner in which the public will be able to obtain assistance and how the .vehicle will be dispatched. A financial statement of the applicant as the same pertains to the operations in the County of Orange, said financial statements to be in such forms an in such detail as may be required by the County. A list of radio frequencies the applicant is authorized to operate on, and a copy of the FCC license(s) in the name of the person providing the service. f. A description of the applicant's capability to provide twenty-four hour coverage, seven days per week for the district covered by the franchise applied for, and an accurate estimate of the minimum and maximum times for a response to calls within such district. g. A copy of the written plan detailing how the applicant will furnish credentialed personnel and a current roster of all members of the rescue squad who are eligible for membership in the North Carolina Association of Rescue and Emergency Medical Services, Inc. ("the Association"); number of hours they have attended training and meetings in the last calendar year; and a copy of the roster filed with the Secretary -Treasurer of the Association for the three years preceding the application for franchise. h. A copy of the applicant's written operational protocols for the management of equipment, supplies and medications. Page 8 of 18 13 A written statement showing that applicant meets the eligibility requirements established by the North Carolina Association of Rescue and Emergency Medical Services, Inc for the type of level of service being requested. j. Any information the County shall deem reasonably necessary for a fair determination of the capability of the applicant to provide rescue services in the County of Orange in accordance with the requirements of state laws and the provisions of these regulations. VI. GRANTING OF FRANCHISE 6.1 Prior to accepting application for the operation of any service, the Board of Commissioner may designate specific service areas as franchise districts. Said districts will be established using criteria that include geographic size, road access, the location of existing medical transportation services, population, and response time. The Commissioners shall have the authority to redistrict or rearrange existing districts ay any time at their discretion. 6.2 An applicant may apply for a franchise to operate an ambulance service, emergency or convalescent, rescue service, or Medical or First Responder Unit or any two or all three. If more than one (1) service is to be provided, an application must be filed for each service. 6.3 Upon receipt of an application for a franchise, the County shall schedule a time and place for hearing the applicant. Within 30 days after hearing, the County shall cause such investigation as it may deem necessary to be made of the applicant and his proposed operations. 6.4 A franchise may be granted if the County finds that: a. The applicant meets both county and state standards 'in addition to the standards outlined in the franchise ordinance; and. b. The proposed service will fit within the existing services so as not to adversely affect the level of service or operations of other franchisees to render service; and c. A need exists for the rendered services in order to improve the level of service available to the residents of the County helping to assure the provisions of adequate and continuing service which preserves, protects, and promotes the public health, safety and welfare and that granting the franchise is a cost effective and reasonable manner of meeting the need. Page 9 of 18 14 SECTION VII. TERM AND TERMINATION OF FRANCHISE 7.1 The County may issue a franchise hereunder to an ambulance provider, to be valid for up to a term of five (5) years. 7.2 The franchise holder can surrender the franchise with 60 days written notice to the County. 7.3 The County may revoke the franchise as provided in Section XIV 1.E. After a notice of service termination is given, the provider may reapply for a franchise if continued service is desired. 7.3 Upon suspension, revocation, or termination of an EMS Provider's License, or an ambulance permit, or franchise granted hereunder, such franchised ambulance service, rescue squad or medical or first responder unit immediately shall cease operations and no care shall be rendered by the personnel associated with the ambulance service, rescue squad or medical or first responder unit. 7.4 Upon suspension, revocation, or termination by the State or Orange County of a driver's license or an attendant's credentials (i.e., first responder, rescue, emergency medical technician, EMT-I, EMT-P or medical responder credentials), such persons shall cease to drive an ambulance or provide medical care, medical or first responder services or attend an ambulance. 7.5 The franchise shall not permit an individual to drive an ambulance or provide medical care in conjunction with the ambulance service, provide rescue service, or medical or first responder service if the individual's credentials have been suspended, revoked or terminated by the State or Orange County. 7.3 Each franchised service shall comply at all times with the requirements of this Ordinance, the franchise granted hereunder, and all applicable state, and local laws relating to health, sanitation, safety, equipment, ambulance design and all other laws and ordinances. 7.4 Prior approval of the County shall be required where ownership or control of more than 10 percent of the right of control of the franchise is acquired by a person or group of persons acting in convert, none of whom own or control 10 percent of more of such right of control, singularly or collectively, at the date of the franchise. By its acceptance of the franchise, the franchisee specifically agrees that any such acquisition occurring without prior approval of the county shall constitute a violation of the franchise by the franchisee and shall be cause for termination at the option of the County. 7.5 Any change of ownership of a franchised service without the approval of the County shall terminate the franchise and shall require a new application and a Page 10 of 18 15 new franchise and conformance with all the requirements of this Ordinance as upon original franchising. 7.6 Any change in the level of service offered of a franchised ambulance service, rescue squad or first responder unit without the prior approval of the County shall terminate the franchise and shall require a new application and a new franchise and conformance with all the requirements of this Ordinance as upon original franchising. 7.7 No franchise may be sold, assigned, mortgaged, or otherwise transferred without the approval of the County; and a finding of conformance with all requirements of this Ordinance as upon original franchising. Each franchised ambulance, rescue, or medical or first responder service, its equipment and the premises designated in the application and all records relating to its maintenance and operation, as such, shall be open to inspection by the State, the County, or their designated representatives. 7.8 The franchise certificate shall be posted in a readily visible location at the base of operations for the franchised service. 7.9 A franchise certificate may not be defaced, removed, or obliterated. SECTION VIII. STANDARDS FOR PERSONNEL 8.1 Ambulance drivers and attendants shall comply with the standards for ambulance drivers and attendants as developed by the North Carolina Medical Caze Commissions as requirements for certification of emergency medical technicians pursuant to Article 7, Chapter 131E-158, and Article 56, Chapter 143 of the General Statutes of North Cazolina, and rules and regulations promulgated by the North Carolina Medical Care Commission and North Carolina Medical Board which are incorporated herein by reference. 8.2 All personnel of Emergency Medical Service providers shall be approved by the County Emergency Medical Services Director prior to providing medical care in Orange County. Each submission for approval shall be accompanied by the submission of a driver's license, criminal records history and letter outlining the applicant's credentials and training. The Department of Emergency Services may designate a form to be used by applicants. 8.3 Each franchise is required to notify the Emergency Services Director, or their designee, when personnel provided for subsection 8.1 leave the service of the franchise. 8.4 All emergency service personnel shall adhere to the standards set by state law, regulations and the Orange County Medical Services, Emergency Medical Practice Protocols and any amendments thereto. A practical examination may be Page 11 of 18 16 given on the Orange County Practice Protocols before permission is granted by the Medical Director to practice in Orange County. , 8.5 Emergency Medical Practice standards of care shall be reviewed by the Emergency Service Peer Review Committee. STANDARD IX. STANDARDS FOR AMBULANCES AND EQUIPMENT 9.1 Ambulances and equipment standards as developed by the North Carolina Medical Care Commission pursuant to Article 7, Chapter 131E-157, and Article 56, Chapter 143, of the General Statutes of North Carolina, shall be applied and the same are incorporated by reference. 9.2 All emergency ambulances and rescue squad vehicles franchised solely in Orange County shall contain the words "PROUDLY SERVING WITH ORANGE COUNTY EMERGENCY SERVICES" lettered on both sides and the rear of the vehicle body. SECTION X. STANDARDS FOR COMMUNICATIONS 10.1 Each ambulance vehicle shall be equipped with an operational two-way radio as provided by l0A NCAC 13P.0207 through l0A NCAC 13P.0213 This section shall not apply to privately owned vehicles of the members. 10.2 Each provider shall maintain current authorizations or Federal Communication Commission licenses for all frequencies and radio transmitters operated by that provider. Copies of all authorizations and licenses shall be provided to the Emergency Services Department and on display and available for inspection per Federal Communication Commission's Rules and Regulations. 10.3 Each base of operations must have at least one open telephone line. Telephone numbers must be registered with each law enforcement agency and the Emergency Services Communications Center in the County of Orange. 10.4 Each franchise shall be dispatched from the Emergency Service Communication Center or an acceptable and approved alternative as long as they are in compliance with the terms of this Ordinance and their franchise agreement as determined by the Emergency Services Director. SECTION XI. INSURANCE 11.1 No franchise shall be issued under this Ordinance, nor shall such franchise be valid after issuance, nor shall any service vehicles be operated in the county of Orange unless the franchisee has at all times in force and effect either insurance coverage, issued by an insurance company licensed to do business in the State of Page 12 of 18 17 North Carolina for every vehicle owned and/or operated by or for the service providing for the payment of damages: a. In the minimum sum of $1,000,000 for injury to or death of individuals in accidents resulting from an cause for which the owner of said vehicle would be liable on account of liability imposed on him by law, regardless of whether the vehicle was being driven by the owner of his agency; and b. In the minimum sum of $1,000,000 for the loss of or damage to the property of another, including personal property, under like circumstances, in sums as may be required by the State or as approved by the County of Orange. c. The insurance coverage minimum limits required in subsection (a) and (b) of this subsection shall be reviewed annually by the Orange County Department of Emergency Services, in Consultation with the County Attorney and Orange County Risk Manager. Such insurance coverage shall be revised as deemed appropriate and as directed by the Orange County Department of Emergency Services. In directing a change in insurance coverage, the Orange County Emergency Services Department shall consider the risk needs protected by this insurance coverage and the availability in the marketplace of the coverage amounts to be required. SECTION XII. RECORDS 12.1 Each franchise shall maintain the following records: a. Records of Dis an tch -Shall show time call was received, time dispatched, time arrived on scene, time arrived at destination, time in service, and time returned to base. b. Trip Record -Shall state all information required in Section (a) In addition to information on a form approved by the County. The trip record shall be so designed as to provide the patient with a copy thereof containing all required information. c. Personnel Checklist and Inspection Report - Shall list contents and description of operation for each vehicle, signed by the individual verifying vehicle operations and equipment. d. Any other records required by state law, rules or regulations or deemed by the Department of Emergency Service as relevant to the effective and efficient operations of the Emergency Management System. Page 13 of 18 18 e. All of the records identified in subsection a through d above shall be maintained for a minimum three (3) year period unless a longer retention period is otherwise required by other retention periods. f. Confidentiality of Patient Records. Each franchise shall maintain confidentiality of patient records as provided by the Health Insurance Portability and Accountability Act of 1996 (HIPPA), Public Law 104-191, N.C. Gen. Stat. 143-518 and all other state and federal law. 12.2 Each franchise shall submit a written monthly report to the Emergency Services Director, or their designee, providing the number of calls and runs during the month. The report shall contain the number of emergency calls, the number of convalescent calls, the total number of calls and the total number of patients transported. SECTION XIII. RATES AND CHARGES 13.1 Each franchisee shall submit a schedule of rates to the County for approval and shall not charge more nor less than the approved by the County rates without specific approval. 13.2 No service shall attempt to collect rates on emergency calls until the patient has reached the point of destination, has received medical attention and is in a condition deemed by the physician fit to consult with the service, but such service may attempt to collect rates with family or guardian of the patient once patient is in the process of receiving medical attention. 13.3 On convalescent calls or calls where a person requires transportation to a non- emergency facility, attempts to collect payment may be made before the ambulance begins its trip. SECTION XIV. ENFORCEMENT 14.1 The Orange County Emergency Services Director shall be the enforcing authority for the regulations contained in this Ordinance. Such Director will: a. Receive all franchise applications from potential providers. b. Review each proposal for conformity to this Ordinance; conduct an investigation of the applicant's proposal under consideration by the County. c. Recommend to the Board of Commissioners the approval/disapproval of the franchise(s). Page 14 of 18 19 d. Inspect the premises, vehicles, equipment, and personnel of franchisees to assure compliance to this Ordinance and perform any other inspection that may be required. Recommend to the Board of Commissioners the temporary or permanent suspension of a franchise in the event of noncompliance with the franchise terms of this Ordinance. Recommend the imposition of misdemeanor or civil penalties as provided therein. f. Immediately stay the operations of a franchise that performs in a manner that is unsafe or detrimental to the health, safety and welfare of the residents of Orange County or the State of North Carolina, performs procedures outside the scope of practice for EMS credentialed personnel or is not in compliance with this Ordinance or their franchise agreement. In case of such stay, the franchise may appeal the suspension as provided in Section XVI. g. Insure by cooperative agreement with other services the continued service in a district where a service franchise has been suspended. h. Receive complaints from the public, other enforcing agencies, and services regarding franchise infractions. i. Recommend improvements to the County and implement procedures which will insure better rescue, medical care and ambulance transportation service. Maintain all records required by this Ordinance and other applicable State and County regulations. SECTION XV. INSPECTIONS 15.1 The County may upon reasonable notice inspect a franchisee's records, premises, and equipment at any time in order to insure compliance with this Ordinance and any franchise granted hereunder. SECTION XVI. ORANGE COUNTY EMERGENCY MEDICAL SERVICE ADVISORY COMMITTEE 16.1 The Orange County Emergency Medical Services Advisory Committee shall be a technical committee to provide guidance and make recommendations to the Board of County Commissioners and Emergency Services Director of Orange County on matters related to emergency medical services such as, but not limited to: Page 15 of 18 20 a. Review enforcement of this Ordinance and make recommendation to the Emergency Services Director on matters relating to the enforcement of this Ordinance. b. Provide information and advice to the Emergency Services Director regarding such standards of care, policies, procedures, and actions which will maintain and improve the quality of emergency medical services for the residents of Orange County, including pre-hospital care provided by volunteer rescue./EMS Squads, county EMS services and privately owned ambulance services. c. Plan, develop and implement emergency medical care in coordination with the regional and statewide system.. 16.2 The goal of the Advisory Committee shall be to assure the provisions of a high level of quality care and service to persons in need of emergency medical services, non- emergency medical services and pre-hospital care in Orange County. 16.3 The County Emergency Medical Services Committee shall be comprised of the Emergency Services Director, Emergency Services Medical Director, the Assistant Medical Director, the Emergency Medical Services Operation Manager and the County Health Director. 16.4 Representatives from the franchised providers may attend any meetings when the Committee considers matters relating to the granting of franchises and/or reviewing complaints from the public and investigations regarding franchise services. 16.5 The Emergency Medical Services Advisory Committee shall hear appeals of stay of franchises. In case of stay of a franchise as provided in Section XIV (f): a. The Emergency Service Director, or his designee, shall provide the franchise written notice of the stay and the reasons for the stay either concurrently with issuance of the stay or if oral suspension within 5 days of notice. Notice shall be provided either orally with a certified letter to follow or by certified mail. b. The Franchisee may appeal the decision to the Emergency Services Medical Advisory Committee within 10 days of receipt of written notice. If the appeal is not heard within 10 days the stay will be dissolved pending a hearing on the appeal. c. An appeal shall be served on the County Attorney who will forward the appeal to Emergency Services Medical Committee. Page 16 of 18 21 d. The franchisee may either appeal by letter or request a hearing before the Emergency Services Medical Committee. e. The Hearing shall be scheduled within 2 days of receipt of notice of appeal and shall be commenced within 10 days. f. The Emergency Services Medical Committee shall provide a written response to the franchise within 10 days of the hearing. The Committee shall remove the stay, provide a recommendation for corrective action and set a time for completion or forward a recommendation to the Board of County Commissioners for suspension or termination of the franchise agreement. g. The Board of County Commissioners shall review the recommendation and make a decision based on the information contained in the recommendation from the County Emergency Medical Services Committee. SECTION XVII. EMERGENCY SERVICES PEER REVIEW COMMITTEE 17.1 In accordance with G.S. 131E-155, the Emergency Service Director shall provide an Emergency Medical Service Peer Review Committee composed of emergency medical service program representatives responsible for analyzing patient care data and outcome measures to evaluate the ongoing quality of patient care, system performance, and medical direction within the EMS system. 17.2 The committee shall include physicians, nurses, EMS personnel, medical facility personnel and county government staff as determined by the Emergency Services Director in consultation with the County Medical Director. 17.3 Review of medical records by the Emergency Service Peer Review Committee is confidential and protected under G.S. 143-518. An Emergency Service Peer Review Committee, its members, proceedings, records and materials produced, and materials considered shall be afforded the same protection afforded the medical Review Committees, their members, proceedings, records, and materials under G.S. 131 E-95. SECTION XVIII. EFFECTIVE DATE; REPEALER; GRANDFATHER PROVISIONS 18.1 This Ordinance shall be amended as of _ day of January, 2010. 18.2 This Ordinance took effect on the 20th day of April, 1993. An Ordinance Regulation the Operation of Ambulance Services and the Administration of Emergency Medical Assistance in Orange County, North Carolina effective May 1, 1981, is hereby repealed effective, April 20, 1993. Any person, firm, or corporation providing ambulance service, rescue service or first responder service Page 17 of 18 22 pursuant to a valid franchise issued by Orange County under the repealed March 1, 1981 Ordinance shall be entitled to continue that service as provided in the franchise and for the term of the franchise. Any such franchise may, however, be suspended, revoked, or terminated as provided in this Ordinance. The amendments to this Ordinance shall be effective on January _, 2010 Valerie P. Foushee, Chair Orange County Board of Commissioners ATTEST: DATE: Donna Baker, Clerk to the Orange County Board of Commissioners Page 18 of 18