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HomeMy WebLinkAboutAgenda 04-05-22; 8-i - First Reading - Emergency Services Franchise by Ordinance – LifeStar Emergency Services - 2023, LLC 1 ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: April 5, 2022 Action Agenda Item No. 8-i SUBJECT: First Reading: Emergency Services Franchise by Ordinance — LifeStar Emergency Services - 2023, LLC DEPARTMENT: Emergency Services ATTACHMENT(S): INFORMATION CONTACT: • LifeStar Franchise Agreement Kirby Saunders, Emergency Services Director, (919) 245-6100 Kim Woodward, Emergency Medical Services EMS Division Chief, (919) 245-6133 PURPOSE: To approve, on First Reading, granting the renewal of a franchise agreement by ordinance to LifeStar Emergency Services - 2023, LLC (LifeStar) to provide routine convalescent transport services and surge capacity emergency services for basic life support (BLS) transportation. Approval on "first reading" is based on State law requiring that a franchise by ordinance pass two readings in order to be granted by the Board of Commissioners. BACKGROUND: On February 2, 2010, the Board of Commissioners held a Public Hearing to determine the need for supplemental ambulance services in accordance with N.C. Gen. Stat. § 153A-250(a). At that time, the Board made the determination that franchise ambulance services were necessary to assure the provision of adequate and continuing ambulance service. State law requires that the Board of County Commissioners grant franchise agreements through County ordinance. This ordinance is required to pass two readings in order to be granted. Orange County has historically granted franchise agreements for convalescent transport and emergency ambulance services and for rescue service. The convalescent transport ambulance services franchises are only used to provide non-emergency convalescent transport to medical facilities typically for the care and treatment of a resident's long term health needs. Franchisees may also provide surge capacity in a basic life support capacity during a widespread emergency that stresses the capacity of Orange County Emergency Medical Services. Orange County Emergency Services provides all other emergency response services for basic and advanced life support needs in the County. Emergency Services has reviewed the overall Emergency Services System in the County to confirm that franchise services continue to be necessary to assure the provision of adequate and continuing ambulance services and to preserve, protect, and promote the public health, safety and welfare. 2 The Department has identified the following services as necessary to supplement and enhance the ambulance services within the Emergency Services System and to the residents of the Orange County. The services are: Convalescent Transport Services Rescue Services • ALS Transport • Confined Space • BLS Transport • Extrication Emergency Services • Heavy Rescue • BLS Transport • High/Low Angle • Medical Responder Non-transport • Swift Water • EMT Non-transport • Trench Collapse • Underwater • Wilderness Search&Rescue LifeStar has applied for Orange County Franchise renewal under the 2010 Franchise Ordinance. The application indicates LifeStar is applying to provide the following services: • Convalescent Transport Services, BLS Transport • Emergency Services, BLS Transport LifeStar is headquartered in Winston Salem, North Carolina, has been in service in the Forsyth County EMS System since 2009 and has expanded into five additional counties including Orange County. LifeStar provides approximately 18,000 Basic Life Support (BLS) transports annually. LifeStar has over 85 employees and a fleet of 31 vehicles. They have shown themselves to be responsive, prompt, and courteous. LifeStar has been in operation in Orange County since 2017. Emergency Services has reviewed the renewal application, in conjunction with NC State Office of Emergency Medical Services, submitted by LifeStar and inspected the premises, vehicles, equipment, and personnel of the company to assure compliance with the ordinance. The North Carolina General Statutes provide also that the Board, prior to granting a franchise, must "find that the franchise applicant is in compliance with Chapter 131E, Article 7."' Emergency Services has concluded that the company is in compliance with Chapter 131E, Article 7 that regulates emergency services permits to operate ambulances, standards for equipment, inspection of equipment and credentialed personnel. Staff is recommending that LifeStar be granted a Franchise to operate within the confines of the attached Franchise Ordinance. The terms of this Franchise Ordinance provides for a five-year franchise for the following: Convalescent Transport Services • Basic Life Support Transport Services Emergency Services • BLS Transport Services The terms outlined in the Franchise Agreement have been negotiated and are consistent with the terms of An Ordinance Regulating Emergency Medical, First Responder and Rescue ' N.C. Gen. Stat. 153A-250(a). 3 Service and Granting of Franchise and Contracts to the Operators In the County of Orange and its' amendments. FINANCIAL IMPACT: LifeStar is a private provider of ambulance services and maintains an independent budget. There is no financial impact on the County. SOCIAL JUSTICE IMPACT: The following Orange County Social Justice Goal is applicable to this item: • GOAL: CREATE A SAFE COMMUNITY The reduction of risks from vehicle/traffic accidents, childhood and senior injuries, gang activity, substance abuse and domestic violence. While the purpose of providing a franchise for ambulance service is not necessary to produce cost savings, the long term benefits of having the franchise is to improve ambulance service to the entire community and to allow better use of existing resources. ENVIRONMENTAL IMPACT: There is no Orange County Environmental Responsibility Goal impact associated with this item. RECOMMENDATION(S): The Manager recommends that the Board: 1. On first reading grant the renewal of a franchise for a five year term to LifeStar Emergency Services - 2023, LLC for Basic Life Support Convalescent Transport Services and Emergency Services. a. Convalescent Transport Services • Basic Life Support Transport Services b. Emergency Services • Basic Life Support Transport Services 2. Approve the Franchise Agreement under which LifeStar Emergency Services - 2023, LLC will operate during the five-year period of franchise. As a condition of granting the Franchise, LifeStar must enter into an Operations Agreement with Orange County within 90 days of granting the franchise which provides for the daily operational functions within the Orange County Emergency Services System; and 3. Direct staff to bring back the Franchise Agreement for second reading approval at the Board's April 26, 2022 Business meeting. 4 ORD-2022-008 LifeStar Emergency Services—2023,LLC d/b/a LifeStar Emergency Services Franchise Ordinance An Ordinance granting a non-exclusive Franchise ("hereafter Franchise") to LifeStar Emergency Services — 2023, LLC d/b/a LifeStar Emergency Services ("the Grantee") to operate Emergency Medical Basic Life Support Transportation Services and Convalescence Basic Life Support Transportation Services in Orange County, North Carolina. WHEREAS, Orange County ("the Grantor"), desires to assure the availability of Emergency Medical and Convalescent Basic Life Support Transportation Services within the County; WHEREAS, the Grantor has, following reasonable notice, and after consideration, analysis and deliberation conducted public proceedings, during which proceedings the technical ability, financial condition, legal qualifications and general character of the Grantee were determined to be acceptable to receive a Franchise to conduct its Emergency Medical and Convalescence Basic Life Support Transportation Services; WHEREAS, the Grantor has determined that Grantee is entitled to have a non- exclusive Franchise granted, that a need exists for the Emergency Medical and Convalescent Basic Life Support Transportation Services contemplated herein to improve the level of services available to residents of Orange County, helping to assure the provisions of adequate and continuing services which preserves, protects, and promotes the public health safety and welfare, and that granting a Franchise to the Grantee is a cost effective and reasonable manner of meeting the need; WHEREAS, the Grantee desires to operate Emergency Medical and Convalescent Basic Life Support Transportation Services within the Grantor's jurisdiction; WHEREAS, the proposed Emergency Medical and convalescent Basic Life Support Transportation Services will fit within the existing services provided by the Orange County Emergency Services System so as not to adversely affect the level of services or operations of other Franchisees to render service; and WHEREAS, the procedures of N.C. Gen. Stat. §153A-250, §153A-45, and §153A-46 have been complied with. NOW THEREFORE, the parties agree as follows: Section 1. Nature and Term of Grant a. The Grantor hereby grants the Grantee a non-exclusive Franchise to operate and maintain Emergency Medical and Convalescent Basic Life Support 5 Transportation Services (be an EMS and Convalescent Services provider) in the Franchise District upon the terms and conditions set forth herein. b. The Franchise granted herein is for a term of five (5) years from the effective date of the Franchise, which shall begin on the first day following the date of acceptance by the Grantee of the Franchise terms and conditions set forth herein. Section 2. Definitions The following words, terms and phrases, when used in this Franchise, shall have the meanings ascribed to them in this Section, except where the context clearly indicates a different meaning: a. 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. b. 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. C. Approved. The term "approved" shall mean approved by the North Carolina Medical Care Commission pursuant to the latter's rules and regulations promulgated under N. C. Gen. Stat. §143B-165. d. Advisory Committee or Committee. The term "Advisory Committee" or "Committee" shall mean the Orange County Emergency Medical Services Committee which is the technical advisory committee designated by the Board of County Commissioners with respect to emergency medical services in Orange County. C. Contract. The term "contract" shall mean the instrument by which both parties agree to the terms of operation of the service to be provided. f. 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. g. County. The term "County" shall mean Orange County and its Board of Commissioners or their designated representative(s). LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 2 of 22 Rev. 6 h. Emergency. The term "emergency" or "emergency transportation services" shall mean the use of a service, its equipment and personnel to provide medical care, rescue, and/or transportation of a patient who is in need of immediate rescue or medical treatment in order to prevent loss of life or further aggravation of physiological or psychological illness or injury. i. Emergency Services System or ESS. Emergency Services System or "ESS" 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. j. 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. k. Emergency Medical Services. "Emergency Medical Services" or "EMS" 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. 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. M. 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 LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 3 of 22 Rev. 7 facility personnel and county government staff as determined by the Emergency Services Director in consultation with the County Medical Director. n. 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. o. Emergency Medical Technician — Intermediate (EMT-1). 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. P. Emergency Medical Technician — Paramedic (EMT-P). 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 an EMT-Paramedic by the State of North Carolina Office of Emergency Medical Services, and approved by the County Medical Director to perform services as an EMT-Paramedic in the Orange County EMS system. q. Emergency Services Director. The term shall mean the person designated by the Orange County Board of Commissioners to manage the overall Emergency Services System in Orange County. r. 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. LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 4 of 22 Rev. 8 s. 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. t. 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. u. Inspection. Inspection shall mean the physical review of buildings and facilities, vehicles, equipment, supplies, storage, repair and maintenance areas, records and any related materials. v. 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. w. 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. x. 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 10A NCAC 13P .0403 and 10A NCAC 13P .0404. The County may, in addition, appoint an 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 N.C. Gen. Stat. §15013-21.6, including subsequent amendments and editions. y. 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. z. 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. aa. 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. bb. Owner. The term "owner" shall man any person or entity who owns an ambulance or provides a service covered by this Ordinance. LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 5 of 22 Rev. 9 cc. 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. dd. 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. ee. 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. ff. Rescue. The term "rescue" shall mean the removal of individuals facing external, non-medical, and non-patient related peril to areas of relative safety. gg. 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. hh. 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. ii. Service. The term"service" shall mean the same as owner. jj. 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. kk. 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. LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 6 of 22 Rev. 10 Section 4. General Responsibilities a. Grantee is authorized under this Franchise to operate the following types of service(s), the combination of which shall constitute Grantee's "EMS Services for the purposes of this Franchise, and subcategories under which they can operate shall be identified in the "Operation Agreement" to be entered into by the Franchisee and the County within 90 days after acceptance of the Franchise permit. i. Emergency Services Basic Life Support Transport Services ii. Convalescent Basic Life Support Transport Services C. Grantee shall comply at all times with the requirements of "An Ordinance Regulating Ambulance, Emergency Medical, First Responder And Rescue Service And Granting Of Franchise And Contracts To The Operator In The County Of Orange ("EMS Franchise Ordinance"), this Franchise Agreements, the Operations Agreement, and all applicable laws relating to health, sanitation, safety, equipment, ambulance design or other EMS Services vehicle design and all legal requirements related to a Model EMS System and all other laws and ordinance; a. Grantee shall maintain in good standing its state and local Drivers and Privilege license (s) to operate its ambulance or other EMS Services as provided for by Law. b. Establish and maintain appropriate and effective professional working relationships with all public health, public safety, and emergency services organization and personnel. c. Professional working relationships shall be cooperative and collaborative in nature. d. Maintain neat, clean, and professional appearance of personnel, equipment and facilities. Section 5. Scope of Service and Service Area a. Grantee shall operate its EMS Services, 24 hours per each and every day of the calendar year, within the Franchise District specified in Exhibit A, except when a different or additional service area is provided for herein. b. Grantor may from time to time alter, and at its sole discretion, amend Exhibit A and the service area of the County that constitute (s) the Franchise District. LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 7 of 22 Rev. 11 C. Grantor shall at all times during the terms of the Franchise provide the highest level of care to all residents within the service area of the Franchise District. Section 6. The Orange County Emergency Services System("ESS") Plan a. Grantee shall comply with the Grantor's official written ESS System Plan for the management and deployment of EMS Services Vehicles within the Franchise District and, additionally, within other service areas pursuant to the EMS System Mutual Aid Plan and any cooperative agreement to continue services in service areas where Franchisees' EMS System franchises has been suspended. b. Grantee shall keep at its place a business at all times the most current copy of the ESS System Plan. Section 7. Staffing and Performance Requirements a. Grantee shall comply with the scope of practice rules promulgated by the North Carolina Medical Board pursuant to law regarding the medical skills and medication that may be used by credentialed emergency medical services personnel at each level of patient care. b. Grantee shall comply with standard for drivers and attendants developed by the North Carolina Medical Care Commission as requirements for certification of emergency medical technicians pursuant to law, rules and regulations promulgated by the Board of Medical Examiners for advanced life support technicians, which is incorporated in this subsection by reference. C. No staff of Grantee shall drive an ambulance vehicle, attend a patient, or permit an ambulance to be operated when transporting a patient within the County unless the driver holds a currently valid North Carolina Drivers license and currently valid credentials as an EMT, EMT-I or EMT-P issued by the North Carolina Department of Health and Human Services, Office of Emergency Medical Services. Notwithstanding the foregoing, in an exceptional circumstance when an EMT, EMT-I, or EMT-P is not available, for the purpose of driving only or when providing Non- Transport Service an approved firefighter, First or Medical Responder, Rescue Services Provider or law enforcement officer with a currently valid North Carolina drivers license may drive an ambulance, provided such driver does not attend a patient or victim or does not otherwise provide medical services to a patient or victim. d. Grantee shall comply with the Grantor's official written EMS System Plan for the use of credentialed EMS personnel for all of the authorized LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 8 of 22 Rev. 12 Practice Settings. Any agreement between Grantee and a third party to provide special events coverage is subject to pre-approval in writing by the Grantor, which approval shall not be reasonable withheld. e. Grantee's staff that operate EMS Service Vehicles shall actively participate in any emergency vehicle operations training provided by the Grantor as directed by the Emergency Services Director. f. Grantee's staff shall comply with Grantor's official written EMS System continuing education plan for EMS personnel under the direction of the Orange County Continuing Education Coordinator. g. Grantee staff shall also participate in all clinical and field internship educational components of Grantor's continuing education plan. h. Grantee shall comply with all education program requirements for qualified credentialed EMS personnel as provided by law. i. Grantee shall assign credentialed staff to assist, upon request, with any orientation provided by Grantor to local area hospitals that routinely receive patients from Grantee. Section 8. Vehicle and Equipment Requirements a. Grantee shall comply with all vehicle and equipment standards as developed by the North Carolina Medical Care Commission pursuant to law, including without limitation, those applicable to the EMS Services. b. Grantee shall maintain for each ambulance and other EMS Services Vehicle a permit as provided for by law. C. Grantee shall comply with the state EMS Non-Transporting Vehicle Permit requirements. d. Grantee shall have available the following minimum number of ambulances and other EMS Services Vehicles in excellent working order to provide coverage to the service area of the Franchise District 24 hours per day. One (1) Type 1 Ambulance, One (1) In Service Rescue Vehicles and other EMS Services Vehicles and equipment as necessary to provide the high quality of services provided for in this Franchise. e. Grantee shall comply with the Grantor's operational protocols for the management of equipment, supplies and medications to assure that each ambulance and other EMS Services Vehicle contains the required LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 9 of 22 Rev. 13 equipment and supplies on each response; for cleaning and maintaining the equipment and vehicles; and to assure that supplies and medications are not used beyond the expiration date and stored in a temperature controlled atmosphere according to manufacturer's specifications. f. Grantee shall comply with the Orange County's written infection control policy including the cleansing and disinfecting of ambulances and other EMS Services Vehicles and equipment that are used to treat or transport patients. g. Grantor may, upon reasonable notice, inspect all equipment, ambulances and other EMS Service Vehicles used by Grantee. Section 9. Communications Requirement a. Grantee shall equip each ambulance and other EMS Services Vehicle with the following: i. An operational two-way radio capable of establishing good quality voice communications from with the geographical confines of Orange County to each hospital emergency department in the County in which the service is based; ii. Two-way radio communication capabilities for communication with all hospital emergency departments to which transportation of patients is made on a regular or routine basis anywhere within the State of North Carolina; and iii. An operational two-way radio capable of establishing communications from within the geographic confines of Orange County to the Orange County Emergency Communications Center, which is the dispatching agency within the County. b. This subsection shall not apply to privately owned vehicles of Grantee's staff. C. Grantee shall maintain current authorization or Federal Communication Commission licenses for all frequencies and radio transmitters operated by Grantee. Grantee shall display at Grantee's headquarters and make available for inspection per Federal Communication Commission's rules and regulations copies of all authorization and licenses. d. Grantee's base of operations shall have at least one open telephone 24 hours per each and every day of the calendar year. Grantee's telephone numbers shall be registered with Orange County Emergency Communication Center, and changes to Grantee's telephone numbers shall LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 10 of 22 Rev. 14 be transmitted to the Emergency Communication Center within 24 hours of such change. e. Grantee's EMS Services shall be dispatched from the Orange County Emergency Communications Center. Section 10. Data Collection and Performance Report a. Grantee shall maintain the following records: i. Records of dispatch which shall show time call was received, time dispatched, time arrived on scene, time arrived at destination, time in service, and time returned to base. ii. Trip Records stating all information required in subsection (i) of this Section 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 containing all required information. iii. Personnel Checklist and Inspection Report listing contents and description for each vehicle, signed by the individual verifying vehicle operations and equipment. iv. A detailed record of complaints received from the public, other enforcing agencies and services regarding Franchise infractions. V. 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 as provided in the "Operations Agreement" and necessary for a fair determination of the capability of the Grantee to continue to provide Emergency Medical Services and Rescue Services in Orange County in accordance with the requirement of law and the provision of this Franchise. b. All of the records identified in subsection (a) above shall be maintained for a minimum three (3) year period unless a longer retention period is otherwise required by law or other retention periods. C. Grantee shall establish and maintain a system to record data that used the Model Data set and data dictionary as specified in "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection." d. Grantees shall maintain confidentiality of patient records as provided by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 11 of 22 Rev. 15 Public Law 104-191, N.C. Gen. Stat. 143-518 and all other state and federal law. e. Grantee 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. f. Grantee may inspect Grantee's records at any time in order to ensure compliance with the EMS Franchise Ordinance and this Franchise Agreement; however, Grantor's shall inspect the Grantee's records at least once a year to ensure compliance with the EMS Franchise Ordinance and this Franchise Agreement. Section 11. Medical Oversight a. Grantee shall designate a representative of Grantee to attend and participate in regular meetings of the Orange County EMS Peer Review Committee. b. Grantee shall monitor and comply with any online medical direction for operating within EMT-P systems. C. Grantee shall comply with the Grantor's plan for Medical Oversight and Written Treatment Protocols. d. Grantee shall comply with the Grantor's written plan to address the management of the EMS System including: i. the triage of patients to appropriate facilities; ii. transport of patients to facilities outside of the system; iii. Arrangement for transporting patients to appropriate facilities when diversion or bypass plans are activated; iv. A mechanism for reporting, monitoring and establishing standards for system response times; V. A special events staffing plan; vi. A disaster plan; and vii. Mass gathering plan. LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 12 of 22 Rev. 16 e. Grantee shall comply with the Medical Director's written guidance regarding decision about the equipment, medical supplies, and medications that will be carried on any ambulance or other EMS Services Vehicle. f. The Medical Director may suspend temporarily, pending due process review by the EMS Peer Review Committee, any of Grantee's EMS personnel from further participation in the EMS system when the Medical Director determines that the activities or medical care rendered by such personnel may be detrimental to the care of the patient, constitute unprofessional behavior or results in non-compliance with credentialing requirements. Section 12. Rates and Adjustments a. Grantee shall submit a schedule of rates to the Grantor for approval and shall not charge more or less than the rates authorized by Orange County without specific authorization from the Grantor. b. Grantee shall not attempt to collect rates on emergency call 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 Grantee may attempt to collect rates with family or guardian of the patient once the patient is in the process of receiving medical attention. C. On Special Event coverage and convalescent calls, Grantee may attempt to collect payment before the ambulance or other EMS Services Vehicle begins its trip. Section 13. Insurance a. Within thirty (30) calendar days after the effective date of issuance of the Franchise, the Grantee shall provide proof of the required insurance. Grantee shall at all times during the Franchise term maintain in force and effect insurance coverage, issued by an insurance company licensed to do business in North Carolina, covering the following: i. Every ambulance or other EMS Services Vehicle owned and/or operated by or for the Grantee proving for the following payment of injury and damages: (a) In the minimum sum of$1,000,000 for injury to or death of individuals in accidents resulting from any cause for which the owner of the vehicle would be liable on account of LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 13 of 22 Rev. 17 liability imposed on him by law, regardless of whether the vehicle was being driven by the owner of his agent; and (b) In the minimum sum of$1,000,000 for the loss of or damage to the property of another, including personal property, or under like circumstances in sums as may be required by the State of North Carolina or as authorized by the Grantor. (c) The insurance coverage minimum limits required in subsection (a) and (b) above shall be evaluated annually by the Orange County Department of Emergency Services in consultation with the Orange County Risk Manager and the County Attorney's Office and may be revised by the Grantor as Grantor deems appropriate, and at Grantor's sole discretion. In directing a change in insurance coverage, the Department of Emergency Services shall consider the risk needs protected by this insurance coverage and the availability in the marketplace of the coverage amounts to be required. ii. Grantee shall at all times during the Franchise term maintain in force and effect insurance coverage, issued by an insurance company licensed to do business in North Carolina for Worker's Compensation coverage for all employees with statutory limits in compliance with applicable law. b. Insurance coverage necessary to comply with this Section shall be approved by the Grantor, and copies of such insurance policies (or certificates of insurance) shall be provided to the Grantor. C. The Grantor shall be named as an additional insured as its interests may appear. Section 14. Transfer of Ownership or Control and Changes in Level of Services a. Prior approval of the Grantor shall be required where ownership or control of more than ten percent of the right or control of the Grantee is acquired by a person or group of persons acting in convert, not of whom own or control ten percent or more of such rights of control, singularly or collectively, at the date of the grant of the Franchise. By its acceptance of the Franchise, the Grantee specifically agrees that any such acquisition occurring without prior approval of the Grantor shall constitute a violation of the Franchise by the grantee and shall be cause for termination at the option of the Grantor. LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 14 of 22 Rev. 18 b. Any change in ownership of Grantee without the approval of the Grantor shall terminate the Franchise and shall require a new application and a new Franchise in conformance with all the requirements of the EMS Franchise Ordinance, as amended and in effect at the time of franchising. C. Any change in the level of services offered by a Grantee's EMS Services unit without the approval of the Grantor shall terminate the Franchise and shall require a new application and a new franchise in conformance with all the requirements of the EMS Franchise Ordinance, as amended and in effect at the time of franchising. d. Grantee may not sell, assign, mortgage or otherwise the transfer the Franchise without the approval of the Grantor; if the Grantor sells, assigns, mortgages or otherwise transfer the Franchise without Grantor's approval this shall terminate the Franchise and require a new application and a new Franchise in conformance with all the requirements of the EMS Franchise Ordinance, as amended and in effect at the time of franchising. Section 15. Miscellaneous Provisions a. Grantor may, upon reasonable notice, inspect the premises, vehicles, equipment and personnel of Grantee to ensure compliance with this Franchise and perform any other inspections that may be required. b. Grantee shall make available for inspection by the State of North Carolina, the Grantor, or their designated representatives, Grantee's EMS Services, its equipment and the premises designated in the application and all records relating to its maintenance and operations as such. C. Grantee shall cooperate with the Grantor to educate the public concerning injury prevention and community health. d. Grantee's staff shall not wear or carry aboard any ambulance of other EMS Services Vehicles firearms or weapons as defined by law, which does not include tools that aid in providing services. The foregoing restriction shall not be construed to apply to equipment used by Grantee to provide EMS Services. e. Grantee shall post its Franchise Certificate, issued to it by the Grantor, in a readily visible location at the Grantee's base of operations for the EMS Service. f. Grantee shall not allow its Franchise Certificate to be defaced, removed, or obliterated. LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 15 of 22 Rev. 19 g. Grantee shall comply with all applicable law and Grantor's policies and procedures related to confidentiality of medical information, including without limitation the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Section 16. Termination Provisions a. Grantee may terminate this Franchise with 60 days written notice to Grantor and the Grantor may revoke the Franchise in the event of noncompliance with the provisions of the EMS Ordinance or this Franchise Agreement. After a notice of services termination is given, the Grantee may reapply for a franchise if a continued service is desired. b. Upon suspension, revocation, termination or a stay by the Emergency Services Director of this Franchise, Grantee shall immediately cease all operations authorized by this Franchise. C. Upon suspension, revocation, termination of a driver's license such person shall cease to dive an ambulance or other EMS Service Vehicle. Upon suspension, revocation or termination of an attendant's certificate (i.e., Medical Responder, EMT, EMT-I or EMT-P) by the Office of Emergency Medical Services or by the Medical Director, such person shall cease to attend patients or otherwise provide medical care. Grantee shall not permit the foregoing person to drive an ambulance or their EMS Service Vehicle or provide medical care in conjunction with EMS Services, if Grantee is found to have notice of or should have had notice of such suspension, revocation or termination at the sole discretion of the Grantor this shall terminate the Franchise and shall require a new application and a new Franchise in conformance with all the requirements of the EMS Franchise Ordinance, as amended and in effect at the time of franchising. d. In the event that Grantee shall at any time during the Franchise desire to sell any of the real or personal property identified in Exhibit B (hereinafter "Asset" or "Assets"), which is hereby incorporated by reference, pursuant to a bona fide offer to a bona fide offer which it shall have received, it shall offer to sell any such Asset or Assets (hereafter "Asset or Assets for Sale) to Grantor at the same process as that contained in such bona fide offer. The offer to Grantor to sell an Asset shall be in writing and shall include a copy of the bona fide offer. The offer to Grantor to ell an Asset shall be in writing and shall include a copy of the bona fide offer for the Asset received by the Grantee. Grantor shall have 60 days from and after receipt thereof to decide whether or not to purchase the Asset or Assets for Sale at such prove. If Grantor shall give notice of intent not to purchase or shall give no notice within the time herein limited, Grantee may accept such offer and proceed with the sale thereunder. If Grantor notifies Grantee that it elects to purchase the Asset or Assets for Sale at such LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 16 of 22 Rev. 20 prove, the parties shall enter into a contract of purchase and sale forthwith. Such contract shall provide, among other things, for the conveyance of good and marketable title b warranty deed. Upon dissolution of the Grantee pursuant to N.C. Gen. Stat. § 55A-14-1, et seq., the Assets shall be either: (a) distributed to one or more appropriately receiving successor Franchisee (s) that will carry on, In Orange County, the functions of ambulance, first or medical responder, rescue or other related emergency services meeting one or more exempt purposes within the meaning of 501(c)(3) of the Internal Revenue code (or the corresponding section of any future federal tax code) or (b) distributed to the grantor for the foregoing public purposes. This subsection 16(d) of this EMS Service Franchise survives the termination of the Franchise. Section 17. Forum for Litigation Any litigation between the Grantor and Grantee arising under or regarding the Franchise shall occur, if in the North Carolina courts, in Orange County Superior Court or District Court having jurisdiction thereof, or if in the federal courts, in the United States District Court for the Middle District of North Carolina. Section 18. Notice Any notice provided for under the Franchise shall be sufficient if in writing and delivered personally to the following address or deposited in the United States Mail, postage prepaid, certified mail, return receipt requested, addressed as follows, or to such other address as the receiving party hereafter shall specify in writing: If to the Grantor: Orange County Emergency Services Post Office Box 8181 Hillsborough,North Carolina 27278 Attn: Emergency Services Director (919) 245-6100 If to the Grantee: LifeStar Emergency Services—2023,LLC d/b/a LifeStar Emergency Services 3475 Myer Lee Drive Winston Salem,North Carolina 27101 Attn: Michel Lee Hoots (336) 722-5433 Section 19. Severability LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 17 of 22 Rev. 21 If any section, subsection, sentence, clause, phrase, or other portion of this Franchise is, for any reason, declared invalid, in whole or in part, by any court, agency, commission, legislative body, or other authority of competent jurisdiction, such portion shall be deemed a separate, distinct and independent portion. Such declaration shall not affect the validity of the remaining portions hereof, which other portions shall continue in full force and effect. Section 20. Reservation of Rights Notwithstanding any other provision of the Franchise, Grantor and Grantee reserve all rights that they may possess under the law unless expressly waived herein. Nothing herein shall constitute a waiver of rights of either parry, provided, however, that both parties warrant and represent that, as of the effective date of the Franchise, they are not aware of any provision in the Franchise that is contrary to applicable law. Section 21. Penalties and Remedies a. A violation of any provision of this Franchise Ordinance or other failure of the Grantee to abide by the provisions of this Franchise shall subject the Grantee to a civil penalty of five hundred ($500) dollars. If Grantee fails to pay this penalty within ten (10) days after being cited for a violation, the Grantor may seek to recover the penalty by filing a civil action in the nature of a debt. b. A violation of any provision of this Franchise Ordinance by the Grantee shall constitute a misdemeanor, punishable as provided in N.C. Gen. Stat. § 14-4. C. The Grantor may seek to enforce this Franchise Ordinance through any appropriate equitable action. d. Each day that a violation continues of this Franchise Ordinance after the Grantee has been notified of the violation shall constitute a separate offense. e. The Grantor may seek to enforce this Franchise Ordinance by using any one or any combination of the foregoing remedies. Section 22. Non-discrimination The Grantee shall at all times remain in compliance with all applicable local, state, and federal laws, rules and regulations including but not limited to all state and federal non- discrimination laws, policies, rules, and regulations and the Orange County Non- Discrimination Policy and Orange County Living Wage Policy (each policy is incorporated herein by reference and may be viewed at http://www.oran ec�ounl nc. ova/departments/purchasing division/contracts.php.) Any LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 18 of 22 Rev. 22 violation of the Orange County Non-Discrimination Policy is a violation of this Franchise and Grantor may immediately terminate this Franchise without further obligation on the part of the Grantor. This paragraph is not intended to limit and does not limit the definition of violation to discrimination. Section 23. Acceptance by Grantee This Franchise and all of its terms and provisions shall be accepted by Grantee in writing in the form hereinafter set forth within thirty (30) days of the grant of this Franchise by the Grantor and when accepted shall be filed with Grantor's Clerk who shall record the same in the Book of Ordinances. Such written acceptance may be upon or at the end of a copy of this Franchise Ordinance and it shall state and express the acceptance of said Franchise and its terms, conditions and provisions; and Grantee shall agree in said written acceptance to abide by, to observe and to perform the same according to all of its terms and provisions, subject to applicable state and federal law and shall declare that statements and recitals contained on said Franchise are correct and that it has made and does make the agreements and statements set forth in this Franchise. Acceptance herein referred to shall be in the following form: The undersigned, Michael Lee Hoots, in his/her capacity as Director of the LifeStar Emergency Services — 2023, LLC d/b/a LifeStar Emergency Services and on behalf of that agency, does hereby accept and approve the foregoing and attached Franchise and all of its terms and conditions; and in consideration of the benefits and privileges granted to it does hereby agree to abide by, carry out, observe and perform all of the obligations and things provided to be carried out and performed by it in said Franchise approved by the Grantor Commissioners, subject to applicable state and federal law. This the 26th day of April, 2022 IN WITNESS WHEREOF, this LifeStar Emergency Services Franchise Ordinance passed on First Reading on the 5th day of April, 2022 and was passed and adopted on Second Reading this the 26th day of April, 2022. Renee Price, Chair Orange County Board of Commissioners ATTEST: Laura Jenson, Clerk/Deputy Clerk to the Orange County Board of Commissioners LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 19 of 22 Rev. 23 ACCEPTANCE FOR GRANTEE: The undersigned, Michael Lee Hoots, in his/her capacity as Director of the LifeStar Emergency Services — 2023, LLC d/b/a LifeStar Emergency Services and on behalf of that agency, does hereby accept and approve the foregoing and attached Franchise and all of its terms and conditions; and in consideration of the benefits and privileges granted to it does hereby agree to abide by, carry out, observe and perform all of the obligations and things provided to be carried out and performed by it in said Franchise approved by the Grantor Commissioners, subject to applicable state and federal law. Michael Lee Hoots, Director LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services STATE OF NORTH CAROLINA ) COUNTY OF ) On the day of , 20 before me a Notary Public for the County and State aforesaid, personally appeared before me on behalf of said agency, acknowledges the signing and execution of the foregoing instrument. IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed by notarial seal on the day and year above written. Notary Public My Commission Expires: LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 20 of 22 Rev. 24 EXHIBIT A TO EMS SERVICES FRANCHISE FOR LIFESTAR EMERGENCY SERVICES—2023 D/B/A LIFESTAR EMERGENCY SERVICES FRANCHISE DISTRICT Geographic Location: All of the County of Orange LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 21 of 22 Rev. 25 EXHIBIT B TO EMS SERVICES FRANCHISE FOR LIFESTAR EMERGENCY SERVICES—2023 D/B/A LIFESTAR EMERGENCY SERVICES (Note: Replace with Completed Exhibit B) LifeStar Emergency Services—2023, LLC d/b/a LifeStar Emergency Services EMS Franchise Agreement Page 22 of 22 Rev.