It is the purpose of this article to:
(1) 
Establish a regulated ambulance service system which can provide clinical quality of care, with reasonable, reliable response time standards, and with the goal of furnishing the best possible chance of survival, without disability or preventable complication, to each ambulance patient.
(2) 
Establish a sole-provider ambulance system, because it is unreasonable to have unnecessarily high rates to make needed improvements to ambulance service in the service area, when a more efficiently designed system can achieve the same results at lower cost. The most efficient design to achieve the goals of high-quality service, at the lowest cost, consistent with the quality of care required, is the implementation of the system described herein.
(3) 
Provide a method to develop specific performance standards, adequate review, and either continuation of service or an appropriate procedure to obtain alternate proposals from other providers.
(4) 
To provide more effective medical oversight by recognizing a multi-jurisdictional medical control board of licensed physicians expert in emergency medicine and related specialties as the entity empowered hereunder to oversee and regulate all clinical aspects of the emergency medical system which affect patient care within this jurisdiction.
(Ordinance 2001-06-01, art. 1, adopted 6/21/01)
The following words and phrases, as used in this article, shall have the following meanings:
Administrator.
That unit of local government designated in the interlocal agreement which has accepted responsibility for providing administrative and clerical services necessary to the orderly issuance, renewal, suspension, revocation, or restriction of licenses, certifications and permits pursuant to authorization by the medical control board, which licenses, certifications, and permits shall be accepted as valid throughout the regulated service area, including this jurisdiction.
Advanced life support ambulance.
Any vehicle which is equipped to provide treatment of life-threatening emergencies through the use of advanced airway management, intravenous therapy, and other advanced pre-hospital care procedures, and which is equipped to transport sick or injured persons to or from health care facilities.
Ambulance.
Any privately or publicly owned motor vehicle or helicopter that is specially designed or constructed and equipped and is intended to be used for and is maintained or operated for the transportation of patients.
Ambulance patient or patient.
Any person being transported in a reclining position within the regulated service area to or from a health care facility except when the transportation originates outside the regulated service area.
Ambulance service contractor.
That entity which is then currently under contract to provide all ambulance and ambulance patient services within this jurisdiction and throughout the regulated service area, except those services specifically exempted by section 7.02.003 of this article.
Approved emergency room/department.
A health care facility which possesses a Level 4 or higher trauma categorization as defined by the department of state health services.
Approved user fee.
Those membership fees, mileage charges, subsidy payments, if any, and total average bill (exclusive of mileage charges) approved for this jurisdiction by the city council from the uniform schedule of price/subsidy options.
Base station physician.
A physician licensed to practice medicine in the state and certified by the medical control board as knowledgeable of the pre-hospital emergency medical protocols, EMS radio procedures and the general operating policies of the ambulance service contractor, and from whom ambulance personnel may take medical direction by radio or other remote communications device.
City council.
That group of officials elected to govern the affairs of this city.
Contract service area.
The geographic area encompassing the regulated service area plus unincorporated areas of Collin County and such counties as may choose to contract with the ambulance service contractor pursuant to a contract incorporating clinical standards required hereunder, and incorporating financial provisions with those contained in the contract with the ambulance service contractor.
Emergency medical technician (EMT).
An individual who is a “specially skilled emergency medical technician” under chapter 773, Texas Health and Safety Code, or its successor.
EMS system.
That network of individuals, organizations, facilities and equipment including, but not limited to, East Texas Medical Center Emergency Medical Service, whose participation is required to generate a clinically appropriate, pre-planned system-wide response to each request for pre-hospital care and/or interfacility transport, so as to provide each patient the best possible chance of survival without disability, given available financial resources.
Extraordinary adjustment.
That adjustment justified on the basis of either an increase in the system standard of care whose cost of implementation and ongoing compliance exceeds the then-remaining balance of the “upgrade reserve,” or on the basis of an unusual increase in the cost of a factor of production when such increase in cost is industry-wide and the result of causes beyond the ambulance service contractor’s reasonable control.
First response, first responder, first response organization.
That service and those units (e.g., fire department, first responders) which provide initial stabilization and trained assistance on-scene and, when required, en route to medical facilities, as well as certain extrication and rescue services. In accordance with priority dispatch protocols, a response unit is routinely sent to all presumptively classified life-threatening calls within the ETMC-EMS service area.
Helicopter rescue unit.
Any rotary wing aircraft providing basic or advanced life support services and patient transportation originating from the scene of emergency incidents which occur within the contract service area.
Interlocal agreement.
That certain agreement between the cities of Lavon, Lucas, Murphy, Parker, Sachse, St, Paul, Wylie and such other cities which shall participate in the Southeast Collin County EMS Coalition for EMS services, adopted effective __________, 2001, pursuant to section 791.001 et seq. of the Texas Government Code annotated and known as the Interlocal Cooperation Act, and called herein interlocal agreement.
Master ambulance service contract.
That ambulance service contract between the Southeast Collin County EMS Coalition and the ambulance service contractor.
Medical audit.
An official inquiry into the circumstances involving an ambulance run or request for ambulance service, conducted by the medical director or a licensed physician designated by the medical director, or by the medical control board.
Medical control.
That direction given ambulance personnel by a base station physician through direct voice contact, with or without vital sign telemetry, as required by applicable medical protocols promulgated by the medical control board, and by chapter 773, Texas Health and Safety Code, or its successors.
Medical control board or MCB.
That board of physicians established and empowered by this article to update from time to time the system standard of care and to monitor compliance with that system standard of care.
Medical director.
An emergency physician, expert in the pre-hospital practice of emergency medicine, appointed by the ambulance service contractor.
Medical protocol.
Any diagnosis-specific or problem-oriented written statement of standard procedures, or algorithm, promulgated by the medical control board as the proper standard of pre-hospital care for a given clinical condition.
Member jurisdiction.
The individual corporate limits of the individual cities which are members of the Southeast Collin County EMS Coalition.
Mutual aid agreement.
A written agreement between one or more providers of ambulance service whereby the signing parties agree to provide backup ambulance service to one another under conditions and pursuant to terms specified in the agreement.
Paramedic.
A person qualified as a certified “paramedic emergency medical technician” as defined by chapter 773, Texas Health and Safety Code, or its successor.
Person.
Any individual, firm, partnership, association, corporation, governmental entity, or other group or combination acting as a unit.
Regulated service area.
The combined corporate limits or legal boundaries of all jurisdictions which adopt this Uniform EMS Ordinance.
Senior paramedic in charge.
That person among the certified personnel assigned to an ambulance, not the driver, who is a certified paramedic designated by the ambulance service contractor as the individual in command of the ambulance.
Special event.
Any public event located within the regulated service area, for which standby ambulance service is arranged in advance, and for which an ambulance (or ambulances) are hired by the sponsor of the event or other interested party.
Specialized mobile intensive care unit.
A vehicle which is specially constructed, equipped, staffed, and employed in the interfacility transport of patients whose requirements for en-route medical support are likely to exceed the clinical capabilities of a paramedic level ambulance.
System standard of care.
The combined compilation of all priority dispatching protocols, pre-arrival instruction protocols (i.e., ambulances), protocols for selecting destination hospital, and standards for certification of pre-hospital care personnel (i.e., telephone call takers, ambulance personnel, and on-line medical control physicians), as well as standards governing requirements for on-board medical equipment and supplies, and licensure of ambulance services and first responder agencies. The system standard of care shall simultaneously serve as both a regulatory and contractual standard.
(Ordinance 2001-06-01, art. 2, adopted 6/21/01)
(a) 
No person shall operate or cause to be operated an ambulance nor furnish, conduct, maintain, advertise or otherwise be engaged in the business or service of the transportation of ambulance patients within the regulated service area, or provide special events standby coverage, unless such person is the ambulance service contractor. No person shall knowingly solicit ambulance services as regulated herein except the ambulance service contractor.
(b) 
However, the prohibitions set forth in subsection (a) of this section shall not be applicable to an ambulance or ambulance service provider which is:
(1) 
Rendering assistance to patients in the case of a major catastrophe or emergency with which the ambulance service contractor’s ambulances are insufficient or unable to cope;
(2) 
Transporting a patient who is picked up from a location beyond the regulated service area and transported to a location within the regulated service area; or
(3) 
Transporting a patient who is picked up from a location beyond the regulated service area and transported to a location beyond the limits of the regulated service area and only incidentally passing through the regulated service area.
(c) 
The ambulance service contractor may use another ambulance service provider for non-emergency transfers to and from the member jurisdictions, if the ambulance service contractor is unable to perform the service due to unavailability or due to exceeding the number of transports as set forth in subsection (d) of this section.
(d) 
The ambulance service contractor shall have the option to transport non-emergency transports to and from the member jurisdictions but will limit the number of such transports that [by] the ambulance service contractor’s generally dedicated unit for the contract service area to no more than five (5) per month.
(e) 
All emergency and non-emergency calls and requests for ambulance services originating within the member jurisdictions will be dispatched through or to the ambulance service contractor’s dispatch center.
(f) 
Violations of this article are hereby declared to be public nuisances and shall be prohibited and abated in actions at law or in equity.
(Ordinance 2001-06-01, art. 3, adopted 6/21/01)
(a) 
System standard of care adopted.
The system standard of care as defined herein is hereby adopted as the minimum requirement for compliance with this article, and the medical control board is hereby recognized as the clinical standards-setting body for this jurisdiction.
(b) 
Physician participation.
Any hospital within this jurisdiction which operates an emergency room or emergency department meeting the requirements of an approved emergency room/department shall be eligible to appoint its physician director of said emergency room or department (or his/her physician designee) to membership on the medical control board, and such representative shall have full voting rights when the MCB has been notified in writing by an officer of the hospital.
(c) 
Coordination of activities.
The medical director appointed by the ambulance service contractor shall serve as ex officio, nonvoting chair of the medical control board, and shall be responsible for arranging meetings, creating the agenda, keeping minutes, ensuring compliance with this article, and developing a process for monitoring compliance with the system standard of care, subject to approval by the medical control board.
(d) 
Duties and responsibilities.
Responsibilities of the medical control board shall be as follows:
(1) 
To set the system standard of care and provide periodic revisions. The system standard of care shall address minimum requirements and recommended higher standards governing the licensure of organizations, the certification of individuals, and the permitting of vehicles employed within the EMS system, and shall be developed in accordance with the following table of contents:
(A) 
Prevention, CPR and other public information programs.
(B) 
Telephone access (emergency and routine).
(C) 
Control center operations.
(D) 
First responder services.
(E) 
Ambulance services.
(F) 
On-line medical control.
(G) 
Quality improvement and clinical research.
(2) 
Authorize the issuance, denial, revocation, suspension, or restriction of licenses, permits and certifications issued pursuant to this article.
(3) 
Licenses, certifications, and permits in good standing issued by any jurisdiction within the regulated service area pursuant to written authorization by the medical control board shall be recognized and accepted as valid by this jurisdiction.
(e) 
Selection of patient destination.
Medical protocols approved by the medical control board shall establish protocols for selection of the destination hospital, which protocols shall be strictly followed by paramedic personnel and on-line medical control physicians, except when a departure from protocol is justified on the basis of special considerations of patient care or practical barriers to implementation (e.g., blocked roads, hospital divert status, etc.). In developing such “transport protocols,” the medical control board shall strictly adhere to the following priorities of consideration, and shall recognize these priorities in the sequence presented:
(1) 
First consideration:
Patient care and safety;
(2) 
Second consideration:
Patient/family choice;
(3) 
Third consideration:
Fairness in distribution of patients among hospitals. In this regard, the following rules shall apply:
(A) 
Non-emergencies.
All “non-emergency patients” (as defined by patient-assessment protocols approved by the medical control board) shall be transported to the destination selected by the patient, the patient’s family, or the patient’s personal physician, without exception.
(B) 
Non-life-threatening emergencies.
Patients experiencing a “non-life-threatening emergency” (as defined by patient-assessment protocols approved by the medical control board) shall be transported to the facility of choice designated by the patient, the patient’s family, or the patient’s personal physician, or, if no such preference is stated, to the nearest hospital approved by the medical control board for receipt of patients experiencing non-life-threatening emergencies.
(C) 
Life-threatening emergencies.
Patients experiencing life-threatening emergencies (as defined by patient-assessment protocols approved by the medical control board) shall, in accordance with transport protocols approved by the medical control board, be delivered to the “nearest appropriate facility,” taking into consideration the patient’s condition and location, the patient’s medical requirements, and the respective capabilities of hospitals within (and, for some types of patients, outside) the “contract service area.” Such transport protocols shall not be inconsistent with then currently approved trauma system protocols (when available).
(D) 
Enforcement.
Inappropriate and unjustified deviations from these patient-destination protocols by a paramedic without direct authorization by a base station physician or inappropriate and unjustified instructions regarding such deviation by a base station physician shall be subject to sanction by the medical control board provided such sanctions are applied in accordance with due process procedures approved by the city attorney. Such sanctions may include reprimand, suspension of certification, or revocation of certification, depending upon frequency and severity of error.
(f) 
Binding arbitration available.
In the event any hospital desires to dispute a policy of the medical control board affecting patient distribution, that hospital may at its option institute procedures for binding arbitration as follows:
(1) 
The hospital wishing to contest the specified policy shall present its position in writing to the medical control board, including one or more proposed remedies acceptable to the hospital.
(2) 
If the medical control board rejects all remedies proposed by the hospital, the hospital may appoint a physician expert in the medical specialty to which the contested policy is related to serve as a member of an arbitration team, provided that such physician shall have no affiliation, direct or indirect, with any hospital or physician group practicing within the contract service area.
(3) 
The medical control board shall then appoint a physician expert in the medical specialty to which the contested policy is related to serve as a member of the arbitration team, provided that such physician shall have no affiliation, direct or indirect, with any hospital or physician group practicing within the contract service area.
(4) 
The two appointed members of the arbitration team shall then jointly appoint a third physician expert in the medical specialty to which the contested policy is related to serve as the third member of the arbitration team, provided that such physician shall have no affiliation, direct or indirect, with any hospital or physician group practicing within the contract service area.
(5) 
The arbitration team shall then review such written documentation related to the dispute as may be available, and shall conduct such site visit inspections and on-site interviews as the team deems appropriate, and shall render a decision on the disputed matter either in favor of the medical control board or in favor of the hospital initiating the arbitration process, and such decision shall be final. The arbitration team shall not have authority to impose any resolution which was not proposed by either the medical control board or the hospital initiating the proceedings.
(6) 
The actual and reasonable cost of the arbitration process, including consulting fees and travel reimbursement, shall be paid by the hospital initiating the arbitration process.
(Ordinance 2001-06-01, art. 4, adopted 6/21/01)
All persons and entities regulated under this article shall comply with the laws of the state and [with] reference to permits, licenses, minimum equipment and minimum qualifications of operators and attendants and all state and federal laws and regulations applicable to its ambulance operation.
(Ordinance 2001-06-01, art. 5, adopted 6/21/01)
(a) 
It shall be unlawful for any person, with intent to defraud, to request or accept the service of any ambulance within the city, having no intention of paying for such service.
(b) 
Failure, by the person requesting or accepting the services of an ambulance, to pay to the person furnishing such service the customary charge therefor within ninety (90) days after demand for payment is made, shall be prima facie evidence of intent to defraud and prima facie evidence that such person had no intention of paying for such services when the same were requested or accepted.
(c) 
Demand for payment, as used in this article, shall be written demand, sent by registered or certified mail addressed to the person requesting or accepting such services and to the address given by or on behalf of such person at the time the services were requested or accepted. Intent to defraud or intention not to pay for such services may be shown by direct evidence.
(Ordinance 2001-06-01, art. 6, adopted 6/21/01)
Any person who shall violate any provision of this article shall be deemed guilty of a misdemeanor and upon conviction thereof shall be fined as provided in section 1.01.009 of the municipal code. Each day such violation shall continue, or be permitted to continue, shall be deemed a separate offense. It shall not be necessary for the complaint to negative any exception contained in this article concerning any prohibited act, but any such exception made in this article may be urged as a defense by any person charged by such complaint.
(Ordinance 2001-06-01, art. 7, adopted 6/21/01)