A. 
The purpose of this article is to enact formal policies and regulations implementing and supplementing the current provisions of the Health and Safety Code, Division 2.5, Chapters 1 through 11, Section 1797 et seq., Division 12, Chapter 5, Section 13862; the Code of Regulations Title 13, Article I, Section 1100 et seq., and Title 22, Division 9, Chapters 1 through 8, Section 100001 et seq., California Vehicle Code, California Highway Patrol Ambulance Drivers Handbook, and local EMS agency policies, to permit and regulate the operation of ambulance services and other medical transport systems within Placer County. In addition, local emergency medical services agency reserves the right to establish exclusive EMS operating areas. Such exclusive operating areas will be established and awarded in compliance with the provisions of California Health and Safety Code, Division 2.5, Section 1797.224. Nothing contained in this article shall be construed to permit a deviation from the minimum standards set forth in state statutes and regulations and nothing contained in this article shall require duplication of certification or accreditation.
B. 
The local EMS agency reserves the right to establish exclusive ambulance zones, in compliance with Section 1797.224 of the Health and Safety Code, for the provision of emergency, nonemergency and interfacility transport of all patients that require the service of an ambulance and/or medical transportation.
C. 
The necessity to establish exclusive ambulance zones is predicated on public policy and the need for an organized system for emergency and nonemergency response.
D. 
An effective ambulance system cannot be assured to the public unless a reasonable business environment is established that assures the stability of ambulance service providers.
E. 
In the event that an agreement is reached between the county of Placer and its local EMS agency for services in additional to those enumerated in the above-mentioned California codes and regulations, the county of Placer retains the ability to reassign those responsibilities to the agency of their choice.
(Prior code § 26.01)
Definitions as stated in the laws, regulations and policies listed in Section 8.04.010 apply to this article. In addition, the following definitions are used in this article, unless the context otherwise requires, the words and terms contained in this section have the meanings ascribed to them in those sections.
"Advanced life support (ALS)"
means special services designed to provide definitive prehospital emergency medical care, including, but not limited to, cardiopulmonary resuscitation, cardiac monitoring, cardiac defibrillation, advanced airway management, intravenous therapy, administration of specified drugs and other medicinal preparations, and other specified techniques and procedures administered by authorized personnel under direct supervision of a base hospital as part of a local EMS system at the scene of an emergency, during transport to an acute care hospital, during interfacility transfer, and while in the emergency department of an acute care hospital until responsibility is assumed by the emergency or other medical staff of that hospital.
"Agency vehicle"
means a vehicle, which responds to an emergency, the attendants of which may treat but not transport patients, and is operated and equipped at the LALS or ALS level by a provider agency under a permit issued pursuant to this chapter.
"Ambulance"
means a vehicle specially constructed, modified, equipped, and used for the purpose of urgent transportation of sick, injured, convalescent, infirm, or otherwise incapacitated persons who may require immediate measures to prevent loss of life or worsening of a traumatic injury or illness, or have sudden need of medical attention.
"Applicant"
means any person, organization, or service provider who applies for a permit under this article.
"Basic life support (BLS)"
means emergency first aid and cardiopulmonary resuscitation procedures which, at a minimum, include recognizing respiratory and cardiac arrest and starting the proper application of cardiopulmonary resuscitation to maintain life without invasive techniques until the victim may be transported or until advanced life support is available.
"Board"
means the governing board of the local EMS agency.
"Commercial ambulance service"
means the operation of any ambulance for profit within Placer County.
"County"
means the county of Placer.
"Department of health and medical services"
means the Placer County department of health and medical services.
"Emergency medical care committee (EMCC)"
means the Placer County committee established pursuant to Section 1797.270 of the Health and Safety Code.
"Emergency medical services"
means the services utilized in responding to a medical emergency.
"Equipment"
means the equipment required in an ambulance, air ambulance or agency vehicle pursuant to this chapter and equipment standards established by the local EMS agency.
"First responder"
means a person who provides the initial response to an emergency.
"Limited advanced life support (LALS)"
means special service designed to provide prehospital emergency medical care limited to techniques and procedures that exceed basic life support but are less than advanced life support and are those procedures specified pursuant to Section 1797.171, Division 2.5, of the California Health and Safety Code.
"Local EMS agency"
means the agency, department, or office having primary responsibility for administration of emergency medical services in a county or region and which is designated pursuant to Health and Safety Code, Chapter 4 (commencing with Section 1797.200).
At the time of the writing of this chapter, Placer County participates in a Joint Powers Agency (Sierra-Sacramento Valley EMS Agency) with four other counties, pursuant to the provisions of Chapter 5 (commencing with Section 6500), Division 7, Title 1 of the Government Code.
"Medical transport vehicle"
means a vehicle, not an ambulance, specifically constructed, modified, equipped, or arranged to accommodate a stretcher or wheelchair and operated for the purpose of transporting sick, injured, convalescent, infirmed, or otherwise incapacitated persons not requiring urgent transportation.
"Patient"
means a person who is sick, injured, wounded, or otherwise incapacitated or helpless and who may be transported in an ambulance, air ambulance or medical transport vehicle, or is cared for at the scene of an emergency by a certified or accredited attendant or a public provider agency, or who dies following the commencement of such transportation.
"Permit"
means the document authorized/issued by the local EMS agency on behalf of the board which issues a permit for a service to provide emergency care and/or medical transportation in Placer County.
"Permittee"
means a person who holds a permit.
"Person"
means a natural person, trust, firm, partnership, association, corporation or public entity.
"Pilot"
means a person who is certified as a commercial pilot by the Federal Aviation Administration.
"Public entity service"
means a service which is provided primarily as a public service by an agency of local government.
"Reports"
means accurate records upon such forms as may be provided or prescribed by the local EMS agency concerning the dispatch, emergency care, or transportation of any patient within or beyond the limits of Placer County. Such reports shall be available, pursuant to policies of the local EMS agency, for inspection at any reasonable time and copies of such records shall be filed upon written request of the local EMS agency within two working days.
"Service"
means the operation of an ambulance, air ambulance, agency or medical transport vehicle to provide medical care or patient transportation within Placer County.
"State"
means the state of California.
"Station"
means an approved facility from which a unit is operated.
"Substation"
means an approved subsidiary facility from which a unit is operated.
"Transfer"
means the movement of a patient by ambulance or air ambulance from one hospital to another hospital, a medical facility, a home or other location.
"Transport"
means the movement of a patient by ambulance or air ambulance from the scene of an emergency to a hospital.
"Unit"
means an ambulance, air ambulance, agency vehicle or any medical transport vehicle.
"Volunteer"
means a person who:
1. 
Acts as a driver or attendant;
2. 
Does not receive more than 50% of his/her annual employment income from the EMS provider that is claiming volunteer status.
"Volunteer service"
means a service which:
1. 
Transports patients without compensation, other than reimbursements to defray the actual expenses of providing such service and;
2. 
Is either wholly or partly subsidized or otherwise operated under the auspices of some governmental or public agency, body or group, or any industrial or non-profit corporation and;
3. 
Uses volunteers.
(Prior code § 26.10)
A. 
Except as provided in subsections A through C of this section, no person may furnish, operate, conduct, maintain, advertise or otherwise be engaged in, or profess to be engaged in business as an ambulance, air ambulance, or medical transport vehicle within Placer County unless such person holds a valid permit authorized/issued by the local EMS agency pursuant to this article.
B. 
A permit will be issued only when the permittee is in compliance with all applicable federal, state, and county codes and regulations, and local EMS agency policies and procedures.
C. 
Criminal action may be taken against an applicant who knowingly provides false information on the permit application.
D. 
For the purpose of determining whether a service meets the requirements of subsections A through C of this section, the local EMS agency may require the following information:
1. 
The number of patients transported by the service originating or terminating within Placer County;
2. 
Location of storage, supply, or resupply of drugs, dangerous drugs and controlled substances;
3. 
Station or substation location;
4. 
Location of business as listed on any business license;
5. 
Advertised business location, telephone number, and mailing address;
6. 
Site to which on-call employees respond when a request for service is received;
7. 
Location of back-up equipment supply or resupply; and
8. 
Any additional pertinent information that may be required by the local EMS agency.
E. 
Whenever a service based outside Placer County, but within the state of California, enters into a written agreement or contract for the provision of service with any medical care facility or medical organization based within Placer County, it must hold a valid permit as described in Section 26.15, unless otherwise exempted in this chapter. Public entity, Automatic and Mutual Aid Agreements are exempt from this section.
F. 
No permit is required if the local EMS agency has authorized/issued a provisional permit to operate a service pursuant to Section 8.04.050 of this article.
G. 
A service permitted in accordance with this article must provide emergency care to and transport any emergency patient regardless of the patient's ability to pay.
H. 
No permittee, under this article shall cause or allow its units to respond to a location without receiving a specific official request for that response.
(Prior code § 26.15)
A. 
Application for a permit must be made upon forms prescribed by the local EMS agency in accordance with this article. The local EMS agency, after receipt of the completed application shall:
1. 
Confirm the applicant's approval as a LALS or ALS provider;
2. 
Cause an investigation to be made of the applicant, the applicant's proposed service and the information contained on the application and;
3. 
Upon completion of the investigation, either issue the permit or reject the application in writing on any grounds prescribed in this article. The written rejection must set forth the reasons therefor and must notify the applicant of his right to appeal.
B. 
In accordance with subsection A of this section, the local EMS agency shall prepare an application form and shall require each applicant to furnish information as it deems necessary to determine the applicant's ability to meet the requirements of this article.
C. 
The applicant must provide proof of insurance coverage as required by Section 8.04.110 of this article.
D. 
A permit expires on July 1st, following the date of issuance, and must be renewed before that date. A renewal application must be submitted at least 30 days prior to the permit expiration date with the same requirements, limitations, terms and conditions applicable to issuance of a permit. A modified application form approved by the local EMS agency shall be used for renewal applications for a permit.
E. 
The local EMS agency shall not approve an application for operation unless that application is in compliance with the policies of the local EMS agency. The application shall include, at a minimum, a description of:
1. 
The name, current address, and certification level of the attendants which the service proposes to utilize;
2. 
How the service or agency proposes that its attendants will comply with requirements under this article for continuing training and periodic certification;
3. 
Communications and 24 hour dispatch capabilities, including; recording of telephone and radio communications of the service, recording maintenance and retrieval system, response times and the protocols used for dispatching the service;
4. 
The equipment, supplies and drugs which the service uses on each BLS, ALS, LALS or medical transport unit must comply with local EMS agency policy;
5. 
How the service or agency proposes to maintain adequate medical records on the treatment of patients, and a general description of their internal quality assurance process and the individuals responsible;
6. 
The name of each base hospital to which patients will be transported and the signature of an authorized representative of each hospital;
7. 
The staffing necessary for the number of units to be operated by the service;
8. 
The service's plan for drug storage, supply and resupply;
9. 
The service's plan for handling and disposal of biohazardous materials;
10. 
The service's plan for Infection Control and;
11. 
The service's plan for the incident command system (ICS), and disaster training, equipment and supplies.
(Prior code § 26.20)
A. 
The local EMS agency may authorize/issue a provisional permit to operate an ambulance service which is limited as to time, place and purpose, based on public need.
B. 
No provisional permit may be issued for a period of time longer than six months.
C. 
A provisional permit may be authorized for renewal at the discretion of the local EMS agency, but in no case may more than one renewal be made.
D. 
A provisional permit may be issued when the applicant is deemed by the local EMS agency to be ineligible for a regular permit because of an inability to meet, in the opinion of the local EMS agency, any requirement of this article and the service is deemed necessary for the convenience and safety of the public to be served thereby.
(Prior code § 26.25)
A. 
Any permit or provisional permit issued pursuant to this article shall be prominently displayed in the principal place of business of the permittee and shall not be altered or defaced in any way. If any official entry on any such permit is defaced, removed, obliterated or altered in any way, the permit shall be rendered immediately null and void and of no force and effect whatever.
B. 
No permit issued pursuant to this article is transferable.
(Prior code § 26.30)
A. 
The local EMS agency shall refuse to issue a permit for one or more of the following reasons:
1. 
Failure to provide a complete application or a determination by the local EMS agency that the applicant fails to meet the requirements of this article;
2. 
If the applicant has previously had an applicable permit revoked or the status is directly at issue, which effects his or her present ability to serve;
3. 
If the applicant has a criminal or health record which reasonably indicates he or she would be unlikely to properly accept the responsibilities of operating a service;
4. 
If there is reasonable cause to believe that the applicant will not provide emergency medical services or medical transport in a manner that will promote the health and general welfare of persons within the county who may need to utilize the applicant's proposed services;
5. 
If the applicant does not have the required equipment for its units;
6. 
If the applicant has not demonstrated, utilizing standard accounting practices and principles, sufficient financial stability or capitalization of a service to assure that the service will be run in an efficient and business-like manner for a period of at least one year or cannot meet the insurance requirements of Section 8.04.110;
7. 
If the applicant proposes to operate a service within a service area where another ambulance service or entity has been granted an exclusive operating area;
8. 
If the applicant for a permit to operate an air ambulance does not meet the Federal Aviation rules for certification under FAR Part 91 or Part 135, or both, as published in the Federal Register, January 1, 1985, as may be amended from time to time; and/or
9. 
Failure to comply with all applicable federal, state and county codes and regulations and local EMS agency policies/procedures.
B. 
If an application for a permit to operate a service, or an endorsement authorizing services at the LALS or ALS level is denied by the local EMS agency for failure to meet the requirements of this article, the applicant shall be notified by personal service or by certified mail within 10 working days of that fact, stating the reason or reasons therefor and the applicant's right of appeal as provided for in this article. No right of appeal exists if the permit is denied pursuant to subsections (A)(1), (2), (6), (7), (8) and (9) of this section.
(Prior code § 26.35)
A. 
An additional unit, unless exempt, in order to be placed into service, must have a current statement of safe operating condition and must be inspected by the California Highway Patrol and the local EMS agency to determine if it complies with this article.
B. 
Each unit must be maintained in a safe operating condition, including all engine parts, body parts, and all other operating parts and equipment used in and on the unit. (Note: In this connection the local EMS agency shall periodically, and at least annually, require each permittee to certify that he or she has had inspected every unit under his or her control and supervision and that, in the opinion of a professional/master mechanic, the unit is in safe operating condition. Successful completion of an annual California Highway Patrol ambulance inspection is acceptable. A written copy of this certificate shall be submitted to the local EMS agency within 10 days of the inspection.) In the case of an air ambulance, maintenance must be in accordance with Federal Aviation Rules Parts 43, 91 and 135 as applicable.
C. 
Each ambulance shall be equipped with one primary mobile two-way radio and at least one portable backup communication device capable of establishing and maintaining communication with the base hospital on the MED NET 1-10 frequencies. Backup communication with a cellular telephone is acceptable. All communications equipment must meet manufacturers specifications for power, output and antenna.
D. 
Units must have printed at a minimum on the front and rear thereof, or in the case of an aircraft, on a sign in the window of the aircraft, the unit number and name of the service. The reflective lettering for such identification shall be at least four inches in height.
E. 
Every unit operated in Placer County shall be in a clean and sanitary condition subject to such sanitary standards as are prescribed by the local EMS agency.
F. 
Relatives of a patient and other persons may ride in an ambulance or medical transport vehicle at the discretion of the attendant(s). Three point restraints for utilization by each passenger riding in an ambulance or medical transport vehicle must be available in ambulances or medical transport vehicles purchased after the effective date of the ordinance codified in this article.
G. 
An ambulance service or entity granted an exclusive operating area as part of the local EMS agency plan, may adopt dispatch protocols and procedures which must be approved by the local EMS agency.
(Prior code § 26.45)
A. 
In addition to any other requirements contained herein, no service may utilize a driver or pilot to operate a unit unless such driver or pilot:
1. 
Is familiar with the geographic area of the organization's service area;
2. 
Has adequate knowledge of all the hospitals within the organization's service area;
3. 
Can operate a two-way radio and;
4. 
Can drive a unit under emergency conditions.
B. 
Each service or agency must provide written notice to the local EMS agency within 10 days of any change in personnel or units unless an alternate plan has been approved by the local EMS agency.
C. 
Services may utilize only those drivers and attendants who are appropriately licensed, certified and accredited.
D. 
Every advanced life support transport unit when in operation must be staffed, at a minimum, by two personnel, one of whom must be locally accredited as an EMT-P and one of whom must be certified as an EMT-IA, unless exempt.
E. 
Every limited advanced life support transport unit when in operation must be staffed, at a minimum, by two personnel, one of whom must be locally certified at the limited advanced life support level and one of whom must be certified as an EMT-IA, unless exempt.
F. 
Every basic life support transport unit when in operation must be staffed, at a minimum, by two personnel, both of whom must be certified as an EMT-IA, unless granted a waiver from the California Highway Patrol (Title 13, California Code of Regulations, Section 1108 and California Vehicle Code Section 2512).
G. 
An agency vehicle endorsed at the LALS level must have at least one individual locally certified as an EMT-II, or if endorsed at the ALS level, one locally accredited EMT-P.
H. 
All providers are responsible to implement reasonable employee shift schedules to avoid problems of sleep deprivation, fatigue, and incompetent performance.
I. 
An operational air ALS unit should be staffed by two EMT-Ps or two registered nurses and, as a minimum, must be staffed by no fewer than one EMT-P or authorized registered nurse and one EMT-IA.
J. 
Services must insure that their attendants are free of physical defects or diseases which may impair their ability to attend to patients. No person, service or agency shall be out of compliance with Government Code Section 8355, in matters relating to providing a drug-free workplace.
K. 
Air ambulance attendants used by a service must have training in aeromedical physiology, aircraft safety, emergency aeromedical procedures, and any other specialized training required by the local EMS agency based on current Association of Air Medical Services (AAMS) national standards.
L. 
Drivers and attendants utilized on medical transport vehicles shall be at least 18 years of age, shall hold a current certificate in level C basic cardiac life support from the American Heart Association/American Red Cross, and first aid from the American Red Cross, and shall demonstrate compliance with all applicable state and local laws and regulations.
(Prior code § 26.50)
A. 
The permittee shall obtain and keep in force during the term of said permit the following insurance coverage issued by a company authorized to do business in the state of California. The required insurance coverage may be revised as deemed necessary by the board.
1. 
Comprehensive general liability insurance to include coverage for bodily injury, property damage, blanket contractual, and personal injury. Minimum limits of liability will be at least three million dollars ($3,000,000.00) per occurrence, combined single limit bodily injury and property damage.
2. 
Workers' compensation insurance for statutory compensation coverage. Employer's liability insurance with limit not less than one million dollars ($1,000,000.00) per occurrence.
3. 
Comprehensive auto liability at a minimum of three million dollars($3,000,000.00) per occurrence, combined single limit bodily injury and property damage. Minimum coverage for medical transport vehicles is three million dollars ($3,000,000.00). The coverage for all permittees must include owned auto, non-owned auto, hired auto, and cross liability or severability of interest clause in policy.
4. 
Professional Liability for all employees providing service. Error or omission and failing to render professional services coverage. Minimum limits for medical transport vehicles is one million dollars ($1,000,000.00). All other permittees must have a minimum of one million dollars ($1,000,000.00) coverage.
B. 
Said insurance shall contain coverage expressly recognizing the indemnification obligations assumed by the ambulance business or applicant in accordance with this article, but shall not be construed to limit in any manner the amount of ambulance business or applicant's liability thereunder; providing further, where permitted by the carrier, said insurance shall expressly name county, its governing board, agents, officers and employees as additional insured.
C. 
Said insurance shall not be subject to cancellation or reduction without 60 days prior written notice to county. The insurance carrier shall serve written notice to the local EMS agency.
D. 
Each unit placed in operation by the commercial service shall be included within the scope of the required insurance coverage and limits, and shall be operated pursuant to the permit issued in accordance with this article.
E. 
Certificate(s) of insurance satisfactory to the Placer County risk manager must be approved before ambulance service commences.
F. 
The provisions of this section regarding liability insurance do not apply to services provided by the state.
G. 
Upon receipt of any notice of cancellation or non-renewal of an insurance policy, the local EMS agency shall either (1) confirm that the provider immediately reinstates insurance coverage prior to cancellation; (2) procure substitute provider coverage and order the permittee to cease service in Placer County and to surrender any permit issued pursuant to this article; (3) see that the insurance is reinstated at the provider's expense; or (4) obtain substitute provider coverage until the matter is resolved at provider's expense.
(Prior code § 26.55)
A. 
All services must adhere to the local EMS agency equipment inventory list.
B. 
All medical equipment and supplies on an agency vehicle must be stored to promote security and protection from the elements.
(Prior code § 26.60)
A. 
Each ground ambulance unit placed in service after July 1, 1991, must: when purchased be configured to meet the mechanical and electrical standards established by the United States Department of Transportation in its specifications designated Docket KKK-A-1822, as amended from time to time.
B. 
In addition to meeting the requirements in Section 8.04.120 and this section, inclusive, LALS and ALS units must, where noted:
1. 
Space as required by Docket KKK-A-1822, as amended from time to time;
2. 
Have additional shelf and other storage space sufficient for controlled substances including locked storage in accordance with Section 8.04.160;
3. 
Have proper storage of other medical equipment and supplies to prevent patient injury in transit and to meet approved procedures for management of patients and;
4. 
Have a system which will control temperature adequately to maintain the integrity of the medical supplies and drugs as well as the health and safety of the patients and attendants.
(Prior code § 26.65)
A. 
Every station and substation used in a commercial or public entity service must meet the following requirements:
1. 
Local Building and Fire Codes;
2. 
The station must be a structure with a system to communicate with each ambulance operating from the station or substation and have adequate sanitary storage space for equipment and material to be used in the operation of the service;
3. 
The substation must be capable of communication with a central dispatch facility with both a primary and a secondary two-way communication system;
4. 
Every station and substation must be properly located to permit any ambulance operating therefrom rapid and safe egress to a main thoroughfare;
5. 
Every station and substation must have adequate off street parking space for all units operating therefrom;
6. 
Every station, unless the service participates in a central dispatch facility approved by the local EMS agency, must be attended by a dispatcher on a 24 hour basis;
7. 
Every station shall be in compliance with all applicable OSHA requirements;
8. 
Every station and substation must be in clean and sanitary condition and have suitable sleeping quarters for attendants who are scheduled to work a 24 hour shift which are private and separate from operational areas.
B. 
Every station and substation shall be inspected prior to the issuance of any permit and, thereafter, shall be inspected at least once yearly by the local EMS agency for the purpose of determining whether or not the station or substation is in compliance with this article and any other Placer County department of health and medical services regulations.
(Prior code § 26.70)
All administration, supply, resupply, documentation, storage and security measures and destruction of drugs, dangerous drugs, controlled substances and hypodermic devices must be in compliance with all laws and regulations of the state and federal government and the local EMS agency. As used in this section, drugs, dangerous drugs and controlled substances have the meaning ascribed to them in State Board of Pharmacy Regulations. Any provider agency that stockpiles drugs shall have a medical director and/or a clinical pharmacist.
(Prior code § 26.80)
A. 
Any change in a service's ambulance fleet must be filed by the permittee with the local EMS agency within 10 days of its occurrence.
B. 
Each service shall submit operational information as required by the local EMS agency.
C. 
A run report/patient care record must be completed, as required by the local EMS agency, by an attendant whenever a unit responds to a request for patient care, including dry runs.
1. 
Patient care information submitted to the local EMS agency is confidential but may be used for quality assurance.
2. 
The hospital copy of the patient care record must be completed and submitted to the receiving medical facility as specified in local EMS agency policy.
3. 
The patient care record prepared by a service shall be the EMS Response Form, ambulance run form or a form approved by the local EMS agency.
D. 
Whenever a unit is involved in a crash and/or experiences mechanical problems resulting in a mission failure the local EMS agency shall be notified immediately.
E. 
Any alleged violation of this article must be reported to the local EMS agency.
(Prior code § 26.85)
A. 
The local EMS agency shall inspect, or cause to be inspected, every unit before it is placed into use, and annually thereafter. Such inspections do not duplicate, and shall not be in lieu of, inspections performed or required by the California Highway Patrol.
B. 
After inspection, a written report shall be prepared indicating every violation or omission of any requirements, standards or provisions contained in this article with respect to the unit inspected. The report shall set a time period for correction of each violation or omission. A copy of the report shall be given to the permittee of the service concerned.
C. 
In addition to the routine inspections required in subsection A of this section, the local EMS agency may make unannounced nonroutine inspections of any unit, attendant, volunteer, pilot or air attendant, station or substation regulated here under, for the purpose of determining whether or not any aspect of a service subject to this article is, or is not, in compliance with the article. A written report shall be prepared pursuant to subsection B of this section.
(Prior code § 26.90)
A. 
Enforcement of this article is the primary responsibility of the local EMS agency.
B. 
An appeal process shall be established by the local EMS agency.
(Prior code § 26.100)
A person exhibits unprofessional conduct if such person fails to maintain that standard of performance, exercise that degree of skill, care, diligence and expertise, or manifests that professional demeanor and attitude which is ordinarily exercised and possessed by other persons in similar positions in California. Unprofessional conduct includes, without limitation:
A. 
The use of obscene, abusive, slanderous or threatening language;
B. 
The use of unreasonable force which unnecessarily increases or inflicts pain upon a patient;
C. 
Conviction of an offense, a diversion status, a nolo contendere guilty plea if the acts involved have a direct bearing on entrusting the person to serve the public;
D. 
Disclosing the contents of examinations for certification or recertification;
E. 
Violation of the confidentiality of health records except as allowed or required by law or regulation and;
F. 
Possessing, diverting or using medical supplies, equipment or drugs for personal or unauthorized use.
G. 
Possession of any firearms or other weapons while on duty or engaged in the performance of prehospital care duties, unless authorized by law.
(Prior code § 26.105)
A. 
Any permit may be revoked or suspended by the local EMS agency if, after inspection by the local EMS agency, the person to whom the permit or endorsement was issued does not comply fully with this article within a reasonable period of time after receiving any request or order of the local EMS agency to do so. "Reasonable" as used herein, is that period of time necessary to take immediate action with due regard for the public interest and for the ordering of necessary supplies and/or parts.
B. 
If an exclusive operating area is granted, the permits of existing ambulance services within the exclusive operating area not granted such exclusive operating area or not determined to be part of an entity granted such exclusive operating area, shall be revoked upon written notice of the local EMS agency. Such notice shall indicate the date and time when the permit is revoked.
C. 
If a permit or endorsement to operate a service is suspended or revoked, the local EMS agency shall immediately notify the appropriate authorities within Placer County of that fact and may request that the business licensing authorities immediately institute proceedings to revoke any business license or permit issued to the person operating the service.
(Prior code § 26.115)
A. 
The local EMS agency may take any disciplinary action set forth in Section 8.04.220(A) and this section when the local EMS agency has reason to believe that a permitted service has violated any section of this article, or any applicable statute, regulation or code.
B. 
Written notice will be furnished to the permittee specifying the reasons for the proposed disciplinary action and informing the permittee of her/his right to file an appeal with the local EMS agency as required by Section 8.04.210 except that such hearing may not be requested if the permit is revoked for the reasons stated in Section 8.04.220(B).
C. 
A notice of revocation or suspension issued in accordance with Section 8.04.240 may state that the effective date of the revocation or suspension is:
1. 
Immediate if the local EMS agency has determined through investigation that such suspension or revocation is in the best interests of the public or;
2. 
Stayed pending formal appeal and review of the proposed action.
D. 
Any emergency ambulance or medical transport service who is served a notice of proposed disciplinary action, other than under Section 8.04.240, has 10 working days from the date of the notice to appeal that action in writing to the local EMS agency. Upon receipt of the appeal, the local EMS agency shall conduct an appeal hearing. In case of immediate suspension or revocation, the decision of the local EMS agency is final. Failure to request an appeal according to the time period prescribed in this section, shall be deemed to be an admission that the suspension or revocation order is well founded and precludes administrative or judicial review.
(Prior code § 26.120)
A. 
Whenever the local EMS agency has reasonable cause to believe that any section of these regulations has been violated, the local EMS agency shall cause written notice to be served upon the person or persons responsible for the alleged violation. Such notice shall be sent to the person or person's address of record and a copy to the employer of record.
B. 
The notice shall specify:
1. 
The section or sections of this article alleged to be violated;
2. 
The facts alleged to constitute the violation; and
3. 
An order to take corrective action within a specified time.
C. 
Such an order becomes final unless, within 10 working days from the date of the notice, it is appealed in writing to the local EMS agency. Upon receipt of an appeal, the local EMS agency shall refer it to the appeal process.
D. 
Failure to comply with a notice of violation shall result in the issue being referred to the administrative hearing process.
(Prior code § 26.125)
A. 
Complaints regarding alleged violations of this article shall be made in writing. The local EMS agency may require the complainant to specify:
1. 
The section of the article alleged to have been violated;
2. 
The date, time and location of the alleged violation;
3. 
The person and/or service involved and;
4. 
The circumstances or details which support the allegation of a violation.
B. 
The complainant may be requested to personally present additional information to substantiate the complaint.
C. 
Based upon information obtained from the complainant, the local EMS agency shall make a determination whether to proceed with the investigation and to set a priority for conducting the investigation.
D. 
The person and service alleged to be in violation shall be notified by the local EMS agency.
E. 
The complaint investigation may include a review of any applicable records, tapes, personal statements, affidavits or other items deemed relevant by the local EMS agency. A summary report detailing the findings of the investigation shall be prepared.
F. 
At the conclusion of the investigation, the receive copies of documents associated with the complaint investigation.
G. 
The local EMS agency shall determine if any disciplinary action should be taken at any time during the complaint investigation process.
H. 
When the local EMS agency is separate from Placer County government, complaints received by the Placer County department of health and medical services that are potential violations of California Health and Safety Code, Section 1798.200, shall be referred to the local EMS agency for necessary action.
(Prior code § 26.130)
Except as otherwise provided herein, every service must be in compliance with this article within 90 days after ordinance approval by the Placer County board of supervisors.
(Prior code § 26.135)
The following shall be exempt from the provisions of this article:
A. 
The occasional use of a vehicle or aircraft not ordinarily used in the business of transporting persons who are sick or injured when an authorized form of approved medical transportation is not available in a life/death situation;
B. 
A vehicle or aircraft not ordinarily used as a unit in case of a major catastrophe or emergency, when services with permits are insufficient to render the services required;
C. 
Persons rendering service as attendants or air attendants in case of a major catastrophe or emergency when permitted attendants cannot be secured;
D. 
An ambulance or medical transport vehicle based and properly permitted outside the county shall be authorized to transport a patient to or through the county but shall not be authorized to transport patients originating in the county;
E. 
A volunteer ambulance service is being operated from a location, station or headquarters outside of Placer County, does not conduct the majority of its business within the boundaries of Placer County, and the patients transported by said service are picked up at a point outside the boundaries of Placer County and transported to a medical facility within Placer County;
F. 
Volunteer units based outside Placer County, except that any such unit receiving a patient within Placer County for transport to a location within Placer County shall comply with the provisions of this article;
G. 
Volunteer attendants based outside Placer County;
H. 
Units owned and operated by search and rescue organizations chartered by the state as corporations not for profit or otherwise existing as nonprofit associations which are not regularly used to transport patients except as part of rescue operations; or
I. 
Units owned and operated by an agency of the United States Government or state of California.
(Prior code § 26.140)
The following miscellaneous provisions on the operation of units within Placer County apply with respect to any permit:
A. 
No county, city or other political subdivision within Placer County may operate a service in violation of this article.
B. 
Personnel records of all certified or permitted personnel are confidential and may only be made available to the person who is the subject of the records, and the local EMS agency, as provided by law.
C. 
A registered nurse employed by a service is subject to this article. Any violation of this article by a registered nurse may result in investigation by the local EMS agency and possible referral to the California State Board of Registered Nurses.
D. 
It is the responsibility of the employer of record to forward any notice issued under this article to a person or persons in their employ, which is undeliverable to the address of record, to that person or persons at their next work shift.
E. 
Medical transport vehicles will carry portable oxygen to supplement patients whose own oxygen supply may run out and will also carry a first aid kit, as determined by the local EMS agency.
F. 
Public Entity services shall demonstrate availability of mutual and/or automatic aid agreements, with adjacent ambulance service areas, which ensure dispatch of the nearest appropriate ambulance. Mutual and/or automatic aid agreements must be reviewed and filed with the local EMS agency.
G. 
Emergency ambulance services shall participate with adjacent ambulance service areas in mutual and/or automatic aid agreements which are approved by the local EMS agency.
(Prior code § 26.145)
A. 
Events with high risk and high exposure will be required to have Placer County permitted ambulances with appropriate personnel and equipment present. Criteria used to evaluate need will include:
1. 
Nature of the event;
2. 
Anticipated attendance;
3. 
Nature of the crowd and;
4. 
Geography and physical characteristics of the event site.
B. 
All permit applicants for special events expecting 5,000 participants and/or attendees shall submit appropriate medical plans, in a format established by the local EMS agency, for approval by the local EMS agency. Public health plans shall be submitted for approval to the Placer County public health officer. A copy of each of those plans shall be submitted to the Placer County office of emergency services.
C. 
Guidelines for the public health plans will be promulgated and approved by the public health officer and guidelines for medical plans will be promulgated and approved by the local EMS agency.
(Prior code § 26.150)
A. 
The Placer County board of supervisors may adopt procedures for reviewing and regulating ambulance rates in the county. If regulated, ambulance permittees shall not charge more than the rates adopted by the Placer County board of supervisors.
B. 
No charge shall be made for transporting uninjured or well persons who accompany a patient when these persons are not treated at an emergency care facility.
C. 
If regulated, the schedule of rates may be adjusted by the Placer County board of supervisors upon the receipt of a permittee request to the local EMS agency. The local EMS agency shall submit a report to the Placer County board of supervisors, which shall conduct a public hearing regarding the requested rate increase.
D. 
A rate change when approved by the Placer County board of supervisors, as applicable, shall be effective on the date of approval.
E. 
Current rate categories and charges shall be posted at each permittee's place of business.
F. 
This section shall not apply to agencies whose rates are set by public hearing procedure.
(Prior code § 26.155)
A. 
Each ambulance provider participating in the transfer of patients with an ambulance will conform to all laws, rules and regulations set forth in the California Health and Safety Code and local EMS agency policies applicable to interfacility transfer of patients, and pursuant to any formal transfer agreements between transferring and receiving facilities involved.
B. 
Treatment performed by an ambulance for the patient in transport, shall be provided with appropriate medical care, including personnel and equipment, according to the California Health and Safety Code and applicable local EMS agency policies.
(Prior code § 26.160)
A. 
Each permittee shall make ambulances available to the county during times of disaster or large scale system emergencies in accordance with the multi-casualty incident plan. Ambulances shall report to a county-designated dispatch center via radio for direction. The designated dispatch center shall coordinate all dispatch functions for said ambulances during the event. All ambulances shall remain under the control of the county until released.
B. 
Permittee shall make every effort to call in off-duty personnel to staff additional ambulances as necessary to meet system demands.
C. 
Permittee shall have on file with the local EMS agency and the Placer County office of emergency services, its disaster response and personnel call-back plan.
D. 
All management and field personnel of permittee shall follow the guidelines and directions of the Placer County multi-casualty incident plan during the event.
E. 
At least once a year, permittee shall participate in a county-organized disaster exercise by providing staff and equipment as necessary to meet the exercise objectives. All of permittee's costs associated with their participation in the disaster exercise shall be the sole responsibility of the permittee.
(Prior code § 26.165)
A. 
No person or service may represent, advertise or imply that it is authorized to provide ambulance or medical transport services unless the service has a current authorization for operation from the local EMS agency.
B. 
No service or agency may use EMT-IIs, EMT-Ps and/or registered nurses unless the service or agency has a current permit authorization by the local EMS agency and the service operates in accordance with all provisions of this article.
C. 
No person may operate a unit within Placer County unless the unit meets the following operation standards:
1. 
No unit may be dispatched unless it is fully operational and;
2. 
The unit at the time it is in use or on call contains equipment and supplies such as are applicable for any specific unit and specified in Sections 8.04.120, 8.04.130 and 8.04.140, whichever may be applicable.
D. 
No person may operate any unit while under the influence of any intoxicating liquor or controlled substance or any drugs that impair the ability to carry out responsibilities.
E. 
No unit may be dispatched with any soiled, dirty or contaminated bandages, dressings, bedding, materials or equipment contained in the patient compartment, unless properly bagged.
F. 
No person, service or agency shall be out of compliance with Government Code Section 8355, in matters relating to providing a drug-free workplace.
(Prior code § 26.185)