For the purpose of this chapter, the following definitions shall apply:
“Advanced life support”
patient care means invasive patient care requiring the advanced skills of paramedical personnel, as defined in Chapter 35.103.020 RCW, before and during transport.
“Ambulance”
means an emergency vehicle designed and used to transport the ill and injured and to provide personnel, facilities, and equipment to treat patients before and during transport.
“Ambulance service” or “ambulance company”
means an organization that operates one or more ambulances.
“Basic life support”
patient care means non-invasive patient care requiring the skills of emergency medical technician-level personnel, as defined in Chapter 18.73 RCW, and not those skills and procedures possessed by paramedical personnel.
“Emergency medical services (“EMS”)”
means medical treatment and care which may be rendered at the scene of any medical emergency or while transporting any patient in an ambulance to an appropriate medical facility, not to include ambulance transportation involving patient care for which paramedics are not qualified.
“Emergency medical transportation”
means the process of driving a patient in an ambulance or alternate emergency vehicle from the scene of an incident, who received Basic Life Support or Advanced Life Support, to an appropriate medical facility.
“Lead agency”
means the agency which is charged with the responsibility to provide or ensure provision of emergency medical services within the City.
“Paramedic”
means an individual who has, at a minimum, successfully completed an Emergency Medical Technician (“EMT”) training course, has been trained under the supervision of an approved EMS medical program director to carry out all phases of pre-hospital advanced life support under written or oral authorization of one or more delegated supervising physicians, and has been examined and certified as a paramedic by the Washington State Health Department or the University of Washington’s school of medicine under RCW 18.71.205.
“Patient”
means an individual receiving medical care.
“Transport”
means an ambulance or alternate emergency vehicle takes a patient from the scene of an incident to an appropriate medical facility.
(Ord. 28702 Ex. B, 2020-11-24)
It shall be unlawful for any person to engage in the business of ambulance service to carry or transport any sick or injured persons from the scene of any accident, disaster, home, building, or other place within the corporate limits of the City without first obtaining all licenses required by Chapter 18.73 RCW and meeting all minimum requirements promulgated pursuant to RCW 18.73.081 and in the Washington Administrative Code.
(Ord. 28702 Ex. B, 2020-11-24)
Ambulance companies routinely operating within the corporate limits of the City must obtain an annual certificate of approval from the Washington State Health Department. The issuance of this certificate is based on ambulance companies meeting all minimum state ambulance requirements and the Ambulance Rules and Regulations as enacted by the state Board of Health.
(Ord. 28702 Ex. B, 2020-11-24)
The Tacoma Fire Department shall be the lead for emergency medical service in the City and those jurisdictions for which it has assumed such contractual responsibility. The Tacoma Fire Department shall be the primary provider of emergency medical services at the first response Basic Life Support and Advanced Life Support levels within the corporate limits of the City and for those jurisdictions for which the Tacoma Fire Department retains contractual responsibility. The Tacoma Fire Department shall also provide Advanced Life Support and Basic Life Support patient transport for emergency medical services within these areas if Fire Department units are available. Patient transports may be distributed through contractual agreement or other method chosen by the Tacoma Fire Department.
(Ord. 28702 Ex. B, 2020-11-24)
The City may contract with a private ambulance service provider or providers for basic life support services at rates and under conditions approved by the City Council. Such contract or contracts may provide, in addition, for such Advanced Life Support services to be provided by a private service provider or providers as the City may require as supplemental to City services.
(Ord. 28702 Ex. B, 2020-11-24)
The following procedures are established for patient transport service to users of the City Fire Department Advanced Life Support (“ALS”) patient transport service and Basic Life Support (“BLS”) patient transport service:
A. 
Charges to be made.
1. 
Transport. All persons who are transported by a City Fire Department ambulance shall be charged for all services at the rates as set by ordinance of the City Council, as amended from time to time, provided that the Tacoma Fire Department may adjust the charges yearly for any cost-of-living adjustment (“COLA”) increases as measured by the Consumer Price Index, Pacific Cities and U.S. City Average for the Seattle-Tacoma-Bremerton areas. Rates for services and supplies shall be set to provide for recovery of actual costs based upon an average charge, which will be reviewed biennially. Each person transported will be billed for all services provided. EMS members and nonmembers will be billed at the same rate.
2. 
Treatment and non-transport. All persons who receive medical treatment by the Tacoma Fire Department and, who after treatment, decline transportation to a local hospital may be charged a non-transport fee. EMS members and nonmembers will be billed at the same rate. The base rate shall be subject to biennial COLA increases in the same manner as the transport rates set forth in Subsection 1 above.
B. 
EMS membership benefits. By reason of special property tax levies for certain emergency medical services which are levied against property within the corporate limits of the City or are levied against property within the corporate limits of a jurisdiction for which the City has assumed contractual EMS responsibility, each resident of the City and of those contractual jurisdictions signing (by recipient or authorized representative) an EMS Membership form containing an affirmation of City residency and an assignment of benefits to the City, together with an appropriate release of medical information, shall become an EMS member and be eligible for membership benefits as herein provided. An EMS member receiving BLS or ALS treatment and/or transport by the City Fire Department shall be deemed to have paid (by reason of the special levy) that portion of the charges incurred which is not payable by third parties and insurers, including, but not limited to, any insurance or medical benefits of any nature available to such member. This EMS membership benefit of coverage of charges in excess of available insurance or medical benefits shall cease when or if:
1. 
A member ceases to be a resident;
2. 
A member refuses to provide requested information pertaining to third party coverage or to provide appropriate releases of information and assignment of benefits to the City on forms provided by the City; or
3. 
Such EMS membership benefit is limited or extinguished by amendment or repeal of this Chapter.
C. 
Nonmembers. Persons receiving BLS or ALS treatment and/or transport by the City Fire Department who are not eligible for an EMS membership shall be required to pay all charges incurred. Where practical, the City, in accordance with procedures to be approved by the Fire Chief, will, with the authorization of a nonmember receiving transport services, first seek payment of charges incurred from such nonmember’s insurance or other medical benefit provider, but such nonmember shall remain fully responsible for any amount due which is not paid by such third parties.
D. 
Medicare and Medicaid. Eligible recipients of Medicare and Medicaid benefits shall be charged as the result of BLS or ALS treatment and/or transport by the City Fire Department at only the maximum rate allowed under the Medicare and Medicaid federal programs, and the City shall accept as payment under the Medicare and Medicaid programs only such maximum amount as the City may collect pursuant to the applicable requirements and guidelines of the Medicare and Medicaid programs.
E. 
Compliance with medicare and medicaid requirements. This chapter and charges for ambulance services hereunder shall be construed and implemented in a manner consistent with applicable requirements of the Medicare and Medicaid programs.
(Ord. 28702 Ex. B, 2020-11-24; Ord. 28919 Ex. A, 2023-12-05; ratified and reconfirmed by Ord. 28942, 2024-01-16)
It shall be the policy and practice of the City to discourage the use of the 911 emergency system to dispatch personnel of the Tacoma Fire Department or its contractors and partners for non-emergency patient lift assistance at licensed care facilities.
A. 
Definitions. For the purpose of this section, the following terms, phrases, words, and their derivations shall have the meanings given:
“Licensed care facility”
means a Washington State licensed care or nursing facility, such as a skilled nursing facility, or an assisted living facility. A registered adult family home is not included in the definition of a licensed care facility.
“Lift assist”
means a response by a fire department emergency response unit or the emergency response unit of a private contractor of the City or the unit of another public safety department providing automatic or mutual aid to the City to a state licensed care or nursing facility for the purpose of lifting a fallen patient to a pre-fall position.
“Non-emergent/emergency”
means a determination, based upon an assessment by the commanding officer of the emergency response unit, that there is not an emergent medical condition or medical necessity justifying the presence of the emergency unit at the facility.
B. 
Determination of non-emergent lift assist. Based upon the assessment undertaken by the commanding officer of an emergency response unit dispatched to a licensed care facility and their determination that no emergent medical condition or emergent medical necessity exists, but the staff of the facility desires that emergency response personnel complete a lift assist of a fallen patient, the officer shall declare the incident a non-emergent lift assist in their incident report.
C. 
Assessment of penalty. The Fire Chief, or designee, shall be authorized to issue a penalty charge for each incident determined to be non-emergency lift assist at licensed care facilities.
D. 
Administrative decision. Notice of the imposition of penalty charges under the provisions of this section shall be sent to the owner or management of the facility where the incident occurred; provided that, with respect to business premises, the owner, manager, or chief administrative agent regularly assigned and employed on the premises at the time of the occurrence shall be presumed to be the appropriate person to receive the notice, unless the City is notified otherwise.
E. 
Waiver of imposition. In the event the Fire Chief, or designee, determines that City’s assessment or determination was in error or there were other mitigating facts which the commanding officer did not possess at the time of the incident, the Fire Chief, or designee, may waive imposition of the applicable penalty(ies).
F. 
Appeal from administrative decision. Any party subject to a penalty under the provisions of this section shall have a right of appeal to the Fire Chief, or designee. A notice of appeal must be submitted in writing no later than ten days after issuance of the notice of the penalty and must be directed to the Fire Chief, at the address listed on the notice of penalty. The written appeal should include the penalty reference number and the party’s reasoning why the determination of notice of non-emergency lift assist should be reconsidered. Within 30 days of receipt of a written appeal, an impartial review of the appeal shall be completed and a recommendation shall be presented to the Fire Chief, or designee, for final decision, which will be reported to the appellant in writing. Unless a notice of appeal is properly filed in accordance with this section within ten days of the issuance of notice of penalty, said penalty is deemed final.
(Ord. 28702 Ex. B, 2020-11-24)