The following words, terms and phrases, when used in this chapter, shall have the meanings ascribed to them in this section, except where the context clearly indicates a different meaning:
"AFD EMS patient transport"
means AFD ambulance transports of previously unevaluated patients. EMS transports may be of patients that are considered either emergent or non-emergent. Providers or patients that call 911 for response and service shall be considered to be AFD EMS transports.
"Ambulance service"
means a service which provides ground transportation to persons who require medical monitoring, and does not include stationary emergency aid services at a particular location.
"Anchorage Area Wide EMS or AAWEMS"
means response apparatus and transport ambulances belonging to Anchorage Fire Department (AFD), Girdwood Volunteer Fire and Rescue Department (GVF&R), and Chugiak Volunteer Fire and Rescue Department (CVF&R).
"Dispatch"
means the receipt of a request for ambulance service or the arrangement for a licensee to fulfill a request for ambulance service.
"Emergency"
means:
1. 
Patients not previously evaluated by a qualified healthcare professional (QHP), including patients who have been treated for an existing problem but who develop new, acute symptoms which have not been evaluated previously by a QHP.
2. 
Any patient condition which could reasonably lead to loss of life or limb or could cause the person significant harm if not treated immediately by a QHP.
"Fire chief"
means the chief of the Anchorage Municipal Fire Department or designee.
"Licensee"
means a person who is in possession of a current and valid ambulance service license issued to pursuant to this chapter.
"Non-emergency call"
means a request for an ambulance to transport or assist patients that would not constitute a 9-1-1 emergency call.
"PAS patient transport"
means private ambulance service transports of patients who meet the eligibility criteria in Section 2.0, and are deemed stable for the duration of the transport, or have a medical escort, and require medical monitoring, and the use of any other method of transportation is contraindicated.
"Patient"
means a person who requires medically monitored transport by an ambulance service.
"Private ambulance service or PAS"
means a service which provides ground transportation to persons who require medical monitoring and does not include stationary emergency aid services at a particular location.
"Qualified healthcare professional (QHP)"
means a physician, nurse practitioner, certified nurse specialist, physician assistant, or other health care professional who is qualified by education, training, licensure/regulation (when applicable) and facility privileging (when applicable) who performs a professional service within their scope of practice and independently reports that professional service.
"Registered nurse (RN)"
means a nurse who has graduated from an accredited nursing program and met the requirements outlined by the State of Alaska Board of Nursing to obtain a nursing license (AS 08.68). An RN's scope of practice is determined by legislation and is regulated by a professional body or council. (Regulations 12 AAC 44)
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
It is unlawful for any person to provide nonemergency ambulance service within the municipality unless that person is in possession of a valid private ambulance service license issued in accordance with this chapter.
B. 
It is unlawful for any person other than the Anchorage Fire Department to provide emergency ambulance service within the municipality.
C. 
It is unlawful for a licensee to provide or to allow another person to provide ambulance service under the authority of his or her license in any manner not in strict compliance with this chapter.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
A person may apply for one of three different licenses under this chapter:
1. 
Type I License authorizes private ambulances to transport previously evaluated patients, including critical care, emergent, and all Type II and III transports.
2. 
Type II License authorizes private ambulances to transport previously evaluated patients requiring Advanced Life Support and all Type III transports.
3. 
Type III License authorizes private ambulances to transport previously evaluated patients requiring Basic Life Support only and patient transports with an accompanying medical escort team.
B. 
A person can change the type of license they hold to another type by following the procedures and paying the fee(s) set forth in section 16.100.030. No refund will be issued for downgraded licenses.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
An application for a private ambulance service license shall be made to the fire chief on an approved form and shall be accompanied by the following:
1. 
The fee pursuant to section 16.100.150.
2. 
Proof of insurance for all vehicles to be operated as ambulances pursuant to the license as required by section 16.100.100.
3. 
A complete list of the name, address, email address, and telephone number for every person who shall have a financial or proprietary interest in the license or licensee.
4. 
Proof that the applicant is at least 18 years of age.
5. 
Proof of current business license.
6. 
Proof that the personnel required to operate the ambulance service by section 16.100.090 are available as of the effective date of the license.
7. 
Proof that the applicant has acquired and installed the equipment that section 16.100.080 requires to be aboard each vehicle to be operated as an ambulance as of the effective date of the license.
8. 
Identification of the EMS Medical Director required by section 16.100.090.
9. 
Identification of the vehicles to be operated as ambulances by vehicle registration number, VIN number, make, model and year, proof that both the body and mechanics of each of them are in good repair, and proof that the applicant is lawfully entitled to use those vehicles for the purpose of an ambulance service.
10. 
All new or used ambulances purchased after [July 27, 2021], or ambulance remounts completed after that date, shall be certified as meeting one or more of the following nationally recognized standards for ambulance design. These standards include the most recent published version of the U.S. Department of Transportation Federal Specification for Star-of-Life Ambulances (KKK-A-1822), the Commission on Accreditation of Ambulance Services Ground Vehicle Standard (CAAS-GVS), or the National Fire Protection Association Standard for Automotive Ambulances (NFPA 1917).
11. 
A complete description of the ambulance markings and color scheme to be used in compliance with section 16.100.070.
12. 
Proof of current registration with the state as an emergency medical service ground ambulance service.
13. 
Proof of prior approval of standing orders by the emergency medical service board.
14. 
Initial applicants will be required to submit a copy of their business plan.
B. 
The fire chief shall issue a license if the applicant complies with all the requirements of subsection A of this section and is certified as required by section 16.100.035, unless good cause exists for denial. A license issued pursuant to this section is nontransferable and shall be valid for one year unless revoked or suspended pursuant to section 16.100.200.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
Upon receipt of an application which meets the requirements of section 16.100.030, the fire chief shall determine whether the applicant is in compliance with the specific laws or municipal regulations administered and enforced by the chief fiscal officer. The chief fiscal officer or designee shall determine whether the applicant owes any taxes, assessments, judgments or bills for collection in connection with the business or activity for which a license is sought. If no such obligations are outstanding, the chief fiscal officer shall so certify.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
A licensee may operate multiple vehicles as ambulances so long as each such vehicle is operated in compliance with all of the requirements of this chapter at all times that it is in service as an ambulance.
B. 
Whenever a licensee removes a vehicle from service as an ambulance, they shall notify the fire chief of the reasons for such action within six hours thereafter. In the absence of such notice, a vehicle shall be considered to be in service for the purpose of enforcing this chapter. Once removed from service, a licensee shall not again use a vehicle as an ambulance unless the fire chief has first approved such use.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
Patients will be categorized as either AAWEMS or PAS transport eligible. Patients that meet criteria outlined in subsection A, B, or C will be deemed PAS transport eligible:
A. 
Pre-evaluated by a physician, physician assistant, nurse practitioner, or registered nurse within a 72-hour period for the same medical condition without onset of new symptoms, degradation in condition, or an acute change in the patient's status requiring additional evaluation or immediate lifesaving treatment.
B. 
The patient has a diagnosed or confirmed pre-existing medical condition (i.e. quadriplegic/paraplegic, other debilitating condition, or palliative care) that meets medical necessity for requiring medically monitored stretcher transport to a routine scheduled appointment at a doctor's office or clinic, or is moving between extended care facilities, Assisted Living Facilities, or private residences or hospital-affiliated hotels and extended stay motels.
C. 
Psychiatric patients or any patient diagnosed with or being treated for or suffering from a mental disability which requires or may require physical restraints and medical monitoring.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
A private ambulance service shall be available to transport patients at all times of every day without exception.
B. 
A private ambulance service may transport patients only as follows:
1. 
Transport of a person between hospitals;
2. 
Transport of a person between a nursing home, skilled nursing facility, assisted living facility, or a hospital and a location approved in advance and eligible for PAS transport;
3. 
Transport of a person to or from a hospital or private residence;
4. 
Transport of a person between a hospital and an airport;
5. 
Transport between a private residence and another location when such transport is approved in advance and eligible for PAS transport;
6. 
Transport between a hospital and a medical clinic;
7. 
Transport of a neonatal patient and equipment along with a neonatal intensive care team; and
8. 
Transport of patients for whom the fire chief requests transportation.
C. 
A private ambulance service shall not discontinue service without prior notice to the fire chief at least 90 days in advance of such action.
D. 
A private ambulance service shall always operate in strict accordance with standing orders previously approved by the emergency medical service board as defined in section 16.95.025.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
It is unlawful for any person other than the fire chief to dispatch a vehicle used as an ambulance within the Municipality of Anchorage.
1. 
Once a private ambulance has been dispatched by AFD, it is their responsibility to coordinate patient movement details directly with the requesting facility, agency, or individual.
2. 
Private ambulance services will contact AFD dispatch immediately if any dispatched patient status changes outside the scope of section 16.100.045.
B. 
It is unlawful for any private ambulance service to respond to an emergency call within the Municipality of Anchorage, except as outlined in section 16.100.230, Emergency and Disaster Operations.
C. 
Private ambulance services are licensed to operate for the provision of pre-evaluated patient transports as outlined in section 16.100.050.
D. 
Any patient transport requests originating with AFD dispatch will be dispatched to Type I, Type II, or Type III licensed ambulances for non-emergency service by use of a rotation system unless the person requesting service designates a particular ambulance service. The fire chief shall determine which patients can be transported by a private ambulance service.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
Every private ambulance shall bear the trade name under which it is operated on each side of the vehicle by use of permanent letters no less than four inches high.
B. 
Every private ambulance shall bear its vehicle number, as assigned to it by the fire chief, on all four sides of the vehicle by use of permanent letters no less than four inches high.
C. 
Every private ambulance shall use a distinctive and unique color scheme.
D. 
It is unlawful to transfer ownership of a vehicle which has been used as a private ambulance until all markings, signs and insignia and the color scheme associated with the ambulance service have been removed, unless such vehicle is transferred as part of a transfer of the ambulance service itself.
E. 
Every private ambulance shall have "if emergency call 911" language on back and sides, and must display "star of life" symbol.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
Generally. A licensee shall ensure that all private ambulances operated pursuant to their license:
1. 
Meet the equipment standards established by state law for a certificated emergency medical service.
2. 
Are equipped with a fully operational two-way radio communications system capable of using the emergency medical service radio frequency as designated by the State of Alaska and the fire chief.
B. 
Cell phones. A licensee shall ensure that all personnel assigned to work on an ambulance are in possession of a cell phone or other electronic device approved by the fire chief.
C. 
Use of emergency signals. It is unlawful for a licensee to operate on an ambulance any lights, sirens or audible signal which is commonly understood to be an emergency signal or for a licensee to permit another person to do so, unless the particular ambulance service transport for which such signal is used originated in an area outside of the municipality, unless approved by the fire chief.
D. 
Each private ambulance must have an AFD approved automatic vehicle location ("AVL") system for each permitted ambulance.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
Ambulance staff. Each private ambulance shall be staffed in accordance with 7 AAC 26.230b(2).
All ambulance vehicle operators shall participate in and successfully complete a recognized emergency vehicle driver's safety program approved by the municipal fire chief within 45 days of their hire.
B. 
EMS medical director. Each ambulance service shall have an EMS medical director whose duties shall include the following:
1. 
Review all run reports on a monthly basis and send a quarterly letter to the fire chief certifying monthly review.
2. 
Provide a set of standing orders for ambulance personnel for approval by the emergency medical service board of the municipality and ensure that ambulance personnel perform services only within the scope of their respective certificates and licenses issued under state law.
3. 
Develop an educational program for teaching and using the standing orders as approved by the emergency medical service board, teaching medical skills and updating medical knowledge; and develop an educational curriculum for all personnel to review run reports, discuss specific medical topics, and review basic medical skills. Educational review should occur at least quarterly.
4. 
Verify current certification or licensing of ambulance personnel pursuant to state law.
5. 
Ensure that all medical equipment required by this chapter is always carried on an ambulance in good working order.
6. 
Be reasonably available to give medical advice to the licensee and name a temporary physician to serve as a physician sponsor during any absence for more than three consecutive days.
7. 
Maintain a current license as a state physician, including maintaining continuing medical education requirements required by the state in order to remain licensed to practice medicine in the state.
8. 
Carry professional liability insurance, which includes coverage for the duties of a physician sponsor as defined in this chapter.
9. 
Provide a quarterly report, educational review and medical operations review of the licensee's ambulance service to the emergency medical service board.
(AO No. 85-71; AO No. 95-12(S-1), § 1, 6-6-1995; AO No. 2021-63, § 1, 1-1-2022)
A. 
Before any license is issued for an ambulance service, the applicant shall furnish one or more policies or certificates of insurance issued by an insurance company authorized to do business in the state for the following coverage for each vehicle to be operated as an ambulance:
1. 
Worker's compensation and employer's liability insurance as required by state law.
2. 
Commercial general liability insurance and:
a. 
Products/completed operations;
b. 
Personal and advertising injury;
c. 
Each occurrence; and
d. 
Medical payments.
3. 
Commercial automobile liability insurance, to include owned, non-owned and hired vehicles.
4. 
Excess liability insurance.
5. 
Professional liability (medical malpractice) insurance covering all physicians and emergency medical technicians.
6. 
Cyber/privacy liability insurance. The cyber coverage shall include, but not be limited to, claims involving invasion of privacy violations (including HIPPA), information theft, and release of private information. The policy shall provide coverage for breach response costs as well as regulatory fines and penalties as well as credit monitoring expenses.
7. 
With the exception of workers compensation and professional liability each policy shall name the municipality as an "additional insured" and the actual policy endorsement shall accompany each certificate of insurance.
8. 
General liability, workers compensation, and automobile policies shall be endorsed to waive all rights of subrogation against the municipality of anchorage by reason of any payment made for claims under the above coverage. This policy endorsement shall accompany each certificate of insurance.
9. 
All policies for general liability shall be primary and noncontributing with any insurance that may be carried by the municipality.
10. 
If the contractor maintains broader coverage and/or higher limits than the minimums shown above, the municipality requires and shall be entitled to the broader coverage and/or the higher limits maintained by the contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the municipality.
B. 
The policy of liability insurance shall be approved as to substance and form by the risk manager for the municipality and filed with the fire chief.
C. 
Every insurance policy or certificate shall contain a clause obligating the insurer or surety to give the fire chief written notice no less than 30 days before the cancellation, expiration, nonrenewal, lapse or other termination of such insurance. A lapse, cancellation, expiration, nonrenewal or termination of insurance coverage shall work an automatic suspension of any license for so long as the licensee is without insurance as required by this section. It is unlawful to provide private ambulance services with a vehicle not insured as required by this section.
D. 
A complete schedule of private ambulance service insurance requirements shall be available for inspection at the fire chief's office.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
The fire chief shall designate a place in the interior of all private ambulances for the posting of a notice stating insurance liability limits and applicability. No person may provide private ambulance service with a vehicle unless this notice is properly posted therein.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
Every licensee shall maintain current and accurate vehicle and medical reports for each patient transported in accordance with AS 18.08.015 and a patient information system or in a format approved by the fire chief.
B. 
The records maintained pursuant to subsection A of this section, as well as any other records related to the operation of an ambulance, shall be retained by the licensee, and shall be made available upon request of the fire chief. The fire chief may require that the licensee forward some or all such records on a periodic basis.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
At least one time each year all MOA licensed PAS ambulances shall undergo a mechanical inspection. MOA licensed PAS ambulances shall be made available for inspection upon demand of the fire chief. Records shall also be made available upon request of the fire chief.
B. 
The owner of an ambulance vehicle shall immediately notify AFD dispatch of any damage or injuries in addition to Alaska State Motorized Vehicle reporting requirements.
C. 
The fire chief may prohibit the operation of a vehicle as an ambulance if determined that it does not comply with the requirements of this chapter or is otherwise unsafe. No person may operate such a vehicle until the fire chief approves such use in writing.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
An ambulance service shall restrict its use of the emergency medical radio frequency designated by the fire chief for communication directly related to the operation of the ambulance service activity. An ambulance service shall immediately cease or modify radio transmissions of any nature upon municipal fire department emergency requests.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
License. Each Type I, II, and III ambulance service shall pay an appropriate fee to the municipality at the office of the fire chief for the issuance or annual renewal of any ambulance service license.
B. 
Patient transport. Each ambulance service shall pay a fee for each patient transport, to be paid on a quarterly basis. This fee will be assessed for each patient transported within the Municipality of Anchorage.
C. 
Schedule of fees. A complete schedule of ambulance service fees shall be available for inspection at the fire chief's office.
D. 
Annual review and public notice. Fees shall be reviewed annually and modified as necessary by the fire chief. Any increase in fees will be made available for public inspection in a report to the assembly.
(AO No. 85-71; AO No. 2001-145(S-1), § 15, 12-11-2001; AO No. 2021-63, § 1, 1-1-2022)
A. 
A licensee is under continuing obligation to keep the information on the application current. Failure to do so shall be a violation of this chapter. A licensee shall give written notice to the fire chief of any change to be made on the application within ten days, and the fire chief shall amend the application accordingly.
B. 
No person may knowingly make a false or misleading statement on the application for a license under this chapter.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
An ambulance service license issued pursuant to this chapter shall be valid for one year from the date of issuance and shall expire automatically if an application for renewal is not received by the fire chief at least ten days before such date.
B. 
All ambulance services licenses will renew March 1 of each year.
1. 
Fees may be prorated for the first year.
2. 
Additionally, renewal expiration dates may be extended up to 18 months from last renewal to realign with the March 1 renewal date.
3. 
Applications are due February 1st of each year. Late submissions may be charged an administrative late fee.
C. 
An application to renew an ambulance service license shall be made to the fire chief in the same manner as an original application and shall be treated in the same manner as an original application.
D. 
If a licensee is no longer qualified to hold the license at the time of renewal, the fire chief shall not renew the license and it shall lapse and become ineffective.
E. 
Any person who has forfeited a license pursuant to this chapter may not apply for a new license for a period of one year thereafter.
F. 
A complete schedule of ambulance licensure fees shall be available for inspection at the fire chief's office. Any increase in fees will be made available for public inspection in a report to the assembly.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
In addition to any other penalty specifically provided in this chapter, the violation of any provision of this chapter or a municipal regulation promulgated under this chapter shall be a misdemeanor, and any person convicted of such a violation shall be subject to a fine.
B. 
In addition to any other remedy or penalty provided by this section, a person who violates a provision of this chapter or a municipal regulation promulgated under this chapter shall be subject to a civil penalty for each offense, injunctive relief to restrain the person from continuing the violation or threat of violation, revocation of private ambulance service license, or both such civil penalty and injunctive relief. Upon application by the municipality for injunctive relief and a finding that a person is violating or threatening to violate a provision of this chapter or a municipal regulation promulgated under this chapter, the superior court shall grant injunctive relief to restrain the violation.
C. 
Each day during which a violation described in this section occurs shall constitute a separate offense.
D. 
A complete schedule of ambulance service penalty fees shall be available for inspection at the fire chief's office. Any increase in fees will be made available for public inspection in a report to the assembly.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
If a licensee is convicted or otherwise found liable by a court of competent jurisdiction for violation of a provision of this chapter or a municipal regulation promulgated pursuant to this chapter, the applicable license shall be automatically suspended or revoked, in addition to the criminal or civil penalty imposed, in accordance with the following schedule commencing on the date of court action:
1. 
First violation: 30-day suspension of license or permit.
2. 
Second violation: 60-day suspension of license or permit.
3. 
Third violation: Revocation of license or permit.
The licensee shall tender physical possession of the ambulance license to the fire chief within 24 hours after the court action is entered on the records.
B. 
Violation of the terms of a suspension or revocation imposed pursuant to this section is a separate violation of this chapter.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
If the fire chief determines that an application for an ambulance license does not meet the requirements of this chapter, the fire chief shall deny the application. The fire chief shall issue a written decision to the applicant, which shall state the specific reasons for that denial.
B. 
A person aggrieved by the denial or revocation of an ambulance license by the fire chief pursuant to this chapter may take an appeal to the Superior Court, Third Judicial District, no later than 30 days following issuance of that decision. Review by the court shall be limited to determining that the decision of the fire chief is supported by substantial evidence.
(AO No. 85-71; AO No. 2021-63, § 1, 1-1-2022)
A. 
In the event of a declared disaster or other local emergency, the ability of the AFD to provide necessary prehospital emergency ambulance care and transportation may be disrupted or be inadequate for the number of casualties. It is necessary, therefore, that private ambulances permitted in the municipality be available to assist with medical needs when there is a declared disaster or other local emergency. In these events, the fire chief will determine the amount of assistance needed, determine accessible acceptable ambulance staffing and configuration, and may authorize the dispatch of any ambulance as permitted by law. Each private ambulance service shall make available any in-service rigs immediately and will recall personnel to make all permitted units staffed and available within four hours at the request of the fire chief. The fire chief shall coordinate all medical assistance requests through the AFD Dispatch, when applicable.
1. 
For local emergencies, the fire chief will bill for all emergency runs dispatched by AFD at AFD rates and reimburse the ambulance provider based on the actual amount collected.
2. 
For declared disasters, the fire chief may also, in their discretion, assist ambulance providers in seeking reimbursement based on each disaster's applicable reimbursement guidance.
B. 
When invited by the fire chief, the PAS's may participate in annual municipally-organized disaster exercises. Costs associated with their participation may be reimbursed if funding is available.
(AO No. 2021-63, § 1, 1-1-2022)
Private ambulance services licensed under this chapter shall provide and document training on the statutory requirements of this chapter as follows:
A. 
Initial training for new employees within 30 days from the effective date of hire.
B. 
Annual training for all employees.
(AO No. 2021-63, § 1, 1-1-2022)