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14511h� � O n Ln b N 0 v In i ORDINANCE NO. 14,511 405 AMBULANCE ORDINANCE REPEALING ORDINANCE 14,062 and 14,087 OF THE LITTLE ROCK CODE OF GENERAL ORDINANCES RELATING TO HEALTH AND SANITATION BY REPEALING CHAPTER 5 THEREOF ENTITLED, "AMBULANCES" AND ENACTING IN LIEU THEREOF A NEW CHAPTER 5 ENTITLED "AMBULANCE SYSTEM CODE "; AND FOR OTHER PURPOSES. NOW, THEREFORE, BE IT ORDAINED BY THE BOARD OF DIRECTORS OF THE CITY OF LITTLE ROCK, ARKANSAS. SECTION 1. REPEAL AND ENACTMENT That Chapter 5, relating to the regulation of ambulances, and by enacting in lieu thereof a new Chapter 5 entitled "Ambulance System Code" containing the following new or revised numbered sections. SECTION 2. PURPOSE AND GENERAL INTENT A. Purpose. It is the purpose of this Ordinance to establish a regulated ambulance service system that can provide each ambulance patient with the best possible chance of survival without disability or preventable complication. B. General Intent. It is the intent of the Board of Directors of the City of Little Rock: 1. That exclusivity is mandatory because it is neither fair nor financially feasible to require a high level of emergency performance from one ambulance company while simultaneously allowing other ambulance companies to select certain preferred nonemergency business. 2. That substantive regulation requiring clinical excellence and city wide lifesaving response time performance cannot reasonably be imposed on an unsubsidized ambulance company without simultaneously granting that ambulance company an exclusive contract to furnish all ambulance service, both emergency and nonemergency, to residents of the City. 3. That the Ambulance Authority, after bid procedures, shall select a private ambulance company for an exclusive contract to provide ambulance personnel to operate the ambulance services in the City of Little Rock. The ambulance company shall provide the ambulance personnel necessary to operate the equip- ment owned by the Ambulance Authority and to provide those management functions delegated to it under contract by the Ambulance Authority. The Ambulance Authority shall own, or serve as primary lessee of, all ambulance and communication equipment, do all billings and collections, and shall provide all administrative oversight for the ambulance service system. 4. That this ambulance Ordinance, which is consistent with the Arkansas Municipal Ambulance Licensing HM. Act, will: a. Furnish bona fide monitoring and medical control of present ambulance operations as soon as possible. b. Allow the City to contract with the Arkansas Emergency Physicians' Foundation to develop written medical standards, protocols, controls, audits, and system evaluation and to provide complete medical control over and evaluation of the Little Rock ambulance service system. C. Require the development of a first responder program. d. Require the Ambulance Authority to fully implement and make the Little Rock ambulance service system authorized and established under this Ordinance operational no later than twelve (12) months after this Ordinance is effective. 5. That the Ambulance Authority shall be required: a. To designate a single EMS Control Center in the city or county from where all ambulance dispatching shall take place. b. To designate and contract with one of Little Rock's hospitals to perform the "telephone patch" function relative to medical control. C. To purchase an appropriate complete UHF communication and recording system. d. To design the communication system, control center and "telephone patch" operation to allow for full - time recording of all ambulance related radio and telephone traffic. SECTION 3. DEFINITIONS A. General Definitions. For the purpose of this Ordinance, the following terms, phrases, words and their derivations shall have the meaning given herein. When not inconsistent with the context, words used in the present tense include the future, words used in the plural include the singular and words used in the singular include the plural. The words "include ", "including" or other similar words of inclusion shall mean without limitation or restriction. The word "shall" as used herein is not merely directory but is considered mandatory. B. Specific Definitions. Unless otherwise specified, the following terms are defined as follows: 1. Ambulance means any motor vehicle equipped with facilities to convey infirm or injured persons in a reclining position. 2. Ambulance Authority (Authority) means the "City of Little Rock, Arkansas Emergency Medical Health Care Facilities Board" established by the City. 3. Ambulance Contractor (Contractor) means the private ambulance company that contracts with the Authority 40� to provide ambulance services to the City under the exclusive contract method. 4. Ambulance District means any of the geographic sub- divisions of the City and other contracted areas established for ambulance service planning and evaluation purposes by the Ambulance Authority. 5. Ambulance Patient means any person who is ill, infirm, injured or otherwise incapacitated, bedridden or helpless and requires and /or requests ambulance service or helicopter rescue service to or from a hospital, physician's office, nursing home or other health care facility. 6. Ambulance Personnel means paramedics, emergency nurses, emergency medical technicians, dispatchers and drivers. 7. Ambulance Run means a patient transport by ambulance or helicopter rescue unit on a for hire fee for service or prepaid capitation basis. 8. Ambulance Service means any business or service established to transport patients from one place to another within the City or other contracted areas by an ambulance or a helicopter rescue unit. 9. Arkansas Emergency Physicians' Foundation (AEPF, INC.) means the nonprofit professional and charitable organization composed of licensed physicians, a majority of whom are regularly engaged in the full - time professional practice of emergency medicine. 10. Base Station Nurse means a nurse licensed by the Arkansas Board of Nurse Examiners under Arkansas law, and certified by the License Officer as a base station nurse. 11. Base Station Physician means a physician licensed under the Arkansas Medical Practices Act, and certified by the AEPF, INC. 12. City means the City of Little Rock, Arkansas. 13. City Directors means the Board of Directors of the City of Little Rock, Arkansas. 14. County means Pulaski County, Arkansas. 15. Dispatcher means any person certified by the License Officer to work in the ambulance control center and dispatch ambulances. 16. Driver means any person who is certified by the License Officer to drive ambulances in Little Rock. 17. Emergency Medical Technician (EMT) means any person certified by the State of Arkansas as an Emergency Medical Technician and certified by the License Officer. 18. Emergency Nurse (EN) means a registered nurse licensed by the State of Arkansas and certified by the License Officer as an Emergency Nurse. 19. Ambulance Control Center means the facility designated by the Authority from which all ambulances are dispatched and controlled. 20. Exclusive Contract Method means the Public Utility : Model described in Definition 34. The Authority, after nationally advertised bid procedures, shall grant an exclusive contract to a private ambulance company to provide ambulance personnel to operate the ambulance services in the City and other contracted areas. The ambulance company shall provide only the ambulance personnel necessary to operate the equipment owned by the Authority and provide those management functions allowed by the Authority. The Authority shall own, or be the primary lessee of, all ambulance and communication equipment, do all billings and collections, and shall provide administrative oversight for the ambulance service system except those duties imposed by contract on the contractor. The AEPF, INC. shall provide all medical advice, medical control, medical audit and medical oversight. 21. First Responder means any person capable of providing qualified first responder emergency care as required by the AEPF, INC. 22. Intercity Patient Transport means an ambulance run which transports a patient from a point within the City to another city, or from another city to a point inside the City. An intercity patient transport in which the ambulance run does not originate in the City by an ambulance from the destination city is not subject to regulation under this Ordinance. 23. License Officer means duly authorized agent of the City Manager of the City of Little Rock, Arkansas. 24. Life Threatening Emergency means any situation posing immediate threat to human life as determined in accordance with AEPF, INC. protocols. 25. Medical Audit means an official inquiry into the circumstances involving an ambulance run or request for service. 26. Medical Director shall be a person selected by the City Manager of the City of Little Rock, Arkansas. 27. Medical Control means medical direction given ambulance personnel by a base station physician through direct voice contact. 28. Medical Protocol means any diagnosis- specific or problem oriented written statement of standard procedure, or algorithm, approved by the AEPF, INC. as the normal standard of prehospital care for that given clinical condition. Base station physicians may, for cause, deviate from approved medical protocol in a specific case where authorized deviation is warranted by special circumstance. 29. Non -Life Threatening Emergency means an emergency situation which does not pose an immediate threat to human life as determined in accordance with AEPF, INC. protocols. 403 30. Operations Contractor means the person granted an exclusive contract by the Ambulance Authority to operate the Little Rock ambulance service system. 31. Paramedic means a person certified by the State of Arkansas as a Paramedic and certified by the License Officer. 32. Person means any natural person, firm, partnership, association, corporation, company or group of individuals acting together for a common purpose or organization, or other organizations of any kind of character. 33. Personnel Certification means an official document issued by the License Officer or his designated representative indicating that the holder of the certification has been found by the AEPF, INC. to meet all requirements for certification. 34. Public Utility Model means that strategy for the organization, financing, management and regulation of an advanced life support ambulance service operation which uses, along with other essential design features, a single level of advanced life support capability to conduct all emergency and nonemergency service within a geographical area. 35. Response Time means the actual elapsed time between receipt of notification at the EMS control center than an ambulance is needed at a location and the arrival of an ambulance at that location. 36. Run Code 1 - Presumptive Designation means any ambulance service request designated as a time critical, life threatening emergency situation by a dispatcher as designated in accordance with AEPF, INC. telephone and dispatch protocols. 37. Run Code 2 - Presumptive Designation means any ambulance service request designated by the dispatcher as an emergency medical condition for which prompt response is appropriate for medical and humanitarian reasons, but which apparently involves no immediate threat to human life of a time critical nature as designated in accordance with AEPF, INC. telephone and dispatch protocols. 38. Run Code 3 - Presumptive Designation means any ambulance service request for nonemergency transporta- tion of a person whose apparent condition cannot appropriately be designated as either Code 1 or Code 2 as designated in accordance with AEPF, INC. telephone and dispatch protocols. 39. Senior Paramedic or EN in Charge means that individual among the certified personnel on board an ambulance unit who is not the driver and who is a Paramedic or EN currently certified under this Ordinance, and who is designated by his or her employer or immediate supervisor as the individual in command of the ambulance and its operation. 40. Special Use Permit means a permit issued by the Medical Director to hospitals and other institutions serving the public for the provision of specialized mobile intensive care services and emergency care to their own residents or admitted patients. 41. System Status Management means the formal and orderly l process of continuously locating ambulance units available for dispatch among post locations throughout the geographic area being served to maintain the best possible readiness configuration at all times. 42. Vehicle Permit means an official document issued under this Ordinance by the License Officer indicating that a given ambulance vehicle and its complement of on- board equipment and supplies conforms to applicable rules and regulations. SECTION 4. RECOGNITION OF CONTROL GRANT OF FRANCHISE AND LICENSE AND DIRECTIONS: _ The Authority is directed to implement a nationally advertised bid process for ambulance services on behalf of the City and is authorized to operate the Little Rock ambulance service system under the supervision and control of the Little Rock Board of Directors. SECTION 5. MANAGEMENT OPTIONS AND MANDATORY REQUIREMENTS A. Mandatory Requirements for Exclusive Contract Method. 1. The Authority shall operate, or cause to be operated, an ambulance service system for Little Rock, Arkansas and for neighboring areas, if appropriate contractual relationships can be developed with those neighboring areas for the equitable sharing of equipment costs, operating costs, medical costs, control and audit costs and management costs. The service operated by the Authority shall have the following characteristics: a. The services rendered must at all times be in compliance with the provisions of this Ordinance. b. All emergency equipment utilized in this service must be owned by or leased to the Authority as primary lessee. C. All billing or collection functions, including but not limited to all legal proceedings which are necessary, shall be performed by the Authority. d. The Ambulance Authority shall be required to apply for and obtain vehicle permits from the AEPF, INC, provided that no fee shall be charged the Ambulance Authority for such permits. e. The Authority shall contract with a qualified private company for the purpose of supplying all labor and management services for the operation of its EMS control center and its direct ambulance operation, and the procurement methods utilized in securing this contract shall be of a nature that encourages competitive pricing of the contractor's services to the Authority. Provided, however, that in the event of an emergency wherein public health and safety are threatened by the poor performance of an existing contractor, or by the absence of qualified bids at reasonable prices for the performance of these services, or by the involvement or other inability to perform of a currently employed contractor, the Authority may directly operate the service system using Authority employees hired for these purposes, for a maximum period of twelve (12) months per episode. 2. The contracting person or company shall comply with all the terms and conditions of this Ordinance. 411 SECTION 6. PHYSICIAN SUPERVISION AND MEDICAL QUALITY CONTROL A. Advisory Contract with AEPF, INC. The City Manager may contract with the Arkansas Emergency Physicians' Foundation (AEPF, INC.) to provide medical advice to the Authority, and physician supervision and medical quality control over the Little Rock ambulance service system. B. AEPF, INC. 1. Powers and Duties of AEPF, INC. The powers and duties of the AEPF, INC. are generally to provide the Authority with information about the necessary elements of the Little Rock ambulance service system and to: a. Establish criteria and make recommendations concerning the issuance, renewal, suspension and revocation of all licenses, permits and certificates issued under this Ordinance. b. Establish reasonable standards of production and patient care, including standards for vehicles and on -board equipment, standards for ambulance and dispatch personnel certification. c. Make official recommendations to the Authority and to the City Directors. d. Establish medical protocols. e. Establish standards, procedures and protocols for the operation of the EMS control center. f. Establish procedures and protocols for first responder medical care. g. Establish standards and procedures governing the reliable provision of twenty -four (24) hour medical control. 2. Medical Audits. a. The AEPF, INC. shall perform medical audits when requested by the License Officer at the request of the Chairman of the Authority, the City Manager, any member of the Little Rock Board of Directors, any licensed paramedic, any licensed physician, or any member of the Ambulance Authority Board. 3. Medical Director. The Medical Director shall implement the policy established by the AEPF, INC. and upon approval of the AEPF, INC, and the Authority, may appoint an Assistant to the Medical Director who shall serve in that capacity at the pleasure of the Medical Director. 4. Annual Report. The Medical Director and the Chairman of the Authority shall make a written report to the City Directors on January 1 of each year detailing the status of the ambulance service system. 7 412 C. Radio Communication. 1. General. The Ambulance Authority and its operations contractor shall ensure that at all times its field personnel have direct access by reliable radio communications to medical consultation and direction concerning the care of patients in the field: a. To ensure that reliable medical communications exist at all times and to ensure that all medical communications are appropriately monitored for backup purposes, the Ambulance Authority shall furnish or otherwise acquire reliable medical communications system. A central medical communications coordination point shall be established at a base hospital while maintaining communications capabilities (via telephone patch) with all other receiving hospitals in the Central Arkansas area. The coordinating hospital shall be staffed at all times by a registered nurse trained in medical control procedures and medical protocols, with appropriate backup provided by base station physicians. The coordinating hospital shall adhere strictly to coordinating procedures adopted by the AEPF, INC. The coordinating system shall be designed to allow a choice to be made by each receiving emergency department as to whether it will handle its own radio calls for medical control or whether these calls should be handled, under defined conditions, by the coordinating hospital. Receiving facilities choosing to receive their own requests for medical control may do so, provided the facility is staffed at all times by an emergency physician certified by the AEPF, INC. in the radio direction of prehospital care in the Little Rock system. Distribution of the requests for medical control among the receiving facilities shall be handled in a manner developed and approved by the AEPF, INC. C. All medical control radio traffic, including phone patch communications, shall be continuously recorded by the ambulance control center and the tapes shall be regularly turned over to the AEPF, INC. for medical audit purposes. All tapes shall be retained for 120 days and may then be recycled. D. Run Reports and Audits. A copy of the approved run report form, approved by the Licensing Officer, shall be left with the emergency receiving facility to which each patient is delivered. The receiving facility physician, using a form designed for such purpose, may request a medical audit to be performed relative to the prehospital or interhopsital care of that patient. Ambulance personnel involved directly in the handling of an audited case after notification from the Medical Director shall attend the audits of that case. Failure to attend the medical audit proceedings without good cause is grounds for suspension or revocation of personnel certification by the AEPF, INC. E. Appeals Section. 1. Adverse decisions made by the AEPF, INC. conducting a medical audit may be appealed to the License Officer within thirty (30) days of the decision. 2. Any decision of the Medical Director or License Officer affecting the issuance, suspension, revocation, or denial of a license, vehicle permit, or personnel certification may be appealed by the person adversely affected by the decision to the City Directors within thirty (30) days of the decision. 3• Appeal from an adverse decision of the City Directors shall be to the court of proper jurisdiction. SECTION 7. STANDARDS OF PRODUCTION AND PERFORMANCE The operations contractor for the Ambulance Authority shall follow the following as minimum standards: Equipment and Management Capability. Each and every ambulance and helicopter rescue and all on- board equipment utilized by the contractor performing services which are the subject of this Ordinance shall comply with equipment standards specified in Section 11. Furthermore, the contractor shall maintain the equipment and shall employ sufficient backup equipment to ensure that a safe level of reserve equipment capacity is available to provide peak period ambulance coverage even at times when unusual occurrences of equipment breakdown and routine equipment maintenance coincide. The maintenance, reserve inventory and surplus equipment requirements shall be as established by rules and regulations adopted by the AEPF, INC, under this Ordinance. B. Personnel The operations contractor shall ensure (a) that two (2) persons certified under this Ordinance are on board each ambulance on ambulance runs or available for dispatch, at least one of who is certified, probationary or fully certified as a Paramedic or Emergency Nurse (EN), and the other of who is certified, probationary or fully certified, as a Paramedic, Emergency Medical Technician (EMT) or Emergency Nurse (EN); and (b) that the person who serves as the driver is certified as an ambulance driver. If only one person on board is a certified Paramedic or EN, that person shall not function as the driver. Finally, the contractor shall establish and maintain sufficient manage- ment capability to ensure that equipment and personnel utilized are managed in an efficient and effective manner to produce the desired clinical performance and response time performance on a routine basis. C. Clinical Performance. The clinical performance of the contractor and its personnel shall be consistent with standard procedures in a modern and well - managed ambulance service system and shall conform to the operating procedures and medical protocols adopted by the AEPF, INC. Where clinical performance deficiencies are discovered, the contractor shall demonstrate an aggressive and effective effort to correct the deficiencies in a timely manner. D. Response Time Performance. Response time performance standards shall be effective no later than twelve (12) months after the effective date of this Ordinance. 1. Run Code 1 Calls. 414 a. For all calls originating from within the City, and appropriately designated on a presumptive basis as Code 1 calls, the licensee shall furnish a diligent good faith effort to manage all available resources so as to achieve a four (4) minute maximum response time for a trained first responder and an eight (8) minute maximum response time for an advanced life support paramedic ambulance. As a condition of maintaining its ambulance service contract in good standing, the contractor shall employ enough personnel, acquire enough equipment and manage its resources in the manner necessary to meet the eight (8) minute response time standard on not less than ninety (90) percent of all presumptively designated Code 1 calls originating each month from within the Little Rock city limits. C. Where an ambulance unit is dispatched from a non - transporting first response only status its response time may be counted as the contractor's ambulance response time even though the patient was transported by a different ambulance. In addition, the response time of a neighboring ambulance service responding by mutual aid request may also be counted as the contractor's ambulance response time, provided the level of life support capability furnished by the neighboring ambulance service is comparable to that required under this Ordinance, as determined by the AEPF, INC., and provided that reliance upon neighboring ambulance service operators is only an occasional event and not a routine method of operation of the contractor. 2. Run Code 2 Calls. The Authority may establish standards governing Run Code 2 calls; provided their standards are not more stringent than those adopted for Run Code 1 calls. 3• Run Code 3 Calls. The contractor's response to Code 3 and Code 4 calls shall be reasonable, but in every case where a conflicting demand for resources occurs, response to Code 1 and Code 2 calls shall take precedence over requests for nonemergency transfer service. Further- more, the contractor shall display sound judgment in developing its system status management plans to preserve a safe level of emergency response capability at all times by delaying response to requests for nonemergency service until additional ambulance units become available whenever the number of remaining ambulance units available for dispatch falls below a reasonably established safe level of emergency reserve capacity, as determined by historical demand analyses. 4. Retrospective Designation. For purposes of this Subsection D, the designation of a run as Code 1, Code 2, Code 3 or Code 4 shall be made by the EMS control center personnel at the point of dispatch on a presumptive basis and no retrospective alteration of such designation shall be allowed. However, runs originally designated as Code 2 or Code 3 may be retrospectively redesignated by the License HE 415 Officer for purposes of response time calculation as more time critical run type, if the License Officer disputes the original designation and if it is the independent judgment of the AEPF, INC. that the original designation was improper, given the information available to the EMS control center personnel at the time of the presumptive designation of the run code type. 5. Exempt Calls. Certain types of calls may be excluded as specified in the contract with the Ambulance Authority. 6. Community Response Time. In addition to the response time performance standard required under Subsection 7D -1 &2 for Run Code 1 and Run Code 2 calls, the contractor shall also, as a condition of maintaining its contract in good standing, furnish and manage its resources in the manner necessary to provide reliable emergency and non - emergency ambulance service throughout the entire City and shall perform its system status management and system status planning operations so as to minimize the differences in the respective average emergency response time performances among the various ambulance districts of the City to the greatest practical extent. In addition, the contractor shall take such steps as necessary to reduce or eliminate any continuing pattern of apparent discrimination in the average response time performance to any given ambulance district or portion thereof. E. Continuous Physician Medical Control Required. Effective no later than twelve (12) months from the effective date of this Ordinance, the contractor shall be responsible for ensuring that its field personnel at all times have access to qualified medical control and direction concerning the care of patients in the field by base station physician or nurse. All medical control and direction shall be available by reliable radio communica- tions, according to the communications standards and other standards of medical control set forth in Section 6. F. Data Systems and Reporting. The operations contractor for the Ambulance Authority shall comply at all times with the data system and reporting standards approved by the Ambulance Authority. G. In- Service Training Program Required. The contractor is required to furnish or otherwise make available without charge to its employees an in- service training program which conforms to the standards for in- service training adopted by the AEPF, INC. All ambulance personnel are required to attend these in- service training programs in accordance with the guidelines promul- gated by the AEPF, INC. Fully Centralized Dispatch Required. 1. Effective no later than twelve (12) months from the effective date of this Ordinance, all dispatching movements of ambulance units subject to regulation under this Ordinance shall be directed from the designated EMS control center. It is unlawful to dispatch or control any ambulance unit subject to M regulation under this Ordinance from any location other than the designated EMS control center. At all times, the EMS control center shall have full authority to direct the positioning; movements and run responses of all manned ambulance units, and to activate on -call crews following the then current system status management procedures. Refusal to Render Emergency Care Prohibited. It is a violation of this Ordinance to fail to respond to call to provide ambulance service, to render first aid treatment as is necessary, or to otherwise refuse or fail to provide any emergency ambulance services within the scope of the ambulance operations. SECTION 8. UNLAWFUL OPERATION A. Operation Prohibited. No person shall operate an ambulance to transport the sick, injured or infirm on a fee for hire basis, regardless of whether an emergency or routine nonemergency patient transport upon any street within the corporate city limits of Little Rock, Arkansas, or other contracted areas unless allowed in accordance with the provisions of this Ordinance. B. Patient Transports Excluded. An ambulance service license shall not be required for ambulance services which are: 1. Owned and operated by an agency of the United States government. 2. Rendering requested assistance to ambulance currently licensed in cases of disaster or major emergency too great for local resources, or in response to provisions of a written "mutual aid agreement" approved by the Ambulance Authority. 3. Engaged in intercounty or intercity patient transport to or from facilities within the City but originating anywhere outside the City. 4. Rendering ambulance services under an exclusive contract with the Authority as defined in Section of this Ordinance. 5. Private companies which use an ambulance solely for the transportation of their employees for illness or injury sustained while performing their work. b. Operating a privately owned ambulance designed especially for the transportation of the infirm or physically handicapped where said ambulance is used solely for the benefit of the owner and not for hire on a fee for service or prepaid basis. 7. An ambulance owned and operated by a licensed hospital or licensed nursing home and used exclusively for specialized mobile intensive care or for inter- institutional transfers of their own admitted patients or residents, provided that the specialized ambulance services shall apply for and receive a special use license as provided for in Section 21 of this Ordinance. C. Unlawful Operation. 12 , 417 Effective one year from the effective date of this Ordinance, it shall be unlawful for any person to operate an intracity ambulance service which provides emergency or nonemergency prehospital care or patient transports except as specifically allowed pursuant to the provisions of this Ordinance. It shall further be unlawful for any person subject to regulation by this Ordinance to operate an ambulance or helicopter rescue unit unless a currently valid vehicle permit has been issued and the vehicle has passed an approved vehicle inspection as prescribed by the AEPF, INC. It shall be unlawful for any person to serve on an ambulance or helicopter rescue unit as ambulance personnel unless that person has in his or her possession a currently valid personnel certification issued as prescribed by the AEPF, INC. and has passed an approved physical and /or psychological examination. SECTION 9. INTERIM PERIOD Interim Period Defined. Under this Ordinance, the Ambulance Authority is required to release requests for bids within three (3) months after the effective date of this Ordinance, to award a contract within eight (8) months from the effective date of the Ordinance, and to have a single contractor providing all emer- gency and nonemergency ambulance service in the City within twelve (12) months from the date this Ordinance is effective. SECTION 10. FIRST RESPONDER PROGRAM A. The City of Little Rock will continue to provide "emergency first responder" program and personnel, provided this service shall maintain at least EMT certification, as certified by the State Health Department. B. The Ambulance Authority's Communication Center personnel shall have no dispatch authority over first responder units provided by the City. The Fire Department will maintain control over the use of fire apparatus as first responders, and shall be advised by the ambulance system dispatch personnel, as to the need for such "first responder" response. In the event the Fire Department dispatch personnel find that five or more pieces of fire apparatus are engaged in emergency conditions, an automatic cessation of use of the Fire Department's first responder program shall occur. The ambulance system shall be advised of the occur- rence. The Fire Department shall retain control over the decision to divert fire apparatus from first responder activity in the event such units are needed for fire purposes. C. The Ambulance Authority, as part of its contract with a competitively selected private ambulance operator, shall require such ambulance provider to sponsor the periodic conduct of a 20 -hour "paramedic assist" course made available to first responder programs. The City will use its best efforts to have its first responder personnel avail themselves of this training. D. The Ambulance Authority, at the option of the City, will bill its patients for the first responder expendable use and replace such expendables on a one - for -one basis. E. The Ambulance Authority will fully cooperate with the City's Communication Center in establishing radio monitoring capability of the ambulance service system's activities 13 and all necessary communication linkages between the various '418 emergency provider organizations' operations. SECTION 11. VEHICLE PERMITS REQUIRED The AEPF, INC. shall inspect all Ambulance Authority vehicles on at least a semi - annual basis. Inspections shall be both scheduled and unscheduled. The AEPF, INC. shall develop reason- able standards and inspection protocols and shall issue permits to those vehicles which comply with the inspection standards. SECTION 12. AMBULANCE AND DISPATCH PERSONNEL CERTIFICATION REQUIRED A. General Requirements for Ambulance Personnel. Every ambulance subject to regulation under this Ordinance is required to have on -board each ambulance unit at least two personnel certified under these regulations. At least one person must be certified, either probationary or fully certified, as a Paramedic or as an Emergency Nurse (EN); and the other person must be certified, either probationary or fully certified, as both "driver" and as either a Paramedic, EN, or an Emergency Medical Technician (EMT). If an ambulance unit is manned by one Paramedic and one EN or EMT, the EMT or EN shall serve as driver even if both persons possess ambulance driver certifications. In such cases, the Paramedic or EN shall function as Senior Paramedic or EN in Charge and shall be responsible for directing patient care and ambulance operations in general at all times. If two Paramedics or Emergency Nurses serve on the same unit, one shall be designated as Senior Paramedic or EN in Charge by the shift supervisor or other appropriate ambulance company management personnel. No person shall be employed or otherwise permitted to drive or attend ambulances subject to this Ordinance, unless he or she shall hold a currently valid certification as a Paramedic, EN or EMT issued under this Ordinance. Furthermore, no person shall function as ambulance dispatcher or system status manager, unless that person shall hold a currently valid certification as a dispatcher issued under this Ordinance. B. Application Process for Ambulance Personnel. The process and requirements for ambulance personnel to become certified under this Ordinance are as follows: Step 1: In step 1, the applicant shall submit a completed application (available from the License Officer) together with additional documentation of related credentials as required on the application form, along with a nonrefundable application fee of $20.00 payable to the City. When the application is complete and in order, an investigation shall be conducted by the License Officer or his designee, and the results along with the application shall be submitted to the AEPF, INC. to determine whether the application shall be rejected for cause or advanced to Step 2. The The AEPF, INC. shall base its decision on this matter upon the following criteria: a. The applicant shall be cleared by a policy check (name check only) of having no record of crimes against persons. b. The applicant shall be at least eighteen (18) years old. 14 ordinance No. 14,511 (Cont'a. 41 C. The applicant shall have no history of addiction to drugs or alcohol. d. The applicant must have a current appropriate license for certification as a Paramedic, EN or EMT from the State of Arkansas. The applicant shall have a valid driver's license. If the applicant's initial application is approved for further processing by the AEPF, INC., the applicant shall be advanced to Step 2. Step 2: In Step 2, if the applicant is applying for EMT or EN certification (i.e., but not for Paramedic certification), the EMT or EN must complete all requirements for "Driver" certification as provided for in this Ordinance. After successful completion of Step 2, the applicant shall be advanced to Step 3. Step 3: In Step 3, the applicant shall take a written test approved and administered by the AEPF, INC. The test shall assess the applicant's knowledge of local medical protocol, the Little Rock ambulance service system in general, special disaster pro- cedures, and such other items as may be deemed appropriate by the AEPF, INC. (The written test may differ for different types of Paramedic, EN, EMT, or dispatcher certification.) Test results shall be turned over to the AEPF, INC. for evaluation. If the applicant's performance on the written test is unsatisfactory, the License Officer may, at his option, either reject the application or prescribe individualized or refresher training for the applicant, along with scheduling a retesting opportunity for the applicant. Step 4: In Step 4, the applicant shall be required to receive a physical examination of the type and extent as specified by the AEPF, INC. Step 5: Applicants for certification as Paramedics who pass the physical examination and all preceding requirements may, at the option of the AEPF, INC. be given an additional practical examination administered by the AEPF, INC. (No such addi- tional practical examination shall be required of applicants for EMT or EN certification.) Results of this practical examination prepared and admin- istered by the AEPF, INC, shall be evaluated by the AEPF, INC., and the application may be advanced for further processing, denied, or at the option of the AEPF, INC., the applicant may be advised to take additional individualized or other refresher training in specific areas, and may be subsequently retested by the AEPF, INC. and then either rejected or advanced to further processing. Similar practical testing may, at the option of the AEPF, INC, be required of applicants for dispatcher certification. Step 6: After an applicant has successfully completed all the above steps, the applicant shall be issued a probationary certification of the type sought. The probationary certification shall be valid for a period of six (6) months from the date of issuance, and shall then automatically expire. 15 Step 7: Prior to assuming the regular duties of a fully certified Paramedic, EMT, EN or dispatcher, the holder of a probationary certification shall be required to work as a "third person" on an operating ambulance unit under the direct supervision of a fully certified Paramedic (i.e., not probationary) with not less than two (2) years street experience. The supervised work experience as a "third person" shall include five (5) eight (8) hour shifts, or the equivalent in other shift patterns, all conducted under the supervision of the same Paramedic. New holders of probationary Paramedic certifications may complete this orientation requirement by working the required number of hours in place of the EMT /RN /Driver, rather than as a "third person" provided the probationary certificate holder has completed ambulance driver certification require- ments. Step 8. After the completion of the orientation experience in Step 7, the supervising Paramedic shall complete a written evaluation report on the probationary certificate holder's performance and provide it to the AEPF, INC. Unless the probationary certificate is suspended or revoked for cause as a result of the holder's performance during the orientation experience, the holder of the probationary certificate may then function in all capacities as though he or she were a fully certified Paramedic, EMT, EN or dispatcher. Provided, however, that for holders of certificates designated "Paramedic -- Probationary ", the AEPF, INC. shall cause several medical audit procedures to be conducted on patients served by the probationary certificate holder while acting as "Senior EMT ". In the audited cases, the certificate holder shall be required to attend scheduled audits. The AEPF, INC. shall make a reasonable effort to schedule the audits at times when the certificate holder is not on duty. If the applicant was issued a certificate as "EMT- - Probationary", the audits shall be performed only at the request of a "Senior Paramedic in Charge" of an ambulance unit at the time the certificate holder was on duty. Step 9: As a result of findings from these medical audit procedures, the AEPF, INC. may, at its option, recommend suspension or revocation of the probationary certificate, may require additional refresher training in lieu of such suspension or certification, may allow the probationary certificate to expire without the issuance of a "full certification" or may recommend the issuance of "full certification ". Written findings and recommendations concerning suspension, revocation, additional training, expiration, issuance or renewals of personnel certifications under these regulations shall be made by the AEPF, INC. to the License Officer. Formal action by the License Officer shall be based upon these findings and recommendations. The final decision concerning all such actions shall be made by the License Officer upon consideration of the recommendations from the AEPF, INC. C. Registered Nurse Attendants. m 42 Arkansas law allows a registered nurse to serve, without Paramedic certification as an ambulance attendant. Under this Ordinance, registered nurses licensed by the State of Arkansas shall be allowed to apply for certification under these regulations as an "Emergency Nurse ". The applicant shall complete all processing requirements that are required of an applicant for Paramedic certification under this Ordinance, except that the applicant's nurse's training, nursing license, and emergency related experience shall be allowed to substitute for Paramedic training, state Paramedic certificate and EMT experience, if the combination of the nurse applicant's training and emergency related experience is, in the opinion of the AEPF, INC. sufficiently extensive to serve as a substitute for Paramedic credentials. The applicant for "Emergency Nurse" certification shall be processed through all steps applicable to Paramedic certificate under this Ordinance, including testing for knowledge of local protocols, possible mandatory refresher training, probationary status, and all other requirements for Paramedic certification under these regulations. Requirements for renewal of "Emergency Nurse" certification shall be the same as requirements for renewal of Paramedic certification under this Ordinance, including requirements for continuing education. However, the AEPF, INC. may at its option, allow the substitution of certain continuing education pro- grams for nurses in lieu of those required for Paramedics. D. Dispatcher Certification. 1. General Responsibilities for Dispatcher Any person employed for the purpose of receiving telephone or other requests for ambulance service and for dispatching ambulances in the Little Rock ambulance service system is required to possess a valid Dispatcher certification issued under this Ordinance. 2. Written Reports Required If a certified Dispatcher has cause to report actions of field personnel for possible disciplinary action, the Dispatcher shall make a written report on forms provided by the License Officer and signed by the Dispatcher. 3. Requirements for Dispatcher. Criteria for Dispatcher certification shall be established by the AEPF, INC. E. Requirements for Driver Certification. Applicants for Ambulance Driver certification shall be issued such certification for a period of one year, provided the following conditions are met: 1. The applicant shall apply for Driver certification on designated forms; The applicant shall have completed Step 1 of the Paramedic, EN or EMT application process described in Section 11; 3. The applicant must have a fault free accident driving record for a period of three (3) years prior to the time of application; The applicant must have an arrest free driving record, 17 422 related to reckless driving or driving under the influence of alcohol or drugs, for a period of three (3) years prior to the application; 5. The applicant shall pass a written examination, approved by the AEPF, INC. and administered by the Authority, demonstrating a working knowledge of the streets of Little Rock, Arkansas, traffic patterns, locations of all hospitals in the metropolitan areas, and access to emergency department entrances at each hospital; 6. Individual applicants who fail to qualify for Driver certification solely as the result of previous accidents, reckless driving, or speeding may be afforded a review by the License Officer. Upon submission of a request for such a hearing, the License Officer shall then set a date for such hearing not less than ten (10) nor more than sixty (60) days from the date of the request. Upon a review of the facts and circumstances related to the events in question and to the applicant's conduct since the time of the events, the License Officer may (1) allow the applicant to receive driver certification, (2) reject the application, or (3) allow such certification with restrictions as deemed prudent by the License Officer. F. Regular Attendance and Successful Participation in In- Service Training Required. Effective 14 months after this Ordinance is effective, as a condition to maintaining and renewing all personnel certifications, every individual certified under these regulations, whether as Paramedic, EN, EMT, Driver, or Dispatcher, shall attend regularly and successfully participate in an in- service training program which shall meet the requirements established by the authority with the recommendations of the AEPF, INC. G. Requirements for Renewal of Certifications. All probationary certifications shall automatically expire six (6) months after the date of issuance. All full certification shall automatically expire two (2) years from the date of issuance, unless applicant's application for renewal is approved and a new certificate is issued. Requirements for renewal shall include: 1. Completion and submission of an "application for certification renewal" on designated forms, together with a $10 renewal fee. The applicant shall complete such written and /or practical testing as may be required by the AEPF, INC. at the time of application for renewal. 3. The applicant, at AEPF, INC.'s option, be required to take a physical examination equivalent to that then currently required of new applicants, and if required, such physical examination shall be furnished at the expense of the applicant. 4. The applicant shall present evidence of having success- fully completed in- service and refresher training requirements in a program approved by the AEPF, INC. 5. The applicant shall attend a general performance evaluation conducted by the AEPF, INC. and related to selected cases handled by the applicant during the preceding period of certification, and as a result M 42 of this performance hearing, the AEPF, INC. may require the applicant to complete skill specific refresher training as considered appropriate by the AEPF, INC. in light of the applicant's past clinical performance in the field. H. If all of the above requirements are successfully fulfilled by the applicant for renewal, the AEPF, INC. shall recommend renewal certification and a new certificate shall be issued valid for a period of two (2) years from its date of issuance. Certificate holders shall, at all times, maintain the appropriate state licensees required of ambulance personnel. If a certificate holder's state license should lapse or be revoked during the period a certificate issued under this Ordinance is valid, then the certification issued under this Ordinance shall be automatically suspended pending reinstatement of the appropriate state license. SECTION 13. INSURANCE No ambulance shall be operated in the City unless there is at all times in force and effect insurance coverage as follows: A. Automobile liability insurance in an amount not less than $100,000 for injury to, or death of, one person, by reason of the carelessness or negligence of the driver of such ambulance, and $300,000 for injury to, or death of, more than one person, resulting from a single accident, by reason of the carelessness or negligence of the driver of such ambulance, and $50,000 for damage to property resulting from any single accident, by reason of the carelessness or negligence of the driver of such ambulance, issued by an insurance company licensed to do business in the State of Arkansas, for each and every ambulance owned and /or operated by the Ambulance Authority, providing for the payment of damages: 1. For injury to or death of individuals in accidents resulting from any cause for which the owner of said vehicle would be liable on account of liability imposed in him by law, regardless of whether the ambulance was being driven by the owner or his agent; and 2. For the loss of or damage to the property of another under like circumstances. B. Uninsured motorist coverage in an amount equal to the bodily injury liability limits as set forth in item A above; C. Malpractice insurance to provide for limitation of each claim of not less than $500,000; D. A $1,000,000 umbrella policy providing additional coverage to all underlying liability policies. E. Said insurance policies shall be submitted to the City Attorney for approval. Satisfactory evidence that such insurance is at all times in force and effect shall be furnished to the City Attorney, in such form as he may specify. F. Every insurance policy required hereunder shall contain a provision for a continuing liability thereunder to the full amount thereof, notwithstanding any recovery thereon, that the liability of the insurer shall not be affected by the insolvency or the bankruptcy of the assured, and that until the policy is revoked or expires, the insurance company will not be relieved from liability on account of nonpayment of premium, failure to renew license at the end of the year, or any act or omission of the named assured. Such policy of W 424 insurance shall be further conditioned for the payment of any judgments up to the limits of said policy recovered against any person other than the owner, his agent, or employee, who may operate the same with the consent or acquiescence of the owner. G. Every insurance policy required hereunder shall extend for the period to be covered by the license applied for, and the insurer shall be obligated to give not less than thirty (30) days written notice to the Medical Director and to the assured before any cancellation or termination thereof earlier than its expiration date; and the cancellation or other termination of any such policy shall automatically revoke and terminate the permits issued for the ambulances covered by such policy, unless another insurance policy complying with the provisions of this section shall be provided and be in effect at the time of such cancellation or termination. H. Each insurance policy described and required herein shall name as additional insureds the City of Little Rock, Arkansas the Ambulance Authority and the AEPF, INC. in addition to the operator of the vehicle. SECTION 14. FEES REQUIRED A. The Ambulance Authority shall pay a fee of three dollars ($3.00) per ambulance run during which a patient was trans- ported to the AEPF, INC. Such payments shall be made on a monthly basis. All such money received by the AEPF, INC. shall be used to fund physician supervision, medical audits, equipment inspections, personnel testing and development and study and enforcement of standards, rules and regulations in accordance with the provisions of the contract between the City and the AEPF, INC. B. Every participating volunteer provider of emergency ambulance service in the system provided for by this Ordinance shall include in billing statements, if any, such three dollar ($3.00) fee as a separate item to be paid directly to the AEPF, INC., and the volunteer provider shall have no obliga- tion or responsibility for collection of said fee. SECTION 15. TRAFFIC LAWS: EXEMPTION When the senior Paramedic in charge of an ambulance has reason- able grounds to believe that an emergency exists, the driver of the ambulance may: A. Park or stand, irrespective of the otherwise applicable rules of law established by ordinance; B. Proceed past a red or stop signal or stop sign, but only after slowing as may be necessary for safe operation; C. Exceed the maximum speed limits permitted by the City so long as life or property is not endangered; or D. Disregard ordinances or regulations of the City governing the direction of movement or turning in specified directions. The exemptions listed in this section shall apply only when such ambulance is making use of audible and visual signs meeting the requirements of the regulations promulgated by the Medical Director. E. The exemptions listed in subsection (A) do not relieve the driver from the duty to drive with regard for the safety of all persons. 20 425 SECTION 16. PROFESSIONAL CONDUCT Paramedics, EMTs, ENs, Drivers, Dispatchers, and other personnel employed by licensees regulated under this Ordinance, including persons involved in billing and collection activities, shall, at all times, conduct themselves in a professional manner as generally described in rules of professional conduct which shall be written and compiled by the AEPF, INC, and which shall be made available to all holders of professional certifications at the time such certification is issued. SECTION 17. PATIENT MANAGEMENT AND MANAGEMENT OF SCENE Authority for patient management in a medical emergency shall be invested in the Senior Paramedic or EN in charge. Authority for the management of the scene of a medical emergency shall be vested in appropriate public safety officials. The scene of a medical emergency shall be managed in a manner described to minimize the risk of death or health impairment to the patient and to other persons who may be exposed to the risks as a result of the emergency condition, and priorities shall be placed upon the interests of those persons exposed to the more serious permeable risks to life and health. Public safety officials shall ordinarily consult the Senior Paramedic or EN in charge at the scene in the determination of relevant risk factors. In the event a licensed physician appears on the scene and desires to assume direction and control of patient care, the licensed physician may do so, but shall be required to sign a form approved by the AEPF, INC. releasing the Senior Paramedic or EN in charge from responsibility for directing patient care, and declaring that such responsibility has been assumed by the signer. SECTION 18. PROTOCOL FOR DETERMINING DESTINATION FACILITY A. For all calls retrospectively designated as Code 3 or Code 4, the patient shall be delivered to the destination of the patient's choice. However, in cases where the patient is incompetent or unable to make a choice, the patient shall be delivered to the destination requested by the appropriate party acting on behalf of the patient. B. For all calls retrospectively designated as Code 2 calls, the patient shall be delivered to the destination of the patient's choice. However, if the patient is incompetent or unable to make a choice, the patient shall be delivered to the designation requested by the appropriate person acting on behalf of the patient. If no requested destination can be determined, the patient shall be delivered to the nearest emergency receiving facility then currently approved for receipt of such patients by the AEPF, INC. No Code 1 or Code 2 patients shall be delivered to an emergency receiving facility when that facility has informed the EMS control center that its emergency receiving capabilities are then temporarily overloaded or are for any reason temporarily inappropriate for receipt of Code 1 or Code 2 patients. The EMS control center shall maintain sufficient communications with all hospitals so that all overload conditions are known to the control center and shall communicate this information to the Paramedic or EN personnel operating in that general area, prior to the occurrence of an emergency incident where this information will be needed. D. No Code 1 or Code 2 type patients shall be delivered to an emergency receiving facility which does not have 24- 21 hour physician coverage of emergency services, as confirmed from listings published and periodically updated by the AEPF, INC. except that in the case of Code 2 type patients specifically requesting to be delivered to an emergency receiving facility not on the current list, such patients shall be delivered to the requested facility. E. The above paragraphs of this section notwithstanding, for calls retrospectively designed as Code 1, the patient shall be delivered to the appropriate emergency receiving facility in conformance with disease specific or problem specific transport protocols then currently in effect and approved by the AEPF, INC. SECTION 19. EXPIRATION AND RENEWAL OF LICENSES CERTIFICATIONS AND PERMITS Under this Ordinance, all certifications and permits issued shall automatically expire, without notification, two (2) years after the original date of issuance, unless provision for earlier expiration is specifically made herein, unless special provision for earlier expiration is made at the time of issuance for cause. Provisions for renewal or reissuance of all licenses, certifications, and permits shall be consistent with this Ordinance, or those the AEPF, INC. shall develop and implement as reasonable standards and procedures for the handling of all renewals. Provided that each license, certification and permit issued shall clearly state that the City may, at its option, and at any time, make changes to the relevant provisions of this Ordinance affecting the holder of the license, certificate, or permit, and that the AEPF, INC. may, at its option, adopt changes which may affect the holder, and provided a reasonable period of time for compliance with these new provisions is made available. Failure to comply with such changes shall result in the automatic expiration of the license, certification, or permit upon the effective date of the adopted changes. In addition, such license, certificate, and permits shall also clearly state that the City, in issuing such document, makes no representation concerning its intention to renew or fail to renew with or without cause such license, certification, or permit, and that to the extent the holder of such document invests personal or company resources in obtaining such permit, the holder does so entirely at his own risk, without any assurance or representation from the City that such license, certification, or permit or representation from the City that such license, certification, or permit will be renewed. SECTION 20. PROVISION FOR MEDICAL AUDIT AND INVESTIGATION OF CONSUMER COMPLAINTS A. The medical audit process shall be conducted under the supervision of the Medical Director and each medical audit hearing shall be directly supervised by a physician appointed by the Medical Director. A medical audit shall be performed at the request of the License Officer at the request of the Chairman of the Authority, the City Manager, any member of the Little Rock Board of Directors, any licensed paramedic, any licensed physician, or any member of the Ambulance Authority Board. B. In addition to medical audits performed upon requests, the AEPF, INC. shall also conduct additional selected audits chosen on a diagnosis specific or problem oriented basis to periodically assess the ambulance service system's ability to deal effectively with specific clinical conditions. These audits shall be periodically performed by reviewing random selection of cases of each type desired. Furthermore, AEPF, INC. physicians may period- ically ride as observers on ambulances to directly observe 22 42; care rendered, and such observations shall be a form of medical audit for evaluation purposes. C. The License Officer and the AEPF, INC. shall establish, and make known to the public, procedures for formal investigation of consumer complaints. The operations contractor and his employees shall cooperate fully with all investigations, and shall answer, in writing, if requested, any inquiries by the AEPF, INC, or the License Officer concerning such investigations. The Chairman /the Authority /and /or the License Officer may instruct the staff of the Authority to conduct an investigation on their behalf. D. If, as a result of findings from a medical audit process, the AEPF, INC. determines that a person certified under this Ordinance should have his or her certification revoked, suspended, or subjected to special restrictions as necessary to protect the public health and safety, a written recommendation shall be made to the License Officer. He shall make whatever additional investigation he considers necessary and appropriate, and shall then determine and implement the appropriate action. SECTION 21. PROVISION FOR SPECIAL USE LICENSURE A. Upon application to and approval by the AEPF, INC. "special use licenses" may be issued to licensed hospitals for provision of specialized mobile intensive care services, and to private companies for purposes restricted to the emergency care and transport of the company's own employees. B. Applicants for specialized mobile intensive care licensure must be hospitals, departments of hospitals, or the Ambulance Authority. C. In addition, licensed hospitals may apply for, and if approved by the AEPF, INC. receive special licensure for the operation of not for hire on a fee for service basis transportation or ambulance type services restricted to the interhospital transport of admitted patients or residents of the hospital applying for such license. This type of transportation is not subject to regulation under this Ordinance, unless a special use license has not been granted. D. Applications for such specialized licensure shall be made on such forms as may be described, prepared, or prescribed by the License Officer, and shall contain the information as is necessary and appropriate to allow an informed judgment on the request by the AEPF, INC. No fee shall be required for the processing of application for such special licensure. E. The AEPF, INC. shall not arbitrarily or without cause with- hold its authorization for the issuance of a special license, provided, however, that licenses so issued shall be clearly restricted to the special purposes defined here- in, and provided there exists a clinical necessity for the special service to be offered, and provided that in the case of such special licensure for purposes other than specialized mobile intensive care, the applicant is able to demonstrate compelling reasons for allowing the draining off of fee for services revenues which would otherwise be available to support advanced life support production capacity to serve the City and other contracted areas. However, because the population served by the Little Rock ambulance service system is, at best, too small to optimize advanced life support service economies of scale, the mere 23 • presence of a desire to operate a transfer service which does not provide specialized mobile intensive care shall not, by itself, constitute a compelling reason to allow the draining off of needed financial resources to support essential advanced life support production capacity. SECTION 22. CONFLICT OF INTEREST It shall be unlawful to be employed or act as a Paramedic, EMT, EN, Dispatcher, or an Ambulance Driver while simultaneously being employed by or representing any other firm or individual engaged in the provision of the usual services of a funeral home, mortuary, or undertaking concern. SECTION 23. PENALTIES FOR VIOLATION: PROVISION FOR APPEAL A. Any person violating, or failing to comply with the provisions of this Ordinance and the applicable provisions hereof shall be considered guilty of an ordinance violation and upon conviction thereof shall be fined an amount not less than $50 nor more than $500, or imprisoned for a period not exceeding 30 days, or both such fine and imprisonment for a period not exceeding 30 days, or both such fine and imprisonment for each such offense. B. Each day that any violation of, or failure to comply with, this act is committed or permitted to continue shall constitute a separate and distinct offense under this section and shall be punishable as such hereunder. Each ambulance run unlawfully performed shall be considered a separate offense. Each hour of illegally rendered standby services shall be considered a separate offense. Each incident of willful falsification of data by a licensee shall be considered a separate offense. Each ambulance run for which records are willfully omitted shall be considered a separate offense. And each instance of willful participation in the committing of an offense by an individual certified as an Paramedic, EMT, EN, Driver, or Dispatcher under this Ordinance shall also be considered a separate offense. SECTION 24. SEVERABILITY AND GENERAL REPEAL If any provisions of this Ordinance or the application thereof to any person or circumstance is held invalid, such invalidity shall not affect the other provisions or applications of this Ordinance which can be given effect without the invalid provision or application, and to this end the provisions of this Ordinance are declared to be severable. All ordinances of the City, or parts thereof, in conflict with this Ordinance are hereby repealed to the extent of such conflict. PASSED: September 20, 1983 ATTEST: APPROVED: p i '� y Cle�ne h ayor J. W. ena d `