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ORDINANCE NO. 14,511
AMBULANCE ORDINANCE
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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.
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NOW, THEREFORE, BE IT ORDAINED BY THE BOARD OF DIRECTORS OF
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THE CITY OF LITTLE ROCK, ARKANSAS.
SECTION 1. REPEAL AND ENACTMENT
That Chapter 5, relating to the regulation of ambulances, and by
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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.
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B. General Intent.
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It is the intent of the Board of Directors of the City of
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Little Rock:
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1. That exclusivity is mandatory because it is neither
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fair nor financially feasible to require a high
level of emergency performance from one ambulance
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company while simultaneously allowing other ambulance
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companies to select certain preferred nonemergency
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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
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Act, will:
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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.
e. 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 �. 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
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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
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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.
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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 - Presumptiv Designation esignation 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
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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 FRANC_H_ISE 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.
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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.
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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.
b. 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.
e. 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.
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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:
A. 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.
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1. Run Code 1 Calls.
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.
b. 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
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Officer for purposes of response time calculation as a
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 a
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.
H. 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
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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.
I. Refusal to Render Emergency Care Prohibited.
It is a violation of this Ordinance to fail to respond to a
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.
6. 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.
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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
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and all necessary communication linkages between the various
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
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.
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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.
e. 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.
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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.
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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;
2. 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;
4. The applicant must have an arrest free driving record,
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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.
2. 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
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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
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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.
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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
destination of the patient's
where the patient is incompe
choice, the patient shall be
requested by the appropriate
patient.
delivered to the
choice. However, in cases
tent or unable to make a
delivered to the destination
party acting on behalf of the
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.
C. 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-
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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.
PROVISION FOR MEDICAL AUDIT AND INVESTIGATION
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.
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
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427
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
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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
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