17255ORDINANCE NO. 17,255
AN ORDINANCE TO AMEND ARTICLE III OF CHAPTER 5
OF THE LITTLE TO AMBULANCE R E O G RELATING
LANCE SERVICEAND EMEREENCY MEDCA 5 1 7
.
SERVICES; AMENDING OUTDATED SECTIONS; ADDING,
DEFINITIONS, CLARIFYING CERTAIN SECTIONS,
DECLARING AN EMERGENCY, AND FOR OTHER
PURPOSES.
WHEREAS, the Board of Directors has determined that
protecting the public's health and safety though the
provision of high quality Emergency Medical Service and
non - emergency (Routine Transport) ambulance service
constitutes an important and legitimate governmental interest
of the governing body of the City of Little Rock; and
WHEREAS, Clinical studies demonstrate that Patients have
a higher potential for survival and recovery in communities
utilizing advanced life support (ALS) in providing Emergency
Medical Service. Other research has demonstrated both the
clinical value and cost effectiveness of providing ALS for
all Ambulance Patients in an integrated rather than
fragmented system; and
WHEREAS, Emergency Medical Service is provided for
Patients in circumstances that call for immediate action by
highly trained persons and the element of time in
transporting the sick, wounded or injured for medical
treatment is essential to the health or life of the Patient;
and
WHEREAS, Cities are granted authority to regulate
emergency medical services pursuant to the Municipal
Ambulance Licensing Act, Ark. Code Ann. §14- 266 -101 et seq.
(Michie 1995); and
1 WHEREAS, Article III of Chapter 5 of Little Rock, Ark.
2
3 Rev. Code is obsolete and requires revision to modernize and
4 clarify ambulance services standards within the City.
5 NOW, THEREFORE BE IT ORDAINED BY THE BOARD OF DIRECTORS
6 OF THE CITY OF LITTLE ROCK, ARKANSAS:
7 SECTION 1. Little Rock, Ark. Rev. Code 55 -56 is hereby
g amended to read as follows:
9 Sec. 5 -56 Definitions.
10 The following words, terms and phrases, when used in
11 this article, shall have the meanings ascribed to them in
12
this section, except where the context clearly indicates a
13
14 different meaning:
15 Ambulance means any motor vehicle equipped with
16 facilities to convey infirm or injured persons in a reclining
17 position.
is Ambulance Authority or the "authority" means the City of
19 Little Rock, Arkansas Emergency Medical Health Care
20
21 Facilities Board. The Ambulance Authority includes the
22 Metropolitan Emergency Medical Services, or "MEMS ".
23 Ambulance contractor or contractor means the private
24 ambulance company, if any, that contracts with the authority
25 to provide ambulance services to the city operating alone or
26 pursuant to any interlocal agreements approved by the board
21
28 of directors with the county, adjoining counties and other
29 municipalities within the counties.
30 Ambulance control center means the facility designated
31 by the authority from which all ambulances are dispatched and
32 controlled.
33 Ambulance district means any of the geographic
34
35
36 -2-
518
1 subdivisions of the city and other contracted areas
2
3 established for ambulance service planning and evaluation
4 purposes by the ambulance authority.
5 Ambulance Service Area means that area which is
6 contained within the boundaries of the municipal limits of
7 the City of Little Rock and the area of those jurisdictions
8
participating by interlocal agreement in the MEMS' System .
9
10 Ambulance patient means any person who is ill, infirm,
11 injured or otherwise incapacitated, bedridden or helpless and
12 requires or requests ambulance service or helicopter rescue
13 service to or from a hospital, physician's office, nursing
14 home or other health care facility.
15 Ambulance personnel means paramedics and emergency
16
medical technicians.
17
is Ambulance run means a patient transport by ambulance on
19 a for hire fee for service or prepaid capitation basis.
20 Ambulance service means any business or service
21 established to. transport patients from one (1) place to
22 another within the city or other contracted areas by an
23
ambulance.
24
25 Arkansas Emergency Physicians' Foundation or AEPF, INC.
26 means the nonprofit professional and charitable organization
27 composed of licensed physicians, a majority of whom are
28 regularly engaged in the full -time professional practice of
29 emergency medicine. This term may apply to this organization,
30
or any similar organization, or a separate board created by
31
32 the city.
33 Base station physician means a physician licensed under
34 the Arkansas Medical Practices Act (A.C.A. § 17 -93 -201, et
35
36 -3-
519
I seq.), and certified by the AEPF, INC., or the American
2
3 College of Emergency Physicians, or operating under the
4 supervision of such a physician.
5 Dispatcher means any person who works in the ambulance
6 control center and dispatches ambulances.
7. Driver means any person who is certified by the license
8
officer to drive ambulances in the City.
9
10 Emergency medical technician or EMT means any person
11 certified.by the state as an emergency medical technician.
12 Exclusive contract method means the public utility model
13 described in the definition of public utility model.
14 Exclusive franchise means the exclusive right to engage
15
in all emergency and non - emergency intracity patient
16
17 transports and intercity and intracounty patient transports
18 originating from within the City of Little Rock. This
19 definition also includes the Authority's operating area as
20 established by interlocal agreement.
21 First responder means any person capable of providing
22 qualified first responder emergency care as required by the
23
AEPF, INC.
24
25 Inteacity patient transport means an ambulance run which
26 transports a patient from one point to another within the
27 City.
28 Intercity patient transport means an ambulance run which
29 transports a patient from a point within the City to another
30
31 city, or from another city to a point inside the City.
32 License officer means the authorized agent of the city
33 manager.
34 Life - threatening emergency means any situation posing
35
36 -4-
520
1 immediate threat to human life as determined in accordance
3 with AEPF, INC. protocols. 521
4 Medical audit means an official inquiry into the
5 circumstances involving an ambulance run or request for
6 service.
7 Medical control means medical direction given ambulance
8
personnel by a base station physician through direct voice
9
10 contact.
11 Medical protocol means any diagnosis- specific or
12 problem- oriented written statement of standard procedure, or
13 algorithm, approved by the AEPF, INC. as the normal standard
14 used to determine level of response, pre - arrival instruction,
15
and of prehospital care for that given clinical condition.
16
17 Non -life threatening emergency means an emergency
18 situation which does not pose an immediate threat to human
19 life as determined in accordance with AEPF, INC. protocols.
20 Operations contractor means the person, if any, granted
21 an exclusive contract by the ambulance authority to operate
22 the city ambulance service system.
23
Paramedic means a person certified by the state as a
24
25 paramedic.
26 Public utility model means that strategy for the
27 organization, financing, management and regulation of an
28 advanced life- support ambulance service operation which uses,
29 along with other essential design features, a single level of
30
advanced and nonemergency service within a geographical area.
31
32 Response time means the actual elapsed time between
33 receipt of notification at the EMS control center that an
34 ambulance is needed at a identifiable location and the
35
36 -5-
1
arrival of an ambulance at that location.
2
3 Run Code 1 - presumptive designation means any ambulance
4 service request designated as a time critical,
5 life- threatening emergency situation by a' dispatcher as
6 designated in accordance with AEPF, INC. telephone and
7 dispatch protocols.
8
Run Code 2 - presumptive designation means any ambulance
9
10 service request designated by the dispatcher as an emergency
11 medical condition for which prompt response is appropriate
12 for medical and humanitarian reasons, but which apparently
13 involves no immediate threat to human life of a time - critical
14 nature as designated in accordance with AEPF, INC. telephone
15 and dispatch protocols.
16
Other Run Codes - presumptive designation means any
17
18 ambulance service request for nonemergency transportation of
19 a person whose apparent condition cannot appropriately be
20 designated as either code 1 or 2 as designated in accordance
21 with AEPF, INC. telephone and dispatch protocols.
22 Senior paramedic in charge means that individual among
23
the certified personnel on board an ambulance unit who is not
24
25 the driver and who is a paramedic currently certified under
26 state law, and who is designated by his employer or immediate
2i supervisor as the individual in command of the ambulance and
28 its operation.
29 Special use permit means a permit issued by the license
30
officer to hospitals serving the public for the provision of
31
32 specialized mobile intensive care services to clinically
33 defined patient populations (such as, neonatal transport),
34 and permits issued pursuant to section 5 -79, subsection (c).
35
36 -6-
522
1 System status management means the formal and orderly
2 523
3 process of continuously locating ambulance units available
4 for dispatch among post locations throughout the geographic
5 area being served to maintain the best possible readiness
6 configuration at all times.
7 SECTION 2. Little Rock, Ark. Rev. Code §5 -57 is hereby
8
amended to read as follows:
9
10 Sec. 5 -57. Penalty.
11 Any person convicted of a violation of any of the
12 provisions of this article shall be punished as provided in
13 section 1 -9. Each day that any violation of, or failure to
14 comply with, this article is committed or permitted to
15
continue shall constitute a separate and distinct offense
16
under this section and shall be punishable as such hereunder.
17
18 Each ambulance run unlawfully performed shall be considered a
19 separate offense. Each hour of illegally rendered standby
20 services shall be considered a separate offense. Each
21 incident of willful falsification of data by a licensee shall
22 be considered a separate offense. Each ambulance run for
23
which records are willfully omitted shall be considered a
24
25 separate offense. Each instance of willful participation in
26 the committing of an offense by an individual working as a
27 paramedic, EMT, or dispatcher shall also be considered a
28 separate offense.
29 SECTION 3. Little Rock, Ark. Rev. Code § 5 -58 is hereby
30
amended to read as follows:
31
32 Sec. 5 -58 Purpose and general intent.
33 (a) Purpose. It is the purpose of this article to
34 establish a regulated ambulance service system that can
35
36 -7-
1
provide
each ambulance patient with the best possible chance
2
of survival without disability or preventable complication.
3
4
(b)
General intent. It is the intent of the board of
5
directors of the city that:
6
(1)
Exclusively is mandatory because it is neither fair
7
nor financially feasible to require a high level of
8
emergency performance from one (1) ambulance company
9
while simultaneously allowing other ambulance
10
11
companies to select certain preferred nonemergency
12
business.
13
(2)
Substantive regulation requiring clinical excellence
14
and citywide lifesaving response time performance
15
cannot reasonably be imposed on an unsubsidized
16
ambulance company without simultaneously granting
17
18
that ambulance company an exclusive contract to
19
furnish all ambulance service, both emergency and
20
nonemergency, to residents of the city.
21
(3)
If the ambulance authority is not operated as a
22
Public Facilities Board (with ambulance services
23
provided by employees of the Board), it may, after
24
bid procedures,. select a private ambulance company
25
26
for an exclusive contract to provide ambulance
27
personnel to operate the ambulance service in the
28
city. The ambulance company shall provide the
29
ambulance personnel necessary to operate the
30
equipment owned by the authority and to provide
31
those management functions delegated to it under
32
33
contract by the ambulance authority. The ambulance
34
authority shall own, or serve, as a primary lessee
35
36
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524
i
of all ambulance and communication equipment, do all
billings and collections and shall provide all
administrative oversight for the ambulance service
system. Nothing in this paragraph shall prevent the
ambulance authority from operating the ambulance
service and providing its own personnel.
(4) This article will:
(a) Furnish bona fide monitoring and medical control
of present ambulance operations.
(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 city ambulance service system.
(c) Require the development of a first responder
program.
(5) The ambulance authority shall be required to:
(a) Designate a single EMS control center in the
city or county from where all ambulance
dispatching shall take place.
(b) Purchase an appropriate complete communication
and recording system.
(c) Design the communication system and control
center operation to allow for full -time
recording of all ambulance - related radio and
telephone traffic.
SECTION 4. Little Rock, Ark. Rev. Code §5 -59 is hereby
amended to read as follows:
MC
525
1
2
3 Sec. 5 -59. Operation on fee or for -hire basis. 526
4 Except as provided in § 5 -58 and §5 -60, no person, or
5 entity, public or private, shall operate an ambulance to
6 transport the sick, injured or infirm on a fee or for -hire
7 basis, regardless of whether an emergency or routine
8
nonemergency patient transport, upon any street within the
9
10 city or other contracted areas.
11 SECTION 5. Little Rock, Ark. Rev. Code §5 -60 is hereby
12 amended to read as follows:
13 Sec. 5 -60 Exemptions.
14 (a) This article does not apply to any intercity patient
15 transport in which the ambulance run does not originate in
16
the city by an ambulance from the destination city.
17
18 (b) An ambulance service license shall not be required
19 for ambulance services which are:
20 (1) Owned and operated by an agency of the United
21 States government.
22 (2) Rendering requested assistance to ambulance
23
currently licensed in cases of disaster or major
24
25 emergency too great for local resources, or in
26 response to provisions of a written mutual aid
27 agreement approved by the ambulance authority.
28 (3) Engaged in intercounty or intercity patient
29 transport to or from facilities within the city and
30
its, franchise area extended by interlocal
31
32 agreement but originating anywhere outside the city
33 and its franchise area.
34 (4) Rendering ambulance services under contract with
35
36 -10-
1 the authority.
2
3 (5) Private companies which use an ambulance solely for
4 the transportation of their employees for illness
5 or injury sustained while performing their work.
6 (6) Operating a privately owned ambulance designed
7 especially for the transportation of the infirm or
8
physicially handicapped where the ambulance is used
9
10 solely for the benefit of the owner and not for
11 hire on a fee for service or prepaid basis.
12 (7) Ambulances owned and operated by a licensed
13 hospital and used exclusively for specialized
14 mobile intensive care or for institutional
15
transfers of their own admitted patients, or
16
residents, provided such hospital shall apply for
17
18 and receive a special use mobile intensive care
19 license or be eligible for grandfather licensing,
20 as provided for under section 5 -79. Such special
21 use permit is non - transferable by the hospital.
22 SECTION 6. Little Rock, Ark. Rev. Code § 5 -61 is hereby
23
amended to read as follows:
24
25 Sec. 5 -61. Medical director generally.
26 The medical director shall be a licensed physician
27 selected by the AEPF, INC., or a similar organization. He
28 shall serve at the pleasure of same.
29 SECTION 7. Little Rock, Ark. Rev. Code §5 -62 "License
30
officer generally" is hereby repealed.
31
32 SECTION 8. Little Rock, Ark. Rev. Code §5 -63 is hereby
33 amended to read as follows:
34
35
36 -11-
527
Sec. 5 -63. Intracity ambulance service.
It shall be unlawful for any person, or entity, public
or private, 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 article.
SECTION 9. Little Rock, Ark. Rev. Code §5 -64 is hereby
amended to read as follows:
Sec. 5 -64. Deviation from medical protocol.
Base station physicians may, for cause, deviate from
approved medical protocol in a specific case where authorized
deviation is warranted by special circumstances.
SECTION 10. Little Rock, Ark. Rev. Code §5 -65 is hereby
amended to read as follows:
Sec. 5 -65. Control by board of directors.
The authority is authorized to operate the city
ambulance service system under the supervision and control.of
the authority's board of directors.
SECTION 11. Little Rock, Ark. Rev. Code §5 -66 is hereby
amended to read as.follows:
Sec. 5 -66 Manaqement options and mandatory requirements.
(a) Mandatory requirements for exclusive contract method
are as follows:
(1) The ambulance authority shall operate, or cause to
be operated, a licensed ambulance service system
for the city, and for neighboring areas, if
appropriate contractual relationships can be
developed with those neighboring areas for the
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528
1 equitable sharing of equipment costs,, operating
2
3 costs, medical costs, control and audit costs and
4 management costs. The service operated by the
5 authority shall have the following characteristics:
6 (a) The services rendered must at all times be in
7 compliance with the provisions of this
8
article.
9
10 (b) All emergency equipment utilized in this
11 service must be owned by or leased to the
12 authority as primary lessee.
13 (c) All billing or collection functions, including
14 but not limited to all legal proceedings which
15 are necessary, shall be performed by the
16
authority.
17
18 The authority shall own, or be the primary lessee of,
19 all ambulance and communication equipment, do all billings
20 and collections, and shall provide administrative oversight
21 for the ambulance service system. The AEPF, INC. shall
22 provide all medical advice, medical control, medical audit
23
• and medical oversight.
24
25 SECTION 12. Little Rock, Ark. Rev. Code 55 -67 is hereby
26 amended to read as follows:
27 Sec 5 -67 Physician supervision and medical quality control.
28 (a) Advisory contract. The city manager may contract
29 with AEPF, INC. or any similar organization to provide
30
medical advice to the authority, and physician supervision
31
32 and medical quality control over the city ambulance service
33 system.
34 (b) AEPF, INC. generally.
35
36 -13-
525
1
(1)
Powers and duties. The powers and duties of the
2
3
AEPF, INC. are generally to provide the authority with
4
information about the necessary elements of the city
5
ambulance
service system and to:
6
a.
Establish reasonable standards of productionand
7
patient care, including standards for vehicles and
8
on -board equipment.
9
b.
Make official recommendations to the authority and
10
11
to the city directors.
12
C.
Establish medical protocols.
13
d.
Establish standards, procedures and protocols for
14
the operation of the EMS control center.
15
e.
Establish procedures and protocols for first
16
responder medical care.
17
18
f.
Establish standards and procedures governing the
19
reliable provision of twenty- four -hour medical
20
control.
21
(2) Medical audits.
22
a.
The AEPF, INC., or similar organization, shall
23
perform medical audits when requested by the
24
license officer, at the request of the chairman of
25
26
the authority, the city manager, any member of the
27
board of directors, any certified paramedic, any
28
licensed physician, or any member of the authority
29
board in accordance with the terms and conditions
30
of its contract with the city.
31
b.
A medical audit performed upon the request of an
32
33
authorized party and which is related to a
34
particular incident, rather than to a concern about
35
36
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530
1 a general protocol or system procedure, shall be
2
3 initiated by a review of all tape recordings,
4 dispatch records, patient report forms, and
5 hospital records related to that incident. If, in
6 the opinion of the auditing physician, additional
7 inquiry or action is appropriate, an oral review of
8
the matter shall be conducted by the auditing
9
10 physician. The person whose performance is the
11 subject of such audit shall be notified of the time
12 and place of such oral review, and the person whose
13 performance is.the subject of the audit may not be
14 excluded for the oral review.
15 C. The medical audit procedure is intended to be
16
17 educational and positive and not vindictive or
18 punitive. Any individual whose actions are under
19 review may not be excluded from the audit process
20 and shall have the right to appear and be heard.
21 (3) Medical director. The medical director shall implement
22 the
policy established by the AEPF, INC. and upon
23
approval of the AEPF, INC. and the authority, may
24
25 appoint an assistant to the medical director who shall
26 serve in that capacity at the pleasure of the medical
27 director.
28 (4) Annual report. The medical director and the chairman of
29 the authority shall make a written report to the board
30
of directors on January 1 of each year detailing the
31
32 status of the ambulance service system.
33 (c) Radio communication.
34 (1) The ambulance authority shall ensure that at all times
35
36 -15-
531
1
its field personnel have direct access by reliable radio
532
2
communications to medical consultation and direction
3
4
concerning the care of patients in the field. To ensure
5
that reliable medical communications exist at all times
6
and to ensure that all medical communications are
7
appropriately monitored for backup purposes, the
8
ambulance authority shall furnish or otherwise acquire
9
reliable medical communications system.
10
11
(2)
All medical control radio traffic shall be continuously
12
recorded by the ambulance control center. All tapes
13
shall be retained for one hundred twenty (120) days and
14
may then be recycled.
15
(d)
Run reports and audits. A copy of the approved run
16
report form, approved by the ambulance authority, shall
17
18
be left with the emergency receiving facility to which
19
each patient is delivered. The receiving facility
20
physician may request a medical audit to be performed
21
relative to the prehospital or interhospital care of
22
that patient. Ambulance personnel involved directly in
23
the handling of an audited case after notification from
24
the medical director shall attend the audits of that
25
.
26
case. Failure to attend the medical audit proceedings
27
without good cause is grounds for disciplinary action by
28
the Executive Director.
29
(e)
Appeals. The AEPF shall make their findings and
30
recommendations to the director of operations, who shall
31
be responsible for any disciplinary action taken against
32
33
ambulance personnel. Such action may be appealed to the
34
Executive Director. In the case of Fire Department First
35
36
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1 Responders, the AEPF shall make their findings and
2
3 recommendations , to the Fire Chief, who shall be
4 responsible for any disciplinary action taken against
5 fire department personnel, in accordance with the City
6 personnel policy and Civil service Rules and
7 Regulations.
8 SECTION 13. Little Rock, Ark. Rev. Code §5 -68 is hereby
9
amended to read as follows:
10
11 Sec. 5 -68. Standards of production and performance.
12 The ambulance authority shall follow the following as
13 minimum standards:
14 (1) Equipment and management capability. Each and every
15 ambulance and all on -board equipment utilized by
16
the authority in performing services which are the
17
18 subject of this article shall comply with
19 applicable standards required for licensure. The
20 authority shall maintain the equipment and shall
21 employ sufficient backup equipment to ensure that a
22 safe level of reserve equipment capacity is
23
available to provide peak period ambulance coverage
24
25 even at times when unusual occurrences of equipment
26 breakdown and routine equipment maintenance
27 coincide.
28 (2) Personnel. The authority shall ensure:
29 a. That two (2) persons certified under state law
30
are on board each ambulance on ambulance runs
31
32 or available for dispatch, at least one (1) of
33 which is certified as a paramedic, and the
34 other of which is certified as a paramedic or
35
36 -17-
533
1
emergency medical technician (EMT).
2
If only one (1) person on board is a certified
3
4
paramedic, that person shall not function as the driver
5
while the patient is on board. The authority shall
6
establish and maintain sufficient management capability
7
to ensure that equipment and personnel utilized are
8
managed in a efficient and effective manner to produce
9
the desired clinical performance and response time
10
11
performance on a routine basis.
12
(3) Clinical performance. The clinical performance of
13
the authority and its personnel shall be consistent
14
with and shall conform to the operating procedures
15
and medical protocols adopted by the AEPF, INC.
16
Where clinical performance deficiencies are
17
discovered, the authority shall demonstrate an
18
19
aggressive and effective effort to correct the
20
deficiencies in a timely manner.
21
(4) Response time performance. Response time
22
performance standards are as follows:
23
a. Code 1 calls (life threatening emergencies)
24
1. The fire department shall furnish a
25
26
diligent good faith effort to manage all
27
available resources to achieve a
28
four - minute maximum response time for a
29
trained first responder to a code 1.
30
2. The authority shall furnish a diligent
31
good faith effort to maintain an
32
33
eight- minute (8:59) maximum response time
34
for an advanced life support paramedic
35
36
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534
ambulance. The authority shall employ
enough personnel, acquire enough 535
equipment and manage its resources in the
manner necessary to meet the eight- minute
response time standard on not less than
ninety (90) percent of all presumptively
designated code 1 calls originating each
month from within the city limits.
3. Where an ambulance unit is dispatched
from a nontransporting
first - response -only status its response
time may be counted as the authority
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 authority's ambulance
response time, provided the level of life
support capability furnished by the
neighboring ambulance service is
comparable to that required under this
article, 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
authority.
b. Code 2 calls. (non -life threatening
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i
1
emergencies) The authority shall establish a
2
12 minute (12:59) response time standard for
3
4
Code 2 calls on not less than ninety (90)
5
percent of all presumptively designated code 2
6
calls originating each month from within the
7
city limits.
8
C. other run codes. (Non -life threatening). The
9
authority's response to other run codes shall
10
11
be reasonable, but in every case where a
12
conflicting demand for resources occurs,
13
response to code 1 and code 2 calls shall take
14
precedence over requests for nonemergency
15
transfer service. Furthermore, the authority
16
shall display sound judgment in developing its
17
1s
system status management plans to preserve a
19
safe level of emergency response capability at
20
all times by delaying response to requests for
21
nonemergency service until additional
22
ambulance units become available whenever the
23
number of remaining ambulance units available
24
for dispatch falls below a reasonably
25
26
established safe level of emergency reserve
27
capacity, as determined by historical demand
28
analyses.
29
d. Retrospective designation. For purposes of
30
this subsection, the designation of a run as
31
code 1, code 2, or other shall be made by the
32
33
authority's system status management personnel
34
at the point of dispatch on a presumptive
35
36
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536
I
basis and no retrospective alteration of such
2
designation shall be allowed. However, runs
3
4
originally designated as code 2, or other may
5
be retrospectively redesignated upward by the
6
Executive Director, if the Executive Director
7
disputes the original designation, and the
8
authority board requests a determination from
9
the AEPF who then reviews and determines that
10
11
the original designation was improper, given
12
the information available to the EMS control
13
center personnel at the time of the
14
presumptive designation of the run code type.
15
e. Exempt calls. Certain types of calls may be
16
excluded as specified by the Medical Director
17
and the Executive Director on a standard form
18
19
signed by both. Such records are maintained in
20
the office of the Operations Manager.
21
f. Community response time. In addition to the
22
response time performance standard required
23
under this section for run code 1 and run code
24
2 calls, the authority shall furnish and
25
26
manage its resources in the manner necessary
27
to provide reliable emergency and nonemergency
28
ambulance service throughout the entire city
29
and shall perform its system status management
30
and system status planning operations so as to
31
minimize the differences in the respective
32
33
average emergency- response -time performances
34
among the various ambulance districts of the
35
36
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537
1
city to the greatest practical extent. In
2
addition, the authority shall take such steps
3
4
as necessary to reduce or eliminate any
5
continuing pattern of apparent discrimination
6
in the average response time performance to
7
any given ambulance district or portion
8
thereof.
9
(5)
Continuous physician medical control required. The
10
11
authority shall be responsible for ensuring that
12
its field personnel at all times have access to
13
qualified medical control and direction concerning
14
the care of patients in the field by a base station
15
physician or nurse. All medical control and
16
direction shall be available by reliable radio
17
communications, according to the communications
18
19
standards and other standards of medical control
20
set forth in section 5 -67.
21
(6)
Data systems and reporting. The ambulance authority
22
shall comply at all times with the data system and
23
reporting standards required by the AEPF, Inc. and
24
applicable statutes.
25
26
(7)
In- service training program required. The authority
27
is required to furnish or otherwise make available
28
without charge to its employees an in- service
29
training program which conforms to the standards
30
for in- service training adopted by the AEPF, INC.
31
All ambulance personnel are required to attend
32
33
these in- service training programs in accordance
34
with the guidelines promulgated by the AEPF, INC.
35
36
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538
• i
(8) Fully centralized dispatch required. All
dispatching movements of ambulance units subject to 5 3 9
regulation under this article shall be directed
from the designated EMS control center. It is
unlawful to dispatch or control any ambulance unit
subject to regulation under this article 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.
(9) Refusal to render emergency care prohibited. It is
a violation of this article to fail to respond to a
call to provide emergency ambulance service, to
render first -aid treatment as is necessary, or to
otherwise refuse to provide any emergency ambulance
services within the scope of the ambulance
operations, provided that these services are not
required if the patient refuses to consent to
treatment.
SECTION 14. Little Rock, Ark. Rev. Code §5 -69 is hereby
amended to read as follows:
Sec. 5 -69. First responder program.
(a) The city 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
d #10
1
personnel shall request first responder units provided
2
by the city. The fire department will maintain control
3
4
over the use of fire apparatus as first responders, and
5
shall be advised by the ambulance system dispatch
6
personnel as to the need for such "first responder"
7
response. In the event the fire department dispatch
8
personnel find that five (5) or more pieces of fire
9
apparatus are engaged in emergency conditions, an
10
11
automatic cessation of use of the fire department's
12
first responder program shall occur. The director of
13
operations or his .designee shall be advised by the
14
Central Station District Chief of the non - availability
15
and resumption of availability of first responders. The
16
fire department shall retain control over the decision
17
18
to divert fire apparatus from first responder activity
19
in the event such units are needed for fire purposes.
20
(c) The ambulance authority shall make its training
21
program available to first responder programs. The city
22
will use its best efforts to have its first responder
23
personnel avail themselves of this training.
24
(d) The ambulance authority, at the option of the
25
26
city, will bill its patients for the first responder
27
expendable use and replace such expendables on a one -for
28
one basis.
29
(e) The ambulance authority will fully cooperate
30
with the city's communication center in establishing
31
radio monitoring capability of the ambulance service
32
33
system's activities and all necessary communication
34
linkages between the various emergency provider
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w w w w w ■w wi w w w w w w w w
1
organizations, operations.
2
3 SECTION 15. Little Rock, Ark. Rev. Code §5 -70 is
4 hereby amended to read as follows:
5 Sec. 5 -70. Vehicle permits.
6 (a) It shall be unlawful for any person subject to
7 regulation by this article to operate an ambulance or
8
helicopter service unless a currently valid state
9
10 vehicle permit has been issued.
11 SECTION 16. Little Rock, Ark. Rev. Code §5 -71 is hereby
12 amended to read as follows:
13 Sec. 5 -71. Ambulance and dispatch personnel
14 certification, etc., required.
15 (a) General requirements for ambulance personnel. Every
16
17 ambulance subject to regulation under this article is
18 required to have on -board each ambulance unit at least two
19 (2) personnel certified under these regulations. At least one
20 (1) person must be certified as a paramedic and the other
21 person must be certified as both driver and as either a
22 paramedic or an emergency medical technician (EMT). If an
23
ambulance unit is manned by one (1) paramedic and one (1)
24
25 EMT, the EMT shall serve as driver even if both persons
26 possess ambulance driver certifications. In such cases, the
27 paramedic shall be responsible for directing patient care and
28 ambulance operations in general at all times. If two
29 paramedics serve on the same unit, one
(1) shall be
30
designated as senior paramedic in charge by the director of
31
32 operations or the shift supervisor. No person shall be
33 employed or otherwise permitted to drive or attend ambulances
34 subject to this chapter, unless he shall hold a currently
35
36 -25-
541
1 valid state certification and is nationally registered as a
2
3 paramedic, or EMT. It shall be unlawful for any person to
4 serve on an ambulance or helicopter rescue unit as ambulance
5 personnel unless that person has in his possession a
6 currently valid state license and are approved for work by
7 the AEPF, INC.
8
(b) Dispatchers.
9
10'
(1) General responsibilities for dispatcher. Any person
11 employed for the purpose of receiving telephone or other
12 requests for ambulance service and for dispatching ambulances
13 in the city ambulance service system is required to receive
14 emergency medical dispatch training as provided by or equal
15 to that provided by the Authority.
16
SECTION 17. Little Rock, Ark. Rev. Code § 5 -72 is hereby
17
18 amended to read as follows:
19 See. 5 -72. Insurance.
20 (a) The authority shall maintain the following
21 insurance:
22 (1) Automobile liability insurance in an amount not less
23
than one hundred thousand dollars ($1,00,000.00) for injury to
24
25 or death of, one (1).person, by reason of the carelessness or
26 negligence of the driver of such ambulance, and three hundred
27 thousand dollars ($300,000.00) for injury to, or death of,
28 more than one (1) person, resulting from any single accident,
29 by reason of the carelessness or negligence of the driver of
30
such ambulance, and fifty thousand dollars ($50,000.00) for
31
32 damage to property resulting from any single accident, by
33 reason of the carelessness or negligence of the driver of
34 such ambulance, issued by an insurance company licensed to do
35
36 -26-
542
1
business
in the state for each and every ambulance owned or
2
operated,
or both owned and operated, by the ambulance
3
4
authority,
providing for the payment.of damages:
5
(a)
For injury to or death of individuals in accidents
6
resulting
from any cause for which the owner of the vehicle
7
would be
liable on account of liability imposed on him by
8
law, regardless
of whether the ambulance was being driven by
9
the owner
or his agent; and
10
(b)
For the loss or damage to the property of another
11
12
under like
circumstances.
13
(2)
Uninsured motorist coverage in an amount equal to
14
the bodily
injury liability limits as set forth in paragraph
15
(1) above.
16
(3) Malpractice
insurance providing a limitation on each
17
claim of
not less than five hundred thousand dollars
1s
19
($500,000.00).
20
(4)
A one - million - dollar umbrella policy providing
21
additional
coverage to all underlying liability policies.
22
(b)
The insurance policies shall be submitted to the
23
city attorney for approval. Satisfactory evidence that such
24
insurance
is at all times in force and effect shall be
25.
26
furnished
to the city attorney,.in such form' as he may
27
specify.'
28
(c)
Every insurance policy required hereunder shall
29
contain a
provision for a continuing liability thereunder to
30
the full
amount thereof, notwithstanding any recovery
31
thereon,
that the liability of the insurer shall not be
32
33
affected
by the insolvency or the bankruptcy of the assured,
34
and that
until the policy is revoked or expires, the
35
36
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543
1 insurance company will not be relieved from liability on
2
3 account of nonpayment of premium, failure to renew license at
4 the end of the year, or any act or omission of the named
5 assured. Such policy of insurance shall be further
6 conditioned for the payment of any judgments up to the limits
7 of the policy recovered against any person other than the
e
owner, his agent, or employee, who may operate the same with
9
10 the consent or acquiescence of the owner.
11 (d) Every insurance policy shall extend for the period
12 to be covered by the license applied for, and the insurer
13 shall be obligated to give not less than thirty (30) days,
14 written notice to the insured before any cancellation or
15 termination thereof earlier than its expiration date. The
16
cancellation or other termination of any such policy shall
17
18 automatically revoke and terminate the permits issued for the
19 ambulances covered by such policy, unless another insurance
20 policy complying with the provisions of this section is
21 provided and in effect at the time of such cancellation or
22 termination.
23
(e) Each insurance policy shall name in additional to
24
25 the Little Rock Ambulance Authority, the City, and AEPF,
26 INC., in addition to the operator of the vehicle.
27 SECTION 18. Little Rock, Ark. Rev. Code S 5 -73 is hereby
28 amended to read as follows:
29 sec. 5 -73. Fees.
30
The City and AEPF, INC., or other similar organization,
31
32 shall negotiate the fees to be paid for the services provided
33 by AEPF in this article. The City may assess this amount as a
34 fee to be assessed the Authority from revenues.
35
36 -28-
544
1 SECTION 19. Little Rock, Ark. Rev. Code §5 -74 is hereby
2
3 repealed.
4 SECTION 20. Little Rock, Ark. Rev. Code §5 -75 is
5 hereby amended to read as follows:
6 Sec. 5 -75. Patient management and management of scene.
7 Authority for patient management in a medical emergency
8
shall be invested in the senior paramedic. Authority for the
9
10 management of the scene of a medical emergency shall be
11 vested in the senior paramedic until appropriate public
12 safety officials arrive on the scene and take control. The
13 scene of a medical emergency shall be managed in a manner
14 described to minimize the risk of death or health impairment
15 to the patient and to other persons who may be exposed to the
16
17 risks as a result of the emergency condition, and priorities
18 shall be placed upon the interests of those persons exposed
19 to the more serious risks to life and health. Public safety
20 officials shall ordinarily consult the senior paramedic in
21 charge at the scene in the determination of relevant risk
22 factors. In the event a licensed physician appears on the
23
scene and desires to assume direction and control of patient
24
25 care, the licensed physician may do so if the base station
26 physician releases the paramedic from responsibility for
27 directing patient care and the physician who is on scene
28 continues care in the ambulance to the hospital.
29 SECTION 21. Little Rock, Ark, Rev. Code 55 -76 is hereby
30
amended to read as follows:
31
32 Sec. 5 -76. Protocol for determining destination
33 facility.
34 (a) For all calls designated as other than Code 1 or 2,
35
36 -29-
545
1 the patient shall be delivered to the destination of the
2
3 patient's. choice. However, in cases where the patient is
4 incompetent or unable to make a choice, the patient shall be
5 delivered to the destination requested by the appropriate
6 party acting on behalf of the patient.
7 (b) For all calls designated as code 1 or code 2 calls,
8
or which, during the course,of a transfer become a code 1
9
10 call, the patient shall be delivered to the destination of
11 the patient's choice. However, if the patient is incompetent
12 or unable to make a choice, the patient shall be delivered to
13 the destination requested by the appropriate person acting on
i
14 behalf of the patient. If no requested destination can be
15 determined, the patient shall be delivered to the nearest
16
medically appropriate emergency receiving facility.
17
18 (c) No code 1 or code 2 patients shall be'delivered to
19 an emergency. receiving facility when that facility has
20 informed the EMS control center that its emergency receiving
21 capabilities are then temporarily overloaded or are for any
22 reason temporarily inappropriate for receipt of code 1 or
23
code 2 patients. The EMS control center shall maintain
24
25 sufficient communications with all hospitals so that all
26 overload conditions are known to the control center and shall
27 communicate this information to the paramedic operating in
28 that general area, prior to the occurrence of an emergency
29 incident where this information will be needed.
30
(d) No code 1 or code 2 type patients shall be delivered
31
32 to an emergency receiving facility which does not have
33 twenty- four -hour physician coverage of emergency services.
34 (e) Other provisions of this section notwithstanding,
35
36 -30-
546
for calls retrospectively designated as code 1, the patient
shall be delivered to the appropriate emergency receiving 547
facility in conformance with disease - specific or
problem- specific transport protocols then currently in effect
and approved by the AEPF, INC.
SECTION 22. Little Rock, Ark. Rev. Code §5 -77 is hereby
repealed.
SECTION 23. Little Rock, Ark. Rev. Code §5 -78 is hereby
amended to read as follows:
Sec 5 -78 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 pursuant to the terms and
conditions of the contract between the city and AEPF, INC.,
or other similar organization. A medical audit shall be
performed at the request of the Executive Director, the
Chairman of the Authority, the City Manager, any member of
the Board of Directors, any certified paramedic, any licensed
physician, or any member of the ambulance authority board.
(b) In addition to medical audits performed upon
request, 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 periodically
-31-
1 ride as observers on ambulances to directly observe care
2
3 rendered, and such observations shall be a form of medical
4 audit for evaluation purposes.
5 (c) The Executive Director and the AEPF, INC. shall
6 establish procedures for formal investigation of consumer
7 complaints. The authority and its employees shall cooperate
8
fully with all investigations, and shall answer, in writing,
9
10 if requested, any inquiries by the AEPF, Inc. concerning such
11 investigations. The Chairman of the Authority or the
12 Executive Director may instruct the staff of the authority to
13 conduct an investigation on their behalf.
14 (d) If, as a result of findings from a medical audit
15
process, the AEPF, INC. believes. that a certified paramedic
16
17 or EMT should have his state certification revoked,
18 suspended, or subjected to special restrictions as necessary
19 to protect the public health and safety, a written
20 recommendation shall be made to the Executive Director. He
21 shall make any additional necessary investigation and shall
22 then determine and implement any necessary and appropriate
23
action.
24
25 SECTION 24. Little Rock, Ark'. Rev. Code §5 -79 is hereby
'
26 amended to read as follows:
27 Sec. 5 -79. Provision for special use licensure.
28 (a) Upon application to and approval by the AEPF, INC.
29 special use licenses may be issued to licensed hospitals for
30
provision of specialized mobile intensive care services, and
31
32 to private companies for purposes restricted to the emergency
33 care and transport of the company's own employees.
34
35
36 -32-
Mi i
1
2
3 (b) Applicants for specialized mobile intensive care
4 licensure must be hospitals, departments of hospitals, or the
5 ambulance authority.
6 (c) Central Arkansas Radiation Therapy Institute (CARTI)
7 is granted a limited special use permit for purposes of
8
continuing their transportation of CARTI patients from, and
9
10' returning to, CARTI facilities. Such permits for this
11 medically necessary transportation may be restricted under
12 this article depending upon the extent of future expansion of
13 these services.
14 (d) Applications for such specialized licensure shall be
15
made on such forms as may be described, prepared, or
16
17 prescribed by the license officer, and shall contain the
18 information as is necessary and appropriate to all an
19 informed judgment on the request by the AEPF, INC. No fee
20 shall be required for the processing of application for such
21 special licensure.
22 (e) The AEPF, INC. shall not arbitrarily or without
23
cause withhold its authorization for the issuance of a
24
25 special license, provided, however, that licenses so issued
26 shall be clearly restricted to the special purposes defined
27 herein, and provided there exists a clinical necessity for
28 the special service to be offered, and provided that in the
29 case of such special licensure for purposes other than
30
specialized mobile intensive care, the applicant is able to
31
32 demonstrate compelling reasons for allowing the draining off
33 of fee for services revenues which would otherwise be
34 available to support advanced life support production
35
36 -33-
549
� s
1 .
capacity to serve the city and other contracted areas.
2
3 However, because the population served by the city ambulance
4 service system is, at best, too small to optimize advanced
5 life support service economies of scale, the mere presence of
6 a desire to operate a transfer service which does not provide
7 specialized mobile intensive care shall not, by itself,
8
constitute a compelling reason to allow the draining off of
9
10 needed financial resources to support essential advanced life
11 support production capacity.
12 SECTION 25. Severability. In the event any title,
13 subtitle, section, subsection, subdivision, paragraph,
14 subparagraph, item, sentence, clause, phrase or word of this
15
ordinance is declared or adjudged to be invalid or
16
unconstitutional, such declaration or adjudication shall not
17
18 affect the remaining portions of this ordinance which shall
19 remain in full force and effect as if the portion so declared
20 or adjudged invalid or unconsitutional was not originally a
21 part of this ordinance.
22 SECTION 25. Emergency. It is hereby found and determined
23
that the provision of emergency medical services and
24
25 ambulance services saves citizen's lives and is therefore
26 essential to the peace, health, and safety of the citizens of
27 Little Rock. Therefore, an emergency is hereby declared to
28 exist and this ordinance being necessary for the preservation
29
30
31
32
33
34
35
36 -34-
550
1
of the public peace,
health and safety shall be in full force
2
and effect from and
after its passage and approval.
3
4
PASSED: August
6, 1996
5
ATTEST:
7
8
CITY CLERK
MA )U
9
APP OVER AS TO
FORM:
10
11
THOMAS . C
CITY ATTORNEY
12
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14
15
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18
19
20
21
22
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24
25
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27
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29
30
31
32
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34
35
36
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551