HomeMy WebLinkAbout19460I
2
ORDINANCE NO. 19,460
3 AN ORDINANCE TO AMEND ARTICLE III OF THE CITY'S
4 AMBULANCE SERVICE CODE (LITTLE ROCK, ARK. CODE § 5 -56 et
5 seq., (REV. 1988)) TO PROVIDE FOR BASIC LIFE SUPPORT (BLS)
6 AMBULANCE TRANSFERS NECESSITATED BY CHANGES IN
7 MEDICARE REIMBURSEMENT; AND FOR OTHER PURPOSES.
8
9 WHEREAS, Metropolitan Emergency Medical Services is currently authorized
10 by the City of Little Rock to operate an all advanced life support ( "ALS ") ambulance
11 service which requires a paramedic to staff the ambulance; and
12 WHEREAS, certain non - emergency transfers, such as, but not limited to, hospital
13 discharges, do not require the services of a paramedic; and
14 WHEREAS, Federal Medicare reimbursement regulations, effective April 1, 2002,
15 are phasing in a reduced payment for non - emergency transfers, i.e., basic life support
16 (BLS); and
17 WHEREAS, such phase in will be complete January 1, 2006; and
18 WHEREAS, the current ordinance can be amended to allow BLS ambulance
19 service under certain circumstances without lowering the quality of care to the citizens
20 of Little Rock.
21 NOW, THEREFORE, BE IT ORDAINED BY THE BOARD OF DIRECTORS
22 OF THE CITY OF LITTLE ROCK, ARKANSAS.
23 Section 1. Section 5 -56 of the Little Rock Code of Ordinances is hereby amended
24 to read as follows:
25 Sec. 5-56. Definitions.
Ordinance [PAGE 1 OF 10]
To Amend Ambulance Ordinance
1 The following words, terms and phrases, when used in this article,
2 shall have the meanings ascribed to them in this section, except where the
3 context clearly indicates a different meaning:
4 Advanced Life Support means a level of emergency service provided
5 by an Emergency Medical Technician - Paramedic (EMT -P) trained at the
6 level of Advance Life Support, including resuscitation techniques such as
7 intubation, intravenous access, and cardiac monitoring.
8 Ambulance means any motor vehicle equipped with facilities to
9 convey infirm or injured persons in a reclining position.
10 Ambulance authority or the authority, means the City of Little Rock,
11 Arkansas emergency medical health care facilities board. The ambulance
12 authority includes the metropolitan emergency medical services, or
13 "MEMS ".
14 Ambulance contractor or contractor means the private ambulance
15 company, if any, that contracts with the authority to provide ambulance
16 services to the city operating alone or pursuant to any interlocal
17 agreements approved by the board of directors with the county, adjoining
18 counties and other municipalities within the counties.
19 Ambulance control center means the facility designated by the
20 authority from which all ambulances are dispatched and controlled.
21 Ambulance district means any of the geographic subdivisions of the
22 city and other contracted areas established for ambulance service planning
23 and evaluation purposes by the ambulance authority.
24 Ambulance patient means any person who is ill, infirm, injured or
25 otherwise incapacitated, bedridden or helpless and requires or requests
26 ambulance service or helicopter rescue service to or from a hospital,
27 physician's office, nursing home or other health care facility.
Ordinance [PAGE 2 OF 10]
To Amend Ambulance Ordinance
I Ambulance personnel means paramedics and emergency medical
2 technicians.
3 Ambulance run means a patient transport by ambulance on a for-
4 hire fee for service or prepaid capitation basis.
5 Ambulance service area means that area which is contained within
6 the boundaries of the municipal limits of the city and the area of those
7 jurisdictions participating by interlocal agreement in the MEMS' System.
8 Arkansas Emergency Physicians' Foundation or AEPF, Inc. means the
9 nonprofit professional and charitable organization composed of licensed
10 physicians, a majority of whom are regularly engaged in the full -time
11 professional practice of emergency medicine. This term may apply to this
12 organization, or any similar organization, or a separate board created by
13 the city.
14 Base station physician means a physician licensed under the
15 Arkansas Medical Practices Act (A.C.A. § 17 -93 -201, et seq.), and certified
16 by the AEPF, Inc., or the American College or Emergency Physicians, or
17 operating under the supervision of such a physician.
18 Basic Life Support(BLS) means a level of emergency service provided
19 by an Emergency Medical Technician (EMT) that includes basic
20 techniques such as bleeding control, simple airway maneuvers, and
21 administration of oxygen.
22 Dispatcher means any person who works in the ambulance control
23 center and dispatches ambulances.
24 Driver means any person who is certified by the license officer to
25 drive ambulances in the city.
26 Emergency Medical Technician or EMT means any person certified by
27 the state as an emergency medical technician.
Ordinance [PAGE 3 of 10]
To Amend Ambulance Ordinance
I Exclusive franchise means the exclusive right to engage in all
2 emergency and non - emergency intracity patient transports and intercity
3 and intracounty patient transports originating from within the city. This
4 definition also includes the authority's operating area as established by
5 interlocal agreement.
6 First responder means any person capable of providing qualified
7 first responder emergency care as required by the AEPF, Inc.
8 Intercity patient transport means an ambulance run which transports
9 a patient from a point within the city to another city, or from another city
10 to appoint inside the city.
11 Intracity patient transport means an ambulance run which transports
12 a patient from one point to another within the city.
13 License officer means the authorized agent of the city manager.
14 Life - threatening emergency means any situation posing immediate
15 threat to human life as determined in accordance with AEPF, Inc.
16 protocols.
17 Medical audit means an official inquiry into the circumstances
18 involving an ambulance run or request for service.
19 Medical control means medical direction given ambulance personnel
20 by a base station physician through direct voice contact.
21 Medical protocol means any diagnosis- specific or problem- oriented
22 written statement of standard procedure, or algorithm, approved by the
23 AEPF, Inc. as the normal standard used to determine level or response,
24 pre - arrival instruction, and of prehospital care for that given clinical
25 condition.
Ordinance [PAGE 4 of 10]
To Amend Ambulance Ordinance
I Non -life threatening emergency means an emergency situation which
2 does not pose an immediate threat to human life as determined in
3 accordance with AEPF, Inc. protocols.
4 Operations contractor means the person, if any, granted an exclusive
5 contract by the ambulance service system.
6 Paramedic means a person certified by the state as a paramedic.
7 Response time means the actual elapsed time between receipt of
8 notification at the EMS control center than an ambulance is needed at an
9 identifiable location and the arrival of an ambulance at that location.
10 Run Code 1 — Presumptive designation means any ALS ambulance
11 service request designated as a time critical, life- threatening emergency
12 situation by a dispatcher as designated in accordance with AEPF, Inc.
13 telephone and dispatch protocols.
14 Run Code 2 — Presumptive designation means any ALS ambulance
15 service request designated by the dispatcher as an emergency medical
16 condition for which prompt response is appropriate for medical and
17 humanitarian reasons, but which apparently involves no immediate threat
18 to human life of a time - critical nature as designated in accordance with
19 AEPF, Inc. telephone and dispatch protocols.
20 Run Codes, other — Presumptive designation means any ambulance
21 service request for nonemergency transportation of a person whose
22 apparent condition cannot appropriately be designated as either code 1 or
23 2 as designated in accordance with AEPF, Inc. telephone and dispatch
24 protocols. The response to this ambulance service request may be either
25 ALS or BLS, as designated in accordance with AEPF telephone and
26 dispatch protocols.
Ordinance [PAGE 5 of 101
To Amend Ambulance Ordinance
I Senior Paramedic in charge means that individual among the certified
2 personnel on board an ambulance unit who is not the driver and who is a
3 paramedic currently certified under state law, and who is designated by
4 his employer or immediate supervisor as the individual in command of
5 the ambulance and its operation.
6 Special use permit means a permit issued by the license officer to
7 hospitals serving the public for the provision of specialized mobile
8 intensive care services to clinically defined patient populations (such as
9 neonatal transport), and permits issued pursuant to section 5 -79,
10 subsection (c).
I I System status management means the formal and orderly process of
12 continuously locating ambulance units available for dispatch among post
13 locations throughout the geographic area being served to maintain the
14 best possible readiness configuration at all times.
15 Section 2. Section 5 -68 (2) of the Little Rock Code of Ordinances is hereby
16 amended to read as follows:
17 (2) Personnel. The authority shall ensure:
18 a. That two (2) persons certified under state law are on board each
19 ambulance on ALS (code 1 or 2) ambulance runs or available for dispatch,
20 at least one (1) of which is certified as a paramedic, and the other of which
21 is certified as a paramedic or emergency medical technician (EMT).
22 If only one (1) person on board is a certified paramedic, that person
23 shall not function as the driver while the patient is on board. The
24 authority shall establish and maintain sufficient management capability to
25 ensure that equipment and personnel utilized are managed in an efficient
26 and effective manner to produce the desired clinical performance and
27 response time performance on a routine basis.
Ordinance [PAGE 6 of 10]
To Amend Ambulance Ordinance
1 Section 3. Section 5 -68(4) of the Little Rock Code of Ordinances is hereby
2 amended to read as follows:
3 (4) Response time performance. Response time performance standards are as
4 follows:
5
a. Code 1 calls (life threatening emergencies).
6
1. The fire department shall furnish a diligent good faith effort to manage
7
all available resources to achieve a four - minute maximum response
8
time for a trained first responder to a code 1.
9
2. The authority shall furnish a diligent good faith effort to maintain an
10
eight- minute (8:59) maximum response time for an advanced life
11
support paramedic ambulance. The authority shall employ enough
12
personnel, acquire enough equipment and manage its resources in the
13
manner necessary to meet the eight- minute response time standard on
14
not less than ninety (90) percent of all presumptively designated code 1
15
calls originating each month from with the city limits.
16
3. Where an ambulance unit is dispatched from a nontransporting first -
17
response -only status its response time may be counted as the authority
18
ambulance response time even though the patient was transported by
19
a different ambulance. In addition, the response time of a neighboring
20
ambulance service responding by mutual aid request may also be
21
counted as the authority's ambulance response time, provided the
22
level of life support capability furnished by the neighboring
23
ambulance service is comparable to that required under this article, as
24
determined by the AEPF, Inc., and provided that reliance upon
25
neighboring ambulance service operators is only an occasional event
26
and not a routine method of operation of the authority.
Ordinance [PAGE 7 OF 10]
To Amend Ambulance Ordinance
I b. Code 2 calls (non -life threatening emergencies). The authority shall
2 establish a 12- minute (12:59) advanced life support paramedic ambulance
3 response time standard for code 2 calls on not less than ninety (90) percent
4 of all presumptively designated code 2 calls originating each month from
5 within the city limits.
6 c. Other run codes (non -life threatening). The authority's response to other
7 run codes shall be reasonable, but in every case where a conflicting
8 demand for resources occurs, response to code 1 and code 2 calls shall
9 take precedence over requests for nonemergency BLS transfer service.
10 Furthermore, the authority shall display sound judgment in developing its
11 system status management plans to preserve a safe level of emergency
12 response capability at all times by delaying response to requests for
13 nonemergency BLS service until additional ambulance units become
14 available whenever the number of remaining ambulance units available
15 for dispatch falls below a reasonably established safe level of emergency
16 reserve capacity, as determined by historical demand analyses.
17 Section 4. Section 7 -71(a) of the Little Rock Code of Ordinances is hereby
18 amended to read as follows:
19 (a) General requirements for ambulance personnel. Every ALS ambulance subject
20 to regulation under this article is required to have on -board each ambulance unit
21 at least two (2) personnel certified under these regulations. At least one (1)
22 person must be certified as a paramedic and the other person must be certified as
23 both driver and as either a paramedic or an emergency medical technician
24 (EMT). If an ambulance unit is manned by one (1) paramedic and one (1) EMT,
25 the EMT shall serve as driver even if both persons possess ambulance driver
26 certifications. In such cases, the paramedic shall be responsible for directing
27 patient care and ambulance operations in general at all times. If two (2)
Ordinance [PAGE 8 of 10]
To Amend Ambulance Ordinance
I paramedics serve on the same unit, one (1) shall be designated as senior
2 paramedic in charge, by the director of operations or the shift supervisor. Every
3 BLS ambulance subject to regulation under this article is required to have on
4 board two EMT's, one to drive and the other to attend. No person shall be
5 employed or otherwise permitted to drive or attend ambulances subject to this
6 chapter, unless he shall hold a currently valid state certification and is nationally
7 registered as a paramedic, or EMT. It shall be unlawful for any person to serve
8 on an ambulance or helicopter rescue unit as ambulance personnel unless that
9 person has in his possession a currently valid state license and is approved for
10 work by the AEPF, Inc.
11 Section 6. Severability. In the event any title, section, paragraph, item, sentence,
12 clause, phrase, or word of this ordinance is declared or adjudged to be invalid or
13 unconstitutional, such declaration or adjudication shall not be affect the remaining
14 portions of the ordinance which shall remain in full force and effect as if the portion so
15 declared or adjudged invalid or unconstitutional were not originally a part of the
16 ordinance.
17 Section 7. Repealer. All laws, ordinances, resolutions, or parts of the same, that
18 are inconsistent with the provisions of this ordinance are hereby repealed to the extent
19 of such inconsistency.
20 Section 8. Emergency Clause. Whereas, it has been determined that it is
21 necessary that the proposed amendments become effective immediately to allow MEMS
22 operations to conform to the reality of recent Medicare reimbursement regulations; and
23 whereas the Board of Directors has determined that such amendments will not
24 adversely affect the health and welfare of the citizens of Little Rock, an emergency is
25 hereby declared and this Ordinance shall take effect immediately upon its passage.
26 PASSED: December 20, 2005
27 H
Ordinance PAGE 9 of 101
To Amend Ambulance Ordinance
I ATTEST:
2
3
4 Nancy Wood, eity Clerk
5
6 APPROVED AS TO LEGAL FORM:
7
8
9 Thomas M. Carpenter, City Attorney
10 H
11 H
12 H
13 H
14 H
15 H
16 H
17 H
18 H
19 H
20 H
21 H
22 H
23 H
24 H
25 H
26 H
27 H
APPROVED:
Ordinance (PAGE 10 OF 101
To Amend Ambulance Ordinance
!kailey, Mayor