HomeMy WebLinkAbout22384 1 ORDINANCE NO. 22,384
2
3 AN ORDINANCE TO AMEND LITTLE ROCK, ARK., REV. CODE
4 CHAPTER 5, §§ 5-1, (1988), THE LITTLE ROCK, ARK., EMERGENCY
5 MEDICAL SERVICES ORDINANCES; AND FOR OTHER PURPOSES.
6
7 WHEREAS, the Board of Directors of the City of Little Rock, Arkansas ("City) enacted various
8 ordinances to enable the City to address the public health and safety issues of Emergency Medical Services
9 in 1961; and,
10 WHEREAS, the Board of Directors enacted a comprehensive update of these Emergency Medical
I 1 Services in 1996 by means of Ordinance No. 17,255 (August 6, 1996); and,
12 WHEREAS,the Board of Directors established the Emergency Medical Health Care Facilities Board
13 by Ordinance No. 14,062 (June 16, 1981); and,
14 WHEREAS, pursuant to said ordinance, the City established the Little Rock Ambulance Authority,
15 d/b/a Metropolitan Emergency Medical Services("MEMS"); and,
16 WHEREAS, the field of emergency medicine has changed over the years, and there is need for the
17 City's ordinances addressing Emergency Medical Services to be update to reflect Local, State and National
18 Practices and Procedures.
19 NOW, THEREFORE, BE IT ORDAINED BY THE BOARD OF DIRECTORS OF THE CITY
20 OF LITTLE ROCK,ARKANSAS:
21 Section 1. Little Rock, Ark., Rev Code, Chapter 5, §§ 5-1, et seq. (1988) is hereby amended to read
22 as follows:
23 ARTICLE I.- IN GENERAL
24 Secs. 5-1 -5-25. - Reserved.
25 ARTICLE II. EMERGENCY MEDICAL HEALTH CARE FACILITIES BOARD
26 (AMBULANCE BOARD)
27 Sec. 5-26. Created.
28 Pursuant to the Public Facilities Boards Act[A.C.A. § 14-137-101,et seq.],there is created the
29 City of Little Rock, Arkansas, Emergency Medical Health Care Facilities Board.
30 Sec. 5-27. Membership.
31 (a) The Emergency Medical Health Care Facilities Board shall consist of five(5)persons selected
32 as provided in A.C.A. § 14-137-108, for terms of five (5) years each. However, the Medical
33 Director for the Emergency Medical Health Care Facilities Board shall be a member of the
34 Emergency Medical Health Care Facilities Board and shall not be subject to any term limits.
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1 Such Board shall, prior to the appointment of each member, submit a letter to the Board of
2 Directors listing the name and occupation of each proposed member for review and/or
3 comment by the Board of Directors. Members shall be residents and Qualified Electors of the
4 City and shall take,and file,with the City Clerk,the Oath of Office prescribed by law.
5 (b) The Board of Directors shall make all reasonable efforts to ensure that the membership consists
6 of persons whose occupation or expertise lies in the following fields:
7 (1) The Medical Director for the Emergency Medical Health Care Facilities Board.
8 (2) Attorney.
9 (3) Health Care Administrator.
10 (4) Business.
11 (5) Consumer.
12 (c) In addition to the membership set out above, if the Emergency Medical Health Care Facilities
13 Board expands, pursuant to the Interlocal Agreement approved by the Board of Directors, to
14 provide ambulance service to counties and other municipalities, not more than two (2)
15 additional members per governmental unit may be added to the membership of such Board.
16 The appointment of such new members, their terms, residency and other qualifications, shall
17 be determined by the terms of the Interlocal Agreement providing for the expansion of service.
18 The Interlocal Agreement must be approved by the Board of Directors.
19 (d) The Mayor of the City of North Little Rock may appoint two(2)members to serve on the Board
20 who shall represent the interests of the City of North Little Rock. These members shall be
21 residents of the City of North Little Rock and shall serve a term of five(5)years provided an
22 Interlocal Agreement concerning ambulances between Little Rock and North Little Rock is in
23 effect. Neither of these members shall be eligible to serve as Chairman of the Board.
24 Sec.5-28. May be Called Ambulance Authority.
25 The Emergency Medical Health Care Facilities Board created by this article may be referred to
26 as the"Ambulance Authority."
27 Sec. 5-29. General Functions.
28 The Ambulance Authority has authority to accomplish,establish,manage,operate,finance and
29 contract for Emergency Medical Health Care Services and Facilities within,or near,the City.
30 Sec.5-30. Fiscal Procedures.
31 The Emergency Medical Health Care Facilities Board is subject to all fiscal procedures of the
32 City.
33 Sec.5-31. Powers.
34 The Ambulance Authority is empowered, from time to time, to loan, acquire, construct,
35 reconstruct,extend,equip,improve,sell,lease,and contract concerning Emergency Medical Health
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I
1 Care Services and Facilities as shall be determined by the Ambulance Authority to be necessary to
2 effect the purposes of this article to provide adequate, efficient and professional Emergency
3 Medical Health Care Services and Facilities as within,or near,the City. In addition,the Ambulance
4 Authority shall have each of the powers set forth in A.C.A. § 14-137-111, and appropriate to the
5 purposes for which the Ambulance Authority is created. The Ambulance Authority may enter into
6 such contractual or cooperative agreements with such persons as may,in its discretion,be advisable
7 to accomplish the purposes of this article, including without limitation, departments, agencies, or
8 instrumentalities of the United States of America, the State, any County or Municipality of this
9 State,or the City.
10 Sec.5-32. Insurance and Indemnity.
11 The Ambulance Authority shall acquire,obtain,or otherwise contract for all forms of insurance
12 that are necessary and advisable to fully protect,insure and hold the City harmless from any liability
13 connected with the Ambulance Authority. In any event,the Ambulance Authority will indemnify
14 and hold the City harmless from any liability the City may incur or suffer as a result of the
15 Ambulance Authority's operations.
16 Sec.5-33. Issuance of Bonds.
17 The Ambulance Authority may issue evidence of indebtedness, including, but not limited to,
18 Revenue Bonds, notes or other evidences of indebtedness, from time to time, and may use the
19 proceeds, either alone, or together with other available funds and revenues, to accomplish the
20 purposes for which the Ambulance Authority is created as the same relates to the providing of
21 adequate, efficient, and professional Emergency Medical Health Care Services and Facilities;
22 provided that the accumulated indebtedness represented by such Revenue Bonds, notes, or other
23 evidences of indebtedness shall be obligations only of the Ambulance Authority and shall not
24 constitute an indebtedness for which the full faith and credit of the City or any of its revenues are
25 pledged, and the principle and interest on the Bonds or other evidence of indebtedness shall be
26 payable from and secured by a pledge of revenues from Emergency Medical Health Care Services
27 and Facilities financed, in whole or in part, from Bond proceeds or other evidence of indebtedness
28 and as authorized by, and in accordance with the provisions of the Public Facilities Board Act
29 [A.C.A. §§ 14-137-101, et seq.], together with such other collateral as may be properly pledged
30 under such Act and as the Ambulance Authority in its discretion may determine.
31 Sec.5-34. Excess Revenues.
32 Any revenues of the Ambulance Authority accumulated in excess of the amount necessary to
33 accomplish the purposes for which the Ambulance Authority is created and to comply with all
34 covenants and agreements of the Ambulance Authority in connection with any outstanding Bonds
35 or other obligations shall be reported to the Board of Directors.
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1 Sec.5-35. Organization and Reports.
2 The Ambulance Authority shall adopt such Bylaws and other Rules and Regulations as shall
3 be necessary for the conduct of its business and consistent with the provisions of the Public
4 Facilities Boards Act[A.C.A. §§ 14-137-101,et seq.]. The Ambulance Authority shall cause to be
5 filed with the City Clerk the annual report described in A.C.A. § 14-137-123 and the Ambulance
6 Authority shall further provide the City with Monthly Financial Statements in a form acceptable to
7 the City.
8 Sec.5-36. Responsibilities.
9 The Ambulance Authority shall provide developmental and financial oversight on all matters
10 concerning Ambulance Service in the City. The Ambulance Authority shall study,review,analyze,
11 advise and report on all matters of public policy affecting ambulance service that come before the
12 Board of Directors including, but not limited to, applications for Franchises, Franchise Fees,
13 applicable rates and proposed regulations and ordinances.
14 Sec.5-37. No Subsidy.
15 The City shall not lend, transfer, give or otherwise extend any monies or subsidize the
16 Ambulance Authority in any way except to the extent of assistance to the Ambulance Authority
17 which may be financed through Ambulance Franchise Fees collected by the City.
18 Sec.5-38 Exclusivity.
19 The Ambulance Authority shall have exclusive Franchise within its service areas to provide
20 Advanced Life Support(ALS) and Basic Life Support(BLS) Ambulance Services subject to any
21 exceptions in the Little Rock Code.
22 Secs.5-39-5-55. Reserved.
23 ARTICLE III. AMBULANCE SERVICE
24 Sec.5-56.Definitions.
25 The following words, terms and phrases, when used in this article, shall have the meanings
26 ascribed to them in this section,except where the context clearly indicates a different meaning:
27 Advanced Life Support(ALS) means a level of emergency service provided by an Emergency
28 Medical Technician-Paramedic trained at the level of Advanced Life Support, including
29 resuscitation techniques such as intubation, intravenous access,and cardiac monitoring.
30 Ambulance means any motor vehicle equipped with facilities to convey infirm or injured
31 persons in a reclining position.
32 Ambulance Authority, or the Authority, means the City of Little Rock, Arkansas, Emergency
33 Medical Health Care Facilities Board. The Ambulance Authority does business as Metropolitan
34 Emergency Medical Services,or"MEMS."
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1 Ambulance Control Center means the facility designated by the Ambulance Authority from
2 which all ambulances are dispatched and controlled.
3 Ambulance Patient means any person who is ill, infirm, injured or otherwise incapacitated,
4 bedridden, or helpless and requires or requests Ambulance Service or Helicopter Rescue Service
5 to or from a hospital, physician's office, medical clinic, nursing home or other health care facility.
6 Ambulance Personnel means Paramedics, Emergency Medical Technicians, Emergency
7 Vehicle Operators and Emergency Medical Responders.
8 Ambulance Run means a patient transport by ambulance on a for-hire fee for service or prepaid
9 capitation basis.
10 Ambulance Service area means that area which is contained within the boundaries of the
11 municipal limits of the City and the area of those jurisdictions participating by Interlocal Agreement
12 in the MEMS System.
13 Arkansas Emergency Physicians'Foundation, Inc., or AEPF means the non-profit professional
14 and charitable organization composed of licensed physicians, a majority of whom are regularly
15 engaged in the full-time professional practice of emergency medicine. This term may apply to this
16 organization, or to any similar organization, or to a separate Board created by the City.
17 Base Station Physician means a physician licensed under the Arkansas Medical Practices Act
18 (A.C.A. §§ 17-95-201, et seq.) and certified by the AEPF or the American College or Emergency
19 Physicians or operating under the supervision of such a physician.
20 Basic Life Support (BLS) means a level of emergency service provided by an Emergency
21 Medical Technician that includes basic techniques such as bleeding control, simple airway
22 maneuvers and administration of oxygen.
23 Dispatcher means any person who works in the Ambulance Control Center and dispatches
24 ambulances.
25 Driver means an Emergency Vehicle Operator or any other person who is certified by the
26 license officer to drive ambulances in the City.
27 EMS means Emergency Medical Services.
28 Emergency Medical Technician, or EMT means any person certified by the State as an
29 Emergency Medical Technician.
30 Exclusive Franchise means the exclusive right to engage in all emergency and nonemergency
31 intracity patient transports and intercity and intracounty patient transports originating from within
32 the City. This definition also includes the Ambulance Authority's operating area as established by
33 Interlocal Agreement.
34 First-Responder means any person capable of providing qualified First-Responder Emergency
35 Care as required by the AEPF or as further defined by the Arkansas Department of Health.
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1
I Intercity Patient Transport means an ambulance run which transports a patient from a point
2 within the City to another City,or from another City to a point inside the City.
3 Intracity means that which takes places solely within the City.
4 License Officer means the authorized agent of the City Manager.
5 Life-Threatening Emergency means an Echo or Delta level response that is designated as time
6 critical and life threatening as defined by the International Academies of Emergency Dispatch
7 ("IAED"). The response time component of life-threatening emergency calls will be measured
8 based on the baseline and benchmark standard endorsed by the Commission on Fire Accreditation
9 International ("CFAI") which also takes into consideration the population density as well as the
10 service area.
11 Medical Control means online medical direction given to ambulance personnel by a base
12 station physician through direct voice contact via telephone or other communication device or
13 platform,or via offline medical direction through the use of standing orders through written clinical
14 guidelines.
15 Medical Propriety Dispatch System, or MPDS means a unified system used to dispatch
16 appropriate aid to medical emergencies including systematized caller interrogation and pre-arrival
17 instructions.
18 Medical Protocol means any diagnosis-specific or problem-oriented written statement of
19 standard procedure, or algorithm, approved by AEPF as the normal standard used to determine
20 level of response,pre-arrival instruction and prehospital care for that given clinical condition.
21 Medical Quality Review means an official inquiry into the circumstances involving an
22 ambulance run or request for service.
23 Nonlife Threatening Emergency means a Charlie,Bravo,Alpha or Omega response as defined
24 by IAED. The response time for these emergencies shall be determined by AEPF.
25 Paramedic means a person licensed by the state as a paramedic.
26 PSAP means a public safety answering point,e.g., 911 call center.
27 Response Time means the time interval from the initial call from the requestor to the arrival of
28 the first ambulance on scene. Response time consists of the following components:
29 (a) Dispatch Time: the time interval from initial call from the requestor until the first
30 dispatch notification for a unit to respond.
31 (b) Turnout Time: the time interval from when response personnel receive the dispatch
32 notification until there is a staffed ambulance responding.
33 (c) Travel Time: the time interval from the staffed ambulance initiates response until it
34 arrives at the scene of the incident.
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1 (d) Dispatch to First Unit Arrival: is a cumulative time for the time components of Turnout
2 and Travel times. This is the time controlled only by the responding resources and not
3 the ambulance control center.
4 The EMS agency response time begins when it receives a response from the primary PSAP and
5 both a full address and a MPDS call determinate has been obtained. The measurement of time
6 stops when the ambulance or other unit arrives at scene of an incident or at a staging area awaiting
7 the arrival of another public safety official due to an unsafe scene.
8 Senior Paramedic in Charge means that individual among the licensed personnel on Board an
9 ambulance unit who is not the driver and who is a paramedic currently certified under State Law,
10 and who is designated by his employer, or immediate supervisor,as the individual in command of
11 the ambulance and its operation. If two (2) or more licensed EMTs on the ambulance, or at the
12 scene, are at the same level of training and experience, the person with the lowest EMT License
13 Number shall be the individual in command of the ambulance, and as applicable, at the scene.
14 Special Use Permit means a permit issued by the license officer to hospitals serving the public
15 for the provision of specialized mobile intensive care services to clinically defined patient
16 populations (such as neonatal transport) and permits issued pursuant to Little Rock Code Section
17 5-79(c).
18 System Status Management means the formal and orderly process of continuously locating
19 ambulance units available for dispatch among post locations throughout the geographic area being
20 served to maintain the best possible readiness configuration at all times.
21 Sec. 5-57. Penalty.
22 Any person convicted of a violation of any of the provisions of this Article shall be punished
23 as provided in Little Rock Code Section 1-9. Each day that any violation, of or failure to comply
24 with this Article, is committed, or permitted to continue, shall constitute a separate and distinct
25 offense under this Section and shall be punishable as such hereunder. Each ambulance run
26 unlawfully performed shall be considered a separate offense. Each hour of illegally rendered
27 standby services shall be considered a separate offense. Each incident of willful falsification of
28 data by a licensee shall be considered a separate offense. Each ambulance run for which records
29 are willfully omitted shall be considered a separate offense. Each instance of willful participation
30 in the committing of an offense by an individual working as a Paramedic, EMT or Dispatcher shall
31 also be considered a separate offense.
32 Sec. 5-58. Purpose and General Intent.
33 (a) Purpose. It is the purpose of this article to establish a regulated Ambulance Service System
34 that can provide each ambulance patient with the best possible chance of survival without
35 disability or preventable complication.
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1 (b) General Intent. It is the intent of the Board of Directors of the City that:
2 (1) Exclusively is mandatory because it is neither fair nor financially feasible to require a
3 high level of emergency performance from one (1) Ambulance Company while
4 simultaneously allowing other ambulance companies to select certain preferred non-
5 emergency business.
6 (2) Substantive regulation requiring clinical excellence and Citywide life-saving response
7 time performance cannot reasonably be imposed on an unsubsidized Ambulance
8 Company without simultaneously granting that Ambulance Company an exclusive
9 contract to furnish all Ambulance Service, both emergency and non-emergency, to
10 residents of the City.
11 (3) If the Ambulance Authority is not operated as a Public Facilities Board (with
12 Ambulance Services provided by employees of the Board), it may, after bid
13 procedures,select a private Ambulance Company for an exclusive contract to provide
14 ambulance personnel to operate the ambulance service in the City. The Ambulance
15 Company shall provide the ambulance personnel necessary to operate the equipment
16 owned by the Ambulance Authority and to provide those management functions
17 delegated to it under contract by the Ambulance Authority. The Ambulance Authority
18 shall own, or shall serve as a primary lessee of, all ambulance and communication
19 equipment and shall provide all administrative oversight for the ambulance service
20 system. Nothing in this paragraph shall prevent the Ambulance Authority from
21 operating the Ambulance Service and providing its own personnel.
22 (4) This article will:
23 a. Furnish bona fide monitoring and medical control of present ambulance
24 operations.
25 b. Allow the City to contract with AEPF to develop written Medical Standards,
26 Protocols, Controls, Medical Quality Reviews and system evaluation and to
27 provide complete medical control over and evaluation of the City's Ambulance
28 Service System.
29 c. Require the development of a First-Responder Program.
30 (5) The Ambulance Authority shall be required to:
31 a. Designate a single EMS Control Center in the City,or County,from where all
32 ambulance dispatching shall take place.
33 b. Purchase an appropriate complete Communication and Recording System.
34 c. Design the communication system and control center operation to allow for
35 full-time recording of all ambulance-related radio and telephone traffic.
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1 (c) Basic Life Support: Non-life threatening emergencies. Notwithstanding any other provision
2 of this chapter, the Ambulance Authority may provide for BLS responses to non-life
3 threatening emergencies as permitted by the State Department of Health,as consistent with this
4 chapter,and as approved by AEPF.
5 Sec. 5-59. Operation on Fee or For-Hire Basis.
6 Except as provided in Little Rock Code Sections 5-58 and 5-60, no person or entity, public or
7 private,shall operate an ambulance to transport the sick, injured,or infirm on a fee or for-hire basis,
8 regardless of whether it is an emergency or routine non-emergency patient transport, upon any
9 street within the City or other contracted areas.
10 Sec. 5-60. Exemptions.
11 An Ambulance Service License shall not be required for Ambulance Services which are:
12 (1) Owned and operated by an Agency of the United States Government.
13 (2) Rendering requested assistance to an ambulance which is currently licensed in cases
14 of disaster, in a major emergency too great for local resources, or in response to
15 provisions of a written mutual aid agreement approved by the Ambulance Authority.
16 (3) Engaged in intercounty or intercity patient transport from facilities anywhere outside
17 of the City and its Franchise Area extended by Interlocal Agreements, but which
18 ambulance run ends anywhere inside the City and its Franchise Area.
19 (4) Rendering ambulance services under contract with the Ambulance Authority.
20 (5) Private companies which use an ambulance solely for the transportation of their
21 employees for illness or injury sustained while performing their work.
22 (6) Operating a privately-owned ambulance designed especially for the transportation of
23 the infirm or physically handicapped where the ambulance is used solely for the benefit
24 of the owner and not for hire on a fee for service or pre-paid basis.
25 (7) Ambulances owned and operated by a licensed hospital and used exclusively for
26 specialized mobile intensive care or for institutional transfers of their own admitted
27 patients or residents, provided such hospital shall apply for and receive a special use
28 mobile intensive care license or be eligible for grandfather licensing, as provided for
29 under Little Rock Code Section 5-79. Such Special Use Permit is non-transferable by
30 the hospital.
31 Sec. 5-61. Medical Director Generally.
32 The Medical Director shall be a licensed physician selected by AEPF,or a similar organization.
33 He shall serve at the pleasure of same.
34 Sec. 5-62. Reserved.
35
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1 Sec.5-63. Intracity Ambulance Service.
2 It shall be unlawful for any person, or entity, public or private, to operate an Intracity
3 Ambulance Service which provides emergency or nonemergency prehospital care or patient
4 transports except as specifically allowed pursuant to the provisions of this article.
5 Sec.5-64. Deviation from Medical Protocol.
6 Base Station Physicians may, for cause, deviate from approved medical protocol in a specific
7 case where authorized deviation is warranted by special circumstances.
8 Sec.5-65. Control by Board of Directors.
9 The Ambulance Authority is authorized to operate the City's Ambulance Service System under
I 0 the supervision and control of the Ambulance Authority's Board of Directors.
11 Sec.5-66. Management Options and Mandatory Requirements.
12 (a) Mandatory requirements for exclusive contract method are as follows:
13 (1) The Ambulance Authority shall operate,or cause to be operated,a licensed Ambulance
14 Service System for the City, and for neighboring areas if appropriate contractual
15 relationships can be developed with those neighboring areas for the equitable sharing
16 of equipment costs, operating costs, medical costs, control and audit costs and
17 management costs. The service operated by the Ambulance Authority shall have the
18 following characteristics:
19 a. The services rendered must at all times be in compliance with the provisions
20 of this Article.
21 b. All emergency equipment utilized in this service must be owned by or leased
22 to the Ambulance Authority as primary lessee.
23 c. All legal proceedings which are necessary, shall be performed by the
24 Ambulance Authority.
25 The Ambulance Authority shall own,or shall be the primary lessee of,all ambulance
26 and communication equipment,shall be responsible for all billings and collections,but
27 may outsource the billings and collections,as needed,and shall provide administrative
28 oversight for the Ambulance Service System. AEPF shall provide all medical advice,
29 medical control, Medical Quality Reviews and medical oversight.
30 Sec.5-67. Physician Supervision and Medical Quality Control.
31 (a) Advisory Contract. The City Manager may contract with AEPF, or any similar organization,
32 to provide medical advice to the Ambulance Authority and physician supervision and medical
33 quality control over the City's Ambulance Service System.
34 (b) The AEPF generally:
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1 (1) Powers and Duties. The powers and duties of AEPF are generally to provide the
2 Ambulance Authority with information about the necessary elements of the City's
3 Ambulance Service System and to:
4 a. Establish reasonable standards of production and patient care, including
5 standards for vehicles and on-board equipment.
6 b. Make official recommendations to the Ambulance Authority and to the City's
7 Board of Directors.
8 c. Establish medical protocols.
9 d. Establish standards, procedures and protocols for the operation of the EMS
10 Control Center.
11 e. Establish procedures and protocols for first-responder medical care.
12 f. Establish standards and procedures governing the reliable provision of twenty-
13 four(24)-hour medical control.
14 (2) Medical Quality Reviews.
15 a. The AEPF, or similar organization, shall perform Medical Quality Reviews
16 when requested by the License Officer, at the request of the Chairman of the
17 Ambulance Authority, the City Manager, any member of the Board of
18 Directors,any Certified Paramedic,any licensed physician, or any member of
19 the Ambulance Authority Board in accordance with the terms and conditions
20 of its contract with the City.
21 b. A Medical Quality Review performed upon the request of an authorized party
22 and which is related to a particular incident, rather than to a concern about a
23 general protocol or system procedure, shall be initiated by a review of all
24 recordings, dispatch records, patient report forms, hospital records, and other
25 records,documents,and information related to that incident. lf, in the opinion
26 of the reviewing physician,additional inquiry or action is appropriate, an oral
27 review of the matter shall be conducted by the reviewing physician. The
28 person whose performance is the subject of such Medical Quality Review shall
29 be notified of the time and place of such oral review, and the person whose
30 performance is the subject of the Medical Quality Review may not be excluded
31 from the oral review.
32 c. The Medical Quality Review Procedure is intended to be educational and
33 positive and not vindictive or punitive. Any individual whose actions are
34 under review may not be excluded from the review process and shall have the
35 right to appear and be heard.
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1 (3) Medical Director. The Medical Director shall implement the policies established by
2 AEPF and upon approval of AEPF and the Ambulance Authority, may appoint an
3 Assistant to the Medical Director who shall serve in that capacity at the pleasure of the
4 Medical Director.
5 (4) Annual Report. The Medical Director and the Chairman of the Ambulance Authority
6 may, at their discretion, make a written report to the Board of Directors on January l''
7 of each year detailing the status of the Ambulance Service System.
8 (c) Radio Communication.
9 (1) The Ambulance Authority shall ensure that at all times its field personnel have direct
10 access by reliable radio or telephone communications to medical consultation and
11 direction concerning the care of patients in the field. To ensure that reliable medical
12 communications exist at all times and to ensure that all medical communications are
13 appropriately monitored for backup purposes, the Ambulance Authority shall furnish
14 or otherwise acquire a reliable Medical Communications System.
15 (2) All medical control radio traffic shall be continuously recorded by the ambulance
16 control center. All tapes or other recording media shall be retained for 120 days and
17 may then be recycled, destroyed or erased.
18 (d) Run Reports and Reviews. A copy of the approved Run Report Form, approved by the
19 Ambulance Authority, shall be left with the emergency receiving facility to which each patient
20 is delivered. The receiving facility physician may request a medical quality review to be
21 performed relative to the prehospital or interhospital care of that patient. Ambulance personnel
22 involved directly in the handling of a medical quality reviewed case after notification from the
23 Medical Director shall attend the reviews of that case. Failure to attend the medical reviews
24 without good cause is grounds for disciplinary action by the Executive Director.
25 (e) Appeals. AEPF shall make its findings and recommendations to the Director of Operations,
26 who shall be responsible for any disciplinary action taken against ambulance personnel or
27 performance improvement plans for ambulance personnel. Such actions may be appealed to
28 the Executive Director. In the case of Fire Department First-Responders, AEPF shall make its
29 findings and recommendations to the Fire Chief, who shall be responsible for any disciplinary
30 action taken against Fire Department Personnel, in accordance with the City's Personnel Policy
31 and Civil Service Rules and Regulations.
32 Sec.5-68. Standards of Production and Performance.
33 The Ambulance Authority shall follow the following as minimum standards:
34 (1) Equipment and Management Capability. Each and every ambulance and all on-board
35 equipment utilized by the Ambulance Authority in performing services which are the subject
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1 of this article shall comply with applicable standards required for licensure. The Ambulance
2 Authority shall maintain the equipment and shall employ sufficient backup equipment to ensure
3 that a safe level of reserve equipment capacity is available to provide peak period ambulance
4 coverage even at times when unusual occurrences of equipment breakdown and routine
5 equipment maintenance coincide.
6 (2) Personnel.The Ambulance Authority shall ensure:
7 a. That each ambulance is staffed by personnel as required by the Arkansas Department
8 of Health.
9 (3) Clinical Performance.The clinical performance of the Ambulance Authority and its personnel
10 shall be consistent with and shall conform to the operating procedures and medical protocols
11 adopted by AEPF. Where clinical performance deficiencies are discovered, the Ambulance
12 Authority shall efficiently and promptly take all reasonable measures to correct the
13 deficiencies.
14 (4) Response Time Performance. Response time performance standards are as follows:
15 a. Life-Threatening Emergency Calls.
16 1. The Fire Department shall make a diligent good faith effort to manage all
17 available resources to achieve the response times for life-threatening
18 emergency calls set by CFAI. Response times under exceptional
19 circumstances, e.g., mass casualty events, shall be exempt from these
20 requirements.
21 2. The Ambulance Authority shall make a diligent good faith effort to manage
22 all available resources to achieve the response times for life-threatening
23 emergency calls set by CFAI. Response times under exceptional
24 circumstances, e.g., mass casualty events, shall be exempt from these
25 requirements.
26 3. Where an ambulance unit is dispatched from a non-transporting first-response-
27 only status, its response time may be counted as the Ambulance Authority
28 ambulance response time even though the patient was transported by a
29 different ambulance. In addition, the response time of a neighboring
30 ambulance service responding by mutual aid request may also be counted as
31 the Ambulance Authority's ambulance response time, provided the level of
32 life support capability furnished by the neighboring ambulance service is
33 comparable to that required under this article, as determined by AEPF, and
34 provided that reliance upon neighboring Ambulance Service Operators is only
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1 an occasional event and not a routine method of operation of the Ambulance
2 Authority.
3 b. Nonlife-Threatening Emergency Calls. The Ambulance Authority shall make a
4 diligent good faith effort to manage all available resources to achieve the response
5 times for nonlife-threatening emergency calls set by the Center for Public Safety
6 Excellence.
7 c. Other Types of Calls (Nonlife-Threatening). The Ambulance Authority's response to
8 other types of calls shall be reasonable, but in every case where a conflicting demand
9 for resources occurs, responses to life-threatening and nonlife-threatening calls shall
10 take precedence over requests for non-emergency BLS transfer service. Furthermore,
11 the Ambulance Authority shall display sound judgment in developing its System Status
12 Management Plans to preserve a safe level of emergency response capability at all
13 times by delaying response to requests for non-emergency BLS service until additional
14 ambulance units become available whenever the number of remaining ambulance units
15 available for dispatch falls below a reasonably established safe level of emergency
16 reserve capacity, as determined by historical demand analyses.
17 (5) Continuous Physician Medical Control Required. The Ambulance Authority shall be
18 responsible for ensuring that its field personnel at all times have access to qualified medical
19 control and direction concerning the care of patients in the field by a base station physician or
20 designee. All medical control and direction shall be available by reliable radio, telephone, or
21 other communication platform, according to the Communications Standards and other
22 standards of medical control set forth in Little Rock Code Section 5-67.
23 (6) Data systems and Reporting. The Ambulance Authority shall comply at all times with the data
24 system and reporting standards required by AEPF, applicable Statutes and the Arkansas
25 Department of Health requirements.
26 (7) In-Service Training Program Required. The Ambulance Authority is required to furnish or
27 otherwise make available without charge to its employees an In-Service Training Program
28 which conforms to the standards for in-service training adopted by AEPF. All ambulance
29 personnel are required to attend these In-Service Training Programs in accordance with the
30 guidelines promulgated by AEPF.
31 (8) Fully Centralized Dispatch Required. All dispatching movements of ambulance units subject
32 to regulation under this article shall be directed from the designated EMS Control Center or
33 other designated area. It is unlawful to dispatch or control any ambulance unit subject to
34 regulation under this article from any location other than the designated EMS Control Center
35 or other designated area. At all times, the EMS Control Center or other designated area shall
lPage 14 of 201
1 have full authority to direct the positioning, movements and run responses of all manned
2 ambulance units, and to activate on-call crews following the then current System Status
3 Management Procedures.
4 Sec.5-69. First-Responder Program.
5 (a) The City will continue to provide "emergency first-responder" program and personnel,
6 provided this service shall maintain at least Emergency Medical Responder Certification, as
7 certified by the State Health Department.
8 (b) The Ambulance Authority's Communication Center personnel shall request first-responder
9 units provided by the City. The Fire Department will maintain control over the use of fire
10 apparatus as first-responders,and shall be advised by the ambulance system dispatch personnel
11 as to the need for such "first-responder" response. The Director of Operations, or his/her
12 designee, shall be advised by the Central Station District Chief of the non-availability and
13 resumption of availability of first-responders. The Fire Department shall retain control over
14 the decision to divert fire apparatus from first-responder activity in the event such units are
15 needed for fire purposes.
16 (c) The Ambulance Authority shall make its training program available to first responder
17 programs.The City will use its best efforts to have its first responder personnel avail themselves
18 of this training.
19 (d) The Ambulance Authority will frilly cooperate with the City's Communication Center in
20 establishing radio monitoring capability of the ambulance service system's activities and all
21 necessary communication linkages between the various emergency provider organizations'
22 operations.
23 Sec.5-70.Vehicle Permits.
24 It shall be unlawful for any person subject to regulation by this article to operate an Ambulance or
25 Helicopter Service unless a currently valid State Vehicle Permit has been issued.
26 Sec.5-71.Dispatch Personnel Certification,etc.,Required.
27 (a) General requirements for Ambulance Personnel. Every ambulance shall be staffed as mandated
28 by the State Health Department.
29 (b) Dispatchers.
30 (1) General Responsibilities for Dispatcher. Any person employed for the purpose of
31 receiving telephone or other requests for Ambulance Service and for dispatching
32 ambulances in the City's Ambulance Service System is required to receive Emergency
33 Medical Dispatch Training as provided by,or equal to,that provided by the Ambulance
34 Authority.
35
[Page 15 01201
1 Sec.5-72. Insurance.
2 (a) The Ambulance Authority shall maintain the following insurance:
3 (1) Automobile Liability Insurance in an amount not less than One Hundred Thousand
4 Dollars ($100,000.00) for injury to or death of, one (1) person, by reason of the
5 carelessness or negligence of the driver of such ambulance; Three Hundred Thousand
6 Dollars ($300,000.00) for injury to, or death of, more than one (1) person, resulting
7 from any single accident, by reason of the carelessness or negligence of the driver of
8 such ambulance; and Fifty Thousand Dollars ($50,000.00) for damage to property
9 resulting from any single accident, by reason of the carelessness or negligence of the
10 driver of such ambulance, issued by an insurance company licensed to do business in
11 the state for each and every ambulance owned or operated,or both owned and operated,
12 by the Ambulance Authority , providing for the payment of damages:
13 a. For injury to or death of individuals in accidents resulting from any cause for
14 which the owner of the vehicle would be liable on account of liability imposed
15 on him by law, regardless of whether the ambulance was being driven by the
16 owner or his agent; and,
17 b. For the loss or damage to the property of another under like circumstances.
18 (2) Malpractice insurance providing a limitation on each claim of not less than Five
19 Hundred Thousand Dollars($500,000.00).
20 (3) One Million Dollars($1,000,000.00)aggregate coverage.
21 (b) Satisfactory evidence that such insurance is at all times in force and effect shall be furnished to
22 the City Attorney, in such form as he may specify.
23 (c) Every insurance policy required hereunder shall contain a provision for a continuing liability
24 thereunder to the full amount thereof, notwithstanding any recovery thereon, that the liability
25 of the insurer shall not be affected by the insolvency or the bankruptcy of the assured,and that
26 until the policy is revoked or expires,the insurance company will not be relieved from liability
27 on account of nonpayment of premium, failure to renew license at the end of the year, or any
28 act or omission of the named assured. Such policy of insurance shall be further conditioned
29 for the payment of any judgments up to the limits of the policy recovered against any person
30 other than the owner, his agent, or employee who may operate the same with the consent or
31 acquiescence of the owner.
32 (d) Every insurance policy shall extend for the period to be covered by the license applied for,and
33 the insurer shall be obligated to give not less than thirty(30)days written notice to the insured
34 before any cancellation or termination thereof earlier than its expiration date. The cancellation
35 or other termination of any such policy shall automatically revoke and terminate the permits
lPage 16 of 20l
1 issued for the ambulances covered by such policy, unless another insurance policy complying
2 with the provisions of this section is provided and is in effect at the time of such cancellation
3 or termination.
4 (e) Each insurance policy shall name in addition to the Little Rock Ambulance Authority,the City
5 and AEPF.
6 Sec.5-73. Fees.
7 The City shall negotiate the fees to be paid for the services provided by AEPF in this Article.
8 The City may assess this amount as a fee to be assessed the Ambulance Authority from revenues.
9 Sec.5-74. Reserved.
10 Sec.5-75. Patient Management and Management of Scene.
11 Authority for patient management in a medical emergency shall be invested in the Senior
12 Paramedic,the Incident Command System,or,when only a BLS unit is involved in an incident,the
13 lead EMT, as appropriate. Authority for the management of the scene of a medical emergency
14 shall be vested in the Senior Paramedic unti I appropriate Public Safety Officials arrive on the scene
15 and take control. The scene of a medical emergency shall be managed in a manner described to
16 minimize the risk of death or health impairment to the patient and to other persons who may be
17 exposed to the risks as a result of the emergency condition,and priorities shall be placed upon the
18 interests of those persons exposed to the more serious risks to life and health. Public Safety Officials
19 shall ordinarily consult the Senior Paramedic in charge at the scene in the determination of relevant
20 risk factors.
21 Sec.5-76. Protocol for Determining Destination Facility.
22 (a) For all calls designated as other than life-threatening emergency or nonlife-threatening
23 emergency, the patient shall be delivered to the destination of the patient's choice, whenever
24 practicable. However, in cases where the patient is incompetent or unable to make a choice,
25 the patient shall be delivered to the destination requested by the appropriate party acting on
26 behalf of the patient,whenever practicable.
27 (b) For all calls designated as life-threatening emergency or nonlife-threatening emergency calls,
28 or which,during the course of a transfer become a life-threatening emergency call,the patient
29 shall be delivered to the destination of the patient's choice,whenever practicable. However, if
30 the patient is incompetent or unable to make a choice, the patient shall be delivered to the
31 destination requested by the appropriate person acting on behalf of the patient, whenever
32 practicable. If no requested destination can be determined,the patient shall be delivered to the
33 nearest medically appropriate emergency receiving facility.
'Page 17 of 201
1 (c) No life-threatening emergency or nonlife-threatening emergency type patients shall be
2 delivered to an emergency receiving facility which does not have twenty-four (24)-hour
3 physician coverage of emergency services, except as otherwise provided by law.
4 (d) Other provisions of this section notwithstanding, for calls retrospectively designated as life-
5 threatening emergency, the patient shall be delivered to the appropriate emergency receiving
6 facility in conformance with disease-specific or problem-specific transport protocols then
7 currently in effect and approved by AEPF.
8 (e) This Section shall not apply to the Arkansas Trauma Communications Center and other State
9 Agencies that dispatch ambulances.
10 Sec. 5-77. Reserved.
11 Sec. 5-78. Medical Quality Review and Investigation of Consumer Complaints.
12 (a) The Medical Quality Review process shall be conducted under the supervision of the Medical
13 Director and each Medical Quality Review hearing shall be directly supervised by a physician
14 appointed by the Medical Director pursuant to the terms and conditions of the contract between
15 the City and AEPF, or other similar organization. A Medical Quality Review shall be
16 performed at the request of the Executive Director,the Chairman of the Ambulance Authority,
17 the City Manager,any member of the Board of Directors,any Certified Paramedic,any licensed
18 physician, or any member of the Ambulance Authority Board.
19 (b) In addition to medical quality reviews performed upon request, AEPF shall also conduct
20 additional selected reviews chosen on a diagnosis-specific or problem-oriented basis to
21 periodically assess the ambulance service system's ability to deal effectively with specific
22 clinical conditions. These reviews shall be periodically performed by reviewing a random
23 selection of cases of each type desired. Furthermore, AEPF physicians may periodically ride
24 as observers on ambulances to directly observe care rendered, and such observations shall be a
25 form of Medical Quality Review for evaluation purposes.
26 (c) The Executive Director and AEPF shall establish procedures for formal investigation of
27 consumer complaints. The Ambulance Authority and its employees shall cooperate fully with
28 all investigations and shall answer in writing any inquiries by AEPF concerning such
29 investigations. The Chairman of the Ambulance Authority or the Executive Director may
30 instruct the staff of the Ambulance Authority to conduct an investigation on their behalf.
31 (d) If, as a result of findings from a Medical Quality Review Process, AEPF believes that a
32 Certified Paramedic or EMT should be subject to restrictions as necessary to protect the public
33 health and safety, a written recommendation shall be made to the Executive Director. He shall
34 make any additional necessary investigation and shall then determine and implement any
35 necessary and appropriate action.
(Page 18 of 201
1 Sec.5-79. Provision for Special Use Licensure.
2 (a) Upon application to and approval by AEPF, Special Use Licenses may be issued to licensed
3 hospitals for provision of Specialized Mobile Intensive Care Services and to private companies
4 for purposes restricted to the emergency care and transport of the company's own employees.
5 (b) Applicants for specialized mobile intensive care licensure must be hospitals, departments of
6 hospitals,or the Ambulance Authority.
7 (c) Central Arkansas Radiation Therapy Institute(CARTI)is granted a Limited Special Use Permit
8 for the purposes of continuing the transportation of CARTI patients from,and return to,CARTI
9 facilities. Such permits for this medically necessary transportation may be restricted under this
10 article depending upon the extent of future expansion of these services.
11 (d) Applications for such specialized licensure shall be made on such forms as may be described,
12 prepared, or prescribed by the License Officer, and shall contain the information that is
13 necessary and appropriate for AEPF to make an informed judgment. No fee shall be required
14 for the processing of application for such special licensure.
15 (e) AEPF shall not arbitrarily or without cause withhold its authorization for the issuance of a
16 special license, provided; however, that licenses so issued shall be clearly restricted to the
17 special purposes defined herein, and provided there exists a clinical necessity for the special
18 service to be offered,and provided that in the case of such special licensure for purposes other
19 than specialized mobile intensive care,the applicant is able to demonstrate compelling reasons
20 for allowing the draining off of fee for services revenues which would otherwise be available
21 to support advanced life support production capacity to serve the City and other contracted
22 areas. However,because the population served by the City's Ambulance Service System is,at
23 best,too small to optimize advanced life support service economies of scale,the mere presence
24 of a desire to operate a transfer service which does not provide specialized mobile intensive
25 care shall not, by itself, constitute a compelling reason to allow the draining off of needed
26 financial resources to support essential advanced life support production capacity.
27 Section 3. Severability. In the event any title, section, paragraph, item, sentence, clause, phrase, or
28 word of this ordinance is declared or adjudged to be invalid or unconstitutional, such declaration or
29 adjudication shall not affect the remaining portions of the ordinance which shall remain in full force and
30 effect as if the portion so declared or adjudged invalid or unconstitutional was not originally a part of the
31 ordinance.
32 Section 4. Repealer. All laws, ordinances,resolutions,or parts of the same,that are inconsistent with
33 the provisions of this ordinance, including but not limited to Little Rock, Ark., Ordinance No. 17,255
34 (August 6, 1996)and Little Rock, Ark., Ordinance No. 14,062(June 16, 1981), are hereby repealed to the
35 extent of such inconsistency.
[Page 19 of 201
i
I PASSED: February 6,2024
2 APPROVED:
34 tai,
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)rt-JA,
5 us. gle , ity Clerk Frank Sc ,Jr.,Mayor
6 AP"' I a: • : TO LEGAL FORM:
7
8 `l./'*4-4— IV.
9 Thomas M. Carpenter,City Attorne
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