Chapter 5.10
EMERGENCY MEDICAL SERVICES (effective December 17, 2024)
Sections:
5.10.060 Powers of the Board of County Commissioners.
5.10.070 Emergency Medical Services Board.
5.10.080 Adoption of rules – Rule-making generally.
5.10.090 Ambulance service area adjustment.
5.10.100 Assignment of ambulance service areas.
5.10.110 Duties of ambulance service provider.
5.10.120 Prohibited activities.
5.10.125 Complaint review process.
5.10.130 Suspension or revocation of assignment.
5.10.010 Title.
This chapter shall be known as the Emergency Medical Services Ordinance or Ambulance Service Area Ordinance. [Ord. 2024-016 § 1; Ord. 2013-007 § 1.]
5.10.020 Authority.
A. The Josephine County Board of Commissioners hereby determines that the health, safety, and general welfare of the citizens of Josephine County requires that ambulance services be regulated so as to provide prompt, effective, efficient and safe service.
B. This chapter is authorized by ORS Chapter 682, OAR Chapter 333, Divisions 250, 255, and 260, Josephine County Home Rule Charter, Chapter II, and other applicable law. [Ord. 2024-016 § 1; Ord. 2013-007 § 2.]
5.10.030 Policy and purpose.
A. Josephine County has developed and adopted a plan relating to the need for and coordination of ambulance services, and has established ambulance service areas to provide efficient and effective ambulance services in accordance with ORS 682.062. That plan has been approved by the Oregon Health Authority.
B. This chapter establishes the methods for selecting ambulance providers for each service area, and establishes the Emergency Medical Services Board. This chapter and the Josephine County Ambulance Service Area Plan (ASA Plan) make up the complete plan for emergency ambulance services for Josephine County. [Ord. 2024-016 § 1; Ord. 2013-007 § 3.]
5.10.040 Definitions.
A. “Administrator” means the Administrator of the Josephine County Health Department or other person designated by the Board of Commissioners to administer the Emergency Medical Services program in Josephine County.
B. “ASA” means Ambulance Service Area as set forth in the ASA Plan.
C. “Board” or “BCC” means the Josephine County Board of Commissioners.
D. “Emergency Medical Services Board” or “EMSB” means the advisory committee that provides advice to the Board on matters relating to the ambulance service area, the provision of ambulance services, the regulation of its providers, and all related matters.
E. “Plan” or “ASA Plan” means the most recent Ambulance Service Area Plan approved by the State of Oregon and adopted by the Board of Commissioners. [Ord. 2024-016 § 1; Ord. 2013-007 § 4.]
5.10.050 Exemptions.
The provisions of the chapter do not apply to:
A. U.S. Government. Vehicles owned or operated by the United States Government or under contract to an agency of the United States Government.
B. Public Catastrophe. Vehicles being used to render temporary assistance in case of a major catastrophe, disaster, or emergency with which the licensed ambulances of the County are unable to cope, or when directed to be used to render temporary assistance by the individual in charge of the scene of an accident or emergency.
C. Institutional Vehicles. Vehicles operated solely on private property or within the confines of institutional grounds, whether or not the incidental crossing of any public street, road or highway through the property or grounds is involved.
D. Lumber Industry. Vehicles operated by lumber industries solely for the transportation of lumber industry employees.
E. Out of County Vehicles. Vehicles operating from a business location, office or headquarters outside the County, that are transporting a patient from an area outside the County to a health care facility within the County, or vehicles which are passing through without a destination in the County.
F. Person With Exempt Vehicle. Any person who drives or who attends a patient transported in a vehicle under subsections (A) through (E) of this section.
G. Doctors and Nurses. Any physician or registered nurse who by state or federal license is authorized to attend patients insofar as their acts are within the scope of activities authorized by their license.
H. Air Carriers. Air ambulances and connecting ground-leg ambulances licensed by the State of Oregon and in conformance with applicable laws. [Ord. 2024-016 § 1; Ord. 2013-007 § 5.]
5.10.060 Powers of the Board of County Commissioners.
A. Rules and Licenses. The BCC shall have the authority to approve rules and to take action concerning licenses in accordance with the provisions of this chapter.
B. Emergency Rules. The BCC may adopt emergency rules. When the BCC finds that immediate action is required, the BCC may adopt emergency rules without notice. Such rules shall expire automatically 120 days after their adoption by the BCC.
C. Other Powers. The BCC shall also have the authority to:
1. Convene the EMSB;
2. Audit records to assure compliance with this chapter;
3. Perform all other acts necessary to implement and enforce the provisions of this chapter;
4. Perform any act necessary to ensure that ambulance service providers comply with all applicable provisions of federal and state law and administrative rules, as well as local ordinances and rules. [Ord. 2024-016 § 1; Ord. 2013-007 § 6.]
5.10.065 Administrator.
A. The BCC shall appoint an Administrator who, under the supervision of the BCC and with assistance of the EMSB, shall be responsible for the administration of this chapter.
B. The Administrator, or persons authorized by the Administrator, is hereby authorized to enter on the premises of any service provider regulated by this chapter at reasonable times and in a reasonable manner to access records related to the provision of ambulance services and to determine compliance with this chapter. [Ord. 2024-016 § 1.]
5.10.070 Emergency Medical Services Board.
The Emergency Medical Services Board (EMSB) as an advisory board to the Board of Commissioners with the duties and responsibilities of reviewing and making recommendations to the BCC on the assignment of Ambulance Service Areas, monitoring the performance of ambulance service providers, reviewing the ASA Plan and other ambulance-related documents, and performing other such emergency medical services matters as may be requested by the BCC or the Administrator. [Ord. 2024-016 § 1; Ord. 2013-007 § 7.]
5.10.080 Adoption of rules – Rule-making generally.
The BCC may, on its own motion, or upon written recommendation from the EMSB, adopt, amend, or repeal administrative rules deemed necessary to achieve the purposes of, and further implement, this chapter by order or resolution of the BCC. Such rules may be adopted as provided for in this chapter. Rules adopted pursuant to the provisions of this chapter shall have the force of law.
A. Prior to adoption, amendment or repeal of any rule the BCC shall:
1. Make copies of the notice of intended rule-making available to the public and post such notice on the County’s website. Such notice shall be made at least 30 days prior to the intended action;
2. Send notice of the intended rule-making to the EMSB prior to intended action; and
3. Send notice to every person, city, or district that has notified the County in writing of its desire to be consulted.
B. The adoption, amendment, or repeal of a rule by the BCC need not be based upon or supported by an evidentiary record. [Ord. 2024-016 § 1; Ord. 2013-007 § 8.]
5.10.090 Ambulance service area adjustment.
For the efficient and effective provision of ambulance service in Josephine County, the Ambulance Service Area Plan approved by the Oregon Health Authority and adopted by the Board of Commissioners is hereby adopted and incorporated herein by this reference.
A. The BCC, after notice to the affected ASAs provider and by the adoption of an order, may adjust the boundaries of the ASA(s) from time to time as necessary to provide efficient and effective ambulance service in accordance with state law.
B. Persons may petition for changes in ASAs; however, the petitioner must demonstrate how these changes will provide for more efficient or effective ambulance services to the public than already exist as defined in ORS 682.062 et seq. and OAR 333-260-0000 et seq.
1. Effectiveness of service is demonstrated by complying with requirements for boundaries, coordination and service standards.
2. Efficiency of service is demonstrated by selecting an ambulance provider that will meet the effectiveness standards of the Plan at a reasonable cost to the consumer.
C. In addition, the petitioner must either demonstrate that the call volume of all ASAs is sufficient to financially support the level of service required or else demonstrate financial soundness of the proposal through other income sources and comply with other provisions for selection.
D. Further rules may be drafted so as to avoid, to the extent practicable, restrictions on free entry into the marketplace and shall provide a mechanism for re-designation to accommodate new licensees or expansions. The rules shall provide for ASAs meeting the requirements as defined in ORS 682.062 et seq. and OAR 333-260-0000 et seq. [Ord. 2024-016 § 1; Ord. 2013-007 § 9.]
5.10.100 Assignment of ambulance service areas.
A. No person shall operate or provide ambulance service in Josephine County unless the person or entity is licensed and contracted to do so by the BCC and licensed by the Oregon Health Authority. Each provider of emergency medical services in Josephine County must be properly licensed, fully insured, and fully in compliance at all times with all applicable federal, state and local statutes, ordinances, and administrative rules.
B. Any person desiring to provide ambulance service within Josephine County shall submit an application to be assigned an ASA during a defined and advertised application period. The application shall be submitted to the BCC. Applications shall be reviewed by the EMSB created by this chapter, which shall recommend the assignment of ASAs to the BCC. The assignment of the ASA shall be made by an order of the BCC.
C. An application required by subsection (B) of this section shall be submitted by the applicant in the manner prescribed by this chapter and shall include the following:
1. The name and address of the person applying for the assignment of an ASA.
2. The ASA the person desires to service and the location from which ambulance services will be provided.
3. A list of vehicles to be used in providing ambulance services including year, make and model and verification that each vehicle is licensed as a basic life support and/or advanced life support ambulance by the State of Oregon.
4. A list of personnel to be used in providing ambulance service and their current emergency medical technician or paramedic license number.
5. A statement that all equipment and supplies in each ambulance comply with all applicable standards set by the Public Health Division of the Oregon Department of Human Services.
6. Proof of financial ability to operate, including but not limited to audits, profit and loss statements, tax returns, references and government reports.
7. A statement of experience in providing ambulance services; together with a statement of ability to comply with the requirements of service in the Josephine County ambulance service area.
8. Proof of all required licensure through the Oregon Health Authority.
9. Any licensing and inspection fees.
10. Any additional information requested by the Josephine County EMSB or BCC.
D. Each application shall be reviewed for the applicant’s conformity with the requirements of Oregon law for providing ambulance services, the specific criteria of the Josephine County ASA Plan and the need for efficient and effective ambulance service within Josephine County. This shall include but not be limited to:
1. Equipment Inspection. At any time after receipt of a license application, or request for license amendment or renewal, the BCC or designee may inspect and test all vehicles and equipment and inspect all proposed vehicle location sites.
2. Approval Criteria. Any application must document that (a) by addition of the proposed service, the overall service to the County will be improved, considering effectiveness, efficiency, and cost, and (b) the proposed service will meet all requirements of state law and this chapter.
3. Recommendation by the EMSB. The EMSB shall review and investigate each application and shall make a written report to the BCC with its recommendation as to (a) the ability of the applicant to meet the requirements for a license, and (b) whether the applicant should be granted a license.
E. The BCC may award a license and contract to an ambulance service provider upon finding that the applicant has met all requirements of applicable state and federal law and administrative rules, this chapter and the rules adopted pursuant to this chapter.
F. One ambulance service provider will be licensed for each of the ambulance service areas in Josephine County. At the option of the Board of Commissioners, the same provider may be licensed for both of the ambulance service areas.
G. The assignment of the initial ASA license shall be valid from the date of issuance until September 30th of the third calendar year following issuance. Thereafter, the assignment of ASAs may be renewed for additional five-year terms commencing on the first day of October, subject to the provisions for suspension or revocation as set forth in JCC 5.10.130.
H. Not less than 180 days prior to the expiration of the assignment of an ASA, any person desiring the renewal of an assignment or a new assignment of an ASA shall submit an application to be assigned an ASA. The application shall include the information required by subsection (C) of this section, except that applications for renewal need only provide such information necessary to bring the original application up to date. The review of the application and assignment of the ASA shall be in accordance with this section.
I. The ambulance service provider shall provide at least 180 days’ written notice to the BCC prior to terminating service.
J. A licensee shall notify both the 9-1-1 Agency and the Administrator immediately if for any reason the licensee becomes unable to provide emergency ambulance service within its ASA.
K. In the event that an entity assigned an ASA discontinues service before the expiration of the assignment, the BCC shall set a time by which applications must be submitted for reassignment of the ASA. The review of the applications and assignment of the ASA shall be for the remainder of the term unless otherwise specified by the BCC.
L. Not less than 15 days prior to any date when the applications for the assignment of an ASA are due, notice of such application due date shall be posted on the County website. Other notice may be provided at the discretion of the BCC.
M. The applicant or licensee may submit an amended application and an amended license may be issued for the balance of the original or renewed license period. [Ord. 2024-016 § 1; Ord. 2013-007 § 10.]
5.10.110 Duties of ambulance service provider.
Upon assignment of an ASA, the ambulance service provider:
A. Shall immediately file with the BCC and EMSB a current list of all fees charged for rendering service. No change may be made in such fees unless authorized by the BCC and EMSB upon written application by the provider. The provider shall file a statement of fees each year during the term of the provider’s contract with the County.
B. Shall maintain on file, and make available upon request of the BCC or EMSB, a current roster of personnel who will be operating under the ambulance provider’s employ and/or control. This roster must include the following information: (1) full name, (2) level of certification or licensure and (3) license or certification number.
C. Shall maintain and make available, upon request of the BCC, all records required by federal, state and local laws and administrative rules.
D. Shall employ only:
1. Emergency medical technicians or paramedics who are certified or licensed or hold provisional license or certification by the Oregon State Health Authority and who meet the requirements of rules adopted pursuant to this chapter; or
2. Substitute personnel as authorized by the Oregon State Health Authority or the Oregon State Board of Medical Examiners.
E. Shall enlist, at the provider’s expense, the services of a supervising physician who meets the requirements of the state Board of Medical Examiners for supervising physicians.
F. Shall make available, upon request, written information to the public concerning all rate information.
G. Shall render emergency medical services 24 hours a day, seven days a week, during every week.
H. Shall provide pre-hospital medical services and ambulance transportation to all persons in the service area without regard to race, color, creed, gender, marital status, sexual orientation, national origin, or ability to pay.
I. Shall submit to the County, prior to approval of a County license, proof of all insurance required by rules adopted pursuant to this chapter.
J. Shall notify the County within 10 working days of any changes in material information that would adversely affect response time or service contained in the license application, related materials, or license.
K. Shall enter into and maintain in effect mutual aid agreements with emergency medical service providers in adjoining counties.
L. Shall provide a written report of its activities to the EMSB at least once each quarter, or more often at the request of the EMSB. The report shall include the total number of calls received, the number of responses, the total elapsed time for response in excess of the required response time, and an explanation of the reason for the delay in response.
M. All employees, agents, associates and managers or directors of any person or entity providing emergency medical services shall at all times comply with all applicable federal, state, and local laws, statutes, and administrative rules, including but not limited to those laws, statutes and rules relating to the equipment and supply of vehicles and the licensing and fitness of personnel. [Ord. 2024-016 § 1; Ord. 2013-007 § 11.]
5.10.120 Prohibited activities.
A. Services. It shall be unlawful for any person to do business or operate an ambulance in Josephine County without having a license issued by Josephine County and a contract to operate such ambulance(s) or ambulance service.
B. Ambulances. No person shall operate a vehicle as an ambulance that is not equipped, operated, and attended by personnel as required under state and County law.
C. Related Prohibitions. No ambulance operator, ambulance service provider, or their employee, agent or representative shall:
1. False Statements. Make a false statement of a material fact, or omit disclosure of a material fact, in an application for a license or in any matter relating directly to the provision of emergency medical services.
2. Overcharging. Charge for services not performed, make duplicate charges for the same service, or charge rates exceeding those on file with BCC.
3. Unauthorized Services. Perform emergency medical services unless authorized by this chapter and the rules adopted pursuant to this chapter. This prohibition does not apply when:
a. The response is for supplemental or mutual aid;
b. An Incident Commander requests additional assistance in response to a multiple casualty incident.
4. Transfer of Assignment. Assignment of an ASA may be made only with the written application to and approval of the BCC. The BCC shall determine the process for assignment of an area or selection of a new provider. The application shall be reviewed in accordance with the provisions of this chapter.
5. Failure to Notify. Fail or refuse to promptly inform the 9-1-1 Center of receipt of a request for emergency medical assistance, or fail to inform the 9-1-1 Center when a licensee’s ambulance(s) becomes unavailable to respond to dispatch orders.
6. Violating Responses. Respond by ambulance to an emergency call in violation of this chapter or rules adopted pursuant to this chapter.
7. Nonresponse. Fail or refuse to respond to a dispatch from the 9-1-1 Center or other authorized dispatch center when an ambulance subject to the call is available for service.
8. Falsifying Licenses. Intentionally falsify, deface, or obliterate any license or certificate required under this chapter.
9. Violation of Law. Violate any federal, state, County, or municipal law, or any rule adopted pursuant to those laws, or operate while any license or certificate for services, ambulances, or employees are suspended or revoked. [Ord. 2024-016 § 1; Ord. 2013-007 § 12.]
5.10.125 Complaint review process.
A. Complaints relating to emergency medical services by citizens shall be in writing, and shall be referred to the Administrator and/or the EMSB for review and resolution. The ESMB or a designee of the Board of Commissioners will conduct investigation and make recommendations to Administrator and the Board of Commissioners to resolve the complaint and any ongoing difficulties related to the provision of emergency medical services.
B. No particular form or format of the complaint is necessary; however, the complaint must be in writing and should include relevant facts, including names, times and dates, places, and issues of concern. [Ord. 2024-016 § 1.]
5.10.130 Suspension or revocation of assignment.
A. The BCC may suspend or revoke the assignment of an ASA upon finding that the service provider has:
1. Violated any provisions of this chapter, the Josephine County ASA Plan, or any provisions of state or federal laws and regulations; or
2. Materially misrepresented facts or information provided in the application for the assignment of an ASA, or in any performance review of the service provider.
B. In any action upon a complaint or review, the EMSB shall provide written notice to the provider of the action anticipated and allow the provider a reasonable opportunity to respond to the notice. In any contemplated action, any member of the EMSB who has or who appears to have a conflict of interest shall declare the conflict or apparent conflict and shall take no part in the supervision, review, revocation or resolution process.
C. In lieu of the suspension or revocation of the assignment of the ASA, the BCC may issue a written warning, or order that the violation be corrected and make the suspension or revocation contingent upon compliance with the order within a stated period of time. Written notice of the BCC decision shall be given to the service provider and shall specify the violation, the action necessary to correct the violation and the date by which the action must be taken. The provider shall notify the BCC of action taken. If the provider fails to take corrective action within the time required, the BCC shall notify the provider that the assignment is suspended or revoked upon receipt of the notice. [Ord. 2024-016 § 1; Ord. 2013-007 § 13.]
5.10.140 Hearing.
A person receiving a notice of the assignment, denial, suspension, revocation, or contingent suspension, or revocation of an ASA may request a hearing before the BCC by filing with the BCC a written request for a hearing within 14 days of the decision, setting forth the reasons for the hearing and the issues proposed to be reviewed. The filing of a hearing request shall stay the action pending the hearing and final determination by the BCC unless the BCC makes an immediate written finding and order that prompt implementation of the decision is required due to an immediate hazard to the public’s safety. The BCC shall set a time and place for a hearing within 14 days of the filing date of the hearing request or immediate order. The hearing shall be de novo on the record or a full de novo hearing, as determined by the BCC. Within 14 days after the conclusion of the hearing, the BCC shall affirm, reverse, or modify its original decision. [Ord. 2024-016 § 1; Ord. 2013-007 § 14.]
5.10.150 Penalties.
A. In addition to any other procedures and remedies provided for by law, violations of this chapter or rules adopted pursuant to this chapter shall be punishable by a fine not to exceed $5,000 per violation.
B. Violators may be cited and prosecuted by civil suit in the appropriate court, by criminal charges where appropriate, or in any other manner provided by law.
C. Notwithstanding other provisions regarding enforcement of this chapter, the County or any affected person may initiate a civil suit to remedy the violation, seeking injunctive or declaratory relief, or pursue any other legal remedy as provided by applicable law. [Ord. 2024-016 § 1; Ord. 2013-007 § 15.]
5.10.160 Nuisance.
In addition to penalties provided by this chapter, violation of any of the provisions of this chapter is declared to be a nuisance and may be regarded as such in all actions, suits and proceedings. Pursuant to state law, this chapter shall be enforceable by the State of Oregon and by Josephine County. [Ord. 2024-016 § 1; Ord. 2013-007 § 16.]
5.10.170 State standards.
Nothing in this chapter, or the rules adopted pursuant to it, shall be construed to establish requirements for ambulance service lower than those established, now or hereafter, by the State of Oregon or the rules adopted by the Oregon Health Division. [Ord. 2024-016 § 1; Ord. 2013-007 § 17.]
5.10.180 Delegation.
The BCC may delegate any or all of its functions under this chapter or rules adopted hereunder to the EMSB or any other entity deemed suitable by the BCC. Decisions of such delegation shall be final unless and until reversed by the BCC. [Ord. 2024-016 § 1; Ord. 2013-007 § 18.]
5.10.190 Dispatch exemption.
Nothing in this chapter or in the ASA Plan is intended to prohibit a 9-1-1 agency from dispatching any other initial responder to the scene of a medical emergency, in addition to dispatching an emergency ambulance service provider. [Ord. 2024-016 § 1; Ord. 2013-007 § 19.]