Chapter 8.32 REGULATORY STANDARDS FOR EMERGENCY SERVICES

A. To establish oversight and regulatory standards for the provision of ambulance and emergency medical services which supplement and exceed the standards of Chapters 18.73 and 70.168 RCW and the regulations adopted thereunder;

B. To promote state-of-the-art clinical quality of EMS care with reasonable, reliable response-time standards, and with the goal of furnishing the best possible chance of survival, without disability or preventable complication, to each EMS patient;

C. To provide a method to develop specific performance standards, adequate review, and medical protocols for such services; and

D. To establish a uniform EMS ordinance which may be adopted by other general purpose governmental units which wish to take advantage of a uniform standard of care in recognition of the role of the medical facilities and health care community as regional providers of primary, secondary, and tertiary medical care. (Ord. 03-010 § 1, 2003: Ord. 95-772 § 1, 1995)

8.32.020 Definitions.

Unless a different meaning is plainly required by the context, words and phrases used in this chapter shall have the meanings attributed to them in RCW 18.73.030 or in this section; provided, that in case of any conflict, this chapter shall control.

“Ambulance patient” means any patient being transported in an ambulance as defined in RCW 18.73.030.

“Ambulance service” means an agency licensed by the state and county to operate one or more ground ambulances as defined by RCW 18.73.030.

“Ambulance service contract” means the contract entered into between Clark County EMS District No. 2 (district) and ambulance service contractor for exclusive market rights (9-1-1 and non-9-1-1 or non-emergency) and responsibilities, for the provision of all ground ambulance service originating within the contract service area, regardless of whether the patient’s destination is within or outside the county, subject to the exemptions defined in this chapter.

“Ambulance service contractor” means the entity which is under contract with Clark County EMS District No. 2 (District) to provide ambulance services.

“Board” means the Clark County board of commissioners.

“Cities” means the cities of Battle Ground, La Center, Ridgefield, and Woodland, Washington, which have adopted the uniform EMS ordinance and entered into the EMS interlocal cooperation agreement.

“County” means Clark County, Washington.

“CRESA” means the Clark regional emergency services agency.

“District” means Clark County Emergency Medical Services District No. 2 established by ordinance pursuant to RCW 36.32.480.

“Emergency medical services” or “EMS” means medical treatment and care which may be rendered of any medical emergency, or while transporting any patient in an ambulance to an appropriate medical facility, including ambulance transportation between medical facilities.

“Emergency medical services administrative board,” “EMS board,” or “EMSAB” means the board established pursuant to this chapter and the EMS interlocal cooperation agreement to provide EMS administrative and financial oversight functions.

“EMS interlocal cooperation agreement” means the agreement entered into between the cities, the county, and the district pursuant to Chapter 39.34 RCW in part to effectuate the enforcement of this chapter.

“Loaded miles” means the ambulance transport of a patient from site of pickup to destination.

“Medical call-taker” or “emergency medical dispatcher” means a person in the employ of or acting under the control of a private or public agency who receives and responds to calls requesting emergency medical services and administers emergency medical dispatch protocols approved by the medical program director.

“Medical program director” or “director” means the medical program director for Clark County certified by the Secretary of the Department of Health pursuant to Chapter 18.71 RCW.

“Medical protocol” means any diagnosis-specific or problem-oriented written statement of standard procedures promulgated pursuant to state or local law or regulation for pre-hospital care for a given clinical condition.

“Online medical control physician” means a physician who gives direction to ambulance or other EMS personnel through direct voice contact or other communication media as required by applicable medical protocols.

“Patient” means any person who is injured, sick, incapacitated, or otherwise found by the medical program director to require emergency medical services.

“Person” means an individual, partnership, company, association, corporation (governmental or private) or any other legal entity including any receiver, trustee, assignee or similar representative.

“Regulated service area” means the combined area of the unincorporated area of Clark County within EMS District No. 2, plus the corporate limits of the cities and all other general purpose jurisdictions which have adopted the uniform EMS ordinance and entered into the EMS interlocal cooperation agreement.

“Response time zones” means those geographic areas designated as urban, suburban, rural and wilderness by the EMS administrative board and in the ambulance service contract and EMS administrative rules adopted pursuant to this chapter.

“System standard of care” or “standard of care” means the combined compilation of all standards for out-of-hospital medical care including but not limited to emergency medical dispatching protocols; EMS patient care guidelines (i.e., first responders and ambulance providers); protocols for selecting destination hospitals; standards for certification of out-of-hospital care personnel (i.e., medical call-takers, emergency medical responders, emergency medical technicians, paramedics and online medical control physicians); standards for permits (i.e., ambulances, first responder units, helicopter rescue units, and special-use mobile intensive care services); response-time standards; standards governing on-board medical equipment and supplies; and standards for licensure of ambulance services. The standard of care shall serve as both a regulatory and contractual standard of care and performance.

“Uniform EMS ordinance” or “ordinance” means the ordinance codified in this chapter and all substantially identical ordinances adopted by general purpose governmental jurisdictions which are also parties to the EMS interlocal cooperation agreement. (Ord. 14-06 § 1 (part), 2014: Ord. 03-010 § 2, 2003: Ord. 95-772 § 2, 1995)

8.32.030 Ambulance service license—Required.

Except as provided in BGMC 8.32.120, no person shall provide ambulance services within the unincorporated area of the county of EMS District No. 2 plus the corporate limits of the city of Battle Ground and all other general purpose jurisdictions which have adopted the uniform EMS ordinance and entered into the EMS interlocal cooperation agreement, unless licensed to do so pursuant to this chapter. (Ord. 14-06 § 1 (part), 2014: Ord. 03-010 § 3, 2003: Ord. 95-772 § 3, 1995)

8.32.035 Regulatory administration.

Clark County shall be the agent of the city to enforce and administer this chapter and shall establish a budget for the support of such activities through an agreement with CRESA’s EMS program; provided, that any criminal prosecution as defined in BGMC 8.32.270 shall be instituted by the city. The specific responsibilities of Clark County as the regulatory administrator shall be as described by the EMS interlocal cooperation agreement. (Ord. 14-06 § 1 (part), 2014: Ord. 03-010 § 9, 2003)

8.32.045 System standard of care—Medical program director’s duties.

The county, as the regulatory administrator, shall contract with the medical program director (MPD) to perform the following duties and responsibilities:

A. To prescribe and periodically revise the standard of care for EMS services so as to supplement or exceed the standards set by state law and regulations;

B. To appoint and receive recommendations from such standing and ad hoc advisory committees as may be appropriate to secure broad-based input for improving the standard of care, with membership on such committees which may include emergency medical service providers such as physicians, nurses and paramedics; public and private emergency response and planning agency personnel; and consumers of emergency medical services, provided there shall be appointed at minimum one standing advisory committee composed of representatives from public and private EMS providers;

C. To recommend to the state the issuance, renewal, suspension, revocation and restriction of certifications provided for by this chapter, subject to appeal or review as prescribed by this chapter and not inconsistent with state law;

D. To establish and maintain a system of clinical monitoring, medical control and medical audit designed to detect and correct deviations from the standard of care which reduce the level of patient care, to identify and correct deficiencies in the system standard of care itself, and advance the practice of pre-hospital medicine through clinical research. (Ord. 14-06 § 1 (part), 2014: Ord. 03-010 § 10, 2003)

8.32.055 System standard of care—Upgrades—Conditions.

Upgrades to the system standard of care may be periodically proposed by the MPD, after input from any appropriate ad hoc or standing advisory committees established pursuant to this chapter. The MPD shall notify the cities and all affected holders of licenses, permits and certifications of the proposed upgrade not less than thirty days prior to the date scheduled for its implementation. The affected persons or entities may submit a statement of financial impact to the MPD documenting their projected actual and reasonable costs of implementing and maintaining such upgrade and the impact of such costs on the fees, if any, they charge for their services or the amount of local government funding for such services. The financial impact statement shall be submitted in a format approved by the MPD. If no financial impact statements are submitted, or if the statements submitted show that the proposed upgrade can be implemented without an increase in fees to consumers or an increase in local government subsidy, the upgrade shall be implemented as scheduled. If financial impact statements are submitted by the ambulance service contractor to show that the upgrade will result in increased fees to consumers or increased local government subsidies, the proposed upgrade shall be referred to the EMS administrative board for review. If financial impact statements are submitted by other affected holders of licenses, permits and certifications to show the upgrade will result in increased fees to consumers, increased local government subsidies, or government funding of EMS, the impact statements shall be referred to the appropriate policy body for that affected holder of licenses, permits and certifications for consideration in adopting the upgrade. (Ord. 14-06 § 1 (part), 2014: Ord. 03-010 § 11, 2003)

8.32.065 System standard of care—Upgrades—Review required.

Upon receipt of a proposal for an upgrade in the system standard of care which is alleged to result in a cost or subsidy increase to the contractor, the EMS administrative board shall schedule a hearing within thirty days of receipt to determine the probable financial impact of the proposed upgrade and review its importance to the provision of quality pre-hospital medicine. The MPD, the cities, the county and the ambulance service contractor shall be given not less than five days’ prior notice of the hearing and shall have the opportunity to present evidence and argument at the hearing. The EMS administrative board shall approve, modify, or deny the proposed upgrade subject to confirmation by the district, and give notice of its decision to the city, county, and ambulance service contractor; provided, that no proposed upgrade shall be modified by the EMS administrative board without the approval of the MPD. The upgrade so approved or modified shall become effective thirty days after notice of the decision of the EMS administrative board, unless prior to the expiration of such time the district gives notice to the EMS administrative board of its election to review the upgrade. The district shall schedule a hearing before the board on the upgrade within thirty days of its notice of election and shall give the MPD, the cities, and ambulance contractor not less than five days’ prior notice of the hearing and the opportunity to present evidence and argument at such hearing. The district may approve, modify or deny the upgrade; provided, that the upgrade shall not be modified without approval of the MPD. The written decision of the board on the upgrade shall be final and conclusive unless review is sought in a court of competent jurisdiction within ten days of the board’s written decision. (Ord. 14-06 § 1 (part), 2014: Ord. 03-010 § 12, 2003)

8.32.100 Prohibited activities.

Except as provided in BGMC 8.32.120, it shall be unlawful for any person including any ambulance service, its agents or employees to intentionally, knowingly, or recklessly:

A. Make a false statement of a material fact, or omit disclosure of a material fact, in any application for a license, certification, or permit required by this chapter;

B. Perform the services of or allow the performance of first responder, EMT or trainee activities by any first responder, EMT or trainee who suffers a suspension, revocation or termination of certification by the Department of Health;

C. Solicit the performance of ambulance services or the transport of an ambulance patient by any person not licensed or certified under this chapter or by use of any vehicle or equipment for which a permit is not in effect under this chapter;

D. Perform the services of a first responder or EMT unless in full conformity with state law, this chapter and the standard of care established hereunder;

E. Provide private ambulance service unless under contract to do so with the district or authorized by Clark regional emergency services agency in time of emergency;

F. If licensed hereunder, fail or refuse to immediately advise Clark regional emergency services agency of receipt of a request for emergency medical assistance;

G. Falsify, deface or obliterate any license, certificate or permit required under this chapter;

H. Transport an ambulance patient in any vehicle other than an ambulance, except as provided in RCW 18.73.170;

I. Advertise on a vehicle a level of services not being provided by that particular vehicle. The level of service must be available anytime that vehicle is available for service; provided, that this chapter shall not be construed to require level of service advertising on vehicles;

J. Wear any badge or device similar to the badge traditionally worn by police or fire personnel while serving on or with an ambulance providing emergency medical transportation within the county unless such ambulance is owned or controlled by a public safety agency and the personnel are employees of the agency;

K. Deny or delay emergency ambulance or other EMS service to any person on account of possible inability to pay, race, creed, religion, age, sex, national origin, physical or mental disability, place of residence, financial condition, presence or absence of medical insurance coverage; provided, that it shall not be a violation of this chapter for ambulance personnel to obtain at the time of service information required for effective billing, to comply with state or federal regulations pertaining to patient care and transport, or to comply with special benefit eligibility procedures established by medical insurers or medical service providers;

L. Charge for any service, equipment or supplies not provided to the patient. (Ord. 03-010 § 4, 2003: Ord. 95-772 § 10, 1995)

8.32.120 Exemptions to chapter provisions.

This chapter shall not apply to:

A. Vehicles being used to render temporary assistance in the case of a public catastrophe or emergency when licensed ambulances are not available or cannot meet overwhelming demand;

B. Vehicles owned or controlled by the United States government;

C. Vehicles operated only on private property or within the confines of institutional grounds;

D. Persons providing wholly volunteer emergency transportation or emergency medical services without compensation or the expectation of compensation on an unplanned and nonregular basis;

E. Vehicles or aircraft responding at the request of an ambulance service provider licensed under this chapter pursuant to a mutual aid agreement approved by the medical program director;

F. Persons or vehicles providing ambulance service for patient transports originating outside the regulated service area or nonstop patient transports through the regulated service area;

G. All air transport services (fixed and rotary wing) approved by the medical program director used for the medical transport purposes;

H. Persons or vehicles providing non-911 ambulance service for intercounty patient transports originating inside the regulated service area in excess of thirty loaded miles. (Ord. 03-010 § 5, 2003: Ord. 95-772 § 12, 1995)

8.32.130 Contract administration.

The county shall appoint the five members of an EMS administrative board. The EMS administrative board shall advise on matters pertaining to EMS contracting and system-wide financial stability and carry out administrative duties through an agreement with CRESA’s EMS program. The specific responsibilities of the district as the contract administrator shall be described in the ambulance services contract and the EMS interlocal cooperation agreement.

A. The EMS administrative board shall consist of five persons, none of whom shall be elected officials, who shall consist of the following:

1. One with expertise in the field of health care administration;

2. One with expertise in business and finance;

3. One with expertise in law;

4. One with expertise in the fields of health care administration or business;

5. One person with expertise in insurance.

B Appointments shall be for three years. The EMS administrative board shall elect such officers and adopt such bylaws as appropriate for orderly conduct of business.

C. The EMS administrative board, as provided in the EMS interlocal agreement, shall:

1. Develop and administer an ambulance procurement process for the contract service area of EMS District No. 2, subject to confirmation by the district;

2. Conduct ongoing ambulance contract administration and oversight;

3. Review and comment on changes in EMS system structure and financing;

4. Review upgrades in the system standard of care which will result in major cost increases, subject to confirmation by the district;

5. Perform such other duties as are prescribed by the EMS interlocal cooperation agreement. (Ord. 14-06 § 1 (part), 2014: Ord. 03-010 § 6, 2003: Ord. 95-772 § 13, 1995)

8.32.140 Administrative rules.

A. Authority. Clark County may adopt, amend and repeal administrative rules deemed necessary to achieve the purposes of this chapter, which the city of Battle Ground will then ratify. Such rules shall include, but are not limited to:

1. Procedures for licensing ambulance services;

2. Procedures for obtaining ambulance vehicle permits;

3. Minimum ambulance vehicle and equipment standards;

4. Minimum ambulance staffing levels; and

5. Minimum ambulance response time standards.

B. Notification Requirements. In promulgating or amending these rules, Clark County shall provide reasonable notice to and opportunity for comment by affected agencies and persons, and shall so advise the city, which notice shall be not less than as follows:

1. Publication in a newspaper of general circulation in the county at least ten days prior to the day of intended action; and

2. At least thirty days’ written notice to all EMS agencies within the county and to those persons on file as having requested such notice from the county. The notice should state the subject matter and purpose of the intended action and the time, place and manner in which interested persons may present their views on the intended action. It should inform the reader that a copy of the proposal and the county recommendation are available for inspection.

C. Rule Adoption Procedure. The city of Battle Ground shall defer to Clark County in the adoption, amendment or replacing of appropriate administrative rules and will adopt said rules by reference.

D. Rule Adoption Effective Date—Appeal. The action taken by Clark County shall become effective on the thirtieth day following public notification unless a written notice of appeal pursuant to BGMC 8.32.240 is timely filed within fourteen days of public notification. Such appeals shall state the alleged errors, the evidence and legal authority to be relied upon on appeal and the requested action. (Ord. 14-06 § 1 (part), 2014: Ord. 03-010 § 7, 2003: Ord. 95-772 § 14, 1995)

8.32.145 Enforcement—Liability limitations.

Nothing in this chapter is intended to create a cause of action or claim against the city or its officials, employees or agents running to specific individuals. Any duty created by this chapter is a general duty running in favor of the public. Nothing in this chapter shall be construed to make the city liable for the costs of ambulance or EMS services. (Ord. 03-010 § 13, 2003)

8.32.220 Ambulance service license—Issuance.

The service provider shall have an ambulance service license issued under BGMC 8.32.030 upon complying with these requirements:

A. The applicant has fully and accurately completed an application on a form approved by CRESA’s EMS program;

B. The applicant has fulfilled all the requirements of the laws of the state of Washington, including but not limited to Chapter 18.73 RCW and its implementing regulations as they now exist or as they may be hereafter amended;

C. The applicant has also met all the requirements of this chapter which supplement or exceed those established by state law, including all elements of the standard of care established hereunder; and

D. The applicant has obtained an ambulance permit as provided in BGMC 8.32.245 and has paid an ambulance and equipment inspection fee of one hundred dollars plus twenty-five dollars per ambulance utilized by the applicant. Such inspection fee shall likewise be paid upon acquisition of additional ambulances. If application for an ambulance permit or permit for an item of equipment is rejected, the applicant or licensee may submit the ambulance or item of equipment one additional time without additional fee, or may seek the board’s review of the rejection, as provided in Clark County Code Section 5.48A.160. (Ord. 14-06 § 1 (part), 2014)

8.32.225 Ambulance service license—Term.

Except as provided in BGMC 8.32.120, ambulance service licenses shall be valid for a period of two years from the date of issuance unless suspended, revoked or restricted for cause. Licenses shall be nontransferable except with the approval of CRESA’s EMS program. (Ord. 14-06 § 1 (part), 2014)

8.32.230 Ambulance service license—Denial, suspension and revocation—Conditions.

CRESA’s EMS program may deny a license application or license renewal, or revoke, suspend or restrict a license if there is reasonable cause to believe that the applicant for or holder of the license has violated any provision or failed to meet any standard established through this chapter which supplements or exceeds that established by state law. (Ord. 14-06 § 1 (part), 2014)

8.32.235 Ambulance service license—Denial, suspension and revocation—Notice.

If CRESA’s EMS program denies a license application or license renewal, or revokes, suspends or restricts a license, the applicant for or holder thereof shall be given a written notice stating:

A. The facts and conclusions upon which the decision is based; and

B. That the decision shall be final and conclusive and that the applicant or holder shall be deemed to have waived all rights to an administrative hearing unless the applicant or holder files with the county a written notice of appeal pursuant to BGMC 8.32.240. Notice of a license revocation, suspension, or restriction shall be given prior to the effective date of such action; provided, CRESA’s EMS program may revoke, suspend or restrict a license, without prior notice, but subject to a timely appeal, if CRESA’s EMS program finds that immediate action is necessary in order to protect the health, welfare or safety of the public. (Ord. 14-06 § 1 (part), 2014)

8.32.240 Ambulance service license—Denial, suspension and revocation—Appeal.

The notice of appeal shall be filed with the county within ten working days following notice of the CRESA EMS program’s decision and shall state the facts and legal authority supporting the appeal.

Upon the filing of an appeal, the county board shall cause to have scheduled a hearing thereon before the hearing examiner appointed by the board within thirty days, and provide at least five days’ notice of the hearing to the applicant or holder. The decision of the CRESA EMS program shall be upheld unless the hearing examiner finds that the decision was arbitrary, capricious or contrary to law. The decision of the board or hearing examiner shall be final and conclusive unless review is sought in a court of competent jurisdiction within ten days of the written decision. (Ord. 14-06 § 1 (part), 2014)

8.32.245 Permits for certain vehicles.

No person or entity shall operate or utilize any vehicle used as an ambulance, used for transport from emergency scenes, health care facilities, or private residences without first having in effect a permit issued by CRESA’s EMS program pursuant to this chapter. Such permits shall be valid for a period of one year unless revoked, suspended or restricted for cause. Permit applications shall be made upon forms approved by CRESA’s EMS program. Such permits shall be nontransferable. (Ord. 14-06 § 1 (part), 2014)

8.32.250 Certifications and permits—Denial, suspension and revocation—Conditions.

The MPD (for certifications) and CRESA’s EMS program (for permits) may not recommend application to the state for an initial or renewed certification or permit; or may recommend revocation, suspension, or restriction of an existing certification or permit for failure to comply with, or for the violation of, any provision of this chapter or any standard or rule established through this chapter which supplements or exceeds that set by state law. (Ord. 14-06 § 1 (part), 2014)

8.32.255 Certifications and permits—Denial, suspension and revocation—Appeals procedure.

The MPD for certifications and CRESA’s EMS program for permits shall notify the applicant for or holder of the certification or permit, in writing, of the facts and conclusions upon which the recommendation is based and the recommendation shall be final and conclusive; and the applicant or holder shall be deemed to have waived all rights to review of the recommendation unless the applicant or holder files with the county a written notice of appeal stating the grounds therefor within ten working days following notice of such recommendation. Such appeal shall be processed pursuant to the terms of BGMC 8.32.240. (Ord. 14-06 § 1 (part), 2014)

8.32.270 Violation—Misdemeanor when—Penalties.

Any of the following violations of this chapter constitutes a misdemeanor punishable upon conviction by not more than ninety days in jail and/or a fine not to exceed five thousand dollars:

A. BGMC 8.32.220, unlicensed service;

B. BGMC 8.32.100, uncertified personnel;

C. BGMC 8.32.245, operation without permit;

D. BGMC 8.32.220(A), false statements;

E. BGMC 8.32.220(B), performing or allowing performance while under suspension, revocation, or termination of Department of Health certification;

F. BGMC 8.32.100(C), solicitation to perform unlicensed, uncertified service or to use vehicles/equipment without permits. (Ord. 14-06 § 1 (part), 2014)

8.32.280 Violation—Civil when—Continuing.

A. Civil Violations. Any other violation of this chapter shall be a civil violation. Each day a violation exists shall be deemed a separate violation.

B. Notice of Civil Violation/Notice to Correct. Whenever the CRESA EMS program has reasonable grounds to believe that a violation of this chapter not listed in BGMC 8.32.270 has been committed or exists, the CRESA EMS program is authorized to issue to the violator a notice of civil violation and/or order to correct notifying the violator of the facts and conclusions upon which the determination of violation is based; order the violation to be corrected within a reasonable period of time; notify the violator of the right to appeal of the notice and/or order pursuant to BGMC 8.32.285; and/or assess civil penalties against any violator within any twelve-month period as follows:

First violation	$100
Second violation	$200
Third violation	$400
Fourth violation	$800
Subsequent violations	$1,000 each

All penalties shall be paid to the county within thirty days after service of the notice of civil violation. If penalties are unpaid between thirty-one and sixty days of service, an additional late penalty of one hundred percent of the original penalty shall be assessed; and if unpaid between sixty-one and ninety days after service, an additional late penalty of two hundred percent of the original penalty shall be assessed.

C. Service of Notices. The notice of civil violation/order to correct shall be served upon the violator by personal service or by certified mail, postage prepaid, return receipt requested, to the violator at his or her last known address. (Ord. 14-06 § 1 (part), 2014)

8.32.285 Civil violation—Notice, penalties and appeal.

Persons to whom a notice of civil violation and/or order to correct have been issued may appeal the notice and/or order pursuant to BGMC Title 20. (Ord. 14-06 § 1 (part), 2014)

8.32.290 Violation—Other penalties.

In addition to or as an alternative to the other penalties provided for in this chapter, violation of or failure to comply with any of the provisions of this chapter shall be grounds for the denial, nonrenewal, revocation, suspension, and restriction of any license, certification, and permit required by this chapter. (Ord. 14-06 § 1 (part), 2014)