Chapter 5.72
AMBULANCE AND EMERGENCY FIRST AID SERVICES
Sections:
5.72.030 Licenses required for ambulance service and certain emergency aid services.
5.72.040 License not transferable.
5.72.050 Required ambulance equipment—Response time.
5.72.060 Standards for ambulance license—Liability insurance.
5.72.070 Duties of the fire chief.
5.72.080 Standards for ambulance company, ambulance attendant/emergency medical technician license.
5.72.090 Expiration and renewal of license.
5.72.100 Denial, revocation or suspension of license.
5.72.120 City emergency medical services director.
5.72.130 Emergency medical system.
5.72.140 Emergency medical response.
5.72.190 Findings and declaration.
5.72.200 Fire department EMS transportation.
5.72.210 Operation and funding.
5.72.010 Definitions.
A. “Advanced life support” or “ALS” means invasive emergency medical services requiring advanced medical treatment skills as defined in Chapter 18.71 RCW.
B. “Ambulance” means any privately or publicly owned vehicle that is especially designed, constructed, equipped, maintained and used for transporting any sick or injured person from the scene of any accident or disaster or emergency situation to or from a hospital, clinic or other location where professional medical care is available. The word “ambulance” may not be used, in part or in its entirety, by any vehicle except as herein defined.
C. “Ambulance attendant, emergency medical technician” means an individual, including drivers, certified and approved as required in this chapter.
D. “Ambulance service/company” means any person who operates an ambulance within the city of Everett which meets standards as described in this chapter which repeatedly conveys injured or sick patients. “Ambulance service/company” shall also include:
1. Any person, corporation or other legal entity who operates an ambulance for hire which:
a. Is stationed within the corporate limits of the city;
b. Is dispatched from within or without the corporate limits of the city and repeatedly or customarily makes trips for hire within the city to pick up injured or sick fares; or
c. Makes any trips into the city for hire to pick up injured or sick fares after occasional or repeated advertising, within the city, for such service; provided, that the provisions of this chapter shall not apply to any ambulance which shall pass through the city in the delivery of fares picked up at points beyond the corporate limits of the city.
2. “Primary ambulance company” means a private ambulance company which has a contract with the city pursuant to this chapter undertaking to effect transportation of patients by referral of the city and which maintains at least one fully equipped, manned and operable ambulance within the city at all times.
E. “Basic life support” or “BLS” means noninvasive emergency medical services requiring basic medical treatment skills as defined in Chapter 18.73 RCW.
F. “City” means the city of Everett.
G. “City emergency medical services director (medical director)” means that individual designated as advisor for the city’s emergency medical services program as set forth in this chapter.
H. “Emergency” means the sudden onset of a medical condition manifesting itself by acute symptoms of such severity (including severe pain) that the absence of immediate medical attention could reasonably be expected to result in any of the following:
1. Placing the patient’s health in serious jeopardy;
2. Serious impairment to bodily functions; or
3. Serious dysfunction of any bodily organ or part.
I. “Emergency medical service” or “EMS” means medical treatment and care that may be rendered at the scene of any medical emergency or while transporting any patient in an ambulance to an appropriate medical facility, including ambulance transportation between medical facilities.
J. “Emergency medical technician” or “EMT” means a person who is certified as such by the Secretary, pursuant to Chapter 18.73 RCW and regulations promulgated thereunder.
K. “EMS member” means a city resident or an employee who is working on business premises of an EMS levy tax paying business located in the city or in any jurisdiction for which the city has assumed contractual EMS responsibility, who has agreed to the EMS membership terms.
L. “Emergency paramedic/aid unit” means any city-owned and city-operated vehicle that is equipped and may be used for transporting any sick or injured person from the scene of any accident or disaster or emergency situation to a hospital, clinic or other location where professional medical care is available.
M. “Fire chief” means the city’s fire chief or his/her duly authorized designee. “Fire department” means the fire department of the city.
N. “License director” means the city clerk.
O. “Paramedic” means a person who is certified as such by the Secretary, pursuant to Chapter 18.73 RCW and regulations promulgated thereunder.
P. “Patient” means an individual who is sick, injured, wounded or otherwise incapacitated or helpless and in need of or receiving medical treatment, including trauma care.
Q. “Person” means any individual, firm, partnership, association, corporation, company, or group of individuals, acting together for a common purpose or organization of any kind, including the city, any other governmental agency except the United States of America, the state of Washington, or Snohomish County.
R. “Resident” means those persons who have their primary residence within the boundaries of the city of Everett or within the boundaries of a jurisdiction imposing an EMS levy and with which the city has contracted for emergency medical services.
S. “Secretary” means the Secretary of the Washington State Department of Health.
T. “Transport” means the use of an emergency paramedic/aid unit to carry any sick or injured person from the scene of any accident or disaster or emergency situation to a hospital, clinic or other location where professional medical care is available. (Ord. 2792-04 § 2, 2004: Ord. 2308-98 § 1, 1998)
5.72.020 Title—Gender.
A. All references to the license director, medical director, secretary, and fire chief shall include their respective designees.
B. Any reference to or use of the terms “he,” “she,” “him,” “her,” or other gender based classification, if applicable as shown by the context thereof, shall apply to the opposite gender also. (Ord. 2308-98 § 2, 1998)
5.72.030 Licenses required for ambulance service and certain emergency aid services.
A. Application for a license to operate an ambulance service shall be made upon forms provided by the city and shall contain:
1. Name, address and telephone number of the applicant;
2. Business name under which the ambulance company will be operated within the city, and business address and telephone number;
3. The number of ambulances to be placed in service within the city;
4. The number of licensed ambulance attendants to be employed;
5. A roster of ambulances to be used in the city with proof that each ambulance is currently licensed as an ambulances by the state of Washington;
6. A roster of certified ambulance attendants with proof that each attendant is currently certified as an emergency medical technician (EMT) by the state of Washington (including certification expiration date);
7. Proof that ambulances and personnel are verified trauma providers as provided in state law;
8. Certificate of insurance as required herein; and
9. The schedule of rates.
B. Prior to issuance of an ambulance license, the application and all pertinent records shall be reviewed by the fire chief to ensure compliance with the license requirements under this chapter, as well as any rules or regulations referenced herein or issued hereunder. Upon written approval of the application by the fire chief, the license director is authorized to issue an ambulance license. All equipment proposed for use shall be subjected to random inspection by the designated fire chief and/or medical director, who shall determine whether said records and equipment conform to all requirements of this chapter. It shall be the responsibility of the licensee to immediately notify the license director in writing of any change in any of the information required on the application.
C. The license director, subject to a review and approval from the fire chief, is responsible for issuing, denying, revoking, renewing, suspending and canceling ambulance licenses to operate an ambulance company within the city.
D. No person shall operate an ambulance service within the city unless there is on file with the license director proof that the required license/licenses have been obtained from the Secretary as required by state law including but not limited to Chapter 18.73 RCW and Chapter 246-976 WAC as now or hereafter amended.
E. No person shall operate an ambulance service within the city unless there is on file with the license director satisfactory proof that the required insurance is in effect as required in this chapter.
F. No person shall operate an ambulance service within the city without first obtaining from the license director the license required by this chapter. The license shall be renewed on an annual basis. The license director shall not issue such ambulance license unless the applicant has fulfilled all requirements of this chapter.
G. Each ambulance service license issued by the license director shall be valid for the period of one year. The license year shall be from January 1st to December 31st of each year.
H. The license director, as authorized by state law, shall establish licensing fees to be paid by each licensed ambulance company. The fee will be determined by a yearly review of administrative costs associated with the requirements of this chapter.
I. The issuance of a license to an ambulance company under the provisions of this chapter does not obligate the city to use the services of that ambulance company or to refer any patient or other person to that ambulance company. Except as may be provided in an ambulance agreement entered into pursuant to Section 5.72.150, the city at its sole discretion may determine whether and to what extent to use the services of any licensed ambulance company and may determine whether and to what extent to refer patients or any other persons to any licensed ambulance company. (Ord. 3206-10 § 1, 2010; Ord. 2308-98 § 3, 1998)
5.72.040 License not transferable.
No ambulance license issued under the provisions of this chapter shall be transferable or assignable. (Ord. 2308-98 § 4, 1998)
5.72.050 Required ambulance equipment—Response time.
A. Each ambulance company licensed pursuant to this chapter shall maintain appropriately equipped, manned and operable ambulance(s) stationed within the city.
B. Each ambulance company licensed pursuant to this chapter shall provide service within ten minutes for code response (defined as use of lights and sirens following emergency response criteria as established by state law) and fifteen minutes for noncode response (defined as no use of lights and sirens following normal traffic laws, from the time at which the city’s fire department requests such service) and said company shall be in compliance with this requirement for at least ninety percent of all requests for service.
1. Response Time Exemptions. The city will consider that “unusual circumstances” beyond the ambulance company’s reasonable control can induce response times that exceed the aforementioned standards. These “unusual circumstances” include only unusually severe weather conditions, disasters, or unusual periods of very high demand upon the system due to mass-casualty situations or where the ambulance minimum requirements within the city are already unavailable because of referrals from the city’s fire department. For determination of compliance the decision of the fire chief will be final.
C. Each ambulance shall be equipped to meet the minimum requirements prescribed by the Secretary and medical director and shall also include the following:
1. Sirens and emergency vehicle lamps which conform with the rules and regulations issued under RCW Title 46, which shall be used only in conformity with said regulations and applicable municipal ordinances;
2. A two-way radio communication system capable of providing communication between the vehicles and hospital emergency rooms, public ambulance company units, public dispatching agency and the licensee’s headquarters. The licensee’s dispatch headquarters shall be staffed on a twenty-four-hour basis, with a telephone dispatcher and a radio dispatcher qualified to process any and all calls. The telephone operator and the radio operator may be the same person; and
3. Medical equipment as prescribed by the medical director.
D. Each ambulance and its equipment shall be maintained in a sanitary manner and in good operating condition. (Ord. 2308-98 § 5, 1998)
5.72.060 Standards for ambulance license—Liability insurance.
A. The license director shall not approve any license for ambulance service nor shall any ambulance be operated in the city unless there is at all times in force an insurance policy which insures the owner of such ambulance, and his/her employees and agents, against all claims for personal injury, death and property damage arising out of or in connection with the performance of activities associated with the operation of the ambulance company. Such policies of insurance shall be endorsed to name the city as an additional insured. The ambulance company shall also indemnify, defend and hold the city harmless from any causes of action arising from the operation of the ambulance company. The minimum scope and limits of coverage shall be set by the license director as recommended by the city attorney. Evidence of such insurance shall accompany the application for license and shall be maintained on a continuous basis through subsequent license renewal periods.
B. Every insurance policy required hereunder shall contain a provision for a continuing liability thereunder to the full amount thereof, notwithstanding any recovery thereon, that the liability of the insurer shall not be affected by the insolvency or the bankruptcy of the insured and that, until the policy is revoked, the insurance company will not be relieved from liability on account of nonpayment of premium, failure to renew license at the end of the year, or any act or omission of the named insured.
C. Every insurance policy required hereunder shall extend for the period to be covered by the license applied for and the insurer shall be obliged to give not less than thirty days written notice to the license director and to the insured before any cancellation, discontinuance or termination of the policy earlier than its expiration date or reduction of limits or change in policy, terms or conditions which would reduce coverage afforded.
D. Publicly owned ambulance/emergency first aid service or any ambulance/emergency first aid service run by a political subdivision of the state of Washington, or by a municipal corporation, or quasi-municipal corporation, may elect to be a self-insurer and thereby be relieved of the duty imposed by this section; provided, the license director is satisfied with the adequacy of the self-insurance. (Ord. 2308-98 § 6, 1998)
5.72.070 Duties of the fire chief.
A. The fire chief may promulgate, revise or rescind such reasonable rules and regulations as may be necessary or appropriate to administer the provisions of this chapter and to perform the duties assigned to the fire chief, in conformity with the intent and purpose of this chapter.
B. The fire chief shall make such regular inspections as he deems necessary, and shall make such reports relative to conditions existing at such times and in such manner as the fire chief may direct. (Ord. 2308-98 § 7, 1998)
5.72.080 Standards for ambulance company, ambulance attendant/emergency medical technician license.
A. Ambulance Company. Each ambulance company shall have, for each vehicle in service, on duty and available for immediate response two ambulance attendants/emergency medical technicians who are licensed for emergency medical services as provided in this chapter. A certificate of license shall be carried on the person of each ambulance attendant/emergency medical technician while on duty.
B. Ambulance Attendant/Emergency Medical Technician—Certificate of License. No person shall perform the duties of an ambulance attendant/emergency medical technician without first obtaining the requisite emergency medical technician certificate from the Secretary and approval of the medical director. (Ord. 2308-98 § 8, 1998)
5.72.090 Expiration and renewal of license.
A. Licenses/certificates for ambulance attendants/ emergency medical technicians shall expire as set forth in Chapter 18.73 RCW.
B. Renewal of any license/certification set forth in this section, upon expiration for any reason or after revocation, shall require conformance with all the requirements pertinent thereto as required by law. (Ord. 2308-98 § 9, 1998)
5.72.100 Denial, revocation or suspension of license.
A. Grounds. The issuance of an ambulance license to operate an ambulance company may be denied, or such license may be suspended or revoked by the license director upon recommendation of the fire chief, upon any of the following grounds:
1. The license was procured by fraud, false representation, or material omission of fact, or for the violation of or failure to comply with any provision of this chapter by the person holding such license, or any of his servants, agents, or employees, while acting within the scope of their employment; or
2. The licensee violates or fails to comply with any provision of this chapter or any applicable city, state, or federal law, or the purpose for which the license was issued, or such license is used for a purpose different from that for which it was issued; or
3. Overcharging of customer rates set forth in the company’s schedule of rates filed with the license director or fraudulent billing; or
4. Failure to maintain ambulances and equipment to the standards set forth in Chapter 246-976 WAC.
B. Suspension. Revocation and Denial—Hearings and Appeals.
1. “Suspension” of a license means that the licensee’s privilege to operate his business is barred for a specific period of time. A suspended license may be reinstated upon the lapse of a specified period of time or by correcting the deficiencies. The conditions of reinstatement will be determined by the license director as recommended by the fire chief.
2. “Revocation” of a license means that the license has been canceled. A licensee whose license has been revoked cannot have his license reinstated but must comply with all conditions of revocation including re-applying for a new license.
3. When the license director suspends or revokes an ambulance license, the license director shall first provide the licensee with a notice of proposed suspension/revocation which shall provide notification to the licensee that a hearing will be held on the revocation/suspension at a time or date determined by the license director. The notice of proposed suspension/revocation will be sent to the licensee at the address found on the licensee’s application. It is the licensee’s duty to keep the address information on the application current at all times. The license director will preside over the hearing. In the event the licensee fails to attend the hearing, the license will automatically be revoked/suspended. Any revocation/suspension will not be effective until the license director makes a determination following the hearing.
4. Notwithstanding subsection B.3 of this section, a license suspension/revocation shall become effective immediately without the benefit of any presuspension/revocation hearing when this chapter requires a summary revocation/suspension or when the license director determines that it is in the best interest of the health, safety and/or welfare of the citizens of Everett to do so.
5. Within ten days following the date of revocation or suspension of any license issued pursuant to this chapter, or within ten days following the date of denial of any licensee regulated by this chapter, an appeal may be filed with the city’s hearing examiner which shall be the municipal court judge unless otherwise directed by the license director. Upon the timely filing of an appeal, the licensee shall be afforded a hearing before the city’s hearing examiner after notices as provided herein has been given. Said appeal shall be in writing and addressed to the city, “ATTENTION: License Director.” Notice of the time and date of such appeal hearing shall be given by delivering a copy of the notice to the holder of the license or by mailing a copy thereof to the holder at his last address as shown by the license director’s records which notice shall be mailed or delivered at least five days before the date fixed from the hearing. The city’s hearing examiner shall, within thirty days after the conclusion of such hearing, issue a decision as to the revocation, suspension or denial. Such decision of the city’s hearing examiner shall be final and conclusive as of the date set forth in the decision, unless within fifteen days from the effective date of the city’s hearing examiner’s order, an aggrieved person or persons obtain a writ of certiorari from the superior court of Washington for Snohomish County for purpose of review of the action taken.
C. The fire chief’s inspection reports shall be prima facie evidence of compliance or noncompliance with, or violation of, the provisions, standards and requirements provided herein.
D. Upon suspension, revocation, or termination of an ambulance license hereunder operations as such shall cease and no person shall permit continued operation. (Ord. 2308-98 § 10, 1998)
5.72.110 Reports.
A. Each licensee of an ambulance company licensed pursuant to this chapter shall maintain accurate records, upon such forms as may be provided or prescribed by, and containing such information as may be required by, the fire chief concerning the transportation of each patient within the city or from one place herein to another place within or beyond its limits. Such records shall be available for inspection by the medical director at any reasonable time.
B. The provisions of subsection A shall apply with equal force in case the patient shall die before being so transported in such ambulance vehicle or dies while being transported therein, or at any time prior to the admission of the patient to a hospital.
C. Each ambulance company shall submit a response report quarterly or on demand of the fire chief.
D. Each ambulance company shall provide a report indicating the location which each ambulance servicing the city is stationed or based, including locations outside the city if those units are to be used within the city. The report shall be updated within ten days to reflect any change in location of ambulances. (Ord. 2308-98 § 11, 1998)
5.72.120 City emergency medical services director.
A. The mayor shall appoint a licensed physician to serve as an advisor to the city’s emergency medical services program as provided by the Everett fire department.
B. Such person shall have expertise in the area of emergency medical services.
C. Such further responsibilities as are deemed necessary shall be set forth in a personal service contract. (Ord. 2308-98 § 12, 1998)
5.72.130 Emergency medical system.
The city fire department shall operate emergency paramedic/aid units and provide emergency medical aid and transportation. All medical emergency dispatches through 911 telephone access shall be answered by the fire department. Ambulance services, as licensed herein, shall not respond to 911 dispatches in the city unless requested to do so by the fire department.
A. Ambulance companies receiving a direct request for emergency medical services shall notify the fire department’s 911 communications center immediately so that a fire department first response can be initiated. The only exception to this requirement shall be for the transport of stable patients from one medical facility to another and routine/nonemergent medical transports and exams. The 911 system must be activated for all prehospital emergency medical service primary examinations and unstable patient care. The fire department shall establish ambulance response criteria and make such criteria known to each ambulance company at the time of application and renewal of business license. Each ambulance company shall submit a response report quarterly or on demand of the fire department outlining compliance with the response criteria.
B. Ambulances shall notify the fire department’s 911 communications center when they are responding or transporting in a code situation (emergency lights and/or siren). They shall give their location and their destination.
C. When an ambulance company provides emergency medical standby (i.e., 10K Fun Runs, etc., by community event promoters), the following conditions shall apply:
1. The ambulance company shall notify the fire department in writing at least fourteen days prior to the date of the event, or as soon to the event as reasonably possible, stating the date, time and scope of standby responsibilities.
2. Ambulance companies engaging in standby activities shall notify the fire department’s 911 communications center immediately on all advanced life support/life threatening calls as required.
3. Ambulance company standby for handling basic life support calls must obtain prior approval and parameters for care set by the fire department.
4. All emergency medical services activity provided by the ambulance company at such events shall be documented and a report forwarded to the fire department within one week subsequent to the completion of the event. (Ord. 2308-98 § 13, 1998)
5.72.140 Emergency medical response.
The city’s fire department should respond to requests for emergency medical aid within the city, and provide such service to persons within the city as required.
A. To accomplish the intent of this section, the mayor shall annually prepare a budget for emergency medical aid response.
B. The mayor shall develop a plan to provide for an emergency medical aid response program by:
1. Planning and budgeting for emergency paramedic/aid units to be strategically located within the city and to be equipped as required by this chapter.
2. Planning and budgeting so that each in-service pumper within the city is equipped as an emergency aid vehicle, in addition to necessary fire suppression equipment, as required by this chapter.
3. Developing a response pattern within the city which maximizes the use of the emergency paramedic/aid units and minimizes initial response time in a coordinated manner using the emergency paramedic/aid units and the fire pumpers.
4. The emergency paramedic/aid units and the fire pumpers shall be utilized to provide emergency medical care at the scene of injury or illness and may provide transportation of the sick and injured. (Ord. 2308-98 § 14, 1998)
5.72.150 Ambulance contract.
The mayor may enter into an agreement with one or more primary ambulance companies. Such agreement may include, but is not limited to, requirements for provision of services, licensing, certifications, liability insurance, activity reporting, fee scheduling and compensation to the city. Such agreement may provide the terms and conditions under which the city will exclusively use the services of one primary ambulance company and exclusively refer patients and other persons to one primary ambulance company.
A. When agreements exist with more than one primary ambulance company, it shall be at the discretion of the fire chief, subject to the terms and conditions of such agreements, to determine whether and to what extent the city will request ambulance service from any primary ambulance company or will refer patients or other persons to any primary ambulance company. Options available for the fire chief’s consideration include, but are not limited to, requesting ambulance service based on a rotational basis, based on the closest unit, or based on an automatic vehicle locating system implemented in the public dispatch center by the ambulance companies with the approval of the fire department. The fire chief is authorized to establish procedures and guidelines for implementing the designated approach for emergency medical service transport.
B. Notwithstanding any provision herein, the fire department shall have the discretion of requesting a specific agency or company when it is deemed to be in the best interests of the patient or the city. (Ord. 3206-10 § 2, 2010: Ord. 2308-98 § 15, 1998)
5.72.160 Training.
A. All training of persons in the city for emergency medical care, except as provided in accredited medical programs, shall be reviewed by the medical director. Certification of instructors for emergency medical care shall be done in the manner and method as determined by the department of health, office of EMS/trauma systems.
B. All persons who intend to teach, instruct or otherwise train persons who are working within the city in emergency medical care shall be approved by the medical director. (Ord. 2308-98 § 16, 1998)
5.72.170 Penalties.
A. Any person violating or failing to comply with any provision of this chapter shall be deemed guilty of a misdemeanor. The fine may not exceed one thousand dollars or imprisonment in jail for a term not exceeding ninety days or both such fine and imprisonment.
B. Each day that any violation of, or failure to comply with, this chapter continues shall constitute a separate and distinct offense under this section and shall be punishable as such hereunder; provided, however, that the court may, in appropriate cases, stay the accumulation of penalties. (Ord. 2308-98 § 17, 1998)
5.72.180 General duty.
It is expressly the purpose of this chapter to provide for and promote the health, safety and welfare of the general public and not to create or otherwise establish or designate any particular class or group of persons who will or should be especially protected or benefited by the terms of this chapter.
It is the specific intent of this chapter that no provision nor any term used in this chapter is intended to impose any duty whatsoever upon the city or any of its officers or employees, for whom the implementation and enforcement of this chapter shall be discretionary and not mandatory.
Nothing contained in this chapter is intended nor shall be construed to create or form the basis of any liability on the part of the city, or its officers, employees or agents, for any injury or damage resulting from any action or inaction on the part of the city related in any manner to the enforcement of this chapter by its officers, employees or agents. (Ord. 2308-98 § 19, 1998)
5.72.190 Findings and declaration.
The provision of emergency medical services is a governmental function in support of public health and safety. The city of Everett, pursuant to RCW 35.27.370(15) and other authority has, since the enactment in 1974 of Ordinance No. 282-74, provided fire department emergency medical services and other emergency responses for the city of Everett and for other cities with which it has contracted for such services. The provision of transportation of patients by ambulance or other suitable conveyance to the hospital, clinic or other location where professional medical care is available is a necessary element of the emergency medical service function. As part of these services to the community, the city has established and maintained both ALS and BLS medical services. The fire department provision of BLS services began in 1974 with primary financial support from the general fund. The fire department provision of ALS services began in 1983 with the passage of the first EMS property tax levy. The cost of ALS medical services comes primarily from the EMS fund with supplemental support in some years from the general fund. In addition, some incidental expenses for BLS medical services are paid out of the EMS fund. Because of the impact of Initiative Measure 747, the current EMS funding is now inadequate to maintain even the requirements of the current level of ALS and BLS service much less to meet the anticipated future needs of the city for ALS and BLS service. It is the goal and intent of this chapter that:
A. Rates be set for charges to be made for those using the EMS transport services so that the city can be reimbursed from insurance and other proceeds for the cost of providing such services;
B. EMS levy funds and reimbursement from the insurance and other proceeds be sufficient to provide the financial support of all EMS services;
C. The fire department be authorized to provide for transport of patients in all ALS situations;
D. The fire department BLS transport shall be in those situations as specified in Section 5.72.200;
E. Any expansion of BLS transport services beyond the current level of BLS transport services as specified in equipment and administrative support shall meet the requirements for annual budget appropriations. (Ord. 2792-04 § 1 (part), 2004: Ord. 2308-98 § 23, 1998)
5.72.200 Fire department EMS transportation.
The fire department shall provide ALS patient transport within the city and for those jurisdictions where the city has assumed contractual responsibility. The fire department shall also provide BLS patient transport within those areas: (1) if private ambulance service is unavailable, or (2) if, in the opinion of the fire department, it is determined to be appropriate for patient care to be transported by the fire department vehicle notwithstanding the availability of private ambulance service. In all other patient transports, the fire department may, at its discretion, elect to request private ambulance companies or other neighboring fire departments to provide patient transportation. (Ord. 2792-04 § 1 (part), 2004: Ord. 2308-98 § 24, 1998)
5.72.210 Operation and funding.
The following procedures are established for users of the city’s fire department ALS and BLS patient transport service:
A. Charges to Be Made. All persons who are transported by fire department emergency paramedic/aid unit shall be charged for all services rendered by the fire department. Each person transported will be billed for all services provided. EMS members and nonmembers, as defined in subsection B of this section, shall be billed at the same rate.
B. EMS Membership Benefits. By reason of property tax levies under RCW 84.52.069 for EMS, which are levied against property within the corporate limits of the city or are levied against property within the corporate limits of a jurisdiction for which the city has assumed contractual EMS responsibility, each resident of the city and those of contractual jurisdictions, by signing (by recipient or authorized representative) a city-approved EMS membership form containing an assignment of benefits to the city, together with an appropriate release of medical information, shall become an EMS member and be entitled to membership benefits as herein provided. An EMS member receiving transport by the fire department unit shall be deemed to have paid (by reason of the special levy imposed under RCW 84.52.069) that portion of the charges incurred which is not payable by third parties and insurers, including but not limited to any insurance or medical benefits of any nature available to such member. This EMS membership benefit of coverage of charges in excess of available insurance or medical benefits shall cease when or if:
1. A member ceases to be a resident;
2. A member refuses to provide requested information pertaining to third party coverage or to provide appropriate releases of information and assignment of benefit to the city on forms provided by the city; or
3. Such EMS membership benefit is limited or extinguished by amendment or repeal of this chapter.
C. Nonmembers. Persons receiving transport by fire department units who are not entitled to an EMS membership shall be required to pay all charges incurred. Where practical, the city, in accordance with procedures to be approved by the finance department, will, with the authorization of a nonmember receiving fire department transport services, first seek payment of charges incurred from such nonmember’s insurance or other medical benefit provided. Such nonmember shall remain fully responsible for any amount due which is not paid by such third parties.
D. Medicare and Medicaid. Eligible recipients of Medicare and Medicaid benefits shall be charged as the result of transport services by the fire department at only the maximum rate allowed under the Medicare and Medicaid federal programs, and the city shall accept as payment under the Medicare and Medicaid programs only such maximum amount as the city may collect pursuant to the applicable requirements and guidelines of the Medicare and Medicaid programs.
E. Additions, Purchase, Compliance with Capital Facilities Plan. Additions and purchases to and for the fire department EMS and patient transport services shall be made in accordance with the city’s budget as the same now exists or as it may hereafter be amended.
F. Additions, Purchases, Financing. The cost of making additions, or purchases to and for the fire department EMS and patient transport services, shall be paid from such sources and by such means as the city from time to time may direct, in accordance with state law and applicable regulations of the State Auditor.
G. Emergency Medical Services Fund. There shall be created and established in the city’s budget a special fund, to be known and designated as the emergency medical services fund. There shall be deposited in the emergency medical services fund: (1) all revenues collected pursuant to the fire department transport service fees established and set forth in subsection N of this section; (2) all revenues collected pursuant to any contract and/or agreement to provide all or a portion of the fire department transport service; (3) appropriations from the city, the county, state and federal government; and (4) such other funds as may be received for the use for fire department transport service. The emergency medical services fund shall be administered in accordance with the state laws and applicable regulations of the State Auditor.
H. Assistance from Other Funds. Assistance for fire department EMS and transport services from other funds shall be accounted for in accordance with state law, applicable regulations of the State Auditor, and in accordance with RCW 36.32.470.
I. Fire Department Transport Service Fees and Rates. Fees for users of the city fire department transport service shall be fixed from time to time at the rates as set by ordinance of the city as amended from time to time; provided, that the fire department may adjust the charges fixed by ordinance yearly for any cost-of-living adjustment (COLA) increase as measured by the Consumer Price Index Pacific Cities and U.S. Cities average for the Seattle-Tacoma-Everett areas; and provided, that the fire chief is authorized to administratively set rates for medical supplies. Rates for services and medical supplies shall be set to provide for recovery of actual costs based upon an average charge, which will be reviewed annually.
J. Use of Emergency Medical Services Fees. All proceeds derived from the fire department transport service fees authorized under this section shall be used solely for the operation, maintenance, and capital needs of fire department transport service.
K. Billing of Emergency Medical Services Fees. Each patient who utilizes the fire department transport service shall be billed by the city in accordance with the fee schedule adopted in subsection N of this section. The department of finance shall establish a procedure to bill and collect fire department transport service fees for the services rendered. Under the procedure, the city may elect to bill the patient directly or bill the patient’s insurance company. If the patient’s insurance does not cover all of the cost of the ambulance service, the city will bill the remaining balance to the patient directly. The city may contract with a public or private entity to bill and collect the fire department transport service fees.
L. Civil Enforcement. The fire department transport service fees imposed by this section may be collected by appropriate civil action instituted by the city attorney for that purpose.
M. Fee Determination Criteria. Fire department transport service fees shall be set at a level to cover the actual costs incurred by the city in providing the fire department transport service. It is the intent of the city that fire department transport service fees shall be charged in exchange for targeted fire department transport service that alleviates the burden placed on such service by its users. In classifying customers served, or ALS, or BLS fire department transport service, the city may, in its discretion, consider any or all of the following factors: the difference in cost of service to various customers; the location of the various customers within the city; the difference of cost of maintenance, operation, repair and replacement of the various equipment used for fire department transport service; the different character of service furnished various customers; and any other criteria or matters which constitute a reasonable ground for distinction.
N. Fire Department Transport Fee Imposed. Fire department transport fees shall be as follows:
1. Patients for whom the fire department provides ALS 1 transport shall be billed eight hundred ninety dollars per transport, the cost of the medical supplies used in the transport, and eighteen dollars and fifty cents per mile. For the purposes of this subsection, “ALS 1” means the following:
Transportation by ground ambulance vehicle and the provision of medically necessary supplies and services, including the provision of an ALS assessment or at least one ALS intervention, which means a procedure that is, pursuant to state and local laws, beyond the scope of practice of an emergency medical technician—basic (EMT—basic).
2. Patients for whom the fire department provides ALS 2 transport shall be billed nine hundred eighty dollars per transport, the cost of the medical supplies used in the transport, and eighteen dollars and fifty cents per mile. For the purposes of this subsection, “ALS 2” means as follows:
Transportation by ground ambulance vehicle and the provision of medically necessary supplies and services including either:
a. At least three separate administrations of one or more medications by intravenous push/bolus or by continuous infusion in accordance with approved protocols, including, but not limited to, the American Heart Association Advanced Cardiac Life Support (ACLS) protocol; or
b. At least one of the following ALS 2 procedures:
(1) Manual defibrillation/cardioversion;
(2) Endotracheal intubation;
(3) Central venous line;
(4) Cardiac pacing;
(5) Chest decompression;
(6) Surgical airway; or
(7) Intraosseous line.
3. Patients for whom BLS transport is provided by the fire department shall be billed six hundred eighty dollars per transport, the cost of the medical supplies used in the transport, and eighteen dollars and fifty cents per mile. For the purposes of this subsection, “BLS” means as follows:
Transportation by ground ambulance vehicle and the provision of medically necessary supplies and services involving noninvasive emergency medical services requiring basic medical treatment skills. The ambulance must be staffed by an individual who is qualified, pursuant to state and local laws, to be an emergency medical technician—basic (EMT—basic).
4. The fire chief is authorized to administratively set the cost of medical supplies. A current list of such costs is available at the fire department.
O. Compliance with Medicare and Medicaid Requirements. This chapter and the fire department transport service fees hereunder shall be construed and implemented in a manner consistent with applicable Medicare and Medicaid requirements. If any part of this chapter is found to conflict with Medicare and Medicaid requirements, the conflicting part of this chapter shall be inoperative to the extent of the conflict and such finding or determination shall not affect the operation of the remainder of this chapter. (Ord. 3722-20 § 1, 2020; Ord. 3205-10 § 1, 2010: Ord. 3049-07 § 1, 2007; Ord. 2792-04 § 1 (part), 2004: Ord. 2308-98 § 25, 1998)
5.72.220 Additional funding.
To the extent permitted under the Washington Constitution and the laws of the state of Washington including, but not limited to, RCW 35.21.768 and 84.52.069, as may be amended, the city may adopt ordinances for the levy and collection of taxes. (Ord. 2792-04 § 1 (part), 2004: Ord. 2308-98 § 26, 1998)