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Backup Documents 05/28/2024 Item #17C ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 7 C TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attomey Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. 2. 3. County Attorney Office County Attorney Office S/ k1m6 512$ 4. BCC Office Board of County Commissioners CFI /►I13l.51 12$ 5. Minutes and Records Clerk of Court's Office PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Cherie DuBock/EMS Phone Number 239-252-3756 Contact/ Depai lucent Agenda Date Item was 5/28/2024 Agenda Item Number 28947 Approved by the BCC I?G Type of Document COPCN Ordinance ,,/ Number of Original 1 Attached V � "49 Documents Attached PO number or account number if document is to be recorded INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature? CD 2. Does the document need to be sent to another agency for additional signatures? If yes, CD provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be CD signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's CD Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the CD document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's CD signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip CD should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 5/28/2024(enter date)and all changes N/A is nod made during the meeting have been incorporated in the attached document. The an option for County Attorney's Office has reviewed the changes,if applicable. this line. 9. Initials of attorney verifying that the attached document is the version approved by the N/A is not BCC, all changes directed by the BCC have been made,and the document is ready for the an option for Chairman's signature. this line. I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12 ! 7C ORDINANCE NO. 24 - 2 5 AN ORDINANCE OF THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, REPEALING ORDINANCE NO. 81-75, AS AMENDED,IN ORDER TO ADOPT UPDATED UNIFORM STANDARDS FOR AMBULANCE OR ADVANCED LIFE SUPPORT SERVICES,INCLUDING THE ISSUANCE OF CERTIFICATES OF PUBLIC CONVENIENCE AND NECESSITY; PROVIDING FOR INCLUSION IN THE CODE OF LAWS AND ORDINANCES; PROVIDING FOR CONFLICT AND SEVERABILITY; AND PROVIDING FOR AN EFFECTIVE DATE. WHEREAS, Chapter 125, Florida Statutes, establishes the right and power of counties to provide for the health, welfare and safety of their citizens by enacting regulations necessary for the protection of the public, including ambulance services; and WHEREAS,the Collier County Board of County Commissioners (Board) desires to make available to its citizens safe, professional emergency health care transportation and non- transportation services for emergency pre-hospital responses and the transfer of patients between and among local medical facilities; and WHEREAS, the Board had previously adopted Ordinance No. 81-75, which was subsequently amended by Ordinance Nos. 82-92, 82-102, 04-12, 05-16, 11-36, 12-04, and 19-38, and which are currently codified as Chapter 50,Article III of the Code of Laws and Ordinances of Collier County, Florida, to establish uniform standards for certification and operation of ambulance or advanced life support services in Collier County, including the issuance of certificates of public convenience and necessity; and WHEREAS, the Board desires to repeal and replace Ordinance No. 81-75 and all subsequent amendments, with the updated standards and policies set forth in this Ordinance. NOW, THEREFORE, BE IT ORDAINED BY THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that: SECTION 1: Purpose. This Ordinance is adopted pursuant to Chapters 125 and 401, Florida Statutes. The purpose of this Ordinance is to provide better protection for the health, safety and welfare of the residents of Collier County, in ambulance and ALS matters, by establishing uniform county-wide standards for certification of ambulance or advanced life support or services, or operations by promulgating complete and clear rules and regulations for operation of all ambulance or rescue companies or services in Collier County. [24-EMG-00518/1860437/1] 1 CAO 17C SECTION 2: Definitions. The following words, terms and phrases, when used in this Ordinance, shall have the meanings ascribed to them in this section, except where the context clearly indicates a different meaning: Administrator shall mean the County Manager, or his or her designee. Advanced Life Support (ALS) shall mean procedures conducted as defined in applicable Florida Statutes and Florida Administrative Code. The provision of ALS services may include ambulance service or ALS non-transport services. Advanced Life Support Non-Transport (ALS non-transport) shall mean the provision of ALS services in an emergency by a licensee until the arrival of an air ambulance or an ambulance which is used for, or intended to be used for, land, air, or water transportation of sick or injured persons requiring or likely to require medical attention during transport. Ambulance means any privately or publicly owned land, air, or water vehicle that is designed, constructed, reconstructed, maintained, equipped or operated, and is used for or intended to be used for air, land, or water transportation of persons who are sick, injured, or otherwise helpless. Basic Life Support (BLS) means the assessment of treatment by a person qualified under Florida Statute and Florida Administrative Code in the use of techniques described in the EMT- Basic National Standard Curriculum or the National EMS Education Standards of the United States Department of Transportation and approved by the Department of Health. Board shall mean the Collier County Board of County Commissioners. Certificate means a certificate of public convenience and necessity as authorized in Chapter 401.25(2)(d), Florida Statutes. Countywide Medical Protocols means the medically correct standing orders or protocols that permit specified ALS and BLS procedures when communication cannot be established with an Operator's medical director or when any delay in patient care would potentially threaten the life or health of the patient, which all Class 1, 3, and 4 certificate holders' emergency medical service professionals, such as paramedics and emergency medical technicians (EMTs), must follow for patient assessment,treatment, transportation, and delivery to definitive care. Countywide Medical Protocols must be approved by the Collier Regional Medical Directors Coalition in accordance with this Ordinance. An Operator's medical director may elect not to have its emergency medical service professionals carry all medicines or perform all procedures required by a Countywide Medical Protocol but such medical director shall ensure that its emergency medical service professionals are fully trained on the entire protocol. Emergency Call shall mean the transit of an ambulance under conditions which warrants travel with flashing lights and siren operating. Governmental Entity shall mean Collier County, a municipality, or an independent special fire control and rescue district within Collier County. Non-governmental Entity shall mean any person, organization, firm, agency, or entity including, but not limited to, a corporation, partnership, limited liability company, or sole proprietorship that is not affiliated, through ownership or control, with a governmental entity. r'h CAO• [24-EMG-00518/1860437/1] 2 �..' 17C Operator shall mean any non-governmental entity or governmental entity providing ambulance or ALS non-transport services. Patient shall mean an individual who is ill, sick, injured,wounded,or otherwise incapacitated or helpless. Rescue Service (Non-ALS) shall mean first response treatment of patients but does not include ALS or transport. Routine Call or Routine Transfer shall mean the transportation of a patient under non- emergency call conditions. SECTION 3: Requirement for Certificate. It shall be unlawful for any non-governmental entity or governmental entity to provide an ambulance service or ALS services or interfacility transport services without first obtaining a certificate therefore from the Board or the Administrator, as provided by this Ordinance. SECTION 4: Exemptions and Exclusions from Certificate Requirement. Certificates shall not be required for: A. Rescue Services (Non-ALS). B. The use of a non-ambulance for any transport of a patient pursuant to the Good Samaritan Act, Chapter 768.13, Florida Statutes. C. Vehicles rendering ambulance-type services when requested to do so by the Board or Administrator in the event of a major catastrophe or other such emergency which requires more ambulances than are available in the county. D. Ambulances based outside the county which pick up a patient in the county and transport the patient out of the county, or which pick up a patient out of the county and transport the patient into the county. E. Vehicles used to transport persons for routine scheduled medical treatments. Vehicles transporting persons who require services en route are not covered by this exemption. SECTION 5: Procedure for Obtaining Certificate. A. Non-governmental entities applying for any classification of certificate shall provide the Administrator with the following information in order for a request for a certificate to be considered. Each request shall contain: [24-EMG-00518/1860437/1] 3 �, 17C 1. The name, age, and address of the owner of the ambulance or ALS Operator, or if the owner is a corporation, then of the directors of the corporation and of all the stockholders holding more than 25% of the outstanding shares. 2. The boundaries of the territory desired to be served (also known as a zone). 3. The number and brief description of the ambulances or other vehicles the applicant will have available. 4. The address of the intended headquarters and any substations. 5. The training and experience of the applicant. 6. The names and addresses of three Collier County residents who will act as references for the applicant. 7. A schedule of rates which the service intends to charge. 8. Such other pertinent information as the Administrator may require. 9. An application or renewal fee of two hundred fifty dollars ($250.00). 10. Financial data including assets and liabilities of the Operator. A schedule of all debts encumbering any equipment shall be included. B. Governmental entities applying for a Class 1, Class 3, and/or Class 4 certificate shall provide the Administrator with the following information in order for a request for a certificate to be granted. Each request shall contain: 1. The name of the governmental entity. 2. (a) The boundaries of the territory to be served by a Class 1 or Class 3 Operator that is a governmental entity includes the governmental entity's jurisdiction and any areas in which the governmental entity has an automatic aid or mutual aid agreement for fire and emergency medical services or in accordance with a closest unit response agreement. If an applicant submits an application that does not include the same number of Collier County EMS ambulances that were previously stationed within the governmental entity's boundaries at the time of its Class 1 certificate application ("Prior Coverage"), a statement that the Class 1 Operator recognizes that Collier County EMS may continue to provide transport services within its territory and, to avoid the disruption of transport services to the public, the governmental entity will coordinate with Collier County EMS related to ambulance coverage within its boundaries until such time as the governmental entity activates the same Prior Coverage. (b) If a governmental entity's ability to provide service under a Class 4 certificate is activated in accordance with this Ordinance,the Operator is authorized to provide fire, rescue, and emergency medical services countywide if the Operator has the closest or most appropriate unit that is able to provide the response. [24-EMG-00518/1860437/1] 4 ,C 01 17C 3. A certification by the Fire Chief or applicable administrator of the governmental entity that the governmental entity has the ability to obtain all licenses and certificates as may be required by Chapter 401, Florida Statutes. 4. The governmental entity's annual report or its last fiscal audit submitted to the Florida Auditor General. 5. A schedule of rates which the service intends to charge, if applicable. The schedule of rates may be a statement that such rates are the rates as set by the Federal Government. 6. The number of vehicles that the applicant will permit under its state license for ambulances and ALS non-transport vehicles, as applicable. No application or renewal fee shall be required for any applicant that is a governmental entity applying for a Class 1, Class 3 or Class 4 certificate. An applicant may apply for multiple certificates simultaneously. SECTION 6: Review of Application. A. For all applicants that are non-governmental entities, the Administrator shall review each application and shall investigate the applicant's reputation, competence, financial responsibility, and any other relevant factors. The Administrator shall also make an investigation as to the public necessity for an ambulance or ALS operation in the territory requested, and shall then make a report to the Board containing his or her recommendation whether to grant a certificate to the applicant within sixty (60) days of the time the Administrator determines the application is complete. B. Notwithstanding any other ordinance or provision, no administrative review or review by the Board, a county-appointed board, entity, or commission shall be required for any applicant that is a governmental entity applying for a Class 1, Class 3, and/or Class 4 certificate. Upon submission of an application that includes the information required by this Ordinance, the Administrator shall administratively approve the application and shall issue the requested certificate or certificates to the governmental entity within sixty (60) days of the application submission. SECTION 7: Requirement for Board Approval in Granting Certificate. The Board shall not grant a certificate to a non-governmental entity unless it shall find, after public hearing and based on competent evidence that each of the following standards has been satisfied: A. That there is a public necessity for the service. In making such determination, the Board shall consider, as a minimum, the following factors: _1U. [24-EMG-00518/1860437/1] 5 17C 1. The extent to which the proposed service is needed to improve the overall emergency medical services (EMS) capabilities of Collier County. 2. The effect of the proposed service on existing services with respect to quality of service and cost of service. 3. The effect of the proposed service on the overall cost of EMS service in the County. 4. The effect of the proposed service on existing hospitals and other health care facilities. 5. The effect of the proposed service on personnel of existing services and the availability of sufficient qualified personnel in the local area to adequately staff all existing services. B. That the applicant has sufficient knowledge and experience to properly operate the proposed service. C. That, if applicable, there is an adequate revenue base for the proposed service. D. That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area. SECTION 8: Appointment of Hearing Officer; Appeals. A. In making the determinations provided for in Section 7 above, the Board may, in its sole discretion, appoint a Hearing Officer to hold a public hearing and to make factual findings and conclusions as a result of the hearing. Should a Hearing Officer be appointed, said hearing officer shall render a written report to the Board within thirty (30) days of the hearing, which report shall contain the officer's findings and conclusions of fact, and a recommended order. The findings and conclusions of fact shall be binding upon the Board, but the recommended order shall be advisory only. B. All decisions rendered by the Administrator or the Board shall be appealable by requesting a hearing before a Hearing Officer. 1. The hearing shall be requested within fifteen (15) business days of the date of the decision to be challenged. 2. A hearing date shall not be postponed or continued unless a request for continuance is received in writing by the Hearing Officer at least ten (10) business days prior to the date set for the hearing. No additional continuances shall be granted without concurrence of the Administrator. [24-EMG-00518/1860437/1] 6 C O) 17C 3. The fact-finding determination of the Hearing Officer shall be limited to whether the alleged violation occurred or whether competent, substantial evidence supports the Administrator's or Board's decision. Based upon this fact-finding determination, the Hearing Officer shall either affirm or reverse the decision of the Administrator or Board. If the Hearing Officer affirms the decision of the Administrator or Board, the named party shall have fifteen(15) calendar days from the date of the decision of the Hearing Officer to comply with the decision of the Administrator or Board unless some other period is agreed to by the County. C. All decisions rendered by the Hearing Officer shall be appealable to the Board of County Commissioners, and all decisions rendered by the Board shall be appealable as permitted by Florida law, and shall be considered quasi-judicial decisions. SECTION 9: Rights and Duties Granted by Certificate. A. The certificate granted by the Board to a non-governmental entity shall be valid for one (1) calendar year and shall be personal to the applicant and not transferable. In the case of a corporation, if there occurs such a transfer of stock or other incidents of ownership as to change the majority or largest stockholder, a new certificate must be applied for. Changes in the officers of the corporation will not require a new certificate. The certificate granted by the Administrator to a governmental entity shall remain valid until such time as the governmental entity provides one (1) year notice to the Administrator that it will no longer be providing ALS services. Notwithstanding, a certificate issued to a governmental entity may be revoked in accordance with this Ordinance. B. A Class 1 and Class 3 certificate holder may increase the number of vehicles providing services upon notifying Collier County within five (5) business days of additional State vehicle permits, including whether such vehicle is an ambulance or providing ALS non- transport services (as applicable). Nothing in this Ordinance shall supersede any State administrative rule that allows a vehicle to provide BLS services. C. Acceptance of the certificate by the applicant shall obligate the applicant to: 1. Service the entire zone granted to the applicant or the area provided in this Ordinance for Class 1, Class 3, and Class 4 certificate holders. 2. Provide coverage to adjoining zones, if available, when requested to do so by emergency dispatch for emergency calls when the certificate holder for that zone is unable to respond. A Class 4 certificate holder is authorized to provide fire, rescue, and emergency medical services countywide if activated in accordance with this Ordinance. 3. Keep posted at the Operator's place of business a copy of the fee schedule, which must be filed with the Administrator (if applicable). [24-EMG-00518/1860437/1] 7 i 17C 4. Operate in accordance with the rules and regulations adopted pursuant to this Ordinance and any applicable County Ordinances, and Chapter 401, Florida Statutes, and any administrative regulations adopted pursuant thereto. 5. Employ, at all times, sufficient personnel experienced in operation and management of emergency medical services to ensure proper and efficient operation. 6. Submission of a list of all vehicles permitted by the State Department of Health. SECTION 10: Renewal of Certificate. Each non-governmental entity certificate holder shall file within ninety (90) days of expiration, an application for renewal of the certificate. Renewals shall be based upon the same standards, as the granting of the original certificate along with such other factors as may be relevant. The renewal application shall be accompanied by a two hundred fifty dollars ($250.00) renewal fee. If the initial certificate was issued under this Ordinance, the renewal certificate may be approved routinely by the Board, upon advice of the Administrator, or the Board may hold a hearing on same. SECTION 11: Emergency Provisions. The Board may modify, suspend or revoke a certificate in the interest of the public health, safety and welfare, only at public hearing and after reasonable notice has been given to the certificate holder affected. However, if a situation exists which poses a serious threat that the Operator will not be available in any certain area of Collier County, the Administrator shall have such temporary emergency powers as are necessary to provide that service. These temporary powers are intended to provide interim protection until such time as the Board meets to resolve the emergency. SECTION 12: Classifications of certificates. To fulfill ongoing needs for emergency medical services in Collier County, as it grows and responds to service needs, there shall be four (4) classifications of service in Collier County, as follows: A. Class 1: Primary ALS Transport: ALS Rescue. �[24-EMG-00518/1860437/I] 8 ` 'L�• 17C 1. An Operator with the capability of rendering on the scene prehospital ALS services with transport capability and who may or may not elect to transport patients based on medical necessity. An Operator rendering this level of service for a governmental entity shall be deemed to be operating under the Class 1 —ALS rescue certificate of public convenience and necessity held by the governmental entity. An Operator holding a Class 1 — ALS rescue certificate may provide post-hospital interfacility medical transfer services and routine ALS and BLS calls within the County. A certificate of public convenience and necessity must be obtained from the County before engaging in this level of medical service. An Operator with a Class 1 —ALS rescue certificate may provide both ambulances and ALS non-transport services based on the information provided to Collier County in accordance with this Ordinance. An Operator with a Class 1 certificate is authorized to have its ALS non-transport vehicles provide transport on a limited basis upon (1)the issuance of an emergency order has been issued by the Governor of the State of Florida declaring or extending a state of emergency for a natural disaster or public health emergency that includes Collier County, (2)the occurrence of an active shooting incident in Collier County as determined by the Collier County Sheriffs Office, (3)the occurrence of an injury to a firefighter, paramedic, or law enforcement officer that results in the need for the immediate transport, or (4) the occurrence of a mass casualty as defined by the Collier County Fire Chiefs Mass Casualty Incident Guidelines in Collier County. A Class 1 certificate holder may also temporarily add additional ambulances based on special events within its boundaries. 2. The medical director for a Class 1 certificate holder shall not delegate or relinquish any responsibilities identified in Chapter 401.265, Florida Statutes, and associated Florida Administrative Code rules. The medical director for a Class 1 certificate holder shall actively participate in the Collier Regional Medical Directors Coalition and must implement the Countywide Medical Protocols developed in accordance with this Ordinance to ensure continuity of care. 3. Only governmental entities may be Class 1 certificate holders. B. Class 2: Inter-Facility Transport Services: BLS or ALS Transfer. An Operator who provides post-hospital inter-facility medical transfer services, both within and outside the County. If requested by the appropriate Class 1 — ALS Rescue Operator, will provide emergency pre-hospital backup service. ALS transfer certificate holders may provide post-hospital medical transfer services for routine and emergency ALS and BLS patients. Class 2 transfer certificate holders must either provide for their own medical director or contract with the County Medical Director, and will operate under the protocols approved by the Class 2 Operator's Medical Director. If the Operator provides for its own medical director,that medical director shall work cooperatively with the County's Office of the Medical Director to ensure continuity of care. Class 2 Operators shall comply with all guidelines and policies approved by the Board of County Commissioners, and shall notify and work with all hospitals and facilities to educate them as to [24-EMG-00518/1860437/1] 9 \``'L� 17C the services Operator provides. The County reserves the right to review and evaluate all calls made by the Operator to ensure that the appropriate level of personnel, supplies, equipment and vehicles are being utilized, as set forth in Florida Statute and Florida Administrative Code. C. Class 3: ALS Non-Transport. 1. An Operator who renders ALS pre-hospital services without transport capability. 2. Class 3 certificate holders work in concert with applicable Class 1 Operators to assure adequate and timely response to prehospital incidents with the intent to either reduce applicable response times or otherwise augment the level of services as requested by the associated Class 1 Operator. Class 3 certificate holders service will improve patient outcomes, reduce time to initial assess to care, and improve performance on quality measures as developed by state or national oversight groups. If requested by a Class 1 Operator, each paramedic employed by a Class 3 certificate holder must accompany a patient on an Operator's ALS transport from scene to hospital when the paramedic for such Class 3 Operator initiates ALS services on a patient prior to the Class 1 Operator transport arrival or if the patient's condition requires that additional level of expertise. Unless an Operator possesses a Class 1 — ALS Rescue certificate issued by the County, a certificate of public convenience and necessity must be obtained from the County before engaging in this level of medical service. 3. The medical director for a Class 3 Operator shall work cooperatively with the Class 1 Operators to ensure continuity of care. The medical director for a Class 3 certificate holder shall not delegate or relinquish any responsibilities identified in Chapter 401.265, Florida Statutes, and associated Florida Administrative Code rules. The medical director for a Class 3 certificate holder shall actively participate in the Collier Regional Medical Directors Coalition and must implement the Countywide Medical Protocols developed in accordance with this Ordinance to ensure continuity of care. 4. Only governmental entities may be Class 3 certificate holders. D. Class 4: Secondary ALS Transport 1. An Operator with the capability of rendering on the scene prehospital ALS services with transport capability and who may or may not elect to transport patients based on medical necessity. An Operator with a Class 4 certificate may only transport upon: a. the request of a Class 1 certificate holder, with such requests being limited to emergencies where due to call volumes, mutual aid is needed; [24-EMG-00518/1860437/1] 10 17C b. the issuance of an emergency order has been issued by the Governor of the State of Florida declaring or extending a state of emergency for a natural disaster or public health emergency that includes Collier County; c. the occurrence of an active shooting incident in Collier County as determined by the Collier County Sheriff's Office; d. the occurrence of an injury to a firefighter, paramedic, or law enforcement officer that results in the need for the immediate transport; or e. the occurrence of a mass casualty as defined by the Collier County Fire Chiefs Mass Casualty Incident Guidelines in Collier County. 2. A Class 4 Operator does not have the authority to provide inter-facility transport services unless there is: a. the issuance of an emergency order has been issued by the Governor of the State of Florida declaring or extending a state of emergency for a natural disaster or public health emergency that includes Collier County; b. the occurrence of an active shooting incident in Collier County as determined by the Collier County Sheriff's Office; or c. the occurrence of a mass casualty as defined by the Collier County Fire Chiefs Mass Casualty Incident Guidelines in Collier County. 3. The medical director for a Class 4 certificate holder shall work cooperatively with Class 1 Operators to ensure continuity of care. The medical director for a Class 4 certificate holder shall not delegate or relinquish any responsibilities identified in Chapter 401.265, Florida Statutes, and associated Florida Administrative Code rules. The medical director for a Class 4 certificate holder shall actively participate in the Collier Regional Medical Directors Coalition and must implement the Countywide Medical Protocols developed in accordance with this Ordinance to ensure continuity of care. 4. Only governmental entities may be Class 4 certificate holders. To qualify for a Class 4 certificate, the Operator must also have a Class 3 certificate. An Operator may be issued multiple certificates for different classes of service. SECTION 13: Transfer or Assignment of Certificates. No certificate issued under this Ordinance shall be assignable or transferable by the person to whom issued unless approval is obtained from the Board in the same manner and subject to the [24-EMG-00518/1860437/1] 11 ��- 17C same application, investigation, fees and public hearing as original applications for certificates. Any majority transfer of shares or stock or interest of any person or Operator so as to cause a change in the directors, officers, majority stockholders or managers of such person or Operator shall be deemed a transfer or assignment as contemplated in this Ordinance and subject to the same rules and regulations as any other transfer or assignment. SECTION 14: Revocation, Alteration or Suspension Grounds. A. Every certificate issued under this Ordinance shall be subject to revocation, alteration and/or suspension of operation, by the Board, for a period of up to one year, where it shall appear that: 1. The Operator has failed or neglected for a period of thirty (30) days during any calendar year to render all services authorized by the certificate. 2. The Operator has been convicted of a felony or any criminal offense involving moral turpitude. 3. The certificate was obtained by an application in which any material fact was omitted or falsely stated. 4. The Operator has knowingly permitted any of its motor vehicles to be operated in violation of the laws which result in conviction of the driver or Operator of a misdemeanor in the second degree or greater, or has knowingly permitted a driver with more than two (2) previous convictions to operate emergency vehicles. 5. The Operator has failed to comply with any of the provisions of this Ordinance. 6. The public interest will best be served by revocation, alteration, or suspension of any certificate upon good cause shown. 7. The Operator or its agent has demanded money or compensation other that established and prescribed under this Ordinance (if applicable). 8. The Operator has without sufficient justification failed or refused to furnish emergency care and/or transportation promptly for a sick or injured person. 9. The Operator or its agent has been found guilty of malpractice or willful and wanton misconduct in the operation of its service. B. All complaints shall be investigated and a report thereon made to the Board, together with findings and recommendations, within fifteen (15) days. If revocation, suspension or alteration of any certificate appears warranted, the Board shall give notice to the Operator holding the certificate that the same will be considered at a specific commission meeting, provided the date of such meeting shall not be less than five (5) days from the date of the [24-EMG-00518/1860437/1] 12 �� ° 17C notice. The Board shall thereupon consider the complaint and either revoke, suspend or alter the certificate or dismiss the complaint. SECTION 15: Collier Regional Medical Directors Coalition The continuity of care for patients of emergency medical services within the County is imperative for the safety of citizens and visitors in Collier County. As a result, the implementation of Countywide Medical Protocols is required by Class 1, Class 3, and Class 4 certificate holders. A. There is hereby created the Collier Regional Medical Directors Coalition (hereinafter the "MD Board"), whose purpose is to ensure that the rendering of on scene prehospital emergency medical services within the County is cooperative and seamless between Operators. B. The members of the MD Board consists of the medical director for each Class 1 and 3 Operator, with each Operator having a single medical director as a member, the Chair of Emergency Medicine, or the Chair of Emergency Medicine's physician designee, from each hospital system that is operating within Collier County, and the Chair of Emergency Medicine, or the Chair of Emergency Medicine's physician designee from the regional trauma center in Lee County. C. The purpose of the MD Board is to develop medical protocols that will be implemented as Countywide Medical Protocols as well as to develop a credentialing and recredentialing standards for EMTs and paramedics of Class 1, 3, and 4 Operators. The MD Board will also make recommendations for equipment, supplies, medications to fulfill medical protocols, including changes related to equipment/medication shortages. D. Any Operator's Medical Director,or the Operator's Medical Director's physician designee, may propose a medical protocol for consideration to be implemented as a Countywide Medical Protocol. The medical protocol shall be deemed a Countywide Medical Protocol upon a majority approval of the MD Board members. E. Operators' Medical Directors have an equal vote on the board and a Medical Director may not represent more than one(1)Operator on the MD Board at any given time. The hospital- based Emergency Medicine chairs are non-voting members. F. The County's Medical Director shall serve as the initial Chair of the MD Board and shall serve a one (1) year term as Chair. G. The MD Board shall be staffed by the Operator that is represented by the Chair. H. Robert's Rules of Order shall be applicable to board meetings and Chapter 286, Florida Statutes, is not applicable. The MD Board shall adopt by-laws for doing its work and conducting its business, including but not limited to quorum, voting on non-protocol related issues,the election and term of the Chair,the appointment of members by Operators [24-EMG-00518/1860437/1] 13 'C. 17C when they share a medical director to ensure each Operator has representation on the MD Board,and how new or modified protocols are implemented to ensure appropriate training. I. The MD Board will designate appropriate working committees and the leadership and responsibilities of those committees. Working committees may include non-MD Board members. J. The MD Board may coordinate with other boards or organizations such as the Lee County Medical Control Board and the Collier County EMS Council. K. The MD Board will conduct quality reviews that are protected by Peer Review statutes and standards in place in Florida for such activities. Each member of the MD Board must agree to comply with Health Insurance Portability and Accountability Act (HIPAA) and Florida Information Protection Act(FIPA)requirements,as amended. Protected health information may not be disclosed to a MD Board member unless an agreement addressing HIPAA and FIPA has been executed between the certificate holder and MD Board member. SECTION 16: General Operating Regulations. All Operators and drivers shall comply with all state statutes and administrative regulations as well as the following regulations: A. Twenty-four Hour Service. Every Operator shall be required to operate sufficient ambulances, if applicable, or relevant apparatus, as stated on the vehicle permit issued by the State Department of Health, Bureau of Emergency Medical Services on immediate call at all times. Notwithstanding, an Operator that is a Class 1 certificate holder may provide less than twenty-four (24) hour services based on the information provided to Collier County in accordance with this Ordinance. B. Prompt Service Required. Every call for service shall be answered promptly and in line with medical necessity. Patients shall be appropriately assessed, treated, packaged, loaded and transported by an Operator that is licensed to transport without being subject to unreasonable delays. All calls for emergency assistance requiring over twenty(20)minutes from time of notification to arrival on scene shall be reported to the Administrator with complete documentation of the circumstances, which delayed the response. Those instances where more than three (3) minutes elapse between receipt of an emergency call and dispatch of an emergency vehicle shall also be reported to the Administrator with documentation of circumstances. C. Bed Linens. Every Operator transporting patients shall provide clean and sanitary bed linens for each patient carried which shall be changed as soon as practicable after the discharge of the patient. D. Daily Log. Every Operator transporting patients shall maintain in a daily log upon which shall be recorded the place or origin, time of call,time of dispatch, time of arrival at scene, [24-EMG-00518/1860437/1] 14 ,�',.,�+` 17C time left for hospital, time of arrival at hospital, and charges for each trip made and such other operating and patient information as may be required by Ordinance. Every Operator shall retain and preserve all daily logs for at least two (2) years, and such logs shall be available for inspection by the Administrator recognizing that information that is protected by the Health Insurance Portability and Accountability Act (HIPAA) and Florida Information Protection Act(FIPA), as amended, may not be disclosed to the Administrator unless an agreement addressing HIPAA and FIPA has been executed between the certificate holder and the County. E. Communications. Each emergency vehicle shall maintain two-way radio communication with the location of primary dispatch from which it operates, as well as any additional communication capabilities required by Ordinance or state law. F. Vehicles and Equipment. Each Operator's vehicles shall be equipped with the proper medical and emergency equipment as jointly agreed to by the Collier Regional Medical Directors Coalition and in accordance with the laws of the State of Florida. G. Certification. All Operators shall certify its paramedics pursuant to Chapter 401.265, Florida Statutes, and Chapter 64J-2.004(4)(a), Florida Administrative Code. The credentialing and recredentialing process developed by the Collier Regional Medical Directors Coalition shall be implemented by all Class 1, 3, and 4 certificate holders, and such certificate holders shall ensure that the credentialing and recredentialing process is incorporated into their respective collective bargaining agreements. H. Application. Each ambulance or ALS service shall be subject to those rules and regulations as promulgated by Ordinances of the Board for the purpose of carrying out this Ordinance. I. Continuity of Care. For Class 1, 3, and 4 certificate holders, each certificate holder must implement the Countywide Medical Protocols developed in accordance with this Ordinance to ensure continuity of care. SECTION 17: Place of Business. Within ninety (90) days of a license being issued by the State Department of Health, each Operator shall maintain a place of business which shall be entirely within the designated operating zone, at which place the Operator shall provide communication with its vehicles, the Collier County Emergency Medical Services Division, and its place of business, a properly listed telephone for receiving all calls for service and at which place of business the Operator shall keep such business records, training records, vehicles, and daily logs available for inspection or audit by the Administrator. Every Operator shall keep on file with the Administrator and the County Emergency Medical Services Division a business address and telephone number at which the Operator may be reached at all times. This information will be maintained at the Emergency Medical Services Division. [24-EMG-00518/1860437/1] 15 17C SECTION 18: Records to be Kept. Every Operator shall keep accurate records of receipts from operations,operating and other expenses, capital expenditure and such other operating and patient information as may be required by the Board or by Florida Statute. SECTION 19: Rates. Every Operator shall file with the Board a schedule of the rates. Such rates shall be filed as a part of each new or renewal application, and a rate schedule shall also be filed when changes in rates are proposed. All such rates shall be subject to review and approval by the Board,unless such rates are those that are set and implemented by the Federal Government. SECTION 20: Operator's Insurance Requirements for Non-Governmental Entities. Every ambulance operator that is not a governmental entity shall carry bodily injury and property damage insurance with solvent and responsible insurers authorized to transact business in the State of Florida to secure payment for any loss or damage resulting from any occurrence arising out of or caused by the operation or use of any of the Operator's motor vehicles. Each vehicle shall be insured for the sum of at least one hundred thousand dollars ($100,000.00) for injuries to or death of any one person arising out of any one accident and the sum of at least three hundred thousand dollars ($300,000.00) for injuries to or death or more than one person in any one accident and for the sum of at least fifty thousand dollars ($50,000.00) for damage to property arising from any one accident. They shall also have malpractice insurance. Every insurance policy or contract for such insurance shall provide for the payment and satisfaction of any financial judgment entered against the Operator and present insured or any person driving the insured vehicle. Such insurance shall be obtained and certificates or certified copies of such policies shall be filed with the Board. All such insurance policies, certificates thereof or certified copies of such insurance policies shall provide for a thirty (30) day cancellation notice to the Board. SECTION 21: Conduct of Drivers and Attendants. All drivers, EMTs and paramedics shall comply with the laws of the State of Florida, in order to meet the requirements set out in this Ordinance.No driver,EMT or paramedic registered hereunder shall: A. Fail or refuse to promptly transport, if applicable, or attend any sick or injured person after responding to a call. [24-EMG-00518/1860437/1] 16 '�� 1 7 C B. Demand or receive compensation other that established and approved in accordance with this Ordinance or fail to give a receipt for moneys received (if applicable). C. Give or allow rebate, commission, discount or any reduced rate not provided in the established rate (if applicable). D. At any time induce or seek to induce any person engaging an ambulance or ALS service to patronize or retain the services of any hospital, convalescent home, mortuary, cemetery, attorney, accident investigator, nurse, medical doctor or other service occupation or profession. E. At any time release a patient from the Operator's care until there is assurance that some responsible person is available to receive such patient. F. Disobey the lawful orders of the law enforcement officer at the scene of an accident, or other similar such emergency or at a fire scene, the fire officer in charge. SECTION 22: Passengers. No person shall be aboard ambulances when engaged in emergency or routine calls except the following: A. Driver, attendants and fire or law enforcement personnel; B. Patients; C. Relatives or close friends of the patient when authorized by the Operator of the ambulance; D. Physicians and nurses; E. Personnel in an observing capacity that are being trained for ambulance or ALS service; or F. Operator's supervisory personnel. SECTION 23: Obedience to Traffic Laws, Ordinances or Regulations. A. Under the provisions of Florida state law,the driver of an ambulance or ALS vehicle when responding to an emergency call or while transporting a patient, may disregard laws, ordinances or regulations governing direction or movement or turning in specified directions so long as he does not endanger life or property when the driver has reasonable grounds to believe that an emergency in fact exists requiring the disregard of such laws. 124-EMG-00518/1860437/11 17 '`"�� 1 7 C B. The exemption herein granted shall apply only when such vehicle is making use of audible and/or visible signals meeting the requirements of this Ordinance. C. The foregoing provisions shall not relieve the driver of a vehicle from the duty to drive with due regard for the safety of all persons, nor shall such provisions protect the driver from the consequences of his or her reckless disregard for the safety of others. SECTION 24: Violations. In addition to the remedies provided herein, a violation of any provision of this Ordinance shall be punishable as provided by law for the violation of County ordinances. SECTION 25: Uniformity of Application. This Ordinance shall constitute a uniform law applicable in all of Collier County. SECTION 26: Authority to enforce. It is hereby declared to be the duty of the Board, its officers, agents, employees and other governmental agencies, the Collier County Sheriffs Office, its deputies and agents, fire departments, as well as the police departments of the various municipalities falling under the provisions of this Ordinance to strictly enforce the provisions of this Ordinance. SECTION 27: Repeal of Ordinance No. 81-75, as amended. Ordinance Nos. 81-75, 82-92, 82-102, 04-12, 05-16, 11-36, 12-04, and 19-38, and all amendments thereto, are hereby repealed in their entirety and superseded by this Ordinance. SECTION 28: Inclusion in the Code of Laws and Ordinances. The provisions of this Ordinance shall be made a part of the Code of Laws and Ordinances of Collier County, Florida, as Chapter 50, Article III of said Code. The Sections of the Ordinance may be renumbered or re-lettered to accomplish such, and the word "Ordinance" may be changed to "section," "article," or any other appropriate word. SECTION 29: Conflict and Severability. In the event this Ordinance conflicts with any other Ordinance of Collier County or other applicable law, the more restrictive shall apply. If any phrase or portion of the Ordinance is held invalid or unconstitutional by any court of competent jurisdiction, such portion shall be deemed a [24-EMG-00518/186043 7/1] 18 17C separate, distinct and independent provision and such holding shall not affect the validity of the remaining portion. SECTION 30: Effective Date. This Ordinance shall become effective upon filing with the Florida Department of State. PASSED AND DULY ADOPTED by the Board of County Commissioners of Collier County, Florida, this Zekday of in Ai , 2024. ATTEST:;` . ,... .••••, 9". BOARD OF COUNTY COMMISSIONERS Crystal K. Kinzel k 19tCourts COLLIER COUNTY, FLORIDA By: By: ilejiali Attest as air., euty Clerk Chri all, Chairman signature _lily Approve a• to f, .nd legality: Al rii ®I�_ Jeffrey A. atzkt w, ounty Attorney 1 This ordinance filed with the $41etary of St9tl ' Offi dcy of and acknowledge en o that filing received this 1 day of I i al. 1.f-, By L//e/ [24-EMG-00518/1860437/1] 19 17C IF a ,„, „,,, Y ;i i 0 :.- .,n t„ FLORIDA DEPARTMENT Of STATE RON DESANTIS CORD BYRD Governor Secretary of State May 30, 2024 Crystal K. Kinzel, Clerk of Court Office of the Clerk of the Circuit Court & Comptroller of Collier County 3329 Tamiami Trail E, Suite #401 Naples, FL 34112 Dear Ms. Kinzel, Pursuant to the provisions of Section 125.66, Florida Statutes, this will acknowledge receipt of your electronic copy of Collier County Ordinance No. 24-25, which was filed in this office on May 29, 2024. Sincerely, Matthew Hargreaves Administrative Code and Register Director MJH/wlh R. A. Gray Building • 500 South Bronough Street • Tallahassee, Florida 32399-0250 Telephone: (850) 245-6270 ���cvc��T coaRi.&(o4 4� 17 C c Clerk of the Circuit Court and Comptroller - Crystal K. Kinzel g g Collier County, Florida * * 3315 Tamiami Trail East, Ste. 102 - Naples, FL 34112-5324 r. Phone: (239) 252-2646 4~ O li'R co1nv .vAP Affidavit of Publication COLLIER COUNTY STATE OF FLORIDA Before the undersigned authority personally appeared Jennifer Hansen, who on oath says that he or she is a Deputy Clerk of the Circuit Court of Collier County, Florida; that the attached copy of advertisement, Business Impact Estimate-Medical Transport Services (CoPCN) Ordinance (BCC 5/28/24)was published on the publically accessible website https://notices.collierclerk.com as designated by Collier County, Florida on 05/17/2024 until 05/30/2024. Affiant further says that the website complies with all legal requirements for publication in chapter 50, Florida Statutes. . (:-• * .i"\-rdtAAZIA-VN- ,� (v. i ii to ��S z-. • 3 cep, {,c✓ _ Mcn (Affi nt1'riited kiAme) Sworn tp.and subscribed before me this 05/30/2024 Crystal K,,I izel Clerk of the Circuit Court& 44 ' (0-& (Dep Clerk Signature) (3a(a &i . h t/al5 0.5139/q (Deputy Clerk Printed Name) Date our r • s4 17 C 0 k1, Business Impact Estimate This form should be included in the agenda packet for the item under which the proposed ordinance is to be considered and must be posted on the County's website by the time notice of the proposed ordinance is published. Published on County website by: S/l1(()L} [expected legal advertising date] Proposed ordinance's Short Title: Establishes uniform standards for certification and operation of ambulance or advanced life support services in Collier County, including the issuance of certificates of public convenience and necessity. This Business Impact Estimate is provided in accordance with section 125.66(3), Florida Statutes. If one or more boxes are checked below, this means the County is of the view that a business impact estimate is not required by state law' for the proposed ordinance, but the County is, nevertheless, providing this Business Impact Estimate as a courtesy and to avoid any procedural issues that could impact the enactment of the proposed ordinance. This Business Impact Estimate may be revised following its initial posting. iThe proposed ordinance is required for compliance with Federal or State law or regulation; ❑ The proposed ordinance relates to the issuance or refinancing of debt; ❑ The proposed ordinance relates to the adoption of budgets or budget amendments, including revenue sources necessary to fund the budget; ❑ The proposed ordinance is required to implement a contract or an agreement, including, but not limited to, any Federal, State, local, or private grant or other financial assistance accepted by the county government; ❑ The proposed ordinance is an emergency ordinance; ❑ The ordinance relates to procurement; or ❑ The proposed ordinance is enacted to implement the following: a. Part II of Chapter 163, Florida Statutes, relating to growth policy, county and municipal planning, and land development regulation, including zoning, development orders, development agreements and development permits; b. Sections 190.005 and 190.046, Florida Statutes, regarding community development districts; c. Section 553.73, Florida Statutes, relating to the Florida Building Code; or d. Section 633.202, Florida Statutes, relating to the Florida Fire Prevention Code. 1 See Section 125.66(3)(c), Florida Statutes. 1 17C In accordance with the provisions of controlling law, even notwithstanding the fact that an exemption noted above may apply, the County hereby publishes the following information: 1. Summary of the proposed ordinance (must include a statement of the public purpose, such as serving the public health, safety, morals and welfare). The ordinance updates Ordinance 81-75, as amended, establishing uniform standards for certification and operation of ambulance or advanced life support services in Collier County, including the issuance of certificates of public convenience and necessity 2. An estimate of the direct economic impact of the proposed ordinance on private, for- profit businesses in the County, if any: (a) An estimate of direct compliance costs that businesses may reasonably incur; (b) Any new charge or fee imposed by the proposed ordinance or for which businesses will be financially responsible; and (c) An estimate of the County's regulatory costs, including estimated revenues from any new charges or fees to cover such costs. No direct cost increase. May result in a loss of business by private providers. 3. Good faith estimate of the number of businesses likely to be impacted by the proposed ordinance: None 4. Additional information the governing body deems useful (if any): The proposed ordinance provides a collaborative approach: Collaboration among Collier County EMS and the different fire agencies fosters a stronger sense of community and enhances overall emergency response efforts. It promotes knowledge/training equalization, standardization of protocols, and mutual support, ultimately benefiting patient care and outcomes. • Sets out a detailed process for applications for a certificate of public convenience and necessity as authorized in F.S. § 401.25(2)(d). • Confirms the requirement of a uniform Countywide Medical Protocols. • Establishes a county wide"Medical Director Coalition"for DATA driven medical treatment. • Upon approval of application, it allows partner agencies the ability to transport. • Allows for appeals of a hearing officer decision to the Board of County Commissioners. 2 Posted to notices.collierclerk.com on May 17, 2024. ogNIT COUkT,e 17C a ° o Clerk of the Circuit Court and Comptroller - Crystal K. Kinzel Collier County, Florida * * 3315 Tamiami Trail East, Ste. 102 - Naples, FL 34112-5324 �o oP Phone: (239) 252-2646 `�4 COUNTY,04� Affidavit of Publication COLLIER COUNTY STATE OF FLORIDA Before the undersigned authority personally appeared Jennifer Hansen,who on oath says that he or she is a Deputy Clerk of the Circuit Court of Collier County, Florida;that the attached copy of advertisement, Medical Transport Services (CoPCN) Ordinance (BCC 5/28/24)was published on the publically accessible website https://notices.collierclerk.com as designated by Collier County, Florida on 05/17/2024 until 05/30/2024. Affiant further says that the website complies with all legal requirements for publication in chapter 50, Florida Statutes. (Af Ian ignatur ` 44t. (Lin CV\ (AffiantPriated lame) 'S'watn,to and subscribed before me this 05/30/2024 •.,, Cmtal°K. Kiazel Clerk of the Circuit Court& aomptro gr' • iD • 0. 6 (De u y Clerk Signature) ��r� aordlas d5i,TiZy (Deputy Clerk Printed Name) Date 17C NOTICE OF PUBLIC HEARING NOTICE OF INTENT TO CONSIDER AN ORDINANCE Notice is hereby given that a public hearing will be held by the Collier County Board of County Commissioners commencing at 9:00 a.m.on May 28,2024, in the Board of County Commissioners meeting room,third floor,Collier Government Center,3299 East Tamiami Trail,Naples,FL,to consider: AN ORDINANCE OF THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, REPEALING ORDINANCE NO. 81-75, AS AMENDED, IN ORDER TO ADOPT UPDATED UNIFORM STANDARDS FOR AMBULANCE OR ADVANCED LIFE SUPPORT SERVICES,INCLUDING THE ISSUANCE OF CERTIFICATES OF PUBLIC CONVENIENCE AND NECESSITY; PROVIDING FOR INCLUSION IN THE CODE OF LAWS AND ORDINANCES; PROVIDING FOR CONFLICT AND SEVERABILITY; AND PROVIDING FOR AN EFFECTIVE DATE. A copy of the proposed Ordinance is on file with the Clerk to the Board and is available for inspection. All interested parties are invited to attend and be heard. All persons wishing to speak on any agenda item must register with the County Manager prior to presentation of the agenda item to be addressed.Individual speakers will be limited to 3 minutes on any item.The selection of an individual to speak on behalf of an organization or group is encouraged.If recognized by the Chairman,a spokesperson for a group or organization may be allotted 10 minutes to speak on an item. Written materials intended to be considered by the Board shall be submitted to the appropriate County staff a minimum of 7 days prior to the public hearing.All materials used in presentations before the Board will become a permanent part of the record. As part of an ongoing initiative to encourage public involvement,the public will have the opportunity to provide public comments remotely, as well as in person, during this proceeding. Individuals who would like to participate remotely should register through the link provided within the specific event/meeting entry on the Calendar of Events on the County website at www.colliercountyfl.gov/our-county/visitors/calendar-of-events after the agenda is posted on the County website. Registration should be done in advance of the public meeting or any deadline specified within the public meeting notice. Individuals who register will receive an email in advance of the public hearing detailing how they can participate remotely in this meeting. Remote participation is provided as a courtesy and is at the user's risk. The County is not responsible for technical issues. For additional information about the meeting,please call Geoffrey Willig at 252-8369 or email to Geoffrey.WilligAcolliercountyfl.gov. Any person who decides to appeal any decision of the Board will need a record of the proceedings pertaining thereto and therefore,may need to ensure that a verbatim record of the proceedings is made,which record includes the testimony and evidence upon which the appeal is based. If you are a person with a disability who needs any accommodation in order to participate in this proceeding,you are entitled,at no cost to you,to the provision of certain assistance.Please contact the Collier County Facilities Management Division, located at 3335 Tamiami Trail East, Suite 101,Naples, FL 34 1 1 2-53 56, (239) 252-8380, at least two days prior to the meeting. Assisted listening devices for the hearing impaired are available in the Board of County Commissioners Office. BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY,FLORIDA CHRIS HALL,CHAIRMAN Posted to notices.collierclerk.com on May 17,2024.