Ordinance 2024-25 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.
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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.
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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:
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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.
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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:
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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.
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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).
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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.
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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 Sheriff's 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
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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;
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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
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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:
I. 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
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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
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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,
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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 ;, 0+
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-005 1 8/1 86043 7/1] 16
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.
`""[24-EMG-00518/1860437/1] 17
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 Sheriff's 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-00518/1860437/1] 18
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 Zeday of In Y , 2024.
ATTEST::?,` . .` 4--, BOARD OF COUNTY COMMISSIONERS
Crystal Kinzel k' Courts COLLIER COUNTY, FLORIDA
By: By:
itejtal&
Attest as air , 94 uty Clerk Chri all, Chairman
signature .tSly
Approves a• to f , .nd legality:
1fIA
Jeffrey A. atzlo w, ounty Attorney
i
This ordinance filed with the
SvAetary of StgtV Off ice thq
l day of L/t , .2
and acknowledge en o that
filing received this / day
of / , ii. ).1AA
By ///�/.
[24-EMG-00518/1860437/1] 19 . ._.
till st,
it
AO F:".
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