EMS Policy Agenda 4/15/2011
COLLIER COUNTY EMERGENCY MEDICAL SERVICES
POLICY ADVISORY BOARD
AGENDA
MEETING TO BE HELD:
NEIGHBORHOOD HEALTH CLINIC
121 Goodlette Road N.
Naples, FL 34102
Second Floor Education Room
DATE:
April 15, 2011
TIME:
4:00 p.m.
1. CALL TO ORDER AND PLEDGE OF ALLEGIANCE
2. AGENDA AND MINUTES
A. Approval of Today's Agenda
3. OLD BUSINESS
A. COPCN Ordinance Review/Recommendations to BCC
4. NEW BUSINESS
5. STAFF REPORTS
6. PUBLIC COMMENT
7. BOARD MEMBER DISCUSSION
8. ESTABLISH NEXT MEETING DATE
9. ADJOURNMENT
ORDINANCE NO. 2011 -
AN ORDINANCE OF THE BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA, AMENDING ORDINANCE 04-12,
AS AMENDED, BY AMENDING, SECTION TWO, DEFINITIONS;
SECTION FOUR, EXEMPTIONS AND EXCLUSIONS FROM
CERTICATE REQUIREMENT; SECTION FIVE, PROCEDURE FOR
OBTAINING CERTIFICATE; SECTION SEVEN, REQUIREMENT
FOR BOARD APPROVAL IN GRANTING CERTIFIC~IE; SECTION
NINE, RIGHTS AND DUTIES GRANTED BY:CERTIFICATE;
SECTION ELEVEN, EMERGENCY PROVIS~9NS; SECTION
TWELVE, CLASSIFICATIONS OF CERTI,t'ICA'l',~S; SECTION
FIFTEEN, GENERAL OPERATING REGtiJ1'ATIO~~;. SECTION
TWENTY, CONDUCT OF DRIVERS ~:,~*~ENDANT~~i'~;ECTION
TWENTY-ONE: PASSENGERS; SECTION TWEN'Ii:Y;:;TWO,
OBEDIENCE TO TRAFFIC ~~WS, ORDINANCES",AND
REGULATIONS. PROVIDING)';ii"i';"FOR'CONFLICT".AND
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SEVERABILITY; PROVIDING FOR INC~P~IQN'IN THE CODE OF
LAWS AND ORDINANCES; AND PROVID!N'(:; FOR AN EFFECTIVE
DATE.
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WHEREAS, Collier County desire~'t'8i~*~ ,(ivailable t6!t;~;citizens safe, professional
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emergency health care transportation and non~tral1$p6rt~ti(jri~serVi~es for emergency pre-hospital
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responses and the tr~~,(~Fof paHe,~~~ between an4,Fong local hospital facilities; and
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WHEREAS, Colli€#?iGoun1iY;:g.~~Jres to facilitlilte the provision of such services and has the
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necessary ~.~uipili:~4~;itr,Clinin~::~~R~rtis~:;rdfe~~i~nal certifications and licenses to do so; and
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:,~REAS, thisu~endrr1e~r;i!1Creates a Class 3 Non-Transport ALS certIficate
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classificati6~"th~t will result'ib:ia benefit to Collier County by reducing response times for certain
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transports and prd~m~g for.the availability of more transport vehicles.
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NOW THERErORE: BE IT ORDAINED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA:
SECTION ONE: Amendments to Section Two of Ordinance No. 04-12, as amended.
Section Two of Ordinance No. 04-12, as amended, is hereby amended as follows:
SECTION TWO: DEFINITIONS.
Words underlined added and words struck through are deleted.
Page 1 of 14
A. Advanced Life Support (ALS) shall mean procedures conducted as defined in applicable
Florida Statutes and Florida .^...dministrative Code, Section ME the Collier County
Medical Director's protocoL
B. Administrator shall mean the County Manager or his designee.
C. Ambulance means any privately or publicly owned land, ai~",<;>r water vehicle that is
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designed, constructed, reconstructed, maintained, equipp~,~i?~operated, and is used for or
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intended to be used for air, land, or water transportatiorl.'ofpersdns,who are sick, injured,
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or otherwise helpless.
D. Board shall mean the Collier County Boatdld~C~)Unty Commissioners.
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Certificate means a certificate of public converti~n.~e and necessity as authorized in
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Section 401.25 (2)(d), Florida Sta~~~~;'.i':,"
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Emergency Call shall mean the transit of;~!:~bulal1ce un~~~ conditions which warrants
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travel with flashil1g1ight~~l:ll1d siren operating.
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Operator shall':mean anY person, orgatrization or governmental entity providing
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ambulance or ALS services:
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R~iient shall"me~, anin~lvidual who is ill, sick, injured, wounded, or otherwise
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ihq~m~,~itated or help'~~~.
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Routiriei;t<P,f!-~1 or RoutPt~ Transfer shall mean the transportation of a patient under non-
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1. Rescue ServiCe shall mean first response treatment of patients but does not include
Advanced Life Support (ALS) or transport.
SECTION TWO: Amendments to Section Four of Ordinance No. 04-12, as amended.
Section Four of Ordinance No. 04-12, as amended, is hereby amended as follows:
Words underlined added and words stnlek through are deleted.
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SECTION FOUR:
EXEMPTIONS AND
REQUIREMENT.
EXCLUSIONS
FROM
CERTICATE
Certificates shall not be required for:
A. Rescue Services.
B. The use of a non-ambulance for any transport of a patient pursuant to the Good Samaritan
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Act, Section 768.13, Florida Statu!es.
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C.
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Vehicles rendering ambulance-type services when requestb~to do so by the Board of
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County Commissioners or County Manager in t~~:e:verit. of a majo'r.catastrophe or other
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such emergency which requires more amb~~mlCes thagt are available in.thepounty.
D. Ambulances based outside the county which ;rd~:~R~:pdtient in the coun~ and transport
him out of the county, or which
up a patient otlN:jt~~~ county and transport him into
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the county.
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Vehicles used to transport persons fotroypj:Ile
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transporting per,$dns wh6feq}lire services::'~n route are not covered by this exemption.
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medical treatments. Vehicles
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SECTION THREE: Adt~~dment~Jo Section Fi~~i~f Ordinance No. 04-12, as amended.
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Section Fiy.~:of'Or4~n~7'~ No.01,mP' as amended, is hereby amended as follows:
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SECTIQ:N,~IVE: PROCEDi.{RE FO~i'~BT AINING CERTIFICATE.
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An'appMpant for a ce~~ficateshall obtain forms from the department from the County to
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be compi6te~,l:ll1d remfued to the Division Administrator. Each application shall contain:
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A. The name, ag~;!:a.nd address of the owner of the ambulance or ALS provider, or if the
owner is a corporation, then of the directors of the corporation and of all the stockholders
holding more that 25% of the outstanding shares. For governmental units, this
information shall be supplied for members of the governing body.
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Words underlined added and words struek through are deleted.
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SECTION FOUR: Amendments to Section Seven of Ordinance No. 04-12, as amended.
Section Seven of Ordinance No. 04-12, as amended, is hereby amended as follows:
SECTION SEVEN: REQUIREMENT FOR BOARD APPROVAL IN GRANTING
CERTIFICATE.
The Board of County Commissioners shall not grant a certificate unless it shall find, after
public hearing and based on competent evidence that each of the r()li'bWing standards has been
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satisfied:
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A. That there is a public necessity for the service. Ip.;iB~hg such det~f111ination, the Board
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(1)
The extent to which the proposed~~~tqe i$:ii~~eded to impro~~ the overall
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Emergency Medical Serv~R~~,emergencv m~di:6~Lservices (EMS) capabilities of
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the County.
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(2)
The effect of the proposed se~i,ce 9;n~xisiihgsefVices with respect to quality of
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service and co;d>.f~ervice.
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SECTIO~,EIVE:', !'Amendfu.~Ilts to S~~ti()1i::Nine of Ordinance No. 04-12, as amended.
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SectiQIiNine ofOrdinant~,N(). 04-f2Y~s,:afuended, is hereby amended as follows:
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SECTION'NlNE: RIGHTS 'XND DdfIES GRANTED BY CERTIFICATE.
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The certifi.~~t~, gran~~d by the Board shall be valid for one calendar year and shall be
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personal to the applic~t'~d 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.
Acceptance of the certificate by the applicant shall obligate the applicant to:
Words underlined added and words struck through are deleted.
Page 4 of 14
A. Service the entire zone granted to the applicant.
B. Provide coverage to adjoining zones, if available. when requested to do so by Emergency
Control emergency dispatch for emergency calls when the certificate holder for that zone
is unable to respond.
C. Keep posted at his place of business a copy of the fee schedule~which must be filed with
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the Administrator (If applicable).
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D. Operate in accordance with the rules and regulations'~~opted"pw.spant to this Ordinance
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and any applicable County Ordinances, and,.X~hapter 401 Florida.'~tatutes, and any
administrative regulations adopted pursua.rit~hereto.
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E. Employ at all times sufficient personnel experi~riq~~,: in operation and management of
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emergency medical services to ensvr~:m8per and effici~mt:9perat.ion.
SECTION SIX: Amendments to Section'Eleven~f-9r,<ljnance"No. 04-12, as amended.
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Section Eleven ofOrdin'H1qe\~iPi:q~-12, as ameJ;1~ed, is herel.W'amended as follows:
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SECTION ELEVEN :"j3MERGENGY PROVISIONS.
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The BoW4Inay modi:fj'y,shspend,pr\~eyoke a certificate in the interest of the public
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health, s#6~and~~i~m.~; only'~i-pUplic hearing and after reasonable notice has been given to
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the certifica~e holder affected. How~~~r, if a situation exists which poses a serious threat that
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ambulance orte~~ue service'fhe Operator will not be available to any certain area of Collier
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County, the Adminis'tr~!~F: shall have such temporary emergency powers as are necessary to
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provide that service. These temporary powers are intended to provide interim protection until
such time as the Board meets to resolve the emergency.
SECTION SEVEN: Amendments to Section Twelve of Ordinance No. 04-12, as amended.
Section Twelve of Ordinance No. 04-12, as amended, is hereby amended as follows:
Words underlined added and words struek through are deleted.
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SECTION TWELVE: CLASSIFICA nONS OF CERTIFICATES.
There shall be three twe ill ~ classifications of service in Collier County, as follows:
A. Class 1: Collier County EMS ALS Transport:
ALS Rescue: An EMS provider Operator with the capability of rendering on the
scene prehospital ALS services and who mayor may not elect to transport
patients. An EMS provider rendering this level..ptservice for a governmental
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entity shall be deemed to be operating under th~ Class"l:'l.ALS rescue certificate
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of public convenience and necessity 1.1yla''bythe governm~iH~t:~ntity. An EMS
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proyider Operator holding a Class'l'-4i~s resctl~ certificate may,provide post-
hospital interfacility medical transfer se~i.R~~ and routine ALS and BLS calls
within the County. A Cel1ificate Of Public C6ri\l~pience and Necessity must be
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obtained from the County before engagip.gmthis level of medical service.
B.
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Class 2: Go~Iie~:<pqJlllty Hospital~fl'
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1. '. 'ACS Transfer; An EMS pf<;>yi4er who renders ALS interfacility medical
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tr,~~fer serVic~~~.::Art'ih3'~~i!pp:>:~~de~ who is awarded a Class 2 - ALS transfer
, :.,' ',,' certi~d!~i~;':!ap.d ~d~~';not possess a Class. 1 - ALS rescue certificate shall not
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", , respond to an,;e~ergenFY call and provide ALS rescue services unless called upon
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A::~k~e approp~~te Class I - ALS rescue provider to provide emergency backup
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se~i~e}IIlthese instances, it shall be deemed to be operating under the Class I -
ALS rescue certificate of the governmental entity requesting such emergency
backup service.
2. Class 2 - ALS transfer certificate holders may provide post-hospital
interfacility medical transfer services and routine ALS and BLS calls within the
Words underlined added and words struek through are deleted.
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County but only to hospitals owned by the certificate holder, however, the Class 2
certificate holder may provide out-of-County transports. Unless an EMS provider
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. Class-2 transfer certificate holders shall contract with the Class 1 rescue
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certificate holder's Medical Director the County fortHW'P~rformance of services
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set forth in Florida Statutes, Secti9n:f:401:265 and Chapter
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F.A.C. and as specifically set forthhehHn, as follows:
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a. He shall supervise and ac6i~'4i~ect responsibility for the medical
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EMTs).
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'; Be,,~hall develop,niedically c'Orrect standing orders or protocols
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:>'}Ie shall' issue standing orders and protocols to ensure that the
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Cl~q, 2 transfe~~'certificate holder transports each of its patients to facilities that
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offcrit:~p~,and level of care appropriate to the patient's medical condition.
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d. He or his appointee shall provide continuous 21 hour per day, 7
day per week medical direction which shall include, in addition to the
development of protocols and standing orders, direction to the Class 2 transfer
certificate holder's personnel as to the availability of
"off line" service to
Words underlined added and words strode through are deleted.
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resolve problems, system conflicts, and provide services in an emergency as that
term is defined by section 252.31(3), Florida Statutes.
e. He shall establish a quality assurance committee to provide for
quality assurance revievyT of all EMTs and paramedics operating under his
supervIsIOn.
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He shall audit the performance of~x~~em personnel by use of a
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quality assurance program that includes but is.I).ot liIIJ.it~qJo a prompt review of
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patient care records, direct 0 bservatioI1,~ ,alid ~()inparison of;ei"formance standards
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for drugs, equipment, system prot6d~~S'.'W1d proO,egures. He shaltJie'responsible
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for participating in quality assurance progt~: developed by the Class 2 transfer
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certificate holder.
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He shall ensui&:,~d'd~i1i;.fYtP,at security procedures of the Class 2
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transfer c~H.J~~t~holder for ~~:di~~~ions, fl~~~' and controlled substances are in
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comphaq,~rrwith c~pters 401, 199~d893, Florid61 St6ltutcs, and chapter 10D 15
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of the Floricla.~^..dmiill~iflitive' Cpde. '.
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Hes&ijlcreate, authorize and ensure adherence to, detailed written
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,operating proc~4Hfes re~ti~ding all aspects of the handling of medications, fluids
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aiiWqqntrolled s~bstances by the EMS personnel and comply ';lith all requirements
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of chapt~~.10i'~199 and 893, Florid61 St61tutcs.
'1. He shall notify the Florida Department of Health, (hereinafter the
"Department") in v.riting when the use of telemetry is not necessary.
J. He shall notify the department in writing of each substitution of
equipment or medication.
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k. He shall assume direct responsibility for the use by an EMT of an
automatic or semi automatic defibrillator; the performance of esophageal intubation
by an EMT; and on routine interfacility transports, the monitoring and maintenance
of non medicated I.V.s by an EMT. He shall ensure that the EMT is trained to
perform these procedures; shall establish '/.Titten protoc91s, for the performance of
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these procedures; and shall provide '.witten eYiden~e;;1o, the Florida Department of
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Health documenting compliance '.'lith the provisiq,hs of this par, agraph.
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He shall ensure that all,~,14:T~dnd paramedic~~C{ ,tr.,ained in the use
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of the trauma scorecard methodologiesh~l'~o':ided"i,1,1 sections ME 2:017 61J 2.001
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of the Florida Administrative Code (F./\..C~~::f~~ adult trauma patients and ME
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2.0175 61J 2.005, F..^....C., fcir,:t~~m~tric trauma patiep,t~.,
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m. He shall Partr~jJat~~~:,i:~iyr?~~I~emb~~ on an EMS vehicle for a
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minimum ?f",Jb~~~:m~ per year ~:'tomplete~;fuinimum of 10 hours per year of
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continuiiig,,"medical;~?lucation related to pre hospital care or teaching or a
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combination of bOth;'
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H~:shq.ll ensure that all of the Class 2 transfer certificate holder's
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~"i lfMTs and pdf,AInedics:'m~ve all proper certifications and receive all training
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rl~~~~Sary to ma~~ain their certification.
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C. Class:i3,l:!AbSNon- Transport:
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1. ALs Non-Transport: An EMS operator who renders Advanced Life
Support pre-hospital services without transport capability.
2. Class 3 certificate holders work in concert with applicable Class 1
providers to assure adequate and timely response to prehospital incidents with the intent
Words underlined added and words struck through are deleted.
Page 9 of 14
to either reduce applicable response times or otherwise augment the level of services as
requested by the associated Class I provider. Unless an EMS provider 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. Class-3 certificate holders shall contract ~th the County for the direction
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and care of all certified ALS personnel to maintain standardized training and patient care
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in Collier County. The County's Office of the Medical Director shall delegate medical
oversight to individual program Medical Directors to oversee the County's Medical
protocols. implementation of equipment and coordination of system-wide patient care
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programs.
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SECTION EIGHT: Amendments to Section FifteenrofOrdinan;ce No. 04-12, as amended.
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Section Fifteen ofOrdina~ce'Nqf!g:4-12, as ambi};d.ed, is hereby amended as follows:
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SECTION FIFTEEN: GENERAL "OPERA TING REGULATIONS.
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All ceI1~;fiqlite holde1i~~;RP'erat6rs{'!m~9rivers shall comply with all state statutes and
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administJ:~tive reguiatidJ:1.~,a~ fOllo{y4t& regulations:
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determined by 'the Board permit issued by the Board, on immediate call at all times.
B. Prompt Service Required. Every call for ambulance service shall be answered promptly.
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
Words underlined added and words struck through are deleted.
Page 10 of 14
calls for emergency assistance requlflng 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 ambulance shall also be reported t9,:.the Administrator with
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documentation of circumstances.
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C. Bed Linens. Every operator transporting patients shal(provide'clean Glean and sanitary
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bed linens shall be provided for each patient ,sfUlied ~which sh~l1::~r;thanged as soon
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as practicable after the discharge of the patient;"
D. Daily Log. Every operator transporting patientssliall!j:maintain in a daily log upon which
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shall be recorded the place or origf*~:Htime of call, tiitieiqf dispatch, time of arrival at
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and such other ol)(,~ra~i#$HlIld patient" iri,f6rmation;~s' may be required by Ordinance.
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Every operatdr:~ij~Jl retain~and preserve aWdaily logs for at least two (2) years, and such
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logs sh~g b~ avail~bie'fqr,iris~~gHpI}:9Y, tqe'Administrator.
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E. <:;:;,Qfuinunicatloris':':,p:,~ch '~y~ance emergency vehicle shall maintain two-way radio
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::::;I:"~g~unication wi~:'th:~ locatio~ of primary dispatch from which it operates, as well as
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any additibJ?.~1 commu1#bation capabilities required by Ordinance or state law.
....',
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F. Vehicles aIla,:Eq\lipfuent. Each vehicle shall be equipped with the proper medical and
emergency equipment as required by the Class -I medical director and the laws of the
State of Florida and shall be subjected to inspection from time to time to insure
compliance with the laws of Florida and this Ordinance.
Words underlined added and words stnlck through are deleted.
Page 11 of!4
G. Certification. In addition to the State of Florida Department of Health, Bureau of
Emergency Medical Services requirements for certification, each paramedic must be
certified by the County Medical Director. Each paramedic must work with a Collier
County EMS ambulance for a sufficient length of time for the ambulance service medical
director to properly judge his capability. At minimum, the p~~edic must work in that
capacity not less than one full month's work shift annUally. or in the case of non-
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transport ALS providers. if ALS services are provided prior to EMS transport arrival. or
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if the patient's condition requires that add~tional level of expertise, the ALS non-
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transport provider will accompany the patient on t~e ALS transport ~om scene to
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agency seeking the Medical Directqiiqe~ification.
subject to those rules and
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Application. Each ambulance or':'ALSSetVldei,shall
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regulation as pro1TI.iilg~t~d,.?y Ordinan'C~s' of the Bqard for the purpose of carrying out
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this ordinanc~;"!('
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SECTION ~: Ameiid.merits't6S~~p.()Jl,.J)venty of Ordinance No. 04-12, as amended.
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SectionJ1Wenty ofOrdii'lan<;e No'::ooif..12, as amended, is hereby amended as follows:
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SECTIONTWENTY: CONPl;JCT OF DRIVERS AND ATTENDANTS.
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All drivers,~:~MT's and paramedics shall comply with the laws of the State of Florida, in
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order to meet the'~e~Wr~rri~nts set out in this Ordinance and no driver, EMT or paramedic
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registered hereunder shall:
*****
I. Operate or ride in aft vehicle ambulance without using seatbelts. (Personnel attending
patients are exempt).
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Page 12 of 14
SECTION TEN: Amendments to Section Twenty-One of Ordinance No. 04-12, as
amended.
Section Twenty-One of Ordinance No. 04-12, as amended, is hereby amended as follows:
SECTION TWENTY-ONE: PASSENGERS.
No person shall be aboard ambulances when engaged in emergency or routine medical calls
routine call except the following:
"l-'
A.
Driver, attendants and fire or law enforcement personnel;::"::):
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B.
Patients;
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D.
the patient when authorized bY"an EMS Battalion"Cmef or position of a higher rank.
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These requests will only be granted.'l.mdere~<>eptional cirC1.1.nlstances.
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Physicians and nurses; 'e ,,':i~:~!ii,':
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Personnel in a11,pBservirigc~pacity that are. being trained for ambulance or ALS service.
E.
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SECTIONELE~~: AmendQl~nts to Section Twenty-Two of Ordinance No. 04-12, as
,I'i amended;;'::'
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Secti~n:Tw~r~-TWO OfOl"di~GU1Ce N<W04-12, as amended, is hereby amended as follows:
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SECTION TwE~TY -TWO: 1:\'
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Under the proVisions of Florida State law. +!he driver of an ambulance or ALS vehicle
OBEDIENCE TO TRAFFIC LAWS, ORDINANCES OR
REGULATIONS.
A.
when responding to an emergency call or while transporting a patient may exercise the
following privileges when such driver has reasonable grounds to believe that an
emergency in fact exists requiring the exercise of such privileges:
* * * * *
Words underlined added and words struek tbreugh are deleted.
Page 13 of 14
SECTION TWELVE:
Conflict and Severability.
In the event this Ordinance should ever conflict with any other Ordinance of Collier
County or other applicable law, the more restrictive shall apply. If any phrase or portion of this
Ordinance is held invalid or unconstitutional by any court of competent jurisdiction, such portion
shall be deemed a separate, distinct, and independent provisions and supn holding shall not affect
,i ,'.
the validity of the remaining portions.
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The provisions of this Ordinance shall be im~de 'a part of theC~de of Laws and
Ordinances of Collier County, Florida. The sectiori~d~~he Ordimmce may be reril11Tibered or re-
'-i;>,;
lettered and internal, cross-references amended throughotit';~9 accomplish such, and the word
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"ordinance" may be changed to "section,''' tt~~~l~," or any other~gproRriate word.
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SECTION FOURTEEN: Effective Date~
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This Ordinance sh~U:'be:9P,nsidered adopted upon th.~ldate written below and subject to
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filing with the FloridaD~partmentQf State.
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PASSEP. AND DULY AlJOPtpEqb)';.avote of majority of the Board of County
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Commissibners of Colli~r County;mlQrida, this day of
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ATTEST. 'j~i"J:.".
DWIGHT E.BROCK, CLERK:
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,2011.
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By:
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, Deputy Clerk
By:
FRED W. COYLE, CHAIRMAN
Approved as to form
and legal sufficiency:
Jennifer B. White
Assistant County Attorney
Words underlined added and words struck through are deleted.
Page 14 of 14