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RESOLUTION NO. 79-137
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
COSTA MESA, CALIFORNIA, APPROVING AGREEMENT WITH
ORANGE COUNTY TO IMPLEMENT MODEL AMBULANCE ORDI-
NANCE AND APPROVING AND ADOPTING COUNTY OF ORANGE,
PUBLIC HEALTH AND MEDICAL SERVICES AMBULANCE
ORDINANCE REGULATION.
THE CITY COUNCIL OF THE CITY OF COSTA MESA DOES HEREBY RESOLVE
AS FOLLOWS:
WHEREAS, the City of Costa Mesa is adopting a model ordinance
for the licensing of ambulance and convalescent transport vehicle
businesses. The model ordinance appears at §9-141 and following of
the Costa Mesa Municipal Code; and
WHEREAS, the major role for licensing and regulating such
businesses is assigned to the Orange County Health Officer; and
WHEREAS, an agreement has been prepared by which the County and
the City agree to perform their respective responsibilities under the
model ordinance and provides that the licensing fees shall be paid to
the County; and
WHEREAS, under the model ordinance the health officer has
promulgated certain regulations entitled "County of Orange, Public Health
and Medical Services Ambulance Ordinance Regulation" which are to be
approved by the City; and
WHEREAS, it would be in the best interest of the citizens of
Costa Mesa and promote the health, safety, and general welfare of the
public by entering into the agreement with the County to implement the
model ordinance and to adopt and approve the regulations.
NOW, THEREFORE, BE IT RESOLVED, that the City Council of the City
of Costa Mesa hereby authorizes the Mayor and City Clerk to execute on
behalf of the City Council that certain agreement implementing the model
ambulance ordinance entitled "Agreement to Provide Licensing and Regula-
tion of Ambulance and Convalescent Transport Service", said agreement to
be executed upon the Council's adoption of the model ordinance becoming
effective.
BE IT FURTHER RESOLVED that the City Council does hereby approve
the County of Orange, Public Health and Medical Services Ambulance
Ordinance Regulation which was effective August 11, 1978, and which is
attached hereto and incorporated herein by this reference.
PASSED AND ADOPTED this 3rd day of December, 1979.
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C yor o the City os a es—)a
ATTEST:
City Clerk of the City of CostVesa
STATE OF CALIFORNIA )
COUNTY OF ORANGE ) SS
CITY OF COSTA MESA )
I, EILEEN P. PHINNEY, City Clerk and ex -officio Clerk of the City
Council of the City of Costa Mesa, hereby certify that the above and
foregoing Resolution No. 79-137 was duly and regularly passed and adopted
by the said City Council at a regular meeting thereof, held on the 3rd
day of December, 1979.
IN WITNESS WHEREOF I have hereunto set my hand and affixed the
Seal of the City of Costa Mesa this 4th day of December, 1979.
City Clerk and ex -officio Clerk the
City Council of the City of Co a Mesa
COUNTY OF ORANGE
PUBLIC HEALTH AND MEDICAL SERVICES
AMBULANCE ORDINANCE REGULATION
Purpose
To establish rules for ambulance equipment, vehicles, personnel operation
and standards of dispatch.
Authority
Orange County Ambulance Ordinance, Section 4-9-20, states that the Health
Officer shall make all necessary and reasonable rules and regulations
subject to the approval of the Board, covering ambulance vehicles, equip-
ment, personnel, and standards of dispatch.
Rules and Regulations for Ambulance Service Operations
I. Required Emergency Equipment
A. Regular Emergency Ambulance Equipment
In addition to the equipment specified in the California Vehicle
Code and the California Administrative Code, the following equip-
ment and supplies shall also be carried and maintained in good
condition and operating order:
1) A demand -type resuscitator capable of delivering 100% oxygen
with clear mask in adult, child and infant sizes, meeting the
American Heart Association standards. A pressure -cycled
resuscitator will not meet this requirement.
2) Not less than 50 4" x 4" gauze sponges.
3) Four oxygen nasal cannulas.
4) Four kidney -shaped or basin -shaped emesis containers.
5) Portable suction with a minimum vacuum of 10 inches of
mercury and free air flow of over 30 liters per minute at the
delivery tube, with a rapid draw down time. Two suction
catheters with Venture valved of French sizes 10, 14, 18 and
rigid pharyngeal suction tips are required.
6) Cervical collars, MINIMUM OF 1 SMALL AND 1 LARGE (OR UNIVERSAL).
7) Spine board straps shall include:
a) Headband strap AVAILABLE, NOT LESS THAN 1-1/2" WIDE.
b) Two nine -foot straps of NOT LESS THAN 1-1/2 WIDE webbed
belting for each of the short and long boards with release,
double "D" rings, VELCRO TYPE or equivalent.
8) Half -ring traction splint shall be a minimum of 43" long and
with a minimum of a 9" ring.
9) Sterile obstetrical kit shall include sterile gloves, scissors
or equivalent, sterile umbilical cord clamp or tape, sterile
dressings, towels, plastic bags, and bulb syringe.
10) Four 4" x 4" vaseline impregnated gauze.
11) No less than 1 U. S. GALLON OF WATER IN COMMERCIAL SEALED
CONTAINER.
12) Humidified oxygen administered by mask or cannula must have
regulator which controls liter flow.
13) Two-way COMMERCIAL radio TO BE OPERATED ON A FCC ASSIGNED
SPECIAL EMERGENCY FREQUENCY, FOR CONTACT WITH A LICENSED BASE
STATION.
14) One additional spare "E" OR "D" 02 tank and one additional "E"
OR "D" tank with regulator which is portable.
15) AIT vehicles shall be equipped with a County -owned and
grant-maintained UHF -EMS radio when such becomes available.
16) OPTIONAL - THE CITY MAY REQUIRE A DIRECT RING DOWN LINE TO
A DESIGNATED PUBLIC SAFETY DISPATCH CENTER. THIS LINE WOULD
BE INSTALLED AND MAINTAINED AT THE AMBULANCE COMPANIES OWN
COST.
EXHIBIT for Resolution No. 79-137
Page 1 of 7
B. Ambulance Design
1) The patient compartment must be of sufficient size and
design to provide space for efficient operation of two
paramedics and their required medical equipment plus the
regular ambulance attendants.
2) Medical equipment must be stored to assure ready access.
3) The rear loading doorway must have a clearance of not less
than 46-1/2" in height.
4) Air conditioning and heating system must be provided and
operable in the patient compartment.
5) Vehicle registration (OR FACSIMILE) AND California Highway
Patrol Emergency Permit must be in the driver compartment
of the vehicle. THE COUNTY LICENSE CARD (OR FACSIMILE)
MUST BE CARRIED AND LICENSE DECAL DISPLAYED IN DESIGNATED
LOCATION.
6) Each vehicle shall have by 6/30/79 printed on the front or
both sides of the ambulance the word "Ambulance". This
required lettering shall not be less than 3-1/2" in height
and not less than 1/2" stroke.
7) Existing licensed ambulances may be licensed with a variance
for Item B (1), (3) and (6) for a period not to exceed three
years.
8) VEHICLE MUST BE MAINTAINED IN A NEAT AND CLEAN MANNER.
C. Prohibited Emergency Equipment
No ambulance may carry legend drugs and devices, cardiac
defibrillators or MAST suits unless prescribed for that patient
or accompanied by a certified Orange County Paramedic without
the specific approval of the Health Officer and then only with
written assurance that use of such drugs or devices will be
restricted to authorized personnel.
II. Dispatch of Paramedics
Unless there are decisive factors to the contrary, each operator who
receives a report form a private party of a medical emergency and in
the judgement of the operator is a true medical emergency, shall
simultaneously notify the appropriate fire/paramedic dispatcher in
that area. Such decisive factors may include the patient's own
desire not to receive paramedic level of care.
III. Delivery Distributions for Emergency Patients
The Orange County Emergency Medical Care Committee has certified
hospitals in Orange County as Receiving Centers. This list of
certified Receiving Centers is utilized by reference to establish
guidelines for determining which facility a patient shall be trans-
ported to for emergency medical care.
A. Unless there are decisive factors to the contrary, (i.e.,
patients own decision), the following patients being transported
for emergency medical care shall be taken to the nearest
Receiving Center:
1) Head and cervical spine injury.
2) Comatose patient.
3) Multiple trauma.
4) Penetrating wounds of the neck, chest or abdomen.
5) Suspected heart attack.
unless,
a) An M.D., properly identified, orders the patient to
another, reasonably close hospital and accepts full
responsibility for this directive. This may be
accomplished, when possible, by phone, provided there
is direct communication and no doubt of identification.
EXHIBIT for Resolution No. 79-137
Page 2 of 7
b) A mentally competent patient of legal age or a person
legally responsible for the patient (spouse, parent or
guardian) directs the operator to proceed to another
hospital and accepts responsibility for the move and
signs an Emergency Transportation Authorization Form
as recommended in this regulation.
B. The following patients shall be taken to the nearest Receiving
Center in cases where the ambulance attendant questions his
capability to maintain life support during transit to another
Receiving Center.
1) Hemorrhage
2) Airway Obstruction
3) Cardiac Arrest
4) Respiratory Distress
5) Imminent Birth
C. An ambulance operator has the option of overruling everyone,
except a physician or paramedic physically present or a physician
that is in direct radio or phone contact if, in his opinion, the
patient's condiiton is too serious, or the need for prompt medical
care too urgent to allow possible delay which might result from
taking him to a more remote facility or to a facility with less
than a Receiving Center classification. In unusual emergencies,
when the operator elects to deliver the patient to a non -Receiving
Center facility for life-saving measures, he should communicate
with the facility by telephone to verify that a physician will be
available.
D. The ambulance operator may transport a patient outside of the
County limits when not a paramedic initiated call and where a
Receiving Center equivalent is closer.
E. Use of the following form is recommended when the patient or a
responsible person directs the ambulance to a hospital which is
not a Receiving Center.
IV. Report of Public Safety Information
Each operator who receives a report from a private party of an injury
or medical condition resulting from a vehicle accident, aircraft
accident, gunshot wound, knife wound, drug overdose, OTHER criminal
activity, CALLS INVOLVING UNSUPERVISED JUVENILES, OR ANY CODE/3 RUN
shall immediately report the receipt of such call and the circum-
stances to the LOCAL OFFICE OF THE Poilce, Sheriff, and/or California
Highway Patrol as appropriate.
V. Odometer Checks
Every County licensed ambulance operator making any patient charges
on the basis of mileage shall have the odometer of each of his
ambulances checked and certified by the County Weights and Measures
Department, no less often than every twelve months. If the County
OR CITY receives a complaint regarding overcharges due to a suspected
ambulance odometer error, the County may require the operator to have
that suspected ambu-odometer rechecked within 15 days. When the
odometer is checked, the seal shall be posted in a conspicuous place
within the ambulance.
VI. Personnel Licensing
A. All personnel required to be licensed under the Ambulance
Ordinance shall have had a physician's medical exam on a County
prescribed form within 90 days.
B. All managers for licensed ambulance services shall meet existing
criminal record requirements of ambulance personnel in the CITY
Ambulance Ordinance. TO BE REPEATED EVERY FOUR YEARS.
EXHIBIT for Resolution No. 79-137
Page 3 of 7
VII. Display of License and Ambulance Rates
Each licensee shall display his license and a list of approved
ambulance rates in a prominant location in each business office.
VIII. Personnel Identification
Each ambulance driver/attendant or
shall wear a name badge indicating
company.
IX. Building Inspection
attendant, licensed by the County
name, and name of the employing
Each ambulance service shall have an inspection made of each requested
licensed location by the LOCAL CITY AGENCY RESPONSIBLE FOR COMPLIANCE
with the Building Code, Zoning Code and other related codes.
X. Application for New License (NEED AND NECESSITY HEARING)
A. Notice of hearing and appointment of hearing officer
Upon the filing of an application, the (HEALTH OFFICER/CITY COUNCIL)
shall appoint a hearing officer who is a member of the staff of
(Public Health and Medical Services/CITY STAFF) and fix a time
and place for public hearing thereon. If two (2) or more appli-
cations are on file, the (Health Officer/CITY COUNCIL) schedule
all such applications to be heard at the same time. Written
notice of the time and place of the hearing shall be given to the
applicant or applicants and to all persons holding similar certi-
ficates or engaged in the same business in the CITY at least 15
days prior thereto, by either causing a copy of such notice to be
delivered to the applicant(s) and above described persons
personally or by mailing a copy thereof by certified or registered
mail addressed to the applicant(s) at the address shown in the
application and to all other persons at their last known address.
Notice shall be given to the public by posting at the Orange
County (Hall of Administration/CITY HALL) at least 15 days prior
to said hearing. The notice shall be substantially in the follow-
ing form:
"You are hereby notified that a hearing will be
held before (name of hearing officer) at ------
------ on the ----- day of --------------, 19--,
at the hour of --------- on the application of
------------------------------ for a Certificate
of Public Health, Safety, and Welfare, and
Necessity to operate ----------------- in the
CITY OF ------------- You may be present at the
hearing. You may, but need not be represented by
counsel. You may present any relevant evidence
and you will be given full opportunity to rebut
the testimony of all persons testifying at this
hearing.
"You are reminded that pursuant to the Rules and
Regulations of the CITY Ambulance Ordinance, the
applicant has the burden of proof at this hearing."
B. General powers of the hearing officer
The hearing officer may receive and rule on the admissibility
of any evidence, hear testimony under oath, call witnesses as
he may deem advisable in the course of the hearing, and may
elect to hear all the applicants on the issue of convenience
and necessity and then hear the individual applicants on the
issue of convenience and necessity and then hear the individual
applicants on the issue of fitness, etc., in the order of the
filing of their applications.
EXHIBIT for Resolution No. 79-137
Page 4 of 7
C.
D.
Burden of proof
In the hearing provided for herein, the burden of proof shall
be upon the applicant to establish by clear, cogent, and con-
vincing evidence that the public convenience and necessity
require such operation of the service for which application
has been made and that the applicant is fit and able to perform
such transportation of persons and property as proposed in the
application.
General procedure to be followed by the hearing officer
The hearing officer shall substantially follow the procedure
and consider the factors set forth herein:
1) The hearing officer shall first determine whether further
service of the type proposed by the applicants is required
in the CITY OF for public health, safety, welfare,
and necessity. In making such finding, the hearing officer
shall take into consideration the following:
a) The number of ambulances already operating in the city.
b) Whether existing ambulances are adequate to meet the
public health, safety, welfare, convenience and necessity.
c) The probable effect of the proposed increase in ambulance
numbers on local ambulance conditions.
d) Whether the increased service will result in competition
that will be adverse to the public interest.
e) The working conditions and wages paid to drivers.
f) The demand of the public for additional service.
g) Whether the present service is inadequate.
h) WHETHER SUCH A NEW SERVICE IS RECOMMENDED BY THE DESIG-
NATED CITY OFFICIALS.
2) Thereafter, the hearing officer shall determine whether the
applicant is fit and able to perform such ambulance service
and to conform to the provisions of this chapter and the
rules and safety standards established by the County of
Orange AND THE CITY OF In making such
determination, he shall take into consideration the character
experience, and responsibility, including financial responsi-
bility, of the applicant and such other relevant facts as he
may deem advisable.
E. Report of the hearing officer
The hearing officer shall within a reasonable time (not to exceed
thirty [30] days from the date the hearing is closed) submit a
written report to the (Health Officer/CITY COUNCIL). Such report
shall contain a brief summary of the evidence considered and state
the officer's findings, conclusions and recommendations. The
recommendations shall include whether public need and necessity
require additional service, and, if so, whether the applicant is
fit and able. The report shall also contain a proposed decision
in such form that it may be adopted by the (Health Officer/CITY
COUNCIL) as (his/THEIR) decision in the case.
F. Disposition by the (Health Officer/CITY COUNCIL)
The (Health Officer/CITY COUNCIL) may adopt, reject or modify the
proposed decision in accordance with the standards set forth
in these regulations.
G. Proposed decision adopted
If the (Health Officer/CITY COUNCIL) adopts the decision, he
shall:
1) Issue such certificates of need and necessity as were
recommended by the hearing officer.
EXHIBIT for Resolution No. 79-137
Page 5 of 7
2) Deny the application or applications because:
a) There was no finding by the hearing officer that the
public need and necessity require additional service
of the type proposed; or
b) There was a finding that the applicant was either not
fit and/or not able to perform such public transporta-
tion; and/or not able to conform to the provisions of
this chapter or rules and safety standards established
by the (County of Orange/CITY OF ).
H. Appeal of (Health Officer/CITY COUNCIL) Denial
1) In the event of a denial, the applicant shall have the right
to appeal to the Board of Supervisors as per Section 11 of
the CITY Ambulance Ordinance.
2) IF CITY COUNCIL HOLDS HEARING, THE CITY COUNCIL'S DECISION
SHALL BE FINAL.
I. Certificate of public need and necessity - Grounds for denial
In addition to the grounds set forth governing the issuance of
a certificate of public need and necessity upon which an appli-
cation may be denied, the Health Officer may deny the same if
it shall appear to his satisfaction that such ambulance or
ambulances proposed to be operated are inadequate or unsafe, or
that the applicant has been convicted of a felony.
In the event that an application for a certificate of public
need and necessity is denied by the (Health Officer/CITY COUNCIL)
and not appealed or that the appeal is denied by the CITY COUNCIL,
such applicant shall not apply for a certificate of public need
and necessity for a period of one year following the date of
such denial. Any application filed within such a one-year
period by an entity over which the prior applicant has substantial
control, or by any corporation where such prior applicant has a
substantial ownership interest shall be deemed to be filed by
such prior applicant.
XI. Process for revocation of ambulance service license
A. An Ambulance Service known or thought to be deficient in one or
more of the basic requirements for continued license, may be
subject to an investigation by the Health Officer or his deputy,
possibly leading to a revocation of license. THE DESIGNATED CITY
OFFICIAL WILL BE NOTIFIED OF SUCH A HEARING.
B. Such an investigation may be requested in writing by the Regional
Paramedic Advisory Committee (RPAC) with which the subject
Ambulance Service is affiliated, public safety agencies, or a
recipient of service.
C. Failure of the Ambulance Service to cooperate with investigation
of the Health Officer shall be grounds for revocation of certifi-
cation. However, the investigation shall, whenever possible be
conducted so as to not interfere with the normal operation of the
licensee.
D. If the facts warrant, a hearing will be scheduled. The Ambulance
Service shall be notified at least 15 days prior to the hearing
date. This notice may be waived in writing by the ambulance
service. Such notification shall contain:
1) The date, time, place and hearing officer for the hearing.
2) The specific charges.
3) Specific person to whom the Ambulance Service should address
any responses or inquiries.
EXHIBIT for Resolution No. 79-137
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E. The Licensee shall, as a matter of right, be entitled continuance
of the hearing for a period not to exceed thirty calendar days.
This continuance shall not deprive the Health Officer of the
power to suspend a license or certificate pending a hearing pur-
suant to Section 14 of the Ambulance Ordinance. The County may
not obtain a continuance without a showing of good cause therefor.
F. The Ambulance Service shall have these rights: to be represented;
to call and examine witnesses; to introduce evidence; to cross
examine opposing witnesses.
G. The hearing need not be conducted according to technical rules
relating to evidence and witnesses. Any relevant evidence shall
be admitted under oath if it is the sort of evidence on which
responsible persons are accustomed to rely in the conduct of
serious affairs. Hearsay evidence may be used for the purpose
of supplementing or explaining other evidence but shall not be
sufficient in itself to support a finding unless it would be
admissible over objection in civil actions.
H. The Health Officer shall have the burden of proof. No discipline
shall be imposed on a licensee unless it is shown by clear and
convincing evidence, except as provided by Section 14 of the
Ambulance Ordinance, that the licensee is in violation of the
Ambulance Ordinance.
I. Following the above hearing, the hearing officer shall within 10
days report the findings of fact in writing to the Health Officer
which support a recommendation to:
1) Dismiss charges;
2) Revoke licensure; or
3) Restrict licensure.
J. The Health Officer will then notify the subject Ambulance Service
AND DESIGNATED CITY OFFICIAL of his final decision and action in
writing within five days. Nothing in this regulation shall pre-
clude an immediate suspension of the subject Ambulance Service's
complete licensure or any portion thereof by the Health Officer
or his Deputy, which shall be based on written documentation
reports filed with the Health Officer, pending a hearing through
the prior mentioned process, if the licensee has:
1) Violated any of the provisions of the Ambulance Ordinance, or
any of the rules and regulations adopted pursuant thereto.
2) Discontinued operations within a response area for seven (7)
days.
3) Violated any ordinance of the County or Statute of the State
of California or the United States, which violation indicates
the unfitness or indifference of the holder to offer safe
and adequate ambulance services or would constitute grounds
for denial of the license.
4) Committed an act which would have been grounds for denial
of license.
Said suspension shall not exceed sixty (60) days.
K. Appeal to the Health Officer's decision may be made to the CITY
COUNCIL in the manner described in Section 11 of the CITY Ambulance
Ordinance.
L. Revocation and Suspension of ambulance driver/attendant or
attendant certificates shall follow the same guidelines as
indicated in this section.
EXHIBIT for Resolution No. 79-137
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