Ordinance 9

EMERGENCY MEDICAL SERVICES

Adopted by the Hennepin County Board of Commissioners of Hennepin County, Minnesota on January 17, 1984

Amended September 17, 1985

Amended June 1, 1999

TABLE OF CONTENTS

I. Purpose

II. Scope

III. Definitions

IV. Administration, Documentation, and Inspections

V. Personnel and Operating Standards

VI. Ambulance Response Standards

VII. Response Time Standards

VIII. Waivers and Variances

IX. Separability

X. Penalty

The County Board of Hennepin County ordains:

SECTION I: PURPOSE

The purpose of this ordinance is to establish standards to protect the health, safety, and general welfare of the people of Hennepin County pursuant to Minn. Stat. 375.51-375.55. This ordinance incorporates herein Minn. Stat. Chapter 144E and Minn.R. Chapter 4690 relating to ambulance services which have been filed for use and examination by the public in the office of the County Auditor.

This ordinance is enacted to

  1. Ensure that emergency medical services are available to provide rapid and appropriate medical treatment to persons experiencing a potential or known medical emergency situation at the scene of the emergency and enroute to a medical treatment center.
  2. Ensure that an appropriately equipped and staffed ambulance is dispatched to the scene of a suspected medical emergency that requires immediate response.
  3. Meet reasonable public expectations for the quality and safety of emergency medical services provided throughout the County.

SECTION II: SCOPE

This ordinance shall be applicable to all ambulance services operated in Hennepin County and subject to licensure and regulation pursuant to Minn. Stat. 144E.001-144E.52, and Minn.R. Chapter 4690 relating to ambulance services.

SECTION III: DEFINITIONS

Subsection 1: "Advanced Ambulance Provider" shall mean an ambulance provider that utilizes ambulances, paramedics, equipment, and procedures subject to Minn. Stat. Chapter 144E and Minn.R. Chapter 4690 relating to advanced ambulance services and this ordinance.

Subsection 2: "Ambulance Services" shall mean the transportation and treatment rendered preliminary to or during transportation to, from, or between health care facilities to ill or injured persons or expectant mothers, including any transportation by stretcher, unless the person to be transported is not likely to require medical treatment during the course of transport.

Subsection 3: "Ambulance Provider" shall mean any individual, firm, partnership, corporation, trustee, association, or unit of government, licensed pursuant to Minnesota Statutes to provide ambulance services and, with respect to acts prohibited or required herein, shall include an ambulance provider's employees.

Subsection 4: "Approved" shall mean acceptable to the Health Authority as determined by conformance to appropriate standards, good public health practice, or good medical practice.

Subsection 5: "Basic Ambulance Provider" shall mean an ambulance provider who utilizes ambulances, emergency medical technicians, equipment and procedures subject to Minn. Stat. Chapter 144E and Minn.R., Chapter 4690 relating to basic ambulance services and this ordinance.

Subsection 6: "Code 2 Response" shall mean an ambulance response that does not utilize red lights and siren.

Subsection 7: "Code 3 Response" shall mean an ambulance response that utilizes red lights and siren.

Subsection 8: "Communication System" shall mean the coordinated radio and telephone communications, personnel, equipment, and procedures and protocols used to direct ambulance services and ambulance service providers in the County as recommended by the EMS Council for purposes of:

A. Dispatch of ambulance services;

B. Coordination of patient information; and

C. Medical control communications between paramedics and physicians.

Subsection 9: "County" shall mean Hennepin County.

Subsection 10: "County Board" shall mean the Hennepin County Board of Commissioners.

Subsection 11: "Emergency" shall mean any sudden, generally unexpected occurrence, event, or set of circumstances which may require immediate medical attention.

Subsection 12: "Emergency Medical Services System" (EMS System) shall mean the Hennepin County system of coordinated communications to dispatch the closest appropriate ambulance within a designated primary service area, medical control of medical emergencies; training and continuing education for public safety personnel, paramedics, emergency medical technicians and physicians working within the EMS System; public information and education; regulation of ambulance services and ambulance providers; and the evaluation and monitoring of the EMS System's operation through quality improvement activities.

Subsection 13: "Emergency Medical Services Council" (EMS Council) shall mean the advisory body appointed by the County Board to develop and recommend acceptable practice and protocols for the operation of the EMS System and to establish acceptable medical practice standards for emergency medical services relating to the County EMS system.

Subsection 14: "Health Authority" shall mean the Hennepin County Community Health Department.

Subsection 15: "Law" shall include federal and state statutes, regulations and this ordinance.

Subsection 16: "Medical Resource Control Center (MRCC)" shall mean the facility, communications equipment and functions approved by the EMS Council and Health Authority to coordinate medical communications between ambulance service providers in the field and medical facilities, to arrange for medical control, and to allow for two-way radio communication between or among medical facilities, medical control physicians, emergency medical technicians, and paramedics.

Subsection 17: "Non-Emergency" shall mean an occurrence or set of circumstances not requiring immediate attention.

Subsection 18: "Pre-Arranged Transfer" shall mean non-emergency transportation which is scheduled to be provided at a later time and for which immediate attention or transportation is not being requested.

Subsection 19: "Pre-arrival Instructions" shall mean the procedures and practices for the provision of basic first aid information over the telephone by specially trained and certified emergency medical dispatchers, using protocols approved by the EMS Council, to persons requesting an emergency or immediate ambulance response.

Subsection 20: "Primary Service Area" shall mean the geographic area designated to an ambulance service provider licensed pursuant to statute and rule by the Minnesota EMS Regulatory Board.

Subsection 21: "Priority Dispatch" shall mean the process and practices by which specially trained and certified emergency medical dispatchers identify the nature, severity and urgency of the request for emergency medical response, based upon protocols reviewed and approved by the EMS Council, to determine whether basic or advanced ambulance services shall be required and whether or not the response shall be Code 3 or Code 2.

Subsection 22: "Routine Transportation" shall mean unscheduled ambulance requests for which the dispatcher has determined that an ambulance is needed for an immediate but non-emergency situation. Routine Transportation does not include special transportation services as defined in Minnesota Statutes 174.30 (1984).

Subsection 23: "Unscheduled Requests" shall mean all ambulance requests which are not Pre-Arranged Transfers.

SECTION IV: ADMINISTRATION, DOCUMENTATION, AND INSPECTIONS

Subsection 1: Information Required: An ambulance provider, upon receipt of a license or license renewal, shall within 30 days submit to the Health Authority a complete copy of the license application as submitted to the EMS Regulatory Board and all other additional information required by the Health Authority including, but not limited to, an affidavit of compliance with the requirements of this ordinance, financial information for cost analysis of service provision, and other information the Health Authority deems necessary to determine an ambulance provider’s compliance with this ordinance.

Subsection 2: Inspection: The Health Authority may inspect or designate and delegate to other authorized officials of the County the inspection of every ambulance provider facility or ambulance as frequently as deemed necessary to ensure compliance with this ordinance. Following an inspection, the Health Authority shall leave the inspection report with any responsible person immediately available or person representing the ambulance provider. Alternatively, the Health Authority may deliver the inspection report to the licensee or authorized agent for the ambulance provider in person or by United States mail. A copy of the inspection report shall be kept in the files of the Health Authority. A copy of the report shall be sent to the Minnesota EMS Regulatory Board.

Subsection 3: Access to Premises and Records: An ambulance provider shall, upon request of the Health Authority and after proper identification, permit access to all parts of the facility or vehicle at any reasonable time for the purpose of inspection and shall exhibit and allow copying of any records, including patient run reports, necessary to ascertain compliance with this ordinance. No persons shall interfere with or hinder the Health Authority in the performance of duties or refuse to permit the Health Authority to make such inspections.

Subsection 4: Removal and Correction of Violations: An ambulance provider upon receipt of a notification of one or more violations of this ordinance shall correct or remove each violation in a reasonable length of time as determined by the Health Authority. The length of time for the correction or removal of each such violation shall be noted on the inspection report. The failure to remove or correct each specific violation within the time period noted on the inspection report shall constitute a separate violation of this ordinance. All actions taken by the Health Authority pursuant to this section regarding the removal and correction of violations shall be in accordance with the due process provisions of Hennepin County Ordinance Number 1: Administrative Procedure.

Subsection 5: Records Required: All ambulance providers subject to this ordinance shall:

A. Maintain all records relating to paramedics and emergency medical technicians including, but not limited to, the name of each paramedic or emergency medical technician; the paramedic or emergency medical technician program attended, the location, and date completed; the documentation of any corrective, disciplinary, or probationary action by the provider’s medical director regarding a paramedic or emergency medical technician, including the disposition of that action; and documentation of attendance and successful completion of all continuing education requirements.

B. Collect and report all information required by the EMS Council or the Health Authority regarding all ambulance service requests and patient care data on forms or by data processing techniques designated by the Health Authority.

C. Record all voice communications between the ambulance dispatcher and all vehicles and all requests for ambulance response whether by land line, telephone, or radio communication utilizing electromagnetic, digital or equivalent techniques. All recorders shall be capable of indicating the date and time of voice communications. All such recordings shall be maintained for not less than six months.

D. Report and record all patient care provided on run report forms approved by the EMS Council. The EMS Council, or the Health Authority may obtain a specific run report at any time to investigate an incident or to ensure compliance with this ordinance and community medical standards.

SECTION V: PERSONNEL AND OPERATING STANDARDS

Subsection 1: General: All ambulance providers shall maintain equipment, staff, facilities, policies and protocols necessary to permit full compliance with this ordinance.

Subsection 2: Practice Requirements: All paramedics and emergency medical technicians providing emergency medical services subject to this ordinance shall:

A. Successfully complete an approved probationary period in accord with the standards established by the EMS Council and supervised by the employing ambulance provider's medical director.

B. Attend training courses designated as mandatory by the EMS Council.

C. Maintain approved County authorization and EMS System identification number as a paramedic or emergency medical technician with the Health Authority.

Subsection 3: Staffing Requirements: All advanced ambulance providers shall provide and maintain not less than two approved paramedics on each ambulance at any time the ambulance is on duty for service. Two paramedics shall ride or drive as attendants on all runs with the exception of unusual or extraordinary circumstances which require the advanced ambulance to be staffed without two paramedics. In a situation when advanced life support transportation service response is required pursuant to this ordinance and two paramedics are not available as attendants, the advanced ambulance provider in whose primary service area the response is required shall send two attendants, one of whom shall be a non-probationary paramedic. If no approved paramedics are available, an attempt shall be made to transfer the request to another advanced ambulance provider. Documentation shall be submitted to the Health Authority on approved forms on all ambulance runs staffed with less than two paramedics.

Subsection 4: Equipment Standards: All advanced or basic ambulances subject to this ordinance shall carry all drugs and equipment as required by the EMS Council.

Subsection 5: Medical and Operational Standards: All ambulance providers and persons subject to this ordinance, shall comply with all medical, operational and communication policies and protocols developed by the EMS Council.

SECTION VI: AMBULANCE RESPONSE STANDARDS

Subsection 1: Advanced Ambulance Response: Advanced ambulance response as defined in Minnesota Statutes and Minn.R. Chapter 4690 shall be the standard for the County for all emergency response and shall be initiated for any of the following situations and conditions except as provided in Subsection 2:

A. All requests for ambulance response initiated through the 911 emergency telephone system.

B. All "Unscheduled Requests" for ambulance response from the public or public safety agencies.

C. Anytime there is any reasonable question regarding the nature, scope, or severity of the emergency or medical situation.

Subsection 2: Advanced or Basic Ambulance Priority Dispatch: An advanced ambulance provider within whose primary service area a request for immediate ambulance response under subsection 1 of this section is received may respond with advanced or basic ambulance service or transfer the request to a basic ambulance provider if the advanced ambulance provider:

A. Maintains capability for on-line two way voice communication with the caller requesting emergency or immediate ambulance response;

B. Utilizes protocols approved by the EMS Council for determining the appropriateness of advanced or basic ambulance response by Code 2 Response or Code 3 Response;

C. Maintains continuous quality assurance systems approved by the EMS Council to monitor and report on the appropriateness of emergency medical dispatch response decisions to the EMS Council and the Health Authority; and

D. Meets all applicable basic ambulance service response provisions of this Ordinance and requirements established by the EMS Council.

Subsection 3: Routine Transportation Response:

A. The dispatcher may dispatch routine transportation or transfer the request for routine transportation to another ambulance provider for routine transportation in the following situations:

  1. A physician in the immediate presence of the patient has determined that Routine Transportation is medically appropriate for the patient.
  2. A nursing home has requested Routine Transportation and the dispatcher has excluded cardiac arrest, acute seizure, shock or hypotension, decreasing or loss of consciousness, breathing difficulty, severe pain, significantly abnormal vital signs, or conditions that may indicate an acute myocardial infarction including chest pain, tightness, or pressure or shortness of breath.

B. All other requests for ambulance services shall be considered an emergency and referred to the appropriate advanced ambulance provider.

Subsection 4: Ambulance Response Transfer:

A. When an advanced ambulance service response is required pursuant to this ordinance but is not available, the advanced ambulance provider in whose primary service area the response is required shall attempt to transfer the request for service to an approved advanced ambulance provider for backup. Documentation of attempted transfer shall be submitted to the Health Authority on approved forms for all ambulance responses requiring advanced ambulance service but responded to by basic ambulance service.

B. When a medical emergency occurs outside the geographical boundaries of the primary service area of the requested ambulance provider, the call and request for ambulance response shall be transferred to the appropriate advanced ambulance provider in whose primary service area the emergency is located.

C. If the dispatcher for an ambulance provider determines the response time standard to an emergency requiring advanced ambulance services cannot be met with the available advanced ambulance provider for that area, the dispatcher shall request the closest advanced ambulance provider available to respond. If no advanced ambulance provider is available, a basic ambulance provider may be dispatched.

D. If a basic ambulance provider responds, under any circumstances, to an emergency other than as provided for in Section VI, subsection 2, the basic ambulance provider shall inform the dispatcher. The dispatcher shall attempt to dispatch an advanced ambulance provider in whose primary service area the emergency has occurred unless that advanced ambulance provider has already responded. If it is determined by the dispatcher of the advanced ambulance provider in whose primary service area the emergency has occurred that the basic ambulance provider can transport the patient to the nearest appropriate hospital before an advanced ambulance provider can reasonably be dispatched and respond to the emergency, then a basic ambulance provider may transport the patient. The basic ambulance provider shall file a report with the Health Authority within twenty days on an approved form describing the incident.

E. An ambulance provider, while responding to or transporting a Pre-Arranged Transfer or Routine Transportation Request, shall not use flashing red lights or siren and shall transfer a request which may require a Code 3 Response to the appropriate advanced ambulance provider within whose primary service area the request occurs. Documentation shall be submitted to the Health Authority on approved forms describing any Pre-Arranged Transfer or Routine Transportation Request which utilizes a Code 3 Response. The use of a Code 3 Response to reduce response time for a Pre-Arranged Transfer or Routine Transportation Request is also prohibited. These provisions shall not apply to any ambulance response to a hospital or transport between hospitals.

SECTION VII: RESPONSE TIME STANDARDS

Subsection 1: EMS Council: The County Board shall establish standards for all ambulance providers' response time. The standards shall be based upon recommendations of the EMS Council which shall be forwarded to the County Board for review and approval as often as the Council determines it is necessary, but at least once every two years. In developing recommended response standards within the County, the EMS Council shall take into consideration the following factors:

A. The level and type of response established in Section VI;

B. Current information regarding population density and geographic accessibility, historical number of ambulance requests and resource utilization;

C. The availability of specific, reliable, accurate and verifiable performance measures such as time standard and percentage of compliance; and

D. The maintenance and improvement of response times within a municipality, contiguous municipalities or primary service areas.

Subsection 2: Compliance Review: The Health Authority shall collect and aggregate information derived from reported records summarizing the performance of the designated ambulance provider in each municipality and in the EMS System. The Health Authority shall review response times with the EMS Council and the approved ambulance provider for a primary service area. The EMS Council may establish review criteria for determining acceptable compliance with the approved response standard and may make a recommendation to the Health Authority on the appropriate action to be taken to assure compliance with the established response standard when the standard and criteria are not met by the designated ambulance provider. The Health Authority shall act to ensure appropriate compliance with response standard established pursuant to this Section including, but not limited to, the submission of a recommendation to the EMS Regulatory Board for redesignation of all or a portion of a primary service area to another ambulance provider.

SECTION VIII: WAIVERS AND VARIANCES

Subsection 1: Waivers: An ambulance service provider may apply to the Health Authority for a waiver of the requirements of this ordinance. The ambulance provider requesting a waiver shall meet the same criteria established for permitting a waiver as provided in Minn.R., Chapter 4690. Application for a waiver shall be made on forms approved by the Health Authority.

Subsection 2: Variances: An ambulance provider may apply to the Health Authority for a variance from requirements of this ordinance. The ambulance provider requesting a variance shall meet the same criteria established for permitting a variance as provided in Minn.R., Chapter 4690. Application for a variance shall be made on forms approved by the Health Authority.

SECTION IX: SEPARABILITY

If any provision or application of any provision of this ordinance is held invalid, that invalidity shall not affect other provisions or applications of this ordinance.

SECTION X: PENALTY

Any person violating any provision of this ordinance shall be guilty of a misdemeanor and upon conviction thereof shall be punished pursuant to Hennepin County Ordinance No. 1.

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