HomeMy WebLinkAbout09/15/1992, 4 - CONFIRMATION OF THE CITY OF SAN LUIS OBISPO INTENT TO NEGOTIATE A NEW AGREEMENT IN THE COUNTRY FOR THE REGULATION OF AMBULANCE SERVICES. MFETING AGENDA
ITEM #
���w��Iwlmllllllllll�° ��llll City Of San lues OBISPO
COUNCIL AGENDA REPORT
FROM: Robert F. Neumann, Fire Chief
SUBJECT: Confirmation of the City of San Luis Obispo intent to negotiate a new
agreement in the County for the regulation of ambulance services.
CAO RECOMMENDATION:
Adopt a resolution requesting the County to negotiate a new ambulance agreement between the cities
and the county and designating the City Managers/Fire Chiefs Committee on ambulance as the
bargaining group for the cities.
HISTORY:
Prior to 1976, an organized approach for the delivery of ambulance service to the citizens of San
Luis Obispo County did not exist. Various cities and districts had individual contractual agreements
with ambulance providers and most of the unincorporated areas of the county were served on a first-
come, first-serve basis. At the urging of the Grand Jury, the County of San Luis Obispo developed
a system known as the EMRM (Emergency Medical Response Manual) that provided various zones
in the county and allowed for the Board of Supervisors to establish rates.
In 1976, the seven cities in the County contractually agreed to allow the County to regulate
ambulance services via the EMRM. The provisions of this agreement called for automatic renewal
every five years unless a city gave one (1) year notice prior to renewal time.
In May of 1990, the seven cities all notified the Board of Supervisors that they were no longer
happy with the current EMRM system and wished it to be reworked when the contract came due at
May of 1991. The cities took this step at the urging of the Fire Chiefs Association based on a
number of problems and concerns that had developed since the inception of the EMRM. Major
points include:
• No local control • Levels of service not well defined.
• Standards of care not established • No input/process for change
0 Duplication of service
All City contracts with the County were terminated by May, 1991. With this contract termination,
of the seven County cities and the realization on the part of the County that the entire EMRM was
outdated, the County Health Director commenced a study to analyze the local situation.
Concurrently, the City Managers established a committee to review ambulance service and
emergency medical service as it pertains to cities. This.Sub-Committee, consisting of two City
Managers and two Fire Chiefs developed a proposal that addressed local and fire service concerns
and presented it to the County Health Director and County Administration in January of 1991.
4 -I
��►��►�ii��uIIIIIIIIIP° ��llll MY Of San tuts OBISPO
COUNCIL AGENDA REPORT
DISCUSSION:
The City Managers Sub-Committee has had numerous meetings with both County administrative
staff and the County Health Director. The group was making significant headway through the
spring of 1992. However, negotiations have completely stalemated with no recent movement. As
late as mid-June, both County administrative staff and the Sub-Committee were optimistic that
County Counsel would bring a draft ordinance forward. However, as of this date, no such draft has
been developed.
With the current negotiations at a stalemate and with the supplemental documentation from the
Grand Jury, now it is time for the seven Cities in the county to reaffirm their commitment to the
formation of a Joint Powers Agency. This action will allow maximum input, local control, better
coordination and system operation and program administration of a more effective ambulance
system. In order to accomplish this, staff recommends that the attached resolution, which is being
brought before the other seven cities within the county, be passed. The Fire Chiefs hope that the
increased awareness of this issue will force the Board of Supervisors to take favorable action.
In July of 1992, the Grand Jury released a report that was very critical of the current system.
A short summary:
• The county-wide 94-1 system of ambulance dispatch is inadequateand needs reworking.
• The County has been lax in its oversight responsibilities and the EMRM (ambulance contracts) is
out of date and needs immediate review.
• Emergency/non-emergency ambulance service need to be separated and/or held to different
criteria.
• Ambulance response times in urban area are unacceptable:
• Ambulance rates are the third highest in the state without any compelling reason.
It recommends:
• The County should consider a competitive bidding process for ambulance services.
• Cities, which perform Paramedic service, should be compensated for those services.
• The County should establish a fair rate of return for ambulance service providers.
0 The County should rework the current EMRM.
'�������►►►IVIIIIII1�� IIUIII MY Of San LUIS OBISPO
WiN COUNCIL AGENDA REPORT
ALTERNATIVES:
1. Abandon current Sub-Committee negotiations and allow each agency to operate independently in
negotiations with the County Health Director and administrative staff.
Pro - This alternative provides an opportunity to improve service levels and design specific
emergency medical services based on local needs and desires. Each city would
maintain the ability to contract with the County for delivering all Ambulance/EMS
services. The local agency may provide more ambulance units if an increased level
of service is desired and if it is willing to assume the additional cost.
Con - Operating independently, a cost-effective, efficient system will not be developed. The
coordination of mutual aid, large scale emergency/disaster situations all require a
county-wide effort. There is no assurance the County will cooperate with individual
cities.
2. Continue with the current negotiations in hopes of reaching eventual accord with the County.
Pro - The method is easily continued. No expense has or is to be incurred.
Con - The County currently is under no pressure to move at anything other than its own
pace which to this point is unacceptably slow.
3. Adopt the proposed resolution which urges the County to negotiate in good faith with the cities.
Pro - This alternative would force the County to deal with a more formal/united group of
cities. It maximizes local control and allows the cities to jointly coordinate medical
response, system operations and program administration. JPA's have proven effective
in dealing with medical insurance and similar benefits and could potentially do the
same for EMS.
Con - The JPA could require some staff time to develop and implement. The cities
establishment of a JPA may require some financial commitment.
RECONEMW DATION:
Adopt the proposed resolution which urges the County to negotiate in good faith with the cities
(Alternative 3).
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��� � ►�VIIIIIii�p ���lll city of San tins OBIspo
COUNCIL AGENDA REPORT
FISCAL DIPACT:
Other than staff time, no outlay will be required in the onset. Long term fiscal requirements,
depending upon the system design, may be more significant. However, provisions in the contract
would provide for a funding source.
ATTACEMUNTS:
1. Resolution
2. February 23, 1989 - Fire Chiefs Letter to City Managers
3. January, 1991 - City Managers/Fire Chiefs Ambulance Proposal
4. July, 1992 - Grand Jury Report
44
RESOLUTION NO. (1992 Series)
A RESOLUTION OF THE CITY COUNCIL OF THE CITY
OF SAN LUIS OBISPO REQUESTING THE COUNTY TO
NEGOTIATE A NEW AMBULANCE AGREEMENT
BETWEEN THE CITIES AND THE COUNTY AND
DESIGNATING THE CITY MANAGERS/FIRE CHIEFS
COMMITTEE ON AMBULANCE AS THE BARGAINING
GROUP FOR THE CITIES.
WHEREAS, the cities and the county entered into a contract for the regulation of ambulance
services countywide in 1976; and
WHEREAS, the cities in February, 1989, expressed a strong interest to the county in seeing
those contracts modified to provide for local input, improved levels of service and performance
standards; and
WHEREAS, the cities and county staff entered into discussions on this issue with no resolution
to the identified problems; and
WHEREAS, the seven cities have all voided the 1976 ambulance services contract between the
cities and the county; and
WHEREAS, the cities desire a system-wide approach to providing emergency medical services;
and
WHEREAS, numerous problems have been identified by the Cities, Grand Jury and professional
consultants paid for by the county and ambulance providers; and
WHEREAS, the Health and Safety Code Section 1797.204 defines an emergency medical system
as an organized pattern of readiness of response services based on public and private agreements;
and
WHEREAS, the Health and Safety Code Section 1797.252 states, "The local EMS Agency
(County) shall, consistent with such plan, coordinate and facilitate arrangements necessary to
develop the Emergency Medical Service system."
WHEREAS, the cities desire to see a Joint Powers Agency, or some other appropriate
mechanism established to involve cities in oversight, direction and modification of ambulance
services countywide; and
WHEREAS, the cities desire to participate in the decision-making process, as it pertains to the
providing of pre-hospital medical care, to their residents.
4�S
NOW, THEREFORE BE IT RESOLVED that the City of San Luis Obispo requests the County
Board of Supervisors to assign and direct County staff to negotiate in good faith with the cities in an
attempt to resolve the long-standing problems which exist with the delivery of pre-hospital medical
care countywide.
BE IT FURTHER RESOLVED that the City of San Luis Obispo is committed through the joint
efforts of the City Managers/Fire Chiefs committee on ambulance services, to resolve problems
associated with the provision of ambulance services within the cities and county.
Upon motion of , seconded by
and on the following roll call vote:
AYES:
NOES:
ABSENT:
the foregoing resolution was adopted this day of 1992.
Ron Dunin, Mayor
ATTEST:
Pam Voges, City Clerk
APPROVED:
John Dun , City Administrative Officer
ens n, ty orney
Robert F. Neumann, Fire hief
"T
IL
ment
TO: City Managers of San Luis Obispo County
FROM: City Fire Chiefs of San Luis Obispo County
SUBJECT: City/County EMS Contract
DATE: February 23, 1989
BACKGROUND - Beginning in 1975 the Cities of Morro Bay, Pismo Beach, Arroyo Grande,
Grover City, San Luis Obispo, Paso Robles and the County of San Luis Obispo developed
contracts to provide ambulance services within the County of San Luis Obispo. Each of
the respective Cities signed similar contracts with the exception of Pismo Beach and
Morro Bay. Atascadero signed an EMS contract at the time of their incorporation.
Pismo Beach and Morro Bay contract's included various covenants which restricted the
counties ability to increase rates and/or to limit various EMS functions performed in
•their particular city. In all signed EMS contracts reference is made to an undated
County Emergency Medical Response Manual (EMRM). The EMRM is a procedural
document which regulates the performance criteria for pre-hospital emergency medical
services both public and private. The existing contracts allow the County to modify the
EMRM without City input and/or comment. At the time contracts were signed, the
EMRM did not significantly impact City EMS operations performed by their respective
Fire Departments. However, the most recent EMRM revision, not yet adopted would have
significant impact on Fire Department emergency response requirements.
The existing EMS contracts compel a City to continue the EMS/County relationship
without change for a 5 year period. The exception is Morro Bay which has a yearly
renewal option. Since the signing of these contracts the County has made numerous
procedural changes which include:
1. Eliminated the Emergency Medical Care Committee and created a non-profit
private corportation known as the Emergency Medical Services Agency (SMSA);
granting the EMSA all authority and responsibility conferred on the county by
the cities' contracts and state law.
2. Revised the EMRM in 1982 and adopted revisions. This revision, without city
input, changed the responsibilities and benefits affecting the cities.
3. Redrafted the EMRM in 1988 without City input (not yet adopted) and
increased the impact discussed in #2 above.
4. Considered ambulance contract revisions which include exclusive operating
areas for private ambulance companies, further restricting local determination
of delivery levels, cost and quality of service. Current City subsidies provided
by free Fire Department services would also continue. Exclusive operating
areas could further increase the city subsidized ambulance rates in county
areas.
Since 1975 Emergency Medical Service levels within the County have undergone
significant changes which include:
1. The transition from a standard first aid training and service level to EMT-I,
then to EMT-II and presently an EMT-Paramedic training and service level. In
addition, the type of medical calls responded to, such as hazardous materials
V25424) 2/23/89 1
4 -7
or radiological incidents, require more technical knowledge and increased
training levels as well.
2. Significant population increases and service demand increases.
3. Implementation of a County wide 9-1-1 system.
Cities under the Health and Safety Code Section 54980 are authorized to provide
Emergency Medical Services which include ambulance services. Existing contracts
between the County and Cities transfers the Cities ambulance authority to the
County without sufficient reviews and approval mechanisms. The County presently
can and has changed ambulance service standards and rate structures without City
input or approval.
However, ambulance service rates are based upon service runs including dry runs,
and all operating and maintenance costs for the total ambulance service area rather
than geographic response zones. Other than mileage, ambulance cost between
operating areas are exactly the same. If a medical incident occurs across the street
or in California Valley, the rate is the same. Added service levels and support
provided by Fire Departments are not reimbursed to the local agency nor is the
patient's cost of service reduced. Cities are, therefore, significantly subsidizing
ambulance rate structures in county areas.
The City Managers of San Luis Obispo County met with County Fire Chiefs to
discuss the existing situation and Cities options to either collectively or individually
correct the ambulance service inequities and loss of local control within their
communities. The Fire Chiefs have researched the existing contracts (Attachment 1)
and Health and Safety Code Sections which apply to Emergency Medical Service.
The Fire Chiefs have identified five alternatives relative to the existing contracts.
ALTERNATIVES
1. Revise the existing County/City ambulance contracts to include references to a
specific EMRK the EMSA and Ordinance 660. • This would permit City input into
proposed EMRM changes.
2. Develop a new County/City contract. This would provide sufficient safeguards to
protect the City's interests and options involving emergency medical service, the
ambulance delivery system and rate structuring.
3. Replace the existing county EMS contract and the EMSA lines of authority with a
J.P.A. This would permit the County and Cities to jointly regulate the management
of emergency medical and ambulance services.
4. Dissolve the current EMS contracts at their renewal dates. This would allow all
agencies to operate independently in providing EMS and ambulance service.
5. Do nothing; allowing the existing contracts to automatically renew themselves. This
would continue the present situation.
V25-(24) 2/23/89 2 Q
A4r V
Some of the arguments for and against the atlernatives are:
1. Revise the Existing County/City Ambulance Contracts to Include a Reference to a
Specific EMRM. the EMSA and Ordinance 660
Pr2 - The emergency medical system continues as is with the exception that
cities would have input into any EMRM changes. This alternative would
require less City staff time since the system would be managed by the
SMSA with increased City involvement when EMRM changes are
proposed.
Con - Only limited local control and input would be available. Local input
would be sought when changes are suggested. In the referenced EMRM
cities would continue to subsidize ambulance costs in county areas in that
basic rate structures other than mileage costs are not based on actual
area response costs. In pursuing only limited revisions to the EMS
contract cities would be prevented from establishing individual
performance standards and/or rate structures. In addition, the existing
contract does not provide sufficient representation on the EMSA board
nor does it include a process for appointing or recommending
representatives to the SMSA except through the Board of Supervisors.
The current EMSA board structure is predominantly composed of special
interest representatives, i.e. physician, nurse, medics, providers, citizens
at large with current or previous medical service affiliation background,
and lacks City and general public interest representation.
2. Develop a New County/City Contract Which Provides Sufficient Safeguards to
Protect the City's Interests and Options Involvina Emergency Medical Services and
the Ambulance Delivery System and Rate Structuring.
Prq - This option provides sufficient flexibility in meeting each City's local
needs for medical and ambulance services and at the same time creates an
opportunity to coordinate EMS delivery. The alternative restores local
control and allows cities to establish service levels within individual
boundaries. The contract could provide the following: the ability to
review and approve ambulance service rates and reduce City ambulance
subsidy for response to county areas. The ability to more frequently
review and reconsider the contract, i.e. one year vs. 5 year period. This
alternative allows a city to operate from a standard contract with local
options to address specific community issues and concerns.
Con - The ambulance rate structure for responses to county areas may increase.
The rates for unincorporated areas should reflect the areas actual cost
of providing service. This alternative may require the formation of
county service districts and/or assessment districts in order to pay for
actual ambulance costs.
3. Replace the Existing County EMS Contract and the SMSA Lines of Authority with a
J.P.A. Whereby the County and Cities Jointly Regulate the Management of
Emergency Medical and Ambulance Services
Pyr - This alternative maximizes local control and allows the cities and the
county to jointly coordinate medical response, system operations and
program administration. The JPA provides the most immediate and direct
V25-(24) 2/23/89 3
involvement in the delivery of emergency medical services. J.P.A:s have
proven effective in dealing with medical insurance and similar benefits
and could potentially do the same for EMS.
Con - The J.P.A. could require significant staff time in order to act on the
specific programs and responsibilities. The insertion or addition of a
J.P.A. into the existing situation could introduce time delays and unneeded
bureaucracy. The level of staff expertise assigned to the J.P.A. might
initially be technically deficient and if not planned properly, could cause
initial disruption in the current delivery system. The cities establishment
of a J.P.A. might require financial subsidies. Impacts on city staff time
could be 2 - 3 meetings/month or more. To our knowledge, no J.P.A.
exists in the State of California which regulates EMS as proposed by this
alternative.
4. Do Not Develop a Joint EMS Contract- Allow All Aaencie to Operate Indenendently
in Providing EMS and Ambulance Services
Pro - Independent contracts or services would provide the greatest opportunity
for local control with a minimum of direct city cost. This alternative
provides an opportunity to improve service levels and design specific
emergency medical services based on local needs and desires. Each city
would maintain the ability to contract with the county for delivering all
Ambulance/EMS services. The local agency may provide more ambulance
units if an increased level of service is desired and if it is willing to
assume the additional cost.
Con - EMS/Ambulance Services operating independently could provide the
highest cost consequences for the county. The independence and
autonomy of the service delivery could produce a disjointed service
especially in a disaster situation where mutual aid resources are required
and coordination has not been built into the system. Operating as
individual cities does not provide the coordination opportunities that
Alternative #2 provides.
5. Do nothing allow the existing EMS contracts to automatically renew themselves
Pro - The county will maintain full control over EMS issues. No additional
staff time will be required.
Con - The cities will continue to transfer local control of EMS issues to the
county. Ambulance rates in county areas will continue to be subsidized
by consumers and cities in incorporated areas. The five year renewal
periods will be the only change period where individual city can address
local needs.
RECOMMENDED ACTION:
The Fire Chiefs have reviewed all the alternatives and recommend the following:
A. Agree on a common goal to maintain local control with City/County cooperation and
allow local communities to determine the level of emergency medical services within
their own jurisdiction.
V25-(24) 2/23/89 4
B. Notify the county that the cities request contract renegotiations begin immediately.
In addition, during a 60 day interim period no county action should be taken which
would change the existing program including modifications to the EMRM, Ordinance
660, SMSA or creating exclusive ambulance operating areas.
C. Choose Alternative #2 and develop a new county/city contract which provides
sufficient safeguards to protect the City's interest and options involving emergency
medical services, the ambulance delivery system and rate structuring.
V25-(24) 2/23/89 5 'J
1�' I
Attachment
SAN LUIS OBISPO CITY MANAGERS/FIRE CHIEFS
AMBULANCE RESPONSE PROPOSAL
Chapter 6.60
AMBULANCES
Article 1 - General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
§ 6.60.100. Legislative Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . 1
§ 6.60.101. Purpose of this Chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
§ 6.60.102. Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
§ 6.60.103. Joint Exercise of Power Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
§ 6.60.104. Emergency Medical Response Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
§ 6.60.105. Emergency Medic Response Manual Approvals . . . . . . . . . . . . . . . . . . . . . 6
§ 6.60.106. Transition Provisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Article 2 - County Designation of Operators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
§ 6.60.200. Designation by SLOEMA . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . 8
§ 6.60.201. Duration of Designation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
§ 6.60.202. Undesignated Operators Prohibited Except For A City . . . . . . . . . . . . . . . . 8
§ 6.60.203. Dispatching Across Service Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
§ 6.60.204. Inter-County Continuation of Calls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
§ 6.60.205. Inter-County Transfers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Article 3 - Operating Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
§ 6.60.300. Current Non-Exclusive Operating Areas . . . . . . . . . . . . . . . . . . . . . . . . . . 10
§ 6.60.301. Ambulance Service Area #1 (Cambria) 10
§ 6.60.302. Ambulance Service Area #2 (Paso Robles) . . . . . . . . . . . . . . . . . . . I. ,. . .1. 11
144A
Page i January 18, 1991
§ 6.60.303. Ambulance Service Area #3 (Morro Bay) . . . . . . . . . . . . . . . . . . . . . . . . . 12
§ 6.60.304. Ambulance Service Area #4 (Atascadero) . . . . . . . . . . . . . . . . . . . .. . . . . .
§ 6.60.305. Ambulance Service Area #5 (San Luis Obispo) . . . . . . . . . . . . . . . . . . . . . 16
§ 6.60.306. Ambulance Service Area #6 (Five Cities Area) . . . . . . . . . . . . . . . . . . . . . 17
§ 6.60.307. Alternative Operating Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
§ 6.60.308. Operating Areas Are Exclusive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
§ 6.60.309. Agreements with Other Counties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Article 4 - Competitive Bidding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
§ 6.60.400. Competitive Bidding - In General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
§ 6.60.401. Private or Public Entities May Bid . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
§ 6.60.402. Joint Exercise of Powers Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
§ 6.60.403. Qualifications of Bidders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
§ 6.60.404. All areas to be bid simultaneously . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
§ 6.60.405. Individual Bids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
§ 6.60.406. Basis for Bids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
§ a. Initial Rates and Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
§ b. Staffing and Equipment Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
§ c. Response to Dispatches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
§ d. Service Fees are Sole Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
§ e. Collection and Disbursement of Service Fees . . . . . . . . . . . . . . . . . . . . . . . 30
§ f. Statutes, Ordinances, etc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Article 5 - Solicitation and Submission of Bids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
§ 6.60.500. Invitation for Bids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
§ 6.60.501. Significance of Submission of Bid 30
§ 6.60.502. Unit Prices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
§ 6.60.503. Estimates - Solely for Bid Comparison . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Page ii January 9, 1991
Al-/3
§ 6.60.504. Written, Sealed Bids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
§ 6.60.505. Bid Opening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
§ 6.60.506. Minor Informalities May be Waived . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
§ 6.60.507. Right to Reject All Bids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Article 6 - Selection of Operator(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
§ 6.60.600. Selection of Operators - In General . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
§ 6.60.601. Determining The Amount of a Bid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
§ 6.60.602. Options If No Bids are submitted for a Service Area. . . . . . . . . . . . . . . . . . . 33
§ 6.60.603. Selection of Lowest Bidder(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
§ 6.60.603.1. Step 1 - Compute All Bid Amounts . . . . . . . . . . . . . . . . . . . . . . . 33
§ 6.60.603.2. Step 2 - Low Bids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Article 7 - Designation of Operators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
§ 6.60.700. Designation of Operators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Article 8 - Vehicle Equipment Ownership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Article 9 - Minimum Service Standards . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
§ 6.60.800. Performance Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Appendix I
Joint Exercise of Powers Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1
Page iii January 10, 1991
'4—)+
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ARTICLE 1 - GENERAL
§ 6.60.100 Legislative Findings.
WHEREAS, the Cities and the County entered into a contract to regulate ambulance operations
within San Luis Obispo County in 1976; and
WHEREAS, the contract did not provide for City input into the County ambulance ordinance,
ambulance charges, or the County Emergency Medical Response Manual; and
WHEREAS, the Cities have canceled the existing contract in order to facilitate negotiations
towards a new EMS contract; and
WHEREAS, population, service demands and county-wide changes have occurred since the
signing of the original contract; and
WHEREAS, it is essential to review and update emergency medical services with the involvement
of each governmental agency affected by such services; and
WHEREAS, Government Code Section 54980 permits cities to provide ambulance services as one
of the Municipal services or functions; and
WHEREAS, a joint powers agency may be created for the administration of emergency medical
services administration by agreement between the county and the cities pursuant to the provision of
Chapter 5 (commencing with Section 6500) of Division of Title 1 of the Government Code.
§ 6.60.101 Purpose of this Chapter. The purpose of this chapter is to develop effective
emergency medical response programs to meet citizen's medical needs for pre-hospital emergency medical
care and transportation by regulating ambulance operations.
Page 1 January 9, 1991
'4-15
§ 6.60.102 Definitions. For the purpose of this chapter, the following terms shall mean:
Ambulance shall mean any publicly or privately owned motor vehicle that is specially
constructed, modified, equipped, or arranged, and operated for the purpose of transporting
patients and shall include, but is not restricted to emergency vehicles used for such purpose,
but shall not include funeral coaches or hearses; provided, however, that an Emergency
Rescue Vehicle as defined hereinafter is not an ambulance.
Ambulance Certificate shall mean a County Ambulance Certificate certifying an ambulance
as having complied with the provisions of this chapter.
Ambulance Company shall mean any private or public entity or person operating one or
more ambulances.
Ambulance Service Area shall mean those ambulance service areas established within the
County of San Luis Obispo and designated on the ambulance service map as approved by
SLOEMA.
Attendant means a person who holds a valid county ambulance attendant's permit.
Central Dispatch means the San Luis Obispo County medical communications system
(MED-COM) dispatch point.
County means the County of San Luis Obispo.
County Licensing Agent means SLOEMA.
Consumer Price Index means the consumer price index for the average income between the
CPN Los Angeles/Anaheim and the CPN, San Francisco, Oakland, San Jose between
Page 2 January 18, 1991
4-1b b
October and October as reported by the United States Department of Labor Bureau of Labor
Statistics.
Dispatch Time means the time the ambulance crew was notified to respond to a call.
Driver means a person who holds a valid county ambulance driver's permit.
Emergency Call shall mean a request for the dispatch of an ambulance to transport or
provide other assistance for a person apparently having a sudden and unforeseen need for
medical attention or transportation.
Emergency Rescue Vehicle shall mean any publicly owned motor vehicle that is specially
constructed, modified, equipped or arranged, and operated to save a person's life in the
event of a sudden, generally unexpected occurrence demanding immediate action, including
but not limited to the transportation of such a person for that purpose.
Emergency Service shall mean the service performed in response to an emergency call.
EMRM shall mean the Emergency Medical Response Manual that will be adopted by the
county and cities within San Luis Obispo County.
EMS means Emergency Medical Services.
EMS Agency means the San Luis Obispo Emergency Medical Services Agency, a
non-profit corporation established by the County of San Luis Obispo which monitors the
medical control and standards of the county EMS system.
EMT-I shall mean Emergency Medical Technician 1.
Page 3 January 18, 1991
` ,1-7
EMT-II shall mean Emergency Medical Technician 2 (limited advanced life support).
EMT-P shall mean Emergency Medical Technician Paramedic (Advanced Life Support).
Health Officer means the Health Officer of the County of San Luis Obispo.
Indigent shall mean a person who is not eligible for Medi-Cal or Medi-Care and who in the
judgement of the County lacks the means through his/her own resources to pay for
emergency ambulance service.
Individual Bid means a bid which is limited to a single service area and which may be
accepted for that single service area regardless of what happens in other service areas.
License means a County Ambulance Company license.
Med-Com means the radio, telephone and dispatch system equipment that makes up the San
Luis Obispo County Medical Communications system.
Non-Service Run shall mean the situation in which an ambulance company responds to an
emergency transport request by central dispatch, but ambulance service is not required.
Patient means a wounded, injured, sick, invalid, dead, convalescent, infirmed or otherwise
incapacitated person.
Pre-Hospital EMS means emergency medical services provided before a patient reaches a
hospital.
Page 4 January 11, 1991
Response Time shall mean the time from when the call is passed from Med-Com to an
ambulance provider until the ambulance unit arrives on scene.
Response Code - Code 1 shall mean ambulance is to arrive at destination at earliest
convenience. Code 2 shall mean proceed to destination as rapidly as possible, obeying all
traffic laws. Code 3 shall mean, using red light and siren, move to destination as rapidly as
possible, keeping in mind the safety of patients and other traffic.
Remote Area shall mean census tracts or enumeration districts without census tracts which
have a population density of 5 to 9 persons per square mile.
Rural Area shall mean all census places with a population of less than 2500 and population
density of 10 to 99 persons per square mile; or census tracts or enumeration districts without
census tracts which have a population density of 10 to 99 persons per square mile.
Service Area means an ambulance service area as defined by Article 3, beginning at
6.60.301.
San Luis Obispo Emergency Medical Authority (SLOEMA) shall mean the Joint Powers
authority between the County and the seven incorporated cities established for the regulation
of ambulance services within the County.
Urban Area - All census places with a population of 2,500 to 500,000 and a population
density of 100 to 999 persons per square mile; or census tracts and enumeration districts
with census tracts which have a population density of 100 to 999 persons per square mile.
§ 6.60.103 Joint Exercise of Power Agreement. A Joint Exercise of Power Agreement between .
San Luis Obispo County and its incorporated Cities is established for the purpose of delivering efficient
Page 5 January 10, 1991
Afrj q
emergency medical response programs necessary to meet citizens medical needs for pre-hosiptal emergency
medical care and transportation by regulating ambulance operations. The Joint Powers Authority shall be
known as the San Luis Obispo Emergency Medical Authority (SLOEMA). The specific joint powers
agreement is found in Appendix I.
§ 6.60.104 Emergency Medical Response Manual. The Board and Incorporated Cities
administered by SLOEMA JPA (Appendix I), shall by resolution adopt an emergency medical response
manual (hereinafter called "EMRM") for the purpose of defining in detail the manner in which ambulance
company operators respond to calls. Copies of the EMRM shall be on file in the office of the County
Clerk and the Health Officer, who shall make them available to the public. Upon adoption, the EMRM
shall have the full force and effect of law.
§ 6.60.105 Emergency Medical Response Manual Approvals
1. The preliminary draft of the EMRM is prepared with the assistance of the SLOEMA and is
submitted to the County Board of Supervisors and the incorporated cities for review. Thirty to
sixty days is allowed for this review.
2. Based on the comments received from the agency reviewing the drafts, the draft EMRM is
revised and a final EMRM is prepared by SLOEMA.
3. The EMRM is submitted to the incorporated cities for review and approval. The EMRM
must be approved by at least 50 percent of the incorporated cities which must represent at least 50
percent of the incorporated population. The cities must respond within 90 days of receiving the
final draft or non-action will be considered as approval.
4. The EMRM shall be scheduled for at least one public hearing before the County Board of
Supervisors before final approval.
Page 6 January 10, 1991
4-ao
§ 6.60.106 Transition Provisions
In the complete transition from the old form of contract to the new system, four distinct phases are
identified (Figure I). Each phase has its own management challenges to meet SLOEMA's
expectations.
• Phase 1 - Pre-implementation From the time of the contract's awarded
in the contractor has 120 days to obtain all of
the equipment and qualified personnel necessary to take over the system. During this
time period the contractor will work with SLOEMA, the EMSA and the hospital
staffs.
• Phase 2 - Reactionary Period Beginning with the first day of service
the contractor will develop information on the demands of the system. An extensive
data collection system should be implemented and include but not limited to:
response times, ALS vs. BLS cost accounting, etc.
0 Phase 3 - Adjustment Period After a reactionary period, the system will enter into
an "Adjustment Period". During this phase, more careful and studied approaches can
be used to adjust to varying demands and more finite objectives. Issues that were not
a priority in the earlier months can now be addressed as more important issues are
solved. This period will last for nine months.
• Phase 4 - Maintenance Period After one year of operation the system will have
matured to the point where expectations are fairly well known and fine-tuning
adjustments can be made simply and easily. During this maintenance phase
management's challenge takes on a new form. First, in order to encourage
SLOEMA to elect its option to extend the contract(s), the Contractor(s) must excel in
Page 7 January 11, 1991
I �
FIGURE T
TRANSIT16N PHASES .
� I
a
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i
system performance. Hence the contractor(s) have an incentive to continue to pursue
above-average performance. Second, due to the tendency to "not fix if it ain't
broke", the contractor(s) will have a continuing challenge to strive for excellence
even though many others may not perceive the need or share the goal. In some ways
this more permanent phase is less risky, but much more challenging. The overall
desirable result will be to have a "high performance" system that is proactive and
responsive to this changing industry.
ARTICLE 2 - SLOEMA DESIGNATION OF OPERATORS
§ 6.60.200 Designation by SLOEMA. Every three years, commencing on ,
SLOEMA shall designate one operator for each ambulance service area in accordance with the provisions
of this chapter.
§ 6.60.201 Duration of Designation. Unless suspended pursuant to Cancellation Agreement
(Article 4), the designation of an operator shall remain in effect for three years.
§ ,6.60.202 Undesignated Operators Prohibited Except For A City. No person, partnership,
corporation, or other organization shall operate an ambulance company in any service area of the County
of San Luis Obispo, unless:
(a) that person, partnership, corporation, public entity or other organization has been
designated by SLOEMA as the ambulance company operator for the ambulance
service area in which the operation occurs; or
(b) such operation is otherwise specifically permitted by this Chapter; or
(c) the entity is a general law or charter city within San Luis Obispo County.
§ 6.60.203 Dispatching across service areas. The provisions of § 6.60.202 notwithstanding,
except for City providers, a designated ambulance operator shall leave its home service area to provide
Page 8 January 18, 1991
44-A5
ambulance services in another service area if it has been dispatched to perform said services pursuant to
the provisions of this chapter or the EMRM.
§ 6.60.204 Inter-County Continuation of Calls. The provisions of § 6.60.202 notwithstanding,
an ambulance company licensed in another county may continue calls into the County of San Luis Obispo
if continuation of such calls is consistent with an agreement between the County of San Luis Obispo and
the other county. In the absence of this agreement, no ambulance shall cross county lines.
§ 6.60.205 Inter-County Transfers. The provisions of § 6.60.202 notwithstanding, an
ambulance company licensed in another county may transport a patient to or from the County of San Luis
Obispo for the purpose of transferring the patient to or from a health care facility in the county of
licensure of the ambulance company.
Page 9 January 7, 1991
J4-A
ARTICLE 3 - OPERATING AREAS
§ 6.60.300 Current Non-Exclusive Operating Areas. Currently the division lines for
ambulance operating service areas are unrelated to county-wide map grids. The existing service area
division lines are both difficult to reproduce and difficult to assign calls for service. To correct this
deficiency, the division lines for existing ambulance service areas have been redefined to coincide with
county-wide map grids. Both the current and the proposed service area boundaries are listed as follows.
§ 6.60.301 Ambulance Service Area #1 Current Boundary Definition (Cambria). Starting at
the intersection of U.S. Highway 1 and Villa Creek Road and extending in a straight line NNE to the
intersection of Highway 46 west and Old Creek Road (Boundary Line 1). Extending in a straight line
from the intersection of Highway 46 west and Old Creek Road NNE to the intersection of the San Luis
Obispo County-Monterey County border and Bryson Hesperia Road (Boundary Line 2).
AMBULANCE SERVICE AREA #1 PROPOSED BOUNDARY DEFINITION (CAMBRIA)
DIVISION LINE BETWEEN SERVICE AREA 1 AND SERVICE AREA 3
COUNTY GRIDS
MAP PAGE
<: Nx.:,.;
. .s:.c::.,,:. ,.:.,::x.s::..,.:..:wc ::,..*e:::�;::::o:.:a:>:�:::.:;.:.;;:;:Nu,;:;:;.:,..,..<w�::.:;;;.;:a:x.n;:::.:>:.:�;:;:rN;:,..w:.,w.:::::..:::..:::;:::;::;.:o;;::;;;;:;.:;.;;:;:;.;;;;;;;;:;.;r;.:;:.>;:>::.::::..,:c>::::.;:
92 A-5 B-4 C-3 D-2 El
65 E-5
66 A-4
DIVISION LINE BETWEEN SERVICE AREA 1 AND SERVICE AREA 2
COUNTY GRIDS
MAP PAGE
:.::.,..v:....:,. .., .
`ivi
...i%`!€!++% :%!i:%:J:...-,;%>:::!:;:%::5;:i:i:::y2?;`iia 'i�iviiiit` i�<�>i>iii2'>�i' i<;iiiasiisifi )3iii>
4 E-1
5 A-2 A-3 A-4 A-5
28 C-1 D-2 D-3 D-5
30 E-1
33 A-2 B-3 B-4 C-5
Page 10 January 7, 1991
DIVISION LINE BETWEEN SERVICE AREA 1 AND SERVICE AREA 2 (CONT.)
COUNTY GRIDS
MAP PAGE
60 D-1 E-2
63 A-3 B-3 B-4 C-5
65 C-1 D-2 D-3
66 A-4
§ 6.60.302 Ambulance Service Area #2 Current Boundary Defuiition (Paso Robles). Starting
at the intersection of Highway 46 west and Old Creek Road and extending in a straight line west to the
intersection of Palo Prietro-Cholame Road and Simmler-Bitter Water Rd (Boundary Line 3).
AMBULANCE SERVICE AREA #2 PROPOSED BOUNDARY DEFINITION (PASO ROBLES)
DIVISION LINE BETWEEN SERVICE AREA 2 AND SERVICE AREA 1
COUNTY GRIDS
MAP PAGE
a ., #
:
'M.Mx. p\
aaa :n,�, : nwm..n , »x.•.. a a..a... i .2..:...:,,i{[ ::...n„ n.: .: ::,`4,i... , :a a
5 A-1 B-2 B-3 B-4 B-5
28 D-1 E-2 E-3 E-4 E-5
33 A-1 B-2 C-3 C-4 D-5
60 E-1
63 A-2 B-2 C-3 C-4 C-5
65 D-1 E-2
66 A-3 B-4
Page 11 January 7, 1991
�a�
DIVISION LINE BETWEEN SERVICE AREA 2 AND SERVICE AREA 3
COUNTY GRIDS
MAP PAGE
66 B-4 C-4 D-5
94 E-1
95 A-1 B-1 C-2 D-3 E-4
98 A-4 B-5
DIVISION LINE BETWEEN SERVICE AREA 2 AND SERVICE AREA 4
COUNTY GRIDS
NIAP PAGE..
...........:....................»is...
a:;>�i::>::
98 B-5 C-4 D-3 E-2
99 A-1 B-1
73 B-5 B-4 C-3 D-3 E-2
74 A-2 B-1 C-1 D-1 E-2
77 A-2 B-2 C-2 D-2 E-2
78 A-2 B-2 C-2 D-1 E-1
81 A-2 A-3 B-3. C-3 D-3 E-3
82 A-4 B-4 C-4 D-4 E-5
111 A-1 B-1 C-1 D-1 E-1
115 A-1 B-1 C-1 D-1 E-2
116 A-3 B-3 C-4 D-4 E-4
118 A-3 B-4 C-4 D-5 E-5
119 A-5
144 B-1 C-1 D-1
§ 6.60.303 Ambulance Service Area #3 Current Boundary Definition (Morro Bay). Starting
at the intersection of Highway 46 west and Old Creek Road and extending in a straight line SSE to the
intersection of Highway 41 west and Cerro Alto Campground (Boundary Line 4). From the intersection of
Page 12 January 7, 1991
L4-a7
Highway 41 west and the Cerro Alto Campground extending in a straight line SSE to the intersection of
Highway 1 and the north entrance of Cuesta College (Boundary Line 5). From the intersection of
Highway 1 and the north entrance to Cuesta College extending in a straight line SW to one mile north of
the Diablo Canyon Nuclear Power Plant (Boundary Line 6).
AMBULANCE SERVICE AREA #3 PROPOSED BOUNDARY DEFINITION (PASO ROBLES)
DIVISION LINE BETWEEN SERVICE AREA 3 AND SERVICE AREA 1
COUNTY GRIDS
MAP PAGE
::::n .::...:.:.::::::.n::..::...:,..,:n::.::::.,n::.:::::n.::.:::::.::n.::.a.:.:............::n:::.:,n:.:.:::: x:.:::.:::. ,::::::::,:::::.::::.::
92 B-5 C-4 D-3 E-2
93 A-1
94 A-1
66 A-5
DIVISION LINE BETWEEN SERVICE AREA 3 AND SERVICE AREA 2
COUNTY GRIDS
MAP PAGE
:'niw.x>„vy:n.n ne':::!2^:p.na,v:::.vni...:....::.....:..v::::n.::.�:.....:.:.,y.::....::..:.:::.. ...................::.....:::.:.v.�.�.'rv::::::::.:.:..:........
.v.................v..,..xx,...::;>Li..x.....nik4'i:i::iYiki:a .. ....... .. .,
66 B-5 C-5
94 D-1 E-2
95 A-2 B-2 C-3 D-4 E-5
98 A-5 B-5
DIVISION LINE BETWEEN SERVICE AREA 3 AND SERVICE AREA 4
COUNTY GRIDS
MAP PAGE
.
;2{22\.::i.iii)i:C:^•ii.:.::i+;+'
:,....,.a,..:,•,.a.»...:naxx.,...a».,»ni,x.;:::�:v.:.v.,x:.,:vn.v.v...,.v...vn::.,.....v...n: i::::,::; ::::<'��SV::::::'5::'::::i:::': ;+`
...............
100 B-1 C-2 D-3 E-3
101 A-4 B-5
124 B-1 C-2 D-2 E-2
125 A-2 B-3 C-4
Page 13 January 7, 1991
J4 o�8
DIVISION LINE BETWEEN SERVICE AREA 3 AND SERVICE AREA 5
COUNTY GRIDS
MAP PAGE
186 A-3 B-2 B-1
153 C-5 D-5 D-4 D-3 E-2
154 A-2 B-2 C-2 D-2 E-2 E-1
152 E-4 E-5
155 A-2 A-3 B-4 B-3 B-2 C-1
126 C-5 D-4 E-3
127 A-1 A-2 B-2 B-1
125 B-5 C-4
§ 6.60.304 Ambulance Service Area #4 Current Boundary Definition (Atascadero). Starting
at the intersection of Highway 41 west and the entrance to the Cerro Alto Campground and extending in a
straight line to the intersection of US 101 and the Highway 58 off/on ramps (Boundary Line 7). From the
intersection of US 101 and the Highway 58 off/on ramp extending in a straight line SE to the intersection
of Hi Mountain Lookout Road and Hi Mountain Road (Boundary Line 8). From the intersection of Hi
Mountain Lookout Road and H]. Mountain Road extending in a straight line SE to the intersection of Soda
Lake Road and Elkhorn Road (Boundary Line 9).
AMBULANCE SERVICE AREA #4 PROPOSED BOUNDARY DEFINITION (ATASCADERO)
DIVISION LINE BETWEEN SERVICE AREA 4 AND SERVICE AREA 3
COUNTY GRIDS
MAP PAGE
.........{.'...F. Y :v.Q'.... .:........ .....�.. ...:..........:..�:::...:.
...:::.::.:. ..::.::.::.:::.:.v...,.:::n.::..:...........:.:............... ..
Ttivi:'�"'rv.'vi4:tiv::nYriw>i::t::riiin''isJ:sriv:n".v$i>i:<45:r':vv'ii:::...v.....v...n............nnn..............................v......v n........ .....
100 C-1 D-2 E-2 E-3
101 A-3 B-4 C-5
124 C-1 D-1 E-1
125 A-1 B-2 C-3 D-4
Page 14 January
p7, 1991
�� 1
DIVISION LINE BETWEEN SERVICE AREA 4 AND SERVICE AREA 5
COUNTY GRIDS
MAP PAGE
125 E-5
127 E-1 D-2
130 A-4 B-4 C-5
159 C-1 D-1 D-3 E-4 E-5
162 A-1 A-2 B-3 C-4 C-5
DIVLSION'LINE BETWEEN SERVICE AREA 4 AND SERVICE AREA 6
COUNTY GRIDS
MAP PAGE
v:::nr.:mr.m.nv:xnrw:.w.wowl
.nm:rmw.mv.. v:x.:..v:mvn:...n:.x.rvry:n}x:CY...^'^:^:m:i'.ii;.3}:v:_:}:C::.•.:nw::::::nry:.i iSi:{m}'1..;:.%i3.}S}%.::A}%n}iSS:niS:.iv}}i}:i.Sii ii}:y is}:mi}::!�!
4ii:::::%:iQw:i:�:.avv..m::.:::.:....:: :::. :. .:..:.. .. ... .
162 C-5 D-5
195 E-1
198 A-1 B-2 C-2 D-2 E-2
199 A-2 B-2 C-2 D-2 E-2
202 A-2 B-2 C-2 D-2 E-2
203 A-2 B-3 C-4 D-5 E-5
208 A-1 B-1 C-2 D-2 E-2
209 A-2 B-3 C-3 D-4 E-4
212 A-4 B-5 C-5
240 D-1 E-1
242 A-2 B-2 C-3 D-4 E-4
247 A-5
244 D-1 E-1
247 A-5
246 A-2 B-2 C-3 D-4 E-5
263 B-1 C-2 D-2 E-3
264 A-3 B-3 C-4 D-4 E-5
Page 15 January 7, 1991
4 30
DIVISION LINE BETWEEN SERVICE AREA 4 AND SERVICE AREA 6 (Cont.)
COUNTY GRIDS
MAP PAGE
268 A-1 B-1 C-1 D-1 E-2
§ 6.60.305 Ambulance Service Area #5 Current Boundary Definition (San Luis Obispo).
Starting at the intersection of Avila Road and US 101 and extending in a straight line to the intersection of
Highway 227 and Price Canyon Road (Boundary Line 10). From the intersection of Highway 227 and
Price Canyon Road, extending in a straight line to the intersection of Hi Mountain Lookout Road and Hi
Mountain Road (Boundary Line 11).
AMBULANCE SERVICE AREA #5 PROPOSED BOUNDARY DEFINITION (SAN LUIS OBISPO)
DIVISION LINE BETWEEN SERVICE AREA 5 AND SERVICE AREA 3
COUNTY GRIDS
MAP PAGE
...:.:......... .::::.;:.;:;:;::.;;;;:.::,:..::::::,:: ..
`<':<i i':>i>>k!'' >ri''=w'> > >»><'n':>iv»€>i>n>»'»>n'>M>'is>i':>»i<<i>z<'r''•« -
186 A-4 B-3 C-2 C-1 D-1
153 E-3 E-4 E-5 D-3 E-2
154 A-3 B-3 C-3 D-3 E-3 E-1
155 A-4 A-5 B-2 B-3 C-1
157 A-1 A-2
126 D-5 E-4
127 A-3 B-2 B-1
125 C-5
Page 16 January 7, 1991
'f-31
DIVISION LINE BETWEEN SERVICE AREA 5 AND SERVICE AREA 4
COUNTY GRIDS
MAP PAGE
125 D-5
127 D-1 D-2 E-3 E-4
130 A-5 B-5
159 B-1 C-2 C-3 D-4 D-5
162 A-3 B-4 B-5
DIVISION LINE BETWEEN SERVICE AREA 5 AND SERVICE AREA 6
COUNTY GRIDS
MAP PAGE
r..:},:i•:!.m,:;ii•:::}:io-,:..}.x..}:i,,:.,i.:.}}:a ::.tn:.:a,,:..,:i.:i.ii..}}:.}.:.}:o:i.,.:....H.:..o:i«:.
227 A-2 A-3 B-1
196 B-5 C-4 D-4 D-3 D-2 E-1
195 A-5 A-4 A-3 B-2 B-1
226 E-4 E-5
§ 6.60.306 Ambulance Service Area ##6 Current Boundary Definition (Five Cities Area). That
area south of Boundary Lines 9, 10, and 11 to the Santa Barbara County Line.
DIVISION LINE BETWEEN SERVICE AREA 6 AND SERVICE AREA 5
COUNTY GRIDS
MAP PAGE
v..ti:.v.: 'i{An}Y?i..:nv:.wy..Y.}:::ro:.}}::q}..}:Y..v.}Y.: ,:A........ 'l.:O::(}}::..}:n}}}i;:n};:!ii}'t::!.`ii;v.v.
..S::`......
::.4}::y..:..:::n.{:.:.Fi.A:}}}}:i ni:4: ::}::::::::}i". ::iY.:i:i::;iiii:::Y.:i::}::i}:: ii::}::i::i:}:�::�;::::::5:::::i;::;::::
iiii
.:l:ti.:i i � ! : :i:_::j.. '.J:::n;:.�! ' : ii:: ?ni:isi:::+:i:ji'H::);�j�;:j:::ii n:r Vin;ri ij�n_�::�:::: f::�$ ::: : i�: X::! ::
227 A-5 A-4 B-3 B-2 C-1
196 C-5 D-5 E-4 E-3 E-2
197 A-1
195 B-5 B-4 B-3 C-2 C-1
Page 17 January 7, 1991
4- 3a
DIVISION LINE BETWEEN SERVICE AREA 6 AND SERVICE AREA 4
COUNTY GRIDS
MAP PAGE
195 C-1 D-1 E-2
198 A-2 B-3 C-3 D-3 E-3
199 A-3 B-3 C-3 D-3 E-3
202 A-3 B-3 C-3 D-3 E-3
203 A-3 B-4 C-5
205 D-1 E-1
208 A-2 B-2 C-3 D-3 E-3
DIVISION LINE BETWEEN SERVICE AREA 6 AND SERVICE AREA 4
COUNTY GRIDS
MAP PAGE
•.r:F..ism'ln,:.iwnYYwnK,.ny:;;!.YYvnvv,M::! ,.xv,.,v,.>:.}:n:nY::;.i:.v,..>v,..iW..->Y.�w.>:.Y:n..v:,.i::.>:.i>:!»....>:.�.:.r.Y...:.>:.i:::::...x:.,,::x.:....::...::::::.:.............::::::...:::::::....x.:.::::::::.:,::x.::..
'iii:: i:: :':.........
':.:'.....
209 A-3 B-4 C-4 D-5 E-5
212 A-5
240 B-1 C-1 D-2 E-2
242 A-3 B-3 C-4 D-5 E-5
244 C-1 D-2 E-2
246 A-3 B-3 C-4 D-5 E-5
262 E-1
263 A-1 B-2 C-3 D-3 E-4
264 A-4 B-4 C-5 D-5 E-5
267 E-1
268 A-2 B-2 C-2 D-2 E-3
§ 6.60.307 Alternative Operating Areas. The current ambulance service areas (Figure 1) and
four alternative service area configurations (Figures 2 - Figure 5) are proposed for evaluation. The
description of the proposed service areas are as follows:
Page 18 January 7, 1991
4-30IL
Figure 1. (Option 1) Current Ambulance Service Area (See 6.60.301 through 6.60.306)
Figure 2. (Option 2) is proposed as one county-wide ambulance service area with no
subparts.
Figure 3. (Option 3) is proposed as two ambulance service areas with Section 1
composed of Section 1, 3, 5, and 6 of the current service areas and Section 2
composed of Section 2 and 4 of the current service area.
Figure 4. (Option 4) is proposed as three ambulance service areas with Section 1
composed of Section 1 and 3 of the current service areas; Section 2 composed
of Section 2 and 4 of the current service areas and Section 3 composed of
Sections 5 and 6 of the current service areas.
Figure 5. (Option 5) is proposed as four ambulance service areas with Section 1
composed of Section 1 of the current service area. Section 2 composed of
Section 2 and 4 of the current service areas. Section 3 composed of Section 3
and 5 of the current service areas. Section 4 composed of Section 6 of the
current service areas.
Page 19 January 7, 1991
14 -34
FIGURE 1 - OPTION 1
CURRE" SERVICE AREAS
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§ 6.60.308 Operating Areas are Exclusive. Following the final selection of county wide
ambulance operating areas, it should be the policy, except as provided in § 6.60.307, that the ambulance
service areas defined in this Chapter are exclusive, i.e. SLOEMA shall designate only one operator to
provide ambulance services in any ambulance service area. Any city or special services district may be
deleted from an operating area by notifying SLOEMA prior to the start of the bidding process. Operators
designated in one area shall not perform services in other areas except when specifically dispatched to do
so pursuant to this Chapter or the EMRM.
§ 6.60.309 Agreements with Other Counties. Notwithstanding the provisions of § 6.60.300,
the San Luis Obispo EMA reserves the right to perform certain existing Joint Exercise of Powers
Agreements for Continuation of Calls with the adjoining counties of Monterey, Kern, and Santa Barbara
and shall enter into agreements with these counties. Under the terms of said agreements, each party
agrees to recognize the certification of Pre-hospital Emergency Medical Services personnel by the other
party, but only for the purpose of allowing the continuation of calls for the delivery of patients originating
in the dispatching county of certification to medical facilities in another county. Said contracts do not
grant permission for ambulance companies to respond to or pick up emergency or other patients across
county lines, unless specifically requested to do so by the requesting county's central ambulance dispatch
or equivalent agency authorized to dispatch ambulances.
Page 20 January
7,, 1991
4-+o.+o
ARTICLE 4 - COMPETITIVE BIDDING
§ 6.60.400 Competitive Bidding - In General. The ambulance operator who is designated by
the county for each ambulance service area shall be determined by competitive bidding in accordance with
the provisions of this article.
§ 6.60.401 Private or Public Entities May Bid. Both private and public entities may submit
bids to be designated as ambulance operators under this Chapter. Incorporated cities may choose to submit
bids proposing to serve an entire ambulance service area, not just a portion of that area and not just the
area within the public entity's territorial limits. To the extent that public entity bidder would otherwise be
precluded from providing ambulance services outside of its boundaries, SLOEMA shall enter into a Joint
Exercise of Powers Agreement with that public entity in accordance with the provisions of 6.60.402 if that
public entity is selected as the ambulance operator for an area pursuant to Article 6.
This section does not preclude incorporated cities from declaring their intentions to provide
ambulance services to the public entities territorial limits only. Such declaration to provide service shall
be, made at least 60 days prior to advertising for competitive bids. If a city declares its intent to provide
ambulance services for its territorial limit, said area shall be excluded from the bid service area and the
bid process provisions of Article 5.
§ 6.60.402 Joint Exercise of Powers Agreement. The Joint Exercise of Powers Agreement
referred to in §6.60.401 shall be an agreement between SLOEMA and the public entity bidder and shall be
executed in accordance with Government Code §§ 6500 et seq, providing for the joint exercise of powers.
By said agreement, SLOEMA shall empower the public entity to operate an ambulance company in the
portion of the ambulance service area which is outside the public entity's territorial limits. The agreement
shall not add any provisions which would be inconsistent with the bid submitted by the bidder.
§ 6.60.403 Qualifications of Bidders. Bidders shall meet the minimum qualifications set forth
Page 21 January 7, 1991
�t-�1
below in this section. Whether or not a bidder meets these qualifications shall be determined by SLOEMA
after bids have been opened and the presumptive low bidders determined. At that time, the presumptive
low bidder shall have the burden of bringing forth evidence sufficient to demonstrate that it meets the
minimum qualifications set forth herein. If the low bidder fails to demonstrate that it is qualified,
SLOEMA shall ignore its bid and re-examine all other bids as if the disqualified bidder had not submitted
a bid. The qualifications which must be met are as follows:
(a) Insurance: Contractor shall not commence work under this Agreement until all
insurance required under this section has been obtained and such insurance has been
approved by the SLOEMA. Contractor shall furnish SLOEMA with Certificates of
Insurance evidencing the required coverage and there shall be a specific contractual
liability endorsement extending Contractor's coverage to include the contractual
liability assumed by Contractor pursuant to this Agreement. These Certificates shall
specify or be endorsed to provide that thirty (30) days' notice must be given, in
writing, to the SLOEMA of any pending change in the limits of liability or of any
cancellation or modification of the policy.
1. Worker's Compensation and EmploYer Liability Insurance: Contractor shall
have in effect during the entire life of this Agreement, Worker's
Compensation and Employer Liability Insurance providing full statutory
coverage. In signing this Agreement, Contractor makes the following
certification, required by Section 1861 of the California Labor Code:
I am aware of the provisions of Section 3700 of the California Labor
Code which require every employer to be insured against liability for
Worker's Compensation or to undertake self-insurance in accordance
with the provisions of the Code, and I will comply with such
provisions before commencing the performance of the work of this
Agreement.
Page 22 January 7, 1991
2. Liability Insurance: Contractor shall take out and maintain during the life of
this Agreement such Bodily Injury Liability and Property Damage Liability
Insurance as shall protect him while performing work covered by this
Agreement from any and all claims for damages for bodily injury, including
accidental death, as well as any and all claims for property damage which
may arise from Contractor's operations under this Agreement, whether such
operations be by himself or by any subcontractor or by anyone directly or
indirectly employed by either of them. Such insurance shall be combined
single limit bodily injury and property damage for each occurrence and shall
not be less than the amount specified below.
Such insurance shall include:
(a) Comprehensive General Liability $5,000,000
(b) Motor Vehicle Liability Insurance $5,000,000
(c) Professional Liability $5,000,000
If this Agreement remains in effect more than three (3) years from the date of
its original execution, SLOEMA may, at its sole discretion, require an
increase in the amount of liability insurance to the level then customary in
similar Agreements by giving sixty (60) days' notice to Contractor.
SLOEMA and its officers, agents, employees and servants shall be named as
additional insured on any such policies of insurance, which shall also contain
a provision that the insurance afforded thereby to SLOEMA, its officers,
agents, employees and servants shall be primary insurance to the full limits of
liability of the policy, and that if SLOEMA or its officers and employees have
other insurance against the loss covered by such a policy, such other insurance
shall be excess insurance only.
Page 23 January 7, 1991
4-43
Certificates of insurance shall contain the following statement naming
SLOEMA as an also insured.
Ambulance provider shall defend, indemnify, and save harmless SLOEMA, its
officers, agents, and employees, from any and all claims, demands, damages,
costs, expenses and liabilities arising out of this Agreement or occasioned by
the negligent performance or attempted negligent performance of the
provisions hereof, including, but not limited to, any negligent act or omission
to act on the part of the provider or his agents or employees or independent
contractors directly responsible to him, except that the above shall not apply
to the sole negligence or willful misconduct of SLOEMA or SLOEMA's
agents, or independent contractors who are directly responsible to SLOEMA.
This indemnification provision shall apply even if there is concurrent or joint
negligence of indemnitor and indemnitee, and even if there is active or passi
negligence by either or both parties.
In the event of the breach of any provision of this section, or in the event any
notice is received which indicates any required insurance coverage will be
diminished or cancelled, SLOEMA at its option, may, notwithstanding any
other provision of this Agreement to the contrary, immediately declare a
material breach of this Agreement and terminate this Agreement.
(b) Financial Requirements: Bidders shall demonstrate to the satisfaction of SLOEMA
they are financially capable of meeting the requirement set forth in this document.
Page 24 January 7, 1991
4-44
(c) Experience Requirements: Bidders (except for cities) must have at least two (2)
years experience as a fully operational Paramedic ambulance service. Bidders
(except for cities) must, at time of application, be a functioning ambulance service
company fully capable of providing ambulance services meeting all requirements of
this document within 30 days of bid submittal.
(d) ui men : Throughout the life of this Agreement, Contractor shall provide and
maintain in good order the types and quantities of equipment specified in this section.
It is further understood that any and all equipment, and permits for this use, will be
provided by Contractor at its expense. Contractor shall:
1. Furnish and equip ambulances as required by the EMSA and the California
Highway Patrol.
2. Equip all ambulance with such other equipment and supplies as may be
reasonably prescribed by the Local EMS Agency or his authorized agents,
who may require other items in addition to the foregoing or in lieu thereof,
subject to the appropriation of funds within a•reasonable time.
3. Two-way vehicular and poitable radio equipment shall be provided, repaired
or replaced by the operator or the vehicle lessor. Radio specifications and
frequency assignments will be developed and specified by SLOEMA.
4. Operate and maintain all ambulances and equipment in a manner which will
not endanger lives or property, and in accordance with all state, federal, and
local laws and ordinances; and policies, regulations, and resolutions not
inconsistent with the contract.
Page 25 January 7, 1991
y -45
(e) Personnel Requirements: Throughout the life of this Agreement, Contractor shall
procure, provide or shall subcontract for the provision of Paramedics who meet or
exceed the requirements specified in this section. Contractor or its subcontractor
shall:
1. Staff each ambulance with one (1) Paramedic) who meets or exceeds the
following minimum requirements:
a) All Paramedics shall have successfully completed a course of
instruction in cardiopulmonary resuscitation adhering to the standards
of the American Heart Association, local chapter thereof, or the
American Red Cross, local chapter thereof. Further, all ambulance
personnel shall have in their possession whenever on duty a current
certificate of completion of such training.
b) All Paramedics shall currently certified by the Medical Director of the
Local EMS Agency as Paramedics and shall have in their possession
whenever on duty current proof of such certification.
C) All Paramedics shall be of good moral character as defined in this
Agreement.
2. Ensure that all Paramedics successfully complete not less than the minimum
hours of continuing education required by the policies set by the Medical
Director of the Local EMS Agency. All such training shall be approved in
advance by the Medical Director of the Local EMS Agency.
Page 26 January 7, 1991
J4 -4(0
3. In addition to the foregoing, ensure that all Paramedics receive at Contractor's
or, if applicable, subcontractor's expense the following training throughout the
term of this Agreement:
a) A street location and identification program designed for the
emergency response requirements of Contractor's area(s) of
responsibility.
b) A Training program designed to ensure that all Paramedics are
thoroughly familiar with all emergency equipment contained in
Contractor's existing and future ambulance(s).
(f) Working_Conditions: Throughout the life of this Agreement, Contractor shall
provide employee wages and working conditions which meet or exceed the following
minimum standards:
1. Crew quarters shall be kept clean and sanitary, and shall be maintained in
accordance with all state, federal, and local laws and ordinances.
2. No Paramedic shall be scheduled to work more than fifteen (15) twenty-four
(24) hour shifts per month, or more than two (2) consecutive twenty-four (24)
hour shifts at any time, exclusive of time required for refresher training,
except in such unusual and extraordinary circumstances as may be approved in
advance by Director of Health Services or his/her authorized agents.
3. No person shall be discriminated against on the basis or race, color, national
origin, religious affiliation, age or sex.
Page 27 January 7, 1991
L4 -4�
4. In the event that Contractor/subcontractor is unable to provide the minimum
staffing described herein, Contractor may request permission to alter such
staffing requirements through SLOEMA.
5. Employee wages must be consistent with state and federal guidelines including
the Fair Labor Standards Act (FLSA).
§ 6.60.404 All areas to be bid simultaneously. When bids are solicited, all service areas within
the county shall be bid simultaneously notwithstanding cities who have declared themselves an exempt
area.
§ 6.60.405 Bids. When bids are solicited, bidders shall have the opportunity to submit
individual or combination bids for ambulance service areas. A bidder may submit a bid for one service
area or for any number of service areas. If an individual bid is the low bid for an ambulance service area,
it may be accepted independently of any of the other individual or combination bids submitted by the same
bidder. The lowest bidder will be selected based on individual areas and will not be based on a
combination bid amount or averages.
§ 6.60.406 Basis for Bids. All bids shall be submitted on the basis that, if the bidder is
designated as an ambulance operator in a service area, the bidder shall comply with the following
provisions, which shall be binding on all ambulance operators not designated as such by SLOEMA
pursuant to this chapter:
Exception: Cities who have declared themselves as exempt areas.
(a) Initial Rates and Adjustments. During the first year following designation as an
ambulance operator, the rates charged tothe public for ambulance services shall not exceed the rates state'
in the operator's bid. One year after the initial designation as an ambulance operator, and every year
Page 28 January 7, 1991
thereafter, the maximum rate which may be charged shall be increased automatically by the percentage
equal to the percentage change in the Consumer Price Index (the avenged increase between the CPIU Los
Angeles/Anaheim and the CPN, San Francisco, Oakland, San Jose.between October - October) for the
most recent twelve month period for which data is then available.
Exception: City providers
(b) Staffing and Equipment Levels. Designated ambulance operators shall provide
whatever staffing and equipment levels are necessary to respond to the scene of all emergency calls in their
service areas in compliance with the performance standards stated in the provisions of Article 9 (Minimum
Performance Standards), commencing with §6.60.800. During the time between solicitation and
submission of bids, the EMSA through SLOEMA shall make available all ambulance run reports for the
most recent period for which they are available. Bidders shall be charged with knowledge of information
therein relating to the historical frequency and distribution of emergency calls. In addition, bidders shall
make their own investigation of the geography, population distribution, traffic routes, and other factors
relevant to the staffing levels required to comply with said Article 9.
(c) Response to Dispatches. All designated private ambulance operators shall respond to
the scene of calls to which they are dispatched by Med-Com without regard to the financial or insurance
status of the patient.
(d) Service Fees are Sole Income. The only income a designated private ambulance
operator shall be entitled to receive for providing ambulance service shall be the fees the operator collects
for the service provided. In all cases, the operator shall bear the risk of nonpayment for ambulance
services and the operator shall have no right to reimbursement by the cities/county or SLOEMA with
respect to fees the operator is unable to collect. All fees will be paid through a lock box account as
specified in Article 8 and distributed to the service provider.
Exception: Cities and County reserves the right to subsidize service areas to support and offset
Page 29 - January7, 1991
4-41
operating costs.
(e) Collection and Disbursement of Service Fees. If required by a City, County or
SLOEMA, ambulance operators shall collect and disburse service fees as specified by the agency.
Collection and disbursement costs for these service fees shall be specified in the bid.
(f) Statutes, Ordinances, etc. All designated ambulance operators shall comply with all
applicable federal, state, and local statutes, ordinances, regulations, and the EMRM in effect at the time of
solicitation of bids.
ARTICLE 5 - SOLICITATION AND SUBMISSION OF BIDS
§ 6.60.500 Invitation for Bids. When a solicitation of bids is required by this Chapter, the
SLOEMA shall prepare a written Invitation for Bids for Ambulance Service, inviting bids for designation
as a county ambulance operator and stating the date on which said bids will be opened. [Said Invitation
shall be published in the L.A. Times, San Diego Times, San Francisco Chronicle, San Jose Mercury News
and a newspaper of general circulation in the County of San Luis Obispo on two dates within a two week
period. Said notice shall also be posted at the following locations for a continuous period of two weeks:
(1) the County Government Center in San Luis Obispo, (2) the County Health Agency in San Luis Obispo,
and (3) each city hall of each incorporated city, (4) each licensed emergency room within the County of
San Luis Obispo. In addition, the notice shall be mailed to each of the then-licensed ambulance companies
operating in the State of California and all persons or firms who have previously requested notice of such
a solicitation. Said publication, posting, and mailing shall be completed at least 90 days before the date
stated for opening of sealed bids.
§ 6.60.501 Significance of Submission of Bid. Submission of a bid shall constitute acceptance
of all applicable provisions of this Chapter and the EMRM. By submitting a bid, a bidder represents that
it meets the qualifications set forth above in this chapter and authorizes the SLOEMA to make such
Page 30 January 7, 1991
L4 —.50
inquiries as it deems appropriate to verify the bidder's qualifications.
§ 6.60.502 Unit Prices. The bid forms shall require the bidder to state unit prices for the
various service components set forth in the bid forms. The unit prices to be stated shall be the rates which
the bidder proposes to charge to patients during the first year of designation as an ambulance operator.
§ 6.60.503 Estimates - Solely for Bid Comparison. The bid form shall state an estimate of the
number of units of service for each service component for which a unit price is required. Separate
estimates shall be provided for each ambulance service area. The estimates shall be based on historical
records of the units of service required in each service area, with adjustments for changes in population
and any other factors which the Health Officer determines are likely to have the volume of services
required in an area. These estimates shall be provided solely to provide a basis for comparison of bids.
No bidder shall have any right to be compensated by the cities, county or SLOEMA in the event that the
actual quantities of service are different from those estimated on the bid form.
§ 6.60.504 Written, Sealed Bids. Written, sealed bids shall be submitted to the SLOEMA on
or before the time for opening of bids, as stated in the solicitation of bids. The bids must be on forms
provided by the Health Officer as approved by SLOEMA and must comply with the Instructions to Bidders
provided by the SLOEMA. Any bids qualified in a manner inconsistent with the bid form shall be
rejected.
§ 6.60.505 Bid Opening. At.the time stated in the invitation for bids, the bids shall be opened
and read aloud. Promptly thereafter, the SLOEMA shall ascertain the successful bidder(s) in accordance
with the provisions of the next Article of this Chapter.
§ 6.60.506 N inor Informalities May be Waived. SLOEMA may waive minor informalities in
bids, where it would be in the public interest to do so.
Page 31 January 7, 1991
4- sl
§ 6.60.507 Right to Reject All Bids. SLOEMA shall have the right to reject all bids for a
service area, or group of service areas, where it appears that more favorable bids could be obtained by
revising the basis for bidding and re-advertising for bids.
Page 32 January 7, 1991
ARTICLE 6 - SELECTION OF OPERATOR(S)
§ 6.60.600 Selection of Operators - In General. Following the provisions of this Article,
SLOEMA shall ascertain the lowest, qualified bidder for each ambulance service area. That bidder shall
be designated as the ambulance operator pursuant to the provisions of the next Article, commencing with §
6.60.700.
§ 6.60.601 Determining The Amount of a Bid. For the purpose of selection of operators, the
amount of a bid submitted pursuant to this Chapter shall be the cost to the public of ambulance service in
the first year of operation, determined by summing all cost components included in the bid form.
§ 6.60.602 Options If No Bids Are Submitted for a Service Area. If no bids are submitted
for a service area, either on an individual or combination basis, SLOEMA reserves the right to--
(a) reject all bids and re-advertise for all areas; or
(b) select operator(s) for the areas for which proposals were submitted, using the bids
submitted.
In the event SLOEMA pursues option (b) above, it shall select operators for the areas for which bids were
submitted in accordance with § 6.60.603. As to areas for which no bids whatsoever were submitted, the
SLOEMA reserves the right to re-advertise for bids for those areas or to negotiate with individuals or
companies to provide service in said areas.
§ 6.60.603 Selection of Lowest Bidder(s). The lowest bidder for each service area shall be the
bidder(s) identified in the manner set forth in the following subsections of this section.
(a) Step 1 - Compute All Bid Amounts. For each service area, the amount of each bid
shall be determined. For combination bids, the amount shall be computed for each service area in which
the bidder proposed to provide service. -
Page 33 January 7, 1991
4- 53
(b) Wp l = Low Bids: In those service areasi where the amount of an individual bid is
lowef than the amounts of all.other.-bids, either individual or combinatibn, said bidshall be deemed to be.
the lowest service area bid.
Page 34 January 7,'_1991
ARTICLE 7 - DESIGNATION OF OPERATORS.
§ 6.60.700 Designation of Operators.
SLOEMA shall have the final authority for designation of ambulance operators and shall issue permit /
license to the operator(s) selected.
Page 35 January 7; 1991
y-SS
ARTICLE 8 - VEHICLE AND EQUIPMENT OWNERSHIP
• Three Way Lease - The business structure of the contract calls for SLOENIA to be both
primary lessee and sub-lessor on the equipment used to operate the system. This protection is built in to
provide equipment to operate the system in the event a takeover should become necessary due to the non-
performance of the contractor. In other words, the fact that SLOEMA does not keep a fleet of ambulances
immediately available will not inhibit a decision to take over the system should that become necessary.
The SLOEMA, by virtue of its position in the three-way lease, can cancel the sub-lease agreement and
take legal possession of all system equipment.
• Lockbox Account - All user fee funds generated from private ambulance system accounts
receivable are collected through a lockbox arrangement at a local bank. Both the SLOEMA and the
contractor are "owners" of the account. Once again, in the event the contractor has to be removed, the
SLOEMA can continue to receive funds from patient bills through the lockbox. Should a default occur,
two thirds of the cash value of the accounts receivable is immediately loaned to the SLOEMA to effect th
takeover. These funds would come from the revenue stream of the then existing accounts receivable.
These funds are effectively borrowed from the contractor for a two year period and then repaid over a
succeeding two years.
Page 36 January 11, 1991
ARTICLE 9 - NUN IUM SERVICE STANDARDS
& 6.60.800 Performance Standards. The operator(s) selected to provide ambulance services in
each of the ambulance service areas shall provide sufficient equipment and personnel to achieve the
following response times, measured from the time an ambulance is dispatched to the time of arrival at the
scene:
Minimum
Percentage of calls handled
Within # of Minutes Specified
ALS —___________--------------
All Areas 8 Min 10 Min 20 Min 60 Min
Urban 90 95% 100% 0
Rural • • 90% 100%
Remote • • • 90%
These standards are administrative in nature established to provide goals in performance. They are
not intended to set a standard of care, nor are they intended to create a private right of action by any party
in the event the operator fails to achieve these standards or SLOEMA fails to enforce them against an
operator.
B. Minimum Staffing Levels (One EMT-Paramedic and one EMT-IA). However, two EMT-
Paramedics are desirable and encouraged. Higher per run costs will be considered where two
Paramedics are provided as staffing minimums.
Page 37 January 7, 1991
4-57
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APPENDIX I
Joint Exercise of Powers Agreement
For San Luis Obispo Cities and County Emergency Medical Authority
This Agreement is made by and among the undersigned public entities, all of which are
organized and operating under the laws of the State of California.
1. The following state laws, among others, authorize the member agencies to enter into this
agreement:
A. Government Code Section 38794 which permits a city to contract for
ambulance service to service the residents of the city as convenience
requires.
B. Government Code Section 54980 which defines "Municipal services or
functions" to include, but not limited to firefighting, police, ambulance,
utility services and.the improvement maintenance, repair and operation of
streets and highways.
C. Government Code Section 54981 which allows the legislative body of any
local agency to contract with any other local agency for the performance
by the latter of municipal services or functions within the territory of the
former.
D. Government Code Section 6500-6515 which permits two or more local
public entities to jointly exercise under an agreement any powers which
are common to each of them.
A-1 December 18, 1990
�-59
E. Health and Safety Code Section 1797.200 allows a county to develop an
emergency medical services program in which case it shall designate a
local EMS agency which can be a joint powers agency created for the
administration of emergency medical services by agreement between
counties or cities and counties.
2. Each of the parties to this agreement desires to join with the other parties for the purpose of:
A. Developing effective emergency medical response programs to meet citizen's medical
needs, for pre-hospital emergency medical care and transportation, by cost effectively
regulating ambulance operations.
3. The governing body of each undersigned public entity has determined that it is in its own best
interest and the public interest in general that this present Agreement be executed and that the entity
shall participate as a member of the joint power authority created by this Agreement.
NOW, THEREFORE, the undersigned, by, between and among themselves, in consideration of
the mutual benefits, promises and agreements set forth below, hereby agree as follows:
A-2 January 9, 1991 �n
4 O
AGREEMENT
ARTICLE I
CREATION OF THE SAN LUIS OBISPO CITIES/COUNTY EMERGENCY MEDICAL
AUTHORITY
This agreement has been created for the purpose of creating a Joint Exercise of Powers Agreement
forming the San Luis Obispo Cities/County Emergency Medical Authority.
Pursuant to Article I, Chapter 5, Division 7, Title I of the Government Code of the State of
California (commencing with Section 6500), the parties hereto hereby create a public agency,
separate and apart from the parities hereto, known as the San Luis Obispo Cities/County
Emergency Medical Authority hereafter called the SLOEMA.
ARTICLE II
PURPOSES
This Agreement is entered into by Member Agencies pursuant to the provisions of California
Government Code Sections 6500, 38794, 54980, 54981, Health and Safety Code 1797.200, et seq.,
to:
1. Regulate the operations of ambulances
2. Develop, approve and implement an EMRM for San Luis Obispo County
3. Enter into service contracts
4. Jointly purchase administrative and other services including, but not limited to,
A-3 December 18, 1990
ad_muustration; data,processing, legal services in.connection with.any of the programs.
ARTICLE III
DEFINITIONS
Tt '
A-4 Decem_bei 18, 1990
ARTICLE IV
PARTIES TO AGREEMENT
Each party to this Agreement certifies that it intends to and does contract with all other parties who
are signatories to this Agreement and, in addition, with such other parties as may later be added
parties to, and signatories of, this Agreement pursuant to Article XVII. Each party to this
Agreement also certifies that the deletion of any party from this Agreement, pursuant to Article
XVIII or XIX, shall not affect this Agreement or the remaining parties' intent to contract as
described above with the other parties to the Agreement then remaining.
ARTICLE V
TERM OF AGREEMENT
This Agreement shall become effective when executed by the cities of Arroyo Grande, Atascadero,
Grover City, Morro Bay, Paso Robles, Pismo Beach, San Luis Obispo and the County of San Luis
Obispo and shall remain in full force until terminated in accordance with Article XXI.
ARTICLE VI
POWERS OF THE AUTHORITY
The Authority is authorized, in its own name, to do all acts necessary to fulfill the purposes of this
Agreement as referred to in Article U, including, but not limited to:
1. Designation of ambulance operating areas
2. Authority to. enter into contracts
3. Acquire hold or dispose of real property
A-5 December 18, 1990
4. Receive property, funds, services from any source
5. Sue and be sued in its own name
6. Lease real or personal property including that of a member agency
7. Receive, collect, invest and disburse monies.
8. Undertake such other activities as may be necessary to carry out the purpose of this
Agreement.
These powers shall be exercised in the manner provided by applicable law and as expressly set
forth in this Agreement.
ARTICLE VII
MEMMER AGENCY RESPONSIBILITIES
The Member Agencies shall have the following responsibilities:
1. To appoint a representative and alternate to the Board of Directors
2. To pay deposits and any adjustments or assessments thereto promptly to the Authority
when due:
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ARTICLE VIII
BOARD OF DIRECTORS
1. MEMBERSHIP There shall be a Board of Directors to govern the affairs of the Authority.
The Authority's Board shall be comprised of one representative from each Member Agency. The
City Council and Board of Supervisors Member Agency shall appoint as its representative the City
Manager, or City Administrator and their designated alternate. The Board member shall serve and
be subject to removal and replacement at the pleasure of the appointing city. Said representative
shall have authority to represent the Member Agency on all County matters pertaining to this
Agreement.
The designated alternate shall attend meetings in the event that the appointed representative is
unable to attend and who shall, as an alternate, have the same rights as the representative so
appointed.
2. OFFICERS The Board of Directors shall elect from its membership a President and
Vice President in accordance to the provisions of the Bylaws. The Board of Directors shall
appoint a Secretary/Treasurer who is not required to be a member of the Board of Directors.
3. POWERS The powers of the Board shall be all of the powers of the Authority not
specifically reserved to the Member Agencies by this Agreement and may include, but not be
limited to, Article II of said Agreement and the following:
A. Approval of ambulance operating areas
B. Approval of contracts
C. Acquisition of real property
D. Election of officers
E. Creation of Bylaws.
A-7 January 9, 1991
F. Receive, collect:and dispose.of monies
G. Approval of service providers, including but:not limited to:
(1) Private.Ambulances
(2) Service Districts
(3) Charter Cities
(.4) 'General IAw Cities
A-8 January 9, 1991 L/
.,o
Attachment 3
Q
GRAND JURY
COLN'TY GOVERNMENT CATER
SAN Luis Oeisro. CALIFORNIA 93408
June 24, 1992 _
Attached herewith for immediate release is a copy of the
1991-92 Grand Jury Final Report on the San Luis Obispo
County Emergency Medical Services System.
L wrence E. Vandeveer
Foreman
1991-92 Grand Jury
The annual payment to SMSA consists of a "training payment" ann _n
"administrative payment" with a CPI inflator determined annually .
The primary source of funds used for this payment comes from fines
levied by the courts .
With this contract revision , the County Health Department assumed
major responsibilities in the system . The department designates the
EMSA Medical Director, approves the formal organizational structure
of the system , administers and approves the Emergency Medical
Response Manual (EMRM) and local ambulance codes and ordinances ,
regulates the ambulance/emergency medical transport services , and
designates "Limited Advanced and Advanced Life Support service
providers licensing of private ambulance providers . " - The Office of
the Sheriff/Coroner is the County Licensing Agency for private
ambulance providers (with no visual inspection) . The County Health
Officer also designates the base station hospitals and specialty
care centers , establishes minimum ambulance performance standards
and monitors and approves the training programs proposed by EMSA.
The EMSA , in consultation with the Health Office, is authorized tc
plan , implement and evaluate a Basic Life Support (BLS) and Advanced
Life Support (ALS) system utilizing EMT-I ' s , EMT- II ' s , EMT-P ' s ,
MICN ' s and First Responder-Defibrillators for the delivery of
emergency medical care . It monitors and provides training programs ,
develops and submits quality assurance reports on a regular ba
prepare state reports , establishes policies and procedures assu .g
medical control of BLS, limited ALS and ALS personnel with the
approval of the Medical Director, and act as the County ' s Emergency
Medical Care Committee . EMSA also issues certificates of completion:
to those persons passing an approved training program and certifies
and recertifies pre-hospital. care personnel . Annually, it reviews
the operations of ALS programs and administer disciplinary actions
regarding pre-hospital care personnel .
The EMSA has a Board of Directors made up of members from both the
private and public sector, including a county representative . The
Agency reports to the Director of Health Services of the County .
Chapter 6. 60 , Ambulances , is the County Code which is pertinent tc
these services .
Ambulance rates are proposed by provider, evaluated/negotiated by
Auditor/Controller staff who make recommendations through the County
Administrative Offices (CAO) to the Board of Supervisors who approve
rates . During the evaluation/negotiation the provider provides
financial and other data to support this proposal . There is nc
requirement for the supplier to provide financial data except at the
time of a requested rate increase .
The following method has been used to establish rates .
1 . Establish allowable expenses plus profit , i . e . , revenue .
Extensive fact finding is performed .
T� 3
3 . The Sheriff ' s Office serves as the County Communications Cente
with a central dispatching system. All "911" calls fror
unincorporated areas go directly to this central dispatc)
center . Emergency calls from the following go • to their "911'
station before they are communicated to Central Dispatch : Pismo
Beach , Arroyo Grande , San Luis Obispo, Morro Bay, Atascadero
Paso Robles and Grover City. Cal Poly and the Cal.iforni ;
Highway Patrol both have their own systems and are not part o:
the "911" network.
4 . Emergency calls in incorporated areas in the "911" system go t,
municipal dispatchers who use radio to notify their fire
departments (First Responders ) , they then notify Centra
Dispatch -which notifies the service providers . This procedur
reportedly takes up to three .minutes to complete .
5 . The California Department of Forestry (CDF) has county fir
department personnel based at the following CDF stations
Shandon, Paso Robles , Park Hill (Santa Margarita) , Californi
Valley, Cambria , Cayucos , San Luis Obispo , Nipomo and San Lui
Obispo Airport .
6 . Emergency calls from unincorporated areas go to Central Dispatc.
which then notifies the appropriate CDF station and the assigne
service provider.
7 . Emergency response times for ambulances in urban areas hav
suggested compliance responses of 90% at eight minutes and 95
.at ten minutes . In 1991 , only four urban areas met bot
criteria . Two areas met the ten-minutes criterion and seven di
not meet either criteria . Ambulance response times for. rura
areas vary according to their distance from the ambulance bas
station.
8 . The number and location of paramedics in the county as of Apri
13 , 1992 , were as follows :
a) City paramedics : San Luis Obispo, 15 ; Atascadero,- 8 ; Morr
Bay, 3 plus 2 interns ; South Bay, 5 plus 2 interns
Cambria District had 5 paramedics .
b) Ambulance company paramedics : San Luis Ambulance Company
15 ; Five Cities Ambulance Company, 6 plus 3 part time
Special Services Ambulance Company, 1 .
c) The county fire department has no paramedics .
9. The CHP certifies the ambulances , performing a physica
inspection of the vehicle and BLS equipment .
10. The SMSA does a cursory annual inspection of vehicles -eac
January on a scheduled basis . This appears to be an inadequat
inspection procedure for ambulance units and their equipment .
jq-&9
-4-
17. The jury could not find any compelling reason for this county ' s
,rates to be third highest in the state .
CONCLUSIONS
1 . The jury concludes that medical transport of patients not
requiring BLS or ALS services should not be required to meet the
same criteria as ambulance use whenever these life support
systems are required by the patient .
2 . The current "911" system of ambulance dispatch can use up a
significant amount of critical time when patients are extremely
vulnerable .
3 . Ambulance emergency response times in urban areas should meet
the eight-minute and ten-minute response criteria without fail .
4 . CDF stations in rural areas need to upgrade some of their staff
to the paramedic level and provide the necessary basic equipment .
S . A study by current city/county staff members to determine the
feasibility of a central 11911" center for all of the county
would be beneficial . The savings in time and money , both
critical issues , could be substantial .
6 . Ambulance units should be inspected on a random , unannounced
basis at least quarterly to ensure complete compliance with
health and safety standards which truly protect citizens .
Disciplinary actions for non-compliance should be sure and
prompt .
7 . The EMRM should be immediately reviewed and updated . It appears
the county has been lax in its oversight responsibilities here
as well as in most other areas of the system .
RECOMMENDATIONS
1 . The county should consider competitive bidding for ambulance
services .
2 . The county, through the EMS agencies , should take immediate
steps to establish policies and procedures ensuring pre-hospital
emergency medical service vehicles are maintained in a clean and
sanitary condition so that the health and safety of patients is
not unduly at risk.
3 . The county fire department should upgrade its , staff so that
paramedic services are more quickly accessible in rural areas
.4 . The county and cities in the "911" system should participate in
a feasibility study of a centralized "911" station as a means of
reducing ambulance response times .
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..... MFMNG AGENDA
BOARD OF SUPERVISORS
COUNTY GOVERNMENT CENTER • SAN LUIS OBISPO, CALIFORNIA 93408 • 805.349.5450
COPIF5 TO:
❑ motcs Action ❑ FYI
Zr-1Council ❑ CDD DIR.
CAO Q^DIR. 411O
FCCAO FIRECI� DAVID BLAXZLY
TPORNEY C3 FW Dix toDISTRICT FIVE
LERK/OR1G. ❑ POLICE01
❑ MCMT.TEAM ❑ RHC DUL V
0 � MEMORANDUM
TO: ROBERT E. HENDRIX, COUNTY ADMINISTRATOR
FROM: DAVID BLAKELY, SUPERVISOR, DISTRICT FIVE
DATE: SEPTEMBER 4, 1192
SUBJECT: AMBULANCE ORDINANCE
It has come to my attention that the Ambulance Ordinance has been dragging on far too long
here $t the Government Canter. There is a lot of pressure from the Cities and son» private
operators to resolve this issue. I also feel it is taking far too long and we need to come up
whh a resolution.
Can you please see what you can do to motivate County Counsel and Mr. Hamm to dmiop
an ordinance for the Board's perusal as soon as possible? Delays on this matter are not a
solution. I feel we need to have it before the Board and we need to resolve It so the Oltles
and your staff can get an to other lasues.
oo: David Barr
Ray Windsor, City of Atascaderc
Board Members
Post-M"brand fax trantmatal memo 7VI pat;; .
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