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HomeMy WebLinkAboutbocc.ord.006.2007AN ORDINANCE OF THE BOARD OF COUNTY COMMISSIONERS OF PITHIN COUNTY, COLORADO REPEALING ORDINANCE NO. 002-2001 AND REPEALING AND REENACTING TITLE 6(HEALTH AND SAFETY - AMBULANCE LICENSING) OF THE PITHIN COUNTY CODE ORDINANCE NO. UOG -2007 Recitals 1. In 1997, by Ordinance No. 28-1997, the Boazd of County Commissioners (BOCC) established a County Emergency Medical Services Council and adopted regulations pertaining to ambulance licensing. 2. Also, in 1997, by CR97-73 and Resolution No.120-1997, the BOCC entered into an Intergovernmental Agreement (IGA) with Eagle County to form a multi-county Area Trauma Advisory Council. 3. In 2001, by Ordinance #02-2001, the BOCC repealed Ordinance #28-1997, Resolution No. 120-1997 and Intergovernmental Agreement C97-73. Ordinance No. 02- 2001 established a county Emergency Medical and Trauma Advisory Council (EMTAC) in Section 1, and adopted regulations for ambulance licensing in Section 2. 4. The BOCC finds it necessazy to repeal Ordinance No. 02-2001 and repeal and reenact Chapter 6.04 of the Pitkin County Code, Ambulance Services, to incorporate the following changes: A. In Section 6.04.010, Emergency Medical and Trauma Advisory Council (EMTAC), the BOCC finds it necessary to repeal and reenact the EMTAC regulations to reflect a change in the job title of the Emergency Management Coordinator and to reduce the number of EMTAC members required to constitute a quorum from six to four members. This will enhance EMTAC's ability to take action at meetings. B. In Section 6.04.040 - Regulations, the BOCC finds it necessary to repeal and reenact this section to comply with Colorado Revised Statutes (C.R.S.) § 25-3.5-308 (as amended October 2006) pertaining to ambulance licensing and with Colorado Code of Regulations (CCR) § 6-CCR 1015-3 promulgated by the Colorado Department of Health and Environment (CDPHE) to carry out the intent of § 25-3.5-308 as amended. These changes will enhance service to victims and permit mutual aid efforts among ambulances represented by EMTAC with the Northwest and Central Mountains RETACS ambulances. ~~ Ordinance No. dG~ -2007 Page 2 NOW THEREFORE BE IT ORDAINED by the Board of County Commissioners of Pitkin County, Colorado that: Ordinance No. 002-2001 is hereby repealed. Chapter 6.04, Health and Safety Ambulance Services) of the Pitkin County Code is hereby repealed and reenacted as described in Eachibit A. INTRODUCED, FIRST READ ,AND SET FOR UBLIC HEARING AT THE REGULAR MEETING ON THE ~t~ DAY OF ~ 2007. . . ~ NOTICE OF,PUBLIC HEA~iI~ PUBLISHED IN THE ASPEN TIMES WEEKLY ON ~DAY OF ~ 2007. APPROVED AND A~PTED AFTER SECOND READING AND PUBLIC HEARING ON THE ~? _ , 2007. PUBLISHED F~R ADOP'I'tON IN THE ASPEN TIMES WEEKLY ON THE ~'~ DAY OF ~ ,2007. TH15 ORDINANCE ~fiALL BECOME EFFECTIVE IMMEDIATELY FOLLOWING FINAL ADOPTION BY THE BOARD OF COUNTY COMMiSSIONERS. ATTEST: Clerk APPROVED AS TO FORM: ~ CounTy Attorney Board of County Commissioners of Pitkin County 11~c~r ~ Michae~~~Chair Date: ~~ ~~~ Hilary Flet r County M ager ~ EXHIBIT A Chapter 6.04 AMBULANCE SERVICES Sections: 6.04.010 Emergency Medical and Trauma Advisory Council (EMTAC). 6.04.020 Authority and Purpose 6.04.030 Definitions 6.04.040 Regulations 6.04.050 Licenses 6.04.060 Revocation and Suspension Procedures 6.04.070 Violation-Penalty. 6.04.010 Emergency Medical and Trauma Advisory Council (EMTAC). A. There is recognized the EMTAC, the composition of which council is as follows: 1. One representative of the Aspen fire protection district; 2. One representative of the Basa1t fire protection district; 3. One representative of the Carbondale fire protection district; 4. One representative of the Snowmass-Wildcat fire protection district; 5. One representative of the Aspen ambulance district; 6. One representative of the Pitkin County sheriff s office; 7. One representative of the Aspen ski company ski patrols; 8. One representative of the Aspen Valley hospital emergency room; 9. One representative of the Aspen Valley hospital trauma coordinator office; 10. One representative of the Aspen Valley hospital trauma surgeons; 11. One representative of the Pitkin County Emergency Management Coordinator's office. A. This EMTAC sha11 represent Pitkin County's interests to the Central Mountains Regional Emergency and Trauma Advisory Council consisting of Pitkin, Eagle, Lake, Park, Chaffee and Summit Counties. B. Members from each of the listed agencies shall be proposed to the boazd of county commissioners in April of each year for appointment to the EMTAC. Each term shall be for one year. In the event new appointments are not approved at that time, the existing members shall continue to serve until appointments are made. C. The council shall hold public meetings as appropriate. Quorum shall consist of at least four members. Action taken shall be by majority vote of the members present at regular meetings. The council shall elect at each September meeting, a president, vice president, treasurer and secretary. D. The president of the council and the county emergency management coordinator shal] provide the board of county commissioners an update on the council's activities and progress twice each yeaz. Page 1 of 14 E. The purpose and duties of the council shall include: Overseeing the annual inspection and licensing process for county ambulances. 2. Coordinating emergency medical and trauma services among the county ambulances services, first responder agencies, and Aspen Valley Hospital; Providing direction and recommendations to our representatives on the Central Mountain Regional Emergency and Trauma Advisory Council; 4. Administering the required State Annual EMS plan and the state subsidy moneys; Implementing and coordinating accident prevention programs on a countywide basis. F. Any three members of the council must attend the Central Mountains Regional Emergency and Trauma Advisory Council and vote on behalf of the council. The Pitkin County Emergency Management Coordinator shall act as the point of contact (POC) for communication purposes between the EMTAC and the RETAC. 6.04.020 Authority and Purpose. These Rules and Regulations are adopted pursuant to the autharity granted the Board of County Commissioners under the Colorado Emergency Medical Services Act, Section 25-3.5-101, et seq., C.R.S., and Section 30-11-107(1)(q), C.R.S. The Board of County Commissioners of Pitkin County finds that the emergency transportation of sick, injured or otherwise incapacitated or helpless persons is a matter closely affecting the public interest and welfare and declazes that it is in the best interest of the public health, safety and welfare, and in accordance with the law, that these Rules and Regulations be adopted. The purpose of these Rules and Regulations is to set forth the requirements for the inspection, licensure and operation of ambulance services, ambulance personnel and ambulance vehicles operating in Pitkin County pursuant to the Colorado Emergency Medical Services (EMS) Act; to establish the structure and authority for regulatory oversight; and to provide for the development, implementation and monitoring of high-quality ambulance services for the County. The application of these Rules and Regulations will assist in providing quality emergency medical care and transportation to the County. 6.04.030 Definitions. As used in these Rules and Regulations are defined in Colorado State Board of Health Rules pertaining to Emergency Medical Services: 6CCR 1015.3 Section 12.2 6.04.040 Regulations. Page 2 of 14 A. Ambulance Service License Required. No person shall provide ambulance service, publicly or privately, in the County unless that person or firm holds a valid license to do so issued by the Board as hereinafter provided. The Board reserves the right to amend these rules and regulations, and any other individual conditions of licensing as applied to any particulaz license, as needed in keeping with its legislative function and in order to implement the policy of the State of Colorado that the regulation and control or ambulance licenses is in the exclusive purview of the Boards of County Commissioners. B. Ambulance Crew Members. No patient shall be transported in an ambulance operating in the County unless the ambulance is staffed by a crew consisting of at least one Emergency Medical Technician (EMT) or Colorado Registered Nurse and one Emergency Vehicle Operator. The Emergency Medical Technician or Registered Nurse will be responsible for direct patient care. C. Medical Director Required. Each ambulance service shall have a single Medical Director to supervise the medical acts performed by all ambulance personnel, who meets the requirements established by the Colorado Board of Medical Examiners in 3 CCR 713-6, Rule 500, and as required by the Colorado Departrnent of Public Health and Environment. The Pitkin County Emergency Medical Trauma Advisory Council (EMTAC) shall be informed within 15 days, in writing, of any changes in Medical Director during the term of the ambulance service license. An attestation by the Medical Director of willingness to provide medical oversight and a medical continuous quality improvement program for the ambulance service shall be included in the application. D. Complaint and Investigation. Complaints against any ambulance service licensed in the county sha11 be directed to Pitkin County Emergency Medical Trauma Advisory Council (EMTAC). Allegations of unlicensed ambulances or vehicles without permits operating within the county sha11 be directed to Pitkin County EMTAThe County shall notify the primary Medical Director and Agency Director of the ambulance service, in writing, of any violation of the ambulance licensing regulations by the ambulance service or alleged complaints or violations by individual medical providers operating on an ambulance service. The County shall enforce the Revocation and Suspension Procedures outlined in Section 6.40.060 of these rules. E. Minimuxn Data Collection and Reporting Requirements. Each ambulance service licensed in the county shall complete a patient care report for each patient who is assessed, The patient caze report shall include the minimum pre-hospital care data set as set forth in the Emergency Medical Services Rules, 6 CCR 1015-3. F. Agency Profile. Each ambulance service licensed in the county shall complete and submit to the Department an agency profile, as defined by the State Emergency Medical Trauma Advisory Council and approved by the Department, to provide information on resources available for planning and coordination of statewide emergency medical and trauma services on an annual basis. G. Advanced Life Support Services. 1. No individual employed or utilized in connection with ambulance services shall provide or claim to provide advanced life support services unless that individual Page 3 of 14 holds a current and valid Colorado EMT certification as an EMT-Intermediate, EMT-Pazamedic, or a valid Colorado medical or nursing license, with current certification in advanced cardiac life support. 2. A graduate EMT-Intermediate ar graduate EMT-Paramedic, holding a valid Colorado EMT certification as an EMT-Basic or higher, may serve as a crew member of an advanced life support ambulance and perform advanced procedures authorized by the Board of Medical Examiners under the direct supervision of a crew member holding a valid Colorado EMT certification of equal or higher level. H. Exceptions to Licensing and Permit Requirements. The provisions of the licensing and permit paragraphs set forth above shall not apply to the following: 1. Vehicles used for the transportation of persons injured at a mine when the personnel used on the vehicles are subject to the mandatory safety standards of the federal Mine Safety and Health Administration, or its successor agency. 2. Vehicles used by other agencies including quick response teams and rescue units that do not routinely transport patients or vehicles used to transport patients for extrication from areas inaccessible to a permitted ambulance. Vehicles used in this capacity may only transport patients to the closest practical point for access to a licensed permitted ambulance or hospital. 3. Vehicles, including ambulances from another state, used during major catastrophe or mass casualty incident rendering services when permitted ambulances are insufficient. 4. An ambulance service that does not transport patients from points originating in the County or the State of Colorado, or transporting a patient originating outside the borders of Colorado. 5. Vehicles used or designed for the scheduled transportation of convalescent patients, individuals with disabilities, or persons who would not be expected to require skilled treatment or care while in the vehicle. 6. Vehicles used solely for the transportation of intoxicated persons or persons incapacitated by alcohol as defined in § 25-1-302, CRS (2004) but who are not otherwise disabled or seriously injured and who would not be expected to require skilled treatment or caze while in the vehicle. Ambulances operated by a department or an agency of the federal government, originating from a federal reservation for the purpose of responding to, or transporting patients under federal responsibility 8. Ambulances based outside the County may respond to calls for service originating within the County under the following conditions: a. When licensed to operate within the County. Page 4 of 14 b. When specifically authorized by the Pitkin County Board of County Commissioners. a Under conditions of major catastrophe or emergency when licensed ambulances are insufficient, not available, or inappropriate for a given transport situation. 9. All-wheel drive, full tracked or other special purpose vehicles designed or used to evacuate patients from areas or terrain inaccessible to licensed ambulances. These special purpose vehicles may only transport patients to the closest practical point of access for a licensed ambulance. I. Insurance. No ambulance service shall operate in the County unless it is covered by workers' compensation insurance, commercial or comprehensive general liability insurance, complying motor vehicle liability insurance, medical malpractice or professional liability insurance, and other insurance policies as may be required by law, in amounts that meet or exceed limits specified in the Workers' Compensation Act, the Governmental Immunity Act, the Motor Vehicle Financial Responsibility Act, or other applicable statutes. 2. Each ambulance service shall maintain current insurance coverage furnished by an insurance carrier appropriately licensed to write such policies in Colorado. Every insurance policy required shall contain the provision for continuing liability thereunder to the full amount thereof: not withstanding any recovery thereon, that the liability of the insured sha11 not be affected by the insolvency or bankruptcy of the insured, and that until the policy is revoked, the insurance company will not be relieved from liability on account of nonpayment of premiums, failure to renew the ambulance service license, or any act or omission of the named insured. J. Ambulance Specifications - Vehicles Obtained Prior to the Effective Date of this Resolution. Ground vehicles obtained, granted a permit and placed in use, as ambulances in the County shall be used as ambulances provided that they continue to meet minimum standazds for suitability, construction and general condition as established by Pitkin County. Operators may appeal adverse decisions by Pitkin County as to suitability, construction, and general condition of such vehicles to the Board. Vehicles commonly designated, as"station wagons" shall not be licensed as ambulances. 2. Each ambulance vehicle shall cleazly display permanent markings on both sides showing the name of the ambulance service under which it is licensed. 3. Each ambulance to be granted a permit shall be maintained at all times in a safe operating condition and in compliance with Colorado motor vehicle statutes, rules, or regulations. At the time of application for permit, the ambulance service shall submit to Page 5 of 14 Pitkin County a certificate prepazed by a qualified mechanic certifying the ambulance is in a safe operating condition. This opinion shall be based on the manufacturer's specifications, standards contained in Colorado Department of Revenue publication 15, "Rules, Regulations and Requirements for Motor Vehicle Official Inspection Stations," effective October 1, 1974, or superseding standazds as approved by the State of Colorado. K. Ambulance Equipment. Each ambulance shall contain the following equipment, which shall be maintained in good working order, in addition to minimum equipment requirements established by the Colorado Department of Public Health and Environment. All equipment on the ambulance shall be properly stored and medications and supplies stored according to manufachuers' recommendations and any federal, state, or local requirements. 1. Minimum Equipment for Basic Life Support Ambulances a. Ventilation and Airway Equipment: i. Portable suction unit, and a house (fixed system) or backup suction unit, with wide bore tubing, rigid phazyngeal curved suction tip, and soft catheter suction tips to include pediatric sizes 6 fr. through 14 fr. ii. Bulb syringe iii. House oxygen and portable oxygen bottle, each with a vaziable flow regulator, with minimum storage capacity of 125 C.£ (M cylinder) and a minimum delivery capability of 2- patients simultaneously at flows of a least 1-15 L.P.M. iv. Portable oxygen system with a minimum storage capacity of 15 C.F. (D cylinder) and a minimum delivery capability for 1-patient at flows of a least 1-15 L.P.M. v. Transparent, non-rebreather oxygen masks and nasal cannula in adult sizes, and transparent, non-rebreather oxygen masks in pediatric sizes. vi. Hand operated, self inflating bag-valve mask resuscitators with oxygen reservoirs and standard 15mm /21mm fittings in the following sizes: • SOOcc bag for infant and neonate • 750cc bag for children • 1000cc bag for adult • Transparent masks for infants, neonate patients, children and adults. vii. Nasophazyngeal airways in adult sizes 24 fr. through 32 fr. Page 6 of 14 viii. Oropharyngeal airways in adult and pediatric sizes to include: infant, child, small adult, adult and large adult. b. Patient Assessment Equipment i. Blood pressure cuffs to include lazge adult, regular adult, child, infant, and neonatal sizes. ii. Stethoscope in adult and pediatric sizes. iii. Penlight. iv. Pulse oximeter with adult and pediatric sensors. c.. Splinting Equipment i. Lower extremity traction splint. ii. Upper and lower extremity splin iii. Long board, scoop, vacuum mattress or equivalent, with appropriate accessories to immobilize the patient from head to heels. iv. Short board or equivalent, with the ability to immobilize the patient from head to pelvis. v. Pediatric spine board or adult spine boazd that can be adapted for pediatric use. vi. Adult and pediatric head immobilization equipment. vii. Adult and pediatric cervical spine immobilization equipment per Medical Director protocol. d. Dressing Materials i. Bandages - various types and sizes per agency needs and Medical Director protocol. ii. Multiple dressings (including occlusive dressings), various sizes per ambulance service requirements, needs and Medical Director protocol. iii. Sterile burn sheets. iv. Povidone and alcohol swabs or equivalent. v. Adhesive tape, per ambulance service requirements, needs, and Medical Director protocol. vi. Sterile irrigation solution. e. Obstetrical Supplies Page 7 of 14 i. Sterile OB kit to include: towels, 4x4 dressings, umbilical tape or cord clamps, scissors, bulb syringe, sterile gloves, and thermal absorbent blanket. ii. Neonate stocking cap or equivalent. £. Miscellaneous Equipment i. Heavy bandage scissors, shears or equivalent capable of cutting clothing, belts, boots, et ii. Two working flashlights. iii. Blasilcets and appropriate heat source for the ambulance patient compartment. g. Ambulance Service Medical Treatment Protocols h. Communications Equipment i. All communications equipment shall be maintained in good working order. The communications equipment must be capable of transmitting and receiving cleaz voice communications. ii. Two-way communications that will enable the ambulance personnel to communicate with: • ambulance service's dispatch • medical control facility or a physician • receiving facilities • mutual aid agencies i. Extrication Equipment • None Required. j. Body Substance Isolation (BSI) Equipment Properly Sized to Fit All Personnel i. Non-sterile disposable gloves in small, medium, and large sizes, to include a minimum 1 box of latex free gloves. ii. Protective eyewear. iii. Non-sterile surgical masks. iv. Fluid proof gowns with full-length sleeves or equivalent. v. Disinfectant spray or wipes for personnel and equipment. Page8of14 vi. Sharps containers for the appropriate disposal and storage of inedical waste and biohazazds. vii. Particulate respirator, N95 type or better. k. Safety Equipment i. A set of three (3) warning reflectors ii. One (1) ten pound (10 IB.) or two (2) five pound (5 1B.) ABC fire extinguishers, with a minimum of one extinguisher accessible from the patient compartment and vehicle exterior and having been serviced within previous yeaz per NFPA 10 section 4. iii. Child safety seat or appropriate protective restraints for patients, crew, accompanying family members, and other vehicle occupants. iv. Properly secured patient transport system (i.e. wheeled stretcher). v. Triage tags as approved by the Colorado Department of Public Health and Environment. vi. Restraining devices for all items not in a securable cabinet. vii. Two "NO SMOKING-OXYGEN IN USE" signs, one in cab one in patient compartment. viii. Reflective vests, coat or equivalent for each member of the crew normally assigned. 2. Minimum Equipment Requirement for Advanced Life Support Ambulances a. All Equipment Listed In Par[ A i. Ventilation Equipment ii. Adult and pediatric endotracheal intubation equipment to include stylets and an endotracheal tube stabilization device and endotracheal tubes uncuffed size range from 2.5 - 5.5, and cuffed size range from 6.0-8.0 per Medical Director protocol. iii. Lazyngoscope and blades, straight, and/or curved of sizes 0-4 iv. Adult and pediatric magill forceps. v. End tidal CO2 detector or alternative device, approved by the FDA, for determining correct tube placement. b. Patient Assessment Equipment Page 9 of 14 i. Portable, battery operated cazdiac monitor- defibrillator with sh~ip chart recorder and adult and pediatric EKG electrodes and defibrillation capabilities. ii. Pulse oximeter with adult and pediatric probes. iii. Electronic blood glucose measuring device. a Intravenous Equipment i. Adult and pediatric intravenous solutions and administration equipment per Medical Director protocol. ii. Adult and pediatric intravenous arm boards. d. Pharmacological Agents i. Phannacological agents and delivery devices per Medical Director protocol. ii. Pediatric "length based" device for sizing drug dosage calculations and sizing equipment. L. Inspections. The Pitkin County EMTAC shall ensure that each ambulance owned or operated by an ambulance service licensed by the County is inspected annually to determine that each ambulance is being properly maintained and contains the required equipment. Such inspections shall be in addition to other safety or motor vehicle inspections required under Colorado law and shall not excuse compliance with any requirements of any other applicable Colorado laws. In the event of non-compliance with any provision of these Rules and Regulations, the inspector may suspend such permit until proper compliance is accomplished. If there exists disagreement concerning compliance with any provision, the ambulance service licensee may petition the Board for a hearing on the matter as provided in these Rules and Regulations. 6.04.050 Licenses. A. Application for Ambulance Service License and Ambulance Permits. An application for an ambulance service license and ambulance permit(s) shall be submitted through the Pitkin County EMTAC to the Boazd and shall contain the following information and necessary supporting documents: 1. The name, address, and telephone number(s) of the owner of each ambulance. 2. The name, address, and telephone number(s) of the applicant. 3. The name, address and telephone number(s) of the person who will be in chazge of the operation of the ambulance service. 4. The trade or other name, if any, under which the applicant does business or proposes to do business. Page 10 of 14 5. If the owner of an ambulance or the applicant is a partnership, the name and address of each partner. If the owner of an ambulance or the applicant is a corporation, the name and address of each stockholder owning ten percent (10%) or more of the outstanding stock of each such corporation and the name and address of each director of the corporation. 6. A description of each ambulance, including the make, model, year of manufacture, vehicle identification number, Colorado license number, and a certificate of mechanical condition. The location and description of the place or places from which it is intended to operate an ambulance service. 8. The area to be served by the proposed ambulance service. 9. Certificates of inspection or other documentation that the physical inspection of the ambulance(s) and equipment has been completed and the ambulance(s) and equipment were found to be in compliance with the provisions of these Rules and ReguLations. 10. Certificate of auto liability insurance as required by these Rules and Regulations. 11. United States currency or a check in the amount of $50.00 per ambulance provided at time of inspection to person or persons providing inspection. In cases that an ambulance fails inspection the fu11 fee of $50.00 will be again due to the person or persons providing inspection at time of re-inspection. B. Issuance of Ambulance Service License and Permit. After receipt of an original application for a license to provide ambulance service and for ambulance permit(s), the EMTAC shall review the application and the applicant's records. Board of County Commissioners shall issue a license to the applicant to provide ambulance service and a permit for each ambulance used, both of which shall be valid for twelve (12) months following the date of issue upon a finding that: The ambulance service, vehicles, and equipment comply with the requirements of these Rules and Regulations. 2. The applicant has in a11 respects complied with the requirements of these Rules and Regulations C. Ambulance Service License and Vehicle Permit Renewal, Applications for license renewal shall be filed annually, but not less than 60 days before the date the license or permit expires. D. Transfer of License or Permit. No license or permit issued by the Board shall be sold, assigned, or otherwise transferred. E. Change in Ownership. Any change of ownership shall require a new application and license with payment of the same license fee as is required for an original application. Any sale or Page 11 of 14 exchange of stock in excess of fifty percent (50%) of the total outstanding stock or a corporation shall be deemed a change or ownership for the purposes of these Rules and Regulations. Any change of ownership or any change of stock ownership of ten percent (10%) or more shall be reported in writing to the Boazd within thirty (30) days. F. Reciprocity. The Board may issue an ambulance service license and ambulance permit(s) to an ambulance service licensed by an adjoining Emergency Medical Trauma Advisory Boazd or Northwest All Hazazd Emergency Management Region, and is licensed according to the Colorado State Boazd of Health Rules pertaining to Emergency Medical Services 6CCR 10153 Section 12 Rules and Regulations upon the recommendation of Pitkin County EMTAC. G. Declared Disaster Event. In the event of a declared disaster, all sections of this chapter pertaining to training or equipment requirements shall be waived far the duration of the disaster declaration. However, it is the intent of this chapter that each service provides the ma~cimum achievable level of inedical care during periods of emergency. H. Requirements for Emergency Vehicle Operators. Be at least eighteen (18) years of age or older and posses a valid Colorado drivers license. 2. Be able to speak, read, and write the English language. 3. Not be addicted to the use of intoxicating liquors or drugs. 4. Possess and maintain documentation of current training in cardiopulmonazy resuscitation. I. Requirements for Patient Care Provider. 1. Not be addicted to the use of intoxicating liquors or drugs. 2. Hold and maintain a valid EMT certificate issued by the Department of Health. A physician or registered nurse must hold and maintain current certification to practice in Colorado. J. Administration. All applications for Ambulance Service License and Ambulance Vehicle Permits shall be filed for processing with the Pitkin County EMTAC. Pursuant to the specific provisions of these Rules and Regulations, the EMTAC shall review all such applications for compliance. Finding that the ambulance service andJor vehicles meet all requirements of these Rules and Regulations, the EMTAC shall forwazd a recommendation for licensure or issuance of permit to the Board of County Commissioners. 2. Should the EMTAC recommend denial of licensure or permit issuance, the reasons for said denial shall be provided in writing. Page 12 of 14 3. The Boazd shall place the question on the agenda as is deemed appropriate by the Board. 4. Licenses and permits issued under this section shall be valid for a period of one calendar year. 6.40.060 Revocation and Suspension Procedures. A. Procedures. Upon a determination by the Board of County Commissioners that any licensed ambulance service has violated or failed to comply with any provisions of these Rules and Regulations, the Boazd of County Commissioners may temporarily suspend for a period not to exceed thirty (30) days any license or permit issued pursuant to these Rules and Regulations. The licensee or permit holder sha11 receive written notice of such temporary suspension stating the nature of the alleged violation and setting a formal hearing. Suspension or revocation may result from violation o£ 1. Any provision of these Rules and Regulations, or 2. Any law of the State of Colorado, or ordinance or regulation of any municipality in the County of Pitkin. Evidence of any such violation may be considered by the Boazd of County Commissioners regardless of any conviction thereof. B. Notice of Suspension or Revocation. Notice of suspension or revocation shall be given by mailing the same in writing to the licensee or permit holder at the address wntained in such ticense. C. Suspension of Ambulance Permit. Suspension of a permit for the operation of any individual ambulance may be made for cause at any time by the Boazd of County Commissioners. The ambulance service affected may petition the Board for a heazing on the suspension of such permit and such hearing shall be conducted within ten (10) days of the receipt of such request. The reinstatement of such ambulance permit may be made by the Boazd of County Commissioners prior to such hearing upon a finding by the EMTAC that the situation causing the suspension has been corrected. D. New Applications. If a license is revoked, the EMTAC shall not accept a new application from the licensee or permit holder for a period of three (3) yeazs from the date of revocation. E. Severability. If any provision of these Rules and Regulations is found by a cour[ of competent jurisdiction to be invalid, the remaining provisions of the Rules and Regulations shall continue in full force and effect. F. Variances. The Board of County Commissioners may grant a variance from the terms of these Rules and Regulations if the Board of County Commissioners finds such action is necessazy to protect the public health, safety, or welfare. Such action may include the issuance of temporazy ambulance service licenses and permits. Such vaziance shall remain in effect for the period specified by the Board. Page 13 of 14 G. Due to services that provide emergency medical caze in Pitkin County and counties other than Pitkin County, Pitkin County may not require a Pitkin County License if said service is licensed by an adjoining Emergency Medical Trauma Advisory Board or Northwest All Hazard Emergency Management Region, and is licensed according to the Colorado State Boazd of Health Rules pertaining to Emergency Medical Services 6CCR 10153 Section 12 Rules and Regulations upon the recommendation oF Pitkin County EMTAC. H. No Third Party Beneficiary. Nothing in these Rules and Regulations shall be construed to create a cause of action and/or civil liability remedy in any person. These Rules and Regulations shall not be construed to create a duty to any third party where no such duty otherwise existed. It is the express intention of the Board that any third party receiving services or benefits under these Rules and Regulations shall he deemed to be an incidental beneficiary only. 6.04.070 Violation-Penalty. Any person who violates any provision of this chapter commits a Class 3 misdemeanor and shall be punished as provided in Section 18-1-106, C.R.S. Page 14 of 14