Chapter 8.08 EMERGENCY MEDICAL SERVICES

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8.08.010 Definitions.

As used in this chapter, the following words, unless the context in which they are used indicates otherwise, shall be given the following meanings:

"Ambulance" means any public or privately owned land vehicle especially constructed or modified and equipped, intended to be used and maintained or operated by, ambulance services for the transportation, upon the roads, streets and highways of this state, of individuals who are sick, injured, or otherwise incapacitated or helpless.

“Ambulance-advanced life support” is a type of permit issued by a county to a vehicle equipped in accordance with Section 8.08.030 of this chapter and operated by an ambulance service authorizing the vehicle to be used to provide ambulance service limited to the scope of practice of the advanced emergency medical technician, emergency medical technician-intermediate or paramedic as defined in the EMS Practice and Medical Director Oversight Rules at 6 CCR 1015-3 Chapter Two.

“Ambulance-basic life support” is a type of permit issued by a county to a vehicle equipped in accordance with Section 8.08.030 of this chapter and authorized to be used to provide ambulance service limited to the scope of practice of the emergency medical technician as defined in the EMS Practice and Medical Director Oversight Rules at 6 CCR 1015-3 Chapter Two.

"Ambulance attendant" means any person authorized to provide direct emergency medical care and treatment to patients transported in an ambulance as provided in this chapter.

"Ambulance driver" means any person authorized to drive an ambulance in this state as provided in this chapter.

"Ambulance service" means the furnishing, operating, conducting, maintaining, advertising, or otherwise engaging in or professing to be engaged in the transportation of patients by ambulance. Taken in context, it also means the person so engaged or professing to be so engaged and the vehicles used for the emergency transportation of persons injured at a mine are excluded from this definition when the personnel utilized in the operation of said vehicles are subject to the mandatory safety standards of the federal mine safety and health administration, or its successor agency.

"Ambulance service license" means those licenses issued by the Pueblo City-County Health Department following satisfactory fulfillment of the conditions found in this chapter.

"Ambulance vehicle permit" means those permits issued by the Pueblo City-County Health Department with respect to an ambulance used or to be used to provide ambulance service in Pueblo County following satisfactory fulfillment of the conditions found in this chapter.

"Applicant" means that person or ambulance service who is an initial applicant or an applicant for renewal of an ambulance service license or ambulance vehicle permit.

"Base" means maintaining a headquarters in or having a substation office or a permanent station in Pueblo County, Colorado.

"Board of County Commissioners" means the Board of County Commissioners of Pueblo County, Colorado.

"County" means the County of Pueblo, Colorado.

"Department" means the Pueblo City-County Health Department.

"Director" means the Director of the Pueblo City-County Health Department.

"Emergency" means any actual or self-perceived event which threatens life, limb, or well-being of an individual in such a manner that a need for immediate medical care is created.

“EMS Provider” refers to all levels of Emergency Medical Technician certification issued by the Colorado Department of Public Health and Environment, included but not limited to, Emergency Medical Technician, Advanced Emergency Medical Technician, Emergency Medical Technician Intermediate and Paramedic.

"Emergency medical technician license" means those certificates issued by the emergency medical services division of the Colorado Department of Health.

”Emergency Medical Responder” means an individual who can demonstrate successful completion of the  Emergency Medical Responder under the provisions of the Colorado Emergency Medical Services Act contained at Section 25-3.5-101, et seq., C.R.S. The Director shall recognize the Emergency Medical Responder training as equivalent to the American Red Cross Advanced First Aid Certification.

"License" means those licenses issued by the Pueblo City-County Health Department following satisfactory fulfillment of the conditions found in this chapter.

"Licensing agent" means that entity or individual designated by the Board of County Commissioners in Section 8.08.020 to enforce the terms and conditions of this chapter.

“Medical Director” means a Colorado licensed physician who establishes protocols and standing orders for medical acts performed by EMS Providers of a prehospital EMS service agency and who is specifically identified as being responsible to assure the competency of the performance of those acts by such EMS Providers as described in the physician’s medical continuous quality improvement program. Any reference to a "physician advisor" in any previously adopted rules shall apply to a "medical director" as defined in these rules.

“Medical quality improvement program” means a process consistent with the EMS Practice and Medical Director Oversight Rules at 6 CCR 1015-3 Chapter Two, used to objectively, systematically and continuously monitor, assess and improve the quality and appropriateness of care provided by the medical care providers operating on an ambulance service.

"Nurse" means a person trained to care for the sick or infirm, especially under the supervision of a physician, and licensed as a registered nurse to practice in the state of Colorado, who can substantiate by documentation, i.e., certification and/or other standard documentation, sufficient training in emergency medicine acceptable to the Pueblo City/County Health Department.

"To operate" means to pick up and transport injured, sick, or disabled patients within the county by private and volunteer ambulance services based in the county.

"Patient" means any individual who is sick, injured, or otherwise incapacitated or helpless.

Patient Care Report means a medical record of an encounter between any patient and a provider of medical care.

"Permit" means the authorization issued by the Board of County Commissioners with respect to an ambulance used or to be used to provide ambulance service in the county.

"Physician" means a doctor of medicine licensed to practice medicine in the State of Colorado, who can substantiate by documentation, i.e., certification and/or other standard documentation, sufficient training in emergency medicine acceptable to the Pueblo City/County Health Department.

"Pueblo County Emergency Medical Services Advisory Council" means the organization with members appointed by their respective agencies from various entities including, but not limited to, the law enforcement agencies, hospitals, EMS providers and responders who are active in Pueblo County whose objectives are to, along with the Pueblo County Sheriff’s Emergency Services Bureau, advise the Board of County Commissioners on the provision of emergency medical services within Pueblo County, Colorado.

“Quick Response Teams” provides initial care to a patient prior to the arrival of an ambulance.

"Rescue unit" means any organized group chartered by the State of Colorado as a corporation not-for-profit or otherwise existing as a nonprofit organization whose purpose is the search for and rescue of lost or injured persons and includes, but is not limited to, such groups as Search and Rescue, Mountain Rescue, ski patrols (either volunteer or professional), law enforcement posses, civil defense units, or other organizations of governmental designation responsible for search and rescue.

"Volunteer emergency medical technician" means an emergency medical technician who does not receive direct remuneration for the performance of emergency medical services. (Res. 14-138 § 1; Res. 95-248 § 1; Res. 92-337 § 1(D))

8.08.020 Licensing Agent designated.

The Board of County Commissioners designates the Director of the Pueblo City-County Health Department or his or her designee as the Licensing Agent for Pueblo County. He or she shall administer the licensing and permit program under the direction of the Board of County Commissioners, and shall serve the Board of County Commissioners as liaison with the Colorado Department of Health, the State Board of Medical Examiners, and the Division of Communications of the Department of Administration. (Res. 92-337 § 1(E))
 

8.08.030 Ambulance service licenses and vehicle permits.

A. Except as set forth in this chapter, no person shall provide ambulance services publicly or privately in Pueblo County unless that person holds a valid ambulance service license to do so, and a valid ambulance vehicle permit for each ambulance used, which is issued by either the Licensing Agent for any ambulance service based in Pueblo County., or the Board of County Commissioners of the county in which such ambulance service is based, if other than Pueblo County.  If an ambulance service is based in a county other than Pueblo it must be licensed in Pueblo County if the patient originates in Pueblo County. The terms and conditions of this chapter shall not apply to:

  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 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 Pueblo County, or transporting a patient originating outside the borders of Pueblo County.
  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 § 27-81-102, CRS but who are not otherwise disabled or seriously injured and who would not be expected to require skilled treatment or care while in the vehicle.
  7. 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.

B.   Licenses and permits issued under the terms and conditions of this chapter shall be granted to the applicant and renewed, by application, upon a finding by the Licensing Agent that the applicant or licensee has complied with the staff, vehicle and equipment standards, requirements and procedures contained in the Colorado Emergency Medical Services and Trauma Act, C.R.S. § 25-3.5-101, et seq., the rules and regulations promulgated by the State Board of Health and located at 6 C.C.R. 1015-3, et seq., (as now and hereafter as may be amended), and such other standards, requirements, and procedures as may be required by and established by resolution of the Board of County Commissioners from time to time. Applications shall be made according to the forms and in the manner prescribed by the Licensing Agent.

C.   Every applicant for an ambulance service license shall complete and submit to the Pueblo City-County Health Department an original application for a license. The application shall include, but not be limited to, the following information:

  1. The name, address, and telephone number of each ambulance service;
  2. The name, address, and telephone number of the person applying for the license and permit(s) hereinafter referred to as the "applicant;"
  3. The name, address, and telephone number of the person who will be in charge of the day-to-day operation of the ambulance service;
  4. The trade or other name, if any, under which the applicant does business or proposes to do business;
  5. The location and description of the place or places from which the applicant intends to operate an ambulance service;
  6. The area to be served by the proposed ambulance service;
  7. Copies of those insurance policies required hereunder;
  8. Documentation that that all persons employed by, or serving for, the ambulance service have maintained the certification appropriate to their respective responsibilities;
  9.  An attestation by the Medical Director of willingness to provide medical oversight and a medical continuous improvement program for the ambulance service;
  10. Documentation that information regarding the amount of professional liability insurance the ambulance service carries was provided to employees.

D. Every applicant for an ambulance vehicle permit shall complete and submit to the Pueblo City-County Health Department an original application for such permit. The application shall include, but not be limited to, the following information:

1.   The name, address, and telephone number of the ambulance service and operator of the service applying for the permit(s);

2.   A description of each ambulance vehicle for which a permit is applied for hereunder including the make, model, year of manufacture, motor and chassis number, a Colorado State License Number for the current year, Colorado State Emergency Vehicle Permit, the length of time the ambulance has been in use, and the color scheme, insignia, name monogram, and other distinguishing characteristics used to designate the ambulance. Additionally, each applicant must provide a current inspection report prepared by the Director or his or her designee relative to the equipment and supply requirements set forth in this chapter.

E.   After receipt of an original application for an ambulance service license and/or ambulance vehicle permit, the Pueblo City-County Health Department shall review the application and the applicant’s record and provide for the inspection of equipment to determine compliance with the terms and conditions of this chapter and the provisions of C.R.S. §§ 25-3.5-301 through 306. The Director shall appoint an inspector, who shall inspect all ambulance vehicles to determine the suitability of condition of the vehicle related to safety, warning systems, emergency medical equipment, supplies, basic sanitation, sterility of equipment used in patient contact, and other related requirements as required by this chapter and the Colorado State Board of Health. The inspector shall have knowledge of the emergency medical service system in Pueblo County. In addition to the foregoing, the appointed inspector may periodically without advance notice, but at least annually, inspect for the continued suitability of the condition of ambulance vehicles to insure compliance with the terms and conditions of this chapter. If, at the time of any inspection, the permitted vehicle is found to be in violation of the terms and conditions of this chapter, the inspector shall have the authority to remove the vehicle from service until such time as all deficiencies found are corrected, and the vehicle is determined to be in compliance by the inspector.

F.   Each ambulance operated by an ambulance service shall be issued a basic life support vehicle permit or an advanced life support permit. The type of permit issued will describe the maximum level of service that could be provided at any time by that vehicle and appropriate staff. In order to be approved for a basic life support vehicle permit or an advanced life support permit, the applicant shall present evidence that the vehicle’s equipment meets or is equivalent to Section Q of these rules. Additionally, the staff of each licensed ambulance shall follow the Southern Colorado RETAC Protocols as established by the Pueblo County Emergency Medical Services Advisory Council.

G. Each ambulance operated in Pueblo County shall have radio communication compatible with the hospitals within Pueblo County.  Any ambulance that is dispatched emergently by the Pueblo County Communication Center shall have radio communication compatible with the Pueblo County 911 system.

H. Each ambulance vehicle shall be equipped with such lights, sirens, and special markings as are required by Colorado law to designate it as an ambulance vehicle, and shall be in compliance with all applicable state regulations.

I.    All ambulance vehicles shall display clean and permanent identification on both sides, visible at all times, showing the name of the service under which they are licensed.

J.    Ambulance design and equipment shall provide sufficient space capability for the performance of cardiopulmonary resuscitation, airway maintenance suction, hemorrhage control, shock care, dressing of wounds/burns, immobilization of fractures, and oxygen therapy. The vehicles shall have a ceiling height sufficient for adequate gravity for administration of IV fluids, and shall meet design criteria in accordance with those guidelines adopted by the Colorado State Department of Health.

K. No ambulance or ambulance service shall operate in Pueblo County unless it is covered by insurance as provided for in this chapter. Each ambulance service shall maintain insurance coverage for itself and for each and every ambulance owned, operated, or leased by the ambulance service, which insurance shall include, but not be limited to, coverage for injury to or death of persons in accidents resulting from any cause for which the owner of the ambulance would be liable on account of any liability imposed on him or her by law, regardless of whether or not the ambulance was being driven by the owner, his or her agent or lessee, or any other person, and coverage as against damage to the property of another, including personal property, under like circumstances, in the following amounts:

1. Worker’s compensation (including occupational disease), and employer’s liability insurance in accordance with any applicable worker’s compensation laws on all employees, servants, and/or agents connected with or engaged in the performance of services rendered by the ambulance service;

2.   Commercial general liability insurance with personal injury and property damage limits at a combined single limit of not less than one million dollars ($1,000,000.00) per occurrence, and one million dollars ($1,000,000.00) general aggregate;

3.   Automobile liability insurance covering all ambulances and vehicles, whether owned or hired by the ambulance service, with personal injury and property damage limits at a combined single limit of not less than one million dollars ($1,000,000.00) per accident;

4.   Professional liability insurance covering the ambulance service and all persons employed thereby with limits at a combined single limit of not less than one million dollars ($1,000,000.00) per occurrence, and one million dollars ($1,000,000.00) general aggregate.

L.   Coverages enumerated in this insurance provision represent only the minimum insurance required hereunder, and the ambulance service should rely on its expertise to obtain any additional insurance coverage needed in the provision of ambulance services. Proof of insurance shall be filed with the Pueblo City-County Health Department at the same time as the application for an ambulance service license is filed with the Department. Every insurance policy required hereunder shall contain a provision for continuing liability thereunder to the full amount thereof, notwithstanding any recovery thereon; a provision that the liability of the insured shall not be affected by the insolvency or bankruptcy of the insured; and language that, until a policy is revoked, the insurance company will not be relieved from liability on account of the nonpayment of premiums by the insured, the failure of the insured to renew the license at the end of the year, or any act or omission of the named insured. At any time such insurance is required to be renewed, proof of renewal shall be provided to the Pueblo City-County Health Department.

M. Each certificate of insurance shall indicate the vehicles covered by the policy, type of insurance, (vehicle and professional liability, etc.), policy number(s), the effective date of the policy, the policy expiration date, the amount of coverage, and shall contain a provision that thirty (30) days prior written notice of any cancellation or termination or revocation of the policy shall be given to the Board and the Pueblo City-County Health Department. Any changes in the status of vehicles listed on the certificates of insurance during the licensing cycle shall be noted on a new certificate of insurance which shall be forwarded to the Pueblo City-County Health Department within thirty (30) days after the changes are made. Additionally, notification of any changes in insurance coverage shall be made in writing within thirty (30) days of such changes to the Pueblo City-County Health Department by the licensee, to be followed with a substitute certificate of insurance as outlined above. The Board or the Pueblo City-County Health Department may require additional proof of insurance at any time during the licensing cycle.

N. Following a determination that an application is in order, the Pueblo City-County Health Department shall issue an ambulance service license to the applicant to provide ambulance service in Pueblo County, and an ambulance vehicle permit for each ambulance used, both of which shall be valid for twelve (12) months following the date of issuance. Each ambulance vehicle permit issued by the Pueblo City-County Health Department shall be displayed on the right-side patient compartment window of each vehicle. Each ambulance vehicle permit shall be issued only for the vehicle described in the application. All ambulance vehicles shall, at all times, meet all applicable terms and conditions of this chapter. Failure of a vehicle to meet such requirements will result in the denial, suspension, or revocation of the ambulance service license and/or ambulance vehicle permit. Upon a determination by the Pueblo City-County Health Department that an ambulance vehicle is not in compliance with this chapter, the Director or appointed inspector may have the ambulance vehicle permit removed until proper compliance is accomplished.

O. No ambulance service license or ambulance vehicle permit issued hereunder shall be sold, assigned, or otherwise transferred. Obtaining or attempting to obtain an ambulance service license or an ambulance vehicle permit by fraudulent means, or misrepresentation, or the sale, assignment, or transfer of an ambulance service license or ambulance vehicle permit shall be grounds for the denial, suspension, or revocation of the license or permit.

P.   Any ambulance service license and/or ambulance vehicle permit issued hereunder, unless revoked by the board or the Pueblo City-County Health Department, may be renewed by filling out an application for an ambulance service license and/or an ambulance vehicle permit. Renewal shall be accomplished in the same manner as the issuance of the original license or permit. Applications for renewal of a license and/or permit shall be filed annually but not less than thirty (30) days before the date of expiration of any such license or permit.

Q.              Minimum Equipment requirements:

1.  Minimum Equipment For Basic Life Support Ambulances is as follows:

a)         Ventilation and Airway Equipment

portable suction unit, and a house (fixed) system, with wide bore tubing, rigid pharyngeal curved suction tip, and soft catheter suction tips to include pediatric sizes 6 fr. through 14 fr.

bulb syringe

house oxygen and two (2) portable oxygen bottles, each with a variable flow regulator.

transparent, non-re breather oxygen masks and nasal cannula in adult sizes, and transparent, non-re breather oxygen masks and nasal cannula in pediatric sizes.

 hand operated, self inflating bag-valve mask resuscitators with oxygen reservoirs and standard 15mm /21mm fittings in the following sizes:

500cc bag for infant and neonate

 750cc bag for children

1000cc bag for adult

nasopharyngeal airways in adult sizes 24 fr. through 32 fr.

oropharyngeal airways in adult and pediatric sizes to include: infant, child, small adult, adult and large adult.

water-based lubricant

b)         Patient Assessment Equipment

blood pressure cuffs to include large adult, regular adult, child and infant sizes.

stethoscope.

penlight.

glucometer

automated external defibrillator with adult and pediatric pads

pulse oximeter with adult and pediatric probes 

 c)        Splinting Equipment

lower extremity traction splint.

upper and lower extremity splints.

two (2)  long board, scoop™, vacuum mattress or equivalent with appropriate accessories to immobilize the patient from head to heels.

short board, K.E.D. or equivalent, with the ability to immobilize the patient from head to pelvis.

pediatric spine board or adult spine board that can be adapted for pediatric use.

adult and pediatric head immobilization equipment.

adult and pediatric cervical spine immobilization equipment.

 d)        Dressing Materials

bandages - including triangular, roller gauze and 4 x 4 sterile bandages

dressings to include occlusive and trauma dressings.

sterile burn sheets.

adhesive tape in one and two inch rolls

e)         Obstetrical Supplies

sterile ob kit to include: towels, 4x4 dressings, umbilical tape or cord clamps, scissors, bulb syringe, sterile gloves and thermal absorbent blanket.

neonate stocking cap or equivalent.

f)         Miscellaneous Equipment

heavy bandage scissors, shears or equivalent capable of cutting clothing, belts, boots, etc.

two working flashlights.

blankets, sheets, pillows and appropriate heat source for the ambulance patient compartment.

arterial tourniquet

irrigation solution (sterile)

triage tags as approved by the department.

“no smoking” posted in front and rear compartment.

2.   Ambulance Service Medical Treatment Protocols.

a)         Body Substance Isolation (BSI) Equipment Properly Sized To Fit All Personnel

non-sterile disposable gloves, to include a minimum 1 box of latex free gloves.

protective eyewear.

body substance isolation kits

non-sterile HEPA masks.

 b)        Safety Equipment

a set of three (3) warning reflectors.

one (1) ten pound (10 lb.) or two (2) five pound (5 lb.) ABC fire extinguishers, with a minimum of one extinguisher accessible from the patient compartment and vehicle exterior.

child safety seat

 safety belts for patients, crew, accompanying family members and other vehicle occupants.

properly secured patient transport system (i.e. wheeled stretcher).

safety vest for each crew member

c)         Pharmacological Agents

pharmacological agents and delivery devices per medical director protocol, see the department’s current ambulance inspection form for complete list.

3.   Minimum Equipment Requirement for Advanced Life Support Ambulances

            All Equipment required for Basic Life Support

  1. Ventilation Equipment

adult and pediatric endotracheal intubation equipment to include stylets and an endotracheal tube stabilization device and endotracheal tubes uncuffed range from 2 – 5.5, and cuffed size range from 6.0-9.0.

laryngoscope and blades, straight and/or curved of sizes 0-4.

adult and pediatric magill forceps.

end tidal co 2 detector or alternative device, approved by the FDA, for determining end tube placement.

chest decompression kit (or equivalent)

nebulizer delivery device

emergency cricothyrotomy kit in adult and pediatric sizes.

alternative airway device

b)         Patient Assessment Equipment

portable, battery operated cardiac monitor- defibrillator with strip chart recorder and adult and pediatric EKG electrodes and defibrillation capabilities.

c)         Intravenous and Medical Equipment

normal saline (500 mL or 1,000 mL).

adult and pediatric intravenous arm boards.

venous tourniquets

alcohol swabs

macrodrip and microdrip sets

house (fixed) and portable sharps containers

blood Y-sets

safety angiocaths sizes ranging from 14g-24g

syringes to include sizes 1mL, 3mL, 5mL, and 10mL.

safety needles (23g)

filter needles

intraosseous infusion delivery system in adult and pediatric sizes.

d)         Pharmacological Agents

pharmacological agents and delivery devices per medical director protocol, see the department’s current ambulance inspection form for complete list.

pediatric "length based" device for sizing drug dosage calculations and sizing equipment.

R.   Fee Schedule:

Each application for an ambulance service license and ambulance vehicle permit shall be accompanied by a check for the appropriate fee, as stated below, payable to the Pueblo City-County Health Department.

Ambulance Service License Fee $100.00

Ambulance Vehicle Permit Fee $ 85.00/vehicle

In addition to the application fee, the applicant will be assessed mileage at the current reimbursement rate established by the Pueblo City-County Health Department for vehicle inspections that take place outside of Pueblo County.

All applicants regardless of governmental or private corporation status are required to submit the above-stated application fees. (Res. 14-138 § 2; Res. 08-340 § 1; Res. 95-248 §§ 2, 3; Res. 92-337 § 2)

8.08.040 Emergency personnel.

A. No patient shall be transported in an ambulance in Pueblo County unless there are two or more individuals, including the driver and attendant, present and authorized to operate the ambulance except under unusual conditions when only one authorized person is available. All ambulance services based in Pueblo County shall be required to provide the following for transportation of patients:

1.   An advanced life support ambulance occupied by at least one Colorado-certified Paramedic and one of the following: A Colorado-certified EMT or Advanced EMT, or one EMT-Intermediate  will respond to all 911 requests for ambulance service in areas of the county having a population of more than thirty thousand (30,000) people;

2.   An advanced life support ambulance occupied by at least one Colorado-certified Paramedic and one of the following: A Colorado-certified EMT or Advanced EMT, or one EMT-Intermediate will respond to non-911, nonemergency requests for ambulance service. One nurse or one physician as defined in Section 8.08.010 or one Colorado-certified Paramedic may occupy the ambulance in lieu of or in addition to the EMT or the EMT-Intermediate or Advanced EMT;

3.   Sufficient medical malpractice insurance coverage as determined by the Director in addition to the required vehicular liability insurance and professional liability insurance set forth elsewhere herein;

4.   A Medical Director as defined in this section.

B.   No person shall be employed by or utilized in connection with an ambulance service based in Pueblo County as an EMT without being certified by the Colorado Department of Public Health and Environment. The Colorado Department of Public Health and Environment may certify more than one category of EMT depending on each EMT’s training and experience. Those categories, EMT, Advanced EMT, EMT-Intermediate and Paramedic, are defined as follows:

  1. "Emergency Medical Technician (EMT)" - An individual who has a current and valid EMT certificate issued by the Colorado Department of Public Health and Environment and who is authorized to provide basic emergency medical care in accordance with the Rules Pertaining to EMS Practice and Medical Director Oversight. For the purposes of these rules, EMT includes the historic EMS Provider level of EMT-Basic (EMT-B).
  2. "Advanced Emergency Medical Technician (AEMT)"- An individual who has a current and valid AEMT certificate issued by the Colorado Department of Public Health and Environment and who is authorized to provide limited acts of advanced emergency medical care in accordance with the Rules Pertaining to EMS Practice and Medical Director Oversight.
  3. "Emergency Medical Technician Intermediate (EMT-I)" - An individual who has a current and valid EMT-I certificate issued by the Colorado Department of Public Health and Environment and who is authorized to provide limited acts of advanced emergency medical care in accordance with the Rules Pertaining to EMS Practice and Medical Director Oversight. For the purposes of these rules, EMT-I includes the historic EMS Provider level of EMT-Intermediate (EMT-I or EMT-I 99).
  4. "Paramedic" - An individual who has a current and valid Paramedic certificate issued by the Colorado Department of Public Health and Environment and who is authorized to provide acts of advanced emergency medical care in accordance with the Rules Pertaining to EMS Practice and Medical Director Oversight. For the purposes of these rules, Paramedic includes the historic EMS Provider level of EMT-Paramedic (EMT-P).

C.   At all times, there shall be at least one attendant in the patient compartment while transporting a patient who shall be qualified at least as an EMT except under unusual circumstances when no such qualified individual is available. One nurse or one physician as defined in Section 8.08.010 or one Colorado-certified Advanced EMT or EMT-Intermediate or Paramedic may occupy the patient compartment in lieu of or in addition to the EMT. No attendant shall provide direct emergency medical care and treatment to patients transported in an ambulance without additionally obtaining a cardiopulmonary resuscitation card. Each attendant must carry on his or her person his or her current cardiopulmonary resuscitation certification card or his or her current Colorado EMT Certification card while on duty as evidence of his or her proficiency and credentials.

D. No person shall operate within Pueblo County as an ambulance driver without first possessing a valid Colorado Driver’s License, a current Colorado Department of Public Health and Environment, Emergency Services Division, approved Advanced First Aid Card or First Responder Certification, and a current cardiopulmonary resuscitation card. An ambulance service serving a population of thirty thousand (30,000) people or more must have its drivers certified as at least an EMT. Each ambulance driver must physically carry his or her Colorado Driver’s License and either his or her Advanced First Aid Certification Card or evidence of First Responder Certification, Colorado EMT Certification Card, if applicable, and his or her cardiopulmonary resuscitation certification card while on duty as evidence of his or her proficiency and credentials.

E.   As a condition of licensure under the terms and conditions of this chapter, it shall be the responsibility of the ambulance service to document, to the satisfaction of the Director or the appointed inspector, that all persons employed by, or serving for, the ambulance service during the year have maintained the certification appropriate to their respective responsibilities current throughout the certified period. Failure to provide such documentation may lead to denial of the renewal of any ambulance service license and/or ambulance vehicle permit. Each operator of an ambulance service shall inform the Director and/or inspector of changes in the employment or certification status of licensed EMT’s and ambulance drivers within one week after such changes occur.

F.   All ambulance services based in Pueblo County shall have a Medical Director whose purpose shall be to set the standards of the medical care of that ambulance service and to review the performance of the ambulance service in medical matters, provided that such standards meet the minimum requirements of, and are not in conflict with, the terms and conditions of this chapter.(Res. 14-138 § 3; Res. 95-248 § 4; Res. 92-337 § 3)

 

8.08.050 Violations and penalties.

A. In any legal action filed against a person who has been issued a license pursuant to the terms and conditions of this chapter and Section 25-3.5-301, et seq., C.R.S., in which it is alleged that the plaintiff’s injury, illness or incapacity was exacerbated or that he or she was otherwise injured by the negligence of the licensee, an act of negligence shall not be presumed based on the fact of the allegation. In the event a judgment is entered against any such licensee, he or she shall, within thirty (30) days thereof, file a copy of the findings of fact, conclusions of law, and order in such case with the Pueblo County Clerk and Recorder. The Board of County Commissioners shall take note of such judgment for purposes of investigation and appropriate action if a violation of the terms and conditions of this chapter and Section 25-3.5-201, et seq., C.R.S., is present. Any and all complaints received directly by the Board of County Commissioners shall be subject to review.
B. 1. Upon a determination by the Board of County Commissioners that any service or person has violated or failed to comply with the terms and conditions of this chapter or the provisions of Section 25-3.5-301, et seq., C.R.S., the Board of County Commissioners may temporarily suspend, for a period not to exceed thirty (30) days, any license or permit issued pursuant to the terms and conditions of this chapter and the provisions of Section 25-3.5-301, et seq., C.R.S. The licensee shall receive written notice of such temporary suspension, and a hearing shall be held no later than ten (10) days after such temporary suspension. After such hearing, the Board of County Commissioners may suspend any license or permit issued pursuant to the terms and conditions of this chapter and Section 25-3.5-301, et seq., C.R.S., for any portion of or for the remainder of the life of any such license or permit. At the end of the suspension period, the person whose license or permit was suspended may apply for a new license or permit as in the case of an original application.
2. The Department, as the licensing agent of Pueblo County, shall have the authority to temporarily suspend any license or permit issued pursuant to the terms and conditions of this chapter at any time upon a finding by the licensing agent that an emergency situation exists due to the facts that a licensee or a permittee has violated the provisions of this chapter as amended, or Section 25-3.5-101, et seq., C.R.S. and there is a threat to the health and safety of the public due to the actions or omissions of such licensee or permittee. In the event the Department makes the determination to temporarily suspend a permit or license on an emergency basis as provided herein, such emergency temporary suspension is subject to the review and rescission or ratification by the Board of County Commissioners no later than ten (10) days from the date the license or permit was temporarily suspended. The Department shall give written notice of any emergency temporary suspension of a license or permit by forwarding a completed notice of temporary suspension, a copy of which is attached hereto and incorporated herein by this reference, to the Pueblo County Attorney’s Office, as soon as possible, but no later than the next business day following said suspension. Business days are defined as Monday through Friday, 8:00 a.m. to 5:00 p.m. The County Attorney’s Office, upon receipt of a written notice of emergency temporary suspension, from the Department shall schedule a hearing on the matter as soon as possible given the schedule of the Board of County Commissioners. The County Attorney Office will also give written notice of the hearing date and time to the licensee or permittee and to the Department. The Board of County Commissioners shall conduct the hearing so scheduled to review the emergency temporary suspension in accordance with the provisions of this subsection. In the event a hearing is not scheduled within ten (10) days of an emergency temporary suspension pursuant to the provisions of this subsection, said suspension shall be lifted and the licensee’s license or permit shall be reinstated automatically.
C. Upon a second violation or failure to comply with the terms and conditions of this chapter and/or Section 25-3.5-301, et seq., C.R.S., by any licensee, the Board of County Commissioners may permanently revoke such license or permit.
D. Any person who violates the terms and conditions of this chapter and/or any provision of Section 25-3.5-301, et seq., C.R.S., commits a Class 3 misdemeanor and shall be punished as provided in Section 18-1-106, C.R.S. (Res. 96-377; Res. 92-337 § 4)
 

8.08.060 Reporting system for ambulance services.

All Pueblo County licensed ambulance services will utilize the statewide Emergency Medical Services Uniform Pre-hospital Care Reporting System operated by the Colorado Department of Public Health and Environment, Emergency Services Division, and corresponding regulations adopted pursuant to the Emergency Medical Services Rules, 6 C.C.R. 1015-3.(Res. 14-138 § 4: Res. 08-340 § 2; Res. 92-337 § 5(A))
 

8.08.070 Emergency Medical Services Advisory Council.

 A.             There is created the Pueblo County Emergency Medical Services Advisory Council. The purpose of the Advisory Council is to advise the Board of County Commissioners on changing laws and the needs of the citizens in Pueblo County in the following areas: standards of treatment; transportation; the training of emergency medical services personnel; communications and documentation systems; and other matters related to the provision of emergency medical services in Pueblo County as requested by the Board of County Commissioners.

B.   The Pueblo County Emergency Medical Services Council shall be authorized to change medical-only protocol guidelines of the Paramedic Protocol Guidelines Southern Colorado RETAC Protocols without prior approval of the Board on behalf of Pueblo County, provided that the medical director representing each hospital in Pueblo County has given his or her written approval of the change. The Emergency Medical Services Council can be contacted for information regarding changes to the medical-only protocol guidelines.(Res. 14-138 § 5; Res. 98-409; Res. 92-337 § 5(B))

 

8.08.080 Liability for damage.

Nothing contained in this chapter shall be construed so as to hold the Pueblo City-County Health Department or county of Pueblo, Colorado, their officers, agents or employees, or any other person authorized to enforce the provisions of this chapter responsible for any damage to persons or property which may occur in connection with the administration and enforcement of this chapter. (Res. 92-337 § 5(C))
 

8.08.090 Administration costs.

The expenses involved in administering this chapter shall be paid out of the county general fund, and shall be included in the budget of the City-County Health Department. (Res. 92-337 § 5(D))
 

8.08.100 Interference in discharge of duties prohibited.

No persons shall interfere with or hinder the Board of County Commissioners or their authorized representatives in the discharge of their duties as herein prescribed. Any such interference shall constitute a violation of this chapter and any person violating this chapter will be subject to the penalties set forth in this chapter. (Res. 92-337 § 5(E))
 

8.08.110 Bylaws and guidelines approved.

The Pueblo County Emergency Medical Services Advisory Council Bylaws and Paramedic Protocol Guidelines are hereby approved on behalf of Pueblo County. (Res. 98-74)