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HomeMy WebLinkAboutCC Resolution 7331 (Ambulance Service Life Support)RESOLUTION NO. 7331 A RESOLUTION AUTHORIZING THE SIGNING OF A CONTRACT, LEASE OR AGREEMENT THE CITY COUNCIL OF THE CITY OF SAN RAFAEL RESOLVES as follows: The MAYOR and CITY CLERK are authorized to execute, on behalf of the City of San Rafael, a contract, lease or agreement with UNITED AMBULANCE SERVICE TO PROVTDF RARTC T,TFF RTTPiDnPT TMFPr_PNTr'v AMBULANCE SERVICE TO PARAMEDTC AREA R_ a copy of which is hereby attached and by this reference made a part hereof. I, JEANNE M. LEONCINI, Clerk of the City of San Rafael, hereby certify that the foregoing resolution was duly and regularly intro- duced and adopted at a Regular meeting of the City Council of said City held on Monday the 21st day of AAril 196 , by the following vote, to wit: AYES: COUNCILMEMBERS: Breiner, Frugoli, Nave, Russom & Mayor Mulryan NOES: COUNCILMEMBERS: None ABSENT: COUNCILMEMBERS: None JEAt NI. LEONCINI, City Clerk ORIGINAi >33, AMBULANCE SERVICE CONTRACT THIS CONTRACT, made and entered into this 21st day of April , 1986, by and between the City of San Rafael, (City) a Chartered City of the State of California, and UNITED AMBULANCE COMPANY (Contractor). RECITALS WHEREAS, it is desirable and in the general public interest, convenience and welfare that Paramedic Service Area B receive prompt, efficient and proper ambulance service; and WHEREAS, the City further desires, in accordance with the exercise of its general police powers, to assure an emergency ambulance service for all persons injured or otherwise incapacitated in Paramedic Service Area B; and WHEREAS, the City's Paramedic Ambulance will only transport those persons determined to have sustained injuries requiring paramedic services; and WHEREAS, an alternative means of transportation other than the City's Paramedic Ambulance is required from the private sector to provide Basic Life Support (BLS) emergency ambulance service to Paramedic Service Area B; and WHEREAS, Marin County has previously executed an ambulance service contract with Contractor to supply BLS emergency ambulance service in its unincorporated jurisdiction; and WHEREAS, The Parties desire to rescind the previous agreement between City and Contractor in the interest of executing a new contract to provide a level of service for BLS emergency ambulance service consistent with the previously e.:ecuted contract for that service between the County of MELr.in and City for Paramedic Service Area B. NOW, THEREFORE, THE PARTIES AGREE AS FOLLOWS: 1. Term: The term of this contract shall be sixty (60) months from the date of its execution unless terminated earlier by thirty (30) days' written notice from either party to the other. 2. Contractor's Responsibilities: A. Contractor will provide BLS emergency ambulance service consistent with the terms articulated in Exhibit A, Contract between City and the County of Marin, dated January 1, 1980, for Paramedic Services to Area B. B. Contractor will provide a maximum response time of 15 minutes in 90 of Code 2 calls and 10 minutes in 90° of Code 3 calls. C. Contractor will provide personnel, equipment and insurance as provided in Exhibit A. D. Contractor will bill City on a monthly basis for any costs allowed by this agreement as provided in Paragraph 3. -2- 3. City's Responsibilities: A. The City shall pay Contractor $50 for each ambulance trip made as a result of an emergency initiated through the San Rafael Fire Dispatch center that does not result in the transportation of a patient. B. The City will ensure that the patient assessment will have been completed and that the patient will be ready for immediate transportation when Contractor's BLS ambulance arrives on the scene. 4. General: A. This Contract can be reviewed at any time by either party for the purpose of examining: Ambulance Availability Response Times Dry Run Percent Uncollectable Percent Adequacy of Service B. Contractor is an independent contractor and shall not be deemed an agent, servant or employee of the City of San Rafael, nor is this Contract to be construed as a partnership, joint venture, or association of City and Contractor. Q ^ J ^ C. Contractor agrees to indemnify, defend and save harmless the City of San R�Lfael, its officers, agents and employees from and against any and all claims and losses whatsoever accruing or re- sulting to any person, firm or corporation for performance of this agreement. D. If any section of this agreement is held invalid by operation of law or by any court of competent jurisdiction or, if compliance with or enforce- ment of anv section should be restrained by such court, the remainder of this agreement shall not be affected. E. Contractor shall furnish and keep in full force and effect at all times during the term of this agreement public liability insurance with a com- bined single limit of $5,000,000.00 and Workers' Compensation insurance covering all employees of Contractor engaged in performing the services required by this agreement. UNITED AMBULANCE COMPANY JRII F. GOTTI, President CITY OF SAN RAFAEL LAWRENCE E. MULR AN, Iayor ATTEST: 0 A. - F . LEO _I, City Clerk AGREEMENT BETWEEN COUNTY OF MARIN AND CONTRACTOR RELATING TO ADVANCED LIFE SUPPORT AND BASIC LIFE SUPPORT EMERGENCY AMBULANCE SERVICE This is an agreement entered into this I s t day of JANUARY 1980, between the County of Marin, State of California, hereinafter referred to as "County," and the City of San Rafael hereinafter referred to as "Contractor": Section I. Definitions of Terms The following definitions shall apply throughout this agreement: A. Communications - the Communications Center operated by the County Sheriff. B. Code Eleven Number - an authorization number issued by Communications indicating the call was dispatched or cleared by Communications. C. Emergency Call - a request for dispatch of an ambulance to transport or provide other assistance for a person apparently having'a sudden and unforeseen need of immediate medical attention. D. Emergency Facility - a hospital.or other institution staffed and equipped to provide emergency medical services. E. Emergency Service - the service performed in response to an emergency call. F. Dry Run - any ambulance -trip made as a result of a Code Eleven authori- zation that does not result in the picking up of a patient, either because upon arrival at the scene, it is found that no ambulance was needed or because the dispatch order for ambulance was cancelled enroute by Communications. G. Emergency Physician - refers to the physician group or organization with which Hospital Base Station provides for emergency physician, 24-hour coverage at Hospital's Emergency Department. H. Contractor - City of San Rafael I. County - The County of Marin, California, or its governing body. J. Procedures Manual - a written guide intended for reference and for instruction to aid ambulance personnel in the handling of emergency situations. K. Advanced Life Support (ALS) - that level of emergency medical care defined in Section 1480, et seq. of the California Health and Safety Code (Wedworth-Townsend Act), approved by the Marin County Health Officer, and authorized in the field and during transport to an emergency facility by a County -approved Hospital Base Station. L. Basic Life Support (BLS) - that level of emergency medical care which includes advanced first aid and cardiopulmonary resuscitation with the use of equipment, to the ill or injured at the scene and during transport to an emergency facility. M. Base Station Hospital - a Marin County Hospital that meets the require- ments of a basic, 24-hour, emergency facility as defined In Title 22 of the California Administrative Code and has been designated by the Marin County Board of Supervisors to direct pre -hospital ALS Services. N. Mobile Intensive Care Nurse (MICN) - a Registered Nurse working in a Base Station Hospital Emergency Department who has successfully com- pleted a prescribed course of training in Advanced Life Support approved' in writing by the Marin County Health Officer and has been certified by the Marin County Health Officer to direct pre -hospital ALS Services while under the supervision of a licensed physician. 0. Mobile Intensive Care Paramedic (MICP) - a person who has been certi- fied by the Marin County Health Officer to perform those pre -hospital advanced life support medical services specified in the California Health and Safety Code, Sections 1480 through 1485. P. Emergency Medical Technician I (EMT -1) - a person possessing a valid course -completion certificate from a program approved by the California State Department of Health for the medical training and education of ambulance personnel as defined by Title 17 of the California Adminis- trative Code. Q. ALS Unit - an ambulance or unit staffed with two, Marin County -certified MICP's and equipped with appropriate medical equipment and supplies. R. BLS Ambulance - an ambulance staffed with two EMT -115 and equipped with appropriate medical equipment.and supplies. S. MEDS - Medical Emergency Dispatch System - a copy of operational manual provided by County to each Contractor. Section II. Services to be Rendered Contractor shall, for the consideration set forth in this agreement, provide Emergency Advanced Life Support seryices and provide for Basic Life Support services to an assigned Service Ares which is described in Appendix "A" attached hereto, and by this reference incorporated herein, in accordance with the minimum requirements of County, which are set forth in Appendix "B", attached hereto and by this reference incorporated herein, operationsl pro- cedures set forth in Appendix "C" attached hereto and by this reference incorporated herein, and Triage Protocols set forth in Appendix "D" attached hereto and by this reference incorporated herein as though fully set forth, upon receipt of verbal Code Eleven authorization issued by Communications. Advanced Life Support service is that level of emergency medical care defined in Section 1480, et seq. of the California Health and Safety Code (Wedworth- Townsend Act), approved by the Marin County Health Officer, and authorized in the field and during transport to an emergency facility by a County -approved Hospital Base Station. Basic Life Support service is that level of emergency medical care which includes advanced first aid and cardiopulmonary resuscitation with the use of equipment, to the ill or injured at the scene and during transport to'' an emergency facility. Section III. Insurance Contractor and any sub -contractors under this agreement must carry, at their own expense, comprehensive Public Liability Insurance in an amount not less than $1,000,000 for injuries or death to one person and $3,000,000 for injuries or death to more than one person in one accident and Property Damage Insurance in the amount of not less than $50,000. Contractor must also carry Professional Liability Insurance in the amount of $1,000,000 per MICP. Contractor must have the aforesaid policies name the County of Contra Costa and the County of Marin, its officers, agents and employees as additional insured under such insurance,and Contractor must file a certificate of such coverage with the Marin and Contra Costa County Administrators within ten days of acceptance of this contract. Certificates shall specify or be endorsed to provide that 30 days notice must be given in writing to County of any pending change in the limits of liability or of any cancellation or modification in the policy. Section IV. General Conditions A. Contractor is an independent contractor and shall not be deemed an agent, servant, or employee of the County of Marin, nor is this con- tract to be construed as a partnership, joint venture, or association of County and Contractor. B. Contractor agrees to indemnify, defend and save harmless the County of Marin, Its officers, agents and employees from and against any and all claims and losses, whatsoever accruing or resulting to any person, firm or corporation for performance of this agreement. -2- C. Contractor may sub -contract the Emergency Basic Life Support services provided for in this contract, provided that such sub -contract contains at a minimum the provisions herein applicable to Basic Life Support ser- vice and the sub -contracting party is qualified to render such service. D. If any of the provisions of this contract are violated by Contractor, County Administrator shall notify Contractor's management representative, hereinafter designated, of said violation by telephone and then confirm in writing. If Contractor shall fail to correct said violation within three days after receiving said written notice, the Board of Supervisors of Marin County shall have the right to suspend the operation of this contract until such violation has been corrected. The decision of the Board of Supervisors as to the existence of a contract violation and its resolution shall be final. E. This contract shall be in full force and effect, and service shall com- mence January 1, 1980, and shall continue on a year-to-year basis there- after by mutual consent of both parties unless 60 days notice of termina- tion is given in writing by either party. Amendments to the text of this agreement may be initiated by either party and shall be incorporated into this agreement by mutual consent. F. County reserves the right to modify standards for vehicles, personnel, training or operating procedures to conform with new State or Federal statutes. Notice of modification shall be mailed to Contractor at least 30 days prior to the effective date of said statutes unless such statutes are urgency measures. G. If any section or sub -section of this contract should be held invalid by operation of law or by any tribunal of competent jurisdiction, or if compliance with or enforcement of any section or sub -section should be restrained by such tribunal, the remainder of this contract shall not be affected thereby. H. The attached appendices are by this reference herein incorporated as part of this contract. They are: "A" - Zones and Substations; "B" - Minimum Requirements; "C" - Operational Procedures; "D" - Triage Protocols. I. A Procedures Manual shall be utilized by Contractor's personnel when handling emergency ambulance calls under this agreement. County Commuhi- cations and the Department of Health and Human Services shall have available a copy of the Procedures Manual, including revisions as they take place, and it shall be available for review, upon request, to other agencies. Contractor shall ensure that drivers, attendants and dispatchers are familiar with contents of said Manual. Contractor's Procedures Manual shall not conflict with the County Communication Manual with regard to dispatching and controlling ambulance$. J. Contractor shall make vehicles, personnel, and records available to County or its designee. ATTEST: U CITY CERK COUNTY OF MARIN -3- `. ijpendix "B" MINIMUM REQUIREMENTS MARIN COUNTY PARAMEDIC SERVICES I. Coverage Requirements A. Must provide continuous 24-hour, 365 -day coverage of all urgent (Code2) and emergent (Code 3) medical emergencies in assigned service area. B. Must provide ALS care and transport and provide for dedicated emergency BLS care and transport to all patients regardless of their ability to pay. Contractor shall assume costs of delivery of Indigent care and dry runs. C. Must guarantee a maximum response time for ALS units and BLS ambulances of ten minutes to.90% of.calls originating in assigned service area. D. Must agree to respond available ALS units and/or BLS ambulances in a mutual aid capacity outside assigned area of responsibility if•directed to do so by County Communications Center. E. Must provide ALS care and transport when directed to do so by the Base Station Hospital. F. Must not utilize an ALS unit to transport non -ALS patients unless pro- vision has been made for back-up ALS service. This back-up may not come from another service area. G. In the event that the ALS unit is in service on an authorized emergency call, Contractor must guarantee that the BLS ambulance responsible for the assigned service area will respond to all urgent (Code 2) and emergent (Code 3) calls when directed to do so by County Communications. H. BLS ambulance must be dedicated solely for emergency use and may not respond to private calls in or out of assigned service area. I. In the event that a BLS ambulance from another service area must respond into Contractor's service area for back-up, Contractor must assume respon- sibility for payment of any dry runs or uncollectibles incurred. I I . Manpower/Trai ni nq A. Advanced Life Support Units must be staffed at all times by two, Marin County -certified Mobile Intensive Care Paramedics trained to levels defined by the Wedworth/Townsend Act, with the exception that the field internship portion of their training is at least 360 hours. B. Paramedics must meet Marin County certification criteria through com- pliance with the following requirements. 1. Successful completion of a course of instruction in Mobile Inten- sive Care Paramedic training approved by the Marin County Health Officer. 2. Successful completion of written, performance and oral examinations approved by the Marin County Health Officer. 3. Certification as an Advanced Cardiac Life Support provider accord- ing to the standards of the American Heart Association. 4. Employment and recommendation by an approved Marin County paramedic provider agency and the paramedic -training agency. 5. Certification will be valid for two years provided the candidate fulfills the continuous service (1), continuing education (2), and skills (3), requirements. 6. Individuals denied certification will be informed in writing of the reason for denial. The individual will be granted, upon request, a hearing before the County Health Officer. -6-. C. Paramedic personnel are eligible for challenging certification in Marin County if the following has been accomplished. 1. Submit verification of employment with an approved Marin County paramedic provider agency. 2. Successful completion of training program approved by the Marin County Health Officer. 3. Submit transcripts from training institution. 4. Certification as an Advanced Cardiac Life Support provider according to the standards of the American Heart Association. 5. Successful completion of written, performance, and oral exami- nations approved by the Marin County Health Officer. 6. Completion of five field shifts supervised by a Marin County Mobile Intensive Care Paramedic or Mobile Intensive Care Nurse. D. Paramedic personnel must maintain eligibility through compliance with the following recertification criteria: I. Satisfactory completion of continuing education, continuous service, and skills requirements set forth by the County Health Officer. 2. Recommendation by•the following: a. Candidate's employer b. Base Hospital Medical Director and the Base Hospital MICN Coordinator. 3. Satisfactory completion of written, performance, and oral exami- nation approved by the County Health Officer. 4. Current certification as an Advanced Cardiac Life Support pro- vider according to the standards of the American Heart Associa- tion. 5. Recertification will .be valid for two years provided the candidate fulfills the continuous service, continuing education, and skills requirements. 6. Individuals denied recertification will be informed in writing of the reason for denial. The individual will be granted, upon request, a hearing before the County Health Officer. E. Paramedic personnel are required to be assigned to paramedic units for not less than 72 hours per month, excluding vacation and sick leave. If the Mobile Intensive Care Paramedic works less than 72 hours per month for two consecutive months or for three months within a cal- endar year, certification may be suspended by the Health Officer. Certification may be re-established by the Health Officer upon satis- factory completion of skills performance exam, plus oral and/or written exams if indicated. F. Paramedic personnel must meet minimum continuing education requirements. A minimum requirement of sixty (60) hours of continuing education per calendar year has been established for all certified personnel. (A minimum of 45 hours must be completed during the first year of the two- year certification period.) Credit hours may be earned in the following ways that relate to emergency medical care: 1. Lectures at hospitals (1 hour lecture for 1 hour credit) 2. Run review experience at hospitals. Minimum of 10 credit hours/ year. (1 hour critique for 1 hour credit) 3. Supervised study (2 hours of study for 1 hour credit) -7- u 4. Teaching (basic life support) 0 hour class for I hour credit) 5. Professional lectures, workshops and seminars approved in advance. (1 hour lecture for 1 hour credit) 6. Clinical. Minimum of 30 credit hours/year. (Credit awarded on individual basis.) 7. Academic courses - approved in advance. (One course unit for a quarter course will equal 10 credit hours, semester units equal 15 credit hours.) G. Paramedic personnel must participate in skills test twice per year as directed by the EMS Training Coordinator and the Health Officer. H. Basic Life Support Units must be staffed at all times by two, Emergency Medical Technician -I's (EMT's) currently certified as spec171ed in Section 6755.1, 6755.2 or 6755.3 of Title 13, California Administrative Code. I. At least annually, EMT -I's shall participate in a minimum of two hours of refresher course training in Cardiopulmonary Resuscitation and demonstrate proficiency in the techniques according to the standards of the American Heart Association. J. Driver must have in his possession al all times a valid California Driver's License, and a current Ambulance Driver's Certificate issued by California Department of Motor Vehicles, if not exempt by State law. III. Communication and Dispatch Requirements A. Contractor must agree to install, utilize and maintain the appropriate radio equipment as follows: 1. All ALS units and BLS ambulances used for emergency medical response must be equipped with two-way radios on frequencies designated by County Communications for the purpose of dispatch- ing by, and status -keeping with, County Communications. 2. Radio equipment, approved by County Sheriff, must be installed prior to assignment of a vehicle for zone coverage. 3. Two-way radios must be operated in conformance with all applicable rules and regulations of the Federal Communications Commission, and in conformance with all applicable County rules and operating procedures. 4. All UHF radio equipment used for biomedical information and the sending of medical telemetry information shall be provided at con- tractor's expense. All patient monitoring equipment shall be provided at contractor's expense. 5. All mobile and portable radio equipment used must be approved by the County Sheriff. 6. County will agree to service contractor -owned radio equipment at the current County time and material rate, provided a signed mainte- nance agreement is in force. 7. Contractor must maintain at contractor's expense, a direct tele- phone line between Communications and his ALS and BLS dispatch office(s) within Marin County. 8. All emergency calls requiring a Code 3 response which contractor receives from sources other than County Communications will be reported immediately to County Communications. County Communica- tions shall assume the responsibility for dispatching the nearest available ambulance. 10 B. Contractor must agree to abide by centralized dispatch procedures monitored by Marin County Communications including: 1. All ALS units and BLS ambulances involved in emergency medical care under this agreement shall be directly dispatched by County Communications and shall be given an authorization number at the time of dispatch. 2. Upon receipt of verbal Code Eleven authorization, as promptly as possible, Contractor must dispatch the appropriate vehicle and crew to the designated location proceeding there in a manner specified by Communications. 3. Contractor shall inform Communications of any changes In avail- ability, location, and status of ALS units and BLS ambulances, in or out of service. Those vehicles which do not have the required on -duty personnel shall be considered out of service and shall be reported as such to Communications and to the County Health Officer. 4. All ALS units and BLS ambulances must use the unit number designated by County Sheriff. IV. Equipment and Supply Requirements A. Vehicles 1. Ambulance vehicles shall meet standards specified in Title 13, Chapter 2, California Administrative Code, and each shall possess a valid Emergency Vehicle Permit issued by California Highway Patrol. 2. Vehicles will be maintained cleanly and in good mechanical and body condition at all times. B. Safety Equipment: Safety Equipment to be carried on ALS and BLS units and maintained in good working order shall include the following: 1. An approved siren 2. An approved steady -burning, red -warning lamp, mounted as specified in Section 808 of California Administrative Code, shall provide adequate warning for at least 500 feet ahead of the vehicle in day- light under normal atmospheric conditions. 3. Approved safety belts installed for the driver and for a passenger in the front seat if a seat is provided. 4. A fire extinguisher of the dry chemical or carbon dioxide type with a minimum 4-B:C rating. The use of vaporizing liquid extinguishers is prohibited. 5. A portable, battery-operated light 6. A spare tire 7. A Jack and tire tools 8. Maps covering the areas in which the ambulance provides service. C. Emergency Medical Equipment and Supplies All equipment and supplies are to be carried on ALS and BLS units at all times and maintained in clean condition and good Working order. (Title 13, California Administrative Code): 1. An ambulance cot and collapsible stretcher; or two stretchers, one of which is collapsible. 2. Straps to secure the patient to the stretcher or ambulance cot, and means of securing the stretcher or ambulance cot in the vehicle. 3. Ankle and wrist restraints. Soft ties are acceptable. 4. Sheets, pillowcases, blankets, and towels for each stretcher or ambulance cot, and two pillows for each ambulance. 5. Three, mouth-to-mouth resuscitation or oropharyngeal airways, one each of a size for adults, children, and infants. 6. At least three, 3" by 15" arm splints and three, 3" x 36" or longer leg and thigh splints with a soft or cushioned surface or roll material for padding for immobilizing and protecting fractured extremities. Equivalent padded board, wraparound, wire ladder, inflatable, or cardboard.splints will meet this requirement. 7. A resuscitator that meets the requirements of Vehicle Code Section 2418.5. A hand -operated, bag -valve -mask unit with clear masks of adult, child, and infant sizes capable of use with oxygen will meet this requirement. 8. Portable oxygen (USP), regulator, and means for administering oxygen, including adequate tubing and semiopen, valveless, trans- parent masks in adult, child, and infant sizes. Oxygen may be administered by resuscitator, bag mask unit, or inhalator. 9. Clean bandages and bandaging supplies: 12, 4" sterile bandage compresses or equivalent Four 3" by 3" sterile guaze pads - Six 2" or 3" roller bandages Four 40" triangular bandages Two rolls of 111, 2" or 3" adhesive tape Two tourniquets Bandage shears Six tongue depressors Large safety pins Two additional sheets Two universal dressings 10" x 30" or larger 10. Two padded mouth gags either commercial or made of three tongue blades taped together and padded. 11. An emesis basis, or disposable bags and covered waste container. 12. Portable suction equipment. 13. Two sandbags, loosely filled, or equivalent material to restrict movement. 14. Two rigid spine boards approximately 14" or more wide, one 32" or more long, and one approximately 72" long, with straps for iminobili- zation of suspected spinal or back injuries. Combination short -long boards are acceptable. 15. Half -ring traction splint for lower extremity with limb -support slings, padded ankle hitch traction strap, and heel rest. 16. Blood pressure manometer, cuff, and stethoscope. 17. Sterile obstetrical supplies including as a minimum: gloves, umbilical cord tape or clamps, dressings, towels, bulb syringes, and clean plastic bags. 18. A gallon or more of clean water in covered, secured, plastic container. D. In addition to the equipment listed above, County requires that all ALS and BLS units be equipped with: 1. Universal dressings, approximately 10" by 3611, compactly folded and packaged in convenient size. 2. Steri le guaze pads, 4" by 4". n- 3. Soft roller self -adhering type bandages, 6" by 5 yards 4. Roll of aluminum foil, 18" by 251, sterilized and wrapped 5. Two sterile burn sheets 6. Cervical collars for child and adult use. 7. Poison kit 8. Normal saline irrigation solution 9. Scoop stretcher 10. Cold packs E. In addition to the equipment listed in C and D above, all ALS units must carry the following: (Items marked with astrisks (*) are to be used only with specific orders of a Base Station Hospital MICN or Emergency Physician): *l. IV sets with pedi drip (60 drops per cc) *2. IV sets with solution drip (15 drops per cc) 3. Sterile alcohol wipes A. IV cannulae and short needles, various sizes *5. Blood tubes (red, purple and -grey tops) *6. Naso -gastric tubes 7. Demand valve *8. Esophageal obturator airways - two *9. Cardiac monitor and defibrillator *10. MAST - trousers 11. Sterile normal saline for irrigation *12 5% Dextrose in water IV solution - 500 cc (four bottles) *13. Normal Saline IV solution - 1000 cc (four bottles) *14. Lactated RingerslV solution - 1000 cc (four bottles) *15. Locked drug box containing the following: a. Aminophylline - 250 mg/10 cc b. Atropine - 1 mg/1 cc c. Benadryl (Diphenhydramine) 50 mg/1 cc d. Calcium Chloride 10% - 1 Gm/10 cc e. Demerol (Meperidine) - 100 mg/1 cc f. Dextrose 50% - 25 Gm/50 cc g. Epinephrine - 1:10,000 and 1:1,000 h. Glucose, oral I. Ipecac Syrup - 4 oz. j. Isuprel (Isoproteronol) - 2 mg/10 cc k. Lasix (Furosemide) - 20 mg/2 cc 1. Lidocaine - 100 mg/lOcc and 2 Gms/50 cc m. Morphine Sulphate - 15 mg/1 cc n. NAHCO3 (Sodium Bicarbonate) 50 meg/50 cc o. Narcan - 0.4 mg/1 cc p. Nitroglycerine - 0.4 mg tablets q. Pitocin - 10 units/1 cc r. Valium - 10 mg/2 cc V. Relationship with County Department of Health and Human Services A. Committees 1. Contractor agrees to designate an MICP as a member on the Paramedic Advisory Committee. 2. Contractor agrees to designate a representative to the Ambulance Committee B. Data Collection 1. Contractor agrees to utilize such standardized ambulance records as County deems necessary for data collection. 2. Contractor agrees to supply County with other ambulance and MICP information•as necessary for statistical reporting. C. System Coordination 1. Contractor agrees to work with County in planning for and imple- mentating coordinated and integrated emergency medical services. 2. The County Health Officer or his designee shall have the right to make inspections of vehicles and personnel, during normal business hours, without prior notice to determine whether contractor is complying with the terms and conditions of this agreement. 3. Contractor must designate a single MICP as a liaison between the County EMS Unit, the Base Hospital and the provider agency. D. Public Education 1. Contractor shall be responsible for providing public education to the community it serves. 2. Public education programs will be coordinated with and consistent with objectives established by the Public Education Sub -Committee of the Emergency Medical Care Committee. -12 Appendix "C" OPERATIONAL GUIDELINES The Contractor must agree to abide by the following operational procedures: A. Local Fire Departments will be dispatched as first responders to all Code 3 medical emergencies. B. The ALS Unit assigned to thb Service Area will be dispatched on all Code 3 medical emergencies. C. The MICP attendant will take charge of the patients) upon reaching the scene. D. The BLS Unit assigned to the Service Area will be dispatched on all Code 2 medical emergencies. E. Ambulance personnel will take charge of the patients) when released by the MICP or Fire Department E14T-1. F. Each person requiring medical attention will be evaluated, and given BLS care as required. Radio contact will be made with the Base Station Hospital for all ALS orders when ALS care is deemed necessary by either of the attending MICP's. G. Any person receiving ALS care will be transported by the ALS Unit to the Receiving Hospital designated by the Base Station Hospital in accordance with County Triage Protocols. H. In those cases where ALS care is not deemed necessary, the MICP will request Communications to dispatch the BLS ambulance responsible for that Service Area,and the patient(s) will be attended until the BLS ambulance arrives on the scene and assumes responsibility for the patient(s). I. ALS units and BLS ambulances will proceed to the Receiving Hospital designated 'by the Base Station Hospital in accordance with County Triage Protocols in the manner (Code 2 or 3) deemed appropriate by. the person in charge (attendant). J. Whenever conflicts arise regarding a patient, his condition, hospital destination, the code of travel, the method of handling, or other matters of diverse opinion which might result in delay of treatment or other poten-t.ial harm to the patient, the person in charge (atten- dant) shall communicate immediately with the Base Station Hospital to receive instructions from the Emergency Physician on duty. K. Whenever any doubt exists as to the patient being alive or dead, the patient is to be considered to be alive and appropriate emergency procedures are to be carried out. L. In an officially declared State of Emergency, either within or outside of Marin County, County Communications, on authority of the County Administrator or Chairman of the Board of Supervisors may request BLS ambulances and/or ALS units to provide assistance. County will provide reasonable reimbursement for service rendered. -13- ' Appendix 1p11 DEPA. HENT OF HEALTH AND HUMAN .,CRVICES DIVISION OF HEALTH SERVICES COUNTY OF MARIN HALL Or JUSTICE CIVIC CENTER SAN RAFAEL, CALIFORNIA PHONE 479-1100 TRIAGE PROTOCOLS -- BLS AND ALS 1979 PURPOSE: To insure that patients suffering from medical emergencies are taken to the nearest facility appropriate to their medical needs. Following stabilization, interhospital transfer guidelines will insure that the patient is transported, when indicated, to the hospital or critical care center appropriate to his needs. These guidelines are based upon categorization profiles which reveal the following: 1. 11arin County has four Hospital Emergency Departments categorized as Basic (California guidelines) or General (Class 111 AMA guidelines). 2. All of these Hospitals are equipped and staffed twenty-four hours a day to provide resuscitation and stabilization of all medical emergencies. 3. With the exception of the intensive Care Nursery (Neonatal) at Marin General Hospital, there are no other regional Critical Care Specialty Centers in Marin County (Trauma, Burn, Spinal Cord, Poison). PROTOCOLS: All ambulance transports will be either Code 11 indicating the patient's condi- tion is stabilized or Code 111 indicating the medical emergency has not been stablized and there exists a threat to the patient's life or limb. The determination of Code Il or Code 111 transport is made by the senior attending ambulance personnel. Consulta- tion may be provided by the physician in charge of the Base Station or Receiving Hospital Emergency Department. CODE 111 Any patient being transported Code 111 whose medical condition, in the opinion of the senior attending ambulance personnel, has not been stabilized will be transported to the nearest Basic Emergency facility. The accompanying map may be used to assist in the determination of the nearest facility. CODE 11 The destination of the patient is determined by: I.' The decision of the patient or the patient's family. 2. The decision of the patient's personal physician. 3. Kaiser members will be taken to Kaiser Hospital. 4. In the event that the patient does not make a choice or is incapable of making a choice, the patient will be transported to the nearest Basic facility. 5. Exceptions (non -Kaiser only) - Code 11 transport of obstetric or neonatal patients will follow the following guidelines; a) All obstetric, neonatal patients from West, Central and Southern Marin will be transported to Marin General Hospital. b) All obstetric, neonatal patients from the Novato Fire District will be transported to 11ovato Community Hospital. -14- DEPAI ,ENT OF HEALTH AND HUMAN—arr<VICES DIVISION OF HEALTH SERVICES COUNTY OF MARIN HALL OF JUSTICE CIVIC CENTER SAN RAFAEL, CALIFORNIA PHONE 479-1100 TRIAGE PROTOCLS - BLS AND ALS 1978 Patient evaluation by senior attending ambulance personnel not stabilized stabilized life or limb at risk CODE 111 �earest Category 111 (Bas EmerQencv Facility CODE 11 Hospital KAISER member of Choice (patient, family) No choice ' Incapable of choice it V • IV HOSPITAL OF CHOICE KAISER HOSPITAL EMERGENCY STBASIC FACILITY XCERTIONS 1JPnnafal patient jQhr;iPtriC pa ent Novato Fire District All other Marin County NOVATO COMMUNITY 1I0SPITAT1 I MARIN GENERAL HOSPITALt •' ',• �` � '{II'i.\Ili.= } t `� 1147 0 ,1 111 � Sn21 1j � % �. GOP r-.. ,or Trt1 A,� _ �� , �� `tui �� ' � ��SJ1J %�-1�► � mit%^ gnI t o � � t ZZ • ��� r.� i'1220 _ It CXVA.TO CD M -A. .. � _�--�-�`• 1 i � L� t"t Aitt'�l G CNE".Ai� •�f)!JE: •,. 1. \ 1230� ` SERVICE AREA B-- North : North central Marin beginning at the most northerly corner of the 2162 acre Victor Sartori parcel as described in Book 177 at Page 160 of Official Records, County of Marin, said point being on the northerly boundary of Rancho San Pedro Santa Margarita y Las Gallinas; thence leaving said Rancho line southerly along the westerly line of said Sartori tract to its point of intersection with the southerly boundary of said Rancho; thence along said Rancho line easterly to Its intersection with the southwesterly city limits of San Rafael; thence east- erly along said San Rafael limits, the westerly line of parcel 6 and the south- erly line of parcel I of CSA 19 to the easterly right of way of Sir Francis Drake East at San Quentin Point; thence leaving said San Rafael limits and continuing easterly along the southerly right of way of California State Highway 17 to the shoreline of San Francisco Bay; thence northerly along the shoreline to the northerly line of said Rancho San Pedro Santa Margarita y Las Gallinas; thence wesierly along said Rancho to the point of beginning. Including also the lower deck (eastbound) of the Richmond -San Rafael Bridge from its westerly terminus to the toll gate area. -5- AMBULANCE SERVICE CONTRACT THIS CONTRACT, made and entered into this 21st day of AiDril , 1986) by and between the City of San Rafael, (City) a Chartered City of the State of California, and UNITED AMBULANCE COMPANY (Contractor). RECITALS WHEREAS, it is desirable and in the general public interest, convenience and welfare that Paramedic Service Area B receive prompt, efficient and proper ambulance service; and WIEREAS, the City further desires, in accordance with the exercise of its general police powers, to assure an emergency ambulance service for all persons injured or otherwise incapacitated in Paramedic Service Area B; and WHEREAS, the City's Paramedic Ambulance will only transport those persons determined to have sustained injuries requiring paramedic services; and WHEREAS, an alternative means of transportation other than the City's Paramedic Ambulance is required from the private sector to provide Basic Life Support (BLS) emergency ambulance service to Paramedic Service Area B; and WHEREAS, Marin County has previously executed an ambulance service contract with Contractor to supply BLS emergency ambulance service in its unincorporated jurisdiction; and WHEREAS, The Parties desire to rescind the previous agreement between City and Contractor in the interest of executing a new contract to provide a level of service for BLS emergency ambulance service consistent with the previously executed contract for that sc-.l-vice between the County of Marin and City for Paramedic Service Area B. NOW, THEREFORE, THE PARTIES AGREE AS FOLLOWS: 1. Term: The term of this contract shall be sixty (60) months from the date of its execution unless terminated earlier by thirty (30) clays' written notice from either partir to the other. 2. Contractor's Responsibilities: A. Contractor will provice BLS emergency ambulance service consistent with the terms articulated in Exhibit A, Contract between City and the County of Marin, dated March 17, 1981, for Paramedic Services -to Area B. B. Contractor will provide a maximum response time of 15 minutes in 900 of Code 2 calls and 10 minutes in 90% of Code 3 calls. C. Contractor will provide personnel, equipment and insurance as provided in Exhibit A. D. Contractor will bill City on a monthly basis for any costs allowed by this agreement as provided in Paragraph 3. -2- 3. City's Responsibilities: A. The City shall pay Contractor $50 for each ambulance trip made as a result of an emergency initiated through the San Rafael Tire Dispatch center that does not result in the transportation of a patient. B. The City will ensure that the patient assessment will have been completed and that the patient will be ready for immediate transportation when Contractor's BLS ambulance arrives on the scene. 4. General: A. This Contract can be reviewed at any time by either party for the purpose of examining: Ambulance Availability Response Times Dry Run Percent Uncollectable Percent Adequacy of Service B. Contractor is an independent contractor and shall not be deemed an agent, servant or employee of the City of San Rafael, nor is this Contract to be construed as a partnership, joint venture, or association of City and Contractor. -3- C. Contractor agrees to indemnify, defend and save harmless the City of San Rafael, its officers, agents and employees from End against any and all claims and losses whatsoever accruing or re- sulting to any person, firm or corporation for performance of this agreement. D. If. any section of this agreement is held invalid by operation of law or by any court of competent jurisdiction or, if compliance with or enforce- ment of any section should be restrained by such court, the remainder of this agreement shall not be affected. E. Contractor shall furnish and keep in full force and effect at all times during the term of this agreement public liability insurance with a com- bined single limit of $5,000,000.00 and Workers' Compensation insurance covering all employees of Contractor engaged in performing the services required by this agreement. UNITED AMBULANCE COMPANY RICHARD F. ANGOTTI, President -4- CITY OF SAN RAFAEL LAWRENCE E. MULRYAN, Mayor ATTEST: JEANNE M. LEONCINI, City Clerk PARAMEDIC SERVICE AREA B Exhibit B North central Marin beginning at the most northerly corner of the 2162 acre Victor Sartori parcel as described in Book 177 at Page 160 of Official Records, County of Marin, said point being on the northerly boundary of Rancho San Pedro Santa Margarita y Las Gallinas; thence leaving said Rancho line southerly along the westerly line of said Sartori tract to its point of intersection with the southerly boundary of said Rancho; thence along said Rancho line easterly to its intersection with the southwesterly city limits of San Rafael; thence easterly along said San Rafael limits, the westerly line of parcel 6 and the southerly line of parcel 1 of CSA 19 to the easterly right of way of Sir Francis Drake East of San Quentin Point; thence leaving said San Rafael limits and continuing easterly along the southerly right of way of California State Highway 17 to the shoreline of San Francisco Bay; thence northerly along the shoreline to the northerly line of said Rancho San Pedro Santa Margarita y Las Gallinas; thence westerly along said Rancho to the point of beginning. Including also the lower deck (eastbound) of the Richmond -San Rafael Bridge from its westerly terminus to the toll gate area.