§ 2½-6. Definitions.

[The following words, terms and phrases, when used in this chapter, shall have the meanings ascribed to them in this section, except where the context clearly indicates a different meaning:]

(1)

Advanced life support (ALS).

(a)

Advanced life support transport means transportation by ground ambulance vehicle permitted at the ALS level by the state and parish, medically necessary supplies and services and either an ALS assessment by ALS personnel or the provision of at least one (1) ALS intervention. Patients with emergency medical conditions as defined in subsection (8) shall be provided with ALS transport.

(b)

Advanced life support assessment means an assessment performed by an ALS crew as part of an emergency response that was necessary because the patient's reported condition at the time of dispatch suggested that ALS intervention was needed. An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service.

(c)

Advanced life support intervention means a procedure that is in accordance with state and local laws, beyond the scope of authority of an emergency medical technician-basic. These procedures include, but are not limited to:

1.

Intravenous therapy

2.

Manual defibrillation/cardioversion

3.

Endotracheal intubation

4.

Central venous line insertion or monitoring

5.

Cardiac pacing

6.

Chest decompression

7.

Surgical airway

8.

Intraosseous lines

9.

Intravenous, intramuscular or subcutaneous medication administration

10.

Inhalation, sublingual or rectal medication administration

11.

Monitoring of pulse oximetry

12.

Monitoring of end-tidal carbon dioxide

(d)

Advanced life support personnel means an individual trained to the level of EMT-intermediate or EMT-paramedic as defined by state laws and regulations, who is qualified to perform enhanced advanced skills that include being able to administer a limited number of medications and perform other interventions.

(e)

Advanced life support ambulance service means the level of service attained when (i) the ambulance service provider is licensed as an advanced life support ambulance service by the Louisiana Bureau of EMS and (ii) the ambulance service provider's vehicles are permitted as advanced life support vehicles by the Louisiana Bureau of EMS and each ambulance is occupied by at least one (1) ambulance driver certified as an EMS driver, EMT-basic (EMT-B), EMT-intermediate (EMT-I) or EMT-paramedic (EMT-P), and at least one (1) patient attendant minimally certified as an EMT-paramedic by the Louisiana Bureau of EMS.

(2)

Basic life support (BLS) means transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS procedures as defined by the Louisiana Bureau of EMS. The ambulance must be staffed by a driver who is, at a minimum, qualified as an EMS driver (EMSD) and a patient attendant who is, at a minimum, an EMT-B.

(3)

Ambulance committee. The OCOG ambulance committee shall administer the operations contract and serve as the regulatory entity for these ambulance ordinances and all medical transportation providers within the parish. Said committee shall consist of three (3) voting members to be appointed by the Ouachita Council of Governments (OCOG). The committee members may be OCOG members or their designees with representation as follows:

(a)

One (1) member representing Ouachita Parish.

(b)

One (1) member representing the City of Monroe.

(c)

One (1) member representing the City of West Monroe.

The contract administrator and licensing officer shall serve in an ex officio capacity on the committee.

(4)

Contract administrator shall mean the person appointed by the OCOG ambulance committee to administer the ambulance ordinance and operations contract. All communications between the parish, cities and the operations contractor will take place through the contract administrator. Unless otherwise stipulated, the contract administrator shall be the executive director of OCOG.

(5)

Licensing officer means the individual designated by the OCOG ambulance committee and empowered to issue permits and licenses, as defined in this chapter, in accordance with policies and procedures governing such issuance as set forth herein. Unless otherwise stipulated, the contract administrator shall serve simultaneously as the licensing officer or it may be a separate position.

(6)

Ambulance and medical transportation vehicles. Ambulance means any authorized emergency vehicle, permitted as an ambulance by the state bureau of EMS, equipped with warning devices, designed and operated as a part of a regular course of conduct or business to transport a sick or injured individual or which is advertised or otherwise held out to the public as such. The operations contractor may use parish-permitted ambulances for nonambulance medical transportation service (NAMTS) but NAMTS providers may not transport patients, as defined in subsection (27) in NAMTS vehicles. The OCOG ambulance committee may establish minimum standards for all medical transportation vehicles, including, but not limited to: ALS ambulance vehicles; BLS ambulance vehicles; and emergency medical response vehicles (EMRVs).

Nonambulance medical transportation vehicle. Nonambulance means any wheelchair van or similar nonambulance vehicle operated by a nonambulance medical transportation service (NAMTS) provider as defined in subsection (24). NAMTS providers may not transport patients, as defined in subsection (27), in NAMTS permitted vehicles. The OCOG ambulance committee may establish minimum standards and licensing requirements for all nonambulance medical transportation vehicles.

(7)

Ambulance service or ambulance provider means any person, firm, association, or government entity licensed by the state bureau of EMS, owning, controlling, or operating any business or service which furnishes, operates, conducts, maintains, advertises, engages in, proposes to engage in, or professes to engage in the business or service of transporting, in ambulances, individuals who may need medical attention during transport. This applies to emergency ambulance calls and nonemergency ambulance calls. However, ambulance service and ambulance provider shall not include any of the following:

(a)

A volunteer nonprofit organization or municipal nonprofit organization operating an invalid coach or coaches.

(b)

An entity rendering assistance to a licensed ambulance or ambulances in the case of a major disaster.

(c)

A licensed hospital providing nonambulance transportation, as defined in subsection (24), for diagnostic and therapeutic purposes when such transportation originates at a licensed hospital.

(d)

An entity operating an ambulance or ambulances from a location outside of the state to transport patients from a location outside of the state to a location inside the state or to transport a patient or patients from a medical facility inside of the state to a location outside of the state.

(e)

An entity providing transportation to employees who become sick or injured during the course of their employment from a job site to the nearest appropriate medical facility.

(8)

Emergency medical condition shall mean a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances, and/or symptoms of substance abuse) such that a prudent layperson, who possess an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. Except in major catastrophes and in disaster situations (as declared by appropriate elected officials) only ambulances that are permitted at the ALS level with ALS personnel may transport patients with emergency medical conditions.

(9)

Emergency ambulance call shall mean a situation that is presumptively classified (at time of dispatch) to have a high index of probability that an emergency medical condition or other situation exists that requires medical intervention as soon as possible to reduce the seriousness of the situation, or when the exact circumstances are unknown, but the nature of the request is suggestive of a true emergency where a patient may be at risk. ALS and BLS ambulances or EMRVs may respond to emergency ambulance calls, but only ALS ambulances may transport patients with emergency medical conditions.

(10)

Nonemergency ambulance call means a call for ambulance service that is not an emergency ambulance call. Nonemergency transportation by ambulance is appropriate if either: the patient is bed-confined, and it is documented that the patient's condition is such that other methods of transportation are contraindicated; or, if the patient's medical condition, regardless of bed confinement, is such that transportation by ambulance is medically required.

(11)

Emergency response means an immediate response by an ambulance at the ALS level of service to an emergency ambulance call as defined herein. An immediate response is one in which the ambulance supplier begins as quickly as possible to take the steps necessary, requiring the least amount of time practicably attainable, to respond to the call. Only ALS ambulances may transport patients with emergency medical conditions.

(12)

Emergency mode means an ambulance or EMRV operating with emergency lights and warning siren (may use air horn in addition to siren) while engaged in an emergency ambulance call. Drivers of ambulances and EMRVs shall operate in the emergency mode with warning lights and siren at all times while engaged in an emergency ambulance call if they are operating the emergency vehicle in a manner to take exemption to the traffic laws and rules of the road which may be allowed by state law, so as to warn other drivers of nonemergency vehicles to yield the right-of-way to the authorized emergency vehicle. Ambulances and EMRVs may use emergency warning lights only, if they are engaged in an emergency ambulance call and they are stopped or parked or if they are moving and operating the vehicle in a manner so as to abide by all traffic laws and regulations stipulated in state law. No driver of any ambulance or EMRV shall assume any special privilege from traffic laws and regulations except when such emergency vehicle is operated in the emergency mode, with warning lights and siren, while engaged in an emergency ambulance call.

(13)

Emergency medical response vehicle (EMRV) means a marked emergency vehicle with fully visual and audible warning signals operated by the parish-licensed ambulance service, the primary purpose of which is to respond to the scene of a medical emergency to provide emergency medical stabilization or support, or command, control, and communications, but which is not an ambulance designed or intended for the purpose of transporting a victim from the scene to a medical facility regardless of its designation. Included are such vehicles referred to but not limited to the designation as sprint car, quick response vehicle, special response vehicle, triage trucks, staff cars, supervisor units, and other similar designations. Personnel operating EMRVs must be certified as either a emergency medical responder (EMR), EMT-B, EMT-I or EMT-P.

(14)

Emergency facilities are those facilities which include as part of their mission providing for the treatment of patients with life-threatening or limb-threatening conditions. They meet or exceed the emergency care guidelines of the American College of Emergency Physicians and they receive ambulance patients with emergency medical conditions.

(15)

Emergency medical responder (EMR) means any certified first responder, as defined by statute and the Louisiana Bureau of EMS. They can perform emergency medical responder services including rescue, first aid, resuscitation, and other services to the extent that they have been trained to perform such services under the provisions of the first responder training curriculum developed by the Louisiana Bureau of EMS. They are not allowed to function autonomously as an ambulance patient attendant.

(16)

Emergency medical services driver (EMSD) means an individual who is authorized to drive an ambulance in the parish. At a minimum, they must be trained and certified as an emergency medical responder and have successfully completed an emergency ambulance driving course with current certification as approved by the ambulance committee. EMRs, EMT-Bs, EMT-Is, and EMT-Ps may also function as EMSD if they successfully complete an emergency ambulance driving course with current certification as approved by the ambulance advisory committee.

(17)

Ambulatory care facilities provide primary medical care services and may be accessible without prior doctor-patient relationship or without an appointment. In general, ambulatory care facilities do not solicit patients with emergency medical conditions, or patients requiring emergency ambulance transport.

(18)

Emergency response call measurements. The following definitions shall be used as time measurements for all ambulance providers licensed pursuant to this chapter. All times shall be recorded in hours, minutes and seconds. These measurements shall be utilized by the ambulance advisory committee to determine licensed ambulance provider's compliance with performance criteria. All of the below-listed times shall be based on transporting units only.

(a)

Fractile response time. Percentile of a specific category of requests for ambulance service that are appropriately answered within a stated response time goal or standard. A fractile response time requirement can be expressed as follows: Every calendar month, the contractor will have an ALS ambulance staffed as required, on the scene of at least X per cent of all (enter level of call here, such as "presumed life threatening") emergency calls in (a specific jurisdiction) in Y minutes or less. An example of this wording follows: "Every calendar month, the contractor will have an ALS ambulance staffed as required, on the scene of at least eighty (80) per cent of all presumed life-threatening emergency calls inside the cities of Monroe and West Monroe in eight (8) minutes zero (0) seconds or less."

(b)

Call received time. When the EMS telecommunicator has answered the call for service from a citizen or from any public safety agency or thirty (30) seconds after the call has been transferred from the Ouachita Parish 911 call center.

(c)

Enroute time. This time is when the assigned unit acknowledges notification of assignment to a specific call by the communications center and declares itself to be enroute.

(d)

On-scene time. This stage begins when the ambulance unit declares itself on-scene, (the unit is fully stopped at the location where the ambulance shall be parked while the crew exits to approach the patient or when it arrives at a predetermined staging area because of hazardous materials, violent crime scenes, etc.) and ends when the ambulance unit declares itself to be enroute to a destination.

(e)

Response time. Elapsed time measurement that begins at the call received time and ends when the assigned ambulance unit declares itself on-scene at the assigned location.

(19)

Emergency medical services (EMS) means the following prehospital and interhospital services:

(a)

Access and coordination. The answering and processing of telephone requests from the public for ambulance or emergency medical responder services, including EMS dispatching, emergency and nonemergency; the providing of medical prearrival instructions to callers by telephone; but excluding the process of 911 complaint-taking when the caller is immediately transferred to the EMS control center;

(b)

Emergency medical responder services. Those emergency services, excluding transportation, which are performed by an EMR. The ambulance advisory committee shall establish minimum standards for training, continuing education and performance standards for EMRs;

(c)

Medical transportation. Transportation and services by either a permitted ambulance (ALS or BLS) or nonambulance medical transportation service vehicle (wheelchair van) as defined in subsection (24);

(d)

On-line medical direction. On-line medical direction is the medical direction provided directly to prehospital providers by the medical director or designee either on-scene or by direct voice communication. Ultimate authority and responsibility for concurrent medical direction rests with the medical director. On-line medical direction in the parish shall be sanctioned and coordinated by the licensed ambulance provider.

(e)

Off-line medical direction. Off-line medical direction is the administrative promulgation and enforcement of accepted standards of prehospital care. Off-line medical direction can be accomplished through both prospective and retrospective methods. Prospective methods include, but are not limited to, training, testing, and certification of providers; protocol development; operational policy and procedures development; and legislative activities. Retrospective activities include, but are not limited to, medical audit and review of care, direction of remedial education, and limitation of patient care functions, if needed. Various aspects of prospective and retrospective medical direction can be handled by committees functioning under the medical director with representation from appropriate medical and EMS personnel. The off-line medical director is appointed by the licensed ambulance provider, and shall be a physician licensed to practice emergency medicine in the State of Louisiana who is familiar with the prehospital emergency response system in Ouachita Parish.

(20)

EMS control center is the communications facility operated by the licensed ambulance provider which serves as the central EMS communications center for the parish.

(21)

Licensed ambulance provider that is the licensed provider for emergency ambulance services in Ouachita Parish. The licensed emergency ambulance provider is authorized to enter into mutual aid agreements with other EMS, public safety and ancillary support agencies.

[(22)

Reserved.]

(23)

Medical necessity for ambulance service. Medical necessity is established when the patient's condition is such that use of any other method of transportation other than ambulance is contraindicated. In any case, in which some means of transportation other than an ambulance could be utilized without endangering the individual's health, whether or not such other transportation is actually available.

(24)

Nonambulance medical transportation service (NAMTS) or medical wheelchair van service means any person, firm, association, or government entity owning, controlling, or operating any business or service which furnishes, operates, conducts, maintains, advertises, engages in, proposes to engage in, or professes to engage in the business or service of transporting individuals in a vehicle other than an ambulance, e.g., wheelchair van with the following stipulations:

(a)

Passengers do not require medical care, attention, or monitoring during transport;

(b)

Passengers do not require the assistance of an attendant during transport;

(c)

Passengers do not require the use of a stretcher for transportation;

(d)

Passengers are ambulatory, ambulatory with assistance, or capable of riding in a wheelchair during transport; and

(e)

Passengers do not meet medical necessity requirements of subsection (23).

Drivers must possess a valid driver's license and be state certified as a first responder, EMT-B, EMT-I or EMT-P.

(25)

Operations contract means a contract between an ambulance provider and the parish to provide ambulance service to the parish in response to emergency ambulance calls and nonemergency ambulance calls within Ouachita Parish.

(26)

Operations contractor means the entity providing emergency and nonemergency ambulance service to Ouachita Parish pursuant to the operations contract.

(27)

Patient means an individual who is ill, sick, injured, wounded, or incapacitated (physically or mentally), and who is in need, or is at risk of needing, medical care or assessment at the scene of a call and during transportation to or from a health care facility or should be transported on a stretcher. Only licensed ambulance services may transport patients as defined herein, and they must be transported in ambulance vehicles permitted by the ambulance committee.

(28)

Ambulance service license. Every ambulance service provider as defined in subsection (7) responding to emergency ambulance calls and nonemergency ambulance calls originating in the parish shall be required to obtain an ambulance service license pursuant to this chapter. This ambulance service license authorizes the provider to respond to emergency and nonemergency ambulance calls.

(29)

Permit means any of the permitting documents required to be obtained pursuant to this chapter. The OCOG ambulance committee is authorized to promulgate permitting criteria for medical transportation vehicles in the parish. The following types of permits are allowed:

(a)

Ambulance permit. Every ambulance operated by an ambulance service provider shall be required to obtain a state ambulance permit subject to inspection and recommendation of the licensing officer, pursuant to this chapter. Ambulances shall be permitted as either:

(i)

ALS ambulance vehicle (can be used for ALS, BLS, or NAMTS transports), or

(ii)

BLS ambulance vehicle (can be used for BLS or NAMTS transports).

(30)

System standard of care means the federal, state and local laws, and policies, rules, regulations and protocols that establish standards governing all clinical and operational aspects of the EMS system in Ouachita Parish. Minimum requirements shall include, but not be limited to, the most current standards recommended by the commission on accreditation of ambulance services The OCOG ambulance committee may establish additional minimum standards of care. The licensed ambulance provider shall maintain accreditation with the commission on accreditation of ambulance services during the term of the contract. If the licensed ambulance provider does not hold such accreditation at the commencement of the contract, it must make application for such accreditation within one (1) year from the commencement date of the contract.

(31)

System status controller (SSC) shall be an employee of the EMS lead agency and a person trained and competent as an EMS dispatcher. The minimum standard of training shall be the current edition of "Emergency Medical Services Dispatcher: National Standard Curriculum" as developed by the U.S. Department of Transportation, National Highway Traffic Safety Administration. The SSC must demonstrate competency in (a) receipt and processing of calls for ambulance service, (b) dispatch and coordination of EMS resources, (c) provision of medical information, and (d) coordination with other public safety services. Only qualified SSCs shall be permitted to work in the EMS control center.

(32)

System status plan means the plan and protocols for staffing, deployment, and redeployment of ambulances which is developed and utilized by an ambulance service provider, and which specifies how many ambulances will be staffed and available within the parish each hour of the day, each day of the week, including the locations of available ambulances (not assigned to calls) within the parish, specified separately for each hour of the day, for each day of the week and the remaining number of ambulances then available in the system, and including protocols for event-driven redeployment of those remaining ambulances. The operations contractor is responsible for development and implementation of the system status plan.

(Ord. No. 8858, Art. I, § 6, 11-20-06)