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AMBULANCE SERVICE ORDINANCE
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HARNETT COUNTY, NORTH CAROLINA
Originally Adopted May 4, 1992
with Amendments through April 21, 1997
TABLE OF CONTENTS
Section 1.0 Definitions ............ ............................... 3
Section 2.0 Violations ............. ............................... 4
Section 3.0 Enforcement ........... ............................... 5
Section 4.0 Franchise - Required ..... ............................... 6
Section 5.0 Fee ................. ............................... 7
Section 6.0 Same - Application ...... ............................... 7
Section 7.0
Same - Granting ........ ............................... 8
Section 8.0
Same -Term ........... ...............................
8
Section 9.0
Standards for Ambulance Franchise ..........................
9
Section 10.0
Standards for Drivers and Attendants
........................ 10
Section 11.0
Standards for Vehicles and Equipment
....................... 10
Section 12.0
Standards for Communications ............................
10
Section 13.0
Insurance ............ ...............................
10
Section 14.0
Records ............. ...............................
11
Section 15.0
Rates and Charges ...... ...............................
11
Section 16.0
Inspection of Records Authorized ..........................
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AMBULANCE AND SERVICES ORDINANCE
Section 1.0 Definitions
Unless the context otherwise requires, the following definitions shall apply in the
interpretation and enforcement of this Ordinance:
A. Ambulance: The term "Ambulance" shall mean any publicly or privately owned
vehicle that is specially designed, constructed or modified and equipped, and is
intended to be used for and is maintained or operated for the transportation upon the
streets and highways in this state of persons who are sick, injured, wounded or
otherwise incapacitated or helpless.
B. Ambulance Attendant: The term "Ambulance Attendant" shall mean the individual
who is responsible for the operation of an ambulance and rendering assistance to the
emergency medical technician during the transportation of a patient. The ambulance
attendant shall at least be certified as an ambulance attendant by the state.
C. Ambulance Service: The term "Ambulance Service" shall mean a publicly or
privately owned enterprise that is engaged in the transportation of patients to
emergency and/or non - emergency medical facilities.
D. Approved: The term "Approved" shall mean approved by the state medical care
commission pursuant to the latter's rules and regulations promulgated under G. S.
§14313-165.
E. Back- ug_Ambulance Service: The term 'Back -up Ambulance Service" shall mean
the system of personnel and equipment meeting the same criteria as ambulance
service, but not normally dispatched at first call response.
F. Board: The term "Board" shall mean the Harnett County Board of Commissioners.
G. County: The term "County" shall mean the Board of Commissioners or a
designated representative.
H. Disnatcher: The term "Dispatcher" shall mean a person who is available at all times
to receive requests for emergency services, to dispatch emergency services, and to
advise the City Police, County Sheriff and Emergency Medical Facilities of any
existing or threatened emergencies.
I. Emergency: The term "Emergency" and "Emergency Transportation Service" shall
mean the operation of an ambulance in order to provide medical care and
transportation of a patient who is in need of immediate medical treatment in order
to prevent loss of life or further aggravation of physiological or psychological
illness or injury.
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J. Emergency Medical Technician (EMT): The term "Emergency Medical Technician"
shall mean an individual who has completed the minimum eighty one (81) hour
program for emergency medical technician certification, and is so certified by the
state.
K. First Responder: The term "First Responder" shall mean the first dispatched
medical or rescue aid to arrive at the scene and provide emergency medical
assistance to stabilize the patient while waiting for further medical aid and/or
transport.
L. Franchise: The term "Franchise" shall mean a permit issued by the County to a
person for the operation of an ambulance service.
M. Franchisee: The term "Franchisee" shall designate the holder of a permit issued by
the County for the operation of an ambulance service.
N. License: The term "License" shall mean any driver's license or permit to operate
a motor vehicle issued under or granted by the laws of the state.
O. Non - emergency Transportation Service: The term "Non- emergency Transportation
Service" shall mean the operation of an ambulance for any purpose other than an
emergency.
P. Operator: The term "Operator" shall mean a person in actual physician control of
an ambulance which is in motion or which has the engine running.
Q. Owner: The term "Owner" shall mean any person or entity who owns and operates
an ambulance service.
R. Patient: The term "Patient" shall mean an individual who is sick, injured, wounded
or otherwise incapacitated or helpless.
S. Person: The term "Person" shall mean any individual, firm, partnership, association,
corporation, company, group of individuals acting together for a common purpose
or organization of any kind, including any governmental agency other than the
United States.
T. Rescue: The term "Rescue" shall mean situations where the victim cannot escape
an area through the normal exit or under his own power.
Section 2.0 Violations
A. It shall be a misdemeanor for any person to obtain or receive ambulance service
without intending at the time of obtaining or receiving such services to pay, if
financially able, the necessary charges. A determination that the recipient of such
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services has failed to pay for the services rendered for a period of ninety (90) days
after request for payment, and that the recipient is financially able to do so, shall
raise a presumption that the recipient of the services did not intend to pay for the
services at the time they were obtained or received.
B. Violation of this article or the terms of any franchise granted hereunder shall be a
misdemeanor as provided by G. S. §14 -4. Each such violation also shall subject the
offender to a civil penalty in the amount of one hundred dollars ($100.00) for each
separate breach of the franchise or violation of this article. This civil penalty must
be paid within ten (10) days after the hearing on the citation has been held as
provided in Section 2- 7- 38(b). if not so paid, such penalty may be recovered by the
County as provided by G. S. §153A- 123(c). If the civil penalty is not paid within
the ten (10) days as provided for above, the County may suspend or revoke the
franchise.
Section 3.0 Enforcement
The Harnett County Office of Emergency Medical Services shall be the enforcing agency
for the regulations contained in this article. Such office will:
A. Receive all franchise proposals from potential providers.
B. Study each proposal for conformance to this article.
C. Recommend to the Board of Commissioners the award of the franchise(s) to the
applicants submitting the best proposal(s).
D. Inspect the premises, vehicles, equipment and personnel of franchisees to assure
compliance to this article and perform any other inspections that may be required.
E. Recommend the temporary or permanent suspension of a franchise in the event of
noncompliance with the franchise terms of this article; recommend the imposition
of misdemeanor or civil penalties as provided therein.
F. Ensure by cooperative agreement with other ambulance services the continued
service in a district where an ambulance service franchise has been suspended.
G. Receive monthly reports from ambulance services and consolidate the same into a
quarterly summary for review by the Board.
H. Receive complaints from the public, other enforcing agencies and ambulance
services regarding franchise infractions; review the complaint with the council;
obtain corrective action with the approval of the Board.
I. Recommend improvements to the County which will ensure better medical
transportation.
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J. Maintain all records required by this article and other applicable County regulations.
K. Perform such of the above functions as may be required by any municipality within
the County.
Section 4.0 Franchise - Required
A. No person, either as owner, agent or otherwise, shall furnish, operate, conduct,
maintain, advertise or otherwise be engaged in or profess to be engaged in the
business or service of emergency and/or non - emergency transportation of patients
within the County unless the person holds a valid permit for each ambulance used
in such business or service issued by the office of emergency medical services of
the state department of human resources and has been granted a franchise for the
operation of such business or service by the County pursuant to this article. All
ambulance and rescue units currently operating will have six (6) months to comply
with this Ordinance and apply for a franchise. If existing Ambulance and Rescue
Units fail to comply they will be required to cease operation.
B. No person shall drive, attend or permit a vehicle to be operated for ambulance
purposes within the County unless he holds a currently valid certificate as an
ambulance attendant or emergency medical technician issued by the state.
C. No franchise shall be required for:
1. Any entity rendering assistance to a franchised ambulance service in
the case of a major catastrophe or emergency with which the services
franchised by the County are insufficient or unable to cope; or
2. Any entity operated from a location or headquarters outside the
County in order to transport patients who are picked up beyond the
limits of the County, but no such entity shall be used to pick up
patients within the County for transporting to locations within the
County or other locations unless it is rendering assistance as referred
to in (1) above; or
3. Any entity that picks up patients within the County for transporting to
locations outside the County over fifty (50) miles from the County boundary
line; or
4. Law enforcement personnel; or
5. A non - profit corporation organized under the laws of the State of North
Carolina which provides emergency ambulance and rescue service pursuant
to or as the result of a valid contract with the County of Harnett; or
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6. In those situations where the patient or his designee should make a written
request for non - emergency transport by a non - franchised entity to the County
EMS Director and said transport is approved by both the EMS Director and
the County Manager. The approval or non - approval of this request will be
at the sole discretion of the EMS Director and the County Manager whose
decision shall be based on the particular needs of the patient and the
County's ability to provide service under the circumstances of each particular
case.
Section 5.0 Fee
The fee for applying for a franchise shall be in the amount designated by the Harnett
County Board of Commissioners.
Section 6.0 Same- Annlication
Application for a franchise to operate ambulances in the County shall be made upon such
forms as may be prepared or prescribed by the County and shall contain:
A. The name and address of the applicant and of the owner of the ambulance.
B. The trade or other fictitious names, if any, under which the applicant does business,
along with a certified copy of an assumed name certificate stating such name or
articles of incorporation stating such name.
C. A resume of the training and experience of the applicant in the transportation and
care of patients.
D. A description and copy of state certification for each ambulance owned and operated
by the applicant.
E. The location and description of the place or places from which it is intended to
operate.
F. Audited financial statement of the applicant as the same pertains to the operations
in the County, such financial statement to be in such form and in such detail as may
be required by the County.
G. A description of the applicant's capability to provide twenty four (24) hour
coverage, seven (7) days per week for the district covered by the franchise applied
for, and an accurate estimate of the minimum and maximum times for a response
to calls within such district.
H. Any information the County shall deem reasonably necessary for a fair
determination of the capability of the applicant to provide ambulance service in the
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County in accordance with the requirements of state laws and the provisions of this
article.
Section 7.0 Same- Grantins
A. Prior to accepting applications from applicants for the operation of an ambulance
service, the County may designate specific service areas as franchise districts, which
districts will be established on criteria that include geographic size, road access, the
location of existing medical transportation services, population and response time.
The County shall have the authority to redistrict or rearrange existing districts at any
time at its discretion.
B. An applicant may apply for a franchise to operate either emergency transportation
service or non - emergency transportation service. If both types of service are to be
provided, separate application must be filed for each type.
An applicant may also apply for a limited franchise to operate for a particular
purpose. If such a limited franchise is granted by the County then the franchise
shall specify the conditions of operation and the franchisee shall be limited and
adhere to that scope of operation.
C. Upon receipt of an application for a franchise, the County shall schedule a time and
place for hearing the applicant. Within thirty (30) days after hearing, the County
shall cause such investigation as it may deem necessary to be made of the applicant
and his proposed operations.
D. A franchise may be granted if the County finds that:
1. The public convenience and necessity require the proposed
ambulance service.
2. Each such ambulance of the applicant, his required equipment and the
premises designated in the application have been certified by the
County and state.
3. Only duly licensed ambulance attendants and emergency medical
technicians are employed in such capacities.
Section 8.0 Same -Term
A. The County may issue a franchise hereunder to an owner of an ambulance service,
to be valid for a term to be determined by the County. Either party, at its option,
may terminate the franchise upon sixty (60) days prior written notice to the other
party. After a notice of service termination is given, the ambulance service shall
reapply for a franchise if continued service is desired.
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B. If any franchisee shall violate or fail to comply with any provision of this article or
a franchise issued hereunder, the franchisee shall be cited by the County for
violation or failure to comply. The County, after a hearing pursuant to this citation,
may impose a civil penalty of one hundred dollars ($100.00) for each separate
breach of the franchise as provided in section 7.0 or may suspend or revoke the
franchise. If upon such hearing the County shall find that the franchisee has
corrected any deficiencies and has brought his operation into compliance with the
provisions of this article, the franchise shall not be suspended or revoked, but a civil
penalty as provided in section 7.0 may be imposed.
C. Upon suspension, revocation or termination of a franchise granted hereunder, such
franchised ambulance service immediately shall cease operation. Upon suspension,
revocation or termination of a driver's license or attendant's certificate or emergency
medical technician certificate, such person shall cease to drive an ambulance or
provide medical care in conjunction with an ambulance service, or attend an
ambulance; and no person shall employ or permit such individual to drive an
ambulance or provide medical care in conjunction with an ambulance service.
Section 9.0 Standards for Ambulance Franchise
A. Each franchised ambulance service shall comply at all times with the requirements
of this article, the franchise granted hereunder, and all applicable state and local
laws relating to health, sanitation, safety, equipment and ambulance design, and all
other laws and ordinances.
B. Prior approval of the County shall be required where ownership or control of more
than ten percent (10) of the right of control of a franchisee is acquired by a person
or group of persons acting in concert, none of whom own or control ten percent
(10 %) or more of such right of control, singularly or collectively, at the date of the
franchise. By its acceptance of the franchise, a franchisee specifically agrees that
any such acquisition occurring without prior approval of the County shall constitute
a violation of the franchise by the franchisee and shall be cause for termination at
the option of the County.
C. Any change of ownership of a franchised ambulance service without the approval
of the County shall terminate the franchise and shall require a new application and
a new franchise and conformance with all the requirements of this article as upon
original franchising.
D. No franchise may be sold, assigned, mortgaged or otherwise transferred without the
approval of the County and a finding of conformance with all requirements of this
article as upon original franchising. Each franchised ambulance service, its
equipment and the premises designated in the application and all records relating to
its maintenance and operation as such, shall be open to inspection by the state, the
County or their designated representatives.
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E. No official entry made upon a franchise may be defaced, removed or obliterated.
Section 10.0 Standards for Drivers and Attendants
Standards for drivers and attendants as developed by the state medical care commission as
requirements for certification of ambulance attendants and emergency medical technicians
pursuant to G. S. Article 26, Chapter 130 ( §130 -233), and Article 56, Chapter 143 ( §143-
507 et seq), shall be applied; and the same are incorporated herein by reference.
Section 11.0 Standards for Vehicles and Equipment
Vehicle and equipment standards as developed by the state medical care commission
pursuant to G. S. Article 26, Chapter 130 ( §130 -232), and Article 56, Chapter 143 ( §143-
507 et seq), shall be applied; and the same are incorporated herein by reference.
Section 12.0 Standards for Communications
A. Each ambulance must be equipped with a two -way VHF radio licensed by the
Federal Communications Commission which must be in operative condition at all
times. The radios must have two (2) crystals which shall be 155.280 and 155.340
megahertz with four channel capability.
B. Each ambulance service shall provide the County a copy of the Federal
Communications Commission license authorizing the use of the communication
equipment owned and operated by that service.
C. Each base of operations must have at least one (1) open telephone line. Telephone
numbers must be registered with each law enforcement agency and communications
center in the County.
Section 13.0 Insurance
No ambulance franchise shall be issued under this article, nor shall such franchise be valid
after issuance, nor shall any ambulance be operated in the County unless there is at all
times in force and effect either insurance coverage, issued by an insurance company
licensed to do business in this state, or a bond with personal or corporate surety, for each
ambulance owned and/or operated by or for the ambulance service, providing for the
payment of damages:
A. In the sum of one million dollars ($1,000,000.00) for injury to or death of
individuals in accidents resulting from any cause for which the owner of the vehicle
would be liable on account of liability imposed on him by law, regardless of
whether the ambulance was being driven by the owner or his agent; and
B. In the sum of five hundred thousand dollars ($500,000.00) for the loss of or damage
to the property of another, including personal property, under like circumstances,
in sums as may be required by the state or as approved by the County.
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Section 14.0 Records
A. Completed State Ambulance Call Reports (ACR)
B. Record of dispatch, which shall show time call was received, time ambulance
dispatched, time arrived on scene, time arrived at destination, time in service and
time returned to base.
C. Trip record, which shall state all information required in subsection (A) in addition
to patient's address and telephone number, condition of patient, type of medical
assistance administered before reaching hospital, total trip miles, schedule of
changes, and name of attendant and driver. The trip record shall be so designed as
to provide the patient with a copy thereof containing all required information. A
copy of the trip record may serve as a receipt for any charges paid.
D. Daily report log, which shall be maintained for the purpose of identifying all
persons transported in any one day.
E. Daily driver and attendant checklist and inspection report which shall list contents
and description of operations for each vehicle, signed by the individual verifying
vehicle operations and equipment.
F. Data sheet, to be submitted on a monthly basis to the Harnett County Department
of Emergency Medical Services.
Section 15.0 Rates and Charges
A. Each franchisee shall submit a schedule of rates to the County for approval and
shall not charge more nor less than the approved rates without specific approval by
the County.
B. No ambulance service shall attempt to collect rates on emergency calls until the
patient has reached the point of destination, has received medical attention and is
in a condition deemed by the physician fit to consult with the ambulance service;
but such service may attempt to collect rates with the family or guardian of the
patient once the patient is in the process of receiving medical attention.
C. On non - emergency calls, or calls where a person requires transportation to a non -
emergency facility, attempts to collect payment can be made before the ambulance
begins its trip.
Section 16.0 Inspection of Records Authorized
The County may inspect a franchisee's records, premises and equipment at any time in
order to ensure compliance with this article and any franchise granted hereunder.
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Duly adopted on this the 21st day of April, 1997.
HARNETT COUNTY BOARD OF COMMISSIONERS
Dan B. Andrews, Chairman
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Kay BUnchard, Clerk to the Board
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