A. The transportation of sick or otherwise injured persons by public or private ambulance is a matter closely affecting the public interest and welfare. It is the policy of the board of supervisors of the county to see that persons requiring ambulance services, as defined hereinafter in Section 5.10.030, receive such service and that such is available and accessible to any person within the county on a twenty-four hour basis. The health, safety and welfare of the residents and visitors of the county require that ambulances be in sound and safe condition and adequately staffed and equipped to provide at least one EMT-II level, or EMT-P, ambulance as the primary response ambulance per licensee and/or primary areas of service, as the minimum level of service.
B. In addition, it is the policy of the board of supervisors that those persons requiring convalescent transport and services, as defined hereinafter in Section 5.10.040, shall be assured that the vehicle is in a sound and safe condition, and is adequately equipped and staffed by appropriately trained personnel.
C. Any county may authorize an advanced life support or limited advanced life support program which provides services utilizing EMT-II or EMT-P, or both, for the delivery of emergency medical care to the sick and injured at the scene of an emergency, during transport to a general acute care hospital, while in the emergency department of a general acute care hospital until care responsibility is assumed by the regular staff of that hospital, and during training within the facilities of a participating general acute care hospital (Section 1797.218 Health and Safety Code).
D. Each county may develop an emergency medical services (EMS) program. Each county developing such a program shall designate a local EMS agency which shall be the county health department, an agency established and operated by the county, an entity with which the county contracts for the purposes of local emergency medical services administration, or a joint powers agency created for the administration of emergency medical services by agreement between counties, or cities and counties (Section 17.97.200 Health and Safety Code).
E. The local EMS agency, using state minimum standards, shall establish policies and procedures to assure medical control of limited advanced life support and advanced life support personnel (Section 1797.220 Health and Safety Code). (Ord. 516 § l(part), 1988).

A. “County” means the County of Madera.
B. “County licensing agency” means the Madera County health department.
C. “Health officer” means the Madera County health officer or other designated official.
D. “Licensee” means any person to whom a county ambulance company and/or a county convalescent transport company license has been issued pursuant to the provisions of this chapter.
E. “Person” means any individual, firm, partnership, association, corporation, company or group of individuals acting together for a common purpose or organization of any kind, including any governmental agency other than the United States. (Ord. 516 § l(part), 1988).

A. “Advanced life support” means special services designed to provide definitive prehospital emergency medical care including, but not limited to, cardiopulmonary resuscitation, cardiac monitoring, cardiac defibrillation, advanced airway management, intravenous therapy, administration of specified drugs and other medical preparations, and other specified techniques under supervision of a base hospital (Section 1797.52 Health and Safety Code; Section 14132 Welfare and Institutions Code).
B. “Ambulance” means any vehicle specially constructed, modified, equipped and used for the purpose of transporting sick, injured, invalid, convalescent, infirm or otherwise incapacitated persons, and containing the equipment and supplies necessary for the level of care provided (Section 51151.1 Administrative Code Title 22; Section 2418.5 Vehicle Code).
C. “Ambulance company” means any private or public entity or person operating one or more ambulances.
D. “Ambulance license” means a county ambulance license certifying an ambulance as having complied with the provisions of this chapter.
E. “Ambulance service” means that operation or service provided by an authorized emergency vehicle, together with a crew meeting all qualifications for skills, including the use of mandatory supplies and equipment to be carried by the vehicle (Sections 165.2418.5 and 2512 Administrative Code Title 13; Section 1797.60 Health and Safety Code).
F. “Attendant” means an individual trained, qualified and who is responsible for the operation of an ambulance and the care of the patients whether or not the attendant also serves as driver (Section 1797.160 Health and Safety Code).
G. “Attendant-driver” means a person who is qualified as an attendant and a driver (Section 1797.160 Health and Safety Code).
H. “Basic life support” means emergency first aid and cardiopulmonary resuscitation procedures which, as a minimum, include recognizing respiratory and cardiac arrest and starting the proper application of cardiopulmonary resuscitation to maintain life without invasive techniques until the victim may be transported or until advanced life support is available (Section 1797.60 Health and Safety Code).
I. “EMCC” means the emergency medical care committee as appointed by the Madera County board of supervisors (Section 1797.270 Health and Safety Code).
J. “EMT-I” means emergency medical technician I (Section 1797.170 Health and Safety Code).
K. “EMT-II” means emergency medical technician II, or a person authorized to provide limited advanced life support (Section 1797.82 Health and Safety Code).
L. “EMT-P” means emergency medical technician paramedic, or a person authorized to provide advanced life support (Section 1797.172 Health and Safety Code).
M. “Limited advanced life support” means special service designed to provide pre-hospital emergency medical care limited to specified techniques and procedures (Section 1797.92 Health and Safety Code).
N. “Mobile intensive care nurse” means a registered nurse certified by the county health officer or his designee as having met specific qualifications (Section 1797.56 Health and Safety Code; Section 2725 Business and Professions Code).
O. “Patient” means a wounded, injured, sick, invalid, convalescent, infirm or otherwise incapacitated person.
P. “Primary areas of service” means those areas of service which are the subject of contract between the ambulance or convalescent transport service and the city and county public entities within the county.
Q. “Primary response ambulance” means an ambulance staffed and equipped to provide EMT-II level or EMT-P level service on a twenty-four hour per day basis within the primary area of service.
R. “Response time” means the time from call received at the ambulance company to arrival of ambulance at the point of need. (Ord. 516 § l(part), 1988).

A. “Convalescent transport company” means any private or public entity operating one or more convalescent transport vehicles.
B. “Convalescent transport license” means a county convalescent transport license certifying a convalescent transport vehicle as having complied with the provisions of this chapter.
C. “Convalescent transport service” means that operational service provided by a convalescent transport vehicle.
D. “Convalescent transport vehicle” means an ambulance or motor vehicle especially constructed or modified, equipped or arranged, or operated for the purpose of commercially transporting patients who could not reasonably be transported by another vehicle, but are not sick, injured or otherwise incapacitated to a degree requiring the services of an ambulance. Convalescent transportation vehicles include, but are not limited to, ambulances, litter vans and wheelchair vans.
Notwithstanding anything to the contrary, nothing in this section is intended to prohibit a convalescent transportation company licensed under this chapter from using litters or gurneys providing convalescent transportation service. (Ord. 516 § l(part), 1988).

The board of supervisors may, by resolution, establish one or more areas of service within the county, and may grant a single license conveying one or more areas of service, or may require a separate application and license for ambulance or convalescent transport services for any area of service (Section 1797.222 Health and Safety Code). (Ord. 516 § l(part), 1988).

The health officer or his designated representative, or any designated and authorized representative of the county, shall have the right to inspect the ambulance or convalescent transport vehicle and equipment of any applicant for a license, or licensee for the purposes of determining compliance with the provisions of this chapter, and all other applicable state and local laws and regulations. The health officer or his designee shall inform the EMCC of any substantive lack of compliance by a licensee not corrected within a reasonable time after such licensee was notified of the violation. (Ord. 516 § l(part), 1988).

It is unlawful for any person or persons to operate, conduct, advertise, market (such market is the minimum contact of office or phone or media advertisement), or otherwise be engaged, in or profess to be engaged in, the ambulance service business, or provide for a charge or a fee for emergency or nonemergency transportation of patients whose condition requires advanced life support services, limited advanced life support services, or those procedures specified pursuant to Section 100015, Title 22, Division 9, Chapter 2, of the California Administrative Code, and related equipment upon the streets, or any public way or place within the county, or any geographic area of service established by the board of supervisors pursuant to this chapter, unless such person or persons hold a current county ambulance license issued for said territory or areas of service pursuant to this chapter, or unless requested by a county official. (Ord. 516 § l(part), 1988).

It is unlawful for any person or persons to operate, conduct, advertise or otherwise be engaged in or profess to be engaged in the convalescent transport business, or provide for a charge or a fee for convalescent transport service upon the streets, or any public way or place within the county, or any geographic area of service established by the board of supervisors pursuant to this chapter unless such person or persons hold a current county convalescent transport license issued for such territory or areas of service pursuant to this chapter. (Ord. 516 § l(part), 1988).

The operation of an ambulance service or convalescent transport service without a license in the county is a misdemeanor subject to the penalties set forth in Section 1.12.010 of this code. (Ord. 516 § l(part), 1988).

Any existing ambulance services or convalescent transport services within ninety days after the effective date of the ordinance codified in this chapter must comply with all provisions of this chapter. Any violation of the standards of performance or other regulatory provisions other than licensing contained in this chapter, or of state law or regulations during the above ninety-day period, may be grounds for denial of a license under this chapter. (Ord. 516 § l(part), 1988).

Application for an ambulance service license or convalescent transport service license hereunder shall be made upon such forms as may be prescribed by the board of supervisors, or an authorized or designated county officer or employee.
A. The application shall contain:
1. The name and address of the applicant and of the owner of the ambulance or convalescent transport service company;
2. The trade or other fictitious name, if any, under which the applicant does business and proposes to do business;
3. A resume specifying the education, training and experience of the applicant in the business of providing patient care and transportation services;
4. A description of each ambulance or convalescent transport vehicle, including the make, model, year of manufacture and motor and chassis numbers; the length of time the ambulance or convalescent transport vehicle has been in use; and the color scheme, insignia, name, monogram or other distinguishing characteristics to be used to designate the applicant’s ambulance or convalescent transport vehicles;
5. The location and description of the geographical area or areas of service within the county, for which the license is sought, if the areas of service have been established by the county;
6. Proof of ability to staff at least one EMT-II (minimum level), or EMT-P, ambulance as the primary response ambulance per licensee and/or primary area of service at all times, and convalescent transport vehicles with persons possessing at least a current American Red Cross First Aid and Personal Safety Certification and a valid Basic Cardiac Life Support card;
7. A certificate of consent to self-insure issued by the director of industrial relations, or a certificate of worker’s compensation insurance issued by an admitted insurer, or an exact copy or duplicate thereof certified by the director of the insurer. The certificate shall state that there is in existence a valid policy or worker’s compensation insurance, the expiration date of the policy, and that the insurer shall give the county at least ten days’ advance notice of a cancellation or nonrenewal of the policy;
8. Such other information as the county shall deem reasonably necessary to a fair determination of compliance with this chapter; and
9. An accompanying license fee to be established by resolution.
B. Applications shall be filed with a designated representative of the county who shall, within sixty days after receipt of a completed application, complete or have completed such investigation as is deemed necessary and submit a recommendation regarding the license to the board of supervisors.
C. The county licensing agency may issue a license hereunder for a specified ambulance service or convalescent transport service to be valid for a period of one year, unless earlier suspended, revoked or terminated, when it finds that the applicant meets the requirements of this chapter as set forth in Sections 5.10.120 through 5.10.150.
D. Applications for renewal of an existing license shall be approved when the county licensing agency finds that the provisions of Sections 5.10.120 through 5.10.150 continue to be met. (Ord. 516 § 1(part), 1988).

A. For ambulance service vehicles, each ambulance to be used, its required equipment and the premises designated in the application shall have been certified by the health officer as provided for in this chapter, and shall have been found by the California Highway Patrol to meet standards as specified in Title 13 of the California Administrative Code, Article 1, Section 1103.2, et al, as well as any vehicle and equipment standards as required by the county health officer, or his designee, in the county Emergency Medical Services Policies and Procedures manual.
B. For convalescent transport service vehicles, each litter and/or wheelchair van shall meet the minimum vehicle and equipment standards as required by any applicable state regulation, as well as any standards as required by the county health officer, or his designee, in administrative policies. (Ord. 516 § l(part), 1988).

A. In the case of ambulance service, only duly licensed ambulance drivers and attendants shall be employed in such capacities.
B. In the case of convalescent transport service, the following personnel standards shall apply:
1. All persons acting as drivers shall possess a current California driver’s license, Class III or higher.
2. All persons serving as attendants shall possess at least a current American Red Cross First Aid and Personal Safety Certificate or equivalent and a valid Basic Cardiac Life Support card.
3. No person shall act in the capacity of a driver or attendant when such person is required by law to register as a sex offender or is convicted of any offense involving force, duress, threat or intimidation.
4. The medical director of the local EMS agency may place on probation any certificate holder or suspend or revoke any certificate issued under the provisions of this chapter and in accordance with guidelines established by the authority upon the finding by that medical director of an imminent threat to the public health and safety as evidenced by the occurrence of any of the following actions:
a. Fraud in the procurement of any certification under this chapter;
b. Gross negligence;
c. Repeated negligent acts;
d. Incompetence;
e. The commission of any fraudulent, dishonest or corrupt act which is substantially related to the qualifications, functions and duties of pre-hospital personnel;
f. Conviction of any crime which is substantially related to the qualification, functions and duties of prehospital personnel. The record of conviction or certified copy thereof shall be conclusive evidence of such conviction;
g. Violating or attempting to violate directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this chapter of the regulations promulgated by the authority pertaining to pre-hospital personnel;
h. Violating or attempting to violate any federal or state statute or regulation which regulates narcotics, dangerous drugs, or controlled substances;
i. Addiction to, the excessive use of, or the misuse of, alcoholic beverages, narcotics, dangerous drugs, or controlled substances.
5. All persons acting in the capacity of driver or attendant shall possess a certificate issued by the local EMS agency indicating compliance with the requirements of this section. Application for such certificate shall be in the form required by the local EMS Agency and shall be accompanied by the fee established by resolution of the board of supervisors. The certificate shall be renewed at least every two years. (Ord. 516 § l(part), 1988).

A. No ambulance or convalescent transport service license shall be issued under this chapter, nor shall such license be valid after issuance, nor shall any ambulance or convalescent transport service be operated in the county unless there is at all times in force and effect insurance coverage, issued by an insurance company licensed to do business in the state of California, for each and every ambulance or convalescent transport vehicle owned or operated by or for the applicant or licensee, providing for the payment of damages:
1. For injury to or death of individuals in accidents resulting from any cause for which the owner of said vehicle would be liable on account of liability imposed on him by law, regardless of whether the ambulance or convalescent transport vehicle was being driven by the owner or his agent; and
2. For the loss of or damage to the property of another, including personal property, under like circumstances, in such sums and under such terms as may be required in regulations promulgated by the county; and
3. For injury or death resulting from malpractice, error or mistake in rendering or failing to render professional services.
B. Liability policy limits shall not be less than one million dollar combined single limit, and the policy shall be endorsed naming the county of Madera, its officers, agents, and employees as additional insureds under such policy.
C. A certificate of insurance shall be submitted to the county licensing agency prior to issuance of each ambulance or convalescent transport service license. The certificate shall show the periods covered, the limits of liability, the expiration date of the policy, and shall state that the insurer shall provide the county with at least sixty days’ advance notice of the cancellation or nonrenewal of the policy. (Ord. 516 § l(part), 1988).

In addition to other requirements of this chapter, the following standards shall be applicable to all holders of licenses for ambulance or convalescent transport services under this chapter:
A. Each ambulance or convalescent transport vehicle used by an ambulance or convalescent transport service, at all times when in use as such, shall:
1. Be suitable for the transportation of patients from the standpoint of health, sanitation and safety, and be maintained in suitable premises; and
2. Contain equipment conforming with the standards, requirements and regulations provided for herein, and by state and federal laws, which equipment shall be in proper and good condition for such use; and
3. Currently comply with all applicable laws and local ordinances relating to health, sanitation and safety.
B. The level of service proposed in the application shall be sufficient to assure all persons using the service adequate ambulance or convalescent transport service as defined by board of supervisors adopted ambulance service objectives and convalescent transport service policy. Standard level of service may be established by resolution of the board of supervisors.
C. All the requirements of this chapter and all other applicable laws and ordinances shall have been met. (Ord. 516 § 1(part), 1988).

For the purpose of determining whether a licensee is maintaining the level of service required by this chapter or standards adopted pursuant to it, or state law, or the specific provisions of the license, the licensee shall submit, at regular intervals to be specified, a copy of all ambulance or convalescent transport service run reports to the county health officer. (Ord. 516 § l(part), 1988).

A. Licensing requirements of this chapter shall not apply to an ambulance, or convalescent transport vehicle, or to the driver or attendant of an ambulance or convalescent transport vehicle which:
1. Is rendering assistance to licensed ambulances in the case of a major catastrophe or emergency with which the licensed ambulances of the county are insufficient or unable to cope; or
2. Is operated pursuant to a Madera County joint powers agreement (continuation-of-call) with another county, or to transport patients picked up at licensed hospitals, nursing homes or extended care facilities within the county to locations beyond the limits of the county; or
3. Is an ambulance or convalescent transport vehicle, or ambulance, or convalescent transport service operated by an agency of the United States, or the state or by any city, county or other governmental agency.
B. Ambulances licensed to provide ambulance services under this chapter do not require a convalescent transport service license to provide convalescent transport services. Any vehicle used for convalescent transport services must meet the convalescent transport vehicle standards. (Ord. 516 § l(part), 1988).

If the operator of a convalescent transport service has reasonable cause to believe that a patient or prospective patient requires, or will require within the time frame of the expected transport, the services of an ambulance rather than convalescent transport, he shall be required to immediately notify the ambulance service company servicing the area to transport the patient. The convalescent transport service is required to report such incidents on the form provided by the licensing agency, within forty-eight hours of occurrence. (Ord. 516 § l(part), 1988).

Any license, certificate or permit issued pursuant to the provisions of this chapter may be suspended, or revoked, or the issuance thereof denied by the board of supervisors, upon recommendation of the EMCC to the licensing agency, or upon independent recommendations of the licensing agency, based upon the grounds set forth in Section 5.10.200 of this chapter and after following the procedures set forth in Sections 5.10.210 through 5.10.230 inclusive, of this chapter. (Ord. 516 § 1 (part), 1988).

A. The board of supervisors, upon recommendation of the EMCC to the licensing agency or upon independent recommendations of the licensing agency, may instruct the county licensing agency to revoke a county license or deny the application therefor, of any person who has not fully complied with all the requirements of Article I, Subchapter 5, Chapter 2, Title 13, of the California Administrative Code, and the provisions of this chapter.
B. The board of supervisors, upon recommendation of the EMCC to the licensing agency, may revoke or suspend a county ambulance service license of any person who does not provide the required minimum level of pre-hospital field care.
C. The board of supervisors, upon recommendation of the EMCC to the licensing agency or upon independent recommendation of the licensing agency, may instruct the county licensing agency to deny the application therefor, of any person who cannot provide proof of ability to provide the required minimum EMT-II, or EMT-P, level of pre-hospital ambulance care upon the granting of the license.
D. The board of supervisors, upon recommendation of the EMCC to the licensing agency or upon independent recommendation of the licensing agency, may instruct the county licensing agency to revoke or suspend the county license or deny the application therefor, of any vehicle which fails to meet the mechanical and equipment requirements set out in state law or regulations, and the provisions of this chapter.
E. Emergency Suspension. The county licensing agency may suspend a license for a violation of this chapter before the EMCC convenes; such suspension of a license may be invoked only upon the finding by the county health officer that the violation cited constitutes an urgent threat to public safety, and that such suspension may not exceed thirty days. (Ord. 516 § l(part), 1988).

A license issued pursuant to the provisions of this chapter may be suspended or revoked only after complying with the following procedures set forth:
A. Upon an alleged violation of any of the provisions of this chapter or other applicable laws and regulations, the licensing agency shall file with the clerk of the board a statement of the charges, and a recommendation shall specify the acts or omissions or charges constituting the violation, and shall specify the chapter sections or other applicable laws or regulations violated.
B. The clerk of the board shall serve a copy of the statement of charges, and recommendation of the licensing agency, upon the licensee charged, by delivering a copy to the licensee by certified mail, postage prepaid, return receipt requested, addressed to the licensee at the place of business as shown on the license application.
C. Within ten days after such service on the licensee, the licensee shall file a written request with the clerk of the board for a hearing upon said charges and recommendations.
D. If no request for a hearing is received from the licensee within said ten days, the hearing shall be deemed waived and the charges admitted. The board may thereupon suspend or revoke the license pursuant to the recommendation of the EMCC.
E. Upon receipt of a request for a hearing, the clerk of the board shall contact the hearing board and arrange a date, time and place for the hearing. Notice thereof shall be given to all parties, by certified mail, postage prepaid, return receipt requested. (Ord. 516 § l(part), 1988).

A. Hearing Officer. The board of supervisors shall, except as stated in subsection B of this section, designate a person to be the hearing officer for any hearing conducted pursuant to this chapter. The hearing officer shall hear all evidence presented and, at the conclusion of the hearing, rule on the charges presented. If the hearing officer determines that there is sufficient evidence to suspend or revoke the license, certificate or permit, then the board of supervisors may thereafter direct the county licensing agency to suspend or revoke the same, subject to right of appeal as set forth hereafter.
B. Hearing Board (Alternate Provision). The board of supervisors shall appoint three members who shall act as the hearing board for the particular hearing for which they are appointed, pursuant to this chapter, excluding EMCC members and agency staff. The hearing board shall hear all evidence presented and, at the conclusion of the hearing, the hearing board shall rule on the charges presented. If the hearing board determines that there is sufficient evidence to suspend or revoke the license, certificate or permit, then the hearing board shall direct the county licensing agency to suspend or revoke the same, subject to right of appeal as set forth hereafter.
C. The hearing officer or three-member board are not bound by the ordinary rules of civil cases and the burden of proof is on the county to be established by a preponderance of the evidence. (Ord. 516 § l(part), 1988).

Any person whose application for a certificate, license or permit is denied, or whose certificate, license or permit is suspended or revoked after a hearing, may appeal to the board of supervisors within thirty days after the date of such denial, suspension or revocation. The appeal shall be in the form of a written notice filed with the clerk of the board of supervisors and signed by the applicant. The notice shall have attached a copy of the written application, suspension or revocation, and shall state clearly and concisely the reasons upon which the appellant relies for his appeal. The clerk of the board of supervisors shall set the matter for hearing within fifteen days after the notice is filed, and shall notify the appellant by certified mail, postage prepaid, return receipt requested, of the setting at least ten days before the hearing by the board. At the hearing, the appellant shall have the burden of establishing to the satisfaction of the board that he is entitled to relief, or otherwise the denial of the application, or the suspension or revocation of the certificate, license or permit, shall stand. The determination of the board of supervisors shall be final. (Ord. 516 § l(part), 1988).