CENTRAL CALIFORNIA EMERGENCY MEDICAL SERVICES
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1 CENTRAL CALIFORNIA EMERGENCY MEDICAL SERVICES A Division of the Fresno County Department of Public Health Manual Subject References Emergency Medical Services Administrative Policies and Procedures Authorization of Ambulance Provider Agencies in Fresno County Division 2.5 of California Health & Safety Code, California Vehicle Code; Fresno County Ambulance Ordinance and Resolutions; Title 13 of the California Code of Regulations; and Title 22 of the California Code of Regulations Policy Number 200 Page 1 of 4 Effective 01/01/97 I. POLICY Ambulance Provider Agencies operating within Fresno County will be authorized by the EMS Agency and Fresno County for the appropriate level of service in accordance with established policy and procedures. II. DEFINITIONS A. Ambulance Dispatch Center - The Fresno County EMS Communications Center is the dispatch center authorized by the EMS Agency to provide ambulance dispatch services for Fresno County. B. Ambulance Provider Agency/Provider Agency - A private or public entity, or individual utilizing any ground, water, or air vehicle specifically designed, constructed, modified, equipped, arranged, maintained, operated, used or staffed, including vehicles specifically licensed or operated pursuant to California Vehicle Code Section 2416, for the purpose of transporting sick, injured, invalid, convalescent, infirm, or otherwise incapacitated persons and which has met all license and other requirements in applicable Federal, State, and local law and regulation (Section of Title 22 of the California Code of Regulations and Section (a) of Title 13 of the California Code of Regulations). C. Ambulance Service Area - A specific geographic area within Fresno County established in EMS Policy and Procedure and within the provider agency s written agreement with the County of Fresno (Attachment A). D. Exclusive Operating Area (EOA) - An exclusive operating area is an area defined by the County Emergency Medical Services Plan for which the EMS agency, upon the recommendation of the County and pursuant to Division 2.5 of the Health and Safety Code, restricts operations to one or more providers of emergency ambulance service, limited advanced life support services, or advanced life support services. E. Exclusive Operating Area Provider (EOA Provider) The ambulance provider contracted for the provision of emergency ambulance and advanced life support ambulance services for a designated exclusive operating area. F. Non-Exclusive Operating Area (Non-EOA) - A non-exclusive operating area is an area defined by the County Emergency Medical Services Plan for which the EMS agency does not restrict operations to one or more providers of emergency ambulance service or advanced life support services (paramedic) ambulance service. Approved By EMS Medical Director Daniel J. Lynch (Signature on File at EMS Agency) Jim Andrews, M.D. (Signature on File at EMS Agency) Revision 1/1/2018
2 Page 2 of 4 Subject Authorization of Ambulance Provider Agencies in Fresno County Policy Number 200 III. PROCEDURE A. Exclusive Operating Areas 1. The Fresno County Exclusive Operating Area - The EOA is composed of the northern portion of the geographic area of Fresno County as specified in Attachments B-1 and B-2. The EOA includes the cities of Fresno, Clovis, Firebaugh, Kerman, Mendota and San Joaquin. 2. The Reedley Exclusive Operating Area This EOA is located in the South-East area of Fresno County as specified in Attachments C-1 and C-2. The EOA includes the Cities of Reedley, Parlier, and Orange Cove, the communities of Squaw Valley, Dunlap, and portions of Kings Canyon National Park. It is designated the Reedley EOA and is Ambulance Zone J. B. Non-Exclusive Operating Areas The following non-exclusive areas are the only geographic areas in Fresno County not initially included as part of the Fresno County or Reedley EOAs: Coalinga/Huron Service Area - Zone C; Selma/Fowler Service Area - Zone G; Sanger/Pine Flat Reservoir Service Area - Zone I; Kingsburg Service Area - Zone K; and The potential exists that, during the term of the County s exclusive operating agreement with the Fresno County EOA Provider for the provision of emergency ambulance services, one or more of the current nonexclusive provider agencies may discontinue or significantly reduce the scope and scale of its operation. In any such case, the County and EMS Agency may require the Fresno County EOA Provider to implement non-exclusive emergency ambulance services within such area(s). C. First Responder Services The County and EMS Agency reserve the right to allow providers, other than ambulance providers, to operate enhanced first responder services for 911 responses, including, but not limited to, advanced life support (paramedic), advanced EMT, or BLS-defibrillation first responder services, within Fresno County. D. Air Ambulance / Air Rescue Services The County and EMS Agency reserve the right to allow providers, other than ambulance providers, to operate advanced life support air ambulance and/or air rescue services within the Fresno County, including the EOAs. This includes flights and air transportation within Fresno County from air providers responding from outside of Fresno County. Unless the air ambulance/air rescue provider is based within Fresno County, no agreement or licensure is required. Dispatch for helicopter air ambulance/air rescue services shall be provided consistent with EMS Agency Policies and Procedures. E. Non-Emergency Transports The County or EMS Agency do not restrict the provision of non-emergency transportation services in EOAs or Non-EOAs that may be provided by entities other than an emergency ambulance service and which do not require vehicles equipped with emergency lights and siren pursuant to California Vehicle Code Section 2416, including, but not limited to, services provided by wheel chair or litter van services. However, providers using ambulance type vehicles for non-emergency medical transportation must remove and/or cover their light-bar and emergency lights if operating within Fresno County. F. Ambulance Dispatch Center The County of Fresno operates a county-wide and centralized ambulance dispatch center through the Fresno County EMS Communications Center. All ambulances in Fresno County
3 Page 3 of 7 Subject Authorization of Ambulance Provider Agencies in Fresno County Policy Number 200 shall receive the primary dispatch of medical incidents from the Fresno County EMS Communications Center. G. Limited Exceptions to the Ambulance Service Areas (including EOAs) Services provided to Ambulance Service Areas (including EOAs) shall encompass the operation of all ground emergency ambulance services with the following exceptions: 1. Disaster Assistance - Ambulances providing assistance at the County s request during disaster incidents may operate within the EOA. 2. Instant Aid/Mutual Aid - The provision of ambulance services pursuant to and requested in accordance with EMS Agency Policies and Procedures and/or under formal instant aid and mutual aid agreements between the ambulance provider and a third party that has been reviewed and approved by the EMS Agency, shall be an exception to the service area. 3. Contracted Specialty Care Units - Ambulance services providing specialty interfacility care and transportation (e.g., neonatal/pediatric transport or critical care transport) utilizing a registered nurse and/or physician staffing, may utilize ambulance vehicles equipped with red emergency warning light and siren only for interfacility transports. Such vehicles and personnel may not be utilized for prehospital responses and such units may not be staffed by paramedics in the place of registered nurses and/or physicians. This includes neonatal and pediatric transport services under contract to Valley Children s Hospital. 4. Veteran s Administration (VA) Contract Ambulance Services - Ambulance services operating pursuant to a federal contract for direct purchase of ambulance services for the Veteran s Administration shall be exempt from the EOA solely for the purpose of servicing that contract. Note: For the purposes of this policy and the exclusive operating areas, Medicare and Medicaid (Medi- Cal) authorizations or other arrangements for reimbursement for services shall be considered a reimbursement arrangement - not a federal or state contract for direct purchase of ambulance services. H. Ambulance Service Areas Ambulance service area boundaries, as established by the local EMS Agency Policies and Procedures, shall be used in determining the dispatching of ambulances within Fresno County. These ambulance service area boundaries include the exclusive operating area and non-exclusive operating areas within Fresno County (see Attachment A). Ambulance response zones within these ambulance service areas have been designated by the EMS Agency through EMS Policy which defines the geographic areas for data collection and identification of the primary ambulance unit and any applicable back-up ambulance units. I. Approved Ambulance Provider Agencies 1. Fresno County EOA - The EMS Agency, in conjunction with Fresno County has designated a single provider agency -- American Ambulance -- for the provision of emergency ambulance services within the Fresno County exclusive operating area, which includes all emergency ambulance services, emergency responses, 7-digit emergency responses, advanced life support ambulance, all critical care transport services, advanced life support interfacility transports, and stand-by services with transport authorization. Therefore, no other ground ambulance provider agencies will be designated for services which are within the geographic area and scope of the exclusive operating area (See Attachment B). 2. Reedley EOA - The EMS Agency, in conjunction with Fresno County has designated a single provider agency -- Sequoia Safety Council -- for the provision of emergency ambulance services within the Reedley exclusive operating area, which includes and 7-digit response, stand-by
4 Page 4 of 7 Subject Authorization of Ambulance Provider Agencies in Fresno County Policy Number 200 service with transport authorization. Therefore, no other ground ambulance provider agencies will be designated for services which are within the geographic area and scope of the exclusive operating area (See Attachment C). 3. Non-Exclusive Ambulance Providers - The EMS Agency, in conjunction with Fresno County has designated the following non-exclusive providers for the provision of emergency ground ambulance services within Fresno County: Ambulance Zone Zone Description Provider Zone C Coalinga / Huron Area Coalinga Fire Dept Zone G Selma / Fowler Area Selma Fire Dept Zone I Sanger / Pine Flat Area Sanger Fire Dept Zone K Kingsburg Area Kingsburg Fire Dept 4. Anyone desiring to provide ground or air ambulance service within a particular service area shall comply with all relevant sections of the Fresno County Ambulance Ordinance and Resolutions and obtain an ambulance provider agreement with the local EMS Agency (unless the air ambulance/air rescue provider is responding from outside of Fresno County, in which case the provider is exempt from the agreement requirement in accordance with Section III.D.). As applicable, such services would be for non-exclusive operating areas within the County of Fresno or for services which are outside the scope of the exclusive operating area. 5. Ambulance operations within Fresno County shall be conducted in strict accordance with all applicable Federal, State, and local codes and regulations including the provisions of the California Health and Safety Code, Title 13 and Title 22 of the California Code of Regulations, the California Vehicle Code, local municipal and county codes and regulations, including Fresno County Ambulance Provider Agreements and local EMS Agency policies and procedures. 6. The local EMS Agency shall be notified in writing no less then sixty (60) days prior to an ambulance provider agency changing their level of service (i.e., ALS to BLS), or of their intent to discontinue providing ambulance service within a service area(s).
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7 Exclusive Operating Area - Description I. is based upon the 2010 Census Tracts. II. The following Census Tracts comprise the Fresno County Exclusive Operating Area: Census Tract Census Tract # 1 Census Tract # 2 Census Tract # 3 Census Tract # 4 Census Tract # 5.01 Census Tract # 5.02 Census Tract # 6 Census Tract # 7 Census Tract # 8 Census Tract # 9.01 Census Tract # 9.02 Census Tract # 10 Census Tract # 11 Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Description
8 Description Fresno County EOA Page 2 Census Tract # Census Tract # 14.1 Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # 15 Census Tract # 16 Census Tract # 17 Census Tract # 18 Census Tract # 19 Census Tract # 20 Census Tract # 21 Census Tract # 22 Census Tract # 23 Census Tract # 24 Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # 28 Includes the area NORTH of American Avenue and WEST of DeWolf Avenue Includes the area NORTH of South Avenue and WEST of Maple Avenue; and includes the area NORTH of Adams Avenue and WEST of Highway 99 (Including SOUTH BOUND lanes of Highway 99 to Adams Ave)
9 Description Fresno County EOA Page 3 Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # 34 Census Tract # 35 Census Tract # 36 Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # 38.09
10 Description Fresno County EOA Page 4 Census Tract # 38.1 Census Tract # 39 Census Tract # Census Tract # Census Tract # 41 Census Tract # Census Tract # Census Tract # Census Tract # 42.1 Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # 45.04
11 Description Fresno County EOA Page 5 Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # 50 Census Tract # 51 Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # 54.09
12 Description Fresno County EOA Page 6 Census Tract # 54.1 Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # 55.1 Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # 55.2 Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # 57.01
13 Description Fresno County EOA Page 7 Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # Census Tract # 73 Includes all of the area NORTH of Kings Canyon Road; and includes the area WEST of DeWolf Avenue Includes the area NORTH of Ashlan Avenue Includes the area NORTH of Ashlan Avenue and WEST of Watts Valley Road Includes the all of the area NORTH of the following boundary - a straight line from the intersection of Watts Valley Road and the Friant Kern Canal EAST to the intersection of Trimmer Springs Road and Sunnyslope Road and then following Trimmer Springs Road EAST to the intersection of Trimmer Springs Road and Balch Camp Road Includes all of the area WEST of East Avenue
14 Description Fresno County EOA Page 8 Census Tract # 74 Includes all of the area WEST of Highway 43 Census Tract # 75 Census Tract # 76 Census Tract # 77 Census Tract # Census Tract # 82 Census Tract # Census Tract # Census Tract # Census Tract # Includes all of the area NORTH of the following boundary - A line from the intersection of Mt. Whitney and Colusa Avenue SOUTHEAST to the intersection of Fresno-Coalinga Road and Butte Avenue, then EAST to the intersection ofgoldenrod and Paige, and then SOUTHEAST to the intersection of Jameson Avenue and Oakland Avenue and thethen EAST to the boundary of Lemoore Naval Air Station (Dickenson Avenue and Oakland Avenue)
15 ATTACHMENT C-1 Reedley EOA
16 Exhibit C-2 Description of Reedley EOA Ambulance Zone J The following Census Tracts (Year 2000 Census Tracts) and descriptions comprise the Rural Response Area of Ambulance Zone J: Census Tract #63 Includes all of the area SOUTHEAST of the following boundary from the intersection of the Cameron Slough and the Kings River, NORTHEAST along the Cameron Slough to the intersection of Reed Avenue and the Cameron Slough and then SOUTH on REED Avenue to Kings Canyon Road and then EAST on Kings Canyon Road to the Friant-Kern Canal. Census Tract #64.03 Includes all of the area SOUTH of Kings Canyon Road and WEST of Cove Road. Census Tract #65 Includes all of Census Tract. Census Tract #68.01 Includes all of the area EAST of Mendocino Avenue and NORTH of Floral Avenue. Census Tract #68.02 Includes all of the area WEST of Smith Road, except for the area SOUTH of Floral Avenue. Census Tract #69 Includes all of the area SOUTHEAST of the Cameron Slough. Census Tract #64.02 Excluding all of the area SOUTH of Kings Canyon Road and WEST of Cove Road. Attachment C-2
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