CENTRAL CALIFORNIA EMERGENCY MEDICAL SERVICES

Transcription

1 CENTRAL CALIFORNIA EMERGENCY MEDICAL SERVICES 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. D. Exclusive Operating Area - 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 (EMT-II), or advanced life support services (paramedic). 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 A-1 and A-2. The EOA includes all or portions of the cities of Fresno, Clovis, Firebaugh, Mendota and San Joaquin. Approved By EMS Division Manager EMS Medical Director Signatures on File at EMS Agency Signatures on File at EMS Agency Revision 7/1/2005

2 Page 2 of 4 Subject Authorization of Ambulance Provider Agencies in Fresno County Policy Number The Reedley Exclusive Operating Area This EOA is located in the South-East area of Fresno County as specified in Attachments B-1 and B-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. 3. The following non-exclusive areas are the only geographic areas in Fresno County not initially included as part of the EOA (but such areas may be included in the Fresno County EOA, as provided herein): Dos Palos Service Area - Zone A; Coalinga/Huron Service Area - Zone C; Selma/Fowler Service Area - Zone G; Sanger/Pine Flat Reservoir Service Area - Zone I; Reedley/Orange Cove/Parlier Service Area - Zone J; Kingsburg Service Area - Zone K; and Kerman/North Central Area - Zone N. The County and the EMS Agency shall have the sole option, in their discretion, to incorporate at any time the geographic areas initially designated as non-exclusive areas into the EOA, thereby requiring the Contractor 1 to be responsible for providing emergency ambulance services and advanced life support (paramedic) ambulance services to these areas. 2 The potential exists that, during the term of the County s exclusive operating agreement with the Contractor for the provision of emergency ambulance services and advanced life support (paramedic) ambulance services, one or more of the current non-exclusive 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 Contractor to implement services under that Agreement within such area(s) and that such area(s) be incorporated into the EOA, as provided herein. Pursuant to this Section III.A.2., the following service area has been incorporated into the EOA: Dos Palos Service Area - Zone A (incorporated into EOA as of November 7, 1998). 4. The County and EMS Agency reserve the right to allow providers other than the Contractor to operate enhanced first responder services for 911 responses, including, but not limited to, advanced life support (paramedic) or BLS-defibrillation first responder services, and to operate advanced life support (paramedic) air ambulance and/or air rescue services within the EOA. This includes flights and air transportation within the EOA. Dispatch for helicopter air ambulance/air rescue services shall be provided consistent with EMS Agency Policies and Procedures. 5. The EOA does not restrict the provision of non-emergency transportation services 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, 1 All references to AContractor@ in this Section III, herein, shall mean the single provider agency for the provision of emergency ambulance services and advanced life support (paramedic) ground ambulance services within the exclusive operating area referred to in Section III.C., herein. 2 However, for Dos Palos Service Area Zone A, upon termination of the County s agreement with the out-of-county non-exclusive provider which had been providing ambulance services to this area since the effective date of this policy, this service area automatically will be incorporated into the EOA by the EMS Agency, upon notice to the Contractor, and the Contractor thereupon shall be responsible for providing emergency ambulance service and advanced life support (paramedic) ground ambulance service to this area.

3 Page 3 of 4 Subject Authorization of Ambulance Provider Agencies in Fresno County Policy Number 200 including, but not limited to, services provided by wheel chair or litter van services. However, providers of non-emergency medical transportation must remove and/or cover their light-bar and emergency lights if operating within the Fresno County exclusive operating area. 6. Limited Exceptions to the EOA The EOA shall encompass the operation of all ground emergency ambulance services and advanced life support (paramedic) ground ambulance services within the EOA with the following exceptions, in which cases the EOA shall not apply to such services: a. Disaster Assistance - Ambulances providing assistance at the County s request during disaster incidents may operate within the EOA. b. 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 exclusive operating provider and a third party that has been reviewed and approved by the County and EMS Agency, shall be exempt from the EOA for that specific incident. c. Contracted Specialty Care Units - Ambulance services providing specialty interfacility care and transportation (e.g., neonatal/pediatric transport or critical care transport) utilizing registered nurse and/or physician staffing, under a contract with a hospital or health maintenance organization and transporting patients during interfacility transfers, 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. d. 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. e. Federally Operated Ambulances - Ambulance services, provided either by an agency of the federal government or a person or entity pursuant to a contract with such agency, shall be exempt from the EOA solely for the purpose of services to that federal facility/agency. Such exception shall not extend to ambulance services provided to the general public except when such members of the public are at such federal facility. f. State Operated and Contracted Ambulances - Ambulance services, provided either by an agency of the state government or a person or entity pursuant to a contract with such agency, shall be exempt from the EOA solely for the purpose of services to that state facility/agency. Such exception shall not extend to ambulance services provided to the general public except when such members of the public are at such state facility. For the purposes of this policy and the exclusive operating area, 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.

4 Page 4 of 4 Subject Authorization of Ambulance Provider Agencies in Fresno County Policy Number 200 B. 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. 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. C. Ambulance Provider Agency 1. The EMS Agency, in conjunction with Fresno County has designated a single provider agency -- American Ambulance -- for the provision of emergency ambulance services and advanced life support (paramedic) ground ambulance services within the Fresno County exclusive operating area designated by the EMS Agency pursuant to the EMS Plan. 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. 2. The EMS Agency, in conjunction with Fresno County has designated a single provider agency -- Sequoia Safety Council -- for the provision of emergency ground ambulance services within the Reedley exclusive operating area designated by the EMS Agency pursuant to the EMS Plan. 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. 3. Anyone desiring to provide ambulance service within a particular service area shall comply with all relevant sections of the Fresno County Ambulance Ordinance and Resolutions and, as applicable, obtain a provider agency agreement with the local EMS Agency. 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. 4. 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 local EMS policies and procedures. 5. 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).

5 ATTACHMENT A-1 Fresno County EOA Attachment B-2

6 Exclusive Operating Area - Description (Revised 11/7/98) I. is based upon the 1990 Census Tracts. II. The following Census Tracts comprise the Metro\Urban Area of the EOA: Census Tract #1 - Includes all of Census Tract. Census Tract #2 - Includes all of Census Tract. Census Tract #3 - Includes all of Census Tract. Census Tract #4 - Includes all of Census Tract. Census Tract #5 - Includes all of Census Tract. Census Tract #6 - Includes all of Census Tract. Census Tract #7 - Excluding the area WEST of Hughes Avenue and SOUTH of Kearney Boulevard. * Census Tract #8 - Excluding the area WEST of Hughes Avenue and NORTH of Grove Avenue. * Census Tract #9 - Includes all of Census Tract. Census Tract #10 - Includes all of Census Tract. Census Tract #11 - Includes all of Census Tract. Census Tract #12 - Includes all of Census Tract. Census Tract #13 - Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract #16 - Includes the area NORTH of American Avenue and WEST of DeWolf Avenue Census Tract #17 - Includes the area NORTH of South Avenue and WEST of Maple Avenue; and includes all of the area NORTH of Adams Avenue.

7 Description - Exclusive Operating Area Page 2 Census Tract #18 - Includes all of Census Tract. Census Tract #19 - Excludes the area NORTH and WEST of the following boundary - line from the intersection of Bryan Avenue and Central Avenue NORTH to Jensen Avenue and then EAST to Valentine Avenue and then NORTH to Grove Avenue and then EAST to Marks Avenue. * Census Tract #20 - Excludes the area bounded by a WESTERN boundary of Marks Avenue, a SOUTHERN boundary of the Southern Pacific Railroad Tracks, a EASTERN boundary from the Southern Pacific Railroad Tracks NORTH on Hughes Avenue to White Street then diagonally in a NORTH-EASTERN direction to Hulbert Avenue then EAST to Sequoia Avenue then NORTH to Dennett Avenue then WEST to Hughes Avenue then NORTH to Olive Avenue, and a NORTHERN boundary of Olive Avenue. * Census Tract #21 - Includes all of Census Tract. Census Tract #22 - Includes all of Census Tract. Census Tract #23 - Includes all of Census Tract. Census Tract #24 - Includes all of Census Tract. Census Tract #25 - Includes all of Census Tract. Census Tract #26 - Includes all of Census Tract. Census Tract #27 - Includes all of Census Tract. Census Tract #28 - Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract #30 - Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract #32 - Includes all of Census Tract. Census Tract #33 - Includes all of Census Tract. Census Tract #34 - Includes all of Census Tract. Census Tract #35 - Includes all of Census Tract. Census Tract #36 - Includes all of Census Tract.

8 Description - Exclusive Operating Area Page 3 Census Tract #37 - Includes all of Census Tract. Census Tract # Excludes all of the area bounded by a line from the intersection of Dakota Avenue and Brawley Avenue NORTH to Saginaw Avenue then WEST to Blythe Avenue then SOUTH to Dakota Avenue then EAST to Brawley Avenue, and excluding the area SOUTHWEST of the following boundary - a line from the intersection of Dakota Avenue and Constance Avenue NORTH to Griffith Way then WEST to State Street then NORTH to Buckingham Avenue then WEST to Polk Avenue then NORTH to Ashlan Avenue then WEST to Wheeler Avenue then South to Griffith Way then WEST to McCaffrey Avenue then NORTH to Willis Avenue then WEST to Carnegie Avenue then NORTH to Gettysburg Avenue then WEST to Hayes. * Census Tract # Excludes all of the area SOUTH of the following boundary - a line NORTH from the intersection of Lead Avenue and Belmont Avenue to McKinley Avenue then EAST to Marks Avenue then NORTH to Yale Avenue then WEST to Lead Avenue then SOUTH to Weldon Avenue then WEST to Marty Avenue then NORTH to Yale Avenue then EAST to Valentine Avenue then NORTH to Terrace Avenue then EAST to Haslan Avenue then NORTH to Brown Avenue then EAST to Lead Avenue then NORTH to Princeton Avenue then WEST to Feland Avenue then NORTH to Cornell Avenue then WEST to Valentine Avenue then SOUTH to Princeton Avenue then WEST to Dewey Avenue then SOUTH to Clinton Avenue then WEST to Knoll Avenue then NORTH to Michigan then WEST to Brawley Avenue then SOUTH to Clinton Avenue then WEST to Hanover Avenue then SOUTH to McKinley Avenue then WEST to Blythe Avenue then SOUTH to Carmen Avenue then WEST to Cecilia Avenue then SOUTH to Floradora Avenue then WEST to Cornelia Avenue; and also excluding the area NORTHWEST of the following boundary - a line from the intersection of Cornelia Avenue and Providence Avenue EAST to Milburn Avenue then NORTH to an area SOUTH of Shields Avenue then EAST to Wapoma Avenue then NORTHWEST to El Capitan Avenue then NORTH to Dayton Avenue then WEST to Blythe Avenue then NORTH to Fedora Avenue then EAST to Bendel Avenue then NORTH to Garland Avenue then EAST to Brunswick Avenue then NORTH to Dakota Avenue. * Census Tract # Including all of the area bounded by a line from the intersection of

9 Description - Exclusive Operating Area Page 4 Cornelia Avenue and University Avenue WEST to Western Avenue then SOUTH to Olive Avenue then WEST to State Street then NORTH to Lamona Avenue then WEST to Ellendale Avenue then SOUTH to Olive Avenue then WEST to Polk Street then NORTH to Hammond Avenue then WEST to Wheeler Avenue then SOUTH to Olive Avenue then WEST to between Wheeler Avenue and McCaffrey Avenue then NORTH to Hedges Avenue then WEST to McCaffrey Avenue then SOUTH to Hammond Avenue then WEST to Carnegie Avenue then NORTH to McKinley Avenue then EAST to Wheeler Avenue then SOUTH to Floradora Avenue then EAST to Polk Avenue then NORTH to Weldon Avenue then EAST to Cornelia Avenue then SOUTH to University Avenue. * Census Tract # Excludes all of the area WEST of the following boundary - a line form the intersection of Gettysburg Avenue and Hayes Avenue NORTH to Shaw Avenue then WEST to Grantland Avenue then NORTH to Barstow Avenue then EAST to Bryan Avenue then NORTH to Wrenwood Avenue then WEST to Fair Avenue then NORTH to Browning Avenue then WEST to Fair Avenue then NORTH to Bullard Avenue then EAST to the intersection of Bullard and Highway 99 then NORTHWEST on Highway 99 to the County line. * Census Tract # Excludes all of the area NORTH of the following boundary - a line from the intersection of Polk Avenue and the County line SOUTH to Alluvial Avenue then EAST to Millburn Avenue then NORTH on Millburn to the end of the end of the road then SOUTHEAST to and continuing on McCampbell Drive to the intersection of Beachwood Avenue and Gentry Avenue then NORTH on Gentry to the County line; and excluding the island bounded by Doolittle Drive, Spaatz Avenue and Blythe Avenue. * Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Excludes the following islands - the island bounded by a line starting at the entrance of San Joaquin County Club SOUTHWEST to Buena Avenue NORTH of Alluvial Avenue then EAST to Valentine Avenue then SOUTH to Spruce Avenue then EAST to Marks Avenue then NORTH to Spyglass Avenue then SOUTHWEST to Laguna Vista Avenue then WEST to Alluvial Avenue then NORTH to Charles Avenue then NORTH to the entrance of the San Joaquin County Club; and the island bounded by a line starting at the Fig Garden Golf

10 Description - Exclusive Operating Area Page 5 Course SOUTH to Boy Scout Road then EAST to River Bottom Road then NORTH to the San Joaquin River; and the island bounded by a line starting at the intersection of Spruce Avenue and Marks Avenue EAST to Van Ness Avenue then SOUTH to Fir Avenue then WEST to Pleasant Avenue then SOUTH to Beechwood Avenue then WEST to Monte Avenue then NORTH to Locust Avenue then WEST to Marks Avenue then NORTH to Spruce Avenue. * Census Tract # Excludes the following islands - the island bounded by a line starting at the intersection of Bullard Avenue and Briarwood Avenue NORTH to Stuart Avenue then EAST to Pleasant Avenue then NORTH to Vartikian Avenue then EAST to Van Ness Avenue then SOUTH to Calimyrna Avenue then EAST to Sequoia Avenue then SOUTH to Bullard Avenue then WEST to Briarwood Avenue; and the island bounded by a line starting at the intersection of Herndon Avenue and Pleasant Avenue EAST to Van Ness Avenue then SOUTH to Warner Avenue then EAST to Sequoia Avenue then SOUTH to Magill Avenue then EAST to Parrish Avenue then NORTH to Warner Avenue then EAST to Forkner Avenue then SOUTH to Sierra Avenue then EAST to Teilman Avenue then NORTH to Palo Alto Avenue then EAST to Fruit Avenue then SOUTH to Bullard Avenue then WEST to Channing Avenue then NORTH to Calimyrna Avenue then WEST to West Avenue then NORTH to Escalon Avenue then SOUTH to Dolores Avenue then WEST to Van Ness Avenue then NORTH to Tenaya Avenue then WEST to Pleasant Avenue then NORTH to Herndon Avenue. * Census Tract # Excludes the following islands - the island bounded by a line starting at the intersection of Channing Avenue and Bullard Avenue EAST to Fruit Avenue then SOUTH to Shaw Avenue then WEST to Durant Avenue then NORTH to San Jose Avenue then WEST to West Avenue then NORTH to Barstow Avenue then EAST to Channing Avenue then NORTH to Bullard Avenue; and the island bounded by a line starting at the intersection of Briarwood Avenue and Roberts Avenue SOUTH to Browning Avenue then EAST to Woodson Avenue then SOUTH to Barstow Avenue then WEST to Marks Avenue then SOUTH to Scott Avenue then EAST to Briarwood Avenue then SOUTH to Shaw Lane then EAST to Forkner Avenue then NORTH to Roberts Avenue then WEST to Sequoia Avenue then NORTH to Bullard Avenue then WEST to Briarwood Avenue then SOUTH to Roberts Avenue. * Census Tract # Includes all of Census Tract.

11 Description - Exclusive Operating Area Page 6 Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Excludes the area of Sierra Avenue and Farris Avenue SOUTH to Escalon Avenue then EAST to a point WEST of Palm Avenue then SOUTH to a point NORTH of Bullard Avenue then WEST to Harrison Avenue then NORTH to Mesa Avenue then WEST to Fruit Avenue then NORTH to Sierra Avenue; and the island bounded by a line starting at the intersection of Maroa Avenue and Vartikian Avenue SOUTH to Bullard Avenue then WEST to Wilson Avenue then NORTH to Stuart Avenue then WEST to Ferger Avenue then NORTH to Sample Avenue then EAST to Fairmont Avenue then NORTH to Vartikian Avenue. * Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Excludes the following islands - the island bounded by a line starting at the intersection of Fruit Avenue and Morris Avenue EAST to Vagedes Avenue then SOUTH to Celeste Avenue then EAST to Farris Avenue then NORTH to Bullard Avenue then EAST to Safford Avenue then SOUTH to Browning Avenue then WEST to Vagedes Avenue then SOUTH to Barstow Avenue then EAST to Safford Avenue then SOUTH to Arthur Avenue then WEST to Fruit Avenue then NORTH to Morris Avenue; and the island bounded by a line starting at the intersection of Bullard Avenue and Nantucket Avenue SOUTH to Morris Avenue then WEST to Winchester Avenue then SOUTH to Celeste Avenue then EAST to Maroa Avenue then SOUTH to Wrenwood Avenue then WEST to Nantucket Avenue then SOUTH to San Carlos Avenue then EAST to Maroa Avenue then SOUTH to Shaw Avenue then WEST to Roosevelt Avenue then NORTH to Scott Avenue then EAST to San Jose Avenue then NORTH to San Ramon Avenue then WEST to Ferger Avenue then NORTH to Barstow Avenue then EAST to Wilson Avenue then NORTH to Robinwood Avenue then WEST to Ferger Avenue then NORTH to Morris Avenue then NORTH to Bullard Avenue then EAST to Nantucket Avenue. * Census Tract #46 -Excludes the following islands - the island bounded by a line starting at the intersection of Palm Avenue and Alamos Avenue WEST to Harrison Avenue then NORTH to Sierra Madre Avenue then WEST to Fruit Avenue then SOUTH to Ashlan Avenue then EAST

12 Description - Exclusive Operating Area Page 7 to Palm Avenue then NORTH to Alamos Avenue; and the island bounded a line starting at the intersection of West Avenue and Shaw Avenue SOUTH to Gettysburg Avenue then EAST to Teilman Avenue then NORTH to Shaw Avenue then WEST to West Avenue. * Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract #48 - Includes all of Census Tract. Census Tract #49 -Excludes the following island - the island bounded by a line starting at the intersection of Ashlan Avenue and AT & SF Railroad Tracks SOUTHEAST along the railroad tracks to Palm Avenue then NORTH to Ashlan Avenue then WEST to the railroad tracks. * Census Tract #50 -Excludes the following island - the island bounded by a line starting at the intersection of Maroa Avenue and Shaw Avenue EAST to Glen Avenue then SOUTH to Ashlan Avenue then WEST to Maroa Avenue then NORTH to Shaw Avenue. * Census Tract #51 - Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract.

13 Description - Exclusive Operating Area Page 8 Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of Census Tract. Census Tract # Includes all of the area NORTH of Belmont Avenue; and includes the area WEST of DeWolf Avenue between Church Avenue and Central Avenue. III. The following Census Tracts comprise the Rural Area of the EOA: Census Tract #39 - Excluding all of the area SOUTH of American Avenue and EAST of Howard Road; and excluding the area EAST of Sutter Avenue and SOUTH of Belmont Avenue; and excluding all of the area EAST of Calaveras Avenue. * Census Tract # 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. Census Tract #74 - Includes all of the area WEST of Highway 43 Census Tract #75 - Includes all of Census Tract. Census Tract #76 - excluding all of the area NORTH of South Avenue and WEST of Westlawn Avenue, and excluding all of the area NORTH of American and WEST of Bryan Avenue. * Census Tract #77 - Includes all of Census Tract. Census Tract #78 - 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 of Sections 4, 5, 8 and 9 of Township 18S, Range 18E, and then SOUTHEAST to the intersection of Jameson Avenue and Oakland Avenue and the boundary of Lemoore Naval Air Station. Census Tract #82 - Includes all of Census Tract. Census Tract #83 - Includes all of Census Tract.

14 Description - Exclusive Operating Area Page 9 Census Tract # Includes all of Census Tract. Census Tract #84.02? Includes all of Census Tract (Zone A added 11/7/98) IV. The following Census Tracts comprise the Remote/Wilderness Area of the EOA: Census Tract # Includes all of Census Tract.

15 ATTACHMENT B-1 Reedley EOA North Central Fire Protection District (e.g., annexations by the City of Fresno).

16 Exhibit B-2 Description of Reedley EOA Ambulance Zone J The following 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 NORTH on REED Avenue to Kings Canyon Road and then EAST on Kings Canyon Road to the Friant-Kern Canal, except for the area SOUTH of Adams Avenue and WEST of Alta Avenue. 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 B-2