Emergency Medical Care Committee (EMCC)Agenda  November 21, 2024, at 10a.m. Lake County Fire 148150lympic Dr. Clearlake, Ca.  1. 2.  Welcome 1.1 Confidentiauty Statement Callto Order 2.1 Roll Call & Introductions 2.2Quorum Reached/Not Reached 2.3 Agenda Approval/Minutes Approval 3.1 North Coast EMS Report: Larry Karsteadt 4.1 Medical. Advisory Report: Larry Karsteadt 4.2 Education: Scheduled Classes/C.E 4.3 Disaster Report: Report from Oes 4.4 Radlo/Communication: Chief Sapeta 4.5 Membership 4.6 Policy Review: NCEMS 4.71FT Review: Jim Dowdy  3. 4.  Agency Reports Subcommittee Reports  4.8 ADDENDUM- Review and Adopt IFT Purpose Statement Review  5. Old Business:  5.1 Ambulance Permit Recommendation for B.O.S.  5.2 Bylaws Discussion: 5.3 EMS Liaison Position 5.4 MICN Program New Business: 6.1 6.2 7.  5.5 ADDENDUM - Review and Adopt EMCC Bylaws  6.  Closing Comments 7.2 Agenda for. January 7.3Location for. January Adjourn  7.1 Public Input-3M Minutes Each for items or topics Not on Agenda  8.  8.1 Next Meeting November 21,2024    EmergencyMedical Care Committee (EMCC) Minutes  September 19, 2024, at 10a.m. Lake County Fire 14815 Olympic Dr. Clearlake, Ca.  1. Welcome  1.1 Confidentiality Statement 1.1.1 Read by Chief Sapeta 2.1 Roll Call & Introductions  2. Callto Order- - called to order at 10:00am by Chief Sapeta  2.1.1 Attended in person: Dean Eichelmann, Christine Hannigan, Willie Sapeta, Morgan Fox, Bruno Sabatier, Najia Sadiq, April Giambra, Christine Andrus, Elise. Jones, Anthony Arton, Zach Pindell, Ashley Giangrosso, Shannon Banks, Michael Green, Janell Rivera. Attended virtually: Larry Karsteadt, Stayce Curry,  Matthew Karp, Kayce Hurd. 2.2Quorum Reached/Not Reached 2.2.1 Quorum Reached 2.3 Agenda Approval/Minutes Approval 2.3.1 Agenda approved 2.3.2 Minutes not available Agency Reports  3.  3.1 North Coast EMS Report: Larry Karsteadt  3.1.1 The annual EMS plans update is underway, currently ini internal review. Ar request for input will be sent outi ini the next fewweeks. 3.1.2 College oft the Redwoods started its new: semester with 30 students plus 3.1.2.1 Fire, paramedic, and lawenforcement classes will be integrated.  two oni the waitlist.  4.  Subcommittee Reports  4.1 Medical Advisory Report: Larry Karsteadt 4.2 Education: Scheduled Classes/C.E  4.1.1 There is a newi medical contractor, and she led the Regional meeting  on 8/14/2024.  4.2.1 Morgan Fox sent out the education calendar.  4.2.2. Janell Rivera is holding the field care audit on October 10", subject TBD. 4.3.1 Fire season started in. June, and there have been several fires this season.  4.3 Disaster Report:  4.3.1.1 Park Fire  4.3.1.1.1 Lake Districts were prepositioned to respond.    4.3.1.2 Structure fire in Lakeport. 4.3.1.2.1 Propane explosions. 4.3.1.2. .2 Small acreage but devastating.  4.3.1.3 Boyles Fire  4.3.1.3.1 The Boyles Fire started in Clearlake on 9/8/2024. 4.3.1.3.2The fire burned upi to multiple command posts.  4.3.1.3.3. About 22 buildings and 80 vehicles burned, but noi injuries or 4.3.1.3.4 Four helicopters and six aircraft were fighting the fire. 4.3.1.3.51 L Lake County Fire and Adventist Health Clear Lake  fatalities.  communicated early.  4.3.1.3.5.1 Triggers were met to decompress the hospital, contact the MHOAC for an ambulance strike team request, and  prepare for possible evacuation.  4.3.1.3.5.1.1 Adventist Health did well staging before 4.3.1.3.5.1.2 Dean contacted the Region and requested  Dean from Public Health arrived. ambulance strike teams.  4.3.1.3.5.1.2.1 The Ambulance Strike team was a crucial resource. They ran about 20 medical calls, most ofwhich were unrelated to the fire. 4.3.1.3.5.1.2.1.1 There is more flexibility now on how ambulance Strike teams are 4.3.1.3.5.1.2.1.2 Seven ambulances arrived at the hospital before they had a back line phone number.  used.  4.3.1.3.5.1.2.1.2.1 There is no abilitytor reprogram the radios on the out-of-countyambulances.    4.3.1.3.5.1.2.2 There was positive feedback from the Region and the. Ambulance strike team said  there was, good coordination.  4.4 Radlo/Communication: Chief Sapeta  4.4.1 Chief Sapeta is working with PG&E on radio towers. 4.4.1.1 Bought a vault 5 years ago to place on Goat Mountain.  4.4.1.1.1 Having 8 repeaters int the Countyi in different places will help. 4.4.1.1.2. AlL possible financial assistance for the vault has been exhausted. The project does not qualify for assistance.  4.4.2Tablet Command software went live, with 40 tablets int the County.  4.51 Membership 4.5.1 Nothingto report 4.6 Policy Review: NCEMS  4.6.1 There are still many policies in draft form. and send them to the EMCC.  4.6.1.1 Hoping Dr. Karp can review the draft policies ini the next few weeks  4.71FT Review:  4.7.1 Behavioral Health's Mobile Crisis Unith helps reduce 911 calls and hospital  visits, and it supports recovery from substance use disorders.  5.  Old Business:  5.1Ambulance Permit Recommendation for B.O.S. Committee would like to have it completed. 5.1.1.1 Minor changes will be made.  5.1.1 The ambulance ordinance has been int the works for 18 months, and the  5.1.1.1.1 Most areas referencing the Public Health Officer will be 5.1.1.1.2, After the changes are made, Supervisor Sabatier will take the ambulance ordinance to County Council, then it will be brought backi to the EMCC fort final review, afterwhich it will be sent to the  changed to the Health Services Director.  Board of Supervisors.  5.2 Bylaws Discussion: Services. Supervisors  5.2.1 Running the EMCC is the responsibiuty of the Department of Health 5.2.1.1 The EMCC is supposed to at least annually report to the Board of 5.2.1.2. Agendas and minutes need to be posted to the countywebsite  5.2.1.3 EMCC meetings are required tol be public.    52131ACCbNyurene is important to indicate whethert the 5.2.1.4The structure needs to be decided and written into the bylaws.  building is wheelchair accessible.  5.2.1.4.1 Teleconferencing is now expected. attend virtually due to distance.  5.2.1.4.1.1 Some members appreciate the ability to 5.2.1.4.1.2There is a question of whether the public must be provided the virtual meeting linkifavirtual  option is created.  5.2.2The bylaws need further amendments.  5.2.2.1Anthony. Arton, Chief Sapeta, Morgan Fox, and Supervisor Green are appointed to the bylaw subcommittee and will meet to reviewthem. 5.2.3.1 A draft of the bylaws with an updated roster was sent out in June. 5.2.3.21 The bylaw edits completed in March reduced membership toa  5.2.3The EMCC membership roster needs review.  manageable number.  5.2.3.2.1 Now need more clarification. 5.2.3.3 Designees need to be added to the roster.  5.2.3.3.1 The hospital designees are not on the official roster yet although Najia was announced by the Board of Supervisors to be as 5.2.3.3.1.1 Historically there were two nurses on the  designee.  committee.  6.  New Business: 6.1 Opioid Settlement Funds  6.1.1 Chief Sapeta drafted three proposals. 6.1.1.1 Funding for the EMS liaison position Care Nurse program which gives guidance to EMTs.  6.1.1.2 Support for building mobile field response and the Mobile Intensive 6.1.1.3 Funding for Narcan distribution- - a Narcan saturation plan  6.1.1.3.1 The program currently does not allow for central distribution 6.1.1.3.2 Lake County Fire wants to be the main fire hub for Narcan 6.1.1.3.1.1 Each of the Districts must apply separately 6.1.1.3.3 North Coast EMS and Behavioral Health have meti to discuss  of Narcan. distribution.  the timeline and relevant funds.    6.1.1.3.3.1 Behavioral Health has hired a consultant for the  expenditure plan.  6.1.1.3.3.1.1 The plan will be reviewed by the Behavioral Health management team and the steering committee. 6.1.1.3.3.1.1.1 The plan then needs to go to the 6.1.1.3.3.11.2Would not expect the plan to be available until the next calendary year.  Board of Supervisors.  6.1.2 Both City municipalities got their own funds but not much.  6.2 MICN Program  6.2.1The purpose of the Mobile Intensive Care Nurse (MICN) program is to serve as al bridge between hospital physicians and EMS personnel by providing medical guidance to Emergency Responders working in the field. 6.22Asubcommittee regardingreinstating the MICN program has been formed. 6.2.2.1 Members of the subcommittee are. Janell Rivera, Zach Pindell, Najia  Sadiq, and a North Coast EMS representative.  6.3 Career Technical Education (CTE) Emergency Services Pathway Program 6.3.1 There is a pilot program at Lower Lake High School, training high school 6.3.1.1 Last year there were 17 students, this year there are 30. test and have decided to re-enroll ini the course.  students to be EMTS.  6.3.1.1.1 Last year's students did not feel ready for the certification  6.3.2 Next year, the course will move to virtual lectures with multiple high schools and the practicum will be in-person with instructors at the Fire District.  7.  Closing Comments 7.1.1 None 7.2 Agenda for November 7.3Location for November 7.3.1TBA Adjourn 1- Adjourned at 11:28am 8.1 Next Meeting November21,2024  7.1 Public Input-3 3 Minutes Each for items or topics Noton Agenda  7.2.1 Election of EMCC Officers - Chair, Vice-Chair, and Secretaryvotes.  8.    Lake County Inter Facility Transfer (IFT) Subcommittee of the  Emergency Medical Care Committee (EMCC)  October17,2024  Purpose Statement forthel Inter-Facility Transfer (rSubcommitee oft the Emergency The Inter-Facility Transfer (IFT) Subcommittee of the Emergency Medical Care Committee (EMCC) is established to foster collaboration between Emergency Medical Services (EMS) providers and the emergency departments of hospitals in Lake County, California. Our primary goal is to enhance patient care duringi inter-faclutytransfers through effective communication, shared best practices, and a unified approach to emergencymedical The Chair of the EMCC will appoint members toi the IFT Subcommittee, ensuring representation from diverse stakeholders, including one member from Lake County Health Services, one from Adventist Clearlake Hospital, one from Sutter Lakeside Hospital, and one representative from each Fire/EMS service operating in Lake County. Appointments will be valid for one year, with new appointments made as necessary or at the beginningof The IFTS Subcommittee will convene monthly from Novemberto March and bi-monthly from April to October. Meetings will include at teleconference option; however, in-person attendance is strongyencouraged to facilitate meaningful collaboration. This subcommittee is exemptf from California Brown Act rules, allowing for flexible discussions. General rules oft the subcommittee include active participationi from all members, with each member encouraged to contribute their insights and expertise. Members are expected to adhere to confidentiality, guidelines regarding patient information and inter- facility transfer cases discussed in meetings. Decisions will be made collaboratively, witha a focus on consensus whenever possible. Additionally, members are encouraged to communicate any agenda items or issues for discussion at least one week priorto the Standing agenda items will include: Confidentiality Statement, IFT transfer issues and concerns, as well as agency reports, to ensure that all members are informed and can contribute to continuous improvement in patient care dumgmerlcllytanster. Through our collective efforts, we aim to strengthen the ties between EMS and hospital services, ultimately enhancing the quality of care for patients in our community.  Medical Care Committee (EMCC)  treatment.  each calendar year.  meetings to ensure a productive agenda to the Chair.    BOARD OF SUPERVISORS, COUNTY OF LAKE, STATE OF CALIFORNIA  ORDINANCE NO. 2687  AN ORDINANCE AMENDING ARTICLE IX OF CHAPTER 9 OF THE LAKE COUNTY CODE PERTAINING TO PERMITTING AND OPERATION OF MEDICAL TRANSPORTATION SERVICES THIS BOARD OF SUPERVISORS OF THE COUNTY OF LAKE ORDINANCE READS AS FOLLOWS: Section 1: Article IX of Chapter 9 of the Lake County Code is hereby amended to read as  follows:  "ARTICLE IX. PERMITTING AND OPERATION OF MEDICAL TRANSPORTATION: SERVICES  Sec. 9-80 Purpose and Intent. Operation Ordinance ofl Lake County.  80.1Title. This article shall be known as the Medical Transportation Service Permitting and 80.2 Purpose. This article aims to provide for the public health, safety, and welfare in the use of alle emergency: and non-emergency medical transportation vehicles by establishment of effective standards for their operation, equipment, and personnel. This article shall apply to all emergency medical transportation: services and all physician/lranster Center ordered non-emergency medical transportation services, whether performed by ground vehicle or by air ambulance. This article shall be  liberally construed for the accomplishment of these purposes.  80.3 Intent. Iti is the intent of this article that each ambulance services permittee shall be allowed to provide emergency ambulance services as well as physician-ordered non-emergency medical transportation services. It is also thei intent of this article that a permit to provide air ambulance services shall be separate from a permit to provide ground ambulance and non-emergency services. In addition, the Lake County Health Services Department (Department), upon approval by the Board, reserves the right to recommend toi the Local Emergency Medical Services Agency (LEMSA) the establishment of exclusive Emergency Medical Services (EMS) operating areas for ambulance services permittees. Such exclusive operation areas shall be established and awarded in compliance with the provisions of this  article and California Health and Safety Code Section 1797.224.  80.4 Medical Control. Iti is thei intent oft this article to provide medical direction and oversight of all Advanced Life Support Providers in Lake County. Medical control shall be maintained according to the current policies, procedures, and protocols of the designated LEMSA with the support of the Lake County  Emergency Medical Care Committee (EMCC).  Sec. 9-81. Definitions. follows:  Unless otherwise specified, for the purposes of this article, words and terms are defined as (a) 911. An Advanced Life Support ambulance available for emergency 911 dispatch and non- emergency dispatch for and in Lake County other than inter-facility transport. (b) Accredited. The fact of being officially recognized, accepted, or approved of, or the act of officially recognizing, accepting, or approving of something.  Revised: 8/23/24C-700 Revision: Anthony Arton, Lake County Public Health Comments "Working DRAFT from: 10/27/2023 Workshop"    (c) Advanced Life Support (ALS). Special services designed to provide advanced pre-hospital care by a Statel Licensed and LEMSA-accredited EMT Paramedic pursuant to California Health and Safety Code Section 1797.52. ALS 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 medicinal preparations, and other specified techniques and procedures administered by authorized personnel under the direct supervision of al base hospital as part of a local EMS: system att the scene of an emergency during transport to an acute care hospital, during Inter-Facility Transfer (IFT), and while in the emergency department of an acute care hospital until responsibility is assumed byt the emergency or other medical staff of (d) Air Ambulance. Any aircraft (fixed wing or rotor) specially constructed or modified, equipped, and used for the purpose of transporting critically ill or injured. This service (e) Air Ambulance Service. An air transportation service which is specifically designed to accommodate the medical needs of a person who isi ill or injured. This service includes (f) Ambulance. Any vehicle specially constructed or modified, equipped, and used for the purpose of transporting sick, injured, invalid, convalescent, or otherwise incapacitated persons and which! has met all license and other requirements in applicable federal, state, (g) Ambulance Service. Any organization or individual(s) providing an ambulance for use in (h) Base Hospital. Al LEMSA-designated hospital is responsible for directing the advanced, limited advanced, and basic life support systems assigned toi it by the LEMSA pursuant to () Basic Life Support (BLS). The type of care that first responders, healthcare providers, and public safety professionals provide to anyone experiencing cardiac arrest, respiratory distress, or an obstructed airway. It requires knowledge and skills inc CardioPulmonary Resuscitation (CPR), using Automated External Defibrillators (AED) and relieving airway obstructions in patients of every age. () Board. The Board of Supervisors of the County of Lake.  that hospital.  includes providing qualified flight crews and aircraft maintenance. providing qualified flight crews and aircraft maintenance.  and local law and regulations.  emergency (and non-emergency) ambulance transports. California Health & Safety Code! Section 1797.58.  (k) Certificate or License. Aspecial document issued to an individual by al LEMSA or Emergency Medical Services Authority (EMSA) denoting competence in the named areas  ofp pre-hospital care.  (I) County. The County ofl Lake, State of California.  (m) Department. The County of Lake Health Services Department, with the Health Services Director as the primary contact. A division of a local or larger government responsible for (n) Emergency. A condition or situation in which an individual has a need for immediate medical attention or where the potential for such a need is perceived by emergency  the oversight and care of matters relating to public health. medical personnel or aj public safety agency.  Revised: 8/23/24.C-700 Revision: Anthony Arton, Lake County Public Health Comments' "Working DRAFTÉ from: 10/27/2023 Workshop"    (o) Emergency Call. Arequest for the dispatch of an ambulance to any sudden unforeseen (p) Emergency Medical Care Committee (EMCC). The Lake County EMCC appointed by the Board pursuant to California Health and Safety Code Sections 1797.270 et seq. means an advisory committee appointed by a County Board that represents EMS system participants and advises the County Board and LEMSA on EMS system issues. (q) Emergency Medical Services (EMS). The services utilized in responding to a medical (r) Emergency Medical Services (EMS) System. An organized arrangement that provides the personnel, facilities, and equipment for the effective and coordinated delivery of medical (s) Emergency Medical Services Authority (EMSA). State lead EMS authority that sets statewide EMS system standards and guidelines pursuant to statute. (t) Emergency Medical Technician (EMT). An individual trained and certified in basic life support pursuant to California Health and Safety Code, Section 1797.80. (u) Emergency Medical Techniclan-Paramedic (EMT-P). See (dd) Paramedic (P). (v) Paramedic (P). Ani individual who is trained, licensed within California and accredited within the North Coast Emergency Medical Services (NCEMS) region in Advanced Life Support pursuant to the California Health and Safety Code and Title 22 of the California (w) Emergency Medical Transportation Services. Transportation by ambulance or air ambulance of sick, injured, invalid, convalescent, informed, or otherwise incapacitated persons whose medical conditions require emergency services or equipment during (x) Exclusive Operation Area. An EMS area or subarea defined by the EMS plan for whicha LEMSA, upon the recommendation of a Department, restricts operations to one or more emergency: ambulance services or providers of limited advanced life supporto oradvanced (y) Health Services Director. The primary contact for the Department, which administers the (z) Inter-Facility Transfer (IFT). Under Health and Safety Code Section 1798.172: (a) The LEMSA shall establish guidelines and standards for the completion and operation of formal transfer agreements between hospitals with varying levels of care in the area of jurisdiction of the LEMSA consistent with Health and Safety Code Sections 1317 to 1317.9a, inclusive, and Chapter 5 (commencing with Section 1798). The level of urgency (aa) Lake County EMS Plan. The plan is currently part of the NCEMS Regional Plan and was established by the LEMSA for delivering EMS within Lake County. It must be reviewed by (1) Public Sector Permit. This permit allows a public ambulance provider, an ambulance provider run by a government entity, to operate multiple or single ALS and BLS level ambulances in the County, as described in Section 9-83.2 of the article. Each ambulance must be fully equipped and staffed with a minimum of one ALS, BLS, or Public Safety responder for response and two personnel for  need for medical attention.  emergency.  care services under emergency conditions.  Code of Regulations.  transport.  life support. Pursuant to Health and Safety Code 1797.85. for the oversight and care of matters relating to public health.  may be non-emergency or "critical" emergency in nature.  the EMSA annually.  Revised: 8/23/24C-700 Revision: Anthony Arton, Lake County Public Health Comments "Working DRAFT from 10/27/2023 Workshop"    transport 24/7/365 for emergency transport calls as well as Priority Ones as defined in the LCFCA Priority One Policy. The holder oft this permit must have mutual aid or response agreements, which are approved by the Department or (2) Private Sector Permit. This permit allows a private ambulance provider, an ambulance provide not run by a government entity, to operate multiple or single ALS and BLS level ambulances, int the County, as described in Section 9-83.2 ofthis article. Each ambulance must be fully equipped and staffed with one ALS and one BLS personnel or two BLS personnel 24/7/365 for physician ordered calls (IFT) and  LEMSA and comply with all local and state requirements.  emergency transport calls, as needed if available.  (bb) Communications Center. The emergency service dispatch system operated for the County (cc) Lake County Fire Chiefs Association (LCFCA). The association composed of the chiefs of (dd) Local EMS Agency (LEMSA). The agency, department, or office that holds primary responsibility for the administration of emergency medical services in the County designated pursuant to California Health and Safety Code Section 1797.200. Through a joint power agreement, the "Local EMS Agency" for Lake County. (ee) Medical Control. The medical management of the EMS system pursuant to California Health and Safety Code, Section 1797.200 and 1798, local laws, regulations, and policies. (ff) Medical Health Officer Area Coordinator (MHOAC). Representation of the 24/7/365 single point of contact for the MHOAC program and is responsible for monitoring, ensuring, and procuring medical and health resources during a local emergency or disaster. The MHOAC is authorized to work with the Regional Disaster 2 Medical Health (RDMHC)1 Program to submit and respond to medical and health requests for resources outside of the Operational. Area (OA). The County of Lake Health Services Director may act jointly as the MHOAC in collaboration with the Public Health Officer, or they may (gg) Mutual Aid. An agreement among emergency responders to lend assistance across. jurisdictional boundaries in emergent and non-emergent circumstances. This may occur duei to an emergency response that exceeds local resources, such as a disaster or ar multiple-alarm fire. Mutual aid may be ad hoc, requested only when an emergency occurs. It may also be a formal standing agreement for cooperative emergency management on a continuing basis, such as ensuring that resources are dispatched from the nearest fire station, regardless of which side of the jurisdictional boundary the incident is on. Agreements that send the closest resources are regularly referred to as (hh) Non-Emergency Medical Transportation Services, or Non-Emergency Services." Physician-ordered transportation by ambulance, litter van (as defined in Section 51151.3 of Title 22 of the California Code of Regulations), or wheelchair van (as defined in Section 51151.5 of Title 22 of the California Code of Regulations) of sick, injured, invalid, convalescent, infirm or otherwise incapacitated persons whose medical conditions require transportation services but do not require emergency services or equipment  of Lake in the State of California.  the fire protection districts around Lake County, California.  appoint an individual to serve int this role.  "automatic aid agreements."  during transport.  Revised: 8/23/24C-700 Revision: Anthony Arton, Lake County Public Health Comments "Working DRAFTfrom: 10/27/2023 Workshop"    (ii) Non-Emergency Medical Transportation Unit, or "Non-Emergency Unit." Any vehicle or aircraft thati is constructed or modified, equipped, and used for the purpose of providing non-emergency medical transportation services and which has met all applicable (j) Patient. Asick, injured, invalid, convalescent, infirm, or otherwise incapacitated person. (kk) Permittee. Any ambulance service which has been granted a permit by the Department toengage in the business of providing emergency medical transportation, services and/or non-emergency medical transportation services as defined in this article. (II) Person. An individual, firm, corporation, association, group, or combination acting asa (mm) Priority One. Refers to the utilization of 911 EMS resources for the transport of a critically ill/injured patient at a local hospital to an out-of-county facility. The transport would ensure the patient receives life or limb-saving services not available at the local hospitals. Patients must meet the requirements set forth in the LCFCA Priority One Policy. (nn) Public Safety 15t Aid. means the recognition of and immediate care fori injury or sudden illness, including medical emergencies, by public safety personnel prior toi the availability ofr medical care by licensed or certified healthcare professionals. Note: Authority cited: Section 1797.107, Health and Safety Code. This would include Cardiopulmonary (oo) Reserve Ambulance. An ambulance, either staffed or non-staffed, is available for (pp) Response. Thei initiation of movement by equipment or personnel to an emergency (qq) Response. Agreement/Ambulanc. The written agreement enteredi into by all permitted ambulance service providers to coordinate resources for response outside oft their (rr) Response Zones. An area defined by the LCFCA in which the permittee shall provide (ss) Service Area. The geographic response area of a permitted ambulance service. The service area must correspond to each individual service license. The service's employee staffing plan, ambulance placement strategy, and available resources must be  licensing, operation, ande equipment laws and regulations.  unit.  Resuscitation.  emergency or non-emergency service. pursuant to dispatch.  exclusive operational areas. ambulance service.  commensurate with the service area.  Sec. 9-82. Administrative Authority  This article shall be administered byt the Department. Sec. 9-83. Emergency and Non-Emergency Services. 83.1. Permits and Permittees.  (a) Permit Required. Itshall be unlawful for any private person, organization, or entity to operate, conduct, advertise, or otherwise engage in or profess to be engaged in the business of emergency or non-emergency medical transportation of patients, either by ground vehicle or by aircraft without possessing a valid permit issued by the Department. Ana applicant currently permitted in another county may submit their permit information to  the Department for review.  Revised: 8/23/24C-700 Revision: Anthony Arton, Lake County Public Health Comments' Working DRAFTf from 10/27/2023 Workshop"    (1) Exceptions. A permit shall not be required for:  (A) Air ambulances originating outside oft the County. Air ambulance at the request of the Department during any "state of war emergency" duly proclaimed "state of emergency" or' "local emergency" as defined by the California Emergency! Services Act (Government Code Section 8550 ets seq.). (B) Ambulance services which are otherwise legally transporting a patient froma location originating outside the County regardless of destination. (C) Ambulances operated by an ambulance service located outside the County in response to a mutual aid request by LCFCA Communications Center, MHOAC, or a base hospital located in the County due to a permittee being temporarily (D) Special event permits are managed by the local fire districts having jurisdiction (2) Duration. Permits are valid for upt to three years or the length of an established (b) Permit Fees. Permit fees shall be those set by resolution of the Board. Public Sector may apply for both Public and Private Sector Permits with only one fee issued at the time of issuance, expressly stating that the application is for other Public and Private Sector Permits. Permittees are required to submit any changes annually for the renewal process. (c) Application or Renewal of Private Sector Permit for Private Ambulance Provider. Each applicant for an initial permit or renewal of an existing permit shall file an application in writing on an approved form, which shall provide the information described in items (1) through (16) below. An applicant for a permit to provide only air ambulance services shall  unable.  for all EMS special event needs. agreement with the local hospital(s).  be subject only to the provisions of Section 9-83.1(e) of this article. (1) Name and description of the applicant. (2) Business address and residence address of the applicant. (3) Trade or firm name, or DBA as recorded. venture, partner, or limited partner.  (4) Ifac corporation,, joint venture, partnership, or limited partnership: the names, permanent addresses, and ownership percentages of each such corporate office, joint (5) Astatement of facts showing the experience of the applicant in the operation of an ambulance service and non-emergency service and that the applicant is qualified to render efficient and continuous twenty-four (24) hour ambulance services and non- emergency services. A photocopy oft the license issued by the Commissioner of the California Highway Patrol (CHP) to ambulances (in accordance with Section 2501 oft the California Vehicle Code and Title 13 of the California Code of Regulations) shall be (6) As statement that the applicant owns or has under its control, in good mechanical condition, required vehicles and equipment to adequately conduct an ambulance service and non-emergency service that meet the requirements established by the California Vehicle Code and this article and that the applicant owns or has access to suitable and safe facilities for maintaining the vehicles and equipment in a clean and sanitary condition. A copy of the most recent Ambulance Inspection Report issued by the California Highway Patrol for each vehicle and a current lamp and brake inspection  appended to the application.  Revised: 8/23/24 C-700F Revision: Anthony Arton, Lake County Public Health Comments' "Working DRAFT from 10/27/2023 Workshop"    certificate issued by a facility certified by the Bureau of Automotive Repair for each vehicle owned or operated by the applicant shall be appended to the application. (7) Astatement, amended: as necessary during the year, for any changed, substituted, loaned, or leased vehicles, giving a complete description ofe each ambulance and non- emergency vehicle operated by the applicant, including the patient capacity thereof. A copy of the most recent Ambulance Inspection Report issued by the CHP for each vehicle and al lamp and brake inspection from ai facility certified by the Bureau of Automotive Repair for each vehicle shall be appended to the application. (8) An affirmation that each permittee ambulance and its appurtenances conform to all applicable provisions oft this article, the California' Vehicle Code, the California Code of Regulations, and any other applicable state or local law shall be provided prior to the (9) Astatement that the applicant has sufficient certified personnel: adequately trained to (10) Proof of authorization by the LEMSA to operate as an ALS Ambulance Provider. A letter of intent to issue authorization from the LEMSA may be used to obtain a (11) A: statement signed by the applicant that, as a condition oft the Department issuinga a permit, the applicant agrees to indemnify and defend the County and its officers and employees against and hold them harmless from any and all claims, losses, damages, and liability for damages, including damage to or loss of property, or injury to or death or person, including properties of the County andi injury to or death of County officials, employees or agents, arising out of, or connected with the applicant's operations (12) A schedule of rates to be charged for emergency ambulance services and non- (13) Proof of obtaining or maintaining a contract with LCFCA Communications Center or their designated agent for dispatch services ofe emergency 911 calls. (14) A disclosure of each instance in which the applicant has had an ambulance service or air ambulance service certificate, license, or permit issued by the State EMS Authority, al LEMSA, or a County or City revoked or suspended for cause, including a description of thet facts and circumstance which formed thel basis for each such revocation or suspension and the date(s) of each such revocation or suspension. (15) Such other facts or information as required by the Department. (16) After the initial application, an applicant for renewal may indicate "no change" if applicable to Items (5)-(14). Each applicant for renewal shall provide information as requested byt the Department to demonstrate the level of compliance withi the performance standards as outlined in Section 9-83.1(c)(1), (2), (3), and (4) of this (d) Application or Renewal of Public Permit for Public Ambulance Provider. For each applicant, an initial permit shall be filed in writing on an approved form which shall provide the information described in items (1) through (16) below. Any changes for renewal will be sent in as an annual update or renewal. An applicant for a permit to provide only air  start of the renewal date of the ambulance operations. deliver emergency medical services of good quality at all times.  temporary permit for up to sixty (60) days.  under said permit. emergency services.  article.  Revised: 8/23/24C-700 Revision: Anthony/ Arton, Lake County Publick Health Comments' Working DRAFTf from 10/27/2023 Workshop"    ambulance services shall be subject only to the provisions of Section 9-83.1(e) of this  article.  (1) Name and description oft the applicant. (2) The business address of the applicant.  (3) As statement for any changed, substituted, loaned, or leased vehicles, givinga complete description of each ambulance and non-emergency vehicle operated by the applicant, including the patient capacity thereof. On initial application and when there (4) Proof ofauthorization by the LEMSA to operate as an ALS provider. Aletter of intent toi issue authorization from the LEMSA may be used to obtain a temporary permit for (5) As statement signed by the applicant that, as a condition of the Department issuing a permit, the applicant agrees to indemnify and defend the County and its officers, employees against, and hold them harmless from any and all claims, losses, damages, and liability for damages, including attorney's fees and other costs of defense incurred by County, whether for damage to or loss of property, injuryt to or death of person, including properties of County and injury to or death of County officials, employees, or agents, arising out of, or connected with applicant's operations under said permit. (6) A schedule of rates to be charged for emergency ambulance services and non- (7) Proof of obtaining and/or maintaining a contract with LCFCA Communications Center or their designated agent for dispatch services ofe emergency 911 calls. (8) A disclosure of each instance in whichi the applicant has had an ambulance service or air ambulance service certificate, license or permit issued by the State EMS Authority, al LEMSA, or a county or city revoked or suspended for cause, including a description of the facts and circumstances which formed the basis for each such revocation or suspension and the date(s) of each such revocation or suspension. (9) Such other facts or information as required by the Department. (10) After thei initial application, an applicant for renewal may indicate "no change" if applicable to Items (5)-(14). Each applicant for renewal shall provide information as requested byt the Department to demonstrate the level of compliance withi the performance standards as outlined in Section 9-83.1(c)(1), (2), (3), and (4) oft this  are changes.  up: to sixty (60) days.  emergency services.  article.  (e) Air Ambulance Permits  (1) Each applicant for a permit to provide air ambulance services which originate in the (2) Air Ambulances operating from within the County must be al LEMSA approved Air (A) Responses to Section 9-83.1(c), items (1), (2), (3), (4), (9), (11), (12), (14), and (B) Adescription of the proposed service, including hours of availability, personnel, triage for emergency and non-emergency calls, area of response and al letter of  County shall submit to the Department thei following:  Ambulance and ALS provider. (15) of this article.  Revised: 8/23/24.C-700 Revision: Anthony Arton, Lake County Publick Health Comments' "Working DRAFT from: 10/27/2023 Workshop"    intent expressing familiarity and willingness to abide by the policies of the (C) Astatement that each aircraft owned or operated by the applicant is maintained inc compliance with applicable federal and state laws and regulations regarding  Department and the LEMSA. licensing and airworthiness.  (f) Investigation by Department. Upon receipt of a complete permit application, the Department shall, as part of its investigation to determine if the applicant meets all the requirements of this article, forward a copy oft the application to the EMCC for its review and recommendation. Upon completion of the investigation, the Department shall provide its written recommendation and the recommendation of the EMCC to the permit applicant and afford the applicant twenty days to make a written response to the Department. The Department shall then review the response of the applicant for determination regarding whether the permit should be granted or denied in accordance with Section 9-83.1(g). (1) The Department may issue a permit upon finding that the applicant meets the (2) The Department may deny or revoke a permit if the applicant does not meet the requirements of this article or if the Department finds that the applicant or any (A) Was previously the holder of a permit issued under this article, which permit has been suspended, revoked, or not reissued, and the terms or conditions oft the (B) Isc committing, or has committed, any act which if committed by any permittee would be grounds for the suspension or revocation of a permit issued pursuant (C) Has acted in the capacity of a permittee under this article without having a valid (D) Has entered a plea of guilty or nolo contrendere to, and has been found guilty of, a felony or crime involving moral turpitude, the time of appeal has elapsed, or the judgment or conviction has been affirmed on appeal. Such criminal convictions may result in the denial of a permit, irrespective of whether an order granting probation following such conviction suspended the imposition of sentence or that a subsequent order under the provisions of Section 1203.4 of the Penal Code allowed such person to withdraw his pleas of guilty and enter a plea of not guilty or that the verdict was set aside, and the case dismissed.  (g) Issuance, Denial, or Revocation of Permit  requirements of this article.  partner, officer, or director thereof:  suspension have not been fulfilled or corrected.  to this article. permit.  (h) Renewal of Permits. Permits shall be renewed every three years by the Department upon application of the permittee. Ifit is determined that the permittee has, during the period of the expiring permit, operated in conformity with the provisions of this article and that the permittee is capable of continuing operation in conformity therewith, the permittee will be notified by the Department sixty (60) days prior to the expiration of the permit. Renewal (2) Completion of all required information requested in the Application for Renewal of  will be dependent upon both: Permit in this article.  (1) Asuccessful performance review conducted by the Department.  Revised: 8/23/24C-700 Revision: Anthony Arton, Lake County Public Health Comments "Working DRAFT from 10/27/2023) Workshop"    (i) Amendment of Permits.  (1) Upon request of the permittee, the Department may amend the conditions specified ini the permit when such changes are in substantial compliance with the provisions of this article. Such an amendment shall not affect the expiration date of the existing (2) Amendments shall not authorize a change in the ownership form specified int the (3) Application for revision of rates charged for emergency ambulance services shall be made toi the Department on forms supplied by the Department. (4) Change in location or level of services shall not be allowed by such amendment unless the change is in compliance with the County EMS Plan and California State Law. The Annual Regional EMS Plan Update shall include wording that the County Ambulance (5) A permittee must conform to the requirements of the permit unless a revision is i) Conditional Operation and Temporary' Variance. In the event of a change in ownership of any kind or nature, any interruption of service of more than twenty-four (24) hours duration, or any substantial change in staffing or equipment of the permittee which causes ambulance services or non-emergency services to be carried out differently than specified in the current operating permit, the permittee shall notify the Department immediately in writing, stating the facts of such change. Upon request by the permittee, the Department may grant a temporary variance from the conditions specified in the original permit ifit finds that such a change is in substantial compliance with the provisions of this article. If the Department finds that such a change is not in substantial compliance with this article, it may suspend or revoke the permit pursuant to! Section 9-86 or 9-87 of this article. In all cases where a change in ownership occurs, an application for a new permit shall be filed within thirty (30) days. In no case shall any temporary variance be valid for more than sixty (k) Responsibilities: and Duties of Permittee. In addition to the other requirements and obligations set forth in this article, permittees providing both ambulance and non- emergency services shall comply with items (1) through (7) below. Permittees providing air ambulance services only shall comply with (2) through (5) below. (1) Private Sector Permittees shall render services required under this article on an as needed basis as defined in their agreement with the local hospital(s) as specified by the permit. Such services shall commence five (5) days after the issuance of a permit unless a different time for commencement is granted by the Department. (2) Public Sector Permittees shall render emergency ambulance services required under this article on a continuous twenty-four (24) hour per day basis throughout the entire service area specified by the permit. Such services shall commence five (5) days after the issuance of a permit unless a different time for commencement is granted by the (3) A Permittee shall take no action to discontinue any services to the service area or any portion thereof without first giving written notice to the Department at least ninety  permit. original permit.  Ordinance was revised that year.  approved by the Department, as provided in this article.  (60) days without written approval of the Department.  Department.  (90) days prior to the proposed discontinuance.  Revised: 8/23/24.C-700 Revision: Anthony Arton, Lake County Public Health Comments "Working DRAFT from 10/27/2023 Workshop"    (4) Private Sector Permittees shall notify the Department, in writing, within five (5) days after receipt of the results of any ambulance, air ambulance or non-emergency vehicle inspection conducted by a State agency regarding any ambulance or air ambulance license. Public! Sector permittees are exempt from DOT/CHP Title 13 inspections, and (5) A Permittee shall notify the Department and Lake County Fire Chiefs Association Emergency Communication Center (ECC) immediately by phone or radio, and the Public Health Officer in writing within seventy-two (72) hours of any known or foreseeable interruption, suspension, delays, or changes in services which may endanger the health, safety or welfare of the service area, or portion thereof, covered (6) Notify Lake County Fire Chiefs Association Emergency Communication Center (ECC), Department, and the LEMSA immediateywhenever an ambulance in emergency service is unable to meet emergency response standards as specified in Section 9-83.2 (7) Permittees generally will not be considered in violation of this ordinance when attempting to correct interruptions other than scheduling/staffing issues if using written ambulance response agreements for 911 ambulance coverage. (1) General Liability for Vehicle Operation. Each permittee shall obtain and keepi in force during the term ofi its permit public liability insurance, issued by a company authorized to do business int the State of California, insuring the owner, and also naming the County as an additional insured, fore each ambulance and each non-emergency vehicle owned or operated by permittee against liability due to injury or damage that may result to persons or property from the negligent operation or defective construction of such ambulance or non-emergency vehicle, or from violation of this article or any other law of the State of California or oft the United States. Said policy shall be not less than one million dollars ($1,000,000) combined single limit for personal injuryand property damage of each vehicle in any one incident. Copies of all certificates of insurance evidencing such policies shall be filed with the Department before a permit isi issued. All policies shall contain a provision. requiring that a minimum off fifteen (15) calendar days' notice be given to the Department prior to the cancellation, modification, or reduction of coverage limits. The amounts of public liability insurance for bodily injury or property damage shall be subject to review and adjustment by the Board annually at the Board's option. Only on initial application for Public. Sector (2) Medical Liability. Each permittee shall maintain comprehensive medical liability insurance in the amount of one million dollars ($1,000,000) and shall furnish the department with a certificate of insurance prior to issuance or renewal of a permit. Said policy shall name the County as an additional insured and shall require thata minimum of fifteen (15) calendar days' notice be given to the Department priort to cancellation, modification, or reduction of coverage limits. The amount of liability coverage shall be subject to review and adjustment by the Board annually at the  there is no other agency to provide this.  by the permittee.  (g) and/or this article.  (I) Insurance and Indemnity.  applicants.  Board's option.  Revised: 8/23/24C-700 Revision: Anthony Arton, Lake County Public Health Comments' Working DRAFT from 10/27/2023 Workshop"    (3) Workers' Compensation. Each permittee shall carry' Workers' Compensation (4) Indemnity. Each Permittee shall defend, indemnify, and hold harmless the County, its agents, and employees from and against any and all actions for damages, losses to persons or property arising out of, or in connection with, the activities of the permittee, its agents or employees. Said defense and indemnification shall include, but not be limited to, any and all cost expenses, attorney's fees and liability incurred.  insurance covering all employees of the permittee.  83.2 Ambulance Operations Standards  (a) Staffing: Unless otherwise approved by the CHP, each ambulance being operated to render emergency medical care shall be staffed by at least one driver and one attendant when transporting a patient. An attendant shall occupy the patient compartment while transporting a person in need of medical attention. Responsibility for patient care shall rest with the highest certified person. The requirement need not apply during a "state of war emergency," duly proclaimed "state of emergency," or "local emergency" as defined by the California Emergency: Services Act (Government Code Sections 8550 et seq). (1) Public Sector permittee shall provide ALS emergency ambulance services ona continuous twenty-four (24) hour per day basis, excluding acts of God, defined as a natural event that causes loss. If, for any reason, a permittee stops ALS emergency ambulance services on a continuous twenty-four (24) hour per day basis, the permittee shall immediately stop any advertisement of emergency services that have been discontinued and shall immediately notify the Department, LCFCA Communications Center, base hospital, and the LEMSA. (2) Private Sector permittees shall provide ALS and/or BLS ambulance services based on an established agreement with the local hospital(s), excluding acts of God, defined as a natural even that causes loss. If, for any reason, a permittee stops ambulance services, the permittee shall immediately stop any advertisement of emergency services that have been discontinued and shall immediately notify the Department, the base (3) Each permittee shall provide ALS ambulances as described by the LEMSA in their Policies, Procedures, and Protocols Manual and as described in Title 22 of the a. Minimum 911 and reserve ambulance requirements for each response zone shall be established by the individual permittee and Department after consultation with the EMCC and reviewed at least every three (3) years.  (b) Ambulance Availability  hospital, and the LEMSA. California Code of Regulations.  (c) Ambulance Safety and Emergency Equipment. Each ambulance shall be equipped with all safety and emergency equipment required for an ambulance by the California Vehicle Code, the California Code of Regulations, and the LEMSA. Ambulances and safety and emergency equipment shall be maintained at all times in good mechanical repair and clean and (1) All Private Sector ambulances shall be inspected for vehicle requirements and safety  sanitary condition. (d) Inspection.  and emergency equipment as required by the CHP.  Revised: 8/23/24.C-700 Revision: Anthony Arton, Lake County Public Health Comments "Working DRAFT from 10/27/2023 Workshop"    (2) The Department and LEMSA may also inspect all ambulances for compliance with local (e) Relationship to First Responders. When EMS isi initially provided by non-ambulance services such as fire or police agencies, the ambulance staff shall be responsible for assuring the transition of patient care, including relaying all pertinent historical and medical information, to ensure that continued appropriate services are rendered, pursuant to (f) Destination of Emergency! Patients. Any patient meeting the definition of critically ill or injured as established by the LEMSA and in need of Code 3 transportation shall be transported to a destination in accordance with LEMSA policies, procedures, and protocols. (g) Ambulance Response Standards. In addition to the current LCFCA Response Matrix and individual Response Zones under Appendix 11 for Response Zones and EMCC Response Time  standards, if any, at the Department and LEMSA's discretion.  LEMSA policy.  Guidelines, the following response standards shall apply:  (1) Dispatch Procedures  a. AlI911 Response Ambulances shall be dispatched by an authorized 911 emergency Dispatch Agency/Center or their authorized dispatch agency. b. The same designated dispatch agency: shall keep all response and availability L Dispatch/valability information to bel kept on! 911 ambulances (along with caller, type of call address, etc.) for a minimum of 180 days: (ii) Unit responding (location and response code) (v) Unit in service hospital (and code) (vi) Unit arrived at the hospital. (vii) Unit available for dispatch (ix) Unit in quarters  records for a minimum of 3 years.  (i) Call received. (ii) Call dispatched. (iv) Unit at scene  (vii) Unit returning to quarters or availablei in the area. (x) Unit out of service (and reason, i.e., mechanical, staffing, etc.)  83.3 Private Permittees Services Operation  (a) Non-Emergency Unit Staffing and Equipment. Each non-emergency unit shall be staffed and equipped in accordance with provisions of Section 51231.1 (Litter Van Requirements), Section 51231.2 (Wheelchair Van Requirements), or Section 51231 (Ambulance Requirements) ofTitle 22 of1 the California Code of Regulations as may be applicable. (b) Availability. Each permittee may provide non-emergency medical transportation services  onan as-needed basis as defined by the local hospital(s).  83.4 Air Ambulance Operations (a) Non-permittees.  (1) Air ambulance services, which originate from aj jurisdiction outside the County, are not  required to possess a permit to operate int the county.  Revised: 8/23/24C-700 Revision: Anthony Arton, Lake County Public Health Comments' "Working DRAFT from 10/27/2023 Workshop"    (2) No air ambulance originating from a jurisdiction outside the County, with the exception of the CHP helicopter, shall respond to an emergency within the County unless requested by LCFCA Communications Center upon the request of the senior prehospital medical personnel at the scene of the emergency or the incident  commander enroute to or from an emergency.  83.5 Data Collection and Reporting  (a) The equipment, premises, vehicle, and/or aircraft maintenance records of calls for the permittee shall be open toi inspection by the Department, the LEMSA, the Base Hospitals,  and CHP during the normal business hours of operation.  Sec. 9-84 User Complaints  Complaints regarding permittees pursuant to this Article shall be resolved at the lowest possible level. Any person who contends that he or she has received inadequate or inappropriate services or excessive ori inappropriate charges shall be directed to attempt resolution of the complaint by meeting and discussing the complaint with the involved person, agency, or entity. Ift this effort is unsuccessful, the complainant may file a written complaint with the Department. The Department shall investigate the allegations and take appropriate action. EMS system or patient care complaints not involving the Ambulance Ordinance should go to the ALS Provider, base hospital, and/or LEMSA pursuant to Quality  Improvement policies. Sec. 9-85 Appeal Procedure  Ifthe Department denies the renewal ofa permit, or if the Department suspends or revokes a permit, the permittee shall have the right to demand an appeal hearing before the Board. Arequest for an appeal hearing shall be made in writing to the Clerk of the Board within fifteen (15) working days following the denial of a renewal, suspension, or revocation of the permit. Such a request shall include a written statement setting forth the basis upon which the Department decision is challenged. Upon receipt of the written request, the Clerk of the Board shall set the matter for a hearing on a date not more than ten (10) days or sooner following receipt of the written request, and the action of the Department should be placed on hold. The Clerk shall notify the appellant and the Department of the date set for the hearing. At the hearing, the Board shall hear the appellant, the Department, and any other interested person who may present evidence relative to the decision of the Department. Within thirty (30) days following the conclusion of the hearing, the Board shall issue a written decision to  determine the appeal. The determination of the Board shall be final.  Sec. 9-86 Emergency Action.  The Department may immediately suspend any permit issued under this article when it makes written findings of the fact requiring such action to protect public health, safety, and welfare. The Department shall immediately notify the permittee oft the suspension. A request for an appeal hearing under this Section 9-86 shall be submitted in writing to the Department within five (5) working days of a Permittee's receipt of the Department's suspension notice. The Department shall then hold a hearing within five (5) working days following receipt of permittee's request for an appeal. At the hearing, the Department shall hear the appellant and any other interested person who may present evidence relative to the decision of the Department. A written decision shall bei issued within five (5) working days after the completion of Revised: 8/23/240 C-700 Revision: Anthony Arton, Lake County Public Health Comments "Working DRAFTfrom 10/27/2023 Workshop"    the hearing. The Department shall ensure adequate EMS coverage for the duration oft the suspension  and appeal under this Section 9-86. Sec. 9-87 Enforcement  87.1 Department Responsibilities  (a) The Department shall make allr necessary and reasonable rules and regulations governing permittees and their operations, equipment, vehicles, and personnel, as well as for the effective and reasonable administration of this article to those items pursuant to this (b) The Department shall inspect the records, facilities, vehicles, equipment, and methods of operation prior to thei issuance of a new or renewed permit, or whenever such inspections are deemed necessary by the Department. Need additional conversation with the LEMSA. 88.2 Penalties- - General. A violation of any provision of this article is punishable as an infraction by ai fine ofr not more than one hundred dollars ($100.00), or as a misdemeanor by ai fine of not more than five hundred dollars ($500.00), or by imprisonment int the County. Jail fora period of not more than six (6) months, or byl both such fine and imprisonment. Each separate day or any portion thereof on which any violation occurs shall be deemed to  Ambulance Ordinance.  constitute a separate offense punishable as herein provided.  Sec. 9-88 Ordinance Review  88.1 Annual Review. The EMCC: shall review the Ambulance Ordinance annually in the month of. January to ensure compliance and relevance of the ordinance, as well as update the ordinance to ensure new emergency issues can be mitigated and dealt with  appropriately and that new! laws do not conflict.  88.2 Response Time Review: response times will be reviewed by the EMCC on a bi-annual basis. Section 2: All ordinances or parts of ordinances or resolutions or parts of resolutions in conflict  herewith are hereby repealed to the extent of such conflict and no further. expiration of fifteen days after its passage, it shall be published at least once in a  Section 3: This ordinance shall take effect on the day of  2024, and before the  newspaper of general circulation in the County of Lake.  The foregoing Ordinance was introduced before the Board of Supervisors on the day of of_  2024, and passed by the following vote on the. of  2024, by the following vote:  AYES: NOES:  ABSENT OR NOTV VOTING:  Revised: 8/23/240 C-700 Revision: Anthony Arton, Lake County Public Health Comments "Working DRAFT from 10/27/2023 Workshop"    COUNTY OF LAKE  Board of Supervisors  ATTEST: SUSAN PARKER Clerk of the Board of Supervisors  By: Deputy  APPROVED. ASTO FORM: LLOYD GUINTIVANO County Counsel By: Deputy  Revised: 8/23/240 C-700 Revision: Anthony Arton,! Lake County Publich Health Comments' "Working DRAFT from: 10/27/2023 Workshop"    APPENDIX1  The LCFCA have dropped their response boundaries, therefore the LCFCA Communications Center ensures the closest and fastest resource to every call throughout  the County.  (1) Listed are response areas for: a. Response Zone 50-52 Protection District. aid or response agreements. b. Response Zone 55-56 Protection District. aid or response agreements. Response Zone 60-62,63,64 Protection District. aid or response agreements. d. Response Zone 65 and 70 Protection District. aid or response agreements. Protection District. aid or response agreements. Response Zone 80 Protection District. aid or response agreements. Protection District. aid or response agreements.  "Regular Response": Response with all available resources available. "Special Response": Response with other resources unavailable."  - Regular Response: Initial response to any zone within the Lakeport Fire ii. Special Response: All zones defined in current LCFCA Response Matrix, mutual Regular Response: Initial response to any zone within the Kelseyville Fire ii. Special Response: All zones defined in current LCFCA Response Matrix, mutual  Regular Response: Initial response to any zone within the South Lake County Fire ii. Special Response: All zones defined in current LCFCA Response Matrix, mutual Regular Response: Initial Response to any zone within the Lake County Fire ii. Special Response: All zones defined in current LCFCA Response Matrix, mutual Regular Response: Initial response to any zone within the Northshore Fire ii. Special Response: All zones defined in current LCFCA Response Matrix, mutual - Regular Response: Initial response to any area within the Northshore Fire ii. Special Response: All areas defined in current LCFCA Response Matrix, mutual Regular Response: Initial response to any area within the Northshore Fire ii. Special Response: All areas defined in current LCFCA Response Matrix, mutual  e. Response Zone 75  g. Response Area 85  h. Response Area! 90  Revised: 8/23/240 C-700F Revision: Anthony Arton, Lake County Publich Health Comments "Working DRAFTÉ from 10/27/2023 Workshop"    Regular Response: Initial response to any zone within the Northshore Fire ii. Special Response: All areas defined in current LCFCA Response Matrix, mutual (2) Response time to be enroute after a call is received shall be: three (3) to five (5) minutes. (3) Response time to the reported scene from the time the ambulance goes enroute will be a. AlI911 units will announce their dispatch response and all other ambulance response information to their designated dispatch agency on a non-protected radio b. AlI911 responses will be dispatched either Code 2 or 3 by the dispatch center based Ambulances shall be available to respond to a new call as promptly as possible after arrival at a hospital with a patient. Their designated dispatch agency will be notified of any delays. If the time at the hospital exceeds 30 minutes, the provider shall track and periodically reportsuch occurrences to the Department and LEMSA.  Protection District. aid or response agreements.  established by the individual agency. (4) Response Procedures  frequency.  upon the identified patient's condition and perceived urgency.  Revised: 8/23/24 C-700 Revision: Anthony Arton, Lake County Publick Health Comments "Working DRAFT from: 10/27/2023 Workshop"    EMERGENCY MEDICAL CARE COMMITTEE  COUNTY OF LAKE BY-LAWS  Revision Date: XXXXXXXX, 2024 Deeember6,1988-Mare5,2024,  ARTICLE I- OFFICIAL NAME OF COMMITTEE  1. The official name of this Committee shall be known as the County of Lake - Emergency Medical  Care Committee (hereafter referred to as COL-EMCC).  ARTICLE II-F PURPOSE OF THE COL-EMCC  1. Itist the intent of the County of Lake to promote the development and accessibility of effective and efficient emergency medical care to the people of the county. The County Board of Supervisors, therefore, establishes the County of Lake Emergency Medical Care Committee for the purpose of reviewing emergency medical care in the County of Lake.  ARTICLEIII-0 OBJECTIVES AND DUTIES OF THE COL-EMCC  1. The objectives of the Emergency Medical Care Committee include the following: a. Improvinginterfaclity communication infrastructure. b. Stakeholder communication and relationship improvement.  Stakeholder conflict mediation.  d. County EMS infrastructure, process, and procedural review to identify system shortfalls and maintain an industry growth mindset through collaboration with local EMS agencies, Lake County Public Health, local base hospitals, the designated Local Emergency Medical Services Agency (LEMSA), and associated partners. e. Ensuring local EMS practices maintain county and state best practices and statute adherence through LEMSA and Lake County Public Health Advisory. Providing open communication and transparency with community members regarding EMS system-based information, shortfalls, and improvements.  2. The Emergency Medical Care Committee shall, at least annually, review the operations of each  of the following:  a. Ambulance services operating within the county.  b. Emergency medical care is offered within the county, including programs for training many people in cardiopulmonary resuscitation and lifesaving first aid techniques. d. Educational and continuing education opportunities and programs related to EMS are e. Disaster planning and preparedness as practiced within the County and between 3. The EMCC shall, at least annually, report to the Lake County Board ofSupervisors, any affected health systems agency, and the designated Local EMS Agency its observations and recommendations relative to its review oft the operations in Article III of this document. 4. The EMCC shall act in an advisory capacity to the Board of Supervisors and to the LEMSA on all matters relating to emergency medical services as directed by the Board of Supervisors.  First aid practices in the county. offered within Lake County. adjacent or adjoining Counties.  Revised: November 15, 2024    5. The following are standing subcommittees oft the COL-EMCC:  a. Interfacility Transfer (IFT): This subcommittee fosters collaboration between Emergency Medical Services (EMS) providers and the two (2) critical access hospitals in Lake County, California. Our primary goal is to enhance patient care during inter-facility transfers through effective communication, shared best practices, and a unified approach to - The Chair of the EMCC will appoint members to the IFT Subcommittee, ensuring representation from diverse stakeholders, including one member each from Lake County Health Services and Behavioral Health Services, one from Adventist Clearlake Hospital, one from Sutter Lakeside Hospital, one representative from each Fire/EMS service operating in Lake County; and other medical service consumers or members oft the general public as the Chair deems appropriate. ii. Appointments will be valid for one year, with new appointments made as necessary or at the beginning of each calendar year. Upon such appointments, IFT shall select a chair and other officers. The IFT chair shall ensure an accurate roster of current IFT members is maintained and shall provide such roster to the Health Services Department and to the clerk to the Board of Supervisors. ili. The IFT Subcommittee will convene monthly from November to March and bi- monthly from April to October, or as otherwise called by the IFT chair. Meetings will include a teleconference option; however, in-person attendance is strongly. encouraged to facilitate meaningful collaboration. Although IFT is a standing subcommittee, it is exempt from Brown Act procedures regarding agendas. iv. General rules oft the subcommittee include active participation from all members, with each member encouraged to contribute their insights and expertise. Members are expected. to adhere to confidentiality guidelines regarding specific patients and cases discussed in meetings. Decisions will be made collaboratively, with a focus on consensuswhenever possible. Larger discussions or recommended actions involving public policies should be elevated to the EMCC chair for possible placement on a future EMCC agenda. M. Att the beginning of each meeting an official confidentiality notice will be applied inc order to protect the privacy and confidentiality of the patients and cases  emergency medical treatment.  discussed.  b. Membership: Keeps updated roster and faciliates approval of members, alternates. 6. The following are ad hoc committees that meet for a limited time or specific purpose: a. Annual Reporting: Prepares draft annual report to the Board of Supervisors for EMCC review and approval; proposes date and possible presenters. b. Bylaws: Meets at least annually to review bylaws and recommend changes. Policy and Procedure Review: Meets as needed to review and recommend changes to public and/or private policies and procedures related to emergency medical care.  ARTICLE IV - MEMBERSHIP  1. Membership shall comprise active emergency care providers and interested emergency care consumers from Lake County willing to expend their energies in achieving a countywide quality 2. Prospective members and alternates shall be selected by their respective organizations, and their names will be submitted to the Membership Subcommittee for application assistance.  emergency medical services system.  Revised: November 15,2024    3. Other community members expressing a sincere interest in having a voice in quality emergency medical services in the County may submit their names to the Membership Subcommittee for screening. The Membership Subcommittee Chairperson shall submit the list of prospective members' names to the EMCC chairperson and to the clerk ofi the Board of Supervisors for final membership confirmation within forty-five (45) days of the prospective member's application. 4. Final confirmation of COL-EMCC members shall be granted by the County of Lake Board of Supervisors in accordance with the provisions oft the Health and Safety Code, Div. 2.5. 5. Approved COL-EMCC members shall serve a term of two (2) years. An individual appointed in the middle ofa a term shall serve from the date of appointment to the end ofi the unexpired term. Appointed members can serve a maximum oft three consecutive terms. a. County supervisors and designated county staff may be assigned to serve as an EMCC member or alternate by virtue of their job titles without submitting a formal application. The clerk to the Board of Supervisors shall be promptly notified of any such assignments. 6. Ana annual membership review shall be conducted by the Membership Subcommittee. 7. Renewal of continuing memberships shall be in. January of the year with an uneven number. a. Attendance and committee participation are conditions for maintaining active membership. b. Members (or their designated alternate) A3HSHERCeENE9eWEOFee) not less than four (4) out of six (6) regular meetings or TWO-THIRDS of the COL-EMCC meetings. C. Ifa member misses three (3) consecutive meetings, he/she will be removed from active membership. Attendance bya designatedaternate constitutes attendance by the member. d. Attendance records and information areto be maintained by the COL-EMCC: Secretary fora all 9. Membership Application Process: All applications aret to be routed to the Clerk to the Board of Supervisors for placement on afuture BoardofSupervisors agenda. Use the online application form or call the county administrative office at 707-263-2368 to be sent an applicationform. a. Each memberi is to select an alternate member representative of his or her choice to ensure b. The alternate member is to have full voting privileges in the event ofa COL-EMCC member's The approved COL-EMCC member is responsible for selecting the alternate who shall represent him or her in their absence and shall submit that name to the COL-EMCC Secretary on the appropriate form. The member is also responsible for notifying the 11. Membership at large shall be composed of selected individuals who represent the following a. Two (2) hospital representatives, one from each county acute care hospital that provides  8. Conditions of membership:  regular COL-EMCC meetings.  10.A Alternates:  representation at the prescribed majority oft the COL-EMCC meetings.  absence.  Secretary of any changes in the alternate. agencies, organizations, or consumer interests: emergency medical care through an emergency department. b. One (1) Lake County Public Health Officer One (1) Lake County Health Services Director e. Two (2) Private ambulances permitted in Lake County . One (1) member of the Lake County Board of Supervisors  d. Two (2) fire district representatives who provide emergency medical services in Lake  County.  12. Membership Quorum:  a. Afifty percent (50%) plus one (1) majority of COL-EMCC members at each COL-EMCC  meeting shall constitute a quorum.  Revised: November 15, 2024    b. Fifty percent (50%) plus one (1) of the COL-EMCC member quorum present shall constitute a Ifless than fifty percent (50%) plus one (1) oft the COL-EMCC members are present at the regular monthly COL-EMCC meeting, no decisions requiring a majority vote shall be presented to the floor and shall have to be carried over to the next regular monthly  majority vote.  meeting.  ARTICLE V- OFFICERS ELECTION OR SELECTION  1. The COL-EMCC shall elect or select a Chairperson, Vice-Chairperson, and Recording Secretary 2. Other Officers and Committee Chairpersons may be elected or selected as deemed necessary by  annually.  the needs or demands of the COL-EMCC. 3. The term of office shall be ONE year. ARTICLE VI- OFFICER'S DUTIES 1. CHAIRPERSON:  a. Conduct all meetings consistent with the COL-EMCC guidelines, policies or bylaws. b. Oversee and coordinate fellow officers' and members' activities and duties to ensure an Have an'agenda prepared byhim/herselfand/or: in conjunction with the efforts ofother officerso or committee members, and distribute this agenda prior to each meeting. d. Coordinate with the COL-EMCC Secretary in orderto properly submit the requiredminutes and reports necessary for an efficiently run andi informative COL-EMCC meeting. e. Informthe Boardof Supervisors of membership vacancies and request the Membership Subcommittee recruit new members in accordance with the provisions of ARTICLEVI, Conduct all EMCC meetings in accordance with the protocols and guidelines of any accepted a. Int the absence of the Chairperson of the COL-EMCC, the Vice-Chairperson shall be responsible for the COL-EMCC Chairperson's duties as provided in ARTICLE VI ofthis b. The Vice Chairperson shall be responsible for furthering COL-EMCC goodwill and public a. Comprehensive and understandable minutes are to be taken and recorded by the COL-  efficient and smoothly run COL-EMCC.  Section 2, Membership Selection of this document.  Rules of Order format. 2. VICE-CHAIRPERSON:  document.  relations and shall assist any committee involved in this endeavor. EMCC Secretary at each regular or special meeting. b. An agenda will be provided prior to each COL-EMCC. Minutes of the previous COL-EMCC meeting shall be provided.  3. SECRETARY:  d. The Secretary shall maintain a channel of communication and information exchange with COL-EMCC Chairperson and earnestly attempt to impart pertinent information and facts to e. The Secretary shall maintain attendance records for all regular and special meetings of COL- f.The Secretary shall maintain an accurate and current roll of membership. Any changes in this roll shall be submitted to the Clerk of the Board of Supervisors and the COL-EMCC Chairperson.  COL-EMCC members promptly.  EMCC.  Revised: November 15, 2024    4. SUBCOMMITTEE CHAIRPERSON: date, and time.  a. Provide the COL-EMCC Chairperson and/or Secretary with the subcommittee meeting place, b. Fora any standing subcommittee, provide the COL-EMCC Chairperson and/or Secretary with the proposed agenda. Agendas are not required for meetings of ad hoc subcommittees d. Report positive or negative decisions or actions undertaken by the subcommittee. For any standing subcommittee, prepare draft meeting minutes for EMCC review and approval. e. Accept responsibility for overseeing a project or committee undertaking through toa  assigned for a limited time or purpose. Report any problems arising within the subcommittee.  positive or negative conclusion. f. Utilize available references, resources, and contacts. . Outline the proposed objectives and goals oft the subcommittee. h. Maintain objectivity and flexibility.  ARTICLE VII-E RECORD KEEPING  1. By statute, EMCCI is not subject to the California Public Records Act (Evidence Code Sec. 1157.7). However, the EMCC bylaws require meetings to be conducted publicly with proper notice, and the agendas and minutes of all EMCC meetings shall be posted on the county agenda center. Subcommittee meetings shall be noticed and conducted as stated int the EMCC bylaws. 2. Notwithstanding the preceding paragraph, annual reports and other writings transmitted to the Board of Supervisors, the Health Services Department and/or other persons or organizations may be subject to California Public Records Act requirements. The Health Services Department shall act ast the custodian of EMCCsannualreportsandother: writings intended for public use.  ARTICLE VIII-T TELECONFERENCING  1. Public attendance and participation by teleconferencing shall be provided toi the extent feasible. Where teleconferencing is anticipated, the sign-in link and instructions shall be listed on the COL-EMCC agenda and made available to the public not less than 72 hours prior to the meeting. 2. COL-EMCC Committee Members: and their respective alternates, as well as a LEMSA representative shall attend EMCC meetings in person whenever practical to help ensure 3. Any EMCC member who cannot attend the meeting in person for good cause but wishes to attend remotely should contact the EMCC chair at least 241 hours in advance of the meeting. Examples of good cause include a medical emergency, caregiving for a family member, a contagious illness, or work-related travel that prevents the member from appearing in person. Remote attendance for good cause is limited to two (2) times per year. 4. Notwithstanding the immediately preceding paragraph, remote attendance by teleconferencing may not be denied to any EMCC member or alternate with a physical or mental disability. 5. Should teleconferencing be interrupted due to Internet outage or other circumstances, the EMCC Chairperson may pause the meeting for a reasonable time until service can be restored. Should an extended Internet outage, software failure or other emergency prevent restoration of teleconferencing, the EMCC Chairperson may exercise reasonable discretion to continue the meeting with those present in person or adjourn the meeting to another date or location.  continued collaboration and engagement.  Revised: November 15, 2024       a  I5S  Revised: November 15, 2024