1998-52950-Ordinance No. 98-064 Recorded 11/6/1998REVIEWED As TO FORM
a_REVIEWED
�i
CODE REVIEWCOMM. 2454
� � � LCOUNSEL
BEFORE THE BOARD OF COUNTY COMMISSIONERS OF DESCHUTES COUNTY, OREGON
An Ordinance Adopting Chapter 8.30,
Ambulance Service Area, of the Deschutes
County Code, Repealing Ordinance * 98 NOV _6 AM 11: 37
No. 97-040, and Declaring an Emergency.
M AIR ; Su1 "' P��f, illi 0LLrW
ORDINANCE NO. 98-064 COUNTY CLERK
WHEREAS, ORS 682.205 requires Deschutes County to develop and adopt a plan for the
coordination of emergency ambulance services and to establish Ambulance Service Areas, consistent
with the plan, to provide efficient and effective emergency ambulance services; and
WHEREAS, ORS 221.485, 221.495, 478.260(3) and 682.025 through 682.355 require
Deschutes County to develop and adopt a plan for emergency ambulance services that recognizes the
authority of incorporated cities and rural fire protection districts to operate and regulate emergency
ambulance services within their own territories subject to the Ambulance Service Area Plan; and
WHEREAS, provision of effective and efficient ambulances services within incorporated cities
and rural fire protection districts must be accomplished primarily on a cooperative basis; and
WHEREAS, an Ambulance Service Area Plan is attached as Exhibit B; now, therefore,
THE BOARD OF COUNTY COMMISSIONERS OF DESCHUTES COUNTY, OREGON,
ORDAINS as follows:
Section 1. REPEALING. Ordinance No. 97-040 is hereby repealed in its entirety.
Section 2. ADDING. Chapter 8.30, Ambulance Service Area, is hereby adopted as set forth in
Exhibit "A," attached hereto and by this reference incorporated herein.
Section 3. ADOPTION. The Ambulance Service Area Plan for Deschutes County is hereby
adopted as set forth in Exhibit "B," attached hereto and by this reference incorporated herein.
Section 4. SUNSET. This ordinance is repealed June 30, 2000.
WICROF ED nyp � _.Ct;E'J
To I
D ; Q 2 `1988
PAGE 1 OF 2 - ORDINANCE NO. 98-064 (11/4/98)
1-:
169 - 2455
Section 5. EMERGENCY. This Ordinance being necessary for the immediate preservation of
the public peace, health and safety, an emergency is declared to exist, and this Ordinance takes effect
on its passage.
DATED this day of , 1998.
ATTEST:
VY ��
Recording Secretary
PAGE 2 OF 2 - ORDINANCE NO. 98-064 (11/4/98)
BOARD OF COUNTY COMMISSIONERS OF
CY PgPt 9C14LANGEN, Chair
ROIXERT L.
IV
NDA L. SWEARINGEN, Commissioner
EXHIBIT "A" 1 �° 2456
Chapter 8.30. Ambulance Service Area
8.30.010.
Title.
8.30.020.
Purpose.
8.30.030.
Definitions.
8.30.035.
Ambulance service area
(ASA) advisory committee -
established.
8.30.040.
Administration.
8.30.045.
Service providers regulated.
8.30.050.
Franchise -application.
8.30.055.
Franchise -review of
application.
8.30.060.
Franchise -terms and
renewals.
8.30.065.
Franchise -discontinuance of
service; transfer.
8.30.070.
Enforcement.
8.30.075.
Interruption of service -
prevention.
8.30.080.
Appeals, abatement and
penalties.
8.30.085
Franchise duties.
8.30.090.
Exemptions.
8.30.010. Title.
This title shall be known as the
Deschutes County Ambulance Service Area.
(Ord. 98-064 §1, 1998)
8.30.020. Purpose.
A. The purpose of this chapter is to
establish ambulance services areas, assign
emergency ambulance service providers,
create an ambulance service area advisory
committee, provide penalties and prescribe
effective dates.
B. For the efficient and effective
provision of emergency ambulance services
in accordance with the (Ambulance Service
Area (ASA) Plan, the ambulance service
areas shown on the map known as Appendix
#1 of the ASA Plan is hereby adopted as the
ASA for Deschutes County. The board, after
notice to the affected ASA provider and by
the adoption of an order, may adjust the
boundaries of an ASA from time to time as
necessary to provide efficient and effective
emergency ambulance services.
8.30.030. Definitions.
For the purposes of this chapter, unless
otherwise apparent from the context, certain
words and phrases used in this chapter are
defined as set forth in the Ambulance
Service Area Plan for Deschutes County,
Oregon. (See Appendix A.)
8.30.035. Ambulance Service Area
(ASA) Advisory Committee -
Established.
A. A committee to be known as the
Ambulance Service Area Advisory
Committee (committee) is hereby
established.
1. The committee shall consist of ten
members; one member from each of the
following:
a. Emergency department physician
b. Ambulance service medical director
c. Deschutes County Health
Department
d. Ambulance service provider
e. Sheriff's Office representative
f. 9-1-1 center representative
g. EMT -Basic
h. EMT -Intermediate
i. EMT -Paramedic
j. Public at large.
2. The board shall designate a county
staff member as the ASA administrator. The
administrator and other county staff as the
board deems appropriate shall be ex -officio
members of the committee.
B. Members shall be appointed by and
serve at the pleasure of the board. The board
may appoint additional persons to the
committee to serve as ex -officio members
or advisors. The board may approve
designation of alternates to serve in the
absence of persons appointed to the
committee.
C. Except for the ASA administrator
and any other county staff, appointments
shall be for staggered terms on the initial
committee for a term not to exceed three
Exhibit
Page of
Ordinance R I' a� `�
years. Subsequent appointments shall be for
two-year terms. Members shall serve until
their successors are appointed and qualified.
Vacancies shall be filled by the board for
the balance of the unexpired term. Persons
may be appointed to successive terms.
D. The committee shall elect a
chairperson. The committee shall meet at
such times it deems necessary or as called
by the administrator or the board. The
chairperson or any two members of the
committee may call a special meeting with
five days notice to other members of the
committee. However, members may waive
such notice.
E. Five committee members constitute
a quorum for the transaction of business. A
majority vote of those present and voting is
required to pass motions.
F. In addition to other duties
prescribed by this chapter, the committee
shall:
1. Review and make recommendations
to the administrator regarding the selection
criteria for determining a franchise to
provide ambulance service.
2. Regularly provide information to
the board from pre -hospital care consumers,
providers and the medical community.
3. Periodically review the ASA Plan
and make recommendations to the board in
regard to:
a. Standards established in the plan
and improvements of or new standards as
required by OAR 333-260-0050
b. Coordination between emergency
medical service resources;
c. Dispatch procedures and
compliance; and
d. Effectiveness and efficiency of the
ASA boundaries.
4. Implement the quality assurance
program outlined in the ASA Plan to insure
compliance with the ASA Plan.
5. Perform such other duties as
directed by the board.
G. Committee members shall avoid
acting in any manner where a conflict of
interest may arise. Any committee member
169 - 2457
having a direct or indirect financial
pecuniary interest in any matter before the
committee for consideration shall withdraw
from participation in any action by the
committee in said matter. Nothing in this
section shall limit the ability of any person
to provide testimony before the committee.
8.30.040. Administration.
The administrator, under the
supervision of the board and with the
assistance of the committee, shall be
responsible for the administration of the
ASA Plan. In order to carry out the duties
imposed by the ASA Plan, the
administrator, or persons authorized by the
administrator, are authorized to enter on the
premises of any person regulated by the
ASA Plan at reasonable times and in a
reasonable manner to determine
compliance. The administrator shall also
have access to records pertaining to
ambulance service operations of any person
regulated by the ASA Plan. These records
shall be made and provided as requested by
the administrator.
8.30.045. Service providers regulated.
A. Effective May 14, 1997, no person
shall provide emergency ambulance
services within Deschutes County unless
such person is franchised in accordance
with this chapter.
B. If there is more than one application
made for an ASA, the provider that meets
the application requirements of Section
8.30.050 and that was providing service on
the effective date of this Ordinance shall be
franchised to provide emergency ambulance
service for the ASA.
8.30.050. Franchise -application.
A. Any person desiring to provide
ambulance service within Deschutes County
shall submit an application to be assigned an
ASA within 30 days of the effective date of
this ordinance. The application shall be
submitted to the administrator.
Exhibit
Page Z of
Ordinance9 t ' o &4
i
B. Applications for franchises shall be
on forms provided by the board. In addition
to information required by the forms, the
board may require additional information it
deems necessary to insure compliance with
this chapter or to make a more informed
decision.
C. The applicant shall provide the
following information:
1. The name and address of the person
or agency applying.
2. The ASA the person desires to
serve, the location(s) from which ambulance
services will be provided, and the level of
service to be provided.
3. A statement as to whether or not the
applicant will subcontract for any service to
be provided. If some service will be
provided by subcontract, a copy of that
subcontract shall be provided.
4. A list of vehicles to be used in
providing emergency ambulance services
including year, make and model, and
verification that each vehicle is licensed as a
basic and/or advance life support ambulance
by the Oregon State Health Division.
5. A statement that all equipment and
supplies in each ambulance conforms to
Health Division standards.
6. A list of personnel to be used in
providing emergency ambulance service
and their current Emergency Medical
Technician level and certificate number, or
other appropriate certification.
7. Proof of financial ability to operate,
including an operating budget for public
bodies or financial statement for private
entities, references, and statement of past
ambulance service. Private companies must
include a profit and loss statement in
addition to the above materials. Other
appropriate financial information such as
income tax returns or reports by
governmental authorities shall also be
submitted upon request. Public bodies must
provide information regarding the sources
and amounts of funding for emergency
ambulance services.
169 - 2458
8. Proof of public liability insurance in
the amount of not less than $100,000.00
because of bodily injury to or death of one
person in any one accident; subject to that
limit for one person, $300,000.00 because
of bodily injury to or death of two or more
persons in any one accident; $20,000.00
because of injury to or destruction of the
property of others in any one accident; and
$500,000.00 because of injury arising from
the negligent provision of pre -hospital care
to any individual. Applicants may be self-
insured.
9. A statement of experience in
providing emergency ambulance service of
a comparable quality and quantity to insure
compliance with this chapter, regulations
promoted thereunder, any franchise issued,
and the ASA Plan.
10. Statement of ability to comply with
the rules and regulations of the ASA Plan
and applicable county ordinances, in the
form of a narrative summary.
11. A description of any prepaid
ambulance plan, including number of years
of operation, funding and term.
12. Any other materials or information
requested.
13. In the case of an application to
transfer or take over an already assigned
franchise:
a. A detailed summary of how the
proposed change will improve emergency
ambulance response time, and the quality
and level of services to the ASA. It shall
include an assessment of how the proposed
change will impact the existing first
response system.
b. Evidence that the call volume in the
ASA is sufficient to financially or otherwise
justify the change in service.
c. Any other records or materials
requested.
D. The board may, from time to time,
by order, adopt fees to defray the actual
reasonable costs incurred by Deschutes
County in processing applications, and
adopt annual franchise fees to defray
Exhibit /4
Page 3 of
Ordinance
reasonable costs of Deschutes County in
administering the ASA Plan.
E. Franchise applications shall be
reviewed by the ASA committee, who will
make a recommendation of assignment of
the ASAs to the board. The assignment of
an ASA shall be made by an order of the
board.
8.30.055. Franchise -review of
application.
A. Applications shall be reviewed by
the committee, who shall make such an
investigation as it deems appropriate, and
who may request assistance of other persons
as necessary.
B. The administrator shall notify the
holder of a franchise for providing
emergency ambulance service to an ASA of
any applications by another person to take
over that franchise.
C. Unless the time is extended by the
board for good cause, the committee shall
make its recommendation to the board to
grant, deny, modify, or attach appropriate
conditions to the application. The
committee shall transmit its
recommendation within 60 days after the
application.
D. Upon receipt of the committee's
recommendation, the board:
1. Shall publish notice of its intent to
hold a public hearing on the application and
recommendations at least 10 days, but not
later than 30 days following publication of
notice.
2. May require additional investigation
by the committee if it finds that there is
insufficient information on which to base its
action.
3. Shall, upon the basis of the
application, the committee's
recommendation, such other information as
is permitted by this chapter, and such
information as is presented to the Board at
the public hearing, make an order granting,
denying, or modifying the application or
attaching conditions thereto.
169 - 2459
4. Shall not make an order adverse to
the applicant or to the holder of, or applicant
for, another franchise effective less than 30
days after the date of such order and shall
notify such persons in writing of the order.
The board may suspend operation of this
subsection and enter an emergency order if
it finds there is an immediate and serious
danger to the public or a health hazard or
public nuisance would be created by a
delay.
5. After the board makes an order
granting an emergency ambulance service
franchise with or without conditions, and
the franchise finds he/she is unable to
provide a particular service, the board may
permit the franchise to subcontract such
service to another person if the board finds
that the quality and extent of the service
would not be jeopardized. The board may
require the filing of such information as it
deems necessary.
8.30.060. Franchise -terms and
renewals.
A. The initial ambulance service
franchise in an ASA shall be valid from the
date of issuance until June 30, 2000.
B. Thereafter, the term of an
emergency ambulance service franchise
shall be three years beginning on July 1 and
ending June 30 three years later.
C. Unless grounds exist for refusal to
renew a franchise under provisions for
suspension or revocation as set forth in this
chapter, or unless the franchise is to be
given to a new person, franchises shall be
renewable. Application for renewal shall be
made on forms provided by the board.
D. Not more than 180 days and not less
than 120 days prior to the expiration of the
franchise, a franchisee wanting to renew the
franchise and any person desiring to take
over the franchise shall submit an
application to the administrator.
E. Review of all applications for
renewal or take over of a franchise shall be
conducted in the same manner as provided
for in this chapter.
Exhibit
Page q of
Ordinance A'o&
}
8.30.065. Franchise -discontinuance of
service; transfer.
A. If a franchise discontinues service
before the expiration date of his/her
franchise, the Board shall set a time by
which applications must be submitted for a
new franchise in the ASA.
B. The committee shall develop an
interim plan for coverage of the ASA, using
existing franchisees and/or other available
resources until the ASA can be reassigned.
C. The board shall issue a temporary
certificate, valid for a stated period not to
exceed six months, entitling a person to
provide emergency ambulance service in all
or part of the ASA. The Board may renew a
temporary certificate for one additional six
month period.
D. A franchise may transfer its
franchise to another person only upon
written notice to and approval by the board.
Review of an application for transfer of a
franchise shall be conducted in the same
manner as for an application pursuant to this
chapter.
8.30.070. Enforcement.
A. Subject to the policies and remedies
stated in this chapter, and penalties provided
elsewhere in this chapter, the administrator
shall, upon reasonable cause, make an
investigation to determine if there is
sufficient reason and cause to suspend,
modify, revoke, or refuse to renew a
franchise as provided in this subsection.
B. If in the judgment of the committee
or board, there is sufficient evidence to
constitute a violation of applicable local,
state or federal law, or if the franchise has
materially misrepresented facts or
information given in the application for the
franchise, the board shall notify the
franchisee in writing, by certified mail, or
by personal service, as is provided by law
for the service of a summons, of the
violation and what steps he must take to
cure the violation. The board shall send a
copy of the notice to the committee.
169 - 460
C. Ten days following the receipt of
notice of violation, the board may enter its
order of revocation, modification,
suspension or non -renewal, and may thereby
revoke, modify, suspend, or not renew the
franchise, unless prior thereto the franchisee
shall file with the board his request for a
hearing on the board's notice of violation. If
said request is timely filed, or if the board
moves on its own, revocation, modification ,
suspension, or non -renewal will be stayed
until the board can, at its earliest
convenience, hold a public hearing on the
matter. Notice of said hearing shall be given
to the franchisee by mail and to all others by
publication in a newspaper of general
circulation in the county or the ASA at least
10 days prior to such hearing. The burden of
proof at the hearing shall be upon the
administrator to show by substantial
evidence in the record as a whole that the
franchisee failed to comply with this
chapter, the ASA Plan, state statute, or
administrative rule.
E. In lieu of the suspension or
revocation of the franchise, the board may
order that the violation be corrected and
make the suspension or revocation
contingent upon compliance with the order
within the period of time stated therein.
Notice of the board action shall be provided
by mail to the franchisee. The notice shall
specify the violation, the action necessary to
correct the violation, and the date by which
the action must be taken. The franchisee
shall notify the board of the corrective
action taken. If the franchisee fails to take
corrective action within the time required,
the board shall notify the franchisee by
certified mail, return receipt requested, or
by personal service, that the franchise is
suspended or revoked upon service of the
notice.
F. Should the franchisee fail to comply
with the board's order, then the board may
take any steps authorized by law to enforce
its order.
Exhlblt �~
Page '5 of
Ordinance 19-04,q
8.30.075. Interruption of service -
prevention.
Whenever the board finds that the
failure of service would adversely impact
the health, welfare or safety of the residents
of this county, the board shall, after
reasonable notice, but not less than 24 hours
notice to the franchisee, hold a public
hearing. Upon appropriate findings after the
hearing, the board shall have the right to
authorize another franchisee or other person
to provide services.
8.30.080. Appeals, abatements and
penalties.
A. All the decisions of the board under
this chapter shall , be reviewable by the
Circuit Court of the State of Oregon for the
County of Deschutes, only by way of writ of
review.
B. The provision of emergency
ambulance service by any person in
violation of this chapter, or regulations
promulgated thereunder, is a nuisance and
the court may, in addition to other remedies
provided by law or by this chapter, institute
injunctive abatement or other appropriate
legal proceedings to temporarily or
permanently enjoin or abate such
emergency ambulance service.
C. Any person who violates any of the
provisions of this chapter is guilty of a
violation. Failure from day to day to comply
with the terms of these provisions shall be a
separate offense for each day. Failure to
comply with any provision shall be a
separate offense for each such provision.
D. Violations of these provisions are
punishable, upon conviction, by a fine of
not more than $500.00 for a noncontinuing
offense, i.e., an offense not spanning two or
more consecutive calendar days. In the case
of a continuing offense, i.e., an offense
which spans two or more consecutive
calendar days, violations of the provisions is
punishable by a fine of not more than
$500.00 per day up to a maximum of
$1,000.00 as provided by law.
169 - 2461
8.30.085. Franchisee duties.
A. The Franchisee:
1. Shall conduct its operation in
compliance with all applicable state and
federal laws, rules and regulations, the
terms of this Ordinance and the Deschutes
County ASA Plan;
2. Shall not fail or refuse to respond to
an emergency call for service when an
ambulance is available for service;
3. Shall not respond to a medical
emergency located outside its assigned ASA
except:
a. When a request for specific
emergency ambulance service is made by
the person calling for the ambulance and the
call does not dictate an emergency service
response;
b. When the franchisee assigned to the
ASA is unavailable to respond and the
franchisee is requested by another
franchisee or 9-1-1 dispatch to respond;
c. When the response is for
supplemental assistance or mutual aid.
4. Shall not voluntarily discontinue
service to its assigned ASA until it has:
a. Given 60 days written notice to the
administrator, or
b. Obtained written approval of the
board.
5. DCC 8.30.085(A)(4) shall not apply
to:
a. Change, restriction or termination
of service when required by any public
agency, public body or court having
jurisdiction; or
b. Transfer of franchises pursuant to
this chapter.
8.30.090. Exemptions.
A. Nothing in this chapter prohibits a
911 agency, responsible for the dispatching
of emergency services, from dispatching an
initial responder to the scene of a medical
emergency in addition to dispatching an
emergency ambulance service provider.
B. This chapter shall not apply to the
following:
Exhibit
Page (_ of
Ordinance q$ - Od
1. Ambulance services and
ambulances owned or operated under the
control of the United States Government;
and
2. Vehicles and aircraft being used to
render temporary assistance in the case of a
major catastrophe or emergency with which
the ambulance services of the surrounding
locality are unable to cope, or when directed
to be used to render temporary assistance by
an official at the scene of an accident; and
3. Vehicles operated solely on private
property or within the confines of
institutional grounds, whether or not the
incidental crossing of any public street, road
or highway through the property or grounds
is involved; and
4. Ambulances or vehicles not covered
by the Deschutes County ASA Plan
transporting patients from outside the
county to a health care facility within the
county, or which are passing through
without a destination in the county.
169 - 2462
Exhibit A
(Page 1 of _
Ordinance 4 01,14
169 2463
A-ee,x, x A
. x'C E'er` rw
AMBULANCE SERVICE AREA PLAN
FOR
DESCHUTES COUNTY, OREGON
Exhibit �'
Page I of �.
Ordinance 01-6(au
169 - 2464
Table of Contents
I. Certification By Governing Body of
Deschutes County ASA Plan........................................................................ Page 4
II. Overview of Deschutes County................................................................................Page 5
III. Definitions................................................................................................................Page 6
IV. Boundaries
1. Ambulance Service Area Narrative and Description................................Page 9
2. Maps..........................................................................................................Page 12
3. Alternatives to Reduce Response Times ................................................... Page 13
V. Systems Elements
1. Notification/Response Times....................................................................Page 14
2. Level of Care.............................................................................................Page 14
3. Personnel................................................................................................... Page 14
4. Medical Supervision.................................................................................Page 15
5. Patient Care Equipment............................................................................ Page 15
6. Vehicles.....................................................................................................Page 15
7. Training.....................................................................................................Page 15
8. Quality Assurance.....................................................................................Page 16
8.1 Structure......................................................................................Page 16
8.2 Process........................................................................................ Page 16
8.3 Problem Resolution..................................................................... Page 17
8.4 Sanctions for Non -Compliant Personnel or Providers................Page 17
8.5 Penalties...................................................................................... Page 18
8.6 Nuisance......................................................................................Page 18
VI. Coordination
1. Authority for Ambulance Service Area Assignment................................Page 19
2. Entity That Will Administer The ASA Plan ............................................ Page 19
3. Complaint Review Process.......................................................................Page 20
4. Mutual Aid Agreements............................................................................Page 20
5. Disaster Response..................................................................................... Page 20
5.1 County Resources Other Than Ambulances ............................... Page 21
5.2 Out of County Resources............................................................ Page 21
5.3 Mass Casualty Incident Plan .......................................................Page 21
6. Coordination............................................................................................. Page 22
7. EMS Responder Guidelines......................................................................Page 22
8. Personnel and Equipment Resources........................................................ Page 23
9. Emergency Communications and Systems Access
Page 2 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page— of _3y
Ordinance qi,009
169 - 2465
9.1 Telephone Access.......................................................................Page 23
9.2 Dispatch Procedures....................................................................Page 23
9.3 Radio System..............................................................................Page 24
10. Emergency Medical Services Dispatcher Training.................................Page 25
VII. Provider Selection
1. Initial Assignment of Existing Ambulance Service Providers .................Page 26
2. Reassignment of an ASA.......................................................................... Page 26
3. Application Process for Applying for an ASA .........................................Page 26
4. Notification of Vacating an ASA..............................................................Page 26
5. Maintenance of Level of Service..............................................................Page 26
VIII. County Ordinances and Rules...................................................................................Page 27
IX. Appendices
1. ASA Map...........................................................................................................#1
2. Fire District Boundaries Maps...........................................................................#2
3. Incorporated City Maps.....................................................................................#3
4. Copy of Mutual Aid Agreement (Example)......................................................#4
5. Copy of Deschutes County Ambulance Service Area Ordinance ......................#5
Page 3 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit _
Page J _ of
Ordinance O' DL
169 - 2466
I. CERTIFICATION OF DESCHUTES COUNTY AMBULANCE SERVICE AREA
PLAN
The undersigned certify pursuant to Oregon Administrative Rule 333-260-0030 (2) (a) (b) (c) that:
1. Each subject or item contained in the Deschutes County Ambulance Service Plan has
been addressed and considered in the adoption of the plan by this body.
2. In this governing body's judgment, the ambulance service areas established in the plan
provide for the efficient and effective provision of ambulance services.
3. To the extent they are applicable, the County has complied with ORS 682.205 (2) (3) and
682.335 and existing local ordinances and rules.
DATED this 47yt- day of 1998.
ATTEST:
Recording Secretary
BOARD OF COUNTY COMMISSIONERS OF
DES)CHUTES COUNTY, OREGON
T L. NIPPER, Commissioner
INDA L. SWE N, C mmissioner
Page 4 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit -
Pacge _1L.__ of
Ordinance W- 0I
169 - 2467
II. OVERVIEW OF DESCHUTES COUNTY
Deschutes County is located in the geographic center of the state. The County covers
approximately 3200 square miles, extending east about 105 miles from the crest of the Cascade
Mountains to the Harney County line, and spreading 53 miles from north to south beginning at
the Jefferson County line and terminating at it southern border along Klamath and Lake
Counties. Population of the county as of January 1998 was 101,200. The City of Bend, with a
population of 33,740, and the City of Redmond with 11,960, are the county's largest cities. Both
are located on Highway 97 which runs north and south through the county. Other population
areas are located along Highway 20 between Black Butte Ranch and Bend. Lumber, tourism,
and small business provide the basis of the county's economy.
Deschutes County has many natural barriers, such as mountains, lakes, rivers, wilderness, and
large roadless areas, which were considered when assigning the ambulance service areas.
Boundaries for the most part had been established several years ago by the prehospital care
providers and have proven effective.
Deschutes County is divided into eight separate ambulance service areas. The ambulance service
providers offer basic, intermediate and advanced life support emergency medical care and
transportation. The seven ambulance service providers that serve Deschutes County, their
boundaries and other general information are described in this ASA Plan. A current set of maps
are on file in the Deschutes County Office of Emergency Services. These maps depict current
boundaries for ambulance service areas, fire districts, response times and the location of the
PSAP.
Page 5 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page �� of
Ordinance %
169 - 2468
III. DEFINITIONS
1. "Address and consider" has the meaning given these terms by ORS 682.205(2)(3).
2. "Ambulance" has the meaning given that term by ORS 682.025.
3. "Ambulance Service" has the meaning given that term by ORS 682.325.
4. "Ambulance Service Area (ASA)" means a geographic area which is served by one
ambulance service provider, and may include all or a portion of a county, or all or
portions of two or more contiguous counties.
5. "Ambulance Service Plan" means a written document, which outlines a process for
establishing a county emergency medical services system. A plan addresses the need for
and coordination of ambulance services by establishing ambulance service areas for the
entire county and by meeting the other requirements of these rules. Approval of a plan
will not depend upon whether it maintains an existing system of providers or changes the
system. For example, a plan may substitute franchising for an open -market system.
6. "ASA Advisory Committee (Committee)" means a committee formed to review
standards, make recommendations to or set new standards for the Board of County
Commissioners for all matters regarding EMS and review and make recommendations
regarding soundness of the ASA.
7. "ASA Administrator" is the person designated by the Board of Commissioners to
administer the ASA ordinance and plan.
8. "Communication System" means two-way radio communications between ambulances,
dispatchers, hospitals and other agencies as needed. A two -channel multi -frequency
capacity is minimally required.
9. "Deschutes County Board of Commissioners (Board)" means the elected officials that has
jurisdiction over the Deschutes County ASA Plan.
10. "Division" means the Oregon Health Division, Department of Human Resources.
11. "Effective Provision of Ambulance Services" means ambulance services provided in
compliance with the county ambulance service plan provisions for boundaries,
coordination and system elements.
12. "Efficient Provision of Ambulance Services" means effective ambulance services
provided in compliance with the county ambulance service plan provisions for provider
selection.
Page 6 of 27 - Deschutes County Ambulance Service Area Plan P
Exhibit
Page_ of
Ordinance 0g' OW
169 - 2469
13. "Emergency" means any non -hospital occurrence or situation involving illness, injury or
disability requiring immediate medical or psychiatric services, wherein delay in the
provision of such services is likely to aggravate the condition and endanger personal
health or safety.
14. "Emergency Medical Service (EMS)" means those pre -hospital functions and services
whose purpose is to prepare for and respond to medical emergencies, including rescue
and ambulance services, patient care, communications and evaluation.
15. "Emergency Medical Technician -Basic (EMT -Basic)" means a person certified by the
Division as defined in OAR 333-265-0000(8).
16. "Emergency Medical Technician -Intermediate (EMT -Intermediate)" means a person
certified by the Division as defined in OAR 333-265-0000(9).
17. "Emergency Medical Technician -Paramedic (EMT -Paramedic)" means a person certified
by the Division as defined in OAR 333-265-0000(10).
18. "First Responder" means a person certified by the Division as defined in ORS
682.025 (11) (a) (b).
19. "Franchise" is the authorization granted to provide emergency ambulance service in a
specific geographic region.
20. "Health Officer" means the Deschutes County Health Officer.
21. "License" means those documents issued by the Division to the owner of an ambulance
service and ambulance, when the service and ambulance are found to be in compliance
with ORS 682.015 to 682.991 and OAR 333-250-0000 through 333-250-0100 and 333-
255-0000 through 333-255-0090.
22. "Physician Advisor" has the meaning of a supervising physician as provided in ORS
682.235.
23. "Notification Time" means the length of time between the initial receipt of the request for
emergency medical service by either a provider or a PSAP, and the notification of all
responding emergency medical service personnel.
24. "Owner" means the person having all the incidents of ownership in an ambulance service
or an ambulance vehicle or where the incidents of ownership are in different persons, the
person, other than a security interest holder or lessor, entitled to the possession of an
ambulance vehicle or operation of an ambulance service under a security agreement or a
Page 7 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page Ll
Ordnance ��o(0
169 -2470
lease for a term of 10 or more successive days.
25. "Patient" means an ill, injured, or disabled person who may be transported in an
ambulance.
26. "Provider" means any public, private or volunteer entity providing EMS.
27. "Provider Selection Process" means the process established by the county for selecting an
ambulance service provider or providers.
28. "Public Service Answering Point (PSAP)" means a 24 hour communications facility
established as an answering location for 9-1-1 calls originating within a given service
area.
29. "Quick Response Team (QRT)" means an agency that provides initial response and basic
life support care without transportation capabilities by certified First Responders.
30. "Response Time" means the length of time between the notification of each provider and
the arrival of each provider's emergency medical service unit(s) at the incident scene.
31. "System Response Time" means the elapsed time from when the PSAP receives the call
until the arrival of the appropriate provider unit(s) on the scene.
Page 8 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page 1_ of
Ordinance q%- a(ou
169 - 2471
IV. BOUNDARIES
1. Ambulance Service Area Narrative and Description.
Deschutes County consists of eight ASAs. The eight ASAs are: (1) Bend; (2) Black Butte
Ranch; (3) Burns; (4) Crooked River Ranch; (5) LaPine; (6) Redmond; (7) Sisters; and (8)
Sunriver. The boundaries of each of the eight ambulance service areas are as follows:
ASA #1 - Bend
Size of ASA: Approximately 750 square miles. However, most of the ASA is comprised of
either the Deschutes National Forest or B.L.M. lands.
BEGINNING at the intersection of the south line of section 16, T17S, RBE, W.M., with the westerly line
of Deschutes County; thence easterly upon section lines approximately 10.4 miles to the SE corner of
section 18, T17S, R10E; thence northerly upon the section line to the NE corner of said section 18;
thence easterly upon section lines to the SE corner of section 9, T17S, R10E; thence northerly upon
section lines to the NW corner of section 3, T17S, R10E; thence easterly upon section lines to the SE
corner of section 36, T16S, R10E; thence northerly upon section lines to the NW corner of section 19,
T16S, R11E; thence easterly upon section lines to the SE corner of section 17, T16S, R11E; thence
northerly upon the section line to the NE corner of said section 17; thence easterly upon the section line
to the NE corner of section 16, T16S, R11E; thence northerly upon section lines approximately 1.5 miles
to the intersection with the south line of section 34, T15S, R11E; thence westerly upon said section line
approximately 1/2 mile to the SW corner of said section 34; thence northerly upon the section line to the
NW corner of said section 34; thence southeasterly approximately 2.9 miles to the SW corner of section
1, T16S, R11E; thence northerly upon the section line to the NW corner of said section 1; thence easterly
upon section lines approximately 2.25 miles to the NE corner of the W 1/2 W 1/2 of section 5, T16S,
R12E; thence southerly to the SE corner of the W 1/2 W 1/2 of said section 5; thence easterly upon
Newcomb Road to the SE corner of section 4, T16S, R12E; thence easterly upon the south line of section
3, T16S, R12E, to the intersection with the centerline of the Deschutes River; thence southerly along the
centerline of the Deschutes River to the intersection with the south line of section 9, T16S, R12E; thence
easterly upon said section line to the NE corner of the W 1/2 of section 16, T16S, R12E; thence southerly
to the SE corner of the NW 1/4 of said section 16; thence westerly to the SW corner of the E 1/2 NW 1/4
of said section 16, thence southerly to the SE comer of the W 1/2 W 1/2 of said section 16; thence
easterly upon section lines to the NW corner of section 19, T16S, R13E; thence southerly approximately
1 mile to the SW corner of said section 19; thence easterly upon section lines to the SE corner of section
24, T16S, R13E, also being a point on the east line of Deschutes County; thence southerly upon said east
line to the southeast corner of section 36, T16S, R13E; thence continuing easterly and southerly upon the
Deschutes County line to the NE corner of section 1, T22S, R21E; thence southerly upon the range line
to the SE corner of section 36, T22S, R21E; thence westerly upon the line common to Deschutes and
Lake Counties to Forest Highway 23; thence northerly upon Forest Highway 23 to the township line
between T21S and T22S, R16E, near Sand Springs; thence westerly upon the south lines of Township
215, Ranges 16E -13E, to Forest Road 9710; thence northerly upon Forest Road 9710 to the north line of
section 19, T19S, R12E; thence westerly upon section lines approximately 3.2 miles to the SW corner of
section 15, T19S, R11E; thence northerly approximately 2 miles to the NE corner of section 9 T19S,
R11E; thence westerly approximately 2 miles to the NW corner of section 8 T19S, R11E; thence
Page 9 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit 14
Page - of�
Ordinance 61S - 0 (Pq
169 - 2472
southerly to the SW corner of said section 8, thence westerly upon section lines approximately 6 miles to
the SW corner of section 8, T19S, R10E; thence northerly upon section lines approximately 2 miles to
Forest Road 4614; thence westerly upon Forest Road 4614 to Forest Road 950; thence northerly upon
Forest Road 950 to Forest Highway 46, a.k.a. Cascade Lakes Highway; thence westerly upon said Forest
Highway 46 to the east line of section 27, T18S, R9E; thence southerly approximately 2.2 miles to the
SE corner of section 3, T19S, R9E; thence westerly approximately 6 miles upon section lines to the SE
corner of section 3, T19S, RBE; thence northerly approximately 3.5 miles to the NE corner of the SE 1/4
of section 22, T18S, ME; thence westerly upon the east -west center lines of sections 22, 21, 20 and 19,
T19S, R8E to the line common to Deschutes and Lane Counties; thence northerly upon said common
County line to the Point of Beginning.
ASA #2 - Black Butte Ranch
Size of ASA: Approximately 3 square miles.
Boundaries: Entire Black Butte Ranch and a portion of Highway 20 from Indian Ford Road west
to the Camp Sherman turnoff.
ASA #3 — Burns
All of T22S, R22E, W.M., and all of T22S, R23E.
ASA #4 - Crooked River Ranch
Size of ASA: Approximately one square mile.
ALL of those portions of Crooked River Ranch lying within Deschutes County.
ASA #5 - La Pine
Size of ASA: Approximately 646 square miles. However, most of the ASA is comprised of the
Deschutes National Forest or in B.L.M. lands and are uninhabited.
All that portion of Deschutes County which lies southerly and westerly of the following described line:
BEGINNING at the intersection of the westerly line of Deschutes County with the north line of section
2, T21 S, R6E, W.M.; thence easterly upon the north lines of Township 21S, in Ranges 6E and 7E to the
NW comer of section 1 in said Range 7E; thence southerly upon the west line of said section 1, to the
SW corner of said section 1; thence easterly upon the south line of said section 1 to the SE corner of said
section 1; thence northerly upon the east line of said section 1 to the NE corner of said section 1; thence
easterly approximately 11.5 miles upon the south lines of Township 20S in Ranges 8E and 9E to the
intersection with Forest Highway 42, a.k.a. South Century Drive; thence northeasterly upon said Forest
Highway 42 to the intersection with the east line of section 27, T20S, R10E; thence northerly upon
section lines to the NW corner of the SW 1/4 of section 23, T20S, R10E; thence easterly to the NE corner
of said SW 1/4; thence northerly to the NW corner of the NE 1/4 of said section 23; thence easterly to the
NE corner of said section 23; thence northerly upon section lines approximately 2 miles to the SW corner
of section 1, T20S, R10E; thence easterly upon the south line of said section 1 to the SW corner of the
Page 10 of 27 - Deschutes County Ambulance Service Area Plan q._
Exhibit IA -
Page
'
Page of (�
Ordinance 9 .�
169 , 2473
SE 1/4 SW 1/4 of said section 1; thence northerly to the NW corner of the SE1/4 SW 1/4 of said section
1; thence easterly to the NE corner of the SE 1/4 SW 1/4 of said section 1; thence northerly to the NW
corner of the SE 1/4 of said section 1; thence easterly to the NE corner of said SE 1/4; thence southerly
upon the east line of said section 1 to the SE comer of said section 1, also being a point on Forest
Highway 40, a.k.a. Spring River Road; thence easterly and northerly upon said Forest Highway to the
intersection with the B.N.R.R. tracks in section 5 of T20S, R11E; thence southerly upon said tracks to the
north line of section 8, T20S, R11E; thence easterly upon the north line of said section 8 to the NE corner
of said section 8; thence southerly upon section lines to the SW corner of section 16, T20S, R11E; thence
easterly upon the south line of said section 16 to the SE corner of said section 16; thence southerly upon
section lines approximately 2 miles to the SW corner of section 27, T20S, RME; thence easterly
approximately 7.5 miles upon section lines to the intersection of the north line of section 35, T20S, R12E
with Forest Road 9710; thence easterly and southerly upon said Forest Road to the south line of section
35, T21S, R13E; thence easterly upon the south lines of Township 21S, in Ranges 13E -16E to a point on
the south line of section 31, T21 S, R16E which intersects Forest Highway 23; thence southerly upon said
Forest Highway to the Deschutes County line and terminus of this description.
ASA #6 - Redmond
Size of ASA: Approximately 223 square miles.
Beginning at the common corner of Deschutes, Jefferson and Crook Counties; thence southerly upon the
County line common to Deschutes and Crook Counties to the SE corner of section 24, T16S, RUE,
W.M.; thence westerly upon section lines to the SW corner of section 19, T16S, R13E; thence northerly
approximately 1 mile to the NW corner of said section 19; thence westerly upon section lines to the SE
corner of the W 1/2 W 1/2 of section 16, T16S, R12E; thence northerly to the NE corner of the W 1/2
SW 1/4 of said section 16; thence easterly to the SE corner of the NW 1/4 of said section 16; thence
northerly to the NE corner of the NW 1/4 of said section 16; thence westerly upon the section line to the
intersection with the centerline of the Deschutes River; thence northerly along the centerline of the
Deschutes River to the intersection with the south line of section 3, T16S, R12E; thence westerly upon
said section line to the SW corner of said section 3; thence westerly upon Newcomb Road to the SE
corner of the W 1/2 W 1/2 of section 5, T16S, R12E; thence northerly to the NE corner of the W 1/2 W
1/2 of said section 5; thence westerly upon section lines to the NW corner of section 1, T16S, R11E;
thence southerly upon the section line to the SW corner of said section 1; thence northwesterly
approximately 2.9 miles to the SW corner of section 27, T15S, R1 1E; thence northerly approximately 11
miles upon section lines to the line common to Deschutes and Jefferson Counties; thence easterly upon
said common County line to the Point of Beginning; excluding all of those portions of Crooked River
Ranch lying within Deschutes County.
ASA #7 - Sisters
Size of ASA: Approximately 326 square miles.
Beginning at the common corner of Deschutes, Linn and Jefferson Counties; thence easterly on the
County line common to Deschutes and Jefferson Counties approximately 21.5 miles to the NE corner of
section 4, T14S, R11E, W.M.; thence southerly upon section lines approximately 12 miles to the SW
corner of section 34, T15S, R1 1E; thence easterly upon the section line approximately 1/2 mile to the NE
corner of section 4, T16S, RUE; thence southerly upon section lines to the NE corner of section 16,
Page 11 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit A
Page 1- of ----
Ordinance n q - o(�, 4
169 - 2 47 4
T16S, R11E; thence westerly upon the section line to the NE corner of section 17, T16S, R11E; thence
southerly upon the section line to the SE corner of said section 17; thence westerly upon section lines to
the NW corner of section 19, T16S, R11E; thence southerly upon section lines to the SE corner of section
36, T16S, R10E; thence westerly upon section lines to the NW corner of section 3, T17S, R10E; thence
southerly upon section lines to the SE corner of section 9, T17S, R10E; thence westerly upon section
lines to the NE corner of section 18, T17S, R10E; thence southerly upon section lines to the SE corner of
said section 18; thence westerly upon section lines approximately 10.4 miles to the County line common
to Deschutes and Lane Counties at the south section line of section 16, T17S, RBE; thence northerly upon
said County line to the Point of Beginning; excluding all of Black Butte Ranch and that portion of U.S.
Highway 20 from Indian Ford Road to the Camp Sherman turnoff.
ASA #8 - Sunriver
Size of ASA: Approximately 150 square miles.
BEGINNING at the intersection of Forest Road 9710 with U.S. Highway 97; thence southerly upon
Highway 97 to the intersection with the north line of section 24, T19S, R11E; thence westerly upon
section lines to the SW corner of section 15, T19S, R11E; thence northerly upon section lines
approximately 2 miles to the NE corner of section 9, T19S, R11E; thence westerly upon the section line
to the intersection with the centerline of the Deschutes River; thence upstream along the centerline of the
Deschutes River approximately 1.25 miles to the east line of section 8, T19S, R11E; thence southerly
upon said section line to the SE corner of said section 8; thence westerly upon section lines
approximately 7 miles to the SW corner of section 8, T19S, R10E; thence northerly upon section lines
approximately 2 miles to Forest Road 4614; thence westerly upon Forest Road 4614 to Forest Road 950;
thence northerly upon Forest Road 950 to Forest Highway 46, a.k.a. Cascade Lakes Highway; thence
westerly upon said Highway 46 to the east line of section 27, T18S, R9E; thence southerly approximately
2.2 miles to the SE corner of section 3, T19S, R9E; thence westerly approximately 6 miles upon section
lines to the SE corner of section 3, T19S, RBE; thence northerly approximately 3.5 miles to the NE
corner of the SE 1/4 of section 22, T18S, RBE; thence westerly upon the east -west center lines of
sections 22, 21, 20, and 19, T19S, R8E to the line common to Deschutes and Lane Counties; thence
southerly and westerly upon said county line to the north line of section 2, T21 S, R6E; thence easterly
upon the north lines of Township 215, in Ranges 6E and 7E to the NW corner of section 1 in said Range
7E; thence southerly upon the west line of said section 1, to the SW corner of said section 1; thence
easterly upon the south line of said section 1 to the SE corner of said section 1; thence northerly upon the
east line of said section 1 to the NE corner of said section 1; thence easterly approximately 11.5 miles
upon the south lines of Township 20S in Ranges 8E and 9E to the intersection with Forest Highway 42,
a.k.a. South Century Drive; thence northeasterly upon said Forest Highway 42 to the intersection with
the east line of section 27, T20S, R10E; thence northerly upon section lines to the NW corner of the SW
1/4 of section 23, T20S, R10E; thence easterly to the NE corner of said SW 1/4; thence northerly to the
NW corner of the NE 1/4 of said section 23; thence easterly to the NE corner of said section 23; thence
northerly upon section lines approximately 2 miles to the SW corner of section 1, T20S, R10E; thence
easterly upon the south line of said section 1 to the SW corner of the SE 1/4 SW 1/4 of said section 1;
thence northerly to the NW corner of the SE 1/4 SW 1/4 of said section 1; thence easterly to the NE
corner of the SE 1/4 SW 1/4 of said section 1; thence northerly to the NW corner of the SE 1/4 of said
section 1; thence easterly to the NE corner of said SE 1/4; thence southerly upon the east line of said
section 1 to the SE corner of said section 1, also being a point on Forest Highway 40, a.k.a. Spring River
Road; thence easterly and northerly upon said Forest Highway to the intersection with the B.N.R.R.
tracks in section 5, T20S, R11E; thence southerly upon said tracks to the north line of section 8, T20S,
Page 12 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page I C1_ of '2, 4�
Ordinance %- D
169 2 47 5
R11E; thence easterly upon the north line of said section 8 to the NE corner of said section 8; thence
southerly upon section lines to the SW comer of section 16, T20S, R11E; thence easterly upon the south
line of said section 16 to the SE corner of said section 16; thence southerly upon section lines
approximately 2 miles to the SW corner of section 27, T20S, R11E; thence easterly approximately 7.5
miles upon section lines to the intersection with Forest Road 9710; thence northwesterly upon said Forest
Road 9710 to the Point of Beginning.
2. Maps.
2.1 ASA Map. (See Appendix #1)
This map represents the boundaries of each of the ambulance service areas within
Deschutes County and the "System Response Time," which includes notification, role
out, and provider response times. Actual response time is subject to the variables of
access, weather, road and traffic conditions as well as other circumstances that can impact
response time.
2.2 Fire District Boundaries (See Appendix #2)
2.3 Incorporated Cities (See Appendix #3)
3. Alternatives To Reduce Response Times.
Heavily forested, mountainous terrain and severe winter weather conditions present difficult
access and long response time to ground ambulances. In those situations, when an urgent
response is indicated, the PSAP may elect to call the nearest appropriate rotary -wing air
ambulance or the Deschutes County Search and Rescue.
In addition, a tiered response system is used to provide the best available patient care while
maximizing the available resources. In some instances, for various reasons, an ambulance service
provider from an adjoining county's ASA could respond quicker to an incident.
Page 13 of 27 - Deschutes County Ambulance Service Area Plan A -
Exhibit
Page 20 of
Ordinance
1.69 - 2476
V. SYSTEM ELEMENTS
1. Notifcation/Response Times.
Notification times for ambulances shall be within two (2) minutes for 90% of the calls.
Provider response time shall be as follows for 90% of the calls: Urban - 6 min.; Suburban - 13
min.; Rural - 43 min.; and Frontier - 4 hours and 28 min.
System Response Time shall be as follows for 90% of the calls: Urban - 8 min.; Suburban - 15
min.; Rural - 45 min.; and Frontier - 4 hours and 30 min.
Monitoring of notification and response times shall be accomplished by the following:
1.1 Information received from the public, dispatch center, prehospital care providers,
hospitals, or county EMS administration.
1.2 Types of information received are written or verbal complaints, patient care report
forms, radio transmission tapes, notification and response time incident cards,
trauma registry forms, etc.
2. Level of Care.
An ambulance operating in Deschutes County and providing basic life support level care must
consist of a qualified driver and one certified EMT -Basic or above. The EMT must always be
with the patient in the patient compartment of the ambulance.
An ambulance operating in Deschutes County and providing intermediate life support level care
must consist of one certified EMT -Basic and one certified EMT -Intermediate. The EMT -
Intermediate must always be with the patient in the patient compartment of the ambulance
intermediate level care is required or rendered.
An ambulance operating in Deschutes County and providing advanced life support level care
must consist of an EMT -Basic and an EMT -Paramedic. The EMT -Paramedic must always be
with the patient in the patient compartment of the ambulance when ALS care is required or being
rendered.
3. Personnel.
When operating an ambulance in Deschutes County, all personnel must meet the requirements of
ORS 682.015 to 682.991 and OAR 333-255-0070(1), (4) or (6). The practice of staffing an
ambulance on a part-time basis with EMTs certified to a higher level of care than is possible at
other times does not construe a requirement that the ambulance provide the same level of care on
Page 14 of 27 - Deschutes County Ambulance Service Area Plan /�
Exhibit1'("
Page zl of _
Ordinance 1%'0(04---
I
169 - 24*17
a regular basis.
4. Medical Supervision.
Each EMS agency utilizing EMTs shall be supervised by a physician licensed under ORS 677,
actively registered and in good standing with the Board of Medical Examiners as a Medical
Doctor (MD) or Doctor of Osteopathic Medicine (DO). The physician must also be approved by
the Board of Medical Examiners as a medical director.
Each EMS agency or ambulance service may have its own medical director. The medical
director shall:
4.1 comply with the requirements listed in OAR 847-35-0025;
4.2 hold at least one meeting a year with the EMTs affiliated with the respective
ambulance services;
4.3 designate an EMT coordinator who shall conduct case reviews in the physicians
absence and send summaries of the reviews and problems identified and proposed
problem resolution to the physician; and
4.4 provide or authorize at least one case review meeting for all EMTs quarterly.
St. Charles Medical Center in Bend, Oregon and Central Oregon District Hospital in Redmond,
Oregon shall be the Medical Resource Hospitals.
5. Patient Care Equipment
Patient care equipment must meet or exceed the Oregon Health Division's requirements as
specified in ORS 682.015 to 682.991 and OAR 333-255-0070(2), (3), (5) or (7). The ambulance
service provider shall maintain a list of equipment for their ambulances, which shall be furnished
to the Board upon their request.
6. Vehicles.
All ambulances must be either a Type I, II, or III and be licensed by the Oregon Health Division.
All ambulances must met or exceed the requirements as set forth in ORS 682.015 to 682.991
and OAR 333-255-0060. An up-to-date list of each provider's ambulances shall be furnished to
the Board upon their request.
7. Training.
Training will be consistent with requirements of the Oregon State Health Division and
Page 15 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page 1,V of 3
Ordinance
169 -° 2478
Department of Transportation curriculum and shall be received through accredited institutions.
8. Quality Assurance.
In order to ensure the delivery of efficient and effective pre -hospital emergency medical care, an
EMS Quality Assurance Program is hereby established.
8.1 Structure
"Deschutes County Ambulance Service Area Advisory Committee (Committee)", shall be
formed by ordinance and be composed of ten members:
a. Emergency department physician
b. Ambulance service medical director
C. Deschutes County Health Department
d Ambulance service provider
e. Sheriff's Office representation
f. 9-1-1 center representative
g. EMT -Basic
h. EMT -Intermediate
L EMT -Paramedic
j. Public member
Members of the Committee shall be appointed by the Deschutes County Board of
Commissioners for a two year term. The initial committee will have staggered terms,
ranging from one to three years. In the event of a tie on decisions of the ASA, the ASA
Administrator shall become a voting member in order to break the tie.
The principal function of the committee shall be to monitor the EMS system within
Deschutes County.
8.2 Process
The Board, in order to ensure the delivery of the most efficient and effective prehospital
Page 16 of 27 - Deschutes County Ambulance Service Area Plan A
Exhibit --
Page 12 of 3,4
Ordinance qt- 01,14
169 - 24'79,
emergency care possible with the available resources, has directed that the ASA Advisory
Committee be established.
Quality assurance in Deschutes County shall be accomplished through frequent case
review, peer review, and periodic review by the medical directors and/or ambulance
governing bodies (see respective Provider Profiles for definitions of governing bodies).
Complaints regarding violation of this ASA Plan, or questions involving prehospital care
provided, shall be submitted in writing to the Board who shall forward it to the
Committee. The Committee shall then review the matter and make recommendations or
changes on such complaints or questions to the Board. The Board shall also resolve any
problems involving system operations (changing protocols to address recurring problems,
etc.). Ongoing input may be provided by consumers, providers or the medical
community to any individual on the Board or members of the Committee. This
individual, in turn, will present the complaint, concern, idea or suggestion (in writing) to
the full Board for consideration.
8.3 Problem Resolution
Problems involving protocol deviation by EMTs or dispatchers shall be referred to the
respective medical director or dispatch supervisor. Problems involving a non-compliant
provider shall be reviewed by the Committee with possible referral to Board if necessary.
The Board may seek background data and recommendations from the Committee in such
instances. However, any member of the Committee who may have a conflict of interest
in the matter shall declare such conflict and refrain from participating in any
recommendations made.
8.4 Sanctions for Non -Compliant Personnel or Providers
Suspension or revocation assignment. Upon a recommendation by the Committee, or
upon its own motion, the Board may suspend or revoke the assignment of an ASA upon a
finding that the provider has:
a. willfully violated provisions of an ordinance, the Deschutes County ASA
Plan or provisions of State or Federal laws and regulations; or
b. materially misrepresented facts or information given in the application for
assignment of an ASA or as part of the review of the performance of the
service furnished by the provider.
In lieu of the suspension or revocation of the assignment of an ASA, the Board may order
that the violation be corrected and make the suspension or revocation contingent upon
compliance with the order, within the period of time stated. Notice of the Board's action
shall be provided to the holder of the assignment which shall specify the violation, the
Page 17 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page Zq of 3 q
Ordinance 'O&q
169 - 2480
action necessary to correct the violation and the date by which the action must be taken.
If the holder of the assignment fails to take corrective action within the time required, the
Board shall notify the holder that the assignment is suspended or revoked upon receipt of
the notice.
A person receiving a notice of the assignment, denial, suspension, revocation or
contingent suspension or revocation of an ASA may request a hearing before the Board
by filing with the Board a written request for a hearing within fourteen (14) days of the
decision, setting forth the reasons for the hearing and the issues proposed to b reviewed.
The filing of a hearing request shall stay the action, pending the hearing and final
determination of the decision, unless a change is required due to an immediate hazard to
the public safety. The Board shall set a time and place for the hearing. Within fourteen
(14) days after the conclusion of the hearing, the Board shall affirm, reverse or modify its
original decision.
8.5 Penalties
Any person who violates any provisions of this ASA Plan or Ordinance is guilty of a
violation. Failure from day-to-day to comply with the terms of this ASA Plan or
Ordinance shall be a separate offense for each such day. Failure to comply with any
provision of the Ordinance shall be a separate offense for each such provision.
Violations of the provisions of this ASA Plan or Ordinance are punishable, upon
conviction, by a fine of not more than Five Hundred Dollars ($500) per day per violation.
8.6 Nuisance
In addition to the penalties provided in this plan, violations of any of the provisions of
this plan and ordinance is declared to be a nuisance and may be regarded as such in all
actions, suits, or proceedings.
Page 18 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit _L__
Page Z— of -3 t4.
Ordinance Al i' QU
169 - 2481
VI. COORDINATION
1. Authority For Ambulance Service Area Assignments.
The Board has the authority to assign an ASA within Deschutes County in compliance with ORS
682.015 to 682.991. Applications by new providers and requests for assignment change or
revocation will be considered for approval if they will improve efficient service delivery and
benefit public health, safety and welfare. Cities have the authority to develop and apply
ambulance licensing ordinances within their jurisdictional boundaries, and nothing in this plan is
intended to obviate that authority.
Future updates to this plan and proposals for assignment changes will be the responsibility of the
Board. The Board shall receive all requests for changes, present those requests to the Committee
for their review and recommendations. Upon completing their review, the Committee shall
present their recommendations to the Board. In addition, the Board has the authority to review
service providers records and initiate an assignment change or service area revocation. For the
purpose of this plan, the Board shall recognize the Committee as an advisory group.
The Deschutes County ASA Plan was prepared with a great deal of input from all county pre-
hospital care providers. The Plan requires that the ambulance services providers maintain service
records in order that the County can carry out its ASA Plan responsibilities.
2. Entity That Will Administer the ASA Plan.
The Deschutes County ASA Committee is hereby established with the adoption of this plan. The
Committee shall serve as the principal entity to administer and accept written proposals for
amendments to this ASA Plan.
The Committee will be activated at any time a concern is submitted, in writing, to the Board, or
when deemed appropriate by seven or more members of the Committee.
This Committee, as with any governmental body, will be subject to the Oregon Open Meeting
Law (ORS Chapter 192), but may temper its activities, within legal limits, according to the
sensitivity of the EMS matter involved. Appeals from the Board, in any case where the Board
would otherwise have the final decision at the county level shall be directed to the appropriate
state regulatory agency, or a Circuit Court, as appropriate.
The Committee shall submit a brief written report of its activities or recommendations
periodically to the Board.
Existence of this committee will:
2.1 prevent needless attention of state regulatory agencies to problems that can be
Page 19 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit �
Page of
Ordinance - 00
�J
169 - 2482
resolved locally;
2.2 increase local awareness of potential problems that may exist; and
2.3 increase the awareness of ambulance medical directors regarding area concerns
and activities.
3. Complaint Review Process.
Complaints regarding violation of this ASA Plan, or questions involving prehospital care
provided, shall be submitted in writing to the Board. The Board shall then forward the complaint
to the Committee for their review and recommendations or changes on such complaints or
questions. The Committee shall also resolve any problems involving system operations (i.e.,
changing protocols to address recurring problems, etc.).
Ongoing input may be provided by consumers, providers or the medical community to any
individual on the Committee or members of the Board. This individual, in turn, will present the
complaint, concern, idea or suggestion in writing to the full Board for consideration.
4. Mutual Aid Agreements. (See Appendix #4)
Each ambulance service provider shall sign a mutual aid agreement with the other providers in
the County and with other providers in adjoining counties to respond with needed personnel and
equipment in accordance with the agreement.
All requests for mutual aid shall be made through the appropriate PSAP.
All mutual aid agreements will be reviewed annually and modified as needed by mutual consent
of all parties.
5. Disaster Response.
The Committee shall coordinate the EMS medical function of disaster planning with any formal
disaster management plan developed by the Deschutes County Sheriff or other appropriate
county authorities.
As an interim goal, until an Emergency Services Plan is implemented, ambulance provider
personnel faced with a multiple -casualty incident shall examine the situation in terms of its
potential or actual magnitude of disaster, and request any appropriate additional resources that
may be available.
Page 20 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page Z--7_ of
Ordinance _ -0� u
169 - 2483
5.1 County Resources Other Than Ambulances
When resources other than ambulances are required for the provision of emergency
medical services during a disaster, a request for additional resources shall be made
through the appropriate PSAP to the County Emergency Services Office.
The Director of the County Emergency Services Office shall be responsible for locating
and coordinating all county EMS resources any time that the MCI Plan is implemented.
The Director of the County Emergency Services Office shall work directly with local
agencies, departments and governments to coordinate necessary resources during any
implementation of the MCI Plan.
5.2 Out of County Resources
When resources from outside Deschutes County are required for the provision of
emergency medical services during a disaster, a request for those resources shall be made
through the appropriate PSAP.
5.3 Mass Casualty Incident (MCI) Management Plan
The purpose of the MCI plan is to provide guidance to EMS response personnel in the
coordination of response activities relating to mass casualty incidents in Deschutes
County.
The plan is intended for use when any single incident or combination of incidents
depletes the resources of any single provider or providers during the normal course of
daily operations or at the request of the Health Officer.
The plan shall identify the responsibility of the provider concerning:
a. coordination;
b. communication
C. move up;
d. triage; and
e. transportation.
The Committee will periodically review the medical component MCI plan and make
recommended changes to meet the county's need. Following the review and changes, the
Page 21 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit -a._..�..�,,.
Page ?-_ of 3 '4
Ordinance
169 - 2484
Director of Emergency Services will be ask to append the changes to the medical
component of the County Emergency Management Plan and the modified MCI plan will
be promulgated.
6. Coordination.
6.1 The highest ranking officer of the fire or police agency in whose jurisdiction the
incident occurs shall be the incident -commander.
6.2 The senior/highest certified EMT at the scene will have overall responsibility for
patient care (triage officer); he/she shall work closely with the incident
commander.
6.3 The on -scene command frequency and staging area will be determined by the
incident -commander. Dispatch center will advise responding units as to location
of the staging area.
7. EMS Responder Guidelines.
7.1 The senior EMT on the first EMS unit to arrive at the scene shall become the
triage officer and shall:
a. assess nature and severity of the incident;
b. advise appropriate PSAP of the situation;
C. request appropriate fire and police services, if not already at the scene;
d. request initiation of EMS mutual aid if needed;
e. alert area hospital(s) of the situation; and
f. establish and organize the transportation of all injured or ill patients.
7.2 Additional EMS units arriving at the scene shall:
a. check-in with Incident -Commander;
b. effect needed rescue, if trained and equipped to do;
C. provide emergency medical care and transport patient(s) to the appropriate
hospital(s).
Page 22 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit ___l
Page 1-— of u
Ordinance -
,
1.69 2485
1.,
8. Personnel and Equipment Resources.
All resources are referenced in Deschutes County's and local emergency response plans.
9. Emergency Communications and Systems Access.
9.1 Telephone Access:
The Deschutes County Communications (9-1-1) Center is located in Bend and is the
Public Safety Answering Point. This center shall receive all emergency service requests
in Deschutes County. Persons having access to telephone service will have access to the
Deschutes County Communications Center by dialing 9-1-1. Upon receipt of a request,
all emergency service providers in Deschutes County, including fire and ambulance, are
dispatched by the Deschutes County Communications Center in Bend Oregon.
9.2 Dispatch Procedures:
a. The appropriate personnel shall be notified by the dispatcher via radio
pagers within two (2) minutes of receipt of a medical call.
b. The dispatcher will obtain from the caller, and relay to the first responders
the following:
1. Location of the incident;
2. Nature of the incident; and
3. Any specific instructions or information that may be pertinent to
the incident.
C. EMS personnel shall inform the dispatch center by radio when any of the
following occurs:
1. In-service;
2. In -route to scene or destination and type or response;
3. Arrival on scene or destination;
4. Transporting patient(s) to hospital or medical facility, the number
of patients, and name of facility; and
5. Arrival at receiving facility.
Page 23 of 27 - Deschutes County Ambulance Service Area Plan QQ
(Exhibit ('
Page 20 of �3q _
Ordinance A
169 - 2486
d. Ambulance personnel shall inform the receiving hospital by radio of the
following:
1.
2.
3.
4.
5.
6.
9.3 Radio System:
Unit identification number;
Age and sex of each patient;
Condition and chief complaint of the each patient;
Vital signs of each patient;
Treatment rendered; and
Estimated time of arrival
a. The PSAP shall:
1. restrict access to authorized personnel only;
2. meet state fire marshal standards;
3. maintain radio consoles capable of communication directly with all
first response agencies dispatched by the PSAP.
4. maintain radio logs which contain all information required by the
Federal Communications Commission and Oregon Revised
Statutes;
5. be equipped with a back-up power source capable of maintaining
all functions of the center.
b. The ambulance service provider shall equip and maintain 60 watt or
greater, multi -channel radios in each ambulance that allows for the
transmission and reception with dispatch, medical resource hospitals, and
mutual aid equipment.
Providers are dispatched by the Deschutes County 9-1-1 Center by radio
pagers. Unless specifically determined by the nature of the call (i.e., non-
emergency patient transfer, etc.) the highest level of ambulance staffing
available at that time shall be dispatched. Other resources (police, fire)
Page 24 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page mil.— of
Ordinance ��'W
169 .- 2487
will be dispatched as deemed appropriate.
10. Emergency Medical Services Dispatcher Training.
10.1 Deschutes County EMS dispatchers must successfully complete an Emergency
Medical Dispatch (EMD) training course as approved by the Oregon Emergency
Management Division and the Board on Public Safety Standards and Training.
10.2 All EMS dispatchers are encouraged to attend any class, course or program which
will enhance their dispatching abilities and skills.
Page 25 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page of
Ordinance qI , nAd
169 - 2488
VII. PROVIDER SELECTION
1. Initial Assignment of Existing Ambulance Service Providers.
On the date of implementation of this Plan, public notice shall be made that the current in-place
provider (who wishes) will be assigned the ASA. The current provider assigned to the area must
meet the standards contained in this Plan, specifically those standards outlining efficiency and
effectiveness, within six (6) months of the date of implementation of this Plan.
In the event that the ASA provider is unable to comply with the standards promulgated for the
ASA by this Plan, the provider will notify the Board in writing of its inability to comply and
identify which standards are involved. The Board will determine if other qualified providers are
available for the ASA who can comply with the standards. If the Board determines no other
qualified providers are available it will petition the Division for a variance from the standards so
that continuous ambulance service may be maintained, by the existing provider, in the ASA.
2. Reassignment of an ASA.
In the event that a reassignment of an ASA is necessary, the committee shall make a written
recommendation to the Board. The committee shall develop appropriate criteria, utilizing the
selection process described in this plan to be presented to the Board for consideration and/or
action by the Board.
3. Application Process for Applying for an ASA.
See Deschutes County Code 8.30 regarding application process for applying for an ASA.
4. Notification of Vacating an ASA.
In the event that an ASA provider wishes to vacate its ASA, the provider shall provide at least
sixty (60) days written notice to the Board. The ASA provider must provide notification in
accordance with the provisions of the initial service agreement or contract.
5. Maintenance of Level of Service.
In the event that an ASA provider is unable to comply with the standards promulgated for the
ASA by this Plan, the provider will notify the Board in writing of its inability to comply and
identify which standards are involved. The Board will determine if other qualified providers are
available for the ASA who can comply with the standards. If the Board determines no other
qualified providers are available, it will apply to the Division for a variance under ORS 682.285
for a variance from the standards so that continuous ambulance service may be maintained by the
existing provider.
Page 26 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page 223_ of
Ordinance eq-okq,
169 2489
VIII. DESCHUTES COUNTY ORDINANCE
The Deschutes County Board of Commissioners shall adopt an ambulance service area
ordinance. The ordinance shall include criteria for administering the Deschutes County
Ambulance Service Area Plan; limiting ambulance services that may operate in the county;
establishing an application process; ambulance franchise terms; enforcement; preventing
interruption of service; appeals, abatement and penalties; duties of the franchisee; and
establishing membership and duties of the advisory committee.
Page 27 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit - �. --
Page fa4 of 4
Ordinance
169 2490
y tt, Cb �-
. ti"f ES r.
AMBULANCE SERVICE AREA PLAN
FOR
DESCHUTES COUNTY, OREGON
Exhibit P-2
Page of
Ordinance
169 - 2491
Table of Contents
Certification By Governing Body of
Deschutes County ASA Plan........................................................................Page 4
Overview of Deschutes County................................................................................Page 5
III. Definitions................................................................................................................Page 6
IV. Boundaries
1. Ambulance Service Area Narrative and Description ................................ Page 9
2. Maps..........................................................................................................Page 12
3. Alternatives to Reduce Response Times ................................................... Page 13
V. Systems Elements
1. Notification/Response Times....................................................................Page 14
2. Level of Care............................................................................................. Page 14
3. Personnel................................................................................................... Page 14
4. Medical Supervision.................................................................................Page 15
5. Patient Care Equipment............................................................................Page 15
6. Vehicles.....................................................................................................Page 15
7. Training Page 15
8. Quality Assurance.....................................................................................Page 16
8.1 Structure......................................................................................Page 16
8.2 Process........................................................................................ Page 16
8.3 Problem Resolution..................................................................... Page 17
8.4 Sanctions for Non -Compliant Personnel or Providers................Page 17
8.5 Penalties...................................................................................... Page 18
8.6 Nuisance...................................................................................... Page 18
VI. Coordination
1. Authority for Ambulance Service Area Assignment................................Page 19
2. Entity That Will Administer The ASA Plan ............................................ Page 19
3. Complaint Review Process.......................................................................Page 20
4. Mutual Aid Agreements............................................................................Page 20
5. Disaster Response.....................................................................................Page 20
5.1 County Resources Other Than Ambulances ............................... Page 21
5.2 Out of County Resources............................................................ Page 21
5.3 Mass Casualty Incident Plan .......................................................Page 21
6. Coordination............................................................................................. Page 22
7. EMS Responder Guidelines......................................................................Page 22
8. Personnel and Equipment Resources........................................................ Page 23
9. Emergency Communications and Systems Access
Page 2 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit L72
Page Z of 27
Ordinance
1.69 - 2492
9.1 Telephone Access....................................................................... Page 23
9.2 Dispatch Procedures....................................................................Page 23
9.3 Radio System.............................................................................. Page 24
10. Emergency Medical Services Dispatcher Training.................................Page 25
VII. Provider Selection
1. Initial Assignment of Existing Ambulance Service Providers .................Page 26
2. Reassignment of an ASA.......................................................................... Page 26
3. Application Process for Applying for an ASA .........................................Page 26
4. Notification of Vacating an ASA..............................................................Page 26
5. Maintenance of Level of Service..............................................................Page 26
VIII. County Ordinances and Rules...................................................................................Page 27
IX. Appendices
1. ASA Map...........................................................................................................#1
2. Fire District Boundaries Maps...........................................................................#2
3. Incorporated City Maps.....................................................................................#3
4. Copy of Mutual Aid Agreement (Example)......................................................#4
5. Copy of Deschutes County Ambulance Service Area Ordinance ......................#5
Page 3 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page ' of
Ordinance 611-0� A
169 - 2493
I. CERTIFICATION OF DESCHUTES COUNTY AMBULANCE SERVICE AREA
PLAN
The undersigned certify pursuant to Oregon Administrative Rule 333-260-0030 (2) (a) (b) (c) that:
1. Each subject or item contained in the Deschutes County Ambulance Service Plan has
been addressed and considered in the adoption of the plan by this body.
2. In this governing body's judgment, the ambulance service areas established in the plan
provide for the efficient and effective provision of ambulance services.
3. To the extent they are applicable, the County has complied with ORS 682.205(2)(3) and
682.335 and existing local ordinances and rules.
DATED this '- day of / U S, Cf � 1998.
ATTEST:
Amt tf(
A44. --
Recording Secretary
BOARD OF COUNTY COMMISSIONERS OF
�;INDA L. SWE GEN, Commissio
Page 4 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit /*�
Page `A of Z'
Ordinance q � - ocvq
169 -° 2494
II. OVERVIEW OF DESCHUTES COUNTY
Deschutes County is located in the geographic center of the state. The County covers
approximately 3200 square miles, extending east about 105 miles from the crest of the Cascade
Mountains to the Harney County line, and spreading 53 miles from north to south beginning at
the Jefferson County line and terminating at it southern border along Klamath and Lake
Counties. Population of the county as of January 1998 was 101,200. The City of Bend, with a
population of 33,740, and the City of Redmond with 11,960, are the county's largest cities. Both
are located on Highway 97 which runs north and south through the county. Other population
areas are located along Highway 20 between Black Butte Ranch and Bend. Lumber, tourism,
and small business provide the basis of the county's economy.
Deschutes County has many natural barriers, such as mountains, lakes, rivers, wilderness, and
large roadless areas, which were considered when assigning the ambulance service areas.
Boundaries for the most part had been established several years ago by the prehospital care
providers and have proven effective.
Deschutes County is divided into eight separate ambulance service areas. The ambulance service
providers offer basic, intermediate and advanced life support emergency medical care and
transportation. The seven ambulance service providers that serve Deschutes County, their
boundaries and other general information are described in this ASA Plan. A current set of maps
are on file in the Deschutes County Office of Emergency Services. These maps depict current
boundaries for ambulance service areas, fire districts, response times and the location of the
PSAP.
Page 5 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit &
Page � of _
Ordinance Oi'�" 00
169 - 24195
III. DEFINITIONS
1. "Address and consider" has the meaning given these terms by ORS 682.205(2)(3).
2. "Ambulance" has the meaning given that term by ORS 682.025.
3. "Ambulance Service" has the meaning given that term by ORS 682.325.
4. "Ambulance Service Area (ASA)" means a geographic area which is served by one
ambulance service provider, and may include all or a portion of a county, or all or
portions of two or more contiguous counties.
5. "Ambulance Service Plan" means a written document, which outlines a process for
establishing a county emergency medical services system. A plan addresses the need for
and coordination of ambulance services by establishing ambulance service areas for the
entire county and by meeting the other requirements of these rules. Approval of a plan
will not depend upon whether it maintains an existing system of providers or changes the
system. For example, a plan may substitute franchising for an open -market system.
6. "ASA Advisory Committee (Committee)" means a committee formed to review
standards, make recommendations to or set new standards for the Board of County
Commissioners for all matters regarding EMS and review and make recommendations
regarding soundness of the ASA.
7. "ASA Administrator" is the person designated by the Board of Commissioners to
administer the ASA ordinance and plan.
8. "Communication System" means two-way radio communications between ambulances,
dispatchers, hospitals and other agencies as needed. A two -channel multi -frequency
capacity is minimally required.
9. "Deschutes County Board of Commissioners (Board)" means the elected officials that has
jurisdiction over the Deschutes County ASA Plan.
10. "Division" means the Oregon Health Division, Department of Human Resources.
11. "Effective Provision of Ambulance Services" means ambulance services provided in
compliance with the county ambulance service plan provisions for boundaries,
coordination and system elements.
12. "Efficient Provision of Ambulance Services" means effective ambulance services
provided in compliance with the county ambulance service plan provisions for provider
selection.
Page 6 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit 6
Page to of 2 I
Ordinance �- ob
169 2496
13. "Emergency" means any non -hospital occurrence or situation involving illness, injury or
disability requiring immediate medical or psychiatric services, wherein delay in the
provision of such services is likely to aggravate the condition and endanger personal
health or safety.
14. "Emergency Medical Service (EMS)" means those pre -hospital functions and services
whose purpose is to prepare for and respond to medical emergencies, including rescue
and ambulance services, patient care, communications and evaluation.
15. "Emergency Medical Technician -Basic (EMT -Basic)" means a person certified by the
Division as defined in OAR 333-265-0000(8).
16. "Emergency Medical Technician -Intermediate (EMT -Intermediate)" means a person
certified by the Division as defined in OAR 333-265-0000(9).
17. "Emergency Medical Technician -Paramedic (EMT -Paramedic)" means a person certified
by the Division as defined in OAR 333-265-0000(10).
18. "First Responder" means a person certified by the Division as defined in ORS
682.025(11) (a) (b).
19. "Franchise" is the authorization granted to provide emergency ambulance service in a
specific geographic region.
20. "Health Officer" means the Deschutes County Health Officer.
21. "License" means those documents issued by the Division to the owner of an ambulance
service and ambulance, when the service and ambulance are found to be in compliance
with ORS 682.015 to 682.991 and OAR 333-250-0000 through 333-250-0100 and 333-
255-0000 through 333-255-0090.
22. "Physician Advisor" has the meaning of a supervising physician as provided in ORS
682.235.
23. "Notification Time" means the length of time between the initial receipt of the request for
emergency medical service by either a provider or a PSAP, and the notification of all
responding emergency medical service personnel.
24. "Owner" means the person having all the incidents of ownership in an ambulance service
or an ambulance vehicle or where the incidents of ownership are in different persons, the
person, other than a security interest holder or lessor, entitled to the possession of an
ambulance vehicle or operation of an ambulance service under a security agreement or a
Page 7 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit 16
Page I— of 27
Ordinance 'I % ✓ 0 (p 4
169 - 2497
lease for a term of 10 or more successive days.
25. "Patient" means an ill, injured, or disabled person who may be transported in an
ambulance.
26. "Provider" means any public, private or volunteer entity providing EMS.
27. "Provider Selection Process" means the process established by the county for selecting an
ambulance service provider or providers.
28. "Public Service Answering Point (PSAP)" means a 24 hour communications facility
established as an answering location for 9-1-1 calls originating within a given service
area.
29. "Quick Response Team (QRT)" means an agency that provides initial response and basic
life support care without transportation capabilities by certified First Responders.
30. "Response Time" means the length of time between the notification of each provider and
the arrival of each provider's emergency medical service unit(s) at the incident scene.
31. "System Response Time" means the elapsed time from when the PSAP receives the call
until the arrival of the appropriate provider unit(s) on the scene.
Page 8 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit —9)
Page I of 2 7
Ordinance �..'��
s 169 2498
IV. BOUNDARIES
1. Ambulance Service Area Narrative and Description.
Deschutes County consists of eight ASAs. The eight ASAs are: (1) Bend; (2) Black Butte
Ranch; (3) Burns; (4) Crooked River Ranch; (5) LaPine; (6) Redmond; (7) Sisters; and (8)
Sunriver. The boundaries of each of the eight ambulance service areas are as follows:
ASA #1 - Bend
Size of ASA: Approximately 750 square miles. However, most of the ASA is comprised of
either the Deschutes National Forest or B.L.M. lands.
BEGINNING at the intersection of the south line of section 16, T17S, R8E, W.M., with the westerly line
of Deschutes County; thence easterly upon section lines approximately 10.4 miles to the SE corner of
section 18, T17S, R10E; thence northerly upon the section line to the NE corner of said section 18;
thence easterly upon section lines to the SE comer of section 9, T17S, R10E; thence northerly upon
section lines to the NW corner of section 3, T17S, R10E; thence easterly upon section lines to the SE
corner of section 36, T16S, R10E; thence northerly upon section lines to the NW comer of section 19,
T16S, R11E; thence easterly upon section lines to the SE corner of section 17, T16S, R11E; thence
northerly upon the section line to the NE corner of said section 17; thence easterly upon the section line
to the NE corner of section 16, T16S, R11E; thence northerly upon section lines approximately 1.5 miles
to the intersection with the south line of section 34, T15S, R11E; thence westerly upon said section line
approximately 1/2 mile to the SW corner of said section 34; thence northerly upon the section line to the
NW corner of said section 34; thence southeasterly approximately 2.9 miles to the SW corner of section
1, T16S, R11E; thence northerly upon the section line to the NW corner of said section 1; thence easterly
upon section lines approximately 2.25 miles to the NE corner of the W 1/2 W 1/2 of section 5, T16S,
R12E; thence southerly to the SE corner of the W 1/2 W 1/2 of said section 5; thence easterly upon
Newcomb Road to the SE corner of section 4, T16S, R12E; thence easterly upon the south line of section
3, T16S, R12E, to the intersection with the centerline of the Deschutes River; thence southerly along the
centerline of the Deschutes River to the intersection with the south line of section 9, T16S, R12E; thence
easterly upon said section line to the NE corner of the W 1/2 of section 16, T16S, R12E; thence southerly
to the SE corner of the NW 1/4 of said section 16; thence westerly to the SW corner of the E 1/2 NW 1/4
of said section 16, thence southerly to the SE corner of the W 1/2 W 1/2 of said section 16; thence
easterly upon section lines to the NW corner of section 19, T16S, R13E; thence southerly approximately
1 mile to the SW corner of said section 19; thence easterly upon section lines to the SE corner of section
24, T16S, R13E, also being a point on the east line of Deschutes County; thence southerly upon said east
line to the southeast corner of section 36, T16S, R13E; thence continuing easterly and southerly upon the
Deschutes County line to the NE corner of section 1, T22S, R21E; thence southerly upon the range line
to the SE corner of section 36, T22S, R21E; thence westerly upon the line common to Deschutes and
Lake Counties to Forest Highway 23; thence northerly upon Forest Highway 23 to the township line
between T21S and T22S, R16E, near Sand Springs; thence westerly upon the south lines of Township
21S, Ranges 16E -13E, to Forest Road 9710; thence northerly upon Forest Road 9710 to the north line of
section 19, T19S, R12E; thence westerly upon section lines approximately 3.2 miles to the SW corner of
section 15, T19S, R11E; thence northerly approximately 2 miles to the NE corner of section 9 T19S,
RIM thence westerly approximately 2 miles to the NW corner of section 8 T19S, R11E; thence
Page 9 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit &
Page � of Z'1_
Ordinance' ��
169 - 2499
southerly to the SW corner of said section 8, thence westerly upon section lines approximately 6 miles to
the SW corner of section 8, T19S, R10E; thence northerly upon section lines approximately 2 miles to
Forest Road 4614; thence westerly upon Forest Road 4614 to Forest Road 950; thence northerly upon
Forest Road 950 to Forest Highway 46, a.k.a. Cascade Lakes Highway; thence westerly upon said Forest
Highway 46 to the east line of section 27, T18S, R9E; thence southerly approximately 2.2 miles to the
SE corner of section 3, T19S, R9E; thence westerly approximately 6 miles upon section lines to the SE
corner of section 3, T19S, RBE; thence northerly approximately 3.5 miles to the NE corner of the SE 1/4
of section 22, T18S, RBE; thence westerly upon the east -west center lines of sections 22, 21, 20 and 19,
T19S, R8E to the line common to Deschutes and Lane Counties; thence northerly upon said common
County line to the Point of Beginning.
ASA #2 - Black Butte Ranch
Size of ASA: Approximately 3 square miles.
Boundaries: Entire Black Butte Ranch and a portion of Highway 20 from Indian Ford Road west
to the Camp Sherman turnoff.
ASA #3 — Burns
All of T22S, R22E, W.M., and all of T22S, R23E.
ASA #4 - Crooked River Ranch
Size of ASA: Approximately one square mile.
ALL of those portions of Crooked River Ranch lying within Deschutes County.
ASA #5 - La Pine
Size of ASA: Approximately 646 square miles. However, most of the ASA is comprised of the
Deschutes National Forest or in B.L.M. lands and are uninhabited.
All that portion of Deschutes County which lies southerly and westerly of the following described line:
BEGINNING at the intersection of the westerly line of Deschutes County with the north line of section
2, T21 S, R6E, W.M.; thence easterly upon the north lines of Township 21S, in Ranges 6E and 7E to the
NW corner of section 1 in said Range 7E; thence southerly upon the west line of said section 1, to the
SW corner of said section 1; thence easterly upon the south line of said section 1 to the SE corner of said
section 1; thence northerly upon the east line of said section 1 to the NE comer of said section 1; thence
easterly approximately 11.5 miles upon the south lines of Township 20S in Ranges 8E and 9E to the
intersection with Forest Highway 42, a.k.a. South Century Drive; thence northeasterly upon said Forest
Highway 42 to the intersection with the east line of section 27, T20S, R10E; thence northerly upon
section lines to the NW corner of the SW 1/4 of section 23, T20S, R10E; thence easterly to the NE comer
of said SW 1/4; thence northerly to the NW corner of the NE 1/4 of said section 23; thence easterly to the
NE corner of said section 23; thence northerly upon section lines approximately 2 miles to the SW corner
of section 1, T20S, R10E; thence easterly upon the south line of said section 1 to the SW comer of the
Page 10 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit C'�
Page ) d of
Ordinance 61`6' ()/off
1,69 - 2500
SE 1/4 SW 1/4 of said section 1; thence northerly to the NW comer of the SE1/4 SW 1/4 of said section
1; thence easterly to the NE corner of the SE 1/4 SW 1/4 of said section l; thence northerly to the NW
corner of the SE 1/4 of said section 1; thence easterly to the NE corner of said SE 1/4; thence southerly
upon the east line of said section 1 to the SE corner of said section 1, also being a point on Forest
Highway 40, a.k.a. Spring River Road; thence easterly and northerly upon said Forest Highway to the
intersection with the B.N.R.R. tracks in section 5 of T20S, R11E; thence southerly upon said tracks to the
north line of section 8, T20S, R11E; thence easterly upon the north line of said section 8 to the NE corner
of said section 8; thence southerly upon section lines to the SW corner of section 16, T20S, R11E; thence
easterly upon the south line of said section 16 to the SE corner of said section 16; thence southerly upon
section lines approximately 2 miles to the SW corner of section 27, T20S, R11E; thence easterly
approximately 7.5 miles upon section lines to the intersection of the north line of section 35, T20S, R12E
with Forest Road 9710; thence easterly and southerly upon said Forest Road to the south line of section
35, T21S, R13E; thence easterly upon the south lines of Township 215, in Ranges 13E -16E to a point on
the south line of section 31, T21S, R16E which intersects Forest Highway 23; thence southerly upon said
Forest Highway to the Deschutes County line and terminus of this description.
ASA #6 - Redmond
Size of ASA: Approximately 223 square miles.
Beginning at the common corner of Deschutes, Jefferson and Crook Counties; thence southerly upon the
County line common to Deschutes and Crook Counties to the SE corner of section 24, T16S, R13E,
W.M.; thence westerly upon section lines to the SW corner of section 19, T16S, R13E; thence northerly
approximately 1 mile to the NW corner of said section 19; thence westerly upon section lines to the SE
corner of the W 1/2 W 1/2 of section 16, T16S, R12E; thence northerly to the NE corner of the W 1/2
SW 1/4 of said section 16; thence easterly to the SE corner of the NW 1/4 of said section 16; thence
northerly to the NE corner of the NW 1/4 of said section 16; thence westerly upon the section line to the
intersection with the centerline of the Deschutes River; thence northerly along the centerline of the
Deschutes River to the intersection with the south line of section 3, T16S, R12E; thence westerly upon
said section line to the SW corner of said section 3; thence westerly upon Newcomb Road to the SE
corner of the W 1/2 W 1/2 of section 5, T16S, RUE; thence northerly to the NE corner of the W 1/2 W
1/2 of said section 5; thence westerly upon section lines to the NW corner of section 1, T16S, R11E;
thence southerly upon the section line to the SW corner of said section 1; thence northwesterly
approximately 2.9 miles to the SW corner of section 27, T15S, R11E; thence northerly approximately 11
miles upon section lines to the line common to Deschutes and Jefferson Counties; thence easterly upon
said common County line to the Point of Beginning; excluding all of those portions of Crooked River
Ranch lying within Deschutes County.
ASA #7 - Sisters
Size of ASA: Approximately 326 square miles.
Beginning at the common corner of Deschutes, Linn and Jefferson Counties; thence easterly on the
County line common to Deschutes and Jefferson Counties approximately 21.5 miles to the NE corner of
section 4, T14S, R11E, W.M.; thence southerly upon section lines approximately 12 miles to the SW
corner of section 34, T15S, R11E; thence easterly upon the section line approximately 1/2 mile to the NE
corner of section 4, T16S, R11E; thence southerly upon section lines to the NE corner of section 16,
Page 11 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page ll__ of Z
Ordinance a4- o (eU
1,69 d 2501
T16S, R11E; thence westerly upon the section line to the NE comer of section 17, T16S, R11E; thence
southerly upon the section line to the SE corner of said section 17; thence westerly upon section lines to
the NW corner of section 19, T16S, R11E; thence southerly upon section lines to the SE corner of section
36, T16S, R10E; thence westerly upon section lines to the NW comer of section 3, T17S, R10E; thence
southerly upon section lines to the SE corner of section 9, T17S, R10E; thence westerly upon section
lines to the NE corner of section 18, T17S, R10E; thence southerly upon section lines to the SE corner of
said section 18; thence westerly upon section lines approximately 10.4 miles to the County line common
to Deschutes and Lane Counties at the south section line of section 16, T17S, RBE; thence northerly upon
said County line to the Point of Beginning; excluding all of Black Butte Ranch and that portion of U.S.
Highway 20 from Indian Ford Road to the Camp Sherman turnoff.
ASA #8 - Sunriver
Size of ASA: Approximately 150 square miles.
BEGINNING at the intersection of Forest Road 9710 with U.S. Highway 97; thence southerly upon
Highway 97 to the intersection with the north line of section 24, T19S, R11E; thence westerly upon
section lines to the SW corner of section 15, T19S, R11E; thence northerly upon section lines
approximately 2 miles to the NE comer of section 9, T19S, R11E; thence westerly upon the section line
to the intersection with the centerline of the Deschutes River; thence upstream along the centerline of the
Deschutes River approximately 1.25 miles to the east line of section 8, T19S, R11E; thence southerly
upon said section line to the SE corner of said section 8; thence westerly upon section lines
approximately 7 miles to the SW corner of section 8, T19S, R10E; thence northerly upon section lines
approximately 2 miles to Forest Road 4614; thence westerly upon Forest Road 4614 to Forest Road 950;
thence northerly upon Forest Road 950 to Forest Highway 46, a.k.a. Cascade Lakes Highway; thence
westerly upon said Highway 46 to the east line of section 27, T18S, R9E; thence southerly approximately
2.2 miles to the SE corner of section 3, T19S, R9E; thence westerly approximately 6 miles upon section
lines to the SE corner of section 3, T19S, RBE; thence northerly approximately 3.5 miles to the NE
corner of the SE 1/4 of section 22, T18S, RBE; thence westerly upon the east -west center lines of
sections 22, 21, 20, and 19, T19S, R8E to the line common to Deschutes and Lane Counties; thence
southerly and westerly upon said county line to the north line of section 2, T21 S, R6E; thence easterly
upon the north lines of Township 215, in Ranges 6E and 7E to the NW comer of section 1 in said Range
7E; thence southerly upon the west line of said section 1, to the SW corner of said section 1; thence
easterly upon the south line of said section 1 to the SE corner of said section 1; thence northerly upon the
east line of said section 1 to the NE corner of said section 1; thence easterly approximately 11.5 miles
upon the south lines of Township 20S in Ranges 8E and 9E to the intersection with Forest Highway 42,
a.k.a. South Century Drive; thence northeasterly upon said Forest Highway 42 to the intersection with
the east line of section 27, T20S, R10E; thence northerly upon section lines to the NW corner of the SW
1/4 of section 23, T20S, R10E; thence easterly to the NE corner of said SW 1/4; thence northerly to the
NW comer of the NE 1/4 of said section 23; thence easterly to the NE corner of said section 23; thence
northerly upon section lines approximately 2 miles to the SW corner of section 1, T20S, R10E; thence
easterly upon the south line of said section 1 to the SW corner of the SE 1/4 SW 1/4 of said section 1;
thence northerly to the NW corner of the SE 1/4 SW 1/4 of said section 1; thence easterly to the NE
corner of the SE 1/4 SW 1/4 of said section 1; thence northerly to the NW corner of the SE 1/4 of said
section 1; thence easterly to the NE corner of said SE 1/4; thence southerly upon the east line of said
section 1 to the SE corner of said section 1, also being a point on Forest Highway 40, a.k.a. Spring River
Road; thence easterly and northerly upon said Forest Highway to the intersection with the B.N.R.R.
tracks in section 5, T20S, R11E; thence southerly upon said tracks to the north line of section 8, T20S,
Page 12 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page 1'� of •Z7
Ordinance 9'0(99 -
169 2502
R11E; thence easterly upon the north line of said section 8 to the NE corner of said section 8; thence
southerly upon section lines to the SW corner of section 16, T20S, R11E; thence easterly upon the south
line of said section 16 to the SE corner of said section 16; thence southerly upon section lines
approximately 2 miles to the SW corner of section 27, T20S, R11E; thence easterly approximately 7.5
miles upon section lines to the intersection with Forest Road 9710; thence northwesterly upon said Forest
Road 9710 to the Point of Beginning.
2. Maps.
2.1 ASA Map. (See Appendix #1)
This map represents the boundaries of each of the ambulance service areas within
Deschutes County and the "System Response Time," which includes notification, role
out, and provider response times. Actual response time is subject to the variables of
access, weather, road and traffic conditions as well as other circumstances that can impact
response time.
2.2 Fire District Boundaries (See Appendix #2)
2.3 Incorporated Cities (See Appendix #3)
3. Alternatives To Reduce Response Times.
Heavily forested, mountainous terrain and severe winter weather conditions present difficult
access and long response time to ground ambulances. In those situations, when an urgent
response is indicated, the PSAP may elect to call the nearest appropriate rotary -wing air
ambulance or the Deschutes County Search and Rescue.
In addition, a tiered response system is used to provide the best available patient care while
maximizing the available resources. In some instances, for various reasons, an ambulance service
provider from an adjoining county's ASA could respond quicker to an incident.
Page 13 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page Lam_ of _1_
Ordinance ai S- D6 N
169 - 2503
V. SYSTEM ELEMENTS
1. Notification/Response Times.
Notification times for ambulances shall be within two (2) minutes for 90% of the calls.
Provider response time shall be as follows for 90% of the calls: Urban - 6 min.; Suburban - 13
min.; Rural - 43 min.; and Frontier - 4 hours and 28 min.
System Response Time shall be as follows for 90% of the calls: Urban - 8 min.; Suburban - 15
min.; Rural - 45 min.; and Frontier - 4 hours and 30 min.
Monitoring of notification and response times shall be accomplished by the following:
1.1 Information received from the public, dispatch center, prehospital care providers,
hospitals, or county EMS administration.
1.2 Types of information received are written or verbal complaints, patient care report
forms, radio transmission tapes, notification and response time incident cards,
trauma registry forms, etc.
Z. Level of Care.
An ambulance operating in Deschutes County and providing basic life support level care must
consist of a qualified driver and one certified EMT -Basic or above. The EMT must always be
with the patient in the patient compartment of the ambulance.
An ambulance operating in Deschutes County and providing intermediate life support level care
must consist of one certified EMT -Basic and one certified EMT -Intermediate. The EMT -
Intermediate must always be with the patient in the patient compartment of the ambulance
intermediate level care is required or rendered.
An ambulance operating in Deschutes County and providing advanced life support level care
must consist of an EMT -Basic and an EMT -Paramedic. The EMT -Paramedic must always be
with the patient in the patient compartment of the ambulance when ALS care is required or being
rendered.
3. Personnel.
When operating an ambulance in Deschutes County, all personnel must meet the requirements of
ORS 682.015 to 682.991 and OAR 333-255-0070(1), (4) or (6). The practice of staffing an
ambulance on a part-time basis with EMTs certified to a higher level of care than is possible at
other times does not construe a requirement that the ambulance provide the same level of care on
Page 14 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page of '2-1_
Ordinance D
169 - 2504
a regular basis.
4. Medical Supervision.
Each EMS agency utilizing EMTs shall be supervised by a physician licensed under ORS 677,
actively registered and in good standing with the Board of Medical Examiners as a Medical
Doctor (MD) or Doctor of Osteopathic Medicine (DO). The physician must also be approved by
the Board of Medical Examiners as a medical director.
Each EMS agency or ambulance service may have its own medical director. The medical
director shall:
4.1 comply with the requirements listed in OAR 847-35-0025;
4.2 hold at least one meeting a year with the EMTs affiliated with the respective
ambulance services;
4.3 designate an EMT coordinator who shall conduct case reviews in the physicians
absence and send summaries of the reviews and problems identified and proposed
problem resolution to the physician; and
4.4 provide or authorize at least one case review meeting for all EMTs quarterly.
St. Charles Medical Center in Bend, Oregon and Central Oregon District Hospital in Redmond,
Oregon shall be the Medical Resource Hospitals.
5. Patient Care Equipment.
Patient care equipment must meet or exceed the Oregon Health Division's requirements as
specified in ORS 682.015 to 682.991 and OAR 333-255-0070(2), (3), (5) or (7). The ambulance
service provider shall maintain a list of equipment for their ambulances, which shall be furnished
to the Board upon their request.
6. Vehicles.
All ambulances must be either a Type I, II, or III and be licensed by the Oregon Health Division.
All ambulances must met or exceed the requirements as set forth in ORS 682.015 to 682.991
and OAR 333-255-0060. An up-to-date list of each provider's ambulances shall be furnished to
the Board upon their request.
7. Training.
Training will be consistent with requirements of the Oregon State Health Division and
Page 15 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit "??
Page of Z�
Ordinance `� " o(e
169 . 2505
Department of Transportation curriculum and shall be received through accredited institutions.
8. Quality Assurance.
In order to ensure the delivery of efficient and effective pre -hospital emergency medical care, an
EMS Quality Assurance Program is hereby established.
8.1 Structure
"Deschutes County Ambulance Service Area Advisory Committee (Committee)", shall be
formed by ordinance and be composed of ten members:
a. Emergency department physician
b. Ambulance service medical director
C. Deschutes County Health Department
d Ambulance service provider
e. Sheriff's Office representation
f. 9-1-1 center representative
g. EMT -Basic
h. EMT -Intermediate
i. EMT -Paramedic
j. Public member
Members of the Committee shall be appointed by the Deschutes County Board of
Commissioners for a two year term. The initial committee will have staggered terms,
ranging from one to three years. In the event of a tie on decisions of the ASA, the ASA
Administrator shall become a voting member in order to break the tie.
The principal function of the committee shall be to monitor the EMS system within
Deschutes County.
8.2 Process
The Board, in order to ensure the delivery of the most efficient and effective prehospital
Page 16 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit k2
Page of
Ordinance ') `O(e
169 - 2506
emergency care possible with the available resources, has directed that the ASA Advisory
Committee be established.
Quality assurance in Deschutes County shall be accomplished through frequent case
review, peer review, and periodic review by the medical directors and/or ambulance
governing bodies (see respective Provider Profiles for definitions of governing bodies).
Complaints regarding violation of this ASA Plan, or questions involving prehospital care
provided, shall be submitted in writing to the Board who shall forward it to the
Committee. The Committee shall then review the matter and make recommendations or
changes on such complaints or questions to the Board. The Board shall also resolve any
problems involving system operations (changing protocols to address recurring problems,
etc.). Ongoing input may be provided by consumers, providers or the medical
community to any individual on the Board or members of the Committee. This
individual, in turn, will present the complaint, concern, idea or suggestion (in writing) to
the full Board for consideration.
8.3 Problem Resolution
Problems involving protocol deviation by EMTs or dispatchers shall be referred to the
respective medical director or dispatch supervisor. Problems involving a non-compliant
provider shall be reviewed by the Committee with possible referral to Board if necessary.
The Board may seek background data and recommendations from the Committee in such
instances. However, any member of the Committee who may have a conflict of interest
in the matter shall declare such conflict and refrain from participating in any
recommendations made.
8.4 Sanctions for Non -Compliant Personnel or Providers
Suspension or revocation assignment. Upon a recommendation by the Committee, or
upon its own motion, the Board may suspend or revoke the assignment of an ASA upon a
finding that the provider has:
a. willfully violated provisions of an ordinance, the Deschutes County ASA
Plan or provisions of State or Federal laws and regulations; or
b. materially misrepresented facts or information given in the application for
assignment of an ASA or as part of the review of the performance of the
service furnished by the provider.
In lieu of the suspension or revocation of the assignment of an ASA, the Board may order
that the violation be corrected and make the suspension or revocation contingent upon
compliance with the order, within the period of time stated. Notice of the Board's action
shall be provided to the holder of the assignment which shall specify the violation, the
Page 17 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Pagel_ of y
Ordinance M � - Ola
169 — 2507
action necessary to correct the violation and the date by which the action must be taken.
If the holder of the assignment fails to take corrective action within the time required, the
Board shall notify the holder that the assignment is suspended or revoked upon receipt of
the notice.
A person receiving a notice of the assignment, denial, suspension, revocation or
contingent suspension or revocation of an ASA may request a hearing before the Board
by filing with the Board a written request for a hearing within fourteen (14) days of the
decision, setting forth the reasons for the hearing and the issues proposed to b reviewed.
The filing of a hearing request shall stay the action, pending the hearing and final
determination of the decision, unless a change is required due to an immediate hazard to
the public safety. The Board shall set a time and place for the hearing. Within fourteen
(14) days after the conclusion of the hearing, the Board shall affirm, reverse or modify its
original decision.
8.5 Penalties
Any person who violates any provisions of this ASA Plan or Ordinance is guilty of a
violation. Failure from day-to-day to comply with the terms of this ASA Plan or
Ordinance shall be a separate offense for each such day. Failure to comply with any
provision of the Ordinance shall be a separate offense for each such provision.
Violations of the provisions of this ASA Plan or Ordinance are punishable, upon
conviction, by a fine of not more than Five Hundred Dollars ($500) per day per violation.
8.6 Nuisance
In addition to the penalties provided in this plan, violations of any of the provisions of
this plan and ordinance is declared to be a nuisance and may be regarded as such in all
actions, suits, or proceedings.
Page 18 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit B
Page 1 Q of 21
Ordinance !1S - °Lu
r 1 169 — 2508
VI. COORDINATION
1. Authority For Ambulance Service Area Assignments.
The Board has the authority to assign an ASA within Deschutes County in compliance with ORS
682.015 to 682.991. Applications by new providers and requests for assignment change or
revocation will be considered for approval if they will improve efficient service delivery and
benefit public health, safety and welfare. Cities have the authority to develop and apply
ambulance licensing ordinances within their jurisdictional boundaries, and nothing in this plan is
intended to obviate that authority.
Future updates to this plan and proposals for assignment changes will be the responsibility of the
Board. The Board shall receive all requests for changes, present those requests to the Committee
for their review and recommendations. Upon completing their review, the Committee shall
present their recommendations to the Board. In addition, the Board has the -authority to review
service providers records and initiate an assignment change or service area revocation. For the
purpose of this plan, the Board shall recognize the Committee as an advisory group.
The Deschutes County ASA Plan was prepared with a great deal of input from all county pre-
hospital care providers. The Plan requires that the ambulance services providers maintain service
records in order that the County can carry out its ASA Plan responsibilities.
2. Entity That Will Administer the ASA Plan.
The Deschutes County ASA Committee is hereby established with the adoption of this plan. The
Committee shall serve as the principal entity to administer and accept written proposals for
amendments to this ASA Plan.
The Committee will be activated at any time a concern is submitted, in writing, to the Board, or
when deemed appropriate by seven or more members of the Committee.
This Committee, as with any governmental body, will be subject to the Oregon Open Meeting
Law (ORS Chapter 192), but may temper its activities, within legal limits, according to the
sensitivity of the EMS matter involved. Appeals from the Board, in any case where the Board
would otherwise have the final decision at the county level shall be directed to the appropriate
state regulatory agency, or a Circuit Court, as appropriate.
The Committee shall submit a brief written report of its activities or recommendations
periodically to the Board.
Existence of this committee will:
2.1 prevent needless attention of state regulatory agencies to problems that can be
Page 19 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page of 2-7
Ordinance q q- oloq
169 - 2509
resolved locally;
2.2 increase local awareness of potential problems that may exist; and
2.3 increase the awareness of ambulance medical directors regarding area concerns
and activities.
3. Complaint Review Process.
Complaints regarding violation of this ASA Plan, or questions involving prehospital care
provided, shall be submitted in writing to the Board. The Board shall then forward the complaint
to the Committee for their review and recommendations or changes on such complaints or
questions. The Committee shall also resolve any problems involving system operations (i.e.,
changing protocols to address recurring problems, etc.).
Ongoing input may be provided by consumers, providers or the medical community to any
individual on the Committee or members of the Board. This individual, in turn, will present the
complaint, concern, idea or suggestion in writing to the full Board for consideration.
4. Mutual Aid Agreements. (See Appendix #4)
Each ambulance service provider shall sign a mutual aid agreement with the other providers in
the County and with other providers in adjoining counties to respond with needed personnel and
equipment in accordance with the agreement.
All requests for mutual aid shall be made through the appropriate PSAP.
All mutual aid agreements will be reviewed annually and modified as needed by mutual consent
of all parties.
5. Disaster Response.
The Committee shall coordinate the EMS medical function of disaster planning with any formal
disaster management plan developed by the Deschutes County Sheriff or other appropriate
county authorities.
As an interim goal, until an Emergency Services Plan is implemented, ambulance provider
personnel faced with a multiple -casualty incident shall examine the situation in terms of its
potential or actual magnitude of disaster, and request any appropriate additional resources that
may be available.
Page 20 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit 6
Page Z -C> of 2'1
Ordinance 0-W
1.69 2510
5.1 County Resources Other Than Ambulances
When resources other than ambulances are required for the provision of emergency
medical services during a disaster, a request for additional resources shall be made
through the appropriate PSAP to the County Emergency Services Office.
The Director of the County Emergency Services Office shall be responsible for locating
and coordinating all county EMS resources any time that the MCI Plan is implemented.
The Director of the County Emergency Services Office shall work directly with local
agencies, departments and governments to coordinate necessary resources during any
implementation of the MCI Plan.
5.2 Out of County Resources
When resources from outside Deschutes County are required for the provision of
emergency medical services during a disaster, a request for those resources shall be made
through the appropriate PSAP.
5.3 Mass Casualty Incident (MCI) Management Plan
The purpose of the MCI plan is to provide guidance to EMS response personnel in the
coordination of response activities relating to mass casualty incidents in Deschutes
County.
The plan is intended for use when any single incident or combination of incidents
depletes the resources of any single provider or providers during the normal course of
daily operations or at the request of the Health Officer.
The plan shall identify the responsibility of the provider concerning:
a. coordination;
b. communication
C. move up;
d. triage; and
e. transportation.
The Committee will periodically review the medical component MCI plan and make
recommended changes to meet the county's need. Following the review and changes, the
Page 21 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit 6
Page Z ( of 2,q_
Ordinance
169 2511
Director of Emergency Services will be ask to append the changes to the medical
component of the County Emergency Management Plan and the modified MCI plan will
be promulgated.
6. Coordination.
6.1 The highest ranking officer of the fire or police agency in whose jurisdiction the
incident occurs shall be the incident -commander.
6.2 The senior/highest certified EMT at the scene will have overall responsibility for
patient care (triage officer); he/she shall work closely with the incident
commander.
6.3 The on -scene command frequency and staging area will be determined by the
incident -commander. Dispatch center will advise responding units as to location
of the staging area.
7. EMS Responder Guidelines.
7.1 The senior EMT on the first EMS unit to arrive at the scene shall become the
triage officer and shall:
a. assess nature and severity of the incident;
b. advise appropriate PSAP of the situation;
C. request appropriate fire and police services, if not already at the scene;
d. request initiation of EMS mutual aid if needed;
e. alert area hospital(s) of the situation; and
f. establish and organize the transportation of all injured or ill patients.
7.2 Additional EMS units arriving at the scene shall:
a. check-in with Incident -Commander;
b. effect needed rescue, if trained and equipped to do;
C. provide emergency medical care and transport patient(s) to the appropriate
hospital(s).
Page 22 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit 6
Page 2L of 2.1
Ordinance 2S-04
169 - 2512
8. Personnel and Equipment Resources.
All resources are referenced in Deschutes County's and local emergency response plans.
9. Emergency Communications and Systems Access.
9.1 Telephone Access:
The Deschutes County Communications (9-1-1) Center is located in Bend and is the
Public Safety Answering Point. This center shall receive all emergency service requests
in Deschutes County. Persons having access to telephone service will have access to the
Deschutes County Communications Center by dialing 9-1-1. Upon receipt of a request,
all emergency service providers in Deschutes County, including fire and ambulance, are
dispatched by the Deschutes County Communications Center in Bend Oregon.
9.2 Dispatch Procedures:
a. The appropriate personnel shall be notified by the dispatcher via radio
pagers within two (2) minutes of receipt of a medical call.
b. The dispatcher will obtain from the caller, and relay to the first responders
the following:
1. Location of the incident;
2. Nature of the incident; and
3. Any specific instructions or information that may be pertinent to
the incident.
C. EMS personnel shall inform the dispatch center by radio when any of the
following occurs:
1. In-service;
2. In -route to scene or destination and type or response;
3. Arrival on scene or destination;
4. Transporting patient(s) to hospital or medical facility, the number
of patients, and name of facility; and
5. Arrival at receiving facility.
Page 23 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page of 2 -7
Ordinance 9S-0(oq
169 - 2513
d. Ambulance personnel shall inform the receiving hospital by radio of the
following:
1.
2.
3.
4.
5.
6.
9.3 Radio System:
Unit identification number;
Age and sex of each patient;
Condition and chief complaint of the each patient;
Vital signs of each patient;
Treatment rendered; and
Estimated time of arrival
a. The PSAP shall:
1. restrict access to authorized personnel only;
2. meet state fire marshal standards;
3. maintain radio consoles capable of communication directly with all
first response agencies dispatched by the PSAP.
4. maintain radio logs which contain all information required by the
Federal Communications Commission and Oregon Revised
Statutes;
5. be equipped with a back-up power source capable of maintaining
all functions of the center.
b. The ambulance service provider shall equip and maintain 60 watt or
greater, multi -channel radios in each ambulance that allows for the
transmission and reception with dispatch, medical resource hospitals, and
mutual aid equipment.
Providers are dispatched by the Deschutes County 9-1-1 Center by radio
pagers. Unless specifically determined by the nature of the call (i.e., non-
emergency patient transfer, etc.) the highest level of ambulance staffing
available at that time shall be dispatched. Other resources (police, fire)
Page 24 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit
Page Z of 2
Ordinance 9 �-W—
169 - 2514
will be dispatched as deemed appropriate.
10. Emergency Medical Services Dispatcher Training.
10.1 Deschutes County EMS dispatchers must successfully complete an Emergency
Medical Dispatch (EMD) training course as approved by the Oregon Emergency
Management Division and the Board on Public Safety Standards and Training.
10.2 All EMS dispatchers are encouraged to attend any class, course or program which
will enhance their dispatching abilities and skills.
Page 25 of 27 - Deschutes County Ambulance Service Area Plan
Exhibit 6
Page Zh of
Ordinance 6�% - 0(01(
Fe
VII. PROVIDER SELECTION
169 - 2515
1. Initial Assignment of Existing Ambulance Service Providers.
On the date of implementation of this Plan, public notice shall be made that the current in-place
provider (who wishes) will be assigned the ASA. The current provider assigned to the area must
meet the standards contained in this Plan, specifically those standards outlining efficiency and
effectiveness, within six (6) months of the date of implementation of this Plan.
In the event that the ASA provider is unable to comply with the standards promulgated for the
ASA by this Plan, the provider will notify the Board in writing of its inability to comply and
identify which standards are involved. The Board will determine if other qualified providers are
available for the ASA who can comply with the standards. If the Board determines no other
qualified providers are available it will petition the Division for a variance from the standards so
that continuous ambulance service may be maintained, by the existing provider, in the ASA.
2. Reassignment of an ASA.
In the event that a reassignment of an ASA is necessary, the committee shall make a written
recommendation to the Board. The committee shall develop appropriate criteria, utilizing the
selection process described in this plan to be presented to the Board for consideration and/or
action by the Board.
3. Application Process for Applying for an ASA.
See Deschutes County Code 8.30 regarding application process for applying for an ASA.
4. Notification of Vacating an ASA.
In the event that an ASA provider wishes to vacate its ASA, the provider shall provide at least
sixty (60) days written notice to the Board. The ASA provider must provide notification in
accordance with the provisions of the initial service agreement or contract.
5. Maintenance of Level of Service.
In the event that an ASA provider is unable to comply with the standards promulgated for the
ASA by this Plan, the provider will notify the Board in writing of its inability to comply and
identify which standards are involved. The Board will determine if other qualified providers are
available for the ASA who can comply with the standards. If the Board determines no other
qualified providers are available, it will apply to the Division for a variance under ORS 682.285
for a variance from the standards so that continuous ambulance service may be maintained by the
existing provider.
Page 26 of 27 - Deschutes County Ambulance Service Area Plan P
Exhibit
Page of 2
Ordinance q `t' O(yq
169
2516
VIII. DESCHUTES COUNTY ORDINANCE
The Deschutes County Board of Commissioners shall adopt an ambulance service area
ordinance. The ordinance shall include criteria for administering the Deschutes County
Ambulance Service Area Plan; limiting ambulance services that may operate in the county;
establishing an application process; ambulance franchise terms; enforcement; preventing
interruption of service; appeals, abatement and penalties; duties of the franchisee; and
establishing membership and duties of the advisory committee.
Page 27 of 27 - Deschutes County Ambulance Service Area Plan b
Exhibit
Page of 2
Ordinance Q $ ' D(Q y