PRIMARY EMS Service


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May 5, 2014

PRIMARY EMS Service REQUEST FOR QUALIFICATIONS

Hamblen County Government OFFICE OF THE HAMBLEN COUNTY MAYOR

PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

PROPOSER’S PROFILE In compliance with this Request for Qualifications, and subject to all the conditions thereof, the undersigned offers, if proposal bid is accepted, to furnish any or all of the items and/or services upon which prices are quoted, at the price set opposite each item, if applicable, to be delivered at the time and place specified herein. The undersigned certifies that he/she has read, understands, and agrees to all terms, conditions, and requirements of this Request for Proposal, and is authorized to contract on behalf of the firm named below. This form must be signed and the information contained herein will be maintained as part of Hamblen County Government’s Vendor File. Company Name: By (Printed): By (Signature): Title: Address

Phone: Fax: Cell: E-mail: Date Signed:

The authorized signature of this page indicates that the vendor has read and agrees to each page of this Request for Qualifications and all the information contained herein.

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

General Instructions & Conditions A.

SUBMISSION OF A PROPOSAL: 1.

Proposals shall be sealed in an envelope, and the outside of the envelope should be marked with “REQUEST FOR QUALIFICATIONS – PRIMARY EMS SERVICE FOR HAMBLEN COUNTY”. No oral, fax, phone, or email copies will be accepted.

2.

All proposals shall contain the signature of an authorized representative of the bidder in the space provided.

3.

All proposals shall be typed or printed in ink. The proposer may not use erasable ink. All corrections made to the proposal shall be initialed.

4.

It is the intent of the Hamblen County Legislative Body and the Hamblen County EMS Regulatory Board to issue a Certificate of Authority for primary and secondary ambulance service for a three (3) year term or at such earlier time as may be necessary due to non-compliance or vacancy.

5.

Proposers should submit proposals as follows:  Three (3) complete, original, BOUND Request for Proposal packets;  One (1) complete, original, UNBOUND Request for Proposal packet;  One (1) electronic exact copy of the Request for Proposal packet on Compact Disc (CD) or thumb drive.

B.

PROPOSALS RECEIVED LATE: It is the proposer’s responsibility to ensure his/her proposal is received by Hamblen County Government prior to the opening date and time specified above. Any proposal received after the opening date and time will remain unopened and on file. Hamblen County Government will not be responsible for proposals received late because of delays by a third party delivery service; i.e., U.S. Mail, UPS, Federal Express, etc. Date of postmark will not be considered. Prices or changes shown on the outside of an envelope will not be acceptable.

C.

COUNTY RESERVES THE RIGHT: Hamblen County Government reserves the right to waive minor informalities in any proposal; to reject any or all proposals with or without cause; and/or to accept the proposal that in its judgment will be in the best interest of the Hamblen County Government. Hamblen County Government reserves the right to award by item, group of items, or total proposal.

D.

CLARIFICATIONS, MODIFICATIONS, AND/OR AMENDMENTS: Hamblen County Government reserves the right to withdraw this RFQ at any time, for any reason, and to issue such clarifications, modifications, and/or amendments as it may deem appropriate.

E.

CANCELLATION OF SERVICE: If at any time during the contract period Hamblen County determines that the vendor is performing poorly, Hamblen County Government may cancel the contract with the vendor at Hamblen County’s discretion. Cancellation shall not release the vendor from legal remedies available to Hamblen County.

F.

MINOR TECHNICALITIES: Hamblen County Government reserves the right to waive minor technicalities in the RFQ when it is in the best interest of Hamblen County Government.

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

G.

DISCUSSIONS WITH VENDORS: Hamblen County Government may conduct discussions with responsible bidders to assure full understanding and responsiveness to solicitation requirements.

H.

RULES, REGULATIONS, LAWS & LICENSES: The awarded vendor shall observe and obey all rules, regulations and laws of the federal, state and local government, which may be applicable to the supply of this product or service.

I.

QUALIFICATION OF BIDDERS: As applicable, bids will be considered only from firms normally engaged in the sale and distribution or provision of the services, as specified herein. Bidders shall have adequate organization, facilities, equipment and personnel to ensure prompt and efficient service to Hamblen County Government. The County reserves the right, before recommending award, to inspect the vendor’s facility; or to take any other action necessary to determine that the vendor’s ability to perform is satisfactory. Hamblen County Government reserves the right to reject bids where evidence submitted or investigation and evaluation indicates an inability of the bidder to perform.

J.

NON-DISCRIMINATION: During the performance of this contract, the contractor agrees as follows: he/she will not discriminate against any employees or applicants for employment because of race, religion, color, sex, national origin, age, disability, or any other basis prohibited by state law relating to discrimination in employment, except where one or more of these are a bona fide occupational qualification reasonably necessary to the normal operations of the contractor. The contractor agrees to post in conspicuous places available to employees and applicants for employment, notices setting forth the provisions of this nondiscrimination clause. During the performance of this contract, the contractor agrees to provide a drug-free workplace.

K.

REQUIRED SUBMITTALS: Any submittals requested should be returned with the bid response and on the prescribed forms.

L.

ORIGINAL BID FILE: The original bid maintained by the Hamblen County Mayor’s Office shall be considered the official copy.

M.

QUESTIONS:

Bid questions shall be addressed as follows: PROCEDURAL QUESTIONS Hamblen Co. Mayor’s Office Karen Rich, Special Projects Coordinator 511 West Second North Street Morristown, TN 37814 Email: [email protected] TECHNICAL QUESTIONS Hamblen Co. Emergency Management Agency Chris Bell, Director 511 West Second North Street Morristown, TN 37814 Email: [email protected]

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

RFQ INFORMATION RFQ Title:

Primary EMS Service for Hamblen County

Date of RFQ Release:

Monday, May 5, 2014

RFQ Due Date:

Tuesday, May 20, 2014 at 2 p.m. EST

RFQ Opening:

Tuesday, May 20, 2014 at 2 p.m. EST Hamblen County Courthouse, Administrative Building West Wing Conference Room (First Floor) 511West Second North Street Morristown, TN 37814

Remit SEALED RFQs to:

Hamblen County Mayor’s Office Attn: Karen Rich, Special Projects Coordinator 511 West Second North Street Morristown, TN 37814

PROPOSALS SHALL BE RECEIVED SEALED AND CLEARLY MARKED AS FOLLOWS: REQUEST FOR QUALIFICATIONS – PRIMARY EMS SERVICE FOR HAMBLEN COUNTY” Questions concerning this Request for Qualifications shall be directed to EMA Director Chris Bell at [email protected] no later than 4 p.m., Monday, May 12, 2014. Responses will be posted to the Hamblen County Government website at www.hamblencountygovernment.us by 4 p.m., Wednesday, May 14, 2014.

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

BACKGROUND The Hamblen County Legislative Body adopted a resolution establishing restrictions and regulations for the operation of patient transport services within Hamblen County, Tennessee, as provided by Tennessee Code Annotated 7-61-103. By adopting this resolution, the Hamblen County Legislative Body desires to establish ambulance regulations in Hamblen County with the intention to regulate any and all other private services that may wish to operate in Hamblen County; to establish regulations for ambulance, convalescent, and invalid transport services and vehicles operating in Hamblen County which charge for those services; and to guarantee the integrity and enhance the level of emergency medical services in Hamblen County. Said regulations are overseen by the Hamblen County Emergency Medical Service (EMS) Regulatory Board. The Hamblen County EMS Regulatory Board holds the responsibility to assure that the regulations established herein are enforced and the Board shall have the power to suspend ambulance service by any service doing business within Hamblen County which fails to comply with these regulations. Recommendation may be made by the Board to the Hamblen County Legislative Body to terminate the certificate of authority of both primary emergency ambulance service, and terminate any service operating hereunder. Whenever possible, a 60-day notice to terminate the authority given herein shall be given by Hamblen County. The Hamblen County Legislative Body asked the EMS Regulatory Board to receive the qualifications from both primary emergency patient transport services and secondary ambulance services seeking to transport patients for hire within Hamblen County and recommend issuance of a certificate of authority for ambulance service within each category to the services which the Hamblen County Legislative Body determines to be the best able to provide that service to the residents of Hamblen County. Any such certificate of authority awarded shall be in effect for a three (3) year term and at the expiration of the three (3) year term or at such earlier time as may be necessary due to non-compliance or vacancy. An emergency services provider certificate shall be issued by the County Commission if: 1) The applicant meets the Board standards and standards set out in this chapter; 2) Financial disclosures show that the applicant has sufficient liquid assets to sustain operation during start-up period of at least six months; 3) The number, kind, and type of equipment owned and proposed to be used or operate is adequate and will meet the standard of care for Hamblen County; 4) No owner or employee of the service provider has committed a crime involving moral turpitude within the last ten years. The remaining pages contain requests for information about your agency and the service(s) you are able to provide. All questions must be answered completely and all requested information must be provided to receive consideration by the EMS Regulatory Board. Please consult the following APPENDICES for additional clarification: APPENDIX A: Ambulance Inventory Checklist (Must be completed and included with submission) APPENDIX B: Resolution Establishing EMS Regulations APPENDIX C: Regulations for Primary EMS Service in Hamblen County

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

PROPOSAL LAYOUT 1. Cover Letter – Include applicant’s name, business address, principal place of business, and the name under which the applicant intends to do business in the county. If the applicant is a corporation, the name and address of any person owning more than ten (10) percent of the applicant’s previously issued stock. If the applicant is doing business other than as a corporation, the name and address of all persons possessing an equity of ownership interest in the business. 2. Statement of Applicant’s Operating Experience – Include a statement of the applicant’s operating experience in providing emergency medical services. 3. Personnel – Provide a list of all persons engaged in the applicant’s operations within the county including the current certification status of all EMT personnel, paramedics, and medical first responders. Include copies of certifications where applicable. Documentation should include the following: a. Staffing of ALS Units b. Staffing of BLS Units c. In-House In-service Training (minimum of 16 hours) d. Paramedic Certifications e. Physicals and Annual Testing 4. Financial Records – Financial records showing the applicant’s financial status for the current year and two (2) preceding years. 5. Training – Include a description of the applicant’s training program, including training requirements for new employees, continuing education requirements, and employee performance evaluation programs. 6. Facilities – Provide a description, including street address, of the facilities or structures used by the applicant in the county in connection with its anticipated services, and the geographic area in which the applicant would operate if such area is less than the total area of the county. 7. Official Permission – Provide a copy of each form of official permission required by the Board, including licenses, permits, and certificates. 8. Vehicles and Equipment – Provide a detailed description of the following items, including proof that they are in compliance with both State of Tennessee and Hamblen County regulations: a. GPS Monitoring Equipment b. ALS Units Equipment List c. BLS Units Equipment List d. Number of ALS Units in Service e. Number of BLS Units in Service f. Communications Equipment and Systems g. Proof of compliance that: i. Each vehicle in the fleet that responds to an emergency call shall contain all equipment and supplies necessary to be classified as a “Class A, Advanced Life Support Ambulance Service” by the Tennessee Department of Health – Division of EMS. ii. All vehicles are equipped with oxygen driven patient resuscitator.

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

PROPOSAL LAYOUT / Vehicles and Equipment, continued iii. Each vehicle is equipped with a 12 lead cardiac monitor with the ability to transmit to local hospitals when applicable. iv. Each vehicle is equipped with an operable pulse oximeter. v. Each vehicle is equipped with wave form capnography. vi. Each vehicle is equipped with a CPAP device and the necessary equipment to perform surgical cricothyrotomy. h. Provide a description of each ambulance to be used, including make, model, year of manufacture, and any vehicle identification numbers. In the case of ground ambulances, the engine, chassis numbers, and the current mileage of each vehicle to be used. In the case of air ambulances, the number of flight and operating hours of each vehicle to be used, the Federal Aviation Administration certificates, licenses or registrations for each vehicle, and the license numbers and status for each employee who will pilot the vehicles engaged in patient transportation. 9. Ambulance Inventory Checklist – Complete the Ambulance Inventory Checklist (Appendix A). If some items from this list are not currently being included in your ALS Units, please give a reason as why they are not included. 10. Insurance – Provide a copy of Liability Insurance Policy. 11. Revenues – Provide a copy of your agency’s Medicare number with all necessary certification to prove validity of Medicare number. 12. Liabilities – Provide a copy of licensing from the State of Division of EMS in Hamblen County (6 months compliance). 13. General – Provide proof of the following, including copies of all necessary certificates, licenses, etc. a. Class A Service b. Physician Medical Director 14. Other – Provide the following information: a. Logistics of emergency services staffing i. Minimum of one (1) ALS unit 24 hours a day, 7 days a week available within Hamblen County. b. Additional items your service will provide to the requirements of State of Tennessee and Hamblen County EMS regulations. c. Additional services your company provides to the agencies and/or citizens of Hamblen County. 15. Hamblen County EMS Regulatory Board Evaluation Criteria Proposals will be considered utilizing the following criteria: a. Does the applicant meet all required criteria set forth in the current county EMS regulations for the service it is applying? b. What additional equipment is applicant committing to provide to Hamblen County above those set forth in the current county EMS regulations? c. Does the service already have a commitment to the local community through service outside its normal operations? Page 7 of 24

PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

PROPOSAL LAYOUT / Evaluation Criteria, continued

d. What is the record of the service in responding to emergency calls in the past (either as primary or a secondary service)? If the service applying is based outside Hamblen County, the service will need to submit the appropriate documentation of response calls for the past six (6) months.

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

EVALUATION AND AWARD The Hamblen County EMS Regulatory Board will review the qualifications received and make a recommendation to the Hamblen County Legislative Body’s Public Safety Committee for consideration to the full Hamblen County Legislative Body. The Hamblen County Legislative Body will award a Primary and Secondary service provider. RFQ Timeline / Dates of Interest (subject to change) Item RFQ Release

Date Monday, May 5, 2014

Time 4 p.m.

Deadline for Questions to be Submitted via Email Responses to Questions will be Posted Online RFQ Due Date and Opening

Monday, May 12, 2014

4 p.m.

To EMS Regulatory Board for Review Consideration by Hamblen County Legislative Body’s Public Safety Committee Award by Hamblen County Legislative Body Notice of Awarded Vendors Date All Aspects of Resolution in Effect and County-Issued Certificates of Authority Considered Active

Tuesday, May 20, 2014

Wednesday, May 14, 4 p.m. 2014 Tuesday, May 20, 2014 2 p.m.

Location Hamblen County Courthouse, Administrative Building, West Wing Conference Room [email protected] www.hamblencountygovernment.us Hamblen County Courthouse, Administrative Building, West Wing Conference Room

Monday, June 9, 2014

11:30 a.m.

Hamblen County Health Department Conference Room

Thursday, June 19, 2014

5 p.m.

Hamblen County Courthouse, Third Floor Large Courtroom

Friday, June 20, 2014 Tuesday, July 1, 2014

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

APPENDIX A Hamblen County Ambulance Inventory Checklist

                                 

Mobile Radio w/ 155.205 & 155.340 Emergency Lights ANSI Class 3 Vest x 4 Triangle Reflectors x 3 Tow Strap x 1 Booster Cable x1 Body Bag x 2 Protocol Manual SOG Manual N95 Facemask x 4 Gloves (S,M,L,XL) x 2 ea. Oxygen: Main (M cylinder) x 1 Oxygen: Portable (D or E cyl) x 3 Portable O2 regulator x 2 Oxygen wrench x 2 Hand Sanitizer x 3 Clamshell Extrication Device x 1 Traction Device (Sager or Hare) x 1 Pediatric Back Board x 1 Pediatric Traction Device x 1 Stair Chair x 1 Disinfectant Spray x 2 Emergency Response Guide x 1 Speed Clips x 9 9 Foot Straps x 3 Adult C-collar x 6 Pedi C-collar x 4 Infant Car Seat x 1 Nasal Cannula x 9 Adult Non-Rebreather x 5 Co2 Cannula x 2 T-mask Nebulizer x 3 Facemask Nebulizer x 3 Pedi Nasal Cannula x 3

                                 

Pedi Non-Rebreather x 3 Pedi Simple Facemask x 3 Infant NRB x 3 Infant SFM x 3 Adult BVM x 3 Child BVM x 3 Infant BVM x 3 Suction Canister/Lid x 2 Suction Cath x 2ea (6,8,10,12,14,16fr) Yankauer Set x 2 Portable Suction Unit x 1 Respirator Circuit x 2 Adult Esophageal Bulb Detector x 2 CPAP (Lg, Reg) x 2 ea Oxygen Powered Respirator x 1 Multi-Size BP Cuffs Stethoscope x 4 Wash Cloth x 4 Pillow Case x 4 Pillow x 3 Towel x 4 Blankets x 2 Sheets x 6 Roller Gauze 4” x 8 Roller Gauze 2” x 8 Sam Splint x 4 Vaseline Gauze x 4 Sterile 4x4 x 25 Convenience Bags x 6 Hot Pack x 6 Cold Pack x 6 Burn Sheets x 2 Trauma Pads x 2 ABD Pads x 6

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

APPENDIX A, continued Hamblen County Ambulance Inventory Checklist

                                

OB Kit x 2 Chest Seals x 2 Ace Bandage x 2 Infant Blanket x 1 Bed Pan x 1 Urinal x 1 Emesis Basin x 2 Bio Haz Bag x 2 Bio Haz Kit x 2 Bio Haz Suit x 2 Triage Pack x 1 Stat Pack or equivalent x 1 12 lead Heart Monitor/Defibrillator with Transmission Capability (ALS) AED (BLS) Adult/Pedi Defib Paddles Pedi Pacer Pad x 2 Adult Pacer Pads x 2 Conductive Gel x 1 Adult Electrodes x 120 Pedi Electrodes x 50 Spare Monitor Batteries x 2 ETCO2 ETT x 3 Pulse Oximeter x 1 Pedi SPO2 (Disposable) x 3 3 Lead Cables x 1 12 Lead Cables x 1 Pacer Cable EKG Paper x 2 Thermometer x 1 Thermometer Covers x 10 Pen Light x 1 Prep Razor x 5 Ring Cutter x 1

                                

Glucometer with strips x 1 Stretcher with 5 straps x 1 Long Spine Board x 2 Scoop Stretcher x 1 Board Splint Set x 1 Trash Can x 1 3 “D” Cell Flashlight x 2 Fire Extinguisher x 2 Trauma Shears x 2 Mega-Mover x 2 Triangular bandages x 8 Penrose Tourniquet x 10 Airway Kit x 1 Combitube x 1 Safety Glasses x 2 Oral Airway (5 sizes) x 2ea. Nasal Airways x 1ea. (20,22,24,26,28,30,32,36fr) ET Tubes x 2ea (2.5-5.5 uncuffed) ET Tubes x 2ea (6.0-9.0 cuffed) Adult Tube Tamer x 2 Adult Laryngoscope x 1 Pediatric Laryngoscope x 1 Macintosh Blade x 1ea (1-4) Miller Blade x 1ea (1-4) Colormetric ETCO2 Detector x 2 Pedi Colormetric ETCO2 Det x 2 Adult Forceps x 1 Pedi Forceps x 1 Esophageal Bulb Detector x 2 Pedi Stylet x 2 Pedi Tube Tamer x 2 Meconium Aspirator x 1 Pediatric Oral Airway (0-4) x 1ea

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

APPENDIX A, continued Hamblen County Ambulance Inventory Checklist

                                 

Pediatric o2 Sat x 4 King Airway (2.0,2.5,3.0) x 1ea Alcohol Preps x 100 Filter needles x 6 Pediatric Arm Board x 2 KY Jelly x 8 Iodine Preps x 10 Nail Polish Remover x 8 INT x 10 IM Needles (22,25g) x 16ea IM Needle (18g) 18ea Normal Saline Prefill Syringes x 12 Syringes (1,3,5,10cc) x 8ea Lancets x 10 Buretrol Drip Set x 2 Intraosseous Needles (15 & 18g) x 2 Broselow Tape x 1 Tape ½” x 2 Tape 1” x 4 Tape 2” x 4 Dial Flow x 4 10gtt Sets x 14 60gtt Sets x 6 Normal Saline 250ml x 2 Normal Saline 500ml x 12 Tegaderm x 50 Safety IV Cath (24,22,20,18,16,14) x 14ea Huber Needle x 2 MAD Device x 2 Adenocard 12mg x 6 Albuterol 2.5mg x 8 Amioderone 150mg x 3 Anectine 200mg x 1 Aspirin 81mg x 2 bottles

                                 

Atropine 1mg x 10 Pedi Atropine 1mg x 2 Benadryl 50mg x 3 Calcium Chloride 1gm x 4 Cardizem 100mg x 2 D50W 25gm x 3 D25W x 2 Demerol 25mg x 2 Dopamine Premix x 1 Epi 1:1000 1mg x 6 Epi 1:10,000 1mg x 16 Etomidate 20mg x 2 Glucagon 1mg x1 Lasix 40mg x 3 Lidocaine 100mg x 10 Lidocaine Premix x 1 Mag Sulfate 5gm x 1 Morphine 10mg x 2 Narcan 0.4mg x 4 Nitro Tabs 0.4mg x 2 bottle Nitro Paste x 1 tube w/patches Norcuron 10mg x 2 Oral Glucose 15gm x 3 Phenergan 25mg x 2 Procainamide 1gm x 1 Sodium BiCarb 8.4% 50mEq x 4 Sodium BiCarb 4.2% 5mEq x 2 Solumedrol 125mg x 3 Solumedrol 1gm x 3 Valium 10mg x 2 Verapamil 5mg x 2 Versed 10mg x 2 Zofran 4mg x 2 Cric Kit x 1

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

APPENDIX B Resolution Establishing EMS Regulations

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

APPENDIX B, continued Resolution Establishing EMS Regulations

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

APPENDIX B, continued Resolution Establishing EMS Regulations

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

APPENDIX B, continued Resolution Establishing EMS Regulations

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

APPENDIX B, continued Resolution Establishing EMS Regulations

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

APPENDIX C Regulations for Primary EMS Service in Hamblen County Under the provisions of TCA 7-61-103, the governing body of any county may enforce restrictions and regulations for the operation of patient transportation services (ambulance, convalescent, invalid, etc.) inside their county. Hamblen County hereby establishes the following regulations for all new or current ambulance services, convalescent services, and invalid transport services operating in Hamblen County who charge for their services. These regulations are intended to apply to ambulance services duly-licensed in accordance with the State of Tennessee. DEFINITIONS The following words, terms and phrases, when used in this article, shall have the meanings ascribed to them in this section, except where the context clearly indicates a different meaning. Ambulance means any privately or publicly owned land vehicle that is especially designed, constructed or modified and equipped and is intended to be used for and is maintained or operated for transportation upon the streets, highways or airways in this state for persons who are sick, injured, wounded, otherwise incapacitated, helpless or in need of medical care. Ambulance service means the principal use of any privately or publicly owned ambulance for the transportation of persons who are sick, injured, wounded, otherwise incapacitated, helpless, or in need of medical care. Board means the Hamblen County Emergency Medical Services Regulatory Board or a designee as having general administrative responsibility for enforcing the provisions of this article. Emergency medical Services or EMS means the services utilized in responding to the perceived need for immediate medical care in order to prevent loss of life or aggravation of illness or injury. Emergency Medical Technician or EMT means an individual licensed by the Tennessee Department of Health, Division of EMS to practice emergency medical care. Hamblen County E-911 means the central dispatch for emergency medical services. Paramedic means any person licensed by the Tennessee Department of Health, Division of EMS as a paramedic. Patient means any individual who is sick, injured, wounded, otherwise incapacitated, helpless, or in need of medical care and transported by an ambulance. Person includes any individual, corporation, firm, company, association, or combination thereof.

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

APPENDIX C, continued Regulations for Primary EMS Service in Hamblen County Service Provider means any service licensed and certified by the Board and the County Commission to provide ambulance service or emergency medical services. Certification – Required (a) No person may operate or advertise as being available to act as a service provider within Hamblen County without receiving an emergency medical service provider certificate of authority from the County Commission. (b) The Emergency Management Director of Hamblen County may waive the requirement of certification in an emergency situation based upon certification to the county mayor that a public emergency presently exists and requires that uncertified persons be allowed to act as service providers until the abatement of the public health emergency. Primary and Secondary RFQ Application; Contents. (a) Any person desiring to receive certification as a service provider shall submit application to the EMA director on such forms as may be required by the Board. The application shall contain the following information: 1) The applicant’s name, business address, principal place of business, and the name under which the applicant intends to do business in the county. If the applicant is a corporation, the name and address of any person owning more than ten percent of the applicant’s previously issued stock. If the applicant is doing business other than as a corporation, the name and address of all persons possessing an equity of ownership interest in the business; 2) A statement of the applicant’s operating experience in providing emergency medical services; 3) A list of all persons engaged in the applicant’s operations within the county including the current certification status of all EMT personnel, paramedics, and medical first responders. 4) Financial records showing the applicant’s financial status for the current year and two preceding years; 5) A description of the applicant’s training program, including training requirements for new employees, continuing education requirements, and employee performance evaluation programs. 6) A description, including street address, of the facilities or structures used by the applicant in the county in connection with its anticipated services, and the geographic area in which the applicant would operate if such area is less than the total area of the county. Page 19 of 24

PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

APPENDIX C, continued Regulations for Primary EMS Service in Hamblen County 7) A copy of each form of official permission required by the Board, including licenses, permits, and certificates. 8) Such other information as required by the Board. (b) In addition to the information required by the provisions of subsections (a) of this section, applicants seeking certification to provide ambulance services shall provide the following information: 1) A description of each ambulance to be used, including the make, model, year of manufacture, and any vehicle identification numbers; 2) In the case of ground ambulances, the engine, chassis numbers, and the current mileage of each vehicle to be used; 3) In the case of air ambulances, the number of flight and operating hours of each vehicle to be used, the Federal Aviation Administration certificates, licenses or registrations for each vehicle, and the license numbers and status for each employee who will pilot the vehicles engaged in patient transportation. 4) Such other information as required by the director or board. (c) The Board shall review all documentation required for an emergency services provider certificate. The Board will then present at the next County Commission Committee Meeting. An emergency services provider certificate shall be issued by the County Commission if: 1) The applicant meets the Board standards and standards set out in this chapter. 2) Financial disclosures show that the applicant has sufficient liquid assets to sustain operation during start-up period of at least six months. 3) The number, kind, and type of equipment owned and proposed to be used or operate is adequate and will meet the standard of care for Hamblen County. 4) No owner or employee of the service provider has committed a crime involving moral turpitude within the last ten years.

VEHICLES AND EQUIPMENT All vehicles shall conform to the rules and regulations of the State of Tennessee Department of Health Licensure and Regulation, Office of Emergency Medical Services and additionally to the rules and regulations of this resolution. No vehicle shall be utilized after having more than 300,000 miles.

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

APPENDIX C, continued Regulations for Primary EMS Service in Hamblen County Any vehicles placed into service must have a GPS monitoring system that tracks speed and logs route traveled continuously. Each unit in service and available for service shall be maintained in such a manner so as to keep the temperature inside the unit between 59 and 86 degrees. Each vehicle must be well maintained in appearance and in a safe operating condition at all times. All units shall be kept clean and hygienic as to the interior and exterior to keep the vehicles and equipment clean. All vehicles shall be inspected semi-annually by an A.S.E. certified or greater mechanic. Additionally, all vehicles, maintenance repair records, and equipment shall be inspected semi-annually by at least one of the members of the Hamblen County EMS Regulatory Board or their designee(s); one of these can be substituted by the annual inspection by the Tennessee office of EMS. Each vehicle in the fleet that responds to an emergency call shall contain all equipment and supplies necessary to be classified as a “Class A, Advanced Life Support Ambulance Service” by the Tennessee Department of Health-Division of EMS and shall contain all of the equipment and supplies listed on the attached Hamblen County supplies and inventory sheet. All vehicles shall be equipped with oxygen driven patient resuscitator. Each vehicle shall be equipped with a 12 lead cardiac monitor with the ability to transmit to local hospitals when applicable, operable pulse oximeter, wave form capnography, CPAP device and the necessary equipment to perform surgical cricothyrotomy in the field. Each BLS unit will be equipped according to state regulations. The primary service is required to have 75% of its fleet be ALS equipped vehicles. Each vehicle shall be equipped with a VHF-High Band two-way radio system and a UHF twoway radio system that will communicate between its base, the local hospitals, and the Hamblen County E-911 Center utilizing designated radio frequencies and Med channels. Vehicle radio wattage shall meet TDH-EMS regulations. All base station radios shall be rated with at least 30 watts of power. PERSONNEL Each ALS unit shall be staffed with at least one Tennessee licensed Paramedic and one Tennessee licensed Emergency Medical Technician on all responses and transports. This applies to all calls whether the call is an emergency, non-emergency, or convalescent in nature. The Tennessee licensed Paramedic shall attend the patient in the patient compartment on all transports to the hospital. Each BLS unit will have a minimum of two (2) EMT Advanced on all transports. All Paramedics shall be certified, and maintain proficiency in Advanced Cardiac Life Support, CPR, ITLS or PHTLS, PALS or PEPP or EPC, Rapid Sequence Intubation utilizing paralytic medications, and emergency surgical cricothyrotomy.

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

APPENDIX C, continued Regulations for Primary EMS Service in Hamblen County All personnel shall complete sixteen hours annually of in house inservice training certified by CEU certificate. All personnel shall receive an annual DOT Physical and annual testing for compliance with OSHA guidelines. Each employee shall receive semi-annual updates and certification in rapid sequence intubation utilizing paralytic medications, needle cricothyrodomy, and exposure control procedures. All employees shall abide by the Tennessee Drug Free Workplace guidelines and each service (employer) shall be a certified Tennessee Drug Free Workplace employer. All personnel shall be physically fit to perform their duties and each service shall keep on file verification of the annual physical exam on each employee. All personnel shall be neat and clean in appearance and shall dress in company issued uniforms with the employee’s name and level of certification easily visible on the uniform. The uniform shirt shall have some type of insignia on it displaying the name of the service. INSURANCE All services operating in Hamblen County shall maintain with insurance companies authorized to do business in the State of Tennessee, liability and collision coverage on all vehicles and professional liability coverage on its employees of not less than $1,000,000.00 per occurrence. A certificate of insurance shall be on file with the County Mayor of Hamblen County. OPERATING BASE Each service shall be in operation 24 hours a day and maintain a dispatcher located in Hamblen County 24 hours a day for the purpose of communications with the public, each unit, other EMS agencies, local hospitals, and the Hamblen County E-911 Center. No service shall advertise any phone number (seven digit, toll free, etc.) for emergencies. All services shall include the 911 number for emergencies in any advertising and shall display the emergency 911 number on each side of all vehicles. All services shall include the emergency 911 number on any advertising or other document that includes a phone number (seven digit, toll free, etc.). No service shall respond in the emergency mode or respond to an emergency call in Hamblen County without being dispatched by the Hamblen County E-911 Center. If the service receives an emergency call, the service shall inform the caller to hang up and immediately call E-911. The service can transport in emergency mode if the patient condition warrants. No unit or service shall cause or permit any vehicle to be dispatched to a call on the basis of information obtained by monitoring a radio frequency assigned to any law enforcement, EMS, fire, rescue, or any other public agency.

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

APPENDIX C, continued Regulations for Primary EMS Service in Hamblen County NAME No service, company, or vehicle other than the duly recognized primary service shall use or display the words “Hamblen County” and/or “Morristown” as a part of its name or advertisement. All vehicles shall boldly display the company name and the unit ID number where it is easily visible from all four sides of the vehicle for the public to see. REVENUE Each vehicle and service provider shall be Medicare enrolled and approved with a current Medicare provider number plainly posted at its administrative office. All services shall accept assignment on all Medicare claims. All services shall utilize electronic billing with Medicare and be able to provide computer billings and invoices to all patients. The service must obtain proper business licenses, pay all fees, taxes, and encumbrances related to their operation in Hamblen County. GENERAL All services and vehicles shall meet all of the requirements of the State of Tennessee Department of Health Licensure and Regulation, Office of Emergency Medical Services and this resolution. The primary service provider shall be licensed as a Class “A” service. All services shall have a Physician Medical Director who is currently a practicing physician who is residency trained, board certified in either internal medicine, family practice, emergency medicine, or surgery with a knowledge of emergency medicine. (see Tennessee Office of Emergency Medical Services for definitions and guidelines for a “Medical Director”) LICENSE All new services desiring to do business in Hamblen County must file a Request for Service with the Hamblen County Mayor’s Office addressing the need for additional patient transport services. The Hamblen County EMS Regulatory Board will review these requests and make recommendation to the Hamblen County Commission. The Hamblen County Commission must approve the proposed service before it will be allowed to operate and provide service in Hamblen County. Each service or unit shall certify annually that it meets all the requirements herein above set out, by filing an affidavit with the Hamblen County Mayor’s Office. The service shall be in compliance with all Tennessee Division of EMS rules and guidelines. Any time replacement units are required by the service, a non-Hamblen County licensed unit may be brought into service in Hamblen County after approved by majority of HCEMS Regulatory Board. This relates to significant maintenance or catastrophic events to the service.

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PRIMARY EMS SERVICE

HAMBLEN COUNTY GOVERNMENT

APPENDIX C, continued Regulations for Primary EMS Service in Hamblen County The service and all ambulances providing service within Hamblen County shall be licensed by the state of Tennessee division of EMS in Hamblen County. Upon receipt of certificate of authority to operate in Hamblen County service has six months to comply. ENFORCEMENT All vehicles, equipment, response reports, records, etc. shall be available at all times for inspection by the Hamblen County EMS Regulatory Board or their designee. The Hamblen County EMS Regulatory Board shall investigate allegations of violations of these regulations and recommend or pursue the necessary action based on the findings. A service shall come to the Board before adding or deleting services and/or vehicles. This request must be made in writing, detailing all aspects of the request. Failure to comply with these regulations may cause legal action or loss of certificate to operate in Hamblen County. Any service or person which provides ambulance service as defined herein without first obtaining a certificate of authority may be enjoined from providing such service and may be cited for such violation(s).A civil penalty in an amount not to exceed $50 per “leg” of such service shall be levied against the violating ambulance service and the violating service may, upon a finding that a violation has occurred, be charged with the court costs of the legal action together with a reasonable attorney’s fee. Such citations shall be prosecuted in the General Sessions Court for Hamblen County. EMS services based outside of Hamblen County shall have no authority to transport in Hamblen County a call that both originates and terminates in Hamblen County. (Except for mutual aid agreement.) SEVERABILITY If any subsection, sentence, word, clause, phrase, or portion of these regulations is, for any reason, held invalid or unconstitutional by any court of confident jurisdiction, such portion shall be deemed a separate, distinct, and independent provision and such holding shall not affect the validity of the remaining portions thereof.

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