HomeMy WebLinkAbout20133453.tiffRESOLUTION
RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE
AND AUTHORIZE CHAIR TO SIGN - THOMPSON VALLEY EMERGENCY MEDICAL
SERVICE
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, pursuant to Section 7-2-100 of the Weld County Code, the Weld County
Department of Public Health and Environment and the Weld County Emergency Medical/Trauma
Service Council have reviewed the application of Thompson Valley Emergency Medical Service
for a Tier I Emergency Medical Services License and recommend approval, and
WHEREAS, after review, the Board deems it advisable to approve said Application for a
Tier I Emergency Medical Services License, a copy of which is attached hereto and incorporated
herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the application of the Thompson Valley Emergency Medical Service for a
Tier I Emergency Medical Services License be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that approval of the License is conditional
upon execution of appropriate Mutual Aid Agreements.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said license.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 16th day of December, A.D., 2013.
BOARD OF COUNTY COMMISSIONERS
WELD COUNXYdCOL Qf2AD
ATTEST:
Weld County Clerk to the Board
ounty Attorney
DEC 312013
Date of signature:
William F. Garcia
's calVIO
Douglas ademacher, Pro-Tem
n P. Conway
l-4oa
Barbara Kirkmeyer
VC k't'
U lJ0 I lP
f-l'L (Kevin, 7alyu
2013-3453
HL0042
Memorandum
TO: Board of County Commissioner
FROM: Dr. Mark Wallace , „A
DATE: December 4, 2013
SUBJECT: Thompson Valley EMS
2014 Application for Ambulance Service License
Thompson Valley EMS, located at 4480 Clydesdale Parkway, Loveland, Colorado, has applied for an
Ambulance Service license pursuant to Chapter 7, of the Weld County Code (WCC). Chapter 7 pertains to
Emergency Medical Services. The Department has reviewed this application and has deemed the ambulance
service to have met all applicable licensure application requirements found in Chapter 7. As such, I am
recommending for licensure.
The Weld County Emergency Medical/Trauma Service (EM/TS) Council reviewed this application on
November 20, 2013. The Council recommended (see attached) that Thompson Valley EMS receive a Tier I
license.
2013-3453
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DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 N. 17th Avenue
Greeley, CO 80631
Web: http://www.co.weld.co.us/Departmants/HealthEnvironmentlindochtml
PubllcHealth
Prtren,. Prvnal.. P,vmel.
Health Administration Public Health &Clinical Environmental Health Communication, Emergency Preparedness
Vital Records Services Services Education & Planning & Response
Tele: 970.304.6410 Tele: 970.304.6420 Tale: 970.304.6415 Tale: 970.304.6470 Tele: 970.304.6420
Fax: 970.304.6412 Fax: 970.304.6416 Fax: 970.304.6411 Fax: 970.304.6452 Fax: 970.304.6469
Our vision: repeal& with the communloes we serve, we are working to make Weld county the healthiest place to lam, teem. work end play.
October 25, 2013
Barry Schaefer
Chair
Weld County Emergency Medical/Trauma Service Council
Via email: bcchaefer@nlattevallevfure.org
SUBJECT: 2014 Thompson Valley EMS Application
NOTICE OF EMERGENCY MEDICAL SERVICES LICENSE APPLICATION TO THE
WELD COUNTY EMERGENCY MEDICAL/TRAUMA SERVICE COUNCIL
The Weld County Department of Public Health and Environment has received and is in process of reviewing an
Emergency Medical Service License Application from Thompson Valley EMS. Attached to this document are the
Ambulance Service License Application, and Maps of its proposed Service Area.
On behalf of the Board of County Commissioners, the Department is requesting the Emergency Medical/Trauma Service
Council review the attached documents in accordance with Section 7-2-100.B.5. of the Weld County Code (enumerated
below). The Department will forward your recommendation to the Commissioners.
Below are the most applicable portions of the code:
Weld County Code, 7-2-100.B.5
The recommendation of the Weld County Emergency Medical/Trauma Service (EM/TS) Council as to
whether or not the issuance of the license will contribute to an efficient, effective, and coordinated
emergency medical response to residents of the County. The EM/TS Council shall also provide:
a. Recommended Service Area.
b. Recommended Tier of License.
Weld County Code, 7-2-10.
No person shall provide or operate an ambulance service publicly or privately in the County unless that
person holds a valid license to do so issued by the Board of County Commissioners, except as provided in
Section 7-2-80 below. The fee for said license shall be set by separate ordinance. The license shall issue
only in the following tiers of service:
Tier I: Licensure authorizing for Primary Care, as defined in Section 7-1-30 of this Chapter.
Tier II: Licensure authorizing for transports of patient(s) to and from licensed medical facilities.
This licensure does not provide for Primary Care, as defined in Section 7-1-30 of this
Chapter.
Tier III: Licensure authorizing for Standby Service, as defined in Section 7-1-30 of this Chapter.
A. The Board of County Commissioners reserves the right to amend these rules and regulations and any
other individual conditions of licensing as applied to any particular license, as needed in keeping with
its legislative function and in order to implement the policy of the State of Colorado that the
regulation and control of ambulance licenses is in the exclusive purview of the boards of county
commissioners. Persons or rums seeking application and approval of any ambulance license under
this Chapter acknowledge that Weld County may contract with specific ambulance service
provider(s) which will serve the emergency ambulance need of Weld County and participating
municipalities.
Please forward the Councils recommendation to the Department including minutes of the EMS Council meeting
pertaining to this application. Please do not hesitate to call me should you have any questions.
Sincerely,
osYtat-cicrit
Shana Vogel
Environmental Health Specialist
Environmental Health Services
Recommendation of the Weld County Emergency Medical/Trauma Service Council
for: Thompson Valley EMS
As required in Section 7-2-100.B.5., the EMTS Council should review the application to assess as to
whether the ambulance service will contribute to an efficient, effective, and coordinated emergency medical
response to residents of the County? Please include any findings related to response time, coordination with
other ambulance services, location, service area, etc. that is the basis for the Council's recommendation:
FINDING #1: - p
P� SO Chat- 0.4- �t.72,t,p 0i3 Q-t)tSre()
k1 ikl " ,.. n.k.e zt.si - I `F3fL— QIA_.f]/ Rat -
FINDING #2:
FINDING #3:
FINDING #4:
Recommended Level of Service: Tier 2 Tier 3
Recommended Service Area:
Pt6 STe-n or -1 t'cP(' Lt cm-i O—
Other EMTS Council recommendations or comments:
(--
Recommendation By: Date: d l /y/ -
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 North 17th Avenue
Greeley, CO 80631
Web: www.weldhealth.orq
Health Administration Public Health B Clinical Environmental Health Communication, Emergency Preparec
Yrtal Records Services Services Education d Planning E Response
Tele: 970304.6410 Tele: 970.3046420 Tole: 970.304.6415 Tele: 970.304.6470 Tele: 970.304.6420
Fax: 970309.6412 Fax: 970.304.6416 Fat 970.304.6411 Fax970.309.6452 Pan 910.304.6469
Oct vision: Tcgether with the communities we serve, we are working to make Weld County the healthiest place to kve. learn. work and;
Po61ic Heald
AMBULANCE SERVICE LICENSE RENEWAL APPLICATION
Date of application: 1 Q - �- - I 3
)
Name of Ambulance Service: NA O T Pcj c)y� \I A L L IS Y SPRY-,
Owner:
Name:C\—\(\i RULE' H LTN SC2VtLES MIST-
Address %G tS (JR\LC ?K is° - LoV a
Phone Number: -> -- LOU, ? - ( C) aS
Operations Manager:
N� A L) t__ESN � R
Address:yt-F So S-L0Vat.s cO C0`a0539)
Phone Number -1--P (“7-1) - C✓ a%
Email: "i� es�,e c �I Q 1 c1S . CATY,
Pursuant to Section 7-2-150 of Weld County Code Ordinance, any change of ownership requires a new application
for ambulance service license.
(For Office Use Only)
Date Received: / / Documents Checked:
Remarks:
Date Referred to EMTC: / /
Approved Recommended (Y/N): Date Referred to B.O.C.C.: / /
Licensing Agent
Page 2
Name and address of each stockholder of partner owning 10% or more of the outstanding stock of the company of
having more than a 10% ownership interest (if applicable):
L c 4lL l O Lt'Sc'rc �?Y SC�C-S tAI sAX1t
t1mPenotJ u WLLF2? NERt-x"14 S tc.r C-3\S1-R..\LT 6' nP ( Tvl
?.C C c))f , — S C f\t 6LmAn
What area of Weld County will be
Wc'c_,-(c1UU1\S Jetc
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served by this company? Please attach a map indicating the service area.
I C
V—OO N) -1-^t' 1.3,0-1-1/2- 1 1J TIFF. c,e
\I 14 L� lsnEC1� C� n\C&D
�CLE �TSZ\C-TS
How many ambulances do you operate?
`\
Location and description of the place(s) from which this ambulance service will operate. If there are more than two
locations, attach a separate sheet with the above information.
Location #1:
Ne'4"c)Street Number:
City: State: Phone:
Location #2:
Street Number:
City: State: Phone:
Medical Director:
Name:
Mailing Address:
Phone Number: _
Please read carefully :
7-2-170 Annual renewal.
All licenses and permits shall be renewed annually, shall expire on December 31 of the year issued, and
shall not be renewed until the application has been approved by the Department. All applications for
renewal of licenses and permits shall be made not later than sixty (60) days prior to the date of expiration.
The Department shall notify, by certified mail, return receipt requested, each licensee of the renewal
requirements of this section within ninety (90) days prior to the date of expiration (Weld County Code
Ordinance 2007-8)
7-2-180 Change of Medical Director
An ambulance service must report any change of medical director, including name, address and telephone
number, to the Director within fifteen (15) calendar days of such change. (Weld County Code Ordinance
2007-8)
Page 3
Please read carefully and provide the following:
G. As required in Section 7-2-90 (G) of the Weld County Code Ordinance, a list of all emergency
medical service providers who may be called upon to respond to an emergency with the
ambulance service. This list shall include the following information on each person:
1. Complete name and date of birth
2. The highest level of certification, licensure or training attained.
3. A copy of current EMT -B, EMT -I or EMT -P certificate issued by the Colorado
Department of Public Health and Environment; nurse licensure or an Advanced First Aid
card from the American Red Cross; or a First Responder course completion certificate
issued by a Division -recognized training center or training group.
4. Proof of valid driver's license.
5. A statement of criminal complaint or convictions, including Class I and II traffic
violations, within the previous twelve (12) months. *
H. As required in Section 7-2-90 of the Weld County Code Ordinance, Proof of insurance, as
required in section 7-3-60 of this Chapter. (Worker's compensation insurance, Public liability
and property damage bodily injury, Property damage, Professional liability, and Ambulance
vehicles coverage.)
I. As required in Section 7-2-90 (I) of the Weld County Code Ordinance, provide a current copy
of EMT or Paramedic protocols adopted by the ambulance service in accordance with
standards approved by the ambulance service's medical director.
J. As required in Section 7-2-90 (J) of the Weld County Code Ordinance, provide a current copy
of the ambulance service's training standards in accordance with the requirements approved
by the ambulance service's medical director. All training must be through a state -certified
emergency medical services training center.
K. As required in Section 7-2-90 (K) of the Weld County Code Ordinance, make available for
review by the Department current records of compliance with the current EMS Laws.
L. As required in Section 7-2-90 (L) of the Weld County Code Ordinance, copies of any
judgments entered against the licensee or license applicant within the previous twelve (12)
months, including findings of fact, conclusions of law and order by any court or other
tribunal.
M. As required in Section 7-2-90 (M) of the Weld County Code Ordinance, such other
information as the Department may require to make a fair determination.
N. As required in Section 7-2-90 (N) of the Weld County Code Ordinance, a list of ambulance
agencies, fire departments, special districts and other EMS providers with which the applicant
has mutual aid agreements
O. As required in Section 7-3-110 of the Weld County Code Ordinance, make available for
review by the Department evidence of a medical continuous quality improvement program
consistent with the requirements defined in the Colorado Board of Medical Examiners rules, 3
C.C.R § 713-6, Rule 500, 3.2, b. (Weld County Code Ordinance 2007-8)
P. As required in Section 12.9.2 E lof the Colorado Rules Pertaining to Emergency Medical
Services, provide a current copy of the ambulance service's pharmacological agents and
delivery devices per medical director protocol.
Page 4
* Please note Section 7-3-50 Criminal record of ambulance crew member. Unless waived by the Board of
County Commissioners, no person shall be employed by an ambulance service as an ambulance crew
member who has been convicted of any of the following offenses within the previous twelve (12) months
from the date of application: felony, misdemeanor or Class I or Class II traffic offense.
I HEREBY CERTIFY THAT [ AM AUTHORIZED TO SUBMIT THE FORGOING APPLICATION AND THE
INFORMATION PROVIDED IN THIS APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND
BELIEF AND CONTAINS NO WILLFUL MISREPRESENTATION OR FALSIFICATION.
IN ADDITION, [ CERTIFY THAT I HAVE READ AND UNDERSTAND THE PROVISIONS AND
REQUIREMENTS OF WELD COUNTY CODE CHAPTER 7, INCLUDING, BUT NOT LIMITED TO,
SECTION 7-8-10, WHICH ENCOURAGES ALL LICENSED AGENCIES PROVIDING EMS RESPONSE IN
WELD COUNTY TO MAKE A GOOD FAITH EFFORT TO EXECUTE WRITTEN MUTUAL AID
AGREEMENTS WITH ALL OTHER EMS PROVIDERS LOCATED WITHIN OR BORDERING ON THEIR
AREAS OF RESPONSE. DETERMINATION THAT AN AMBULANCE SERVICES LICENSE HAS BEEN ISSUED INFORMATION CONSTITUTES GROUND OR L jEN E REVOCATION FALSE
AND PO SSBASED
CRIMINAL
PROSECUTION.
Signature Qf,/Applicant
l0 -A--13
Date
SUBSCRIBED AND AFFIRMED BEFORE ME THIS 1314
DAY OCTo (,E %., , 20 \ 3 , IN THE COUNTY OF
L CQ , r C , STATE OF COLORADO.
MARVI S DOLGENER
NOTARY PUBLIC ��
STATE OF COLORADO Signature of otary
NOTARY ID 19914010442 M Copwiission expires: 13 i / 15
MY COMMISSION EXPIRES JULY 31, 2015
Thompson Valley EMS
Location #1:
2100 N. Boise Ave.
Loveland, CO 80538
970-669-7256
Location #2:
380 N. Wilson Ave
Loveland, CO 80537
970-776-8474
Location #3:
740 N. 2nd St.
Berthoud, CO 80513
970-344-7158
Location #4:
4645 Sunview Dr
Loveland, CO 80538
970-461-8799
Location #5 (Headquarters):
4480 Clydesdale Parkway
Loveland, CO 80538
970-663-6025
Medical Director Information
Michael J. Jobin, M.D., FACEP
Assistant Professor
University of Colorado School of Medicine Department of Emergency Medicine
University Hospital Anschutz Medical Campus
Mail Stop B215
12401 East 17th Ave, Room 753
Aurora, CO 80045
Office 720-848-6777
Home 303-388-2500
Mobile 303-882-3222
Michael.Jobin(a7ucdenver.edu
Mutual Aid Agreements
Since we are licensed in both Weld County and Larimer County we don't have any official
mutual aid agreements in place. We are dispatched as needed and respond when surrounding
EMS agencies are in need of EMS support services.
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