HomeMy WebLinkAbout20133448.tiffRESOLUTION
RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE
AND AUTHORIZE CHAIR TO SIGN - JOHNSTOWN FIRE PROTECTION DISTRICT
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 the Johnstown Fire Protection District 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 Johnstown Fire Protection District 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 County Clerk to the Board
ounty Attorney
rbara Kirkmeyer
DEC 312013
Date of signature:
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Cei- Wlr(aim, labia)
\I% 119
2013-3448
HL0042
Memorandum
TO: Board of County Cotnmissio
FROM: Dr. Mark Wallace
DATE: December 4, 2013
SUBJECT: Johnstown Fire Protection District
2014 Application for Ambulance Service License
Johnstown Fire Protection District, located at 100 Telep Avenue, Johnstown, 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 Johnstown Fire Protection District
receive a Tier I license.
2013-3448
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DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 N. 17th Avenue
Greeley, CO 80631
Pub& Heetth
Web: http://www.co.weld.co.us/Departments/HealthEnvironmentfindex.html
Health Administration Public Health Mica] Environmental Health Communication, Emergency Preparedness
Vital Records Services Services Education&Planning & Response
Tele: 970.304.6410 Tele: 970.304.6420 Tele: 970.304.6415 Tele: 970.304.6470 Tele: 970.304.6420
Far 970304.6412 Far 970.304.6416 Far 910.304.6411 Far 970.304.6452 Far 970.304.6469
Our vision: Together with the communities we serve, we ate working to make Weld County the healthiest place to live, learn, work endplay.
October 30, 2013
Barry Schaefer
Chair
Weld County Emergency Meclical/Trauma Service Council
Via email: bschaefer(&,,alattevalleyfire.org
SUBJECT: 2014 Johnstown Fire Protection District EMS Application
NOTICE OF EMERGENCY MEDICAL SERVICES LICENSE APPLICATION TO lim
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 Johnstown Fire Protection District. 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 firms 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,
(AltA
Rachel Scanlan
Environmental Health Specialist
Environmental Health Services
Recommendation of the Weld County Emergency Medical/Trauma Service Council
for: Johnstown Fire Protection District
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:
eyed/ - 2c-�006v nigis Rea aTheP ► . tifJ
FINDING #2:l^,/i"1(,AGUI
AV- MuritAt' MD
FINDING #3:
FINDING #4:
Recommended Level of Service:
Recommended Service Area:
, AS Ls e0
Tier Tier 2 Tier 3
cm 4110L4 eiAr ncS--
Other EMTS Council recommendations or comments:
Recommendation By ,� Date:
-149-715—
L
Page 2
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 North 17th Avenue
Greeley, CO 80631
Public Health
Web: www.weldhealth.orq
Health Administration Public Health & Clinical Environmental Health Communication, Emergency Preparedness
Vital Records Services Services Education & Planning 8 Response
Tele: 970.304.6410 Tele: 970.304.6420 Tele: 970.3044415 Tele: 970.304.6470 Tele: 970.304.6420
Fax: 970.304.6412 Fax: 970.3044416 Fax: 970.3046411 Fax: 970.304.6452 Fax: 970.304.6469
Our Asian: Together with the communities we serve, we are working to make Weld county the healthiest place to twe, learn, work and play.
AMBULANCE SERVICE LICENSE RENEWAL APPLICATION
Date of application: 10/24/2013
Name of Ambulance Service: Johnstown Fire Protection District
Owner:
Name: _Johnstown Fire Protection District _
Address: 100 Telep Ave Johnstown, CO 80534
Phone Number: _970-587-4477
Operations Manager:
Name: Chief Bernie Covillo
Address: 100 Telep Ave Johnstown, CO 80534 _
Phone Number: 970-5874477
Pursuant to Section 7-2-150 of Weld County Code Ordinance, any change of ownership requires a new application for ambulance
service license.
Date Received: / /
(For Office Use Only)
Documents Checked:
Remarks:
Approved Recommended (Y/N):
Date Referred to B.O.C.C.:
/
/
Licensing Agent
Page 3
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):
N/A
What area of Weld County will be served by this company? Please attach a map indicating the service area.
See map attached
How many ambulances do you operate? 1
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:
Street Number: 100 Telep Ave
City: _Johnstown State: CO Phone: 80534
Location #2:
Street Number:
City:
Medical Director:
Name: _Dr. Farstad _
State: Phone:
Mailing Address: _1024 South Lenny, Fort Collins, CO 80524
Phone Number: 970-435-8006
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 5
I HEREBY CERTIFY THAT I 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, I 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 BASED ON FALSE
INFORMATION CONSTITUTES GROUNDS FOR LICENSE REVOCATION AND POSSIBLE CRIMINAL
PROSECUTION
ignature of Applicant
4 4T ! !o21/3
11tle Date
SUBSCRIBED AND AFFIRMED BEFORE ME THIS I 1 lea
DAY O �oher , 20 I 3 , IN THE COUNTY OF
1il8,� , STATE OF COLORADO.
MELISSA SOBESKI
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID # 20054034234
MY COMMISSION EXPIRES AUGUST 31. 2017
My Commission expires: $ / 31 / .01
EMS MUTUAL AID AGREEMENT
This agreement, made and entered into this 18th day of April 2013, by and between
Thompson Valley EMS and Windsor -Severance Fire Protection Districts
Johnstown Fire Protection District & the Milliken Fire Protection District
WITNESS THAT:
WHEREAS, the agencies hereto maintain paid and/or volunteer emergency medical
services, together with personnel and equipment therefore; and
WHEREAS, it is, and will continue to be, to the mutual benefit of each of the agencies to
assist the other when necessary in providing additional emergency medical equipment and
personnel for the purpose of delivering pre -hospital patient care within the boundaries of the other
agency, and in turn to receive such assistance and
NOW, THEREFORE, in consideration of the premises and the mutual covenants,
performances and agreements hereinafter set forth, it is mutually understood and agreed between
agencies as follows:
1 DEFINITIONS:
1.1 The agency responding to a request within the boundaries of the other agency is
designated as the "answering agency".
1.2 The agency requesting aid under this agreement is designated as the "requesting
agency".
1.3 "Director" or "Chief' means the person responsible for the respective ambulance
service/company or his/her designated and authorized representative.
2 MUTUAL, AID ASSISTANCE:
2.1 Each of the agencies agree to respond to the requests for assistance within the
boundaries of the other agency upon request of the requesting director at any and all
times, provided that it shall be entirely within the discretion of the director of the
answering agency as to what personnel and equipment shall answer such call and
whether or not, in any event, such call may be answered consistently with the safety
and protection of the citizens and property of said answering agency.
1
2.2 Each of the agencies agree to answer calls of the other agency subject to the
approval of each call by the Director/Chief of the answering agencies set forth in
paragraph 2.1 above, without charge to the other agency, and with the express
understanding that
a. EMS personnel and equipment of said answering agency shall be
subject only to the liability, workman's compensation, and/or other
insurance of the answering agency. The equipment and employees of
the answering agency shall at all times be under the supervision and
control of the Director/Chief of said agency, or his/her designated
assistant.
b. The answering agency shall at all times remain under its own Treatment
Protocols.
c. The answering agency may bill, collect, and retain all receipts, if any are
received, from the patient or patients that are attended to and transported
by the answering agency.
3 ADDITIONAL PROVISIONS:
3.1 Any request for aid hereunder should include a statement of the amount and type of
equipment and personnel requested, and shall specify the location to which the
equipment and personnel are to be dispatched, however, the amount and type of
equipment and number of personnel to be furnished shall be determined by a
representative of the answering agency.
3.2 In the event that the request is to respond to a specific call at which the requesting
agency is present, the answering agency shall report to the person -in -charge of the
requesting agency at the location to which the equipment and personnel is
dispatched and shall coordinate all activities with that official. The resources or
facilities that are assigned shall be under the immediate supervision of the
designated person of the answering agency. This person shall coordinate all efforts
with the requesting person -in -charge.
3.3 For "stand by" requests, an answering agency will be released by the requesting
agency when the services of the answering agency are no longer required or when
the answering agency is needed within the area for which it normally provides
emergency medical care or other emergency public services.
3.4 The equipment and personnel of each of the agencies while engaged in performing
any mutual aid service activity or undertaking under the provisions of this
agreement, shall have and retain all rights, privileges and immunity of and be
deemed to be engaged in the service and employment of such agency,
notwithstanding that such mutual aid service is being performed in the response area
of the requesting agency or for and on behalf of the other agency.
3.5 If at any time the answering agency responds to a mutual aid call where the
2
requesting agency is not at the scene, the answering agency will follow its own
Standard Operating Procedures and not those of the requesting agency..
3.6 Each agency waives all claims against the other agency for compensation for any
loss of or damage to equipment and for any loss, damage, personal injury or death
sustained by EMS personnel, which occurs as a consequence of the performance of
this agreement. Nothing herein shall be construed as a waiver of any immunity,
defense, or limitation afforded to Thompson Valley Health Services District under
the Colorado Governmental Immunity Act.
3.7 This agreement shall become effective upon the approval and signature by the
authorized representatives of the agencies hereto and shall continue until such time
as either agency gives sixty-day advance written notice to the other agency of its
intentions to terminate this agreement.
3.8 This agreement may be supplemented with various exhibits to be alphabetically
designated in chronological order of adoption and signed by the respective agencies.
These exhibits may set forth specific areas of first response, additional protocol, and
other communications and procedural matters.
19 As Operator, the PVH EMS Director's signature appears on mutual aid agreement
and Exhibit A as an indication of their understanding and acceptance this agreement.
IN WITNESS WHEREOF, the duly authorized representatives of the respective agencies hereto
have signed these presents of the dates respectively indicated.
Thompson Valley Health
Services District, d/bla Fondle Valley Hospital
Thompson Valley ly91S 4 EMS
Chief
4- as -i3
Date
S � ""fan --
Director
g/%61'3
Date
Windsor -Severance / Johnstown
Fire Pro 'on Di • ,. lose Protection District
Fire Chi
e Date
Fire Chief
r
2,07/7 1 l Is
Milliken
F Protection District
Fire Chef
it13
Date
3
Date
EXHIBIT A
EMS MUTUAL AID AGREEMENT
In addition to the provisions set forth in the attached mutual aid agreement, the following provisions
are understood and agreed upon.
4.0 The first agency to arrive on scene may cancel any or all other agencies, if the other
agencies' services are not required.
4.1 Each agency agrees to establish a common radio frequency and agrees to monitor this
frequency when responding in aid of the other. This will commonly be 800 MHz Mutual
Aid 1, but may be on another channel as assigned by dispatch.
4.2 In addition to provision 3.5, each agency agrees that patient destinations will be determined
by nearest hospital, patient choice, destination protocols, or on-line medical control
whichever is appropriate.
4.3 In addition to provision 3.5, it is understood that the first ambulance agency to arrive shall
take charge of and coordinate patient care. Each agency also agrees to coordinate its efforts
with the first arriving fire, ambulance, and law enforcement agency.
Poudre Valley Hospital
EMS
Director
Date
Windsor -Severance Johnstown
Fire ProtectiDistrict Fife Prot n District
Fire Chief Fire Chief
1S
t3
Date
4
Milliken
Fire Protectiop District
Fire Chief
1+11eJ l3
Date
EMS MUTUAL AID AGREEMENT
This agreement, made and entered into this le day of April 2013, by and between
Poudre Valley Hospital EMS and Windsor -Severance Fire Protection District,
Johnstown Fire Protection District & the Milliken Fire Protection District
WITNESS THAT:
WHEREAS, the agencies hereto maintain paid and/or volunteer emergency medical
services, together with personnel and equipment therefore; and
WHEREAS, it is, and will continue to be, to the mutual benefit of each of the agencies to
assist the other when necessary in providing additional emergency medical equipment and
personnel for the purpose of delivering pre -hospital patient care within the boundaries of the other
agency, and in turn to receive such assistance and
NOW, THEREFORE, in consideration of the premises and the mutual covenants,
performances and agreements hereinafter set forth, it is mutually understood and agreed between
agencies as follows:
l DEFINITIONS:
1.1 The agency responding to a request within the boundaries of the other agency is
designated as the "answering agency".
1.2 The agency requesting aid under this agreement is designated as the "requesting
agency".
1.3 "Director" or "Chief' means the person responsible for the respective ambulance
service/company or his/her designated and authorized representative.
2 MUTUAL AID ASSISTANCE:
2.1 Each of the agencies agree to respond to the requests for assistance within the
boundaries of the other agency upon request of the requesting director at any and all
times, provided that it shall be entirely within the discretion of the director of the
answering agency as to what personnel and equipment shall answer such call and
whether or not, in any event, such call may be answered consistently with the safety
and protection of the citizens and property of said answering agency.
I
2.2 Each of the agencies agree to answer calls of the other agency subject to the
approval of each rail by the Director/Chief of the answering agencies set forth in
paragraph 2.1 above, without charge to the other agency, and with the express
understanding that
a. EMS personnel and equipment of said answering agency shall be
subject only to the liability, workman's compensation, and/or other
insurance of the answering agency. The equipment and employees of
the answering agency shall at all times be under the supervision and
control of the Director/Chief of said agency, or his/her designated
assistant.
b. The answering agency shall at all times remain under its own Treatment
Protocols.
c. The answering agency may bill, collect, and retain all receipts, if any are
received, from the patient or patients that are attended to and transported
by the answering agency.
3 ADDITIONAL PROVISIONS:
3.1 Any request for aid hereunder should include a statement of the amount and type of
equipment and personnel requested, and shall specify the location to which the
equipment and personnel are to be dispatched, however, the amount and type of
equipment and number of personnel to be furnished shall be determined by a
representative of the answering agency.
3.2 In the event that the request is to respond to a specific call at which the requesting
agency is present, the answering agency shall report to the person -in -charge of the
requesting agency at the location to which the equipment and personnel is
dispatched and shall coordinate all activities with that official. The resources or
facilities that are assigned shall be under the immediate supervision of the
designated person of the answering agency. This person shall coordinate all efforts
with the requesting person -in -charge.
3.3 For "stand by" requests, an answering agency will be released by the requesting
agency when the services of the answering agency are no longer required or when
the answering agency is needed within the area for which it normally provides
emergency medical care or other emergency public services.
3.4 The equipment and personnel of each of the agencies while engaged in performing
any mutual aid service activity or undertaking under the provisions of this
agreement, shall have and retain all rights, privileges and immunity of and be
deemed to be engaged in the service and employment of such agency,
notwithstanding that such mutual aid service is being performed in the response area
of the requesting agency or for and on behalf of the other agency.
3.5 If at any time the answering agency responds to a mutual aid call where the
2
EMS
Director
4//sylf
Date
requesting agency is not at the scene, the answering agency will follow its own
Standard Operating Procedures and not those of the requesting agency..
3.6 Each agency waives all claims against the other agency for compensation for any
loss of or damage to equipment and for any loss, damage, personal injury or death
sustained by EMS personnel, which occurs as a consequence of the performance of
this agreement. Nothing herein shall be construed as a waiver of any immunity,
defense, or limitation afforded to Thompson Valley Health Services District under
the Colorado Governmental Immunity Act.
3.7 This agreement shall become effective upon the approval and signature by the
authorized representatives of the agencies hereto and shall continue until such time
as either agency gives sixty-day advance written notice to the other agency of its
intentions to terminate this agreement.
3.8 This agreement may be supplemented with various exhibits to be alphabetically
designated in chronological order of adoption and signed by the respective agencies.
These exhibits may set forth specific areas of first response, additional protocol, and
other communications and procedural matters.
3.9 As Operator, the PVH EMS Director's signature appears on mutual aid agreement
and Exhibit A as an indication of their understanding and acceptance this agreement.
IN WITNESS WHEREOF, the duly authorized representatives of the respective agencies hereto
have signed these presents of the dates respectively indicated.
Poudre Valley Hospital Poudre Valley Hospital
EMS
Director
9/e/3
Date
Windsor -Severance ohnstown
Fire Prot =n Distric Protection District
Fire Chie
Date
Fire Chief
t3
3
Milliken
Pro? lion District
a....
Fire Chief
td 143
Date
EXHIBIT A
EMS MUTUAL AID AGREEMENT
In addition to the provisions set forth in the attached mutual aid agreement, the following provisions
are understood and agreed upon.
4.0 The first agency to arrive on scene may cancel any or all other agencies, if the other
agencies' services are not required.
4.1 Each agency agrees to establish a common radio frequency and agrees to monitor this
frequency when responding in aid of the other. This will commonly be 800 MHz Mutual
Aid 1, but may be on another channel as assigned by dispatch.
4.2 In addition to provision 3.5, each agency agrees that patient destinations will be determined
by nearest hospital, patient choice, destination protocols, or on-line medical control
whichever is appropriate.
4.3 In addition to provision 3.5, it is understood that the first ambulance agency to arrive shall
take charge of and coordinate patient care. Each agency also agrees to coordinate its efforts
with the first arriving fire, ambulance, and law enforcement agency.
Poudre Valley Hospital
EMS /l EMS
Director
Date
Windsor -Severance
Poudre Valley Hospital
Date
Director
4/fr/f5
Johnstown Milliken
F. Protection District Fire Protection District
Fire Chief
)81).6l3
Date
4
Fire C 'ef
L 191 13
Date
Hello