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Home My WebLink About20194890.tiffRESOLUTION RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - POUDRE VALLEY HOSPITAL 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 Services Council have reviewed the application of the Poudre Valley Hospital 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 Poudre Valley Hospital Emergency Medical Service for a Tier I Emergency Medical Services License, be, and hereby is, approved. 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 27th day of November, A.D., 2019. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: detaysj jdfa;ok Weld County Clerk to the Board BY: APP AV Deputy Clerk to the Board Coun y Attorney Date of signature: 12/1 ii/I9 Mike Freeman, Pro-Tem arbara Kirkmeyer,1Chair EXCUSED Sean P. Conway Steve Moreno / T G) ► 0 E-Pn ( R R) I /I o/20 2019-4890 HL0051 x Memorandum TO: Barbara Kirkmeyer, Chair Board of County Commissioners FROM: Mark E. Wallace, MD, MPH Executive Director Department of Public Health & Environment DATE: November 21, 2019 SUBJECT: 2020 Applications for Ambulance Service Licenses Enclosed for the Board's review are thirteen applications for ambulance service licenses pursuant to the Weld County Code Chapter 7, Emergency Medical Services, from the ambulance service providers listed below. The Weld County Emergency Medical Trauma Service (EMTS) Council reviewed the application for each ambulance service provider on November 20, 2019, and approved all thirteen applications. Changes from last year include adding North Metro Fire Rescue District and Platteville-Gilcrest Fire Protection District as new ambulance services. Based on the delegated responsibility of the Department, we have reviewed the applications and have deemed all ambulance services listed below to have met all applicable licensure application requirements found in Chapter 7. As such, I am recommending the following ambulance service providers for licensure: Tier I Frederick & Firestone Fire Protection District 8426 Kosmerl Place Frederick, Colorado Front Range Fire Rescue 101 South Irene Avenue Milliken, Colorado Mountain View Fire Protection District 3561 Stagecoach Road, Unit 200 Longmont, Colorado Banner Health/NCMC Paramedic Service 1801 - 16th Street Greeley, Colorado Poudre Valley EMS 3509 South Mason Fort Collins, Colorado Tier I Continued Southeast Weld Fire Protection District 65 East Gandy Avenue Keenesburg, Colorado Thompson Valley EMS 4480 Clydesdale Parkway Loveland, Colorado Windsor Severance Fire Protection District 100 North 7th Street Windsor, Colorado Platte Valley Ambulance Service EMS 1600 Prairie Center Parkway Brighton, Colorado Platteville-Gilcrest Fire Protection District 303 Main Street Platteville, Colorado Tier I Continued North Metro Fire Rescue District 101 Spader Way Broomfield, Colorado Tier II American Medical Response of Colorado 3800 Pearl Street Boulder, Colorado Tier III Stadium Medical 695 Canosa Court Denver, Colorado 2019-4890 l l /;3,7 O MINFORPMEIPMForaistaraistarolotototolotatoteliorMIN WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT License to Operate Ambulance Service TIER I POUDRE VALLEY HOSPITAL EMERGENCY MEDICAL SERVICE Name of Service 2315 EAST HARMONY ROAD, SUITE 200, FORT COLLINS, COLORADO 80524 Address POUDRE VALLEY HEALTHCARE, INC. Name of Owner IS LICENSED UNTIL DECEMBER 31, 2020, TO OPERATE AN AMBULANCE SERVICE IN WELD COUNTY IN ACCORDANCE WITH EXISTING WELD COUNTY RULES AND REGULATIONS. r NOV 2 ? 2019 AIR, BOARD OF WELD CO NTY COMMISSIOERS DATE NOT TRANSFERRABLE / POST IN A CONSPICUOUS PLACE Tier I: Licensure authorizing for Primary Care, as defined in Section 7-1-39 of the Weld County Code. 1861 riri rmriri Jonsta G Lgi Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Poudre Valley Hospital 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. The EMTS Council voting members have reviewed PVH - EMS's application for Tier I Ambulance License The Council unanimously agrees that PVH - EMS is continually striving to contribute to an efficient, effective, and coordinate response to those within their defined service area as well as assisting as necessary to their neighbors In 2019 PVH EMS contracted with three additional Fire Districts within the county They have been able to maintain excellent service delivery in all districts they serve PVH - EMS has established mutual aid agreements with PGFPD, FRFR, TVEMS, & WSFR PVH - EMS is willing to assist any agency that request assistance with EMS Transport PVH-EMS also has several mutual aid agreements outside of Weld County The Council has not been made aware of any complaints into the level of service that PVH - EMS is providing to the citizens and guest of their response and mutual aid areas The quality of service is meeting the needs of their service area PVH - EMS communicates effectively with their neighboring agencies when responding to calls that may be on the borders of their district. PVH - EMS has a representative at all EMTS Council meeting and is active within the Council Recommended Level of Service. Tier 1 Tier 2 Tier 3 Recommended Service Area: _ The service area indicated within PVH-EMS Tier I application, indicates PVH - EMS will be providing service to their defined service area The EMTS Council finds in favor of this service area. Other EMTS Council recommendations or comments. The EMTS Council voting membership unanimously voted to recommend PVH-EMS for a Tier I Ambulance License Recommendation By _Lance Homann g- 614---- EMTS Council Chair Date li / a3 I lel Poudre Valley Hospital Emergency Medical Services 3509 S. Mason Street Fort Collins, CO 80525 M 775.304.1752 F 970.237.7915 uchealth.org November 4, 2019 Weld County — Department of Public Health and Environment 1555 N. 17th Avenue Greeley, CO 80631 To whom it may concern, UCHealth EMS recently began providing EMS coverage in three additional areas including Evans, Kersey, & LaSalle. Included in this packet is all of the required items of the ambulance license application. The digital copies of these documents have been emailed to Kevin Antuna. Included in this packet are the following documents: • UCHealth 2020 Ambulance License Application • Operating Locations • District Maps • Employee Certifications and Driver's License Information • Protocols and Signed Medication Delivery Document • Employee Training and Continuing Education Policy • Training Center Certification • UCHealth Mutual Aid Agreements • Liability and Vehicle Insurance • Vehicle List Please feel free to contact me with any questions you may have. Sincerely, Monique Rose 1 AMtc:ULANCE SERVICE LICENSE APPLICATION Date of Application 10/17/2019 _ Name of Ambulance Service. Poudre Valley Hospital Emergency Medical Services Owner. Name Poudre Valley Healthcare Inc Address, 1024 South Lemay, Fort Collins, CO 80524 Phone Number 970-495-7000 _ Operations Manage' Name Dave Schmillen Address 3509 South Mason, Fort Collins, CO 80525 Phone Number 970-232-1750 Email. dave schmillen@uchealth org Medical Director Name Darren Tremblay, D O Address 1024 South Lemay, Fort Collins, CO 80524 Phone Number 970-495-8006 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) Not Applicable What area of Weld County will be served by this company? Please attach a map indicating the service area. Windsor, Severance Johnstown, Milliken, Evans, Kersey and LaSalle I How many ambulances do you operate? 25 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 See attached form City State' Phone Location #2 Street Number, City. State Phone As required in Section 7-3-30 of the Weld County Code Ordinance and Chapter 4 Section 6 of the CDPHE Emergency Medical and Trauma Care System regulations, as of the date of the application, are you in compliance with the minimum data collection and reporting of transportation and/or treatment of patients Yes ❑ No As required in Section 7-3-40 of the Weld County Code and Chapter 3 Section 3 ofthe CDPHE Emergency Medical Services regulations, as of the date of the application, are you in compliance with the reporting requirements of the agency profile ®Yes 0 N Please read carefully' Sec. 7-2-10 Leeense for Ambulance Service. 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 patients that originate in Weld County 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 foi Standby Service, as defined in Section 7-1-30 of this Chapter Level of Service Requested ❑ Tier I ❑ Tier II D Tier III 2 I i I Applicant Title I HEREBY CERTIFY THAT I AM AUTHORIZED TO SUBMIT THE FORGOING APPLICATION AND THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUE'I 0 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 AGRCEMCNTS WITH ALL OTHER EMS PROVIDERS LOCATED WITHIN OR BORDERING ON THEIR ARCAS OF RESPONSE, DETERMINATION THAT AN AMBULANCE SERVICES LICENSE HAS BEEN ISSUED BASED ON FALSE INFORMA n oN CONSTITUTES GROUNDS FOR LICENSE REVOCATION AND POSSIBLE CRIMINAL PROSECUTION I iv(si-L►-at-tc.F_ 'bits/(l Date SUBSCRIBED AND AFFIRMED BEFORE ME THIS ac DAY o G4p}F1,aN , 20 to\ , IN THE COUNTY OF L ;+Y�N , STATE OF COLORADO WOE LENOIR NOTARYPUIBLIC OTATEOFCOLORADO NOTARY ID 20184004293 MYCOMMISSION EXPIRES2.3-2020 ignattire of Notary My Commission expires oY /03 /2a>U *Please make additional copies as necessary. 6 Location #1 3509 S Mason, Fort Collins, CO 80525 Location #2 181 Timber Ridge Pkway, Severance, CO 80550 Location #3 2100 37th St, Evans, CO 80620 Location #4 27128 Co Rd 53, Kersey, CO 80644 Location #5 118 Main St, La Salle, CO 80645 Location #6 Front Range Fire Rescue Station 3 / UCHealth 4225 Yosemite Dr, Greeley CO 80634 Disclaimer � is!Mg..gf d&o.4Wy^y db 6y.0Avn, of MY h uMIVeraTbbYJ4/1031 7- VVJAUtftYaMb1ncecuMeywla+l(tlot.. co sl+nmlw rut:, 'ti Cs) tlHmt .6s% wrxriesegiarmileekette canvecb 04TAsG ai bCt mebunsa, a=eae r tnitoimmdnlinaam•vola an WWI lyrfAemrtg 1cSmfarpe 14) AtaA r., , ofttay °•ac mz n7aeelboa Wiu A. i i I Platte Valley Fire Protection District I 44.M H•.I• ...we*. A w , }ww,.•M•••.r �`tif„ w ... � �.M� 1. M.., —yip- . Front Range Fire Rescue Fire Protection District 6'4164 6, r 1 _ ): 40WCR 38, X 381 W 11 & 8 iNC, 36 u 36 38 - 3 �� v�7... 3+4';ly `` • e ' zee ,� y ~ i.TT. I f r) l 34 d� a w;*.�.a.a,__L, ..i....__ ____3111.91.11 , 34 k b 4 C `` 7 Legend A Station 1 3i------ 1 A Station 2 34 Windsor -Severance Fire Rescue - --, ®wr. _ r ` ' � I w ---- • ' .:. ins " ' ,�� T s: L'. III NN..'; �.._ '�I . • I _uchcalth_ October 17, 2019 To Whom IT May Concern, To Whom It May Concern UCHealth EMS Emergency Medical Services 3509 South Mason St Fort Collins CO 808Z4 O 970 495 7904 F 970 237 7915 uchealth org UCHealth Emergency Medical Services (UCHealth EMS) has mutual aid agreements in place with the following agencies Fort Collins Police Services Larimer County Sheriff's Office Larimer County Dive Team Larimer County Search and Rescue Jackson County Emergency Medical Services Livermore Fire Protection District Red Feather Lakes Fire Protection District Wellington Fire Protection District Glacierview Fire Protection District Estes Park Emergency Medical Services Thompson Valley Emergency Medical Services Poudre Canyon Fire Protection District Rist Canyon Volunteer Fire Department Crystal Lakes Fire Department Laramie County, Wyoming Front Range Fire Rescue Windsor Severance Fire Rescue The above represents our current mutual aid agreements However, UCHealth EMS will, in good faith, respond when called to any call for service Sincerely, Monique Rose Division Chief UCHealth EMS Monique Rose@uchealth org 970-495-7904 Hello