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Home My WebLink About20194897.tiffRESOLUTION RE: APPROVE APPLICATION FOR TIER II EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - AMERICAN MEDICAL RESPONSE OF COLORADO 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 American Medical Response of Colorado for a Tier II Emergency Medical Services License and recommend approval, and WHEREAS, after review, the Board deems it advisable to approve said Application for a Tier II 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 American Medical Response of Colorado fora Tier II 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 W D COUNTY, COI,�ORADO ATTEST: dettifm) ado; Weld County Clerk to the Board BY: A Deputy Clerk to the Board APPRQV-FD AS T y Date of signature: 1V-A�/1°( arbara Kirkmeyer, hair Mike Freeman, Pro-Tem Steve Moreno cc t I-1L.(Mw/C,'OEM t RR) /1`F/2o 2019-4897 HL0051 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 I I fa Tier I Continued 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 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 2019-4897 HL©051 wo rarardronatorototoranormonommorotouroaromporotouIoaL'mII O WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT License to Operate Ambulance Service TIER II AMERICAN MEDICAL RESPONSE OF COLORADO Name of Service 3800 PEARL STREET, BOULDER, COLORADO 80301 Address GMR 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 J • NOV 27 Zoos OU TY COMMISSION HAIR, BOARD OF WELD SSI ON RS DATE NOT TRANSFERRABLE / POST IN A CONSPICUOUS PLACE 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 the Weld County Code. rotorstonammarommatoromarommonotowp O O Recommendation of the Weld County Emergency Medical/Trauma Service Council for: American Medical Response of Colorado 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 AMR's application for Tier II Ambulance License. The Council unanimously agrees that AMR is continually striving to contribute to an efficient, effective, and coordinate response by providing interfacility transfer support to Banner. The effort aids in keeping Banner units available for 911 Calls. AMR does not have any mutual aid agreements in place. AMR is a support service for Banner NCMC Ambulance. The Council has not been made aware of any complaints into the level of service that AMR 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. AMR communicates effectively with Banner regarding the service needs of Banner. Recommended Level of Service: Tier 1 Tier 3 Recommended Service Area: _ AMR does not have a defined service area. AMR is a support service to Banner for interfacility transfers. Other EMTS Council recommendations or comments: The Council recommended for AMR to amend their application for a Tier II license. Recommendation By: _Lance Homann Q EMTS Council Chair Date: It / f I WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue, Greeley, CO 80631 www.weldhealth.org AMBULANCE SERVICE LICENSE APPLICATION Date of Application: vl ;,D I 1 11'1 Name of Ambulance Service: Owner: Name:rNl Address: (0=503 S, F►'rNUrbs(cKe.ern Phone Number: N:53— 4c1 5 — 1•Z 00 Operations Manager: Name: OhrtNtr in v LA)t_11 terns Address: ea_-t� Phone Number: --12.0 - 35-4_ la �� l Email: djh-i5 YLy, (-QC Ilcorn-s Medical Director: Name: .y Address: COY fir` -e r Lo.xxx l VC11O.9e_ C.0 e)0‘ Phone Number: "7 — 4--1c,..... 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): C.t�- 1 °rc l c t w- ►�1 ttl ctic Lex'S e C11rrL i (reerxare 4 Yc cje. CD 8tU What area of Weld County will be served by this company? Please attach a map indicating the service area. .r Health Administration Vital Records Tele: 970-304-6410 Fax: 970-304-6412 Public Health & Clinical Services Tele: 970-304-6420 Fax: 970-304-6416 Environmental Health Services Tele: 970-304-6415 Fox: 970-304-6411 Communication, Education & Planning Tele: 970-304-6470 Fax: 970-304-6452 Emergency Preparedness & Response Tele: 970-304-6470 Fax: 970-304-6452 Public Health Page 1 How many ambulances do you operate? 4 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: 47OD a 015 1 17riv� City: " -t er-Alterts.. Location #2: Street Number: State: c] Phone: 8O528 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: IN Yes ❑ No As required in Section 7-3-40 of the Weld County Code and Chapter 3 Section 3 of the CDPHE Emergency Medical Services regulations, as of the date of the application, are you in compliance with the reporting requirements of the agency profile: EYes 1:1 No Please read carefully: Sec. 7-2-10 License 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 for Standby Service, as defined in Section 7-1-30 of this Chapter. Level of Service Requested: 0 Tier I J. Tier II 0 Tier III Page 2 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 SE', ICES LICENSE HAS BEEN ISSUED BASED ON FALSE INFORMATION CONSTIT T OUNDS F• `LICENSE REVOCATION AND POSSIBLE CRIMINAL PROSECUTION. �r~" plicant T SUBSCRIBEp�A D AFFIRMED BEFORE ME THIS DAY (e be /L , 20 / 1 , IN THE COUNTY OF `gt7 U a -tie , STATE OF COLORADO. Date �iA--- --s—, BOBBIE M EMICH-KERCHER b Notary Public - State of Colorado I Notary ID 20184016955 b My Commission Expires Apr 18, 2022 b — V arwsik 7., Signature of Notary My Commission expires: WI /7 1-7 d 2."2" *Please make additional copies as necessary. Page 6 Map of Service Area - Working as a Tier II licensed ambulance Provider we will transport patients for Banner Health from their facilities. The Map below shows the locations of the Banner Hospitals. Tlntnath ii ta7 'eland 4 npion Kclim ors Eaton Lucerne es ii Gr9ey BS Garden City Evans La Salle I have attached the following documents to this application: gr 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. 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. 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. O A list of ambulance agencies, fire departments, special districts and other EMS providers with which the applicant has mutual aid agreements, or: At this time our agency does not have mutual aid agreements with other ambulance agencies, fire departments, special districts or EMS providers. 4 A current copy of the ambulance service's pharmacological agents and delivery devices per medical director protocol. Page 3 IMR. 10/15/2019 To whom it may concern: American Medical Response is requesting Tier II ambulance licensing in Weld county to be able to perform inter facility ambulance transports. American Medical Response has entered into a service agreement with Banner Health to assist in transporting patients from facility to facility. The ambulances will assist by completing transports to leave Banner Health Paramedics available for 911 response calls. Sincerely, Christopher Williams Regional Director Northern Colorado & Wyoming Hello