HomeMy WebLinkAbout20163603.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
Service 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 Service 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 Service 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 28th day of November, A.D., 2016.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: daifilt) G% jelea;ei
Weld County Clerk to the Board
BY:
C.?".,.a.,4,a,
eputy Clerk to the Board
APPAS
oun y Attorney
Date of signature: (a (east (Co
Mike Freeman, Chair
Sean P. Conway, Pro-Tem
aCU /
Julie A. Cozad
Steve Moreno
CC: 1 --IL CSTiercilmw/Ka)
p t /o3/i'7
2016-3603
HL0048
Memorandum
TO:
Mike Freeman, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: 11/28/16
SUBJECT: 2017 Applications for Ambulance Service
License
Enclosed for the Board's review are eleven applications for ambulance service licenses pursuant to Chapter 7 of
the Weld County Code (WCC) from the ambulance service providers listed below. Chapter 7 pertains to
Emergency Medical Services.
The Weld County Emergency Medical Trauma Service (EMTS) Council reviewed the application for each
ambulance service on November 16, 2016. The Council approved 10 of the 11 applications. *Colorado Motocross
is contingent on their attendance at BOCC hearing (11/28/16). *Stadium Medical was the only application not
approved by EMTS council.
Based on the scope 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,
am recommending the following ambulance service providers listed 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/Northern
Colorado Medical Center
Paramedic Service
1801 16th Street
Greeley, Colorado
Tier I continued
NX Poudre Valley EMS
3509 South Mason
Fort Collins, Colorado
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
Tier I continued
Platte Valley Ambulance
Service EMS
1600 Prairie Center Parkway
Brighton, Colorado
Tier III
*Colorado Motocross Medics
729 Remington Street
Fort Collins, Colorado
*Stadium Medical
695 Canosa Court
fpnver. Colorado
2016-3603
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Recommendation of the Weld County Emergency Medical/Trauma Service Council
for: Poudre Valley Health 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: Poudre Valley Health EMS (PVH EMS) services approximately 100 square miles of Weld
County, running 700 calls for service.
FINDING #2: PVH EMS is in good standings with the Weld County Department of Public Health &
Environment.
FINDING #3: Per neighboring agencies, PVH EMS provides mutual and auto aid in an efficient, effective
and coordinated manner.
FINDING #4:
Recommended Level of Service: XX Tier 1 Tier 2 Tier 3
Recommended Service Area: As listed in the PVH EMS 2017 application.
Other EMTS Council recommendations or comments:
Recommendation By: Date: 1 /- in ---(10
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: /CA S --/Z O/6
Name of Ambulance Service: Poth)td Vote/_ hict tsxn 5n' S - (IC AtteCrern
Owner:
Name: i0t i [ Gn C446, ,zwc
Address: _ Ziff" 6._ Atilam *rink_ ≤Q w42 Qvy _n_s-427
Phone Number: (PoD Z3)- 790o
Operations Manager:
t4'°n t -S
Name:
Address:0 /il spry Si ail_.—gtc z r
Phone Number: 170) 2 3 7- 790
Email. 774 . .O4 V .C�F�
Medical Director:
Name: G hit% APOS-re.S.
Address;
Phone Number: ( ?O) (Mc:. tao6
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/4
What area of Weld County will be served by this company? Please attach a map indicating
the service area.
LesPic✓So 69,4ets s% tsiSvplevt. Sc!/ cG isiA/c.'6 AiscucE
Health Administration
Vital Records
Talc: 970-;-304- 64
Fox: 5q0-304-6412
Public Health &
Clinical Services
t ele: 970-304-6420
i-ox: 970.304-64 i 6
Environmental Health
Services
Tele: 970-304-641 5
rox: 970-304-6/0 I
Communication.
Education & Planning
Telrt. 970.304.6470
Fax: 970-:304.6452
Emergency Preparedness
L Response
Te le: 970-304-6470
Fax: 970-304.6452
Public Health
Page 1
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:
Street Number: /9�
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:
lv 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:
iYes ❑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: iTier I ❑ Tier H ElTier 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 SERVICES LICENSE HAS BEEN ISSUED BASED ON FALSE
INFORMATION CONSTITUTES GROUNDS FOR LICENSE REVOCATION AND POSSIBLE CRIMINAL
PROSECUTION.
Signature of Applicant Title
/0/2-5-40/6
Date
SUBSCRIBED AND AFFIRMED BEFORE ME THIS 2C
DAY/ OC k ►2.ar , 20 f , IN THE COUNTY OF
L,ec rtWi1 r , STATE OF COLORADO.
MICHAEL ELLIOTT
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 20144010721
MY COMMISSION EXPIRES MARCH 07, 2018
Signature of Notary
My Commission expires: 03 / 07 / 20 (8
*Please make additional copies as necessary.
Page 6
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UCHealth
October 25, 2016
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley, CO 80631
To Whom It May Concern:
Poudre Valley Hospital
Emergency Medical Services
Poudre Valley Hospital Emergency Medical Services (PVH-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
Sincerely,
.°_,•-a.3
Thomas Cain, FP -C, RN, MA
Manager, Emergency Medical Services
Division Chief -Logistics and Support
Poudre Valley Hospital EMS
University of Colorado Health
thomas.cain@uchealth.org
970-237-7904
3509 S. Mason St. Suite #1 • Fort Collins, CO 80525 • Phone: 970-237-7000
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