§ 10-112. Definitions.

For purposes of this article, the following words, terms and phrases shall have the meaning given herein.

Advanced life support (ALS) means treatment of life-threatening medical emergencies through the use of techniques such as endotracheal intubation, the administration of drugs or intravenous fluids, telemetry, cardiac monitoring and cardiac defibrillation by a qualified person, pursuant to the rules of the Florida Department of Health set out in Chapter 64E-2, Florida Administrative Code (FAC), and F.S. § 401.23(1).

Advanced life support service means any emergency, nonemergency and/or inter-facility medical transport service which uses advanced life support techniques (F.S. § 401.23).

(1)

Transport. ALS service maintained or operated with the intention of providing emergency, non-emergency and/or inter-facility patient transportation on a regular basis as a matter of established operational policy.

(2)

Nontransport. ALS service maintained or operated with the intention of accessing, assessing, treating and stabilizing patients at the scene of medical emergencies and not providing patient transportation as a matter of established operational policy.

Air ambulance means any fixed-wing or rotary-wing aircraft used for, or intended to be used for, air transportation of sick or injured persons requiring or likely to require medical attention during transport. F.S. § 401.23.

Air ambulance service means any publicly or privately owned service, licensed by the State of Florida, which operates air ambulances to transport persons requiring or likely to require medical attention during transport. F.S. § 401.23.

Ambulance shall mean any privately or publicly owned land, air or water vehicle that is designed, constructed, reconstructed, maintained, equipped or operated, and is used for or intended to be used for air, land or water transportation of persons who are sick, injured, or have special needs, and are likely to require medical attention during transport.

Ambulance driver means any person who meets the requirements of F.S. § 401.281.

Applicant shall mean any person, firm, corporation, association, or governmental agency seeking a permit or certificate required by this article.

Basic life support (BLS) means treatment of medical emergencies by a qualified person through the use of techniques such as patient assessment, cardiopulmonary resuscitation (CPR), splinting, obstetrical assistance, bandaging, administration of oxygen, application of medical anti-shock trousers, administration of a subcutaneous injection using a pre-measured auto-injector of epinephrine to a person suffering an anaphylactic reaction, and other techniques described in the Emergency Medical Technician Basic Training Course Curriculum of the United States Department of Transportation. The term "basic life support" also includes other techniques which have been approved and are performed under conditions specified, as defined in F.S. § 401.23.

Board shall mean the Marion County Board of County Commissioners.

Certificate or COPCN means a certificate of public convenience and necessity, as authorized in F.S. § 401.25.

Certificate holder means any person, corporation or governing body that possesses a current COPCN.

County means Marion County, Florida.

County administrator or administrator means the County Administrator of Marion County, or his or her designee.

Department means the Florida Department of Health.

Emergency means any medical incident involving the activation of the 911 system and requiring ALS (including air ambulance) or BLS patient care.

Emergency call means the response of any permitted emergency vehicle while en route to a call for assistance or while transporting an unstable patient to a receiving facility.

EMS means emergency medical services.

Emergency medical services provider means any entity licensed in the State of Florida to provide advanced life support (ALS) including air ambulance, or basic life support (BLS), and whether a nontransportation or a transportation service.

Emergency medical technician means a person who is certified by the Florida State Department of Health to perform basic life support as defined in F.S. § 401.23.

First responder means personnel belonging to agencies, such as fire departments or law enforcement agencies, who are trained in the treatment of life-threatening emergencies through the use of basic techniques such as cardiopulmonary resuscitation, splinting, obstetrical assistance, bandaging, and other techniques as qualified and authorized by the medical director of a licensee, if applicable. These licensees may also have personnel trained and authorized by their respective medical director to utilize a semi-automatic external defibrillator for the purpose of detecting the presence of ventricular fibrillation and delivering the appropriate charge and counter-shock(s). The primary duties of first responders are scene control, including removal of patients to a safe location; rapid delivery of initial care and stabilization; participating as part of an ALS team when paramedics arrive at scene; and providing assistance with extrication and loading of patients.

First response service means any fire department, fire service or law enforcement agency dispatched to any emergency call for the purpose of providing first responder medical care to the sick and injured and using personnel certified and/or trained as first responders and/or EMTs and/or paramedics. This does not include a response for the purpose of rescue or fire operations.

HIPAA means the Federal Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936.

Interfacility transfer or transport means the nonemergency transportation of a patient between two (2) facilities licensed under chapter 393, chapter 395, chapter 400, or chapter 429, pursuant to F.S. § 401.23. Ambulance interfacility transportation may be scheduled or unscheduled transportation for patients with medical conditions requiring BLS or ALS care that contraindicate any other form of transportation.

Licensee means any ALS, including air ambulance service, or BLS service, licensed pursuant to F.S. § 401.23.

Medical advisory committee means the advisory committee established in section 10-115, to make recommendations to the county administrator for the adoption and update of standards of care, and to perform other duties set forth in section 10-115.

Medical direction means direct supervision by a physician through established standing orders, pursuant to the rules of the State of Florida, Bureau of EMS, of the medical performance of a licensee's emergency medical technicians, paramedics and others. This may be accomplished by on-line and/or off-line medical direction.

Medical director means a licensed physician who is employed or contracted by a licensee and who provides medical direction and supervision, including appropriate quality assurance, but not including administrative and managerial functions, for daily operations and training pursuant to F.S. § 401.23.

Nonemergency call condition means a call condition that does not meet the definition of "Emergency call" condition as defined above.

Nonemergency transportation service means any privately or publicly owned service employing a land, air or water vehicle that is designed, constructed, reconstructed, maintained, equipped or operated for, and is used for, or intended to be used for air, land or water transportation of persons with nonemergency conditions, including persons in wheelchairs, who may require specialized transportation, but who do not require medical treatment or monitoring during transport.

Off-line medical direction means medical direction by established medical care protocols when on-line medical direction is not available.

On-line medical direction means medical direction by an appropriate physician, which may include, but shall not be limited to, a medical facility physician, an emergency department physician, an on-scene physician or a licensee's medical director.

Paramedic means a person who is certified by the Florida State Department of Health to perform basic and advanced life support as defined in F.S. § 401.23(17).

Patient means an individual who is ill, sick, injured, wounded, or otherwise incapacitated or has special needs.

Rescue services shall mean first response treatment of patients, but does not include ALS or transport.

Response time shall be measured by any licensed BLS or ALS (including air ambulance) transport service from the time that the ambulance was notified of the call for service and ends when the ambulance arrives on the scene of the dispatched address. Times shall be recorded in minutes and seconds and shall be reported to the board upon request at a ninety (90) percent fractile time.

Routine response or routine transport means the response to or the transportation of a patient under conditions other than an "emergency call" condition as described above.

Stable or stabilize means, with respect to a medical condition, to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no medical deterioration of the condition is likely to result from or occur during the transfer of the individual to or from a medical facility as defined by the Federal Emergency Medical Treatment and Active Labor Act of 1996 (EMTALA). This definition is not meant to preclude the transport of nonstable patients.

Stand-by services means the positioning of either ALS (including air ambulance) or BLS medical transport or non-transport service providers at public or private events, either scheduled or unscheduled, as requested by an event sponsor where such services may be required or voluntarily requested based upon the needs of the event. Providers of stand-by services may set rates and charges for these services.

System means those persons in the county who are authorized by a licensee's medical director to perform first-responder, BLS, EMT, and/or ALS (including air ambulance) services.

System overload means a number of emergency runs simultaneously in progress (i.e., the total number of emergency requests holding plus emergency runs dispatched but not yet completed) which exceed the number of available ambulances to respond, resulting in a delay in dispatch and/or response of an ambulance.

Standard of care means the written body of standards, policies and protocols governing all clinical aspects of a licensee's emergency medical services that is approved by the licensee's medical director, and which is developed and periodically updated. As used in this context, "standard of care" is a comprehensive term, including:

(1)

"Input standards," which include, but are not limited to, personnel certification requirements, in-service training requirements, equipment specifications, on-board inventory requirements, and other requirements that the licensee must fulfill before receipt of a request for service;

(2)

"Performance standards," which include, but are not limited to, priority dispatching protocols and pre-arrival instructions, medical protocols, response time standards, protocols governing authority for on-scene control of patient care, and other performance specifications that may be requested by the county administrator; and

(3)

"Outcome standards," which include, but are not limited to, target survival rates for certain narrowly defined presenting problems or presumptive diagnoses, such as witnessed cardiac arrests involving patients whose medical histories meet defined criteria. Outcome standards are results the licensee intends to achieve by meeting its input and performance standards.

Turnout time means the time interval that begins when the emergency response facility (ERFs) and emergency response units (ERUs) notification process begins by either an audible alarm or visual announcement or both and ends at the beginning point of travel time, as defined in NFPA 1710 (2010) (Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations and Special Operations to the Public by Career Fire Departments), Chapter 3 Definitions, [Section] 3.53.8.

(Ord. No. 14-04, § 2, 3-4-14)