2024 RFP Ambulance Svc Area Franchise #S-C00055-00010854.pdf

COVER PAGE

Department of Public Health

AMBULANCE SERVICE AREA FRANCHISE

Request for Proposal (RFP)

[RFP #S-C00055-00010854]

Date of Issue: July 1, 2024

Closing Date and Time: August 30, 2024 5:00 PM

Single Point of Contact (SPC): Jessica Kosydar

Address: 230 Strand Street

City, State, Zip St. Helens, Oregon 97051

Phone (voice) 503-397-7309

Email: Jessica.kosydar@columbiacountyor.gov

Columbia County Mission:

At Columbia County, we serve with integrity and leadership to provide responsible government. We engage by listening and being proactive to community needs. We connect to build partnerships and opportunities. We innovate with resourcefulness to promote a healthy and prosperous Columbia County

TABLE OF CONTENTS

SECTION 1: GENERAL INFORMATION

1.1 INTRODUCTION

1.2 SCHEDULE

1.3 SINGLE POINT OF CONTACT (SPC)

SECTION 2: AUTHORITY, OVERVIEW, AND SCOPE

2.1 AUTHORITY AND METHOD

2.2 DEFINITION OF TERMS

2.3 OVERVIEW AND PURPOSE

2.4 SCOPE OF WORK / SPECIFICATIONS

SECTION 3: FRANCHISE PROPOSAL REQUIREMENTS

3.1 MINIMUM QUALIFICATIONS

3.2 MINIMUM SUBMISSION REQUIREMENTS

3.3 QUESTIONS / REQUESTS FOR CLARIFICATIONS

3.4 PROPOSAL DELIVERY OPTIONS

3.5 PROPOSAL DUE

3.6 EVALUATION PROCESS

SECTION 4: FRANCHISE AWARD PROTEST

SECTION 5: OWNERSHIP/PERMISSION TO USE MATERIALS

5.1 COST OF SUBMITTING A PROPOSAL

LIST OF ATTACHMENTS

ATTACHMENT A AMBULANCE SERVICE AREA PLAN

ATTACHMENT B AMBULANCE SERVICE AREA PROPOSAL COVER SHEET

ATTACHMENT C AMBULANCE SERVICE AREA PROPOSAL CHECKLIST

1. GENERAL INFORMATION

1.1 INTRODUCTION

Columbia County, acting by and through the authority of the Columbia County Board of County Commissioners, (“County”), is issuing this Request for Proposals for one or more qualified franchisees to furnish all labor, equipment, materials, and tools required to perform Ambulance Transportation Services for those in need of service within the County’s service areas. Franchisees are required to ensure that properly trained and certified personnel will provide timely emergency medical services to patients at the scene of their illness or injury, and then transport the patient to an appropriate treatment facility in the shortest practicable time utilizing safe, reliable, and clean vehicles, and provide the most reliable, safe and effective pre-hospital care services to those served.

1.2 SCHEDULE

The table below represents a tentative schedule of events. All times are listed in

Pacific Time. All dates listed are subject to change.

1.3 SINGLE POINT OF CONTACT (SPC)

The SPC for this RFP is identified on the Cover Page, along with the SPC’s contact information. Proposers shall direct all communications related to any provision of the RFP only to the SPC, whether about the technical requirements of the RFP, contractual requirements, the RFP process, or any other provision.

2. AUTHORITY, OVERVIEW, AND SCOPE

2.1 AUTHORITY AND METHOD

This RFP is issued under the authority of the Columbia County Board of

Commissioners.

2.2 DEFINITION OF TERMS

For the purposes of this RFP, capitalized words are defined in Columbia County

Ambulance Service Ordinance, Ordinance No. 2016-1, and the Columbia County

Ambulance Service Area Plan, Ordinance No. 2024.

2.3 OVERVIEW AND PURPOSE

2.3.1 Project Overview, Background and Purpose

Event Date Time

Questions Due July 19, 2024 5:00 PM

Closing (Proposals Due) August 30, 2024 5:00 PM

Columbia County is in the northwest portion of the state, bordered by Washington

State and the Columbia River on the North and East, Washington and Multnomah

Counties to the South, and Clatsop County to the West. The County has a total land mass of 657 sq. miles (420,301 acres). The County consists primarily of heavily forested valleys and coastal mountain ranges with elevations ranging from sea level to 2,240 ft. in the Coastal Range Mountains.

According to the 2020 U.S. Census Bureau's most current available data, Columbia

County is home to approximately 52,589 residents. This is a 9.3% increase from

2010 Census data.

Scappoose, St. Helens, Columbia City, Rainier, and Clatskanie are located along

US Highway 30, which runs through the County's eastern and northern portions along the Columbia River. Most residents dwell in or around the incorporated cities located within the County. Agriculture, forest products, manufacturing, and tourism, provide the basis of the County's economy.

Columbia County is seeking Franchise Proposals to provide ambulance services in each of the seven designated Ambulance Service Areas. Franchisees will provide

24 hours a day, 365 days a year, service to those in need within their Service

Area(s), and as mutual aid requests dictate.

The objective of the RFP is to identify franchisees that offer the highest quality service as efficiently and timely as possible.

The County will issue one franchise per service area as a result of this RFP.

An ASA Provider franchise will have a term five years, beginning on January 1, 2025, and ending on December 31, 2029.

Thereafter, unless the Board finds that a longer or shorter term is required in the public interest, the term of ambulance service franchises shall be five (5) years, beginning on January 1 of a year and ending December 31 five years later.

Unless grounds exist for refusal to renew a franchise, or for suspension or revocation of a franchise as outlined in Section 16 of Ordinance No. 2016-1, or unless the franchise is to be given to a new ambulance service provider, franchises may be renewed by the Board, in its sole discretion, without opening the application process to new applicants.

2.4 SCOPE OF WORK/SPECIFICATIONS

All providers are required to provide effective and efficient ambulance services as defined in the Ambulance Service Plan. (Attachment A)

3. FRANCHISE PROPOSAL REQUIREMENTS

3.1 MINIMUM QUALIFICATIONS

To be considered for evaluation, Proposals must demonstrate how Proposers meet all requirements of this section:

3.1.1 Licensing Requirements

Ambulance Business License with the Oregon Health Authority, Public

Health Division

3.1.2 Certification Requirements

Paramedic and Advanced EMT Certified Staff for ASA 1-5, 7 and

Paramedic, Advanced EMT, and EMT Basic for ASA 6

3.1.3 Other Requirements in Ordinance No. 2016-1:

3.1.3a The name and address of the Proposer.

3.1.3b The Ambulance Service Area the Proposer desires to serve, the location(s) from which ambulance services will be provided, and the level of service to be provided.

3.1.3c A statement as to whether the Proposer will subcontract for any service to be provided. If some service will be provided by subcontract, a copy of that subcontract shall be provided.

3.1.3d A list of all vehicles to be used in providing ambulance services including year, make, and model, and verification that each vehicle is certified as a basic life support, intermediate life support and/or advanced life support vehicle by the State of Oregon.

3.1.3e A statement that all equipment and supplies in each ambulance conform to State standards.

3.1.3f A list of all personnel to be used in providing ambulance services and their current Emergency Medical Technician certificate number, or other appropriate certification.

3.1.3g Proof of financial ability to operate, including an operating budget or financial statement, references and/or statement of past ambulance service. Private companies must provide a profit and loss statement, in addition to the above materials. Other appropriate financial information, such as income tax returns or reports by governmental authorities shall also be submitted upon request.

3.1.3h Current Mutual Aid Agreements and status of pending agreements, including timeline for completion.

3.1.3i Proof of the following minimum levels of insurance to protect the County, its officers, agents, and employees:

i. Workers’ compensation and employers’ liability insurance meeting statutory limits mandated by state and federal laws.

ii. Commercial General liability and property damage insurance in an amount of not less than 2 million per occurrence.

iii. Automobile liability (owned, non-owned, and hired) for bodily injury and property damage in an amount of not less than 2 million per occurrence.

iv. Professional liability insurance covering claims made at any time prior, during or subsequent to the completion of the Proposer’s services, with a limit of not less than 2 million.

3.1.3.j Upon issuance of a franchise, franchisees must provide a certificate or certificates of insurance in the above amounts naming the County, its officers, agents and employees, as additional insureds which shall be accompanied by one or more additional insured endorsements. Franchisees are required to notify the County no less than thirty (30) days in advance that a policy is going to expire, be terminated, canceled or modified in any material way. The County, in its sole discretion, may raise the minimum level of insurance required if the County’s tort claim limit under Oregon law exceeds 2 million. All coverage shall be carried for the duration of the applicable statute of repose in Oregon. All policies, except for workers’ compensation, shall contain a waiver of subrogation against the County.

A statement of experience in properly providing ambulance service of comparable quality and quantity to the service required by Ordinance

No. 2016-1, Ordinance 2024-1, Oregon law and regulations promulgated thereunder.

3.1.3k Proof of compliance with the terms and conditions of the

ASA Plan and applicable County Ordinances, in the form of a narrative summary.

3.2 MINIMUM SUBMISSION REQUIREMENTS

3.2.1 Proposal Format and Quantity

Proposals should follow the format and reference the sections listed in Section 3.

Responses to each section and subsection should be labeled to indicate the item being addressed.

Proposer shall submit one original signed Proposal electronic copy of the complete Proposal via email in Adobe Acrobat (PDF). If Proposer believes any of their Proposal is exempt from disclosure under Oregon Public Records Law

(ORS 192.410 through 192.505), Proposer shall complete and submit the

Affidavit of Trade Secret (Attachment B) and submit one complete fully redacted version of its Proposal, clearly identified as the redacted version.

Proposer may choose to submit their Proposal in a sealed package addressed to the SPC with the Proposer’s name and the RFP title and number visible on the outside of the package.

3.2.2 Authorized Representative

Failure of the authorized representative to sign the Proposal may subject the

Proposal to rejection by the County.

3.3 QUESTIONS / REQUESTS FOR CLARIFICATIONS

All inquiries, whether relating to the RFP process, administration, deadline, or method of award, or the intent or technical aspects of the RFP must:

• Be delivered to the SPC via email.

• Reference the RFP number

• Identify Proposer’s name and contact information.

• Refer to the specific part of the RFP being questioned (i.e. page, section, and paragraph number); and

• Be received by the due date and time for Questions/Requests for

Clarification identified in the Schedule.

Questions will be posted and answered on the County Public Health webpage.

Proposers are responsible for frequently checking the webpage to review questions and answers.

3.4 PROPOSAL DELIVERY OPTIONS

The proposer is solely responsible for ensuring its Proposal is received by the SPC in accordance with the RFP requirements before Closing. The County is not responsible for any delays in mail or by common carriers or by transmission errors or delays, or for any mis-delivery for any reason. Proposers are responsible for verifying that emails have been received by the SPC. A Proposal submitted by any means not authorized below will be rejected.

3.4.1 Delivery through Mail or Parcel Carrier

A Proposal may be submitted through the mail or via parcel carrier and must be clearly labeled and submitted in a sealed envelope, package, or box. The outside of the sealed submission must clearly identify the Proposer’s name and the RFP title and number. It must be addressed to the attention of the SPC at the address listed on the Cover Page.

3.4.2 Delivery in Person

A Proposal may be hand delivered and must be clearly labeled and submitted in a sealed envelope, package, or box. A Proposal will be accepted, prior to Closing, during the County’s normal Monday – Friday business hours of 8:30 a.m. to 5 p.m. Pacific Time, except during State of Oregon holidays and other times when the County offices are closed. The outside of the sealed submission must identify the Proposer’s name and the RFP number. It must be delivered to the attention of the SPC at the address listed on the Cover Page.

3.5 PROPOSAL DUE

A Proposal (including all required submittal items) must be received by the SPC on or before the due date.

A Proposal received after the due date is considered LATE and will NOT be accepted for evaluation. A late Proposal will be returned to the Proposer or destroyed.

3.6 EVALUATION PROCESS

3.6.1 The Administrator will form and chair a review committee of the following potential person(s): Columbia County Counsel, Public Health

Officer, and the Public Health Department Director. The committee will review each proposal for compliance with the terms of this RFP and shall make such investigation as may be appropriate. County reserves the right to request references in addition to those provided by the Proposer

(References), to investigate any references whether furnished by the

Proposer and to investigate the past performance of any Proposer.

County may investigate the qualifications of a Proposer, including but not limited to: successful performance of similar services; compliance with specifications and contractual obligations; its completion or delivery of services on schedule; and its lawful payment of suppliers, subcontractors, and workers. County may postpone the award or execution of the

Contract after the announcement of the apparent successful Proposer to complete its investigation.

3.6.2 The Administrator shall notify the holder of a current franchise of any competing Proposal.

3.6.3 Should there be more than one Proposal for an ASA, the committee may request additional information from all interested parties. This may include a summary of how the proposed coverage will benefit the citizens, improve emergency medical care delivery, impact to current first response system, or other documents as requested.

3.6.4 The SPC will average the scores for each Proposal, calculated by totaling the points awarded by each committee member and dividing by the number of members.

3.6.5 Once all information has been received, the administrator will make a written recommendation to the Board. Upon receipt of the Administrator’s recommendation, the Board will hold a hearing on the proposals and the

Administrator’s recommendation at least ten (10) days, but not later than thirty

(30) days following publication of notice of the hearing. The Board may require additional investigation by the Administrator if it finds that there is insufficient information on which to base its action.

3.6.6 The Board will make an order granting, denying or modifying Franchises or attach conditions thereto.

3.6.7 After a franchise is granted, the Board and the franchisee will enter into for a Franchise Agreement for a term of five (5) years.

3.6.8 The Board will not make an order adverse to a current franchisee effective less than thirty (30) days after the date of such order and shall notify such franchise holder in writing of such order. The Board may suspend operation of this provision and enter an emergency order if it finds that there is an immediate and serious danger to the public or that a health hazard or public nuisance would be created by a delay.

Proposal Content Requirements

Cover Sheet Mandatory

History/Narrative Mandatory

Personnel List/Applicable Certifications Mandatory

Proof of Public Liability Insurance Mandatory

List of Vehicles / Licensing /Insurance / Maintenance Record Mandatory

Operating Budget or financial statement Mandatory

Current Mutual Aid Agreements with list of pending Mandatory

Evaluator Rating Description Score

Excellent: The proposal successfully addresses all relevant aspects of the element being evaluated. Any shortcomings are minor, and the element contributes appropriately to meet the requirements of the criterion.

Good: The proposal addresses the element well; although, certain improvements are possibly related to meeting the overall criterion. 4

Fair: The proposal broadly addresses the element; however, there are significant weaknesses that would need additional clarification or justification concerning meeting the overall criterion.

Poor: The proposal has inherent weaknesses concerning the element being evaluated and does not materially support the criterion. 2

Fail: The proposal fails to address the element in all aspects and its relationship to supporting the criterion. 1

Competitive Criteria Scale

Score

Awarded

Points

Credentials, Experience, and local management team – licensing of ambulances, medical doctor license 1-5

Dispatch / Communications – Ability to work with PSAP and

CAD, GPS transponders included in vehicles 1-5

Service Delivery Model – Plan for Emergency, Non-

Emergency and interfacility transfers 1-5

Ambulance Deployment Plan – Plan for reporting response times, response improvement plans, mutual aid agreements with adjoining districts

Vehicles – maintenance checks, planned replacement schedule, budget for repairs, alternate modes of transportation

Medical Equipment and Supplies - maintenance checks, planned replacement schedule, budget for repairs 1-5

Personnel

(work/life balance, wage/benefit level, career opportunities, resiliency)

Hospital Relations and Community Education – Complaint protocol, community involvement 1-5

Budget – stability for staffing, clear record keeping, allowances for growth in staff/new equipment 1-5

Clinical Quality Performance – Quality Assurance plan

4. FRANCHISE AWARD PROTEST

All decisions of the Board shall be reviewable by the Circuit Court of the State of

Oregon for the County of Columbia, only by way of writ of review.

5. OWNERSHIP/PERMISSION TO USE MATERIALS

All Proposals are public record and are subject to public inspection after the County issues the Notice of the Intent to Award. Application of the Oregon Public Records

Law will determine whether any information is exempt from disclosure.

All Proposals submitted in response to this RFP become the property of the

County. By submitting a Proposal in response to this RFP, Proposer grants the

County a non-exclusive, perpetual, irrevocable, royalty-free license for the rights to copy, distribute, display, prepare derivative works of, and transmit the Proposal solely for the purpose of evaluating the Proposal, negotiating an Agreement if awarded to Proposer, or as otherwise needed to administer the RFP process, and to fulfill obligations under Oregon Public Records Law (ORS 192.410 through 192.505).

Proposals, including supporting materials, will not be returned to Proposer.

5.1 COST OF SUBMITTING A PROPOSAL

Proposer shall pay all costs associated with submitting its Proposal, including, but not limited to, the cost to prepare and submit the Proposal, the cost of samples and other supporting materials, the cost to participate in demonstrations or prices associated with protests.

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BEFORE THE BOARD OF COMMISSIONERS

FOR COLUMBIA COUNTY, OREGON

In the Matter of Adopting the Columbia County I Ambulance Service Ordinance and Plan ORDINANCE NO. 2024-1

The Board of County Commissioners for Columbia County, Oregon, ordains as follows:

SECTION 1. TITLE.

This Ordinance shall be known as Ordinance No. 2024-1.

SECTION 2. AUTHORITY.

This Ordinance is adopted pursuant to ORS 203.035, ORS 682.062, and ORS 682.017.

SECTION 3. POLICY AND PURPOSE.

The Board of County Commissioners finds:

1. That ORS 682.062 and OAR 333-260-0000 to 333-260-0070 require Columbia County to develop and adopt a plan for the County relating to the need for and coordination of ambulance services and to establish Ambulance Service Areas (ASAs) consistent with an adopted Ambulance Service Plan.

2. That this Ordinance adopts the Columbia County Ambulance Service Plan (Plan). The Plan establishes Ambulance Service Areas, expectations for ambulance provider operational system elements, establishing structure and processes for quality assurance, coordination of resources among ASA providers and other resources, mass casualty incident plan development and implementation, emergency communication and systems access expectations, methods for selecting ambulance service providers for each Ambulance Service Area, and establishes an Ambulance Service Area Advisory Committee, consistent with ORS 682.062, 682.017 and 682.031 and implementing regulations.

SECTION 4. HISTORY.

Ordinance No. 90-23 was adopted in 1990, establishing Ambulance Service Areas;

assigning Ambulance Serve Providers; Creating an Ambulance Service Advisory Committee; providing penalties; and prescribing effective dates. The Ordinance was amended in 2002 by Ordinance No. 2002-3, modifying Section 15 of the Ordinance, and was amended again in 2016 by Ordinance No. 2016-1 to (1) integrate the amendments

ORDINANCE NO. 2024-1 Page 1

ATTACHMENT A

BOOK�_PAGE ___ _

made by Ordinance No. 2002-3 into the Columbia County Ambulance Service Ordinance, to update statutory and administrative rule references in the Ordinance which had been renumbered, to correct typographical errors in the Ordinance, to delete ordinance provisions which were no longer relevant to the Ambulance Service Ordinance, to add ordinance provisions to enhance administrative efficiency, and too adopt a format which was similar to other County Ordinances. In addition to Ordinance No. 90-23, the County adopted its Ambulance Service Plan by Order No. 143-91, "In the Matter of the Adoption of the Columbia County Ambulance Service Plan of August 14, 1991" on August 21, 1991.

On May 18, 2016, the County adopted amendments to the Ambulance Service Plan Area boundaries by Order No. 16-2016 to address two areas of Clatsop County served by Columbia County fire and ambulance providers.

In 2022, the County hired Fitch and Associates to conduct an operational analysis of ambulance services, identify gaps and potentially duplicative services, provide financial and service models for improvement, and finalize a new ambulance service plan that satisfies the Oregon Health Authority rules and requirements. Fitch and Associates conducted its analysis and presented a report to the County in September 2022 and a draft Plan in March 2023. The County consulted with its EMS leaders and emergency response partners to finalize the draft Plan and submitted it to the Oregon Health Authority for approval on May 25, 2023. The Oregon Health Authority reviewed the Plan and required further development by notice dated September 15, 2023. Thereafter, the County made the required changes and conducted additional outreach to and consultation with its Ambulance Service Committee, EMS leaders, and emergency response partners and resubmitted the updated plan on October 23, 2023. The Oregon Health Authority approved the modified Plan on by notice dated December 12, 2023. The Plan is now ready for adoption.

SECTION 5. ADOPTION or AMENDMENT.

The Columbia County Ambulance Service Plan which is attached hereto as Exhibit A, is hereby adopted.

SECTION 6. SEVERABILITY.

The provisions of this Ordinance are severable. If any provision of this Ordinance is determined to be invalid by a court of competent jurisdiction, such provision shall be considered a separate, distinct and independent provision, and the decision shall not affect the validity of the remaining portions thereof.

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ORDINANCE NO. 2024-1 Page 2

BOOK __ PAGE. __ _

SECTION 7. SCRIVENER'S ERRORS.

A scrivener's error in any portion of this Ordinance or its attachments may be corrected by order of the Board of County Commissioners.

DATED this Ll_ day of ±ctn (U()..VV\ c: , 2024.

l'

BOARD OF COUNTY COMMISSIONERS

FOR COLUMBIA COUNTY, OREGON

By: l!:'e�� Casey 2reWfur

:�pra�&;k--.

Office of County Counsel

ORDINANCE NO. 2024-1 Page 3

Ambulance Service Area Plan

EXHIBIT A

IA

AMBULANCE SERVICE AREA PLAN

COLUMBIA COUNTY, OREGON

ADOPTED FEBRUARY 21, 2024

EFFECTIVE MAY 21, 2024

BOOK. __ PAGE __ _

page0 Columbia County, Oregon

BOOK ___ PAGE'------

I. COLUMBIA COUNTY AMBULANCE SERVICE AREA PLAN CERTIFICATION

II. OVERVIEW OF COLUMBIA COUNTY

Ill. DEFINITIONS

IV. BOUNDARIES

1. AMBULANCE SERVICE AREA DESCRIPTION

2. MAPS

3. ALTERNATIVES TO REDUCE RESPONSE TIMES

V. SYSTEM ELEMENTS

1. 911 DISPATCHED CALLS

2. NON-EMERGENCY AND INTERFACILITY TRANSFERS

3. NOTIFICATIONS AND RESPONSE TIMES

4. LEVEL OF CARE

5. PERSONNEL

6. MEDICAL SUPERVISION

7. PATIENT CARE EQUIPMENT

8. VEHICLES

9. TRAINING

VI. QUALITY ASSURANCE

1. STRUCTURE ....••••••..•.•.••••....••••••....•••••.....•••••....••••••.....••••••.....••••••....•••••••....••••.••....••••••.......••••••••

2. PROCESS

3. COLUMBIA COUNTY ADMINISTRATOR NOTIFICATION

4. PROBLEM RESOLUTION

5. SANCTIONS 'FOR NO COMPLIANT PERSONNEL OR PROVIDERS

6. PENAL TIES

VII. COORDINATION

1. AUTHORITY

2. COMPLAINT REVIEW PROCESS

3. MUTUAL AID AGREEMENTS

4. DISASTER RESPONSE

4.1 COUNTY RESOURCES OTHER THAN AMBULANCES

4.2 OUT OF COUNTY RESOURCES

4.3 MASS CASUAL TY INCIDENT (MCI) PLAN

Ambulance Service Area Plan page 1 Columbia County, Oregon

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4.4 PERSONNEL AND EQUIPMENT RESOURCES

4.5 NON-TRANSPORTING EMS PROVIDER

4.6 HAZARDOUS MATERIALS (HAZ-MAT)

4.7 SEARCH AND RESCUE

4.8 EXTRICATION

4.9 SPECIALIZED RESCUE

4.10 EMERGENCY COMMUNICATION AND SYSTEM ACCESS

4.10.1 TELEPHONE

4.10.2 DISPATCH PROCEDURES

4.10.3 RADIO SYSTEM

4.10.4 COMPUTER-AIDED DISPATCH (CAD) INTEGRATION

4.10.5 EMERGENCY MEDICAL SERVICES DISPATCHER TRAINING

4.10.6 MASS GATHERINGS

VIII. PROVIDER SELECTION

1. INITIAL ASSIGNMENT

A. FIRST RESPONSE

2. REASSIGNMENT

3. APPLICATION FOR AN ASA

4. NOTIFICATION OF VACATING AN ASA

5. MAINTENANCE OF LEVEL OF SERVICES •..•.•••••••••••••.•.•.•.........•.•.....•••••••••••••••••••.•••..•...........•.••••••••.•••• 28

5.1 FAILURE TO NOTIFY

5.2 REVOCATION OF AN ASA

6. RENEWAL PROCESS FOR AN ASA

IX. COUNTY ORDINANCES AND RULES

X. APPENDIX

Ambulance Service Area Plan page 2 Columbia County, Oregon

BOOK. ___ PAGE ___ _

I. COLUMBIA COUNTY AMBULANCE SERVICE AREA PLAN CERTIFICATION

The undersigned certify pursuant to Oregon Administrative Rule 333-260-0030(2)(a)(b) and (c) that:

1. Each subject or item contained in the Columbia County Ambulance Service Plan has been addressed and considered in the Board of County Commissioners' adoption of the

Plan.

2. In the Board of County Commissioners, the ambulance service areas established in the

Plan, provide for the efficient and effective provision of ambulance services.

3. To the extent they are applicable, the County has complied with ORS 682.062 to

682.991 and existing local ordinances and rules.

DATED this L\_ day of .}dfU lY'l4 2024.

Ambulance Service Area Plan page 3

BOARD OF COUNTY COMMISSIONERS

FOR COLUMBIA COUNTY, OREGON

By:�1 Casey Garrett, Chair

Columbia County, Oregon

II. OVERVIEW OF COLUMBIA COUNTY

BOOK,_ __ PAGE ___ _

Columbia County is in the northwest portion of the state, bordered by Washington State and the Columbia River on the North and East, Washington and Multnomah Counties to the South, and Clatsop County to the West.

The County has a total land mass of 657 sq. miles (420,301 acres), with an additional 32 sq.

miles of water comprised primarily from the Columbia River. Columbia County has over 62 miles of Columbia River shoreline, the most in the state. The County consists primarily of heavily forested valleys and coastal mountain ranges with elevations ranging from sea level to

2,240 ft. in the Coastal Range Mountains.

According to the 2020 U.S. Census Bureau's most current available data, Columbia County is home to approximately 52,589 residents (as shown below), a 9.3% increase from 2010 Census data.

Jurisdiction Population Percent of County

City of St Helens 13,817 26.3

City of Scappoose 8,010 15.2

City of Vernonia 2,374 4.5

City of Columbia City 1,949 3.7

City of Rainier 1,911 3.6

City of Clatskanie 1,716 3.3

City of Prescott 82 0.2

Unincorporate Areas (by 22,730 43.2 subtraction)

Total Columbia County 52,589 100

Source: 2020 United States Census Bureau

Scappoose, St. Helens, Columbia City, Rainier, and Clatskanie are located along US Highway 30, which runs through the County's eastern and northern portions along the Columbia River. Most

Ambulance Service Area Plan page4 Columbia County, Oregon residents dwell in or around the incorporated cities located within the County. Agriculture, forest products, manufacturing, and tourism, provide the basis of the County's economy.

Ill. DEFINITIONS

1. "Advanced Emergency Medical Technician (AEMT or Advanced EMT)" means a person licensed by the Authority as an Advanced Emergency Medical Technician. OAR 333-265-

000(1).

2. "Ambulance" means a privately or publicly owned motor vehicle, aircraft or watercraft that is regularly provided or offered to be provided for the emergency transportation of persons who are ill or injured or who have disabilities. ORS 682.025(1).

3. "Ambulance Service" means a person, governmental unit or other entity that operates ambulances and that holds itself out as providing prehospital care or medical transportation to persons who are ill or injured or who have disabilities.

4. "Ambulance Service Area (ASA)" means a geographic area served by one ambulance service provider and may include all or a portion of a county or all or portions of two or more contiguous counties.

5. "Ambulance Service Plan" means a written document, which outlines a process for establishing a county emergency medical services system. A plan addresses the need for and coordination of ambulance services by establishing ambulance service areas for the entire county and by meeting the other requirements of these rules. Approval of a plan will not depend upon whether it maintains an existing system of providers or changes the system. For example, a plan may substitute franchising for an open-market system.

6. "ASA Advisory Committee (Committee)" means a committee formed to review standards, make recommendations to, or set new standards for the Board of County Commissioners for all matters regarding Emergency Medical Services (EMS) and review and make recommendations regarding the soundness of the ASA.

7. "ASA Administrator" is the person designated by the Board of Commissioners to administer the ASA Ordinance and Plan.

8. "Columbia 911" is the communications dispatch center within Columbia County utilized for all emergent and non-emergent requests made by the public, emergency services

Ambulance Service Area Plan page 5 Columbia County, Oregon

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personnel, and government officials. This is a stand-alone facility and is not owned or operated by Columbia County.

9. "Columbia County Board of Commissioners (Board)" means the elected governing body with jurisdiction over the Columbia County ASA Plan.

10. "Communication System" means a system of two-way radio communications between ambulances, dispatchers, hospitals, and other agencies as needed. A two-channel multi frequency capacity is minimally required.

11. "Computer-Aided Dispatch (CAD)" means systems utilized by dispatchers, call-takers, and 9-

1-1 operators to prioritize and record incident calls, identify the status and location of responders in the field, and effectively dispatch responder personnel.

12. "Disaster" means an occurrence of a natural catastrophe, technological accident, or human caused event that has resulted in severe property damage, deaths, and/or multiple injuries.

13. "Division" means the Public Health Division, Oregon Health Authority. OAR 333-260-

0010{7).

14. "Effective Provision of Ambulance Services" means ambulance services that comply with the County Ambulance Service Plan provisions or boundaries, coordination, and system elements.

15. "Emergency" means those medical or trauma conditions that manifest themselves by symptoms of sufficient severity that a prudent layperson possessing an average knowledge of health and medicine would reasonably expect that failure to receive immediate medical care would place the health of a person or the fetus in the case of a pregnant woman, in serious jeopardy. An emergency condition also includes any condition specifically dealt with in the emergency medical dispatch system adopted by Columbia 911.

16. "Emergency care" means the performance of acts or procedures under emergency conditions in the observation, care, and counsel of persons who are ill or injured or who have disabilities; in the administration of care or medications as prescribed by a licensed physician, insofar as any of these acts is based upon knowledge and application of the principles of biological, physical and social science as required by a completed course utilizing an approved curriculum in pre-hospital emergency care. However, "emergency

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care" does not include acts of medical diagnosis or prescription of therapeutic or corrective measures. ORS 682.025(3).

17. "Emergency Medical Dispatch (EMD)" means a series of components that allow an emergency communications dispatcher to triage calls, send appropriate resources with the appropriate response, and provide pre-arrival/post-dispatch instructions as needed.

18. "Emergency Medical Responder (EMR)" means a person licensed by the Authority as an

Emergency Medical Responder. OAR 333-265-000(17).

19. "Emergency Medical Services (EMS) Agency" means any person, governmental agency or unit, or other entity that utilizes emergency medical services providers to provide prehospital emergency or non-emergency care. An emergency medical services agency may be either an ambulance service or a non-transporting service. OAR 333-265-0000(17).

20. "Emergency Medical Services Provider (EMS Provider)" means a person who has received formal training in pre-hospital and emergency care and is licensed to attend to any person who is ill, injured, or who has a disability. Police officers, fire fighters, funeral home employees, and other personnel serving in a dual capacity, one of which meets the definition of "emergency medical services provider," are "emergency medical service providers" within the meaning of ORS Chapter 682. OAR 333-265-0000(18).

21. "Emergency Medical Technician (EMT)" means a person licensed by the Authority as an

Emergency Medical Technician. OAR 333-265-0000(19).

22. "Emergency Medical Technician-Intermediate (EMT-Intermediate)" means a person licensed by the Authority as an EMT-Intermediate. OAR 333-265-0000(20).

23. "Franchise" means the authorization granted by the Board to provide exclusive emergency ambulance services in a specific geographic region within Columbia County.

24. "Frontier Area" means the areas of the state with a population density of six or fewer persons per square mile and are accessible by paved roads.

25. "Inter-Facility Ambulance" means an ambulance that is licensed by the State of Oregon and provides transportation services between hospitals or transfers to and from a hospital to a residential care facility, assisted living facility, adult foster care home, convalescent care facility, non-urgent medical clinic, rehabilitation center, or private residence.

Ambulance Service Area Plan page 7 Columbia County, Oregon

26. "Health Officer" means the Columbia County Public Health Officer.

27. "License" means those documents issued by the Authority to the owner of an ambulance service and ambulance when the service and ambulance are found to comply with ORS

820.350 to 820.380 and rules adopted thereunder and OAR 333-250-0200 through 333-250-

0410 and 333-255-0000 through 333-255-0082.

28. "Mass Casualty Incident (MCI)" means an incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties.

29. "Non-Emergency" means those medical or trauma conditions not specifically dealt with in the emergency medical dispatch system adopted by the County. Unless specified by rule, those conditions that fall within the emergency medical dispatch system shall immediately be transferred to the emergency ambulance providers designated by Columbia County through the 911 system.

30. "Non-Emergency Ambulance" means any privately or publicly owned motor vehicle, aircraft, or marine craft operated by a Division-licensed ambulance service and that is regularly provided or offered to be provided for the emergency and non-emergency transportation of persons suffering from illness, injury or disability. OAR 333-260-0010(1).

31. "Non-Emergency care" means the performance of acts or procedures on a patient who is not expected to die, become permanently disabled or suffer permanent harm within the next 24-hours, including but not limited to observation, care and counsel of a patient and the administration of medications prescribed by a physician licensed under ORS chapter

677, insofar as any of those acts are based upon knowledge and application of the principles of biological, physical and social science and are performed in accordance with scope of practice rules adopted by the Oregon Medical Board in the course of providing prehospital care as defined by this rule. See ORS 682.025(8).

32. "Notification Time" means the length of time between the initial receipt of the request for emergency medical service by either a provider or a PSAP and the notification of all responding emergency medical service personnel.

33. "Owner" means the person having all the incidents of ownership in an ambulance service or an ambulance vehicle or where the incidents of ownership are in different persons, the

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person, other than a security interest holder or leaser, entitled to the possession of an ambulance vehicle or operation of an ambulance service under a security agreement or a lease for a term of 10 or more successive days.

34. "Paramedic" means a person who is licensed by the Authority as a Paramedic. OAR 333-

265-0000(26).

35. "Patient" means a person who is ill or injured or who has a disability and who receives emergency or nonemergency care from an EMS provider. OAR 333-265-0000(27).

36. "Priority Dispatch" is a system used by the PSAP to prioritize calls from least severe to most severe.

37. "Provider Selection Process" means the process established by the County for selecting an

Ambulance Service Provider or Providers.

38. "Public Service Answering Point (PSAP)" means a 24-hour communications facility established as an answering location for 9-1-1 calls originating within a given service area.

39. "Quick Response Team (ORT)" means an agency that provides initial response and basic life support care without transportation capabilities by licensed emergency medical service providers.

40. "Rural Area" means a geographic area 10 or more miles from a population center of 50,000 or more, with a population density greater than six persons per square mile.

41. "Search and Rescue Area" means the areas of the state that are primarily forest, recreational or wilderness lands that are not accessible by paved roads or not inhabited by six or more persons on a year-round basis. - No established prehospital response time.

OAR 333-200-00B0(E).

42. "Suburban Area" means an area that is not urban, and which is contiguous to an urban community, including the area within a 10-mile radius of that community's center and the areas beyond the 10-mile radius which are contiguous to the urban community and have a population density of 1,000 or more per square mile.

43. "Urban Area" means an incorporated community of 50,000 or more population.

Ambulance Service Area Plan page 9 Columbia County, Oregon

IV. BOUNDARIES

1. AMBULANCE SERVICE AREA DESCRIPTION

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The entire County shall be included in an ambulance service plan known as the Columbia County

Ambulance Service Area Plan. The ASA's have been adopted in accordance with Section 7 of the

Columbia County Ambulance Service Ordinance by the Board of Commissioners. Boundaries of the ASA can be modified as dispatched equipment, roads, populations, providers, etc., change.

The County is divided into seven Ambulance Service Areas (ASAs):

• Ambulance Service Area - 1 Sauvie Island Area

• Ambulance Service Area - 2 Scappoose Area

• Ambulance Service Area - 3 St. Helens Area

• Ambulance Service Area - 4 Rainier Area

• Ambulance Service Area - 5 Clatskanie Area

• Ambulance Service Area - 6 Mist-Birkenfeld

• Ambulance Service Area - 7 Vernonia Area

The ASAs are designed to promote cooperation and coordination with 911 area fire districts and incorporated city boundaries to minimize the effects of artificial and geographical barriers on response times and patient outcomes.

The ambulance service providers that serve Columbia County, a description of their boundaries, and other general information are attached in this ASA Plan in the appendices. In addition, a current set of maps that depict current boundaries for the ambulance service areas, fire districts, and the Public Safety Answering Point (PSAP) location are on file with Columbia

County Public Health and are attached to this plan in the appendices.

2. MAPS

The maps attached in the appendices represent the boundaries of each ambulance service area within Columbia County and the "System Response Times," which include notification, turnout time, and response times. Actual response time is subject to access, weather, road and traffic conditions, and other circumstances that can affect response times.

3. ALTERNATIVES TO REDUCE RESPONSE TIMES

Heavily forested, mountainous terrain and severe weather conditions can present difficult access and possible long response times to emergency transporting ambulances. When an urgent response is indicated, Columbia 911 Communications Center will work with the nearest appropriate agency/resources and, at their request, place on standby or activate rotary-wing air ambulance services. During inclement weather, four-wheel all-terrain vehicles will be used

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where possible, with snowmobiles and helicopters as alternatives to access unplowed roads and wilderness areas.

In addition, a tiered response system is utilized to provide the best available patient care while maximizing available resources. The tiered response system also includes activating adjoining county medical and air ambulance services for remote areas or critical care scenes, allowing a direct route to a medical facility.

Transport-to-Meet has been highlighted by the State of Oregon's Health Authority. ORS

682.035 provides that ORS Chapter 682 and ORS 820.330 to 820.380 do not apply to vehicles being used to render temporary assistance in the case of major catastrophe or emergency with which the ambulance services of the surrounding locality are unable to cope, or when directed to be used to render temporary assistance by an official at the scene of an accident.

V. SYSTEM ELEMENTS

1. 911 DISPATCHED CALLS

The County designates dispatch centers for Ambulance Providers and the 911 calls for medical assistance are answered by Columbia 911 Communications Center (PSAP). The dispatch center providing ambulance dispatch shall have a Medical Director and use emergency medical dispatch protocols approved by the EMS Medical Director. This Plan establishes the goal of a single dispatch center designated by the County to provide dispatch and data collection for

EMS. As such, the PSAP's Computer-Aided Dispatch system (CAD) will be the official timekeeper for all compliance issues associated with the ASA Plan and response time criteria. In some cases, ambulance services may receive direct calls for service. In such cases, the service receiving such a call shall notify Columbia 911 when able for radio dispatch. The contact address and phone number for Columbia 911 is listed below:

Columbia 911 Communications District

58611 McNulty Way, St Helens, OR 97051

Emergency Calls: 911

Non-Emergency Calls: (503) 397-1521

2. NON-EMERGENCY AND INTERFACILITY TRANSFERS

The Board shall designate one or more non-emergency ambulance providers in each ASA in accordance with Oregon Administrative Rules (OAR 333-260-0070(3)). These designated emergency ambulance providers are also authorized to provide non-emergency ambulance service within their assigned ASA. Columbia County does not have a hospital or critical access

Ambulance Service Area Plan page 11 Columbia County, Oregon care center located within its borders. As such, a non-emergency interfacility transfer can include requests from long-term care centers, clinics, urgent care, dialysis centers, and hospice facilities.

The Board recognizes that other non-emergency ambulance providers exist outside of the

County and may provide non-emergency ambulance service within the County. However, the designated ASA provider shall have the first right of refusal for all non-emergency and inter facility transfers that originate within their assigned ASA, except in the case of extremely specialized services (neo-natal transport) or excessively life-threatening circumstances that require air transportation. Should the ASA provider be unable to provide service, it is the provider's responsibility to ensure that alternate service is available.

3. NOTIFICATIONS AND RESPONSE TIMES

Standards established by the State of Oregon, known as the Trauma System Response Times

Standards OAR 333-200-0080, maintain a minimum standard for the Columbia County ASA

System. In reviewing proposed changes to the response times, the County may consider the following general guidelines.

Service Area Definition Response Time

Urban An incorporated community of 50,000 or more population 8 Minutes

An area which is not urban, and which is contiguous to an urban community; includes the area within a 10-mile radius

Suburban of that community's center. It also includes areas beyond the 10- mile radius which are contiguous to the urban 15 Minutes community and have a population density of 1,000 or more per square mile

A geographic area 10 or more miles from a population

Rural center of 50,000 or more, with a population density of 45 Minutes greater than six persons per square mile

When an emergency call is received by Columbia 911 Communications Center, the appropriate ambulance service provider, based on closest available unit, will be immediately dispatched to

Ambulance Service Area Plan page 12 Columbia County, Oregon handle the call. Columbia 911 will factor in distance between the emergency medical incident and the nearest ambulance in miles. Appropriate units from outside of the emergency incident

ASA will be factored into response. The closest appropriate unit will be dispatched, even if it comes from a neighboring ASA. All ambulances providing service in Columbia County's franchises must be equipped with GPS AVL transponders compatible with Columbia 911 dispatch software's. This will achieve the County's goal of expedited emergency care for its residents, regardless of agency affiliation or unit location. Current Columbia County franchise providers will have until July of 2025 to become compliant with this requirement. Any ambulance service originating outside of Columbia County, or utilizing a different PSAP than

Columbia 911, must be compliant with Section VII, 4.10.4, Computer-Aided Dispatch (CAD)

Integration upon establishment of any new franchise agreement.

Provider Response Time compliance shall be as follows:

Service Area Response Time Compliance

Percentage

City of St. Helens 15 Minutes 90%

City of Scappoose 15 Minutes 90%

City of Rainier 15 Minutes 90%

City of Clatskanie 15 Minutes 90%

City of Vernonia 15 Minutes 90%

Rural Areas 45 Minutes 90%

Frontier Areas 120 Minutes 90%

In the future, as improvements are made to Emergency Medical Dispatch (EMD) triage, increasing demand and intensity on emergency service systems, or overall improvement in clinical care outcomes may allow for longer response times. The ASA Advisory Committee will continuously review response time regulations from the OHA, in conjunction with recommendations made by local EMS physician advisors, best practices around Columbia

County, and other interested medical partners as improvements are made in triage and first response.

4. LEVEL OF CARE

Protocols, Policies, and Procedures: Providers in each trauma system area shall function under one set of off-tine prehospital trauma protocols and one set of on line medical control trauma policies and procedures which address basic, intermediate, and advanced levels of care.

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Off-line treatment protocols shall clearly describe all treatment and transportation procedures and identify those that require online medical authorization. In addition, medical control policies and procedures must assure consistent area-wide coordination, data collection, and area-wide quality improvement responsibility.

All ambulances and ambulance services in Columbia County must maintain a current license with the Oregon Health Authority, Public Health Division. Equipment and supplies for vehicles must meet or exceed standards as outlined in OAR and this Plan.

An ambulance area service provider who utilizes a subcontractor or automatic aid agreement within its ASA to provide any part of its response commitments will maintain a written agreement to outline performance criteria standards for the subcontractor. The provider will notify the ASA Administrator in writing of any subcontracting arrangements.

The delivery of an Advanced Life Support assessment and treatment is the preferred level of care for Columbia County. Therefore, an ASA provider without continuous coverage at the

Advanced Life Support (ALS) level shall maintain mutual aid agreements with other agencies capable of ALS service delivery. Basic Life Support (BLS) first response is allowed by Columbia

County ASA providers or mutual aid when acuity levels and resource needs prevent immediate

Advance Life Support…