Title
Emergency Medical Services, a division of the Chief Administrative Office, recommending the Board approve the Final Passage (Second Reading) of Ordinance 5263 to repeal and replace Ordinance 5132 (Chapter 8.74) - County Emergency Medical Service and Medical Transportation to allow for non-emergency Interfacility Transports to be staffed at the level of service determined by the physician responsible for the patient, which includes Basic Life Support level of service. (Refer 5/12/2026, Item 29)
FUNDING: N/A
Body
DISCUSSION / BACKGROUND
On May 12, 2026, the Board heard Ordinance 5263 to repeal and replace Ordinance 5132 (Chapter 8.74) - County Emergency Medical Service and Medical Transportation to allow for non-emergency Interfacility Transports to be staffed at the level of service determined by the physician responsible for the patient, which includes Basic Life Support level of service and Continued the matter to May 19, 2026 for Final Passage (Second Reading).
The County has established an emergency medical services program in accordance with California Health and Safety Code and has adopted Chapter 8.74 - County Emergency Medical Service and Medical Transportation, as a framework for the integrated operation of a local emergency and non-emergency medical services and medical transportation system in the County. The County's Emergency Medical Services (EMS) Agency, housed in the Chief Administrative Office, is the local regulatory body for EMS within the County, pursuant to the State EMS Act. The EMS Ordinance establishes exclusive operating areas, standards and requirements for emergency and non-emergency medical services including personnel and training, equipment and supplies, response times, communications, and medical transportation.
The County EMS Agency regulates emergency and non-emergency ambulance and medical transport services, which includes the provision of non-emergency interfacility transports (IFTs). A non-emergency IFT occurs when a physician at a facility has determined that a patient needs care at another facility and does not need emergency transport. Non-emergency IFTs can strain the EMS system, as they can require long transports that may not require advanced life support (ALS) services. ALS means special services designed to provide definitive pre-hospital emergency medical care administered by authorized personnel under the direct supervision of a base hospital as part of a local EMS system. Currently, the County’s Ordinance requires ALS as the minimum service level for all IFTs and does not allow for Basic Life Support (BLS) level of service.
The County has established an application and permitting process for private ambulance companies to provide non-exclusive IFT and CCT services. Private ambulance companies utilizing EMS personnel to provide IFTs may do so after successfully completing an application and permitting process and entering into an agreement with the County. Current Ordinance Code Section 8.74.100 outlines that each IFT shall be staffed with no less than one Emergency Medical Technician (EMT) and one EMT-P. Staff have determined that the EMS system would benefit from revising this requirement to allow for non-emergency IFTs to be staffed at the level of service determined by the physician responsible for the patient and shall be equipped with the minimum inventory list requirements established by the EMS Agency. In the absence of a physician order specifying level of service, the transport agency shall default to one EMT-P and one EMT. This change would help preserve critical resources within the 911/emergency EMS system by keeping ALS ambulances available for 911 responses and would allow permitted providers to provide non-emergency IFTs, at the appropriate level of service for eligible transports. This change is expected to improve resource allocation while still ensuring appropriate patient care standards are met.
On April 7, 2026, with Legistar file 26-0563, the Board provided conceptual approval to amend Ordinance Code Section 8.74, in compliance with Board Policy A-3 Ordinance - New or Amended, which states that “proposals for new ordinances and ordinance amendments shall first be presented to the Board for conceptual review and authorization to prepare the draft ordinance or ordinance amendment.”
Staff are requesting the Board amend Ordinance Code Section 8.74, to allow for non-emergency IFTs to be staffed at the level of service determined by the physician responsible for the patient. The proposed Ordinance has been reviewed by County Counsel. The proposed Ordinance has also been sent to the two contracted providers for the exclusive operating areas for review. Notice of this item was published in the Mountain Democrat at least five days prior to this item being heard on May 12, 2026. The major changes in the ordinance are as follows:
- Updates Sec. 8.74.060. Service requirements to clarify that all ambulance responses and transports shall be provided in conformity with the California Code of Regulations, State regulations and requirements, the County's policies and procedures, removing the requirement for ALS service for all responses.
- Updates California Code of Regulations references to 2025 updated regulation numbers.
- Updates Sec. 8.74.100. Operational requirements to require no less than one EMT-P and one EMT for ALS Ambulance personnel and that each BLS ambulance shall be staffed with no less than two EMTs. The updates require that “each IFT shall be staffed at no less than the level of service determined by order of the physician responsible for the patient and shall meet all requirements as set forth in subsection B of this Section. In the absence of a physician order specifying level of service (ALS/BLS), the IFT shall be staffed with no less than one EMT-P and one EMT. Each ambulance contractor with the County shall retain a written record of the physician order specifying the required level of service.” Updates to Sec. 8.74.100 also specify that each ambulance must have the minimum inventory list dictated by the EMS Agency, which is dependent upon level of service the ambulance is providing.
The EMS Division anticipates that a more comprehensive update of Ordinance Code Section 8.74 may be needed in the upcoming years as part of the Division’s efforts to improve the ambulance system to more efficiently and effectively serve the County and improve patient outcomes. This initial update will improve resource allocation while still ensuring appropriate patient care standards are met.
If the first reading is approved on May 12, 2026, and the Ordinance is adopted on May 19, 2026, the amended Ordinance will be effective June 18, 2026, which is 30 days after final adoption.
ALTERNATIVES
The Board could choose not to amend the ordinance.
PRIOR BOARD ACTION
11/17/2020 - Legistar file 20-1345 - Approval of update to Chapter 8.74.
07/21/2020 - Legistar file 20-0891 - Approval of updated Advanced Life Support (ALS) Interfacility Transport (IFT) and Critical Care Transport (CCT) Permitting Application/Agreement boilerplate.
04/04/2026 - Legistar file 26-0563 - Conceptual Approval to amend the Ordinance Code
OTHER DEPARTMENT / AGENCY INVOLVEMENT
County Counsel
CAO RECOMMENDATION / COMMENTS
Approve as recommended.
FINANCIAL IMPACT
There is no financial impact associated with this matter.
CLERK OF THE BOARD FOLLOW UP ACTIONS
1) If approved, continue this matter to the Board of Supervisors regular meeting scheduled on May 19, 2026, for Final Passage (Second Reading).
2) Following Final Passage, publish the Summary Ordinance within 15 days after its passage in a newspaper of general circulation published and circulated in the County.
STRATEGIC PLAN COMPONENT
N/A
CONTACT
Emma Owens, Chief Budget Officer