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Item C07
} C.7 `, County of Monroe �y,4 ' �, "tr, BOARD OF COUNTY COMMISSIONERS Mayor Michelle Coldiron,District 2 �1 nff `ll Mayor Pro Tem David Rice,District 4 -Ile Florida.Keys Craig Cates,District 1 Eddie Martinez,District 3 w Mike Forster,District 5 County Commission Meeting September 15, 2021 Agenda Item Number: C.7 Agenda Item Summary #8624 BULK ITEM: Yes DEPARTMENT: Emergency Services TIME APPROXIMATE: STAFF CONTACT: Steven Hudson (305) 289-6342 None AGENDA ITEM WORDING: Issuance (renewal) of a Class B Certificate of Public Convenience & Necessity (COPCN) to National Health Transport Inc. for the operation of a non-emergency medical transportation service in all geographical locations in Monroe County for the period October 19, 2021 through October 18, 2023. National Health Transport Inc. is not permitted to perform 911 emergency response work in Monroe County. ITEM BACKGROUND: In October of 2015, a Class B COPCN was issued to National Health Transportation to operate a non-emergency medical transportation service in all geographical locations of Monroe County, Florida. National Health Transportation's current Class B COPCN will expire on October 18, 2021. In view of the foregoing, National Health Transport Inc. is applying for renewal of its Class B COPCN to commence on October 19, 2021 and expire on October 18, 2023. PREVIOUS RELEVANT BOCC ACTION: 10/21/15: MCBOCC approved the issuance of National Health's Class B COPCN certificate for the period October 19, 2015 through October 18, 2017. 10/18/17: MCBOCC approved renewal of National Health's Class B COPCN certificate for the period October 19, 2017 through October 18, 2019. 10/16/19: MCBOCC approved renewal of National Health's Class B COPCN certificate for the period October 19, 2019 through October 18, 2021. CONTRACT/AGREEMENT CHANGES: The Class B COPCN for National Health Transportation currently expires on October 18, 2021. STAFF RECOMMENDATION: Approval of the issuance (renewal) of a Class B COPCN to National Health Transport Inc. which exempts services within the City of Marathon per the attached Objection Letter from the City of Marathon. DOCUMENTATION: National Health Transport Class B Application-Redacted Packet Pg.252 C.7 National Health Transport Class B COPCN 08.27.2021 City of Marathon Objection Letter-National Health Transport Class B COPCN FINANCIAL IMPACT: Effective Date: 10/19/21 Expiration Date: 10/18/23 Total Dollar Value of Contract: N/A Total Cost to County: N/A Current Year Portion: N/A Budgeted: N/A Source of Funds: N/A CPI: N/A Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: N/A Revenue Producing: N/A If yes, amount: N/A Grant: N/A County Match: N/A Insurance Required: N/A Additional Details: N/A REVIEWED BY: Pedro Mercado Completed 08/30/2021 10:28 AM Steven Hudson Completed 08/30/2021 10:47 AM Purchasing Completed 08/30/2021 10:52 AM Budget and Finance Completed 08/30/2021 11:08 AM Maria Slavik Completed 08/30/2021 11:11 AM Liz Yongue Completed 08/30/2021 4:15 PM Board of County Commissioners Pending 09/15/2021 9:00 AM Packet Pg.253 MONROE COUNTY,FLORIDA APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY (COPCN) r_ CLASS B NON-EMERGENCY MEDICAL TRANSPORTATION SERVICE 0 (PRINT OR TYPE) 2 ❑ INITIAL APPLICATION-$950.00 RENF VAI,APPLICATION-$475.00 IF RENEWAL,PLEASE LIST NUMBER OF PREVIOUS CERTIFICATE:# 1. NAME OF SERVICE NATIONAL HEALTH TRANSPORT INC. z 0 BUSINESS MAILING ADDRESS 2290 NW 1 10TH AVENUE, SWEETWATER, FL 33172 z 305-636-5509 305-636-5509 U BUSINESS PHONE NUMBER EMERGENCY PHONE NUMBER CL 0 2. TYPE OF OWNERSHIP(i.e.,Sole Proprietor,Partnership,Corporation,etc.) S-CORP DATE OF INCORPORATION OR FORMATION OF THE BUSINESS ASSOCIATION 01/2010 3. LIST ALL OFFICERS,DIRECTORS,AND SHAREHOLDERS(Use separate sheet if necessary): 0 --------------NAME ----- AGE ADDRESS TELEPHONE# FPOSITION/TITLE RAUL RODRIGUEZ 42 215 SW 125 Ave, Miami, FL 33184 305-479-3471 CEO .......... wr 0 4. DESCRIBE THE GEOGRAPHIC AREA(S)THAT YOUR SERVICE DESIRES TO SERVE(Use separate sheet if necessary): all geographical areas within Monroe County 0 ................. 5. LIST THE ADDRESS AND/OR DESCRIBE THE LOCATION OF YOUR BASE STATION AND ALL SUB- STATIONS(Use separate sheet if necessary): BASE STATION 19970 Overseas Hwy, Sugarloaf Key, FL 33040 z SUB-STATION E Page I of 3 Packet Pg. 254 6. DESCRIBE YOUR COMMUNICATION SYSTEM(Attach copy of all FCC licenses): ........... .............................. FREQUENCIES CALL NUMBERS #OF MOBILES i # 0 OF PORTABLES see attached ...................... - ---- ---- --___------- 0 7. LIST THE NAMES AND ADDRESSES OF THREE(3)U.S.CITIZENS WHO WILL ACT AS REFERENCES FOR Z YOUR SERVICE: 0 Z NAME ADDRESS CL 0 Teresita Fernandez 481 W 40th Place, Hialeah, FL 33012 Alexis Mantecon 3267 Riviera Drive, Coral Gables, FL 33143 -- ------------ 201 Westward Drive, Miami Springs, FL 33166 Daniel Espino ............. 0 8. ATTACH A SCHEDULE OF RATES WHICH YOUR SERVICE WILL CHARGE DURING THE COPCN PERIOD. 9. PROVIDE VERIFICATION OF ADEQUATE INSURANCE COVERAGE DURING THE COPCN PERIOD. 10. ATTACH A STATEMENT INDICATING THE METHOD OF SCREENING THAT WILL BE USED TO ASSURE THAT ALL CALLS RESPONDED TO REQUIRE ONLY TRANSPORTATION AS MAY BE PROVIDED BY A NON-EMERGENCY MEDICAL TRANSPORTATION SERVICE AND VEHICLE. 11. ATTACH A CHECK OR MONEY ORDER IN THE APPROPRIATE AMOUNT,MADE PAYABLE TO THE 2 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS. 12. ATTACH A COPY OF AUDIT REPORT AS REQUIRED BY THE MONROE COUNTY NON-EMERGENCY MEDICAL SERVICES ORDINANCES. 0 1,THE UNDERSIGNED REPRESENTATIVE OF THE ABOVE NAMED SERVICE,DO HEREBY ATTEST MY SERVICE L) MEETS ALL OF THE REQUIREMENTS FOR OPERATION OF A NON-EMERGENCY MEDICAL TRANSPORTATION SERVICE IN MONROE COUNTY AND THE STATE OF FLORIDA. I FURTHER ATTEST THAT ALL THE INFORMATION CONTAINED IN THIS APPLICATION,TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. 0 SIGNATURE OF APPLI A,-,-rT/A_tJTH0RI'. .D RE 4ES TIVE ALISSAD.GARCJA My COMMISSION#HH 151116 NO'KR 8,SX. L EXPIRES:July 10,2025 Bonded Tteu Notary Puble Undenwkm .2 Z I- IGNATtR DATE E Page 2 of 3 Packet Pg. 255 13 sselo e jo (lemeueU) 93uenssi) lapel 9U-uoge ail ddV 13 sselo :podsuej_L q4lBGH IB MWN :4u8wq3B44V w LO O Im clq m CL 00 'It Cd U ci ce) 04 V4 co m w w U) (n z z LL I LL mw z z ---------- .............—----- u (n U) ......... ..... Lo Lo cn co C) 40. ---------- E 14 CD 0 o N N CD CD LO LO UJ UJ W r) 00 LL U- o ........... ..................... ...... .......... u cc cc li i 0 75 Z (D (D —j"--j.......... C.7.a 0 o p4 G "®cFederal CommunicationsCommission W ZPublic Safety and Homeland SecurityBureau LL y * a 4 RADIO STATION AUTHORIZATION Nis LICENSEE:NATI HEALT l TRANSPORT INC Call Sign File Number WQYV762 0007636306 : Radio Service PW-Public Safe Pool Conventional ATTN:RAUL RODRI � : Safety 9 NATIONAL HEALTH TRANSP `It- gE CL 2950 NW 7TH AVE , MIAMI,FL 33127 Regulatory Status PRS y Frequency Coordination Number FCC Registration Number(F N): 00^1`57818 PS20170200029 Grant Date Effective Date Expiration Date Print Date 02-06-2017 02 6i6-2017" 02-06-2027 02-07-2017 STATION TEC .•NICAL SPECIFICATIONS Fixed Location Address or Mobile Area of Operation��'-' l °t Loc. 1 Area of operation f <= Countywide:MONROE,FL Antennas U Loc Ant Frequencies Sta. No. No. E ioh11(powooawouo) t EP Ant. Ant. Construct No. No. (MHz) CIS. Units Pagers D p ator (watts) Ht./Tp AAT Deadline 1 1 000463.11250000 MO 20 11 �Y F3E 100.000 meters meters Date 02-06-2018 1 1 000468.11250000 MO 20 11K2F3E OUO 100.000 02-06-2018 1 1 000463.13750000 MO 20 11K2173E Q 10 „.000 02-06-2018 1 1 000468.13750000 MO 20 11 K2F3E 10g U'Ob, ',4 02-06-2018 1 1 000463.16250000 MO 20 11K2F3E l p.00 C000 02-06-2018 1 1 000468.16250000 MO 20 11 K2F3E 100.000, 100 0 c-� § 02-06-2018 C Conditions: Pursuant to§309(h)of the Communications Act of 1934,as amended,47 U.S.C.§309(h),this license is subject to the following conditions: This license shall not vest in the licensee any right to operate the station nor any right in the use of the frequencies designated in the license beyond the term thereof nor in any other manner than authorized herein. Neither the license nor the right granted thereunder shall be assigned or otherwise transferred in violation of the Communications Act of 1934, § y§ the Communications Act of 1934 as amended. See 47 U.S.C. ,606. g m as amended. See 7 U.S.C. 310(d). This license is subject in terms to the right of use or control conferred b 706 of FCC 601-ULSHSI cJ Page l of 4 August 2007 Packet Pg.257 C.7.a Licensee Name: NATIONAL HEALTH TRANSPORT INC Call Sign: WQYV762 File Number: 0007636306 Print Date: 02-07-2017 c 0. Ch Antennas Loc Ant Frequencies Sta. No. No. Emission Output ERP Ant. Ant. Construct No. No. (MHz) CIS. Units Pagers Designator Power (watts) t./Tp AAT Deadline (watts) meters meters Date 1 1 000462.95000000 MO 20 11K2F3E 100.000 100.000 02-06-2018 1 1 000467.9500000� MO 20 11K2F3E 100.000 100.000 02-06-2018 0 1 1 000462.96250000 ` MO 20 llK2F3E 100.000 100.000 02-06-2018 r 1 1 000467.96250000 14\\6 20 11K2173E 100.000 100.000 02-06-2018 CL q 0 1 1 000462.97500000 MO- ,'20 11K2F3E 100.000 100.000 02-06-2018 ca 1 1 000463.02500000 Mp, 2'0 11K2F3E 100.000 100.000 02-06-2018 = Ca 1 1 000468.02500000 MO 20 11K2173E 100.000 100.000 02-06-2018 1 1 000463.05000000 NAO 26 11K2173E 100.000 100.000 02-06-2018 1 1 000463.00000000 MO : 26 11K2F3E 100.000 100.000 02-06-2018 tq 1 1 000468.00000000 MO 20(',- l_r 4 11K2f3E 100.000 100.000 02-06-2018 1 1 000468.17500000 MO 20a3C213E 100.000 100.000 02-06-2018 y 1 1 000463.18750000 MO 20 j 11 K2173E 100.000 100.000 02-06-2018 1 1 000468.18750000 MO 20 11 00 100.000 02-06-2018 ® ' 1 1 000463.01250000 MO 20 11 F3E 100.0 0 100.000 02-06-2018 1 1 000468.01250000 MO 20 11K2 I00,0up 100.000 02-06-2018 1 1 000463.03750000 MO 20 11K2F3E 40.0 700.000 02-06-2018 < } 1 1 000468.03750000 MO 20 11K2F3E 100.000-14841 0 02-06-2018 1 1 000463.06250000 MO 20 11K2F3E �-0-0 1 02-06-2018 �._ 1 1 000468.06250000 MO 20 11K2F3E 100.000 100.000-r'-. 02-06-2018 1 1 000463.08750000 MO 20 11 K2F3E 100.000`100 dA 02-06-2018 FCC 601-ULSHSI 2 Page 2 of 4 August 2007 Packet Pg.258 C.7.a Licensee Name: NATIONAL HEALTH TRANSPORT INC Call Sign: WQYV762 File Number: 0007636306 Print Date: 02-07-2017 s. Antennas Loc Ant Frequencies Sta. No. No. Emission Output EP Ant. Ant. Construct No. No. (MHz) Cls. Units Pagers Designator Power (watts) t./Tp AAT Deadline M (watts) meters meters Date 1 1 000468.08750000 MO 20 11K2F3E 100.000 100.000 02-06-2018 d F 1 l 000462.9875000� MO 20 11K2F3E 100.000 100.000 02-06-2018 1 1 000467.98750000\ MO 20 11K2F3E 100.000 100.000 02-06-2018 1 1 000467.97500000 t 20 11K2F3E 100.000 100.000 1 1 000468.05000000 MO '20 11K2F3E 100.000 100.000 02-06-2018 ! y Ch 1 1 000463.07500000 MO 20 11K2F3E 100.000 100.000 02-06-2018 `r CJ 1 1 000468.07500000 MO 20 11 K2173E 100.000 100.000 02-06-2018 1 1 000463.10000000 MO 20 11K2F3E 100.000 100.000 02-06-2018 1 1 000468.10000000 MO 20 11K2F3E 100.000 100.000 02-06-2018 W 1 1 000463.12500000 MO 20': ` : 11 K2f3E 100.000 100.000 02-06-2018 1 1 000468.12500000 MO 20 �• ' 13E 100.000 100.000 02-06-2018 Ch 1 1 000463.15000000 MO 20 .E 11 ME 100.000 100.000 02-06-2018 1 1 000468.15000000 MO 20 11 V~=' AO 100.000 02-06-2018 1 1 000463.17500000 MO 20 11 F3E 100.0 0 100.000 02-06-2018 Control Points Control Pt.No. 1 Address:2950 NW 7th Ave City:Miami County: MIAMI-DADE State:FL Telephone Number: (35) eath >_ y — Associated Call Signs <NA> 1 cn FCC 601-ULSBSI U Page 3 of 4 August 2007 Packet Pg.259 C.7.a Licensee Name: NATIONAL HEALTH TRANSPORT INC Call Sign: WQYV762 File Number: 0007636306 Print Date: 02-07-2017 0. Ch Waivers/Conditions: NONE .t CL k �» �` tJ CJ 0 cn i k e.f �f 0 0.. t FCC 601-ULSHSI Page 4 of 4 August 2007 Packet Pg.260 C.7.a 0 0. MR- NATIONAL HEALTH v, TRANsPoRr Y .F+ 0 Schedule of Rates for Monroe County CL U ca Ambulatory patients will be$25.00 flat rate (within15 mile radius)each additional mile$1.00 Wheelchair bound patients will be$50.00 flat rate (within 15 mile radius) each additional mile$1.50 c Non-Medical Stretcher patients will be$100.00 flat rate (within 15 mile radius)each additional at$2.00 CD 0 0 19970 Overseas Highway, Sugarloaf Key FL 33040 1 OFFICE: 305-636-5555 1 FAX: 305-636-5503 WWW.NATIONALHEALTHTRANSPORT.COM Packet Pg.261 C.7.a Page 1 o .4 CERTIFICATE LIABILITY I DATE(MMIDDlYYYY) 07/01/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES O 0. BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. I-- If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Wallas Towers Watson Certificate Center 0) NAME: Willis Towers Watson Southeast, Inc. PHONE 1-877-945-7378 FAX 1888-467-2378 c/o 26 Century Blvd iAXC No,txiv /A/C,No): - f8 P.O. Box 305191 E-MAIL ADDRESS:ADDRESS: _ Nashville, TN 372305191 USA INSURER{Si AFFORDING COVERAGE NAIC# f8 INSURERA: Coverys Specialty Insurance Company 15686 INSURED INSURERB: Old Republic Insurance Company 24147 National Health Transport Inc -- -- --- -- -- - -- - 2290 NW 110th Avenue INSURER C Sweetwater, FL 33172 INSURER D: CL INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:W21536959 REVISION NUMBER: N THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR '.ADDL SUBR POLICY EFF POLICY EXP _-- _-- CI _ImTRTYPE OF INSURANCE POLICY NUMBER JMMMRNYYYJ, M DpooffL LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00C X DAMA(_E TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ SO,OOC 0) A X Retro Date: 06/23/2014 MED EXP(Any one person) $ 5,OOC O 005FL000036286 06/23/2021 06/23/2022 PERSONAL BADVINJURY $ 1,000,00C GENT AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $ 3,000,0oC O E U X POLICY❑JC LOC PRODUCTS COMP/OPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLELIMlT $ 1,000,000 N Ea acodentt_ W X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED MWTB 313612-21 06/01/2021 06/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE _ $ ...._ ___. AUTOS ONLY AUTOS ONLY .,Per accidents _._ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _. EXCESS LIAB � CLAIMS-MADE AGGREGATE $ O DED RETENTION$W, _ $ M WORKERS COMPENSATION PER Y/N STATUTE ERH _ AND EMPLOYERS'LIABILITY ANYPROPRIEfOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? -- - - - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below _..., E.L.DISEASE-POLICY LIMIT $ W A Facility Professional Liability 005FL000036266 06/23/2021,06/23/2022 Each Medical Incident,$1,000,000 N Retro Date: 06/23/2010 Annual Aggregate $3,000,000 .W._. .... _ ..... DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) Proof of Coverage. N CERTIFICATE HOLDER CANCELLATION O M SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 0) AUTHORIZED REPRESENTATIVE U Monroe County ¢ ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 21280619 BATCH: 2152340 Packet Pg.262 C.7.a r_ 0 0. y t' TRANSPORT NATIONAL HEALTH U #12. There were no non-medical transports during the previous licensed period. CL U ca M c 0 76 19970 Overseas Highway,Sugarloaf Key FL 33040 1 OFFICE: 305-636-5555 1 FAX: 305-636-5503 WWW.NATIONALHEALTHTRANSPORT.COM Packet Pg.263 C.7.a BOARD OF COUNTY COMMISSIONERS c County of Monroe Mayor Heather Carruthers,District 3 Ch The Florida Keys �r �� � Mayor Pro Tem Michelle Coldiron,District 2 Craig Cates,District 1 F David Rice,District 4 r 1 Sylvia J.Murphy,District 5 U Monroe Cotinty Fire Rescue 490 631 Street Ocean o Marathon,FL 33050400 z Phone(305)289-6088 c CL MEMORANDUM 0 TO: Nicole Rhodes FROM: Cara Johnson a SUBJECT: Check for Deposit DATE: August 24, 2021 A Attached please find Check# dated 08/11/2021 in the amount of$475.00 to be deposited in the General Fund. This check has been issued for the renewal application of a Class B Certificate of Public Convenience and Necessity for National Health Transport Inc. Thank you, 0 Cara Johnson 76 Packet Pg.264 C.7.a , NATIONAL HEALTH TRANSPORT INC VARIABLE ACCOUNT 2290 NW 110 AVENUE MIAMI,FL 33172 81.275) a(DATE ._.... O Pffi� IV =, TO THE �R � ORDER OF � _ mw0 RS C CL v U CJ II y O 0. Packet Pg.265 C.7.a National Health Transport Triage and Dispatch Guidelines 0. These guidelines are to be used as a tool in the handling of requests for service, determining the appropriate level of service, dispatching the appropriate vehicle, monitoring timely responses, and notifying the appropriate party in the event of a deviation. As a guideline, this is not a, "be 0 all-end all" source of information. This document should be consulted in U conjunction with the National Health Transport Standard Operating 0. Guidelines and Medical Protocols. The basis for these guidelines is the Centers for Medicare and Medicaid Services, Ambulance Fee Schedule, Chapter 10, Rev. 125. Access to the original document is located here: https://www.cms.gov/manuals/Downloads/bpl02clO.pdf These guidelines are in full compliance with Local, State, and Federal laws. y A At all times sound judgment, consultation with peers and management and acting in the best interest of patient safety should prevail over the need for a quick decision. 0 National Health Transport Dispatch and Triage Guidelines v.2 Page 1 Packet Pg.266 C.7.a r_ 0 Contents Communications Center Role and Responsibility 3 Response Time Standards and Vehicle Capabilities..................................................................................6 HospiceTransportation........................................................................................................................... 10 National Health Transport Vehicle Dispatch Protocol............................................................................. 14 0 BLSUnit Dispatch Criteria........................................................................................................................ 17 CL ALS Unit Non-Emergency Dispatch Criteria............................................................................................. 18 U SCT Unit Non-Emergency Dispatch Criteria............................................................................................. 19 �+ CCT Unit Dispatch Criteria Interfacilit 20 U 0 Critical Patient Conditions.......................................................................................................................23 Broward Hospital Capabilities.................................................................................................................30 Miami-Dade Hospital Capabilities...........................................................................................................31 BariatricTable..........................................................................................................................................32 0 CJ 0 National Health Transport Dispatch and Triage Guidelines v.2 Page 2 Packet Pg.267 C.7.a Communications Center Role and Responsibility 0. • The National Health Transport Communication Center is equipped to handle and coordinate between: a) Referring and receiving medical and healthcare facilities b) Transport personnel c) Different Bases of Operation d) Vehicle Operators e) Local Public Safety; i.e., local 911 EMS, FD, and PD f) Area Air Ambulance services y g) Area Emergency Departments h) Local OEM and/or Emergency Managers • The Communication Center integrates these resources through: a) Local and long distance phone lines �-- b) Broadband internet capabilities c) UHF and VHF Radio Frequencies d) Cell phones e) Radio • Communication personnel and/or Dispatch Supervisors have many general and specific duties which include but are not limited to: a) Monitoring of dispatch, scheduled and future transports b) Completion of detailed logs, reports, and authorization requests c) Input of required patient demographics and data d) Handling of general questions or requests from employees and y customers e) Daily contact with ambulance personnel, mechanics and administrators f) Access to Trauma Centers and/or EMSystem© for bed availability in rare cases of mass patient incidents National Health Transport Dispatch and Triage Guidelines v.2 Page 3 Packet Pg.268 C.7.a g) Record and relay incoming ER reports to the appropriate Hospital Emergency Room h) Access to the program Medical Director in case the medical crew needs discretionary decisions or on-line medical control; 24 hours a day/ 7 days a week- only after exhausting all other appropriate resources. i) Inform appropriate administrator in cases of accident, injury and/or illness of any staff member j) Have contact with any unit when needed k) Maintain continuity of operations and report relevant information to appropriate recipients 1) Maintain operational knowledge of trauma services and specialty y referral centers m) Maintain and ensure correct operation of all communication center and company equipment n) Access and maintain logs of all transport requests, referrals, and/or missed, lost, or cancelled transports o) First point of contact for all parties involved in the transport program p) Use retrospective demand analysis to deploy the appropriate number A of vehicles on a continual basis • Dispatcher responsibility: a) The posting and assignment of personnel to an appropriate unit. b) Reference the National Health Transport Level of Service Algorithm and Dispatch Guidelines to triage calls that come into the Communications Center c) If possible, provide the most accurate ETA by inquiring from the closest appropriate available unit(s) d) Examine triaged calls and alert the most appropriate unit(s) e) Assure that the dispatched unit received the information and is responding f) Inform the assigned unit of the appropriate sense of urgency or bed side time. National Health Transport Dispatch and Triage Guidelines v.2 Page 4 Packet Pg.269 C.7.a g) Monitor units for response time compliance: i.e., Copy page/Enroute, On-scene, Transporting, Destination & In-Service time; through the computer aided dispatch system (CAD) 0. h) Alert facilities and/or appropriate parties of delays i) Upon completion of transport notify all necessary parties of out of compliance issues- If an Immediate Response is not assigned to a unit within 20 minutes of the initial call, a Supervisor must be made aware. j) Maintain thorough notations in the CAD system of any relevant developments throughout the transport. k) Maintain thorough notations in the CAD system of any relevant equipment or personnel movements and pass down of all relevant information to future shifts. y 1) Monitor each unit for the appropriate off time and notify the unit(s) of an appropriate Clear for Station time. m) Notify supervisory staff of any calls being dispatched that may cause a unit to work past their scheduled off time. n) Access and printing necessary Daily Reports o) Activation and deactivation of each unit and personnel in the CAD system appropriately and timely. A 0 National Health Transport Dispatch and Triage Guidelines v.2 Page 5 Packet Pg.270 C.7.a Response Time Standards and Vehicle Capabilities 0 0. 1) The following shall be the response time standard for ambulance transports: (a) Unscheduled Transports a. Immediate Response- <45 minutes with 85% reliability b. ASAP- <60 minutes with 85% reliability (b) Scheduled Transports- on time with 85% reliability 0 2) National Health Transport different transport unit types and minimum staffing and level of service capabilities: a) Ambulatory unit No equipment One Driver 0 b) Wheelchair unit Wheelchair and ambulatory transport One Driver c) Non Medical Stretcher unit Ambulatory y Wheelchair (if combo) Stretcher transport One Driver and one attendant d) BLS unit Stretcher transports BLS transports One Driver and one EMT y e) ALS unit Stretcher transports y BLS transports ALS1 transports One EMT and one Paramedic f) SCT unit Stretcher transports BLS transports National Health Transport Dispatch and Triage Guidelines v.2 Page 6 Packet Pg.271 C.7.a ALS1 transports SCT transports One EMT and one 1 Paramedic with additional training; 0. Limited CCT capability g) CCT unit BLS transports ALS1 transports SCT transports One EMT and one CCT Paramedic 3) Dedicated Units: a) University of Miami (SCT or ALS) y b) Palmetto General Hospital (BLS) c) Palm Springs Hospital (BLS) d) HCA University Hospital (BLS or ALS) e) Cleveland Clinic (BLS) f) Florida Medical Center "FMC" (BLS or ALS) 4) Equipment Resources on units: A a) Ambulatory- no equipment, passengers able to ambulate on their own without any assistance. b) Wheelchair- Wheelchair- Passenger must be able to physically support themselves in the chair or have the appropriate restraints to be safely transported. Passengers may be transported on oxygen if they provide their own tank and be able to regulate oxygen delivery without the assistance of others. c) Non-Medical Stretcher- Stretcher- Patients that do not require the 0 presence of an attendant nor will be likely to need any medical attention during transport. d) BLS— Oxygen, Inverter, Oral suctioning, Orthotic devices e) ALS — BLS equipment plus Cardiac Monitor, Standard Protocol Pharmaceuticals, deep suctioning, ability to move one patient on one IV pump National Health Transport Dispatch and Triage Guidelines v.2 Page 7 Packet Pg.272 C.7.a f) SCT - ALS equipment plus ventilator, 3 IV pumps, occasional CCT Medic g) CCT— SCT equipment plus, 3 IV pumps, FT CCT Medic + Enhanced EMT h) Bariatric stretchers- may be placed on any level of vehicle to0. accommodate those patients with a BMI of greater than 55. i) Pediatric Car Seat — may be placed on any level of vehicle to accommodate a pediatric patient that requires one and there will not be one provided by facility or family 5) Intake & Dispatch Algorithm a) Initial call taking b) Triage of call based on levels of service: (a) Ambulatory y (b) Wheelchair (c) Non- Medical Stretcher Unit (d) Basic Life Support a. Emergency b. Non-Emergency (e) Advanced Life Support a. Emergency A i. ALS Assessment b. Non-Emergency (f) ALS 2 1. Manual defibrillation/ cardioversion 2. Endotracheal intubation 3. Central Venous Line placement 4. Cardiac Pacing 5. Chest Decompression 0 6. Surgical Airway placement 7. Intraosseous Line placement 8. At least (3) separate administrations of one or more medications by intravenous push/bolus or by continuous infusion (excluding crystalloid) fluids or (2) ground ambulance transport, medically necessary supplies and National Health Transport Dispatch and Triage Guidelines v.2 Page 8 Packet Pg.273 C.7.a services, and the provision of at least one of the ALS2 procedures listed in Ws 1-7. (g) SCT - SCT is the inter-facility transportation of a critically injured 0. or ill beneficiary by a ground ambulance vehicle, including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT-Paramedic. SCT is necessary when a beneficiary's condition requires ongoing care that must be furnished by one or more health professionals in an appropriate speciality area, for example, emergency or critical care nursing, emergency medicine, respiratory care, cardiovascular care, or a paramedic with additional training. 0 A 0 National Health Transport Dispatch and Triage Guidelines v.2 Page 9 Packet Pg.274 C.7.a r- Hospice Transportation 0. If an ambulance transport occurs on the date of hospice election, but before all the criteria for hospice eligibility and coverage are met (i.e., the initial assessment has been conducted and the plan of care has been developed and includes the ambulance transport), the hospice is not responsible for the transport and the ambulance transport is covered through the ambulance benefit. Ambulance transports of a hospice patient, which are related to the terminal CO Cn diagnosis and which occur after the effective date of election, are the responsibility of the hospice facility. 0 A 0 0. National Health Transport Dispatch and Triage Guidelines v.2 Page 10 Packet Pg.275 C.7.a LEVEL OF SERVICE ALGORITHM 0. Thank you for ➢ Name of patient and available demographics calling National ➢ Location of patient ➢ Destination location Health Transport, ➢ Dx or Chief Complaint 76 this is ➢ Determine severity of patient.If immediate response,proceed to response profile and speaking, how return to this section after ETA's given an ambulance dispatched. ➢ Special equipment,Personnel,or BBP precautions? may assist you? O ➢ If the patient is more 300lbs?;obtain height and reference the"Bariatric Chart" ➢ Call back number(s)and name of referring facility/agency. ➢ Any family wanting to accompany the patient? CL ➢ Insurance information. CJ ➢ Determine which of the response profiles to utilize: ➢ If the condition of the patient warrants an immediate response; Response Profile ➢Select"Priority 1"Immediate Response ➢Alert The Dispatcher ➢ Reference"Level of Service"algorithm. _ • Click"Save"and continue in CAD system. O • Continue taking information. ➢ The patient ready now—select"Priority 9"ASAP;go to"Level of Service"algorithm. y ➢ Scheduled-select"appropriate priority"non-emergency;go to"Level of Service" W algorithm. O O ➢ Immediate Response. ➢ Obtain best available ETA<45 ETA's ➢ ASAP ➢ Obtain best available ETA<60 y ➢ Discharge from facility ➢ All University of Miami facilities(UM ER to ER,Bascom Palmer,Sylvester)<30 ➢ Floor<60 National Health Transport Dispatch and Triage Guidelines v.2 Page 11 Packet Pg.276 C.7.a Does the patient complain of Shortness of Breath,Chest Pain,Acute' Altered Mental Status,Loss of Consciousness,or rapid onset :Palpitations? 1 Yes Not N Is the patient critical,has the potential for decompensatcun,or potentially unstable? Yes: See"Triage Is the patient on: and Dispatch': any equipment? Guidelines"for- appropriate S ALS/SCI'/CCf vehicle CL Yes 1 J Monitori Ventilator Does the Pt have.: any condition that V7 may meet medical'. necessity? I Oral - Suctioning i.. Yes Devices' If no other Deep. Oral See"BLS Is the equipment Unit patient a needed BLS pt. Dispatch to sit in Go to"Origin and Criteria"': chairo Destination" wheelche _ algorithm E No Ye: N fis IV` Is Pt able to ambulate? � Is it:Hep: No '' Ves:Locked? Yesl No Isthe patient able Set asto get upfrom bed= Ambulatory wthout assistance? U f no ot What` No` Yes .0.Pt.me is"BedequipmeConfinement" Medicationneeded, criter a,BLS pt1 is running?pt.Go goto"Origin&'. "Origin and Destination" Destination algorithm algorithm No Normal: Other: Can the patient Send Saline safely:go by NM Wheelchair 0. stretcher' Unit Send NM See"Triage NO Yes stretcher r and Dispatch.' Guidelines"± '� for appropriate ql5/Scf/CCT _ EN ria,:in&.ithm National Health Transport Dispatch and Triage Guidelines v.2 Page 12 Packet Pg.277 C.7.a AMBULANCE ORIGIN/DESTI NATION The following matrix outlines origin/destination combinations which may help a supplier determine coverage y of ambulance transportation within the Medicare Program. These are covered origin/destinations; however, the patient must still meet medical necessity requirements for the trans ort. DESTINATION D E G H I J ij P R S X D C C N/AoE C C C C N/AG C N/A C C N/A C N/A N/A z OH C CL C '{, C N/C C N/A `' R I N/C C N/A N/A N/A I G C N/A C C N/A ** N/C C N/A N/A I N ' ���`� C C C C C C C N/A 7 P C C T N/A t N R M#MMM C C C C C N/A S N/A C C N/A C N/A '��� X N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A C Covered Service A 41 Ry1 N/A Origin/destination combinations that cannot logically occur and will be denied N/C D Diagnostic/Therapeutic Site (other than Por H) E Residential or Custodial Facility(e.g. Nursing Home or Assisted Living) y G Hospital Based Dialysis H Hospital I Site of Transfer (Landing Zone, etc.) Between Modes (i.e. Ground to Air) j Non-Hospital Based (Free-Standing) Dialysis N Skilled Nursing Facility(Rehabilitation) p Physician's Office R Residence - S Scene of Accident X Intermediate Stop at Physician's Office During Emergency Trip to Hospital (destination only) National Health Transport Dispatch and Triage Guidelines v.2 Page 13 Packet Pg.278 C.7.a r_ 0 National Health Transport Vehicle Dispatch Protocol Purpose The purpose of this document is to establish a protocol to safely and effectively dispatch the appropriate ambulance in a manner consistent with the patient's medical condition. This protocol applies to those requests for service that involve transporting a patient to an emergency room, discharges from facilities y and inter-facility transports. 0 History National Health Transport has seen a significant shift from the use of the local �-- 911 systems for patients needing medical attention but not requiring the use of emergency responders, i.e. local fire departments and EMS systems. This change y has allowed EMS providers to be available for the general public and not necessarily have to respond to patients in skilled patient care medical facilities. The established structure is in no way intended to circumvent the 911 system. Those patients identified as acute or life threatening with conditions that lie outside of the guidelines established herein should immediately be referred to 911. Procedure Dispatch representatives must be able to distinguish a method of response, a level of care (ALS or BLS) and the initial priority in which the appropriate vehicle, equipment and personnel will be dispatched. 1. Immediate Response a. Advanced Life Support b. Basic Life Support National Health Transport Dispatch and Triage Guidelines v.2 Page 14 Packet Pg.279 C.7.a 2. ASAP 3. Non-Emergency a. Scheduled 0. b. Will Call 4. Pre-Scheduled > 24 Immediate Response An Immediate Response is one in which the ambulance begins as quickly as possible to take the steps necessary to respond to the call. Requests for this response may originate from local fire departments, EMS systems, Assisted Living Facilities and Skilled Nursing Facilities. U This level of response may be requested by any facility and is based on the patient's current perceived condition. In most cases the chief complaint will be sudden change in patient's normal condition and the illness has presented itself as an acute onset. The following are some examples of an Advanced Life Support response and are not intended to be all inclusive: A Severe abdominal pain Chest Pain Abnormal cardiac rhythm Altered level Conscious Abnormal skin signs Seizure Abnormal vital signs incl. pulse ox Eye-vision loss or pain Allergic reaction Non-trauma headache Blood glucose -60 or+250 Cardiac Symptom other than C/P y Respiratory difficulty Hemorrhage rectal or vaginal or other Medical device failure Neurological distress-facial droop, vertigo Post op complication Pregnancy Psychiatric abnormality Severe dehydration Syncope Heat and cold exposure Examples of a Basic Life Support response: National Health Transport Dispatch and Triage Guidelines v.2 Page 15 Packet Pg.280 C.7.a Minor injuries without evidence of hemodynamic instability, Witnessed falls w/ no LOC Back pain — non-specific0. Infectious disease requiring isolation Pain-unable to sit or ambulate Fever with other symptoms - Sick Acute onset illnesses that will not likely require ALS interventions or assessments. 0 ASAP ASAP calls are defined by the caller as requesting our next available time, which y we strive for nothing more than 1 hours from the initial request. If ASAP times are in excess of the 1.5 threshold a supervisor must be made aware prior to an extended time being given to the caller. Medical Conditions that are most appropriate for this category are any of the immediate response conditions previously listed but do NOT or have not been associated with a sudden onset or acute nature and: A Patients requiring cardiac monitoring Patient safety-danger to self/others Advanced airway management Isolation Chemical restraint Suctioning Oxygen or IV therapy management Patient safety-risk of falling out of chair Orthopedic device-traction, backboard i2 Non-Emergency 0 Non-Emergency calls are those calls when the caller request a specific time or wishes to place the response in a "will call" status. Any of the previous medical conditions may be categorized as scheduled so long as the medical condition is not of an acute nature. National Health Transport Dispatch and Triage Guidelines v.2 Page 16 Packet Pg.281 C.7.a Pre-Scheduled Same as Scheduled except these transports will be arranged by the caller at least 24 hours in advance. (Example: Long distance transports) BLS Unit Dispatch Criteria "Basic life support" means treatment of medical emergencies by qualified personnel through the use of techniques such as patient assessment, cardiopulmonary resuscitation (CPR), splinting, obstetrical assistance, bandaging, administration of oxygen, administration of a subcutaneous injection 0. using a premeasured autoinjector 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 by rules of the State of Florida Department of Emergency Medical Services. Below are conditions that are considered Basic Life Support and warrant the W dispatch of a BLS ambulance. Patients that cannot regulate their own oxygen delivery Patients that suffer moderate to severe pain on movement Chronic Altered Mental status Status post hip fracture with immobilization, i.e. abductor pillow Non-Medicated Saline IV Patients requiring isolation for transport 0 Stage 2 or greater decubitus on the buttocks y Orthopedic devices requiring special handling Patients that are confused, combative, lethargic, or comatose Any patient that needs to be restrained or a flight risk during transport Psychiatric disorders with a danger to self or others Any patient that is contracted Dislodged or disconnected Foley catheters, PEG Tubes National Health Transport Dispatch and Triage Guidelines v.2 Page 17 Packet Pg.282 C.7.a Trauma with a mechanism of Injury that does not meet the trauma alert criteria Any response to a fall, laceration, or hemorrhaging of any kind should be screened for blood thinner use and consider ALS if confirmed. Dislodged or disconnected Foley catheters, PEG Tubes Patient's that meet the bed confined criteria (unable to walk, unable to sit in a chair or wheelchair, unable to get out of bed without assistance), that there is a risk or fear that they could fall off the stretcher, needs vital signs monitored, or that you can say with certainty that transportation by other means is contraindicated. ALS Unit Non-Emergency Dispatch Criteria 0 "Advanced Life Support" 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 rules of the State of Florida Department of Emergency Medical Services. I. If the patient has any of the following conditions, dispatch ALS: a. Shortness of Breath b. Change in mentation c. Chest pain or angina equivalent, i.e., i. SOB y ii. Severe diaphoresis (sweating) iii. Referred pain of any kind, i.e., left arm, jaw or back pain y d. Cardiac Dysrhythmias e. Syncope of any etiology f. Recurrent seizures or new onset seizures g. Orthostatic Vital signs h. Dizziness i. Nausea & Vomiting National Health Transport Dispatch and Triage Guidelines v.2 Page 18 Packet Pg.283 C.7.a j. Hematuria (Blood in urine), Hematochezia (Blood in stool) k. Lethargy I. New onset Neurological deficit m. Loss of consciousness of any etiology n. Blood sugar <60mg/dl or > 200 mg/dl (as per SNF caller) o. Frank blood in urine, stool or hemoptysis (coughing up blood) p. Coughing up frothy pink sputum q. Severe pulmonary congestion r. Trauma 0 s. Mid to High grade fever > 102.0*F t. Allergic reaction or anaphylaxis u. Medication reaction y v. Disconnected or dislodged Trach tube, PICC line, port-a-cath and/or dialysis shunt. w. Patients with severe pain of unknown etiology x. Unstable Pediatric patient SCT Unit Non-Emergency Dispatch Criteria W Strong consideration for a SCT response should be given to the following when the service is available. In the event that a CCT or SCT response is not available a Supervisor should be notified, and the Supervisor must consult with the responding Paramedic so both the Paramedic and the requesting party is comfortable with the transportation and medical procedures and capabilities y available. 0 1) Protocol Allowable Drugs 2) CPAP or BiPAP 3) Blood products ONLY WITH RN accompanying if it hasn't been initiated. 4) Chronic vented patients 5) Newly vented patients; Dispatch CCT first and if not available then SCT. 6) STEMI or Non-STEMI patients who aren't critical if CCT is available. National Health Transport Dispatch and Triage Guidelines v.2 Page 19 Packet Pg.284 C.7.a i) Potentially unstable patients may require (1) additional medic or BLS unit (Dispatcher Discretion.) 7) Chronic Tracheostomy patients0. 8) Newly intubated patients may require (1) additional paramedic based on condition. 9) Newly cried patients may require (1) additional paramedic based on condition. 10) Cardioverted or Defibrillated patients with possible need for (1) additional medic0 11) PICC and Central lines CL 12) High Risk OB patients with (1) additional CCT paramedic. 13) Central Venous Line Placement to include UVC and Dispatch CCT first; if y N/A then SCT. 14) Cardiac Pacing (TCP- Transcutaneous Pacing only) 15) Chest Decompression (Needle) 16) Intraosseous line- (Manual or EZ 1/0) A CCT Unit Dispatch Criteria (Interfacility) Strong consideration for a CCT response should be given to the following when the service is available. In the event that a CCT or SCT response is not available a Supervisor should be notified, and the Supervisor must consult with the responding Paramedic so both the Paramedic and the requesting party is comfortable with the transportation and medical procedures and capabilities available. 1) Critical or very unstable patients will require at least (1) CCT and, if available, (1) ALS or SCT. If those units aren't available, then consider a BLS unit for manpower assistance. National Health Transport Dispatch and Triage Guidelines v.2 Page 20 Packet Pg.285 C.7.a 2) Status post cardiac arrest patient will require a minimum of ALS or SCT Medic AND (1) CCT Medic. 3) Refractory shock of any kind: (ANY Systolic BP less than 90) 0. a) Hypovolemic Shock (Burns, dehydration, etc.) b) Hemorrhagic Shock (Blood loss) 4) Obstructive/ Mechanical Shocks (1) Cardiogenic Shock (Heart Failure) (2) Pericardial Tamponade (Blood in the pericardial sac) (3) Pulmonary Embolism (Blood clot in the lungs) (4) Tension Pneumothorax (Air in the pleural space & collapsed lung) b) Distributive Shocks (1) Anaphylactic Shock (Life-threatening allergic reaction) y (2) Septic Shock (Overwhelming infection causing shock) (3) Neurogenic Shock (Shock caused by high cervical injury) 5) Status Asthmaticus (Severe Asthma attack not responsive to treatment) 6) Status Epilepticus (Recurrent seizures not responding to treatment) 7) Active or Refractory Cardiac Arrythmias (Abnormal and/or life-threatening heart rhythm) 8) Complicated Overdose (Can severely affect the heart, respiratory and A circulatory status or can cause liver and/or kidney failure) 9) Respiratory Failure (Patients may require intubation; i.e. asthma, COPD, pneumonia, near-drowning, ARDS, etc...) 10) MODS (Multi-System Organ Failure) 11) Disseminated Intravascular Coagulation 12) Failed Cardiac Cath Lab patients or those deemed as 'High-Risk' or high potential for decompensation. (1) Possible coronary artery perforation 0 (2) Unable to place stent (3) Vasospasm induced arrhythmias (4) Sudden Death (5) Complication on Cath table 13) Hypotensive G.I. Bleeds 14) Dissecting Aortic, Thoracic or Abdominal Aneurysms 15) Ruptured and/or Leaking Aneurysms National Health Transport Dispatch and Triage Guidelines v.2 Page 21 Packet Pg.286 C.7.a 16) Hemorrhagic Strokes (CVA's) 17) Embolic Strokes 18) Transplant patients who are Unstable or Critical 0. 19) Unstable Chemotherapy patients 20) Unstable Trauma Transfer 21) Significant Burn victim with Airway and/or Chest involvement, i.e., intubated patients, multiple escharotomies and/or fasciotomies. a) Burn victims with multiple trauma 22) Pediatric patients with significant new onset illness and/or serious injury 23) Complications of any surgery patient 24) Sickle Cell Crisis 25) Thyrotoxicosis (Thyroid Storm) y 26) Complex Trauma victim 27) IABP with CCT Unit + (RN, MD and/or Perfusionist) 28) Paced patients with possible need for RN and/or MD. 29) High Risk OB patients. 30) IVC and ICP patients 31) New Cricothyrotomy, or Tracheotomy patients. 32) Sedative, Analgesic, Anesthetics or Paralytic drips (infusions). A 33) A-lines, CVP's, Swan Ganz (PA Catheters) 34) Any IVC drains, ICP monitoring, shunts, bolts or burr holes 0 National Health Transport Dispatch and Triage Guidelines v.2 Page 22 Packet Pg.287 C.7.a Critical Patient Conditions Strong consideration for a CCT response should be given to the following when the service is available. In the event that a CCT or SCT response is not available a Supervisor should be notified, and the Supervisor must consult with the responding Paramedic so both the Paramedic and the requesting party is comfortable with the transportation and medical procedures and capabilities available. ■ Advanced Airway Management Techniques ■ Paralytics- (Neuromuscular Blockers) o Depolarizing Agent o Non-Depolarizing Agents • Chest Tube Monitoring o Heimlich Valves • Chest Tube Placement y • Thoracic Escharotomies W ■ Fasciotomies ■ Pericardiocentesis ■ Internal Pacing • Transvenous • Overdrive Pacing • Trans-Esophageal y • Epicardial Pacing ■ Central Venous Catheter Management/ Interpretation • UVC's- Umbilical Venous Catheters ■ Arterial Line Management/ Placement • UAC's- Umbilical Artery Catheters o Femoral lines o Radial lines ■ Intra-Aortic Balloon Pumps (IABP) National Health Transport Dispatch and Triage Guidelines v.2 Page 23 Packet Pg.288 C.7.a ■ Blood and/or Blood By-Product Administration & Monitoring • Electrolyte Interpretation • Arterial Blood Gas Interpretation/ Measurement . • Ventilator Management o Invasive Ventilation • Basic Radiographic Interpretation • Intracranial Pressure Monitoring lines • Venous cutdowns • Infusion pumps o Single or multi-chamber o Syringe Pumps ■ Advanced Pharmacological Interventions • Sedative Infusions • Narcotic/Analgesia Infusions • Paralytic Infusions • Anesthetic Infusions _ o Ketamine o Diprivan (Propofol) y • Vaso-Active Infusions o Norepinephrine (Levophed) o Phenylephrine (Neo-Synephrine) o Vasopressin (Pitressin) • Electrolyte Infusions o Potassium Chloride o Calcium Chloride ■ 3% Normal Saline (Osmotic Diuretic) ■ Mannitol • Insulin Infusions • Vasodilators (Cardiac Infusions) o Nitroprusside Sodium o Nesitiride (Natrecor) o Hydralazine Hydrochloride (Apresoline, Alazine) o Nicardipine (Cardene) National Health Transport Dispatch and Triage Guidelines v.2 Page 24 Packet Pg.289 C.7.a o Fenoldopam (Corlopam) • Central Acting Anti hypertensives o Clonidine Hydrochloride (Catapres, Dixaril) 0. • ACE Inhibitors o Enalapril (Vasotec) • Beta Blockers o Esmolol Hydrochloride (Brevibloc) o Labetolol Hydrochloride (Normodyne, Trandate) • Antidysrhythmics o Propanolol Hydrochloride (Inderal) 0. • Inotropic Agents o Milrinone Lactate (Primacor) o Inamrinone Lactate (Inocor) • Anticoagulant/Anti platelet Therapy o Heparin Sodium o Enoxaparin (Lovenox) o Warfarin Sodium (Coumadin) o Eptifibatide (Integrillin) y o Abciximab (ReoPro) A o Tirofiban (Aggrastat) o Clopidogrel Bisulfate (Plavix) • Fibrinolytics o Tenectaplase Recombinant (TNKase) o Reteplase Recombinant (Retavase) o Alteplase Recombinant (Activase) y • Antiepileptics o Phenytoin (Dilantin) o Phenobarbital Sodium o Fosphenytoin Sodium (Cerebryx) • Miscellaneous Drugs o Dexamethasone (Decadron) o Nimodipine (Nimotop) • Neuromuscular Blocker Infusions Only (Not IV Bolus) National Health Transport Dispatch and Triage Guidelines v.2 Page 25 Packet Pg.290 C.7.a o Vecuronium (Norcuron) o Rocuronium Bromide (Zemuron) o Pancuronium Bromide (Pavulon) • Narcotic Analgesia Infusion (Not IV Bolus) o Fentanyl Citrate (Sublimaze, Duragesic) • Benzodiazepine Infusions (Not IV Bolus) o Midazolam Hydrochloride (Versed) o Lorazepam (Ativan) • General Anesthetics and Hypnotic-Sedative Infusion (**Not to be given IV Bolus) CL o **Propofol (Diprivan) o Ketamine y • Antibiotic Infusions o Cefazolin Sodium (Ancef, Kefzol, Zolicef) o Ceftriaxone Sodium ( Rocephin) o Imipenem-Cilastatin Sodium (Primaxin) o Vancomycin Hydrochloride (Vanocin) o Gentamicin Sulfate (Garamycin) y o Clindamycin Hydrochloride (Cleocin, Dalacin) W o Ampicillin/ Sulbactam Sodium (Unasyn) o Fluconazole (Diflucan) • Barbiturates (IV Bolus or Infusion) o Methohexital (Brevital) o Pentobarbital Sodium (Nembutal) o Thiopental Sodium (Pentothal) ■ Invasive Hemodynamic Monitoring • Invasive Blood Pressure 0 • SWAN-Ganz catheters (PA Catheters) • CVP The following types of calls will require a medical team from the hospital with their equipment + (1) CCT unit. ■ Ventricular Assist Devices (VAD's) National Health Transport Dispatch and Triage Guidelines v.2 Page 26 Packet Pg.291 C.7.a • Bi-VAD's • LVA D's • RVAD's 0. • Impala Pump ■ ECMO • VA ECMO • VV ECMO ■ High Risk OB Patients • Fetal Doppler • Fetal Heart Monitoring ■ Inhaled Nitric Oxide Therapy ■ High Frequency Oscillation Ventilation 0 A 0 National Health Transport Dispatch and Triage Guidelines v.2 Page 27 Packet Pg.292 C.7.a Transportation of Repetitive Patients 0 0. I. PURPOSE A. This Policy is intended to assure that National Health Transport only submits bills to Medicare and other government programs for repetitive transports when those transports meet medical necessity requirements. "Repetitive transports" are those transports that occur three or more times 0 during a ten day period or at least once per week for at least three weeks for treatment of the same condition, such as the types of treatments listed below. This would exclude transports for follow-up visits relating to a single and non- continuing incident. The following are some examples of services that may result in repetitive transports: 0 i. Dialysis; ii. Hyperbaric services; iii. Radiation treatment; iv. Chemotherapy treatment; and V. Wound care. A II. REQUIREMENTS FOR REPETITIVE TRANSPORTS A. Where ambulance services are rendered to repetitive patients, National Health Transport shall ensure that medical necessity requirements are y satisfied, and transport by other means is contraindicated by the patient's condition. In order to qualify for repetitive ambulance transport by National Health Transport the patient must meet the following criteria: i. The patient meets medical necessity criteria for ambulance transport. See Chapter 10 of Medicare Benefit Policy Manual. ii. A PCS form or other verification of medical necessity signed by the patient's physician is on file. This PCS form must be dated no National Health Transport Dispatch and Triage Guidelines v.2 Page 28 Packet Pg.293 C.7.a earlier than 60 days before the date the service is furnished. (See CFR Section 410.40(d)(2)). iii. The treatment received by the patient is consistent with the patient's diagnosed condition. B. National Health Transport requires the following procedures to be followed when a call is received requesting transport services on a scheduled repetitive basis: i. The dispatch centers will be responsible to respond to requests to schedule repetitive patient transports. Dispatch personnel will be responsible for initiating the Repetitive Patient Assessment process and requesting a complete Physician y Certification Statement ("PCS") from the referral source and schedule the National Health Transport Repetitive Patient Clinical Assessment, prior to the first transport. For continuing guidance on Repetitive Patient Transportation please refer to National Health Transport Policy for Repetitive Patient Transports. A 0 National Health Transport Dispatch and Triage Guidelines v.2 Page 29 Packet Pg.294 C.7.a r_ Broward Hospital Capabilities 0. is Broward Health Medical Center 1600 S Andrews Ave,Fart Lauderdale,FL 33316 Y Y Y Y Y Y .E+ Broward Health Coral Springs 3000 Coral Hills Dr.,Coral Springs,FL 33065 Y Y Y N N Y M Broward Health Imperial Point 6401 North Federal Highway,Fart Lauderdale,FL:'33308 Y Y Y N Y N Broward Medical Center-North 201 E Sample Rd,Pompano Beach,FL 33064 Y Y Y Y N N Cleveland Clinic 3100 Weston RD.Weston,FL33331 Y Y Y N N N I A Florida Medical Center-A Campus of North Shore 5000 W.Oakland Park Blvd.,Ft.Lauderdale,FL 33313 Y Y Y N N N 0 Fort Lauderdale Hospital 1601 E.Las Olas Blvd.Fort Lauderdale N N N N Y N z Healthsouth Sunrise Rehab Hospital 4399 Nob Hill Rd.Sunrise,FL N N N N N N CL Holy Cross 4725 N Federal Hwy,Fort Lauderdale FL,33308 Y N Y N N N L) Joe DiMaggio Children s Hospital 1005 Joe DiMaggio Dr,Hollywood,FL N Y P 7 Y P N Y N Kindred Hospital-Fort Lauderdale 1516 E.Las Olas;Blvd,Fort Lauderdale' N N N N N N Kindred Hospital-Hollywood 1859 Van Buren St,Hollywood,FL N N N N N N Larkin Community Hospital Behavior) Hollywood 1201 N 37th Ave,Hollywood,FL N N N N Y N Memorial Hospital Miramar 1901 SW 172nd Ave,Miramar,FL 33029 Y N N N N Y Memorial Hospital Pembroke 7800 Sheridan St.Pembroke Pines,FL33024 Y N Y N N N 0) Memorial Hospital West 703 N Flamingo Rd,Pembroke Pines,FL 33028 Y Y Y N N Y Memorial Regional Hospital 3501 Johnson St.,Hollywood,FL33021 Y Y Y Y N N Memorial Regional Hospital South 3600 Washington St,Hollywood,FL Y N N N N Y Northwest Medical Center 2801 N State Rd 7,Margate,FL 33063 Y Y Y N N Y Plantation General Hospital 401 NW 42nd Ave,Plantation,FL 33317 Y N Y N Y Y (u U South Florida State Hospital 800 E+Cypress Dr,Pembroke Pines,FL N N N N Y N M St.Anthony's Rehabilitation Hospital 3487 NW 30th St,Lauderdale Lakes,FL N N N N N N University Hospital and Medical Center 7201 N University Dr.,Tamarac,FL 33321 Y Y Y N Y N 0 West Boca Medical Center 21644 State Rd 7 33428 Y N N N Y t8 U West Boca Emergency Center at Coconut Creek 4890 State Rd 7,Coconut Creek,FL 33073 Y N N N N N Westside Regional Medical Center 8201 W Broward Blvd,Plantation,FL 33324 Y Y Y N N N WestsideRegionalMedicalCenter-Davie Y Y Y N N N y ***ALL SERVICES PROVIDED AT NICKLAUS CHILDEN'S HOSP ARE FOR PEDIATRIC PATIENTS ONLY*** ***IN STEMI SECTION(Y*)DENOTES LEVEL 1 CARDIOVASCULAR SERVICES*** ***NO ONSITE CARDIAC SURGERY AVAILABLE AT LEVEL 1 FACILITIES** National Health Transport Dispatch and Triage Guidelines v.2 Page 30 Packet Pg.295 C.7.a Miami-Dade Hospital Capabilities O i Ch HOSpltal Name Address ER STEMI STROKE TRAUMA PSYCH PEDS El Aventura 20900 Biscayne Blvd,"Aventurar,'..FL33180 Y '.:Y .:COMP LEVEL Y NIAi Baptist Main 8900 N Kendall Dr,Miami,FL 33176 Y Y COMP LEVEL 2 N/A Y Coral Gables 3100 Douglas Rd,Coral Gables FL33134 Y N/A PRIMARY N N/A N/A 0) Doctors 5000 University Dr,Coral Gables,FL 33146 Y N/A N/A N N/A N/A M Hialeah Hospital 651 E 25th St,Hialeah,FL33013 Y N/A PRIMARY N Y N/A O M Homestead Hospital 975 Baptist Way,Homestead,FL 33033 Y N/A N/A N N/A Y O Jackson Memorial 1611 NW 12th Ave,M!amI,FL 33 13 6 Y Y COMP LEVEL 1 Y Y 160 NW 170th St,North Miami Beach,FL z Jackson North Hospital 33169 Y Y. PRIMARY N/A N/A N/A CL CL Jackson South Hospital 9333 SW 152nd St,Miami,FL33157 Y* N/A LEVEL 2 Y N/A j U Kendall Reginal Hospital 11750SW 40th St,Miami,FL 33175 Y Y COMP LEVEL 1 Y N/A Kindred Hospital 5190 SW 8th St,Coral Gables,FL 33134 N/A N/A N/A N/A N/A N/A t8 U Larkin Community Hospital 7031 SW 62nd Ave,South Miami,FL33143 Y N/A N/A N/A Y N/A Larkin Palm Springs Hospital 1475 W 49th PI,Hialeah,FL 33012 Y N/A PRIMARY N/A N/A N/A I O Mercy Hospital 3663 S Miami Ave,Miami,FL 33133 Y Y PRIMARY N/A Y N/A Mount Sinai Hospital 4300 Alton Rd,Miami Beach,FL33140 Y Y COMP N/A Y N/A 0) Nicklaus Children's 3100 SW 62nd Ave,Miami,FL 33155 Y Y COMP LEVEL 1 Y N/A North Shore Hospital 1100 NW 95th St,Miami,FL 33150 Y Y* PRIMARY N/A Y N/A Palmetto Hospital 2001 W 68th St,Hialeah,FL 33016 Y Y COMP N/A Y Y N Promise Hospital 14001 NW 82nd Ave,Hialeah,FL 33016 N/A N/A N/A N/A N/A N/A South Miami Hospital 6200 SW 73rd St,South Miami,FL 33143 Y Y PRIMARY N/A N/A N/A Southern Winds Hospital 4225 W 20th Ave,Hialeah,FL33012 N/A N/A N/A N/A Y N/A I U University of Miami Hospital 1400 NW 12th Ave,Miami,FL 33136 Y Y PRIMARY N/A Y N/A West Kendall Baptist Hospital 9555 SW 162nd Ave,Miami,FL33196 Y N/A PRIMARY N/A N/A Y 0 Westchester Hospital 2500 SW 75th Ave,Miami,FL 33155 Y N/A N/A N/A Y N/A U N ***ALL SERVICES PROVIDED AT NICKLAUS CHILDEN'S fn HOSP ARE FOR PEDIATRIC PATIENTS ONLY*** ***IN STEMI SECTION(Y*)DENOTES LEVEL 1 CARDIOVASCULAR SERVICES*** O ***NO ONSITE CARDIAC SURGERY AVAILABLE AT N LEVEL 1 FACILITIES** National Health Transport Dispatch and Triage Guidelines v.2 Page 31 Packet Pg.296 C.7.a Bariatric Table 0 From time to time we are called upon to transport patients that exceed 0. the weight capacity to be transported safely by two crew members. The chart below has been designed to use as a guideline by cross referencing the patient height with the patient weight and determining a body mass index. It has been determined that any BMI exceeding 55 will likely need a large body mass LBS stretcher and additional crew support for 0 transport. U CL 51011 51 11 51211 51311 51411 ` 515" 51611 51711 60 61 62 63 64 65 66 67 0 275 53.70 51.96 50.29 48.71 47.20 45.76 44.38 43.07 300 58.58 56.68 54.86 53.14 51.49 49.92 48.42 46.98 325 63.47 61.40 59.44 57.56 55.78 54.08 52.45 50.90 350 68.35 66.12 64.01 61.99 60.07 58.24 56.49 54.81 400 78.11 75.57 73.15 70.85 68.65 66.56 64.55 62.64 450 87.88 85.02 82.30 79.71 77.23 74.88 72.62 70.47 W 518" 51911 511011 ' 5111" 610O 1 611" 61211 613" 614" 68 69 70 71 72 73 74 75 76 0 300 45.61 44.30 43.04 41.84 40.68 325 49.41 47.99 46.63 45.32 44.07 350 53.21 51.68 50.21 48.81 47.46 46.17 44.93 43.74 42.60 0. 400 60.81 59.06 57.39 55.78 54.24 52.77 51.35 49.99 48.68 450 68.41 66.45 64.56 6276 61.02 59.36 57.77 56.24 54.77 500 76.02 73.83 71.73 69.73 67.80 65.96 64.19 62.49 60.86 U 0 Indicates the need for the Large Body Surface Stretcher y National Health Transport Dispatch and Triage Guidelines v.2 Page 32 Packet Pg.297 13 sselo a jo fly ) 3 enssl) p pep - ogeoll ssel Hosea q4lBGH IBMW :4u8wq3B44V co V CL Imo ' m -apinE)aolnaag x3p93 luaiano eas'sllwll awg loljls ulgllnn pall;eq lsnw swlelo uallu/A•apin!Daoi/uaS ino ul palsll swell aaglo pue sluawnilsul 91gego6ou 'slelaw snoloajd 'tilemel•6-a'000`6$sl anlen AGeupomIxa;o swall jol wnwlxeVI-ssol peluewnoop lenloe paaoxa louueo iGanooab *anlen paJeloap pezljoglne aq}ao 001.$Jo ialeoA oql of pellwll sl leloads ao'lelluanbasuoo`leluaploul'loaalp Jag;agnn 96ewep to swiol aaglo pue'slsoo'seal s,Aeuiol;e 'lgoid'lsaialul awooul 'sales to ssol 'a6eMloed eql to anlen olsulalul 6ulpnloul'ssol Aue col x3P93 woal aanooaa 01;g6Ij ino,,-Aldde apin!D aouuag x3pa3 luaaano aql ul punol suogellwl-l•wlelo Alewg a alll pue ssol lenloe inoA luawnoop'abjego leuoglppe ue Aed'anlen a9g6lq a aieloop nog(ssalun 'uollewjolulslw io'tianllapslw'AJanllap-uou'l(elap'a6ewep'ssol to llnsai aql jaq;agnn'a6ejoed aad oo l,$to ssaoxe ul wlelo Aue aol elglsuodsaa eq lou ll!m x3Pa3-woo-x9p9l uo algellene'apinE)aolniag x3pa3 luaiino aql ul suoglpuoo aowas eql of luaweei6e jnoA selnlgsuoo walsAs slgl to ash -jegwnu lun000e x3paJ anon(to uollellaoueo agl qll^^6uole'sa6aego 6ullllq leuolllppe ul llnsai pinoo pue lualnpneal sl sasodand 6uiddlgs aol lagel slgl to Ad000logd e 6ulsn -6ulddlgs aol lagel leui6uo papid aql Aluo asfl :6uluieM -peuueos pue peaj aq ueo loge)agl to uoi:pod apoojeq eql legl os luawdlgs jnoA of 11 xgle pue gonod bulddigs ul logel aoeld-C -aull leluozuoq aql 6uole a6ed paluud aql plo3 -Z •aaluljd lablul jo easel inoA of legel anon(luljd of 96ed slgl uo uollnq,luUcl,aq1 asfl-6 :lagel slq;6ul;uljd je;jV d�3�!£�l9!6P099 ^^{O60L0{i0S{ZP - a I-- O J c = w In 0 O � Z M C7 M o W cn r 4 Q .:� - N am z N O u- - N�, W _. .....v.... - - z Q a wco cn a p W ZMEE ai¢c`t� m V r � W W o - N GC Z _ ,- W < = W _ Ca CD w cD Y o� M W cn 0 — M cD 0 W�/ LL -� _ L N cri Q Lu p F-w LLti . a- Z co W _ Z5��� C9 Cn oa Y o OaZcNv cn� �zd o o — F- _ d13 sselo e p (le eua ) 93 uens§ �Z eZe§o NDdOD 13 sse|0 wodsu qllBBH IBMW :Wam Qoq! ® ^ \ C4\ \ < \ \aa. \ �\ 2 t � ( � o { / 0 a / \ \ coco E / / ® \ ./ / ƒ ) u U C,) ) 2 •° / \ � W 2 t � • » � } ƒ o E z �/ / %/ \ [-I Z \ � t ¢ \ @ W / \ \ Cl) ± ƒ 7 » � \ � � � 4 0 / / \ ƒ o o ƒ / co \ = t k > C QL) co � Cl) 0 / ul§ @Z m « 2 / 22 2k d d q S � co / \ � \ { \ \ E ® t k o \ co { C) q W ./ � { co / o / _ k 3 § \ U � � / ° \ 0 co ƒ \ d \ co \ k ( � \ � k Q \ / o w \ z a » k 2 � co � \ / 2 k � / \ / Cl) Q = E o « a @ U E / co \ ƒ 7 \ \ 0 0 0 0 0 \ / z / ) d % Cd ? U) / \ / Cl) 3 / ° m / © U ' » o o o ® / ) o / « 2 / \ / \ / Cl) / / co / 2 S/ o \ « « \ a .3 = ® t % / / ƒ U Ty 01 MARATHON, FIX)KIDA r �x CAM .V 805 Overseas llwy, Marathon, FL .3:050 z Phone (05) 289-4116 I'ax (05) 289- 1 3 1 wNN7\x .cl.m-,ra tl-ioil.fl.us CL U ca VIA EMAIL, AND U.S. MAIL, August 30, 2021 0 Mayor Michelle Coldiron Monroe County Board of County Commissioners 530 Whitehead Street Key West, Florida 33040 � Ill;: September 15, 2021, County Commission Meeting Atpenda. Item Suanniary 48624, y U Dear Mayor Coldiron: CLU I ant writing on behalf of the City of Marathon Fire Fescue regardin<,o agenda item number 8624 on the September 15. 2021 County Commission meeting. "Phis agenda item regards an application for issuance of a Class A and Class B Certificate of Public Convenience and Necessity (COPCN) for National Health "Transport for the operation of an ALS and BI..S "Transport Service, as well as a Non-Emergency 'ri-ansport Service. in Monroe County, Florida. This application proposes such services within the City of Marathon, r Section 11-173(d)(2) ofthe Monroe County Code. which addresses such natters, provides in relevant � part: _ "The board will consider the public's convenience and the necessity for the service in the zone or area requested and whether the applicant has the ability to provide the necessary service. The board will consider recommendations from municipalities within the applicants requested service /one or area" The City has reviewed the application and reconln-iends that the Commission deny the application based on the first two criteria listed in Section 11-173(d)(2): the public's convenience and necessity for the service in the zone or area requested, 1. The Public's Convenience Granting these applications does not make thineos more convenient for the public. To the contrary,. there is the potential for the public's convenience to be negatively impacted. In the past when other companies were granted the: ability to provide services to our City they would cause our fire department to scale down in size, only to have to expand when they were unable to provide the service fOr multiple reasons, including but not limited to: � personnel. cost ofrui1ning the service in the 1�'eys, etc. As 1"ire Chief; I have been with the � city for over 9 years and have seven this happen multiple times. I aim responsible for providing the citizens and visitors of Marathon wvith the highest level of nnedical care from home to hospital, hospital to hospital, and scene to Trauma Star ifrequired. Because the city provides Packet Pg. 300 C.7.c all of the above services_ I can ensure that our egLIipn-rent, personnel, and system meet these hig,h standards and provide required services to anyone who needs it. CL 2. Necessity for the Service CO There is no need for these additional companies- as the current providers in Monroe County are more than adequate for the number of enner+oencies that we have. I have spoken to Fisherman's Hospital and asked if they requested additional services. They responded that theyhad not. We didnot task or requirezany additional assistance I:or o�u° services. Thus, we do not know ofany reason why there is the need for additional serwTiccs. Lased upon the above, it is the City of Marathon's recommendation. in accordance with Section 11- 173(d)(2) of the Monroe Count), Code, that the COPCN application for National Health Transport be N denied for the. City of Marathon for the reasons set forth herein. W U CL Respectfully U 0 13n ,ohnson Fire Chief y Copy; Marathon City Council Georoe Garrett. City Manager Steve Williams. CityAttorney Roman Gastesi. Monroe County Administrator Bob SehillinsLer. Monroc County Attorney w Steve Hudson. Monroe County Fire Chief% limcroeney Services Division Director C 0 0 i3 Packet Pg. 301