Chapter 69 – Ambulance Service

Chapter 69–Ambulance Service


69.010.    License required.


  1. Ambulance service. No person either as an owner, agent or otherwise shall furnish, operate, maintain, advertise, or otherwise be engaged in or profess to be engaged in the business or service of transportation of patients upon the streets, alleys, public ways or places within the City, unless he holds a currently valid license for an ambulance service issued pursuant to this Chapter.


  1. No ambulance shall be operated, and no individual shall drive nor attend in or on the streets, alleys, or any public way or place within the City, unless it shall be currently licensed as an ambulance.


  1. Ambulance personnel. No person shall be employed nor otherwise permitted to drive, attend, or drive and attend an ambulance subject to this Chapter, unless he shall hold a currently valid license as an attendant, driver or driver-attendant, or an apprentice licensed for such position, issued pursuant to this Chapter.


  1. Licenses shall not be required for ambulance services which are:


  1. Owned and operated by an agency of the United States government or by the City of Holden, Missouri.


  1. Rendering requested assistance to ambulances currently licensed in cases of disaster or major emergency too great for local resources; or in response to the provisions of written community mutual aid agreements.


  1. Operated from a location or headquarters outside the City and transporting patients who are picked up outside the limits of the City to locations within the City, or through the City to other locations.


69.020.    Application for license.  Applications for a license hereunder shall be made on such forms as may be described, prepared or prescribed by the director and shall contain the following information:

  1. Name and address of the applicant and the trade name under which he (it) conducts business; if a corporation, its name, date and place of incorporation, address of its principal place of business and the names of its principal officers and their addresses; and if a partnership, association, or unincorporated company, the names of the partners or other persons comprising the association or company and the business and residence address of each partner or person.


  1. The number of vehicles to be operated or controlled by the applicant and a description of each vehicle and an itemization of all equipment in each such vehicle.


  1. Name and address of each employee and statement of qualifications of each such employee as an ambulance driver or attendant.

69.030.    Licensee requirements.  There shall at all times be at least one duly qualified person attending patients being serviced by said ambulances, said attendant to be instructed in first aid procedures and having received a valid certificate of passage of an advanced First Aid course from the American Red Cross, or its equivalent.


69.040.    Duty of director.  Under the provisions of this Chapter, the director is hereby empowered and ordered to:


  1. Accept applications for all types of licenses issued pursuant to this Chapter, and to cause such investigation as he deems necessary to be made of the applicant and\or of his proposed operations.


  1. Issue the appropriate license hereunder, each to be valid for a period of one (1) year unless earlier suspended, revoked or terminated when he finds that:


  1. The public convenience and necessity require the proposed ambulance service.


  1. Each ambulance, and its required equipment designated in the application, have been certified as provided for herein.


  1. The applicant is a responsible and proper person to conduct or work in such a service.


  1. Only duly qualified drivers and attendants are employed in such capacities.


  1. All the requirements of this Chapter and the city ordinances of Holden and all other applicable laws have been met.


  1. Examine or cause to be examined, all ambulance personnel applicants.


  1. Reinspect, reexamine, or cause reinspection or reexamination within 30 days prior to renewal of licenses, for any and all of the requirements relative to the license to be renewed.
  2. Revoke or cause the revocation of any license issued pursuant to this Chapter when there is due cause for such revocation. License holders wishing to appeal shall be granted an administrative hearing by the director of the City within 30 days of request of such proceedings.


  1. Be qualified for emergency medical training.


  1. Be in charge of the ambulance personnel schedule.


  1. Be in charge of billing and upkeep of files.


  1. Be responsible for the vehicles’ maintenance and insure that said vehicles pass state inspections and state regulations.


  1. Be in charge of making volunteer payroll.
  2. Be in charge of all personnel matters. Should problems arise with personnel, the director shall report said action or problems to the committee, who then at their discretion may forward the information to the city council.


  1. Be in charge of personnel training.


  1. Be in charge of purchasing with permission of the city council.


  1. Be responsible for filing of insurance claims.


69.050.    False information contained in the application.  False information contained in an application for a license hereunder shall be considered sufficient grounds for denial of said license.


69.060.    Liability insurance.


  1. No ambulance service license shall be issued under this Chapter, nor shall such license be valid, nor shall any ambulance be operated in the City unless there is at all times in force and effect insurance coverage, in an amount to be determined by the director issued by an insurance company licensed to do business in the State of Missouri, for each and every ambulance owned and/or operated by or for the applicant or licensee, providing for the payment of damages:


  1. For injury to or death of individuals in accidents resulting from any cause for which the owner of said vehicle would be liable on account of liability imposed on him by law, regardless of whether the ambulance was being driven by the owner or his agent; and


  1. For the loss of or damage to the property of another under like circumstances.


  1. Said insurance policies shall be submitted to the director for approval prior to the issuance of such ambulance license. Satisfactory evidence that such insurance is at all times in force and effect shall be furnished to the director, in such form as he may specify, by all licensees required to provide such insurance under the provisions of this Chapter.


  1. Every insurance policy required hereunder shall contain a provision for a continuing liability thereunder to the full amount thereof, notwithstanding any recovery thereon, that the liability of the insurer shall not be affected by the insolvency of the bankruptcy of the assured, and that until the policy is revoked or expires, the insurance company will not be relieved from liability on account of non-payment of premium, failure to renew license at the end of the year, or any act or omission of the named assured. Such policy of insurance shall be further conditioned for the payment of any judgments up to the limits of said policy recovered against any person other than the owner, his agent or employee, who may operate the same with the consent or acquiescence of the owner.




  1. Every insurance policy required hereunder shall extend for the period to be covered by the license applied for and the insurer shall be obligated to give not less than 30 days written notice to the director and to the assured before any cancellation or termination thereof earlier than its expiration date and the cancellation or other termination of any such policy shall automatically revoke and terminate the licenses issued for the ambulances covered by such policy, unless another insurance policy complying with the provisions of this section shall be provided and be in effect at the time of such cancellation or termination.


69.070.    Vehicles must be kept in a clean and sanitary condition.  Every vehicle operated under this Chapter shall be kept clean and sanitary according to rules and regulations which may from time to time be promulgated by the director.

69.080.    Rates and charges.  The charges for ambulance service in Holden shall be made and approved by the city council of the City of Holden and will be posted in the ambulance office and with the city clerk.


69.090.    Revocation of license.


  1. The director may, and is hereby authorized to, suspend or revoke a license issued hereunder for failure of a licensee to comply and to maintain compliance with, or for his violation of any applicable provisions, standards or requirements of this Chapter or of regulations promulgated hereunder, or of any other applicable laws, ordinances, or regulations. Before issuing a suspension or revocation notice, the director shall first give the licensee a written notice to comply within ten days.  Should licensee fail to comply to the satisfaction of the director within the ten-day period, he may issue a suspension or revocation notice to the licensee.  Within thirty days after a suspension, the licensee shall be afforded a hearing, after reasonable notice.  The director shall, within ten days after conclusion of such hearing, issue a written decision (which shall include written findings of fact) as to the suspension of said license.  Such written decision shall be promptly transmitted to the licensee to whom it refers.


  1. The initial, semi-annual or other inspection reports of the director herein provided for, shall be prima facie evidence of compliance or noncompliance with, or violation of, the provisions, standards and requirements provided herein, and of the regulations promulgated hereunder, for the licensing of ambulances.


  1. Upon suspension, revocation or termination of license hereunder such licensee shall cease operations.
  2. Revoked licenses shall be surrendered immediately to the director.


69.100.    Vehicle equipment requirements.  No vehicle may be used as an ambulance unless it has in good working order the following equipment:


  1. Electrically powered siren or sirens, mounted in compliance with state motor vehicle regulations. May be standard or coaster sirens or electric sirens at the option of the owner.  Audible signals should be of sufficient pitch to be noticeable at least 500 feet from the ambulance vehicle.


  1. A minimum of two flashing red lights aimed forward, at a level from the ground which permits easy visibility through the rear window of vehicles traveling the same direction.


  1. The name of the owner or company shall be designated on the vehicle either on the sides or in the front and rear, in such a manner as will make it easy to identify the ownership of the vehicle.


  1. Proper designation-“Ambulance”, “Rescue”, “Mobile Emergency Unit”-shall appear on the vehicle, facing front and rear in sufficient size lettering to make identification of the vehicle easily recognizable.


  1. Access shall be provided to the driver’s compartment from either side of the vehicle and to the patients’ compartment from the rear and the curb side front of the vehicle.


  1. Illumination shall be adequate throughout the patients’ compartment that provides a minimum intensity of 40 foot candle power for the observation of vital signs at the level of the patients. Windows, if provided, should insure privacy and safety.


  1. Interior surfaces of the patients’ compartment shall be insulated, resistant to water, heat and chemicals and easily cleaned.


  1. Equipment, installed and portable, and all supplies shall be positioned for ready accessibility and not impinge on litters or access areas. Storage cabinets and installed equipment shall be designed or positioned for protection from projecting injurious objects, including recessed ceiling hooks for suspension of intravenous fluid containers.


  1. Four (4) oropharyngeal airways for adults, children and infants (2 each side). Four (4)mouth-to-mouth breathing tubes (“S” Tubes).  Four (4) mouth gags or tongue blades taped together.


  1. One (1) permanently installed suction device capable of a vacuum of at least 300 mm. Hg., when the tube to the suction tip is clamped. Suction force should be controllable.  One (1) portable suction device adequate for pharyngeal suction.


  1. One manually operated, self-re-filling, portable bag-maskvalve unit which operates on air or oxygen enrichment.
  2. Two (2) portable oxygen supplies large enough to provide an oxygen flow of ten (10) liters per minute for at least thirty (30) minutes. One (1) installed oxygen supply of at least 5,000 liters, with sufficient yokes, reducing valves, flowmeters, regulators, tubes, and mask for four (4) patients.  A humidifier with sterile water and unbreakable bottle shall also be available.


  1. One (1) backboard shall be readily available and when placed under the patient on a litter, shall provide the necessary resistance for external cardiac compression. Cardiac compression machines may be carried to provide compression.
  2. One (1) short and two (2) long spine boards with appropriate straps, one (1) scoop stretcher may be substituted for one (1) long spine board. Two (2) lower extremity traction splints with padded ankle-hitch  or skin traction device.  Four (4) triangular bandages for fractures of shoulder and upper arm.  Two (2) each length of 15, 36 and 54 inches of splints made of wood, plastic, canvas, wire or other appropriate materials for immobilization of fractures.


  1. Twenty-four (24) each size 4 x 4 or 4 x 8 sterile gauze pads for covering wounds.  Six (6) each size of 4 inch width soft roller or elastic bandages.  Six (6) sterile nonporous dressings for occlusion of sucking chest wounds.  Four (4) universal dressings, approximately ten (10) by thirtysix (36) inches, folded to 10 x 9 for covering large wounds, including burns.  Two (2) sterile sheets (for burns).  Four (4) rolls each of adhesive tape-1, 2 and 3 inch width.  Two (2) bandage shears.


  1. Activated charcoal and syrup of ipecac shall be provided, as well as potable water and equipment for oral administration and for irrigation of the conjunctiva and skin, or one (1) poison kit.


  1. Two (2) fire extinguishers. Two (2) pillows.  Four (4) sheets.  Two (2) pillow cases.  Four (4) towels.  Two (2) boxes tissues.  Four (4) emesis basins.  One (1) bed pan.  One (1) urinal.  Four (4) thermometers.  One (1) aneriod blood pressure manometer.  One (1) stethoscope.  Three (3) sandbags.  Restraints for violent patients.  Container for used paper and linen items.  Two (2) disposable OB kits.


69.110.    Records.  Each licensee of an ambulance hereunder shall maintain accurate records concerning the transportation of each patient within the City as follows;


  1. Daily log of each and every ambulance run accepted, with consecutive entries of calendar date, time of day, patient identification, patient destinations, general classification of emergency, condition of patient on arrival at destination, and such other data as the director may prescribe by regulation.


  1. Trip ticket for each ambulance run containing the information required in Subsection 1 above and such other entries as the ambulance service may desire or the director may require by regulation. The director may establish a standard trip ticket form and require timely submission to this office of duplicate copies by each licensee.
  2. Records will be retained by the legally responsible owner or operator for three (3) years, readily available for inspection as may be ordered by the director, notwithstanding transfers, sale or discontinuance of the ambulance service or business.


69.120.    Obedience to traffic laws, ordinances and regulations.

  1. The driver of an ambulance, when responding to an emergency call or while transporting a patient, may exercise the privileges set forth in this section but subject to the conditions herein stated, and only when the licensed attendant has reasonable grounds to believe that an emergency in fact exists requiring the exercise of such privileges.
  2. Subject to the provisions of subsection 1 hereof, the driver of an ambulance may;
    1. Park or stand, irrespective of the otherwise applicable provisions of law, ordinances or regulations;


  1. Proceed past a red or stop signal or stop sign, but only after slowing down as may be necessary for safe operation;


  1. Exceed the maximum speed limits permitted by law, ordinance or regulation so long as he does not endanger life or property;


  1. Disregard laws, ordinances or regulations governing direction or movement or turning in specified directions;


  1. The exemptions herein granted shall apply only when such ambulance is making use of audible and visual signals meeting the requirements of law, ordinance or regulation;


  1. The foregoing provisions shall not relive the driver of an ambulance from the duty to drive with regard for safety of all persons, nor shall such provisions protect the driver from the consequences of his disregard for the safety of others.


69.130.    Compliance with provisions of Federal Highway Safety Act of 1973.  Each licensee of an ambulance hereunder shall comply with the provisions of the federal Highway Safety Act of 1973 as they pertain to the operations of ambulances.


69.140.    Penalties for violation.  Every person who is convicted for violation of any of the provisions of this Chapter shall be punished by a fine not exceeding $500 or imprisoned for a period not exceeding ninety (90) days or by both such fine and imprisonment.