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5.Combined Emergency Service – these are full service emergency service agencies, which may be found in places such as airports or large colleges and universities. Their key feature is that all personnel are trained not only in ambulance (EMT) care, but as a firefighter and a peace officer (police function). They may be found in smaller towns and cities, where size or budget does not warrant separate services. This multi-functionality allows to make the most of limited resource or budget, but having a single team respond to any emergency.

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Municipal Certificate of Need Applications
Bureau of EMS Policy Statement
Policy Statement # 09-01
Date January 6, 2009
Subject Re: Municipal Certificate of Need Applications "Muni-CON"
Supercedes/Updates 97-01, 01-06

Under the provisions of New York State Public Health Law Article 30, section 3008(7)a, a municipality, as defined by Article 1 of the General Municipal Law, may determine that need exists to establish an ambulance or advanced life support service (ALS-FR). Before the municipality may begin operation, it must make notification to the State Emergency Medical Services Council (SEMSCO) and possess an EMS Operating Certificate. In order to obtain an EMS operating certificate, the municipality must complete the following steps:

1.The municipality must file a written request with the State Emergency Medical Services Council (SEMSCO). The request must be sent to the SEMSCO in care of the Bureau of Emergency Medical Services (BEMS). The written request must include the following items:
1.a) A certified copy of the local law, ordinance or resolution from the municipal legislative body empowering the municipality to establish and operate a certified EMS service. The local law, ordinance or resolution should include, but not be limited to, the following:
■A statement of need;
■A statement establishing the type of service (ie. ALS-FR or Ambulance);
■A statement declaring the area to be served; and
■The date the resolution is to take effect.
2.A letter from the chief executive officer of the municipality requesting Public Health Law Operating Authority as a certified ALS-FR or ambulance service.
3.A complete Application for EMS Operating Certificate, a map identifying the area of operation (geography to be served may not exceed the boundaries of the applying municipality) and evidence that the service meets or exceeds all New York State Department of Health applicable standards.
4.If the municipality intends on providing Advanced Life Support, it must apply to the appropriate Regional Emergency Medical Services Advisory Council (REMAC) and be approved to provide advanced life support care. The approval letter from the REMAC, stating the actual level of care approved, must be included in the submission.
5.If the municipality intends to contract with another EMS provider for service, the filing should include copies of signed contracts or agreements.
6.If the municipality intends to operate an ALS-FR, the filing must include a transport agreement with an appropriately authorized NYS certified ambulance service.
7.The filing for a municipal service must be sent to the following address by certified mail or other return receipt delivery:

New York State EMS Council
c/o Bureau of Emergency Medical Services - Operations Unit
New York State Department of Health
Hedley Park Place - 433 River Street
Troy, N.Y. 12180
2.Prior to the issuance of a Certificate of Operating Authority, the ALS-FR or ambulance service must complete and submit the following to the appropriate DOH EMS Regional Office:
◦The Application for EMS Operating Certificate (DOH-206) packet.
◦If intending to provide adjunct Basic Life Support (BLS) and ALS levels of care, include written REMAC authorization.
◦" Identify a physician medical director using the Medical Director Verification Form (DOH-4362).
3.A full service inspection will then be conducted by the Department's appropriate regional EMS staff. The full service inspection may not take place before the filing is complete, received and reviewed by the Bureau of EMS. The inspection establishes that the EMS service meets or exceeds the appropriate training, staffing and equipment standards as set forth by 10NYCRR Part 800.
4.Upon successful completion of the inspection and receipt of the NYS DOH Operating Certificate, the service may begin operation. The municipality shall be granted operating authority for a period of two years starting on the date the request is received by the Bureau of EMS.
5.In order to convert the municipal declaration to a permanent operating authority, the ALS-FR or ambulance service must receive a determination of public need from the Regional EMS Council (REMSCO). Prior to the expiration of the municipal ALS-FR or ambulance service (two years from the date of the original filing with SEMSCO) a complete application for New ALS-FR or ambulance service must be received by the REMSCO. The REMSCO must render a determination of need pursuant to PHL 3008. The application process, filing information and required documentation may be found in DOH Policy Statement 06-06. The policy may be found at http://www.health.state.ny.us/nysdoh/ems/pdf/06-06.pdf. It is strongly recommended that the municipality file the application for a new service at least 90 days prior to the expiration of the original certificate.
6.Should the municipality make notification to the SEMSCO that it wishes to operate an ALS-FR or ambulance service and then, prior to beginning service or anytime during the two year period, determine that it is not in the best interest of the local government and/or community, it may rescind the declaration. As with the original declaration, this must be done by local law, ordinance or resolution rescinding the original local law, ordinance or resolution. This must be accompanied by a cover letter and submitted to the SEMSCO, in care of the Department by certified mail or other return receipt delivery.
Additional Information
•The municipality is responsible for this EMS agency, even if they enter into contracts with another organization to provide the EMS response.
•An operating certificate obtained under the provisions of 3008 section 7(a) for the original two year authority and the subsequent permanent authority may not be transferred.
•If the municipality fails to become operational during the initial two years and does not rescind the declaration, it may not file another municipal declaration to establish an EMS service under the provisions of 3008 section 7(a).
•With the exception of an entire county, a municipality may only declare operating authority for the geography over which it has direct jurisdiction (e.g. an incorporated village contained within the borders of a town would not be included within the authority of an EMS agency established by the town {Also see next item}).
•Multiple municipalities, under written inter-municipal agreements, may collaborate to operate a single EMS service to serve several municipalities as long as each participating municipality submits a declaration to the SEMSCO.
•A municipality that intends to collect fees for the provision of EMS services (patient billing) will need to apply for provider status in accordance with Federal and State Medicare/Medicaid regulations. While the municipality may contract for billing services, it must be the billing entity.
•The failure to initiate EMS operation in a timely manner (within 60 days of notification to the SEMSCO) may contradict the declaration of need and may work against the municipality's ability to transition to a permanent operating authority after the two year period.
Available Web Based Resources

Quoted from bumblethru

It was the three musketeers that figured the als $$$ in the budget. Rotterdam is already 2 month without it. What happened to the $250K lost als money that rems collected?

The three musketeers found a way to slip a budget past the taxpayer's nose and hired a legal firm without taxpayer's knowledge.....they surely could bamboozle a way to collect als money............no?

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800.5 Requirements For An Advanced Life Support System
(a) An advanced life support system must meet the following requirements:
(1) designation of a qualified physician to provide medical supervision and direction;
(2) integration with a hospital emergency service, or intensive care, coronary care, or other appropriate hospital unit.
(b) An ambulance, when providing advanced life support services, must meet the requirements of Sections 800.23 and 800.24 of this Part and utilize a treatment record provided by or approved by the department, including submission of such record for use in quality assurance programs.
(c) An advanced life support system providing prehospital intermediate care must include the following:
(1) voice communications to receive medical direction;
(2) equipment and supplies to provide prehospital intermediate care; and
(3) staffing by a certified emergency medical technician-intermediate, emergency medical technician-critical care, or or emergency medical technician-paramedic, as appropriate.
(d) An advanced life support system providing prehospital critical care and/or EMT-Paramedic services must include the following:
(1) voice communications to receive medical direction;
(2) biomedical telemetry;
(3) equipment and supplies to provide pre-hospital critical care and/or EMT-paramedic services; and
(4) staffing by a certified emergency medical technician-critical care or emergency medical technician-paramedic, as appropriate.

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10.1.2 - Vehicle Requirements for Basic Life Support and Advanced Life Support
(Rev. 1, 10-01-03)
A3-3114, B3-2120.1, HO-236.1
Basic Life Support ambulances must be staffed by at least two people, at least one of whom must be certified as an emergency medical technician (EMT) by the State or local authority where the services are being furnished and be legally authorized to operate all
lifesaving and life-sustaining equipment on board the vehicle. Advanced Life Support (ALS) vehicles must be staffed by at least two people, at least one of whom must be certified by the State or local authority as an EMT-Intermediate or an EMT-Paramedic.
10.1.3 - Verification of Compliance
(Rev. 1, 10-01-03)
B3-2120.1.C, B3-2120.1.C, HO-236.1
In determining whether the vehicles and personnel of each supplier meet all of the above requirements, carriers may accept the supplier’s statement (absent information to the contrary) that its vehicles and personnel meet all of the requirements if:
1. The statement describes the first aid, safety, and other patient care items with which the vehicles are equipped;
2. The statement shows the extent of first aid training acquired by the personnel assigned to those vehicles;
3. The statement contains the supplier’s agreement to notify the carrier of any change in operation which could affect the coverage of ambulance services; and
4. The information provided indicates that the requirements are met.

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The statement must be accompanied by documentary evidence that the ambulance has the equipment required by State and local authorities. Documentary evidence could include a letter from such authorities, a copy of a license, permit, certificate, etc., issued by the authorities. The carrier will keep the statement and supporting documentation on file.
When a supplier does not submit such a statement or whenever there is a question about a supplier’s compliance with any of the above requirements for vehicle and crew (including suppliers who have completed the statement), carriers will take appropriate action including, where necessary, on-site inspection of the vehicles and verification of the qualifications of personnel to determine whether the ambulance service qualifies for reimbursement under Medicare. Since the requirements described above for coverage of ambulance services are applicable to the overall operation of the ambulance supplier’s service, information regarding personnel and vehicles need not be obtained on an individual trip basis.
10.1.4 -

Quoted from bumblethru

So when the rpd dispatchers receive an ambulance call....who gets called 1st? 2nd? 3rd? etc....
And who exactly determines that calling order??

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A. Disclosure of interests. A municipal official or employee or officer who participates in discussions or gives official opinions on any matters before the Rotterdam Town Board, an official board, agency, officer or employee or officer shall publicly disclose in the official record the nature and extent of any direct or indirect financial or other interest he or any member of his family has in such matters, unless he or she refrains from voting upon or otherwise participating in the matter.
B. Gifts. Except as set forth in § 31-8, a Town officer or employee shall not solicit anything of value from any person who has received or sought a financial benefit from the Town, nor accept anything of value from any person who the Town officer or employee knows or should reasonably have known received or sought a financial benefit from the Town within the previous 24 months. The purpose of this provision is to avoid circumstances where it could reasonably be inferred that the gift was intended to influence such Town officer or employee, or could reasonably be expected to influence such Town officer or employee in the performance of his or her official duties, or was intended as a reward for any official action taken by such Town officer or employee.
C. Use of Town property. With the exception of vehicle use by members of the Rotterdam Police Department, no Town officer or employee shall use or permit the use of Town property (including land, vehicles, equipment, materials and any other property) for personal convenience or profit, except when such use is available to Town citizens generally or is provided on the same terms and conditions as a matter of written Town policy.
D. Representation. A Town officer or employee shall not represent any other person in any matter that person has before the Town nor represent any other person in any matter against the interests of the Town.
E. Appearances. A Town officer or employee shall not appear before any agency of the Town, except on his or her own behalf or on behalf of the Town.
F. Confidential information. Town officers and employees and former Town officers and employees shall not disclose any confidential information or use it to further anyone's personal interests.
G. Revolving door. A Town officer or employee who is required to file an annual disclosure statement pursuant to § 31-12 shall not appear or practice before the particular Town agency in which the Town officer or employee served or by which he or she was employed, except on his or her own behalf, or receive compensation for working on any matter before the particular Town agency in which the Town officer or employee served or by which he or she was employed, for a period of one year after the termination of his or her Town service or employment; however, the bar shall be permanent for any Town offer or employee as to particular matters on which the Town officer or employee personally worked while in Town service that are still pending after the termination of his or her Town service or employment.
H. Avoidance of conflicts. Town officers and employees shall not knowingly acquire, solicit, negotiate for, or accept any interest, employment, or other thing of value which would put them in violation of this Code of Ethics.
I. Conflict with other codes of conduct.

(1) Recognizing the need for professional integrity and the fact that various professional associations have adopted standards of conduct for their members, the Town hereby requires that each Town officer or employee who is affected by a professional Code of Ethics be bound, in addition to the within chapter, by his/her respective code of ethics. Any conflict between the provisions of this chapter and a given professional code of conduct of a Town officer or employee is to be resolved by the Ethics Board. However, the Ethics Board must at all times give the greatest latitude to said individual's professional code of conduct and, whenever possible, reconcile this to complement and respect the individual's professional code of conduct.
(2) Substantial consideration shall be given to the effect that deviation from an individual's professional code of conduct will have on that individual's ability to practice his/her profession. If need be, the Ethics Board is authorized and required to obtain advisory opinions from the appropriate professional association to clarify any given situation.
§ 31-6 Specific Town officers and employees.

A. Specific officers and employees.

(1) Professionally licensed. All Town officers and employees with professional licenses are prohibited from knowingly exercising discretion in any matter of Town interest which shall involve any person, firm or corporation which is a client of his/hers or a client of his/her firm or has been a client within the immediate past one year and shall not knowingly have any interest in or accept compensation, direct or indirect, from any person, firm or corporation which has an interest in matters coming before any Town agency or before any public benefit corporation whose members are appointed by the Supervisor or the Town Board

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R’dam to open bids on emergency services
John Purcell 03/30/11

Proposed REMS audit remains unscheduled

The long wait is over – emergency medical service providers can now submit bids to provide service for Rotterdam.

For several weeks a resolution has appeared on the Rotterdam Town Board’s agenda to authorize Supervisor Frank Del Gallo to go out for bids for Basic Life Support services and reimbursement of Advance Life Support Services for the town. During its Wednesday, March 23, meeting, the board approved the resolution, which means the town is moving closer to an agreement after the tax district vote that would have provided funding for Rotterdam Emergency Medical Services failed in December by a nearly 2-to-1 margin.

There was no discussion by board members before unanimously voting on the resolution to authorize the bids.

An outspoken critic of REMS and Rotterdam resident Kelly Rhinesmith questioned what is happening with the proposed audit on REMS.

“All along the way, we have had at least three or more proposals by the supervisor to audit REMS over the ALS that has been missing from the town coffers,” said Rhinesmith. “That contract would designate the EMS provider … and that service would always be the first dispatched to all emergencies.”

This would mean whoever is designated handles the majority of billing, said Rhinesmith, which concerned her since there are proposed audits still pending.

“We could be risking a company that we know now has gone though untold amount of money,” she said of REMS. “We are not just talking about small change, we are talking about potentially what is hundreds of thousands of dollars. In my opinion, I think it would be irresponsible until we can at least determine what happened to this money.”

REMS attorney Frank Salamone previously stated the company had kept revenue received from ALS billing after an oral agreement was reached with the previous board, and the money was used for “operational costs,” but Del Gallo has said he wants to see a written agreement or an approved resolution.

“Where is the audit, and are we even going to consider [a bid from REMS] unless and until these questions can be answered and any related determinations can be made?” asked Rhinesmith.

Del Gallo had sent a letter to REMS saying the Town Board would obtain independent auditors, but a vote on the resolution was delayed until the tax district vote was completed and has yet to resurface.

“As far as the money in the audit, you just don’t push the state into doing something, they do it when they get to it,” said Del Gallo. “Once the audit is done, and if we find some money is missing or not … then at least we will have a chance to get that money, hopefully.”

Rhinesmith had also questioned if it was necessary to have a formal bidding process since it won’t be costing the town money, but Del Gallo said due to the amount of potential revenue, it is needed.

“Whether its REMS, Mohawk, or the man on the moon, we don’t care, because it still has to go out for bid because of the cost,” said Del Gallo.

Until an audit is completed, Del Gallo said he thought “you were innocent until you were proven guilty.”.............>>>>.......................>>>>......................http://www.spotlightnews.com/news/view_news.php?news_id=1301517159