Chapter 77
Emergency Medical Services
[HISTORY: Adopted by the Board of Commissioners of Henderson County. Amended 1-19-1983; 5-17-
1995; 11-18-1998;
7-26-2000; 8-1-2005; 9-6-2005; 8-5-2013.] 
§ 77-1. Definitions. 
The following terms are defined for purposes of this Chapter: 
(1)
Ambulance - Any privately or publicly owned motor vehicle, aircraft or vessel that is 
specially designed, constructed or modified and equipped and is intended to be used for 
and is maintained or operated for the transportation on the streets or highways, waterways
or airways of this County of persons who are sick, injured, wounded or otherwise 
incapacitated or helpless and that is permitted by the Department of Human Resources, 
Division of Facility Services, Office of Emergency Medical Services, and any vehicle 
meeting the definition of an "EMS nontransporting vehicle" under Title 10A of the North
Carolina Administrative Code (currently found in 10A NCAC 13P.0109), as it may be 
amended from time to time. 
(2)
Ambulance Provider License  - The legal authorization issued by NCOEMS for a person,
firm, corporation or association to operate an ambulance service within a specified 
geographical service area which includes the areas of Henderson County that a franchisee
is authorized to serve under the terms of the franchise. 
(3)
Ambulance Service - A public or privately owned enterprise that is engaged in the 
transportation of patients to emergency and/or nonemergency medical facilities.   
(4)
Approved - Approved by the North Carolina Medical Care Commission pursuant to the 
latter's rules and regulations promulgated under N.C.G.S. 143B-165.
(5)
Backup Ambulance Service - The system of personnel and equipment meeting the same 
criteria as ambulance service but not normally dispatched at first-call response.   
(6)
County - The County of Henderson Board of Commissioners or designated 
representative.   
(7)
Dispatcher - A person who is available at all times to receive requests for emergency 
services, to dispatch emergency services and to advise the city police, County Sheriff and
emergency medical facilities of any existing or threatened emergencies.   
(8)
Emergency And Emergency Transportation Service - The operation of an ambulance in 
order to provide medical care and transportation of a patient who is in need of immediate 
medical treatment in order to prevent loss of life or further aggravation of physiological 
or psychological illness or injury.   
(9)
Emergency Medical Technician - An individual who has completed a training program in
emergency medical care at least equal to the National Standard Training Program for 
emergency medical technicians as defined by the United States Department of 
Transportation and has been certified as an emergency medical technician by NCOEMS. 
(10)
First Responder - The first dispatched medical or rescue aid to arrive at the scene and 
provide emergency medical assistance to stabilize the patient while waiting for further 
medical aid and/or transport.   
(11)
Franchise - A permit issued by the County to a person for the operation of an ambulance 
service.   
(12)
Franchisee - Any person having been issued a franchise by the County for the operation 
of an ambulance service.   
(13)
License - Any driver's license or permit to operate a motor vehicle issued under or 
granted by the laws of the State of North Carolina. 
(14)  
Medical Responder- An individual who has completed a training program in emergency 
medical care and first aid approved by the North Carolina Office of Emergency Medical 
Services (NCOEMS) and has been certified as a Medical Responder NCOEMS.
(15)
Nonemergency Transportation Services - The operation of an ambulance for any purpose
other than an emergency.   
  
(16)
Operator - A person in actual physical control of an ambulance which is in motion or 
which has the engine running.   
(17)
Owner - Any person or entity who or which owns and operates an ambulance service.   
(18)
Patient - An individual who is sick, injured, wounded or otherwise incapacitated or 
helpless such that the need for some medical assistance might be anticipated.
(19)
Person - Any individual, firm, partnership, association, corporation, company, group of 
individuals acting together for a common purpose or organization of any kind, including 
any governmental agency other than the United States.   
(20)
Rescue - Situations where the victim cannot escape an area through the normal exit or 
under their own power.  
 
§ 77-2. Franchise Required.  
A.
No person, either as owner, agent or otherwise, shall furnish, operate, conduct, maintain, 
advertise or otherwise be engaged in or profess to be engaged in the business or service 
of emergency and/or nonemergency transportation of patients within the County of 
Henderson unless the person holds a valid permit for each ambulance used in such 
business or service issued by the Office of Emergency Medical Services of the North 
Carolina Department of Human Resources and an ambulance provider license and has 
been granted a franchise for the operation of such business or service by the County 
pursuant to this Chapter.
B.
No person shall operate an ambulance or drive, attend or permit a vehicle to be operated 
for ambulance purposes within the County of Henderson unless he or she holds a 
currently valid certificate as an ambulance attendant or emergency medical technician 
issued by the State of North Carolina, except pursuant to a mutual aid agreement entered 
into between Henderson County and an agency or entity licensed under standards 
comparable to those employed in this Chapter. 
C.
No franchise shall be required for:  
(1)
Any entity rendering assistance at the request of Henderson County in the case 
of a major catastrophe or other emergency situation for which the services of 
Henderson County are insufficient or unable to cope. 
(2)
Any entity operated from a location or headquarters outside of Henderson 
County in order to transport patients who are picked up beyond the limits of 
Henderson County, but no such entity shall be used to pick up patients  
within the County of Henderson for transporting to locations within the County 
of Henderson unless it is rendering assistance as referred to in Subsection C (1).
(3)
Law enforcement personnel.  
(4)
County-owned and -operated ambulances. 
(5)
Hospital transportation services for the purpose of patient transfer in which the 
service is exclusively owned and operated by one of the hospitals involved.  
(6)
Medical air ambulances which are properly licensed to provide emergency 
medical transportation services.  
 
§ 77-3. Franchise Application. 
Application for a franchise to operate ambulances in the County of Henderson shall be made upon such
forms as may be prepared or prescribed by the County and shall contain:  
A.
The name and address of the applicant and of the owner of the ambulance.  
B.
The trade or other fictitious names, if any, under which the applicant does business along
with a certified copy of an assumed name certificate stating such name or articles of 
incorporation stating such name.  
C.
A transcript of the training and experience of the applicant in the transportation and care 
of  patients including references from every location in which the applicant has been 
franchised for the past 15 years, if any.
D.
A description and copy of state certification for each ambulance owned and operated by 
the applicant.  
E.
A description and copy of the ambulance provider license issued by NCOEMS.
F.
The location and description of the place from which it is intended to operate.  
  
G.
An audited financial statement of the applicant as the same pertains to the operations in 
the County of Henderson, said financial statement to be in such form and in such detail as
may be required by the County.  
H.
A description of the applicant's capability to provide 24 hour coverage, 7 days per week, 
for the district covered by the franchise applied for and an accurate estimate of the 
minimum and maximum time for a response call within such districts demonstrating that 
minimum and maximum response times within the district covered by the franchise 
applied for would meet the requirements for the level of service for which application is 
made.   
I.
A description of:
(1)
Proposed service area
(2)
Arrangements for medical direction and oversight.
(3)
Agency medical certification level for NCOEMS.
(4)
Compliance plan for EMS system continuing education training requirements.
J.
Any information the County shall deem reasonably necessary for a fair determination of 
the capability of the applicant to provide ambulance service in the County of Henderson 
in accordance with the requirements of state laws and the provisions of this regulation.  
K.
The County reserves the right to deny any application if the Board of Commissioners 
finds the grant of such application is contrary to the interest of the citizens of the County. 
 
§ 77-4. Grant of Franchise.  
A.
Prior to accepting applications from applicants for the operation of an ambulance service,
the Board of Commissioners may designate specific service areas as franchise districts. 
Said districts will be established on criteria that include geographic size, road access, and 
the location of existing medical transportation services, population and response time. 
The Board of Commissioners shall have the authority to redistrict or rearrange existing 
districts at any time at its discretion.  
B.
An applicant may apply for a franchise to operate a nonemergency transportation service.
Emergency transportation services will be provided pursuant to Section 77-2, Subsection 
C (1) of this Chapter.  
C.
Upon receipt of an application for a franchise, the County may schedule a time and place 
for hearing the applicant. Within 90 days after the hearing, the County shall cause such 
investigation as it may deem necessary to be made of the applicant and his proposed 
operations.  
D.
A franchise may be granted if the County finds that:  
(1)
The public convenience and necessity require the proposed ambulance service 
and the franchise will benefit the County.  
(2)
Each such ambulance of the applicant, his required equipment and the premises 
designated in the application has been certified by the County and the State of 
North Carolina.  
(3)
Only duly licensed ambulance attendants and emergency medical technicians 
are employed in such capacities.
(4)
The franchise will provide services and equipment the County does not or 
cannot provide and will not adversely affect current operations financially or 
otherwise.    
  
§ 77-5. Term of Franchise.  
A.
The County may issue a franchise hereunder to an owner of an ambulance service, to be 
valid for a term to be determined by the County, provided that either, as its option, may 
terminate the franchise upon 60 days' prior written notice to the other party. After a 
notice of service termination is given, the ambulance service shall reapply for a franchise 
if continued service is desired.  
B.
If any franchisee shall violate or fail to comply with any provision of this Chapter or a 
franchise issued hereunder, said franchisee shall be cited by the County for said violation 
or failure to comply. The County, after a hearing pursuant to the citation, may impose a 
civil penalty as provided in § 77-13 hereinafter or may suspend or revoke the franchise. 
  
If, upon such hearing, the County shall find that the franchisee has corrected any 
deficiencies and has brought the operation into compliance with the provisions of this 
Chapter, the franchise may not be suspended, revoked, or a civil penalty as provided 
in § 77-13 hereinafter may be imposed.
C.
Upon suspension, revocation or termination of a franchise granted hereunder, such 
franchised ambulance service immediately shall cease operations. Upon suspension, 
revocation or termination of a driver's license or medical responders certificate or 
emergency medical technician certificate, such person shall cease to drive an ambulance 
or provide medical care in conjunction with an ambulance service or attend an 
ambulance, and no person shall employ or permit such individual to drive an ambulance 
or provide medical care in conjunction with an ambulance service.    
§ 77-6. Operation of Franchise; Sale or Transfer.  
A.
Each franchised ambulance service shall comply at all times with the requirements of this
Chapter, the franchise granted hereunder and all applicable state and local laws relating to
health, sanitation, safety, equipment and ambulance design and all other laws and 
ordinances. Each franchised ambulance service shall also comply at all times with the 
then-current Henderson County Emergency Services program. Each franchised 
ambulance service shall be provided with a copy of this program and all its requirements 
at the time of the grant of its franchise, and shall be provided with copies of all 
amendments to the program. 
B.
Prior approval of the County shall be required where ownership or control of more than 
10% of the right of control of the franchisee is acquired by a person or group of persons 
acting in concert, none of whom own or control 10% or more of such right of control, 
singularly or collectively, at the date of the franchise. By its acceptance of the franchise, 
the franchisee specifically agrees that any such acquisition occurring without prior 
approval of the County shall constitute a violation of the franchise by the franchisee and 
shall be cause for termination at the option of the County.  
C.
Any change of ownership of a franchised ambulance service without the approval of the 
County shall terminate the franchise and shall require a new application and a new 
franchise and conformance with all the requirements of this chapter as upon original 
franchising.  
D.
No franchise may be sold, assigned, mortgaged or otherwise transferred without the 
approval of the County and a finding of conformance with all requirements of this 
chapter as upon original franchising. Each franchised ambulance service, its equipment 
and the premises designated in the application, and all records relating to its maintenance 
and operation, as such, shall be open to inspection by the state, the County or their 
designated representatives.  
E.
No official entry made upon a franchise may be defeated, removed or obliterated.  
  
§ 77-7. Drivers and Attendants. 
Standards for drivers and attendants as developed by the North Carolina Medical Care Commission as
requirements for certification of medical responders and emergency medical technicians pursuant to 
are incorporated herein by reference.  
§ 77-8. Vehicles and Equipment. 
Vehicle and equipment standards as developed by the North Carolina Medical Care Commission pursuant
are incorporated herein by reference.  
§ 77-9. Communications.  
A.
Each ambulance must be equipped with a two-way VHF radio licensed by the Federal 
Communications Commission which must be in operative condition at all times.  
  
B.
Each ambulance service shall provide the County a copy of the Federal Communications 
Commission license authorizing the use of the communication equipment owned and 
operated by that service.  
C.
Each base of operations must have at least one open telephone line. Telephone numbers 
must be registered with each law enforcement agency and communications center in the 
County of Henderson.    
§
77-10. Insurance. 
No ambulance franchise shall be issued under this Chapter, nor shall such franchise be valid after issuance,
nor shall any ambulance be operated in the County of Henderson, unless there is at all times in force and
effect insurance coverage, issued by an insurance company licensed to do business in the State of North
Carolina, for each and every ambulance owned and/or operated by or for the ambulance service providing
the payment of damages:  
A.
In the sum of no less than $1,000,000 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  
B.
In the sum of $1,000,000 for the loss of or damage to the property of another, including 
personal property, under like circumstances, in sums as may be required by the State of 
North Carolina or as approved by the County of Henderson.
   
§ 77-11. Records. 
Each franchisee shall maintain the following records:  
A.
Record of dispatch, which shall show the time the call,
was received, the time the 
ambulance dispatched, the time arrived on the scene, the time arrived at destination, the 
time in service and the time returned to base.  
B.
Trip record, which shall state all information required in Subsection A, in addition to the 
patient's address and telephone number, condition of the patient, type of medical 
assistance administered before reaching the hospital, total trip miles, schedule of charges 
and the name of the attendant and the driver. The trip record shall be so designated as to 
provide the patient with a copy thereof containing all required information. A copy of the
trip record may serve as a receipt for any charges made.  
C.
Daily report log, which shall be maintained for the purpose of identifying more than 1 
person transported in any 1 day.  
D.
Daily driver and attendant checklist and inspection report, which shall list contents and 
description of operations for each vehicle, signed by the individual verifying vehicle 
operations and equipment.  
E.
Monthly activities report, which shall be submitted as requested to the Henderson County
Emergency Medical Services. 
   
§ 77-12. Rates and Charges.  
A.
The franchisee must keep on file with the Henderson County Office of Emergency 
Medical Services its current rate schedule for services provided in accordance with the 
franchise. The franchisee is expressly prohibited from charging any rate of service that 
exceeds the comparable rate of service charged by Henderson County without first 
obtaining specific approval from the Henderson County Board of Commissioners. 
B.
No ambulance service shall attempt to collect rates on emergency calls until the patient 
has reached the point of destination, has received medical attention and is in a condition 
deemed by the physician fit to consult with the ambulance service, but such service may 
attempt to collect rates with the family or guardian of the patient once the patient is in the
process of receiving medical attention.  
C.
On nonemergency calls, or calls where a person requires transportation to a 
nonemergency facility, attempts to collect payment can be made before the ambulance 
begins its trip. 
   
  
§ 77-13. Violations and Penalties. 
Violation of this Chapter, or the terms of any franchise granted hereunder, shall be subject to the penalties
set forth in Henderson County Code, Chapter 1, General Provisions, Article II.  
§ 77-14. Enforcement. 
The Henderson County Office of Emergency Medical Services shall be the enforcing agency for the
regulations contained in this Chapter. Such office will:  
A.
Receive all franchise proposals from potential providers.  
B.
Study each proposal for conformance with this Chapter.  
C.
Recommend to the Board of Commissioners whether or not to award the franchise to the 
applicant.
D.
Inspect the premises, vehicles, equipment and personnel of franchisees to assure 
compliance with this Chapter and perform any other inspections that may be required.  
E.
Recommend the temporary or permanent suspension of a franchise in the event of 
noncompliance with the franchise terms of this Chapter.  
F.
Recommend the imposition of misdemeanor or civil penalties.  
G.
Ensure by cooperative agreement with other ambulance services the continued service in 
a district where an ambulance service franchise has been suspended.  
H.
Bi-annually or as requested receive reports from ambulance services and consolidate the 
same into a summary for review by the Board of Commissioners upon request.
I.
Receive complaints from the public, other enforcing agencies and ambulance services 
regarding franchise infractions, review the complaint and recommend actions to the 
Board of Commissioners.  
J.
Recommend improvements to the County which will ensure better medical 
transportation.  
K.
Maintain all
records required by this chapter and other applicable County regulations. 
   
§ 77-15. Territorial Jurisdiction. 
The provisions of this Chapter shall apply in both the incorporated and unincorporated areas within the
geographic confines of the County of Henderson.  
§ 77-16. Inspections. 
The County may inspect a franchisee's records, premises and equipment at any time in order to ensure
compliance with this Chapter and any franchise granted hereunder.  
§ 77-17. Amendments. 
The Board of Commissioners of the County of Henderson may, through appropriate actions, amend or
expand this Chapter to include other emergency departments or agencies as deemed necessary.  
§ 77-18. Through
77-35. (Reserved)