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HomeMy WebLinkAboutCovenant Medical Center/WaterlooFireRescue/BlackHawkDispatch-3/2/2015EMS CONTINGENCY PLAN AGREEMENT Section 1. Identity of Parties. Covenant Medical Center, Inc. Ambulance Service 3421 West 9th Street Waterloo, IA 50702 Waterloo Fire Rescue 425 East 3rd Street Waterloo, IA 50703 Black Hawk County Dispatch 225 East fith Street Waterloo, IA 50703 Section 2. Purpose of Agreement. Iowa law requires an ambulance service program to maintain an EMS contingency plan that will be put into operation when coverage pursuant to the 2417 rule is not possible due to unforeseen circumstances. This agreement will allow participating ambulance services to ensure patient transportation is available, define the responsibilities of each program, and provide risk management. An EMS contingency plan is defined as "an agreement or dispatching policy between two or more ambulance service programs that addresses how and under what circumstances patient transportation will be provided in a given service area." 641 Iowa Administrative Code 132.1 (147A). A transport agreement is defined as "a written agreement between two or more service programs that specifies the duties and responsibilities of the agreeing parties to ensure appropriate transportation of patients in a given service area." 641 Iowa Administrative Code 132.1 (147A). For purposes of this agreement, the "requesting service program" is the ambulance service program which requests assistance pursuant to this agreement and the "responding service program" is the ambulance service program which is requested to respond pursuant to this agreement. Parties to the agreement may function as either requesting service programs or responding service programs depending on the circumstances of the response. The parties have entered into this agreement to effectuate these requirements. Section 3. Duties and Responsibilities. 3.1 Authority to Request and Provide Assistance. The senior EMT of a service program or his or her designee shall have the authority to make a request for assistance or to provide assistance under this agreement. All requests for assistance shall be placed through the local communications center. Page 1 of 4 3.2 When Assistance May Be Requested. Assistance pursuant to this agreement may be requested when an unforeseen incident or event occurs, including but not limited to equipment or vehicle malfunction, failure, or unavailability, or staff illness or injury. 3.3 Response to Request. The responding service program shall determine the availability of staff and vehicles and either respond or notify the communications center to dispatch another program. Notwithstanding anything to the contrary in this agreement, responding service program retains sole discretion whether to respond to any request for assistance, based on its own needs and other factors it considers relevant at the time, and the responding service program will not be liable for any injury, death, damage or loss - resulting from any decision not to respond to a request for services. In the event of a response, there shall be no liability whatsoever for the responding service program's failure to reach the place of an emergency call whenever such failure is due to events beyond the control of the responding service program, which shall necessarily include but not be limited to weather events or other emergency needs within the jurisdiction of the responding service programs which may impair or prevent a timely response. 3.4 Personnel, Vehicles, and Equipment. The requesting service program shall include in the request for assistance the specific personnel, vehicle, and equipment needs and the location of need. The final decision on the number and nature of personnel, equipment and vehicles to be sent shall be solely that of the responding service program. 3.5 Authority at the Scene. The responding service program shall report to the senior EMT of the requesting service program. The senior EMT of the requesting service program shall have the authority to issue reasonable orders and directives unless he or she relinquishes this authority to another EMS provider of equal or higher certification on either service program. The purpose of this section is to maintain order at the scene and shall not be construed to establish an employee/employer relationship. 3.6 Reporting and Recordkeeping. The requesting service program shall maintain records regarding the frequency of the use of this agreement and provide them to the Bureau of Emergency and Trauma Service upon request. Each service program shall maintain individual patient care reports. Section 4. Duration of Agreement. The agreement shall be in effect upon signature of two or more service programs. The agreement shall be in effect from the date of execution unless terminated earlier in accordance with the termination section of this agreement. Section 5. Compensation/Reimbursement Ambulance service who transports the patient bills the patient or the insurer. In the event Waterloo Fire Rescue transports a patient from one Covenant Campus to another Covenant campus location (Horizon's patient at Kimball Ridge to Covenant Medical Center, Inc. or from the Cancer Treatment Center to Covenant Medical Center, Inc.); Waterloo Fire Rescue will invoice Covenant Medical Center, Inc. for that transfer. Section 6. Termination. Any party to this agreement may withdraw from the agreement by providing thirty days written notice by certified mail to the other parties and to their EMS Regional Coordinator. Staff contact information is available at www.idph.state.ia.us/ems » Bureau » Bureau Staff. If a party withdraws from the agreement, the agreement shall Page 2 of 4 remain in effect as to all remaining parties so long as two or more service programs are parties to the agreement. Section 7. Insurance. Each party to the agreement shall procure and maintain such insurance or self-insurance as is required by applicable federal and state law and as may be appropriate and reasonable to cover its staff, equipment, vehicles, and property, including but not limited to general liability insurance, with minimum limits of $1,000,000 single claim and $3,000,000 aggregate, workers compensation at applicable statutory minimums, unemployment insurance, automobile liability, and property damage. Section 8. Mutual Indemnification. Each party shall indemnify and hold harmless the other from any and all claims, loss, liability or damage of any kind, including but not limited to reasonable attomeys' fees, arising from: (a) the breach of the indemnifying party's obligations or representations hereunder; or (b) the negligent, willful or intentional acts or omissions of the indemnifying party in the performance of its duties under this agreement. Section 9. Status and Responsibilities of Parties. Nothing in this agreement shall be construed as creating or constituting the relationship of partnership or joint venture between the parties hereto. Each party shall be deemed to be an independent contractor. No party, unless otherwise specifically provided for herein, has the authority to enter into any contract or create an obligation or liability on behalf of, in the name of, or biding upon another to this agreement. Each of the parties shall be responsible for ensuring that all persons acting on behalf of the party are properly licensed, certified, or accredited as required by applicable federal and state law. Each of the parties to the agreement shall be responsible for withholding taxes, social security, unemployment, worker's compensation, and other taxes for its employees and shall hold all other parties harmless for the same. Section 10. No Third -Party Beneficiaries. This agreement is entered by the parties for their benefit. There is no intent by any party to create, imply or establish a third -party beneficiary or status or rights in any person except as expressly set forth in this agreement, and no such third party shall have any right to enforce, or any right to enjoy, any benefit created or established under this agreement. Section 11. General Terms. This agreement is the entire agreement between the parties concerning the subject matter hereof. It may not be amended except in a written instrument signed by the parties. This agreement is binding upon and shall inure to the benefit of each party and its respective successors. Time is of the essence hereof. In witness whereof, the parties have executed this EMS Contingency Plan Agreement by their duly authorized representatives. Page 3 of 4 Section 12. Execution. Print Service Name City of Operation Service Contact (print name) Service Representative (signature) Date Covenant Medical Center, Inc. Waterloo, Iowa Tami W. Jones, Director Nursing Operations Michele M. Panicucci,/ Sr. VP/CFO V� r �/ , /31,r' /' Waterloo Fire Ambulance Waterloo, Iowa Bafb-McBride fl f-Vue [CIS (jam t< " a '34 -ii S Black Hawk County Dispatch Waterloo, Iowa Judy Flores 1h d4.1645 v �/P3'6 Page 4 of 4