California Ambulance Driver's Handbook Review

General Information and Explanatory Notes

• Handbook Purpose and Scope: The California Highway Patrol (CHP) Ambulance Driver’s Handbook (HPH 82.4) consolidates statutes, regulations, and information regarding the operation and equipment of emergency ambulances. It serves as a reference for ambulance driver certificates, attendant requirements, and service operations.
• Regulatory Compliance: Statutes governing emergency ambulances are established for public health and safety. Compliance, sound judgment, and defensive driving are essential. Regulations in Titles 13 and 22 of the California Code of Regulations (CCR) apply to all publicly and privately owned ambulances used for emergency service.
      * Exclusions: Regulations do not apply to ambulances not used for emergency calls or federally owned and operated ambulances.
• Licensing Requirements: Owners of private ambulance services must be licensed by the CHP pursuant to 13 CCR Section 1107 before responding to emergency calls.
• Definitions (Verbatim):
      * Ambulance: Per 13 CCR Section $1100.2(a)$, ‘a vehicle specially constructed, modified or equipped, and used for the purpose of transporting sick, injured, convalescent, infirm, or otherwise incapacitated persons.’
      * Ambulance Service: Per 13 CCR Section $1100.2(c)$, ‘a private or public organization or individual providing an ambulance for use in emergency service.’
      * Emergency Call: Per 13 CCR Section $1100.2(e)$, ‘a request for an ambulance to transport or assist persons in apparent sudden need of medical attention; or, in a medical emergency, as determined by a physician, to transport blood, any therapeutic device, accessory to such device, or tissue or organ for transplant.’
      * Emergency Service: Per 13 CCR Section $1100.2(f)$, a function ‘performed in response to an emergency call. Emergency service also includes transportation of a patient, regardless of a presumption of death of the patient, or transportation of a body for the purpose of making an anatomical gift.’
• Code 3 Operation: Refers to the use of red lights and siren. These are restricted to authorized emergency vehicles in police, fire, and lifesaving services per Section $30$ of the California Vehicle Code (CVC).
• Convictions Disclosure: Under Penal Code Section $1203.4(a)$, convictions affecting certification remain convictions despite court dismissals or set-aside verdicts. Applicants must disclose convictions in response to direct questions on any questionnaire.
• Ambulance Identification: Per 13 CCR Section $1100.4$, the operating name (public entity or licensee) must be displayed on both sides and the rear of the vehicle. Letters must be in sharp contrast to the background and legible during daylight from a distance of $50\,\text{ft}$. All ambulances under one license must share the same identification.
• Service Availability: Private licensees must have at least one ambulance available $24\,\text{hours}$ daily. Special event or industrial services that do not respond to the general public are exempt from this requirement.
• Fire Extinguishers: Must be dry chemical or carbon dioxide type with a minimum $4\text{-B:C}$ rating. They must be inspected and serviced yearly or immediately after use.
• Ambulance Inspections: Vehicles are inspected initially and annually by the CHP per 13 CCR Section $1107.2$. Drivers must verify the inspection status using form CHP 301 (Special Vehicle Identification Certificate/Permit) or CHP 299 (Ambulance Inspection Report). Random inspections may also occur.
• Exemptions: The CHP cannot grant statutory exemptions; regulatory exemptions require good cause and may require county health officer or board concurrence. Exemptions are valid for a maximum of $2\,\text{years}$, are non-transferable, and expire upon change of ownership.
• Grounds for License Suspension or Revocation: Per Section $2542$ CVC and 13 CCR Section $1109$, grounds include:
      * CVC violations related to licensed activities.
      * Felony convictions or misdemeanors involving moral turpitude.
      * Dishonesty, fraud, or deceit for personal gain.
      * Aiding unlicensed persons in evading traffic laws.
      * Failure to keep or make records available for $3\,\text{years}$.
      * Unlawful use of sirens/lamps and demonstrated incompetence in patient care.
      * Fraudulent billing practices.

Ambulance Driver Certification

• Basic Requirements: Drivers must be at least $18$ years of age, hold a valid California Driver License, and possess an ambulance driver certificate (CVC Section $12527$).
• Certificate Exemptions:
      * Salaried, full-time police officers, deputy sheriffs, or fire department members of public agencies while on duty. Volunteers and part-time members are not exempt.
      * Out-of-state drivers providing interstate service only, if licensed in their origin state.
• Application Process and Fees: Applications are made at the DMV.
      * Initial fee: $\$57.00$ ($\$25.00$ for the certificate and $\$32.00$ for fingerprints).
      * Renewal fee: $\$12.00$.
• Prerequisites: Knowledge test, Live Scan fingerprints, and submission of a medical certification for commercial vehicle operation.
• Certificate Terms:
      * Temporary Certificate: Issued upon passing tests and fingerprinting; valid for $180\,\text{days}$.
      * Regular Certificate: Issued after background review; valid for a term not exceeding $5\,\text{years}$, expiring on the same date as the driver license.
      * Conditional Validity: Valid only with a CA Driver License and a medical certificate issued within the preceding $2\,\text{years}$. Within $1\,\text{year}$ of initial issuance, the driver must possess an EMT-1 certificate or equivalent training license.
• Denial, Suspension, and Revocation (Section 13372 CVC):
      * Mandatory: Sex offenders (PC Section 290), habitual drug users, or those on parole/probation for felonies or crimes of violence.
      * Discretionary: Felony/theft conviction within $7\,\text{years}$, moral turpitude within $7\,\text{years}$, habitual alcohol use, DL suspension for unsafe operations within $3\,\text{years}$, or involvement in a motor vehicle accident causing death/injury (or $3$ accidents in one year).
• Hearings and Reviews: Disqualified applicants may request a hearing in writing within $15\,\text{days}$ of notice. An informal hearing is conducted by a DMV referee, followed by a final decision from a committee representing the DMV, EMSA, and CHP.

Ambulance Personnel Training and Operations

• Management Responsibilities: Owners must ensure drivers demonstrate proficiency in operating their assigned ambulance before unsupervised use (13 CCR Section $1106(a)$). Owners must participate in the DMV Pull Notice System.
• Personnel Files: Must include employment date, license facsimiles, medical training evidence, and a $5\text{-year}$ work history summary.
• Driver Responsibilities:
      * Must respond promptly to emergency calls or notify dispatchers immediately if unable to respond.
      * Speed must not exceed $15\,\text{mph}$ when disobeying official traffic control stop signs or signals (13 CCR Section $1105[b]$).
      * Patients must be taken to the most accessible facility equipped to handle their needs.
      * Code 3 (lights and siren) is prohibited in heavy congestion where no time advantage is gained.
• Authorized Emergency Vehicle (AEV) Privileges: Per CVC Section $21055$, drivers are exempt from various traffic laws IF responding to a call AND sounding a siren with a lighted red lamp visible from the front.
      * Due Regard: Defined by Black's Law Dictionary as ‘consideration in a degree appropriate to the demands of a particular case.’ Section $21056$ CVC mandates drivers maintain due regard and does not protect against an arbitrary exercise of privileges.
• Warning Equipment Visibility: At least one steady burning red lamp must be visible from $1,000\,\text{ft}$ to the front. Flashing upper-beam headlamps are permitted (alternating left/right).
• Safety Precautions During Code 3: Drivers should assume others cannot hear the siren, restrict siren use to effective situations, and avoid passing on the right.
• Inspections: Drivers must inspect ambulances at the beginning of each shift to ensure equipment is functional and the vehicle is safe. Particular attention must be paid to areas where exhaust gases (Carbon Monoxide) might accumulate.

Emergency Medical Services Authority (EMSA) Requirements

• Training Standards: EMT-1 is the minimum standard for ambulance attendants. Advanced Life Support (ALS) levels include AEMT-II and EMT-P. Training should include prevention of infectious diseases and hazardous materials response.
• Medical Control: Local EMS directors establish policies for dispatch, destination, and patient care.
• Essential Equipment List (Pursuant to 13 CCR Section 1103.2):
      * One ambulance cot and one collapsible stretcher (or two stretchers).
      * Patient straps, wrist restraints, and ankle restraints.
      * Sheets, pillowcases, blankets, towels, and $2$ pillows.
      * $3$ oropharyngeal airways (adult, child, infant).
      * At least $4$ pneumatic or rigid splints.
      * Hand-operated bag-valve-mask unit (resuscitator) with clear masks in $3$ sizes.
      * Oxygen supply: regulator and tubing capable of providing $10\,dm^3\,\text{min}^{-1}$ for $20\,\text{min}$.
      * Bandaging: $12$ sterile compress bandages, four $3 \times 3\,\text{in}$ gauze pads, six roller bandages ($2, 3, 4,\,\text{or}\,6\,\text{in}$), two rolls of adhesive tape ($1, 2,\,\text{or}\,3\,\text{in}$), bandage shears, and two $10 \times 30\,\text{in}$ universal dressings.
      * Emesis basin (or disposable bags), portable suction, and $2$ sandbags (or equivalent).
      * Two spinal immobilization devices (one at least $30\,\text{in}$, the other at least $60\,\text{in}$).
      * Half-ring traction splint for lower extremities.
      * Sterile OB supplies (gloves, cord tape/clamps, dressings, bulb syringe).
      * $1\,\text{gallon}$ potable water or $2\,dm^3$ saline solution.
      * Bedpan/fracture pan and one urinal.
• Safety Equipment List:
      * Siren and steady-burning red lamp.
      * Seat belts for driver and front passenger.
      * $4\text{-B:C}$ dry chemical or $CO_2$ fire extinguisher (vaporizing liquid type prohibited).
      * Portable battery-operated light.
      * Spare wheel, inflated tire, jack, and tools.
      * GPS or maps of the service area.
      * Operable interior/exterior door latches for vehicles manufactured after Jan $1$, $1980$.
• Call Records: Every service must retain records of emergency calls for at least $3\,\text{years}$. Records include the time of call, location, arrival/departure times, destination, and patient identity/description.