In Tennessee, there are several different ways that counties ensure that the citizens are provided with adequate emergency medical care. They include:
- County government-operated exclusive provider
- County EMS providing emergency (911) transportation with a third-party ambulance provider for non-emergency transports
- Third-party EMS services with or without regulation by county government
Tennessee county governments are authorized to provide ambulance services. This authorization is granted by T.C.A. § 7-61-102.
All county governing bodies are authorized and directed to make provisions to ensure that at least one licensed ambulance service is available within their county. This may be provided as a county service, but can also be accomplished through other means, including, but not limited to: providing a license or franchise to a private company; contracting with a public, private, or nonprofit entity for the service; entering into an interlocal agreement with one or more local governments; or entering into an agreement with a hospital or other healthcare facility. A county is not required to appropriate county revenues for ambulance service if the service can be provided by any other means. T.C.A. § 7-61-102(b).
The governing body of any county may adopt and enforce reasonable regulations to control the provision of private or nonprofit ambulance service. T.C.A. § 7-61-102(e).
A county can not provide and maintain, license, franchise, or contract for ambulance service within the boundaries of a municipality that has made provisions for ambulance service without the approval of the municipal governing body of the area to be served. T.C.A. § 7-61-102(d).
Counties are authorized to provide ambulance service to cities or another county as a long as the governing body of that city or county has formalized the arrangement. T.C.A. § 7-61-102(f) states:
(1) Except as provided in subdivision (f)(2), any two (2) or more counties and municipalities may enter into agreements with each other and with persons providing both emergency and nonemergency ambulance service for a county or counties on a countywide basis, for joint or cooperative action to provide for ambulance service as authorized in this chapter.
(2) In any county having a metropolitan form of government and a population in excess of five hundred thousand (500,000), or in any county having a population of not less than eight hundred twenty-five thousand (825,000) nor more than eight hundred thirty thousand (830,000), according to the 1990 federal census or any subsequent federal census, any two (2) or more counties and municipalities may enter into agreements for joint or cooperative action to provide for ambulance service as authorized in this chapter.
Counties are authorized under T.C.A. § 5-16-101(b)(2) to operate emergency medical services and charge fees or rates for such services under the urban type public facilities law.
The Emergency Medical Services Act of 1983, T.C.A. § 68-140-301 et seq., establishes a state emergency medical services board to regulate agencies that provide ambulance and emergency medical services. Although counties are not required to provide ambulance services (T.C.A. § 68-140-318), they must comply with this act if they choose to provide them. T.C.A. § 68-140-316.
The regulation of EMS services is needed to ensure that an acceptable level of emergency medical service is provided to the citizens of the county. These regulations may include a performance-based contract with penalty provisions for non-compliance, or a determination that it is in the best interest of the county to be the sole provider of ambulance services.
In summary, counties are authorized but not required to provide an ambulance service. Counties may choose to provide the ambulance service exclusively or to regulate third party services; they may also contract for the provision of this service by private entities or other governmental agencies. Counties are authorized to charge fees or rates for such services under the urban type public facilities law.