(a) In rural areas, as determined by the authority, where the use of a base hospital having a basic emergency medical service special permit pursuant to subdivision (c) of Section 1277 is precluded because of geographic or other extenuating circumstances, a local EMS agency, in order to assure medical direction to prehospital emergency medical care personnel, may utilize other hospitals which do not have a basic emergency medical service permit but which have been approved by the medical director of the local EMS agency for utilization as a base hospital, if both of the following apply:

1. (1) Medical control is maintained in accordance with policies and procedures established by the local EMS agency, with the approval of the medical director of the local EMS agency.
2. (2) Approval is secured from the authority.

(b)

1. (1) In rural areas, as determined by the authority, when the use of a hospital having a basic emergency medical service special permit is precluded because of geographic or other extenuating circumstances, as determined by the authority, the medical director of the local EMS agency may authorize another facility which does not have this special permit to receive patients requiring emergency medical services if the facility has adequate staff and equipment to provide these services, as determined by the medical director of the local EMS agency.

2. (2) A local EMS agency which utilizes in its EMS system any facility which does not have a special permit to receive patients requiring emergency medical care pursuant to paragraph (1) shall submit to the authority, as part of the plan required by Section 1797.254, protocols approved by the medical director of the local EMS agency to ensure that the use of that facility is in the best interests of patient care. The protocols addressing patient safety and the use of the nonpermit facility shall take into account, but not be limited to, the following:

   1. (A) The medical staff, and the availability of the staff at various times to care for patients requiring emergency medical services.
   2. (B) The ability of staff to care for the degree and severity of patient injuries.
   3. (C) The equipment and services available at the facility necessary to care for patients requiring emergency medical services and the severity of their injuries.
   4. (D) The availability of more comprehensive emergency medical services and the distance and travel time necessary to make the alternative emergency medical services available.
   5. (E) The time of day and any limitations which may apply for a nonpermit facility to treat patients requiring emergency medical services.
3. (3) Any change in the status of a nonpermit facility, authorized pursuant to this subdivision to care for patients requiring emergency medical services, with respect to protocols and the facility’s ability to care for the patients shall be reported by the facility to the local EMS agency.