Definitions in
RCW
18.71.200,
18.71.205,
18.73.030, and
70.168.015 and the definitions in
this section apply throughout this chapter unless the context clearly requires
otherwise.
(1) "Activation of the
trauma system" means mobilizing resources to care for a trauma patient in
accordance with regional patient care procedures.
(2) "Adolescence" means the period of
physical and psychological development from the onset of puberty to maturity,
approximately 12 to 18 years of age.
(3) "Advanced cardiac life support (ACLS)"
means a training course established with national standards recognized by the
department that includes the education and clinical interventions used to treat
cardiac arrest and other acute cardiac related problems.
(4) "Advanced emergency medical technician
(AEMT)" means a person who has been examined and certified by the secretary as
an intermediate life support technician as defined in
RCW
18.71.200 and
18.71.205.
(5) "Advanced first aid" means an advanced
first-aid course prescribed by the American Red Cross or its
equivalent.
(6) "Advanced life
support (ALS)" means the level of care or service that involves invasive
emergency medical procedures requiring the advanced medical treatment skills of
a paramedic.
(7) "Agency response
time" means the interval from dispatch to arrival on the scene.
(8) "Aid service" means an EMS agency
licensed by the secretary to operate one or more aid vehicles, consistent with
regional and state plans, and the department-approved license application. Aid
services respond with aid equipment and certified emergency medical services
providers to the scene of an emergency to provide initial care and treatment to
ill or injured people.
(9)
"Ambulance" or "aid service activation" means the dispatch or other initiation
of a response by an ambulance or aid service to provide prehospital care or
interfacility ambulance transport.
(10) "Ambulance service" means an EMS agency
licensed by the secretary to operate one or more ground or air ambulances,
consistent with regional and state plans, and the department-approved license
application.
(11) "Approved" means
approved by the department of health.
(12) "ATLS" means advanced trauma life
support, a course developed by the American College of Surgeons.
(13) "Attending surgeon" means a physician
who is board-certified or board-qualified in general surgery, and who has
surgical privileges delineated by the facility's medical staff. The attending
surgeon is responsible for care of the trauma patient, participates in all
major therapeutic decisions, and is present during operative
procedures.
(14) "Available" for
designated trauma services described in WAC
246-976-485 through
246-976-890 means physically
present in the facility and able to deliver care to the patient within the time
specified. If no time is specified, the equipment or personnel must be
available as reasonable and appropriate for the needs of the patient.
(15) "Basic life support (BLS)" means the
level of care or service that involves basic emergency medical procedures
requiring basic medical treatment skills as defined in chapter 18.73
RCW.
(16) "Board certified" or
"board-certified" means that a physician has been certified by the appropriate
specialty board recognized by the American Board of Medical Specialties. For
the purposes of this chapter, references to "board certified" include
physicians who are board-qualified.
(17) "Board-qualified" means physicians who
have graduated less than five years previously from a residency program
accredited for the appropriate specialty by the accreditation council for
graduate medical education.
(18)
"BP" means blood pressure.
(19)
"Certification" means the secretary recognizes that an individual has proof of
meeting predetermined qualifications, and authorizes the individual to perform
certain procedures.
(20) "Consumer"
means an individual who is not associated with the EMS/TC system, either for
pay or as a volunteer, except for service on the steering committee, or
regional or local EMS/TC councils.
(21) "Continuing medical education method
(CME method)" means a method of obtaining education required for the
recertification of EMS providers. The CME method requires the successful
completion of department-approved knowledge and practical skill certification
examinations to recertify.
(22)
"County operating procedures (COPs)" means department-approved written
operational procedures adopted by the county MPD and the local EMS council.
COPs provide county level guidance and operational direction which supports the
delivery of patient care and coordination of patient transport and movement
within the local emergency care system. COPs must be compatible with and work
in coordination with state triage and destination procedures, regional patient
care procedures, and patient care protocols.
(23) "CPR" means cardiopulmonary
resuscitation.
(24) "Data user"
means any individual who may access or possess data for any use, including
quality improvement, administrative record keeping, research, surveillance, or
evaluation.
(25) "Data use
agreement" means a signed agreement with the department for transmitting,
receiving, and using records containing individually identifiable or
potentially identifiable health information. The agreement specifies, at a
minimum what information will be exchanged, the conditions or restrictions
under which the information will be used and protected, restrictions on
redisclosure of data and restrictions on attempt to locate information
associated with a specific individual.
(26) "Department" means the Washington state
department of health.
(27)
"Dispatch" means to identify and direct an emergency response unit to an
incident location.
(28) "Diversion"
means the EMS transport of a patient past the usual receiving facility to
another facility due to temporary unavailability of care resources at the usual
receiving facility.
(29) "E-code"
means external cause code, an etiology included in the International
Classification of Diseases (ICD).
(30) "ED" means emergency
department.
(31) "Electronic
patient care report" means the record of patient care produced in an electronic
data system.
(32) "EMS agency"
means an EMS service such as an emergency services supervisory organization
(ESSO), aid or ambulance service licensed or recognized by the secretary to
provide prehospital care or interfacility transport.
(33) "Emergency medical procedures" means the
skills that are performed within the scope of practice of EMS personnel
certified by the secretary under chapters 18.71 and 18.73 RCW.
(34) "Emergency medical services and trauma
care (EMS/TC) system" means an organized approach to providing personnel,
facilities, and equipment for effective and coordinated medical treatment of
patients with a medical emergency or injury requiring immediate medical or
surgical intervention to prevent death or disability. The emergency medical
services and trauma care system includes prevention activities, prehospital
care, hospital care, and rehabilitation.
(35) "Emergency medical responder (EMR)"
means a person who has been examined and certified by the secretary as a first
responder to render prehospital EMS care as defined in
RCW
18.73.081.
(36) "Emergency medical technician (EMT)"
means a person who has been examined and certified by the secretary as an EMT
to render prehospital EMS care as defined in
RCW
18.73.081.
(37) "EMS" means emergency medical
services.
(38) "EMS provider" means
an individual certified by the secretary or the University of Washington School
of Medicine under chapters 18.71 and 18.73 RCW to provide prehospital emergency
response, patient care, and transport.
(39) "Emergency services supervisory
organization (ESSO)" means an entity that is authorized by the secretary to use
first responders to provide medical evaluation and initial treatment to sick or
injured people, while in the course of duties with the organization for on-site
medical care prior to any necessary activation of emergency medical services.
ESSOs include law enforcement agencies, disaster management organizations,
search and rescue operations, and diversion centers.
(40) "EMS/TC" means emergency medical
services and trauma care.
(41)
"Endorsement" means a higher form of recognition that requires successful
completion of a department-approved MPD specialized training course.
Endorsements are added to an EMS providers primary EMS certification.
(42) "General surgeon" means a licensed
physician who has completed a residency program in surgery and who has surgical
privileges delineated by the facility.
(43) "ICD" means the international
classification of diseases, a coding system developed by the World Health
Organization.
(44) "Initial
recognition application procedure (IRAP)" means the application and procedure
that a senior EMS instructor (SEI) candidate must complete and submit to the
department to apply for initial recognition as an SEI.
(45) "Injury and violence prevention" means
any combination of educational, legislative, enforcement, engineering and
emergency response initiatives used to reduce the number and severity of
injuries.
(46) "Interfacility
transport" means medical transport of a patient between recognized medical
treatment facilities requested by a licensed health care provider.
(47) "Intermediate life support (ILS)" means
the level of care or service that may involve invasive emergency medical
procedures requiring the medical treatment skills of an advanced emergency
medical technician (AEMT).
(48)
"Venous access" means a fluid or medication administered directly into the
venous system.
(49) "Local council"
means a local EMS/TC council authorized by
RCW
70.168.120(1).
(50) "Medical control" means oral or written
direction provided by the MPD or MPD physician delegate to EMS providers who
provide medical care to patients of all age groups.
(51) "Medical control agreement" means a
department-approved written agreement between two or more MPDs, that provides
guidance regarding aspects of medical oversight to support continuity of
patient care between counties. MPD agreements must be compatible and work in
coordination with state triage and destination procedures, county operating
procedures, patient care procedures, and patient care protocols.
(52) "Medical program director (MPD)" means a
person who meets the requirements of chapters 18.71 and 18.73 RCW and is
certified by the secretary as the county MPD. The MPD is responsible for both
the supervision of training and medical control of EMS providers.
(53) "
Medical program director delegate (MPD
delegate)" means a
physician appointed by the MPD and recognized and
approved
by the
department. An MPD delegate may be:
(a)
A prehospital training physician who supervises specified aspects of training
EMS personnel; or
(b) A prehospital
supervising physician who provides online medical control of EMS
personnel.
(54) "Medical
program director policy" means a department-approved written policy adopted by
the county MPD that establishes expectations, procedures, and guidance related
to the administrative activities of providing oversight to EMS providers and
are within the roles and responsibilities of the MPD.
(55) "National Emergency Medical Services
Information System (NEMSIS)" means the national database used to store EMS data
from the U.S. States and Territories and is a national standard for how
prehospital and interfacility transport information is collected.
(56) "Ongoing training and evaluation program
(OTEP)" means a continuous program of education for the recertification of EMS
providers. An OTEP must be approved by the MPD and the department.
(57) "Pediatric advanced life support (PALS)"
means a training course established with department recognized national
standards for clinical interventions used to treat pediatric cardiac arrest and
other acute cardiac related problems.
(58) "Paramedic" or "physician's trained
emergency medical service paramedic" means a person who has been trained in an
approved program to perform all phases of prehospital emergency medical care,
including advanced life support, under written or oral authorization of an MPD
or approved physician delegate, examined and certified by the secretary under
chapter 18.71 RCW.
(59) "
Pediatric
education requirement (PER)" means the pediatric education and training
standards required for certain specialty physicians and nurses who care for
pediatric patients in designated trauma services as identified in WAC
246-976-886 and
246-976-887.
(60)
"Pediatric education for prehospital providers (PEPP)" means a training course
for EMS providers established with department recognized national standards for
clinical interventions used to treat pediatric emergencies.
(61) "Physician" means an individual licensed
under the provisions of chapters 18.71 or 18.57 RCW.
(62) "Physician with specific delineation of
surgical privileges" means a physician with surgical privileges delineated for
emergency/life-saving surgical intervention and stabilization of a trauma
patient prior to transfer to a higher level of care. Surgery privileges are
awarded by the facility's credentialing process.
(63) "Postgraduate year" means the
classification system for residents who are undergoing postgraduate training.
The number indicates the year the resident is in during the resident's
postmedical school residency program.
(64) "Practical skills examination" means a
test conducted in an initial course, or a test conducted during a
recertification period, to determine competence in each of the practical skills
or group of skills specified by the department.
(65) "Prehospital index (PHI)" means a
scoring system used to trigger activation of a hospital trauma resuscitation
team.
(66) "Prehospital patient
care protocols" means the department-approved, written orders adopted by the
MPD under RCW 18.73.030
(16) and
70.168.015(27)
which direct the out-of-hospital care of patients. These protocols are related
only to delivery and documentation of direct patient treatment. The protocols
meet or exceed statewide minimum standards developed by the department in rule
as authorized in chapter 70.168 RCW. Protocols must be compatible with and work
in coordination with state triage and destination procedures, regional patient
care procedures, and county operating procedures.
(67) "Prehospital provider" means EMS
provider.
(68) "Prehospital trauma
care service" means an EMS agency that is verified by the secretary to provide
prehospital trauma care.
(69)
"Prehospital trauma life support (PHTLS)" means a training course for EMS
providers established with department recognized national standards for
clinical interventions used to treat trauma patients.
(70) "Prehospital triage and destination
procedure" means the statewide minimum standard and method used by prehospital
providers to evaluate patients for time sensitive emergencies, identify the
most appropriate destination, and alert the receiving facility of the patient's
condition to help inform activation of the trauma, cardiac or stroke system of
care from the field.
(71) "Public
education" means education of the population at large, targeted groups, or
individuals, in preventive measures and efforts to alter specific injury,
trauma, and medical-related behaviors.
(72) "Quality improvement (QI)" or "quality
assurance (QA)" means a process/program to monitor and evaluate care provided
in the EMS/TC system.
(73)
"Recertification" means the process of renewing a current EMS
certification.
(74) "Recognition
application procedure (RAP)" means the application and procedure that must be
completed by a department recognized senior EMS instructor (SEI) to apply for
renewal of an SEI recognition.
(75)
"Regional council" means the regional EMS/TC council established by
RCW
70.168.100.
(76) "Regional patient care procedure (PCP)"
means department-approved written operating guidelines adopted by the regional
emergency medical services and trauma care council, in consultation with the
local emergency medical services and trauma care councils, emergency
communication centers, and the emergency medical services county medical
program directors. PCPs provide an operational framework and broad overarching
guidance for the coordination of patient transport and movement within the
regional emergency care system. PCPs identify the level of medical care
personnel to be dispatched to an emergency scene, procedures for triage of
patients, the level of trauma care facility, mental health facility, or
chemical dependency program to first receive the patient, and the name and
location of other trauma care facilities, mental health facilities, or chemical
dependency programs to receive the patient should an interfacility transfer be
necessary. Procedures on interfacility transfer of patients are consistent with
the transfer procedures in chapter 70.170 RCW. Patient care procedures do not
relate to direct patient care and must be compatible with and work in
coordination with state triage and destination procedures.
(77) "
Regional plan" means the plan defined
in WAC
246-976-960
(1)(b) that has been
approved by the
department.
(78) "Registered nurse"
means an individual licensed under the provisions of chapter 18.79
RCW.
(79) "Reinstatement" means the
process of reissuing an EMS certification that is revoked or suspended by the
department.
(80) "Reissuance" means
the process of reissuing a certification that is expired.
(81) "Reversion" means the process of
reverting a current EMS certification to a lower level of EMS
certification.
(82) "Rural" means
an unincorporated or incorporated area with a total population of less than
10,000 people, or with a population density of less than 1,000 people per
square mile.
(83) "Secretary" means
the secretary of the department of health.
(84) "Senior EMS instructor (SEI)" means an
individual approved and recognized by the department to conduct initial
emergency medical responder (EMR) or emergency medical technician (EMT)
training courses.
(85) "
Special
competence" means that an individual has been deemed competent and committed to
a medical specialty area with documented training, board
certification and
experience, which has been reviewed and accepted as evidence of a
practitioner's expertise:
(a) For physicians,
by the facility's medical staff;
(b) For registered nurses, by the facility's
department of nursing;
(c) For
physician assistants and advanced registered nurse practitioners, as defined in
the facility's bylaws.
(86) "Specialty care transport (SCT)" means
the level of care or service needed during an interfacility transport for a
patient who is critically injured or ill and whose condition requires care by a
physician, registered nurse, or a paramedic who has received special training
and approval of the MPD.
(87)
"State plan" means the emergency medical services and trauma care system plan
described in
RCW
70.168.015(7), adopted by
the department under
RCW
70.168.060(10).
(88) "Steering committee" means the EMS/TC
steering committee created by
RCW
70.168.020.
(89) "
Substance use disorder professional
(SUDP)" means an individual certified in substance use disorder counseling
under chapters 18.205 RCW and
246-811 WAC.
(90) "Suburban" means an incorporated or
unincorporated area with a population of 10,000 to 29,999 or any area with a
population density of between 1,000 and 2,000 people per square mile.
(91) "System response time" for trauma means
the interval from discovery of an injury until the patient arrives at a
designated trauma facility.
(92)
"Training program" means an organization that is approved by the department to
conduct initial and ongoing EMS training as identified in the approved training
program application on file with the department.
(93) "Training program director" means the
individual responsible for oversight of a department-approved EMS training
program.
(94) "Trauma registry"
means the statewide data registry to collect data on incidence, severity, and
causes of trauma described in
RCW
70.168.090(1).
(95) "Trauma rehabilitation coordinator"
means a person designated to facilitate early rehabilitation interventions and
the trauma patient's access to a designated rehabilitation center.
(96) "Trauma response area" means a service
coverage zone identified in an approved regional plan.
(97) "Trauma service" means the clinical
service within a hospital or clinic that is designated by the department to
provide care to trauma patients.
(98) "
Urban" means:
(a) An incorporated area over 30,000;
or
(b) An incorporated or
unincorporated area of at least 10,000 people and a population density over
2,000 people per square mile.
(99) "Verification" means an EMS agency is
capable of providing verified trauma care services and is credentialed under
chapters 18.73 and 70.168 RCW.
(100) "Washington EMS information system
(WEMSIS)" means the statewide electronic EMS data system responsible for
collecting EMS data described in
RCW
70.168.090(2).
(101) "WEMSIS data administrator" means an
EMS agency representative who is assigned by their agency as the primary
contact for WEMSIS data submission management as indicated in the
department-approved EMS agency licensing application.
(102) "Wilderness" means any rural area not
readily accessible by public or private maintained road.