Definitions

The definitions set forth in 105 CMR 170.020 shall apply for the purpose of 105 CMR 170.000, unless the context or subject matter clearly requires a different interpretation. Accreditation means the process by which a certificate is issued by the Department pursuant to 105 CMR 170.946 through 170.950 indicating that the holder has met the requirements for providing Department-approved training for EMTs and EMT-candidates. Administrative Requirements (A/R) means requirements issued by the Department’s Office of Emergency Medical Services to interpret, clarify and further define the application of certain provisions of 105 CMR 170.000. Advanced EMT means the level of EMS personnel that has replaced "EMT-Intermediate" as set forth, at a minimum, in the U.S. Department of Transportation's National Highway Traffic Safety Administration's National EMS Scope of Practice Model and as used in its National EMS Education Standards. The Advanced EMT’s clinical practice is defined by the Statewide Treatment Protocols. Advanced Life Support (ALS) means the pre-hospital use of medical techniques and skills defined by the Statewide Treatment Protocols by Paramedics and Advanced EMTs certified pursuant to 105 CMR 170.000. Ambulance means any aircraft, boat, motor vehicle, or any other means of transportation, however named, whether privately or publicly owned, which is intended to be used for, and is maintained and operated for, the response to and the transportation of sick or injured individuals. Ambulance Service means the business or regular activity, whether for profit or not, of providing emergency medical services, emergency response, primary ambulance response, pre-hospital emergency care, with or without transportation, to sick or injured individuals by ambulance. Appropriate Health Care Facility means an emergency department, either physically located within an acute care hospital licensed by the Department pursuant to 105 CMR 130.000: Hospital Licensure to provide emergency services, or in a satellite emergency facility approved by the Department pursuant to 105 CMR 130.821: Approval for Satellite Emergency Facility, that is closest by transport time or conforms to a Department-approved point-of-entry plan. EMS personnel may, upon the direction of an emergency department physician, take incoming ambulance patients to one of the following other hospital departments, based on the patient’s medical needs: labor and delivery, cardiac catheterization, operating room, interventional neurology, intensive care unit, pediatric emergency department area, burn resuscitation and treatment area or acute resuscitation area. An appropriate health care facility also means a facility that meets the definition of a community behavioral health center (CBHC) established by the Executive Office of Health and Human Services that is closest by transport time, but only as set out in a Department-approved point-of-entry plan and only for those patients who fit triage criteria set out in a Department-approved point-of-entry plan. Authorization to Practice means approval granted to an EMT by his or her employing EMS service's affiliate hospital medical director, which enables that EMT to work as an EMT and receive medical control pursuant to the employing service's affiliation agreement and in conformance with the Statewide Treatment Protocols. Basic Life Support (BLS) means the pre-hospital use of techniques and skills defined by the Statewide Treatment Protocols by EMT-Basics certified pursuant to 105 CMR 170.000. Certificate of Inspection means the formal certification, issued pursuant to 105 CMR 170.415, that the EMS vehicle meets the standards applicable to its type or class of vehicle. Certification of EMTs means a process by which a certificate is issued by the Department indicating that the holder has met the requirements for an EMT at a specified level of training established by the Department. Chief Examiner means a person appointed by the Department who is responsible for the organization and operation of a Department-approved EMT examination at a specific site. CMED means the medical communications subsystem within the statewide EMS communications system. Code Black Status System means a secure cloud-based system established by the Department to allow hospitals and CMED centers access to real-time information regarding the code black status of all appropriate health care facilities in Massachusetts licensed to provide emergency services. Commission on Accreditation of Allied Health Education Programs (CAAHEP) means the national accrediting organization for educational programs in allied health professions, which reviews and accredits EMS programs in collaboration with its Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP). Commission on Accreditation of Medical Transport Systems (CAMTS) means the national accrediting organization for air medical and ground transport systems providing critical care services. Commissioner means the Commissioner of Public Health. Company means a corporation, a partnership, a business trust, an association, or an organized group of persons, whether incorporated or not; or any receiver, trustee, or other liquidating agent of any of the foregoing while acting in such capacity. Critical Care Services means the provision by an ambulance service of prehospital or interfacility patient care, stabilization, and transport services to critically ill and injured patients, using medical techniques, pharmacology, and technological life support systems that exceed those in the Statewide Treatment Protocols, including the ALS Interfacility Transfer Protocol, and as set out by the ambulance service and approved by the Department. Continuing Education means instructional courses for certified EMS personnel to meet training requirements for maintenance of certification. Department means the Department of Public Health. Emergency means a condition or situation in which an individual has a need for immediate medical attention, or where the potential for such need is perceived by the individual, a bystander or an emergency medical services provider. Emergency Medical Services (EMS) means the pre-hospital assessment, treatment and other services utilized in responding to an emergency or provided during the emergency or inter- facility transport of patients to appropriate health care facilities. EMS First Responder (EFR) means a person certified pursuant to 105 CMR 170.000 who has, at a minimum, successfully completed a course in emergency medical care approved by the Department pursuant to M.G.L. c. 111, § 201 and 105 CMR 171.000: Massachusetts First Responder Training and who provides emergency medical care through employment by or in association with a licensed EFR service. EMS First Response means the dispatch and response by the closest, most appropriate EMS personnel or EMS vehicle in the shortest practicable amount of time by a qualified EMS first response service. EMS First Response Service (EFR Service) means the business or regular activity, whether for profit or not, by a licensed EMS provider, designated as a service zone provider pursuant to a Department-approved service zone plan for the purpose of providing rapid response and EMS. EMS First Response Vehicle (EFR Vehicle) means any aircraft, boat, motor vehicle or any other means of transportation, whether privately or publicly owned, that is intended and is maintained and operated for the rapid response of EMS personnel, equipment and supplies to emergencies by an EFR service or by an ambulance service and is not utilized for patient transport. EMS Personnel means EFRs and EMTs. EMS Plan means a plan that includes an inventory and assessment of EMS resources and a plan for the optimal maintenance, coordination and utilization of those resources: (1) to improve the EMS system and its component elements; and (2) to coordinate with all state and municipal public safety agencies’ mass casualty and other public emergency plans. EMS Provider means the following: (1) an EFR service, an ambulance service, or a hospital or facility approved by the Department to provide EMS including, without limitation, a trauma center, or (2) any individual associated with an EFR service, an ambulance service, or a hospital or facility approved by the Department to provide EMS, who is engaged in providing EMS. Such individuals include, without limitation, an EMT, an EFR, a medical communications system operator and a medical control physician, to the extent such physician provides EMS. EMS System means all EMS providers and equipment; communications systems linking them to each other; training and education programs; the Regional EMS Councils and all of their operations; EMS plans, protocols, statutes, regulations, administrative requirements and guidelines; and all other components of such system, and their interaction with each other and with patients, providing equally for all patients quality care, operating under the leadership and direction of the Department. EMS Vehicle means an ambulance or an EMS first response vehicle. Emergency Medical Technician (EMT) means a person who has successfully completed a full course in emergency medical care approved by the Department, and who is certified by the Department in accordance with 105 CMR 170.000 to provide emergency medical services to sick or injured persons in accordance with the Statewide Treatment Protocols. The term EMT shall include EMT-Basic, Advanced EMT, and Paramedic. Emergency Response means the dispatch and response of the closest appropriate ambulance, EMS personnel and other EMS vehicle to an emergency in the shortest practicable amount of time in conformance with the service zone plan. EMT-Basic means the level "Emergency Medical Technician," or "EMT" as set forth, at a minimum, in the U.S. Department of Transportation's National Highway Traffic Safety Administration's National EMS Scope of Practice Model and as used in its National EMS Education Standards. The term also includes EMT-Basics who are taking the supplemental training required to meet the EMT level of the National EMS Scope of Practice Model, in accordance with administrative requirements of the Department. The EMT-Basic’s clinical practice is defined by the Statewide Treatment Protocols. First Responder means a member of any of the following entities: a police or fire department; state police participating in highway patrol; an emergency reserve unit of a volunteer fire department or fire protection district, and any persons appointed permanent or temporary lifeguards by the Commonwealth or any of its political subdivisions. A first responder shall not mean a police officer, firefighter or person engaged in police and fire work whose duties are primarily clerical or administrative. First responders are required to successfully complete, at a minimum, the course of emergency medical care that meets the standards of M.G.L. c. 111, § 201 and 105 CMR 171.000: Massachusetts First Responder Training. First Responder Agency means a police department, a fire department, the state police participating in highway patrol, an emergency reserve unit of a volunteer fire department or fire protection district, or the Commonwealth or any of its political subdivisions that appoints permanent or temporary lifeguards. A first responder agency shall not mean a service that is a licensed EFR service. Headquarters means the principal place of business of an Ambulance or EFR service. Hospital means a hospital that is licensed or certified by the Department pursuant to M.G.L. c. 111, § 51 or other applicable law, with an emergency department, and which is established or maintained for the purpose of caring for persons admitted thereto for diagnosis, medical, surgical or restorative treatment which is rendered within said institution Immediate Dispatch means dispatching, or toning out or calling for an ambulance, to be sent out, without any delay, when a call to respond to an emergency is received. Immediate dispatch includes the toning out for on-call or volunteer personnel to respond to and staff an ambulance. Initial Training means an educational program that meets or exceeds the current U.S. Department of Transportation's National EMS Education Standards and Instructional Guidelines for EMT-Basic, Advanced EMT or Paramedic, and any additional standards established by the Department, and consists of didactic, clinical and field training, to prepare students to become certified EMTs at the applicable level of care. Instructor/Coordinator (I/C) means a person approved by the Department to organize and teach the EMT-Basic or Advanced EMT course. License means an authorization to provide ambulance or EMS first response service, pursuant to the provisions of 105 CMR 170.000. Local Jurisdiction means an entity empowered by the legislative body within a city, town, fire district or water district to select service zone providers including, but not limited to, a city council, board of selectmen, board of aldermen, mayor or town manager. Massachusetts Emergency Medical Care Advisory Board (EMCAB) means the EMS System Advisory Board established under M.G.L. c. 111C, § 13. Medical Control means the clinical oversight by a qualified physician to all components of the EMS system including, without limitation, the Statewide Treatment Protocols, medical direction, training of and authorization to practice for EMS personnel, quality assurance and continuous quality improvement. Medical Direction means the authorization for treatment established in the Statewide Treatment Protocols provided by a qualified medical control physician to EMS personnel, whether on-line, via direct communication or telecommunication, or off-line, via standing orders. National Registry of Emergency Medical Technicians (NREMT) means the national organization that tests and provides NREMT certification to EMTs at all levels, on the basis of which EMTs apply to states for state certification or licensure to work as an EMT. Paramedic means the level of EMS personnel that has replaced "EMT-paramedic" as set forth, at a minimum, in the U.S. Department of Transportation's National Highway Traffic Safety Administration's National EMS Scope of Practice Model and as used in its National EMS Education Standards. The Paramedic’s clinical practice is defined by the Statewide Treatment Protocols. Patient means an individual who is sick or injured and requires EMS and/or transportation in an ambulance. Patient Care Report means a report or other written record, such as a dispatch record, generated by all services to document every response to an EMS call including each time an EMS vehicle is dispatched, whether or not a patient is encountered or ultimately transported by an ambulance service. Person means an individual, a company, or an entity or an agency or political subdivision of the Commonwealth. Place of Business means the locations owned, leased or used pursuant to an agreement by an EMS provider for EMS purposes including headquarters, branch offices and garages. Point-of-entry Plan means a plan that is designed to ensure that EMTs transport a patient(s) in their care to the closest appropriate health care facility. Primary Ambulance Response means first-line ambulance response, pre-hospital treatment and transportation by an ambulance service designated as a service zone provider or recognized in the service zone plan to provide first-line ambulance response, pre-hospital treatment and transportation pursuant to a provider contract. Primary Ambulance Service means the business or regular activity, whether for profit or not, by a licensed ambulance service, designated under a service zone plan for the purpose of providing rapid response and pre-hospital EMS including, without limitation, patient assessment, patient treatment, patient preparation for transport and patient transport to appropriate health care facilities, in conformance with the service zone plan. Professional Boundaries means the limits of the professional relationship to ensure a safe interface between a professional, such as EMS personnel, EMS training providers and EMS Examiners and Chief Examiners, and their respective patients, candidates or students. A violation of Professional Boundaries includes an action that is harmful to or exploitative of the patient, student or, candidate and can be either sexual or nonsexual in nature. Provider Contract means an agreement, written or verbal, with an ambulance service to provide primary ambulance response to facilities with health care professionals on site, or to special events or functions with a dedicated ambulance on site. This definition shall not preclude any other category of provider contract that is recognized by the local jurisdiction in the service zone plan. Recertification Year means April 1st of one calendar year through March 31st of the next calendar year. Region means a geographic area of the state defined by the Department as an EMS planning area. Regional EMS Council means an entity created pursuant to M.G.L. c. 111C, § 4 and designated by the Department to assist the Department in coordinating, maintaining and improving the EMS system in a region. Regular Operating Area means any local jurisdiction or part thereof in which the ambulance service: (1) is the designated primary ambulance service; (2) has an agreement with the primary ambulance service; (3) has an agreement to provide backup service; (4) has a provider contract; or (5) has a base location. Service means an EFR service or an ambulance service. Service Zone means a geographic area defined by and comprised of one or more local jurisdictions, in which a local jurisdiction may select, and the Department shall designate, an EFR service and an ambulance service to provide EMS first response and primary ambulance response to the public within that defined geographic area, pursuant to M.G.L. c. 111C, § 10. Service Zone Provider means an EMS provider, selected by a local jurisdiction and designated by the Department to provide primary ambulance service or EMS first response, or both, to the public within a service zone. A service zone provider shall be staffed and equipped to be available for primary ambulance service or EMS first response 24 hours per day, seven days per week. Special Population means any person or group of persons with unique medical, physical or social problems that require other than customary emergency medical care. Statewide Treatment Protocols means the Emergency Medical Services Pre-hospital Treatment Protocols approved by the Department for application statewide. Trained to the First Responder Level means successful completion, at a minimum, of the course of emergency medical care that meets the standards of M.G.L. c. 111, § 201 and 105 CMR 171.000: Massachusetts First Responder Training. Training Institution means a school or other entity that offers initial training and/or continuing education, and refers to such school or other organization only with regard to its provision of EMS training programs. Training Program means an EMS instructional course, offered either as initial training, or continuing education. Transportation means the conveyence of a patient by ambulance because of medical necessity or extenuating circumstances to prevent significant aggravation or deterioration of the patient's condition, or because the condition of the patient is unknown and could reasonably be suspected to warrant the use of an ambulance, or because the patient could not be moved by any other means. Trauma means tissue injury due to the direct effects of externally applied mechanical, thermal, electrical, electromagnetic or nuclear energy, as further defined in the Statewide Treatment Protocols. Trauma shall not mean toxic ingestion, poisoning or foreign body ingestion. Unique Population means the population of a state institution, an industrial plant or a university.