Definitions

Definitions. EMS Provider Levels of Care MS EMS provider levels of care, their definitions, and respective scope of practice shall follow nationally recognized levels of care in the field of Emergency Medical Services, as defined in the current iteration of the National EMS Scope of Practice Model. Approved MS EMS education programs shall educate EMS providers in competencies for each respective level of care as prescribed in the current iteration of the National EMS Education Standards. The State EMS Medical Director may approve EMS protocols for ambulance services and Non-Transport EMS entities that follow the National Model EMS Clinical Guidelines. EMS protocols submitted to BEMS for approval shall delineate emergency care authorized for each respective level of EMS provider, not to exceed the National EMS Scope of Practice Model and National Model EMS Clinical Guidelines. State approved nationally recognized levels of EMS provider include: 1. Emergency Medical Responder (titled Medical First Responder) 2. Emergency Medical Technician (EMT) 3. Advanced EMT (AEMT) 4. Paramedic On request of the off-line medical director, and approval of MDTQA, skills beyond those prescribed in the National EMS Scope of Practice Model may be approved at any of the preceding provider levels through the adoption of approved clinical standards; however, the off-line medical director must verify skill competencies annually for any skill approved by MDTQA beyond those included in the National EMS Scope of Practice Model. BEMS shall publish the list of any skills and clinical standards approved beyond those included in the National EMS Scope of Practice Model along with the expected competencies to be verified annually. MS EMS provider levels shall also include EMS Driver and Critical Care Paramedic (as defined in this Part). The following terms shall have the following meanings as used in this Part: 1. "Advanced Life Support" means the provision of an ALS assessment by ALS personnel or the provision of at least one ALS intervention which includes basic life support functions including cardiopulmonary resuscitation( CPR), plus cardiac defibrillation, telemetered electrocardiography, administration antiarrhythmic agents, intravenous therapy, administration of specific medications, drugs and solutions, use of adjunctive ventilation devices, trauma care and other authorized techniques and procedures. Advanced life support (ALS) assessment is an assessment performed by an ALS crew as part of an emergency response that was necessary because the patient's reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment. An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service. In the case of an appropriately dispatched ALS emergency service, if the ALS crew completes an ALS assessment, the services provided are at the ALS emergency level. This is regardless of whether the patient required ALS intervention services during the transport and provided the ambulance transportation itself was medically reasonable. 2. "Advanced Life Support personnel" means persons other than physicians engaged in the provision of advanced life support, as defined, and regulated by rules and regulations promulgated pursuant to Section 41-60-13. 3. "Advanced Life Support services" means implementation of the 15 components of an EMS system to a level capability which provides noninvasive and invasive emergency patient care designed to optimize the patient's chances of surviving the emergency situation. Services shall include use of sophisticated transportation vehicles, a communications capability (two-way voice and/or biomedical telemetry) and staffing by Advanced EMTs and Paramedics providing on- site, pre-hospital mobile and hospital intensive care under medical control. 4. "Ambulance" means any privately or publicly owned land or air vehicle that is specially designed, constructed, modified, or equipped to be used, maintained and operated upon the streets, highway or airways of this state to assist persons who are sick, injured, wounded or otherwise incapacitated or helpless, and as required by this Part properly licensed by BEMS. 5. "Ambulance Placement Strategy (System Status Plan)" means a planned outline or protocol governing the deployment and event-driven redeployment of the ambulance service's resources, both geographically and by time-of-day/day-of-week. 6. "Ambulance Post" means a designated location for ambulance placement within the system status plan. Depending upon its frequency and type of use, a "post" may be a facility with sleeping quarters, and/or day rooms for crews, or simply a street-corner or parking lot location to which units are sometimes deployed. 7. "Ambulance Service Area" means the geographic response area of the licensed ambulance service. The service area must correspond to each individual service license. The service's employee staffing plan, ambulance placement strategy, and available resources must be commensurate with the service area. 8. "Area wide EMS System" means an emergency medical service area (trade, catchment, market, patient flow) that provides essentially all the definitive emergency medical care (95%) for all emergencies, including the most critically ill and injured patients. Only highly specialized and limited-use services may need to be obtained outside of the area. The area must contain adequate population and available medical resources to implement and sustain an EMS operation. At least three major modes exist: (a) multiple urbanized communities and their related suburbs; (b) a metropolitan center and its surrounding rural areas; and (c) a metropolitan center and extreme rural-wilderness settings. The areas may be inter- or intra-state. 9. "Automated External Defibrillator (AED)" means a defibrillator which: a) is capable of cardiac rhythm analysis; b) will charge and deliver a shock after electrically detecting the presence of a cardiac dysrhythmia or is a shock-advisory device in which the defibrillator will analyze the rhythm and display on-screen advising the operator to press a "shock" control to deliver the shock; c) must be capable of printing a post event summary (at a minimum the post event summary should include times, joules delivered, ECG), and d) an on screen display of the ECG (optional). 10. "Basic Life Support Services (BLS)" means implementation of the 15 components of and EMS system to a level of capability which provides pre-hospital noninvasive emergency patient care designed to optimize the patient's chance of surviving the emergency situation. There would be universal access to and dispatch of national standard ambulances, with appropriate medical and communication equipment operated by Emergency Medical Technicians-Ambulance. Regional triage protocols should be used to direct patients to appropriately categorized hospitals. 11. "Board" means the Mississippi State Board of Health. 12. “Bypass” (diversion) means a medical protocol or medical order for the transport of an EMS patient past a normally used EMS receiving facility to a designated medical facility for the purpose for accessing more readily available or appropriate medical care. 13. "Certificate” means official acknowledgment that an individual has successfully completed (i) the recommended basic emergency medical technician training course referred to in this chapter which entitles that individual to perform the functions and duties of an emergency medical technician, or (ii) the recommended medical first responder training course referred to in this chapter which entitles that individual to perform the functions and duties of a medical first responder. 14. "Critical Care Units (Centers)" means sophisticated treatment facilities in large medical centers and hospitals that provide advanced definitive care for the most critically ill patients. The units are available for the diagnosis and care of specific patient problems including major trauma, burn, spinal cord injury, poisoning, acute cardiac, high-risk infant, and behavioral emergencies. 15. "Communication Resource" means an entity responsible for implementation of direct medical control (See detailed description in section on Medical Direction). 16. "Delegated Practice" means only physicians are licensed to practice medicine. Pre-hospital providers must act only under the medical direction of a physician. 17. “Department” means the Mississippi State Department of Health, Bureau of Emergency Medical Services. 18. "Direct Medical Control" means when a physician provides immediate medical direction to pre- hospital providers in remote locations. 19. “Diversion” - see "Bypass." 20. "DOT" means the United States Department of Transportation. 21. "Emergency Medical Condition" means a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, psychiatric disturbances and/or symptoms of substance abuse, such that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part; 22. "Emergency Medical Services (EMS)" means services utilized in responding to a perceived individual's need for immediate medical care to prevent death or aggravation of physiological or psychological illness or injury. 23. "EMS Personnel" means key individual EMS providers. This includes physician, emergency, and critical care nurse, EMT, Advanced EMT, Paramedic, dispatchers, telephone screeners, first aid responders, project administrators and medical consultants and system coordinators. 24. "EMS System" means a system which provides for the arrangement of personnel, facilities, and equipment of the effective and coordinated delivery of health care services in an appropriate geographical area under emergency conditions (occurring as a result of the patient's condition or because of natural disasters or similar conditions). The system is managed by a public or nonprofit private entity. The components of an EMS System include: A. Manpower B. Training C. Communications D. Transportation E. Facilities F. Critical Care Units G. Public Safety Agencies H. Consumer Participation I. Access to Care J. Patient Transfer K. Coordinated Patient Recordkeeping L. Public Information and Education M. Review and Evaluation N. Disaster Plan O. Mutual Aid 25. "Emergency mode" means an ambulance or special use EMS vehicle operating with emergency lights and warning siren (or warning siren and air horn) while engaged in an emergency medical call. 26. "Emergency response" means responding immediately at the basic life support or advanced life support level of service to an emergency medical call. An immediate response is one in which the ambulance supplier begins as quickly as possible to take the steps necessary to respond to the call. 27. "Emergency medical call" means a situation that is presumptively classified at time of dispatch to have a high index of probability that an emergency medical condition or other situation exists that requires medical intervention as soon as possible to reduce the seriousness of the situation, or when the exact circumstances are unknown, but the nature of the request is suggestive of a true emergency where a patient may be at risk. 28. "Executive officer" means the executive officer of the State Department of Health or his designated representative. 29. “Field Categorization” (classification) means a medical emergency classification procedure for patients that is applicable under conditions encountered at the site of a medical emergency. 30. “Field Triage” means classification of patients according to medical need at the scene of an injury or onset of an illness. 31. "First responder" means a person who uses a limited amount of equipment to perform the initial assessment of and intervention with sick, wounded or otherwise incapacitated persons. 32. “Inclusive Trauma Care System” means a trauma care system that incorporates every health care facility in a community in a system in order to provide a continuum of services for all injured persons who require care in an acute care facility; in such a system, the injured patient's needs are matched to the appropriate hospital resources. 33. "Implied Consent" means legal position that assumes an unconscious patient, or one so badly injured or ill that he cannot respond, would consent to receiving emergency care. Implied consent applies to children when a parent or guardian is not at the scene. 34. "Intervener Physicians" means a licensed M.D. or D.O., having not previously established a doctor/patient relationship with the emergency patient and willing to accept responsibility for a medical emergency scene, and can provide proof of a current Medical Licensure. 35. "Lead Agency" means an organization which has been delegated the responsibility for coordinating all components and care aspects for an EMS system. 36. “Level I” means hospitals that have met the requirements for Level I as stated in the Mississippi Trauma Rules and Regulations. 37. “Level II” means hospitals that have met the requirements for Level II as stated in Mississippi Trauma Rules and Regulations. 38. “Level III” means hospitals that have met the requirements for Level III as stated in Mississippi Trauma Rules and Regulations. 39. “Level IV” means hospitals that have met the requirements for Level IV as stated in Mississippi Trauma Rules and Regulations. 40. "Licensure" means an authorization to any person, firm, cooperation, or governmental division or agency to provide ambulance services in the State of Mississippi. 41. "License Location" means a fixed location where the ambulance service conducts business or controls the deployment of ambulances to the service area. 42. “Major Trauma” means that subset of injuries that encompasses the patient with or at risk for the most severe or critical types of injury and therefore requires a system approach in order to save life and limb. 43. “Major Trauma Patient” (or "major trauma" or " critically injured patient") means a person who has sustained acute injury and by means of a standardized field triage criteria (anatomic, physiology, and mechanism of injury) is judged to be at significant risk of mortality or major morbidity. 44. “Mechanism of Injury” means the source of forces that produce mechanical deformations and physiological responses that cause an anatomic lesion of functional change in humans. 45. "Medical Control" means directions and advice provided from a centrally designated medical facility staffed by appropriate personnel, operating under medical supervision, supplying professional support through radio or telephonic communication for on-site and in-transit basic and advanced life support services given by field and satellite facility personnel. Statewide medical control may be approved by BEMS for Primary Agencies of Emergency Support Function 8 (ESF-8) in the Mississippi Comprehensive Emergency Management Plan. 46. "Medical Direction" - (medical accountability) means when a physician is identified to develop, implement, and evaluate all medical aspects of an EMS system. 47. "Medical Director" means (offline, administrative) should be a physician both credible and knowledgeable in EMS systems planning, implementation, and operations. This off-line physician assumes total responsibility for the system's activities. He is appointed by the local EMS lead agency. The administrative medical director works in close liaison with government agencies, public safety and disaster operations, legislative and executive offices, professional societies, and the public. Off-line program activities include liaison with other state and regional EMS medical directors to conceptualize clinical and component system designs, establish standards, monitor, and evaluate the integration of component and system activities. A. This off-line physician assures medical soundness and appropriateness of all aspects of the program and is responsible for the conceptual and systems design and overall supervision of the EMS program. B. The administrative (off-line) medical director develops all area protocols. These protocols serve as the basis for EMS system role definition of EMS personnel, curriculum development, competency determination, and maintenance, monitoring, and evaluation. C. The off-line medical director meets on a regular basis with on- line medical directors and the EMS training director to evaluate on-line system performance, to review problems, and suggest changes in treatment, triage, or operational protocols. All on- line medical directors must be approved by the off-line medical director. 48. “Mississippi Trauma Advisory Committee” (MTAC) - (See Appendix A) means the advisory body created by legislature for the purpose of providing assistance in all areas of trauma care system development and technical support to the Department of Health; members are comprised of EMS Advisory Council members appointed by the chairman. 49. “Mississippi Trauma Care System Plan” (State Trauma Plan) means a formally organized plan developed by the Mississippi State Department of Health, pursuant to legislative directive, which sets out a comprehensive system of prevention and management of major traumatic injuries. 50. "On-Line (Supervising ALS) Medical Director" means On-Line medical control is provided through designated Primary Resource and Base Station Hospitals under the area direction of a supervisory ALS medical director who is on-line to the pre-hospital system stationed at the designated Base Station Hospital. Each provider of ALS must also have an on-line medical director. The system must also have an on-line medical director for EMS training. These supervisory medical directors are organizationally responsible to the administrative off-line medical director of the local EMS lead agency for program implementation and operations within his area of jurisdiction. A. The ALS (on-line) medical director supervises the advanced life support, pre- and inter-hospital system and is responsible for the actual day-to-day operation of the EMS system. He carries out the "EMS systems design" in terms of pre-and inter-hospital transportation care and provides ALS direction to EMS providers depending on the transportation care and provides ALS direction to EMS providers depending on the system's configuration. He monitors all pre- hospital ALS activities within that system's region or area of responsibility. The ALS physician must review and monitor compliance to protocols for both the pre-and inter- hospital settings. B. The ALS (on-line) medical director in conjunction with the EMS training medical director reviews paramedics, Advanced EMTs, EMTs, mobile intensive care nurses, and physician competencies and recommends certification, re-certification, and decertification of these personnel to the EMS health officer of the lead agency responsible for the certification decertification, and recertification of EMS personnel. Monitoring the competency of all pre- hospital EMS personnel activities is within his responsibility. C. He or she attends medical control meetings where area system performance and problems are discussed and recommendations to the administrative off-line director are made. He also conducts regular case reviews and other competency evaluation and maintenance procedures and reports back to the administrative (off-line) medical director. D. This ALS (on-line) physician assumes the supervision and responsibility for all advanced care rendered in an emergency at the scene of an accident and en route to the hospital under his area jurisdiction. Each on-line medical director representing the hospitals providing medical control has the authority to delegate his duties to other emergency department physicians who may be on duty and placed in a position of giving medical direction to pre-hospital ALS personnel. 51. “Pediatric Trauma Center” means either (a) a licensed acute care hospital which typically treats persons fourteen (14) years of age or less, which meets all relevant criteria contained in these Regulations and which has been designated as a pediatric Trauma Center; or (b) the pediatric component of a Trauma Center with pediatric specialist and a pediatric intensive care unit. 52. “Performance Improvement” (or "quality improvement") means a method of evaluating and improving processes of patient care which emphasizes a multi-disciplinary approach to problem solving, and focuses not on individuals, but systems of patient care which might cause variations in patient outcome. 53. "Permit" means an authorization issued for an ambulance vehicle as meeting the standards adopted pursuant to this chapter. 54. "Pre-hospital Provider" means all personnel providing emergency medical care in a location remote from facilities capable of providing definitive medical care. 55. “Protocols” means standards for EMS practice in a variety of situations within the EMS system. 56. “Service Area” (or "catchment area") means that geographic service area defined by the local EMS agency licensure. Statewide medical control may be approved by BEMS for Primary Agencies of Emergency Support Function 8 (ESF-8) in the Mississippi Comprehensive Emergency Management Plan. 57. “Standing Orders” are those specific portions of the treatment protocols that may be carried out by ALS personnel without having to establish contact with medical control facility. These standing orders represent nationally recognized treatment modalities and allow the ALS personnel to treat life-threatening problems without delay. 58. “State EMS Medical Director” means a Mississippi licensed physician, employed by the Mississippi Department of Health, who is responsible for the development, implementation, and evaluation of standards and guidelines for the provision of emergency medical services and EMS medical direction in the state. This physician must have experience in EMS medical direction and be board certified in emergency medicine. This physician must be experienced with EMS systems, EMS medical direction, evaluation processes, teaching, and curriculum development. It is the goal of the State EMS Medical Director to ensure the care delivered by EMS systems in the state is consistent with recognized standards and that quality is maintained in a manner that assures professional and public accountability. The State EMS Medical Director must serve as an advocate for efficient and effective emergency medical services throughout the state. The Responsibilities of the State EMS Medical Director include but are not limited to: A. Oversight of all aspects of EMS Medical direction in the state Oversight of the of standards and minimum qualifications for EMS Medical Directors B. Approval of Offline Medical Directors for ambulance services C. Approval of protocols for ambulance services D. Approve training programs, training standards, and curricula for EMS providers and medical directors E. Oversight of all aspects of EMS quality assurance and performance improvement in the state F. Approval of the Quality Assurance and Performance Improvement plans for ambulance services G. Serve as Chairman of the Committee on Medical Direction, Training, and Quality Assurance H. Serve as Chairman of the EMS Performance Improvement Committee I. Serve as Chairman of the EMS Protocol Committee J. Act as a liaison with public safety and disaster planning agencies K. Act as a liaison with national EMS agencies L. Oversight of issues related to complaints, investigations, disciplinary procedures involving patient care, performance standards, and medical direction 59. “State Trauma Plan” – See Mississippi Trauma Care Plan 60. “Subscription” means a program that allows customers to pay an up- front established fee to offset any future emergency medical transport expenses. 61. “Surveillance” means the ongoing and systematic collection, analysis, and interpretation of health data in the process of describing and monitoring a health event. “Trauma” - a term derived from the Greek for "wound"; it refers to any bodily injury (see "Injury"). 62. “Trauma Care Facility” (or "trauma center") means a hospital that has been designated by the department to perform specified trauma care services within a Trauma Care Region pursuant to standards adopted by the department. 63. “Trauma Care System Planning and Development Act of 1990” means the federal law that amended the Public Health Service Act to add Title XII - Trauma Programs. The purpose of the legislation being to assist State governments in developing, implementing, and improving regional systems of trauma care, and to fund research and demonstration projects to improve rural EMS and trauma. 64. “Trauma Care System” means an organized approach to treating patients with acute injuries; it provides dedicated (available 24 hours a day) personnel, facilities, and equipment for effective and coordinated trauma care in an appropriate geographical region, known as a Trauma Care Region. 65. “Trauma Center Designation” means the process by which the Department identifies facilities within a Trauma Care Region. 66. “Trauma Program Manager” means a designated individual with responsibility for coordination of all activities on the trauma service and works in collaboration with the trauma service director. 67. "Transfer" - The movement (including the discharge) of a patient outside a hospital's facilities at the direction of any person employed by (or affiliated or associated, directly or indirectly with) the hospital, but does not include such a movement of a patient who (a) has been declared dead, or (b) leaves the facility without the permission of any such person. 68. "Treatment Protocols" means written uniform treatment and care plans for emergency and critical patients. These treatment plans must be approved and signed by the off-line medical director and/or medical groups. (Appendix 2) 69. “Triage” means the process of sorting injured patients on the basis of the actual or perceived degree of injury and assigning them to the most effective and efficient regional care resources, in order to insure optimal care and the best chance of survival.