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TITLE 25HEALTH SERVICES
PART 1DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 157EMERGENCY MEDICAL CARE
SUBCHAPTER AEMERGENCY MEDICAL SERVICES - PART A
RULE §157.2Definitions

The following words and terms, when used in these sections, shall have the following meanings, unless the context clearly indicates otherwise:

  (1) Abandonment - Leaving a patient without medical care once patient contact has been established, unless emergency medical services personnel are following a physician directive or the patient signs a release; turning the care of a patient over to an individual of lesser training when advanced treatment modalities have been initiated to include, but not limited to, IVs, intubation, and drug therapy.

  (2) Accreditation - Formal recognition by a national association of a provider's service or an education program based on voluntarily met standards established by that association.

  (3) Act - Emergency Medical Services Act, Health and Safety Code, Chapter 773.

  (4) Advanced life support (ALS) - Emergency prehospital or interfacility care that uses invasive medical acts. The provision of advanced life support shall be under the medical supervision and control of a licensed physician.

  (5) Advanced life support (ALS) vehicle - A vehicle that is designed for transporting the sick and injured and that meets the requirements of a basic life support vehicle and has sufficient equipment and supplies for providing intravenous therapy and endotracheal or esophageal intubation or both.

  (6) Air ambulance provider - A person who operates/leases a fixed-wing or rotor-wing air ambulance aircraft, equipped and staffed to provide a medical care environment on-board appropriate to the patient's needs. The term air ambulance provider is not synonymous with and does not refer to the Federal Aviation Administration (FAA) air carrier certificate holder unless they also maintain and control the medical aspects that are consistent with EMS provider licensure.

  (7) Basic life support (BLS) - Emergency prehospital or interfacility care that uses noninvasive medical acts. The provision of basic life support shall be under the medical supervision and control of a licensed physician.

  (8) Basic life support (BLS) vehicle - A vehicle that is designed for transporting the sick or injured and that has sufficient equipment and supplies for providing basic life support.

  (9) Basic trauma facility - A hospital designated by the department as having met the criteria for a Level IV trauma facility as described in §157.125 of this title (relating to Requirements for Trauma Facility Designation). Basic trauma facilities provide resuscitation, stabilization, and arrange for appropriate transfer of major and severe trauma patients to a higher level trauma facility, provide ongoing educational opportunities in trauma related topics for health care professionals and the public, and implement targeted injury prevention programs.

  (10) Board - The Texas Board of Health.

  (11) Bureau - The Bureau of Emergency Management of the Texas Department of Health.

  (12) Bureau chief - The chief of the Bureau of Emergency Management.

  (13) Bypass - Direction given to a prehospital emergency medical services unit, by direct/on-line medical control or predetermined triage criteria, to pass the nearest hospital for the most appropriate hospital/trauma facility. Bypass protocols should have local physician input into their development and should be reviewed through the regional performance improvement process.

  (14) Candidate - An individual who is requesting emergency medical services personnel certification or licensure, recertification or relicensure from the Texas Department of Health.

  (15) Certificant - Emergency medical services personnel with current certification from the Texas Department of Health.

  (16) Comprehensive trauma facility - A hospital designated by the department as having met the criteria for a Level I trauma facility as described in §157.125 of this title. Comprehensive trauma facilities manage major and severe trauma patients, provide ongoing educational opportunities in trauma related topics for health care professionals and the public, implement targeted injury prevention programs, and conduct trauma research.

  (17) Course medical director - A licensed physician approved by the department with experience in and current knowledge of emergency care who shall provide direction over all instruction and clinical practice required in EMS training courses.

  (18) Credit hour - Continuing education credit unit awarded for successful completion of a unit of learning activity as defined in §157.32 of this title (relating to EMS Education Program and Course Approval).

  (19) Critically injured person - A person suffering major or severe trauma, with severe multi system injuries or major unisystem injury; the extent of the injury may be difficult to ascertain, but which has the potential of producing mortality or major disability.

  (20) Department - The Texas Department of Health.

  (21) Designation - A formal recognition by the department of a hospital's trauma care capabilities and commitment.

  (22) Diversion - A procedure put into effect by a trauma facility to insure appropriate patient care when that facility is unable to provide the level of care demanded by a trauma patient's injuries or when the facility has temporarily exhausted its resources.

  (23) Emergency call - a telephone call or other similar communication from a member of the public, as part of a 9-1-1 system or other emergency access communication system, made to obtain emergency medical services.

  (24) Emergency care attendant (ECA) - An individual who is certified by the department as minimally proficient to provide emergency prehospital care by providing initial aid that promotes comfort and avoids aggravation of an injury or illness.

  (25) Emergency medical services (EMS) - Services used to respond to an individual's perceived need for immediate medical care and to prevent death or aggravation of physiological or psychological illness or injury.

  (26) Emergency medical services (EMS) operator - a person who, as an employee of a public agency, as that term is defined by Health and Safety Code, §771.001, receives emergency calls.

  (27) Emergency Medical Service Administrator - The principal executive manager of an emergency medical service organization who is responsible for the non-medical operations, staffing, policies and procedures, and overall management of the service.

  (28) Emergency medical services and trauma care system - An arrangement of available resources that are coordinated for the effective delivery of emergency health care services in geographical regions consistent with planning and management standards.

  (29) Emergency medical services personnel -

    (A) emergency care attendant (ECA);

    (B) emergency medical technician (EMT);

    (C) emergency medical technician-intermediate (EMT-I); or

    (D) emergency medical technician-paramedic (EMT-P).

  (30) Emergency medical services (EMS) provider - A person who uses, operates or maintains EMS vehicles and EMS personnel to provide EMS. See §157.11 of this title (relating to Requirements for an EMS Provider License) regarding fee exemption.

  (31) Emergency medical services (EMS) volunteer provider - An EMS which has at least 75% of the total personnel as volunteers and is a nonprofit organization. See §157.11 of this title regarding fee exemption.

  (32) Emergency medical services (EMS) volunteer - EMS personnel who provide emergency prehospital or interfacility care in affiliation with a licensed EMS provider or a registered First Responder organization without remuneration, except for reimbursement for expenses.

  (33) Emergency medical technician (EMT) - An individual who is certified by the department as minimally proficient to perform emergency prehospital care that is necessary for basic life support and that includes the control of hemorrhaging and cardiopulmonary resuscitation.

  (34) Emergency medical technician-intermediate (EMT-I) - An individual who is certified by the department as minimally proficient in performing skills required to provide emergency prehospital or interfacility care by initiating and maintaining under medical supervision certain procedures, including intravenous therapy and endotracheal or esophageal intubation or both.

  (35) Emergency medical technician-paramedic (EMT-P) - An individual who is certified by the department as minimally proficient to provide emergency prehospital or interfacility care by providing advanced life support that includes initiation and maintenance under medical supervision of certain procedures, including intravenous therapy, endotracheal or esophageal intubation or both, electrical cardiac defibrillation or cardioversion, and drug therapy.

  (36) Emergency medical services vehicle-

    (A) basic life support vehicle;

    (B) advanced life support vehicle;

    (C) mobile intensive care unit (MICU);

    (D) MICU rotor wing and MICU fixed wing air medical vehicles; or

    (E) specialized emergency medical service vehicle.

  (37) Emergency prehospital care - Care provided to the sick and injured before or during transportation to a medical facility, including any necessary stabilization of the sick or injured in connection with that transportation.

  (38) Facility triage - The process of assigning patients to an appropriate trauma facility based on injury severity and facility availability.

  (39) General trauma facility - A hospital designated by the department as having met the criteria for a Level III trauma facility as described in §157.125 of this title. General trauma facilities provide resuscitation, stabilization, and assessment of injury victims and either provide treatment or arrange for appropriate transfer to a higher level trauma facility, provide ongoing educational opportunities in trauma related topics for health care professionals and the public, and implement targeted injury prevention programs.

  (40) Governmental entity - A county, a city or town, a school district, or a special district or authority created in accordance with the Texas Constitution, including a rural fire prevention district, an emergency services district, a water district, a municipal utility district, and a hospital district.

  (41) Health care entity - A first responder, EMS provider, physician, nurse, hospital, designated trauma facility, or a rehabilitation program.

  (42) Industrial ambulance - Any vehicle owned and operated by an industrial facility as defined in the Texas Transportation Code, Chapter 541, §201, and used for initial transport or transfer of company employees who become urgently ill or injured on company premises to an appropriate medical facility.

  (43) Interfacility care - Care provided while transporting a patient between medical facilities.

  (44) Lead trauma facility - A trauma facility that has made an additional commitment to its trauma service area. This commitment, which usually is offered by the highest level of trauma facility in a given trauma service area, includes receipt of major and severe trauma patients transferred from lower level trauma facilities. It also includes on-going support of the regional advisory council and the provision of regional outreach, prevention, and trauma educational activities to all trauma care providers in the trauma service area regardless of health care system affiliation.

  (45) Licensee - An individual who holds a current paramedic license from the Texas Department of Health (department); an individual who uses, maintains or operates EMS vehicles and EMS personnel to provide EMS and who holds an EMS provider license from the department.

  (46) Major trauma facility - A hospital designated by the department as having met the criteria for a Level II trauma facility as described in §157.125 of this title. Major trauma facilities provide similar services to the Level I trauma facility although research and some medical specialty areas are not required for Level II facilities, provide ongoing educational opportunities in trauma related topics for health care professionals and the public, and implement targeted injury prevention programs.

  (47) Major trauma patient - A person with injuries, or potential injuries, severe enough to benefit from treatment at a trauma facility. These patients may or may not present with alterations in vital signs or level of consciousness or obvious significant injuries (see severe trauma patient), but have been involved in an incident which results in a high index of suspicion for significant injury and/or disability. Co-morbid factors such as age and/or the presence of significant medical problems should also be considered. These patients should initiate a system's or health care entity's trauma response, including prehospital triage to a designated trauma facility. For performance improvement purposes, these patients are also identified retrospectively by an injury severity score of 9 or above.

  (48) Medical control - The supervision of prehospital emergency medical service providers by a licensed physician. This encompasses on-line (direct voice contact) and off-line (written protocol and procedural review).

Cont'd...

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