(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 twelve to eighteen years of age.
(3) "Advanced cardiac life support (ACLS)" means a course 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
(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 invasive emergency medical services requiring the advanced medical treatment skills of a paramedic.
(7) "Agency" means an aid or ambulance service licensed by the secretary to provide prehospital care or interfacility ambulance transport.
(8) "Agency response time" means the interval from dispatch to arrival on the scene.
(9) "Aid service" means an agency licensed by the secretary to operate one or more aid vehicles, consistent with regional and state plans.
(10) "Ambulance service" means an agency licensed by the secretary to operate one or more ground or air ambulances.
(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
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 emergency medical services requiring basic medical treatment skills as defined in chapter 18.73
(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" or (CME method) means prehospital EMS recertification education required after initial EMS certification to maintain and enhance skill and knowledge. The CME method requires the successful completion of department-approved knowledge and practical skill certification examinations to recertify.
(22) "County operating procedures" or "COPS" means the written operational procedures adopted by the county MPD and the local EMS council specific to county needs.
(23) "CPR" means cardiopulmonary resuscitation.
(24) "Critical care transport" means the interfacility transport of a patient whose condition requires care by a physician, RN or a paramedic who has received special training and approval by the MPD.
(25) "Department" means the Washington state department of health.
(26) "Dispatch" means to identify and direct an emergency response unit to an incident location.
(27) "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.
(28) "E-code" means external cause code, an etiology included in the International Classification of Diseases (ICD).
(29) "ED" means emergency department.
(30) "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
(31) "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.
(32) "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
(33) "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
(34) "EMS" means emergency medical services.
(35) "EMS provider" means an individual certified by the secretary or the University of Washington School of Medicine under chapters 18.71
RCW to provide prehospital emergency response, patient care, and transport.
(36) "EMS/TC" means emergency medical services and trauma care.
(37) "General surgeon" means a licensed physician who has completed a residency program in surgery and who has surgical privileges delineated by the facility.
(38) "ICD" means the international classification of diseases, a coding system developed by the World Health Organization.
(39) "Injury prevention" means any combination of educational, legislative, enforcement, engineering and emergency response initiatives used to reduce the number and severity of injuries.
(40) "Interfacility transport" means medical transport of a patient between recognized medical treatment facilities requested by a licensed health care provider.
(41) "Intermediate life support (ILS)" means invasive emergency medical services requiring the advanced medical treatment skills of an advanced EMT (AEMT).
(42) "IV" means a fluid or medication administered directly into the venous system.
(43) "Local council" means a local EMS/TC council authorized by RCW 70.168.120
(44) "Medical control" means oral or written direction of medical care that certified prehospital EMS personnel provide to patients of all age groups. The oral or written direction is provided by the MPD or MPD delegate.
(45) "Medical control agreement" means a written agreement between two or more MPDs, using similar protocols that are consistent with regional plans, to assure continuity of patient care between counties, and to facilitate assistance.
(46) "Medical program director (MPD)" means a person who meets the requirements of chapters 18.71
RCW and is certified by the secretary. The MPD is responsible for both the supervision of training and medical control of EMS providers.
(47) "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.
(48) "Ongoing training and evaluation program (OTEP)" means a continuous program of prehospital EMS education for EMS personnel after completion of initial training. An OTEP is approved by the MPD and the department. An OTEP must meet the EMS education requirements and core topic content required for recertification. The OTEP method includes evaluations of the knowledge and skills covered in the topic content following each topic presentation.
(49) "PALS" means a pediatric advanced life support course.
(50) "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
(51) "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
(52) "PEPP" means pediatric education for prehospital professionals.
(53) "PHTLS" means a prehospital trauma life support course.
(54) "Physician" means an individual licensed under the provisions of chapters 18.71
(55) "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.
(56) "Postgraduate year" means the classification system for residents who are undergoing postgraduate training. The number indicates the year the resident is in during his/her postmedical school residency program.
(57) "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.
(58) "Prehospital index (PHI)" means a scoring system used to trigger activation of a hospital trauma resuscitation team.
(59) "Prehospital patient care protocols" means the department-approved, written orders adopted by the MPD under RCW 18.73.030
(15) 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
(60) "Prehospital provider" means EMS provider.
(61) "Prehospital trauma care service" means an agency that is verified by the secretary to provide prehospital trauma care.
(62) "Prehospital trauma triage procedure" means the method used by prehospital providers to evaluate injured patients and determine whether to activate the trauma system from the field. It is described in WAC 246-976-930
(63) "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.
(64) "Quality improvement (QI)" or "quality assurance (QA)" means a process/program to monitor and evaluate care provided in the EMS/TC system.
(65) "Regional council" means the regional EMS/TC council established by RCW 70.168.100
(66) "Regional patient care procedures" 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 medical program director, in accordance with statewide minimum standards. The patient care procedures 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 to first receive the patient, and the name and location of other trauma care facilities 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.
(67) "Regional plan" means the plan defined in WAC 246-976-960
(1)(b) that has been approved by the department.
(68) "Registered nurse" means an individual licensed under the provisions of chapter 18.79
(69) "Rural" means an unincorporated or incorporated area with a total population of less than ten thousand people, or with a population density of less than one thousand people per square mile.
(70) "Secretary" means the secretary of the department of health.
(71) "Senior EMS instructor (SEI)" means an individual approved by the department to be responsible for the administration, quality of instruction and the conduct of initial emergency medical responder (EMR) and emergency medical technician (EMT) training courses.
(72) "Special competence" means that an individual has been deemed competent and committed to a medical specialty area with documented training, board certification and/or 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.
(73) "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
(74) "Steering committee" means the EMS/TC steering committee created by RCW 70.168.020
(75) "Suburban" means an incorporated or unincorporated area with a population of ten thousand to twenty-nine thousand nine hundred ninety-nine or any area with a population density of between one thousand and two thousand people per square mile.
(76) "System response time" for trauma means the interval from discovery of an injury until the patient arrives at a designated trauma facility.
(77) "Training program" means an organization that is approved by the department to be responsible for specified aspects of training EMS personnel.
(78) "Trauma rehabilitation coordinator" means a person designated to facilitate early rehabilitation interventions and the trauma patient's access to a designated rehabilitation center.
(79) "Trauma response area" means a service coverage zone identified in an approved regional plan.
(80) "Trauma service" means the clinical service within a hospital or clinic that is designated by the department to provide care to trauma patients.
(81) "Urban" means:
(a) An incorporated area over thirty thousand; or
(b) An incorporated or unincorporated area of at least ten thousand people and a population density over two thousand people per square mile.
(82) "Verification" means a prehospital agency is capable of providing verified trauma care services and is credentialed under chapters 18.73
(83) "Wilderness" means any rural area not readily accessible by public or private maintained road.
[Statutory Authority: Chapters 18.71
, 18.73, and 70.168
RCW. WSR 11-07-078, § 246-976-010, filed 3/22/11, effective 5/15/11; WSR 05-01-221, § 246-976-010, filed 12/22/04, effective 1/22/05; WSR 00-08-102, § 246-976-010, filed 4/5/00, effective 5/6/00. Statutory Authority: Chapter 18.71
RCW. WSR 96-03-052, § 246-976-010, filed 1/12/96, effective 2/12/96. Statutory Authority: RCW 43.70.040
and chapters 18.71
, 18.73 and 70.168
RCW. WSR 93-01-148 (Order 323), § 246-976-010, filed 12/23/92, effective 1/23/93.]