| (50) Lead trauma facility - A trauma facility which
usually offers the highest level of trauma care in a given trauma
service area, and which 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.
(51) Legal entity name - The name of the lawful or
legally standing association, corporation, partnership, proprietorship,
trust, or individual. Has legal capacity to:
(A) enter into agreements or contracts;
(B) assume obligations;
(C) incur and pay debts;
(D) sue and be sued in its own right; and
(E) to be accountable for illegal activities.
(52) Licensee - A person who holds a current paramedic
license from the Texas Department of State Health Services (department)
or a person who uses, maintains or operates EMS vehicles and EMS personnel
to provide EMS and who holds an EMS provider license from the department.
(53) 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.
(54) 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.
(55) 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).
(56) Medical Director - The licensed physician who
provides medical supervision to the EMS personnel of a licensed EMS
provider or a recognized First Responder Organization under the terms
of the Medical Practices Act (Occupations Code, Chapters 151 - 165
and rules promulgated by the Texas Medical Board. Also may be referred
to as off-line medical control.
(57) Medical oversight - The assistance and management
given to health care providers and/or entities involved in regional
EMS/trauma systems planning by a physician or group of physicians
designated to provide technical assistance.
(58) Medical supervision - Direction given to emergency
medical services personnel by a licensed physician under the terms
of the Medical Practice Act, (Occupations Code, Chapters 151 - 165)
and rules promulgated by the Texas Medical Board pursuant to the terms
of the Medical Practice Act.
(59) Mobile intensive care unit (MICU) - A vehicle
that is designed for transporting the sick or injured and that meets
the requirements of the advanced life support vehicle and which has
sufficient equipment and supplies to provide cardiac monitoring, defibrillation,
cardioversion, drug therapy, and two-way communication with at least
one paramedic on the vehicle when providing EMS.
(60) Off-line medical direction - The licensed physician
who provides approved protocols and medical supervision to the EMS
personnel of a licensed EMS provider under the terms of the Medical
Practices Act (Occupations Code, Chapters 151 - 165) and a rules promulgated
by the Texas Medical Board (22 Texas Administrative Code, §197.3).
(61) Online course - A directed learning process, comprised
of educational information (articles, videos, images, web links),
communication (messaging, discussion forums) with a process and some
way to measure students' knowledge.
(62) Operational name - Name under which the business
or operation is conducted and presented to the world.
(63) Operational policies - Policies and procedures
which are the basis for the provision of EMS and which include, but
are not limited to such areas as vehicle maintenance, proper maintenance
and storage of supplies, equipment, medications, and patient care
devices; complaint investigation, multicasualty incidents, and hazardous
materials; but do not include personnel or financial policies.
(64) Out of service vehicle - The period when a licensed
EMS Provider vehicle is unable to respond or be response ready for
an emergency or non-emergency response.
(65) Person - An individual, corporation, organization,
government, governmental subdivision or agency, business, trust, partnership,
association, or any other legal entity.
(66) Prehospital triage - The process of identifying
medical/injury acuity or the potential for severe injury based upon
physiological criteria, injury patterns, and/or high-energy mechanisms
and transporting patients to a facility appropriate for their medical/injury
needs. Prehospital triage for injury victims is guided by the prehospital
triage protocol adopted by the regional advisory council (RAC) and
approved by the department.
(67) Practical exam - Sometime referred to as psychomotor,
is an exam that assesses the subject's ability to perceive instructions
and perform motor responses.
(68) Protocols - A detailed, written set of instructions
by the EMS Provider medical director, which may include delegated
standing medical orders, to guide patient care or the performance
of medical procedures as approved.
(69) Primary EMS provider response area - The geographic
area in which an EMS agency routinely provides emergency EMS as agreed
upon by a local or county governmental entity or by contract.
(70) Public safety answering point (PSAP) - The call
center responsible for answering calls to an emergency telephone number
for ambulance services; sometimes called "public safety access point,"
or "dispatch center."
(71) Quality management - Quality assurance, quality
improvement, and/or performance improvement activities.
(72) Regional Advisory Council (RAC) - An organization
serving as the Department of State Health Services recognized health
care coalition responsible for the development, implementation and
maintenance of the regional trauma and emergency health care system
within the geographic jurisdiction of the Trauma Service Area. A Regional
Advisory Council must maintain §501(c)(3) status.
(73) Regional EMS/trauma system - A network of healthcare
providers within a given trauma service area (TSA) collectively focusing
on traumatic injury as a public health problem, based on the given
resources within each TSA.
(74) Regional medical control - Physician supervision
for prehospital emergency medical services (EMS) providers in a given
trauma service area or other geographic area intended to provide standardized
oversight, treatment, and transport guidelines, which should, at minimum,
follow the regional advisory council's regional EMS/trauma system
plan components related to these issues and 22 Texas Administrative
Code, §197.3(relating to Off-line Medical Director).
(75) Recertification - The procedure for renewal of
emergency medical services certification.
(76) Receiving facility - A facility to which an EMS
vehicle may transport a patient who requires prompt continuous medical
care.
(77) Reciprocity - The recognition of certification
or privileges granted to an individual from another state or recognized
EMS system.
(78) Relicensure - The procedure for renewal of a paramedic
license as described in §157.40 of this title (relating to Paramedic
Licensure); the procedure for renewal of an EMS provider license as
described in §157.11 of this title.
(79) Response pending status - The status of an EMS
vehicle that just delivered a patient to a final receiving facility,
and the dispatch center has another EMS response waiting that EMS
vehicle.
(80) Response ready - When an EMS vehicle is equipped
and staffed in accordance with §157.11 of this title (relating
to Requirements for a Provider License) and is immediately available
to respond to any emergency call 24 hours per day, seven days per
week (24/7).
(81) Scope of practice - The procedures, actions and
processes that an EMS personnel are permitted to undertake in keeping
with the terms of their professional license or certification and
approved by their EMS provider's medical director.
(82) Severe trauma patient - A person with injuries
or potential injuries that require treatment at a tertiary trauma
facility. These patients may be identified by an alteration in vital
signs and/or level of consciousness or by the presence of significant
injuries and shall initiate a system's and/or health care entity's
highest level of 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 15 or above.
(83) Shall - Mandatory requirements.
(84) Site survey - An on-site review of a trauma facility
applicant to determine if it meets the criteria for a particular level
of designation.
(85) Sole provider - The only licensed emergency medical
service provider in a geographically contiguous service area and in
which the next closest provider is greater than 20 miles from the
limits of the area.
(86) Specialized emergency medical services vehicle
- A vehicle that is designed for responding to and transporting sick
or injured persons by any means of transportation other than by standard
automotive ground ambulance or rotor or fixed wing air craft and that
has sufficient staffing, equipment and supplies to provide for the
specialized needs of the patient transported. This category includes,
but is not limited to, water craft, off-road vehicles, and specially
designed, configured or equipped vehicles used for transporting special
care patients such as critical neonatal or burn patients.
(87) Specialty centers - Entities that care for specific
types of patients such as trauma, pediatric, stroke, cardiac hospitals
and burn units that have received certification, categorization, verification
or other form of recognition by an appropriate agency regarding their
capability to definitively treat these types of patients.
(88) Staffing plan - A document which indicates the
overall working schedule patterns of EMS personnel.
(89) Standard of care - Care equivalent to what any
reasonable, prudent person of like certification level would have
given in a similar situation, based on locally, regionally and nationally
adopted standard emergency medical services curricula as adopted by
reference in §157.32 of this title (relating to Emergency Medical
Services Training and Course Approval).
(90) Substation - An EMS provider station location
that is not the fixed station and which is likely to provide rapid
access to a location to which the EMS vehicle may be dispatched.
(91) Trauma - An injury or wound to a living body caused
by the application of an external force or violence, including burn
injuries. Poisonings, near-drownings and suffocations, other than
those due to external forces are to be excluded from this definition.
(92) Trauma facility - A hospital that has successfully
completed the designation process, is capable of stabilization and/or
definitive treatment of critically injured persons and actively participates
in a regional EMS/trauma system.
(93) Trauma nurse coordinator/trauma program manager
- A registered nurse with demonstrated interest, education, and experience
in trauma care and who, in partnership with the trauma medical director
and hospital administration, is responsible for coordination of trauma
care at a designated trauma facility. This coordination should include
active participation in the trauma performance improvement program,
the authority to positively impact trauma care of trauma patients
in all areas of the hospital, and targeted prevention and education
activities for the public and health care professionals.
(94) Trauma patient - Any critically injured person
who has been evaluated by a physician, a registered nurse, or emergency
medical services personnel, and found to require medical care in a
trauma facility based on local, regional or national medical standards.
(95) Trauma registry - A statewide database which documents
and integrates medical and system information related to the provision
of trauma care by health care entities.
(96) Trauma Service Area - An organized geographical
area of at least three counties administered by a regional advisory
council for the purpose of providing prompt and efficient transportation
and/or treatment of sick and injured patients.
(97) When in service - The period of time when an EMS
vehicle is at the scene or when enroute to a facility with a patient.
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