Title of Rule and Other Identifying Information: WAC 246-976-010, definition section of the EMS and trauma system WAC.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: WAC 246-976-010 is an existing WAC. The words and phrases identified in this section clarify the meaning of existing language used within the EMS and trauma system WAC, chapter 246-976 WAC. Recent amendments to the designation standards and the adoption of rule language for the advanced life support (ALS)/intermediate life support (ILS) ongoing training and evaluation program (OTEP) have identified the need for additions, deletions and amendments to words and phrases within WAC 246-976-010. The proposed changes only clarify existing language within the designation standards and the ALS/ILS OTEP rule without changing the existing language's effect.

     The proposed language amends the following existing definitions to further clarify language within chapter 246-976 WAC:

     •     Adolescent.

     •     Board certified.

     •     CME.

     •     Continuing medical education (CME).

     •     Ongoing training and evaluation program (OTEP).

     •     Practical examination.

     •     Quality assurance (QA).

     •     Senior EMS instructor (SEI).

     The proposed language also adds the following definitions to WAC 246-976-010 to clarify language used within chapter 246-976 WAC:

     •     Diversion.

     •     Pediatric education requirements.

     •     Physician with specific delineation of surgical privileges.

     •     Postgraduate year.

     •     Quality improvement.

     •     Trauma service.

     Reasons Supporting Proposal: The proposed changes enhance customer service by clarifying existing language. Without proper clarification of words and phrases the rules within chapter 246-976 WAC may be misinterpreted and could lead to confusion.

     Statutory Authority for Adoption: Chapters 18.71, 18.73, and 70.168 RCW.

     Statute Being Implemented: Chapters 18.71, 18.73, and 70.168 RCW.

     Rule is not necessitated by federal law, federal or state court decision.

     Name of Proponent: Department of Health, governmental.

     Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Kathy Schmitt/Dane Kessler, 310 Israel Road S.E., Tumwater, WA 98501, (360) 236-2828.

September 1, 2004

M. C. Selecky

Secretary

OTS-7236.3

AMENDATORY SECTION(Amending WSR 00-08-102, filed 4/5/00, effective 5/6/00)

WAC 246-976-010   Definitions.   Definitions in RCW 18.71.200, 18.71.205, 18.73.030, and 70.168.015 apply to this chapter. In addition, unless the context plainly requires a different meaning, the following words and phrases used in this chapter mean:

     "ACLS" means advanced cardiac life support, a course developed by the American Heart Association.

     "Activation of the trauma system" means mobilizing resources to care for a trauma patient in accordance with regional patient care procedures. When the prehospital provider identifies a major trauma patient, using approved prehospital trauma triage procedures, he or she notifies both dispatch and medical control from the field.

     (("Adolescence")) "Adolescent" means the period of physical and psychological development from the onset of puberty to maturity, approximately twelve to eighteen years of age.

     "Advanced first aid," for the purposes of RCW 18.73.120, 18.73.150, and 18.73.170, means a course of at least twenty-four hours of instruction, which includes at least:

     • CPR;

     • Airway management;

     • Trauma/wound care;

     • Immobilization.

     "Agency response time" means the interval from agency notification to arrival on the scene. It is the combination of activation and enroute times defined under system response times in this section.

     "Aid service" means an agency licensed by the department to operate one or more aid vehicles, consistent with regional and state plans.

     "Airway technician" means a person who:

     • Has been trained in an approved program to perform endotracheal airway management and other authorized aids to ventilation under written or oral authorization of an MPD or approved physician delegate; and

     • Has been examined and certified as an airway technician by the department or by the University of Washington's school of medicine.

     "ALS" means advanced life support.

     "Ambulance service" means an agency licensed by the department to operate one or more ground or air ambulances. Ground ambulance service operation must be consistent with regional and state plans. Air ambulance service operation must be consistent with the state plan.

     "Approved" means approved by the department of health.

     "ATLS" means advanced trauma life support, a course developed by the American College of Surgeons.

     "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.

     "Available" for designated trauma services described in WAC 246-976-485 through 246-976-890 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.

     "BLS" means basic life support.

     "Basic life support" means emergency medical services requiring basic medical treatment skills as defined in chapter 18.73 RCW.

     "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.

     "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.

     "BP" means blood pressure.

     "Certification" means the department recognizes that an individual has met predetermined qualifications, and authorizes the individual to perform certain procedures.

     (("CME" means continuing medical education.))

     "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, licensing and certification committee, or regional or local EMS/TC councils.

     "Continuing medical education (CME) method" ((means ongoing)) or "continuing medical education method" or "CME" or "CME method" is the completion of recertification education requirements after initial certification to maintain and enhance skill and knowledge. CME requires the successful completion of a written and practical skills examination to recertify.

     "CPR" means cardiopulmonary resuscitation.

     "Dispatch" means to identify and direct an emergency response unit to an incident location.

     "Diversion" for trauma care means the EMS transport of a trauma patient past the usual receiving trauma service to another trauma service due to temporary unavailability of trauma care resources at the usual receiving trauma service.

     "E-code" means external cause code, an etiology included in the International Classification of Diseases (ICD).

     "ED" means emergency department.

     "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 service and trauma care system includes prevention activities, prehospital care, hospital care, and rehabilitation.

     "EMS" means emergency medical services.

     "EMS/TC" means emergency medical services and trauma care.

     "EMT" means emergency medical technician.

     "General surgeon" means a licensed physician who has completed a residency program in surgery and who has surgical privileges delineated by the facility.

     "ICD" means the international classification of diseases, a coding system developed by the World Health Organization.

     "ILS" means intermediate life support.

     "Injury prevention" means any combination of educational, legislative, enforcement, engineering and emergency response initiatives used to reduce the number and severity of injuries.

     "Interfacility transport" means medical transport of a patient between recognized medical treatment facilities requested by a licensed health care provider.

     "Intermediate life support (ILS) technician" means a person who:

     • Has been trained in an approved program to perform specific phases of advanced cardiac and trauma life support as specified in this chapter, under written or oral direction of an MPD or approved physician delegate; and

     • Has been examined and certified as an ILS technician by the department or by the University of Washington's school of medicine.

     "Intravenous therapy technician" means a person who:

     • Has been trained in an approved program to initiate IV access and administer intravenous solutions under written or oral authorization of an MPD or approved physician delegate; and

     • Has been examined and certified as an intravenous therapy technician by the department or by the University of Washington's school of medicine.

     "IV" means intravenous.

     "Licensing and certification committee (L&C committee)" means the emergency medical services licensing and certification advisory committee created by RCW 18.73.040.

     "Local council" means a local EMS/TC council authorized by RCW 70.168.120(1).

     "Local medical community" means the organized local medical society existing in a county or counties; or in the absence of an organized medical society, majority physician consensus in the county or counties.

     "Medical control" means MPD authority to direct the medical care provided by certified EMS personnel in the prehospital EMS system.

     "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.

     "MPD" means medical program director.

     "Must" means shall.

     "Ongoing training and evaluation((" (OTEP) means a course of education authorized for first responders and EMTs in RCW 18.73.081 (3)(b))) program" or "ongoing training and evaluation program (OTEP)" or "OTEP" or "OTEP program" or "OTEP method" is a program of education for EMS personnel that is approved by the MPD and the department to meet the education requirements and core topic content for recertification. OTEP includes cognitive, affective and psychomotor evaluations following completion of each topic presentation to determine student competence of topic content.

     "PALS" means pediatric advanced life support, a course developed by the American Heart Association.

     "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; and

     • Has been examined and certified as a paramedic by the department or by the University of Washington's school of medicine.

     "Pediatric education requirement" or "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 and 246-976-887.

     "Physician" means an individual licensed under the provisions of chapters 18.71 or 18.57 RCW.

     "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.

     "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.

     "Practical skills examination" means a test conducted in an initial course, or a test or series of evaluations during a recertification period, to determine competence in each of the practical skills specified by the department.

     "Prehospital agencies" means providers of prehospital care or interfacility ambulance transport.

     "Prehospital index" means a scoring system used to activate a hospital trauma resuscitation team.

     "Prehospital patient care protocols" means the written procedures adopted by the MPD under RCW 18.73.030(13) and 70.168.015(26) which direct the out-of-hospital emergency care of the emergency patient which includes the trauma care patient. These protocols are related only to delivery and documentation of direct patient treatment.

     "Prehospital trauma care services" means agencies that are verified to provide prehospital trauma care.

     "Prehospital trauma triage procedures" 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(2).

     "Public education" means education of the population at large, targeted groups or individuals, in preventive measures and efforts to alter specific injury-related behaviors.

     (("Quality assurance (QA)" means an organized quality assessment and improvement program to audit and evaluate care provided in EMS/TC systems, with the goal of improving patient outcomes.)) "Quality improvement" or "QI" or "quality assurance" means a process/program to monitor and evaluate care provided in trauma services and EMS/TC systems.

     "Regional council" means the regional EMS/TC council established by RCW 70.168.100.

     "Regional patient care procedures (RPCP)" means procedures adopted by a regional council under RCW 18.73.030(14) and 70.168.015(23), and approved by the department. Regional patient care procedures do not relate to direct patient care.

     "Regional plan" means the plan defined in WAC 246-976-960 (1)(b) that has been approved by the department.

     "Registered nurse" means an individual licensed under the provisions of chapter 18.79 RCW.

     "Response area" means a service coverage zone identified in an approved regional plan.

     "Rural" means unincorporated or incorporated areas with total populations less than ten thousand people, or with a population density of less than one thousand people per square mile.

     "((Senior EMT instructor ())SEI(()))" means an individual approved to be responsible for the quality of instruction and the conduct of basic life support training courses.

     "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:

     • For physicians, by the facility's medical staff;

     • For registered nurses, by the facility's department of nursing;

     • For physician assistants and advanced registered nurse practitioners, as defined in the facility's bylaws.

     "Specialized training" means approved training of certified EMS personnel to use a skill, technique, or equipment that is not included in the standard course curriculum.

     "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(10).

     "Steering committee" means the EMS/TC steering committee created by RCW 70.168.020.

     "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 one thousand to two thousand people per square mile.

     "System response time" for trauma means the interval from discovery of an injury until the patient arrives at a designated trauma facility. It includes:

     "Discovery time": The interval from injury to discovery of the injury;

     "System access time": The interval from discovery to call received;

     "911 time": The interval from call received to dispatch notified, including the time it takes the call answerer to:

     • Process the call, including citizen interview; and

     • Give the information to the dispatcher;

     "Dispatch time": The interval from call received by the dispatcher to agency notification;

     • "Activation time": The interval from agency notification to start of response;

     • "Enroute time": The interval from the end of activation time to the beginning of on-scene time;

     • "Patient access time": The interval from the end of enroute time to the beginning of patient care;

     • "On scene time": The interval from arrival at the scene to departure from the scene. This includes extrication, resuscitation, treatment, and loading;

     • "Transport time": The interval from leaving the scene to arrival at a health care facility;

     "Training agency" means an organization or individual that is approved to be responsible for specified aspects of training of EMS personnel.

     "Training physician" means a physician delegated by the MPD and approved by the department to be responsible for specified aspects of training of EMS personnel.

     "Trauma rehabilitation coordinator" means a person designated to facilitate early rehabilitation interventions and the trauma patient's access to a designated rehabilitation center.

     "Trauma service" means the clinical service within a hospital or clinic that is designated by the department to provide care to trauma patients.

     "Urban" means:

     • An incorporated area over thirty thousand; or

     • An incorporated or unincorporated area of at least ten thousand people and a population density over two thousand people per square mile.

     "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. 00-08-102, § 246-976-010, filed 4/5/00, effective 5/6/00. Statutory Authority: Chapter 18.71 RCW. 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. 93-01-148 (Order 323), § 246-976-010, filed 12/23/92, effective 1/23/93.]

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