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" 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 en route 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.
"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" or
"continuing medical education method" or "CME" or "CME method"
is the completion of prehospital recertification education
requirements after initial prehospital 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 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) and70.168.015
(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 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.
"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;
• "En route 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 en
route 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. 05-01-221, § 246-976-010, filed 12/22/04, effective 1/22/05; 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.]