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

1. (1) Abandonment--Leaving a patient without medical care once patient contact has been established, unless emergency medical services (EMS) 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. (2) Act--Emergency Medical Services Act, Health and Safety Code, Chapter 773.
3. (3) 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.
4. (4) 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.
5. (5) 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.
6. (6) Basic life support (BLS)--Emergency prehospital or interfacility care that uses noninvasive medical acts. The provision of basic life support may be under the medical supervision and control of a licensed physician.
7. (7) 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.
8. (8) Basic trauma facility--A hospital designated by the department as having met the criteria for a Level IV trauma facility as described in the publication titled "Texas Trauma Facility Criteria" which is adopted by reference in §157.121 of this title (relating to Purpose). Basic trauma facilities provide resuscitation, stabilization, and arrange for appropriate transfer of all major and severe trauma patients to a higher level trauma facility.
9. (9) Board--The Texas Board of Health.
10. (10) Bureau--The Bureau of Emergency Management of the Texas Department of Health.
11. (11) Bureau chief--The chief of the Bureau of Emergency Management of the Texas Department of Health.
12. (12) 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.
13. (13) Candidate--An individual who is requesting emergency medical services personnel certification from the Texas Department of Health.
14. (14) Certificant--Emergency medical services personnel with current certification from the Texas Department of Health.
15. (15) Comprehensive trauma facility--A hospital designated by the department as having met the criteria for a Level I trauma facility as described in the publication titled "Texas Trauma Facility Criteria" which is adopted by reference in §157.121 of this title (relating to Purpose). Comprehensive trauma facilities manage major and severe trauma patients, provide educational opportunities in trauma related topics for health care professionals, and conduct trauma research.
16. (16) Course medical director--A physician licensed to practice in Texas who shall provide direction over all instruction and clinical practice required in an EMT-I and EMT-P training course.
17. (17) Critically injured person--A person suffering major or severe trauma, with severe multisystem 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.
18. (18) Department--The Texas Department of Health.
19. (19) Designation--A formal recognition by the department of a hospital's trauma care capabilities and commitment.
20. (20) 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.
21. (21) 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.
22. (22) 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.
23. (23) 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.

24. (24) Emergency medical services personnel--

    1. (A) emergency care attendant (ECA);
    2. (B) emergency medical technician (EMT);
    3. (C) emergency medical technician-intermediate (EMT-I); or
    4. (D) emergency medical technician-paramedic (EMT-P).
25. (25) Emergency medical services provider--A person who uses or maintains emergency medical services vehicles and emergency medical services personnel to provide emergency medical services. See §157.11 of this title (relating to Requirements for an EMS Provider License) regarding fee exemption.
26. (26) Emergency medical services volunteer--Emergency medical services personnel who provide emergency prehospital or interfacility care without remuneration, except for reimbursement for expenses.
27. (27) Emergency medical services volunteer provider--An emergency medical services which has at least 75% of the total personnel as volunteers and is recognized as a nonprofit corporation by the Internal Revenue Service, §501(c)(3). See §157.11 of this title (relating to Requirements for an EMS Provider License) regarding fee exemption.
28. (28) Emergency medical technician (EMT)--An individual who is certified by the department as minimally proficient to perform emergency prehospital or interfacility care that is necessary for basic life support and that includes the control of hemorrhaging and cardiopulmonary resuscitation.
29. (29) 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 under medical supervision certain procedures, including intravenous therapy and endotracheal or esophageal intubation or both.
30. (30) 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 under medical supervision of certain procedures, including intravenous therapy, endotracheal or esophageal intubation or both, electrical cardiac defibrillation or cardioversion, and drug therapy.

31. (31) Emergency medical services vehicle--

    1. (A) basic life support vehicle;
    2. (B) advanced life support vehicle;
    3. (C) mobile intensive care unit; or
    4. (D) specialized emergency medical services vehicle.
32. (32) 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.
33. (33) Facility triage--The process of assigning patients to an appropriate trauma facility based on injury severity and facility availability.
34. (34) Fleet--For the purpose of determining fees, a fleet is twenty or more EMS vehicles operated by an EMS provider in any given service area.
35. (35) General trauma facility--A hospital designated by the department as having met the criteria for a Level III trauma facility as described in the publication titled "Texas Trauma Facility Criteria" which is adopted by reference in §157.121 of this title (relating to Purpose). 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.
36. (36) 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, a water district, a municipal utility district, and a hospital district.
37. (37) Health care entity--A prehospital provider, physician, nurse, hospital, designated trauma facility, or a rehabilitation program.
38. (38) Health care facility--A licensed hospital.
39. (39) Industrial ambulance--Any vehicle owned and operated by an industrial facility including both ground vehicles at industrial sites used for the initial transport or transfer of the unstable urgently sick or injured and ground vehicles at industrial sites used to transport persons at those sites who become sick, injured, wounded, or otherwise incapacitated in the course of their employment from job site to an appropriate medical facility; provided, however, that the vehicle is not available for hire or use by the general public except when assisting the local community in disaster situations or when existing ambulance service is not available.
40. (40) Interfacility care--Care provided while transporting a patient between medical facilities.
41. (41) 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 outreach and increased educational activities. The responsibilities may be shared by trauma facilities.
42. (42) Major trauma facility--A hospital designated by the department as having met the criteria for a Level II trauma facility as described in the "Texas Trauma Facility Criteria" which is adopted by reference in §157.121 of this title (relating to Purpose). 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.
43. (43) Major trauma injury victim/patient--A person with injuries severe enough to benefit from treatment at a trauma facility, whose revised trauma score (RTS) is less than 11, and/or whose injury severity score (ISS) is nine or above.
44. (44) Medical control--The supervision of prehospital emergency medical service providers by a licensed physician through voice communication. Medical control is also referred to as on-line medical supervision.
45. (45) Medical oversight--The assistance given to the regional advisory council (RAC) and/or regional health care entities in system planning by a physician or group of physicians designated by the RAC to provide technical assistance.
46. (46) Medical supervision--Direction given to emergency medical services personnel by a licensed physician under the terms of the Medical Practice Act, (Texas Civil Statutes, Article 4495b) and rules promulgated by the Texas State Board of Medical Examiners pursuant to the terms of the Medical Practice Act.
47. (47) 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 has sufficient equipment and supplies to provide cardiac monitoring, defibrillation, cardioversion, drug therapy, and two-way radio or cellular phone communication.
48. (48) Operational policies--Policies and procedures which are the basis for the operation of the service and include, but are not limited to, such areas as vehicle maintenance, complaint investigation, multicasualty incidents, hazardous materials; but do not include personnel or financial policies.
49. (49) Pediatric trauma facility--A pediatric or other hospital designated by the department as having met the criteria as described in the publication titled "Pediatric Trauma Care" which is adopted by reference in §157.121 of this title (relating to Purpose).
50. (50) Person--An individual, corporation, organization, government, governmental subdivision or agency, business, trust, partnership, association, or any other legal entity.
51. (51) Physician assistant--A graduate of a physician assistant or surgeon assistant training program who has passed the examination given by the National Commission on the Certification of Physician Assistants, and who is registered as a physician assistant with the Texas State Board of Medical Examiners.
52. (52) Prehospital triage--The process of identifying injury severity so that the appropriate care level can be readily accessed according to patient care guidelines.
53. (53) Quality management--Quality assurance and quality improvement activities.
54. (54) Recertification--The procedure for renewal of emergency medical services certification.
55. (55) Reciprocity--The recognition of certification or privileges granted to an individual from another state.
56. (56) Regional EMS/trauma system--An emergency medical services and trauma care system that has been developed by an RAC in a multi-county area and has been recognized by the bureau.
57. (57) Regional medical control--Direct on-line physician communication for prehospital providers in a given trauma service area. Regional medical control is usually based at the lead trauma facility.
58. (58) Service area--A trade, market, patient flow, or other catchment area in which an emergency medical services provider provides emergency prehospital care.
59. (59) Severe trauma injury victim/patient--A person with injuries severe enough to require care at a comprehensive or major trauma facility, whose RTS is less than 11, and whose ISS is 16 or above.
60. (60) Shall--Mandatory requirements.
61. (61) Site survey--An on-site review of a trauma facility applicant to determine if it meets the criteria for a particular level of designation.
62. (62) Sole provider--The only emergency medical services provider in a service area.
63. (63) Specialized emergency medical services vehicle--A vehicle that is designed for transporting the sick or injured by means of air, water, or ground transportation, that is not a basic life support or advanced life support vehicle or a mobile intensive unit, and that has sufficient equipment and supplies to provide for the specialized needs of the patient transported. The term includes fixed wing aircraft, helicopters, boats, and ground transfer vehicles used for transporting the sick or injured.
64. (64) Specialty centers--Entities that care for specific types of trauma patients such as pediatric hospitals and burn units.
65. (65) Staffing plan--A document which indicates the overall shift patterns of EMS personnel.
66. (66) Standard of care--Care equivalent to what any reasonable, prudent person of like certification level would have given in a similar situation, based on medical protocols and standard emergency medical services curricula as adopted by reference in §§157.32-157.35 of this title (relating to Emergency Medical Services Training and Course Approval).
67. (67) Trauma--An injury or wound to a living body caused by the application of an external force or violence. Burn injuries are to be included in this definition, and poisonings, near-drownings, and suffocations, other than those due to external forces, are to be excluded from this definition.
68. (68) Trauma facility--A health care facility that is capable of comprehensive treatment of seriously injured persons and is part of a regional emergency medical services (EMS)/trauma system.
69. (69) Trauma nurse--A registered nurse with demonstrated interest and experience in trauma care.
70. (70) 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.
71. (71) Trauma registry--A statewide database which documents and integrates medical and system information related to the provision of trauma care by health care entities.
72. (72) When in service--The period of time when an EMS vehicle is at the scene or when en route to a facility with a patient.

Source Note:The provisions of this §157.2 adopted to be effective August 1, 1990, 15 TexReg 4003; amended to be effective February 17, 1992, 17 TexReg 943; amended to be effective June 22, 1995, 20 TexReg 4238; amended to be effective December 29, 1995, 20 TexReg 10772.