Alabama Administrative Code › Title 420 - ALABAMA STATE BOARD OF HEALTH › Chapter 420-2-1 - EMERGENCY MEDICAL SERVICES › Section 420-2-1-.02 - Definitions

Current through Register Vol. 42, No. 9, June 28, 2024
(1) "Abandonment"
			 means the unilateral termination of theprovider/patient relationship at a time
			 when continuing care is still needed. This includes the termination of care
			 without the patient's consent.
(2)
			 "Academic Dishonesty" means any emergency medical services (EMS) student who
			 submits a license or test application, a report of continuing education
			 requirements, student record, clinical rotation record, intent to train form,
			 self-study document, or any other document which is material to those of a
			 student in an emergency medical services personnel (EMSP) training program and
			 which is fraudulent or knowingly false in any respect.
(3) "Accreditation" means the educational
			 program meets or exceeds the educational standards specified in the "ADPH, OEMS
			 Credentialing Manual for Accreditation of Levels 1 and 2 education
			 programs."
(4) "Accreditation
			 Withdrawn" means accreditation may be withdrawn from a program with
			 Probationary Accreditation or Administrative Probation, if at the conclusion of
			 the specified probationary period, the accreditation review process confirms
			 that the program is not in compliance with the administrative requirements for
			 maintaining accreditation.
(5)
			 "Accreditation Withheld" means that the program is not in substantial
			 compliance with the essential elements of an education program.
(6) "Advanced Cardiac Life Support (ACLS)"
			 means an approved course of instruction which follows the American Heart
			 Association's Emergency Cardiac Care guidelines.
(7) "Advanced Emergency Medical Technician
			 (AEMT)" means any individual who is an emergency medical services personnel and
			 is 18 years of age or older who has successfully completed the AEMT course of
			 instruction, or its equivalent, as approved by the State Board of Health or its
			 designee, and has passed the state approved AEMT certification exam, and who
			 has been granted a current, valid AEMT license by the State Board of
			 Health.
(8) "Advanced Life Support
			 (ALS)" means the treatment of potentially life-threatening medical emergencies
			 through the use of invasive medical techniques specified as advanced life
			 support techniques in these rules which would ordinarily be performed or
			 provided by physicians but may be performed by active licensed EMSP pursuant to
			 these rules.
(9) "Advanced Trauma
			 Life Support (ATLS)" means the course of instruction developed and sponsored by
			 the American College of Surgeons.
(10) "Air Ambulance" means an aircraft
			 approved by the Federal Aviation Administration (FAA), licensed by the Office
			 of Emergency Medical Services (OEMS), and intended to be used for and
			 maintained or operated for the transportation of sick or injured persons to a
			 medical care facility.
(11)
			 "Alabama Department of Public Health (ADPH or the Department)" means the State
			 of Alabama Department of Public Health, as defined by §
								22-1-1,
Code of Ala.
			 1975
, and any officer, agent, or employee of the Department that
			 is authorized to act for the Department with respect to the enforcement and
			 administration of these rules.
(12)
			 "Alabama EMS Critical Care Patient Care Protocols" means a written document
			 approved by the State Board of Health for Critical Care Paramedics working for
			 a Critical Care licensed provider service which specifies adult and pediatric
			 patient treatment procedures, medication administration, and other
			 administrative and organizational guidelines that shall be followed upon
			 assessment and treatment of an adult or pediatric patient.
(13) "Alabama EMS Patient Care Protocols"
			 means a written document approved by the State Board of Health for each
			 emergency medical technician licensure level which specifies adult and
			 pediatric patient treatment procedures, medication administration, and other
			 administrative and organizational guidelines that shall be followed upon
			 assessment and treatment of an adult or pediatric patient.
(14) "Alabama Trauma Communications Center
			 (ATCC)" means a central communication facility with the capability to
			 constantly communicate with all prehospital providers and hospitals that have
			 been designated by the Department as trauma centers. The ATCC's capabilities
			 include the ability to immediately and directly link the prehospital providers
			 to the trauma centers.
(15)
			 "Alabama Trauma System" means an organized system designed to ensure that
			 severely injured adult and pediatric patients are promptly transported and
			 treated at trauma centers that are appropriate to the severity of the
			 injury.
(16) "ALS Level 1
			 Authorization" means all fluids or medications described within the scope of
			 practice of the Paramedic as approved by the State Board of Health.
(17) "ALS Level 1 - Critical Care
			 Authorization" means all fluids or medications described within the Critical
			 Care practice of the Critical Care Paramedic as approved by the State Board of
			 Health.
(18) "ALS Level 2
			 Authorization" means all fluids or medications described within the scope of
			 practice of the Advanced EMT as approved by the State Board of
			 Health.
(19) "ALS Level 3
			 Authorization" means all fluids or medications described within the scope of
			 practice of the EMT-Intermediate (I-85) as approved by the State Board of
			 Health.
(20) "Automated External
			 Defibrillator (AED)" means a cardiac defibrillator that is a sophisticated,
			 reliable computerized device that uses voice and visual prompts to guide
			 healthcare providers to safely defibrillate ventricular fibrillation sudden
			 cardiac arrest.
(21) "Basic Life
			 Support (BLS)" means non-invasive life support measures provided to
			 patients.
(22) "Board" or "State
			 Board of Health" means the Board of Health of the State of Alabama as defined
			 by §
								22-2-1,
Code of Ala.
			 1975
, or the State Health Officer, or his or her designee, when
			 acting for the Board.
(23)
			 "Certification" means a demonstration such as, but not limited to, the issuance
			 of a card or certificate by which an organization provides public information
			 concerning individuals who have successfully completed a certification process
			 and demonstrated an ability to perform competently.
(24) "Clinical Preceptor" means an individual
			 who, under the direction of the program director, supervises and evaluates the
			 students during clinical rotations in a controlled environment such as a
			 hospital or urgent care clinic.
(25) "CoAEMSP" means the Committee on
			 Accreditation for the Emergency Medical Services Professions.
(26) "Cohort" means the period of time it
			 takes to complete course work for one EMS level without interruption. As a
			 student progresses from Level 3 to Level 1, the cohort time frame will increase
			 relative to the amount of course work.
(27) "Community Paramedic" means an
			 individual who is an emergency medical services personnel and is 18 years of
			 age or older, and who is currently licensed as a paramedic, has at least 2
			 years of full-time service, has successfully completed a community paramedic
			 training program from an accredited college or university approved by the
			 Board, has passed the state community paramedic examination and has met the
			 requirements for becoming a licensed community paramedic, and who has been
			 granted a current, valid Community Paramedic license by the Board.
(28) "Community Paramedicine Program" means
			 the provision of episodic care, patient evaluation, advice, and treatment
			 directed at preventing or improving a particular medical condition, within the
			 scope of practice of the emergency medical services personnel.
(29) "Controlled Substance Oversight
			 Coordinator (CSOC) " means a Paramedic who is responsible for all aspects of
			 the controlled substance plan of a provider service and is the designated
			 contact person for any issues pertaining to the service's controlled
			 substances.
(30) "Controlled
			 Substance Plan (CSP)" means the plan written by each ALS fluid/drug service
			 which specifies the method of ownership, security, drug testing for employees,
			 quality assurance, and tables to be used for accounting logs. The CSP also
			 contains original signatures from the service medical direction physician, the
			 pharmacist from the medical direction hospital, and the controlled substance
			 coordinator. This plan shall be submitted to and approved by the
			 OEMS.
(31) "Course Instructor"
			 means an individual who is authorized by the appropriate entity to present and
			 assess competence in all subject matter contained in a curriculum. This person,
			 along with the program director, makes final evaluations concerning student
			 competence.
(32) "Criminal History
			 Release Authorization" means a signed form that authorizes the OEMS to review
			 and utilize the criminal history of an EMSP, or EMSP applicant, for licensure
			 purposes.
(33) "Critical Care
			 Paramedic" means a paramedic endorsed by the OEMS, certified by the
			 International Board of Specialty Certifications (IBSC) as Critical Care
			 Paramedic - Certified (CCP-C) or Flight Paramedic - Certified (FP-C) or by the
			 Board of Certification for Emergency Nursing as a Certified Flight Registered
			 Nurse (CFRN) or Certified Transport Registered Nurse (CTRN).
(34) "Critical Care Practice" means an
			 expanded scope of practice within the State of Alabama that may be practiced by
			 paramedics who have a current endorsement on their emergency medical services
			 personnel (EMSP) license and who must be working for a provider service that is
			 currently licensed at the Critical Care level.
(35) "Definitive Care Facility" means a
			 facility that has the capability to render care to conclusively manage a
			 patient's current medical condition. This may include, but is not limited to,
			 facilities such as urgent care facilities, family practice facilities, doctor's
			 offices, and emergency departments.
(36) "Dereliction of Duty" means that person
			 willfully or negligently failed to perform his or her duties or performed them
			 in aculpably inefficient manner.
(37) "Drug Diversion" means the transfer of
			 any legally prescribed substance from the individual for whom it was
			 prescribed, to another person for any illicit or unintended use.
(38) "Duty to Act" means a legal and moral
			 obligation requiring an EMSP to take necessary action to prevent harm to
			 another person or to the general public, while on duty at a licensed provider
			 service to include, but not limited to: responding to calls in an expeditious
			 but safe manner; performing a thorough assessment of both the patient and the
			 emergency scene; providing appropriate treatment to a patient; and transporting
			 to an appropriate receiving facility when transport is warranted and
			 consented.
(39) "Education Level 1"
			 means a course of instruction that provides an individual with the knowledge
			 and clinical skills of emergency medical care necessary to function at the
			 approved EMT, Advanced EMT, and Paramedic levels of care.
(40) "Education Level 2" means a course of
			 instruction that provides an individual with the knowledge and clinical skills
			 of emergency medical care necessary to function at the approved EMT or Advanced
			 EMT levels of care.
(41) "Education
			 Level 3" means a course of instruction that provides an individual with the
			 knowledge and clinical skills of emergency medical care necessary to function
			 at the approved EMT level of care.
(42) "Electronic Patient Care Report (e-PCR)"
			 means a Board approved method of electronic recording of an occurrence by
			 emergency or non-emergency response EMS personnel where a medical or injured
			 patient was encountered, evaluated, treated, or transported.
(43) "Emergency Medical Dispatcher (EMO)"
			 means an individual who has received certification from the Alabama Statewide
			 911 Board and the Alabama Department of Public Health's EMO program (the
			 Alabama EMO program) or a nationally recognized EMO certification
			 course.
(44) "Emergency Medical
			 Provider Service" means any emergency medical service properly licensed to
			 provide out-of-hospital emergency medical response services within the State of
			 Alabama. These include basic life support (BLS) transport, ALS transport, and
			 ALS non-transport.
(45) "Emergency
			 Medical Responder (EMR)" means any person 18 years of age or older who has
			 successfully completed the Emergency Medical Responder course of instruction,
			 or its equivalent, as approved by the Board or its designee, who has passed the
			 State approved EMSP certification exam, and who has been granted a current,
			 valid EMSP license by the Board.
(46) "Emergency Medical Services" means a
			 system of coordinated medical assistance and care provided by emergency medical
			 services personnel, including the transportation and medical care of sick or
			 injured individuals before arrival at a definitive care facility, continuation
			 of care within a definitive care facility subject to the approval from that
			 facility, and integrated medical care with the oversight of a medical
			 director.
(47) "Emergency Medical
			 Services Education Program" means any approved or credentialed program that
			 provides education for EMR or EMS personnel for Level I, II, or III.
(48) "Emergency Medical Services Educational
			 Institution" means a single institution or site of higher learning which meets
			 the EMS educational requirements of the OEMS and that has approval from the
			 Alabama Community College System or the Alabama Commission on Higher Education
			 to offer EMS educational programs for the recognized levels of
			 licensure.
(49) "Emergency Medical
			 Services Personnel (EMSP)" means all recognized National Highway Traffic Safety
			 Administration (NHTSA) levels of personnel licensed by the Board, who have met
			 all primary and/or renewal educational requirements of these rules, and are
			 allowed to provide medical care within the level of their scope of practice
			 granted by the OEMS.
(50)
			 "Emergency Medical Technician (EMT)" means any person 18 years of age or older
			 who has successfully completed the EMT course of instruction, or its
			 equivalent, as approved by the Board or its designee, who has passed the State
			 approved EMT certification exam, and who has been granted a current, valid EMT
			 license by the Board.
(51)
			 "Emergency Medical Technician-Intermediate" means any person 18 years of age or
			 older who has successfully completed the 1985 EMT-Intermediate course of
			 instruction, or its equivalent, as approved by the Board, who has passed the
			 State approved EMT-Intermediate certification exam, and who has been granted a
			 current, valid license by the Board.
(52) "Emergency Vehicle Operator" means an
			 individual who has met the requirements of the Board to operate an
			 ambulance.
(53) "Emergency Vehicle
			 Operators Course (EVOC)" means the national standard curriculum developed by
			 the NHTSA and conducted by an authorized OEMS instructor. This course may be
			 substituted with the Alabama Fire College Apparatus Operator Course or
			 Emergency Vehicle Driver Course, or the NAEMT Emergency Vehicle Operator Safety
			 Course.
(54) "Federal Aviation
			 Regulations (FAR)" means rules prescribed by the FAA governing all aviation
			 activities in the United States. The FAR's are part of Title 14 of the Code of
			 Federal Regulations.
(55) "Field
			 Preceptor" means an individual, who under the direction of the program
			 director, supervises and evaluates the students during clinical rotations on an
			 ambulance in the prehospital environment.
(56) "Ground Ambulance" means a motor vehicle
			 intended to be used for and maintained or operated for the transportation of
			 persons who are sick or injured to a medical care facility.
(57) "Guest Lecturer" means an individual
			 with specialized subject matter expertise, who on occasion, instructs a
			 specific topic of curriculum under the direction of the program
			 director.
(58) "Impaired EMS
			 Personnel" means an individual licensed under these rules who misuses or abuses
			 alcohol, drugs, or both, or who has a mental or behavioral issue which could
			 affect the individual's judgment, skills, and abilities to practice.
(59) "Industry Standard Stretcher Locking
			 Device" means a stretcher locking device permanently affixed to the vehicle
			 which meets or exceeds the standards as adopted by the State Board of
			 Health.
(60) "Industry Standard
			 Wheelchair Locking Device" means a wheelchair locking device permanently
			 affixed to the vehicle for use in Demand Responsive Systems under Title III of
			 the Americans with Disabilities Act (ADA) which meets or exceeds the Department
			 of Transportation (DOT) specifications for Ground Ambulances under Guideline
			 Specifications for Wheelchair Securement Devices. When the wheelchair is
			 secured in accordance with the manufacturer's instructions, the securement
			 systems, recognized by the ambulance industry to provide the capability of
			 securing the wheelchair in the vehicle, shall limit the movement of an occupied
			 wheelchair to no more than 2 inches in any direction under normal operating
			 conditions. All wheelchair locking devices shall be affixed to the vehicle so
			 as to secure the wheelchair in a forward or rear facing position. Side facing
			 securement is not permitted under any circumstances. This does not negate the
			 necessity for providing a separate seatbelt and shoulder harness for each
			 wheelchair or wheelchair user as specified elsewhere in these rules.
(61) "Licensure" means the state's grant of
			 legal authority to perform skills within a designated scope of practice. Under
			 the licensure system, states define, by statute, the tasks and function or
			 scope of practice of a profession and provide that these tasks may be legally
			 performed only by those who are licensed. As such, licensure prohibits anyone
			 from practicing the profession who is not licensed, regardless of whether or
			 not the individual has been certified by a private organization.
(62) "MDPID" means the Medical Direction
			 Physician Identification Number.
(63) "Medical Direction" means directions and
			 advice provided from a designated medical direction physician.
(64) "Medical Direction Hospital" means a
			 hospital which has properly credentialed and licensed medical direction
			 physician coverage in the emergency department 24 hours per day, 7 days a week;
			 assists with the initial and ongoing training of emergency medical provider
			 services; maintains a communication system capable of serving the EMS providers
			 for the areas served; and conducts continuing quality improvement of patient
			 care to include the identification of deficiencies in procedures or performance
			 among participating out-of-hospital provider services. The medical direction
			 hospital provides logistical and/or supervising responsibilities for active
			 licensed EMS personnel.
(65) "Moral
			 Turpitude" means an act or behavior that gravely violates moral sentiment or
			 accepted moral standards of society, as further defined by state law.
(66) "Non-Transport ALS Provider Service"
			 means a non-transporting emergency medical provider service that is licensed by
			 the OEMS and that provides ALS services.
(67) "Non-Transport BLS Provider Service"
			 means a non-transporting service that provides BLS services that is recognized,
			 but not licensed by the OEMS.
(68)
			 "Non-Transport vehicle" means a vehicle operated with the intent to provide BLS
			 or ALS on-scene stabilization, but not intended to transport a
			 patient.
(69) "NREMT" means the
			 National Registry of Emergency Medical Technicians.
(70) "Office of Emergency Medical Services
			 (OEMS)" means the subdivision of the Department charged with the enforcement
			 and administration of these rules.
(71) "On-Line Medical Director" means a
			 licensed physician who has completed and maintains a current certification in
			 ACLS and ATLS or maintains board certification in emergency medicine or
			 pediatric medicine if the physician works in a designated pediatric specialty
			 hospital, and shall have successfully completed the approved Alabama EMS
			 Medical Directors Course, the annual refresher course, and been issued a MDPID
			 number.
(72) "Paramedic" means any
			 person 18 years of age or older who has successfully completed the paramedic
			 course of instruction, or its equivalent, as approved by the Board, and who has
			 passed the State approved paramedic certification exam, and who has been
			 granted a current, valid paramedic license by the Board.
(73) "Patient" means a person who receives or
			 requests medical care or for whom medical care is requested because such
			 individual is sick or injured,
(74)
			 "Pediatric Palliative and End of Life (PPEL) Care Order" means a directive
			 that, once executed by the representative of a qualified minor and entered into
			 the medical record by the attending physician of the qualified minor in
			 accordance with Section
			 22-8A-15, Code of Alabama 1975,
			 becomes the medical order for all health care providers with respect to the
			 extent of use of emergency medical equipment and treatment, medication, and any
			 other technological or medical interventions available to provide palliative
			 and supportive care to the qualified minor.
(75) "Permitted Vehicle" means any vehicle to
			 be used for the response to and care of patients that has been inspected,
			 approved, and issued a decal by the OEMS.
(76) "Physician" means an individual
			 currently licensed to practice medicine or osteopathy by the Medical Licensure
			 Commission of Alabama.
(77)
			 "Portable Physician Do Not Attempt Resuscitation (DNAR) Order" means a
			 physician's written order, in a form prescribed by Rule
			 420-5-19-.02, that resuscitative
			 measures not be provided to a person under a physician's care in the event the
			 person is found with cardiopulmonary cessation. A DNAR order includes, without
			 limitation, physician orders written as "do not resuscitate," "do not allow
			 resuscitation," "do not allow resuscitative measures," "DNAR," "DNR," "allow
			 natural death," or "AND."
(78)
			 "Practical Skills Proctor" means an individual who assists with practical
			 skills instruction under the direction of the course instructor and/or program
			 director.
(79) "Preceptor" means an
			 individual with a higher level of licensure who is responsible for the
			 supervision and instruction of an EMS student on a clinical rotation.
(80) "Probationary Accreditation" indicates a
			 program is presently accredited; however, there is evidence that the program
			 has substantial deficiencies that threaten the capability of the program to
			 provide acceptable educational experiences for the students. The site visit
			 usually produces the necessary evidence; however, an onsite review is not
			 required for this action to be recommended if the facts are not in
			 dispute.
(81) "Program Director"
			 means an individual who is responsible for managing administrative details of a
			 program and its courses under the policies, procedures, and rules as stated
			 herein and as otherwise referred to by the ADPH, OEMS. This person oversees all
			 instructional courses and staffing administration and is not limited to the
			 description above. Regional Directors are considered Program Directors for
			 approved off site Level 2 or 3 EMS education courses within their respective
			 region.
(82) "Program Medical
			 Director" means the Alabama licensed physician who provides medical direction
			 for all didactic and clinical instruction and clinical practice
			 experience.
(83) "Provider
			 Services" means an organization which provides either air or ground emergency
			 medical services to the public.
(84) "Quality Improvement Education" means
			 the remedial or ongoing education determined necessary by an emergency medical
			 provider service's and/or the OEMS' quality assurance reviews and offered to
			 improve the delivery of care of an individual emergency medical provider
			 service or active licensed EMS personnel.
(85) "Recumbent Position" means a position
			 whereby a patient is placed in a prone, supine, lying down, reclining or
			 leaning back position, or angle of 20 degrees or more from the upright or
			 vertical angle of 90 degrees.
(86)
			 "Regional Agency" means a contractor located in a specific geographic area of
			 the state that provides services specified in a contract. These agencies have
			 no regulatory authority other than that conferred by the OEMS.
(87) "Resuscitative Measures" means
			 cardiopulmonary resuscitation, cardiac compression, endotracheal intubation and
			 other advanced airway management, artificial ventilation, cardiac resuscitation
			 medications, and cardiac defibrillation delivered by any means. This term does
			 not mean and shall not be deemed to include such medical interventions as
			 intravenous fluids, oxygen, suction, control of bleeding, administration of
			 pain medication by properly licensed and authorized personnel, and the
			 provision of support and comfort to patients, family members, friends, and
			 other individuals.
(88) "Scope of
			 Practice" means clearly defined levels of skills and roles allowed for each
			 level of emergency medical services personnel.
(89) "Service Area" means 90 nautical miles
			 from an air ambulance provider service's base of operation.
(90) "Service Medical Director" means a
			 physician who holds a current MDPID number and is responsible for medical
			 direction and oversight for the day-to-day operations of a licensed emergency
			 medical provider service(s).
(91)
			 "Shall" means a mandatory requirement.
(92) "Site Visit Team Member" means an
			 individual who has been approved to be a participant in the site visit of an
			 EMS education program seeking accreditation from the OEMS.
(93) "Specialty Care Ambulance" means a
			 transport vehicle that is utilized for the interfacility transport of a
			 critically ill or injured patient or one that requires specific monitoring or
			 interventions and incorporates specialized staffing.
(94) "State Emergency Medical Control
			 Committee (SEMCC) " means a committee authorized by §
								22-18-6,
Code of Ala.
			 1975
, to assist in formulating rules and policies pertaining to
			 EMS.
(95) "Stretcher" means a cot,
			 gurney, litter, or stretcher device of the type that can be used for and is
			 maintained solely for the transportation of patients in a vehicle in a
			 recumbent position. Either one or both of the patient's legs shall be
			 maintained in a horizontal position or angle of 180 degrees at the foot of the
			 stretcher, unless it is medically necessary to do otherwise, or to maintain any
			 other position of either one or both of the legs above the horizontal angle 180
			 degrees. The stretcher shall be capable of being locked solely into an
			 ambulance by an industry standard stretcher or cot locking device as defined by
			 the rules.
(96) "Tactical
			 Paramedic" means a paramedic endorsed by the OEMS and certified by the
			 International Board of Specialty Certifications (IBSC) as a Tactical
			 Paramedic-Certified (TP-C). This certification grants all current protocols to
			 be Category A, with the utilization of an expanded scope of practice and
			 medication formulary only when the individual has received the current
			 endorsement on his or her EMSP license issued by the OEMS and is actively
			 engaged in a tactical operation with a law enforcement agency.
(97) "Wheelchair" means a specialty chair or
			 mobility aid that belongs to a class of three or four wheeled devices, usable
			 indoors, usually designed for and used by persons with mobility impairments.
			 Wheelchairs, as defined in these rules, shall not exceed 30 inches in width and
			 48 inches in length, as measured 2 inches above the ground, and shall not weigh
			 more than 600 pounds when occupied.
Authors:
William Crawford, M.D.; Jamie
				  Gray
Statutory Authority:
Code of Ala.
				  1975
, §
										22-18-1,
et
				  seq
.