Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 12 - Bureau of Emergency Medical Services › Subpart 32 - Trauma System › Chapter 7 - Burn Centers › Appendix 15-12-32-7-9 - GLOSSARY

Current through June 25, 2024
"Advanced EMT: - a person providing basic and limited
					 advanced emergency care and transportation for critical and emergent patients
					 who access the emergency medical system. This individual possess the basic
					 knowledge and skills necessary to provide patient care and transportation. AEMT
					 function as a part of a comprehensive EMS response, under medical oversight.
					 AEMTs perform interventions with the basic and advanced equipment typically
					 found on an ambulance. (National EMS Scope of Practice Model) AEMTs must
					 possess valid licensed issued by the BEMS.
"Advanced life Support" - shall mean a sophisticated level
					 of pre-hospital and interhospital emergency care which includes basic life
					 support functions including cardiopulmonary resuscitation (CPR), plus cardiac
					 defibrillation, telemetered electrocardiography, administration of
					 antiarrhythmic agents, intravenous therapy, administration of specific
					 medications, drugs and solutions, use of adjunctive ventilation devices, trauma
					 care and other authorized techniques and procedures.
"Advanced life support personnel" - shall mean persons
					 other than physicians engaged in the provision of advanced life support, as
					 defined and regulated by rules and regulations promulgated pursuant to Section
					 41-60-13.
"Advanced Life Support Services" - shall mean
					 implementation of the 15 components of an EMS system to a level capability
					 which provides noninvasive and invasive emergency patient care designed to
					 optimize the patient's chances of surviving the emergency situation. Services
					 shall include use of sophisticated transportation vehicles, a communications
					 capability (two-way voice and/or biomedical telemetry) and staffing by Advanced
					 EMTs and Paramedics providing on-site, pre-hospital mobile and hospital
					 intensive care under medical control.
"Ambulance" - shall mean any privately or publicly owned
					 land or air vehicle that is especially designed, constructed, modified or
					 equipped to be used, maintained and operated upon the streets, highway or
					 airways of this state to assist persons who are sick, injured, wounded or
					 otherwise incapacitated or helpless.
"Ambulance Placement Strategy (System Status Plan)" - a
					 planned outline or protocol governing the deployment and event-driven
					 redeployment of the ambulance service's resources, both geographically and by
					 time-of-day/day-of-week. Every system has a plan; the plan may be written or
					 not, elaborate or simple, efficient or wasteful, effective or deadly.
"Ambulance Post" - a designated location for ambulance
					 placement within the system status plan. Depending upon its frequency and type
					 of use, a "post" may be a facility with sleeping quarters or day rooms for
					 crews, or simply a street-corner or parking lot location to which units are
					 sometimes deployed.
"Ambulance Service Area" - the geographic response area of
					 the licensed ambulance service. The service area must correspond to each
					 individual service license. The service's employee staffing plan, ambulance
					 placement strategy and available resources must be commensurate with the
					 service area.
"Area wide EMS System" - is an emergency medical service
					 area (trade, catchment, market, patient flow) that provides essentially all of
					 the definitive emergency medical care (95¢) for all emergencies, including
					 the most critically ill and injured patients. Only highly specialized and
					 limited-use services may need to be obtained outside of the area. The area must
					 contain adequate population and available medical resources to implement and
					 sustain an EMS operation. At least three major modes exist: (a) multiple
					 urbanized communities and their related suburbs; (b) a metropolitan center and
					 its surrounding rural areas; and (c) a metropolitan center and extreme
					 rural-wilderness settings. The areas may be inter- or intra-state.
"Associate/Receiving Hospital" - is a designated
					 participating hospital working in conjunction with and under the supervision of
					 the Resource Hospital to carry out the system implementation. They shall have
					 an emergency department/service which offers emergency care 24 hours a day,
					 with at least one physician available to the emergency care area within
					 approximately 30 minutes through a medical staff call roster. Specialty
					 consultation must be available by request of the attending medical staff member
					 or by transfer to a designated hospital where definitive care can be provided.
					 They must be capable of providing 24-hour-a-day acute care to critically ill
					 patients. They do not, however, have to be equipped with biomedical telemetry
					 within its confines.
"Automated External Defibrillator (AED)" - means a
					 defibrillator which: a) is capable of cardiac rhythm analysis; b) will charge
					 and deliver a shock after electrically detecting the presence of a cardiac
					 dysrhythmia or is a shock-advisory device in which the defibrillator will
					 analyze the rhythm and display a message advising the operator to press a
					 "shock" control to deliver the shock; c) must be capable of printing a post
					 event summary (at a minimum the post event summary should include times, joules
					 delivered, ECG) and d) an on screen display of the ECG. (optional)
"Base Station Hospital" - is designated participating
					 hospital working in conjunction with and under the supervision of the Resource
					 Hospital to carry out the systems implementation. These hospitals may function
					 as a pre-hospital Communications Resource as defined in the section on Medical
					 Direction. The hospitals may participate in training and evaluation of ALS
					 personnel. They must have emergency department's staffed 24-hours-a-day by
					 critical care nurses and at least one emergency physician or physicians under
					 the direction and supervision of a physician totally versed and committed to
					 emergency medicine. It must have specialty consultation available within
					 approximately 30 minutes by members of the medical staff or by senior-level
					 residents. Pre-hospital ALS personnel transmit patient information to the Base
					 Station Hospitals and receive appropriate medical directions from them. The
					 hospitals should be equipped with voice and biomedical telemetry equipment.
					 Each Base Station Hospital must have an On-Line Medical Director.
"Basic Life Support Services (BLS)" - Implementation of
					 the 15 components of and EMS system to a level of capability which provides
					 pre-hospital noninvasive emergency patient care designed to optimize the
					 patient's chance of surviving the emergency situation. There would be universal
					 access to and dispatch of national standard ambulances, with appropriate
					 medical and communication equipment operated by Emergency Medical
					 Technicians-Ambulance. Regional triage protocols should be used to direct
					 patients to appropriately categorized hospitals.
"Board" means the State Board of Health;
"Bypass" (diversion) - A medical protocol or medical order
					 for the transport of an EMS patient past a normally used EMS receiving facility
					 to a designated medical facility for the purpose for accessing more readily
					 available or appropriate medical care.
"Certificate" means official acknowledgment that an
					 individual has successfully completed (i) the recommended basic emergency
					 medical technician training course referred to in this chapter which entitles
					 that individual to perform the functions and duties of an emergency medical
					 technician, or (ii) the recommended medical first responder training course
					 referred to in this chapter which entitles that individual to perform the
					 functions and duties of a medical first responder;
"Critical Care Units (Centers)" - are sophisticated
					 treatment facilities in large medical centers and hospitals that provide
					 advanced definitive care for the most critically ill patients. The units are
					 available for the diagnosis and care of specific patient problems including
					 major trauma, burn, spinal cord injury, poisoning, acute cardiac, high risk
					 infant and behavioral emergencies.
"Communication Resource" - an entity responsible for
					 implementation of direct medical control (See detailed description in section
					 on Medical Direction).
"Delegated Practice" - Only physicians are licensed to
					 practice medicine. Pre-hospital providers must act only under the medical
					 direction of a physician.
"Department" - the Mississippi State Department of Health,
					 Bureau of Emergency Medical Services.
"Direct Medical Control" - When a physician provides
					 immediate medical direction to pre-hospital providers in remote locations.
"Diversion" - see "Bypass."
"DOT" - shall mean United States Department of
					 Transportation.
"Emergency Medical Condition" means a medical condition
					 manifesting itself by acute symptoms of sufficient severity, including severe
					 pain, psychiatric disturbances and/or symptoms of substance abuse, such that a
					 prudent layperson who possesses an average knowledge of health and medicine
					 could reasonably expect the absence of immediate medical attention to result in
					 placing the health of the individual (or, with respect to a pregnant woman, the
					 health of the woman or her unborn child) in serious jeopardy, serious
					 impairment to bodily functions, or serious dysfunction of any bodily organ or
					 part;
"Emergency Medical Services (EMS)" - Services utilized in
					 responding to a perceived individual's need for immediate medical care to
					 prevent death or aggravation of physiological or psychological illness or
					 injury.
"EMS Personnel" - Key individual EMS providers. This
					 includes physician, emergency and critical care nurse, EMT, Advanced EMT,
					 Paramedic, dispatchers, telephone screeners, first aid responders, project
					 administrators and medical consultants and system coordinators.
"EMS System" - A system which provides for the arrangement
					 of personnel, facilities, and equipment of the effective and coordinated
					 delivery of health care services in an appropriate geographical area under
					 emergency conditions (occurring as a result of the patient's condition or
					 because of natural disasters or similar conditions). The system is managed by a
					 public or nonprofit private entity. The components of an EMS System include:
manpower
training
communications
transportation
facilities
critical care units
public safety agencies
consumer participation
access to care
patient transfer
coordinated patient recordkeeping
public information and education
review and evaluation
disaster plan
mutual aid
"Emergency medical technician" - A person providng out of
					 hospital emergency medical care and transportation for critical and emergenct
					 patients who access the EMS system. EMTs have the basic knowledge and skills
					 necessary to stabilize and safely transport patients ranging from non-emergency
					 and routine medical transports to life threatening emergencies. EMTs function
					 as part of a comprehensive EMS system, under medical oversight. EMTs perform
					 interventions with the basic equipment found on an ambulance. (National EMS
					 Scope of Practice Model) EMTs must possess valid licensed issued by the BEMS.
"Emergency mode" means an ambulance or special use EMS
					 vehicle operating with emergency lights and warning siren (or warning siren and
					 air horn) while engaged in an emergency medical call.
"Emergency response" means responding immediately at the
					 basic life support or advanced life support level of service to an emergency
					 medical call. An immediate response is one in which the ambulance supplier
					 begins as quickly as possible to take the steps necessary to respond to the
					 call;
"Emergency medical call" means a situation that is
					 presumptively classified at time of dispatch to have a high index of
					 probability that an emergency medical condition or other situation exists that
					 requires medical intervention as soon as possible to reduce the seriousness of
					 the situation, or when the exact circumstances are unknown, but the nature of
					 the request is suggestive of a true emergency where a patient may be at risk;
"Executive officer" - shall mean the executive officer of
					 the State Department of Health or his designated representative.
"Field Categorization" (classification) - a medical
					 emergency classification procedure for patients that is applicable under
					 conditions encountered at the site of a medical emergency.
"Field Triage" - Classification of patients according to
					 medical need at the scene of an injury or onset of an illness.
"First responder" means a person who uses a limited amount
					 of equipment to perform the initial assessment of and intervention with sick,
					 wounded or otherwise incapacitated persons
"Medical first responder" means a person who uses a
					 limited amount of equipment to perform the initial assessment of and
					 intervention with sick, wounded or otherwise incapacitated persons who (i) is
					 trained to assist other EMS personnel by successfully completing, and remaining
					 current in refresher training in accordance with, an approved "First Responder:
					 National Standard Curriculum" training program, as developed and promulgated by
					 the United States Department of Transportation, (ii) is nationally registered
					 as a first responder by the National Registry of Emergency Medical Technicians;
					 and (iii) is certified as a medical first responder by the State Department of
					 Health, Division of Emergency Medical Services.
"Inclusive Trauma Care System" - a trauma care system that
					 incorporates every health care facility in a community in a system in order to
					 provide a continuum of services for all injured persons who require care in an
					 acute care facility; in such a system, the injured patient's needs are matched
					 to the appropriate hospital resources.
"Implied Consent" - shall mean legal position that assumes
					 an unconscious patient, or one so badly injured or ill that he cannot respond,
					 would consent to receiving emergency care. Implied consent applies to children
					 when parent or guardian is not at the scene.
"Intervener Physicians" - A licensed M.D. or D.O., having
					 not previously established a doctor/patient relationship with the emergency
					 patient and willing to accept responsibility for a medical emergency scene, and
					 can provide proof of a current Medical Licensure.
"Lead Agency" - is an organization which has been
					 delegated the responsibility for coordinating all component and care aspects
					 for an EMS system.
"Level I" - Hospitals that have met the requirements for
					 Level I as stated in the Mississippi Trauma Rules and Regulations.
"Level II" - Hospitals that have met the requirements for
					 Level II as stated in Mississippi Trauma Rules and Regulations.
"Level III" - Hospitals that have met the requirements for
					 Level III as stated in Mississippi Trauma Rules and Regulations.
"Level IV" - Hospitals that have met the requirements for
					 Level IV as stated in Mississippi Trauma Rules and Regulations.
"Licensure" - shall mean an authorization to any person,
					 firm, cooperation, or governmental division or agency to provide ambulance
					 services in the State of Mississippi.
"License Location" - shall be defined as a fixed location
					 where the ambulance service conducts business or controls the deployment of
					 ambulances to the service area.
"Major Trauma" - that subset of injuries that encompasses
					 the patient with or at risk for the most severe or critical types of injury and
					 therefore requires a system approach in order to save life and limb.
"Major Trauma Patient" (or "major trauma" or " critically
					 injured patient") - a person who has sustained acute injury and by means of a
					 standardized field triage criteria (anatomic, physiology, and mechanism of
					 injury) is judged to be at significant risk of mortality or major morbidity.
"Mechanism of Injury" - the source of forces that produce
					 mechanical deformations and physiological responses that cause an anatomic
					 lesion of functional change in humans.
"Medical Control" - shall mean directions and advice
					 provided from a centrally designated medical facility staffed by appropriate
					 personnel, operating under medical supervision, supplying professional support
					 through radio or telephonic communication for on-site and in-transit basic and
					 advanced life support services given by field and satellite facility personnel.
"Medical Direction" - (medical accountability) - When a
					 physician is identified to develop, implement and evaluate all medical aspects
					 of an EMS system.
"Medical Director" - (off line, administrative) should be
					 a physician both credible and knowledgeable in EMS systems planning,
					 implementation, and operations. This off-line physician assumes total
					 responsibility for the system's activities. He is appointed by the local EMS
					 lead agency. The administrative medical director works in close liaison with
					 government agencies, public safety and disaster operations, legislative and
					 executive offices, professional societies, and the public. Off-line program
					 activities include liaison with other state and regional EMS medical directors
					 to conceptualize clinical and component system designs, establish standards,
					 monitor and evaluate the integration of component and system activities.
This off-line physician assures medical soundness and
					 appropriateness of all aspects of the program and is responsible for the
					 conceptual and systems design and overall supervision of the EMS program.
The administrative (off-line) medical director develop all
					 area protocols. These protocols serve as the basis for EMS system role
					 definition of EMS personnel, curriculum development, competency determination,
					 and maintenance, monitoring, and evaluation.
The off-line medical director meets on a regular basis
					 with on-line medical directors and the EMS training director to evaluate
					 on-line system performance, to review problems, and suggest changes in
					 treatment, triage, or operational protocols. All on-line medical directors must
					 be approved by the off-line medical director.
"Mississippi Trauma Advisory Committee" (MTAC) - (See
					 Appendix A) advisory body created by legislature for the purpose of providing
					 assistance in all areas of trauma care system development and technical support
					 to the Department of Health; members are comprised of EMS Advisory Council
					 members appointed by the chairman.
"Mississippi Trauma Care System Plan" (State Trauma Plan)
					 - a formally organized plan developed by the Mississippi State Department of
					 Health, pursuant to legislative directive, which sets out a comprehensive
					 system of prevention and management of major traumatic injuries.
"On-Line (Supervising ALS) Medical Director" - On-Line
					 medical control is provided through designated Primary Resource and Base
					 Station Hospitals under the area direction of a supervisory ALS medical
					 director who is on-line to the pre-hospital system stationed at the designated
					 Base Station Hospital. Each provider of ALS must also have an on-line medical
					 director. The system must also have an on-line medical director for EMS
					 training. These supervisory medical directors are organizationally responsible
					 to the administrative (off-line medical director of the local EMS lead agency
					 for program implementation and operations within his area of jurisdiction).
The ALS (on-line) medical director supervises the advanced
					 life support, pre- and inter-hospital system and is responsible for the actual
					 day-to-day operation of the EMS system. He carries out the "EMS systems design"
					 in terms of pre-and inter-hospital transportation care and provides ALS
					 direction to EMS providers depending on the transportation care and provides
					 ALS direction to EMS providers depending on the system's configuration. He
					 monitors all pre-hospital ALS activities within that system's region or area of
					 responsibility. The ALS physician must review and monitor compliance to
					 protocols for both the pre-and inter-hospital settings.
The ALS (on-line) medical director in conjunction with the
					 EMS training medical director reviews paramedics, Advanced EMTs, EMTs, mobile
					 intensive care nurses, and physician competencies and recommends certification,
					 re-certification, and decertification of these personnel to the EMS health
					 officer of the lead agency responsible for the certification decertification,
					 and recertification of EMS personnel. Monitoring the competency of all
					 pre-hospital EMS personnel activities is within his responsibility.
He attends medical control meetings where area system
					 performance and problems are discussed and recommendations to the
					 administrative off-line director are made. He also conducts regular case
					 reviews and other competency evaluation and maintenance procedures and reports
					 back to the administrative (off-line) medical director.
This ALS (on-line) physician assumes the supervision and
					 responsibility for all advanced care rendered in an emergency at the scene of
					 an accident and en route to the hospital under his area jurisdiction. Each
					 on-line medical director representing the hospitals providing medical control
					 has the authority to delegate his duties to other emergency department
					 physicians who may be on duty and placed in a position of giving medical
					 direction to pre-hospital ALS personnel.
"Paramedic" - an allied health professional whose primary
					 focus is to provide advanced emergency medical care for critical and emergent
					 patients who access the emergency medical system. This individual possesses the
					 complex knowledge and skills necessary to provide patient care and
					 transportation. Paramedics function as part of a comprehensive EMS response,
					 under medical oversight. Paramedics perform interventions with the basic and
					 advanced equipment typically found on an ambulance. (National EMS Scope of
					 Practice Model) Paramedics must possess valid licensed issued by the BEMS.
"Pediatric Trauma Center" - Either (a) a licensed acute
					 care hospital which typically treats persons fourteen (14) years of age or
					 less, which meets all relevant criteria contained in these Regulations and
					 which has been designated as a pediatric Trauma Center; or (b) the pediatric
					 component of a Trauma Center with pediatric specialist and a pediatric
					 intensive care unit.
"Performance Improvement" (or "quality improvement") - a
					 method of evaluating and improving processes of patient care which emphasizes a
					 multi-disciplinary approach to problem solving, and focuses not on individuals,
					 but systems of patient care which might cause variations in patient outcome.
"Permit" - shall mean an authorization issued for an
					 ambulance vehicle as meeting the standards adopted pursuant to this chapter.
"Pre-hospital Provider" - all personnel providing
					 emergency medical care in a location remote from facilities capable of
					 providing definitive medical care.
"Primary Resource Hospital" - The Primary Resource
					 Hospital (PRH) is responsible for implementing the medical control design of
					 the ALS system. It has the major functional responsibility for implementing
					 protocols (treatment, triage, and operations) and the monitoring of program
					 compliance to these by on-line medical supervision. This hospital must be an
					 acute general care facility equipped with voice and biomedical telemetry
					 equipment. It should be staffed with critical care nurses and emergency
					 physicians, or physicians under the direction and supervision of physicians
					 totally versed and committed to emergency medicine. It must be capable of
					 functioning as a Communications Resource as described in the section on Medical
					 Direction and pre-hospital ALS personnel should be able to receive medical
					 control and direction from this facility anywhere within the district. It is
					 also understood that this facility is responsible for overall supervision of
					 medical directions that may be issued by other participating hospitals within
					 the district.
This hospital provides and coordinates interdisciplinary
					 training for ALS providers within the district. The lead agency may choose to
					 delegate or contract this responsibility to other institutions."
"Protocols" - standards for EMS practice in a variety of
					 situations within the EMS system.
"Regional Trauma Plan" - a document developed by the
					 various Trauma Care Regions that follows the State Trauma Plan, and approved by
					 the Mississippi State Department of Health, which describes the policies,
					 procedures and protocols for a comprehensive system of prevention and
					 management of major traumatic injuries in that Trauma Care Region.
"Regionalization" - the identification of available
					 resources within a given geographic area, and coordination of services to meet
					 the need of a specific group of patients.
"Service Area" (or "catchment area") - that geographic
					 service area defined by the local EMS agency licensure.
"Specialty Care Facility" - an acute care facility that
					 provides specialized services and specially trained personnel to care for a
					 specific portion of the injured population, such as pediatric, burn injury, or
					 spinal cord injury patients.
"Surveillance" - the ongoing and systematic collection,
					 analysis, and interpretation of health data in the process of describing and
					 monitoring a health event.
"Trauma" - a term derived from the Greek for "wound"; it
					 refers to any bodily injury (see "Injury").
"Trauma Care Facility" (or "trauma center") - a hospital
					 that has been designated by the department to perform specified trauma care
					 services within a Trauma Care Region pursuant to standards adopted by the
					 department.
"Trauma Care Region" - Trauma Care Region is a geographic
					 area of the state formally organized, in accordance with standards promulgated
					 by the department and has received designation from the department, for
					 purposes of developing and inclusive care system.
"Trauma Care System Planning and Development Act of 1990"
					 - The federal law that amended the Public Health Service Act to add Title XII -
					 Trauma Programs. The purpose of the legislation being to assist State
					 governments in developing, implementing and improving regional systems of
					 trauma care, and to fund research and demonstration projects to improve rural
					 EMS and trauma.
"Trauma Care System" - an organized approach to treating
					 patients with acute injuries; it provides dedicated (available 24 hours a day)
					 personnel, facilities, and equipment for effective and coordinated trauma care
					 in an appropriate geographical region, known as a Trauma Care Region.
"Trauma Center Designation" - the process by which the
					 Department identifies facilities within a Trauma Care Region.
"Trauma Program Manager" - a designated individual with
					 responsibility for coordination of all activities on the trauma service and
					 works in collaboration with the trauma service director.
"Standing Orders" - are those specific portions of the
					 treatment protocols that may be carried out by ALS personnel without having to
					 establish contact with medical control facility. These standing orders
					 represent nationally recognized treatment modalities and allow the ALS
					 personnel to treat life-threatening problems without delay.
"State EMS Medical Director" ' A Mississippi licensed
					 physician, employed by the Mississippi Department of Health, who is responsible
					 for the development, implementation, and evaluation of standards and guidelines
					 for the provision of emergency medical services and EMS medical direction in
					 the state. This physician must have experience in EMS medical direction and be
					 board certified in emergency medicine. This physician must be experienced with
					 EMS systems, EMS medical direction, evaluation processes, teaching, and
					 curriculum development. It is the goal of the State EMS Medical Director to
					 ensure the care delivered by EMS systems in the state is consistent with
					 recognized standards and that quality is maintained in a manner that assures
					 professional and public accountability. The State EMS Medical Director must
					 serve as an advocate for efficient and effective emergency medical services
					 throughout the state.
The Responsibilities of the State EMS Medical Director
					 include but are not limited to:
* Oversight of all aspects of EMS Medical direction in the
					 state
* Oversight of the of standards and minimum qualifications
					 for EMS Medical Directors
* Approval of Offline Medical Directors for ambulance
					 services
* Approval of protocols for ambulance services
* Approve training programs, training standards, and
					 curricula for EMS providers and medical directors.
* Oversight of all aspects of EMS quality assurance and
					 performance improvement in the state
* Approval of the Quality Assurance and Performance
					 Improvement plans for ambulance services
* Serve as Chairman of the Committee on Medical Direction,
					 Training, and Quality Assurance
* Serve as Chairman of the EMS Performance Improvement
					 Committee
* Serve as Chairman of the EMS Protocol Committee
* Act as a liaison with public safety and disaster
					 planning agencies
* Act as a liaison with national EMS agencies
* Oversight of issues related to complaints,
					 investigations, disciplinary procedures involving patient care, performance
					 standards, and medical direction
"State Trauma Plan" ' See Mississippi Trauma Care Plan
"Transfer" - The movement (including the discharge) of a
					 patient outside a hospital's facilities at the direction of any person employed
					 by (or affiliated or associated, directly or indirectly with) the hospital, but
					 does not include such a movement of a patient who (a) has been declared dead,
					 or (b) leaves the facility without the permission of any such person.
"Treatment Protocols" - are written uniform treatment and
					 care plans for emergency and critical patients. These treatment plans must be
					 approved and signed by the off-line medical director and/or medical groups.
					 (Appendix 2)
"Triage" - the process of sorting injured patients on the
					 basis of the actual or perceived degree of injury and assigning them to the
					 most effective and efficient regional care resources, in order to insure
					 optimal care and the best chance of survival.
"Triage Criteria" - a measure or method of assessing the
					 severity of a person's injuries that is used for patient evaluation, especially
					 in the prehospital setting, and that utilizes anatomic or physiologic
					 considerations or mechanism of injury.
"Triage Protocols" - are region wide plans for
					 identifying, selecting and transporting specific critical patients to
					 appropriate, designated treatment facilities.