North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter P - EMERGENCY MEDICAL SERVICES AND TRAUMA RULES › Section .0100 - DEFINITIONS › Section 13P .0102 - DEFINITION

Current through Register Vol. 39, No. 2, July 15, 2024
In addition to the definitions in G.S. 131E-155, the
					 following definitions apply throughout this Subchapter:
(1) "Affiliated EMS Provider" means the firm,
				  corporation, agency, organization, or association identified with a specific
				  county EMS system as a condition for EMS Provider Licensing as required by Rule
				  .0204 of this Subchapter.
(2)
				  "Affiliated Hospital" means a non-trauma center hospital that is owned by the
				  Trauma Center or a hospital with a contract or other agreement to allow for the
				  acceptance or transfer of the Trauma Center's patient population to the
				  non-trauma center hospital.
(3)
				  "Affiliate" or "Affiliation" means a reciprocal agreement and association that
				  includes active participation, collaboration, and involvement in a process or
				  system between two or more parties.
(4) "Alternative Practice Setting" means a
				  practice setting that utilizes credentialed EMS personnel that may not be
				  affiliated with or under the oversight of an EMS System or EMS System Medical
				  Director.
(5) "Air Medical
				  Ambulance" means an aircraft configured and medically equipped to transport
				  patients by air. The patient care compartment of air medical ambulances shall
				  be staffed by medical crew members approved for the mission by the Medical
				  Director.
(6) "Air Medical Program"
				  means a SCTP or EMS System utilizing rotary-wing or fixed-wing aircraft
				  configured and operated to transport patients.
(7) "Assistant Medical Director" means a
				  physician, EMS-PA, or EMS-NP who assists the Medical Director with the medical
				  aspects of the management of a practice setting utilizing credentialed EMS
				  personnel or medical crew members.
(8) "Bypass" means a decision made by the
				  patient care technician to transport a patient from the scene of an accident or
				  medical emergency past a receiving facility for the purposes of accessing a
				  facility with a higher level of care, by a hospital of its own volition to
				  reroute a patient from the scene of an accident or medical emergency or
				  referring hospital to a facility with a higher level of care.
(9) "Community Paramedicine" means an EMS
				  System utilizing credentialed personnel who have received additional training
				  as determined by the EMS System Medical Director to provide knowledge and
				  skills for the community needs beyond the 911 emergency response and transport
				  operating guidelines defined in the EMS System plan.
(10) "Contingencies" mean conditions placed
				  on a designation that, if unmet, may result in the loss or amendment of a
				  designation.
(11) "Convalescent
				  Ambulance" means an ambulance used on a scheduled basis solely to transport
				  patients having a known non- emergency medical condition. Convalescent
				  ambulances shall not be used in place of any other category of ambulance
				  defined in this Subchapter.
(12)
				  "Deficiency" means the failure to meet essential criteria for a designation
				  that can serve as the basis for a focused review or denial of a
				  designation.
(13) "Department"
				  means the North Carolina Department of Health and Human Services.
(14) "Diversion" means the hospital is unable
				  to accept a patient due to a lack of staffing or resources.
(15) "Educational Medical Advisor" means the
				  physician responsible for overseeing the medical aspects of approved EMS
				  educational programs.
(16) "EMS
				  Care" means all services provided within each EMS System by its affiliated EMS
				  agencies and personnel that relate to the dispatch, response, treatment, and
				  disposition of any patient.
(17)
				  "EMS Educational Institution" means any agency credentialed by the OEMS to
				  offer EMS educational programs.
(18) "EMS Non-Transporting Vehicle" means a
				  motor vehicle operated by a licensed EMS provider dedicated and equipped to
				  move medical equipment and EMS personnel functioning within the scope of
				  practice of an AEMT or Paramedic to the scene of a request for assistance. EMS
				  nontransporting vehicles shall not be used for the transportation of patients
				  on the streets, highways, waterways, or airways of the state.
(19) "EMS Peer Review Committee" means a
				  committee as defined in G.S. 131E-155(6b).
(20) "EMS Provider" means those entities
				  defined in G.S. 131E-155(13a) that hold a current license issued by the
				  Department pursuant to G.S. 131E-155.1.
(21) "EMS System" means a coordinated
				  arrangement of local resources under the authority of the county government
				  (including all agencies, personnel, equipment, and facilities) organized to
				  respond to medical emergencies and integrated with other health care providers
				  and networks including public health, community health monitoring activities,
				  and special needs populations.
(22)
				  "Essential Criteria" means those items that are the requirements for the
				  respective level of trauma center designation (I, II, or III), as set forth in
				  Rule .0901 of this Subchapter.
(23)
				  "Focused Review" means an evaluation by the OEMS of corrective actions to
				  remove contingencies that are a result of deficiencies following a site
				  visit.
(24) "Ground Ambulance"
				  means an ambulance used to transport patients with traumatic or medical
				  conditions or patients for whom the need for specialty care, emergency, or non-
				  emergency medical care is anticipated either at the patient location or during
				  transport.
(25) "Hospital" means a
				  licensed facility as defined in G.S. 131E-176 or an acute care in-patient
				  diagnostic and treatment facility located within the State of North Carolina
				  that is owned and operated by an agency of the United States
				  government.
(26) "Inclusive Trauma
				  System" means an organized, multi-disciplinary, evidence-based approach to
				  provide quality care and to improve measurable outcomes for all defined injured
				  patients. EMS, hospitals, other health systems, and clinicians shall
				  participate in a structured manner through leadership, advocacy, injury
				  prevention, education, clinical care, performance improvement, and research
				  resulting in integrated trauma care.
(27) "Infectious Disease Control Policy"
				  means a written policy describing how the EMS system will protect and prevent
				  its patients and EMS professionals from exposure and illness associated with
				  contagions and infectious disease.
(28) "Lead RAC Agency" means the agency
				  (comprised of one or more Level I or II trauma centers) that provides staff
				  support and serves as the coordinating entity for trauma planning.
(29) "Level I Trauma Center" means a hospital
				  that has the capability of providing guidance, research, and total care for
				  every aspect of injury from prevention to rehabilitation.
(30) "Level II Trauma Center" means a
				  hospital that provides trauma care regardless of the severity of the injury,
				  but may lack the comprehensive care as a Level I trauma center, and does not
				  have trauma research as a primary objective.
(31) "Level III Trauma Center" means a
				  hospital that provides assessment, resuscitation, emergency operations, and
				  stabilization, and arranges for hospital transfer as needed to a Level I or II
				  trauma center.
(32) "Medical Crew
				  Member" means EMS personnel or other health care professionals who are licensed
				  or registered in North Carolina and are affiliated with a SCTP.
(33) "Medical Director" means the physician
				  responsible for the medical aspects of the management of a practice setting
				  utilizing credentialed EMS personnel or medical crew members, or a Trauma
				  Center.
(34) "Medical Oversight"
				  means the responsibility for the management and accountability of the medical
				  care aspects of a practice setting utilizing credentialed EMS personnel or
				  medical crew members. Medical Oversight includes physician direction of the
				  initial education and continuing education of EMS personnel or medical crew
				  members; development and monitoring of both operational and treatment
				  protocols; evaluation of the medical care rendered by EMS personnel or medical
				  crew members; participation in system or program evaluation; and directing, by
				  two-way voice communications, the medical care rendered by the EMS personnel or
				  medical crew members.
(35) "Mobile
				  Integrated Healthcare" means utilizing credentialed personnel who have received
				  additional training as determined by the Alternative Practice Setting medical
				  director to provide knowledge and skills for the healthcare provider program
				  needs.
(36) "Office of Emergency
				  Medical Services" means a section of the Division of Health Service Regulation
				  of the North Carolina Department of Health and Human Services located at 1201
				  Umstead Drive, Raleigh, North Carolina 27603.
(37) "On-line Medical Control" means the
				  medical supervision or oversight provided to EMS personnel through direct
				  communication in- person, via radio, cellular phone, or other communication
				  device during the time the patient is under the care of an EMS
				  professional.
(38) "Operational
				  Protocols" means the administrative policies and procedures of an EMS System or
				  that provide guidance for the day-to-day operation of the system.
(39) "Physician" means a medical or
				  osteopathic doctor licensed by the North Carolina Medical Board to practice
				  medicine in the state of North Carolina.
(40) "Regional Advisory Committee" means a
				  committee comprised of a lead RAC agency and a group representing trauma care
				  providers and the community, for the purpose of regional planning,
				  establishing, and maintaining a coordinated trauma system.
(41) "Request for Proposal" means a State
				  document that must be completed by each hospital seeking initial or renewal
				  trauma center designation.
(42)
				  "Specialized Ambulance Protocol Summary (SAPS) means a document listing of all
				  standard medical equipment, supplies, and medications, approved by the
				  Specialty Care or Air Medical Program Medical Director as sufficient to manage
				  the anticipated number and severity of injury or illness of the patients, for
				  all vehicles used in the program based on the treatment protocols and approved
				  by the OEMS.
(43) "Significant
				  Failure to Comply" means a degree of non-compliance determined by the OEMS
				  during compliance monitoring to exceed the ability of the local EMS System to
				  correct, warranting enforcement action pursuant to Section .1500 of this
				  Subchapter.
(44) "Specialty Care
				  Transport Program" means a program designed and operated for the transportation
				  of a patient by ground or air requiring specialized interventions, monitoring,
				  and staffing by a paramedic who has received additional training as determined
				  by the program Medical Director beyond the minimum training prescribed by the
				  OEMS, or by one or more other healthcare professional(s) qualified for the
				  provision of specialized care based on the patient's condition.
(45) "Specialty Care Transport Program
				  Continuing Education Coordinator" means a Level I EMS Instructor within a SCTP
				  who is responsible for the coordination of EMS continuing education programs
				  for EMS personnel within the program.
(46) "Stretcher" means any wheeled or
				  portable device capable of transporting a person in a recumbent position and
				  may only be used in an ambulance vehicle permitted by the Department.
(47) "Stroke" means an acute cerebrovascular
				  hemorrhage or occlusion resulting in a neurologic deficit.
(48) "System Continuing Education
				  Coordinator" means the Level II EMS Instructor designated by the local EMS
				  System who is responsible for the coordination of EMS continuing education
				  programs.
(49) "System Data" means
				  all information required for daily electronic submission to the OEMS by all EMS
				  Systems using the EMS data set, data dictionary, and file format as specified
				  in "North Carolina College of Emergency Physicians: Standards for Medical
				  Oversight and Data Collection," incorporated herein by reference including
				  subsequent amendments and editions. This document is available from the OEMS at
https://oems.nc.gov/systems
at
				  no cost.
(50) "Trauma Center" means
				  a hospital designated by the State of North Carolina and distinguished by its
				  ability to manage, on a 24- hour basis, the severely injured patient or those
				  at risk for severe injury.
(51)
				  "Trauma Patient" means any patient with an ICD-CM discharge diagnosis as
				  defined in the "North Carolina Trauma Registry Data Dictionary," incorporated
				  herein by reference, including subsequent amendments and editions. This
				  document is available from the OEMS online at
https://oems.nc.gov/wp-content/uploads/2022/10/datadictionary.pdf
at no cost.
(52) "Trauma Program"
				  means an administrative entity that includes the trauma service and coordinates
				  other trauma-related activities. It shall also include the trauma Medical
				  Director, trauma program manager/trauma coordinator, and trauma registrar. This
				  program's reporting structure shall give it the ability to interact with at
				  least equal authority with other departments in the hospital providing patient
				  care.
(53) "Trauma Registry" means
				  a disease-specific data collection composed of a file of uniform data elements
				  that describe the injury event, demographics, pre-hospital information,
				  diagnosis, care, outcomes, and costs of treatment for injured patients
				  collected and electronically submitted as defined by the OEMS. The elements of
				  the Trauma Registry can be accessed online at
https://oems.nc.gov/wp-content/uploads/2022/10/datadictionary.pdf
at no cost.
(54) "Treatment
				  Protocols" means a document approved by the Medical Directors of the local EMS
				  System, Specialty Care Transport Program, Alternative Practice Setting, or
				  Trauma Center and the OEMS specifying the diagnostic procedures, treatment
				  procedures, medication administration, and patient-care- related policies that
				  shall be completed by EMS personnel or medical crew members based upon the
				  assessment of a patient.
(55)
				  "Triage" means the assessment and categorization of a patient to determine the
				  level of EMS and healthcare facility based care required.
(56) "Water Ambulance" means a watercraft
				  specifically configured and medically equipped to transport patients.
Authority
					 G.S.
					 131E-155(6b);
					 131E-162;
					 143-508(b);
					 143-508(d)(1);
					 143-508(d)(2);
					 143- 508(d)(3); 143-508(d)(4); 143-508(d)(5); 143-508(d)(6); 143-508(d)(7);
					 143-508(d)(8); 143- 508(d)(13); 143-518(a)(5);
Temporary Adoption
					 Eff. January 1, 2002;
Eff. April 1, 2003;
Amended Eff.
					 March 3, 2009 pursuant to E.O. 9, Beverly Perdue, March 3, 2009;
Pursuant to
					 G.S.
					 150B-21.3(c), a bill was not
					 ratified by the General Assembly to disapprove this rule;
Readopted
					 Eff. January 1, 2017;
Amended Eff. July 1, 2021; September 1, 2019;
					 July 1, 2018.