Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 31 - VIRGINIA EMERGENCY MEDICAL SERVICES REGULATIONS › Part I - General Provisions › Article 1 - Definitions › Section 12VAC5-31-10 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
The following words and terms when used in this chapter
						shall have the following meanings unless the context clearly indicates
						otherwise.
"Abandonment" means the termination of a health care
						provider-patient relationship without assurance that an equal or higher level
						of care meeting the assessed needs of the patient's condition is present and
						available.
"Accreditation" means approval granted to an entity by
						the Office of Emergency Medical Services (EMS) after the institution has met
						specific requirements enabling the institution to conduct basic or advanced
						life support training and education programs. There are four levels of
						accreditation: interim, provisional, full, and probationary.
"Accreditation cycle" means the term or cycle at the
						conclusion of which accreditation expires unless a full self-study is
						performed. Accreditation cycles are typically quinquennial (five-year) but
						these terms may be shorter, triennial (three-year) or biennial (two-year), if
						the Office of EMS deems it necessary.
"Accreditation date" means the date of the accreditation
						decision that is awarded to an entity following its full site visit and
						review.
"Accreditation decision" means the conclusion reached
						about an entity status after evaluation of the results of the onsite survey,
						recommendations of the site review team, and any other relevant information
						such as documentation of compliance with standards, documentation of plans to
						correct deficiencies, or evidence of recent improvements.
"Accreditation denied" means an accreditation decision
						that results when an entity has been denied accreditation. This accreditation
						decision becomes effective only when all available appeal procedures have been
						exhausted.
"Acute" means a medical condition having a rapid onset
						and a short duration.
"Acute care hospital" means any hospital that provides
						emergency medical services on a 24-hour basis.
"Administrative Process Act" or "APA" means Chapter 40
						(§
											2.2-4000 et
						seq.) of Title 2.2 of the Code of Virginia.
"Advanced life support" or "ALS" means the provision of
						care by EMS personnel who are certified as an Emergency Medical Technician
						(EMT) - Enhanced, Advanced EMT, Intermediate, or Paramedic or equivalent as
						approved by the Board of Health.
Advanced life support in the air medical environment is a
						mission generally defined as the transport of a patient who receives care
						during a transport that includes an invasive medical procedure or the
						administration of medications, including IV infusions, in addition to any
						noninvasive care that is authorized by the Office of EMS.
"Advanced life support certification course" means a
						training program that allows a student to become eligible for a new ALS
						certification level. Programs must meet the educational requirements
						established by the Office of EMS as defined by the respective advanced life
						support curriculum. Initial certification courses include:
1. Emergency Medical Technician-Enhanced;
2. Advanced EMT;
3. Advanced EMT to Intermediate Bridge;
4. EMT-Enhanced to Intermediate Bridge;
5. Intermediate;
6. Intermediate to Paramedic Bridge;
7. Paramedic;
8. Registered Nurse to Paramedic Bridge; and
9. Other programs approved by the Office of EMS.
"Advanced life support coordinator" means a person who
						has met the criteria established by the Office of EMS to assume responsibility
						for conducting ALS training programs.
"Advanced life support transport" means the
						transportation of a patient who is receiving ALS level care.
"Affiliated" means a person who is employed by or a
						member of an EMS agency.
"Air medical specialist" means a person trained in the
						concept of flight physiology and the effects of flight on patients through
						documented completion of a program approved by the Office of EMS. This training
						must include but is not limited to aerodynamics, weather, communications,
						safety around aircraft/ambulances, scene safety, landing zone operations,
						flight physiology, equipment/aircraft familiarization, basic flight navigation,
						flight documentation, and survival training specific to service area.
"Ambulance" means, as defined by §
											32.1-111.1 of the
						Code of Virginia, any vehicle, vessel or craft that holds a valid permit issued
						by the Office of EMS and that is specially constructed, equipped, maintained
						and operated, and intended to be used for emergency medical care and the
						transportation of patients who are sick, injured, wounded, or otherwise
						incapacitated or helpless. The word "ambulance" may not appear on any vehicle,
						vessel or aircraft that does not hold a valid EMS vehicle permit.
"Approved locking device" means a mechanism that prevents
						removal or opening of a drug kit by means other than securing the drug kit by
						the handle only.
"Assistant director" means the Assistant Director of the
						Office of Emergency Medical Services.
"Attendant-in-charge" or "AIC" means the certified or
						licensed person who is qualified and designated to be primarily responsible for
						the provision of emergency medical care.
"Attendant" means a certified or licensed person
						qualified to assist in the provision of emergency medical care.
"Basic life support" or "BLS" means the provision of care
						by EMS personnel who are certified as First Responder, Emergency Medical
						Responder (EMR), or Emergency Medical Technician or equivalent as approved by
						the Board of Health.
Basic life support in the air medical environment means a
						mission generally defined as the transport of a patient who receives care
						during a transport that is commensurate with the scope of practice of an EMT.
						In the Commonwealth of Virginia care that is provided in the air medical
						environment must be assumed at a minimum by a Virginia certified Paramedic who
						is a part of the regular air medical crew. (fixed wing excluded)
"BLS certification course" means a training program that
						allows a student to become eligible for a new BLS certification level. Programs
						must meet the educational requirements established by the Office of EMS as
						defined by the respective basic life support curriculum. Initial certification
						courses include:
1. EMS First Responder;
2. EMS First Responder Bridge to EMT;
3. Emergency Medical Responder;
4. Emergency Medical Responder Bridge to EMT;
5. Emergency Medical Technician; and
6. Other programs approved by the Office of EMS.
"Board" or "state board" means the State Board of
						Health.
"Candidate" means any person who is enrolled in or is
						taking a course leading toward initial certification.
"Candidate status" means the status awarded to a program
						that has made application to the Office of EMS for accreditation but that is
						not yet accredited.
"CDC" means the United States Centers for Disease Control
						and Prevention.
"Certification" means a credential issued by the Office
						of EMS for a specified period of time to a person who has successfully
						completed an approved training program.
"Certification candidate" means a person seeking EMS
						certification from the Office of EMS.
"Certification candidate status" means any candidate or
						provider who becomes eligible for certification testing but who has not yet
						taken the certification test using that eligibility.
"Certification examiner" means an individual designated
						by the Office of EMS to administer a state certification examination.
"Certification transfer" means the issuance of
						certification through reciprocity, legal recognition, challenge or equivalency
						based on prior training, certification or licensure.
"Chief executive officer" means the person authorized or
						designated by the agency or service as the highest in administrative rank or
						authority.
"Commercial mobile radio service" or "CMRS" means the
						same as that term is defined in §§ 3 (27) and 332 (d) of the Federal
						Telecommunications Act of 1996 (
						47
						USC §
												151 et seq.) and the Omnibus
						Budget Reconciliation Act of 1993 (
						Public Law
						103-66, 107 USC § 312 ) and includes the term
						"wireless" and service provided by any wireless real time two-way voice
						communication device, including radio-telephone communications used in cellular
						telephone service or personal communications service (e.g., cellular telephone,
						800/900 MHz Specialized Mobile Radio, Personal Communications Service,
						etc.).
"Commissioner" means the State Health Commissioner, the
						commissioner's duly authorized representative, or in the event of the
						commissioner's absence or a vacancy in the office of State Health Commissioner,
						the Acting Commissioner or Deputy Commissioner.
"Continuing education" or "CE" means an instructional
						program that enhances a particular area of knowledge or skills beyond
						compulsory or required initial training.
"Course" means a basic or advanced life support training
						program leading to certification or award of continuing education credit
						hours.
"Course coordinator" means the person identified on the
						course approval request as the coordinator who is responsible with the
						physician course director for all aspects of the program including but not
						limited to assuring adherence to the rules and regulations, office policies,
						and any contract components.
"Critical care" or "CC" in the air medical environment is
						a mission defined as an interfacility transport of a critically ill or injured
						patient whose condition warrants care commensurate with the scope of practice
						of a physician or registered nurse.
"Critical criteria" means an identified essential element
						of a state practical certification examination that must be properly performed
						to successfully pass the station.
"Defibrillation" means the discharge of an electrical
						current through a patient's heart for the purpose of restoring a perfusing
						cardiac rhythm. For the purpose of these regulations, defibrillation includes
						cardioversion.
"Defibrillator -- automated external" or "AED" means an
						automatic or semi-automatic device, or both, capable of rhythm analysis and
						defibrillation after electronically detecting the presence of ventricular
						fibrillation and ventricular tachycardia, approved by the U.S. Food and Drug
						Administration.
"Defibrillator -- manual" means a monitor/defibrillator
						that has no capability for rhythm analysis and will charge and deliver a shock
						only at the command of the operator. For the purpose of compliance with these
						regulations, a manual defibrillator must be capable of synchronized
						cardioversion and noninvasive external pacing. A manual defibrillator must be
						approved by the U.S. Food and Drug Administration.
"Designated emergency response agency" means an EMS
						agency recognized by an ordinance or a resolution of the governing body of any
						county, city or town as an integral part of the official public safety program
						of the county, city or town with a responsibility for providing emergency
						medical response.
"Designated infection control officer" means a liaison
						between the medical facility treating the source patient and the exposed
						employee. This person has been formally trained for this position and is
						knowledgeable in proper post exposure medical follow up procedures and current
						regulations and laws governing disease transmission.
"Director" means the Director of the Office of Emergency
						Medical Services.
"Diversion" means a change in the normal or established
						pattern of patient transport at the direction of a medical care
						facility.
"Emergency medical services" or "EMS" means health care,
						public health, and public safety services used in the medical response to the
						real or perceived need for immediate medical assessment, care, or
						transportation and preventive care or transportation in order to prevent loss
						of life or aggravation of physiological or psychological illness or
						injury.
"EMS Advisory Board" means the Emergency Medical Services
						Advisory Board as appointed by the Governor.
"EMS agency status report" means a report submitted on
						forms specified by the Office of EMS that documents the operational
						capabilities of an EMS agency including data on personnel, vehicles and other
						related resources.
"EMS education coordinator" means any EMS provider,
						registered nurse, physician assistant, doctor of osteopathic medicine, or
						doctor of medicine who possesses Virginia certification as an EMS education
						coordinator. Such certification does not confer authorization to practice
						EMS.
"Emergency medical services agency" or "EMS agency" means
						any person engaged in the business, service, or regular activity, whether or
						not for profit, of transporting or rendering immediate medical care and
						providing transportation to persons who are sick, injured, or otherwise
						incapacitated or helpless and that holds a valid license as an emergency
						medical services agency issued by the commissioner in accordance with §
											32.1-111.6
						of the Code of Virginia.
"Emergency medical services personnel" or "EMS personnel"
						means individuals who are employed by or affiliated members of an emergency
						medical services agency and who provide emergency medical services pursuant to
						an emergency medical services agency license issued to that agency by the
						commissioner and in accordance with the authorization of that agency's
						operational medical director.
"Emergency medical services physician" or "EMS physician"
						means a physician who holds current endorsement from the Office of EMS and may
						serve as an EMS agency operational medical director or training program
						physician course director.
"Emergency medical services provider" or "EMS provider"
						means any person who holds a valid certificate as an emergency medical services
						provider issued by the commissioner.
"Emergency medical services system" or "EMS system" means
						the system of emergency medical services agencies, vehicles, equipment, and
						personnel; health care facilities; other health care and emergency services
						providers; and other components engaged in the planning, coordination, and
						delivery of emergency medical services in the Commonwealth, including
						individuals and facilities providing communications and other services
						necessary to facilitate the delivery of emergency medical services in the
						Commonwealth.
"Emergency medical services vehicle" or "EMS vehicle"
						means any vehicle, vessel, aircraft, or ambulance that holds a valid emergency
						medical services vehicle permit issued by the Office of EMS that is equipped,
						maintained or operated to provide emergency medical care or transportation of
						patients who are sick, injured, wounded, or otherwise incapacitated or
						helpless.
"Emergency medical services vehicle permit" means an
						authorization issued by the Office of EMS for any vehicle, vessel or aircraft
						meeting the standards and criteria established by regulation for emergency
						medical services vehicles.
"Emergency medical technician instructor" means an EMS
						provider who holds a valid certification issued by the Office of EMS to
						announce and coordinate BLS programs.
"Emergency vehicle operator's course" or "EVOC" means an
						approved course of instruction for EMS vehicle operators that includes safe
						driving skills, knowledge of the state motor vehicle code affecting emergency
						vehicles, and driving skills necessary for operation of emergency vehicles
						during response to an incident or transport of a patient to a health care
						facility. This course must include classroom and driving range skill
						instruction. An approved course of instruction includes the course objectives
						as identified within the U.S. Department of Transportation Emergency Vehicle
						Operator curriculum or as approved by the Office of EMS.
"Exam series" means a sequence of opportunities to
						complete a certification examination with any allowed retest.
"FAA" means the U.S. Federal Aviation
						Administration.
"FAR" means Federal Aviation Regulations.
"FCC" means the U.S. Federal Communications
						Commission.
"Financial Assistance Review Committee" or "FARC" means
						the committee appointed by the EMS Advisory Board to administer the Rescue
						Squad Assistance Fund.
"Full accreditation" means an accreditation decision
						awarded to an entity that demonstrates satisfactory compliance with applicable
						Virginia standards in all performance areas.
"Fund" means the Virginia Rescue Squad Assistance
						Fund.
"Institutional self study" means a document whereby
						training programs seeking accreditation answer questions about their program
						for the purpose of determining their level of preparation to conduct initial
						EMS training programs.
"Instructor" means the teacher for a specific class or
						lesson of an EMS training program.
"Instructor aide" means providers certified at or above
						the level of instruction.
"Interfacility transport" in the air medical environment
						means as a mission for whom an admitted patient or patients were transported
						from a hospital or care giving facility (clinic, nursing home, etc.) to a
						receiving facility or airport.
"Interim accreditation" means an accreditation decision
						that results when a previously unaccredited EMS entity has been granted
						approval to operate one training program, for a period not to exceed 120 days,
						during which its application is being considered and before a provisional or
						full accreditation is issued, providing the following conditions are
						satisfied:
(i) a complete application for accreditation is received
						by the Office of EMS and
(ii) a complete institutional self study is submitted to
						the Office of EMS. Students attending a program with interim accreditation will
						not be eligible to sit for state testing until the entity achieves official
						notification of accreditation at the provisional or full level.
"Invasive procedure" means a medical procedure that
						involves entry into the living body, as by incision or by insertion of an
						instrument.
"License" means an authorization issued by the Office of
						EMS to provide emergency medical services in the state as an EMS agency.
"Local EMS resource" means a person recognized by the
						Office of EMS to perform specified functions for a designated geographic area.
						This person may be designated to perform one or more of the functions otherwise
						provided by regional EMS councils.
"Local EMS response plan" means a written document that
						details the primary service area and responding interval standards as approved
						by the local government and the operational medical director.
"Local governing body" or "governing body" means members
						of the governing body of a city, county, or town in the Commonwealth who are
						elected to that position or their designee.
"Major medical emergency" means an emergency that cannot
						be managed through the use of locally available emergency medical resources and
						that requires implementation of special procedures to ensure the best outcome
						for the greatest number of patients as determined by the EMS provider in charge
						or incident commander on the scene. This event includes local emergencies
						declared by the locality's government and states of emergency declared by the
						Governor.
"Medical care facility" means, as defined by §
											32.1-102.1 of the
						Code of Virginia, any institution, place, building or agency, whether licensed
						or required to be licensed by the board or the Department of Behavioral Health
						and Developmental Services, whether operated for profit or nonprofit and
						whether privately owned or privately operated or owned or operated by a local
						governmental unit, by or in which health services are furnished, conducted,
						operated or offered for the prevention, diagnosis or treatment of human
						disease, pain, injury, deformity or physical condition, whether medical or
						surgical.
"Medical control" means the direction and advice provided
						through a communications device (on-line) to on-site and in-transit EMS
						personnel from a designated medical care facility staffed by appropriate
						personnel and operating under physician supervision.
"Medical direction" means the direction and supervision
						of EMS personnel by the Operational Medical Director of the EMS agency with
						which he is affiliated.
"Medical emergency" means the sudden onset of a medical
						condition that manifests itself by symptoms of sufficient severity, including
						severe pain, that the absence of immediate medical attention could reasonably
						be expected by a prudent layperson who possesses an average knowledge of health
						and medicine to result in (i) serious jeopardy to the mental or physical health
						of the individual, (ii) danger of serious impairment of the individual's bodily
						functions, (iii) serious dysfunction of any of the individual's bodily organs,
						or (iv) in the case of a pregnant woman, serious jeopardy to the health of the
						fetus.
"Medical practitioner" means a physician, dentist,
						podiatrist, licensed nurse practitioner, licensed physician's assistant, or
						other person licensed, registered or otherwise permitted to distribute,
						dispense, prescribe and administer, or conduct research with respect to, a
						controlled substance in the course of professional practice or research in this
						Commonwealth.
"Mutual aid agreement" means a written document
						specifying a formal understanding to lend aid to an EMS agency.
"Neonatal" or "neonate" means, for the purpose of
						interfacility transportation, any infant who is deemed a newborn within a
						hospital, has not been discharged since the birthing process, and is currently
						receiving medical care under a physician.
"Nonprofit" means without the intention of financial
						gain, advantage, or benefit as defined by federal tax law.
"OSHA" means the U.S. Occupational Safety and Health
						Administration or Virginia Occupational Safety and Health, the state agency
						designated to perform its functions in Virginia.
"Office of EMS" means the Office of Emergency Medical
						Services within the Virginia Department of Health.
"Operational medical director" or "OMD" means an EMS
						physician, currently licensed to practice medicine or osteopathic medicine in
						the Commonwealth, who is formally recognized and responsible for providing
						medical direction, oversight and quality improvement to an EMS agency and
						personnel.
"Operator" means a person qualified and designated to
						drive or pilot a specified class of permitted EMS vehicle.
"Patient" means a person who needs immediate medical
						attention or transport, or both, whose physical or mental condition is such
						that he is in danger of loss of life or health impairment, or who may be
						incapacitated or helpless as a result of physical or mental condition or a
						person who requires medical attention during transport from one medical care
						facility to another.
"Person" means, as defined in the Code of Virginia, any
						person, firm, partnership, association, corporation, company, or group of
						individuals acting together for a common purpose or organization of any kind,
						including any government agency other than an agency of the United States
						government.
"Physician" means an individual who holds a valid,
						unrestricted license to practice medicine or osteopathy in the
						Commonwealth.
"Physician assistant" means an individual who holds a
						valid, unrestricted license to practice as a physician assistant in the
						Commonwealth.
"Physician course director" or "PCD" means an EMS
						physician who is responsible for the clinical aspects of emergency medical care
						training programs, including the clinical and field actions of enrolled
						students.
"Prehospital patient care report" or "PPCR" means a
						document used to summarize the facts and events of an EMS incident and
						includes, but is not limited to, the type of medical emergency or nature of the
						call, the response time, the treatment provided and other minimum data items as
						prescribed by the board. "PPCR" includes any supplements, addenda, or other
						related attachments that document patient information or care provided.
"Prehospital scene" means, in the air medical
						environment, the direct response to the scene of incident or injury, such as a
						roadway, etc.
"Prescriber" means a practitioner who is authorized
						pursuant to §§
											54.1-3303
						and
						54.1-3408
						of the Code of Virginia to issue a prescription.
"Primary retest status" means any candidate or provider
						who failed his primary certification attempt. Primary retest status expires 90
						days after the primary test date.
"Primary service area" means the specific geographic area
						designated or prescribed by a locality (county, city or town) in which an EMS
						agency provides prehospital emergency medical care or transportation. This
						designated or prescribed geographic area served must include all locations for
						which the EMS agency is principally dispatched (i.e., first due response
						agency).
"Private Mobile Radio Service" or "PMRS" means the same
						as that term is defined in § 20.3 of the Federal Communications
						Commission's Rules,
						47 CFR
						20.3. For purposes of this definition, PMRS
						includes "industrial" and "public safety" radio services authorized under Part
						90 of the Federal Communications Commission's Rules,
						47 CFR 90.1 et
						seq., with the exception of certain for-profit commercial paging services and
						800/900 MHz Specialized Mobile Radio Services that are interconnected to the
						public switched telephone network and are therefore classified as CMRS.
"Probationary status" means the Office of EMS will place
						an institution on publicly disclosed probation when it has not completed a
						timely, thorough, and credible root cause analysis and action plan of any
						sentinel event occurring there. When the entity completes an acceptable root
						cause analysis and develops an acceptable action plan, the Office of EMS will
						remove the probation designation from the entity's accreditation status.
"Provisional accreditation" means an accreditation
						decision that results when a previously unaccredited entity has demonstrated
						satisfactory compliance with a subset of standards during a preliminary on-site
						evaluation. This decision remains in effect for a period not to exceed 365
						days, until one of the other official accreditation decision categories is
						assigned based upon an a follow-up site visit against all applicable
						standards.
"Public safety answering point" or "PSAP" means a
						facility equipped and staffed on a 24-hour basis to receive requests for
						emergency medical assistance for one or more EMS agencies.
"Quality management program" or "QM" means the continuous
						study of and improvement of an EMS agency or system including the collection of
						data, the identification of deficiencies through continuous evaluation, the
						education of personnel and the establishment of goals, policies and programs
						that improve patient outcomes in EMS systems.
"Reaccreditation date" means the date of the
						reaccreditation decision that is awarded to an entity following a full site
						visit and review.
"Recertification" means the process used by certified EMS
						personnel to maintain their training certifications.
"Reentry" means the process by which EMS personnel may
						regain a training certification that has lapsed within the last two
						years.
"Reentry status" means any candidate or provider whose
						certification has lapsed within the last two years.
"Regional EMS council" means an organization designated
						by the board that is authorized to receive and disburse public funds in
						compliance with established performance standards and whose function is to
						plan, develop, maintain, expand and improve an efficient and effective regional
						emergency medical services system within a designated geographical area
						pursuant to §
											32.1-111.4:2
						of the Code of Virginia.
"Regional trauma triage plan" means a formal written plan
						developed by a regional EMS council or local EMS resource and approved by the
						commissioner that incorporates the region's geographic variations, trauma care
						capabilities and resources for the triage of trauma patients pursuant to §
											32.1-111.3
						of the Code of Virginia.
"Registered nurse" means a person who is licensed or
						holds a multistate privilege under the provisions of Chapter 30 (§
											54.1-3000 et seq.) of
						Title 54.1 of the Code of Virginia to practice professional nursing.
"Regulated medical device" means equipment or other items
						that may only be purchased or possessed upon the approval of a physician and
						that the manufacture or sale of which is regulated by the U.S. Food and Drug
						Administration.
"Regulated waste" means liquid or semi-liquid blood or
						other potentially infectious materials; contaminated items that would release
						blood or other potentially infectious materials in a liquid or semi-liquid
						state if compressed; items that are caked with dried blood or potentially
						infectious materials and are capable of releasing these materials during
						handling; items dripping with liquid product; contaminated sharps; pathological
						and microbiological waste containing blood or other potentially infectious
						materials.
"Regulations" means, as defined in the Code of Virginia,
						any statement of general application, having the force of law, affecting the
						rights or conduct of any person, promulgated by an authorized board or
						agency.
"Rescue" means a service that may include the search for
						lost persons, gaining access to persons trapped, extrication of persons from
						potentially dangerous situations and the rendering of other assistance to such
						persons.
"Rescue vehicle" means a vehicle, vessel or aircraft that
						is maintained and operated to assist with the location and removal of victims
						from a hazardous or life-threatening situation to areas of safety or
						treatment.
"Responding time" means the elapsed time in minutes
						between the time a call for emergency medical services is received by the PSAP
						until the appropriate emergency medical response unit arrives on the
						scene.
"Responding time standard" means a time standard in
						minutes, established by the EMS agency, the locality and OMD, in which the EMS
						agency will comply with 90% or greater reliability.
"Response obligation to locality" means a requirement of
						a designated emergency response agency to lend aid to all other designated
						emergency response agencies within the locality or localities in which the EMS
						agency is based.
"Revocation" means the permanent removal of an EMS agency
						license, vehicle permit, training certification, ALS coordinator endorsement,
						EMS education coordinator, EMS physician endorsement or any other designation
						issued by the Office of EMS.
"Safety apparel" means personal protective safety
						clothing that is intended to provide conspicuity during both daytime and
						nighttime usage and that meets the Performance Class 2 or 3 requirements of the
						ANSI/ISEA 107-2010 publication entitled "American National Standard for
						High-Visibility Safety Apparel and Headwear."
"Secondary certification status" means any candidate or
						provider who is no longer in primary retest status.
"Secondary retest status" means any candidate or provider
						who failed their secondary certification attempt. Secondary retest status
						expires 90 days after the secondary test date.
"Sentinel event" means any significant occurrence,
						action, or change in the operational status of the entity from the time when it
						either applied for candidate status or was accredited. The change in status can
						be based on but not limited to one or all of the events indicated below:
Entering into an agreement of sale of an accredited
						entity or an accreditation candidate.
Entering into an agreement to purchase or otherwise
						directly or indirectly acquire an accredited entity or accreditation
						candidate.
Financial impairment of an accredited entity or candidate
						for accreditation, which affects its operational performance or entity
						control.
Insolvency or bankruptcy filing.
Change in ownership or control greater than 25%.
Disruption of service to student body.
Discontinuance of classes or business operations.
Failure to report a change in program personnel,
						location, change in training level or Committee on Accreditation of Educational
						Programs for the Emergency Medical Services Professions (CoAEMSP) accreditation
						status.
Failure to meet minimum examination scores as established
						by the Office of EMS.
Loss of CoAEMSP or Commission on Accreditation of Allied
						Health Education Programs (CAAHEP) accreditation.
Company fine or fines of greater than $100,000 for
						regulatory violation, marketing or advertising practices, antitrust, or tax
						disputes.
"Special conditions" means a notation placed upon an EMS
						agency or registration, variance or exemption documents that modifies or
						restricts specific requirements of these regulations.
"Specialized air medical training" means a course of
						instruction and continuing education in the concept of flight physiology and
						the effects of flight on patients that has been approved by the Office of EMS.
						This training must include but is not limited to aerodynamics, weather,
						communications, safety around aircraft/ambulances, scene safety, landing zone
						operations, flight physiology, equipment/aircraft familiarization, basic flight
						navigation, flight documentation, and survival training specific to service
						area.
"Specialty care mission" in the air medical environment
						means the transport of a patient requiring specialty patient care by one or
						more medical professionals who are added to the regularly scheduled medical
						transport team.
"Specialty care provider" in the air medical environment
						means a provider of specialized medical care, to include but not limited to
						neonatal, pediatric, and perinatal.
"Standard of care" means the established approach to the
						provision of basic and advanced medical care that is considered appropriate,
						prudent and in the best interests of patients within a geographic area as
						derived by consensus among the physicians responsible for the delivery and
						oversight of that care. The standard of care is dynamic with changes reflective
						of knowledge gained by research and practice.
"Standard operating procedure" or "SOP" means
						preestablished written agency authorized procedures and guidelines for
						activities performed by affiliated EMS agency.
"Supplemented transport" means an interfacility transport
						for which the sending physician has determined that the medically necessary
						care and equipment needs of a critically injured or ill patient is beyond the
						scope of practice of the available EMS personnel of the EMS agency.
"Suspension" means the temporary removal of an EMS agency
						license, vehicle permit, training certification, ALS coordinator endorsement,
						EMS education coordinator, EMS physician endorsement or any other designation
						issued by the Office of EMS.
"Test site coordinator" means an individual designated by
						the Office of EMS to coordinate the logistics of a state certification
						examination site.
"Training officer" means an individual who is responsible
						for the maintenance and completion of agency personnel training records and who
						acts as a liaison between the agency, the operational medical director, and a
						participant in the agency and regional quality assurance process.
"Trauma center" means a specialized hospital facility
						distinguished by the immediate availability of specialized surgeons, physician
						specialists, anesthesiologists, nurses, and resuscitation and life support
						equipment on a 24-hour basis to care for severely injured patients or those at
						risk for severe injury. In Virginia, trauma centers are designated by the
						Virginia Department of Health as Level I, II or III.
"Trauma center designation" means the formal recognition
						by the board of a hospital as a provider of specialized services to meet the
						needs of the severely injured patient. This usually involves a contractual
						relationship based on adherence to standards.
"Triage" means the process of sorting patients to
						establish treatment and transportation priorities according to severity of
						injury and medical need.
"USDOT" means the U.S. Department of
						Transportation.
"Vehicle operating weight" means the combined weight of
						the vehicle, vessel or craft; a full complement of fuel; and all required and
						optional equipment and supplies.
"Virginia Statewide Trauma Registry" or "Trauma Registry"
						means a collection of data on patients who receive hospital care for certain
						types of injuries. The collection and analysis of such data is primarily
						intended to evaluate the quality of trauma care and outcomes in individual
						institutions and trauma systems. The secondary purpose is to provide useful
						information for the surveillance of injury morbidity and mortality.
Statutory Authority: §§
													32.1-12
						  and
						  32.1-111.4
						  of the Code of Virginia.