Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0056 - Trauma Program, Wyoming › Chapter 1 - GENERAL PROVISIONS › Section 1-3 - Definitions

Current through July 13, 2024
The following definitions shall apply in the interpretation
				  and enforcement of these rules. Where the context in which words are used in
				  these rules indicates that such is the intent, words in the singular number
				  shall include the plural and vice versa. Throughout these rules, gender
				  pronouns are used interchangeably. The drafters have attempted to utilize each
				  gender pronoun in equal numbers, in random distribution. Words in each gender
				  shall include individuals of the other gender.
(a) "Advanced Trauma Life Support Course" or
				"ATLS" means the Advanced Trauma Life Support Course approved by the American
				College of Surgeons. When required by these rules, a physician shall maintain
				ATLS certification.
(b) "Acute Care
				Hospital" means a "hospital licensed in Wyoming pursuant to
				W.S.
				35-2-901 through
				35-2-912 and which provides acute
				patient care to patients with injuries or illnesses."
(c) "Area Trauma Hospital" or "ATH" means a
				designated facility that has the facilities and surgical capabilities to
				provide care for the majority of injured patients. Area Trauma Hospitals may
				serve as referral centers for Community Trauma Hospitals and Trauma Receiving
				Facilities. An ATH need not include a neurosurgeon on staff.
(d) "Basic Life Support" or "BLS" means
				treatment rendered by personnel trained to at least the Basic EMT level,
				including but not limited to procedures such as bandaging, splinting, basic
				first aid, and performing cardiopulmonary resuscitation (CPR), as defined in
				the Wyoming Emergency Medical Services Act of 1977, W.S. W.S.
				W.S.
				33-36-101, or as amended.
(e) "Board" means the Wyoming State Board of
				Medicine established by W.S. W.S.
				W.S.
				33-26-102(iii).
(f) "Board Certified" means a physician who
				has been awarded a board diploma in a specialty recognized by the American
				Board of Medical Specialties, the Canadian Board, the American Osteopathic
				Association, or the American Board of Oral and Maxillofacial Surgery.
(g) "Board Eligible" or "Board Admissible"
				refers to a physician who has applied to the Board and has received a ruling
				that he has fulfilled the requirements to take the necessary examinations to
				become board certified in a specialty.
(h) "By-pass" or "Bypass" means direction
				given to a prehospital emergency medical services unit, by direct/on-line
				medical control or predetermined triage criteria, to divert past the nearest
				hospital and transport the patient to a facility better equipped and staffed to
				care for that particular patient's needs.
(i) "Certified Critical Registered Nurse" or
				"CCRN" means a registered nurse who has completed the American Association of
				Critical-Care Nurses course of study and examination in the care of critically
				injured and ill patients.
(j)
				"Certified Registered Nurse Anesthetist" or "CRNA" means a registered nurse who
				has graduated from a school of nurse anesthesia accredited by the Council on
				Accreditation of Educational Programs of Nurse Anesthesia or its predecessor,
				and who has been certified as a nurse anesthetist by the Council on
				Certification of Nurse Anesthetists.
(k) "Community Trauma Hospital" or "CTH"
				refers to a designated facility that typically does not have twenty-four (24)
				hours per day coverage of its emergency department and shall, at a minimum,
				have only one (1) surgeon on staff. With these exceptions, these facilities are
				similar to Area Trauma Hospitals and may serve as referral centers for Trauma
				Receiving Facilities.
(l)
				"Consolidated Omnibus Budget Reconciliation Act" or "COBRA" refers to the
				consolidated Omnibus Budget Reconciliation Act of 1986 ( Pub.L. 99-272,100
				Stat.82). Adherence to COBRA is mandatory.
(m) "Continuing Education" refers to the
				minimum educational requirements necessary to remain certified in a medical
				discipline. "Continuing Nursing Education" refers to education approved or
				recognized by a national nurse's organization. "Continuing Medical Education"
				or "CME" refers to continuing education approved by the Board, Department of
				Health, State of Wyoming, or affiliated agencies.
(n) "Department" means the Wyoming Department
				of Health.
(o) "Designated
				Facility" refers to a health care facility that satisfies the requirements of
				one (1) of the four (4) categories of trauma facilities described in these
				rules.
(p) "Designation" refers to
				the process by which the Wyoming Office of Emergency Medical Services (OEMS)
				accepts plans submitted by Wyoming Health Care Facilities for inclusion within
				the Wyoming Trauma Plan, validates the plan, and assigns to the facilities the
				appropriate level as described in these rules.
(q) "Desirable" applies to a suggested
				criterion or standard which is not mandated or required for a trauma center.
				Compliance with this criterion or standard may be considered in the designation
				process.
(r) "Emergency Department"
				or "ED" or "Emergency Room" or "ER" means the area of a licensed health
				facility that customarily receives patients in need of emergency evaluation
				and/or care.
(s) "Emergency Medical
				Services" or "EMS" means the many agencies, personnel, and institutions
				involved in the planning, providing, and monitoring of emergency care for those
				suffering sudden illness or injury.
(t) "Emergency Medical Services for Children"
				or "EMS-C" means that portion of the emergency medical services system relating
				to the training of personnel and the provision of patient care to children
				suffering sudden illness or injury.
(u) "Emergency Medical System" means the
				entire system that provides care to a trauma patient through the entire
				spectrum of care.
(v) "Emergency
				Medical Technician" or "EMT" means a person who has graduated from a Division
				approved training program for Emergency Medical Technicians.
(w) "Emergency Medical Treatment and Active
				Labor Act" or "EMTALA" refers to that portion of COBRA codified at Section 1867
				of the Social Security Act, and the accompanying regulations in
				42 CFR §
										489.20(1), (m),
				(p), and (r).
(x) "Emergency physician" means a physician
				who provides medical coverage in an emergency room.
(y) "Emergency nurse" means a registered
				nurse who provides patient care or administrative services in an emergency
				room.
(z) "Essential" applies to a
				criterion or standard, compliance with which is mandated or required for
				designation.
(aa) "First Responder"
				means an individual who has completed an approved training program sponsored or
				approved by the OEMS in locating, providing initial basic emergency treatment,
				and removing individuals from imminent danger, and who is presently
				certified.
(bb) "Health Care
				Facility" means a facility as defined in W.S. W.S.
				W.S.
				35-2-901(a)(x).
(cc) "Health Care Provider" means a person
				who is licensed, certified, or otherwise authorized by the law of this state to
				provide health care in the ordinary course of business or practice of a
				profession, but does not include a person who provides services solely through
				the sale or dispensing of drugs or medical devices.
(dd) "Hospital" means a facility as defined
				in W.S. W.S.
				35-2-901(a)(xiii).
(ee) "Immediately Available" means
				unencumbered by conflicting duties or responsibilities, responding without
				delay when notified, and being within the specified area of the trauma facility
				when the patient arrives.
(ff)
				"Incident" means an admission to a hospital, both inpatient and outpatient,
				involving traumatic care for an individual patient within a one (1) year period
				to a single hospital. Admissions of the same patient for causes not directly
				related to an earlier admission shall be considered a separate
				incident.
(gg) "In House" means
				present at all times and immediately available to the trauma center or
				hospital. On call personnel are not considered in house.
(hh) "JCAHO" means the Joint Commission for
				Accreditation of Health Care Organizations, which is the organization
				responsible for accrediting Hospitals.
(ii) "Medical Control" means direction,
				advice, and supervision provided by medical personnel at a medical facility to
				prehospital personnel by radio, telephonic communications, written protocol, or
				direct verbal order. Medical control is also referred to as on-line medical
				supervision.
(jj) "Medical
				Director" means a licensed physician who is responsible for supervising medical
				decisions. OEMS will employ a statewide medical director to provide medical
				oversight to the state trauma plan. Each designated facility will be required
				to have its own medical director.
(kk) "Mid-level practitioner" refers to a
				physician assistant or advanced practitioner of nursing as defined in Title 33
				of the statutes.
(ll) "Monitored
				Bed Unit" or "MBU" refers to each area of a facility that focuses on patients
				who are acutely ill but with a reversible disease. These patients require
				skilled nursing care, close observation, monitoring and management. All
				patients, who in the opinion of the attending physician are critically ill,
				unstable or require intensive monitoring, can be admitted to a MBU.
(mm) "Multi Disciplinary Trauma Committee"
				means a committee within each of the designated facilities that provides
				oversight and leadership to the trauma program of that specific
				facility.
(nn) "Off-line
				administration" refers to establishment and monitoring of medical components of
				a medical system including protocols, standing orders, educational programs,
				and the quality and delivery of on-line medical supervision.
(oo) "On Call" means agreeing to be available
				to respond to the trauma center in order to provide a defined service. On call
				personnel shall be at the trauma center or hospital when their presence is
				required, in accordance with an on call roster, and either promptly available
				or readily available.
(pp) "On Site
				Survey Team" refers to a multi disciplinary group of individuals who are
				knowledgeable in trauma care and trauma care systems. A team will be charged
				with the duty to inspect and interview each hospital or facility for purposes
				of designation verification.
(qq)
				"Patient" means a sick, injured, incapacitated, or helpless individual who
				requires medical supervision, treatment, or monitoring.
(rr) "Pediatric Advanced Life Support" or
				"PALS" means a course of training available through the American Heart
				Association. When required by these rules, medical personnel shall maintain
				PALS certification.
(ss) "Peer
				Review Process" means the review of professional practices within a health care
				facility for the purpose of reducing morbidity and mortality and for the
				improvement of care of patients in the facility.
(tt) "Physician" means a doctor of medicine
				or osteopathy licensed by the Board of Medicine to practice medicine and/or
				surgery under state law by the board.
(uu) "Poor" means any patient at or below
				300% of the federal poverty level.
(vv) "Prehospital Provider" means personnel
				who are certified or who are licensed and function at any level in actually
				delivering prehospital care.
(ww)
				"Promptly Available" refers to those personnel who can be attending patients at
				the hospital or health care facility within a maximum of thirty (30) minutes
				from the time they are called.
(xx)
				"Protocol" means a written instrument that guides the collection of data
				regarding the patient, provides for actions to be taken based on the collected
				data, and provides for a minimum level of safe practice in specific
				situations.
(yy) "Quality
				Assurance" or "QA" means the evaluation of the performance of a hospital's or
				system's response to a given standard.
(zz) "Quality Improvement" or "QI" means a
				quality evaluation program that is on-going, team led, and research driven. QI
				focuses on care and performance improvement. QI emphasizes seeking ways to
				improve service, deliver care, manage resources, and develop professional
				competence.
(aaa) "Readily
				Available" refers to personnel who can be attending patients at the trauma
				center or hospital, within a maximum of one (1) hour from the time they are
				called.
(bbb) "Regional Advisory
				Council" or "RAC" means a council consisting of representatives of the Trauma
				Service Area (TSA), that provides consultation, education, and quality review
				for the member hospitals and health care facilities.
(ccc) "Regional Trauma Center" or "RTC" means
				a designated facility that has the medical staff and facilities to provide
				advanced care to trauma patients and serves as a referral hospital for the ATH,
				CTH, and Trauma Receiving Facility (TRF).
(ddd) "Registered Nurse" means a person who
				is licensed as a registered professional nurse in the state of
				Wyoming.
(eee) "Site Survey" means
				an on site review of a facility to determine if it meets the criteria for a
				particular level of designation or re-designation.
(fff) "State Trauma Plan" or "Trauma Care
				System" means a comprehensive plan, as required by W.S. W.S.
				W.S.
				35-1-801, designed to organize Wyoming's
				health care facilities to more efficiently care for trauma patients.
(ggg) "Trauma" means a physical wound or
				injury, including a blunt injury, penetrating injury, or burn injury caused by
				external force or violence.
(hhh)
				"Trauma Care System" or "Trauma System" means an organized approach to
				providing care to trauma patients that provides personnel, facilities, and
				equipment for effective and coordinated trauma care.
(iii) "Trauma Care Services" or "Traumatic
				Care" means services to patients with at least one (1) injury diagnosis code,
				using the International Classification of Diseases, 9th Edition, from 800.0
				through 904, 925 through 929, 940 through 959.9, and 994.7, plus at least one
				(1) of the following:
(i) Hospitalization for
				one (1) calendar day;
(ii)
				Admission to the intensive care unit or monitored bed unit;
(iii) Cardiac or respiratory arrest on route
				to the hospital or emergency room;
(iv) Dead on arrival at the
				facility;
(v) Transfer from or to
				another acute care hospital;
(vi)
				Admission directly from the emergency room to the operating room;
(vii) Trauma team activation;
(viii) Meets prehospital triage
				criteria;
(ix) Ambulance services
				providing transportation to a hospital or emergency room.