Miss. Code. tit. 15, pt. 12, subpt. 32, ch. 7, app 15-12-32-7-11
"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 Emergency Medical Technician-Intermediates or Emergency Medical Technician-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-Basic, EMT-Intermediate, 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" - shall mean an individual who possesses a valid emergency medical technicians certificate issued pursuant to the provisions of this chapter.
"Emergency medical technician-intermediate" - shall mean a person specially trained in advanced life support modules as authorized by the Mississippi State Department of Health.
"Emergency medical technician-paramedic" - shall mean a person specially trained in an advanced life support training program authorized by the Mississippi State Department of Health.
"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.
"Implementation" (or "implemented") - the development and activation of a Regional Trauma Plan by a designated Trauma Care Region including the triage, transport and treatment of trauma patients in accordance with the plan.
"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 in conjunction with the supervisory ALS (on-line) medical directors of each Base Station Hospital, medical directors for paramedic services, medical director for EMS training, and critical care consultants develop all area protocols. These protocols serve as the basis for EMS system role definition of ALS 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 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, intermediates, 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.
"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, and approved by the 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 area defined by the local EMS agency in its Regional Trauma Plan as the area served by a designated Trauma Center.
"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 System 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.
Miss. Code. tit. 15, pt. 12, subpt. 32, ch. 7, app 15-12-32-7-11