6 Colo. Code Regs. § 1015-3-2-2

Current through Register Vol. 47, No. 11, June 10, 2024

Section 6 CCR 1015-3-2-2 - Definitions

2.1 All definitions that appear in Sections 25-3.5-103, 25-3.5-205 - 207, C.R.S., and 6 CCR 1015-3, Chapter One shall apply to these rules. Unless otherwise stated, the definitions in this section shall apply to:

2.1.1 Prehospital and Interfacility Transport settings,

2.1.2 CIHCS (Out- of- Hospital) settings, and

2.1.3 Clinical settings.

2.2 "Advanced Cardiac Life Support (ACLS)" - a course of instruction designed to prepare students in the practice of advanced emergency cardiac care.

2.3 "Advanced Emergency Medical Technician (AEMT)" - an individual who has a current and valid AEMT certificate or license issued by the Department and who is authorized to provide limited acts of advanced emergency medical care in accordance with these rules.

2.4 "Care Coordination" - the deliberate organization of patient care activities between two or more participants, including the patient, involved in the patient's care to facilitate the appropriate delivery of medical care services.

2.5 "Certificate" - designation as having met the requirements of Section 5 of Chapter One, 6 CCR 1015-3, issued to an individual by the Department. Certification is equivalent to licensure for purposes of the State Administrative Procedure Act, Section 24-4-101, et seq., C.R.S.

2.6 "Clinical Medical Director" - for purposes of these rules, a physician licensed in Colorado and in good standing who determines, authorizes, and directs, through protocols, standing orders, and operational policies or procedures developed by the facility's medical staff, the medical acts performed by EMS providers in a clinical setting. The clinical medical director is also responsible for assuring the competency of the performance of those acts by EMS providers as described in the Facility's Medical Continuous Quality Improvement Program.

2.7 "Clinical Setting" - a health care facility licensed or certified by the Department pursuant to Section 25-1.5-103(1)(a), C.R.S.

2.8 "Colorado Medical Board" - the Colorado Medical Board established in Title 12, Article 240, C.R.S.

2.9 "Community Integrated Health Care Service (CIHCS)" - the provision of certain out-of-hospital medical services that a Community Paramedic may provide and may include:

2.9.1 Services authorized pursuant to Section 25-3.5-1203(3), C.R.S.

2.9.2 Services authorized pursuant to 6 CCR 1011-3, Standards for Community Integrated Health Care Service Agencies.

2.9.3 Services authorized under the scope of practice as set forth in this chapter.

2.9.4 Services authorized pursuant to Section 25-3.5-206(4) (a.5)(II), C.R.S.

2.10 "Community Integrated Health Care Service Agency (CIHCS Agency)" - a sole proprietorship, partnership, corporation, nonprofit entity, special district, governmental unit or agency, or licensed or certified health care facility that is subject to regulation under Article 1.5 or 3 of Title 25, C.R.S., that manages and offers, directly or by contract, community integrated health care services.

2.11 "CIHCS Agency Medical Director" - as used in these rules, means a Colorado licensed physician in good standing who is identified as being responsible for supervising, directing, and assuring the competency of those individuals who are employed by or contracted with the CIHCS Agency to perform community integrated health care services on behalf of the agency.

2.12 "Consumer" - an individual receiving community integrated health care services.

2.13 "Consumer Service Plan" - the approved written plan specific to each consumer receiving CIHCS in a series of visits that: identifies the consumer's physical, medical, social, mental health, and/or environmental needs, as necessary; sets forth the out-of-hospital medical services the CIHCS Agency agrees to provide to the consumer; and is overseen by the CIHCS Agency medical director.

2.14 "Department" - the Colorado Department of Public Health and Environment.

2.15 "Direct Verbal Order" - verbal authorization given by a physician to an EMS provider for the performance of specific medical acts through a Medical Base Station or in person; or in a clinical setting, given by a physician contemporaneous to when a patient is receiving treatment or by a medical supervisor as an instruction based on a physician order.

2.16 "Emergency Medical Practice Advisory Council (EMPAC)" - the council established pursuant to Section 25-3.5-206, C.R.S. that is responsible for advising the Department regarding the appropriate scope of practice for EMS providers and for the criteria for physicians to serve as EMS agency medical directors, CIHCS Agency medical directors or clinical medical directors.

2.17 "Emergency Medical Technician (EMT)" - an individual who has a current and valid EMT certificate or license issued by the Department and who is authorized to provide basic emergency medical care in accordance with these rules.

2.18 "Emergency Medical Technician with Intravenous Authorization (EMT-IV)" - an individual who has a current and valid EMT certificate or license issued by the Department and who has met the conditions defined in Section 6.6 of these rules.

2.19 "Emergency Medical Technician-Intermediate (EMT-I)" - an individual who has a current and valid EMT-Intermediate certificate or license issued by the Department and who is authorized to provide limited acts of advanced emergency medical care in accordance with these rules.

2.20 "EMS Agency Medical Director" - for purposes of these rules, means a physician licensed in Colorado and in good standing who authorizes and directs, through protocols and standing orders, the performance of students-in-training enrolled in Department-recognized EMS education programs, Graduate AEMTs, EMT-Is, or Paramedics, or EMS providers of a prehospital EMS service agency and who is specifically identified as being responsible to assure the competency of the performance of those acts by such EMS providers as described in the physician's medical CQI program.

2.21 "EMS Provider" - means an individual who holds a valid emergency medical service provider certificate or license issued by the Department and includes Emergency Medical Technician, Advanced Emergency Medical Technician, Emergency Medical Technician-Intermediate, and Paramedic.

2.22 "EMS Service Agency or EMS Agency" - any organized agency including but not limited to a "rescue unit" as defined in Section 25-3.5-103(11), C.R.S., using EMS providers to render initial emergency medical care to a patient prior to or during transport. This definition does not include criminal law enforcement agencies, unless the criminal law enforcement personnel are EMS providers who function with a "rescue unit" as defined in Section 25-3.5-103(11), C.R.S. or are performing any medical act described in these rules.

2.23 "Graduate Advanced EMT" - an individual who has a current and valid Colorado EMT certification or license issued by the Department and who has successfully completed a Department-recognized AEMT initial course but has not yet successfully completed the certification or licensing requirements set forth in the Rules Pertaining to EMS and EMR Education, EMS Certification or Licensure, and EMR Registration, 6 CCR 1015-3, Chapter One, for the AEMT level.

2.24 "Graduate Paramedic" - an individual who has a current and valid Colorado EMT certificate or license, AEMT certificate or license, or EMT-I certificate or license issued by the Department and who has successfully completed a Department-recognized Paramedic initial course but has not yet successfully completed the certification or licensing requirements set forth in the Rules Pertaining to EMS and EMR Education, EMS Certification and Licensure, and EMR Registration, 6 CCR 1015-3, Chapter One for the Paramedic level.

2.25 "In-Scope Tasks and Procedures" - tasks and procedures performed by an EMS provider within the EMS provider's scope of practice in a clinical setting as set forth in these rules.

2.26 "Interfacility Transport" - any transport of a patient from one licensed healthcare facility to another licensed healthcare facility, after a higher level medical care provider (i.e., a physician, physician assistant, or an individual of similar/equivalent training, certification, licensing, and patient interaction) has initiated treatment.

2.27 "International Board of Specialty Certification (IBSC)" - a non-profit organization that develops and administers a national Community Paramedic certification exam.

2.28 "Licensed in Good Standing" - as used in these rules, means that a physician functioning as a medical director, or a physician, physician assistant, advanced practice nurse, or registered nurse functioning as a medical supervisor, holds a current and valid Colorado license to practice the applicable profession.

2.29 "Maintenance" - to observe the patient while continuing, assessing, adjusting, and/or discontinuing care of a previously established medical procedure or medication via standing order, written physician order, or the direct verbal order of a physician.

2.30 "Medical Acts"- as used in these rules, means the tasks, medications, or procedures that an EMS provider is authorized to perform or administer within the EMS provider's applicable scope of practice including in-scope tasks and procedures in a clinical setting.

2.31 "Medical Base Station" - the source of direct medical communications with EMS providers.

2.32 "Medical Direction" - may include, but is not limited to, the following duties:

2.32.1 Approval of the medical components of treatment protocols and appropriate prearrival instructions;

2.32.2 Routine review of program performance and maintenance of active involvement in quality improvement activities, including access to prehospital recordings as necessary for the evaluation of care;

2.32.3 Authority to recommend appropriate changes to protocols for the improvement of patient care;

2.32.4 Provision of oversight for the ongoing education, training, and quality assurance of EMS providers as appropriate for the medical acts being performed in the prehospital, out-of-hospital, or clinical setting in which the EMS provider is practicing; and

2.32.5 Reporting of any misconduct by certified or licensed EMS providers that the medical director knows or reasonably believes has occurred.

2.33 "Medical Supervision" - the oversight, guidance, and instructions that a medical supervisor provides to an EMS provider in a clinical setting, as defined in Section 25-3.5-207(1)(d), C.R.S. and these rules.

2.34 "Medical Supervisor" - in a clinical setting, means a Colorado licensed physician, physician assistant, advanced practice nurse, or registered nurse.

2.35 "Monitoring" - to observe and detect changes, or the absence of changes, in the clinical status of the patient for the purpose of documentation.

2.36 "Out-of-hospital Medical Services" - services performed by a Paramedic with a Community Paramedic endorsement, including the initial assessment of the patient and any subsequent assessments, as needed; the furnishing of medical treatment and interventions; care coordination; resource navigation; patient education; medication inventory, compliance and administration; gathering of laboratory and diagnostic data; nursing services; rehabilitative services; complementary health services; as well as the furnishing of other necessary services and goods for the purpose of preventing, alleviating, curing, or healing human illness, physical disability, physical injury; alcohol, drug, or controlled substance abuse; behavioral health services that may be provided in an out-of-hospital setting; and the medical acts identified in Appendix G of these rules. Out-of-hospital medical services cannot be provided or performed in the prehospital setting.

2.37 "Paramedic" - for purposes of this Chapter Two, an individual who has a current and valid Paramedic certificate or license issued by the Department and who is authorized to provide advanced emergency medical care in a prehospital or clinical setting in accordance with these rules.

2.38 "Paramedic with Community Paramedic Endorsement (P-CP)" - an individual who has a current and valid Paramedic certificate or license issued by the Department and who has met the requirements in these rules to obtain a Community Paramedic endorsement from the Department and is authorized to provide acts in accordance with these rules relating to community integrated health care services, and as set forth in Sections 25-3.5-206, C.R.S., and 25-3.5-1301, et seq., C.R.S.

2.39 "Paramedic with Critical Care Endorsement (P-CC)" - an individual who has a current and valid Paramedic certificate or license issued by the Department and who has met the requirements in these rules to obtain a Critical Care endorsement from the Department and is authorized to provide acts in accordance with conditions defined in these rules relating to critical care and as set forth in Section 25-3.5-206, C.R.S.

2.40 "Point of Care Testing (POCT)" - medical diagnostic testing performed outside the clinical laboratory in close proximity to where the patient is receiving care, the results of which are used for clinical decision-making.

2.41 "Prehospital Care" - any medical acts performed prior to a patient receiving care at a licensed healthcare facility.

2.42 "Prehospital Setting" - means one of the following settings in which an EMS provider performs patient care, which care is subject to medical direction by an EMS agency medical director at the site of an emergency, during emergency transport, or during interfacility transport.

2.43 "Protocol" - written standards for patient medical assessment and management approved by a medical director.

2.44 "Scope of Practice" - refers to the tasks, medications, and procedures (medical acts) that an EMS provider is authorized to perform or administer in accordance with Sections 25-3.5-203 and 25-3.5-206, C.R.S., and rules promulgated pursuant to those sections.

2.45 "State Emergency Medical and Trauma Services Advisory Council (SEMTAC)" - A council created in the Department pursuant to Section 25-3.5-104, C.R.S., that advises the Department on all matters relating to emergency medical and trauma services.

2.46 "Standing Order" - written authorization provided in advance by a medical director for the performance of specific medical acts by EMS.

2.47 "Supervision" - as applicable to physician medical direction, means the oversight, direction, or medical management that the medical director provides to an EMS provider in any setting. Supervision may be through direct observation or by indirect oversight as defined in the medical director's CQI program.

2.48 "Waiver" - a Department-approved exception to these rules granted to an EMS agency medical director.

2.49 "Written Order" - written authorization that a physician issues to an EMS provider for the performance of specific medical acts.

6 CCR 1015-3-2-2

37 CR 12, June 25, 2014, effective 5/21/2014

37 CR 12, June 25, 2014, effective 7/15/2014

37 CR 22, November 25, 2014, effective 12/15/2014

38 CR 24, December 25, 2015, effective 1/14/2016

40 CR 10, May 25, 2017, effective 7/1/2017

40 CR 20, October 25, 2017, effective 1/1/2018

40 CR 21, November 10, 2017, effective 1/1/2018

41 CR 23, December 10, 2018, effective 1/14/2019

43 CR 22, November 25, 2020, effective 1/1/2021

44 CR 23, December 10, 2021, effective 12/30/2021

45 CR 10, May 25, 2022, effective 6/14/2022