Section 157.2 - DefinitionsThe following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
(1) Abandonment--Leaving a patient without appropriate medical care once patient contact has been established, unless emergency medical services personnel are following the medical director's protocols, a physician directive, or the patient signs a release; or turning the care of a patient over to an individual of lesser education when advanced treatment modalities have been initiated.(2) Accreditation--Formal recognition by a national association of a provider's service or an education program based on standards established by that association.(3) Act--Emergency Health Care Act, Texas Health and Safety Code Chapter 773.(4) Active pursuit of department designation as a trauma facility--An undesignated facility recognized by the department after applying for designation as a trauma facility and has met the requirement to be eligible for uncompensated trauma care funds.(5) Acute Stroke-Ready Level IV stroke facility--A hospital reviewed by a department-approved survey organization and meeting the national stroke standards of care for an acute stroke-ready facility as described in § 157.133 of this chapter (relating to Requirements for Stroke Facility Designation).(6) Administrator of record (AOR)--The administrator for an emergency medical services (EMS) provider who meets the requirements of Texas Health and Safety Code § 773.05712.(7) Advanced emergency medical technician (AEMT)--An individual certified by the department and minimally proficient in performing the basic life support skills required to provide emergency prehospital or interfacility care and initiating and maintaining under medical supervision, certain advanced life support procedures, including intravenous therapy and endotracheal or esophageal intubation.(8) Advanced Level II stroke facility--A hospital that completes a designation survey with a department-approved survey organization, meets the national stroke standards for Non-Comprehensive Thrombectomy Stroke Center, and meets the requirements of an Advanced Level II stroke facility as defined by § 157.133 of this chapter.(9) Advanced Level III trauma facility--A hospital surveyed by a department-approved survey organization that meets the state requirements and American College of Surgeons (ACS) standards for a Level III trauma facility as described in § 157.125 of this chapter (relating to Requirements for Trauma Facility Designation Effective Through August 31, 2025) and §157.126 of this chapter (relating to Trauma Facility Designation Requirements Effective on September 1, 2025).(10) Advanced life support (ALS)--Emergency prehospital or interfacility care that uses invasive medical acts and includes ALS assessment. The provision of advanced life support must be under the medical supervision and control of a licensed physician.(11) Advanced life support assessment--Assessment performed by an AEMT or paramedic that qualifies as advanced life support based upon initial dispatch information, when it could reasonably be believed the patient was suffering from an acute condition that may require advanced skills.(12) Advanced life support vehicle--A vehicle designed for transporting the sick and injured and meeting the requirements of § 157.11 of this chapter (relating to Requirements for an EMS Provider License) as an ALS vehicle and having sufficient equipment and supplies for providing an advanced level of care based on national standards and the EMS provider's medical director-approved treatment protocols.(13) Advanced practice provider (APP)--A nurse practitioner or physician assistant reviewed and credentialed by the facility and may have additional credentialing to participate in the designation program.(14) Air ambulance provider--A person who operates, maintains, or leases a fixed-wing or rotor-wing air ambulance aircraft, equipped and staffed to provide a medical care environment on-board appropriate to the patient's needs. The term air ambulance provider is not synonymous with and does not refer to the Federal Aviation Administration (FAA) air carrier certificate holder unless the air ambulance provider maintains and controls the medical aspects consistent with EMS provider licensure.(15) Ambulance--A vehicle for transportation of the sick or injured patient to, from, or between places of treatment for an illness or injury and that provides out-of-hospital medical care to the patient.(16) American College of Surgeons (ACS)--The organization that sets the national standards for trauma centers, trauma verification, the National Trauma Data Standards (NTDS), National Trauma Data Bank (NTDB), Trauma Quality Improvement Program (TQIP), and regional system standards.(17) Approved survey organization--An organization that has received department authorization to conduct designation surveys, meeting the department's designation survey guidelines and expectations.(18) Authorized ambulance vehicle--A vehicle authorized to be operated by the licensed provider and meeting all criteria for approval as described in § 157.11(e) of this chapter.(19) Bad debt--The unreimbursed cost for patient care to a hospital providing trauma care.(20) Basic Level IV trauma facility--A hospital managing 101 or more trauma patients meeting NTDB registry inclusion criteria annually surveyed by a department-approved survey organization and meeting the state requirements and ACS standards, or a hospital managing 100 or less trauma patients meeting NTDB registry inclusion criteria annually surveyed by the department or a department-approved survey organization, and meeting the state designation requirements for a Level IV trauma facility as described in § 157.125 and §157.126 of this chapter.(21) Basic life support (BLS)--Emergency prehospital or interfacility care that uses noninvasive medical acts. The provision of basic life support will have sufficient equipment and supplies for providing basic-level care based on national standards and the EMS provider's medical director-approved treatment protocols.(22) Basic life support (BLS) vehicle--A vehicle designed for transporting the sick or injured and having sufficient equipment and supplies for providing basic life support based on national standards and the EMS provider's medical director-approved treatment protocols.(23) Bypass--Direction given to prehospital emergency medical services personnel by direct on-line medical control, or off-line medical director protocols to bypass the nearest facility for the most appropriate facility.(24) Calculation of the costs of uncompensated trauma care--A calculation of a hospital's total costs of uncompensated trauma care for patients meeting the hospital's trauma activation guidelines and meeting NTDB registry inclusion criteria determined by summing its charges related to uncompensated trauma care as defined in § 157.130 of this chapter (relating to Funds for Emergency Medical Services, Trauma Facilities, and Trauma Care Systems, and the Designated Trauma Facility and Emergency Services Account), then applying the cost-to-charge ratio derived in accordance with generally accepted accounting principles.(25) Candidate--An individual requesting emergency medical services personnel certification, licensure, recertification, or re-licensure from the department.(26) Certificant--Emergency medical services personnel with current certification from the department.(27) Charity care--The unreimbursed cost to a hospital providing health care services for an inpatient, emergency department, transferred, or expired person classified by the hospital as "financially indigent."(28) Commissioner--The commissioner of the Texas Department of State Health Services.(29) Comprehensive Level I stroke facility--A hospital surveyed by a department-approved survey organization meeting the national standards of care for a Comprehensive Stroke Center, participates in its local Regional Advisory Council (RAC), participates in the regional stroke plan, and submits data to the department, as requested as defined by § 157.133 of this chapter.(30) Comprehensive Level I trauma facility--A hospital surveyed by a department-approved survey organization meeting the state designation requirements and ACS standards for a Level I trauma facility as described in § 157.125 and §157.126 of this chapter.(31) Concurrent performance improvement--Performance improvement reviews occurring from prehospital, trauma activation, or admission through to discharge. The primary level of review must be completed within 14 days of discharge, 80 percent of the time.(32) Concurrent trauma registry abstraction--Trauma registry data abstraction and registry data entry occurring after the management of the trauma patient and completed within 60 days after the patient's discharge, 80 percent of the time.(33) Consumer Protection Division (CPD)--A division within the Texas Department of State Health Services responsible for the oversight of EMS provider licensure, certification, education, and complaint investigation. The division is responsible for the hospital designation process for trauma, stroke, maternal, and neonatal facilities; the RAC system development and advances; and funding, grant management, and distribution of funding for the division.(34) Contingent designation--A designation awarded to a facility with one to three unmet designation requirements. The department develops a corrective action plan (CAP) for the facility and the facility must complete this plan and meet requirements to remain designated. Contingent designations may require a focused survey to validate requirements are met. The facility must demonstrate requirements are met to maintain designation.(35) Contingent probationary designation--A designation awarded to a facility with four or more unmet designation requirements. The department develops a CAP for the facility and the facility must complete this plan and meet requirements to remain designated. The facility may be required to submit documentation reflecting the CAP to the department at defined intervals. Contingent probationary designation may require a full survey within 12 to 18 months after the original survey date. The facility must demonstrate requirements are met to maintain designation.(36) Corrective action plan (CAP)--A plan for the facility developed by the department describing the actions the facility is required to correct.(37) Cost-to-charges ratio--A ratio covering all applicable hospital costs and charges relating to inpatient care determined by the Texas Health and Human Services Commission from the hospital's Medicaid cost report.(38) County of licensure--The county in which the physical address of a licensed EMS provider is located, as indicated by the provider on the application for licensure that is filed with the department.(39) Course medical director--A Texas-licensed physician, approved by the department, with experience in and current knowledge of emergency care who must provide direction over all instruction and clinical practice required in EMS training courses.(40) Credit hour--Continuing education credit unit awarded for successful completion of a unit of learning activity as defined in § 157.32 of this chapter (relating to Emergency Medical Services Education Program and Course Approval).(41) Critically injured person--An individual suffering with multi-system injuries or major single-system injury; the extent of the injury may be difficult to ascertain but has the potential of producing mortality or major disability.(42) Definitive care--The phase of care in which therapeutic interventions, treatments, or procedures are performed to stop or control an injury, illness, or disease and promote recovery.(43) Department--The Texas Department of State Health Services.(44) Designated facility administrator--Administrator responsible for the oversight, funding, contracts, and leadership of designated programs.(45) Designated infection control officer--A designated officer who serves as a liaison between the employer and the employees who have been or believe to have been exposed to a potentially life-threatening infectious disease through a person who was treated or transported by the EMS provider.(46) Designation--A formal recognition by the department of a hospital's capabilities, commitment, care practices, and participation in the RAC to serve as a designated facility.(47) Designation appeal--The process for a hospital that has been downgraded or denied a specific level of designation to appeal the designation decision.(48) Designation survey--An on-site or virtual review of a facility applicant to determine if it meets the criteria for a particular level of designation.(49) Dispatch--The sending of individuals and equipment by EMS for assessment, prompt efficient treatment, and transportation, if required, of a sick or injured patient.(50) Distance learning--A method of learning remotely without being in regular face-to-face contact with an instructor in the classroom.(51) Diversion--A procedure put into effect by a health care facility notifying EMS when that facility is unable to provide the level of care demanded by a patient's injuries or condition due to lack of capacity or capabilities, or when the facility has temporarily exhausted its resources and requesting patients be transported to another facility.(52) Emergency call--A call or other similar communication from a member of the public, as part of a 9-1-1 system or other emergency access communication system, made to obtain emergency medical services.(53) Emergency care attendant (ECA)--An individual who is certified by the department as minimally proficient in performing emergency prehospital care by providing initial aid that promotes comfort and avoids aggravation of an injury or illness.(54) Emergency medical services (EMS)--Services used to respond to an individual's perceived need for medical care and to prevent death or aggravation of physiological or psychological illness or injury.(55) EMS medical director--The licensed physician who provides medical supervision to the EMS personnel of a licensed EMS provider or a recognized first responder organization (FRO) under the terms of the Medical Practice Act (Texas Occupations Code Chapters 151 - 165) and rules promulgated by the Texas Medical Board; may also be called "off-line medical control."(56) Emergency medical services operator--An individual who, as an employee of a public or private agency, receives emergency calls and may provide medical information or medical instructions to the public during those emergency calls.(57) Emergency medical services personnel-- (A) emergency care attendant (ECA);(B) emergency medical technician (EMT);(C) advanced emergency medical technician (AEMT);(D) emergency medical technician-paramedic (EMT-P); or(E) licensed paramedic (LP).(58) Emergency medical services provider--An organization that uses, operates, or maintains EMS vehicles and EMS personnel to provide emergency medical services.(59) Emergency medical services times-- (A) Time of call--The date and time a phone rings at a public safety answering point (PSAP) or other designated entity, requesting EMS services.(B) Dispatch time--The date and time a responding EMS provider is notified by dispatch.(C) En route--The date and time the EMS vehicle starts moving to respond.(D) On scene--The date and time a responding EMS vehicle stops moving when it arrives at the location of the response.(E) At patient side--The date and time the EMS personnel of the responding EMS vehicle arrives at the patient's side.(F) Transport--The date and time the responding EMS vehicle leaves the location of the response and starts moving toward the destination.(G) Arrival time--The date and time the responding EMS vehicle arrives with the patient at the destination or transfer point.(H) Transfer of care--The date and time patient care is transferred to the destination health care staff or transfer point of health care.(I) Back in service--The date and time the EMS vehicle is back in service and available for another response.(60) Emergency medical services vehicle--(A) basic life support (BLS) vehicle;(B) advanced life support (ALS) vehicle;(C) mobile intensive care unit (MICU) vehicle;(D) MICU rotor-wing and MICU fixed-wing air medical vehicles; or(E) specialized emergency medical service vehicle.(61) Emergency medical services volunteer--EMS personnel who provide emergency prehospital or interfacility care in affiliation with a licensed EMS provider or a registered FRO without remuneration, except for reimbursement for expenses.(62) Emergency medical services volunteer provider--An EMS provider with at least 75 percent of personnel as volunteers and is a nonprofit organization. See § 157.11 of this chapter regarding fee exemption.(63) Emergency medical technician (EMT)--An individual certified by the department as minimally proficient in performing emergency prehospital care necessary for basic life support and includes the control of hemorrhaging and cardiopulmonary resuscitation.(64) Emergency medical technician-paramedic (EMT-P)--An individual certified by the department as minimally proficient in performing emergency prehospital or interfacility care in health care facility's emergency or urgent care clinical setting, including a hospital emergency room and a freestanding emergency medical care facility, by providing advanced life support that includes initiation and maintenance under medical supervision of certain procedures, including intravenous therapy, endotracheal or esophageal intubation or both, electrical cardiac defibrillation or cardioversion, and drug therapy.(65) Emergency prehospital care--Care provided to the sick and injured within a health care facility's emergency or urgent care clinical setting, including a hospital emergency room and freestanding emergency medical care facility, before or during transportation to a medical facility, including any necessary stabilization of the sick or injured in connection with transportation.(66) Event--A variation from the established care management guidelines or system operations such as delays in response, delays in care, hospital event such as complications, or death. An event or variation in care creates a need for review of the care or system processes to identify opportunities for improvement.(67) Event resolution--An event, as described in paragraph (66) of this section, that is identified and reviewed to determine the impact to the patient and if opportunities for improvement in care or the system exist, with a specific action plan tracked with data analysis to demonstrate the action plan created the desired change to achieve the desired goal, and improved outcomes are sustained.(68) Extraordinary emergency--A serious, unexpected event or situation requiring immediate action to reduce or minimize disruption to established health care services within the EMS and trauma care system.(69) Field triage--The process of determining which facility is most appropriate for patients based on injury severity, time-sensitive disease factors, and facility availability. Refer to paragraph (104) of this section.(70) Financially indigent--An uninsured or underinsured patient unable to pay for the trauma services rendered based on the hospital's eligibility system.(71) First responder organization (FRO)--A group or association of certified EMS personnel that work in cooperation with licensed EMS providers.(72) Fixed location--The address as it appears on the initial or renewal EMS provider license application in which the patient care records and administrative departments are located.(73) Governmental entity--A county, a city or town, a school district, or a special district or authority created in accordance with the Texas Constitution, including a rural fire prevention district, an emergency services district, a water district, a municipal utility district, and a hospital district.(74) Governor's EMS and Trauma Advisory Council (GETAC)--An advisory council appointed by the Governor of Texas that provides professional recommendations to the EMS/Trauma System Section regarding EMS and trauma system development and serves as a forum for stakeholder input.(75) Inactive EMS provider status--The period of time when a licensed EMS provider is not able to respond to an EMS dispatch.(76) Industrial ambulance--Any vehicle owned and operated by an industrial facility as defined in the Texas Transportation Code § 541.201 and used for initial transport or transfer of company employees who become urgently ill or injured on company premises to an appropriate health care facility.(77) Injury severity score (ISS)--An anatomical scoring system providing an overall score for trauma patients. The ISS standardizes the severity of trauma injuries based on the three worst abbreviated injury scales (AIS) from the body regions. These regions are the head and neck, face, chest, abdomen, extremity, and external as defined by the Association for the Advancement of Automotive Medicine (AAAM). The highest abbreviated injury score in the three most severely injured body regions have the scores squared, then added together to define the patient's ISS.(78) Interfacility care--Care provided while transporting a patient between health care facilities.(79) Legal entity name--The name of the lawful or legally standing association, corporation, partnership, proprietorship, trust, or individual. Has legal capacity to: (A) enter into agreements or contracts;(D) sue and be sued in its own right; and(E) to be accountable for illegal activities.(80) Level of harm--A classification system defining the impact of an event to the patient and assists in defining the urgency of review. There are five levels of harm used to define the impact to the patient as defined by the American Society for Health Care Risk Management: (A) No harm--The patient was not symptomatic or no symptoms were detected, and no treatment or intervention was required.(B) Mild harm--The patient was symptomatic, symptoms were mild, loss of function or harm was either minimal or intermediate but short-term, and no interventions or only minimal interventions were needed.(C) Moderate harm--The patient was symptomatic, required intervention such as additional operative procedure, therapeutic treatment, or an increased length of stay, required a higher level of care, or may experience long-term loss of function.(D) Severe harm--The patient was symptomatic, required life-saving or other major medical or surgical intervention, or may experience shortened life expectancy, and may experience major permanent or long-term loss of function.(E) Death harm--The event was a contributing factor in the patient's death.(81) Levels of review--Describes the levels of performance improvement review for an event in the designation program's quality improvement or performance improvement patient safety (PIPS) plan. There are four levels of review: (A) Primary level of review--Initial investigation of identified events by the facility's designation program performance improvement personnel to capture the event details and to validate and document the timeline, contributing factors, and level of harm. The program manager usually addresses system issues with no level of harm, including identifying the opportunities for improvement and action plan appropriate for the event, and keeping the program medical director updated. This must be written in the facility's performance improvement plan.(B) Secondary level of review--The level of review by the facility's designation program medical director in which the program personnel prepare the documentation and facts for the review. The program medical director reviews the documentation and either agrees or corrects the level of harm, defines the opportunities for improvement with action plans, or refers to the next level of review.(C) Tertiary level of review--The third level of review by the facility's designation program to evaluate care practices and compliance to defined management guidelines, identify opportunities for improvement, and define a plan of correction (POC). Minutes capturing the event, discussion, and identified opportunities for improvement with action plans must be documented.(D) Quaternary level of review--The highest level of review, which may be conducted by an entity external to the facility program as an element of the performance improvement plan. The event, review, and discussion of the event, and identified opportunities for improvement with action plans must be documented.(82) Licensee--A person who holds a current paramedic license from the department, or an organization that uses, maintains, or operates EMS vehicles and provides EMS personnel to provide emergency medical services, and who holds an EMS provider license from the department.(83) Major Level II trauma facility--A hospital surveyed by a department-approved survey organization meeting the state designation requirements and ACS standards for a Level II trauma facility as described in § 157.125 and §157.126 of this chapter.(84) Major trauma patient--An individual with injuries, or potential injuries, who benefits from treatment at a trauma facility. The patient may or may not present with alterations in vital signs or level of consciousness, or with obvious, significant injuries, but has been involved in an event that produces a high index of suspicion for significant injury and potential disability. Co-morbid factors such as age or the presence of significant preexisting medical conditions are also considered. The patient initiates a system response to include field triage to the most appropriate designated trauma facility.(85) Medical control--The supervision of prehospital EMS providers and FROs by a licensed physician. This encompasses on-line (direct voice contact) and off-line (written protocol and procedural review).(86) Medical oversight--The assistance and management given to health care providers and entities involved in regional EMS/trauma systems planning by a physician or group of physicians designated to provide technical assistance to the EMS provider or FRO medical director.(87) Medical supervision--Direction given to EMS personnel by a licensed physician under the terms of the Medical Practice Act (Texas Occupations Code Chapters 151 - 165) and rules promulgated by the Texas Medical Board.(88) Mobile intensive care unit--A vehicle designed for transporting the sick or injured, meeting the requirements of the advanced life support vehicle, and having sufficient equipment and supplies to provide cardiac monitoring, defibrillation, cardioversion, drug therapy, and two-way communication with at least one paramedic on the vehicle when providing EMS.(89) National EMS Compact--The agreement among states to allow the day-to-day movement of EMS personnel across state boundaries.(90) National EMS Information System (NEMSIS)--A universal standard for how patient care information resulting from an EMS response is collected.(91) National Trauma Data Bank (NTDB)--The national repository for trauma registry data, defined by the ACS with inclusion criteria and data elements required for submission.(92) National Trauma Data Standards (NTDS)--The American College of Surgeons' standard data elements with definitions required for submission to the NTDB, as defined in paragraph (91) of this section.(93) Non-contiguous emergency department--A hospital emergency department located in a separate building, not contiguous with the designated facility. May be referred to as a satellite emergency department.(94) Off-line medical director--The licensed physician who provides approved protocols and medical supervision to the EMS personnel of a licensed EMS provider under the terms of the Medical Practice Act (Texas Occupations Code Chapters 151 - 165) and rules promulgated by the Texas Medical Board.(95) On-line course--A directed learning process comprised of educational information (articles, videos, images, web links), communication (messaging, discussion forums) for virtual learning, and measures to evaluate the student's knowledge.(96) Operational name--Name under which the business or operation is conducted and presented to the world.(97) Operational policies--Policies and procedures that are the basis for the provision of EMS and that include such areas as vehicle maintenance; proper maintenance and storage of supplies, equipment, medications, and patient care devices; complaint investigations; multi-casualty incidents; and hazardous materials; but do not include personnel or financial policies.(98) Operations Committee--Committee serving as the facility's trauma program administrative oversight for designation and responsible for the approval of trauma management guidelines, operational plan, and procedures within the program or system having the potential to impact care practices or designation.(99) Operative or surgical intervention--Any surgical procedure provided to address trauma injuries for patients taken directly from the scene, emergency department, or other hospital location to an operating suite for patients meeting the hospital's trauma activation guidelines and meeting NTDB registry inclusion criteria.(100) Out of service vehicle--The period of time when a licensed EMS vehicle is unable to respond to an emergency or non-emergency response.(101) Performance improvement and patient safety (PIPS) plan--The written plan and processes for evaluating patient care, system response, and adherence to established patient management guidelines; defining variations from care or system response; assigning the level of harm and level of review; identifying opportunities for improvement; and developing the CAP. The CAP outlines data analysis and measures to track the action plan to ensure the desired changes are met and maintained to resolve the event. The medical director, program manager, and administrator have the authority and oversight over PIPS.(102) Plan of correction (POC)--A report submitted to the department by the facility detailing how the facility will correct one or multiple requirements defined as "not met" during a trauma designation survey review that is reported in the survey summary or documented in the self-attestation.(103) Practical exam--An evaluation that assesses the person's ability to perceive instructions and perform motor responses, also referred to as a psychomotor exam.(104) Prehospital triage--The process of identifying medical or injury acuity or the potential for severe injury based upon physiological criteria, injury patterns, and high-energy mechanisms and transporting patients to a facility appropriate for the patient's medical or injury needs. Prehospital triage for injured patients or time-sensitive disease events is guided by the approved prehospital triage guidelines adopted by the RAC and approved by the department. May also be referred to as "field triage" or "prehospital field triage."(105) Primary EMS provider response area--The geographic area in which an EMS agency routinely provides emergency EMS as agreed upon by a local or county governmental entity or by contract.(106) Primary Level III stroke facility--A hospital designated by the department and meets the department-approved national stroke standards of care for a primary stroke center, participates in its RAC, participates in the regional stroke plan, and submits data as requested by the department.(107) Protocols--A detailed, written set of instructions by the EMS provider's medical director, which may include delegated standing medical orders, to guide patient care or the performance of medical procedures as approved.(108) Public safety answering point (PSAP)--The call center responsible for answering calls to an emergency telephone number for ambulance services; sometimes called "public safety access point" or "dispatch center."(109) Quality management--Quality assessment, quality improvement, and performance improvement activities. See definition of PIPS in paragraph (101) of this section.(110) Receiving facility--A health care facility to which an EMS vehicle may transport a patient requiring prompt continuous medical care, or a facility receiving a patient being transferred for definitive care.(111) Recertification--The procedure for renewal of EMS certification.(112) Reciprocity--The recognition of certification or privileges granted to an individual from another state or recognized EMS system.(113) Regional Advisory Council (RAC)--A nonprofit organization recognized by the department and responsible for system coordination for the development, implementation, and maintenance of the regional trauma and emergency health care system within its geographic jurisdiction of the Trauma Service Area. A RAC must maintain 501(c)(3) status.(114) Regional Advisory Council Performance Improvement Plan--A written plan of the RAC's processes to review identified or referred events, identify opportunities for improvement, define action plans and data required to correct the event, and establish measures to evaluate the action plan through to event resolution.(115) Regional medical control--Physician supervision for prehospital EMS providers in a given trauma service area (TSA) or other geographic area intended to provide standardized oversight, treatment, and transport guidelines, which should, at minimum, follow the RAC's regional trauma and emergency health care system plan components related to these issues and 22 Texas Administrative Code § 197.3(relating to Off-line Medical Director).(116) Relicensure--The procedure for renewal of a paramedic license as described in § 157.40 of this chapter (relating to Paramedic Licensure); the procedure for renewal of an EMS provider license as described in § 157.11 of this chapter.(117) Response pending status--The status of an EMS vehicle that just delivered a patient to a final receiving facility and for which the dispatch center has another EMS response waiting.(118) Response ready--When an EMS vehicle is equipped and staffed in accordance with § 157.11 of this chapter and is immediately available to respond to any emergency call 24-hours per day, seven days per week (24/7).(119) Rural county--A county with a population of less than 50,000 based on the latest estimated federal census population figures.(120) Scope of practice--The procedures, actions, and processes EMS personnel are authorized to perform as approved by the EMS provider's medical director.(121) Scope of services--The types of services and the resources to provide those services that a facility has available.(122) Severe trauma patient--A person with injuries or potential injuries defined as high-risk for mortality or disability and meeting trauma activation guidelines and meeting NTDB registry inclusion criteria benefitting from definitive treatment at a designated trauma facility. These patients may be identified by an alteration in vital signs or level of consciousness or by the presence of significant injuries and must initiate a level of trauma response defined by the facility, including prehospital triage to a designated trauma facility.(123) Simulation training--Training, typically scenario-based or skill-based, utilizing simulated patients or system events to improve or assess knowledge, competencies, or skills.(124) Sole provider--The only licensed EMS provider in a geographically contiguous service area and in which the next closest provider is greater than 20 miles from the limits of the area.(125) Specialized EMS vehicle--A vehicle designed for responding to and transporting sick or injured persons by any means of transportation other than by standard automotive ground ambulance or rotor or fixed-wing aircraft and that has sufficient staffing, equipment, and supplies to provide for the specialized needs of the patient transported. This category includes watercrafts, off-road vehicles, and specially designed, configured, or equipped vehicles used for transporting special care patients such as critical neonatal or burn patients.(126) Specialty resource centers--Entities caring for specific types of patients such as pediatric, cardiac, and burn injuries that have received certification, categorization, verification, or other forms of recognition by an appropriate agency regarding the capability to definitively treat these types of patients.(127) Staffing plan--A document indicating the overall working schedule patterns of EMS or hospital personnel.(128) Standard of care--Care equivalent to what any reasonable, prudent person of like education or certification level would have given in a similar situation, based on documented, evidence-based practices or adopted standard EMS curricula as adopted by reference in § 157.32 of this chapter; also refers to the documented standards of care reflecting evidence-based practice.(129) State EMS Registry--State repository for the collection of EMS response data as defined in Chapter 103 of this title (relating to Injury Prevention and Control).(130) State Trauma Registry--Statewide database managed by the department; responsible for the collection, maintenance, and evaluation of medical and system information related to required reportable events as defined in Chapter 103 of this title.(131) Stroke--A time-sensitive medical condition occurring when the blood supply to the brain is reduced or blocked, caused by a ruptured blood vessel or clot, preventing brain tissue oxygenation.(132) Stroke activation--The process of mobilizing the stroke care team when a patient screens positive for stroke symptoms; may be referred to as a "stroke alert" or "code stroke."(133) Stroke facility--A hospital that has successfully completed the designation process and is capable of resuscitating and stabilizing, transferring, or providing definitive treatment to stroke patients and actively participates in its local RAC and system plan.(134) Stroke medical director (SMD)--A physician meeting the department's requirements for the stroke medical director and having the authority and oversight for the stroke program, including the performance improvement process, data management, and outcome reviews.(135) Stroke program manager (SPM)--A registered nurse meeting the requirements for the stroke program manager and having the authority and oversight for the stroke program, including the performance improvement process, data management, and outcome reviews.(136) Substation--An EMS provider station location, not the fixed station, and likely to provide rapid access to a location to which the EMS vehicle may be dispatched.(137) Telemedicine medical service--A health care service delivered by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state, and acting within the scope of the physician's or health professional's license to a patient at a different physical location than the physician or health professional using telecommunications or technology as defined in Texas Occupations Code § 111.001.(138) Transport mode--As documented on the patient care record, the usage of emergency warning equipment when responding to an EMS dispatch and when transporting a patient to a receiving facility.(139) Trauma--An injury or wound to a living body caused by the application of an external force or violence, including burn injuries, and meeting the trauma program's trauma activation guidelines.(140) Trauma activation guidelines--Established criteria identifying the potential injury risk to the human body and defining the resources and response times required to evaluate, resuscitate, and stabilize the trauma patient. The guidelines must meet the national recommendations, but each trauma program defines the activation guidelines for the facility. The facility may choose to have one activation level, two activation levels, or three activation levels. (A) The highest level of trauma activation is commonly based on physiological changes in the patient's level of consciousness, airway or potential respiratory compromise, hypotension or signs of shock, significant hemorrhage, or evidence of severe trauma.(B) The second level of trauma activation is commonly based on the patient's physiological stability with anatomical injuries or mechanisms of injury having the potential for serious injuries.(C) The third level of trauma activation is designed for low-energy or single-system injuries that may require specialty service evaluation and intervention.(141) Trauma administrator--Administrator responsible for the facility oversight, funding, contracts, and collaborative leadership of the program, and serves as an interface with the chief executive team as defined by the facility's organizational structure.(142) Trauma and emergency health care system plan--The inclusive system that refers to the care rendered after a traumatic injury or time-sensitive disease or illness where the optimal outcome is the critical determinant. The system components encompass special populations, epidemiology, risk assessments, surveillance, regional leadership, system integration, business or finance models, prehospital care, definitive care facilities, system coordination for patient flow, prevention and outreach, rehabilitation, emergency preparedness and response, system performance improvement, data management, and research. These components are integrated into the regional self-assessment.(143) Trauma care--Care provided to an injured patient meeting the hospital's trauma activation guidelines and meeting NTDB registry inclusion criteria and the continuum of care throughout the system, including discharge and follow-up care or transfer.(144) Trauma Designation Review Committee--Committee responsible for reviewing trauma designation appeals, reviewing requirement exception and waiver requests, and outlining specific requirements not met in order to identify potential opportunities to improve future rule amendments.(145) Trauma facility--A hospital that has successfully completed the designation process, is capable of resuscitating and stabilizing, transferring, or providing definitive treatment to patients meeting trauma activation criteria, and actively participates in its local RAC and the development of the regional trauma and emergency health care system plan.(146) Trauma medical director (TMD)--A physician meeting the requirements and demonstrating the competencies and leadership for the oversight and authority of the trauma program as defined by the level of designation and having the authority and oversight for the trauma program, including the performance improvement and patient safety processes, trauma registry, data management, peer review processes, outcome reviews, and participation in the RAC (TMD or designee) and the development of the regional trauma and emergency health care system plan.(147) Trauma patient--Any injured person who has been evaluated by a physician, a registered nurse, or EMS personnel, and found to require medical care in a trauma facility based on local or national medical standards.(148) Trauma program manager (TPM)--A registered nurse who in partnership with the TMD and hospital administration is responsible for oversight and authority of the trauma program as defined by the level of designation, including the trauma performance improvement and patient safety processes, trauma registry, data management, injury prevention, outreach education, outcome reviews, and research as appropriate to the level of designation.(149) Trauma Quality Improvement Program (TQIP)--The ACS risk-adjusted benchmarking program using submitted data to evaluate specific types of injuries and events to compare cohorts' outcomes with other trauma centers; assisting in defining opportunities for improvement in specific patient cohorts.(150) Trauma registrar--An individual meeting the requirements and whose job responsibilities include trauma patient data abstraction, trauma registry data entry, injury coding, and injury severity scoring, in addition to registry report writing and data management skills specific to the trauma registry and trauma program.(151) Trauma registry--A trauma facility database capturing required elements of trauma care for each patient.(152) Trauma service area--Described in § 157.122 of this subchapter (relating to Trauma Service Areas).(153) Uncompensated trauma care--The sum of "charity care" and "bad debt." Contractual adjustments in reimbursement for trauma services based upon an agreement with a payor (including Medicaid, Medicare, Children's Health Insurance Program (CHIP), or other health insurance programs) are not uncompensated trauma care.(154) Urban county--A county with a population of 50,000 or more based on the latest estimated federal census population figures.(155) Verification--Process used by the ACS to review a facility seeking trauma verification to validate the defined standards are met with documented compliance for successful trauma center verification. If a Level I or Level II facility is not verified by the ACS, the department cannot designate the facility.(156) When in service--The period of time when an EMS vehicle is responding to an EMS dispatch, at the scene, or en route to a facility with a patient.25 Tex. Admin. Code § 157.2
The provisions of this §157.2 adopted to be effective September 1, 2000, 25 TexReg 3749; Amended by Texas Register, Volume 42, Number 05, February 3, 2017, TexReg 439, eff. 2/12/2017; Amended by Texas Register, Volume 49, Number 46, November 15, 2024, TexReg 9247, eff. 11/24/2024