Major Topic #1: Definitions

For the purpose of this document, the following definitions were adopted:

Critical Care Transport — The level of transport care that is provided to patients with an immediate life-threatening illness or injuries associated with single or multiple organ system failure. This level
of care requires an expert level of provider knowledge and skills, a setting providing necessary equipment, and the ability to handle the added challenge of transport. Critical care transport requires a high level of medical direction and sophistication of care because of the patient’s complex medical problems.

EMS System — A consolidated system of essential components designed to provide a coordinated, timely and effective response to medical emergencies. A comprehensive EMS system has each of the elements illustrated in the following diagram:

Facility — Licensed health care entity (e.g., hospital, clinic, rehab, nursing home)

Guideline — Something that is to be preferred, but that does not have the force of a standard. Providers/services are not held legally responsible for acting at this level of performance. A suggestion rather than a mandate.

Integrated Regional Health Care System – A regionally based system that provides its community members with seamless, comprehensive health care, including all who directly provide preventive services, acute care, and rehabilitation, as well as the components of the health care system that support their function. Examples of components providing support may include: insurance carriers, regulatory agencies, statutory public/government entities, consumer groups, and professional associations. In an integrated regional health care system, the efforts of all stakeholders are coordinated to ensure the active involvement of all entities in the process of planning, implementing, evaluating and problem solving.

Integration – The consolidation and coordination of separate units into a unified, harmonious whole.

Interfacility Transfer — Any transfer, after initial assessment and stabilization, from and to a health care facility. Examples would include:

• hospital to hospital;
• clinic to hospital;
• hospital to rehabilitation; and
• hospital to long-term care.

Levels of Patient Acuity – In order to provide safe and effective care, provider capabilities must match the patient’s current and potential needs. It is important to have consistent terminology to define the levels of patient acuity. For each level, examples are provided of the types of needs the patient might have and the level of care likely to be required at each level.

• Stable with no risk for deterioration — Oxygen, monitoring of vital signs, saline lock, basic emergency medical care).
  
  
• Stable with low risk of deterioration — Running IV, some IV medications including pain medications, pulse oximetry, increased need for assessment and interpretation skills (advanced care).
  
  
• Stable with medium risk of deterioration — 3-lead EKG monitoring, basic cardiac
  medications, e.g., heparin or nitroglycerine (advanced care +).
  
  
• Stable with high risk of deterioration – Patients requiring advanced airway but secured, intubated, on ventilator, patients on multiple vasoactive medication drips (advanced care +), patients whose condition has been initially stabilized, but has likelihood of deterioration, based on assessment or knowledge of provider regarding specific illness/injury.
  
  
• Unstable — Any patient who cannot be stabilized at the transferring facility, who is deteriorating or likely to deteriorate, such as patients who require invasive monitoring, balloon pump, who are post-resuscitation, or who have sustained multiple trauma (critical care or available crew with time considerations).

Medical Oversight – Medical authority and responsibility for all medical care provided by the service, including active day-to-day role in the function and management of the service as it relates to patient care activities. There are several terms that refer to the activities involved in medical oversight:

Outcome Evaluation — Examines the effectiveness or efficacy of particular interventions on patient status. An outcome evaluation of IFT assesses a particular clinical aspect of patient care during IFT, and its impact on patient outcome.

Process Evaluation — Process evaluation focuses on the quality of implementation — how well the process was carried out. It examines operational and system efficiency. It would be difficult to arrive at the conclusion that a specific intervention caused a specific outcome if the process of achieving it was not carried out as intended.

Region – A particular area, zone, district, or territory. For the purpose of developing an IFT plan, a region could be defined as the one EMS system or a combination of several EMS systems. A region can be defined and/or influenced by numerous determinants, such as:

• jurisdictions;
• geographic locations;
• service areas of providers;
• service areas of insurance carriers and
• referral patterns.

Service Area – The defined response boundaries, mutually agreed upon contractually and/or as designated by a regulatory body, to provide IFT within a single or combination of several EMS systems. A service area could be a region or part of a region, and can be defined and/or influenced by numerous determinants, such as:

• jurisdictions;
• geographic locations;
• service areas of providers; and
• service areas of insurance carriers.

Specialty Care Transport (SCT) – As defined by the Centers for Medicare & Medicaid Services (CMS) — is IFT of a critically injured or ill beneficiary by a ground ambulance vehicle including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT-Paramedic. SCT is necessary when a beneficiary’s condition requires ongoing care that must be furnished by one or more health professionals in an appropriate specialty area, for example, emergency or critical care nursing, emergency medicine, respiratory care, cardiovascular care, or a paramedic with additional training.

Standard — Is described as a basis for comparison; a reference point against which other
things can be evaluated. Standards set a benchmark for subsequent work.

Transfer – The comprehensive infrastructure and process involved before, during, and after moving a patient from one location to another.

Transport – The physical process of moving a patient from one location to another.