Title 7 . Health and Social Services

Chapter 26 . Embalming and Other Post-Mortem Services

Section 999. Definitions

7 AAC 26.999. Definitions

In this chapter,

(1) "active emergency medical services responder" means a person who has actively participated, either as a volunteer or paid professional, in pre-hospital emergency patient care;

(2) "acute care hospital" means a state licensed hospital or federal hospital that provides medical and surgical outpatient and inpatient services to persons with injuries or illnesses;

(3) "advanced life support" has the meaning given in AS 18.08.090 ;

(4) "aeromedical service" means a medivac service, an air ambulance service, a critical care air ambulance service, or a specialty aeromedical transport team;

(5) "aeromedical transport team" means a team of two or more health care workers who are trained and equipped to provide care to a patient being transported in an aircraft;

(6) "air medivacs" means transporting emergency patients by fixed or rotary wing aircraft with at least one certified or licensed emergency medical responder in attendance;

(7) "appropriate equipment to perform basic and advanced life-support emergency procedures" means the basic ambulance equipment recommended by the American College of Surgeons as of July 15, 1992, unless a specific exception is granted by the department, plus any additional equipment necessary to carry out the advanced life-support procedures offered by the emergency medical service, including advanced airway devices, monitor/defibrillators, and intravenous supplies;

(8) "automatic defibrillator" means a defibrillator that is capable of automatic rhythm analysis, and that will charge and deliver a countershock, without operator intervention, after electronically detecting the presence of ventricular fibrillation or rapid ventricular tachycardia;

(9) "basic life support" means those emergency care skills outlined in the goals and objectives of the department's Emergency Medical Technician-I Course Objectives, adopted by reference in 7 AAC 26.050(b) (2), including administration of oxygen, of the patient's prescribed nitroglycerin, bronchodilator inhaler, or epinephrine autoinjector, and of over-the-counter medicines, such as activated charcoal, that are necessary to carry out the objectives outlined in the course; "basic life support" does not include manual defibrillation;

(10) "certified or licensed medical personnel" means EMT-Is, EMT-IIs, EMT-IIIs, mobile intensive care paramedics, physician's assistants, nurse practitioners, registered nurses, certified emergency nurses, critical care registered nurses, or physicians authorized by law to provide medical care in Alaska or in the state in which the certified service is based;

(11) "certifying officer" means a person designated by the department to ensure

(A) the security of the written examination;

(B) that the practical examination for certification meets department-approved objectives for testing EMT-Is, EMT-IIs, or EMT-IIIs, as appropriate, by determining the fair conduct of the test; and

(C) that the required skills are evaluated by an appropriate examiner during the written and practical examination;

(12) "continuing medical education" means instruction in topics included in the training course curriculum for EMT-Is, EMT-IIs, or EMT-IIIs, that may be presented using critiques, didactic sessions, practical drills, workshops, seminars, or other department-approved means; additional topics for continuing medical education include: air medical emergency care, athletic injuries, battered spouses, child abuse, communications, crime scene response, disabled adults, electrical hazards, explosion injuries, extrication, medical terminology, farm machinery injuries, hazardous materials, incident management, industrial injuries, infectious diseases, injury prevention, medico-legal aspects, neonatal care/sudden infant death syndrome (SIDS), protective breathing apparatus, radioactive materials, rape intervention, rappelling, sea survival, hyperbaric medicine, or special rescue (aerial, diving, mountain, search);

(13) "CPR" means cardiopulmonary resuscitation;

(14) "critical care air ambulance service" means an organization or entity that is, or that uses by contractual arrangement, an aircraft operator or operators, with appropriate aircraft, and that provides or advertises to provide emergency medical care that includes advanced life support services and air transportation under the direct or indirect supervision of a medical director, through personnel trained at least to the mobile intensive care paramedic, physician's assistant, nurse practitioner, registered nurse, critical care registered nurse, certified emergency nurse, or physician level; generally, a critical care air ambulance service has the expertise to provide a higher level of medical care than does a medivac service and usually provides transportation from the initial treatment hospital to a referral hospital;

(15) "department" means the Department of Health and Social Services;

(16) "department-approved medivac training" means a course, approved by the department, that includes training in the following, as appropriate to meet the needs of the applicant:

(A) decision to medivac, planning and systems coordination, and escort training objectives;

(B) aircraft and equipment considerations, such as types of aircraft, patient care, selection of aircraft and air carriers, minimum and special needs, effects of the environment, safety factors, and transferring and retrieving equipment;

(C) physiological aspects of pressure and the atmosphere, including composition, layers and physiological divisions of the atmosphere, atmospheric pressure, the circulation system, basic respiratory physiology, hypoxia and shock, cabin pressurization and decompression, gas expansion disorders, evolved gas problems, and acceleration or deceleration forces on the body;

(D) supporting activities, such as recordkeeping and the role of protocols and standing orders;

(E) lifting and moving patients, survival during inflight emergencies, and general inflight patient care, including care of patients who require special considerations in the airborne environment;

(F) medical equipment used aboard aircraft;

(G) changes in barometric pressure, decompression sickness and air embolism, and changes in partial pressure of oxygen;

(H) other environmental factors affecting patient care, including humidity, temperature, ventilation, and noise;

(I) aircraft systems, including electrical, pressurization, lighting, and ventilation; and

(J) aircraft emergencies such as electrical failure, rapid decompression, emergency landings, and principles of survival;

(17) "department-approved aeromedical training" means a course, approved by the department, that includes training in the following, as appropriate to meet the needs of the applicant:

(A) physiological aspects of pressure and the atmosphere, including composition, layers and physiological divisions of the atmosphere, atmospheric pressure, the circulation system, basic respiratory physiology, hypoxia and shock, cabin pressurization and decompression, gas expansion disorders, evolved gas problems, and acceleration or deceleration forces on the body;

(B) specific medical situations, such as escort responsibilities and self care, patient stress and prolonged immobility, medication problems and side effects, motion sickness, nosebleed, hearing problems, flying across time zones and international borders, patient preparation for transportation, enplaning and deplaning, stages of flight, oxygen administration, intravenous therapy, tracheal suction, CPR, chest tubes, retention balloons, and dressing change;

(C) specific medical situations, such as patient assessment, head injuries, chest, abdominal, neck or spinal injuries, orthopedic disorders, facial wounds and injuries, eye problems, ear and throat problems, respiratory problems, cardiac problems, gastrointestinal problems, poisoning and overdose, hematologic disorders, urological disorders, behavioral states, maternal transport, infant and pediatric transport, burns, hypothermia and cold water near-drowning, and diving injuries;

(D) responsibilities during preflight, inflight, and postflight phases of an air ambulance mission;

(E) legal considerations of air ambulance service and recordkeeping for air ambulance services;

(F) lifting and moving patients, and general inflight patient care, including care of patients who require special considerations in the airborne environment;

(G) medications, including the times that medications are administered and adjustments that are required when changing time zones;

(H) medical equipment used aboard aircraft;

(I) changes in barometric pressure, decompression sickness and air embolism, and changes in partial pressure of oxygen;

(J) other environmental factors affecting patient care, including humidity, temperature, ventilation, and noise;

(K) aircraft systems, including electrical, pressurization, lighting, and ventilation; and

(L) aircraft emergencies, such as electrical failure, rapid decompression, emergency landings, and principles of survival;

(18) "direct or indirect supervision" means direct voice contact or by written standing orders;

(19) "EMD" means an emergency medical dispatcher;

(20) "EMD medical director" means a physician who is authorized to practice medicine in Alaska who assumes medical oversight of emergency medical dispatch services, including the approval of systematized caller interrogation questions, systematized pre-arrival instructions, and protocols to match the dispatcher's evaluation of injury or illness severity and the number of victims with vehicle response modes and configurations;

(21) "emergency medical dispatcher" means a person certified by the department who has successfully completed a department-approved emergency medical dispatcher course and has met all other department requirements for certification;

(22) "emergency medical dispatch priority reference system" means a protocol system approved by the EMD medical director, used by a dispatch agency to dispatch aid to medical emergencies, and must include

(A) systematized caller interrogation questions;

(B) systematized pre-arrival instructions; and

(C) protocols matching the dispatcher's evaluation of injury or illness severity and numbers of victims with vehicle response modes and configurations;

(23) "emergency medical service" means an organization that provides basic or advanced life support medical services outside a hospital;

(24) "emergency medical services" means the provision of emergency medical care and transportation of the sick or injured;

(25) "emergency medical technician" has the meaning given in AS 18.08.090 ;

(26) "emergency trauma technician" means a person who has

(A) successfully completed an emergency trauma technician training course approved by the department under 7 AAC 26.450; and

(B) a valid ETT card signed by an ETT instructor;

(27) "EMS" means emergency medical services;

(28) "EMS communications capability" means point-to-point voice communications between EMS responders in the field and a higher-level medical facility, such as a clinic with mid-level practitioners, or a hospital;

(29) "EMS training" means ETT, EMT-I, EMT-II, EMT-III, or defibrillator technician training;

(30) "EMT" means an emergency medical technician;

(31) "ETT" means emergency trauma technician;

(32) repealed 7/4/99;

(33) repealed 7/4/99;

(34) "gross misconduct" means the knowing violation of AS 18.08 or the regulations adopted under it;

(35) "high-risk maternal transport team" means a team of two or more health care workers who are trained and equipped to provide care to women with potentially serious complications of pregnancy during transport;

(36) "high risk newborn transport team" means a team of two or more health care workers who are trained and equipped to provide care to newborns during transport;

(37) "hours of instruction" means hours devoted to the didactic, clinical, and psychomotor training of the course participants, but does not include hours used for the certification testing of students;

(38) "inflight patient care form" means a preprinted form that includes spaces for recording information, including the patient's name; date of flight; name of air carrier; diagnosis; originating and terminating points and patient's condition upon departure and arrival; an inflight medical attendant's report of the patient's status, including vital signs, level of consciousness, drugs administered, and details of therapeutic intervention; unusual circumstances encountered during the flight, including inordinate altitudes flown, turbulence, and times associated with these abnormal conditions; and other information, such as billing information for medical and transportation expenses;

(39) "intervener physician" means a physician who has not previously established a doctor/patient relationship with the emergency patient, but who is willing to accept responsibility for a medical emergency, and who can provide proof of a valid medical license;

(40) "manual defibrillator" means a defibrillator that has no built-in capability for rhythm analysis and will charge and deliver a countershock only at the command of the operator;

(41) "medivac service" means an organization or entity that provides aeromedical evacuation or medically assisted transportation and usually provides transportation from the scene of the emergency, or a remote village or occupation site, to the initial treatment hospital;

(42) "medical director" means, except in 7 AAC 26.620, an individual who meets the applicable qualifications in 7 AAC 26.630 and who agrees to perform the responsibilities specified in this chapter for supervision of an EMT-I, an EMT-II, an EMT-III, a manual defibrillator technician, an emergency medical dispatcher, a manual defibrillator technician training program, an EMT-I, EMT-II, or EMT-III training course, an emergency medical service, a medivac service, a critical care air ambulance service, or a specialty aeromedical transport team;

(43) "mid-level practitioner" means a person certified or licensed by the state as a nurse practitioner or as a physician assistant;

(44) repealed 8/16/2002;

(45) "mutual aid agreement" means a written agreement that permits an emergency medical service to go to the aid of another emergency medical service within or outside the local service area, and to receive aid from another emergency medical service within or outside of the local service area, during multiple casualty incidents or other situations as defined in the agreement;

(46) "on-line physician" means a physician immediately available in person or by radio or telephone, when medically appropriate, for communication of medical direction to non-physician prehospital care-givers;

(47) "organization that provides basic or advanced life-support emergency medical services outside a hospital" means an organization, such as an ambulance service, rescue squad, fire department, or medivac service that, as one of its primary functions, provides basic or advanced life-support emergency medical services;

(48) "other organization having ancillary emergency health or patient care responsibilities" means an organization such as the community health aide program, the uniformed services, the National Park Service, the United States Forest Service, a logging camp, the Alaska Marine Highway System, the Alaska Railroad, or private corporation, that must provide services to individuals needing immediate medical care in order to prevent loss of life or aggravation of psychological or physiological illness or injury;

(49) "pediatric transport team" means a team of two or more health care workers who are trained and equipped to provide care to children during transport;

(50) "pre-arrival instructions" means telephone rendered, medically approved, written instructions given by trained EMD's through callers that help to provide aid to the victim and control of the situation before the arrival of prehospital EMS personnel; "pre-arrival instructions" are part of an EMDPRS and are used as close to word-for-word as possible;

(51) "pediatric transport team" means a team of two or more health workers who are trained and equipped to provide care to children during transport;

(52) "protocols" mean written standards for EMS practice in a variety of situations within the EMS system;

(53) "reasonable period of time" means that period of time in which the medical attendant with the patient, or the supervising physician, feels that the patient's condition will not deteriorate significantly;

(54) "refresher training course" means a course, of at least 24 hours in length, that includes didactic and practical skills appropriate for an EMT-I, EMT-II, or EMT-III, and includes at least the following topics: vital signs, splinting, spinal injury management, patient evaluation, EMS reports, and updates on medical equipment information and use of oxygen equipment and bag masks;

(55) "reverification" means the process used by the Committee on Trauma, American College of Surgeons (ACS), to re-evaluate the trauma care capabilities and performance of a hospital previously verified as meeting the criteria of a level I, level II, or level III trauma center using the guidelines set out in the ACS Resources for Optimal Care of the Injured Patient;

(56) "responsible official" means a person who has administrative responsibility for the operations of an emergency medical service, and includes the chief of a fire department or ambulance service;

(57) Resources for Optimal Care of the Injured Patient: 1993 is a publication of the Committee on Trauma, American College of Surgeons, that includes criteria for four different levels of trauma centers;

(58) "semi-automatic defibrillator" means a defibrillator that is capable of electronically detecting ventricular fibrillation and rapid ventricular tachycardia, but requires user interaction in order to deliver a countershock;

(59) "skill sheets" means the guidebook, prepared by the department and revised through January, 2002 and adopted by reference, containing frequently used and critical psychomotor skills;

(60) "specialty aeromedical transport team" means an aeromedical transport team that provides advanced life support services and can accommodate the special medical needs of the category of patient the applicant is certified to serve, including a high-risk newborn transport team, high-risk maternal transport team, or pediatric transport team; generally, a specialty air medical transport team transports a certain category of patient to a specialty hospital referral center capable of meeting the particular needs of the patient;

(61) "standing orders" means strictly defined written orders for actions, techniques, or drug administration, to be used when communication contact has not been made with a base station physician;

(62) "state-approved EMS training agency" means a regional nonprofit EMS agency, a regional native corporation which provides EMS training, an Alaska university providing EMS training, a state agency providing EMS training, or an organization that employs emergency medical technician instructors;

(63) "successful course completion" means verification by the department-approved instructor of a training course, on forms provided by the department, that the student met all didactic objectives and psychomotor skill requirements within the training course's classroom setting;

(64) "trauma center" means an acute care hospital, clinic, or other entity that has met minimum standards for staffing, equipment, and organizational commitment to manage the care and treatment of traumatic injury victims, and is certified by the department as a level l, level II, level III, or level IV trauma center under 7 AAC 26.720 or recertified under 7 AAC 26.730;

(65) "trauma patient" means a victim of an external cause of injury that results in major or minor tissue damage or destruction caused by intentional or unintentional exposure to thermal, mechanical, electrical, or chemical energy, or by the absence of heat or oxygen (International Classification of Diseases, ICD-9 codes 800 - 959) or other categories of injuries as defined by the department;

(66) "trauma registry" means a statewide database on traumatic injury victims, whose injuries are of sufficient severity to result in hospitalization or death, to assess the appropriateness and quality of care and treatment in the prehospital and hospital setting and to study the epidemiology of serious injuries;

(67) "vehicle response configuration" means the specific vehicles of varied types, capabilities, and numbers responding to render assistance;

(68) "vehicle response mode" means the use of driving techniques, such as red lights-and-siren, to respond to an emergency medical situation;

(69) "verification" means the process used by the Committee on Trauma, American College of Surgeons, to assess the trauma care capabilities and performance of a hospital as a trauma center;

(70) "voice recorder" means a device capable of continuous recording of the voice communications at the scene.

(71) "under the direct supervision of a physician or mobile intensive care paramedic" means that the physician or mobile intensive care paramedic is physically present and able to view, provide patient care, and provide recommendations regarding the assessment and treatment provided by the mobile intensive care paramedic intern from the time of arrival at the scene to the time the patient care is transferred to another medical provider;

(72) "MICP" means mobile intensive care paramedic;

(73) "MICP course coordinator" means an individual who is certified in accordance with 7 AAC 26.174 to fulfill the responsibilities set out in 7 AAC 26.176;

(74) "mobile intensive care paramedic" has the meaning given that term by AS 08.64.380 ;

(75) "AED" means automated external defibrillation;

(76) "manual defibrillator technician" means a person certified to use a manual defibrillator under 7 AAC 26.510 - 7 AAC 26.580;

(77) "commissioner" means the commissioner of health and social services;

(78) "working day" means a day other than Saturday, Sunday, or a state holiday.

(79) "distance delivery education" means educational activities in which the student and the instructor are not in the same physical location; "distance delivery education" includes performing directed studies, reading journal articles, viewing video tapes, and participating in educational programs on the Internet or via videoconference or teleconference;

(80) "EMT-Basic" means a person who has been certified or licensed as an EMT-Basic in a state or territory or by the National Registry of Emergency Medical Technicians;

(81) "EMT-Intermediate" means a person who has been certified or licensed as an EMT-Intermediate in a state or territory or by the National Registry of Emergency Medical Techicians;

(82) "EMT-Paramedic" means a person who has been certified or licensed as an EMT-Paramedic or MICP in a state or territory, or who has been certified as an EMT-Paramedic by the National Registry of Emergency Medical Technicians;

(83) "ETT card" means documentation of successful completion of an ETT training course approved by the department under 7 AAC 26.450;

(84) "First Responder" means a person who has been certified or licensed as a First Responder in a state or territory or by the National Registry of Emergency Medical Technicians;

(85) "patient contact" means a contact by an EMT with a person who is sick or injured in which the EMT performs at least one of the following:

(A) patient assessment;

(B) obtaining vital signs;

(C) providing treatment;

(86) "primary instructor" means an EMT-I instructor, EMT-II instructor, EMT-III instructor, ETT instructor, or MICP course coordinator who

(A) requested course approval under this chapter; or

(B) coordinated a training program approved by the department under this chapter, or taught more hours in that program than any other instructor.

History: Eff. 4/7/96, Register 138; am 5/22/96, Register 138; am 3/11/98, Register 145; am 7/4/99, Register 151; am 6/23/2001, Register 158; am 8/16/2002, Register 163

Authority: AS 18.08.010

AS 18.08.080

AS 18.08.082

AS 18.08.084

Editor's note: Before Register 138, July 1996, the history of 7 AAC 26.999 was contained in 7 AAC 26.900. The history line for 7 AAC 26.999 does not reflect the prior history.

The publications listed in 7 AAC 26.999 are available for a fee from the section of community health and emergency medical services, division of public health, Department of Health and Social Services, P.O. Box 110616, Juneau, Alaska, 99811-0616, or may be viewed at that office.