190.100. Definitions.

MISSOURI STATUTES AND CODES

Definitions.

190.100. As used in sections 190.001 to 190.245, the following wordsand terms mean:

(1) "Advanced life support (ALS)", an advanced level of care asprovided to the adult and pediatric patient such as defined by nationalcurricula, and any modifications to that curricula specified in rulesadopted by the department pursuant to sections 190.001 to 190.245;

(2) "Ambulance", any privately or publicly owned vehicle or craftthat is specially designed, constructed or modified, staffed or equippedfor, and is intended or used, maintained or operated for the transportationof persons who are sick, injured, wounded or otherwise incapacitated orhelpless, or who require the presence of medical equipment being used onsuch individuals, but the term does not include any motor vehicle speciallydesigned, constructed or converted for the regular transportation ofpersons who are disabled, handicapped, normally using a wheelchair, orotherwise not acutely ill, or emergency vehicles used within airports;

(3) "Ambulance service", a person or entity that provides emergencyor nonemergency ambulance transportation and services, or both, incompliance with sections 190.001 to 190.245, and the rules promulgated bythe department pursuant to sections 190.001 to 190.245;

(4) "Ambulance service area", a specific geographic area in which anambulance service has been authorized to operate;

(5) "Basic life support (BLS)", a basic level of care, as provided tothe adult and pediatric patient as defined by national curricula, and anymodifications to that curricula specified in rules adopted by thedepartment pursuant to sections 190.001 to 190.245;

(6) "Council", the state advisory council on emergency medicalservices;

(7) "Department", the department of health and senior services, stateof Missouri;

(8) "Director", the director of the department of health and seniorservices or the director's duly authorized representative;

(9) "Dispatch agency", any person or organization that receivesrequests for emergency medical services from the public, by telephone orother means, and is responsible for dispatching emergency medical services;

(10) "Emergency", the sudden and, at the time, unexpected onset of ahealth condition that manifests itself by symptoms of sufficient severitythat would lead a prudent layperson, possessing an average knowledge ofhealth and medicine, to believe that the absence of immediate medical carecould result in:

(a) Placing the person's health, or with respect to a pregnant woman,the health of the woman or her unborn child, in significant jeopardy;

(b) Serious impairment to a bodily function;

(d) Inadequately controlled pain;

(11) "Emergency medical dispatcher", a person who receives emergencycalls from the public and has successfully completed an emergency medicaldispatcher course, meeting or exceeding the national curriculum of theUnited States Department of Transportation and any modifications to suchcurricula specified by the department through rules adopted pursuant tosections 190.001 to 190.245;

(12) "Emergency medical response agency", any person that regularlyprovides a level of care that includes first response, basic life supportor advanced life support, exclusive of patient transportation;

(13) "Emergency medical services for children (EMS-C) system", thearrangement of personnel, facilities and equipment for effective andcoordinated delivery of pediatric emergency medical services required inprevention and management of incidents which occur as a result of a medicalemergency or of an injury event, natural disaster or similar situation;

(14) "Emergency medical services (EMS) system", the arrangement ofpersonnel, facilities and equipment for the effective and coordinateddelivery of emergency medical services required in prevention andmanagement of incidents occurring as a result of an illness, injury,natural disaster or similar situation;

(15) "Emergency medical technician", a person licensed in emergencymedical care in accordance with standards prescribed by sections 190.001 to190.245, and by rules adopted by the department pursuant to sections190.001 to 190.245;

(16) "Emergency medical technician-basic" or "EMT-B", a person whohas successfully completed a course of instruction in basic life support asprescribed by the department and is licensed by the department inaccordance with standards prescribed by sections 190.001 to 190.245 andrules adopted by the department pursuant to sections 190.001 to 190.245;

(17) "Emergency medical technician-intermediate" or "EMT-I", a personwho has successfully completed a course of instruction in certain aspectsof advanced life support care as prescribed by the department and islicensed by the department in accordance with sections 190.001 to 190.245and rules and regulations adopted by the department pursuant to sections190.001 to 190.245;

(18) "Emergency medical technician-paramedic" or "EMT-P", a personwho has successfully completed a course of instruction in advanced lifesupport care as prescribed by the department and is licensed by thedepartment in accordance with sections 190.001 to 190.245 and rules adoptedby the department pursuant to sections 190.001 to 190.245;

(19) "Emergency services", health care items and services furnishedor required to screen and stabilize an emergency which may include, butshall not be limited to, health care services that are provided in alicensed hospital's emergency facility by an appropriate provider or by anambulance service or emergency medical response agency;

(20) "First responder", a person who has successfully completed anemergency first response course meeting or exceeding the nationalcurriculum of the United States Department of Transportation and anymodifications to such curricula specified by the department through rulesadopted pursuant to sections 190.001 to 190.245 and who provides emergencymedical care through employment by or in association with an emergencymedical response agency;

(21) "Health care facility", a hospital, nursing home, physician'soffice or other fixed location at which medical and health care servicesare performed;

(22) "Hospital", an establishment as defined in the hospitallicensing law, subsection 2 of section 197.020, RSMo, or a hospitaloperated by the state;

(23) "Medical control", supervision provided by or under thedirection of physicians to providers by written or verbal communications;

(24) "Medical direction", medical guidance and supervision providedby a physician to an emergency services provider or emergency medicalservices system;

(25) "Medical director", a physician licensed pursuant to chapter334, RSMo, designated by the ambulance service or emergency medicalresponse agency and who meets criteria specified by the department by rulespursuant to sections 190.001 to 190.245;

(26) "Memorandum of understanding", an agreement between an emergencymedical response agency or dispatch agency and an ambulance service orservices within whose territory the agency operates, in order to coordinateemergency medical services;

(27) "Patient", an individual who is sick, injured, wounded,diseased, or otherwise incapacitated or helpless, or dead, excludingdeceased individuals being transported from or between private or publicinstitutions, homes or cemeteries, and individuals declared dead prior tothe time an ambulance is called for assistance;

(28) "Person", as used in these definitions and elsewhere in sections190.001 to 190.245, any individual, firm, partnership, copartnership, jointventure, association, cooperative organization, corporation, municipal orprivate, and whether organized for profit or not, state, county, politicalsubdivision, state department, commission, board, bureau or fraternalorganization, estate, public trust, business or common law trust, receiver,assignee for the benefit of creditors, trustee or trustee in bankruptcy, orany other service user or provider;

(29) "Physician", a person licensed as a physician pursuant tochapter 334, RSMo;

(30) "Political subdivision", any municipality, city, county, citynot within a county, ambulance district or fire protection district locatedin this state which provides or has authority to provide ambulance service;

(31) "Professional organization", any organized group or associationwith an ongoing interest regarding emergency medical services. Such groupsand associations could include those representing volunteers, labor,management, firefighters, EMT-B's, nurses, EMT-P's, physicians,communications specialists and instructors. Organizations could alsorepresent the interests of ground ambulance services, air ambulanceservices, fire service organizations, law enforcement, hospitals, traumacenters, communication centers, pediatric services, labor unions and poisoncontrol services;

(32) "Proof of financial responsibility", proof of ability to respondto damages for liability, on account of accidents occurring subsequent tothe effective date of such proof, arising out of the ownership, maintenanceor use of a motor vehicle in the financial amount set in rules promulgatedby the department, but in no event less than the statutory minimum requiredfor motor vehicles. Proof of financial responsibility shall be used asproof of self-insurance;

(33) "Protocol", a predetermined, written medical care guideline,which may include standing orders;

(34) "Regional EMS advisory committee", a committee formed within anemergency medical services (EMS) region to advise ambulance services, thestate advisory council on EMS and the department;

(35) "Specialty care transportation", the transportation of a patientrequiring the services of an emergency medical technician-paramedic who hasreceived additional training beyond the training prescribed by thedepartment. Specialty care transportation services shall be defined inwriting in the appropriate local protocols for ground and air ambulanceservices and approved by the local physician medical director. Theprotocols shall be maintained by the local ambulance service and shalldefine the additional training required of the emergency medicaltechnician-paramedic;

(36) "Stabilize", with respect to an emergency, the provision of suchmedical treatment as may be necessary to attempt to assure withinreasonable medical probability that no material deterioration of anindividual's medical condition is likely to result from or occur duringambulance transportation unless the likely benefits of such transportationoutweigh the risks;

(37) "State advisory council on emergency medical services", acommittee formed to advise the department on policy affecting emergencymedical service throughout the state;

(38) "State EMS medical directors advisory committee", a subcommitteeof the state advisory council on emergency medical services formed toadvise the state advisory council on emergency medical services and thedepartment on medical issues;

(39) "STEMI" or "ST-elevation myocardial infarction", a type of heartattack in which impaired blood flow to the patient's heart muscle isevidenced by ST-segment elevation in electrocardiogram analysis, and asfurther defined in rules promulgated by the department under sections190.001 to 190.250;

(40) "STEMI care", includes education and prevention, emergencytransport, triage, and acute care and rehabilitative services for STEMIthat requires immediate medical or surgical intervention or treatment;

(41) "STEMI center", a hospital that is currently designated as suchby the department to care for patients with ST-segment elevation myocardialinfarctions;

(42) "Stroke", a condition of impaired blood flow to a patient'sbrain as defined by the department;

(43) "Stroke care", includes emergency transport, triage, and acuteintervention and other acute care services for stroke that potentiallyrequire immediate medical or surgical intervention or treatment, and mayinclude education, primary prevention, acute intervention, acute andsubacute management, prevention of complications, secondary strokeprevention, and rehabilitative services;

(44) "Stroke center", a hospital that is currently designated as suchby the department;

(45) "Trauma", an injury to human tissues and organs resulting fromthe transfer of energy from the environment;

(46) "Trauma care" includes injury prevention, triage, acute care andrehabilitative services for major single system or multisystem injuriesthat potentially require immediate medical or surgical intervention ortreatment;

(47) "Trauma center", a hospital that is currently designated as suchby the department.