New Jersey Administrative Code
Title 8 - HEALTH
Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES
Subchapter 1 - AUTHORITY, SCOPE AND DEFINITIONS
Section 8:41-1.3 - Definitions
The following words and terms, as used in this chapter, shall have the following meanings, unless the context in which they are used clearly indicates otherwise:
"ACLS certification" or "certification in ACLS" means valid certification in Advanced Cardiac Life Support as issued by the American Heart Association.
"Acute care hospital" means any hospital, validly licensed by the Department, which maintains and operates organized facilities and services for the diagnosis, treatment or care of persons suffering from acute illness, injury or deformity and in which all diagnoses, treatment and care are administered by or performed under the direction of persons who, in accordance with 45:9-6, are validly licensed to practice medicine and surgery by the New Jersey State Board of Medical Examiners.
"Advanced life support" or "ALS" means an advanced level of pre-hospital, inter-facility or emergency medical care that includes basic life support functions, cardiac monitoring, cardiac defibrillation, telemetered electrocardiography, administration of anti-arrhythmic agents, intravenous (IV) therapy, administration of specific medications, drugs and solutions, utilization of adjunctive ventilation devices, trauma care and other techniques and procedures authorized in writing by the Commissioner.
"Advanced practice nurse" means a person who is validly licensed by the New Jersey Board of Nursing in accordance with the standards set forth at 45:11-45 et seq.
"Advertising" means any information directly or indirectly issued, distributed, hand-delivered or implied through any medium and utilized for the purpose of promoting the service of a provider.
"AHA CPR Guidelines" means the "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" as published by the American Heart Association, National Center, 7272 Greenville Avenue, Dallas, TX 75231-4596, incorporated herein by reference, as amended and supplemented. A copy of the guidelines is on file and available for inspection at the Office of Emergency Medical Services.
"Aircraft" means a device that is utilized, or intended to be utilized, for flight in the air, and shall include both airplanes and helicopters.
"Air medical service" means an entity that is validly licensed by the Department to provide pre-hospital advanced life support care to accident or trauma victims or ALS inter-facility transfers of acutely ill or injured patients requiring specialty medical care by way of a specially equipped and specially staffed air medical unit.
"Air medical unit" or "AMU" means a specially equipped helicopter or airplane that is validly licensed by the Department and operated in accordance with the standards set forth in this chapter.
"Airplane" means, as defined at 14 C.F.R. 1.1, an engine-driven fixed-wing aircraft heavier than air, which is supported in flight by the dynamic reaction of the air against its wings.
"ALS crewmember" means:
1. A registered nurse who meets the requirements set forth at 8:41-9.9 or 10.8(d)1 through (d)5vii; and/or
2. An EMT-Paramedic, who staffs a mobile intensive care unit, specialty care transport unit or air medical unit.
"ALS inter-facility transfer" means the transportation of a patient in need of advanced life support care or medical monitoring that is beyond the capabilities of BLS ambulances and their crewmembers from one health care facility to another (such as a nursing home, rehabilitation facility or other facility as provided for at N.J.S.A. 26:2H-2a ) via a specialty care transport unit or air medical unit.
"AMD Standard" means the ambulance design and construction specifications (KKK-A-1822E) published by the Ambulance Manufacturers Division of the Truck Body and Equipment Association. Copies of the standards may be obtained from the Truck Body and Equipment Association, Suite 1220, 5530 Wisconsin Avenue, Washington, D.C. 20015.
"APLS certification" or "certified in APLS" means valid certification in Advanced Pediatric Life Support as issued by the American College of Emergency Physicians and the American Academy of Pediatrics.
"Automated external defibrillator or AED" means a device that can be attached to a patient in cardiopulmonary arrest, analyze an electrocardiogram for the presence of potentially lethal dysrhythmias (specifically, ventricular fibrillation and fast ventricular tachycardia), deliver an electrical defibrillation to the patient in accordance with the requirements of standard treatment protocols, and produce an event summary that documents significant events in the utilization of the device, specifically events prior to and after an electrical defibrillation.
"Available" means ready for immediate utilization (pertaining to equipment, vehicles and personnel) or immediately accessible (pertaining to records).
"Base station" means the actual communications console that permits the receiving of voice communications as well as telemetered electrocardiograms. Such base station shall be readily accessible to the medical command physician.
"Basic life support" or "BLS" means a basic level of pre-hospital care that includes patient stabilization, airway clearance and maintenance, cardiopulmonary resuscitation (CPR) (to the level of the Professional Rescuer or Health Care Provider as issued by either the American Heart Association, the American Red Cross, the National Safety Council or other entity determined by the Department to comply with AHA CPR Guidelines), hemorrhage control, initial wound care, fracture stabilization, victim extrication and other techniques and procedures as defined in the United States Department of Transportation (U.S.D.O.T.) EMT-Basic National Standards Curriculum (obtainable from The National Highway Traffic Safety Administration, 400 7th Street S.W., Washington, D.C. 20590, by accessing their website at http://www.nhtsa.dot.gov/people/injury/ems or by calling (888) 327-4236).
"Basic life support ambulance" or "BLS ambulance" means an emergency medical services vehicle that is validly licensed by the Department and operated in accordance with the standards set forth at N.J.A.C. 8:40.
"Basic life support ambulance service" or "BLS ambulance service" means an entity that is validly licensed by the Department to provide pre-hospital basic life support care; and/or BLS inter-facility transfers.
"BLS inter-facility transfer" means the transportation of a patient not in need of advanced life support care from one health care facility to another via a basic life support ambulance.
"Cardiac defibrillation" means the discharge of electrical current through the fibrillating myocardium for the purpose of restoring a perfusing cardiac rhythm.
"Certificate of need" means the formal written approval of the New Jersey Department of Health and Senior Services to construct or expand a health care facility or to institute a new health care service, in accordance with requirements set forth at N.J.A.C. 8:33.
"Certified" or "certification" means official documentation that a person has completed all the requirements of an approved training program and has demonstrated competence in the subject matter to the satisfaction of the certifying agency.
"Commissioner" means the Commissioner of the New Jersey Department of Health and Senior Services.
"Communicable disease" means an illness due to a specific infectious agent or its toxic products, specifically including, but not limited to, those pathogens defined in the Federal bloodborne pathogen standards found at 29 C.F.R. 1910.1030(b), and which occurs through transmission of that agent or its toxic products from a reservoir to a susceptible host.
"Communications failure," when applied to medical command, means circumstances that prevent ALS crewmembers from engaging in two-way communications with the medical command physician due to technical difficulties.
"Communications failure protocols" means the specific course of treatment to be followed by ALS crewmembers in the event that two-way communications with the medical command physician cannot be made. Communications failure protocols shall first be approved by the Department, in accordance with 8:41-3.21.
"Contaminated" means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.
"Contaminated sharps" means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes and exposed ends of dental wires.
"Controlled dangerous substance" means a drug, substance or immediate precursor identified in Schedules I through V of the New Jersey Controlled Dangerous Substances Act (24:21-5 through 24:21-8.1 ). The term shall not include distilled spirits, wine or malt beverages, as those terms are defined or utilized in 33:1-1 et seq., or tobacco and tobacco products.
"Convicted" or "conviction" means a finding of guilt by a judge or jury, a guilty plea, a plea of nolo contendere or non-vult or entry into a pre-trial intervention program, or other diversionary program authorized under the statutes of the State of New Jersey or under any other state's statutes.
"CPR certification" means valid certification in cardiopulmonary resuscitation to the level of the Professional Rescuer or Health Care Provider as issued by either the American Heart Association, the American Red Cross, the National Safety Council or other entity determined by the Department to comply with AHA CPR Guidelines.
"Crashworthy" means that all supplies, equipment, oxygen systems and patient litters carried on the vehicle shall remain firmly in place and shall not present a hazard to any vehicle occupant in the event of an accident or sudden change in vehicle speed or direction. Crashworthy retention systems shall not incorporate rubber straps, "shock cords" or Velcro(R) type closures. Crashworthy retention systems for some items are covered by specific Federal standards. The Department's test for crashworthiness of other retention systems is whether the item can be removed from place without unlatching or unbuckling the retention system.
"Crewmember" means any person (including, but not limited to, an EMT-Basic, EMT-Paramedic or registered nurse, excluding pilots) who staffs a mobile intensive care unit, specialty care transport unit or air medical unit.
"Crime" means, in accordance with the New Jersey Code of Criminal Justice, specifically 2C:1-4, any offense for which a sentence of imprisonment in excess of six months is authorized.
"Department" means the New Jersey Department of Health and Senior Services.
"Department-Initiated-Out-of-Service" or "DIOOS" means the immediate removal from service of a vehicle by Department staff, such that the vehicle may not be utilized for the provision of any basic and/or advanced life support care. Vehicles removed from service in this manner shall be identified by the placement of an official Department "Out-of-Service" sticker on at least one of the vehicle's windows.
"Director" means the person responsible for all activities of a mobile intensive care program or air medical service. The criteria for directors differ for mobile intensive care programs and air medical services. The specific criteria for each is set forth at 8:41-9.3 and 11.3, respectively.
"Disorderly persons offense" or "petty disorderly persons offense" shall have the same meaning as the definition provided by the New Jersey Code of Criminal Justice at N.J.S.A. 2C:1-4, incorporated herein by reference, as amended and supplemented. Generally, such offenses are under the jurisdiction of municipal courts, carry out a maximum jail term of six months or less, and are characterized by being minor in nature, not giving rise to the rights of trial by jury or indictment by grand jury. Examples of these offenses include harassment, obstructing a public passage, and fighting in a public place.
"Emergency" means a person's perceived need for immediate medical care in order to prevent death or aggravation of physiological or psychological illness or injury.
"Emergency medical services" or "EMS" means a system for the provision of emergency care and transportation of persons who are sick or injured and in need of immediate medical care.
"Emergency Medical Technician-Basic" or "EMT-Basic" means a person trained in basic life support care and validly certified or recognized by the Commissioner in accordance with the standards for Emergency Medical Technician-Basic certification as set forth at N.J.A.C. 8:40A.
"Emergency Medical Technician-Paramedic" or "EMT-Paramedic" means a person trained in advanced life support care and validly certified or recognized by the Commissioner in accordance with the standards for Emergency Medical Technician-Paramedic certification as set forth at N.J.A.C. 8:41A.
"Emergency response" means the provision of pre-hospital basic life support care by crewmembers staffing a basic life support ambulance, and includes those services that are provided after a call has been received by a 9-1-1 dispatcher requiring an immediate response (for example, automobile accidents, mass gatherings, special events and stadium/arena EMS services) as well as emergent responses to long-term care facilities that may or may not be routed through a 9-1-1 dispatcher.
"EMS educator" means the person responsible for coordinating all activities associated with the clinical portion of an EMT-Paramedic training program. The specific responsibilities required of an EMS educator are set forth at 8:41A-2.4(c)1 through 8.
"EMT-Paramedic student" means a person enrolled in an approved EMT-Paramedic training program, as provided for at N.J.A.C. 8:41A. An EMT-Paramedic student shall not be utilized to meet the minimum staffing requirements set forth at 8:41-9.8, 10.7 or 11.7.
"EMT-Paramedic training program" means a course of study, as provided for at N.J.A.C. 8:41A, consisting of both didactic and clinical instruction, designed for the purpose of preparing a person to sit for the National Registry of Emergency Medical Technicians-Paramedic Certification Examination.
"Federal Specification, KKK-A-1822" means the Federal Specification for the Star-of-Life Ambulance KKK-A-1822E, Edition E, June 1, 2002, incorporated herein by reference, as amended and supplemented. Copies of the standards may be obtained from the General Services Administration, Centralized Mailing List Service (TCAFL) P.O. Box 6477, Fort Worth, Texas 76115.
"Flight nurse" means a registered nurse who meets the criteria set forth at 8:41-9.9 and who has successfully completed specialized training in air medical care. Flight nurses are given a unique identification number.
"Flight paramedic" means an individual certified by the Department as an Emergency Medical Technician-Paramedic in accordance with the standard set forth in N.J.A.C. 8:41A and who has successfully completed specialized training in air medical care. Flight paramedics are given a unique identification number.
"FMVSS" means Federal Motor Vehicle Safety Standards, as set forth at 49 C.F.R. 571, incorporated herein by reference. Copies of the standards may be obtained from the Superintendent of Documents, Washington, D.C.
"Health care facility" means a facility so defined in the Health Care Facilities Planning Act, N.J.S.A. 26:2H-1.1 et seq.
"Helicopter" means a heavier-than-air aircraft that depends principally for its support in flight on the lift generated by one or more rotors.
"Impervious" means not allowing liquids or dirt to penetrate the surface of the material. For the purposes of this chapter, impervious surfaces do not include coverings made of or containing carpet, velour or cloth.
"In-service" means the presence of a mobile intensive care unit, specialty care transport unit or air medical unit at a sending or receiving health care facility; the picking up, transporting or discharging of any patient; or any instance where the mobile intensive care unit, specialty care transport unit or air medical unit is ready to accept patients and perform advanced life support care.
"ITLS certification" or "certification in ITLS" means valid certification in International Trauma Life Support as issued by the American College of Emergency Physicians.
"JEMS (Jersey Emergency Medical Services) Communications Plan" means the authorized communications plan for emergency medical services, as issued by the Department. Copies of the plan are available, for a fee, from the Office of Emergency Medical Services.
"License" or "licensed" means validly licensed by the Commissioner in accordance with the standards for licensure as set forth in this chapter.
"Medical command" means the medical direction provided to ALS crewmembers by a medical command physician. The criteria for medical command differ for mobile intensive care units, specialty care transport units and air medical units. The specific criteria for each is set forth at 8:41-9.6, 10.6 and 11.6, respectively.
"Medical command physician" means a physician validly licensed by the New Jersey Board of Medical Examiners or another state's board of medical examiners (or equivalent licensing agency) who provides medical direction to ALS crewmembers via radio, telephone or other direct means of communications. The criteria for medical command physicians differ for mobile intensive care units, specialty care transport units and air medical units. The specific criteria for each is set forth at 8:41-9.5, 10.5 and 11.5, respectively.
"Medical control" means the general medical oversight provided to the operations of a mobile intensive care program, specialty care transport service or air medical service, including written protocols, quality assurance and other medical supervision of the service's operations.
"Medical director" means the physician responsible for the medical oversight of the operations of a mobile intensive care program, specialty care transport service or air medical service. The specific criteria required of a medical director are set forth at 8:41-9.4, 10.4 and 11.4, respectively.
"Medical record" means any information and/or reports (including, but not limited to, patient care reports) that describe a person's physical condition and/or medical history.
"MICU Advisory Council" means the advisory council charged with advising the Commissioner on matters regarding the provision of pre-hospital advanced life support care, as defined at 26:2K-16.
"Mobile intensive care hospital" means an acute care hospital authorized by the Commissioner, by way of a certificate of need, to develop and maintain a mobile intensive care program for the purpose of providing advanced life support care to a specific population, geographic region or political subdivision.
"Mobile intensive care nurse" or "MICN" means a registered nurse who meets all of the criteria set forth at N.J.A.C. 8:41-9.9.
"Mobile intensive care program" means a program, operated by a mobile intensive care hospital, which is validly licensed by the Department to provide pre-hospital advanced life support care by way of a specially equipped and staffed mobile intensive care unit. The mobile intensive care hospital shall be vested with the ultimate responsibility for the delivery of services and shall be held accountable for the actions of all of its crewmembers in the event that there are violations of any State or Federal licensing standards.
"Mobile intensive care unit" or "MICU" means a specialized emergency medical services vehicle that is validly licensed by the Department and operated in accordance with the standards set forth in this chapter.
"Mobility assistance vehicle" or "MAV" means a specialized transport vehicle that is validly licensed by the Department and operated in accordance with the standards set forth at N.J.A.C. 8:40.
"Neonatal" means the period of time from the moment of birth up to and including the 28th day following birth.
"Office of Emergency Medical Services" or "OEMS" means the Office of Emergency Medical Services in the New Jersey Department of Health and Senior Services, PO Box 360, Trenton, New Jersey 08625-0360. The telephone number for OEMS is (609) 633-7777.
"PALS certification" or "certification in PALS" means valid certification in Pediatric Advanced Life Support as issued by the American Heart Association.
"Patient" means any person who is ill or injured, living or deceased and with whom a crewmember has established physical or verbal contact.
"Patient care report" means the written documentation completed each time a crewmember makes physical or verbal contact with a patient.
"Pediatric" means the period of time beginning with the 29th day following birth up to, but not including, a person's thirteenth birthday.
"Petty disorderly persons offense" shall have the same meaning as the definition provided by the New Jersey Code of Criminal Justice at N.J.S.A. 2C:1-4, incorporated herein by reference, as amended and supplemented. Generally, such offenses are under the jurisdiction of municipal courts, carry a maximum jail term of six months or less, and are characterized by being minor in nature, not giving rise to the rights of trial by jury or indictment by grand jury. Examples of these offenses include harassment, obstructing a public passage, and fighting in a public place.
"Physician" means a person who is validly licensed by the New Jersey State Board of Medical Examiners in accordance with the standards set forth at 45:9-6.
"Physician assistant" means a person who is validly licensed by the New Jersey State Board of Medical Examiners in accordance with the standards set forth at N.J.S.A. 45:9-27.1 3.
"PHTLS certification" or "certification in PHTLS" means valid certification in Pre-Hospital Trauma Life Support as issued by the National Association of EMTs.
"Positive latching mechanism" means a latching mechanism that requires the manual release of the latching device. This does not include magnetic or friction-type latches.
"Pre-hospital" means the period of time prior to the delivery of a patient to a physician or registered nurse at an acute care hospital or satellite emergency department.
"Provider" means a mobile intensive care program, specialty care transport service or air medical service. By virtue of such status, the provider shall assume full legal responsibility for the delivery of services and shall be held accountable for the actions of its crewmembers in the event that there are violations of any State or Federal licensing standards.
"Provider-Initiated-Out-of-Service" or "PIOOS" means the temporary removal from service of a vehicle by the provider. A provider may choose to remove a vehicle from service for various reasons including, but not limited to, when the vehicle is in transit for repairs, when being utilized for official administrative duties or when being utilized in a parade or similar ceremony. Vehicles removed from service in this manner shall be identified by the placement of a placard in one of the vehicle's windows.
"Receiving health care facility" means a licensed health care facility, such as a nursing home, rehabilitation facility or other facility as provided for at N.J.S.A. 26:2H-2a, to which a patient is transferred following evaluation and/or treatment.
"Regional dispatch center" means a facility that provides coordinated dispatching of emergency services for a given area.
"Regional trauma center" means a State designated Level One hospital-based trauma center equipped and staffed to provide emergency medical services to accident or trauma victims.
"Registered nurse" means a person who is validly licensed by the New Jersey State Board of Nursing in accordance with the standards set forth at 45:11-26.
"Regulated medical waste" means, as defined at 7:26-3A.5, those medical wastes that have been listed or meet the waste characteristic classification criteria described at 7:26-3A.6 and that must be managed in accordance with the requirements of N.J.A.C. 7:26-3A.
"Respiratory care practitioner" means a person who is validly licensed by the New Jersey State Board of Respiratory Care in accordance with the standards set forth at 45:14E-10.
"Revocation" or "revoked" means the permanent voiding, withdrawal and/or cancellation of a license or certification.
"Satellite emergency department" means a facility that is owned and operated by an acute care hospital, which provides emergency care and treatment.
"Sending health care facility" means a licensed health care facility such as a nursing home, rehabilitation facility or other facility as provided for at 26:2H-2(a), incorporated herein by reference as amended and supplemented, from which a patient is transferred by the patient's attending physician for treatment or services not available at the sending licensed health care facility.
"Specialty care coordinator" means the person responsible for the general operation of a specialty care transport service. The criteria for a specialty care coordinator is set forth at 8:41-10.3.
"Specialty care transport service" means an entity that is validly licensed by the Department to provide ALS inter-facility transfers, by way of a specially equipped and staffed specialty care transport unit, between a sending health care facility and a receiving health care facility (such as a nursing home, rehabilitation facility or other facility as provided for at N.J.S.A. 26:2H-2a ) of patients requiring specialized medical intervention or medical monitoring that is beyond the capabilities of BLS ambulances and their crewmembers.
"Specialty care transport unit" or "SCTU" means a specialized transport medical service vehicle that is validly licensed by the Department and operated in accordance with the standards set forth in this chapter.
"Specialty staff" means validly licensed or certified persons such as physicians, specially trained nurses or respiratory care practitioners that may accompany the required crewmembers on a mobile intensive care unit, specialty care transport unit or air medical unit.
"Specific order" means an order by a medical command physician with regard to the treatment of a patient, whether directly transmitted by the physician or relayed through a registered nurse.
"Standing orders" means specific treatment protocols, authorized by the Commissioner, that occur prior to any communications with the medical command physician.
"Star of Life" means the symbol described in certification of registration number 1,058,022, which the United States Commissioner of Patents and Trademarks has issued to the National Highway Traffic Safety Administration.
"Therapeutic agent" means any drug or agent which is utilized in the treatment of the sick or injured, including those authorized in accordance with 8:41-6.1.
"Untreated regulated medical waste" means regulated medical waste, as defined in this subchapter, which has not been treated to substantially reduce or eliminate its potential for causing disease.
"Valid" or "validly" means original (not a photo copy), current, up-to-date, not expired, in effect and/or not past the renewal date required by the issuer.
"Vehicle" means a mobile intensive care unit, specialty care transport unit or air medical unit, as defined in this subchapter.
