641—142.1(144A) Definitions. For the purpose of these rules, the following definitions shall apply:
“Adult” means an individual 18 years of age or older.
“Attending physician” means a physician selected by, or assigned to, the patient who has primary responsibility for the treatment and care of the patient.
“Attending physician assistant” means the physician assistant selected by, or assigned to, the patient who has primary responsibility for the treatment and care of the patient.
“Comfort care” means care within the scope of the health care provider’s training and certification to alleviate pain and suffering, but does not include resuscitative measures.
“Department” means the Iowa department of public health.
“Emergency medical care” means such medical procedures as:
	1.	Administration of intravenous solutions.
	2.	Intubation.
	3.	Performance of cardiac defibrillation and synchronized cardioversion.
	4.	Administration of emergency drugs as provided by rule by the department.
	5.	Any other medical procedure approved by the department, by rule, as appropriate to be performed by emergency medical care providers who have been certified in that procedure.
“EMS provider” means an emergency medical care provider as defined in Iowa Code section 147A.1.
“Health care provider” means a person, including an emergency medical care provider, who is licensed, certified, or otherwise authorized or permitted by the law of this state to administer health care in the ordinary course of business or in the practice of a profession.
“Hospital” means any hospital licensed under the provisions of Iowa Code section 135B.1.
“Life-sustaining procedure” means any medical procedure, treatment, or intervention, including resuscitation, which utilizes mechanical or artificial means to sustain, restore or supplant a spontaneous vital function, and when applied to a patient in a terminal condition, would serve only to prolong the dying process. “Life-sustaining procedure” does not include the provision of nutrition or hydration except when required to be provided parenterally or through intubation or the administration of medication or performance of any medical procedure deemed necessary to provide comfort care or to alleviate pain.
“Medical direction” means direction, advice, or orders provided by a medical director, supervising physician, or physician designee (in accordance with written parameters and protocols) to emergency medical care providers.
“Medical director” means any physician licensed under Iowa Code chapter 148 who shall be responsible for overall medical direction of the service program and who has completed a medical director workshop, sponsored by the department, within one year of assuming duties.
“On-line medical direction” means immediate medical direction provided directly to service program emergency medical care providers, in accordance with written parameters and protocols, by the medical director, supervising physician or physician designee either on scene or by any telecommunications system.
“Out-of-hospital do-not-resuscitate identifier” or “OOH DNR identifier” means a durable yet easily removable unique identification approved by the department and worn by a patient who has an out-of-hospital do-not-resuscitate order.
“Out-of-hospital do-not-resuscitate order” or “OOH DNR order” means a written order on a form approved by the department, signed by an attending physician, executed in accordance with the requirements of Iowa Code section 144A.7A and issued consistent with Iowa Code section 144A.2, that directs the withholding or withdrawal of resuscitation when an adult patient in a terminal condition is outside the hospital.
“Out-of-hospital do-not-resuscitate protocol” or “OOH DNR protocol” means the statewide protocol approved by the department and intended to avoid unwarranted resuscitation by emergency medical care providers when a valid out-of-hospital do-not-resuscitate order or identifier is encountered.
“Patient” means any individual who is sick, injured, or otherwise incapacitated.
“Physician” means any individual licensed under Iowa Code chapter 148.
“Physician assistant” or “PA” means an individual licensed pursuant to Iowa Code chapter 148C.
“Physician designee” means any registered nurse licensed under Iowa Code chapter 152, or any physician assistant licensed under Iowa Code chapter 148C and approved by the board of physician assistants. The physician designee acts as an intermediary for a supervising physician in accordance with written policies and protocols in directing the actions of emergency medical care providers.
“Qualified patient” means any adult patient as defined in Iowa Code section 144A.2.
“Registered nurse” or “RN” means an individual licensed pursuant to Iowa Code chapter 152.
“Resuscitation” means any medical intervention that utilizes mechanical or artificial means to sustain, restore, or supplant a spontaneous vital function, including but not limited to chest compression, defibrillation, intubation, and emergency drugs intended to alter cardiac function or otherwise to sustain life.
“Service program” or “service” means any medical care ambulance service or nontransport service that has received authorization by the department.
“Supervising physician” means any physician licensed under Iowa Code chapter 148, 150, or 150A. The supervising physician is responsible for medical direction of emergency medical care providers when such providers are providing emergency medical care.
“Terminal condition” means an incurable or irreversible condition that, without the administration of life-sustaining procedures, will, in the opinion of the attending physician, result in death within a relatively short period of time or a state of permanent unconsciousness from which, to a reasonable degree of medical certainty, there can be no recovery.
[ARC 6847C, IAB 2/8/23, effective 3/15/23]