Source: http://regulations.delaware.gov/register/november2013/final/17%20DE%20Reg%20523%2011-01-13.htm
Timestamp: 2018-03-22 23:34:23
Document Index: 419627010

Matched Legal Cases: ['§10115', '§5', '§5', '§6', '§6', '§6', '§7', '§5', '§5', '§7']

The Delaware Department of Health and Social Services (“DHSS”) initiated proceedings to adopt the State of Delaware Trauma System Regulations. The DHSS proceedings to adopt regulations were initiated pursuant to 29 Delaware Code Chapter 101 and authority as prescribed by 16 Delaware Code, Chapter 97, Section 9706 (g)(2).
On September 1, 2013 (Volume 17, Issue 3), DHSS published in the Delaware Register of Regulations its notice of proposed regulations, pursuant to 29 Del.C. §10115. It requested that written materials and suggestions from the public concerning the proposed regulations be delivered to DHSS by October 3, 2013, after which time the DHSS would review information, factual evidence and public comment to the said proposed regulations.
In accordance with Delaware Law, public notices regarding proposed Department of Health and Social Services (DHSS) State of Delaware Trauma System Regulations were published in the Delaware State News, the News Journal and the Delaware Register of Regulations.
State Council for Persons with Disabilities, Kyle Hodges, Director
Governor’s Advisory Council for Exceptional Citizens (GACEC):
The State Council for Persons with Disabilities (SCPD) and the Governor’s Advisory Council for Exceptional Citizens (GACEC) have reviewed the Department of Health and Social Services/Division of Public Health’s (DPH) proposal to adopt many discrete amendments to its 16-page set of regulations covering Delaware’s trauma system. Some of the key features are as follows: 1) general alignment with American College of Surgeons’ trauma standards (§5.1); 2) authorization to exceed the American College of Surgeons’ standards (§5.1.1); 3) incorporation of DPH pre-hospital trauma triage guidance in lieu of listing specific guidance in the regulation (§6.1); 4) authorization of some discretion (given time and distance considerations) to transfer patients with significant head trauma or spinal cord injury to a Level 1 or Level 2 Trauma Center without an available neurosurgeon (§6.2); 5) adoption of more liberal standards for referral to burn centers (§6.4); and 6) adoption of new criteria, effective January 1, 2014, for patient inclusion in the hospital trauma registry (§7.7). The proposed regulation was published as 17 DE Reg. 288 in the September 1, 2013 issue of the Register of Regulations. SCPD has the following observations.
First, §5.2.2.4 recites as follows:
5.2.2.4. Emergency Medicine department physicians, orthopedic surgeons, and neurosurgeons taking trauma call must be Board certified or eligible.
(NOTE: Non-boarded physicians in these specialty areas who have active privileges at a designated Trauma System facility at the time of promulgation of these revisions will be grandfathered)
Assuming “promulgation of these revisions” refers to an earlier version of the regulation, it would be clearer to simply insert a date. Individuals reading the regulation will otherwise have to guess at the effective date of the provision. Moreover, it is conceptually “odd” to have a “desirable”, non-essential “grandfather” provision. In effect, covered facilities are encouraged, but not required, to employ only a Board Certified or eligible physician unless the physician is grandfathered.
Agency Response: The Agency appreciates and acknowledges these comments. We will add the date of promulgation of the original regulations, 2001, to clarify this Note. 5.2.2.4 is Essential in the current regulations and is not proposed to be changed. Desirable refers to 5.2.2.3 directly above 5.2.2.4, and the classification as Essential follows 5.2.2.4.
Second, §5.2.4 consists of an outline/list of “essential” participating hospital criteria. It would benefit from an introductory narrative. For example, the introduction could simply recite as follows: “Trauma System Participating Hospitals must have the following in place:”
Agency Response: The Agency appreciates and acknowledges these comments. The terms Essential and Desirable are taken from the format of the American College of Surgeons Committee on Trauma’s document “Resources for Optimal Care of the Injured Patient” which Delaware utilizes for all Levels 1, 2, and 3 Trauma Center standards and site visits. This section was formatted to be in alignment with the national document.
Third, in §7.7.1.1, the former standards contemplated patient inclusion in the hospital Trauma Registry based on “admission”. The new standards literally only authorize inclusion of patients in the Registry based on a “transfer”. It may be preferable to include patients in the Registry who are directly admitted to a trauma center without being “transferred” from another facility.
Agency Response: The Agency appreciates and acknowledges these comments. 7.7.1.1.1 states admission to the hospital. The transfer criteria are items 7.7.1.1.2 and 7.7.1.1.3.
The public comment period was open from September 1, 2013 through October 3, 2013.
Based on comments received during the public comment period non-substantive changes have been made to the proposed regulation. The regulation has been approved by the Delaware Attorney General’s office and the Cabinet Secretary of DHSS.
THEREFORE, IT IS ORDERED, that the proposed State of Delaware Trauma System Regulations are adopted and shall become effective November 11, 2013, after publication of the final regulation in the Delaware Register of Regulations.
(NOTE: Non-boarded physicians in these specialty areas who have active privileges at a designated Trauma System facility at the time of promulgation of these revisions [in 2001] will be grandfathered.)
Prehospital Trauma Triage Scheme Implementation Guidelines Due to the dynamic nature of identification and evolution of best practices in prehospital care, the prehospital trauma triage guidance will be found solely in the current State of Delaware, Department of Health and Social Services, Division of Public Health, Office of Emergency Medical Services, Statewide Standard Treatment Protocols, Guidelines, Policies, and Paramedic Standing Orders and Statewide Standard Treatment Protocols and Basic Life Support Standing Orders. The Trauma System Committee will [be] ask[ed] for input by the State EMS Medical Director through the Trauma System Manager during every Standing Orders revision process.
17 DE Reg. 523 (11/01/13) (Final)