2023 Colorado Revised Statutes › Title 25 - PUBLIC HEALTH AND ENVIRONMENT (§§ 25-1-101 — 25-59-106) › HOSPITALS (§§ 25-3-100.5 — 25-3.5-1401) › Article 3.5 - EMERGENCY MEDICAL AND TRAUMA SERVICES (§§ 25-3.5-101 — 25-3.5-1401) › Part 7 - STATEWIDE TRAUMA SYSTEM (§§ 25-3.5-701 — 25-3.5-709) › Section 25-3.5-704 - Statewide emergency medical and trauma care system - development and implementation - duties of department - rules

(1)
The department shall develop, implement, and monitor a statewide emergency medical and trauma care system in accordance with the provisions of this part 7 and with rules adopted by the board. Pursuant to section
24-50-504 (2)
, the department may contract with any public or private entity in performing any of its duties concerning education, the statewide trauma registry, and the verification process as set forth in this part 7.
(2)
The board shall adopt rules for the statewide emergency medical and trauma care system, including but not limited to the following:
(a)
Minimum services in rendering patient care.
These rules ensure the appropriate access through designated centers to the following minimum services:
(I)
Prehospital care;
(II)
Hospital care;
(III)
Rehabilitative care;
(IV)
Injury prevention;
(V)
Disaster medical care;
(VI)
Education and research; and
(VII)
Trauma communications.
(b)
Transport protocols.
The board shall set forth trauma transport protocols in these rules, which include but are not limited to a requirement that a facility that receives an injured person provide the appropriate available care, which may include stabilizing an injured person before transferring that person to the appropriate facility based on the person's injury. These rules ensure that when the most appropriate trauma facility for an injured person is not easily accessible in an area, that person will be transferred as soon as medically feasible to the nearest appropriate facility, which may be in or out of the state. These rules shall conform with applicable federal law governing the transfer of patients.
(c)
Regional emergency medical and trauma advisory councils - plans established - process.
(I)
These rules provide for the implementation of regional emergency medical and trauma system plans that describe methods for providing the appropriate service and care to persons who are ill or injured in areas included under a regional emergency medical and trauma system plan. In these rules, the board shall specify that:
(A)
The governing body of each county or city and county throughout the state shall establish a regional emergency medical and trauma advisory council (RETAC) with the governing body of four or more other counties, or with the governing body of a city and county, to form a multicounty RETAC. The number of members on a RETAC shall be defined by the participating counties. Membership shall reflect, as equally as possible, representation between hospital and prehospital providers and from each participating county and city and county. There shall be at least one member from each participating county and city and county in the RETAC. Each county within a RETAC shall be located in reasonable geographic proximity to the other counties and city and counties within the same RETAC. In establishing a RETAC, the governing body shall obtain input from health-care facilities and providers within the area to be served by the RETAC. If the governing body for a county or city and county fails to establish a RETAC by July 1, 2002, two counties with a combined population of at least seven hundred fifty thousand residents may apply to the council for establishment of a RETAC of fewer than four counties. The council shall conduct a hearing with all counties that may be affected by the establishment of a RETAC with fewer than four counties before deciding whether to grant such application. The decision on such an application shall be completed within sixty days after the date of application. For all other counties that do not qualify as a two-county RETAC and that have not established a RETAC by July 1, 2002, the council shall designate an established RETAC to serve as the county's or city and county's RETAC.
(B)
No later than July 1, 2003, each RETAC with approval from the governing bodies for a multicounty RETAC shall submit a regional emergency medical and trauma system plan to the council for approval by the department. If the governing body for a county or city and county fails to submit a plan, if a county or city and county is not included in a multicounty plan, or, if a multicounty plan is not approved pursuant to a procedure established by the board for approving plans, the department shall design a plan for the county, city and county, or multicounty area.
(II)
In addition to any issues the board requires to be addressed, every regional emergency medical and trauma system plan shall address the following issues:
(A)
The provision of minimum services and care at the most appropriate facilities in response to the following factors: Facility-established triage and transport plans; interfacility transfer agreements; geographical barriers; population density; emergency medical services and trauma care resources; and accessibility to designated facilities;
(B)
The level of commitment of counties and city and counties under a regional emergency medical and trauma system plan to cooperate in the development and implementation of a statewide communications system and the statewide emergency medical and trauma care system;
(C)
The methods for ensuring facility and county or city and county adherence to the regional emergency medical and trauma system plan, compliance with board rules and procedures, and commitment to the continuing quality improvement system described in paragraph (h) of this subsection (2);
(D)
A description of public information, education, and prevention programs to be provided for the area;
(E)
A description of the functions that will be contracted services; and
(F)
The identification of regional emergency medical and trauma system needs through the use of a needs assessment instrument developed by the department; except that the use of such instrument shall be subject to approval by the counties and city and counties included in a RETAC.
(III)
The board shall specify in regional emergency medical and trauma system plan rules the time frames for approving regional emergency medical and trauma system plans and for resubmitting plans, as well as the number of times the plans may be resubmitted by a governing body before the department designs a plan for a multicounty area. The department shall provide technical assistance to any RETAC for preparation, implementation, and modification, as necessary, of regional emergency medical and trauma system plans.
(IV)
(A)
A county may request that the county be included in two separate RETACs because of geographical concerns. The council shall review and approve any request that a county be divided prior to inclusion within two separate RETACs if the county demonstrates such a division will not adversely impact the emergency medical and trauma needs for the county, that such a division is beneficial to both RETACs, and that such division does not create a RETAC with fewer than five contiguous counties, except for RETACs that contain two counties with a combined population of at least seven hundred fifty thousand residents pursuant to sub-subparagraph (A) of subparagraph (I) of this paragraph (c).
(B)
A county that is included in two separate RETACs may request that the council allocate any portion of the fifteen thousand dollars received by a RETAC, pursuant to section
25-3.5-603
, between the two separate RETACs.
(d)
Designation of facilities.
The designation rules shall provide that every facility in this state required to be licensed in accordance with article
3
of this title and that receives ambulance patients shall participate in the statewide emergency medical and trauma care system. Each such facility shall submit an application to the department requesting designation as a specific level trauma facility or requesting nondesignation status. A facility that is given nondesignated status shall not represent that it is a designated facility, as prohibited in section
25-3.5-707
. The board shall include provisions for the following:
(I)
The criteria to be applied for designating and periodically reviewing facilities based on level of care capability providing trauma care. In establishing such criteria, the board shall take into consideration recognized national standards including, but not limited to, standards on trauma resources for optimal care of the injured patient adopted by the American college of surgeons' committee and the guidelines for trauma care systems adopted by the American college of emergency physicians.
(II)
A verification process;
(III)
The length of a designation period;
(IV)
The process for evaluating, reviewing, and designating facilities, including an ongoing periodic review process for designated facilities, which process shall take into account the national standards referenced in subparagraph (I) of this paragraph (d). Each facility shall be subject to review in accordance with rules adopted pursuant to this paragraph (d). In the event a certified facility seeks to be designated at a different level or seeks nondesignation status, the facility shall comply with the board's procedures for initial designation.
(V)
Disciplinary sanctions, which shall be limited to the revocation of a designation, temporary suspension while the facility takes remedial steps to correct the cause of the discipline, redesignation, or assignment of nondesignation status to a facility;
(VI)
A designation fee established in accordance with section
25-3.5-705
; and
(VII)
An appeals process concerning department decisions in connection with evaluations, reviews, designations, and sanctions.
(e)
Communications system.
(I)
The communications system rules shall require that a regional emergency medical and trauma system plan ensure citizen access to emergency medical and trauma services through the 911 telephone system or its local equivalent and that the plan include adequate provisions for:
(A)
Public safety dispatch to ambulance service and for efficient communication from ambulance to ambulance and from ambulance to a designated facility;
(B)
Efficient communications among the trauma facilities and between trauma facilities and other medical care facilities;
(C)
Efficient communications among service agencies to coordinate prehospital, day-to-day, and disaster activities; and
(D)
Efficient communications among counties and RETACs to coordinate prehospital, day-to-day, and disaster activities.
(II)
In addition, the board shall require that a regional emergency medical and trauma system plan identify the key resource facilities for the area. The key resource facilities shall assist the RETAC in resolving trauma care issues that arise in the area and in coordinating patient destination and interfacility transfer policies to assure that patients are transferred to the appropriate facility for treatment in or outside of the area.
(f)
Statewide trauma registry.
(I)
The registry rules shall require the department to establish and oversee the operation of a statewide trauma registry. The rules shall allow for the provision of technical assistance and training to designated facilities within the various trauma areas in connection with requirements to collect, compile, and maintain information for the statewide central registry. Each licensed facility, clinic, or prehospital provider that provides any service or care to or for persons with trauma injury in this state shall collect the information described in this subparagraph (I) about any such person who is admitted to a hospital as an inpatient or transferred from one facility to another or who dies from trauma injury. The facility, clinic, or prehospital provider shall submit the following information to the registry:
(A)
Admission and readmission information;
(B)
Number of trauma deaths;
(C)
Number and types of transfers to and from the facility or the provider; and
(D)
Injury cause, type, and severity.
(II)
In addition to the information described in subparagraph (I) of this paragraph (f), facilities designated as level I, II, or III shall provide such additional information as may be required by board rules.
(III)
The registry rules shall include provisions concerning access to information in the registry that does not identify patients or physicians. Any data maintained in the registry that identifies patients or physicians shall be strictly confidential and shall not be admissible in any civil or criminal proceeding.
(g)
Public information, education, and injury prevention.
The department and county, district, and municipal public health agencies may operate injury prevention programs, but the public information, education, and injury prevention rules shall require the department and county, district, and municipal public health agencies to consult with the state and regional emergency medical and trauma advisory councils in developing and implementing area and state-based injury prevention and public information and education programs including, but not limited to, a pediatric injury prevention and public awareness component. In addition, the rules shall require that regional emergency medical and trauma system plans include a description of public information and education programs to be provided for the area.
(h)
(I)
Continuing quality improvement system (CQI).
These rules require the department to oversee a continuing quality improvement system for the statewide emergency medical and trauma care system. The board shall specify the methods and periods for assessing the quality of regional emergency medical and trauma systems and the statewide emergency medical and trauma care system. These rules must include the following requirements:
(A)
That RETACs assess periodically the quality of their respective regional emergency medical and trauma system plans and that the state assess periodically the quality of the statewide emergency medical and trauma care system to determine whether positive results under regional emergency medical and trauma system plans and the statewide emergency medical and trauma care system can be demonstrated;
(B)
That all facilities comply with the trauma registry rules;
(C)
That reports concerning regional emergency medical and trauma system plans include results for the emergency medical and trauma area, identification of problems under the regional emergency medical and trauma system plan, and recommendations for resolving problems under the plan. In preparing these reports, the RETACs shall obtain input from facilities, counties included under the regional emergency medical and trauma system plan, and service agencies.
(D)
That the names of patients or information that identifies individual patients shall be kept confidential and shall not be publicly disclosed without the patient's consent;
(E)
That the department be allowed access to prehospital, hospital, and coroner records of emergency medical and trauma patients to assess the continuing quality improvement system for the area and state-based injury prevention and public information and education programs pursuant to subsection (2)(g) of this section. All information provided to the department shall be confidential pursuant to this subsection (2)(h). To the greatest extent possible, patient-identifying information shall not be gathered. If patient-identifying information is necessary, the department shall keep such information strictly confidential, and such information may only be released outside of the department upon written authorization of the patient. The department shall prepare an annual report that includes an evaluation of the statewide emergency medical and trauma services system. Such report shall be distributed to all designated trauma centers, ambulance services, and service agencies.
(F)
That nothing in this subsection (2)(h)(I) prohibits the department from providing information to health information organization networks from its EMS agency patient care database including access to individualized patient information in accordance with section
25-3.5-501 (3)
.
(II)
Data or information related to the identification of individual patient's, provider's, or facility's care outcomes collected as a result of the continuing quality improvement system and records or reports collected or compiled as a result of the continuing quality improvement system are confidential and are exempt from the open records law in part 2 of article
72
of title
24
. Data, information, records, or reports are not subject to subpoena or discovery and are not admissible in any civil action, except pursuant to a court order that provides for the protection of sensitive information about interested parties. Nothing in this subsection (2)(h)(II):
(A)
Precludes the patient or the patient's representative from obtaining the patient's medical records as provided in section
25-1-801
;
(B)
Shall be construed to allow access to confidential professional review committee records or reviews conducted under part 2 of article
30
of title
12
; or
(C)
Prohibits the department from providing information to health information organization networks from its EMS agency patient care database including individualized patient information in accordance with section
25-3.5-501 (3)
.
(III)
That reports concerning regional emergency medical and trauma system plans include results for the emergency medical and trauma area, identification of problems under the regional emergency medical and trauma system plan, and recommendations for resolving problems under the plan. In preparing these reports, the RETACs shall obtain input from facilities, counties included under the regional emergency medical and trauma system plan, and service agencies.
(i)
Trauma care for pediatric patients.
The trauma care for pediatric patient rules shall provide for the improvement of the quality of care for pediatric patients.
(3)
The board shall adopt rules that take into consideration recognized national standards for emergency medical and trauma care systems, such as the standards on trauma resources for optimal care of the injured patient adopted by the American college of surgeons' committee on trauma and the guidelines for emergency medical and trauma care systems adopted by the American college of emergency physicians and the American academy of pediatrics.
(4)
The board shall adopt and the department shall use only cost-efficient administrative procedures and forms for the statewide emergency medical and trauma care system.
(5)
In adopting its rules, the board shall consult with and seek advice from the council, as defined in section
25-3.5-703
(3.5), where appropriate, and from any other appropriate agency. In addition, the board shall obtain input from appropriate health-care agencies, institutions, facilities, and providers at the national, state, and local levels and from counties and city and counties.
Amended by 2019 Ch. 136, § 153, eff. 10/1/2019.
Amended by 2019 Ch. 38, § 2, eff. 8/2/2019.
Amended by 2018 Ch. 63, § 3, eff. 8/8/2018.
Amended by 2017 Ch. 33, § 5, eff. 3/16/2017.
L. 95: Entire part R&RE, p. 1354, § 3, effective July 1. L. 96: (1) amended, p. 1471, § 19, effective June 1. L. 99: IP(2) and (2)(h) amended, p. 413, § 2, effective April 22. L. 2002: (1), IP(2), (2)(c), IP(2)(d), (2)(d)(IV), (2)(d)(V), (2)(e), (2)(f)(III), (2)(g), IP(2)(h)(I), (2)(h)(I)(A), (2)(h)(I)(C), (2)(h)(III), (3), (4), and (5) amended and (2)(h)(I)(E) added, p. 699, § 4, effective May 29. L. 2003: (2)(d)(I) and (2)(d)(IV) amended, p. 2057, § 1, effective May 22; (2)(h)(I)(E) amended, p. 2007, § 85, effective May 22. L. 2004: (1) amended, p. 1693, § 27, effective 7/1/2005. L. 2005: IP(2)(d) amended, p. 281, § 15, effective August 8. L. 2007: (2)(h)(I)(E) amended, p. 2041, § 66, effective June 1. L. 2010: (2)(g) amended, (HB 10-1422), ch. 2092, p. 2092, § 88, effective August 11. L. 2017: IP(2)(h)(I) and (2)(h)(I)(E) amended, (SB 17 -056), ch. 93, p. 93, § 5, effective March 16. L. 2018: (2)(h)(I)(F) added and (2)(h)(II) amended, (HB 18-1032), ch. 613, p. 613, § 3, effective August 8. L. 2019: (1) amended, (SB 19 -044), ch. 131, p. 131, § 2, effective August 2; (2)(h)(II)(B) amended, (HB 19-1172), ch. 1701, p. 1701, § 153, effective October 1.
For the legislative declaration in SB 19-044, see section 1 of chapter 38, Session Laws of Colorado 2019.