Arkansas Administrative Code › Agency 007 - ARKANSAS DEPARTMENT OF HEALTH › Division 28 - Emergency Medical Services & Trauma Systems › Rule 007.28.08-002 - Rules for Trauma Systems

Current through Register Vol. 49, No. 6, June, 2024
Authority
The following Rules and Regulations pertaining to the
				comprehensive, statewide, Trauma System are duly adopted and promulgated by the
				Arkansas State Board of Health pursuant to the authority expressly conferred by
				Act 559 of 1993 (The Trauma System Act), and the laws of the State of Arkansas
				including, without limitation, Act 96 of 1913 (Arkansas Statutes, 1947, Section
				82-110).
SECTION I.
DEFINITIONS
For the purpose of these regulations the following terms are
				defined:
NOTE: All definitions refer to the "adult trauma patient"
				unless otherwise identified.
AACN:
American Association of Critical Care
				Nurses
AANN:
American Association of Neuroscience
				Nurses
ACEP:
American College of Emergency
				Physicians
ACGME:
Accreditation Council for Graduate Medical
				Education
ACLS-certified:
Individuals certified by the
				American Heart Association in Advanced Cardiac Life Support
ACS COT:
American Collegeof Surgeons Committee on
				trauma
ACS:
American College of Surgeons
ACOS:
American College of Osteopathic
				Surgeons
Act:
Act 559, The Trauma System Act of 1993
Adult:
Age classification 18 years old and
				above
AIS:
Abbreviated Injury Scale: An anatomic
				severity scoring system
ALS:
Advanced Life Support, including techniques
				of resuscitation, such as intubation, intravenous access, and cardiac
				monitoring
Alternate Criteria:
Those criteria for inclusion
				in the trauma service, which are offered as an alternative to Board
				Certification. The non-board-certified surgeon must have completed an approved
				surgical residency program. The surgeon must be licensed to practice medicine
				and approved for surgical privileges by the hospital's credentialing committee.
				The surgeon must meet all criteria established by the trauma director to serve
				on the trauma team. The surgeon must have experience in caring for trauma
				patients which must be tracked by the performance improvement (PI) program. The
				Trauma director must attest to the surgeon's experience and quality of patient
				care as part of the recurring granting of trauma team privileges consistent
				with the hospital's policy. This individual is expected to meet all other
				qualifications for members of the trauma team.
AMA:
American Medical Association
AOA:
American Osteopathic Association
APLS:
Advanced Pediatric Life Support Course
				jointly developed and sponsored by the American College of Emergency Physicians
				and American Academy of Pediatrics-covers the knowledge and skills necessary
				for the initial management of pediatric emergencies, including trauma.
Asystole:
Absence of spontaneous cardiac
				activity.
ATLS Course:
Advanced Trauma Life Support Course
				of the American College of Surgeons
BLS:
Basic Life Support techniques of
				resuscitation, including simple airway maneuvers and administration of
				oxygen.
Basic (Level IV) Facility:
Medical facility that
				provides screening and definitive care or stabilization and transfer of
				severely injured patients in remote areas where no alternative care is
				available, or stabilization while arranging for transfer to a Level I, Level
				II, or Level III facility that can provide further definitive surgical
				care.
Board:
The State Board of Health as provided for
				in Ark. Code Ann. §
									20-7-102.
				*
Board-certified:
Physicians certified by
				appropriate specialty boards recognized by the American Board of Medical
				Specialties.
Burn patient referral:
In general, patients for
				referral are so-called "major bums," described as burns involving 20 percent or
				greater body surface area (BSA) in an adult, or 10 percent or greater BSA in a
				child; additionally, burns of lesser BSA in patients with concomitant'serious
				disease-for example, cirrhosis, diabetes, and cardiac disease-should be
				considered for transfer, as should special problems, such as inhalational
				injuries and burns involving hands,
feet,
face, and
				genitalia.
Bypass (Divert Status):
Transport of an EMS
				patient past a normally used EMS receiving facility for the purpose of
				accessing more readily available or appropriate medical care.
CCRN:
Critical Care Registered Nurse certification
				from the American Association of Critical Care Nurses.
CDC:
Centers for Disease Control and Prevention in
				Atlanta, GA-a Federal agency committed to epidemiological surveillance, control
				of disease processes, particularly those secondary to infection or trauma, and
				prevention.
Certificate of Special Competency or Added
				Qualifications:
Recognition of specialized education in selected areas
				of care and acknowledged by the American Board of Medical Specialties.
Child:
Age class from one year old through 17
				years of age
Communication system:
A collection of individual
				communication networks, a transmission system, relay stations, and control and
				base stations capable of interconnection and interoperation that are designed
				to form an integral whole. The individual components must serve a common
				purpose, be technically compatible, employ common procedures, respond to
				control, and operate in unison.
Comorbidity:
Significant cardiac, respiratory, or
				metabolic diseases that stimulate the triage of injured patients to trauma
				centers.
Comprehensive (Level I) Facility:
Regional
				resource trauma center that has the capability of providing leadership and
				total care for every aspect of injury from prevention through
				rehabilitation.
Continuing Medical Education (CME):
Defined
				educational activities for practicing physicians, often resulting in approved
				credit hours from the AMA, state medical society, a medical school, or
				hospital.
Credentialing:
Approval of physician as a member
				of the trauma team, based on a review of the individual's training and
				experience by the trauma service director and the appropriate service
				chief.
Demonstrated commitment:
Provision of evidence
				(visible and written) that clearly demonstrates an institution-wide commitment
				to trauma care.
Department:
The Arkansas Department of
				Health
Designation:
The process by which a hospital is
				identified by the Department as an appropriate facility to receive
				traumatically injured patients.
Desirable characteristic:
A component of the
				trauma care facility standards whose presence or availability is encouraged but
				not required for designation.
Disaster:
Sudden event with a variable mixture of
				injury to or sickness of human beings, destruction, or contamination of
				property, overwhelming demand on local response resources, and disruption of
				organized societal mechanisms.
Diversion:
A procedure put into effect by a trauma
				facility to insure appropriate patient care when that facility is unable to
				provide the level of care demanded by a trauma patient's injuries or when the
				facility has temporarily exhausted its resources. . -
Emergency Medical Services
(EMS): The
				transportation and medical care provided the critically ill or injured patient
				prior to arrival at an emergency department and within a medical facility
				subject to the individual approval of the medical staff and governing board of
				that facility. ,
ENA:
Emergency Nurses Association
ENPC:
Emergency Nurse Pediatric Course developed
				and sponsored by the ENA which covers the knowledge and skills necessary for
				the initial nursing assessment and management of pediatric patients in the
				emergency department.
Required characteristic:
A component of the trauma
				care facility standards that is required for designation. , , .'
Extrication Services:
The services provided by the
				use of specialized equipment for the purpose of gaining access and entry to
				entrapped patients.
Field Triage:
Classification of patients according
				to medical need at the scene of an injury or onset of an illness.
GCS:
Glasgow Coma Scale-A scoring system that
				defines eye, motor, and verbal responses in the patient with injury to the
				brain.
General (Level III) Facility:
Hospital that
				provides assessment, resuscitation, emergency surgery, and definitive care or
				stabilization while arranging for transfer to a Level I or Level II facility
				that can provide further definitive surgical care.
General Surgery Accredited Residency Program:
Programs approved by the Accreditation Council for Graduate Medical
				Education.
Hospital criteria:
Essential or desirable
				characteristics that help categorize Level I, II, III, and IV trauma
				facilities.
ICD-9:
Current Edition of International
				Classification of Diseases-a standard coding system that includes all injuries
				and disease processes.
ICP:
Intracranial pressure, often monitored in
				patients with severe injuries to the brain.
Immediately available to the patient:
Services
				provided by a trauma facility that are in-house 24 hours a day, 7 days a
				week.
Inclusive Trauma Care System:
A trauma care system
				that incorporates every health care facility in a community in a system in
				order to provide a continuum of services for all injured persons who require
				care in an acute facility; in such a system, the injured patient's needs are
				matched to the appropriate hospital resources. '
Infant:
Age class from birth to one year
				old.
In-house:
Physically present in the
				hospital.
Injury:
The result of an act that damages, harms,
				or hurts; unintentional or intentional damage to the body resulting from acute
				exposure to mechanical, thermal, electrical, or . chemical energy or from the
				absence of such essentials as heat or oxygen (see Trauma).
Injury control:
Programs designed to teach
				potential victims how to avoid injuries.
Interfacility transfer:
The transfer of a patient
				from one hospital to another hospital.
ISS:
Injury Severity Score-the sum of the squares
				of the Abbreviated Injury Scale scores of the three most severely injured body
				regions.
Lead Trauma Facility:
A trauma facility that has
				made an additional commitment to its trauma service region. This commitment,
				which usually is offered by the highest Level of trauma facility in a given
				trauma service region, includes outreach and increased educational activities.
				The responsibilities may be shared by trauma facilities.
Major (Level II) Facility:
Hospital that provides
				screening and definitive care of the traumatically injured patient regardless
				of the severity of injury, but does not conduct a trauma research program or a
				general surgery residency program.
Mechanism of Injury:
The source of forces that
				produce mechanical deformations and physiologic responses that cause an
				anatomic lesion or functional change in humans.
Medical control (Direct):
Immediate medical
				direction to prehospital personnel in remote locations provided by a physician
				or an authorized communications resource person under the direction of a
				physician.
Medical control (Indirect):
The establishment and
				monitoring of all medical components of an EMS system, including protocols,
				standing orders, education programs, and the quality and delivery of direct
				control.
Medical oversight:
The assistance given to the
				Trauma Regional Advisory Council (TRAC) and/or regional health care entities in
				system planning by a physician or group of physicians designated by the TRAC to
				provide technical assistance.
Morbidity:
The relative incidence of disease.
Mortality:
The proportion of deaths to population.
Multidisciplinary trauma review committee:
Committee composed of the trauma service director and other physician
				members of the trauma service that reviews trauma deaths in a system or
				hospital.
Multiple or
mass casualty triage: Specialized
				techniques of triage used when large numbers of injured patients are
				concentrated in one area.
OGME: Osteopathic Graduate Medical Education
On-call:
Committed for a specific time period to
				be available and respond within an agreed amount of time to provide care for a
				patient in the hospital.
Over-triage:
Directing patients to trauma centers
				when they do not need such specialized care. Over-triage occurs because of
				incorrect identification of patients as having severe injuries when
				retrospective analysis indicates minor injuries.
PALS:
Pediatric Advanced Life Support Course
				developed and sponsored by the American Heart Association and the American
				Academy of Pediatrics-covers the knowledge and skills necessary for the initial
				management of pediatric emergencies, including trauma.
Pediatric Trauma Center:
Children's hospital
				fulfilling the criteria for comprehensive trauma care.
Pediatric Trauma Score:
An injury scoring system
				used in some centers caring for pediatric patients.
Pediatric trauma surgeon:
Certified pediatric
				surgeon with a commitment to trauma or certified general surgeon with special
				training and documented CME relevant to pediatric trauma care. \
Postgraduate year (PGY):
Classification system for
				residents in postgraduate trainirig-the number indicates the year they are in
				during the postmedical school residency program; for example, PGY 1 is one year
				after graduation from medical school.
Prehospital care provider:
An individual or
				organization certified by the Section to provide out-of-hospital emergency
				medical services.
Promptly available to the patient:
Services
				provided by a trauma facility that are available to the patient within 30
				minutes.
Protocol:
A written procedure to ensure
				standardization of care.
Regionalization:
The identification of available
				resources within a given geographic area and coordination of services to meet
				the needs of a specific group of patients.
Rehabilitation:
Services that seek to return a
				trauma patient to the fullest physical, psychologic, social, vocational, and
				educational level of functioning of which he or she is capable, consistent with
				physiologic or anatomic impairments and environmental limitations. ''.'
Research: Clinical or laboratory studies designed to produce
				new knowledge applicable to the care of injured patients.
*
Response time:
Interval between notification and
				arrival of general surgeon or surgical specialist in the emergency department
				or operating room.
Resuscitation:
The phase of trauma or specialty
				care where emergency life support treatment is provided to sustain vital bodily
				functions.
RTS:
Revised Trauma Score-A prehospital/emergency
				department scoring system in which numerical values are assigned to differing
				levels of Glasgow Coma Scale, systolic blood pressure, and respiratory
				rate.
Section:
The Section of EMS and Trauma Systems;
				the organization within the Department responsible for the enforcement of EMS
				and Trauma Systems legislation within the State of Arkansas.
Sensory, Motor, and Circulation
(SMC's): Refers to
				the assessment of the patient's ability to feel and move, and the status of the
				patient's blood circulation.
State Trauma Registry:
A database of information,
				submitted to the Section by the hospitals, relating to the care of trauma
				patients as defined in these Rules and Regulations. The information is used to
				evaluate the quality of care provided.
Transfer agreement:
A formal, written agreement
				between hospitals for the transfer and acceptance of patients.
Note: This
				is not a substitute for the Emergency Medical Treatment and Labor Act (EMTALA)
				transfer forms.
Trauma:
A term derived from the Greek for
				''wound," it refers to any bodily injury (see Injury).
Trauma Advisory Council:
The body of individuals
				appointed by the Governor to advise, assists, and make recommendations to the
				Section concerning the development of the statewide trauma system.
Trauma call roster:
The listing of surgeons
				assigned to provide trauma care, including date of coverage and alternate
				surgeons.
Trauma Care Systems and Planning Act:
The law that
				amended the Public Health Service
Act. to add Title-XII-Trauma Programs. The purpose of the
				legislation is to assist state governments in developing, implementing, and
				improving regional systems of trauma care and to fund research and
				demonstration projects to improve rural EMS and trauma care
				(PL-101-590).
Trauma Center (Facility):
A specialized hospital
				facility distinguished by the immediate availability of specialized surgeons,
				physician specialists, anesthesiologists, nurses, and resuscitation and life
				support equipment on a 24-hour basis to care for severely injured patients or
				those at risk for severe injury. *
Trauma Center Designation:
The process by which
				the Section of EMS & Trauma Systems identifies and selects facilities to
				care for severely injured patients within a trauma care system.
Trauma Coordinator/Trauma Program Manager:
A
				registered nurse with responsibility for monitoring and evaluating nursing care
				of trauma patients and the coordination of quality improvement and patient
				safety programs for the trauma center in conjunction with the trauma medical
				director.
Trauma fellowship:
Formal advanced postresidency
				training in the care of injured patients.
Trauma patient:
The patient which presents acute
				bodily injuries secondary to an external force requiring immediate
				interventions deemed necessary to preserve life and limb. For statistical
				purposes, the definition will apply to the
traumatically injured patient
that:
Is admitted for observation for a period of time greater than 8
				hours, or
Is admitted to the hospital, or
Is transferred to another trauma system facility, or
Expires
Trauma prevention programs:
Internal institutional
				and external outreach educational programs designed to increase awareness of
				methods for prevention and/or avoidance of trauma related injuries.
Trauma program:
An administrative unit that
				includes the trauma service and coordinates other trauma related activities;
				for example, injury prevention, public education, CME activities, etc.
Trauma Regional Advisory Council (TRAC):
The
				Council formed within a Trauma Service Region that develops and oversees the
				region's trauma system plan.
Trauma Registry:
The collection and analysis of
				trauma data from the trauma system.
Trauma Service:
A clinical service established by.
				the medical staff that has oversight of and responsibility for the care of the
				trauma patient.
Trauma Service Director:
Physician designated by
				the institution and medical staff to coordinate trauma care.
Trauma Service Region (TSR):
A geographic region
				of the state approved by the Section to implement a comprehensive trauma care
				system plan.
Trauma System:
An integrated network that ensures
				that acutely injured patients are expeditiously taken to hospitals appropriate
				for their level of injury.
Trauma Team:
A group of health care professionals
				organized to provide care to the trauma patient in a coordinated and timely
				fashion.
Triage:
The sorting of patients in terms of
				priority, treatment, transportation, and destination, so that the patient can
				be transported to the appropriate hospital based upon established
				criteria.
TRISS:
Trauma Score/Injury Severity Score-the
				likelihood of patient survival based on a regression equation that includes
				patient age, ISS, RTS, and the type of injury (blunt or penetrating).
Under-triage:
Directing fewer patients to trauma
				centers than is warranted because of incorrect identification of patients as
				having minor injuries when retrospective analysis indicates severe
				injuries.
Words implying the masculine gender may be applied to
				both males and females.
SECTION
			 II:
ADMINISTRATIVE
A. All communications concerning these Rules
			 and Regulations shall be addressed to the Arkansas Department of Health,
			 Section of EMS and Trauma Systems, 5800 West 10th
			 Street, Suite 800, Little Rock, Arkansas 72204-1763.
B. Purpose
The purpose of these Rules and Regulations is to establish the
				procedures and standards for the implementation of a statewide comprehensive
				trauma system in order to decrease morbidity and mortality which results from
				trauma.