Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 25 - DEPARTMENT OF HEALTH SERVICES - EMERGENCY MEDICAL SERVICES › Article 13 - TRAUMA CENTERS AND TRAUMA REGISTRIES › Table 13.1 - Arizona Trauma Center Standards (A.R.S. Sections 36-2202(A)(4), 36-2209(A)(2), and 36-2225(A)(4)) Key

Current through Register Vol. 30, No. 28, July 12, 2024
E = Essential and required
I(P) = Level I Pediatric trauma center
II(P) = Level II Pediatric trauma center
ICU = Intensive care unit
In-house = On the premises of the health care
				  institution
ISS = Injury severity score, the sum of the squares of the
				  abbreviated injury scale scores of the three most severely injured body
				  regions
Child life = A program of support to injured children and
				  their families to reduce stress and anxiety by:
a. Explaining medical equipment and
				procedures to children in a non-threatening and age-appropriate
				manner,
b. Explaining a diagnosis
				to a child in an age-appropriate manner, and
c. Helping children and their families
				develop strategies to cope with the diagnosis and expected outcome
Trauma Facilities
							 Criteria
Levels
I
I(P)
II
II(P)
III
IV
A. Institutional Organization
1. Trauma service
E
E
E
E
E
-
2. Trauma medical director
E
E
E
E
E
-
3. Trauma multidisciplinary peer review
							 committee
E
E
E
E
E
-
4. Injury prevention program
							 (R9-25-1308(G)(5)(a))
E
E
E
E
-
-
5. Injury prevention activities
							 (R9-25-1308(G)(3))
E
E
E
E
E
E
6. Educational outreach program
							 (R9-25-1308(G)(5)(b))
E
E
E
E
-
-
7. Educational outreach activities
							 (R9-25-1308(G)(4))
E
E
E
E
E
-
8. Child maltreatment assessment capability
E
E
E
E
E
E
B. Hospital
							 Departments/Divisions/Sections
1. Surgery
E
E
E
E
E
-
2. Neurosurgery
E
E
E
E
-
-
3. Orthopedic surgery
E
E
E
E
E
-
4. Emergency medicine
E
E
E
E
E
-
5. Pediatric emergency department area
-
E
-
E
-
-
6. Anesthesia
E
E
E
E
E
-
C. Clinical Capabilities
1. Written on-call schedule for each component of the
							 trauma service if a team member is not in-house
E
E
E
E
E
E
2. Physician specialist available 24 hours/day
a. General surgeon
E
E
E
E
E
-
i. Published back-up schedule
E
E
E
E
-
-
ii. Dedicated to single hospital when on-call
E
E
E
E
-
-
iii. Surgeon credentialed for pediatric trauma
							 care
-
E
-
E
-
-
b. Emergency medicine physician
E
E
E
E
E
-
c. Pediatric emergency medicine physician
-
E
-
-
-
-
3. Specialist on-call and available 24
							 hours/day
a. Orthopedic surgeon
E
E
E
E
E
-
b. Pediatric-credentialed orthopedic surgeon
-
E
-
E
-
-
c. Neurosurgeon
E
E
E
E
-
-
d. Pediatric-credentialed neurosurgeon
-
E
-
E
-
-
e. Critical care medicine physician
E
E
E
E
-
-
f. Pediatric-credentialed critical care medicine
							 physician
-
E
-
E
-
-
g. Radiologist
E
E
E
E
E
h. Hand surgeon
E
E
E
E
-
-
i. Ophthalmic surgeon
E
E
E
E
-
-
j. Plastic surgeon
E
E
E
E
-
-
k. Thoracic surgeon
E
E
E
E
-
-
l. Cardiac surgeon
E
E
-
-
-
-
m. Obstetrics/gynecologic surgeon
E
E
-
-
-
-
n. Oral/maxillofacial surgeon (plastic surgeon,
							 otolar-yngologist, or oral/maxillofacial surgeon)
E
E
E
E
-
-
4. Qualified anesthesia personnel member on-call and
							 available 24 hours/day
a. Physician or certified nurse anesthetist
E
E
E
E
E
-
b. Physician or certified nurse anesthetist with a
							 pediat-ric credential
-
E
-
E
-
-
5. Volume performance standards:
a. 1200 trauma admissions per year,
b. 240 admissions with ISS > 15 per year,
							 or
c. Average of 35 patients with ISS > 15 for each
							 trauma team surgeon per year
E
-
-
-
-
-
d. 200 trauma admissions < 15 years of age per
							 year,
-
E
-
-
-
-
D.
							 Facilities/Resources/Capabilities
1. Emergency department
a. Designated physician director
E
E
E
E
E
-
b. Personnel members with pediatric-specific
							 trauma-related training
-
E
-
E
-
-
c. Resuscitation equipment for patients of all
							 sizes
i. Airway control and ventilation equipment
E
E
E
E
E
E
ii. Pulse oximetry
E
E
E
E
E
E
iii. Suction devices
E
E
E
E
E
E
iv.
							 Electrocardiograph-oscilloscope-defibrillator
E
E
E
E
E
E
v. Color-coded, length-based tool to assist with
							 medication dosing and equipment selection for children
E
E
E
E
E
E
vi. Central venous pressure monitoring
							 equipment
E
E
E
E
E
-
vii. Standard intravenous fluids and administration
							 sets
E
E
E
E
E
E
viii. Large-bore intravenous catheters
E
E
E
E
E
E
ix. Sterile surgical sets for:
(1) Airway control/cricothyrotomy
E
E
E
E
E
E
(2) Thoracostomy
E
E
E
E
E
E
(3) Central line insertion
E
E
E
E
E
-
(4) Thoracotomy
E
E
E
E
E
-
x. Arterial catheters
E
E
E
E
-
-
xi. X-ray availability 24 hours/day
E
E
E
E
E
-
xii. Thermal control equipment
(1) For patient
E
E
E
E
E
E
(2) For fluids and blood
E
E
E
E
E
E
xiii. Rapid infusion system/capability
E
E
E
E
E
E
xiv. Qualitative end-tidal CO2
							 monitoring
E
E
E
E
E
E
d. Communication with EMS personnel
E
E
E
E
E
E
e. Capability to resuscitate, stabilize, and transfer
							 pedi-atric patients
E
E
E
E
E
E
2. Operating room
a. Immediately available 24 hours/day
E
E
E
E
-
-
b. Size-specific equipment
i. Cardiopulmonary bypass
E
E
-
-
-
-
ii. Operating microscope
E
E
-
-
-
-
c. Thermal control equipment
i. For patient
E
E
E
E
E
E
ii. For fluids and blood
E
E
E
E
E
E
d. X-ray capability including C-arm image
							 intensifier
E
E
E
E
E
-
e. Endoscopes, bronchoscope
E
E
E
E
E
-
f. Craniotomy instruments
E
E
E
E
-
-
g. Equipment for long bone and pelvic fixation
E
E
E
E
E
-
h. Rapid infusion system/capability
E
E
E
E
E
E
3. Postanesthesia recovery room or surgical
							 ICU
a. Registered nurses available 24 hours/day
E
E
E
E
E
E
b. Equipment for monitoring and resuscitation
E
E
E
E
E
E
c. Intracranial pressure monitoring equipment
E
E
E
E
-
-
d. Pulse oximetry
E
E
E
E
E
E
e. Thermal control equipment
i. For patient
E
E
E
E
E
E
ii. For fluids and blood
E
E
E
E
E
E
4. ICU or critical care unit for injured
							 patients
a. Pediatric ICU
-
E
-
E
-
-
b. Registered nurses with trauma-related
							 training
E
E
E
E
E
-
c. Registered nurses with pediatric-specific
							 trauma-related training
-
E
-
E
-
-
d. Designated surgical director or surgical
							 co-director
E
E
E
E
E
-
e. Physician (fourth year of residency training or
							 higher) assigned to surgical ICU service and in-house 24 hours/day
E
E
-
-
-
-
f. Physician (fourth year of residency training or
							 higher) with a pediatric credential assigned to surgical ICU service and
							 in-house 24 hours/day
-
E
-
-
-
-
g. Surgically directed and staffed ICU service
E
E
E
E
-
-
h. Equipment for monitoring and resuscitation
E
E
E
E
E
-
i. Intracranial pressure monitoring equipment
E
E
E
E
-
-
5. Respiratory therapy services (Available 24
							 hours/day)
a. Available in-house
E
E
E
E
-
-
b. On-call and available within 45 minutes after
							 notification
-
-
-
-
E
-
6. Radiological services (Available 24
							 hours/day)
a. In-house radiology technologist
E
E
E
E
E
-
b. Radiology technologist on-call and available
							 within 45 minutes after notification
-
-
-
-
-
E
c. Resuscitation equipment for patients of all sizes,
							 as specified in subsection (D)(1)(c)(i) to (v)
E
E
E
E
E
E
d. Angiography
E
E
E
E
-
-
e. Sonography
E
E
E
E
E
-
f. Computed tomography (CT)
E
E
E
E
E
-
i. In-house CT technician
E
E
E
E
-
-
ii. CT technician on-call and available within 45
							 minutes after notification
-
-
-
-
E
-
g. Magnetic resonance imaging
E
E
E
E
-
-
7. Clinical laboratory service (Available 24
							 hours/day)
a. Standard analyses of blood, urine, and other body
							 fluids
E
E
E
E
E
E
b. Blood typing and cross-matching
E
E
E
E
E
-
c. Coagulation studies
E
E
E
E
E
E
d. Comprehensive blood bank or access to a community
							 central blood bank and adequate storage facilities
E
E
E
E
E
-
e. Blood gases and pH determinations
E
E
E
E
E
E
f. Microbiology
E
E
E
E
E
-
E. Rehabilitation Services Specific to the
							 Patient Population
1. Physical therapy
E
E
E
E
E
-
2. Occupational therapy
E
E
E
E
-
-
3. Speech therapy
E
E
E
E
-
-
F. Social Services Specific to the Patient
							 Population
1. Social services
E
E
E
E
E
-
2. Child life program
-
E
-
E
-
-
G. Performance Improvement
1. Multidisciplinary peer review committee
E
E
-
E
E
-
2. Performance improvement personnel dedicated to the
							 trauma service
E
E
E
E
-
-