Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations › Section 19 CSR 30-40.430 - Standards for Trauma Center Designation

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment changes continuing education
				  hours/credentialing requirements to be consistent with required continuing
				  education/credentialing requirements by the national verifying body for trauma
				  centers, adds credentialing courses for nurses, changes EMS Bureau to
				  department's time critical diagnosis unit, requires nurses in the ICU to be
				  current in ATLS, updates the publication date for the National Trauma Data
				  Standard, removes continuing medical education requirements for physicians who
				  are emergency medicine board certified or board eligible through the American
				  Board of Emergency Medicine or the American Osteopathic Board of Emergency
				  Medicine and who are practicing in the emergency department of a trauma center,
				  removes requirements relating to the operation or construction of a helipad at
				  trauma centers, and adds an option for trauma centers to enter trauma data into
				  a national data registry or databank that will allow the trauma center to
				  perform its performance improvement and patient safety program
				  requirements.
(1) General
				Standards for Trauma Center Designation.
(A)
				The hospital board of directors, administration, medical staff and nursing
				staff shall demonstrate a commitment to quality trauma care. Methods of
				demonstrating the commitment shall include, but not be limited to, a board
				resolution that the hospital governing body agrees to establish policy and
				procedures for the maintenance of services essential for a trauma center;
				assure that all trauma patients will receive medical care at the level of the
				hospital's designation; commit the institution's financial, human and physical
				resources as needed for the trauma program; and establish a priority admission
				for the trauma patient to the full services of the institution. (I-R, II-R,
				III-R)
(B) Trauma centers shall
				agree to accept all trauma victims appropriate for the level of care provided
				at the hospital, regardless of race, sex, creed or ability to pay. (I-R, II-R,
				III-R)
(C) The hospital shall
				demonstrate evidence of a trauma program that provides the trauma team with
				appropriate experience to maintain skill and proficiency in the care of trauma
				patients. Such evidence shall include meeting of continuing education unit
				requirements by all professional staff, documented regular attendance by all
				core trauma surgeons and liaison representation from neurosurgeons, orthopedic
				surgeons, emergency medicine physicians, and anesthesiologists at trauma
				program performance improvement and patient safety program meetings,
				documentation of continued experience as defined by the trauma medical director
				in management of sufficient numbers of severely injured patients to maintain
				skill levels, and outcome data on quality of patient care as defined by
				regional emergency medical service committees. Regular attendance shall be
				defined by each trauma service, but shall be not less than fifty percent (50%)
				of all meetings. The trauma medical director must ensure and document
				dissemination of information and findings from the peer review meetings to the
				non-core surgeons on the trauma call roster.
(D) The trauma center shall have a helicopter
				landing area. (I-R, II-R, III-R)
1. The
				landing area shall serve solely as the receiving and take-off area for medical
				helicopters and shall be cordoned off at all times from the general public to
				assure its continual availability and safe operation. (I-R, II-R,
				III-R)
2. The landing area shall be
				on the hospital premises no more than three (3) minutes from the emergency
				room. (I-R, II-R, III-R)
(E) The hospital shall appoint a
				board-certified surgeon to serve as the trauma medical director. (I-R, II-R,
				III-R)
1. There shall be a job description and
				organization chart depicting the relationship between the trauma medical
				director and other services. (I-R, II-R, III-R)
2. The trauma medical director shall be a
				member of the surgical trauma call roster. (I-R, II-R, III-R)
3. The trauma medical director shall be
				responsible for the oversight of the education and training of the medical and
				nursing staff in trauma care. (I-R, II-R, III-R)
4. The trauma medical director shall document
				thirty-six (36) hours of continuing medical education (CME) in trauma care
				every three (3) years. (I-R, II-R, III-R)
5. The trauma medical director shall
				participate in the trauma center's research and publication projects.
				(I-R)
(F) There shall be
				a trauma nurse coordinator/trauma program manager. (I-R, II-R, III-R)
1. There shall be a job description and
				organization chart depicting the relationship between the trauma nurse
				coordinator/trauma program manager and other services. (I-R, II-R,
				III-R)
2. The trauma nurse
				coordinator/trauma program manager shall document thirty-six (36) hours of
				continuing nursing education in trauma care every three (3) years. (I-R, II-R,
				III-R)
(G) By the time of
				the initial review, all general surgeon members of the surgical trauma call
				roster shall have successfully completed or be registered for a provider
				Advanced Trauma Life Support (ATLS) course. Current certification must then be
				maintained by each general surgeon on the trauma call roster. (I-R, II-R,
				III-R)
(H) The hospital shall
				demonstrate that there is a plan for adequate post-discharge follow-up on
				trauma patients, including rehabilitation. (I-R, II-R, III-R)
(I) A trauma registry shall be completed on
				each patient who sustains a traumatic injury and meets the following criteria:
				Includes at least one (1) code within the range of the following injury
				diagnostic codes as defined in the International Classification of Diseases,
				Ninth Revision, Clinical Modification (ICD-9)-(CM) 800-959.9, which is
				incorporated by reference in this rule as published by the Centers for Disease
				Control and Prevention in 2006 and is available at National Center for Health
				Statistics, 1600 Clifton Road, Atlanta, GA 30333. This rule does not
				incorporate any subsequent amendments or additions. Excludes all diagnostic
				codes within the following code ranges: 905-909.9 (late effects of injury),
				910-924.9 (superficial injuries, including blisters, contusions, abrasions, and
				insect bites), 930-939.9 (foreign bodies), and must include one (1) of the
				following criteria: hospital admission, patient transfer out of facility, or
				death resulting from the traumatic injury (independent of hospital admission or
				hospital transfer status). Trauma centers shall enter trauma care data elements
				for each patient who meets these criteria. The trauma care data elements shall
				be those identified and defined by the National Trauma Data Standard, which is
				incorporated by reference in this rule as published by the American College of
				Surgeons in 2022 and is available at the American College of Surgeons, 633 N.
				St. Clair St., Chicago, IL 60611. This rule does not incorporate any subsequent
				amendments or additions. (I-R, II-R, III-R)
1.
				Trauma centers shall enter trauma care data elements for each patient who meets
				the criteria above into the following:
A.
				Trauma centers shall submit data into the department's Missouri trauma
				registry. The data required in subsection (1)(I) above shall be submitted
				electronically into the Missouri trauma registry via the department's website
				at
www.health.mo.gov
; or (I-R, II-R,
				III-R)
B. Trauma centers shall
				submit data into a national data registry or data bank capable of being used by
				the trauma center to perform its ongoing performance improvement and patient
				safety program requirements for its trauma patients. The trauma center shall
				submit data for each data element included in the national data registry or
				data bank's data system. (I-R, II-R, III-R)
2. Electronic data shall be submitted
				quarterly, ninety (90) days after the quarter ends. The trauma registry must be
				current and complete. (I-R, II-R, III-R)
3. Information provided by hospitals on the
				trauma registry shall be subject to the same confidentiality requirements and
				procedures contained in section
				192.067, RSMo. (I-R, II-R,
				III-R)
(J) A patient log
				of those patients entered into the trauma registry with admission date, patient
				name, and injuries must be available for use during the site review process.
				(I-R, II-R, III-R)
(K) The hospital
				shall have a trauma team activation protocol that establishes the criteria used
				to rank trauma patients according to the severity and type of injury and
				identifies the persons authorized to notify trauma team members when a severely
				injured patient is en route or has arrived at the trauma center. (I-R, II-R,
				III-R)
1. The trauma team activation protocol
				shall provide for immediate notification and response requirements for trauma
				team members when a severely injured patient is en route to the trauma center.
				(I-R, II-R, III-R)
(L)
				The hospital shall have a plan to notify an organ or tissue procurement
				organization and cooperate in the procurement of anatomical gifts in accordance
				with the provisions in section
				194.233, RSMo. (I-R,
				II-R, III-R)
(M) There shall be no
				level III trauma centers designated within fifteen (15) miles of any Missouri
				level I or II trauma center. Hospitals which have continually been level III
				trauma centers since January 1, 1989, and which are within fifteen (15) miles
				of a Missouri level I or II trauma center may continue as level III trauma
				centers, provided they continue to meet standards for level III trauma
				centers.