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 30-40.410 - Definitions and Abbreviations Relating to Trauma Centers

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment adds virtual reviews to the
				  definitions for trauma centers.
(1) The following definitions and
				abbreviations shall be used in the interpretation of the rules in
				19 CSR
				30-40.400 to
				19 CSR
				30-40.450:
(A)
				Advanced cardiac life support (ACLS) certified means that an individual has
				successfully completed a course of training in advanced cardiac life-support
				techniques certified by the American Heart Association and that certification
				is maintained;
(B) Anesthesiologist
				assistant (AA) means a person who meets each of the following conditions:
1. Has graduated from an anesthesiologist
				assistant program accredited by the American Medical Association's Committee on
				Allied Health Education and Accreditation or by its successor agency;
2. Has passed the certifying examination
				administered by the National Commission on Certification of Anesthesiologist
				Assistants;
3. Has active
				certification by the National Commission on Certification of Anesthesiologist
				Assistants;
4. Is currently
				licensed as an anesthesiologist assistant in the state of Missouri;
				and
5. Provides health care
				services delegated by a licensed anesthesiologist. For the purposes of
				subsection (1)(B), the licensed anesthesiologist shall be "immediately
				available" as this term is defined in section
				334.400,
				RSMo.
(C) ATLS course
				means the advanced trauma life support course approved by the American College
				of Surgeons when required, certification shall be maintained;
(D) Board-admissible means that a physician
				has applied to a specialty board and has received a ruling that s/he has
				fulfilled the requirements to take the examinations. Board certification must
				be obtained within five (5) years of the first appointment;
(E) Board-certified means that a physician
				has fulfilled all requirements, has satisfactorily completed the written and
				oral examinations, and has been awarded a board diploma in a specialty
				field;
(F) Certified registered
				nurse anesthetist (CRNA) means a registered nurse who has graduated from a
				school of nurse anesthesia accredited by the Council on Accreditation of
				Educational Programs of Nurse Anesthesia or its predecessor and who has been
				certified as a nurse anesthetist by the Council on Certification of Nurse
				Anesthetists;
(G) CME means
				continuing medical education and refers to the highest level of continuing
				education approved by the Missouri State Medical Association, the Missouri
				Association of Osteopathic Physicians and Surgeons, The American Osteopathic
				Association, or the Accreditation Council for Continuing Medical
				Education;
(H) Continuing nursing
				education means education approved or recognized by a national and/or state
				professional organization and/or trauma medical director;
(I) Core surgeon is a member of the trauma
				team listed on the trauma call schedule ten percent (10%) of the time or
				greater;
(J) Credentialed or
				credentialing is a hospital-specific system of documenting and recognizing the
				qualifications of medical staff and nurses and authorizing the performance of
				certain procedures and establishing clinical privileges in the hospital
				setting;
(K) EMS Bureau means the
				Missouri Department of Health and Senior Services Emergency Medical Services
				Bureau;
(L) Glasgow coma scale is a
				scoring system for assessing a patient's level of consciousness utilizing a
				point system which measures eye opening, verbal response, and motor response.
				The higher the total score, the better the patient's neurological
				status;
(M) Immediately available
				(IA) means being present at bedside at the time of the patient's arrival at the
				hospital when prior notification is possible and no more than twenty (20)
				minutes from the hospital under normal driving and weather
				conditions;
(N) In-house (IH) means
				being on the hospital premises twenty-four (24) hours a day;
(O) Liaison means one (1) physician
				representative from each of the following areas: Emergency Medicine,
				Neurosurgery, Orthopedics, and Anesthesia who is selected to attend the
				Performance Improvement and Patient Safety Committee and to disseminate
				information to the other physicians within his/her specialty taking trauma
				call;
(P) Missouri trauma registry
				is a statewide data collection system to compile and maintain statistics on
				mortality and morbidity of trauma victims, using a reporting method provided by
				the Missouri Department of Health and Senior Services;
(Q) Multidisciplinary trauma conference means
				a meeting of members of the trauma team and other appropriate hospital
				personnel to review the care of trauma patients at the hospital;
(R) Non-core surgeon is a member of the
				trauma call team listed on the trauma call schedule less than ten percent (10%)
				of the time;
(S) PALS means
				Pediatric Advanced Life Support, ENPC means Emergency Nurses Pediatric Course,
				and APLS means Advanced Pediatrics Life Support; when required, certification
				shall be maintained;
(T) Physician
				advisory group is two (2) or more physicians who collectively assume the role
				of a medical advisor;
(U) Promptly
				available (PA) means arrival at the patient's bedside within thirty (30)
				minutes after notification of a patient's arrival at the hospital under normal
				driving and weather conditions;
(V)
				R is a symbol to indicate that a standard is a requirement for trauma center
				designation at a particular level;
(W) Review is the inspection of hospitals to
				determine compliance with the rules of this chapter. There are four (4) types
				of reviews: the initial review of hospitals never before designated as trauma
				centers or hospitals never before reviewed for compliance with the rules of
				this chapter or hospitals applying for a new level of trauma center
				designation; the verification review to evaluate the correction of any
				deficiencies noted in a previous review; and the validation review, which shall
				occur every five (5) years to assure continued compliance with the rules of
				this chapter, and a focus review to allow review of substantial deficiencies by
				a review team;
(X) Revised trauma
				score (RTS) is a numerical methodology for categorizing the physiological
				status of trauma patients;
(Y)
				Senior trauma surgery resident is a physician in at least the third
				post-graduate year of study;
(Z)
				Severely injured adult patient is an injured patient with a glasgow coma score
				(GCS) less than fourteen (14) or a systolic blood pressure less than ninety
				(90) millimeters of mercury or respirations less than ten (10) per minute or
				more than twenty-nine (29) per minute;
(AA) Severely injured child is defined as a
				patient fourteen (14) years of age or less having a GCS less than fourteen
				(14), shock following injury, pediatric trauma score less than eight (8), or
				with any of the following conditions: unable to establish or maintain an
				airway; ineffective respiratory effort; penetrating injury to head, neck,
				chest, abdomen, or extremity proximal to elbow or knee; burns greater than ten
				percent (10%) of the body surface area or involving inhalation injury; two (2)
				or more proximal long bone fractures or pelvic fracture; open or depressed
				skull fracture; suspected spinal cord injury and/or paralysis; amputation
				proximal to wrist or ankle; facial or tracheal injury with airway compromise;
				pre-existing medical conditions; or respiratory or cardiopulmonary arrest after
				injury;
(BB) Surgical trauma call
				roster is a hospital-specific list of surgeons assigned to trauma care,
				including date(s) of coverage and back-up surgeons when indicated;
(CC) Trauma center is a hospital that has
				been designated in accordance with the rules in this chapter to provide
				systematized medical and nursing care to trauma patients. Level I is the
				highest level of designation and functions as a resource center for the
				hospitals within that region. Level II is the next highest level of designation
				dealing with large volumes of serious trauma. Level III is the next level with
				limited resources;
(DD) Trauma
				medical director is a surgeon designated by the hospital who is responsible for
				the trauma service and performance improvement and patient safety programs
				related to trauma care;
(EE) Trauma
				nurse coordinator/trauma program manager is a registered nurse designated by
				the hospital with responsibility for monitoring and evaluating the care of
				trauma patients and the coordination of performance improvement and patient
				safety programs for the trauma center in conjunction with the trauma medical
				director;
(FF) Trauma nursing
				course is an education program in nursing care of trauma patients;
(GG) Trauma service is an organizational
				component of the hospital specializing in the care of injured
				patients;
(HH) Trauma team is a
				team consisting of the emergency physician, physicians on the surgical trauma
				call roster, appropriate anesthesiology staff, nursing and other support staff
				as needed;
(II) Trauma team
				activation protocol is a hospital document outlining the criteria used to
				identify severely injured patients and the procedures for notification of
				trauma team members and indicating surgical and non-surgical specialty response
				times acceptable for treating major trauma patients;
(JJ) Trauma triage is an estimation of injury
				severity at the scene of an accident; and
(KK) Virtual review means a type of review
				conducted through the use of secure virtual video and audio conferencing and
				secure file transfers in order to determine compliance with the rules of this
				chapter.