reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 1 - Hospital Organization › Rule 15-3-1-3.1.4 - Trauma Service

Current through June 25, 2024
The trauma service shall be established and recognized by
						the medical staff and be responsible for the overall coordination and
						management of the system of care rendered to the injured patient. The trauma
						service will vary in each organization depending on the needs of the patient
						and the resources available. The trauma service shall come under the
						organization and direction of a surgeon who is board certified with special
						interest in trauma care. All patients with multiple system trauma or serious
						injury shall be evaluated and or admitted by the trauma surgical service. The
						surgeon responsible for the overall care of the patient must be
						identified.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 1 - Hospital Organization › Rule 15-3-1-3.1.5 - Trauma Medical Director (TMD)

Current through June 25, 2024
Level I Trauma Centers shall have a physician director
						Board Certified in General Surgery of the trauma program. The medical director
						plays an important administrative role, and may not direct more than one adult
						trauma center. The medical director will be responsible for developing a
						performance improvement process and will have overall accountability and
						administrative authority for the trauma program. The medical director must be
						given administrative support to implement the requirements specified by the
						state trauma plan. The director is responsible for working with the
						credentialing process of the hospital, and in consultation with the appropriate
						service chiefs, for recommending appointment and removal of physicians from the
						trauma team. He must cooperate with nursing administration to support the
						nursing needs of the trauma patient and develop treatment protocols for the
						trauma patients. The director in collaboration with the Trauma Program Manager
						(TPM) must coordinate the budgetary process for the trauma program. The
						director must be currently certified in Advanced Trauma Life Support (ATLS),
						maintain personal involvement in care of the injured, maintain education in
						trauma care, and maintain involvement in professional organizations. The trauma
						director must be actively involved with the trauma system development. The TMD
						must perform an annual assessment of the general surgeons and mid-level
						providers assigned to the trauma service using a formal documented
						process.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 1 - Hospital Organization › Rule 15-3-1-3.1.6 - Trauma Program Manager (TPM)

Current through June 25, 2024
1. Level I Trauma
					 Centers must have a registered nurse working full time in the role of Trauma
					 Program Manager (TPM). Working in conjunction with the TMD, the TPM is
					 responsible for organization of the program and all systems necessary for the
					 multidisciplinary approach throughout the continuum of trauma care. The TPM is
					 responsible for working with the trauma team to assure optimal patient care.
					 There are many requirements for data coordination and performance improvement,
					 education and prevention activities incumbent upon this position. The TPM must
					 obtain 16 hours of trauma related education per year.
2. The TPM or his/hers designee must offer or
					 coordinate services for trauma education. The TPM should liaison with local EMS
					 personnel, the Department and other trauma centers.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 1 - Hospital Organization › Rule 15-3-1-3.1.7 - Trauma Team

Current through June 25, 2024
There shall be identified members of the trauma team.
						Policies must be in place describing the respective role of all personnel on
						the trauma team. The composition of the trauma team in any hospital will depend
						on the characteristics of the hospital and its staff. All physicians and
						mid-level providers (Physician Assistant/Nurse Practitioner) on the trauma team
						responsible for directing the initial resuscitation of the trauma patients must
						be currently certified in The American College of Surgeons Advanced Trauma Life
						Support (ATLS). ATLS requirements are waived for Board Certified Emergency
						Medicine and Board Certified General Surgery Physicians. Composition of the
						trauma team for a severely injured patient includes:
1. Emergency Physician and/or mid-level
					 providers (Physician Assistant/Nurse Practitioner)
2. General/Trauma Surgeon
3. Nurses: ED*
4. Laboratory Technicians
5. Respiratory Therapist
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 1 - Hospital Organization › Rule 15-3-1-3.1.8 - Multidisciplinary Trauma Committee

Current through June 25, 2024
1. The purpose of
					 the committee is to provide oversight and leadership to the entire trauma
					 program. Each trauma center may choose to have one or more committees as needed
					 to accomplish the task. One committee must be multi-disciplinary and focus on
					 program oversight and leadership. The major focus will be on PI activities,
					 policy development, communication among all team members, and establishment of
					 standards of care, and education and outreach programs for injury prevention.
					 The committee has administrative and systematic control and oversees
					 implementation of all program related services, meets regularly, takes
					 attendance, maintains minutes and works to correct overall program deficiencies
					 to optimize patient care. Membership for the committee includes representatives
					 from:
a. Trauma Medical Director (Chairman;
					 must be present at greater than 50% of the meetings).
b. Emergency Medicine
c. General Surgery
d. Orthopedics
e. Neurosurgery
f. Anesthesia
g. Operating Room
h. Intensive Care
i. Respiratory Therapy
j. Radiology
k. Laboratory
l. Rehabilitation
m. Pre-hospital Care Providers
n. Administration
o. Pediatrics
p. Nursing
q. Trauma Program Manager
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 2 - Clinical Components › Rule 15-3-1-3.2.2 - Qualifications of Surgeons on the Trauma Team

Current through June 25, 2024
1. Basic to
					 qualification for trauma care for any surgeon is Board Certification in a
					 surgical specialty recognized by the American Board of Medical Specialties, the
					 Advisory Board for Osteopathic Specialties, the Royal College of Physicians,
					 the American Dental Association and Surgeons of Canada, or other appropriate
					 foreign board. Many boards require a practice period. Such an individual may be
					 included when recognition by major professional organizations has been received
					 in their specialty. The board certification criteria apply to the general
					 surgeons, orthopedic surgeons, and neurosurgeons.
2. Alternate criteria in lieu of board
					 certification are as follows:
a. A non-board
					 certified general surgeon must have completed a surgical residency program.
b. He/she must be licensed to
					 practice medicine.
c. He/she must
					 be approved by the hospital's credentialing committee for surgical privileges.
d. The surgeon must meet all
					 criteria established by the trauma director to serve on the trauma team.
e. The surgeons' experience in
					 caring for the trauma patient must be tracked by the PI program.
f. The TMD must attest to the surgeons'
					 experience and quality as part of the recurring granting of trauma team
					 privileges.
g. The TMD, using the
					 trauma PI program, is responsible for determining each general surgeon's
					 ability to participate on the trauma team.
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 2 - Clinical Components › Rule 15-3-1-3.2.3 - Qualification of Emergency Physicians

Current through June 25, 2024
1. For those
					 physicians providing emergency medicine coverage, board certification in
					 Emergency Medicine or General Surgery is equired or current certification in
					 ATLS.
2. Alternative criteria for
					 the non-boarded physician working in the Emergency Department are as follows:
a. He/she must be licensed to practice
					 medicine
b. He/she must be approved
					 by the hospital's credentialing committee for emergency medicine
					 privileges.
c. The physician must
					 meet all criteria established by the trauma and emergency medical director to
					 serve on the trauma team.
d. The
					 physician's experience in caring for the trauma patient must be tracked by the
					 PI program.
e. The trauma and
					 emergency medical director must attest to the physician's experience and
					 quality as part of the recurring granting of trauma team privileges.
f. ATLS must be obtained within 18 months of
					 hire.
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 3 - Facility Standards › Rule 15-3-1-3.3.1 - Emergency Department

Current through June 25, 2024
1. The facility
					 must have an emergency department, division, service, or section staffed so
					 trauma patients are assured immediate and appropriate initial care. The
					 emergency physician and/or mid-level provider (Physician Assistant/Nurse
					 Practitioner) must be in-house 24 hours/day and immediately available at all
					 times. The emergency department medical director must meet the recommended
					 requirements related to commitment, experience, continuing education, ongoing
					 credentialing, and board certification in emergency medicine.
2. The emergency department medical director,
					 along with the Trauma Medical Director, will establish trauma-specific
					 credentials that must exceed those that are required for general hospital
					 privileges. Examples of credentialing requirements would include skill
					 proficiency, training requirements, conference attendance, education
					 requirements, ATLS verification and specialty board certification.
3. The emergency medicine physician will be
					 responsible for activating the trauma team based on predetermined response
					 protocols. He will provide team leadership and care for the trauma patient
					 until the arrival of the surgeon in the resuscitation area. The emergency
					 department must have established standards and procedures to ensure immediate
					 and appropriate care for the adult and pediatric trauma patient. The emergency
					 department medical director, or his/her designee, must act as a liaison and
					 participate with the Multidisciplinary Trauma Committee and the trauma PI
					 process.
4. There shall be an
					 adequate number of RN's staffing the trauma resuscitation area in-house 24
					 hours/day. Emergency nurses staffing the trauma resuscitation area must be a
					 current provider of Trauma Nurse Core Curriculum (TNCC) or Advance Trauma Care
					 for Nurses (ATCN), and participate in the ongoing PI process of the trauma
					 program. Nurses must obtain TNCC or ATCN within 18 months of assignment to the
					 ER.
5. The list of required
					 equipment necessary for the ED can be found on-line at the Department's
					 website.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 3 - Facility Standards › Rule 15-3-1-3.3.2 - Surgical Suites/Anesthesia

Current through June 25, 2024
1. The operating
					 room (OR) must be staffed and available in-house 24 hours/day.
2. An operating room must be adequately
					 staffed and available within 30 minutes of time of notification. Availability
					 of the operating room personnel and timeliness of starting operations must be
					 continuously evaluated by the trauma performance improvement process, and
					 measures must be implemented to ensure optimal care.
3. The OR nurses should participate in the
					 care of the trauma patient and be competent in the surgical stabilization of
					 the major trauma patient.
4. The
					 surgical nurses are an integral member of the trauma team, and must participate
					 in the ongoing PI process of the trauma program and be represented on the
					 Multidisciplinary Trauma Committee.
5. The OR supervisor must be able to
					 demonstrate a prioritization scheme to assure the availability of an operating
					 room for the emergent trauma during a busy operative schedule. There must be an
					 on-call system for additional personnel for multiple patient admissions.
6. The anesthesia department in a
					 Level I Trauma Center must be ideally organized and run by an anesthesiologist
					 who is highly experienced and devoted to the care of the injured patient.
					 Anesthesiologists on the trauma team must have successfully completed an
					 anesthesia residency program approved by the Accreditation Council for Graduate
					 Medical Education, the American Board of Osteopathic Specialties and have board
					 certification in anesthesia. One anesthesiologist must maintain commitment to
					 education in trauma related anesthesia.
7. Anesthesia must be in-house and available
					 24 hours/day. Anesthesia chief residents or Certified Registered Nurse
					 Anesthetist (CRNAs) may fill this requirement. When residents or CRNAs are
					 utilized, the staff anesthesiologist on-call will be available within 30
					 minutes, and present for all operations.
8. Hospital policy must be established to
					 determine when the anesthesiologist must be immediately available for airway
					 control and assisting with resuscitation. The availability of the
					 anesthesiologist and the absence of delays in airway control or operative
					 anesthesia must be documented and monitored by the PI process. The maximum
					 response time for all trauma patients is 30 minutes from the time notified to
					 respond.
9. The list of required
					 equipment necessary for Surgery and Anesthesia can be found on line at the
					 Department's website.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 3 - Facility Standards › Rule 15-3-1-3.3.3 - Post Anesthesia Care Unit (PACU)

Current through June 25, 2024
1. Level I trauma
					 centers must have a PACU staffed 24 hours/day and available to the
					 postoperative trauma patient. Frequently it is advantageous to bypass the PACU
					 and directly admit to the ICU. In this instance, the ICU may meet these
					 requirements.
2. PACU staffing must
					 be in sufficient numbers to meet the critical needs of the trauma patient.
3. The list of required equipment
					 necessary for PACU can be found on line at the Department's website.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 3 - Facility Standards › Rule 15-3-1-3.3.4 - Intensive Care Unit (ICU)

Current through June 25, 2024
1. Level I trauma
					 centers must have an Intensive Care Unit (ICU) that meets the needs of the
					 adult trauma patient.
2. The
					 surgical director or co-director must be the TMD, or general surgeon taking
					 trauma call. The director is responsible for the quality of care and
					 administration of the ICU and will set policy and establish standards of care
					 to meet the unique needs of the trauma patient.
3. The surgeon assumes and maintains
					 responsibility for the care of the serious or multiple injured patients. A
					 surgically directed ICU physician team is essential. The team will provide
					 in-house physician coverage for all ICU trauma patients at all times. This
					 service can be staffed by appropriately trained physicians from different
					 specialties, but must be led by a qualified surgeon as determined by critical
					 care credentials consistent with the medical staff privileging process of the
					 institution. The trauma surgeon must maintain control over all the aspects of
					 care, including but not limited to respiratory care and management of
					 mechanical ventilation; placement and use of pulmonary catheters; management of
					 fluid and electrolytes, antimicrobials, and enteral and parenteral nutrition.
4. There must be in-house
					 physician coverage for the ICU at all times. A physician credentialed by the
					 facility must be available to the trauma patient in the ICU 24 hours/day. This
					 coverage is for emergencies only and is not intended to replace the primary
					 surgeon but rather is intended to ensure that the patient's immediate needs are
					 met while the surgeon is contacted.
5. Level I Trauma Centers must provide
					 staffing in sufficient numbers to meet the critical needs of the trauma
					 patient. Critical care nurses must be available 24 hours per day. ICU nurses
					 are integral part of the trauma team and as such, shall be represented on the
					 Multidisciplinary Trauma Committee and participate in the PI process of the
					 trauma program at least 50% of the time.
6. The list of required equipment necessary
					 for the ICU can be found on line at the Department's website.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 4 - Clinical Support Services › Rule 15-3-1-3.4.1 - Respiratory Therapy Service

Current through June 25, 2024
The service must be staffed with qualified personnel
						in-house 24 hours/day to provide the necessary treatment for the injured
						patient.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 4 - Clinical Support Services › Rule 15-3-1-3.4.2 - Radiological Service

Current through June 25, 2024
1. A radiological
					 service must have a certified radiological technician in-house 24 hours/day and
					 immediately available at all times for general radiological procedures. A
					 technician must be in-house and immediately available for computerized
					 tomography (CT) for both head and body.
2. Sonography, angiography, and MRI must be
					 available to the trauma team and may be covered with a technician on call.
3. The radiology liaison must
					 attend at least 50 percent of committee meetings and should educate and guide
					 the entire trauma team in the appropriate use of radiologic services.
4. A staff radiologist must be
					 promptly available, when requested, for the interpretation of radiographs,
					 performance of complex imaging studies or interventional procedures. The
					 radiologist must insure the preliminary interpretations are promptly reported
					 to the trauma team and the PI program must monitor all changes in
					 interpretation.
5. Written policy
					 must exist delineating the prioritization/availability of the CT scanner for
					 trauma patients.
6. The trauma
					 center must have policies designed to ensure that trauma patients who may
					 require resuscitation and monitoring are accompanied by appropriate trauma
					 providers during transportation to, and while in, the radiology department.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 4 - Clinical Support Services › Rule 15-3-1-3.4.3 - Clinical Laboratory Service

Current through June 25, 2024
1. Clinical
					 laboratory service must have the following services available in-house 24
					 hours/day:
a. Access to a blood bank and
					 adequate storage facilities. Sufficient quantities of blood and blood products
					 must be maintained at all times. Blood typing and cross-match capabilities must
					 be readily available.
b. Standard
					 analysis of blood, urine and other body fluids including micro-sampling when
					 appropriate.
c. Blood gas and PH
					 determinations (this function may be performed by services other than the
					 clinical laboratory service, when applicable.)
d. Alcohol and drug screening.
e. Coagulation studies.
f. Microbiology
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 4 - Clinical Support Services › Rule 15-3-1-3.4.4 - Acute Hemodialysis

Current through June 25, 2024
Level I Trauma Centers must have Acute Hemodialysis
						services.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 4 - Clinical Support Services › Rule 15-3-1-3.4.5 - Burn Care

Current through June 25, 2024
There must be a written protocol to transfer the patient
						to a Burn Center that provides this service if this service if it is not
						available at the Level I Trauma Center. Policies and procedures shall be in
						place to assure the appropriate care is rendered during the initial
						resuscitation and transfer of the patient.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 4 - Clinical Support Services › Rule 15-3-1-3.4.6 - Rehabilitation/Social Services

Current through June 25, 2024
1. Recognizing that
					 early rehabilitation is imperative for the trauma patient, a physical medicine
					 and rehabilitation specialist must be available for the trauma
					 program.
2. The rehabilitation of
					 the trauma patient and the continued support of the family members are an
					 important part of the trauma system. Each facility will be required to address
					 a plan for integration of rehabilitation into the acute and primary care of the
					 trauma patient, at the earliest stage possible after admission to the trauma
					 center. Hospitals will be required to identify a mechanism to initiate
					 rehabilitation services and/or consultation in a timely manner as well as
					 policies regarding coordination of the Multidisciplinary Rehabilitation Team.
					 The rehabilitation services must minimally include;
a. Occupational Therapy
b. Physical Therapy
c. Speech Pathology.
d. Social Work
e. Psychological
f. Nutritional support
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 4 - Clinical Support Services › Rule 15-3-1-3.4.7 - Prevention/Public Outreach

Current through June 25, 2024
1. Level I trauma
					 centers will be responsible for taking a lead role in coordination of
					 appropriate agencies, professional groups and hospitals in their region to
					 develop a strategic plan for public awareness. This plan must take into
					 consideration public awareness of the trauma system, access to the system,
					 public support for the system, as well as specific prevention strategies.
					 Prevention programs must be specific to the needs of the hospital and/or
					 geographic area. A trauma center's prevention program must include and track
					 partnerships with other community organizations. At a minimum, trauma registry
					 data must be utilized to identify injury trends and focus prevention
					 needs.
2. Outreach is the act of
					 providing resources to individuals and institutions that do not have the
					 opportunities to maintain current knowledge and skills. Staff members at a
					 Level I trauma center must provide consultation to staff members of other level
					 facilities. For example: Advanced Trauma Life Support (ATLS), Pre Hospital
					 Trauma Life Support (PHTLS), Trauma Nurse Curriculum Course (TNCC), and
					 Transport Nurse Advanced Trauma Course (TNATC) courses can be coordinated by
					 the trauma center.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 4 - Clinical Support Services › Rule 15-3-1-3.4.8 - Transfer Guidelines

Current through June 25, 2024
Level I Trauma Centers shall work in collaboration with
						the referral trauma facilities in the system and develop inter-facility
						transfer guidelines. These guidelines must address criteria to identify
						high-risk trauma patients that could benefit from a higher level of trauma
						care. All designated facilities will agree to provide services to the trauma
						victim regardless of his/her ability to pay.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 4 - Clinical Support Services › Rule 15-3-1-3.4.9 - Education

Current through June 25, 2024
1. Level I Trauma Centers must have an
					 internal trauma education programs including training in trauma for physicians,
					 nurses and pre-hospital providers. The Level I trauma centers must take a
					 leadership role in providing educational activities. Education can be
					 accomplished via many mechanisms (i.e. classic CME, preceptorships,
					 fellowships, clinical rotations, telecommunications or providing locum tenens
					 etc.).
2. Level I Trauma Centers
					 must have a written trauma education plan.
3. The Level I trauma center is expected to
					 support a surgical residency program. Additionally there should be a senior
					 resident rotation in at least one of the following disciplines: emergency
					 medicine, general surgery, orthopedic surgery, neurosurgery or support a trauma
					 fellowship. The Level I should provide ATLS courses for the system.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 3 - Level I Trauma Centers › Subchapter 4 - Clinical Support Services › Rule 15-3-1-3.4.10 - Research

Current through June 25, 2024
1. A trauma research program must be designed
					 to produce new knowledge applicable to the care of the injured patient. The
					 research may be conducted in a number of ways including traditional laboratory
					 and clinical research, reviews of clinical series, and epidemiological or other
					 studies. Publication of articles in peer-review journals as well as
					 presentations of results at local, statewide and national meetings and ongoing
					 studies approved by human and animal research review boards are expected from
					 productive programs. The program should have an organized structure that
					 fosters and monitors ongoing productivity.
2. The research program must be balanced to
					 reflect a number of different interests. There must be a research committee,
					 and identifiable Institutional Review Board process, active research protocols,
					 surgeons involved in extramural educational presentations and adequate number
					 of peer reviewed scientific publications. Publications should appear in
					 peer-reviewed journals. In a three-year cycle, the minimum activity is ten
					 publications from the physicians representing any of the four following
					 specialties: emergency medicine, general surgery, orthopedic surgery, and
					 neurosurgery.
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 4 - Level II Trauma Centers › Subchapter 1 - Hospital Organization › Rule 15-3-1-4.1.1 - General

Current through June 25, 2024
A Level II Trauma Center is an acute care facility with
						the commitment, resources, and specialty training necessary to provide
						sophisticated trauma care, and provide leadership in performance improvement
						activities.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 4 - Level II Trauma Centers › Subchapter 1 - Hospital Organization › Rule 15-3-1-4.1.2 - Hospital Departments/Divisions/Sections

Current through June 25, 2024
The Level II Trauma Center must have the following
						departments, divisions, or sections:
1. Emergency Medicine
2. Trauma/General Surgery
3. Orthopedic Surgery
4. Neurological Surgery
5. Anesthesia
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 4 - Level II Trauma Centers › Subchapter 1 - Hospital Organization › Rule 15-3-1-4.1.3 - Trauma Program

Current through June 25, 2024
1. There must be a
					 written commitment on behalf of the entire facility to the organization of
					 trauma care. The written commitment shall be in the form of a resolution at the
					 time of application passed by an appropriate quorum of the members of the
					 governing authority. Should the business organization be other than a
					 corporation, a letter explaining such together with a written commitment of the
					 hospital's chief executive officer to the establishment of a trauma care
					 program may be sufficient. The trauma program must be established and
					 recognized by the medical staff and hospital administration. The trauma program
					 must come under the direction of a surgeon with current or previous board
					 certification in General Surgery. An identified hospital administrative leader
					 must work closely with the trauma medical director to establish and maintain
					 the components of the trauma program including appropriate financial support.
					 The trauma program location in the organizational structure of the hospital
					 must be placed so that it may interact effectively with at least equal
					 authority with other departments providing patient care. An administrative
					 structure must minimally include an administrator, medical director, trauma
					 program manager (TPM), trauma registrar and the appropriate support staff
					 Administrative support includes human resources, educational activities,
					 community outreach activities, and research. The trauma program must be
					 multidisciplinary in nature and the performance improvement evaluation of this
					 care must extend to all the involved departments.
2. Compliance with the above will be
					 evidenced by, but not limited to:
a.
					 Governing authority and medical staff letter of commitment in the form of a
					 resolution;
b. Written policies and
					 procedures and guidelines for care of the trauma patient;
c. Defined trauma team and written roles and
					 responsibilities;
d. Appointed
					 Trauma Medical Director with a written job description;
e. Appointed Trauma Program Manager with a
					 written job description;
f. A
					 written Trauma Performance Improvement plan;
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 4 - Level II Trauma Centers › Subchapter 1 - Hospital Organization › Rule 15-3-1-4.1.4 - Trauma Service

Current through June 25, 2024
The trauma service must established and recognized by the
						medical staff and be responsible for the overall coordination and management of
						the system of care rendered to the injured patient. The trauma service will
						vary in each organization depending on the needs of the patient and the
						resources available. The trauma service must come under the organization and
						direction of a surgeon with current or previous board certification in General
						Surgery. All patients with multiple system trauma or serious injury must be
						evaluated and or admitted by the trauma service. The surgeon responsible for
						the overall care of the patient must be identified.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 4 - Level II Trauma Centers › Subchapter 1 - Hospital Organization › Rule 15-3-1-4.1.5 - Trauma Medical Director (TMD)

Current through June 25, 2024
Level II Trauma Centers must have a physician director
						current or previous Board Certified in General Surgery of the trauma program.
						The trauma program medical director plays an important administrative role, and
						may not direct more than one trauma center. The medical director will be
						responsible for developing a performance improvement process and will have
						overall accountability and administrative authority for the trauma program. The
						medical director must be given administrative support to implement the
						requirements specified by the State trauma plan. The director is responsible
						for working with the credentialing process of the hospital, and, in
						consultation with the appropriate service chiefs, recommending appointment and
						removal of physicians from the trauma team. He should cooperate with nursing
						administration to support the nursing needs of the trauma patient and develop
						treatment protocols for the trauma patients. The director in collaboration with
						the trauma program manager (TPM) should coordinate the budgetary process for
						the trauma program. The director must be currently certified in Advanced Trauma
						Life Support (ATLS), maintain personal involvement in care of the injured,
						maintain education in trauma care, and maintain involvement in professional
						organizations. The trauma director must be actively involved with trauma system
						development. The TMD must perform an annual assessment of the general surgeons
						and mid-level providers assigned to the trauma service using a formal
						documented process.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 4 - Level II Trauma Centers › Subchapter 1 - Hospital Organization › Rule 15-3-1-4.1.6 - Trauma Program Manager (TPM)

Current through June 25, 2024
1. Level II Trauma
					 Centers must have a registered nurse working full time in the role of Trauma
					 Program Manager (TPM). Working in conjunction with the TMD, the TPM is
					 responsible for organization of the program and all systems necessary for the
					 multidisciplinary approach throughout the continuum of trauma care. The TPM is
					 responsible for working with the trauma team to assure optimal patient care.
					 There are many requirements for data coordination and performance improvement,
					 education and prevention activities incumbent upon this position. The TPM must
					 obtain 16 hours of trauma related education per year.
2. The TPM or his/her designee should offer
					 or coordinate services for trauma education. The TPM should liaison with local
					 EMS personnel, the Department and other trauma centers.
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 4 - Level II Trauma Centers › Subchapter 1 - Hospital Organization › Rule 15-3-1-4.1.7 - Trauma Team

Current through June 25, 2024
The team approach is optimal in the care of the multiple
						injured patients. There must be identified members of the trauma team. Policies
						should be in place describing the respective role of all personnel on the
						trauma team. The composition of the trauma team in any hospital will depend on
						the characteristics of that hospital and its staff. The team leader must be a
						qualified general surgeon. All physicians and mid-level providers (Physician
						Assistant/Nurse Practitioner) on the trauma team responsible for directing the
						initial resuscitation of the trauma patients must be currently certified in The
						American College of Surgeons Advanced Trauma Life Support (ATLS). ATLS
						requirements are waived for Board Certified Emergency Medicine and Board
						Certified General Surgery Physicians. Minimum composition of the trauma team
						for a severely injured patient shall include:
1. Emergency Physicians and/or mid-level
					 providers (Physician Assistant/Nurse Practitioner)
2. General/Trauma Surgeon
3. Nurses
4. Laboratory Technicians
5. Respiratory Therapists
Miss. Code Ann.
						§
												41-59-5
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 4 - Level II Trauma Centers › Subchapter 1 - Hospital Organization › Rule 15-3-1-4.1.8 - Multidisciplinary Trauma Committee

Current through June 25, 2024
1. The purpose of
					 the committee is to provide oversight and leadership to the entire trauma
					 program. The exact format will be hospital specific and may be accomplished by
					 collaboration with another designated trauma center in the region. Each trauma
					 center may choose to have one or more committees to accomplish the tasks
					 necessary. One committee should be multidisciplinary and focus on program
					 oversight and leadership. The major focus will be on PI activities, policy
					 development, communication among all team members, establishment of standards
					 of care, education and outreach programs, and injury prevention. The committee
					 has administrative and systematic control and oversees implementation of all
					 program related services, meets regularly, takes attendance, maintains minutes
					 and works to correct overall program deficiencies to optimize patient care.
					 Membership for the committee includes representatives from:
a. Trauma Medical Director (Chairman; must be
					 present greater than 50% of the meetings)
b. Emergency Medicine
c. General Surgery
d. Orthopedics
e. Neurosurgery
f. Anesthesia
g. Operating Room
h. Intensive Care
i. Respiratory Therapy
j. Radiology
k. Laboratory
l. Rehabilitation
m. Pre-hospital Care Providers
n. Administration
o. Pediatrics
p. Nursing
q. Trauma Program Manager
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 4 - Level II Trauma Centers › Subchapter 2 - Clinical Components › Rule 15-3-1-4.2.1 - Required Components

Current through June 25, 2024
Level II Trauma Centers must maintain published call
						schedules and have the following physician coverage immediately available 24
						hours/day:
1. Emergency Medicine
					 (In-house 24 hours/day). Emergency Physician and/or mid-level provider
					 (Physician Assistant/Nurse Practitioner) must be in the specified trauma
					 resuscitation area upon patient arrival.
2. Trauma/General Surgery. The trauma surgeon
					 on-call must be unencumbered and immediately available to respond to the trauma
					 patient. The general surgeon is expected to be in the emergency department upon
					 arrival of the seriously injured patient. Hospital policy must be established
					 to define conditions requiring the trauma surgeon's presence with the clear
					 requirement on the part of the hospital and surgeon that the surgeon will
					 participate in the early care of the patient. The trauma surgeon's
					 participation in major therapeutic decisions, presence in the emergency
					 department for major resuscitation and presence at operative procedures is
					 mandatory. The on-call surgeon must be dedicated to the trauma center and not
					 on-call at any other hospital. There must be a back-up surgeon schedule
					 published. A system must be developed to assure notification of the on-call
					 surgeon and compliance with these criteria and their appropriateness must be
					 documented and monitored by the PI process. Response time for Alpha Activations
					 is 30 minutes and starts at patient arrival or EMS notification, whichever is
					 shorter. Response time for Bravo Activations is 45 minutes from the time
					 notified to respond.
3. Orthopedic
					 Surgery. It is desirable to have the orthopedists dedicated to the trauma
					 center solely while on-call or a backup schedule should be available. The
					 maximum response time for all trauma patients is 60 minutes from the time
					 notified to respond.
4. Neurologic
					 Surgery. It is desirable to have the neurosurgeon dedicated to the trauma
					 center solely while on-call or a backup schedule should be available. The
					 maximum response time for all trauma patients is 30 minutes from the time
					 notified to respond.
5. It is
					 desirable the following specialists be on-call and available 24 hours/day:
a. Critical Care Medicine
b. Obstetrics/Gynecologic Surgery
c. Plastic Surgery
d. Radiology
e. Thoracic Surgery*
*A trauma surgeon is presumed to be qualified and have
						privileges to provide emergency thoracic surgical care to patients with
						thoracic injuries. If this is not the case, the facility should have a
						board-certified thoracic surgeon immediately available (within 30 minutes of
						the time notified to respond).
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 4 - Level II Trauma Centers › Subchapter 2 - Clinical Components › Rule 15-3-1-4.2.2 - Qualifications of Surgeons on the Trauma Team

Current through June 25, 2024
1. Basic to
					 qualification for trauma care for any surgeon is current or previous Board
					 Certification in a surgical specialty recognized by the American Board of
					 Medical Specialties, the Advisory Board for Osteopathic Specialties, the
					 American Dental Association, the Royal College of Physicians and Surgeons of
					 Canada or other appropriate foreign board. Many boards require a practice
					 period. Such an individual may be included when recognition by major
					 professional organizations has been received in their specialty. The board
					 certification criteria apply to the general surgeons, orthopedic surgeons, and
					 neurosurgeons.
2. Alternate
					 criteria in lieu of board certification are as follows:
a. A Non-board certified general surgeon must
					 have completed a surgical residency program.
b. He/she must be licensed to practice
					 medicine.
c. He/she must be
					 approved by the hospital's credentialing committee for surgical privileges.
d. The surgeon must meet all
					 criteria established by the TMD to serve on the trauma team.
e. The surgeon's experience in caring for the
					 trauma patient must be tracked by the PI program.
f. The TMD must attest to the surgeon's
					 experience and quality as part of the recurring granting of trauma team
					 privileges.
g. The TMD, using the
					 trauma PI program, is responsible for determining each general surgeon's
					 ability to participate on the trauma team.
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 3 - Bureau of Acute Care Systems › Subpart 1 - Trauma System of Care › Chapter 4 - Level II Trauma Centers › Subchapter 2 - Clinical Components › Rule 15-3-1-4.2.3 - Qualifications of Emergency Physicians

Current through June 25, 2024
1. For those
					 physicians providing emergency medicine coverage, current or previous board
					 certification in Emergency Medicine or General Surgery is required or current
					 certification in ATLS.
2.
					 Alternative criteria for the non-boarded physician working in the Emergency
					 Department are as follows:
a. He/she must be
					 licensed to practice medicine.
b.
					 He/she must be approved by the hospital's credentialing committee for emergency
					 medicine privileges.
c. The
					 physician must meet all criteria established by the trauma and emergency
					 medical director to serve on the trauma team.
d. The physician's experience in caring for
					 the trauma patient must be tracked by the PI program.
e. The emergency medical director must attest
					 to the physician's experience and quality as part of the recurring granting of
					 trauma team privileges.
f. ATLS
					 must be obtained within 18 months of hire.