Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 185 - NEBRASKA STATEWIDE TRAUMA SYSTEM › Chapter 1 - STATEWIDE TRAUMA SYSTEM › Section 185-1-004 - STANDARDS FOR DESIGNATION OF TRAUMA CENTERS - LEVELS OF TRAUMA CENTERS

Current through June 17, 2024
The standards and levels of trauma center designation are set out
	 below.
004.01
COMPREHENSIVE LEVEL TRAUMA CENTERS.
A Comprehensive
  Level Trauma Center must have current verification from the American College of
  Surgeons as a Level I Trauma Center.
004.02
ADVANCED LEVEL TRAUMA
  CENTERS.
An Advanced Level Trauma Center must have current
  verification from the American College of Surgeons as a Level II Trauma Center
  or meet the standards indicated by an X under "advanced" on the Trauma Centers
  Criteria Chart in this chapter.
004.03
GENERAL LEVEL TRAUMA
  CENTERS.
A General Level Trauma Center must have current
  verification from the American College of Surgeons as a Level III Trauma Center
  or meet the standards indicated by an X under "general" on the Trauma Centers
  Criteria Chart in this chapter.
004.04
BASIC LEVEL TRAUMA
  CENTERS.
A basic level trauma center must have current
  verification from the American College of Surgeons as a Level IV Trauma Center
  or meet the standards indicated by an X under "basic" on the Trauma Centers
  Criteria Chart in this chapter.
004.05
TRAUMA CENTERS CRITERIA
  CHART.
The standards a facility must meet for designation are:
CATEGORIES
ADVANCED
GENERAL
BASIC
Institutional organization must include the
				  following:
Institutional support as evidenced by a signed board
				  resolution; a signed medical staff resolution; hospital administrator and
				  trauma medical director working together; and an organizational chart that
				  places the trauma program in equal authority with other
				  departments.
X
X
X
The trauma program must demonstrate its ability to influence
				  care across all phases of trauma treatment within the hospital.
X
X
X
Trauma medical director who is a current board certified
				  general surgeon (or general surgeon eligible for certification by the American
				  Board of Surgery) or a general surgeon who is an American College of Surgeons
				  Fellow with a special interest in trauma care and who participates in trauma
				  call.
X
X
Trauma medical director who is a physician on staff at the
				  hospital.
X
Trauma coordinator or manager.
X
X
X
Trauma team that consists of physicians, advanced practice
				  providers, nurses, and allied health professionals to respond to a trauma
				  emergency in the hospital emergency department. At a minimum:
a. The team is under the leadership of the trauma surgeon,
				  general surgeon or in basic trauma centers, a physician or an advanced practice
				  provider covering the emergency department;
b. When the trauma surgeon is not inhouse, the physician or
				  advanced practice provider covering the emergency department will act as team
				  leader until the trauma surgeon arrives in the resuscitation area; and
c. A trauma team that includes a registered
				  nurse.
X
X
X
Trauma peer review committee where the trauma medical
				  director must attend 50% of the meetings. Meeting minutes that reflect detailed
				  discussion, action steps, and conclusions must be maintained.
At the advanced level, the committee meeting must be
				  conducted independently from hospital or department based peer review and be
				  incorporated into the hospital wide activities.
X
X
X
At the general or basic level, the committee meeting may be
				  part of another hospital quality meeting but the meeting minutes must reflect a
				  separate section devoted to trauma care.
Multidisciplinary trauma review committee may have members
				  from all disciplines that are involved in the care of the trauma patient, meets
				  at least twice a year, and meets all requirements in 185 NAC 1-008 and all
				  subsections.
X
X
X
Hospital departments, divisions, or sections must
				  include the following:
General surgery.
X
X
Neurological surgery.
X
Orthopedic surgery.
X
Emergency medicine.
X
Anesthesia.
X
X
Services available in-house and immediately available
				  24 hours a day include:
Emergency services physician.
X
X
Services available within 15 minutes of patient's
				  arrival include:
General surgery.
X
Has a written physician back-up call schedule for general
				  surgery. In trauma centers with accredited residency training programs, the
				  chief resident may serve as back up.
X
Has a surgeon dedicated to a single hospital. This means the
				  surgeon is not on call at another hospital at the same time.
X
Anesthesia.
X
Services on-call 24 hours a day
				  include:
General surgery.
X
X
Primary care physician or advanced practice provider covering
				  the emergency department.
In basic trauma centers where an advanced practice provider
				  takes first call for the emergency department, there must be written criteria
				  stating when the on-call back up attending physicians must be contacted for
				  unstable patients.
X
Anesthesia.
X
Orthopedic surgery.
X
Has an orthopedic surgeon dedicated to single hospital
				  (meaning not on call at another hospital at the same time) or back up call. In
				  trauma centers with accredited residency training programs, the chief resident
				  may serve as back up.
X
Neurologic surgery.
X
Has a neurosurgeon dedicated to single hospital (meaning not
				  on call at another hospital at the same time) or back up call in trauma centers
				  with accredited residency training programs the chief resident may serve as
				  back up.
X
Obstetrics gynecologic surgery.
X
Oral maxillofacial surgery.
X
Ophthalmic surgery.
X
Plastic surgery.
X
Critical care medicine.
X
Radiology.
X
X
X
Interventional radiology.
In advanced trauma centers, an interventional radiologist
				  must either be available within 30 minutes, 24 hours a day or a written
				  contingency plan with 100% performance improvement program review of all
				  patients must be in place.
X
Thoracic surgery.
X
General or Trauma Surgeon must meet the
				  following:
Board certified or eligible for board certification by an
				  appropriate specialty board recognized by the American Board of Medical
				  Specialists or meets all of the following alternative criteria:
a. Completed an approved residency program;
b. Is approved for privileges by the hospital's credentialing
				  committee;
c. Meet all criteria established by the hospital's trauma
				  director;
d. Experienced in trauma care that is tracked by a p
				  performance improvement program; and
X
X
Has a physician representative from general or trauma surgery
				  who attends at least 50% of the trauma peer review committee meeting held at
				  least twice a year.
X
X
Has a physician representative from general or trauma surgery
				  who attends at least 50% of the trauma peer review committee meetings held at
				  least twice a year if one is on staff and actively involved in the care of
				  trauma patients.
X
Emergency medicine physician; primary care physician or
				  advanced practice provider covering the emergency department must meet the
				  following:
Has a physician who is board certified or eligible for board
				  certification by an appropriate specialty board recognized by the American
				  Board of Medical Specialists or meets all of the following alternative
				  criteria:
a. Completed an approved residency program;
b. Approved for privileges by the hospital's credentialing
				  committee;
c. Meet all criteria established by the hospital's trauma
				  director;
d. Is experienced in trauma care that is tracked by a
				  performance improvement program; and
X
Has a physician representative who attends at least 50% of
				  the trauma peer review committee meetings held a minimum of twice a
				  year.
X
X
X
Neurosurgery must meet the following:
General level trauma centers are not required to have a
				  neurosurgeon on staff. If one is on staff and participates in the care of
				  trauma patients, they must meet the standards indicated by an X under "general"
				  in the following.
Has a neurological surgeon who is board certified or eligible
				  for board certification by an appropriate specialty board recognized by the
				  American Board of Medical Specialists or meets all of the following alternative
				  criteria:
a. Completed an approved residency program;
b. Is approved for privileges by the hospital's credentialing
				  committee;
c. Meet all criteria established by the hospital's trauma
				  director;
d. Experienced in trauma care that is tracked by a
				  performance improvement program; and
X
X
A neurosurgical surgeon attends at least 50% of the trauma
				  peer review committee meetings held a minimum of twice a year.
X
A neurosurgical surgeon, if one is on staff and actively
				  involved in trauma care, attends at least 50% of the trauma peer review
				  committee meetings held a minimum of twice a year.
X
X
Orthopedic surgery must meet the
				  following:
Orthopedic surgeon who is board certified or eligible for
				  board certification by an appropriate specialty board recognized by the
				  American Board of Medical Specialists or meets all of the following alternative
				  criteria:
a. Completed an approved residency program;
b. Is licensed to practice medicine and approved for
				  privileges by the hospital's credentialing committee;
c. Meet all criteria established by the hospital's trauma
				  director;
d. Experienced in trauma care that is tracked by a
				  performance improvement program; and
X
An orthopedic surgeon attends at least 50% of the trauma peer
				  review committee meetings held a minimum of twice a year.
X
An orthopedic surgeon, if one is on staff and actively
				  involved in trauma care, attends at least 50% of the trauma peer review
				  committee meetings held a minimum of twice a year.
X
X
Radiology must include the
				  following:
A radiologist attends at least 50% of the trauma peer review
				  committee meetings held a minimum of twice a year.
X
X
A radiologist, if one is on staff and actively involved in
				  trauma care, attends at least 50% of the trauma peer review committee meetings
				  held a minimum of twice a year.
X
Facilities, resources, and capabilities
				  include:
Presence of a surgeon at resuscitation. In a hospital with a
				  general surgery accredited residency program, if a team of surgeons initiates
				  evaluation and treatment of the trauma patient, that team of surgeons may
				  include a surgical resident from the hospital's residency program, if the
				  resident has reached a seniority level of post graduate year (PGY) 4 or higher.
				  If the surgical resident is a member of the evaluation and treatment team, the
				  attending surgeon may take call from outside the hospital if the hospital
				  establishes local criteria defining what requires the attending surgeon's
				  immediate presence.
X
Emergency department must meet the
				  following:
Trauma team activation criteria that includes physiologic,
				  anatomic, and mechanism of injury with written protocol defining activation
				  process.
X
X
X
Heliport or landing zone located close enough to permit the
				  facility to receive or transfer patients by air.
X
X
X
Have a designated physician director for the emergency
				  department.
X
X
X
Emergency department includes equipment for patient
				  resuscitation of all ages:
Airway control and ventilation equipment including airway
				  control and ventilation equipment; bag valve mask and reservoir; oropharyngeal
				  airway devices; laryngoscope and blades; endotracheal tubes; supraglottic
				  airway device; or alternate airway device and portable video
				  laryngoscope.
X
X
X
Suction equipment and devices.
X
X
X
Drugs necessary for Rapid Sequence
				  Intubation.
X
X
X
Pulse oximetry.
X
X
X
Electrocardiograph-oscilloscope-defibrillator.
X
X
X
Qualitative end-tidal carbon dioxide.
X
X
Quantitative or qualitative end-tidal carbon
				  dioxide.
X
Large bore, long intravenous catheter for needle
				  decompression (minimum 14 gauge, 3.25 inch).
X
X
X
Standard IV fluids and administration sets.
X
X
X
Large bore intravenous catheters.
X
X
X
Intraosseous needle or kit.
X
X
X
Cricothyroidotomy kit or equipment for surgical
				  airway.
X
X
X
Thoracostomy tray.
X
X
X
Hemorrhage control tourniquets.
X
X
X
Traction splints (in basic trauma centers, traction splints
				  may be shared with local emergency medical service with a written plan for
				  obtaining equipment).
X
X
X
Pelvic binder (in basic trauma centers, pelvic binders may be
				  shared with local emergency medical service with a written plan for obtaining
				  equipment).
X
X
X
Pediatric resuscitation tape.
X
X
X
Thermal control for patient.
X
X
X
Equipment for communication with Emergency medical
				  services.
X
X
X
Device capable of detecting severe
				  hypothermia.
X
X
X
Thermal control for fluids and blood.
X
X
Rapid infuser system in general trauma centers, the rapid
				  infuser may be shared with the operating room.
X
X
Ultrasound.
X
X
Central venous pressure monitoring equipment.
X
X
Reversal agents for anti-coagulant and anti-platelet
				  medications.
X
Central line insertion.
X
Thoracotomy equipment.
X
Arterial catheters.
X
Internal paddles.
X
Cervical traction devices.
X
Operating room must include:
Basic trauma centers are not required to have an operating
				  room. If available and used in the care of trauma patients, they must meet the
				  standards indicated by an X under
				  "basic".
Personnel available within 15 minutes, 24 hours a day seven
				  days a week.
X
Personnel available within 30 minutes, 24 hours a day seven
				  days a week.
X
X
Age specific equipment.
X
X
Thermal control for patient.
X
X
X
Thermal control for fluids and blood.
X
X
X
X-Ray capability including c-arm image
				  intensifier.
X
Endoscopes and bronchoscope
X
X
Craniotomy instruments.
X
Equipment for long bone and pelvic fixation.
X
Rapid infuser system (in general trauma centers, the rapid
				  infuser may be shared with the emergency department).
X
X
X
Post anesthetic recovery room (Critical Care Unit is
				  acceptable) must include:
Basic trauma centers are not required to have post anesthetic
				  recovery rooms. If available and used in the care of trauma patients, they must
				  meet the standards indicated by an X under "basic".
Registered nurses available 24 hours a day, seven days a
				  week.
X
X
Monitoring equipment.
X
X
X
Pulse oximetry.
X
X
X
Thermal control.
X
X
X
Critical Care Unit for injured patients must include
				  the following equipment for monitoring and resuscitation:
Basic Trauma Centers are not required to have a Critical Care
				  Unit. If available and used in the care of trauma patients, they must meet the
				  standards indicated by an X under "basic.
Airway control and ventilation equipment including bag valve
				  mask with reservoir; oropharyngeal airway devices; laryngoscope and blades;
				  endotracheal tubes; airway suction equipment; supraglottic airway device; or
				  alternate airway device and portable video laryngoscope.
X
X
X
Ventilator.
X
X
Suction equipment and devices.
X
X
X
Pulse oximetry.
X
X
X
Electrocardiograph-oscilloscope-defibrillator.
X
X
X
Qualitative end-tidal carbon dioxide.
X
X
X
Designated surgical director or surgical
				  co-director.
X
X
Intracranial pressure monitoring
equipment.
X
Pediatric patients treated in an adult center (Patients
				  estimated to be less than 16 years of age that are admitted to an observation
				  or inpatient bed that is designated for adult patients.)
Advanced, basic, and general level facilities are not
				  required to have a formal Pediatric Critical Care Unit; however, if pediatrics
				  patients are treated on-site they must meet the standards indicated by an X in
				  the applicable category.
Trauma surgeons must be credentialed in pediatric care and
				  have pediatric advance life support certification. Criteria must include
				  Pediatric Advanced Life Support certification.
X
X
Equipment in all patient care areas for monitoring and
				  resuscitation of pediatric patients must include:
Pediatric airway control and ventilation equipment: including
				  bag valve mask with reservoir; oropharyngeal airway devices; laryngoscope and
				  blades; endotracheal tubes; airway suction equipment; supraglottic airway
				  device; or alternate airway device and portable video
				  laryngoscope.
X
X
X
Electrocardiograph-oscilloscope-defibrillator.
X
X
X
Pulse oximetry.
X
X
X
Thermal control.
X
X
X
The hospital must have a pediatric critical care unit or a
				  written plan for the transfer of pediatric trauma patients.
X
X
X
A trauma center that has a dedicated Pediatric Critical
				  Care Unit on-site must have equipment for monitoring and resuscitation for
				  pediatric patients of all ages that include:
Airway control and ventilation equipment including bag valve
				  mask with reservoir; oropharyngeal airway devices; laryngoscope and blades;
				  endotracheal tubes; airway suction equipment; supraglottic airway device; or
				  alternate airway device and portable video laryngoscope.
X
X
Ventilator.
X
X
Suction equipment and devices.
X
X
Drugs necessary for Rapid Sequence
				  Intubation.
X
X
Pulse oximetry.
X
X
Electrocardiograph-oscilloscope-defibrillator.
X
X
Qualitative end-tidal carbon dioxide.
X
X
Thermal control.
X
X
Intracranial pressure monitoring
equipment.
X
Respiratory therapy service must be:
Available in-house 24 hours a day, seven days a
				  week.
X
On-Call 24 hours a day, seven days a
				  week.
X
Radiological services-available 24 hours every day and
				  includes:
In-house radiology technician.
X
Angiography.
X
Ultrasound.
X
X
Computerized tomography.
X
X
In-house computerized tomography
X
technician.
Magnetic Resonance Imaging.
X
On-call radiology.
X
X
Clinical laboratory service available 24 hours every
				  day and includes:
Standard analyses of blood, urine, and other body fluids
				  including point of care testing and micro sampling.
X
X
X
Blood typing and cross matching.
X
X
Coagulation studies.
X
X
Packed red blood cells, frozen fresh plasma, platelets, and
				  cryoprecipitate rapidly available for massive transfusion.
X
Packed red blood cells, frozen fresh plasma, and rapidly
				  available for massive transfusion.
X
Two or more units of O Negative blood available or rapidly
				  released in an alternate system.
X
Massive transfusion policy.
X
X
Laboratory technologist available inhouse 24 hours a day
				  seven days a week.
X
X
Laboratory technologist available within 30 minutes of
				  patient's arrival.
X
Blood gases and Potential of Hydrogen (PH)
				  determinations.
X
X
Microbiology.
X
X
Acute hemodialysis includes:
The hospital must have acute hemodialysis in-house. A written
				  plan must be in place to transfer the patient if hemodialysis is not
				  immediately available.
X
The hospital must have a written plan for the transfer of
				  trauma patients to receive acute hemodialysis if not
				  in-house.
X
X
Burn care includes:
The hospital must have a written plan for the transfer of
				  burn patients to receive burn care if not in-house.
X
X
X
Acute spinal cord and head injury management
				  includes:
The hospital must provide management of acute spinal cord and
				  head injury care in-house. A written plan must be in place to transfer the
				  patient if these services are not immediately available.
X
The hospital must have a written plan for the transfer of
				  patients with acute spinal cord and head injury to receive care for acute
				  spinal cord and head injury if not inhouse.
X
X
If head injury patients are managed inhouse, the equipment
				  and a surgeon credentialed by the hospital to perform a craniotomy or
				  craniectomy and intracranial pressure monitoring must be
				  available.
X
If spinal cord injured patients are managed in-house, a
				  surgeon credentialed by the hospital to perform operative spinal stabilization
				  and the necessary equipment to treat and monitor spinal cord injuries must be
				  available.
X
Rehabilitation service includes:
Hospitals must provide for in-patient acute rehabilitation or
				  have a written plan for the transfer of trauma patients to rehabilitation
				  services if not provided in house.
X
X
X
Hospitals must provide for in-patient physical
				  therapy.
X
X
Hospitals must provide for in-patient occupational
				  therapy.
X
X
Hospitals must provide for in-patient speech
				  therapy.
X
X
Hospitals must provide for in-patient social services or have
				  a written plan for the provision of trauma patients to social service if not
				  provided in-house.
X
X
X
Trauma
				  education
32 hours of trauma continuing medical education every
				  four years or eight hours each full year employed if employed less than four
				  years:
General or trauma surgeons.
X
Emergency medicine physicians who are certified by the
				  American Board of Emergency Medicine or American Osteopathic Board of Emergency
				  Medicine are exempt from continuing medical education with documentation of
				  current board certification.
X
Emergency medicine physicians that are not board certified,
				  primary care physician, or advanced practice provider covering the emergency
				  department.
X
Neurosurgeon.
X
Orthopedic surgeon.
X
16 hours of trauma continuing medical education every
				  four years or four hours each full year employed if employed less than four
				  years:
General or trauma surgeons.
X
X
Emergency medicine physicians who are certified by the
				  American Board of Emergency Medicine or American Osteopathic Board of Emergency
				  Medicine are exempt from continuing medical education with documentation of
				  current board certification.
X
X
Emergency medicine physicians that are not board certified,
				  primary care physician, or advanced practice provider covering the emergency
				  department.
X
X
Neurosurgeon.
X
Orthopedic surgeon, if on staff and involved in the care of
				  trauma patients.
X
X
Advanced Trauma Life Support
				  certification:
General and trauma surgeons within one year of
				  hire.
X
X
X
Locum Tenens general and trauma surgeons upon date of
				  hire.
X
X
X
Physicians who specialized in emergency medicine, primary or
				  family care, and advanced practice providers providing care to trauma patients
				  in the emergency department within one year of hire.
X
X
X
Locum Tenens physicians providing care to trauma patients in
				  the emergency department upon date of hire.
X
X
X
The Emergency Nurses Association Trauma Nurse Core
				  Course Certification or a Department approved equivalent:
Trauma Nurse Core Course certification will not count towards
				  any other nursing continuing trauma education requirements.
All registered nurses covering the emergency department
				  within one year of hire.
X
X
X
Upon use for all registered nurses not directly employed by
				  the hospital
X
X
X
8 hours of trauma continuing nursing education every
				  four years or two hours of such education for each full year employed if
				  employed less than four years. Four of the eight hours must be in pediatric
				  trauma or one hour of such education for each full year employed if employed
				  less than four years:
All registered nurses covering the emergency
				  department.
X
X
X
16 hours of trauma continuing nursing education every
				  four years or four hours of such education for each full year employed if
				  employed less than four years:
All critical care unit registered nurses.
X
X
All registered nurses treating pediatric trauma patients in
				  an adult critical care unit must have four hours of pediatric
				  trauma.
X
All registered nurses in a dedicated pediatric critical care
				  unit on-site must have four hours of pediatric trauma.
X
X
Disaster planning and drills
				  must:
Hold a minimum of two disaster drills per year to include
				  emergency medical services. One of these may be a tabletop
				  drill.
X
X
X
Performance improvement program must include the
				  following
Trauma performance improvement activities must include use
				  of trauma registry reports (written by the facility or obtained from the State
				  Registrar). The facility must track: performance improvement indicators;
				  response times in order to identify opportunities for improvement; event
				  identification and levels of review resulting in development of corrective
				  action plans; methods of monitoring and reevaluation; and detailed
				  documentation of discussions in process improvement meetings. Distribution of
				  such information within the trauma system is required. Facilities must use the
				  trauma registry to run statistical reports.
Performance improvement program with written
				  plan.
X
X
X
Pediatric-specific performance improvement
				  indicators.
X
X
X
Submits trauma registry data as required by the
				  Department.
X
X
X
There is a peer review process in place to review and
				  categorize deaths.
X
X
X
Multidisciplinary trauma review committee that meets at least
				  twice a year and meets all requirements in 185 NAC 1008 and
				  subsections.
X
X
X
The trauma registry data is used for: improving patient care
				  and addressing provider and system related issues.
X
X
X
Medical, nursing, or allied health (such as X-ray, lab, or
				  radiology) participates in the multidisciplinary trauma review
				  committee.
X
X
X
Review and provide feedback to emergency medical services on
				  patient documentation reports. This may include, but is not limited to: chart
				  review, education and training on patient care, or hands on skills training on
				  trauma patient care.
X
X
X
Hospital provided or sponsored programs to
				  include:
The hospital must provide physicians, advanced practice
				  providers, and registered nurse's continuing education within the hospital's
				  trauma system at least once a year.
X
X
Provide feedback on patient care and outcomes to the
				  referring hospital.
X
X
Prevention activities
				  include:
Coordinate and participate in injury prevention
				  programs.
X
X
X