Washington Administrative Code › Title 246 - Health, Department of › TRAUMA/EMERGENCY MEDICAL SERVICES › Chapter 246-976 - Emergency medical services and trauma care systems › DESIGNATION OF TRAUMA CARE FACILITIES › Section 246-976-700 - Trauma Service Standards

Current through Register Vol. 24-14, July 15, 2024
WAC 246-976-700 Trauma Service
								Standards
Adult Levels
Pediatric Levels
A facility with a designated trauma service
								must have:
I
II
III
IV
V
I P
II P
III P
(1) A written trauma scope of service outlining
								the trauma care resources and capabilities available twenty-four hours every
								day for:
X
X
X
X
X
X
X
X
(a) Adult and pediatric trauma patient
								care;
X
X
X
X
X
(b) Pediatric trauma patient care.
X
X
X
(2) A trauma medical director responsible for the
								organization and direction of the trauma service who:
X
X
X
X
X
X
X
X
(a) Is currently certified in advanced trauma life
								support (ATLS);
X
X
X
X
X
X
(b) Is a board-certified general
								surgeon;
X
X
(c) Is a board-certified general surgeon
or
general surgeon trained in advanced cardiac life support (ACLS)
								;
X
(d) Is a board-certified general surgeon ,
								emergency physician, a general surgeon ACLS trained with current certification
								in advanced trauma life support (ATLS ) or a physician ACLS trained and current
								certification in ATLS;
X
(e) Is a board-certified general surgeon ,
								emergency physician, a physician ACLS trained with current certification in
								ATLS, or a physician assistant or advanced registered nurse practitioner ACLS
								trained who is currently certified in ATLS ;
X
(f) Is a board-certified pediatric surgeon or a
								board-certified general surgeon with special competence in the care of
								pediatric patients;
X
X
(g) Is a board-certified general surgeon with
								special competence in the care of pediatric patients or a general surgeon ACLS
								trained and with special competence in the care of pediatric
								patients;
X
(h) Must complete thirty-six hours in three years
								of verifiable, external, trauma-related continuing medical education
								(CME);
X
X
X
X
(i) Meets the pediatric education requirement
								(PER) as defined in subsection (27) of this section;
X
X
X
X
X
X
X
X
(j) Must have responsibility and authority for
								determining each general surgeon's ability to participate on the trauma call
								panel based on an annual review, conducted in conjunction with medical staffing
								and with authority through the trauma quality improvement program and hospital
								policy;
X
X
X
X
X
X
(k) Is a member of and actively participates in a
								regional or national trauma organizations.
X
X
X
X
(3) A trauma program manager or trauma service
								coordinator responsible for the overall operation of trauma service
								who:
X
X
X
X
X
X
X
X
(a) Is a registered nurse;
X
X
X
X
X
X
X
X
(b) Has taken ACLS;
X
X
X
X
X
X
X
X
(c) Has successfully completed a trauma nursing
								core course (TNCC) or a department approved equivalent course, and successfully
								completes thirty-six hours of trauma-related education every three years in
								either external continuing education or in an internal education process
								conducted by the trauma program. The trauma education must include, but is not
								limited to, the following topics:
X
X
X
X
X
X
X
X
(i) Mechanism of injury;
X
X
X
X
X
X
X
X
(ii) Shock and fluid resuscitation;
X
X
X
X
X
X
X
X
(iii) Initial assessment;
X
X
X
X
X
X
X
X
(iv) Stabilization and transport.
X
X
X
X
X
X
X
X
(d) Has taken pediatric advanced life support
								(PALS) or emergency nursing pediatric course (ENPC), and thereafter meets the
								PER contact hours as defined in subsection (27) of this section;
X
X
X
X
X
(e) Has current PALS or ENPC
								certification;
X
X
X
(f) Has attended a trauma program manager
								orientation course provided by the department or a department approved
								equivalent, within the first eighteen months in the role;
X
X
X
X
X
X
X
X
(g) Is responsible for the overall supervision of
								the trauma registry and the quality of data submitted to the
								registry.
X
X
X
X
X
X
X
X
(4) A multidisciplinary trauma quality improvement
								program that must:
X
X
X
X
X
X
X
X
(a) Be led by the multidisciplinary trauma service
								committee :
X
X
X
X
X
X
X
X
(i) The trauma medical director serves as chair of
								the multidisciplinary trauma service committee;
X
X
X
X
X
X
X
X
(ii) The trauma medical director must attend a
								minimum of fifty percent of the peer review committee meetings;
X
X
X
X
X
X
X
X
(iii) The trauma medical director and trauma
								program manager must have the authority and be empowered by the hospital
								governing body to lead the program to ensure compliance with trauma service
								standards.
X
X
X
X
X
X
X
X
(b) Demonstrate a continuous quality improvement
								process supported by a reliable method of data collection that consistently
								obtains the information necessary to identify opportunities for
								improvement;
X
X
X
X
X
X
X
X
(c) Have membership representation and
								participation that reflects the facility's trauma scope of service;
X
X
X
X
X
X
X
X
(d) Have an organizational structure that
								facilitates the process of quality improvement with a reporting relationship to
								the hospital's administrative team and medical executive committee that ensures
								adequate evaluation of all aspects of trauma care;
X
X
X
X
X
X
X
X
(e) Have authority to establish trauma care
								standards and implement patient care policies, procedures, guidelines, and
								protocols throughout the hospital and the trauma service must use clinical
								practice guidelines, protocols, and algorithms derived from evidence-based
								validated resources;
X
X
X
X
X
X
X
X
(f) Have a current trauma quality improvement plan
								that outlines the trauma service's quality improvement process;
X
X
X
X
X
X
X
X
(g) Have a process to monitor and track compliance
								with the trauma care standards using audit filters and benchmarks;
X
X
X
X
X
X
X
X
(h) Have a process to evaluate the care provided
								to trauma patients and to resolve identified prehospital, physician, nursing,
								or system issues;
X
X
X
X
X
X
X
X
(i) Have a process in which outcome measures are
								documented within the trauma quality improvement program's written plan which
								must be reviewed and updated at least annually. Outcome measures will include,
								at a minimum:
X
X
X
X
X
X
X
X
(i) Mortality (with and without opportunities for
								improvement);
(ii) Trauma surgeon response time (level
								I-III);
(iii) Undertriage rate;
(iv) Emergency department length of stay greater
								than three hours for patients transferred out;
(v) Missed injuries;
(vi) Complications.
(j) Have a process for correcting problems or
								deficiencies;
X
X
X
X
X
X
X
X
(k) Have a process for problem resolution, outcome
								improvements, and assurance of safety. This process must be readily
								identifiable through methods of monitoring, reevaluation, benchmarking, and
								documentation;
X
X
X
X
X
X
X
X
(l) Have a process to continuously evaluate
								compliance with full and modified (if used) trauma team activation criteriaas
								follows:
X
X
X
X
X
X
X
X
(i) The attending surgeon's arrival within fifteen
								minutes for level II and thirty minutes for level III services for patients
								with appropriate activation criteria must be monitored by the hospital's trauma
								quality improvement program;
X
X
X
X
X
X
(ii) All trauma team activations must be
								categorized by the level of response activation and quantified by number and
								percentage;
X
X
X
X
X
X
X
X
(iii) Trauma surgeon response time to full
								activations and for backup call response must be determined and monitored.
								Variances should be documented and reviewed for reason for delay, opportunities
								for improvement, and corrective actions; and
X
X
X
X
X
X
(iv) Rates of undertriage must be monitored and
								reviewed quarterly.
X
X
X
X
X
X
X
X
(m) Have assurance from other hospital quality
								improvement committees, including peer review if conducted separately from the
								multidisciplinary trauma service committee, that resolution was achieved on
								trauma-related issues. The following requirements must also be
								satisfied:
X
X
X
X
X
X
X
X
(i) Peer review must occur at regular intervals to
								ensure that the volume of cases is reviewed in a timely fashion;
X
X
X
X
X
X
X
X
(ii) A process must be in place to ensure that the
								trauma program manager receives feedback from peer review for trauma-related
								issues;
X
X
X
X
X
X
X
X
(iii) All trauma-related mortalities must be
								systematically reviewed and those mortalities with opportunities for
								improvement identified for peer review;
X
X
X
X
X
X
X
X
(iv) This effort must involve the participation
								and leadership of the trauma medical director and any departments, such as:
								General surgery, emergency medicine, orthopedics, neurosurgery, anesthesia,
								critical care, lab and radiology; and
X
X
X
X
X
X
X
X
(v) The multidisciplinary trauma peer review
								committee must systematically review significant complications and process
								variances associated with unanticipated outcomes and determine opportunities
								for improvement.
X
X
X
X
X
X
X
X
(n) Have a process to ensure the confidentiality
								of patient and provider information, in accordance with
								RCW
								70.41.200 and
								70.168.090;
X
X
X
X
X
X
X
X
(o) Have a process to communicate with and provide
								feedback to referring trauma services and trauma care providers;
X
X
X
X
X
X
X
X
(p) Be able to integrate trauma quality
								improvement into the hospital's quality improvement program for level III, IV,
								V trauma services or level III pediatric trauma services with a total annual
								trauma volume of less than one hundred patients; however, trauma care must be
								formally addressed in accordance with the quality improvement requirements in
								this subsection. In that case, the trauma medical director is not required to
								serve as chair;
X
X
X
X
(q) Have a pediatric-specific trauma quality
								improvement program for a trauma service admitting at least one hundred
								pediatric trauma patients annually. For a trauma service admitting less than
								one hundred pediatric trauma patients annually, or that is transferring trauma
								patients, the trauma service must review each case for timeliness and
								appropriateness of care;
X
X
X
X
X
X
X
X
(r) Be a multidisciplinary trauma quality
								improvement program that transcends normal department hierarchies and
								includes:
X
X
X
X
X
X
X
X
Identified medical staff representatives or their
								designees from departments of general surgery, emergency medicine, orthopedics,
								neurosurgery, anesthesiology, critical care, and radiology who must participate
								actively in the multidisciplinary trauma quality improvement program with at
								least fifty percent attendance at peer review committee meetings.
X
X
X
X
X
X
(s) Use risk-adjusted data for benchmarking and
								performance improvement:
X
X
X
X
X
X
X
X
(i) The risk-adjusted benchmarking system to
								measure performance must be the American College of Surgeons Trauma Quality
								Improvement Program (TQIP);
X
X
X
X
(ii) Data must be collected in compliance with the
								National Trauma Data Standard (NTDS) and submitted to the National Trauma Data
								Bank® (NTDB®) every year in a timely fashion so that data can be
								aggregated and analyzed at the national level;
X
X
X
X
(iii) Use risk-adjusted data provided by the state
								for the purposes of benchmarking and performance improvement.
X
X
X
X
(5) Written trauma service standards of care to
								ensure appropriate care throughout the facility for:
X
X
X
X
X
X
X
X
(a) Adult and pediatric trauma
								patients;
X
X
X
X
X
(b) Pediatric trauma patients.
X
X
X
(6) Participation in the regional quality
								improvement program as defined in WAC
								246-976-910.
X
X
X
X
X
X
X
X
(7) Participation in the Washington state trauma
								registry as defined in WAC
								246-976-430.
X
X
X
X
X
X
X
X
(8) Written transfer-in guidelines consistent with
								the facility's designation level and trauma scope of service. The guidelines
								must identify the type, severity and complexity of injuries the facility can
								safely accept, admit, and provide with definitive care.
X
X
X
X
X
X
X
X
(9) Written transfer-out guidelines consistent
								with the facility's designation level and trauma scope of service. The
								guidelines must identify the type, severity and complexity of injuries that
								exceed the resources and capabilities of the trauma service.
X
X
X
X
X
X
X
X
(a) Collaborative treatment and transfer
								guidelines reflecting facilities' capabilities must be developed and regularly
								reviewed, with input from higher-level trauma services that receive these
								patients;
X
X
X
(b) The decision to transfer an injured patient to
								a specialty care facility in an acute situation must be based solely on the
								needs of the patient and not on the requirements of the patient's specific
								provider network, health maintenance organization, a preferred provider
								organization, or the patient's ability to pay;
X
X
X
X
X
X
X
X
(c) Acute transfers out must be subjected to
								individual case review to determine the rationale for transfer, appropriateness
								of care, and opportunities for improvement. Follow-up from the center to which
								the patient was transferred should be obtained as part of the case review; and
X
X
X
X
X
X
X
X
(d) Trauma patients must not be admitted or
								transferred by a primary care physician without the knowledge and consent of
								the trauma service. The quality improvement program should monitor adherence to
								this guideline.
X
X
X
X
X
X
(10) Written interfacility transfer agreements
								with all trauma services that receive the facility's trauma patients.
								Agreements must include a process to identify medical control during the
								interfacility transfer, and address the responsibilities of the trauma service,
								the receiving hospital, and the verified prehospital transport agency. All
								trauma patients must be transported by a trauma verified prehospital transport
								agency.
X
X
X
X
X
X
X
X
(11) An air medical transport plan addressing the
								receipt or transfer of trauma patients with a heli-stop, landing zone, or
								airport located close enough to permit the facility to receive or transfer
								trauma patients by fixed-wing or rotary-wing aircraft.
X
X
X
X
X
X
X
X
(12) A written diversion protocol for the
								emergency department to divert trauma patients from the field to another trauma
								service when resources are temporarily unavailable. The process must
								include:
X
X
X
X
X
X
X
X
(a) Trauma service and patient criteria used to
								decide when diversion is necessary;
X
X
X
X
X
X
X
X
(b) How the divert status will be communicated to
								the nearby trauma services and prehospital agencies;
X
X
X
X
X
X
X
X
(c) How the diversion will be coordinated with the
								appropriate pre-hospital agency;
X
X
X
X
X
X
X
X
(d) A method of documenting/tracking when the
								trauma service is on trauma divert, including the date, time, duration, reason,
								and decision maker;
X
X
X
X
X
X
X
X
(e) Assurance that the decision to divert patients
								from the emergency department is communicated to the trauma surgeon
								on-call;
X
X
X
X
X
X
(f) Involvement of the trauma surgeon in the
								decision regarding diversion each time the center goes on bypass;
X
X
X
X
(g) Routine monitoring, documenting and reporting
								of trauma center diversion hours, including the reason for initiating the
								diversion policy. Trauma center diversion must not exceed five percent of the
								time.
X
X
X
X
X
X
(13) A trauma team activation protocol consistent
								with the facility's trauma scope of service. The protocol must:
X
X
X
X
X
X
X
X
(a) Define the physiologic, anatomic, and
								mechanism of injury criteria used to activate the full and modified (if used)
								trauma teams;
X
X
X
X
X
X
X
X
(b) Identify members of the full and modified (if
								used) trauma teams consistent with the provider requirements of this
								chapter;
X
X
X
X
X
X
X
X
(c) Define the process to activate the trauma
								team. The process must:
X
X
X
X
X
X
X
X
(i) Consistently apply the trauma service's
								established criteria;
X
X
X
X
X
X
X
X
(ii) Use information obtained from prehospital
								providers or an emergency department assessment for patients not delivered by a
								prehospital agency;
X
X
X
X
X
X
X
X
(iii) Be applied regardless of time post injury or
								previous care, whether delivered by prehospital or other means and whether
								transported from the scene or transferred from another facility;
X
X
X
X
X
X
X
X
(iv) Include a method to upgrade a modified
								activation to a full activation when newly acquired information warrants
								additional capabilities and resources;
X
X
X
X
X
X
X
X
(v) Include the mandatory presence of a general
								surgeon for full trauma team activations. The general surgeon assumes
								leadership and overall care using professional judgment regarding the need for
								surgery or transfer;
X
X
X
X
X
X
(vi) Include the mandatory presence of a general
								surgeon if general surgery services are included in the facility's trauma scope
								of service. The general surgeon assumes leadership and overall care using
								professional judgment regarding the need for surgery or transfer;
X
(vii) For trauma team activations in pediatric
								designated trauma services (within five minutes for level I, twenty minutes for
								level II or thirty minutes for level III), one of the following pediatric
								physician specialists must respond:
X
X
X
(A) A pediatric surgeon;
(B) A pediatric emergency medicine
								physician;
(C) A pediatric intensivist;
(D) A pediatrician;
(E) A postgraduate year two or higher pediatric
								resident.
(viii) Require multisystem injured patients to be
								admitted to or evaluated by an identifiable surgical service staffed by
								credentialed trauma providers.
X
X
X
(14) Emergency care services available twenty-four
								hours every day with:
X
X
X
X
X
X
X
X
(a) An emergency department (except for level V
								clinics);
X
X
X
X
X
X
X
X
(b) The ability to resuscitate and stabilize adult
								and pediatric trauma patients in a designated resuscitation area;
X
X
X
X
X
(c) The ability to resuscitate and stabilize
								pediatric trauma patients in a designated resuscitation area;
X
X
X
(d) A medical director, who:
X
X
X
X
X
X
(i) Is board-certified in emergency medicine,
								board-certified in general surgery, or is board-certified in another relevant
								specialty practicing emergency medicine as their primary practice;
X
X
X
(ii) Is board-certified in pediatric emergency
								medicine, board-certified in emergency medicine with special competence in the
								care of pediatric patients, board-certified in general surgery with special
								competence in the care of pediatric patients, or board-certified in a relevant
								specialty practicing emergency medicine as their primary practice with special
								competence in the care of pediatric patients.
X
X
X
(e) Emergency physicians who:
X
X
X
X
X
X
X
X
(i) Are board-certified in emergency medicine or
								board-certified in a relevant specialty practicing emergency medicine as their
								primary practice. This requirement can be met by a postgraduate year two or
								higher emergency medicine or general surgery resident working under the direct
								supervision of the attending emergency physician. The resident must be
								available within five minutes of notification of the patient's arrival to
								provide leadership and care until arrival of the general surgeon;
X
X
(ii) Are board-certified in pediatric emergency
								medicine, are board-certified in emergency medicine with special competence in
								the care of pediatric patients,
or
are board-certified in a
								relevant specialty practicing emergency medicine as their primary practice with
								special competence in the care of pediatric patients. This requirement can be
								met by a postgraduate year two or higher emergency medicine or general surgery
								resident with special competence in the care of pediatric trauma patients and
								working under the direct supervision of the attending emergency physician. The
								resident must be available within five minutes of notification of the patient's
								arrival to provide leadership and care until arrival of the general
								surgeon;
X
X
(iii) Are board-certified in emergency medicine or
								another relevant specialty practicing emergency medicine as their primary
								practice
or
physicians practicing emergency medicine as their
								primary practice with current certification in ACLS and ATLS;
X
(iv) Are board-certified in pediatric emergency
								medicine, are board-certified in emergency medicine or surgery, with special
								competence in the care of pediatric patients, are board-certified in a relevant
								specialty practicing emergency medicine as their primary practice, with special
								competence in the care of pediatric patients,
or
are physicians
								with current certification in ATLS who are practicing emergency medicine as
								their primary practice with special competence in the care of pediatric
								patients;
X
(v) Are board-certified in emergency medicine or
								another relevant specialty and practicing emergency medicine as their primary
								practice
or
physicians with current certification in ACLS and
								ATLS. A physician assistant (PA) or advanced registered nurse practitioner
								(ARNP) current in ACLS and ATLS may initiate evaluation and treatment upon the
								patient's arrival in the emergency department until the arrival of the
								physician;
X
(vi) Are board-certified or qualified in emergency
								medicine, surgery, or other relevant specialty and practicing emergency
								medicine as their primary practice
or
are physicians with current
								certification in ACLS and ATLS,
or
are PAs or ARNPs with current
								certification in ACLS and ATLS ;
X
(vii) Are available within five minutes of
								notification of the patient's arrival in the emergency department;
X
X
X
X
X
X
(viii) Are on-call and available within twenty
								minutes of notification of the patient's arrival in the emergency
								department;
X
X
(ix) Are currently certified in ACLS and ATLS.
								This requirement applies to all emergency physicians and residents who care for
								trauma patients in the emergency department except this requirement does not
								apply to physicians who are board-certified in emergency medicine
or
board-certified in another relevant specialty and practicing
								emergency medicine as their primary practice;
X
X
X
X
X
(x) Are currently certified in ATLS. This
								requirement applies to all emergency physicians and residents who care for
								pediatric patients in the emergency department except this requirement does not
								apply to physicians who are board-certified in pediatric emergency medicine,
								board-certified in emergency medicine,
or
board-certified in
								another relevant specialty and practicing emergency medicine as their primary
								practice;
X
X
X
(xi) Meet the PER as defined in subsection (27) of
								this section;
X
X
X
X
X
X
X
X
(xii) If the liaison or designee from emergency
								medicine, must complete thirty-six hours of trauma-related CME every three
								years in either external CME or in an internal educational process conducted by
								the trauma program or meet the requirements for participation in maintenance of
								certification of a member board of the American Board of Medical Specialties at
								the time of renewal;
X
X
X
X
(xiii) If they are emergency physicians who
								participate on the trauma team, they must be knowledgeable and current in the
								care of injured patients. This requirement may be met by completing thirty-six
								hours of trauma-related CME every three years in either external CME or in an
								internal educational process conducted by the trauma program or meet the
								requirements for participation in maintenance of certification of a member
								board of the American Board of Medical Specialties at the time of
								renewal;
X
X
X
X
(xiv) Nonboard-certified emergency physicians and
								advanced practitioners who participate in the initial care or evaluation of
								trauma activated patients in the emergency department must have current ATLS
								certification;
X
X
X
X
X
X
X
X
(xv) Must be able to provide initial resuscitative
								care to known trauma activated patients;
X
X
X
X
X
X
(xvi) Have completed appropriate orientation,
								credentialing, initial ED management/evaluation processes, and skill
								maintenance for advanced practitioners who participate in the initial
								assessment of trauma patients.
X
X
X
X
X
X
X
X
(f) Emergency care registered nurses (RNs)
								who:
X
X
X
X
X
X
X
X
(i) Are in the emergency department and available
								within five minutes of notification of patient's arrival;
X
X
X
X
X
X
(ii) Are in-house and available within five
								minutes of notification of the patient's arrival ;
X
X
(iii) Have current certification in
								ACLS;
X
X
X
X
X
(iv) Have successfully completed TNCC or a
								department approved equivalent course;
X
X
X
X
X
X
X
X
(v) Have completed twelve hours of trauma related
								education every designation period. The trauma education must include, but is
								not limited to, the following topics:
X
X
X
X
X
X
X
(A) Mechanism of injury;
(B) Shock and fluid resuscitation;
(C) Initial assessment;
(D) Stabilization and transport.
(vi) Meet the PER as defined in subsection (27) of
								this section.
X
X
X
X
X
X
X
X
(g) Standard emergency equipment for the
								resuscitation and life support of adult and pediatric trauma patients,
								including:
X
X
X
X
X
X
X
X
(i) Immobilization devices:
X
X
X
X
X
X
X
X
(A) Back board;
X
X
X
X
X
X
X
X
(B) Cervical injury;
X
X
X
X
X
X
X
X
(C) Long-bone.
X
X
X
X
X
X
X
X
(ii)(A) Infusion control device:
X
X
X
X
X
X
X
X
(B) Rapid infusion capability.
X
X
X
X
X
X
(iii) Intraosseous devices;
X
X
X
X
X
X
X
X
(iv) Sterile surgical sets:
X
X
X
X
X
X
X
X
(A) Thoracostomy with closed drainage
								devices;
X
X
X
X
X
X
X
X
(B) Emergency transcutaneous airway;
X
X
X
X
X
X
X
X
(C) Bedside ultrasound;
X
X
X
X
X
X
X
(D) Thoracotomy;
X
X
X
X
X
X
(v) Thermal control equipment:
X
X
X
X
X
X
X
X
(A) Blood and fluid warming;
X
X
X
X
X
X
X
X
(B) Thermometer capable of detecting
								hypothermia;
X
X
X
X
X
X
X
X
(C) Patient warming and cooling.
X
X
X
X
X
X
X
X
(vi) Other equipment:
X
X
X
X
X
X
X
X
(A) Medication chart, tape or other system to
								assure ready access to information on proper doses-per-kilogram for
								resuscitation drugs and equipment sizes for pediatric patients;
X
X
X
X
X
X
X
X
(B) Pediatric emergency airway equipment readily
								available or transported in-house with the pediatric patient for evaluation,
								treatment or diagnostics, including bag-valve masks, face masks, and oral/nasal
								airways.
X
X
X
X
X
X
X
X
(15) Respiratory therapy services, with a
								respiratory care practitioner available within five minutes of notification of
								patient's arrival.
X
X
X
X
X
X
(16) Diagnostic imaging services (except for level
								V clinics) with:
X
X
X
X
X
X
X
X
(a) A radiologist in person or by teleradiology,
								who is:
X
X
X
X
X
X
(i) On-call and available within twenty minutes of
								the trauma team leader's request;
X
X
X
X
(ii) On-call and available within thirty minutes
								of the trauma team leader's request;
X
X
(iii) Board certified or eligible for
								certification by an appropriate radiology board according to current
								requirements for licensed radiologists who take trauma call.
X
X
X
X
(b) Personnel able to perform routine radiological
								capabilities who are:
X
X
X
X
X
X
X
X
(i) Available within five minutes of notification
								of the patient's arrival;
X
X
X
X
(ii) On-call and available within twenty minutes
								of notification of the patient's arrival.
X
X
X
X
(c) A technologist able to perform computerized
								tomography who is:
X
X
X
X
X
X
(i) Available within five minutes of the trauma
								team leader's request;
X
X
(ii) On-call and available within twenty minutes
								of the trauma team leader's request.
X
X
X
X
(d) A radiologic peer review process that reviews
								routine interpretations of images for accuracy. Determinations related to
								trauma patients must be communicated to the trauma program quality
								committee;
X
X
X
X
X
X
(e) Angiography with a technologist on-call and
								available within thirty minutes of the trauma team leader's
								request;
X
X
X
X
(f) Magnetic resonance imaging with a technologist
								on-call and available within sixty minutes of the trauma team leader's
								request;
X
X
X
X
(g) Sonography with a technologist on-call and
								available within thirty minutes of the trauma team leader's
								request;
X
X
X
X
(h) Interventional radiology services on-call and
								available within thirty minutes of the trauma team leader's
								request;
X
X
X
X
(i) Radiologists who are involved, at a minimum,
								in protocol development and trend analysis that relate to diagnostic
								imaging;
X
X
X
X
X
X
(j) Facilities that have a mechanism in place to
								view radiographic imaging from referring hospitals that are within their
								catchment area.
X
X
X
X
(17) Clinical laboratory services (except for
								level V clinics), with:
X
X
X
X
X
X
X
X
(a) Lab services available within five minutes of
								notification of the patient's arrival;
X
X
X
X
X
X
(b) Lab services on-call and available within
								twenty minutes of notification of the patient's arrival;
X
X
(c) Blood gases and pH determination;
X
X
X
X
X
X
X
(d) Coagulation studies;
X
X
X
X
X
X
X
X
(e) Drug or toxicology measurements;
X
X
X
X
X
X
X
X
(f) Microbiology;
X
X
X
X
X
X
X
X
(g) Serum alcohol determination;
X
X
X
X
X
X
X
X
(h) Serum and urine osmolality;
X
X
X
X
(i) Standard analysis of blood, urine, and other
								body fluids.
X
X
X
X
X
X
X
X
(18) Blood and blood-component services (except
								for level V clinics) with:
X
X
X
X
X
X
X
X
(a) Ability to obtain blood typing and
								crossmatching;
X
X
X
X
X
X
X
X
(b) Autotransfusion;
X
X
X
X
X
X
(c) Blood and blood components available from
								in-house or through community services, to meet patient needs;
X
X
X
X
X
X
X
X
(d) Blood storage capability;
X
X
X
X
X
X
X
(e) Noncrossmatched blood available on patient
								arrival in the emergency department;
X
X
X
X
X
X
X
X
(f) Policies and procedures for massive
								transfusion.
X
X
X
X
X
X
X
(19) General surgery services with:
X
X
X
X
X
X
(a) Surgeons who meet the following
								requirements:
X
X
X
X
X
X
(i) Are board-certified in general surgery and
								available within fifteen minutes of notification of the patient's arrival when
								the full trauma team is activated. This requirement can be met by a
								postgraduate year four or higher surgery resident. The resident may initiate
								evaluation and treatment upon the patient's arrival in the emergency department
								until arrival of the general surgeon. In this case the general surgeon must be
								available within fifteen minutes of notification of patient's
								arrival;
X
(ii) Are board-certified in pediatric surgery or
								board-certified in general surgery with special competence in the care of
								pediatric patients and are available within fifteen minutes of notification of
								the patient's arrival when the full trauma team is activated. This requirement
								can be met by a post graduate year four or higher pediatric surgery resident or
								a general surgery resident with special competence in the care of pediatric
								patients. The resident may initiate evaluation and treatment upon the patient's
								arrival in the emergency department until arrival of the pediatric or general
								surgeon. In this case the pediatric or general surgeon must be available within
								fifteen minutes of notification of patient's arrival;
X
(iii) Are board-certified in general surgery. For
								full trauma team activations, the surgeon must be in the emergency department
								upon patient arrival when prehospital estimated time of arrival (ETA) is
								fifteen minutes or more. Otherwise the surgeon must be in the emergency
								department within fifteen minutes of notification of patient's arrival. This
								requirement can be met by a postgraduate year four or higher surgery resident.
								The resident may initiate evaluation and treatment upon the patient's arrival
								in the emergency department until arrival of the general surgeon;
X
(iv) Are board-certified in pediatric surgery
or
board-certified in general surgery with special competence in
								the care of pediatric patients. For full trauma team activations, the surgeon
								must be in the emergency department upon patient arrival when prehospital
								estimated time of arrival (ETA) is fifteen minutes or more. Otherwise the
								surgeon must be in the emergency department within fifteen minutes of
								notification of patient's arrival. This requirement can be met by a
								postgraduate year four or higher pediatric surgery resident or a general
								surgical resident with special competence in the care of pediatric patients.
								The resident may initiate evaluation and treatment upon the patient's arrival
								in the emergency department until arrival of the pediatric or general
								surgeon;
X
(v) Are board-certified or trained in ACLS and
								currently certified in ATLS. For full trauma team activations, the surgeon must
								be in the emergency department upon patient arrival when prehospital estimated
								time of arrival (ETA) is thirty minutes or more. Otherwise the surgeon must be
								in the emergency department within thirty minutes of notification of patient's
								arrival;
X
(vi) Are board-certified or board-qualified with
								special competence in the care of pediatric patients. For full trauma team
								activations, the surgeon must be in the emergency department upon patient
								arrival when prehospital estimated time of arrival (ETA) is thirty minutes or
								more. Otherwise the surgeon must be in the emergency department within thirty
								minutes of notification of patient's arrival;
X
(vii) Are trained in ACLS and currently certified
								in ATLS. This requirement applies to all surgeons and residents caring for
								trauma patients except this requirement does not apply to surgeons who are
								board certified in general surgery;
X
X
X
(viii) Are currently certified in ATLS. This
								requirement applies to all surgeons and residents caring for pediatric trauma
								patients except this requirement does not apply to surgeons who are board
								certified in pediatric or general surgery;
X
X
X
(ix) Meet the PER as defined in subsection (27) of
								this section;
X
X
X
X
X
X
(x) Have privileges in general
								surgery;
X
X
X
(xi) Maintain at least eighty percent attendance
								at activations with a mechanism for documenting this attendance record, as
								required for full trauma activations. The expectation is for one hundred
								percent attendance at activations;
X
X
X
X
X
X
(xii) The attending surgeon is expected to be
								present in the operating room for all operations. A mechanism for documenting
								this presence is required;
X
X
X
X
X
X
(xiii) A surgeon from the trauma call panel must
								participate in the hospital's disaster planning process;
X
X
X
X
X
X
(xiv) Each member of the group of general surgeons
								must attend at least fifty percent of the peer review committee
								meetings;
X
X
X
X
(xv) If at least fifty percent of the general
								surgeons did not attend the peer review committee meetings, then the trauma
								service must be able to demonstrate that there is a formal process for
								communicating information from the committee meetings to the group of general
								surgeons.
X
X
(b) A published schedule for first call with a
								written plan for surgery coverage if the surgeon on call for trauma is
								otherwise clinically engaged. The plan must take into consideration the trauma
								service's total patient volume, patient acuity, geographic proximity to other
								trauma services, depth of trauma care resources, and the trauma scope of
								service. Diversion or transfer to definitive care should be the last option.
								The plan must be monitored through the trauma service's trauma quality
								improvement program. In addition:
X
X
X
X
X
X
(i) Surgical commitment is required for a properly
								functioning trauma center;
X
X
X
X
X
X
(ii) The trauma surgeon on call must be dedicated
								to a single trauma center while on duty;
X
X
X
X
(iii) The liaison from general surgery must
								complete thirty-six hours of trauma-related CME every three years in either
								external CME or in an internal educational process conducted by the trauma
								program or meet the requirements for participation in maintenance of
								certification of a member board of the American Board of Medical Specialties at
								the time of renewal;
X
X
X
X
(iv) Other general surgeons who participate on the
								trauma team must be knowledgeable and current in the care of injured patients.
								This requirement may be met by completing thirty-six hours of trauma-related
								CME every three years in either external CME or in an internal educational
								process conducted by the trauma program or meet the requirements for
								participation in maintenance of certification of a member board of the American
								Board of Medical Specialties at the time of renewal.
X
X
X
X
(c) General surgery services that meet all level
								III general surgery service standards if the facility's trauma scope of service
								includes general surgery services twenty-four hours every day
or
transfer trauma patients who need general surgery services to a designated
								trauma service with general surgery services available.
X
(20) Neurosurgery services with neurosurgeons who
								meet the following requirements:
X
X
X
X
(a) Are board-certified, and available within five
								minutes of the trauma team leader's request;
X
X
This requirement can be met by a postgraduate year
								four or higher neurosurgery resident. The resident may initiate evaluation and
								treatment upon the patient's arrival in the emergency department until arrival
								of the neurosurgeon. In this case the neurosurgeon must be available within
								thirty minutes of the trauma team leader's request.
X
X
(b) Are board-certified or board-qualified and
								on-call and available within thirty minutes of the trauma team leader's
								request;
X
X
(c) Are board-certified or board-qualified and
								on-call and available within thirty minutes of the trauma team leader's request
								if the facility's trauma scope of service includes neurosurgery services
								twenty-four hours every day
or
transfer trauma patients who need
								neurosurgery services to a designated trauma service with neurosurgery services
								available;
X
X
X
(d) The liaison from neurosurgery must complete
								thirty-six hours of trauma-related CME every three years in either external CME
								or in an internal educational process conducted by the trauma program or meet
								the requirements for participation in maintenance of certification of a member
								board of the American Board of Medical Specialties at the time of
								renewal;
X
X
X
X
(e) Other neurosurgeons who participate on the
								trauma team must be knowledgeable and current in the care of injured patients.
								This requirement may be met by completing thirty-six hours of trauma-related
								CME every three years in either external CME or in an internal educational
								process conducted by the trauma program or meet the requirements for
								participation in maintenance of certification of a member board of the American
								Board of Medical Specialties at the time of renewal;
X
X
X
X
(f) The facility must have a predefined and
								thoroughly developed neurotrauma diversion plan that is implemented when the
								neurosurgeon on call becomes encumbered. A neurotrauma diversion plan must
								include the following:
X
X
X
X
(i) Emergency medical services notification of
								neurosurgery advisory status/divert;
X
X
X
X
(ii) A thorough review of each instance by the
								quality improvement program; and
X
X
X
X
(iii) Monitoring of the efficacy of the process by
								the quality improvement program.
X
X
X
X
(g) A published schedule for first call with a
								written plan for neurosurgery coverage is required, for when the neurosurgeon
								on call for trauma is otherwise clinically engaged. The plan must take into
								consideration the trauma services total patient volume, patient acuity,
								geographic proximity to other trauma services, depth of trauma care resources,
								and the trauma scope of service. Diversion or transfer to definitive care
								should be the last option. The plan must be monitored through the trauma
								services trauma quality improvement program;
X
X
X
X
(h) If one neurosurgeon covers two trauma services
								within the same limited geographic area, there must be a contingency
								plan.
X
X
X
X
(21) Surgical services on-call and available
								within thirty minutes of the trauma team leader's request for:
X
X
X
X
X
X
(a) Cardiac surgery;
X
X
(b) Microsurgery;
X
X
(c) Obstetric surgery
or
for level
								III trauma services, a plan to manage the pregnant trauma patient;
X
X
X
X
X
X
(d) Orthopedic surgery including the
								following:
X
X
X
X
X
X
(i) Orthopedic team members must have dedicated
								call at their institution or have an effective backup call system;
X
X
X
X
(ii) If the on-call orthopedic surgeon is unable
								to respond promptly, a backup consultant on-call surgeon must be
								available;
X
X
X
X
(iii) If the orthopedic surgeon is not dedicated
								to a single facility while on call, then a published backup schedule is
								required;
X
X
(iv) A published schedule for first call with a
								written plan for orthopedic surgery coverage is required for when the
								orthopedic surgeon on call for trauma is otherwise clinically engaged. The plan
								must take into consideration the trauma services total patient volume, patient
								acuity, geographic proximity to other trauma services, depth of trauma care
								resources, and the trauma scope of service. Diversion or transfer to definitive
								care should be the last option. The plan must be monitored through the trauma
								services trauma quality;
X
X
X
X
X
X
(v) The liaison from orthopedic surgery must
								complete thirty-six hours of trauma-related CME every three years in either
								external CME or in an internal educational process conducted by the trauma
								program or meet the requirements for participation in maintenance of
								certification of a member board of the American Board of Medical Specialties at
								the time of renewal;
X
X
X
X
(vi) Other orthopedic surgeons who participate on
								the trauma team must be knowledgeable and current in the care of injured
								patients. This requirement may be met by completing thirty-six hours of
								trauma-related CME every three years in either external CME or in an internal
								educational process conducted by the trauma program or meet the requirements
								for participation in maintenance of certification of a member board of the
								American Board of Medical Specialties at the time of renewal.
X
X
X
X
(e) Orthopedic surgery services on-call and
								available within thirty minutes of the trauma team leader's request if the
								facility's trauma scope of service includes orthopedic surgery services
								twenty-four hours every day or transfer trauma patients who need orthopedic
								surgery services to a designated trauma service with orthopedic surgery
								services available;
X
(f) Thoracic surgery;
X
X
X
X
(g) Urologic surgery;
X
X
X
X
(h) Vascular surgery.
X
X
X
X
(22) Surgical services on-call for patient
								consultation or management at the trauma team leader's request for:
X
X
X
X
(a) Cranial facial surgery;
X
X
X
X
(b) Gynecologic surgery;
X
X
X
X
(c) Ophthalmic surgery;
X
X
X
X
(d) Plastic surgery.
X
X
X
X
(23) Anesthesiology services with board-certified
								anesthesiologists or certified registered nurse anesthetists (CRNAs) who meet
								the following requirements:
X
X
X
X
X
X
(a) Are available within five minutes of the
								trauma team leader's request;
X
X
(b) Are on-call and available within twenty
								minutes of the trauma team leader's request;
X
X
(c) Are on-call and available within thirty
								minutes of the trauma team leader's request;
X
X
(d) Are ACLS trained except this requirement does
								not apply to physicians board-certified in anesthesiology;
X
X
X
X
X
X
(e) Are highly experienced and committed to the
								care of injured patients; who organize and supervise the anesthetic care of
								injured patients; and who serve as the designated liaison to the trauma
								program;
X
X
X
X
(f) When anesthesiology senior residents or CRNAs
								are used to fulfill availability requirements, the attending anesthesiologist
								on call must be advised, available within thirty minutes at all times, and
								present for all operations;
X
X
X
X
(g) A published schedule for first call, with a
								written plan for anesthesia coverage is required for when the anesthesia
								provider on call for trauma is otherwise clinically engaged. The plan must take
								into consideration the trauma services total patient volume, patient acuity,
								geographic proximity to other trauma services, depth of trauma care resources,
								and the trauma scope of service. Diversion or transfer to definitive care
								should be the last option. The plan must be monitored through the trauma
								services trauma quality improvement program;
X
X
X
X
X
X
(h) Meet the PER as defined in subsection (27) of
								this section;
X
X
X
X
X
X
(i) Meet all level III anesthesiology service
								standards if the facility's trauma scope of service includes surgery services
								twenty-four hours every day
or
transfer trauma patients who need
								surgery services to a designated trauma service with surgery services
								available.
X
(24) Operating room services with:
X
X
X
X
X
X
(a) Hospital staff responsible for opening and
								preparing the operating room available within five minutes of
								notification;
X
X
X
X
X
X
(b) Operating room staff on-call and available
								within fifteen minutes of notification;
X
X
X
X
(c) Operating room staff on-call and available
								within thirty minutes of notification;
X
X
(d) A written plan to mobilize additional surgical
								team members for trauma patient surgery;
X
X
X
X
X
X
(e) Delays in operating room availability
								routinely monitored. Any case that is associated with a significant delay or
								adverse outcome must be reviewed for reasons for delay and opportunity for
								improvement;
X
X
X
X
X
X
(f) Standard surgery instruments and equipment
								needed to perform operations on adult and pediatric patients,
								including:
X
X
X
X
X
X
(i) Blood recovery and transfusion;
X
X
X
X
X
X
(ii) Bronchoscopy equipment;
X
X
X
X
X
X
(iii) Cardiopulmonary bypass;
X
X
X
X
(iv) Craniotomy set;
X
X
X
X
(v) Endoscopy equipment;
X
X
X
X
X
X
(vi) Rapid infusion capability;
X
X
X
X
X
X
(vii) Thermal control equipment:
X
X
X
X
X
X
(A) Blood and fluid warming;
X
X
X
X
X
X
(B) Patient warming and cooling.
X
X
X
X
X
X
(g) Operating room services that meet all level
								III operating room service standards if the facility's trauma scope of care
								includes surgery services twenty-four hours every day
or
transfer
								trauma patients who need surgery services to a designated trauma service with
								surgery services available.
X
(25) Post anesthesia care (PACU) services
								with:
X
X
X
X
X
X
(a) At least one registered nurse available
								twenty-four hours every day;
X
X
(b) At least one registered nurse on-call and
								available twenty-four hours every day;
X
X
X
X
(c) Registered nurses who are ACLS
								trained;
X
X
X
X
X
X
(d) PACU equipment to monitor and resuscitate
								patients, including:
X
X
X
X
X
X
(i) Pulse oximetry;
(ii) End-tidal carbon dioxide
								detection;
(iii) Arterial pressure monitoring;
(iv) Patient rewarming.
(e) Post anesthesia care services that meet all
								level III post anesthesia care service standards if the facility's trauma scope
								of care includes general surgery services twenty-four hours every day
or
transfer trauma patients who need surgery services to a
								designated trauma service with surgery services available.
X
(26) Critical care services with:
X
X
X
X
X
(a) A critical care medical director who
								is:
X
X
X
X
X
(i) Board-certified in:
X
(A) Surgery and critical care;
X
(B) Pediatric critical care.
X
(ii) Board-certified in critical care
or
board-certified in surgery, internal medicine, or
								anesthesiology with special competence in critical care;
X
X
(iii) Board-certified in critical care with
								special competence in pediatric critical care
or
is
								board-certified in surgery, internal medicine, or anesthesiology with special
								competence in pediatric critical care;
X
(iv) Responsible for coordinating with the
								attending physician for trauma patient care.
X
X
X
X
X
(b) Physician coverage of critically ill trauma
								patients in the intensive care unit (ICU) by appropriately trained physicians
								who meet the following requirements:
X
X
X
X
X
X
(i) Must be available in-house within fifteen
								minutes, twenty-four hours per day;
X
X
(ii) Must be available within fifteen minutes,
								twenty-four hours per day;
X
X
(iii) Must be available within thirty minutes with
								a formal plan in place for emergency coverage.
X
X
(c) For all levels of trauma service, the quality
								improvement program must ensure timely and appropriate ICU coverage is
								provided;
X
X
X
X
X
X
(d) The timely response of credentialed providers
								to the ICU must be continuously monitored as part of the quality improvement
								program;
X
X
X
X
X
X
(e) A designated ICU physician liaison or designee
								to the trauma service. This liaison must attend at least fifty percent of the
								multi-disciplinary peer review meetings with documentation by the trauma
								quality improvement program;
X
X
X
X
X
X
(f) The physician liaison or designee from the ICU
								must complete thirty-six hours of trauma-related CME every three years in
								either external CME or in an internal educational process conducted by the
								trauma program or meet the requirements for participation in maintenance of
								certification of a member board of the American Board of Medical Specialties at
								the time of renewal;
X
X
X
X
(g) Other ICU physicians who participate on the
								trauma team must be knowledgeable and current in the care of injured patients.
								This requirement may be met by completing thirty-six hours of trauma-related
								CME every three years in either external CME or in an internal educational
								process conducted by the trauma program or meet the requirements for
								participation in maintenance of certification of a member board of the American
								Board of Medical Specialties at the time of renewal;
X
X
X
X
(h) Critical care registered nurses
								who:
X
X
X
X
X
(i) Are ACLS trained;
X
X
X
(ii) Have special competence in pediatric critical
								care;
X
X
(iii) Have completed a minimum of six contact
								hours of trauma specific education every three-year designation
								period;
X
X
X
X
(iv) Have completed a minimum of three contact
								hours of trauma specific education every three-year designation
								period.
X
(i) A physician directed code team;
X
X
X
X
X
(j) Pediatric patient isolation
								capacity;
X
X
(k) General surgery consults for critical care
								trauma patients
or
if intensivists are the primary admitting
								nonsurgical physician caring for trauma patients, the intensivists must
								complete a minimum of twelve hours of external or internal trauma critical care
								specific CME every three-year designation period;
X
X
X
X
X
X
(l) Standard critical care equipment for adult and
								pediatric trauma patients, including:
X
X
X
X
X
(i) Cardiac devices:
X
X
X
X
X
(A) Cardiac pacing capabilities;
X
X
X
X
X
(B) Cardiac monitor with at least two pressure
								monitoring modules (cardiac output and hard copy recording), with the
								capability to continuously monitor heart rate, respiratory rate, and
								temperature.
X
X
X
X
X
(ii) Intracranial pressure monitoring
								devices;
X
X
X
X
(iii) Intravenous supplies:
X
X
X
X
X
(A) Infusion control device;
X
X
X
X
X
(B) Rapid infusion capability.
X
X
X
X
X
(iv) Sterile surgical sets:
X
X
X
X
X
(A) Thoracostomy;
X
X
X
X
X
(B) Emergency surgical airway;
X
X
X
X
X
(C) Bedside ultrasound;
X
X
X
X
X
(D) Thoracotomy.
X
X
X
X
X
(v) Thermal control equipment:
X
X
X
X
X
(A) Blood and fluid warming;
X
X
X
X
X
(B) Devices for assuring warmth during
								transport;
X
X
X
X
X
(C) Expanded scale thermometer capable of
								detecting hypothermia;
X
X
X
X
X
(D) Patient warming and cooling.
X
X
X
X
X
(m) A written policy to transfer all pediatric
								trauma patients who need critical care services to a pediatric designated
								trauma service with critical care services available;
X
X
X
(n) Surgical collaboration to set and implement
								policies and administrative decisions impacting trauma patients admitted to the
								ICU;
X
X
X
X
X
X
(o) Critical care services that meet all level III
								critical care service standards, if the facility's trauma scope of service
								includes critical care services for trauma patients twenty-four hours every day
or
transfer trauma patients who need critical care services to a
								designated trauma service with critical care services available;
X
(p) Critical care services that meet all level II
								pediatric critical care service standards if the facility's trauma scope of
								care includes pediatric critical care services for trauma patients twenty-four
								hours every day
or
transfer pediatric trauma patients who need
								critical care services to a designated pediatric trauma service, with pediatric
								critical care services available.
X
(27) Pediatric education requirement
								(PER):
X
X
X
X
X
X
X
X
(a) The pediatric trauma medical director and the
								liaisons from neurosurgery, orthopedic surgery, emergency medicine, and
								critical care medicine must complete thirty-six hours of trauma-related CME
								every three years in either external CME or in an internal educational process
								conducted by the trauma program or meet the requirements for participation in
								maintenance of certification of a member board of the American Board of Medical
								Specialties at the time of renewal;
X
X
(b) PER must be met by the following providers who
								are directly involved in the initial resuscitation and stabilization of
								pediatric trauma patients:
X
X
X
X
X
X
X
X
(i) Emergency department physicians;
X
X
X
X
X
X
X
X
(ii) Emergency department registered
								nurses;
X
X
X
X
X
X
X
X
(iii) Physician assistants or ARNPs who
								participate in the initial care or evaluation of trauma activated patients in
								the emergency department;
X
X
X
X
X
X
X
X
(iv) Emergency medicine or surgical residents who
								initiate care prior to the arrival of the emergency physician;
X
X
X
X
(v) General surgeons;
X
X
X
X
X
X
(vi) Surgical residents who initiate care prior to
								the arrival of the general surgeon;
X
X
X
X
(vii) Anesthesiologists and CRNAs;
X
X
X
X
X
X
(viii) General surgeons, anesthesiologists, and
								CRNAs if the facility's trauma scope of service includes general surgery
								services twenty-four hours every day;
X
(ix) Intensivists involved in the resuscitation,
								stabilization and in-patient care of pediatric trauma patients.
X
X
X
(c) PER must be met by completing pediatric
								specific contact hours as defined below:
X
X
X
X
X
X
X
X
(i) Five contact hours per provider during each
								three-year designation period;
X
X
X
X
X
(ii) Seven contact hours per provider during each
								three-year designation period;
X
X
X
(iii) Contact hours should include, but are not
								limited to, the following topics:
X
X
X
X
X
X
X
X
(A) Initial stabilization and transfer of
								pediatric trauma;
X
X
X
X
X
X
X
X
(B) Assessment and management of pediatric airway
								and breathing;
X
X
X
X
X
X
X
X
(C) Assessment and management of pediatric shock,
								including vascular access;
X
X
X
X
X
X
X
X
(D) Assessment and management of pediatric head
								injuries;
X
X
X
X
X
X
X
X
(E) Assessment and management of pediatric blunt
								abdominal trauma.
X
X
X
X
X
X
X
X
(iv) Contact hours may be accomplished through one
								or more, but not limited to, the following methods:
X
X
X
X
X
X
X
X
(A) Review and discussion of individual pediatric
								trauma cases within the trauma quality improvement program;
X
X
X
X
X
X
X
X
(B) Staff meetings;
X
X
X
X
X
X
X
X
(C) Classes, formal or informal;
X
X
X
X
X
X
X
X
(D) Web-based learning;
X
X
X
X
X
X
X
X
(E) Certification in ATLS, PALS, APLS, ENPC, or
								other department approved equivalents;
X
X
X
X
X
X
X
X
(F) Other methods of learning which appropriately
								communicates the required topics listed in this section.
X
X
X
X
X
X
X
X
(28) Acute dialysis services or must transfer
								trauma patients needing dialysis.
X
X
X
X
X
X
X
X
(29) A burn center, in accordance with the
								American Burn Association, to care for burn patients or must transfer burn
								patients to a burn center, in accordance with the American Burn Association
								transfer guidelines.
X
X
X
X
X
X
X
X
(30) Services on-call for consultation or patient
								management:
X
X
X
X
X
X
(a) Cardiology;
X
X
X
X
(b) Gastroenterology;
X
X
X
X
(c) Hematology;
X
X
X
X
(d) Infectious disease specialists;
X
X
X
X
(e) Internal medicine;
X
X
X
(f) Nephrology;
X
X
X
X
(g) Neurology;
X
X
X
X
(h) Pediatric neurology;
X
X
(i) Pathology;
X
X
X
X
X
X
(j) Pediatrician;
X
X
X
X
X
(k) Pulmonology;
X
X
X
X
(l) Psychiatry
or
a plan for
								management of the psychiatric trauma patient.
X
X
X
X
(31) Ancillary services available for trauma
								patient care:
X
X
X
X
X
X
X
X
(a) Adult protective services;
X
X
X
X
X
(b) Child protective services;
X
X
X
X
X
X
X
X
(c) Chemical dependency services;
X
X
X
X
X
X
(d) Nutritionist services;
X
X
X
X
X
X
X
(e) Occupational therapy services;
X
X
X
X
X
X
(f) Pastoral or spiritual care;
X
X
X
X
X
X
X
X
(g) Pediatric therapeutic recreation/child life
								specialist;
X
X
(h) Pharmacy services, with an in-house
								pharmacist;
X
X
(i) Pharmacy services;
X
X
X
X
X
X
(j) Physical therapy services;
X
X
X
X
X
X
X
(k) Psychological services;
X
X
X
X
X
X
(l) Social services;
X
X
X
X
X
X
X
(m) Speech therapy services.
X
X
X
X
X
X
(32) A trauma care outreach program,
								including:
X
X
X
X
(a) Telephone consultations with physicians of the
								community and outlying areas;
X
X
X
X
(b) On-site consultations with physicians of the
								community and outlying areas.
X
X
X
X
(33) Injury prevention, including:
X
X
X
X
X
X
X
X
(a) A public injury prevention education program
								to include:
X
X
X
X
X
X
(i) An employee in a leadership position that has
								injury prevention as part of their job description;
X
X
X
X
X
X
X
X
(ii) Registry data used to identify injury
								prevention priorities that are appropriate for local
								implementation;
X
X
X
X
X
X
X
X
(iii) Trauma centers that have an organized and
								effective approach to injury prevention and prioritize those efforts based on
								local trauma registry and epidemiologic data.
X
X
X
X
X
X
X
X
(b) Participation in community or regional injury
								prevention activities that include partnerships with other community
								organizations;
X
X
X
X
X
X
X
X
(c) A written plan for drug and alcohol screening
								and brief intervention and referral for treatment;
X
X
X
X
X
X
X
X
(d) Screening and brief intervention for drug and
								alcohol use. All patients who have screened positive must receive an
								intervention by appropriately trained staff and this intervention must be
								documented.
X
X
X
X
X
X
X
X
(34) A formal trauma education training program
								for:
X
X
X
X
(a) Allied health care professional;
X
X
X
X
(b) Community physicians;
X
X
X
X
(c) Nurses;
X
X
X
X
(d) Prehospital personnel;
X
X
X
X
(e) Staff physicians.
X
X
X
X
(35) Provisions to allow for initial and
								maintenance training of invasive manipulative skills for prehospital
								personnel.
X
X
X
X
X
X
X
(36) Residency programs that must:
X
X
(a) Be accredited by the Accreditation Council of
								Graduate Medical Education;
X
X
(b) Be committed to training physicians in trauma
								management.
X
X
(37) A trauma research program conducting research
								applicable to the adult and pediatric trauma patient population,
								including:
X
X
(a) At a minimum, a trauma research program that
								publishes twenty peer-reviewed articles in journals included in Index Medicus
								or PubMed within a three-year period;
X
X
(b) These publications must result from work
								related to the trauma center or the trauma system in which the trauma center
								participates;
X
X
(c) Of the twenty articles, at least one must be
								authored or co-authored by members of the general surgery trauma
								team;
X
X
(d) At least one article each from three of the
								following disciplines is required: Basic sciences, neurosurgery, emergency
								medicine, orthopedics, radiology, anesthesia, vascular surgery,
								plastics/maxillofacial surgery, critical care, cardiothoracic surgery,
								rehabilitation, and nursing;
X
X
(e) In combined level I adult and pediatric
								centers, half of the required research must be pediatric research;
X
X
(f) The administration of a level I trauma center
								must demonstrate support for the research program by including the provision of
								basic laboratory space, sophisticated research equipment, advanced information
								systems, biostatical support, salary support for basic and translational
								scientists, or seed grants for less experienced faculty.
X
X
(38) For joint trauma service designation (when
								two or more hospitals apply to share a single trauma designation):
X
X
X
X
X
X
(a) A single, joint multidisciplinary trauma
								quality improvement program in accordance with the trauma quality improvement
								standards defined in subsection (4) of this section;
X
X
X
X
X
X
(b) A set of common policies and procedures
								adhered to by all hospitals and providers in the joint trauma
								service;
X
X
X
X
X
X
(c) A predetermined, published hospital rotation
								schedule for trauma care.
X
X
X
X
X
X
(39) Trauma centers must meet the disaster-related
								requirements of the facility's accrediting agency.
X
X
X
X
X
X
X
X
(40) Organ procurement activities,
								including:
X
X
X
X
X
X
(a) An established relationship with a recognized
								organ procurement organization (OPO);
X
X
X
X
X
X
(b) A written policy in place for notification of
								the regional OPO;
X
X
X
X
X
X
(c) The trauma center must review its organ
								donation rate annually;
X
X
X
X
X
X
(d) Written protocols defining the clinical
								criteria and confirmatory tests for the diagnosis of brain death.
X
X
X
X
X
X
Statutory Authority:
						RCW
						70.168.050,
						70.168.060, and
						70.168.070. 09-23-085, §
						246-976-700, filed 11/16/09, effective
						12/17/09.