Section 325.130. Trauma facility verification; designation and re-designation.

Rule 6. (1) A healthcare facility, which intends to provide trauma care, shall obtain designation as a trauma facility, and   a  healthcare  facility shall not self designate itself as a trauma facility.

(2)     A healthcare facility shall not use the word "trauma" to describe its facility, or in its advertising, unless it obtains  and  maintains  a designation as a "trauma facility" from the department.

(3)   A healthcare facility that wishes to identify itself as a  trauma facility shall meet the criteria for the level of designation being sought.

(4)   The department shall re-designate the trauma capabilities of each healthcare facility on the basis of verification and designation requirements in effect at the time of re-designation.

(5)   To obtain a designation as a "trauma facility", the institution shall apply to the department. An applicant healthcare facility has a right to an administrative hearing if denied a specific trauma facility level designation.

(6)     The department shall designate the existing trauma resources of all participating healthcare facilities in the state, based upon the following categories:

(a)   A level I regional trauma research center shall   comply  with  the standards that are incorporated by reference pursuant to R 325.129(2)(l), and all of the following:

(i)   Comply with data submission requirements in R 325.133 and R 325.134.

(ii)   Develop and submit a performance improvement plan based on standards that are incorporated by reference in these rules, pursuant to R 325.129(2)(l) and R 325.135.

(iii)      Participate in coordinating and implementing regional injury prevention plans.

(iv)   Provide staff assistance to the department in the designation and verification process of community trauma facilities and trauma support facilities contingent upon sufficient funding being appropriated.

(b)    A level II regional trauma center shall comply with the standards that are incorporated by reference and verification criteria established by  the American College of Surgeons Committee on Trauma (ACSCOT) for level II trauma facilities, pursuant to R 325.129(2)(l), and all of the following:

(i)   Comply with data submission requirements in R 325.133 and R 325.134.

(ii)   Develop and submit a performance improvement plan based on standards that are incorporated by reference in these rules, pursuant to R 325.129(2)(l) and R 325.135.

(iii)      Participate in coordinating and implementing regional injury prevention plans.

(iv)   Provide staff assistance to the department in the designation and verification process of community trauma facilities and trauma support facilities, contingent upon sufficient funding being appropriated.

(c)      For a level III, community trauma facility, verification criteria shall be established by the department, with the advice and recommendations of the state trauma advisory  subcommittee   and  emergency   medical  services coordinating committee. The standards are incorporated by reference in these rules, based upon verification criteria established by ACSCOT for level III facilities, pursuant to R 325.129(2)(l), and all of the following:

(i)   Comply with data submission requirements in R 325.133 and R 325.134.

(ii)   Develop and submit a performance improvement plan based on standards that are incorporated by reference in these rules, pursuant to R 325.129(2)(l) and R 325.135.

(iii)      Participate  in  coordinating  and  implementing     regional      injury prevention plans.

(d)   For a Level IV, trauma support facility, verification  shall   be completed using an "in-state" process, and criteria shall be established by the department, with the advice and recommendations of the  state   trauma  advisory subcommittee  and emergency medical services coordinating committee. The standards are incorporated by reference in these rules, based upon relevant verification criteria established by ACSCOT for level IV facilities, pursuant to R 325.129(2)(l) and shall include all of the following essential components:

(i)   Institutional organization, which shall include all of the following: (A)Trauma program.

(B)Trauma team.

(C)Trauma coordinator/TPM.

(ii)      Clinical  capabilities   -  specialty  immediately  available  24       hours/day,   as documented in a published on-call schedule.

(iii) Clinical qualifications, which shall include both of the following: (A)General/trauma surgeon, who has ATLS completion. (B)Emergency medicine, with ATLS completion.

(iv) Facilities/resources/capabilities, presence of  surgeon  at  operative procedures.

(v)     Emergency  department  equipped  with  all  of   the     following     resuscitation equipment:

(A)Airway control and ventilation equipment. (B)Pulse oximetry.

(C)Suction devices.

(D)Electrocardiograph-oscilloscope-defibrillator. (E)Standard IV fluids and administration sets. (F)Large-bore intravenous catheters.

(G)Sterile surgical sets for all of the following:

(1) Airway control/cricothyrotomy. (2)Thoracostomy.

(3) Venous cutdown.

(G)  Drugs necessary for emergency care.

(H)  Broselow tape.

(I)  Thermal control equipment for patient.

(J)   Qualitative end-tidal Co2 determination.

(K)  ) Communication with EMS vehicles.

(vi)   Operating room with personnel available 24  hours  /day,  which  shall include both of the following:

(A)Thermal control equipment for both of the following:

(1)   Patient.

(2)   Fluids and blood.

(B) X-ray capability.

(vii)   Postanesthetic recovery room,  which  shall  include both  of  the following:

(A)  Equipment for monitoring and resuscitation.

(B)Intracranial pressure monitoring equipment, which shall include both      of the following:

(1) Pulse oximetry. (2)Thermal control.

(viii)   Respiratory therapy services.

(ix)   adiological services available 24 hours/day.

(x)   Clinical laboratory service available 24 hours/day, which shall include all of the following:

(A)     Standard  analyses  of   blood,  urine,  and     other     body     fluids,     including microsampling when appropriate.

(B)  Blood typing and cross-matching.

(C)  Coagulation studies.

(D)   Comprehensive blood bank or access to a community  central  blood  bank and adequate storage facilities.

(E)  Blood gases and pH determinations.

(F)  ) Microbiology including the following:

(1)  Acute Hemodialysis or transfer agreement.

(2)   Burn care, organized in-house or transfer agreement with burn center.

(3)   Acute spinal  cord   management  in-house   or  transfer  agreement  with regional acute spinal cord injury rehabilitation center.

(4)      Rehabilitation  services  in-house  or  transfer  agreement   to      an     approved rehabilitation facility.

(5) Performance improvement, which shall include all of the following:

(a)   ) Performance improvement programs.

(b)   Participation in state, local, or regional registry.

(c)   Audit of all trauma deaths.

(d)  Morbidity and mortality review.

(e)   ) Medical nursing audit including the following:

(i)   Continuing education/outreach.

(ii)   Prevention.

(e)   The facility shall comply with  data  submission  requirements  as  set forth in R

325.133 and R 325.134.

(f)   The facility shall develop and submit a performance improvement plan based on standards that are incorporated by reference in these rules, pursuant to R 325.129(2)(l) and R 325.135.

(g)      The  facility   shall  participate   in  coordinating   and  implementing regional injury prevention plans.

(h)   The department may, with the advice and recommendations of the state trauma advisory committee and  emergency  medical   services  coordinating committee, modify the criteria or establish additional levels of trauma care resources as appropriate to maintain an effective state trauma system and protect the public welfare, except that the department shall not establish any criteria for the purpose of limiting the number of health care facilities that qualify for a particular trauma level under these rules.

(7)    The resources of healthcare facilities applying for level I regional trauma research facility or level II regional trauma facility  designation status shall be verified by the ACSCOT and shall do all of the following:

(a)  ) Comply with data submission requirements in R 325.133 and R 325.134.

(b)   Develop and submit a performance improvement plan based on standards that are incorporated by reference in these rules, pursuant to R 325.129(2)(l) and R 325.135.

(c)   ) Participate in coordinating and implementing regional injury prevention plans.

(d)  Provide staff assistance to the department in the designation and verification process of community trauma facilities and trauma support facilities contingent upon sufficient funding being appropriated.

(8)       Healthcare facilities seeking designation as a level III, community trauma facility shall be verified using either an "in-state" process established by the department, with the advice of the state trauma advisory subcommittee, or by the ACSCOT and shall do all of the following:

(a)  ) Comply with data submission requirements in R 325.133 and R 325.134.

(b)   Develop and submit a performance improvement plan based on standards that are incorporated by reference in these rules, pursuant to R 325.129(2)(l) and R 325.135.

(c)   ) Participate in coordinating and implementing regional injury prevention plans.

(9)      Healthcare facilities seeking designation as a Level IV, Trauma Support Facility shall be verified using an "in-state" process established by the department, with the advice of the state trauma  advisory subcommittee, and shall do all of the following:

(a)  ) Comply with data submission requirements in R 325.133 and R 325.134.

(b)   Develop and submit a performance improvement plan based on standards that are incorporated by reference in these rules, pursuant to R 325.129(2)(l) and R 325.135.

(c)   ) Participate in coordinating and implementing regional injury prevention plans.

(10)      Healthcare facilities wishing to be re-designated as a Level I Regional Trauma Research Facility must independently obtain ACS verification at that level, and shall comply with the standards that are incorporated by reference pursuant to R 325.129(2)(l), and all of the following:

(a)  ) Comply with data submission requirements in R 325.133 and R 325.134.

(b)   Develop and submit a performance improvement plan based on standards that are incorporated by reference in these rules, pursuant to R 325.129(2)(l) and R 325.135.

(c)   ) Participate in coordinating and implementing regional injury prevention plans.

(d)  Provide staff assistance to the department in the designation and verification process of community trauma facilities and trauma support facilities contingent upon sufficient funding being appropriated.

(11)   Healthcare facilities wishing to be re-designated as  a  Level  II regional trauma facility must independently obtain ACS verification at that level, and shall comply with the standards that are incorporated by reference pursuant to R 325.129(2)(l), and all of the following:

(a)    Comply with data submission requirements as set forth in R 325.133 and R 325.134.

(b)   Develop and submit a performance improvement plan  based  on  standards

that are incorporated  by  reference   in  these  rules,   pursuant  to  R 325.129(2)(l) and R 325.135.

(c)   ) Participate in coordinating and implementing regional injury prevention plans.

(d)  Provide staff assistance to the department in the designation and verification process of community trauma facilities and trauma support facilities contingent upon sufficient funding being appropriated.

(12)   Healthcare facilities wishing to be re-designated as a Level III community trauma facility must obtain verification at that level using either "in-state" resources, or the ACSCOT, and shall comply with the standards that are incorporated by reference pursuant to R 325.129(2)(l),  and  all  of  the following:

(a)  ) Comply with data submission requirements in R 325.133 and R 325.134.

(b)   Develop and submit a performance improvement plan based on standards that are incorporated by reference in these rules, pursuant to R 325.129(2)(l) and R 325.135.

(c)   ) Participate in coordinating and implementing regional injury prevention plans.

(13)   Healthcare facilities wishing to be re-designated as a Level IV trauma support facility must obtain verification at that level using an "in-state" process. Criteria shall be established by the department, with the advice and recommendations of the state trauma advisory subcommittee and  emergency

medical services coordinating committee, based upon relevant most current verification criteria established by ACSCOT for level IV facilities, and shall comply with the standards that are incorporated by reference pursuant to R 325.129(2)(l), and those listed in R 325.130, and all of the following:

(a)  ) Comply with data submission requirements in R 325.133 and R 324.134.

(b)   Develop and submit a performance improvement plan based on standards that are incorporated by reference in these rules, pursuant to R 325.129(2)(l) and R 325.135.

(c)   ) Participate in coordinating and implementing regional injury prevention plans.

History: 2007 AACS.