007.28.08 Ark. Code R. 002
Authority
The following Rules and Regulations pertaining to the comprehensive, statewide, Trauma System are duly adopted and promulgated by the Arkansas State Board of Health pursuant to the authority expressly conferred by Act 559 of 1993 (The Trauma System Act), and the laws of the State of Arkansas including, without limitation, Act 96 of 1913 (Arkansas Statutes, 1947, Section 82-110).
For the purpose of these regulations the following terms are defined:
NOTE: All definitions refer to the "adult trauma patient" unless otherwise identified.
AACN: American Association of Critical Care Nurses
AANN: American Association of Neuroscience Nurses
ACEP: American College of Emergency Physicians
ACGME: Accreditation Council for Graduate Medical Education
ACLS-certified: Individuals certified by the American Heart Association in Advanced Cardiac Life Support
ACS COT: American Collegeof Surgeons Committee on trauma
ACS: American College of Surgeons
ACOS: American College of Osteopathic Surgeons
Act: Act 559, The Trauma System Act of 1993
Adult: Age classification 18 years old and above
AIS: Abbreviated Injury Scale: An anatomic severity scoring system
ALS: Advanced Life Support, including techniques of resuscitation, such as intubation, intravenous access, and cardiac monitoring
Alternate Criteria: Those criteria for inclusion in the trauma service, which are offered as an alternative to Board Certification. The non-board-certified surgeon must have completed an approved surgical residency program. The surgeon must be licensed to practice medicine and approved for surgical privileges by the hospital's credentialing committee. The surgeon must meet all criteria established by the trauma director to serve on the trauma team. The surgeon must have experience in caring for trauma patients which must be tracked by the performance improvement (PI) program. The Trauma director must attest to the surgeon's experience and quality of patient care as part of the recurring granting of trauma team privileges consistent with the hospital's policy. This individual is expected to meet all other qualifications for members of the trauma team.
AMA: American Medical Association
AOA: American Osteopathic Association
APLS: Advanced Pediatric Life Support Course jointly developed and sponsored by the American College of Emergency Physicians and American Academy of Pediatrics-covers the knowledge and skills necessary for the initial management of pediatric emergencies, including trauma.
Asystole: Absence of spontaneous cardiac activity.
ATLS Course: Advanced Trauma Life Support Course of the American College of Surgeons
BLS: Basic Life Support techniques of resuscitation, including simple airway maneuvers and administration of oxygen.
Basic (Level IV) Facility: Medical facility that provides screening and definitive care or stabilization and transfer of severely injured patients in remote areas where no alternative care is available, or stabilization while arranging for transfer to a Level I, Level II, or Level III facility that can provide further definitive surgical care.
Board: The State Board of Health as provided for in Ark. Code Ann. § 20-7-102. *
Board-certified: Physicians certified by appropriate specialty boards recognized by the American Board of Medical Specialties.
Burn patient referral: In general, patients for referral are so-called "major bums," described as burns involving 20 percent or greater body surface area (BSA) in an adult, or 10 percent or greater BSA in a child; additionally, burns of lesser BSA in patients with concomitant'serious disease-for example, cirrhosis, diabetes, and cardiac disease-should be considered for transfer, as should special problems, such as inhalational injuries and burns involving hands, feet, face, and genitalia.
Bypass (Divert Status): Transport of an EMS patient past a normally used EMS receiving facility for the purpose of accessing more readily available or appropriate medical care.
CCRN: Critical Care Registered Nurse certification from the American Association of Critical Care Nurses.
CDC: Centers for Disease Control and Prevention in Atlanta, GA-a Federal agency committed to epidemiological surveillance, control of disease processes, particularly those secondary to infection or trauma, and prevention.
Certificate of Special Competency or Added Qualifications: Recognition of specialized education in selected areas of care and acknowledged by the American Board of Medical Specialties.
Child: Age class from one year old through 17 years of age
Communication system: A collection of individual communication networks, a transmission system, relay stations, and control and base stations capable of interconnection and interoperation that are designed to form an integral whole. The individual components must serve a common purpose, be technically compatible, employ common procedures, respond to control, and operate in unison.
Comorbidity: Significant cardiac, respiratory, or metabolic diseases that stimulate the triage of injured patients to trauma centers.
Comprehensive (Level I) Facility: Regional resource trauma center that has the capability of providing leadership and total care for every aspect of injury from prevention through rehabilitation.
Continuing Medical Education (CME): Defined educational activities for practicing physicians, often resulting in approved credit hours from the AMA, state medical society, a medical school, or hospital.
Credentialing: Approval of physician as a member of the trauma team, based on a review of the individual's training and experience by the trauma service director and the appropriate service chief.
Demonstrated commitment: Provision of evidence (visible and written) that clearly demonstrates an institution-wide commitment to trauma care.
Department: The Arkansas Department of Health
Designation: The process by which a hospital is identified by the Department as an appropriate facility to receive traumatically injured patients.
Desirable characteristic: A component of the trauma care facility standards whose presence or availability is encouraged but not required for designation.
Disaster: Sudden event with a variable mixture of injury to or sickness of human beings, destruction, or contamination of property, overwhelming demand on local response resources, and disruption of organized societal mechanisms.
Diversion: A procedure put into effect by a trauma facility to insure appropriate patient care when that facility is unable to provide the level of care demanded by a trauma patient's injuries or when the facility has temporarily exhausted its resources. . -
Emergency Medical Services (EMS): The transportation and medical care provided the critically ill or injured patient prior to arrival at an emergency department and within a medical facility subject to the individual approval of the medical staff and governing board of that facility. ,
ENA: Emergency Nurses Association
ENPC: Emergency Nurse Pediatric Course developed and sponsored by the ENA which covers the knowledge and skills necessary for the initial nursing assessment and management of pediatric patients in the emergency department.
Required characteristic: A component of the trauma care facility standards that is required for designation.,, .'
Extrication Services: The services provided by the use of specialized equipment for the purpose of gaining access and entry to entrapped patients.
Field Triage: Classification of patients according to medical need at the scene of an injury or onset of an illness.
GCS: Glasgow Coma Scale-A scoring system that defines eye, motor, and verbal responses in the patient with injury to the brain.
General (Level III) Facility: Hospital that provides assessment, resuscitation, emergency surgery, and definitive care or stabilization while arranging for transfer to a Level I or Level II facility that can provide further definitive surgical care.
General Surgery Accredited Residency Program: Programs approved by the Accreditation Council for Graduate Medical Education.
Hospital criteria: Essential or desirable characteristics that help categorize Level I, II, III, and IV trauma facilities.
ICD-9: Current Edition of International Classification of Diseases-a standard coding system that includes all injuries and disease processes.
ICP: Intracranial pressure, often monitored in patients with severe injuries to the brain.
Immediately available to the patient: Services provided by a trauma facility that are in-house 24 hours a day, 7 days a week.
Inclusive Trauma Care System: A trauma care system that incorporates every health care facility in a community in a system in order to provide a continuum of services for all injured persons who require care in an acute facility; in such a system, the injured patient's needs are matched to the appropriate hospital resources. '
Infant: Age class from birth to one year old.
In-house: Physically present in the hospital.
Injury: The result of an act that damages, harms, or hurts; unintentional or intentional damage to the body resulting from acute exposure to mechanical, thermal, electrical, or . chemical energy or from the absence of such essentials as heat or oxygen (see Trauma).
Injury control: Programs designed to teach potential victims how to avoid injuries.
Interfacility transfer: The transfer of a patient from one hospital to another hospital.
ISS: Injury Severity Score-the sum of the squares of the Abbreviated Injury Scale scores of the three most severely injured body regions.
Lead Trauma Facility: A trauma facility that has made an additional commitment to its trauma service region. This commitment, which usually is offered by the highest Level of trauma facility in a given trauma service region, includes outreach and increased educational activities. The responsibilities may be shared by trauma facilities.
Major (Level II) Facility: Hospital that provides screening and definitive care of the traumatically injured patient regardless of the severity of injury, but does not conduct a trauma research program or a general surgery residency program.
Mechanism of Injury: The source of forces that produce mechanical deformations and physiologic responses that cause an anatomic lesion or functional change in humans.
Medical control (Direct): Immediate medical direction to prehospital personnel in remote locations provided by a physician or an authorized communications resource person under the direction of a physician.
Medical control (Indirect): The establishment and monitoring of all medical components of an EMS system, including protocols, standing orders, education programs, and the quality and delivery of direct control.
Medical oversight: The assistance given to the Trauma Regional Advisory Council (TRAC) and/or regional health care entities in system planning by a physician or group of physicians designated by the TRAC to provide technical assistance.
Morbidity: The relative incidence of disease. Mortality: The proportion of deaths to population.
Multidisciplinary trauma review committee: Committee composed of the trauma service director and other physician members of the trauma service that reviews trauma deaths in a system or hospital.
Multiple or mass casualty triage: Specialized techniques of triage used when large numbers of injured patients are concentrated in one area.
OGME: Osteopathic Graduate Medical Education
On-call: Committed for a specific time period to be available and respond within an agreed amount of time to provide care for a patient in the hospital.
Over-triage: Directing patients to trauma centers when they do not need such specialized care. Over-triage occurs because of incorrect identification of patients as having severe injuries when retrospective analysis indicates minor injuries.
PALS: Pediatric Advanced Life Support Course developed and sponsored by the American Heart Association and the American Academy of Pediatrics-covers the knowledge and skills necessary for the initial management of pediatric emergencies, including trauma.
Pediatric Trauma Center: Children's hospital fulfilling the criteria for comprehensive trauma care.
Pediatric Trauma Score: An injury scoring system used in some centers caring for pediatric patients.
Pediatric trauma surgeon: Certified pediatric surgeon with a commitment to trauma or certified general surgeon with special training and documented CME relevant to pediatric trauma care. \
Postgraduate year (PGY): Classification system for residents in postgraduate trainirig-the number indicates the year they are in during the postmedical school residency program; for example, PGY 1 is one year after graduation from medical school.
Prehospital care provider: An individual or organization certified by the Section to provide out-of-hospital emergency medical services.
Promptly available to the patient: Services provided by a trauma facility that are available to the patient within 30 minutes.
Protocol: A written procedure to ensure standardization of care.
Regionalization: The identification of available resources within a given geographic area and coordination of services to meet the needs of a specific group of patients.
Rehabilitation: Services that seek to return a trauma patient to the fullest physical, psychologic, social, vocational, and educational level of functioning of which he or she is capable, consistent with physiologic or anatomic impairments and environmental limitations. ''.'
Research: Clinical or laboratory studies designed to produce new knowledge applicable to the care of injured patients.
*
Response time: Interval between notification and arrival of general surgeon or surgical specialist in the emergency department or operating room.
Resuscitation: The phase of trauma or specialty care where emergency life support treatment is provided to sustain vital bodily functions.
RTS: Revised Trauma Score-A prehospital/emergency department scoring system in which numerical values are assigned to differing levels of Glasgow Coma Scale, systolic blood pressure, and respiratory rate.
Section: The Section of EMS and Trauma Systems; the organization within the Department responsible for the enforcement of EMS and Trauma Systems legislation within the State of Arkansas.
Sensory, Motor, and Circulation (SMC's): Refers to the assessment of the patient's ability to feel and move, and the status of the patient's blood circulation.
State Trauma Registry: A database of information, submitted to the Section by the hospitals, relating to the care of trauma patients as defined in these Rules and Regulations. The information is used to evaluate the quality of care provided.
Transfer agreement: A formal, written agreement between hospitals for the transfer and acceptance of patients. Note: This is not a substitute for the Emergency Medical Treatment and Labor Act (EMTALA) transfer forms.
Trauma: A term derived from the Greek for ''wound," it refers to any bodily injury (see Injury).
Trauma Advisory Council: The body of individuals appointed by the Governor to advise, assists, and make recommendations to the Section concerning the development of the statewide trauma system.
Trauma call roster: The listing of surgeons assigned to provide trauma care, including date of coverage and alternate surgeons.
Trauma Care Systems and Planning Act: The law that amended the Public Health Service
Act. to add Title-XII-Trauma Programs. The purpose of the legislation is to assist state governments in developing, implementing, and improving regional systems of trauma care and to fund research and demonstration projects to improve rural EMS and trauma care (PL-101-590).
Trauma Center (Facility): A specialized hospital facility distinguished by the immediate availability of specialized surgeons, physician specialists, anesthesiologists, nurses, and resuscitation and life support equipment on a 24-hour basis to care for severely injured patients or those at risk for severe injury. *
Trauma Center Designation: The process by which the Section of EMS & Trauma Systems identifies and selects facilities to care for severely injured patients within a trauma care system.
Trauma Coordinator/Trauma Program Manager: A registered nurse with responsibility for monitoring and evaluating nursing care of trauma patients and the coordination of quality improvement and patient safety programs for the trauma center in conjunction with the trauma medical director.
Trauma fellowship: Formal advanced postresidency training in the care of injured patients.
Trauma patient: The patient which presents acute bodily injuries secondary to an external force requiring immediate interventions deemed necessary to preserve life and limb. For statistical purposes, the definition will apply to the traumatically injured patient that:
Is admitted for observation for a period of time greater than 8 hours, or
Is admitted to the hospital, or
Is transferred to another trauma system facility, or
Expires
Trauma prevention programs: Internal institutional and external outreach educational programs designed to increase awareness of methods for prevention and/or avoidance of trauma related injuries.
Trauma program: An administrative unit that includes the trauma service and coordinates other trauma related activities; for example, injury prevention, public education, CME activities, etc.
Trauma Regional Advisory Council (TRAC): The Council formed within a Trauma Service Region that develops and oversees the region's trauma system plan.
Trauma Registry: The collection and analysis of trauma data from the trauma system.
Trauma Service: A clinical service established by. the medical staff that has oversight of and responsibility for the care of the trauma patient.
Trauma Service Director: Physician designated by the institution and medical staff to coordinate trauma care.
Trauma Service Region (TSR): A geographic region of the state approved by the Section to implement a comprehensive trauma care system plan.
Trauma System: An integrated network that ensures that acutely injured patients are expeditiously taken to hospitals appropriate for their level of injury.
Trauma Team: A group of health care professionals organized to provide care to the trauma patient in a coordinated and timely fashion.
Triage: The sorting of patients in terms of priority, treatment, transportation, and destination, so that the patient can be transported to the appropriate hospital based upon established criteria.
TRISS: Trauma Score/Injury Severity Score-the likelihood of patient survival based on a regression equation that includes patient age, ISS, RTS, and the type of injury (blunt or penetrating).
Under-triage: Directing fewer patients to trauma centers than is warranted because of incorrect identification of patients as having minor injuries when retrospective analysis indicates severe injuries.
Words implying the masculine gender may be applied to both males and females.
The purpose of these Rules and Regulations is to establish the procedures and standards for the implementation of a statewide comprehensive trauma system in order to decrease morbidity and mortality which results from trauma.
Because trauma is a preventable disease, community information and prevention is an important component of the Arkansas Trauma Care System. The Section shall actively promote and encourage trauma system education and injury prevention throughout Arkansas.
The Section shall establish and maintain an Educational Resource Center which will provide information on statewide trauma system components and established injury prevention programs on the local, state, and national level. The Center shall function as a clearinghouse to gather information regarding trauma care continuing education opportunities and make this information available to the trauma system providers.
It shall be the responsibility of all designated trauma facilities to implement public education and injury prevention programs in the approved Trauma Service Region (TSR) as outlined in Section VII.G.
Emergency care of the traumatically injured patient is best accomplished using an inclusive, multi-level trauma care systems approach. Triage, transport, and transfer protocols have been developed to ensure that trauma patients will receive prompt and potentially lifesaving treatment.
Traumatically injured patients will be appropriately assessed using the Prehospital Triage Criteria & Decision Scheme as defined in Section IV.C.
Extrication of the traumatically injured patient shall be initiated as needed by the prehospital care provider. (Ref. Emergency Medical
Services Rules and Regulations). '-.
Basic Life Support interventions (establishment of patient airway, hemorrhage control, spinal immobilization, fracture immobilization, etc.) will be initiated by the prehospital care provider following established local protocols. Advanced life support protocols shall be kept on file with the Section (ref. Emergency Medical Services Rules and Regulations).
Patient transport will be initiated by the prehospital care provider following established local protocols.
Contact with the receiving hospital will be made as soon as possible. An accurate description of the incident, injuries, current medical interventions based upon established protocols, and patient status will be relayed to the facility. Further management guidance will be requested from the receiving hospital medical control as required during transport.
Patient care shall follow established local protocols.
v
The Trauma" system should not be activated when the following,
patient conditions occur:
These patients should be transported at the direction of the medical examiner or coroner.
Patients who meet the trauma criteria as outlined in Section IV.C. shall be transported to a Level I or Level II Facility unless:
Medical control may override the transport requirement outlined in Section IV.D. 1. under the following conditions:
The role of the Level I (Comprehensive) and Level II (Major) Trauma facilities shall be to provide the highest level, of definitive, comprehensive care for the severely injured adult and pediatric patient with complex, multi-system trauma. In the event of the availability of a specialized Pediatric Trauma Center, the Level I or Level II facilities may elect to arrange for transfer of care to that facility for pediatric patients. Level I and Level II Trauma facilities should have the capability of providing total patient care for every aspect of injury from prevention through the arrangement of rehabilitative services. The role of the Level III (General facility is to provide initial evaluation and stabilization, including surgical intervention, of the severely injured adult or pediatric patient. Critically injured patients who require specialty care are transferred to a higher Level trauma facility in accordance with established criteria. The role of the Level IV (Basic) facility is to provide resuscitation and stabilization of the severely injured adult or pediatric patient prior to transferring the patient to a higher Level trauma facility.
The trauma facility shall monitor the EMS Communications system at all times. In the event of a trauma patient being transported, the EMS report shall be transmitted by the hospital provider to the Emergency Department of the receiving facility.
Based upon the information received, the trauma facility triage nurse or other appropriate medical control officer shall assign a trauma score and, where indicated, activate the Trauma Treatment Protocol for that facility as outlined in Section V.C.
Trauma patients shall undergo appropriate emergency department screening and evaluation as prescribed by local protocol.
* Systolic Blood Pressure of 90 or less with other signs/symptoms of shock
* Respiratory Rate of 10 or less; or 29 or greater
* Glasgow Coma Scale of 13 or less
* Trauma Score of 11 or less
* Pediatric Trauma Score of 9 or less
* Penetrating injury to the head/open or depressed skull fracture
* Penetrating injury of the neck, torso, or groin
* Amputation above the wrist or ankle
* Spinal cord injury with limb paralysis or alteration of Sensory Motor Circulation (SMC's)
* Flail Chest
* Pelvic Fracture
* Two or more obvious long bone fractures above the elbows or knees
* Major burns: 15% or greater and/or with respiratory involvement
* High voltage electrical burns
* Severe maxillofacial injuries
* Speed 40 fnph or greater * Vehicle deformity 20" or greater
* Vehicle Rollover * Ejection from moving vehicle
* Death of same vehicle occupant * Motorcycle 20 mph or greater
* Pedestrian or pedal cyclist vs. vehicle 20 mph or greater
* Falls 20 feet or greater (consider pediatric rules if applicable)
* Children > 10 Feet or 2 to 3 times the height of the child
* 1 story = 10 Feet
TRAUMA PATIENTS WHO MEET NONE OF THE ABOVE CRITERIA SHOULD UNDERGO APPROPRIATE EMERGENCY DEPARTMENT EVALUATION AND MANAGEMENT.
The trauma facility shall monitor the EMS Communications system at all times. In the event of a trauma patient being transported, the EMS report shall be transmitted by the prehospital provider to the Emergency Department of the receiving facility.
Based upon the information received, the trauma facility triage nurse or other appropriate medical control officer shall assign a trauma score and, where indicated, activate the Trauma Treatment Protocol for that facility as outlined in Section V.E.
Trauma patients shall undergo appropriate screening and emergency department evaluation, observation, and consideration for discharge or admission.,
The trauma patient whose condition deteriorates or is found to have significant injuries not detected in the initial evaluation should be reclassified and the Trauma Team activated.
* Systolic Blood Pressure of 90 or less with other signs/symptoms of shock
* Respiratory Rate of 10 or less; or 29 or greater
* Evidence of stridor or retractions,.
* Glasgow Coma Scale of 13 or less
* Trauma Score of 11 or less
* Pediatric Trauma Score of 9 or less
* Penetrating injury to the head/open or depressed skull fracture
* Penetrating injury of the neck, torso, or groin
* Amputation above the wrist or ankJe
* Spinal cord injury with limb paralysis or alteration of Sensory Motor . Circulation (SMC's)
* Flail Chest
* Pelvic Fracture
* Two or more obvious long bone fractures above the elbows or knees *Major burns: 15% or greater and/or with respiratory involvement
* High voltage electrical bums *
* Severe maxillofacial injuries
EMS & Trauma Systems. To assist the trauma facility in the development of these guidelines, recommendations for early transfer criteria are found in Section V.F.
* Speed 40 mph or greater * Vehicle deformity 20" or greater
* Vehicle Rollover " * Ejection from moving vehicle
* Death of same-vehicle occupant * Motorcycle 20 mph or greater
* Pedestrian or pedal cyclist vs. vehicle 20 mph or greater
* Falls 20 feet or greater (consider pediatric rules if applicable)
* Consider any of the following Co-Morbid Factors
* Extremes of age: 12 or less/55 or more
* Pregnancy > than 20 weeks
* Hostile environment: (e.g.; extremes of heat or cold)
* Medical illness or prior history (Chronic Obstructive Pulmonary Disease [COPD], Congestive Heart Failure [CHF], renal failure,
cardiac, diabetes, cirrhosis, morbid obesity, etc.)
* Pregnancy
* Immunosupressed patients
* Anti-coagulation and bleeding disorders
*EMS provider judgment (For example cases of prolonged extrication)
* Time sensitive extremity injury (Potential Vascular Injury)
PATIENTS WHO DETERIORATE OR ARE FOUND TO HAVE SIGNIFICANT INJURIES SHOULD BE RECLASSIFIED AND THE TRAUMA TEAM ACTIVATED. OTHER PATIENTS SHOULD UNDERGO APPROPRIATE EMERGENCY DEPARTMENT EVALUATION AND OBSERVATION AND CONSIDERATION FOR DISCHARGE OR ADMISSION.
(THESE GUIDELINES ARE NOT INTENDED TO BE HOSPITAL SPECIFIC)
CENTRAL NERVOUS SYSTEM
* Head Injury Penetrating injury or open fracture (with or without Cerebral
, Spina] Fluid [CSF] leak) "" Depressed skull fracture
Glasgow Coma Scale 13 or less or GCS deterioration Lateralizing signs
* Spinal Cord Injury Spinal column injury or major vertebral injury
CHEST
* Major chest wall injury
* Wide mediastinum or other signs suggesting great vessel injury
* Cardiac injury
* Patients who may require prolonged ventilation
PELVIS
* Unstable pelvis ring disruption
* Unstable pelvis fracture with shock or other evidence of continuing hemorrhage
* Open pelvic injury
MAJOR EXTREMITY INJURIES
* Fracture/dislocation with loss of distal pulses
* Open long-bone fractures
* Extremity ischemia
MULTIPLE-SYSTEM INJURY
* Head injury combined with face, chest, abdominal, or pelvic injury
* Bums associated with injuries
* Multiple long-bone fractures
* Injury to more than two body regions
* Severe maxillofacial injury
CO-MORBID FACTORS
* Age 55 or greater
*Age (12 or less)
* Cardiac or respiratory disease
*Insulin-dependent diabetes, morbid obesity
* Pregnancy
*Immunosupression
SECONDARY DETERIORATION (LATE SEQUELAE)
* Mechanical ventilation required
* Sepsis
* Single or multiple organ system failure (deterioration in central nervous, cardiac, pulmonary, hepatic renal, or coagulation systems.
* Major tissue necrosis
Trauma facilities shall establish written transfer agreements with other cooperating facilities in advance to expedite the care of the trauma patient. A copy of the transfer agreement(s) shall be kept on file in the Section of EMS and Trauma Systems.
(SAMPLE FORMAT)
Any hospital that desires authorization to provide trauma care services within the Arkansas Trauma System shall request designation from the Section. No hospital may be represented to the public as an Arkansas designated trauma facility unless that hospital holds a certificate of trauma facility designation issued by the Arkansas Department of Health.
An application for trauma facility designation shall be made on forms provided by the Department.
Upon the review and approval by the Section of the application materials submitted in section VI.B.l., an on-site survey of the facility will be scheduled. All costs associated with conducting on-site surveys shall be the responsibility of the applicant. The on-site survey shall be conducted based upon the standards described in Section VII or Section VIII as applicable. The survey team shall consist of members approved by the Section as outlined in Section IX. The survey team shall submit a comprehensive report to the Section. The Section shall review the survey findings and issue a decision recommending one of the following options:
Upon approval by the Section of all application requirements as set forth in Section VI.B.l & 2, a Certificate of Trauma Facility Designation will be issued identifying the * facility as a state-certified provider of trauma care. This certificate shall be in force for a time period not to exceed four years from the date of issue or if provisional, shall be reviewed after one (1) year.
A facility's application for designation may be denied for, but not limited to, the following reasons:
Six (6) months after the denial of a facility's application for designation as outlined in Section VI.B.2.e., the facility may reapply for Level designation as described in section VI.B.l. &2.
creed, national origin, sexual preference, age, handicap, medical problem, or inability to pay.
Occasional failure of a hospital or facility to meet its obligations shall not be grounds for denial, suspension, or revocation by the Section if the circumstances under which the failure occurred:
Upon receipt of a complaint describing an alleged violation of these Sections, the Section shall:
If the Section proposes to suspend or revoke a designation, the Section shall notify the facility by registered or certified mail at the last address shown in the Section records. The notice shall state the alleged facts that warrant the action and state that the hospital or facility has an opportunity to request a hearing in accordance with the department's formal hearing procedures.
The highest Level of pediatric trauma care is provided in a Pediatric Trauma Resource Facility. This facility shall be capable of providing comprehensive care for all injured infants and children, particularly the most severely injured in a given region. When no pediatric facility is available, infants and children with multisystem injuries can be treated in an adult trauma facility that has demonstrated a significant commitment to pediatric care as determined by the criteria outlined in Section VIII.B.
PEDIATRIC TRAUMA REGIONAL | ADULT TRAUMA FACILITY WITH | |
RESOURCE FACILITY | PEDIATRIC COMMITMENT | |
A pediatric surgeon credcntialcd in trauma care will be | A surgeon must be on call and promptly available and | |
immediately available and present in the OR for any and all | Pediatric | present in the ED at time of arrival of the patient, and will be |
operative procedures. A general surgical resident at a | Surgeon | available to care for pediatric trauma patients in the ICU. |
minimum PGY 3 or higher Resident level may initiate | The adult trauma surgeon must have special interest in and | |
resuscitative care until the attending pediatric surgeon arrives. | commitment to care of the injured child. | |
General | E | |
Children's hospital or general hospital with a separate | Surgeon | General hospital with an organized pediatric service. |
pediatric department. | Hospital | |
Pediatric emergency department with appropriate personnel, | Designated pediatric area in an emergency department | |
equipment, and facilities. | staffed with pediatric trauma personnel and appropriate | |
Emergen | equipment. | |
Pediatric ICU with pediatric surgery and other surgical | cy Depart m | Pediatric ICU with appropriately trained personnel and |
medical and nursing personnel and equipment needed to care | cnt | equipment. |
for the injured child. | ||
Pediatric trauma service organized and run by a pediatric | ICU | Pediatric trauma service administered by the pediatric |
surgeon. | surgeon and run by his/her designee. | |
1. Pediatric Surgeon | 1. Pediatric Surgeon | |
2. Pediatric Orthopedics | Trauma | 2. General Surgeon |
3. Pediatric Neurosurgeon | Service | 3. Orthopedics |
4. Pediatric Anesthesiologist | 4. Neurosurgeon | |
5. Pediatric Intensivist | 5. Surgical Critical Care Specialist | |
6. Pediatric Emergency Physician | Trauma | 6. Emergency Physicians |
7. Pediatric Radiologists | Team | 7. Radiologists |
8. Other Pediatric Surgical Specialists | 8. Pediatricians | |
9. Other Medical Pediatric Specialists | 9. Trauma Nurse coordinator | |
10. Pediatric Trauma Nurse Coordinator | 10. Pediatric-trained Trauma Nurses | |
II. Pediatric Trauma Nurse |
R | Research | D |
R | Injury Prevention Program | R |
R | Pediatric Trauma Service | R |
R | Psychosocial Services | R |
R | Rehabilitation | R |
R | Emergency Department | R |
R | Pediatric Intensive Care , | R |
R | 24 hour a day immediate | R |
R | Operating Room availability With in-house anesthesia and Nursing personnel | R |
R | Trauma Registry | R |
As part of the trauma facility designation process, following a successful application process, an on-site survey of the prospective trauma facility shall be conducted to evaluate the quality of the applicant's compliance with the standards outlined in Section VII or Section VIII.
The review of hospitals for trauma center designation shall include interviews with designated hospital staff, a review of the physical plant and equipment, and a review of records and documents as deemed necessary to assure compliance with the requirements of the rules of this document. The cost of any and all site reviews shall be paid by each applicant hospital or renewing trauma center unless adequate funding is available from the Section of EMS and Trauma Systems to pay for reviews.
Specialty Facility) who currently works in a designated trauma center and who is a fellow of the American College of Surgeons or a member of the American College of Osteopathic Surgeons (ACOS).
The Section shall approve the designation of Trauma Service Regions (TSR's).
A complete trauma system must include early integration of Rehabilitation services into all phases of acute and primary care. Trauma system hospitals shall demonstrate that rehabilitation services are initiated at the earliest possible point after trauma patient admission.
The Section shall develop and maintain a statewide trauma Data Collection and evaluation system (ref. Act 559, The Trauma System Act, Section 6.a).
May obtain funding from the trauma system to participate in trauma registry data collection efforts.
If any provision of these Rules and Regulations, or the application thereof to any person or circumstances is held invalid, such invalidity shall not affect other provisions or applications of these Rules and Regulations which can give effect without the invalid provisions or applications, and to this end the provisions hereto are declared to be severable.
All Regulations and parts of Regulations in conflict herewith are hereby repealed.
007.28.08 Ark. Code R. 002