Each adult trauma care facility shall have departments, divisions, services, or sections with designated chiefs and shall be staffed by qualified specialists in the following areas:
In each adult trauma care facility, a clearly identifiable neurosurgeon shall be promptly available when a patient needs to be seen. Immediate care necessitates a reliable on-call schedule with a specific protocol for back-up coverage.
The requirement set forth in § 2704.2 may be fulfilled by an in-house neurosurgeon or other surgeon who has special competence in the care of patients with neurotrauma, as judged by the chief of neurosurgery, and who is capable of undertaking measures for the stabilization and treatment of neurotrauma patients.
In each adult trauma care facility, the following minimum personnel and equipment required for the treatment of severe neurological trauma shall be on call and promptly available for the treatment of trauma patients at all times:
The care of neurological trauma may also include a readily available magnetic resonance imaging (MRI) scanner.
An orthopedic surgeon shall be available at all times for the optimal management of the trauma patient. The orthopedic surgeon shall be a member of the trauma team.
An orthopedic surgeon shall have immediate and ongoing participation in the care of patients with musculoskeletal injuries, and shall interact with the rest of the trauma team regarding the patient's care.
An orthopedic surgeon shall be promptly available to participate in the initial evaluation of the trauma patient in the emergency department. The orthopedic surgeon shall evaluate the neurovascular status and structural integrity of the extremities and axial skeleton.
The minimum qualifications of an orthopedic surgeon on-call shall include board certification or eligibility for board certification during the first five (5) years after residency, documentation of a minimum of sixteen (16) hours of Category I or II CME per year in skeletal traumatology, and participation in the facility's trauma service educational and quality improvement activities.
An orthopedic surgeon shall have demonstrated skill in:
Each adult trauma care facility shall provide, for optimal musculoskeletal management, an adequate extended team composed of orthopedic assistants, nurses, physician assistants, and others who can assist with casts and traction, and can provide evaluation and care of patients both in the emergency room and on the acute care units.
Operating room nurses and technologists shall be experienced in the use and care of fracture-fixation instruments and devices, as well as be able to provide appropriate assistance during skeletal surgery. Appropriately trained X-ray technologists must be available in the operating room to assist with fluoroscopic procedures and to provide prompt radiographs when needed.
Each adult trauma care facility shall maintain essential equipment for optimal fracture treatment, including:
Each adult trauma care facility shall maintain an adequate number of orthopedists committed to trauma care. Orthopedists assigned to provide scheduled coverage for trauma patients shall qualify for membership on the trauma service team and shall participate in service activities, especially those related to quality improvement and to the development of institutional protocols for systematic evaluation and management of common injuries.
In Level I facilities, orthopedic members of the trauma service are responsible for teaching and research appropriately related to musculoskeletal injuries and for providing readily available consultation to physicians in the surrounding community.
In each adult trauma care facility, a general orthopedist shall provide primary care for musculoskeletal injuries. When orthopedic trauma specialists are not immediately available, the initial orthopedic care may be provided by another member of the staff, who shall then transfer that patient to the specialist. Interhospital transfer shall be required in appropriate cases.
D.C. Mun. Regs. tit. 22, r. 22-B2704