D.C. Mun. Regs. tit. 22, r. 22-B2805
Each pediatric trauma care facility shall have the following surgical specialties available in-house twenty-four (24) hours each day:
The evaluation and treatment of a patient may be started by a team of surgeons that includes, at a minimum, a post-graduate resident in at least the fourth (4th) year of training.
The attending surgeon shall participate in each major therapeutic decision and be present at each operative procedure. Compliance with these criteria and their appropriateness shall be monitored by the hospital's trauma performance improvement program.
An attending neurosurgeon shall be available and dedicated to that hospital's trauma service. This requirement may be satisfied by an in-house neurosurgery resident or physician who has special competence, as judged by the chief of neurosurgery, in the care of patients with neurological trauma, and who is capable of initiating measures to stabilize the patient and initiate diagnostic procedures.
Each Level I facility shall have personnel on-call and promptly available with competence to access or perform procedures in the following areas:
Each Level II facility shall have personnel on-call and available with the competence to perform procedures in the following areas:
Each Level II facility may have personnel on-call and available with competence to perform procedures in the following areas:
In non-surgical specialty cases the patient's primary care physician shall be notified at an appropriate time.
Thoracic surgery may be performed by a general trauma surgeon with privileges to provide thoracic surgical care to patients with thoracic injuries.
Transplant specialists shall be provided as follows:
The requirement to provide emergency medical services may be satisfied by an emergency medicine chief resident capable of assessing emergency situations in trauma patients and providing any indicated treatment. When senior residents are used to satisfy availability requirements, the staff specialist on-call shall be advised and be available for consultations.
The requirement to provide anesthesiology services may be satisfied in a Level I facility by an anesthesiology chief resident or a certified nurse anesthetist (CRNA) capable of assessing emergency situations in trauma patients, and providing any indicated treatment, including surgical anesthesia. When an anesthesiology resident or a CRNA is used to satisfy availability requirements the staff anesthesiologist on-call shall be advised and be promptly available.
The requirement to provide anesthesiology services is satisfied in a Level II facility when the staff anesthesiologist will be in the hospital at the time of, or shortly after, the patient's arrival. Before the staff anesthesiologist arrives, an Anesthesiology chief resident or a CRNA capable of assessing emergency situations in trauma patients and of initiating and providing any indicated treatment shall be available.
D.C. Mun. Regs. tit. 22, r. 22-B2805