(a) Trauma Care Facilities - Designation Process. - (i) The facility designation categories are as follows:
- (A) Regional Trauma Centers (RTCs);
- (B) Area Trauma Hospitals (ATHs);
- (C) Community Trauma Hospitals (CTHs); and
- (D) Trauma Receiving Facilities (TRFs).
- (ii) The designation process shall consist of:
- (A) Each facility providing information to the OEMS regarding that facility's capabilities as a trauma facility;
- (B) A site survey as specified in Chapter 2, Section 1, (c);
- (C) Identification of facility requirements that are not met by the facility. The OEMS shall provide advice and education to assist the facility in meeting these identified requirements; and
- (D) Upon meeting the facility requirements, the OEMS shall assign a specific designation for a period of three (3) years.
- (iii) The OEMS may provide consultation, advice, and/or technical assistance to facilities who request assistance in any aspect of this process. Telephone the OEMS Trauma Program Coordinator at (307) 777-7955.
- (iv) The OEMS shall develop a designation criteria form for facilities seeking designation or renewal of designation as trauma care facilities. The form shall include:
- (A) System standards for facility level and category of designation sought;
- (B) Designation criteria form requirements;
- (D) Goals and objectives of the facility;
- (E) Capability to provide trauma care;
- (F) Commitment to serve the trauma care needs of the statewide system;
- (G) Compliance with goals of the state trauma plan; and
- (H) Geographic area for which the facility proposes to provide trauma care coverage.
- (v) The OEMS's analysis of the submitted designation criteria form shall include a review of:
- (A) The evidence of participation in system planning;
- (B) The completeness of the form materials submitted; and
- (C) The facility's self-study for comparison with the criteria.
- (vi) The facility shall:
- (A) Submit designation criteria form to OEMS within ninety (90) working days of receiving the these materials from the OEMS;
- (B) Within thirty (30) working days of receipt of a form from the facility, the OEMS shall review the designation criteria form for completeness and notify the facility of the result of that review;
- (I) If the form is complete, the facility shall be notified in writing;
- (II) If the form is incomplete, the facility shall be notified in writing of omissions or errors. The facility may refile the form when complete; and
- (vii) The OEMS may grant provisional designation, for a period not exceeding one (1) year, to facilities that are currently unable to meet the standards of this Chapter of these rules, in order to ensure adequate trauma care.
- (viii) The OEMS shall;
- (A) Conduct a site survey of each facility in accordance with this Chapter, Section 1(b) (ii) (B) and Section 1(c); and
- (B) Consider applications for designation, if and when applications are received, from facilities located and licensed in adjacent states in the same manner as applications received from facilities located and licensed in Wyoming.
- (ix) After an evaluation to determine the current capability of each facility to meet or exceed the requirements of this Chapter for the applicable level of designation applied for, the OEMS shall designate the health care facility, based on the following guidelines:
- (A) Evaluation of the designation criteria form submitted;
- (B) Recommendations from the on site survey team;
- (C) For facilities that have been previously designated, outcomes of trauma patients during the previous designation period;
- (D) Quality of care provided to patients residing in that area;
- (E) Ability of each facility to comply with goals of the state and regional plan; and
- (F) Compliance with these rules during the previous designation period.
- (x) The OEMS shall:
- (A) Notify the facility in writing of designation or denial of designation. This notification shall include a written report of the site survey; and
- (B) Notify the OEMS and RACs of the name, location, level, and category of service of facilities that have been designated.
- (xi) The OEMS shall issue a renewal designation criteria form as described in this section, for all interested health care facilities, including those currently designated, no later than one hundred twenty (120) working days prior to the expiration of each facility's current designation.
(b) Site survey for designation. The OEMS shall perform a site survey of all facilities prior to designation. - (i) The OEMS shall establish multi disciplinary on site survey teams composed of individuals knowledgeable in trauma care appropriate to the level of designation requested. On site survey team members may include:
- (B) Emergency physicians;
- (C) Trauma nurse coordinators;
- (D) Physicians knowledgeable in pediatric trauma;
- (F) Hospital or medical administrators;
- (G) OEMS personnel; and/or
- (H) Other specialties as needed for the level and category applied for.
- (ii) On site survey teams for Regional Trauma Centers and Area Trauma Hospitals will, consist of a general surgeon who is an out-of-state surveyor, an emergency physician, and a trauma nurse coordinator with experience in similar trauma systems.
- (iii) On site survey teams for Community Trauma Hospitals and Trauma Receiving Facilities may be composed of in state surveyors, including a general surgeon, an emergency physician, and a trauma nurse coordinator.
- (iv) The on site survey team shall evaluate the appropriateness and capabilities of the facility to provide high quality trauma care services, and validate the facility's ability to meet the responsibilities, equipment, and performance standards for the level of designation sought. The evaluation shall include, but not necessarily be limited to:
- (A) Reviewing medical records, staff rosters, and schedules, quality assurance committee meeting minutes, and other documents relevant to trauma care;
- (B) Reviewing equipment and the physical plant; and
- (C) Conducting interviews with the appropriate hospital personnel.
- (v) The on site survey team shall:
- (A) Make a verbal report of findings to the facility prior to leaving the facility; and
- (B) Make written recommendations to the OEMS in the format prescribed by the OEMS.
- (vi) The OEMS shall review the report and recommendations to determine if the facility is substantially in compliance with the criteria. If the facility does not meet the criteria for the level of designation for which it applied, the OEMS, at its sole discretion, shall discuss designation at a lower level with the facility.
- (vii) In the event there is an area in which the facility does not comply with the criteria, the OEMS shall within thirty (30) working days notify the facility, in writing, of deficiencies and recommend corrective action. The facility may submit to the OEMS a report which outlines the educational and corrective action taken. Before approving the designation, the OEMS may, at its sole discretion, elect to perform an on site inspection to confirm that the action taken brings the facility into compliance with all relevant criteria. If the OEMS elects not to perform an on site inspection and if the report substantiates action which brings the facility into compliance with all relevant criteria, the OEMS may approve the designation. If the facility disagrees that there is a need for corrective action, the facility may file a grievance according to Section 4 of these rules.
- (viii) The OEMS shall require and maintain confidentiality of information, records, and reports developed pursuant to site surveys to the extent allowed by law. Members of the on site survey team shall not divulge any information obtained or included in reports submitted to the OEMS relating to the site survey, unless ordered to do so by a court of competent jurisdiction.
- (ix) The facility may submit to the OEMS written objections to the report or recommendations or concerns regarding conflicts of interest pertaining to any member of the on site survey team.
- (x) Applications from facilities located and licensed in adjacent states shall be treated in same manner as applications received from Wyoming facilities.
(c) A designated trauma facility shall: - (i) Notify those facilities necessary for appropriate transfer of trauma patients as soon as possible before the applicable situation, if it anticipates being unable to comply with designation standards for twenty-four (24) hours or more1;
- (iii) Comply with the provisions within these sections, all current state and system standards as described in this Chapter, and all policies, protocols, and procedures set forth in the system plan;
- (iv) Continue its commitment to provide the resources, personnel, equipment, and response as required by its designation level;
- (v) Participate in the state trauma registry as described in Section 1 of Chapter 3 of these rules; and
- (vi) Have a written transfer agreement with a receiving trauma facility2 (as appropriate) for the transfer of severely injured trauma patients. This transfer agreement shall include written guidelines for determining the basis for seeking consultation and arranging the transport of trauma patients. Trauma transport protocols must comply with current EMTALA and COBRA/OBRA regulations and shall include the following:
- (A) The physician in the initial receiving facility shall be responsible for a decision to transfer a patient to another facility. Unless circumstances make such contact impossible, a physician or a physician-supervised mid-level practitioner in the initial receiving facility shall have direct contact with the physician at the accepting hospital before the transfer occurs;
- (B) Once the decision to transfer has been made, it should be accomplished as soon as it is feasible. Resuscitation and stabilization should begin at the referring hospital, realizing that the patient's problems may be such that true stabilization may only be possible at another facility3. Transport decisions must comply with current EMTALA and COBRA/OBRA regulations;
- (C) The mode of transportation used for transfer shall be determined based on time, medical interventions necessary for ongoing life support during transfer, and availability of resources. The referring and accepting physicians shall agree, prior to initiating transfer, who will assume responsibility for on-line medical control during transfer;
- (D) All designated trauma services shall have written transfer agreements for the identification and transfer of patients with special care needs who meet interhospital transfer criteria; and
(d) The OEMS may at any time review, inspect, evaluate, and audit all trauma patient records, trauma quality assurance committee minutes, and other documents relevant to trauma care in any designated facility at any time to verify compliance with criteria. The OEMS shall maintain confidentiality of such records as required by federal and state statutes and rules. Such inspection shall be scheduled by the OEMS when appropriate.
(e) When a health care facility is designated or loses its designation as a trauma care facility, such information is not confidential and is considered public information.
(f) Whereby the OEMS may grant a waiver from designation to hospitals and medical facilities that do not maintain an emergency department or advertize to care for trauma patients.