Health, Family Health and Preparedness, Emergency Medical Services

Rule R426-9

Statewide Trauma System Standards

Notice of Proposed Rule

(New Rule)

DAR File No.: 36981
Filed: 10/23/2012 11:51:25 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this rule is to fulfill the Governor's mandate for rule review and simplification.

Summary of the rule or change:

The rule change eliminates redundancy, provides sequential numbering, and reflects best practice updates for all aspects of the Emergency Medical Services Act (Title 26, Chapter 8a).

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 8a

Anticipated cost or savings to:

the state budget:

No anticipated fiscal impact to the state budget because there are no changes in the rule requirements that are imposed by these amendments.

local governments:

No anticipated fiscal impact to local governments because there are no changes in the rule requirements that are imposed by these amendments.

small businesses:

No anticipated fiscal impact to small businesses because there are no changes in the rule requirements that are imposed by these amendments.

persons other than small businesses, businesses, or local governmental entities:

No anticipated fiscal impact to businesses because there are no changes in the rule requirements that are imposed by these amendments.

Compliance costs for affected persons:

No anticipated fiscal impact to affected persons because there are no changes in the rule requirements that are imposed by these amendments.

Comments by the department head on the fiscal impact the rule may have on businesses:

In response to the Governor's Executive Order to examine all administrative rules and reduce regulatory impact that may be inhibiting economic growth, the rules governing Emergency Medical Services providers are being repealed, simplified and reenacted. Fiscal impact is expected to be positive for business as the requirements are streamlined and updated.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Family Health and Preparedness, Emergency Medical Services
3760 S HIGHLAND DR
SALT LAKE CITY, UT 84106

Direct questions regarding this rule to:

• Guy Dansie at the above address, by phone at 801-273-6671, by FAX at 801-273-4165, or by Internet E-mail at [email protected]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

12/17/2012

This rule may become effective on:

12/24/2012

Authorized by:

David Patton, Executive Director

R426. Health, Family Health and Preparedness, Emergency Medical Services.

R426-9. Statewide Trauma System Standards.

R426-9-1. Authority and Purpose.

(1) Authority - This rule is established under Title 26, Chapter 8a, Part 2A, Statewide Trauma System, which authorizes the Department to:

(a) establish and actively supervise a statewide trauma system;

(b) establish, by rule, trauma center designation requirements and model state guidelines for triage, treatment, transport, and transfer of trauma patients to the most appropriate health care facility; and

(c) designate trauma care facilities consistent with the trauma center designation requirements and verification process.

(2) This rule provides standards for the categorization of all hospitals and the voluntary designation of Trauma Centers to assist physicians in selecting the most appropriate physician and facility based upon the nature of the patient's critical care problem and the capabilities of the facility.

(3) It is intended that the categorization process be dynamic and updated periodically to reflect changes in national standards, medical facility capabilities, and treatment processes. Also, as suggested by the Utah Medical Association, the standards are in no way to be construed as mandating the transfer of any patient contrary to the wishes of his attending physician, rather the standards serve as an expression of the type of facilities and care available in the respective hospitals for the use of physicians requesting transfer of patients requiring skills and facilities not available in their own hospitals.

 

R426-9-2. Trauma System Advisory Committee.

(1) The trauma system advisory committee, created pursuant to 26-8a-251, shall:

(a) be a broad and balanced representation of healthcare providers and health care delivery systems; and

(b) conduct meetings in accordance with committee procedures established by the Department and applicable statutes.

(2) The Department shall appoint committee members to serve terms from one to four years.

(3) The Department may re-appoint committee members for one additional term in the position initially appointed by the Department.

(4) Causes for removal of a committee member include the following:

(a) more than two unexcused absences from meetings within 12 calendar months;

(b) more than three excused absences from meetings within 12 calendar months;

(c) conviction of a felony; or

(d) change in organizational affiliation or employment which may affect the appropriate representation of a position on the committee for which the member was appointed.

 

R426-9-3. Trauma Center Categorization Guidelines.

The Department adopts as criteria for Level I, Level II, Level III, and Pediatric trauma center designation, compliance with national standards published in the American College of Surgeons document: Resources for Optimal Care of the Injured Patient 2006. The Department adopts as criteria for Level IV and Level V trauma center designation the American College of Surgeons document: Resources for Optimal Care of the Injured Patient 1999, except that a Level V trauma center need not have a general surgeon on the medical staff and may be staffed by nurse practitioners or certified physician assistants.

 

R426-9-4. Trauma Review.

(1) The Department shall evaluate trauma centers and applicants to verify compliance with standards set in R426-5-2. In conducting each evaluation, the Department shall consult with experts from the following disciplines:

(a) trauma surgery;

(b) emergency medicine;

(c) emergency or critical care nursing; and

(d) hospital administration.

(2) A consultant shall not assist the Department in evaluating a facility in which the consultant is employed, practices, or has any financial interest.

 

R426-5-5. Trauma Center Categorization Process.

The Department shall:

(1) Develop a survey document based upon the Trauma Center Criteria described in R426-5.

(2) Periodically survey all Utah hospitals which provide emergency trauma care to determine the maximum level of trauma care which each is capable of providing.

(3) Disseminate survey results to all Utah hospitals, and as appropriate, to state EMS agencies.

 

R426-5-6. Trauma Center Designation Process.

(1) Hospitals seeking voluntary designation and all designated Trauma Centers desiring to remain designated, shall apply for designation by submitting the following information to the Department at least 30 days prior to the date of the scheduled site visit:

(a) A completed and signed application and appropriate fees for trauma center verification;

(b) A letter from the hospital administrator of continued commitment to comply with current trauma center designation standards as applicable to the applicant's designation level;

(c) The data specified under R426-5-8 are current;

(d) Level I and Level II Trauma Centers must submit a copy of the Pre-review Questionnaire (PRQ) from the American College of Surgeons in lieu of the application in 1a above.

(e) Level III Level IV and Level V trauma centers must submit a complete Department approved application.

(2) Hospitals desiring to be designated as Level I and Level II Trauma Centers must be verified by the American College of Surgeons (ACS) within three (3) months of the expiration date of previous designation and must submit a copy of the full ACS report detailing the results of the ACS site visit. A Department representative must be present during the entire ACS verification visit. Hospitals desiring to be Level III, Level IV or Level v Trauma Centers must be designated by hosting a formal site visit by the Department.

(3) The Department and its consultants may conduct observation, review and monitoring activities with any designated trauma center to verify compliance with designation requirements.

(4) Trauma centers shall be designated for a period of three years unless the designation is rescinded by the Department for non-compliance to standards set forth in R426-9-6 or adjusted to coincide with the American College of Surgeons verification timetable.

(5) The Department shall disseminate a list of designated trauma centers to all Utah hospitals, and state EMS agencies, and as appropriate, to hospitals in nearby states which refer patients to Utah hospitals.

 

R426-9-7. Data Requirements for an Inclusive Trauma System.

(1) All hospitals shall collect, and quarterly submit to the Department, Trauma Registry information necessary to maintain an inclusive trauma system. The Department shall provide funds to hospitals, excluding designated trauma centers, for the data collection process. The inclusion criteria for a trauma patient are as follows:

(a) ICD9 Diagnostic Codes between 800 and 959.9 (trauma); and

(b) At least one of the following patient conditions:

admitted to the hospital for 24 hours or longer; transferred in or out of your hospital via EMS transport (including air ambulance); death resulting from the traumatic injury (independent of hospital admission or hospital transfer status; all air ambulance transports (including death in transport and patients flown in but not admitted to the hospital).

(c) Exclusion criteria are ICD9 Diagnostic Codes:

930-939.9 (foreign bodies)

905-909.9 (late effects of injury)

910-924.9 (superficial injuries, including blisters, contusions, abrasions, and insect bites)

The information shall be in a standardized electronic format specified by the Department which includes:

(i) Demographics:

Database Record Number

Institution ID number

Medical Record Number

Social Security Number

Patient Home Zip Code

Sex

Date of Birth

Age Number and Units

Patient's Home Country

Patient's Home State

Patient's Home County

Patient's Home City

Alternate Home Residence

Race

Ethnicity

(ii) Injury:

Date of Injury

Time of Injury

Blunt, Penetrating, or Burn Injury

Cause of Injury Description

Cause of Injury Code

Work Related Injury (y/n)

Patient's Occupational Industry

Patient's Occupation

Primary E-Code

Location E-Code

Additional E-Code

Incident Location Zip Code

Incident State

Incident County

Incident City

Protective Devices

Child Specific Restraint

Airbag Deployment

(iii) Prehospital:

Name of EMS Service

Transport Origin Scene or Referring Facility

Trip Form Obtained (y/n)

EMS Dispatch Date

EMS Dispatch Time

EMS Unit Arrival on Scene Date

EMS Unit Arrival on Scene Time

EMS Unit Scene Departure Date

EMS Unit Scene Departure Time

Transport Mode

Other Transport Mode

Initial Field Systolic Blood Pressure

Initial Field Pulse Rate

Initial Field Respiratory Rate

Initial Field Oxygen Saturation

Initial Field GCS-Eye

Initial Field GCS-Verbal

Initial Field GCS-Motor

Initial Field GCS-Total

Inter-Facility Transfer

(iv) Referring Hospital:

Transfer from Another Hospital (y/n)

Name or Code

Arrival Date

Arrival Time

Discharge Date

Discharge time

Transfer Mode

Admitted or ER

Procedures

Pulse

Capillary Refill

Respiratory Rate

Respiratory Effort

Blood Pressure

Eye Movement

Verbal Response

Motor Response

Glascow Coma Score Total

Revised Trauma Score Total

(v) Emergency Department Information:

Mode of Transport

Arrival Date

Arrival Time

Discharge Time

Discharge Date

Initial ED/Hospital Pulse Rate

Initial ED/Hospital Temperature

Initial ED/Hospital Respiratory Rate

Initial ED/Hospital Respiratory Assistance

Initial ED/Hospital Oxygen Saturation

Initial ED/Hospital Systolic Blood Pressure

Initial ED/Hospital GCS-Eye

Initial ED/Hospital GCS-Verbal

Initial ED/Hospital GCS-Motor

Initial ED/Hospital GCS-Total

Initial ED/Hospital GCS Assessment Qualifiers

Revised Trauma Score Total

Alcohol Use Indicator

Drug Use Indicator

ED Discharge Disposition

ED Death

ED Discharge Date

ED Discharge Time

(vi) Emergency Department Treatment:

Procedures Done (pick list)

Paralytics used prior to GCS (y/n)

(vii) Admission Information:

Admit from ER or Direct Admit

Admitted from what Source

Time of Hospital Admission

Date of Hospital Admission

Hospital Procedures

Hospital Procedure Start Date

Hospital Procedure Start Time

(viii) Hospital Diagnosis:

ICD9 Diagnosis Codes

Injury Diagnoses

Co-Morbid Conditions

AIS Score for Diagnosis (calculated)

Injury Severity Score

(ix) Quality Assurance Indicators:

Hospital Complications

(x) Outcome:

Discharge Time

Discharge Date

Total Days Length of Stay

Total ICU Length of Stay

Total Ventilator Days

Disposition from Hospital

Destination Facility

(xi)Charges:

Payment Sources

 

R426-9-8. Trauma Triage and Transfer Guidelines.

The Department adopts by reference the 2009 Resources and Guidelines for the Triage and Transfer of Trauma Patients published by the Utah Department of Health as model guidelines for triage, transfer, and transport of trauma patients. The guidelines do not mandate the transfer of any patient contrary to the judgment of the attending physician. They are a resource for pre-hospital and hospital providers to assist in the triage, transfer and transport of trauma patients to designated trauma centers or acute care hospitals which are appropriate to adequately receive trauma patients.

 

R426-9-9. Noncompliance to Standards.

(1) The Department may warn, reduce, deny, suspend, revoke, or place on probation a facility designation, if the Department finds evidence that the facility has not been or will not be operated in compliance to standards adopted under R426-9.

(2) A hospital, clinic, health care provider, or health care delivery system may not profess or advertise to be designated as a trauma center if the Department has not designated it as such pursuant to this rule.

 

R426-9-10. Statutory Penalties.

As required by Section 63G-3-201(5): Any person or agency who violates any provision of this rule, per incident, may be assessed a penalty as provided in Section 26-23-6.

 

KEY: emergency medical services, trauma, reporting, trauma center designation

Date of Enactment or Last Substantive Amendment: 2012

Authorizing, and Implemented or Interpreted Law: 26-8a-252