DAR File No. 37689

Health, Family Health and Preparedness, Emergency Medical Services

Rule R426-9

Statewide Trauma System Standards

Notice of Proposed Rule

(New Rule)

DAR File No.: 37689
Filed: 06/04/2013 10:22:22 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This new rule is in response to the Governor's mandate for rule review and simplification. This proposed new rule is part of a change to the sequence of numbering for Title R426 that allows for a new set of rules that begins with Rules R426-1 through R426-9. This is part of a set of rules to update, and re-number all of the administrative rules in a more concise and logical order for implementation.

Summary of the rule or change:

This new rule reflects updates for current rules in Rule R426-5 for the designation of a statewide trauma system. The new rule contains the process and criteria used to determine designation eligibility and level. It is a new rule due to the fact that there is not a current effective rule that has the number R426-9. (DAR NOTE: The proposed repeal and reenactment of Rule R426-5 is under DAR No. 37685 in this issue, July 1, 2013, of the Bulletin.)

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 existing rule requirements that are imposed by this new rule.

local governments:

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

small businesses:

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

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

No anticipated fiscal impact to businesses because there are no changes in the existing rule requirements that are imposed by this new rule.

Compliance costs for affected persons:

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

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

No anticipated effect on business because the requirements are unchanged and the businesses use this data to help develop policy.

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 gdansie@utah.gov

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:

07/31/2013

This rule may become effective on:

08/07/2013

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, 252, 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 R426-9-3. 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.

 

R426-9-5. Trauma Center Categorization Process.

The Department shall:

(1) Develop a survey document based upon the Trauma Center Criteria described in R426-9-3.

(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.

 

R426-9-6. 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 R426-9-7 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 monthly submit to the Department, Trauma Registry information necessary to maintain an inclusive trauma system. Designated trauma centers shall provide such data in an electronic format. 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) Demographic Data:

Tracking Number

Hospital Number

Date of Birth

Age

Age Unit

Sex

Race

Other Race

Ethnicity

Medical Record Number

Social Security Number

Patient Home Zip Code

Patient's Home Country

Patient's Home State

Patient's Home County

Patient's Home City

Patient's Home Zip Code

Alternate Home Residence

(ii) Event Data:

Injury Time

Injury Date

Cause Code

Trauma Type

Work Related

Patient's Occupational Industry

Patient's Occupation

ICD-9/10 Primary E-Code

ICD-9/10 Location E-Code

Protective Devices

Child Specific Restraint

Airbag Deployment

Incident Country

Incident Location Zip Code

Incident State

Incident County

Incident City

Location Code

Injury Details

(iii) Referring Hospital:

Hospital Transfer

Transport Mode into Referring Hospital

Referring Hospital

Referring Hospital Arrival Time

Referring Hospital Arrival Date

Referring Hospital Discharge Time

Referring Hospital Discharge Date

Referring Hospital Admission Type

Referring Hospital Pulse

Referring Hospital Respiratory Rate

Referring Hospital Systolic Blood Pressure

Referring Hospital GCS -Eye

Referring Hospital GCS -Verbal

Referring Hospital GCS -Motor

Referring Hospital GCS Assessment Qualifiers

Referring Hospital GCS Total

Referring Hospital Procedures

(iv) Prehospital:

Transport Mode Into Hospital

Other Transport Mode

EMS Agency

EMS Origin

EMS Notify Time

EMS Notify Date

EMS Respond Time

EMS Respond Date

EMS Unit Arrival on Scene Time

EMS Unit Arrival on Scene Date

EMS Unit Scene Departure Time

EMS Unit Scene Departure Date

EMS Destination Arrival Time

EMS Destination Arrival Date

EMS Destination

EMS Trip Form Received

Initial Field Pulse Rate

Initial Field Respiratory Rate

Initial Field Systolic Blood Pressure

Initial Field Oxygen Saturation

Initial Field GCS-Eye

Initial Field GCS-Verbal

Initial Field GCS-Motor

Initial Field GCS Assessment Qualifiers

Initial Field GCS-Total

(v) Emergency Department/Hospital Information:

Admit Type

Admit Service

ED/Hospital Arrival Time

ED/Hospital Arrival Date

ED Admission Time

ED Admission Date

ED Discharge Time

ED Discharge Date

Inpatient Admission Time

Inpatient Admission Date

Hospital Discharge Time

Hospital Discharge Date

ED Discharge Disposition

ED Transferring EMS Agency

ED Discharge Destination Hospital

Transfer Reason

Hospital Discharge Disposition

Hospital Discharge Destination Hospital

DC Transferring EMS Agency

Outcome

Initial ED/Hospital Pulse Rate

Initial ED/Hospital Respiratory Rate

Initial ED/Hospital Respiratory Assistance

Initial ED/Hospital Systolic Blood Pressure

Initial ED/Hospital Temperature

Initial ED/Hospital Oxygen Saturation

Initial ED/Hospital Supplemental Oxygen

Initial ED/Hospital GCS-Eye

Initial ED/Hospital GCS-Verbal

Initial ED/Hospital GCS-Motor

Initial ED/Hospital GCS Assessment Qualifiers

Initial ED/Hospital GCS-Total

Alcohol Use Indicator

Drug Use Indicator

Inpatient Length of Stay

Total ICU Length of Stay

Total Ventilator Days

Primary Method of Payment

Hospital Complications

Initial ED/Hospital Height

Initial ED/Hospital Weight

Signs of Life

(vi) Hospital Procedures

ICD-9/10 Hospital Procedures

Hospital Procedure Start Time

Hospital Procedure Start Date

(vii) Diagnosis:

Co-Morbid Conditions

Injury Diagnosis Codes

(viii) Injury Severity Information

Abbreviated Injury Scale (AIS) Score

AIS Predot Code

ISS Body Region

AIS Version

Locally Calculated Injury Severity Score

 

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 R426-9-3.

(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: 2013

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