Section 22-B2704. HOSPITAL DEPARTMENTS, DIVISIONS, SERVICES, SECTIONS

 

2704.1Each 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:

 

(a)General Surgery;

 

(b)Neurologic Surgery;

 

(c)Orthopedic Surgery;

 

(d)Emergency Services; and

 

(e)Anesthesia.

 

2704.2In 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.

 

2704.3The 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.

 

2704.4In 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:

 

(a)Specifically named general surgeon;

 

(b)Specifically named neurosurgeon;

 

(c)Emergency department staffed twenty-four (24) hours a day by a physician who has successfully completed training in Advanced Trauma Life Support (ATLS) or who has demonstrated his or her level of expertise as determined by the Trauma Service Director;

 

(d)Twenty-four (24) hour availability of an operating room capable of the rapid acceptance of patients for craniotomy or spinal surgery;

 

(e)Twenty-four (24) hour availability of a computerized tomographic (CT) scanner and technician;

 

(f)Intensive care unit (ICU) with appropriate equipment and staffing, including capabilities for monitoring intracranial pressure (ICP); and

 

(g)A clearly defined bypass plan in the event of unavailability of the neurosurgeon or other essential resources.

 

2704.5The care of neurological trauma may also include a readily available magnetic resonance imaging (MRI) scanner.

 

2704.6An 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.

 

2704.7An 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.

 

2704.8An 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.

 

2704.9The 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.

 

2704.10An orthopedic surgeon shall have demonstrated skill in:

 

(a)The management of open wounds;

 

(b)Recognition and treatment of compartment syndrome;

 

(c)External fixation of femoral fractures; and

 

(d)Internal fixation of femoral fractures.

 

2704.11Each 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.

 

2704.12Operating 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.

 

2704.13Each adult trauma care facility shall maintain essential equipment for optimal fracture treatment, including:

 

(a)A complete stock of plaster, fiberglass cast, and splint material with adequate padding;

 

(b)Equipment for skeletal traction of spine and extremities;

 

(c)A complete set of modular external fixation devices;

 

(d)A pulse-lavage unit with appropriate protective shields, including waterproof gowns and drapes;

 

(e)Tissue pressure measurement equipment;

 

(f)An image-intensifier fluoroscope;

 

(g)A fracture table, compatible with the fluoroscope, that permits supine and lateral decubitus positions, with attachments for procedures on femur, tibia, upper extremity, and pelvis;

 

(h)A radiolucent operating table for intraoperative fluoroscopy of pelvis, extremities, and spine;

 

(i)Intramedullary nailing instruments and implants for femur, tibia, and humerus; interlocking nail equipment for the femur and tibia, and nails that can be used without reaming the medullary canal shall also be available;

 

(j)Standard sets of instruments, including power drills, reamers, and wire drivers for fracture fixation of small and large bones, with assorted plates and screws, including fixation devices for the proximal and distal femur, with sideplate length sufficient for extensive shaft comminution and multiple levels of injury;

 

(k)Instruments and implants for reducing and stabilizing spinal injuries and for decompressing the spinal canal if necessary; and

 

(l)Equipment and supplies for microvascular and microneural surgery.

 

2704.14Each 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.

 

2704.15In 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.

 

2704.16In 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.

 

source

Notice of Final Rulemaking published at 46 DCR 8741 (October 29, 1999); as amended by Notice of Emergency and Proposed Rulemaking published at 51 DCR 3915 (April 16, 2004) [EXPIRED]; as amended by Final Rulemaking published at 51 DCR 7260 (July 23, 2004).