Section 22-B2705. CLINICAL CAPABILITIES (HOSPITAL PERSONNEL)

 

2705.1Each adult trauma care facility shall have the following specialties available in-house twenty-four (24) hours per day:

 

(a)General Surgery;

 

(b)Emergency Medicine; and

 

(c)Anesthesiology.

 

2705.2The patient evaluation and treatment team shall consist of a team of surgeons that will include, at a minimum, a post-graduate resident in at least the fourth (4th) year of training.

 

2705.3The attending surgeon shall participate in each major therapeutic decision and be present at each operative procedure. The hospital's trauma performance improvement program shall monitor compliance with the requirements of this section.

 

2705.4An 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 directed toward stabilizing the patient and initiating diagnostic procedures.

 

2705.5The requirement to provide emergency medical services may be fulfilled 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 fulfill availability requirements, the staff specialist on-call shall be advised and be available for consultations.

 

2705.6In Level I facilities, the requirement to provide anesthesiology services may be satisfied by anesthesiology chief residents or a certified nurse anesthetist (CRNA) capable of assessing emergency situations in trauma patients and providing any indicated treatment, including surgical anesthesia. Whenever a Level I facility uses an anesthesiology resident or a certified nurse anesthetist (CRNA) to satisfy this requirement, the facility shall notify the staff anesthesiologist on-call, who shall be promptly available.

 

2705.7In Level II facilities, the requirement to provide anesthesiology services is satisfied when the staff anesthesiologist is in the hospital at the time of, or shortly after, the patient's arrival. Before the staff anesthesiologist arrives, an anesthesiology chief resident or certified nurse anesthetist (CRNA) capable of assessing emergency situations in trauma patients and of initiating and providing any indicated treatment shall be available.

 

2705.8Each Level I facility shall have personnel on-call and promptly available with competence to assess and/or perform procedures in the following areas:

 

(a)Cardiac Surgery;

 

(b)Cardiology;

 

(c)Hand Surgery;

 

(d)Infectious Disease;

 

(e)Internal Medicine;

 

(f)Microvascular Surgery (replant/flaps);

 

(g)Obstetrics-Gynecologic Surgery;

 

(h)Ophthalmic Surgery;

 

(i)Oral/Maxillofacial Surgery;

 

(j)Orthopedic Surgery;

 

(k)Plastic Surgery;

 

(l)Pulmonary Medicine;

 

(m)Radiology;

 

(n)Thoracic Surgery; and

 

(o)Urologic Surgery;

 

2705.9Each Level II facility shall have personnel on-call and available with the competence to perform procedures in the following areas:

 

(a)Cardiology;

 

(b)Internal Medicine;

 

(c)Obstetric/Gynecologic Surgery;

 

(d)Ophthalmic Surgery;

 

(e)Oral/Maxillofacial Surgery;

 

(f)Orthopedic Surgery;

 

(g)Plastic Surgery;

 

(h)Pulmonary Medicine;

 

(i)Thoracic Surgery;

 

(j)Urologic Surgery; and

 

(k)Radiology.

 

2705.10Each Level II facility may have personnel on-call and available with competence to perform procedures in the following areas:

 

(a)Cardiac Surgery;

 

(b)Hand Surgery;

 

(c)Infectious Disease; and

 

(d)Microvascular Surgery (replant/flaps).

 

2705.11In non-surgical specialty cases, the patient's primary care physician shall be notified at an appropriate time.

 

2705.12Thoracic surgery may be performed by a general trauma surgeon with privileges to provide thoracic surgical care to patients with thoracic injuries.

 

2705.13Transplant specialists shall be provided as follows:

 

(a)Level I facilities may have transplant specialists on-staff and available to respond for consultation; if no transplant specialists are on-staff, a Level I facility shall have a written transfer agreement with another facility for needed transplant service;

 

(b)Level II facilities shall have a written transfer agreement with another facility for needed transplant service, and transfer shall take place if transplant personnel or resources are not available at the Level II facility.

 

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).