Section 22-B2800. GENERAL PROVISIONS

 

2800.1The Director, Department of Health, shall designate Level I and Level II hospitals for pediatric trauma care services as the inclusive trauma system in the District of Columbia, provided a facility complies with the provisions of this chapter.

 

2800.2The provisions of this chapter shall be used by the District of Columbia for the purposes of assessing the suitability of hospitals for receipt of certain pediatric trauma patients in the District of Columbia's Emergency Medical Services System (EMS).

 

2800.3An inclusive trauma care system is a system that is fully integrated into the EMS system and is designated to meet the needs of all injured patients requiring care in an acute care facility, regardless of severity of injury, Geographic location, or population density.

 

2800.4An inclusive trauma care system shall have the following components:

 

(a)Medical direction;

 

(b)Prevention;

 

(c)Communication;

 

(d)Training;

 

(e)Triage;

 

(f)Prehospital care;

 

(g)Transportation;

 

(h)Hospital care;

 

(i)Public education;

 

(j)Rehabilitation; and

 

(k)Research.

 

2800.5An inclusive trauma care system shall be composed of the following:

 

(a)System management;

 

(b)Prehospital providers;

 

(c)Acute care facilities; and

 

(d)Rehabilitation/reconstructive services.

 

2800.6The designation of a pediatric trauma center as Level I and Level II guarantees the immediate availability and dedication of specialized surgeons, anesthesiologists, physician specialists, nurses, and resuscitation life-support equipment at the facilities on a twenty-four (24) hour-a day basis.

 

2800.7Level I facilities shall have the capability to provide total care for every aspect of an injury, and shall ensure prompt transfer between facilities during all phases of acute and rehabilitative care.

 

2800.8A Level I pediatric trauma center shall be an institution which, in addition to meeting the Level II guidelines, shall deploy and coordinate resources for the special types of care required for the major and multiple pediatric trauma victim and have a continued commitment to training and research as minimal characteristics of the hospital's commitment to pediatric trauma care.

 

2800.9Level II facilities may have the capability to provide total care for every aspect of an injury and may ensure prompt transfer between facilities during all phases of acute and rehabilitative care.

 

2800.10For optimal care of the severely injured, Level I and Level II facilities shall meet the following requirements:

 

(a)Skilled surgeons and other members of the trauma team shall be immediately available;

 

(b)When an arriving patient meets the hospital-specific guidelines defining a major resuscitation, the attending surgeon shall be present in the emergency department:

 

(1)Upon arrival of the patient, when there is advance notification from the field; or

 

(2)Within fifteen (15) minutes of activating the trauma team, when there is no advance notification;

 

(c)Compliance with the requirements of subsections (a) and (b) at a rate of eighty percent (80%) or greater shall be documented; and

 

(d)The following minimum criteria shall be used to define a major resuscitation:

 

(1)Hypotension: infant less than sixty (60) Systolic Blood Pressure (SBP), child less than seventy (70) SBP, and adolescent less than eighty (80) SBP;

 

(2)Glasgow Coma Scale less than eight (8) with hemodynamic instability;

 

(3)Penetrating injury with hemodynamic instability;

 

(4)Transfusion: interhospital transfer;

 

(5)Burns more than fifty percent (50%) of body surface;

 

(6)Vascular, thoracic, abdominal management;

 

(7)Hemodynamics Instability: infant less than sixty (60) SBP, child less than seventy (70) SBP, adolescent less than eighty (80) SBP, Oxygen saturation less than ninety-three percent (93%), and capillary refill more than four (4) seconds; and

 

(8)Discretion of Surgical Coordinator or Emergency Department (ED) attending physician.

 

2800.11All major pediatric trauma patients shall be admitted to a pediatric trauma center.

 

2800.12Each Level I facility shall conduct research at the clinical or basic sciences level, and shall be responsible for disseminating new information.

 

2800.13A designated person in each Level I and Level II facility shall be responsible for multi-disciplinary and interdepartmental coordination of trauma care.

 

2800.14Each facility shall be in compliance with all applicable local laws and regulations.

 

2800.15The management and operation of any pediatric trauma care facility shall be in accordance with good medical and public health practices.

 

source

Notice of Final Rulemaking published at 46 DCR 8779 (October 29, 1999); as amended by Notice of Emergency and Proposed Rulemaking published at 51 DCR 3933 (April 16, 2004) [EXPIRED]; as amended by Final Rulemaking published at 51 DCR 7277 (July 23, 2004).