Section 22-B2805. CLINICAL CAPABILITIES (HOSPITAL PERSONNEL)

 

2805.1Each pediatric trauma care facility shall have the following surgical specialties available in-house twenty-four (24) hours each day:

 

(a)General Surgery;

 

(b)Repealed.

 

(c)Repealed.

 

(d)Emergency Medicine;

 

(e)Anesthesiology; and

 

(f)Repealed.

 

2805.2The evaluation and treatment of a patient may be started by a team of surgeons that includes, at a minimum, a post-graduate resident in at least the fourth (4th) year of training.

 

2805.3The attending surgeon shall participate in each major therapeutic decision and be present at each operative procedure. Compliance with these criteria and their appropriateness shall be monitored by the hospital's trauma performance improvement program.

 

2805.4An 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 to stabilize the patient and initiate diagnostic procedures.

 

2805.5Each Level I facility shall have personnel on-call and promptly available with competence to access or perform procedures in the following areas:

 

(a)Cardiac Surgery;

 

(b)Cardiology;

 

(c)Hand Surgery;

 

(d)Infectious Disease;

 

(e)Microvascular Surgery (replant/flaps);

 

(f)Ophthalmic Surgery;

 

(g)Oral/Maxillofacial Surgery;

 

(h)Orthopedic Surgery;

 

(i)Internal Medicine;

 

(j)Plastic Surgery;

 

(k)Pulmonary Medicine;

 

(l)Radiology;

 

(m)Urologic Surgery;

 

(n)Obstetrics-Gynecologic Surgery; and

 

(o)Thoracic Surgery.

 

2805.6Each 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.

 

2805.7Each 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).

 

2805.8In non-surgical specialty cases the patient's primary care physician shall be notified at an appropriate time.

 

2805.9Thoracic surgery may be performed by a general trauma surgeon with privileges to provide thoracic surgical care to patients with thoracic injuries.

 

2805.10Transplant 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.

 

2805.11The requirement to provide emergency medical services may be satisfied 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 satisfy availability requirements, the staff specialist on-call shall be advised and be available for consultations.

 

2805.12The requirement to provide anesthesiology services may be satisfied in a Level I facility by an anesthesiology chief resident or a certified nurse anesthetist (CRNA) capable of assessing emergency situations in trauma patients, and providing any indicated treatment, including surgical anesthesia. When an anesthesiology resident or a CRNA is used to satisfy availability requirements the staff anesthesiologist on-call shall be advised and be promptly available.

 

2805.13The requirement to provide anesthesiology services is satisfied in a Level II facility when the staff anesthesiologist will be in the hospital at the time of, or shortly after, the patient's arrival. Before the staff anesthesiologist arrives, an Anesthesiology chief resident or a CRNA capable of assessing emergency situations in trauma patients and of initiating and providing any indicated treatment shall be available.

 

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).