Current through Register Vol. 48, No. 12, March 22, 2024
a) Level I
Trauma Centers, under the direction of Level I Trauma Center Medical Directors,
shall be responsible for coordinating and managing trauma care in the EMS
Region. This responsibility includes obtaining the cooperation of all Level II
Trauma Centers, Participating Hospitals, and EMS Systems in the EMS Region. A
Level I Trauma Center Medical Director shall be the chairperson of the Regional
Trauma Advisory Committee.
b) The
Trauma Center Medical Director shall be a trauma surgeon, board certified in
surgery, with at least two years of post-residency experience in trauma care
and with 24-hour independent operating privileges.
c) The trauma center shall provide a trauma
service, separate from the general surgery service, that is an identified
hospital service functioning under the designated director and staffed by
trauma surgeons with one year of experience in trauma, and who are available
in-house 24 hours a day for immediate response.
1) Trauma surgeons shall have 10 hours of
trauma-related CME every two years.
2) The trauma surgeon requirement may be
fulfilled by residents with a minimum of four years of general surgery
residency training with independent operating room privileges and who have
current Advanced Trauma Life Support (ATLS) verification.
3) If the resident is fulfilling the trauma
surgeon requirement, the attending physician must be consulted within 30
minutes after the patient's being classified as Category I or II.
4) If the resident is fulfilling the trauma
surgeon requirement, it is mandatory that an attending be present 30 minutes
after the decision to operate is made.
5) The trauma surgeon, resident or surgical
subspecialist shall be consulted when the decision is made to admit a Category
II patient. The trauma surgeon or appropriate subspecialist shall see the
patient within 12 hours after Emergency Department (ED) arrival.
6) A physician with current ATLS verification
or who has current competency in the initial resuscitation of the trauma
patient as verified by the professional staff competency plan must be present
24 hours per day in the Level I Trauma Center to treat the trauma
patient.
7) The hospital's quality
improvement program shall monitor compliance with this subsection
(c).
8) The trauma center shall
have the option of allowing the ED personnel to determine that a trauma patient
with an isolated injury may be treated by one of the services listed in
subsection (d) of this Section. An isolated injury refers to the transfer of
energy to a single specific anatomic body region with no potential for
multisystem involvement. The subspecialist is to arrive within the designated
time listed in subsection (d) after notification that his or her services are
needed at the hospital. When the need for neurosurgical intervention has been
identified, the neurosurgeon must arrive and be available in a fully staffed
operating room within 60 minutes after the identification of need for operative
intervention.
d) The
trauma center shall have the following surgical services within the designated
times listed below:
1) On call to arrive at
the hospital to treat the patient within 30 minutes after notification that
their services are needed at the hospital:
A)
Cardiothoracic; this requirement may be fulfilled by a cardiothoracic surgeon
or a trauma/general surgeon with experience in cardiothoracic surgery for
lifesaving procedures; the surgeon must have cardiothoracic
privileges;
B) Obstetrics;
and
C) Pediatric surgery as
designated by Section
515.2035 of this Part or by
transfer agreement.
2)
On call to arrive at the hospital to treat the patient within 60 minutes after
notification that their services are needed at the hospital:
A) Orthopedic;
B) Vascular;
C) Ophthalmologic;
D) Oral-Dental;
E) Otorhinolaryngologic;
F) Plastic/maxillofacial;
G) Urologic;
H) Reimplantation service, or a transfer
agreement; and
I) Neurosurgical.
When the need for neurosurgical intervention has been identified, the
neurosurgeon must arrive and be available in a fully staffed operating room
within 60 minutes after the identification of the need for operative
intervention.
3)
Twenty-four hours a day, or a transfer agreement:
A) Burn center staffed by Registered Nurses
trained in burn care; and
B) Acute
spinal cord injury management.
e) The trauma center shall provide the
following nonsurgical services within the designated times:
1) Emergency Medicine staffed 24 hours a day
in the ED by:
A) A physician who has
competency in trauma as demonstrated by:
i)
Board certification or board eligibility by the American Board of Emergency
Medicine (ABEM) or the American Osteopathic Board of Emergency Medicine (AOBEM)
of the American Osteopathic Association (AOA); and
ii) Ten hours per year of American Medical
Association (AMA) or AOA-approved Category I or II trauma-related CME;
or
B) A physician who
was working in the emergency department of a trauma center prior to January 1,
2000, and who had completed 12 months of internship, followed by at least 7000
hours of hospital-based Emergency Medicine over at least a 60-month period
(including 2800 hours within one 24-month period), and CME totaling 50 hours,
10 of which are trauma related, for each post-internship year in which the
physician completed any hospital-based Emergency Medicine hours.
2) Anesthesiology Services:
A) The anesthesiology service or department
shall be supervised by anesthesiologists. "Supervise", for the purposes of this
subsection, means to manage, control and direct the services performed,
including being present in the trauma center and immediately available for
consultation while the services are being performed.
B) Anesthesiology services shall be available
24 hours a day in-house.
C) Direct
patient care services may be performed by an anesthesiologist or a certified
registered nurse anesthetist (CRNA) acting under the direct supervision of an
anesthesiologist.
3)
Radiology staffed by:
A) A technician with the
ability to perform a computerized axial tomography (CAT) scan in-house, 24
hours a day.
B) A radiologist with
the ability to read CAT scans and perform angiography available within 30
minutes. This requirement may be met by a Post Graduate Year (PGY) II radiology
resident with six months experience in CAT and angiography. Teleradiographic
equipment may be used to transmit CAT scans to radiologists off site in lieu of
the radiologists' response to the trauma center to read CAT scans. The
radiology department shall provide a quality monitoring process to validate the
resident's compliance with the time requirements and competency to read CAT
scans and perform angiography.
4) Intensive Care Medicine Unit (ICU) having
available 24 hours a day in-house:
A) A
physician credentialed by the hospital. This requirement may be fulfilled by
second and third year residents who have had intensive care training and are
under the supervision of a staff physician possessing full intensive care
privileges;
B) One Registered
Professional Nurse per shift with two years of ICU or critical care experience
and four hours of trauma-related critical care continuing education per year;
and
C) The following equipment:
i) Airway control and ventilation
devices;
ii) Oxygen source with
concentration controls;
iii)
Cardiac emergency cart;
iv)
Electrocardiograph-oscilloscope-defibrillator;
v) Cardiac output monitoring;
vi) Electronic pressure monitoring;
vii) Mechanical
ventilator-respirators;
viii)
Pulmonary function measuring devices, i.e., pulse oximeter and
CO2 monitoring;
ix) Temperature control devices;
x) Drugs, intravenous fluids, and supplies in
accordance with the Hospital Licensing Requirements (77 Ill. Adm. Code
250.1050,
250.2140, and
250.2710);
xi) Intracranial pressure monitoring devices;
and
xii) Intra-aortic balloon pump
capability.
5) Laboratory 24 hours a day in-house,
providing the following:
A) Standard analysis
of blood, urine, and other body fluids;
B) Blood typing and cross-matching;
C) Coagulation studies;
D) Comprehensive blood bank or access to a
community central blood bank and adequate hospital storage facilities (see
Hospital Licensing Requirements (77 Ill. Adm. Code
250.520));
E) Blood gases and pH
determinations;
F) Microbiology, to
include the ability to initiate aerobic and anaerobic cultures on a 24 hour per
day basis; and
G) Drug and alcohol
screening.
6) Cardiology
-- 60 minutes.
7) Internal Medicine
-- 60 minutes.
8) Pediatrics -- 60
minutes.
9) Postanesthetic recovery
capabilities 24 hours a day (may be fulfilled by ICU).
10) Acute hemodialysis capability 24 hours a
day.
11) The trauma center shall
demonstrate an ongoing relationship with its designated organ procurement
agency (OPA).
f) The
trauma center shall meet the following professional staff requirements:
1) The ED Director shall be a physician board
certified by the ABEM or certified by the AOBEM of the AOA;
2) The ED treating the Category I or Category
II trauma patient shall be cared for by at least one RN who holds a current
nationally recognized trauma nursing certification such as Trauma Certified
Registered Nurse (TCRN), Advanced Trauma Certified Nurse (ATCN), or Trauma
Nursing Core Course (TNCC); or is currently recognized as a Trauma Nurse
Specialist (TNS);
3) A full-time
Trauma Coordinator shall be dedicated solely to the Trauma Program;
4) An operating room shall be staffed
in-house and available 24 hours a day; and
5) Staff shall include occupational therapy,
speech therapy, physical therapy, social work, dietary, and
psychiatry.
g) The
trauma center shall develop a professional staff competency plan, including but
not limited to trauma surgeons and emergency medicine physicians treating the
trauma patients. Physicians caring for trauma patients in the Level I Trauma
Center must demonstrate the following:
1)
Board certification/Board eligibility in their specialty;
2) Successful completion of trauma-related
CME requirements as specified in this Section;
3) Ongoing clinical involvement in the care
of the trauma patient as evidenced by the routine participation in one or more
of the following: trauma call rosters, trauma teams, and attendance at trauma
rounds/trauma meetings;
4)
Physician specific outcome measurements for high volume/high acuity
procedures;
5) For trauma surgeons
and emergency medicine physicians only, the successful completion of an ATLS
provider course.
h) The
trauma center shall provide and maintain the following equipment:
1) Airway control and ventilation equipment
including laryngoscopes and endotracheal tubes of appropriate sizes, bag-mask,
resuscitator, sources of oxygen, mechanical ventilator, pulse oximetry and
CO2 monitoring;
2) Suction devices and equipment (pulmonary
and gastric);
3)
Electrocardiograph-oscilloscope-defibrillator;
4) Apparatus to establish central venous
pressure monitoring;
5) All
standard intravenous fluids and administration devices;
6) Sterile surgical instruments or sets for
emergency care, such as cricothyrotomy, tracheostomy, thoracotomy,
thoracostomy, cut down, peritoneal lavage, and intraosseous;
7) Drugs and supplies necessary for emergency
care;
8) X-ray and CAT scan
capability;
9) Spinal
immobilization equipment;
10)
Temporary pacemaker;
11)
Temperature control device; and
12)
Specialized pediatric resuscitation cart with measuring device in the emergency
area.
AGENCY NOTE: Broselow(TM) Pediatric
Tape will meet this requirement.
i)
The trauma center must
have helicopter landing capabilities approved by State and federal
authorities. (Section
3.95(i) of the
Act) The helicopter landing capabilities shall:
1) Comply with the Aviation Safety Rules of
the Illinois Department of Transportation (92 Ill. Adm. Code 14, specifically
14.790,
14.792, and
14.795);
2) Be covered by a favorable airspace
determination letter issued by the Federal Aeronautics Administration pursuant
to Sections 307 and 309 of the Federal Aviation Act of 1958, and
14 CFR
157 and
14 CFR 77, Subpart D;
3) Be provided on the campus of the trauma
center; and
4) Out-of-state trauma
centers are exempt from this subsection but must provide proof of compliance
with their state's rules that govern aviation safety.
j) The trauma center shall perform focused
outcome analyses of its trauma services on a quarterly basis, and shall provide
on site or upon request all minutes related to these reviews to the Department.
The analyses shall consist of at least:
1)
Review of all patient deaths, excluding dead on arrival (DOA). Patients must be
assigned a status of non-preventable death, potentially preventable death,
preventable death, or cannot be determined, using the American College of
Surgeons "Performance Improvement" (Chapter 16, from "Resources for Optimal
Care of the Injured Patient, 1999"). Factors contributing to the death must be
included in the review. A cumulative report of these findings should be kept on
site and available to the Department upon request.
2) Review of all morbidities. A morbidity is
a negative outcome that is the result of the original trauma and/or treatment
rendered or omitted. Factors contributing to the morbidity must be included in
the review. A cumulative report of these findings must be presented quarterly
to the Region.
3) Review of audit
filters. An audit filter is a clinical and/or internal resource indicator used
to examine the process of care and to identify potential patient care and/or
internal resource problems.
4)
All information contained in or relating to any medical audit performed
of a trauma center's trauma services pursuant to the Act or by an EMSMD or his
designee of medical care rendered by system personnel, shall be afforded the
same status as is provided information concerning medical studies in Article
VIII, Part 21 of the Code of Civil Procedure. (Section
3.110(a) of the
Act)
k) Every two years
the trauma center shall provide written protocols with the redesignation
packet, which shall include the following:
1)
Policies for treating patients in the Level I Trauma Center, which include
Trauma Category I and Trauma Category II criteria as required in Section
515.Appendices C and F of this Part;
2) Clinical protocols for the management of
the trauma patient in basic resuscitation and management of specific injuries,
kept on site and available to the Department upon request;
3) The protocols for transferring trauma
patients to more specialized care;
4) A policy that a blood alcohol test will be
drawn on any motor vehicle crash victim who is believed to have been the driver
of the vehicle;
5) A suspension
policy for trauma nurse specialists, meeting due process requirements (see
Section 515.2200); and
6) A professional staff competency plan in
accordance with subsection (g) of this Section.
l) Changes to the Trauma Center Plan must be
approved by the Department prior to implementation.
m) The practices of the trauma center shall
reflect the protocols and policies of the EMS Region and Trauma Center
plan.
n) The resuscitation care of
a Trauma Category I or Trauma Category II patient must be documented on a
Trauma Flow Sheet, which at minimum contains trauma category classification;
time and place of classification (field or in-house); time of arrival of
patient to trauma center; notification of surgical specialties and time of
arrival to see patient (may exclude isolated injuries for Category II
patients).
o) The trauma center
shall maintain a job description for the Trauma Center Medical Director that
details his/her responsibility and authority for the coordination and
management of trauma services.
p)
The trauma center shall maintain a job description for the Trauma Coordinator
that details his/her responsibility and authority for the coordination and
management of trauma services.
q)
The trauma service must be identified in the facility's budget, with sufficient
funds dedicated to support the trauma director and trauma coordinator's
positions and to provide for the operation of the trauma registry.
r) The trauma center shall develop a policy
that identifies resource limitations that would result in the diversion of a
trauma patient to another facility. The hospital shall also develop a policy
that identifies what measures will be taken to avoid requesting a resource
limitation/bypass (see Section
515.315).
1) Such diversion must be reported to the
Department by telephone if it occurs during business hours or written
notification by fax of diversion must be sent within 24 hours following the
diversion.
2) Both forms of
notification shall include at minimum:
A) The
name of the trauma center;
B) Date
and time of resource limitation; and
C) The reason for resource
limitation.
s) The trauma center shall develop a plan for
implementing a program of public information and education concerning trauma
care for adult and pediatric patients.