Current through Register Vol. 48, No. 12, March 22, 2024
a) The Level I
Pediatric Trauma Center Director shall advise the Trauma Center Medical
Director and shall be a member of the Regional Trauma Advisory Board.
b) The Pediatric Trauma Center Medical
Director shall be board certified in pediatric surgery or be a general surgeon,
with at least two years of experience in pediatric trauma care, 10 hours per
year of trauma-related continuing medical education (CME), and 24-hour
independent operating privileges, as evidenced by:
1) care and supervision for 50 pediatric
trauma cases per year; and
2)
ongoing involvement in pediatric trauma care.
c) The trauma center shall provide a
pediatric trauma service separate from the general surgery service. The
pediatric trauma service shall be staffed by pediatric trauma surgeons with one
year of experience in pediatric trauma or general surgeons with two years of
pediatric trauma care experience, who are available in-house 24 hours a day for
immediate response.
1) The pediatric trauma
surgeon requirement may be fulfilled by residents with a minimum of four years
of general surgery residency training with independent operating room
privileges for pediatric surgery and who have current Advanced Trauma Life
Support (ATLS) verification.
2) If
the resident is fulfilling the pediatric trauma surgeon requirement, the
attending pediatric trauma surgeon must be consulted within 30 minutes after
the patient's being classified as Category I or II.
3) If the resident is fulfilling the
pediatric trauma surgeon requirement, it is mandatory that the attending
pediatric trauma surgeon be present for patients undergoing operative
procedures by the time the surgery begins.
4) The pediatric trauma surgeon, pediatric
surgery resident or surgical subspecialist shall be consulted when the decision
is made to admit a Category II patient. The pediatric trauma surgeon or
appropriate subspecialist shall see the patient within 12 hours after the
patient arrives in the Emergency Department (ED).
5) 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 Pediatric Trauma Center to treat the trauma
patient.
6) The hospital's quality
improvement program shall monitor compliance with this subsection
(c).
7) 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. Any patient meeting the definition of isolated
injury requires consultation with the appropriate subspecialist. That
subspecialist is to arrive within the time designated in subsection (d) after
the 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. An isolated injury
refers to the transfer of energy to a single specific anatomic body region with
no potential for multisystem involvement.
d) The trauma center shall provide the
following surgical services within the designated times, by physicians
credentialed by the hospital to provide pediatric care:
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 pediatric
trauma/general surgeon with experience in pediatric cardiothoracic surgery for
lifesaving procedures; the surgeon must have pediatric cardiothoracic
privileges; and
B) Obstetrics, or a
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;
I)
Neurosurgery.
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 pediatric trauma center shall provide
the following nonsurgical services:
1)
Department of Pediatrics with a designated Board certified pediatrician in the
role of chairman.
2) Emergency
Medicine staffed 24 hours a day in the ED by a physician who is board prepared
or certified by the ABEM or by the American Board of Pediatrics and Pediatric
Emergency Medicine (ABP/PEM) or AOBEM with two year ongoing involvement in
daily pediatric trauma care and 10 hours per year of trauma-related
CME.
3) Anesthesiology Services:
A) The anesthesiology service or department
shall be supervised by pediatric anesthesiologists. "Supervise," for the
purposes of this subsection (e)(3)(A), 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) Pediatric
anesthesiology services as credentialed by the hospital available 24 hours a
day in-house.
C) Direct patient
care services may be performed by a pediatric anesthesiologist or a certified
registered nurse anesthetist (CRNA) with experience in pediatric anesthesia
acting under the direct supervision of a pediatric anesthesiologist.
4) 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.
C) A pediatric
radiologist on staff to provide a quality improvement process to validate
interpretation of pediatric films.
5) Pediatric intensive care unit having
available 24 hours a day:
A) A physician
credentialed by the hospital. This requirement may be fulfilled by pediatric or
general surgery residents at the second or third year level or by pediatric or
surgical critical care fellows who have had pediatric intensive care training
and are under the supervision of a staff physician possessing full pediatric
intensive care privileges;
B) One
Registered Professional Nurse per shift with two years of pediatric intensive
care or critical care experience and four hours of trauma-related pediatric
critical care continuing education per year; and
C) The following pediatric 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
CO[2] 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); and
xi) Intracranial pressure monitoring
devices.
6)
Laboratory 24 hours a day in-house, providing the following:
A) Standard analysis of blood and urine, and
other body fluids using micro-sampling techniques;
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) Toxicology
screening.
7) A
board-certified pediatrician shall be available within 60 minutes after
notification.
8) Pediatric
cardiology 60 minutes after notification.
9) Postanesthetic recovery capabilities 24
hours a day (may be fulfilled by a pediatric ICU).
10) Acute hemodialysis capability 24 hours a
day.
11) Open heart
capability.
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 ABP/PEM or certified by the AOBEM;
2) The Emergency Department 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) or Trauma Nursing Core Course (TNCC);
or is currently recognized as a Trauma Nurse Specialist (TNS);
3) A full-time Trauma Coordinator 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, child
protective services, dietary and pediatric 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 Pediatric 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 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,
CO2 monitoring and pulse oximeter;
2) Suction devices and equipment (pulmonary
and gastric);
3)
Electrocardiograph-oscilloscope-defibrillator, pacemaker;
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, intraosseous;
7) Drugs and supplies necessary for emergency
care;
8) X-ray and CAT scan
capability;
9) Spinal
immobilization equipment;
10)
Temperature control devices;
11)
Pediatric measuring device;
12)
Scale; and
13) Specialized
pediatric resuscitation cart with measuring device in the emergency area.
AGENCY NOTE: Broselow(TM) Pediatric
Tape will meet this requirement.
i) The trauma service must be identified in
the facility's budget, with sufficient funds dedicated to support the trauma
director and trauma coordinator positions and to provide for the operation of
the trauma registry.
j) A level I
Pediatric Trauma Center shall meet the requirements of Section 515.2030(i)-(s)
of this Part.