Current through Register Vol. 48, No. 12, March 22, 2024
a) A Level II
Trauma Center, under the direction of a Level II Trauma Center Medical
Director, shall be responsible for providing trauma care in accordance with the
EMS System Program Plan.
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 will arrive at
the hospital to treat the trauma patient within 30 minutes after the patient's
being classified as a Category I trauma patient.
1) The trauma surgeons shall have 20 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 and current 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 for patients
undergoing operative procedures by the time the surgery begins.
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 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 II 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
maintain a call schedule that identifies at least a primary and back-up
surgeon, each listed by surgeon's name.
9) 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) or (e) 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 must arrive within the time frame listed in subsection (d) or
(e) 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 on call to arrive at
the hospital to treat the patient within 60 minutes after notification that
their services are needed:
1) 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;
2) Orthopedic;
3) Urologic; and
4) Obstetrics.
e) The trauma center shall have the following
surgical specialties on call to arrive at the hospital to treat the patient
within 60 minutes after notification that their services are needed. 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. The following
services may be provided by written transfer agreement. These services must be
provided according to subsection (c)(9) of this Section for isolated injuries
when the trauma surgeon is not required to respond:
1) Neurosurgical;
2) Ophthalmologic;
3) Oral-Dental;
4) Otorhinolaryngologic;
5) Reimplantation;
6) Plastic/Maxillofacial;
7) Burn center staffed by Registered
Professional Nurses trained in burn care;
8) Acute spinal cord injury management;
and
9) Pediatric surgery as
designated by Section
515.2045 of this Part.
f) 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 ABEM or the AOBEM;
and
ii) Ten hours per year of 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) Anesthesiology services shall be in
compliance with the Hospital Licensing Act and the Hospital Licensing
Requirements, 77 Ill. Adm. Code
250.1410. Staff shall be on call
to arrive at the hospital to administer anesthesia within 30 minutes after
notification that their services are needed at the hospital.
B) Direct patient care services may be
performed by an anesthesiologist or a CRNA.
3) 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.
4) Radiology
staffed by:
A) A technician with the ability
to perform a CAT scan available within 30 minutes; and
B) A radiologist with the ability to read CAT
scans and perform angiography available within 60 minutes. This requirement may
be met by a PGY II radiology resident with six months experience in CAT and
angiography. 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. Teleradiographic
equipment may be used to transmit CAT scans off site in lieu of the
radiologist's response to the trauma center to read CAT scans.
5) Cardiology - 60
minutes.
6) Internal Medicine - 60
minutes.
7) Postanesthetic recovery
capability staffed and available within 30 minutes may be fulfilled by
ICU.
8) Intensive Care Medicine
Unit having available the following:
A) A
physician credentialed by the hospital and available within 30 minutes. 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 experience and four hours of trauma-related
critical care continuing education per year.
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) Temperature control devices;
vi) Drugs, intravenous fluids, and supplies
in accordance with the Hospital Licensing Requirements (77 Ill. Adm. Code
250.1050,
250.2140, and
250.2710);
vii) Mechanical
ventilator-respirators;
viii)
Pulmonary function measuring devices (i.e., pulse oximeter,
CO2 monitoring); and
ix) Drugs, intravenous fluids and supplies in
accordance with Hospital Licensing Requirements (77 Ill. Adm. Code 250.1050,
250.2140 and 250.2710).
9) Pediatrics - 60 minutes.
10) Acute hemodialysis capability 24 hours a
day or a transfer agreement.
g) 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 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 and
available within 30 minutes 24 hours a day; and
5) Staff shall include occupational therapy,
speech therapy, physical therapy, social work, dietary, and
psychiatry.
h) 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 II Trauma
Center must demonstrate the following:
1)
Board certification/Board eligibility in their specialty;
2) Successful completion of trauma-related
continuing medical education (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
based on the frequency and acuity of procedures or other peer review measures
pertinent to the facility trauma patient volume;
5) For trauma surgeons and emergency medicine
physicians only, the successful completion of an ATLS provider
course.
i) 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 oximeter and
CO2 monitoring;
2) Suction device;
3)
Electrocardiograph-oscilloscope-defibrillator;
4) Apparatus to establish central venous
pressure monitoring;
5) All
standard intravenous fluids and administration devices;
6) Sterile surgical sets of procedures
standard for ED, such as cricothyrotomy, tracheostomy, thoracotomy, cut down,
peritoneal lavage, and intraosseous;
7) Drugs and supplies necessary for emergency
care;
8) X-ray and CAT scan
capability, available within 30 minutes;
9) Spinal immobilization equipment;
10) Temporary pacemaker;
11) Temperature control device; and
12) Specialized pediatric resuscitation with
measuring device cart in the emergency area.
AGENCY NOTE: Broselow(TM) Tape will
meet this requirement.
j)
The trauma center must
have helicopter landing capabilities approved by State and federal
authorities. (Section
3.100(j) 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
14.790,
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;
and
3) Be provided on the campus of
the trauma center.
Out-of-state trauma centers are exempted from this subsection
(j) but must comply with their state's rules that govern aviation
safety.
k) The
trauma center shall perform focused outcome analyses of its trauma services on
a quarterly basis and shall provide all minutes related to these reviews on
site or at the request of 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, or preventable death, or
cannot be determined, using the American College of Surgeons "Performance
Improvement" (Chapter 19, from "Resources for the Optimal Care of the Injured
Patient, 1999"). Factors contributing to the death must be included in the
review. A cumulative report of these findings shall be available on site and
upon request by the Department.
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)
l) Every two years
the trauma center shall provide to the Department written protocols concerning
the following:
1) Policies for treating
patients in the trauma center, which includes Trauma Category I and Trauma
Category II criteria as required in Section 515.Appendices C and F of this
Part;
2) Clinical protocols for
management of the trauma patient in basic resuscitation and management of
specific injuries. Protocols are to be kept on site and available to the
Department upon request;
3) The
transfer of trauma patients to the Level I Trauma Center serving the EMS Region
or a more specialized level of care;
4) A policy that blood alcohol will be drawn
on a 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).
6) A professional staff competency plan in
accordance with subsection (k) of this Section.
m) Changes to the Trauma Center Plan must be
approved by the Department prior to implementation.
n) The practices of the trauma center shall
reflect the protocols and policies of the EMS Region and Trauma Center
Plan.
o) 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).
p) The trauma center
shall maintain a job description for the Trauma Center Medical Director, which
details his/her responsibility and authority for the coordination and
management of trauma services.
q)
The trauma center shall maintain a job description for the Trauma Coordinator,
which details the responsibility and authority for the coordination and
management of trauma services.
r)
The trauma service must be identified in the facility's budget with sufficient
funds dedicated to support, at a minimum, the trauma director and trauma
coordinator positions and to provide for operation of the trauma
registry.
s) The trauma center
shall develop a policy that identifies situations that would result in trauma
bypass. 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.
t) The trauma center shall develop a plan for
implementing a program of public information and education concerning trauma
care for adult and pediatric patients.