Current through Register Vol. 48, No. 12, March 22, 2024
a) The Level II
Pediatric Trauma 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, and have 10
hours per year of trauma-related CME, and 24-hour independent operating
privileges, as evidenced by either:
1)
responsibility for 50 pediatric trauma cases per year; or
2) both:
A)
responsibility for 10 percent of the total number of pediatric trauma cases at
the trauma center per year; and
B)
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 who have
one year of experience in trauma, who have 24-hour independent operating
privileges, 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 pediatric trauma surgeon
requirement may be fulfilled by residents with a minimum of four years of
pediatric surgery residency training and who have current 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 Category I
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 ED arrival.
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 II 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
maintain a call schedule that identifies at least a primary and back-up
pediatric surgeon with each surgeon listed by name.
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) or (e) 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 by physicians who are credentialed by the hospital
to provide pediatric care, and who are 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 pediatric trauma/general
surgeon with experience in pediatric cardiothoracic surgery for lifesaving
procedures; the surgeon must have pediatric cardiothoracic
privileges;
2)
Obstetrics;
3) Orthopedic;
and
4) Urologic.
e) The trauma center shall have
the following surgical specialties by physicians who are credentialed by the
hospital to provide pediatric care and who are on call to arrive at the
hospital to treat the patient within 60 minutes after notification that their
services are needed. These services may be provided by written transfer
agreement. These services must be provided according to subsection (c)(7) of
this Section for isolated injuries when the trauma surgeon is not required to
respond:
1) Neurosurgical with two years
experience in pediatric neurosurgery;
2) Ophthalmologic;
3) Oral-dental;
4) Otorhinolaryngologic;
5) Reimplantation;
6) Plastic/maxillofacial;
7) Burn center staffed by registered nurses
trained in burn care; and
8) Acute
spinal cord injury management.
f) The pediatric 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 physician who is board prepared or certified by the ABEM,
ABP/PEM or AOBEM with two-year ongoing involvement in daily pediatric trauma
care, and 10 hours per year of trauma-related CME.
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 with experience in pediatric
anesthesia under the direct supervision of an anesthesiologist.
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) Toxicology
screening.
4) Department
of Pediatrics with board certified pediatrician in the role of Chairman, and a
board certified pediatrician shall be available within 60 minutes after
notification that his or her services are needed.
5) Radiology staffed by:
A) A technician with the ability to perform a
CAT scan available within 30 minutes after notification;
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; and
C) A pediatric radiologist on staff to
provide a quality improvement process to validate interpretation of pediatric
films.
6) Pediatric
cardiology 60 minutes after notification.
7) Postanesthetic recovery capability staffed
and available within 30 minutes (may be fulfilled by pediatric ICU).
8) ICU 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 in the ICU, with pediatric experience documented
by two years in pediatric ICU or critical care and four hours of trauma related
pediatric critical care continuing education per year; and
C) The following pediatric equipment 24 hours
a day in-house:
i) Airway control and
ventilation devices;
ii) Oxygen
source with concentration controls;
iii) Pulse oximeter and
CO2 monitoring;
iv) Cardiac emergency cart;
v)
Electrocardiograph-oscilloscope-defibrillator;
vi) Temperature control devices;
vii) Drugs, intravenous fluids, and supplies
in accordance with the Hospital Licensing Requirements (77 Ill. Adm. Code
250.1050,
250.2140, and
250.2710); and
viii) Mechanical
ventilator-respirators.
9) 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, AOBEM, or
ABP/PEM.
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 dedicated solely to the trauma program.
4) An operating room shall be staffed and
available within 30 minutes, 24 hours a day.
5) Staff shall include occupational therapy,
speech therapy, social work, child protective services 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
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 on 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,
CO2 monitoring, and pulse oximeter;
2) Suction device;
3)
Electrocardiograph-oscilloscope-defibrillator, pacemaker;
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, 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)
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.
j) 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.
k) For
additional requirements for Level II Pediatric Trauma Centers, see Section
515.2040.
l) A Level II Pediatric Trauma Center shall
meet the requirements of Section 515.2030(i)-(s) of this Part.