Code of Maryland Regulations
Title 30 - MARYLAND INSTITUTE FOR EMERGENCY MEDICAL SERVICES SYSTEMS (MIEMSS)
Subtitle 08 - DESIGNATION OF TRAUMA AND SPECIALTY REFERRAL CENTERS
Chapter 30.08.01 - General Provisions
Section 30.08.01.02 - Definitions
Universal Citation: MD Code Reg 30.08.01.02
Current through Register Vol. 51, No. 19, September 20, 2024
A. In this subtitle, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Adult burn center" means:
(a) An in-State hospital designated by MIEMSS and approved by the EMS Board to provide comprehensive burn treatment services to burn patients 15 years old or older; or
(b) An out-of-State hospital that has entered into an agreement with MIEMSS and that has been approved by the EMS Board to provide comprehensive burn treatment services to burn patients 15 years old or older.
(1-1) "Adult trauma center" means:
(a) An in-State hospital designated by MIEMSS and approved by the EMS Board to provide comprehensive trauma services to trauma patients 15 years old and older; or
(b) An out-of-State hospital that has entered into an agreement with MIEMSS and that has been approved by the EMS Board to provide comprehensive trauma treatment services to trauma patients 15 years old and older.
(2) "Advanced Burn Life Support (ABLS®)" means a course developed and approved by the American Burn Association.
(2-1) "Advanced Pediatric Life Support (APLS®)" means a course developed and approved by the American Academy of Pediatrics (AAP) and American College of Emergency Physicians (ACEP).
(2-2) "Advanced Practice Professionals (APPs)" are non-physicians that are educated at an advanced level to provide patient care in a range of settings; they include Nurse Practitioners (NPs), Nurse Anesthetists, Midwives, Clinical Nurse Specialists (CNS) and Physician Assistants (PAs).
(3) "Advanced Trauma Life Support (ATLS®)" means a course developed and approved by the American College of Surgeons.
(4) "Appropriately trained" means a health care provider who has received the necessary training to develop the knowledge and skills needed for the appropriate care of the trauma or specialty care patient.
(5) "Approved" means a formal process of review and acceptance by the appropriate authority.
(6) "Attending" means a physician with practice privileges delineated by the hospital's medical staff.
(7) "Attending burn staff surgeon" means a surgical member of the burn team appointed by the adult or pediatric burn center director with credentials and privileges appropriate to the burn service.
(8) "Board certified" means a physician certified by an appropriate specialty board recognized by the American Board of Medical Specialties.
(9) "Board eligible" means a physician qualified to take the examination to complete the certification process as specified by an appropriate specialty board that is recognized by the American Board of Medical Specialties.
(10) "Burn care director" means a surgeon designated by the institution and medical staff to coordinate the activities of the adult or pediatric burn center.
(11) "Burn care system" means a coordinated component of an emergency medical services system which encompasses one or more adult or pediatric burn centers and features communication links to, and triage-transfer protocols between, health care facilities, prehospital personnel, and transportation services.
(12) "Burn Center" means an Adult or Pediatric Burn Center in Maryland unless otherwise indicated.
(13) "Burn service" means a clinical service established by the medical staff which has responsibility for burn patients.
(14) "Burn team" means a group of health care professionals organized to provide care to the burn patient in a coordinated system of care.
(15) "Burn unit" means a specific area within the adult or pediatric burn center that:
(a) Has committed the resources necessary to meet the criteria for an adult or pediatricburn center; and
(b) Contains beds and other physical equipment related to care of the patient with burn injury.
(16) "Bypass" means the diversionary status of a trauma or specialty referral center that is requested and identified in the County/Hospital Alert Tracking System (CHATS) in accordance with a MIEMSS or regional program due to a lack of staff, facilities, or equipment.
(16-1) "Continuing Education (CE)" means education provided for adults after they have left the formal education system consisting of short or part-time courses that brings participants up to date in a particular area of knowledge or skills.
(17) "Continuing Medical Education (CME)" means training approved by the Accreditation Council of Continuing Medical Education or accredited by a state medical society recognized by that Council.
(18) "Credentialing" means a hospital's process for granting practice privileges to health care providers.
(19) "Data quality guideline" means a written procedure for ascertaining the accuracy and completeness of data.
(20) "Dedicated" means a designated resource whose primary use is for a specific trauma or specialty care program.
(21) "Definitive care" means a level of therapeutic intervention capable of providing comprehensive services for the patient's particular injuries, or associated conditions, or both.
(22) "Designation" means a process by which a hospital is identified by MIEMSS as an appropriate facility to receive patients with particular injuries or illnesses.
(23) "Desirable" means a component of the standards whose presence or availability is encouraged but not required for designation.
(24) "Emergency department (ED)" means a department or patient care area within a hospital which:
(a) Is organized to provide emergency medical care 24 hours a day; and
(b) Meets the applicable standards in COMAR 30.08.05.
(25) Emergency Medical Services.
(a) "Emergency medical services (EMS)" means a comprehensive system of emergency medical care that starts with prevention and continues through rehabilitation.
(b) "Emergency medical services (EMS)" includes:
(i) Comprehensive EMS, trauma, and specialty care system legislation, regulations, and policies;
(ii) Medical oversight and physician involvement;
(iii) Trained volunteer, career, and commercial personnel;
(iv) State and local government resource management and administration;
(v) Integrated communications system including 911 centers, medical consultation centers, ambulances, and receiving hospitals;
(vi) Medical ground, air, and water transportation systems;
(vii) Cooperating facilities including hospitals, trauma centers, and specialty referral centers;
(viii) Public information, education, and prevention programs; and
(ix) Data collection, evaluation, quality improvement, and research.
(26) "EMS Plan" means the plan to ensure effective coordination and evaluation of emergency medical services delivered in the State, as developed and approved by the EMS Board.
(27) "EMS provider" means an individual certified or licensed by a state to provide out-of-hospital emergency medical services.
(27-1) "Emergent Consultation"- means a physician consultation required for evaluation of known or potentially unstable injuries, injuries requiring time sensitive surgical interventions, or other reasons as determined and documented by the attending trauma, or general surgeon, or ED attending physician.
(28) "Essential" means a component of the standards that is required for designation.
(29) "Executive Director" means the Executive Director of MIEMSS.
(30) Repealed.
(31) "Fellowship" means formal, advanced, postresidency, specialty training.
(32) "Geographic proximity" means that distance, which is optional for Level III perinatal centers and mandatory for Level III+ perinatal centers, so that patients requiring Level IV services may be transported from a Level III or Level III+ sending facility to the Level IV perinatal center in less than 30 minutes by nonemergency transport.
(33) "Geographic service area" means the area defined by the EMS Board that is normally served by a designated hospital for patients with a particular illness or injury.
(34) "Immediately available" means a source available as soon as it is requested.
(35) "Immediate response" means reacting at once to a patient care need.
(36) "In-house" means physically present in the hospital.
(37) "Injury surveillance" means routine monitoring of the type of injury and incidence for a specific population.
(38) "Inpatient discharge data" means certain information from inpatient hospital records that is submitted by the hospital to the Health Services Cost Review Commission as required by law.
(39) "Interfacility transfer" means the transfer of a patient from one hospital to another hospital.
(40) "Learning outcomes" means an individual's performance, which can be measured by objective means, that results from the individual's participation in an educational program.
(41) "Level I trauma center" means a hospital that:
(a) Meets the Level I trauma center standards in COMAR 30.08.05; and
(b) Is designated by MIEMSS and approved by the EMS Board.
(42) "Level II trauma center" means a hospital that:
(a) Meets the Level II trauma center standards in COMAR 30.08.05; and
(b) Is designated by MIEMSS and approved by the EMS Board.
(43) Repealed.
(44) "Level IIIB perinatal referral center" means a hospital that:
(a) Meets the Level III perinatal referral center standards in COMAR 30.08.12; and
(b) Is designated by MIEMSS and approved by the EMS Board as capable of providing medical intensive care to newborns of all:
(i) Gestational ages, and
(ii) Birth weights.
(45) "Level III trauma center" means a community hospital with a trauma program which meets the Level III trauma center standards in COMAR 30.08.05.
(46) "Level IIIC perinatal referral center" means a hospital that:
(a) Meets the Level IV perinatal referral center standards in COMAR 30.08.12; and
(b) Provides comprehensive neonatal and obstetrical services, including all subspecialty services.
(47) "Maryland Trauma Registry Data Dictionary for Adult Patients" means the listing of data inclusion criteria, data elements and audit filters to be collected on patients with traumatic injuries treated in a Maryland Trauma Center which is incorporated by reference in COMAR 30.01.02.01 (B(B)(2).
(48) "Maternal-fetal medicine" means a subspecialty recognized by the American Board of Obstetrics and Gynecology which addresses the medical care of high-risk pregnant women and their fetuses.
(49) Most Critical Patients.
(a) "Most critical patients" means those patients who:
(i) Have confirmed BP< 90 mmHg at any time in adults and age-specific hypotension,
(ii) Have GSW to the head, neck, chest, or abdomen attributed to trauma,
(iii) Have a GCS score <9 with mechanism attributed to trauma,
(iv) Are transferred from other hospitals receiving blood or vasoactives to maintain vital signs,
(v) Are intubated and transferred from the scene, or
(vi) Have a respiratory compromise or are in need of an emergent airway, including intubated patients who are transferred from another facility with ongoing respiratory compromise.
(b) "Most critical patients" includes those patients who
(i) Are intubated and are currently stable from a respiratory standpoint,
(ii) Have a tourniquet or pelvic binder applied,
(iii) Are currently in Cardiac arrest or receiving CPR,
(iv)Have presence of motor paralysis,
(v) Have an amputation proximal to the ankle or wrist,
(vi) Have Hypoxia as evidenced by saturation <90 percent,
(vii) Have uncontrolled external hemorrhage, or
(viii) Penetrating torso injury with evisceration.
(50) "Multidisciplinary committee" means a group of health care professionals from two or more professional disciplines within a trauma or specialty referral center that reflects the multidisciplinary nature of trauma or specialty care.
(51) "Multiple Casualty Incident (MCI)" means two or more injured people requiring emergency care simultaneously.
(51-1) "National Trauma Data Bank (NTDB)" means the American College of Surgeons (ACS) aggregated trauma registry of standardization of key trauma data elements for research and improving care for the surgical patient.
(52) "Neonatal referral center" means an out-of-State facility that has entered into an agreement with MIEMSS which has been approved by the EMS Board to accept transfers in order to provide neonatal care.
(53) "Neonate" means a patient who is less than 28 days old.
(54) "Neonatologist" means a pediatrician certified by the American Board of Pediatrics in neonatology.
(54-1) "Neurotrauma center" means an in-State hospital designated by MIEMSS and approved by the EMS Board to provide specialized care of traumatic brain injured and spinal cord injured patients.
(55) "Nurse manager" means a registered nurse who has a full-time commitment to a specific patient care unit and is administratively responsible for the nursing service of that unit.
(56) "Office of Administrative Hearings (OAH)" means the unit within Maryland's Executive Branch responsible for scheduling and conducting administrative hearings.
(57) "Office of Hospital Programs" means the office within MIEMSS that is responsible for the designation, verification, and reverification of the trauma and specialty care programs.
(58) "On-call" means committed for a specific time period to be available and respond within the specific amount of time to provide care for a patient in the hospital.
(59) On-Site Review Record.
(a) "On-site review record" means any record of the on-site visit and of the on-site review team.
(b) "On-site review record" includes, but is not limited to:
(i) Proceedings;
(ii) Records;
(iii) Files;
(iv) Notes;
(v) Deliberations;
(vi) Reports;
(vii) Documents;
(viii) Statements;
(ix) Minutes; and
(x) Any other oral or written communication.
(60) "Optional" means a component of the standards that may be present or available but is not required for designation.
(61) "Outcome" means a measurable health status that follows as a result of an injury or illness.
(62) "Patient care log" means a list of patients' names and other information that is recorded by hospitals or prehospital care agencies.
(63) "Patient care record" means a record that contains information regarding the assessment and the care provided to a patient by any health care provider in any practice setting.
(64) "Patient discharge summary" means an abbreviated narrative, created after discharge from a health care facility, of a patient's record during that hospitalization.
(65) "Patient identifier" means a unique number that is assigned to only one patient in order to identify records pertaining to the evaluation and care of that particular patient.
(66) "Pediatric Advanced Life Support (PALS®)" means a pediatric resuscitation course developed and approved by the American Heart Association.
(66-1) "Pediatric burn center" means:
(a) An in-State hospital designated by MIEMSS and approved by the EMS Board to provide comprehensive burn treatment services to burn patients that have not reached their fifteenth (15th) birthday; or
(b) An out-of-State hospital that has entered into an agreement with MIEMSS and that has been approved by the EMS Board to provide comprehensive burn treatment services to burn patients that have not reached their fifteenth (15th) birthday.
(66-2) "Pediatric trauma center" means:
(a) An in-State hospital designated by MIEMSS and approved by the EMS Board to provide comprehensive trauma services to trauma patients who have not reached their fifteenth (15th) birthday; or
(b) An out-of-State hospital that has entered into an agreement with MIEMSS and that has been approved by the EMS Board to provide compressive trauma treatment services to trauma patients who have not reached their fifteenth (15th) birthday.
(67) "Perinatal referral center" means:
(a) An in-State hospital designated by MIEMSS and approved by the EMS Board to provide comprehensive obstetrical and neonatal services; or
(b) An out-of-State hospital that has entered into an agreement with MIEMSS which has been approved by the EMS Board to provide comprehensive obstetrical and neonatal services.
(68) "Person" means:
(a) An individual or group of individuals;
(b) A State or federal agency; or
(c) A business entity.
(69) "Physical plant" means a building and associated structures.
(70) "Postgraduate year (PGY)" means a classification system for residents indicating the year of post-medical school residency.
(71) "Prehospital service" means a service that is provided from the time of injury or illness until the patient arrives in the hospital.
(72) "Preliminary investigation" means fact finding and information gathering to enable MIEMSS to determine whether justification exists to initiate disciplinary action or to conduct a further investigation.
(73) "Primary Adult Resource Center (PARC)" means a comprehensive trauma program, including a dedicated trauma care facility, dedicated staff and services, and designated, specialized, advanced training and research programs, which meets the PARC standards in COMAR 30.08.05 and which, in Maryland, is defined in statute as the R Adams Cowley Shock Trauma Center.
(74) "Promptly available" means a resource available within 30 minutes of the time it was requested.
(75) "Protocol" means a written procedure to ensure standardization of a process.
(76) "Quality management (QM)" means the quality management of trauma and specialty care services.
(77) "Quality management program record" means a documented record related to quality management activities.
(78) "Readily available" means a resource available for use a short time after it is requested.
(79) "Resuscitation" means the phase of trauma or specialty care where emergency life support treatment is provided to sustain vital body functions.
(80) "Reverification" means the process by which MIEMSS renews a trauma or specialty referral center's designation status.
(81) "Sonologist" means a physician with special training in ultrasonography.
(82) "Specialty referral center" means:
(a) An in-State hospital that has been designated by MIEMSS and approved by the EMS Board to provide care for a specific patient population with special care needs; or
(b) An out-of-State facility that has entered into an agreement with MIEMSS which has been approved by the EMS Board to provide specialty care.
(83) "State trauma registry" means a database of information, submitted to MIEMSS by hospitals, relating to the care of trauma and burn patients that is used to evaluate the quality of care provided.
(84) "SYSCOM" means the Systems Communications Center, an EMS communications center located within MIEMSS, that is used for coordination of medical communication on a Statewide basis.
(85) "Transfer agreement" means a formal agreement between hospitals for the transfer and acceptance of patients.
(86) "Transporting service" means an agency or entity providing patient care transport.
(87) "Transport vehicle" means a vehicle or other conveyance used to transport patients.
(88) "Trauma" means a major single system or multisystem injury or mechanism of injury which has a reasonable probability of disability or death.
(89) Trauma Center.
(a) "Trauma center" means a hospital that has been designated by MIEMSS and approved by the EMS Board to provide care to trauma patients.
(b) "Trauma center" includes an out-of-State facility that has entered into an agreement with MIEMSS which has been approved by the EMS Board to provide care to trauma patients.
(90) "Trauma Network (TraumaNet)" means an organization of representatives of trauma centers which includes trauma surgeons, trauma coordinators, and hospital administrators.
(91) "Trauma panel" means the group of physicians within a specific trauma center credentialed by the trauma center hospital to provide trauma care.
(92) "Trauma patient care resource" means the physical facilities, equipment, supplies, and medical personnel that are:
(a) Used to provide care to trauma patients; and
(b) Identified as immediately available, readily available, or promptly available.
(92-1) "Trauma Quality Improvement Committee (TQIC)" is a medical review committee established by MIEMSS as an advisory body for quality issue and evaluation affecting the care of trauma patients and the Maryland Trauma System. The TQIC will address issues primarily related to the system-wide delivery of trauma care across the continuum (pre-hospital care to discharge from the trauma center) identifying performance improvement activities and indicators to support resolution strategies.
(93) "Trauma Resuscitation Team" means a group of trauma trained health care providers required to be present at the patient's bedside following trauma team activation. The minimum team requirements for all levels of activation include: Trauma Attending/General Surgeon/PGY4/APP, ED Lead Physician, ED RN's, and a Recorder/Documenter. The highest level of response requires, at a minimum, the Trauma Resuscitation Team, an Anesthesiologist or CRNA (as per institutional-specific criteria), and Respiratory Therapy.
(93-1) "Trauma Service" means a group of trauma-trained physicians that are responsible for the initial resuscitation and care of the trauma patient, including Trauma/General Surgeon, Emergency Medicine, Neurosurgery, and Orthopedic Surgery.
(94) "Trend" means a tendency towards a particular conclusion or end point, usually determined by an analysis of data.
(95) "Triage" means the sorting of patients in terms of priority, treatment, transportation, and destination, so that the patient can be transported to the appropriate hospital according to triage protocols.
(96) "Unit of care" means the hospital subunit where the patient is receiving care at any point in time.
(97) "Verification" means the process by which MIEMSS determines that a hospital, which is applying for a particular designation status, is in substantial compliance with the standards for the designation requested.
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