New Mexico Administrative Code
Title 7 - HEALTH
Chapter 27 - EMERGENCY MEDICAL SERVICES
Part 7 - TRAUMA CARE SYSTEM
Section 7.27.7.15 - APPENDIX D TABLE 1

Universal Citation: 7 NM Admin Code 7.27.7.15
Current through Register Vol. 35, No. 18, September 24, 2024

STATE OF NEW MEXICO Trauma Care System Regulations/ Standards for Designation
Organization/ Management (E) Essential (D) Desirable (N/A) Not Applicable
Level III Level IV
(1) A Trauma Center must demonstrate substantial medical, administrative and financial commitment for the level of designation requested. Commitment must be demonstrated and include documentation from hospital's:
a. Board of Directors; E E
b. Medical Staff; and E E
c. Administrative team. E E
(2) For the purpose of administrating trauma care, a designated Trauma Center shall have a trauma program. The trauma program includes a management team, which oversees the trauma program. The trauma program shall:
a. Be organized and directed by a trauma program medical director who is proficient in, and committed to the care of the injured. The trauma program medical director shall be:
(i) Board certified or eligible in general surgery, or other surgical specialties or emergency medicine as justified by the applicant and approved by the State. E E
(ii) With training in trauma services and care. D D
(iii) Responsible for overall clinical direction, management and administration of the hospital's trauma program. E D
(iv) Currently certified in ATLS (Advanced Trauma Life Support) E E
(v) Demonstrate a commitment to trauma research; and D D
(vi) Must agree to actively participate in a defined trauma related continuing education program on an annual basis. E D
b. Define a program for providing care to the trauma patient to include coordination with the departments of surgery and emergency medicine and other hospital departments. E E
c. Provide ongoing coordination of the trauma program by a Trauma Nurse Coordinator who:
(i) In collaboration with the trauma program medical director, monitors and coordinates trauma programs and system elements, including:
(A) Clinical Activities; E E
(B) Trauma education and prevention activities; E E
(C) Research; D D
(D) Management activities per hospital needs; E E
(E) Trauma Registry; and E E
(F) Quality Improvement E E
(ii) Is a full-time position E D
(iii) Is licensed in State of New Mexico as a Registered Nurse E E
(iv) Has appropriate resources/staff to meet the requirements of these regulations and commitments of the hospital. E E
(v) Has demonstrated expertise in trauma care as identified by a minimum of 5 years recent nursing experience in one of the following areas:
(A) Trauma systems/care D D
(B) Emergency department D D
(C) Critical Care D D
(D) Trauma Program D D
(vi) Minimum current/continuing education:
(A) 5 hours/year trauma E E
(B) 2 hours/year pediatric E E
(C) TNCC (Trauma Nurse Core Curriculum) or equivalent E E
(vii) Participates in the development, implementation or continuation of trauma care systems at their appropriate ReTrAC (Regional Trauma Advisory Council) E E
d. Provide a multidisciplinary trauma committee, which provides input to the trauma program and to hospital administration as needed. The Trauma Committee shall demonstrate coordination between the Departments of Surgery and Emergency Medicine and be responsible for, but not limited to, the trauma program's Process Improvement process. Membership shall include:
(i) An emergency physician; E E
(ii) Trauma medical director; E D
(iii) A neurosurgeon; D D
(iv) An orthopedic surgeon; D D
(v) A pediatrician; D D
(vi) An anesthesiologist/CRNA; D D
(vii) The trauma rehabilitation coordinator, trauma social worker and discharge planner; and input from physiatrist; (if available) D D
(viii) Trauma Nurse Coordinator; E E
(ix) Other appropriate nursing disciplines; E E
(x) Radiology; and D D
(xi) Administration. E D
e. Include a trauma resuscitation team which shall be;
(i) Directed by an emergency medical physician who is proficient in the care of the injured, and who assumes responsibility for the overall care and coordination of the trauma patient until the care is formally turned over to the trauma/general surgeon (as appropriate per Level of designation) E N/A
(ii) The team shall be organized and directed by an in-house ED physician E D
(iii) All members of the team shall be promptly available upon notification. (Trauma PI process must verify prompt availability, outcome driven) E D
(iv) The trauma resuscitation team shall be activated in accordance with the hospital's trauma program and consistent with the regional trauma plan. E E
(v) Members of the trauma team shall:
(A) Be oriented to the trauma care system; E D
(B) Participate in the trauma PI (Performance/Process Improvement) program; E D
(C) Participate in ongoing CME/CE in trauma; E D
(D) Be oriented to the internal trauma patient clinical management system at the hospital; E E
(E) Be oriented to the trauma program policies and procedures to include all operations of the trauma program including internal written triage, treatment and transfer protocols and procedures to identify which patients are triaged in and out of trauma program's clinical service. E E
(3) A Trauma Center shall have an Emergency Department with established standards and procedures to ensure immediate and appropriate care for the adult and pediatric trauma patients and a designated trauma resuscitation and treatment space with the capacity to meet the needs of the expected volume. E E
(4) A Trauma Center shall have a surgery department, including:
a. General surgery on call and promptly available as requested. E D
b. Trauma/general surgeons must be Board certified or eligible in general surgery. E D
c. Trauma/general surgeons must have received ATLS (Advanced Trauma Life Support) once in their career (note: if surgeon is available) E E
d. A minimum of 6 hours per year or 18 hours over a three year period of continuing education related to trauma. (note: if surgeon is available) E E
e. Neurosurgery, Board certified and promptly available on-call. D N/A
f. The following surgical services on-call and available promptly:
(i) Gynecological surgery; D D
(ii) Hand surgery; D D
(iii) Microsurgery; D D
(iv) Obstetric surgery; D D
(v) Orthopedic surgery; D D
(vi) Otorhinolaryngologic/maxillofacial surgery and capable of managing upper airway trauma; D D
(vii) Plastic surgery; D D
(viii) Thoracic surgery; and D D
(ix) Urologic surgery; D D
(x) General surgery for trauma service backup. D D
(xi) Pediatric surgeon available for consultation. D D
(5) A Trauma Center shall have other specialties including:
a. Anesthesiology, with an anesthesiologist or CRNA who is on-call and promptly available and current in ACLS (Advanced Cardiac Life Support). E D
b. The following services on-call and available promptly:
(i) Cardiology; D D
(ii) Gastroenterology; D D
(iii) Hematology; D D
(iv) Internal medicine; E D
(v) Nephrology; D D
(vi) Pathology; D D
(vii) Pediatrics; E D
(viii) Pulmonology/Intensivist D D
(ix) Psychiatry; and D N/A
(x) Radiology. E D
c. Other physician specialists on-call and available to the trauma as defined by their protocols. E D
Note: Internal Trauma PI process must verify "promptly" available services; outcome driven
(6) A Trauma Center shall have approved policies to divert/redistribute and transfer patients to other designated facilities, based on it's ability each patient at a particular time and collaborative work with their respective ReTrAC. E E
(7) A Trauma Center shall
a. Have a PI program, which includes quality improvement principals and an outcome orientation as provided for in this chapter. E E
b. Participate in regional trauma PI programs via their respective ReTrAC E E
Resources and Capabilities/Interhospital Transfer Guidelines
(1) A Trauma Center shall have an Emergency Department with:
a. A physician director who is:
(i) Board certified or eligible in emergency medicine; and/or D D
(ii) If not Board certified in emergency medicine;
(A) Current with ATLS and PALS (Pediatric Advanced Life Support) E E
(B) Must have 5 years or 7,000 hours experience in emergency medicine E D
b. Emergency physicians;
(i) With 50% Board certified or eligible in emergency medicine, with the remainder practicing emergency medicine as their primary practice with special competency in the care of trauma patients and Board certified in pediatrics, family practice, internal medicine, or general surgery. D D
(ii) In-house and immediately available upon the patient's arrival to the ED. E D
(iii) If not emergency medicine Board certified:
(A) Current with ATLS; E E
(B) Current with PALS; or E E
(iv) If not Board certified in any of the above specialties, they must be/have;
(A) Current with ATLS; E E
(B) Current with PALS; and E E
(C) Five (5) years or seven thousand (7,000) hours experience in emergency medicine. E D
(v) A minimum of 6 hours per year or 18 hours over a three year period of continuing education related to trauma. E E
(vi) Must have had ATLS once in their career E E
c. Trauma resuscitation/ED nurses:
(i) In the ED 24 hours per day E D
(A) At least two trauma resuscitation nurses D D
(B) At least one trauma-trained nurse E D
(ii) Currently RN licensed; E E
(iii) TNCC provider verification or an approved equivalent; E E
(iv) Orientation to their nurse role (trauma resuscitation nurse) E D
(v) Participates in a formal trauma PI program by representation; E D
(vi) Minimum of 6 hours per year continuing education related to trauma which may include credit for the TNCC; E E
(vii) Collaborates with health care professional and families in donor identification and care, the organ and tissue procurement process and recipient care. E E
d. An ED nurse manager
(i) Is currently RN licensed; E E
(ii) TNCC provider verification or an approved equivalent; D, Note D, Note
(iii) Participates in a formal trauma PI program; E D
(iv) Minimum of 6 hours per year continuing education related to trauma which may include TNCC E D
Note: The ED nurse manager who routinely staffs to provide patient care, shall meet the requirements of the trauma resuscitation/ED nurse (as described above)
e. Equipment for resuscitation and life support of adult trauma patients, including:
(i) Airway control and ventilation equipment including:
(A) Airways; E E
(B) Laryngoscopes, including curved and straight; E E
(C) Endotracheal tubes of all sizes; E E
(D) Bag-valve mask resuscitator, with full range of mask sizes E E
(E) Sources of oxygen; E E
(F) Mechanical ventilation; E E
(ii) Suction devices, including:
(A) Back-up suction source; E E
(B) Suction catheters; and E E
(C) Tonsil suction tip. E E
(iii) Electrocardiograph; E E
(iv) Cardiac monitor; E E
(v) Defibrillator, including internal and external paddles; E D N/A for internal paddles
(vi) All standard apparatus to establish central venous pressure monitoring; E E
(vii) All standard intravenous fluids and administering devices E E
(viii) Sterile surgical sets for procedures standard for ED trauma care such as thoracotomy, vascular access, chest decompression; E D
(ix) Gastric lavage equipment; E E
(x) Drugs and supplies necessary for emergency care; E E
(xi) Capability for the rapid infusion of fluids; E E
(xii) Capability for rapid fluid recovery and transfusion; E E
(xiii) Thermal control equipment for;
(A) Patient; E E
(B) Blood; E E
(xiv) Two-way radio linked with prehospital vehicles; E E
(xv) Cervical injury immobilization devices; E E
(xvi) Long-bone stabilization devices. E E
f. Trauma social services or crisis intervention services based on an approved hospital protocol. D D
(2) A Trauma center shall have an Operating Room (OR) that:
a. Assures prompt availability of an OR suite 24 hours per day; and E D
b. Staffs with at least one RN in-house for the anticipated volume of patients and the remainder of the OR team and support staff on-call and promptly available. D D
c. Has OR nurses who:
(i) Are currently licensed as RNs; E E
(ii) Can demonstrate trauma preparedness for the care of the trauma patient in the OR through hospital approved competencies and/or formal training course; E D
(iii) Complete a structured orientation program related to the perioperative care of the trauma patient; E D
(iv) Minimum of 6 hours per year continuing education related to the perioperative care of the trauma patient; E D
(v) Participates in the multidisciplinary trauma committee by representation including patient care conferences; E E
(vi) Participates in trauma PI activities by representation. E E
d. Has a documented method for prompt mobilization of consecutive surgical teams for trauma patients; E D
e. Collaborates with health professionals and families in donor identification and care, the organ and tissue procurement process and recipient care. E E
f. Includes equipment or capabilities including;
(i) Cardiopulmonary bypass; D D
(ii) Operating microscope; D N/A
(iii) Thermal control equipment for patients; E E
(iv) Thermal control for blood; E E
(v) Rapid infusion capability; E E
(vi) Rapid fluid recovery capability; E D
(vii) Radiology capability; E E
(viii) Bronchoscope in operating room; E D
(ix) Endoscopes available E D
(x) Monitoring equipment; and E E
(xi) Instruments for external and internal fixation of fractures; D D
(xii) Instruments and equipment appropriate for pediatric trauma care; D D
g. Designated operative treatment space with the capacity to meet the needs of the expected patient volume. E D
(3) A Trauma Center shall have a post-anesthesia care unit or an acceptable surgical intensive care unit designated for surgical patient recovery with:
a. Essential personnel, including at least one nurse with critical care and post-anesthesia care training, readily available 24 hours a day; E D
b. Can demonstrate trauma preparedness for the care of the post-anesthesia trauma patient through approved competencies and/or formal training courses; E D
c. Completes a structured orientation program related to the post-anesthesia perioperative care of the trauma patient; E D
d. Appropriate monitoring and resuscitative equipment. E D
(4) A Trauma Center shall have an intensive care unit (ICU) with:
a. A medical director who is Board certified or eligible in critical care, internal medicine, pulmonary medicine, cardiology, or surgery; E D
b. A physician on duty in the ICU 24 hours a day, or who is immediately available; Note: May be met by an ED physician meeting the requirements of these regulations E D
c. A physician-directed code team; E D
d. Intensive care registered nurses who:
(i) Are currently RN licensed; E D
(ii) TNCC verified or an equivalent course; E D
(iii) Completes a structured orientation and competency program which includes content related to the care of a trauma patient; E D
(iv) Minimum of 6 hours per year continuing education related to trauma; E D
(v) Participates in a multidisciplinary trauma committee including patient-care conferences by representation; E D
(vi) Participates in trauma PI activities; E D
(vii) Collaborates with health care professionals and families in donor identification and care, the organ and tissue procurement and recipient care. E E
e. Equipment appropriate for adult including:
(i) Airway control and ventilation devices; E E
(ii) Oxygen source with concentration controls; E E
(iii) Cardiac emergency cart; E E
(iv) Temporary pacemaker; E D
(v) Electrocardiograph-cardiac monitor-defibrillator; E E
(vi) Cardiac output monitoring; D D
(vii) Electronic pressure monitoring D D
(viii) Mechanical ventilator devices; E D
(ix) Patient weighing devices; E E
(x) Pulmonary function measuring devices; D D
(xi) Temperature control devices; E D
(xii) Drugs, intravenous fluids, and supplies; and E E
(xiii) Intracranial pressure monitoring devices. D D
f. Designated trauma critical care and treatment space with the capacity to meet the needs of the expected patient volume. E D
(5) A Trauma Center shall have a clinical laboratory immediately available based upon the expected volume of patients, including:
a. Standard analysis of blood, urine, and other body fluids; E, Note E, Note
b. Coagulation studies; E, Note E, Note
c. Blood gases and pH determination; E, Note E, Note
d. Serum and urine osmolality; E, Note D
e. Microbiology; E, Note D
f. Alcohol determination; E, Note D
g. Drug screening; and D D
h. Microtechnique. E, Note D
Note: Shall be promptly available
(6) A Trauma Center shall have transfusion services including:
a. Blood and blood components available from in-house or through community services, to meet patient needs in a timely fashion; E D
b. Ability to have non-crossmatched blood available on patient arrival to the ED; E D
c. Procedures and ability to perform massive transfusions and autotransfusion; and E D
d. Blood storage capability; E D
(7) A Trauma Center shall have radiological services including:
a. The following services in-house and immediately available:
(i) Computerized tomography E, Note D
Note: Shall be promptly available
(ii) Radiology capability; E, Note E, Note
Note: If not in-house 24 hours per day, must have an approved early notification process
(iii) In-house CT technician 24 hours a day E, Note D
Note: Shall be promptly available
(iv) In-house radiology technician 24 hours a day E, Note D
Note: Shall be promptly available
Note: Trauma PI process must verify promptly available services, outcome driven
b. The following services on-call and promptly available:
(i) Angiography D D
(ii) Sonography D D
(8) A Trauma Center shall have acute dialysis capability, or a written agreement with an appropriate facility for such. E E
(9) A Trauma Center shall have:
a. A physician-directed burn unit which is staffed by nursing personnel trained in burn care and is equipped to care for extensively burned patients; and/or D D
b. Written transfer agreement with a burn center or hospital with a burn unit. E E
(10) A Trauma Center shall be able to manage Traumatic Brain Injury and/or spinal cord injury; or have written transfer agreements with a facility with such capabilities. Adherence to current management guidelines shall be considered. E E
(11) A Trauma Center shall have a designated trauma rehabilitation coordinator. D D
(12) A Trauma Center shall have:
a. A physician-directed rehabilitation medicine service which is staffed by personnel trained in rehabilitation care and is equipped to care for the trauma patient and/or; D D
b. Written agreements to transfer patients to a designated rehabilitation service when medically feasible. E E
(13) A Trauma Center shall have a heliport or helipad meeting applicable standards and any applicable Department-approved procedures and located close enough to permit the facility to receive and transfer patients by air. E, Note E, Note
Note: May be fulfilled through a designated landing site with supporting written protocols.
(14) In addition to all transfer agreements in this section, designated Trauma Centers shall have additional written transfer agreements for the identification and transfer of patients with special care needs who meet inter-hospital transfer criteria, to include the following patients categories:
a. Pediatrics E E
b. Obstetrics E E
c. Other considerations based upon the specific hospital needs E E
(15) Transfer agreements shall include the responsibility of the transferring hospital and the receiving hospital, and shall assign medical control during inter-hospital transfer. E E
(16) Transferring facilities shall use Department-approved pre-hospital services for inter-facility transfer of trauma patients. E E
Outreach, Training, and Public Education
(1) A Trauma Center shall have:
a. An outreach consultation and referral program with physicians of the community, prehospital care agencies and outlying areas regarding trauma care developed through participation with their respective ReTrAC. E E
b. An outreach program with other designated trauma centers and hospitals developed through participation with their respective ReTrAC to include: E E
(i) Agreement to participate in regional trauma monitoring and PI meetings as defined by the State IPEMS Bureau; E E
(ii) Monitoring of the transfers in and out of the designated trauma center; E E
(iii) Establishing transfer agreements and referral feedback mechanisms. E E
c. Training, including;
(i) Offers or participates in a formal program of continuing trauma care education for:
(A) Staff and community physicians; E E
(B) Staff and community nurses; E E
(C) System and trauma clinical training for all allied health care professionals throughout the continuum; E D
(D) Prehospital personnel; E D
(ii) Hospital to cooperate and make available initial and maintenance training of invasive skills for prehospital personnel. E D
d. A public awareness/education program, developed through collaboration with their respective ReTrAC addressing:
(i) Injury prevention and wellness issues relevant to the region; E E
(ii) Problems confronting the medical and nursing professions including hospitals regarding; hospital diversion, ED saturation as well as hospital capacity and access to care within their respective regions. E E
e. Planning and implementation policies and procedures for Mass Casualty Incidents (MCI) developed through collaboration with their respective ReTrAC. E E
Educational and Certification Requirements of Designated Trauma Care Personnel
Unless otherwise stated in these regulations, all trauma personnel educational and or certification standards shall be met within six months of employment or contract. E E

STATE OF NEW MEXICO Trauma Care Regulations/Standards for Designation Pediatric Guidelines for Trauma Center Designation (E) Essential (D) Desirable (N/A) 3.Not Applicable
Level III Level IV
(1) HOSPITAL SHALL:
1.1 Meet the requirements of a basic 24-hour emergency facility and be licensed under the New Mexico Administrative Code. E E
(2) PROFESSIONAL STAFF: Physician
2.1 All full-time Emergency Department physicians' education should consist of at least 16 hours of pediatric emergency CME credit every 2 years or have an acceptable hospital plan documenting pediatric proficiency. E D
(3) PROFESSIONAL STAFF: Nursing
3.1 Emergency Department: At least one Registered Nurse (RN) per shift shall have successfully completed the ENPC or PALS provider course and be designated for providing and/or monitoring pediatric nursing care. E D
3.2 Intensive Care Unit (Hospital without PICU): at least one RN per shift shall be currently verified as a PALS provider or equivalent pediatric critical care course and be designated for providing and/or monitoring pediatric nursing care. E D
3.3 Post-Anesthesia Care Unit (PACU) or designated post-recovery area: at least one RN per shift shall be currently verified as a PALS provider or have completed competency verification in the post-operative care of the pediatric patient. E D
3.4 All nurses assigned to each department for providing and/or monitoring pediatric care shall complete two hours of pediatric education per year. E D
3.5 Pediatric Liaison Nurse: one shall be designated. This nurse works in collaboration with the Trauma Nurse Coordinator to ensure and document all pediatric data for the Hospital Trauma Registry and to assist in coordination and documenting pediatric nursing education. E Note 4 D
3.5.1 Minimum Qualifications include: Works in the ED, ICU, PICU, Pediatric or QI Minimum of one-year experience in the care of the pediatric patient. Completion of at least two hours of education in pediatric topics (in addition to ENPC) per year. D D
(4) EQUIPMENT STATNDARDS, EMERGENCY DEPARTMENT
The Emergency Department shall have:
4.1 Resuscitation area with dedicated pediatric equipment. E Note 1 E Note 1
4.2 Airway control and ventilation equipment E E
4.2.1 Laryngoscope blades with handles, curved, straight for infant and child E E
4.2.2 Pediatric airways: endotracheal tubes postoperative, cuffed with stylets (all appropriate sizes) and lubricant; pediatric McGill forceps; pediatric airways E E
4.2.3 Suction device with pediatric suction catheters (all appropriate sizes) E E
4.2.4 Pediatric cricothyroidotomy tray with set up for needle cricothyroidotomy (all appropriate sizes) E SC
4.2.5 Pediatric bag-valve-mask (BVM) resuscitation device with premature infant, infant, child and adult clear mask to use with the BVM device with over-riding pop-off valve. E D
4.2.6 Oxygen with oxygen-delivery device overriding for premature infant, infant, child and adult clear mask to use. E D
4.2.7 Pediatric chest tubes (all appropriate sizes) E SC
4.2.8 Pulse oximeter with pediatric and adult sensors E D
4.2.9 Equipment for needle thoracostomy for tension pneumothorax E D
4.3 Circulatory Support Equipment
4.3.1 Pediatric IV supplies (all appropriate sizes) with IV rate-control devices E E
4.3.2 Appropriate fluids for pediatric resuscitation (ACLS/PALS Guidelines) E E
4.3.3 Introsseous needles or spinal needles for introsseous infusion (all appropriate sizes) E E
4.3.4 Monitor defibrillator and pediatric paddles with 0-400 watt/second capabilities E E
4.3.5 Pediatric blood-pressure cuffs; premature infant, infants, child, adult and thigh sizes E D
4.3.6 Doppler monitor E D
4.3.7 Temperature control device for IV fluids E Note 2 E Note 3
4.3.8 Multilumen catheter (all appropriate sizes) D D
4.4 Special Trays
4.4.1 Thoractomy SC SC
4.4.2 Thoracostomy D SC
4.4.3 Tracheostomy D SC
4.4.4 Diagnostic Peritoneal Lavage D D
4.4.5 Lumbar Puncture E D
4.4.6 Venesection D D
4.4.7 Obstetrical Emergency Delivery E E
4.5 Miscellaneous Equipment
4.5.1 Spinal Immobilization device: backboards, head-rolls, or head immobilization devices, cervical collars to include sizes for children six years or younger E E
4.5.2 Pediatric patient warming devices E Note 3 E Note 3
4.5.3 Thermometers E E
4.5.4 Pediatric Foley catheters (all appropriate sizes) E E
4.5.5 Pediatric splinting devices, femur traction device, general traction equipment E E
4.5.6 Casting capabilities E E
4.5.7 Sterile dressings for burn care E E
4.5.8 Nasogastric tubes/infant feeding tubes (all appropriate sizes) E E
4.5.9 Pediatric scales for weight measurement E E
4.6 Medications; all appropriate medications in pediatric dosages as required for resuscitation (ATLS/PALS recommendations) E E
4.7 Pediatric reference materials for drug dosage listed in kg (i.e. Broslow Tape) E E
4.8 Quality Management; The hospital shall:
4.8.1 Review all pediatric deaths and transfer complications E E
4.8.2 Maintain a pediatric log or registry of all pediatric deaths and transfers E E
Notes 1. Pediatric crash carts should be utilized to maintain the proper pediatric equipment and supplies. The pediatric crash cart should be labeled or color coded for clear recognition, 2. Fluid may be warded in standard warmer if IV fluid warming devices are unavailable so long as the appropriate temperature is maintained. 3. Warming methods may be used if devices are unavailable (warmed blankets, warmed bags of IV fluids. 4. The Trauma Nurse Coordinator may meet this standard without the need for additional personnel. SC Special Consideration: This term is applicable to items that are not essential or desired components for designation. However, facilities wishing to meet specific criteria must provide the appropriate documentation for certifications and ongoing training.

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