Rules & Regulations of the State of Tennessee
Title 0720 - Health Facilities Commission
Chapter 0720-31 - Standards for Pediatric Emergency Care Facilities
Section 0720-31 - TABLE 1

TABLE 1. PEDIATRIC EMERGENCY CARE FACILITIES

Part 1/7

FACILITY DESIGNATION/LEVEL

1. PERSONNEL

CRPC

General

Primary

Basic

Physician with pediatric emergency care experience

EED

EED

EED

EP

RN with pediatric training

EED &EPI

EED

EED

EED

Respiratory therapist

EH

EH

EH

Trauma coordinator

E

Nurse educator

E

E

Trauma team *

E

SE

SE

Specialist consultants * (Available in less than 1 hour) 1

Pediatrician

EP

EP

EP

SE

Radiologist

EP

EP

EP

SE

Anesthesiologist *

EP

EP

EP

SE

Cardiologist

EP

Critical Care Physician

EP

Nephrologist

EP

Hematologist/oncologist

EP

Endocrinologist

EP

Gastroenterologist

EP

Neurologist

EP

Pulmonologist

EP

Psychiatrist/Psychologist

EP

Infectious Disease Physician

EP

Surgical specialists* (Available in less than 1 hour)

General surgeon

EP

EP

SE

Pediatric surgeon *

EP

SE

Neurosurgeon

EP

SE

Orthopedic surgeon

EP

SE

SE

Otolaryngologist

EP

Urologist

EP

Plastic surgeon

EP

Oral/maxillofacial surgeon

EP

Gynecologist

EP

Microvascular surgeon

EP

Hand surgeon

EP

Ophthalmologist

EP

Cardiac surgeon

EP

Pathologist

EP

Pediondontist

EP

Physical Medicine/Rehabilitation physician

E

Trauma Rehabilitation Program

Physical Therapy

E

Occupational Therapy

E

Speech Therapy

SE

Special Education

E

TABLE 1. PEDIATRIC EMERGENCY CARE FACILITIES

Part 2/7

FACILITY DESIGNATION/LEVEL

2. EQUIPMENT

CRPC

General

Primary

Basic

EMS communication equipment*

E

E

E

E

Organized emergency cart*

EED&EPI

EED

EED

EED

Printed drug doses/tape

EED&EPI

EED

EED

EED

Monitoring devices

ECG monitor/defibrillator with pediatric paddles or pads 0-400 joules and hard copy capabilities

EED&EPI

EED

EH

EH

Pulse oximeter (adult/pediatric probes)

EED&EPI

EED

EH

EH

Blood pressure cuffs (infant, child, adult, thigh)

EED&EPI

EED

EED

EED

Rectal thermometer probe (28 deg. - 42 deg. C)

EED&EPI

EED

EH

EH

Otoscope, ophthalmoscope, stethoscope

EED&EPI

EED

EED

EED

Cardiopulmonary monitor with pediatric and hard copy capability, visible/audible alarms, routine testing and maintenance

EED&EPI

EED

EED

EH

Doppler and noninvasive blood pressure monitoring (infant, child, adult)

EED&EPI

EED

EH

End tidal CO2 detector

EED

EED

EED

EED

End tidal CO2 monitor

EED&EPI

EH

SE

Monitor for central venous pressure, arterial lines, temperature

EH&EPI

EH

SE

Monitor for pulmonary arterial pressure and intracranial pressure

EPI

Transportable monitor

EED&EPI

EED

EH

EH

Airway control/ventilation equipment

Bag-valve-mask device: pediatric (450 mL), and adult (1000 mL) with oxygen reservoir and without pop-off valve. Infant, child, and adult masks

EED&EPI

EED

EED

EED

Oxygen delivery device with flow meter

EED&EPI

EED

EED

EED

Clear oxygen masks, standard and non-rebreathing (neonatal to adult size)

EED&EPI

EED

EED

EED

Nasal cannula (infant, child, adult)

EED&EPI

EED

EED

EED

PEEP valve

EED&EPI

EED

Suction devices-catheters 6-14 fr, yankauer-tip/suction equipment

EED&EPI

EED

EED

EED

Nasal airways (infant, child, adult)

EED&EPI

EED

EED

EED

Nasogastric tubes (sizes 6-16 fr)

EED&EPI

EED

EED

EED

Laryngoscope handle and blades:

- curved 2,3

EED&EPI

EED

EED

EED

- straight or Miller 0,1,1-1/2, 2,3

EED&EPI

EED

EED

EED

Endotracheal tubes:

- uncuffed (2.5-5.5)

EED&EPI

EED

EED

EED

- cuffed (6.0-9.0) [all pediatric sizes EPI]

EED&EPI

EED

EED

EED

Stylets for endotracheal tubes (pediatric, adult)

EED&EPI

EED

EED

EED

Lubricant, water soluble

EED

EED

EED

EED

Magill forceps (pediatric, adult)

EED

EED

EED

EED

Spirometers, chest physiotherapy and suctioning equipment

EPI

Continuous oxygen analyzers with alarms

EPI

Inhalation therapy equipment

EPI

Tracheostomy tubes (sizes 0-6)

EED

EH

EH

Oxygen blender

EED&EPI

EED

EED

EED

Pediatric endoscopes and bronchoscopes available

EH

EH

Respired gas humidifiers and bronchoscopes available

EPI

Pediatric ventilators

EPI

EH

Difficult airway kit

EED&EPI

EED

SE

SE

Vascular access supplies

Arm boards (infant, child, and adult sizes)

EED&EPI

EED

EED

EED

Butterflies (19-25 gauge)

EED&EPI

EED

EED

EED

Catheters for intravenous lines (16-24 gauge)

EED&EPI

EED

EED

EED

Needles (18-27 gauge)

EED&EPI

EED

EED

EED

Intraosseous needles

EED&EPI

EED

EED

EED

Umbilical vessel catheters (3,5 fr) and cannulation tray

EED

EED

EH

EH

IV administration sets and extension tubing with calibrated chambers

EED&EPI

EED

EED

EED

Extension tubing, stopcocks, T-connectors

EED&EPI

EED

EED

EED

Infusion device able to regulate rate and volume of infusate

EED&EPI

EED

EED

EED

Isotonic balanced salt solution and D[5[ 0.5 normal saline

EED

EED

EED

EED

Central venous access utilizing Seldinger technique (4-7 fr)

EED&EPI

EED

EED

IV fluid/blood warmer

EED&EPI

EED

EH

Blood gas kit

EED

EED

EH

Rapid infusion pumps

EED&EPI

EH

TABLE 1. PEDIATRIC EMERGENCY CARE FACILITIES

Part 3/7

FACILITY DESIGNATION/LEVEL

2. EQUIPMENT AND SUPPLIES (Cont.)

CRPC

General

Primary

Basic

Specialized pediatric trays

Lumbar puncture

EED&EPI

EED

EED

EH

Urinary catheterization: Foley 6-14 fr

EED&EPI

EED

EED

EED

Venous cutdown

EED&EPI

EED

EH

EH

Thoracostomy tray with chest tube sizes 10-28 fr

EED&EPI

EED

SE

Peritoneal lavage tray

EED&EPI

EED

SE

Needle cricothyrotomy set

EED&EPI

EED

EED

Intracranial pressure monitor tray

EED&EPI

SE

Obstetrical Kit

EED

EED

EED

EED

Oral Airway (1 in 0-5)

EED&EPI

EED

EED

EED

Tracheostomy tray

EED&EPI

EED

SE

Fracture management devices

Cervical immobilization equipment suitable for ped. patients

EED

EED

EED

EED

Spine board (child/adult)

EED

EED

EED

EED

Extremity splints

EED

EED

EED

EED

Femur splint; child, adult

EED

EED

EED

EED

Activated charcoal

EED

EED

EED

EH

Beta-agonist for inhalation

EED&EPI

EED

EED

EH

Bretylium

EED&EPI

EED

EH

EH

Calcium chloride

EED&EPI

EED

EH

EH

Corticosteroids (dexamethasone, methylprednisolone)

EED

EED

EED

EH

Cyanide kit and pediatric doses

EED

Dextrose-25% and 50%

EED&EPI

EED

EED

EH

Digitalis antibody

EH

EH

EH

Diphenhydramine

EED

EED

EED

EH

Epinephrine (1:1000, 1:10,000)

EED&EPI

EED

EED

EH

Factor VIII, IX concentrates, DDAVP

EH

EH

EH

Flumazenil

EH

EH

EH

EH

Furosemide

EED&EPI

EED

EED

EH

Glucagon

EED

EED

EED

Insulin

EH

EH

EH

Ipecac

EED

EED

EED

EH

Kayexalate

EH

EH

EH

Ketamine

EED

EH

ED

Magnesium sulfate

EED&EPI

EED

EH

Mannitol-20%

EED&EPI

EH

EH

Methylene blue

EH

EH

EH

EH

N-acetyl cysteine

EH

EH

EH

Naloxone

EED

EED

EED

EH

Potassium chloride

EED

EED

EED

Prostaglandin

EH

EH

EH

Sodium bicarbonate 4.2%, 7.5% and 8.4%

EED&EPI

EED

EED

EH

Succinylcholine

EED

EED

EH

Whole bowel irrigation solution

EH

EH

EH

TABLE 1. PEDIATRIC EMERGENCY CARE FACILITIES

Part 4/7

FACILITY DESIGNATION/LEVEL

2. EQUIPMENT AND SUPPLIES (Cont.)

CRPC

General

Primary

Basic

MEDICATION CLASSES

Analgesics

EED

EED

EH

EH

Antibiotics

EED

EED

EED

EH

Anticonvulsants

EED&EPI

EED

EED

EH

Antihypertensive agents

EED

EED

EH

EH

Antipyretics

EED

EED

EED

EH

PALS and ACLS medications

EED&EPI

EED

EED

EH

Chelating agents for heavy metal poisonings

EH

Nondepolarizing neuromuscular blocking agents

EED

EED

EED

Rapid sequence intubation medications

EED&EPI

EED

EH

Sedatives and antianxiety medications

EED&EPI

EED

EH

EH

MISCELLANEOUS

Resuscitation board

EED&EPI

EED

EED

EED

Infant scale

EED&EPI

EED

EED

EED

Heating source (for infant warming)

EED&EPI

EED

EED

EED

Precalculated drug sheets or length-base tape

EED

EED

EED

EED

Pediatric restraint equipment (to use for painful or difficult procedures)

EED

EED

EED

Portable radiography

EED&EPI

EH

EH

Slit lamp

EH

EH

EH

Infant incubators

EH

Bilirubin lights

EH

Pacemaker capability

EH

EH

Thermal control for patient and/or resuscitation room

EED

EED

EED

3. FACILITIES

Emergency Department

Two or more areas with capacity and equipment to resuscitate medical/surgical/trauma pediatric patients

E

One or more areas as above

E

Separate Pediatric designated site

E

Access to helicopter landing site

E

E

E

E

Hospital support services

Pediatric inpatient care

E

E

Pediatric intensive care unit

E

Child abuse team

E

E

Child life support

EH

Operating Room

Operating room staff

EP

EP

SE

One RN physically present in OR

E

EP

Second operating room available and staffed within 30 minutes

E

Thermal control equipment

E

E

X-ray capability, including C-arm

E

E

Endoscopes, all varieties

E

Craniotomy equipment, including ICP monitoring equipment

E

Invasive and noninvasive monitoring equipment

E

E

Pediatric anesthesia and ventilation equipment

E

E

Pediatric airway control equipment

E

E

Defibrillator, monitor, including internal and external paddles

E

E

Laparotomy tray

E

E

Thoracotomy tray and chest retractors of appropriate size

E

Synthetic grafts of all sizes

E

Spinal and neck immobilization equipment

E

Fracture table with pediatric capability

E

Auto-transfusion with pediatric capability

E

Pediatric drug dosage chart

E

E

TABLE 1. PEDIATRIC EMERGENCY CARE FACILITIES

Part 5/7

FACILITY DESIGNATION/LEVEL

3. FACILITIES (Cont.)

CRPC

General

Primary

Basic

OPERATING ROOM (CONT.)

Tracheostomy tubes, neonatal through adolescent

E

E

Anesthesia and surgical suite promptly available

EP

EP

SE

PEDIATRIC INTENSIVE CARE UNIT

Distinct, controlled access unit

E

Proximity to elevators

E

MD on-call room

E

Waiting room and separate family counseling room

E

Patients' personal effects storage and privacy provision

E

Patient isolation capacity and isolation cart

E

Medication station with drug refrigerator and locked cabinet

E

Emergency equipment storage

E

Separate clean and soiled utility rooms

E

Nourishment station

E

Separate staff and patient toilets

E

Clocks, radios, and televisions

E

Two oxygen, two vacuum, and >2 compressed air outlets/bed

E

Computerized lab reporting

E

Easy, rapid access to head of beds and cribs

E

Pressure monitoring capability, with 4 simultaneous pressures

E

Electric patient isolation capability

E

Recovery Room

RNs and other essential personnel on call 24 hrs/day

E

E

E*

Staff competent in the post-anesthesia care of the pediatric pt.

E

E

E*

Airway equipment

E

E

E*

Pressure monitoring capability

E

E

E*

Thermal control equipment

E

E

E*

Radiant warmer

E

E

E*

Blood warmer

E

E

E*

Resuscitation cart

E

E

E*

Immediate access to sterile surgical supplies for emergency

E

E*

Pediatric drug dosage chart

E

E

E

E* If surgery performed on pediatric patients

Laboratory services

Hematology

E

E

E

E

Chemistry

E

E

E

E

Microbiology

E

E

E

SE

Microcapabilities

E

E

Blood bank

E

E

SE

Drug levels/toxicology

E

SE

SE

Refractometer

EPI

Blood gases

E

E

E

Radiology Service

Routine services 24 hours per day

EH

EH

E

E

Computed tomography scan 24 hours per day

E

E

SE

Ultrasound 24 hours per day

E

E

SE

Magnetic Resonance Imaging Availability

E

E

Nuclear medicine

E

SE

Fluoroscopy/contrast studies 24 hours per day

E

E

SE

Angiography 24 hours per day

E

E

SE

TABLE 1. PEDIATRIC EMERGENCY CARE FACILITIES

Part 6/7

FACILITY DESIGNATION/LEVEL

3. FACILITIES (Cont.)

CRPC

General

Primary

Basic

OTHER

Pediatric Echocardiography

E

Pediatric Cardiac Catheterization

E

Electroencephalography

E

Access to:

Regional poison control center

E

E

E

E

Hemodialysis capability/transfer agreement

E

E

E

Rehabilitation medicine/transfer agreement

E

E

SE

Acute spinal cord injury management capability/transfer agreement

E

E

SE

Hyperbaric oxygen chamber availability/transfer agreement when appropriate

E

4. Access, Triage, Transfer, and Transport

Support of medical control*

E

E

SE

SE

Accept call-ahead ambulance information

E

E

E

E

Transfer agreements for: In-patient pediatric care

E

E

ICU pediatric care

E

E

E

Major trauma care

ES

E

E

E

Burn care

ES

E

E

E

Hemodialysis

ES

E

E

E

Spinal injury care

ES

E

E

E

Rehabilitation care

ES

E

E

E

Accept all critically ill patients from lower-level hospitals within a region

E

SE

Access to transport services appropriate for pediatrics

E

E

E

E

Provide 24-hour consultation to lower-level facilities

E

Consultation agreements with CRPC

E

E

E

5. Education, Training, Research, and Quality Assessment and Improvement*

Education and Training

Public education, injury prevention

E

E

SE

SE

Assure staff training in resuscitation and stabilization

E

E

E

E

Assist with pre-hospital education

E

SE

SE

SE

CPR certification for PICU nurses and respiratory therapists

E

CPR certification for ED nurses and RRTs

E

E

E

E

Resuscitation practice sessions

E

SE

SE

SE

Ongoing CME for RNs and RRTs from the PICU

E

Ongoing CME for RNs and RRTs from the ED

E

E

E

E

Network educational resources for training all levels of health professionals

E

SE

RESEARCH

Support state EMSC and CRPC research efforts and data collection

E

E

E

E

Participate in and/or maintain trauma registry

E

E

SE

SE

Participate in regional pediatric critical care education

E

TABLE 1. PEDIATRIC EMERGENCY CARE FACILITIES

Part 7/7

FACILITY DESIGNATION/LEVEL

5. Education, Training, Research, and Quality Assessment and Improvement* (Cont.)

CRPC

General

Primary

Basic

QUALITY ASSESSMENT AND IMPROVEMENT

Structured QA/QI program with indicators and periodic review

E

E

E

E

Participate in regional quality review by CRPC and/or local EMS authority

E

E

E

E

6. ADMINISTRATIVE SUPPORT AND HOSPITAL COMMITMENT

Make available clinical resources for training pre-hospital personnel

E

SE

SE

Assure properly trained ED staff

E

E

E

E

Assure availability of all necessary

equipment/supplies/protocols/agreements/policies

E

E

E

E

Provide emergency care and stabilization for all pediatric patients

E

E

E

E

Support networking education/training for health care professionals

E

E

E

E

Assure appropriate medical control and input to ED management and pediatric care

E

SE

SE

SE

Participate in network pediatric emergency care

E

E

E

E

Assure conformity with building and federal codes for PICU

E

Assure transport services and agreements are available

E

E

E

E

Assure resources available for data collection

E

E

E

E

Assure availability of: Social services

E

E

E

Child abuse support services

EP

EP

EP

Child life support

E

On-line pre-hospital control

E

SE

SE

SE

Respiratory care

EED

EH

EH

SE

Pediatric Critical Care Committee

E

Pediatric Trauma Committee

E

Child development services

E