Sec. 30.08.05.13. Facility or Unit Capabilities

	PARC	I	II	III	ED
A. Emergency Department.  Emergency Department (ED) requirements are as follows:
(1) A designated ED physician director and nurse manager;	NA	E	E	E	E
(2) Board-certified or board-eligible attending physician with demonstrated competence in the care of critically injured patients in-house 24 hours a day;	NA	E	E	E	D
(3) A dedicated Trauma Resuscitation Unit (TRU) with dedicated staff, equipment and supplies 24 hours a day;	E	NA	NA	NA	NA
(4) Dedicated trauma resuscitation area with dedicated staff, equipment, and supplies 24 hours a day;	NA	E	E	E	E
(5) Senior attending trauma surgeon available 24 hours a day through EMRC/SYSCOM as a resource for trauma consultation Statewide;	E	NA		NA	NA
(6) A sufficient number of registered nurses and other providers, who are competent to provide care during trauma resuscitation and present in sufficient numbers to manage projected case load, and a plan to reinforce the number of staff on immediate notice of multiple admissions;	E	E	E	E	E
(7) Defined and agreed on roles and responsibilities approved by the TMD with the overall goal to have available  ED resources needed to care for patients;	NA	E	E	E	E
(8) Verification of functioning life-safety emergency equipment and supplies organized for trauma resuscitation present and immediately available 24 hours a day;	E	E	E	E	E
(9) Direct communication link to pre hospital providers and transport vehicles;	E	E	E	E	E
(10) Designated as Base Station by MIEMSS;	E	E	E	E	E
(11) Emergency Equipment located in the Resuscitation area/ED for:	E	E	E	E	E
(a) Airway control or cricothyrotomy;	E	E	E	E	E
(b) Difficult Airway Equipment;	E	E	E	E	E
(c) Thoracotomy;	E	E	E	E	E
(d) Vascular access;	E	E	E	E	E
(e) Thoracostomy/Chest decompression;	E	E	E	E	E
(f) Peritoneal Lavage;	E	E	E	E	E
(g) Bedside Ultrasound;	E	E	E	E	E
(h) Extremity Hemorrhage Control devises/Tourniquet;	E	E	E	E	E
(i) Rapid Infuser and Warmer; and	E	E	E	E	E
(j) Access to compartment measurement device;	E	E	E	E	E
(12) Policies and protocols for trauma team response and roles in ED trauma resuscitation in accordance withRegulation .11 of this chapter;	E	E	E	E	E
(13) Drugs necessary for emergency care; and	E	E	E	E	E
(14) Auto transfusion equipment and capability immediately available.	E	E	E	E	E
B. Operating Room.  Operating Room (OR) requirements are as follows:
(1) OR rooms adequately staffed with in-house personnel dedicated to trauma 24 hours a day;	E	D	NA	NA	NA
(2) OR available within 15 minutes of notification with adequate in-house staff;	E	E	E	E	NA
(3) X-ray capability including C-arm image intensifier 24 hours a day;	E	E	E	E	NA
(4) Equipment and instrumentation appropriate for:
(a) Neurosurgery;	E	E	E	E	NA
(b) Vascular surgery;	E	E	E	E	NA
(c) Pelvic and long-bone fracture fixation; and	E	E	E	E	NA
(d) Cardiopulmonary bypass:
(i) Cardiopulmonary bypass;	E	E	D	NA	NA
(ii) If cardiopulmonary bypass equipment is not immediately available, a written contingency plan, including immediate patient transfer to an appropriate center with a 100 percent performance improvement review of all patients transferred;	NA	E	E	E	NA
(5) Rapid fluid infusers, blood recapturing thermal control equipment for patients and resuscitation fluids,intraoperative radiologic capabilities, equipment for fracture fixation, and equipment for bronchoscopy and gastrointestinal endoscopy;	E	E	E	E	NA
(6) Equipment for continuous monitoring of temperature, hemodynamics, and gas exchange; and	E	E	E	E	NA
(7) Endoscopes.	E	E	E	E	NA
C. Post-Anesthesia Care Unit (PACU) requirements are as follows:
(1) Dedicated to trauma and staffed 24 hours a day;	E	NA	NA	NA	NA
(2) PACU Room/s available to trauma patients with registered nurses and other essential staff 24 hours a day; and	NA	E	E	E	NA
(3) The necessary equipment to monitor and resuscitate patients including equipment for continuous monitoring of temperature, hemodynamics, and gas exchange.	E	E	E	E	NA
D. Intensive Care Unit (ICU). Intensive care unit requirements are as follows:
(1) Dedicated ICU for trauma with appropriately trained registered nurse staff;	E	NA	NA	NA	NA
(2) Designated ICU bed availability for trauma patients with appropriately trained trauma registered nurses in sufficient numbers based on patient acuity;	E	E	E	E	NA
(3) Written plan for triaging patients from the intensive care unit to free up beds for trauma patients when necessary or provision of alternate critical care beds for trauma patients with appropriately trained registered nurse staff;	E	E	E	E	NA
(4) The means to ensure that the trauma surgeon is kept informed and concurs with major therapeutic and management decisions made by the ICU team which can collaboratively manage many of the daily care requirements;	E	E	E	E	NA
(5) The means to ensure that trauma patients are not admitted or transferred by a primary care physician without the knowledge and consent of the trauma service;	E	E	E	E	NA
(6) The necessary equipment to monitor and resuscitate patients;	E	E	E	E	NA
(7) Support services with immediate access to clinical diagnostic services such as arterial blood gases, hematocrits, and chest X-rays available within 30 minutes;	E	E	E	E	NA
(8) A Respiratory Therapist available in the hospital 24 hours per day;	E	E	E	E	E
(9) Nutrition support services available; and	E	E	E	E	NA
(10) Acute continuous hemodialysis capability.	E	E	E	E	NA
E. Acute Spinal Cord and Head Injury Management Capability.  Acute spinal cord or head injury management requirements are as follows:
(1) Dedicated Neurotrauma units with dedicated, specialty trained nursing and support staff;	E	NA	NA	NA	NA
(2) Neuro-intensive services with intracranial ressure capabilities for trauma patients;	NA	E	D	D	NA
(3) Intracranial pressure monitoring equipment available with neurosurgical coverage;	E	E	E	E	E
(4) Dedicated services to care for spinal cord injury  and patient management;  and	E	NA	NA	NA	NA
(5) Orthopedics or Neurosurgery management of the spine patients with appropriate neuro monitoring consistent with current standards of care to meet the needs of the patient.	E	E	E	E	E
F. Burn Care.  Burn care requirements are as follows:
(1) Ability to provide initial resuscitation for burn patients;	E	E	E	E	E
(2) Proper equipment for the care of burned patients, prior to transfer to burn center; and	E	E	E	E	E
(3) A hospital shall complete transfers to in-State hospitals, or to out-of-State hospitals listed in the Maryland Emergency Medical Services Interhospital Transfer Resource Manual, in accordance with the guidelines contained in the Maryland Emergency Medical Services Interhospital Transfer Resource Manual without the need for separate transfer agreements.	E	E	E	E	E
(4) A hospital shall have a written transfer agreement in place for transfer of a patient to an out-of-State hospital not listed in the Maryland Emergency Medical Services Interhospital Transfer Resource Manual, if the hospital transfers to such out-of-State hospital more than five times a year.	E	E	E	E	E
G. Radiological Special Capabilities.  Radiological special capabilities requirements are as follows:
(1) Qualified radiologists and staff available within 60 minutes of consultation notification to perform complex imaging studies, or interventional procedures;	E	E	E	E	E
(2) A Board-certified or board-eligible, in-house Radiology Attending on-call who shall provide interpretations of radiographs within 30 minutes;	E	NA	NA	NA	NA
(3) Qualified in-house Radiology or Teleradiology available 24 hours a day  for the interpretations of radiographs;	NA	E	E	E	E
(4) Changes in interpretation between preliminary and final reports, as well as missed injuries, monitored through the QM program;	E	E	E	E	NA
(5) A mechanism in place to view radiographic imaging from referring hospitals;	E	D	D	D	NA
(6) In-house trauma-dedicated technicians 24 hours a day;	E	NA	NA	NA	NA
(7) In-house radiology technicians 24 hours a day;	E	E	E	E	E
(8) Dedicated computed tomography (CT) scan and angiography facilities and staff 24 hours a day;	E	NA	NA	NA	NA
(9) Interventional Angiography;	E	E	E	D	NA
(10) Sonography;	E	E	E	E	D
(11) Nuclear scanning;	E	E	E	E	NA
(12) Magnetic resonance imaging (MRI) capability available 24 hours per day;	E	E	E	D	D
(13) An MRI technologist who may respond from outside the hospital with the QM program documenting and reviewing arrival within 60 minutes of being called; and	E	E	E	D	D
(14) Computed tomography (CT):
(a) Computed tomography (CT) in-house and available 24 hours a day;	E	E	E	E	NA
(b) In-house CT technician 24 hours a day; and	E	E	E	E	NA
(c) Back-up CT scan capabilities.	E	E	E	E	NA
H. Rehabilitation.  Rehabilitation requirements are as follows:
(1) Rehabilitation services staffed by personnel trained in rehabilitative care and properly equipped for acute care of the critically injured patient;	E	E	D	D	NA
(2) Rehabilitation consultation services, occupational therapy, speech therapy, physical therapy, and social services available in the critical care phase as needed;	E	E	D	D	NA
(3) Full in-house service or transfer process in place to a rehabilitation service for Long-term care or sub-acute care;	E	E	E	E	NA
(4) Ongoing continuity of care for patients with traumatic brain, musculoskeletal, and soft tissue injuries provided in affiliated rehabilitation facility by attending trauma center specialists and sub-specialists; and	E	NA	NA	NA	NA
(5) Transfer agreements to Rehabilitation hospitals, for the primary three rehabilitation hospitals the trauma center utilizes which may be a joint transfer agreement if  the Trauma Center is a part of a health system that utilizes a particular rehabilitation center.	E	E	E	E	NA
I. Clinical Laboratory Service.
(1) A clinical laboratory service shall be available 24 hours a day capable of providing:	E	E	E	E	E
(a) Standard analysis of blood, urine, and other body fluids;
(b) Blood-typing and cross-matching;
(c) Comprehensive blood bank or access to a central blood bank in the community and adequate storage facilities with stock minimums set by protocol for blood products;
(d) Blood gases and pH determinations;
(e) Coagulation studies;
(f) Microbiology; and
(g) Drug and alcohol screening.
(2) The blood bank shall have an adequate in-house supply of red blood cells, fresh frozen plasma, platelets, cryoprecipitate, and appropriate coagulation factors to meet the needs of injured patients.	E	E	E	E	E
(3) A massive transfusion protocol developed collaboratively between the trauma service and the blood bank.	E	E	E	E	E
(4) A dedicated satellite lab or Point-of-Care available near or in the trauma resuscitation area for essential lab studies.	E	E	D	D	NA
J. Equipment for Resuscitation.  Equipment for resuscitation of patients of all Ages in the ED, OR, PACU, and ICU shall be immediately available and include:
(1)  Airway control and ventilation equipment, difficult airway equipment, including laryngoscopes and endotracheal tubes of all sizes, bag-mask resuscitator, pocket masks, and oxygen;	E	E	E	E	E
(2) Suction devices;	E	E	E	E	E
(3) Pulse oximetry;	E	E	E	E	E
(4) Electrocardiograph-oscilloscope-defibrillator;	E	E	E	E	E
(5) Standard intravenous fluids and administration devices, including large-bore intravenous catheters;	E	E	E	E	E
(6) End-tidal CO2 determination;	E	E	E	E	E
(7) Apparatus to establish hemodynamic monitoring;	E	E	E	E	NA
(8) Skeletal traction devices, including capabilities for cervical traction;	E	E	E	E	E
(9) Arterial catheters;	E	E	E	E	NA
(10) Thermal control equipment for patient and fluids;	E	E	E	E	E
(11) Rapid Infuser and Warmer;	E	E	E	E	E
(12) Compartmental pressure measuring device; and	E	E	E	E	D
(13) Portable ultrasound.	E	E	E	E	E