44:68:02:07.  Designation criteria for Level IV community trauma hospitals. A Level IV community trauma hospital shall meet the following criteria:

 

          (1)  The hospital organization shall have:

 

               (a)  A trauma program recognized by the hospital, including a physician medical director and trauma nurse leader;

               (b)  A hospital-specific definition of a trauma team alert patient;

               (c)  A multidisciplinary operational and performance improvement review committee with a defined purpose and meeting format. The committee may be combined with another performance improvement committee established by the hospital;

               (d)  Defined trauma team roles and responsibility;

               (e)  Defined trauma team activation guidelines; and

               (f)  Defined trauma transfer protocols;

 

          (2)  The hospital's medical capabilities shall include:

 

               (a)  Anesthesia services, which includes coverage by a licensed anesthesia provider pursuant to SDCL chapter 36-9A and SDCL chapter 36-4; and

               (b)  Trauma or general surgeon coverage to the emergency department at least 292 days each calendar year. If the trauma or general surgeon is on-call, the surgeon shall arrive within 30 minutes of patient arrival at least 85 percent of the time. The hospital shall have referral protocols in place for those times no surgeon is available;

 

          (3)  The hospital's emergency department shall include the following capabilities and equipment:

 

               (a)  Twenty-four hours a day, seven days a week operation;

               (b)  A designated medical director;

               (c)  Physician coverage of the emergency department for all trauma team activations 24 hours a day, seven days a week. If physician is on-call, the physician shall arrive within 15 minutes of patient arrival 85 percent of the time;

               (d)  A registered nurse available in the hospital and promptly available to the emergency department;

               (e)  Airway control and ventilation equipment including laryngoscope and endotracheal tubes of all sizes, other invasive airway adjuncts, bag-mask resuscitator, pocket masks, and oxygen;

               (f)  Pulse oximetry;

               (g)  End-tidal carbon dioxide detectors;

               (h)  Suction devices;

               (i)  Electrocardigraph-oscilloscope-defibrillator;

               (j)  Pediatric resuscitation equipment;

               (k)  Standard intravenous fluids and administration devices, including large bore intravenous catheters;

               (l)  Sterile surgical sets, including:

 

                      (i)    Airway control, cricothyrotomy, tracheostomy trays, or thoracotomy;

                      (ii)   Vascular access; and

                      (iii)  Needle decompression or chest tubes (various sizes);

 

               (m) Gastric decompression or nasal gastric tubes;

               (n)  X-ray availability 24 hours a day, seven days a week;

               (o)  Two-way communication with vehicles of emergency transport;

               (p)  Thermal control equipment for patients, as well as for blood and fluids; and

               (q)  Vascular Doppler;

 

          (4)  The hospital's surgical services shall include:

 

               (a)  An operating room team on-call with a maximum 30 minute response time, 85 percent of the time. The response time for the operating room team shall be documented and monitored;

               (b)  Thermal control equipment for patients, as well as for blood and fluids; and

               (c)  Rapid infuser system which may include pressure bags;

 

          (5)  The hospital's postanesthesia care unit services shall include:

 

               (a)  A registered nurse available 24 hours a day, seven days a week. On-call availability is acceptable. Times shall be documented and monitored;

               (b)  Pulse oximetry;

               (c)  End-tidal carbon dioxide detection; and

               (d)  Patient re-warming and thermal control monitoring;

 

          (6)  The hospital's intensive care unit services shall include:

 

               (a)  Trauma surgeon director or co-director;

               (b)  Pulse oximetry;

               (c)  End-tidal carbon dioxide detection; and

               (d)  Patient re-warming and thermal control monitoring;

 

          (7)  The hospital's radiology services shall include:

 

               (a)  A radiology technologist on-call with a maximum 30 minute response time. Response times shall be documented and monitored; and

               (b)  Conventional radiography;

 

          (8)  The hospital's laboratory services and capabilities shall include:

 

               (a)  A clinical laboratory available 24 hours a day, seven days a week;

               (b)  Standard analysis of blood, urine, and other body fluids;

               (c)  An O-negative blood supply;

               (d)  Coagulation studies; and

               (e)  Blood gas and pH determination;

 

          (9)  The hospital's support services shall include:

 

               (a)  Respiratory services; and

               (b)  Acute hemodialysis capability, either available on-site or via a transfer agreement;

 

          (10)  The hospital's trauma prevention and outreach shall include injury prevention and public awareness activities;

 

          (11)  The hospital's performance improvement and patient safety shall include:

 

               (a)  An organized and structured performance improvement program;

               (b)  A multidisciplinary performance improvement review committee. The committee may be combined with another performance improvement committee established by the hospital;

               (c)  The collection and submission of trauma data pursuant to chapter 44:68:04;

               (d)  A hospital and pre-hospital trauma care performance improvement review;

               (e)  A quarterly mortality and morbidity case review;

               (f)  An operation performance improvement review program including notification and arrival times for the following team members:

 

                      (i)    A trauma surgeon;

                      (ii)   An anesthesiologist or certified registered nurse anesthetist;

                      (iii)  A radiology technologist;

                      (iv)  A laboratory technician;

                      (v)   A surgery team;

                      (vi)  A post anesthesia recovery team; and

                      (vii) A respiratory therapist, if part of the trauma team;

 

               (g)  A published on-call schedule for trauma team members; and

               (h)  A collaborative involvement in pre-hospital care protocols; and

 

          (12)  The hospital's staff educational requirements shall be as follows:

 

               (a)  The physician medical director shall have current certification in ATLS education;

               (b)  The surgeon shall:

 

                      (i)    Have current certification in ATLS education; or

                      (ii)   Have documentation indicating successful completion of ATLS education at least once and a minimum of 16 hours of trauma continuing medical education credits every four years;

 

               (c)  The physician covering the emergency department shall:

 

                      (i)    Have current certification in ATLS education; or

                      (ii)   Have documentation indicating successful completion of ATLS education at least once and a minimum of 16 hours of trauma continuing medical education credits every four years;

 

               (d)  The physician assistant or nurse practitioner covering the emergency department shall:

 

                      (i)    Have current certification in ATLS education; or

                      (ii)   Have documentation indicating successful completion of ATLS education at least once and a minimum of 16 hours of trauma continuing medical education credits every four years;

 

               (e)  The trauma coordinator shall be current in TNCC education; and

               (f)  Each emergency department nurse shall be current in TNCC education.

 

          Source: 35 SDR 304, effective June 29, 2009.

          General Authority: SDCL 34-12-54.

          Law Implemented: SDCL 34-12-53, 34-12-54.