ac agenda 8-10-10 2

North Carolina EMS Advisory Council

Department of Health and Human Services Division of Health Service Regulation Office of Emergency Medical Services

The Jane S. McKimmon Conference Center

Raleigh, North Carolina

August 10, 2010 11:00 a.m.

A G E N D A

I. Call to Order ................................................................................................ Mr. Graham Pervier Chairman

II. Introduction of Guests ................................................................................ Mr. Graham Pervier

III. Approval of Minutes of the May 11, 2010, Meeting ................................. Mr. Graham Pervier IV. Election of Advisory Council Chairman and Vice Chairman V. Appointment of Committee Chairs ............................................................................. Chairman

VI. Compliance and Education Committee Report .............................................. Ms. Susan Safran

• Duke Endowment Cardiac Arrest Toolkit Grant Update ......................... Dr. Greg Mears VII. Injury Committee Report ......................................................................... Mr. Wayne Ashworth

VIII. Hospital Preparedness Update ........................................................................... Mr. Bob Bailey IX. Dr. George Johnson, Jr., Award Committee Report ............................... Mr. Wayne Ashworth X. Education Task Force Update ....................................................................... Mr. Dennis Taylor

XI. Agency Activity Report ............................................................. Ms. Regina Godette-Crawford XII. Other Business

XIII. Adjournment

North Carolina EMS Advisory Council


Compliance and Education Committee

North Carolina State University The Jane S. McKimmon Center


August 10, 2010 9:30 a.m.

I. Call to Order ............................................................................................ Ms. Susan Safran Chair

II. Approval of Minutes of the May 11, 2010, Meeting ................................ Ms. Susan Safran

III. Duke Endowment Cardiac Arrest Toolkit Grant Update ............................. Dr. Greg Mears

IV. Education Task Force Update .................................................................. Mr. Dennis Taylor

V. Rules Revision .......................................................................................... Mr. Donnie Sides

VI. OEMS Education Update .................................................................... Ms. Barbara Chorney

VII. Other Business VIII. Adjourn

MINUTES

NORTH CAROLINA EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL

Department of Health and Human Services

Division of Health Service Regulation Office of Emergency Medical Services

The Jane S. McKimmon Conference Center

North Carolina State University Raleigh, North Carolina

May 11, 2010 11:00 A.M.

Members Present

Mr. Graham Pervier, Presiding Mr. F. Wayne Ashworth Dr. William K. Atkinson Mr. Bob Bailey Mr. Terry Barber Dr. Nicholas Benson Dr. Thomas Blackwell Dr. Michael Chang Ms. Kathy Dutton Ms. Carolyn Hughes Dr. Elizabeth Kanof Dr. Steven E. Landau Mr. R. Keith Lovin Dr. Donna Moro-Sutherland Dr. Brent Myers Mr. Robert Poe Mr. Tony Seamon, Jr. Mr. Dennis A. Taylor Mr. Stephen E. Taylor Dr. James Winslow, III

Members Absent

Mr. Carl McKnight Ms. Stacey Ryan Ms. Susan M. Safran

The Honorable William Wainwright

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Staff Members Present Mr. Wally Ainsworth

Dr. Roy Alson Ms. Ann Marie Brown Ms. Shelley Carraway Ms. Barbara Chorney Ms. Regina Godette-Crawford Ms. Brenda Harrington Mr. Kyle Jordan Dr. Greg Mears Mr. Tom Mitchell Ms. Nadine Pfeiffer

Mr. Drexdal Pratt Mr. Donnie Sides Ms. Kimberly Sides Mr. Brad Thompson Ms. Jessica Trembly Mr. Carl Van Cott

Ms. Julie Williams Others Present

Mr. Jim Albright, Guilford County EMS Ms. Kushana Ballard, New Hanover Regional Medical Center Ms. Renee Godwin Batts, NC Community College System Mr. Robert Bednar, UNC Air Care, NC Academy of Physicians Assistants Mr. Brendan Berry, WakeMed Dr. Tom Clancy, New Hanover Regional Medical Center Mr. Steve Coffey, Havelock Fire Rescue Ms. Shea D’Anna, Carolinas Medical Center Mr. Joel Faircloth, NC Association of Rescue and EMS Mr. Sean Gibson, WakeMed Mr. Dale Hill, Capital RAC/WakeMed Mr. Jeff Horton, Acting Director, Division of Health Service Regulation

Mr. Jim Jones, DHHS, Public Affairs Officer Mr. Gordon Joyner, NC Association of Rescue and EMS Mr. Randy Kearns, State Burn Disaster Program, UNC Mr. Skip Kirkwood, Wake County EMS Dr. Hervy Kornegay, Jr., NC Association of Rescue and EMS Ms. Claudia McCormick, Duke Hospital Ms. Tracy T. McPherson, NC Community College System Ms. Bernie Medeiros, New Hanover Regional Medical Center Mr. Brandon Mitchell, Durham County EMS Ms. Kelli Moore, Mission Hospitals Mr. Chris Parker, Wilson County EMS Mr. Alan Parnell, Wilson County EMS Mr. Joe Penner, Mecklenburg EMS

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Ms. Rhonda Reeder, EastCare/Pitt County Memorial Hospital Dr. Bill Shillinglaw, Mission Hospitals Ms. Mary Beth Skarote, Triad RAC/NC Association of Paramedics Mr. Mike Smith, Durham County EMS Mr. Sean Sondej, Duke Hospital Mr. Kent Spitler, Gaston College EMS Education, NC Association of EMS Curriculum

Educators Ms. Christy Spivey, New Hanover Regional Medical Center Ms. Deb Stafford, New Hanover Regional Medical Center Mr. Jeff Strickler, NC Emergency Nurses Association Mr. Chris Thompson, Wilson County EMS Dr. Steven Vaslef, Duke Hospital Mr. Danny C. West, Charlotte Fire Department Ms. Dianne Wheaton, Wake Forest University Baptist Ms. Ginger Wilkins, Wake Forest University Baptist

Mr. George Winstead, Nash County EMS Mr. Joseph Zalkin, Wake County EMS (1) Purpose of the Meeting: The NC EMS Advisory Council met (1) to hear reports from

the Compliance and Education Committee, the Injury Committee and to hear a Hospital Preparedness update; (2) to hear an update from the Education Task Force and (3) to consider Mission Hospital’s request for Level II Trauma Center Designation renewal. Renewal certificates for trauma center designations were presented to North Carolina Baptist Hospital (Level I), Duke Hospital (Level I), New Hanover Regional Medical Center (Level II), and Mission Hospital (Level II).

(2) Actions of the Council:

Mr. Pervier, Chairman of the Council, called the meeting to order at 11:00 a.m.

(a) Motion was made by Mr. Poe, seconded by Dr. Benson, and unanimously

approved that:

RESOLVED: The EMS Advisory Council minutes of the February 10, 2010, meeting be approved as submitted.

(b) Motion was made by Mr. Ashworth on behalf of the Injury Committee and

unanimously approved that:

RESOLVED: The Council accept the recommendation of the NCOEMS staff and Injury Committee that Mission Hospital’s designation as a Level II trauma center be renewed.

Explanation: Mission Hospital in Asheville, North Carolina was reviewed on December 11, 2009, by the NC Office of EMS for consideration of a state renewal designation as a Level II trauma center. Numerous strengths were noted with no deficiencies. Due to the recent administrative changes, a consultation visit by the OEMS is encouraged following the resolution of several vacancies to ensure the

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trauma center has remained committed to the promise of providing quality patient care.

(c) Motion was made by Dr. Benson on behalf of the Compliance and Education

Committee and unanimously approved that:

RESOLVED: The Council accept the recommendation of the Compliance and Education Committee that the Medical Ambulance/Evacuation Bus: Vehicle and Equipment Requirements; Pediatric Specialty Care Ground Ambulance: Vehicle and Equipment Requirements; Staffing for Medical Ambulance/Evacuation Bus Vehicles and the Staffing for Pediatric Specialty Care Ground Ambulances proposed rules be presented to the NC Medical Care Commission for the rule making process.

Explanation: The first set of proposed rules involves the Medical

Ambulance/Evacuation Bus. Six or eight providers in the state have utilized Homeland Security funds to purchase 20 passenger patient carrying buses which are stretcher bound patient buses equipped with oxygen and other minor equipment that comes with the bus. In order to make these transports legal outside of a disaster that is declared by the Governor or the President, the vehicle must be permitted with a licensed agency. Several counties have indicated that they want to use these vehicles for local emergencies such as mass casualty auto crashes with multiple patients or evacuations of facilities that may be in their county that doesn’t rise to the level of a state disaster. In order to get reimbursement for these and to be legal to carry these patients in the vehicle, there needs to be minimum standards and minimum staffing requirements in place with a permit.

The second set of proposed rules involves a Pediatric Ambulance Category

Vehicle. Several hospitals already have these vehicles and are using them under the Specialty Care umbrella. Under Specialty Care, they are not allowed to take patients home and in some of these cases, children are carried home and provided home care with very specialized equipment that normally doesn’t reside on ambulances that we have ground services for. The suggestion was made that we create a rule that would allow them to have a special category permit that would allow them to carry children to any location that is necessary that requires specialized equipment and specialized staffing.

The proposed rules will go to the Medical Care Commission to formally begin the

review process, comment period and revision period before formally being adopted. Technical issues in wording can be addressed at this time.

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(3) Other Actions of the Council:

(a) Mr. Pervier welcomed guests to the Council meeting.

(b) Mr. Jeff Horton presented a certificate to North Carolina Baptist Hospital for the renewal of its designation as a Level I trauma center effective through February 28, 2014. Representatives in attendance to receive the certificate were Dr. Michael Chang, Trauma Medical Director, Dianne Wheaton, Trauma Program Manager, Mary Beth Skarote, Emergency Response Coordinator and Ginger Wilkins, Pediatric Trauma Coordinator. North Carolina Baptist Hospital was noted for the following strengths: 1) the hospital’s administrative support and the chairman of the department of surgery’s commitment; 2) the trauma medical director, the emergency department clinical director and staff; 3) the pre-hospital education program; 4) the geriatric care facilities; 5) the rehabilitation program and the inpatient rehabilitation unit; 6) the injury prevention coordinator; 7) the burn center; and 8) the pediatric trauma program.

(c) Mr. Jeff Horton presented a certificate to Duke Hospital for the renewal of its

designation as a Level I trauma center effective through February 28, 2014. Representatives in attendance to receive the certificate were Dr. Steve Vaslef, Trauma Medical Director, Claudia McCormick, Trauma Program Manager, and Sean Sondej, Vice President Emergency Services and Medical Surgery and Critical Care. Duke Hospital was noted for the following strengths: 1) the commitment of the hospital and administration; 2) the trauma medical director, the trauma program manager and the trauma clinical coordinator; 3) the clinical educator assigned to trauma; 4) the anesthesia department and their involvement in the ICU; 5) the research program and its productions; 6) the education and injury prevention program; and 7) orthopedic surgery and neurosurgery support.

(d) Mr. Jeff Horton presented a certificate to New Hanover Regional Medical Center

for the renewal of its designation as a Level II trauma center effective through February 28, 2013. Representatives in attendance to receive the certificate were Dr. Thomas Clancy, Trauma Medical Director, Christy Spivey, Director Emergency Department and Trauma Services, Bernie Medeiros, SERAC Manager, Kushana Ballard, Senior Trauma Registrar, and Deb Stafford, Trauma Registrar. New Hanover Regional Medical Center was noted for the following strengths: 1) the trauma medical director and the trauma program; 2) strong commitment from administration; 3) the injury and outreach programs are robust; and 4) the EMS service is strong and well integrated.

(e) Mr. Jeff Horton presented a certificate to Mission Hospital for the renewal of its

designation as a Level II trauma center effective through February 28, 2014. Representatives in attendance to receive the certificate were Dr. Bill Shillinglaw, Trauma Medical Director, Program Director and Kelli Moore, Trauma and Ortho Trauma. Mission Hospital was noted for the following strengths: 1) the only trauma center in western North Carolina and its commitment to care for all patients in the region; 2) the trauma program manager, PI clinical coordinator, trauma and acute care surgery attending staff; 3) the trauma medical director; 4) the excellent physical plant, especially Trauma Neuro ICU, the ED, the OR and the upcoming

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CT scanner in the ED; 5) the overall nursing care; and 6) the dedicated hospital based orthopedic surgery group.

(f) Mr. Ashworth, on behalf of the Injury Committee, reported that trauma centers

being considered for designation/re-designation in the future will now be voted on, and if approved, be presented their certificate at the same meeting. In the past, this had been a two-step process where hospital staff would have to return to the next EMS Advisory Council meeting to receive their certificate.

Secondly, Mr. Ashworth reported on the discussion that took place on patient reporting procedures particularly involving pre-hospital providers as they transport patients into different medical facilities and what kind of reporting procedures they would use in telling the hospital what has been done in the field. There was much discussion as to how this should be enabled and whether it should be a two way process. Most people seem to agree that the hospital has a reasonable expectation to know what has been done to and for the patient in the field, and the pre-hospital providers have a reasonable expectation of being able to get feedback from the medical facilities after they have turned over a patient so that they can improve their quality care as well. Wake Med is actively involved in pursuing this as well as other hospitals. At this time, this is not specified in rule.

(g) Dr. Benson, in the absence of Ms. Safran, reported from the Compliance and

Education Committee. Dr. Benson stated that Dr. Mears shared with the Committee what he considers to be a ground breaking event that links data of pre-hospital care with data for ED care and on in to other spears that can have a revolutionary impact on the quality of care that is delivered not just in North Carolina but nationwide. He then asked Dr. Mears to present a brief demonstration to the Council members and guests on the NC Outcomes Data System.

Dr. Mears reported that through the NC Outcomes Data system, we have successfully linked EMS data to our Credentialing Information System (CIS), the NC Motor Vehicle Crash database, NCDETECT, the Trauma Registry, the NC Stroke Registry, the NC Stemi Registry, a data source for hospital admissions called Hospital Discharge Database, and a data source from the Medical Examiner. The linkage to these databases gives us a continuum of care and a system of care approach that we have been endorsing for quite a while.

(h) Ms. Chorney provided an update on Emergency Medicine Today (EM Today). The

conference will be held October 1 – 6, 2010. Pre-conference will be held on October 1-3 with the actual conference being held October 4-6. The Call for Presentations has closed for this year with 121 potential presentations having been received.

(i) Mr. Dennis Taylor, Chairman of the Education Task Force that was appointed in February 2010, provided an update for the Council. The Task Force was charged to look at how the national EMS Education Agenda for the Future could be incorporated into North Carolina EMS. The Task Force has looked at issues of credential levels and continuing education and the issues of curriculum and accreditation. The Task Force has been divided into four sub groups to begin

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working on addressing these issues and is making great progress. The Task Force plans to have recommendations for the EMS Advisory Council at the August meeting to follow with public hearings on these recommendations in September or October if approved by the Council.

(j) Due to two resignations on the Education Task Force, Mr. Pervier appointed Mr.

Dale Hill, Director, Wake Med Emergency Services Institute and Mr. Michael Keller, Professor EMS Division, Gaston College to fill these vacancies.

(k) Mr. Bailey introduced Ms. Shelley Carraway, OEMS Hospital Preparedness

Coordinator, who updated the Council on the Hospital Preparedness Program as follows:

ASPR Hospital Preparedness Program:

• Year one of a three year ASPR grant will be ending on June 30, 2010. Contracts and projects have been approved and are in place for all of the eight Regional Advisory Committees (RACs) related to the Regional Hospital Preparedness Program;

• The State Mortuary Response Team (SMORT) educational project through Central Piedmont Community College continues with the recommendation of two additional modules to be added this grant cycle;

• A contract has been executed to develop a template and eight RACs regional response and recovery plans for ESF-8 activities as well as going out to each region to develop regional plans. Work began in April on this greatly anticipated project;

• A contract for the development of updated and online version of the initial SMAT training curriculum has been released;

• Mission Coordination Team Training and State Medical Support Training are scheduled to be completed prior to June 30, 2010;

• Work continues on projects with GIS, Communications, EMS Data Systems, Burn Surge and Pharmacy;

• Grant guidelines have been received to apply for year two continuation of this grant which will begin on July 1, 2010, and go through June 30, 2011. The new funding allocation for North Carolina is $11,012,906. This is an increase over year one but not quite back to original funding levels; and

• Application for year two of the three year cycle is due May 21, 2010. The current and ongoing priorities involve planning, education and exercise.

ASPR Pandemic Influenza Healthcare Preparedness for States: • Projects for the H1N1 grant program are underway. The H1N1 focus for

hospitals is on three preparedness issues: 1) Hospital Continuity of Operations plans; 2) Hospital Medical Surge Capacity plans; and 3) Hospital Alternate Care Facility Plans;

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• Contracts are in process for North Carolina hospitals to use this funding to address healthcare workforce preparedness as well as strategies for medical surge capacity issues surrounding an H1N1 major event. The grant also provides plan development, training funds and student outreach/education projects; and

• Contracts are in place with the University of North Carolina system for the health centers on all 17 campuses for H1N1 response. Review of applications for funding from the hospitals has been completed with awards being determined. This grant is due to end July 31, 2010.

Statewide Tabletop Exercise:

• The North Carolina State Medical Support Shelter (SMSS) Tabletop

Exercise took place on April 29, 2010, at Robeson Community College. This exercise was designed to establish a learning environment for players to exercise emergency response plans, policies and procedures as they pertain to the notification, mobilization, setup and demobilization of SMSS assets in the sustainment and support of the NC SMSS based on the Coastal Region Evacuation and Sheltering Standard Operating Guide. Subject matter experts and local representatives from numerous agencies took place in the exercise.

ASPR ESAR-VHP Program: • We received an additional supplemental grant this year for our ESAR-VHP

Program known as ServNC. For the first project, NCOEMS is currently working with the representatives from the following databases: 1) Health Care Personnel Registry (Nurse Aid, Medical Aide, and Geriatric Air); 2) North Carolina Psychology Board; and 3) the North Carolina State Board of Dental Examiners;

• A second project has had NCOEMS working with Emergency Management at the state level, State Medical Assistance teams, and the Medical Reserve Corps to finalize the state’s ID card system. To date, a badging system has been determined by all involved parties. They are now moving forward to integrate this ID badging system with the ServNC database;

• North Carolina has added a new feature to ServNC. This feature allows email attachments to be sent to email accounts outside of the ServNC system. This feature has been requested by all unit leaders to ensure the information is disseminated to all registered volunteers in ServNC in a timely manner; and

• We have just received notification that there will be an additional supplemental grant for ESAR-VHP.

Mobile Disaster Hospital:

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• The State Medical Response System (SMRS) Mobile Disaster Hospital is still continuing with efforts to fund equipment, planning and education initiatives to allow further development of the Medical Disaster Hospital in order to prepare it for deployment.

Disaster Medical Preparedness Conference: • The third annual Disaster Medical Preparedness Conference took place

April 20-22, 2010, at the Sheraton Greensboro/Koury Convention Center. Two general sessions and three concurrent sessions took place with a full day of preconference activities as well. The conference provided an opportunity for professionals from a number of agencies and associations to discuss how disaster impacts all of us in the health care community.

Agency Update: Mr. Pratt reported on the following:

• Chris Cangemi and Wally Ainsworth have both accepted Regional Specialist positions in our Eastern Regional EMS Office;

• Nominations for the Dr. George Johnson, Jr. Award are now being accepted through June 30, 2010. Guidelines for submitting these nominations as well as the criteria for this award will be distributed to credentialed personnel. The purpose of the award is to recognize those individuals that have made a statewide/national impact to Emergency Medical Services in North Carolina;

• Beth Diaz has accepted the position of Rural Trauma Specialist with the OEMS. This position is funded by Rural Health and she will work with the rural hospitals in NC to help determine how they can be involved in our trauma system;

• The 20th anniversary for the Paramedic Competition will be taking place at EM Today in October. This is a major milestone in EMS history and special recognition will be given at the banquet on Tuesday night; and

• The Model System Task Force has been chaired by Terry Barber. Being that it is not a statutory or regulatory function to have a designation but rather a recognition program, the group will complete its work so that implementation may begin once the budget stabilizes. Any recommendations will be held until that time.

The next Advisory Council meeting will be held at the McKimmon Center on Tuesday, August 10, 2010. There being no further business, the meeting adjourned at 12:05 p.m. Minutes submitted by Julie Williams.

MINUTES NORTH CAROLINA OFFICE OF EMERGENCY MEDICAL SERVICES

ADVISORY COUNCIL

Compliance and Education Committee Department of Health and Human Services


Jane S. McKimmon Center


May 11, 2010 9:30 a.m.

Members Present

Mr. Terry Barber Dr. Nicholas Benson Dr. Thomas Blackwell Ms. Carolyn Hughes Dr. Elizabeth Kanof Mr. R. Keith Lovin Mr. Robert Poe Mr. Dennis Taylor Mr. Stephen Taylor

Members Absent Ms. Stacey Ryan Ms. Susan Safran, Chair The Honorable William Wainwright

Staff Members Present

Mr. Wally Ainsworth Ms. Barbara Chorney Mr. Kyle Jordan Dr. Greg Mears Mr. Tom Mitchell Mr. Donnie Sides Ms. Kimberly Sides Ms. Jessica Trembly

Others Present

Mr. Robert Bednar Mr. Joel Faircloth Mr. Skip Kirkwood Ms. Tracy McPherson Ms. Kelli Moore Mr. Chris Parker Mr. Alan Parnell Mr. Kent Spitler Mr. Chris Thompson Mr. George Winstead

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(1) Purpose of the Meeting: The Committee met to receive updates on OEMS activities of the Compliance and Education Sections.

(2) Actions of the Committee:

Dr. Benson called the meeting to order at 9:35 a.m.

(a) Motion was made by Dr. Kanof, seconded by Mr. Poe and approved that:

RESOLVED: The Compliance and Education Committee minutes of the February 10, 2010 meeting be approved.

(b) Motion was made by Mr. D. Taylor, seconded by Ms. Hughes and approved, with a no vote from

Mr. Barber that:

RESOLVED: The Compliance and Education Committee recommend to the EMS Advisory Council that the Office proceed with the development of Medical Ambulance/Evacuation Bus permitting rules and to also move forward with the rules review process.

Explanation: A draft version of the new EMS rules with an implementation date of January 1, 2011 was presented to the committee. The group focused on the Medical Ambulance/Evacuation Bus permitting section. This section also included Pediatric Transport Ambulance permitting, staffing requirements for Medical Ambulance/Evacuation Buses, and staffing requirements for Pediatric Transport Ambulances. Discussion was held regarding these proposed rules with the rule process being explained and clarified. It was decided that these rules will be going to the Medical Care Commission for review. Once the Commission has reviewed, these draft rules will be presented to the public for comment.

Other Actions of the Committee:

(a) Dr. Mears presented the OEMS Activity Update. He provided a demonstration of the EMS Outcomes Linkage System. Patient outcome from the data systems are now linked. North Carolina is among one of the first states to incorporate their data. PreMIS is linked to NC DETECT (Emergency Department data system). Also, funding was received from the National Highway Transportation Safety Administration (NHTSA) to link to the NC Crash database.

The new, integrated system allows access to information that we have never before been able to assess. Assessments can be done without identifying patients with the exception of PreMIS and the Trauma Registry.

Notification has been sent to EMS systems indicating that the system is now ready for use. The goal for this coming year is to fill in all data sources related to patients. The Performance Improvement Center (PIC) is working on a process for how to use this data and how it should be released.

With no further business, the meeting was adjourned at 10:30 a.m.

Minutes submitted by Jessica Trembly.

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NORTH CAROLINA EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL August 10, 2010

10A NCAC 13P RULES REVISION

2010 / 2011

Rule Title Action .0201 EMS Systems Amend .0511 Criminal Histories Amend .0701 Denial, Suspension, Amendment or Revocation Repeal .0702 Procedures for Denial, Suspension, Amendment, or Revocation Repeal .0901 Level I Trauma Center Application Criteria Amend .0902 Level I Trauma Center Administration Amend .0903 Level I Trauma Center Physician and Trauma Team Services Amend .0904 Level I Trauma Center Trauma Team Activation Amend .0905 Level I Trauma Center Emergency Department Criteria Amend .0906 Level I Trauma Center Operating Room, Post Anesthesia Care Unit and Surgical Intensive Care Unit Criteria Adopt .0907 Level I Trauma Center Intensive Care and Critical Care Management Criteria Adopt .0908 Level I Trauma Center Radiology Services Criteria Adopt .0909 Level I Trauma Center Respiratory Therapy and Clinical Laboratory Criteria Adopt .0910 Level I Trauma Center Rehabilitation Services Criteria Adopt .0911 Level I Trauma Center Performance Improvement Criteria Adopt .0912 Level I Trauma Center Outreach Program, Public Education and Injury Prevention Criteria Adopt .0913 Level I Trauma Center Research Criteria Adopt .0914 Level I Trauma Center Continuing Education Criteria Adopt .0915 Level II Trauma Center Application Criteria Adopt .0916 Level II Trauma Center Administration Adopt .0917 Level II Trauma Center Physician and Trauma Team Services Adopt .0918 Level II Trauma Center Trauma Team Activation Adopt .0919 Level II Trauma Center Emergency Department Criteria Adopt .0920 Level II Trauma Center Operating Room, Post Anesthesia Care Unit and Surgical Intensive Care Unit Criteria Adopt .0921 Level II Trauma Center Intensive Care and Critical Care Management Criteria Adopt .0922 Level II Trauma Center Radiology Services Criteria Adopt .0923 Level II Trauma Center Respiratory Therapy and Clinical Laboratory Criteria Adopt .0924 Level II Trauma Center Rehabilitation Services Criteria Adopt .0925 Level II Trauma Center Performance Improvement Criteria Adopt .0926 Level II Trauma Center Outreach Program, Public Education and Injury Prevention Criteria Adopt .0927 Level II Trauma Center Continuing Education Criteria Adopt .0928 Level III Trauma Center Application Criteria Amend .0929 Level III Trauma Center Administration Adopt .0930 Level III Trauma Center Physician and Trauma Team Services Adopt .0931 Level III Trauma Center Trauma Team Activation Adopt .0932 Level III Trauma Center Emergency Department Criteria Adopt .0933 Level III Trauma Center Operating Room, Post Anesthesia Care Unit and Surgical Intensive Care Unit Criteria Adopt .0934 Level III Trauma Center Intensive Care and Critical Care Management Criteria Adopt .0935 Level III Trauma Center Radiology Services Criteria Adopt .0936 Level III Trauma Center Respiratory Therapy and Clinical Laboratory Criteria Adopt .0937 Level III Trauma Center Rehabilitation Services Criteria Adopt .0938 Level III Trauma Center Performance Improvement Criteria Adopt .0939 Level III Trauma Center Outreach Program, Public Education and Injury Prevention Criteria Adopt .0940 Level III Trauma Center Continuing Education Criteria Adopt .0941 Initial Designation Process Adopt .0942 Designated Trauma Center Administration Structure Changes Adopt .0943 Renewal Designation Options Adopt .0944 State Only Site Visit Renewal Designation Process Adopt .0945 State/ACS Combined Site Visit Renewal Designation Process Adopt .0946 State Only Trauma Site Survey Team Composition Adopt .0947 State/ACS Combined Trauma Site Survey Team Composition Adopt

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.1101 State Trauma System Amend

.1102 Regional Trauma System Plan Amend

.1501 Enforcement Definitions Adopt

.1502 EMS Systems Adopt

.1503 Licensed EMS Providers Adopt

.1504 Specialty Care Transport Programs Adopt

.1505 Trauma Centers Adopt

.1506 EMS Educational Institutions Adopt

.1507 EMS Vehicle Permits Adopt

.1508 EMS Personnel Credentials Adopt

.1509 Summary Suspension Adopt

.1510 Procedures for Denial, Suspension, Amendment, or Revocation Adopt



2010 / 2011

RULES FOR REVIEW BY THE COMPLIANCE COMMITTEE

Rule Title Action .0201 EMS System Requirements Amend .0511 Criminal Histories Amend .0701 Denial, Suspension, Amendment or Revocation Repeal .0702 Procedures for Denial, Suspension, Amendment, or Revocation Repeal .1101 State Trauma System Amend .1102 Regional Trauma System Plan Amend .1501 Enforcement Definitions Adopt .1502 EMS Systems Adopt .1503 Licensed EMS Providers Adopt .1504 Specialty Care Transport Programs Adopt .1505 Trauma Centers Adopt .1506 EMS Educational Institutions Adopt .1507 EMS Vehicle Permits Adopt .1508 EMS Personnel Credentials Adopt .1509 Summary Suspension Adopt .1510 Procedures for Denial, Suspension, Amendment, or Revocation Adopt



2010 / 2011

RULES FOR REVIEW BY THE INJURY COMMITTEE

Rule Title Action .0901 Level I Trauma Center Application Criteria Amend .0902 Level I Trauma Center Administration Amend .0903 Level I Trauma Center Physician and Trauma Team Services Amend .0904 Level I Trauma Center Trauma Team Activation Amend .0905 Level I Trauma Center Emergency Department Criteria Amend .0906 Level I Trauma Center Operating Room, Post Anesthesia Care Unit and Surgical Intensive Care Unit Criteria Adopt .0907 Level I Trauma Center Intensive Care and Critical Care Management Criteria Adopt .0908 Level I Trauma Center Radiology Services Criteria Adopt .0909 Level I Trauma Center Respiratory Therapy and Clinical Laboratory Criteria Adopt .0910 Level I Trauma Center Rehabilitation Services Criteria Adopt .0911 Level I Trauma Center Performance Improvement Criteria Adopt .0912 Level I Trauma Center Outreach Program, Public Education and Injury Prevention Criteria Adopt .0913 Level I Trauma Center Research Criteria Adopt .0914 Level I Trauma Center Continuing Education Criteria Adopt .0915 Level II Trauma Center Application Criteria Adopt .0916 Level II Trauma Center Administration Adopt .0917 Level II Trauma Center Physician and Trauma Team Services Adopt .0918 Level II Trauma Center Trauma Team Activation Adopt .0919 Level II Trauma Center Emergency Department Criteria Adopt .0920 Level II Trauma Center Operating Room, Post Anesthesia Care Unit and Surgical Intensive Care Unit Criteria Adopt .0921 Level II Trauma Center Intensive Care and Critical Care Management Criteria Adopt .0922 Level II Trauma Center Radiology Services Criteria Adopt .0923 Level II Trauma Center Respiratory Therapy and Clinical Laboratory Criteria Adopt .0924 Level II Trauma Center Rehabilitation Services Criteria Adopt .0925 Level II Trauma Center Performance Improvement Criteria Adopt .0926 Level II Trauma Center Outreach Program, Public Education and Injury Prevention Criteria Adopt .0927 Level II Trauma Center Continuing Education Criteria Adopt .0928 Level III Trauma Center Application Criteria Amend .0929 Level III Trauma Center Administration Adopt .0930 Level III Trauma Center Physician and Trauma Team Services Adopt .0931 Level III Trauma Center Trauma Team Activation Adopt .0932 Level III Trauma Center Emergency Department Criteria Adopt .0933 Level III Trauma Center Operating Room, Post Anesthesia Care Unit and Surgical Intensive Care Unit Criteria Adopt .0934 Level III Trauma Center Intensive Care and Critical Care Management Criteria Adopt .0935 Level III Trauma Center Radiology Services Criteria Adopt .0936 Level III Trauma Center Respiratory Therapy and Clinical Laboratory Criteria Adopt .0937 Level III Trauma Center Rehabilitation Services Criteria Adopt .0938 Level III Trauma Center Performance Improvement Criteria Adopt .0939 Level III Trauma Center Outreach Program, Public Education and Injury Prevention Criteria Adopt .0940 Level III Trauma Center Continuing Education Criteria Adopt .0941 Initial Designation Process Adopt .0942 Designated Trauma Center Administration Structure Changes Adopt .0943 Renewal Designation Options Adopt .0944 State Only Site Visit Renewal Designation Process Adopt .0945 State/ACS Combined Site Visit Renewal Designation Process Adopt .0946 State Only Trauma Site Survey Team Composition Adopt .0947 State/ACS Combined Trauma Site Survey Team Composition Adopt

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Office of Emergency Medical Services Overview of Proposed Changes to the EMS and Trauma Rules 10A NCAC 13P

For Consideration by the Emergency Medical Services Advisory Council August 10, 2010

Proposed effective date: April 1, 2011 Section .0200 – EMS Systems .0201 The agency determined this rule is in need of revision after issues were identified by the EMSAC Education Task Force that pertain to communications centers utilizing emergency medical dispatch priority reference system (EMDPRS) protocols. Specifically, language is being added that require the EMS system to have a defined service area for each communications center providing pre-arrival medical instructions, to require that each center the service 24-7, and for the EMS system providing these services to develop plans for the continued delivery of these services during disaster conditions, during mass casualty incidents, or situations requiring referral to specialty hotlines. Section .0500 – EMS Personnel The changes to this section are proposed for revision separate from issues being addressed by the EMSAC Education Task Force. .0511 This revision is necessary to address the shift from paper fingerprint cards to an electronic scan of an applicants fingerprints. The authority to obtain the fingerprints and criminal background histories is already in statute. This is needed to address changes in technology only and does not expand the agency’s authority to gather any additional criminal background history. This revision also addresses the collection of processing fees from the applicant prior to conducting the criminal background history check. There is no increase in background check processing fees and this is already authorized in statute. Section .0700 – Enforcement This entire section is being repealed and moved to a new Section .1500 – Denial, Suspension, Amendment, and Revocation. This is considered necessary to make the enforcement rules easier to read and use. Also, the agency will use this opportunity to update criteria within each area of enforcement. A more detailed review will be addressed later on in Section .1500 of this summary document. Section .0900 – Trauma Center Standards and Approval This entire section is being reformatted to make it easier to locate the various components and standards for the initial and renewal designation of trauma centers. Currently every aspect of the designation process was contained in five lengthy and difficult to use rules. This reformatting now expands the criteria for the three levels of trauma centers into 47 focused and specific rules. Furthermore, some of the criteria addressing continuing education, research, and performance

of 2

improvement are in need of updating. A document that addresses each of these topics is being incorporated by reference into rule that will enable the agency to ensure these standards are kept contemporary and specific to the needs of the healthcare industry as technology and practices continue to advance. Section .1100 – Trauma System Design Rules .1101 and .1102 only have minor revisions that reflect current practices on the process for RAC affiliation and how RAC affiliation membership changes should be reported to the OEMS. Section 1500 – Denial, Suspension, Amendment, or Revocation This is the new enforcement section. Where the old .0700 sections consisted of two rules, this new section is being expanded to 10 rules. The agency’s approach to enforcement is being changed to provide options currently unavailable for EMS systems, educational institutions, and specialty care providers to undergo a focused review when it is determined that an application for designation fails to meet the criteria at the time of designation, but as with trauma centers, utilizing an expanded process enables the applicant to function pending resolution of any noted deficiencies. Also, the criteria warranting administrative sanctions is being expanded to include failures to report, fraudulent representations, or refusal to provide information necessary to verify compliance. There is also additional language that is being included for credentialed personnel to address the new chemical dependency rules to be codified effective January 1, 2011.

1

RULES PROPOSED FOR REVISION 1

FOR REVIEW BY THE EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL 2

August 10, 2010 3

4

COMPLIANCE COMMITTEE 5

6

10A NCAC 13P .0201 EMS SYSTEM REQUIREMENTS 7

(a) County governments shall establish EMS Systems. Each EMS System shall have: 8

(1) a defined geographical service area for the EMS System. The minimum service area for an EMS 9

System shall be one county. There may be multiple EMS Provider service areas within the service 10

area of an EMS System. The highest level of care offered within any EMS Provider service area 11

must be available to the citizens within that service area 24 hours per day; 12

(2) a defined scope of practice for all EMS personnel, functioning in the EMS System, within the 13

parameters set forth by the North Carolina Medical Board pursuant to G.S. 143-514; 14

(3) written policies and procedures describing the dispatch, coordination and oversight of all 15

responders that provide EMS care, specialty patient care skills and procedures as defined in Rule 16

.0301(a)(4) of this Subchapter, and ambulance transport within the system; 17

(4) at least one licensed EMS Provider; 18

(5) a listing of permitted ambulances to provide coverage to the service area 24 hours per day; 19

(6) personnel credentialed to perform within the scope of practice of the system and to staff the 20

ambulance vehicles as required by G.S. 131E-158. There shall be a written plan for the use of 21

credentialed EMS personnel for all practice settings used within the system; 22

(7) written policies and procedures specific to the utilization of the EMS System's EMS Care data for 23

the daily and on-going management of all EMS System resources; 24

(8) a written Infectious Disease Control Policy as defined in Rule .0102(33) of this Subchapter and 25

written procedures which are approved by the EMS System medical director that address the 26

cleansing and disinfecting of vehicles and equipment that are used to treat or transport patients; 27

(9) a listing of facilities that will provide online medical direction for all EMS Providers operating 28

within the EMS System; 29

(10) an EMS communication system that provides for: 30

(A) public access using the emergency telephone number 9-1-1 within the public dial 31

telephone network as the primary method for the public to request emergency assistance. 32

This number shall be connected to the emergency communications center or PSAP with 33

immediate assistance available such that no caller will be instructed to hang up the 34

telephone and dial another telephone number. A person calling for emergency assistance 35

shall not be required to speak with more than two persons to request emergency medical 36

assistance; 37

2

(B) an emergency communications system operated by public safety telecommunicators with 1

training in the management of calls for medical assistance available 24 hours per day; 2

(C) dispatch of the most appropriate emergency medical response unit or units to any caller's 3

request for assistance. The dispatch of all response vehicles shall be in accordance with a 4

written EMS System plan for the management and deployment of response vehicles 5

including requests for mutual aid; and 6

(D) two-way radio voice communications from within the defined service area to the 7

emergency communications center or PSAP and to facilities where patients are routinely 8

transported. The emergency communications system shall maintain all required FCC 9

radio licenses or authorizations; 10

(11) written policies and procedures for addressing the use of SCTP and Air Medical Programs within 11

the system; 12

(12) a written continuing education program for all credentialed EMS personnel, under the direction of 13

a System Continuing Education Coordinator, developed and modified based on feedback from 14

system EMS Care data, review, and evaluation of patient outcomes and quality management peer 15

reviews, that follows the guidelines of the: 16

(A) "US DOT NHTSA First Responder Refresher: National Standard Curriculum" for MR 17

personnel; 18

(B) "US DOT NHTSA EMT-Basic Refresher: National Standard Curriculum" for EMT 19

personnel; 20

(C) "EMT-P and EMT-I Continuing Education National Guidelines" for EMT-I and EMT-P 21

personnel; and 22

(D) "US DOT NHTSA Emergency Medical Dispatcher: National Standard Curriculum" for 23

EMD personnel. 24

These documents are incorporated by reference in accordance with G.S. 150B-21.6, including 25

subsequent amendments and additions. These documents are available from NHTSA, 400 7th 26

Street, SW, Washington, D.C. 20590, at no cost; 27

(13) written policies and procedures to address management of the EMS System that includes: 28

(A) triage and transport of all acutely ill and injured patients with time-dependent or other 29

specialized care issues including trauma, stroke, STEMI, burn, and pediatric patients that 30

may require the by-pass of other licensed health care facilities and which are based upon 31

the expanded clinical capabilities of the selected healthcare facilities; 32

(B) triage and transport of patients to facilities outside of the system; 33

(C) arrangements for transporting patients to appropriate facilities when diversion or bypass 34

plans are activated; 35

(D) reporting, monitoring, and establishing standards for system response times using data 36

provided by the OEMS; 37

3

(E) weekly updating of the SMARTT EMS Provider information; 1

(F) a disaster plan; and 2

(G) a mass-gathering plan; 3

(14) affiliation as defined in Rule .0102(4) of this Subchapter with the trauma RAC as required by Rule 4

.1101(b) of this Subchapter; and 5

(15) medical oversight as required by Section .0400 of this Subchapter. 6

(b) Each EMS System that utilizes emergency medical dispatching agencies applying the principles of EMD or 7

offering EMD services, procedures, or programs to the public shall have: 8

(1) a defined service area for each agency; 9

(2) adequate personnel within each agency, credentialed in accordance with the requirements of 10

Section .0500 of this Subchapter, to ensure continuous EMD services to the citizens within that 11

service area are available 24 hours per day; and 12

(3) EMD responsibilities in special situations, such as disasters, multi-casualty incidents, or situations 13

requiring referral to specialty hotlines. 14

(b) (c) An application to establish an EMS System shall be submitted by the county to the OEMS for review. When 15

the system is comprised of more than one county, only one application shall be submitted. The proposal shall 16

demonstrate that the system meets the requirements in Paragraph (a) of this Rule. System approval shall be granted 17

for a period of six years. Systems shall apply to OEMS for reapproval. 18

19

History Note: Authority G.S. 131E-155(1), (6), (8), (9), (15);143-508(b), (d)(1), (d)(2), (d)(3), (d)(5), (d)(8), 20

(d)(9), (d)(10), (d)(13); 143-509(1), (3), (4), (5);143-517; 143-518; 21

Temporary Adoption Eff. January 1, 2002; 22

Eff. August 1, 2004; 23

Amended Eff. April 1, 2011; January 1, 2009. 24

25

10A NCAC 13P .0511 CRIMINAL HISTORIES 26

(a) The criminal background histories for all individuals who apply for EMS credentials, seek to renew EMS 27

credentials, or hold EMS credentials shall be reviewed pursuant to G.S. 131E-159(g). 28

(b) In addition to Paragraph (a) of this Rule, the OEMS shall carry out the following for all EMS Personnel whose 29

primary residence is outside North Carolina, individuals who have resided in North Carolina for 60 months or less, 30

and individuals under investigation that may be subject to administrative enforcement action by the Department 31

under the provisions of Rule .0701(e) .1508 of this Subchapter: 32

(1) obtain a signed consent form for a criminal history check; 33

(2) obtain fingerprints on an SBI identification card; and card or live scan electronic fingerprinting 34

system at an agency approved by the North Carolina Department of Justice, State Bureau of 35

Investigation; 36

(3) obtain the criminal history from the Department of Justice. Justice; and 37

4

(4) collect any processing fees from the individual identified in Paragraph (a) or (b) of this Rule as 1

required by the Department of Justice pursuant to G.S. 114-19.21 prior to conducting the criminal 2

history background check. 3

(c) An individual is not eligible for initial or renewal of EMS credentials if the applicant refuses to consent to any 4

criminal history check required by G.S. 131E-159(g). 5

6

History Note: Authority G.S. 143-508(d)(3),(10); 131E-159(g); 114-19.21; 7

Eff. January 1, 2009. 2009; 8

Amended Eff. April 1, 2011. 9

10

10A NCAC 13P .0701 DENIAL, SUSPENSION, AMENDMENT OR REVOCATION 11

History Note: Authority G.S. 131E-155.1(d); 131E-157(c); 131E-159(a),(f); 131E-162; 143-508(d)(10); 12


Eff. January 1, 2004; 14

Amended Eff. January 1, 2009. 2009; 15

Repealed Eff. January 1, 2011. 16

17

10A NCAC 13P .0702 PROCEDURES FOR DENIAL, SUSPENSION, AMENDMENT, OR 18

REVOCATION 19

History Note: Authority G.S. 143-508(d)(10); 20


Eff. April 1, 2003. 2003; 22

Repealed Eff. January 1, 2011. 23

24

10A NCAC 13P .1501 ENFORCEMENT DEFINITIONS 25

Notwithstanding Section .0100 of this Subchapter, for the purpose of this Section, the following definitions apply to 26

Rules .1502, 1503, 1504, and .1506 for EMS Systems, Licensed EMS Providers, Specialty Care Transport 27

Programs, and EMS Educational Institutions: 28

(1) "Contingencies" mean conditions placed on an initial or renewal designation, approval or license 29

that, if unmet, can result in the loss or amendment of the designation, approval, or license. 30

(2) "Deficiency" means the failure to meet essential criteria for designation, approval, or licensing as 31

specified in Sections .0200, .0300 or .0600 of this Subchapter, that can serve as the basis for a 32

focused review or denial of a designation, approval or license. 33

(3) "Essential Criteria" means those items listed in Sections .0200, .0300 or .0600 of this Subchapter 34

that are the minimum requirements for the respective application for initial or renewal designation, 35

approval, or licensing. 36

5

(5) “Focused Review” means an evaluation by the OEMS of a regulated entity’s corrective actions to 1

remove contingencies that are a result of deficiencies placed upon it following review of an 2

application for renewal. 3

4

History Note: Authority G.S. 131E-155(13a); 143-508(b),(d)(1),(d)(4),(d)(13); 5

Eff. April 1, 2011. 6

7

10A NCAC 13P .1502 EMS SYSTEMS 8

(a) The OEMS may deny the initial or renewal designation, without first allowing a focused review, of an EMS 9

System for any of the following reasons: 10

(1) failure to comply with the requirements of Rule .0201 of this Subchapter; 11

(2) obtaining or attempting to obtain designation through fraud or misrepresentation. 12

(b) When an EMS System is required to have a focused review, it must demonstrate compliance with the provisions 13

of Rule .0201 of this Subchapter within one year or less. 14

(c) The OEMS may revoke an EMS System designation at any time or deny a request for renewal of designation, 15

whenever the OEMS finds that the EMS System has failed to comply with the provisions of Rule .0201 of this 16

Subchapter; and 17

(1) it is not probable that the EMS System can remedy the deficiencies within 12 months or less; 18

(2) although the EMS System may be able to remedy the deficiencies within a reasonable period of 19

time, it is not probable that the EMS System shall be able to remain in compliance with 20

designation rules for the foreseeable future; 21

(3) the EMS System fails to meet the requirements of a focused review; 22

(4) failure to comply endangers the health, safety, or welfare of the public; 23

(5) repetition of deficiencies placed on the EMS System in previous compliance site visits; or 24

(6) altering, destroying or attempting to destroy evidence needed for a complaint investigation. 25

(d) The OEMS shall give the Board of Commissioners in the county or counties of the EMS System written notice 26

of revocation. This notice shall be given personally or by certified mail and shall set forth: 27

(1) the factual allegations; 28

(2) the statutes or rules alleged to be violated; and 29

(3) notice of the county's right to a contested case hearing on the amendment of the designation. 30

(e) In the event of a revocation, the OEMS shall provide written notification to all hospitals and emergency medical 31

services providers within the EMS System's defined service area. 32

(f) Focused review is not a procedural prerequisite to the revocation of a designation pursuant to Paragraph (c) of 33

this Rule. 34

35

History Note: Authority G.S. 143-508(d)(10), (d)(13); 36

Eff. April 1, 2011. 37

6

10A NCAC 13P .1503 LICENSED EMS PROVIDERS 1

(a) The Department may amend any EMS Provider license by reducing it from a full license to a provisional license 2

whenever the Department finds that: 3

(1) the licensee has failed to comply with the provisions of G.S. 131E, Article 7, and the rules adopted 4

under that article; 5

(2) there is a reasonable probability that the licensee can remedy the licensure deficiencies within a 6

reasonable length of time; and 7

(3) there is a reasonable probability that the licensee will be able thereafter to remain in compliance 8

with the licensure rules for the foreseeable future. 9

(b) The Department shall give the licensee written notice of the amendment of the EMS Provider license. This 10

notice shall be given personally or by certified mail and shall set forth: 11

(1) the length of the provisional EMS Provider license; 12



(4) notice to the EMS provider's right to a contested case hearing on the amendment of the EMS 15

Provider license. 16

(c) The provisional EMS Provider license is effective immediately upon its receipt by the licensee and shall be 17

posted in a prominent location at the primary business location of the EMS Provider, accessible to public view, in 18

lieu of the full license. The provisional license remains in effect until the Department: 19

(1) restores the licensee to full licensure status; or 20

(2) revokes the licensee's license. 21

(d) The Department may revoke or suspend an EMS Provider license whenever the Department finds that the 22

licensee: 23

(1) has failed to comply with the provisions of G.S. 131E, Article 7, and the rules adopted under that 24

article and it is not reasonably probable that the licensee can remedy the licensure deficiencies 25

within a reasonable length of time; 26


Article and, although the licensee may be able to remedy the deficiencies within a reasonable 28

period of time, it is not reasonably probable that the licensee will be able to remain in compliance 29

with licensure rules for the foreseeable future; 30

(3) has failed to comply with the provision of G.S. 131E, Article 7, and the rules adopted under that 31

article that endanger the health, safety or welfare of the patients cared for or transported by the 32

licensee; 33

(4) obtained or attempted to obtain an ambulance permit, EMS nontransporting vehicle permit, or 34

EMS Provider license through fraud or misrepresentation; 35

(5) repetition of deficiencies placed on the EMS Provider License in previous compliance site visits; 36

7

(6) fails to provide emergency medical care within the defined EMS service area in a timely manner 1

as determined by the EMS System; 2

(7) altering, destroying, attempting to destroy, withholding or delaying release of evidence, records, or 3

documents needed for a complaint investigation; or 4

(8) is continuing to operate within an EMS System after a Board of County Commissioners has 5

terminated its affiliation with the licensee. 6

(e) The issuance of a provisional EMS Provider license is not a procedural prerequisite to the revocation or 7

suspension of a license pursuant to Paragraph (d) of this Rule. 8

9

History Note: Authority G.S. 131E-155.1(d); 143-508(d)(10); 10

Eff. April 1, 2011. 11

12

10A NCAC 13P .1504 SPECIALTY CARE TRANSPORT PROGRAMS 13

(a) The Department may deny the initial or renewal designation, without first allowing a focused review, of a SCTP 14

for any of the following reasons: 15

(1) failure to comply with the provisions of G.S.131E, Article 7 and the rules adopted under that 16

Article; 17

(2) obtaining or attempting to obtain designation through fraud or misrepresentation; 18

(3) endangerment to the health, safety, or welfare of patients cared for by the SCTP; or 19

(4) repetition of deficiencies placed on the trauma center in previous site visits. 20

(b) When an SCTP is required to have a focused review, it must demonstrate compliance with the provisions of 21

G.S. 131E, Article 7 and the rules adopted under that Article within one year or less. 22

(c) The OEMS may revoke an SCTP designation at any time or deny a request for renewal of designation whenever 23

the OEMS finds that the SCTP has failed to comply with the provisions of G.S.131E, Article 7 and the rules adopted 24

under that Article; and 25

(1) it is not probable that the SCTP can remedy the deficiencies within one year or less; 26

(2) although the SCTP may be able to remedy the deficiencies within a reasonable period of time, it is 27

not probable that the SCTP shall be able to remain in compliance with designation rules for the 28

foreseeable future; 29

(3) the SCTP fails to meet the requirements of a focused review; 30

(4) endangerment to the health, safety, or welfare of patients cared for or transported by the SCTP; 31

(5) fails to provide SCTP services within the defined service area in a timely manner as determined by 32

the OEMS; 33

(6) is continuing to operate within an EMS System after a Board of County Commissioners has 34

terminated its affiliation with the SCTP; or 35


8

(d) The OEMS shall give the SCTP written notice of revocation. This notice shall be given personally or by 1

certified mail and shall set forth: 2



(3) notice of the hospital's right to a contested case hearing on the amendment of the designation. 5

(e) Focused review is not a procedural prerequisite to the revocation of a designation pursuant to Paragraph (c) of 6

this Rule. 7

8

History Note: Authority 143-508(d)(10), (d)(13); 9

Eff. April 1, 2011. 10

11

10A NCAC 13P .1505 TRAUMA CENTERS 12

(a) The OEMS may deny the initial or renewal designation, without first allowing a focused review, of a trauma 13

center for any of the following reasons: 14

(1) failure to comply with G.S. 131E-162 and the rules adopted under that Statute; 15

(2) attempting to obtain a trauma center designation through fraud or misrepresentation; 16

(3) endangerment to the health, safety, or welfare of patients cared for in the hospital; or 17

(4) repetition of deficiencies placed on the trauma center in previous site visits. 18

(b) When a trauma center is required to have a focused review, it must demonstrate compliance with the provisions 19

of G.S.131E-162 and the rules adopted under that Statute within 12 months or less. 20

(c) The OEMS may revoke a trauma center designation at any time or deny a request for renewal of designation, 21

whenever the OEMS finds that the trauma center has failed to comply with the provisions of G.S. 131E-162 and the 22

rules adopted under that Statute; and 23

(1) it is not probable that the trauma center can remedy the deficiencies within 12 months or less; 24

(2) although the trauma center may be able to remedy the deficiencies within a reasonable period of 25

time, it is not probable that the trauma center shall be able to remain in compliance with 26

designation rules for the foreseeable future; 27

(3) the trauma center fails to meet the requirements of a focused review; 28

(4) failure to comply endangers the health, safety, or welfare of patients cared for in the trauma center; 29

or 30


(d) The OEMS shall give the trauma center written notice of revocation. This notice shall be given personally or by 32

certified mail and shall set forth: 33



(3) notice of the hospital's right to a contested case hearing on the amendment of the designation. 36

9


this Rule. 2

(f) With the OEMS' approval, a trauma center may voluntarily withdraw its designation for a maximum of one year 3

by submitting a written request. This request shall include the reasons for withdrawal and a plan for resolution of the 4

issues. To reactivate the designation, the facility shall provide to the OEMS written documentation of compliance. 5

Voluntary withdrawal shall not affect the original expiration date of the trauma center's designation. 6

(g) If the trauma center fails to resolve the issues which resulted in a voluntary withdrawal within the specified time 7

period for resolution, the OEMS may revoke the trauma center designation. 8

(h) In the event of a revocation or voluntary withdrawal, the OEMS shall provide written notification to all hospitals 9

and emergency medical services providers within the trauma center's defined trauma primary catchment area. The 10

OEMS shall provide written notification to all hospitals and emergency medical services providers within the trauma 11

center's defined trauma primary catchment area if, and when, the voluntary withdrawal reactivates to full 12

designation. 13

14

History Note: Authority G.S. 131E-162; 143-508(d)(10); 15

Eff. April 1, 2011. 16

17

10A NCAC 13P .1506 EMS EDUCATIONAL INSTITUTIONS 18

(a) The OEMS may deny the initial or renewal designation, without first allowing a focused review, of an EMS 19

Educational Institution for any of the following reasons: 20

(1) failure to comply with the provisions of Section .0600 of this Subchapter; 21

(2) attempting to obtain a EMS Educational Institution designation through fraud or 22

misrepresentation; 23

(3) endangerment to the health, safety, or welfare of patients cared by students of the EMS 24

Educational Institution; or 25

(4) repetition of deficiencies placed on the EMS Educational Institution in previous compliance site 26

visits. 27

(b) When a EMS Educational Institution is required to have a focused review, it must demonstrate compliance with 28

the provisions of Section .0600 of this Subchapter within 12 months or less. 29

(c) The OEMS may revoke a EMS Educational Institution designation at any time or deny a request for renewal of 30

designation, whenever the OEMS finds that the EMS Educational Institution has failed to comply with the 31

provisions of Section .0600 of this Subchapter; and: 32

(1) it is not probable that the EMS Educational Institution can remedy the deficiencies within 12 33

months or less; 34

(2) although the EMS Educational Institution may be able to remedy the deficiencies within a 35

reasonable period of time, it is not probable that the EMS Educational Institution shall be able to 36

remain in compliance with designation rules for the foreseeable future; 37

10

(3) the EMS Educational Institution fails to meet the requirements of a focused review; 1

(4) failure to comply endangers the health, safety, or welfare of patients cared for as part of an EMS 2

educational program; or 3


(d) The OEMS shall give the EMS Educational Institution written notice of revocation. This notice shall be given 5

personally or by certified mail and shall set forth: 6



(3) notice of the EMS Educational Institution 's right to a contested case hearing on the amendment of 9

the designation. 10


this Rule. 12

(f) With the OEMS' approval, an EMS Educational Institution may voluntarily withdraw its designation for a 13

maximum of one year by submitting a written request. This request shall include the reasons for withdrawal and a 14

plan for resolution of the issues. To reactivate the designation, the institution shall provide to the OEMS written 15

documentation of compliance. Voluntary withdrawal shall not affect the original expiration date of the EMS 16

Educational Institution's designation. 17

(g) If the institution fails to resolve the issues which resulted in a voluntary withdrawal within the specified time 18

period for resolution, the OEMS may revoke the EMS Educational Institution designation. 19

(h) In the event of a revocation or voluntary withdrawal, the OEMS shall provide written notification to all EMS 20

Systems within the EMS Educational Institution’s defined service area. The OEMS shall provide written notification 21

to all EMS Systems within the EMS Educational Institution's defined service area if, and when, the voluntary 22

withdrawal reactivates to full designation. 23

24

History Note: 143-508(d)(4), (d)(10); 25

Eff. April 1, 2011. 26

27

10A NCAC 13P .1507 EMS VEHICLE PERMITS 28

(a) In lieu of suspension or revocation, the Department may issue a temporary permit for an ambulance or EMS 29

nontransporting vehicle whenever the Department finds that: 30

(1) the EMS Provider to which that vehicle is assigned has failed to comply with the provisions of 31

G.S. 131E, Article 7, and the rules adopted under that Article; 32

(2) there is a reasonable probability that the EMS Provider can remedy the permit deficiencies within 33

a length of time determined by the Department; and 34

(3) there is a reasonable probability that the EMS Provider will be willing and able to remain in 35

compliance with the rules regarding vehicle permits for the foreseeable future. 36

11

(b) The Department shall give the EMS Provider written notice of the temporary permit. This notice shall be given 1

personally or by certified mail and shall set forth: 2

(1) the duration of the temporary permit not to exceed 60 days; 3

(2) a copy of the vehicle inspection form; 4


(4) notice of the EMS Provider's right to a contested case hearing on the temporary permit. 6

(c) The temporary permit is effective immediately upon its receipt by the EMS Provider and remains in effect until 7

the earlier of the expiration date of the permit or until the Department: 8

(1) restores the vehicle to full permitted status; or 9

(2) suspends or revokes the vehicle permit. 10

(d) The Department may deny, suspend, or revoke the permit of an ambulance or EMS nontransporting vehicle if 11

the EMS Provider: 12


Article; 14

(2) obtains or attempts to obtain a permit through fraud or misrepresentation; 15

(3) has a repetition of contingencies in previous compliance site visits; 16

(4) fails to provide emergency medical care within the defined EMS service area in a timely manner 17

as determined by the EMS System; 18

(5) continues to operate the ambulance or nontransporting vehicle in a county after written 19

notification by a Board of Commissioners to cease operations in that county; 20

(6) altering, destroying or attempting to destroy evidence needed for a complaint investigation; or 21

(7) does not possess a valid EMS Provider License. 22

23

History Note: Authority G.S. 131E-156(c),(d); 131E-157(c); 24

Eff. April 1, 2011. 25

26

10A NCAC 13P .1508 EMS PERSONNEL CREDENTIALS 27

(a) Persons convicted of a felony forfeit all EMS credentials pursuant to G.S. 15A-1331A. 28

(b) An EMS credential which has been forfeited under G.S.15A-1331A may not be reinstated until the person has 29

successfully complied with the court’s requirements, has petitioned the OEMS for reinstatement, has appeared 30

before the EMS Disciplinary Committee, and has had reinstatement approved. The EMS credential may initially be 31

reinstated with restrictions. 32

(c) The Department may amend, deny, suspend, or revoke the credentials of EMS personnel for any of the 33

following reasons: 34

(1) failure to comply with the applicable performance and credentialing requirements as found in this 35

Subchapter; 36

12

(2) making false statements or representations to the OEMS or willfully concealing information in 1

connection with an application for credentials; 2

(3) making false statements or representations, willfully concealing information, or failing to respond 3

within a reasonable period of time and in a reasonable manner to inquiries from the OEMS during 4

a complaint investigation; 5

(4) tampering with or falsifying any record used in the process of obtaining an initial EMS credential 6

or in the renewal of an EMS credential; 7

(5) in any manner or using any medium, engaging in the stealing, manipulating, copying, reproducing 8

or reconstructing of any written EMS credentialing examination questions or scenarios; 9

(6) cheating or assisting others to cheat while preparing to take or when taking a written EMS 10

credentialing examination; 11

(7) altering an EMS credential, using an EMS credential that has been altered or permitting or 12

allowing another person to use his or her EMS credential for the purpose of alteration. Altering 13

includes changing the name, expiration date or any other information appearing on the EMS 14

credential; 15

(8) unprofessional conduct, including a failure to comply with the rules relating to the proper function 16

of credentialed EMS personnel contained in this Subchapter or the performance of or attempt to 17

perform a procedure that is detrimental to the health and safety of any person or that is beyond the 18

scope of practice of credentialed EMS personnel or EMS instructors; 19

(9) being unable to perform as credentialed EMS personnel with reasonable skill and safety to patients 20

and the public by reason of illness, use of alcohol, drugs, chemicals, or any other type of material 21

or by reason of any physical or mental abnormality; 22

(10) conviction in any court of a crime involving moral turpitude, a conviction of a felony, or 23

conviction of a crime involving the scope of practice of credentialed EMS personnel; 24

(11) while under court ordered supervised probation; 25

(12) by false representations obtaining or attempting to obtain money or anything of value from a 26

patient; 27

(13) adjudication of mental incompetence; 28

(14) lack of competence to practice with a reasonable degree of skill and safety for patients including a 29

failure to perform a prescribed procedure, failure to perform a prescribed procedure competently 30

or performance of a procedure that is not within the scope of practice of credentialed EMS 31

personnel or EMS instructors; 32

(15) performing as an EMT-I, EMT-P, or EMD in any EMS System in which the individual is not 33

affiliated and authorized to function; 34

(16) testing positive for any substance, legal or illegal, that is likely to impair the physical or 35

psychological ability of the credentialed EMS personnel to perform all required or expected 36

functions while on duty; 37

13

(17) failure to comply with G.S. 143-518 regarding the use or disclosure of records or data associated 1

with EMS Systems, Specialty Care Transport Programs, or patients; 2

(18) refusing to consent to any criminal history check required by G.S. 131E-159; 3

(19) abandoning or neglecting a patient who is in need of care, without making reasonable 4

arrangements for the continuation of such care; 5

(20) harassing, abusing, or intimidating a patient either physically or verbally; 6

(21) falsifying a patient's record or any controlled substance records; 7

(22) engaging in any activities of a sexual nature with a patient including kissing, fondling or touching 8

while responsible for the care of that individual; 9

(23) any criminal arrests that involve charges which have been determined by the Department to 10

indicate a necessity to seek action in order to further protect the public pending adjudication by a 11

court; 12

(24) altering, destroying or attempting to destroy evidence needed for a complaint investigation; 13

(25) as a condition to the issuance of an encumbered EMS credential with limited and restricted 14

practices for persons in the chemical addiction or abuse treatment program; or 15

(26) representing or allowing others to represent that the credentialed EMS personnel has a credential 16

that the credentialed EMS personnel does not in fact have. 17

(d) When a person who is credentialed to practice as an EMS professional is also credentialed in another 18

jurisdiction and that other jurisdiction takes disciplinary action against the person, the Department may summarily 19

impose the same or lesser disciplinary action upon receipt of the other jurisdiction’s action. The EMS professional 20

may request a hearing before the EMS Disciplinary Committee. At the hearing the issues will be limited to: 21

(1) whether the person against whom action was taken by the other jurisdiction and the Department 22

are the same person; 23

(2) whether the conduct found by the other jurisdiction also violates the rules of the Medical Care 24

Commission; and 25

(3) whether the sanction imposed by the other jurisdiction is lawful under North Carolina law. 26

27

History Note: Authority G.S. 131E-159(f),(g); 143-508(d)(10); 28

Eff. April 1, 2011. 29

30

10A NCAC 13P. 1509 SUMMARY SUSPENSION 31

In accordance with G.S. 150B-3(c) an EMS Provider License, EMS Vehicle Permit, or EMS credential may be 32

summarily suspended if the public health, safety, or welfare requires emergency action. This determination is 33

delegated to the Chief of the OEMS. For EMS credentials, this determination shall be made following review by the 34

EMS Disciplinary Committee pursuant to G.S. 131E-159(f). Such a finding shall be incorporated with the order of 35

the Department and the order is effective on the date specified in the order or on service of the certified copy of the 36

order at the last known address of the affected party, whichever is later, and continues to be effective during the 37

14

proceedings. Failure to receive the order because of refusal of service or unknown address does not invalidate the 1

order. Proceedings shall be commenced in a timely manner. 2

3

History Note: Authority G.S. 131E-159(f); 150B-3(c); 4

Eff. April 1, 2011. 5

6

10A NCAC 13P .1510 PROCEDURES FOR DENIAL, SUSPENSION, AMENDMENT, OR 7

REVOCATION 8

Denial, suspension, amendment or revocation of credentials, licenses, permits, approvals, or designations shall 9

follow the law regarding contested cases found in G.S. 150B. 10

11

History Note: Authority G.S. 143-508(d)(10); 12

Eff. April 1, 2011. 13

14

1

RULES PROPOSED FOR REVISION 1

FOR REVIEW BY THE EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL 2

August 10, 2010 3

4

INJURY COMMITTEE 5

6

10A NCAC 13P .0901 LEVEL I TRAUMA CENTER APPLICATION CRITERIA 7

To receive designation as a Level I Trauma Center, a hospital shall have the following: have: 8

(1) A a trauma program and a trauma service that have been operational for at least 12 months prior to 9

application for designation; and 10

(2) for at least 12 months prior to submitting a Request for Proposal, Membership membership in and 11

inclusion of all trauma patient records in the North Carolina Trauma Registry for at least 12 12

months prior to submitting a Request for Proposal; Registry, in accordance with the North 13

Carolina Trauma Registry Data Dictionary, which is incorporated by reference, including 14

subsequent amendments and editions. This document is available online at 15

www.traumaregistry.ncdhhs.gov or by contacting the OEMS at 2707 Mail Service Center, 16

Raleigh, NC 27699-2707, at no cost. 17

(3) A trauma medical director who is a board-certified general surgeon. The trauma medical director 18

must: 19

(a) Have a minimum of three years clinical experience on a trauma service or trauma 20

fellowship training; 21

(b) Serve on the center's trauma service; 22

(c) Participate in providing care to patients with life-threatening or urgent injuries; 23

(d) Participate in the North Carolina Chapter of the ACS Committee on Trauma as well as 24

other regional and national trauma organizations; 25

(e) Remain a provider in the ACS' ATLS Course and in the provision of trauma-related 26

instruction to other health care personnel; and 27

(f) Be involved with trauma research and the publication of results and presentations; 28

(4) A full-time TNC/TPM who is a registered nurse, licensed by the North Carolina Board of Nursing; 29

(5) A full-time TR who has a working knowledge of medical terminology, is able to operate a 30

personal computer, and has the ability to extract data from the medical record; 31

(6) A hospital department/division/section for general surgery, neurological surgery, emergency 32

medicine, anesthesiology, and orthopaedic surgery, with designated chair or physician liaison to 33

the trauma program for each; 34

(7) Clinical capabilities in general surgery with separate posted call schedules. One shall be for 35

trauma, one for general surgery and one back-up call schedule for trauma. In those instances 36

where a physician may simultaneously be listed on more than one schedule, there must be a 37

2

defined back-up surgeon listed on the schedule to allow the trauma surgeon to provide care for the 1

trauma patient. If a trauma surgeon is simultaneously on call at more than one hospital, there shall 2

be a defined, posted trauma surgery back-up call schedule composed of surgeons credentialed to 3

serve on the trauma panel; 4

(8) A trauma team to provide evaluation and treatment of a trauma patient 24 hours per day that 5

includes: 6

(a) An in-house trauma attending or PGY4 or senior general surgical resident. The trauma 7

attending participates in therapeutic decisions and is present at all operative procedures. 8

(b) An emergency physician who is present in the Emergency Department 24 hours per day 9

who is either board-certified or prepared in emergency medicine (by the American Board 10

of Emergency Medicine or the American Osteopathic Board of Emergency Medicine). 11

Emergency physicians caring only for pediatric patients may, as an alternative, be 12

boarded or prepared in pediatric emergency medicine. Emergency physicians must be 13

board-certified within five years after successful completion of a residency in emergency 14

medicine and serve as a designated member of the trauma team to ensure immediate care 15

for the injured patient until the arrival of the trauma surgeon; 16

(c) Neurosurgery specialists who are never simultaneously on-call at another Level II or 17

higher trauma center, who are promptly available, if requested by the trauma team leader, 18

unless there is either an in-house attending neurosurgeon, a PGY2 or higher in-house 19

neurosurgery resident or an in-house trauma surgeon or emergency physician as long as 20

the institution can document management guidelines and annual continuing medical 21

education for neurosurgical emergencies. There must be a specified back-up on the call 22

schedule whenever the neurosurgeon is simultaneously on-call at a hospital other than the 23

trauma center; 24

(d) Orthopaedic surgery specialists who are never simultaneously on-call at another Level II 25

or higher trauma center, who are promptly available, if requested by the trauma team 26

leader, unless there is either an in-house attending orthopaedic surgeon, a PGY2 or higher 27

in-house orthopaedic surgery resident or an in-house trauma surgeon or emergency 28

physician as long as the institution can document management guidelines and annual 29

continuing medical education for orthopaedic emergencies. There must be a specified 30

written back-up on the call schedule whenever the orthopaedist is simultaneously on-call 31

at a hospital other than the trauma center; 32

(e) An in-house anesthesiologist or a CA3 resident as long as an anesthesiologist on-call is 33

advised and promptly available if requested by the trauma team leader; and 34

(f) Registered nursing personnel trained in the care of trauma patients; 35

3

(9) A written credentialing process established by the Department of Surgery to approve mid-level 1

practitioners and attending general surgeons covering the trauma service. The surgeons must have 2

board certification in general surgery within five years of completing residency; 3

(10) Neurosurgeons and orthopaedists serving the trauma service who are board certified or eligible. 4

Those who are eligible must be board certified within five years after successful completion of the 5

residency; 6

(11) Written protocols relating to trauma management formulated and updated to remain current; 7

(12) Criteria to ensure team activation prior to arrival, and trauma attending arrival within 15 minutes 8

of the arrival of trauma and burn patients that include the following conditions: 9

(a) Shock; 10

(b) Respiratory distress; 11

(c) Airway compromise; 12

(d) Unresponsiveness (GSC less than nine) with potential for multiple injuries; 13

(e) Gunshot wound to neck, chest or abdomen; 14

(f) Patients receiving blood to maintain vital signs; and 15

(g) ED physician's decision to activate; 16

(13) Surgical evaluation, based upon the following criteria, by the trauma attending surgeon who is 17

promptly available: 18

(a) Proximal amputations; 19

(b) Burns meeting institutional transfer criteria; 20

(c) Vascular compromise; 21

(d) Crush to chest or pelvis; 22

(e) Two or more proximal long bone fractures; and 23

(f) Spinal cord injury. 24

A PGY4 or higher surgical resident, a PGY3 or higher emergency medicine resident, a nurse 25

practitioner or physician's assistant, who is a member of the designated surgical response team, 26

may initiate the evaluation; 27

(14) Surgical consults for patients with traumatic injuries, at the request of the ED physician, will 28

conducted by a member of the trauma surgical team. Criteria for the consults include: 29

(a) Falls greater than 20 feet; 30

(b) Pedestrian struck by motor vehicle; 31

(c) Motor vehicle crash with: 32

(i) Ejection (includes motorcycle); 33

(ii) Rollover; 34

(iii) Speed greater than 40 mph; or 35

(iv) Death of another individual in the same vehicle; and 36

(d) Extremes of age, less than five or greater than 70 years. 37

4

A senior surgical resident may initiate the evaluation; 1

(15) Clinical capabilities (promptly available if requested by the trauma team leader, with a posted on-2

call schedule), that include individuals credentialed in the following: 3

(a) Cardiac surgery; 4

(b) Critical care; 5

(c) Hand surgery; 6

(d) Microvascular/replant surgery, or if service is not available, a transfer agreement must 7

exist; 8

(e) Neurosurgery (The neurosurgeon must be dedicated to one hospital or a back-up call 9

schedule must be available. If fewer than 25 emergency neurosurgical trauma operations 10

are done in a year, and the neurosurgeon is dedicated only to that hospital, then a 11

published back-up call list is not necessary); 12

(f) Obstetrics/gynecologic surgery; 13

(g) Opthalmic surgery; 14

(h) Oral maxillofacial surgery; 15

(i) Orthopaedics (dedicated to one hospital or a back-up call schedule must be available); 16

(j) Pediatric surgery; 17

(k) Plastic surgery; 18

(l) Radiology; 19

(m) Thoracic surgery; and 20

(n) Urologic surgery; 21

(16) An Emergency Department that has: 22

(a) A designated physician director who is board-certified or prepared in emergency 23

medicine (by the American Board of Emergency Medicine or the American Osteopathic 24

Board of Emergency Medicine); 25

(b) 24-hour-per-day staffing by physicians physically present in the ED such that: 26

(i) At least one physician on every shift in the ED is either board-certified or 27

prepared in emergency medicine (by the American Board of Emergency 28

Medicine or the American Osteopathic Board of Emergency Medicine) to serve 29

as the designated member of the trauma team to ensure immediate care until the 30

arrival of the trauma surgeon. Emergency physicians caring only for pediatric 31

patients may, as an alternative, be boarded in pediatric emergency medicine. All 32

emergency physicians must be board-certified within five years after successful 33

completion of the residency; 34

(ii) All remaining emergency physicians, if not board-certified or prepared in 35

emergency medicine as outlined in Subitem (16)(b)(i) of this Rule, are board-36

certified, or eligible by the American Board of Surgery, American Board of 37

5

Family Practice, or American Board of Internal Medicine, with each being 1

board-certified within five years after successful completion of a residency; and 2

(iii) All emergency physicians practice emergency medicine as their primary 3

specialty. 4

(c) Nursing personnel with experience in trauma care who continually monitor the trauma 5

patient from hospital arrival to disposition to an intensive care unit, operating room, or 6

patient care unit; 7

(d) Equipment for patients of all ages to include: 8

(i) Airway control and ventilation equipment (laryngoscopes, endotracheal tubes, 9

bag-mask resuscitators, pocket masks, and oxygen); 10

(ii) Pulse oximetry; 11

(iii) End-tidal carbon dioxide determination equipment; 12

(iv) Suction devices; 13

(v) Electrocardiograph-oscilloscope-defibrillator with internal paddles; 14

(vi) Apparatus to establish central venous pressure monitoring; 15

(vii) Intravenous fluids and administration devices that include large bore catheters 16

and intraosseous infusion devices; 17

(viii) Sterile surgical sets for airway control/cricothyrotomy, thoracotomy, vascular 18

access, thoracostomy, peritoneal lavage, and central line insertion; 19

(ix) Apparatus for gastric decompression; 20

(x) 24-hour-per-day x-ray capability; 21

(xi) Two-way communication equipment for communication with the emergency 22

transport system; 23

(xii) Skeletal traction devices, including capability for cervical traction; 24

(xiii) Arterial catheters; 25

(xiv) Thermal control equipment for patients; 26

(xv) Thermal control equipment for blood and fluids; 27

(xvi) A rapid infuser system; 28

(xvii) A dosing reference and measurement system to ensure appropriate age related 29

medical care; 30

(xviii) Sonography; and 31

(xix) A doppler; 32

(17) An operating suite that is immediately available 24 hours per day and has: 33

(a) 24-hour-per-day immediate availability of in-house staffing; 34

(b) Equipment for patients of all ages that includes: 35

(i) Cardiopulmonary bypass capability; 36

(ii) Thermal control equipment for patients; 37

6

(iii) Thermal control equipment for blood and fluids; 1

(iv) 24-hour-per-day x-ray capability including c-arm image intensifier; 2

(v) Endoscopes and bronchoscopes; 3

(vi) Craniotomy instruments; 4

(vii) The capability of fixation of long-bone and pelvic fractures; and 5

(viii) A rapid infuser system; 6

(18) A postanesthetic recovery room or surgical intensive care unit that has: 7

(a) 24-hour-per-day in-house staffing by registered nurses; 8


(i) The capability for resuscitation and continuous monitoring of temperature, 10

hemodynamics, and gas exchange; 11

(ii) The capability for continuous monitoring of intracranial pressure; 12

(iii) Pulse oximetry; 13

(iv) End-tidal carbon dioxide determination capability; 14

(v) Thermal control equipment for patients; and 15

(vi) Thermal control equipment for blood and fluids; 16

(19) An intensive care unit for trauma patients that has: 17

(a) A designated surgical director for trauma patients; 18

(b) A physician on duty in the intensive care unit 24 hours per day or immediately available 19

from within the hospital as long as this physician is not the sole physician on-call for the 20

Emergency Department; 21

(c) Ratio of one nurse per two patients on each shift; 22

(d) Equipment for patients of all ages that includes: 23


bag-mask resuscitators, and pocket masks); 25

(ii) An oxygen source with concentration controls; 26

(iii) A cardiac emergency cart; 27

(iv) A temporary transvenous pacemaker; 28

(v) Electrocardiograph-oscilloscope-defibrillator; 29

(vi) Cardiac output monitoring capability; 30

(vii) Electronic pressure monitoring capability; 31

(viii) A mechanical ventilator; 32

(ix) Patient weighing devices; 33

(x) Pulmonary function measuring devices; 34

(xi) Temperature control devices; and 35

(xii) Intracranial pressure monitoring devices. 36

7

(e) Within 30 minutes of request, the ability to perform blood gas measurements, hematocrit 1

level, and chest x-ray studies; 2

(20) Acute hemodialysis capability; 3

(21) Physician-directed burn center staffed by nursing personnel trained in burn care or a transfer 4

agreement with a burn center; 5

(22) Acute spinal cord management capability or transfer agreement with a hospital capable of caring 6

for a spinal cord injured patient; 7

(23) Radiological capabilities that include: 8

(a) 24-hour-per-day in-house radiology technologist; 9

(b) 24-hour-per-day in-house computerized tomography technologist; 10

(c) Sonography; 11

(d) Computed tomography; 12

(e) Angiography; 13

(f) Magnetic resonance imaging; and 14

(g) Resuscitation equipment that includes airway management and IV therapy; 15

(24) Respiratory therapy services available in-house 24 hours per day; 16

(25) 24-hour-per-day clinical laboratory service that must include: 17

(a) Analysis of blood, urine, and other body fluids, including micro-sampling when 18

appropriate; 19

(b) Blood-typing and cross-matching; 20

(c) Coagulation studies; 21

(d) Comprehensive blood bank or access to community central blood bank with storage 22

facilities; 23

(e) Blood gases and pH determination; and 24

(f) Microbiology; 25

(26) A rehabilitation service that provides: 26

(a) A staff trained in rehabilitation care of critically injured patients; 27

(b) Functional assessment and recommendations regarding short- and long-term 28

rehabilitation needs within one week of the patient's admission to the hospital or as soon 29

as hemodynamically stable; 30

(c) In-house rehabilitation service or a transfer agreement with a rehabilitation facility 31

accredited by the Commission on Accreditation of Rehabilitation Facilities; 32

(d) Physical, occupational, speech therapies, and social services; and 33

(e) Substance abuse evaluation and counseling capability; 34

(27) A performance improvement program, as outlined in the North Carolina Chapter of the American 35

College of Surgeons Committee on Trauma document "Performance Improvement Guidelines for 36

North Carolina Trauma Centers," incorporated by reference in accordance with G.S. 150B-21.6, 37

8

including subsequent amendments and editions. This document is available from the OEMS, 2707 1

Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. This performance 2

improvement program must include: 3

(a) The state Trauma Registry whose data is submitted to the OEMS at least weekly and 4

includes all the center's trauma patients as defined in Rule .0102(68) of this Subchapter 5

who are either diverted to an affiliated hospital, admitted to the trauma center for greater 6

than 24 hours from an ED or hospital, die in the ED, are DOA or are transferred from the 7

ED to the OR, ICU, or another hospital (including transfer to any affiliated hospital); 8

(b) Morbidity and mortality reviews including all trauma deaths; 9

(c) Trauma performance committee that meets at least quarterly and includes physicians, 10

nurses, pre-hospital personnel, and a variety of other healthcare providers, and reviews 11

policies, procedures, and system issues and whose members or designee attends at least 12

50 percent of the regular meetings; 13

(d) Multidisciplinary peer review committee that meets at least quarterly and includes 14

physicians from trauma, neurosurgery, orthopaedics, emergency medicine, 15

anesthesiology, and other specialty physicians, as needed, specific to the case, and the 16

trauma nurse coordinator/program manager and whose members or designee attends at 17

least 50 percent of the regular meetings; 18

(e) Identification of discretionary and non-discretionary audit filters; 19

(f) Documentation and review of times and reasons for trauma-related diversion of patients 20

from the scene or referring hospital; 21

(g) Documentation and review of response times for trauma surgeons, neurosurgeons, 22

anesthesiologists or airway managers, and orthopaedists. All must demonstrate 80 23

percent compliance. 24

(h) Monitoring of trauma team notification times; 25

(i) Review of pre-hospital trauma care that includes dead-on-arrivals; and 26

(j) Review of times and reasons for transfer of injured patients; 27

(28) An outreach program that includes: 28

(a) Transfer agreements to address the transfer and receipt of trauma patients; 29

(b) Programs for physicians within the community and within the referral area (that include 30

telephone and on-site consultations) about how to access the trauma center resources and 31

refer patients within the system; 32

(c) Development of a Regional Advisory Committee as specified in Rule .1102 of this 33

Subchapter; 34

(d) Development of regional criteria for coordination of trauma care; 35

(e) Assessment of trauma system operations at the regional level; and 36

(f) ATLS; 37

9

(29) A program of injury prevention and public education that includes: 1

(a) Epidemiology research that includes studies in injury control, collaboration with other 2

institutions on research, monitoring progress of prevention programs, and consultation 3

with researchers on evaluation measures; 4

(b) Surveillance methods that includes trauma registry data, special Emergency Department 5

and field collection projects; 6

(c) Designation of a injury prevention coordinator; and 7

(d) Outreach activities, program development, information resources, and collaboration with 8

existing national, regional, and state trauma programs. 9

(30) A trauma research program designed to produce new knowledge applicable to the care of injured 10

patients that includes: 11

(a) An identifiable institutional review board process; 12

(b) Educational presentations that must include 12 education/outreach presentations offered 13

outside the trauma center over a three-year period; and 14

(c) 10 peer-reviewed publications over a three-year period that could come from any aspect 15

of the trauma program; and 16

(31) A written continuing education program for staff physicians, nurses, allied health personnel, and 17

community physicians that includes: 18

(a) A general surgery residency program; 19

(b) 20 hours of Category I or II trauma-related continuing medical education (as approved by 20

the Accreditation Council for Continuing Medical Education) every two years for all 21

attending general surgeons on the trauma service, orthopedists, and neurosurgeons, with 22

at least 50 percent of this being external education including conferences and meetings 23

outside of the trauma center. Continuing education based on the reading of content such 24

as journals or other continuing medical education documents is not considered education 25

outside of the trauma center; 26

(c) 20 hours of Category I or II trauma-related continuing medical education (as approved by 27


emergency physicians, with at least 50 percent of this being external education including 29

conferences and meetings outside of the trauma center or visiting lecturers or speakers 30

from outside the trauma center. Continuing education based on the reading of content 31

such as journals or other continuing medical education documents is not considered 32

education outside of the trauma center; 33

(d) ATLS completion for general surgeons on the trauma service and emergency physicians. 34

Emergency physicians, if not boarded in emergency medicine, must be current in ATLS; 35

(e) 20 contact hours of trauma-related continuing education (beyond in-house in-services) 36

every two years for the TNC/TPM; 37

10

(f) 16 hours of trauma-registry-related or trauma-related continuing education every two 1

years, as deemed appropriate by the trauma nurse coordinator/program manager for the 2

trauma registrar; 3

(g) At least an 80 percent compliance rate for 16 hours of trauma-related continuing 4

education (as approved by the TNC/TPM)every two years related to trauma care for RN's 5

and LPN's in transport programs, Emergency Departments, primary intensive care units, 6

primary trauma floors, and other areas deemed appropriate by the TNC/TPM; and 7

(h) 16 hours of trauma-related continuing education every two years for mid-level 8

practitioners routinely caring for trauma patients. 9

10

History Note: Authority G.S. 131E-162; 11


Eff. April 1, 2003; 13

Amended Eff. April 1, 2011; January 1, 2009; January 1, 2004. 14

15

10A NCAC 13P .0902 LEVEL II TRAUMA CENTER CRITERIA LEVEL I TRAUMA CENTER 16

ADMINISTRATION 17

(a) A Level I Trauma Center shall designate a trauma medical director who is a board-certified general surgeon. 18

The trauma medical director must: 19

(1) have a minimum of three years clinical experience on a trauma service or trauma fellowship 20

training; 21

(2) serve on the center's trauma service; 22

(3) participate in providing care to patients with life-threatening or urgent injuries; 23

(4) participate in the North Carolina Chapter of the ACS Committee on Trauma as well as other 24

regional and national trauma organizations; 25

(5) remain a provider in the ACS' ATLS Course and in the provision of trauma-related instruction to 26

other health care personnel; and 27

(6) be involved with trauma research and the publication of results and presentations. 28

(b) A Level I Trauma Center shall designate a full-time TNC/TPM who is a registered nurse and licensed by the 29

North Carolina Board of Nursing. 30

(c) A Level I Trauma Center shall designate a full-time TR who has a working knowledge of medical terminology, 31

is able to operate a personal computer and has the ability to extract data from the medical record. 32

To receive designation as a Level II Trauma Center, a hospital shall have the following: 33

(1) A trauma program and a trauma service that have been operational for at least 12 months prior to 34

application for designation; 35

(2) Membership in and inclusion of all trauma patient records in the North Carolina Trauma Registry 36

for at least 12 months prior to submitting a Request for Proposal; 37

11


must: 2

(a) Have at least three years clinical experience on a trauma service or trauma fellowship 3

training; 4

(b) Serve on the center's trauma service; 5

(c) Participate in providing care to patients with life-threatening urgent injuries; 6

(d) Participate in the North Carolina Chapter of the ACS' Committee on Trauma as well as 7

other regional and national trauma organizations; and 8

(e) Remain a provider in the ACS' ATLS and in the provision of trauma-related instruction 9

to other health care personnel; 10

(4) A full-time trauma nurse coordinator TNC/TPM who is a registered nurse, licensed by the North 11

Carolina Board of Nursing; 12

(5) A full-time TR who has a working knowledge of medical terminology, is able to operate a 13

personal computer, and has the ability to extract data from the medical record; 14

(6) A hospital department/division/section for general surgery, neurological surgery, emergency 15

medicine, anesthesiology, and orthopedic surgery, with designated chair or physician liaison to the 16

trauma program for each; 17

(7) Clinical capabilities in general surgery with separate posted call schedules. One shall be for 18

trauma, one for general surgery and one back-up call schedule for trauma. In those instances 19

where a physician may simultaneously be listed on more than one schedule, there must be a 20

defined back-up surgeon listed on the schedule to allow the trauma surgeon to provide care for the 21

trauma patient. If a trauma surgeon is simultaneously on call at more than one hospital, there shall 22

be a defined, posted trauma surgery back-up call schedule composed of surgeons credentialed to 23

serve on the trauma panel; 24

(8) A trauma team to provide evaluation and treatment of a trauma patient 24 hours per day that 25

includes: 26

(a) A trauma attending or PGY4 or senior general surgical resident. The trauma attending 27

participates in therapeutic decisions and is present at all operative procedures. 28

(b) An emergency physician who is present in the Emergency Department 24 hours per day 29

who is either board-certified or prepared in emergency medicine (by the American Board 30

of Emergency Medicine or the American Osteopathic Board of Emergency Medicine) or 31

board-certified or eligible by the American Board of Surgery, American Board of Family 32

Practice, or American Board of Internal Medicine and practices emergency medicine as 33

his primary specialty. This emergency physician if prepared or eligible must be board-34

certified within five years after successful completion of the residency and serves as a 35

designated member of the trauma team to ensure immediate care for the injured patient 36

until the arrival of the trauma surgeon; 37

12

(c) Neurosurgery specialists who are never simultaneously on-call at another Level II or 1

higher trauma center, who are promptly available, if requested by the trauma team leader, 2

as long as there is either an in-house attending neurosurgeon; a PGY2 or higher in-house 3

neurosurgery resident; or in-house emergency physician or the on-call trauma surgeon as 4

long as the institution can document management guidelines and annual continuing 5

medical education for neurosurgical emergencies. There must be a specified back-up on 6

the call schedule whenever the neurosurgeon is simultaneously on-call at a hospital other 7

than the trauma center; 8

(d) Orthopaedic surgery specialists who are never simultaneously on-call at another Level II 9

or higher trauma center, who are promptly available, if requested by the trauma team 10

leader, as long as there is either an in-house attending orthopaedic surgeon; a PGY2 or 11

higher in-house orthopaedic surgery resident; or in-house emergency physician or the on-12

call trauma surgeon as long as the institution can document management guidelines and 13

annual continuing medical education for orthopaedic emergencies. There must be a 14

specified back-up on the call schedule whenever the orthopaedic surgeon is 15

simultaneously on-call at a hospital other than the trauma center; and 16

(e) An in-house anesthesiologist or a CA3 resident unless an anesthesiologist on-call is 17

advised and promptly available after notification or an in-house CRNA under physician 18

supervision, practicing in accordance with G.S. 90-171.20(7)e, pending the arrival of the 19

anesthesiologist; 20

(9) A credentialing process established by the Department of Surgery to approve mid-level 21



(10) Neurosurgeons and orthopaedists serving the trauma service who are board certified or eligible. 24

Those who are eligible must be board certified within five years after successful completion of the 25

residency; 26

(11) Written protocols relating to trauma care management formulated and updated to remain current; 27

(12) Criteria to ensure team activation prior to arrival, and attending arrival within 20 minutes of the 28

arrival of trauma and burn patients that include the following conditions: 29

(a) Shock; 30



(d) Unresponsiveness (GCS less than nine with potential for multiple injuries; 33

(e) Gunshot wound to neck, chest or abdomen; 34

(f) Patients receiving blood to maintain vital signs; and 35

(g) ED physician's decision to activate; 36

13

(13) Surgical evaluation, based upon the following criteria, by the health professional who is promptly 1

available: 2





(e) Two or more proximal long bone fractures; and 7

(f) Spinal cord injury; 8

(14) Surgical consults, based upon the following criteria, by the health professional who is promptly 9

available: 10





(ii) Rollover; 15


(iv) Death of another individual in the same vehicle; or 17

(d) Extremes of age, less than five or greater than 70 years; 18


call schedule), that include individuals credentialed in the following: 20

(a) Critical care; 21

(b) Hand surgery; 22

(c) Neurosurgery (The neurosurgeon must be dedicated to one hospital or a back-up call 23



published back-up call list is not necessary.); 26

(d) Obstetrics/gynecologic surgery; 27

(e) Opthalmic surgery; 28

(f) Oral maxillofacial surgery; 29

(g) Orthopaedics (dedicated to one hospital or a back-up call schedule must be available); 30

(h) Plastic surgery; 31

(i) Radiology; 32

(j) Thoracic surgery; and 33

(k) Urologic surgery; 34


14

(a) A physician director who is board-certified or prepared in emergency medicine (by the 1

American Board of Emergency Medicine or the American Osteopathic Board of 2

Emergency Medicine); 3

(b) 24-hour-per-day staffing by physicians physically present in the Emergency Department 4

who: 5

(i) Are either board-certified or prepared in emergency medicine (by the American 6

Board of Emergency Medicine or the American Osteopathic Board of 7

Emergency Medicine or board-certified or eligible by the American Board of 8

Surgery, American Board of Family Practice, or American Board of Internal 9

Medicine). These emergency physicians must be board-certified within five 10

years after successful completion of a residency; 11

(ii) Are hospital designated members of the trauma team; and 12

(iii) Practice emergency medicine as their primary specialty; 13










(v) An electrocardiograph-oscilloscope-defibrillator with internal paddles; 23

(vi) An apparatus to establish central venous pressure monitoring; 24





(ix) An apparatus for gastric decompression; 29




(xii) Skeletal traction devices, including capability for cervical traction; 33

(xiii) Arterial catheters; 34

(xiv) Thermal control equipment for patients; 35

(xv) Thermal control equipment for blood and fluids; 36

(xvi) A rapid infuser system; 37

15

(xvii) A dosing reference and measurement system to ensure appropriate age related 1

medical care; 2

(xviii) Sonography; and 3

(xix) A Doppler; 4

(17) An operating suite that is immediately available 24 hours per day and has: 5

(a) 24-hour-per-day immediate availability of in-house staffing; 6


(i) Thermal control equipment for patients; 8

(ii) Thermal control equipment for blood and fluids; 9

(iii) 24-hour-per-day x-ray capability, including c-arm image intensifier; 10

(iv) Endoscopes and bronchoscopes; 11

(v) Craniotomy instruments; 12

(vi) The capability of fixation of long-bone and pelvic fractures; and 13

(vii) A rapid infuser system; 14


(a) 24-hour-per-day in-house staffing by registered nurses; 16

(b) Equipment for patients of all ages to include: 17

(i) Capability for resuscitation and continuous monitoring of temperature, 18


(ii) Capability for continuous monitoring of intracranial pressure; 20

(iii) Pulse oximetry; 21

(iv) End-tidal carbon dioxide determination capability; 22

(v) Thermal control equipment for patients; and 23

(vi) Thermal control equipment for blood and fluids; 24


(a) A hospital designated surgical director of trauma patients; 26

(b) A physician on duty in the intensive care unit 24 hours per day or immediately available 27

from within the hospital as long as this physician is not the sole physician on-call for the 28

Emergency Department; 29

(c) Ratio of one nurse per two patients on each shift; 30



bag-mask resuscitators, and pocket masks); 33




(v) Electrocardiograph-oscilloscope-defibrillator; 37

16





(x) Pulmonary function measuring devices; 5


(xii) Intracranial pressure monitoring devices; and 7

(e) Within 30 minutes of request, the ability to perform blood gas measurements, hematocrit 8


(20) Acute hemodialysis capability or utilization of a transfer agreement; 10

(21) Physician-directed burn center staffed by nursing personnel trained in burn care or a transfer 11

agreement with a burn center; 12




(a) 24-hour-per-day in-house radiology technologist; 16

(b) 24-hour-per-day in-house computerized tomography technologist; 17

(c) Sonography; 18

(d) Computed tomography; 19

(e) Angiography; and 20

(f) Resuscitation equipment that includes airway management and IV therapy; 21

(24) Respiratory therapy services available in-house 24 hours per day; 22



appropriate; 25



(d) Comprehensive blood bank or access to a community central blood bank with storage 28

facilities; 29



(26) A rehabilitation service that provides: 32

(a) A staff trained in rehabilitation care of critically injured patients; 33

(b) For trauma patients, functional assessment and recommendation regarding short- and 34

long-term rehabilitation needs within one week of the patient's admission to the hospital 35

or as soon as hemodynamically stable; 36

17

(c) In-house rehabilitation service or a transfer agreement with a rehabilitation facility 1


(d) Physical, occupational, speech therapies, and social services; and 3

(e) Substance abuse evaluation and counseling capability; 4












(b) Morbidity and mortality reviews that include all trauma deaths; 16


nurses, pre-hospital personnel, and a variety of other healthcare providers, and reviews 18

policies, procedures, and system issues and whose members or designee attends at least 19

50 percent of the regular meetings; 20


physicians from trauma, neurosurgery, orthopaedics, emergency medicine, 22

anesthesiology, and other specialty physicians, as needed, specific to the case, and the 23

TNC/TPM and whose members or designee attends at least 50 percent of the regular 24

meetings; 25




(g) Documentation and review of response times for trauma surgeons, neurosurgeons, 29

anesthesiologists or airway managers, and orthopaedists. All must demonstrate 80 30

percent compliance; 31


(i) Review of pre-hospital trauma care to include dead-on-arrivals; and 33

(j) Review of times and reasons for transfer of injured patients; 34


(a) Transfer agreements to address the transfer and receipt of trauma patients; 36

18

(b) Programs for physicians within the community and within the referral area (that include 1



(c) Development of a Regional Advisory Committee as specified in Rule .1102 of this 4

Subchapter; 5

(d) Development of regional criteria for coordination of trauma care; and 6

(e) Assessment of trauma system operations at the regional level; 7

(29) A program of injury prevention and public education that includes: 8

(a) Designation of an injury prevention coordinator; and 9

(b) Outreach activities, program development, information resources, and collaboration with 10

existing national, regional, and state trauma programs; and 11



(a) 20 hours of Category I or II trauma-related continuing medical education (as approved by 14


attending general surgeons on the trauma service, orthopaedics, and neurosurgeons, with 16

at least 50 percent of this being external education including conferences and meetings 17

outside of the trauma center or visiting lecturers or speakers from outside the trauma 18

center. Continuing education based on the reading of content such as journals or other 19

continuing medical education documents is not considered education outside of the 20

trauma center; 21








(c) ATLS completion for general surgeons on the trauma service and emergency physicians. 29

Emergency physicians, if not boarded in emergency medicine, must be current in ATLS. 30

(d) 20 contact hours of trauma-related continuing education (beyond in-house in-services) 31


(e) 16 hours of trauma-registry-related or trauma-related continuing education every two 33

years, as deemed appropriate by the TNC/TPM, for the trauma registrar; 34

(f) at least 80 percent compliance rate for 16 hours of trauma-related continuing education 35

(as approved by the TNC/TPM)every two years related to trauma care for RN's and 36

LPN's in transport programs, Emergency Departments, primary intensive care units, 37

19

primary trauma floors, and other areas deemed appropriate by the trauma nurse 1

coordinator/program manager; and 2

(g) 16 contact hours of trauma-related continuing education every two years for mid-level 3


5



Eff. April 1, 2003; 8


10

10A NCAC 13P .0903 LEVEL III TRAUMA CENTER CRITERIA LEVEL I TRAUMA CENTER 11

PHYSICIAN AND TRAUMA TEAM SERVICES 12

(a) A Level I Trauma Center shall ensure there is a department/division/section for general surgery, neurological 13

surgery, emergency medicine, anesthesiology, and orthopaedic surgery, with a designated chair or physician liaison 14

to the trauma program for each. 15

(b) Clinical capabilities in general surgery must be posted with separate call schedules. One shall be for trauma, one 16

shall be for general surgery and one shall be a back-up call schedule for trauma. In those instances where a physician 17

may simultaneously be listed on more than one schedule, there must be a defined back-up surgeon listed on the 18

schedule to allow the trauma surgeon to provide care for the trauma patient. If a trauma surgeon is simultaneously 19

on call at more than one hospital, there shall be a defined, posted trauma surgery back-up call schedule composed of 20

surgeons credentialed to serve on the trauma panel. 21

(c) A Level I Trauma Center shall ensure the availability of a trauma team to provide evaluation and treatment of a 22

trauma patient 24 hours per day that includes: 23

(1) an in-house trauma attending or PGY4 or senior general surgical resident. The trauma attending 24

participates in therapeutic decisions and is present at all operative procedures; 25

(2) an emergency physician who is present in the Emergency Department 24 hours per day who is 26

either board-certified or prepared in emergency medicine (by the American Board of Emergency 27

Medicine or the American Osteopathic Board of Emergency Medicine). Emergency physicians 28

caring only for pediatric patients may, as an alternative, be boarded or prepared in pediatric 29

emergency medicine. Emergency physicians must be board-certified within five years after 30

successful completion of a residency in emergency medicine and serve as a designated member of 31

the trauma team to ensure immediate care for the injured patient until the arrival of the trauma 32

surgeon; 33

(3) neurosurgery specialists who are never simultaneously on-call at another Level II or higher trauma 34

center, who are promptly available, if requested by the trauma team leader, unless there is either 35

an in-house attending neurosurgeon, a PGY2 or higher in-house neurosurgery resident or an in-36

house trauma surgeon or emergency physician as long as the institution can document 37

20

management guidelines and annual continuing medical education for neurosurgical emergencies. 1

There must be a specified back-up on the call schedule whenever the neurosurgeon is 2

simultaneously on-call at a hospital other than the trauma center; 3

(4) orthopaedic surgery specialists who are never simultaneously on-call at another Level II or higher 4

trauma center, who are promptly available, if requested by the trauma team leader, unless there is 5

either an in-house attending orthopaedic surgeon, a PGY2 or higher in-house orthopaedic surgery 6

resident or an in-house trauma surgeon or emergency physician as long as the institution can 7

document management guidelines and annual continuing medical education for orthopaedic 8

emergencies. There must be a specified written back-up on the call schedule whenever the 9

orthopaedist is simultaneously on-call at a hospital other than the trauma center; 10

(5) an in-house anesthesiologist or a CA3 resident as long as an anesthesiologist on-call is advised and 11

promptly available if requested by the trauma team leader; and 12

(6) registered nursing personnel trained in the care of trauma patients. 13

(d) A written credentialing process shall be established by the Department of Surgery to approve mid-level 14

practitioners and attending general surgeons covering the trauma service. The surgeons must have board certification 15

in general surgery within five years of completing residency. 16

(e) Neurosurgeons and orthopaedists serving the trauma service must be board certified or eligible. Those who are 17

eligible must be board certified within five years after successful completion of the residency. 18

To receive designation as a Level III Trauma Center, a hospital shall have: 19

(1) A trauma program and a trauma service that have been operational for at least 12 months prior to 20


(2) Membership in and inclusion of all trauma patient records in the North Carolina Trauma Registry 22

for at least 12 months prior to submitting a Request for Proposal application; 23


must: 25

(a) Serve on the center's trauma service; 26

(b) Participate in providing care to patients with life-threatening or urgent injuries; 27

(c) Participate in the North Carolina Chapter of the ACS' Committee on Trauma; and 28

(d) Remain a provider in the ACS' ATLS Course in the provision of trauma-related 29

instruction to other health care personnel; 30

(4) A hospital designated trauma nurse coordinator TNC/TPM who is a registered nurse, licensed by 31

the North Carolina Board of Nursing; 32

(5) A TR who has a working knowledge of medical terminology, is able to operate a personal 33

computer, and has the ability to extract data from the medical record; 34

(6) A hospital department/division/section for general surgery, emergency medicine, anesthesiology, 35

and orthopaedic surgery, with designated chair or physician liaison to the trauma program for 36

each; 37

21

(7) Clinical capabilities in general surgery with a written posted call schedule that indicates who is on 1

call for both trauma and general surgery. If a trauma surgeon is simultaneously on call at more 2

than one hospital, there must be a defined, posted trauma surgery back-up call schedule composed 3

of surgeons credentialed to serve on the trauma panel. The trauma service director shall specify, in 4

writing, the specific credentials that each back-up surgeon must have. These must state that the 5

back-up surgeon has surgical privileges at the trauma center and is boarded or eligible in general 6

surgery (with board certification in general surgery within five years of completing residency); 7

(8) Response of a trauma team to provide evaluation and treatment of a trauma patient 24 hours per 8

day that includes: 9

(a) A trauma attending whose presence at the patient's bedside within 30 minutes of 10

notification is documented and who participates in therapeutic decisions and is present at 11

all operative procedures; 12

(b) An emergency physician who is present in the ED 24 hours per day who is either board-13

certified or prepared in emergency medicine (by the American Board of Emergency 14

Medicine or the American Osteopathic Board of Emergency Medicine) or board-certified 15

or eligible by the American Board of Surgery, American Board of Family Practice, or 16

American Board of Internal Medicine and practices emergency medicine as his primary 17

specialty. This emergency physician if prepared or eligible must be board-certified within 18

five years after successful completion of the residency and serve as a hospital designated 19

member of the trauma team to ensure immediate care for the trauma patient until the 20

arrival of the trauma surgeon; and 21

(c) An anesthesiologist who is on-call and promptly available after notification by the trauma 22

team leader or an in-house CRNA under physician supervision, practicing in accordance 23

with G.S. 90-171.20(7)e, pending the arrival of the anesthesiologist within 30 minutes of 24

notification; 25

(9) A credentialing process established by the Department of Surgery to approve mid-level 26



(10) Board certification or eligibility of orthopaedists and neurosurgeons (if participating),with board 29

certification within five years after successful completion of residency; 30

(11) Written protocols relating to trauma care management formulated and updated. Activation 31

guidelines shall reflect criteria that ensures patients receive timely and appropriate treatment 32

including stabilization, intervention and transfer. Documentation of effectiveness of variances 33

from activation criteria addressed in Items (12), (13), and (14) of this Rule must be available for 34

review; 35

(12) Criteria to ensure team activation prior to arrival of trauma and burn patients that include the 36

following conditions: 37

22

(a) Shock; 1



(d) Unresponsiveness (GSC less than nine) with evidence for multiple injuries; 4

(e) Gunshot wound to neck, or torso; or 5

(f) ED physician's decision to activate; 6

(13) Trauma Treatment Guidelines based on facility capabilities that ensure surgical evaluation or 7

appropriate transfer, based upon the following criteria, by the health professional who is promptly 8

available: 9





(e) Two or more proximal long bone fractures; 14

(f) Spinal cord injury; and 15

(g) Gunshot wound to the head; 16

(14) Surgical consults or appropriate transfers determined by Trauma Treatment Guidelines based on 17

facility capabilities, based upon the following criteria, by the health professional who is promptly 18

available: 19





(ii) Rollover; 24


(iv) Death of another individual in the same vehicle; and 26

(d) Extremes of age, less than five or greater than 70 years; 27


call schedule) that include individuals credentialed in the following: 29

(a) Orthopaedics; 30

(b) Radiology; and 31

(c) Neurosurgery, if actively participating in the acute resuscitation and operative 32

management of patients managed by the trauma team; 33


(a) A physician director who is board-certified or prepared in emergency medicine (by the 35

American Board of Emergency Medicine or the American Osteopathic Board of 36


23

(b) 24-hour-per-day staffing by physicians physically present in the Emergency Department 1

who: 2

(i) Are either board-certified or prepared in emergency medicine (by the American 3

Board of Emergency Medicine or the American Osteopathic Board of 4

Emergency Medicine) or board-certified or eligible by the American Board of 5

Surgery, American Board of Family Practice, or American Board of Internal 6

Medicine. These emergency physicians must be board-certified within five years 7

after successful completion of a residency; 8

(ii) Are designated members of the trauma team to ensure immediate care to the 9

trauma patient; and 10

(iii) Practice emergency medicine as their primary specialty; 11




(d) Resuscitation equipment for patients of all ages that includes: 15






(v) An Electrocardiograph-oscilloscope-defibrillator with internal paddles; 21

(vi) Apparatus to establish central venous pressure monitoring; 22





(ix) Apparatus for gastric decompression; 27




(xii) Skeletal traction devices; 31

(xiii) Thermal control equipment for patients; 32

(xiv) Thermal control equipment for blood and fluids; 33

(xv) A rapid infuser system; 34

(xvi) A dosing reference and measurement system to ensure appropriate age related 35

medical care; and 36

(xvii) A Doppler; 37

24

(17) An operating suite that has: 1

(a) Personnel available 24 hours a day, on-call, and available within 30 minutes of 2

notification unless in-house; 3

(b) Age-specific equipment that includes: 4

(i) Thermal control equipment for patients; 5

(ii) Thermal control equipment for blood and fluids; 6

(iii) 24-hour-per-day x-ray capability, including c-arm image intensifier; 7

(iv) Endoscopes and bronchoscopes; 8

(v) Equipment for long bone and pelvic fracture fixation; and 9

(vi) A rapid infuser system; 10


(a) 24-hour-per-day availability of registered nurses within 30 minutes from inside or outside 12

the hospital; 13


(i) The capability for resuscitation and continuous monitoring of temperature, 15



(iii) End-tidal carbon dioxide determination; 18

(iv) Thermal control equipment for patients; and 19

(v) Thermal control equipment for blood and fluids; 20


(a) A trauma surgeon who actively participates in the committee overseeing the ICU; 22

(b) A physician on duty in the intensive care unit 24-hours-per-day or immediately available 23

from within the hospital (which may be a physician who is the sole physician on-call for 24

the ED); 25

(c) Equipment for patients of all ages that includes: 26


bag-mask resuscitators and pocket masks); 28




(v) An electrocardiograph-oscilloscope-defibrillator; 32





(x) Pulmonary function measuring devices; and 37

25


(d) Within 30 minutes of request, the ability to perform blood gas measurements, hematocrit 2


(20) Acute hemodialysis capability or utilization of a written transfer agreement; 4

(21) Physician-directed burn center staffed by nursing personnel trained in burn care or a written 5

transfer agreement with a burn center; 6



(23) Acute head injury management capability or transfer agreement with a hospital capable of caring 9

for a head injury; 10


(a) Radiology technologist and computer tomography technologist available within 30 12

minutes of notification or documentation that procedures are available within 30 minutes; 13

(b) Computed Tomography; 14

(c) Sonography; and 15

(d) Resuscitation equipment that includes airway management and IV therapy; 16

(25) Respiratory therapy services on-call 24 hours per day; 17



appropriate; 20



(d) Comprehensive blood bank or access to a community central blood bank with storage 23

facilities; 24



(27) In-house rehabilitation service or transfer agreement with a rehabilitation facility accredited by the 27

Commission on Accreditation of Rehabilitation Facilities; 28

(28) Physical therapy and social services; 29









26




(b) Morbidity and mortality reviews including all trauma deaths; 4


orthopaedics and neurosurgery if participating in trauma service, nurses, pre-hospital 6

personnel, and a variety of other healthcare providers, and reviews policies, procedures, 7

and system issues and whose members or designee attends at least 50 percent of the 8

regular meetings; 9


physicians from trauma, emergency medicine, and other specialty physicians as needed 11

specific to the case, and the trauma nurse coordinator/program manager and whose 12

members or designee attends at least 50 percent of the regular meetings; 13




(g) Documentation and review of response times for trauma surgeons, airway managers, and 17

orthopaedists. All must demonstrate 80 percent compliance; 18


(i) Documentation (unless in-house) and review of Emergency Department response times 20

for anesthesiologists or airway managers and computerized tomography technologist; 21

(j) Documentation of availability of the surgeon on-call for trauma, such that compliance is 22

90 percent or greater where there is no trauma surgeon back-up call schedule; 23

(k) Trauma performance and multidisciplinary peer review committees may be incorporated 24

together or included in other staff meetings as appropriate for the facility performance 25

improvement rules; 26

(l) Review of pre-hospital trauma care including dead-on-arrivals; and 27

(m) Review of times and reasons for transfer of injured patients; 28


(a) Transfer agreements to address the transfer and receipt of trauma patients; and 30

(b) Participation in a RAC; 31

(31) Coordination or participation in community prevention activities; and 32



(a) 20 hours of Category I or II trauma-related continuing medical education (as approved by 35


attending general surgeons on the trauma service, orthopaedists, and neurosurgeons if 37

27

participating in trauma service, with at least 50 percent of this being external education 1

including conferences and meetings outside of the trauma center or visiting lecturers or 2

speakers from outside the trauma center. Continuing education based on the reading of 3

content such as journals or other continuing medical education documents is not 4

considered education outside of the trauma center; 5


the Accreditation Council for Continuing Medical Education)every two years for all 7






(c) ATLS completion for general surgeons on the trauma service and emergency physicians. 13

Emergency physicians, if not boarded in emergency medicine, must be current in ATLS; 14

(d) 20 contact hours of trauma-related continuing education (beyond in-house in- services) 15


(e) 16 hours of trauma-registry-related or trauma-related continuing education every two 17

years, as deemed appropriate by the TNC/TPM, for the trauma registrar; 18

(f) At least an 80 percent compliance rate for 16 hours of trauma-related continuing 19

education (as approved by the trauma nurse coordinator/program manager) every two 20

years related to trauma care for RN's and LPN's in transport programs, Emergency 21

Departments, primary intensive care units, primary trauma floors, and other areas deemed 22

appropriate by the trauma nurse coordinator/program manager; and 23

(g) 16 hours of trauma-related continuing education every two years for mid-level 24


26



Eff. April 1, 2003; 29


31

10A NCAC 13P .0904 INITIAL DESIGNATION LEVEL I TRAUMA CENTER TRAUMA TEAM 32

ACTIVATION 33

To ensure activation of the trauma team for a Level I Trauma Center, the trauma center shall: 34

(1) have written protocols relating to trauma management formulated and updated to remain current; 35

(2) have criteria established to ensure team activation prior to arrival, and trauma attending arrival 36

within 15 minutes of the arrival of trauma and burn patients that include the following conditions: 37

28

(a) shock; 1

(b) respiratory distress; 2

(c) airway compromise; 3

(d) unresponsiveness (GSC less than nine) with potential for multiple injuries; 4

(e) gunshot wound to neck, chest or abdomen; 5

(f) patients receiving blood to maintain vital signs; and 6

(g) ED physician's decision to activate. 7

(3) ensure performance of a surgical evaluation, based upon the following criteria, by the trauma 8

attending surgeon who is promptly available for the following conditions: 9

(a) proximal amputations; 10

(b) burns meeting institutional transfer criteria; 11

(c) vascular compromise; 12

(d) crush to chest or pelvis; 13

(e) two or more proximal long bone fractures; and 14

(f) spinal cord injury. 15

A PGY4 or higher surgical resident, a PGY3 or higher emergency medicine resident, a nurse 16

practitioner or physician's assistant, who is a member of the designated surgical response team, 17

may initiate the evaluation. 18

(4) ensure surgical consults for patients with traumatic injuries, at the request of the ED physician, be 19

conducted by a member of the trauma surgical team. Criteria for the consults include: 20

(a) falls greater than 20 feet; 21

(b) pedestrian struck by motor vehicle; 22

(c) motor vehicle crash with: 23

(i) ejection (includes motorcycle); 24

(ii) rollover; 25

(iii) speed greater than 40 mph; or 26

(iv) death of another individual in the same vehicle; and 27

(d) extremes of age, less than five or greater than 70 years. 28

A senior surgical resident may initiate the evaluation; and 29

(5) ensure clinical capabilities are available, (promptly available if requested by the trauma team 30

leader, with a posted on-call schedule), that include individuals credentialed in the following: 31

(a) cardiac surgery; 32

(b) critical care; 33

(c) hand surgery; 34

(d) microvascular/replant surgery, or if service is not available, a transfer agreement must 35

exist; 36

29

(e) neurosurgery (The neurosurgeon must be dedicated to one hospital or a back-up call 1



published back-up call list is not necessary); 4

(f) obstetrics/gynecologic surgery; 5

(g) opthalmic surgery; 6

(h) oral maxillofacial surgery; 7

(i) orthopaedics (dedicated to one hospital or a back-up call schedule must be available); 8

(j) pediatric surgery; 9

(k) plastic surgery; 10

(l) radiology; 11

(m) thoracic surgery; and 12

(n) urologic surgery. 13

(a) For initial Trauma Center designation, the hospital shall request a consult visit by OEMS and have the consult 14

within one year prior to submission of the RFP. 15

(b) A hospital interested in pursuing Trauma Center designation shall submit a letter of intent 180 days prior to the 16

submission of an RFP to the OEMS. The letter shall define the hospital's primary trauma catchment area. 17

Simultaneously, Level I or II applicants shall also demonstrate the need for the Trauma Center designation by 18

submitting one original and three copies of documents that include: 19

(1) The population to be served and the extent to which the population is underserved for trauma care 20

with the methodology used to reach this conclusion; 21

(2) Geographic considerations to include trauma primary and secondary catchment area and distance 22

from other Trauma Centers; and 23

(3) Evidence the Trauma Center will admit at least 1200 trauma patients yearly or show that its 24

trauma service will be taking care of at least 240 trauma patients with an Injury Severity Score 25

(ISS) greater than or equal to 15 yearly. This criteria shall be met without compromising the 26

quality of care or cost effectiveness of any other designated Level I or II Trauma Center sharing 27

all or part of its catchment area or by jeopardizing the existing Trauma Center's ability to meet this 28

same 240-patient minimum. 29

(c) The hospital must be actively participating in the state Trauma Registry and submit data to the OEMS at least 30

weekly and include all the Trauma Center's trauma patients as defined in Rule .0102(68) of this Subchapter who are 31

either diverted to an affiliated hospital, admitted to the Trauma Center for greater than 24 hours from an ED or 32

hospital, die in the ED, are DOA or are transferred from the ED to the OR, ICU, or another hospital (including 33

transfer to any affiliated hospital) a minimum of 12 months prior to application. 34

(d) OEMS shall review the regional Trauma Registry data, from both the applicant and the existing trauma 35

center(s), and ascertain the applicant's ability to satisfy the justification of need information required in 36

Subparagraphs (b)(1) through (3) of this Rule. Simultaneously, the applicant's primary RAC shall be notified by the 37

30

OEMS of the application and be provided the regional data as required in Subparagraphs (b)(1) through (3) of this 1

Rule submitted by the applicant for review and comment. The RAC shall be given a minimum of 30 days to submit 2

any concerns in writing for OEMS' consideration. If no comments are received, OEMS shall proceed. 3

(e) OEMS shall notify the hospital in writing of its decision to allow submission of an RFP. The RAC shall also be 4

notified by the OEMS so that any necessary changes in protocols can be considered. 5

(f) OEMS shall notify the respective Board of County Commissioners in the applicant's trauma primary catchment 6

area of the request for initial designation to allow for comment. 7

(g) Hospitals desiring to be considered for initial trauma center designation shall complete and submit one paper 8

copy with signatures and an electronic copy of the RFP to the OEMS at least 90 days prior to the proposed site visit 9

date. 10

(h) For Level I, II, and III applicants, the RFP shall demonstrate that the hospital meets the standards for the 11

designation level applied for as found in Rules .0901, .0902, or .0903 of this Section. 12

(i) If OEMS does not recommend a site visit based upon failure to comply with Rules .0901, .0902, or .0903, the 13

reasons shall be forwarded to the hospital in writing within 30 days of the decision. The hospital may reapply for 14

designation within six months following the submission of an updated RFP. If the hospital fails to respond within 15

six months, the hospital shall reapply following the process outlined in Paragraphs (a) through (h) of this Rule. 16

(j) If the OEMS recommends the hospital for a site visit, the OEMS shall notify the hospital within 30 days and the 17

site visit shall be conducted within six months of the recommendation. The site visit date shall be mutually agreeable 18

to the hospital and the OEMS. 19

(k) Any in-state reviewer for a Level I or II visit (except the OEMS representatives) shall be from outside the 20

planning region in which the hospital is located. The composition of a Level I or II state site survey team shall be as 21

follows: 22

(1) One out-of-state Fellow of the ACS, experienced as a site surveyor, who shall be designated the 23

primary reviewer; 24

(2) One emergency physician who works in a trauma center, is a member of the American College of 25

Emergency Physicians, and is boarded in emergency medicine (by the American Board of 26

Emergency Medicine or the American Osteopathic Board of Emergency Medicine); 27

(3) One in-state trauma surgeon who is a member of the North Carolina Committee on Trauma; 28

(4) One out-of-state trauma nurse coordinator/program manager and one in-state trauma nurse 29

coordinator/program manager; and 30

(5) OEMS Staff. 31

(l) All site team members for a Level III visit shall be from in-state, and all (except for the OEMS representatives) 32

shall be from outside the planning region in which the hospital is located. The composition of a Level III state site 33

survey team shall be as follows: 34

(1) One Fellow of the ACS, who is a member of the North Carolina Committee on Trauma and shall 35

be designated the primary reviewer; 36

31

(2) One emergency physician who currently works in a designated trauma center, is a member of the 1

North Carolina College of Emergency Physicians, and is boarded in emergency medicine (by the 2

American Board of Emergency Medicine or the American Osteopathic Board of Emergency 3

Medicine); 4

(3) A trauma nurse coordinator/program manager; and 5

(4) OEMS Staff. 6

(m) On the day of the site visit the hospital shall make available all requested patient medical charts. 7

(n) The lead researcher of the site review team shall give a verbal post-conference report representing a consensus 8

of the site review team at the summary conference. A written consensus report shall be completed, to include a peer 9

review report, by the primary reviewer and submitted to OEMS within 30 days of the site visit. 10

(o) The report of the site survey team and the staff recommendations shall be reviewed by the State Emergency 11

Medical Services Advisory Council at its next regularly scheduled meeting which is more than 45 days following 12

the site visit. Based upon the site visit report and the staff recommendation, the State Emergency Medical Services 13

Advisory Council shall recommend to the OEMS that the request for Trauma Center designation be approved or 14

denied. 15

(p) All criteria defined in Rule .0901, .0902, or .0903 of this Section shall be met for initial designation at the level 16

requested. Initial designation shall not be granted if deficiencies exist. 17

(q) Hospitals with a deficiency(ies) shall be given up to 12 months to demonstrate compliance. Satisfaction of 18

deficiency(ies) may require an additional site visit. If compliance is not demonstrated within the time period, to be 19

defined by OEMS, the hospital shall submit a new application and updated RFP and follow the process outlined in 20

Paragraphs (a) through (h) of this Rule. 21

(r) The final decision regarding Trauma Center designation shall be rendered by the OEMS. 22

(s) The OEMS shall notify the hospital in writing, of the State Emergency Medical Services Advisory Council's and 23

OEMS' final recommendation within 30 days of the Advisory Council meeting. 24

(t) If a trauma center changes its trauma program administrative structure (such that the trauma service, trauma 25

medical director, trauma nurse coordinator/program manager or trauma registrar are relocated on the hospital's 26

organizational chart) at any time, it shall notify OEMS of this change in writing within 30 days of the occurrence. 27

(u) Initial designation as a trauma center is valid for a period of three years. 28

29

History Note: Authority G.S. 131E-162; 143-509(3); 30


Eff. April 1, 2003; 32


34

10A NCAC 13P .0905 RENEWAL DESIGNATION PROCESS LEVEL I TRAUMA CENTER 35

EMERGENCY DEPARTMENT CRITERIA 36

The emergency department of a Level I Trauma Center shall: 37

32

(1) have a designated physician director who is board-certified or prepared in emergency medicine 1

(by the American Board of Emergency Medicine or the American Osteopathic Board of 2


(2) ensure 24-hour-per-day staffing by physicians physically present in the ED such that: 4

(a) at least one physician on every shift in the ED is either board-certified or prepared in 5

emergency medicine (by the American Board of Emergency Medicine or the American 6

Osteopathic Board of Emergency Medicine) to serve as the designated member of the 7

trauma team to ensure immediate care until the arrival of the trauma surgeon. Emergency 8

physicians caring only for pediatric patients may, as an alternative, be boarded in 9

pediatric emergency medicine. All emergency physicians must be board-certified within 10

five years after successful completion of the residency; 11

(b) all remaining emergency physicians, if not board-certified or prepared in emergency 12

medicine as outlined in Subitem (2)(a) of this Rule, are board-certified, or eligible by the 13

American Board of Surgery, American Board of Family Practice, or American Board of 14

Internal Medicine, with each being board-certified within five years after successful 15

completion of a residency; and 16

(c) all emergency physicians practice emergency medicine as their primary specialty. 17

(3) have nursing personnel with experience in trauma care who continually monitor the trauma patient 18

from hospital arrival to disposition to an intensive care unit, operating room, or patient care unit; 19

and 20

(4) have equipment for patients of all ages to include: 21

(a) airway control and ventilation equipment (laryngoscopes, endotracheal tubes, bag-mask 22

resuscitators, pocket masks, and oxygen); 23

(b) pulse oximetry; 24

(c) end-tidal carbon dioxide determination equipment; 25

(d) suction devices; 26

(e) electrocardiograph-oscilloscope-defibrillator with internal paddles; 27

(f) apparatus to establish central venous pressure monitoring; 28

(g) intravenous fluids and administration devices that include large bore catheters and 29

intraosseous infusion devices; 30

(h) sterile surgical sets for airway control/cricothyrotomy, thoracotomy, vascular access, 31

thoracostomy, peritoneal lavage, and central line insertion; 32

(i) apparatus for gastric decompression; 33

(j) 24-hour-per-day x-ray capability; 34

(k) two-way communication equipment for communication with the emergency transport 35

system; 36

(l) skeletal traction devices, including capability for cervical traction; 37

33

(m) arterial catheters; 1

(n) thermal control equipment for patients; 2

(o) thermal control equipment for blood and fluids; 3

(p) a rapid infuser system; 4

(q) a dosing reference and measurement system to ensure appropriate age related medical 5

care; 6

(r) sonography; and 7

(s) a doppler. 8

(a) Hospitals may utilize one of two options to achieve Trauma Center renewal: 9

(1) Undergo a site visit conducted by OEMS to obtain a four-year renewal designation; or 10

(2) Undergo a verification visit arranged by the ACS, in conjunction with OEMS, to obtain a four-11

year renewal designation. 12

(b) For hospitals choosing Subparagraph (a)(1) of this Rule: 13

(1) Prior to the end of the designation period, the OEMS shall forward to the hospital an RFP for 14

completion. The hospital shall, within 10 days of receipt of the RFP, define for OEMS the 15

Trauma Center's trauma primary catchment area. Upon this notification, OEMS shall notify the 16

respective Board of County Commissioners in the applicant's trauma primary catchment area of 17

the request for renewal to allow for comment. 18

(2) Hospitals shall complete and submit one paper copy and an electronic copy of the RFP to the 19

OEMS and the specified site surveyors at least 30 days prior to the site visit. The RFP shall 20

include information that supports compliance with the criteria contained in Rule .0901, .0902, or 21

.0903 of this Section as it relates to the Trauma Center's level of designation. 22

(3) All criteria defined in Rule .0901, .0902, or .0903 of this Section, as relates to the Trauma Center's 23

level of designation, shall be met for renewal designation. 24

(4) A site visit shall be conducted within 120 days prior to the end of the designation period. The site 25

visit shall be scheduled on a date mutually agreeable to the hospital and the OEMS. 26

(5) The composition of a Level I or II site survey team shall be the same as that specified in Rule 27

.0904(k) of this Section. 28

(6) The composition of a Level III site survey team shall be the same as that specified in Rule .0904(l) 29

of this Section. 30

(7) On the day of the site visit the hospital shall make available all requested patient medical charts. 31

(8) The primary reviewer of the site review team shall give a verbal post-conference report 32

representing a consensus of the site review team at the summary conference. A written consensus 33

report shall be completed, to include a peer review report, by the primary reviewer and submitted 34

to OEMS within 30 days of the site visit. 35

(9) The report of the site survey team and a staff recommendation shall be reviewed by the State 36

Emergency Medical Services Advisory Council at its next regularly scheduled meeting which is 37

34

more than 30 days following the site visit. Based upon the site visit report and the staff 1

recommendation, the State Emergency Medical Services Advisory Council shall recommend to 2

the OEMS that the request for Trauma Center renewal be approved; approved with a 3

contingency(ies) due to a deficiency(ies) requiring a focused review; approved with a 4

contingency(ies) not due to a deficiency(ies) requiring a consultative visit; or denied. 5

(10) Hospitals with a deficiency(ies) have up to 10 working days prior to the State EMS Advisory 6

Council meeting to provide documentation to demonstrate compliance. If the hospital has a 7

deficiency that cannot be corrected in this period prior to the State EMS Advisory Council 8

meeting, the hospital, instead of a four-year renewal, shall be given 12 months by the OEMS to 9

demonstrate compliance and undergo a focused review, that may require an additional site visit. 10

The hospital shall retain its Trauma Center designation during the focused review period. If 11

compliance is demonstrated within the prescribed time period, the hospital shall be granted its 12

designation for the four-year period from the previous designation's expiration date. If compliance 13

is not demonstrated within the time period, as specified by OEMS, the Trauma Center designation 14

shall not be renewed. To become redesignated, the hospital shall submit an updated RFP and 15

follow the initial applicant process outlined in Rule .0904 of this Section. 16

(11) The final decision regarding trauma center renewal shall be rendered by the OEMS. 17

(12) The OEMS shall notify the hospital of the State Emergency Medical Services Advisory Council's 18

and OEMS' final recommendation within 30 days of the Advisory Council meeting. 19

(13) The four-year renewal date that may be eventually granted shall not be extended due to the 20

focused review period. 21

(c) For hospitals choosing Subparagraph (a)(2) of this Rule: 22

(1) At least six months prior to the end of the Trauma Center's designation period, the trauma center 23

must notify the OEMS of its intent to undergo an ACS verification visit. It must simultaneously 24

define in writing to the OEMS its trauma primary catchment area. Trauma Centers choosing this 25

option must then comply with all the ACS' verification procedures, as well as any additional state 26

criteria as outlined in Rule .0901, .0902, or .0903, as apply to their level of designation. 27

(2) When completing the ACS' documentation for verification, the Trauma Center must ensure access 28

to the ACS on-line PRQ (pre-review questionnaire) to OEMS. The Trauma Center must 29

simultaneously complete documents supplied by OEMS to verify compliance with additional 30

North Carolina criteria (i.e., criteria that exceed the ACS criteria) and forward these to OEMS and 31

the ACS. 32

(3) The OEMS shall notify the Board of County Commissioners within the trauma center's trauma 33

primary catchment area of the Trauma Center's request for renewal to allow for comments. 34

(4) The Trauma Center must make sure the site visit is scheduled to ensure that the ACS' final written 35

report, accompanying medical record reviews and cover letter are received by OEMS at least 30 36

days prior to a regularly scheduled State Emergency Medical Services Advisory Council meeting 37

35

to ensure that the Trauma Center's state designation period does not terminate without 1

consideration by the State Emergency Medical Services Advisory Council. 2

(5) The composition of the Level I or Level II site team must be as specified in Rule .0904(k) of this 3

Section, except that both the required trauma surgeons and the emergency physician may be from 4

out-of-state. Neither North Carolina Committee on Trauma nor North Carolina College of 5

Emergency Physician membership is required of the surgeons or emergency physician, 6

respectively, if from out-of-state. The date, time, and all proposed site team members of the site 7

visit team must be submitted to the OEMS for review at least 45 days prior to the site visit. The 8

OEMS shall approve the site visit schedule if the schedule does not conflict with the ability of 9

attendance by required OEMS staff. The OEMS shall approve the proposed site team members if 10

the OEMS determines there is no conflict of interest, such as previous employment, by any site 11

team member associated with the site visit. 12

(6) The composition of the Level III site team must be as specified in Rule .0904(l) of this Section, 13

except that the trauma surgeon, emergency physician, and trauma nurse coordinator/program 14

manager may be from out-of-state. Neither North Carolina Committee on Trauma nor North 15

Carolina College of Emergency Physician membership is required of the surgeon or emergency 16

physician, respectively, if from out-of-state. The date, time, and all proposed site team members 17

of the site visit team must be submitted to the OEMS for review at least 45 days prior to the site 18

visit. The OEMS shall approve the site visit schedule if the schedule does not conflict with the 19

ability of attendance by required OEMS staff. The OEMS shall approve the proposed site team 20

members if the OEMS determines there is no conflict of interest, such as previous employment, by 21

any site team member associated with the site visit. 22

(7) All state Trauma Center criteria must be met as defined in Rules .0901, .0902, and .0903 of this 23

Section, for renewal of state designation. An ACS' verification is not required for state 24

designation. An ACS' verification does not ensure a state designation. 25

(8) ACS reviewers shall complete the state designation preliminary reporting form immediately prior 26

to the post conference meeting. This document and the ACS final written report and supporting 27

documentation described in Subparagraph (c)(4) of this Rule shall be used to generate a staff 28

summary of findings report following the post conference meeting for presentation to the NC 29

EMS Advisory Council for redesignation. 30

(9) The final written report issued by the ACS' verification review committee, the accompanying 31

medical record reviews (from which all identifiers may be removed), and cover letter must be 32

forwarded to OEMS within 10 working days of its receipt by the Trauma Center seeking renewal. 33

(10) The OEMS shall present its summary of findings report to the State Emergency Medical Services 34

Advisory Council at its next regularly scheduled meeting. The State EMS Advisory Council shall 35

recommend to the Chief of the OEMS that the request for Trauma Center renewal be approved; 36

36

approved with a contingency(ies) due to a deficiency(ies) requiring a focused review; approved 1

with a contingency(ies) not due to a deficiency(ies); or denied. 2

(11) The OEMS shall notify the hospital in writing of the State Emergency Medical Services Advisory 3

Council's and OEMS' final recommendation within 30 days of the Advisory Council meeting. 4

(12) Hospitals with contingencies, as the result of a deficiency(ies), as determined by OEMS, have up 5

to 10 working days prior to the State EMS Advisory Council meeting to provide documentation to 6

demonstrate compliance. If the hospital has a deficiency that cannot be corrected in this time 7

period prior to the State EMS Advisory Council meeting, the hospital, instead of a four-year 8

renewal, may undergo a focused review (to be conducted by the OEMS) whereby the Trauma 9

Center is given 12 months by the OEMS to demonstrate compliance. Satisfaction of 10

contingency(ies) may require an additional site visit. The hospital shall retain its Trauma Center 11

designation during the focused review period. If compliance is demonstrated within the prescribed 12

time period, the hospital shall be granted its designation for the four-year period from the previous 13

designation's expiration date. If compliance is not demonstrated within the time period, as 14

specified by OEMS, the Trauma Center designation shall not be renewed. To become 15

redesignated, the hospital shall submit a new RFP and follow the initial applicant process outlined 16

in Rule .0904 of this Section. 17

(d) If a Trauma Center currently using the ACS' verification process chooses not to renew using this process, it 18

must notify the OEMS at least six months prior to the end of its state trauma center designation period of its 19

intention to exercise the option in Subparagraph (a)(1) of this Rule. 20

21



Eff. April 1, 2003; 24

Amended Eff. April 1, 2011; April 1, 2009; January 1, 2009; January 1, 2004. 25

26

10A NCAC 13P .0906 LEVEL I TRAUMA CENTER OPERATING ROOM, POST ANESTHESIA CARE 27

UNIT AND SURGICAL INTENSIVE CARE UNIT CRITERIA 28

(a) The operating room of a Level I Trauma Center shall ensure an operating suite is immediately available 24 29

hours per day and has the following: 30

(1) 24-hour-per-day immediate availability of in-house staffing; and 31

(2) equipment for patients of all ages that includes: 32

(A) cardiopulmonary bypass capability; 33

(B) thermal control equipment for patients; 34

(C) thermal control equipment for blood and fluids; 35

(D) 24-hour-per-day x-ray capability including c-arm image intensifier; 36

(E) endoscopes and bronchoscopes; 37

37

(F) craniotomy instruments; 1

(G) the capability of fixation of long-bone and pelvic fractures; and 2

(H) a rapid infuser system. 3

(b) The post anesthesia care unit or surgical intensive care unit of a Level I Trauma Center shall have: 4

(1) 24-hour-per-day in-house staffing by registered nurses; and 5


(A) the capability for resuscitation and continuous monitoring of temperature, 7


(B) the capability for continuous monitoring of intracranial pressure; 9

(C) pulse oximetry; 10

(D) end-tidal carbon dioxide determination capability; 11

(E) thermal control equipment for patients; and 12

(F) thermal control equipment for blood and fluids. 13

14


Eff. April 1, 2011. 16

17

10A NCAC 13P .0907 LEVEL I TRAUMA CENTER INTENSIVE CARE UNIT AND CRITICAL CARE 18

MANAGEMENT CRITERIA 19

(a) The intensive care unit for trauma patients for a Level I Trauma Center shall have: 20

(1) a designated surgical director for trauma patients; 21

(2) a physician on duty in the intensive care unit 24 hours per day or immediately available from 22

within the hospital as long as this physician is not the sole physician on-call for the emergency 23

department; 24

(3) a ratio of one nurse per two patients on each shift; 25


(A) airway control and ventilation equipment (laryngoscopes, endotracheal tubes, bag-mask 27

resuscitators, and pocket masks); 28

(B) an oxygen source with concentration controls; 29

(C) a cardiac emergency cart; 30

(D) a temporary transvenous pacemaker; 31

(E) electrocardiograph-oscilloscope-defibrillator; 32

(F) cardiac output monitoring capability; 33

(G) electronic pressure monitoring capability; 34

(H) a mechanical ventilator; 35

(I) patient weighing devices; 36

(J) pulmonary function measuring devices; 37

38

(K) temperature control devices; and 1

(L) intracranial pressure monitoring devices; and 2

(5) within 30 minutes of request, the ability to perform blood gas measurements, hematocrit level, and 3

chest x-ray studies. 4

(b) A Level I Trauma Center shall have acute hemodialysis capability. 5

(c) A Level I Trauma Center shall have a physician-directed burn center staffed by nursing personnel trained in 6

burn care or a transfer agreement with a burn center. 7

(d) A Level I Trauma Center shall have an acute spinal cord management capability or transfer agreement with a 8

hospital capable of caring for a spinal cord injured patient. 9

10


Eff. April 1, 2011. 12

13

10A NCAC 13P .0908 LEVEL I TRAUMA CENTER RADIOLOGY SERVICES CRITERIA 14

The radiology services for a Level I Trauma Center shall have: 15

(1) a 24-hour-per-day in-house radiology technologist; 16

(2) a 24-hour-per-day in-house computerized tomography technologist; 17

(3) the ability to provide sonography; 18

(4) the ability to provide computed tomography; 19

(5) the ability to provide angiography; 20

(6) the ability to provide magnetic resonance imaging; and 21

(7) resuscitation equipment that includes airway management and IV therapy. 22

23


Eff. April 1, 2011. 25

26

10A NCAC 13P .0909 LEVEL I TRAUMA CENTER RESPIRATORY THERAPY AND CLINICAL 27

LABORATORY CRITERIA 28

(a) A Level I Trauma Center shall ensure respiratory therapy services are available in-house 24 hours per day. 29

(b) A Level I Trauma Center shall have a 24-hour-per-day clinical laboratory service that must include: 30

(1) analysis of blood, urine, and other body fluids, including micro-sampling when appropriate; 31

(2) blood-typing and cross-matching; 32

(3) coagulation studies; 33

(4) comprehensive blood bank or access to community central blood bank with storage facilities; 34

(5) blood gases and pH determination; and 35

(6) microbiology. 36

37

39


Eff. April 1, 2011. 2

3

10A NCAC 13P .0910 LEVEL I TRAUMA CENTER REHABILITATION SERVICES CRITERIA 4

The rehabilitation services for a Level I Trauma Center shall: 5

(1) provide a staff trained in rehabilitation care of critically injured patients; 6

(2) for trauma patients, provide a functional assessment with recommendations regarding short- and 7

long-term rehabilitation needs within one week of the patient's admission to the hospital or as soon 8


(3) provide in-house rehabilitation service or a transfer agreement with a rehabilitation facility 10


(4) provide physical, occupational, speech therapies, and social services; and 12

(5) have substance abuse evaluation and counseling capability. 13

14


Eff. April 1, 2011. 16

17

10A NCAC 13P .0911 LEVEL I TRAUMA CENTER PERFORMANCE IMPROVEMENT CRITERIA 18

A Level I Trauma Center shall participate in a performance improvement program, as outlined in the “North 19

Carolina Committee on Trauma, Performance Improvement/Outcomes Subcommittee of the American College of 20

Surgeons: Performance Improvement, Research, and Continuing Education Standards for the North Carolina 21

Trauma System,” which is incorporated by reference, including subsequent amendments and editions. This 22

document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. 23

24


Eff. April 1, 2011. 26

27

10A NCAC 13P .0912 LEVEL I TRAUMA CENTER OUTREACH PROGRAM, PUBLIC EDUCATION 28

AND INJURY PREVENTION CRITERIA 29

A Level I Trauma Center shall participate in: 30

(1) an outreach program that includes: 31

(a) transfer agreements to address the transfer and receipt of trauma patients; 32

(b) programs for physicians within the community and within the referral area (that include 33



(c) development of a Regional Advisory Committee as specified in Rule .1102 of this 36

Subchapter; 37

40

(d) development of regional criteria for coordination of trauma care; 1

(e) assessment of trauma system operations at the regional level; and 2

(f) ATLS. 3

(2) a program of injury prevention and public education that includes: 4

(a) epidemiology research that includes studies in injury control, collaboration with other 5

institutions on research, monitoring progress of prevention programs, and consultation 6

with researchers on evaluation measures; 7

(b) surveillance methods that includes trauma registry data, special emergency department 8

and field collection projects; 9

(c) designation of a injury prevention coordinator; and 10

(d) outreach activities, program development, information resources, and collaboration with 11


13


Eff. April 1, 2011. 15

16

10A NCAC 13P .0913 LEVEL I TRAUMA CENTER RESEARCH CRITERIA 17

A Level I Trauma Center shall participate in a trauma research program, as outlined in the “North Carolina 18

Committee on Trauma, Performance Improvement/Outcomes Subcommittee of the American College of Surgeons: 19

Performance Improvement, Research, and Continuing Education Standards for the North Carolina Trauma System,” 20

which is incorporated by reference, including subsequent amendments and editions. This document is available 21

from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. 22

23


Eff. April 1, 2011. 25

26

10A NCAC 13P .0914 LEVEL I TRAUMA CENTER CONTINUING EDUCATION CRITERIA 27

A Level I Trauma Center shall participate in a continuing education program, as outlined in the “North Carolina 28





33


Eff. April 1, 2011. 35

36

37

41

10A NCAC 13P .0915 LEVEL II TRAUMA CENTER APPLICATION CRITERIA 1

To receive designation as a Level II Trauma Center, a hospital shall have: 2

(1) a trauma program and a trauma service that have been operational for at least 12 months prior to 3

application for designation; and 4

(2) for at least 12 months prior to submitting a Request for Proposal, membership in and inclusion of 5

all trauma patient records in the North Carolina Trauma Registry, in accordance with the North 6





11


Eff. April 1, 2011. 13

14

10A NCAC 13P .0916 LEVEL II TRAUMA CENTER ADMINISTRATION 15

(a) A Level II Trauma Center shall designate a trauma medical director who is a board-certified general surgeon. 16


(1) have at least three years clinical experience on a trauma service or trauma fellowship training; 18


(3) participate in providing care to patients with life-threatening urgent injuries; 20

(4) participate in the North Carolina Chapter of the ACS' Committee on Trauma as well as other 21

regional and national trauma organizations; and 22

(5) remain a provider in the ACS' ATLS and in the provision of trauma-related instruction to other 23

health care personnel. 24

(b) A Level II Trauma Center shall designate a full-time trauma nurse coordinator TNC/TPM who is a registered 25

nurse and licensed by the North Carolina Board of Nursing. 26

(c) A Level II Trauma Center shall designate a full-time TR who has a working knowledge of medical terminology, 27

is able to operate a personal computer, and has the ability to extract data from the medical record. 28

29


Eff. April 1, 2011. 31

32

10A NCAC 13P .0917 LEVEL II TRAUMA CENTER PHYSICIAN AND TRAUMA TEAM SERVICES 33

(a) A Level II Trauma Center shall ensure there is a department/division/section for general surgery, neurological 34

surgery, emergency medicine, anesthesiology, and orthopedic surgery, with a designated chair or physician liaison 35

to the trauma program for each. 36

42

(b) Clinical capabilities in general surgery must be posted with separate call schedules. One shall be for trauma, one 1

shall be for general surgery and one shall be a back-up call schedule for trauma. In those instances where a 2

physician may simultaneously be listed on more than one schedule, there must be a defined back-up surgeon listed 3

on the schedule to allow the trauma surgeon to provide care for the trauma patient. If a trauma surgeon is 4

simultaneously on call at more than one hospital, there shall be a defined, posted trauma surgery back-up call 5

schedule composed of surgeons credentialed to serve on the trauma panel. 6

(c) A Level II Trauma Center shall ensure the availability of a trauma team to provide evaluation and treatment of a 7

trauma patient 24 hours per day that includes: 8

(1) a trauma attending or PGY4 or senior general surgical resident. The trauma attending participates 9

in therapeutic decisions and is present at all operative procedures. 10

(2) an emergency physician who is present in the emergency department 24 hours per day who is 11

either board-certified or prepared in emergency medicine (by the American Board of Emergency 12

Medicine or the American Osteopathic Board of Emergency Medicine) or board-certified or 13

eligible by the American Board of Surgery, American Board of Family Practice, or American 14

Board of Internal Medicine and practices emergency medicine as his primary specialty. This 15

emergency physician if prepared or eligible must be board-certified within five years after 16

successful completion of the residency and serves as a designated member of the trauma team to 17

ensure immediate care for the injured patient until the arrival of the trauma surgeon; 18

(3) neurosurgery specialists who are never simultaneously on-call at another Level II or higher trauma 19

center, who are promptly available, if requested by the trauma team leader, as long as there is 20

either an in-house attending neurosurgeon; a PGY2 or higher in-house neurosurgery resident; or 21

in-house emergency physician or the on-call trauma surgeon as long as the institution can 22

document management guidelines and annual continuing medical education for neurosurgical 23

emergencies. There must be a specified back-up on the call schedule whenever the neurosurgeon 24

is simultaneously on-call at a hospital other than the trauma center; 25

(4) orthopaedic surgery specialists who are never simultaneously on-call at another Level II or higher 26

trauma center, who are promptly available, if requested by the trauma team leader, as long as there 27

is either an in-house attending orthopaedic surgeon; a PGY2 or higher in-house orthopaedic 28

surgery resident; or in-house emergency physician or the on-call trauma surgeon as long as the 29

institution can document management guidelines and annual continuing medical education for 30

orthopaedic emergencies. There must be a specified back-up on the call schedule whenever the 31

orthopaedic surgeon is simultaneously on-call at a hospital other than the trauma center; and 32

(5) an in-house anesthesiologist or a CA3 resident unless an anesthesiologist on-call is advised and 33

promptly available after notification or an in-house CRNA under physician supervision, practicing 34

in accordance with G.S. 90-171.20(7)e, pending the arrival of the anesthesiologist. 35

43

(d) A credentialing process shall be established by the Department of Surgery to approve mid-level practitioners 1

and attending general surgeons covering the trauma service. The surgeons must have board certification in general 2

surgery within five years of completing residency. 3

(e) Neurosurgeons and orthopaedists serving the trauma service must be board certified or eligible. Those who are 4

eligible must be board certified within five years after successful completion of the residency. 5

6


Eff. April 1, 2011. 8

9

10A NCAC 13P .0918 LEVEL II TRAUMA CENTER TRAUMA TEAM ACTIVATION 10

To ensure activation of the trauma team for a Level II Trauma Center, the trauma center shall: 11

(1) have written protocols relating to trauma care management formulated and updated to remain 12

current; 13

(2) have criteria established to ensure team activation prior to arrival, and attending arrival within 20 14

minutes of the arrival of trauma and burn patients that include the following conditions: 15

(a) shock; 16



(d) unresponsiveness (GCS less than nine with potential for multiple injuries; 19

(e) gunshot wound to neck, chest or abdomen; 20

(f) patients receiving blood to maintain vital signs; and 21

(g) ED physician's decision to activate. 22

(3) ensure performance of a surgical evaluation, based upon the following criteria, by the health 23

professional who is promptly available for the following conditions: 24





(e) two or more proximal long bone fractures; and 29

(f) spinal cord injury; 30

(4) ensure surgical consults, based upon the following criteria, by the health professional who is 31

promptly available for the following: 32





(ii) rollover; 37

44


(iv) death of another individual in the same vehicle; or 2

(d) extremes of age, less than five or greater than 70 years; 3

(5) ensure clinical capabilities (promptly available if requested by the trauma team leader, with a 4

posted on-call schedule), that include individuals credentialed in the following: 5

(a) critical care; 6

(b) hand surgery; 7

(c) neurosurgery (The neurosurgeon must be dedicated to one hospital or a back-up call 8



published back-up call list is not necessary.); 11

(d) obstetrics/gynecologic surgery; 12

(e) opthalmic surgery; 13

(f) oral maxillofacial surgery; 14

(g) orthopaedics (dedicated to one hospital or a back-up call schedule must be available); 15

(h) plastic surgery; 16

(i) radiology; 17

(j) thoracic surgery; and 18

(k) urologic surgery. 19

20


Eff. April 1, 2011. 22

23

10A NCAC 13P .0919 LEVEL II TRAUMA CENTER EMERGENCY DEPARTMENT CRITERIA 24

The emergency department of a Level II Trauma Center shall: 25




(2) ensure 24-hour-per-day staffing by physicians physically present in the Emergency Department 29

who: 30

(a) are either board-certified or prepared in emergency medicine (by the American Board of 31

Emergency Medicine or the American Osteopathic Board of Emergency Medicine or 32


Practice, or American Board of Internal Medicine). These emergency physicians must be 34

board-certified within five years after successful completion of a residency; 35

(b) are hospital designated members of the trauma team; and 36

(c) practice emergency medicine as their primary specialty. 37

45


from hospital arrival to disposition to an intensive care unit, operating room, or patient care unit. 2

(4) have equipment for patients of all ages that includes: 3






(e) an electrocardiograph-oscilloscope-defibrillator with internal paddles; 9

(f) an apparatus to establish central venous pressure monitoring; 10





(i) an apparatus for gastric decompression; 15



system; 18

(l) skeletal traction devices, including capability for cervical traction; 19

(m) arterial catheters; 20

(n) thermal control equipment for patients; 21

(o) thermal control equipment for blood and fluids; 22

(p) a rapid infuser system; 23

(q) a dosing reference and measurement system to ensure appropriate age related medical 24

care; 25

(r) sonography; and 26

(s) a doppler. 27

28


Eff. April 1, 2011. 30

31

10A NCAC 13P .0920 LEVEL II TRAUMA CENTER OPERATING ROOM, POST ANESTHESIA 32

CARE UNIT AND SURGICAL INTENSIVE CARE UNIT CRITERIA 33

(a) The operating room of a Level II Trauma Center shall ensure an operating suite that is immediately available 24 34

hours per day and has the following: 35

(1) 24-hour-per-day immediate availability of in-house staffing; and 36


46

(A) thermal control equipment for patients; 1

(B) thermal control equipment for blood and fluids; 2

(C) 24-hour-per-day x-ray capability, including c-arm image intensifier; 3

(D) endoscopes and bronchoscopes; 4

(E) craniotomy instruments; 5

(F) the capability of fixation of long-bone and pelvic fractures; and 6

(G) a rapid infuser system. 7

(b) The post anesthesia care unit or surgical intensive care unit of a Level II Trauma Center shall have: 8

(1) 24-hour-per-day in-house staffing by registered nurses; and 9

(2) equipment for patients of all ages to include: 10

(A) capability for resuscitation and continuous monitoring of temperature, hemodynamics, 11

and gas exchange; 12

(B) capability for continuous monitoring of intracranial pressure; 13

(C) pulse oximetry; 14

(D) end-tidal carbon dioxide determination capability; 15

(E) thermal control equipment for patients; and 16

(F) thermal control equipment for blood and fluids. 17

18


Eff. April 1, 2011. 20

21

10A NCAC 13P .0921 LEVEL II TRAUMA CENTER INTENSIVE CARE AND CRITICAL CARE 22

MANAGEMENT CRITERIA 23

(a) The intensive care unit for trauma patients for a Level II Trauma Center shall have: 24

(1) a hospital designated surgical director of trauma patients; 25

(2) a physician on duty in the intensive care unit 24 hours per day or immediately available from 26

within the hospital as long as this physician is not the sole physician on-call for the emergency 27

department; 28

(3) a ratio of one nurse per two patients on each shift; 29



resuscitators, and pocket masks); 32




(E) electrocardiograph-oscilloscope-defibrillator; 36


47




(J) pulmonary function measuring devices; 4


(L) intracranial pressure monitoring devices; and 6



(b) A Level II Trauma Center shall have acute hemodialysis capability or utilization of a transfer agreement. 9

(c) A Level II Trauma Center shall have a physician-directed burn center staffed by nursing personnel trained in 10

burn care or a transfer agreement with a burn center. 11

(d) A Level II Trauma Center shall have an acute spinal cord management capability or transfer agreement with a 12


14


Eff. April 1, 2011. 16

17

10A NCAC 13P .0922 LEVEL II TRAUMA CENTER RADIOLOGY SERVICES CRITERIA 18

The radiology services for a Level II Trauma Center shall have: 19

(1) a 24-hour-per-day in-house radiology technologist; 20

(2) a 24-hour-per-day in-house computerized tomography technologist; 21

(3) the ability to provide sonography; 22


(5) the ability to provide angiography; and 24


26


Eff. April 1, 2011. 28

29

10A NCAC 13P .0923 LEVEL II TRAUMA CENTER RESPIRATORY THERAPY CLINICAL AND 30


(a) A Level II Trauma Center shall ensure respiratory therapy services are available in-house 24 hours per day. 32

(b) A Level II Trauma Center shall have a 24-hour-per-day clinical laboratory service that must include: 33




(4) comprehensive blood bank or access to a community central blood bank with storage facilities; 37

48


(6) microbiology. 2

3


Eff. April 1, 2011. 5

6

10A NCAC 13P .0924 LEVEL II TRAUMA CENTER REHABILITATION SERVICES CRITERIA 7

The rehabilitation services for a Level II Trauma Center shall: 8

(1) provide a staff trained in rehabilitation care of critically injured patients; 9

(2) for trauma patients, provide a functional assessment with recommendations regarding short- and 10

long-term rehabilitation needs within one week of the patient's admission to the hospital or as soon 11




(4) provide physical, occupational, speech therapies, and social services; and 15

(5) have substance abuse evaluation and counseling capability. 16

17


Eff. April 1, 2011. 19

20

10A NCAC 13P .0925 LEVEL II TRAUMA CENTER PERFORMANCE IMPROVEMENT CRITERIA 21

A Level II Trauma Center shall participate in a performance improvement program, as outlined in the “North 22



Trauma System,” which are incorporated by reference, including subsequent amendments and editions. This 25


27


Eff. April 1, 2011. 29

30

10A NCAC 13P .0926 LEVEL II TRAUMA CENTER OUTREACH PROGRAM, PUBLIC EDUCATION 31

AND INJURY PREVENTION CRITERIA 32

A Level II Trauma Center shall participate in: 33


(a) transfer agreements to address the transfer and receipt of trauma patients; 35

49

(b) programs for physicians within the community and within the referral area (that include 1



(c) development of a Regional Advisory Committee as specified in Rule .1102 of this 4

Subchapter; 5

(d) development of regional criteria for coordination of trauma care; and 6

(e) assessment of trauma system operations at the regional level. 7

(2) a program of injury prevention and public education that includes: 8

(a) designation of an injury prevention coordinator; and 9

(b) outreach activities, program development, information resources, and collaboration with 10


12


Eff. April 1, 2011. 14

15

10A NCAC 13P .0927 LEVEL II TRAUMA CENTER CONTINUING EDUCATION CRITERIA 16

A Level II Trauma Center shall participate in a written continuing education program, as outlined in the “North 17





22


Eff. April 1, 2011. 24

25

10A NCAC 13P .0928 LEVEL III TRAUMA CENTER APPLICATION CRITERIA 26

To receive designation as a Level III Trauma Center, a hospital shall have: 27

(1) a trauma program and a trauma service that have been operational for at least 12 months prior to 28


(2) for at least 12 months prior to submitting a Request for Proposal, membership in and inclusion of 30

all trauma patient records in the North Carolina Trauma Registry, in accordance with the North 31





36


50

Eff. April 1, 2011. 1

2

10A NCAC 13P .0929 LEVEL III TRAUMA CENTER ADMINISTRATION 3

(a) A Level III Trauma Center shall designate a trauma medical director who is a board-certified general surgeon. 4



(2) participate in providing care to patients with life-threatening or urgent injuries; 7

(3) participate in the North Carolina Chapter of the ACS' Committee on Trauma; and 8

(4) remain a provider in the ACS' ATLS Course in the provision of trauma-related instruction to other 9

health care personnel. 10

(b) A Level III Trauma Center shall designate a trauma nurse coordinator TNC/TPM who is a registered nurse and 11

licensed by the North Carolina Board of Nursing. 12

(c) A Level III Trauma Center shall designate a TR who has a working knowledge of medical terminology, is able 13

to operate a personal computer, and has the ability to extract data from the medical record. 14

15


Eff. April 1, 2011. 17

18

10A NCAC 13P .0930 LEVEL III TRAUMA CENTER PHYSICIAN AND TRAUMA TEAM SERVICES 19

(a) A Level III Trauma Center shall ensure there is a department/division/section for general surgery, emergency 20

medicine, anesthesiology, and orthopaedic surgery, with designated chair or physician liaison to the trauma program 21

for each. 22

(b) A Level III Trauma Center shall have clinical capabilities in general surgery with a written posted call schedule 23

that indicates who is on call for both trauma and general surgery. If a trauma surgeon is simultaneously on call at 24

more than one hospital, there must be a defined, posted trauma surgery back-up call schedule composed of surgeons 25

credentialed to serve on the trauma panel. The trauma service director shall specify, in writing, the specific 26

credentials that each back-up surgeon must have. These must state that the back-up surgeon has surgical privileges 27

at the trauma center and is boarded or eligible in general surgery (with board certification in general surgery within 28

five years of completing residency). 29

(c) A Level III Trauma Center shall ensure the availability of a trauma team to provide evaluation and treatment of 30

a trauma patient 24 hours per day that includes: 31

(1) a trauma attending whose presence at the patient's bedside within 30 minutes of notification is 32

documented and who participates in therapeutic decisions and is present at all operative 33

procedures; 34

(2) an emergency physician who is present in the ED 24 hours per day who is either board-certified or 35

prepared in emergency medicine (by the American Board of Emergency Medicine or the 36

American Osteopathic Board of Emergency Medicine) or board-certified or eligible by the 37

51

American Board of Surgery, American Board of Family Practice, or American Board of Internal 1

Medicine and practices emergency medicine as his primary specialty. This emergency physician if 2

prepared or eligible must be board-certified within five years after successful completion of the 3

residency and serve as a hospital designated member of the trauma team to ensure immediate care 4

for the trauma patient until the arrival of the trauma surgeon; and 5

(3) an anesthesiologist who is on-call and promptly available after notification by the trauma team 6

leader or an in-house CRNA under physician supervision, practicing in accordance with G.S. 90-7

171.20(7)e, pending the arrival of the anesthesiologist within 30 minutes of notification. 8

(d) A written credentialing process shall be established by the Department of Surgery to approve mid-level 9

practitioners and attending general surgeons covering the trauma service. The surgeons must have board certification 10

in general surgery within five years of completing residency. 11

(e) Neurosurgeons (if participating) and orthopaedists serving the trauma service must be board certified or eligible. 12

Those who are eligible must be board certified within five years after successful completion of residency. 13

14


Eff. April 1, 2011. 16

17

10A NCAC 13P .0931 LEVEL III TRAUMA CENTER TRAUMA TEAM ACTIVATION 18

To ensure activation of the trauma team for a Level III Trauma Center, the trauma center shall: 19

(1) have written protocols relating to trauma care management formulated and updated. Activation 20

guidelines shall reflect criteria that ensures patients receive timely and appropriate treatment 21

including stabilization, intervention and transfer. Documentation of effectiveness of variances 22

from activation criteria addressed in Items (2), (3), and (4) of this Rule must be available for 23

review. 24

(2) have criteria established to ensure team activation prior to arrival of trauma and burn patients that 25

include the following conditions: 26

(a) shock; 27



(d) unresponsiveness (GSC less than nine) with evidence for multiple injuries; 30

(e) gunshot wound to neck, or torso; or 31

(f) ED physician's decision to activate. 32

(3) have trauma treatment guidelines based on facility capabilities that ensure surgical evaluation or 33

appropriate transfer, based upon the following criteria, by the health professional who is promptly 34

available: 35



52



(e) two or more proximal long bone fractures; 3

(f) spinal cord injury; and 4

(g) gunshot wound to the head. 5

(4) ensure surgical consults or appropriate transfers determined by Trauma Treatment Guidelines 6

based on facility capabilities, based upon the following criteria, by the health professional who is 7

promptly available: 8





(ii) rollover; 13


(iv) death of another individual in the same vehicle; and 15

(d) extremes of age, less than five or greater than 70 years. 16

(5) ensure clinical capabilities (promptly available if requested by the trauma team leader, with a 17

posted on-call schedule) that include individuals credentialed in the following: 18

(a) orthopaedics; 19

(b) radiology; and 20

(c) neurosurgery, if actively participating in the acute resuscitation and operative 21

management of patients managed by the trauma team. 22

23


Eff. April 1, 2011. 25

26

10A NCAC 13P .0932 LEVEL III TRAUMA CENTER EMERGENCY DEPARTMENT CRITERIA 27

The emergency department of a Level III Trauma Center shall: 28




(2) ensure 24-hour-per-day staffing by physicians physically present in the emergency department 32

who: 33

(a) are either board-certified or prepared in emergency medicine (by the American Board of 34

Emergency Medicine or the American Osteopathic Board of Emergency Medicine) or 35


53

Practice, or American Board of Internal Medicine. These emergency physicians must be 1

board-certified within five years after successful completion of a residency; 2

(b) are designated members of the trauma team to ensure immediate care to the trauma 3

patient; and 4

(c) practice emergency medicine as their primary specialty; 5


from hospital arrival to disposition to an intensive care unit, operating room, or patient care unit; 7

and 8

(4) have resuscitation equipment for patients of all ages that includes: 9






(e) an Electrocardiograph-oscilloscope-defibrillator with internal paddles; 15

(f) apparatus to establish central venous pressure monitoring; 16





(i) apparatus for gastric decompression; 21



system; 24

(l) skeletal traction devices; 25

(m) thermal control equipment for patients; 26

(n) thermal control equipment for blood and fluids; 27

(o) a rapid infuser system; 28

(p) a dosing reference and measurement system to ensure appropriate age related medical 29

care; and 30

(q) a doppler. 31

32


Eff. April 1, 2011. 34

35

36

54

10A NCAC 13P .0933 LEVEL III TRAUMA CENTER OPERATING ROOM, POST ANESTHESIA 1

CARE UNIT AND SURGICAL CARE UNIT CRITERIA 2

(a) The operating room of a Level III Trauma Center shall provide an operating suite that has the following: 3

(1) personnel available 24 hours a day, on-call, and available within 30 minutes of notification unless 4

in-house; and 5

(2) age-specific equipment that includes: 6

(A) thermal control equipment for patients; 7

(B) thermal control equipment for blood and fluids; 8

(C) 24-hour-per-day x-ray capability, including c-arm image intensifier; 9

(E) endoscopes and bronchoscopes; 10

(F) equipment for long bone and pelvic fracture fixation; and 11

(G) a rapid infuser system. 12

(b) The post anesthesia care unit or surgical intensive care unit of a Level III Trauma Center shall have: 13

(1) 24-hour-per-day availability of registered nurses within 30 minutes from inside or outside the 14

hospital; and 15


(A) the capability for resuscitation and continuous monitoring of temperature, 17


(B) pulse oximetry; 19

(C) end-tidal carbon dioxide determination; 20

(D) thermal control equipment for patients; and 21

(E) thermal control equipment for blood and fluids. 22

23


Eff. April 1, 2011. 25

26

10A NCAC 13P .0934 LEVEL III TRAUMA CENTER INTENSIVE CARE UNIT AND CRITICAL 27

CARE MANAGEMENT CRITERIA 28

(a) The intensive care unit for trauma patients for a Level III Trauma Center shall have: 29

(1) a trauma surgeon who actively participates in the committee overseeing the ICU; 30

(2) a physician on duty in the intensive care unit 24-hours-per-day or immediately available from 31

within the hospital (which may be a physician who is the sole physician on-call for the ED); 32



resuscitators and pocket masks); 35



55


(E) an electrocardiograph-oscilloscope-defibrillator; 2





(J) pulmonary function measuring devices; and 7




(b) A Level III Trauma Center shall have acute hemodialysis capability or utilization of a written transfer 11

agreement. 12

(c) A Level III Trauma Center shall have a physician-directed burn center staffed by nursing personnel trained in 13

burn care or a written transfer agreement with a burn center. 14

(d) A Level III Trauma Center shall have an acute spinal cord management capability or transfer agreement with a 15


(e) A Level III Trauma Center shall have an acute head injury management capability or transfer agreement with a 17

hospital capable of caring for a head injury. 18

19


Eff. April 1, 2011. 21

22

10A NCAC 13P .0935 LEVEL III TRAUMA CENTER RADIOLOGY SERVICES CRITERIA 23

The radiology services for a Level III Trauma Center shall have: 24

(1) a radiology technologist and computer tomography technologist available within 30 minutes of 25

notification or documentation that procedures are available within 30 minutes; 26


(3) the ability to provide sonography; and 28


30


Eff. April 1, 2011. 32

33

10A NCAC 13P .0936 LEVEL III TRAUMA CENTER RESPIRATORY THERAPY AND CLINICAL 34


(a) A Level III Trauma Center shall ensure respiratory therapy services are on-call 24 hours per day. 36

(b) A Level III Trauma Center shall have a 24-hour-per-day clinical laboratory service that must include: 37

56




(4) comprehensive blood bank or access to a community central blood bank with storage facilities; 4


(6) microbiology. 6

7


Eff. April 1, 2011. 9

10

10A NCAC 13P .0937 LEVEL III TRAUMA CENTER REHABILITATION SERVICES CRITERIA 11

The rehabilitation services for a Level III Trauma Center shall: 12


accredited by the Commission on Accreditation of Rehabilitation Facilities; and 14

(2) provide physical therapy and social services. 15

16


Eff. April 1, 2011. 18

19

10A NCAC 13P .0938 LEVEL III TRAUMA CENTER PERFORMANCE IMPROVEMENT CRITERIA 20

A Level III Trauma Center shall participate in a performance improvement program, as outlined in the “North 21





26


Eff. April 1, 2011. 28

29

10A NCAC 13P .0939 LEVEL III TRAUMA CENTER OUTREACH PROGRAM, PUBLIC 30

EDUCATION AND INJURY PREVENTION CRITERIA 31

A Level III Trauma Center shall participate in the following: 32


(a) transfer agreements to address the transfer and receipt of trauma patients; and 34

(b) participation in a RAC; and 35

(2) coordination or participation in community injury prevention activities. 36

37

57


Eff. April 1, 2011. 2

3

10A NCAC 13P .0940 LEVEL III TRAUMA CENTER CONTINUING EDUCATION CRITERIA 4

A Level III Trauma Center shall provide a written continuing education program, as outlined in the “North Carolina 5





10


Eff. April 1, 2011. 12

13

10A NCAC 13P .0941 INITIAL DESIGNATION PROCESS 14

(a) For initial Trauma Center designation, the hospital shall request a consult visit by OEMS and have the consult 15

within one year prior to submission of the RFP. 16

(b) A hospital interested in pursuing Trauma Center designation shall submit a letter of intent at least 180 days prior 17

to the submission of an RFP to the OEMS. The letter shall define the hospital's primary trauma catchment area. 18

Simultaneously, Level I or II applicants shall also demonstrate the need for the Trauma Center designation by 19

submitting one original and three copies of documents that include: 20

(1) The population to be served and the extent to which the population is underserved for trauma care 21

with the methodology used to reach this conclusion; 22

(2) Geographic considerations to include trauma primary and secondary catchment area and distance 23

from other Trauma Centers; and 24

(3) Evidence the Trauma Center will admit at least 1200 trauma patients yearly or show that its 25

trauma service will be taking care of at least 240 trauma patients with an Injury Severity Score 26

(ISS) greater than or equal to 15 yearly. This criteria shall be met without compromising the 27

quality of care or cost effectiveness of any other designated Level I or II Trauma Center sharing 28

all or part of its catchment area or by jeopardizing the existing Trauma Center's ability to meet this 29

same 240-patient minimum. 30

(c) The hospital must be actively participating in the state Trauma Registry and submit data to the OEMS at least 31

weekly and include all the Trauma Center's trauma patients as defined in Rule .0102(67) of this Subchapter who are 32

either diverted to an affiliated hospital, admitted to the Trauma Center for greater than 24 hours from an ED or 33

hospital, die in the ED, are DOA or are transferred from the ED to the OR, ICU, or another hospital, including 34

transfer to any affiliated hospital, a minimum of 12 months prior to application. 35

(d) OEMS shall review the regional Trauma Registry data, from both the applicant and the existing trauma 36

center(s), and ascertain the applicant's ability to satisfy the justification of need information required in 37

58

Subparagraphs (b)(1) through (3) of this Rule. Simultaneously, the applicant's primary RAC shall be notified by the 1

OEMS of the application and be provided the regional data as required in Subparagraphs (b)(1) through (3) of this 2

Rule submitted by the applicant for review and comment. The RAC shall be given a minimum of 30 days to submit 3

any concerns in writing for OEMS' consideration. If no comments are received, OEMS shall proceed. 4

(e) OEMS shall notify the hospital in writing of its decision to allow submission of an RFP. The RAC shall also be 5

notified by the OEMS so that any necessary changes in protocols can be considered. 6

(f) OEMS shall notify the respective Board of County Commissioners in the applicant's trauma primary catchment 7

area of the request for initial designation to allow for comment. 8

(g) Hospitals desiring to be considered for initial trauma center designation shall complete and submit to the OEMS 9

one original RFP with signatures and the number of copies of the RFP, as needed for the survey team as determined 10

by the OEMS, at least 90 days prior to the proposed site visit date. 11

(h) For Level I, II, and III applicants, the RFP shall demonstrate that the hospital meets the standards for the 12

designation level applied for as found in Rules .0901 through .0940 of this Section. 13

(i) If OEMS does not recommend a site visit based upon failure to comply with Rules .0901 through .0940 of this 14

Section, the reasons shall be forwarded to the hospital in writing within 30 days of the decision. The hospital may 15

reapply for designation within six months following the submission of an updated RFP. If the hospital fails to 16

respond within six months, the hospital shall reapply following the process outlined in Paragraphs (a) through (h) of 17

this Rule. 18

(j) If the OEMS recommends the hospital for a site visit, the OEMS shall notify the hospital within 30 days and the 19

site visit shall be conducted within six months of the recommendation. The site visit date shall be mutually agreeable 20

to the hospital and the OEMS. 21

(k) On the day of the site visit the hospital shall make available all requested patient medical charts. 22

(l) The primary reviewer of the site review team shall give a verbal post-conference report representing a consensus 23

of the site review team at the summary conference. A written consensus report shall be completed, to include a peer 24

review report, by the primary reviewer and submitted to OEMS within 30 days of the site visit. 25

(m) The report of the site survey team and the staff recommendations shall be reviewed by the State Emergency 26

Medical Services Advisory Council at its next regularly scheduled meeting following the site visit. Based upon the 27

site visit report and the staff recommendation, the State Emergency Medical Services Advisory Council shall 28

recommend to the OEMS that the request for Trauma Center designation be approved or denied. 29

(n) All criteria defined in Rules .0901 through .0940 of this Section shall be met for initial designation at the level 30

requested. Initial designation shall not be granted if deficiencies exist. 31

(o) Hospitals with a deficiency(ies) shall be given up to 12 months to demonstrate compliance. Satisfaction of 32

deficiency(ies) may require an additional site visit. If compliance is not demonstrated within the time period, to be 33

defined by OEMS, the hospital shall submit a new application and updated RFP and follow the process outlined in 34

Paragraphs (a) through (h) of this Rule. 35

(p) The final decision regarding Trauma Center designation shall be rendered by the OEMS. 36

59

(q) The OEMS shall notify the hospital in writing, of the State Emergency Medical Services Advisory Council's and 1

OEMS' final recommendation within 30 days of the Advisory Council meeting. 2

(r) Initial designation as a trauma center is valid for a period of three years. 3

4


Eff. April 1, 2011. 6

7

10A NCAC 13P .0942 DESIGNATED TRAUMA CENTER ADMINISTRATIVE STRUCTURE 8

CHANGES 9

If a trauma center changes its trauma program administrative structure, such that the trauma service, trauma medical 10

director, trauma nurse coordinator/program manager or trauma registrar are relocated on the hospital's organizational 11

chart at any time, it shall notify the OEMS of this change in writing within 30 days of the occurrence. 12

13


Eff. April 1, 2011. 15

16

10A NCAC 13P .0943 RENEWAL DESIGNATION OPTIONS 17

Hospitals may utilize one of two options to achieve Trauma Center renewal designation: 18

(1) undergo a site visit conducted by OEMS to obtain a four-year renewal designation pursuant to 19

Rule .0944 of this Section; or 20

(2) undergo a verification visit arranged by the ACS, in conjunction with OEMS, to obtain a four-year 21

renewal designation pursuant to Rule .0945 of this Section. 22

23


Eff. April 1, 2011. 25

26

10A NCAC 13P .0944 STATE ONLY SITE VISIT RENEWAL DESIGNATION PROCESS 27

For hospitals choosing to undergo a site visit conducted only by the OEMS, the following shall apply: 28

(1) Prior to the end of the designation period, the OEMS shall forward to the hospital an RFP for 29

completion. The hospital shall, within 10 days of receipt of the RFP, define for OEMS the 30

Trauma Center's trauma primary catchment area. Upon this notification, OEMS shall notify the 31

respective Board of County Commissioners in the applicant's trauma primary catchment area of 32

the request for renewal to allow for comment. 33

(2) Hospitals shall complete and submit to the OEMS one paper original RFP with signatures and the 34

number of copies of the RFP, as needed for the site team as determined by the OEMS, at least 30 35

days prior to the site visit. The RFP shall include information that supports compliance with the 36

60

criteria contained in Rules .0901 through .0940 of this Section as it relates to the Trauma Center's 1

level of designation. 2

(3) All criteria defined in Rules .0901 through .0940 of this Section, as it relates to the Trauma 3

Center's level of designation, shall be met for renewal designation. 4

(4) A site visit shall be conducted within 120 days prior to the end of the designation period. The site 5

visit shall be scheduled on a date mutually agreeable to the hospital and the OEMS. 6

(5) On the day of the site visit the hospital shall make available all requested patient medical charts. 7

(6) The primary reviewer of the site review team shall give a verbal post-conference report 8

representing a consensus of the site review team at the summary conference. A written consensus 9

report shall be completed, to include a peer review report, by the primary reviewer and submitted 10

to OEMS within 30 days of the site visit. 11

(7) The report of the site survey team and a staff recommendation shall be reviewed by the State 12

Emergency Medical Services Advisory Council at its next regularly scheduled meeting. Based 13

upon the site visit report and the staff recommendation, the State Emergency Medical Services 14

Advisory Council shall recommend to the OEMS that the request for Trauma Center renewal be 15

approved; approved with a deficiency(ies) requiring a focused review; approved with a 16

contingency(ies) not due to a deficiency(ies) recommending a consultative visit; or denied. 17





demonstrate compliance and undergo a focused review, that may require an additional site visit. 22

The hospital shall receive a 12 month Trauma Center designation during the focused review 23

period. If compliance is demonstrated within the 12 month time period, the hospital shall be 24

granted its designation for the four-year period from the previous designation's expiration date. If 25

compliance is not demonstrated within the time period, as specified by OEMS, the Trauma Center 26

designation shall not be renewed. To become redesignated, the hospital shall submit an updated 27

RFP and follow the initial applicant process outlined in Rule .0941 of this Section. 28

(9) The final decision regarding trauma center renewal shall be rendered by the OEMS. 29

(10) The OEMS shall notify the hospital of the State Emergency Medical Services Advisory Council's 30

and OEMS' final recommendation within 30 days of the Advisory Council meeting. 31

(11) Hospitals with a deficiency(ies) shall submit an action plan to the OEMS to address the 32

deficiency(ies) 10 days following the receipt of the written final decision on the trauma 33

recommendation. 34



37

61


Eff. April 1, 2011. 2

3

10A NCAC 13P .0945 STATE/ACS COMBINED SITE VISIT RENEWAL DESIGNATION PROCESS 4

(a) To achieve Trauma Center renewal designation, hospitals may undergo a verification visit arranged by the ACS, 5

in conjunction with the OEMS, to obtain a four-year renewal designation. 6

(b) For hospitals choosing to undergo a site visit conducted by the ACS, in conjunction with the OEMS, the 7

following shall apply: 8

(1) At least six months prior to the end of the Trauma Center's designation period, the trauma center 9

must notify the OEMS of its intent to undergo an ACS verification visit. It must simultaneously 10

define in writing to the OEMS its trauma primary catchment area. Trauma Centers choosing this 11

option must then comply with all ACS' verification procedures, as well as any additional state 12

criteria as outlined in Rules .0901 through .0940 of this Section, as apply to their level of 13

designation. 14

(2) When completing the ACS' documentation for verification, the Trauma Center must ensure access 15

to the ACS on-line PRQ (pre-review questionnaire) to the OEMS. The Trauma Center must 16

simultaneously complete documents supplied by the OEMS to verify compliance with North 17

Carolina criteria and forward these to the OEMS and the ACS. 18

(3) The OEMS shall notify the Board of County Commissioners within the trauma center's trauma 19

primary catchment area of the Trauma Center's request for renewal to allow for comments. 20

(4) The Trauma Center must make sure the site visit is scheduled to ensure that the ACS' final written 21

report, accompanying medical record reviews and cover letter are received by the OEMS at least 22

30 days prior to a regularly scheduled State Emergency Medical Services Advisory Council 23

meeting to ensure that the Trauma Center's state designation period does not terminate without 24

consideration by the State Emergency Medical Services Advisory Council. 25

(5) The date and time of the site visit must be submitted to the OEMS for review at least 45 days prior 26

to the site visit. The OEMS shall approve the site visit schedule if the schedule does not conflict 27

with the ability of attendance by required OEMS staff. 28

(6) All state Trauma Center criteria must be met as defined in Rules .0901 through .0940 of this 29

Section, for renewal of state designation. An ACS' verification is not required for state 30

designation. An ACS' verification does not ensure a state designation. 31

(7) ACS reviewers shall complete the state designation preliminary reporting form immediately prior 32

to the post conference meeting. This document and the ACS final written report and supporting 33

documentation described in Subparagraph (b)(4) of this Rule shall be used to generate a staff 34

summary of findings report following the post conference meeting for presentation to the NC 35

EMS Advisory Council for redesignation. 36

62

(8) The final written report issued by the ACS' verification review committee, the accompanying 1

medical record reviews (from which all identifiers may be removed), and cover letter must be 2

forwarded to OEMS within 10 working days of its receipt by the Trauma Center seeking renewal. 3

(9) The OEMS shall present its summary of findings report to the State Emergency Medical Services 4

Advisory Council at its next regularly scheduled meeting. The State EMS Advisory Council shall 5

recommend to the Chief of the OEMS that the request for Trauma Center renewal be approved; 6

approved with a deficiency(ies) requiring a focused review; approved with a contingency(ies) not 7

due to a deficiency(ies) recommending a consultative visit; or denied. 8





demonstrate compliance and undergo a focused review, that may require an additional site visit to 13

be conducted by the OEMS. The hospital shall receive a 12 month Trauma Center designation 14

during the focused review period. If compliance is demonstrated within the 12 month time period, 15

the hospital shall be granted its designation for the four-year period from the pervious 16

designation’s expiration date. If compliance is not demonstrated within the time period, as 17

specified by OEMS, the Trauma Center designation shall not be renewed. To become 18

redesignated, the hospital shall submit a new RFP and follow the initial applicant process outlined 19

in Rule .0941 of this Section. 20

(11) The final decision regarding trauma center designation shall be rendered by the OEMS. 21

(12) The OEMS shall notify the hospital in writing of the State Emergency Medical Services Advisory 22

Council's and OEMS' final recommendation within 30 days of the Advisory Council meeting. 23

(13) Hospitals with a deficiency(ies) shall submit an action plan to the OEMS to address the 24

deficiency(ies) 10 days following the receipt of the written final decision on the trauma 25

recommendation. 26



(c) If a Trauma Center currently using the ACS' verification process chooses not to renew using this process, it must 29

notify the OEMS at least six months prior to the end of its state trauma center designation period of its intention to 30

exercise the option in Rule .0944 of this Section. 31

32


Eff. April 1, 2011. 34

35

36

63

10A NCAC 13P .0946 STATE ONLY TRAUMA SITE SURVEY TEAM COMPOSITION 1

(a) Any in-state reviewer for a state only Level I or II visit, except for the OEMS representatives, shall be from 2

outside the RAC in which the hospital is located. The composition of a Level I or II state site survey team shall be 3

as follows: 4

(1) one out-of-state Fellow of the ACS, experienced as a site surveyor, who shall be designated the 5

primary reviewer; 6

(2) one emergency physician who currently works in a designated trauma center, is a member of the 7

American College of Emergency Physicians, and is boarded in emergency medicine (by the 8


Medicine); 10

(3) one in-state trauma surgeon who is a member of the North Carolina Committee on Trauma; 11

(4) one out-of-state trauma nurse coordinator/program manager; and 12

(5) OEMS staff. 13

(b) All site team members for a state only Level III visit shall be from in-state and, except for the OEMS 14

representatives, shall be from outside the RAC in which the hospital is located. The composition of a Level III state 15

site survey team shall be as follows: 16

(1) one Fellow of the ACS, who is a member of the North Carolina Committee on Trauma and shall 17

be designated the primary reviewer; 18

(2) one emergency physician who currently works in a designated trauma center, is a member of the 19

North Carolina College of Emergency Physicians, and is boarded in emergency medicine (by the 20


Medicine); 22

(3) one trauma nurse coordinator/program manager; and 23

(4) OEMS staff. 24

25


Eff. April 1, 2011. 27

28

10A NCAC 13P .0947 STATE/ACS COMBINED TRAUMA SITE SURVEY TEAM COMPOSITION 29

(a) Any in-state review for a State/ACS combined Level I or II visit, except for the OEMS representatives, shall be 30

from outside the RAC region in which the hospital is located. The composition of a Level I or II state site survey 31

team shall be as follows: 32

(1) one out-of-state Fellow of the ACS, experienced as a site surveyor, who shall be designated the 33

primary reviewer; 34

(2) one in-state or out-of-state emergency physician who currently works in a designated trauma 35

center, is a member of the American College of Emergency Physicians, and is boarded in 36

emergency medicine (by the American Board of Emergency Medicine or the American 37

64

Osteopathic Board of Emergency Medicine), and has membership in the North Carolina College 1

of Emergency Physicians if from in-state only; 2

(3) one in-state or out-of-state trauma surgeon who is a member of the North Carolina Committee on 3

Trauma if from in-state only; 4

(4) one out-of-state trauma nurse coordinator/program manager; and 5

(5) OEMS staff. 6

(b) All site team members for a State/ACS combined Level III visit, except for the OEMS representatives, shall be 7

from outside the RAC in which the hospital is located. The composition of a Level III state site survey team shall be 8

as follows: 9

(1) one in-state or out-of-state Fellow of the ACS, who is a member of the North Carolina Committee 10

if from in-state only, and shall be designated the primary reviewer; 11

(2) one in-state or out-of-state emergency physician who currently works in a designated trauma 12

center, is boarded in emergency medicine (by the American Board of Emergency Medicine or the 13

American Osteopathic Board of Emergency Medicine), and is a member of the North Carolina 14

College of Emergency Physicians if from in-state only; 15

(3) one trauma nurse coordinator/program manager; and 16

(4) OEMS staff. 17

(c) All proposed members of the site visit team must be submitted to the OEMS for review at least 45 days prior to 18

the site visit. The OEMS shall approve the proposed site team members if the OEMS determines there is no conflict 19

of interest, such as previous employment, by any site team member associated with the site visit. 20

21


Eff. April 1, 2011. 23

24

10A NCAC 13P .1101 STATE TRAUMA SYSTEM 25

(a) The state trauma system consists of regional plans, policies, guidelines and performance improvement initiatives 26

by the RACs to create an Inclusive Trauma System monitored by the OEMS. 27

(b) Each hospital and EMS System shall affiliate as defined in Rule .0102(4) of this Subchapter and participate with 28

the RAC that includes the Level I or II Trauma Center in which the majority of trauma patient referrals and 29

transports occur. are sent to the affiliated RAC’s designated Level I or II Trauma Center. Each hospital and EMS 30

System shall submit to the OEMS upon request patient transfer patterns from data sources that support the choice of 31

their primary RAC affiliation. Each RAC shall include at least one Level I or II Trauma Center. 32

(c) The OEMS shall notify each RAC of its hospital and EMS System membership. 33

(d) Each hospital and each EMS System must update and submit its RAC affiliation information to the OEMS no 34

later than July 1 of each year. RAC affiliation may only be changed during this annual update and only if supported 35

by a change in transfer patterns. patterns to another Level I or II Trauma Center. Documentation detailing these new 36

transfer patterns must be included in the request to change affiliation. 37

65

1



Eff. April 1, 2003; 4


6 10A NCAC 13P .1102 REGIONAL TRAUMA SYSTEM PLAN 7

(a) A Level I or II Trauma Center shall facilitate development of and provide RAC staff support that includes the 8

following: 9

(1) The trauma medical director(s) from the lead RAC agency; 10

(2) Trauma nurse coordinator(s) or program manager(s) from the lead RAC agency; and 11

(3) An individual to coordinate RAC activities. 12

(b) The RAC membership shall include the following: 13

(1) The trauma medical director(s) and the trauma nurse coordinator(s) or program manager(s) from 14

the lead RAC agency; 15

(2) If on staff, an outreach coordinator(s), injury prevention coordinator(s) or designee(s), as well as a 16

RAC registrar or designee(s) from the lead RAC agency; 17

(3) A senior level hospital administrator; 18

(4) An emergency physician; 19

(5) A representative from each EMS system participating in the RAC; 20

(6) A representative from each hospital participating in the RAC; 21

(7) Community representatives; and 22

(8) An EMS System physician involved in medical oversight. 23

(c) The RAC shall develop and submit a plan within one year of notification of the RAC membership, or for 24

existing RACs within six months of the implementation date of this rule, to the OEMS membership containing: 25

(1) Organizational structure to include the roles of the members of the system; 26

(2) Goals and objectives to include the orientation of the providers to the regional system; 27

(3) RAC membership list, rules of order, terms of office, meeting schedule (held at a minimum of two 28

times per year); 29

(4) Copies of documents and information required by the OEMS as defined in Rule .1103 of this 30

Section; 31

(5) System evaluation tools to be utilized; 32

(6) Written documentation of regional support for the plan; and 33

(7) Performance improvement activities to include utilization of patient care data. 34

(d) The RAC shall submit to the OEMS prepare an annual progress report no later than July 1 of each year that 35

assesses compliance with the regional trauma system plan and specifies any updates to the plan. This report shall be 36

made available to the OEMS for review upon request. 37

66

(e) Upon OEMS' receipt of a letter of intent for initial Level I or II Trauma Center designation pursuant to Rule 1

.0904(b) .0941(b) of this Subchapter, the applicant's RAC shall be provided the applicant's data from OEMS to 2

review and comment. 3

(f) The RAC has 30 days to comment on the request for initial designation. 4

(g) The OEMS shall notify the RAC of the OEMS approval to submit an RFP so that necessary changes in 5

protocols can be considered. 6

7



Eff. April 1, 2003; 10


12

MINUTES NORTH CAROLINA EMERGENCY MEDICAL SERVICES FOR CHILDREN

ADVISORY COMMITTEE


Dorothea Dix Campus

Council Bldg., Room 139 Raleigh, North Carolina

May 11, 2010 – 1:00pm

Members present: Dr. Kim Askew Mr. David Cuddeback Ms. Jessica Gerdes Dr. Cheryl Jackson Dr. Jessica Katznelson (via conference call) Dr. Donna Moro-Sutherland Dr. Gerri Mattson Ms. Robin Pariso Ms. Michelle Rudisill Staff present: Ms. Gloria Hale Ms. Nadine Pfeiffer Guest: Jena Thompson (1) Purpose of the Meeting To provide an update on initiatives of the EMSC Program and discuss statewide needs in EMSC. (2) Actions of the Committee (a) Dr. Kim Askew, Chair, opened the meeting and introductions were made. A motion was made by Dr. Moro-Sutherland to approve the meeting minutes from February 10, 2010. Ms. Jessica Gerdes seconded the motion and the minutes were approved.

(b) Announcements: Ms. Gloria Hale will be taking on additional responsibilities as the Rule-coordinator for the Division of Health Service Regulation. She expects to continue to manage the EMSC Program while taking on these new responsibilities.

2

(c) EMSC Program Update: The Joint EMSC Annual Program Meeting and Mid-Year NASEMSO meeting will take place May 25-27, 2010 in Bethesda, Maryland. NASEMSO’s Pediatric Emergency Care (PEC) Council will meet all day on the 25th and will break out into 6 topical workgroups, including child injury prevention, trauma, pediatric data, pediatric emergency preparedness, pediatric education, and family- centered care. It is anticipated that a project will be identified by the Council from these discussions that will benefit all state EMS programs. Federal EMSC is looking to support a PEC Council project in the future.

(d) EM Today will take place October 2-6, 2010 with the main conference sessions taking place October 4-6, 2010. Several pediatric sessions were recruited and will include a preconference session on pediatric prehospital care skills by Wake Forest University Baptist Medical Center, recognition of child abuse and neglect by UNC Hospitals at Chapel Hill, and pediatric poisonings by staff at the state’s poison control center at Carolinas Medical Care Center.

(e) Ms. Hale will be submitting an EMSC grant carryover request to federal EMSC. If approved, the program plans to fund the development of an online training module with the state Agency for Public Telecommunications on safe pediatric transports. The training would be open to all EMS personnel and would provide certificates of completion and CEUs. The program may also be able to purchase additional Broselow Tapes that can be provided as incentives to hospital emergency departments to complete the program’s planned pediatric preparedness survey.

(f) Equipment for use on ambulances was recently purchased for distribution to EMS Systems and EMS agencies. Items included pediatric size IV arm boards, suction catheters in sizes 8fr and 12fr, Broselow Tapes, Ferno Pedi-mates, Evenflo convertible child safety seats, and mini-Broselow Bags. The selection of equipment was based on newly-required items by OEMS and by gaps identified after analysis of the program’s EMSC performance measure surveys. (g) Ms. Hale reported that a stakeholder was interested in obtaining materials from N.C.’s Office Preparedness for Pediatric Emergencies initiative. The stakeholder had obtained information from an old web page maintained by the EMS PIC. Ms. Hale was unable to locate any printed or electronic materials. Members discussed the likelihood of similar materials available from others. Dr. Gerri Mattson and Dr. Kim Askew offered to search the Internet to locate such materials and pass on the information. (3) Old Business (a) Emergency Guidelines for Schools is in the process of being mailed to each School District Superintendent for distribution to each public school. The Department of Public Instruction has offered to make additional copies of the guidelines available for purchase at cost. Members suggested that the guidelines be made available to after school programs and private schools which can be made known through several agencies and at meetings.

3

(b) The Emergency Department Preparedness for Pediatrics Survey workgroup met in February. A survey is being drafted by Drs. Katznelson and Jackson using a template from Illinois and from concepts in recently updated recommendations from the AAP, ENA, and ACEP. The workgroup is hoping to enlist the assistance of the regional RAC Coordinators in providing outreach to their hospital members to complete the survey. The workgroup will meet via conference call to review the survey instrument and to plan next steps. (c) Emergency Care Education for School Nurses – Ms. Jessica Gerdes discussed the need for more emergency care training to be available for school nurses throughout the state. She proposed that the EMSC program send a school nurse to Illinois this summer to take their school nurse emergency care course and then teach it as a train-the-trainer here in N.C. Funds are not available at this time, however, to send someone there. The course may be able to be replicated in our state. Ms. Hale will contact Evelyn Lyons, Illinois EMSC Manager, to discuss. (d) Data was received from 78 of 100 EMS Systems from the statewide pediatric continuing education survey. Many questions were asked, including knowledge of or participation in KIDBase, whether EMS providers took PEPP, NALS, PALS and how often, and whether the Pediatric ToolKits were used. Preliminary findings suggest that most counties offer PALS, with PEPP following close behind. Pediatric Toolkits were used infrequently with only 9 of 78 systems having used them. In addition, the majority of EMS Systems were not participating in the KIDBase program, 55 of 78. Ms. Hale will present the results in more detail at the next meeting. (e) The program is collaborating with the state Office of the Chief Medical Examiner in analyzing data from child abuse deaths from 2007-2009 to review EMS response such as resuscitation provided on scene, calls to law enforcement and reports made to CPS and/or hospital staff. SIDS and poisonings will also be reviewed in terms of EMS response and actions taken. Analysis is expected to be complete in early 2011 and presentations will be made to both the EMSC Advisory Committee and the state Child Fatality Prevention Team at future meetings. (4) New Business (a) David Cuddeback, NREMT-P, Training Officer from Duplin County EMS, discussed their system’s initiative to develop written protocols for prehospital care of children with special health care needs. Mr. Cuddeback utilized the guidelines created by members of the EMSC Advisory Committee. Ms. Hale suggested that Duplin County’s protocols could be used as model protocols for all state systems. Dr. Cheryl Jackson asked whether there was a way to look at outcomes. Members were asked to review the protocols and provide any comments or revisions to Dr. Kim Askew. Once finalized, Ms. Hale will submit to NCCEP for adoption and inclusion into statewide protocols. (b) Jana Thompson, from the Center for Child and Family Health at UNC, presented information on a statewide initiative, “The Period of Purple Crying.” It is aimed at new parents to decrease the risk of Shaken Baby Syndrome. All hospitals are having new

4

parents watch the video about crying babies and what to do, but members discussed how they could assist the program in emergency departments. (5) Other Business (a) The next meeting of the EMSC Advisory Committee will be Tuesday, August 10, 2010, 1:00pm – 2:30pm. It will take place in Room 139 of the Council Bldg. on the Dorothea Dix Campus. The meeting adjourned at 3:15pm.

MINUTES NORTH CAROLINA OFFICE OF EMERGENCY MEDICAL SERVICES

ADVISORY COUNCIL

Injury Committee Department of Health and Human Services


McKimmon Center 1101 Gorman Street Raleigh, NC 27606

May 11, 2010 9:30 a.m.

Members Present

Mr. F. Wayne Ashworth, Chairman Dr. William K. Atkinson Mr. Bob Bailey Ms. Kathy Dutton Dr. Steven Landau Dr. Donna Moro-Sutherland Dr. Brent Myers Mr. Tony Seamon, Jr.

Members Absent

Dr. Michael Chang Dr. Russell Howerton Mr. Carl McKnight Dr. Tripp Winslow

Staff Members Present

Dr. Roy Alson Mr. Chris Cangemi Ms. McKenzie Cook Ms. Gloria Hale Ms. Brenda Harrington Ms. Nadine Pfeiffer Chief Drexdal Pratt Ms. Julie Williams

Others Present

Mr. Robert Bednar Ms. Shea D’Anna Mr. Dale Hill Mr. Gordon Joyner Dr. Henry Kornegay, Jr. Ms. Kelli Moore Dr. Bill Shillinglaw Ms. Mary Beth Skarote

2

(1) Purpose of the Meeting: The Committee met to receive an update on the EMS for Children (EMSC) program as well as to receive information on Mission Hospital’s level II trauma center designation renewal. The Committee also met to discuss the trauma news updates in the state of North Carolina.

(2) Actions of the Committee:

Mr. Ashworth called the meeting to order at 9:33 a.m.

(a) Motion was made by Mr. Seamon, seconded by Dr. Moro-Sutherland and approved that:

RESOLVED: The Injury Committee minutes of the February 10, 2010, meeting be approved.

(b) Motion was made by Mr. Bailey, seconded by Mr. Seamon and approved that:

RESOLVED: The Injury Committee recommend to the EMS Advisory Council that Mission Hospital retain its Level II Trauma Center designation for 4 years.

Explanation: Mission Hospital had a site visit on December 11, 2009. The hospital has notable

strengths: (1) only trauma center in Western North Carolina; (2) committed to care of all patients in the region; and (3) the commitment of their trauma program manager and their performance improvement coordinator.

Other Actions of the Committee:

(a) Ms. Gloria Hale provided an update on the EMS for Children (EMSC) program. The EMSC Program has hired a recent graduate from UNC Chapel Hill, Jennie Olympio, to work on a special project reviewing and analyzing child fatalities due to child abuse and/or neglect. The focus of the project will be EMS response and reporting. In addition, she will review EMS response to SIDS deaths and to child poisonings. She will work at the Office of the Chief Medical Examiner. Ms. Olympio’s work will culminate in a report which will include emergency care system recommendations in managing calls involving suspected child abuse or neglect.

OEMS staff will attend the upcoming Annual EMSC Program Meeting which will be held jointly this year with NASEMSO’s Mid-Year Meeting. May 25-27, 2010. The Pediatric Emergency Care Council will meet on May 25th.

(b) Ms Nadine Pfeiffer updated the committee on the recent focus review conducted at New Hanover Regional Medical Center on March 15, 2010. All concerns that the office had were cleared up during that visit.

(c) Ms. Pfeiffer stated the Medical Care Commission has granted permission for rules that pertain to the Chemical Dependency General Statue begin the rule making process. Also Ms. Pfeiffer stated that they are anticipating that these new rules will take effect in October 2010. The Medical Care Commission is also scheduled to meet tomorrow to discuss the Pediatric Bus Rules and hope for the rules to take effect January 1, 2011.

3

(d) STAC met recently and the Performance Improvement imitative has been approved. There will be a reference document in OEMS’ rules. STAC also created an executive committee and the executive committee will delegate tasks to smaller groups that were created.

(e) Ms. Pfeiffer also gave an update on EMS Run Sheets, which the office was asked to look into during the last Injury Committee Meeting. OEMS cannot ask the EMS stations to submit to the hospital only to the agency itself. Dr. Atkinson reported that WakeMed is starting to use an extraction program in hopes to be able to close the loop on all patient cases that enter the hospital. There was also discussion that if EMS systems were going to have to submit to the hospitals, the hospitals should also be willing to submit data back to the EMS system.

With no further business, the meeting was adjourned at 10:40 a.m. Minutes submitted by McKenzie Cook.

ac agenda 8-10-10 2

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