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Home My WebLink About20021230.tiff STATE OF COLORADO Bill Owens,Governor Jane E.Norton,Executive Director .o4.eotp 'Pi Dedicated to protecting and improving the health and environment of the people of Colorado 4300 Cherry Creek Dr.S. Laboratory and Radiation Services Division • tt. ay j * Denver,Colorado 80246-1530 8100 Lowry Blvd. itx• Y Phone(303)692-2000 Denver,Colorado 80230-6928 •Ian TDD Line(303)691-7700 (303)692-3090 Colorado Department Located in Glendale,Colorado of Public Health http://www.cdphe.state.co.us and Environment To: Members of the Colorado State Board of Health From: Gail Finley Rarey, Chief, EMS and Injury Prevention Section Through: Jillian Jacobellis, Division Director, Health Promotion and Disease Prevention Ned Calonge, Acting Chief Medical OfficeS�2 Date: May 7, 2002 Subject: Request for Emergency Changes for the Statewide Emergency Medical and Trauma System Rules Attached are materials related to a department request that the Board of Health adopt emergency rules related to the Statewide Emergency Medical and Trauma System. Emergency adoption of these rules is imperatively necessary to comply with state statute, for the preservation of public health safety or welfare and that compliance with the requirements of C.R.S. §24-4-103 would be contrary to the public interest. The department has determined that the authority of the State Emergency Medical and Trauma Services Advisory Council (SEMTAC) and the Regional Emergency Medical and Trauma Service Advisory Councils (RETACs) to act are subject to challenge without the proposed amendments, so the revision is necessary to ensure that the council will be able to continue its work in compliance with state statute. The proposed amendments to rules for emergency adoption pertain to the Statewide Emergency Medical and Trauma Care System and make the following changes: 1. Replaces references to the State Advisory EMS Council and the State Trauma Advisory Council with references or definition as needed to the State Emergency Medical and Trauma Services Advisory Council (SEMTAC). 2. Replaces references to the Area Trauma Advisory Councils (ATACs)with references to the Regional Emergency Medical and Trauma Service Advisory Councils (RETACs). 3. Modifies timelines for actions by the RETACs, applicants for designation as trauma centers, SEMTAC and the department based on the SEMTAC meeting no less than four times per year. Should you have any questions about the proposed rules please contact me at 303/692.2997. Attachments /) J:\Trauma Program\RULES\Emergency Rules\BOH Memo.doc GM . ,�„,(,.� n 2002-1230 e EMERGENCY FINDINGS AND JUSTIFICATION FOR ADOPTION OF EMERGENCY RULES FOR THE STATEWIDE EMERGENCY MEDICAL AND TRAUMA CARE SYSTEM—May 6, 2002 Emergency adoption of these rules is imperatively necessary to comply with state statute and for the preservation of public health, safety or welfare. Compliance with the requirements of C.R.S. §24-4-103 would be contrary to the public interest. The department has determined that the authority of the State Emergency Medical and Trauma Services Advisory Council (SEMTAC) and Regional Emergency Medical and Trauma Service Advisory Councils (RETACs) to act are subject to challenge without the proposed amendments; hence the revision is necessary to ensure that the council will be able to continue its work in conformance with state statute.These changes are in the public interest because they create consistency between statute and rule and thereby ensure actions of the State Emergency Medical and Trauma Services Advisory Council (SEMTAC) and Regional Emergency Medical and Trauma Service Advisory Councils (RETACs) are recognized as legal actions. Additionally, the proposed revisions modify timelines for action by the RETACs, hospitals and the department in conformance with the meeting schedule of the SEMTAC. Failure to pass these rules would jeopardize the publics' health and safety in the continued development of a coordinated, quality Statewide Emergency Medical and Trauma Care System in Colorado. STATEMENT OF BASIS AND PURPOSE AND SPECIFIC STATUTORY AUTHORITY FOR THE STATEWIDE EMERGENCY MEDICAL AND TRAUMA CARE SYSTEM RULES—May 6,2002 Basis and Purpose. The General Assembly of the State of Colorado during the 62nd general session in 2000, made modifications to sections C.R.S. §25-3.5-101 through §25- 3.5-709 declaring that the provision of adequate emergency medical and trauma services in all areas of the state is a matter of statewide concern. As a result, the Statewide Emergency Medical and Trauma Care System was created by merging the system development efforts of the State Advisory EMS Council and the State Trauma Advisory Council into the State Emergency Medical and Trauma Services Advisory Council (SEMTAC) and redefining the Area Trauma Advisory Councils as Regional Emergency Medical and Trauma Service Advisory Councils (RETACs). The department has determined that the authority of the SEMTAC to act is subject to challenge without the proposed amendments, therefore the revision is necessary to ensure that the council will be able to continue its work in compliance with state statute. Replacing language referencing the appropriate entities in the rules as soon as possible is necessary as these entities on-going actions and activities are critical to state readiness and preparedness for disaster response. Notice has been given to both the current SEMTAC members and RETAC representatives that the department would be taking this action at this time. J:\Trauma Program\RULES\Emergency Rules\FINDINGS AND JUSTIFICATION 5.02.doc 5/7/2002 These amendments to rules pertaining to the Statewide Emergency Medical and Trauma Care System make the following changes: 1. Replaces references to the State Advisory EMS Council and the State Trauma Advisory Council with references or definition as needed to the State Emergency Medical and Trauma Services Advisory Council (SEMTAC). 2. Replaces references to the Area Trauma Advisory Councils (ATACs) with references to the Regional Emergency Medical and Trauma Service Advisory Councils (RETACs). 3. Modifies timelines for actions by the RETACs, applicants for designation as trauma centers, SEMTAC and the department based on the SEMTAC meeting no less than four times per year. REGULATORY ANALYSIS FOR THE STATEWIDE EMERGENCY MEDICAL AND TRAUMA CARE SYSTEM RULES—May 6,2002 1. A description of the classes of persons who will be affected by the proposed rule, including the classes of persons who will bear the costs of the proposed rule, and the classes of persons who will benefit from the proposed rule. The same classes of persons will be affected,bear any costs and will benefit from the adoption of the proposed rule. The classes of persons include the State Emergency Medical and Trauma Services Council (SEMTAC)members, Regional Emergency Medical and Trauma Services Council (RETAC)members, provider groups (e.g. physicians, emergency medical technicians, nurses,hospital administrators) and the Department. 2. A description of the probable quantitative and qualitative impacts of the proposed rule, economic or otherwise, upon the affected classes of persons (to the extent possible). Qualitative impacts include assurance that all actions and activities acted on by the affected classes of persons with decision-making authority will have been done within the context of the statutes and their authority to act will not be the basis for any kind of legal challenge. Quantitative impacts should be minimal, as the rules have been modified to reflect operational practice within current budgets for over one budget cycle. 3. A discussion of the probable costs to the agency adopting the proposed rule and to any other agency in implementing and enforcing the proposed rule and any impact on state revenue. No additional costs are anticipated for any state agency not will it have any impact on state revenue. J:\Trauma Program\RULES\Emergency Rules\FINDINGS AND JUSTIFICATION 5.02.doc 5/7/2002 4. A comparison of the probable costs and benefits of the proposed rule if it is adopted to the probable costs and benefits if the proposed rule is not adopted. If the rule is adopted: Any costs are unknown at this time. Benefits include assurance that all actions and activities acted on by the affected classes of persons with decision-making authority will have been done within the context of the statutes and their authority to act will not be the basis for any kind of legal challenge. If the rule is not adopted: Costs could be considerable as timelines currently in rule for action to be taken by SEMTAC and RETACs are inconsistent with when the SEMTAC meets. Facilities seeking designation could challenge the council and the department for not meeting deadlines in rule. As the department begins another round of trauma center designation these timeline inconsistencies must be addressed. 5. A determination of whether there are less costly methods or less intrusive methods of achieving the purpose of the proposed rule. This was determined to be the least intrusive and least costly method of achieving the purposes of the proposed rules, i.e. consistency with statutes. 6. A description of alternative methods of achieving the purpose of the proposed rule that were seriously considered by the agency and the reasons why the alternative methods were rejected in favor of proceeding with the proposed rule. No other methods were considered as current rules are inconsistent with statute and an emergency rule making process was the most expeditious method to ensure on-going actions and activities of the councils are consistent with statute. 7. To the extent practical, a quantification of the data used in the analysis,the analysis must take into account both short-term and long-term consequences. Data is only available to potentially identify the impact if hospitals challenge the authority of the SEMTAC and the department to take action on their applications for designation. The data lists the potential dates for site reviews and needs to be extrapolated to identify those who might appeal and what those costs might be. This would take more time and a more detailed analysis than can be made at this time. J:\Trauma Program\RULES\Emergency Rules\FINDINGS AND JUSTIFICATION 5.02.doc 5/7/2002 Rules Pertaining to Emergency Medical Services 6 CCR 1015-3 Section 2 -Definitions 2.5 "Council" - State Emergency Medical Services and Trauma SERVICES Advisory Council. COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TRAUMA PROGRAM Emergency Medical Services Rules—6CCR-1015-3 DRAFT May 6,2002 Page 1 of 1 Colorado Board of Health Rules and Regulations Emergency Medical Services Account 6 CCR 1015-1 Section 2-Definitions: 2.4 "COUNCIL"MEANS THE STATE EMERGENCY MEDICAL AND TRAUMA SERVICE ADVISORY COUNCIL CREATED IN 25-3.5-104 Section 4-Awarding of Funds 4.1 The Division, in consultation with the Council, may,within statutory limitations, re-establish funding priorities for the EMS Grant Program to address specific needs related to the upgrading of the Colorado EMS EMERGENCY MEDICAL AND TRAUMA CARE system. COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TRAUMA PROGRAM Emergency Medical Services Account Rules—6CCR-1015-1 Draft May 6,2002 STATE OF COLORADO COLORADO BOARD OF HEALTH RULES AND REGULATIONS PERTAINING TO THE STATEWIDE EMERGENCY MEDICAL AND TRAUMA CARE SYSTEM CHAPTER TWO-AREA REGIONAL EMERGENCY MEDICAL AND TRAUMA SERVICE ADVISORY COUNCILS 201. In order to ensure effective system development and regional EMERGENCY MEDICAL AND trauma planning, all areas REGIONS must comply with the following minimum standards and planning regulations. 202. On or before July I, 1997,the governing body of each COUNTY OR city and county throughout the state shall establish an area trauma advisory council(ATAC)A REGIONAL EMERGENCY MEDICAL AND TRAUMA SERVICES ADVISORY COUNCIL(RETAC). Area Trauma Advisory Councils(hereinafter, ATACsRETACS,referring to the councils and the geographical areas they represent)must prepare plans to create and maintain coordinated, integrated EMERGENCY MEDICAL AND trauma system services throughout the areaREGION. In order to secure Department approval, each plan must identify the area REGION'S goals and objectives. The plan must identify existing area-REGIONAL resources,the resources that are needed in the areaREGION, and the arms REGION'S action plan to secure needed resources. The goals and objectives must relate to this information. 203. Plans must be submitted to the Department by July 1, 1998 2003,and every other year thereafter. 204. Minimum Standards for Area-REGIONAL EMERGENCY MEDICAL AND Trauma Resources A. Communication The area-REGION must provide communication and dispatch systems that insure coordinated coverage,specifically: 1. Utilization of the universal 9-1-1 or a local equivalent that is well publicized and accessible for citizens and visitors to the area REGION. 6. Two-way communications between ambulances and trauma facilities outside the ATAC RETAC area 9. A system for notification and alerting trauma teams, fixed and rotary wing emergency services, and trauma facilities CENTERS. C. Interfacility Transfer and Consultation 2. Actions Required (3) Consultation and or transfer decisions in patients with traumatic injuries less severe than those listed above shall be determined by the ATAC RETAC based on resources,facilities, COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TRAUMA PROGRAM Chapter 2 Draft May 6,2002 Page I of 6 and personnel available in the region and shall be made in accordance with ATAC RETAC protocols. 5. Noncomplicated Trauma Injuries Interfacility transfer of noncomplicated, non-life threatening single system injury (i.e. isolated hip fracture) trauma patients shall be made in accordance with ATAC RETAC protocols. ATACs RETACS must monitor transport within their regions and report systematic exceptions to the protocols or regulations to the Department. 6. ATACs RETACS must monitor treatment and transfer of patients with the above conditions. Documentation and QA must be completed on such patients. Systematic exceptions of the standards must be reported to the Department. For example,if significantly injured patients with multi-system trauma injuries are consistently transported to undesignated or level IV facilities,such transport deviation from the standards would constitute a systematic exception that must be reported. 7T Aromas-RETACS are responsible for ensuring that interfacility transfer agreements exist in all facilities transferring patients within and outside the area. D. Interfacility Transfer and Consultation'2-Pediatrics* 10. ATACs RETACS must monitor transport of pediatric trauma patients within their regions and report systematic exceptions to the protocols or regulations to the Department. E. Divert If coordinated within the ATAC RETAC and pursuant to protocol, facilities may go on divert I status for the following reasons: Trauma facilities must keep a record of times and reasons for going on divert status. This information must be made available for ATAC RETAC and/or Department audit. ATACs RETACS must audit facility diversion of trauma patients in their areas. Upon consideration of the reason for divert status,the authorizing personnel and other pertinent facts, ATACs may institute corrective action if the diversion was not reasonable or necessary. F. Bypass ATACS RETACS must develop protocols for patient destination within their areas that address bypass for situations not addressed in the algorithmS. Bypass situations must be monitored and the ATAC RETAC must require justification for deviation. 205. Minimum Standards and Organizational Requirements for ATACRETAC A. County commissioners from the counties comprising each ATAC RETAC shall determine how council members will be selected. B. Each ATAC RETAC shall meet at least four times per year. A chairperson of the Council RETAC shall be selected and that person or his/her designee shall serve as the liaison for that areaREGION's communications with the Department. The Councils-RETACS may appoint COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TRAUMA PROGRAM Chapter 2 Draft May 6.2002 Page 2 of 6 • subcommittees, advisory groups or otherwise obtain community assistance in completion of council business. After the appointment of members to the-rTAGRETAC,the Council-RETAC shall establish by-laws which include council member terms of office and other pertinent matters. C. Multi-county ATACs RETACS must be comprised of counties that are contiguous. When establishing ATACSRETACS,areas must attempt to represent all participant counties if possible. At least seventy five percent of council membership must reside in, or provide health care services within the-arcaREGION. Statutorily specified members must reside in or provide services within the-areaREGION. D. Areas-REGIONS must identify at least one key resource facility that will be used, and that be represented on the area-REGIONAL council. The key resource facility shall be a Level I or II facility, and shall provide consultation and technical assistance to the area-REGION regarding education,quality,training,-communications,and other trauma issues. E. Areas-REGIONS must develop system monitoring protocols that allow for oversight of state and area-REGIONAL standards and require communication among area-REGIONAL prehospital physician advisors. F. Areas-REGIONS must establish oversight quality of care goals for the ATACRETAC. These goals(QA/QI)and standards must conform to the QA/QI standards set forth elsewhere in these regulations. G. Areas-REGIONS must develop injury prevention goals and objectives. The area-REGION must monitor injury prevention programs within theirAGRETAC,and develop coordination where possible. H. Areas-REGIONS must integrate the provision of trauma services with other local and statewide disaster plans(such as State Patrol,county administration,Office of Emergency Management). 206. Plan Requirements A. Existing Area-REGIONAL Resources 1. Identify the population density of the area-REGION including: a. Total population b. Population per square mile c. Population of major towns/cities d. Other pertinent information 2. Submit a map ofthe-areaREGION,showing cities and towns,and any geographical barriers I to air and ground transportation of trauma patients 3. For each hospital available in the area-REGION identify: I a. Name of hospital (list all) b. Number of total staffed beds for each hospital and area total COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TRAUMA PROGRAM Chapter 2 Draft May 6,2002 Page 3 of 6 c. Number of total staff for each hospital d. ED and/or services that are available 24 hr./day e. Trauma center status and level of each trauma facility 8. List any specialized MEDICAL OR trauma care services in the area-REGION(such as bum centers,rehabilitation,pediatric, spinal cord injury;) 12. Identify EMERGENCY MEDICAL AND trauma data collection practices and capacity for expansion: 13. Describe current quality improvement/assurance activities in place for EMERGENCY MEDICAL AND trauma care. B. Resources Needed 1. Identify predicted population growth or loss that would impact EMERGENCY MEDICAL AND trauma service delivery. 2. Identify on a map the predicted changes in the layout of population and any new barriers to EMERGENCY MEDICAL AND trauma care that are expected due to these changes. 3. Identify hospital resources that are needed in the area—REGION to properly address EMERGENCY MEDICAL AND trauma patient or system needs. 4. Identify prehospital services that are needed for proper transfer and care of EMERGENCY MEDICAL AND trauma patients. 5. Identify the types of services from key resource facilities that are needed for essential EMERGENCY MEDICAL AND trauma care in the-area.REGION. 6. Identify what specialized EMERGENCY MEDICAL AND trauma care services are needed in the area to serve the patient population. 7. Identify what communications capabilities the area needs to effectively operate the EMERGENCY MEDICAL AND trauma system, and where shortfalls currently exist. 11. Specify if data collection systems must be enhanced or changed in order to capture the data needed for the EMERGENCY MEDICAL AND trauma CARE system(essential minimum data specified by the Board of Health)and estimate what(finances,personnel,and training) would be required. C. Area-REGIONAL Analysis 1. Based upon the area-REGIONAL needs assessment and resources inventory, identify the two most important goals in the ATAC RETAC over the next two year period. State why these goals were chosen(goals must relate to resources needed section). 2. Explain how the above stated goals promote efficiency, integration and coordination of EMERGENCY MEDICAL AND trauma service provision throughout the ATACRETAC. COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TRAUMA PROGRAM Chapter 2 Draft May 6,2002 Page 4 of 6 3. Identify all counties that were invited to participate in theCRETAC,and how the final group was determined. Explain why that composition was chosen,and how it promotes the integration and coordination of EMERGENCY MEDICAL AND trauma service provision in the ATAC RETAC and in adjacent geographical areas. 4. Identify the optimal number of trauma centers needed in the ATACRETAC,their proposed location and the rationale for additional centers beyond what is currently available. 5. Identify how the ATAC RETAC will prevent duplication of services in the area. 6. Identify what efficiencies are anticipated or experienced by multi-county participation in the ATACRETAC. 7. Identify how the ATAC RETAC will address multiple and/or different sets of protocols from different providers and physician advisors in the area. 8. Identify how the ATAC RETAC will address back up issues among the various providers (when back up is not completely available within each provider organization). 9. Identify how the ATAC RETAC will communicate with providers to seek input, to disseminate information,and to ensure participation in the system. 10. Identify how the ATAC RETAC will coordinate care with adjacent ATACsRETACS, neighboring states if relevant,and/or counties not within the ATAC RETAC area. 207. The Council STATE EMERGENCY MEDICAL AND TRAUMA SERVICES ADVISORY COUNCIL(SEMTAC)may grant exemptions from one or more standards of these regulations if the applicant can submit information that demonstrates that such exemption is justified. The council must find,based upon the information submitted and other pertinent factors,that particular standards is inappropriate because of special circumstances which would render such compliance unreasonable, burdensome or impractical. Exemptions or variances may be limited in time or may be conditioned as the Council considers necessary to protect the public welfare. 208. ATACs RETACS must submit a biennial report to the state Trauma Council SEMTAC BEGINNING JULY 1,2003,indicating progress on system implementation and matters of citizen or provider concern in the-areaREGION. 209. ATACs RETACS must estimate approximate costs for implementation of the EMERGENCY MEDCIAL AND trauma CARE system in the area-REGION and submit these estimates to the Department along with the plan.Known actual costs shall be submitted with plan updates. 210. ATACsRETACS must submit plans to the Department COUNCIL by July 1 of every other year. Each plan must be approved-or returned to the ATAC RETAC for revision within three-menths AUGUST 15T" OF THE SAME YEAR by the Department COUNCIL. REVISED PPlans may MUST be resubmitted twice for approvalBY SEPTEMBER 15TH OF THE SAME YEAR. Resubmissions should incorporate any required changes. the plan's rejection. If the Department does not approve the plan on the third submission, the Department will develop an acceptable plan for that area-REGION that the area must implement.If an ATAC RETAC does not resubmit the amended plan within the three month li. it BY SEPTEMBER 15TH the opportunity for resubmission is forfeited. COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TRAUMA PROGRAM Chapter 2 Draft May 6,2002 Page 5 of 6 211. Plans remain in effect unless the ATAC RETAC notifies the Department the plan is not functional as implemented and the ATAC RETAC wishes to replace the plan. A replacement plan must be submitted within two months after such notification. Minor modifications to a plan can be submitted with the annual report of the region, and approved by the Department at that time. Major modifications must go through the plan process specified in these rules. COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TRAUMA PROGRAM Chapter 2 Draft May 6,2002 Page 6 of 6 COLORADO STATEWIDE EMERGENCY MEDICAL AND TRAUMA CARE SYSTEM RULES ANDREGULATIONS-CHAPTER 2 AREA REGIONAL EMERGENCY MEDICAL AND TRAUMA SERVICE ADVISORY COUNCILS EXHIBIT A-ADULT PREHOSPITAL TRAUMA TRIAGE ALGORITHM Triage and transport decisions for adult trauma patients must be classified and tailspin_ted as follows: HIGH RISK ADULT TRAUMA PATIENT If there are equivalent trauma centers in an area destination will be made in accordance with the regional ATAC RETAC plan. PATIENTS WITH UNCOMPLICATED SINGLE SYSTEM EXTREMITY INJURIES MAY BE TRANSPORTED TO THE NEAREST FACILITY OR IN ACCORDANCE WITH A TAr RETAC PROTOCOLS. COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TRAUMA PROGRAM Trauma Triage Algorithm Draft May 6,2002 COLORADO EMERGENCY MEDICAL AND TRAUMA CARE SYSTEM EXHIBIT B-PEDIATRIC PREHOSPITAL TRAUMA TRIAGE ALGORITHM HIGH RISK PEDIATRIC TRAUMA PATIENT If there are equivalent trauma centers in an area destination will be made in accordance with the regional ATAG RETAC plan. I*Individuals 13 to 18 years of age,transport can follow adult or pediatric prehospital destination algorithms based on severity of illness. COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TRAUMA PROGRAM Trauma Triage Algorithm Draft May 6,2002 STATE OF COLORADO COLORADO BOARD OF HEALTH RULES AND REGULATIONS PERTAINING TO THE STATEWIDE EMERGENCY MEDICAL AND TRAUMA CARE SYSTEM CHAPTER THREE -DESIGNATION OF TRAUMA FACILITIES Definitions October 1999 On or after July 1, 1997,every facility in this state required to be licensed in accordance with article 3 of title 25 and that receives ambulance patients shall participate in the statewide EMERGENCY MEDICAL AND trauma care system. In the following rules,the teen"council"shall refer to the State EMERGENCY MEDICAL AND Trauma Advisory Council created by 25-3.5-104.3, C.R.S., and the term"ATAC""RETAC" shall refer to the area REGIONAL EMERGENCY AND Trauma Advisory Council as defined in 25-3.5-703(4 6.8), C.R.S. (19952001). Continuing Medical Education (CME). For Levels I, II,III—trauma surgeons, emergency physicians, anesthesia providers, orthopedic surgeons, and neurosurgeons shall have Facility or ATAC RETAC defined trauma related CME over a three year period with at least half provided outside of own institution. For Level IV —physicians providing trauma care shall have Facility or ATM' RETAC defined trauma related CME over a three year period. General surgeons taking trauma call at Level III and all physicians taking trauma call at Level IV centers must have successfully completed an ATLS course. Outreach —the act of providing resources to other facilities in order to improve response to the injured patient. These resources shall include, but not be limited to, clinical consultation and public and professional education. Trauma centers shall be centers of excellence and shall share this expertise with other trauma centers and non-designated facilities. Timely and appropriate communication,consultation and feedback is imperative to patient outcome. Key Resource Facilities are Level I&II trauma centers which have an expanded responsibility in providing on-going consultation,education and technical support to referring facilities,individuals,or ATACs RETACs. COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TRAUMA PROGRAM Chapter 3 Draft May 6,2002 Page I of 301. Designation Process A. Applications 3. An application for trauma center designation or re-designation must contain a signed board of director's resolution affirming the facility's commitment to seek designation and participate in the statewide EMERGENCY MEDICAL AND trauma CARE system. It also must state, at a minimum,: d.How the facility's designation or re-designation fits into its Area REGIONAL EMERGENCY Trauma Advisory Council(ATAC)(RETAC)plans, organization and geography 4. A facility requesting specialty status as a burn or pediatric trauma care center must file a request that at a minimum states: c. How the facility's specialty designation will integrate into its ATAC RETAC plan,specifically why it is a necessary component to the area ATAC RETAC and how it will enhance trauma care, as well as how it integrates into the organization and geography of the area 7. The criteria to be applied for designation facilities are provided in the in rule 303 (general criteria), rule 304 (pediatric facilities), and rules 305 and 306 (burn facilities),but shall also include: b. how the facility's designation fits into the design and plans of the ATAC RETAC, and B. Review Process 2. Such review shall be conducted by the following teams: d. Level IV facilities -team of 2 members: 1) Reviewers must reside outside of the ATAC RETAC in which the facility under review is located 4. The on-site review team shall make a verbal report of its findings(exit interview)to the applicant prior to leaving the facility. It THE DEPARTMENT shall forward written findings and recommendations to the STATE EMERGENCY MEDICAL AND TRAUMA ADVISORY Council within 30 days of the review date ACCORDING TO TIMEFRAMES CONSISTENT WITH THE COUNCIL BYLAWS. The Council, or a subcommittee thereof, shall review the reports of the on-site review team, consider any unique attributes or circumstances that make the facility capable of meeting particular or special community needs=,and render a recommendation to the Department within 60 days of receipt of the team's findings. 5. The Department shall make the final determination of designation regarding each application upon consideration of all pertinent factors, including but not limited to the application, the evaluation and recommendations by the on-site review team,the best interests of trauma patients,any unique attributes or circumstances that make the facility capable of meeting particular or special community needs', and the manner in which this application integrates into the statewide EMERGENCY MEDICAL AND trauma CARE system. COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TRAUMA PROGRAM Chapter 3 Draft May 6,2002 Page 2 of 61 8. Six months prior to the end of the designation period,the applicant shall file a notice to continue or withdraw from its designated status. If a notice to continue is filed,the Department shall verify the facility's compliance with the designation standards and these regulations and perform a new site visit which shall conform to the visits addressed in section LB. 301(B) of these regulations. 302. Denial or Revocation of Designation or redesignation. A. Denial 1. The Department may deny designation or redesignation to a facility if the facility: d. Submits an application that does not comply with or integrate into its ATAC RETAC plan C. Procedures for Revocation or Denial 1. Procedures for revocation or denial of designation or redesignation are as follows: f. If a facility chooses not to pursue the corrective plan of action,it may surrender its designation and sign a non-designation agreement,or it may appeal the denial or revocation in accordance with section I9-above 301(B)(9). COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TRAUMA PROGRAM Chapter 3 Draft May 6,2002 Page 3 of 64 2 ! ) ) w w / § F = m cn Yi § 4 ) n z § m w E. § § § o $ ; z u Q w m w u § k § g © % o (/\ GG ® H F k � ] ) 7 § \ / u �d / zdk f ) / \ ) t5 oz W � z 1414 \ k } /) \ / 0 § } § k § } ) \ \ ) \ § n 4aOO § § c ; e § Cl) . © goo t 2 o ] § \/ 7 \ ( § its \ k § % \ -O ] § ) ) B. ± & B. ) / ] ( ! { ° — o 0f \ B ! , COLORADO STATEWIDE EMERGENCY MEDICAL AND TRAUMA CARE SYSTEM RULES %ND REGULATIONS- CHAPTER 3 DESIGNATION OF TRAUMA FACILITIES 304. CRITERIA FOR TRAUMA CENTERS WITH PEDIATRIC COMMITMENT CATEGORY a ' 0 `kimN� 1•Xias T � ,,. 9L'� z I ,. tl L1'd. 8 e p ^�0 t a t , z i. � r m Syr • I t •u• w•„s .0 ' 1 I i f0 C I V0 t ffi. , "' f` ._ G`IA CYli �Tfj t ,l�i¢�'. o M 1% CI it ,_ . a. te'§tt , .' =.�e..� a i, '� citi COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TRAUM A PROGRAM Chapter 3 Draft May 6,2002 Page 5 of 6} 307. CRITERIA FOR DESIGNATED REGIONAL PEDIATRIC TRAUMA CENTERS A. Administration and organization criteria. A Regional Pediatric Trauma Center as defined in section 25-3.5-703 (4)(f) C.R.S. shall have a trauma program with: 5. A facility defined Trauma Team activation protocol. The protocol shall base activation of the team on the anatomical,physiological,mechanism of injury, and co-morbid factors as outlined in the pediatric prehospital trauma triage algorithms as set forth in Chapter 2 of the Statewide EMERGENCY MEDICAL AND Trauma CARE System Rules, 6 CCR 1015 -4. K. Organized burn care for those patients identified in section 306 of this chapter in the Statewide EMERGENCY MEDICAL AND Trauma CARE System rules, 6 CCR 1015-4, with: 1. Specialty designation as a burn center; or 2. Transfer agreements with a facility with a specialty designation as a burn center. R. Trauma divert protocols, to include: 1. A method to report trauma diverts to the Area REGIONAL EMERGENCY Trauma Advisory Council(ATAC)(RETAC) for monitoring; 2. A method for notification of prehospital providers when on divert; a. Facility defined criteria for going on divert, not to exceed those identified in the definition section of this chapter; and b. A method for monitoring times and reasons for going on divert. U. A quality assurance program in accordance with Section 303 (O)of this chapter of the Statewide EMERGENCY MEDICAL AND Trauma CARE System rules, 6 CCR 1015-4. V. Participation in ATAC RETAC quality improvement programs established in accordance with Chapter 2 of the Statewide EMERGENCY MEDICAL AND Trauma CARE System rules, 6 CCR 1015-4. COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TRAUMA PROGRAM Chapter 3 Draft May 6,2002 Page 6 of 6l Hello