Definitions and Abbreviations Relating to Trauma Centers

PURPOSE: This rule defines terminology related to trauma centers. (1) The following definitions and abbreviations shall be used in the interpretation of the rules in 19 CSR 30-40.400 to 19 CSR 30-40.450: (A) Advanced cardiac life support (ACLS) certified means that an individual has successfully completed a course of training in advanced cardiac life-support techniques certified by the American Heart Association and that certification is maintained; (B) Anesthesiologist assistant (AA) means a person who meets each of the following conditions: 1. Has graduated from an anesthesiologist assistant program accredited by the American Medical Association’s Committee on Allied Health Education and Accreditation or by its successor agency; 2. Has passed the certifying examination administered by the National Commission on Certification of Anesthesiologist Assistants; 3. Has active certification by the National Commission on Certification of Anesthesiologist Assistants; 4. Is currently licensed as an anesthesiologist assistant in the state of Missouri; and 5. Provides health care services delegated by a licensed anesthesiologist. For the purposes of subsection (1)(B), the licensed anesthesiologist shall be “immediately available” as this term is defined in section 334.400, RSMo; (C) ATLS course means the advanced trauma life-support course approved by the American College of Surgeons when required, certification shall be maintained; (D) Board-admissible means that a physician has applied to a specialty board and has received a ruling that s/he has fulfilled the requirements to take the examinations. Board certification must be obtained within five (5) years of the first appointment; (E) Board-certified means that a physician has fulfilled all requirements, has satisfactorily completed the written and oral examinations, and has been awarded a board diploma in a specialty field; (F) Certified registered nurse anesthetist (CRNA) means a registered nurse who has graduated from a school of nurse anesthesia accredited by the Council on Accreditation of Educational Programs of Nurse Anesthesia or its predecessor and who has been certified as a nurse anesthetist by the Council on Certification of Nurse Anesthetists; (G) CME means continuing medical education and refers to the highest level of continuing education approved by the Missouri State Medical Association, the Missouri Association of Osteopathic Physicians and Surgeons, The American Osteopathic Association, or the Accreditation Council for Continuing Medical Education; (H) Continuing nursing education means education approved or recognized by a national and/or state professional organization and/or trauma medical director; (I) Core surgeon is a member of the trauma team listed on the trauma call schedule ten percent (10%) of the time or greater; (J) Credentialed or credentialing is a hospital-specific system of documenting and recognizing the qualifications of medical staff and nurses and authorizing the performance of certain procedures and establishing clinical privileges in the hospital setting; (K) EMS Bureau means the Missouri Department of Health and Senior Services Emergency Medical Services Bureau; (L) Glasgow coma scale is a scoring system for assessing a patient’s level of consciousness utilizing a point system which measures eye opening, verbal response, and motor response. The higher the total score, the better the patient’s neurological status; (M) Immediately available (IA) means being present at bedside at the time of the patient’s arrival at the hospital when prior notification is possible and no more than twenty (20) minutes from the hospital under normal driving and weather conditions; (N) In-house (IH) means being on the hospital premises twenty-four (24) hours a day. (O) Liaison means one (1) physician representative from each of the following areas: Emergency Medicine, Neurosurgery, Orthopedics, and Anesthesia who is selected to attend the Performance Improvement and Patient Safety Committee and to disseminate information to the other physicians within his/ her specialty taking trauma call; (P) Missouri trauma registry is a statewide data collection system to compile and maintain statistics on mortality and morbidity of trauma victims, using a reporting method provided by the Missouri Department of Health and Senior Services; (Q) Multidisciplinary trauma conference means a meeting of members of the trauma team and other appropriate hospital personnel to review the care of trauma patients at the hospital; (R) Non-core surgeon is a member of the trauma call team listed on the trauma call schedule less than ten percent (10%) of the time; (S) PALS means pediatric advanced life support, ENPC means Emergency Nurses Pediatric Course, and APLS means Advanced Pediatrics Life Support; when required, certification shall be maintained; (T) Physician advisory group is two (2) or more physicians who collectively assume the role of a medical advisor; (U) Promptly available (PA) means arrival at the patient’s bedside within thirty (30) minutes after notification of a patient’s arrival at the hospital under normal driving and weather conditions; (V) R is a symbol to indicate that a standard is a requirement for trauma center designation at a particular level; (W) Review is the inspection of hospitals to determine compliance with the rules of this chapter. There are four (4) types of reviews: the initial review of hospitals never before designated as trauma centers or hospitals never before reviewed for compliance with the rules of this chapter or hospitals applying for a new level of trauma center designation; the verification review to evaluate the correction of any deficiencies noted in a previous review; and the validation review, which shall occur every five (5) years to assure continued compliance with the rules of this chapter, and a focus review to allow review of substantial deficiencies by a review team; (X) Revised trauma score (RTS) is a numerical methodology for categorizing the physiological status of trauma patients; (Y) Senior trauma surgery resident is a physician in at least the third post-graduate year of study; (Z) Severely injured adult patient is an injured patient with a glasgow coma score (GCS) less than fourteen (14) or a systolic blood pressure less than ninety (90) millimeters of mercury or respirations less than ten (10) per minute or more than twentynine (29) per minute. (AA) Severely injured child is defined as a patient fourteen (14) years of age or less having a GCS less than fourteen (14), shock following injury, pediatric trauma score less than eight (8), or with any of the following conditions: unable to establish or maintain an airway; ineffective respiratory effort; penetrating injury to head, neck, chest, abdomen, or extremity proximal to elbow or knee; burns greater than ten percent (10%) of the body surface area or involving inhalation injury; two (2) or more proximal long bone fractures or pelvic fracture; open or depressed skull fracture; suspected spinal cord injury and/ or paralysis; amputation proximal to wrist or ankle; facial or tracheal injury with airway compromise; pre-existing medical conditions; or respiratory or cardiopulmonary arrest after injury; (BB) Surgical trauma call roster is a hospital-specific list of surgeons assigned to trauma care, including date(s) of coverage and back-up surgeons when indicated; (CC) Trauma center is a hospital that has been designated in accordance with the rules in this chapter to provide systematized medical and nursing care to trauma patients. Level I is the highest level of designation and functions as a resource center for the hospitals within that region. Level II is the next highest level of designation dealing with large volumes of serious trauma. Level III is the next level with limited resources; (DD) Trauma medical director is a surgeon designated by the hospital who is responsible for the trauma service and performance improvement and patient safety programs related to trauma care; (EE) Trauma nurse coordinator/trauma program manager is a registered nurse designated by the hospital with responsibility for monitoring and evaluating the care of trauma patients and the coordination of performance improvement and patient safety programs for the trauma center in conjunction with the trauma medical director; (FF) Trauma nursing course is an education program in nursing care of trauma patients; (GG) Trauma service is an organizational component of the hospital specializing in the care of injured patients; (HH) Trauma team is a team consisting of the emergency physician, physicians on the surgical trauma call roster, appropriate anesthesiology staff, nursing, and other support staff as needed; (II) Trauma team activation protocol is a hospital document outlining the criteria used to identify severely injured patients and the procedures for notification of trauma team members and indicating surgical and non-surgical specialty response times acceptable for treating major trauma patients; (JJ) Trauma triage is an estimation of injury severity at the scene of an accident; and (KK) Virtual review means a type of review conducted through the use of secure virtual video and audio conferencing and secure file transfers in order to determine compliance with the rules of this chapter. AUTHORITY: section 190.185, RSMo 2016, and section 190.241, RSMo Supp. 2022.* Emergency rule filed Aug. 28, 1998, effective Sept. 7, 1998, expired March 5, 1999. Original rule filed Sept. 1, 1998, effective Feb. 28, 1999. Amended: Filed Jan. 16, 2007, effective Aug. 30, 2007. Amended: Filed May 19, 2008, effective Jan. 30, 2009. Emergency amendment filed Nov. 21, 2022, effective Dec. 7, 2022, expires June 4, 2023. Amended: Filed Nov. 21, 2022, effective June 30, 2023. *Original authority: 190.185, RSMo 1973, amended 1989, 1993, 1995, 1998, 2002, and 190.241, RSMo 1987, amended 1998, 2008, 2016, 2017, 2022.