Emergency services

1. Each general acute hospital shall provide emergency services to its inpatients. If the hospital does not provide emergency services to the public, it shall be prepared to provide immediate lifesaving measures to individuals who may appear for emergency care and arrange for their transfer to another hospital that does provide a public emergency service. a. Each hospital shall have a well-defined plan for emergency care service based on the capability of the hospital and its specialized supportive services. (1) The hospital plan for emergency care services must be developed to coordinate with representatives of community emergency medical services agencies or groups. (2) Hospitals without emergency service for the public shall have written policies and procedures governing the handling of emergencies. b. Every hospital with an emergency service shall provide treatment to every individual in an emergency without discrimination on account of economic status or source of payment. c. Every emergency service shall have a qualified licensed health care practitioner designated in charge of the emergency medical services to ensure that emergency patient care services meet the standards herein and for the coordination of professional coverage according to a plan established by the medical staff and approved by the governing body. d. A hospital must have one or more licensed health care practitioners qualified by training and experience in care of emergency patients on duty or call at all times and available to respond to emergencies within thirty minutes. The licensed health care practitioner shall determine the nature, level, and urgency of care required of all individuals seeking treatment and categorize them accordingly, assuring that serious cases are accorded priority treatment. e. The staffing pattern of nursing or allied health personnel must be consistent with the scope and complexity of the emergency services provided. At least one licensed individual who is qualified by training and experience in emergency care must be assigned to the emergency services at all times. f. A current roster of licensed health care practitioners, medical specialists, or consultants on emergency call, including alternates, must be kept posted at all times in the emergency service area. g. There must be current written policies governing emergency services. The policies and procedures must pertain to at least the following: (1) Medical staff and obligation for emergency patient care. (2) Circumstances under which definitive care will not be provided and procedures to be followed in referrals. (3) Procedures that may or may not be performed in the emergency service area. (4) Handling of individuals who are emotionally ill, under the influence of drugs or alcohol, dead on arrival, or other categories of special cases as determined necessary. (5) Procedures for early transfer of severely ill or injured to special in-house treatment areas or to other facilities. (6) Written instructions to be given for followup care and disposition of all cases. (7) Notification of patient's personal licensed health care practitioner and transmission of relevant reports. (8) Disclosure of patient information in accordance with federal and state law. (9) Communication with police, health authorities, and emergency vehicle operators. (10) Appropriate utilization of observation beds. (11) Procurement of equipment and drugs. (12) Location and storage of medications, supplies, and special equipment. (13) Operation of the emergency service in times of disaster. h. A list of poison antidotes and the telephone number of the poison control center must be posted in a prominent place in the emergency service area. i. The emergency service shall have necessary supportive services available on a twenty-four-hour basis. These services must include onsite clinical laboratory service plasma expanders, provision for blood or blood products; pharmaceutical service; onsite radiology service including protocol to govern the interpretation by a radiologist of diagnostic images produced by x-ray, or other modalities if provided, including a procedure for the prompt communication of the radiologist's interpretation; and surgical and anesthesia service or referral process for surgical and anesthesia service. j. At a minimum, the following special supplies and equipment must be available in a complete set of adult and pediatric sizes for the provision of emergency services: (1) Oxygen. (2) Pulse oximeter. (3) Complete set of bag/valve/mask ventilation devices. (4) Complete set of oral and nasal airways. (5) Suction equipment. (6) Endotracheal intubation, pericardiocentesis, thoracotomy, and cricotracheotomy trays. (7) Electrocardiograph. (8) Cardiac monitor and defibrillator with battery pack. (9) Moveable equipment cart for use as a crash cart. (10) American heart association advanced cardiac life support recommended drug inventory. (11) Intravenous fluids including lactated ringers solution and dextrose five percent in water. (12) Infusion pump. (13) Pressure infuser. (14) Gastric lavage equipment. (15) Urinary catheter kits. (16) Emergency obstetrical pack. (17) Spine board. (18) Rigid cervical collars. (19) Fracture splints. (20) Sterile dressings and bandages. (21) Gurney or exam table. k. Facilities must be provided to assure prompt diagnosis and emergency treatment. (1) Facilities must be separate from, and independent of, the operating rooms. (2) The location of the emergency services must be easily accessible from an exterior entrance of the hospital. l. Adequate emergency room medical records on every patient must be kept and must include: (1) Patient identification and history of disease or injury. (2) Physical findings and laboratory and x-ray reports, if any. (3) Time of arrival, time of treatment, major diagnosis, treatment provided, and disposition including discharge instructions. 2. Primary care hospitals are subject to the emergency services requirements for general acute hospitals in this section. Primary care hospitals providing emergency services to the public may provide low intensity outpatient services consistent with those services commonly provided in a physician's office and consistent with the privileges granted to the licensed health care practitioner rendering the service. 3. Specialized hospitals are subject to the emergency services requirements for general acute hospitals in this section, with the exception of rural emergency hospitals, which are subject to the emergency services requirements for primary care hospitals in this section.