Pediatric Trauma

(1) A CRPC and a state designated pediatric trauma center shall have a pediatric trauma program with the following requirements: (a) A pediatric trauma medical director who shall be a pediatric surgeon, board certified/board eligible in pediatric surgery, with demonstrated competence in care of the injured child. The director shall have full responsibility and authority for the pediatric trauma program and shall meet the following requirements: 1. 36 hours of category I external trauma/critical care CME every three (3) years or twelve (12) hours each year, and attend one national meeting whose focus is pediatric trauma or critical care every three (3) years; 2. Participates in the physician call schedule; 3. Has the authority to manage all aspects of trauma care; 4. Authorizes trauma service privileges of the on-call providers; 5. Works in cooperation with nursing administration to support the nursing needs of trauma patients; 6. Develops treatment protocols along with the trauma team; 7. Coordinates performance improvement and peer review processes; 8. With the assistance of the facility administration and the trauma program coordinator, be involved in coordinating the budgetary process for the trauma program; 9. Participates in regional and national trauma organizations; and 10. Retains a current ATLS certification and participates in the provision of trauma- related instruction to other health care personnel. STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 (b) Current board certified/board eligible pediatric surgeons on the trauma service who shall have successfully completed the ATLS course at least once. Maintenance of current ATLS status is strongly encouraged. (c) Shall be involved in local/regional EMS agencies/facilities and/or personnel and assist in trauma education, performance improvement, and feedback regarding care. (d) A trauma program leader who shall: 1. Be an RN with experience in pediatric emergency and/or critical care nursing; 2. Have a defined job description and organizational chart delineating roles and responsibilities; 3. Be provided the administrative and budgetary support to complete educational, clinical, administrative and outreach activities for the trauma program; and 4. Show evidence of educational preparation with a minimum of 12 hours internal or external of trauma related continuing education per year. This shall include attending one (1) national meeting within a three (3) year trauma program designated cycle. (e) Shall submit trauma registry data electronically to the state trauma registry on all closed patient files for the Board to analyze. 1. Data shall be transmitted to the state trauma registry in accordance with the state trauma rules. Failure to submit data may result in the delinquent facility’s necessity to appear before the Board for any disciplinary action it deems appropriate. 2. Shall have a full-time equivalent trauma registrar for each five hundred (500) through seven hundred fifty (750) trauma patients per year. (f) The pediatric trauma program must annually admit two hundred (200) or more pediatric trauma patients younger than fifteen (15) years of age. These admissions may include inpatient or twenty-three (23) hour observations, but should exclude patients admitted for drowning, poisoning, foreign bodies, asphyxiation or suffocation without presence of injury, patients who are dead on arrival to the facility or other pediatric patients excluded as per the most recent version of the Resources for Optimal Care of the Injured Patient by the American College of Surgeons Committee on Trauma. (g) Shall have a pediatric trauma committee chaired by the pediatric trauma medical director with designated representation from pediatric general surgery and liaisons to the trauma program from pediatric emergency medicine, pediatric critical care, neurosurgery, pediatric anesthesia, pediatric radiology, pediatric orthopedics, and the pediatric trauma program leader. The pediatric trauma committee shall meet at least quarterly. Members or designees shall attend at least fifty percent (50%) of meetings. 1. This committee shall assure participation in a pediatric trauma process improvement program with the following requirements and responsibilities: (i) Administration shall provide resources to support the trauma process improvement program; (ii) A performance improvement coordinator shall be designated with dedicated time for this responsibility; STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 (iii) The trauma registry shall be used to support the PIPS process; (iv) Identify process and outcome measures; (v) Have a morbidity and mortality review of trauma patients; (vi) Maintain a trauma bypass/diversion log: (I) Trauma bypass/diversion shall not exceed five percent (5%). (II) Pediatric surgery on-call shall be involved in bypass/diversion decisions. (III) All bypass/diversions shall be reviewed. (vii) Document and review response/consult times for pediatric surgeons, neurosurgeons, pediatric anesthesia, and pediatric orthopedists, all of whom must demonstrate eighty percent (80%) compliance with facility determined timed guidelines; (viii) Monitor team notification times. For highest level of trauma activation, the pediatric trauma surgeon must be present within fifteen (15) minutes of patient arrival eighty percent (80%) of the time; (ix) Review pre-hospital trauma care to include patients dead on arrival; (x) Review times, reasons and appropriateness of care for transfer of injured patients; (xi) Demonstrate that action taken as a result of issues identified in the process improvement program created a measurable improvement. Documentation shall include where appropriate: problem identification, analysis, preventability, action plan, implementation and reevaluation; (xii) Evaluation of operational process improvement (evaluation of systems issues) shall occur to address, assess, and correct global trauma program and system issues, and correct overall program deficiencies to continue to optimize patient care. (h) Shall have clearly defined graded activation criteria. 1. Criteria for the highest level of activation shall be clearly defined and evaluated by the pediatric trauma committee. 2. For the highest level of activation, the trauma team shall be immediately available and the pediatric trauma attending available within fifteen (15) minutes of patient arrival eighty percent (80%) of the time, and shall include a trauma chief resident with three (3) to five (5) years of post-graduate year training or a pediatric emergency physician. (i) Shall have an injury prevention program which: 1. Shall have an organized and effective approach to injury prevention and must prioritize those efforts based on trauma registry and epidemiologic data; STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 2. Shall have a full-time injury prevention coordinator dedicated to the trauma program to ensure community and regional injury prevention activities are implemented and evaluated for effectiveness; 3. Shall implement at least two programs that address one of the major causes of injury in the community; and 4. Shall screen for alcohol and drug abuse in admitted patients. (j) The PTC shall also have other subspecialty trained surgical and medical providers who are board eligible or board certified and meeting the requirements of maintenance of certification, or who are credentialed providers in Tennessee prior to the promulgation of these rules in their respective subspecialty as listed in Table 1. (2) State Pediatric Trauma Center Designation (a) The Board shall implement the designation process. (b) The preliminary designation process for facilities aspiring for designation as a Pediatric Trauma Center shall consist of the following: 1. Each facility desiring designation shall submit an application to the Board; 2. A Department site visit team (“team”) shall review each submitted application and shall act in an advisory capacity to the Board; 3. The team shall communicate deemed application deficiencies to the facility in writing; 4. The facility shall have thirty (30) days to submit required information; and 5. Arrangements shall be made for a provisional site visit for those facilities meeting application requirements. (c) The site visit team shall consist of the following for Pediatric Trauma Centers: 1. A pediatric trauma surgeon medical director or a pediatric trauma surgeon who has previously been a medical director from an out-of-state pediatric trauma center who shall serve as team leader. 2. A pediatric trauma surgeon from an in-state pediatric trauma center. 3. An in-state pediatric trauma leader from a pediatric trauma center. 4. The state trauma program manager and/or state EMS director. (d) The team shall be appointed by the state trauma system director and/or state trauma system assistant director. (e) The team shall conduct a provisional visit to ensure compliance with all criteria required for designation as a Pediatric Trauma Center. During the provisional visit, the applicant shall demonstrate that the required mechanisms to meet the criteria for the desired designation level are in place. (f) The team shall identify deficiencies and areas for improvement it deems necessary for designation. STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 (g) If the team does not cite any deficiencies and concludes that the facility is otherwise in compliance with all applicable standards, it shall approve the applicant to function with provisional status for a period of one (1) year. (h) If, during the provisional visit, the team cites deficiencies, it shall not approve provisional status for the applicant to function as a Pediatric Trauma Center. Centers with deficiencies shall have fifteen (15) days from receipt of the deficiency report to provide documentation demonstrating compliance. If the facility is unable to correct the deficiencies within fifteen (15) days, the application shall be denied, and the applicant may not resubmit an application for trauma center designation for at least one (1) year from the date of denial. (i) Facilities granted provisional status as a Pediatric Trauma Center shall adhere to the following: 1. The facility shall be prepared to provide: (i) A description of changes made after the grant of provisional status; (ii) A description of areas of improvement cited during the provisional visit; and (iii) A summary of the facility’s trauma service based on the trauma registry report. 2. The team shall conduct a site visit at the termination of the applicant’s one (1) year provisional designation as a Pediatric Trauma Center. 3. During the follow-up visit, the team shall identify the presence of deficiencies and areas of improvement. (j) Upon completion of the follow-up visit, the team shall submit its findings and designation recommendation to the Board. 1. If the team cites deficiencies found during its follow-up visit, they shall be included in its report to the Board. 2. At the time that the team’s report is presented to the Board, the facility requesting Pediatric Trauma Center designation shall be allowed to present evidence to the Board demonstrating action taken to correct the cited deficiencies. (k) The final decision regarding Pediatric Trauma Center designation shall be rendered by the Board. If granted, the designation is in effect for a period of three (3) years. (l) If the Board denies the application, the facility may not reapply for at least one (1) year. If provisional status was granted, such status will be revoked. (m) The facility applying for Pediatric Trauma Center designation shall bear all costs of the application process, including the costs of a site visit. (n) A facility seeking a consultation/verification site visit through the American College of Surgeons as a Level I Pediatric Trauma Center shall coordinate with state trauma system director and/or state trauma system assistant director to ensure his/her attendance at the ACS site visit. If state trauma system director and/or state trauma system assistant director is unable to attend the site visit, the finalized report from the site visit shall be shared with the state trauma system director and/or state trauma STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 system assistant director for presentation to the Board if the facility seeks a reciprocal designation as a Pediatric Trauma Center. (o) Denial of Provisional or Full Designation. When the Board denies provisional or full designation, it must provide the facility with a written notification of the action and the basis for the action. The notice will inform the facility of the right to appeal and the procedure to appeal the action under the provisions of the Uniform Administrative Procedures Act. (3) State Pediatric Trauma Center Verification (a) Following designation as a pediatric trauma center, a verification site visit shall be conducted at the facility every three (3) years. (b) The team shall advise the center of an upcoming verification visit at least sixty (60) days prior to the visit. After the facility receives notice of the upcoming verification site visit, it shall prepare all materials the team requests for submission. (c) The team shall conduct an exit interview with the facility at the conclusion of the verification visit. (d) During the exit interview the team shall communicate the following: 1. The presence of deficiencies; 2. The facility’s strengths and weaknesses; and 3. Recommendations for improvements and correction of deficiencies. (e) The team shall submit a site visit report within sixty (60) days of completion of the site visit. It shall submit a copy of the report to the Board, the Chief Executive Officer of the facility, the Pediatric Trauma Medical Director and the Pediatric Trauma Program Manager (TPM). (f) If the team does not cite deficiencies and the center is in compliance with all applicable standards, it shall recommend that the facility maintain its designation as a Pediatric Trauma Center for a period of three (3) additional years. (g) If during the site visit the team identifies deficiencies, the center shall have a period not to exceed sixty (60) days to correct deficiencies. (h) If the team ascertains that deficiencies have not been corrected within sixty (60) days, whether through desk review or an on-site visit, the center must present an explanation to the Board at its next scheduled meeting. (i) The facility shall bear all costs of the verification process, including the costs of a site visit. (j) If a Pediatric Trauma Center already designated by the Board elects to undergo an American College of Surgeons Pediatric Level I trauma center consultation/verification site visit, the facility shall coordinate with the state trauma system director and/or state trauma system assistant director to ensure his/her attendance at the review. If the state trauma system director and/or state trauma system assistant director is unable to attend the site visit, the finalized report from the site visit shall be shared with the state trauma system director and/or state trauma system assistant director for presentation STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 to the Board if the facility seeks a reciprocal state designation as a Pediatric Trauma Center. (4) State Pediatric Trauma Center Disciplinary Action (a) The Board may, in accordance with the Uniform Administrative Procedures Act, revoke, suspend, place on probation, or otherwise discipline, a facility’s trauma center designation. (b) The Board may revoke, suspend, place on probation, or otherwise discipline, the designation or provisional status of a center when an owner, officer, director, manager, employee or independent contractor: 1. Fails to comply with the provisions of these rules; 2. Makes a false statement of material fact about the center’s capabilities or other pertinent circumstances in any record or matter under investigation for any purposes connected with these rules; 3. Prevents, interferes with, or attempts to impede in any way, the work of a representative of the Board; 4. Falsely advertises or in any way misrepresents the facility’s ability to care for patients based on its designation status; 5. Fails to provide reports required by the trauma registry or the Commission in a timely and complete fashion; or 6. Fails to comply with or complete a plan of correction in the time or manner specified. (c) Denial of Provisional or Full Designation. When the Board denies provisional or full designation, it must provide the center with a written notification of the action and the basis for the action. The notice will inform the center of the right to appeal and the procedure to appeal the action under the provisions of the Uniform Administrative Procedures Act. (5) State Pediatric Trauma Center Prohibitions (a) It shall be a violation of these regulations for any health care facility to hold out, advertise or otherwise represent itself to be a “trauma center” as licensed by the Board unless it has complied with the regulations set out herein and the Board has so designated it. (b) Any facility the Board designates as a trauma center, at any level, shall comply with the requirements of EMTALA. The medical needs of a patient and the available medical resources of the facility, rather than the financial resources of a patient, shall be the determining factors concerning the scope of service provided. (c) The term “trauma center” refers to a main facility campus that has met all requirements to satisfy trauma center rule designation. Off campus sites are excluded in this designation. Authority: T.C.A. §§ 68-11-202, 68-11-209, and 68-11-251. Administrative History: New rule filed July 10, 2025; effective October 8, 2025. STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 0720-31 TABLE 1. Table 1 (Parts 1–6) provides a summary for emergency care facilities for each level of pediatric health care. Personnel, equipment, and issues that are essential at each designation or level are described as either being essential in the emergency department (EED), essential in the pediatric intensive care unit (EPI), essential within the facility (EF), essential in the facility and immediately available within 15 minutes (EFI), or promptly available (EP). An optional but strongly encouraged category (SE) is used to describe personnel, activities or issues that may be essential to network a comprehensive regionalized EMS- EMSC system in rural areas. Although these are not generally required of a specific facility, they are strongly encouraged if such services are not available within a reasonable distance.* *Some services are usually available at a Comprehensive Regional Pediatric Center but, if not provided, then transfer agreements must be in place (ES). Other capabilities must be available in the pediatric intensive care units but should be promptly available to the emergency department and facility (EPI and EP). 1 All medical specialists shall have pediatric expertise as evidenced by board certification, fellowship training, or demonstrated commitment and continuing medical education in their subspecialty area. 2 A forensic pathologist must be available either as part of the facility staff or on a consulting basis. 3 Medications may be exempted if the facility can demonstrate PALS recommendation changes, manufacturer recalls or shortages, or Food and Drug Administration requirement issues. 4 A resident in postgraduate year >3 or a pediatric emergency attending physician who is part of the trauma team may be approved to begin resuscitation while awaiting the arrival of the pediatric surgery attending/fellow, but cannot independently fulfill the responsibilities of, or substitute for, the pediatric surgery attending/fellow. The presence of such a resident or attending pediatric emergency physician may allow the surgery attending/fellow to participate in the physician call schedule from outside the facility. 5 This requirement can also be met by having one surgeon who is board certified or board eligible with demonstrated interest and skills in pediatric neurosurgical trauma care. This is evidenced by 12 hours of pediatric neurosurgical CMEs per year, of which 8 are pediatric trauma care. 6 The Vascular surgeon requirement may be provided by a pediatric trauma surgeon. TABLE 1. PEDIATRIC EMERGENCY CARE FACILITIES Part 1/6 FACILITY DESIGNATION/LEVEL 1. PERSONNEL CRPC General w/PICU General Primary Basic PTC Physician with pediatric emergency care experience EED EED EED EED EP EED RN with pediatric training EED&EPI EED&EPI EED EED EED EED& EPI Full-time ED RN personnel 24 hours a day trained in pediatric trauma specific education/competencies E E Respiratory therapist EED&EPI EED&EPI EF EF EED& EPI Trauma program leader E SE E CRPC Coordinator E Nurse educator EED&EPI EED&EPI E SE SE E Trauma team E SE SE SE E STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 Physician Pediatric Emergency Care Coordinator EED EED EED EED EED E Nursing Pediatric Emergency Care Coordinator EED EED EED EED EED E Pediatric Anesthesia Services EP EP EP EP EFI Specialist consultants Pediatrician EP EP EP EP SE EP Pediatric Radiologist EP SE SE SE SE EP Radiologist EP EP EP SE Anesthesiologist EP EP SE Pediatric Anesthesiologist EP EP EP Pediatric Cardiologist EP EP EP Pediatric Critical Care Physician EP EP EFI Pediatric Nephrologist EP SE EP Pediatric Hematologist/Oncologist EP SE EP Pediatric Endocrinologist EP SE EP Pediatric Gastroenterologist EP SE EP Neurologist EP Pediatric Neurologist EP SE EP Pediatric Pulmonologist EP SE EP Psychiatrist/Psychologist EP SE EP Pediatric Infectious Disease Physician EP SE EP Physical Medicine/Rehabilitation Physician E E Interventional Radiologist EP Pathology EP2 E Surgical specialists General surgeon EP EP SE Pediatric surgeon EP EP SE EFI4 Neurosurgery EP Pediatric Neurosurgeon SE SE SE EP5 Pediatric Orthopedic surgeon EP E SE SE EP Otolaryngologist EP Pediatric Otolaryngologist EP SE EP Pediatric Urologist EP EP Pediatric Plastic surgeon * EP EP Oral/Maxillofacial surgeon EP EP Gynecologist EP EP Microvascular surgeon * EP EP Hand surgeon * EP EP Pediatric Ophthalmologist EP E EP Pediatric Cardiac surgeon * EP EP Vascular surgeon * EP6 EP6 Rehabilitation Program Physical Therapy E E E Occupational Therapy E E E Speech Therapy E E E School Education Program E E Part 2/6 FACILITY DESIGNATION/LEVEL 2. EQUIPMENT AND SUPPLIES CRPC General w/ PICU General Primary Basic PTC EMS communication equipment E E E E E E Organized emergency cart EED&EPI EED&EPI EED EED EED EED A length based resuscitation tape and precalculated pediatric drug dosing reference in EED&EPI EED&EPI EED EED EED EED STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 mg and mL Tourniquets for hemorrhage control EED EED EED EED EED EED Ultrasound for performing FAST examination EED Monitoring devices Continuous pulse oximeter monitoring with alarms (adult/pediatric probes) EED&EPI EED&EPI EED EED EED EED& EPI Blood pressure cuffs (infant, child, adult) EED&EPI EED&EPI EED EED EED EED& EPI Rectal thermometer probe EED&EPI EED&EPI EED EF EF EED& EPI Otoscope, ophthalmoscope, stethoscope EED&EPI EED&EPI EED EED EED EED& EPI Cardiopulmonary monitor and defibrillator with pediatric paddles or pads and hard copy capability, visible/audible alarms, routine testing and maintenance EED&EPI EED&EPI EED EED EF EED& EPI Noninvasive blood pressure monitoring (infant, child, adult) EED&EPI EED&EPI EED EF EED& EPI End tidal CO2 detector for neonate and child EED&EPI EED&EPI EED EED EED EED& EPI End tidal CO2 monitor EED&EPI EED&EPI EED EED EED EED& EPI Monitor for central venous pressure, arterial lines, temperature EF&EPI EF&EPI EF&E PI Monitor for intracranial pressure EPI EPI Transportable monitor EED&EPI EED&EPI EED EF EF EED& EPI Airway control/ventilation equipment Bag-valve-mask device: neonatal, pediatric, and adult with oxygen reservoir and without pop-off valve. Infant, child, and adult masks EED&EPI EED&EPI EED EED EED EED& EPI Oxygen delivery device with flow meter EED&EPI EED&EPI EED EED EED EED& EPI Oral airway (1 set of sizes 0–5 or equivalent) EED&EPI EED&EPI EED EED EED EED& EPI Clear non-rebreathing oxygen masks (neonatal to adult size) EED&EPI EED&EPI EED EED EED EED& EPI Nasal cannula (infant, child, adult) EED&EPI EED&EPI EED EED EED EED& EPI PEEP valve EED&EPI EED&EPI EED EED& EPI Suction devices-catheters 6–14 fr, rigid-tip/suction equipment EED&EPI EED&EPI EED EED EED EED& EPI Nasal airways (infant, child, adult) EED&EPI EED&EPI EED EED EED EED& EPI Nasogastric tubes (sizes 8–16 fr) EED&EPI EED&EPI EED EED EED EED& EPI Laryngoscope handle and blades - curved 2, 3, 4 EED&EPI EED&EPI EED EED EED EED& EPI - straight 0, 1, 2, 3 EED&EPI EED&EPI EED EED EED EED& EPI Endotracheal tubes: sizes 2.5–3.0 uncuffed and sizes 3.0–8.0 cuffed EED&EPI EED&EPI EED EED EED EED& EPI Stylets for endotracheal tubes (pediatric, adult) EED&EPI EED&EPI EED EED EED EED& EPI Lubricant, water soluble EED EED&EPI EED EED EED EED Magill forceps (pediatric, adult) EED EED&EPI EED EED EED EED STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 Spirometers and chest physiotherapy equipment EF EF EF EF EF Inhalation therapy equipment (pediatric and adult sizes) EED&EPI EED&EPI EED EED EED EED& EPI Tracheostomy tubes (sizes 3–6) EF EF EF EF EF Nasal atomizer EED EED EED EED EED EED Pediatric endoscopes and bronchoscopes available EF EF EF EF Pediatric conventional ventilators EED&EPI EED&EPI EF EED& EPI High frequency oscillatory ventilator EPI EPI EPI Difficult airway equipment and protocol for the management of patients with a difficult airway EED&EPI EED&EPI EED SE SE EED& EPI Vascular access supplies Arm boards (infant, child, and adult sizes) EED&EPI EED&EPI EED EED EED EED& EPI Catheters for intravenous lines (16–24 gauge) EED&EPI EED&EPI EED EED EED EED& EPI Needles (various sizes ranging 18–27 gauge) EED&EPI EED&EPI EED EED EED EED& EPI Intraosseous needles EED&EPI EED&EPI EED EED EED EED& EPI Umbilical vessel catheters (3,5 fr) and cannulation tray EED EED EED EF SE EED IV administration sets and extension tubing, stopcocks, luer to luer connectors and T- connectors EED&EPI EED&EPI EED EED EED EED& EPI Ultrasound machine for vascular access EED&EPI EED&EPI EED& EPI Infusion device able to regulate rate and volume of infusate EED&EPI EED&EPI EED EED EED EED& EPI Central venous access catheters (4–7 fr) EED&EPI EED&EPI EED EED& EPI IV fluid/blood warmer EED&EPI EED&EPI EED EF SE EED& EPI Blood gas kit EED&EPI EED&EPI EED EF SE EED& EPI Rapid infusion device EED&EPI EED&EPI EF SE SE EED& EPI Specialized pediatric trays Lumbar puncture EED&EPI EED&EPI EED EED EF EED& EPI Urinary catheterization: Foley 6–14 fr (may accept a 5 or 6 fr feeding tube or umbilical catheter as compliant for the 6 fr Foley) EED&EPI EED&EPI EED EED EED EED& EPI Thoracostomy tray with chest tube sizes 10–28 fr EED&EPI EED&EPI EED SE EED& EPI Intracranial pressure monitor tray EED&EPI EED& EPI Obstetrical Kit EED EED EED EED EED EED Thoracotomy Tray EF EF Pediatric Pericardiocentesis Tray EF EF Fracture management devices Cervical immobilization equipment suitable for ped. patients EED EED EED EED EED EED Spine board (child/adult) EED EED EED EED EED EED Extremity splints EED EED EED EED EED EED Femur splint; child, adult EED EED EED EED EED EED STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 Medications3 Beta-2 agonist for inhalation EED&EPI EED&EPI EED EED EED EED& EPI Calcium chloride EED&EPI EED&EPI EED EF EF EED& EPI Corticosteroids (dexamethasone, methylprednisolone) EED EED&EPI EED EED EED EED Cyanide kit and pediatric doses EED EF EF SE SE EED Dantrolene EF EF EF EF EF EF Dextrose – 10% and 25% EED&EPI EED&EPI EED EED EED EED& EPI Digoxin antibody EF EF EF EF SE EF Diphenhydramine EED EED EED EED EF EED Epinephrine (1:1,000 or 1mg/mL) EED&EPI EED&EPI EED EED EED EED& EPI Epinephrine (1:10,000 or 0.1mg/mL) EED&EPI EED&EPI EED EED EED EED& EPI Factor VIII, IX concentrates, DDAVP EF EF EF EF EF Flumazenil EF EF EF EF EF EF Furosemide EED&EPI EED&EPI EED EED EF EED& EPI Glucagon EED EED EED EED EED Hypertonic 3% sodium chloride IV solution EED&EPI EED&EPI EF EF EF EED& EPI Insulin EF EF EF EF EF EF Intralipid EF EF EF SE EF Isotonic balanced salt solution and D5NS EED&EPI EED&EPI EED EED EED EED& EPI Kayexalate EF EF EF EF EF Ketamine EED&EPI EED&EPI EED EED EF EED& EPI Magnesium sulfate EED&EPI EED&EPI EED EF EF EED& EPI Mannitol-20% EED&EPI EED&EPI EF EF EF EED& EPI Methylene blue EF EF EF EF EF EF N-acetyl cysteine EF EF EF EF SE EF Naloxone EED&EPI EED&EPI EED EED EED EED& EPI Nitric oxide EF EF EF Ondansetron EF EF EF EF EF EF Potassium chloride EF EF EF EF EF EF Prostaglandin EF EF EF EF EF Sodium bicarbonate 4.2% and 8.4% EED&EPI EED&EPI EED EED EED EF Succinylcholine EED EED EED EF EF Whole bowel irrigation solution EF EF EF EF EF Medication classes Analgesics EED EED EED EF EF EED Antibiotics EED EED EED EED EF EED Anticonvulsants EED&EPI EED&EPI EED EED EED EED& EPI Antihypertensive agents EED EED EED EF EF EED Antipyretics EED EED EED EED EF EED PALS and ACLS medications EED&EPI EED&EPI EED EED EED EED& EPI STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 Chelating agents for heavy metal poisonings EF EF EF Nondepolarizing neuromuscular blocking agents EED EED EED EED EED EED Rapid sequence intubation medications EED&EPI EED&EPI EED EF EED EED& EPI Sedatives and antianxiety medications EED&EPI EED&EPI EED EF EF EED& EPI Miscellaneous Resuscitation board EED&EPI EED&EPI EED EED EED EED& EPI Infant and child scale (measure in kg only) EED&EPI EED&EPI EED EED EED EED& EPI Heating source (for infant warming) EED&EPI EED&EPI EED EED EED EED& EPI Pediatric restraint equipment EED EED EED EED EED Portable radiography EED&EF EED&EF EF EF EED& EPI Slit Lamp EF EF EF EF EF Infant incubators EF EF EF Bilirubin lights EF EF EF Pacemaker capability EF EF EF EF Thermal control for patient and/or resuscitation room EED EED EED EED EED Part 3/6 FACILITY DESIGNATION/LEVEL 3. FACILITIES CRPC General w/ PICU General Primary Basic PTC Emergency Department Two or more areas with capacity and equipment to resuscitate medical/surgical/trauma pediatric patients E E One or more areas as above E E Access to helicopter landing site E E E E E E Facility Support Services Pediatric inpatient care E E E E Pediatric intensive care unit E E E Child abuse team E E E E Child life support EF EF EF Operating Room Operating room staff EP EP EP SE EP One PALS certified RN physically present in the OR for pediatric procedures E E E E Operating room, dedicated to the trauma service, with adequate staff in-house and immediately available 24 hours a day E Second operating room available and staffed within 30 minutes E E Thermal control equipment E E E E X-ray capability, including C-arm E E E E Endoscopes, all varieties E E Craniotomy equipment, including ICP monitoring equipment E E Invasive and noninvasive monitoring equipment E E E E Pediatric anesthesia and ventilation equipment E E E E Pediatric airway control equipment E E E E STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 Defibrillator, monitor, including internal and external paddles E E E E Laparotomy tray E E E E A rapid volume infuser for the utilization of transfusion protocol E Thoracotomy tray and chest retractors of appropriate size E E Synthetic grafts of all sizes E E Spinal and neck immobilization equipment E E Fracture table with pediatric capability E E Auto-transfusion with pediatric capability E E Precalulated pediatric drug dosing reference in mg and mL E E E E E E Tracheostomy tubes, neonatal through adolescent E E E E Anesthesia and surgical suite promptly available EP EP EP SE Pediatric Intensive Care Unit Distinct, controlled access unit E E E Proximity to elevators E E E MD on-call room E E E Waiting room and separate family counseling room E E E Patients’ personal effects storage and privacy provision E E E Patient isolation capacity and isolation cart E E E Medication station with drug refrigerator and locked cabinet E E E Precalculated pediatric drug dosing reference in mg and mL E E E Emergency equipment storage E E E Separate clean and soiled utility rooms E E E Nourishment station E E E Separate staff and patient toilets E E E Two oxygen, two vacuum, and > 2 compressed air outlets/bed E E E Computerized lab reporting E E E Easy, rapid access to head of beds and cribs E E E Pressure monitoring capability, with simultaneous pressures E E E Patient isolation capability E E E Recovery Room RNs and other essential personnel on call 24 hrs/ day E E E E* E Staff competent in the post-anesthesia care of the pediatric pt. E E E E* E Airway equipment E E E E* E Pressure monitoring capability E E E E* E Thermal control equipment E E E E* E Blood warmer E E E E* E Resuscitation cart E E E E* E Immediate access to sterile surgical supplies for emergency E E E E* E Pediatric drug dosage chart E E E E E E* If surgery performed on pediatric patients Laboratory Services Hematology E E E E E E Chemistry E E E E E E STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 Microbiology E E E E SE E Microcapabilities E E E E Blood bank E E E SE E Shall have a pediatric transfusion protocol developed collaboratively between the trauma service and the blood bank (i.e. MTP) E Drug levels/toxicology E E SE SE E Blood gases E E E E E Radiology Services Routine services 24 hours per day EF EF EF E E EF Computed tomography scan 24 hours per day EF EF E SE EF Ultrasound 24 hours per day E E E SE E Magnetic Resonance Imaging Availability E E E E Nuclear medicine E SE SE E Fluoroscopy/contrast studies 24 hours per day E E E SE E Angiography 24 hours per day E E E SE E Interventional Radiology Services E Other Pediatric Echocardiography EP EP EP Pediatric Cardiac Catheterization * E E Electroencephalography EP EP EP Access to: Regional poison control center E E E E E E Hemodialysis capability E Rehabilitation medicine E Acute spinal cord injury management capability E Hyperbaric oxygen chamber availability/transfer agreement when appropriate E E Part 4/6 FACILITY DESIGNATION/LEVEL 4. ACCESS, TRIAGE, TRANSFER AND TRANSPORT CRPC General w/ PICU General Primary Basic PTC Support of medical control E E E SE SE E Accept call-ahead ambulance information E E E E E E Transfer agreements for: In-patient pediatric care E E E E E ICU pediatric care E E E E E Major trauma care ES E E E E Burn care ES E E E E ES Hemodialysis and Extracorporeal Life Support ES E E E E Spinal injury care ES E E E E Rehabilitation care ES E E E E Reimplantation, hand & microvascular surgery ES Accept all critically ill patients from lower-level facilities within a region E SE Access to transport services appropriate for pediatrics E E E E E E Provide 24-hour consultation to lower-level facilities E E Consultation agreements with CRPC E E E E E Accepts all critically ill pediatric trauma patients from lower level facilities within a region E E STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 Part 5/6 FACILITY DESIGNATION/LEVEL 5. EDUCATION, TRAINING, RESEARCH, and QUALITY ASSESSMENT and IMPROVEMENT CRPC General w/ PICU General Primary Basic PTC Education and Training Public education, injury prevention E E E SE SE E Assure staff training in resuscitation and stabilization E E E E E E Assist with pre-hospital education E E SE SE SE E CPR certification for PICU nurses and RTs E E E CPR certification for ED nurses and RTs E E E E E E Multidisciplinary resuscitation simulation with physician engagement E E E E E E Ongoing Pediatric CE for RNs and RTs from the PICU E E E Ongoing Pediatric CE for RNs and RTs from the ED E E E E E E Ongoing Pediatric Trauma-related CE for PICU and PACU RNs E E Network educational resources for training all levels of health professionals E SE SE E Research Support state EMSC research efforts and data collection E E E E E E Participate in and/or maintain trauma registry E E E SE SE E Participate in regional pediatric critical care education E E Quality Assessment and Improvement Structured QA/QI program with indicators and periodic review E E E E E E Participate in regional quality review by CRPC and/or local EMS authority E E E E E E Part 6/6 FACILITY DESIGNATION/LEVEL 6. ADMINISTRATIVE SUPPORT and FACILITY COMMITMENT CRPC General w/ PICU General Primary Basic PTC Make available clinical resources for training pre- hospital personnel E SE SE SE E Assure properly trained ED staff E E E E E E Assure availability of all necessary equipment/supplies/protocols/agreements/policies E E E E E E Provide emergency care and stabilization for all pediatric patients E E E E E E Support networking education/training for health care professionals E E E E E E Assure appropriate medical control and input to ED management and pediatric care E SE SE SE SE E Participate in network pediatric emergency care E E E E E E Assure conformity with building and federal codes for PICU E E E Assure availability of interfacility transfer guidelines and interfacility transfer agreements for pediatric patients E E E E E E Assure resources available for data collection E E E E E E Assure availability of: Social services E E E E E Child abuse support services EP EP EP EP E STANDARDS FOR PEDIATRIC EMERGENCY CARE FACILITIES CHAPTER 0720-31 Child life specialists E E E Case Management E E E Chaplain Support E E E Biomedical Technician E E E Nutritionist/Registered Dietician E E E Pharmacist with Pediatric Training E E E Radiology Technician E E E On-line pre-hospital control E SE SE SE SE E Respiratory care EED&EPI EED&EPI EF EF SE E Pediatric Critical Care Committee E E E Pediatric Trauma Committee E E Child development services E E