1. (1) The REH shall have personnel management as a section of the hospital's personnel system. The REH shall be adequately staffed at all times to meet the needs of the patient population served. At a minimum, the ED must be physically staffed 24 hours a day, 7 days a week by a physician, an NP, or a PA competent in the skills needed to address emergency medical care and able to receive patients and activate the appropriate medical resources to meet the care needed by the patient.

2. (2) Staff qualifications for REHs.

   1. (a) The REH medical director shall be:

      1. 1. Either

         1. (i) Board certified by the American Board of Emergency Medicine, the American Osteopathic Board of Emergency Medicine, the American Board of Physician Specialties, or a like credentialing organization for emergency medicine; or
         2. (ii) Certified or Board eligible to sit for the examination of one of the following boards: internal medicine, family medicine, or surgery. The physician shall also hold a current certificate from each of the following approved programs: Advanced Coronary Life Support; Advanced Trauma Life Support; and Advanced Pediatric Life Support; and must have at least 3 years of full-time clinical experience in emergency medicine within the past 5 years.  Physicians meeting the aforesaid criteria with at least 1 but fewer than 3 years of full-time clinical experience in emergency medicine must also hold a certificate of completion for al1 modules of the Emergency Medicine Core Training (EMCT) Program. Physicians who are not board certified in emergency medicine will need to annually maintain one-half of their Alabama State Continuing Medical Education credits in emergency medicine.
      2. 2. Competent in management and administration of clinical services in an emergency department.
      3. 3. Knowledgeable about emergency medical services (EMS) operations and the regional EMS network.
      4. 4. Responsible for assessing and making recommendations to the hospital's credentialing body related to the qualifications of REH physicians and the clinical privileges granted to REH practitioners.

      5. 5. Responsible to provide medical direction for the REH's health care activities and consultation for, and medical supervision of, the health care staff and for assuring that the clinical staff are continuously qualified, competent, and supervised in the emergency care of patients.

         1. (i) In conjunction with the PA and/or NP staff member(s), the REH medical director shall participate in developing, executing, and periodically reviewing the REH's written policies governing the services it furnishes.
         2. (ii) In conjunction with the PA and/or NP staff members, the REH medical director shall periodically review the REH's patient records, provide medical orders, and provide medical care services to the patients of the REH.
   2. (b) Each REH physician shall be individually credentialed by the hospital medical staff.
   3. (c) A physician must be present onsite for sufficient periods of time to provide medical direction, consultation, and supervision for the services provided in the REH, and must be available through direct telephone or electronic communication for consultation, assistance with medical emergencies, or patient referral.

   4. (d) The REH must have a physician, a PA, or an NP with training or experience in emergency care on call at all times and immediately available by telephone and available onsite within 30 minutes. An NP working onsite without a physician present must:

      1. 1. Be certified as a family nurse practitioner (certified to treat both adult and pediatric patients);
      2. 2. Have 4000 hours of advanced practice experience in the collaborating physician's practice specialty area;
      3. 3. Have had competency certified by the collaborating physician for skills in the protocol, to include intubation;
      4. 4. Have current certifications in Advanced Coronary Life Support, Advanced Life Support in Obstetrics, and Pediatric Advanced Life Support.

   5. (e) A PA working in the REH must:

      1. 1. Have had competency certified by the supervising physician for skills in the protocol;
      2. 2. Have current certifications in Advanced Coronary Life Support, Advanced Life Support in Obstetrics, and Pediatric Advanced Life Support.

   6. (f) The Director of Nursing Services in the REH shall be a registered nurse with an active and unencumbered license from the Alabama Board of Nursing and shall direct all nursing services and all nursing support personnel. The Director of Nursing must:

      1. 1. Have 2 years of experience as an emergency room RN.
      2. 2. Provide evidence of competent management and administration of clinical services in an ED.
      3. 3. Ensure nursing and support staff are appropriately educated and qualified.
      4. 4. Meet the additional qualifications for RNs in the subparagraphs below.

   7. (g) Each RN in an REH shall:

      1. 1. Provide evidence of at least 1 year of experience as a staff nurse in an acute care facility.
      2. 2. Have successfully completed the Emergency Nursing Pediatric Course/Trauma Nursing Core Course (ENPC/TNCC) and have current certifications in Advanced Coronary Life Support and Pediatric Advanced Life Support.
      3. 3. For practice beyond basic nursing education, demonstrate successful completion of an organized program of study and facility-based validated competency which assesses the nurse's knowledge, skills, and ability to perform emergency nursing procedures safely and to manage patient complications.
3. (3) At least one licensed RN meeting the above-stated requirements shall be onsite at the REH at all times.
4. (4) At all times, at least one certified and registered radiology technologist shall be onsite at the REH or immediately available by telephone or electronic communication and available onsite within 30 minutes.
5. (5) At all times, at least one person qualified to perform laboratory testing at the level of laboratory services provided onsite by the REH shall be onsite at the REH or immediately available by telephone or electronic communication and available onsite within 30 minutes.
6. (6) Each REH shall have a fulltime administrative director who directs the daily administrative operations of the REH, ensures the employees and staff are adequately trained, and provides oversight of the maintenance of the REH, coordination of patient safety, and quality improvement programs and activities.
7. (7) Personnel Records. Each REH shall maintain a personnel record for each employee. At a minimum, the record shall include an application for employment that contains information regarding the applicant's education, training, experience, and if applicable, registration, certification, or licensure information.

Author: Dana H. Billingsley

Statutory Authority: Code of Ala. 1975, §§22-21-20, et seq.

History: New Rule: Published August 31, 2023; effective October 15, 2023.