1. (a) Note. Federal Emergency Medical Treatment & Labor Act, 42 U.S.C. § 1395dd requirements apply.

2. (b)

   1. (1) Every licensed hospital shall have a dedicated emergency department.

   2. (2) The following hospitals are excepted:

      1. (A) Psychiatric hospitals;
      2. (B) Rehabilitation hospitals;
      3. (C) Long-term acute care hospitals; and
      4. (D) Prison hospitals.
3. (c) The hospital's emergency department shall have organized services, procedures, and nationally recognized protocols for emergencies.

4. (d)

   1. (1) Diagnostic and treatment equipment, medications, supplies, and space shall be adequate in terms of the size and scope of services provided.

   2. (2) Resuscitation and life support equipment shall include but not be limited to:

      1. (A) Airway control and ventilation equipment including:

5. (i) Laryngoscope and endotracheal tubes;

   1. (ii) Valve-mask resuscitator;

      1. (iii) Sources of oxygen;

         1. (iv) Pulse oximeter; and
         2. (v) CO2 monitoring;
      2. (B) Suction devices;
      3. (C) Standard IV fluids and administration devices, including IV catheters;
      4. (D) Intravenous fluid and blood warmers;
      5. (E) Sterile surgical sets for standard ED procedures;
      6. (F) Gastric lavage equipment; and
      7. (G) Blood pressure monitoring equipment.

6. (e)

   1. (1) Each emergency department shall have diagnostic imaging and diagnostic laboratory capabilities available twenty-four (24) hours per day, seven (7) days per week.

   2. (2) Such laboratory services shall include:

      1. (A) Standard analyses of:

         1. (i) Blood;
         2. (ii) Urine; and
         3. (iii) Other body fluids;
      2. (B) Blood typing and crossmatching;
      3. (C) Coagulation studies;

      4. (D) Comprehensive blood bank or access to:

         1. (i) A community central blood bank; and
         2. (ii) Adequate hospital storage facilities; and
      5. (E) Blood gases and pH determination.
7. (f) An inventory list of all supplies and equipment, including all items on the “crash cart”, shall be checked each shift and after each use.
8. (g) The location and telephone number of the nearest poison control center and a list of poison antidotes shall be posted in the emergency department.

9. (h) Screening examination.

   1. (1) Each patient presenting to the emergency department (ED) shall have a medical screening examination by qualified medical personnel.

   2. (2) The examination shall be completely documented.

      1. (i) Treatment and disposition.

   3. (1)

      1. (A) If a patient is screened as having an emergency medical condition, a physician shall be contacted to discuss the assessment findings and patient’s condition.
      2. (B) A physician shall determine disposition of the patient.

   4. (2)

      1. (A) If a patient is screened as having a nonemergency medical condition, a hospital may allow treatment and disposition of the patient by a:

         1. (i) Physician; or
         2. (ii) Nonphysician licensed medical professional.
      2. (B) This individual must be appropriately credentialed by the medical staff with approval by the governing body to provide nonemergent medical care in the emergency department.

10. (j) Physician availability.

    1. (1) Arrangements shall be provided, such as a duty or on-call roster, to ensure a physician is available for all emergency patients as determined by the screening examination.
    2. (2) Arrangements shall be made for obtaining specialized medical services.

11. (k) Staffing.

    1. (1) The emergency service shall be under the supervision of a registered nurse.

    2. (2) All patient care personnel assigned to the emergency department shall:

       1. (A) Receive orientation; and
       2. (B) Be competent in life support measures.
    3. (3) An advanced cardiac life support or pediatric advanced life support, as appropriate, trained person shall be in-house and immediately available.

    4. (4)

       1. (A) The registered nurse shall assume the responsibility for the nursing functions of the emergency services.

       2. (B) This includes:

          1. (i) Supervision;
          2. (ii) Evaluation of the patient's emergency nursing care needs;
          3. (iii) The assignment of nursing care for each patient to other nursing personnel in accordance with the:
12. (a) (a) Patient's needs; and

13. (b) (b) Preparation and competence of the nursing staff;

    1. (iv) Supplies and equipment;

       1. (v) The emergency department record (see 20 CAR § 43-106, general administration, and 20 CAR § 43-114, medical record requirements for outpatient services, emergency room, and observation services); and

          1. (vi) Maintenance of an emergency department log.

    2. (5) Emergency medical technician (EMT). Pursuant to the Emergency Medical Services Act, Arkansas Code § 20-13-201 et seq., if a hospital allows an Arkansas-certified emergency medical technician to perform specified procedures within the emergency room or be a member of a hospital code team the following action shall be taken:

       1. (A)

          1. (i) The medical staff shall approve the privileges granted to the individual EMT with concurrence of the hospital's governing body.
          2. (ii) Specific policies governing the supervision and the procedures to be performed by an EMT shall be:
14. (a) (a) Developed by the medical staff; and

15. (b) (b) Approved by the hospital's governing body.

    1. (iii) In no event shall an EMT perform a procedure that he or she is not certified to do by the Division of Emergency Medical Services of the Department of Health;

       1. (B) Approved EMTs shall function in accordance with physician's orders and under the direct supervision of either the physician or registered nurse responsible for emergency services;

       2. (C) Students in EMT training programs approved by the Division of Emergency Medical Services of the Department of Health shall be trained by qualified instructors within the hospital under guidelines:

          1. (i) Established by the medical staff; and
          2. (ii) Approved by the governing body; and

       3. (D) A roster with the delineation of privileges shall be maintained and readily available.

          1. (l) Medications. See 20 CAR § 43-111, medications, and 20 CAR § 43-115, pharmacy.)
          2. (m) Off-campus emergency departments (off-campus EDs).
    2. (1) Off-campus EDs shall meet all requirements for hospital EDs.

    3. (2) Off-campus EDs shall:

       1. (A) Function as a department of the parent hospital;

       2. (B) Be fully integrated into the parent hospital’s systems and operations:

          1. (i) Medical staff must be part of the parent hospital’s single organized medical staff;
          2. (ii) Nursing personnel must be part of the hospital’s single organized nursing service;
          3. (iii) Emergency laboratory and imaging services must be available twenty-four (24) hours per day, seven (7) days per week;
          4. (iv) Quality assessment/performance improvement (QAPI) program must be integrated into the parent hospital’s QAPI program;
          5. (v) Records must be maintained as part of the hospital’s single medical record system;
          6. (vi) Infection prevention and control practices must meet the requirements of the parent hospital’s infection control policies and practices;
          7. (vii) Emergency services must meet accepted standards of practice for hospital emergency departments; and
          8. (viii) Patients who require further care must have access to all services of the main hospital; and
       3. (C) Be open twenty-four (24) hours per day, seven (7) days per week.

16. (n) Emergency services facility.

    1. (1) The Department of Health may license under Arkansas Code § 20-9-218 hospitals that have discontinued inpatient services to continue to provide emergency services if there is no other hospital emergency service in the community.
    2. (2) The emergency services facility shall be subject to inspection and to all other provisions of Arkansas Code § 20-9-201 et seq., and the Emergency Medical Services Act, Arkansas Code § 20-13-201 et seq., as amended.
    3. (3) The emergency services facility shall have agreements with licensed hospitals to accept patients who are in need of inpatient hospital services.
    4. (4) An emergency facility shall not have licensed inpatient beds, however, at least one (1) holding/observation bed shall be provided for patient use not to exceed twenty-four (24) hours.

    5. (5)

       1. (A) Emergency service facilities shall provide or contract to provide emergency ambulance services licensed by the Department of Health that include radio communication and patient telemetry.
       2. (B) It is further required that contractual agreements be made for patient air transport services.
    6. (6) Policies and procedures shall be developed and approved by the Division of Health Facilities Services prior to issuance of a license, and the facility may not provide services without a license.

    7. (7)

       1. (A) Clinically relevant educational programs shall be conducted on a regularly scheduled basis of not fewer than twelve (12) per year.

       2. (B) There shall be evidence of:

          1. (i) Program dates;
          2. (ii) Attendance; and
          3. (iii) Subject matter.
    8. (8) There shall be an ongoing QA/PI program that is specific to the patient care administered.

Codification Notes: “IV” means intravenous. "QA/PI" means quality assurance/performance improvement.