For the purpose of this part, the following terms are defined:

1. (1) “Abbreviated injury scale” means an anatomic injury severity scoring system;
2. (2) “ABEM” means American Board of Emergency Medicine;
3. (3) “ABMS” means American Board of Medical Specialties;
4. (4) “ABP” means American Board of Pediatrics;
5. (5) “ABS” means American Board of Surgery;
6. (6) “ACEP” means American College of Emergency Physicians;
7. (7) “ACGME” means Accreditation Council for Graduate Medical Education;
8. (8) “ACLS” means advanced cardiac life support;
9. (9) “ACLS-certified” means individuals certified by the American Heart Association in advanced cardiac life support;
10. (10) “ACOS” means American College of Osteopathic Surgeons;
11. (11) “ACS” means American College of Surgeons;
12. (12) “ACS COT” means American College of Surgeons Committee on Trauma;
13. (13) “ADH” means Department of Health (used interchangeably with “Department” as described in Arkansas Code § 20-13-803);
14. (14) “Advanced Pediatric Life Support course” means a program jointly developed and sponsored by the American College of Emergency Physicians and American Academy of Pediatrics;
15. (15) “Advanced Trauma Life Support course” means a course certified through the ACS with a four-year certification;
16. (16) “AIS” means abbreviated injury scale;

17. (17)

    1. (A) “Alcohol screening and intervention” means a:

       1. (i) Method to screen trauma patients for risky alcohol use or abuse; and
       2. (ii) Plan to assist patients with positive screens.
    2. (B) Screening can be in the form of a consumption questionnaire or biological measurements.
    3. (C) Assistance can be a provision of appropriate referrals or in-house intervention such as brief motivational interviewing;

18. (18)

    1. (A) “Alpha” means dashboard status in which trauma services are provided at a trauma center and open to EMS and transfers.
    2. (B) This status only needs updating upon any changes to the system;
19. (19) “ALS” means advanced life support;

20. (20)

    1. (A) “Alternate pathway” means criteria that shall be satisfied by a provider to be a member of a facility’s trauma team in a specialty for which he or she does not hold board certification.
    2. (B) The alternate pathway is determined by the Department of Health and is specific to specialties.
    3. (C) Facilities that wish to be designated with physicians who qualify for participation under the alternate pathway shall notify the Department of Health Trauma Section at least three (3) months prior to the designation visit;
21. (21) “AMA” means American Medical Association;
22. (22) “AOA/HFAP” means American Osteopathic Association/Healthcare Facilities Accreditation Program;
23. (23) “AOBEM” means American Osteopathic Board of Emergency Medicine;
24. (24) “APLS” means advanced pediatric life support;

25. (25)

    1. (A) The “Arkansas Health Data Initiative” was established by Acts 2003, No. 1035, Arkansas Code § 20-8-401 et seq.
    2. (B) This initiative is designed to “serve as an access point for studies concerning state and federal health information, to inform and support Arkansas health policy officials.”
    3. (C) Acts 2003, No. 1035 authorizes the director of the Arkansas Center for Health Improvement to establish and maintain this program;

26. (26)

    1. (A) “Arkansas Trauma Communications Center” means Arkansas Trauma System's patient transport coordination center for both prehospital emergencies and for interfacility transfers.
    2. (B) Staffed with both paramedics and RNs, it uses the AWIN network and dashboard to coordinate the transport of trauma patients to the closest, most appropriate trauma center or, if appropriate, the closest hospital (used interchangeably with “call center” as described in Arkansas Code § 20-13-817);
27. (27) “Asystole” means absence of spontaneous cardiac activity;
28. (28) “ATCN” means Advanced Trauma Care for Nurses;
29. (29) “ATLS” means Advanced Trauma Life Support;
30. (30) “ATCC” means Arkansas Trauma Communications Center;
31. (31) “Audit filters” means state audit filters, which are tools that assist with monitoring the process of care relative to standards of care;
32. (32) “AWIN” means Arkansas Wireless Information Network;
33. (33) “Backfill agreement” means a formal, signed agreement between EMS providers with cross-jurisdictional (adjoining county) provision of emergency services from one (1) service to another when existing resources are, or may be, inadequate or depleted;

34. (34) “Basic life support” means transportation by:

    1. (A) Ground ambulance vehicle;
    2. (B) Provision of medically necessary supplies and service; and
    3. (C) The provision of BLS ambulance services;

35. (35)

    1. (A) “Basic life support (BLS) personnel” means that the ambulance shall be staffed by an individual who is qualified in accordance with state and local laws as an emergency medical technician (EMT).

    2. (B)

       1. (i) These laws may vary from state to state.
       2. (ii) For example, only in some states is an EMT permitted to operate limited equipment on board the vehicle, assist more qualified personnel in performing assessments and interventions, and establish a peripheral intravenous (IV) line;
36. (36) “BLS” means basic life support;
37. (37) “Board” means the State Board of Health as provided for in Arkansas Code § 20-7-102;
38. (38) “Board-certified” means physicians certified by appropriate specialty boards recognized by the ABMS or the AOA;

39. (39)

    1. (A) “Board-eligible” means the time a candidate has from the end of training to successfully complete a certifying examination.
    2. (B) This period is defined by the specialty board;

40. (40)

    1. (A) “Bravo” means the dashboard status in which the particular trauma service is provided but the trauma center is at capacity.
    2. (B) Delay is possible.
    3. (C) This status reverts to alpha every two (2) hours and shall be updated by the trauma center if necessary.
    4. (D) This represents a capacity rather than a capability issue;
41. (41) “Bypass” means transport of a trauma patient past a receiving trauma center normally used by the EMS provider for the purpose of accessing more readily available or appropriate medical care;
42. (42) “CCRN” means critical care registered nurse;
43. (43) “CD” means compact disc;
44. (44) “CDC” means the Centers for Disease Control and Prevention;
45. (45) “CE” means continuing education;
46. (46) “Centers for Disease Control and Prevention” means a federal agency committed to epidemiological surveillance and control of disease processes, particularly those secondary to infection or trauma, and prevention;
47. (47) “CEO” means chief executive officer;

48. (48)

    1. (A) “Charlie” means the dashboard status in which the particular trauma service is never provided at the trauma center.
    2. (B) This is a capability rather than a capacity issue.
    3. (C) This status never needs updating unless the center begins offering the service;

49. (49)

    1. (A) “Charlie temp” means a dashboard status in which the particular trauma service is normally provided at the trauma center but is temporarily unavailable.
    2. (B) This status shall be updated by the trauma center when capability returns to normal.
    3. (C) This represents diversion and is characterized by a change in capability rather than capacity;
50. (50) “Closed” means dashboard status in which a trauma center has a major internal emergency (structural damage, environmental or utility problems, etc.) and cannot accept any patients including self-referrals or by private vehicle;
51. (51) “CME” means continuing medical education;
52. (52) “CMS” means Centers for Medicare & Medicaid Services;

53. (53)

    1. (A) “Communications system” means a collection of individual communication networks, such as transmission systems, relay stations, and control and base stations capable of interconnection and interoperation that are designed to form an integral whole.

    2. (B) The individual components shall:

       1. (i) Serve a common purpose;
       2. (ii) Be technically compatible;
       3. (iii) Employ common procedures;
       4. (iv) Respond to control; and
       5. (v) Operate in unison;

54. (54)

    1. (A) “Comorbidity” means an underlying process present prior to the injury that contributes to the morbidity of the injury and may affect triage decisions.
    2. (B) Examples are significant cardiac, respiratory, or metabolic diseases that stimulate the triage of injured patients to trauma centers;

55. (55) “Continuing medical education” means defined educational activities for practicing physicians, often resulting in approved credit hours from:

    1. (A) The AMA;
    2. (B) The AOA;
    3. (C) The state medical society;
    4. (D) The state osteopathic medical association;
    5. (E) A medical school; or
    6. (F) A hospital;
56. (56) “COO” means Chief Operating Officer;

57. (57)

    1. (A) “Core surgeon” means the on-call panel of surgeons taking greater than sixty percent (60%) of current trauma calls within their specialty.
    2. (B) Responsible for all credentialing requirements within their specialty, including at least fifty percent (50%) attendance at Trauma Peer Review Committee meetings;
58. (58) “Credentialing” means approval of a physician as a member of the trauma team based on a review of the individual’s training and experience by the TMD and the appropriate service chief;
59. (59) “CRNA” means Certified Registered Nurse Anesthetist;
60. (60) “CT” means computed tomography or CT scan;

61. (61) “Dashboard” means an up-to-date, live computer screen depiction at the ATCC of the capability and capacity to deliver trauma services of:

    1. (A) Every designated trauma center in the Arkansas Trauma System; and
    2. (B) Those hospitals that are “in pursuit of designation”;

62. (62)

    1. (A) “Delta” means the dashboard status in which the particular trauma service is provided but is at capacity and resolution (e.g., return of services availability) is not expected for at least twelve (12) hours.
    2. (B) This represents diversion and is a capacity rather than a capability issue;
63. (63) “Demonstrated commitment” means provision of evidence (visible and written) that clearly demonstrates an institution wide commitment to trauma care;
64. (64) “Designation” means the process by which a hospital is identified by the Department of Health as an appropriate trauma center to receive traumatically injured patients;
65. (65) “Desirable characteristic” means a component of the trauma center care standards, the presence or availability of which is encouraged but not required for designation;
66. (66) “Disaster” means sudden event with a variable mixture of injury to or sickness of human beings, destruction or contamination of property, overwhelming demand on local response resources, and/or disruption of organized societal mechanisms;
67. (67) “Diversion” means a procedure put into effect by a trauma center to ensure appropriate patient care when that center is unable to provide its usual and expected capability and capacity, either on a permanent or temporary basis;

68. (68)

    1. (A) “Early consultation” means “as early as the need is recognized”.
    2. (B) The expectation is that if the trauma panel member is requested to be at the bedside, he or she will respond to the bedside within thirty (30) minutes;
69. (69) “ECHO” means echocardiogram;
70. (70) “ED” means emergency department;
71. (71) “EM” means emergency medicine;

72. (72)

    1. (A) “Emergency medical services” means the transportation and medical care provided to the ill or injured prior to arrival at a medical facility by a certified emergency medical technician or other health care provider.
    2. (B) Continuation of the initial emergency care within a medical facility subject to the approval of the medical staff and governing board of that facility (Arkansas Code § 20-13-202(6));
73. (73) “Emergency nurse pediatric course” means a course developed and sponsored by the ENA which covers the knowledge and skills necessary for the initial nursing assessment and management of pediatric patients in the ED;
74. (74) “EMR” means electronic medical record;
75. (75) “EMS” means emergency medical services;

76. (76) “EMS provider” means an individual licensed by the Department of Health’s section of EMS to include, without limitation:

    1. (A) EMT;
    2. (B) Advanced EMT;
    3. (C) Paramedic; and
    4. (D) EMS instructor;
77. (77) “EMTALA” means Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd;
78. (78) “ENA” means Emergency Nurses Association;

79. (79)

    1. (A) "Encounter form” means the patient care record approved by the Department of Health’s section of EMS that fully describes all prehospital care provided.
    2. (B) The encounter form shall be left with the receiving hospital at the time of transfer of care or no more than twenty-four (24) hours after the transfer of care.
    3. (C) This form shall include a patient narrative;
80. (80) “ENPC” means emergency nurse pediatric course;
81. (81) “ENT” means ear, nose, and throat;
82. (82) “ETT” means endotracheal tubes;
83. (83) “Extrication” means the services provided by the use of specialized equipment for the purpose of gaining access to, and ultimately extricating, entrapped patients;
84. (84) “FACS” means fellow of the American College of Surgeons;
85. (85) “FACOS” means Fellow of the American College of Osteopathic Surgeons;
86. (86) “FAST” means focused assessment with sonography for trauma;
87. (87) “Field triage” means classification of patients according to medical need at the scene of a traumatic injury;
88. (88) “FTE” means full-time equivalent;
89. (89) “GCS” means Glasgow Coma Scale;
90. (90) “General surgery residency program” means general surgical postgraduate training approved by the ACGME or the AOA;
91. (91) “Glasgow Coma Scale” means a scoring system that defines eye, motor, and verbal responses in the patient with injury to the brain;
92. (92) “Health Insurance Portability and Accountability Act of 1996, 45 C.F.R. pts. 160, 162, and 164, as amended by the Health Information Technology for Economic and Clinical Health Act, 78 FR 5566”, requires that health care organizations standardize patient health, administrative and financial data;

93. (93)

    1. (A) “HIPAA” means Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191.
    2. (B) See subdivision (92) of this section;
94. (94) “Hospital criteria” means required or desirable characteristics that help categorize Level I, II, III, and IV trauma centers;
95. (95) “ICD” means International Classification of Diseases;
96. (96) “ICP” means intracranial pressure (often monitored in patients with severe injuries to the brain);
97. (97) “ICU” means intensive care unit;
98. (98) “Immediately available to the patient” means services provided by a trauma center that are in-house twenty-four (24) hours a day, seven (7) days a week;

99. (99)

    1. (A) “Inclusive trauma care system” means a trauma care system that incorporates various levels of healthcare facilities in a community in a system in order to provide a continuum of services for all injured persons who require care in an acute facility.
    2. (B) In such a system, the injured patient’s needs are matched to the appropriate hospital resources;
100. (100) “In-house” means physically present in the hospital;
101. (101) “In-pursuit of designation” means a hospital’s status while it attempts, prior to its designation site survey, to become designated as a trauma center within the Arkansas Trauma System;

102. (102) “Injury” means:

     1. (A) The result of an act that damages, harms, or hurts; or
     2. (B) Unintentional or intentional damage to the body resulting from acute exposure to mechanical, thermal, electrical, or chemical energy or from the absence of such essentials as heat or oxygen (see Trauma);
103. (103) “Injury and Violence Prevention Section” means the organization within the Department of Health responsible for development and promotion of injury prevention programs as set forth in Arkansas Code § 20-13-818;
104. (104) “Injury control” means activities designed to teach decrease the burden of injury;
105. (105) “Injury severity score” means the sum of the squares of the AIS scores of the three (3) most severely injured body regions;
106. (106) “Interfacility transfer” means the transfer of a patient from one (1) facility to another facility;
107. (107) “International Classification of Diseases” means a standard coding system that includes all injuries and disease processes;
108. (108) “ISS” means injury severity score;
109. (109) “IVP” means injury and violence prevention (used interchangeably with “injury prevention programs” as described in Arkansas Code § 20-13-818);

110. (110)

     1. (A) “Massive transfusion protocol” means a written protocol:

        1. (i) Required for Level I, II, and III trauma centers; and
        2. (ii) Desired for Level IV trauma centers.
     2. (B) The massive transfusion protocol is used to identify and manage patients with significant blood loss who require ongoing resuscitation with blood components to maintain intravascular volume and hemostasis;

111. (111)

     1. (A) “Mechanism of injury” means the source of forces that produce mechanical deformations and physiologic responses that causes an anatomic lesion or functional change in humans.

     2. (B) The circumstance in which an injury occurs such as:

        1. (i) Sudden deceleration;
        2. (ii) Wounding by a projectile; or
        3. (iii) Crushing by a heavy object;
112. (112) “Medical control-direct” means direction to prehospital personnel provided by a physician or an authorized communications resource person under the direction of a physician;

113. (113) “Medical control-indirect” means the establishment and monitoring of all medical components of an EMS system, including:

     1. (A) Protocols;
     2. (B) Standing orders;
     3. (C) Education programs; and
     4. (D) The quality and delivery of direct control;
114. (114) “Medical oversight” means the assistance given to the TRACs by a physician or group of physicians designated by the TRAC to provide technical assistance in regional system planning;

115. (115)

     1. (A) “Mid-level practitioner” means:

        1. (i) A physician assistant;
        2. (ii) An RN; or
        3. (iii) An advanced nurse practitioner.
     2. (B) Mid-level practitioners may participate in the care of trauma patients.
     3. (C) They may initiate trauma resuscitation and perform procedures as long as they are current in ATLS.
     4. (D) The supervising physician shall meet the ATLS requirements described within this document.
     5. (E) The supervising physician shall be notified of the arrival of trauma patients and be available for assistance.
     6. (F) This process and resulting patient outcomes shall be reviewed through the trauma QI program;
116. (116) “Morbidity” means the relative incidence of disease;
117. (117) “Mortality” means the number of deaths in a defined population in a defined unit of time typically represented as mortality rate;
118. (118) “MRI” means magnetic resonance imaging;
119. (119) “Multiple or mass casualty triage” means specialized techniques of triage used when large numbers of injured patients are concentrated in one area;

120. (120)

     1. (A) “Noncore surgeon” means not part of surgical trauma coverage, taking less than forty percent (40%) of trauma call of a given specialty.
     2. (B) Not responsible for QI meeting attendance, but is required to maintain CME and all other requirements within his or her specialty;
121. (121) “NSA” means nonsurgical admission;

122. (122)

     1. (A) “Occasional failure to meet standards” means a temporary or unforeseen circumstance in which a trauma center cannot meet a standard of care (as set forth in 20 CAR §§ 80-501 et seq., and 80-601 et seq. ) less than five percent (5%) of the time annually.
     2. (B) This shall be monitored by the center’s QI program;
123. (123) “OGME” means osteopathic graduate medical education;
124. (124) “OMFS” means oral and maxillofacial surgery;
125. (125) “On-call” means committed for a specific time period to be available and respond within an agreed amount of time to provide care for a patient in the hospital;
126. (126) “OPO” means organ procurement organization;
127. (127) “OR” means operating room;
128. (128) “ORIF” means open reduction internal fixation;

129. (129) “Over-triage” means (two (2) definitions):

     1. (A)

        1. (i) When the trauma team is activated at a level higher than required by the facility’s criteria.

        2. (ii) Example.

           1. (a) (a) The facility’s Level I criteria calls for activation for a patient with a GCS of less than nine (< 9).
           2. (b) (b) The patient’s condition by EMS report is a GCS of twelve (12), yet the facility activates a Level I response; or

     2. (B)

        1. (i) When the trauma team is activated appropriately according to the facility’s criteria but the patient’s condition does not require such services.

        2. (ii) Example.

           1. (a) (a) A facility activates a Level II for all patients in a rollover motor vehicle crash.
           2. (b) (b) This is an internal evaluation of appropriateness of the criteria;
130. (130) “PACU” means post-anesthesia care unit;
131. (131) “PALS” means pediatric advanced life support;

132. (132)

     1. (A) “Pediatric advanced life support course” means a course developed and sponsored by the American Heart Association and the American Academy of Pediatrics.
     2. (B) This course covers the knowledge and skills necessary for the initial management of pediatric emergencies, including trauma;

133. (133)

     1. (A) “Pediatric patient” means a person less than or equal to fifteen (≤15) years old (cut off at fifteen (15) years, three hundred sixty-four (364) days) for the purpose of data collection.
     2. (B) Facilities have the discretion to define a pediatric patient differently for the purpose of admission to that facility.
     3. (C) The facility is responsible for reporting capability to care for a pediatric patient, as defined by that facility, to the TRAC and to the ATCC.
     4. (D) All facilities are required to provide emergency care within their capabilities to all patients regardless of age and shall be compliant with CMS/EMTALA regulations;
134. (134) “Pediatric trauma center” means a pediatric hospital fulfilling the criteria for comprehensive trauma care;
135. (135) “Pediatric trauma score” means an injury scoring system used in some centers caring for pediatric patients;
136. (136) “Pediatric trauma surgeon” means a certified pediatric surgeon with a commitment to trauma or certified general surgeon with special training and documented CME relevant to pediatric trauma care;
137. (137) “PET” means positron emission tomography;
138. (138) “PGY” means post-graduate year;

139. (139)

     1. (A) “Post-graduate year” means a classification system for residents in post-graduate training.
     2. (B) The number indicates the year they are in during the post-medical school residency program.
     3. (C) For example, PGY 1 is one (1) year after graduation from medical school;
140. (140) “Promptly available to the patient” means services provided by a trauma center that are available to the patient within thirty (30) minutes of patient arrival or notification, whichever comes first;
141. (141) “Protocol” means a written procedure to ensure standardization of care;
142. (142) “QI” means quality improvement;
143. (143) “Regionalization” means the identification of available resources within a given geographic area and coordination of services to meet the needs of a specific group of patients;
144. (144) “Rehabilitation” means services that seek to return a trauma patient to the fullest physical, psychological, social, vocational, and educational level of functioning of which he or she is capable, consistent with physiological or anatomic impairments and environmental limitations;
145. (145) “Required characteristic” means a component of trauma center care standards that is required for designation;
146. (146) “Research” means clinical or laboratory studies designed to produce new knowledge applicable to the care of injured patients;
147. (147) “Response time” means the interval between notification and arrival of a general surgeon or surgical specialist in the ED or OR;
148. (148) “Resuscitation” means the phase of trauma or specialty care where emergency life support treatment is provided to sustain vital bodily functions;

149. (149)

     1. (A) “Revised trauma score” means a physiological scoring system, with high inter-rater reliability and demonstrated accuracy in predicting death.
     2. (B) It is scored from the first set of data obtained on the patient, and consists of GCS, systolic blood pressure, and respiratory rate;
150. (150) “RN” means registered nurse;
151. (151) “RTS” means revised trauma score;
152. (152) “RTTDC” means Rural Trauma Team Development Course;

153. (153)

     1. (A) “Short form” means an abbreviated encounter form that is left at the receiving hospital at the time of transfer of care when a completed encounter form is not available.
     2. (B) This form does not replace the requirement to provide a completed encounter form to the receiving hospital within twenty-four (24) hours after the transfer of care;

154. (154)

     1. (A) “Staff physician” means a physician who is credentialed by a hospital to provide care.
     2. (B) He or she may or may not be on the trauma call panel;
155. (155) “TAC” means Trauma Advisory Council;
156. (156) “TIR” means Trauma Image Repository;
157. (157) “TJC” means The Joint Commission (formerly known as JCAHO);
158. (158) “TMCD” means trauma medical codirector;
159. (159) “TMD” means trauma medical director;
160. (160) “TMR” means trauma multidisciplinary review;
161. (161) “TPM” means trauma program manager;
162. (162) “TRAC” means trauma regional advisory council;
163. (163) “TRAC medical director” means a physician appointed to provide medical oversight and technical assistance within a TRAC;
164. (164) “TRAC MD” means TRAC medical director;

165. (165)

     1. (A) “Transfer agreement” means a formal, written agreement between trauma centers for the transfer and acceptance of trauma patients.
     2. (B) Note. This is not a substitute for the EMTALA transfer forms;

166. (166)

     1. (A) “Trauma” means a term derived from the Greek for “wound”.

     2. (B) For the purpose of this part, trauma is strictly defined as:

        1. (i) A blunt or penetrating injury; and

        2. (ii) Certain special considerations such as:

           1. (a) (a) Burns;
           2. (b) (b) Age;
        3. (c) (c) Use of anticoagulation medication; and
        4. (d) (d) Pregnancy more than twenty (>20) weeks;
167. (167) “Trauma Advisory Council” means the body of individuals appointed by the Governor to advise, assist, and make recommendations to the Trauma Section concerning the development and operation of the statewide trauma system (Arkansas Code § 20-13-807);

168. (168)

     1. (A) “Trauma band” means a wristband applied to trauma patients during transport to the ED or while being treated in the ED.
     2. (B) Each band has a unique identifier consisting of an alpha-numeric seven character combination (example: A000001) that will serve as a patient identifier in the EMS and trauma registries;
169. (169) “Trauma call panel” means the listing of surgeons and physicians assigned to provide trauma care, including date of coverage and alternate surgeons;
170. (170) “Trauma center” means a specialized, licensed hospital distinguished by the immediate availability of physicians and equipment on a twenty-four (24) hours a day, seven (7) days a week basis to care for severely injured patients or those at risk for severe injury;
171. (171) “Trauma center designation” means the process by which the Trauma Section identifies and verifies trauma centers’ capability and capacity to care for severely injured patients within a trauma care system;

172. (172)

     1. (A) “Trauma image repository” means a centrally located server that stores images received from trauma centers that participate in the Arkansas Trauma System.
     2. (B) The purpose is to share electronic images, such as CT scans, MRIs, X-rays, PET scans, ECHOs, and ultrasounds with trauma centers where the patient is to be transferred for trauma care.
     3. (C) The repository is a secure, web-based program that allows the physicians and hospital staff access to patients’ electronic images.
     4. (D) The purpose of the repository is to provide instant electronic access to images so that definitive care can be delivered to the patient immediately upon arrival at the higher level trauma center.
     5. (E) It also vastly decreases the likelihood that patients will need to be rescanned at the receiving facility;
173. (173) “Trauma liaison” means the designated physician representative or their physician designee within a given specialty;

174. (174)

     1. (A) “Trauma medical codirector” means a physician in a Level III trauma center designated by the institution and medical staff to coordinate trauma care when the TMD is not a surgeon.
     2. (B) All qualifications, duties, and responsibilities required of the TMD are applicable to the TMCD;
175. (175) “Trauma medical director” means a physician designated by the institution and medical staff to coordinate trauma care;

176. (176)

     1. (A) “Trauma multidisciplinary review process” means an active process, led by the TMD and TPM, with representation from all core surgeons, specialties, and services, who participate on the trauma team at the facility, which is authorized to establish, review, and improve the care of the injured.

     2. (B) This process shall consist of two (2) distinct committees:

        1. (i) “Trauma Program Operations Review Committee” means a committee composed of the full membership of TMR as stated above that assesses, addresses, and corrects trauma program system issues; and
        2. (ii) “Trauma Peer Review Committee” means a committee composed of the TMD, other physician and nonphysician members of the trauma service, and subspecialist involved in patient care in a case under review, that examines sentinel events, including trauma deaths, in a system or hospital;

177. (177)

     1. (A) “Trauma patient” means the patient who presents with acute bodily injuries secondary to an external force requiring immediate intervention deemed necessary to preserve life and limb (see definition of Trauma).

     2. (B) For statistical purposes, the definition will apply to the traumatically injured patient who:

        1. (i) Is admitted for observation for a period of time greater than eight (8) hours;
        2. (ii) Is admitted to the hospital;
        3. (iii) Is transferred to another trauma center; or
        4. (iv) Expires;
178. (178) “Trauma Peer Review Committee” is composed of the TMD, other physician and nonphysician members of the trauma service, and subspecialist involved in patient care in a case under review, that examines sentinel events, including trauma deaths, in a system or hospital;

179. (179)

     1. (A) “Trauma program” means an administrative unit that includes the trauma service and coordinates other trauma-related activities.
     2. (B) For example, IVP, public education, CME activities, etc.;

180. (180)

     1. (A) “Trauma program manager” means the RN who is responsible for the successful operation of the trauma program, including data abstraction, QI, internal and community education, and IVP efforts on behalf of the trauma center.
     2. (B) The TPM may have other personnel resources to perform the above duties, but retains the ultimate responsibility for their success.
     3. (C) The TPM may have a different title, depending on the organizational structure of the facility (such as trauma coordinator), but the FTE allocation and responsibilities remain the same;
181. (181) “Trauma Program Operations Review Committee” is composed of the full membership of TMR as stated above, that assesses, addresses, and corrects trauma program system issues;
182. (182) “Trauma Regional Advisory Council” means the council formed within a trauma region that develops and oversees the region’s trauma system plan, to include, without limitation, QI and IVP activities;

183. (183)

     1. (A) “Trauma registry” means a mechanism for the collection and analysis of trauma data from the trauma system.
     2. (B) More specifically, a database of information, submitted to the Trauma Registry Section by the trauma centers, relating to the care of trauma patients as defined in this part.
     3. (C) The information is used to evaluate the quality of care provided;
184. (184) “Trauma/injury severity score” means the likelihood of patient survival based on a regression equation that includes patient age, ISS, RTS, and the type of injury (blunt or penetrating);
185. (185) “Trauma Section” means the organization within the Department of Health responsible for implementation of the trauma system per the Trauma System Act, Acts 2009, No. 393, Arkansas Code § 20-13-801 et seq.;

186. (186)

     1. (A) “Trauma service” means the group of providers (physicians, mid-level practitioners such as physician assistants or nurse practitioners, and nurses) who are responsible for the care of the trauma patient and the trauma QI program in the trauma center.
     2. (B) In some centers this includes the general surgeons and liaisons from the various specialties.
     3. (C) In larger, tertiary facilities, this may be a separate team that provides only trauma care;

187. (187)

     1. (A) “Trauma system” means an integrated network that ensures that acutely injured patients are expeditiously taken to facilities appropriate for their level of injury and receive the best possible care.
     2. (B) Licensed ambulance services shall appropriately triage all traumatically injured patients using the Field Triage Decision Scheme: The Arkansas Trauma Triage Protocol.
     3. (C) The lead EMSP will make the destination decision considering the ATCC recommendation, patient’s condition, distance of travel, patient preference and system status;
188. (188) “Trauma team” means a group of healthcare professionals organized to provide care to the trauma patient in a coordinated and timely fashion;
189. (189) “Triage” means the sorting of patients in terms of priority, treatment, transportation, and destination, so that the patient can be transported to the most appropriate trauma center or, when appropriate, hospital based upon established criteria;
190. (190) “TRISS” means trauma score/injury severity score; and

191. (191) “Under-triage” (two definitions) means:

     1. (A)

        1. (i)

           1. (a) (a) When the trauma team is activated at a lower level than required by the facility’s criteria.
           2. (b) (b) Example. The trauma center’s Level I criteria calls for activation for a patient with a GCS of less than nine (< 9).
        2. (ii) The patient’s condition by EMS report has a GCS of six (6), yet the facility activates as Level II response; or

     2. (B)

        1. (i) When the trauma team is activated appropriately according to the facility’s criteria but the patient’s condition does not require such services.
        2. (ii) Example. A facility activates a Level II for all patients in a rollover motor vehicle crash.
        3. (iii) This is an internal evaluation of the appropriateness of the criteria.