2700.1 The Director, Department of Health, shall designate Level I and Level II hospitals for adult trauma care facilities as the inclusive trauma system in the District of Columbia, provided a facility complies with the provisions of this chapter.

2700.2 The provisions of this chapter shall be used by the District of Columbia for the purposes of assessing the suitability of hospitals for receipt of certain trauma patients in the District of Columbia's Emergency Medical Services System (EMS).

2700.3 An inclusive trauma care system is a system that is fully integrated into the EMS and is designated to meet the needs of all injured patients requiring care in an acute care facility, regardless of severity of injury, geographic location, or population density.

2700.4 An inclusive trauma care system shall have the following components:

1. (a) Medical direction;
2. (b) Prevention;
3. (c) Communication;
4. (d) Training;
5. (e) Triage;
6. (f) Prehospital care;
7. (g) Transportation;
8. (h) Hospital care;
9. (i) Public education;
10. (j) Rehabilitation; and
11. (k) Research.

2700.5 An inclusive trauma care system shall also include the following:

1. (a) System management;

2. (b) Prehospital provider;

3. (c) Acute care facilities; and

4. (d) Rehabilitation/reconstructive services.2700.6 The designation of an adult trauma care facility as Level I or Level II guarantees the immediate availability and dedication of specialized surgeons, anesthesiologists, physician specialists, nurses, and resuscitation life-support equipment at the facility on a twenty-four (24) hour a day basis.2700.7 Level I facilities shall have the capability to provide total care for every aspect of an injury, and shall ensure prompt transfer between facilities during all phases of acute and rehabilitative care.2700.8 A Level I trauma facility shall be an institution which, in addition to meeting the Level II guidelines, shall deploy and coordinate resources for the special types of care required for the major and multiple trauma victim and have a continued commitment to training and research as minimal characteristics of the hospital's commitment to trauma care.2700.9 Level II facilities may have the capability to provide total care for every aspect of an injury and may ensure prompt transfer between facilities during all phases of acute and rehabilitative care.2700.10 For optimal care of the severely injured, Level I and Level II facilities shall meet the following requirements:- (a) Skilled surgeons and other members of the trauma team shall be immediately available;
5. (b) When an arriving patient meets the hospital-specific guidelines defining a major resuscitation, the attending surgeon shall be present in the emergency department:
6. (1) Upon arrival of the patient, when there is advance notification from the field; or
7. (2) Within fifteen (15) minutes of activating the trauma team, when there is no advance notification;
8. (c) Compliance with the requirements of subsections (a) and (b) at a rate of eighty percent (80%) or greater shall be documented; and
9. (d) The following minimum criteria shall be used to define a major resuscitation:
10. (1) Confirmed blood pressure less than ninety (90) millimeters of mercury

(mmHg) at any time in adults;

(2) Respiratory compromise, airway obstruction, or intubation;

(3) Transfer patients from other hospitals receiving blood to maintain vital signs;

(4) Gunshot wounds to the abdomen, neck, or chest;

(5) Glasgow Coma Scale (GCS) less than eight (<8) with mechanism attributed to trauma; and

(6) Emergency physician's discretion.

2700.11 All major trauma patients shall be admitted to an adult trauma care facility.

2700.12 Each Level I facility shall conduct research at the clinical or basic sciences level, and shall be responsible for disseminating new information.

2700.13 A designated person in each Level I and Level II facility shall be responsible for multi-disciplinary and interdepartmental coordination of trauma care.

2700.14 Each facility shall be in compliance with all applicable local laws and regulations.

2700.15 The management and operation of any adult trauma care facility shall be in accordance with good medical and public health practices.

AUTHORITY: Unless otherwise noted, the authority for this chapter is the Health-Care and Community Residence Facility, Hospice and Home Care Licensure Act of 1983 §§2(b) and 5, D.C. Code, 2001 Ed. §§44-501 and 44-504; Reorganization Plan No. 4 of 1996, 3 D.C. Code, 2001 Ed. at 413; and Mayor's Order 98-137 (August 20, 1998).

SOURCE: Notice of Final Rulemaking published at 46 DCR 8741 (October 29, 1999); as amended by Notice of Emergency and Proposed Rulemaking published at 51 DCR 3915 (April 16, 2004) [EXPIRED]; as amended by Final Rulemaking published at 51 DCR 7260 (July 23, 2004).