2706.1 Emergency department personnel in each adult trauma care facility shall consist of at least the following:

1. (a) A designated physician director of the emergency department;
2. (b) Physicians with special competence in the care of the critically injured, who are designated members of the trauma team and are physically present in the emergency department and sufficient in number to provide coverage twenty-four (24) hours per day; and
3. (c) Nursing personnel with special capability in trauma care who provide continual monitoring of the trauma patient from hospital arrival to disposition in the Intensive Care Unit (ICU), Operating Room (OR), or patient care unit.

2706.2 The requirement for an emergency medicine physician may be satisfied by emergency medicine senior residents capable of assessing emergency situations in trauma patients and providing any indicated treatment. When senior residents are used to satisfy this requirement, the facility shall advise the staff specialist on-call who shall be promptly available. Institutions that have emergency medicine residency training programs shall provide supervision twenty-four (24) hours per day by an in-house attending emergency physician.

2706.3 A facility shall have a team available for twenty-four (24) hours per day in-house coverage in the emergency department. The team shall provide the initial management of the major trauma patient and shall consist of at least the following personnel:

1. (a) An emergency department attending physician with knowledge of trauma care who is Advanced Trauma Life Support (ATLS) Certified or has demonstrated an appropriate level of expertise as determined by the Trauma Service Director, but not less than sixteen (16) hours trauma- related CME, clinical involvement, and special interest in trauma;
2. (b) Surgical residents who shall be in at least the fourth (4th) year of post-graduate specialty training;
3. (c) An anesthesiologist; however, the initial response may be by a anesthesiology chief resident or a critical care nurse anesthetist with trauma proficiency, and the attending anesthesiologist shall be promptly available;
4. (d) A minimum of two (2) nurses familiar with emergency and critical care, qualified to function as members of the trauma team by specific criteria defining orientation and practice requirements; at least one (1) nurse shall have specialized knowledge

of trauma care; and

(e) Registered nurses, licensed practical nurses, and nurse aides in sufficient number to provide appropriate coverage.

2706.4 The in-house team shall be on group call pagers to meet each patient with maximum readiness upon arrival. If the in-house team is not on group call pagers, a paging system shall function to mobilize the team within a maximum of two (2) minutes.

2706.5 The annual team responses for an adult Level I trauma center shall be at least twelve hundred (1200) patients, or a minimum of two hundred and forty (240) patients with an Injury Severity Score greater than fifteen (>15), or an average of more than thirty five (35) patients with an Injury Severity Score greater than fifteen (15) for all trauma panel surgeons.

2706.6 Repealed.

2706.7 Each adult trauma care facility shall have mobile X-ray capability with twenty-four (24) hours per day coverage by in-house technicians.

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).