2806.1 In each pediatric trauma facility, emergency department personnel shall consist of at least the following:

1. (a) A designated physician director of the emergency department;
2. (b) A physician with special competence in care of the critically injured who is a designated member of the trauma team and is physically present in the emergency department 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 pediatric intensive care unit (PICU), operating room (OR), or patient care unit.

2806.2 The requirement for an emergency medicine physician may be satisfied by an emergency medicine senior resident capable of assessing emergency situations in trauma patients and providing any indicated treatment. When a senior resident is used to satisfy this requirement the staff specialist on-call will be advised and will be promptly available. Supervision shall be provided by an in-house attending emergency physician twenty-four (24) hours per day in an institution where there is an emergency medicine residency training program.

2806.3 A team available for twenty-four (24) hours per day in-house coverage in the emergency department and who provides the initial management of the major pediatric trauma patient 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 and may be Pediatric Advanced Life Support (PALS) Certified, or who has demonstrated an appropriate level of expertise as determined by the Trauma Service Director. An appropriate level of expertise is demonstrated with not less than sixteen (16) hours trauma-related Continuing Medical Education (CME), board certification, clinical involvement, and special interest in trauma.
2. (b) Surgical residents, as follows:
3. (1) In Level I facilities, each surgical resident shall be in at least his or her fourth (4th) year of post-graduate specialty training; and
4. (2) In Level II facilities, each surgical resident shall be at least in his or her third (3rd) year of post-graduate specialty training;
5. (c) An anesthesiologist who shall be promptly available when the initial response by

an anesthesiology chief resident or a critical care nurse anesthetist;

(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; one (1) nurse shall have specialized knowledge of trauma care; and

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

2806.4 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.

2806.5 The annual team responses for a pediatric 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 of greater than fifteen (15), or more than thirty five (35) patients with an Injury Severity Score of greater than fifteen (15) on average for all trauma panel surgeons.

2806.6 Repealed.

2806.7 Each pediatric 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 8779 (October 29, 1999); as amended by Notice of Emergency and Proposed Rulemaking published at 51 DCR 3933 (April 16, 2004) [EXPIRED]; as amended by Final Rulemaking published at 51 DCR 7277 (July 23, 2004).