(a) General requirements for emergency services.

1. (1) Written protocols for the provision of emergency services by a PCH/CAH shall be developed for the area served by the PCH/CAH; they shall take into consideration the service capabilities of the PCH/CAH, the general hospital(s) with which it has a formal affiliation pursuant to section 407.1 of this Part, and other area providers, as appropriate.
2. (2) PCHs/CAHs shall participate in a system which assures the availability of emergency medical services on a 24-hour a day basis within a service area-wide emergency medical services system. A PCH/CAH shall maintain an instantaneous communications link with its affiliated general hospital(s) and other appropriate providers of emergency medical services, medical backup and consultation, and medical control.

3. (3) At a minimum, PCHs/CAHs shall maintain an adequate supply of emergency equipment, supplies, and medication readily available for treating emergency cases. The items available shall include, but need not be limited to:

   1. (i) drugs and biologicals commonly used in life-saving procedures such as analgesics, local anesthetics, antibiotics, anticonvulsants, antidotes and emetics, serums and toxoids, antiarrhythmics, cardiac glycosides, antihypertensives, diuretics, and oral and IV electrolytes and replacement solutions (adult and pediatric); and
   2. (ii) equipment and supplies commonly used in lifesaving and life support procedures including but not limited to airway control and ventilation devices in adult and pediatric sizes, portable (transport) mechanical ventilators, endotracheal tubes, bag/valve/mask, oxygen, tourniquets, immobilization devices, nasogastric tubes, splints, IV therapy supplies, suction machine, defibrillator, cardiac monitor, chest tubes, and indwelling urinary catheters.
4. (4) Emergency services shall be coordinated with appropriate area providers including ambulance providers serving the pre-hospital delivery system of the PCH's/CAH's service area.
5. (5) PCHs/CAHs shall establish comprehensive written procedures for screening and assessing patients to determine the most appropriate on-site treatment, for identifying cases beyond the facility's capability to treat which require safe transfer to a more appropriate facility, and for arranging such transfers.
6. (6) PCHs/CAHs shall maintain, or coordinate with the general hospital(s) with which it has a formal affiliation pursuant to section 407.1 of this Part, or, if a member of a rural health network, through the network, an emergency transportation system with advanced life support capability available on a 24-hour a day on call basis to provide timely inter-facility transport.
7. (7) PCHs/CAHs, in cooperation with other area emergency medical service providers, shall develop written procedures to allow appropriately trained PCH/CAH personnel to provide patient care on ambulances in potentially life-threatening situations where such assistance is required; and

8. (8) PCHs that do not provide 24-hour a day on-site emergency services shall:

   1. (i) ensure that patients in need of emergency care arriving at the facility during non-operating hours are provided with information necessary to contact hospital personnel responsible for arranging for providing emergency care; and
   2. (ii) ensure that EMS/ambulance personnel transporting patients are able, during operating and non-operating hours, to contact hospital personnel responsible for arranging for providing emergency care to facilitate appropriate and timely patient disposition.