1. (1) The operator shall assure that limited emergency services are provided in accordance with this subdivision or subdivisions (b) and (c) of this section as appropriate.

2. (2) When limited emergency services are provided by an upgraded diagnostic and treatment center, the governing body through its medical/professional staff shall assure:

   1. (i) the availability of limited emergency services on a 24-hour a day basis, seven days a week, within a network-wide emergency medical services (EMS) system as defined by a network operational plan or cooperative agreement; and
   2. (ii) the availability of a 24-hour a day, continuous on-line communications link with its affiliated hospital(s) and other appropriate providers of emergency services, medical backup, consultation, inter-facility transport and medical control.

3. (3) UD&TCs that do not provide 24-hour a day on-site limited emergency services shall ensure that:

   1. (i) patients in need of emergency care and arriving at the facility during non-operating hours are provided with information necessary to contact center personnel responsible for arranging/providing needed emergency care; and

   2. (ii) EMS/ambulance personnel are able, at all times, to contact center personnel responsible for arranging/providing needed emergency care to facilitate appropriate patient disposition.

      (b) Organization.

4. (1) the entity or person established as operator shall ensure:

   1. (i) that its medical/professional staff are sufficient in number and qualified to provide emergency services in accordance with patient needs and the service capabilities of the facility; and

   2. (ii) that the medical/professional staff includes at least one licensed physician and one or more currently licensed or registered health care practitioners including but not limited to registered physician's assistants and nurse practitioners appointed by the operator's governing body, which shall mean the governing authority as defined in section 600.9(a) of this Title. The members of the medical/professional staff shall:

      1. (a) provide services in accordance with the UD&TC's policies and procedures;
      2. (b) arrange for, or refer patients to, providers or services not available at the UD&TC as needed;
      3. (c) assure that appropriate patient health records are maintained and transferred as required when patients are referred or transferred; and

      4. (d) participate in the development, implementation and periodic review of the written policies and procedures governing the services of the UD&TC, which shall specify:

         1. (1) the responsibilities of the emergency services unit to evaluate, initially manage and treat, or transfer patients to another facility for treatment;
         2. (2) the organizational structure of the limited emergency service, including lines of administrative authority and delineation of responsibilities for patient services; and
         3. (3) the prohibition of any refusal to treat or transfer patients based on their ability or inability to pay for services.

5. (2) At a minimum, the UD&TC 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, antiarrythmics, 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 procedures such as: 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.
6. (3) Emergency services shall be coordinated with other services of the UD&TC to facilitate continuity of care and discharge planning when post emergency needs do not require transfer to another facility.
7. (4) Emergency services shall be coordinated with other appropriate network providers, including ambulance providers serving the pre-hospital delivery system of the network.

8. (5) UD&TCs shall have an advanced life support (ALS) supported emergency transportation system available on a 24-hour a day on call basis to provide timely inter-facility transport.

   (c) General policies and procedures.

   The UD&TC shall:

9. (1) maintain the location and telephone number of the State Department of Health designated poison control center at the telephone switchboard and in the emergency service area of the center;
10. (2) establish written procedures for screening and assessing patients to determine the most appropriate on-site treatment and for identifying cases beyond the facility's capacity to serve in order to arrange safe transfer to a more appropriate facility; and
11. (3) in cooperation with other network emergency medical service providers, develop written procedures to permit appropriately trained UD&TC personnel to provide necessary patient care on ambulances in potentially life threatening situations where such assistance is required.

(a) General.