1. (a) Level III. A Level III hospital will provide services with at least a licensed independent practitioner, registered nurse, licensed practical nurse, or an Intermediate, Advanced Emergency Medical Technician (AEMT), or paramedic , as defined in OAC 310:641-1-7, on site 24 hours a day. A hospital must be classified at Level III for emergency ophthalmology services if it complies with all of this Section:

   1. (1) Clinical services and resources. Diagnostic, surgical, or medical specialty services are not required.
   2. (2) Personnel. A physician, licensed independent practitioner, registered nurse, licensed practical nurse, or an Intermediate, Advanced Emergency Medical Technician (AEMT),or paramedic , as defined in OAC 310:641-1-7, will be on site 24 hours a day. In the absence of a physician, licensed independent practitioner, registered nurse, or paramedic, at least one of the practitioners on duty will have received training in advanced life support techniques and will be competent to initiate treatment of the emergency patient.

   3. (3) Supplies and equipment. In addition to the requirements at OAC 310:667-59-9(a)(3), the hospital must have the following equipment and supplies on site, functional, and immediately available:

      1. (A) Ophthalmic irrigating device or procedure and sterile irrigating solution suitable for ophthalmic irrigation;
      2. (B) Nitrazine pH paper;
      3. (C) Distance and near vision charts or projector, or other equipment for the proper assessment of visual acuity;
      4. (D) Ophthalmoscope;

      5. (E) Agents for pupillary dilation such as:

         1. (i) Topical sympathomimetic; and
         2. (ii) Topical parasympatholytics.

      6. (F) Drugs for the treatment of acute angle-closure glaucoma including:

         1. (i) Topical miotic agents;
         2. (ii) Topical adrenergic antagonists;
         3. (iii) Oral and intravenous carbonic anhydrase inhibitors; and
         4. (iv) Hyperosmotic agents.
      7. (G) Topical anesthetic agents;
      8. (H) Penlight and loupes or magnifying lenses;
      9. (I) Equipment for tonometry;
      10. (J) Sterile, individually wrapped, fluorescein impregnated paper strips;
      11. (K) Supplies and equipment necessary for patching the eye;
      12. (L) Lid retractors;
      13. (M) Ophthalmic spud device or equivalent;
      14. (N) Topical antibiotics;
      15. (O) Eye shields; and
      16. (P) Light source with a blue filter or Wood lamp.

   4. (4) Agreements and policies on transfers.

      1. (A) The hospital must have written policies defining the medical conditions and circumstances for emergency patients that may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another hospital.
      2. (B) The hospital must have a written agreement with a hospital, or board certified, board eligible, or residency trained ophthalmologist, or group of ophthalmologists to provide immediate consultative services for ophthalmology patients 24 hours a day. These services must include providing instructions for the initiation of appropriate therapy and/or patient transfer. Appropriately trained and credentialed optometrists may also provide consultative and therapeutic services within their scope of practice.

2. (b) Level II. A Level II hospital will provide emergency medical services with an organized emergency department. A physician and nursing staff will be on site 24 hours a day. A hospital must be classified at Level II for emergency ophthalmology services if it complies with all of this subsection (b):

   1. (1) Clinical services and resources.

      1. (A) Emergency services. A physician competent in the care of the emergent ophthalmology patient and credentialed by the hospital to provide emergency medical services and nursing personnel must be on site 24 hours a day.
      2. (B) Diagnostic imaging. The hospital's diagnostic x-ray services must be available 24 hours a day. A radiology technologist will be on duty or on call and immediately available 24 hours a day.

      3. (C) Clinical laboratory service. The hospital's clinical laboratory services must be available 24 hours a day. All or part of these services may be provided by arrangements with certified reference laboratories that are available on an emergency basis 24 hours a day. These services include:

         1. (i) Standard analysis of blood, urine, and other body fluids to include routine chemistry and hematology testing;
         2. (ii) Coagulation studies;
         3. (iii) Blood gas/pH analysis; and
         4. (iv) Comprehensive microbiology services or appropriate supplies for the collection, preservation, and transport of clinical specimens for aerobic and anaerobic bacterial, mycobacterial, and fungus cultures.

   2. (2) Personnel.

      1. (A) Emergency services director. The medical staff will designate a physician credentialed to provide emergency medical care as emergency services director.
      2. (B) Ophthalmologist. A physician board certified, board eligible, or residency trained in ophthalmology will be available for consultation on site or immediately available by telephone or other electronic means 24 hours a day.
      3. (C) Optometrist. Appropriately trained and credentialed optometrists may also provide consultative and therapeutic services within their scope of practice.

   3. (3) Supplies and equipment. In addition to the requirements at OAC 310:667-59-9(a)(3), the hospital must have the following equipment and supplies on site, functional, and immediately available:

      1. (A) The equipment and supplies listed in (a)(3)(A) through (O) in this Section for Level III classification; and
      2. (B)

   Slit-lamp biomicroscope.

   1. (4) Agreements and policies on transfers.

      1. (A) The hospital must have written policies defining the medical conditions and circumstances for emergency patients that may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another hospital.
      2. (B) The hospital must have a written agreement with a hospital, or board certified, board eligible, or residency trained ophthalmologist, or group of ophthalmologists to provide immediate consultative services for ophthalmology patients 24 hours a day. These services must include providing instructions for the initiation of appropriate therapy and/or patient transfer.

3. (c) Level I. A Level I hospital must provide emergency medical services with organized emergency and ophthalmology departments. A physician and nursing staff with special capability in ophthalmic care will be on site 24 hours a day. The hospital must have the capability to provide immediate diagnostic imaging and sight saving surgical intervention 24 hours a day. A hospital must be classified at Level I for emergency ophthalmology services if it complies with (c)(1) through (c)(4) of this subsection:

   1. (1) Clinical services and resources.

      1. (A) Emergency services. A physician competent in the care of the emergent ophthalmology patient and credentialed by the hospital to provide emergency medical services and nursing personnel with special capability in ophthalmic care must be on site 24 hours a day.
      2. (B) Ophthalmology and ophthalmic surgery. The hospital must have an organized ophthalmology and ophthalmic surgery service with appropriately credentialed physicians experienced in ophthalmic medical and surgical procedures immediately available 24 hours a day. Physician members of the ophthalmology service must be board certified, board eligible, or residency trained in ophthalmology. On call physicians will respond as required by the hospital's policy.
      3. (C) Neurology. A board certified, board eligible, or residency trained neurologist must be on site or on call 24 hours a day and promptly available in the emergency department.
      4. (D) Anesthesia. A board certified, board eligible, or residency trained anesthesiologist must be on site or on call 24 hours a day and promptly available. All anesthesia will be administered in accordance with OAC 310:667-25-2.
      5. (E) Operating suite. An operating suite with adequate staff and equipment must be immediately available 24 hours a day. The hospital will define and document in writing the minimum staffing requirements for the operating suite. An on call schedule for emergency replacement staff must be maintained. At least one operating suite will have conventional and laser surgery and photocoagulation capability.
      6. (F) Post-anesthesia recovery unit. The hospital must have a post-anesthesia recovery room or intensive care unit that is in compliance with OAC 310:667-15-7 and nursing personnel and anesthesia services remaining in the unit until the patient is discharged from post-anesthesia care.

      7. (G) Intensive care unit. The hospital's intensive care unit mustinclude:

         1. (i) Compliance with OAC 310:667-15-7;
         2. (ii) A registered nurse on duty in the intensive care unit when it does not have a patient;
         3. (iii) A registered nurse on call and immediately available when the unitdoes not have a patient; and
         4. (iv) The hospital will define and document in writing the minimum staffing requirements for the intensive care unit. These staffing requirements will be monitored through the quality improvement program.

      8. (H) Diagnostic Imaging. The will have diagnostic x-ray, computed tomography, and ultrasonography services available 24 hours a day. A radiologic technologist, computerized tomography technologist, and staff designated as qualified to perform ultrasonography will be on duty or on call and immediately available 24 hours a day. A single technologist designated as qualified by the radiologist in both diagnostic x-ray and computerized tomography procedures may be used to meet this requirement if an on call schedule of additional diagnostic imaging personnel is maintained. The diagnostic imaging services include:

         1. (i) Angiography;
         2. (ii) Ultrasonography;
         3. (iii) Computed tomography;
         4. (iv) Magnetic resonance imaging; and
         5. (v) Neuroradiology.

      9. (I) Clinical laboratory service. The hospital must have clinical laboratory services are available 24 hours a day. All or part of these services may be provided by arrangements with certified reference laboratories that are available on an emergency basis 24 hours a day. These services include:

         1. (i) All the clinical laboratory services listed for Level II classification as set forth in (b)(1)(C) of this Section;
         2. (ii) Comprehensive immunohematology services including blood typing and compatibility testing;
         3. (iii) A supply of blood and blood products on hand that is properly stored and adequate to meet expected patient needs; and
         4. (iv) Access to services provided by a community central blood bank.
      10. (J) Social services. Social services available and provided as required in Subchapter 31 of this Chapter.

   2. (2) Personnel.

      1. (A) Emergency services director. The medical staff will designate a physician credentialed to provide emergency medical care as emergency services director.
      2. (B) Ophthalmology services director. The medical staff will designate a physician credentialed to provide medical and/or surgical ophthalmic care as ophthalmology services director.
      3. (C) Physician qualifications. Physician members of the ophthalmology service must be board certified, board eligible, or residency trained in ophthalmology.
      4. (D) Optometrist. Appropriately trained and credentialed optometrists may also provide consultative and therapeutic services within their scope of practice.

   3. (3) Supplies and equipment. In addition to the requirements at OAC 310:667-59-19(b)(3), the hospital must have the following equipment and supplies on site, functional, and immediately available:

      1. (A) Gonioscopy equipment; and
      2. (B) Equipment for indirect ophthalmoscopy.
   4. (4) Policies on transfers. The hospital must have written policies defining the medical conditions and circumstances for those emergency patients that may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another facility.

Added at 17 Ok Reg 2992, eff 7-13-00

Amended at 20 Ok Reg 1664, eff 6-12-03

Amended at 39 Ok Reg 1392, eff 9-11-22