1. (a) Level III. A Level III hospital will provide emergency medical 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 310:641-7, on site 24 hours a day. A hospital must be classified at Level III for emergency psychiatric services if it complies with all of this subsection:

   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 level emergency medical technician, at least one of the practitioners on duty will have received training in advanced life support techniques and must be competent to initiate treatment of the emergency patient.
   3. (3) Outpatient psychiatric resources. The hospital will maintain a current list of outpatient psychiatric resources available within the community or region and make appropriate referrals for patients who do not require emergency inpatient psychiatric treatment.

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

      1. (A) Psychotropic medications appropriate for treating psychiatric emergencies including benzodiazepines such as lorazepam and neuroleptics such as haloperidol; and
      2. (B) Thiamine and glucose for intravenous administration.

   5. (5) 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 psychiatrist, or group of psychiatrists to provide immediate consultative services for psychiatric patients 24 hours a day. These services include providing instructions for the initiation of appropriate therapy and/or patient transfer.

2. (b) Level II. A Level II hospital will provide emergency medical services with an organized emergency department. A physician and nursing staff must be on site 24 hours a day. A hospital must be classified at Level II for emergency psychiatric 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 psychiatric patient and credentialed by the hospital to provide emergency medical services and nursing personnel must be on site 24 hours a day.
      2. (B) Outpatient psychiatric resources. A Level II hospital is subject to the same outpatient psychiatric resources requirements as a Level III hospital as set forth in (a)(3) of this Section.
      3. (C) Diagnostic imaging. The hospital's diagnostic x-ray services must be available 24 hours a day. A radiologic technologist will be on duty or on call and immediately available 24 hours a day.

      4. (D) Clinical laboratory service. The hospital's clinical laboratory services will 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;
         4. (iv) Therapeutic drug monitoring;
         5. (v) Drug and alcohol screening; and
         6. (vi) 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) Psychiatrist. A physician board certified, board eligible, or residency trained in psychiatry will be available for consultation on site or immediately available by telephone or other electronic means 24 hours a day.

   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) Equipment to perform electroencephalographic (EEG) testing;
      2. (B) Psychotropic medications appropriate to deal with psychiatric emergencies including benzodiazepines such as lorazepam and neuroleptics such as haloperidol; and
      3. (C) Thiamine and glucose for intravenous administration.
   4. (4) Agreements and policies on transfers. A Level II hospital is subject to the same agreements and policies on transfers requirements as a Level III hospital as set forth in (a)(5) of this Section.

3. (c) Level I. A Level I hospital will provide emergency medical services with organized emergency and psychiatry departments. A physician and nursing staff with special capability in psychiatric care must be on site 24 hours a day. The hospital must have the capability to provide immediate emergency inpatient psychiatric treatment 24 hours a day. A hospital must be classified at Level I for emergency psychiatric services if it complies with all of this subsection (c):

   1. (1) Clinical services and resources.

      1. (A) Emergency services. A physician competent in the care of the emergent psychiatric patient and credentialed by the hospital to provide emergency medical services and nursing personnel with special capability in psychiatric care must be on site 24 hours a day. Emergency room personnel must receive training on the facility's policies and procedures related to psychiatric patients including those for the use of physical and chemical restraints and seclusion, obtaining informed consent for psychotropic medications, suicide precautions, patient right to refuse treatment and the duty to protect, Emergency Order of Detention and commitment procedures, and determining a patient's legal status.
      2. (B) Psychiatry. The hospital must have an organized psychiatric service with appropriately credentialed physicians immediately available 24 hours a day. Physician members of the psychiatric service must be board certified, board eligible, or residency trained in psychiatry. On call physicians will respond as required by the hospital's policy.
      3. (C) Outpatient psychiatric resources. The hospital will maintain a current list of outpatient psychiatric resources available within the community or region and make appropriate referrals and follow-ups for patients who do not require emergency inpatient psychiatric treatment.
      4. (D) Inpatient psychiatric services. All inpatient psychiatric services will be provided under the direction of a physician director of inpatient psychiatric services and will comply with Subchapter 33 of this Chapter.

      5. (E) Diagnostic Imaging. The hospital's diagnostic x-ray and computed tomography services must be available 24 hours a day. A radiologic technologist and computerized tomography technologist 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) Computed tomography;
         2. (ii) Magnetic resonance imaging; and
         3. (iii) Neuroradiology.
      6. (F) Clinical laboratory service. A Level I hospital is subject to the same clinical laboratory service requirements as a Level II hospital as set forth in (b)(1)(D) of this Section.
      7. (G) Social services. Social services must be available and provided in accordance with 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) Psychiatric services director. The medical staff will designate a physician credentialed to provide psychiatric care as psychiatric services director.
      3. (C) Psychiatric nursing services director. A registered nurse with experience in psychiatric nursing will be responsible for psychiatric nursing service administration.
      4. (D) Physician qualifications. Physician members of the psychiatry service must be board certified, board eligible, or residency trained in psychiatry.
   3. (3) Supplies and equipment: Emergency department. A Level I hospital is subject to the same supplies and equipment requirements as a Level II hospital as set forth in (b)(3) of this Section.
   4. (4) Policies on transfers. The policies on transfers are as set forth in (a)(5)(A) of this Section (relating to policies on transfers).

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