1. (a) Level IV. A Level IV hospital will provide emergency medical services with at least a licensed independent practitioner, registered nurse, licensed practical nurse, or intermediate or paramedic level emergency medical technician on site 24 hours a day. A hospital must be classified at Level IV for trauma and emergency operative services if it complies with all of this subsection (a):

   1. (1) Clinical services and resources. No diagnostic, surgical, or medical specialty services are 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 310:641-7,isrequired 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 must have received training in advanced life support techniques and must be competent to initiate treatment of the emergency patient.

   3. (3) Supplies and equipment. The hospital must have equipment for use in the resuscitation of patients of all ages on site, functional, and immediately available, including the following:

      1. (A) Airway control and ventilation equipment, including laryngoscopes and endotracheal tubes of all sizes, bag-mask resuscitator, pocket masks, and oxygen;
      2. (B) Suction devices;
      3. (C) Electrocardiograph-oscilloscope-defibrillator-pacer;
      4. (D) Standard intravenous fluids and administration devices, including large-bore intravenous catheters;

      5. (E) Sterile surgical sets for:

         1. (i) Airway control/cricothyrotomy;
         2. (ii) Vascular access; and
         3. (iii) Chest decompression.
      6. (F) Equipment for gastric decompression;
      7. (G) Drugs necessary for emergency care;
      8. (H) Two-way communication with vehicles of emergency transport system as required at OAC 310:667-29-1(c)(4); and
      9. (I) Thermal control equipment for patients.

   4. (4) Agreements and policies on transfers.

      1. (A) 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 hospital.
      2. (B) The hospital must have a transfer agreement with a hospital capable of providing trauma care for severely injured patients. This agreement must include reciprocal provisions requiring the hospital to accept return transfers of patients at such time as the hospital has the capability and capacity to provide needed care and cannot incorporate financial provisions for transfers.
      3. (C) The hospital must have transfer agreements with a hospital capable of providing burn care in a physician-directed, organized burn care center with a staff of nursing personnel trained in burn care and equipped properly for care of the extensively burned patient.
      4. (D) The hospital must have transfer agreements with a hospital capable of providing acute spinal cord and head injury management and rehabilitation.
      5. (E) The hospital must have transfer agreements with a hospital capable of providing rehabilitation services in a rehabilitation center with a staff of personnel trained in rehabilitation care and equipped properly for acute care of the critically injured patient.

   5. (5) Quality Improvement. In addition to any other quality improvement requirements governing the hospital to, the quality improvement program must also include the following subjects:

      1. (A) Trauma registry;
      2. (B) Audit for all trauma deaths to include prehospital care and care received at a transferring hospital;
      3. (C) Morbidity and mortality review;
      4. (D) Medical nursing audit, utilization review, tissue review; and
      5. (E) The availability and response times of on call staff specialists is defined in writing, documented, and continuously monitored.

2. (b) Level III. A Level III hospital will provide emergency medical services with an organized trauma service and emergency department. A physician and nursing staff with special capability in trauma care are required on site 24 hours a day. General surgery and anesthesiology services will be available either on duty or on call. A hospital must be classified at Level III for trauma and emergency operative services if it complies with all of this subsection (b):

   1. (1) Clinical services and resources.

      1. (A) Trauma service. A trauma service will be established by the medical staff and will be responsible for coordinating the care of injured patients, the training of personnel, and trauma quality improvement.

         1. (i) Privileges for physicians participating in the trauma service will be determined by the medical staff credentialing process.
         2. (ii) All patients with multiple-system or major injury will be evaluated by the trauma service.
         3. (iii) The surgeon responsible for the overall care of the admitted patient must be identified.
      2. (B) Emergency services. A physician competent in the care of the critically injured and credentialed by the hospital to provide emergency medical services and nursing personnel with special capability in trauma care must be on site 24 hours a day. The emergency service may also serve as the trauma service.
      3. (C) General surgery. A board certified, board eligible, or residency trained general surgeon must be on call 24 hours a day and promptly available in the emergency department.
      4. (D) Anesthesia. Anesthesia services must be on call 24 hours a day, promptly available, and administered in accordance with OAC 310:667-25-2.
      5. (E) Internal medicine. A physician board certified, board eligible, or residency trained in internal medicine must be on call 24 hours a day and promptly available in the emergency department.
      6. (F) Orthopedic Surgery. A physician board certified, board eligible, or residency trained in orthopedics and competent in the care of orthopedic emergencies must be on site or on call 24 hours a day and promptly available in the emergency department. In the absence of the orthopedic surgeon, a physician designated by the trauma director and credentialed to provide stabilizing emergency orthopedic treatment may provide care prior to transfer.
      7. (G) Operating suite. An operating suite with thermal control equipment for patients and infusion of blood and fluids must be available 24 hours a day.
      8. (H) Post-anesthesia recovery unit. The hospital is required to have a post-anesthesia recovery room or intensive care unit that is in compliance with OAC 310:667-15-7 with the nursing personnel and anesthesia services remaining in the unit until the patient is discharged from post-anesthesia care.

      9. (I) 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 has a patient;
         3. (iii) A registered nurse on call and immediately available when it does not have a patient; and
         4. (iv) Written policies defining the minimum staffing requirements for the intensive care unit thatare monitored for compliance through the quality improvement program.
      10. (J) Diagnostic imaging. The hospital must have diagnostic x-ray services available 24 hours a day. A radiology technologist must be on duty or on call and immediately available 24 hours a day.

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

          1. (i) Comprehensive immunohematology services including blood typing and compatibility testing;
          2. (ii) A supply of blood and blood products on hand that is properly stored and adequate to meet expected patient needs;
          3. (iii) Access to services provided by a community central blood bank;
          4. (iv) Standard analysis of blood, urine, and other body fluids to include routine chemistry and hematology testing;
          5. (v) Coagulation studies;
          6. (vi) Blood gas/pH analysis;
          7. (vii) Comprehensive microbiology services or appropriate supplies for the collection, preservation, and transport of clinical specimens for aerobic and anaerobic bacterial, mycobacterial, and fungus cultures; and
          8. (viii) Drug and alcohol screening.
      12. (L) Social services. Social services must be available and provided in accordance with Subchapter 31 of this Chapter.

      13. (M) Burn Care.

          1. (i) The hospital must provide burn care in a physician-directed, organized burn care center with nursing staff personnel trained in burn care and equipped properly for care of the extensively burned patient; or
          2. (ii) If the hospital is unable to satisfy (i) of this subparagraph (M), it must have a written transfer agreement with a hospital that meets the requirement of (i) of this subparagraph (M).

      14. (N) Spinal cord and head injury management.

          1. (i) The hospital must provide acute spinal cord and head injury management; or
          2. (ii) If the hospital is unable to satisfy (i) of this subparagraph (N), it must have a written transfer agreement with a hospital that provides acute spinal cord and head injury management and comprehensive rehabilitation services.

      15. (O) Rehabilitation services.

          1. (i) The hospital must provide rehabilitation services in a rehabilitation center with a staff of personnel trained in rehabilitation care and equipped properly for acute care of the critically injured patient; or
          2. (ii) If the hospital is unable to satisfy (i) of this subparagraph (O), it must have a written transfer agreement with a hospital that satisfies (i) of this subparagraph (O) and the requirements of Subchapter 35 of this Chapter.

   2. (2) Personnel.

      1. (A) Trauma service director. The medical staff will designate surgeon as trauma service director. The trauma service director's responsibilities include:

         1. (i) all trauma patients and administrative authority for the hospital's trauma program, through the quality improvement process; and
         2. (ii) recommending appointments and removals from the trauma service.
      2. (B) Emergency services director. The medical staff will designate a physician credentialed to provide emergency medical care as emergency services director. The emergency services director may serve as the trauma service director.
      3. (C) Surgical director. The medical staff will designate a surgeon credentialed by the hospital to be the director of care for surgical and critical care for trauma patients.

   3. (3) Supplies and equipment.

      1. (A) Emergency department. The emergency department must have equipment for use in the resuscitation of patients of all ages on site, functional, and available in the emergency department, including the following:

         1. (i) Airway control and ventilation equipment, including laryngoscopes and endotracheal tubes of all sizes, bag-mask resuscitator, pocket masks, and oxygen;
         2. (ii) Pulse oximetry;
         3. (iii) Suction devices;
         4. (iv) Electrocardiograph-oscilloscope-defibrillator-pacer;
         5. (v) Apparatus to establish central venous pressure monitoring;
         6. (vi) Standard intravenous fluids and administration devices, including large-bore intravenous catheters;

         7. (vii) Sterile surgical sets for:

            1. (I) Airway control/cricothyrotomy;
            2. (II) Thoracotomy;
            3. (III) Vascular access; and
            4. (IV) Chest decompression.
         8. (viii) Equipment for gastric decompression;
         9. (ix) Drugs necessary for emergency care;
         10. (x) Two-way communication with vehicles of emergency transport system as required at OAC 310:667-29-1(c)(4);
         11. (xi) Skeletal traction devices including cervical immobilization device; and
         12. (xii) Thermal control equipment for patients and infusion of blood, blood products, and other fluids.

      2. (B) Post-anesthesia recovery unit. The post-anesthesia recovery unit must have the following supplies and equipment on site, functional, and available for use:

         1. (i) Equipment for the continuous monitoring of temperature, hemodynamics, and gas exchange;
         2. (ii) Pulse oximetry;
         3. (iii) End-tidal CO2 determination; and
         4. (iv) Thermal control equipment for patients and infusion of blood, blood products, and other fluids.

      3. (C) Intensive care unit. The intensive care unit must have the following supplies and equipment on site, functional, and available for use:

         1. (i) Equipment for the continuous monitoring of temperature, hemodynamics, and gas exchange;
         2. (ii) Cardiopulmonary resuscitation cart;
         3. (iii) Electrocardiograph-oscilloscope-defibrillator-pacer;

         4. (iv) Sterile surgical sets for:

            1. (I) Airway control/cricothyrotomy;
            2. (II) Thoracotomy;
            3. (III) Vascular access; and
            4. (IV) Chest decompression.
   4. (4) Policies on transfers. The applicable policies on transfers for a Level III hospital are as set forth in (a)(4)(A) and (a)(4)(B) of this Section (relating to agreement and policies on transfers).

   5. (5) Quality Improvement. In addition to any other quality improvement requirements governing the hospital, the quality improvement program must also include the following subjects:

      1. (A) all the quality improvement subjects listed for Level IV classification set forth in (a)(5) of this Section;
      2. (B) Published on call schedules for surgeons, neurosurgeons, and orthopedic surgeons; and
      3. (C) Review of the times and reasons for trauma-related bypass.
   6. (6) Continuing education. The hospital will provide and document formal continuing education programs for physicians, nurses, and allied health personnel.
   7. (7) Organ Procurement. The hospital, in association with an organ procurement organization certified by the CMS, will create and maintain policies and procedures to identify and refer potential organ donors.

3. (c) Level II. A Level II hospital will provide emergency medical services with an organized trauma service and emergency department. A physician and nursing staff with special capability in trauma care will be on site 24 hours a day. General surgery, anesthesiology, and neurosurgery services will be available on site or on call 24 hours a day. Services from an extensive group of clinical specialties including cardiology, internal medicine, orthopedics, and obstetrics/gynecology must be promptly available on call. A hospital must be classified at Level II for trauma and emergency operative services if it complies with all of this subsection (c):

   1. (1) Clinical services and resources.

      1. (A) Trauma service. A Level II hospital is subject to the same trauma service requirements as a Level III hospital as set forth in (b)(1)(A) of this Section.
      2. (B) Emergency services. A physician competent in the care of the critically injured and credentialed by the hospital to provide emergency medical services; and nursing personnel with special capability in trauma care must be on site 24 hours a day.
      3. (C) General surgery. A general surgeon or senior surgical resident competent and appropriately credentialed by the hospital 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 in the emergency department. If the anesthesiologist is not present in the hospital, before the physician's arrival, anesthesia services may be provided by a certified registered nurse anesthetist (CRNA). The CRNA must be competent in the assessment of emergent situations in trauma patients and of initiating and providing any indicated treatment. All anesthesia must be administered in accordance with OAC 310:667-25-2.
      5. (E) Neurologic surgery. A board certified, board eligible, or residency trained neurosurgeon or other physician competent in the care of patients with neurotrauma and appropriately credentialed must be on site or on call 24 hours a day and promptly available in the emergency department. If care is initiated by a physician other than a neurosurgeon, the neurosurgeon on call will respond as required by the hospital's policy.

      6. (F) Other specialties. The hospital must also have services from the following specialties on call and promptly available:

         1. (i) Cardiac surgery;
         2. (ii) Cardiology;
         3. (iii) Internal medicine;
         4. (iv) Obstetric/gynecologic surgery;
         5. (v) Ophthalmic surgery;
         6. (vi) Oral/maxillofacial surgery;
         7. (vii) Orthopedic surgery;
         8. (viii) Otolaryngology;
         9. (ix) Pediatrics;
         10. (x) Plastic surgery;
         11. (xi) Clinical licensed psychologist or psychiatrist;
         12. (xii) Pulmonary medicine;
         13. (xiii) Radiology;
         14. (xiv) Thoracic surgery; and
         15. (xv) Urology and urologic surgery.
      7. (G) Operating suite. An operating suite with adequate staff and equipment must be immediately available 24 hours a day. The hospital must have written policies defining the minimum staffing requirements for the operating suite. An on call schedule for emergency replacement staff will be maintained.
      8. (H) Post-anesthesia recovery unit. A level II hospital is subject to the same post-anesthesia recovery unit requirements as a Level III hospital as set forth in (b)(1)(H) of this Section.

      9. (I) Intensive care unit. The hospital's intensive care unit must include:

         1. (i) Compliance with OAC 310:667-15-7;
         2. (ii) A registered nurse on duty in the intensive care unit when it has a patient;
         3. (iii) A registered nurse on call and immediately available when the unit does not have a patient;
         4. (iv) A physician with privileges in critical care on duty in the unit or immediately available 24 hours a day; and
         5. (v) Written policies defining the minimum staffing requirements for the intensive care unit that are continuously monitored for compliance through the quality improvement program.

      10. (J) Diagnostic Imaging. The hospital's diagnostic x-ray 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 service provides the following services:

          1. (i) Angiography;
          2. (ii) Ultrasonography;
          3. (iii) Computed tomography;
          4. (iv) Magnetic resonance imaging;
          5. (v) Neuroradiology; and
          6. (vi) Nuclear medicine imaging.
      11. (K) Clinical laboratory service. A Level II hospital is subject to the same clinical laboratory service requirements as a Level III hospital as set forth in (b)(1)(K) in this Section.
      12. (L) Respiratory therapy. Routine respiratory therapy procedures and mechanical ventilators will be available 24 hours a day. Respiratory therapy services will comply -with OAC 310:667-23-6.
      13. (M) Social services. Social services must be available and provided in accordance with Subchapter 31 of this Chapter.
      14. (N) Burn Care. A Level II hospital is subject to the same burn care requirements as a Level III hospital as set forth in (b)(1)(M) of this Section.
      15. (O) Spinal cord and head injury management. The hospital must provide acute spinal cord and head injury management including at least the ability to initiate rehabilitative care prior to transfer and must have a written transfer agreement with a hospital that provides comprehensive rehabilitation services.
      16. (P) Rehabilitation services. A Level II hospital is subject to the same rehabilitation services requirements as a Level III hospital as set forth in (b)(1)(O) of this Section.

   2. (2) Personnel.

      1. (A) Trauma service director. A Level II hospital is subject to the same trauma service director requirements as a Level III hospital as set forth in (b)(2)(A) of this Section.

      2. (B) Trauma coordinator. The hospital must have a designated trauma coordinator who may also serve as the prevention coordinator. Under the supervision of the trauma service director, the trauma coordinator is responsible for organizing the services and systems of the trauma service to ensure there is a multidisciplinary approach throughout the continuum of trauma care. The trauma coordinator's responsibilities include:

         1. (i) Clinical activities such as design of clinical protocols, monitoring care, and assisting the staff in problem solving;
         2. (ii) Educational activities such as professional staff development, case reviews, continuing education, and community trauma education and prevention programs;
         3. (iii) Quality improvement activities such as development of quality monitors, audits, and case reviews in all phases of trauma care;
         4. (iv) Administrative tasks for the trauma service such as those related to services' organization, personnel, budget preparation, and accountability;
         5. (v) Trauma registry data collection, coding, scoring, and validation; and
         6. (vi) Consultation and liaison to the medical staff, prehospital emergency medical service agencies, patient families, and the community at large.
      3. (C) Prevention coordinator. The hospital must have a designated prevention coordinator who may also serve as the trauma coordinator. Under the supervision of the trauma director, the prevention coordinator is responsible for the organization and management of the hospital's outreach, prevention, and public education activities.
      4. (D) Emergency services director. The medical staff will designate a physician credentialed to provide emergency medical care as emergency services director.
      5. (E) Surgical director. A Level II hospital is subject to the same surgical director requirements as a Level III hospital as set forth in (b)(2)(C) of this Section.

   3. (3) Supplies and equipment.

      1. (A) Emergency department. The emergency department must have equipment for use in the resuscitation of patients of all ages on site, functional, and available in the emergency department, including at least the following:

         1. (i) All the emergency department equipment listed for Level III classification as set forth in (b)(3)(A) of this Section;
         2. (ii) End-tidal CO2 determination; and
         3. (iii) Arterial catheters.

      2. (B) Operating suite. The operating suite must have the following supplies and equipment on site, functional and available for use:

         1. (i) Thermal control equipment for patients and infusion of blood, blood products, and other fluids;
         2. (ii) X-ray capability including c-arm intensifier;
         3. (iii) Endoscopes;
         4. (iv) Craniotomy instruments; and
         5. (v) Equipment appropriate for fixation of long-bone and pelvic fractures.

      3. (C) Post-anesthesia recovery unit. The post-anesthesia recovery unit must have the following supplies and equipment on site, functional, and available for use:

         1. (i) All the post-anesthesia recovery unit supplies and equipment listed for a Level III classification as set forth in (b)(3)(B) of this Section; and
         2. (ii) Equipment for the continuous monitoring of intracranial pressure.
      4. (D) Intensive care unit. A Level II hospital is subject to the same intensive care unit requirements as a Level III hospital as set forth in (b)(3)(C) of this Section.
   4. (4) Policies on transfers. The hospital must have written policies defining the medical conditions and circumstances for those emergency patients which may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another hospital.

   5. (5) Quality Improvement. The hospital will establish a multidisciplinary trauma committee composed of the trauma service director, emergency services director, trauma coordinator, and other members of the medical and nursing staff that treat trauma and emergency operative patients. The trauma committee will meet regularly to review and evaluate patient outcomes and the quality of care provided by the trauma service. In addition to any other requirements of this Chapter, the hospital quality improvement program must include:

      1. (A) Trauma registry;
      2. (B) Audit for all trauma deaths to include prehospital care and care received at a transferring hospital;
      3. (C) Morbidity and mortality review;
      4. (D) Medical nursing audit, utilization review, tissue review;
      5. (E) Regularly scheduled multidisciplinary trauma and emergency operative services review conferences;
      6. (F) Published on call schedules for surgeons, neurosurgeons, and orthopedic surgeons;
      7. (G) Review of the times and reasons for trauma-related bypass;
      8. (H) The availability and response times of on call staff specialists will be defined in writing, documented, and continuously monitored; and
      9. (I) Quality improvement staff with time dedicated to and specific for trauma and emergency operative services.
   6. (6) Continuing education. The hospital will provide and document formal continuing education programs for physicians, nurses, and allied health personnel. Continuing education programs will be available to all state physicians, nurses, allied health personnel, and emergency medical service providers.
   7. (7) Organ Procurement. The hospital, in association with an organ procurement organization certified by CMS, will create and maintain policies and procedures to identify and refer potential organ donors.

   8. (8) Outreach programs. The hospital will have organized outreach programs under the direction of a designated prevention coordinator.

      1. (A) Consultation. The hospital will provide on-site and/or electronic consultations with community health care providers and those in outlying areas as requested and appropriate.
      2. (B) Prevention and public education programs. The hospital will serve as a public information resource and collaborate with other institutions and national, regional, and state programs in research and data collection projects in epidemiology, surveillance, and injury prevention, and other areas.

4. (d) Level I. A Level I hospital will provide emergency medical services with an organized trauma service and emergency department. A physician and nursing staff with special capability in trauma care will be on site 24 hours a day. General surgery, anesthesiology, and neurosurgery services will be available on site or on call 24 hours a day. Additional clinical services and specialties such as nuclear diagnostic imaging, cardiac surgery, hand surgery, and infectious disease specialists must be promptly available. A Level I hospital must have an organized trauma research program with a designated director. A hospital must be classified as Level I for trauma and emergency operative services if it complies with all of this subsection (d):

   1. (1) Clinical services and resources.

      1. (A) Trauma service. A level I hospital is subject to the same trauma service requirements as a Level III hospital as set forth in (b)(1)(A) of this Section.
      2. (B) Emergency services. A Level I hospital is subject to the same emergency services requirement as a Level II hospital as set forth in (c)(1)(B) of this Section.
      3. (C) General surgery. A Level I hospital is subject to the same general surgery requirements as a Level II hospital set forth in (c)(1)(C) of this Section.
      4. (D) Anesthesia. A board certified, board eligible, or residency trained anesthesiologist will be on site or on call 24 hours a day and promptly available. All anesthesia will be administered as required in accordance with OAC 310:667-25-2.
      5. (E) Neurologic surgery. A Level I hospital is subject to the same neurologic surgery requirement as a Level II hospital as set forth in (c)(1)(E) of this Section.

      6. (F) Other specialties. The hospital must also have the following specialty services on call and promptly available:

         1. (i) All the specialty services listed for a Level II classification as set forth in (c)(1)(F) of this Section;
         2. (ii) Hand surgery;
         3. (iii) Infectious disease;
         4. (iv) Microvascular surgery; and
         5. (v) Pediatric surgery.
      7. (G) Operating suite. A Level I hospital is subject to the same operating suite requirements as a Level II hospital as set forth in (c)(1)(G) of this Section.
      8. (H) Post-anesthesia recovery unit. A Level I hospital is subject to the same post-anesthesia recovery unit requirements as a Level III hospital as set forth in (b)(1)(H) of this Section.
      9. (I) Intensive care unit. A Level I hospital is subject to the same intensive care unit requirements as a Level II hospital as set forth in (c)(1)(I) of this Section.
      10. (J) Diagnostic Imaging. A Level I hospital is subject to the same diagnostic imaging requirements as a Level II hospital as set forth in (c)(1)(J) of this Section.
      11. (K) Clinical laboratory service. A Level I hospital is subject to the same clinical laboratory service requirements as a Level III hospital as set forth in (b)(1)(K) of this Section.
      12. (L) Respiratory therapy. Routine respiratory therapy procedures and mechanical ventilators will be available 24 hours a day. Respiratory therapy services will comply with OAC 310:667-23-6.
      13. (M) Acute hemodialysis. The hospital must have the capability to provide acute hemodialysis services 24 hours a day. All staff providing hemodialysis patient care will have documented hemodialysis training and experience.
      14. (N) Social services. Social services must be available and provided in accordance with Subchapter 31 of this Chapter.
      15. (O) Burn Care. A Level I hospital is subject to the same burn care requirements as a Level III hospital as set forth in (b)(1)(M) of this Section.
      16. (P) Spinal cord and head injury management. A Level I hospital is subject to the same spinal cord and head injury management requirements as a Level II hospital as set forth (c)(1)(O) of this Section.
      17. (Q) Rehabilitation services. A Level I hospital is subject to the same rehabilitation services requirements as a Level III hospital as set forth in (b)(1)(O) of this Section.

   2. (2) Personnel.

      1. (A) Trauma service director. A Level I hospital is subject to the same trauma service director requirements as a Level III hospital as set forth in (b)(2)(A) of this Section.
      2. (B) Trauma coordinator. A Level I hospital is subject to the same trauma coordinator requirements as a Level II hospital as set forth in (c)(2)(B) of this Section.
      3. (C) Prevention coordinator. A Level I hospital is subject to the same prevention coordinator requirements as a Level II hospital as set forth in (c)(2)(C) of this Section.
      4. (D) Emergency services director. A Level I hospital is subject to the same prevention emergency services director requirements as a Level II hospital as set forth in (c)(2)(D) of this Section.
      5. (E) Surgical director. A Level I hospital is subject to the same surgical director requirements as a Level III hospital as set forth in (b)(2)(C) of this Section].
      6. (F) Research director. The medical staff will designate a physician as research director who may also serve as the trauma service director. The research director is responsible for the organization and management of the hospital's trauma and emergency operative research activities.

   3. (3) Supplies and equipment.

      1. (A) Emergency department. The emergency department must have equipment for use in the resuscitation of patients of all ages on site, functional, and available in the emergency department, including the following:

         1. (i) Airway control and ventilation equipment, including laryngoscopes and endotracheal tubes of all sizes, bag-mask resuscitator, pocket masks, and oxygen and all the emergency department equipment listed for Level III classification set forth in (b)(3)(A) of this Section;
         2. (ii) End-tidal CO2 determination; and
         3. (iii) Arterial catheters.

      2. (B) Operating suite. The operating suite must have the following supplies and equipment on site, functional and available for use:

         1. (i) All the operating suite supplies and equipment listed for Level II classification as set forth in (c)(3)(B) of this Section;
         2. (ii) Cardiopulmonary bypass capability; and
         3. (iii) Operating microscope.

      3. (C) Post-anesthesia recovery unit. The post-anesthesia recovery unit must have the following supplies and equipment on site, functional, and available for use:

         1. (i) All post-anesthesia recovery unit supplies and equipment listed for a Level III classification as set forth in (b)(3)(B) of this Section; and
         2. (ii) Equipment for the continuous monitoring of intracranial pressure.
      4. (D) Intensive care unit. A Level I hospital is subject to the same intensive care unit requirement as a Level III hospital as set forth in (b)(3)(C) of this Section.
   4. (4) Policies on transfers. A Level I hospital is subject to the same policies on transfers requirement as a Level II hospital as set forth in (c)(4) of this Section.
   5. (5) Quality Improvement. A Level I hospital is subject to the same quality improvement requirements as a Level II hospital as set forth in (c)(5) of this Section.
   6. (6) Continuing education. A Level I hospital is subject to the same continuing education requirement as a Level II hospital as set forth in (c)(6) of this Section.
   7. (7) Organ Procurement. A Level I hospital is subject to the same organ procurement requirements as a Level II hospital as set forth (c)(7) of this Section.
   8. (8) Outreach programs. A Level I hospital is subject to the same outreach programs requirements as a Level II hospital as set forth in (c)(8) of this Section.
   9. (9) Research programs. The hospital will have an organized trauma and emergency operative services research program under the direction of a designated research director. Research groups will meet regularly and all research proposals will be approved by an Institutional Review Board (IRB) before the program is launched. The research director will maintain evidence of the productivity of the research program through documentation of presentations and copies of published articles.

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

Amended at 17 Ok Reg 3450, eff 8-29-00 (emergency)

Amended at 18 Ok Reg 2032, eff 6-11-01

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

Amended at 21 Ok Reg 573, eff 1-12-04 (emergency)

Amended at 21 Ok Reg 2785, eff 7-12-04

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