1. (1) All levels of Pediatric Emergency Care Facilities shall:

   1. (a) Be capable of providing appropriate triage, resuscitation, stabilization and, when appropriate, timely transfer of pediatric patients for a higher level of care;
   2. (b) Be responsible for having appropriate transfer agreements to assure that all pediatric patients receive timely emergency care at the most appropriate pediatric facility available;
   3. (c) Have transfer agreements and transfer guidelines in accordance with the current Health Resources and Services Administration (HRSA) EMSC performance measures requirements;
   4. (d) Have the ability to communicate with a Comprehensive Regional Pediatric Center for pediatric consultation; and
   5. (e) Develop policies that describe safe transport and handoff of patients between all patient care areas of the facility and between other facilities.
2. (2) A Primary Pediatric Emergency Facility shall support Basic Facilities within a region when necessary by having triage and transfer agreements to receive appropriate patients as a part of a regional pediatric care network.
3. (3) A General Pediatric Emergency Facility shall support the Basic and Primary Facilities within a region by having triage and transfer agreements to receive appropriate patients as a part of a regional pediatric care network.
4. (4) A General Pediatric Emergency Facility shall have a defined separate pediatric inpatient service with a department of pediatrics within the medical staff structure.

5. (5) A Comprehensive Regional Pediatric Center shall:

   1. (a) Assist with the provision of regional pre-hospital indirect (off-line) and direct (on-line) medical control for pediatric patients.

   2. (b) Promote a regional network of indirect and direct medical control by non-CRPC facilities within the region by working closely with the regional Emergency Medical Services medical directors to assure:

      1. 1. Standards for pre-hospital care;
      2. 2. Triage and transfer guidelines; and
      3. 3. Quality indicators for pre-hospital care.

   3. (c) Accept all patients who require a higher level of care not available at non-CRPC facilities through:

      1. 1. Prearranged transfer agreements to facilitate timely inter-facility triage and transfer of pediatric patients who need a higher level of care not available at the non-CRPC facility; and
      2. 2. Prearranged transfer agreements for pediatric patients needing specialized care not available at the Comprehensive Regional Pediatric Center.

   4. (d) Assure a pediatric transport service that:

      1. 1. Is available to all regional facilities;
      2. 2. Provides a network for transport of appropriate patients from all regional hospitals to the Comprehensive Regional Pediatric Center or to an alternative facility when necessary; and
      3. 3. Transports children to the most appropriate facility in their region for emergency and trauma care. Local destination guidelines for EMS should assure that in regions with two (2) Comprehensive Regional Pediatric Centers, or one (1) Comprehensive Regional Pediatric Center and another facility with Level 1 Adult Trauma capability, seriously injured children are cared for in the facility most appropriate for their injuries.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-209, and 68-11-251. Administrative History: pursuant to Public Chapter 1119 of 2022 effective July 1, 2022. Amendments filed July 10, 2025; effective October 8, 2025.