Statutes, codes, and regulations
Arizona Administrative Code
Title 9 - HEALTH SERVICESChapter 25 - DEPARTMENT OF HEALTH SERVICES - EMERGENCY MEDICAL SERVICES
Article 13 - TRAUMA CENTERS AND TRAUMA REGISTRIES
Table 13.1 - Arizona Trauma Center Standards (A.R.S. Sections 36-2202(A)(4), 36-2209(A)(2), and 36-2225(A)(4)) Key:

Ariz. Admin. Code § tit. 9, ch. 25, art. 13, tbl. 13.1

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Current through Register Vol. 30, No. 40, October 4, 2024
Table 13.1 - Arizona Trauma Center Standards (A.R.S. Sections 36-2202(A)(4), 36-2209(A)(2), and 36-2225(A)(4)) Key:

E = Essential and required

I(P) = Level I Pediatric trauma center

II(P) = Level II Pediatric trauma center

ICU = Intensive care unit

In-house = On the premises of the health care institution

ISS = Injury severity score, the sum of the squares of the abbreviated injury scale scores of the three most severely injured body regions

Child life = A program of support to injured children and their families to reduce stress and anxiety by:

a. Explaining medical equipment and procedures to children in a non-threatening and age-appropriate manner,
b. Explaining a diagnosis to a child in an age-appropriate manner, and
c. Helping children and their families develop strategies to cope with the diagnosis and expected outcome

Trauma Facilities Criteria

Levels

I

I(P)

II

II(P)

III

IV

A. Institutional Organization

1. Trauma service

E

E

E

E

E

-

2. Trauma medical director

E

E

E

E

E

-

3. Trauma multidisciplinary peer review committee

E

E

E

E

E

-

4. Injury prevention program (R9-25-1308(G)(5)(a))

E

E

E

E

-

-

5. Injury prevention activities (R9-25-1308(G)(3))

E

E

E

E

E

E

6. Educational outreach program (R9-25-1308(G)(5)(b))

E

E

E

E

-

-

7. Educational outreach activities (R9-25-1308(G)(4))

E

E

E

E

E

-

8. Child maltreatment assessment capability

E

E

E

E

E

E

B. Hospital Departments/Divisions/Sections

1. Surgery

E

E

E

E

E

-

2. Neurosurgery

E

E

E

E

-

-

3. Orthopedic surgery

E

E

E

E

E

-

4. Emergency medicine

E

E

E

E

E

-

5. Pediatric emergency department area

-

E

-

E

-

-

6. Anesthesia

E

E

E

E

E

-

C. Clinical Capabilities

1. Written on-call schedule for each component of the trauma service if a team member is not in-house

E

E

E

E

E

E

2. Physician specialist available 24 hours/day

a. General surgeon

E

E

E

E

E

-

i. Published back-up schedule

E

E

E

E

-

-

ii. Dedicated to single hospital when on-call

E

E

E

E

-

-

iii. Surgeon credentialed for pediatric trauma care

-

E

-

E

-

-

b. Emergency medicine physician

E

E

E

E

E

-

c. Pediatric emergency medicine physician

-

E

-

-

-

-

3. Specialist on-call and available 24 hours/day

a. Orthopedic surgeon

E

E

E

E

E

-

b. Pediatric-credentialed orthopedic surgeon

-

E

-

E

-

-

c. Neurosurgeon

E

E

E

E

-

-

d. Pediatric-credentialed neurosurgeon

-

E

-

E

-

-

e. Critical care medicine physician

E

E

E

E

-

-

f. Pediatric-credentialed critical care medicine physician

-

E

-

E

-

-

g. Radiologist

E

E

E

E

E

h. Hand surgeon

E

E

E

E

-

-

i. Ophthalmic surgeon

E

E

E

E

-

-

j. Plastic surgeon

E

E

E

E

-

-

k. Thoracic surgeon

E

E

E

E

-

-

l. Cardiac surgeon

E

E

-

-

-

-

m. Obstetrics/gynecologic surgeon

E

E

-

-

-

-

n. Oral/maxillofacial surgeon (plastic surgeon, otolar-yngologist, or oral/maxillofacial surgeon)

E

E

E

E

-

-

4. Qualified anesthesia personnel member on-call and available 24 hours/day

a. Physician or certified nurse anesthetist

E

E

E

E

E

-

b. Physician or certified nurse anesthetist with a pediat-ric credential

-

E

-

E

-

-

5. Volume performance standards:

a. 1200 trauma admissions per year,

b. 240 admissions with ISS > 15 per year, or

c. Average of 35 patients with ISS > 15 for each trauma team surgeon per year

E

-

-

-

-

-

d. 200 trauma admissions < 15 years of age per year,

-

E

-

-

-

-

D. Facilities/Resources/Capabilities

1. Emergency department

a. Designated physician director

E

E

E

E

E

-

b. Personnel members with pediatric-specific trauma-related training

-

E

-

E

-

-

c. Resuscitation equipment for patients of all sizes

i. Airway control and ventilation equipment

E

E

E

E

E

E

ii. Pulse oximetry

E

E

E

E

E

E

iii. Suction devices

E

E

E

E

E

E

iv. Electrocardiograph-oscilloscope-defibrillator

E

E

E

E

E

E

v. Color-coded, length-based tool to assist with medication dosing and equipment selection for children

E

E

E

E

E

E

vi. Central venous pressure monitoring equipment

E

E

E

E

E

-

vii. Standard intravenous fluids and administration sets

E

E

E

E

E

E

viii. Large-bore intravenous catheters

E

E

E

E

E

E

ix. Sterile surgical sets for:

(1) Airway control/cricothyrotomy

E

E

E

E

E

E

(2) Thoracostomy

E

E

E

E

E

E

(3) Central line insertion

E

E

E

E

E

-

(4) Thoracotomy

E

E

E

E

E

-

x. Arterial catheters

E

E

E

E

-

-

xi. X-ray availability 24 hours/day

E

E

E

E

E

-

xii. Thermal control equipment

(1) For patient

E

E

E

E

E

E

(2) For fluids and blood

E

E

E

E

E

E

xiii. Rapid infusion system/capability

E

E

E

E

E

E

xiv. Qualitative end-tidal CO2 monitoring

E

E

E

E

E

E

d. Communication with EMS personnel

E

E

E

E

E

E

e. Capability to resuscitate, stabilize, and transfer pedi-atric patients

E

E

E

E

E

E

2. Operating room

a. Immediately available 24 hours/day

E

E

E

E

-

-

b. Size-specific equipment

i. Cardiopulmonary bypass

E

E

-

-

-

-

ii. Operating microscope

E

E

-

-

-

-

c. Thermal control equipment

i. For patient

E

E

E

E

E

E

ii. For fluids and blood

E

E

E

E

E

E

d. X-ray capability including C-arm image intensifier

E

E

E

E

E

-

e. Endoscopes, bronchoscope

E

E

E

E

E

-

f. Craniotomy instruments

E

E

E

E

-

-

g. Equipment for long bone and pelvic fixation

E

E

E

E

E

-

h. Rapid infusion system/capability

E

E

E

E

E

E

3. Postanesthesia recovery room or surgical ICU

a. Registered nurses available 24 hours/day

E

E

E

E

E

E

b. Equipment for monitoring and resuscitation

E

E

E

E

E

E

c. Intracranial pressure monitoring equipment

E

E

E

E

-

-

d. Pulse oximetry

E

E

E

E

E

E

e. Thermal control equipment

i. For patient

E

E

E

E

E

E

ii. For fluids and blood

E

E

E

E

E

E

4. ICU or critical care unit for injured patients

a. Pediatric ICU

-

E

-

E

-

-

b. Registered nurses with trauma-related training

E

E

E

E

E

-

c. Registered nurses with pediatric-specific trauma-related training

-

E

-

E

-

-

d. Designated surgical director or surgical co-director

E

E

E

E

E

-

e. Physician (fourth year of residency training or higher) assigned to surgical ICU service and in-house 24 hours/day

E

E

-

-

-

-

f. Physician (fourth year of residency training or higher) with a pediatric credential assigned to surgical ICU service and in-house 24 hours/day

-

E

-

-

-

-

g. Surgically directed and staffed ICU service

E

E

E

E

-

-

h. Equipment for monitoring and resuscitation

E

E

E

E

E

-

i. Intracranial pressure monitoring equipment

E

E

E

E

-

-

5. Respiratory therapy services (Available 24 hours/day)

a. Available in-house

E

E

E

E

-

-

b. On-call and available within 45 minutes after notification

-

-

-

-

E

-

6. Radiological services (Available 24 hours/day)

a. In-house radiology technologist

E

E

E

E

E

-

b. Radiology technologist on-call and available within 45 minutes after notification

-

-

-

-

-

E

c. Resuscitation equipment for patients of all sizes, as specified in subsection (D)(1)(c)(i) to (v)

E

E

E

E

E

E

d. Angiography

E

E

E

E

-

-

e. Sonography

E

E

E

E

E

-

f. Computed tomography (CT)

E

E

E

E

E

-

i. In-house CT technician

E

E

E

E

-

-

ii. CT technician on-call and available within 45 minutes after notification

-

-

-

-

E

-

g. Magnetic resonance imaging

E

E

E

E

-

-

7. Clinical laboratory service (Available 24 hours/day)

a. Standard analyses of blood, urine, and other body fluids

E

E

E

E

E

E

b. Blood typing and cross-matching

E

E

E

E

E

-

c. Coagulation studies

E

E

E

E

E

E

d. Comprehensive blood bank or access to a community central blood bank and adequate storage facilities

E

E

E

E

E

-

e. Blood gases and pH determinations

E

E

E

E

E

E

f. Microbiology

E

E

E

E

E

-

E. Rehabilitation Services Specific to the Patient Population

1. Physical therapy

E

E

E

E

E

-

2. Occupational therapy

E

E

E

E

-

-

3. Speech therapy

E

E

E

E

-

-

F. Social Services Specific to the Patient Population

1. Social services

E

E

E

E

E

-

2. Child life program

-

E

-

E

-

-

G. Performance Improvement

1. Multidisciplinary peer review committee

E

E

-

E

E

-

2. Performance improvement personnel dedicated to the trauma service

E

E

E

E

-

-

Ariz. Admin. Code tit. 9, ch. 25, art. 13, tbl. 13.1

Adopted by final rulemaking at 23 A.A.R. 2656, effective 1/1/2018. Amended by final expedited rulemaking at 29 A.A.R. 2321, effective 9/18/2023.