6 Colo. Code Regs. § 1011-1 Chapter 09 Part 18

Current through Register Vol. 47, No. 11, June 10, 2024

Part 18 - EMERGENCY SERVICES (Required Only for Community Clinics Providing Emergency Services)

18.1 Organization

(A) The community clinic providing emergency services shall develop and implement policies and procedures outlining the scope of services provided.

(B) Each patient shall be discharged only upon a provider's recorded authorization including instructions given to the patient for follow-up care, modified diet, medications, and signs and symptoms to be reported to a provider, if relevant, and a contact to call in case the patient has questions after discharge.

(C) The location and telephone number of a poison control center shall be posted prominently in the facility.

18.2 Emergency Services Personnel

(A) An appropriately qualified physician shall be available to cover emergency services on-site or by telephone. Where coverage is provided by phone, the physician must be able to arrive in the emergency services area within thirty (30) minutes of the need for physician services having been determined.

(B) Nursing care shall be supervised by a registered nurse qualified by training and experience in emergency services.

(C) There shall be sufficient registered nurses with the adequate training and experience to meet the needs of the patient census. At minimum, there shall be one registered nurse on-site during the hours of operation.

(D) Registered nurse training shall include, at a minimum, Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS), or comparable certifications, to assure competency in adult and pediatric emergency care.

(E) The clinic shall have at least one of the provider staff on duty at all times during operating hours who is qualified in ACLS or board certified in emergency medicine.

(F) Every patient shall be under the care of a provider with appropriate specialization.

(G) There shall be procedures for accessing additional staff to meet unanticipated needs.

(H) A current roster of on-call providers, including alternates, shall be made available at all times.

18.3 Minimum Services

(A) Emergency services shall be provided during all hours of operation, as specified in Part 6.5.

(B) The clinic shall provide, at a minimum, basic and advanced life support for both adult and pediatric patients during all operating hours.

(C) The clinic shall provide, at a minimum, the following services on-site commensurate to the scope of services provided:

(1) Initial stabilization and treatment for any acute medical, traumatic, and/or behavioral health patient, including, but not limited to: IV therapy, oxygen therapy, respiratory assistance, and emergency obstetrics.

(2) Diagnostic imaging services, including those services necessary to rule out emergency conditions.

(3) Laboratory services, to include those services necessary to rule out emergency conditions.

(4) Pharmacy services, to include those services necessary to manage emergency conditions.

(5) Procedural sedation or regional anesthesia used during the course of providing treatment.

(D) All patients presenting for emergency services shall be offered a medical screening exam, regardless of an individual's ability to pay, method of payment, or insurance status. The provision of medical screening shall not be delayed in order to inquire about the individual's method of payment or insurance status.

18.4 Policies and Procedures

The facility shall develop and implement policies, procedures, and/or guidelines for the following:

(A) Clinical care guidelines that shall be based on nationally-recognized guidelines, procedure manuals, and reference materials.

(B) Emergency triage policies and procedures for obstetrical emergencies.

(C) Duties and responsibilities of health care personnel delivering care, to include the training and experience required for assigned responsibilities and clearly defined lines of authority.

(D) An easily accessible centralized record on each individual presenting who is in need of emergency services and whether they refused treatment, was refused treatment, or whether the individual was transferred, admitted and treated, died, stabilized and transferred, or discharged.

(E) Processing patients presenting for emergency services including procedures for initial assessment, prioritization for medical screening and treatment, and patient reassessment and monitoring.

(F) Provision of further medical examination and such treatment as may be required to stabilize or transfer the individual within the staff and facility's capabilities available at the clinic.

(1) The clinic shall transfer patients to a higher level of care when their needs exceed the clinic's scope of services.

(2) The transferring clinic must provide the medical treatment, within its capacity, which minimizes the risk to the individual; send all pertinent medical records available at the time of transfer; effect the transfer through qualified persons and transportation equipment; and obtain the consent of the receiving facility.

18.5 Minimum Equipment

Community clinics providing emergency services shall provide, at a minimum, the following equipment, for both adult and pediatric patients:

(A) Airway control and ventilation equipment including laryngoscopes and endotracheal tubes of all sizes, bag mask resuscitators, and oxygen.

(B) Pulse oximetry.

(C) End tidal CO2 determination.

(D) Suction devices.

(E) 12-lead electrocardiogram monitoring with cardiac defibrillator or automated external defibrillator.

(F) Standard intravenous fluids and administration devices, including large bore intravenous catheters.

(G) Sterile surgical sets for:

(1) Airway control/cricothyrotomy.

(2) Vascular access to include central line insertion and intraosseous access.

(3) Thoracostomy-needle and tube.

(H) Gastric decompression.

(I) Drugs for emergency services including, but not limited to, those that support cardiac resuscitation, respiratory resuscitation, and hemodynamic stability.

(J) X-ray availability.

(K) Spinal immobilization equipment.

(L) Thermal control equipment for patient/fluids.

(M) Medication chart, tape, or other system to assure ready access to information on proper dose-per-kilogram for resuscitation drugs and equipment sizes for pediatric patients.

6 CCR 1011-1 Chapter 09 Part 18