6 Colo. Code Regs. § 1015-4-300
Current through Register Vol. 47, No. 24, December 25, 2024
Section 6 CCR 1015-4-300 - Definitions1. Advanced Trauma Life Support (ATLS) or equivalent - The training provided in accordance with the American College of Surgeons curriculum for Advanced Trauma Life Support. An equivalent program is one which has been approved by the Department. The burden shall be upon the applicant to prove that the program is equivalent to ATLS.2. Consultation - Telephone or telemedicine, as specified in this chapter, to determine the necessity of transfer and the circumstances of transfer including, but not limited to, additional diagnostic/therapeutic issues, availability of resources, and weather conditions. Consultation occurs between the attending trauma surgeon, or physician in a Level IV or V facility, of a referring facility and an appropriate attending physician from the trauma service at a receiving trauma center with the resources necessary to meet the patient's needs. Trauma consultation shall include written documentation completed by staff at both facilities. Disagreements as to patient disposition will be documented at both facilities for Department review.3. Core group - The core group of surgeons is comprised of those surgeons identified by the Trauma Medical Director who provide coverage for at least 60 percent of the trauma call schedule.4. Department - The Colorado Department of Public Health and Environment, unless the context requires otherwise.5. Divert - The facility cannot currently accept EMS traffic. EMS shall transport trauma patients to an alternate destination in accordance with the prehospital trauma algorithm.6. Emergent Intervention - Provision of medical services that can be undertaken to address: 1) uncontrolled bleeding; 2) Physiologic criteria as outlined in Chapter One, Exhibit A or B of the prehospital trauma triage algorithm; or 3) a traumatic injury that requires emergency surgery.7. Emergent Surgery - A surgical procedure for which it has been determined that no alternative therapy is available and for which the delay could result in death or permanent impairment of health.8. Expanded Scope of Care - An expanded scope of care is any specialty or service line that provides treatment at a trauma center beyond the minimum requirements of the trauma center's designation level, either on a part-time or full-time basis.9. Focused Review - A type of interim trauma designation review focusing on the areas of concern from a previous review or plan of correction. Both the application and the review process may be shortened to focus on previous deficits.10. Key Resource Facilities - Level I and II certified trauma facilities which have an expanded responsibility in providing on-going consultation, education, and technical support to referring facilities, individuals, or RETACS.11. Met with Reservations - Evidence of some degree of compliance with regulatory standards, but where further action is required for full compliance.12. Morbidity and Mortality Review - A case presentation of all complications, deaths, and cases of interest for educational purposes to improve overall care to the trauma patient. Case presentations shall include all aspects and contributing factors of trauma care from prehospital care to discharge or death. The multi-disciplinary group of health professionals shall meet on a regular basis, but not less than every two months, or every quarter for Level IV and V facilities. The documentation of the review shall include date, reason for review, problem identification, corrective action, resolution, and education. Documented minutes shall be maintained on site and readily available.13. Multidisciplinary Trauma Committee - This committee is responsible for the development, implementation, and monitoring of the trauma program at each designated trauma center. Functions include, but are not limited to: establishing policies and procedures; reviewing process issues, e.g., communications; promoting educational offerings; reviewing systems issues, e.g., response times and notification times; and reviewing and analyzing trauma registry data for program evaluation and utilization. Attendance requirements will be established by the committee. Membership will be established by the facility.14. Multisystem Trauma - Two or more body regions or systems that are injured with physiologic criteria or the potential for physiologic compromise, as defined in Chapter One Exhibits A and B of the prehospital trauma triage algorithm.15. Outreach - The act of providing resources to other facilities in order to improve response to the injured patient. These resources shall include, but not be limited to, clinical consultation and public and professional education. Trauma centers shall be centers of excellence and shall share this expertise with other trauma centers and nondesignated facilities. Timely and appropriate communication, consultation, and feedback are imperative to patient outcome.16. Plan of Correction - Identifies how the facility plans to correct deficiencies or standards identified as met with reservations cited in the Department's written notice to the facility, within an identified timeline. A plan of correction may also be required to meet a waiver request or fulfill a request from the Department to address a temporary issue identified by the Department or the facility.17. Promptly Available - Unless otherwise specified, promptly available shall be a facility-defined timeframe based on current standards of clinically appropriate care.18. Quality/Performance Improvement Program - A defined plan for the process to monitor and improve the performance of a trauma program is essential. This plan shall address the entire spectrum of services necessary to ensure optimal care to the trauma patient, from prehospital to rehabilitative care. This plan may be parallel to, and interactive with, the hospital-wide quality improvement program but shall not be replaced by the facility process. In Level IV-V facilities, this plan may be part of the hospital-wide quality improvement program, but must have facility-defined, trauma-related indicators and components. Implementation of the plan is overseen by the Trauma Medical Director. Trauma-related issues must be documented separately, and the TMD has authority over any trauma issues.19. Regional Emergency Medical and Trauma Advisory Council (RETAC) - The representative body appointed by the governing bodies of counties or cities and counties for the purpose of providing recommendations concerning regional area emergency medical and trauma service plans for such counties or cities and counties.20. Resources or Necessary Resources - As used in this 6 CCR 1015-4, Chapter Three are the instruments, equipment, medications, training, and qualified personnel required to provide appropriate care for the patient.21. Scope of Care - A scope of care is a description of the facility's capabilities to manage the trauma patient. This description must include administrative support and specialty availability that ensures continuity of care for all admitted patients.22. State Emergency Medical and Trauma Services Advisory Council (SEMTAC) - Pursuant to Section 25-3.5-104(4), C.R.S., the State Emergency Medical and Trauma Services Advisory Council is a board appointed by the governor that advises and makes recommendations to the Department on all matters relating to emergency medical and trauma services.23. Special Audit for Trauma Deaths - All trauma deaths shall be audited. A comprehensive review audit shall be initiated by the Trauma Medical Director in Levels I, II, III facilities and by the appropriate personnel designated by the Level IV and V facilities. The trauma nurse coordinator shall participate in these audits. A written critique shall be used to document the process to include the assessment, corrective action, and resolution.24. Transfer Agreement - A written agreement with one or more hospitals or healthcare institutions for the transfer of patients from one to another.25. Trauma Nurse Coordinator - The terms "trauma nurse coordinator," "trauma coordinator" and "trauma program manager" are used interchangeably in these regulations (6 CCR 1015). The trauma nurse coordinator (TNC) works to promote optimal care for the trauma patient through participation in clinical programs, administrative functions, and professional and public education. The TNC shall be actively involved in the state trauma system. The essential responsibilities of the TNC include maintenance of the trauma registry, continuous quality improvement in trauma care, educational activities, and injury prevention.26. Trauma Nurse Core Course (TNCC) or equivalent - the training provided in accordance with the Emergency Nurses Association curriculum. An equivalent program is one that has been approved by the Department. The burden shall be upon the applicant to prove that the program is equivalent to the TNCC.27. Trauma Service - The Trauma Service is an organized, identifiable program which includes: a Trauma Medical Director, a Trauma Nurse Coordinator, a Multidisciplinary Trauma Committee, a Quality Improvement Program, Injury Prevention and Data Collection/Trauma Registry.28. Trauma Medical Director (TMD) - The Trauma Medical Director is a board certified general surgeon who is responsible for: service leadership, overseeing all aspects of trauma care, and administrative authority for the hospital trauma program including: trauma multidisciplinary committee, trauma quality improvement program, physician appointment to and removal from trauma service, policy and procedure enforcement, peer review, trauma research program, and key resource facility functions, if applicable; participates in the on-call schedule; practices at the facility for which he/she is medical director on a full time basis; and participates in all facility trauma-related committees. In Level I facilities, the Trauma Medical Director shall participate in an organized trauma research program with regular meetings with documented evidence of productivity. In Level IV and V, the Trauma Medical Director may be a physician so designated by the facility who takes responsibility for overseeing the program.29. Trauma Team - A facility-defined team of clinicians and ancillary staff, including those required by these rules.30. Trauma Team Activation - A facility-defined method (protocol) for notification of the trauma team of the impending arrival of a trauma patient based on the prehospital trauma triage algorithms as set forth in 6 CCR 1015-4, Chapter One.31. Waiver - A waiver is an exception to the trauma rules approved by the Department. The request for a waiver shall demonstrate that the alternative meets the intent of the rule. Waivers are generally granted for a limited term and shall be granted for a period no longer than the designation cycle. Waivers cannot be granted for any statutory requirement under state or federal law, requirements under state licensing, federal certification or local safety, fire, electrical, building, zoning, or similar codes.39 CR 02, January 25, 2016, effective 2/14/201640 CR 08, April 25, 2017, effective 5/15/201741 CR 22, November 25, 2018, effective 12/15/201842 CR 10, May 25, 2019, effective 6/14/201943 CR 09, May 10, 2020, effective 6/14/202044 CR 10, May 25, 2021, effective 7/1/2021