Or. Admin. Code § 333-200-0080

Current through Register Vol. 63, No. 11, November 1, 2024

Section 333-200-0080 - Standards for Area Trauma System Plans

Area trauma system plans shall describe how each of the following standards are met or exceeded. Interpretation and implementation of the standards as set forth in this rule shall be in general accordance with the guidelines of the Resources for Optimal Care of the Injured Patient, 2022 Standards, Revised December 2023; Verification, Review and Consultation Program, American College of Surgeons. For the purposes of section (4) of this rule, interpretation and implementation of standards shall be in general accordance with the National Guideline for Field Triage of Injured Patients, Recommendations of the National Expert Panel on Field Triage, 2021.

(1) Communications and Dispatch:

(a) System access: Residents and visitors in a communications coverage area shall be able to access emergency medical services by calling 9-1-1 as set forth in ORS 403.115;

(b) Dispatch response: Dispatchers for emergency medical care providers shall have protocols which include pre-arrival patient care instructions, and which require the dispatch of the appropriate level of available responding units (basic or advanced life support) based on medical need;

(c) Special Resources: All emergency medical services dispatchers shall maintain an up-to-date list of available law enforcement agencies, fire departments, air and ground ambulance services, quick response units that respond to an ill or injured person to provide initial emergency medical care prior to transportation by an ambulance and special responders for extrication, water rescue, hazardous material incidents and protocols for their use;

(d) Prehospital/Hospital: Ambulances shall have either a UHF or VHF radio that will provide reliable communications between the ambulance and central dispatch, the receiving hospital, and online medical direction. If the information has to be relayed through the dispatching agency, that agency shall be responsible to relay patient information to the hospital; and

(e) Training: There shall be training and certification standards for all tele-communicators that process telephone requests for or dispatch emergency care providers. The authorization to establish these standards is the responsibility of the Department of Public Safety Standards and Training in accordance with ORS 181.640.

(2) Responders and Prehospital Response Times:

(a) Ambulance Service Areas (ASAs): The existing ASAs shall be described as well as a summary of the ATAB's efforts to promote each county adopting an ASA plan in accordance with ORS 682.062;

(b) Prehospital response times: Trauma system patients shall receive prehospital emergency medical care within the following prehospital response time parameters 90 percent of the time:

(A) Urban area, an incorporated community of 50,000 or more population - 8 minutes;

(B) Suburban area, an area which is not urban, and which is contiguous to an urban community. It includes the area within a 10-mile radius of that community's center. It also includes areas beyond the 10-mile radius which are contiguous to the urban community and have a population density of 1,000 or more per square mile - 15 minutes;

(C) Rural area, a geographic area 10 or more miles from a population center of 50,000 or more, with a population density of greater than six persons per square mile - 45 minutes;

(D) Frontier area, the areas of the state with a population density of six or fewer persons per square mile and are accessible by paved roads - 2 hours; and

(E) Search and rescue area, the areas of the state that are primarily forest, recreational or wilderness lands that are not accessible by paved roads or not inhabited by six or more persons on a year-round basis. - No established prehospital response time.

(c) Field command: A uniform policy shall assign responsibility for directing the care of the trauma patient in the prehospital setting in cases of response by multiple providers to assure scene control by the most qualified responder;

(d) Utilization of air ambulance: Protocols for the medical direction, activation and utilization of air ambulance service(s) shall be established;

(e) Patient Care Report: All prehospital emergency care providers shall use a patient care report as defined in OAR 333-255-0000; and

(f) Utilization of Oregon Trauma System identification bracelet: All prehospital emergency medical care providers shall use the official Oregon Health Authority (Authority) numbered trauma system identification bracelet when the patient meets trauma system entry criteria or is entered into the trauma system and notify the receiving trauma hospital of the incoming patient. The prehospital emergency medical care provider shall record the number on the patient's patient care report.

(3) Medical Direction and Treatment:

(a) Protocols, policies and procedures: Providers in each trauma system area shall function under an effective and coordinated set of off-line prehospital trauma protocols and on-line medical direction trauma policies and procedures which address basic, intermediate and advanced levels of care. Off-line treatment protocols shall clearly describe all treatment and transportation procedures and identify those procedures which require on-line medical authorization. Medical direction policies and procedures must assure consistent area-wide coordination, data collection and area-wide quality improvement responsibility;

(b) Hospital status: In the event that on-line medical direction serves two or more categorized or designated hospitals, there shall be a system for medical direction to continuously determine the current status of hospital trauma care capabilities; and

(c) Physician qualifications: On-line medical direction physicians must be qualified for this role by virtue of training, experience and interest in prehospital trauma care as demonstrated through emergency medicine and Advanced Trauma Life Support (ATLS) training in accordance with the American College of Surgeons ATLS course.

(4)

(a) Triage and Transportation: Triage and transportation protocols shall be written to ensure that patients who at any time meet field triage criteria as set forth in Exhibit 2 will be transported directly to a categorized trauma hospital as described under OAR 333-200-0090. The protocols must be based on field triage criteria (Exhibit 2) and identify the following:

(A) Which patients are appropriate for transport to a Level I, II, III or IV trauma hospital based on the capabilities of the hospitals in the ATAB;

(B) Conditions in which an ambulance may bypass a Level III or IV trauma hospital in order to transport directly to a Level I or II trauma hospital; and

(C) Conditions in which air transport should be considered for transport directly to a Level I or II trauma hospital.

(b) Triage and transportation protocols shall be followed unless otherwise advised by on-line medical direction or under the following circumstances:

(A) If unable to establish and maintain an adequate airway, the patient shall be taken to the nearest hospital to obtain definitive airway control. Upon establishing and maintaining airway control, the patient shall be immediately transferred to a Level I or Level II trauma hospital;

(B) If the scene time plus transport time to a Level I or Level II trauma hospital is significantly greater than the scene time plus transport time to a closer Level III or Level IV trauma hospital;

(C) If the hospital is unable to meet hospital resource standards as defined in Exhibit 4, when there are multiple patients involved, or the patient needs specialty care; or

(D) If on-line medical direction overrides these standards for patients with special circumstances, such as membership in a health maintenance organization, and if the patient's condition permits.

(E) Application of paragraphs (B), (C), and (D) of this subsection must not delay definitive medical or surgical treatment.

(5) Hospital Resources:

(a) Trauma system hospital identification: Either the categorization or designation method of identifying trauma system hospitals as described under OAR 333-200-0090(2), (4) and (5) shall be recommended to the Authority; and

(b) Resource criteria: Trauma system hospitals shall meet or exceed the trauma hospital resource standards as set forth in Exhibit 4 and hospital activation criteria as set forth in Exhibit 3. Area criteria that exceed the criteria set forth in Exhibit 4 shall be accompanied by an informational statement of the additional costs that a hospital will incur to meet these standards.

(6) Inter-hospital Transfers:

(a) Identification of patients: ATAB-wide criteria which meet or exceed any of the criteria set forth in Exhibit 5 of these rules shall be established to identify patients who should be transferred to a Level I or II trauma system hospital or specialty care center.

(b) When it is determined that a patient transfer is warranted:

(A) The transfer shall take place after the stabilization of the patient's emergency medical condition has been provided within the capabilities of the local hospital, which may include operative intervention; and

(B) The transfer to a Level I or II trauma hospital shall not be delayed for diagnostic procedures that have no impact on the transfer process or the immediate need for resuscitation.

(c) In all situations regarding an inter-hospital transfer, the decision to retain or transfer the patient shall be based on medical knowledge, experience, and resources available to the patient.

(d) The hospital's trauma performance improvement and patient safety process shall monitor all cases meeting inter-hospital transfer criteria. The Authority, through annual reports and site surveys, shall monitor this performance category.

(7) Inter-hospital Transfers with Health Maintenance Organizations:

(a) Trauma system hospitals shall facilitate the transfer of a member of a health maintenance organization or other managed health care organization when the emergency medical condition of the member permits and no deterioration of that condition is likely to result from or occur during the transfer of the patient. Trauma system hospitals shall transfer a patient in accordance with the provisions of ORS 431A.065(2) and any other applicable laws or regulations.

(b) A patient will be deemed stabilized, if the treating physician attending to the patient in the trauma hospital has determined, within reasonable clinical confidence, that the emergency medical condition has been resolved.

(c) Hospitals or health maintenance organizations may not attempt to influence patients and families, prior to the patient's stabilization, into making decisions affecting their trauma treatment by informing them of financial obligations if they remain in the trauma facility.

(d) Health maintenance organizations and non-designated trauma facilities shall report follow-up information to the transferring trauma system hospital and all required data as set forth in the Oregon Trauma Registry data dictionary; and

(e) Hospitals or health maintenance organizations that receive or transfer trauma patients shall participate in regional quality improvement activities.

(8) Rehabilitation Resources:

(a) Capabilities for trauma rehabilitation in each trauma system area and transfer procedures to other rehabilitation facilities shall be described; and

(b) Rehabilitation resources for burns, pediatrics, neurotrauma and extended care shall be included.

(9) Quality Improvement:

(a) Provisions shall be made for at least quarterly review of medical direction, prehospital emergency medical care and hospital care of trauma cases:

(A) Area-wide criteria for identifying trauma cases for audit shall be described and shall include all trauma related deaths;

(B) Responsibility for identifying and reviewing all trauma cases meeting audit criteria shall be assigned; and

(C) Quarterly reports shall be submitted to the Authority by the ATAB or its representative on confidential forms.

(b) The ATAB, STAB, all Area and State Quality Improvement Committee(s) and the Authority shall meet in executive session as set forth in ORS 192.660 when discussing individual patient cases; and

(c) No member of any ATAB, the STAB, or any committee, subcommittee, or task force thereof, shall disclose information or records protected by ORS 431A.090 or 41.675 to unauthorized persons. Any person violating these rules shall be immediately removed by the Authority from membership on any trauma system committee, subcommittee or task force thereof.

(10) Education and Research:

(a) Trauma training: Trauma system hospitals shall provide or assist in the provision of prehospital trauma management courses to all EMS providers involved in the prehospital emergency medical care of severely injured patients; and

(b) Research: In areas with Level I hospitals, clinical and basic research in trauma and publication of results involving surgical and nonsurgical specialists, nurses, and allied health professionals engaged in trauma care, shall be promoted.

(11) Prevention:

(a) Public education: Public education and awareness activities shall be developed by trauma system hospitals to increase understanding of the trauma system and injury prevention. These activities shall be appropriate to the size and resources of the area; and

(b) Development and evaluation: Trauma prevention activities to identify and address area problems shall be supported.

(12) Disaster Management: Provisions for addressing triage of trauma system patients to non-trauma hospitals during a natural or manmade disaster must be addressed and include:

(a) Implementation and termination of the disaster management plan; and

(b) Reporting requirements of the Oregon Trauma Registry and Oregon Trauma Program.

Or. Admin. Code § 333-200-0080

HD 5-1987, f. & ef. 6-26-87; HD 9-1993, f. 6-22-93, cert. ef. 7-1-93; HD 7-1995, f. & cert. ef. 11-6-95; HD 5-1997, f. & cert. ef. 3-12-97; OHD 6-2000, f. & cert. ef. 5-4-00; OHD 6-2001, f. & cert. ef. 4-24-01; PH 16-2012, f. 12-20-12, cert. ef. 1-1-13; PH 27-2015, f. 12-8-15, cert. ef. 1/1/2016; PH 254-2018, amend filed 09/25/2018, effective 9/25/2018; PH 6-2019, minor correction filed 02/22/2019, effective 2/22/2019; PH 26-2024, amend filed 04/05/2024, effective 10/15/2024; PH 76-2024, amend filed 10/29/2024, effective 11/1/2024

To view attachments referenced in rule text, click here to view rule.

Statutory/Other Authority: ORS 431A.065

Statutes/Other Implemented: ORS 431A.060 & 431A.065