Tenn. Comp. R. & Regs. 0720-31

Current through December 26, 2024

Section 0720-31 - TABLE 1

Table 1 (Parts 1-7) provides a summary for emergency care facilities for each level of pediatric health care. Personnel, equipment, and issues that are essential at each designation or level are described as either being essential in the emergency department (EED), essential in the pediatric intensive care unit (EPI), essential within the hospital (EH), or promptly available (EP). An optional but strongly encouraged category (SE) is used to describe personnel, activities or issues that may be essential to network a comprehensive regionalized EMS-EMSC system in rural areas. Although these are not generally required of a specific hospital, they are strongly encouraged if such services are not available within a reasonable distance.*

*Some services are usually available at a Comprehensive Regional Pediatric Center but, if not provided, then transfer agreements must be in place (ES). Other capabilities must be available in the pediatric intensive care units but should be promptly available to the emergency department and hospital (EPI and EP).

¹ All medical specialists should have pediatric expertise as evidenced by board certification, fellowship training, or demonstrated commitment and continuing medical education in their subspecialty area.

² Or substituted by a current signed transfer agreement with an institution with cardiothoracic surgery and cardiopulmonary bypass capability.

³ Forensic pathologist must be available either as part of the hospital staff or on a consulting basis.

⁴ Resuscitative medications may be exempted if the hospital can demonstrate PALS recommendation changes, manufacturer recalls or shortages, or Food and Drug Administration requirement issues.

TABLE 1. PEDIATRIC EMERGENCY CARE FACILITIES
Part 1/7	FACILITY DESIGNATION/LEVEL
1. PERSONNEL	CRPC	General	Primary	Basic
Physician with pediatric emergency care experience	EED	EED	EED	EP
RN with pediatric training	EED &EPI	EED	EED	EED
Respiratory therapist	EH	EH	EH
Trauma coordinator	E
Nurse educator	E	E
Trauma team *	E	SE	SE
Specialist consultants * (Available in less than 1 hour)1
Pediatrician	EP	EP	EP	SE
Radiologist	EP	EP	EP	SE
Anesthesiologist *	EP	EP	EP	SE
Cardiologist	EP
Critical Care Physician	EP
Nephrologist	EP
Hematologist/oncologist	EP
Endocrinologist	EP
Gastroenterologist	EP
Neurologist	EP
Pulmonologist	EP
Psychiatrist/Psychologist	EP
Infectious Disease Physician	EP
Surgical specialists* (Available in less than 1 hour)
General surgeon		EP	EP	SE
Pediatric surgeon *	EP	SE
Neurosurgeon	EP	SE
Orthopedic surgeon	EP	SE	SE
Otolaryngologist	EP
Urologist	EP
Plastic surgeon	EP
Oral/maxillofacial surgeon	EP
Gynecologist	EP
Microvascular surgeon	EP
Hand surgeon	EP
Ophthalmologist	EP
Cardiac surgeon	EP
Pathologist	EP
Pediondontist	EP
Physical Medicine/Rehabilitation physician	E
Trauma Rehabilitation Program
Physical Therapy	E
Occupational Therapy	E
Speech Therapy	SE
Special Education	E

TABLE 1. PEDIATRIC EMERGENCY CARE FACILITIES
Part 2/7	FACILITY DESIGNATION/LEVEL
2. EQUIPMENT	CRPC	General	Primary	Basic
EMS communication equipment*	E	E	E	E
Organized emergency cart*	EED&EPI	EED	EED	EED
Printed drug doses/tape	EED&EPI	EED	EED	EED
Monitoring devices
ECG monitor/defibrillator with pediatric paddles or pads 0-400 joules and hard copy capabilities	EED&EPI	EED	EH	EH
Pulse oximeter (adult/pediatric probes)	EED&EPI	EED	EH	EH
Blood pressure cuffs (infant, child, adult, thigh)	EED&EPI	EED	EED	EED
Rectal thermometer probe (28 deg. - 42 deg. C)	EED&EPI	EED	EH	EH
Otoscope, ophthalmoscope, stethoscope	EED&EPI	EED	EED	EED
Cardiopulmonary monitor with pediatric and hard copy capability, visible/audible alarms, routine testing and maintenance	EED&EPI	EED	EED	EH
Doppler and noninvasive blood pressure monitoring (infant, child, adult)	EED&EPI	EED	EH
End tidal CO2 detector	EED	EED	EED	EED
End tidal CO2 monitor	EED&EPI	EH	SE
Monitor for central venous pressure, arterial lines, temperature	EH&EPI	EH	SE
Monitor for pulmonary arterial pressure and intracranial pressure	EPI
Transportable monitor	EED&EPI	EED	EH	EH
Airway control/ventilation equipment
Bag-valve-mask device: pediatric (450 mL), and adult (1000 mL) with oxygen reservoir and without pop-off valve. Infant, child, and adult masks	EED&EPI	EED	EED	EED
Oxygen delivery device with flow meter	EED&EPI	EED	EED	EED
Clear oxygen masks, standard and non-rebreathing (neonatal to adult size)	EED&EPI	EED	EED	EED
Nasal cannula (infant, child, adult)	EED&EPI	EED	EED	EED
PEEP valve	EED&EPI	EED
Suction devices-catheters 6-14 fr, yankauer-tip/suction equipment	EED&EPI	EED	EED	EED
Nasal airways (infant, child, adult)	EED&EPI	EED	EED	EED
Nasogastric tubes (sizes 6-16 fr)	EED&EPI	EED	EED	EED
Laryngoscope handle and blades:
- curved 2,3	EED&EPI	EED	EED	EED
- straight or Miller 0,1,1-1/2, 2,3	EED&EPI	EED	EED	EED
Endotracheal tubes:
- uncuffed (2.5-5.5)	EED&EPI	EED	EED	EED
- cuffed (6.0-9.0) [all pediatric sizes EPI]	EED&EPI	EED	EED	EED
Stylets for endotracheal tubes (pediatric, adult)	EED&EPI	EED	EED	EED
Lubricant, water soluble	EED	EED	EED	EED
Magill forceps (pediatric, adult)	EED	EED	EED	EED
Spirometers, chest physiotherapy and suctioning equipment	EPI
Continuous oxygen analyzers with alarms	EPI
Inhalation therapy equipment	EPI
Tracheostomy tubes (sizes 0-6)	EED	EH	EH
Oxygen blender	EED&EPI	EED	EED	EED
Pediatric endoscopes and bronchoscopes available	EH	EH
Respired gas humidifiers and bronchoscopes available	EPI
Pediatric ventilators	EPI	EH
Difficult airway kit	EED&EPI	EED	SE	SE
Vascular access supplies
Arm boards (infant, child, and adult sizes)	EED&EPI	EED	EED	EED
Butterflies (19-25 gauge)	EED&EPI	EED	EED	EED
Catheters for intravenous lines (16-24 gauge)	EED&EPI	EED	EED	EED
Needles (18-27 gauge)	EED&EPI	EED	EED	EED
Intraosseous needles	EED&EPI	EED	EED	EED
Umbilical vessel catheters (3,5 fr) and cannulation tray	EED	EED	EH	EH
IV administration sets and extension tubing with calibrated chambers	EED&EPI	EED	EED	EED
Extension tubing, stopcocks, T-connectors	EED&EPI	EED	EED	EED
Infusion device able to regulate rate and volume of infusate	EED&EPI	EED	EED	EED
Isotonic balanced salt solution and D[5[ 0.5 normal saline	EED	EED	EED	EED
Central venous access utilizing Seldinger technique (4-7 fr)	EED&EPI	EED	EED
IV fluid/blood warmer	EED&EPI	EED	EH
Blood gas kit	EED	EED	EH
Rapid infusion pumps	EED&EPI	EH

TABLE 1. PEDIATRIC EMERGENCY CARE FACILITIES
Part 3/7	FACILITY DESIGNATION/LEVEL
2. EQUIPMENT AND SUPPLIES (Cont.)	CRPC	General	Primary	Basic
Specialized pediatric trays
Lumbar puncture	EED&EPI	EED	EED	EH
Urinary catheterization: Foley 6-14 fr	EED&EPI	EED	EED	EED
Venous cutdown	EED&EPI	EED	EH	EH
Thoracostomy tray with chest tube sizes 10-28 fr	EED&EPI	EED	SE
Peritoneal lavage tray	EED&EPI	EED	SE
Needle cricothyrotomy set	EED&EPI	EED	EED
Intracranial pressure monitor tray	EED&EPI	SE
Obstetrical Kit	EED	EED	EED	EED
Oral Airway (1 in 0-5)	EED&EPI	EED	EED	EED
Tracheostomy tray	EED&EPI	EED	SE
Fracture management devices
Cervical immobilization equipment suitable for ped. patients	EED	EED	EED	EED
Spine board (child/adult)	EED	EED	EED	EED
Extremity splints	EED	EED	EED	EED
Femur splint; child, adult	EED	EED	EED	EED
Activated charcoal	EED	EED	EED	EH
Beta-agonist for inhalation	EED&EPI	EED	EED	EH
Bretylium	EED&EPI	EED	EH	EH
Calcium chloride	EED&EPI	EED	EH	EH
Corticosteroids (dexamethasone, methylprednisolone)	EED	EED	EED	EH
Cyanide kit and pediatric doses	EED
Dextrose-25% and 50%	EED&EPI	EED	EED	EH
Digitalis antibody	EH	EH	EH
Diphenhydramine	EED	EED	EED	EH
Epinephrine (1:1000, 1:10,000)	EED&EPI	EED	EED	EH
Factor VIII, IX concentrates, DDAVP	EH	EH	EH
Flumazenil	EH	EH	EH	EH
Furosemide	EED&EPI	EED	EED	EH
Glucagon	EED	EED	EED
Insulin	EH	EH	EH
Ipecac	EED	EED	EED	EH
Kayexalate	EH	EH	EH
Ketamine	EED	EH	ED
Magnesium sulfate	EED&EPI	EED	EH
Mannitol-20%	EED&EPI	EH	EH
Methylene blue	EH	EH	EH	EH
N-acetyl cysteine	EH	EH	EH
Naloxone	EED	EED	EED	EH
Potassium chloride	EED	EED	EED
Prostaglandin	EH	EH	EH
Sodium bicarbonate 4.2%, 7.5% and 8.4%	EED&EPI	EED	EED	EH
Succinylcholine	EED	EED	EH
Whole bowel irrigation solution	EH	EH	EH

TABLE 1. PEDIATRIC EMERGENCY CARE FACILITIES
Part 4/7	FACILITY DESIGNATION/LEVEL
2. EQUIPMENT AND SUPPLIES (Cont.)	CRPC	General	Primary	Basic
MEDICATION CLASSES
Analgesics	EED	EED	EH	EH
Antibiotics	EED	EED	EED	EH
Anticonvulsants	EED&EPI	EED	EED	EH
Antihypertensive agents	EED	EED	EH	EH
Antipyretics	EED	EED	EED	EH
PALS and ACLS medications	EED&EPI	EED	EED	EH
Chelating agents for heavy metal poisonings	EH
Nondepolarizing neuromuscular blocking agents	EED	EED	EED
Rapid sequence intubation medications	EED&EPI	EED	EH
Sedatives and antianxiety medications	EED&EPI	EED	EH	EH
MISCELLANEOUS
Resuscitation board	EED&EPI	EED	EED	EED
Infant scale	EED&EPI	EED	EED	EED
Heating source (for infant warming)	EED&EPI	EED	EED	EED
Precalculated drug sheets or length-base tape	EED	EED	EED	EED
Pediatric restraint equipment (to use for painful or difficult procedures)	EED	EED	EED
Portable radiography	EED&EPI	EH	EH
Slit lamp	EH	EH	EH
Infant incubators	EH
Bilirubin lights	EH
Pacemaker capability	EH	EH
Thermal control for patient and/or resuscitation room	EED	EED	EED
3. FACILITIES
Emergency Department
Two or more areas with capacity and equipment to resuscitate medical/surgical/trauma pediatric patients	E
One or more areas as above		E
Separate Pediatric designated site	E
Access to helicopter landing site	E	E	E	E
Hospital support services
Pediatric inpatient care	E	E
Pediatric intensive care unit	E
Child abuse team	E	E
Child life support	EH
Operating Room
Operating room staff	EP	EP	SE
One RN physically present in OR	E	EP
Second operating room available and staffed within 30 minutes	E
Thermal control equipment	E	E
X-ray capability, including C-arm	E	E
Endoscopes, all varieties	E
Craniotomy equipment, including ICP monitoring equipment	E
Invasive and noninvasive monitoring equipment	E	E
Pediatric anesthesia and ventilation equipment	E	E
Pediatric airway control equipment	E	E
Defibrillator, monitor, including internal and external paddles	E	E
Laparotomy tray	E	E
Thoracotomy tray and chest retractors of appropriate size	E
Synthetic grafts of all sizes	E
Spinal and neck immobilization equipment	E
Fracture table with pediatric capability	E
Auto-transfusion with pediatric capability	E
Pediatric drug dosage chart	E	E

TABLE 1. PEDIATRIC EMERGENCY CARE FACILITIES
Part 5/7	FACILITY DESIGNATION/LEVEL
3. FACILITIES (Cont.)	CRPC	General	Primary	Basic
OPERATING ROOM (CONT.)
Tracheostomy tubes, neonatal through adolescent	E	E
Anesthesia and surgical suite promptly available	EP	EP	SE
PEDIATRIC INTENSIVE CARE UNIT
Distinct, controlled access unit	E
Proximity to elevators	E
MD on-call room	E
Waiting room and separate family counseling room	E
Patients' personal effects storage and privacy provision	E
Patient isolation capacity and isolation cart	E
Medication station with drug refrigerator and locked cabinet	E
Emergency equipment storage	E
Separate clean and soiled utility rooms	E
Nourishment station	E
Separate staff and patient toilets	E
Clocks, radios, and televisions	E
Two oxygen, two vacuum, and >2 compressed air outlets/bed	E
Computerized lab reporting	E
Easy, rapid access to head of beds and cribs	E
Pressure monitoring capability, with 4 simultaneous pressures	E
Electric patient isolation capability	E
Recovery Room
RNs and other essential personnel on call 24 hrs/day	E	E	E*
Staff competent in the post-anesthesia care of the pediatric pt.	E	E	E*
Airway equipment	E	E	E*
Pressure monitoring capability	E	E	E*
Thermal control equipment	E	E	E*
Radiant warmer	E	E	E*
Blood warmer	E	E	E*
Resuscitation cart	E	E	E*
Immediate access to sterile surgical supplies for emergency	E		E*
Pediatric drug dosage chart	E	E	E
E* If surgery performed on pediatric patients
Laboratory services
Hematology	E	E	E	E
Chemistry	E	E	E	E
Microbiology	E	E	E	SE
Microcapabilities	E	E
Blood bank	E	E	SE
Drug levels/toxicology	E	SE	SE
Refractometer	EPI
Blood gases	E	E	E
Radiology Service
Routine services 24 hours per day	EH	EH	E	E
Computed tomography scan 24 hours per day	E	E	SE
Ultrasound 24 hours per day	E	E	SE
Magnetic Resonance Imaging Availability	E	E
Nuclear medicine	E	SE
Fluoroscopy/contrast studies 24 hours per day	E	E	SE
Angiography 24 hours per day	E	E	SE

TABLE 1. PEDIATRIC EMERGENCY CARE FACILITIES
Part 6/7	FACILITY DESIGNATION/LEVEL
3. FACILITIES (Cont.)	CRPC	General	Primary	Basic
OTHER
Pediatric Echocardiography	E
Pediatric Cardiac Catheterization	E
Electroencephalography	E
Access to:
Regional poison control center	E	E	E	E
Hemodialysis capability/transfer agreement	E	E	E
Rehabilitation medicine/transfer agreement	E	E	SE
Acute spinal cord injury management capability/transfer agreement	E	E	SE
Hyperbaric oxygen chamber availability/transfer agreement when appropriate	E
4. Access, Triage, Transfer, and Transport
Support of medical control*	E	E	SE	SE
Accept call-ahead ambulance information	E	E	E	E
Transfer agreements for: In-patient pediatric care			E	E
ICU pediatric care		E	E	E
Major trauma care	ES	E	E	E
Burn care	ES	E	E	E
Hemodialysis	ES	E	E	E
Spinal injury care	ES	E	E	E
Rehabilitation care	ES	E	E	E
Accept all critically ill patients from lower-level hospitals within a region	E	SE
Access to transport services appropriate for pediatrics	E	E	E	E
Provide 24-hour consultation to lower-level facilities	E
Consultation agreements with CRPC		E	E	E
5. Education, Training, Research, and Quality Assessment and Improvement*
Education and Training
Public education, injury prevention	E	E	SE	SE
Assure staff training in resuscitation and stabilization	E	E	E	E
Assist with pre-hospital education	E	SE	SE	SE
CPR certification for PICU nurses and respiratory therapists	E
CPR certification for ED nurses and RRTs	E	E	E	E
Resuscitation practice sessions	E	SE	SE	SE
Ongoing CME for RNs and RRTs from the PICU	E
Ongoing CME for RNs and RRTs from the ED	E	E	E	E
Network educational resources for training all levels of health professionals	E	SE
RESEARCH
Support state EMSC and CRPC research efforts and data collection	E	E	E	E
Participate in and/or maintain trauma registry	E	E	SE	SE
Participate in regional pediatric critical care education	E

TABLE 1. PEDIATRIC EMERGENCY CARE FACILITIES
Part 7/7	FACILITY DESIGNATION/LEVEL
5. Education, Training, Research, and Quality Assessment and Improvement* (Cont.)	CRPC	General	Primary	Basic
QUALITY ASSESSMENT AND IMPROVEMENT
Structured QA/QI program with indicators and periodic review	E	E	E	E
Participate in regional quality review by CRPC and/or local EMS authority	E	E	E	E
6. ADMINISTRATIVE SUPPORT AND HOSPITAL COMMITMENT
Make available clinical resources for training pre-hospital personnel	E	SE	SE
Assure properly trained ED staff	E	E	E	E
Assure availability of all necessary equipment/supplies/protocols/agreements/policies	E	E	E	E
Provide emergency care and stabilization for all pediatric patients	E	E	E	E
Support networking education/training for health care professionals	E	E	E	E
Assure appropriate medical control and input to ED management and pediatric care	E	SE	SE	SE
Participate in network pediatric emergency care	E	E	E	E
Assure conformity with building and federal codes for PICU	E
Assure transport services and agreements are available	E	E	E	E
Assure resources available for data collection	E	E	E	E
Assure availability of: Social services	E	E	E
Child abuse support services	EP	EP	EP
Child life support	E
On-line pre-hospital control	E	SE	SE	SE
Respiratory care	EED	EH	EH	SE
Pediatric Critical Care Committee	E
Pediatric Trauma Committee	E
Child development services	E

Tenn. Comp. R. & Regs. 0720-31

Amendment filed March 27, 2015; effective June 25, 2015. Transferred from chapter 1200-08-30 pursuant to Public Chapter 1119 of 2022 effective 7/1/2022.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-202, 68-11-209, and 68-11-251.