Title 30 — Subtitle 08. Designation of Trauma and Specialty Referral Centers

“Adult burn center” means:

“Adult trauma center” means:

“Advanced Burn Life Support (ABLS®)” means a course developed and approved by the American Burn Association.

“Advanced Pediatric Life Support (APLS®)” means a course developed and approved by the American Academy of Pediatrics (AAP) and American College of Emergency Physicians (ACEP).

“Advanced practice professionals (APPs)” are non-physicians that are educated at an advanced level to provide patient care in a range of settings; they include nurse practitioners (NPs), nurse anesthetists, midwives, clinical nurse specialists (CNS) and physician assistants (PAs).

“Advanced Trauma Life Support (ATLS®)” means a course developed and approved by the American College of Surgeons.

“Appropriately trained” means a health care provider who has received the necessary training to develop the knowledge and skills needed for the appropriate care of the trauma or specialty care patient.

“Approved” means a formal process of review and acceptance by the appropriate authority.

“Attending”

“Attending burn staff surgeon” means a surgical member of the burn team appointed by the adult or pediatric burn center director with credentials and privileges appropriate to the burn service.

“Board certified” means a physician certified by an appropriate specialty board recognized by the American Board of Medical Specialties.

“Board eligible” means a physician qualified to take the examination to complete the certification process as specified by an appropriate specialty board that is recognized by the American Board of Medical Specialties.

“Burn care director” means a surgeon designated by the institution and medical staff to coordinate the activities of the adult or pediatric burn center.

“Burn care system” means a coordinated component of an emergency medical services system which encompasses one or more adult or pediatric burn centers and features communication links to, and triage-transfer protocols between, health care facilities, prehospital personnel, and transportation services.

“Burn Center” means an adult or pediatric burn center in Maryland unless otherwise indicated.

“Burn service” means a clinical service established by the medical staff which has responsibility for burn patients.

“Burn team” means a group of health care professionals organized to provide care to the burn patient in a coordinated system of care.

“Burn unit” means a specific area within the adult or pediatric burn center that:

“Bypass” means the diversionary status of a trauma or specialty referral center that is requested and identified in the County/Hospital Alert Tracking System (CHATS) in accordance with a MIEMSS or regional program due to a lack of staff, facilities, or equipment.

“Continuing education (CE)” means education provided for adults after they have left the formal education system consisting of short or part-time courses that brings participants up to date in a particular area of knowledge or skills.

“Continuing medical education (CME)” means training approved by the Accreditation Council of Continuing Medical Education or accredited by a state medical society recognized by that Council.

“Credentialing” means a hospital's process for granting practice privileges to health care providers.

“Data quality guideline” means a written procedure for ascertaining the accuracy and completeness of data.

“Dedicated” means a designated resource whose primary use is for a specific trauma or specialty care program.

“Definitive care” means a level of therapeutic intervention capable of providing comprehensive services for the patient's particular injuries, or associated conditions, or both.

“Designation” means a process by which a hospital is identified by MIEMSS as an appropriate facility to receive patients with particular injuries or illnesses.

“Desirable” means a component of the standards whose presence or availability is encouraged but not required for designation.

“Emergency department (ED)” means a department or patient care area within a hospital which:

Emergency Medical Services.

“EMS Plan” means the plan to ensure effective coordination and evaluation of emergency medical services delivered in the State, as developed and approved by the EMS Board.

“EMS provider” means an individual certified or licensed by a state to provide out-of-hospital emergency medical services.

“Emergent consultation” means a physician consultation required for evaluation of known or potentially unstable injuries, injuries requiring time sensitive surgical interventions, or other reasons as determined and documented by the attending trauma, or general surgeon, or ED attending physician.

“Essential” means a component of the standards that is required for designation.

“Executive Director” means the Executive Director of MIEMSS.

Repealed.

“Fellowship” means formal, advanced, postresidency, specialty training.

“Geographic proximity” means that distance, which is optional for Level III perinatal centers and mandatory for Level III+ perinatal centers, so that patients requiring Level IV services may be transported from a Level III or Level III+ sending facility to the Level IV perinatal center in less than 30 minutes by nonemergency transport.

“Geographic service area” means the area defined by the EMS Board that is normally served by a designated hospital for patients with a particular illness or injury.

“Immediately available” means a source available as soon as it is requested.

“Immediate response” means reacting at once to a patient care need.

“In-house” means physically present in the hospital.

“Injury surveillance” means routine monitoring of the type of injury and incidence for a specific population.

“Inpatient discharge data” means certain information from inpatient hospital records that is submitted by the hospital to the Health Services Cost Review Commission as required by law.

“Interfacility transfer” means the transfer of a patient from one hospital to another hospital.

“Learning outcomes” means an individual's performance, which can be measured by objective means, that results from the individual's participation in an educational program.

“Level I trauma center” means a hospital that:

“Level II trauma center” means a hospital that:

Repealed.

“Level III perinatal referral center” means a hospital that:

“Level III trauma center” means a community hospital with a trauma program which meets the Level III trauma center standards in COMAR 30.08.05.

“Level IV perinatal referral center” means a hospital that:

“Maryland Trauma Registry Data Dictionary for Adult Patients” means the listing of data inclusion criteria, data elements and audit filters to be collected on patients with traumatic injuries treated in a Maryland Trauma Center which is incorporated by reference in COMAR 30.01.02.01(B)(2).

“Maternal-fetal medicine” means a subspecialty recognized by the American Board of Obstetrics and Gynecology which addresses the medical care of high-risk pregnant women and their fetuses.

Most Critical Patients.

“Multidisciplinary committee” means a group of health care professionals from two or more professional disciplines within a trauma or specialty referral center that reflects the multidisciplinary nature of trauma or specialty care.

“Multiple casualty incident (MCI)” means two or more injured people requiring emergency care simultaneously.

“National Trauma Data Bank (NTDB)” means the American College of Surgeons (ACS) aggregated trauma registry of standardization of key trauma data elements for research and improving care for the surgical patient.

“Neonatal referral center” means an out-of-State facility that has entered into an agreement with MIEMSS which has been approved by the EMS Board to accept transfers in order to provide neonatal care.

“Neonate” means a patient who is less than 28 days old.

“Neonatologist” means a pediatrician certified by the American Board of Pediatrics in neonatology.

“Neurotrauma center” means an in-State hospital designated by MIEMSS and approved by the EMS Board to provide specialized care of traumatic brain injured and spinal cord injured patients.

“Nurse manager” means a registered nurse who has a full-time commitment to a specific patient care unit and is administratively responsible for the nursing service of that unit.

“Office of Administrative Hearings (OAH)” means the unit within Maryland's Executive Branch responsible for scheduling and conducting administrative hearings.

“Office of Hospital Programs” means the office within MIEMSS that is responsible for the designation, verification, and reverification of the trauma and specialty care programs.

“On call” means committed for a specific time period to be available and respond within the specific amount of time to provide care for a patient in the hospital.

On-Site Review Record.

“Optional” means a component of the standards that may be present or available but is not required for designation.

“Outcome” means a measurable health status that follows as a result of an injury or illness.

“Patient care log” means a list of patients' names and other information that is recorded by hospitals or prehospital care agencies.

“Patient care record” means a record that contains information regarding the assessment and the care provided to a patient by any health care provider in any practice setting.

“Patient discharge summary” means an abbreviated narrative, created after discharge from a health care facility, of a patient's record during that hospitalization.

“Patient identifier” means a unique number that is assigned to only one patient in order to identify records pertaining to the evaluation and care of that particular patient.

“Pediatric Advanced Life Support (PALS®)” means a pediatric resuscitation course developed and approved by the American Heart Association.

“Pediatric burn center” means:

“Pediatric trauma center” means:

“Perinatal referral center” means:

“Person” means:

“Physical plant” means a building and associated structures.

“Postgraduate year (PGY)” means a classification system for residents indicating the year of post-medical school residency.

“Prehospital service” means a service that is provided from the time of injury or illness until the patient arrives in the hospital.

“Preliminary investigation” means fact finding and information gathering to enable MIEMSS to determine whether justification exists to initiate disciplinary action or to conduct a further investigation.

“Primary Adult Resource Center (PARC)” means a comprehensive trauma program, including a dedicated trauma care facility, dedicated staff and services, and designated, specialized, advanced training and research programs, which meets the PARC standards in COMAR 30.08.05 and which, in Maryland, is defined in statute as the R Adams Cowley Shock Trauma Center.

“Promptly available” means a resource available within 30 minutes of the time it was requested.

“Protocol” means a written procedure to ensure standardization of a process.

“Quality management (QM)” means the quality management of trauma and specialty care services.

“Quality management program record” means a documented record related to quality management activities.

“Readily available” means a resource available for use a short time after it is requested.

“Resuscitation” means the phase of trauma or specialty care where emergency life support treatment is provided to sustain vital body functions.

“Reverification” means the process by which MIEMSS renews a trauma or specialty referral center's designation status.

“Sonologist” means a physician with special training in ultrasonography.

“Specialty referral center” means:

“State trauma registry” means a database of information, submitted to MIEMSS by hospitals, relating to the care of trauma and burn patients that is used to evaluate the quality of care provided.

“SYSCOM” means the Systems Communications Center, an EMS communications center located within MIEMSS, that is used for coordination of medical communication on a Statewide basis.

“Transfer agreement” means a formal agreement between hospitals for the transfer and acceptance of patients.

“Transporting service” means an agency or entity providing patient care transport.

“Transport vehicle” means a vehicle or other conveyance used to transport patients.

“Trauma” means a major single system or multisystem injury or mechanism of injury which has a reasonable probability of disability or death.

Trauma Center.

“Trauma Network (TraumaNet)” means an organization of representatives of trauma centers which includes trauma surgeons, trauma coordinators, and hospital administrators.

“Trauma panel” means the group of physicians within a specific trauma center credentialed by the trauma center hospital to provide trauma care.

“Trauma patient care resource” means the physical facilities, equipment, supplies, and medical personnel that are:

“Trauma Quality Improvement Committee (TQIC)” is a medical review committee established by MIEMSS as an advisory body for quality issue and evaluation affecting the care of trauma patients and the Maryland Trauma System. The TQIC will address issues primarily related to the system-wide delivery of trauma care across the continuum (pre-hospital care to discharge from the trauma center) identifying performance improvement activities and indicators to support resolution strategies.

“Trauma resuscitation team” means a group of trauma trained health care providers required to be present at the patient’s bedside following trauma team activation. The minimum team requirements for all levels of activation include: trauma attending/general surgeon/PGY4/APP, ED lead physician, ED RN’s, and a recorder/documenter. The highest level of response requires, at a minimum, the trauma resuscitation team, an anesthesiologist or CRNA (as per institutional-specific criteria), and Respiratory Therapy.

“Trauma service” means a group of trauma-trained physicians that are responsible for the initial resuscitation and care of the trauma patient, including trauma/general surgeon, emergency medicine, neurosurgery, and orthopedic surgery.

“Trend” means a tendency towards a particular conclusion or end point, usually determined by an analysis of data.

“Triage” means the sorting of patients in terms of priority, treatment, transportation, and destination, so that the patient can be transported to the appropriate hospital according to triage protocols.

“Unit of care” means the hospital subunit where the patient is receiving care at any point in time.

“Verification” means the process by which MIEMSS determines that a hospital, which is applying for a particular designation status, is in substantial compliance with the standards for the designation requested.

With the approval of the EMS Board, designate and verify hospitals to be trauma or specialty referral centers;

Establish standards for trauma and specialty care, triage, and transfer protocols for injured patients;

Establish and manage the State trauma registry;

Facilitate the establishment of Statewide, inclusive, trauma and specialty care systems by encouraging all hospitals to participate in:

Develop a quality management and improvement program to:

With the consultation and advice of appropriate persons, develop and periodically review:

Annually evaluate the effectiveness of the Statewide trauma and specialty care systems and its component subsystems by using trauma registry and other appropriate data to identify and analyze system and patient care trends and outcomes;

Periodically conduct special studies of the Statewide trauma and specialty care systems to evaluate:

Consult with appropriate persons in determining the need for trauma or specialty care services;

Facilitate and, where necessary, develop and maintain, public information, education, and prevention programs as an integral component of the trauma and specialty care systems;

As necessary, recommend to the EMS Board additional regulations to ensure the quality of the Statewide trauma and specialty care systems;

Provide technical assistance and support to hospitals and providers as necessary to implement the components of the EMS Plan; and

As necessary, verify compliance with trauma and specialty care standards by:

Trauma centers, in COMAR 30.08.05; or

Specialty referral centers, in the appropriate specialty care standards within this subtitle.

Primary Adult Resource Center;

Level I trauma center;

Level II trauma center; or

Level III trauma center.

A single hospital or one or more hospitals under common ownership may be designated as a single trauma or specialty center program with more than one clinical location if:

In this subtitle, in the case of a designated trauma or specialty center with more than one clinical location:

Establish criteria for the number and level of trauma and specialty referral centers to be designated; and

For specialty referral centers that require a certificate of need from the Maryland Health Care Commission, establish the criteria for the number of specialty referral centers in coordination with the Maryland Health Care Commission.

Access to trauma or specialty care;

Level of care;

Capacity to provide the care; and

Timeliness of care received.

Health Occupations Article, Title 1, Subtitle 4, and §14-506, Annotated Code of Maryland; and

General Provisions Article, Title 4, Subtitle 3, Annotated Code of Maryland.

Would add unnecessary duplication of services to a geographic service area where there is not a sufficient need for additional trauma or specialty services;

Is unable to meet the requirements of this subtitle for the level of designation sought;

Makes a false statement or omits a material fact in the hospital records, documentation, or materials required to be submitted that pertain to the designation process;

Is less qualified than another applicant hospital in the same geographic service area;

Is applying for designation as a specialty center that requires a certificate of need from the Maryland Health Care Commission but does not have the required certificate of need or a waiver of the certificate of need; or

Should not be designated for any other relevant reason.

MIEMSS shall issue a written notice of denial to the hospital.

The notice of denial shall conform to State Government Article, §10-207, Annotated Code of Maryland.

MIEMSS shall send the notice of denial to the chief executive officer of the hospital.

MIEMSS shall notify the EMS Board of the action taken.

MIEMSS shall establish multidisciplinary on-site review teams composed of individuals knowledgeable in trauma or specialty care and trauma or specialty care systems.

The composition of the team shall be appropriate to the level of designation sought.

For trauma center designation, MIEMSS shall select a team which, at a minimum, shall include MIEMSS staff and representatives from three of the following categories:

A staff person from MIEMSS shall accompany and coordinate the functions of the review team.

A team shall consist of professionals who do not have any conflict or competitive interest with the applicant.

If a hospital can demonstrate a reasonable basis for concern, MIEMSS shall consider allegations that conflicts of interest exist between an on-site reviewer and an applicant.

Contact with Members of On-Site Review Team.

The on-site review team shall:

Confidentiality of On-Site Review Records.

The on-site review team shall consist of MIEMSS staff, as well as medical, administrative, and nursing professionals having expertise in the specialty being designated;

The Executive Director may appoint additional staff from other State agencies to the on-site review team when those agencies have shared regulatory oversight in the specialty referral center;

MIEMSS shall select a team, which, at a minimum, shall include MIEMSS staff and three representatives from the following categories:

The on-site review team members shall:

Designate the hospital as a trauma or specialty referral center as proposed by the applicant;

Designate the hospital at a level of designation lower than the applicant proposed, if the on-site review determined that the hospital does not meet the standards for the level of designation proposed;

Adjust the level of an applicant's designation based on system needs and the hospital's ability to meet those needs; or

Deny designation as a trauma center at any level or as a specialty referral center.

MIEMSS may initially designate a trauma or specialty referral center as provisional on the conditions and for the provisional period, including any extensions, which MIEMSS deems appropriate;

MIEMSS shall require each provisional trauma or specialty referral center to:

At the end of the provisional period, including any extensions, MIEMSS may:

MIEMSS may grant full designation to a hospital in full compliance with this chapter for a period not to exceed 5 years, excluding an extension during the reverification process as set forth in Regulation .10 of this chapter.

Does not meet the requirements of this subtitle for the level of designation or specialty;

Has engaged in unauthorized contact with an on-site review team member, as prohibited by Regulation .05B(7) of this chapter;

Made a false statement or omitted a material fact in the hospital records, documentation, or materials required to be submitted that pertain to the designation process;

Is less qualified than another applicant hospital in the same geographic service area; or

Should not be designated for another relevant reason.

MIEMSS shall issue a written notice of denial of designation to a hospital.

The notice of denial of designation shall conform to State Government Article, §10-207, Annotated Code of Maryland.

MIEMSS shall send the notice of denial of designation to the chief executive officer of the hospital.

MIEMSS shall notify the EMS Board of the action taken.

Approves the hospital at a level of designation lower than the applicant proposed;

Designates the hospital as provisional; or

Denies designation as a trauma center at any level or as a specialty center.

Not later than 20 business days from the date a hospital receives MIEMSS' decision, the hospital may appeal MIEMSS' decision by filing written exceptions with the Executive Director for consideration by the EMS Board.

For the written exceptions to be considered timely, a hospital shall file the written exceptions with the Executive Director within 20 business days from the date the hospital receives MIEMSS' decision.

The exceptions shall state with specificity the reasons why MIEMSS' decision should be overturned.

The hospital shall mail a copy of the exceptions to MIEMSS by first class mail, postage prepaid.

Not later than 20 business days from the date the exceptions are filed with the Executive Director, MIEMSS may file a response.

MIEMSS shall mail a copy of its response to the hospital by first class mail, postage prepaid.

Not later than 90 calendar days from the date of the filing of the hospital's exceptions or MIEMSS' response, whichever is later, the EMS Board shall issue a written decision granting or denying the exceptions.

If the EMS Board denies the exceptions, the proposed decision, as affirmed by the EMS Board, is the final agency decision.

If the EMS Board grants the exceptions, in whole or in part, the EMS Board shall modify the proposed decision accordingly and the modified decision is the final agency decision.

An appeal to the EMS Board is not a contested case as defined in State Government Article, §10-202(d), Annotated Code of Maryland, and the decision of the EMS Board is the final agency decision and is not subject to judicial review.

Has the right to relinquish its designation as a trauma or specialty referral center or to request a designation lower than its current level of designation; and

Shall provide the Office of Hospital Programs with 90 calendar days advance written notice of its request to change its designation status.

At its discretion, may repeat all or part of the designation process set forth in this chapter; and

Shall consider the request based upon the criteria described in Regulation .02 of this chapter.

A designated trauma or specialty referral center shall notify the Office of Hospital Programs within 5 business days if it is temporarily unable to comply with the requirements for designated trauma or specialty centers as set forth in COMAR 30.08.03.

The notice shall be in writing and shall specify the reasons for and the anticipated duration of the temporary inability to comply with the standards.

MIEMSS shall determine whether the temporary inability to comply with the standards warrants disciplinary action under COMAR 30.08.13.

Complete the reverification process every 3 years; and

If verified by the American Burn Association:

MIEMSS may accept verification of a trauma or specialty referral center by a nationally recognized medical specialty organization in lieu of conducting an on-site reverification review;

MIEMSS may determine that there is sufficient data available to MIEMSS concerning the ongoing operation of the trauma or specialty center so that an on-site review is not necessary for a determination of reverification; or

MIEMSS may conduct an on-site review for reverification with MIEMSS staff and representatives, if any, from among the categories required for an initial designation site-review team as MIEMSS deems appropriate.

MIEMSS shall send written notice to the chief executive officer of the trauma or specialty referral center requesting that the trauma or specialty referral center submit, within 60 calendar days, a request for reverification of its designation status; and

Designated trauma or specialty referral center shall retain its current designation status until the reverification process is completed.

Lists the trauma and specialty referral centers that have requested reverification of their designation status;

Requests a person with knowledge of any reason why a designated trauma or specialty referral center should not have its designation status reverified to submit a written statement of the reason to MIEMSS within 20 business days following publication of the notice; and

Requests that a hospital not designated that wishes to be considered for designation as a trauma or specialty referral center submit a written application to the Office of Hospital Programs in accordance with Regulation .03 of this chapter within 60 calendar days following publication of the notice.

Comply with the applicable standards for trauma or specialty care as developed by MIEMSS and set forth in COMAR 30.08.05—30.08.12;

Receive all trauma or specialty patients, regardless of race, color, religion, age, sex, marital status, national origin, ancestry, physical or mental disability, or ability to pay;

Upon MIEMSS' request, provide data to MIEMSS related to trauma or specialty care programs;

Allow MIEMSS to monitor compliance with applicable regulations and standards as set forth by MIEMSS, including providing MIEMSS with access to:

Require confidentiality of information relating to an individual patient, provider, and hospital care outcomes in accordance with:

MIEMSS may impose additional requirements on a trauma or specialty referral center if it determines that the requirements are necessary for the immediate protection of trauma or specialty patients.

MIEMSS shall provide the designated trauma or specialty referral center with advance written notice of an additional emergency standard.

The designated trauma or specialty referral center shall have reasonable time to comply with the emergency standard.

EMS providers;

Hospitals, both designated and nondesignated including, but not limited to:

Office of Medical Examiner reports; and

Other sources outside of the trauma and specialty care systems including, but not limited to:

Demography;

Anatomy;

Physiology;

Severity;

Epidemiology;

Resource utilization;

Quality improvement;

Outcomes; and

Finance.

Determining the data standards for the State trauma registry;

Setting forth the data standards for the State trauma registry in:

Establishing protocols for quality monitoring, consistent with MIEMSS' most current data quality guidelines;

Conducting studies to assess the completeness and accuracy of case identification and data collection; and

Ensuring that the data entered in the State trauma registry is complete and accurate.

Trauma victims dead at the scene of the trauma;

Patients meeting State trauma or specialty triage criteria who are transported to a hospital;

Patients transported in accordance with interfacility transfer policies to receive a higher level of care or for special resources; and

Patients transported to specialty referral centers.

As required by the Health Services Cost Review Commission under Health-General Article, §19-130, Annotated Code of Maryland; or

In accordance with:

To an approved regional or State quality improvement program if the regional or State quality improvement program is subject to the same confidentiality guidelines as MIEMSS;

To a scientific research professional associated with a scientific research organization, if:

MIEMSS shall provide aggregate State trauma registry and specialty care data to hospitals, public or private agencies, and other interested parties for:

“E” means the standard is essential.

“D” means the standard is desirable.

“NA” means the standard does not apply.

Standards in this chapter;

Patient volume;

Geographic coverage;

Population;

Competing applications; and

New applications.

Applicable guidelines and professional standards;

Trauma outcome standards; and

Published results of peer-reviewed trauma research.

When considering an applicant hospital for designation or reverification, MIEMSS shall take into account the number and distribution of trauma centers that allow designated trauma centers to:

Unless the volume criteria are waived under the geographic coverage criteria in §E of this regulation, the minimum acceptable annual volume of admissions for an applicant hospital requesting designation or reverification at the following levels is:

In the volume criteria:

When considering an applicant hospital for designation or reverification, MIEMSS shall:

An applicant hospital that is located within 30 linear miles of a same or higher level trauma center shall meet the volume requirements contained in §D of this regulation.

MIEMSS may waive the volume requirements contained in §D of this regulation for an applicant hospital that is located at a distance greater than 30 linear miles from an existing trauma center.

Shall take into account the applicant hospital's geographic trauma patient catchment area given the current and projected population density within that area;

Shall require a population base of approximately 1 million for designation or reverification as a PARC or Level I or Level II trauma center;

Shall utilize the most recent population data published by the State Data Center of the Maryland Office of Planning; and

May waive the population requirement contained in this section for an applicant hospital that meets the volume requirements contained in §D of this regulation.

MIEMSS may give preference to an applicant hospital with a designated specialty referral center which may support or be supported by the presence of a trauma center.

If there are two or more applicants for the same level in the same geographic coverage area where patient volumes or population would likely be insufficient to support both applicants, based on the criteria in §§C—F of this regulation and Regulation .21 of this chapter, MIEMSS shall:

If two or more applicants for different levels in the same geographic coverage area meet all criteria, and patient volumes would likely be insufficient to support both applicants, MIEMSS may give preference to the applicant seeking the higher level trauma designation or reverification.

Meet the trauma designation criteria; and

Demonstrate that its proposed trauma center can generate sufficient patient volume without adversely affecting patient volumes at other existing, designated trauma centers.

861.21 — Lung contusion, without open wound to thorax;

861.31 — Lung contusion, with open wound into thorax; or

807.4 — Flail chest;

864.03 — Moderate laceration injury to liver without mention of open wound into cavity;

864.04 — Major laceration injury to liver without mention of open wound into cavity;

864.13 — Moderate laceration injury to liver with open wound into cavity;

864.14 — Major laceration of liver with open wound into cavity;

865.03 — Injury to spleen with laceration extending into parenchyma without mention of open wound into cavity;

865.04 — Injury to spleen with massive parenchymal disruption without mention of open wound into cavity;

865.13 — Injury to spleen with laceration extending into parenchyma and open wound into cavity;

865.14 — Injury to spleen with massive parenchymal disruption and open wound into cavity;

866.01 — Hematoma of kidney without rupture of capsule or mention of open wound into cavity;

866.02 — Laceration of kidney without mention of open wound into cavity;

866.11 — Hematoma of kidney without rupture of capsule but with open wound into cavity; or

866.12 — Laceration of kidney with open wound into cavity;

Cranial:

Thoracic:

Vascular:

Abdominal:

Spinal:

808.43 — Multiple, closed, pelvic fractures with disruption of pelvic circle; or

808.53 — Multiple, open, pelvic fractures with disruption of pelvic circle; or

820.XX — Fractures of neck of femur;

821.XX — Fractures of other and unspecified parts of femur; or

823.X2 — Fractures of fibula with tibia.

Maintain a designated unit or units for specialized acute burn care;

Be a hospital designated as a Level II or higher trauma center;

If an in-State hospital, have one of the following issued by the Maryland Health Care Commission:

Demonstrate commitment to the optimal care of the hospital’s burn injured patients by the hospital’s board of directors, administration, medical staff, and nursing staff by formulating a board of director’s resolution, updated yearly, stating that:

Complete transfers to in-State hospitals, or to out-of-State hospitals listed in the Maryland Emergency Medical Services Interhospital Transfer Resource Manual, in accordance with the guidelines contained in the Maryland Emergency Medical Services Interhospital Transfer Resource Manual without the need for separate transfer agreements;

Have a written transfer agreement in place for transfer of a patient to an out-of-State hospital not listed in the Maryland Emergency Medical Services Interhospital Transfer Resource Manual, if the hospital transfers to such out-of-State hospital more than five times a year;

Have a written transfer agreement in place for transfer of a patient to a rehabilitation hospital if the hospital transfers to such a rehabilitation hospital more than two times a year;

Have and maintain current accreditation by an organization that has been granted deeming authority by the Centers for Medicare & Medicaid Services and approved by the Maryland Department of Health to accredit hospitals in the State;

Use the resources of the burn center for patients with burn injuries and those suffering from burn-like diseases; and

Have administrative and budgetary commitment in order to support the needs of the burn center, inclusive of clerical and clinical nursing personnel, that helps fulfill needs of the concurrent PI, outreach, injury prevention, and research.

Maintain access to an EMS system for the transport of patients (public safety and commercial services) with burns from referral sources within the geographic service area;

Participate in regional or State EMS committees and councils at least three times per year;

Have a written hospital emergency preparedness/multiple casualty incident (MCI) plan for the triage and early treatment of adult and pediatric patients burned in an MCI;

Ensure that the MCI plan for the geographic service area is reviewed and updated on an annual basis by the hospital Emergency Preparedness Committee and EMS liaisons and drill inclusive of burn patients annually; and

Provide education on the current concepts in triage and burn care treatment to prehospital and hospital care providers within its geographic service area.

A burn center shall formally establish and maintain an organized burn service that is responsible for coordinating the care of the burn patient.

A burn center shall maintain an organizational chart relating personnel within the burn unit to other hospital staff; a combined leadership model for trauma and burn center is acceptable.

A burn center shall maintain an appropriate policy and procedure manual that:

The burn center shall participate in the State Burn Registry for burn patients, both inpatient and outpatient modules.

The State Burn Registry shall include all patients who are treated at the burn center inclusive of outpatient and inpatient venues for burn care treatment.

A burn center shall treat an average of 100 or more unique inpatients and outpatients (ED treat and discharge and first clinic visit) with acute burn injuries annually.

A burn center shall admit at least 60 patients annually who meet the referral criteria in Regulation .17 of this chapter.

A burn center director is authorized to direct and coordinate all medical services for patients admitted to the burn service.

Medical care for patients in the burn center shall be provided by the burn center director or qualified physicians approved by the director and shall conform to burn center care protocols.

Privileges for physicians participating in the burn service shall be approved by the burn center director and determined by the medical staff credentialing process.

A burn center shall appoint a qualified burn center director to oversee the care of patients in the burn service.

A burn center director shall meet the requirements in Regulation .05 of this chapter.

Creation of policies and procedures within the burn center that specify the care of burn patients and ensures that medical care conforms to burn center protocols;

Creation of policies and protocols for use throughout the burn care system for initial care, triage, and transport of burn patients;

Cooperation with regional EMS authorities in regard to all aspects of burn treatment;

Communication with physicians and other authorities regarding patients who have been referred and admitted for follow-up and/or feedback;

Direction of a burn center’s administrative functions;

Direction and active participation in a burn center quality management program;

Acting as liaison between adjacent and regional burn centers;

Development of and participation in both internal and external continuing medical education programs in the care of burn injuries;

Maintaining current ABLS®; and

Oversight of the burn prevention program and initiatives.

Be assigned to the burn service;

Be available within 15 minutes, 24 hours a day;

For the adult burn center, be current in ATLS® or ABLS®; and

Have a liaison to the burn QM program with 50 percent attendance.

For the adult burn center, be current in ATLS® or ABLS®; and

A liaison to the burn QM program with 50 percent attendance.

General surgery/pediatric surgery;

Thoracic surgery;

Neurologic surgery;

Obstetrics/gynecology;

Ophthalmology;

Orthopedic surgery;

Otorhinolaryngology;

Plastic surgery;

Urology; and

Vascular.

Anesthesiology;

Critical care medicine;

Pediatrics;

Psychiatry;

Interventional radiology (perform complex imaging studies or interventional procedures); and

Interventional angiography.

Cardiology;

Patient protection service (adult or child);

Gastroenterology;

Hematology;

Infectious disease;

Nephrology;

Neurology;

Pathology; and

Pulmonology.

Psychology; and

Physiatry.

A burn center shall have a clinical nurse manager who is administratively responsible for the burn unit.

A nurse manager shall:

A burn center shall have an organizational chart relating the nurse manager to the burn service and other members of the burn team.

Have qualified nurses to take care of burn patients;

Have a plan to determine staffing and overall care including:

Have a burn unit orientation program that documents nursing competencies specific to care and treatment of burn patients, including critical care, wound care, psychosocial, and rehabilitation, inclusive of a basic trauma course;

Require each new staff nurse hired for the burn units to complete the orientation program before assuming independent practice in the burn units; and

Provide burn center staff with a minimum of continuing education annually of:

Permanently; or

On a rotating basis for at least 1 year;

Have a social service consultation available to the burn service; and

Assign a social worker to the burn center for both inpatients and outpatients, either:

A pharmacist available for consultation;

A respiratory therapist to assess and manage patients on the burn service; and

For pediatric burn centers, a child life specialist.

A burn service shall have a QM program that is multidisciplinary.

A burn center director is responsible for the QM program.

A burn unit multidisciplinary committee shall:

A burn center shall hold patient care conferences at least weekly to review and evaluate the status of each patient admitted to the burn center.

Each clinical discipline shall be represented to appropriately contribute to the treatment plan for each patient.

Patient care conferences shall be documented in the progress notes of each patient or in minutes of the conferences.

Hold morbidity and mortality conferences at least monthly; and

Maintain appropriate documentation of morbidity and mortality conferences.

Severity of burns;

Mortality;

Incidence of complications;

Length of hospitalizations; and

Hospital charges for care.

A burn center shall have an educational program for the medical staff.

If residents rotate on the burn service, a burn service director or the director’s designee shall provide an orientation program for new residents.

A burn center shall have effective means of isolation that are consistent with principles or universal precautions and barrier techniques to decrease the risk of cross-infection and cross-contamination.

A burn center shall:

Recreational or child-life therapy;

Psychosocial support for family members or other significant persons;

Availability for continuing age appropriate academic courses for the patient;

Coordinated discharge planning;

Follow-up after hospital discharge;

Access to community resources;

Evaluation of the patient’s physical, psychological, developmental, and vocational status; and

Planning for future rehabilitative and reconstructive needs.

Weight measurement devices for kilogram measurement;

Difficult airway equipment capable for surgical intervention;

Emergency carts with age-appropriate equipment; and

Temperature control/measurement devices for:

That allograft tissues are to be obtained only from those tissues banks that adhere to the standards of the American Association of Tissue Banks, if applicable; and

Compliance with U.S. Food and Drug Administration regulations published in 21 CFR Part 1270 Human Tissue Intended for Transplantation;

Complicate management;

Prolong recovery; and

Affect mortality;

If trauma poses the greater immediate risk, the patient may be treated initially in the trauma center until stable before being transferred to a burn center; and

Physician judgment is necessary in these situations and shall be in concert with the regional medical control plan and triage protocols;

Provide evidence and maintenance of qualifications including academic and burn-related education and clinical experience;

Comply with a job description developed by the hospital that reflects the role and responsibilities as defined by COMAR, and an organizational chart depicting the relationship between the BPM and other services, including the Department of Nursing/Trauma and Burn Nursing;

Ensure participation in local, State, and national burn-related activities, including but not limited to EMS Advisory Councils, State burn-related committees and events, and national burn-related activities and events;

Participate in burn educational activities external to the institution’s staff development programs;

Maintain and provide evidence of 8 hours annually of internal and 8 hours external burn-related CE; and

Supervise burn registry staff, burn clinical performance improvement staff, injury prevention staff, and outreach staff.

Demographic data;

Injury data;

Hospital data;

Description of injury;

Diagnosis;

Comorbidities;

Procedure codes;

Complications;

Outcome; and

Outpatient module, which includes outpatient information, Lund and Browder, treatment, complications, and comorbidities.

Anatomy and physiology; and

Medical terminology.

Ensuring assigned cases are compliant with MD Data Dictionary Inclusion Criteria or other burn center self-defined criteria;

Compiling abstracted data for BR case from various sources; and

Appropriately coding injuries, complications, and procedures.

Minimize duplication of services;

Achieve and sustain the volumes necessary for:

Minimize the potential adverse effect on quality of care that may result if patient volumes are reduced,

Projected number of patients who would require access to that specialty referral center; and

Number of physicians who would provide medical care for that population.