# COMAR Title 30 — Maryland Institute for Emergency Medical Services Systems (MIEMSS)

## Subtitle 08 — Designation of Trauma and Specialty Referral Centers

### Chapter 05 — Trauma Center Designation and Verification Standards

#### Regulation .08 Non-Surgical Specialty.

*COMAR 30.08.05.08*

PARC
            I
            II
            III
            ED
          
        
        
          
            A. Anesthesia. Anesthesia requirements are as follows:
            
            
            
            
            
          
          
            (1) Board-certified, fellowship trained Anesthesiology Attending in-house, dedicated 24 hours a day to trauma care should be at the bedside upon arrival, and documented at least 80 percent of the time;
            E
            NA
            NA
            NA
            NA
          
          
            (2) Board-certified or board-eligible, in-house attending 24 hours a day;
            NA
            E
            E
            E
            NA
          
          
            (3) Attending anesthesiologist or CRNA taking trauma call shall be at the bedside within 15 minutes of being called with institution-specific criteria defining conditions requiring an immediate response, and present for all operations; and
            NA
            E
            E
            E
            NA
          
          
            (4) A liaison to the trauma QM program with 50 percent attendance.
            E
            E
            E
            E
            E
          
          
            B. Emergency Medicine. Emergency Medicine (EM) requirements are as follows:
            
            
            
            
            
          
          
            (1) Physician Director or designated Director of Trauma Services in Emergency Medicine who:
            
            
            
            
            
          
          
            (a) Is Board certified or board eligible in EM with evidence of active participation in daily emergency care;
            NA
            E
            E
            E
            D
          
          
            (b) Has administrative duties in the Emergency Department (ED);
            NA
            E
            E
            E
            D
          
          
            (c) Demonstrates the successful completion of the ATLS® course, at least once; and
            NA
            E
            E
            E
            E
          
          
            (d) Maintains ATLS® certification;
            NA
            E
            E
            E
            E
          
          
            (2) Emergency physician in-house 24 hours a day who is:
            
            
            
            
            
          
          
            (a) Board certified or board eligible in EM;
            NA
            E
            E
            E
            E
          
          
            (b) Board certified or board eligible in a non-EM specialty with at least 7,000 hours of emergency practice and current ATLS® certification;
            NA
            NA
            NA
            E
            E
          
          
            (c) If certified by boards other than EM and treating trauma patients in the ED, current ATLS® status; or
            NA
            E
            E
            E
            E
          
          
            (d) Has demonstrated special capabilities through commitment, continuing education, and experience;
            NA
            NA
            NA
            NA
            E
          
          
            (3) Advanced Practice Professionals (APP) providing care to the trauma patient who have current ATLS® certification; and
            NA
            E
            E
            E
            E
          
          
            (4) A liaison to the trauma QM program with 50 percent attendance.
            NA
            E
            E
            E
            E
          
          
            C. Critical Care. Critical care requirements are as follows:
            
            
            
            
            
          
          
            (1) Intensive care with a designated surgical director who is fellowship trained and board certified in surgery or critical care;
            E
            E
            D
            NA
            NA
          
          
            (2) A board certified surgeon who serves as director or co-director of the ICU and is actively involved in, and responsible for, setting policies and administrative decisions related to trauma ICU patients;
            NA
            NA
            E
            D
            NA
          
          
            (3) A trauma surgeon who retains responsibility for the patient and coordinates all therapeutic decisions;
            NA
            E
            E
            E
            NA
          
          
            (4) If Telemedicine is used, physician/s who have privileges in critical care and  be approved by the TMD; and
            E
            E
            E
            E
            NA
          
          
            (5) A liaison to the trauma QM program with 50 percent attendance.
            E
            E
            E
            E
            NA