MIEMSS shall use the following criteria when designating or reverifying trauma centers from among those applicant hospitals that apply for designation or reverification: Standards in this chapter; Patient volume; Geographic coverage; Population; Competing applications; and New applications. When applying the criteria, MIEMSS may consider: Applicable guidelines and professional standards; Trauma outcome standards; and Published results of peer-reviewed trauma research. An applicant hospital shall comply with the applicable standards for trauma care in Regulations .01—.19 of this chapter. Patient Volume. 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: Minimize duplication of services; Achieve and sustain the volumes necessary for: Optimal outcome; Cost efficiency; Maintenance of expertise; Quality care; and Where applicable, research and physician and nurse education; and Minimize the potential adverse effect on quality of care that may result if volumes are reduced. 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: For PARC: 2,000 total trauma hospital admissions; and 800 hospital admissions of patients with severe injury; For Level I: 800 total trauma hospital admissions; and 240 hospital admissions of patients with severe injury; For Level II: 400 total trauma hospital admissions; and 120 hospital admissions of patients with severe injury; and For Level III: 300 total trauma hospital admissions; and 75 hospital admissions of patients with severe injury. In the volume criteria: Total trauma hospital admissions include all trauma patients who meet the case inclusion criteria, as defined in the Maryland State Trauma Registry Data Dictionaries issued by MIEMSS, and who are treated at the hospital: As an inpatient admission; or For trauma resuscitation, as an outpatient; and Hospital admissions of patients with severe injury include only injured patients who: Are admitted as inpatients; and Meet the injury severity criteria in Regulation .21 of this chapter. Geographic Coverage. When considering an applicant hospital for designation or reverification, MIEMSS shall: Ensure reasonable geographic access to the trauma system; Minimize duplicative services within close proximity; and Consider the number, geographic distribution, and resource capabilities of other hospitals and trauma centers within the Statewide trauma system. 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. Population. When considering an applicant hospital for designation or reverification, MIEMSS: 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. Competing Applications. 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: Give preference to the applicant with an established trauma program that can demonstrate that its past experience and performance: Is indicative of quality patient care; Is consistent with professional standards; and Results in optimal patient outcome; and Consider demonstrated patient outcomes and the recommendation of the site survey team to determine the most qualified applicant if both applicants have been verified through MIEMSS' inspection as meeting the standards for the requested level. 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. New Applicants. A hospital applying for designation as a trauma center that has not been previously designated as a trauma center pursuant to this subtitle shall: 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.