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<regulation prefix="Regulation" num=".02" citation="COMAR 30.08.08.02" title_num="30" subtitle_num="08" chapter_num="08" heading="Organization.">
  <paragraph num="A.">
    <text>The hospital's board of directors, administrators, and medical and nursing staffs shall demonstrate commitment to the optimal care of injured pediatric patients by:</text>
    <paragraph num="(1)">
      <text>Formulating a board of director's resolution stating that:</text>
      <paragraph num="(a)">
        <text>The hospital agrees to meet the Maryland Pediatric Trauma Center designation standards; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The hospital has a commitment to the infrastructure and the financial, human, and physical resources necessary to support the hospital’s designation as a pediatric trauma center;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Establishing an identifiable organization whose dedication to the care of injured children is shown in:</text>
      <paragraph num="(a)">
        <text>Its mission statement;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The configuration of its medical, administrative, and support staffs; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The configuration of its physical plant;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Participating in the Statewide trauma system, including submission of patient care data to the State Trauma Registry for system and quality management (QM);</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Assuring that all pediatric trauma patients shall receive medical care commensurate with the hospital's designation as a pediatric trauma center; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>A board of director's resolution, bylaws, contracts, and budgets, all specific to the pediatric trauma center, indicating the hospital's commitment to the financial, human, and physical resource infrastructure that is necessary to support the hospital's designation as a pediatric trauma center.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The hospital shall:</text>
    <paragraph num="(1)">
      <text>Be licensed as an acute care hospital by the Maryland Department of Health or, if located outside Maryland, in the state in which it is located;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Be accredited by an organization that has been granted deeming authority by the Centers for Medicare &amp; Medicaid Services and approved by the Maryland Department of Health to accredit hospitals in the State;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Maintain current equipment and technology to support optimal pediatric trauma care;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Admit annually 200 or more injured children who are younger than 15 years old;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Have the ability to treat effectively all types of pediatric injuries, including:</text>
      <paragraph num="(a)">
        <text>Brain injury;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Spinal cord injury;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Solid organ injury;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Chest injury;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Complex musculoskeletal injury;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Burns;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Eye injury;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Hand and upper extremity injury; and</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Lower extremity injury; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>Have a heliport or helipad positioned at the closest safe location so there is a limited distance from the helipad to the hospital.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The pediatric trauma center shall have a pediatric trauma leadership team responsible for monitoring and coordinating all components of the pediatric trauma program, including:</text>
    <paragraph num="(1)">
      <text>A pediatric trauma medical director (TMD) who:</text>
      <paragraph num="(a)">
        <text>Is a board-certified pediatric surgeon;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Demonstrates expertise and commitment to the care of injured children;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>With the trauma program manager (TPM), is empowered by the hospital’s governing body to lead the pediatric trauma center;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Has the authority and scope for administering all aspects of trauma care and is responsible for the overall clinical coordination of the pediatric trauma center;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Has the responsibility for the oversight of the QM process related to all pediatric trauma patients;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Participates in and publishes pediatric trauma research;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Has a job description developed by the hospital to reflect the role and responsibilities as defined by COMAR;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Appears on the hospital’s organizational chart where the relationship between the TMD and other hospital services are depicted and delineated;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Participates in local, regional, state and national activities related to pediatric injury care and prevention; and</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Participates in pediatric trauma education activities such as undergraduate medical education, postgraduate training programs, and continuing education (CE); and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A pediatric trauma program manager (TPM) who:</text>
      <paragraph num="(a)">
        <text>Is a 1.0 full-time equivalent (FTE) committed to the management of the pediatric trauma center;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Meets the requirements of Regulation .20 of this chapter; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>If the 1.0 FTE TPM has oversight of additional centers or services, the TPM is assisted by a 1.0 FTE QM nurse coordinator for each additional center or service.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>There shall be one or more committees that provide expert input to the hospital’s management of the pediatric trauma program. The committees shall:</text>
    <paragraph num="(1)">
      <text>Under the leadership of the TMD and TPM or designee, ensure physician trauma peer review includes active participation by representatives from general surgery to address clinical care issues;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Under the leadership of the TMD, conduct trauma multidisciplinary review that includes orthopedic surgery, emergency medicine, critical care, anesthesia, neurosurgery, radiology, rehabilitation, and nursing to address and ensure multidisciplinary review of clinical care and systematic issues; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Monitor, track, and trend pediatric trauma care within hospital departments, medical and nursing staffs, and representative disciplines across the trauma care continuum.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The pediatric trauma center shall have a pediatric trauma resuscitation team:</text>
    <paragraph num="(1)">
      <text>Whose members are:</text>
      <paragraph num="(a)">
        <text>Present in house and immediately available upon notification;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Oriented to the internal pediatric trauma clinical management protocols and policies; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Have demonstrated skills for pediatric trauma care that are appropriate and specific to their specialty roles;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>That is available in the trauma resuscitation areas upon arrival of all trauma patients when there is advanced notification;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>That follows clearly defined policies and protocols for activation criteria and roles and responsibilities;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>That includes a team leader, who shall be either:</text>
      <paragraph num="(a)">
        <text>An attending pediatric surgeon; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A postgraduate, year-3 or above general surgeon; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>That includes an in-house emergency medicine physician who has experience and training in pediatric trauma resuscitation, and shall act as the pediatric trauma resuscitation team leader until relieved by the pediatric trauma surgeon in the resuscitation area.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>There is a pediatric trauma multidisciplinary team that, in addition to physicians and nurses, consists of professionals with a focus on the unique needs of children and families, including:</text>
    <paragraph num="(1)">
      <text>Social work;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Child psychiatry;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Child life therapy;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Rehabilitation services, that is, physical, occupational, and speech therapies; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Respiratory therapy.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>The hospital shall have a completed interdisciplinary plan of care specific to the needs of each pediatric trauma patient that addresses all phases of care, including acute care of injuries, disposition, discharge, and rehabilitation needs.</text>
  </paragraph>
  <paragraph num="H.">
    <text>The hospital shall have written policies and procedures to direct the organized and safe interhospital transfer process of pediatric trauma patients. The hospital shall:</text>
    <paragraph num="(1)">
      <text>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; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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 an out-of-State hospital more than five times a year.</text>
    </paragraph>
  </paragraph>
</regulation>