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

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

### Chapter 08 — Pediatric Trauma Center Standards

#### Regulation .05 Pediatric Emergency Department (PED).

*COMAR 30.08.08.05*

The hospital shall have an ED dedicated to pediatric care, including:

A. A designated and dedicated ED physician director and nurse manager;

B. A sufficient number of registered nurses and other clinicians who:

  (1) Have the necessary knowledge and skills to provide care during trauma resuscitation;

  (2) Are present to manage projected caseloads; and

  (3) Immediately reinforce the number of staff upon notice of multiple admissions;

C. Defined and agreed upon roles and responsibilities approved by the TMD to ensure availability of ED resources;

D. Verification of functioning life-safety emergency equipment and supplies organized for trauma resuscitation present and immediately available 24 hours a day;

E. An identified pediatric trauma resuscitation room with dedicated staff, equipment, and supplies 24 hours a day;

F. Designation by MIEMSS as a pediatric base station;

G. Policies and protocols for trauma team response and roles in ED trauma resuscitation in accordance with Regulation .20 of this chapter; and

H. Equipment for resuscitation of patients of all ages, including:

  (1) Airway management equipment and supplies including a “difficult airway cart”;

  (2) Emergency equipment located in the resuscitation area/ED for:

    (a) Thoracotomy;

    (b) Vascular access;

    (c) Thoracostomy or chest decompression;

    (d) Bedside ultrasound;

    (e) Extremity hemorrhage control devices/tourniquet; and

    (f) Rapid infuser and warmer;

  (3) Medications necessary for the resuscitation and emergency care of children with immediate capability for appropriate pediatric dosages based on weight in kilograms;

  (4) Printed pre-calculated pediatric drug dosage reference materials, including, but not limited to, charts, wall posters, and length-based dosage tapes;

  (5) The following monitoring devices:

    (a) ECG monitor/defibrillator capable of providing a hard copy rhythm strip, and with internal and external pediatric paddles capable of delivering from 0 to 360 joules;

    (b) Pulse oximeter with adult and pediatric probes;

    (c) Blood pressure cuffs in infant, child, adult, and thigh sizes;

    (d) Thermometer probe capable of reading from 28 to 42 degrees centigrade;

    (e) Otoscope;

    (f) Ophthalmoscope;

    (g) Transport monitor with pediatric capabilities;

    (h) Doppler and noninvasive blood pressure monitoring devices for infant, child, and adult;

    (i) End-tidal carbon dioxide monitor; and

    (j) Pressure monitor for central venous pressure and arterial line pressure;

  (6) Standard intravenous fluids and administration devices, including large-bore intravenous catheters;

  (7) Newborn resuscitation supplies;

  (8) Compartmental pressure measuring devices immediately available; and

  (9) Cervical and skeletal traction devices immediately available.