<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 30.08.08.05" title_num="30" subtitle_num="08" chapter_num="08" heading="Pediatric Emergency Department (PED).">
  <text>The hospital shall have an ED dedicated to pediatric care, including:</text>
  <paragraph num="A.">
    <text>A designated and dedicated ED physician director and nurse manager;</text>
  </paragraph>
  <paragraph num="B.">
    <text>A sufficient number of registered nurses and other clinicians who:</text>
    <paragraph num="(1)">
      <text>Have the necessary knowledge and skills to provide care during trauma resuscitation;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Are present to manage projected caseloads; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Immediately reinforce the number of staff upon notice of multiple admissions;</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Defined and agreed upon roles and responsibilities approved by the TMD to ensure availability of ED resources;</text>
  </paragraph>
  <paragraph num="D.">
    <text>Verification of functioning life-safety emergency equipment and supplies organized for trauma resuscitation present and immediately available 24 hours a day;</text>
  </paragraph>
  <paragraph num="E.">
    <text>An identified pediatric trauma resuscitation room with dedicated staff, equipment, and supplies 24 hours a day;</text>
  </paragraph>
  <paragraph num="F.">
    <text>Designation by MIEMSS as a pediatric base station;</text>
  </paragraph>
  <paragraph num="G.">
    <text>Policies and protocols for trauma team response and roles in ED trauma resuscitation in accordance with Regulation .20 of this chapter; and</text>
  </paragraph>
  <paragraph num="H.">
    <text>Equipment for resuscitation of patients of all ages, including:</text>
    <paragraph num="(1)">
      <text>Airway management equipment and supplies including a “difficult airway cart”;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Emergency equipment located in the resuscitation area/ED for:</text>
      <paragraph num="(a)">
        <text>Thoracotomy;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Vascular access;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Thoracostomy or chest decompression;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Bedside ultrasound;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Extremity hemorrhage control devices/tourniquet; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Rapid infuser and warmer;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Medications necessary for the resuscitation and emergency care of children with immediate capability for appropriate pediatric dosages based on weight in kilograms;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Printed pre-calculated pediatric drug dosage reference materials, including, but not limited to, charts, wall posters, and length-based dosage tapes;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The following monitoring devices:</text>
      <paragraph num="(a)">
        <text>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;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Pulse oximeter with adult and pediatric probes;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Blood pressure cuffs in infant, child, adult, and thigh sizes;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Thermometer probe capable of reading from 28 to 42 degrees centigrade;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Otoscope;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Ophthalmoscope;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Transport monitor with pediatric capabilities;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Doppler and noninvasive blood pressure monitoring devices for infant, child, and adult;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>End-tidal carbon dioxide monitor; and</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Pressure monitor for central venous pressure and arterial line pressure;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>Standard intravenous fluids and administration devices, including large-bore intravenous catheters;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Newborn resuscitation supplies;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Compartmental pressure measuring devices immediately available; and</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Cervical and skeletal traction devices immediately available.</text>
    </paragraph>
  </paragraph>
</regulation>