<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 30.08.09.04" title_num="30" subtitle_num="08" chapter_num="09" heading="Facility.">
  <paragraph num="A.">
    <text>Ophthalmic Treatment Area. The hospital shall have:</text>
    <paragraph num="(1)">
      <text>An ophthalmic treatment area that is identified for and dedicated to the examination of ophthalmic emergencies;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A medical director of the eye trauma center to oversee the management of the ophthalmic treatment area;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>A nurse manager responsible for the ophthalmic treatment area;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Organized equipment and supplies to care for eye trauma, including:</text>
      <paragraph num="(a)">
        <text>A slitlamp biomicroscope;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>An indirect ophthalmoscope;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A visual acuity chart (that is, Snellen and near chart);</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Color plates, either Ishihara, or Hardy-Rand-Rittler;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Applanation Tonometry (that is, Tonopen, iCare®); and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Diagnostic ophthalmic lenses for gonioscopy and ophthalmoscopy;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>The following readily available medications necessary for the treatment and diagnosis of ophthalmic emergencies (in the event of regional or national drug shortages, pharmacy will assist with sourcing of appropriate, alternative options):</text>
      <paragraph num="(a)">
        <text>Systemic eye pressure lowering medications;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Topical intraocular pressure lowering medications of different classes;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Mydriatic and cycloplegic drops;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Topical anesthetics, such as proparacaine and tetracaine; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Fluorescein drops or strips;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>Sterile surgical sets specifically for ophthalmic trauma care readily available and located in the ophthalmic treatment area, including:</text>
      <paragraph num="(a)">
        <text>Vitreous tap and inject equipment;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Lateral canthotomy set;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Ocular lavage set-up; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>pH strips;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>Equipment for skin laceration repair;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>The following equipment:</text>
      <paragraph num="(a)">
        <text>Laser iridotomy (YAG or Argon);</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Argon laser for retinopexy;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Cryoprobe available for retinopexy; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Either of the following equipment for pneumatic retinopexy:</text>
        <paragraph num="(i)">
          <text>SF6; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>C3 F8 gas; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>Corneal foreign body removal equipment such as 27-30 gauge needle and corneal burr;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(9)">
      <text>Pharmacy support available to obtain intravitreal antimicrobial medications and steroids within 1 hour, 24 hours a day; and</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Pharmacy support available to obtain topical fortified antimicrobial medications within 1 hour, 24 hours a day.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Operating Room (OR). The hospital shall have an OR:</text>
    <paragraph num="(1)">
      <text>With adequately trained staff in ophthalmic surgery available with 1-hour response for ophthalmic emergencies 24 hours a day as needed per eye trauma center policies and procedures;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Available ophthalmic surgery within 1 hour of notice; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>With operating microscope equipment readily available for:</text>
      <paragraph num="(a)">
        <text>Vitreoretinal surgery;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Oculoplastic surgery;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Anterior segment surgery; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Pediatric patients.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The hospital shall have an inpatient unit available with inpatient beds with nursing staff who have knowledge and skills specific for the care of post-operative patients.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Ongoing care management and disposition of care may be integrated into the outpatient setting as indicated.</text>
  </paragraph>
  <paragraph num="E.">
    <text>A hospital shall have CT scan and ocular echography available 24 hours a day.</text>
  </paragraph>
</regulation>