Chapter 09. Eye Trauma Center Standards
Regulation .01 Organization.LinkCopy Citation
The hospital shall:
A.
Be designated by MIEMSS and approved by the EMS Board as a Level II, Level I, or PARC trauma center;
B.
Have a board of directors' resolution that states its commitment to provide state-of-the-art optimal eye trauma care as part of the Statewide emergency medical system;
C.
Have an organized eye trauma center with a medical director who has:
(1)
Authority to run the eye trauma center; and
(2)
Responsibility for:
(a)
Clinical coordination of the eye trauma center;
(b)
Quality management; and
(c)
Participation in the State and regional EMS system quality management, education, and prevention activities; and
D.
Have a designated eye trauma center nurse manager who has authority and responsibility for nursing and patient care services.
Regulation .02 Medical Staff.LinkCopy Citation
The hospital shall have:
A.
The following physician coverage:
(1)
An ophthalmology fellow or ophthalmology resident in house 24 hours a day, to be at the bedside within 30 minutes for emergent consultation requests, with a board-certified or board-eligible ophthalmologist on call and available to be at the bedside within 60 minutes for emergent consultation requests; and
(2)
A board-certified or board-eligible emergency medicine physician in house 24 hours a day for eye trauma triage, with a board-certified or board-eligible attending ophthalmologist on call and available be at the bedside within 60 minutes for emergent consultation; and
B.
Ophthalmic subspecialty coverage on call and available 24 hours a day for vitreoretinal, oculoplastics, and anterior segment surgery.
Regulation .03 Nursing Services.LinkCopy Citation
A.
The hospital shall provide all nurses who care for patients in the eye trauma center with:
(1)
Special education in ophthalmic emergencies and eye trauma care; and
(2)
Specific orientation to eye trauma center procedures and protocols for ophthalmic emergencies.
B.
A nurse working in the eye trauma center, adult and pediatric ED RN involved with eye trauma triage and care in that setting, and pre/post op and OR eye surgery staff shall have at least 4 hours of continuing education in ophthalmic emergencies every 2 years.
Regulation .04 Facility.LinkCopy Citation
A.
Ophthalmic Treatment Area. The hospital shall have:
(1)
An ophthalmic treatment area that is identified for and dedicated to the examination of ophthalmic emergencies;
(2)
A medical director of the eye trauma center to oversee the management of the ophthalmic treatment area;
(3)
A nurse manager responsible for the ophthalmic treatment area;
(4)
Organized equipment and supplies to care for eye trauma, including:
(a)
A slitlamp biomicroscope;
(b)
An indirect ophthalmoscope;
(c)
A visual acuity chart (that is, Snellen and near chart);
(d)
Color plates, either Ishihara, or Hardy-Rand-Rittler;
(e)
Applanation Tonometry (that is, Tonopen, iCare®); and
(f)
Diagnostic ophthalmic lenses for gonioscopy and ophthalmoscopy;
(5)
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):
(a)
Systemic eye pressure lowering medications;
(b)
Topical intraocular pressure lowering medications of different classes;
(c)
Mydriatic and cycloplegic drops;
(d)
Topical anesthetics, such as proparacaine and tetracaine; and
(e)
Fluorescein drops or strips;
(6)
Sterile surgical sets specifically for ophthalmic trauma care readily available and located in the ophthalmic treatment area, including:
(a)
Vitreous tap and inject equipment;
(b)
Lateral canthotomy set;
(c)
Ocular lavage set-up; and
(d)
pH strips;
(7)
Equipment for skin laceration repair;
(8)
The following equipment:
(a)
Laser iridotomy (YAG or Argon);
(b)
Argon laser for retinopexy;
(c)
Cryoprobe available for retinopexy; and
(d)
Either of the following equipment for pneumatic retinopexy:
(i)
SF6; or
(ii)
C3 F8 gas; and
(e)
Corneal foreign body removal equipment such as 27-30 gauge needle and corneal burr;
(9)
Pharmacy support available to obtain intravitreal antimicrobial medications and steroids within 1 hour, 24 hours a day; and
(10)
Pharmacy support available to obtain topical fortified antimicrobial medications within 1 hour, 24 hours a day.
B.
Operating Room (OR). The hospital shall have an OR:
(1)
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;
(2)
Available ophthalmic surgery within 1 hour of notice; and
(3)
With operating microscope equipment readily available for:
(a)
Vitreoretinal surgery;
(b)
Oculoplastic surgery;
(c)
Anterior segment surgery; and
(d)
Pediatric patients.
C.
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.
D.
Ongoing care management and disposition of care may be integrated into the outpatient setting as indicated.
E.
A hospital shall have CT scan and ocular echography available 24 hours a day.
Regulation .05 Quality Management.LinkCopy Citation
The hospital shall:
A.
Have ongoing QM of the eye trauma center that is integrated into the hospital's overall QM program;
B.
Participate in the State EMS system QM activities, as described in this subtitle;
C.
Maintain an eye trauma registry;
D.
Participate in and maintain the State eye trauma registry; and
E.
Have QM activities, including:
(1)
Problem identification;
(2)
Problem analysis;
(3)
Action planning;
(4)
Implementation of the plan;
(5)
Reevaluation of the plan; and
(6)
Loop closure.
Regulation .06 Prevention and Public Education.LinkCopy Citation
The hospital shall:
A.
Provide leadership and coordination for the development and implementation of prevention and public education programs for eye injuries; and
B.
Monitor the progress of eye trauma prevention programs in cooperation with State quality monitoring activities.
Regulation .07 Research.LinkCopy Citation
The hospital shall:
A.
Have an organized eye clinical research program with a documented research plan; and
B.
Conduct research and submit to MIEMSS a summary of publications that may span topics of prevention, interventions, outcomes, or costs of treatment.
Regulation .08 Training.LinkCopy Citation
The Eye Trauma Center shall develop and provide education and training concerning ophthalmic injuries for:
A.
Physicians;
B.
Nurses;
C.
EMS clinicians; and
D.
Other appropriate allied health personnel.
Chapter annotations
Authority: Education Article, §13-509, Annotated Code of Maryland
History: Effective date: May 3, 1999 (26:9 Md. R. 731)
History: Regulation .01A amended effective July 1, 2002 (29:12 Md. R. 933)
History: Regulation .01C, D amended effective March 7, 2022 (49:5 Md. R. 367)
History: Regulation .02 amended effective March 7, 2022 (49:5 Md. R. 367)
History: Regulation .03 amended effective March 7, 2022 (49:5 Md. R. 367)
History: Regulation .04 amended effective March 7, 2022 (49:5 Md. R. 367)
History: Regulation .05 amended effective June 4, 2007 (34:11 Md. R. 972); March 7, 2022 (49:5 Md. R. 367)
History: Regulation .05D amended effective July 1, 2002 (29:12 Md. R. 933)
History: Regulation .07B amended effective July 1, 2002 (29:12 Md. R. 933); March 7, 2022 (49:5 Md. R. 367)
History: Regulation .08 amended effective July 1, 2002 (29:12 Md. R. 933); March 7, 2022 (49:5 Md. R. 367)