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<chapter num="09" heading="Eye Trauma Center Standards" title_num="30" subtitle_num="08">
  <regulation prefix="Regulation" num=".01" heading="Organization.">
    <text>The hospital shall:</text>
    <paragraph num="A.">
      <text>Be designated by MIEMSS and approved by the EMS Board as a Level II, Level I, or PARC trauma center;</text>
    </paragraph>
    <paragraph num="B.">
      <text>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;</text>
    </paragraph>
    <paragraph num="C.">
      <text>Have an organized eye trauma center with a medical director who has:</text>
      <paragraph num="(1)">
        <text>Authority to run the eye trauma center; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Responsibility for:</text>
        <paragraph num="(a)">
          <text>Clinical coordination of the eye trauma center;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Quality management; and</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Participation in the State and regional EMS system quality management, education, and prevention activities; and</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="D.">
      <text>Have a designated eye trauma center nurse manager who has authority and responsibility for nursing and patient care services.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".02" heading="Medical Staff.">
    <text>The hospital shall have:</text>
    <paragraph num="A.">
      <text>The following physician coverage:</text>
      <paragraph num="(1)">
        <text>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</text>
      </paragraph>
      <paragraph num="(2)">
        <text>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</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>Ophthalmic subspecialty coverage on call and available 24 hours a day for vitreoretinal, oculoplastics, and anterior segment surgery.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Nursing Services.">
    <paragraph num="A.">
      <text>The hospital shall provide all nurses who care for patients in the eye trauma center with:</text>
      <paragraph num="(1)">
        <text>Special education in ophthalmic emergencies and eye trauma care; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Specific orientation to eye trauma center procedures and protocols for ophthalmic emergencies.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>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.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" 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>
  <regulation prefix="Regulation" num=".05" heading="Quality Management.">
    <text>The hospital shall:</text>
    <paragraph num="A.">
      <text>Have ongoing QM of the eye trauma center that is integrated into the hospital's overall QM program;</text>
    </paragraph>
    <paragraph num="B.">
      <text>Participate in the State EMS system QM activities, as described in this subtitle;</text>
    </paragraph>
    <paragraph num="C.">
      <text>Maintain an eye trauma registry;</text>
    </paragraph>
    <paragraph num="D.">
      <text>Participate in and maintain the State eye trauma registry; and</text>
    </paragraph>
    <paragraph num="E.">
      <text>Have QM activities, including:</text>
      <paragraph num="(1)">
        <text>Problem identification;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Problem analysis;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Action planning;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Implementation of the plan;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Reevaluation of the plan; and</text>
      </paragraph>
      <paragraph num="(6)">
        <text>Loop closure.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".06" heading="Prevention and Public Education.">
    <text>The hospital shall:</text>
    <paragraph num="A.">
      <text>Provide leadership and coordination for the development and implementation of prevention and public education programs for eye injuries; and</text>
    </paragraph>
    <paragraph num="B.">
      <text>Monitor the progress of eye trauma prevention programs in cooperation with State quality monitoring activities.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".07" heading="Research.">
    <text>The hospital shall:</text>
    <paragraph num="A.">
      <text>Have an organized eye clinical research program with a documented research plan; and</text>
    </paragraph>
    <paragraph num="B.">
      <text>Conduct research and submit to MIEMSS a summary of publications that may span topics of prevention, interventions, outcomes, or costs of treatment.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".08" heading="Training.">
    <text>The Eye Trauma Center shall develop and provide education and training concerning ophthalmic injuries for:</text>
    <paragraph num="A.">
      <text>Physicians;</text>
    </paragraph>
    <paragraph num="B.">
      <text>Nurses;</text>
    </paragraph>
    <paragraph num="C.">
      <text>EMS clinicians; and</text>
    </paragraph>
    <paragraph num="D.">
      <text>Other appropriate allied health personnel.</text>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="Authority">Education Article, §13-509, Annotated Code of Maryland</annotation>
    <annotation type="History" subtype="Administrative History">Effective date: May 3, 1999 (26:9 Md. R. 731)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .01A amended effective July 1, 2002 (29:12 Md. R. 933)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .01C, D amended effective March 7, 2022 (49:5 Md. R. 367)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02 amended effective March 7, 2022 (49:5 Md. R. 367)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03 amended effective March 7, 2022 (49:5 Md. R. 367)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .04 amended effective March 7, 2022 (49:5 Md. R. 367)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05 amended effective June 4, 2007 (34:11 Md. R. 972); March 7, 2022 (49:5 Md. R. 367)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05D amended effective July 1, 2002 (29:12 Md. R. 933)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .07B amended effective July 1, 2002 (29:12 Md. R. 933); March 7, 2022 (49:5 Md. R. 367)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .08 amended effective July 1, 2002 (29:12 Md. R. 933); March 7, 2022 (49:5 Md. R. 367)</annotation>
  </annotations>
</chapter>