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

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

### Chapter 11 — Designated Primary Stroke Center Standards

#### Regulation .13 Policies, Protocols, Guidelines, and Agreements.

*COMAR 30.08.11.13*

The hospital shall develop and implement:

A. A written policy which demonstrates that the hospital has established the stroke center to:

  (1) Monitor the care delivered to acute stroke patients;

  (2) Improve the quality of care delivered to acute stroke patients;

  (3) Move patients through the initial acute care phase of their hospital stay in a timely fashion; and

  (4) Ensure that all stroke patients will receive medical care commensurate with the hospital's designation as a primary stroke center;

B. Written procedures for rapidly activating the stroke team to care for potentially eligible fibrinolytic and endovascular candidates within 15 minutes of notification; and

C. Written care protocols for the treatment of acute stroke which:

  (1) Address:

    (a) Evaluation of each patient by a member of the emergency department clinical staff within 10 minutes of the patient's arrival at the hospital emergency department;

    (b) At least one member of the stroke team arriving at the acute stroke patient's bedside within 15 minutes of notification;

    (c) Ischemic stroke;

    (d) Hemorrhagic stroke;

    (e) Stabilization of vital functions;

    (f) Initial diagnostic tests;

    (g) The use of medications including fibrinolytics;

    (h) Care of the potential endovascular candidate;

    (i) Timely and safe patient transfer; and

    (j) The hospital's plan for updating the protocols at least annually;

  (2) Are maintained up-to-date in:

    (a) The emergency department;

    (b) The stroke unit;

    (c) The intensive care unit; and

    (d) All other locations where stroke care is provided.