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

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

### Chapter 14 — Hand and Upper Extremity Trauma Center Standards

#### Regulation .02 Organization.

*COMAR 30.08.14.02*

A. A hand and upper extremity trauma center shall:

  (1) Be licensed as an acute care hospital by the hospital licensing authority in the jurisdiction in which it is located;

  (2) Be accredited by [the Joint Commission on Accreditation of Health Care Organizations] an organization that has been granted deeming authority by the Centers for Medicare & Medicaid Services and approved by the Maryland Department of Health to accredit hospitals in the State, with a designated hand surgery service;

  (3) Have an emergency department which offers comprehensive emergency care 24 hours a day with:

    (a) At least one physician experienced in emergency care on duty in the emergency care area; and

    (b) In-hospital physician coverage by members of the medical staff or by senior-level residents who are postgraduate year 3 or higher for the following services:

      (i) Medical;

      (ii) Surgical;

      (iii) Orthopedic; and

      (iv) Anesthesia;

  (4) Have a resolution adopted by the Board of Directors of the hospital committing the hospital to:

    (a) Participate in State and regional emergency medical services; and

    (b) Maintain the infrastructure necessary to support the hospital's provision of state-of-the-art hand and upper extremity trauma care including the following resources necessary to the provision of such service:

      (i) Financial;

      (ii) Human; and

      (iii) Physical.

B. The hand and upper extremity trauma center shall have:

  (1) A medical director;

  (2) Appropriately educated nurse leaders and clinical staff to provide care for hand and upper extremity trauma patients;

  (3) A fellowship training program in hand surgery accredited by the ACGME;

  (4) A comprehensive post-trauma rehabilitation program accredited by CARF;

  (5) A quality improvement program which participates in State and regional emergency medical services quality management;

  (6) An educational program for physicians, nurses, and therapists who treat trauma patients with single system upper extremity trauma;

  (7) A policy committee that oversees the activities of the hand and upper extremity trauma center;

  (8) An internal morbidity and mortality conference scheduled to meet at least monthly to record and discuss any complications;

  (9) A maintained hand registry; and

  (10) Timely submission of data to the MIEMSS State trauma registry.