<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 30.08.17.06" title_num="30" subtitle_num="08" chapter_num="17" heading="Stroke Team.">
  <paragraph num="A.">
    <text>In addition to meeting the requirement of COMAR 30.08.11.05, the hospital shall:</text>
    <paragraph num="(1)">
      <text>Establish one or more acute stroke teams which shall respond to the emergency department with coordinated services for the effective delivery of emergency and acute stroke treatment;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Use the National Institutes of Health Stroke Scale (NIHSS) for the initial assessment of patients with acute stroke, with clinicians performing an NIHSS having documented training in the completion of the NIHSS; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Perform ongoing neurological assessment on patients with acute stroke.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The acute stroke team shall include at a minimum:</text>
    <paragraph num="(1)">
      <text>A physician, with special competence in caring for the acute stroke patient, who is Board-certified or Board-eligible in:</text>
      <paragraph num="(a)">
        <text>Neurology;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Critical care medicine; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Emergency medicine; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>At least one additional health care provider, with experience in caring for the acute stroke patient, who may be:</text>
      <paragraph num="(a)">
        <text>An emergency physician;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A neurology resident or fellow;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>An internist;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A registered nurse;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>A physician assistant; or</text>
      </paragraph>
      <paragraph num="(f)">
        <text>A nurse practitioner.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>If a physician otherwise satisfies §B(1) of this regulation but is not Board-certified or Board-eligible in neurology, a Board-certified or Board-eligible neurologist shall be available within 15 minutes for consultation under the terms of a written agreement by:</text>
    <paragraph num="(1)">
      <text>Telephone; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Audio/visual communication.</text>
    </paragraph>
  </paragraph>
</regulation>