(a) A Level I or II pediatric trauma center is a licensed hospital which has been designated as a Level I or II pediatric trauma center by the local EMS agency. While both Level I and II pediatric trauma centers are similar, a Level I pediatric trauma center is required to have staff and resources not required of a Level II pediatric trauma center. The additional Level I requirements for pediatric trauma centers are located in Section 100262. A Level I or Level II pediatric trauma center shall have at least the following:
(1) A pediatric trauma program medical director who is a board-certified surgeon with experience in pediatric trauma care (may also be trauma program medical director for adult trauma services), whose responsibilities include, but are not limited to, factors that affect all aspects of pediatric trauma care such as:
(A) recommending pediatric trauma team physician privileges;
(B) working with nursing and administration to support the needs of pediatric trauma patients;
(D) determining appropriate equipment and supplies for pediatric trauma care;
(E) ensuring the development of policies and procedures to manage domestic violence and child abuse and neglect;
(F) having authority and accountability for the pediatric trauma quality improvement peer review process;
(G) correcting deficiencies in pediatric trauma care or excluding from trauma call those trauma team members who no longer meet standards;
(H) coordinating pediatric trauma care with other hospital and professional services;
(I) coordinating with local and State EMS agencies;
(J) assisting in the coordination of the budgetary process for the trauma program; and
(K) identifying representatives from neurosurgery, orthopedic surgery, emergency medicine, pediatrics and other appropriate disciplines to assist in identifying physicians from their disciplines who have pediatric trauma care experience and who are qualified to be members of the pediatric trauma program.
(2) A pediatric trauma nurse coordinator/manager who is a registered nurse with qualifications (may also be trauma nurse coordinator/manager for adult trauma services) including evidence of educational preparation and clinical experience in the care of pediatric trauma patients, administrative ability, and responsibilities that include but are not limited to factors that affect all aspects of pediatric trauma care, including:
(A) organizing services and systems necessary for the multidisciplinary approach to the care of the injured child;
(B) coordinating day-to-day clinical process and performance improvement as it pertains to pediatric trauma nursing and ancillary personnel; and
(C) collaborating with the pediatric trauma program medical director in carrying out the educational, clinical, research, administrative and outreach activities of the pediatric trauma program.
(3) A pediatric trauma service which can provide for the implementation of the requirements specified in this section and provide for coordination with the local EMS agency.
(4) A pediatric trauma team, which is a multidisciplinary team responsible for the initial resuscitation and management of the pediatric trauma patient.
(A) the pediatric trauma team leader shall be a surgeon with pediatric trauma experience as defined by the trauma program medical director;
(B) the remainder of the team shall include physician, nursing and support personnel in sufficient numbers to evaluate, resuscitate, treat and stabilize pediatric trauma patients.
(5) Department(s), division(s), service(s) or section(s) that include at least the following surgical specialists and which are staffed by qualified specialists with pediatric experience:
A. neurologic;
B. obstetric/gynecologic (may be provided through a written transfer agreement with a hospital that has a department, division, service, or section that provides this service);
C. ophthalmologic;
D. oral or maxillofacial or head and neck;
E. orthopaedic;
F. pediatric;
G. plastic;
H. urologic; and
I. microsurgery/reimplantation (may be provided through a written transfer agreement with a hospital that has a department, division, service, or section that provides this service).
(6) Department(s), division(s), service(s), or section(s) that include at least the following non-surgical specialties which are staffed by qualified specialists with pediatric experience:
A. anesthesiology;
B. cardiology;
C. critical care;
D. emergency medicine;
E. gastroenterology;
F. general pediatrics;
G. hematology/oncology;
H. infectious disease;
I. neonatology;
J. nephrology;
K. neurology;
L. pathology;
M. psychiatry;
N. pulmonology;
O. radiology; and
P. rehabilitation/physical medicine. This requirement may be provided through a written agreement with a pediatric rehabilitation center.
(7) An emergency department, division, service or section staffed with qualified specialists in emergency medicine with pediatric trauma experience, who are immediately available.
(8) Qualified surgical specialist(s) or specialty availability, which shall be available as follows:
(A) Pediatric surgeon, capable of evaluating and treating pediatric trauma patients shall be immediately available for trauma team activation and promptly available for consultation. This requirement may be fulfilled by:
1. a staff pediatric surgeon with experience in pediatric trauma care; or
2. a staff trauma surgeon with experience in pediatric trauma care; or
3. a senior general surgical resident who has completed at least three clinical years of surgical residency training. When a senior resident is the responsible surgeon:
a. the senior resident shall be able to provide the overall control and surgical leadership necessary for the care of the patient, including initiating surgical care; and
b. a staff pediatric surgeon with experience in pediatric trauma care or a staff trauma surgeon with experience in pediatric trauma care shall be on-call and promptly available; and
c. a staff pediatric surgeon or a staff surgeon with experience in pediatric trauma care shall participate in major therapeutic decisions, be advised of all pediatric trauma patient admissions and be present in the emergency department for major resuscitations and in the operating room for all trauma operative procedures.
(B) On-call and promptly available with pediatric experience;
1. neurologic;
2. obstetric/gynecologic. This surgical service may be provided through a written transfer agreement;
3. ophthalmologic;
4. oral or maxillofacial or head and neck;
5. orthopaedic;
6. plastic;
7. reimplantation/microsurgery capability. This surgical service may be provided through a written transfer agreement;
8. urologic;
(C) Requirements may be fulfilled by supervised senior residents as defined in Section 100245 of this Chapter who are capable of assessing emergent situations in their respective specialties. When a senior resident is the responsible surgeon:
1. The senior resident shall be able to provide the overall control and surgical leadership necessary for the care of the patient, including initiating surgical care;
2. a staff trauma surgeon or a staff surgeon with experience in trauma care shall be on-call and promptly available;
3. a staff trauma surgeon or a staff surgeon with experience in trauma care shall be advised of all trauma patient admissions, participate in major therapeutic decisions, and be present in the emergency department for major resuscitations and in the operating room for all trauma operative procedures.
(D) Available for consultation or consultation and transfer agreements for pediatric trauma patients requiring the following surgical services;
1. burns;
2. cardiothoracic; and
3. spinal cord injury.
(9) Qualified nonsurgical specialist(s) or specialty availability, which shall be available as follows:
(A) Emergency medicine, in-house and immediately available at all times. This requirement may be fulfilled by a qualified specialist in pediatric emergency medicine; or a qualified specialist in emergency medicine with pediatric experience; or a subspecialty resident in pediatric emergency medicine who has completed at least one year of subspecialty residency education in pediatric emergency medicine. In such cases, the senior resident(s) shall be capable of assessing emergency situations in trauma patients and of providing for initial resuscitation. Emergency medicine physicians who are qualified specialists in emergency medicine and are board certified in emergency medicine or pediatric emergency medicine shall not be required by the local EMS agency to complete an advanced trauma life support course. Current ATLS verification is required for all emergency medicine physicians who provide emergency trauma care and are qualified specialists in a speciality other than emergency medicine. When a senior resident is the responsible emergency physician in-house:
1. a qualified specialist in pediatric emergency medicine, or emergency medicine with pediatric experience shall be promptly available; and
2. the qualified specialist on-call shall be notified of all patients who require resuscitation, operative surgical intervention, or intensive care unit admission.
(B) Anesthesiology, Level II shall be promptly available with a mechanism established to ensure that the anesthesiologist is in the operating room when the patient arrives. This requirement may be fulfilled by a senior resident or certified registered nurse anesthetists with pediatric experience who are capable of assessing emergent situations in pediatric trauma patients and of providing any indicated treatment and are supervised by the staff anesthesiologist. In such cases, the staff anesthesiologist with pediatric experience on-call shall be advised about the patient, be promptly available at all times, and be present for all operations.
(C) Radiology, promptly available; and
(D) Available for consultation or provided through transfer agreement, qualified specialists with pediatric experience:
a. adolescent medicine;
b. child development;
c. genetics/dysmorphology;
d. neuroradiology;
e. obstetrics;
f. pediatric allergy and immunology;
g. pediatric dentistry;
h. pediatric endocrinology;
i. pediatric pulmonology; and
j. rehabilitation/physical medicine.
(E) Pediatric critical care, in-house and immediately available. The in-house requirement may be fulfilled by:
1. a qualified specialist in pediatric critical care medicine; or
2. a qualified specialist in anesthesiology with experience in pediatric critical care;
3. a qualified surgeon with expertise in pediatric critical care; or
4. a physician who has completed at least two years of residency in pediatrics. When a senior resident is the responsible pediatric critical care physician then:
a. a qualified specialist in pediatric critical care medicine, or a qualified specialist in anesthesiology with experience in pediatric critical care, shall be on-call and promptly available; and;
b. the qualified specialist on-call shall be advised about all patients who may require admission to the pediatric intensive care unit and shall participate in all major therapeutic decisions and interventions;
(F) Qualified specialists with pediatric experience shall be on the hospital staff and available for consultation:
1. general pediatrics;
2. mental health;
3. neonatology;
4. nephrology;
5. pathology;
6. pediatric cardiology;
7. pediatric gastroenterology;
8. pediatric hematology/oncology;
9. pediatric infectious disease;
10. pediatric neurology; and
11. pediatric radiology.
(b) In addition to licensure requirements, pediatric trauma centers shall have the following service capabilities:
(1) Radiological service. The radiological service shall have in-house and immediately available a radiological technician capable of performing plain film and computed tomography imaging. A radiological service shall have the following additional services promptly available for children:
(A) angiography; and
(B) ultrasound.
(2) Clinical laboratory service. A clinical laboratory service shall have:
(A) a comprehensive blood bank or access to a community central blood bank; and
(B) clinical laboratory services immediately available with micro sampling capability.
(3) Surgical service. A surgical service shall have an operating suite that is available or being utilized for trauma patients and that has:
(A) Operating staff who are promptly available unless operating on a trauma patient and back up personnel who are promptly available; and
(B) appropriate surgical equipment and supplies as determined by the pediatric trauma program medical director.
(4) Nursing services that are staffed by qualified licensed nurses with education, experience, and demonstrated clinical competence in the care of critically ill and injured children.
(c) A Level I and II pediatric trauma center shall have a basic or comprehensive emergency service which have special permits issued pursuant to Chapter 1, Division 5 of Title 22. The emergency service shall:
(1) designate an emergency physician to be a member of the pediatric trauma team;
(2) provide emergency medical services to pediatric patients; and
(3) have appropriate pediatric equipment and supplies as approved by the director of emergency medicine in collaboration with the trauma program medical director.
(d) In addition to the special permit licensing services, a pediatric trauma center shall have, pursuant to Section 70301 of Chapter 1, Division 5 of Title 22 of the California Code of Regulations, the following approved supplemental services:
(1) Burn Center. This service may be provided through a written transfer agreement with a Burn Center;
(2) Physical Therapy Service. Physical therapy services to include personnel trained in pediatric physical therapy and equipped for acute care of the critically injured child;
(3) Rehabilitation Center. Rehabilitation services to include personnel trained in rehabilitation care and equipped for acute care of the critically injured patient. These services may be provided through a written transfer agreement with a rehabilitation center;
(4) Respiratory Care Service. Respiratory care services to include personnel trained in respiratory therapy and equipped for acute care of the critically injured patient;
(5) Acute hemodialysis capability;
(6) Occupational therapy service. Occupational therapy services to include personnel trained in pediatric occupational therapy and equipped for acute care of the critically injured child;
(7) Speech therapy service. Speech therapy services to include personnel trained in pediatric speech therapy and equipped for acute care of the critically injured child; and
(8) Social Service.
(e) A trauma center shall have the following services or programs that do not require a license or special permit.
(1) A Pediatric Intensive Care Unit (PICU) approved by the California State Department of Health Services California Children Services (CCS).
(A) The PICU shall have appropriate equipment and supplies as determined by the physician responsible for the pediatric intensive care service and the pediatric trauma program medical director;
(B) the pediatric intensive care specialist shall be promptly available to care for trauma patients in the intensive care unit; and
(C) the qualified specialist in (B) above shall be a member of the trauma team.
(2) Acute spinal cord injury management capability. This service may be provided through a written transfer agreement with a Rehabilitation Center;
(3) Protocol to identify potential organ donors as described in Division 7, Chapter 3.5 of the California Health and Safety Code;
(4) An outreach program, to include:
(A) capability to provide both telephone and on-site consultations with physicians in the community and outlying areas;
(B) trauma prevention for the general public;
(C) public education and illness/injury prevention education.
(5) written interfacility transfer agreements with referring and speciality hospitals; and
(6) continuing education. Continuing education in pediatric trauma care shall be provided for:
(A) staff physicians;
(B) staff nurses;
(C) staff allied health personnel;
(D) EMS personnel; and
(E) other community physicians and health care personnel.
(7) In addition to special permit licensing services, a pediatric trauma center shall have:
(A) outreach and injury prevention programs specifically related to pediatric trauma and injury prevention;
(B) a suspected child abuse and neglect team (SCAN);
(C) an aeromedical transport plan with designated landing site; and
(D) Child Life program.
Credits
Note: Authority cited: Sections 1797.107 and 1798.161, Health and Safety Code. Reference: Sections 1798.161 and 1798.165, Health and Safety Code.
