(a) A limited services rural hospital (LSRH) shall
provide the emergency care necessary to meet the needs of its patients
in accordance with acceptable standards of practice.
(b) An LSRH shall provide to each patient, without
regard to the individual's ability to pay, an appropriate medical
screening, examination, and stabilization within the facility's capability,
including ancillary services routinely available to the hospital,
to determine whether an emergency medical condition exists and shall
provide any necessary stabilizing treatment.
(c) An LSRH shall have an emergency suite that complies
with §511.163(e) of this chapter (relating to Spatial Requirements).
(d) The organization of the LSRH's emergency services
must be appropriate to the scope of the services offered.
(e) Emergency services must be organized under the
direction of a qualified physician member of the LSRH's medical staff
who is the medical director or clinical director.
(f) Emergency services must be integrated with other
LSRH departments.
(g) The LSRH must maintain patient medical records
for all emergency patients. The medical records shall contain patient
identification, the reason for the visit, name of physician, name
of nurse, time admitted to the emergency suite, treatment, time discharged,
and disposition.
(h) The policies and procedures governing medical care
provided in the emergency suite must be established by and must be
a continued responsibility of the medical staff.
(i) There must be adequate medical and nursing personnel
qualified in emergency care to meet the written emergency procedures
and needs anticipated by the LSRH.
(j) There must be on-duty and on-site 24 hours a day,
seven days a week at least one person qualified, as determined by
the medical staff, to initiate immediate appropriate lifesaving measures
and at least one nurse with current advanced cardiac life support
and pediatric advanced life support certification. This individual
or individuals must be able to receive patients and activate the appropriate
medical resources to meet the care needed by the patient.
(k) Qualified personnel must be physically present
in the emergency treatment area at all times.
(l) An LSRH must maintain schedules, names, and phone
numbers of all physicians and others on emergency call duty, including
alternates. The LSRH must maintain the schedules for at least one
year.
(m) In accordance with Code of Federal Regulations
Title 42 (42 CFR) §485.516(c)(4), there must be a physician,
a physician assistant, or an advanced practice registered nurse, with
training or experience in emergency care, on call and immediately
available by telephone or radio contact, and available on-site at
the LSRH within 30 minutes, on a 24-hour a day basis, if the LSRH
is located in an area other than an area described in 42 CFR §485.618(d)(1)(ii).
(n) Emergency services must be available 24-hours per
day.
(o) An LSRH shall keep adequate age-appropriate equipment,
supplies, and medication used in treating emergency cases and make
this equipment, supplies, and medication readily available for treating
emergency cases.
(p) The age-appropriate emergency equipment and supplies
available at the LSRH shall include at least the following:
(1) emergency call system;
(2) oxygen;
(3) mechanical ventilatory assistance equipment, including
airways, manual breathing bag, endotracheal tubes, ambu bag/valve/mask;
(4) cardiac defibrillator;
(5) cardiac monitoring equipment;
(6) laryngoscopes and endotracheal tubes;
(7) suction equipment;
(8) stabilization devices for cervical injuries;
(9) blood pressure monitoring equipment;
(10) pulse oximeter or similar medical device to measure
blood oxygenation;
(11) tourniquets;
(12) immobilization devices;
(13) nasogastric tubes;
(14) splints;
(15) Intravenous (IV) therapy supplies;
(16) suction machine;
(17) chest tubes;
(18) indwelling urinary catheters; and
(19) drugs and biologicals commonly used in life-saving
procedures as specified by the medical staff, which shall include:
(A) analgesics,
(B) local anesthetics,
(C) antibiotics,
(D) anticonvulsants,
(E) antidotes and emetics,
(F) serums and toxoids,
(G) antiarrhythmics,
(H) cardiac glycosides,
(I) antihypertensives,
(J) diuretics, and
(K) electrolytes and replacement solutions.
(q) Equipment and supplies must be available at the
LSRH for administering intravenous medications as well as facilities
for bleeding control and emergency splinting of fractures.
(r) The LSRH shall periodically test emergency equipment
according to the LSRH's adopted policy.
(s) An LSRH shall provide, either directly or under
arrangements, services for the procurement, safekeeping, and transfusion
of blood, including the availability of blood products needed for
emergencies on a 24-hour a day basis.
(t) Provision for the storage of blood and blood products
must be made as needed. If blood banking services are provided under
an arrangement, the arrangement is approved by the LSRH's medical
staff and by the persons directly responsible for the operation of
the LSRH. An LSRH shall ensure all blood and blood components are
stored in accordance with §511.45(h) of this subchapter (relating
to Laboratory Services).
(u) An LSRH shall, in coordination with emergency response
systems in the area, establish procedures under which a physician
is immediately available by telephone or radio contact on a 24-hour
a day basis to receive emergency calls, provide information on treatment
of emergency patients, and refer patients to the LSRH or other appropriate
locations for treatment.
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