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RULE §157.123Regional Emergency Medical Services/Trauma Systems

(a) The bureau of emergency management (bureau) shall recognize the establishment of a regional emergency medical services (EMS)/trauma system (system) within a trauma service area (TSA) as described in §157.122 of this title (relating to Trauma Service Areas).

(b) Establishment of a regional EMS/trauma system consists of three phases.

  (1) The first phase begins with the establishment of a regional advisory council (RAC) and ends with recognition of the RAC by the bureau.

    (A) All health care entities who care for trauma patients should be offered membership on the RAC. RACs shall:

      (i) be operated in a manner that maximizes inclusion of their constituents and ensures membership approval of "participation requirements";

      (ii) have documented evidence that participation guidelines have been discussed and affirmed by vote of the entire RAC voting membership;

      (iii) have clear definitions of participation guidelines in the organization's by-laws and/or other official RAC files;

      (iv) have documentation that participation guidelines have been communicated to EMS providers and hospitals, regardless of past participation history;

      (v) have documented attendance records;

      (vi) have consistency in the annual participation reporting period;

      (vii) send participation "progress reports" to EMS providers and hospitals at some period during the reporting year;

      (viii) send participation requirements "non-compliancy" letters to appropriate EMS providers and hospitals at end of reporting year;

      (ix) be cognizant of the direct and indirect fiscal roles they play on behalf of their members; and

      (x) be particularly cognizant of the logistical challenges faced by rural and volunteer agencies and open to considering viable alternatives to members' physical presence at all meetings.

    (B) The bureau shall recognize only one official RAC for a TSA.

    (C) At least quarterly, a RAC shall submit evidence of on-going activity, such as meeting notices and minutes, to the bureau.

    (D) Annually, the RAC shall file a report with the bureau which describes progress toward system development, demonstrates on-going activity, and includes evidence that members of the RAC are currently involved in trauma care.

    (E) The RAC functions without the expectation of comprehensive, permanent and/or unrestricted state funding.

    (F) RACs may request technical assistance from the bureau at any time.

  (2) The second phase begins with RAC recognition by the bureau and ends with approval of a complete EMS/trauma system plan (plan) by the bureau.

    (A) The RAC shall develop a system plan based on standard guidelines for comprehensive system development. The system plan is subject to approval by the bureau.

    (B) The bureau shall review the plan to assure that:

      (i) all counties within the TSA have been included unless a specific county, or portion thereof, has been aligned within an adjacent system;

      (ii) all health care entities and interested specialty centers have been given an opportunity to participate in the planning process; and

      (iii) the following components have been addressed:

        (I) injury prevention;

        (II) access to the system;

        (III) communications;

        (IV) medical oversight;

        (V) pre-hospital triage criteria;

        (VI) diversion policies;

        (VII) bypass protocols;

        (VIII) regional medical control;

        (IX) regional trauma treatment guidelines;

          (-a-) Guidelines consistent with current Advanced Trauma Life Support (ATLS), Advanced Pediatric Life Support (APLS), Basic Trauma Life Support (BTLS), Pre-Hospital Trauma Life Support (PHTLS), Trauma Nurse Core Course (TNCC), Emergency Nurse Pediatric Course (ENPC), Pediatric Advanced Life Support (PALS) and Pediatric Education For Pre-Hospital Providers (PEPP) standards shall be developed, implemented, and evaluated.

          (-b-) Individual agencies and medical directors may, and are encouraged, to exceed the minimum standards.

          (-c-) Major/severe trauma patients will be cared for by health professionals with documented education and skill in the assessment and care of injuries throughout their pre-hospital and hospital course.

          (-d-) Major/severe trauma patients will have their medical care, as documented by pre-hospital run forms and hospital charts, reviewed by the individual entity's medical director for appropriateness and quality of care.

          (-e-) Major/severe trauma patients will have deviations from standard of care addressed through a documented trauma performance improvement process.

        (X) facility triage criteria;

        (XI) inter-hospital transfers;

        (XII) planning for the designation of trauma facilities, including the identification of the lead facility(ies); and

        (XIII) regional guidelines for disaster preparedness; and

        (XIV) a performance improvement program that evaluates processes and outcomes from a system perspective.

    (C) Bureau approval of the completed plan may qualify health care entities participating in the system to receive state funding for trauma care if funding is available.

  (3) The third phase begins with approval of a complete plan by the bureau and ends with the regional EMS/trauma system being recognized by the bureau.

    (A) Upon approval, a RAC implements the plan to include:

      (i) education of all entities about the plan components;

      (ii) on-going review of resource, process, and outcome data; and

      (iii) if necessary, revision and re-approval of the plan or plan components by the bureau.

    (B) Following implementation of the plan, the bureau shall recommend to the commissioner of health (commissioner) the designation of a regional EMS/trauma system if the applicant RAC meets or exceeds the current Texas EMS/trauma systems essential criteria; actively participates at the bureau's quarterly RAC Chairs meetings; and submits data as requested.

    (C) The designation process shall consist of three phases:

      (i) The first phase is the application phase which begins with completing and submitting to the bureau a complete application and non-refundable fee for designation as a regional EMS/trauma system and ends when the bureau approves a site survey (survey);

      (ii) The second phase is the review phase which begins with the survey and ends with a bureau recommendation to the commissioner to designate a regional EMS/trauma system; and

      (iii) The third phase is the final phase which begins with the commissioner reviewing the recommendations and ends with his/her final decision. This phase also includes an appeal procedure for the denial of a designation application in accordance with the Administrative Procedure Act, Government Code, Chapter 2001.

    (D) The bureau's analysis of submitted application materials, which may result in recommendations for corrective action when deficiencies are noted, shall include a review of:

      (i) evidence of participation at the bureau's quarterly RAC Chairs meetings;

      (ii) the completeness and appropriateness of the application materials submitted, including the non-refundable application fee.

      (iii) the non-refundable application fee shall be based on the trauma service area's geographic size, population and trauma death rate.

      (iv) a RAC's non-refundable application fee shall be no more than $10,000 and not less than $2500.

    (E) When the application phase results in a bureau approval for survey, the bureau shall notify the regional EMS/trauma system's RAC that will then contract for the survey by a team of approved non-Texas Department of Health (department) surveyors.

      (i) The bureau, at its discretion, may appoint an observer to accompany the survey team. In this event, the cost for the observer(s) shall be borne by the bureau. A RAC shall have the right to refuse to allow non-department observers to participate in a survey.

      (ii) The survey shall be completed within one year of the date of the approval of the application.

      (iii) At any time, a RAC may file a complaint with the bureau regarding the conduct of a surveyor. The bureau will investigate and notify the RAC of the outcome.

    (F) The survey team composition shall consist of at minimum a physician; an EMS provider representative; a trauma nurse from a designated trauma facility; all of which shall have demonstrated knowledge and experience with system development. A fourth surveyor with experience in system management may be requested by the RAC or the bureau.


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