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TITLE 25HEALTH SERVICES
PART 1DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 131FREESTANDING EMERGENCY MEDICAL CARE FACILITIES
SUBCHAPTER GPHYSICAL PLANT AND CONSTRUCTION REQUIREMENTS
RULE §131.143Construction Requirements for a New Facility

    (D) As a minimum requirement, all facilities shall provide at least one emergency treatment room to handle emergencies. The room(s) and facilities shall meet the following requirements.

      (i) The emergency treatment room for a single patient shall have a minimum clear area of 120 square feet clear floor area exclusive of fixed and movable cabinets and shelves. The minimum clear room dimension exclusive of fixed cabinets and built-in shelves shall be 10 feet. The emergency treatment room shall contain cabinets, work counter, examination light, and a hand washing fixture with hands-free operable controls.

      (ii) When a multiple-bed emergency treatment room is provided, the clearance between the side of a bed/gurney and a wall/partition shall be a minimum of four feet. The clearance between the sides of beds/gurneys shall be a minimum of six feet. The minimum distance at the foot of the bed/gurney shall not be less than seven feet for single load area/room or ten feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds/gurneys. The multiple-bed emergency treatment room shall contain cabinets, medication storage, work counter, examination light, and a hand washing fixture with hands-free operable controls. The fixed and movable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. The requirements of this clause are illustrated in Table (5), Diagram (A) of §131.148(e) of this title (relating to Tables).

      (iii) One hand washing fixture with hands-free operable controls shall be provided for each bed/gurney location. One hand washing fixture may serve two beds/gurneys if distributed appropriately between the two.

      (iv) Storage space shall be provided within the room or suite and be under staff control for general medical-surgical emergency supplies and medications. Adequate space shall be provided for emergency equipment such as emergency treatment trays, ventilator, defibrillator, splints, cardiac monitor, etc.

    (E) As a minimum requirement, all facilities shall provide at least one exam room. The room(s) and facilities shall meet the following requirements.

      (i) The exam room for a single patient shall have a minimum clear area of 100 square feet clear floor area exclusive of fixed and movable cabinets and shelves. The minimum clear room dimension exclusive of fixed cabinets and built-in shelves shall be 9 feet. The examination room shall contain cabinets, work counter, examination light, and a hand washing fixture with hands-free operable controls.

      (ii) When a multiple-bed exam room is provided, the clearance between the side of the bed/gurney and a wall/partition shall be a minimum of 3 feet. The clearance between sides of the beds/gurneys shall be a minimum of 6 feet. The minimum distance at the foot of the bed/gurney shall not be less than seven feet for single load area/room or 10 feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between 2 beds/gurneys. The multiple-bed examination room shall contain cabinets, work counters, and a hand washing fixture with hands-free operable controls. The fixed and moveable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. The requirements of this clause are illustrated in Table 5, Diagram (B) of §131.148(e) of this title. Provisions shall be made for visual privacy between multiple stations.

      (iii) One hand washing fixture shall be provided for every four beds/gurneys or fraction thereof. Fixtures shall be uniformly distributed and not located within the exam area behind the curtains.

    (F) Storage space shall be provided within the emergency suite and be under staff control for general medical emergency supplies and medications. Adequate space shall be provided for emergency equipment such as emergency treatment trays, ventilator, defibrillator, splints, cardiac monitor, etc.

    (G) A medical staff work area and charting area(s) shall be provided. The area may be combined with the control station/nurse station.

    (H) An area or alcove located out of traffic and convenient to the treatment and exam room(s) shall be provided for an emergency crash cart.

    (I) An alcove shall be provided for stretcher and wheelchair storage. The storage shall be located out of the line of traffic.

    (J) A nourishment station shall be provided containing a work counter with sink, microwave, refrigerator and storage cabinets and not located in the clean workroom.

    (K) When provided, an ice machine supplying ice for therapeutic purposes shall be located in the clean utility room. A self-dispensing ice machine shall be provided for ice for human consumption and located in a clean utility room or the nurse station.

    (L) Patient toilet room(s) shall be provided and shall be convenient to treatment rooms, examination rooms, and trauma rooms a hand washing fixture with hands-free operable controls. Patient toilet room shall be at a ratio of 1 toilet room for every 5 treatment, exam, trauma stations or fraction thereof.

    (M) A clean storage room shall be provided for clean supplies and linens as needed. A hand washing fixture shall be provided within the room with hands-free operable controls.

    (N) Soiled workroom shall be provided and contain a work counter, a clinical sink or equivalent flushing type fixture, hand washing fixture with hands-free operable controls, waste receptacles, and soiled linen receptacles.

    (O) A housekeeping room containing a floor receptor or service sink and storage space for housekeeping supplies and equipment shall be provided for the exclusive use of the emergency suite and shall be directly accessible from the emergency suite. When automatic film processors are used, a receptacle of adequate size with hot and cold water for cleaning the processor racks shall be provided. When there is only one housekeeping room for the entire facility there shall be policies and procedures in place, as describe in §131.55 of this title (relating to Sanitary Conditions and Hygienic Practices) for proper use of cleaning up body fluids versus general cleaning, and the use of separate equipment and supplies.

    (P) Staff toilets may be outside the suite but shall be convenient for staff use and include hand washing fixtures with hands-free operable controls. When a department has 4 or more treatment or examination rooms, toilet facilities shall be in the suite.

  (4) Trauma Treatment rooms. When provided, a trauma room it shall comply with the following.

    (A) A trauma room shall be 250 square feet of clear floor area exclusive of aisles and fixed and moveable cabinets and shelves. The minimum clear dimension between fixed cabinets and built-in shelves shall be 12 feet. The trauma room shall contain a work counter, cabinets, and examination light.

    (B) When multiple-patient trauma stations are provided, the clearance between the head of the bed/gurney to the wall/partition shall be a minimum of 3 feet. The clearance between the side of a bed/gurney and a wall/partition shall be a minimum of 6 feet. The clearance between the sides of beds/gurneys shall be a minimum of 12 feet. The minimum distance at the foot of the bed/gurney shall not be less than 7 feet for single load area/room or 10 feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between 2 beds/gurneys. The multiple-bed trauma room shall contain cabinets, medication storage, work counter, examination light, and scrub sink with hands-free operable controls. The fixed and moveable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. The requirements of this subparagraph are illustrated in Table 5, Diagram (C) of §131.148(e) of this title. Provisions shall be made for visual privacy between multiple stations.

    (C) A scrub station shall be located within five feet of the either inside or outside entrance to each trauma room. One scrub station may serve two trauma beds/gurneys. Scrub facilities shall be arranged to minimize any incidental splatter on nearby personnel or supply carts. The scrub sinks shall be recessed out of the main line of traffic.

    (D) All doorway openings from the ambulance entrance to the trauma room shall be a minimum of five feet wide.

  (5) Holding or observation room/area.

    (A) When a holding or observation room/area is provided within or adjacent to the emergency suite, it shall comply with the following.

    (B) A single holding/observation room shall have a minimum clear area of 100 square feet exclusive of fixed and movable cabinets and shelves. The holding/observation room shall contain a work counter and hand washing fixture with hands-free operable controls.

      (i) The single holding/observation room shall be near the nurse station and near a patient toilet room which contains a hand washing fixture with hands-free operable controls.

      (ii) In a multiple-bed holding/observation room/area, the clearance between the side of the bed/gurney and a wall/partition shall be a minimum of 3 feet. The clearance between sides of the beds/gurneys shall be a minimum of 6 feet. The minimum distance at the foot of the bed/gurney shall not be less than 7 feet for single load area/room or 10 feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between 2 beds/gurneys. The multiple-bed holding/observation room/area shall contain cabinets, work counters, and a hand washing fixture with hands-free operable controls. One hand washing fixture shall be provided for every 4 holding/observation beds or fraction thereof. Fixtures shall be uniformly distributed. The fixed and moveable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. The requirements of this clause are illustrated in Table 5, Diagram (B) of §131.148(e) of this title.

      (iii) In a multiple-bed holding/observation room/area, a patient toilet room with a hand washing fixture with hands-free operable controls shall be provided within the room or area.

    (C) When a multiple-bed gurney holding or observation room is not within or adjacent to the emergency suite, the following additional spaces shall be provided:

      (i) A stretcher and wheelchair storage alcove/room shall be provided. The alcove/room for stretcher and wheelchair storage shall be located out of the line of traffic.

      (ii) A clean storage room shall be provided within or adjacent to the holding or observation room. The clean storage room shall be provided for clean supplies and linen as needed. A hand washing fixture shall be provided with hands-free operable controls.

      (iii) Soiled workroom. A soiled workroom shall be provided within or adjacent to the holding or observation room. The workroom shall contain a work counter, a clinical sink or equivalent flushing type fixture, hand washing fixture with hands-free operable controls, waste receptacles, and soiled linen receptacles. The soiled workroom required in support of a treatment/exam room may be combined with the holding or observation room/area if confidently located between the 2 areas.

  (6) Medication work room or alcove. A medication work room or alcove shall be provided and located separate from patient and public areas and under the direct supervision of staff. A work counter, refrigerator, medication storage, and locked storage for biologicals and drugs shall be provided. A hand washing fixture with hands-free operable controls shall be located in the medication work room or alcove. Water spouts used at lavatories and sinks shall have clearances adequate to avoid contaminating utensils and the contents of carafes, etc.

    (A) Functional space shall be provided and areas required for records, reports, and accounting activities.

    (B) Space for the poison control center shall be provided with storage facilities for reaction data and drug information centers.

  (7) Diagnostic radiographic (X-ray). A diagnostic radiographic (X-ray) room shall be provided and be readily available to the emergency suite. The diagnostic radiographic (X-ray) room size shall be in compliance with the manufacturer's recommendations. Clearance and unobstructed space shall not be less than three feet around the diagnostic equipment. Dressing room(s) shall be provided and located near the X-ray room.

  (8) Computed tomography (CT) scanning. A CT room shall be provided and be readily available to the emergency suite. Clearance and unobstructed space shall not be less than three feet on each side of the diagnostic equipment. The CT room(s) size shall be in compliance with the manufacturer's recommendations and shall contain the following.

    (A) A control room shall be provided with a view window permitting view of the patient. The control room shall be located to allow convenient film processing.

    (B) A patient toilet room shall be provided conveniently to the procedure room. When directly accessible to the scan room, the toilet room shall be arranged so that a patient may leave the toilet room without having to reenter the scan room. The toilet room shall have a hand washing fixture with hands-free operable controls.

  (9) Laboratory services. Laboratory suite shall be provided with the following minimum facilities.

    (A) The laboratory work room(s) shall include counter(s), space appropriately designed for laboratory equipment, and sink(s) with hands-free operable controls.

    (B) Each laboratory room or work area shall be provided with a hand washing fixture(s) with hands-free operable controls.

Cont'd...

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