22 CCR 100160.01

California

Requirements for all PedRCs.

22 CCR 100160.01

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22 CCR 100160.01

§ 100160.01. Requirements for all PedRCs. All PedRC general acute care hospitals (GACHs) designated under this article shall meet the following requirements:

(a)

Capabilities. Have, at a minimum, the following capabilities:

(1)

Consultant Availability. Personnel available twenty-four (24) hours a day, seven (7) days a week, 365 days a year to provide consultation to the emergency department through live interactive telehealth or other means, as determined by the local EMS agency (LEMSA).

(A)

PedRCs shall have a process for obtaining and providing consultation via phone or telehealth when needed and when IFT is not warranted or possible.

(B)

Personnel available for consultation shall include, but are not limited to, the following:

(i)

A qualified pediatric specialist;

(ii)

A qualified pediatric critical care physician;

(iii)

Respiratory care specialists who respond to the emergency department and have verified their competency to support oxygenation and ventilation of pediatric patients to the Director of Respiratory Services. Verification of competency may include, but is not limited to current completion of any of the following:

(I)

Current completion of a nationally recognized Pediatric Advanced Life Support Course approved by the LEMSA; or

(II)

The American Academy of Pediatrics and American College of Emergency Physicians-sponsored Advanced Pediatric Life Support Course; or

(III)

Continuing education courses specific to resuscitation of pediatric patients.

(2)

Clinical Services. Support services, including respiratory care, laboratory, radiology, and pharmacy that include appropriate staff and equipment for pediatric patient care.

(3)

Equipment, Supplies, and Medications. Pediatric equipment, supplies, and medications appropriate for patients ranging from neonates to adolescents, including, but not limited to:

(A)

A length-based resuscitation tape, medical software, or other system available to ensure proper sizing of resuscitation equipment and proper dosing of medication;

(B)

Portable resuscitation supplies, such as a crash cart or bag, with a method of verification of contents on a regular basis;

(C)

Equipment for patient and fluid warming, patient restraint, weight scale (in kilograms) and pain scale tools for all ages of pediatric patients;

(D)

Monitoring equipment appropriate for pediatric patients including, but not limited to, blood pressure cuffs, doppler device, electrocardiogram monitor/defibrillator, hypothermia thermometer, pulse oximeter, and end tidal carbon dioxide monitor;

(E)

Respiratory equipment and supplies appropriate for pediatric patients including, but not limited to, clear oxygen masks, bagmask devices, intubation equipment, supraglottic airways, oral and nasal airways, nasogastric tubes, and suction equipment;

(F)

Vascular access supplies and equipment for pediatric patients including, but not limited to, intravenous catheters, intraosseous needles, infusion devices, and Intravenous solutions;

(G)

Fracture management devices for pediatric patients including extremity splints and spinal motion restriction devices;

(H)

Medications for the care of pediatric patients requiring resuscitation;

(I)

Specialized pediatric trays or kits including, but not limited to:

(i)

Lumbar puncture tray;

(ii)

Difficult airway kit with devices to assist intubation and ventilation;

(iii)

Tube thoracostomy tray including chest tubes in sizes for pediatric patients.

(J)

Newborn delivery kits including, but not be limited to:

(i)

Towel;

(ii)

Clamps and scissors for cutting the umbilical cord;

(iii)

Bulb suction;

(iv)

Warming pad;

(v)

Neonatal bag-mask ventilation device with appropriate sized masks;

(vi)

Urinary catheter for neonates.

(4)

Rapid Transfer Ability. The ability to rapidly transfer pediatric patients to a higher level of care PedRC when clinically appropriate. This capability shall include written transfer protocols or arrangements with one or more higher level of care PedRC and prearranged agreements with EMS providers, in compliance with all LEMSA policies and procedures, as well as service provider contracts and designations.

(b)

Program Staffing. Meet the following program staffing requirements:

(1)

PECC Requirement. All PedRCs shall have one or more PECC who is either assigned to the emergency department or has emergency care responsibilities. PECCs shall meet the relevant qualifications set forth in paragraph (2) of this section and shall be designated as follows:

(A)

Basic PedRCs. Basic PedRCs may have one or more PECC who shall be a nurse, nurse practitioner, PA, or a physician.

(B)

Higher Level PedRCs. General, Advanced, or Comprehensive PedRCs shall have two PECCs. One PECC shall be a physician and the other shall be a physician or a nurse, nurse practitioner, or a Physician Assistant (PA).

(2)

PECC Qualifications.

(A)

Nurse, Nurse Practitioner, Physician Assistant PECC. Nurse, nurse practitioner, and physician assistant PECCs shall be licensed in California and meet, at a minimum, all the following requirements:

(i)

Have at least two (2) years of pediatric emergency care experience within the previous five (5) years;

(ii)

Demonstrated competency in resuscitation of pediatric patients of all ages, from neonates to adolescents, through a nationally recognized Pediatric Advanced Life Support or American College of Emergency Physicians-sponsored Advanced Pediatric Life Support course;

(iii)

Every two (2) years, completion of a minimum of ten (10) continuing education contact hours in pediatric emergency care.

(B)

Physician PECC. Physician PECCs shall be licensed in California and meet, at a minimum, all the following requirements:

(i)

Have competency in resuscitation of pediatric patients;

(ii)

Be either:

(I)

A board-certified emergency medicine physician; or

(II)

A qualified specialist in pediatrics or family medicine, with certification from a nationally recognized Pediatric Advanced Life Support course, such as an American College of Emergency Physicians-sponsored Advanced Pediatric Life Support course.

(3)

PECC Responsibilities. PECCs are responsible for all the following:

(A)

Ensuring family-centered care practices are in place;

(B)

Acting as the liaison with:

(i)

Appropriate GACH-based pediatric care committees;

(ii)

Other PedRCs, the LEMSA, base hospitals, EMS providers, and GACHs in geographic proximity, as appropriate, to maximize the availability and quality of pediatric care.

(C)

Facilitating pediatric emergency care continuing education and competency evaluations in pediatric care for emergency department staff;

(D)

Coordinating pediatric disaster preparedness;

(E)

Providing oversight for the pediatric components of the emergency department QI program.

(c)

System Participation and Coordination.

(1)

Policy Development Participation. Collaborate with the LEMSA and EMS providers, in the LEMSA's development of relevant policies and procedures to expedite and optimize the IFTs of pediatric patients from non-PedRC or lower-level PedRCs to higher level of care PedRCs, when medically appropriate.

(2)

IFT of Pediatric Patients. PedRCs shall adhere to the LEMSA's policy regarding the IFT of pediatric patients. In addition:

(A)

Pediatric IFT Requirements. PedRCs shall develop and implement IFT policies, protocols, and guidelines for the transfer of pediatric patients that shall include the following:

(i)

Identification of pediatric patients eligible for interfacility transfer;

(ii)

Process for selecting the appropriate partner PedRC(s);

(iii)

Clinical criteria for automatic acceptance of qualifying patients at the appropriate partner PedRC center;

(iv)

Specific processes for IFTs that ensure continuous twenty-four (24) hours per day, seven (7) days per week, 365 days a year access to partner PedRC physician(s) for timely notification and coordination of incoming IFT patient referrals;

(v)

Standardized communication language to be used between the referring GACH and the receiving partner PedRC to facilitate rapid transfer of the patient, including the minimum required patient information to be exchanged to facilitate rapid transfer;

(vi)

Guidance for selecting the appropriate transport service to match each patient's needs. Considerations shall include transport personnel scope of practice and the identification of patients for whom more rapid departure to the destination PedRC (such as via emergency ambulance through the 911 response system) outweighs the benefit of delaying transport to await providers with broader scope of practice, such as a critical care transport registered nurse;

(vii)

Process for the transfer of patient consent forms, emergency department medical record, initial electronic patient care record (ePCR) and personal belongings for the IFT patient;

(viii)

Process for providing information relating to the receiving PedRC, including location and/or directions, to the IFT patient's family, care givers, or legal guardian.

(B)

Pediatric IFT Agreements. To optimize patient safety and the potential for improved outcome, requirements set forth in subparagraph (A) of this section may be met by establishing IFT agreements in advance, supported by LEMSA policies. Agreements should address special considerations, including patient selection and destination for pediatric patients.

(d)

Continuing Education. Continuing education in pediatric care shall be provided for:

(1)

Organized medical staff;

(2)

Staff nurses;

(3)

Staff allied health personnel;

(4)

EMS personnel; and

(5)

Other community physicians and health care personnel.

(e)

Data Collection, QI, and Evaluation. All PedRCs are subject to the requirements of Article 6, of this subchapter.

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