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S.B. 115 Enrolled

                 

TRAUMA SYSTEM AMENDMENTS

                 
2000 GENERAL SESSION

                 
STATE OF UTAH

                 
Sponsor: Robert F. Montgomery

                  AN ACT RELATING TO HEALTH; DEFINING TERMS; ESTABLISHING A STATEWIDE
                  TRAUMA SYSTEM; CREATING THE TRAUMA SYSTEM ADVISORY COMMITTEE;
                  ESTABLISHING THE DUTIES OF THE DEPARTMENT AND EXTENDING RULEMAKING
                  AUTHORITY; ESTABLISHING A STATEWIDE TRAUMA REGISTRY; REQUIRING THE
                  SUBMISSION OF DATA TO THE REGISTRY; REQUIRING THE DEPARTMENT TO
                  PROVIDE TECHNICAL AND, IN SOME INSTANCES, FINANCIAL ASSISTANCE TO
                  MANDATORY REPORTERS; IMPOSING CONFIDENTIALITY REQUIREMENTS AND
                  EXTENDING IMMUNITY FOR REPORTING; PROVIDING FOR THE ESTABLISHMENT
                  OF TRAUMA CENTER DESIGNATIONS AND PERMITTING HOSPITALS TO
                  VOLUNTARILY APPLY FOR SUCH DESIGNATIONS; REQUIRING THE DEPARTMENT
                  TO STUDY THE EFFECTIVENESS OF THE STATEWIDE TRAUMA SYSTEM; MAKING
                  CONFORMING AMENDMENTS; AND PROVIDING AN EFFECTIVE DATE.
                  This act affects sections of Utah Code Annotated 1953 as follows:
                  AMENDS:
                      26-8a-102, as enacted by Chapter 141, Laws of Utah 1999
                      26-8a-203, as enacted by Chapter 141, Laws of Utah 1999
                  ENACTS:
                      26-8a-250, Utah Code Annotated 1953
                      26-8a-251, Utah Code Annotated 1953
                      26-8a-252, Utah Code Annotated 1953
                      26-8a-253, Utah Code Annotated 1953
                      26-8a-254, Utah Code Annotated 1953
                  Be it enacted by the Legislature of the state of Utah:
                      Section 1. Section 26-8a-102 is amended to read:
                       26-8a-102. Definitions.

                      As used in this chapter:
                      (1) "Ambulance" means a ground, air, or water vehicle that:
                      (a) transports patients and is used to provide emergency medical services; and
                      (b) is required to obtain a permit under Section 26-8a-304 to operate in the state.
                      (2) "Ambulance provider" means an emergency medical service provider that:
                      (a) transports and provides emergency medical care to patients; and
                      (b) is required to obtain a license under Part 4, Ambulance and Paramedic Providers.
                      (3) "Committee" means the State Emergency Medical Services Committee created by Section
                  26-1-7 .
                      [(4) (a) "Critical care categorization guidelines" means a stratified profile of hospital critical
                  care services related to emergency patient condition which aids a physician in selecting the most
                  appropriate facility for critical patient referral.]
                      [(b) Guideline categories include trauma, spinal cord, burns, high risk infant, pediatrics,
                  poisons, cardiac, respiratory, and psychiatric.]
                      [(5)] (4) "Direct medical observation" means in-person observation of a patient by a
                  physician, registered nurse, physician's assistant, or individual certified under Section 26-8a-302 .
                      [(6)] (5) "Emergency medical condition" means:
                      (a) a medical condition that manifests itself by symptoms of sufficient severity, including
                  severe pain, that a prudent layperson, who possesses an average knowledge of health and medicine,
                  could reasonably expect the absence of immediate medical attention to result in:
                      (i) placing the individual's health in serious jeopardy;
                      (ii) serious impairment to bodily functions; or
                      (iii) serious dysfunction of any bodily organ or part; or
                      (b) a medical condition that in the opinion of a physician or his designee requires direct
                  medical observation during transport or may require the intervention of an individual certified under
                  Section 26-8a-302 during transport.
                      [(7)] (6) "Emergency medical service personnel":
                      (a) means an individual who provides emergency medical services to a patient and is required

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                  to be certified under Section 26-8a-302 ; and
                      (b) includes a paramedic, medical director of a licensed emergency medical service provider,
                  emergency medical service instructor, and other categories established by the committee.
                      [(8)] (7) "Emergency medical service providers" means:
                      (a) licensed ambulance providers and paramedic providers;
                      (b) a facility or provider that is required to be designated under Section 26-8a-303 ; and
                      (c) emergency medical service personnel.
                      [(9)] (8) "Emergency medical services" means medical services, transportation services, or
                  both rendered to a patient.
                      [(10)] (9) "Emergency medical service vehicle" means a land, air, or water vehicle that is:
                      (a) maintained and used for the transportation of emergency medical personnel, equipment,
                  and supplies to the scene of a medical emergency; and
                      (b) required to be permitted under Section 26-8a-304 .
                      [(11)] (10) "Interested party" means:
                      (a) a licensed or designated emergency medical services provider that provides emergency
                  medical services within or in an area that abuts an exclusive geographic service area that is the subject
                  of an application submitted pursuant to Part 4, Ambulance and Paramedic Providers;
                      (b) any municipality, county, or fire district that lies within or abuts a geographic service area
                  that is the subject of an application submitted pursuant to Part 4, Ambulance and Paramedic
                  Providers; or
                      (c) the department when acting in the interest of the public.
                      [(12)] (11) "Medical control" means a person who provides medical supervision to an
                  emergency medical service provider.
                      [(13)] (12) "Paramedic provider" means an entity that:
                      (a) employs emergency medical service personnel; and
                      (b) is required to obtain a license under Part 4, Ambulance and Paramedic Providers.
                      [(14)] (13) "Patient" means an individual who, as the result of illness or injury, meets any of
                  the criteria in Section 26-8a-305 .

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                      (14) "Trauma" means an injury requiring immediate medical or surgical intervention.
                      (15) "Trauma system" means a single, statewide system that:
                      (a) organizes and coordinates the delivery of trauma care within defined geographic areas
                  from the time of injury through transport and rehabilitative care; and
                      (b) is inclusive of all prehospital providers, hospitals, and rehabilitative facilities in delivering
                  care for trauma patients, regardless of severity.
                      (16) "Triage" means the sorting of patients in terms of disposition, destination, or priority.
                  For prehospital trauma victims, triage requires a determination of injury severity to assess the
                  appropriate level of care according to established patient care protocols.
                      (17) "Triage, treatment, transportation, and transfer guidelines" means written procedures
                  that:
                      (a) direct the care of patients; and
                      (b) are adopted by the medical staff of an emergency patient receiving facility, trauma center,
                  or an emergency medical service provider.
                      Section 2. Section 26-8a-203 is amended to read:
                       26-8a-203. Data collection.
                      (1) The committee shall[: (a) approve or disapprove the state emergency medical service
                  plan prepared by the department pursuant to Subsection (2)(b) and make recommendations
                  concerning the emergency medical service plan prepared pursuant to P. L. 93-641, as amended; (b)
                  approve critical care categorization guidelines and treatment protocols developed by the department
                  pursuant to Subsections (2)(c) and (d); (c) categorize all hospital critical care facilities and designate
                  trauma, burn, spinal cord, and poison care facilities in the state consistent with guidelines approved
                  under Subsection (1)(b); and (d)]specify the information that must be collected for the emergency
                  medical services data system established pursuant to Subsection (2)[(a)].
                      (2) The department shall[: (a)] establish an emergency medical services data system which
                  shall provide for the collection of information, as defined by the committee, relating to the treatment
                  and care of patients who use or have used the emergency medical services system[;].
                      [(b) prepare a state plan for the coordinated delivery of emergency medical services which

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                  shall be updated at least every three years and shall reflect recommendations of local government
                  emergency medical services councils;]
                      [(c) develop hospital critical care categorization guidelines, in consultation with the state
                  medical association and state hospital association, which may not require the transfer of any patient
                  contrary to the wishes of the patient, his next of kin, or his attending physician; and]
                      [(d) develop treatment protocols for the critical care guideline categories described in
                  Subsection 26-8a-102 (4)(b).]
                      (3) Persons providing emergency medical services shall provide information to the
                  department for the emergency medical services data system established pursuant to Subsection
                  (2)[(a)].
                      Section 3. Section 26-8a-250 is enacted to read:
                 
Part 2a. Statewide Trauma System

                      26-8a-250. Establishment of statewide trauma system.
                      The department shall establish and actively supervise a statewide trauma system to:
                      (1) promote optimal care for trauma patients;
                      (2) alleviate unnecessary death and disability from trauma and emergency illness;
                      (3) inform health care providers about trauma system capabilities;
                      (4) encourage the efficient and effective continuum of patient care, including prevention,
                  prehospital care, hospital care, and rehabilitative care; and
                      (5) minimize the overall cost of trauma care.
                      Section 4. Section 26-8a-251 is enacted to read:
                      26-8a-251. Trauma system advisory committee.
                      (1) There is created within the department the trauma system advisory committee.
                      (2) (a) The committee shall be comprised of individuals knowledgeable in adult or pediatric
                  trauma care, including physicians, nurses, hospital administrators, emergency medical services
                  personnel, government officials, consumers, and persons affiliated with professional health care
                  associations.
                      (b) Representation on the committee shall be broad and balanced among the health care

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                  delivery systems in the state with no more than three representatives coming from any single delivery
                  system.
                      (3) The committee shall:
                      (a) advise the department regarding trauma system needs throughout the state;
                      (b) assist the department in evaluating the quality and outcomes of the overall trauma system;
                      (c) review and comment on proposals and rules governing the statewide trauma system; and
                      (d) make recommendations for the development of statewide triage, treatment,
                  transportation, and transfer guidelines.
                      (4) The department shall:
                      (a) determine, by rule, the term and causes for removal of committee members;
                      (b) establish committee procedures and administration policies consistent with this chapter
                  and department rule; and
                      (c) provide administrative support to the committee.
                      Section 5. Section 26-8a-252 is enacted to read:
                      26-8a-252. Department duties.
                      In connection with the statewide trauma system established in Section 26-8a-250 , the
                  department shall:
                      (1) establish a statewide trauma system plan that:
                      (a) identifies statewide trauma care needs, objectives, and priorities;
                      (b) identifies the equipment, facilities, personnel training, and other things necessary to create
                  and maintain a statewide trauma system; and
                      (c) organizes and coordinates trauma care within defined geographic areas;
                      (2) support the statewide trauma system by:
                      (a) facilitating the coordination of prehospital, acute care, and rehabilitation services and
                  providers through state regulation and oversight;
                      (b) facilitating the ongoing evaluation and refinement of the statewide trauma system;
                      (c) providing educational programs;
                      (d) encouraging cooperation between community organizations, health care facilities, public

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                  health officials, emergency medical service providers, and rehabilitation facilities for the development
                  of a statewide trauma system;
                      (e) implementing a quality assurance program using information from the statewide trauma
                  registry established pursuant to Section 26-8a-253 ;
                      (f) establishing trauma center designation requirements in accordance with Section
                  26-8a-254 ; and
                      (g) developing standards so that:
                      (i) trauma centers are categorized according to their capability to provide care;
                      (ii) trauma victims are triaged at the initial point of patient contact; and
                      (iii) trauma patients are sent to appropriate health care facilities.
                      Section 6. Section 26-8a-253 is enacted to read:
                      26-8a-253. Statewide trauma registry and quality assurance program.
                      (1) The department shall:
                      (a) establish and fund a statewide trauma registry to collect and analyze information on the
                  incidence, severity, causes, and outcomes of trauma;
                      (b) establish, by rule, the data elements, the medical care providers that must report, and the
                  time frame and format for reporting;
                      (c) use the data collected to:
                      (i) improve the availability and delivery of prehospital and hospital trauma care;
                      (ii) assess trauma care delivery, patient care outcomes, and compliance with the requirements
                  of this chapter and applicable department rules; and
                      (iii) regularly produce and disseminate reports to data providers, state government, and the
                  public; and
                      (d) support data collection and abstraction by providing:
                      (i) a data collection system and technical assistance to each hospital that submits data; and
                      (ii) funding or, at the discretion of the department, personnel for collection and abstraction
                  for each hospital not designated as a Level I or II trauma center under the standards established
                  pursuant to Section 26-8a-254 .

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                      (2) (a) Except as provided in Subsection (2)(b), each hospital shall submit trauma data in
                  accordance with rules established under Subsection (1) until July 1, 2003.
                      (b) A hospital designated as a trauma center shall continue to submit data beyond July 1,
                  2003, as part of the ongoing quality assurance program established in Section 26-8a-252 .
                      (3) Before July 1, 2003, the department shall assess:
                      (a) the effectiveness of the data collected pursuant to Subsection (1); and
                      (b) the impact of the statewide trauma system on the provision of trauma care.
                      (4) Data collected under this section shall be subject to Title 26, Chapter 3, Health Statistics.
                      (5) No person may be held civilly liable for having provided data to the department in
                  accordance with this section.
                      Section 7. Section 26-8a-254 is enacted to read:
                      26-8a-254. Trauma center designations and guidelines.
                      (1) The department, after seeking the advice of the trauma system advisory committee, shall
                  establish by rule:
                      (a) trauma center designation requirements; and
                      (b) model state guidelines for triage, treatment, transportation, and transfer of trauma patients
                  to the most appropriate health care facility.
                      (2) The department shall designate as a trauma center each hospital that:
                      (a) voluntarily requests a trauma center designation; and
                      (b) meets the applicable requirements established pursuant to Subsection (1).
                      Section 8. Effective date.
                      This act takes effect on July 1, 2000.

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