Summary of, and comparison with, existing or proposed federal regulations
There appears to be no existing or proposed federal regulations that address the activities to be regulated by the proposed rules.
Comparison with rules in adjacent states
Adjacent states generally have a similar hospital classification process to Wisconsin. Most states require Level I and II trauma care facilities to be verified by the ACS and allow Level III and IV trauma care facilities to be verified by the ACS or by the appropriate department in each state.
Illinois:
Illinois statute confers on the Illinois Department of Public Health the authority and responsibility to designate applicant hospitals as Level I or Level II trauma centers. 210 ILCS 50/3.90(b)(4). The Illinois Department of Health must attempt to designate trauma centers in all areas of the state and ensure that at least one Level I trauma center serves each Emergency Medical Services region, unless waived by the Department. 515 Ill. Adm. Code 2000(a).
Illinois statute also confers on the Illinois Department of Health the authority and responsibility to establish the minimum standards for designation as a Level I or Level II trauma center. 210 ILCS 50/3.90(b)(1). The designation criteria for Level I and II trauma centers are specified in 515 Ill. Adm. Code 2030 and 515 Ill. Adm. Code 2040 respectively.
Iowa:
Iowa statute confers on the Iowa Department of Public Health the responsibility to adopt rules which specify hospital and emergency care facility verification criteria as well as the verification process. Iowa Code § 147A.23(2)b. Level I and II trauma care facilities must be verified by the ACS Committee on Trauma. 641 IAC 134.2(6)(a). Level III and IV trauma care facilities must be verified by the Iowa Department of Public Health in consultation with the trauma survey team. 641 IAC 134.2(6)(d). Iowa’s level III and IV verification are the criteria from the Resources for the Optimal Care of the Injured Patient 2014, adopted by reference into Iowa Administrative Code. 641 IAC 134.2(3).
Michigan:
Michigan Public Health Code 333.20910(1) confers on the Department of Health and Human Services the responsibility to develop, implement and promulgate rules for the implementation and operation of a statewide trauma care system and to develop a statewide process for verification and designation of trauma facilities. Health care facilities seeking designation as a Level I or II trauma care facility must be verified by the ACS Committee on Trauma and comply with the additional requirements specified by the Michigan Department of Health and Human Services regarding data submission requirements, participation in regional injury prevention plans and regional performance improvement processes and providing assistance to the Department of Health and Human Services in the designation and verification process of other facilities. Mich. Admin. Code R 325.130(6).
Health care facilities seeking designation as a Level III trauma care facility may either be verified by the ACS Committee on Trauma or by the Department of Health and Human Services. Mich Admin. Code R 325.130(7). All Level III facilities, regardless of verification method, must comply with additional data submission requirements and participate in regional injury prevention plans and performance improvement processes. Health care facilities seeking designation as a Level IV trauma care facility must be verified by the Department of Health and Human Services. Mich. Admin. Code R 325.130(8). These facilities must comply with additional data submission requirements and participate in regional injury prevention plans and performance improvement processes. Mich. Admin. Code R 325.130(8).
Minnesota:
Minnesota Statue 144.603(1) (2017) confers on the Commissioner of the Department of Health the responsibility to adopt criteria to ensure that severely injured people are promptly transported and treated at trauma hospitals appropriate to the severity of injury. These criteria must be based on Minnesota’s comprehensive statewide trauma system plan with the advice of the Trauma Advisory Council and using accepted standards from the ACS, the American College of Emergency Physicians, the Minnesota Emergency Medical Services Regulatory Board, the national Trauma Center Association of America and other trauma experts. Minn. Stat. 144.603(2) (2017).
Facilities seeking designation as a Level I or II trauma care facility must be verified by the ACS. Minn. Stat. 144.605(3) (2017). Facilities seeking designation as a Level III trauma care facility may either be verified by the ACS or by the Department of Health using the criteria adopted by the Commissioner. Minn. Stat. 144.605(4) (2017). Facilities seeking designation as a Level IV trauma care facility must be verified by the Department of Health using the criteria adopted by the Commissioner. Minn. Stat. 144.605(4) (2017).
Summary of factual data and analytical methodologies
The department relied on the following sources to draft the proposed rule:
A.
Resources for the Optimal Care of the Injured Patient: 1999, Committee on Trauma, American College of Surgeons (1998). This publication is on file in the Department’s Division of Public Health.B.
Resources for the Optimal Care of the Injured Patient: 2006, Committee on Trauma, American College of Surgeons (2006). This publication is on file in the Department’s Division of Public Health.D.
Data collected from a voluntary statewide survey completed by Level III and IV trauma care facilities concerning the impact of the new criteria in the 2014 edition of the ACS’ Resources for the Optimal Care of the Injured Patient. This 12 question survey was conducted by the Office of Preparedness and Emergency Health Care, Division of Public Health, Department of Health Services. This survey was conducted through Survey Monkey and was distributed via email on October 11, 2016 to the trauma coordinators of the Level III and IV trauma care facilities in the state. The trauma care facilities were given until October 18, 2016 to answer the survey and 76 out of 99 Level III and IV trauma care facilities completed the survey.E.
The department formed an Advisory Committee consisting of urban and rural representatives from the Wisconsin Hospital Association, trauma coordinators from Level III and IV trauma care facilities, trauma care nurses and doctors from the Statewide Trauma Advisory Council and Classification Review Committee and hospital administrators. The committee members reviewed the initial draft language and their input guided the development of the proposed rule text.
Analysis and supporting documents used to determine effect on small business
See economic impact analysis.
Effect on small business
See economic impact analysis.
Agency contact person
Susan Uttech
State Public Health Accreditation Director
1 W. Wilson St.
Madison, WI 53701
608 267-3561
Statement on quality of agency data
The data sources referenced and used to draft the rules and analyses are accurate, reliable, objective and are discussed in the “Summary of factual data and analytical methodologies.”
Place where comments are to be submitted and deadline for submission
RULE TEXT
SECTION 1. DHS 118.03 (2m) is created to read:
DHS 118.03 (2m) “APP” means advanced practice provider.
SECTION 2. DHS 118.03 (3m) is created to read:
DHS 118.03 (3m) “ATLS” means advanced trauma life support.
SECTION 3. DHS 118.03(6m) is created to read:
DHS 118.03(6m) “CT” means computed tomography.
SECTION 4. DHS 118.03(10m) is created to read:
DHS 118.03(10m) “EMS” means emergency medical services.
SECTION 5. DHS 118.03 (17m) is created to read:
DHS 118.03 (17m) “ICU” means intensive care unit.
SECTION 6. DHS 118.03(24m) is created to read:
DHS 118.03(24m) “MRI” means magnetic resonance imaging.
SECTION 7. DHS 118.03 (32) is amended to read:
DHS 118.03 (32) “Pediatric trauma center” means a freestanding or separate administrative unit in a hospital that is dedicated to providing for addressing the trauma needs of a pediatric patient population and meets the resource requirements outlined by the ACS in Chapter 10 of the publication Resources for the Optimal Care of the Injured Patient: 1999 for verification as a pediatric trauma center. The trauma center may be freestanding or a separate administrative unit in a larger hospital. SECTION 8. DHS 118.03 (32) (note) is repealed.
SECTION 9. DHS 118.03 (34m) is created to read:
