WAC 246-976-390   Verification of trauma care services.  (1) The department will:

     (a) Publish procedures for verification. Verification will expire with the period of licensure. The application for verification will be incorporated in the application for licensure;

     (b) Verify prehospital trauma care services in the following categories:

     (i) Aid service: Basic, intermediate and advanced (paramedic) life support;

     (ii) Ground ambulance service: Basic, intermediate and advanced (paramedic) life support;

     (iii) Air ambulance service: After July 31, 2001, the department will consider that an air ambulance service has met the requirements of subsections (4), (6), and (9) of this section if it has been accredited by CAMTS or another accrediting organization approved by the department as having equivalent requirements as CAMTS for aeromedical transport;

     (c) Review the minimum response times for verified prehospital trauma services at least biennially, considering data available from the trauma registry and with the advice of the steering committee;

     (d) Forward applications for verification for aid and ground ambulance services to the appropriate regional council for review and comment;

     (e) Approve an applicant to provide verified prehospital trauma care, based on satisfactory evaluations as described in this section;

     (f) Notify the regional council and the MPD in writing of the name, location, and level of verified services;

     (g) Renew approval of a verified service upon reapplication, if the service continues to meet standards established in this chapter and verification remains consistent with the regional plan.

     (2) The department will identify minimum and maximum numbers of prehospital services, based on the approved regional and state plans. The department will:

     (a) Establish and review biennially the minimum and maximum number of prehospital services based upon distribution and level of service identified for each response area in the approved regional plan.

     (b) Evaluate an applicant for trauma verification based upon demonstrated ability of the provider to meet standards defined in this section 24-hours every day.

     (c) Verify the trauma capabilities of a licensed prehospital service if it determines that the applicant:

     (i) Proposes services that are identified in the regional plan for ground services, or the state plan for air ambulance services, in the proposed response areas.

     (ii) Agrees to operate under approved regional patient care procedures and prehospital patient care protocols.

     (3) Regional council responsibilities regarding verification are described in WAC 246-976-960.

     (4) To apply for verification, a licensed ambulance or aid service must submit application on forms provided by the department, including:

     (a) Documentation required for licensure specified by WAC 246-976-260(2);

     (b) A policy that a trauma training program is required for all personnel responding to trauma incidents. The program must meet learning objectives established by the department and be approved by the MPD;

     (c) Documentation that the provider has the ability twenty-four hours every day to deliver personnel and equipment required for verification to the scene of a trauma within the agency response times identified in this section; and

     (d) Documentation that the provider will participate in an approved regional quality assurance program.

     (5) Verified aid services must provide personnel on each trauma response including:

     (a) Basic life support: At least one individual, first responder or above;

     (b) Intermediate life support:

     (i) At least one ILS technician; or

     (ii) At least one IV/airway technician; or

     (iii) At least two individuals, one IV technician and one airway technician.

     (c) Advanced life support - Paramedic: At least one paramedic.

     (6) Verified ambulance services must provide personnel on each trauma response including:

     (a) Basic life support: At least two certified individuals -- one EMT plus one first responder;

     (b) Intermediate life support:

     (i) One ILS technician, plus one EMT; or

     (ii) One IV/airway technician, plus one EMT; or

     (iii) One IV technician and one airway technician;

     (c) Advanced life support - Paramedic: At least two certified individuals -- one paramedic and one EMT.

     (7) Verified BLS vehicles must carry equipment identified in WAC 246-976-300, Table C.

     (8) Verified ILS and paramedic vehicles must provide equipment identified in Table D, in addition to meeting the requirements of WAC 246-976-300:

TABLE D: EQUIPMENT FOR VERIFIED TRAUMA SERVICES (NOTE: "ASST" MEANS ASSORTMENTS)				AMBULANCE		AID VEHICLE
				PAR	ILS	PAR	ILS
AIRWAY MANAGEMENT
	Airway Adjuncts
		Adjunctive airways, per protocol		1	1	1	1
		Laryngoscope handle, spare batteries		1	1	1	1
			Adult blades, set	1	1	1	1
			Pediatric blades, straight (0, 1, 2)	1ea	1ea	1ea	1ea
			Pediatric blades, curved (2)	1ea	1ea	1ea	1ea
		McGill forceps, adult & pediatric		1	1	1	1
		ET tubes, adult (±1/2 mm)		1ea	1ea	1ea	1ea
		ET tubes, pediatric, with stylet
			Uncuffed (2.5 - 5.0 mm)	1ea	1ea	1ea	1ea
			Cuffed or uncuffed (6.0 mm)	1ea	1ea	1ea	1ea
	End-tidal CO2 detector			1ea	1ea	1ea	1ea
	Oxygen saturation monitor			1ea	1ea	1ea	1ea
	Suction
		Portable, powered		1	1	1	1
PATIENT ASSESSMENT AND CARE
		Sphygmomanometer
			Adult, large	1	1	1	1
			Pediatric	1	1	1	1
TRAUMA EMERGENCIES
	IV access
		Administration sets
			Adult	1	1	1	1
			Pediatric, w/volume control	4	4	2	2
		Catheters, intravenous (14-24 ga)		asst	asst	asst	asst
			Needles
			Hypodermic	asst	asst	asst	asst
			Intraosseous, per protocol	2	2	1	1
		Sharps container		1	1	1	1
		Syringes		asst	asst	asst	asst
		Glucose measuring supplies		Yes	Yes	Yes	Yes
		Pressure infusion device		1	1	1	1
		Medications according to local patient care protocols

     (9) Verified air ambulance services must meet equipment requirements described in WAC 246-976-320.

     (10) Verified aid services must meet the following minimum agency response times for all major trauma responses to response areas as defined by the department and identified in the regional plan:

     (a) To urban response areas: Eight minutes or less, eighty percent of the time;

     (b) To suburban response areas: Fifteen minutes or less, eighty percent of the time;

     (c) To rural response areas: Forty-five minutes or less, eighty percent of the time;

     (d) To wilderness response areas: As soon as possible.

     (11) Verified ground ambulance services must meet the following minimum agency response times for all major trauma responses to response areas as defined by the department and identified in the regional plan:

     (a) To urban response areas: Ten minutes or less, eighty percent of the time;

     (b) To suburban response areas: Twenty minutes or less, eighty percent of the time;

     (c) To rural response areas: Forty-five minutes or less, eighty percent of the time;

     (d) To wilderness response areas: As soon as possible.

     (12) Verified air ambulance services must meet minimum agency response times as identified in the state plan.



[Statutory Authority: RCW 18.73.140. 00-22-124, § 246-976-390, filed 11/1/00, effective 12/2/00. Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-390, filed 4/5/00, effective 5/6/00. Statutory Authority: RCW 43.70.040 and chapters 18.71, 18.73 and 70.168 RCW. 93-01-148 (Order 323), § 246-976-390, filed 12/23/92, effective 1/23/93.]