S.B. 115

1

TRAUMA SYSTEM AMENDMENTS
2 2000 GENERAL SESSION
3 STATE OF UTAH
4 Sponsor: Robert F. Montgomery
5 AN ACT RELATING TO HEALTH; DEFINING TERMS; ESTABLISHING A STATEWIDE
6 TRAUMA SYSTEM; CREATING THE TRAUMA SYSTEM ADVISORY COMMITTEE;
7 ESTABLISHING THE DUTIES OF THE DEPARTMENT AND EXTENDING RULEMAKING
8 AUTHORITY; ESTABLISHING A STATEWIDE TRAUMA REGISTRY; REQUIRING THE
9 SUBMISSION OF DATA TO THE REGISTRY; REQUIRING THE DEPARTMENT TO
10 PROVIDE TECHNICAL AND, IN SOME INSTANCES, FINANCIAL ASSISTANCE TO
11 MANDATORY REPORTERS; IMPOSING CONFIDENTIALITY REQUIREMENTS AND
12 EXTENDING IMMUNITY FOR REPORTING; ESTABLISHING TRAUMA CENTER
13 DESIGNATIONS AND PERMITTING HOSPITALS TO VOLUNTARILY APPLY FOR SUCH
14 DESIGNATIONS; REQUIRING THE DEPARTMENT TO STUDY THE EFFECTIVENESS OF
15 THE STATEWIDE TRAUMA SYSTEM; MAKING CONFORMING AMENDMENTS; AND
16 PROVIDING AN EFFECTIVE DATE.
17 This act affects sections of Utah Code Annotated 1953 as follows:
18 AMENDS:
19 26-8a-102, as enacted by Chapter 141, Laws of Utah 1999
20 26-8a-203, as enacted by Chapter 141, Laws of Utah 1999
21 ENACTS:
22 26-8a-250, Utah Code Annotated 1953
23 26-8a-251, Utah Code Annotated 1953
24 26-8a-252, Utah Code Annotated 1953
25 26-8a-253, Utah Code Annotated 1953
26 26-8a-254, Utah Code Annotated 1953
27 Be it enacted by the Legislature of the state of Utah:

28 Section 1. Section 26-8a-102 is amended to read:
29 26-8a-102. Definitions.
30 As used in this chapter:
31 (1) "Ambulance" means a ground, air, or water vehicle that:
32 (a) transports patients and is used to provide emergency medical services; and
33 (b) is required to obtain a permit under Section 26-8a-304 to operate in the state.
34 (2) "Ambulance provider" means an emergency medical service provider that:
35 (a) transports and provides emergency medical care to patients; and
36 (b) is required to obtain a license under Part 4, Ambulance and Paramedic Providers.
37 (3) "Committee" means the State Emergency Medical Services Committee created by
38 Section 26-1-7 .
39 [(4) (a) "Critical care categorization guidelines" means a stratified profile of hospital
40 critical care services related to emergency patient condition which aids a physician in selecting the
41 most appropriate facility for critical patient referral.]
42 [(b) Guideline categories include trauma, spinal cord, burns, high risk infant, pediatrics,
43 poisons, cardiac, respiratory, and psychiatric.]
44 [(5)] (4) "Direct medical observation" means in-person observation of a patient by a
45 physician, registered nurse, physician's assistant, or individual certified under Section 26-8a-302 .
46 [(6)] (5) "Emergency medical condition" means:
47 (a) a medical condition that manifests itself by symptoms of sufficient severity, including
48 severe pain, that a prudent layperson, who possesses an average knowledge of health and medicine,
49 could reasonably expect the absence of immediate medical attention to result in:
50 (i) placing the individual's health in serious jeopardy;
51 (ii) serious impairment to bodily functions; or
52 (iii) serious dysfunction of any bodily organ or part; or
53 (b) a medical condition that in the opinion of a physician or his designee requires direct
54 medical observation during transport or may require the intervention of an individual certified
55 under Section 26-8a-302 during transport.
56 [(7)] (6) "Emergency medical service personnel":
57 (a) means an individual who provides emergency medical services to a patient and is
58 required to be certified under Section 26-8a-302 ; and

59 (b) includes a paramedic, medical director of a licensed emergency medical service
60 provider, emergency medical service instructor, and other categories established by the committee.
61 [(8)] (7) "Emergency medical service providers" means:
62 (a) licensed ambulance providers and paramedic providers;
63 (b) a facility or provider that is required to be designated under Section 26-8a-303 ; and
64 (c) emergency medical service personnel.
65 [(9)] (8) "Emergency medical services" means medical services, transportation services,
66 or both rendered to a patient.
67 [(10)] (9) "Emergency medical service vehicle" means a land, air, or water vehicle that is:
68 (a) maintained and used for the transportation of emergency medical personnel, equipment,
69 and supplies to the scene of a medical emergency; and
70 (b) required to be permitted under Section 26-8a-304 .
71 [(11)] (10) "Interested party" means:
72 (a) a licensed or designated emergency medical services provider that provides emergency
73 medical services within or in an area that abuts an exclusive geographic service area that is the
74 subject of an application submitted pursuant to Part 4, Ambulance and Paramedic Providers;
75 (b) any municipality, county, or fire district that lies within or abuts a geographic service
76 area that is the subject of an application submitted pursuant to Part 4, Ambulance and Paramedic
77 Providers; or
78 (c) the department when acting in the interest of the public.
79 [(12)] (11) "Medical control" means a person who provides medical supervision to an
80 emergency medical service provider.
81 [(13)] (12) "Paramedic provider" means an entity that:
82 (a) employs emergency medical service personnel; and
83 (b) is required to obtain a license under Part 4, Ambulance and Paramedic Providers.
84 [(14)] (13) "Patient" means an individual who, as the result of illness or injury, meets any
85 of the criteria in Section 26-8a-305 .
86 (14) "Trauma" means an injury requiring immediate medical or surgical intervention.
87 (15) "Trauma system" means a single, statewide system that:
88 (a) organizes and coordinates the delivery of trauma care within defined geographic areas
89 from the time of injury through transport and rehabilitative care; and

90 (b) is inclusive of all prehospital providers, hospitals, and rehabilitative facilities in
91 delivering care for trauma patients, regardless of severity.
92 (16) "Triage" means the sorting of patients in terms of disposition, destination, or priority.
93 For prehospital trauma victims, triage requires a determination of injury severity to assess the
94 appropriate level of care according to established patient care protocols.
95 (17) "Triage, treatment, transportation, and transfer guidelines" means written procedures
96 that:
97 (a) direct the care of patients; and
98 (b) are adopted by the medical staff of an emergency patient receiving facility, trauma
99 center, or an emergency medical service provider.
100 Section 2. Section 26-8a-203 is amended to read:
101 26-8a-203. Data collection.
102 (1) The committee shall[: (a) approve or disapprove the state emergency medical service
103 plan prepared by the department pursuant to Subsection (2)(b) and make recommendations
104 concerning the emergency medical service plan prepared pursuant to P. L. 93-641, as amended;
105 (b) approve critical care categorization guidelines and treatment protocols developed by the
106 department pursuant to Subsections (2)(c) and (d); (c) categorize all hospital critical care facilities
107 and designate trauma, burn, spinal cord, and poison care facilities in the state consistent with
108 guidelines approved under Subsection (1)(b); and (d)]specify the information that must be
109 collected for the emergency medical services data system established pursuant to Subsection
110 (2)[(a)].
111 (2) The department shall[: (a)] establish an emergency medical services data system which
112 shall provide for the collection of information, as defined by the committee, relating to the
113 treatment and care of patients who use or have used the emergency medical services system[;].
114 [(b) prepare a state plan for the coordinated delivery of emergency medical services which
115 shall be updated at least every three years and shall reflect recommendations of local government
116 emergency medical services councils;]
117 [(c) develop hospital critical care categorization guidelines, in consultation with the state
118 medical association and state hospital association, which may not require the transfer of any patient
119 contrary to the wishes of the patient, his next of kin, or his attending physician; and]
120 [(d) develop treatment protocols for the critical care guideline categories described in

121 Subsection 26-8a-102 (4)(b).]
122 (3) Persons providing emergency medical services shall provide information to the
123 department for the emergency medical services data system established pursuant to Subsection
124 (2)[(a)].
125 Section 3. Section 26-8a-250 is enacted to read:
126 Part 2a. Statewide Trauma System
127 26-8a-250. Establishment of statewide trauma system.
128 The department shall establish and actively supervise a statewide trauma system to:
129 (1) promote optimal care for trauma patients;
130 (2) alleviate unnecessary death and disability from trauma and emergency illness;
131 (3) inform health care providers about trauma system capabilities;
132 (4) encourage the efficient and effective continuum of patient care, including prevention,
133 prehospital care, hospital care, and rehabilitative care; and
134 (5) minimize the overall cost of trauma care.
135 Section 4. Section 26-8a-251 is enacted to read:
136 26-8a-251. Trauma system advisory committee.
137 (1) There is created within the department the trauma system advisory committee.
138 (2) (a) The committee shall be comprised of individuals knowledgeable in adult or
139 pediatric trauma care, including physicians, nurses, hospital administrators, emergency medical
140 services personnel, government officials, consumers, and persons affiliated with professional
141 health care associations.
142 (b) Representation on the committee shall be broad and balanced among the health care
143 delivery systems in the state with no more than three representatives coming from any single
144 delivery system.
145 (3) The committee shall:
146 (a) advise the department regarding trauma system needs throughout the state;
147 (b) assist the department in evaluating the quality and outcomes of the overall trauma
148 system;
149 (c) review and comment on proposals and rules governing the statewide trauma system;
150 and
151 (d) make recommendations for the development of statewide triage, treatment,

152 transportation, and transfer guidelines.
153 (4) The department shall:
154 (a) determine, by rule, the term and causes for removal of committee members;
155 (b) establish committee procedures and administration policies consistent with this chapter
156 and department rule; and
157 (c) provide administrative support to the committee.
158 Section 5. Section 26-8a-252 is enacted to read:
159 26-8a-252. Department duties.
160 In connection with the statewide trauma system established in Section 26-8a-250 , the
161 department shall:
162 (1) establish a statewide trauma system plan that:
163 (a) identifies statewide trauma care needs, objectives, and priorities;
164 (b) identifies the equipment, facilities, personnel training, and other things necessary to
165 create and maintain a statewide trauma system; and
166 (c) organizes and coordinates trauma care within defined geographic areas;
167 (2) support the statewide trauma system by:
168 (a) facilitating the coordination of prehospital, acute care, and rehabilitation services and
169 providers through state regulation and oversight;
170 (b) facilitating the ongoing evaluation and refinement of the statewide trauma system;
171 (c) providing educational programs;
172 (d) encouraging cooperation between community organizations, health care facilities,
173 public health officials, emergency medical service providers, and rehabilitation facilities for the
174 development of a statewide trauma system;
175 (e) implementing a quality assurance program using information from the statewide trauma
176 registry established pursuant to Section 26-8a-253 ;
177 (f) establishing trauma center designation requirements in accordance with Section
178 26-8a-254 ; and
179 (g) developing standards so that:
180 (i) trauma centers are categorized according to their capability to provide care;
181 (ii) trauma victims are triaged at the initial point of patient contact; and
182 (iii) trauma patients are sent to appropriate health care facilities.

183 Section 6. Section 26-8a-253 is enacted to read:
184 26-8a-253. Statewide trauma registry and quality assurance program.
185 (1) The department shall:
186 (a) establish and fund a statewide trauma registry to collect and analyze information on
187 the incidence, severity, causes, and outcomes of trauma;
188 (b) establish, by rule, the data elements, the medical care providers that must report, and
189 the time frame and format for reporting;
190 (c) use the data collected to:
191 (i) improve the availability and delivery of prehospital and hospital trauma care;
192 (ii) assess trauma care delivery, patient care outcomes, and compliance with the
193 requirements of this chapter and applicable department rules; and
194 (iii) regularly produce and disseminate reports to data providers, state government, and the
195 public; and
196 (d) support data collection and abstraction by providing:
197 (i) a data collection system and technical assistance to each hospital that submits data; and
198 (ii) funding or, at the discretion of the department, personnel for collection and abstraction
199 for each hospital not designated as a Level I or II trauma center under the standards established
200 pursuant to Section 26-8a-254 .
201 (2) (a) Except as provided in Subsection (2)(b), each hospital shall submit trauma data in
202 accordance with rules established under Subsection (1) until July 1, 2003.
203 (b) A hospital designated as a trauma center shall continue to submit data beyond July 1,
204 2003, as part of the ongoing quality assurance program established in Section 26-8a-252 .
205 (3) Before July 1, 2003, the department shall assess:
206 (a) the effectiveness of the data collected pursuant to Subsection (1); and
207 (b) the impact of the statewide trauma system on the provision of trauma care.
208 (4) Data collected under this section shall be subject to Title 26, Chapter 3, Health
209 Statistics.
210 (5) No person may be held civilly liable for having provided data to the department in
211 accordance with this section.
212 Section 7. Section 26-8a-254 is enacted to read:
213 26-8a-254. Trauma center designations and guidelines.

214 (1) The department, after seeking the advice of the trauma system advisory committee,
215 shall establish by rule:
216 (a) trauma center designation requirements; and
217 (b) model state guidelines for triage, treatment, transportation, and transfer of trauma
218 patients to the most appropriate health care facility.
219 (2) The department shall designate as a trauma center each hospital that:
220 (a) voluntarily requests a trauma center designation; and
221 (b) meets the applicable requirements established pursuant to Subsection (1).
222 Section 8. Effective date.
223 This act takes effect on July 1, 2000.




Legislative Review Note
as of 1-13-00 12:33 PM

A limited legal review of this legislation raises no obvious constitutional or statutory concerns.

Office of Legislative Research and General Counsel