1. How Trauma Changes over Time
Laws to Rules to Tools
How Trauma Changes over Time

2. And Why Do I Care???

3. The Law 25-3.5 Part 7 Legislative declaration
(1)  The general assembly hereby finds and declares that trauma is the greatest single cause of death and disability in Colorado for persons under the age of forty-five years and that trauma care is a unique type of emergency medical service.
(2)  The general assembly further finds that a trauma system task force made up of various emergency health and trauma care entities submitted a report to the general assembly in 1993 indicating a compelling need to develop and implement a statewide trauma care system in order to assure that appropriate resources are available to trauma victims from the point of injury through rehabilitative care. In addition, a statewide system is essential to provide Colorado residents and visitors with a greater probability of surviving a life-threatening injury and to reduce trauma-related morbidity and mortality in this state.
(3)  The general assembly, therefore, declares that it is necessary to enact legislation directing the board of health to adopt rules that govern the implementation and oversight of the trauma care system. The general assembly further declares that to ensure the availability and coordination of resources necessary to provide essential care, it is necessary to enact legislation that directs the department of public health and environment to collaborate with existing agencies and organizations, including governing bodies for counties and cities and counties, in implementing and monitoring a statewide trauma care system.

4. How Are Laws and Rules Related??
Colorado Revised Statutes (Laws)
(passed by the Colorado Legislature and signed by Governor)
Tells someone or some entity to do/not do something
(Gives the big idea & often tells state agency to make rules)
Rules/regulations detail how those big ideas are carried out – they are the practical steps to implementing laws.

5. How Trauma System Ideas Become Rules 25-3.5-701 et seq. C.R.S.
Law gives CDPHE responsibility to “develop, implement, and monitor” state EMS and trauma system
“in accordance with…rules adopted by the Colorado Board of Health”

6. “in accordance with… rules adopted by the Colorado Board of Health”
How Ideas Become Rules
“in accordance with… rules adopted by the Colorado Board of Health”
Ideas come from changes to law, ….staff, STAKEHOLDERS, change in practice
SEMTAC forms a task force to examine ideas and draft language for rule changes, if necessary
Task force meets to define scope of project, carry out drafting, make recommendation to STAC/SEMTAC. All meetings are PUBLIC.
PUBLIC comment is solicited in meetings, between meetings and through website

7. “in accordance with… rules adopted by the Colorado Board of Health”
How Ideas Become Rules
“in accordance with… rules adopted by the Colorado Board of Health”
Task force makes recommendations to STAC/SEMTAC for new or revised rule
STAC carefully reviews proposed rules and makes a recommendation to SEMTAC. SEMTAC has PUBLIC discussion and votes to support or not.
Staff submits to the Attorney General’s Office for official review of proposed rule and at same time…
Staff requests time on Board of Health agenda to request a hearing – again a PUBLIC meeting.

8. How Ideas Become Rules
“in accordance with… rules adopted by the Colorado Board of Health”
2months later…
SEMTAC’s recommendation is presented to the Board of Health at a hearing taking PUBLIC testimony.
The Board of Health votes to approve rule (or not).
Staff submits to Attorney General’s Office for final review and submits to Secretary of State’s Office for publication
Approximately 45 days after the hearing, the rule becomes effective and is published on the Secretary of State’s website.

10. Why Now?
The Colorado Department of Public Health and Environment (CDPHE) is required by law to regularly review all existing rules to determine
if still necessary,
avoid duplication and
reduce regulatory burden on INDUSTRY.
Requires the department notify
STAKEHOLDERS and solicit input.

11. Trauma Rules Current Structure
6 CCR (Code of Colorado Regulations)
Chapter One – Trauma Registry Rules
Chapter Two – State Emergency Medical and Trauma Care System Standards
Chapter Three – Designation of Trauma Facilities
Chapter Four – Regional Emergency Medical and Trauma Advisory Councils (RETACs)
Official version always on Secretary of State’s website

12. Chapter 1 – Colorado Trauma Registry (1998)
Covers the required collection of trauma data in Colorado
Updates 2000, 2005
Completely re-written
Effective date of February 2016

13. Chapter 2 – State Emergency Medical and Trauma Care System Standards (2002?)
Communication
Prehospital (response)
Interfacility Transfer – Adults
Mandatory consult and transfer
Non-designated facilities
RETAC monitoring
Interfacility Transfer – Pediatrics (age 14 and under)
Divert and Bypass
Prehospital Trauma Triage Algorithm (2010)

14. Chapter 3 - Designation of Trauma Facilities (1998?)
Definitions (ongoing additions)
Designation Process (2005, 2007)
Enforcement and Disciplinary Process (2005)
Designation Criteria Level I-II (2008)
Trauma Quality Improvement for Levels III-V (2017)
Expanded Scope of Care for Levels III-IV (2017)
Designation Criteria Levels III – V (2003)
Burn Unit Referral Criteria
Designation Criteria, RPTC

15. Chapter 4 – Regional Emergency Medical and Trauma Advisory Councils
Everything about RETAC
Not been overhauled in 15+ years

16. And Why Do I Care???

17. Trauma Designation: Rules to Tools
Initial state rules and tools were a multi-page table
Refined/changed to allow more room for comment
Revised for rule revision
Revised for formatting and rule revision

18. Trauma Designation: Rules to Tools
C. FACILITIES/RESOURCES/CAPABILITIES (CONT.)
Level I
Level II
Level
III V
4. Intensive care units (ICUs) for trauma patients (Cont.)
b. Equipment - Appropriate monitoring and resuscitation equipment E
---
c. Support Services - Immediate access to clinical diagnostic services
5. Acute Hemodialysis Capability

19. Trauma Designation: Rules to Tools
Initial state rules and tools were a multi-pagetable
Refined/changed to allow more room for comment
Revised for rule revision
Revised for formatting and rule revision

20. Trauma Designation:
Rules to Tools

21. Chapter 4 - History
Not been overhauled in 15 plus years (original language?)
Intended to include all things RETAC

22. Next Steps Ongoing Rule Drafting Ongoing Making
Ongoing Change to Scoring Tool
Electronic Form
Start Over Again…