(a) A limited services rural hospital (LSRH) shall provide the emergency care necessary to meet the needs of its patients in accordance with acceptable standards of practice.
(b) An LSRH shall provide to each patient, without regard to the individual's ability to pay, an appropriate medical screening, examination, and stabilization within the facility's capability, including ancillary services routinely available to the hospital, to determine whether an emergency medical condition exists and shall provide any necessary stabilizing treatment.
(c) An LSRH shall have an emergency suite that complies with §511.163(e) of this chapter (relating to Spatial Requirements).
(d) The organization of the LSRH's emergency services must be appropriate to the scope of the services offered.
(e) Emergency services must be organized under the direction of a qualified physician member of the LSRH's medical staff who is the medical director or clinical director.
(f) Emergency services must be integrated with other LSRH departments.
(g) The LSRH must maintain patient medical records for all emergency patients. The medical records shall contain patient identification, the reason for the visit, name of physician, name of nurse, time admitted to the emergency suite, treatment, time discharged, and disposition.
(h) The policies and procedures governing medical care provided in the emergency suite must be established by and must be a continued responsibility of the medical staff.
(i) There must be adequate medical and nursing personnel qualified in emergency care to meet the written emergency procedures and needs anticipated by the LSRH.
(j) There must be on-duty and on-site 24 hours a day, seven days a week at least one person qualified, as determined by the medical staff, to initiate immediate appropriate lifesaving measures and at least one nurse with current advanced cardiac life support and pediatric advanced life support certification. This individual or individuals must be able to receive patients and activate the appropriate medical resources to meet the care needed by the patient.
(k) Qualified personnel must be physically present in the emergency treatment area at all times.
(l) An LSRH must maintain schedules, names, and phone numbers of all physicians and others on emergency call duty, including alternates. The LSRH must maintain the schedules for at least one year.
(m) In accordance with Code of Federal Regulations Title 42 (42 CFR) §485.516(c)(4), there must be a physician, a physician assistant, or an advanced practice registered nurse, with training or experience in emergency care, on call and immediately available by telephone or radio contact, and available on-site at the LSRH within 30 minutes, on a 24-hour a day basis, if the LSRH is located in an area other than an area described in 42 CFR §485.618(d)(1)(ii).
(n) Emergency services must be available 24-hours per day.
(o) An LSRH shall keep adequate age-appropriate equipment, supplies, and medication used in treating emergency cases and make this equipment, supplies, and medication readily available for treating emergency cases.
(p) The age-appropriate emergency equipment and supplies available at the LSRH shall include at least the following:
  (1) emergency call system;
  (2) oxygen;
  (3) mechanical ventilatory assistance equipment, including airways, manual breathing bag, endotracheal tubes, ambu bag/valve/mask;
  (4) cardiac defibrillator;
  (5) cardiac monitoring equipment;
  (6) laryngoscopes and endotracheal tubes;
  (7) suction equipment;
  (8) stabilization devices for cervical injuries;
  (9) blood pressure monitoring equipment;
  (10) pulse oximeter or similar medical device to measure blood oxygenation;
  (11) tourniquets;
  (12) immobilization devices;
  (13) nasogastric tubes;
  (14) splints;
  (15) Intravenous (IV) therapy supplies;
  (16) suction machine;
  (17) chest tubes;
  (18) indwelling urinary catheters; and
  (19) drugs and biologicals commonly used in life-saving procedures as specified by the medical staff, which shall include:
    (A) analgesics,
    (B) local anesthetics,
    (C) antibiotics,
    (D) anticonvulsants,
    (E) antidotes and emetics,
    (F) serums and toxoids,
    (G) antiarrhythmics,
    (H) cardiac glycosides,
    (I) antihypertensives,
    (J) diuretics, and
    (K) electrolytes and replacement solutions.
(q) Equipment and supplies must be available at the LSRH for administering intravenous medications as well as facilities for bleeding control and emergency splinting of fractures.
(r) The LSRH shall periodically test emergency equipment according to the LSRH's adopted policy.
(s) An LSRH shall provide, either directly or under arrangements, services for the procurement, safekeeping, and transfusion of blood, including the availability of blood products needed for emergencies on a 24-hour a day basis.
(t) Provision for the storage of blood and blood products must be made as needed. If blood banking services are provided under an arrangement, the arrangement is approved by the LSRH's medical staff and by the persons directly responsible for the operation of the LSRH. An LSRH shall ensure all blood and blood components are stored in accordance with §511.45(h) of this subchapter (relating to Laboratory Services).
(u) An LSRH shall, in coordination with emergency response systems in the area, establish procedures under which a physician is immediately available by telephone or radio contact on a 24-hour a day basis to receive emergency calls, provide information on treatment of emergency patients, and refer patients to the LSRH or other appropriate locations for treatment.

Source Note: The provisions of this §511.44 adopted to be effective October 5, 2023, 48 TexReg 5668