Physician feedback from the Texas Medical Association and a broad swath of other stakeholders informed the final iteration of the state’s emergency medical services (EMS) and trauma care rules, which extend physician involvement in the trauma facility designation process.
The Texas Department of State Health Services (DSHS) reached its final regulations, published Nov. 15 in the Texas Register, after two rounds of extensive comments requiring thorough review.
“It took a huge amount of dedication on the part of the state,” said Robert Greenberg, MD, a consultant to TMA’s Committee on Emergency Medical Services and Trauma. “They listened to us and acted on our recommendations.”
TMA weighed in on two previously proposed sets of EMS and trauma care rules, issued months apart, articulating the importance of aligning state standards with those of the American College of Surgeons (ACS) as well as preserving the multidisciplinary requirement for surveyor teams of level I and level II trauma centers.
In response, the newly published rules enshrine medicine’s involvement in the survey designation process by requiring both a trauma nurse and an emergency medicine physician for level I and level II centers. The rules entail two phases, the first will go into effect Jan. 1, 2025, before ultimately being replaced with a slightly modified set of rules Sept. 1, 2025.
Simultaneously, the new rules also allow flexibility for the composition of survey teams who designate level IV centers, which make up approximately two-thirds of trauma facilities in Texas, according to DSHS. Such teams may adjust their makeup based on the number of trauma patients meeting National Trauma Data Bank registry inclusion criteria annually, so not every survey requires the participation of an emergency medicine physician.
Hilary Fairbrother, MD, chair of TMA’s Committee on Emergency Medical Services and Trauma, called the changes “common sense, when the initial rules were so prescriptive.”
“The majority of [Texas] patients who are treated and evaluated for trauma are treated and evaluated at level IV centers,” she said. “We didn’t want to see our survey teams only be so one-sided [excluding an emergency physician and trauma nurse] when it came to our busiest [level I and II] trauma centers.”
One minor change to the rules, meant to preclude any potential conflicts of interest, requires out-of-state surveyors for the designation of level I and level II facilities. Though new to Texas, that’s not an uncommon requirement in other states, Dr. Greenberg notes.
The sum of DSHS’ tailoring of requirements and earlier rule revisions represents a win for medicine, Dr. Greenberg says.
“We’ve been able to maintain and extend physician involvement in the trauma designation process, and it will ensure quality care is provided in the state of Texas,” Dr. Greenberg said. “It’s absolutely a step forward.”
“They really listened,” Dr. Fairbrother said. “For the large part, the things that we commented on in our letters, they really were able to adopt and address. That is a testament, frankly, to the power of physicians being together in an organization like TMA.”
Jessica Ridge
Reporter, Division of Communications and Marketing
(512) 370-1395