Levels of emergency care range from initial emergency management as Standby Emergency Medical Service, with a Physician on call; to definitive emergency care as Basic Emergency Medical Service, with a Physician on duty; to a Comprehensive Emergency Medical Service as an Emergency Department.
If provided, initial emergency management shall be provided in a specifically designated area of the hospital which shall include the following elements:
A well-marked, illuminated and covered entrance, at grade level. The emergency vehicle entry cover shall provide shelter for both the patient and the emergency medical crew during transfer from an emergency vehicle into the building. This exterior entrance shall not be substituted for the required accessible entrance to the hospital, protected from the weather by canopy or roof overhang assigned for passengers loading zone. Ambulance entrances shall provide a minimum of 6 feet (183 mm) in clear width to accommodate bariatric stretchers, mobile patient lift devices, and accompanying attendants. Reception shall be located to permit staff observation and control of access to treatment area, pedestrian and ambulance entrances, and public waiting area.
Standby emergency service shall include at least one treatment room with the following elements:
- The area shall not be less than 120 square feet (11.15 m2) of clear floor area, exclusive of toilet room(s), waiting area and storage.
- Each treatment room shall contain an examination light, work counter, and handwashing station.
- Medical equipment, cabinets, medication storage and counter space for writing.
- The dimensions and arrangement of treatment rooms shall be such that there is a minimum of 3 feet (914 mm) between the sides and foot of the bed/gurney and any wall or any other fixed obstruction. The treatment room may have additional space and provisions for several patients with cubicle curtains for privacy.
- Multiple-station treatment rooms shall provide a minimum of 80 square feet (7.43 m2) per patient gurney, with a minimum 8 foot width (2,438 mm) and 3 feet (914 mm) at the foot of the bed/gurney, with a minimum of 3 feet to any wall or fixed obstruction, and a minimum of 5 feet (1524 mm) between patient gurneys. Patient gurneys shall be separated from adjoining cubicles by curtains. Handwashing fixtures shall be provided for each four treatment stations and for each major fraction thereof in multiple-station areas. These shall be uniformly distributed to provide equal access from each patient station.
Exception: Where renovation of existing treatment rooms is undertaken in facilities approved under the 2001 or prior California Building Code, existing treatment rooms may be renovated, or replaced in kind one for one in the renovated space. Such treatment rooms shall have no less than 80 square feet (7.43 m2) of clear floor area, the least dimension of which shall be 8 feet (2438 mm).
Equipment and supply storage shall be provided and be sized for general medical/surgical emergency supplies, medications and equipment such as ventilator, defibrillator, splints, etc. This storage shall be located in an alcove or room, out of corridor or hallway traffic, and under staff control.
Provisions for reception, control, and public waiting, including a public toilet room(s) with handwashing fixture(s), and public telephone.
Patient toilet room(s) with handwashing fixture(s) shall be immediately accessible to the treatment room(s).
Communication connections to the Poison Control Center and local EMS system shall be provided.
A patient cubicle with a minimum clear floor area of 100 square feet (9.29 m2) shall be provided under the visual control of an emergency service staff work area. The patient station shall have space at bedside for visitors and shall have provision for visual privacy from casual observation by other patients and visitors. A handwashing station shall be located in each room, and at least one handwashing station shall be provided for every four patient stations, and for each major fraction thereof, in open-bay areas. These shall be uniformly distributed to provide equal access from each patient station.
Exception: For small and rural hospitals, the observation area need not be dedicated solely for that purpose.
If provided, the airborne infection isolation exam/treatment room shall comply with the requirements of Section 1184.108.40.206.3.
When 24-hour basic emergency service is to be provided, at a minimum, all the provisions of Standby Emergency Service under Section 1224.33.2 and the following shall be provided:
In addition to the requirements of Section 1220.127.116.11 the emergency entrance shall have direct access from public roads for ambulance and vehicle traffic conforming with the requirements of the local authorities having jurisdiction. Entrance and driveway shall be clearly marked. If a raised platform is used for ambulance discharge, provide a ramp for pedestrian and wheelchair access.
Examination and treatment rooms shall meet the requirements under Section 118.104.22.168.
These rooms are for emergency procedures, including emergency surgery, and shall have at least 250 square feet (23.23 m2) of clear floor space. A minimum clearance of 5 feet (152 mm) shall be provided around all sides of the procedure table or gurney. Each room shall have cabinets and emergency supply shelves, image viewing capability, examination lights, and counter space for writing. Additional space with cubicle curtains for privacy may be provided to accommodate more than one patient at a time in the trauma room with a minimum clear floor area of 200 square feet (18.58 m2) for each patient bay defined by the privacy curtains. There shall be storage provided for immediate access to attire used for universal precautions. Doors leading from the ambulance entrance to the cardiac trauma room shall have an opening with a minimum width of 5 feet (1524 mm). At least one scrub sink shall be located outside the entrance to each trauma room. One scrub station consisting of two scrub positions is permitted to serve two trauma rooms if located adjacent to the entrance of each procedure room. The placement of scrub sinks shall not restrict the minimum required corridor width.
At least one orthopedic or cast room shall be provided within the emergency service space. Provisions shall include storage for splints and other orthopedic supplies, traction hooks, image viewing capability, and examination lights. If a sink is used for the disposal of plaster of paris, a plaster trap shall be provided. The clear floor space for this area shall be a minimum of 180 square feet (16.7 m2)
Communication connections shall be provided as required under Section 122.214.171.124. The communications center may be a part of the staff work and charting area.
Equipment and supply storage shall be provided as required under Section 1126.96.36.199.
Provide rooms for clean, soiled or used supplies.
These areas shall have space for counters, cabinets, and medication storage, and shall be provided with handwashing stations. They may be combined with or include centers for reception and communication.
A staff lounge shall be located within the Emergency Department and include staff clothing change areas with lockers, showers, toilets and handwashing stations for male and female staff.
If provided shall comply with the requirements of Section 1188.8.131.52.3.
When a secure holding room is provided, it shall meet the following requirements. The location of the secure holding room(s) shall facilitate staff observation and monitoring of patients in these areas. The secure holding room shall have a minimum clear floor area of 60 square feet (5.57 square meters) with a minimum wall length of 7 feet (2.13 meters) and a maximum wall length of 11 feet (3.35 meters). This room shall be designed to prevent injury to patients:
- All finishes, light fixtures, vents, diffusers, and fire protection/alarm components shall be tamper resistant and ligature resistant.
- There shall not be any electrical outlets, medical gas outlets, or similar devices.
- There shall be no sharp corners, edges, or protrusions, and the walls shall be free of objects or accessories of any kind.
- Patient room doors shall swing out and shall have hardware on the exterior side of the door only. The minimum width shall be 44 inches (1120 mm).
- A small impact-resistant view panel or window shall be provided in the door for discreet staff observation of the patient.
When 24-hour comprehensive emergency service is to be provided, an Emergency Department shall be provided. At a minimum, all the provisions of Stand-by Emergency Service under Section 1224.33.2, the provisions of Basic Emergency Service under Section 1224.33.3, and all of the following shall be provided:
In addition to the requirements of Section 1184.108.40.206, the triage area shall include triage station(s) with the following minimum requirements:
- 100 square feet (9.29 m2) minimum clear floor area for each private triage room and 80 square feet (7.4 m2) minimum clear floor area for each station in open-bay triage areas.
- Provisions for patient privacy.
- Handwashing station in each triage room. In open-bay triage areas, one handwashing station shall be provided for every four triage stations.
- Immediate access to emergency call and code call stations.
- Medical gas outlets for triage areas in compliance with Table 1220.127.116.11.
A fast-track area may be used for treating patients presenting simple and less serious conditions. If a fast-track area is provided, it shall meet the following requirements:
- Space requirements – each fast-track station shall have a minimum 100 square feet (9.29 m2) of clear floor area.
- Each station shall include a handwashing station, work/documentation counter, examination table light.
- Storage areas for supplies and medication.
- A separate procedure room may be provided. It shall have a minimum clear floor area of 120 square feet (11.15 m2).
A pre-screening area may be used prior to admission to the Emergency Department. If pre-screening is provided, each station must have a minimum of 80 square feet (7.4 m2) of clear floor area, a handwashing station, documentation counter, and a storage cabinet. Pre-screening stations, whether private rooms or open bays, are considered a part of the waiting area and must meet the same ventilation requirements.
Provisions shall be made to accommodate on-call sleeping room(s) for physicians and/or medical staff within the Emergency Department.
Provisions shall be made to accommodate police briefing/debriefing and press releases. This may be located outside the Emergency Department.
Observation rooms for the monitoring of patients up to 24 hours may be provided as a distinct unit within, the emergency department. If provided the unit shall have the following:
- Handwashing stations shall be provided in each patient room and for each four treatment stations, and for each major fraction thereof. These shall be uniformly distributed to provide equal access from each patient station. Handwashing stations shall be directly accessible to nurse stations and patient care areas.
- Each patient station shall have a minimum of 120 square feet (11.15 m2) of clear floor area including space at each bedside for visitors and provision for visual privacy from casual observation by other patients and visitors.
- One toilet room shall be provided for each six treatment stations and for each major fraction thereof.
- An administrative center/nurse station, in compliance with Section 118.104.22.168, positioned to allow staff to observe each patient care station or room.
- A nourishment area in compliance with Section 122.214.171.124.