State Designation of Level III and IV
Trauma Care Facilities
Frequently Asked Questions
November 2006
1.
Is there paperwork beyond the application and
criteria forms that is required to demonstrate the "Trauma Care
Facility Commitment”?
Answer:
No.
The commitment is demonstrated by completing the
application and criteria and the signature by the Administrator/Chief
Executive Officer and by putting the criteria into action.
2.
What is meant by "participation in Regional
Trauma Advisory Councils (RTACs)”?
Answer:
As
part of being a State designated Level III or IV Trauma Care Facility, a
representative of your hospital must attend the Regional Trauma Advisory
Council meetings on a regular basis and keep the hospital administration
informed of regional actions and issues.
This is an important criterion that will be looked at during a
site visit review.
3.
What happens if a hospital decides not to designate
as a Level III, IV or "unclassified" Trauma Care Facility and
does not submit the application?
Answer:
1997
Wisconsin Act 154 states that "the rules shall include a method by
which to classify all hospitals
as to their respective emergency care capabilities”.
If a hospital chooses not to classify at all, the State may
perform a site visit and classify the hospital.
4.
Who is required to take an Advanced Life Support
Course?
Answer:
* Footnote
5 states "Level III and IV Trauma Care Facility physicians involved
in the care of trauma patients shall take the Advanced Trauma Life
Support Course and the refresher course every four years to meet
Continuing Medical Education requirements.
If a physician is currently Emergency Medicine board certified,
the Advanced Trauma Life Support course only needs to be completed
once."
This means that the Emergency Department physicians and general
surgeons who will be caring for trauma patients
in a major resuscitation should be Advanced Trauma Life Support
certified.
Currently, surgeons re-certify every four years.
Should
the new American College of Surgeons recommendations
require that
surgeons take only the initial Advanced Trauma Life Support Course if they
maintain their board certification, the State Trauma Advisory Council
will follow the same recommendation.
Footnote 13 states: "The
Emergency Department physicians will have three years, from the trauma
care facility's classification (July 1, 2005) or from the date of the
Emergency Department physician joining the trauma team at the Trauma
Care Facility to successfully complete this course."
This will also hold true for general
surgeons.
5.
Does the Trauma Service Director have to be a
general surgeon?
Answer:
No.
This is recommended, but not required.
6.
If the emergency department physician in a Level
III or IV Trauma Care Facility has decided to have the patient
transported to a trauma center, does the general surgeon on call still
have to come in?
Answer: Yes.
When the general surgeon is paged for a major trauma patient,
he/she must respond to the emergency department regardless of the
decision to transfer the patient. In
a Level III Trauma Care Facility the general surgeon is expected to
respond for all major trauma patients. He/she shall be a part of the
trauma team activation, which is explained in *footnote 6.
The surgeon may need to give operative control of hemorrhage or
other necessary treatment prior to transfer.
In
Frequently Asked Questions on the website EMTALA.com
it states: "As noted above, Section 1395dd(d)(1)(C) imposes a penalty on a
physician who fails to respond to an emergency situation when he is
assigned as the on-call physician."
For
Level III and IV Trauma Care Facilities, 30 minutes is the maximum time
for the surgeon to respond and this begins at the time of the patient
arrival.
A
major trauma patient is defined as a patient who has sustained major or
severe injuries to more than one system of a person's body or major
injury to a single system of the body and that has the potential of
causing death or major disability as defined in Administrative Rule
Chapter HFS 118. The
minimum criteria that defines a major resuscitation of a trauma patient
that requires a surgical response is:
-
Confirmed systolic blood pressure <90 at any
time in adults and age specific hypertension for children
-
Respiratory compromise/obstruction and/or
intubation
-
Transfer patients from other hospitals
receiving blood to maintain vital signs
-
Emergency physician's discretion
-
Gunshot wounds to the abdomen, neck, or chest
-
Glasgow Coma Scale <8 with mechanism
attributed to trauma
Your trauma care facility is welcome to add any
other criteria as deemed necessary.
7.
Clarification:
Footnote
4 - "Any inpatients admitted to a Level IV Trauma Care Facility
shall not have injuries requiring major surgical or surgical specialty
care”. This is referring
to major trauma patients, not the single limb or hip fracture or other
less serious traumatic injuries.
8. What are some recommended educational courses for
nurses?
Answer:
-
Trauma
Nursing Core Course (TNCC)
-
Emergency
Nursing Pediatric Course (ENPC)
-
Trauma
Nurse Specialist (TNS)
-
Course
in Advanced Trauma Nursing (CATN)
-
Pediatric
Advanced Life Support (PALS)
-
Advanced
Trauma Care for Nurses (ATCN)
Trauma
Coordinators from your Level I and II Verified Centers can provide
further information on available educational courses.
9.
Do new committees have to be established to perform
Performance Improvement on trauma patients?
Answer:
No.
You can incorporate your trauma “performance improvement” into
existing performance improvement/quality assurance committees as long as
the required criteria are met.
10.Clarification:
Level
III and IV Trauma Care Facilities need to have transfer agreements
with (at a minimum) a Level I or II American College of Surgeons Verified
Trauma Center in their region. It is up to
the hospital to decide which hospital(s) they will have transfer
agreements with depending on where their trauma patient referral and
transfer patterns exist.
*Footnotes
can be found under the section entitled "Trauma Care Facility
Classification/Designation of Wisconsin Hospitals in the Level III and
IV Hospital Assessment and Classification Criteria document.
Additional
information will be added as frequent questions arise. Contact the EMS
Section at (608) 266-1568 to ask or add questions.
Last Revised: March 26, 2009 |
