Frequently
Asked Questions
State Designation of Level
III and IV Trauma Care Facilities
April 2005
1. On the application, Section A, is this an initial or a
re-classification?
Answer: This is the initial State designation of all hospitals
in
Please
fill out the application and criteria in its entirety.
2. Is there additional paperwork beyond the application and criteria forms
that is required for the State, to demonstrate the "Trauma Care Facility
Commitment?"
Answer: No. By
completing the application and criteria and the signature by the
Administrator/Chief Executive Officer, and putting the criteria into action,
the commitment is demonstrated.
3. What does "participation" in Regional Trauma Advisory
Councils (RTACs) mean?
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 will be an important
criteria that will be looked at during a site visit review.
4. What about the site visits?
Answer: Site visits are an essential component of a trauma
system and shall occur for all Level III and IV facilities in the future. The process and dates are still to be
determined. Stay tuned to your Regional
Trauma Advisory Council for further information.
5. What happens if a hospital decides not to designate as a Level III, IV
or "unclassified" and does not send in the application?
Answer: 1997 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 do a site visit and classify the hospital.
6. Who is required to take 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 Continued Medical Education
requirements. If a physician currently
is Emergency Medicine Board Certified, 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 that trauma patient in a major resuscitation should be Advanced
Trauma Life Support certified.
Currently, the Surgeons should re-certify every four years. However, if the new
*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 the general surgeons.
7. Does the Trauma Service Director have to be a General Surgeon?
Answer: No, recommended, but not required.
8. If the Emergency Department Physician in a Level III or IV Trauma Care
Facility has decided to transport the patient 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
out. In a Level III Trauma Care
Facility, as the general surgeon is expected to respond for all major trauma
patients he/shall 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.
On
the web-site, EMTALA.com under "frequently asked questions", 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 Facility's, 30 minutes is the maximum time for the
surgeon to respond and this begins at the time of notification.
A
major trauma patient means he/she 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 that has the potential of causing death or major disability as defined
in Administrative Rules Chapter 118.
(There will be further information for hospitals regarding definition of
major trauma, and triage and transport protocols that Emergency Medical
Services use in the near future after the designation process is completed).
9. Do we still mark "yes" to the trauma registry though the
state has not implemented it yet?
Answer: Yes. By
marking "yes" you are committing to participating in the state trauma
registry when applicable. It is a
requirement to be a Trauma Care Facility.
10. 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 traumatic injuries.
11. What are some of the 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 for you.
12. Do new committees have to be established to perform Performance
Improvement on trauma patients?
Answer: No. You may incorporate your trauma Performance
Improvement into existing Performance Improvement/Quality Assurance committees
as long as the required criteria are met.
13.Clarification: Level III and IV Trauma Care Facilities need to have
transfer agreements with at a minimum their Level I or II American College of
Surgeons Verified Trauma Centers in their region. It is up to the hospital to decide which
hospitals they will have transfer agreements with depending on where their
trauma patients referral and transfer patterns exist.
14. When is the final due date for all hospitals to designate?
Answer: All hospitals must be classified by
*Footnotes
can be found at the Trauma System website:
www.dhfs.wisconsin.gov/ems
under the section titled "Trauma Care Facility
Classification/Designation of Wisconsin Hospitals in the Level III and IV
Hospital Assessment and Classification Criteria document. Please refer to footnotes as requested in the
document.
This
document shall be added to as more questions arise. Feel free to contact Marianne Peck, State
Trauma Coordinator at 608-266-0601 or peckme@dhfs.state.wi.us to add questions or
to clarify.
Thank
you to everyone for their continued dedication and hard work to implement the
Trauma Care System to care for our visitors and citizens in