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Frequently Asked Questions ( Vol II )
The process of Trauma
Center Designation for the State of Wisconsin is new. Therefore, it will be
necessary to provide guidelines in the interpretation of the criteria
necessary to be a state designated trauma care facility.
Please note the latest
document regarding the State Trauma Advisory Council's interpretation of the
designation criteria.
Frequently Asked Questions Vol II
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 Wisconsin, therefore, the initial classification/designation
box should be marked.
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
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 American College of Surgeons recommendations include the Surgeons
only taking Advanced Trauma Life Support Course once if they maintain their
Board Certification, then the State Trauma Advisory Council and the State
shall 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 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 July 1, 2005 according to statute - 1997 ACT 154. Therefore, to
accomplish this goal, all applications must be turned in to Marianne Peck,
State Trauma Coordinator by June 17, 2005.
*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 Wisconsin.
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