Level III Trauma Centers must maintain published call
schedules and have the following physician coverage immediately available 24
hours/day:
1. Emergency Medicine
(In-house 24 hours/day). Emergency Physician and/or mid-level provider
(Physician Assistant/Nurse Practitioner) must be in the specified trauma
resuscitation area upon patient arrival.
2. Trauma/General Surgery. It is desirable
that a back up surgeon schedule is published. It is desirable that the surgeon
on-call is dedicated to the trauma center and not on-call to any other hospital
while on trauma call. A system should be developed to assure notification of
the on-call surgeon and compliance with these criteria and their
appropriateness must be documented and monitored by the PI process. Response
time for Alpha Alert/Activations is 30 minutes and starts at patient arrival or
EMS notification, whichever is sooner. Response time for Bravo
Alerts/Activations is 45 minutes from the time notified to respond.
3. Orthopedic Surgery. It is desirable to
have the orthopedists dedicated to the trauma center solely while on-call. The
maximum response time for all trauma patients is 60 minutes from the time
notified to respond.
4. Anesthesia.
Anesthesia must be immediately available with a mechanism established to ensure
early notification of the on-call anesthesiologist. Anesthesia chief residents
or Certified Registered Nurse Anesthetist (CRNAs) may fill this requirement.
When residents or CRNAs are utilized, the staff anesthesiologist on-call will
be advised, promptly available, and present for all operations. Hospital policy
must be established to determine when the anesthesiologist must be immediately
available for airway control and assisting with resuscitation. The availability
of the anesthesiologist and the absence of delays in airway control or
operative anesthesia must be documented and monitored by the PI process. The
maximum response time for all trauma patients is 30 minutes from the time
notified to respond.
5. The
following specialists must be on-call and promptly available 24 hours/day:
Radiology
6. It is desirable
(although not required) to have the following specialist available to a Level
III Trauma Center:
a. Hand Surgery
b. Obstetrics/Gynecology Surgery
c. Ophthalmic Surgery
d. Oral/Maxillofacial Surgery
e. Plastic Surgery
f. Critical Care Medicine
g. Thoracic Surgery*
h. Microvascular Surgery
*A trauma surgeon is presumed to be qualified and have
privileges to provide emergency thoracic surgical care to patients with
thoracic injuries. If this is not the case, the facility should have a
board-certified thoracic surgeon immediately available (within 30 minutes of
the time notified to respond).
7. The staff specialist on-call will be
notified at the discretion of the trauma surgeon and will be promptly
available. The PI program will continuously monitor this
availability.
8. Policies and
procedures should exist to notify the transferring hospital of the patient's
condition.
