Enhancing the Treatment and Prevention of Trauma in Southwest Wisconsin

Frequent Questions

Frequently Asked Questions

State Designation of Level III and IV Trauma Care Facilities

April 2005

 

 

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. 

 

 

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.

 

 

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.

 

 

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.

 

 

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.

 

 

 

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.

 

Does the Trauma Service Director have to be a General Surgeon?

Answer:  No, recommended, but not required.

 

 

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).

 

 

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.

 

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.

 

 

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.

 

 

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.

 

 

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.

 

 

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.

 

 

If a Level IV has general surgeons can they be held to the same expectations for surgeon response as a Level III?

Answer: No. Level IV does not require a surgeon, therefore we cannot hold a Level IV to the same expectations as a Level III. However, if there is a surgeon in a Level IV who is taking trauma call through a call schedule and is notified of a trauma case; then that person must come in according to EMTALA.

 

 

Can a surgeon be on call at more than one institution?

Answer: Yes, however it is not recommended. According to the ACS book it is desired in a Level III to have a surgeon dedicated to one hospital, not essential. Though STAC does not recommend call at more than one facility — our recommendations shall not supersede ACS. 

 

 

*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.