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RESOURCES for OPTIMAL CARE of the INJURED PATIENT 2014 I TABLE of CONTENTS

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RESOURCES for OPTIMAL CARE of the INJURED PATIENT 2014 I TABLE of CONTENTS CHAPTERCHAPTTER 1 RESOURCESRegionalRegional TraumaTrauma Systems:Sysstems: OptimalOptimal Elements,Elements, Integration,Integration, anandd AssessmentAssessment FOR OPTIMAL CARE OF THE INJURED PATIENT 2014 ® COMMITTEE ON TRAUMA AMERICAN COLLEGE OF SURGEONS RESOURCESRESOURCEES FORFOR OPTIMALOPTIMAL CARECARE OFOF THETHE INJUREDINJURED PATIENTPPATIENT 20142014 1 Resources for Optimal Care of the Injured Patient is intended as an instructive tool to assist surgeons and health care institutions in improving the care of injured patients. It is not intended to replace the professional judgment of the surgeon or health care administrator in individual circumstances. The American College of Surgeons and its Committee on Trauma cannot accept, and expressly disclaim, liability for claims arising from the use of this work. Copyright © 2014 American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611-3211 All rights reserved. ISBN 978-0-9846699-8-1 TABLE OF CONTENTS Primary Editors Introduction ............................................................................................1 Chapter 1 Regional Trauma Systems: Optimal Elements, Integration, and Assessment .............................8 Chapter 2 Descriptions of Trauma Center Levels and Their Roles in a Trauma System ............................ 16 Chapter 3 Prehospital Trauma Care ................................................................................ 23 Chapter 4 Interhospital Transfer ................................................................................... 30 Chapter 5 Hospital Organization and the Trauma Program ....................................................... 35 Chapter 6 Clinical Functions: General Surgery ..................................................................... 45 Chapter 7 Clinical Functions: Emergency Medicine ............................................................... 49 Chapter 8 Clinical Functions: Neurosurgery ....................................................................... 53 Chapter 9 Clinical Functions: Orthopaedic Surgery ............................................................... 58 Chapter 10 Pediatric Trauma Care ................................................................................... 65 Chapter 11 Collaborative Clinical Services .......................................................................... 76 Chapter 12 Rehabilitation ........................................................................................... 88 Chapter 13 Rural Trauma Care ...................................................................................... 94 RESOURCES FOR OPTIMAL CARE OF THE INJURED PATIENT 2014 i TABLE OF CONTENTS Chapter 14 Guidelines for Trauma Centers Caring for Burn Patients ............................................... 100 Chapter 15 Trauma Registry ....................................................................................... 107 Chapter 16 Performance Improvement and Patient Safety ........................................................ 114 Chapter 17 Education and Outreach ............................................................................... 134 Chapter 18 Prevention ............................................................................................. 139 Chapter 19 Trauma Research and Scholarship ..................................................................... 144 Chapter 20 Disaster Planning and Management .................................................................. 149 Chapter 21 Solid Organ Procurement .............................................................................. 155 Chapter 22 Verification, Review, & Consultation Program.......................................................... 158 Chapter 23 Criteria Quick Reference Guide ........................................................................ 164 Index ................................................................................................. 194 ii RESOURCES FOR OPTIMAL CARE OF THE INJURED PATIENT 2014 PRIMARY EDITORS Primary Editors Michael F. Rotondo, MD, FACS Chief Executive Officer – University of Rochester Medical Faculty Group Senior Associate Dean for Clinical Affairs – School of Medicine and Dentistry Professor – Division of Trauma and Acute Care Surgery, Department of Surgery Rochester, NY Chris Cribari, MD, FACS Medical Director Acute Care Surgery Medical Center of the Rockies University of Colorado Health Loveland, CO R. Stephen Smith, MD, FACS Chair, Department of Surgery University of South Carolina School of Medicine Columbia, SC Staff of the ACS Committee on Trauma Carol Williams Administrative Director (retired) Trauma Programs Jean Clemency Administrative Director Trauma Programs Marlene (Molly) Lozada Program Administrator Verification, Review, & Consultation Program Nels D. Sanddal, PhD, REMT Manager Trauma Systems and Trauma Center Verification Programs Contributing Authors Since the revision of this document spanned several years, it is impossible to list each contributing author without inadvertently excluding one, or several, important contributors. Contributing Organizations Similarly, it is impossible to list all of the professional organizations and associations who have reviewed and provided input into the various drafts of this edition of Resources for Optimal Care of the Injured Patient. RESOURCES FOR OPTIMAL CARE OF THE INJURED PATIENT 2014 iii INTRODUCTION History The American College of Surgeons (ACS) was founded in 1913 on the basic principles of improving the care of surgical patients and the education of surgeons. The ACS Committee on Trauma (ACS-COT) is the oldest standing committee of the College. Established in 1922 by Charles L. Scudder, MD, FACS, this committee focuses on improving the care of injured patients, believing that trauma is a surgical disease demanding surgical leadership. This resources document was first published in 1976 and established guidelines for care of injured patients. The evolution of the name of this document corresponds with the evolution of the philosophy of care set forth by the ACS-COT. The initial name, Optimal Hospital Resources for Care of the Injured Patient (1976), evolved to Resources for Optimal Care of the Injured Patient (1990 and 1993). This subtle change in emphasis from “optimal hospital resources” to “optimal care, given available resources” reflects an important and abiding principle: The needs of all injured patients are addressed wherever they are injured and wherever they receive care. This subtle name change better acknowledges that few individual facilities can provide all resources to all patients in all situations. This reality forces the development of a trauma system of care instead of simply developing trauma centers. An ideal trauma system includes all the components identified with optimal trauma care, such as prevention, access, prehospital care and transportation, acute hospital care, rehabilitation, and research activities. The term “inclusive” trauma system is used for this all-encompassing approach, as opposed to the term “exclusive” system, which focuses only on the major trauma center. It must be noted however that an “inclusive” system does not mean an unplanned or unregulated system. Each facility should have an identifiable role based on resources and needs of the community rather than their self-selected level of designation. Although this document still addresses trauma center verification and consultation, it also emphasizes the need for various levels of trauma centers to cooperate in the care of injured patients to avoid wasting precious medical resources. The intent of this emphasis is to provide optimal care in a cost-effective manner. In this revision the principles of developing an inclusive trauma system were further refined. Level I and II criteria were reviewed and revised to ensure that both types of trauma centers are available to provide high quality definitive care. Level IV trauma center criteria were further expanded including the need for participation in the broader regional trauma system. Early clinical decision making is emphasized in the evaluation and transfer of patients, similar to the principles outlined in the Rural Trauma Team Development Course. RESOURCES FOR OPTIMAL CARE OF THE INJURED PATIENT 2014 1 INTRODUCTION Definitive Care Facilities Essential to the development of a trauma care system is the designation of definitive trauma care facilities. The trauma care system is a network of definitive care facilities that provides a spectrum of care for all injured patients. In an area with adequate Level I resources, it may not be necessary to have Level II centers. Similarly, when Level I, II, and III centers can provide care for the volume of trauma patients in the region, Level III centers may not be necessary. Level II and III centers will be essential for the care of patients in rural and more remote regions. It must be emphasized that in any trauma system, the designating authority should be responsible for determining the anticipated volume of major trauma patients and assessing available resources to determine the optimal number and level of trauma centers in a given area. Conceptually, effective trauma systems must have a lead hospital. These lead hospitals should be the highest level available within the trauma system. In many areas, Level I centers will serve as the lead hospitals. In systems with less dense populations, Level II facilities may assume this role. In smaller community and rural settings, Level
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