|
LEVELS |
| A facility with a
designated trauma
service must have: |
I |
II |
III |
IV |
V |
| (1) An emergency
department, including: |
X |
X |
X |
X |
|
| (a) An area designated for
adult and pediatric
resuscitation; |
X |
X |
X |
X |
|
| (b) Written standards of
care to ensure immediate
and appropriate care for
adult and pediatric trauma
patients; |
X |
X |
X |
X |
|
| (c) A physician director
who: |
X |
X |
X |
|
|
| (i) Is board-certified in
emergency medicine,
surgery or other relevant
specialty (or for level I,
has documented
experience as director of
an emergency department
which has been
previously recognized as
a level I trauma center
either by a regional entity
or as verified by the
Committee on Trauma of
the American College of
Surgeons); |
X |
X |
X |
|
|
| (ii) Is ATLS and ACLS
trained, except this
requirement does not
apply to a physician
board-certified in
emergency medicine or
surgery; |
X |
X |
X |
|
|
| (iii) Has completed the
pediatric education
requirement (PER) as
defined in WAC 246-976-886, except that
this requirement does not
apply to a physician
board-certified in pediatric
emergency medicine; |
X |
X |
X |
|
|
| (d) Physicians who: |
X |
X |
X |
X |
|
| (i) Are board-certified in
emergency medicine, or
board-certified in a
specialty and practicing
emergency medicine as
their primary practice with
special competence in
care of trauma patients;
(level I only - this
requirement may be met
by a surgical resident
postgraduate year two
who is ATLS and ACLS
trained, has completed the
PER as defined in WAC 246-976-886, and is
working under the direct
supervision of the
attending emergency
physician, until the arrival
of the surgeon to assume
leadership of the trauma
team); |
X |
X |
|
|
|
| (ii) Have special
competence in
resuscitation, care and
treatment of trauma
patients; |
X |
X |
X |
X |
|
| (iii) Are available within
five minutes of patient's
arrival in the emergency
department; |
X |
X |
X |
|
|
| (iv) Are on-call and
available within twenty
minutes of notification of
patient arrival. A
physician assistant or
advanced registered
nurse practitioner who is
ACLS and ATLS trained
and has completed the
PER requirement, may
initiate evaluation and
treatment upon the
patient's arrival in the
emergency department
until the arrival of the
attending physician; |
|
|
|
X |
|
| (v) Are ATLS and ACLS
trained, except this
requirement does not
apply to a physician
board-certified in
emergency medicine; |
X |
X |
X |
X |
|
| (vi) Have completed the
PER as defined in WAC 246-976-886, except this
requirement does not
apply to a physician
board-certified in pediatric
emergency medicine (or
emergency medicine for
level IV); |
X |
X |
X |
X |
|
| (e) Registered nurses
who: |
X |
X |
X |
X |
|
| (i) Are in the emergency
department and available
within five minutes of
patient's arrival; |
X |
X |
X |
|
|
| (ii) Are in-house and
available within five
minutes of notification of
patient arrival; |
|
|
|
X |
|
| (iii) Are ACLS trained; |
X |
X |
X |
X |
|
| (iv) Have completed the
PER as defined in WAC 246-976-886; |
X |
X |
X |
X |
|
| (v) Have successfully
completed a trauma life
support course as defined
in WAC 246-976-885; |
X |
X |
X |
X |
|
| (2) Emergency care
services available
twenty-four hours every
day with: |
|
|
|
|
X |
| (a) An area designated for
adult or pediatric
resuscitation; |
|
|
|
|
X |
| (b) Written standards of
care to ensure immediate
and appropriate care of
adult and pediatric trauma
patients; |
|
|
|
|
X |
| (c) A physician, physician
assistant, or advanced
registered nurse
practitioner, on-call and
available within twenty
minutes of notification of
team activation, who has
ATLS training, except the
ATLS requirement does
not apply to a physician
board-certified in
emergency medicine or
board-certified in surgery; |
|
|
|
|
X |
| (3) Equipment for
resuscitation and life
support of pediatric and
adult trauma patients,
including equipment
described in WAC 246-976-620; |
X |
X |
X |
X |
X |
| (4) Radiological services,
with: |
X |
X |
X |
X |
|
| (a) A radiologist on-call
and available within
twenty minutes of team
leader's request; |
X |
X |
|
|
|
| (b) A radiologist on-call
and available within thirty
minutes of team leader's
request; |
|
|
X |
|
|
| (c) A technician able to
perform routine
radiological capabilities: |
X |
X |
X |
X |
|
| (i) Available within five
minutes of notification of
team activation; |
X |
X |
|
|
|
| (ii) On-call and available
within twenty minutes of
notification of team
activation; |
|
|
X |
X
|
|
| (d) A technician able to
perform computerized
tomography: |
X |
X |
X |
|
|
| (i) Available within five
minutes of team leader's
request; |
X |
|
|
|
|
| (ii) On-call and available
within twenty minutes of
team leader's request; |
|
X |
X |
|
|
| (e) A technician on-call
and available within
twenty minutes of team
leader's request, able to
perform the following: |
X |
X |
|
|
|
| (i) Angiography of all
types; |
X |
X |
|
|
|
| (ii) Sonography; |
X |
X |
|
|
|
| (5) Respiratory therapy
available within five
minutes of notification of
team activation; |
X |
X |
|
|
|
| (6) Respiratory therapy
on-call and available
within thirty minutes of
notification of team
activation; |
|
|
X |
|
|
| (7) Clinical laboratory
services, including: |
X |
X |
X |
X |
|
| (a) A clinical laboratory
technologist available
within five minutes of
notification of team
activation; |
X |
X |
X |
|
|
| (b) A clinical laboratory
technologist on-call and
available within twenty
minutes of notification of
team activation; |
|
|
|
X |
|
| (c) Standard analysis of
blood, urine, and other
body fluids; |
X |
X |
X |
X |
|
| (d) Coagulation studies; |
X |
X |
X |
X |
|
| (e) Blood gases and pH
determination; |
X |
X |
X |
X |
|
| (f) Serum and urine
osmolality; |
X |
X |
|
|
|
| (g) Microbiology; |
X |
X |
X |
|
|
| (h) Serum alcohol
determination; |
X |
X |
X |
X |
|
| (i) Drug or toxicology
screening; |
X |
X |
X |
X |
|
| (8) Blood and
blood-component
services, including: |
X |
X |
X |
X |
|
| (a) Blood and blood
components available
from in-house or through
community services, to
meet patient needs; |
X |
X |
X |
X |
|
| (b) Noncrossmatched
blood available on patient
arrival in the emergency
department; |
X |
X |
X |
X |
|
| (c) Ability to obtain blood
typing and
crossmatching; |
X |
X |
X |
X |
|
| (d) Policies and
procedures for massive
transfusion; |
X |
X |
X |
X |
|
| (e) Autotransfusion; |
X |
X |
X |
|
|
| (f) Blood storage
capability; |
X |
X |
X |
X |
|
| (9) A surgery department,
including: |
X |
X |
X |
X |
|
| (a) General surgery
services, with: |
X |
X |
X |
|
|
| (i) An attending,
board-certified general
surgeon available within
five minutes of
notification of team
activation. A
postgraduate year four or
above surgical resident
may initiate evaluation
and treatment upon the
patient's arrival in the
emergency department
until the arrival of the
attending surgeon. In
this case the attending
surgeon must be available
within twenty minutes of
notification of team
activation; |
X |
|
|
|
|
| (ii) An attending,
board-certified general
surgeon on-call and
available within twenty
minutes of notification of
team activation. A
postgraduate year four or
above surgical resident
may initiate evaluation
and treatment upon the
patient's arrival in the
emergency department
until the arrival of the
attending surgeon. The
attending surgeon must
be available within twenty
minutes upon notification
of team activation; |
|
X |
|
|
|
| (iii) An attending general
surgeon, on-call and
available within thirty
minutes of notification of
team activation; |
|
|
X |
|
|
| (iv) All general surgeons
(and surgical residents for
level I and II) who are
responsible for care and
treatment of trauma
patients must: |
X |
X |
X |
|
|
| (A) Be trained in ATLS
and ACLS, except this
requirement does not
apply to a physician
board-certified in surgery;
and |
X |
X |
X |
|
|
| (B) Have completed the
PER as defined in WAC 246-976-886; and |
X |
X |
X |
|
|
| (C) Have specific
delineation of trauma
surgery privileges by the
medical staff; |
X |
X |
X |
|
|
| (b) Surgery services with
a general surgeon or
physician with specific
delineation of surgical
privileges by the medical
staff for resuscitation,
stabilization and treatment
of trauma patients. The
physician must be: |
|
|
|
X |
|
| (i) On-call and available
within thirty minutes of
notification of team
activation; |
|
|
|
X |
|
| (ii) ATLS and ACLS
trained, except this
requirement does not
apply to a physician
board-certified in surgery; |
|
|
|
X |
|
| (c) Neurosurgical services
with: |
X |
X |
|
|
|
| (i) A neurosurgeon: |
X |
X |
|
|
|
| (A) Available within five
minutes of team leader's
request. A postgraduate
year four or above
neurosurgery resident
may initiate evaluation
and treatment upon the
patient's arrival in the
emergency department
until the arrival of the
attending neurosurgeon.
In this case the
neurosurgeon must arrive
within thirty minutes of
team leader's request; |
X |
|
|
|
|
| (B) On-call and available
within thirty minutes of
team leader's request; |
|
X |
|
|
|
| (ii) Ability to provide
acute and ongoing care
for acute head and spinal
cord injuries; |
X |
X |
|
|
|
| (d) Ability to resuscitate
and stabilize acute head
and/or spinal cord
injuries; |
|
|
X |
X |
|
| (e) A neurosurgeon
on-call and available
within thirty minutes of
team leader's request or
written transfer guidelines
and agreements for head
and spinal cord injuries; |
|
|
X |
X |
|
| (f) The following surgical
services on-call and
available within thirty
minutes as requested by
the trauma team leader: |
X |
X |
X |
|
|
| (i) Cardiac surgery; |
X |
|
|
|
|
| (ii) Microsurgery; |
X |
|
|
|
|
| (iii) Obstetric surgery (or,
for level III, a plan to
manage the pregnant
trauma patient); |
X |
X |
X |
|
|
| (iv) Orthopedic surgery; |
X |
X |
|
|
|
| (v) Thoracic surgery; |
X |
X |
|
|
|
| (vi) Urologic surgery; |
X |
X |
|
|
|
| (vii) Vascular surgery. |
X |
X |
|
|
|
| (g) The following surgical
services on-call for
patient consultation or
management: |
X |
X |
X |
|
|
| (i) Gynecologic surgery; |
X |
X |
|
|
|
| (ii) Ophthalmic surgery; |
X |
X |
|
|
|
| (iii) Oral/maxillofacial or
otorhinolaryngologic
surgery; |
X |
X |
|
|
|
| (iv) Plastic surgery; |
X |
X |
|
|
|
| (v) Orthopedic surgery; |
|
|
X |
|
|
| (10) Anesthesiology, with
an anesthesiologist (or
certified registered nurse
anesthetist for level III
and IV) who: |
X |
X |
X |
X |
|
| (a) Is available within five
minutes of team leader's
request; |
X |
|
|
|
|
| (b) Is on-call and available
within twenty minutes of
team leader's request; |
|
X |
|
|
|
| (c) Is on-call and available
within thirty minutes of
team leader's request; |
|
|
X |
X |
|
| (d) Is ACLS trained,
except this requirement
does not apply to a
physician board-certified
in anesthesiology; |
X |
X |
X |
X |
|
| (e) Has completed the
pediatric education
requirement (PER) as
defined in WAC 246-976-886; |
X |
X |
X |
|
|
| (11) An operating room
and a registered nurse or
designee responsible for
opening and preparing
the operating room,
available within five
minutes of notification of
team activation, with: |
X |
X |
X |
X |
|
| (a) Other essential
personnel as identified by
the trauma service on-call
and available within
twenty minutes of
notification of team
activation; |
X |
X |
|
|
|
| (b) Other essential
personnel as identified by
the trauma service on-call
and available within thirty
minutes of notification of
team activation; |
|
|
X |
X |
|
| (c) A written policy
providing for mobilization
of additional surgical
teams for trauma patients;
and |
X |
X |
X |
|
|
| (d) Instruments and
equipment appropriate for
pediatric and adult
surgery, including
equipment described in
WAC 246-976-620. |
X |
X |
X |
X |
|
| (12) A postanesthetic
recovery service with: |
X |
X |
X |
X |
|
| (a) At least one registered
nurse available
twenty-four hours a day; |
X |
|
|
|
|
| (b) At least one registered
nurse on-call and
available twenty-four
hours a day; |
|
X |
X |
X |
|
| (c) Nurses ACLS trained; |
X |
X |
X |
X |
|
| (d) Nurses who have
completed the PER as
defined in WAC 246-976-886; and |
X |
X |
X |
|
|
| (13) A critical care service
with: |
X |
X |
X |
|
|
| (a) A medical director who
is: |
|
|
|
|
|
| (i) Board-certified in
surgery with special
competence in critical
care; |
X |
|
|
|
|
| (ii) Board-certified in
surgery, internal medicine,
or anesthesiology, with
special competence in
critical care; |
|
X |
X |
|
|
| (iii) Responsible for
coordinating with the
attending staff for the
care of trauma patients; |
X |
X |
X |
|
|
| (b) A physician directed
code team; |
X |
X |
X |
|
|
| (c) Critical care registered
nurses with special
competence in trauma
care, who: |
X |
X |
X |
|
|
| (i) Are ACLS trained; and |
X |
X |
X |
|
|
| (ii) Have successfully
completed a trauma life
support course as defined
in WAC 246-976-885; |
X |
X |
X |
|
|
| (d) Designation as a
pediatric trauma service
or written transfer
guidelines and
agreements for pediatric
trauma patients requiring
critical care services; |
X |
X |
X |
|
|
| (e) Equipment as
described in WAC 246-976-620; |
X |
X |
X |
|
|
| (14) A critical care service
which meets requirements
for a level III trauma
service, if critical care
services are included in
your written scope of
trauma service, or written
transfer guidelines and
agreements for trauma
patients requiring critical
care services; |
|
|
|
X |
|
| (15) Acute dialysis
capability, or written
transfer agreements for
dialysis services; |
X |
X |
X |
X |
|
| (16) The following
services on-call and
available for patient
consultation or
management during the
in-patient stay: |
X |
X |
X |
|
|
| (a) Cardiology; |
X |
X |
|
|
|
| (b) Gastroenterology; |
X |
X |
|
|
|
| (c) Hematology; |
X |
X |
|
|
|
| (d) Infectious disease
specialists; |
X |
X |
|
|
|
| (e) Internal medicine; |
X |
X |
X |
|
|
| (f) Nephrology; |
X |
X |
|
|
|
| (g) Neurology; |
X |
X |
|
|
|
| (h) Pathology; |
X |
X |
X |
|
|
| (i) Pediatrics; |
X |
X |
|
|
|
| (j) Pulmonology; |
X |
X |
|
|
|
| (k) Psychiatry or care plan
for trauma patients
requiring psychiatric
management; |
X |
X |
|
|
|
| (17) Written policy and
procedures for access to
ancillary services for
in-patient care, including: |
X |
X |
X |
X |
|
| (a) Chemical dependency
services; |
X |
X |
X |
|
|
| (b) Child and adult
protection services; |
X |
X |
X |
X |
|
| (c) Clergy or pastoral
care; |
X |
X |
X |
X |
|
| (d) Nutritionist services; |
X |
X |
X |
X |
|
| (e) Pharmacy services,
with pharmacist in-house; |
X |
|
|
|
|
| (f) Pharmacy services; |
|
X |
X |
X |
|
| (g) Occupational therapy
services; |
X |
X |
X |
|
|
| (h) Physical therapy
services; |
X |
X |
X |
X |
|
| (i) Speech therapy
services; |
X |
X |
X |
|
|
| (j) Social services; |
X |
X |
X |
X |
|
| (k) Psychological
services; |
X |
X |
X |
|
|
| (18) Ability to resuscitate
and stabilize burn
patients; |
X |
X |
X |
X |
X |
| (19) A physician directed
burn unit staffed by
nursing personnel trained
in burn care and equipped
to care for extensively
burned patients; or
written transfer guidelines
and agreements in
accordance with the
guidelines of the
American Burn
Association; |
X |
X |
X |
X |
X |
| (20) A trauma
rehabilitation coordinator
to facilitate the trauma
patient's access to
rehabilitation services; |
X |
X |
X |
|
|
| (21) A designated trauma
rehabilitation service; or
written agreements to
transfer patients to a
designated trauma
rehabilitation service
when medically feasible. |
X |
X |
X |
|
|