Required Clinical Components

Required Clinical Components 1. Tertiary pediatric Trauma Centers must maintain published call schedules and have the following physician coverage immediately available 24 hours/day: 2. Pediatric 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. 3. Trauma/General/Pediatric Surgery (in-house 24 hours/day). The surgeon covering pediatric trauma call must be unencumbered and immediately available to respond to the pediatric trauma patient. The 24-hour-in-house availability of the attending surgeon is the most direct method for providing this involvement. A PGY 4 or 5 resident may be approved to begin the resuscitation while awaiting the arrival of the attending surgeon but cannot be considered a replacement for the attending surgeon in the ED. The surgeon is expected to be in the ED upon arrival of the seriously injured pediatric patient. The surgeon’s participation in major therapeutic decisions, presence in the ED for major resuscitation, and presence at operative procedures is mandatory. There must be a back-up surgeon schedule published. A system must be developed to assure early 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 Activations is 15 minutes and starts at patient arrival or EMS notification, whichever is shorter. Response time for Bravo Activations is 20 minutes from patient arrival. 4. Orthopedic Surgery. It is required to have the orthopedic surgeon dedicated to the pediatric Trauma Center solely while on-call, but if not dedicated, a published back-up call schedule must be available. Response time for all trauma activations is 60 minutes from the time notified to respond. 5. Neurological Surgery. The neurosurgeons on the pediatric trauma team must be board certified. The pediatric neurosurgeon liaison to the pediatric trauma team must attend a minimum of 50% of the peer review committees annually and participate in the multidisciplinary trauma committee. It is required to have the neurosurgeon dedicated to the pediatric trauma center solely while on-call, but if not dedicated, a published back-up call schedule must be available. Response time for all trauma activations is 30 minutes from the time notified to respond. 6. It is desirable the following specialists are promptly available 24 hours/day: a. Cardiac Surgery b. Cardiology c. Critical Care Medicine d. Hand Surgery e. Infectious Disease f. Microvascular Surgery g. Nephrology h. Nutritional support i. Obstetrics/Gynecologic Surgery j. Ophthalmic Surgery k. Oral/Maxillofacial l. Pediatrics m. Pediatric Critical Care Medicine n. Pediatric Rehabilitation o. Plastic Surgery p. Pulmonary Medicine q. Radiology r. Thoracic Surgery* s. Child Life or Family Support Programs * The trauma surgeon is presumed to be qualified and have privileges to provide emergency thoracic surgical care to pediatric patients with thoracic injuries. If this is not the case, the facility must have a board- certified thoracic surgeon available for the injured pediatric patient (within 30 minutes of the time notified to respond). 7. Policies and procedures must exist to notify the transferring hospital of the patient’s condition.