Summary of the Requirements for a Trauma Coordinator
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Registered Nurse recommended
Demonstrated expertise in trauma care
Professional accreditation (ATS)
Continuing education in trauma/trauma nursing
Demonstrated PI management experience
Knowledgeable of Trauma Registry functions and management
Demonstrated development of trauma program and systems
Clinical expertise
Advanced clinical education in trauma related care
Budget experience
Proven management experience
Role of a Trauma Coordinator
The five components of a Trauma Coordinators role:
1. Clinical Activities
- Assures that standards of care are met for patients throughout the trauma
care continuum
-
Applies primary and secondary assessment and interventions based in
ATLS guidelines for trauma resuscitation (practice management
guidelines and algorithms)
-
Integration of multidisciplinary team
-
Monitors and assures data collection
-
Patient advocate within Trauma system
-
Conducts/supervises patient rounds, follow-up and regional referrals
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Reviews documentation for accuracy and completeness for Trauma
Registry and PI
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Provides feedback to nursing and ancillary staff
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Make recommendation regarding Transfers:
Major chest injury, aorta and cardiac injury
Prolonged ventilation
Head and spinal cord injury
Amputation, mangled extremities, vascular injury
Major burns
Children and pregnancy
Late effect_ sepsis, MODS and tissue necrosis
(The five components of a Trauma Coordinators role- continued)
2. Professional and Public Education
- Assures personal educational needs are met
- Performs literature reviews
3. Research Activities
- Interprets and communicates recent nursing innovations and research
findings
- Assists with data collection
4. QA Activities
- Develops plans and implements PI for trauma dept.
- Co-Chairs Trauma Committee
- Analyzes Trauma data and provides feedback to staff
- Manages Trauma Registry
5. Administrative Functions
- Implementation of protocols and standards for “best practices”
- Management of Trauma Budget
- Coordinates multi-disciplinary trauma committee
- Liaison with state and local EMS and governmental groups
- Assists with strategic plan for trauma program
- Plans and supervises trauma education courses for Trauma nurses and
ancillary staff
Trauma Coordinator Roles – Further Defined
As this job and its requirements are relatively new in healthcare, there are obvious
differences between an experienced Trauma Coordinator and a Novice Trauma
Coordinator.
A Novice Trauma Coordinator will be an RN with at least one year full-time
experience working in an Emergency Department.
The primary focus of the Novice will be:
- Verification and designation
- Establish /learn Trauma Registry
- Setup/evaluate program process
- Clinical care and clinical care guidelines
- Design, implementation and evaluation of a PI program
- Establish reporting systems
- Provide input into trauma budget
- Develop job descriptions and performance requirements
- Design evaluation tools
- Establish administrative goals
- Develop and implement P&P, practice management guidelines
- Determine Team roles and responsibilities
- Develop education for all areas
- Develop prevention programs, both in-house and community
A Transitional Trauma Coordinator will have proven effectiveness in all of the roles
of the Novice as well as:
- Administrative responsibilities
- Implementation of care management
- Develop EMS and regional protocols and relationships
- Develop Trauma conferences and education for nurses and physicians and pre-hospital
personnel.
- Professional development will include TCAC
An Expert Trauma Coordinator will have all of the above to include:
- Successfully completed 2 or more ACoS/State Verification reviews.
- Expand the use of the Trauma Registry from data collection to information production
- Involvement in regional and national PI activities
- Involvement in National Committee and councils
- Evaluate of fiscal performance
- Hold Trauma Conferences
- Approved Site surveyor
- Trauma research/publication
- Assuring market position for institution
Profile of a Trauma Coordinator
Age - 38.5 years
Gender - female
Experience - 3.3 years
Education - 75% BSN or greater
Optional Titles for a Trauma Coordinator:
Administrative Director/Trauma Critical Care
Clinical Leader of Trauma Services
Clinical Nurse Specialist Trauma Services
Trauma Nurse Coordinator
Coordinator, Program Manager, Director of Trauma Services
Trauma Nurse Practitioner
CME Requirements
All members of the trauma team must be knowledgeable about current practices
in trauma care. The trauma medical director and liaison from neurosurgery,
orthopaedic surgery, and emergency medicine must accrue an average of 16
hours annually or 48 hours over three years of verifiable external trauma-related
CME. The other general surgeons, neurosurgeons, orthopaedic surgeons, and
emergency medicine physicians who take trauma call in Level I and II centers
also must be knowledgeable and current in care of the injured patient. This
requirement may be met by documenting acquisition of 16 hours of CME per
year on average or by demonstrating participation in an internal educational
process conducted by the trauma program based on the principles of practicebased learning and the performance improvement and patient safety program.
Examples of Information that an Experienced Trauma Coordinator MUST know
Staffing:
1. If a surgeon has completed a residency, he/she is eligible to take call as
the attending in an adult hospital.
2. Mandatory presence for resuscitation in the Emergency Department (ED)
is interpreted to mean the attending surgeon's presence in the
resuscitation bay upon patient arrival, with proper notification from the
field. (See also F.13.)
3. There must be a mechanism for communication of P/I results transferred
to part-time (non-core) group attending trauma surgeons, with
documentation.
4. If a surgeon is not board certified but is in the process of taking the
American Board of Surgery examination, he/she is eligible to be included
on the trauma call panel.
5. Surgical fellows who are board eligible and are functioning as an attending
on the trauma call panel, also need to have the same credentialing as the
other members of the trauma call panel, such as completion of ATLS®
coursework, attendance at P/I meetings, and any other credentialing
required of any attending surgeon.
6. There must be a multidisciplinary peer review committee—with
participation by the trauma medical director, or designee, and
representatives from general surgery, orthopaedic surgery, neurosurgery,
emergency medicine, and anesthesia—working to improve trauma care by
reviewing selected deaths, complications, and sentinel events with the
objectives of identifying issues and appropriate responses. Participation
should include attendance by the aforementioned representatives at no
less than 50 percent of the multidisciplinary committee meetings. General
surgery attendance at the multidisciplinary peer review committee is
essential, as the general surgeon is the foundation for trauma care in the
trauma program. Attendance by each member of the core group of
general surgeons should be at least 50% of the multidisciplinary
committee meetings.
7. The trauma medical director at each trauma center is to decide which
surgeons constitute the core group and is to define objective criteria as to
how the important information from the performance improvement
committee is sent to the non-core group. The core group is expected to
take 60 percent of trauma call hours.
8. Physicians with trauma privileges must have full and unrestricted
privileges in the specialty in which they practice and in the department
with which they are affiliated.
9. For a Level I trauma center, either a senior-level resident or an attending
must be in house at all times.
10. General surgeons, neurosurgeons, and/or orthopaedic surgeons on the
trauma call panel must have full and unrestricted privileges in the specialty
for which they are credentialed.
11. In a Level I trauma center, the trauma medical director can be a Fellow of
the ACS and must possess documentation of an appropraite number of
years of formal postdoctoral surgical education or board certification.
12. The trauma medical director is not eligible via the alternate pathway
criteria.
13. A trauma medical director cannot be the trauma medical director at two
trauma centers.
14. A Level I trauma center must have its own full-time trauma program
manager. This includes a pediatric Level I hospital. A Level II center can
have a part-time manager.
15. Trauma medical directors in the Level I, II, or III trauma centers should be
current in ATLS, but do not have to be instructors.
16. Trauma medical directors must take trauma call.
17. In a Level I pediatric trauma center, there must be at least two pediatrictrained orthopaedic surgeons, neurosurgeons, pediatric surgeons, and
emergency medicine physicians.
18. Pediatric CME has been eliminated as a requirement.
19. There are no volume requirements for Level I trauma centers caring only
for children.
20. For pediatric Level I trauma centers, the CT tech is no longer required to
be in-house 24 hours seven days a week, but physical presence after
notification must be in less than 30 minutes. This is to be monitored by the
P/I process.
21. The pediatric surgical resident who is board eligible or board certified in
general surgery, taking further training in pediatrics, can be the response
person leading a primary resuscitation in a hospital that takes care of
children only.
Research requirements for verified trauma centers
1. Research committee requirement has been eliminated.
2. Research director requirement also has been eliminated.
3. Essential criteria for having at least one paper from each of the four main
medical professions (general surgery, emergency medicine, orthopaedic
surgery, and neurosurgery) is also eliminated.
4. There must be 10 papers per three-year interval.
5. Credit for scientific publications is acceptable if the reviewers think giving
credit is justified, even if not published in a mainstream peer-review
journal, but rather published in other forms.
6. Presentations made in foreign countries are acceptable for inclusion in the
count of total trauma presentations made.
7. A manuscript, but not an abstract, is an acceptable document for a
research requirement. Index Medicus listing is the gold standard.
Certification and educational requirements for verified trauma centers
1. The Verification Review Committee (VRC) does not recognize credit for
studying for successful completion of board certification renewal without a
certificate stating the number of hours and category.
2. Lack of Continuing Education Units (CEUs) for nurses in the ICU and ED
is no longer a deficiency, but is a weakness.
3. Category I or II CME must be accredited by an organization that is
accredited by the Accreditation Council for Graduate Medical Education
(ACGME) and/or other organizations.
4. In Level I, II, and III trauma centers, all members of the trauma team
should be knowledgeable about current practices in trauma care. In Level
I and II trauma centers, the trauma medical director and the liaisons from
neurosurgery, orthopaedic surgery, and emergency medicine must accrue
an average of 16 hours annually or 48 hours over three years of verifiable
external trauma-related Continuing Medical Education (CME). Programs
given by visiting professors, invited speakers, and teaching an ATLS
course are considered outside education. The other general surgeons,
neurosurgeons, orthopaedic surgeons, and emergency medicine
physicians who take trauma call in Level I and II centers also must be
knowledgeable and current in care of the injured patient. This requirement
may be met by documenting acquisition of 16 hours of CME per year on
average or by demonstrating participation in an internal educational
process conducted by the trauma program based on the principles of
practice-based learning and the performance improvement and patient
safety program.
Policies regarding trauma admissions and transfers and criteria for major
resuscitation
1. If a Level I trauma center is to include burn patients toward its total trauma
admissions, those burn cases should be involved in the P/I process for
trauma. If the burn patients are admitted to a separate service and the
trauma surgeon is not involved, then the number should not count.
2. If a Level III trauma center has neurosurgical coverage, that center should
be held to the same standards as a Level II trauma center, or that center
should consistently transfer neurosurgical cases to a higher level of care,
i.e. Level I or II.
3. If nonsurgical admits total 10 percent or greater of total admissions, there
must be a P/I process to look at these admissions.
4. Trauma patient admissions to nonsurgical services should not count
toward total admissions for volume requirements in the Level I hospitals.
5. Additional documents submitted to the ACS after a review must be signed
by the hospital’s CEO.
6. Trauma patients admitted to the hospital who do not meet the highest
level of activation should be seen by the attending surgeon in a time
deemed appropriate by the hospital, which is to be monitored by the
hospital's P/I program, and will be checked by the reviewers at the time of
the review.
7. A Level I trauma center does not need a cardiac cath lab.
8. All patients admitted to a Level I trauma center should be treated by that
center, except for burns and the rare patient requiring replant.
9. Surgical traction devices are no longer an essential in the emergency
department.
10. An ICU log documenting the response or presence of the surgeon is no
longer required.
11. The date on the certificate for an initial verification review will be the date
on which the Verification Review Committee has agreed the hospital has
met all essential criteria. The date on the certificate for a reverification
review that requires a focus review will be the date of the notification of the
results of the original reverification review.
12. Platelets should be available within 45 minutes of request at Level I, II,
and III trauma centers.
13. For Level I, II, and III trauma centers, the trauma surgeon is expected be
in the emergency department upon patient arrival, with adequate
notification from the field. For Level I and II trauma centers, the maximum
acceptable response time is 15 minutes and for Level III trauma centers,
the maximum acceptable response time is 30 minutes. Response time will
be tracked from patient arrival rather than from notification or activation,
with an 80 percent threshold.
14. Criteria for trauma admissions toward volume performance include:
a. Admissions with ICD-9 diagnosis code between 800.00 and 959.9,
excluding 905 to 909;
b. Admissions for 23-hour observation;
c. Patients who were admitted or who died after receiving any
evaluation or treatment.
15. The minimum criteria for the definition of a major resuscitation are as
follows:
. Confirmed blood pressure <90 at any time in adults and age-specific
hypotension in children;
a. Gunshot wounds to the neck, chest, or abdomen;
b. GCS <8 with mechanism attributed to trauma;
c. Transfer patients from other hospitals receiving blood to maintain
vital signs;
d. Respiratory compromise/obstruction and/or intubation in a patient
who is not transferred from another facility;
e. Emergency physician's discretion.
Chart write-ups
1. A: Effective April 2003, chart write-ups cannot include date of injury, date
of admission, date of discharge, or medical record number.
2. It is recommended that solid organ injuries be graded.
3. For Level II trauma centers with low volumes, the ED may be left
uncovered (for response to in-house codes) with a P/I filter if no other
physician is in house.
Neurosurgery backup call coverage
1. The neurosurgery backup call coverage requirement can be met by the
following:
a. A published backup call schedule;
b. A chief neurosurgery resident;
c. Redirect to a similar or higher-level verified trauma center with
available neurosurgery coverage within the community;
d. A trained trauma surgeon credentialed to treat;
Any patient diverted or transferred must be reviewed by the trauma PI program