![]() An orthopaedic surgical resident (PGY-4 or PGY-5) may provide trauma resuscitation while the attending orthopaedist is providing patient care. Even so, a backup mechanism should be in place in case the attending is busy. Qualified attending trauma surgeons are required to be at the patient’s bedside within 15 minutes of the patient’s arrival and usually stay in the hospital 24 hours a day when on call. ![]() The ISS is calculated from the assessment of the patient’s injuries according to the Abbreviated Injury Scale (AIS) and is the sum of the squares of the highest AIS in the three most severely injured body regions.Įach Level I director of orthopaedic trauma must have completed an Orthopaedic Trauma Association (OTA)–approved fellowship in orthopaedic trauma. ISS is a complex scoring system that correlates closely to the morbidity and mortality of injured patients. To maintain this level of proficiency and ensure adequate case loads for resident education, Level I centers are required to admit at least 1,200 trauma patients annually or have 240 patients with an Injury Severity Score (ISS) greater than 15. One feature of Level I facilities is their responsibility for leadership in education, research, and system planning. They are often university-affiliated teaching facilities. These are tertiary care facilities that have established methods to efficiently accept transfers of critically ill patients. These aspirations clearly demonstrate the importance of committed orthopaedic surgeons to a well-coordinated trauma service.Ī trauma system’s Level I trauma centers are usually the most capable hospitals to provide comprehensive definitive care for the critically injured patient. ![]() They are also encouraged to also participate as an instructor in ATLS. At Level I and II centers, participating orthopaedic surgeons are encouraged to demonstrate a commitment to trauma by completing a formal trauma fellowship and participating in combat-related trauma (through military service). An alternate pathway is available for individuals who completed their training outside the United States or Canada and are not board-certified by one of these organizations.Īll orthopaedic surgeons providing trauma services must complete 48 hours of trauma-related continuing medical education every 3 years. Orthopaedic surgeons who provide trauma services at an ACS-verified trauma center must be either board-certified or board-eligible by the American Board of Orthopaedic Surgery, the American Osteopathic Association, or the Royal College of Physicians and Surgeons of Canada. The lead facility may be a Level I, II, or III center. Within a trauma system, local authorities often designate one trauma center as the lead facility and a resource facility for others within the region. Trauma centers are verified and designated from Level I (the highest) to Level IV (the lowest). Some states simply require trauma centers to be ACS verified others adopt the ACS standards and then verify and designate the centers themselves. Most of these agencies have adopted the ACS standards to one degree or another. Trauma centers are usually designated by the department of health or department of emergency medical services (EMS) in the individual state or county. Designation is a legal process implemented by the state or county with statutory authority. ![]() The ACS COTpublication, Resources for the Optimal Care of the Injured Patient, includes the standards that hospitals must meet to be verified by the ACS as a trauma center. The ACS COT meets twice a year and conducts various educational courses, including Advanced Trauma Life Support (ATLS), Rural Trauma Team Development, Advanced Trauma Operative Management, and Advanced Surgical Skills for Exposure in Trauma. Orthopaedic surgeons continue to be actively involved in the ACS COT, which has a separate subcommittee of AAOS fellows who are interested in trauma systems and their development. The ACS Committee on Trauma (COT) can trace its roots to 1922, when, as the Committee on Fractures, it sought to establish principles and guidelines that would improve the poor treatment provided to fracture patients. However, what a center is required to have to achieve a specific level and how the process actually occurs tends to be a mystery to many.įor nearly 30 years, the American College of Surgeons (ACS) has verified trauma center designations, although the ACS’ involvement with trauma care goes back much earlier. Just as sports medicine physicians tend to distinguish themselves by the notoriety of the athletic team that they cover, trauma surgeons tend to do the same by the level of trauma center that they cover.
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