Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0056 - Trauma Program, Wyoming › Chapter 4 - FACILITY STANDARDS › Section 4-3 - Community Trauma Hospitals

Current through July 13, 2024
Community Trauma Hospitals (CTH) are generally small, rural
				  facilities with a commitment to the resuscitation of the trauma patient and
				  with written transfer protocols in place to assure those patients who require a
				  higher level of care are appropriately transferred for definitive care. The
				  hospital is predominantly staffed with family physicians experienced and/or
				  trained across a broad composite field of medicine including appropriate areas
				  of acute trauma management. Frequently, these physicians are the obstetric and
				  intensive care providers of the TSA. They commonly work in consultation with a
				  board certified general surgeon who is committed to trauma management. A system
				  for early notification of the physician on call shall be developed so that he
				  can consistently be present at the time of arrival of the major trauma patient
				  in the emergency department. This level of designation requires a
				  general/trauma surgeon on call and promptly available to respond to the trauma
				  patient. However, this level contemplates that there may be only one surgeon in
				  the community and he may not be available at all times. During periods when the
				  surgeon is not available, the hospital must notify other facilities that
				  routinely transfer/refer patients to the CTH for emergency surgical
				  services.20 Since this level contemplates a surgeon
				  in the community who is committed to trauma care, it is anticipated that the
				  CTH shall provide initial resuscitation and immediate operative intervention to
				  control hemorrhage to assure maximum stabilization prior to transfer to a
				  higher level of care. In many instances, patients will be maintained in the CTH
				  unless the medical needs of the patient require secondary transfer. The
				  decision to transfer a patient rests with the physician attending the trauma
				  patient. An institution intending to provide prolonged ventilatory care must
				  assure that a physician qualified to provide ventilatory care is available at
				  all times. If physician support is not available twenty-four (24) hours per
				  day, transfer to a higher level of care is recommended.
(a) Hospital Organization.
(i) Trauma Program. The trauma program shall
				be established and recognized by the medical staff and hospital administration.
				The trauma program shall come under the overall organization and direction of a
				general surgeon or emergency physician who is trained, experienced, and
				committed to the care of the injured patient.
(ii) Trauma Program Director. The director
				must be a board certified general surgeon, a board certified emergency
				physician, or a board certified physician with demonstrated competency in
				trauma care. The director shall develop a quality improvement process and,
				through this process, shall be responsible for all trauma patients and
				administrative authority for the hospital's trauma program. The director must
				be given administrative support to implement the requirements specified by the
				Wyoming Trauma Plan.21
(iii) Trauma Team. The hospital shall have a
				policy describing the respective roles of all personnel on the trauma team. The
				composition of the trauma team in any hospital will depend on the
				characteristics of development, communication among all team members,
				development of standards of care, education and outreach programs, and
				interaction with appropriate groups for injury prevention. Suggested membership
				for the committee include representatives (if available in the community) from:
(A) Surgeons;
(B) Emergency physicians;
(C) Anesthesia;
(D) Laboratory technician;
(E) Physician with emergency department
				privileges;
(F) Prehospital care
				providers;
(G) Respiratory
				therapist;
(H) Family physician(s)
				skilled in trauma care;
(I)
				Registered nurses;
(J) Physician
				specialists as dictated by clinical needs;
(K) Radiology technician; and
(L) Social services/pastoral care.
(iv) Trauma Nurse Coordinator. A
				CTH shall have at least a part-time registered nurse working in the role of a
				trauma nurse coordinator. Working in conjunction with the trauma program
				director, the trauma nurse coordinator shall organize the program and all
				systems necessary for the multi disciplinary approach throughout the continuum
				of trauma care. The trauma nurse coordinator shall coordinate optimal patient
				care for all injured patients.22
(v) Multi Disciplinary Trauma Committee. The
				purpose of the committee is to provide oversight and leadership to the entire
				trauma program. The committee shall focus on quality improvement activities,
				policy development, communication among all team members, development of
				standards of care, education and outreach programs, and interaction with
				appropriate groups for injury prevention. The clinical managers (or designees)
				of the organizational areas involved in trauma care shall play an active role
				with the committee. The committee shall include representatives from each of
				the following areas, unless the hospital has no such organizational area
				defined:
(A) Administration;
(B) Anesthesia;
(C) Emergency department;
(D) Family physicians;
(E) General surgery;
(F) Intensive Care;
(G) Medical Records;
(H) Pediatrics;
(I) Nursing;
(J) Prehospital care providers;
(K) Radiology;
(L) Rehabilitation;
(M) Respiratory therapy; and
(N) Trauma Nurse Coordinator.