Hospital governance | | | |
a) Demonstrated commitment to priority treatment of severely injured patients | E* | E | E |
|
b) Assure adequate resources and staff | E | E | E |
|
c) Be committed to the trauma system | E | E | E |
|
Medical/surgical director | | | |
a) A physician or surgeon responsible for the medical and specialty services providing trauma care within the hospital | E | E | E |
|
Medical services | | | |
a) A multiprofessional trauma system within the hospital providing priority service (i.e., operating room, laboratory, diagnostic imaging, nursing and critical care) | E | E | — |
|
b) 24-h trauma team response to include: | | | |
• Trauma team leader (maximum 20-min response time) | E† | E | — |
• General surgery consultation (maximum 20-min response time) | | | |
• Other surgical consultation as required (maximum 30-min response time) | | | |
|
c) 24-h coverage by the following surgical services (response time 30 min): | | | |
• Neurosurgery | E | O | — |
• Pediatric surgery | E | O | — |
• Urology | E | O | — |
• Vascular surgery | E | O | — |
• Plastic surgery | E | O | — |
• Thoracic surgery | E | O | — |
• Orthopedic surgery | E | D | — |
• Cardiac surgery | D | — | — |
• Gynecology and obstetrics | D | O | — |
• Ophthalmology | D | — | — |
• Otolaryngology | D | — | — |
• Oral surgery | D | — | — |
|
d) Nonsurgical specialties, 24-h schedule | | | |
• Radiology (maximum 30-min response time) | E | E | D |
• Pediatrics (maximum 30-min response time)‡ | E | O | O |
• Anesthesia (maximum 30-min response time) | E | E | O |
• Critical care (maximum 30-min response time) | E | E | — |
• Cardiology | E | D | — |
• Respirology | E | D | — |
• Gastroenterology | E | O | — |
• Hematology | E | D | — |
• Infectious disease | E | D | — |
• Internal medicine | E | E | — |
• Nephrology | E | O | — |
• Pathology | E | D | — |
• Psychiatry | E | D | — |
• Neuroradiology | E | — | — |
|
Specialty services within the hospital | | | |
a) Emergency Department | | | |
1) Personnel | | | |
• designated chief, fellow of Royal College of Physicians and Surgeons of Canada | E | D | — |
• 24-h coverage by an emergency physician with appropriate training | E | E | — |
• medical personnel in hospital | E | E | — |
• dedicated nursing personnel in hospital | E | E | D |
• surgical residents in-house 24 h/d in university hospital | D | — | — |
|
2) Equipment | | | |
• advanced airway management equipment (adults and children) | E | E | D |
• multichannel monitoring of blood pressure, pulse rate, oxygen saturation, body temperature | E | D | D |
• electrocardiograph monitor and defibrillator | E | E | O |
• dedicated portable or in-place radiography equipment | E | E | O |
• dedicated equipment for communication to ambulance services | E | E | E |
• equipment for chest tube placement and pericardiocentesis | E | E | O |
• equipment for fracture stabilization and traction | E | E | E |
• resuscitation room | E | D | — |
• rapid infusion warmer | E | D | — |
• surgical equipment (i.e., for abdominal lavage, wound closure, cricothyroidotomy, insertion of central venous and arterial lines, pericardiocentesis) | E | D | — |
|
b) Intensive care unit | | | |
1) Personnel | | | |
• medical director of intensive care | E | E | — |
• 24-h in-hospital medical attendance | E | D | — |
• dedicated intensive care unit nursing | E | E | — |
• treatment conjoint with attending surgeons | E | E | — |
|
2) Equipment | | | |
• electrocardiographic monitoring and recording | E | E | D |
• cardiac resuscitation cart | E | E | D |
• cardiac pacemaker equipment | E | D | — |
• cardiac defibrillator | E | E | E |
• airway control equipment | E | E | — |
• mechanical ventilators and monitors | E | E | — |
• oxygen supply and saturation monitor | E | E | D |
• arterial catheters, peripheral and central venous | E | D | — |
• priority laboratory analysis (blood gas, pH, hemoanalysis, urea nitrogen, electrolytes, etc. | E | E | E |
• multichannel monitoring equipment | E | D | — |
• pulmonary artery catheters | E | D | — |
• bronchoscope and gastroscope | E | E | — |
• chest tube, cricothyroidotomy, cut-down trays | E | E | — |
• intracranial pressure equipment and monitor | E | — | — |
• portable light source | E | E | E |
• weighing equipment | E | E | E |
• special care bed (i.e., isolation) | E | D | — |
• special intensive care unit beds and stretchers | E | D | — |
• hemodialysis program in hospital or | E | — | — |
• protocols for transfer of hemodialysis patients | E | E | E |
• immediate access to laboratory equipment and reports | E | E | D |
|
c) Burn unit (or transfer agreement with burn unit) | E | O | — |
• medical director | E | O | — |
• protocols for transport and transfer of burn patients | E | E | E |
|
d) Radiology | | | |
• technician available within 10 min | E | D | D |
• 30-min attending staff call-in | E | E | E |
• angiography | E | D | — |
• ultrasonography | E | E | — |
• computed tomography | E | — | — |
• access to magnetic resonance imaging and digital subtraction angiography | D | — | — |
|
e) Rehabilitation | | | |
• assigned medical director of rehabilitation program | E | — | — |
• protocols for referral for rehabilitation | E | E | E |
|
f) Operating room | | | |
• 24-h operating-room availability for immediate surgery with the necessary equipment and personnel | E | E§ | — |
|
g) Laboratory system | | | |
• available 24 h/d | E | D | D |
• blood bank system capable of providing unmatched blood within 10 min | E | E | O |
|
h) Quality improvement programs and trauma registry | | | |
• evidence of continuous multiprofessional quality improvement process | E | E | E |
• trauma registry participation with recognized severity indices | E | E | E |
• review of deaths, yearly report | E | E | E |
• review of morbidity, yearly report | E | E | E |
|
i) Communication system for external support | | | |
• a system for physician–physician communication and transport for referred trauma cases | E | E | E |
• participation in pre-hospital care as appropriate to local circumstances | E | E | E |
|
j) Public education | | | |
• programs for public education in injury prevention | E | E | E |
|
k) Trauma research programs | E | — | — |
|
l) Continuing education programs for: | | | |
• doctors in the hospital | E | E | E |
• nurses | E | E | E |
• allied health personnel | E | D | D |
• medical education within the community/region | E | D | D |
• residency medical education as appropriate to university affiliation | E | — | — |