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Mon Oct 9 16:31:53 BST 2006

Dear List:

I would hope for a deeper understanding of trauma systems by readers of
this list.  The tone of these discussions is why I rarely participate.
I "get out" enough to know of what I speak and I never write about
something that I don't see adequate research to support.  Let's get on
with the ability for universal access to quality trauma care - we are
failing in that endeavor.  Surveyors for the states I mentioned do not
use a "checklist" to designate centers.  Furthermore, the ACS would not
have a Level IV or a tiered trauma response (the subject of recent
requests) were it not for Oregon's innovations outside of ACS standards
at that time".  Hospitals in states with enabling legislation still must
be designated by their oversight agency even if verified.  If a state
has problems, it is up to the trauma community to work to improve them.

Connie Potter, Executive Director
National Foundation for Trauma Care
(505) 525-9511

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-----Original Message-----
From: p.bjorn [mailto:p.bjorn at netzero.net] 
Sent: Thursday, October 05, 2006 10:09 AM
To: Trauma &amp; Critical Care mailing list
Subject: Re: ACS or local designation

----- Original Message -----
From: "Connie Potter" <Connie at traumafoundation.org>
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Sent: Thursday, October 05, 2006 4:27 PM
Subject: ACS or local designation

Re:  ACS and "local" designation.  There is NO state or system that
calls trauma centers "certified".   There are a number of states that
have established their own trauma center standards (IL, WA, OR, MD, PA,
and more) by adapting the ACS guidelines to the rural nature of their
state and DESIGNATE trauma centers.  The differences are minor for the
most part.  I know of no system that would call a hospital a Level II
that would otherwise only be an ACS Level IV.

Connie,

If you think the differences are "minor for the most part," then you've
got
to get out more.

Maine's is one example of a binary, inclusive, voluntary system,
resulting
in two levels of trauma hospital: the Regional Trauma Center and the
Trauma
System Hospital.  Many administrative spokespersons at Trauma System
Hospitals, when asked what level their hospital is, have no familiarity
with
any sort of third or fourth level, and will therefore predictably answer
"Level II."   When sophisticated system members answer, correctly, that
they're Trauma System Hospitals, the surveyors aren't left with a box
they
can check.  Some will throw a dart into Level III or IV (and be right
about
half the time), some will talk the System Hospital into Level II, some
will
leave a blank.  I've seen it happen countless times.

Likewise when my hospital -- a regional trauma center -- is asked the
same
question, we struggle to explain the various
designation/certification/verification constructs which exist.  We are a
Maine RTC, which is Level I within our binary system (which can't be
properly compared to Texas or Wyoming or California or Illinois); but we
are
ACS Level II, which is the only reliable common frame of reference.
When
I'm done explaining this, the questioner invariably asks, "So which
level
are you?"

Whatever you claim to know, or believe has been established in the
literature, there are no reliable common denominators for trauma center
capability outside of the only international verifying body, that being
the
ACS.  It's not about belonging to anybody's list; it's about structural,
functional, and cultural differences from system to system.  We can
agree
that systems improve patient care; but we can't compare systems without
describing standards -- and simply having a system does not describe
anything close to a standard.

Pret

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ACS or local designation