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Mon Aug 20 19:55:55 BST 2007

C'mon there's got to be some role your comfortable with the Gov handling. OK
so first they should fund it right? Everybody agrees with that? Then what's
wrong with promulgating standards and inspecting to make sure the money is
spent to meet them. I mean the ACS guidelines are virtual or de-facto
standards and no one seems too freaked out about that. (Except for the
volume requirements which I may have unwittingly contributed to). Agreed you
can blow off the parts that don't fit your system. But I think as a nation
we should be able to do better. The state I live in doesn't have a trauma
system and the state I work in doesn't even have an MD state trauma
director.

Rob

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ronald Gross
Sent: Monday, August 20, 2007 2:14 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Mass vs NH vs Conn. Trauma Stds

"... leading neatly into the discussion of local, national, and regional
standardization..."

I'm from the government, and I am here to help.

YEAH, RIGHT!!

>>> "Bjorn, Pret" <pbjorn at emh.org> 8/20/2007 1:16 PM >>>
Being honest, it's only rarely conscious disingenuity.  Sometimes you
HAVE to pick a label, and different systems have different definitions.

We constantly are asked what level trauma center we are -- and surveyors
or researchers don't want to hear, "do you mean VERIFICATION or
DESIGNATION?"   Cripes, even the NTDB only very recently acknowledged
the difference.

... leading neatly into the discussion of local, national, and regional
standardization...

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross
Sent: Monday, August 20, 2007 12:03 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Mass vs NH vs Conn. Trauma Stds

"some hospitals will self-identify as "level II trauma centers."  Apart
from being a little confusing to folks outside of the system (like
survey-takers), it's a fairly harmless
choice of terms for marketing and recruiting."

And, as such, is false advertizing and I dare say a bit disingenuous.
Sorry, but you is or you ain't.  And you can't self label.

Ron

>>> "Bjorn, Pret" <pbjorn at emh.org> 8/20/2007 10:25 AM >>>
Maine's trauma system uses ACS level I or II verification as criteria
for "Regional Trauma Center" designation.  There are three RTC's in
Maine: Portland (ACS level I), Lewiston (level II) and Bangor (likewise,
level II).

All other hospitals are non-verified, but pretty much any among them
would qualify as ACS level III or IV.  The system is voluntary and
inclusive by necessity, owing to the state's geography (big and sparsely
populated), economy (poor), and disease-related demographics (relatively
old and frightfully blunt-mechanism).  

In short, any licensed hospital with a 24/7 ED is -- by default -- a
"Trauma System Hospital."  Disqualifying any of these (often very
remote) hospitals would surely cause more M&M than it might ever hope to
prevent.  Instead, the system relies on the RTC's to provide education
and performance improvement to their respective service areas: feedback,
outreach, CME, and so forth.  

Because the system is binary, some hospitals will self-identify as
"level II trauma centers."  Apart from being a little confusing to folks
outside of the system (like survey-takers), it's a fairly harmless
choice of terms for marketing and recruiting.  Sometimes it's just
misspeach. 

Where the trauma system is concerned, there are no differences between
ACS levels I and II: an RTC is and RTC, representing the tertiary care
target for all major injuries throughout the respective rural service
area.  This basically aligns with generations of prudent practice: the
three RTC's find themselves at the bottom of regional service area
"funnels."  

There's considerably more to the system, of course; but that's the
30,000-foot view.

Pret Bjorn, RN
Trauma Coordinator
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com 
Sent: Sunday, August 19, 2007 6:24 PM
To: SURGINET at listserv.utoronto.ca 
Cc: trauma-list at trauma.org 
Subject: Mass vs NH vs Conn. Trauma Stds

I know what was intended by the ACS regarding Level 1, Level 2, and
Level 3 trauma centers, but I am curious about Massachusetts, New
Hampshire, Connecticut, Maine, etc., Is there a quality difference for
general surgery trauma cases, neurosurgery cases, etc. between a Level I
and a  Level II trauma center as defined by the State Health Departments
in the North  Eastern states...

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