ASTM F1286-90(2002)

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Designation:F1286–90(Reapproved2002)
Standard Guide for
Development and Operation of Level 1 Pediatric Trauma
Facilities
This standard is issued under the fixed designation F 1286; the number immediately following the designation indicates the year of
original adoption or, in the case of revision, the year of last revision. A number in parentheses indicates the year of last reapproval. A
superscript epsilon (e) indicates an editorial change since the last revision or reapproval.
1. Scope 4. Significance and Use
1.1 This guide establishes minimum guidelines for the 4.1 The purpose of this guide is to provide guidelines for
development and operation of a pediatric trauma facility in a categorizing pediatric trauma centers to ensure consistency of
children’s or general hospital. A pediatric trauma facility is an pediatric trauma care throughout the nation. The guidelines
institution whose medical and administrative leadership has will form the quantitative basis for audit and ongoing quality
expressed the personal, institutional, and financial commitment assurance.
to optimal care of the injured child 24 h a day, 365 days a year. 4.2 This guide can be used in conjunction with objective
1.2 This guide defines the system, organizational structure, quality assurance outcome measures as outlined in Guide
clinical personnel, and physical equipment necessary for a F 1224.
pediatric trauma facility, whether freestanding or a joint 4.3 This guide can be used by local, regional, and national
adult/pediatric facility in either a children’s hospital or general authorities to establish pediatric trauma centers.
hospital committed to the care of injured children.
5. Implementation of Pediatric Trauma Facilities
1.3 The criteria outline in this guide incorporates levels of
categorization and their essential or desired characteristics. 5.1 The implementation of a pediatric trauma facility des-
ignation will be conducted consistent with the regulation of
2. Referenced Documents
local, state, and federal government authorities having juris-
2.1 ASTM Standards: diction for this process.
F 1224 Guide for Providing System Evaluation for Emer- 5.2 The most significant ingredient necessary for optimal
gency Medical Services care of the pediatric trauma patient is commitment, both
personal and institutional. For the institutions, optimal care
3. Terminology
means providing capable personnel who are immediately
3.1 Definitions: available, sophisticated equipment, services that are frequently
3.1.1 trauma care system—a coordinated network of emer-
expensive to purchase and maintain, and priority of access to
gency medical systems (EMS) comprised of one or more laboratory, radiology, operating suites, and intensive care
trauma centers linked by triage protocols, appropriate commu-
facilities and services. For the medical and nursing staff,
nications, transportation services, and prehospital care to optimal care means a commitment to the concept of adequate
manage effectively the injured child from initial injury to
staffing, prompt availability, continuing education, and quality
complete rehabilitation.The trauma care system is a subsystem assurance.
within the EMS system.
5.3 It is recognized that a Level I pediatric trauma center
3.1.2 trauma center—a hospital that has made the institu- should be located in a facility providing comprehensive care
tional commitment to fulfill all criteria outlined in Sections 1
for children. The institutions must demonstrate a continuing
through4andwhereavailablebedesignatedbytheappropriate commitment to a high level of pediatric trauma care. Methods
authority.
of demonstrating the commitment to the trauma system shall
3.2 Definitions of Terms Specific to This Standard: include, but not be limited to, a broad resolution that the
3.2.1 pediatric patient—a patient whose morphologic
hospital governing body agrees to do the following:
growth potential has not been completed. In general, a patient 5.3.1 Participate in the operations and integration of a
less than 15 years old or consistent with local practice.
regional or statewide system, to ensure pediatric patient care
data for system management, quality assessment, and opera-
tions research,
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
5.3.2 Establish policy and procedures for the maintenance
Medical Services and is the direct responsibility of Subcommittee F30.03 on
of services essential for a trauma center/system,
Organization/Management.
Current edition approved July 9, 1990. Published August 1990.
Annual Book of ASTM Standards, Vol 13.02.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.
F1286–90 (2002)
5.3.3 Ensure that all pediatric trauma patients will receive 6.2.2.1 A pediatric surgeon as chief of the pediatric trauma
medical care to the level of the institution’s accreditation, and service who shall have special interest and experience in major
5.3.4 Establish a priority admission for the pediatric trauma pediatric trauma care and the leadership skills to head a
patient to the full services of the institution, including adequate multidisciplinary team approach to the management of the
resuscitation facilities and personnel, operating room availabil- patient. This surgeon shall have a significant time commitment
ity, and intensive care unit availability. The Level I pediatric to major trauma care.
trauma center must assume the responsibility for ensuring
6.2.2.2 The pediatric trauma service shall have designated
prompt access for all patients requiring trauma care. pediatricspecialistsavailable24hperdayforcareofthemajor
5.3.5 Written transfer agreements to receive and transfer the trauma patients.
pediatric trauma patient must be in place.
6.2.2.3 Children with significant injuries shall undergo
5.3.6 The pediatric trauma center must have the capability evaluation by the trauma service and disposition to the appro-
to receive the pediatric trauma patient by ground or by air.
priate hospital service.
6.2.2.4 All pediatric trauma patients shall be treated by
6. Criteria for Level I Pediatric Trauma Facilities personnel who are organized as a team and available in-house
from the major trauma service and the pediatric service 24 h
6.1 Participation Requirements:
per day with attending coverage as specified.
6.1.1 Designation as a Level I trauma center confers upon a
6.2.2.5 A designated pediatric surgeon is responsible for
facility the recognition that it has the commitment, personnel,
multidisciplinary and interdepartmental coordination of effort
and resources to provide optimum medical and psychological
to trauma care.
care for the critically injured child.
6.3 Trauma Service Director:
6.1.2 The center shall have appropriate support services for
6.3.1 Fundamental to the establishment and organization of
the child and the family and commitment to the ongoing care
a hospital’s pediatric trauma service is the recognition that the
and total rehabilitation of the patient. This shall include the
individual identified and accountable for the operation of this
following:
service must be qualified to serve in this capacity. The
6.1.2.1 Evidence of appropriate social service intervention
following indicators shall be present:
and follow-up,
6.3.1.1 Evidence of qualifications, including pediatric edu-
6.1.2.2 Identification of members of the rehabilitation team,
cational preparation in pediatric surgery and a certificate of
6.1.2.3 Discharge summary of the trauma care to the pa-
special qualifications in pediatric surgery,
tient’s private physician, where appropriate, and
6.3.1.2 Selection process as defined by the hospital’s medi-
6.1.2.4 Documentationinthepatient’smedicalrecordofthe
cal staff bylaws,
post-discharge plan.
6.3.1.3 Participation in local/state/national trauma-related
6.1.3 ALevel I pediatric trauma center shall demonstrate its
activities,
capability to manage injured and their sequelae to major
6.3.1.4 Educational involvement such as the Advance
injuries or critical conditions such as:
Trauma Life Support (ATLS) course, teaching in the under-
6.1.3.1 Signs of shock or hypotension associated with one
graduate, graduate, and postgraduate level training programs
or more system injuries,
within the department of surgery. There shall be evidence of
6.1.3.2 Fractures of the axial skeleton,
interface and collaboration between nursing management re-
6.1.3.3 Two or more proximal long-bone fractures,
sponsible for the trauma nursing service and the physician
6.1.3.4 Amputation or traumatic avulsion of one or more
management responsible for the trauma service,
extremities proximal to digits,
6.3.1.5 Participation in research and publication efforts of
6.1.3.5 Suspected or actual spinal cord injuries,
pediatric trauma,
6.1.3.6 Head injuries,
6.3.1.6 Evidence of active participation by the trauma pro-
6.1.3.7 One or more system injuries requiring pediatric
gram director in the resuscitation or surgery, or both, of
intensive care, intracranial pressure monitoring, or mechanical
multisystem trauma patients,
ventilation support, and
6.3.1.7 A job description and organizational chart depicting
6.1.3.8 Thermal or chemical injury.
the relationship between the trauma program director and other
6.2 Service Requirements:
hospital clinical services, and
6.2.1 Criteria guidelines embrace administrative and physi-
6.3.1.8 Evidence that a multidisciplinary method of provid-
cal attributes of individual trauma centers. By this means,
ing, monitoring, and evaluating trauma patients throughout
autonomous functioning of the trauma service may be ensured,
their hospital stay is in effect through the hospital organiza-
and its staffing and direction sharply defined. The definition of
tional plan.
bed capacity, intensive care unit, operating room capability,
6.4 Nursing Requirements:
and proximity to an availability of supporting services (radi-
ology, laboratory, and so forth) are important features of the 6.4.1 The hospital organization must define the roles of the
concept. The intent is to ensure the optimal coordination of nursing team members and their areas of responsibility, ac-
services for the trauma patient. countability, and authority.
6.2.2 The hospital shall have an organized, defined trauma 6.4.2 It is suggested that the trauma plan for the nursing
servicewithintheinstitutionalstructurethatshallconsistofthe department include the ability to immediately mobilize quali-
following: fied nursing resources.
F1286–90 (2002)
6.4.3 Essential to the overall coordination and integration of 6.6.2.5 Oral surgery,
the trauma center or system in the hospital is the designation of 6.6.2.6 Urologic surgery,
an individual as the pediatric trauma nurse coordinator. The
6.6.2.7 Hand surgery,
traumanursecoordinatorshouldberesponsibileformonitoring
6.6.2.8 Burn,
and promoting all trauma-related activities associated with
6.6.2.9 Radiology,
patient care, and for providing documented evidence thereof.
6.6.2.10 Vascular radiology,
6.4.3.1 Participation in trauma educational activities sepa-
6.6.2.11 Neuroradiology,
rate from the institution’s in-house trauma education program
6.6.2.12 Mental health services,
as either program coordinator, consultant, or faculty member
6.6.2.13 Pediatric medicine,
shall be required. There must be evidence of specific pediatric
6.6.2.14 Pediatric critical care,
nursing practice application. There must be evidence of docu-
6.6.2.15 Neurosurgery, and
mentation of this participation.
6.6.2.16 Anesthesia.
6.4.4 The following indicators shall be present:
6.6.3 Pediatric Consultation—Specialists shall be on-staff
6.4.4.1 Evidence of qualification to include educational
and available on-site to respond for pediatric consultation in
preparation, certification, and experience in pediatrics,
the following areas:
6.4.4.2 Participation in local, state, and national pediatric
6.6.3.1 Cardiology,
trauma-related nursing activities,
6.6.3.2 Gastroenterology,
6.4.4.3 Evidenceofparticipationintraumaresearchthrough
6.6.3.3 Hematology,
promotion or coordination,
6.6.3.4 Infectious disease,
6.4.4.4 A job description and organizational chart depicting
6.6.3.5 Psychiatry,
the relationship between the trauma nurse coordinator and
6.6.3.6 Neurology,
other services, and
6.6.3.7 Pulmonary disease,
6.4.4.5 Evidence of participation in the establishment of
6.6.3.8 Clinical pathology,
systems to influence the nursing care of pediatric trauma
6.6.3.9 Rehabilitation medicine, and
patients.
6.6.3.10 Nephrology.
6.5 Department Requirements—There shall be surgery de-
6.6.4 Subspecialists—All subspecialists in a Level I spe-
partments, divisions, services, or sections with designated
cialty pediatric trauma center shall be board certified subspe-
chiefs and staffed by qualified specialists with expertise in
cialists where appropriate.
pediatrics in the following areas:
6.5.1 Pediatric general surgery,
7. Hospital Resource Requirements
6.5.2 Orthopedic surgery,
6.5.3 Cardiac surgery,
7.1 General—A Level I pediatric trauma facility shall have
6.5.4 Vascular surgery,
all of the hospital resources described in this section.
6.5.5 Neurosurgery,
7.2 Emergency Department:
6.5.6 Urology,
7.2.1 The hospital shall have an easily accessible and
6.5.7 Ear, nose, and throat,
identifiable designated resuscitation area used for neonate,
6.5.8 Plastic and maxillofacial surgery,
pediatric/adolescent major trauma patients.
6.5.9 Oral surgery,
7.2.2 The physical environment shall have areas for at least
6.5.10 Ophthalmic surgery, two simultaneous resuscitations.
6.5.11 Transplant or transfer agreement,
7.2.3 The hospital should demonstrate a commitment to
6.5.12 Reimplantation, or appropriate transfer agreement,
pediatric emergency care, and demonstrate compliance with
and the following requirements:
6.5.13 Obstetrics and gynecologic surgery consultation.
7.2.3.1 The designated trauma resuscitation area must be of
6.6 Physician Requirements:
adequate size to accommodate the full trauma resuscitation
6.6.1 Specialists—Specialists shall be available in-hospital team.
24 h per day, as follows:
7.2.3.2 Adequate facilities and personnel must be available
6.6.1.1 Pediatric surgical attendant or resident,
within the emergency department to care simultaneously for
6.6.1.2 Pediatric attendant or resident,
more than one multisystem trauma patient. Back up areas to
6.6.1.3 Anesthesiologist or resident, and accomplish this need not be separately designated but should
be immediately available.
6.6.1.4 Neurosurgical attendant or resident, or surgical des-
ignee of chief of neurosurgery.
7.2.3.3 Undernormalconditions,theemergencydepartment
6.6.2 Attending Staff—Attending (on-s
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