1、Designation: F 1286 90 (Reapproved 2002)Standard Guide forDevelopment and Operation of Level 1 Pediatric TraumaFacilities1This standard is issued under the fixed designation F 1286; the number immediately following the designation indicates the year oforiginal adoption or, in the case of revision, t
2、he year of last revision. A number in parentheses indicates the year of last reapproval. Asuperscript epsilon (e) indicates an editorial change since the last revision or reapproval.1. Scope1.1 This guide establishes minimum guidelines for thedevelopment and operation of a pediatric trauma facility
3、in achildrens or general hospital. A pediatric trauma facility is aninstitution whose medical and administrative leadership hasexpressed the personal, institutional, and financial commitmentto optimal care of the injured child 24 h a day, 365 days a year.1.2 This guide defines the system, organizati
4、onal structure,clinical personnel, and physical equipment necessary for apediatric trauma facility, whether freestanding or a jointadult/pediatric facility in either a childrens hospital or generalhospital committed to the care of injured children.1.3 The criteria outline in this guide incorporates
5、levels ofcategorization and their essential or desired characteristics.2. Referenced Documents2.1 ASTM Standards:F 1224 Guide for Providing System Evaluation for Emer-gency Medical Services23. Terminology3.1 Definitions:3.1.1 trauma care systema coordinated network of emer-gency medical systems (EMS
6、) comprised of one or moretrauma centers linked by triage protocols, appropriate commu-nications, transportation services, and prehospital care tomanage effectively the injured child from initial injury tocomplete rehabilitation. The trauma care system is a subsystemwithin the EMS system.3.1.2 traum
7、a centera hospital that has made the institu-tional commitment to fulfill all criteria outlined in Sections 1through 4 and where available be designated by the appropriateauthority.3.2 Definitions of Terms Specific to This Standard:3.2.1 pediatric patienta patient whose morphologicgrowth potential h
8、as not been completed. In general, a patientless than 15 years old or consistent with local practice.4. Significance and Use4.1 The purpose of this guide is to provide guidelines forcategorizing pediatric trauma centers to ensure consistency ofpediatric trauma care throughout the nation. The guideli
9、neswill form the quantitative basis for audit and ongoing qualityassurance.4.2 This guide can be used in conjunction with objectivequality assurance outcome measures as outlined in GuideF 1224.4.3 This guide can be used by local, regional, and nationalauthorities to establish pediatric trauma center
10、s.5. Implementation of Pediatric Trauma Facilities5.1 The implementation of a pediatric trauma facility des-ignation will be conducted consistent with the regulation oflocal, state, and federal government authorities having juris-diction for this process.5.2 The most significant ingredient necessary
11、 for optimalcare of the pediatric trauma patient is commitment, bothpersonal and institutional. For the institutions, optimal caremeans providing capable personnel who are immediatelyavailable, sophisticated equipment, services that are frequentlyexpensive to purchase and maintain, and priority of a
12、ccess tolaboratory, radiology, operating suites, and intensive carefacilities and services. For the medical and nursing staff,optimal care means a commitment to the concept of adequatestaffing, prompt availability, continuing education, and qualityassurance.5.3 It is recognized that a Level I pediat
13、ric trauma centershould be located in a facility providing comprehensive carefor children. The institutions must demonstrate a continuingcommitment to a high level of pediatric trauma care. Methodsof demonstrating the commitment to the trauma system shallinclude, but not be limited to, a broad resol
14、ution that thehospital governing body agrees to do the following:5.3.1 Participate in the operations and integration of aregional or statewide system, to ensure pediatric patient caredata for system management, quality assessment, and opera-tions research,5.3.2 Establish policy and procedures for th
15、e maintenanceof services essential for a trauma center/system,1This guide is under the jurisdiction of ASTM Committee F30 on EmergencyMedical Services and is the direct responsibility of Subcommittee F30.03 onOrganization/Management.Current edition approved July 9, 1990. Published August 1990.2Annua
16、l Book of ASTM Standards, Vol 13.02.1Copyright ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.5.3.3 Ensure that all pediatric trauma patients will receivemedical care to the level of the institutions accreditation, and5.3.4 Establish a priorit
17、y admission for the pediatric traumapatient to the full services of the institution, including adequateresuscitation facilities and personnel, operating room availabil-ity, and intensive care unit availability. The Level I pediatrictrauma center must assume the responsibility for ensuringprompt acce
18、ss for all patients requiring trauma care.5.3.5 Written transfer agreements to receive and transfer thepediatric trauma patient must be in place.5.3.6 The pediatric trauma center must have the capabilityto receive the pediatric trauma patient by ground or by air.6. Criteria for Level I Pediatric Tra
19、uma Facilities6.1 Participation Requirements:6.1.1 Designation as a Level I trauma center confers upon afacility the recognition that it has the commitment, personnel,and resources to provide optimum medical and psychologicalcare for the critically injured child.6.1.2 The center shall have appropria
20、te support services forthe child and the family and commitment to the ongoing careand total rehabilitation of the patient. This shall include thefollowing:6.1.2.1 Evidence of appropriate social service interventionand follow-up,6.1.2.2 Identification of members of the rehabilitation team,6.1.2.3 Dis
21、charge summary of the trauma care to the pa-tients private physician, where appropriate, and6.1.2.4 Documentation in the patients medical record of thepost-discharge plan.6.1.3 A Level I pediatric trauma center shall demonstrate itscapability to manage injured and their sequelae to majorinjuries or
22、critical conditions such as:6.1.3.1 Signs of shock or hypotension associated with oneor more system injuries,6.1.3.2 Fractures of the axial skeleton,6.1.3.3 Two or more proximal long-bone fractures,6.1.3.4 Amputation or traumatic avulsion of one or moreextremities proximal to digits,6.1.3.5 Suspecte
23、d or actual spinal cord injuries,6.1.3.6 Head injuries,6.1.3.7 One or more system injuries requiring pediatricintensive care, intracranial pressure monitoring, or mechanicalventilation support, and6.1.3.8 Thermal or chemical injury.6.2 Service Requirements:6.2.1 Criteria guidelines embrace administr
24、ative and physi-cal attributes of individual trauma centers. By this means,autonomous functioning of the trauma service may be ensured,and its staffing and direction sharply defined. The definition ofbed capacity, intensive care unit, operating room capability,and proximity to an availability of sup
25、porting services (radi-ology, laboratory, and so forth) are important features of theconcept. The intent is to ensure the optimal coordination ofservices for the trauma patient.6.2.2 The hospital shall have an organized, defined traumaservice within the institutional structure that shall consist of
26、thefollowing:6.2.2.1 A pediatric surgeon as chief of the pediatric traumaservice who shall have special interest and experience in majorpediatric trauma care and the leadership skills to head amultidisciplinary team approach to the management of thepatient. This surgeon shall have a significant time
27、 commitmentto major trauma care.6.2.2.2 The pediatric trauma service shall have designatedpediatric specialists available 24 h per day for care of the majortrauma patients.6.2.2.3 Children with significant injuries shall undergoevaluation by the trauma service and disposition to the appro-priate hos
28、pital service.6.2.2.4 All pediatric trauma patients shall be treated bypersonnel who are organized as a team and available in-housefrom the major trauma service and the pediatric service 24 hper day with attending coverage as specified.6.2.2.5 A designated pediatric surgeon is responsible formultidi
29、sciplinary and interdepartmental coordination of effortto trauma care.6.3 Trauma Service Director:6.3.1 Fundamental to the establishment and organization ofa hospitals pediatric trauma service is the recognition that theindividual identified and accountable for the operation of thisservice must be q
30、ualified to serve in this capacity. Thefollowing indicators shall be present:6.3.1.1 Evidence of qualifications, including pediatric edu-cational preparation in pediatric surgery and a certificate ofspecial qualifications in pediatric surgery,6.3.1.2 Selection process as defined by the hospitals med
31、i-cal staff bylaws,6.3.1.3 Participation in local/state/national trauma-relatedactivities,6.3.1.4 Educational involvement such as the AdvanceTrauma Life Support (ATLS) course, teaching in the under-graduate, graduate, and postgraduate level training programswithin the department of surgery. There sh
32、all be evidence ofinterface and collaboration between nursing management re-sponsible for the trauma nursing service and the physicianmanagement responsible for the trauma service,6.3.1.5 Participation in research and publication efforts ofpediatric trauma,6.3.1.6 Evidence of active participation by
33、 the trauma pro-gram director in the resuscitation or surgery, or both, ofmultisystem trauma patients,6.3.1.7 A job description and organizational chart depictingthe relationship between the trauma program director and otherhospital clinical services, and6.3.1.8 Evidence that a multidisciplinary met
34、hod of provid-ing, monitoring, and evaluating trauma patients throughouttheir hospital stay is in effect through the hospital organiza-tional plan.6.4 Nursing Requirements:6.4.1 The hospital organization must define the roles of thenursing team members and their areas of responsibility, ac-countabil
35、ity, and authority.6.4.2 It is suggested that the trauma plan for the nursingdepartment include the ability to immediately mobilize quali-fied nursing resources.F 1286 90 (2002)26.4.3 Essential to the overall coordination and integration ofthe trauma center or system in the hospital is the designati
36、on ofan individual as the pediatric trauma nurse coordinator. Thetrauma nurse coordinator should be responsibile for monitoringand promoting all trauma-related activities associated withpatient care, and for providing documented evidence thereof.6.4.3.1 Participation in trauma educational activities
37、 sepa-rate from the institutions in-house trauma education programas either program coordinator, consultant, or faculty membershall be required. There must be evidence of specific pediatricnursing practice application. There must be evidence of docu-mentation of this participation.6.4.4 The followin
38、g indicators shall be present:6.4.4.1 Evidence of qualification to include educationalpreparation, certification, and experience in pediatrics,6.4.4.2 Participation in local, state, and national pediatrictrauma-related nursing activities,6.4.4.3 Evidence of participation in trauma research throughpr
39、omotion or coordination,6.4.4.4 A job description and organizational chart depictingthe relationship between the trauma nurse coordinator andother services, and6.4.4.5 Evidence of participation in the establishment ofsystems to influence the nursing care of pediatric traumapatients.6.5 Department Re
40、quirementsThere shall be surgery de-partments, divisions, services, or sections with designatedchiefs and staffed by qualified specialists with expertise inpediatrics in the following areas:6.5.1 Pediatric general surgery,6.5.2 Orthopedic surgery,6.5.3 Cardiac surgery,6.5.4 Vascular surgery,6.5.5 Ne
41、urosurgery,6.5.6 Urology,6.5.7 Ear, nose, and throat,6.5.8 Plastic and maxillofacial surgery,6.5.9 Oral surgery,6.5.10 Ophthalmic surgery,6.5.11 Transplant or transfer agreement,6.5.12 Reimplantation, or appropriate transfer agreement,and6.5.13 Obstetrics and gynecologic surgery consultation.6.6 Phy
42、sician Requirements:6.6.1 SpecialistsSpecialists shall be available in-hospital24 h per day, as follows:6.6.1.1 Pediatric surgical attendant or resident,6.6.1.2 Pediatric attendant or resident,6.6.1.3 Anesthesiologist or resident, and6.6.1.4 Neurosurgical attendant or resident, or surgical des-ignee
43、 of chief of neurosurgery.6.6.2 Attending StaffAttending (on-site) staff with exper-tise in pediatrics shall be on-call and promptly available in thefollowing areas:6.6.2.1 Orthopedic surgery,6.6.2.2 Ophthalmic surgery,6.6.2.3 Ear, nose and throat,6.6.2.4 Plastic surgery,6.6.2.5 Oral surgery,6.6.2.6
44、 Urologic surgery,6.6.2.7 Hand surgery,6.6.2.8 Burn,6.6.2.9 Radiology,6.6.2.10 Vascular radiology,6.6.2.11 Neuroradiology,6.6.2.12 Mental health services,6.6.2.13 Pediatric medicine,6.6.2.14 Pediatric critical care,6.6.2.15 Neurosurgery, and6.6.2.16 Anesthesia.6.6.3 Pediatric ConsultationSpecialists
45、 shall be on-staffand available on-site to respond for pediatric consultation inthe following areas:6.6.3.1 Cardiology,6.6.3.2 Gastroenterology,6.6.3.3 Hematology,6.6.3.4 Infectious disease,6.6.3.5 Psychiatry,6.6.3.6 Neurology,6.6.3.7 Pulmonary disease,6.6.3.8 Clinical pathology,6.6.3.9 Rehabilitati
46、on medicine, and6.6.3.10 Nephrology.6.6.4 SubspecialistsAll subspecialists in a Level I spe-cialty pediatric trauma center shall be board certified subspe-cialists where appropriate.7. Hospital Resource Requirements7.1 GeneralA Level I pediatric trauma facility shall haveall of the hospital resource
47、s described in this section.7.2 Emergency Department:7.2.1 The hospital shall have an easily accessible andidentifiable designated resuscitation area used for neonate,pediatric/adolescent major trauma patients.7.2.2 The physical environment shall have areas for at leasttwo simultaneous resuscitation
48、s.7.2.3 The hospital should demonstrate a commitment topediatric emergency care, and demonstrate compliance withthe following requirements:7.2.3.1 The designated trauma resuscitation area must be ofadequate size to accommodate the full trauma resuscitationteam.7.2.3.2 Adequate facilities and personn
49、el must be availablewithin the emergency department to care simultaneously formore than one multisystem trauma patient. Back up areas toaccomplish this need not be separately designated but shouldbe immediately available.7.2.3.3 Under normal conditions, the emergency departmentshall be open at all times.7.2.3.4 All closures of the emergency department, for what-ever reasons, shall be documented with notification of appro-priate authorities and institutions.7.2.3.5 The institution shall develop formal written proto-cols with neighboring trauma centers to accept trauma pat
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