2022 Standards Q&A

The institution will determine the credentialing requirements for APPs.

The COT is giving this careful consideration and will determine how best to address the concerns. In the meantime, the 2014 Resources for Optimal Care of the Injured Patient (aka, the Orange Book) contains Level IV criteria that are still relevant, current, and can continue to be used.

For focused visits, the trauma center will be reviewed using the same standards by which it was previously reviewed. In this instance, the focused visit will be reviewed using the 2014 Standards.

The 2022 Standards defines all standards required for trauma center verification by the ACS VRC program. The 2022 version should be able to be used alone, independent from previous versions of the standards. It’s important to understand that the 2022 version organizes the standards based on the nine categories. Some criteria have moved out of their placement in the Orange Book to a new standard in the Gray Book and some criteria were absorbed into standards with broader requirements.

In all trauma centers, a registered nurse is not required to serve as a TPM.

In Level I trauma centers, the injury prevention professional must be someone other than the TPM or PI personnel. In Level II and III trauma centers, the TPM or the PI personnel may serve as the designated injury prevention professional as long as they meet the requirements stated in Standard 2.10 or Standard 4.34.

Injury prevention activities refer to one-time events.

In Level I and II trauma centers, the dedicated operating room must be prioritized for fracture care in nonemergent orthopaedic traumas. Operational details related to staffing, frequency of availability, and use by other services should be collaboratively determined and approved by the TMD and the orthopaedic trauma leader. The frequency of availability should be sufficient to provide timely fracture care for patients.

To meet the standard, a neurosurgery published backup call schedule is not required.

In Level I and II centers, anesthesia services are required to be available within 15 minutes of request. Providers can take call onsite or offsite. Time of request to time of response must be tracked.

In all trauma centers, the ICU surgical director, whether it is the director or co-director, must be board-certified or board-eligible in general surgery. In Level I adult trauma centers, the ICU surgical director must be board-certified or board-eligible in surgical critical care.

The qualifications for ICU physicians are determined by the hospital.

As noted in the standard’s additional information section, “’continuous’ is defined as 24/7/365 and implies there are no gaps in coverage.” The required surgical expertise must exist in Level I and II trauma centers. Therefore, transfer agreements are not acceptable to meet this standard.

As stated in the definitions and requirements section, the standard defines the count of entries as all patients who meet NTDS inclusion criteria, and those patients who meet inclusion criteria for hospital, local, regional, and state purposes. Therefore, patients who meet your hospital’s inclusion criteria, but do not meet NTDS criteria, do count towards the FTE requirements for the standard. 

In Level II and III trauma centers, the standard can be met by having the TPM who is CAISS certified serve as the 0.5 FTE registrar.

All trauma registrars, clinical and non-clinical, are required to meet Standard 4.33.

When the annual volume exceeds 1,000 registry patient entries, the trauma center must have at least 1 FTE PI personnel. However, in the Additional Information section, it states that greater trauma center volumes might necessitate additional personnel. The trauma center determines PI personnel needs based on its patient volume.

The only disaster course that meets this standard is the DMEP course.

An online version of the course, eDMEP, will be launched in the spring of 2023. Please check the course webpage for current offerings and updates.

All admitted patients greater than 12 years old, regardless of length of stay, must be screened.  Trauma centers must achieve a screening rate of at least 80 percent to meet the standard. 

The 2022 version should be able to be used alone, independent from previous versions of the standards. It’s important to understand that the 2022 version organizes the standards differently.  For PIPS, many of the requirements from the 2014 Standards are listed in the Resources section as audit filters, event review, and report reviews.  For example, ‘Accuracy of trauma team activation protocols’ should flag both undertriage and overtriage situations for review.

There are no attendance requirements for geriatric liaisons.

Articles must be published or accepted for publication in peer-reviewed and indexed journals. The standard does not list specific index services/databases to meet this requirement.