ASTM F1286-90(2009)
(Guide)Standard Guide for Development and Operation of Level 1 Pediatric Trauma Facilities (Withdrawn 2015)
Standard Guide for Development and Operation of Level 1 Pediatric Trauma Facilities (Withdrawn 2015)
SIGNIFICANCE AND USE
The purpose of this guide is to provide guidelines for categorizing pediatric trauma centers to ensure consistency of pediatric trauma care throughout the nation. The guidelines will form the quantitative basis for audit and ongoing quality assurance.
This guide can be used in conjunction with objective quality assurance outcome measures as outlined in Guide F 1224.
This guide can be used by local, regional, and national authorities to establish pediatric trauma centers.
SCOPE
1.1 This guide establishes minimum guidelines for the development and operation of a pediatric trauma facility in a children's or general hospital. A pediatric trauma facility is an institution whose medical and administrative leadership has expressed the personal, institutional, and financial commitment to optimal care of the injured child 24 h a day, 365 days a year.
1.2 This guide defines the system, organizational structure, clinical personnel, and physical equipment necessary for a pediatric trauma facility, whether freestanding or a joint adult/pediatric facility in either a children's hospital or general hospital committed to the care of injured children.
1.3 The criteria outline in this guide incorporates levels of categorization and their essential or desired characteristics.
WITHDRAWN RATIONALE
This guide established minimum guidelines for the development and operation of a pediatric trauma facility in a children's or general hospital.
Formerly under the jurisdiction of Committee F30 on Emergency Medical Services, this guide was withdrawn in June 2015. This standard is being withdrawn without replacement due to its limited use by industry.
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Standards Content (Sample)
NOTICE: This standard has either been superseded and replaced by a new version or withdrawn.
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Designation: F1286 − 90 (Reapproved2009)
Standard Guide for
Development and Operation of Level 1 Pediatric Trauma
Facilities
This standard is issued under the fixed designation F1286; 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 (´) indicates an editorial change since the last revision or reapproval.
1. Scope 3.1.2 trauma center—a hospital that has made the institu-
tional commitment to fulfill all criteria outlined in Sections 1
1.1 This guide establishes minimum guidelines for the
through4andwhereavailablebedesignatedbytheappropriate
development and operation of a pediatric trauma facility in a
authority.
children’s or general hospital. A pediatric trauma facility is an
institution whose medical and administrative leadership has 3.2 Definitions of Terms Specific to This Standard:
3.2.1 pediatric patient—a patient whose morphologic
expressedthepersonal,institutional,andfinancialcommitment
to optimal care of the injured child 24 h a day, 365 days a year. growth potential has not been completed. In general, a patient
less than 15 years old or consistent with local practice.
1.2 This guide defines the system, organizational structure,
clinical personnel, and physical equipment necessary for a
4. Significance and Use
pediatric trauma facility, whether freestanding or a joint
4.1 The purpose of this guide is to provide guidelines for
adult/pediatric facility in either a children’s hospital or general
categorizing pediatric trauma centers to ensure consistency of
hospital committed to the care of injured children.
pediatric trauma care throughout the nation. The guidelines
1.3 The criteria outline in this guide incorporates levels of
will form the quantitative basis for audit and ongoing quality
categorization and their essential or desired characteristics.
assurance.
4.2 This guide can be used in conjunction with objective
2. Referenced Documents
quality assurance outcome measures as outlined in Guide
2.1 ASTM Standards:
F1224.
F1224 Guide for Providing System Evaluation for Emer-
3 4.3 This guide can be used by local, regional, and national
gency Medical Services (Withdrawn 2012)
authorities to establish pediatric trauma centers.
3. Terminology
5. Implementation of Pediatric Trauma Facilities
3.1 Definitions:
5.1 The implementation of a pediatric trauma facility des-
3.1.1 trauma care system—a coordinated network of emer-
ignation will be conducted consistent with the regulation of
gency medical systems (EMS) comprised of one or more
local, state, and federal government authorities having juris-
trauma centers linked by triage protocols, appropriate
diction for this process.
communications, transportation services, and prehospital care
5.2 The most significant ingredient necessary for optimal
to manage effectively the injured child from initial injury to
care of the pediatric trauma patient is commitment, both
complete rehabilitation.The trauma care system is a subsystem
personal and institutional. For the institutions, optimal care
within the EMS system.
means providing capable personnel who are immediately
available, sophisticated equipment, services that are frequently
expensive to purchase and maintain, and priority of access to
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
laboratory, radiology, operating suites, and intensive care
Medical Services and is the direct responsibility of Subcommittee F30.03 on
facilities and services. For the medical and nursing staff,
Organization/Management.
optimal care means a commitment to the concept of adequate
Current edition approved March 1, 2009. Published March 2009. Originally
approved in 1990. Last previous edition approved in 2002 as F1286 – 90(2002).
staffing, prompt availability, continuing education, and quality
DOI: 10.1520/F1286-90R09.
assurance.
For referenced ASTM standards, visit the ASTM website, www.astm.org, or
contact ASTM Customer Service at service@astm.org. For Annual Book of ASTM
5.3 It is recognized that a Level I pediatric trauma center
Standards volume information, refer to the standard’s Document Summary page on
should be located in a facility providing comprehensive care
the ASTM website.
for children. The institutions must demonstrate a continuing
The last approved version of this historical standard is referenced on
www.astm.org. commitment to a high level of pediatric trauma care. Methods
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959. United States
F1286 − 90 (2009)
of demonstrating the commitment to the trauma system shall and its staffing and direction sharply defined. The definition of
include, but not be limited to, a broad resolution that the bed capacity, intensive care unit, operating room capability,
hospital governing body agrees to do the following: and proximity to an availability of supporting services
5.3.1 Participate in the operations and integration of a (radiology, laboratory, and so forth) are important features of
regional or statewide system, to ensure pediatric patient care the concept. The intent is to ensure the optimal coordination of
data for system management, quality assessment, and opera- services for the trauma patient.
tions research,
6.2.2 The hospital shall have an organized, defined trauma
5.3.2 Establish policy and procedures for the maintenance
servicewithintheinstitutionalstructurethatshallconsistofthe
of services essential for a trauma center/system,
following:
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
patient. This surgeon shall have a significant time commitment
availability, and intensive care unit availability. The Level I
to major trauma care.
pediatric trauma center must assume the responsibility for
6.2.2.2 The pediatric trauma service shall have designated
ensuring 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
6.1 Participation Requirements:
from the major trauma service and the pediatric service 24 h
6.1.1 Designation as a Level I trauma center confers upon a
per day with attending coverage as specified.
facility the recognition that it has the commitment, personnel,
6.2.2.5 A designated pediatric surgeon is responsible for
and resources to provide optimum medical and psychological
multidisciplinary and interdepartmental coordination of effort
care for the critically injured child.
to trauma care.
6.1.2 The center shall have appropriate support services for
the child and the family and commitment to the ongoing care
6.3 Trauma Service Director:
and total rehabilitation of the patient. This shall include the
6.3.1 Fundamental to the establishment and organization of
following:
a hospital’s pediatric trauma service is the recognition that the
6.1.2.1 Evidence of appropriate social service intervention
individual identified and accountable for the operation of this
and follow-up,
service must be qualified to serve in this capacity. The
6.1.2.2 Identification of members of the rehabilitation team,
following indicators shall be present:
6.1.2.3 Discharge summary of the trauma care to the pa-
6.3.1.1 Evidence of qualifications, including pediatric edu-
tient’s private physician, where appropriate, and
cational preparation in pediatric surgery and a certificate of
6.1.2.4 Documentationinthepatient’smedicalrecordofthe
special qualifications in pediatric surgery,
post-discharge plan.
6.3.1.2 Selection process as defined by the hospital’s medi-
6.1.3 ALevel I pediatric trauma center shall demonstrate its
cal staff bylaws,
capability to manage injured and their sequelae to major
6.3.1.3 Participation in local/state/national trauma-related
injuries or critical conditions such as:
activities,
6.1.3.1 Signs of shock or hypotension associated with one
6.3.1.4 Educational involvement such as the Advance
or more system injuries,
Trauma Life Support (ATLS) course, teaching in the
6.1.3.2 Fractures of the axial skeleton,
undergraduate, graduate, and postgraduate level training pro-
6.1.3.3 Two or more proximal long-bone fractures,
grams within the department of surgery. There shall be evi-
6.1.3.4 Amputation or traumatic avulsion of one or more
dence of interface and collaboration between nursing manage-
extremities proximal to digits,
ment responsible for the trauma nursing service and the
6.1.3.5 Suspected or actual spinal cord injuries,
physician management responsible for the trauma service,
6.1.3.6 Head injuries,
6.1.3.7 One or more system injuries requiring pediatric
6.3.1.5 Participation in research and publication efforts of
intensive care, intracranial pressure monitoring, or mechanical pediatric trauma,
ventilation support, and
6.3.1.6 Evidence of active participation by the trauma pro-
6.1.3.8 Thermal or chemical injury.
gram director in the resuscitation or surgery, or both, of
multisystem trauma patients,
6.2 Service Requirements:
6.2.1 Criteria guidelines embrace administrative and physi- 6.3.1.7 Ajob description and organizational chart depicting
cal attributes of individual trauma centers. By this means, the relationship between the trauma program director and other
autonomous functioning of the trauma service may be ensured, hospital clinical services, and
F1286 − 90 (2009)
6.3.1.8 Evidence that a multidisciplinary method of 6.6.1.1 Pediatric surgical attendant or resident,
providing,monitoring,andevaluatingtraumapatientsthrough- 6.6.1.2 Pediatric attendant or resident,
out their hospital stay is in effect through the hospital organi- 6.6.1.3 Anesthesiologist or resident, and
zational plan. 6.6.1.4 Neurosurgical attendant or resident, or surgical des-
ignee of chief of neurosurgery.
6.4 Nursing Requirements:
6.6.2 Attending Staff—Attending (on-site) staff with exper-
6.4.1 The hospital organization must define the roles of the
tise in pediatrics shall be on-call and promptly available in the
nursing team members and their areas of responsibility,
following areas:
accountability, and authority.
6.6.2.1 Orthopedic surgery,
6.4.2 It is suggested that the trauma plan for the nursing
6.6.2.2 Ophthalmic surgery,
department include the ability to immediately mobilize quali-
6.6.2.3 Ear, nose and throat,
fied nursing resources.
6.6.2.4 Plastic surgery,
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 Ajob 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 6.6.4 Subspecialists—All subspecialists in a Level I spe-
departments, 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,
7.1 General—A Level I pediatric trauma facility shall have
6.5.3 Cardiac surgery,
all of the hospital resources described in this section.
6.5.4 Vascular surgery,
7.2 Emergency Department:
6.5.5 Neurosurgery,
7.2.1 The hospital shall have an easily accessible and
6.5.6 Urology,
identifiable designated resuscitation area used for neonate,
6.5.7 Ear, nose, and throat,
pediatric/adolescent major trauma patients.
6.5.8 Plastic and maxillofacial surgery,
7.2.2 The physical environment shall have areas for at least
6.5.9 Oral surgery,
two simultaneous resuscitations.
6.5.10 Ophthalmic surgery,
7.2.3 The hospital should demonstrate a commitment to
6.5.11 Transplant or transfer agreement,
pediatric emergency care, and demonstrate compliance with
6.5.12 Reimplantation, or appropriate transfer agreement,
the following requiremen
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