ACS Verfication Process and Designation

ACS Verfication Process and Designation 

The American College of Surgeons (ACS) was founded in 1913 on the basic principles of improving the care of surgical patients and the education of surgeons. The ACS Committee on Trauma (ACS-COT) is the oldest standing committee of the College. Established in 1922 by Charles L. Scudder, MD, FACS, this committee focuses on improving the care of injured patients, believing that trauma is a surgical disease demanding surgical leadership. This resources document was first published in 1976 and established guidelines for care of injured patients.

The evolution of the name of this document corresponds with the evolution of the philosophy of care set forth by the ACS-COT. The initial name, Optimal Hospital Resources for Care of the Injured Patient (1976), evolved to Resources for Optimal Care of the Injured Patient (1990 and 1993). This subtle change in emphasis from “optimal hospital resources” to “optimal care, given available resources” reflects an important and abiding principle: The needs of all injured patients are addressed wherever they are injured and wherever they receive care. This subtle name change better acknowledges that few individual facilities can provide all resources to all patients in all situations. This reality forces the development of a trauma system of care instead of simply developing trauma centers.

An ideal trauma system includes all the components identified with optimal trauma care, such as prevention, access, prehospital care and transportation, acute hospital care, rehabilitation, and research activities. The term “inclusive” trauma system is used for this all-encompassing approach, as opposed to the term “exclusive” system, which focuses only on the major trauma center. It must be noted however that an “inclusive” system does not mean an unplanned or unregulated system. Each facility should have an identifiable role based on resources and needs of the community rather than their self-selected level of designation. Although this document still addresses trauma center verification and consultation, it also emphasizes the need for various levels of trauma centers to cooperate in the care of injured patients to avoid wasting precious medical resources. The intent of this emphasis is to provide optimal care in a cost-effective manner. Essential to the development of a trauma care system is the designation of definitive trauma care facilities. The trauma care system is a network of definitive care facilities that provides a spectrum of care for all injured patients. In an area with adequate Level I resources, it may not be necessary to have Level II centers. Similarly, when Level I, II, and III centers can provide care for the volume of trauma patients in the region, Level III centers may not be necessary. Level II and III centers will be essential for the care of patients in rural and more remote regions. It must be emphasized that in any trauma system, the designating authority should be responsible for determining the anticipated volume of major trauma patients and assessing available resources to determine the optimal number and level of trauma centers in a given area.

Level I

The Level I facility is a regional resource trauma center that is a tertiary care facility central to the trauma care system. Ultimately, all patients who require the resources of the Level I center should have access to it, either directly or through efficient transfer processes. This facility must have the capability of providing leadership and total care for every aspect of injury, from prevention through rehabilitation. In its central role, the Level I center must have adequate depth of resources and personnel.

Because of the large personnel and facility resources required for patient care, education, and research, most Level I trauma centers are, for the most part, university-based teaching hospitals. Other hospitals willing to commit these resources, however, may meet the criteria for Level I recognition.

In addition to acute care responsibilities, Level I trauma centers have a major responsibility for providing leadership in education, research, and system planning. This responsibility extends to all hospitals caring for injured patients in their regions. Medical education programs include residency program support and postgraduate training in trauma for physicians, nurses, and prehospital providers. Education can be accomplished through a variety of mechanisms, including classic continuing medical education (CME), trauma and critical care fellowships, preceptorships, personnel exchanges, and other approaches appropriate to the local situation. Research and prevention programs, as defined in this document, are essential for a Level I trauma center.