For the first time in several years, a meeting occurred between ACEP Board leadership and the American College of Surgeons Committee on Trauma (ACS COT). Many issues important to emergency physicians were discussed. Often when lines of communication open, positive relationships develop. Common understanding of important issues leads to mutually beneficial outcomes. Such was the case here.

Trauma Center Verification

One of the most important ACEP issues discussed at this March meeting was trauma center verification requirements. As the saying goes, timing is everything! It turns out that ACS COT had just published the new trauma verification guidelines and was finalizing the clarification document used by site reviewers to interpret them. We were able to discuss several issues, one of which was Level 1 and 2 trauma center criteria requiring any emergency physician caring for trauma patients to be EM board certified. We have heard reports that, in some areas, non–EM-boarded physicians who have been practicing for many years, appropriately meeting quality indicators, were no longer being allowed to care for trauma patients, possibly threatening the physician’s livelihood. We educated our surgical colleagues that there are a significant number of physicians who are American Board of Medical Specialties (ABMS) boarded but not EM boarded who have been working in such trauma centers for many years, are part of the local quality improvement program, and have been performing well over time. Excluding these individuals from working with trauma patients seemed shortsighted and not necessarily the right thing for patients, particularly in more rural settings.

Not only were our concerns heard but we were given a very short window of opportunity to help craft final clarifying language that would be mutually agreeable. Working closely with our surgical colleagues over a series of days, we crafted language and negotiated with the lead ACS author, finally achieving insertion of the following language:

Physicians boarded in other specialties, such as internal medicine, family practice, etc., through an accredited program may be included on the trauma call; however, they must be current in ATLS [advanced trauma life support]. For Level I and II Trauma Centers, individuals completing training after June 2016 must be board certified by the appropriate emergency medicine board according to the current requirements. Other physicians may provide care in the emergency room but cannot participate in trauma care. 

What this means is that physicians who are ABMS boarded in any specialty and who have been working in a Level 1 or Level 2 trauma center before 2016 but who are not boarded in EM can still take care of trauma patients as long as they remain current in ATLS. EM-boarded physicians are exempt from this requirement. This means that no one’s job will be threatened (there have been isolated reports of this in the past). We believe this is a huge win for many ACEP physicians and gives those who were already working in this setting and doing a good job some measure of protection.

But wait—it didn’t stop there! We discussed what it means to be a Fellow in the College and the criteria used to determine recipients of this designation, which we consider truly an honor. Ours are actually more stringent criteria than many specialties use to confer fellow designation. ACS COT leadership was so impressed with FACEP that they inserted the following language:

If a physician has not been certified within the time frame by the certifying board after successful completion of an [Accreditation Council for Graduate Medical Education] or Canadian residency, the physician is not eligible for inclusion in the trauma team. Such a physician may be included when given recognition as a fellow by a major professional organization (for example, the American College of Emergency Physicians). The only recognized organization is the American College of Emergency Physicians.

This essentially means that if physicians are Fellows in the College but not boarded, they still meets the trauma center criteria. We believe this is another huge win for ACEP members and their patients.

“States may request national ACS to provide verification, but they may also modify national criteria and verify centers themselves. As you might expect, this is quite variable from state to state and many states do it entirely themselves without national involvement.”

It is important to understand these are national criteria employed when ACS COT sends review teams into states for verification visits. However, trauma verification is largely a state-run process. States may request national ACS to provide verification, but they may also modify national criteria and verify centers themselves. As you might expect, this is quite variable from state to state, and many states do it entirely themselves without national involvement.

Another concern raised at times is that emergency physicians are not part of the verification team. This is not completely true. There are many states where emergency physicians are an integral part of the team. For instance, in my home state of Virginia, I have been doing trauma verification visits for more than 10 years. Generally, the authority for trauma center designation rests with state health departments. They set the standards locally. If an emergency physician is not included on the team in your state, that is the place to start advocating for inclusion. The verification team from national ACS traditionally includes two trauma surgeons. However, it was noted that certain states require an emergency physician as part of the site visit team. When verifying in those states, the national ACS team includes an emergency physician as requested by the state. The surgeons at our discussion felt having an emergency physician added an important dimension and noted that, “they caught things we would have missed.” Discussions are ongoing in this regard at the national level. However, advocating for emergency physician inclusion at a state level may be more productive since the requirements are actually set by each state.

More Collaboration Ahead

Further demonstrating this new era of cooperation, a joint task force has been formed with representatives from the ACEP Medical Services Committee, the National Association of EMS Physicians, and ACS COT to develop a guidance document on use of tranexamic acid in the field.

Going forward, we look to even more collaboration in an ongoing, mutually beneficial, close relationship with ACS COT.

Dr. Perina is an ACEP Board Member and ACEP representative to ACS COT.