In this chapter:
"Ambulance service provider" has the meaning specified in s. 256.01 (3)
, Stats., namely, a person engaged in the business of transporting sick, disabled or injured individuals by ambulance to or from facilities or institutions providing health services.
"Assessment and classification criteria" means the required trauma care services and capabilities for a hospital to be classified as a Level III or IV trauma care facility.
"Audit" means a close examination of a situation or event in a multidisciplinary peer review.
"Bypass" means to forego delivery of a patient to the nearest hospital for a hospital whose resources are more appropriate for the patient's injury pursuant to direction given to a pre-hospital emergency medical service by on-line medical direction or predetermined triage criteria.
"Classification" means the process whereby a hospital identifies its service level as a trauma care facility and the department reviews and approves the hospital as a provider of a level of trauma care services to meet the needs of the severely injured patient.
"Coordinating facility" means an ACS verified level I or II hospital that has a collaborative relationship with the regional trauma advisory council and the department as specified under s. DHS 118.06 (3) (c)
"Definitive care" means comprehensive care for the full spectrum of injuries beyond the initial assessment and resuscitation phase.
"Department" means the department of health services.
"Dispatch" means identifying and coordinating the emergency resources needed to respond to a specific traumatic injury or illness.
"Emergency medical technician" or "EMT" means an individual licensed by the department under ch. DHS 110
as an EMT-basic, EMT-basic IV, EMT-intermediate or EMT-paramedic.
"Executive council" means the RTAC leadership body, which is composed of professionals from each region who reflect trauma care expertise, leadership and diversity within each trauma care region.
"First responder" means a person who is certified under ch. DHS 113
and who provides emergency care to a sick, disabled or injured individual prior to the arrival of an ambulance as a condition of employment or as a member of a first responder service.
"First responder service" means a group of persons licensed by the department as a first responder group under s. 256.15 (8)
, Stats., who are employed or organized to provide emergency care to sick, disabled, or injured individuals as a response for aid requested through a public service access point in conjunction with the dispatch of an ambulance, but who do not provide ambulance transportation of a patient.
"Fiscal agent" means the person or organization responsible for transactions of RTAC funds.
"Health care provider" means a medical professional who or organization that is involved in either the detection, prevention or care of an injured person and includes all of the following:
"Hospital" means entities approved under subch. II of ch. 50
, Stats., and ch. DHS 124
, including critical access hospitals, that routinely provide trauma care, excluding hospitals whose principal purpose is to treat persons with a mental illness.
"Indicator review" means the RTAC's assessment of trauma system performance based on desired trauma system measurements and used by the RTAC in the performance improvement process.
"Lead agency" means an organization or agency that serves as the focal point for program development on the local, regional and state level. In this chapter, the department serves as the lead agency.
"Level I" means a class of trauma care facility that is characterized by the hospital's capability of providing leadership and total care for every aspect of traumatic injury from prevention through rehabilitation, including research.
"Level II" means a class of trauma care facility that is characterized by the hospital's ability to provide initial definitive trauma care regardless of the severity of injury, but may not be able to provide the same comprehensive care as a level I trauma center.
"Level III" means a class of trauma care facility that is characterized by the hospital's ability to:
Provide emergency surgery and arrange, when necessary, transfer to a level I or II trauma facility for definitive surgical and intensive trauma care.
"Level IV" means a class of trauma care facility that is characterized by the hospital's ability to stabilize and provide advanced trauma life support prior to patient transfer.
"Loop-closure" means the process whereby an RTAC has identified a quality improvement problem, completed an evaluation, developed an action plan and notified appropriate health care providers of the results.
"Medical director" means the physician who is designated in an EMT operational plan to be responsible for all of the following off-line medical direction activities:
Controlling, directing and supervising all phases of the emergency medical services program operated under the plan and the EMT's performing under the plan.
Establishing standard operating protocols for EMTs performing under the plan.
Coordinating and supervising evaluation activities carried out under the plan.
Designating on-line medical control physicians, if the physicians are to be used in implementing the emergency medical services program.
"Needs assessment" means a written report prepared by an RTAC identifying and documenting trauma care and injury prevention resources and deficiencies within a defined area of the trauma system and which serves as the basis for developing a regional trauma plan.
"Nurse anesthetist" means a professional nurse licensed under ch. 441, Stats.
, who has obtained, through additional education and successful completion of a national examination, a certification as an anesthesia nursing specialist.
"Off-line medical direction" means medical direction that does not involve voice communication provided to EMTs and first responders providing direct patient care.
"On-line medical direction" means medical direction of the activities of an EMT that involves voice communication provided to the EMTs by the medical director or by a physician designated by the medical director.
"On-line medical control physician" means a physician who is designated by the medical director to provide voice communicated medical direction to emergency medical technician and first responder personnel and to assume responsibility for the care provided by emergency medical technician and first responder personnel in response to that direction.
"Out-of-hospital" means care provided to sick or injured persons before or during transportation to a medical facility, including any necessary stabilization of the sick or injured person.
"Pediatric trauma center" means a hospital that is dedicated to providing for the trauma needs of a pediatric patient population and meets the resource requirements outlined by the ACS in chapter 10 of the publication Resources for Optimal Care of the Injured Patient: 1999" for verification as a pediatric trauma center. The trauma center may be freestanding or a separate administrative unit in a larger hospital.
DHS 118.03 Note
The publication, Resources for Optimal Care of the Injured Patient: 1999, Committee on Trauma, American College of Surgeons (1998), is on file in the Department's Division of Public Health, the Legislative Reference Bureau and the Secretary of State's Office, and is available for purchase from the American College of Surgery, 633 W. Saint Clair St., Chicago, Illinois 60611-3211. Chapter 10
is titled "Pediatric Trauma Care."
"Performance improvement" means a method of evaluating and improving processes of trauma patient care that emphasizes a multidisciplinary approach to problem solving.
"Physician" means a person licensed under ch. 448, Stats.
, to practice medicine and surgery.
"Protocol" means a written statement approved by the department and signed and dated by the medical director that lists and describes the steps any out-of-hospital care provider is to follow in assessing and treating a patient.
"Regional trauma advisory council" or "RTAC" means an organized group of healthcare entities and other concerned individuals who have an interest in organizing and improving trauma care within a specified geographic region approved by the department.
"Regional trauma plan" means a written report prepared by an RTAC that meets all of the following criteria:
Identifies the region's current trauma care development strengths and weaknesses.
Describes specific goals for future growth and activities in the region.
"Resource hospital" means a hospital in Wisconsin or a bordering state that makes a written commitment to assist the level III coordinating facility of an RTAC to meet the needs required for the development, implementation, maintenance and evaluation of the regional trauma system.
"Rural" means outside a metropolitan statistical area specified under 42 CFR 412.62
(ii) (A) or in a city, village or town with a population of less than 14,000.
"Statewide trauma advisory council" or "STAC" means the entity established by the department to advise the department on a variety of issues pertaining to the establishment and operation of the statewide trauma care system.
"Trauma care system" means a comprehensive and organized approach to facilitating and coordinating a multidisciplinary system response to traumatically injured patients and includes the continuum of care from initial injury detection through definitive care, rehabilitation and injury control.
"Trauma care facility" means a hospital that the department has approved as having the services and capabilities of a level I, II, III or IV trauma care facility.
"Traumatic injury" means major or severe injuries to more than one system of a person's body or major injury to a single system of the body that has the potential of causing death or major disability.
"Trauma registry" means a system for collecting data from hospitals for which the department manages and analyzes the data and disseminates the results.
"Triage" means classifying patients according to the severity of their medical conditions at the scene of an injury or onset of illness and subsequently providing care first to those patients with the greatest medical needs and who are likely to benefit from that care.
"Unclassified hospital" means a hospital that either has chosen not to be a part of Wisconsin's trauma care system, or a hospital that the department has not approved as a level I, II, III or IV trauma care facility.
"Urban" means an area within a metropolitan statistical area specified under 42 CFR 412.62
(ii) (A) or in a city, village or town with a population of 14,000 or more.
"Verification" means the process specified by the ACS whereby a hospital desiring recognition as a level I, II, III or IV trauma care facility is designated as that level by the ACS.
DHS 118.03 History
History: CR 04-055
: cr. Register December 2004 No. 588
, eff. 1-1-05; corrections in (1), (9), (11), (13), (14) and (17) made under s. 13.92 (4) (b) 6.
, Stats., Register January 2009 No. 637
; correction in (11) made under s. 13.92 (4) (b) 7.
, Stats., Register July 2011 No. 667
The department shall be the lead agency for the development, implementation and monitoring of the statewide trauma care system.
(2) Lead agency duties.
The lead agency shall do all of the following:
(a) General duties.
Develop and revise guidelines and administrative rules for the statewide trauma care system.
Approve the designation of all trauma care geographic regions based on consideration of what represents the best care of the trauma patient.
DHS 118.04 Note
Note: Wisconsin is divided into 9 trauma care geographic regions. Each region has an RTAC. A trauma care region is defined by the location of the health care providers that have selected a particular RTAC for primary membership and in which the majority of each provider's trauma care and prevention occurs.
Review the geographic distribution and organization of regional trauma advisory councils and ensure executive councils that promote the optimal operation of the statewide trauma care system.
Approve coordinating facilities, fiscal agents, executive councils and resource hospitals under sub. (6) (c)
Establish and revise the assessment and classification criteria for characterizing a hospital as a trauma facility.
Review and approve hospital applications to be a trauma care facility in accordance with standards and guidance given by the American college of surgeons in the publication Resources for Optimal Care of the Injured Patient: 1999 and the criteria in appendix A and according to the process under sub. (6) (a)
DHS 118.04 Note
Notes: 1. The publication, Resources for Optimal Care of the Injured Patient: 1999, Committee on Trauma, American College of Surgeons (1998), is on file in the Department's Division of Public Health and the Legislative Reference Bureau, and is available for purchase from the American College of Surgery, 633 W. Saint Clair St., Chicago, Illinois 60611-3211.
DHS 118.04 Note
2. Hospitals are verified by the American College of Surgeons as level I or II trauma care facilities based on conformance with the standards and guidelines contained in the publication, Resources for Optimal Care of the Injured Patient: 1999. The Department bases its classification of hospitals as level III or IV trauma care facilities on appendix A of this chapter.
Review and approve regional trauma needs assessments, triage and transport protocols and plans under sub. (6) (c)