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.