Trauma center

Workflow & Functional Relationships in a Trauma Care Facility

A level I trauma center provides the most comprehensive trauma care. There must be a trauma/general surgeon in the
hospital 24-hours a day. If a surgical resident is in the hospital 24-hours a day, then the attending surgeon can take call
from outside the hospital but must be able to respond within 15 minutes. There must also be an anesthesiologist and
full OR staff available in the hospital 24-hours a day as well as a critical care physician 24-hours a day. If anesthesia
residents or CRNAs are take in-hospital night call, an attending anesthesiologist must be available from home within 30
minutes. There must also be immediate availability of an orthopedic surgeon, neurosurgeon, radiologist, plastic surgeon,
and oral/maxillofacial surgeon. There must be > 1,200 trauma admissions per year. The key physician liaisons to the
trauma program (trauma surgeon, emergency medicine physician, neurosurgeon, orthopedic surgeon, critical care
physician) must all do at least 16 hours of trauma-related CME per year. These centers must participate in research and
have at least 20 publications per year.
Proposed Space Program
Space Proposed Note
Area m2
Patient access
Ambulance drop off 4 The Trauma Care Facility should be preferably accessible by two separate
Ambulance entrances: one for ambulance patients and the other for ambulant patients.
Cars These entrances must be at grade-level, well-marked, illuminated, and
covered. There should be direct access from public roads for ambulance and
Ambulance 150 vehicle traffic, with the entrance and driveway clearly marked and paved.
entrance & Temporary parking should be provided close to the entrance.
In an existing hospital, these entrances must be common with the hospital’s
decontamination emergency entrance or close to the emergency entrance to ensure a single
Walk-in drop off 4 Cars point of arrival for a patient in acute distress. In case the entrance to the
Trauma Care Facility is necessarily separated from the hospital’s emergency
entrance due to limitations of space, patient load, etc., it must be ensured
that there are appropriate internal logistics and access to rush trauma
Walk-in entrance 100 patients mistakenly arriving at hospital emergency entrance and non-trauma
patients arriving at trauma center entrance to their respective areas of
definitive care.
WAITING AREA & 150 The Waiting Area should provide sufficient space for waiting patients as well
Toilets (Male as relatives / escorts. It should be preferably open and nearer to the Triage
+Female) and Reception areas. Seating should be comfortable and adequate. Space
should be allowed for wheelchairs, walking aids and patients being assisted.
Waiting Areas shall be negatively pressured vis a vis the other areas of the
Trauma Care Facility.
Security (Office & 25
Toilet)
Patient care areas
TRIAGE & RECEPTION 100 The Reception / Triage and Staff Station shall be located where staff can
AREA observe and control access to treatment areas, pedestrian and ambulance
3 Triage Units entrances, and waiting areas. Patient movement between Triage and the
(16m2/Unit) following areas should be given special consideration:
Reception, Waiting area, Resuscitation, Treatment & Ambulatory Care,
patient toilets and Diagnostic Imaging.
 Each Triage/Assessment space should be of not less than 16m2
 The minimum combined Reception and Triage area must be 1.8
m2/1000 patient attendances per annum and there should be a
minimum allocation of one triage/assessment cubicle per 10,000
annual attendances.
TRAUMA 50  There should be a minimum of 25 m2 per resuscitation bay excluding
RESUSCITATION AREA storage space. An additional one quarter to one third of this figure
(RED AREA) should be allowed for storage.
2 RESUSCITATION  For an average case-mix of 20,000 patients per year, a Trauma Center
Units (25m2/Unit) should have a minimum of two Resuscitation bays with one additional
bay per 10,000 patients per year.
COMBINED TRAUMA 100 Combined trauma treatment and imaging facilities allows for polytraumatised
TREATMENT AND or severely injured patients to be stabilized and
IMAGING ROOM examined according to ATLS guidelines including the use of diagnostic imaging
(4 Patients) within 20 minutes of arrival at the hospital. The combined trauma imaging
and treatment area is best viable in a multi-bay environment design and
25 m2/ room
allows for the treatment and imaging of a minimum of four patients.
TREATMENT AREAS 200  A typical treatment cubicle should be minimum 12m2 in size and the
(YELLOW AREA) minimum space between two beds should be at least 2.4 meters.
(16 Patients)
12 m2/ room

TRAUMA OPERATING 280 Ideally, the trauma ORs should be located nearby or adjacent to the
ROOM (L I) Resuscitation Suite to minimize transportation time for an unstable trauma
patient. On the basis of functional program and the schematic design, the size
(4 Room)
of the OR and the layout of the surgical suite should be established. An OR
70 m2/ room
size between 600 and 750 sqft can accommodate most surgical procedures
required in trauma care with portable imaging equipment being used. If
considering fixed imaging equipment in the OR, room sizing requires specific
planning in the context of the modality and type of procedures to be
performed.
ICU beds (L I) 810  30 beds (10- ICU 20 –General trauma beds)
(30 beds)
14 m2/ room +
Services 13m2/bed
Observation Ward 520
(20 beds)
12 m2/ bed +
Services 13m2/bed
Isolation rooms 28
(2 Room)
14 m2/ room
Recovery 150
(6 beds)
12 m2/ bed +
Services 13m2/bed
Facilities for patients relatives
Waiting Area 75
Communication 20
Room
Refreshment Area 20
Toilets 40
Clinical Support Services
Pharmacy & 60
Storage
Blood Bank 100
Radiology 200
X-ray
CT-scan
Lab Services 60
CSSD 200
Staff facilities
Staff changing 60
rooms
Staff shower and 40
toilets
Staff dining area 100
Office accommodation
Administrative 160
support
(10 offices)
16 m2/ office
Staff offices 160
(10 offices)
16 m2/ office
Staff Rest 40
Total Area 3998
Total Area + 6396.8
Circulation (1.6)
General Notes:
 A Level I trauma center must meet admission volume performance requirements (one of the
following):
a) Admit at least 1200 trauma patients yearly,
b) 240 admissions with an Injury Severity Score (ISS) of more than 15,
c) An average of 35 patients with an ISS of more than 15 for the trauma panel surgeons (general
surgeons who take trauma all).
 2-14 and 2-15 Any adult trauma center that annually admits 100 or more injured children younger than
15 years must fulfill the following additional criteria demonstrating their capability to care for injured
children: Trauma surgeons must be credentialed for pediatric trauma care by the hospital’s
credentialing body, there must be a pediatric emergency department area, pediatric intensive care
area, appropriate resuscitation equipment, and a pediatric-specific trauma PIPS program.
 Level I and II centers provide sufficient resources, including instruments, equipment, and personnel, for
modern musculoskeletal trauma care, with readily available operating rooms for musculoskeletal
trauma procedures.
 All pediatric trauma centers must have the following programs: pediatric rehabilitation, child life and
family support programs, pediatric social work, child protective services, pediatric injury prevention,
community outreach, and education of health professionals and the general public in the care of
pediatric trauma patients
 A Level I pediatric trauma center must have at least 2 surgeons who are board-certified or board-
eligible in pediatric surgery by the American Board of Surgery
 In a Level I trauma center, there is an in-house CT technologist.
 MRI capability is available 24 hours per day at Level I trauma centers.