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NeuroSurgery Coverage and Response

NeuroSurgery Coverage and Response - Clinical Hub, References, Level I Adult Trauma Center Manual, Operational Guidelines, Ortho/Neuro Coverage



To meet the requirements of the American College of Surgeons and ensure coverage of the neurologically injured trauma during emergent and routine care.


NeuroSurgery coverage is defined as

  1. Active participation and support of the neurosurgical service.
  2. More than one neurosurgeon on staff and participating in the adult trauma program
  3. An attending neurosurgeon or designee is promptly available and dedicated to the trauma program when on call.
  4. An Attending is on call and promptly available to come to the hospital when requested by the Trauma Surgeon or Emergency Department physician.
  5. A back up call plan is available when neurosurgery first line resources have become encumbered.
  6. All Neuro Surgeons will have access to PACS in their home environment.


  1. Primary Neuro Surgery Coverage
    1. An in -house NeuroSurgeon will provide coverage for the care of the patient with a traumatic brain injury or spinal cord injury 24 hours a day, 365 day.
    2. The in-house requirement may be fulfilled by a senior postgraduate in year 4 or higher neurosurgical resident.
    3. The Neurosurgery in house provider will respond to all Level I trauma activations within 30 minutes of patient arrival to the Emergency Department or hospital.
    4. When the in-house coverage is provided by senior resident, the NeuroSurgery Attending will be requested to respond within 30 minutes for the following scenarios:
      1. A trauma patient requiring craniotomy/craniectomy going to the Operating Room
      2. A trauma patient with an acute, emergency spine case going to the Operating Room
      3. Any other emergent neurosurgical need
    5. The NeuroSurgery Attending will document in his note the time that was called and arrived at the hospital. If the Trauma patient is in the Emergency Department, the response can be noted on the trauma flow sheet.
  2. Back up NeuroSurgery Call Coverage
    1. When the Attending NeuroSurgeon responds to the hospital, the senior neurosurgical resident can become the back up surgeon available for Level I activations or other emergency neurosurgical scenarios as defined above.
    2. The NeuroSurgery Fellow, when available, can provide back up emergency coverage.
    3. The post graduate level 2 is in-house and can provide additional coverage.
    4. There is a NeuroSurgery back up Attending on call when all other resources have been exhausted or there is an emergent need for the back up Attending to respond.
  3. All delays in NeuroSurgery response times will be reviewed Trauma Performance Improvement and Patient Safety Program.

References:  American College of Surgeons Committee on Trauma. Resources for the Optimal Care of the Injured Patient: 2014. Chicago, IL, American College of Surgeons, 2014