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Orthopedic Surgery Coverage and Response

Orthopedic Surgery 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 orthopedically injured trauma during emergent and routine care.


Orthopedic Surgery coverage is defined as

  1. Active participation and support of the orthopedic trauma service.
  2. More than one orthopedic surgeon on staff and participating in the adult trauma program
  3. An attending orthopedic surgeon 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 orthopedic first line resources have become encumbered.


  1. Primary Orthopedic Coverage
    1. An in -house Orthopedic surgeon will provide coverage for the care of the patient with a traumatic orthopedic injury 24 hours a day.
    2. The in-house requirement may be fulfilled by a senior postgraduate in year 4 or higher orthopedic surgery resident.
    3. The Orthopedic Surgery 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 a senior resident, the Orthopedic Surgery Attending will be requested to respond within 30 minutes for the following scenarios:
      1. All major emergent traumatic orthopedic operations
      2. Unstable pelvic injuries
      3. Multiple injured patients
      4. Acute limb salvage situations
      5. Any other orthopedic emergency
    5. The Orthopedic Surgery 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 Orthopedic Surgery Call Coverage
    1. When the Attending Orthopedic Surgeon responds to the hospital, the senior orthopedic surgery resident can become the backup surgeon available for Level I activations or other emergency neurosurgical scenarios as defined above.
    2. The post graduate level 2 is in-house and can provide additional coverage.
    3. There are certain scenarios when a Backup Attending Orthopedic Surgeon is on call. The backup can be activated when all other resources have been exhausted or there is an emergent need for the backup attending to respond.
  3. All delays in Orthopedic Surgery 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