ER Hand Care Committee

Volunteer Note

L. Scott Levin, MD

Over the past eight years, ASSH has collaborated with the American College of Surgeons to optimize care of traumatic hand injuries.  This partnership began in 2006 when the Institute of Medicine (IOM) released a report that exposed deficiencies in emergency medical care, such as access to specialists in the ER.  Following this report, ASSH took responsibility to ensure that our members provide proper hand trauma care in an expeditious manner, protecting the public trust in our skill and availability.  This led to the creation of the ASSH Hand Trauma Task Force in 2008.

Working collaboratively with the Committee on Trauma (COT) of the American College of Surgeons (ACS), the Task Force established a pathway that facilitated changes in the ACS publication "Resources for Optimal Care of the Injured Patient."  Prior to the ASSH Trauma Task Force efforts, the regulations for Level I trauma centers required only "availability" of microvascular care.  There was no mention of 24/7/365 coverage or specific terminology that included replantation or revascularization.  Furthermore, there was no mention of the need to transfer severe upper extremity injuries to other Level I centers in cases where the existing Level I center could not provide certain services, such as replantation and care of the mutilated upper extremity.  With written support from the leadership of AAOS, ASRM, AAHS, and ASPS, the Hand Society brought forth a request to the ACS COT (following their formal process to request language changes in the emergency care manual) asking that the new edition of "Resources for Optimal Care of the Injured Patient" contain specific language requiring Level I centers to provide continual coverage for hand emergencies that includes replantation and revascularization. The request also included a change that would encourage Level I centers  unable to provide such care to proactively establish a transfer agreement with another Level I center in order to expedite patient care, particularly for time sensitive injuries.  These changes were accepted and incorporated into the new manual that will be released in July 2014.

The implications of these changes are monumental.  Following our success in these endeavors, the ASSH Trauma Task Force (now the permanent ER Hand Care Committee) recently ignited another important partnership, this time with the American College of Emergency Physicians (ACEP), who we met with this spring.  Our partnerships with ACS and ACEP are invaluable.  We are glad to have received ASSH member support of these collaborations, which was voiced in a series of member surveys released by our Trauma Task Force in the past.  With these partnerships, we hope to enhance education and clinical training for care of the injured upper extremity.

As a result of our work with the ACS, ACEP, OTA (Orthopaedic Trauma Association), and other stakeholders, we are moving forward with the ultimate goal of optimizing care by creating a regional referral system for the entire country.  This system would function much like burn centers with concentration of expertise in centers that have appropriate resources and personnel to handle any upper extremity emergency. The ASSH ER Hand Care Committee has roughly stratified hand care based on injury severity. 

As we work toward the next phase of quality improvement, I am proud to share our accomplishments at this point in time.  I also want to thank the many members of the ASSH for contacting me with words of encouragement, as well as those who have shared their frustration with systems that are less than ideal in their communities.  Finally, my gratitude to leadership, ASSH Council, and the dedicated central office staff of the ASSH. Together we are making a difference.