American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

The Committee on Trauma State Chair’s Relationship with Chapters

The American College of Surgeons Committee on Trauma (ACS COT) develops and implements programs that support injury prevention and ensure optimal patient outcomes across the continuum of care. COT programs provide meaningful trauma-related professional development, education, outcomes, and advocacy programs worldwide.

The COT is divided into regional COTs (RCOTs), the leadership of which oversees the operation of programs and courses such as ATLS at the local level. To ensure all RCOTs operate with aligned organizational structure, roles, and responsibilities, the ACS COT publishes the Blue Book as a guide.

The relationship structure between RCOTs and chapters vary by country, and recent revisions to the Blue Book help clarify these cooperative relationships and establish best practices for communication between the RCOTs and chapters. The excerpt from the Blue Book, which includes language encouraging collaboration between the RCOT and ACS chapters can be found here. In particular, ACS chapters should focus on the following sections.

Page 4, Section 3, Nomination Process for State/Provincial/Country Chairs

 Nominations are based on previous performance in COT/RCOT programs or activities and demonstrated leadership such as performance in vice chair roles, or key committee positions. S/P/C Chairs are nominated by the Region Chief in consultation with the outgoing S/P/C Chair and members of the RCOT. When an ACS Chapter exists, the Region Chief will notify the ACS Chapter President and Governor(s) who will be given the opportunity to comment. Any recommendations made by the ACS Chapter will be considered but are non-binding on the COT. Once the nomination is approved by the Chair of the RCOT, the nominee is formally appointed by the Chair of the COT.

Page 5 Section 1: Qualifications for Country Chairs

 Country Chairs should be experienced trauma surgeons familiar with the structure and objectives of the COT, preferably through experience in the Country RCOT. They must be an active ATLS® instructor (an exception may be made in a country without an ATLS program). Country Chairs who are surgeons should be Fellows of the ACS; if ACS Fellowship is not an option, then a board certified or equivalent surgeon may be acceptable. In certain circumstances, a physician who is an experienced trauma care provider, is an active ATLS instructor, and is an Affiliate Member of the ACS may serve in this role.

Page 5, Section 3, Role of State/Provincial/Country Chair

State/Provincial/Country chairs are responsible for the organization and activities of their Regional COT. They are to provide guidance and counsel to, and are accountable for the performance of their Vice Chairs.  The S/P/C Committee on Trauma should be involved in all trauma-related activities and convene formally, at least annually, to discuss progress and establish priorities for its state/province/country. S/P/C Chairs are expected to have a collaborative working relationship with the ACS Chapter when one exists. Ideally, they should serve as a council member and participate in the activities of the ACS Chapter. Country Chairs are encouraged to sit on the International Injury Care Committee and may serve on an additional program committee as appointed by the Chair of the COT.

Page 7, Section 3, Financial Considerations for S/P/C Regional Committees on Trauma

Local agreements should be reached for use of revenue generated from COT courses and activities. It is the expectation of the ACS COT that the majority of these funds be re-invested in S/P/C RCOT efforts to advance the care of the injured patient. The funds can also be allocated to support travel to attend COT meetings. With agreement of the S/P/C RCOT, some funds may also be used to support ACS Chapter activities (e.g., Stop the bleed training, trauma speaker at Chapter meetings, etc.). Accounting of income and expenses for RCOT activities should be managed based on standard accounting principles and may be managed independently by the RCOT or in concert with the ACS Chapter based on local agreements. Annual financial reports must be submitted to the ACS COT office in accordance with the directions provided each year. If concerns are raised, the ACS COT may request and independent audit. S/P/C RCOT must comply with local regulations regarding financial reporting and auditing.

Page 9, Section 4, Procedure for Development of a Regional Committee on Trauma in a New Country

Countries that do not currently have an RCOT are encouraged to form one. If there is an existing ATLS program, the leadership of that program may form an official RCOT in the country through discussion with the Region Chief and nomination of a Country Chair as outlined above. Any country that does not yet have an ATLS program may also apply to form an RCOT through discussion with the Region Chief and nomination of a Country Chair. If an ACS Chapter exists in the country that is seeking to form a new RCOT, the chapter should be included in the process to ensure good collaboration between the RCOT and the ACS Chapter.

Page 9, Section 4, Process to Manage Concerns about Appointment or Performance of COT or RCOT Members

  1. Concerns about performance of a national committee member should be brought to the attention of the medical director or COT chair. At their discretion, the issue may be delegated to the committee chair or pillar lead and or be brought to the executive committee as needed.
  2. Concerns about the performance or appointment of members of the regional committees should be initially raised with the country/state/provincial chair. If not solved at this level, then escalated to the region chief, and if not solved there, brought to the chair of the regional committees. The regional committee chair can involve the COT chair, medical director or ACS Member Services Division, as needed. 

As the RCOTs adopt these suggested best practices, the ACS encourages chapters to always approach their relationship with the RCOT with a reciprocal spirit of collegiality and cooperation.