Expected response times are common in the verification and designation standards for all trauma centers. Some examples are:

• Trauma surgeon at Level I or Level II ACS centers for highest-level trauma activation – 15 minutes
• Trauma surgeon at Level III ACS centers for highest-level trauma activation – 30 minutes
• OR and PACU personnel and backups – 30 minutes
• Neurosurgeon and orthopedic surgeon response to certain high-risk patient conditions – 30 minutes
• Interventional radiologist and team for hemorrhage control – 60 minutes to needle stick

However, the majority of standards say nothing about how soon the backup trauma surgeon must arrive when called. Each trauma center is left to decide this on its own.

What is a reasonable time frame? Here’s how I think about it:

• With the exception of interventional radiology and the trauma surgeon at higher-level trauma centers, everyone else has a 30-minute expectation.
• And if you look at the interventional response, it’s a whole team, and most people have to be there within about 30 minutes to have the patient prepped and ready for the needle stick.
• If you are the trauma surgeon on duty when the s#!t hits the fan, how long do you want to wait for your partner to arrive to help out? Probably not long!

My recommendation is to have an expected response time of no more than 30 minutes. This should be reasonable for most trauma centers. However, each one will need to examine their own particular factors. How often is the backup surgeon needed? Do you really want to have them stay in-house or exclude them from the backup schedule if they are slightly outside the 30-minute window?

If your center does have backup surgeons living on the fringe, so to speak, you could consider a system where the on-call surgeon calls the backup to put them on notice once they become seriously encumbered. This would help the backup improve their readiness, allowing them to arrive more quickly if needed.

I think the most important thing is to think about this process well in advance to make sure that your backup is readily available to maintain patient safety during any potential crush of activity.

If you have developed a different way of dealing with the backup surgeon issue, please describe it in the comments!