Updated COVID Guidance for Conducting a COT Trauma Education Course

We are aware that there has been a great deal of contradictory rhetoric surrounding the need to wear masks and social distance in indoor settings, particularly since the COVID Vaccines have become available. We are also aware of the political perspectives that have influenced individuals and communities. However, the emergence of the Delta and other variants of the virus necessitate that we continue to exercise caution as we resume/continue our educational efforts.

Our basic premise is this:

Rather than thinking of the precautions we take as a sacrifice, we believe they should be thought of as acts of kindness towards our fellow human beings, efforts we undertake to care for each other and to “do no harm”.

For this reason, we are updating our guidance to specifically require the following:

• All COT Education Courses will require that ALL participants (including faculty, educators, and staff) wear appropriate masks during the Course; this applies regardless of vaccination status. The COT is aware that some localities have done away with mask mandates, and that some have specifically stated that publicly funded entities may not require masks. However, these latter statutes do not apply to ACS/COT educational offerings. Regardless of local guidance, masks are required for all COT Educational offerings.
• The mask must be worn such that it covers both the nose and the mouth
• If a podium speaker is 10 feet or more away from ALL Participants, the speaker may unmask so that the participants may see the speaker’s face during the presentation. However, the speaker must re-mask as soon as s/he is done speaking. The default, however, is that presenters remain masked.
• The only other time that masks can be removed during the Course is when a participant is eating and drinking.
• Food consumption should not take place during educational sessions.
• If a site is going to allow beverages to be consumed during educational sessions, adequate physical distancing between participants must be maintained. Participants should be advised that if they going to drink a beverage during an educational session, the mask should be replaced immediately after the participant has finished drinking.
• The space in which food consumption will take place should be large enough to accommodate physical distancing since participants will have to remove their masks while eating.
• All efforts should be made to try to accommodate individuals who request separate eating areas while food consumption is taking place. If this is not possible, this should be made clear to the potential participant prior to the Course
• Buffet style food, shared utensils, beverages (including a group coffee/tea service), are not recommended. Food should be boxed or individually wrapped. Beverages should be individually bottled.
• The site should provide explicit pre-course communication of expectations to all participants (Students and Faculty). This should include an explanation of the mask-wearing requirements, physical distancing, and infection control precautions that will be taken, as well as the policy for refusal to follow stated precautions (e.g., removal from course). If podium speakers will be unmasked (with 10 ft social distancing), this should be communicated. Also, the food provision/eating arrangements should be clear. Participants need this information so that they can make informed decisions regarding their participation in the Course.
• The site should notify participants of the routine screening (e.g., taking a temperature, completing a questionnaire) that is part of your institutional protocol.
• Specific guidance should be given stating that participants who do not feel well should stay home and that participants who are ill will be requested to leave.
• Course sites should provide gloves for skill stations.
• Sites should make it clear that anyone—students, faculty, or staff—refusing to follow the above safety guidelines will be asked to leave the course.

• IAD should be held in venues large enough to allow for appropriate physical distancing.
• Sites may consider using video conferencing (e.g., WebEx, Teams, Zoom, or another platform) to complete the IAD. This may be completed in one day, or over several days.
• Masks should be worn at all times with possible exemption for podium speakers as noted above.

• Maintain student-to-faculty ratios, as outlined in the administrative guide for each course. Larger stations are not recommended by Senior Educators and make physical distancing more difficult.
• Ensure Skill Station rooms are large enough to allow learners and instructor(s) to maintain appropriate physical distancing.
• Where applicable, participants should be at a task trainer or simulation station one at a time. Ensure adequate cleaning between each student, and adequate physical distancing between instructor and student.
• Some “team” type skills in the ATLS (Advanced Trauma Life Support) and TEAM (Trauma Evaluation and Management) courses may temporarily be taught with video rather than hands-on practice. This may include pelvic immobilization, log roll, traction splint, and helmet removal.
• Skill stations in the ATLS Course such as Adjuncts, Secondary Survey, and Team Training/Initial Assessment may be conducted as a small group interactive discussion with appropriate physical distancing.

• Appropriate PPE should be worn at all times.
• Physical distancing requirements should be maintained at all times.
• Student numbers should be kept low to allow for adequate physical distancing in the lab.

• Mannequins or other simulators may be substituted for moulage “victims.”
• If using live moulage patients, “victims” should wear masks at all times, have no physical contact with course participants, and maintain appropriate physical distancing.
• Options:
  • IA may be conducted as usual with PPE and frequent hand sanitizing.
  • IA may be conducted with a mannequin that is thoroughly cleaned between sessions. Instructors and students should wear masks and gloves.
  • In extreme cases, IA may be conducted in a manner like the oral boards. The instructor would provide the scenario and responses to maneuvers, but no “victim” would be involved. This may be completed via video conferencing, if necessary.

• Pretests can be taken online. ATLS, RTTDC, DMEP, and ATOM have online systems that provide access to the pretest.
• Written posttests should be conducted in a space large enough to allow for adequate physical distancing. In the case of participants needing to take remedial exams for courses with written posttests, these can be proctored remotely. Please contact atls@facs.org to discuss this type of option. The ATOM course is currently the only program with an online posttest.

Available solutions for each course component are listed in the charts below. You can choose which method works best for your site. If in doubt, please email staff at the addresses specified under each course.

Advanced Trauma Life Support (ATLS)

* Some team type skills (e.g., pelvic immobilization, log roll, traction splint, helmet removal, adjuncts, secondary survey, Team Training/Initial Assessment) may be completed via video or as small interactive discussions with appropriate physical distancing.
** In extreme cases, these may be conducted like the oral boards via video conference.

Please note that there is NO COMPLETELY REMOTE OPTION at present for ANY ATLS Course. If a site has questions regarding what elements of a Course it is planning may be conducted remotely, the site should contact the ATLS office at atls@facs.org. For Instructor Courses, the only person who may participate remotely is the Educator if travel is not possible and the plan has been approved by the ATLS Chair.

Trauma Evaluation and Management (TEAM)

For questions about the TEAM course, contact atls@facs.org.

Disaster Management & Emergency Preparedness (DMEP)

For samples of how Course Sites have held the DMEP course 100% online, contact COTDisaster@facs.org.

Rural Trauma Team Development Course (RTTDC)

At this time, the RTTDC Workgroup recommends that courses be held live and in-person. This may require limited participant numbers to maintain proper physical distancing and infection control procedures. Any proposal for a partially remote/virtual course should be sent to rttdc@facs.org for review by the RTTDC Director and Work Group.

Advanced Surgical Skills for Exposure in Trauma (ASSET)

For questions about the ASSET program, contact ASSET@facs.org

Advanced Trauma Operative Management (ATOM)

For questions about the ATOM program, contact ATOM@facs.org

Basic Endovascular Skills for Trauma (BEST)

For questions about the BEST program, contact BEST@facs.org.