U.S. Department
of Transportation
Federal Highway
Administration
Mr. Brian R. Searles
Secretary of Transportation
Agency of Transportation
State of Vermont
National Life Building, Drawer 33
Montpelier, VT 05633-5001
Dear Mr. Searles:
February 22, 2002
400 Seventh St., S.W.
Washington, D.C. 20590
Refer to: HOTO-1
Thank you for your November 5 letter seeking approval for the development and implementation
of an experimental sign program for Level I Trauma Centers.
Although your letter was submitted as a Request for Experimentation, we have considered it to
be a Request for Interpretation. The word message "Level I Trauma Centers" is the type of
supplemental sign which may be used with the standard Emergency Medical Services symbol
sign. We hope our explanation below clarifies the use of word messages with this symbol sign.
For recordkeeping purposes, we have entitled it 2-487(I)-"Level I Trauma Center signs." You
may use this sign immediately if you take the following the actions:
a. Develop a policy in regard to how Vermont will clarify the difference to motorists between
Hospital services and Level I Trauma Centers;
b. Develop a policy which details the specific criteria for ambulance service and emergency
department facilities, staff, and hours of operation for Level I Trauma Centers as an alternate
to those detailed in the Emergency Medical Services program; and
c. Modify the design of the proposed sign to include the standard Emergency Medical Services
symbol, D9-13, within the design of the sign.
In developing your policy, we offer the following comments
1. Section 2D.44 General Service Signs (D9 Series) of the Millennium edition of the Manual on
Uniform Traffic Control Devices (MUTCD) requires "All General Service signs and
supplemental panels shall have white letters, symbols, and borders on a blue background,"
that "General Service signs, if used at intersections, shall carry a legend for one or more of
the following services: Food, Gas, Diesel, LP-Gas, Lodging, Camping, Phone, Hospital,
Tourist Information, Police, or Truck Parking along with a directional message," and
"Symbols and word message General Service legends shall not be intermixed on the same
sign." As the sign proposed by Vermont Transportation is a legend sign with no symbol, the
design satisfies the general requirements for general services signs.
2. What are the consequences in terms of medical care for a person seeking a hospital who
follows the information provided by the proposed "Level I Trauma Center" sign; are hospital
services provided? If not, how can the proposed sign be modified to clearly indicate that
only Level I Trauma services are provided?
3. There are two types of medical services signs, each with a different symbol, detailed in
Section 2D.44, the Hospital symbol sign, and the Emergency Medical Services symbol sign.
From the information in your letter, your request is more closely related to the Emergency
Medical Services symbol sign than to the use of the Hospital symbol sign. Use of the
Emergency Medical Services symbol sign requires each State to develop guidelines for the
implementation of the Emergency Medical Services sign, which satisfy certain criteria for
ambulance service and emergency department facilities, staff, and hours of operation.
Additionally, the MUTCD requires that "The Emergency Medical Services symbol sign shall
not be used to identify services other than qualified hospitals, ambulance stations, and
qualified free-standing emergency medical treatment centers. If used, the Emergency
Medical Services symbol shall be supplemented by a sign identifying the type of service
provided." The sign proposed by Vermont Transportation for Level I Trauma Centers would
be such a supplemental sign.
4. If Vermont were to adopt guidelines for Level I Trauma Centers in a like manner to those
detailed in Section 2D.44 of the MUTCD, then the use of the proposed word legend general
service sign "Level I Trauma Center Next Right" could be viewed as a word legend alternate
(corresponding to the Level I Trauma Center program) to the Emergency Medical Services
symbol sign rather than a replacement of the H symbol for Hospital sign.
If you have any questions while preparing the requested information, please feel free to call
Mr. Fred Ranck at 708-283-3545.
Sincerely yours,
Shelley J. Row, P.E.
Director, Office of Transportation
Operations