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