Initial Live Video Conference (LVC)
ATCN Program Application
This form is for use by institutions requesting initiating an Advanced Trauma Care for
Nurses course at their institution via a teleconference link. This proposal should be
received by ATCN office at least 4 months prior to the desired initial course date. The
live video conference (LVC) course will consist of an ATLS course provided per a
teleconference “live” link with both audio and video presentations of the ATLS lectures
to the ATCN remote site. The ATCN LVC sites will be coordinated through the ATCN
office.
The ATCN LVC course program is coordinated through the national ATCN office and an
approved ATLS site with teleconference capabilities. Following approval by the ATCN
Executive Committee, the institution will be asked to sign a Memorandum of
Understanding outlining the responsibilities of each party involved.
Date of Request
Name of Requestor
Degrees
Institution
Address
City
State
Work Phone
ZIP
Country
Work FAX
E-mail
Name of Contact Person if not same as above
Degrees
Institution
Address
City
Work Phone
State
ZIP
Work FAX
Country
E-mail
Name of ACS Committee on Trauma State Chair
Institution
Address
City
State
Work Phone
ZIP
Country
Work FAX
E-mail
Proposed date of course
Provider
The following items must be attached to the request:
ATCN Course Authorization Form
Letter of support from ATLS Course Director specifically referencing approval
of the ATCN Live Video Conference option.
Letter/Documentation from Facility verifying that the facility has the technical
capabilities required to conduct an ATCN LVC and sufficient past experiences
with live video conferencing capabilities.
List of proposed faculty for course – if you already have ATCN faculty available
(This will be completed once the program application has been submitted
and a National faculty assigned by the ATCN chair)
Proposed budget (use categories found in ATCN Financial Report Form)
Complete this document and send with attachments by e-mail to:
Michael Glenn, RN
Trauma/Surgical PI Coordinator
Harborview Medical Center
325 9th Ave
Box 359731
Seattle, WA 98104
Phone: (206) 744-1856
Email: maglenn@uw.edu
Advanced Trauma Care for Nurses®
Memorandum of Understanding for
Inaugural International or State Program
Live Video Conference Option
This document details the arrangements for a joint endeavor between the Society of Trauma Nurses (STN,)
the Advanced Trauma Care for Nurses (ATCN) Committee and
(Place Name of your institution here) , hereinafter known as ( institution) for the purpose of the
development of Advanced Trauma Care For Nurses.
Effective date
The Memorandum of Understanding (MOU) will come into effect on the date that the signatures
of the appropriate representatives of the STN ATCN and institution have been affixed to the final page of
this document
Conduct of Live Video Conference (LVC) Course
LVC can be requested as either Option 1 or Option 2.
Option 1:
□ Utilize the live video conference (LVC) course system to develop a sustainable ATCN site
with on-going ATLS video conferenceing
In order to facilitate the training of instructors to conduct future ATCN courses, ATCN will be
responsible for identifying the ATCN instructors, and course Director (hereinafter referred to as
the visiting faculty) to teach the teleconference course
The inaugural course will be conducted in accordance with the policies and procedures approved
by the ATCN Executive Committee
ATCN will train a cadre of local Instructor Candidates as well as course Directors and
Coordinators during the inaugural course. The Instructor Candidates and Course Directors must
satisfactorily complete the requirements of their status as defined in the policies and procedures of
ATCN.
Costs
The institution will be responsible for the financial outlay for the inaugural course as well as future
courses which include course materials, direct and indirect charges and material and material
shipping costs.
The institution will be responsible for arranging for pre-payment (if requested) of business class
airfare for visiting faculty and those conducting the inaugural courses, meals and lodging, and all
course related transportation or other expenses.
Course Materials
The institution will order the required ATCN materials from the STN office and be responsible for
distribution of course materials to all course candidates for the inaugural courses.
The institution will provide the equipment required to conduct the courses as outlined in the
policies and procedures manual. ATCN will provide course schedules, case scenarios, tests, etc.
as outlined in the policies and procedures manual.
ATCN will advise institution of manual revisions and (known as) is responsible for insuring that
all ATCN instructors and students have the revised manuals for use in courses held after the date
of revisions.
Conduct of all Future ATCN Courses
The institution will be responsible for the conduct of future ATCN Provider Courses held in/at that
institutions country/state and will insure that the courses are conducted in accordance with the
essential requirements established for the program by the ATCN Committee as outlined in the
ATCN Policy and Procedure Manual.
ATCN national office will be responsible for assigning / approving ATLS LVC site for each
course.
The institution will be responsible for ensuring the maintenance of high standards for all courses
and that the content of the courses remain consistent for all courses conducted by them.
Should another institution or state request the ATCN program, the institution will advise them that
a written request to ATCN must be made.
Student and Instructor Reciprocity
Student reciprocity shall exist and nurses with valid status at the provider course level will be
recognized by the ATCN. Instructor reciprocity also shall exist and qualified ATCN instructors
are eligible to teach approved ATCN courses.
Course Reporting and Records Maintenance
The institution will be responsible for submitting completed course reports and course fees as
outlined in the ATCN Policy and Procedure Manual for each course conducted. The ATCN will
be responsible for reviewing the post course reports and maintaining records on all courses
conducted.
This MOU may be amended with mutual consent in writing of all parties. Any disagreement with
respect to the MOU will be resolved by consultation between both organizations.
Option 2:
□ One time course option – provide an ATCN LVC course
In order to facilitate the training of instructors to conduct future ATCN courses, ATCN will be
responsible for identifying the ATCN instructors, and course Director (hereinafter referred to as
the visiting faculty) to teach the LVC course
The inaugural course will be conducted in accordance with the policies and procedures approved
by the ATCN Executive Committee
Cost
The institution will be responsible for the financial outlay for the inaugural course which include
course materials, direct and indirect charges and material and material shipping costs.
The institution will be responsible for arranging for pre-payment (if requested) of business class
airfare for visiting faculty and those conducting the inaugural course, meals and lodging, and all
course related transportation or other expenses.
Course Materials
The institution will order the required ATCN materials from the STN office and be responsible for
distribution of course materials to all course candidates for the course.
The institution will provide the equipment required to conduct the courses as outlined in the
policies and procedures manual. ATCN will provide course schedules, case scenarios, tests, etc.
as outlined in the policies and procedures manual.
ATCN will advise institution of manual revisions and (known as) is responsible for insuring that
all ATCN instructors and students have the revised manuals for use in courses held after the date
of revisions.
Student and Instructor Reciprocity
Student reciprocity shall exist and nurses with valid status at the provider course level will be
recognized by the ATCN. Instructor reciprocity also shall exist and qualified ATCN instructors
are eligible to teach approved ATCN courses.
Course Reporting and Records Maintenance
The institution will be responsible for submitting completed course reports and course fees as
outlined in the ATCN Policy and Procedure Manual for each course conducted. The ATCN will
be responsible for reviewing the post course reports and maintaining records on course.
This MOU may be amended with mutual consent in writing of all parties. Any disagreement with
respect to the MOU will be resolved by consultation between both organizations.
_____________________________
Signature
_________________
Date
For: Institution
______________________________
Signature
For ATCN
_________________
Date