Trauma is any life-threatening occurrence, either accidental or intentional, that causes injuries. The leading causes of trauma are motor vehicle accidents, falls, and assaults. Trauma is the leading cause of death among Americans under 44 years of age.
In order to qualify as a trauma center, a hospital must meet certain criteria as established by the American College of Surgeons (ACS). Trauma centers vary in their specific capabilities and are identified by "Level" designation: Level-I (Level-1) being the highest, to Level-III (Level-3) being the lowest (some states have four designated levels, in which case Level-IV (Level-4) is the lowest).
Higher levels of trauma centers will have trauma surgeons available, including those trained in such specialties as neurosurgeons and orthopedic surgeons as well as highly sophisticated medical diagnostic equipment. Lower levels of trauma centers may only be able to provide initial care and stabilization of a traumatic injury and arrange for transfer of the victim to a higher level of trauma care.
The operation of a trauma center is extremely expensive. Some areas are under-served by trauma centers because of this expense (for example, Harborview Medical Center in Seattle serves the states of Washington, Idaho, Montana, and Alaska). In Florida, Orlando Regional Medical Center, built to serve five counties, serves more than twenty.
As there is no way to schedule the need for emergency services, patient traffic at trauma centers can vary widely. A variety of different methods have been developed for dealing with this. Halifax Health in Daytona Beach, Florida will soon deploy a "pod system," allowing trauma care to be provided by several different small Emergency Departments at different hospitals, rather than at one central large trauma center.
A trauma center will often have a helipad for receiving patients that have been airlifted to the hospital. In many cases, persons injured in remote areas and transported to a distant trauma center by helicopter can receive faster and better medical care than if they had been transported by ground ambulance to a closer hospital which is not a designated trauma center.
Level I trauma center hospitals in most states in the U.S. (New York, and Pennsylvania among others are notable exceptions) are designated by the American College of Surgeons (ACS) for a period of three years. Pennsylvania has its own rankings system, based on the criteria of the Commonwealth's Trauma Foundation.
The ACS does not officially designate hospitals as regional trauma centers, however. Numerous U.S. hospitals that are not listed on the organization's trauma roster nevertheless refer to their emergency or trauma units as "level I trauma centers." The ACS describes that responsibility as "a geopolitical process by which empowered entities, government or otherwise, are authorized to designate." The ACS's self-appointed mission is limited to confirming and reporting on any given hospital's ability to comply with the ACS standard of care known as Resources for Optimal Care of the Injured Patient.
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