Definitions

Trauma center

Trauma center

A trauma center is a hospital equipped to provide comprehensive emergency medical services to patients suffering traumatic injuries. Trauma centers were established as the medical establishment realized that traumatic injuries often require complex and multi-disciplinary treatment, including surgery in order to give the victim the best possible chance for survival and recovery.

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.

History

The concept of a trauma center was developed at the University of Maryland, Baltimore in the 1960s and 1970s by heart surgeon and shock researcher R Adams Cowley, who founded what became the Shock Trauma Center in Baltimore, Maryland in 1961. Cook County Hospital in Chicago, Illinois claims to be the first trauma center (opened in 1966) in the United States. Dr. David R Boyd interned at Cook County Hospital from 1963-1964 before being drafted into the United States Army. Upon his release from the Army, Dr. Boyd became the first shock-trauma fellow at the Shock Trauma Center from 1967-1968. Dr. Boyd returned to Cook County Hospital, where he went on to serve as resident director of the Cook County Trauma Unit.

Definitions in the United States

In the United States, trauma centers are ranked by the American College of Surgeons (ACS), from level I (comprehensive service) to level III (limited-care). The different levels refer to the kinds of resources available in a trauma center and the number of patients admitted yearly. These are categories that define national standards for trauma care in hospitals. Level I and level II assignments are also given adult and or pediatric designations. Additionally, some states have their own trauma center rankings separate from the ACS. These levels may range from level I to level IV.

Level I

A level I trauma center provides the highest level of surgical care to trauma patients. It has a full range of specialists and equipment available 24 hours a day and admits a minimum required annual volume of severely injured patients. A level I trauma center is required to have a certain number of surgeons and anesthesiologists on duty 24 hours a day at the hospital, an education program, preventive and outreach programs. Key elements include 24-hour in-house coverage by general surgeons and prompt availability of care in varying specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, oral and maxillofacial surgery, and critical care, which are needed to adequately respond and care for various forms of trauma that a patient may suffer. Additionally, a Level I center has a program of research, is a leader in trauma education and injury prevention, and is a referral resource for communities in nearby regions.

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.

Level II

A level II trauma center works in collaboration with a Level I center. It provides comprehensive trauma care and supplements the clinical expertise of a level I institution. It provides 24-hour availability of all essential specialties, personnel, and equipment. Minimum volume requirements may depend on local conditions. These institutions are not required to have an ongoing program of research or a surgical residency program.

Level III

A level III trauma center does not have the full availability of specialists, but does have resources for emergency resuscitation, surgery, and intensive care of most trauma patients. A level III center has transfer agreements with level I or level II trauma centers that provide back-up resources for the care of exceptionally severe injuries.

Level IV

A level IV trauma center exists in some states where the resources do not exist for a level III trauma center. It provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. It may also provide surgery and critical care services as defined in the scope of services of trauma care. A trauma trained nurse is immediately available, and physicians are available upon the patients arrival to the Emergency Department. Transfer agreements exist with other trauma centers with higher levels when conditions warrant a transfer.

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