Trauma Center Designation
I forget all of the specific criteria, but the level of trauma center is basically determined by the hospitals ability to handle complex trauma. For the most part, this is determined by the availability of surgical specialists. This usually means an in-house trauma surgeon (usually a general surgeon) and 24 hr on-call coverage in the subspecialties (orthopedic surgery, neurosurgery, plastic surgery). Typically there must be a trauma or surgical ICU staffed by critical care specialists. Beyond trauma center designation there are separate desigantions for pediatric trauma, burn center, and replant centers(for amputations).
Level I trauma centers handle the majority of polytrauma. This is particularly true in Mass, where medevac is readily available. In Boston, MGH, Brigham, Beth israel, and Boston medical are all level I trauma centers. The majority of penetrating trauma (gunshots, stabbings) goes to Boston Medical, mostly due to proximity, and they are accustomed to handling it. Blunt trauma (MVAs) including pediatric, seems to go mostly to the general by medevac, but is typically divided among the major teaching centers. Interestingly, pediatric polytraumas are typically flown to the general and not Children's. They are sometimes stabilized and transferred to Children's. The reason for this is not entirely clear because Children's has a Level I pediatric trauma center designation. It may be logistics because their helipad is actually next door at the Brigham (they do not have their own). Rhode Island Hospital handles metro Providence and southeast Mass. Umass covers most of central, and Baystate Medical covers western Mass. Traumas from southern Maine and New Hampshire are often flown to Boston.
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, plastic surgery (plastic surgeons often take calls for hand and facial injuries fixing both the bone and soft tissue of these specialized regions), 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.[6]
Level I trauma center hospitals in most states in the U.S. (New York, and Pennsylvania among others are notable exceptions)[citation needed] 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.[7]
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.[6]
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.[6]
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.[8][6]
Hope this helps.
--Scannergeek
Last edited by Scanner-geek; 08-12-2009 at 09:29 PM..
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