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Trauma center

Trauma center

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A trauma center is a hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....

 equipped to provide comprehensive emergency medical services to patients suffering traumatic
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

 injuries. Trauma centers grew into existence out of the realization that traumatic injury is a disease process unto itself requiring specialized and experienced multidisciplinary treatment and specialized resources.

According to the CDC
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...

, injuries are the leading cause of death for children and adults ages 1–44.

The leading causes of trauma are motor vehicle accidents, falls, and assaults.

In the United States, a hospital can receive Trauma Center verification by meeting specific criteria established by the American College of Surgeons (ACS) and passing a site review by the Verification Review Committee. Official designation as a Trauma Center is determined by individual state law provisions. 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 five designated levels, in which case Level-V (Level-5) is the lowest).

Higher levels of trauma centers will have trauma surgeons available, including those trained in such specialties as Neurosurgery
Neurosurgery
Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spine, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.-In the United States:In...

 and Orthopedic surgery
Orthopedic surgery
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...

 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
Harborview Medical Center
Harborview Medical Center, located on Seattle's First Hill, is a public hospital in King County, Washington and is managed by UW Medicine.-Overview:...

 in Seattle
Seattle, Washington
Seattle is the county seat of King County, Washington. With 608,660 residents as of the 2010 Census, Seattle is the largest city in the Northwestern United States. The Seattle metropolitan area of about 3.4 million inhabitants is the 15th largest metropolitan area in the country...

 is the only Level I trauma center to serve the entirety of Washington, Idaho
Idaho
Idaho is a state in the Rocky Mountain area of the United States. The state's largest city and capital is Boise. Residents are called "Idahoans". Idaho was admitted to the Union on July 3, 1890, as the 43rd state....

, Montana
Montana
Montana is a state in the Western United States. The western third of Montana contains numerous mountain ranges. Smaller, "island ranges" are found in the central third of the state, for a total of 77 named ranges of the Rocky Mountains. This geographical fact is reflected in the state's name,...

, and Alaska
Alaska
Alaska is the largest state in the United States by area. It is situated in the northwest extremity of the North American continent, with Canada to the east, the Arctic Ocean to the north, and the Pacific Ocean to the west and south, with Russia further west across the Bering Strait...

).
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.

A trauma center will often have a helipad
Helipad
Helipad is a common abbreviation for helicopter landing pad, a landing area for helicopters. While helicopters are able to operate on a variety of relatively flat surfaces, a fabricated helipad provides a clearly marked hard surface away from obstacles where a helicopter can safely...

 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
Helicopter
A helicopter is a type of rotorcraft in which lift and thrust are supplied by one or more engine-driven rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forwards, backwards, and laterally...

 can receive faster and better medical care than if they had been transported by ground ambulance
Ambulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...

 to a closer hospital that does not have a designated trauma center. The trauma level certification can directly affect the patient's outcome and determine if the patient needs to be transferred to a higher level trauma center.

History


The concept of a trauma center was developed at the University of Maryland, Baltimore
University of Maryland, Baltimore
University of Maryland, Baltimore, was founded in 1807. It comprises some of the oldest professional schools in the nation and world. It is the original campus of the University System of Maryland. Located on 60 acres in downtown Baltimore, Maryland, it is part of the University System of Maryland...

, in the 1960s and 1970s by heart surgeon and shock researcher R Adams Cowley
R Adams Cowley
R Adams Cowley was an American surgeon considered a pioneer in emergency medicine and the treatment of shock trauma. He is also known for being one of the first to perform open-heart surgery and invented both a surgical clamp that bears his name and a prototype pacemaker that was used by Dwight D...

, 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
United States Army
The United States Army is the main branch of the United States Armed Forces responsible for land-based military operations. It is the largest and oldest established branch of the U.S. military, and is one of seven U.S. uniformed services...

. 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 (www.cookcountytrauma.com)
.

Definitions in the United States


In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

, trauma centers are ranked by the American College of Surgeons
American College of Surgeons
The American College of Surgeons is an educational association of surgeons created in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice.-Membership:...

 (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 designations are also given adult
Adult
An adult is a human being or living organism that is of relatively mature age, typically associated with sexual maturity and the attainment of reproductive age....

 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. Some hospitals are less-formally designated Level V.

The ACS does not officially designate hospitals as trauma centers. Numerous U.S. hospitals that are not verified by ACS claim Trauma Center designation. Most states have legislation which determines the process for designation of Trauma Centers within their state. 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.

The Trauma Information Exchange Program (TIEP) is a program of the American Trauma Society in collaboration with the Johns Hopkins Center for Injury Research and Policy and is funded by the Centers for Disease Control and Prevention. TIEP maintains an inventory of trauma centers in the U.S., collects data and develops information related to the causes, treatment and outcomes of injury, and facilitates the exchange of information among trauma care institutions, care providers, researchers, payers and policy makers.



Note: A trauma center is a hospital that is designated by a state or local authority or is verified by the American College of Surgeons.

Level I


A Level I Trauma Center provides the highest level of surgical care to trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

 patients. Being treated at a Level I Trauma Center increases a seriously injured patient’s chances of survival by an estimated 20 to 25 percent.
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 surgeon
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

s, emergency physician
Emergency physician
An emergency physician is a physician who works at an emergency department to care for acutely ill patients. The emergency physician is a specialist in advanced cardiac life support , trauma care such as fractures and soft tissue injuries, and management of other life-threatening situations.In...

s and anesthesiologist
Anesthesiologist
An anesthesiologist or anaesthetist is a physician trained in anesthesia and peri-operative medicine....

s on duty 24 hours a day at the hospital, an education program, and 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
Orthopedic surgery
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...

, neurosurgery
Neurosurgery
Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spine, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.-In the United States:In...

, plastic surgery
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...

 (plastic surgeons often take calls for hand injuries), anesthesiology, emergency medicine
Emergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...

, radiology
Radiology
Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. Radiologists use an array of imaging technologies to diagnose or treat diseases...

, internal medicine
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...

, oral and maxillofacial surgery
Oral and maxillofacial surgery
Oral and maxillofacial surgery is surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. It is an internationally recognized surgical specialty...

 (trained to treat injuries of the facial skin, muscles, bones), 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 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, Example: Rural or Community hospitals.

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 for trauma care. A trauma-trained nurse is immediately available, and physicians are available upon the patient's arrival to the Emergency Department. Transfer agreements exist with other trauma centers of higher levels, for use when conditions warrant a transfer.

Level V


Provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. May provide surgical and critical-care services, as defined in the service's scope of trauma-care services. A trauma-trained nurse is immediately available, and physicians are available upon patient arrival in the Emergency Department.
If not open 24 hours daily, the facility must have an after-hours trauma-response protocol.

Pediatric Trauma Centers


A facility can be designated an adult Trauma Center, a pediatric Trauma Center, or an adult & pediatric Trauma Center. If a hospital provides trauma care to both adult and pediatric patients, the Level designation may not be the same for each group. For example, a Level 1 adult Trauma Center may also be a Level 2 pediatric Trauma Center. This is because pediatric trauma surgery is a specialty unto itself. Adult trauma surgeons are not generally specialized in providing surgical trauma care to children, and vice versa, and the difference in practice is significant.

Maryland Shock Trauma Adult Resource Center


There is one Trauma Center in the country which is designated at a Level above a Level 1 Trauma Center. The R Adams Cowley Shock Trauma Center
R Adams Cowley Shock Trauma Center
R Adams Cowley Shock Trauma Center is a free-standing trauma hospital in Baltimore, Maryland and is part of the University of Maryland Medical Center. It was the first facility in the world to treat shock...

 at the University of Maryland Medical Center
University of Maryland Medical Center
The University of Maryland Medical Center is a teaching hospital with 705 beds based in Baltimore, Maryland, that provides the full range of health care to people throughout Maryland and the Mid-Atlantic region. It gets more than 35,000 inpatient admissions and 165,000 outpatient visits each year...

 is the only hospital in the world dedicated to trauma care alone. It is a free-standing, self contained, trauma hospital which accepts only patients with traumatic injuries, or patients in need of hyperbaric medicine such as smoke inhalation or carbon monoxide poisoned patients, or those with Necrotizing fasciitis
Necrotizing fasciitis
Necrotizing fasciitis , commonly known as flesh-eating disease or Flesh-eating bacteria syndrome, is a rare infection of the deeper layers of skin and subcutaneous tissues, easily spreading across the fascial plane within the subcutaneous tissue.Necrotizing fasciitis is a quickly progressing and...

 (gangrene aka the 'flesh eating bacteria'). Shock Trauma, as it is known, carries the designation of Primary Adult Resource Center in the state of Maryland and provides a level of care above that found even in Level 1 Trauma Centers. It is also the state Neurotrauma (brain and spinal cord injury) center.

See also

  • Emergency medicine
    Emergency medicine
    Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...

  • Trauma surgery
    Trauma surgery
    Trauma surgery is a surgical specialty involved in the invasive treatment of physical injuries, typically in an emergency setting. Trauma surgeons generally complete residency training in general surgery and often fellowship training in trauma or surgical critical care...

  • Traumatology
    Traumatology
    Traumatology is the study of wounds and injuries caused by accidents or violence to a person, and the surgical therapy and repair of the damage. Traumatology is a branch of medicine. It is often considered a subset of surgery and in countries without the specialty of trauma surgery it is most...

  • Trauma team
    Trauma team
    A Trauma team is a group of healthcare workers who tend to seriously ill or injured patients who arrive at a hospital emergency department. The team is composed of a number of specific roles, with a typical team consisting of:...

  • Trauma (medicine)
    Trauma (medicine)
    Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...


External links


State trauma system regulation