A
trauma center is a
hospitalA hospital is an institution for health care providing patient treatment by specialized staff and equipment, and often but not always providing for longer-term patient stays....
equipped to provide comprehensive emergency medical services to patients suffering
traumaticPhysical trauma refers to a physical injury, generally of a considerably severe degree. A trauma patient is someone who has suffered serious and life-threatening physical injury with the potential for secondary complications such as shock, respiratory failure and death.-Common causes:Comprehensive...
injuries. Trauma centers were established as the medical establishment realized that traumatic injuries often require complex and multi-disciplinary treatment, including
surgerySurgery is a 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, to help improve bodily function or appearance, or sometimes for some other reason...
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.
A
trauma center is a
hospitalA hospital is an institution for health care providing patient treatment by specialized staff and equipment, and often but not always providing for longer-term patient stays....
equipped to provide comprehensive emergency medical services to patients suffering
traumaticPhysical trauma refers to a physical injury, generally of a considerably severe degree. A trauma patient is someone who has suffered serious and life-threatening physical injury with the potential for secondary complications such as shock, respiratory failure and death.-Common causes:Comprehensive...
injuries. Trauma centers were established as the medical establishment realized that traumatic injuries often require complex and multi-disciplinary treatment, including
surgerySurgery is a 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, to help improve bodily function or appearance, or sometimes for some other reason...
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 in America, 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
neurosurgeonNeurosurgery is the surgery discipline focused on treating the central nervous system, peripheral nervous systems and spinal column diseases amenable to surgical intervention....
s and
orthopedic surgeonsOrthopedic 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 CenterHarborview Medical Center, located on Seattle's First Hill, is a public hospital in King County, Washington and is managed by the University of Washington. It was founded in 1877 as King County Hospital, a six-bed welfare hospital in a two-story south Seattle building. By 1906, it had moved into a...
in
SeattleSeattle is located in the Pacific Northwest region of the United States. Situated in the western part of Washington State on an isthmus between Puget Sound and Lake Washington, about south of the Canada – United States border, it is named after Chief Sealth, of the Duwamish and Suquamish tribes...
is the only Level I trauma center to serve the entirety of
WashingtonWashington is a state in the Pacific Northwest region of the United States. Washington was carved out of the western part of Washington Territory which had been ceded by Britain in 1846 by the Oregon Treaty as settlement of the Oregon Boundary Dispute. It was admitted to the Union as the...
,
IdahoIdaho is a state in the Pacific Northwest region of the United States of America. The state's largest city and capital is Boise. Residents are called "Idahoans." Idaho was admitted to the Union on 3 July 1890 as the 43rd state....
,
MontanaMontana is a state in the Western United States. The western third of the state contains numerous mountain ranges; other '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
AlaskaAlaska is the largest state of the United States of America 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. 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
helipadThe word helipad is a portmanteau meaning helicopter landing pad, a landing area for helicopters. Though helicopters can usually land anywhere preferably flat , a fabricated helipad provides a clearly marked hard surface away from obstacles where a helicopter can land...
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
helicopterA helicopter is an aircraft that is lifted and propelled by one or more horizontal rotors, each rotor consisting of two or more rotor blades. Helicopters are classified as rotorcraft or rotary-wing aircraft to distinguish them from fixed-wing aircraft because the helicopter achieves lift with the...
can receive faster and better medical care than if they had been transported by ground
ambulanceAn ambulance is a vehicle for transporting sick or injured people, to, from or between places of treatment for an illness or injury. The term ambulance is used to describe a vehicle used to bring medical care to patients outside of the hospital or to transport the patient to hospital for follow-up...
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, BaltimoreUniversity 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...
in the 1960s and 1970s by heart surgeon and shock researcher
R Adams CowleyR 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, MarylandBaltimore is an independent city and the largest city in the state of Maryland. The city is located in central Maryland along the tidal portion of the Patapsco River, an arm of the Chesapeake Bay. Baltimore is sometimes referred to as Baltimore City in order to distinguish it from surrounding...
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 ArmyThe United States Army is the branch of the United States Military responsible for land-based military operations. It is the largest and oldest established branch of the U.S. military and is one of seven 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.
Definitions in the United States
In the
United StatesThe 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 SurgeonsThe 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
adultThe term adult has at least three distinct meanings. It can indicate a biologically grown or mature person. It may also mean a plant, animal, or person who has reached full growth or alternatively is capable of reproduction, or the classification legal adult, generally determined as a person who...
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
traumaPhysical trauma refers to a physical injury, generally of a considerably severe degree. A trauma patient is someone who has suffered serious and life-threatening physical injury with the potential for secondary complications such as shock, respiratory failure and death.-Common causes:Comprehensive...
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
surgeonSurgery is a 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, to help improve bodily function or appearance, or sometimes for some other reason...
s and
anesthesiologistAn anaesthetist , or anesthesiologist , also "anaesthesiologist," is a medical doctor trained to administer anesthesia and manage the medical care of patients before, during, and after surgery...
s 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 surgeryOrthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...
,
neurosurgeryNeurosurgery is the surgery discipline focused on treating the central nervous system, peripheral nervous systems and spinal column diseases amenable to surgical intervention....
,
plastic surgeryPlastic surgery is a medical specialty concerned with the correction or restoration of form and function. While famous for aesthetic surgery, plastic surgery also includes two main fields: body modification and reconstructive surgery...
(plastic surgeons often take calls for hand and facial injuries fixing both the bone and soft tissue of these specialized regions), anesthesiology,
emergency medicineEmergency medicine is a medical specialty in which a physician receives practical training to provide 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...
,
radiologyRadiology is the branch or specialty of medicine that deals with the study and application of imaging technology like x-ray and radiation to diagnosing and treating disease....
,
internal medicineInternal medicine is the medical specialty concerned with the diagnosis, management and nonsurgical treatment of unusual or serious diseases. According to some sources, an emphasis on internal structures is implied. In North America, specialists in internal medicine are commonly called, "internists"...
,
oral and maxillofacial surgeryOral 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...
, 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 YorkNew York is a state in the Mid-Atlantic and Northeastern regions of the United States and is the nation's third most populous. The state is bordered by New Jersey and Pennsylvania to the south, and Connecticut, Massachusetts and Vermont to the east...
, and
PennsylvaniaThe Commonwealth of Pennsylvania , often colloquially referred to as PA by natives and Northeasterners, is a state located in the Northeastern and Middle Atlantic regions of the United States...
among others are notable exceptions) are designated by the
American College of SurgeonsThe 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) 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.
External links
State trauma system regulation