Trauma center

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Overview

A trauma center is a hospital equipped to perform as a casualty receiving station for the emergency medical services by providing the best possible medical care for traumatic injuries 24 hours a day, 365 days per year. Trauma centers were established as the medical establishment realized that such injuries often require immediate and complex surgery to save the patient.

In order to qualify as a trauma center, a hospital must have a number of facilities, including a high-quality intensive-care ward and an operating room staffed around the clock. A trauma service is led by a team of trauma surgeons, including such specialists as neurosurgeons and orthopedic surgeons. A trauma center will often have a helipad for receiving patients by MEDEVAC.

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, Washington serves the states of Washington, Idaho, Montana, and Alaska). In Florida, Orlando Regional Medical Center, built to serve five counties, serves more than twenty. Still, in many cases, persons injured in remote areas and brought to a trauma center by helicopter can receive faster and better care than a person injured in a city and taken to a normal hospital by ground ambulance.

In the United States, trauma centers are ranked, from limited-care facilities up to comprehensive service in Level I centers. Some centers specialize in adult or pediatric care.

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 [2][3]. Cook County Hospital in Chicago, Illinois claims to be the first trauma center (opened in 1966) in the United States.[4] 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.[5]

Definitions

The four 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. Developed and recommended by the American College of Surgeons.

Level Description
I A Level I trauma center has a full range of specialists and equipment available 24 hours a day and admits a minimum required annual volume of severely injured patients. 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.
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.
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.
IV A Level IV trauma center provides stabilization and treatment of severely injured patients in remote areas where no alternative care is available.

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