All hospitals care for many types of injuries and emergency conditions ranging

All hospitals care for many types of injuries and emergency conditions ranging from minor to severe, but not all hospitals are designated as a Trauma Center. When a patient needs emergency assistance, they will be taken to the hospital’s Emergency Room (ER). Here, emergency physicians will assess whether these patients in critical condition should be treated by specialists in Emergency Medicine or by specialists in the Trauma Center. Emergency Medicine typically addresses broader, non-life-threatening injuries such as broken bones, minor burns or injuries that may require stitches. 

Emergency Room & Trauma Designation and Verification

Emergency Room Designation

According to Trzeciak (2003), an Emergency Room treats many common conditions ranging from minor, non-life-threatening injuries to possible heart attacks and strokes. The training for Emergency Medicine differs from Trauma because it typically encompasses a broader spectrum of emergency conditions. Physicians and surgeons in Emergency Medicine see patients with the following types of injuries or conditions: Broken bones, Chest pains, Loss of consciousness, Minor burns, Minor lacerations requiring stitches, Severe abdominal pain/ vomiting/ diarrhea, Sprains, Signs of a heart attack, and Signs of a stroke (Trzeciak, 2003).

Emergency Room Verification

Certification and Compliance for the Emergency Room or Emergency Departments is under the Emergency Medical Treatment and Labor (EMTALA) (Zibulewsky, 2001).

The Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals with

emergency departments to provide a medical screening examination to any individual

who comes to the emergency department and requests such an examination, and prohibits hospitals with emergency departments from refusing to examine or treat individuals with an emergency medical condition. The term “hospital” includes critical access hospitals. (EMTALA, 1986).

In turn, the regulation defines “dedicated emergency department” as any department or

facility of the hospital that either: (1) is licensed by the state as an emergency department;

(2) held out to the public as providing treatment for emergency medical conditions; or (3) on one-third of the visits to the department in the preceding calendar year actually provided treatment for emergency medical conditions on an urgent basis. (Aacharya, Gastman, & Denier, 2011).

Trauma Centers

According to Peitzman (2002) Trauma centers across the United States are identified by a designation process and a verification process. The different levels (i.e., Level I, II, III, IV or V) refer to the kinds of resources available within a trauma center and the number of patients admitted yearly. Being at a Level 1 trauma center provides the highest level of surgical care for trauma patients.

Trauma Designation

Trauma Center designation is a process outlined and developed at a state or local level. The state or local municipality identifies unique criteria in which to categorize Trauma Centers. These categories may vary from state to state.

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 for 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 II pediatric trauma center. Pediatric trauma surgery is its own specialty and adult trauma surgeons are not generally specialized in providing surgical trauma care to children, and vice versa.

Trauma Verification

Trauma Center Verification is an evaluation process done by the American College of Surgeons (ACS) to evaluate and improve trauma care. The ACS does not designate trauma centers but verifies the presence of the resources listed in Resources for Optimal Care of the Injured Patient. This is a voluntary process by the Trauma Center and lasts for a 3-year period. Part of the verification process includes requiring all members of the trauma team to be knowledgeable about current practices in neurotrauma care and the best evidence for the care of the neurotrauma patient, including head, spine/spinal cord, and peripheral nerve injury. Use of Brain Trauma Foundation’s Guidelines for topics such as adult and pediatric head injury, prehospital management, surgical management, penetrating injury, and acute spine and spinal cord injury is strongly recommended for all trauma centers.

Trauma Center Levels
         As mentioned above, Trauma categories vary from state to state. Outlined below are common criteria for Trauma Centers verified by the ACS and also designated by states and municipalities. Facilities are designated/verified as Adult and/or Pediatric Trauma Centers. It is not uncommon for facilities to have different designations for each group (ie. a Trauma Center may be a Level I Adult facility and also a Level II Pediatric Facility). (ACS, n.d.)

Level I

Level I Trauma Center is a comprehensive regional resource that is a tertiary care facility central to the trauma system. A Level I Trauma Center is capable of providing total care for every aspect of injury – from prevention through rehabilitation.

According to the ACS (n.d.) requirements of Level I Trauma Centers Include:

24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, pediatric and critical care.

Referral resource for communities in nearby regions.

Provides leadership in prevention, public education to surrounding communities.

Provides continuing education of the trauma team members.

Incorporates a comprehensive quality assessment program.

Operates an organized teaching and research effort to help direct new innovations in trauma care.

Program for substance abuse screening and patient intervention.

Meets minimum requirement for annual volume of severely injured patients.

Level II

A Level II Trauma Center is able to initiate definitive care for all injured patients.

According to the ACS (n.d.) requirements (Standards by the ACS) of Level II Trauma Centers Include:

24-hour immediate coverage by general surgeons, as well as coverage by the specialties of orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology and critical care.

Tertiary care needs such as cardiac surgery, hemodialysis and microvascular surgery may be referred to a Level I Trauma Center.

Provides trauma prevention and continuing education programs for staff.

Incorporates a comprehensive quality assessment program.

Level III

A Level III Trauma Center has demonstrated an ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations.

According to the ACS (n.d.) requirements (Standards by the ACS) of Level III Trauma Centers Include:

24-hour immediate coverage by emergency medicine physicians and the prompt availability of general surgeons and anesthesiologists.

Incorporates a comprehensive quality assessment program

Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma Center.

Provides back-up care for rural and community hospitals.

Offers continued education of the nursing and allied health personnel or the trauma team.

Involved with prevention efforts and must have an active outreach program for its referring communities.

Trauma Centers in Texas

The following information was obtained for the Texas Department of State Health Services (DSHS, n.d.).

20 facilities are currently designated as Level I Comprehensive Trauma Facilities.

26 facilities are currently designated as Level II Major Trauma Facilities.

62 facilities are currently designated as Level III Advanced Trauma Facilities.

194 Facilities are currently designated as Level IV Basic Trauma Facilities.

Designations may include, but not limited to Adult, Maternal, Neonatal, Stroke, Trauma, and Data Sources

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