A trauma center (or trauma centre) is a hospital equipped and staffed to provide care for patients suffering from major traumatic injuries such as falls, motor vehicle collisions, or gunshot wounds. A trauma center may also refer to an emergency department (also known as a "casualty department" or "accident and emergency") without the presence of specialized services to care for victims of major trauma.
In the United States, a hospital can receive trauma center status 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 and Level III (Level-3) being the lowest (some states have five designated levels, in which case Level V (Level-5) is the lowest).
The highest levels of trauma centers have access to specialist medical and nursing care, including emergency medicine, trauma surgery, critical care, neurosurgery, orthopedic surgery, anesthesiology, and radiology, as well as a wide variety of highly specialized and sophisticated surgical and diagnostic equipment.Lower levels of trauma centers may be able to provide only initial care and stabilization of a traumatic injury and arrange for transfer of the patient to a higher level of trauma care.
The operation of a trauma center is often expensive and some areas may be underserved by trauma centers because of that expense.[ citation needed ] As there is no way to schedule the need for emergency services, patient traffic at trauma centers can vary widely.[ citation needed ]
A trauma center may have a helipad for receiving patients that have been airlifted to the hospital. In some cases, persons injured in remote areas and transported to a distant trauma center by helicopter can receive faster and better medical care than if they had been transported by ground ambulance to a closer hospital that does not have a designated trauma center.
Trauma centres grew into existence out of the realisation that traumatic injury is a disease process unto itself requiring specialised and experienced multidisciplinary treatment and specialised resources. The world's first trauma centre, the first hospital to be established specifically to treat injured rather than ill patients, was the Birmingham Accident Hospital, which opened in Birmingham, England in 1941 after a series of studies found that the treatment of injured persons within England was inadequate. By 1947, the hospital had three trauma teams, each including two surgeons and an anaesthetist, and a burns team with three surgeons. The hospital became part of the National Health Service in its formation in July 1948 and closed in 1993.The NHS now has 27 major trauma centres established across England, four in Scotland, and one planned in Wales.
According to the CDC, injuries are the leading cause of death for American children and young adults ages 1–19.The leading causes of trauma are motor vehicle collisions, falls, and assaults with a deadly weapon.
In the United States of America, Robert J. Baker and Robert J. Freeark established the first civilian Shock Trauma Unit at Cook County Hospital in Chicago, Illinois on March 16, 1966.The concept of a shock trauma center was also developed at the University of Maryland, Baltimore, in the 1950s and 1960s by thoracic surgeon and shock researcher R Adams Cowley, who founded what became the Shock Trauma Center in Baltimore, Maryland, on July 1, 1966. The R Adams Cowley Shock Trauma Center is one of the first shock trauma centers in the world. Cook County Hospital in Chicago trauma center (opened in 1966). David R. Boyd interned at Cook County Hospital from 1963 to 1964 before being drafted into the Army of the United States of America. Upon his release from the Army, Boyd became the first shock-trauma fellow at the R Adams Cowley Shock Trauma Center, and then went on to develop the National System for Emergency Medical Services, under President Ford. In 1968 the American Trauma Society was created by various co-founders to include R Adams Cowley, Rene Joyeuse as they saw the importance of increased education and training of emergency providers and for nationwide quality trauma care.
According to the founder of the Trauma Unit at Sunnybrook Health Sciences Centre in Toronto, Ontario, Marvin Tile, "the nature of injuries at Sunnybrook has changed over the years. When the trauma center first opened in 1976, about 98 percent of patients suffered from blunt-force trauma caused by accidents and falls. Now, as many as 20 percent of patients arrive with gunshot and knife wounds".
Fraser Health Authority in British Columbia, located at Royal Columbian Hospital and Abbotsford Regional Hospital, services the BC area, "Each year, Fraser Health treats almost 130,000 trauma patients as part of the integrated B.C. trauma system".
In the United States, trauma centers are ranked by the American College of Surgeons (ACS) or local state governments, from Level I (comprehensive service) to Level III (limited-care). The different levels refer to the types 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 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 that determines the process for designation of trauma centers within that state. The ACS describes this 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 US, 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 policymakers.
Note that a trauma center is a hospital that is designated by a state or local authority or is verified by the American College of Surgeons.
A Level I trauma center provides the highest level of surgical care to trauma patients. Being treated at a Level I trauma center can reduce mortality by 25% compared to a non-trauma center.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 the following people on duty 24 hours a day at the hospital:
Key elements include 24‑hour in‑house coverage by general surgeons and prompt availability of care in varying specialties—such as orthopedic surgery, cardiothoracic surgery, neurosurgery, plastic surgery, anesthesiology, emergency medicine, radiology, internal medicine, otolaryngology, 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, as well as provide rehabilitation services.
Most Level I trauma centers are teaching hospitals/campuses. 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.
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. Oftentimes, level II centers possess critical care services capable of caring for almost all injury types indefinitely. Minimum volume requirements may depend on local conditions. Such institutions are not required to have an ongoing program of research or a surgical residency program.
A Level III trauma center does not have the full availability of specialists but has 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 patients with exceptionally severe injuries (such as multiple trauma).
A Level IV trauma center exists in some states in which 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 in the Emergency Department. Transfer agreements exist with other trauma centers of higher levels, for use when conditions warrant a transfer.
A Level V trauma center provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. They 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.
A facility can be designated an adult trauma center, a pediatric trauma center, or an adult and 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 I adult trauma center may also be a Level II pediatric trauma center. That 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. In contrast to adult trauma centers, pediatric trauma centers only have two ratings, either level I or level II.
UC Davis Medical Center is part of UC Davis Health and a major academic health center located in Sacramento, California. It is owned and operated by the University of California as part of its University of California, Davis campus. The medical center sits on a 142-acre (57 ha) campus located between the Elmhurst, Tahoe Park, and Oak Park residential neighborhoods. The site incorporates the land and some of the buildings of the former Sacramento Medical Center as well as much of the land previously occupied by the California State Fair until its 1967 move to a new location.
Children's Hospital of The King's Daughters (CHKD), located in Norfolk, Virginia, United States, is the only freestanding children's hospital in Virginia. The hospital treats infants, children, teens, and young adults aged 0–21 and even some adults who require pediatric care.
Children's Minnesota is a nationally ranked non-profit, acute care children's hospital system located in St. Paul and Minneapolis, Minnesota. The hospital has 384 pediatric beds between their campuses. Children's Minnesota provides comprehensive pediatric specialties and subspecialties to infants, children, teens, and young adults aged 0–21 throughout Minnesota and surrounding regions and sometimes also treats adults that require pediatric care. Children's Minnesota Minneapolis features an American College of Surgeons verified Level 1 Pediatric Trauma Center, 1 of 4 in the state. In addition to its two hospitals, Children's Minnesota has 12 primary and specialty care clinics, and six rehabilitation sites representing more than 60 pediatric specialties.
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. Shock Trauma was founded by R Adams Cowley, considered the father and major innovator of trauma medicine.
The American College of Surgeons (ACS) is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice and is headquartered in Chicago, IL. The ACS was established in Chicago, IL, in 1913 at the initiative of Franklin Martin, MD, FACS. The College is a surgical society dedicated to promoting the highest standards of surgical care through education of, and advocacy for, its Fellows and their patients, and to safeguarding standards of care in an optimal and ethical practice environment.
R Adams Cowley was an American surgeon considered a pioneer in emergency medicine and the treatment of shock trauma. Called the "Father of Trauma Medicine", he was the founder of the United States' first trauma center at the University of Maryland in 1958, after the US Army awarded him $100,000 to study shock in people—the first award of its kind in the United States. The trauma unit at first consisted of two beds, and was later expanded to four beds. Many people called the four-bed unit the "death lab." Cowley was the creator of the "Golden Hour" concept, the period of 60 minutes or less following injury when immediate definitive care is crucial to a trauma patient's survival. He was a leader in the use of helicopters for medical evacuations of civilians, beginning in 1969, and founded the Society of Thoracic Surgeons. He also founded the nation's first statewide EMS system, called MIEMSS by Executive Order of Maryland's Governor Mandel, 1972, as well as the National Study Center for Trauma and EMS, enacted by Congress in 1986 and signed into law by President Ronald Reagan. He is also known for being one of the first surgeons to perform open-heart surgery and invented both a surgical clamp that bears his name and the prototype pacemaker that was used by Dwight D. Eisenhower.
St. Cloud Hospital is a hospital in St. Cloud, Minnesota, United States. It is a Catholic-affiliated, not-for-profit institution and part of the CentraCare Health System. The hospital has more than 9,000 employees, 400 physicians and 1,200 volunteers. It serves 690,000 people in a 12-county area.
The University of Maryland Medical Center (UMMC) is a teaching hospital with 757 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. UMMC has approximately 6,500 employees as well as 1,000 attending physicians, and provides training for about half of Maryland's physicians and other health care professionals. All members of the medical staff are on the faculty of the University of Maryland School of Medicine.
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Dayton Children's Hospital stylized as Dayton Children's formerly The Children's Medical Center of Dayton is a pediatric acute care children's teaching hospital located in Dayton, Ohio. The hospital has 167 pediatric beds and is affiliated the Boonshoft School of Medicine at Wright State University. The hospital provides comprehensive pediatric specialties and subspecialties to infants, children, teens, and young adults aged 0–21 throughout western Ohio and the surrounding states. Dayton Children's Hospital also features the only ACS verified Level 1 Pediatric Trauma Center in the region.
Santa Clara Valley Medical Center, commonly known as Valley Medical Center or simply Valley Medical, is a prominent 731-bed public tertiary, teaching, and research hospital in San Jose, California. Located in the Fruitdale neighborhood of West San Jose, Valley Medical Center is the anchor facility of the Santa Clara County Health System, serving Santa Clara County. Valley Medical is home to numerous innovative research and care centers, such as the Rehabilitation Trauma Center, the only federally-designated spinal cord injury center in Northern California.
Field triage is the process by which emergency medical services providers decide on the destination for the injured subject.
Medical centers in the United States are conglomerations of health care facilities including hospitals and research facilities that also either include or are closely affiliated with a medical school. Although the term medical center is sometimes loosely used to refer to any concentration of health care providers including local clinics and individual hospital buildings, the term academic medical center more specifically refers to larger facilities or groups of facilities that include a full spectrum of health services, medical education, and medical research.
Ascension St. Mary's Hospital is a hospital in Saginaw, Michigan, United States. Ascension St. Mary's is certified as a Comprehensive Stroke Center by The Joint Commission. The hospital is a member of Ascension Michigan, and is a teaching affiliate of the Michigan State University College of Human Medicine as well as Central Michigan University. The American College of Surgeons verified the emergency department as a level II trauma center. The 268-bed hospital includes various specialty services, including neurological surgery, oncology and orthopedics.
Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting. Trauma surgeons generally complete residency training in General Surgery and often fellowship training in trauma or surgical critical care. The trauma surgeon is responsible for initially resuscitating and stabilizing and later evaluating and managing the patient. The attending trauma surgeon also leads the trauma team, which typically includes nurses and support staff as well as resident physicians in teaching hospitals.
The Trauma Quality Improvement Program (TQIP) was initiated in 2008 by the American College of Surgeons Committee on Trauma. Its aim is to provide risk-adjusted data for the purpose of reducing variability in adult trauma outcomes and offering best practice guidelines to improve trauma care. TQIP makes use of national data to allows hospitals to objectively evaluate their trauma centers' performance relative to other hospitals. TQIP's administrative costs are less than those of other programs, making it an accessible tool for assessing performance and enhancing quality of trauma care.
Natividad Medical Center (NMC) is a 172-bed acute-care teaching hospital located in Salinas, California. The hospital is owned and operated by Monterey County and the hospital's emergency department receives approximately 52,000 visits per year.
Cook Children's Medical Center is a nationally recognized not-for-profit pediatric hospital located in Fort Worth, Texas. One of the largest freestanding pediatric medical centers in the U.S., Cook Children's main campus is located in Tarrant County. The hospital provides comprehensive pediatric specialties and subspecialties to infants, children, teens, and young adults aged 0–21 throughout the Dallas-Fort Worth metro and the greater region. Cook Children's also has an ACS verified level II pediatric trauma center. The hospital has a rooftop helipad for the critical transport of pediatric patients to and from the hospital.
Valley Children's Hospital (VCH), formerly Children's Hospital Central California is a stand-alone, pediatric acute care children's teaching hospital located in Madera County, California. The hospital has 358 pediatric beds and is affiliated the Stanford University School of Medicine. The hospital is a member of Valley Children's Healthcare and is one of only two children's hospitals in the network, servicing approximately 1.3 million children and adolescents in their coverage area. The hospital provides comprehensive pediatric specialties and subspecialties to infants, children, teens, and young adults aged 0–21 throughout Madera County, Fresno, and California. Valley Children's also sometimes treats adults that require pediatric care.
Upstate University Hospital is a 752-bed non-profit, teaching hospital located in Syracuse, New York. Upstate University Hospital is a part of the Upstate Health System, as the flagship hospital in the system. As the hospital is a teaching hospital, it is affiliated with the Norton College of Medicine at State University of New York Upstate Medical University. The hospital is also an American College of Surgeons verified Level 1 Trauma Center, the only in the region and one of 21 in New York. Attached to the hospital is the Upstate Golisano Children's Hospital that treats infants, children, teens, and young adults aged 0–21.