Trauma center

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Typical trauma room at Level I Trauma Center. Scripps Mercy Trauma Room.jpg
Typical trauma room at Level I Trauma Center.

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 & emergency") without the presence of specialized services to care for victims of major trauma.

Hospital health care institution

A hospital is a health care institution providing patient treatment with specialized medical and nursing staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emergency department to treat urgent health problems ranging from fire and accident victims to a sudden illness. A district hospital typically is the major health care facility in its region, with a large number of beds for intensive care and additional beds for patients who need long-term care. Specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric treatment and certain disease categories. Specialized hospitals can help reduce health care costs compared to general hospitals. Hospitals are classified as general, specialty, or government depending on the sources of income received.

Major trauma injury that could cause prolonged disability or death

Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Depending on the severity of injury, quickness of management and transportation to an appropriate medical facility may be necessary to prevent loss of life or limb. The initial assessment is critical, and involves a physical evaluation and also may include the use of imaging tools to determine the types of injuries accurately and to formulate a course of treatment.

Falling (accident) adverse event, accidental or intentional

Falling is the second leading cause of accidental death worldwide and is a major cause of personal injury, especially for the elderly. Falls in older adults are an important class of preventable injuries. Builders, electricians, miners, and painters are occupations with high rates of fall injuries.

Contents

In the United States of America, 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. [1] 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).

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 highly sophisticated surgical and diagnostic equipment. [2] [3] [4] 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.

Emergency medicine medical specialty concerned with care for patients who require immediate medical attention

Emergency medicine, also known as accident and emergency medicine, is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians care for unscheduled and undifferentiated patients of all ages. As first-line providers, their primary responsibility is to initiate resuscitation and stabilization and to start investigations and interventions to diagnose and treat illnesses in the acute phase. Emergency physicians generally practice in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units, but may also work in primary care settings such as urgent care clinics. Sub-specializations of emergency medicine include disaster medicine, medical toxicology, ultrasonography, critical care medicine, hyperbaric medicine, sports medicine, palliative care, or aerospace medicine.

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.

Neurosurgery medical specialty of disorders which affect any portion of the nervous system

Neurosurgery, or neurological surgery, is the medical specialty concerned with the prevention, diagnosis, surgical treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.

The operation of a trauma center is extremely expensive. Some areas—especially rural regions—are under-served by trauma centers because of this expense. As there is no way to schedule the need for emergency services, patient traffic at trauma centers can vary widely. A variety of methods have been developed for dealing with this.[ citation needed ]

A trauma center will often have a helipad 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 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. 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.[ citation needed ]

Helipad landing area or platform for helicopters

A helipad is a landing area or platform for helicopters and powered lift aircraft.

Helicopter Type of rotor craft in which lift and thrust are supplied by rotors

A helicopter is a type of rotorcraft in which lift and thrust are supplied by rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forward, backward, and laterally. These attributes allow helicopters to be used in congested or isolated areas where fixed-wing aircraft and many forms of VTOL aircraft cannot perform.

Ambulance vehicle equipped for transporting and care for ill and wounded people

An ambulance is a vehicle which can transport medical patients to treatment, and in some instances will also provide out-of-hospital medical care to the patient.

History

UK

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 on its formation in July 1948 and closed in 1993. [5] The NHS now has 27 major trauma centres established across England, 2 in Scotland, and one planned in Wales.

Birmingham Accident Hospital Hospital in England

Birmingham Accident Hospital, formerly known as Birmingham Accident Hospital and Rehabilitation Centre, was established in April 1941 as Birmingham's response to two reports, the British Medical Association's Committee on Fractures (1935) and the Interdepartmental Committee (1939) on the Rehabilitation of Persons injured by Accidents. Both organisations recommended specialist treatment and rehabilitation facities. The hospital, generally recognized as the world's first trauma center, used the existing buildings of Queen's Hospital, a former Teaching Hospital in Bath Row, Birmingham, England, in the United Kingdom. It changed its name to Birmingham Accident Hospital in 1974 and closed in 1993. A listed building it is now part of Queens Hospital Close, a student accommodation complex. A blue plaque commemorates its former role.

National Health Service (England) publicly funded system of healthcare in England

The National Health Service (NHS) is the publicly funded national healthcare system for England and one of the four National Health Services for each constituent country of the United Kingdom. It is the largest single-payer healthcare system in the world. (Important to note that the single payer term means something a little different to the phrase used widely in the USA. The English NHS is both Payer and Provider of healthcare.. Primarily funded through the government funding and overseen by the Department of Health and Social Care, NHS England provides healthcare to all legal English residents, with most services free at the point of use. Some services, such as emergency treatment and treatment of infectious diseases, are free for everyone, including visitors.

A Major Trauma Centre (MTC) is a specialist unit within the National Health Service of the United Kingdom, set up to provide specialised trauma care and rehabilitation. They are usually found within larger hospitals in major cities which have the necessary infrastructure and staff to deal with major trauma cases.

US

According to the CDC, injuries are the leading cause of death for American children and adults ages 1–44. The leading causes of trauma are motor vehicle collisions, falls, and assaults with a deadly weapon.

In the United States of America, Drs. Robert J. Baker and Robert J. Freeark established the first civilian Shock Trauma Unit at Cook County Hospital in Chicago, IL on March 16, 1966. [6] 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. [7] Cook County Hospital in Chicago trauma center (opened in 1966). [8] Dr. 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, Dr. Boyd became the first shock-trauma fellow at the R Adams Cowley Shock Trauma Center, from 1967 to 1968. Boyd returned to Cook County Hospital, where he would later serve as resident director of the Cook County Trauma Unit. [9]

Canada

According to the founder of the Trauma Unit at Sunnybrook Health Sciences Centre in Toronto, Ontario, Dr. 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". [10]

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" [11]

Definitions in the United States of America

In the United States of America, trauma centers are ranked by the American College of Surgeons (ACS), 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. [12] 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 US 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 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. [13]

The Trauma Information Exchange Program (TIEP) [14] 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 policy makers.

Traumaccenters.jpg

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. [15]

Level I

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. [16] It has a full range of specialists and equipment available 24 hours a day [17] and admits a minimum required annual volume of severely injured patients. In addition, these trauma centers must be able to provide care for pediatric patients. Many Level II trauma centers would qualify for Level I if they were equipped to handle all pediatric emergencies.

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 and oral and maxillofacial surgery (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 and 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. [18]

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 patients with exceptionally severe injuries (e.g., multiple trauma). [18]

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. [18] [19]

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 I adult trauma center may also be a Level II 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.

See also

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References

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  6. Medical World News, January 27, 1967
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  10. "Sunnybrook doctor names to Order of Canada", Community Jul 08, 2009 City Centre Mirror
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State trauma system regulation