Definition/Introduction
In the United States, trauma centers are identified through a designation process and a verification process. The criteria for the designation of a trauma center varies from state to state, and the designation process itself is the responsibility of state or regional authorities and not healthcare organizations.[1] The trauma center level (Level I- Level V) refers to the resources available to care for a trauma patient. A Level I trauma center can provide the highest level of care for a patient presenting after a traumatic injury. A Level IV or V trauma center will stabilize an injured patient and arrange for transfer to a higher level of care. This designation is unique for adult and pediatric facilities.
Trauma centers are evaluated and verified by the American College of Surgeons (ACS) to improve trauma care. The ACS provides verification of trauma centers, not a designation. It verifies that the facility has the resources available for the trauma patient. The ACS will evaluate a facility's preparedness, resources, policies, and quality improvement process. Verification by the ACS is valid for three years.[2]
Issues of Concern
Trauma centers are verified as an adult or pediatric trauma centers. It is not uncommon for hospitals to have designations for different levels for adult and pediatric populations. The criteria for trauma centers verified by the ACS are as follows. [3]
A Level I Trauma Center is a tertiary care hospital that offers a comprehensive approach to the trauma patient from injury through rehabilitation. Key components include:
24-hour in-hospital access to general surgeons
Availability of anesthesia, emergency medicine, neurosurgery, orthopedic surgery, radiology, plastic surgery, and maxillofacial surgery
Referral center for community hospitals
Public health education including the prevention of traumatic injuries
Continuing education for all team members involved in trauma care
Quality assessment and improvement programs
Teaching and research in trauma management
Polysubstance abuse identification and intervention
Evaluates and treats a minimum number of trauma patients annually
A Level II Trauma Center initiates the treatment of all trauma patients. Key components include:
24-hour access to general surgeons
Availability of anesthesiology, radiology, emergency medicine, neurosurgery, and orthopedic surgery
Sub-specialized care may be necessary to transfer to a Level I Trauma Center
Continuing education for all team members involved in trauma care
Quality assessment and improvement programs
A Level III Trauma Center provides prompt assessment, management, surgery, and stabilization for trauma patients. Key components include:
24-hour access to emergency medicine physicians
Availability of general surgeons
Quality assessment and improvement programs
Agreements to transfer patients requiring a higher level of care
Backup care for outlying hospitals
Continuing education for all team members involved in trauma care
Outreach education program for prevention of traumatic injuries
A Level IV Trauma Center can provide Advanced Trauma Life Support (ATLS) to trauma patients before transfer to a higher level of care. Key components include:
Emergency department able to implement ATLS protocols
Nurses and physicians available when trauma patients arrive
Surgery and intensive care, when available
Agreements to transfer patients requiring a higher level of care
Quality assessment and improvement programs
Outreach education program for prevention of traumatic injuries
A Level V Trauma Center can provide evaluation, initial management, and preparation before transfer to a higher level of trauma care. Key components include:
Emergency department able to implement ATLS protocols
Nurses and physicians available when trauma patients arrive
After hours protocols if the facility closes
Surgery and intensive care, when available
Agreements to transfer patients requiring a higher level of care
Clinical Significance
Research has shown that trauma management given at a designated trauma center is superior compared to trauma management at a facility that is not designated as a trauma center.[4][5] Mortality risk from trauma is significantly lower if patients receive care at a designated trauma center.[6][7][8][9]
Nursing, Allied Health, and Interprofessional Team Interventions
Approximately 80% of errors in medicine are a result of inadequate communication. High-risk environments include trauma facilities. Interprofessional teamwork and development should focus on communication, shared responsibility, collective decision-making, and understanding the roles of team members.[10]
