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A trauma center, or trauma centre, is a hospital equipped and staffed to provide care for patients suffering from major trauma such as falls, motor vehicle collisions, or . The term "trauma center" may be used incorrectly to refer to an emergency department (also known as a "casualty department" or "accident and emergency") that lacks the presence of specialized services or certification 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 four or five designated levels).
The highest levels of trauma centers have access to specialist medical and nurse care, including emergency medicine, trauma surgery, oral and maxillofacial surgery, critical care, neurosurgery, orthopedic surgery, anesthesiology, and radiology, as well as a wide variety of highly specialized and sophisticated surgical and diagnostic equipment.
The operation of a trauma center is often expensive and some areas may be underserved by trauma centers because of that expense. As there is no way to schedule the need for emergency services, patient traffic at trauma centers can vary widely.
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.
In the United States, Robert J. Baker and Robert J. Freeark established the first civilian Shock Trauma Unit at Cook County Hospital (opened 1834) in Chicago, Illinois on March 16, 1966.Medical World News, January 27, 1967 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 Gerald Ford. In 1968 the American Trauma Society was created by various co-founders, including R Adams Cowley and Rene Joyeuse as they saw the importance of increased education and training of emergency providers and for nationwide quality trauma care.
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".Fraser Health regional trauma program receives distinction award, July 5, 2016
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) Trauma Information Exchange Program; , American Trauma Society. 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.
A trauma center is a hospital that is designated by a state or local authority or is verified by the American College of Surgeons. Trauma Center Designation and Verification by Level of Trauma Care , Trauma Information Exchange Program, American Trauma Society
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.
Level I and II trauma centers are focused on maintaining the capability "to take a patient to the operating room immediately 24/7/365".
This requires careful management of hospital resources to ensure their constant availability around the clock. For example, Elective surgery must be booked in such a way as to leave gaps in the schedule, to ensure that at least one fully-equipped operating room is always available for immediate use by the trauma service at all times.A trauma center must ensure that a general or trauma surgeon can respond to a patient's bedside within 15 minutes of notification at least 80% of the time. To satisfy this requirement, most Level I and many Level II centers have a surgeon in-house at all times, and there is usually another surgeon on backup (that is, on call to respond from home) if needed. They also have a Surgical nursing and scrub technician or two surgical nurses in-house at all times to support the trauma surgeon on duty. These surgical personnel must be supported by a complete trauma team of nurses and technicians in the emergency department able to care for, support, and safely transport critically ill patients through the hospital.
Nurses on a trauma team are often the most experienced nurses in the emergency department, with extensive training in critical care skills such as advanced airway management and rapid delivery of blood transfusions.Other specialists do not need to be in-house at the trauma center on a 24/7/365 basis, but they also must be carefully managed to avoid occupational burnout and to ensure consistent rapid response when on call.
For example, neurosurgeons are notoriously scarce and will burn out if there are not enough of them on call for a trauma center to share the workload.
In contrast to adult trauma centers, the ACS will only verify and most states designate pediatric trauma centers as either Level I or Level II. Only a handful of states designate pediatric trauma centers beyond Level II; Hawaii and Washington designate up to Level III, while New Hampshire and Texas designate up to Level IV.
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