Trauma Centers. Levels I through V. Transportation to and from. How does all of this connect? Well, buckle up because you are about to learn. The first trauma center was established in 1966 in San Fransisco, and trauma care and emergency medicine have only grown from there. Now, trauma care centers are categorized by the level of care they provide, the resources they have, and the annual intake of patients. While the services at each level of care vary a little from state to state, the basic principles of each level remain the same. So let’s get into it…
Level I
Generally, Level I Trauma Centers provide comprehensive tertiary care from prevention to rehabilitation for any injury. Despite being called “level one” this is the highest trauma center level. These centers include 24-hour coverage of multiple specialties. These facilities also generally…
- Are teaching hospitals/campuses
- Have a program of research
- Leaders in trauma education and injury prevention
- Are referral resources for surrounding communities and centers
- Offer substance abuse screening, programs, and patient intervention
- Meet minimum requirements for annual patient volume
As the highest level of emergency care, Level I Centers require immediate transportation for patients, supplies, and medical products. Patient transport is essential in emergency situations involving Level I care, whether that is ambulance transportation or air medical transportation. In addition to patient services, these facilities provide emergency surgery and trauma care, creating a high need for fast and efficient blood and organ transport via ground or air transportation. Time is of the essence in these situations, so the safe and immediate transport of organs, blood, or other medical specimens and product is vital.
Level II
Level II Centers will initiate care for patients with all injuries, working in collaboration with a Level I Center. These centers also have 24-hour care with all essential specialties and provide trauma prevention as well as…
- Continuing education for staff
- Meet minimum volume requirements (depending on local standards)
- Refers tertiary care needs to Level I Center
In terms of transportation, the needs of Level II Centers are often similar to those of Level I, requiring immediate transportation of both patients and medical products.
Level III
On to Level III Centers! This level has the ability to care for the assessment, resuscitation, surgery, intensive care, and stabilization of patients in emergency operations. These centers do not have the variety of specialists that Level I and II centers do. However, they still maintain…
- 24-hour coverage from emergency medical physicians, surgeons, and anesthesiologists
- Transfer agreements with level 1 or 2 trauma centers
- Back up care for local hospitals
- Continuing education for nursing, allied health personnel, and trauma team
- Prevention and active outreach program for referring communities
Transportation to and from Level III centers is essential to pay attention to, in that this level still sees a lot of emergency operations. These centers often prepare patients to be transported to another facility, typically local. Therefore, these centers often utilize ambulance transportation from a Level III to a Level II or I Center.
Level IV
Almost there – Level IV. Initial evaluations, stabilization, and diagnostics are conducted in these centers before transferring patients to a higher level of care. Sometimes, more critical-care services and surgery are offered here in addition to…
- Trauma-trained nurses available (physicians available upon arrival)
- Transfer agreements with other higher-level trauma centers
- Basic emergency department facilities
- 24-hour laboratory coverage
- Involvement in prevention and active outreach program efforts
Similar to Level III, Level IV Centers involve a lot of patient transfers to higher care facilities.
Level V
Last but not least, Level V Trauma Centers are equipped as basic emergency department facilities for initial evaluation, stabilization, and diagnosis, preparing patients for a transfer to a higher level of care. These centers have…
- Available trauma nurses and physicians
- After-hours response protocol (not all Level V Centers are open 24 hours)
- Transfer agreements with higher-level centers
- Some, not all, have surgical and critical-care services
Patient transportation is essential in these centers, as most Level V Center visits result in transfer to a higher level of care if the patient requires it. Since these centers aren’t as emergent as the higher levels, NEMT transportation back to a personal residence prior to a Level V visit could be utilized.
Pediatric Trauma Centers
Honorable mention in Trauma Care Levels – Pediatric Trauma Centers. A Level I Trauma Center might be a Level II Pediatric Trauma Center; it depends on whether the location has the appropriate resources to treat pediatric patients properly. These centers hold all of the essential criteria of the center levels mentioned above, in addition to having…
- Pediatric surgeon directing pediatric trauma services
- Pediatric-credentialed trauma surgeons and pediatric specialists
- Separate pediatric emergency room and ICU
- Pediatric equipment for resuscitation in all care areas
Pediatric transportation requires slightly different processes than adult transport. Thankfully, many services, including Medi-Ops, have pediatric and NICU transportation services in addition to adult transportation services.
All in all, levels of trauma centers are vital to understanding medical emergencies as well as addressing what kinds of transportation might be required for patient and medical product needs in emergency situations. The levels in emergency medicine create specific environments for a patient to get optimal medical care. While emergency medicine continues to evolve and grow, the leaps made in trauma centers are huge in patient care.