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Trauma center levels
From WikEM
Contents
Back Ground
- Trauma centers are categorized from Level I-V with designation of adult and pediatric care
- Centers are evaluated and verified by the ACS
US Trauma Center Levels
Level I
- 24-hour in-house coverage by gen surg, and prompt availability of care in ortho, NS, anesthesiology, EM, IM, rads, plastics, OMFS, and critical care
- Referral center
- Community leadership and education
- Continuing education
- QA program
- Operates an organized teaching and research effort
Level II
- 24-hour immediate coverage by gen surg, as well as coverage by ortho, NS, anesthesiology, EM, rads, and critical care
- Tertiary care needs such as CT surg, need for HD, vasc surgery may be referred to a Level I Trauma Center
- Provides trauma prevention and to continuing education programs
- QA program
Level III
- 24-hour immediate coverage by EM providers and the prompt availability of gen surgery and anesthesiology
- QA program
- Transfer agreements with Level I and/or Level II Trauma Centers
- Provides back-up care for rural and community hospitals
- Continuing education
Level IV
- Basic ED which can implement ATLS protocols ("trauma nurse" and physician)
- 24-hour labs
- May provide surgery and critical-care services
- Transfer agreements with Level I and/or Level II Trauma Centers
- QA program
Level V
- Basic ED which can implement ATLS protocols ("trauma nurse" and physician)
- After-hours activation protocols if facility is not open 24-hours a day
- May provide surgery and critical-care services if available
- Transfer agreements with Level I and/or Level II Trauma Centers
Criteria for Transport to Trauma Center[1]
- Abnormal vital signs
- BP < 90
- RR < 10 or > 30
- GCS < 14
- Penetrating trauma to head, neck, torso, proximal extremities
- Flail chest
- Two or more long bone fractures
- Mangled extremities
- Pelvic fracture
- Depressed skull fracture
- Neuro deficit
- Vehicle ejection
- Death in same passenger compartment
- Significant vehicle extrusion
- Pedestrian or bicyclist struck by vehicle with significant impact
- Motorcycle crash > 20 mph
- Elderly or children
- Patients on anticoagulants
- Pregnant patients > 20 weeks gestation
External Links
References
- ↑ Gross EA, Martel ML. Multiple trauma, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 36: 287-295.
