Over
recent years, the U.S. has seen a surge in trauma centers opening up as
hospitals expand their offerings to treat critically injured patients while
also increasing their bottom line. At the same time, dangerous remote work
operations and emergency response teams are realizing the importance of having
trauma centers on hand to reduce permanent disablement and death from serious
injuries.
But
while the benefits of trauma centers may be obvious, the path to setting one up
is less straightforward. Read on for trauma center basics, categorization
levels, setup steps, and other important considerations.
This
guide is for informational purposes only. If planning a trauma center, we
recommend consulting your municipality’s or state’s governing agencies and
resources for requirements and guidelines.
What
Is Physical Trauma?
Physical
trauma is defined as a serious bodily injury and is broken up into two main
categories:
Penetrating
trauma: When an object pierces the body or skin, typically leading to an open
wound
Blunt
force trauma: When a force or object strikes the body, potentially leading to
broken bones, deep cuts, or concussions
Common
causes of physical trauma include falls, motor vehicle crashes, burns,
assaults, and gunshot wounds. Physical trauma can also be caused by surgery,
which is sometimes referred to as a controlled injury.
What
Is a Trauma Center?
A
trauma center is a facility that provides resources and specialized medical
services to patients with traumatic — and oftentimes life-threatening and disabling
— injuries. This treatment is proven to reduce the chances of permanent
disability and death for the injured patients.
The
main difference between a regular hospital and a trauma center is the latter’s
requirement for a team of health care providers trained in specialty care to be
available 24/7. These providers must have expertise in treating traumatic
injuries and often include nurses, radiologists, cardiac surgeons, orthopedic
surgeons, neurosurgeons, and trauma surgeons. Trauma centers often require
specialty resources to be available 24/7 as well, such as a pharmacy, blood
bank, diagnostic testing, laboratory testing, an operating room, and a trauma
resuscitation area within the emergency department.
While
trauma centers are often located within hospitals, their services are purely
supplementary — they are not meant to replace the emergency department or other
traditional hospital services.
Trauma
Center Levels
In
the United States, trauma centers are categorized into specific levels via two
processes: designation and verification. These levels set national standards
for trauma care and are based on the types and quantities of resources
available in a trauma center, as well as the number of patients admitted
annually.
The
designation process takes place first and occurs at the state or local level,
where the unique criteria used to categorize trauma centers are identified. As
such, the requirements to meet each trauma center level vary from one state to
the next.
The
American College of Surgeons (ACS) then carries out the verification process to
verify that the resources listed in Resources for Optimal Care of the Injured
Patient (including commitment, policies, resources, readiness, performance
improvement, and patient care) are present. Designed to evaluate and optimize
trauma care, this process is voluntary, and its findings expire after three
years.
While
trauma center categories vary by state, below are common criteria for trauma
center levels designated by state and municipalities and verified by the ACS.
Categorization for adult and pediatric facilities is unique, so facilities
commonly achieve different designations for each group. For instance, a trauma
center may be a level II adult facility but a level III pediatric facility.
Level
I Trauma Centers
A
level I trauma center is a tertiary care facility that serves a central role in
the trauma system and is a holistic regional resource. It should be able to
provide comprehensive care for all aspects of injury, starting with prevention
and ending with rehabilitation.
Requirements
for level I trauma centers often include:
·
A
minimum annual volume of severely injured patients
·
A
substance abuse patient intervention and screening program
·
Research
and training efforts to pursue trauma care innovations
·
A
comprehensive quality assessment program
·
Continuing
education for members of the trauma team
·
Provision
of public education and prevention leadership to nearby communities
·
Referrals
for nearby communities
·
Round-the-clock
in-house coverage by general surgeons
·
Specialty
care available promptly, including critical care, pediatric care, oral and
maxillofacial, plastic surgery, internal medicine, radiology, emergency
medicine, anesthesiology, neurosurgery, and orthopedic surgery
Level
II Trauma Centers
Level
II trauma centers should be capable of initiating definitive care for all
injured patients.
Requirements
for level II trauma centers often include:
·
A
comprehensive quality assessment program
·
Continuing
education and trauma prevention programs for trauma care team members
·
Ability
to refer tertiary care needs (such as microvascular surgery, hemodialysis, and
cardiac surgery) to a level I trauma center
·
Immediate
round-the-clock coverage by general surgeons
·
Specialty
care available for critical care, radiology, emergency medicine,
anesthesiology, neurosurgery, and orthopedic surgery
Level
III Trauma Centers
Trauma
centers that have demonstrated a capability to provide emergency care,
intensive care, stabilization of injured patients, surgery, resuscitation, and
prompt assessment generally qualify for level III categorization.
Requirements
for level III trauma centers often include:
·
An
active outreach program and prevention efforts for referring communities
·
Continuing
education for trauma team members or for allied health and nursing personnel
·
Transfer
agreements in place with level I and II trauma centers for patients who require
more comprehensive care
·
A
comprehensive quality assessment program
·
Immediate
round-the-clock coverage by emergency medicine physicians
·
Prompt
availability of anesthesiologists and general surgeons
Level
IV Trauma Centers
Level
IV trauma centers provide diagnostic, stabilization, and evaluation
capabilities for injured patients. Trauma centers must demonstrate the ability
to provide patients with advanced trauma life support (ATLS) before
transferring them to a higher-level facility in order to qualify for level IV
categorization.
Requirements
for level IV trauma centers often include:
·
An
active outreach program and prevention efforts for referring communities
·
A
comprehensive quality assessment program
·
Transfer
agreements in place with higher-level trauma centers for patients who require
more comprehensive care
·
Ability
to provide critical care services and surgery if available
·
24-hour
laboratory coverage
·
Ability
to implement ATLS protocols with basic emergency department facilities
·
Physicians
and trauma nurse(s) available upon patient arrival
Level
V Trauma Centers
Level
V trauma centers provide diagnostic, evaluation, and stabilization capabilities
for patients and then prepare to transfer them to higher-level care facilities.
Requirements
for level V trauma centers often include:
·
Transfer
agreements in place with level I, II, and III trauma centers for patients who
require more comprehensive care
·
Ability
to provide critical care services and surgery if available
·
Protocols
for after-hours activation is the facility is not open 24/7
·
Physicians
and trauma nurse(s) available upon patient arrival
·
Ability
to implement ATLS protocols with basic emergency department facilities
Steps
to Set Up a Trauma Center
Successfully
setting up a trauma center so that it achieves accreditation and is verified by
the ACS is no simple task. Richard Buchler, director of Trauma Ready, explains
six steps that are crucial to making a trauma center both functional and
profitable:
Understand
the requirements: If you’ve read up to this point, you should already know the
common requirements that are set by your municipality or state and verified by
the ACS. Be sure to consult local resources to learn about the specific
requirements in your area.
Consider
finances: While many hospitals assume that a trauma center will be more of a
financial burden than a financial asset, this isn’t always the case. Depending
on your hospital’s payer mix, a trauma center can easily add to your bottom
line both immediately and long-term with downstream revenue. To make this
happen, work with the physicians to ensure adequate documentation for
reimbursement. Proper reimbursement will also require correct coding, as the
trauma center should receive additional reimbursement for every minute that a
trauma surgeon spends with the patient post-stabilization.
Set
up a trauma system: The whole hospital ecosystem needs to buy into the trauma
program for it to be successful. Everyone across all phases of care — from
prehospital and emergency department care to operating room procedures,
subspecialist involvement, and follow-up — needs to understand and be involved
in the system. Quality and regulatory compliance should be built in from the
very beginning.
Prepare
for capacity issues: Capacity is a common challenge for trauma centers: patient
volumes can fluctuate significantly and thus are difficult to predict. Careful
planning and a unique, scalable model for staffing, equipment, and space will
be necessary. While emergency department and intensive care unit (ICU) staff
can be trained and volunteer to be part of the trauma center team for when
demand surges, coming up with additional beds and operating rooms without monopolizing
the hospital’s resources may be more challenging.
Prepare
the rest of the hospital: The entire hospital will be affected by the new
trauma center and should be prepared for potential changes. Imaging, radiology,
neurology, and orthopedics may be particularly impacted if the trauma center
quickly becomes busy.
Educate
the community: A trauma center is a great benefit to and resource for the
community. Reach out to community members to highlight the positive impact that
the trauma center will have and educate on trauma prevention.