![Imago0052822637s](https://upload.wikimedia.org/wikipedia/commons/c/cb/Imago0052822637s.jpg)
A trauma center (or trauma centre) is a
hospital equipped and staffed to provide care for patients suffering from
major traumatic injuries such as
fall
Autumn, also known as fall in American English and Canadian English, is one of the four temperate seasons on Earth. Outside the tropics, autumn marks the transition from summer to winter, in September (Northern Hemisphere) or March ( Southe ...
s,
motor vehicle collisions, or
gunshot wound
A gunshot wound (GSW) is a penetrating injury caused by a projectile (e.g. a bullet) from a gun (typically firearm or air gun). Damages may include bleeding, bone fractures, organ damage, wound infection, loss of the ability to move part ...
s. A trauma center may also refer to an
emergency department (also known as a "casualty department" or "accident and emergency") without the presence of specialized services 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 five designated levels, in which case Level V (Level-5) is the lowest).
The highest levels of trauma centers have access to specialist medical and
nursing
Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health ...
care, including
emergency medicine,
trauma surgery
Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting. Trauma surgeons generally complete residency training in general surgery and often fe ...
,
critical care,
neurosurgery
Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and pe ...
,
orthopedic surgery
Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
,
anesthesiology
Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...
, and
radiology
Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiat ...
, as well as a wide variety of highly specialized and sophisticated surgical and diagnostic equipment. Lower levels of trauma centers may be able to provide only initial care and stabilization of a traumatic injury and arrange for transfer of the patient to a higher level of trauma care.
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
A helicopter is a type of rotorcraft in which lift and thrust are supplied by horizontally spinning rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forward, backward and laterally. These attributes ...
can receive faster and better medical care than if they had been transported by ground
ambulance
An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport.
Ambulances are used to respond to medi ...
to a closer hospital that does not have a designated trauma center.
History
U.K.
Trauma centres grew into existence out of the realisation that
traumatic injury
An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, or o ...
is a disease process unto itself requiring specialised and experienced multidisciplinary treatment and specialised resources. The world's first trauma centre, the first hospital to be established specifically to treat injured rather than ill patients, was the
Birmingham Accident Hospital
Birmingham Accident Hospital, formerly known as Birmingham Accident Hospital and Rehabilitation Centre, was established in April 1941 as Birmingham's response to two reports, the British Medical Association's Committee on Fractures (1935) and th ...
, which opened in
Birmingham
Birmingham ( ) is a City status in the United Kingdom, city and metropolitan borough in the metropolitan county of West Midlands (county), West Midlands in England. It is the second-largest city in the United Kingdom with a population of 1. ...
, England in 1941 after a series of studies found that the treatment of injured persons within England was inadequate. By 1947, the hospital had three
trauma team
''Trauma Team'' is a 2010 simulation video game developed and published by Atlus for the Wii. It is the fifth entry and current final entry in the ''Trauma Center'' series. The narrative of ''Trauma Team'' follows six protagonists who operate in ...
s, each including two surgeons and an anaesthetist, and a burns team with three surgeons. The hospital became part of the
National Health Service
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
in its formation in July 1948 and closed in 1993. The NHS now has 27
major trauma centres established across
England
England is a country that is part of the United Kingdom. It shares land borders with Wales to its west and Scotland to its north. The Irish Sea lies northwest and the Celtic Sea to the southwest. It is separated from continental Europe b ...
, four in
Scotland
Scotland (, ) is a Countries of the United Kingdom, country that is part of the United Kingdom. Covering the northern third of the island of Great Britain, mainland Scotland has a Anglo-Scottish border, border with England to the southeast ...
, and one planned in
Wales
Wales ( cy, Cymru ) is a country that is part of the United Kingdom. It is bordered by England to the east, the Irish Sea to the north and west, the Celtic Sea to the south west and the Bristol Channel to the south. It had a population in ...
.
U.S.
According to the
CDC
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
, injuries are the leading cause of death for American children and young adults ages 1–19. The leading causes of trauma are motor vehicle collisions, falls, and assaults with a deadly weapon.
In the United States of America, Robert J. Baker and Robert J. Freeark established the first civilian Shock Trauma Unit at Cook County Hospital in Chicago, Illinois on March 16, 1966. The concept of a shock trauma center was also developed at the
University of Maryland, Baltimore
The University of Maryland, Baltimore (UMB) is a public university in Baltimore, Maryland. Founded in 1807, it comprises some of the oldest professional schools of dentistry, law, medicine, pharmacy, social work and nursing in the United States ...
, in the 1950s and 1960s by thoracic surgeon and
shock
Shock may refer to:
Common uses Collective noun
*Shock, a historic commercial term for a group of 60, see English numerals#Special names
* Stook, or shock of grain, stacked sheaves
Healthcare
* Shock (circulatory), circulatory medical emergen ...
researcher
R Adams Cowley
R Adams Cowley (July 25, 1917 – October 27, 1991) was an American surgeon considered a pioneer in emergency medicine and the treatment of Shock (circulatory), shock Physical trauma, trauma. Called the "Father of Trauma Medicine", he was the foun ...
, who founded what became the
Shock Trauma Center in
Baltimore
Baltimore ( , locally: or ) is the List of municipalities in Maryland, most populous city in the U.S. state of Maryland, fourth most populous city in the Mid-Atlantic (United States), Mid-Atlantic, and List of United States cities by popula ...
,
Maryland
Maryland ( ) is a state in the Mid-Atlantic region of the United States. It shares borders with Virginia, West Virginia, and the District of Columbia to its south and west; Pennsylvania to its north; and Delaware and the Atlantic Ocean to ...
, 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
The John H. Stroger Jr. Hospital of Cook County (formerly Cook County Hospital) is a public hospital in Chicago, Illinois, United States. It is part of the Cook County Health and Hospital System, along with Provident Hospital of Cook County and ...
in Chicago trauma center (opened in 1966). David R. Boyd interned at
Cook County Hospital
The John H. Stroger Jr. Hospital of Cook County (formerly Cook County Hospital) is a public hospital in Chicago, Illinois, United States. It is part of the Cook County Health and Hospital System, along with Provident Hospital of Cook County and ...
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
Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...
, under
President Ford
Gerald Rudolph Ford Jr. ( ; born Leslie Lynch King Jr.; July 14, 1913December 26, 2006) was an American politician who served as the 38th president of the United States from 1974 to 1977. He was the only president never to have been elected ...
. In 1968 the American Trauma Society was created by various co-founders to include
R Adams Cowley
R Adams Cowley (July 25, 1917 – October 27, 1991) was an American surgeon considered a pioneer in emergency medicine and the treatment of Shock (circulatory), shock Physical trauma, trauma. Called the "Father of Trauma Medicine", he was the foun ...
,
Rene Joyeuse as they saw the importance of increased education and training of emergency providers and for nationwide quality trauma care.
Canada
According to the founder of the Trauma Unit at
Sunnybrook Health Sciences Centre in
Toronto
Toronto ( ; or ) is the capital city of the Canadian province of Ontario. With a recorded population of 2,794,356 in 2021, it is the most populous city in Canada and the fourth most populous city in North America. The city is the anch ...
, Ontario,
Marvin Tile, "the nature of injuries at Sunnybrook has changed over the years. When the trauma center first opened in 1976, about 98 percent of patients suffered from blunt-force trauma caused by accidents and falls. Now, as many as 20 percent of patients arrive with gunshot and
knife
A knife ( : knives; from Old Norse 'knife, dirk') is a tool or weapon with a cutting edge or blade, usually attached to a handle or hilt. One of the earliest tools used by humanity, knives appeared at least 2.5 million years ago, as evidence ...
wounds".
Fraser Health Authority
The Fraser Health Authority (FHA) is one of five publicly funded health authorities into which the Provinces and territories of Canada, Canadian province of British Columbia (BC) is divided. It is governed by the provincial ''Health Authorities Ac ...
in
British Columbia
British Columbia (commonly abbreviated as BC) is the westernmost province of Canada, situated between the Pacific Ocean and the Rocky Mountains. It has a diverse geography, with rugged landscapes that include rocky coastlines, sandy beaches, ...
, located at
Royal Columbian Hospital
Royal Columbian Hospital (RCH) is the oldest hospital in British Columbia and one of the busiest in the Fraser Health Authority. It is located in New Westminster overlooking the Fraser River and is the only hospital in the Lower Mainland that is ...
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".
Definitions in United States
In the United States, trauma centers are ranked by the
American College of Surgeons (ACS) or local state governments, from Level I (comprehensive service) to Level III (limited-care). The different levels refer to the types of resources available in a trauma center and the number of patients admitted yearly. These are categories that define national standards for trauma care in
hospitals. Level I and Level II designations are also given adult or
pediatric
Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until the ...
designations.
Additionally, some states have their own trauma-center rankings separate from the ACS. These levels may range from Level I to Level IV. Some hospitals are less-formally designated Level V.
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) 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
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
. 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.
Note that a trauma center is a hospital that is designated by a state or local authority or is verified by the American College of Surgeons.
Level I
A Level I trauma center provides the highest level of surgical care to
trauma
Trauma most often refers to:
* Major trauma, in physical medicine, severe physical injury caused by an external source
* Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event
*Traumatic i ...
patients. Being treated at a Level I trauma center can reduce mortality by 25% compared to a non-trauma center. It has a full range of specialists and equipment available 24 hours a day
and admits a minimum required annual volume of severely injured patients.
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:
:*
surgeons
:*
emergency physician
An emergency physician (often called an "ER doctor" in the United States) is a physician who works at an emergency department to care for ill patients. The emergency physician is a specialist in advanced cardiac life support (advanced life suppor ...
s
:*
anesthesiologist
Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine ...
s
:*
nurses
Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health c ...
:*
respiratory therapist
A respiratory therapist is a specialized healthcare practitioner trained in critical care and cardio-pulmonary medicine in order to work therapeutically with people who have acute critical conditions, cardiac and pulmonary disease. Respirator ...
s
:* an education program
:* preventive and outreach programs.
Key elements include 24‑hour in‑house coverage by general surgeons and prompt availability of care in varying specialties—such as
orthopedic surgery
Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
,
cardiothoracic surgery
Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart (heart disease), lungs ( lung disease), and other pleural or mediastinal str ...
,
neurosurgery
Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and pe ...
,
plastic surgery
Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes cranio ...
,
anesthesiology
Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...
,
emergency medicine,
radiology
Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiat ...
,
internal medicine,
otolaryngology
Otorhinolaryngology ( , abbreviated ORL and also known as otolaryngology, otolaryngology–head and neck surgery (ORL–H&N or OHNS), or ear, nose, and throat (ENT)) is a surgical subspeciality within medicine that deals with the surgical a ...
,
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 II
A Level II trauma center works in collaboration with a Level I center. It provides comprehensive trauma care and supplements the clinical expertise of a Level I institution. It provides 24-hour availability of all essential specialties, personnel, and equipment. Oftentimes, level II centers possess critical care services capable of caring for almost all injury types indefinitely. Minimum volume requirements may depend on local conditions. Such institutions are not required to have an ongoing program of research or a surgical residency program.
Level III
A Level III trauma center does not have the full availability of specialists but has resources for emergency resuscitation, surgery, and intensive care of most trauma patients. A Level III center has transfer agreements with Level I or Level II trauma centers that provide back-up resources for the care of patients with exceptionally severe injuries (such as multiple trauma).
Level IV
A Level IV trauma center exists in some states in which the resources do not exist for a Level III trauma center. It provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. It may also provide surgery and critical-care services, as defined in the scope of services for trauma care. A trauma-trained nurse is immediately available, and physicians are available upon the patient's arrival in the Emergency Department. Transfer agreements exist with other trauma centers of higher levels, for use when conditions warrant a transfer.
Level V
A Level V trauma center provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. They may provide surgical and critical-care services, as defined in the service's scope of trauma care services. A trauma-trained nurse is immediately available, and physicians are available upon patient arrival in the emergency department. If not open 24 hours daily, the facility must have an after-hours trauma response protocol.
Pediatric trauma centers
A facility can be designated an adult trauma center, a pediatric trauma center, or an adult and pediatric trauma center. If a hospital provides trauma care to both adult and pediatric patients, the level designation may not be the same for each group. For example, a Level I adult trauma center may also be a Level II pediatric trauma center. That is because pediatric trauma surgery is a specialty unto itself. Adult trauma surgeons are not generally specialized in providing surgical trauma care to children and vice versa, and the difference in practice is significant. In contrast to adult trauma centers, pediatric trauma centers only have two ratings, either level I or level II.
See also
*
Emergency medicine
*
Trauma (medicine)
*
Trauma surgery
Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting. Trauma surgeons generally complete residency training in general surgery and often fe ...
*
Trauma team
''Trauma Team'' is a 2010 simulation video game developed and published by Atlus for the Wii. It is the fifth entry and current final entry in the ''Trauma Center'' series. The narrative of ''Trauma Team'' follows six protagonists who operate in ...
*
Traumatology
In medicine, traumatology (from Greek ''trauma'', meaning injury or wound) is the study of wounds and injuries caused by accidents or violence to a person, and the surgical therapy and repair of the damage. Traumatology is a branch of medicine. ...
*
List of trauma centers in the United States
*
This is a list of hospitals in the United States that are verified as trauma center
A trauma center (or trauma centre) is a hospital equipped and staffed to provide care for patients suffering from major traumatic injuries such as falls, ...
References
External links
Injury Prevention & Control: Trauma Careat Centers for Disease Control and Prevention
Trauma Centers Fact Sheetat Centers for Disease Control and Prevention
Trauma Levels Explained American Trauma Society
€”American College of Surgeons
Trauma Center Association of America formerly known as the National Foundation for Trauma Care
U.S. Trauma Center Crisis Report (2004)* Report
U.S. Trauma Center Preparedness for a Terrorist Attack in the Community* Report
Harris Poll: Trauma Care: Public's Knowledge and Perception of Importance 2004* NHS England major trauma centre
* NHS England 2012 major trauma centres ma
Urgent and emergency care services* NHS England Ambulance trauma codin
When to call 999* NHS Wales trauma centre
Accident and emergency departments* NHS Scotland trauma centres lis
State trauma system regulation
Bureau of Emergency Medical Services & Trauma System Arizona Department of Health Services
Georgia Trauma CommissionPA Trauma Systems Foundation25 Texas Administrative Code 157.125(Texas Requirements for Trauma Facility Designation)
Maryland Trauma System
{{DEFAULTSORT:Trauma Center
Traumatology
Emergency medicine
Trauma surgery
Hospital departments