Advanced Trauma Center and Hospital.

• 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, motor vehicle collisions, or gunshot wounds. 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.[1] 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 care, including emergency
medicine, trauma surgery, critical care, neurosurgery, orthopedic surgery, anesthesiology, and radiology, as well
as a wide variety of highly specialized and sophisticated surgical and diagnostic equipment.Lower levels of
trauma centers may only be able to provide initial care and stabilization of a traumatic injury and arrange for
transfer of the victim to a higher level of trauma care.

• The operation of a trauma center is extremely expensive. Some areas, especially rural regions, are 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 variety of methods have been developed for dealing with
that.
• A trauma center will often have a helipad for receiving patients that have been airlifted to the hospital. In many
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. The trauma level certification can directly affect the patient's outcome and
determine if the patient needs to be transferred to a higher-level trauma center.
 HASTORY OF TRAUMA CENTRE
UK

Trauma centres grew into existence out of the realisation that traumatic injury 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, which opened in Birmingham, 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 teams,
each including two surgeons and an anaesthetist(Anaesthetists are perioperative physicians trained in all forms of
anaesthesia and are members of multidisciplinary teams providing healthcare to patients. They assess patients
before their procedures and play an important role in caring for the patient before, during and after surgery.)
, and a burns team with three surgeons. The hospital became part of the National Health Service on its formation
in July 1948 and closed in 1993. The NHS now has 27 major trauma centres established across England, 4 in
Scotland, and one planned in Wales.

US

According to the CDC(Centers for Disease Control and Prevention), injuries are the leading cause of death for
American children and young adults ages 1–19.[6] The leading causes of trauma are motor vehicle collisions, falls,
and assaults with a deadly weapon.
In the United States of America, Drs. Robert J. Baker and Robert J. Freeark established the first civilian Shock Trauma
Unit at Cook County Hospital in Chicago, IL on March 16, 1966. 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). Dr. 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, Dr.
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 President Ford. In 1968 the American Trauma
Society was created by various co-founders to include Dr. R Adams Cowley, Dr. 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, Ontario, Dr. 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 wounds".
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"

In the United States, trauma centers are ranked by the American College of Surgeons (ACS), 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 and or pediatric 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 US 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. 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 policy makers.

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 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. In addition, these trauma centers must
be able to provide care for pediatric patients.[citation needed] Many Level II trauma centers would qualify for Level I if they
were equipped to handle all pediatric emergencies.

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 physicians
• anesthesiologists
• nurses
• respiratory therapists
• 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, cardiothoracic surgery, neurosurgery, plastic surgery, anesthesiology, emergency medicine, radiology,
internal medicine, otolaryngology and oral and maxillofacial surgery (trained to treat injuries of the facial skin, muscles, bones),
and critical care, which are needed to adequately respond and care for various forms of trauma that a patient may suffer and
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. 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 to 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. 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.
 Trauma Center Levels Explained

Designation Vs. Verification

Trauma center levels across the United States are identified in two fashions – A designation process and a verification process.
The different levels (ie. Level I, II, III, IV or V) refer to the kinds 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. Categorization is
unique to both Adult and Pediatric facilities.

Trauma Center designation is a process outlined and developed at a state or local level. The state or local municipality
identifies unique criteria in which to categorize Trauma Centers. These categories may vary from state to state and are typically
outlined through legislative or regulatory authority.

Trauma Center Verification is an evaluation process done by the American College of Surgeons (ACS) to evaluate and improve
trauma care. The ACS does not designate trauma centers; instead, it verifies the presence of the resources listed in Resources
for Optimal Care of the Injured Patient. These include commitment, readiness, resources, policies, patient care, and
performance improvement.

Trauma Center Levels

As mentioned above, Trauma categories vary from state to state. Outlined below are common criteria for Trauma Centers
verified by the ACS and also designated by states and municipalities. Facilities are designated/verified as Adult and/or
Pediatric Trauma Centers. It is not uncommon for facilities to have different designations for each group (ie. a Trauma Center
may be a Level I Adult facility and also a Level II Pediatric Facility).
Level I

Level I Trauma Center is a comprehensive regional resource that is a tertiary care facility central to the trauma
system. A Level I Trauma Center is capable of providing total care for every aspect of injury – from prevention
through rehabilitation.

Elements of Level I Trauma Centers Include:

• 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic
surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral
and maxillofacial, pediatric and critical care.
• Referral resource for communities in nearby regions.
• Provides leadership in prevention, public education to surrounding communities.
• Provides continuing education of the trauma team members.
• Incorporates a comprehensive quality assessment program.
• Operates an organized teaching and research effort to help direct new innovations in trauma care.
• Program for substance abuse screening and patient intervention.
• Meets minimum requirement for annual volume of severely injured patients.
Level II
A Level II Trauma Center is able to initiate definitive care for all injured patients.
Elements of Level II Trauma Centers Include:
24-hour immediate coverage by general surgeons, as well as coverage by the specialties of orthopedic surgery,
neurosurgery, anesthesiology, emergency medicine, radiology and critical care.
Tertiary care needs such as cardiac surgery, hemodialysis and microvascular surgery may be referred to a Level I
Trauma Center.
Provides trauma prevention and continuing education programs for staff.
Incorporates a comprehensive quality assessment program.
Level III
A Level III Trauma Center has demonstrated an ability to provide prompt assessment, resuscitation, surgery,
intensive care and stabilization of injured patients and emergency operations.
Elements of Level III Trauma Centers Include:
24-hour immediate coverage by emergency medicine physicians and the prompt availability of general surgeons and
anesthesiologists.
Incorporates a comprehensive quality assessment program.
Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma
Center.
Provides back-up care for rural and community hospitals.
Offers continued education of the nursing and allied health personnel or the trauma team.
Involved with prevention efforts and must have an active outreach program for its referring communities.
Level IV
A Level IV Trauma Center has demonstrated an ability to provide advanced trauma life support (ATLS) prior to
transfer of patients to a higher level trauma center. It provides evaluation, stabilization, and diagnostic capabilities
for injured patients.
Elements of Level IV Trauma Centers Include:
Basic emergency department facilities to implement ATLS protocols and 24-hour laboratory coverage. Available
trauma nurse(s) and physicians available upon patient arrival.
May provide surgery and critical-care services if available.
Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma
Center.
Incorporates a comprehensive quality assessment program.
Involved with prevention efforts and must have an active outreach program for its referring communities.
Level V
A Level V Trauma Center provides initial evaluation, stabilization and diagnostic capabilities and prepares patients for
transfer to higher levels of care.
Elements of Level V Trauma Centers Include:
Basic emergency department facilities to implement ATLS protocols.
Available trauma nurse(s) and physicians available upon patient arrival.
After-hours activation protocols if facility is not open 24-hours a day.
May provide surgery and critical-care services if available.
Has developed transfer agreements for patients requiring more comprehensive care at a Level I through III Trauma
Centers.