HCA Virginia - January 08, 2020

Real life, local trauma care

Helicopters swoop in, doctors rush by, and intense injuries roll through the door. This may seem like a scene from your favorite TV drama, but it’s not. It’s real, it’s life and death, and it’s happening daily at your local trauma center.

Emergency vs trauma

Emergency rooms (ERs) are not created equal—especially when it comes to their ability to treat life-threatening injuries (trauma). Emergencies may include heart attack, stroke, severe stomach pains, breathing problems, even most broken bones. But, trauma includes car accidents, gunshot wounds, stabbings, major burns, serious falls, brain injuries, and other severe injuries. 

That’s not to say that heart attacks and stroke aren’t traumatic experiences. But, medically, trauma involves a life-threatening injury. Just as hospitals can be designated as providing the highest levels of stroke care, or rated for their fast diagnosis and treatment of chest pain, there are different levels of trauma care.

Setting trauma care standards

In the U.S., Trauma Center standards are set nationally, with the different levels expressed as roman numerals (I, II, III, IV, and V). These levels establish that the center has the equipment, experience, and physician specialties needed to handle different types of traumatic injury. Adult and pediatric trauma standards are defined separately.

Level I is the highest designation. A Level I Trauma Center handles virtually any injury or emergency. It’s these centers, in highly populated areas, that are the basis for what we see on TV shows. State or local governments use these standards to establish the designations (or categories of care) that will be available in that area. That’s why the criteria for each trauma level can vary from state to state, or even within some states.

Next comes verification—which is the way each facility gets assigned a trauma level. Trauma Center Verification is handled by the American College of Surgeons and is good for 3 years. It is common for facilities to have different designations for adults and children (e.g., a Level I Adult and a Level II Pediatric facility). 

Part of the designation is based on the experience level of the trauma center—how many patients are treated there each year. So, it’s also common for hospitals to meet all the criteria for a higher trauma level for several months before they receive official verification.

Basically, hospitals have to be providing treatments at a certain trauma level before they can receive verification for that level.

How trauma levels are defined

It’s important to point out that hospitals can have many different designations and not all of them follow a similar scale as Trauma Levels. For instance, NICU levels (for neonatal intensive care units) have an opposite scale with Level I for basic care and Level IV for the highest, most comprehensive level of care.

Here’s how each trauma level is defined:

Level I trauma center:

Able to provide comprehensive care for every aspect of injury – from prevention through rehabilitation. It’s the highest level of care available. Level I trauma centers have 24-hour, in-house coverage by general surgeons.

Level II trauma center:

Able to initiate definitive care for all injured patients. Level II trauma centers have 24-hour immediate coverage by general surgeons.

Level III trauma center:

Able to provide prompt assessment, resuscitation, surgery, intensive care, stabilization of injured patients, and emergency operations. Level III trauma centers have 24-hour immediate coverage by emergency medicine physicians.

Level IV trauma center:

Able to provide advanced trauma life support prior to transfer of patients to a higher-level trauma center. It provides evaluation, stabilization, and diagnostic capabilities for injured patients.

Level V trauma center:

Able to provide initial evaluation, stabilization, and diagnostic capabilities while preparing the patient for transfer to higher levels of care.

If you witness an accident or severe injury, don’t wait. Call 9-1-1. For less serious questions, our nurses are on call 24/7/365. You can also find a physician or learn about your local HCA ER.