A trauma center is the heart of an inclusive trauma system. It is the leading organization in implementing all activities of trauma patient care, prevention, and control.
Trauma Center Level
The Committee on Trauma of the American College of Surgeon (1998), classified a trauma center into 4 levels as follows:
Level 1
A regional trauma center.
Having the capacity to provide advanced tertiary care.
Leading every step in accident work, from prevention to rehabilitation. Being the center for training, research, and system development planning.
Requiring sufficient support, both in terms of personnel and budget.
Level 2
A hospital capable of providing definitive care almost similar to trauma center level 1. The hospital must have sufficient professional officers who are able to give immediate service around the clock. These should include general surgeons, anesthesiologists, neurosurgeons, orthopedists, emergency physicians, etc. But not able to provide as intricate treatment as level 1 (For example, a patient who needs advanced-surgical critical care, a cardiac patient or a patient with great vessel injury.)
A hospital situated in an area with dense population, with a great number of trauma patients, but there is no Trauma Center Level 1 in the vicinity.
Taking a role as a leading organization in regional training and development planning.
Level 3
A hospital in an area with no Trauma Centers of Level 1 or 2
Capable of providing primary care, resuscitation, emergency operations,
stabilization, and transfer for definitive care, under the standards set up by a professional institution.
Level 4
A hospital in a community or a health station in a remote area. Servicing
doctors may be only general practitioners, not surgeons, but can provide
advanced trauma life support before transfer.
Operations based on treatment protocols for resuscitation, transfer protocols, and data reporting.
Have an efficient coordinating system with Trauma Centers Level 1 and 2.
Important Characteristics of Trauma Centers Level 1 and Level 2
The hospitals assigned, as Trauma Centers Level 1 and Level 2 must follow the national master plan made on the basis of population density, communication routes, and annual number of injuries, readiness in terms of personnel, equipment, and past outputs.
The hospital must be the lead hospital in building up a nursing network from the initial step to definitive care, covering all communities in its responsible area.
The hospital must have surgical commitment in order to be able to proceed all programs according to the plan. The indicators for surgical commitment can be:
- Full-time director is a surgeon.
- Active surgical role is taken in all patient care activities.
- There is surgical participation in quality development programs.
- The surgeon supports and promotes development of trauma patient care.
- There is a surgical leadership in supporting trauma programs in lower level hospitals and hospitals in the community.
Surgical commitment is a very important factor to drive a trauma program to success.
The hospital must have sufficient professional officers who are able to give immediate services around the clock . These should include general surgeons, anesthesiologists, neurosurgeons, orthopedists , emergency physicians, etc.
The hospital must set up a performance improvement program in order to retain its academic and servicing excellence. Every surgeon must be audited. The approved surgeon must participate in decision-making and treat all critical patients.
Trauma Centers Level 1 and Level 2 must receive adequate budget to support their staff development and to procure equipment necessary for maintaining servicing standards.
The hospital must have an accurate triage system to screen and transfer the patients to the appropriate hospital.
Undertriage means a patient is severely injured, but the hospital fails to state that it is a severe case and so refers that patient to Trauma Center Level 3 or Level 4. This may cause a disaster because the patient does not receive definitive care within time.
Overtriage means a patient is not severely injured or ill, but is reported as a severe case and sent to Trauma Center Level 1 or Level 2. This situation does not have any impact on the patient, but adds to the burden of the hospital receiving the case.
However, overtriage is more acceptable in order to weigh down the number of undertriage patients.
In general, overtriage is allowed at 50% so that undertriage patients are roughly 5%. This method must be applied for screening patients in Trauma Centers Level 3, Level 4, and pre-hospital care.
For more information, please contact Trauma Center Tel. +66 (0) 7742 9500 Email :info@samuihospital.com
