What's a "LEVEL 1 TRAUMA CENTER" you ask?

[ColbertWatcher]

I'm so glad you asked me that.

Let's find out what http://en.wikipedia.org/wiki/Trauma_center#Level_I">Wikip*dia has to say about all this, shall we?

A level I trauma center provides the highest level of surgical care to trauma patients. 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 surgeons and anesthesiologists on duty 24 hours a day at the hospital, 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, neurosurgery, plastic surgery (plastic surgeons often take calls for hand and facial injuries fixing both the bone and soft tissue of these specialized regions), anesthesiology, emergency medicine, radiology, internal medicine, 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. 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.

Gee, that's nice, but how can I know if my local hospital meets these criteria?

Here is a list of hospitals that the American College of Surgeons (ACS)

"... verifies the presence of the resources listed in Resources for Optimal Care of the Injured Patient ..."

(The ACS does not designate trauma centers ... {which} ... is a voluntary process and only those trauma centers that have successfully completed a verification visit are listed below.)

Do you know if your local hospital is on the list? Do you know where the closest one is? Make sure you check the list!

Okay, that's interesting, but why are you posting this?

Long ago, I took a first aid course and the instructor said that in the event of head injuries that people calling for the EMTs should request that the injured person be taken to a Level 1 trauma center.

I live in LA, so maybe that's not true any more since, we're http://kcet.org/socal/2009/02/critical-care.html">hemorrhaging hospitals.

(EDITED TO ADD)
* Link to CDC for traumatic brain injury: http://www.cdc.gov/ncipc/tbi/tbi.htm
* Wikip*dia's section for signs & symptoms of TBI: http://en.wikipedia.org/wiki/Traumatic_brain_injury#Signs_and_symptoms

[Lasher]

1. You would think the EMTs and 911 folks could be expected to direct them to a Level 1 center.

But then again, there was that case in Texas where they cut back on the 911 center and it was taking them over 5 minutes to answer a call.

[SoCalDem]

2. I have heard tales too, from EMTs who just want to "drop their patient off"

ASAP..at the nearest hospital, and hightail it away before they are asked to take them elsewhere:(

[SmileyRose]

28. The EMT's who came for my husband REFUSED to take him out of the county.

We have one hospital in this county and it's so bad you wouldn't take an injured stray there. I requested he be taken to the ER our insurance company deals with, in Atlanta, only 12 miles away. They refused, claiming he was not stable enough to make it that far. His care suffered tremendously because of the delay in getting him a decent ER. We sat in the shit hospital for 13 hours. He did have an ER bed and was hooked up to the monitor but only the most minimal care was given because they knew our insurance would not pay for more. They kept him alive, but by no means made any effort to actually stabilize him nor assess what was wrong. This is probably a good thing given the level of seeming total lack of professionalism and caring by the medical staff (not just to us but in general). In fact, when his heart completely stopped in the ER, the monitor was screaming with 2 different buzzers, the nurses in the nursing station didn't even bother looking up, they were too busy talking about a new nail salon (I kid you not) and got all pissed off when I started yelling for help. We finally convinced one overworked ER doctor to call for transport to the hospital in Atlanta.

It would have taken the EMT's at total of 1 hour more round trip to get my husband where he really needed to be. Instead it took 14 hours before he got fully adequate medical care. If we ever have that kind of crisis again (and I hope never) I may just put him in our own car, go to the Er in Atlanta to where the ambulances go and start screaming for help to get him out of the car. I don't trust my local EMT's anymore. I'm not blaming the individuals who came here. I have no idea what restrictions they may be working under by their government bosses.

Now, on the flip side, the EMT's in Michigan saved my brother's life by going way above and beyond the call of duty getting him to adequate medical care. So it's not like this everywhere.

[ColbertWatcher]

34. A few years ago, I had heard that several hospitals were closing in the LA area ...

... if I recall, there are now less than half of what there used to be maybe 15 years ago.

Also, check out that link in the OP (if you haven't already) it's a short clip from a local PBS show about the state of hospitals in LA.

We wouldn't have these problems if we simply got profit out of the healthcare equation.

[SmileyRose]

35. The absolute best medical care he's gotten so far

We have a non-profit HMO and they deal with an Atlanta non-profit hospital. Thus far, going on 10 years, his level of care has been exceptional. Previously we had a for profit HMO that dealt with a big national hospital corp's Atlanta hospitals. The care was acceptable, with only a few battles, and we were generally happy. So far Atlanta generally seems to have decent hospitals in areas where there is a decent middle class population.

As the economy suffers, and the marginally middle class like me become lower class, the hospitals in those areas are really suffering. My local hospital was never that great but now they are limping along because they have to offer so much indigent care that no one ever pays for.

The medical care in this country is a mess. I want single payer, universal access to medical care (not insurance, but ACCESS) and I want us to remember that private non-profit care may be preferable to government clinics in some instances.

[Fire_Medic_Dave]

46. Ambulance Services are bad about pressuring employees to get back in service...

so they can take more calls. All of the ambulance personnel I know love transporting people out of the county. They actually have time to complete their paperwork, get something to eat on the way back and not have a supervisor showing up at the ER yelling at them to get back in service because the ambulance service didn't schedule enough ambulances for that night.

David

[ColbertWatcher]

3. I was told that you can never assume anything in an emergency.

Always ask specifically for a level 1 trauma center (for head injuries). And, it's best to know ahead of time where the closest one is.

[Lasher]

4. Good advice.

And if you have insurance it might be a good idea to check ahead of time to see if they'll cover you at that paticular facility. I'm pretty sure most policies have to cover you in an emergency even at a facility they won't work with. Then after you're stabalized you have to transfer or start paying yourself.

[Fire_Medic_Dave]

29. We are required by the State to take trauma patients to a Level 1 trauma center.

There are a couple very specific situations that can allow you to divert to another hospital but they are very rare.

David

[ColbertWatcher]

33. But, is that common? n/t

[Fire_Medic_Dave]

36. Most places.

I'm sure there are still a few holdout states, probably very few though.

David

[ColbertWatcher]

41. Good to know, thank you for replying.

I hope the economy doesn't alter the care people will receive.

[Fire_Medic_Dave]

45. Not on a large scale.

It may affect certain aspects. Hospitals not buying new helicopters, cutting back on "non-essential" staff, replacing staff nurses with PRN nurses that they don't have to pay benefits. Of course it sucks if you are those patients whose care is affected.

David

[skooooo]

5. This doesn't make any sense...

It doesn't have the state of Washington even listed. Surely Seattle has a hospital like this? Makes me wonder if the list is complete.

[ProfessorGAC]

6. I'm Questioning It Too

There is a hospital (a big one) about 20 miles from where i live and when they achieved Class 1 status, there was an article in every paper in the Chicago market. Perhaps there's more than one certification board.
GAC

[skooooo]

7. plus it doesn't even list Chicago...

Yeah, this list is incomplete, to say the least.

[Critters2]

18. St. Francis in Peoria is a level 1, too. They state this in all their advertising,

and I just checked their website, which says so as well.

[donheld]

20. See this for Illinois

http://www.idph.state.il.us/about/traumaregions.htm

[ColbertWatcher]

24. I suspect, "Class 1" is not the same as "Level 1" ...

... otherwise they would be on the list.

And yes, there may be more than one group that certifies.

Unfortunately, the ACS has not certified any hospital in that area as "Level 1."

[jmowreader]

11. I can kinda understand WHY Washington State isn't listed...

http://depts.washington.edu/surgery/synopsis/vol11issue1/p3.html

Harborview Medical Center of The University of Washington, which is in Seattle, has the only Level 1 trauma center in the state. Which is REAL comforting to know if you really fuck yourself up in the Tri-Cities or Spokane. There are two Level II centers in Spokane--one's at Deaconess, the other at Sacred Heart.

Which makes me wonder: where the hell was the state on this? In North Carolina, if a hospital wants to build a new department they have to be approved and receive a Certificate of Need for that department. I assume that's the case everywhere. The thing is, Deaconess and Sacred Heart are two miles apart. I'm having a hard time believing you need two trauma centers this detailed that close together--

[quiller4]

14. The difference between level I and level II isn't extreme

It usually is the difference between have the specialty surgeon present or on-call and able to respond w/i 30 minutes. Since the call to the specialist goes out while you are still in the aid car en route to the hospital, as a patient you aren't likely to notice the difference. In cases where a variety of specialty surgeons are required, then you are air-lifted to a Level I center.

The population of Tacoma is slightly smaller than Spokane. Tacoma General and St. Joseph share a Level II certification and split the responsibility of specialty surgeon staffing. Deaconess and Sacret Heart have a similar arrangement. On the west, Madigan is also a Level II as is St. Peters in Olympia. The polulation is more than high enough to support that. There remains concern that southwestern Washington is under-served.

[proud patriot]

39. Thanks good to know , my hospital is a level II and about 15 minutes away

:hi:

[MadMaddie]

53. I am actually stunned the Washington state doesn't have more

I live on the Eastside by Evergreen and that would be my hospital of choice.

WTF?

[quiller4]

13. The list is far from complete.

Harborview is a Level I center. St. Joesph/Tacoma General and Madigan are both Level II but all 3 provide 24 hour neurosurgery coverage. It has been almost 7 years since Washington State hospitals were classed and several were upgraded.

[Pavulon]

15. Yep missing WakeMed and Duke

both level1 centers.

[ColbertWatcher]

27. Maybe they haven't updated their webpage?

Do you have a link showing Harborview as "Level 1"?

[quiller4]

49. Yes-the following is from same Wiki article used for definition

"The operation of a trauma center is extremely expensive. Some areas are under-served by trauma centers because of this expense (for example, Harborview Medical Center in Seattle is the only Level I trauma center to serve the entirety of Washington, Idaho, Montana, and Alaska)."

Here is a link to Harborview's web page uwmedicine.washington.edu/Facilities/Harborview/CentersOfEmphasis/Trauma

[Gormy Cuss]

17. According to the disclaimer, the list is of ** verified** trauma centers.

From the link:

Verified Trauma Centers

The designation of trauma facilities is a geopolitical process by which empowered entities, government or otherwise, are authorized to designate. 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. This is a voluntary process and only those trauma centers that have successfully completed a verification visit are listed below.

So there are probably a number of designated trauma centers absent from this list.

[ColbertWatcher]

23. The list is from the ACS.

The ACS does not technically certify hospitals, but merely confirm that certain criteria are met.

I hope Seattle has a hospital like this. But, unfortunately, if it is not on the list the ACS, no hospital has been verified Level 1.

Sorry.

[quiller4]

37. ACS is not the only verification

According to the American Trauma Society there are 196 certified level one trauma facilities of which 93 have been verified by the ACS. (source National Inventory of Cerrtified Trauma Centers JAMA 26 March 2003)

Harborview Hospital in Seattle is rated as the number 3 Trauma Center in the country and the number one pediatric level 1 trauma center in the US. It is one of few hospitals certified to serve multiple states as it serves Washington, Alaska, Idaho and Montana.

[madfloridian]

55. Florida is not listed either.

[ChazII]

8. Less than one mile from my drive way. n/t

[NNN0LHI]

9. I have two of them both 20 miles away from my house

Disadvantages of small town life.

Don

[Critters2]

19. 20 miles from a level 1 is really good. Ambulances can make

good speed getting there, or you can get there even more quickly by helicopter from smaller hospitals. Hospitals and other services are so easily available in Illinois that I don't even think of the state as having rural areas any more. I find Illinoisans are spoiled by having a hospital in every little town. Ottawa has one, LaSalle-Peru has one, Princeton has one, Streator has one, and on and on...and they all compete with one another, buy the latest doodad, and tack the expense onto patients' bills. Everyone doesn't need a hospital within walking distance!

Iowa has only 4 level 1 trauma centers in the state, afaik. I was 90 miles from one, and about the same distance from Mayo's in Rochester MN. I never thought about it, though, because I'd known so many people flown to Des Moines or Rochester from our small local hospital, who got the care they needed. And we weren't paying for a damned open MRI in every little hamlet in the state.

[MiniMe]

10. There is nothing listed in Maryland, and only Children's in DC

And Children's is listed for pediatrics only. George Washington is the designate hospital for the President, and I would think they would have to staff a complete trauma unit. Washington Hospital Center, which is where Children's is, is a shock Trauma unit also. And where is John's Hopkins in Baltimore?

[RB TexLa]

12. And those places are expensive, I think I'd just take my chances at a regular ER

[Fire_Medic_Dave]

30. With serious trauma you would likely die as Natasha Richardson did.

[RB TexLa]

38. I came to understand that I will die a long time ago.

[Fire_Medic_Dave]

43. Then why go to any ER?

[RB TexLa]

44. To not die as quickly. Isn't that why anyone purchases medical services?

[Fire_Medic_Dave]

47. Then why wouldn't you go to the recommended hospital for your condition?

If I'm having a stroke I want to go to a 24 hour stroke center. If I'm having a heart attack I want to go to a hospital with a cath lab. If I have serious trauma I want to go to a Level 1 Trauma Center. Those are the places where I'm going to get the best care.

David

[RB TexLa]

50. I doubt the cost is always worth the amount of risk a level 1 lowers from a level 2.

The best care is not always a better value than the next to best care. I just don't always put that much importance on myself, and really do not like people being put out on me. I'm not going to be the one screaming that I deserve to be taken immediately to the BEST place for me. There isn't anything wrong with "good enough."

[Fire_Medic_Dave]

51. No increased cost here.

Of course being transferred to the appropriate hospital after the doctors at the other hospital tell you they can't take care of you would dramatically increase your cost. I don't know what people are talking about demanding to go to certain hospitals their are destination guidelines for ambulance personnel in regards to where patients are supposed to go. You have to personally speak with a physician at the hospital you want to go to and have them agree to accept you as a patient in order for them to take you somewhere else. Good enough in this case isn't, if you need a neurosurgeon then you need to go to a hospital with a neurosurgeon, thus the designation system.

David

[RB TexLa]

52. I do not see myself paying for an ambulance, we have cars. Yes, I know if I'm unconscious

I'm their ATM to do with as they wish.

[Fire_Medic_Dave]

54. It seems we are talking about different things.

I am talking about serious trauma requiring a Level 1 Trauma Center.

David

[rucky]

16. It's not Canada's healthcare system we need to criticize...

it's the fact that Canadians are so damn polite!

When Richardson first refused treatment, the EMT's should've said: "Are you insane?! Get your butt in the back of the bus!"

I'm half kidding, but I'm wondering if she was well advised of the risks (or was completely truthful to the first-responders) when she refused treatment.

[Critters2]

21. As I said in another thread, my cousin's husband died of a hematoma

in December. He fell, said he felt fine, was vomiting within the hour, and my cousin drove him to Carle Foundation Hosp in Urbana, IL. A 20 minute drive to a level 1 trauma center. He still died.

There are no guarantees, and there's not always someone to blame.

[ColbertWatcher]

26. "my cousin drove him to ..." No ambulance!?

I agree there are no guarantees, but unless your cousin is a trained emergency medical professional, I doubt your cousin was able to look for the symptoms and provide optimal care during that 20-minute ride.

I'm sorry for your family's loss.

[Critters2]

31. Again, they had no idea how serious the injury was.

Neither did Natasha Richardson.

Accidents happen. Why the need to blame someone?

[ColbertWatcher]

32. I'm sorry.

I'm not blaming, just wondering.

[ColbertWatcher]

25. You have a point.

But, after reviewing some of the symptoms of traumatic brain injury, I wonder if anyone even recognized them? Or, did they show up later after the EMTs left and the non-medically-trained people didn't recognize any of them?

[Posteritatis]

40. There's also the fact that we've got a seperate system for each province

Health is a provincial responsibility, not a federal one, which tends to sail over the head of a lot of Americans and Canadians who talk about "Canada's health care system."

And treating a conscious adult against their will in all but a very few cases - one of which this was not - opens some pretty nasty doors.

[rainbow4321]

22. Trauma center of the Southwest: Parkland Hospital

OK so I'm a little bias as I sit here at Starbucks in my Parkland logo hat to hide my just rolled out of bed hair.
I work at Parkland. The one thing you don't want to have happen after you are in a trauma is to have your "golden hour" wasted at some community hospital. Which translates into Careflight landing at your accident site and you being whisked to the trauma center---and in North Texas that damn well better be Parkland. If it involves severe burns make that anywhere in the Southwest. I don't work in trauma or burns, but I know we have the best of the best.

[readmoreoften]

42. There is no Level 1 trauma center within 300 miles of my city--and I'm in a state capital.

Austin, Texas. Level II is the best we got. :shrug:

[Fire_Medic_Dave]

48. How far is San Antonio?