Difference between Level I and Level III ER?

suzanne4, RN · May 30, 2004

A Level I is usally the receiving hospital in your area. There are certain requrements as to types of physicians that have to be in house 24 hours per day, also type of ancillary services that must be provided on a 24 hour basis.

A Level III meets the minimal amount of the requirements to be designated as a trauma facility. It also depends on where the hospital is situated. So I wouldn't go on designation alone. Some rural hospitals see more trauma than the bigger facility 50 miles away because they are the only ones that are there.

lorah · May 30, 2004

I'm sorry I should have been more specific. I am curious about the "environment" for example: nursing, doctors, admin, assignments? Night shift/day shift what is your ED like?

ang75 · May 30, 2004

I have worked all 3. Let me tell you, the more advanced in Trauma generally the busier the ER and less crap. When I worked at Denver General and St. A's in Denver, there wasn't half of the he said, she said hooey. People were just too busy to really want to know who was sleeping with whom. On the other side of the coin, when I worked in a rural hosp. as I do now...

Gossip, Gossip, Gossip.

But we did seem to see more multi-system traumas in the rural ones. In the bigguns, they came in just as much, but half of the pt's had been stabilized by smaller hosps.

My personal opinion? I miss the Level III's. It was just so darn much fun.

veetach · Jun 1, 2004

A Level I is usally the receiving hospital in your area. There are certain requrements as to types of physicians that have to be in house 24 hours per day, also type of ancillary services that must be provided on a 24 hour basis.
A Level III meets the minimal amount of the requirements to be designated as a trauma facility. It also depends on where the hospital is situated. So I wouldn't go on designation alone. Some rural hospitals see more trauma than the bigger facility 50 miles away because they are the only ones that are there.

This is very true. I used to work at a Level III, and the ER only had 7 beds!!! It was located 100+ miles from the next trauma center though, so we saw lots of trauma, believe it or not.

I am currently working at a 25 bed ER and we see 50,000+ pts per year and are thinking about a Level III trauma certification, and we are only 50 mi from our closest Level I (we have 2 within 50 mi) these two ER's do NOT compare in any way. we see lots of trauma here, probably 5-10 times as much as the other hospital, so I think it would depend on where the ER was located and how far you are from your local Level I.

I agree with Ang, though. The busier the ER, the less time people have to gossip.

lorah · Jun 2, 2004

The Level III I am thinking about is not rural at all. It is a hospital located in a metropolitan area, it's just level III. Nothing fancy about it. There is a Level II 10 minutes away and a Level I 20 minutes away.

Where do I fit in? I am not a gossip type so the small ER might not be for me, but I don't see ER as my forever job anyway to go work trauma after trauma. I am thinking school nurse. Seriously. WHat to do? WHat to do?! :rolleyes:

CEN35 · Jun 2, 2004

Basically it is determined by the national board of Trauma something or other? They explained it all too us when I did my CEN and TNCC. Basically, the difference between a level I and level II is research. A level II is supposed to be able to handle anything. A level I is required to do a ton of research, so it is usually a teaching hospital with many residents. The attendings are not going to do the research, so the residents are appointed things to do by the attendings.

Level 3 & 4? yes there is actually criteria for a level 4. It is mostly PR stuff, and capability is limited.

out............

psychomachia · Jun 2, 2004

Currently, I am in a Level II ER. What is it like working in a Level I hospital and what is it like in a Level III? I am trying to find my fit.

This is from the site http://nsucomems.tripod.com/what_is_a_trauma_center.htm

It's about Florida Trauma Centers, but since I live in Florida, that's what you get for free...

What is a Trauma Center?

A trauma center, as trauma surgeons are fond of saying, is NOT just an emergency room. State designated trauma centers meet specific criteria as set forth by governing agencies. Florida is quite specific in their designation of trauma centers and follows the American College of Surgeon's recommendations for accreditation. The Florida Department of Health has a voluminous document, available on line, that details the mechanisms behind accreditation. You can visit the DOH website or specifics. The NSUCOM EMS club will try to provide its members with a basic, "overview" of trauma center services. The trauma surgeon is the resuscitation team leader. The trauma surgeon is an individual who has completed a general surgical resisdency. Trauma surgeons have additional fellowship training (two more years) in surgical critical care and trauma surgery. Currently, the University of Miami/Jackson Memorial Ryder Trauma Center offers these post graduate surgical fellowships.

Florida trauma centers are currently designated as level one or two. The state does not currently classify level III trauma centers. Level III trauma centers are basically 24 hour emergency rooms that have designated trauma teams, on call professionals, and are capable of transferring patients to a higher level of care. When injured patients meet trauma alert criteria, state guidelines stipulate that they should be conveyed via emergency medical services to level one or level two facilities. The term "closest appropriate facility" applies to the transport of critically ill patients. Indeed, pediatric patients may require expert care immediately available at level one or pediatric referral centers. Florida also approves hospitals to function as pediatric trauma referral centers. These hospitals are either Level One facilities or meet the qualifications outlined by the American College of Surgeon's Committee on Trauma.

Level One Facility Requirements:

In house qualified trauma surgeon

In house qualified neurosurgeon

In house qualified radiologist

In house qualified emergency physician

In house qualified anesthesiologist

Trauma medical director (trauma surgeon)

Emergency medicine medical director (MD/DO)

Trauma program manager (RN)

24 hour CT availability

24 hour equipped and staffed operating suite

Backup and equipped surgical suite

Trauma intensive care facilities for adult and pediatric patients

Trained trauma team

-At least 1 trauma surgeon (as team leader)

-At least 1 attending EM physician

-At least 2 trained trauma nurses

Dedicated resuscitation suites (to manage two simultaneously multi-system injured patients)

24 hour laboratory facilities

Protocol for in house burn care

Rehabilitation facilities

Helicopter landing pad

Pediatric resuscitation facilities, personnel, and intensive care units

Administrative requirements

Research requirements

EMS requirements

*The term, "qualified" pertains to state guidelines. In some instances, senior emergency medicine residents/fellows or senior surgical resisdents can substitute for their attending counterparts.

Level Two Facility Requirements:

Same as above, except requirements for in house and on call physicians vary. Level Two facilities generally meet all Level One criteria but are not required to have neurosurgeons/trauma surgeons in house. Furthermore, Level Two facilities are not mandated to handle pediatric trauma. Emergency rooms must necessarily be capable of managing critically ill and injured pediatric patients, but Level II facilities are generally not designated as pediaric trauma referral centers (PTRCs). Some hospitals, like North Broward Medical Center, are Level II designated and elect to keep a trauma surgeon in house 24 hours/day. The state requires that on call trauma specialists must sign a letter of commitment and arrive promptly once summoned by house staff.

State Approved Trauma Centers, as of 07/02

FACILITY REGION DESIGNATION

Broward General Medical Center Ft. Lauderdale Level One Adult / PTRC

North Broward Medical Center Pompano Beach Level Two Adult

Memorial Hospital Hollywood Hollywood Level One Adult / PTRC

Ryder Trauma Center at UM/JM Miami Level One Adult / PTRC

Miami Children's Hospital Miami PTRC

Orlando Regional Medical Center Orlando Level One Adult / PTRC

Tampa General Hospital Tampa Level One Adult / PTRC

Bayfront Medical Center St. Petersburg Level Two Adult and PTRC w/All Children's

Shands Jacksonville, UFHSCJ Jacksonville Level One Adult / PTRC

Lakeland Ragional Medical Center Lakeland Level Two Adult

Sacred Heart Hospital Pensacola Level Two Adult

Holmes Regional Medical Center Melbourne Level Two Adult

Hailifax Medical Center Daytona Beach Level Two Adult

West Florida Medical Center NW Florida Level Two Adult

Baptist Hospital Pensacola Level Two Adult

St. Mary's Hospital Palm Beach Level Two Adult / PTRC

Lee Memorial Hospital Central Florida Level Two Adult

Delray Beach Medical Center Delray Beach Level Two Adult

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As far as what it's like to work in one versus the other, you'll have to see for yourself.

mommatrauma, RN · Mar 7, 2005

Ok...Trauma designation is set up by the American College of Surgeon's...it is fairly standard throughout the US as far as criteria goes...That being said...just remember...you have the great red sign outside your door...it says..EMERGENCY...so as emergency rooms go...you are expected to be able to handle ANYTHING...Working in Philadelphia..we probably have the most level 1 trauma centers in a concentrated area per capita then any other place...so chances are, if you are a trauma in or immediately surrounding a city...you'll be coming to a level 1 center...Where the differences come in to play is when you are more out in the boondocks and level 3 is 10 minutes away and level 1 is 40 minutes away...Depending on the stability of pt...and the level of care needed...they will probably be going to closest hospital for stabilization and then be transferred out...The differences between level 1 and level 2 are small, but are more than research...it also has to do with in house surgeons and specialties...and just for the record, in my level 1 although the residents do a great part of research...we have our own in ED research team consisting of An attending and a few research fellows...plus our ED Attendings also participate in ALL of our research, from deciding topics, to inclusion/exclusion criteria and control groups...Are staff are very proactive in that sense...As for level 3 pretty much that is any trauma that any ER can handle as long as the have 24 xry and ct scan w/radiology dept....I have never heard of any level 4 for trauma systems, and as of right now there are no hospitals designated with a level 4 title, in the US at least.