Quote from lorah
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
Helicopter landing pad
Pediatric resuscitation facilities, personnel, and intensive care units
*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
As far as what it's like to work in one versus the other, you'll have to see for yourself.