ER Standards of Care in Level 4 hospitals

[stevierae]

Does anybody here work in an ED in a Level IV trauma center? Can you tell me if the same guidelines that are in place for trauma patients apply to patients that are brought in, either unaccompanied, or by family or via ambulance, with complaints of acute abdominal pain that may be surgical? Should there be a general surgeon on call, as well as anesthesia and an OR and PACU crew on call; capability of doing STAT lab work and typing and crossing blood for possible transfusion, and capability to perform ultrasounds and CTs that can be read immediately by a radiologist?

I would appreciate it if anybody can direct me to any resources about standards for this type of trauma center ED, and let me know if they are national, or state specific.

I am confused, because I looked up a certain Level 4 Oregon hospital--in the descrition, it made it sound like specailly trained ER nurses were at all times available--yet, in an article written by their EMS director, he stated that the ER is not staffed full time, and, when a patient presents to the ER, a floor nurse may well be the one to respond.

Thank you so much!

[suzanne4, RN]

Level IV in trauma rating has almost no ancillary staff in house at night, perhaps not even a physician in the ER. Many times they are staffed by a PA, with an MD available for back-up or consultation. CT and ultrasound would definitely be on-call. They should have a general surgeon and anesthesia on-call, but they could be a distance out..................

There may be only one lab person in-house during the night shift who is responsible for everything, cross-matching blood, running the lab tests, etc.

When the have a Level IV rating, they usually do not want any true emergencies coming in.

But these ratings are also state specific.....................but if really sick, don't consider the ER there unless it is the only place available for miles.

Most states only have Level I, II, and III.

[stevierae]

Level IV in trauma rating has almost no ancillary staff in house at night, perhaps not even a physician in the ER. Many times they are staffed by a PA, with an MD available for back-up or consultation. CT and ultrasound would definitely be on-call. They should have a general surgeon and anesthesia on-call, but they could be a distance out..................

There may be only one lab person in-house during the night shift who is responsible for everything, cross-matching blood, running the lab tests, etc.

When the have a Level IV rating, they usually do not want any true emergencies coming in.

But these ratings are also state specific.....................but if really sick, don't consider the ER there unless it is the only place available for miles.

Most states only have Level I, II, and III.

Thank you, Suzanne! :)

[traumaRUs, MSN, APRN]

Suzanne is correct - in Illinois, Indiana, and Nevada (where I've been licensed) -there are only level I, II, III and III's rarely get any of the good stuff - lol.