Explain the different trauma level designations to me please.

bamagt · Jan 13, 2009

Level 1 trauma is where the big boys go. Level 1 means that they have all types of surgeons in hospital 24/7. In this type of hospital you will get lots and lots of trauma.

Level 3 is your regular ER pretty much. You will see lots of general medical stuff including: chest pain, codes, strokes... You will prob see a lot more of this at a level 1 center.

That's the basic gist of it someone else should be able to fill you in further.

core0 · Jan 13, 2009

I have seen mention of Level 1 trauma ER, Level 3 trauma ER.
Could someone explain the differences to me please. I plan on doing some travel contracts in the US (I am in Canada) and in order to request what type of assignment I will want I need to know these different designations.
I currently work in a fairly small ER serving a population of just under 100,000, not sure how many ER visits/year we get. My worry is that I will land some place over my head, which won't benefit me, the patients or the hospital.
Some of you sound like you work in some really interesting places. I have to say that my reason for travelling is to get a bit of experience some place new while enjoying a new place for a few weeks.

Wiki in this case provides a pretty good overview:

http://en.wikipedia.org/wiki/Trauma_center

Level 1 has in house anesthesia and surgery. Rapid availability of all other specialties. Must have a research component.

Level 2 has in house anesthesia and surgery (or within rapid call times depending on the state). Other specialties available. Does not have to have a research component.

Level 3 surgery and anesthesia available within a designated time limit. May not have all specialties available.

Level 4 usually rural centers that have some capability for resuscitation before transferring to a higher level of care. May have some surgical capability but lacks most specialty services.

David Carpenter, PA-C

lpnflorida · Jan 13, 2009

Level 1 trauma centers also have surgical residencies, teaching hospital. in addition to what has already been stated

core0 · Jan 13, 2009

Level 1 trauma centers also have surgical residencies, teaching hospital. in addition to what has already been stated

Actually no. That's a common misperception. Most are housed in academic centers, but there are several that are not (and have no surgical residency). There is a requirement for research but that can be met many different ways.

David Carpenter, PA-C

lpnflorida · Jan 13, 2009

17 17-5 The Level I trauma center provides a continuous rotation in trauma surgery for senior residents that is part of an Accreditation Council for Graduate Medical Education- accredited program in any of the following disciplines: general surgery, orthopaedic surgery, or neurosurgery; or supports an acute care surgery fellowship consistent with the educational requirements of the American Association for the Surgery of Trauma. SEE FAQ

as taken from the American College of Surgeons.

http://www.facs.org/trauma/vrc1.html

core0 · Jan 13, 2009

17 17-5 The Level I trauma center provides a continuous rotation in trauma surgery for senior residents that is part of an Accreditation Council for Graduate Medical Education- accredited program in any of the following disciplines: general surgery, orthopaedic surgery, or neurosurgery; or supports an acute care surgery fellowship consistent with the educational requirements of the American Association for the Surgery of Trauma. SEE FAQ
as taken from the American College of Surgeons.
http://www.facs.org/trauma/vrc1.html

Interesting. I can think of one program off hand that does not meet this requirement and is on the level 1 list. They did get their designation before this rule change so may be grandfathered in.

David Carpenter, PA-C

runnergal74 · Jan 13, 2009

To add to the fellow posts, as someone who works in the ER, that any time you can be around a Level 1 or Level 2 trauma center it will be worth it. It is also important to see first hand what defines a Level 1 or Level 2 according to the facility in which you are at (i.e. mechanism of injury, vital signs, etc.). I have found different classifications of Levels depending upon facility. Either way, your experience will grow and those who are veterans in the field in handling traumas will only benefit you more.

Good luck!

kmoonshine, RN · Jan 13, 2009

You can look through the definitions here:

http://www.facs.org/trauma/verifivisitoutcomes.html

I think that the biggie for level 1 facilities is to have neurosurgery available 24/7 (but I'm not positive about this one; its a hard one to meet due to neurosurgeon shortages). To be a level 1 center, your facility must be active in research too.

You can always take a TNCC class (Trauma Nursing Core Course, which is offered through many hospitals) to gain more info so you feel more comfortable with trauma care. In reality, any facility can get anything through their doors (I once had family drive a pt to the ED with a fatal GSW to the neck; I was working a level 3 facility and the pt needed level 1 trauma care and should have had his chest cracked along with cardiothoracic surgeons ready to go at bedside). So, keep that in mind!

Also, no reputable level 1 facility would throw you into a trauma without proper training. Many level 1 centers have a dedicated trauma team; you might be asked to jump in for the experience, but you wouldn't be running the show.

czyja, MSN, RN · Jan 13, 2009

Also, no reputable level 1 facility would throw you into a trauma without proper training. Many level 1 centers have a dedicated trauma team; you might be asked to jump in for the experience, but you wouldn't be running the show.

Indeed. I doubt a Level 1 facility would keep its accreditation for very long if this were happening.

FlyingScot, RN · Jan 13, 2009

Personally I think any hospital advertising themselves as a Level 3 is just using it as a marketing tool because basically all it's saying is "Hey! We have an ER". That being said just because a hospital is not a designated Trauma Center does not mean you will not frequently deal with critical trauma patients. Case in point, I worked in a smallish community hospital on the outskirts of a large city with 3 Level 1 centers and 2 Level 2 centers but because of our location as the closest hospital to some very large rural counties we usually got the nasty farm and construction accidents first. We stabilized and packaged them for transport or if too unstable took them to surgery at our facility. True, we didn't see as many but we saw enough to keep things exciting.

Pepperlady · Jan 14, 2009

Thanks to everyone for your replies.

My only concern with going to a level 1 is that as a traveller you are usually there to fill a gap or a shortage and there is little time for orientation let alone for taking hold of learning opportunities. Perhaps I am wrong, my travel experience til now has been in ICU/Critical Care Units.