Levels of ER's?

Like where I work in st.louis were a level 1- Level one is generally a big city hospital and can treat any critical patients. Level 2- can treat the majority of critical patients except they may not have some specialized physicians or ICU's like us in a level 1 there usually located in the suburbs and moderate sized cities, and level 3- is generally a small community hospital or rural hospital it will be able to stabilize and transport critically ill to a level 1 or 2 facility, the major difference is the level 3 and 4 centers dont have the specialist on call that we do in a level 1 or 2 facility.

Where I live it is determined by the actual capabilities on the MD's you have. Our level one flies patients out and receives in. We have neurosurgeons, cardiothoracic surgeons, intensivists, hospitalists. Pretty well equipped to handle anyone.

I am also at a level three. I wish someone would tell the patients that. Especially when we have a 3 car pile up on the interstate (one young lady was thrown 100 ft) and the oh-so-bright EMT dude cancels ALS because, hell, all three will fit into his ambulance. Then he brings them to me fully dressed, and nary a tube installed pre hospital- one was boarded and collared. I work with only a secretary at night, plus a security/maintenance guy.

Two of the three had to be transferred out emergently to our local "Mecca" hospital. Of course, the miracle of the incredible, faster than light, psychic RN had already occurred. Sure don't want to repeat that performance anytime soon.