Saturday, July 4, 2009

What makes a Trauma Center?

Numerous recent conversations with friends of mine have brought me to seek an answer to the question, "What makes a trauma center?" I run into this all the time because Columbia is a Level II Trauma center while Cornell is a Level I Trauma center. What do these different designations mean?

The concept of the "trauma center" began in the 1960's in either Baltimore, MD (Ever heard of the hospital called the Shock Trauma Center? yeah.) or Chicago, IL (Cook County, the hospital that the TV Show ER is about). These are facilities who are equipped to handle any form of trauma care or complication 24 hours a day without delay in care.

What do the levels mean?

Level I: 24-hour in-house trauma surgeons and anesthesiologists as well as rapidly available (at Cornell, that means <10 onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="">es. In addition, Level I's must be conducting active scientific research into trauma care, be involved in trauma education (ie- have a trauma fellowship) and be able to and willing to act as a referral center for neighboring regions. You might be thinking this is extremely expensive. It's even more expensive than you are imagining, I promise you.

Level II: must have 24-hour availability of all the required specialties, but they do NOT have to have training programs in all the specialties. In addition, they are not required to be conducting ongoing research into trauma care.

Level III: does not have 24-hour access to all the required specialties. However, they DO have the facilities required for emergency management, critical care and general surgery for simple trauma patients. These are generally smaller community hospitals without all the specialties that may be required, such as neurosurgery or hand surgery.

Level IV: Their job is to asses, stabilize, and transfer to a higher level center. So, Columbia is a huge hospital with residencies in everything under the sun, so why is it level II? There are a number of resons. First, no super passionate trauma surgeon. Second, the ER is literally in a DIFFERENT BUILDING from the rest of the hospital. Little bit of logistical stupidity. It is just too far from the ER to transfer an unstable, hemmorrhaging trauma patient to the operating room. (lots of famous trauma centers, like Shock Trauma, have a Trauma operating room literally adjacent to the Emergency Room. The patient is moved about 20 feet to get into the OR). Third, lack of trauma research. Fourth, lack of a full cohort of trauma-specialized staff.

That is all going to change. Dr. Maruzio Miglietta is a recent addition to the Columbia Presbyterian surgical staff. He is a trauma surgeon who has trained at every big name in Trauma that exists. The guy's resume is mind-blowing. He is dedicated to increasing the level to Trauma care at Columbia by first building staff and then getting the funds to remedy the physical and logistical issues that prevent Columbia from becoming Level I. His vision for Columbia will require increased staff, development of a Trauma fellowship, resesarch (which he is already conducting) and construction to change the layout of the ER to make it more trauma-friendly. The construction is already planned -- the Columbia ER is embarking on a renovation project that will renew the facilities from top to bottom.

I, for one, am very excited about this prospect. Columbia is in a high-trauma neighborhood of New York City and yet, we don't see many traumas due to our Level II status. A recent fire on the Columbia hospital campus sent three injured trauma patients to Harlem Hospital!! How embarassing. Hopefully, under Dr. Miglietta's direction, all that will change.

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