Understanding trauma center levels

If you experience a physical trauma, you’ll receive treatment through a hospital’s emergency department — but not all emergency departments are created equal. In addition to providing emergency care, some hospitals also function as trauma centers, and they’re staffed by specially trained health professionals who treat life-threatening injuries. Here’s a guide to understanding trauma center levels and what each level provides.

What Is a Trauma Center?

A trauma center is an area of a hospital that’s equipped to treat people who are severely hurt. Think of the most high-risk injuries: gunshot wounds, serious car crash injuries, and major burns. These are the types of injuries that are seen in a trauma center.

Trauma centers offer more extensive care than emergency departments, and the difference between a trauma center and emergency room can be life and death. So, it’s important to understand what these facilities offer.

Trauma Center Levels

There are five different levels of trauma centers in the United States, but they can vary from state to state, and not every state recognizes all five levels. Pennsylvania only recognizes Levels I through IV, for example.

The American Trauma Society verifies the common criteria for each level.

Level I trauma centers

These centers provide total care, from prevention through rehabilitation. They offer 24-hour, in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopaedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, pediatric, and critical care. They also offer a teaching program for medical residents, as well as ongoing research.

Level II trauma centers

These centers are similar to Level I trauma centers but don’t necessarily offer teaching or research. They offer 24-hour immediate coverage by general surgeons, as well as coverage by the specialties of orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology and critical care. Both Levels I and II can treat children and adults.

Level III trauma centers

These centers are smaller than Level I and II centers but can provide prompt care to injured patients. They generally provide 24-hour coverage by emergency medicine physicians and the prompt availability of general surgeons and anesthesiologists.

Level IV trauma centers

These centers provide evaluation, stabilization, and diagnostic capabilities for injured patients, including trauma care and life support before they are transferred to a larger, higher-level trauma center.

Level V trauma centers

These centers, which are not recognized in Pennsylvania, provide initial evaluation, stabilization, and diagnostic capabilities. They also prepare patients for transfer to higher levels of care.

The Difference Between Trauma Centers and Emergency Rooms

Trauma centers are typically located within hospitals, often in the emergency department. Emergency rooms provide care to people with injuries ranging from a sprained ankle to a heart attack — and they are staffed with doctors, nurses, and medical experts who handle a variety of conditions.

Trauma centers, on the other hand, are for patients with the most extreme injuries. At trauma centers, you’ll find highly trained clinicians who specialize in treating traumatic injuries, including:

  • Trauma surgeons
  • Neurosurgeons
  • Orthopaedic surgeons
  • Cardiac surgeons
  • Radiologists
  • Registered nurses

They staff the center 24/7 and have access to such resources as an operating room, resuscitation area, laboratory, and diagnostic testing equipment. They are always prepared to treat patients.

When should you go to a trauma center?

In the most serious circumstances, paramedics must evaluate a patient’s condition and decide where they go for care.

Trauma centers treat:

  • Gunshot and stab wounds.
  • Major burns.
  • Traumatic car crash injuries.
  • Blunt force trauma.
  • Brain injuries.

Emergency rooms treat:

  • Broken bones.
  • Fainting or loss of consciousness.
  • Heart attacks.
  • Less severe burns.
  • Strokes.
  • Severe vomiting, stomach pains, and/or diarrhea.

How Are Trauma Centers Accredited?

All trauma centers must be accredited (officially recognized) by an independent organization. This accreditation varies by state. The Pennsylvania Trauma Systems Foundation has overseen the accreditation of hospitals in the state since 1986.

Trauma Care at UPMC

UPMC Mercy and UPMC Presbyterian are both Level I trauma centers, while UPMC Hamot, UPMC Altoona, and UPMC Williamsport are Level II. UPMC Children’s Hospital of Pittsburgh serves as a Level I pediatric trauma center. Trauma centers at UPMC are equipped to treat the most seriously injured patients, with operating rooms and specially trained doctors and nurses ready at all times.

UPMC has written the book on trauma care — literally. Andrew Peitzman, MD, of UPMC published “The Trauma Manual” in 1998. The book, currently available in its 4th edition, is the first comprehensive guide to trauma center care. The manual includes sections on the specifics of patient injury and resuscitation, as well as common problems that trauma staff may encounter with a high-risk patient.

Learn more about these services by visiting the UPMC Trauma Care System website.

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