Difference Between a Level I and Level II Trauma Center

I got into a discussion about how Level 1 and Level 2 trauma centers differed at a clinical last night with another medic. I’d been to both of the Level 1 trauma centers in Houston that night.

She said a Level 1 had to have a medical school or residency program. I didn’t think it was a requirement, but was often done because residents could count toward always present specialties requirements.

Turns out she was right. But we both also thought there was very little difference other than that between 1 and 2. So today I did a little research and found the PDF documents on the American College of Surgeons (ACS) website talking about criteria for the levels of trauma centers. ACS certifies most trauma centers in the US. Doing some time consuming comparisons of the two documents, I compiled this list of things a Level 1 has to have that a level 2 does not.

Level I must:

  • Admit at least 1200 trauma patients yearly
    or 240 admissions with an Injury Severity Score (ISS) of more than 15
    or an average of 35 patients with an ISS of more than 15 for the trauma panel surgeons (general surgeons who take trauma all)
  • A General surgeon or appropriate substitute (postgraudate-year 4 or 5 resident) must be in house 24 hours a day for major resuscitations (must be present and participate in major resuscitations, therapeutic decisions, and operations).
  • Emergency department physicians must be present in the emergency department at all times.
  • A neurosugeon must be designated as the liaison
  • Plastic surgery, hand surgery, and spinal injury care capabilities present.
  • Anesthesia services are available in-house 24 hours a day.
  • Both must have a adequately staffed OR that is immediately available, but in Level I this criterion is met by having a complete operating team in the hospital at all times, with individuals who are dedicated only to the operating room.
  • In-house CT technologist.
  • A surgically directed ICU physician team.
  • In-house physician coverage for ICU at all times.
  • A full spectrum of surgical specialists available. (orthopaedic surgery, neurosurgery, cardiac surgery, thoracic surgery, hand surgery, microvascular surgery, plastic surgery, obstetric and gynecologic surgery, ophthalmology, otolaryngology, and urology).
  • A continuous rotation in trauma surgery for senior residents (PGY 4 or higher) 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 support an acute care surgery fellowship consistent with the educational requirements of the American Association for the Surgery of Trauma

I should point out there are two specialities for trauma centers adult and pediatric. Which is why I went to both, because one was a pediatric patient so we went to Memorial Herman Downtown for the pediatric patient. We went to Ben Taub for the adult.

Don’t know if this really belongs on Newbie, but it was medical related and I didn’t want to put it somewhere else.

  • http://transportjockey.wordpress.com/ Transport Jockey

    Thanks for posting this. I was trying to look it up to see what the difference between our nearest trauma center (lvl2) in BFE was with the nearest lvl1s in El Paso

  • Suzi

    I can definitely see the difference that these would make to a patient coming in for trauma.

  • Shantalr

    Great info. Thanks!

  • Mirage50230

    The main difference between level 1 and 2 is that level 1 also has to do trauma related research.  I worked at a level 2 and that was the only thing keeping us from being a level 1.