Term Paper on "Reasons a City or Region May Need a Level I Trauma Hospital"

Term Paper 17 pages (4675 words) Sources: 6 Style: APA

[EXCERPT] . . . .

East Asian Culture

The health care system in the United States is often a point of pride within and outside the U.S. Here we have some of the best facilities, doctors and researchers as anywhere in the world. Clearly historically healthcare has been a number one priority of the culture and the government, despite the inability of the nation to establish a universal health care delivery system, instead relying on an intricate set of private and publicly funded institutions that serve the health care needs of the people. Healthcare in the United States offers advancements to this country and the world, especially in the case of specialization in surgical and emergency medical care and also in trauma and emergency medical services.

This being said it is also important to understand why it is so important to have specialized emergency care available, and especially Level I trauma centers in any given community. It is important, because in emergency medicine time matters almost more than anything else with regard to mortality and recovery. This is true with regard to illness or injury and is true regardless of location, be it urban or rural, regardless of socioeconomic status of the individual, and regardless of age of the individual, though the very young and the very old often require special care. Health care subsystems are also important and should be maintained, developed and expanded to meet the needs of as many people as possible. The development of the American College of Surgeons quadratic system of Levels of care ability ranging from Level I to level IV with regard to trauma centers is a significant modern element in the further development of emergency health care in the United States. Yet, there are challenges to the system that require significant interest on the part of the health care systems and those who utilize it and even study it. This work will briefly discuss the history of the Emergency Medical System in the United States, it will address key problems within the system and lastly will look at why it is important to have access to Level I trauma centers in as many communities as possible.

Background

In 1987 the American College of Surgeons created a system of classification and certification for trauma centers that include four classifications and certifications, I-IV, with level I being the highest ranking service, with the greatest level of care offerings, especially with regard to specialized surgical services. The development of such systems is a cumulative one, and frequently needs revision and change, to help it best meet the needs of a changing demographic. The system of Emergency Medicine, in general also has a long history, from the development of war-time triage systems to those that better meet the needs of the civilian crisis situation.

Civilian triage criteria, developed and refined over the past 25 years, rely on physiologic, anatomic, and mechanistic indicators of severe injury in an attempt to optimize overtriage and undertriage. As organized trauma systems continue to mature, the need for more accurate direction of high- versus low-acuity patients to regional centers, stratified by their capabilities, becomes more apparent and is essential in avoiding a completely 'exclusive' trauma system... The care of injured patients requires special resources, regardless of the era or situation. This is particularly so with larger numbers and/or more severe injuries... The development of civilian field triage criteria for trauma has paralleled the development of specialized trauma centers and was linked to the concept of bypassing closer facilities in favor of those with superior capabilities. (Mackersie, Sept. 2006, pg. 1)

The development of the Field Triage decision protocol and its implementation has also clearly impacted the development of a system of emergency medicine that makes immediate decisions based upon patient condition and other factors to determine the best prehospital protocol for service.

In September 1966 the National Academy of Sciences National Research Council outlined the grievous state of affairs in the now classic report entitled, "Accidental Death and Disability: The Neglected Disease of Modern Society" [12]. Only 65% of the nation's ambulance attendants had even "first aid" training; 10% had no training whatsoever. Radio equipment, dispatching, and emergency departments were all grossly inadequate. Fifty percent of "ambulances" were driven by morticians, since they had the only business in town with vehicles that could transport a person horizontally. The Council document prompted the passage of the National Highway Safety Act, which proposed that the Department of Transportation provide guidelines for EMS, that money be allotted for ambulances, equipment, and communications, and that training be made available for prehospital care providers [13]. (O'Brian, 1998, pg. 105)

Without such a system this triage would have to be performed in the hospital ED and in so doing precious time is lost, and the nearest hospital may not be a level 1 trauma center, and unable to provide immediate emergency surgical care. (Mackersie, Sept. 2006, pg. 290)

This set of protocols determines, more than any other set of standards who is treated, in what order and where. Level I -IV trauma center classifications are called for in nearly every community in the world on a daily basis. Though it is true that this need is greater in urban areas, simply because there is a greater concentration of people, the system is needed frequently in rural areas as well and the time it takes to get a person to proper medical care may change but the urgency does not.

Trauma systems provide rapid, organized treatment to critically injured patients. From the out-of-hospital phase through emergency department (ED) treatment, disposition, and rehabilitation, trauma systems help optimize and expedite care. The benefits of an organized trauma system for patient outcomes have been demonstrated in numerous studies. (Fishman et. al., October 2006, pg. 347)

The emergency medical system, as well as the Level System designed and certified by the ACS have undergone changes and requires a high level of compliance, among trauma centers and communities where they are located in several areas, for recertification, which occurs every three years as a service of the American College of Surgeons. In order for a hospital and/or community to be certified as a level I trauma center several conditions must be met and most services must be available 24 hours a day. According to the ACS some of the key elements of a Level I trauma center include 24-hour in house availability of general surgeons and rapid availability of specialized surgeons and support staff, including those in the orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine and critical care. The ACS also demands that a Level I trauma center retain individuals who provide cardiac surgery, hand surgery, microvascular surgery and hemodialysis on a 24-hour on call basis.

In addition there are several other aspects that must be included, in the community and the hospital setting for a trauma center to be certified as a Level I center and those include centers that provide leadership in prevention, public education and continuing education to trauma staff. The center must also be committed to constant improvement and be supportive of a continual quality assessment program and a research driven change process. (Barnes-Jewish Hospital Website at (http://www.barnesjewish.org/groups/default.asp?NavID=1093)

Level I trauma center designation signifies to consumers of the health care system as well as other institutions, who may be in geographic locations that are able to transfer patients to such centers that the center can receive and treat high level traumas in an efficient and life saving manner. Without such a center individuals who live in the area are put at risk for not being able to receive life saving care that could mean not only the difference between life and death but also the difference between any achieved quality of life after the emergency or none, as so many traumatic events, be they as a result of injury or infirmity require a timely response to care that cannot always be achieved if a patient requires transport to different facilities to be treated in the best possible manner, with the best possible known outcome.

Our nation's EDs provide the one point of universal access to our health care system. They are the nation's final safety net. Indeed the public fully expects such access, and it is doubtful that patients realize it is eroding. Yet, policy experts and decision makers seem to be unaware of the trend, and certainly no focused efforts are under way to resolve the problem." (ACS Publication June 2006 A Growing Crisis In Patient Access to Emergency Surgical Care at (http://www.facs.org/ahp/emergcarecrisis.pdf)

The ACS stresses in this publication that the whole of the emergency medical care system is under attack, as it is eroding from within and it is the foundation of the nation's ability to respond to terrorist attacks and natural disasters. "Emergency care capability has never been more important that it is in the post 9/11 world, and the need to strengthen it has never been more urgent." Emergency care has become a more utilized institution than it… READ MORE

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