Trauma center

United Kingdom in Birmingham, United Kingdom, was the world's first trauma center. Trauma centres grew into existence out of the realisation that traumatic injury is a disease process unto itself requiring specialised and experienced multidisciplinary treatment and specialised resources. The world's first trauma centre, the first hospital to be established specifically to treat injured rather than ill patients, was the Birmingham Accident Hospital, which opened in Birmingham, England in 1941 after a series of studies found that the treatment of injured persons within England was inadequate. By 1947, the hospital had three trauma teams, each including two surgeons and an anaesthetist, and a burns team with three surgeons. The hospital became part of the National Health Service in its formation in July 1948 and closed in 1993. United States , a Level I trauma center in Columbus, Ohio , a Level I trauma center in Houston , a Level I trauma center in Miami According to the CDC, injuries are the leading cause of death for American children and young adults ages 1–19. The leading causes of trauma are motor vehicle collisions, falls, and assaults with a deadly weapon. In the United States, Robert J. Baker and Robert J. Freeark established the first civilian Shock Trauma Unit at Cook County Hospital (opened 1834) in Chicago, Illinois on March 16, 1966. The concept of a shock trauma center was also developed at the University of Maryland, Baltimore, in the 1950s and 1960s by thoracic surgeon and shock researcher R Adams Cowley, who founded what became the Shock Trauma Center in Baltimore, Maryland, on July 1, 1966. The R Adams Cowley Shock Trauma Center is one of the first shock trauma centers in the world. Cook County Hospital in Chicago trauma center (opened in 1966). David R. Boyd interned at Cook County Hospital from 1963 to 1964 before being drafted into the Army of the United States of America. Upon his release from the Army, Boyd became the first shock-trauma fellow at the R Adams Cowley Shock Trauma Center, and then went on to develop the National System for Emergency Medical Services, under President Ford. In 1968 the American Trauma Society was created by various co-founders, including R Adams Cowley and Rene Joyeuse as they saw the importance of increased education and training of emergency providers and for nationwide quality trauma care. Canada According to the founder of the Trauma Unit at Sunnybrook Health Sciences Centre in Toronto, Ontario, Marvin Tile, "the nature of injuries at Sunnybrook has changed over the years. When the trauma centre first opened in 1976, about 98 per cent of patients suffered from blunt-force trauma caused by accidents and falls. Now, as many as 20 per cent of patients arrive with gunshot and knife wounds". Fraser Health Authority in British Columbia, located at Royal Columbian Hospital and Abbotsford Regional Hospital, services the BC area, "Each year, Fraser Health treats almost 130,000 trauma patients as part of the integrated B.C. trauma system". ==Definitions in United States==

In the United States, trauma centers are certified by the American College of Surgeons (ACS) or local state governments, from Level I (comprehensive service) to Level III (limited-care). The different levels refer to the types of resources available in a trauma center and the number of patients admitted yearly. These are categories that define national standards for trauma care in hospitals. Level I through Level II designations are also given adult or pediatric designations. Additionally, some states have their own trauma-center rankings separate from that of the ACS. These levels may range from Level I to Level IV. Some hospitals are less-formally designated Level V. The ACS does not officially designate hospitals as trauma centers. Numerous U.S. hospitals that are not verified by ACS claim trauma center designation. Most states have legislation that determines the process for designation of trauma centers within that state. The ACS describes this responsibility as "a geopolitical process by which empowered entities, government or otherwise, are authorized to designate." The ACS's self-appointed mission is limited to confirming and reporting on any given hospital's ability to comply with the ACS standard of care known as Resources for Optimal Care of the Injured Patient. The Trauma Information Exchange Program (TIEP) is a program of the American Trauma Society in collaboration with the Johns Hopkins Center for Injury Research and Policy and is funded by the Centers for Disease Control and Prevention. TIEP maintains an inventory of trauma centers in the US, collects data and develops information related to the causes, treatment and outcomes of injury, and facilitates the exchange of information among trauma care institutions, care providers, researchers, payers and policymakers. Level I A Level I trauma center provides the highest level of surgical care to trauma patients. Being treated at a Level I trauma center can reduce mortality by 25% compared to a non-trauma center. It has a full range of specialists and equipment available 24 hours a day and admits a minimum required annual volume of severely injured patients. A Level I trauma center is required to have a certain number of the following people on duty 24 hours a day at the hospital: • Surgeons • Emergency physicians • Anesthesiologists • Nurses • Respiratory therapists • An education program • Preventive and outreach programs Key elements include 24‑hour in‑house coverage by general surgeons and prompt availability of care in varying specialties—such as orthopedic surgery, cardiothoracic surgery, neurosurgery, plastic surgery, anesthesiology, emergency medicine, radiology, internal medicine, otolaryngology, oral and maxillofacial surgery, and critical care, which are needed to adequately respond and care for various forms of trauma that a patient may suffer, as well as provide rehabilitation services. Level I and II trauma centers are focused on maintaining the capability "to take a patient to the operating room immediately 24/7/365". This requires careful management of hospital resources to ensure their constant availability around the clock. Level III A Level III trauma center does not have the full availability of specialists but has resources for emergency resuscitation, surgery, and intensive care of most trauma patients. A Level III center has transfer agreements with Level I or Level II trauma centers that provide back-up resources for the care of patients with exceptionally severe injuries, such as multiple trauma. Level V A Level V trauma center provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. They may provide surgical and critical-care services, as defined in the service's scope of trauma care services. A trauma-trained nurse is immediately available, and physicians are available upon patient arrival in the emergency department. If not open 24 hours daily, the facility must have an after-hours trauma response protocol. and Washington designate up to Level III, while New Hampshire and Texas designate up to Level IV. ==Current system in the United Kingdom==

There are 27 major trauma centres (MTCs) in England, four in Scotland, one in Wales and one in Northern Ireland. The UK system operates on a "hub and spoke" model with regional trauma networks headed by one or two major trauma centres (MTCs) and supported by trauma units (TUs). Major trauma centre Major trauma centres are very similar to Level I trauma centers in the U.S., with teams of specialized care available around the clock to treat patients with injuries of all possible severity. MTCs can be designated as "adult only", "children's only" or "adult and children" to identify what patients they are prepared to treat. Trauma unit Trauma units can play two roles, the first is to care for those who are less seriously injured which avoids overconsumption of resources in the major trauma centres. The other is to stabilize then transfer patients who are far from a major trauma centre or too unstable to be transported there directly. ==See also==