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SFGH Level 1 Trauma ProgramThe Level I Trauma Program

What Trauma Is

Trauma is accidental or intentional physical injury caused by events such as motor-vehicle crashes, falls, explosions, shootings, or stabbings. It occurs without warning and can happen to anyone. Unintentional injury is the 5th leading cause of death among all ages in the United States. Thus, it is likely that in your lifetime, either you or someone very close to you, will sustain a traumatic injury. Although traumatic injuries occur at all ages, the typical victim is young, healthy, and enjoying the most productive years of his/her life.

ambulanceWhat is the difference between a Trauma Center and an Emergency Department?

An Emergency Department has a broad scope of practice treating heart attacks, chest pain, asthma, minor cuts, sprains, allergic reactions, gastrointestinal bleeding. It is a single-specialty department characterized by on-site hospital based procedures, principal referral service with short duration follow-up, but no major operative procedures or ICU. After a decision is made to admit the person to the hospital, ED transfers the patient to another service. In the case of the severely injured patient, the transfer is usually to the Trauma Service.

A Trauma Center has a focused scope of practice including general surgery, neurosurgery, and orthopedic services. It has multiple specialties characterized by hospital-based and outpatient practice, rapid or immediate response to major injury patients, admitting services with long-term follow-up, admitting performance of major operative procedures, and post-admission critical care. Trauma Care follows a progression that usually includes: pre-hospital care, resuscitation, operative care, critical care, acute recovery, discharge planning & rehabilitation, long-term follow-up, and functional recovery.

What is the difference between a Level I, II, III, IV Trauma Center?

The four levels refer to the kinds 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.  The American College of Surgeons developed and continues to recommended the standards and the California State Trauma Care Systems uses the levels in its regulations.

  • Level I: A Level I trauma center has a full range of specialists and equipment available 24-hours a day and admits a minimum required annual volume of severely injured patients.  Additionally, a Level I center has a program of research, is a leader in trauma education and injury prevention, and is a referral resource for communities in neighboring regions (community outreach).
  • Level II: A Level II trauma center works in collaboration with a Level I center.  It provides comprehensive trauma care and supplements the clinical expertise of a Level I institution.  It provides 24-hour availability of all essential specialties, personnel and equipment.   Minimum volume requirements may depend on local conditions.  These institutions are not required to have an ongoing program of research or a surgical residency program.
  • Level III: A Level III trauma center does not have the full availability of specialists, but does have resources for the emergency resuscitation, surgery and intensive care of most trauma patients.  A Level III center has transfer agreements with Level I and/or Level II trauma centers that provide back-up resources for the care of exceptionally severe injuries.
  • Level IV: A Level IV trauma center provides the stabilization and treatment of severely injured patients in remote areas where no alternative care is available.

What is a Trauma System?

A Trauma System is an inclusive, regionalizaed coordinated effort organized to delivery the full range of care to all injured patients.  Trauma systems are integrated within the local EMS system.

Injury Data for the City and County of San Francisco, 2001

The following data is from the California Department of Health Services, EPIC branch and includes injuries treated at San Francisco General Hospital and other hospitals in the San Francisco.

Five Leading Causes of Fatal Injuries in the City and County of San Francisco, 2001


All Ages

Rank Cause of Injury

Number of Injuries

1 Unintentional - Poisoning 111
2 Suicide/Self-Inflicted 106
3 Homicide/Assault 63
4 Unintentional - Fall 54
5 Unintentional - Motor Vehicle Traffic, Unspecified 37

Prepared by California Department of Health Services, EPIC Branch
Source: California Department of Health Services, Vital Statistics Death Statistical Master File
Warning: 1999 and later death data use ICD-10 cause of death codes.
Use caution in comparing 1999 and later death data to previous years' death data or any hospitalization data.
November 12, 2003
http://www.applications.dhs.ca.gov/epicdata/content/sum_topfive.htm

Five Leading Causes of Hospitalized Nonfatal Injuries in the City and County of San Francisco, 2001


All Ages

Rank Cause of Injury

Number of Injuries

1 Unintentional - Fall 2,569
2 Homicide/Assault 482
3 Suicide/Self-Inflicted 457
4 Unintentional - Poisoning 300
5 Unintentional - Motor Vehicle Traffic, Occupant 255

Prepared by California Department of Health Services, EPIC Branch
Source: California Office of Statewide Health Planning and Development, Patient Discharge Data
November 12, 2003
http://www.applications.dhs.ca.gov/epicdata/content/sum_topfive.htm


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