How is a Trauma Center Like a Restaurant?

Charles Adams Jr., MD

Trauma centers (TC) are hospitals that are set up to care for severely injured or ill patients.

There is an old analogy that running a trauma center is like running a restaurant, but that restaurant must be open 24 hours a day, seven days a week, 365 days a year. You never know when 100 people will suddenly arrive, but when they do, they will want to eat right away. Trauma centers, like the restaurant, must be ready to handle a huge influx of severely injured patients at any given time, but instead of hunger, these patients will be fighting for their lives.

Unique centers

TCs are designated by level based on the resources the hospital has available to care for any possible traumatic injury a patient may have. Level 1 is the highest designation possible for a trauma center, and they are truly unique. Unlike other hospitals or emergency clinics, level 1 TCs are the only hospitals able to care for the sickest patients. An institution must make a huge commitment to be a level 1 center.

To do this, they are staffed 24-hours a day with special general surgeons known as trauma surgeons. These surgeons are board-certified in both general surgery and surgical critical care. They can care for a wide variety of injuries affecting the abdominal organs, the heart and lungs, soft tissue and blood vessels, and the brain.

Additionally, Level 1 TCs provide definitive care for every possible traumatic injury and have 24-hour coverage for all medical specialties such as neurologic and orthopedic surgeons, radiologists, anesthesiologists, and a host of other specialists dedicated to caring for trauma patients.

These centers also serve as regional referral centers to support all local hospitals, and accept injured patients requiring advanced or specialty care. They never turn a patient away and care for everyone regardless of whether they can pay for the care they receive, no matter how intense or costly that care is.

Beyond medical care

Level 1 trauma centers have many functions in addition to providing direct medical care. All level 1 TCs are dedicated to improving all aspects of traumatic injury. They are involved in community outreach and injury prevention. Their medical staff seek to promote trauma education for other providers and provide support to the healthcare system to establish a safety net for injured patients.

TCs have a requirement to perform trauma-related research to learn and teach important lessons about treating injured patients. One of their most essential functions is that all Level 1 TCs maintain a registry of all patients they admit. The registry collects hundreds of important data points and enables continuous quality improvement. Its aim is to minimize errors, improve patient safety, and promote the best outcomes possible.

Trauma centers constantly strive to do better, to learn important lessons from bad outcomes so that the care of trauma patients always gets better. The trauma registry and the Trauma Quality Programs are powerful engines of change that have saved countless lives in our country. Care does not end when the patient leaves the TC. We also try to assist patients as they re-integrate back into society.

Responding to the community’s needs

Level 1 TCs are responsive to changes in society and often sound the alarm about important public health threats. They are dedicated to substance abuse screening and treatment and have been at the forefront of trying to reduce substance abuse and the devastating injuries associated with these behaviors. TCs seize upon teachable moments and hope to offer a second chance to people who have made bad decisions. Unfortunately, some bad decisions cannot be reversed, and it is this what drives TC efforts to prevent injury.

To maintain their Level 1 status, all TCs undergo a thorough re-accreditation visit every three years. These visits are designed to ensure that TCs have all the tools required to care for trauma patients. In addition to the tools, the visit also focuses on outcomes and TCs must demonstrate that they are committed to quality improvement.

Clearly, it takes a very special hospital to be able to care for every possible conceivable injury, at a moment’s notice, and to strive to get it right every time. That is ultimately what it means to be a trauma center.

Learn more about the Andrew F. Anderson Emergency Center at Rhode Island Hospital.

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