The Committee on Trauma (COT) of the American College of Surgeons (ACS) has re-verified Barnes-Jewish Hospital’s trauma center at Level I, the highest level of trauma care available. There are four separate categories of verification in the COT’s program (Level I, II, III, and IV), each with specific criteria that must be met by a facility seeking that level of verification.
LEVEL I
As verified by the American College of Surgeons' Committee on Trauma, a Level I Trauma Center is a comprehensive regional resource that is a tertiary care facility central to the trauma system. A Level I Trauma Center is capable of providing total care for every aspect of injury – from prevention through rehabilitation.
Key elements of a Level I Trauma Center include 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine and critical care. Other capabilities include cardiac, hand, pediatric, microvascular surgery and hemodialysis. The Level I Trauma Center provides leadership in prevention, public education and continuing education of the trauma team members. The Level I Trauma Center is committed to continued improvement through a comprehensive quality assessment program and an organized research effort to help direct new innovations in trauma care.
LEVEL II
As verified by the American College of Surgeons' Committee on Trauma, a Level II Trauma Center is able to initiate definitive care for all injured patients.
Key elements of a Level II Trauma Center include 24-hour immediate coverage by general surgeons, as well as coverage by the specialties of orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology and critical care. Tertiary care needs such as cardiac surgery, hemodialysis and microvascular surgery may be referred to a Level I Trauma Center. The Level II Trauma Center is committed to trauma prevention and to continuing education of the trauma team members. The Level II Trauma Center is dedicated to continued improvement in trauma care through a comprehensive quality assessment program.
LEVEL III
As verified by the American College of Surgeons' Committee on Trauma, a Level III Trauma Center has demonstrated an ability to provide prompt assessment, resuscitation, stabilization of injured patients and emergency operations.
Key elements of a Level III Trauma Center include 24-hour immediate coverage by emergency medicine physicians and the prompt availability of general surgeons and anesthesiologists. The Level III program is dedicated to continued improvement in trauma care through a comprehensive quality assessment program. The Level III Trauma Center has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma Center. A Level III Trauma Center is committed to the continued education of the nursing and allied health personnel or the trauma team. It must be involved with prevention and must have an active outreach program for its referring communities. The Level III Trauma Center is also dedicated to improving trauma care through a comprehensive quality assessment program.
LEVEL IV
As verified by the American College of Surgeons' Committee on Trauma, a Level IV Trauma Center has demonstrated an ability to provide advanced trauma life support (ATLS) prior to transfer of patients to a higher level trauma center.
Key elements of a Level IV Trauma Center include basic emergency department facilities to implement ATLS protocols and 24-hour laboratory coverage. Transfer to higher level trauma centers follows the guidelines outlined in formal transfer agreements. The Level IV center is committed to continued improvement of these trauma care activities through a formal quality assessment program. The Level IV center should be involved in prevention, outreach and education within its community.