Trauma Centers

[JBE 328]

Aside from WCMC, and maybe St Lukes??(Memory) on the other side of the river, are there any other Level 1 Trauma Centers in the area??

The reason I ask this, is because over the past few years I've been a member here, I've regularly seen IA's and IW's about patients transported to WCMC via Stat Flight or NYSP. Not to knock either, but I think many would be better served by having PHC, NWHC, HVHC, and one of the Dutchess hospitals as a Level 1 TC.

That's a lot of area to cover and with an ever growing population, are you really getting your tax dollars worth??

Discuss.

[Danger 160]

The other day I was discussing with somebody how perhaps St. Francis in Poughkeepsie should become a Level 1 and Kingston Hospital and/or Vassar Brothers go to Level 2.

[DOC22 1]

Aside from WCMC, and maybe St Lukes??(Memory) on the other side of the river, are there any other Level 1 Trauma Centers in the area??

The reason I ask this, is because over the past few years I've been a member here, I've regularly seen IA's and IW's about patients transported to WCMC via Stat Flight or NYSP. Not to knock either, but I think many would be better served by having PHC, NWHC, HVHC, and one of the Dutchess hospitals as a Level 1 TC.

That's a lot of area to cover and with an ever growing population, are you really getting your tax dollars worth??

Discuss.

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Living in Lake Carmel, I would love to see PHC or even NWHC become Level 1 TCs. I've been a patient in both, and was very satisfied with the care I received.

[helicopper 1,050]

Aside from WCMC, and maybe St Lukes??(Memory) on the other side of the river, are there any other Level 1 Trauma Centers in the area??

The reason I ask this, is because over the past few years I've been a member here, I've regularly seen IA's and IW's about patients transported to WCMC via Stat Flight or NYSP. Not to knock either, but I think many would be better served by having PHC, NWHC, HVHC, and one of the Dutchess hospitals as a Level 1 TC.

That's a lot of area to cover and with an ever growing population, are you really getting your tax dollars worth??

Discuss.

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Westchester is the only Level 1 trauma center in the Hudson Valley Region. The only Area (Level 2) trauma centers are St. Francis, Sound Shore (New Rochelle), Good Samaritan and Nyack. That's all folks. Hudson Valley was designated an area trauma center for a while but gave up the designation.

As good as a local community hospital may be, the requirements for a Level 1 trauma center designation are incredible and the costs to achieve them mind boggling. If Hudson Valley chose to give up the AREA designation, you can imagine how difficult that must have been to maintain because I can tell you they invested ALOT in getting the designation.

Regional trauma centers are designed to be just that - regional. We (happily) don't see the sort of volume that justifies duplicate centers in close proximity. Having two regional centers competing with each other could negatively impact the whole house of cards.

If you look at the statistics, there are tens of thousands of ER visits that don't require a trauma center - the proportion of IA's that involve transport to the Level 1 trauma centers at Westchester or Jacobi do not reflect a big percentage of these total ER visits. In other (simpler, I hope) words, the volume does not support establishing additional centers in Westchester, Putnam and Dutchess.

A disparate proportion of trauma center candidates also go to Westchester because it is more fashionable to fly them there than drive to one of the area centers.

[201/65 94]

There has been some rumor that once the new Orange Regional Medical Center is built they may attempt to become a level 2 TC.

I believe Catskill Regional Medical Center, home to the new Life Net 7-5, is very close to becoming a level 2 TC.

[Oswegowind 17]

As Chris192 said, the volume in the Hudson Valley region does not warrant an additional Level 1 TC. Albany is also a level 1 and that provides sufficient coverage for the combined areas. In NYC there are many more level 1's, many more trauma's, many more people...With cars being made safer and campaigns by police to ensure safer driving, such as click-it or ticket, there has been a significant reduction in the amount of level 1 trauma jobs over time.

For example, I remember the days when Garrison would get at least one major piaa on Rte 9 per week. To this day, "South of the Bird and Bottle" which is a bread and breakfast along route 9, stays with me. Although, I don't listen to a scanner all that much anymore, I haven't seen any new crosses added to the roadside in that area alone.

[Guest paramedico987]

There's also [bordering W/chester]:

Stamford Hosp - Level II

Danbury Hosp - Level II

Norwalk Hosp - Level II

Jacobi MC - Level I

St. Barnibas - Level II

North Central Bronx - Level II

The reality is that the resources required of a Level II center will meet the needs of MOST trauma patiets, so as far as getting credentialing for area hospitals I suppose it would be usefull to get Putnam upgraded to Level II or get Hudson Valley back, but I would imagine that NWH would get dumped on even more if they upgraded and they can't handle the increased voloume as it is right now.

[Guest partyrock]

I'd double check your source. North Central is not a Trauma Center. Lincoln is the third Trauma Center in the boogie down, but if you're gonna go there you might as well jump across the river to Harlem Hospital.

Edited May 27, 2007 by partyrock

[jps385 0]

There's also [bordering W/chester]:

Stamford Hosp - Level II

Danbury Hosp - Level II

Norwalk Hosp - Level II

Jacobi MC - Level I

St. Barnibas - Level II

North Central Bronx - Level II

The reality is that the resources required of a Level II center will meet the needs of MOST trauma patiets, so as far as getting credentialing for area hospitals I suppose it would be usefull to get Putnam upgraded to Level II or get Hudson Valley back, but I would imagine that NWH would get dumped on even more if they upgraded and they can't handle the increased voloume as it is right now.

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ST Barnabas is a level 1, North Central isn't a trauma center, but lincoln is level 1 (bit of a ride though).

[RescueKujo 130]

As good as a local community hospital may be, the requirements for a Level 1 trauma center designation are incredible and the costs to achieve them mind boggling.  If Hudson Valley chose to give up the AREA designation, you can imagine how difficult that must have been to maintain because I can tell you they invested ALOT in getting the designation.

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Level 1's must have an onsite thorasic surgeon and a CT Scanner. That plus other onsite requirements are what cause the associated costs to be so high.

[DOC22 1]

Just out of curiosity, what is required to achieve and maintain Level 1 and Level 2 center?

[vodoly 535]

Hackensack Hospital St Joe's paterson Morristown Jersey City Medical Center and of course "THE U " in newark are all trauma centers In northen NJ I beleive you have to have 24/7 Neuro as well

[jps385 0]

Just out of curiosity, what is required to achieve and maintain Level 1 and Level 2 center?

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Level One Facility Requirements:

In house qualified trauma surgeon

In house qualified radiologist

In house qualified emergency physician

In house qualified anesthesiologist

Trauma medical director (trauma surgeon)

Emergency medicine medical director (MD/DO)

Trauma program manager (RN)

24 hour CT availability

24 hour equipped and staffed operating suite

Backup and equipped surgical suite

Trauma intensive care facilities for adult and pediatric patients

Trained trauma team

-At least 1 trauma surgeon (as team leader)

-At least 1 attending EM physician

-At least 2 trained trauma nurses

Dedicated resuscitation suites (to manage two simultaneously multi-system injured patients)

24 hour laboratory facilities

Protocol for in house burn care

Rehabilitation facilities

Helicopter landing pad

Pediatric resuscitation facilities, personnel, and intensive care units

Administrative requirements

Research requirements

EMS requirements

*The term, "qualified" pertains to state guidelines. In some instances, senior emergency medicine residents/fellows or senior surgical resisdents can substitute for their attending counterparts.

Level Two Facility Requirements:

Same as above, except requirements for in house and on call physicians vary. Level Two facilities generally meet all Level One criteria but are not required to have neurosurgeons/trauma surgeons in house. Furthermore, Level Two facilities are not mandated to handle pediatric trauma. Emergency rooms must necessarily be capable of managing critically ill and injured pediatric patients, but Level II facilities are generally not designated as pediaric trauma referral centers (PTRCs). The state requires that on call trauma specialists must sign a letter of commitment and arrive promptly once summoned by house staff.

This is from American College of Surgeons who acredit trauma centers. Not all facilites in NYC have the helipad. All Level 1 are not created equally St. barnabas for example has very limtied pediatric surgery and Neurosurgery.

Edited May 27, 2007 by jps385

[DOC22 1]

Level One Facility Requirements:

In house qualified trauma surgeon

In house qualified radiologist

In house qualified emergency physician

In house qualified anesthesiologist

Trauma medical director (trauma surgeon)

Emergency medicine medical director (MD/DO)

Trauma program manager (RN)

24 hour CT availability

24 hour equipped and staffed operating suite

Backup and equipped surgical suite

Trauma intensive care facilities for adult and pediatric patients

Trained trauma team

    -At least 1 trauma surgeon (as team leader)

    -At least 1 attending EM physician

    -At least 2 trained trauma nurses

Dedicated resuscitation suites (to manage two simultaneously multi-system injured patients)

24 hour laboratory facilities

Protocol for in house burn care

Rehabilitation facilities

Helicopter landing pad

Pediatric resuscitation facilities, personnel, and intensive care units

Administrative requirements

Research requirements

EMS requirements

*The term,  "qualified" pertains to state guidelines. In some instances, senior emergency medicine residents/fellows or senior surgical resisdents can substitute for their attending counterparts.

Level Two Facility Requirements:

Same as above, except requirements for in house and on call physicians vary. Level Two facilities generally meet all Level One criteria but are not required to have neurosurgeons/trauma surgeons in house. Furthermore, Level Two facilities are not mandated to handle pediatric trauma. Emergency rooms must necessarily be capable of managing critically ill and injured pediatric patients, but Level II facilities are generally not designated as pediaric trauma referral centers (PTRCs).  The state requires that on call trauma specialists must sign a letter of commitment and arrive promptly once summoned by house staff. 

This is from American College of Surgeons who acredit trauma centers.  Not all facilites in NYC have the helipad.  All Level 1 are not created equally St. barnabas for example has very limtied pediatric surgery and Neurosurgery.

←

Thank you, jps

[INIT915 1,119]

This is from American College of Surgeons who acredit trauma centers.  Not all facilites in NYC have the helipad.  All Level 1 are not created equally St. barnabas for example has very limtied pediatric surgery and Neurosurgery.

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This is a bit misleading. ACS verified Trauma Centers and NYS DOH designated Trauma Centers are two different animals entirely.

You do not have to be ACS accredited to by a NYS TC.

Up until recently, WMC was the ONLY ACS verified TC in all of New York State. WMC recently gave up that designation due to the cost of maintaining it.

As it stands today, NOT ONE SINGLE NYS Trauma Center holds dual ACS verification.

If you review the list of national verified TC's, at this link, you will see not one NY hospital is included http://www.facs.org/trauma/verified.html.

This goes for Burn Centers as well. You do not need to be verified by the American Burn Association as a Burn Center in order to actually run a Burn Center in NYS. http://www.ameriburn.org/verification_verifiedcenters.php shows you that only two NYS Burn Centers hold ABA Verification, while the rest of NYS Burn Centers are designated by DOH, but not simultaneously by ABA.

So, that list provided earlier does not match NYS requirements exactly, while they do have many in common. For instance, it was only recently WMC required that the Attending Trauma Surgeon be in house. Before that, he/she only had to be within a 20-minute drive.

[INIT915 1,119]

Here is a short read, outlining what NYS DOH requires of you in order to qualify as a Trauma Center:

http://www.health.state.ny.us/nysdoh/ems/p...umastds7085.pdf

[Guest mediconpatrol]

"If Hudson Valley chose to give up the AREA designation, you can imagine how difficult that must have been to maintain because I can tell you they invested ALOT in getting the designation."

As a nurse at Hudson Valley Hospital, I can address some of the issues regarding the trauma designation.

It was a huge financial burden with minimum reimbrusement. Most true trauma patients are a long term patient with initial acute care as well as the initial rehab of the patient. With HMO and insurance now-a-days, hospitals see very little money.

The 2 surgeons who pioneered the idea of being an area trauma center had both moved to the west coast. With such a designation there has to be an increase in dedication of all the surgeons to maintain.

The requirements we had to maintain to get the designation was 24 hour in-house anesthesia and 24 house doctor coverage. Oue emergency physicians had to be trauma certified and our nursing staff had to maintain TNCC, which to this date is still a requirement. We also had to have a 20 minute of less response time of the surgeon and operating room team (they were called as soon as we received ems notification).

Another issue from the in-hospital portion of this, which we generally don't think about when we are working outside the hospital, is the care after the emergency room. Our Critical Care Unit is a 10 bed unit that cares for all criticals, trauma, neuro, cardiac and post operatives. We do not have the capabilities in house to maintain a trauma only unit...so it stressed our in house capabilities to the seams.

We also found we were transferring just as many patients to wcmc based on speciality surgeries that we were are not capable of performing, ex: certain ortho injuries and traumatic brain injuries.

After much thought was decided that in the best interest of patient and hospital viability we give up the designation. We do still take pride in the fact that we can handle any emergency in our ED, stabalize and then transferre the patient to an appropiate facility if necessary, especially with the helipad adjacent to the ED.