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Old 03-09-2015, 05:00 PM
 
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Sorry for the length of the posting but I felt it appropriate to provide some extra explanatory material along with the basic question being asked of you (to give you a better understanding of the issues and concerns of this posting).

Read on:


For a while now, in choosing where to live (i.e., the exact physical location where my living abobe would be situated within a metro area or region of the U.S.), a major factor for me is a desire to live as close as possible to a Level I Trauma Center hospital ... rather than just a Level II or III or IV or V or a basic community hospital that isn’t any type of a trauma center at all. Of course, there are that much less Level I Trauma Centers which exist than the other lower levels of trauma center (and then there are any number of hospitals that are not rated to be any type of trauma center at all). My reasoning is that, if something majorly serious or traumatic happens to me, unless I'm rather near to the location of a Level I Trauma Center, I may well be at a considerable disadvantage. In such situations, time is of the essence and, if you have to be brought to a non-trauma center community hospital or even to a lower-rated trauma center (whether a Level II or III or IV or V trauma center) just to then have to be prepared by said lower-level hospital to be transported from there by helicopter or ambulance to a distant or even very distant Level I Trauma Center hospital (sometimes even perhaps out-of-state), that could be a matter of life and death for you.

That is, don't necessarily think that it is a given that, as soon as you are brought to such a lower-level hospital and they try to first revive or treat or stabilize you (if they can at all and then are equipped to do so to the necessary extent), you are able to then be immediately brought to the helipad (if the hospital you were brought to even has a helipad at or near its location) and have a helicopter just waiting to immediately transport you to the nearest Level I Trauma Center. If said lower-level hospital even has a helipad at or near its location at all, whatever helicopters serve them might be on other trips or simply not ready to take off yet and it takes time to even get you to said helipad whether on top of one of the hospital buildings or on a building or patch of land nearby to the hospital campus). And if instead of having a helipad there, they have to try to transport you by ambulance, the ambulance may well have to make its way through traffic, traffic lights, obstructions, less-than-ideal road conditions, et al and then may have to travel a good distance in the area or region or even out-of-state.
I can bring up a great multitude of examples of bad medical outcomes that reflect on these brought-up issues, but here’s just one: Think of what happened to the late entertainer Joan Rivers on August 28, 2014 and then she died one week later on September 4, 2014). She had her heart stop and she stopped breathing during a botched endoscopy at an off-campus independent endoscopy center in the Upper East Side/Yorkville neighborhood of Manhattan (New York City) and, even being just one mile from a Level I Trauma Center (Mount Sinai Hospital), the delay in getting her from the non-hospital off-site endoscopy center to Mount Sinai Hospital by an ambulance (which took time to arrive at the non-hospital off-site endoscopy center from elsewhere) through all the denseness of the traffic and road conditions of Manhattan, cost Joan Rivers her life (she incurred irreversible brain damage because of the delay). The experts say (and common sense says) that she should have had such a biopsy procedure on her vocal cords done within a hospital (and then ideally a Level I Trauma Center hospital rather than a lower-rated hospital) to have had the best chance of survival if something went wrong during the procedure (and something did, in fact, go wrong for her).
IN SUMMARY: It is ideal to live as close to a Level I Trauma Center as can be (and I myself usually work out of home as well as well as simply live in it, so I am at my home and shop/recreate, et al in my home area more often than not … so it is important to me what type of hospitals are near to where I spend most of my time). But, as stated earlier, there are only so many of Level I Trauma Centers situated in any metro areas or regions ... and enough metro areas don't have any Level I Trauma Centers at all. (and enough do not even have any Level II Trauma Centers nearby or even in their locale or region either).

MY QUESTION to you (ideally to be answered by those who are have this requested knowledge by virtue of being medical professionals or other persons who, however they acquired said knowledge, have real knowledge about the true workings of the trauma center system in the U.S.):

It appears, to my previous readings of varied information on the web, that a Level II Trauma Center can offer all or just about all that a Level I Trauma Center can except that it doesn't necessarily have an organized teaching and research effort occurring on its campus to help direct new innovations in trauma care. Yet more recents readings of the differences (e.g., from the American Trauma Society website) appears to say that, while a Level II has "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", a Level I has all that plus it also has 24/7-available specialists in internal medicine, plastic surgery, oral and maxillofacial, and pediatric care. Certainly, pediatric care doesn't matter to myself personally (as I am an adult) and plastic surgery is not a life-or-death matter but can be delayed until after you are revived, kept alive, treated, and stabilized. And perhaps as well, oral and maxillofacial surgery can also have a delay in its administration until sometime after you are revived, kept alive, treated, and stabilized. That only leaves “Internal medicine” (i.e., internists) as the only category mentioned for Level I that is not as well mentioned for Level II. Yet I tend to doubt that a Level II Trauma Center doesn’t also have a staff of 24/7 internists on their staff (i.e., that it is instead the case that you will find a 24/7 waiting person or persons who are internists only at a Level I Trauma Center)

The question to you who are experienced and/or truly knowledgeable persons on this matter is: Do you think that, for all intents and purposes, everything of medical consequence for an adult (not a child) that is truly very serious or traumatic in nature can just as well be handled by a Level II Trauma Center (i.e., that the pressing medical steps or procedures needed to be performed on a trauma victim brought in to them that does or can succeed in keeping that person alive can be performed just as well by a Level II Trauma Center)? Remember that I shared my postulation or speculation in the just-previous paragraph that the availability of plastic surgery and oral/maxillofacial surgery that a Level I can offer but a Level II purportedly can’t offer are not procedures that are meant to keep one alive versus dead but rather just followup procedures that can just as well be administered to a trauma victim (if needed) sometime after said trauma victim is first revived, kept alive, treated, and stabilized. In other words, time may not necessarily be of the essence when it comes to plastic surgery or oral/maxillofacial surgery (such procedures, it appears to my mind, can wait until sometime later).

So would YOU YOURSELF, as an experienced medical practitioner (if you are, in fact, a medical practitioner of whatever type) or otherwise a person knowledgeable about the workings of the medical system truly be satisfied to be in reasonable proximity to a Level II Trauma Center yet to be at quite a distance from the nearest Level I Trauma Center (e.g., 10-15 miles away, 25 miles away, 40 or 50 miles away)? Would a Level II Trauma Center in the vicinity of where you live and work each day satisfy YOU personally enough (while, at the same time, not having a Level I Trauma Center in your area that can be reasonably walked to or driven to but must instead have you transported to it by helicopter or else a quite long-distance ambulance trip)?

Last edited by UsAll; 03-09-2015 at 06:19 PM..

 
Old 03-09-2015, 10:19 PM
 
Location: Texas
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Long post, but I will offer my opinion on a short answer.

Yes, in most situations, a Level II Trauma Center is just as good and offers virtually 24/7 access to all specialties as a Level I. Many large, tertiary academic centers are, in fact, only classified as Level II's. The difference between most Level I's and II's is nowhere near as significant between say a Level II and a Level III.

For example, I live in Denver. The University of Colorado Hospital, which is a large academic teaching hospital, is a Level II. It can handle anything, including getting major trauma sent to it from other, outlying facilities. The Public Level I Hospital is actually much smaller. The Level I sees more "gun and knife" trauma, but the University Hospital sees tons of trauma as well. Further, in many, if not most, Level II Trauma Centers, they have their own fellowship trained Trauma General and Orthoapedic surgeons etc, so even many specialists are sub specialized specifically in trauma.

There are lots of reasons hospitals voluntarily stay at the Level II designation, even if they could easily obtain Level I status. In some cases, there are political and other reasons that the number of Level I's are limited. Many reasons there are so few (comparatively) Level I's.

Last edited by Texas Ag 93; 03-09-2015 at 10:39 PM..
 
Old 03-10-2015, 03:02 AM
 
2,236 posts, read 2,101,926 times
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Quote:
Originally Posted by Texas Ag 93 View Post
Long post, but I will offer my opinion on a short answer.

Yes, in most situations, a Level II Trauma Center is just as good and offers virtually 24/7 access to all specialties as a Level I. Many large, tertiary academic centers are, in fact, only classified as Level II's. The difference between most Level I's and II's is nowhere near as significant between say a Level II and a Level III.

For example, I live in Denver. The University of Colorado Hospital, which is a large academic teaching hospital, is a Level II. It can handle anything, including getting major trauma sent to it from other, outlying facilities. The Public Level I Hospital is actually much smaller. The Level I sees more "gun and knife" trauma, but the University Hospital sees tons of trauma as well. Further, in many, if not most, Level II Trauma Centers, they have their own fellowship trained Trauma General and Orthoapedic surgeons etc, so even many specialists are sub specialized specifically in trauma.

There are lots of reasons hospitals voluntarily stay at the Level II designation, even if they could easily obtain Level I status. In some cases, there are political and other reasons that the number of Level I's are limited. Many reasons there are so few (comparatively) Level I's.

Thank you for your response.

Hmm, one would think that any hospital which is directly connected (physically and logistically) to an adjoining medical school would, by default , be a Level I Trauma Center because they would be capable of it ... although I know there are at least some exceptions (for instance, the University of Chicago Medical Center-- connected to the world-famous and renowned University of Chicago Medical School --is not any type of trauma center ... though it used to be). They chose to give up that designation. But there are a host of other Level I Trauma Centers spread around Chicagoland.

Are you a medical practitioner yourself (e.g., an M.D., a surgeon, working in hospital administration, et al)? If so, you appear to be saying, based upon your actual first-hand knowledge or experience, that, for just about ANY Level II Trauma Center, they will have on-hand ANY and EVERY type of medical specialist relevant to trauma treatment (or even more than one of such specialists) on-hand at their trauma center 24/7/365 ... just like a Level I Trauma Center would? If this is true, it would leave that many more options open for where to choose to live (as Level I Trauma Centers are relatively few and very often spread out from one another).
 
Old 03-10-2015, 07:03 AM
 
Location: Texas
3,488 posts, read 2,559,030 times
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Quote:
Originally Posted by UsAll View Post
Thank you for your response.

Hmm, one would think that any hospital which is directly connected (physically and logistically) to an adjoining medical school would, by default , be a Level I Trauma Center because they would be capable of it ... although I know there are at least some exceptions (for instance, the University of Chicago Medical Center-- connected to the world-famous and renowned University of Chicago Medical School --is not any type of trauma center ... though it used to be). They chose to give up that designation. But there are a host of other Level I Trauma Centers spread around Chicagoland.

Are you a medical practitioner yourself (e.g., an M.D., a surgeon, working in hospital administration, et al)? If so, you appear to be saying, based upon your actual first-hand knowledge or experience, that, for just about ANY Level II Trauma Center, they will have on-hand ANY and EVERY type of medical specialist relevant to trauma treatment (or even more than one of such specialists) on-hand at their trauma center 24/7/365 ... just like a Level I Trauma Center would? If this is true, it would leave that many more options open for where to choose to live (as Level I Trauma Centers are relatively few and very often spread out from one another).
There are lots of Academic Medical Centers that are not Level I's, like the example I gave above and your Univ of Chicago example. Many institutions don't want the hassle of it (including the patient population), even if they do have the staff and facilities. Moreover, the ability to seek and maintain Level I status may or may not be limited by other factors. Sometimes, there is a history between institutions that factors into it. In many cases, the Hospital or Academic Medical Center is a Public institution and has oversight from legislative groups that play into it. Most large well known Trauma Centers are county hospitals, for instance. In some states, there are still Certificate of Needs requirements that hospitals must get approved to get facilities upgrades and do construction. So, yes, there is a lot that goes into it.

My background is a Master's degree in Healthcare Administration and 12 years working in large hospitals, mostly academic, starting in the Houston area, which is home to the largest Medical Center in the World, including two Level I trauma centers right next door to each other. My husband is a surgeon, and most of our friends and colleagues are medical practitioners as well. So, I know more than the average bear, but there are plenty of people who know more than I, including about this subject.

TBH, I would not have living close to a Level I Trauma Center on my list of criteria for selecting where to live at all. If you have health issues and see lots of doctors, then yes, living in close proximity to good health care is important. But, near a Level I? Overkill, IMO. Of course, not all Level II hospitals are created equal. I think most, certainly those affiliated with medical schools, certainly have what you need. I wouldn't even worry about the level of trauma center I live nearby period, and I am a person who worries a good deal

Last edited by Texas Ag 93; 03-10-2015 at 07:47 AM..
 
Old 03-10-2015, 11:33 AM
 
2,236 posts, read 2,101,926 times
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Quote:
Originally Posted by Texas Ag 93 View Post
There are lots of Academic Medical Centers that are not Level I's, like the example I gave above and your Univ of Chicago example. Many institutions don't want the hassle of it (including the patient population), even if they do have the staff and facilities. Moreover, the ability to seek and maintain Level I status may or may not be limited by other factors. Sometimes, there is a history between institutions that factors into it. In many cases, the Hospital or Academic Medical Center is a Public institution and has oversight from legislative groups that play into it. Most large well known Trauma Centers are county hospitals, for instance. In some states, there are still Certificate of Needs requirements that hospitals must get approved to get facilities upgrades and do construction. So, yes, there is a lot that goes into it.

My background is a Master's degree in Healthcare Administration and 12 years working in large hospitals, mostly academic, starting in the Houston area, which is home to the largest Medical Center in the World, including two Level I trauma centers right next door to each other. My husband is a surgeon, and most of our friends and colleagues are medical practitioners as well. So, I know more than the average bear, but there are plenty of people who know more than I, including about this subject.

TBH, I would not have living close to a Level I Trauma Center on my list of criteria for selecting where to live at all. If you have health issues and see lots of doctors, then yes, living in close proximity to good health care is important. But, near a Level I? Overkill, IMO. Of course, not all Level II hospitals are created equal. I think most, certainly those affiliated with medical schools, certainly have what you need. I wouldn't even worry about the level of trauma center I live nearby period, and I am a person who worries a good deal
Are there Level II's that are not affiliated with a medical school? And does "affiliated" mean that they are on the same campus as the medical school or otherwise, whether on the same physical campus or not, they are the "official" hospital of that medical school? Or may it be the case that some Level II's simply have a "working relationship" with whatever medical school (and whatever number of other nearby hospitals may also have such a working relationship with that same medical school)?

Yes, in the end, even if living right down the street from any type of trauma center (even a Level I) or having one in the greater vicinity, one can have a good outcome or less-than-good or even a bad outcome (such as death) when one is in an emergency or trauma situation. You can be brought (even in a very timely manner) to the most-highly-rated hospital but then you may experience a medical mishap or mistake in even this very most-highly-rated hospital and you may pay the price for that ... either being seriously debilitated or winding up dead. Like the old saying by Benjamin Franklin goes (a bit paraphrased here): "The only guarantees in life are death and taxes." All we can do, in the end, is have hope. Not even faith (trust) in the system-- for it may work or not work for you when you need it to --but just hope that it will work when you need it to.

Thank you for your input and feedback.
 
Old 03-10-2015, 01:40 PM
 
Location: Texas
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Usually, a true Academic Medical Center includes, at minimum, a teaching hospital and a medical school on the same campus. Larger AMC's will also often have nursing schools, dental schools, research facilities and even Schools of Public Health and/or Pharmacy, all, again, on the same campus.

And yes, there are all levels of Trauma Centers, including Level I's that are not affiliated with medical schools at all. Again, I'll use Denver as an example. As I said before, the University Hospital is Level II, affiliated with the UC Medical School and staffed by Med school faculty, residents and students. It is part of the Anschutz Medical Campus, which is the type of comprehensive Academic Medical Center I described above.

One Level I is Denver Health. It is a public hospital that serves a primarily indigent and uninsured population. Some of its physicians are University of Colorado faculty and residents. Some of its physicians are ones they hire directly themselves that have no academic appointment.

Then, in the South part of the metro area, there is another Level I (Swedish Medical Center) that is not only not affiliated with a medical school, but is a private, for-profit facility. I believe it does have some private, limited residency training, though I could be wrong about that.

Is that sufficiently confusing?
 
Old 03-11-2015, 09:10 PM
 
2,236 posts, read 2,101,926 times
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Quote:
Originally Posted by Texas Ag 93 View Post
Usually, a true Academic Medical Center includes, at minimum, a teaching hospital and a medical school on the same campus. Larger AMC's will also often have nursing schools, dental schools, research facilities and even Schools of Public Health and/or Pharmacy, all, again, on the same campus.

And yes, there are all levels of Trauma Centers, including Level I's that are not affiliated with medical schools at all. Again, I'll use Denver as an example. As I said before, the University Hospital is Level II, affiliated with the UC Medical School and staffed by Med school faculty, residents and students. It is part of the Anschutz Medical Campus, which is the type of comprehensive Academic Medical Center I described above.

One Level I is Denver Health. It is a public hospital that serves a primarily indigent and uninsured population. Some of its physicians are University of Colorado faculty and residents. Some of its physicians are ones they hire directly themselves that have no academic appointment.

Then, in the South part of the metro area, there is another Level I (Swedish Medical Center) that is not only not affiliated with a medical school, but is a private, for-profit facility. I believe it does have some private, limited residency training, though I could be wrong about that.

Is that sufficiently confusing?

What an utterly cuckoo system!! In the end (as you've said or alluded to earlier in the thread), it must be "politics" to a good degree that determines how many of any type of trauma centers there are in any given metro area or region and who among any collection of hospitals in a metro area or region is allowed to be designated as a Level I versus a Level II or whatever other trauma center level or else not getting any type of trauma center designation at all.

For instance, the latest statement by the University of Chicago Medical Center (dated March 2015), titled "The Latest Statement on Trauma Care on the South Side" (Trauma Documents - The University of Chicago Medicine) seems to say that they didn't want to be overwhelmed anymore with so many victims of violence from Chicago's very large South Side (as well as from elsewhere in greater Chicagoland and surrounding area outside Chicagoland) ... wanting their hospital to serve a host of other medical needs. They say that they want there to be a major focus on "the essential issue of violence prevention" and didn't want to anymore take on "the long-term financial and operational realities of running an adult trauma center" (though they still have a pediatric trauma center) and hence wish for other Chicago-area institutions to take on that task. And hence they gave up being a Level I Adult Trauma Center. Though that leaves the very large land area which constitutes Chicago's South Side as being unserved by any adult trauma center. I've been down in their area in times past. Depending on where in southside Chicago a trauma victim is situated (say, from the area of the Univerity of Chicago campus), it can be 8.6 to 8.9 to 9.2 miles from that location to the University of Illinois Hospital west of Chicago's Loop ... depending on what route is taken by an ambulance.

Last edited by UsAll; 03-11-2015 at 09:31 PM..
 
Old 03-11-2015, 09:30 PM
 
Location: Texas
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Statistically speaking, trauma does not happen by accident (pun fully intended). While it is entirely possible that you or I could suffer a catastrophic injury or die in a trauma, across the whole of the population, that's not what happens. What happens is that a subset of the population is largely the victims of trauma. That subset of the population tends to be largely lower on the socio-economic scale and uninsured. They are people who make very poor choices in many aspects of their lives, including their own health and well-being. They are the people who shoot people (and get shot at); they are the people who drive drunk; they are the people who don't wear seat belts and get ejected from cars; they are the people who say "Here, hold my beer while I try this"......

So, they are the ones who end up in trauma centers, and subsequently the hospital requiring the highest level of care, for days and weeks, often unable to pay their bill. So, it's no wonder that in your example above, the University of Chicago would choose to discontinue their program.

Of course, Trauma Centers cater to everyone else as well, and heaven forbid I need their services, I will be thankful for a great Level I or II center.
 
Old 03-11-2015, 09:36 PM
 
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Can I ask what you expect to happen in your home that would require a level 1 trama center? I mean what if you're driving on the other side of town and get in a car accident?

Last edited by Spazkat9696; 03-11-2015 at 10:04 PM..
 
Old 03-11-2015, 09:57 PM
 
Location: Texas
3,488 posts, read 2,559,030 times
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One other thing with regard to your original question about the difference between a Level I and II, is that Level I's are required (I think) to have some research components, have to do a lot more QA, reporting and compilation of data (about types and mechanisms of trauma) etc. I don't know the specifics, though.
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