Supplementary Table: Key Components of Trauma Centers: ACS (USA) Versus RCS (UK)

Supplementary Table: Key Components of Trauma Centers: ACS (USA) versus RCS (UK)

American College of Surgeons (ACS), USA[27]
LEVEL 1 / Total care from resuscitation to rehabilitation and recovery, all subspecialties covered.
Resources/Specialties: Trauma and critical care surgery, General Surgery, Orthopedics, Neurosurgery (including capacity to cater for spinal injuries), Anesthetics, Emergency Medicine, Radiology (with a dedicated radiologist acting as a liaison to the trauma service), Interventional Radiology, Plastic surgery (including hand surgery) and pediatric surgery. Specialties like General Surgery must have in house cover from a consultant or senior trainee. Trauma theatres must be available when needed. Prompt response by teams required (time limits specified). 24-hour conventional radiology, CT, MRI, ultrasound and interventional radiology availability. An in-house CT radiographer. Trauma surgeon remains in charge of patients in the ICU.
Quality Assessment: multidisciplinary peer-review of deaths, morbidities and sentinel events
Leadership and Education: for trauma team members, and for the whole network, injury prevention, education and training
LEVEL 2 / Can initiate definitive trauma care, may lack some subspecialties
Resources/Specialties: 24 hour cover by general surgery (Immediate), neurosurgery, orthopedic surgery, anesthetics, emergency medicine and critical care, BUT may need referral to level 1 center for cardiac surgery, hemodialysis or microvascular surgery
Education: ongoing education to staff, trauma prevention for the community Quality assessment
LEVEL 3 / Can provide assessment, resuscitation and emergency surgery
Resources/Specialties: Emergency Medicine (Immediate), General Surgery and anesthetics (prompt).
Education: ongoing education to staff, trauma prevention for the community Quality assessment
Transfer agreements- with level 1 and 2 centers, and provides backup for rural hospitals.
LEVEL 4 / Can provide ATLS prior to transfer to higher center
Resources/Specialties: basic emergency department facilities that can provide ATLS, has emergency doctor and nurse immediately available.24 hour laboratory services. May provide surgery and ICU if available
Education: ongoing education to staff, trauma prevention for the community Quality assessment
Transfer agreements- with level 1 and 2 centers
LEVEL 5 / Initial evaluation and ATLS
Resources/Specialties: basic emergency department facilities that can provide ATLS, has doctor and nurse available, if facility not 24 hours has activation protocol. May provide surgery and critical care if available
Education: ongoing education to staff, trauma prevention for the community Quality assessment Transfer agreements- with level 1 and 2 centers
Royal College of Surgeons of England (RCS), England [16, 18]
MAJOR TRAUMA CENTER / A specialist hospital responsible for the care of major trauma patients across the region “A clinical culture and management structure that reflects the importance of major trauma”.[ 18]
Resources/Specialties: Has all the surgical specialties Quality Assessment
Volume: Minimum 400 patients per year with major trauma (ISS>15), ideally >600/year, and serve a population of 2 to 3 million[18]
TRAUMA UNIT / “Manages injured patients in its local catchment area”. [18]
Role: Manages patients with less severe injuries, e.g. ISS<15

• Needs to be able to cope with major trauma cases as major trauma cases may present there due to either under-triage, or for immediate life-saving interventions prior to care at a majortrauma center
• Has close links with MTC through a network and immediate transfer agreements Quality Assessment