There was a time when the local hospital emergency room was a person’s only choice for an illness or injury that wouldn’t wait for normal business hours. Today, it’s one of a menu of options for such care, from video doctor visits on your smartphone to neighborhood microhospitals and stand-alone ERs. Even with traditional hospital ERs, there are trauma designations and other distinctions.

While such variety provides convenience and choice, it also brings confusion and creates more of a burden on you, the patient, to know exactly where to go and what it will cost.
We talked to our emergency medicine experts to help us de-mystify the types of facilities and designations you may see for where you get care. In doing so, we hope to give you the information you need to pre-plan for the healthcare needs of your family and find the most convenient and affordable option to meet your situations.

Defining an emergency

It starts with knowing what a health emergency is. Generally speaking, it’s a serious or life-threatening condition that requires immediate attention or advanced care. When you see the big red letters for “Emergency Room” or “Emergency Department,” you’re looking at a place that cares for life-threatening and other emergency medical conditions such as heart attack, major broken bones and large wounds, and one that is equipped with the specialized staff and equipment to do so at any time. These facilities were once easy to identify because they were always attached to hospitals. Today, many emergency departments stand alone, nestled in neighborhood shopping centers, or they are part of a small community hospital, sometimes called a micro-hospital. Keep in mind they are still emergency rooms with these basic capabilities.

So what is a trauma center?

Not all emergencies are created equal, and similarly not all ERs are equipped to handle all emergencies at the same level of care. That’s where trauma designations come in.
Accredited trauma centers are capable of caring for severe injuries, and the level of the designation coincides with the severity of the injuries they can treat. The most advanced trauma centers (Levels I and II) can treat almost any condition at any time, from serious car crashes to gunshot wounds. ERs that receive trauma patients whose injuries exceed their capabilities are required to transfer them to higher-level facilities.

Trauma centers are designated as such by independent state agencies and/or verified by the American College of Surgeons (ACS). ACS is the gold standard that trauma centers aspire to but they don’t necessarily have to be verified as such. Technically, a trauma center designation is for the entire hospital as trauma center staff work throughout the hospital in many different departments. Trauma centers are staffed with caregivers specially trained in trauma care.

“It means that all of the staff from the nurses to the doctors to the trauma surgeons to the radiologists—everybody involved in the care of the patient from arrival through discharge home, and even ensuring that they can do well at home, has special education and training for a trauma center,” says Jeanne Schuppe, Director of the Emergency Department at Good Samaritan Medical Center, a Level II Trauma Center (more on that below).

Trauma centers are classified by different levels with the highest level (Level I) able to care for all traumas in-house and lower levels focusing more on stabilizing patients and transferring to a higher level of care (See the Levels of Trauma below).

Care after hours

Many people end up in an ER as a result of scheduling, not necessarily medical necessity. This can be costly, as the advanced, round-the-clock care provided by ERs is by nature more expensive. And, by law, if you come to an emergency room for care that facility is required to treat you. For less serious issues, there are more appropriate alternatives for care. Urgent care refers to clinics that operate on a walk-in basis and keep non-traditional hours, but are not designated emergency facilities. Some family medicine clinics offer walk-in care at certain times.

These alternatives can save you money and time, while providing care in the most optimal way.

Have a plan

In the event you are sick or have an emergency, you don’t want to be scrambling or searching for where to go or what to do. You might view emergency care as strictly left for chance, but when the unexpected happens it’s good to have a game plan drawn up in advance. Calling 911 is the obvious first step you need to take in the most serious of emergencies, but you should know what services are close to you for needs that don’t rise to such a level. Our experts recommend the following steps:

• Know where your closest emergency department is. Whether it is part of a hospital or a satellite facility, take the time to know the level of care it provides and what your insurance covers.
• Find out if your primary care doctor provides same-day visits or offers after-hours care. This is often the best option for urgent, but non-emergency medical issues.
  For affordable after-hours care, find out if an urgent care facility is near you and exactly what its capabilities are.
• Find out where the nearest accredited Chest Pain and Certified Stroke Centers are. These emergency departments provide the best care for these specific critical issues.
• Keep vital information with you. “Keep a list in your wallet with medications you’re taking, any allergies, your primary care doctor, and advanced directives,” says Heather Johnson, Clinical Supervisor of the Emergency Department at St. Vincent Healthcare.
• Know your insurance. Specifically, know if you have a high-deductible plan because that can make emergency care very expensive. Find out if you have differing co-pays for urgent care, emergency care and doctor visits. When you have a true emergency, don’t worry about insurance. But if you have more time and options, your cost of care can vary quite a bit.

 

Know Your Levels

Trauma center levels are really most relevant for EMS care providers. Ambulance staff have protocols in place that guide them to the appropriate level of trauma center based on a patient’s injuries or suspected injuries. Knowing the designation levels can help inform you if you have multiple options in your area.

The ACS recognizes five levels of trauma centers, but I-IV are easily the most common. For a more thorough explanation of trauma levels visit the American Trauma Society. If you want to know about the capabilities of a trauma center near you, below are some highlights of the different levels.

Level I:

• The highest level of trauma designation and capable of caring for every aspect of an injury.
• All surgeons and specialists are either in-house or promptly available.
• Meet a minimum yearly patient volume.
• Perform medical research to drive innovation in trauma care and may provide treatments not available at other facilities.

Level II:

• Capable of initiating care for all injuries and completing care for almost any injury.
• 24-hour coverage by trauma surgeons and emergency physicians.
• All other specialists, such as orthopedic surgeons, anesthesiologists and more, are on call and have designated response times based on the injury.

Level III:

• 24-hour coverage by emergency physicians and trauma surgeons on call.
• Based on the injury, may be required to consult with or transfer to a higher level of trauma center.

Level IV:

• Primarily focused on evaluating, stabilizing and diagnosing trauma patients before transferring to a higher level of trauma center.
•  Trauma nurses are available upon patient arrival.
• May provide surgical and critical-care services if available, but not required.

All trauma centers must have a comprehensive quality assessment and improvement program and an education and prevention outreach program for surrounding communities.