Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

full-service general hospitals that do not support medical or nursing educational programs
(e.g., residency training) or trauma research. Patient care remains exemplary, and
community outreach activities are a key part of the hospital’s mission. Most Level Two
Trauma Centers are located in large urban areas that are served by an academic medical
center but with a sufficiently large population to require a second full-service trauma
center, or they are in mid-sized urban areas that are not served by an academic medical
center. In the latter situation, the Level Two Trauma Center acts as the regional trauma
center, serving as the tertiary referral center for Level Three and Four Trauma Centers, as
well as for non-trauma centers and other facilities within the region.
Level Three Trauma Centers. Level Three Trauma Centers provide most trauma care in
the United States. They typically are located in community hospitals that serve small
urban or large suburban areas. Key specialists and services are available, suitable for
managing patients with injuries of a single system and few comorbidities. However,
medical and surgical subspecialist coverage may be limited, and patients with multiple or
severe injuries, with complex comorbidities, or who are very young or very old are
usually transferred to a nearby Level One or Level Two Trauma Center after initial
stabilization. Most Level Three Trauma Centers play an integral role in the regional
trauma system and collaborate with a Level One or Level Two Trauma Center within the
region. Again, patient care is exemplary, within the resources of the hospital and the
community. Community outreach is essential, particularly in terms of support for the
typically volunteer local emergency medical service agencies that serve the area.
Non-Trauma Centers
All facilities that receive emergency patients, including hospitals and free-standing
diagnostic and treatment clinics, should have the capabilities for resuscitating and
stabilizing injured patients of all ages. Therefore, protocols should be in place for
sustentative trauma care (including education of medical and nursing staff in early care of
injured patients) and for identification of patients in need of transfer to hospitals capable
of providing definitive trauma care (which should be known to all urgent care personnel
through prior development of formal transfer agreements). All such facilities should be:
• Considered part of the regional trauma system.
• Prepared to provide, within their communities, anticipatory guidance related to
injuries that is consistent with programs advocated by regional experts in injury
prevention.
• Participants in regional programs for performance improvement of community
trauma care, with special emphasis on the outcomes of patients transferred to
local trauma centers.
Treatment
Treatment of blast trauma involves full integration of the regional EMS system and the
regional trauma system, in accordance with plans developed in collaboration with
regional public safety and emergency management agencies. Although most blast trauma
is caused by explosive or incendiary agents, the possibility of other weapons of mass
destruction (WMD), such as biological, chemical, or nuclear weapons, should always be
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