Trauma centers: Radiologists’ role

w hile in Denver on vacation this past summer , I took note of the newspaper coverage given to drive-by shootings and other acts o f apparently random violence; the local editorials discussed how to stop them. Even the Governor held a special session with experts to develop strategies to deal with the violence and its aftermath. One editorial especially caught nay eye: "Denver is lucky to have three trauma care inst i tut ions"-for it properly focused on the excellent care that level I trauma centers provide. It even gave some specific examples o f lives recently saved in these trauma centers. But how many did they say again? Three? Perhaps Denver has a corner on the market for level I trauma centers, and perhaps if you live in any of the 70 or so metropolitan centers in the United States, you, too, believe that your city has multiple level I tramna centers. (For awhile, I was under the mistaken impression that there were five such trauma centers in Columbus, Ohio, as well; in fact, there are t h r e e O h i o State University, Childrens, and Grant Hospitals have designation f r o m t h e American College o f Surgeons (ACS) as level I trauma centers.) The National Academy of Sciences/ National Research Council originally proposed that emergency facilities be categorized based on the institutional ability to deal with the broad spectrum of trauma; the article was entitled "Accidental Death and Disability: The Neglected Disease o f Modern Society" (1966). Since 1976, the A m e r i c a n College o f Surgeons has published, and repeatedly updated, a document from its Commit tee on Trauma proposing a national ne twork of trauma centers. This network would consist o f level I (regional resource centers), level II (comnmnity trauma centers), and level III (rural health centers). Yet, even in 1994, realization o f the network has not occurred. The number o f verified centers are: level I, <100; level II, 75-100; and level III, <20. Why? Well, for starters, the level I designation is difficult to obtain, because site visits, p roof o f specialists, many o f t hem not only on call but in-house at all times, and peripheral centers for burn treatment, head and spinal cord injury, and rehabilitation centers (to mention some of the many requirements) are expensive to maintain and require vast resources. Designation is supposed to be a cooperative venture among hospitals in the city, and the injured are to be transported to the appropriate center even though that means bypassing the closest hospital. Such cooperation is frequently difficult to obta in w h e n hospitals see themselves as competitors. The ACS believed that only a few level I centers would be needed; the majority o f centers were envisioned by the ACS as level II. But wi th even fewer level II centers, we must search for other reasons; some clearly are political. In addition, who, after all, likes to be labeled #2? In some regions, hospitals may follow state or county guidelines, where they exist, for trauma level des ignat ion. W h e r e these guidelines are not followed, the hospital may simply designate itself a level I trauma center! I suggest you investigate in your area which hospitals call themselves level I trauma centers, and which of those have met the rigorous criteria as applied by the ACS and your state o r county. The criteria for radiologists' availability in the ACS trauma centers are vague; yet, we can and ottght to play a major role. Our prompt diagnoses in the emergency setting--as radiologists all k n o w c a n n o t be m a t c h e d by untrained observers who only know radiology as a sideline. To be a major player, we must be on site w h e n most trauma cases arrive. Radiologists who abdicate their positions will surely lose them to those who hustle in the Emergency Department.