It’s always dangerous writing about something that I know nothing about, and I will admit it right off the start with this piece. But once in a while a piece of information is shared that just keeps bothering a person…and maybe we all can be enlightened, which is my hope.
From what I know, since 2005 the State of Minnesota Department of Health has implemented a voluntary system by which hospitals are designated levels for the type of trauma patients that they can handle. The designations go from Level 1 (most severe) to level 4 with a few hospitals in the state being “undesignated”. Designation is based upon certain requirements and once designated a hospital has that designation for 3 years. The State Department of Health can lower a designation during that period if services offered at the facility changes. EMS providers follow rules as to what hospital to transport a patient to depending upon injuries and what trauma level a hospital is.
Having said that…the State of Minnesota has 4 Level 1 Trauma hospitals, 3 in the Twin Cities. They are North Memorial, Hennepin County Medical Center, and Regions Hospital with the 4th being St. Mary’s in Rochester. Level 2 Trauma Centers include the St. Cloud Hospital, both hospitals in Duluth; Meritcare, Innovis, Altru in Fargo/Grand Forks; and the University of Minnesota Fairview Medical Center in Mpls.
The next level is 3. Â Level 3 hospitals include: St. Mary’s in Detroit Lakes, Lakewood Medical Center in Staples, St. Joseph’s in Brainerd, Cuyuna Regional Medical Center in Crosby, Riverwood Medical Center in Aitkin, Grand Itasca Medical Center in Grand Rapids and Fairview Mesabi Medical Center in Hibbing. Many of these facilities are significantly smaller than NCRHÂ which has one of NW Minnesota’s busiest 24 hour staffed emergency room operations. Bemidji is even a base for the North Memorial Air Helicopter operations for NW Minnesota.
This all might be a moot point. United Hospital in St. Paul, which is a prominant operation, is listed as an undesignated trauma hospital, which is also surprising to me. Should there be any concern about this level 4 designation? Â What does a level 3 trauma hospital offer that a level 4 does not? I am a strong supporter of North Country Regional Hospital and think they do an outstanding job and this is no reflection on their operations. It’s really more just curiosity driven. Maybe we all can get smarter on this subject.
I am the trauma medical director for one of the Level I trauma centers in the Twin Cities, and a national and state trauma center reviewer. Level 4 centers are primarily stabilization facilities. They do not need to have a surgeon, and may not evan have a doctor in the hospital when the patient arrives. If paramedics are transporting someone who does not have a good airway, or who is in shock and in need of IVs for fluids, they will stop at a Level 4 go get those things taken care of. Then they are on their way to the closest appropriate higher level center.
A Level 3 center does have an ED doc and a surgeon available. Depending on the injuries, they may be able to treat and admit the patient to their hospital. For example, someone with a few rib fractures could be very well taken care of at such a center. If they have more serious injuries or need specialists not available there, they have 30 minutes to get them moving to the closest Level 1 or 2 center.
Children are best taken care of at the nearest Level 1 adult center, unless they have injuries that require followup treatments or rehab. In that case, they should be taken to the nearest Level 1 Pediatric Trauma Center (Regions or Mayo).
Michael McGonigal MD
Director of Trauma Services
Author of the Trauma Professional’s Blog (http://www.regionstraumapro.com)
I think level fours and level IIIs can only take natural health medical emegernices
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