Not all hospitals are created equal. Depending on the size, or location, there may be vast differences in the services and care available to a patient. If you come to the hospital for emergency care, you may find yourself in a trauma center.
Have you ever wondered what’s the difference between an emergency room (ER) and a trauma center?
In essence, an emergency room is a portion of a hospital that is open 24 hours, 365 days a year and is dedicated to treating life-threatening illnesses or injuries. Conversely, a trauma center is an entire hospital system that is specifically certified to treat patients who have experienced a severe injury, such as a bad concussion, a broken back, or serious burns.
Here’s some insider information on both and why it's so important you understand their capabilities so you know where to go and what to expect.
What is an Emergency Room and How Does It Operate?
An emergency room is dedicated to general emergencies. Here are some guidelines for Determining if the ER is more appropriate for your care. We'll also discuss trauma center "levels" below, as some hospitals can be trauma-certified without providing all the advanced care available.
The characteristics of an emergency room:
Let's look at these points in more detail.
Emergency Rooms are Open 24/7
Many people go to the emergency room because it's always open. No matter what's going on, the emergency department is open and ready to take care of whatever walks through their doors.
Keep in mind that Urgent Care and Emergency Rooms are two different things. An Urgent Care is not always open and will often refer more serious patients to an emergency room. If you're really sick and you go to urgent care, they will likely call an ambulance to have you transported up to an ER.
Note: While emergency rooms are open 24/7, some will become so full that they go on "bypass." This is essentially stating that they are at capacity and will refer ambulances to a different hospital. However, if you're just walking into an ED, they will still need to care for you, it just might take a while (depending on your injury or illness).
Emergency Rooms have a Physician available
Emergency rooms always have a physician on hand. Now, here's something to keep in mind: you won't necessarily see a physician. Sometimes, a PA or an NP will be working at the ED, and they'll be the ones to handle your care.
Also, in some states and some hospitals, the physicians working in an ER might not be "board-certified emergency room physicians." This means that, though they are physicians, they didn't specialize in emergency care. Again, this is a state-by-state thing, so check with your area to determine the official rules around this.
Emergency Rooms Can't Turn People Away
Emergency rooms are required to at least provide everyone with a medical screening and to treat immediate life threats. There's a thing called EMTALA, it's an act that essentially requires hospitals with emergency rooms to provide screenings and treatment for people, regardless of their ability to pay.
This is good news for people who need help in an emergency. During an emergency is not a time to worry about payment and all that. However, keep in mind that some people will abuse the emergency room, essentially using the emergency department as their primary source of health care.
When overuse of an ER happens, it leads to overcrowding, which means that people who have real emergencies might be delayed in getting the care they need. Health systems are trying to improve this problem by starting programs that help take people to other facilities (mental health centers, urgent care), instead of clogging the ER.
Emergency Rooms May be Limited in the Care They Can Provide
While emergency rooms must provide care to everyone, that doesn't mean that all ERs are equal. Certainly, there is a base level of care that must be provided at every ER, but that's not always as much care as you might think.
For example, take an emergency like a broken bone. In some ERs, there will be physicians there who are trained to reset and cast a broken bone, or even perform surgery if needed. However, some may not have surgeons on hand all the time. This leads to these patients taking another ride in an ambulance to a larger, more capable hospital.
Also, emergency rooms will sometimes experience malfunctions, losing their ability to read lab values or to perform a CT scan. This is rare, but it's worth noting that, just like things break down in your own home, equipment can break down or need repair at an ER.
And this leads us to another point: freestanding ERs.
What's a Freestanding Emergency Room?
In some areas, the "freestanding" emergency room has become a popular way to provide care. But how exactly do freestanding emergency rooms operate?
Essentially, a freestanding emergency room is not attached to a hospital. This means that, if you go to the freestanding ER, and it turns out you have a condition that warrants admission to a hospital, you will have to be transferred (often by ambulance), to another hospital.
Think about a freestanding ER as an urgent care that is upgraded to provide full emergency services. Freestanding ERs should be able to provide everything a hospital ER can provide - CT scans, labs, etc. But this is where things get muddy. If you have a severe injury, a freestanding emergency department will be preparing to transfer you to a more capable hospital right as you walk into the door.
Now, let's talk about trauma centers and their capabilities in light of what we've already discussed.
What's a Trauma Center?
All trauma centers have emergency departments, but not all emergency departments have a trauma center. Emergency departments that are not attached to a hospital can’t get trauma certification.
Let's talk about some of the different types of trauma centers:
Keep in mind that, in some states, the classifications and capabilities of a trauma center will be different. However, this guide should give you a general idea of what each center can provide.
Level 4 Trauma Centers Capability
Level 4 trauma centers are sometimes known as "trauma-ready" facilities. These trauma centers are likely to exist at smaller hospitals.
What can they do? Trauma 4 facilities have trained their staff to recognize and respond to trauma patients and provide care for life-threatening injuries.
What can't they do? Level 4 trauma centers will be limited in the amount of emergency surgery they can provide - and sometimes they can't provide emergency surgery at all. Also, the number of specialists will be limited.
Note: some states don't even recognize "level 4" trauma centers, as they do not hold extensive trauma capability. Again, terminology may vary by state.
Level 3 Trauma Centers Capability
The level three trauma center is common for average hospitals.
What can they do? Level 3 trauma centers often have some emergency surgery capability, as well as training their emergency staff to be trauma-ready.
What can't they do? Often, level 3 trauma centers are limited in their ability to provide specialty care. This means that patients with severe head injuries or severe burns are likely to be transferred (sometimes by helicopter) to a level 1 or level 2 facility.
Level 2 Trauma Centers Capability
A level 2 trauma center is usually located in a large city or a centrally located area. Level 2 trauma centers are often large institutions.
What can they do? Level 2 trauma centers can provide a wide range of surgical trauma interventions, as well as rehab care and specialists.
What can't they do? A Level 2 trauma center is often only differentiated from a Level 1 in its involvement with education. That's why you often see level 1 trauma centers associated with a large university, such as John Hopkins or the University of Michigan.
Level 1 Trauma Centers Capability
A Level 1 trauma center is the highest trauma classification. What can they do? Level 1 trauma centers can provide a full range of emergency surgeries as well as access to injury specialists. Level 1 is the highest classification.
What can't they do? Level 1 is the highest classification. However, some may have certain specialties. For example, a Level 1 trauma center can specialize in pediatrics, having more specialists available to treat young kids. This is important to keep in mind because the trauma classifications make it seem like the hospitals are "equal."
Trauma Center vs. Emergency Department: Why it Matters
If you want to ensure that you'll get the most appropriate medical care, then it's important to know the type of hospitals in your area. Know that the big hospital thirty minutes away might be able to provide better care than the small hospital down the road, and in some instances, it might be appropriate to take the longer journey to the bigger facility.
I advise everyone to become aware of the capabilities of the hospitals in their area. Usually, you can find this information online, but there's no reason you can't call your hospital and ask them about their trauma status. The more you know, the better prepared you'll be!
Are you prepared? Take some time to read about how to prepare a family first aid kit.