WHAT MAKES A PEDIATRIC LEVEL I TRAUMA CENTER UNIQUE

Trauma has been reported as the most common cause of pediatric mortality and disability. In fact, according to the ACS, more children die from injury than from all other causes combined. It is imperative to have systems in place that are developed based on knowledge, experience, and skill to help reduce the negative secondary effects and long-term medical and psychological problems that often follow a traumatic injury.

Children are not just small adults. There are anatomical and physiological differences that must be factored in when providing care for a child. In addition, there are differences in the mechanisms of injury in the various stages of childhood. These differences must be considered when anticipating the potential injuries sustained and providing the most effective treatment plans. Statistics have shown that there are increased rates of survival when a pediatric patient receives care at a Pediatric Trauma Center. The circumstances surrounding injury in children necessitate a unique response to major trauma and the allocation of specialized pediatric resources.

As the region’s only Level 1 Pediatric Trauma Center, Upstate Golisano Children’s Hospital takes a comprehensive approach to trauma. Childhood injury is a major public health concern, and there must be processes in place to evaluate and improve systems of emergency medicine and provide the highest quality of pediatric trauma care.

This high-quality care begins with injury prevention, continues with pre-hospital services and hospitalbased trauma care, and does not end until follow up care and/or rehabilitation has been established.

Pre-Hospital

The primary goals of EMS in the pre-hospital setting are to prevent further injury, initiate resuscitation and provide safe and timely transport to the appropriate location. The Center for Disease Control (CDC) publishes field criteria to assist EMS providers in the decision-making process when it comes to the appropriate location of transport. NYSDOH Division of Emergency Medical Services for Children (EMSC) further recognizes the importance of an appropriate transport destination, stating that, “children should be transported from the field to a level 1 or 2 Pediatric Trauma Center if they meet CDC field trauma triage guidelines and are able to arrive within 60 minutes of injury.”

Communication through an Activation System

In addition to transport, part of pre-hospital care includes notifying Upstate that a patient is on the way. This communication between EMS and the Pediatric Emergency Department (PED) is through Upstate’s Trauma Activation System and is based on a defined set of criteria. Once the information is received, a page is sent out alerting the necessary teams who can then make the essential preparations to facilitate safe and efficient medical treatment. Thus, care of the trauma patient begins before the patient even arrives at Upstate. The activation level determines what personnel is required to be present and the expected period of time in which they must arrive.

Levels of Activation:

A Level I trauma is the highest activation and is initiated for a patient who meets a certain mechanism of injury criteria and/or has unstable vital signs consistent with life threatening injuries. The Trauma Surgeon is required to be at the patient's bedside within 15 min of the patient's arrival. A Level II trauma is activated for patients who have stable vital signs pre-hospital but have either sustained or potentially have a severe injury. For both levels, the appropriate resources, including such areas as the Operating Room, Pediatric Intensive care Unit (PICU), radiology and blood bank are set in motion, and the full system prepares for whatever immediate care is needed. A Trauma Consult is another form of activation and is used when the patient has sustained a traumatic injury and is stable, but must be evaluated by the trauma team to determine an appropriate disposition and plan of care