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Categorization of Emergency Services

Hospitals are categorized by their ability to provide acute care as determined by the availability of doctors, nurses, supporting staff and other resources. The Joint Commission on Accreditation of Healthcare Organizations (which accredits hospitals in the United States and other countries) has established 4 levels of emergency service.

Level I : Emergency service 24 hours a day with at least one physician experienced in emergency care on duty in the emergency department. There must be in-house physician cover by residents at the senior level or higher for medical, surgical, orthopedic, obstetric-gynecologic, pediatric, and anesthesiologic services.

Level II : Emergency care 24 hours a day with at least one physician experienced in emergency care on duty in the emergency care area. Specialty consultation should be available within 30 minutes.

Level III : Emergency care 24 hours a day with at least one physician on duty in the emergency care area available within 30 minutes.

Level IV : This service is capable of performing triage function (sorting of patients) and can administer life saving first aid until transportation to the nearest appropriate facility is available.

Categorization of Trauma Centers

Hospitals are also categorized from trauma management point of view. The American College of Surgeons have established the following categories of trauma facilities.

Level I Trauma Center : One or more emergency physicians, a general surgeon, anesthesiology services, laboratory, blood bank and operating theatre team must be available in house 24 hours a day. All subspecialty services should be available on call. A commitment to education and research in trauma must be demonstrated.

Level II Trauma Center : Similar to Level 1 but does not include commitment to education or research.

Level III Trauma Center : Does not have all the resources available at Level 1 or 2. Initial stabilization and life saving procedures are performed and the patient is then transferred to a higher center.