When Minutes Matter, UK's Level-1 Pediatric and Adult Trauma Centers Can Mean the Difference in Life or Death

LEXINGTON, Ky. (March 15, 2018) — Car crashes, motorcycle accidents, falls from a rooftop or a cliff, gunshot wounds and even injuries from tornadoes. These are some of the types of incidents that can lead to being rushed to the hospital. And while nearly every hospital has an emergency room, a very serious injury may require a trauma center that offers more complex care – a difference that when minutes matter, could mean life or death.  

Earlier this year, University of Kentucky Chandler Hospital received re-verification as a Level-1 Trauma Center and as a Level-1 Pediatric Trauma Center by the Verification Review Committee (VRC) with the Committee on Trauma of the American College of Surgeons. This designation requires a two-day on-site review by a team of reviewers experienced in the field of trauma and recognizes the trauma center's dedication to providing optimal care for the most serious and critically injured patients.  

"Being a Level-1 Trauma Center and having verification means we have trauma surgeons and a multidisciplinary team of highly trained personnel available 24 hours a day, seven days a week," said Dr. Andrew Bernard, trauma surgeon and UK Adult Trauma Medical Director.  

Trauma centers handle the extreme cases where there is an issue of immediate survival and have highly-specialized surgeons on staff that work with the most advanced equipment to increase the likelihood of survival in patients. UK’s Pediatric and Adult Trauma Centers are the only Level-1 trauma centers for Central and Eastern Kentucky and UK is one of only 20 centers in the United States to be verified as both a pediatric Level I trauma center and an adult Level I trauma center.  

The biggest difference in a hospital emergency room (ER) and a trauma center is the breadth of services provided, mainly surgical services, said Dr. Joseph Iocono, pediatric trauma surgeon and chief of the Division of Pediatric Surgery. An ER can handle anything from sprained ankles to heart attacks. However, if the patient needs immediate surgical services to save their life, minutes count.  

UK is equipped and staffed to take care of any injured patient from birth until elderly, said Iocono.   

How do you know if you need a Trauma Center?  

Most often, a trip to the trauma center will not be decided by you. Patients with severe injuries, like those that require a trauma center, are often brought to the hospital by ambulance. Always call 911 in the event of any of these injuries.  

• Traumatic car crashes injuries  
• Gunshot wounds  
• Stab wounds  
• Serious falls  
• Blunt trauma (striking or being struck by an object)  
• Traumatic brain injuries  


 If the patient is not awake, is actively bleeding or may be bleeding internally or if they are having difficulty breathing, getting to a trauma center is paramount.  

Often times people think they can take someone to the nearest hospital faster by transporting them themselves, but other factors can make this a bad and possibly even fatal decision.  

"By calling 911, you have paramedics that in a moment of assessment, will know whether the patient needs a trauma center or you can be cared for by the closest ER," Iocono said. "If you are outside of Lexington, that may mean going to a regional hospital that is a level II or III trauma center that can stabilize the patient the best they can while they work with us to get them to UK as quickly as possible."  

Even if you are in Lexington, it may mean passing a closer hospital's emergency room to get to UK's trauma center. "If a patient has a severe traumatic injury such as a gunshot wound, you may not even stop in the emergency department," Bernard said. "Within one to two minutes of arriving at our door you may go straight to an operating table because that's where we control bleeding and save lives."   

Surgical Readiness  

It is that sort of trauma surgical readiness that makes a Level-1 trauma center special.   

And it isn't just the type of injury that makes UK Chandler Hospital invaluable for Kentuckians, it is the ability to handle a volume of patients.  

"At any time we may have two, three or even a half dozen patients who are severely injured and need a surgeon for immediate care and all of this happens within a very short amount of time," Bernard said. "But this is what we see and what we do every day at UK."  

While in a scenario such as the mass shootings in Las Vegas or Orlando where two dozen or more adults had gunshot wounds, resources can be strained. "But that is what we train for and practice for and prepare for," Bernard said.   

"We make sure we have backups systems in place to 'surge up' to meet that type of capacity of trauma patients if needed."    

While no one wants to think about gun violence and mass shootings happening in their community, both Iocono and Bernard insist it is their job to think about them and, more importantly, to prepare for them.  

"We practice mass casualty situations and simulations and we learn from others who have gone through these types of catastrophes," Bernard said.  

For example, trauma experts that cared for victims of the Boston Marathon bombing have shared information. "It is sad we have to do this, but you have a network of people that have been through it who tell you what worked and what didn't," Iocono said.  

Beyond UK: Kentucky's Trauma Care System  

While UK is the Level-1 trauma center for this region of the state, other hospitals across the state are part of the Kentucky Trauma Care System developed in 2012.  

Currently, 18 hospitals are part of the state's statewide trauma care system and verified Level I through Level IV depending on the resources available at the facility.  

"The goal of the state trauma system is getting the 'right patient to the right place at the right time'," said Iocono. "It also provides education for doctors, nurses and paramedics to care for and assess severely injured patients, so that they are taken to the most appropriate facility as quickly as possible."