Hospital Emergency Departments and Trauma Centers

Today Los Angeles county's emergency medical services system has two hospital based components: hospital emergency departments and trauma centers. In both instances, to receive patients through the prehospital care system, hospitals must have a basic or comprehensive emergency service permit with a physician on duty at all times. Base hospitals must be licensed at either level and have specially trained staff available at all times. Receiving hospitals are not base stations and may be licensed at a lower level. Their emergency department may be covered by a physician who has not been certified by the American Board of Emergency Medicine, nor trained in emergency medicine. In 1989 Los Angeles had 143 licensed general acute care hospitals. Of these, two had comprehensive emergency services, 89 basic emergency services, 19 standby, and 33 had no emergency department at all. These hospitals handled 2,416,434 emergency department visits that year. According to the Annual Report of Hospitals, there were 510,343 emergency department visits in county operated emergency hospitals. Finally, two of the County's six Comprehensive Health Centers also receive basic life support ambulance patients. More than 3,074 patients were transported to these centers that year. (LAEMSA, 1991, p.4-5,6.) The Central Los Angeles area, which includes the majority of South Central Los Angeles, has thirteen emergency hospitals with 216 treatment stations. (A treatment station is a space within a licensed emergency room where staff is capable of providing an average of one hour of care per patient.) The emergency services at these hospitals managed 507,639 emergency visits or 21 % of the County's total visits for 1989. LAEMSA implemented its trauma care system in 1983. Initially twenty-three hospitals received approval as trauma centers. However, by 1991 this number had dropped to thirteen. Centers dropping out cited numerous problems including: inadequate medical reimbursement; availability of specialty care physicians such as neurosurgeons; cost containment policies instituted in 1983; patient's ability to pay; the mix of blunt vs. penetrating trauma; competition for scarce hospital resources such as intensive care beds and convenient surgery times between hospital specialties; excessive numbers of trauma cases for training surgeons compared to other types of surgery; and the desire not to treat certain patients that care givers perceived as posing a threat to them or their patients (See: Narad and Smiley, 1992; Moorhead, 1990; Melnick, et.al., 1989; Bishop, 1989; AOR, 1987).

Medical Care for the Injured

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