Collin County has 14 hospitals and four trauma centers. With the county population expected to reach more than 2.5 million people by 2040—with much of that growth expected in Frisco and McKinney—area medical officials are evaluating the need for expanding trauma care.

“Everywhere you look there is growth,” said Mickie Watson, trauma program manager at Texas Health Resources, a non-profit organization that operates a network of hospitals. “Well, with that growth is going to come a lot of people. And with all of that growth is going to come trauma.”

Charles Gressle, CEO of Medical City Frisco and Medical City Plano, said when looking at the state of Texas and the nation, a Level I trauma center—the highest level of service—is needed for about every 1 million people. This means Collin County would need two Level I trauma centers by 2040.

In response to that demand, Medical City Plano, a local hospital, received certification May 11 as the county’s first Level I trauma facility.

Before Medical City Plano’s designation, the northern Dallas-Fort Worth suburbs had relied on Parkland Hospital in Dallas to serve as the lead trauma center in the region because it was the closest Level I facility.

Trauma patients requiring the highest level of care from as far north as southern Oklahoma would have been transferred to Parkland.

In addition to Medical City Plano, Collin County has three hospitals with lower-level trauma designations: Medical City McKinney and Texas Health Presbyterian Hospital Plano are Level III trauma facilities, and Texas Health Presbyterian Hospital Allen is a Level IV facility. Denton County has two Level III facilities—Medical City Lewisville and Medical City Denton.

Frisco does not have a hospital with any level of trauma designation.

Texas Health Presbyterian Hospital Plano is working on being designated as a Level II facility. The hospital has been increasing its capabilities since 2014 and has been operating at a Level II facility since September 2015.

Watson said the hospital hopes to be officially certified as a Level II facility by the end of June or mid-July.

Baylor Scott & White Medical Center-McKinney, which is currently not a trauma center, is also working to become a designated Level III trauma facility. This would add another trauma center to the region.

Susan Hall, a spokesperson at Baylor Scott & White Medical Center-McKinney, said the hospital has not received official notification from the state, which may take a few more months.

Watson said the area is fortunate to have several trauma centers, but she sees the need growing even more in the future as the population grows.

From 2003-11—the latest data available from the Texas Department of State Health Services—trauma cases in Collin County increased by about 135 percent, and the county population increased by about 36 percent.

In Denton County, trauma cases increased by 76 percent from 2003-11, and the population increased by 34 percent during the same time period.

“Do we have enough [trauma centers] to support the population in this area?” said Mike Mixson, trauma services manager at Medical City McKinney. “That’s what we’re currently evaluating on a regional basis.”

Understanding trauma levels

Any injury can be classified as a traumatic injury, Mixson said. But trauma levels vary as does the level of care required for each patient.

Hospitals see two types of patients: a medical patient, which is someone who is ill, and an injured patient, which is usually a healthy person who is injured, Mixson said.

“That doesn’t mean that every injury requires a full trauma response, and that’s what differentiates a trauma center from an emergency department or a hospital facility,” he said.

Trauma centers have specific processes in place based on the type of injury, how the injury occurred and the body’s response, Mixson said.

The centers are categorized by level ranging from the highest level of care, Level I, to a Level IV facility. The requirements for the levels are designated by the state, and Level I and II facilities are also verified by the American College of Surgeons.

Level I and II centers provide the same level of care for trauma patients and have a full range of specialists and equipment. Level I trauma centers differ from Level II facilities because they have specialists on-hand 24/7, and also offer research and teaching.

The process to be certified from a Level II to a Level I can take 18 months to three years. After representatives from ACS visit a hospital seeking a Level I designation, the hospital must operate for a full year as Level I center before it is officially designated. It took Medical City Plano nearly two years to receive its Level I designation by the state.

Level I and Level II facilities are required to see patients within 15 minutes of arrival because they have surgeons and specialists in-house, according to the Texas EMS Trauma & Acute Care Foundation’s Trauma Activation Guidelines.

Although Level III facilities do not have the full availability of specialists a Level I or II facility has, they still have the resources for emergency surgery and intensive care for most trauma patients. Surgeons and specialists are on call and are required to respond within 30 minutes.

The staff of a lowest level of trauma facility, Level IV, provides an initial evaluation, stabilization and diagnostics, but based on the severity of a case, it is likely to transfer the patient to the nearest trauma center with a higher designation.

How hospitals work together

In a trauma situation, paramedics determine the level of patient care needed, and the patient is subsequently transferred to the nearest trauma facility that can provide the needed care, Gressle said.

All nearby trauma centers work together as part of a regional trauma system, and representatives from each hospital take part in the North Central Trauma Regional Advisory Council.

In large-scale emergency situations, such as a tornado touchdown causing many injuries, NCTRAC members are able to use a computer software system to update other hospitals and trauma centers on the number of beds available and the hospital capacity.

This status is available to all hospitals, EMS agencies, fire departments, air medical agencies and EMS ground transport companies, Mixson said.