As Tarrant County’s only Level I trauma center, John Peter Smith Hospital in Fort Worth sees nearly 4,000 trauma patients a year. Combine those trauma patients with patients who have less severe injuries and the hospital is between 87-92 percent full on a daily basis, according to JPS CEO and President Robert Earley.


Although Tarrant County has 10 trauma centers, Earley said the county will need more in the future to accommodate population growth.


“We are trying our best to accommodate growth the best we can,” he said. “We actually have a committee in place now looking at JPS and its current capacity. There’s definitely a need for more capacity in trauma care and mental health as well.”


With a population of 2 million, Tarrant County is the third largest county in Texas in terms of population. That number is expected to grow to almost 2.7 million by 2040, according to U.S. Census Bureau data.


“Everywhere you look there is growth,” said Mickie Watson, trauma program manager at Texas Health Resources, a nonprofit 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 more trauma.”


The American College of Surgeons estimates that one Level I trauma center—the highest designation a hospital can receive—is needed per 1 million people, meaning Tarrant County needs aExperts: County growth warrants more trauma centers    t least two Level I hospitals. In comparison, Dallas County, which has a population of 2.5 m illion, has four Level I trauma centers.


Although there are no plans currently for another Level I center in Tarrant County, Baylor Scott & White Medical-Grapevine is in active pursuit of Level II. Earley said the addition of another Level II center will help alleviate some capacity of JPS.


“We are proud to be helping Baylor-Grapevine on their Level II; our team over here at JPS has been working with the Baylor-Grapevine crew, and we have a lot of respect for them,” he said.


Tarrant County has two Level II trauma facilities: Cook Children’s Medical Center in Fort Worth and Texas Health Harris Methodist Hospital in Fort Worth.


Baylor Scott & White All Saints Medical Center-Fort Worth, Texas Health Harris Methodist Hospital Hurst-Euless-Bedford and Medical City Arlington are the county’s Level III facilities. Medical City North Hills, Texas Health Huguley Hospital, Texas Health Arlington Memorial and Texas Health Harris Methodist Hospital Azle are the county’s Level IV hospitals.



Understanding trauma levels


Any injury can be classified as a traumatic injury, Earley 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 or has a disease that is causing other complications, and an injured patient, which is usually a healthy person who is injured. Trauma centers have specific processes in place based on the type of injury, how the injury occurred and the body’s response. 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 facilities are required to have a research component and have a full range of specialists and equipment in-house available 24 hours a day. Level I trauma centers also differ from Level II facilities in that they have a  teaching and research component. A Level II center can handle a majority of trauma incidents, but it does not have a full range of specialists in-house available 24 hours a day; instead specialists are on call 24 hours a day.


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. Doctors are required to respond within 30 minutes.


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


Experts: County growth warrants more trauma centers



Baylor-Grapevine seeks Level II


In August or September, Baylor Scott & White Medical Center-Grapevine is expected to become a verified Level II trauma center.


BSWMCG President Steven R. Newton said for residents in and surrounding Grapevine, earning the designation would mean most trauma patients would no longer have to be transported to Dallas or Fort Worth.


“Baylor Scott & White-Grapevine is equipped with the resources to provide treatment from the beginning to the end so that the patient does not have to be transferred from one center to another,” he said.


Newton said the designation would help serve a need in the community that is not currently being met.


“In trauma care, every second counts, and having the availability of a high-functioning trauma center in this community allows for immediate care of the injured and can make a difference in saving someone’s life,” he said. “Patients and their families will no longer be transferred out of their communities to downtown Dallas or Fort Worth as our facility can now provide those comprehensive services to those who are critically injured.”


Newton said there are no plans at this time for the facility to pursue Level I trauma designation.



How hospitals work together


As a Level I facility, Earley said JPS goes through various drills to make sure its ready for large-scale events, natural disasters or bombings as well as when international and world leaders come into town.


“When the Super Bowl came to Arlington, [JPS], the county, law-enforcement officials and first responders did weekly activities to prepare for what could potentially happen at an event like the Super Bowl,” he said. “We are also very cognizant of when the [Texas] Motor Speedway has an event in and it’s actually quite frankly not so much for the drivers, but it’s for the amount of people who go out to watch the event and who might get in an accident.”


Although JPS can handle a substantial number of trauma patients at one time, Earley said it is important that 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.


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 saturation—or capacity—level. This status is available to all hospitals, EMS agencies, fire departments, air medical agencies and EMS ground transport companies.