Until Medical City Plano received its designation, the population in the northern Dallas-Forth 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.

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 yet received official notification from the state, which may be 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 or has a disease that is causing other complications, 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 in-house available 24 hours a day. Level I trauma centers differ from Level II facilities because they also offer teaching and research.

The process to be certified from a Level II to a Level I can take 18 months to three years. 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 saturation—or capacity—level.

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

Non-trauma center emergency rooms, such as Methodist McKinney Hospital, can typically handle any trauma case that comes in, stabilize the patient and then transfer him or her to a hospital with increased trauma care if needed.

“When we get a patient who needs services that we cannot provide, like a stroke center, [catheterization] lab, ICU, et cetera, we stabilize them and then transfer them to an area hospital with a higher level of care,” Methodist McKinney Hospital President Joe Minissale said in an email.