









































                                                                                                                         2021, Vol. 1 (2) 1-2 
 https://doi.org/10.47488/dhrp.v1i2.4 

  
 

http://dhrproceedings.org 1 © DHR Health Institute for Research and Development 
 

 

TRAUMA BULLETIN 

A Christmas Story 

Jeffrey J. Skubic1,2 

1 Trauma Medical Director, DHR Health, Edinburg, TX, USA 
2 Assistant Professor of Surgery, The University of Texas at Rio Grande Valley - School of Medicine, 
Edinburg, TX, USA 
 
E-mail: j.skubic@dhr-rgv.com 
 
Received 12/03/2020 
Accepted for publication 01/28/2021 
Published 03/05/2021 

Keywords:  Trauma; Injury; Emergency;  Surgery;

It is Christmas night at your house at 2100 hours.  Everyone is 
all sitting around the house lounging, enjoying themselves 
after a long well deserved Christmas feast. Giggling erupts 
from the living room, where all the children of the extended 
family are watching holiday cartoons.  Frank Sinatra sings for 
his supper on the radio in the distant kitchen, while a large 
crackle erupts from the beautifully cut logs in the fireplace.  
Suddenly there is a loud boom, boom, and thud.  The crash is 
heard from the front stairwell. After quickly placing your glass 
of port down, you rush to the front of the house only to find 
your beloved 80-year-old uncle on the hardwood floor face 
down.  After you carefully roll him over, you note a swollen 
right face and very deformed nose.  Your astutely peel open 
his right eye and note that he does not have full motion of his 
right eye.  Feeling the effects of the alcohol, you ask your 
brother, who does not drink, to drive both of you to the 
hospital immediately.  You assist your uncle to the car and 
have him hold an ice pack to his face the entire ride.  At the 
hospital emergency room (ER), the emergency physician and 
trauma surgeon on call examine your uncle.  After examining 
him and performing a CT they share the news that your uncle 
has a severely deformed nasal fracture, a severe right orbital 
fracture, and real concern for nerve entrapment. He also has a 
small subdural hematoma that needs to be watched.  The 
trauma surgeon then shares the dreaded news with you:  There 
are no appropriate surgeons on call that night; they are going 
to prepare to transfer your uncle 250 miles to San Antonio, 
where the appropriate trauma team and surgeons will be 
waiting to receive him. 

You, as a healthcare worker, will you demand that they keep 
your uncle here?  Will you stamp your feet and demand they 
call each surgeon and find someone willing to come in?  Will 
you call the physician administrator on-call, complain that this 

is unacceptable, and demand they find a surgeon?  Will you, 
yourself, retrieve your cell phone from your jacket and call 
your colleagues demanding that one of them come to the 
hospital immediately to operate on your family member. 
Despite trying all, your uncle is loaded on a helicopter and is 
gone. You share your frustration with your family.  

Unfortunately, we and many others are faced with this 
awkward scenario. But why should this occur in 2020 in one 
of the more advanced countries in the world? The answer lies 
in an understanding that trauma is a disease, and the trauma 
patient requires the appropriate care from the appropriate 
facility as quickly as possible to treat their disease. That is the 
case for myocardial infarction and a cerebral bleed. The same 
is true for the trauma victim; why should they be treated any 
less? For this to occur, we need to have the level of care near 
the trauma patient with the resources to care for the victim 
24/7 completely. Trauma, like all other diseases, knows no 
limits!  

Your family asks you, “What should our uncle really get?”  

“He needs a ‘level one’ here!” 

“A what?” they ask. 

“A level one Trauma Center. Let me explain:” 

Trauma centers in the United States are identified in two 
fashions: A designation process and a verification process. 
The different levels (i.e. Level I, II, III, IV or V) refer to the 
resources available in a trauma center and the number of 
patients admitted yearly. These are categories defined by 
national standards for trauma care in hospitals. The 
categorization area is also unique to both adult and pediatric 



A Christmas Story    2020, Vol. 1 (2) 1-2   

  
 

http://dhrproceedings.org 2 © DHR Health Institute for Research and Development 
    
 

facilities. The Trauma Center designation is a process outlined 
and developed at a state or local level. The state or local 
municipality identifies unique criteria in which to categorize 
Trauma Centers. These categories vary from state to state and 
are typically outlined through legislative or regulatory 
authority. Trauma Center Verification is an evaluation process 
done by the American College of Surgeons (ACS) to evaluate 
and improve trauma care. The ACS does not designate trauma 
centers; instead, it verifies the presence of the resources listed 
in Resources for Optimal Care of the Injured Patient. These 
include commitment, readiness, resources, policies, patient 
care, performance improvement, education, and research.  
Verification is a voluntary process by the Trauma Center, and 
if verified, it lasts for a 3-year period.  Let me outline the 
common criteria for a Level One Trauma Center as verified by 
the ACS and also designated by states.  

Level I Trauma Center is a comprehensive regional resource 
that is a tertiary care facility central to a trauma system. A 
Level I Trauma Center is capable of providing total care for 
every aspect of injury – from prevention of the injuries 
through to the rehabilitation. In fact, rehabilitation is the key 
to the victim making a complete recovery. The key resources 
of a Level I Trauma Centers include 24-hour in-house 
coverage by trauma (general) surgeons and prompt 
availability of care in specialties such as orthopedic surgery, 
neurosurgery, anesthesiology, emergency medicine, 
radiology, internal medicine, plastic surgery, oral and 
maxillofacial, hand surgery, cardiac surgery, thoracic surgery, 
vascular surgery, obstetrics and gynecology, ophthalmology, 
urology and critical care. They are a referral resource for 
communities in nearby regions. They provide leadership in the 
prevention, public education to surrounding communities, and 
continuing education to their trauma team members. Level one 
trauma centers incorporate a comprehensive quality 
assessment program to keep their trauma care at a high level 
of performance. They provide organized teaching and 
research effort to help direct new innovations in trauma care 
particularly unique to the community they serve. Importantly 
they have programs for substance abuse screening and patient 
intervention. Finally, they need to meet a minimum 
requirement for the annual volume of severely injured patients 
to keep their trauma team experienced and always ready.  

In our uncle's case, he is best served in such a center with all 
the resources listed above available to him. He has multiple 
injuries and an ongoing injury of concern. He will require 
surgery and maybe even a second surgery. Then he will need 
post-operative care and rehabilitation to get him back to his 
quality of life. He needs an experienced team that can provide 
his trauma care immediately and not far from his home. Sadly 
we don’t have that here. 

So why should anyone not be provided with that level of care? 
As the New Year comes, let us continue to push to have a level 
one trauma center in the Rio Grande Valley. Let us not have 
to repeat this Christmas story. In the New Year let us treat our 
trauma victims the way they should be, and here at home.   

Diclosures 

JJS declares no conflicts of interest.  

References 

No references used in this document. 

  

 


