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News | Aug. 20, 2021

LRMC verified as only Level II Trauma Center overseas

By Marcy Sanchez

Landstuhl Regional Medical Center recently became the only medical facility outside the United States verified as a Level II Trauma Center by the American College of Surgeons.
Previously verified as a Level III Trauma Center, LRMC’s new designation reflects the medical center’s commitment toward maintaining a robust trauma program in compliance with 286 criteria focused on immediate and comprehensive care following trauma incidents.
“The verification reaffirms LRMC’s commitment to the injured warfighter,” said U.S. Army Lt. Col. Brad Rittenhouse, medical director for LRMC’s Trauma Program. “Trauma care is more than simply providing the medical care (required). It's a whole system of ensuring the adequate resources are at the trauma center, adequate training of providers and support staff exists, and the program encapsulates (those requirements) and maintains organization of that system.”
According to the American College of Surgeons, a Level II trauma center is able to initiate definitive care for all injured patients. Some elements for the verification include 24-hour immediate coverage by general surgeons, orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology and critical care. At the height of the wars in Iraq and Afghanistan, LRMC was verified as a Level I Trauma Center partly due to the volume of trauma patients evacuated to the medical center.
“It was incredibly busy,” said Peter Williams, manager for LRMC’s Trauma Program and former Army nurse who served at LRMC’s Intensive Care Unit from 2011-2013. “It was very turbulent, very high volume time with very complex trauma.
Although patient throughput has decreased over the past few years, the need for trauma care remains.
According to Williams, a San Antonio native, while LRMC presently has a much lower volume of trauma patients, the complexity of injuries has not gone down.
“Actually, data has shown that the complexity or the severity scores of those patients have actually gone up since the height of the war,’ he said. “(Injuries) are probably as or more complicated than they were in the past.”
Additionally, as a Level I Trauma Center, LRMC was very involved with research and publications of trauma injuries. Although that effort has also contracted, the hospital remains dedicated to contributing trauma research and data to the medical community as part of its exclusive role in providing trauma care to injured Service Members from four U.S. unified combatant commands; U.S. European Command (USEUCOM), U.S. Africa Command (USAFRICOM), U.S. Central Command (USCENTCOM), and the U.S. Special Operations Command (USSOCOM).
“(LRMC’s) trauma system is the most unique in the world as it spans through three continents, which no other system does,” said Rittenhouse, a native of Springfield, Missouri. “Unfortunately, the (Department of Defense) trauma system has a lot of experience from the last 20 years, more than most civilian institutions, whether here in Europe or U.S.”
In response to the Level II Trauma Center verification, the number of physicians has doubled in the Intensive Care Unit, one of the first stops for trauma patients.  
“More ICU doctors means more capabilities so we have the ability to care for sicker trauma patients or sicker patients (in general),” said U.S. Army Maj. Nathan Boyer, medical director, Intensive Care Unit, LRMC, a native of Boise, Idaho. “No matter time of day or whenever they come in, we're always here to assess them.”
According to Boyer, the Level II Trauma Center verification allows LRMC units like the ICU to maintain the personnel required to treat trauma patients 24/7, as well as the level of complexity and the quality of care.
While tertiary care needs such as cardiac surgery, hemodialysis and microvascular surgery may be referred to a Level I Trauma Center in the host nation or Continental U.S., other services, such as vascular surgery and interventional radiology, which had been missing from LRMC’s arsenal since downgrading to a Level III Trauma Center five years ago, relaunched in response to the Level II Trauma Center verification.
Aside from the treatment of medevacked Service Members, these services benefit other patient populations near LRMC.
“Peripheral vascular surgery involves care of the blood vessels in the body, arteries, veins but not those in the heart or the brain,” explains U.S. Air Force Lt. Col.  Jennifer Sexton, chief, vascular surgery, whose surgical program only relaunched nine months ago. “I can offer a broader service to our patients, although vascular injuries would initially be cared for (at the point of injury), I can do any follow-on procedures that are necessary and continue that care (at LRMC).”
Connie Johnson, incoming Trauma Program manager, explains the verification also benefits the Joint-Service staff at LRMC, a blend of U.S. Army, Air Force and civilian healthcare professionals, in conserving a ready medical force.
“One of the main reasons for becoming a Level II Trauma Center is to ensure we have the right resources and capabilities to handle those type of injured patients that are admitted to our hospital,” said Johnson. “When (LRMC staff) do deploy, they’ll be more ready to handle (trauma). It's all inclusive of who's going to benefit (from the verification).”
Lastly, LRMC’s own Medical Transient Detachment, designed to accommodate injured and ill Service Members, along with its relationships with supporting organizations such as the American Red Cross, USO and Fisher House are better poised to support Service Members and their families, making LRMC the preferred location for overseas trauma efforts.
“(LRMC) can deliver the level of care they're accustomed to and deserving of,” said Williams. “We're better suited to accommodate them and can make a very unpleasant situation a lot more comfortable.”
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