A trauma center is a hospital, or facility connected to a hospital, with the necessary medical equipment and resources to provide care for patients with severe injuries. In the United States, trauma centers may be classified into five different levels: Level I – V. All facilities, regardless of their level, play a critical role in the American health care system

Hawaii has only one Level I Trauma Center in the state, that is Queen’s Hospital and Queen’s is the only one in the Pacific.

What are the Truama Levels?

A Level I Trauma Center is capable of providing total care for every aspect of injury – from prevention through rehabilitation.

A Level II Trauma Center is able to initiate definitive care for all injured patients

A Level III Trauma Center has demonstrated an ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations.

A Level IV Trauma Center has demonstrated an ability to provide advanced trauma life support (ATLS) prior to transfer of patients to a higher level trauma center.  It provides evaluation, stabilization, and diagnostic capabilities for injured patients.

A Level V Trauma Center provides initial evaluation, stabilization and diagnostic capabilities and prepares patients for transfer to higher levels of care.

According to the CDC, there is  roughly 25% reduction in fatalities among severely injured patients who receive care at a Level I trauma center rather than a non-trauma center.

Emergency rooms are not trauma centers and only specialize in quick, more basic treatment of mild to moderate injuries as well as illnesses. However, they do not usually have the specialized equipment and resources to treat more severe injuries.

The number of hospital beds in Hawaii may or may not be a good gauge on what the medical community can handle. How many of those beds are occupied at any given time will depend on how stressed the system would be.


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  • CAH: Critical access hospital – a federal designation given to small hospitals that provide essential emergency and acute care services in remote areas.
  • Intermediate Care Facility (ICF) level of care: a medical level of care that requires intermittent nursing care. It is also known as custodial care.
  • Skilled Nursing Facility (SNF) level of care: a medical level of care that requires 24 hour skilled care such as physical or occupational therapy, nursing monitoring, etc.
  • ACH: acute care hospital
  • REHAB: Acute medical rehabilitation

The military could provide the USNS Mercy.which is a Level I trauma center and has a blood bank capacity of 5000 units. It is a hospital afloat capable of holding 1000 patients aboard a converted oil tanker. This would take time and would not help the immediate need of the Islands.

The “Just in Time” delivery system is a vulnerability in the time of a disaster. If power goes out, water flow is interrupted and or the Harbor is closed it would be a disaster into itself for the medical facilities in Hawaii.

How long would the supplies last that are on hand and could they be easily transferred to other hospitals and clinics in Hawaii? Think about the medicine that must be refrigerated, if there is no electricity to keep medicine at the temperature it must be maintained then that medicine would expire. Pharmacies may have back up power but a vast majority of homes do not have auxiliary power.

A big issue with Hawaii is the tourism industry. All the tourists that would need medical care, food supplies, hotel accommodations, etc.

Would these hospitals be enough and would they have the supplies needed for long term care? If the ports and airfields are damaged how long would it take to get them back up and operational to receive the supplies needed for the population? Hawaii recently put out guidance that you need to be prepared for 14 days, not the normal 72 hours, as it will take time following a disaster for a logistics bridge to be built to Hawaii if our harbors and airports are affected by a major disaster and we may be relying on our own resources longer than other places within the United States.