The San Diego Union Tribune reports that the American College of Surgeons has named Scripps Memorial Hospital La Jolla San Diego’s fourth Level 1 trauma center, formally recognizing the medical center’s efforts around medical education and research.

According to college guidelines, a top-tier rating is reserved for those facilities that can prove they admit at least 1,200 trauma patients per year, at least 240 of which have high injury severity scores as those numbers are “the minimum volume that is believed to be adequate to support the education and research requirements of a Level 1 trauma center.”

During site visits that include reviewing patient charts and other documents, inspectors verify a wide range of factors, including that centers train surgical residents, conduct education and other outreach activities for their communities and participate in ongoing research.

In terms of the range of treatment capabilities they offer, Level 1 and Level 2 centers are identical. Both are required to provide “total care for every aspect of injury, from prevention through rehabilitation.” Some services, such as the reattachment of severed extremities, might only be found at Level 1.

Each must prove through regular inspections that they staff a 24/7 trauma team, including the presence of an attending surgeon round the clock. Both levels must demonstrate that their trauma teams can be fully activated in no more than 15 minutes for the most severe cases that include patients with respiratory difficulties and injuries ranging from penetrating wounds and skull fractures to amputations and “crushed or mangled” extremities.

Scripps La Jolla began working toward Level 1 designation in 2018, hiring Dr. Walter Biffl, previously at Queen’s Medical Center in Honolulu, to serve as its trauma medical director.

Biffl oversaw the gradual introduction of medical residents from Navy Medical Center San Diego. The Navy already had an existing relationship with Scripps Mercy Hospital in Hillcrest, previously the health system’s lone Level 1 center. Already known for trauma research before coming to San Diego, Biffl has worked to expand La Jolla’s scholarly activity.

San Diego County’s trauma system, one of the first and most developed in the nation, assigns specific territories called “catchment areas” to each adult trauma center, with Scripps La Jolla receiving all severe traumatic injuries from the northern shore of Mission Bay north all the way to the Orange County Border.

Palomar Medical Center Escondido, a Level 2 facility, handles cases throughout non-coastal North County east to the Imperial County border with Sharp Memorial Hospital, also Level 2, receiving cases in a wide swath that generally follows Interstate 8. Scripps Mercy and UC San Diego Medical Center, both Level 1, split responsibility for cases from downtown San Diego and Hillcrest south to the border. Rady Children’s Hospital in San Diego, also Level 1, handles all pediatric trauma cases countywide.