The document discusses different models of HMOs including staff, group, and network models. It also discusses different levels of trauma care from level I to level V trauma centers. A level I trauma center is a regional resource that can provide care from injury prevention to rehabilitation with 24/7 coverage of specialists. Lower levels have fewer resources and may transfer patients to higher levels. The document provides details on requirements for different trauma center levels and examples of trauma centers in the state of Georgia across levels I-IV.

1. HMO Models (Staff, Group, And Network)
Discuss the various HMO model and justify the answer
The HMO consists of various models that include staff, group,
and network based on the analysis. Staff is the most influential
people in an HMO because they deliver health services through
salaried experts and physicians. The HMO employs them to take
care of the HMO enrollees. The HMO characterizes the staff,
and they are said to serve the HMO's membership. For example,
the physician who takes care of a patient's health is said only to
take care and see patients in the HMO's facility. The patients
are told to receive services only through a limited number of
experts and physicians.
The group is considered a model in the HMO, making them one
of the essential parts. The HMO is said to offer compensation to
groups to offer contractual services at a negotiated rate. The
group is said to be responsible for giving compensation to their

2. physicians and offering contracts to hospitals to care for their
patients. The group practices many works with the HMO that is
it provides services to the non-HMO patients. It helps the non-
HMO patients to attain the service they require. The group is a
speciality that provides care and services to the HMO's
members.
Network in HMO models pertains to offering contracts to only
one physician group to take care of the patients. The HMOs may
contract a multi-speciality group or other health care workers to
provide them with physicians who will take care of the patient.
It can be said that HMOs that have networks contract more than
one physician to provide care to their patients. The network may
involve a single large group or a multi-speciality group. The
employed physician may decide to offer services to both the
HMO members and the non-HMO members because it is
allowed by the HMO. According to the analysis, the staff and
network are the most suited models required in the region. The
reason is that they provide physicians who take care of the
HMO members and the non-HMO members. They offer more
than one physician who takes care of the patients.
Discuss the vital and application of levels of emergency
department trauma care
Trauma is categorized according to different states.
Consequently, there are various trauma care levels. Level 1
pertains to the regional resource that offers central trauma
system care. For example, Leve I is said to provide care for all
injuries through rehabilitation. There are various factors in the
level I trauma centre. The factors include providing a
continuation of education to trauma team members, providing
leadership on public education to the community, and offering
referral resources to communities in the neighbouring regions.
Level II is said to establish definitive care for wounded
patients. Various factors are associated with level II. The
factors include providing trauma prevention education to staff,
offering a quality assessment program, and offering 24-hour
immediate coverage to the general surgeons. In addition, level

3. III provides evaluation, recovery, surgery, intensive care,
stabilization to all wounded patients and stabilization in the
emergency operations. In level III, various factors are
associated with this level. The factors include providing backup
care to rural ad community hospitals, continuing education on
nursing, and offering quality evaluation programs. Level IV has
provided advanced life support during the transfer of patients to
a higher-level trauma centre. It has also provided evaluation,
stabilization, and diagonalization on injured patients. The level
factors include providing patients with surgery and critical -care
services, a quality evaluation program, and improved transfer
agreements for patients requiring care. Lastly, level V offers
stabilization and diagnostic capabilities. It also prepares
patients who require transfer to higher-level care. This level
includes providing surgery and agent care services to patients,
providing trauma nurses and physicians required by emergency
patients, and offering basic emergency department facilities.
Finally, the critical Access Hospital is provided to rural
hospitals that are centres for Medical care and medical services.
Congress established the Critical Access Hospital through the
Balanced Budget Act. Critical Access Hospital was selected due
to the concern of medical reimbursement and accreditation.

4. References
American Trauma Society, (2017). Trauma centre levels
explained. Retrieved from:
http://www.amtrauma.org/?page=traumalevels
American College of Surgeons. (2017). Verified trauma centres'
FAQs. Retrieved from:
https://www.facs.org/quality%20programs/trauma/vrc/faq
All hospitals care for many types of injuries and emergency
conditions ranging from minor to severe, but not all hospitals
are designated as a Trauma Center. When a patient needs
emergency assistance, they will be taken to the hospital’s
Emergency Room (ER). Here, emergency physicians will assess
whether these patients in critical condition should be treated by
specialists in Emergency Medicine or by specialists in the
Trauma Center. Emergency Medicine typically addresses
broader, non-life-threatening injuries such as broken bones,
minor burns or injuries that may require stitches.
Emergency Room & Trauma Designation and Verification
Emergency Room Designation
According to Trzeciak (2003), an Emergency Room treats many
common conditions ranging from minor, non-life-threatening
injuries to possible heart attacks and strokes. The training for
Emergency Medicine differs from Trauma because it typically
encompasses a broader spectrum of emergency conditions.
Physicians and surgeons in Emergency Medicine see patients
with the following types of injuries or conditions: Broken
bones, Chest pains, Loss of consciousness, Minor burns, Minor
lacerations requiring stitches, Severe abdominal pain/ vomiting/
diarrhea, Sprains, Signs of a heart attack, and Signs of a stroke
(Trzeciak, 2003).
Emergency Room Verification
Certification and Compliance for the Emergency Room or

5. Emergency Departments is under the Emergency Medical
Treatment and Labor (EMTALA) (Zibulewsky, 2001).
The Emergency Medical Treatment and Labor Act (EMTALA)
requires hospitals with
emergency departments to provide a medical screening
examination to any individual
who comes to the emergency department and requests such an
examination, and prohibits hospitals with emergency
departments from refusing to examine or treat individuals with
an emergency medical condition. The term “hospital” includes
critical access hospitals. (EMTALA, 1986).
In turn, the regulation defines “dedicated emergency
department” as any department or
facility of the hospital that either: (1) is licensed by the state as
an emergency department;
(2) held out to the public as providing treatment for emergency
medical conditions; or (3) on one-third of the visits to the
department in the preceding calendar year actually provided
treatment for emergency medical conditions on an urgent basis.
(Aacharya, Gastman, & Denier, 2011).
Trauma Centers
According to Peitzman (2002) Trauma centers across the United
States are identified by a designation process and a verification
process. The different levels (i.e., Level I, II, III, IV or V) refer
to the kinds of resources available within a trauma center and
the number of patients admitted yearly. Being at a Level 1
trauma center provides the highest level of surgical care for
trauma patients.
Trauma Designation
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 may vary from state to state.
A facility can be designated an adult trauma center, a pediatric
trauma center, or an adult & pediatric trauma center. If a
hospital provides trauma care for both adult and pediatric

6. patients, the Level designation may not be the same for each
group. For example, a Level 1 adult trauma center may also be a
Level II pediatric trauma center. Pediatric trauma surgery is its
own specialty and adult trauma surgeons are not generally
specialized in providing surgical trauma care to children, and
vice versa.
Trauma Verification
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 but
verifies the presence of the resources listed in Resources for
Optimal Care of the Injured Patient. This is a voluntary process
by the Trauma Center and lasts for a 3-year period. Part of the
verification process includes requiring all members of the
trauma team to be knowledgeable about current practices in
neurotrauma care and the best evidence for the care of the
neurotrauma patient, including head, spine/spinal cord, and
peripheral nerve injury. Use of Brain Trauma Foundation’s
Guidelines for topics such as adult and pediatric head injury,
prehospital management, surgical management, penetrating
injury, and acute spine and spinal cord injury is strongly
recommended for all trauma centers.
Trauma Center Levels
As mentioned above, Trauma categories vary from state to
state. Outlined below are common criteria for Trauma Centers
verified by the ACS and also designated by states and
municipalities. Facilities are designated/verified as Adult and/or
Pediatric Trauma Centers. It is not uncommon for facilities to
have different designations for each group (ie. a Trauma Center
may be a Level I Adult facility and also a Level II Pediatric
Facility). (ACS, n.d.)
Level I
Level I Trauma Center is a comprehensive regional resource
that is a tertiary care facility central to the trauma system. A
Level I Trauma Center is capable of providing total care for

7. every aspect of injury – from prevention through rehabilitation.
According to the ACS (n.d.) requirements of Level I Trauma
Centers Include:
· 24-hour in-house coverage by 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,
pediatric and critical care.
· Referral resource for communities in nearby regions.
· Provides leadership in prevention, public education to
surrounding communities.
· Provides continuing education of the trauma team members.
· Incorporates a comprehensive quality assessment program.
· Operates an organized teaching and research effort to help
direct new innovations in trauma care.
· Program for substance abuse screening and patient
intervention.
· Meets minimum requirement for annual volume of severely
injured patients.
Level II
A Level II Trauma Center is able to initiate definitive care for
all injured patients.
According to the ACS (n.d.) requirements (Standards by the
ACS) of Level II Trauma Centers Include:
· 24-hour immediate coverage by general surgeons, as well as
coverage by the specialties of orthopedic surgery, neurosurgery,
anesthesiology, emergency medicine, radiology and critical
care.
· Tertiary care needs such as cardiac surgery, hemodialysis and
microvascular surgery may be referred to a Level I Trauma
Center.
· Provides trauma prevention and continuing education
programs for staff.
· Incorporates a comprehensive quality assessment program.

8. Level III
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.
According to the ACS (n.d.) requirements (Standards by the
ACS) of Level III Trauma Centers Include:
· 24-hour immediate coverage by emergency medicine
physicians and the prompt availability of general surgeons and
anesthesiologists.
· Incorporates a comprehensive quality assessment program
· Has developed transfer agreements for patients requiring more
comprehensive care at a Level I or Level II Trauma Center .
· Provides back-up care for rural and community hospitals.
· Offers continued education of the nursing and allied health
personnel or the trauma team.
· Involved with prevention efforts and must have an active
outreach program for its referring communiti es.
Trauma Centers in Texas
The following information was obtained for the Texas
Department of State Health Services (DSHS, n.d.).
· 20 facilities are currently designated as Level I
Comprehensive Trauma Facilities.
· 26 facilities are currently designated as Level II Major Trauma
Facilities.
· 62 facilities are currently designated as Level III Advanced
Trauma Facilities.
· 194 Facilities are currently designated as Level IV Basic
Trauma Facilities.
Designations may include, but not limited to Adult, Maternal,
Neonatal, Stroke, Trauma, and Data Sources
RESPOND IN 300 WORDS

9. Emergency room (ER) is a department of the hospital that treats
various conditions, illnesses, and injuries. The conditions,
illnesses, and injuries treated in an ER are broken bones,
stomach pains, strokes, heart attacks, and more. The trauma
units are typically accessed through the emergency department
but have their own beds and unit in the emergency department.
Trauma units handled brain injuries, severe car crashes,
assaults, gunshots, stab wounds, severe falls, and severe burns.
Trauma centers offer more extensive care than emergency
departments. Knowing which patients need a trauma center
versus an emergency room could be the difference between life
and death for these patients.
Trauma centers provide a comprehensible level of trauma
care. There are five levels of trauma centers, and the highest
level is level one. The American College of Surgeons, trying to
improve trauma care, came up with a consultation/verification
program in 1987. The level of the trauma center is determined
by the verification status by the American College of Surgeons.
In order to be a Level One trauma center, which is the
highest level of trauma centers according to the American
College of Surgeons, the following qualifications need to be
met:
· There must be a trauma/general surgeon in the hospital 24
hours a day.
· If there is a surgical resident in the hospital 24 hours a day,
then the attending surgeon can be on call from outside the
hospital and be able to get to the hospital within 15 minutes if
called in.
· There must be an anesthesiologist and full OR staff available
in the hospital 24 hours a day and a critical physician 24 hours
a day.
· If an anesthesia resident or CRNAs takes in hospital night
calls, then the anesthesiologist can pull call if they are within
30 minutes of the hospital.
· An orthopedic surgeon, neurosurgeon, radiologist, plastic

10. surgeon, and oral/maxillofacial surgeon must be immediately
availability.
· There must be more than 1200 trauma admissions per year.
· The leading physician must do at least 16 hours of trauma-
related CME per year.
· The centers must participate in research and have at least 20
publications.
In a Level Two, the hospital must have:
· 24-hour coverage by an in-hospital general/trauma surgeon
and an anesthesiologist.
The main difference between Level One and Level Two is that
Level Two does not have to do the publications.
A Level 3 does not require as much as Level One and Level
Two trauma centers. They do not have to have an in-hospital
general/trauma surgeon 24 hours a day in a Level Three, but a
surgeon must be on call. An Anesthesia and OR staff must be
within 30 minutes of the hospital and be on call. In Level Three,
the hospital must have transfer arrangements to transfer trauma
patients if they require services not available at the hospital.
There are five Level One trauma centers in the state of
Georgia, and they are as follows:
August University Medical Center in Augusta, Grady Memorial
Hospital in Atlanta, Medical Center Navicient Health in Macon,
Memorial Health University Medical Center in Savannah, and
Wellstar Atlanta Medical Center in Atlanta. There are eight
Level Two hospitals in Georgia, and they are as follows:
Doctors Hospital of Augusta in Augusta, Floyd Medical Center
in Rome, Northside Gwinnett Medical Center in Lawrenceville,
Northeast Georgia Medical Center in Gainesville, Piedmont
Athens Regional in Athens, Piedmont Columbus Regional in
Columbus, WellStar Kennestone Hospital in Marietta and
WellStar North Fulton Hospital in Roswell. There are eight
Level Three hospitals in Georgia, and they are Cartersville
Medical Center in Cartersville, Crisp Regional in Cordele,
Fairview Park Hospital in Dublin, Hamilton Medical Center in
Dalton, John D. Archbold in Thomasville, Piedmont Walton in

11. Monroe, Redmond Regional in Rome, and WellStar Cobb
Hospital in Austell. There are eight Level Four trauma centers,
three Pediatric Centers, with one of the Pediatric Center
hospitals being a Level One and the other two are Level Two.
There are two burn centers in Georgia and are verified by the
ACS.
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