Trauma is the leading cause of years of life lost before the age of 75 years. Interestingly, while many European EDs are directed by an anesthesiologist with an interest in trauma, in the United States very few anesthesiologists specialize in trauma.
To attain level one status, a trauma center must have an available OR and an available, experienced anesthesiologist. A retrospective study of 27,633 patients analyzing the risk-adjusted odds ratio of admission to Level I or II (tertiary care) trauma centers and odds ratio of death after implementation of a state-wide (Oregon) trauma system showed an odds ratio of death of 0.82 (95% CI 0.73-0.92). [Mullins RJ et al. J Trauma 40: 536, 1996]