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A trauma center (or trauma centre) is a hospital equipped and staffed to provide care for patients suffering from major traumatic injuries such as falls, motor vehicle collisions, or gunshot wounds. A trauma center may also refer to an emergency department (also known as a "casualty department" or "accident & emergency") without the presence of specialized services to care for victims of major trauma.Official designation as a trauma center is determined by individual state law provisions. Trauma centers vary in their specific capabilities and are identified by "Level" designation: Level-I (Level-1) being the highest, to Level-III (Level-3) being the lowest (some states have five designated levels, in which case Level-V (Level-5) is the lowest).The highest levels of trauma centers have access to specialist medical and nursing care including emergency medicine, trauma surgery, critical care, neurosurgery, orthopedic surgery, anesthesiology and radiology, as well as highly sophisticated surgical and diagnostic equipment.Lower levels of trauma centers may only be able to provide initial care and stabilization of a traumatic injury and arrange for transfer of the victim to a higher level of trauma care.The operation of a trauma center is extremely expensive. Some areas—especially rural regions—are under-served by trauma centers because of this expense. As there is no way to schedule the need for emergency services, patient traffic at trauma centers can vary widely. A variety of methods have been developed for dealing with this.A trauma center will often have a helipad for receiving patients that have been airlifted to the hospital. In many cases, persons injured in remote areas and transported to a distant trauma center by helicopter can receive faster and better medical care than if they had been transported by ground ambulance to a closer hospital that does not have a designated trauma center. The trauma level certification can directly affect the patient's outcome and determine if the patient needs to be transferred to a higher level trauma center.From Level I (comprehensive service) to Level III (limited-care). The different levels refer to the types of resources available in a trauma center and the number of patients admitted yearly. These are categories that define national standards for trauma care in hospitals. Level I and Level II designations are also given adult and or pediatric designations.Level IA Level I trauma center provides the highest level of surgical care to trauma patients. Being treated at a Level I trauma center can reduce mortality by 25% compared to a non-trauma center.It has a full range of specialists and equipment available 24 hours a day and admits a minimum required annual volume of severely injured patients. In addition, these trauma centers must be able to provide care for pediatric patients. Many Level II trauma centers would qualify for Level I if they were equipped to handle all pediatric emergencies.A Level I trauma center is required to have a certain number of the following people on duty 24 hours a day at the hospital:surgeonsemergency physiciansanesthesiologistsnursesrespiratory therapistsan education programpreventive and outreach programs.Key elements include 24‑hour in‑house coverage by general surgeons and prompt availability of care in varying specialties—such as orthopedic surgery, cardiothoracic surgery, neurosurgery, plastic surgery, anesthesiology, emergency medicine, radiology, internal medicine, otolaryngology and oral and maxillofacial surgery (trained to treat injuries of the facial skin, muscles, bones), and critical care, which are needed to adequately respond and care for various forms of trauma that a patient may suffer and rehabilitation services.Most Level I trauma centers are teaching hospitals/campuses. Additionally, a Level I center has a program of research, is a leader in trauma education and injury prevention, and is a referral resource for communities in nearby regions.Level IIA Level II trauma center works in collaboration with a Level I center. It provides comprehensive trauma care and supplements the clinical expertise of a Level I institution. It provides 24-hour availability of all essential specialties, personnel, and equipment. Minimum volume requirements may depend on local conditions. These institutions are not required to have an ongoing program of research or a surgical residency program.Level IIIA Level III trauma center does not have the full availability of specialists, but does have resources for emergency resuscitation, surgery, and intensive care of most trauma patients. A Level III center has transfer agreements with Level I or Level II trauma centers that provide back-up resources for the care of patients with exceptionally severe injuries (e.g., multiple trauma).Level IVA Level IV trauma center exists in some states where the resources do not exist for a Level III trauma center. It provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. It may also provide surgery and critical-care services, as defined in the scope of services for trauma care. A trauma-trained nurse is immediately available, and physicians are available upon the patient's arrival to the Emergency Department. Transfer agreements exist with other trauma centers of higher levels, for use when conditions warrant a transfer.Level VProvides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. May provide surgical and critical-care services, as defined in the service's scope of trauma-care services. A trauma-trained nurse is immediately available, and physicians are available upon patient arrival in the Emergency Department. If not open 24 hours daily, the facility must have an after-hours trauma response protocol.Pediatric trauma centersA facility can be designated an adult trauma center, a pediatric trauma center, or an adult & pediatric trauma center. If a hospital provides trauma care to both adult and pediatric patients, the Level designation may not be the same for each group. For example, a Level I adult trauma center may also be a Level II pediatric trauma center. This is because pediatric trauma surgery is a specialty unto itself. Adult trauma surgeons are not generally specialized in providing surgical trauma care to children, and vice versa, and the difference in practice is significant.

Nagarajan Srinivas (நாகராஜன் ஸ்ரீனிவாஸ்) : Thanks for the A2A.The main function of healthcare systems—wherever they are in the world—is to promote health among the country's citizens. In designing and operating any system, policy makers aim to satisfy three leading requirements:Ensuring that all people have adequate access to the benefits of health care,Ensuring that the system delivers care of consistently high quality, andEnsuring all this at a sustainable level of cost.These three objectives raise many complex questions:What constitutes adequate access and quality care?What is sustainable cost?Should market forces (competitive factors) be allowed to play a role in managing healthcare costs, quality, and service?Should healthcare systems shift their current focus on caring for the sick to a more holistic effort to maintain citizens' health?The answers to all those questions vary widely, depending on the historical, political, and social context of each national system. Each country makes choices and suffer consequences. There is more criticism of the healthcare systems from their own citizens, than one can imagine. Every country has this phenomenon.Hence emulating another’s country’s healthcare model is near about impossible. That said, we can adopt some good practices from different countries.China: China’s effort to streamline the value chain in distribution of all pharma products: new rules will allow a maximum of two invoices between a manufacturer and hospital – each manufacturer will sell to a distributor and that distributor will sell directly to hospitals, eliminating multi-tiered distribution. This means that cost of drugs, consumables are more or less standard across the country and has the potential to reduce costs by almost 30%.Cuba: Cuba’s health care system is based on preventive medicine and the results achieved are outstanding. We should follow their example and replace the curative model, inefficient and more expensive, with a prevention-based system.Their infant mortality rate (IMR) of 4.2 per thousand births is among the lowest in the world. India’s IMR is 34 per thousand births with Kerala being the best state at 8 per thousand births. The secretary general of the United Nations, Ban Ki-moon, during a visit to Cuba hailed its healthcare service as, “a model for many countries”Thailand: Thailand’s demographic and economic similarity to India makes this sort of comparison relevant. Health expenditures as a share of GDP are similar—4.4% for Thailand and 4.1% for India. However, outcomes vary widely: In Thailand, the under 5 years’ age mortality is 12.3 per 1,000 live births; maternal mortality, 20 per 100,000 live births. By contrast, the numbers in India are higher by multiples: 47.7 and 174.How did they do it? Thailand leveraged technology extensively. Its national civil registration database forms the backbone of all health schemes in the country, ensuring that a beneficiary cannot enrol in two schemes at the same time. Every Thai citizen is given a health card which is portable across the country (he could visit any hospital—public or private) and get treated. The hospitals are reimbursed based on outcomes (patients treated) with elaborate supporting metrics. India could well use Aadhaar as we approach the launch of the National Health Protection Scheme (NHPS). Unfortunately Aadhaar has become a hot potato.The Thai government launched a universal health coverage (UHC) scheme for the informal sector covering 70% of Thailand’s 70 million people. But this UHC push was wisely matched by structural reforms, which explains a big part of the huge gaps in expenditures and outcomes between the two nations. (Disclosure: I was involved as a consultant to the Thai government in architecting the solution).India needs reforms in 5 key areas of healthcare:Public health: The government has traditionally been a poor performer. Drainage systems, supply of drinking water, poor hygiene standards have contributed to spread of diseases. We have to increase spend and efficiency in this case. We also need to improve food supply standards. There has to be efficient provisioning of environmental services that reduce the incidence and spread of disease. We have done reasonably well in clinical services like vaccination and screeningRoutine health care: The NRHM (National Rural Health Mission) launched in 2005 is just good on paper. There has been no report or even a robust measurement framework to evaluate the results and outcomes. The government has singularly failed to deliver the services. The government facilities are poor and is neglected. Most people move towards the private hospitals even for routine care.Care involving hospitalisation of OPD surgeries: In this case the frequency is low, but the cost of the event is very high. It is a perfect candidate for insurance. There has to be a government subsidy for the cover the people in the bottom of the pyramid. Every cooperative (farmers cooperative, volunteer organisation etc.) should be mandated to have a standard insurance plan that cover major illnesses and manageable coverage with the option to seek treatment in government or private hospitals.Human resources: We are facing a massive deficit of trained people — doctors, nurses, midwives, pharmacists, therapists and often they are being filled by unqualified people. The Skills India program should be targeted towards developing professionals and addressing the deficit. One thing we urgently need is equivalent to ‘nurse practitioners ‘ where nurses with 10 years experience can become rural doctors and treat routine diseases.Financing: The government has to change the system by giving the financial power to buy healthcare services in the hands of the patient and giving cash transfer (DBT as is done in LPG subsidy) for routine healthcare expenses. The transfers should be conditional against periodic checkups.Overall management of the healthcare system: A lot can be said here, but there has to be strong regulation without the license-permit raj model. We should emphasise public health services as opposed to medical services because the well-organised medical doctor lobby has far greater clout.

Talent and especially talent on the ball is the factor most overrated by fans and players alike when evaluating a footballer.Given the option I would always rather trade luck (in terms of opportunity and avoiding injuries) and mental strength for the fairy dust of prodigious skill manipulating a football.Physical and especially mental bravery can compensate in large part for a deficit of pace, technique or skill that might otherwise prevent a footballer reaching a high level in the professional game.And at the very top level (where all the basic characteristics of a good footballer are a given) it is physical and especially mental bravery that allows mediocre players to be good players and very good players to be top class.Physical and especially mental bravery are the two attributes that can't really be taught or improved upon as a function of personality. Obviously there are exceptions to the rule in each case (young players who suddenly emerge seemingly transformed as mature players - such as Man Utd's Roy Keane) but there aren't many of them and I would consider them outliers.Bravery of all kinds can be suppressed or dormant but it has to be in there somewhere to evidence itself and I don't think it is a characteristic that is common to everyone.I always remember working for a very shrewd manager who lamented of his number 9: "I can make him a better player, with better positional awareness, better fitness and stamina, we can even work a bit on his pace, but I can't make him brave."There are many reasons why players don’t make it, fall away, or fail to transfer their ability to match situations. Some ‘Tuesday morning footballers’ are consistently on the bench due to inconsistency or lack of a key component (either physical or mental)Everywhere at every level you see managers persist with selecting mavericks and rough diamonds when there is nothing in their performances, other than blind optimism, that suggests they should be picked.And there are many reasons why players get tagged with the reputation of being superstars in training but insipid in matches.Here is a run through of some typical scenarios. I am going to tackle them all together as most of them are interrelated in some way or other:1.The player is simply not as good as their direct replacement in the starting line up. Not as good can mean mentally, physically, tactically or emotionally weaker. Perhaps they can perform with freedom in training because there is no pressure on them. They are unlikely to feature in a match any time soon while their route to the first team is blocked. This will hamper or maybe even kill their career.2.They are off form and cannot get a starting berth on current merit. But in training, again, they can play with freedom and without pressure.3. They are not fit or returning from an injury and need a run of games to regain previous form and confidence. Perhaps there is an underlying problem that comes to the fore in the intensity of a big match.4.The coach has a policy of not changing a winning team so they can't get back in until the team lose. Their situation is a fait accompli - however hard they train.5. They are not part of the manager's specific starting game plan for this match and they will only feature if there is a change of tactics in play and a substitution is required. And that may mean that they can’t get up to speed in matches. They need a run of games. Again luck and seizing limited opportunities is nine tenths of the law here in terms of the player wrestling back their dream of fulfilling their potential.6.There is a personality clash somewhere that means that the player is out of favour and will only feature as an absolute necessity. However, he trains with intensity as he has one eye on a move as soon as possible. These sorts of players are professional, strong, resourceful and typically successful in the longer term.7. The player has specific skills that have seen them pigeonholed as 'an impact sub'. These skills could include blinding pace or the personality of a lightweight but skillful player who only excels against tiring opponents. It is a tag that no player wants as it makes them a ‘fill-in’, a bit part player whose place in the team never becomes secure. Show me an impact sub or a utility player and I will show you a player that the odds are against short, medium and long term.8.The player is in decline but can still 'do a job' as a substitute in games where their experience can have an important effect on a result or team performance. This decline is not so evident training with familiar teammates.9. The player may also be a legacy signing from a previous coaching regime and as such the current manager doesn't rate them or want to play them. He may give them a showcase in certain games in an attempt to put them 'in the shop window' for other clubs' scouts to evaluate - and leave them out at other times. Again, it is hard to find form, match fitness or consistency when your appearances are sporadic. Bad luck kills good ability, every time.10. There are many reasons why second-stringers fail as regular starters and the clue is largely in the reasons why they were benched in the first place.It could be as simple as the wrong player, in the wrong club at the wrong time.11. The player takes time to get up to the speed of the competition and simply needs to play a lot of consecutive matches to reach an optimum level.12. The player may have talent but is young and lacking experience, and needs to be nurtured carefully. Young players are generally very inconsistent as a function of their physical status and emotional immaturity. But they will typically train well in a familiar, less hostile environment.13. The player may have a poor attitude and is content just to pick up their wages and doesn't care about playing.14. The player may have talent but lacks consistency in their play.The player may have talent but goes to pieces in front of a ground or when playing at an opponents' stadium.15. The player is being asked to perform a role in matches that is not a good fit with their skill-set.16. The player's 'head is gone' as the result of poor morale, or off field or on field problems. This is reflected in their poor performance and inconsistency. This often occurs when a player is regularly singled out by fans for abuse or nonconstructive criticism.17. The player is not mentally or physically fit enough to perform consistently well.And here is the relevant context:By the time players are playing at the top levels - elite international underage teams and the likes - it is more than likely that they have the physical raw material to make it at some level professionally, even if they have to drop down levels for physical development levels.At that stage though, other more fugitive factors come into play: opportunity to continue developing through elite level game time, perception of quality amongst scouts, coaches, peers and managers, luck with injuries for example.Players themselves naturally focus on physical attributes (the thing they seem to have most control over) to explain success. And you can see why, all these other imponderables come into sharper focus as D Day looms for players' careers.It often looks like a beauty contest where luck and perception can easily overwhelm talent and personal motivation as defining factors.In this respect football takes on all the key themes of elite jobs where the opportunities for advancement are limited by a small number of new slots - like modelling, pop music or acting, for example. And that's why the attrition rates and the hard luck stories of the 'nearly men' are so pronounced and the rewards for the victors have to be so high.Take Harry Kane for example, his rise to international prominence with Spurs was really the product of a lot of seemingly unconnected factors. If the dice were rolled again, in his case, he could just as easily be plying his trade at a lower level as a loanee again, and worrying about his longer term prospects at Spurs. Small margins not absolutes like ‘talent will out’ define all our life chances and outcomes - whatever walk of life we are in.