What are the differences between emergency room levels?

Emergency Departments (ED's or ER's) are categorized into five levels of care. Level I is the highest level and must have immediately available surgical specialists and sub-specialists (surgeons, neurosurgeons, orthopedic surgeons, anesthesiologists, plastic surgeons) in order to handle the most severe and complicated injuries.  These ED's are all in large cities, usually have a wide area of service with helicopter transport, and are fully staffed with Emergency Medicine specialists. They are associated with medical schools.

Level II is the ED in most large and medium size hospitals, with surgeons and anesthesiologists on call 24 hours daily, with an ICU and staffed usually with Emergency Medicine specialists.  This Level can handle common surgical problems, most auto accidents and almost all illnesses including heart attacks and strokes.

Level III ED's may not have on-call surgeons at all times, but usually can handle surgical problems within 24 hours.  These have physicians in the ED 24 hours daily, but the physician may not be an Emergency Medicine specialist. This ED is best at treating and stabilizing the sicker or more severely injured patient for rapid transfer to a Level II or Level I facility.
Level IV and V facilities are found in some states.  They are usually in rural areas, may not have a physician at all times and are intended to stabilize a patient for transfer.

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