Avera St. Luke's has received verification as a Level III Trauma Center from the American College of Surgeons, making it one of seven hospitals in the state with a Level III or II rating.
Level III trauma centers must have continuous physician and surgeon emergency room coverage, as well as an orthopedic surgeon on-call 24/7. Additionally, the hospital must meet many patient care procedural and response time guidelines set by the American College of Surgeons.
The only hospitals in the state with the higher Level II rating are in Sioux Falls and Rapid City.
Sanford Medical Center in Aberdeen passed all inspections for its emergency room and other departments before it opened in July, but it is too new to have an American College of Surgeons rating.
There are no Level I facilities in South Dakota. Those are large research hospitals with physician residency programs. The nearest Level I hospital is in Minneapolis.
"I think that being a Level III trauma center ensures that the systems are in place to optimally care for injured patients," said Dr. Chris Larson, St. Luke's trauma medical director. "It doesn't mean we weren't doing the procedures before, but now (the procedures) have been verified at a national level."
Larson said Avera St. Luke's trauma center can handle most cases without having to airlift a patient to Sioux Falls. St. Luke's has six emergency-room physicians, four trauma surgeons and about 17 nurses.
Once an ambulance crew activates the trauma team -- for example, in the case of a vehicle accident -- the surgeon must arrive within 30 minutes. It is usually much less time than that, Larson said. The surgeon is usually there to meet the patients on arrival.
"It all starts with starting at the right place," he said. "A patient might have a broken femur, but that can wait. It is more important to assess if the patient has internal bleeding, like a ruptured spleen, that needs immediate surgery."
In these situations, time is of the essence, said Carna Atherton-Pray, Avera St. Luke's director of emergency and critical care services.
Avera surgeons can usually handle most trauma cases.
The cases where patients would likely be airlifted to another hospital include cardiac surgery involving special bypass techniques, unstable pelvic fractures or head injuries requiring a neurosurgeon, Larson said.
Level II facilities have 24-hour access to a neurosurgeon. Avera St. Luke's does not have a full-time neurosurgeon, but does have one that services the hospital on an outreach basis.
Avera St. Luke's is the only Level III facility in the region.
Based on regulatory guidelines established by the American College of Surgeons, it takes at least one year for a new medical center to apply for trauma level verification, said Kirby Kleffman, Sanford director of the critical care unit, emergency department and trauma.
Most hospital trauma centers in smaller towns are rated by the state as a Level IV or V. A Level IV facility has surgery coverage at least 80 percent of the calendar year, while Level V facilities routinely transfer surgical patients to larger facilities.
Atherton-Pray said the verification process at Avera not only involved the emergency room, but the entire hospital. Other hospital departments -- such as radiology, laboratory, therapy, anesthesiology and surgery -- all combine to assure a trauma patient gets good care, she said.
While most people think of the emergency department as the trauma center, it is actually the entire hospital that is the trauma center, according to the American College of Surgeons evaluation system, Atherton-Pray said.
"Not only does Level III status hold us internally to a standard, but it also shows the public we are held to a standard that requires continued improvement," she said. "These are research-based standards that are constantly upgraded as more knowledge is acquired."
"Level III is a very appropriate level for our community," said K.C. DeBoer, vice president of the hospital division. "Based on patient volume and other factors, Level III is right where we should be. It shows we are a regional leader."