Hailey Tran
The role level of a hospital is indicative of its capabilities, resources, and level of expertise. Hospitals are often classified into different tiers or levels, with each level possessing distinct characteristics and serving specific purposes. In the context of military healthcare, the Army's health service support system employs a structure known as echelons to denote the varying levels of care and corresponding capabilities available at military field hospitals and medical facilities. These echelons range from Echelon I to Echelon V, with each successive level building upon the capabilities of the previous one. Understanding the role level of a hospital is crucial for determining the types of services it can provide, the severity of cases it can handle, and its place within the broader healthcare ecosystem.
| Characteristics | Values |
|---|---|
| Number of echelons (or levels) of care | 5 |
| First level of care | Echelon I |
| First level of care capabilities | Treat minor injuries, prepare those with serious injuries for evacuation to a higher level of care |
| Second level of care | Echelon II |
| Second level of capabilities | Examine and evaluate patients, treat and return to duty or evacuate to a higher level of care, evacuate patients from Echelon I |
| Third level of care | Echelon III |
| Third level of capabilities | Evacuate patients from division-level and other units, provide hospital care and resuscitation, prepare patients to return to duty or stabilise for evacuation, provide surgical care if possible |
| Fourth level of care | Echelon IV |
| Fourth level of capabilities | Receive patients evacuated from Echelon III, provide general and specialised surgical and medical care |
| Highest level of care | Echelon V |
| Highest level of capabilities | Medical, surgical, rehabilitative, and convalescent care to help soldiers return to function |
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What You'll Learn
Military field hospitals
A field hospital is a temporary hospital or mobile medical unit that treats casualties on-site before they can be safely transported to permanent facilities. The term "field hospital" was initially used in military medicine, for instance, the Mobile Army Surgical Hospital (MASH). However, it is also used to describe alternate care sites used in disasters and emergencies. Field hospitals are often established in easily accessible and visible buildings, such as restaurants, schools, or hotels, or in tent-like shelters, including inflatable structures.
Field hospitals are generally larger than temporary aid stations but smaller than permanent military hospitals. They can be transported by aircraft and trucks and are usually delivered in standard military-owned demountable containers (MILVAN) cargo containers. These hospitals are assembled by staff into tent hospitals to treat patients. A Combat Support Hospital (CSH), for example, can deploy with between 44 and 248 hospital beds, with 44 being the most common. During the Cold War, the Medical Unit, Self-contained, Transportable (MUST) designation was applied to active duty units, which included all the necessary personnel and equipment to provide care for 200 beds.
Battalion aid stations, Brigade Support Battalions, and Forward Surgical Teams are usually the first point of contact for wounded soldiers. The CSH then receives patients via helicopter air ambulance and stabilizes them for further treatment at fixed facility hospitals. The CSH is capable of providing definitive care for many cases and can treat civilians and wounded enemy soldiers, depending on the operational environment.
Field hospitals are also prevalent during disease outbreaks and pandemics, such as the COVID-19 pandemic, especially in the developing world. These hospitals are managed by various organizations, such as the French emergency medical service (SAMU) in France and the civil defence military units (Unité d'instruction et d'intervention de la sécurité civile, UIISC) in other parts of the world.
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Medical treatment facilities
Primary care is generally the first level of care that patients receive for their medical concerns. It involves consulting with a primary care provider, such as a general practitioner or family physician, who takes a whole-of-society approach to health promotion, disease prevention, treatment, and rehabilitation. This level of care also includes other healthcare professionals such as pharmacists, physiotherapists, and speech therapists, depending on the specific healthcare system within a country.
Secondary care involves seeing specialists such as oncologists or endocrinologists. This level of care is typically provided in smaller facilities that may lack the specialised equipment and expertise of tertiary-care centres.
Tertiary care is a higher level of specialised care provided in a hospital setting. It involves advanced and complex diagnostics, procedures, and treatments performed by medical specialists using state-of-the-art equipment. Examples of tertiary care services include specialist cancer management, neurosurgery, cardiac surgery, transplant services, and advanced neonatology services. Tertiary care centres may be available at a regional or national level, and patients may need to travel to access these services.
Quaternary care is an extension of tertiary care but is even more specialised. It is the highest form of healthcare practice, performing major medical procedures and offering advanced diagnostic centres, specialised intensive care units, and modern medical facilities. Quaternary care is highly specialised and may not be offered at every hospital or medical centre.
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Evacuation
However, there are also situations where the need for evacuation is not immediately obvious. In these cases, a careful assessment of the hospital's infrastructure and environmental factors is necessary. This includes evaluating the risks to the hospital's water, sewer, electricity, and heat supply, as well as the overall building integrity. Based on this assessment, the decision team can choose to either evacuate or defer the decision and reassess the situation at a later time.
When an evacuation is ordered, the sequence of patient evacuation becomes crucial. In most cases, the most resource-intensive patients are evacuated first, followed by others. This decision-making process is challenging and raises ethical issues regarding whom to evacuate and who has the authority to make such decisions. Hospital staff must balance the obligation to care for patients with the need to ensure their own safety during an evacuation.
To effectively carry out an evacuation, hospital personnel must be well-trained and confident in their roles. Ongoing disaster preparedness training enhances their ability to respond to emergencies and safely evacuate patients. It is imperative that hospital staff have access to support services to maintain their physical and mental health, especially in the face of ethical challenges and emergency roles during crises.
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Stabilisation
In the context of intensive care nursing, stabilisation takes on a broader scope. Nurses act as advocates and links between patients, their families, and the healthcare system. They grapple with ethical dilemmas, respecting patient autonomy while also acting in their best interests. Stabilisation in intensive care involves assessing vital signs, administering medication, ensuring a clear airway, and providing wound care.
Additionally, stabilisation plays a vital role in managing patients with opioid use disorder. Nurses employ Medication-Assisted Treatment (MAT), combining FDA-approved medications with counselling and behavioural therapies to address acute symptoms, withdrawal, and long-term treatment strategies. This holistic approach underscores the importance of stabilisation in promoting patient safety, comfort, and overall well-being.
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Resuscitation
One key aspect of a successful resuscitation team is its composition. Top-performing hospitals often have dedicated or designated resuscitation teams comprising diverse disciplines, including physicians, nurses, and other clinical and administrative staff. This multidisciplinary approach ensures that a range of expertise is readily available during in-hospital cardiac arrests (IHCA).
Clear roles and responsibilities within the resuscitation team are essential. Each member should understand their specific duties, with designated responders identified ahead of time. The team leader, for instance, holds a crucial role and must possess advanced life support qualifications or equivalent training. Their role is typically assigned based on clinical knowledge, skills, and experience, ensuring the most qualified individual leads the resuscitation effort.
Effective communication and leadership during IHCA are also distinguishing factors between top-performing and non-top-performing hospitals. Successful resuscitation teams exhibit better communication, including direct orders, clear role assignments, and closed-loop communication, where team members explicitly acknowledge and verbalize requests. This structured approach helps prevent chaotic and confusing situations, which are commonly observed in underperforming hospitals.
Training and education are other critical components. Regular and comprehensive training programs ensure that clinical staff are proficient in resuscitation practices. Annual updates, including assessments, are recommended to maintain knowledge and skills. Non-clinical staff are also expected to have basic resuscitation skills, such as knowing how to summon help and initiate chest compressions until trained help arrives.
Additionally, hospitals should have policies and protocols in place for managing cardiac arrest calls from remote areas of the hospital site, which may include calling an ambulance in addition to the resuscitation team. These measures ensure a swift and coordinated response, improving the chances of positive patient outcomes.
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Frequently asked questions
Hospitals are generally classified into three levels—community hospitals, secondary hospitals, and tertiary hospitals.
Community hospitals are primary care hospitals that offer essential medical services and patient care. Secondary hospitals offer specialised services and treat patients with specific conditions. Tertiary hospitals are large, multispecialty hospitals that offer advanced medical services and are equipped to handle complex procedures.
You can find the level of your local hospital by searching for it on the internet or by contacting your local healthcare provider.
