EMS: Trauma Center Designation

Issues of Concern

Trauma centers are verified as adult or pediatric facilities. Hospitals may have different designation levels for adult and pediatric populations. The ACS verifies trauma centers based on specific criteria, as explained below.

A level I trauma center is a tertiary care hospital that provides comprehensive care from initial injury through rehabilitation. The requirements for this kind of facility include the following:

• 24-hour in-hospital access to general surgeons
• Specialty availability, including anesthesia, emergency medicine, intensive care unit (ICU), neurosurgery, orthopedic surgery, radiology, ophthalmology, and geriatric care
• Surgical expertise in cardiothoracic, vascular, hand, plastic, obstetric and gynecologic, otolaryngologic, and urologic surgery
• Referral center for community hospitals that require specialized trauma care
• Public health initiatives, including injury prevention programs
• Ongoing education for all professionals involved in trauma care
• Quality monitoring and improvement efforts
• Teaching and research in trauma management
• Identification and intervention for polysubstance use
• Mental health screening for individuals with traumatic injuries
• Minimum annual patient volume, treating at least 1,200 trauma cases or 240 patients with an Injury Severity Score (ISS) over 15
• Pediatric requirement, with level I pediatric trauma centers treating at least 200 trauma patients under 15 years of age annually

A level II trauma center provides initial treatment for all trauma cases, with the ability to stabilize and transfer patients requiring more specialized care. Requirements for such facilities include the following:

• 24-hour access to general surgeons
• Specialty availability, including anesthesia, emergency medicine, ICU, neurosurgery, orthopedic surgery, radiology, ophthalmology, and geriatric care
• Surgical expertise in cardiothoracic, vascular, hand, plastic, obstetric and gynecologic, otolaryngologic, and urologic surgery
• Coordination with level I trauma centers for specialized care when needed
• Ongoing education for all professionals involved in trauma care
• Quality monitoring and performance improvement programs

A level III trauma center provides prompt assessment, management, surgery, and stabilization for patients with traumatic injuries. Key components include the following:

• 24-hour access to emergency medicine physicians
• Availability of general surgeons, anesthesia, ICU, and orthopedic surgery
• Quality monitoring and improvement programs
• Transfer agreements for patients requiring a higher level of care
• Support for outlying hospitals, providing backup care when needed
• Continuing education for all trauma care team members
• Community outreach programs focused on traumatic injury prevention

A level IV trauma center delivers Advanced Trauma Life Support (ATLS) before transferring patients to a higher level of care. Requirements for these centers include the following:

• Emergency department capable of implementing ATLS protocols
• Availability of on-call nurses and physicians upon patient arrival
• Surgical and intensive care services, when available
• Transfer agreements for patients needing advanced trauma care
• Quality monitoring and improvement initiatives
• Community outreach programs focused on traumatic injury prevention

A level V trauma center provides initial evaluation, stabilization, and transfer coordination for patients needing advanced care. Essential components include the following:

• Emergency department capable of implementing ATLS protocols
• Availability of on-call nurses and physicians upon patient arrival
• After-hours protocols if the facility is not open round-the-clock
• Surgical and intensive care services, when available
• Transfer agreements to ensure timely access to higher-level trauma care

Trauma center designation ensures that patients receive appropriate care based on the severity of their injuries and the facility’s available resources. Each level plays a distinct role within the trauma system, from initial stabilization to comprehensive treatment and rehabilitation.[3]

Clinical Significance

Research indicates that trauma management at a designated trauma center leads to better outcomes than care at a nondesignated facility.[4][5] Receiving treatment at a designated trauma center significantly reduces mortality risk following traumatic injury.[6][7][8][9] Telehealth has been proposed as a strategy to enhance trauma care access in rural areas. Peer-to-peer telehealth consultations may help prevent early trauma-related deaths and minimize unnecessary transfers for low-acuity injuries.[10]

Nursing, Allied Health, and Interprofessional Team Interventions

Approximately 80% of medical errors stem from inadequate communication, particularly in high-risk environments such as trauma facilities. Strengthening interprofessional teamwork involves enhancing communication, fostering shared responsibility, promoting collective decision-making, and ensuring a clear understanding of team member roles.[11]