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Trauma Center Levels Defined

Trauma centers can be verified/designated by the state or local government authority or verified by the American College of Surgeons (ACS). Centers are designated and assigned a level based on guidelines specific to each state. In addition, the ACS verifies trauma centers based on criteria set forth in the Resources for Optimal Care of the Injured Patient often referred to as the “Orange Book.” The Orange Book was developed by the ACS Committee on Trauma and outlines the descriptions of trauma centers and the various levels.

 

Click the links below for a description of the ACS requirements & distinctions [1]:

Level I Level I & II  Level III  Level IV
 
Click here for the most up to date map of all US Trauma & Disaster Response Centers. Feel free to contact TCAA staff at 704-360-4665 or info@traumacenters.org with additional questions.

Level I

  • Admit at least 1,200 trauma patients yearly or have 240 admissions with an Injury Severity Score of more than 15.
  • Maintain a surgically directed critical care service including 24-hour pre and post anesthesia services, an operating room available within 15 minutes, radiology, ICU team coverage, a full spectrum of surgical specialists, medical consultants, support services, 24-hour laboratory services and an adequate blood supply, medical social workers available 24 hours and advanced practitioners.
  • Orthopaedic care must be overseen by an individual who has completed a fellowship in orthopaedic traumatology approved by the Orthopaedic Trauma Association.
  • Cardiothoracic surgery capabilities must be available 24 hours per day and should have cardiopulmonary bypass equipment.
  • Participate in the training of residents and be a leader in education and outreach activities including providing continuous rotations for senior residents, providing emergency medicine and the surgical specialty residency programs, providing an acute care surgery fellowship, and offering continuing education for trauma nurses and continuing medical education for trauma surgeons.
  • Establish a successful trauma research program with a minimum of 20 peer-reviewed articles published in specified journals OR 10 peer-reviewed articles published in specified journals and the demonstration of four specified trauma-related scholarly activities.
  • Led by an ICU physician boarded in surgical critical care.

Level I & II

  • Qualified attending surgeons must participate in major therapeutic decisions, be present in the emergency department for major resuscitations, be present at operative procedures, and be actively involved in the critical care of all seriously injured patients.
  • A resident in postgraduate year 4 or 5 or an attending emergency physician who is part of the trauma team may be approved to begin resuscitation while awaiting the arrival of the attending surgeon but cannot independently fulfill the responsibilities of, or substitute for, the attending surgeon.
  • The trauma surgeon on call must be dedicated to a single trauma center while on duty.
  • In addition, a published backup call schedule for trauma surgery must be available.
  • The trauma director must have responsibility and authority for determining each general surgeon’s ability to participate on the trauma panel based on an annual review.
  • Surgeon must be present in the emergency department on patient arrival, with adequate notification from the field.
  • Surgeon’s presence must be in compliance at least 80 percent of the time.
  • Participate in regional disaster management plans and exercises.

Level III

  • Level III trauma centers can provide prompt assessment, resuscitation, emergency operations, and stabilization and also arrange for transfer to a facility that can provide definitive trauma care when needed.
  • Provide continuous general surgical coverage.
  • The trauma director must have responsibility and authority for determining each general surgeon’s ability to participate on the trauma panel based on an annual review.
  • Surgeon must be present in the emergency department on patient arrival, with adequate notification from the field.
  • Surgeon’s presence must be in compliance at least 80 percent of the time.
  • Participate in regional disaster management plans and exercises.

Level IV

  • Provide the initial evaluation and assessment of injured patients, and transfer patients pursuant to a well-defined transfer plan.
  • Ensure 24-hour emergency coverage by a physician or mid-level provider.
  • Be continuously available for resuscitation, with coverage by a registered nurse and physician or mid-level provider, and it must have a physician director
  • Providers must maintain current Advanced Trauma Life Support® certification as part of their competencies in trauma.
  • Attend a minimum of 8 hours of trauma-related continuing medical education (CME) per year.
  • Develop and regularly review collaborative treatment and transfer guidelines with input from higher-level trauma centers in the region.
  • Participate in regional and statewide trauma system meetings and committees that provide oversight.
  • Act as the local trauma authority, and provide training for prehospital and hospital-based providers.
  • Surgeon must be present in the emergency department on patient arrival, with adequate notification from the field.
  • Surgeon’s presence must be in compliance at least 80 percent of the time.
  • Participate in regional disaster management plans and exercises.


[1] American College of Surgeons. (2014). Resources for optimal care of the injured patient. Chicago, Ill: American College of Surgeons, Committee on Trauma.

 

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