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Trauma Center Designations and Levels

Written by: American Trauma Society 1.1.2000

Trauma centers across the United States are identified by a designation process and a verification process. The different levels (i.e. Level I, II, III, IV or V) refer to the kinds of resources available within a trauma center and the number of patients admitted yearly. Being at a Level 1 trauma center provides the highest level of surgical care for trauma patients.

Trauma Center designation is a process outlined and developed at a state or local level. The state or local municipality identifies unique criteria in which to categorize Trauma Centers. These categories may vary from state to state.

A facility can be designated an adult trauma center, a pediatric trauma center, or an adult & pediatric trauma center. If a hospital provides trauma care for both adult and pediatric patients, the Level designation may not be the same for each group. For example, a Level 1 adult trauma center may also be a Level II pediatric trauma center. Pediatric trauma surgery is its own speciality and adult trauma surgeons are not generally specialized in providing surgical trauma care to children, and vice versa.

Trauma Center Verification is an evaluation process done by the American College of Surgeons (ACS) to evaluate and improve trauma care. The ACS does not designate trauma centers but verifies the presence of the resources listed in Resources for Optimal Care of the Injured Patient. This is a voluntary process by the Trauma Center and lasts for a 3-year period. Part of the verification process includes requiring all members of the trauma team to be knowledgeable about current practices in neurotrauma care and the best evidence for the care of the neurotrauma patient, including head, spine/spinal cord, and peripheral nerve injury. Use of Brain Trauma Foundation’s Guidelines for topics such as adult and pediatric head injury, prehospital management, surgical management, penetrating injury, and acute spine and spinal cord injury is strongly recommended for all trauma centers.


Trauma Center Levels

As mentioned above, Trauma categories vary from state to state. Outlined below are common criteria for Trauma Centers verified by the ACS and also designated by states and municipalities. Facilities are designated/verified as Adult and/or Pediatric Trauma Centers. It is not uncommon for facilities to have different designations for each group (ie. a Trauma Center may be a Level I Adult facility and also a Level II Pediatric Facility).

Level I

Level I Trauma Center is a comprehensive regional resource that is a tertiary care facility central to the trauma system. A Level I Trauma Center is capable of providing total care for every aspect of injury – from prevention through rehabilitation.

Elements of Level I Trauma Centers Include:

  • 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, pediatric and critical care.
  • Referral resource for communities in nearby regions.
  • Provides leadership in prevention, public education to surrounding communities.
  • Provides continuing education of the trauma team members.
  • Incorporates a comprehensive quality assessment program.
  • Operates an organized teaching and research effort to help direct new innovations in trauma care.
  • Program for substance abuse screening and patient intervention.
  • Meets minimum requirement for annual volume of severely injured patients.

Level II

A Level II Trauma Center is able to initiate definitive care for all injured patients.

Elements of Level II Trauma Centers Include:

  • 24-hour immediate coverage by general surgeons, as well as coverage by the specialties of orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology and critical care.
  • Tertiary care needs such as cardiac surgery, hemodialysis and microvascular surgery may be referred to a Level I Trauma Center.
  • Provides trauma prevention and continuing education programs for staff.
  • Incorporates a comprehensive quality assessment program.

Level III

A Level III Trauma Center has demonstrated an ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations.

Elements of Level III Trauma Centers Include:

  • 24-hour immediate coverage by emergency medicine physicians and the prompt availability of general surgeons and anesthesiologists.
  • Incorporates a comprehensive quality assessment program
  • Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma Center.
  • Provides back-up care for rural and community hospitals.
  • Offers continued education of the nursing and allied health personnel or the trauma team.
  • Involved with prevention efforts and must have an active outreach program for its referring communities.

Level IV

A Level IV Trauma Center has demonstrated an ability to provide advanced trauma life support (ATLS) prior to transfer of patients to a higher level trauma center. It provides evaluation, stabilization, and diagnostic capabilities for injured patients.

Elements of Level IV Trauma Centers Include:

  • Basic emergency department facilities to implement ATLS protocols and 24-hour laboratory coverage. Available trauma nurse(s) and physicians available upon patient arrival.
  • May provide surgery and critical-care services if available.
  • Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level II Trauma Center.
  • Incorporates a comprehensive quality assessment program
  • Involved with prevention efforts and must have an active outreach program for its referring communities.

Level V

A Level V Trauma Center provides initial evaluation, stabilization and diagnostic capabilities and prepares patients for transfer to higher levels of care.

Elements of Level V Trauma Centers Include:

  • Basic emergency department facilities to implement ATLS protocols
  • Available trauma nurse(s) and physicians available upon patient arrival.
  • After-hours activation protocols if facility is not open 24-hours a day.
  • May provide surgery and critical-care services if available.
  • Has developed transfer agreements for patients requiring more comprehensive care at a Level I though III Trauma Centers.