Explainer: The Five Trauma Center Levels

  • Posted on January 29, 2021

In the U.S., trauma is the leading killer of people under 40 years, the fourth most common cause of death for all Americans. The most common causes of traumatic injury are falls and motor vehicle crashes and include burns, gunshot wounds, assaults, and other severe and life-threatening events. Traumatic injuries are responsible for $177 billion in costs annually.

In response, many hospitals looking have established Trauma Centers to provide specialized medical services and treatments for patients with the most serious injuries. These centers statistically help reduce the likelihood of death or permanent damage, and can be a valuable source of data through their trauma registries.

What is a Designated Trauma Center?

While trauma centers are typically within hospitals, they cannot replace the traditional hospital and its emergency department for more minor injuries. Because of the grave nature of the injuries seen in trauma centers, they must be prepared to treat the most life-threatening severe, and disabling injuries on an ongoing basis.

Trauma centers in the U.S. are designated in different levels to signify the available resources and the number of patients admitted yearly. If a facility has both Adult and Pediatric Trauma Centers, the designation may differ for each. The designation process is established at a state or local level and may vary from state to state. However, most Trauma Centers are designated into five levels with similar criteria, with Level 1 being the highest and offering the most extensive amount of care.

Additionally, Trauma Center Verification is a voluntary process conducted by the American College of Surgeons (ACS) to evaluate and improve trauma care and covers a center for three years. Verification recognizes the presence of the resources listed in Resources for Optimal Care of the Injured Patient, including commitment, readiness, resources, policies, patient care, and performance improvement.

While trauma categories vary from state to state, most designation levels share common criteria for trauma centers verified by the ACS and designated by states and municipalities. Below are typical examples of standards for the five levels of trauma centers:

Level I Trauma Center

Level 1 is the highest or most comprehensive care center for trauma, capable of providing total care for every aspect of injury – from prevention through rehabilitation. These centers typically serve as a referral resource for the region and usually include:

  • 24-hour in-house critical care coverage by general surgeons and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, and more.
  • Community leadership in prevention and public education to surrounding communities
  • Continuing education for trauma team members, as well as organized teaching and research efforts to drive innovation in trauma care
  • Comprehensive quality assessment program.
  • Meeting the minimum requirement for annual volume of severely injured patients (typically a volume of 600 major trauma patients a year or more).

Level II Trauma Center

Level II trauma centers can initiate definitive care for all injured patients and provide similar experienced medical services and resources but do not typically include the research and residency components. Requirements for Level II designation usually include:

  • 24-hour immediate coverage by general surgeons, as well as coverage by additional specialties
  • Tertiary care needs may be referred to a Level I Trauma Center, such as cardiac surgery, hemodialysis, and microvascular surgery
  • Community trauma prevention and continuing education programs for staff
  • Comprehensive quality assessment program.
  • Volume requirements typically around 350 major trauma patients per year

Level III Trauma Centers

Level III Trauma Centers are typically are smaller community hospitals that can handle moderate injuries and stabilize severe trauma patients for transport to a higher-level trauma center. Level III trauma centers do not require neurosurgical resources. They have demonstrated an ability to provide prompt assessment, resuscitation, surgery, intensive care, and stabilization of seriously injured patients. Other common requirements include:

  • 24-hour general surgical coverage, including prompt availability of surgeons and anesthesiologists
  • Comprehensive quality assessment program
  • Transfer agreements for patients needing Level I or Level II Trauma care
  • Back-up care for rural and community hospitals
  • Continuing education for the nursing and allied health personnel
  • Prevention efforts and active outreach program

Level IV Trauma Centers

Level IV Trauma Centers can provide initial care and stabilization of a traumatic injury while arranging transfer to a higher level of trauma care. They can ensure 24-hour emergency coverage by a registered nurse and physician or mid-level provider, conducting the initial evaluation and assessment of injured patients while creating a well-defined transfer plan. Other common expectations include:

  • Development and regular review of collaborative treatment and transfer guidelines with input from higher-level trauma centers in the region
  • Participation in regional and statewide trauma system meetings and committees
  • Surgeon present in the ED on patient arrival, with an adequate notification from the field
  • 24-hour laboratory coverage

Level V Trauma Centers

A Level V Trauma Center provides initial evaluation, stabilization and diagnostic services, and preparation for transfer to higher trauma care levels. Elements of Level V Trauma Centers include:

  • Basic emergency department facilities to implement trauma protocols
  • Available trauma nurse(s) and physicians available upon patient arrival
  • After-hours activation protocols if the facility is not open 24-hours a day
  • Surgery and critical-care services, if available
  • Transfer agreements to Level I through III Trauma Centers

How Data Comes Into Play

As trauma centers intake the most severe patients and record extensive amounts of data, this information can help gain helpful insight into the most common types of trauma suffered in the U.S., if and how prevention campaigns impact the trends what kinds of treatment are most effective. All these data points can help create new protocols and best practices to improve patient care and outcomes in trauma cases. Trauma registries have a long list of beneficial uses, including assisting in research for a wide range of health care fields.

Not only does a trauma registry help hospitals evaluate what is and isn’t working in their EDs and trauma centers, but the data can also be useful in financial planning and accreditation. According to the American Trauma Society, hospital-based trauma prevention strategies and community outreach programs have a long history of success.

To be an American College of Surgeons verified trauma center, hospitals are required to have 80% or more of the trauma patients entered into the registry within 60 days of discharge. Many hospitals have their state, regional, and internal guidelines that require patient data to be added in even earlier. Today, software tools can play an essential role in making trauma system data easier to input, process, and update.

Patient Registries for Better Decisions and Better Care

As the continuum of care from pre-hospital to hospital to discharge becomes more fluid, sharing the data between providers can deliver better care for patients and more insight into improving the industry as a whole. ESO is the leading provider of software to EMS agencies and drives the charge in connecting EMS agencies and hospitals to create closed-loop, bidirectional reporting to improve patient care. Additionally, ESO is currently developing a software tool focusing on Patient Registries and enabling better patient information communication throughout the entire spectrum of care.


For more information on bidirectional software for communication between EMS and emergency departments, take an ESO Health Data Exchange tour.

Learn more about the future of patient registries, explore the vision of ESO Patient Registry.