What Are the 5 Trauma Center Levels?

At its core, the trauma center comprises a hospital’s official services, personnel team, and equipment designated to treat injured patients. Trauma center levels are used to communicate the extent that a facility can help manage an injury. These designations began as part of battlefield medicine efforts during the Civil War and continue to be necessary today because – put simply – not all injuries are equal.

How Many Trauma Center Levels Are There?

There are five levels of trauma center care. Each is referred to by its number, one through five, A level one trauma center has the highest capacity for trauma care, with the ability to provide all aspects and necessary resources to care for any critically injured patient.

It’s important to note that the designation of each level is managed by regional authorities rather than a national healthcare organization. This means that there are state-by-state variances among the designations, although the verification process is overseen at a national level. Trauma centers voluntarily agree to a three-year process of oversight and inspection by The American College of Surgeons (ACS) to achieve recognition and confirmation of their designated status.

Now that you know that a level one trauma center in New York may look slightly different from a level one trauma center in Kentucky, let’s get into the standard criteria and common attributes that identify and comprise the five trauma center levels.

Level I Trauma Center

As stated above, a level 1 trauma center has the capacity to oversee and conduct patient care across the entire continuum of their injury-related healthcare needs. This means that a patient with a serious bone fracture requiring surgical intervention will be stabilized, have operative and postoperative needs met, and follow up with necessary rehab treatments, all in the same hospital.

The designation goes beyond the ability to treat complex and critical patients, though. States often require level 1 trauma centers to engage in community outreach and contribute to education and research efforts.

Common Features of Level I:

• Offers 24/7 availability of all medical and surgical specialties and subspecialties, including (but not limited to) radiology, hemodialysis, neurosurgery, pulmonology, and orthopedic surgery
• Services a minimum number of trauma patients annually, or meets the requirements for cases above an Injury Severity Score (ISS) to indicate ongoing competency and need (standards differ by state, and between pediatric and adult trauma centers)
• Has polysubstance treatment and intervention programs
• Stays involved with the community via education programs and injury prevention work
• Maintains high competency standards with regular personnel education initiatives and training
• Performs routine performance improvement and quality improvement (CQI) measures
• Collects data and contributes published articles related to trauma research
• Supports the local region as a referral resource, assisting with critical patients transferred from other facilities

Level II Trauma Center

Level 2 trauma centers share many of the same qualities of a level 1, but often lack the ability to guarantee access at any given moment to all medical and surgical specialties. For example, this might mean that a level 2 trauma center can promise that an orthopedic surgeon is always available within a moment’s notice, but not a cardiac surgeon.

Common Features of Level II:

• Offers 24/7 availability of emergency services and general surgeons
• Has considerable, but not total, medical and surgical specialty availability including (but not limited to) radiology, intensive care, and geriatric care
• Develops in-house and community-oriented education and injury prevention initiatives
• Organizes ongoing employee education and training
• Performs CQI initiatives and performance improvement measures
• Maintains an agreement with level I trauma center for transferring purposes and a working relationship with medical facilities of the surrounding area that may need support

Level III Trauma Center

Level 3 trauma centers are often equipped to handle many injuries that come through their ER doors. However, without the ability to guarantee surgical capabilities or the 24/7 presence of specialty doctors or surgeons, severely injured, or critical, patients are often transferred to a level 1 or level 2 facility.

Common Features of Level III:

• Offers 24/7 availability of ER care
• Has some capacity for general surgery and specialty medicine interventions or surgeries
• Adopts and adheres to ongoing education and training for all trauma staff
• Perform CQI measures
• Stays involved with the community via education efforts and injury prevention projects
• Maintains transfer agreements with level 1 and 2 trauma centers

Level IV Trauma Center

A level 4 trauma center is typically part of a smaller, often rural hospital that provides advanced trauma life support (ATLS) to stabilize the trauma patient before transferring them to a higher acuity trauma center.

Common Features of Level IV:

• Has basic emergency medicine capabilities
• May provide general surgery and specialty services like radiology, intensive care, or orthopedic medicine if available
• Stays involved in outreach with the local community, often to assist with injury prevention education and initiatives
• Performs CQI and ongoing employee education and training
• Utilizes transfer agreements with nearby larger facilities

Level V Trauma Center

The least-equipped of the trauma center levels, level 5 trauma centers are often housed in small, rural hospitals that serve to assess and stabilize critical trauma patients using ATLS so that the patient can be safely transferred to a larger facility.

Common Features of Level V:

• Trains ER staff to implement ATLS when necessary
• Has access to on-call trauma nurses and physicians to be available as needed for patients
• Keeps protocols in place for after hours emergencies (if the facility isn’t open 24/7)
• May have some availability of specialty services and general surgery
• Utilizes transfer agreements for safe transport of critical patients

Want to Learn More About the Benefits of Trauma Care?

No matter which of the five trauma center levels a facility boasts, the availability of trauma teams can benefit patient outcomes while decreasing facility costs. Looking for more win-wins for your facility? Get the latest expert-informed resources and health care guides today.