Profile Definitions and Methodology

A hospital's trauma program verification status is provided by The American College of Surgeons (ACS) Committee on Trauma (COT) Verification Program and is updated on a quarterly basis.

The designation of trauma facilities is a political process enacted by bodies of government duly authorized to designate. Establishing trauma systems, selecting participating institutions, and designating the role of those institutions in the system are the responsibilities of local, regional, or state health care system agencies. The necessary steps to ensure that communication and transportation systems mesh with the designated trauma centers require a focus on the entire system. Medical leadership is essential to these processes.

The Committee on Trauma (COT) Verification Program is designed to (1) assist hospitals in evaluation and improvement of trauma care and (2) provide information regarding institutional capability, performance, and system development to aid those who are responsible for developing and maintaining these systems.  Trauma center verification is the process by which the ACS confirms that the hospital is performing as a trauma center and meets the criteria contained in the Resources for Optimal Care of the Injured Patient document.

Trauma center levels:

• Level I
  The Level I facility is a regional resource trauma center that is a tertiary care facility central to the trauma care system.  Ultimately, all patients who require the resources of the Level I center should have access to it.  This facility must have the capability of providing leadership and total care for every aspect of injury, from prevention through rehabilitation.  In its central role, the Level I center must have adequate depth of resources and personnel.
• Level II
  The Level II trauma center is a hospital that is also expected to provide initial definitive trauma care, regardless of the severity of injury.  Depending on geographic location, patient volume, personnel, and resources, however, the Level II trauma center may not be able to provide the same comprehensive care as a Level I trauma center.  Therefore, patients with more complex injuries may have to be transferred to a Level I center (for example, patients requiring advanced and extended surgical critical care).  Level II trauma centers may be the most prevalent facility in a community, managing the majority of trauma patients.
• Level III
  The Level III trauma center serves communities that do not have immediate access to a Level I or II institution.  Level III trauma centers can provide prompt assessment, resuscitation, emergency operations, and stabilization and also arrange for possible transfer to a facility that can provide definitive trauma care.  General surgeons are required in a Level III facility.  Planning for care of injured patients in these hospitals requires transfer agreements and standardized treatment protocols.  Level III trauma centers are generally not appropriate in an urban  or suburb an area with adequate Level I and/or Level II resources.
• Level IV
  Level IV trauma facilities provide advanced trauma life-support prior to patient transfer in remote areas where no higher level of care is available.  Such a facility may be a clinic rather than a hospital and may or may not have a physician available.  Because of geographic isolation, however, the Level IV trauma facility is the de facto primary care provider.  If willing to make the commitment to provide optimal care, given its resources, the Level IV trauma facility should be an integral part of the inclusive trauma care system.  As at Level III trauma centers, treatment protocols for resuscitation, transfer protocols, data reporting, and participation in system performance improvement are essential.

The American College of Surgeons does not warrant or make any guarantees or assurances related to outcomes of treatment provided by institutions which utilize the consultation or verification services of the college.