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
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.
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
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
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
- 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.
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.