Considering trauma center designation for your emergency department

Bill Briggs outlines what it takes for an emergency department to achieve trauma center designation and the key advantages.

Authored by:
Bill Briggs, MSN, RN, CEN, TCRN, NEA-BC, FAEN
Vice President and Managing Partner

Nearly every emergency department without trauma designation receives occasional trauma patients. Even urgent care centers, freestanding emergency departments, rural health centers, and medical offices at ski slopes receive trauma patients. In rural areas, there may be no trauma center within many miles and weather may interfere with air transfers. Other times well-meaning bystanders drive the patient to the nearest facility.

Have you considered what it would take for your emergency department to earn trauma center designation? Whether you’re in a rural area or a more urban setting, trauma designation can enhance care delivery, improve patient outcomes, and strengthen your hospital’s reputation.

Understanding trauma center terminology is essential. States are responsible for designating trauma centers and granting them the license and authority to operate. The levels of designation vary by state. Some designate only Levels I, II, and III, while others may include Levels IV and V. The American College of Surgeons (ACS) verifies Levels I, II, and III, ensuring that these facilities meet the specific standards for the level of care they provide. However, ACS verification is not a license to operate as a trauma center. Depending on the state, it may be a requirement for trauma designation or simply a voluntary choice.
Level I and II Trauma Centers have the comprehensive resources necessary to care for all trauma patients, including immediate access to trauma surgeons, operating rooms, specialists, and a wide array of diagnostic and treatment capabilities. For the purposes of this article, we will focus on other levels of trauma centers.

Level III Trauma Centers are hospitals equipped to provide prompt assessment, resuscitation, surgery, intensive care, and stabilization of injured patients, including emergency surgery. It must have a 24-hour emergency department, immediate access to general surgeons and anesthesiologists, and lab, imaging, and blood bank capabilities. Severely injured patients or those needing specialty care are transferred after stabilization. The trauma program must also include performance improvement, clinical guidelines, transfer agreements, and injury prevention initiatives.”

Level IV Trauma Centers provide advanced trauma life support before transferring patients to a higher level of care. Trauma physicians, nurses, and laboratory services must be available upon patient arrival. The center’s trauma program must also include performance improvement, clinical guidelines, transfer agreements, and injury prevention.

Level V Trauma Centers offer initial evaluation, stabilization, and diagnostic capabilities, preparing patients for transfer to a higher level of care. Trauma physicians and nurses must be available upon patient arrival. Some Level V centers may be closed at night but must have after-hours activation protocols in place. Transfer agreements for higher-level care must also be established

There are several advantages to being a trauma center, even at the lower levels, particularly in areas where no other care is available. These include

Improved patient outcomes due to faster care availability, enhanced staff training, clinical protocols, and better coordination of care.
Strengthened community reputation.
Increased resources from reimbursements, government funding, grants, and philanthropic donations.

Emergency Medical Services (EMS) should avoid bringing severely injured patients to a lower-level trauma center if a better option is available, such as helicopter transfer to a Level I or II trauma center. However, in many areas where EMS is limited to basic life support, a stop at a lower-level trauma center may be necessary to stabilize the patient for transfer to a higher-level center.

Where to start?

First, determine the need for a trauma center in your geographic area. Consider the distance to the nearest trauma centers and their capabilities, transport times, and any potential challenges like weather or geography. Evaluate whether ground and air transportation are available. Data from your facility and local EMS agencies can be valuable, along with examples of lives saved through timely care or lives lost due to lack of care.

Next, research the requirements for each level of trauma center in your state. This information is typically available online through the state health department. With these details, you can assess the feasibility of starting a trauma program.

Then, develop a proposal for leadership that includes a clear rationale for the trauma center, the necessary steps to establish the program, and a detailed budget. This should cover training costs, staffing needs (such as a trauma program manager, coordinator, or registrar), equipment, state or ACS application fees, and other expenses. Be sure to factor in potential revenue from grants, trauma activation fees, and other sources. Finally, outline a timeline and plan for establishing the trauma center.”

Get help when planning a new trauma center. Reach out to other trauma centers, your state health department, and professional organizations like the American Trauma Society, American College of Surgeons, Trauma Centers of America, and the Society of Trauma Nurses. Your EMS colleagues can also be valuable allies in supporting trauma care in the community. Consultants can provide guidance to help you get started and stay on track.

When presenting your proposal, be prepared to answer many questions. It’s likely your proposal may be rejected initially, so persistence is key. Ask about any concerns regarding becoming a trauma center and develop a thoughtful response for each one.

Once your proposal is approved, begin implementing your plan, ensuring that every detail is addressed and documented. A timeline is essential, and it’s important to stick to it. A trauma committee at your facility will be key to ensuring the plan’s success.

Establishing a trauma center at any level is a significant undertaking that requires careful planning, dedicated resources, and teamwork. However, the impact on patient care, community health, and your hospital’s reputation is invaluable.