Some parts of the United States acknowledge three levels of trauma centers, while others acknowledge five levels. Level 1 trauma is for the most serious injuries, where trauma is often large and requires a fast response time.

Trauma centers provide immediate definitive care to people with severe injuries.

The lower levels focus on evaluating and stabilizing the person so that, if necessary, staff can transfer them to a higher level facility.

Hospitals vary in how they determine who needs to attend a higher level of trauma center. Healthcare professionals will likely judge this according to physiological data and the type and mechanism of injury.

Keep reading to learn more about the five levels of trauma centers, as well as pediatric trauma centers.

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In U.S. states that acknowledge five levels of trauma centers, the highest level is level 1. These centers provide the most comprehensible level of trauma care.

As the level decreases, the centers tend to have fewer resources and facilities. However, the resources and availability of staff are enough to provide a basic level of trauma care.

Level 1

A level 1 trauma center is a specialist care facility. It provides care for each aspect of an injury, including prevention, treatment, and rehabilitation.

According to the American Trauma Society, a level 1 trauma center usually:

  • has surgeons available within the facility 24 hours a day
  • has prompt availability of practitioners such as orthopedic surgeons and neurosurgeons
  • acts as a referral resource for people in nearby regions
  • provides public education to the surrounding communities
  • offers continuing education for staff within its facility
  • uses a quality assessment program
  • uses teaching and research to help develop and improve trauma care
  • has a screening and intervention program in place for people living with substance use disorders
  • meets a minimum requirement regarding the annual volume of severely injured patients

Level 2

Level 1 and level 2 trauma centers are very similar, and both can manage people with severe injuries. Both centers require surgeons to be available 24-7 to respond to a trauma patient shortly after their arrival at the center.

One of the main differences between level 1 and level 2 trauma centers is that level 2 centers do not have the research and publication expectations of a level 1 center.

The American College of Surgeons also note that in level 1 trauma centers, the director of the intensive care unit (ICU) must be a surgeon with a current board certification in surgical critical care.

This requirement is not in place for level 2 trauma centers, which also do not require continuous rotations in trauma surgery for senior residents.

Level 3

A recent article in OTA International notes that level 3 trauma centers typically:

  • provide care to injured people within their capabilities and resources
  • transfer stabilized patients to level 1 or level 2 centers, when necessary
  • are in areas that are farther away from higher level trauma facilities
  • provide continuous surgical coverage
  • offer programs to medical staff to improve care

Unlike level 1 and level 2 trauma centers, surgeons, anesthetists, and other members of staff do not need to be on-site 24 hours a day. However, they must be able to reach the hospital within 30 minutes if the center contacts them.

Level 4

Level 4 trauma centers are usually located in more rural areas. They have resources to provide advanced trauma life support (ATLS) before transferring patients to a higher level trauma center.

ATLS is a training program for medical providers that teaches them how to manage those dealing with acute trauma. It enables level 4 trauma centers to evaluate, stabilize, and diagnose injured people.

Elements of level 4 trauma centers include:

  • basic emergency department facilities
  • trauma nurses and physicians available when the injured person arrives
  • the provision of surgery and critical care services
  • the ability to transfer patients to level 1 or level 2 trauma centers if they require more comprehensive care
  • an active outreach program for its referring communities

Level 5

Level 5 refers to the most basic type of trauma center. As with level 4 trauma centers, level 5 trauma centers can provide ATLS and evaluate, stabilize, and diagnose people with injuries.

The features of a level 5 trauma center usually include:

  • basic emergency department facilities
  • nurses and medical staff available on patient arrival
  • after-hours protocols if not open 24 hours a day
  • may provide surgery and critical care services
  • transfers patients needing more comprehensive care to level 1, 2, or 3 centers

A pediatric trauma center is a facility that specializes in treating injured children. It must meet all the criteria of an adult center but also have the following:

  • a pediatric surgeon who oversees the pediatric trauma service
  • surgeons who have credentials for pediatric trauma care
  • pediatric specialists in several disciplines, including orthopedics, neurosurgery, and rehabilitation
  • a separate pediatric emergency room and ICU
  • specialized equipment to resuscitate children in all patient care areas
  • pediatric-specific quality assurance and performance improvement

A 2019 study analyzed injured children who attended either a pediatric trauma center, a general trauma center, or a nontrauma center. Children who received treatment in pediatric trauma centers were more likely to survive their injuries than those who attended the other facilities.

Trauma centers are facilities that treat severely injured or critically ill individuals.

Although some states adopt a three-tier scale of trauma levels, others acknowledge five different levels of trauma centers.

Level 1 and 2 trauma centers usually provide more comprehensive care than the lower levels. However, the lower level centers are still able to evaluate and stabilize people, allowing staff to transfer them to higher level centers if necessary.