Trauma System Introduction

Table of Contents

Trauma Center History

Trauma Care has evolved into a specialty in many local and regional hospitals over recent years. Historically called emergency rooms, trauma centers have established high quality, comprehensive medical services for patients. The public relies on trauma centers to provide quality care from initial injury to final disposition, whether at the local hospital or tertiary care center. Regardless of where the trauma program is located, it provides critical services in a timely manner to patients who often need lifesaving measures. As a Trauma Program Manager (TPM), it is a primary responsibility to ensure patients are receiving the best care possible. This is often accomplished by compilation and analysis of data, policy review, and continuous quality improvement initiatives. The following chapters will provide an overview of many aspects of trauma care and acts as a guide to help the TPM succeed in their role.  TPM will be referenced throughout the manual and will be the collective title for the role.

Trauma Center Levels

The verification of trauma levels is important in qualifying what essential services are offered at a hospital. The Iowa Department of Public Health (IDPH) is responsible for the verification, or re-verification, of each Level III and IV hospital on a three-year cycle. Criteria from the American College of Surgeons Committee on Trauma (ACS-COT) is utilized to ensure consistent practice standards and available resources. Basic definitions of each trauma level are outlined below. 

Level I

Verified by the ACS-COT, a Level I Adult or Pediatric Trauma Center is a comprehensive regional resource that is a tertiary care facility central to the trauma system. A Level I Trauma Center is capable of providing total care for every aspect of injury – from prevention through rehabilitation.

Key elements of a Level I Trauma Center include 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, and critical care. Other capabilities include cardiac, hand, pediatric, microvascular surgery, and hemodialysis. The Level I Trauma Center provides leadership in prevention, public education, and continuing education of the trauma team members. The Level I Trauma Center is committed to continued improvement through a comprehensive quality assessment program and an organized research effort to help direct new innovations in trauma care.

Level II

Verified by the ACS-COT, a Level II Adult or Pediatric Trauma Center is able to initiate definitive care for all injured patients.

Key elements of a Level II Trauma Center include 24-hour immediate coverage by general surgeons, as well as coverage by the specialties of orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology and critical care. Tertiary care needs such as cardiac surgery, hemodialysis and microvascular surgery may be referred to a Level I Trauma Center. The Level II Trauma Center is committed to trauma prevention and to continuing education of the trauma team members. The Level II Trauma Center is dedicated to continued improvement in trauma care through a comprehensive quality assessment program.

Level III

Verified by either the ACS-COT or the Iowa Trauma System, a Level III Trauma Center has demonstrated the ability to provide prompt assessment, resuscitation, stabilization of injured patients and emergency operations.

Key elements of a Level III Trauma Center include 24-hour immediate coverage by emergency medicine physicians and the prompt availability of general surgeons and anesthesiologists. The Level III program is dedicated to continued improvement in trauma care through a comprehensive quality assessment program. The Level III Trauma Center has demonstrated prompt transfer protocols for patients requiring more comprehensive care at a Level I or Level II Trauma Center. A Level III Trauma Center is committed to the continued education of the nursing and allied health personnel or the trauma team. It must be involved with prevention and must have an active outreach program for its referring communities. The Level III Trauma Center is also dedicated to improving trauma care through a comprehensive quality assessment program.

Level IV

Verified by the Iowa Trauma System, a Level IV Trauma Center demonstrates the ability to provide Advanced Trauma Life Support (ATLS) prior to transfer of patients to a higher level trauma center.

Key elements of a Level IV Trauma Center include basic emergency department facilities to implement ATLS protocols and 24-hour laboratory coverage. The Level IV Trauma Center has demonstrated prompt transfer protocols for patients requiring more comprehensive care at a definitive care facility. The Level IV center is committed to continued improvement of these trauma care activities through a formal quality assessment program. The Level IV center should be involved in prevention, outreach and education within its community.
List of Iowa Trauma Care Facilities PDF - updated 11/03/22

Iowa Plan for Trauma System Development 2022-2027

Draft plan in progress

The Iowa trauma system strives to develop and maintain a comprehensive, coordinated statewide and local injury network. The State Trauma Plan for 2022-2027 (DRAFT) will:

  • Guide comprehensive system development
  • Address system operational requirements
  • Allow for local trauma system variations based on assessment results
  • Reflect inclusiveness of the operational components as they fall under assessment, policy development, and assurance
  • Demonstrate an all-encompassing methodology, ranging from injury prevention activities to prehospital trauma care, acute care facilities, and post-acute care rehabilitation
  • Reflect integration with the State Health Plan and with the State's Emergency Response Plan
  • Allow for a dynamic process that will evolve with changing injury epidemiology and resource availability—both human and financial

The ultimate evaluation outcome of trauma system implementation is a reduction in morbidity and mortality. Iowa will accomplish this goal by planning and implementing a care improvement process, enhancing system performance, using evidence-based research, developing and implementing targeted injury prevention programs, and revisions to trauma system plans based on system assessments and data-based needs.