ArticleOpen access emergency medicine : OAEM2026
A Twelve-Year Retrospective Analysis of a Journey Towards Rural Level I Trauma Center Verification.
Article in Open access emergency medicine : OAEM, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
Purpose: This study describes the transformation of a rural trauma center in the Upper Mountain West, which expanded from 280 to 305 beds between 2011 and 2022, and from an American College of Surgeons (ACS) verified Level II to Level I facility, serving a four-state region. Patients and Methods: A retrospective analysis of all 8947 trauma activations from 2011-2022 was conducted using the institution's trauma registry. A structured gap analysis assessed alignment with ACS Level I principles. Results: The gap analysis identified four priority areas for growth and development of our trauma program to become an ACS Level I Trauma Center: patient volumes, absence of a Surgical Intensive Care Unit (SICU), lack of a surgical residency program, and limited trauma research infrastructure. Targeted interventions led to the establishment of a dedicated SICU, initiation of PGY-4 surgical rotations, and the development of trauma-focused research capacity. By 2023, the number of severely injured patients (Injury Severity Score (ISS) ≥16) exceeded ACS thresholds despite total admissions remaining below 1200. Between 2011 and 2022, 8947 trauma patients were treated. Mean patient age increased from 42.6 to 51.8 years ( Conclusion: Strategic investments in infrastructure, workforce development, education, and research enabled this rural trauma center to achieve Level I criteria while adapting to changing patient demographics and clinical demands. These implementation strategies may inform similar resource-constrained rural trauma systems pursuing ACS Level I verification.
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