Atotal of 428 U.S. trauma centers have been sur- veyed and verified by the American College of Surgeons (ACS), which means the College has
confirmed the presence of support mechanisms as
outlined in the Resources for Optimal Care of the Injured
Patient at these facilities.*† In recent years, there has
been intense controversy surrounding the number
of trauma centers that should be available in a given
region, their level of designation, and the designation
process. One side argues that trauma centers, especially Level II institutions, have proliferated at an
uncontrolled pace. The individuals on this side of the
debate argue that this lack of restraint has resulted
in an oversupply of care in specific areas, increased
spending, and enhanced competition between centers, thereby destabilizing the system as a whole.
Individuals on the other side of the debate maintain
that the new centers fill a perceptible community
need and that the decision for a hospital to become
a trauma center is the prerogative of the individual
institution. According to the individuals who hold this
view, any hospital capable of meeting the standards
should be free to pursue trauma center designation.
To assist in resolving this debate, the ACS Committee on Trauma (COT) has taken two significant steps in
recent years: ( 1) released a position statement on trauma
center designation, and ( 2) developed a new instrument to measure the trauma center needs of the various
regions in the U.S. This article focuses largely on this
tool—the ACS Needs Based Assessment of Trauma
Systems (ACS NBATS).
COT position statement
In 2014, the ACS COT developed and the ACS Board
of Regents approved a Statement on Trauma Center
Designation Based upon System Need, which was published in the January 2015 Bulletin.‡ In this statement,
the College makes the following assertions: the designation of trauma centers is the responsibility of the lead
state or county-level agency; the distribution of trauma
centers should be guided by a regional plan based on
the needs of the populations served, with health care
providers advocating for the collective interests of
patients served; and that system needs to be assessed
using objective measures of trauma system access, quality of care, trauma-related mortality rates, and system
efficiencies.‡ Although the importance of controlling
the allocation of trauma centers by the lead governmental entity based on regional population need has
been recognized since the 1980s, few trauma systems
have been able to meet the criteria outlined in the ACS
• Explains the controversy surrounding the number
of designated trauma centers in the U.S.
• Outlines College activities aimed at responding
to the concerns raised in this debate
• Describes the development and
deployment of ACS NBATS, the College’s
new needs assessment tool
*American College of Surgeons. Searching for verified trauma centers.
Available at: facs.org/search/trauma-centers. Accessed July 8, 2016.
†American College of Surgeons Committee on Trauma. American
College of Surgeons Trauma Center Search 2016. Available at: facs.org/
search/trauma-centers?country=United%20States. Accessed July 8, 2016.
‡American College of Surgeons’ Committee on Trauma. Statement
on trauma center designation based upon system need. Bull Am Coll Surg.
2015;100( 1): 51-52. Available at: bulletin.facs.org/2015/01/statement-on-
trauma-center-designation-based-upon-system-need/. Accessed July 8,2016. continued on page 14