COT statement. Therefore, trauma system designation
has been driven by individual institutional priorities,
and timely access to trauma care has fluctuated with
the economic tide. The authors of the statement called
for an international group of experts, stakeholders, and
policymakers to convene and plan for optimal future
regional trauma system development.
Needs Based Trauma Center
Designation Consensus Conference
In August 2015, the ACS COT convened the Needs Based
Trauma Center Designation Consensus Conference. A
broad group of stakeholders involved in the establishment, operation, and designation of trauma centers
throughout the U.S. attended the meeting, which
featured representatives of national professional organizations, including emergency medicine, prehospital
professionals, and surgeons, as well as administrators
from individual trauma centers, regional advisory
councils, state health and hospital departments, and
the national U.S. Department of Homeland Security
and U.S. Health and Human Services (HHS) Office of
the Assistant Secretary for Preparedness and Response
(see Table 1, page 13). The goal of this conference was
to review the principles outlined in the ACS COT statement and to begin work on a set of practical methods
and metrics to determine a needs based designation of
trauma centers that would be broadly accepted.
This diverse group of attendees unanimously sup-
ported the concept that trauma center designation
within a regional trauma system should be based on the
needs of the population served, as outlined in the ACS
position statement. The consensus group also unani-
mously endorsed each of the ACS COT Principles for
Trauma Center Designation outlined in Table 2, this
page. Furthermore, meeting attendees confirmed the
immediate need for a practical tool that draws from
existing data and can be used to assist regions that
are struggling with the issue of new trauma center
The group collaborated on the development of a
tool to assist administrators from various regions in
performing a needs assessment and determining the
number of trauma centers required to meet patient
demand. The conference workgroup was fully cognizant of the challenges involved in this process, not the
least of which is a lack of proven metrics that accurately
evaluates need. Ultimately, the group determined two
goals in developing this tool: ( 1) to produce a pragmatic
and relatively simple instrument that would be based
on presently available data, and ( 2) to start a process
that would lead to future improvements and refinements in the approach.
The final product—the ACS NBATS tool—is designed
to evaluate the need within a particular geographic
area, termed a trauma service area (TSA). A TSA can
range in size from a small county to a multistate region,
and from several thousand to several million people.
The assessment tool evaluates the number of centers
ACS COT PRINCIPLES FOR TRAUMA CENTER DESIGNATION
• Trauma center designation within a regional trauma system
should be based on the needs of the population served.
• The best interests of the population served should be
held above the interests of stakeholder groups.
• Trauma centers and stakeholders within a region have a duty to work together
cooperatively to achieve the first two goals, even in the face of competition.
• The role of the academic Level I trauma center is important to patient care and
system function and should be actively preserved by those in the system.
• A practical tool should be developed, based upon currently
available data, that can be used to assist regions currently
struggling with the issue of new trauma center designation.
continued on page 16