Trauma System
All acute care hospitals in New Hampshire (NH) are capable of caring for any patient that presents. However, select hospitals in NH have worked to obtain designation as a trauma hospital as defined by the American College of Surgeons (ACS). The ACS verifies and NH designates Level I-IV trauma centers and Level I-II pediatric trauma centers.
A Level I Trauma Center is a tertiary care facility that provides comprehensive trauma care and serves as a referral center for complex trauma cases. It must provide 24-hour access to general surgery and a broad range of medical and surgical specialties. Level I centers also support injury prevention, professional education, quality improvement, research, and teaching, as well as addressing substance use and mental health needs among trauma patients. These centers must meet established annual trauma volumes. Pediatric Level I Trauma Centers must treat at least 200 trauma patients under 15 years of age annually.
A Level II Trauma Center provides comprehensive initial evaluation and treatment for trauma patients, with the capability to stabilize patients and transfer those requiring more specialized care. These centers provide 24-hour access to general surgeons and a broad range of specialty services. Level II centers coordinate with Level I Trauma Centers when higher-level expertise or resources are needed and maintain ongoing trauma education, quality monitoring, and performance improvement programs.
A Pediatric Level II hospital will have a defined separate pediatric inpatient service and a department/division of pediatrics within the medical staff structure. A Level II facility will be capable of identifying those pediatric patients who are critically ill or injured, stabilizing pediatric patients and will also provide ongoing inpatient care or appropriate transfer to a Level I pediatric critical care center.
A Level III Trauma Center provides prompt assessment, treatment, surgical intervention, and stabilization for trauma patients, with 24-hour access to emergency medicine physicians and availability of general surgery, anesthesia, intensive care, and orthopedic services. These centers maintain transfer agreements for patients requiring higher-level trauma care and provide support to outlying hospitals when needed. They also emphasize ongoing trauma education, quality improvement, and community outreach focused on injury prevention.
A Level IV Trauma Center provides initial trauma assessment, stabilization before transferring patients who require a higher level of care. These centers have an emergency department capable of providing Advanced Trauma Life Support (ATLS) when trauma patients arrive. Surgical and intensive care services may be available, and centers maintain transfer agreements, quality improvement programs, and community outreach focused on injury prevention.
Learn more:
- EMS: Trauma Center Designation - StatPearls - NCBI Bookshelf
- New Hampshire Trauma Map - More about the NH Trauma System including the Trauma Systems Map can be found here.
- Trauma Medical Review Committee - The Trauma Medical Review Committee (TMRC) is formed by a multidisciplinary group that advises the development and ongoing improvement of the NH Trauma System. More information including meeting minutes, schedule, and committee members can be found here.
- Pediatric Readiness - The ACS has been a collaborator on the National Pediatric Readiness Project (NPRP) since 2026. Of note, questions about trauma center level or verification in the 2026 NPRP assessment are not scored but are for data collection purposes.