Committee on Trauma Releases Standards for Level IV Trauma Centers

The ACS Committee on Trauma (ACS COT) has released new standards for Level IV trauma centers. The resource, Resources for Optimal Care of the Injured Patient: Level IV Trauma Center Standards (2026), can help Level IV trauma centers assess capabilities, identify improvement opportunities, and strengthen trauma care delivery. 

“These standards provide a clear, nationally consistent framework while recognizing that states and centers differ in their resources, capabilities, and specific needs. Our goal is to help hospitals identify gaps, strengthen performance improvement, and build sustainable capacity to deliver the best possible care for injured patients,” said Avery Nathens, MD, PhD, FACS, Medical Director, ACS Trauma Quality Programs. 

The manual contains 30 standards organized across seven areas:  

1. Institutional administrative commitment 
2. Program scope and governance     
3. Staffing, facilities, and equipment
4. Patient care expectations and protocols 
5. Data surveillance and systems
6. Performance improvement and patient safety
7. Professional education and community outreach 

Among the areas addressed are continuous emergency department physician coverage, emergency airway management, pediatric readiness, access to blood products and diagnostic services, transfer protocols, trauma registry operations, performance improvement, feedback from receiving trauma centers, and continuing education for clinicians and nurses. 

The ACS does not verify Level IV trauma centers. Rather, these standards are intended to complement state trauma system requirements and may serve as guidance for states and regions developing or updating their own Level IV designation criteria. State trauma systems retain authority for designation requirements and oversight in accordance with state law.

The standards also emphasize coordination across trauma systems. Level IV centers are expected to participate in regional or statewide trauma activities, establish predetermined referral relationships, communicate directly with receiving facilities during patient transfers, participate in prehospital performance improvement, and request feedback from higher-level centers on the outcomes of transferred patients.