CHICAGO —The American College of Surgeons Committee on Trauma (ACS COT) has released new standards for Level IV trauma centers. The new 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.
Level IV trauma centers frequently serve as the first point of access to trauma care for patients in rural and remote communities. These facilities provide essential early interventions, stabilize patients, and coordinate transfers to higher-level trauma centers when more advanced care is needed. When appropriate expertise and resources are available, Level IV centers may also provide definitive care for selected patients closer to home.
“Level IV trauma centers are an essential part of an effective trauma system, particularly in rural and remote communities. 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:
- Institutional administrative commitment
- Program scope and governance
- Staffing, facilities, and equipment
- Patient care expectations and protocols
- Data surveillance and systems
- Performance improvement and patient safety
- 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 standards reflect ACS’ broader commitment to supporting clinicians and their teams caring for patients in rural communities. 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.
“Patients in rural communities may depend on a Level IV trauma center as their first, or even only, immediate source of trauma care. These hospitals must be prepared to rapidly evaluate injured patients, begin critical stabilization, and coordinate a safe transfer when higher-level care is needed. Trauma center levels describe differences in resource depth, not differences in the commitment to quality. The new standards give rural hospitals a practical roadmap for strengthening those capabilities while supporting appropriate care closer to home,” said Michael Person, MD, FACS, Rural Program Area Chair, ACS Committee on Trauma.
The standards also emphasize coordination across the trauma system. 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 about the outcomes of transferred patients.
The standards were developed through a collaborative, stakeholder-informed process led by ACS COT trauma and rural surgery experts, with input gathered during multiple feedback periods.
The new Resources for Optimal Care of the Injured Patient: Level IV Trauma Center Standards (2026) is available to download on the ACS website.
The ACS Committee on Trauma was formed in 1922 to develop and implement programs that support injury prevention and ensure optimal patient outcomes across the continuum of care. These programs incorporate advocacy, education, trauma center and trauma system resources, best practice creation, outcome assessment, and continuous quality improvement.
