Are Level I and Level II trauma centers that different?

UF Health TraumaOne
When accidents happen and severe injuries occur, one hospital stands above all others in providing comprehensive, lifesaving care. That’s UF Health Jacksonville, home to TraumaOne, the only adult and pediatric Level I trauma center in Northeast Florida and Southeast Georgia.

You’ve likely heard that statement before, but do you understand the difference between a Level I and Level II trauma center? There are some key distinctions.

UF Health TraumaOne is covered around-the-clock by University of Florida trauma surgeons and specially

trained support staff, including nurses, paramedics, residents, fellows, physician assistants, nurse practitioners and psychologists. As a Level I trauma center, it can provide complete care for every aspect of injury, from prevention through rehabilitation.

A Level II trauma center can initiate definitive care for injured patients and has general surgeons on hand 24/7. But for the most severe cases, the American College of Surgeons recommends patients be taken to a Level I center. TraumaOne services include cardiothoracic surgery, complex vascular surgery, oral and maxillofacial surgery, interventional radiology and complex orthopaedic procedures such as pelvic reconstruction.

“As a Level I trauma center, we pride ourselves on being the best place for trauma care in the region,” said David Meysenburg, nurse manager for TraumaOne. “Everybody in the community should expect that from us.”

Level I advantages

TraumaOne’s infrastructure and personnel make it the best-equipped trauma center in Northeast Florida and Southeast Georgia to handle mass casualty events. Some advantages include a dedicated trauma resuscitation unit and an emergency room significantly larger than those of other hospitals.

“If an incident such as a mass shooting occurred, we have the space and the manpower to take care of those patients,” Meysenburg said. “We also have the operating room space and more trauma surgeons on staff than other trauma centers in the region. This allows us to perform lifesaving surgery on multiple trauma victims simultaneously.”

Level I trauma centers also have technology and equipment Level II trauma centers don’t. The ECMO machine is a prime example.

ECMO, which stands for extracorporeal membrane oxygenation, is the technique of taking blood from the vein, adding oxygen and removing carbon dioxide, warming the blood, and then pumping it through the body. This is essential when a patient has suffered severe lung or chest wall injuries and has lost lung function.

“Other trauma centers in the area don’t offer this technology for trauma patients,” said Andy Kerwin, MD, chief of acute care surgery at UF Health Jacksonville. “It’s a prime example of why the most severely injured patients will do better at a Level I.”

Then there’s TraumaOne Flight Services. No other trauma center in the region provides air transportation in conjunction with its trauma program. UF Health Jacksonville has three helicopters that are strategically placed across the region, ready to respond and provide timely, advanced care that is essentially an extension of the trauma center.

“It’s an integral part of TraumaOne,” said Chad McIntyre, manager of Flight Services. “Our three-person flight crews are highly trained and prepared to deliver rapid, pre-hospital care that is critical to survival.”

Education and research

While Level I and Level II trauma centers provide continuing education programs for staff, TraumaOne is considered a leader in the region, offering outreach education to the general public and facilitating detailed classes for local EMS personnel.

TraumaOne teaches public courses on Stop the Bleed, a program that emphasizes bleeding-control techniques for bystanders to help prevent deaths during mass casualty events. Other regular initiatives include:

  • The Bike Rodeo, which teaches bicycle safety to young children
  • Mock DUI events geared toward high school students during prom season
  • Programs on car seat safety and distracted driving
  • Sessions with senior citizens to help prevent falls

In addition, through its affiliation with the University of Florida College of Medicine – Jacksonville, TraumaOne serves as an education hub for medical students and resident physicians, who gain valuable exposure and experience in the treatment of critically injured patients.

A Level I trauma center is also the premier location in the region for trauma research, helping forge new innovations in trauma care. Level II centers are not required to engage in research.

“All of our TraumaOne physicians are involved in research, which contributes to a lot of the equipment and technology we acquire,” Meysenburg said. “Level I trauma centers are almost always tied to academic health centers.”

Trauma center designation and data

The Florida Department of Health designates trauma centers throughout the state, and the American College of Surgeons verifies them. Verification lasts for three years. A trauma center must provide adult and pediatric services in order to be considered for Level I designation.

Multiple research groups have conducted retrospective studies over the years to explore data that illustrate the differences in outcomes at Level I and Level II trauma centers. Much of the patient information is taken from the National Trauma Data Bank.

In a study published in 2017 in The Journal of Trauma and Acute Care Surgery, researchers looked into the risk of death within the first 24 hours of admission at the two highest levels of trauma centers. The study included trauma patients with low blood pressure. When adjusting for risk among the 13,846 patients, the mortality rate was significantly elevated at the Level II trauma centers. The difference was the greatest between the fourth and seventh hour of post-admission.

“The four-hour to seven-hour time window post-admission is critical for hemodynamically unstable trauma patients,” researchers wrote. “Variations in available treatment modalities may account for higher relative mortality at Level II trauma centers during this time.”

A separate study published in The Journal of Trauma: Injury, Infection, and Critical Care examined the outcomes of trauma patients in Ohio over a nearly four-year span. Hospital mortality and discharge destination were used to gauge success of outcomes.

The study included 18,103 patients, 56 percent of whom were taken to a Level I trauma center.

“Patients taken to Level I centers had more severe injuries, more penetrating injuries, more complications, yet similar unadjusted mortality compared with Level II centers,” researchers said. In adjusted analysis, “patients treated at Level I hospitals were more likely to be discharged home or to a rehabilitation center or skilled nursing facility.”


Other studies report similar findings. As researchers continue to comb through data on trauma center outcomes, we know one thing is clear: Level I trauma centers like UF Health TraumaOne have the most resources, the latest technology and the most skilled personnel to provide lifesaving care to critically injured patients.