By FlexMedStaff

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As a locums practitioner, you should know where you are needed and the demand for your services. For specific specialties, their services are in high demand at hospitals designated as trauma hospitals. Trauma hospitals across the country have been designated a trauma level of 1, 2, 3, 4, or 5. Facilities will have adult and pediatric trauma designations. State and local agencies are responsible for designating the trauma level of each hospital. At the same time, the American College of Surgeons is responsible for verifying that each facility has the resources, processes, and policies in place to meet the criteria for a specific trauma level. This article does not review all requirements for each trauma facility. Instead, this article highlights which physician specialties are needed at each trauma level. This way, physicians will be aware of where there might be a higher demand for their services if the facility must find a practitioner in a specific specialty to maintain their trauma status. The demand for your services can affect your compensation rate and fair market value.

**This article only looks at what physicians are needed at Adult trauma centers.    

Level 1

These facilities must provide coverage in every specialty to treat any patient. General Surgeons are required to be in-house at all times. The attending should be close by if general surgery residents are in-house. All other subspecialties must be available in emergencies but are not required to be in-house. This includes orthopaedic surgeons, neurosurgeons, anesthesiologists, cardiothoracic surgeons, vascular surgeons, plastic surgeons, otolaryngologists, urologists, and intensivists. If you are a surgeon or subspecialist, know that a level 1 trauma center can not maintain its trauma status without someone from your specialty covering that service line.

Level 2

Level 2 facilities should be able to handle patients similar to Level 1, with a few exceptions. General surgeons must be available at level 2 facilities, but they are not required to be in-house. Level 2 trauma centers must have coverage for neurosurgery, orthopaedic surgery, ENT, ICU, and anesthesia. They do not require coverage for cardiothoracic surgery or plastic surgery.

Level 3

A level 3 trauma center should be able to stabilize all patients but have in place a referral system to level 1 and 2 trauma centers for patients that require a higher level of care. All level 3 trauma centers should have general surgery, anesthesiology, orthopedic surgery, and internal medicine coverage.  Level 3 centers do not require neurosurgery coverage like Level 1 and 2. Level 3 trauma centers usually have other specialties but are not required to.

Level 4

A level 4 trauma center is expected to have a physician available to help stabilize and prepare a trauma patient for transfer to a higher level of care. These facilities are usually open 24 hours and have full-time access to laboratory services. These facilities may be covered by an emergency medicine physician, hospitalist, primary care physician, or advanced practice practitioner. A Level 4 trauma center may have surgeons available and an ICU, but not required.

Level 5

Level 5 trauma centers are very similar to Level 4. They are small and expected to transfer most trauma patients to a higher level of care. If they are not open 24 hours, they are expected to be available if a trauma patient requires evaluation after hours.  


A practitioner seeking part-time or locums-type work can search for openings at trauma hospitals. As discussed in this article, each trauma level, particular Level 1, 2, and 3, requires specific specialties to provide coverage. Knowing what specialties are needed for each trauma level can help establish the demand for your services. At trauma centers, you can contract directly with the facility to provide services so that they are not in danger of staffing shortages. Surgeons and subspecialists should look at contracting directly for part-time or locums-type work at trauma centers where their services are needed to comply with state agencies and the American College of Surgeons.

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