State Flex Program EMS/Trauma Activities and Integration of CAHs into Trauma Systems (Briefing Paper #27)

Publication Date: Mar 2010
Author(s): Gregg W, Jennings N, Dickerson C
Research Center(s): Minnesota
Topic(s): Flex Program, Health Care Services

This paper provides a portrait of State Flex Program EMS and trauma-related activities with particular focus on designation of Critical Access Hospitals (CAHs) as trauma centers. An associated policy brief summarizes these same findings. Information on state EMS/trauma activities supported by 2008-2009 Flex grants was collected through telephone interviews with State Flex Coordinators, State Office of Rural Health (SORH) Directors, and related EMS stakeholders (e.g., CAH trauma coordinators and State EMS staff). Data were collected in two phases: 1) telephone interviews with SORH representatives about state Flex Program efforts and state trauma delivery systems (March-April 2009); and 2) interviews with project personnel engaged in activities targeting system development, center designation, and/or trauma team training (June-August 2009). State-specific data on CAH trauma center designation found in Table 2 was updated to March 31, 2010.


Many states are paying more attention to trauma care in rural areas. Almost two-thirds (62%) of all Flex grantees included at least one trauma-related activity in their 2008-2009 State Flex grant workplans. Twenty-four of the 28 states with trauma-related objectives targeted two or more trauma area objectives, and many states targeted all three trauma area objectives. Those data undercount rural trauma activity, because ten states that did not include trauma-related objectives in their 2008-2009 work plans were currently engaged in trauma activities (largely as a carryover from previous year’s efforts). Trauma team training was the most frequently funded workplan activity.

More than one-third of all Critical Access Hospitals in the U.S. have been designated as trauma centers. As of March 31, 2010 the project team identified a combined total of 560 CAHs designated as trauma centers.


The results of this study document heightened activity related to designating CAHs as trauma centers. Several states reported that participating in the Flex Grant Program was a key to getting CAHs involved. Norms are changing in some states: Respondents told us that, as more facilities obtained designation status, the remaining facilities found themselves left out of the process and some sought designation to be part of the larger state group again.
Significant barriers remain. In particular, lack of funding, lack of national standards (at present there are no national standards for trauma center designation, system planning, or trauma team training) and lack of available Level IV and V designation in many states all hamper progress toward trauma care systems that serve rural areas effectively.

Respondents emphasized the need to build on existing efforts. They also recommended using trauma registry data as a valuable educational tool. Registry data can convince rural hospitals of the need to improve their trauma care abilities. Equally important, registry data also helps educate state-level policy and program personnel about continuing disparities in rural trauma care and the need to work toward integrated, coordinated systems in which all parties have designated roles to play.