Highlights of the National Trauma Capacity Assessment
The resilience of the United States trauma system is increasingly under scrutiny as demand for emergency services climbs. A recent comprehensive study published in JAMA Surgery provides a sobering look at the current state of trauma center utilization. The key highlights include:
1. Level I and II trauma centers, the backbone of the system, consistently operate at high occupancy, frequently exceeding 80% for inpatient beds and 75% for ICU beds.
2. In the South and West regions, nearly 80% of Level I and II centers maintained these high occupancy levels for more than 75 weeks of the study period.
3. Simulation modeling indicates that a sustained influx of just 241 patients per day nationwide would saturate all designated trauma beds within 90 days.
4. During major disasters with higher casualty rates (1,500 to 2,000 daily), the national trauma bed deficit could exceed 20,000 beds within just 45 days.
Background: The Fragility of the American Safety Net
The US trauma system is designed to provide rapid, specialized care for life-threatening injuries. Central to this system are Level I and II trauma centers, which provide the highest level of surgical expertise and resource availability. However, these centers do not exist in a vacuum; they also serve as general tertiary care hubs for aging populations with complex comorbidities.
In recent years, the intersection of rising daily trauma volumes, seasonal respiratory surges, and healthcare staffing shortages has pushed many hospitals to their limits. While the system is designed to handle individual emergencies, its ability to manage ‘surges’—sudden spikes in volume from mass shootings, natural disasters, or industrial accidents—remains a critical concern for national security and public health. Until now, there has been a lack of granular, facility-level data to quantify exactly how much ‘reserve capacity’ exists within the national trauma infrastructure.
Study Design and Methodology
In a cross-sectional study led by Acharya et al., researchers analyzed 121 weeks of data spanning from January 2022 to April 2024. The study utilized facility-level bed availability and occupancy reports from the US Department of Health and Human Services (HHS).
The analysis included 2,027 hospitals with trauma center designations across the United States. The researchers categorized these facilities by their trauma level (I through V) and geographic region. The primary metrics evaluated were mean weekly occupancy rates for adult inpatient beds and intensive care units (ICUs).
Simulation Modeling of Casualty Influx
To move beyond static occupancy data, the team conducted simulation modeling to evaluate how the system would respond to a sudden and sustained surge. They assumed a 10% allocation (approximately 3,610 beds) of the total 36,101 adult trauma-designated beds in Level I/II centers nationwide would be available for new trauma patients. They then tested various casualty influx scenarios, varying the number of daily admissions and the expected length of stay (LOS) to determine how quickly the system would reach a breaking point.
Key Findings: A System Strained to the Limit
The results of the study suggest that the US trauma system is currently operating in a state of ‘chronic strain.’
Occupancy Rates by Trauma Level and Region
Level I and II trauma centers, which are essential for treating the most severely injured patients, were found to be the most heavily utilized. Across most regions, these centers consistently operated at occupancy rates exceeding 80% for inpatient beds. ICU occupancy was similarly high, often hovering above 75%.
Regional disparities were significant. The South and West were identified as the most pressured areas. In these regions, approximately 80% of Level I and II centers exceeded the 80% inpatient occupancy threshold for 75 weeks or longer during the study period. This suggests that for these hospitals, high occupancy is not a seasonal spike but a permanent operational reality. In contrast, Level III and lower-level trauma centers showed lower overall occupancy, though they exhibited more significant regional variation.
Simulated Surge Scenarios and Bed Deficits
The simulation results provide a stark warning for disaster preparedness. Under a ‘modest’ sustained influx of 241 patients per day—roughly the scale of a multi-city disaster or a prolonged civil emergency—the national capacity of designated trauma beds would be completely saturated within 90 days.
When the simulation increased the influx to 1,500–2,000 patients per day (reflecting a major national or regional catastrophe), the system collapsed much faster. In these scenarios, the national trauma bed deficit exceeded 20,000 beds within 45 days. These models take into account dynamic length-of-stay assumptions, meaning that even if hospitals attempted to discharge patients faster to make room, the sheer volume of incoming casualties would still overwhelm the available infrastructure.
Clinical and Policy Implications
These findings have profound implications for clinical practice and healthcare policy. When a hospital operates at or above 80% capacity, its efficiency begins to drop. This phenomenon, often called ‘hospital crowding,’ is linked to increased emergency department boarding times, delayed surgical interventions, and higher rates of medical errors.
The 80% Threshold and Patient Safety
For trauma surgeons and emergency physicians, high occupancy means that a patient arriving with a life-threatening injury may face delays in moving from the ER to an ICU bed or an operating suite. The ‘Golden Hour’ of trauma care—the window in which rapid intervention most significantly improves survival—is jeopardized when the physical space to treat patients is unavailable. The study highlights that the US trauma system has very little ‘elasticity’ left to accommodate the unexpected.
Regional Load-Balancing as a Solution
One potential solution discussed by experts is the implementation of more robust regional load-balancing mechanisms. Currently, trauma centers often operate as individual entities. In a surge event, one Level I center might be overwhelmed while a nearby Level III center has available beds. However, Level III centers may lack the specialized staff or equipment needed for complex trauma. Improving the ability to rapidly transfer stabilized patients from high-level centers to lower-level centers could free up critical beds, but this requires significant policy coordination and financial incentives for lower-level facilities to maintain readiness.
Expert Commentary and Limitations
While this study provides the most detailed map of trauma capacity to date, it is important to note certain limitations. The occupancy data from HHS reflects total hospital occupancy, not just trauma-specific beds. However, because trauma patients require the same resources (nursing, imaging, ICU) as other critically ill patients, total occupancy is a highly relevant proxy for trauma capacity.
Critics might argue that hospitals can ‘flex’ their capacity by canceling elective surgeries or opening surge wards. While true, these measures are temporary and often come at a high cost to other patient populations. Furthermore, the simulation assumes a national distribution of patients, whereas real-world disasters are usually localized, meaning local deficits would likely appear even sooner than the national models suggest.
From a clinical perspective, the data underscores the need for ‘trauma system resilience’ to be a central pillar of national healthcare strategy. We cannot simply build more beds; we must optimize how existing beds are used through better data integration and regional cooperation.
Conclusion: A Call for Resilient Infrastructure
The US trauma system is the nation’s primary defense against injury-related mortality, yet it is operating at the edge of its capacity. The finding that Level I and II centers are consistently near-full suggests that the system lacks the reserve capacity necessary to respond to major disasters.
To address this, national trauma capacity planning must move beyond facility-level preparedness to a regionalized, scalable infrastructure. This includes investing in load-balancing technologies, supporting the readiness of Level III and IV centers to take on overflow, and ensuring that trauma centers are not forced to trade off daily care for disaster readiness. Without these changes, the next major mass casualty event could find a system with nowhere to put the patients who need it most.
References
1. Acharya P, Staudenmayer K, Jarman MP, Griffin R, Kerby JD, Hashmi ZG. Bed Capacity and Utilization at Hospitals With Trauma Centers. JAMA Surg. 2026 Feb 4. doi: 10.1001/jamasurg.2025.6406.
2. American College of Surgeons Committee on Trauma. Resources for Optimal Care of the Injured Patient. 2022.
3. National Academies of Sciences, Engineering, and Medicine. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press; 2016.
