The American College of Surgeons (ACS) Committee on Trauma has just released Resources for Optimal Care of the Injured Patient: Level IV Trauma Center Standards (2026).
According to the ACS, the goals of the new standards are to help Level IV trauma centers assess their capabilities, identify gaps in care, strengthen their performance improvement efforts, and strengthen care delivery.
“Level IV trauma centers are an essential part of an effective trauma system, particularly in rural and remote communities,” said Avery Nathens, MD, PhD, FACS, medical director of ACS Trauma Quality Programs. “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.”
The ACS has clarified that it does not have a verification program for 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,” according to an ACS press release. “State trauma systems retain authority for designation requirements and oversight in accordance with state law.”
In comparison to ACS standards for Level I, II and III trauma center (the Grey Book), the requirements of the new Level IV standards are generally scaled down and made conditional.
The new Level IV Trauma Center Standards document is accessible from the ACS Quality Program Standards Manuals page.
