Eight hospitals in the San Joaquin Valley have emergency departments that are designated as “trauma centers” equipped to deal with varying degrees of injuries, including one Level I facility capable of treating the most serious forms of trauma.

But none of those trauma centers are in Merced County.

That will change if Mercy Medical Center in Merced succeeds in a quest to be tabbed as a trauma center hospital. Tim Williams, administrator for the Merced County Emergency Medical Services Agency, told the Central Valley Journalism Collaborative that officials at Mercy Medical are in the early stages of the process to seek a Level III trauma designation for its emergency room.

Mercy Medical had almost 62,600 patient visits to its emergency department in 2024, according to the U.S. Centers for Medicare & Medicaid Services. 

“Traumatic injury is the primary cause of death for people ages 1 to 44, regardless of gender, race, or economic status,” the California Emergency Medical Services Authority reports. “Injuries, both unintentional and those caused by acts of violence, are among the top ten killers for Americans of all ages.

“Trauma” includes injuries from motor vehicle collisions, falls, burns, stabbing and gunshot wounds, or other blunt or penetrating forces, according to the agency.

Williams said that while the hospital is apparently moving forward with its effort, his office has yet to receive an application detailing Mercy Medical Center’s plans. The Merced County EMSA has the responsibility, designated by the state EMS Authority, to make the trauma center designation.

“We have been told that MMCM would be applying for a Level III Trauma Center, but until we receive an application, it would only be speculation,” Williams said in an email to CVJC.

Christy Gonzalez, Mercy Medical Center’s communications manager, did not respond to repeated queries – both by phone message and email – between Feb. 12 and March 3 about the hospital’s trauma center aspirations or other information about the hospital’s plans. The hospital’s CEO, Dale Johns, also did not respond to multiple email inquiries, nor did the corporate communications staff for the hospital’s parent organization, Dignity Health / CommonSpirit Health.

California has 82 hospital emergency rooms designated with one of four trauma center levels, each level reflecting different capabilities, equipment, staffing and capacity:

  • Level I trauma centers, according to the American College of Surgeons, offer “comprehensive trauma care for all injuries” in addition to providing regional trauma system leadership. California has 24 Level I trauma centers, including four that are pediatric Level I centers. Community Regional Medical Center in Fresno, about an hour southeast of Merced, is the only Level I trauma center in the San Joaquin Valley.
  • Level II trauma centers “are expected to provide initial definitive trauma care for a wide range of injuries and injury severity and may take on additional responsibilities in the region related to education, system leadership, and disaster planning,” ACS reports. There are 35 adult Level II trauma centers in the state, of which the closest to Merced are Memorial Medical Center and Doctors Medical Center, both in Modesto, about 45 minutes north of Merced. Valley Children’s Hospital in Madera, about 50 miles southeast of Merced, is a pediatric Level II center.
  • Level III trauma centers “typically serve communities that may not have timely access to a Level I or II trauma center and fulfill a critical role by serving more remote and/or rural populations. Level III trauma centers provide definitive care to patients with mild to moderate injuries, allowing patients to be cared for closer to home. California has 11 Level III centers, including Kaweah Health Medical Center in Visalia.
  • A Level IV trauma center is an emergency room with “equipment and resources necessary for initial stabilization and personnel knowledgeable in the treatment of adult and pediatric trauma,” where people can receive initial stabilization of injuries before they are transferred to a higher-level facility. There are 11 Level IV trauma centers in California.

Mercy Medical Center’s parent company, Dignity Health, has eight California hospitals that are tabbed as trauma centers: six Level II centers that can provide initial definitive trauma care for a wide range of injuries and injury severity, according to the American College of Surgeons which verifies hospitals’ trauma capacity, and two Level III centers that provide care for mild to moderate traumatic injuries, typically in remote or rural communities that may not have timely access to either Level I or II centers.

What would it mean for patients?

Designation as a trauma center, at whatever level, indicates that a hospital emergency room is equipped to provide a certain standard of professional staffing, equipment and facilities, and standards and processes verified by the American College of Surgeons.

Establishment of trauma centers as part of a regional trauma system reduces mortality and complications among patients, according to the American College of Surgeons.

And while Level I and Level II centers are designed to provide higher levels of care for more serious trauma cases, even Level III centers in more rural communities – such as the one reportedly being planned at Mercy Merced – are associated with better outcomes for patients.

“Development of rural Level III trauma centers in a regionalized system can significantly reduce the need for transfer to a remote, higher level trauma center,” doctors wrote in a 2018 research article published in the Journal of Trauma and Acute Care Surgery. “This may benefit the patient, family, and trauma system, with no adverse effect upon patient outcome.”

“Research indicates that trauma management at a designated trauma center leads to better outcomes than care at a nondesignated facility,” wrote emergency physicians Dr. Alison Southern and Dr. Daniel Celik, associate professors of emergency medicine with Northeast Ohio State University in a 2025 article on the National Institutes of Health website.

Williams, who oversees emergency medical services across Merced County, said there could be multiple advantages to having a local trauma center, including:

  • Local trauma services for trauma patients.
  • Quicker care for trauma patients.
  • Closer transport time for trauma patients “instead of the 45 minutes or longer that currently exists.”
  • Keeping patients local so they have family support.

The process, however, is not a fast one. The California EMS Authority reported in an email to CVJC that the American College of Surgeons application and verification process can take 18 to 24 months. “Local EMS agencies can then designate as Level I, II, or III trauma receiving centers for their local EMS agency any hospital which has attained verification from the ACS.”

What’s required for a Level III trauma center?

Level III trauma centers “typically serve communities that may not have timely access to a Level I or II trauma center and fulfill a critical role in much of the United States by serving more remote and/or rural populations,” according to the American College of Surgeons standards of “Resources for Optimal Care of the Injured Patient,” updated in 2025.

ACS standards for Level III trauma centers include:

  • An operating room that must be fully staffed and available within 30 minutes of notification of an incoming trauma patient.
  • Access to an operating room that must be made available for non-emergency orthopedic trauma such as broken bones.
  • An adequate supply available of red blood cells and plasma.
  • 24-hour availability of imaging services accessible for patient care within 30 minutes for conventional radiography, within 30 minutes for CT scans, and within 15 minutes for point-of-care ultrasound.
  • Availability of cerebral monitoring equipment (in Level III centers that provide neurotrauma care for patients with moderate to severe traumatic brain injury).
  • A documented backup call schedule or a backup plan for trauma surgery.
  • An emergency department director who is board-certified or board-eligible.
  • Emergency department physicians must be board-certified or board-eligible in emergency medicine, pediatric emergency medicine, or a specialty other than emergency medicine, and hold a current certification in advanced-trauma life support.
  • Have a board-certified or board-eligible neurosurgeon (in Level III centers that provide neurotrauma care for patients with moderate to severe traumatic brain injury).
  • Anesthesia services must be available within 30 minutes of request.
  • Doctor coverage of the hospital intensive-care unit available within 30 minutes of request, with a formal plan in place for emergency coverage.
  • Continuous availability of internal medicine specialists 24 hours a day, seven days a week, 365 days a year.
  • Have renal replacement therapy services (such as dialysis) available to support patients with acute kidney failure or have a transfer agreement in place for such services.
  • Have a trauma surgeon at the patient’s bedside within 30 minutes of patient arrival for the highest level of trauma activation at least 80% of the time.
  • Have a written plan approved by the trauma medical director that defines the types of neurotrauma injuries that may be treated at the center.
  • Have a neurotrauma contingency plan that includes the potential for diversion, and must implement the plan when neurosurgery capability is encumbered, overwhelmed or unavailable (in Level III centers that provide neurotrauma care for patients with moderate to severe traumatic brain injury).
  • Must meet the mental health needs of trauma patients by having a process for referral to a mental health provider when required.
  • For at least 80% of patients who screen positive for alcohol abuse, provide a brief intervention by appropriately trained staff prior to discharge, or a trackable mechanism for referral to an outside substance-abuse program.
  • Have a written Performance-Improvement / Patient-Safety plan.

What’s in it for a hospital?

Meeting all of those standards doesn’t come cheap. A paper prepared by doctors and clinicians in Georgia for the 2022 annual meeting of the American Association for the Surgery of Trauma reported that the average annual readiness cost is more than $1.7 million for a Level III trauma center, with the costliest factor being sufficient clinical medical staff to meet standards.

Many hospitals add what are called “activation fees” to the bills of patients whose level of trauma injury, assessed prior to arrival at the emergency department, triggers the need for trauma services. A research study published by JAMA Surgery in 2024 found an average listed trauma activation fee of more than $6,500 among Level III trauma centers, with lower fees for cash-paying patients and for negotiated fees with insurers.

But between trauma activation fees and higher levels of reimbursement from Medicare for treatment of trauma patients, trauma surgeon Dr. John Josephs wrote in a 2016 article in Becker’s Hospital Review as the then-CEO of EmCare Acute Care Surgery.

Josephs also described what he called a “halo effect” to describe additional patient volume in a hospital’s emergency room. “What we’ve found, and it’s been well documented in the medical literature, is that when a hospital becomes a designated trauma facility, it receives increased traffic from the emergency medical services agencies that already come there.”

“Once emergency medical technicians and paramedics get comfortable with a certain emergency department, they start going there more and more frequently,” even for non-trauma patients, Josephs added, creating higher overall patient volume in the emergency department.

As a result, “the inpatient beds are filled more quickly and regularly, there are more higher-acuity patients so there are more X-rays, more laboratory tests and more patients who need the rehab facilities,” he wrote. “The general surgery referrals get busier, the orthopedic referrals grow. The volume in the operating rooms tends to grow as well.”

“I have seen hospitals that were struggling prior to trauma designation — newer facilities in a saturated area or older hospitals unsuccessfully competing with shiny new high-tech sites — go on to become the most robust, well-regarded facilities in their communities,” Josephs wrote. “Trauma designation allows challenged hospitals to build strong, positive reputations of quality that can help recapture patients. Becoming a trauma facility truly can help breathe new life into a hospital.”

Tim Sheehan is the Health Care Reporting Fellow at the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. Contact Sheehan at tim@cvlocaljournalism.org.