Two major hospitals can share level I status in a rural community setting.

Background: Even though development of Level I trauma centers is thought to improve outcome of injury treatment, the political barriers in communities where two capable hospitals compete for designation can be formidable. This report documents the initial experience of a Level I trauma center developed in a two-hospital setting whereby each hospital hosted the trauma center on an alternating annual basis.

Methods: Preliminary efforts began with a community-based report on trauma care to which both hospitals and their associated school of medicine contributed. In addition to confirming need, all parties agreed to develop a single Level I trauma center that would be verified by the appropriate state agency and would receive professional and financial support from all three institutions.

Results: The Southern Illinois Trauma Center began to function on July 1, 1999. Prehospital acceptance of the community agreement has resulted in appropriate triage to the designated hospital in 95% of the 1,000 cases seen annually. Integration of trauma care into the surgical residency program has been valuable both for function of the trauma center and as a teaching enhancement for trauma and critical care as reflected by significantly improved American Board of Surgery In-Training Examination scores. The trauma center is governed by a trauma committee with representation from the three institutions. The percentage of trauma transfers has increased over 3 years from 23% to 28%. Four annual institutional site changeovers have now occurred without incident or disruption of service. The trauma center finances are reviewed by the participants on a biannual basis and have been deemed favorable.

Conclusion: The community medical resources are commonly polarized between two large hospitals but need not prevent centralized trauma center development if preagreed community support can be achieved. Annual site change is not an impediment and could be successfully used in other similar communities, provided they are receptive to the concept of sharing Level I trauma center site designation.