Lyn Nelson
                     Lyn Nelson

According to research published in the New England Journal of Medicine, receiving care in a trauma center reduces the chance of death by 25% compared to receiving it in an undesignated hospital. A trauma center is a hospital that can offer specialized medical care and resources to patients with traumatic injuries. 

Lyn Nelson is the trauma coordinator for the Bureau of Emergency Preparedness, Emergency Medical Services (EMS), and Systems of Care in the Upper Peninsula. The Upper Peninsula is known as Region 8. Her job is to provide technical assistance throughout to Region 8 hospitals in their attainment and retainment of trauma center designations. She has extensive experience working in EMS and a Level II trauma center. In addition to state employment, Lyn currently serves as the Sands Township EMS Coordinator (Basic Life Support ambulance transport), Sands Township Fire, Marquette County Sheriff’s Office Technical Rescue, USAC American Rally Association National Safety Steward, and Region 8 Healthcare Preparedness Medical Coordination Center member. She is passionate about the Upper Peninsula having trauma centers.

“People living in the U.P. might not even know what it means to be a trauma center," Nelson said. "There needs to be more education about the importance of this designation. Our hospitals must educate their communities on what their trauma level is and what that means."

What does “trauma” mean?

The Bureau of Emergency Preparedness, EMS, and Systems of Care employs trauma triage guidelines that are applied in EMS and in hospitals. By these guidelines, the patients with the most serious injuries are those who have issues responding with an injury causing low blood pressure, breathing issues, mangled limbs, pelvic fractures, skull fractures, or paralysis. These patients may also have more serious injuries to their head, neck, torso, or chest. These individuals are among the most seriously injured and must be transported to a trauma hospital as soon as possible.

Trauma Center Level Criteria

  • Level I = highest volume, surgically treats all types of injuries, must have onsite research
  • Level II = high volume, may be the leader of trauma care for a geography without a Level I, 24-hour surgical / orthopedic / neurology, may transfer patient to another trauma center
  • Level III = 24-hour surgeon and orthopedic coverage, may transfer patient to another trauma center
  • Level IV = no 24-hour surgical coverage, provides stabilization of trauma patient and transfers to another trauma center

To qualify as a Trauma Center Program, hospitals must have the following:

  • Care meeting Advanced Trauma Life Support standards
  • Trauma specific education for staff and collaboration with prehospital care
  • Program Manager and Medical Director with specific duties and oversight as endorsed by hospital leadership
  • Activation criteria and trauma response team to bedside
  • Injury prevention for top mechanisms of injury
  • Peer reviews and performance improvement 

In the Upper Peninsula of Michigan, there are several Level IV trauma centers, two Level III trauma centers and one Level II trauma center. There are no Level I trauma centers in the Upper Peninsula.

Region 8 Trauma Center Standings as of December 2022

  • Aspirus Ironwood - IV
  • Aspirus Iron River not designated as a trauma center
  • Aspirus Keweenaw not designated as a trauma center
  • Aspirus Ontonagon - IV 
  • Baraga - IV
  • Helen Newberry Joy - IV  
  • Marshfield Dickinson - IV applied
  • Munising - IV applied
  • MyMichigan Sault - III
  • OSF St. Francis - IV
  • Schoolcraft - IV applied
  • UPHS Bell - IV applied
  • UPHS Marquette - II
  • UPHS Portage - III

In Michigan, quick reference guides are issued to all hospitals so they know the criteria they must meet to become a trauma center. This gives hospitals access to all questions and they are urged to annotate the document to show how they have met each row of the guide. The first section of the assessment explains that the decision by a hospital to become a trauma facility requires the commitment of the institutional governing body and the medical staff. Documentation must be submitted stating commitment. If a hospital cannot supply documentation, this is known as a Type I deficiency. If a hospital has any Type I deficiency, it will not pass the evaluation. 

”I think it’s on all the providers who hold a medical license to know what their community assets are and explain that to people who are fellow medical providers in their community and friends and family who may need medical care.” Nelson said. “This will explain why they want their closest hospital to be a certain level of trauma center, so they can take care of these kinds of patients who would otherwise be flown or driven a number of miles to another place.”

What does it mean if a hospital does not qualify for hospital designation? 

When Region 8 hospitals are visited by the Bureau of Emergency Preparedness, EMS, and Systems of Care, Designation Committee surveyors determine if the hospital has everything necessary to achieve the level for which they've applied. If they do not, a hospital may automatically fail and re-apply in 12 months, or the hospital may be granted a 12 month extension with a revisit to see if minor deficiencies have been resolved. During COVID, hospitals needing to meet required criteria had a slight extension granted. Some of the hospitals met the standards in the required timeframe, while others did not. Facilities that have not met requirements should not be accepting critically injured patients. 

“If you look at a map, it shows that if someone is hurt in a specific region, their hospital level and capabilities are taken into consideration. It all depends on the injuries of that specific patient reaching the appropriate location at the appropriate time,” Nelson said. “In order to bring the patient to whatever type of surgical needs they have as quickly as possible, we may need to arrange rendezvous spots with a helicopter or have a helicopter waiting at a hospital landing pad.” 

Nelson added that the hardest part for her in these situations is that hospitals are given the evaluation checklist ahead of time and know what criteria they will need to meet. Part of her role is to work with hospitals as a consultant. 

“They are welcome to ask me a question, and if I don't know the answer, I will either look it up and explain to them or connect them with a peer who has attempted to resolve the same problem for themselves.”

She said that hospital trauma committees need to meet regularly and demonstrate they are doing peer review and performance improvement for best patient outcomes.

How do we help more U.P. Hospitals meet trauma center criteria?

Nelson said that in order for more U.P. hospitals to meet, retain or increase their trauma center level, they must have key personnel with support and education to do their jobs. In this area, time and education can be lacking due to personnel turnover which proposes a barrier to regionalization.

“Our numbers are really small on those critically injured across the U.P., and thankfully so. But that still means the program must be ready,” she said. 

To learn more about the trauma centers and trauma center designation, visit the Michigan Statewide Systems of Care website.


The Northern Michigan University Center for Rural Health seeks to improve the health and well-being of Upper Peninsula residents and communities by developing collaborative partnerships that enhance the access and availability of affordable, quality healthcare services. For questions or comments related to this story, contact