In 1989, House Bill 18 was passed during the 71st Legislature. The purpose of the bill was to develop an emergency medical services (EMS) and trauma care system. This allowed for the creation of trauma service areas (TSAs), formed regional advisory councils (RACs), and outlined the trauma facility designation process. The trauma designation rules went into effect on December 26, 2006. 

The Texas Department of State Health Services (DSHS) has the authority to designate facilities. The Office of EMS/Trauma Systems Section of DSHS works with hospitals and Regional Advisory Councils (RACs) to:

• Develop facility designation protocols,
• Develop policies, and
• Designate facilities in the state.

Announcement

The Texas Department of State Health Services (DSHS) is pleased to announce the release of the Trauma Designation Survey Guidelines. These guidelines have been developed in accordance with the Texas Administrative Code (TAC) Section 157.126 requirements and the American College of Surgeons (ACS) verification standards.

The goal of these guidelines is to establish a standardized structure for conducting designation surveys in Texas, helping to streamline the designation process and promote consistency across the state.

We encourage you to review these guidelines thoroughly to understand their impact on current and future survey scheduling. 

Adopted Trauma Rule Comparison Documents 

• Chapter 157 Adopted Level III Rule Language Comparison Document 
• Chapter 157 Adopted Level IV Rule Language Comparison Document

Register Now

Statewide Trauma Designation Meetings   

Texas trauma designation program staff are invited to attend our monthly meeting in collaboration with the department and peers throughout the state. Share ideas and best practices to improve patient outcomes for Texans.    

Join us by requesting registration below:

• Monthly, recurring - Trauma Level I & II 
• Monthly, recurring - Trauma Level III & Non-Rural Level IV   
• Monthly, recurring - Trauma Rural Level IV   
• September 15, 11 am – 12:30 pm - Texas Trauma Survey Guidelines Facility Training
• September 15, 3 – 4:30 pm - Texas Trauma Survey Guidelines Facility Training
• September 16, 11 am – 12:30 pm - Texas Trauma Survey Guidelines Facility Training
• September 16, 3 – 4:30 pm - Texas Trauma Survey Guidelines Facility Training
• September 17, 11 am – 12:30 pm - Texas Trauma Survey Guidelines Facility Training
• September 18, 11 am – 12:30 pm - Texas Trauma Survey Guidelines Facility Training
• September 18, 1:30 – 3 pm - Texas Trauma Survey Guidelines Facility Training
• September 19, 11 am – 12:30 pm - Texas Trauma Survey Guidelines Facility Training
• September 19, 1 – 2:30 pm - Texas Trauma Survey Guidelines Facility Training
• September 29, 11 am – 12:30 pm - Texas Trauma Survey Guidelines Facility Training 
• September 29, 2 – 3:30 pm - Texas Trauma Survey Guidelines Facility Training 
• September 30, 11 am – 12:30 pm - Texas Trauma Survey Guidelines Facility Training 
• October 7, 2025 – Trauma PI: Ask the Experts (all levels)  
• November 4, 2025 – Trauma PI: Ask the Experts (all levels) 
• December 9, 2025 – Trauma PI: Ask the Experts (rural level IV)  

Overview

• Trauma Systems Rules

Related Programs 

• EMS & Trauma System Funding
• Texas EMS/Trauma Registry

Councils

• Governor's EMS & Trauma Advisory Council (GETAC)
• Regional Advisory Councils (RACs)

Documents

• Applications and Forms
• DSHS Designation Program: Facility Program Contact Update Form
  Use our online verification system to verify your current contact information (instructions).

Trauma Facility Designation Survey Documents

• Trauma Designation Survey Guidelines
• Texas DSHS Designation Survey Organization Application
• Trauma Facility Designation Rule Exception Request
• Physician Requirement Exception Request

Fees

The non-refundable trauma application fees for a three-year designation period are as follows:

• Level I trauma facility application fee will be no more than $10 per licensed bed, with an upper limit of $5,000.00 and a lower limit of $4,000.00.
• Level II trauma facility application fee will be no more than $10 per licensed bed, with an upper limit of $5,000.00 and a lower limit of $4,000.00.
• Level III trauma facility application fee will be no more than $10 per licensed bed, with an upper limit of $2,500.00 and a lower limit of $1,500.00.
• Level IV trauma facility application fee will be no more than $10 per licensed bed, with an upper limit of $1,000.00 and a lower limit of $500.00.

Facilities

• List of Facilities by Designation Level
• Facilities "In Active Pursuit of Designation"

Map

• EMS/Trauma Systems Interactive Map

Best Practice Guidelines

• ACS TQIP Best Practice Guidelines
• GETAC Trauma Systems Committee - Recommended Best Practice Guidelines

Resources

• DSHS Virtual Survey Guidelines
• Level IV Trauma Center TOPIC Workshop Documents
  • Trauma Center Performance Improvement Patient Safety (PIPS) Master Plan
  • Level I Trauma Center Monthly Dashboard
  • Trauma Outcomes & Performance Improvement Course- Levels of Harm
• ISS Scoring/TQIP Assistance Workgroup Resource Documents
  • Trauma Registry Mentorship List
  • ISS Web-Data State Registry Entry
  • TQIP Assistance Mentorship List
  • Benefits of TQIP

For the purposes of Trauma Facility designation, DSHS will accept certifications or survey results from these recognized organizations: 

• American College of Surgeons (ACS): Comprehensive, Major, and Advanced 
• Texas EMS Trauma & Acute Care Foundation (TETAF): Advanced and Basic