Original Investigation 

Bed Capacity and Utilization at Hospitals With Trauma Centers

Pawan Acharya, Kristan Staudenmayer, Molly P. Jarman, et al

JAMA Surg Published Online: February 4, 2026

doi: 10.1001/jamasurg.2025.6406

Key Points

Question  What is the current utilization and reserve capacity of the US hospitals to absorb a sustained surge in acute trauma care demand?

Findings  This cross-sectional study of 2027 trauma hospitals found that level I/II centers constantly operated above 80% occupancy. Simulations showed that a sustained influx of 241 patients per day would fully saturate available trauma beds within 90 days.

Meaning  The US trauma system constantly operating at high occupancy rate has limited reserve capacity and is vulnerable to surges in demand, highlighting the need for proactive planning, regional coordination, and scalable surge infrastructure.

Abstract

Importance  As trauma care–related demand continues to rise, the US trauma system’s current utilization and ability to accommodate surges from mass casualty events or disasters remain uncertain. Understanding existing trauma bed occupancy and reserve capacity is essential for national preparedness.

Objective  To assess the current occupancy and distribution of adult trauma-designated beds across US hospitals and evaluate the system’s ability to absorb a sudden and sustained surge in trauma volume.

Design, Setting, and Participants  This cross-sectional study analyzed 121 weeks (January 2022–April 2024) of facility-level bed availability and occupancy data from the US Department of Health and Human Services for 2027 hospitals with trauma center designation. Simulation modeling was conducted to evaluate bed capacity under various casualty influx scenarios, assuming a 10% allocation (n = 3610) of the 36 101 adult-trauma designated beds in level I/II centers nationwide.

Exposures  Various casualty influx scenarios.

Main Outcomes and Measures  Primary outcomes included mean weekly occupancy rates for adult inpatient and intensive care unit (ICU) beds by trauma center level and region, percentage of centers exceeding 80% occupancy for prolonged durations, and simulated bed deficits under sustained patient influx scenarios.

Results  Level I and II trauma centers consistently operated at high occupancy, exceeding 80% for inpatient beds and 75% for ICU beds across most regions. Nearly 80% of level I/II centers in the South and West exceeded 80% inpatient occupancy for 75 weeks or longer. In contrast, level III and lower-level centers showed lower occupancy but notable regional variation. Simulation modeling revealed that at sustained influx rates of 1500 to 2000 patients per day, national trauma bed deficits exceeded 20 000 beds within 45 days. Even modest influxes of 241 patients per day saturated all designated trauma beds within 90 days under dynamic length-of-stay assumptions.

Conclusions and Relevance  The US trauma system, particularly its tertiary centers (level I/II) are operating under sustained high occupancy with limited reserve capacity for patient surges. These findings highlight the urgent need for national trauma capacity planning, regional load-balancing mechanisms, and scalable infrastructure to enhance trauma system resilience.