Data suggests Cleveland doesn’t need another trauma center, Signal analysis finds

Trauma care in Cleveland is under the microscope right now.  

The Cleveland Clinic announced in January that it plans to open a Level I trauma center at its main campus to treat the most severe injuries from things like gunshots and car crashes. Adding it would cut down on the need to transfer patients to other health systems’ high-level trauma centers, Clinic officials have said.

The announcement received a cold reception from MetroHealth, the county’s public hospital, which has operated an adult Level 1 trauma center for decades. The hospital’s CEO called the decision to open another trauma center “reckless” in a letter to the Clinic’s CEO, saying the region could not sustain it. 

The rift led to questions: Does Cleveland need another high-level trauma center? MetroHealth leaders and state lawmakers asked for a needs assessment to better understand the data. 

Studies like this are possible. Seven years ago, a group that coordinates trauma care in the area looked at the data and found that there wasn’t a need for new trauma centers in Northeast Ohio — a region including Cuyahoga, Ashtabula, Lake, Lorain and Geauga counties.

Has anything changed since then? Signal Cleveland ran the same assessment using numbers from 2024, the most recent reliable data available. It included information such as population, numbers of existing trauma centers and numbers of severely injured patients. Also included was a metric for injured patients who didn’t go to a trauma hospital. 

Signal’s analysis found Northeast Ohio had enough trauma care available. Dr. Glen Tinkoff, a former system chief for trauma and acute care surgery at University Hospitals and a former medical director of the Northern Ohio Trauma System, reviewed Signal Cleveland’s analysis and confirmed the finding.

“There’s an adequate number, and there’s no need for an additional Level 1 trauma center in the city of Cleveland,” Tinkoff said. 

Two other trauma surgeons also reviewed Signal Cleveland’s analysis and came to a similar conclusion: Dr. Ronald Simon, a former director of trauma at a New York City hospital who is unaffiliated with any local hospitals, and Dr. Vanessa Ho, a trauma surgeon at MetroHealth who is opposed to the Clinic’s plan. 

The method Signal Cleveland replicated, which is called the Needs Based Assessment of Trauma Systems or NBATS, has limitations, said Molly Jarman, an associate professor of surgery at Harvard Medical School and Mass General Brigham who has studied trauma center needs. For example, it doesn’t account for whether patients died on the way to a trauma center, and one study found the tool underestimates trauma needs in urban areas. It also can’t help determine where, within a region, trauma centers should be geographically located. 

More sophisticated ways now exist to measure need and to determine where new trauma centers should be placed, Jarman said, but such analyses often are conducted by hospitals or requested by state agencies. Signal Cleveland used publicly available information. 

“There are always limitations,” Jarman said. “But it can’t hurt to look at how much need there is and whether or not that need is being met.” 

State Rep. Bride Rose Sweeney, a lawmaker who previously asked the Cleveland Clinic for a needs assessment, wrote in a statement that Signal Cleveland’s analysis highlights some concerns that have been raised about the need for a new trauma center.  

“At the same time, it’s preliminary and reinforces the need for an updated, independent assessment so the community can fully understand the impact of this proposal,” Sweeney wrote. 

Signal Cleveland shared its assessment with spokespeople for the Cleveland Clinic and emailed it to Dr. Jeffrey Claridge, a trauma surgeon helping lead the Clinic’s new trauma center. Claridge was a principal investigator of the 2019 needs assessment on which Signal Cleveland based its methods. At the time the analysis was published, he worked for MetroHealth. 

Claridge did not respond to an email requesting his feedback. A spokesperson for the Cleveland Clinic directed Signal Cleveland to a press release about why it’s expanding trauma care in town. Reasons include ensuring more patients can get lifesaving care close to home and limiting patient transfers.   

“An important factor to highlight is the fact that each year, over 600 patients who are brought to Cleveland Clinic following traumatic injuries have to be transferred out of our system because we do not have the required trauma designation needed to treat them,” wrote Angela Smith, senior director of corporate communications, in an email to Signal Cleveland. “…This introduces additional risks to patients.” 

Those risks include infection and delayed care “when patients can least afford” it, according to a letter the Cleveland Clinic sent last week to lawmakers who had requested a needs assessment. The letter again referenced the number of patients it transfers out of its system annually, including over 100 of the Clinic’s own staff or their family members who had to seek trauma care elsewhere last year. It did not add any more data, aside from pointing out that traumatic injuries have risen between 2016 and 2023. 

The hospital added in the letter that “suggestions that Cleveland Clinic would pursue any course of action that could jeopardize patient lives are unfounded, misleading, and dishonest.” 

The number of patient transfers happening between hospitals and hospital systems is not accounted for in the analysis Signal Cleveland replicated below. 

More information about Signal Cleveland’s methodology and data can be viewed here.

How does the analysis work?

The number of points assigned to each piece of data was set by the American College of Surgeons Committee on Trauma, which created the tool. The national nonprofit also verifies trauma centers. 

Step 1: Define the region

The first step is to define the region where need is being measured. Signal Cleveland’s analysis included Cuyahoga, Lorain, Lake, Geauga and Ashtabula counties — the same region the 2019 assessment used. We’ll call the region Northeast Ohio. 

The 2019 assessment chose these borders based off of Ohio’s Homeland Security regions. At the time, the authors called the geographic boundaries “relatively arbitrary” because county lines don’t typically get factored into decision-making about where actual trauma patients need to go. Instead, that’s dependent on things like how serious an injury is and which hospital is closest.

Step 2: Population

The population of the region matters because the assumption is that more people will require more care. 

The population of the five counties was 1,987,252 in 2024, assigning the region eight points. 

Step 3: Median transport time

This measures how long it takes for a trauma patient to travel between the scene of their injury and a trauma center. 

Studies show that trauma patients who get to a trauma center more quickly are more likely to survive. 

The region had a median transport time of 13 minutes in 2024, assigning it one point. 

This measurement includes patients taken by ambulance and by flight. It does not include patients who drove themselves to the hospital or who were transferred between hospitals.  

The data comes from the state’s Department of Public Safety, which keeps a trauma registry to track serious injuries in the state. About 30% of the injuries that should’ve been included did not have a valid time of departure or were missing other data. So this point is limited to the 4,671 of the 6,675 total injuries that had complete data to calculate median transport time.

Step 4: Community Support

The method attempts to account for whether the trauma center has support from the community by looking at whether or not various agencies are in favor of the new trauma center. 

That includes neighboring city and county governments, trauma system advisory committees and the state’s “lead agency” — in Ohio, that’s the state’s Division of Emergency Medical Services. 

The 2019 assessment skipped this metric because it was not looking at adding a specific trauma center. 

The Cleveland Clinic’s plans for a new trauma center have received mixed community support. While MetroHealth has come out against it, a Cleveland-based community foundation gave $50 million to the Clinic to help expand its main campus trauma center and improve emergency care. Neither the City of Cleveland, Cuyahoga County nor the Northern Ohio Trauma System have weighed in publicly in favor or in opposition.   

Signal Cleveland asked the Cleveland Clinic whether it had received support from community organizations or agencies that might qualify according to the needs assessment. It did not answer the question. Signal Cleveland assigned the Cleveland Clinic 0 points.

Measuring community support is one of the method’s weaknesses, Jarman said. It can be difficult for community members to judge whether or not a new trauma center is needed, she added. 

“Maybe this shouldn’t be weighted as high as it is,” she said. 

Plus, each state handles trauma systems distinctly. Some states require hospitals to show the need for a new trauma center before one is designated. That’s not the case in Ohio, where the state’s Division of EMS and its advisory trauma committee typically do not make recommendations regarding need or support for new trauma centers. In Ohio, the process to become a trauma center is instead based on certification by the American College of Surgeons.

Step 5: Severely injured patients discharged from hospitals or medical centers that weren’t trauma centers

This metric looks at how many patients needed to go to a trauma center but were instead treated at a different type of place, like an emergency room without a trauma center. 

“It’s probably the most important measure, if we’re talking about the need to open a new trauma center,” Jarman said. “The first thing I would look at is the number of people who needed a trauma center and didn’t get one.” 

Signal Cleveland’s assessment looked at patients who were discharged alive from non-trauma facilities. In Northeast Ohio, the total was 21 patients in 2024 — assigning the region 0 points.

This data comes from Ohio’s Department of Public Safety, which keeps a trauma registry. It specifically looks at the number of trauma patients who were discharged from acute care or critical access hospitals instead of trauma centers.

Step 6: Existing trauma centers

The assessment takes away points when it starts counting how many existing Level I, II and III trauma centers already exist in a region. 

It subtracts more points for the Level I and II trauma centers, which have the ability to treat the most severely injured patients.

Below is a map of trauma centers in the region as of April 2026. Adult and pediatric trauma centers are counted separately by Ohio’s Division of EMS, even if they are within the same health system. 

The existence of three Level I, three Level II and six Level III trauma centers in the region means that nine points are removed from the total. 

Step 7: Number of severely injured patients seen in trauma centers

This measure compares two things: how many severely injured patients are expected to need care in the region and how many are seen at existing trauma centers. 

The idea is to understand the volume of severe injuries that existing trauma centers treat. Trauma surgeons need lots of experience providing care, Jarman said, especially because the types of injuries they see vary a lot day to day. 

“You want trauma surgeons to see as many different patients with as many different needs over the course of a year or the course several years,” Jarman said. 

To get verified by the American College of Surgeons, adult Level I trauma centers are supposed to see a minimum of 240 severely injured patients annually. The assessment estimates the expected number of highly injured patients by multiplying the number of existing Level I and Level II centers in the region by 500. In Northeast Ohio, that means 3,000 expected patients. 

In 2024, the region had 1,247 severely injured patients, more than 1,700 fewer than expected. That means two points are taken away.

Signal Cleveland’s analysis looked at all severely injured patients in the region, no matter whether they went to a Level I, Level II or Level III trauma center, meaning it may slightly overstate need. The 2019 analysis appeared to just look at severely injured patients who went to a Level I or II center. 

Step 8: Total the points

According to the 2019 analysis, regions with negative points are not in need of additional trauma centers. 

Methods

How we assessed need for trauma care in Northeast Ohio 

Signal Cleveland’s analysis of trauma needs in Northeast Ohio is an effort to update a similar analysis published in 2019.

The 2019 analysis was conducted under a research grant for Ohio’s division of Emergency Medical Services.

Here is more information about the methods and data we used. 

Data sources

The 2019 assessment used census data, Ohio’s trauma registry and a map of state-designated trauma centers on the Ohio EMS website.

Signal Cleveland used the same sources. To calculate populations, Signal Cleveland used the U.S. Census American Community Survey’s one-year estimates. 

To determine how many trauma centers exist in the region, Signal Cleveland used the Ohio Designated Trauma Centers map on Ohio’s EMS Website. 

The rest of the data points relied on numbers from Ohio’s trauma registry, which is kept by the state’s Department of Public Safety. The department provided the numbers shared in the study pursuant to Signal Cleveland’s requests, including:

• How many severely injured patients were discharged alive in the region from non-trauma centers, i.e. acute care and critical access facilities 
• How many severely injured patients were seen in trauma centers in the region. The department provided county-by-county data, which Signal Cleveland added up. 

Signal Cleveland requested data on median transport time from the state’s Department of Public Safety. Spokespeople for the department told Signal Cleveland that the information would require significant reprogramming from existing databases, which would force the department to create a new record, which it is not required to do under public records law. 

Signal Cleveland instead accessed the number by asking several state lawmakers to make the same request to the state’s Department of Public Safety. The department calculated the median transport time for the lawmakers using data kept in the trauma registry that tracks the time ambulances left a scene to the time they arrived at the hospital. 

Year of analysis

The majority of the information collected is from 2024. That includes census data and trauma registry data. 

This is because 2024 is the latest year with reliable data available from the U.S. Census American Community Survey’s one-year population estimate for counties. Signal Cleveland used 2024 data for all information and data about traumatic injuries because Ohio’s trauma registry data for 2025 was labeled preliminary. 

The only information that did not come from 2024 was about which state-designated trauma centers exist. Signal Cleveland used information collected in 2026 from a map of designated trauma centers on Ohio’s EMS Website. This is similar to the 2019 analysis, which collected the data on which trauma centers exist in October 2018 while the rest of the data came from 2017. 

Based on press releases and annual trauma reports published by the state’s Department of Public Safety, no new trauma centers were added in Northeast Ohio between 2024 and 2026. One trauma center was removed, however. MetroHealth’s Parma hospital ceased to be a Level III trauma center in August 2025.   

Severe injury definition 

Several data points in Signal Cleveland’s analysis refer to “severe injuries.” Severe injuries are defined as those with injury severity scores – scores determined by medical providers – of above 15.  

On patients discharged from non-trauma centers

One data point in the analysis looked at how many severely injured patients were discharged from non-trauma centers. This is meant to measure how many patients who needed higher-level trauma care did not receive it. 

Signal Cleveland included the number of patients who were discharged alive, as this appeared to be the same method used in the 2019 analysis. The original NBATS methodology simply requests researchers look at those discharged from non-trauma centers. 

Other researchers who have completed NBATS assessments also included in this measure the number of severely injured patients who died in non-trauma centers. This group of people is not accounted for in Signal Cleveland’s analysis.