Nevada hearing considers adding Level 4 trauma designation for rural critical access hospitals

Assembly members heard testimony and questions on AB326, a bill to allow the Nevada State Board of Health to recognize trauma Level 4 designations for critical access hospitals.

AB326, introduced by Assemblymember Greg Koenig, would permit the State Board of Health to adopt standards recognizing trauma levels 1 through 4; Nevada currently recognizes only levels 1–3. Sponsor Greg Koenig said the change aims to improve trauma care access for rural residents and travelers who cross long distances to reach higher-level trauma centers.

Blaine Osborne, president of Nevada Rural Hospital Partners, called AB326 “an infrastructure bill” that would “spur investment in advanced trauma life support training across rural Nevada.” He told the committee the proposal would let the Board of Health set standards for a Level 4 designation and would not automatically let a facility move from Level 4 to a higher level without the existing, comprehensive needs assessment.

Jeff Prater, CEO of Carson Valley Health, described the capabilities a Level 4 designation would recognize: on-site advanced trauma life support, 24‑hour laboratory coverage, trauma-trained nursing staff and formal transfer agreements. Prater said Carson Valley Health already operates to many Level 4 standards and that the hospital received 233 traumas in 2024; 151 arrived by private vehicle and 82 by ambulance, of which fewer than half required transfer to a higher center. He said the hospital’s trauma team and procedures helped reduce transfer times by about one hour since early 2018.

Presenters stressed what Level 4 is and is not: it formalizes stabilization and initial advanced care and collaborative transfer protocols, but it would not replace higher-level centers or require emergency medical transport to stop unnecessarily. Prater described examples from Alaska and a local cycling injury to illustrate how early recognition and activation of trauma teams stabilizes patients before transfer.

Committee members asked about cost and staffing. Prater and Osborne said the primary costs are training, the time of a medical director and staff participation in quality review and registry reporting; precise training costs were not provided. On staffing shortages, presenters said the bill emphasizes training existing staff rather than bringing large numbers of new clinicians into rural hospitals and that the designation could help recruit clinicians and advanced practice providers.

Supporters who testified included John Elliott, trauma director at Carson Valley Health; Dr. Kathy Glauner, emergency department medical director at Carson Valley Health; Dr. Candrayee, a board‑certified emergency physician and CEO of the physician group that staffs Carson Valley Health; the Nevada Association of Counties; the Nevada Advanced Practice Nurses Association; the Vegas Chamber; the University of Nevada medical school office of rural health; and several rural hospital administrators who described local volumes and the distances patients travel for trauma care.

No formal vote or committee action was recorded during the hearing. The sponsor closed by saying AB326 would increase the timeliness and quality of care for people in rural areas and for travelers across the state. The committee recessed at points during the hearing for technical issues, then resumed and closed the bill hearing on AB326.

Why it matters: supporters said the designation would formalize work some rural hospitals already do, strengthen coordination with higher‑level centers and could reduce transfer delays that affect outcomes for seriously injured patients.

What’s next: the committee hearing concluded with testimony and questions; no formal action or vote was recorded during this session.