Bailey added that EMS is also part of the system and need to be included in training plans. He said it is the delivery mechanism to the trauma center in most instances. The training that takes place should also address the hospitals that patients should be directed to.

Kizer added that the impact on training centers should not be underestimated. Having been involved in trying to regionalize a number of different types of services, he observed that “the major opposition to this consistently comes from academic health centers or academic university training programs because of the impact it can have on [their] training programs.”