B+A recently worked with the South Carolina Office of Rural Health and several rural hospitals to assess feasibility for becoming Level IV trauma centers in under-served and remote areas of the state. The hospitals are already serving a significant number of injured patients in their Emergency Departments, and a Level IV trauma designation could help formalize infrastructure of the trauma program and recover program costs through the assessment of trauma activation fees. B+A worked with the leadership of several hospitals to understand the challenges of the rural environment, complete a gap analysis of their hospital resources, and provide volume estimates and financial projections.