If memory and history serve me correctly, the original author of the Shock-Trauma Center concept was R Adams Cowley, MD, based on the physiology of shock and the bodies response at the cellular level. The Golden Hour was predicated on this concept for optimum patient outcome.
Ego, politics, statutes, regulations and/or finances where not included in the original research.
If the original injuries don't kill the patient, the sequela of cellular shock will in 2 to 7 days.
Unfortunately, in the rural and/or frontier setting, the "Community Hospital" is the only resource available. Once there, there patient is held back, and in some cases dies as a result, by the alphabet soup of COBRA, OBRA, EMTALA government regulations and consequences.
Level I and Level II Trauma designation differ only in terms of teaching, research and in-house neurosurgery vs. non-teaching, non-research and on-call neurosurgery I believe. Both have the same standards for patient management processes, and, hopefully, staffing well practiced in the same.
FINAL ANSWER: "IF YOU THINK IT, DO IT!" If it meets ACS Trauma Criteria, go to the closet Trauma Center via the most rapid method of transport available.
