As published by the Caledonian Record on Tuesday, June 3rd, 2025.
By Robert Nutter, President & Chief Executive Officer, Littleton Regional Healthcare
If you have an accident, your access to care – and potentially your survival – should never depend on whether you live in a rural or urban area. Unfortunately, a 
2017 report from the Centers for Disease Control and Prevention (CDC) revealed a disparity: the rural death rate from unintentional injuries was 50% greater than the urban rate. One key factor behind this disparity is limited access to trauma care and the distance to an appropriate facility for treatment.
At Littleton Regional Healthcare (LRH), we are proud to have made significant investments to address this disparity for our patients in New Hampshire’s greater North Country region and Northeast Kingdom of Vermont. Our hard work and dedication have been recognized with the prestigious designation as a Level III Trauma Center for adults and Level IV for pediatric patients by the State of New Hampshire Department of Safety’s Division of Fire Standards and Training and Emergency Medical Services (FSTEMS). The achievement is the culmination of a rigorous evaluation by a multidisciplinary FSTEMS team, which included trauma surgeons, a trauma-expert registered nurse, and paramedics, ensuring that LRH will provide prompt emergency assessment, resuscitation, and treatment of injured patients.
LRH is the only hospital in northern New Hampshire to receive Level III Trauma Center certification for adults, joining a select group of hospitals across the state. The certification speaks to the highest standards of trauma care that we uphold every day, from immediate emergency response to ongoing patient care. This milestone for our community hospital is also a direct reflection of revitalized partnerships between LRH and local EMS agencies. Together, we have built a stronger, more responsive trauma system with strengthened communication, enhanced collaboration, and improved transitions of care that our community can depend on.
Northern New Hampshire’s unique outdoor recreational culture – skiing, snowmobiling, hiking, climbing, off-roading, and more – attracts both adventure and, unfortunately, leads to a greater chance of traumatic injuries. Last year, LRH experienced 2,526 trauma-related visits to our Emergency Department, more than 25% of our overall Emergency Department volume, and we expect an increase in the years ahead. This designation is a vital step in ensuring our community receives the best care when it is needed the most.
Level III Trauma Center certification enhances LRH’s ability to deliver rapid and appropriate care. LRH offers 24-hour board-certified, fellowship-trained emergency medicine physician coverage, as well as access to general surgery and anesthesia services. As part of the statewide Trauma System, LRH has established transfer agreements with Level I and Level II trauma centers, ensuring that patients requiring more specialized care receive it. Additionally, our certification requires ongoing quality and improvement programs, trauma-specific continuing education for clinical staff, and an active injury prevention and outreach program.
This designation represents not only the availability of specially trained emergency medicine physicians and surgeons but also a commitment to continuous improvement. A multi-disciplinary team led the efforts to achieve this designation, and we will continue our dedication to providing exceptional care. Special thanks go to Dr. Jonathan Klinger, FACEP, emergency physician, and Dr. Daniel Underbakke, FACS, general surgeon, for their leadership in building the systems required to achieve and maintain this certification, and the entire multi-disciplinary trauma committee at LRH for their tireless efforts in pursuing this designation.
Very few rural hospitals meet the rigorous criteria for a Level III trauma designation. LRH is the only Critical Access Hospital in the state to be awarded Level III status. The commitment required is significant and reflects our determination to ensure the best care for our community. For example, as a Level III Trauma Center, an attending surgeon with experience in trauma care must be available within 30 minutes of a patient’s arrival. As the number of trauma-related visits continues to rise, we are investing in additional medical staff and specialized surgeons to meet and exceed these high standards.
Achieving the Level III Trauma Center designation is the culmination of years of hard work. It ensures that patients in our region now have access to the same high-quality trauma care as those in more populated areas. When recovery or even survival depends upon the speed of treatment, having a trusted local resource is invaluable. LRH is proud to be that resource for the residents of this region and those who visit our wonderful area.
Going forward, patients in the northern part of the state and neighboring Vermont can receive specialty care for traumatic injuries locally. Now more than ever, local Emergency Medical Services (EMS) and hospitals in nearby communities can rely on LRH for resources to support trauma cases and provide patients throughout the region with a higher level of care.
Click here to read the initial announcement of LRH’s trauma designation.
