An 8-month-old baby fell 3 feet and hit his head on a carpeted floor in a San Francisco hotel room. He was crying and the parents, who were from South Korea, called an ambulance. By the time the child arrived at the hospital he was obviously fine. After a bottle, a nap, and a few hours in the hospital, he was discharged.

The hospital sent a bill 2 years later, which included a charge of $15,666 for a trauma activation.

A trauma activation involves paging a number of hospital staff to go to the emergency department as quickly as possible. Those paged may include an attending surgeon, two or three surgical residents, an anesthesiologist or anesthesia resident, a respiratory therapist, a critical care nurse, and operating room nurse, and x-ray technician, a chaplain, and various others.

The trauma team assesses the patient and if serious injuries are present, expeditiously diagnoses and treats the problem. But in cases like the one described above, the team quickly disperses and returns to their usual duties.

The story above was one of several recounted in an article on The authors found a huge variation in the fees for trauma activation ranging from $1,112 in one hospital to a high of $50,659 at another.

This is not a new issue. In 2014, I blogged about a Tampa Bay Times story on trauma activation fees in Florida which at the time averaged over $10,000 with a maximum of $33,000. That article said hospital administrators admitted the charges were based on what other hospitals were charging and were unrelated to the resources used.

A different California hospital’s trauma activation fee was $22,550 for a young man injured in a minor motorcycle crash. He suffered a cut on his head that required two staples and received some IV fluid and ibuprofen. No x-rays, scans, or bloodwork were done.

I can understand hospitals charging a fee for trauma activations to help recover some of the costs of having a trauma service. The staff may require some special training. Managing the service, collecting data, and other incidentals may increase costs.

However, nearly all of the personnel involved in a trauma activation are already in the hospital and receive their salaries whether trauma activations occur or not. In the above examples, I would guess most members of the team spent 0 to 5 minutes at the patient’s bedside.

Despite attempts to do so, bills like those mentioned in the Tampa Bay Times and Vox stories are impossible to defend. The Vox piece quoted a hospital spokesperson: “Trauma team activation does not mean every patient will consult with and/or be cared for by a trauma surgeon. The activation engages a team of medical professionals. Which professional assesses and cares for a trauma patient depends on the needs and injury/illness of the patient.”

That statement hardly justifies the bill which admittedly is not resource-based.

The American College of Surgeons told Vox that to avoid missing a seriously injured patient a 25-35% over triage rate is acceptable. I agree with that, but it doesn’t mean a five-figure trauma activation fee is warranted for a patient with a cut on his head requiring two staples.

Imagine going into a shoe store and trying on four pairs of shoes. The salesperson, paid by the store owner, has gone to the back and retrieved them one at a time. But you decide not to buy anything. Should you be billed for the salesperson’s services?

Or at a car dealership, you test drive a car with the salesperson as a passenger. You determine the car is not what you had in mind. Should you have to pay for that experience?


Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last 8 years, he has been blogging at and tweeting as @SkepticScalpel. His blog has had more than 3,000,000 page views, and he has over 18,000 followers on Twitter.