Chaplains’ reports of integration in Adult Level I trauma centers in the United States: Scope of involvement, services, and coverage

Background Professional healthcare chaplains provide spiritual, religious, and existential support to patients, families, and staff. Nevertheless, chaplains’ roles in trauma centers remain poorly documented. Objectives This study aimed at examining chaplains’ reports of their integration, involvement, and service coverage in Adult Level I Trauma Centers across the United States. Methods We conducted a nationwide mixed-methods survey of chaplains working in 242 Adult Level I Trauma Centers listed by the Trauma Center Association of America. The survey gathered data on chaplains’ responsibilities during early trauma workup and post-acute services, trauma response protocols, teaching, coverage models, and integration into interdisciplinary trauma teams. Follow-up interviews provided additional qualitative insights. Results Among 299 chaplain respondents representing 238 trauma centers, chaplains’ integration into trauma care varied substantially. While 72.9% reported being part of interdisciplinary trauma teams, only 54.5% were involved in every trauma case, and only 42.5% indicated having designated trauma chaplains. Most chaplains provided family support (96.7%) and participated in death notifications (80.3%), though post-acute bereavement services remained limited. Most (80.6%) reported providing spiritual care follow-up post-trauma. Insufficient staffing, high trauma case load, lack of trauma chaplaincy protocols, and inconsistent chaplain coverage were cited as barriers to high-quality and well-integrated chaplaincy services. Conclusions Chaplaincy integration in Adult Level I Trauma Centers ranges from highly structured models with specialized personnel to minimal consultation-based services, revealing significant gaps. To fully adopt interdisciplinary trauma care, many institutions need to address chaplain coverage, staffing, and integration challenges that hinder the delivery of consistent, 24/7, high-quality trauma chaplaincy services.