According to the american college of surgeons committee on trauma an adult trauma patient should be transported to the highest level of trauma center if

I think he patient should be transported to the highest level of trauma center if she or he has a Glasgow Coma Scale (GCS) score of equal or below 13 with a mechanism attributed to trauma. The GCS is a neurological scale that gives an objective and reliable way of recording the conscious state of an individual.

If you get a map and put the countries a states all together it forms all one piece you can also tell because of the earth quakes