Level 1 trauma centers provide the highest level of care to critically ill or seriously injured patients.

On Staten Island, a borough with no public hospital, that distinction went to two privately run facilities, Richmond University Medical Center and Staten Island University Hospital north.

That is, until last week when RUMC lost its status as an adult level one trauma center, leaving only SIUH to treat all of the most serious traumas.

"It's definitely a concern here, and especially if you get into an automobile accident or something over on the north shore, instead of going to the nearest hospital, you may have to come over here," said one man.

The state Department of Health pulled RUMC’s status after it failed to meet the verification standards set by the American College of Surgeons.

According to people familiar with verification, it is a long and rigorous process that takes place every two years, meant to ensure that hospitals meet strenuous requirements for these critical patients.

RUMC told NY1 that conversations about the situation have centered on research and on-call requirements for level one trauma designation.

"I would want to make sure that I was getting the best care, the closest care, if there was something like, I was in major need of care," said one woman.

RUMC says it is still allowed to assess, stabilize and quickly transfer trauma patients to other facilities.

It also still has a level one status for children.

But residents say the change for adult patients is troublesome.

For starters SIUH and RUMC are about 5 miles away from each other, and with island traffic, many worry about the impact of precious transportation time on the neediest patients.

They also worry SIUH is too busy:

"It's so packed here, I don't know how they could treat everyone, they have a hard time now when you have an emergency treating people," said another woman.

"While officials at Staten Island University Hospital couldn’t provide specific numbers, they do say they've noticed an uptick in the number of trauma cases at the hospital since RUMC lost its trauma one status."

An SIUH spokesperson says the hospital IS equipped to handle the extra patients.

Meantime, RUMC says it expects the matter to be resolved shortly, and hopes to regain its status again soon.