The "x" refers to the level of your designated trauma center. It does NOT refer to the level of the trauma activation. So only Level I trauma centers should use 0681, only Level II trauma centers should use 0682, and so on.

No. The activation must occur prior to patient arrival, which is the main point of a trauma activation (getting resources to the patient before they arrive). If the activation at your hospital does occur before arrival but you have a documentation issue, make sure there is an easy way for nurses to document the time of activation in the EMR so that it shows up before the patient is documented as arrived.