Abstract Background We hypothesized that trauma video practices would be affected as a result of Health Insurance Portability and Accountabilty Act (HIPAA) enactment. Methods A survey was distributed electronically to coordinators and/or directors of level 1 trauma centers. Centers were queried on demographics, trauma video use, and reasons for changes, if any, in their video practice patterns. Descriptive statistics and chi-square analysis were employed. Results Survey response rate was 75%. Prior to HIPAA, 58% of responding trauma centers used video compared to 18% now. On a Likert scale of 1–5, video analysis rated 3.80. For those using video currently, the most common purposes are education (91%) and quality assurance (83%). HIPAA has affected the way video is used at one third of these centers. Ten percent receive institutional review board approval for videotaping, 35% get patient consent, and more than half report capturing a poor patient outcome on tape. The most commonly cited reasons for stopping video use were HIPAA and legal concerns about patient privacy, consent, and discoverability (79%). Scarce resources were, in part, to blame at 70% of centers, while video technology was found to be ineffective at only 32%. Conclusions A minority of level I trauma centers currently use video, although it is effective according to users. HIPAA and medicolegal concerns have affected its use at some centers and contributed to its abandonment at others.