MISSOURI S TIME CRITICAL DIAGNOSIS SYSTEM

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1 MISSOURI S TIME CRITICAL DIAGNOSIS SYSTEM DISCLOSURES No animals were harmed in the production of this presentation. I do not have any conflicts of interest or significant financial affiliations with any pharmaceutical or medical device companies and have created this activity without bias or influence from all external commercial entities. 1

2 IN THE BEGINNING Dr Bill Jermyn, SAC Chairperson Initiates dialog Many long discussions and presentations Much skepticism on the concept from around the State THE TCD JOURNEY 2003 Missouri Foundation for Health engages on the need for EMS and Trauma reform Dr Bill Jermyn appointed as inaugural State EMS Medical Director 2006 Emergency Care System planning began Stroke, STEMI, task force initiated along with a Trauma Gap Analysis 2008 TCD Legislation passed formalized Trauma, STEMI, Stroke task force and implementation teams 2009 ACS COT review 2010 NHTSA follow-up review task force work groups develop Regs, Regs filed in

3 RESEARCH AND DATA Leading causes of death in Missouri st Heart Disease including ST Elevation MI 12.7% higher than national rate 10 th highest mortality among 50 states 4 th Stroke 12.5% higher in Missouri than the national rate, Only small % receive definitive care within the therapeutic window. Unintentional injury 5 th all populations, 1 st under 30 Y/O. Up 23% since 1990 Gaps in access to trauma centers in rural Mo. HEART DISEASE Heart disease, including STEMI, is the leading cause of death in this state. (Source: Death MICA, 2010) In 2010, Missouri s heart disease death rate was 12.7 percent higher than the national rate (201.8 vs per 100,000). (Source: CDC Wonder) Missouri has the 10th highest heart disease mortality rate of the 50 states. (Source: CDC Wonder, 2010) The prevalence of heart disease was higher than the national average (201.8 vs per 100,000). Missouri ranked 13th among the 50 states for heart disease prevalence in (Source: BRFSS Ever had angina or coronary heart disease?) 3

4 STROKE Stroke is now the fourth leading cause of death in the state. (Source: Death MICA, 2010) In 2010, Missouri s stroke death rate was 12.5 percent higher than the national rate (44.0 vs per 100,000). (Source: CDC Wonder, 2010) Missouri has the 14th highest stroke mortality rate of the 50 states. (Source: CDC Wonder, 2010) Missouri was ranked 4th in stroke prevalence. (Source: BRFSS, 2010 Ever told you had a stroke?) TRAUMA Trauma (unintentional injury) is the fifth leading cause of death in Missouri. (Source: Death MICA, 2010) Injuries and Poisonings are the most frequent causes of visits to the emergency department, causing more than 2.7 million ER visits between 2006 and (Source: ER MICA) Injuries and Poisonings accounted for the second highest total for inpatient hospital charges - $2.4 billion in (Source: Hospital Discharges, Charges and Days of Care MICA) Compared to the entire United States, Missouri has Lower rates of emergency department visits for all three major categories of injuries unintentional (9,558.1 vs. 8,759.0 per 100,000), assault (588.7 vs ) and self-inflicted (153.0 vs ). (Source: US-CDC WISQARS, 2010; Missouri-Injury MICA, 2010) Death rates from accidental injuries that exceed the national rates for all unintentional injuries (47.9 vs per 100,000), falls (8.7 vs. 7.9), and motor vehicle injuries (12.8 vs. 9.4). (Source: CDC Wonder, 2010) A death rate from suicide that exceeds the national rate (14.2 vs. 12.2). (Source: CDC Wonder, 2010) Missouri s death rates for unintentional injuries have increased 23.3 percent (from 38.7 to 47.7) between 1990 and (Source: Death MICA) 4

5 MISSOURI S TIME CRITICAL DIAGNOSIS SYSTEM BILL S BILL TIME CRITICAL DIAGNOSIS SYSTEM LEGISLATION PASSED MAY 15 TH, 2008 Dr John William Bill Jermyn, III February 14 th, 1951 to May 15 th

6 SIGNED INTO LAW JULY 11 TH, 2008 Law became effective August 28 th,

7 LAWS AND REGULATIONS Legislative Synopsis: 2008: House Bill 1790 enabling reform passed unanimously by the Missouri General Assembly and signed into law Section , RSMo Definitions Section , RSMo Public Information & Education Section , RSMo Center Designation Section , RSMo Transportation to Centers THE PLAN Assemble Task Force Develop work groups from Task Force Goals for work groups Recommendations to Task Force 7

8 WORK GROUPS Rural and Urban System Coordination Work Group 911 Coordination System Work Group Public Education Work Group Professional Education Work Group Quality Assurance Work Group Trauma Stroke STEMI Task Force Resource and Recommendation group RECOMMENDATIONS BECOME REGULATIONS STEMI and Stroke regulations become effective June 30 th, 2013 Trauma Regulations delayed. Stroke Centers applications begin August 15 th, 2013 STEMI Centers applications begin February 23 rd, 2015 EMS State or Community Based triage plans initiated once Center Designations are Made. 8

9 STATE TCD TRIAGE PLAN THE HOOK! C:\Users\rmalexa\Desktop\TCD Transport Protocol pdf C:\Users\rmalexa\Desktop\Transport Protocol Algorithm pdf REFERENCES Missouri Department of Health and Senior Services TCD resource postings 9

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