May 2013 TEXAS EVOLUTION OF TEXAS TRAUMA SYSTEM

Transcription

1 May 2013 TEXAS EVOLUTION OF TEXAS TRAUMA SYSTEM Trauma Systems Committee Governor s EMS and Trauma Advisory Council May 2013 Jorie Klein, RN, Committee Chair Trauma System Committee Governor s EMS Trauma Advisory Council Ronny Stewart, MD, FACS Chair, Department of Surgery, UTHSCSA San Antonio, Texas Garrett Hall, CSTR Trauma Registry Manager Parkland Health & Hospital System

2 American College of Surgeons 1922 Committee on Treatment of Fractures 18 Fellows, Charles Scudder, Chair 1931 First Outline of Treatment of Fractures Last Edition, Committee on Trauma 1954 Manual, Early Care of Soft Tissue Injuries 1972 Early Care of Injured Patient, 1976, 1982, Optimal Hospital Resources for Care of the Seriously Injured 1979 Hospital Resources for Optimal Care ACS Standards

3 American College of Surgeons COT Chair, C. T. Thompson, MD 1980 October Bulletin, Verification Program for Hospitals Not Approved 1982 Update on Trauma Consultation Program - Failed 1983 Trauma Defined as a Surgical Disease COT Chair, Donald Trunkey, MD 1986 Approval of Verification Program COT Chair, Erwin Thal, MD

4 American College of Surgeons First COT Verification Review Committee Frank Mitchell, Jr., MD Hank Cleveland, MD David Root, MD Donald Trunkey, MD Charles Wolferth, MD Resources for Optimal Care of the Injured Patient: 1987 (booklet), 1990 (orange), 1993 (blue), 1996 (yellow), 1999 (green) REVISED EDITION IN DEVELOPMENT

5 Trauma Nurse Network MIEMSS Need for Centralized Information and Networking for Trauma Nurses MIEMSS Funding for Development, Space, Annual Conference 1987 ATS / TNN Definition of Trauma Coordinator: Promotes optimal trauma care in the context of a regionalized trauma care system through; clinical activities, professional and public education, quality assurance, administrative functions and research

6 TEXAS TRAUMA SYSTEM 1988 VISION That all the people of Texas, because of the effectiveness of our prevention programs, are the least likely in the nation to be seriously injured or killed; but if injured, have the best chance for survival and maximal potential for recovery.

7 Major Provisions TRAUMA SYSTEM LEGISLATION Omnibus Rural Health Care Rescue Act (HB-18) May 1989 Directed the Bureau of Emergency Management to: a. Develop and monitor a statewide trauma system b. Designate trauma facilities c. Develop trauma registry d. Monitor patient care in each health care facility in state

8 Texas Trauma Technical Advisory Committee

9 State / Regional Development Incentives for system development/participation: a. The need to coordinate care for trauma patients is great. b. Decisions will be made by the RAC that could affect your agency; you want to be in the loop of information. c. The RAC needs expertise in its planning process. d. Available monies are being targeted to areas working on system development and to those entities participating.

10 TRAUMA SYSTEM RULES (Adopted by the Texas Board of Health in January 1992) Major Provisions 1. Divide the state into 22 regions (Trauma Service Areas-TSAs) a. Must consist of at least three counties b. Must have at least a potential General (Level III) trauma facility willing to take on Lead trauma facility responsibilities c. May be re-aligned

11 Trauma Nurses 1992 CDC Trauma Care System s Task Force 1992 HRSA s Model Trauma System Plan TEXAS Development of the Texas Trauma Coordinators Forum Started with 5 Dedicated Specifically to the Trauma Coordinator / Trauma Program Manager Assistance with Program Development Trauma Center Resource Manual (example tools/templates Education Survey Assistance

12 SYSTEM DEVELOPMENT Twenty-Two Regional Advisory Councils Established (1995) Panhandle RAC B RAC North Texas RAC Big Country RAC North Central Texas Trauma RAC Northeast Texas RAC Piney Woods RAC Deep East Texas Trauma RAC Far West Texas & Southern New Mexico RAC Texas J RAC Concho Valley RAC Central Texas Trauma Council Heart of Texas RAC Brazos Valley RAC Capital Area Trauma RAC Southwest Texas RAC Southeast Texas Trauma RAC East Texas Gulf Coast RAC Golden Crescent RAC Seven Flags RAC Coastal Bend RAC Lower Rio Grande Valley RAC

13 Texas Trauma Coordinators Forum Designation Workshops Assist Level III and IVs Annual Conference / EMS Conference Alignment as a Recognized Strong Stakeholder Group at State Level Input on State Regulations THA / TOARCH Members of Multiple Committees at State Level HRSA Trauma System Development Workshops GOAL: Improve Trauma System / Improve Patient Outcomes

14 Texas Trauma System Texas Trauma Coordinators Forum Active at State Level Emergency Health Care Advisory Committee Trauma System Committee TC / TPM Members State Registry Stakeholder Participation Focus On Regional Development RAC Bylaws Field Triage Criteria Integration EMS, Air Medical, Trauma Centers

15 REGIONAL ADVISORY COUNCILS UTILIZATION OF FUNDS Regional Data Systems EMS and Hospital Grant Programs Regional Communications Needs Trauma System Plan, implementation, and Evaluation Trauma Education Courses Public Awareness Campaigns Injury Prevention activities/programs

16 Texas Trauma System 1993 Federal Grant Regional Trauma System Planning Ten Regional Trauma Advisory Councils Recognized ( B, C, F, G, I, L, N, Q, R, U) RACs Report to TTAC Members Dr. James Red Duke Named Spokesperson For Texas Trauma System State Trauma Registry First Hospital Data Wichita General Hospital Trauma Registry Moved To Epidemiology Dispro Rules Adopted

17 Texas Trauma System Goals Develop Statewide Trauma System Facilitate Development of Regional Trauma System Plans (Seven of Recognized RACs had committees) Solicit Available Federal Funding Designated Trauma Facilities Implement Designation In-State Site Surveys Basic Trauma Facilities 7 Rural Hospitals Identified

18 Texas Trauma System Goals Implement In-State Site Survey Option For General Trauma Facilities (1994) Develop a Statewide Trauma Registry Disseminate Trauma System Information Maintain Program Database 300 Stakeholder Organizations

19 Trauma Facility Designation 1994 Hospital Application Approved Site Survey Brownfield Regional 7/93 10/93 1/94 UMC Lubbock 6/93 7/93 10/93 Parkland 10/93 5/92 12/93 ETMC 7/93 8/93 1/94 Wood County, Quitman 8/93 9/93 1/94 Eagle Lake 9/93 10/93 1/94 Hermann Hospital 9/93 10/93 1/94 Designated

20 Texas Trauma System Resources Trauma System Resources (December) 1994 (August) # of RACs Recognized # of RACs TSP Approved 0 0 # of RACs Designated TC 2 4 # of RACs PI Process 0 0 # of Designated TC 2 7 # of Hospitals Participating 5 5 # of Pre-Hospital Agencies Participating

21 Trauma System Funding State 1. None available until FY Bills to fund uncompensated trauma care were filed in the 1991, 1993, and 1995 legislative sessions, but did not pass. 3. In 1997, legislation created an EMS/Trauma System Fund; it was appropriated $4 million for the FY98/99 biennium. 4. In 1999, the EMS/Trauma System Fund was appropriated a projected $9.5 million for the FY00/01 biennium.

22 EMS/TRAUMA CARE SYSTEM ACCOUNT (former SB-102) Established by SB-102 Specifies allotments: $250,000 extraordinary emergencies 70% - eligible EMS providers 25% - eligible RACs 3% - TDH administrative costs 2% - uncompensated trauma care $4 million for biennium Tertiary Care Account

23 Trauma System Development

24 Senate Finance Committee Sub-Committee on Trauma Subcommittee Hearings Save Our ER x GETAC Trauma System Committee Texas Hospital Association EMS Agencies Multiple Surveys Set the Stage

25 Texas Trauma Service Areas

26 Texas EMS, Trauma Acute Care Foundation Beginning Discussion in 2004 Goal: Operationalize Concepts of Trauma System Development Formalized By-Laws, Voting Structure 2006 RACs Targeted Members Divisions EMS, Trauma, Pediatric, RAC, Injury Prevention, Professional Education, Acute Care

27 TETAF Trauma Division Site Survey Process Level III & IV Designation Assistance Advocacy EMS Division Education Advocacy Acute Care Designation Advocacy

28 TETAF Pediatric Injury Prevention Professional Education

29 Disaster Integration Coordinated Effort Community Integration Investment in Different Expertise Right For The Community STAND READY

30 Texas State Committee Governor s Trauma / Emergency Advisory Council Pediatric Committee Injury Prevention Committee Medical Director s Committee EMS Provider s Committee Education Committee Trauma System Committee Aero-medical Task Force Stroke Committee Cardiac Committee Disaster Committee

31

32 RAC Assessment of EMS Coverage, 2009

33 Texas ACS System Consultation May 2011 Findings Registry Data To Manage System State Leadership Trauma System Plan Funding Strong RACs Strong in Some Regions State PI Process

34 Level I - 16 SYSTEM DEVELOPMENT Level II 12 Level III - 48 Level IV Goal Inclusive Trauma System TOTAL: 268 DESIGNATED TRAUMA FACILITIES IN TEXAS

35 2011 Texas Trauma Registry Incidents Report February Texas Trauma Registry Annual Report The 2012 Texas Trauma Registry Annual Report is the first report of Texas Trauma aggregated data presented to the GETAC Trauma System Committee. The report was developed using trauma incidents data reported to the DSHS Texas EMS & Trauma Registry Data Base. The 2012 Annual Report reviews 2011 trauma admissions data submitted to the State of Texas during the 2012 annual call for data, totaling 117,122 trauma records meeting the State of Texas Trauma Registry Inclusion criteria. This report was developed to mirror parts of the 2012 NTDB Annual Report and to serve as a benchmark report for the State of Texas compared to the Nation. The goal of this report is the same as the 2012 NTDB Annual Report. To inform the medical community, the public, and decision makers about a wide variety of issues characterize the current state of care for injured persons in the State of Texas and benchmarked to our country.

36 Trauma Incidents by Trauma Center Level 2011 Texas Trauma Registry 2011 Texas EMS Trauma Incidents Registry Report Reported Trauma Incidents by Trauma Center Level N=117,122 Trauma Systems Committee Governor s EMS and Trauma Advisory Council February Level I Level II Level III Level IV Non-Designated Level I Level II Level III Level IV Non-Designated

37 2011 Texas Texas Trauma Incidents by Age Trauma Registry Texas Trauma Incidents by Age Report N=117,122 Age Incidents Percent Deaths Case Fatality Rate Trauma Systems Committee < 1 year % % 1-4 Governor s 5636 EMS and Trauma 4.812% Advisory 81 Council % % % February % % % % % % % % % % % % % % % % % % % % NK / NR % % Total % %

38 Number of Trauma Case 2011 Texas Texas Trauma Incidents by Age Trauma Registry Texas Trauma Incidents by Age Report 2500 Trauma Systems Committee Governor s EMS and Trauma Advisory Council February < year Age

39 Comparison of Texas Trauma Incidents by Age to NTDB Trauma Incidents by Age 2011 Texas Trauma Registry Incidents Report 2012 Texas Annual Report Trauma Systems Committee Governor s EMS and Trauma Advisory Council February NTDB Annual Report

40 Trauma Incidents by Age Compared to NTDB 2012 Annual Report 2011 Texas Texas Trauma Registry Incidents by Age Incidents Report N=117,122 N=773,299 NTDB 2012 Annual Report Incidents by Age Case Case Age Incidents Percent Deaths Incidents Percent Deaths Fatality Fatality Rate Trauma Systems Committee Rate < 1 year % % % % Governor s EMS and Trauma Advisory Council % % % % % % % % February % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % NK / NR % % % % Total % % % %

41 Case Fatality Rate (%) 2011 Texas Texas Case Fatality Rate by Age Trauma Registry Incidents Report Texas Case Fatality Rate by Age 5.00% 4.50% 4.00% 3.50% 3.00% Trauma Systems Committee Governor s EMS and Trauma Advisory Council February % 2.00% 1.50% 1.00% 0.50% 0.00% < year Age

42 2011 Texas Texas Trauma Incidents by Age and Trauma Center Level Trauma Registry Incidents Report Texas Trauma Incidents by Age and Trauma Center Level Number of Trauma Cases Trauma Systems Committee Governor s EMS and Trauma Advisory Council February 2013 Level 1 Level 2 Level 3 Level 4 Non-Designated Age

43 Level 1 Trauma Center Incidents by Age 2011 Texas Trauma Registry Texas Level 1 Trauma Incidents by Age Report N=37,490 Age Incidents Percent Deaths Case Fatality Rate < 1 year % % % % % % % % % % % % % % % % % % % % % % % % % % NK / NR % % Total % %

44 2011 Texas Level 2 Trauma Center Incidents by Age Trauma Registry Texas Level 2 Trauma Incidents by Age Report N=13,034 Age Incidents Percent Deaths Case Fatality Rate Trauma Systems Committee < 1 year % % 1-4 Governor s 607 EMS and 4.657% Trauma Advisory 6 Council % % % February 5.110% % % % % % % % % % % % % % % % % % % % NK / NR % % Total % %

45 Level 3 Trauma Center Incidents by Age 2011 Texas Trauma Registry Texas Level 3 Trauma Incidents by Age Report N=29939 Age Incidents Percent Deaths Case Fatality Rate Trauma Systems Committee < 1 year % % % % Governor s EMS and Trauma Advisory Council % % February 3.186% % % % % % % % % % % % % % % % % % % % NK / NR % % Total % %

46 Level 4 Trauma Center Incidents by Age 2011 Texas Trauma Registry Texas Level 4 Trauma Incidents by Age Report N=23737 Case Fatality Age Incidents Percent Deaths Rate Trauma Systems Committee < 1 year % % 1-4 Governor s EMS 985 and Trauma 4.150% Advisory Council % % % February % % % % % % % % % % % % % % % % % % % % NK / NR % % Total % %

47 Non-Designated Incidents by Age 2011 Texas Texas Non-Designated Trauma Incidents by Age Trauma Registry Incidents Report N=12922 Age Incidents Percent Deaths Case Fatality Rate Trauma Systems Committee < 1 year % % % % Governor s EMS and Trauma Advisory Council % % February 7.406% % % % % % % % % % % % % % % % % % % % NK / NR % % Total % %

48 Texas Incidents by CDC Mechanism of Injury Grouping 2011 Texas Texas Trauma Registry Registry Incidents Percentage Incidents by Report Motor Vehicle Traffic CDC Mechanism of Injury Grouping 1% 2% 2% 2% 1% 1% 3% 3% 5% 5% 8% 22% N = 117,112 46% Fall Struck by Against Cut / Pierce Transport Firearm Other Specified and Classifable Fire / Burn Natural / Enviormental Unspecified Machinery Pedal Cyclist Other Not Elsewhere Classifable Overexertion Pedestrian NR/NK Poisoning Drowning / Submersion Suffocation

49 Percent Texas Incidents by Selected Mechanism of Injury 2011 Texas Trauma Registry Trauma Incidents Incidents Percent Report 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 46% N=117,122 Trauma Systems Committee Governor s EMS and Trauma Advisory Council Fall by Selected Mechanism of Injury 22% Motor Vehicle Traffic February % Struck by Against 5% 5% Mechanism of Injury 3% Cut / Pierce Transport Firearm

50 Texas Incidents by CDC Mechanism of Injury Grouping 2011 Texas Trauma Registry State of Texas Incidents Trauma Registry Report CDC Grouping Total Total Death Male Male Death Female Female Deaths NR / NK Sex NR / NK Sex Death 1 Cut / Pierce Drowning / Submersion Fall Fire / Burn Firearm Machinery Motor Vehicle Traffic Pedal Cyclist Pedestrian Transport Natural / Environmental Overexertion Poisoning Struck by Against Suffocation Other Specified and 16 Other Not Elsewhere 17 Classifiable Classifiable Unspecified NR/NK Total

51 Percent Texas Level 1 Trauma Centers Incidents by Selected Mechanism of Injury 2011 Texas Trauma Level Registry 1 Trauma Centers Incidents Percent Report 35% 30% 25% 20% 15% 10% 5% 0% 31% Fall by Selected Mechanism of Injury N=37,490 30% Motor Vehicle Traffic 10% Struck by Against Mechanism of Injury 6% 5% 5% Cut / Pierce Firearm Transport

52 17 Other Not Elsewhere Classifiable Unspecified NR/NK Total Texas Level 1 Trauma Centers Incidents by Selected Mechanism of Injury 2011 Texas Trauma Registry Level 1 Trauma Incidents Centers Report Total Male Female NR/NK Sex CDC Grouping Total Death Male Death Female Deaths NR/NK Deaths 1 Cut / Pierce Drowning / Submersion Fall Fire / Burn Firearm Machinery Motor Vehicle Traffic Pedal Cyclist Pedestrian Transport Natural / Environmental Overexertion Poisoning Struck by Against Suffocation Other Specified and Classifiable

53 Texas Level 2 Trauma Centers Incidents by Selected Mechanism of Injury 2011 Texas Trauma Registry Report Level 2 Trauma Centers Incidents Percent by Selected Mechanism of Injury N=13,034 50% 47% 40% Percent 30% 20% 10% 0% Fall 23% Motor Vehicle Traffic 8% 6% Struck by Against Mechanism of Injury 4% 3% Transport Cut / Pierce Firearm

54 Texas Level 2 Trauma Centers Incidents by Selected Mechanism of Injury 2011 Texas Trauma Registry Level 2 Trauma Incidents Centers Report Female NR/NK Sex CDC Grouping Total Total Death Male Male Death Female Deaths NR/NK Deaths 1 Cut / Pierce Drowning / Submersion Fall Fire / Burn Firearm Machinery Motor Vehicle Traffic Pedal Cyclist Pedestrian Transport Natural / Environmental Overexertion Poisoning Struck by Against Suffocation Other Specified and Classifiable Other Not Elsewhere Classifiable Unspecified NR/NK Total

55 Texas Level 3 Trauma Centers Incidents by Selected Mechanism of Injury 2011 Texas Trauma Registry Report Level 3 Trauma Centers Incidents Percent by Selected Mechanism of Injury N=29,939 Percent 60% 50% 40% 30% 20% 10% 0% 48% Fall 24% Motor Vehicle Traffic 7% 5% 4% 2% Struck by Against Mechanism of Injury Transport Cut / Pierce Firearm

56 Texas Level 3 Trauma Centers Incidents by Selected Mechanism of Injury 2011 Texas Trauma Registry Incidents Report CDC Grouping Total Level 3 Trauma Centers Total Death Male Male Death Female Female Deaths NR/NK Sex NR/NK Deaths 1 Cut / Pierce Drowning / Submersion Fall Fire / Burn Firearm Machinery Motor Vehicle Traffic Pedal Cyclist Pedestrian Transport Natural / Environmental Overexertion Poisoning Struck by Against Suffocation Other Specified and Classifiable Other Not Elsewhere Classifiable Unspecified NR/NK Total

57 Texas Level 4 Trauma Centers Incidents by Selected Mechanism of Injury 2011 Texas Trauma Registry Report Level 4 Trauma Centers Incidents Percent by Selected Mechanism of Injury N=23,737 Percent 70% 60% 50% 40% 30% 20% 10% 0% 59% Fall 11% Motor Vehicle Traffic 7% Struck by Against 4% 4% Mechanism of Injury 1% Transport Cut / Pierce Firearm

58 Texas Level 4 Trauma Centers Incidents by Selected Mechanism of Injury 2011 Texas Trauma Registry Incidents Report CDC Grouping Total Level 4 Trauma Centers Total Death Male Male Death Female Female Deaths NR/NK Sex NR/NK Deaths 1 Cut / Pierce Drowning / Submersion Fall Fire / Burn Firearm Machinery Motor Vehicle Traffic Pedal Cyclist Pedestrian Transport Natural / Environmental Overexertion Poisoning Struck by Against Suffocation Other Specified and Classifiable Other Not Elsewhere Classifiable Unspecified NR/NK Total

59

60 Summary Continuing to Move To Inclusive System Criteria Revisions Added Geriatric Specific Criteria Pediatric Specific Criteria Regional Participation Registry NTDB PI Concurrent Registry Concurrent Data Validation Requires Commitment, Dedication, Funding