The Medical Center of Louisiana is a member of the LSU Health Sciences Center – Health Care

1. Trauma Services FISCAL YEAR STATISTICS 2005 ANNUAL REPORT The Medical Center of Louisiana is a member of the LSU Health Sciences Center – Health Care Services Division, and is affiliated with LSU and Tulane Schools of Medicine.

2. Table of Contents 2

3. TRAUMA PROGRAM REPRESENTATIVESNorman McSwain, MD, Trauma Program Director 3

4. TRAUMA PROGRAM OVERVIEW The Trauma Program at the Medical Center of Louisiana operates under the guidance of the Director of Trauma, with the 24-hour support of the departments of Surgery, Emergency Medicine, Orthopedics, Neurosurgery, Radiology, Pathology, all Surgical subspecialties, Blood Bank, Nursing, and Allied Health personnel. The Trauma Program includes full-time in-house faculty who manage and supervise resuscitation and surgical interventions in all cases. On April 9, 1996 the American College of Surgeons verified Charity Hospital as a Level I Trauma Center. This verification is for three years, and the Trauma Center successfully underwent re-verification March 5, 1999 and again in March 2002. With over 4,000 trauma patients a year, this makes Charity’s Level I Trauma Center one of the busiest verified inner-city centers in the country. Subsequently, the Trauma Center has been licensed and designated as a Primary Trauma Center by the Division of Health and Human Resources according to state statute. 4

5. Since its inception, Trauma Team members have consistently filled a leadership role in the development and implementation of optimal trauma care for the State of Louisiana. Responsibilities are held within the following committees and organizations: • American Association for Parenteral and Enteral Nutrition • Louisiana State Committee on Trauma • American Association for the Surgery of Trauma • Louisiana State Highway Safety Council • American College of Surgeons Committee on Trauma • Metropolitan Safety Council • American Nurses Association • Society of Trauma Nurses • National and International Surgical, Orthopedic, and NeuoSurg Assoc. • American Trauma Society • Eastern Association for the Surgery of Trauma • New Orleans Surgical Society • Emergency Nurses Association • Orleans Parish Medical Society • Gubernatorial Ad Hoc Committee on Trauma 5

6. The in-house Trauma Team consists of an attending trauma surgeon, chief surgical resident, and additional surgical residents at other levels. The surgical faculties are trauma-committed surgeons with special interest and expertise in trauma care. The Trauma Team evaluates, resuscitates and definitively treats all major traumas. In addition to the medical support, trauma office staff are fundamental to Charity’s trauma services progress, execution and evaluation. Working in conjunction with the Director of the Trauma Program, the Trauma Program Manager and the Coordinators are responsible for the organization of services necessary for an interdisciplinary approach in the delivery of optimal care to the trauma patient. Clinical monitoring, concurrent performance improvement, and community outreach and prevention programs are but a few of the services implemented by the Trauma Program personnel. While the main goal of the Trauma Service is optimal patient care, the service also provides leadership in education and research. There are on-going educational programs for nursing, residents and students in the form of attending rounds and operative supervision as well as didactic discussions and conferences. Trauma surgical faculty members are nationally and internationally recognized for their expertise in research, and research work done at the Trauma Center has been presented many times at the national and international levels. 6

7. Trauma Team member education is pre-eminent for the Trauma Services. Outreach and educational efforts occur simultaneously. The Trauma Program has become a well-recognized educational resource and has not only been the preceptor of students from many colleges and universities in our own community, but has received medical personnel from all over the world wanting to interact with the Trauma Center. A strong part of the Trauma Program’s outreach is providing education to all care providers. This is accomplished through a variety of mechanisms, including monthly orientation of new hospital personnel to their responsibilities within the Trauma Center, monthly interdisciplinary trauma care conferences, and continuing staff in-services, workshops, and updates on the optimal care of the trauma patient to prehospital care providers, physicians and nurses. In addition, the Trauma Committee members organize and teach trauma education courses. These courses include but are not limited to, Advanced Trauma Life Support, Advanced Cardiac Life Support, Trauma Nurse Core Curriculum, and Advanced Trauma Care for Nurses. A Level I Trauma Center has the highest level of response for the major trauma patient, as well as trauma related research, teaching and outpatient care programs. The Trauma Team requires the cohesive medical approach of physicians, nurses, technicians and ancillary staff to assure that the trauma patient is evaluated, resuscitated and treated expeditiously and appropriately. In addition, the program continues to be active in allied initiatives with one of the most active trauma injury prevention programs in the country, to our rehabilitation with the overall objective to continually reduce deaths and disabilities from trauma. 7

8. MEDICAL CENTER OF LOUISIANACHARITY HOSPITAL TRAUMA PROGRAM ANNUAL REPORT Patient Statistics Fiscal Year 2005

9. PATIENT DEMOGRAPHICSn = 3907 FY 2005 Trauma is endemic in young Afro-American males in Orleans Parish. These data mirror national data which demonstrate that trauma is a disease of young people and the #1 cause of death in people less than age 44. (Pediatrics: 0-12; Adults: 13-64; Elderly 65+) 9 MCLNOTrauma Registry

10. FATAL TRAUMAn = 192 FY 2005 Overall trauma patient mortality was 4.9%. Of these, 52% (100) either expired in the Emergency Department or were DOA. There were 92 in-hospital deaths representing 4.2% of all admitted trauma patients. 10 MCLNO Trauma Registry

11. PARISH OF INJURY vs. RESIDENCEn=3907 FY 2005 46% of patients treated were residents of parishes other than Orleans. Patients who were known to be injured in outside parishes accounted for 10% of all evaluations and/or admissions. The actual number increased from 417 last year to 585 this year. This increase is the result of recent contractual agreements with outside parishes. 11 MCLNO Trauma Registry

12. PATIENT TRIAGE SUMMARYn=2092 FY 2005 True + {Predicted Major Trauma/Actual Major Trauma True – {Predicted Non-Major Trauma/Actual Non-Major Trauma OVERTRIAGE=False + {Predicted Major Trauma/Actual Non-Major Trauma UNDERTRIAGE=False – {Predicted Non-Major Trauma/Actual Major Trauma 12 MCLNO Trauma Registry

13. MECHANISM OF INJURYn=3907 FY 2005 Blunt trauma accounts for 71% of all trauma cases seen by this facility, which is designated as the official Orleans Parish Trauma Center. Penetrating trauma accounts for 28% which has increased by 5% since FY 2004. 13 MCLNO Trauma Registry

14. SEVERITY OF INJURYn=3907 FY 2005 • Major Trauma • Includes any patient who is known or reasonably suspected to have sustained an injury that merits treatment by a trauma team capable of immediate surgery and one or more of the following: • Transfer from another hospital, • Admission to ICU, • Hospitalization for three or more days, • Abbreviated Injury Scale Value of 3 or more • Survival probability 90% or less, or • Death. Fifty-five percent (55%) of the injured patients treated by the MCLNO Trauma Center were victims of Major Trauma. 14 MCLNO Trauma Registry

15. PATIENT TRANSPORTATIONn=3907 FY 2005 Seventy-nine percent (79%) of patients transported were brought to MCLNO via an ambulance. The New Orleans Health Department ambulance service, was responsible for 72% of the pre-hospital care. 15 MCLNO Trauma Registry

16. INJURY SEVERITY SCORE (ISS)BY MECHANISM OF INJURYn=1500* FY2005 *Activated Patients who were either admitted or died in the ED. The injury severity score (ISS) is a way of assigning severity of injury numerically for standardization and outcome prediction. ISS is related linearly with mortality, and an ISS >= 15 is considered major trauma. 16 MCLNO Trauma Registry

17. ETIOLOGY BY INTENTn=3907 FY 2005 Thirty-one percent (31%) of all patients seen and treated were victims of intentional assault. Violence prevention remains a top priority of the Trauma Center’s Outreach and Community Activity Program. 17 MCLNO Trauma Registry

18. INTENTIONAL INJURIESn=1296 FY 2005 Where the data are known, 97% of intentional injuries were the result of an assault and 3% were self inflicted. Gunshot and stabbings continue to be the major cause of intentional injuries. 18 MCLNO Trauma Registry

19. TRAUMA ACTIVATION LEVELSBY INJURY SEVERITY SCOREn=1502* FY 2005 *Activated Patients who were either admitted or died in the ED. Injury Severity Score Of the 3,880 trauma patients for fiscal year 2005, 3,097 (79%) required trauma system activation. Fifty percent (50%) of these were designated as needing the highest level of Activation. 19 MCLNO Trauma Registry

20. VEHICULAR TRAUMA FY 2005 n=1175 n=196 n=120 Protective devices are seat belts, air bags, child seats, and helmets. Seat belt usage decreased from 61% to 48% while motorcycle helmet usage increased from 36% in FY 2004 to 61% in FY 2005. Bicycle helmet usage was documented in 4 out of 120 bicycle injuries. 20 MCLNO Trauma Registry

21. EMERGENCY CENTER TRAUMA ADMISSIONSby Day of Weekn=3907 FY 2005 Weekends remain the most active period, with Saturday, Sunday, and Monday accounting for 48% of the total weekly admissions. (Day is 0800 to 0759.) 21 MCLNO Trauma Registry

22. EMERGENCY CENTER TRAUMA ADMISSIONSby Shiftn=3512 FY 2005 The highest volume of trauma patients seen in the Emergency Department continued to be during the evening hours. MCLNO Trauma Registry 22

23. EMERGENCY CENTER MAJOR TRAUMAPATIENT TURNAROUND TIME (Number of Patients) FY 2003-2005 23 MCLNO Trauma Registry

24. EMERGENCY DEPARTMENT DISPOSITIONn=3907 FY 2005 Fifty-nine (59%) of admitted patients required intensive care or urgent operative care upon admission. Forty-one percent (41%) of patients were discharged to home from the ED compared to Thirty-eight (38%) in FY 2004. 24 MCLNO Trauma Registry

25. ADMITTING SERVICEn=2209 FY 2005 All major trauma patients are initially seen and evaluated by the Trauma Team. Once cleared for poly-trauma, consultation is obtained as appropriate. Orthopedics and neurosurgery remain active in the care of these patients. “Other Surgical” reflects the involvement of plastic, urology, ENT, pediatric and oral surgery services. 25 MCLNO Trauma Registry

26. PROCEDURES ON TRAUMA PATIENTS FY 2005 Number of Procedures N=932 Number of Procedures N=9,920 There were 9,920 total procedures performed on 3,083 patients (79% of all trauma patients). SURVIVORS = 3.2 avg. # procedures – FATALITIES = 5.6 avg. # procedures 26 MCLNO Trauma Registry

27. HEAD INJURYn=649 FY 2005 Seventeen percent (17%) of trauma patients suffered head injuries, the majority being secondary to blunt trauma. Twenty-five (25%), or 161 patients, experienced disability or death. 27 MCLNO Trauma Registry

28. SPINAL INJURYn=71 FY 2005 One point eight percent (1.8%) of patients suffered spinal cord injury with 48% of these patients having disability or death. This represents 34 patients. 28 MCLNO Trauma Registry

29. HOSPITAL DISCHARGE DISPOSITIONn=3907 FY 2005 Eighty-three percent (83%) of all patients were discharged home or left against medical advice; 363 (9%) were transferred to medical facilities. 29 MCLNO Trauma Registry

30. EYE & ORGAN PROCUREMENTn=192 deaths FY 2005 A major contribution made by this trauma center’s patients is the “gift of life” through organ donation. Thirty-two patients were satisfactory donors and 55 organs or tissue were recovered. 30 MCLNO Trauma Registry

31. DRUG & ALCOHOL RESULTSFOR TRAUMA ACTIVATIONS(BASED ON PERCENTAGE OF TESTED POPULATION) FY 2005 n=1118 n=1432 n=957 n=936 n=817 n=662 n=496 n=295 n=298 n=51 n=41 n=33 31 MCLNO Trauma Registry

32. REIMBURSEMENT SUMMARYn=3907 FY 2005 The Trauma Center provides services for all patients regardless of payor status. Forty (40%) of patients have some form of payment assistance.*Includes private insurance, worker’s compensation, HMO/PPO. MAP represents Medicaid Applied For. MCLNO Trauma Registry 32

33. FY 2005 SPREADSHEET COMPARISONSlides 9-10 MCLNO Trauma Registry 33

34. FY 2005 SPREADSHEET COMPARISONSLIDES 11-14 MCLNO Trauma Registry 34

35. FY 2005 SPREADSHEET COMPARISON SLIDES15-16 MCLNO Trauma Registry 35

36. FY 2005 SPREADSHEET COMPARISONSLIDES 17-19 MCLNO Trauma Registry 36

37. FY 2005 SPREADSHEET COMPARISONSlides 21-24 MCLNO Trauma Registry 37

38. FY 2005 SPREADSHEET COMPARISONSlides 25-38 MCLNO Trauma Registry 38

39. FY 2005 SPREADSHEET COMPARISONSlides 29-32 39 MCLNO Trauma Registry

40. American College of SurgeonsCertificate of Verification 40

41. Louisiana Department ofHealth & Hospitals License 41