HRSA Model Trauma Systems Planning Evaluation

1. HRSA Model Trauma Systems Planning & Evaluation July 24, 2008 Gail Cooper

2. Common Names HRSA Model Trauma Systems Planning & Evaluation (MTSPE) Model Trauma Plan �National Trauma Plan�

3. HRSA Model Trauma Plan Do you fit? Sure, with a little tweaking here & there all States fit one way or another It�s not a prescriptive document, it is a guide!

4. HRSA Model Trauma Plan How does California fit? By identifying resources already at work in California to reduce trauma death & disability (Assessment) Working to close the gaps in service delivery (Policy Development) Measuring results, morbidity & mortality (Assurance)

5. HRSA Model Trauma Plan What does it mean? Change; Toward more universal statewide coverage

6. Looking Back: The Need for Change New Plan/New Model Move away from components Toward inclusive, integrated, & evidence based Develop Trauma System Planning and Evaluation: A Public Health Approach Planning Guide Integrates essential elements of the model trauma system plan using a public health approach Incorporates new information on Systems Development Self-evaluation document BIS (Benchmarks, Indicators, & Scoring)

7. Process for Future TraumaSystem Development Funded by HRSA Use the village approach Solicit comments frequently Incorporate ideas from key trauma leaders Build consensus among stakeholders Repeatedly educate stakeholders about the public health approach to trauma care

8. Why Public Health Gives credibility to trauma as a public health problem Reasonable, methodical approach recommended by the IOM Grounds trauma in a theoretical base Incorporates trauma & injury within the framework of public health Allows trauma to be more competitive for funding

9. The Process Review: 1992 Draft Model Trauma Care System Plan Trauma System Agenda for the Future HRSA Evaluation instrument ACS/COT Trauma system consultation manual Literature review: Skamania conference Literature since Skamania conference

10. Leaders & Task Groups The Village people: ACEP STN NASEMSP NASEMSO

11. Trauma System Planning & Evaluation: A Public Health Approach � the public health approach is simply a proven, systematic method of problem identification & problem solving; it provides a conceptual framework for trauma system development, management & ongoing performance improvement

12. Trauma System Planning & Evaluation Guide Fresh approach to trauma system planning Focus around 3 Core Functions of Public Health (A, PD, A) Use Trauma Agenda for the Future components (NHTSA) Provide practical information Include updated version of HRSA Trauma System evaluation tool (BIS self evaluation) Incorporate NACCHO Standards for Public Health Offices where applicable

13. Public Health Goals Prevent epidemics & spread of disease Protect against environmental hazards Prevent Injuries Promote and encourage healthy behaviors Respond to disasters & assist communities in recovery Assure the quality & accessibility of Health Services In the broadest sense, public health is designed to promote health. This can be accomplished in a variety of ways from environmental modification to public information and education. Public health goals Prevent epidemics Protect against environmental hazards Prevent injuries Promote and encourage healthy behaviors Respond to disasters and assist communities with recovery In the broadest sense, public health is designed to promote health. This can be accomplished in a variety of ways from environmental modification to public information and education. Public health goals Prevent epidemics Protect against environmental hazards Prevent injuries Promote and encourage healthy behaviors Respond to disasters and assist communities with recovery

14. Mission of Public Health Assuring conditions in which people can be healthy Substance of Public Health; Organized community efforts aimed at the prevention of disease & the promotion of health The mission of a public health system can be stated simply and succinctly.The mission of a public health system can be stated simply and succinctly.

15. The goals of the trauma system are not dissimilar to those previously listed for the public health system. It is also about promoting a life style that is free from injury and/or returning a person who has sustained an injury to his or her pre-injury status. The goals of the trauma system are not dissimilar to those previously listed for the public health system. It is also about promoting a life style that is free from injury and/or returning a person who has sustained an injury to his or her pre-injury status.

16. Mission of the Trauma System Prevent injuries while ensuring that the right patient gets to the right hospital in the right amount of time In its broadest sense trauma systems also seek to ensure conditions in which people can be healthy. In this case free from injury and its effects. Trauma system can be broadly described as an �injury prevention and control system�. Overall goal is injury prevention and control system- prevent injuries, reduce mortality and morbidity from injuries In its broadest sense trauma systems also seek to ensure conditions in which people can be healthy. In this case free from injury and its effects. Trauma system can be broadly described as an �injury prevention and control system�. Overall goal is injury prevention and control system- prevent injuries, reduce mortality and morbidity from injuries

19. This slide is additional visual verification that the items that are familiar to us as trauma system practitioners are, indeed, captured in the three core functions and ten essential services of a public health approach. The trauma system components that have guided trauma system development since the early 1990�s are listed to the right of the red vertical line. As you can see each of those is covered nicely in a core element or essential service. This slide is additional visual verification that the items that are familiar to us as trauma system practitioners are, indeed, captured in the three core functions and ten essential services of a public health approach. The trauma system components that have guided trauma system development since the early 1990�s are listed to the right of the red vertical line. As you can see each of those is covered nicely in a core element or essential service.

20. Why a public health approach? Assure consistency with the Trauma System Agenda for the Future Begin looking at outcomes rather than just the structure & process Give credibility to trauma as a public health problem Improve dialogue between trauma/EMS professionals, public health professionals & policy-makers

21. Why a public health approach ? Reasonable, methodical approach recommended by the Institute of Medicine Enhance integration of trauma systems into public health disaster planning & bioterrorism response planning Allow trauma & EMS to be more competitive for funding Grounds trauma system in theoretical base Incorporates both EMS & trauma within a public health system

22. Supporting the Model Recent IOM report on the Future of Emergency Medical Services ACS/COT Systems Consultation Guide Regional Trauma Systems: Optimal Elements, Integration, & Assessment Key Trauma System Leadership, National, State & Local

23. Vision for the Future of Emergency Care Emergency Care System Coordinated, Regionalized, Accountable

24. Key Problems Fragmentation: Lack of coordination between local service providers; between EMS and public safety; & between EMS & air medical services Uncertain Quality: Little or no performance data; lack of national standards for training & credentialing. Disaster Preparedness: Inadequate training, equipment, funding. Evidence Base: limited understanding of effectiveness

25. Key Recommendations Communications Improve data & communications systems interoperability between EMS agencies, hospitals, & public health departments. State regulation of air medical providers with respect to communications, dispatch, & transport protocols.

26. Workforce Standards Improve the quality & consistency of EMS by encouraging states to: Require national accreditation of paramedic education programs. Accept national certification as a prerequisite for state licensure. Establish a common scope of practice for EMS personnel across states, with state licensing reciprocity.

27. Research Study to examine the gaps in emergency and trauma care research. Development of a research strategy. Increased funding for prehospital EMS research, emphasizing systems & outcomes research.

28. Disaster Preparedness Elevation of emergency care to a position of parity with other public safety entities in disaster planning & operations. Increase in funding for EMS-related disaster preparedness through dedicated funding streams. Incorporate disaster preparedness training into EMS professional training & continuing education.

29. CA & Model Trauma System The HRSA Model Trauma System Planning and Evaluation (MTSPE) document provides a guide for states in enhancing trauma care. The guide provides a structure for further developing the statewide system MTSPE guide is one tool for states to use in developing an inclusive trauma system ACS/COT Systems Consultation guide Public Health and Trauma System both focus on risk reduction Trauma continues to be a leading cause of death in California Hopefully, this presentation has provided you with a basic understanding of the rational behind framing trauma care systems in a public health dialogue. The long-term impact of this paradigm shift can only be evaluated by those that succeed us in our ongoing attempts to reduce the unnecessary burden of injury and create a healthier and safer environment for all Americans.Hopefully, this presentation has provided you with a basic understanding of the rational behind framing trauma care systems in a public health dialogue. The long-term impact of this paradigm shift can only be evaluated by those that succeed us in our ongoing attempts to reduce the unnecessary burden of injury and create a healthier and safer environment for all Americans.

30. Conclusion: California�s Direction Use the MTSPE guide to evolve a statewide system Continue developing the regional approach to trauma care within California using the BIS as a guide to improvement Rely on data to assist in setting standards, guidelines and benchmarks that may be unique to California Incorporate the COT Systems Consultation Guide (Regional Trauma Systems: Optimal Elements, Integration, and Assessment)

31. Conclusion: California�s Direction Leadership in Trauma Systems State, Regional, Local, Many Benchmarks & Indicators already achieved Statutes, Regulations, Funding available It will never be enough! The timing is right to move California to the next level of trauma system development

32. JUST DO IT Build on the synergy & cooperative spirit of this summit