State of Texas: American College of Surgeons Trauma Systems Consultation Site Visit Team

1. State of Texas:American College of Surgeons Trauma Systems Consultation Site Visit Team • Christoph Kaufmann, MD, MPH, FACS (Team Leader) • Jane Ball, RN, DrPH • Alasdair Conn, MD, FACS • Ted Delbridge, MD, FACEP • Rajan Gupta, MD, FACS • Gerry Pratsch, RN, MPH • Drexdal Pratt, CEM • Nels Sanddal, MS, REMT-B • Jolene Whitney, MPA • Holly Michaels, ACS Staff

2. State of Texas:American College of Surgeons Trauma Systems Consultation Site Visit Team • Christoph Kaufmann, MD, MPH, FACS (Team Leader) • Jane Ball, RN, DrPH • Alasdair Conn, MD, FACS • Ted Delbridge, MD, FACEP • Rajan Gupta, MD, FACS • Gerry Pratsch, RN, MPH • Drexdal Pratt, CEM • Nels Sanddal, MS, REMT-B • Jolene Whitney, MPA • Holly Michaels, ACS Staff

3. American College of Surgeons COMMITTEE ON TRAUMA Consultation Program for Trauma Systems • Consultative, not verification • Multi-disciplinary structure • Independently derived recommendations • Consensus-based process • Basis = Inclusive and integrated trauma system • Basis = best interests of the patient

4. Mission / Objectives • ACS Consultation Objective: • To help promote a sustainable effort in the graduated development of an inclusive and integrated trauma system for Texas

5. Texas

6. “Texas: It’s Like a Whole Other Country”

7. Texas • Lone Star State • 268,601 square miles; 80% rural • Population – 25 million • 35% growth 1990-2005; 12.7% 2000-2006 • Largest rural population in the U.S. (3.6 million) • 6% of state public health and EMS monies spent on undocumented persons • 32 trauma deaths every day in Texas

8. Fatalities per 100 Million Vehicle Miles

9. Current Status • 249 designated trauma facilities • 15 Level I trauma centers, 9 Level II, 42 Level III, and 183 Level IV • 22 RACs • Huge geographic area to cover

13. Advantages & Assets • Enabling legislation • Longstanding RAC structure • Trauma center verification process/criteria • Multiple funding sources • red light camera, tobacco endowment, 911 surcharge, DUI/DWI convictions, state traffic fines, driver responsibility • Support by lead Level III facilities • Some of the best trauma centers in the world • Care provider expertise • Liability protection for all health care personnel

14. Advantages & Assets • Strong confidentiality statute • Early consideration of integrated emergency care system • Disaster planning and response capability is outstanding • GETAC advisory at gubernatorial level • Dedicated injury epidemiologist • Recognized need for a trauma data system • Strong academic centers • Capable and invested State and RAC staff

15. Challenges and Vulnerabilities: • Exclusive system design • No statewide trauma registry data or EMS data • No trauma system performance improvement • Funding never secure • Poor communication about patient flow and care between RACs • Inadequate system research • Rising proportion of uninsured and undocumented persons • EMS not an essential service • Some areas not covered by EMS

16. Opportunities for Change: • Timing is right for system change and to develop and implement a more inclusive and integrated trauma system throughout the state • Embrace the concept of the inclusive and integrated trauma system • Educate the legislature and the public about trauma, a public health crisis • The legislature has asked for a report regarding the status of trauma care in Texas • Health care reform may offer opportunities • Extremely committed stakeholders at all levels

17. Recommendations

18. Key Recommendations • “get a plan” • get a registry (or two) • get data • get people • get system PI • get (more) money

19. Key Recommendations - Plan • Update the Strategic Plan for the Texas EMS/Trauma System and formally revisit it on a scheduled basis, e.g. every 3 years.

20. Key Recommendations - Data • Comply with the Texas Code 773.113 regarding the development of a statewide trauma reporting and analysis system. • Continue to actively pursue the purchase, installation and roll-out of a trauma registry (NTDS compliant) and an EMS information system (NEMSIS compliant). • Commit necessary resources to ensure development and maintenance of a reliable statewide EMS information system.

21. Key Recommendations - Data • Coordinate meetings between the state Office of EMS and Trauma, the Regional Advisory Committees, and the state Office of Prevention and Preparedness injury epidemiologist to evaluate and explore existing datasets to generate trauma data and to describe the patterns of injury in the state.

22. Key Recommendations - Personnel • Re-establish the position and hire a full-time trauma system program manager. • Designate a state EMS medical director through an appointment or contractual relationship. The state EMS medical director role should be to advise DSHS staff, provide strategic direction, and serve as a resource for regional and local EMS medical directors and system administrators in the State. • Establish a state trauma medical director position or consultant and clearly define this individual’s role. 

23. Key Recommendations - PI • Develop a statewide trauma system performance improvement plan and implement it.   • Require all RACs to complete a regional assessment with a facilitator using the same set of indicators selected by the state from the HRSA Model Trauma System Planning and Evaluation document. • Establish minimum state performance improvement audit filters to adequately evaluate the trauma process and outcomes statewide, including filters for special populations (pediatric, burns, SCI, TBI, geriatric).  • Collate RAC information to identify instances of failed or delayed interfacility transfer for all trauma patients with an emphasis on special populations (pediatric, burns, SCI, TBI, geriatric)

24. Key Recommendation - Funding • Develop a vision and strategy to identify and capitalize on all available revenue resources to support, enhance, and sustain the trauma system.

25. Focus Questions

26. Focus Questions • Houston-Galveston capacity • Improve: • care for special populations • rehabilitation • injury prevention • system evaluation • Performance improvement • Trauma registry

27. Site Visit Team – Closing Comments • Christoph Kaufmann, MD, MPH, FACS (Team Leader) • Jane Ball, RN, DrPH • Alasdair Conn, MD, FACS • Ted Delbridge, MD, FACEP • Rajan Gupta, MD, FACS • Gerry Pratsch, RN, MPH • Drexdal Pratt, CEM • Nels Sanddal, MS, REMT-B • Jolene Whitney, MPA • Holly Michaels, ACS Staff

28. American College of Surgeons COMMITTEE ON TRAUMA Consultation Program for Trauma Systems Thank You !