2010 State Trauma Update Kansas Medical Society Paul B. Harrison, MD FACS Chair, Advisory Committee on Trauma

What is a trauma system? Mission is to prevent injuries while ensuring that the right patient gets to the right hospital in the right amount of time.

Goals of the Kansas Trauma System Reduce the number of preventable deaths Improve outcomes for traumatic injuries Encourage provider preparation and response to trauma Reduce medical costs through appropriate use of resources Increase public awareness & prevention Design an inclusive and comprehensive system Develop trauma education resources Kansas Trauma Plan 2001

State Trauma Program: Infrastructure Advisory Committee on Trauma Appointed by the Governor's office KDHE: Lead Agency Regional Trauma Councils Trauma Registry- Data collection Trauma Center designation Regional Trauma Councils Hospitals- administrators, physicians, nurses EMS Public Health Departments

Progress continues to be made!

Update on State Trauma System State  Priority projects  Level IV trauma center designation Regional  Regional Performance Improvement Federal  Trauma Care & Health Care Reform

State Designated Trauma Centers: Level I Adult, Level II Pediatric Trauma Centers University of Kansas Hospital Via Christi- St. Francis Wesley Medical Center Level II Adult Trauma Centers Overland Park Regional Medical Center Stormont Vail Regional Health Center Level III Trauma Centers Labette Health Via Christi- Pittsburg

Projects 2010 Update the BIS assessment- 5/2010 Update regulations to include Level IV trauma center designation Update state trauma registry system Develop interface EMS/trauma Data Awarded CDC Funding for field triage Regional PI

Proposed Level IV criteria: Trauma Team Education requirements  Physician- ATLS  ED Nurse- TNCC Trauma Team Activation Plan On call schedule Equipment for resuscitation Quality improvement program Transfer protocol

Trauma/EMS Interface Board of EMS & Trauma Program awarded a grant from KDOT to support interface 6-8 months completion EMS Data will be downloaded into the trauma registry 2 data elements will be provided back to EMS Other NHTSA Data Project– KS one of 4 states

Trauma/EMS Data Interface

Training & Education: Establish min. standards for trauma care Prehospital PHTLS Nurses TNCC Physicians ATLS Hospitals Rural Trauma Team Development (RTTDC)

Trauma Education: Trauma Education Funding Sources: Kansas Rural Health Options Project (KRHOP) Regional Trauma Councils Christopher & Dana Reeves Foundation Grant KRHOP Funds: RTTDC, ATLS, PHTLS, TNCC $1,000 ATLS scholarships ( 20) Outcome? Trauma Education Survey

Survey Results: ATLS

CDC Field Triage Implementation Project Awarded funding from CDC Kansas, Massachusetts, Michigan Goal: Pilot Field Triage Guidelines in state/region SE Regional Trauma Region will serve as pilot area

Field Triage Decision Scheme: The National Trauma Triage Protocol U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Injury Prevention and Control Division of Injury Response

Published: January 2009 Available for FREE at:

Source: MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma- center care on mortality. N Engl J Med Jan 26; 354(4): “If you are severely injured, care at a Level I trauma center lowers your risk of death by 25%.”

History of the Decision Scheme The American College of Surgeons-Committee on Trauma (ACS-COT) developed guidelines to designate “trauma centers” in Set standards for personnel, facilities, and processes necessary for the best care of injured persons Studies showed mortality reduction in regions with trauma centers

History of the Decision Scheme National consensus conference in 1987 resulted in first ACS field triage protocol, the “Triage Decision Scheme”  The Decision Scheme serves as the basis for field triage of trauma patients in most EMS systems in the U.S.

History of the Decision Scheme The Decision Scheme has been revised four times (1990, 1993, 1999, 2006) In the Centers for Disease Control and Prevention (CDC), with support from the National Highway Traffic Safety Administration (NHTSA), convened the National Expert Panel on Field Triage

Field Triage Decision Scheme: The National Trauma Triage Protocol

Why this Decision Scheme is Unique Takes into account recent changes in assessment and care of the injured patient in the U.S. Adds views of a broader range of disciplines and expertise into the process

Purpose This Decision Scheme was revised to facilitate more effective triage and better match trauma patients’ conditions with the medical resources best equipped to treat them

Step 1:Physiologic Criteria

Step 2: Anatomic Criteria

Step 3: Mechanism of Injury Criteria

Step 4: Special Considerations

Federal: Health Care Reform

Health Care Reform Emergency & Trauma Care Systems Support regionalized, coordinated and accountable emergency care  Funds appropriated FY11 for research in emergency medicine & regionalized emergency care systems Mandate & fund integrated trauma system development  Establishes new trauma center program to strengthen ED & trauma center capacity

Regional Trauma Councils Cornerstone of the state system An opportunity for input into the state system Opportunity to become involved at regional level Responsible for assessing regional resources Responsible for identifying educational needs and then providing education Responsible for community prevention efforts

Regional Trauma Plans Regional Plans Reviewed & Updated:2005, 2007, 2009 To be revised in Recommendations Tailor & adopt CDC field triage guidelines Support trauma education assessment Injury prevention based on trauma data

Kansas Trauma Program Web site:  ACT  Regional Trauma Council  Education  Regulations  Publications  Contact information  Newsletter

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