How Trauma Changes over Time Laws to Rules to Tools How Trauma Changes over Time

And Why Do I Care???

The Law 25-3.5 Part 7 Legislative declaration (1)  The general assembly hereby finds and declares that trauma is the greatest single cause of death and disability in Colorado for persons under the age of forty-five years and that trauma care is a unique type of emergency medical service. (2)  The general assembly further finds that a trauma system task force made up of various emergency health and trauma care entities submitted a report to the general assembly in 1993 indicating a compelling need to develop and implement a statewide trauma care system in order to assure that appropriate resources are available to trauma victims from the point of injury through rehabilitative care. In addition, a statewide system is essential to provide Colorado residents and visitors with a greater probability of surviving a life-threatening injury and to reduce trauma-related morbidity and mortality in this state. (3)  The general assembly, therefore, declares that it is necessary to enact legislation directing the board of health to adopt rules that govern the implementation and oversight of the trauma care system. The general assembly further declares that to ensure the availability and coordination of resources necessary to provide essential care, it is necessary to enact legislation that directs the department of public health and environment to collaborate with existing agencies and organizations, including governing bodies for counties and cities and counties, in implementing and monitoring a statewide trauma care system.

How Are Laws and Rules Related?? Colorado Revised Statutes (Laws) (passed by the Colorado Legislature and signed by Governor) Tells someone or some entity to do/not do something (Gives the big idea & often tells state agency to make rules) Rules/regulations detail how those big ideas are carried out – they are the practical steps to implementing laws.

How Trauma System Ideas Become Rules 25-3.5-701 et seq. C.R.S. Law gives CDPHE responsibility to “develop, implement, and monitor” state EMS and trauma system “in accordance with…rules adopted by the Colorado Board of Health”

“in accordance with… rules adopted by the Colorado Board of Health” How Ideas Become Rules “in accordance with… rules adopted by the Colorado Board of Health” Ideas come from changes to law, ….staff, STAKEHOLDERS, change in practice SEMTAC forms a task force to examine ideas and draft language for rule changes, if necessary Task force meets to define scope of project, carry out drafting, make recommendation to STAC/SEMTAC. All meetings are PUBLIC. PUBLIC comment is solicited in meetings, between meetings and through website

“in accordance with… rules adopted by the Colorado Board of Health” How Ideas Become Rules “in accordance with… rules adopted by the Colorado Board of Health” Task force makes recommendations to STAC/SEMTAC for new or revised rule STAC carefully reviews proposed rules and makes a recommendation to SEMTAC. SEMTAC has PUBLIC discussion and votes to support or not. Staff submits to the Attorney General’s Office for official review of proposed rule and at same time… Staff requests time on Board of Health agenda to request a hearing – again a PUBLIC meeting.

How Ideas Become Rules “in accordance with… rules adopted by the Colorado Board of Health” 2months later… SEMTAC’s recommendation is presented to the Board of Health at a hearing taking PUBLIC testimony. The Board of Health votes to approve rule (or not). Staff submits to Attorney General’s Office for final review and submits to Secretary of State’s Office for publication Approximately 45 days after the hearing, the rule becomes effective and is published on the Secretary of State’s website.

Why Now? The Colorado Department of Public Health and Environment (CDPHE) is required by law to regularly review all existing rules to determine if still necessary, avoid duplication and reduce regulatory burden on INDUSTRY. Requires the department notify STAKEHOLDERS and solicit input.

Trauma Rules Current Structure 6 CCR 1015-4 (Code of Colorado Regulations) Chapter One – Trauma Registry Rules Chapter Two – State Emergency Medical and Trauma Care System Standards Chapter Three – Designation of Trauma Facilities Chapter Four – Regional Emergency Medical and Trauma Advisory Councils (RETACs) Official version always on Secretary of State’s website

Chapter 1 – Colorado Trauma Registry (1998) Covers the required collection of trauma data in Colorado Updates 2000, 2005 Completely re-written Effective date of February 2016

Chapter 2 – State Emergency Medical and Trauma Care System Standards (2002?) Communication Prehospital (response) Interfacility Transfer – Adults Mandatory consult and transfer Non-designated facilities RETAC monitoring Interfacility Transfer – Pediatrics (age 14 and under) Divert and Bypass Prehospital Trauma Triage Algorithm (2010)

Chapter 3 - Designation of Trauma Facilities (1998?) Definitions (ongoing additions) Designation Process (2005, 2007) Enforcement and Disciplinary Process (2005) Designation Criteria Level I-II (2008) Trauma Quality Improvement for Levels III-V (2017) Expanded Scope of Care for Levels III-IV (2017) Designation Criteria Levels III – V (2003) Burn Unit Referral Criteria Designation Criteria, RPTC

Chapter 4 – Regional Emergency Medical and Trauma Advisory Councils Everything about RETAC Not been overhauled in 15+ years

And Why Do I Care???

Trauma Designation: Rules to Tools Initial state rules and tools were a multi-page table Refined/changed to allow more room for comment Revised for rule revision Revised for formatting and rule revision

Trauma Designation: Rules to Tools   C. FACILITIES/RESOURCES/CAPABILITIES (CONT.) Level I Level II Level III V 4. Intensive care units (ICUs) for trauma patients (Cont.) b. Equipment - Appropriate monitoring and resuscitation equipment E --- c. Support Services - Immediate access to clinical diagnostic services 5. Acute Hemodialysis Capability

Trauma Designation: Rules to Tools Initial state rules and tools were a multi-pagetable Refined/changed to allow more room for comment Revised for rule revision Revised for formatting and rule revision

Trauma Designation: Rules to Tools

Chapter 4 - History Not been overhauled in 15 plus years (original language?) Intended to include all things RETAC

Next Steps Ongoing Rule Drafting Ongoing Making Ongoing Change to Scoring Tool Electronic Form Start Over Again…