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

Common Names HRSA Model Trauma Systems Planning & Evaluation (MTSPE) HRSA Model Trauma Systems Planning & Evaluation (MTSPE) Model Trauma Plan Model Trauma Plan “National Trauma Plan” “National Trauma Plan”

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

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

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

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)

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

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

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

Leaders & Task Groups The Village people: The Village people: ACEP STN NASEMSP NASEMSO Key Framers of New Document Key Framers of New Document Use ACS/COT as entity to produce new document Use ACS/COT as entity to produce new document HRSA HRSA ACS/COT ACS/COT CDC CDC NHTSA NHTSA

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 Draft, DHHS/HRSA, Feb 2003, p. 5

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

Public Health Goals Prevent epidemics & spread of disease Prevent epidemics & spread of disease Protect against environmental hazards Protect against environmental hazards Prevent Injuries Prevent Injuries Promote and encourage healthy behaviors Promote and encourage healthy behaviors Respond to disasters & assist communities in recovery Respond to disasters & assist communities in recovery Assure the quality & accessibility of Health Services Assure the quality & accessibility of Health Services

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 IOM, 1988

Trauma System Goals Decrease the incidence and severity of trauma Decrease the incidence and severity of trauma Ensure optimal, equitable & accessible care for all persons sustaining trauma Ensure optimal, equitable & accessible care for all persons sustaining trauma Prevent unnecessary deaths & disabilities from trauma Prevent unnecessary deaths & disabilities from trauma Contain costs while enhancing efficiency Contain costs while enhancing efficiency Implement quality & performance improvement of trauma care through out the system Implement quality & performance improvement of trauma care through out the system Ensure certain designated facilities have appropriate resources to meet the needs of the injured Ensure certain designated facilities have appropriate resources to meet the needs of the injured

Mission of the Trauma System Prevent injuries while ensuring that the right patient gets to the right hospital in the right amount of time

Benefits to the Trauma System: Access to a well-established & accepted conceptual model for health care system assessment, planning, intervention, & evaluation. Access to a well-established & accepted conceptual model for health care system assessment, planning, intervention, & evaluation. Potential communications infrastructure (notification systems) Potential communications infrastructure (notification systems) Access to all-hazards information Access to all-hazards information Population-based data Population-based data Resources for disaster preparedness Resources for disaster preparedness Opportunity to integrate the trauma system into other community health efforts to promote overall health Opportunity to integrate the trauma system into other community health efforts to promote overall health A more precise identification of populations at risk & a targeting of specific issues based on these data A more precise identification of populations at risk & a targeting of specific issues based on these data Framework for injury prevention strategies Framework for injury prevention strategies

Access to all-hazards information Access to all-hazards information Access to a well-established health system infrastructure Access to a well-established health system infrastructure Health system response that differentiates facilities by level of resource availability Health system response that differentiates facilities by level of resource availability Existing protocols and guidelines for the care process Existing protocols and guidelines for the care process Access to patient outcome data Access to patient outcome data Existing performance improvement process Existing performance improvement process Additional resources for injury prevention efforts Additional resources for injury prevention efforts Resources to provide all-hazards care Resources to provide all-hazards care Recognition that injury continues to be a public health problem despite significant efforts at trauma system development Recognition that injury continues to be a public health problem despite significant efforts at trauma system development Benefits to the Public Health System:

Public Health Core Functions Trauma System Components CORE FUNCTIONESSENTIAL SERVICE 1992 CORE COMPONENT SUBCOMPONENTS AssessmentMonitor heath Diagnose & investigate EvaluationNeeds assessment Data collection Research Policy DevelopmentInform, educate, & empower Mobilize partnerships Public information and education Injury prevention Trauma system committee Develop policiesLegislation Regulations Trauma system planning and operations Regulations and rules AssuranceEnforce lawsState Lead Agency Ensure links to or provision of care Prehospital careCommunications Triage and transport, medical direction, & treatment protocols Definitive careFacility designation, interfacility transfer, & rehabilitation Ensure competent workforce Human resourcesWorkforce resources & educational preparation Evaluation Data collection Research Interdisciplinary Review Committee

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

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

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

Vision for the Future of Emergency Care Emergency Care System Coordinated, Regionalized, Accountable IOM, 2005

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

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

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

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

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

CA & Model Trauma System The HRSA Model Trauma System Planning and Evaluation (MTSPE) document provides a guide for states in enhancing trauma care. 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 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 MTSPE guide is one tool for states to use in developing an inclusive trauma system ACS/COT Systems Consultation guide ACS/COT Systems Consultation guide Public Health and Trauma System both focus on risk reduction Public Health and Trauma System both focus on risk reduction Trauma continues to be a leading cause of death in California Trauma continues to be a leading cause of death in California

Conclusion: California’s Direction Use the MTSPE guide to evolve a statewide system 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 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 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) Incorporate the COT Systems Consultation Guide (Regional Trauma Systems: Optimal Elements, Integration, and Assessment)

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

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