Hospital Categorization: Role in Advancing Emergency Medicine Track D September 15, 2003 Barcelona Lewis R. Goldfrank, MD Professor and Chairman of Emergency Medicine New York University Medical Center Bellevue Hospital Center New York University School of Medicine Medical Director, New York City Poison Center

History 1966 National Academy of Sciences:Accidental Disease and Disability: The Neglected Disease of Modern Society The leading cause of death in children and adults and the nation’s most important environmental health problem

History Focus on civilian response to trauma, simultaneously society was beginning to appreciate the military accomplishments for the severely injured in Korea and Vietnam. Progress in Seattle, Miami and Belfast showed that death from acute myocardial infarction could be reduced by organized prehospital care.

History National Highway and Safety Act Department of Transportation funds prehospital EMS.

1973 Public Law the Emergency Medical Services Systems (EMSS Act) Development Regional EMS systems to include: manpower, training, communications, transportation, facilities, critical care units, public safety agencies, consumer participation, access to care, transfer of care, standardization of patient records, public information and education, independent review and evaluation, disaster linkage and mutual aid agreements. [Fifteen key components]

State and Regional Categorization and Implementation Categorization has emerged as one of the cornerstones of Federal emergency planning and grant awarding evidence for decreased morbidity and mortality for Newborns, Burns, Poisonings and Trauma

Y Model Regional Poison Information and Control Center Systems

JCAHO Level I facility minimal standards: Comprehensive ED care 24 hrs/day with in hospital physician coverage by medical staff or senior level residents.

The American Heart Association and the Committee on trauma of the American College of Surgeons developed guidelines for governing location, function and design staffing

Costs of injury to society. Most of the resources currently are directed to prevention of death while most of the economic and social cost are associated with nonfatal injuries. Martinez R. Putting It Together: A Model for Integrating Injury Control System Elements. Prehospital and Disaster Medicine 1995;10:17/72.

Philosophy ACCIDENTS aRe Not raNdom eVents THey are PreDIctABle thEy CAN BE PreVENTed Committee on Injury Prevention and Control, Institute of Medicine. Reducing the Burden of Injury: Advancing and Treatment. Washington, DC: National Academy Press; 1999.

The Josiah Macy Jr. Foundation Conference on the role of emergency medicine in the future of American medical care. Recommendation 1 The United States Public Health Service in its next “Statement of Public Health Objectives for the Nation,” should specify, as a new goal, that access to high quality emergency medical care should be available for all persons who need such care.

Recommendation 2 The Society of Academic Emergency Medicine (SAEM), the American College of Emergency Physicians (ACEP), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) should revise the classification of emergency departments.

Recommendation 3 The deans and faculty of all LCME- accredited medical schools, with the assistance of the Association of American Medical Colleges and the Association of Academic Health Centers, should establish in their schools appropriately staffed and supported academic departments of Emergency Medicine.

By holding Level 1 emergency centers (ECs) to objective standards based on the quality of care delivered as well as administrative, research, and educational efforts, SAEM hopes to improve patient care.

Abstract “should revise the classification of emergency departments... To reflect the level of care available in emergency departments, and indicate whether or not facilities are adequate and whether appropriately qualified and credentialed emergency physicians are available 24 hours a day.” Acad Emerg Med 1999;6:

Boyd DR. A Symposium on the Illinois Trauma Program. A Systems approach to the care of the critically injured. J Trauma 1973;13:

Categorization Standards Staffing Professional Training and Continuing Education Facility Equipment and Supplies Ancillary Services EC Records

Categorization Standards Manuals and References Continuous Quality Improvement Education Research Administration

Categorization Standards Out-of-hospital Care Information Systems Disaster Planning Benchmarking Hospital Accreditations

The New York Times January 26, 1989