1. GETAC Trauma System Committee
May 11, 2017

2. Texas GETAC Trauma System Committee
Jorie Klein, BSN
Lori Boyett, BSN
Alex Ramos, BSN
Brian Eastridge, MD, FACS
Raji Gandhi, MD, MPH, FACS
Kathy Rogers, RN, MSN
Lori Vinson, RN, MSN
Craig Rhyne, MD
Kevin Cunningham, LP
Elmo Lopez, CEO
Hillary Chollet, MD
Ian Mitchell, MD

3. Vision
A unified, comprehensive, and effective Emergency Healthcare System for a healthy and safe Texas.

4. Mission
To promote, develop, and maintain a comprehensive data driven Emergency Healthcare System that will meet the needs of all patients and will raise the standards for high quality community health care by implementing innovative techniques and accountable systems for the delivery of emergency care for the entire population.

5. Welcome Review of current rules. Trauma / EMS Registry
Trauma Strategic Plan

6. Strategic Objectives take precedence
Objectives from the Strategic Plan for the Texas Emergency Healthcare System May & July Meeting Follow-up
Strategic Objectives take precedence
Items Assigned to Trauma System Committee
Objectives and Strategies
Objectives for Trauma System Committee
Strategies To Accomplish

7. Clinical Care Objectives
High priority – injuries where treatment / management can reduce secondary injuries
Hemorrhage/shock, TBI, spine injuries
TQIP best practice guidelines
Texas registry data / national benchmarks
Advocate for EMS as essential service
Reduce time from onset to definitive care
Field triage, transport, transfers
Psychological support / care for injured
Include rehabilitation in care system
Use trauma registry data

8. Trauma System Committee Deliverables Status Review Green = completed; Orange = Active; Red = Not Initiated
High priority
Injuries with hemorrhagic shock, TBI, Spinal cord Injuries, active hemorrhage, multisystem injury with shock and potential for secondary injury from bleeding
Activation Criteria – Transfer Guidelines – Transfer Follow-p
Activation Guidelines – Every Reginal Advisory Council will establish field triage criteria to address the priority patients. (Recommend Inclusion in the RAC Criteria)
Brian Eastridge, MD
Transfer Guidelines – Regional auto-accept guidelines for the priority patients
Rhyne, Chollet, Gandhi
Transfer follow up – Standardized process
Ramos, Boyett, Rodgers

9. Priority – Regional Field Triage Criteria
2001 CDC Field Triage
2014 ACS Resources Document
2017 ATLS Guidelines

10. Priority – Transfer Guidelines
Reduce time from onset of injury to definitive care
Attention should be directed at life-saving stabilization, not definitive diagnostic testing.
It is recognized that non-essential testing and procedures will delay transfer and should be avoided, however stabilization should be undertaken before transport.
Examples of stabilization include:
Maintenance and protection of airway.
Decompression of tension and simple PTX.
Establishment of redundant large bore IV or IO
Maintenance of normothermia
Decompression of the stomach if indicated, especially if transported by air.

11. Priority – Transfer Recommendations
Exhaustive scanning frequently must be repeated at the receiving facility, often because of the quality of images, failure to transfer the images to the receiving facility, inability to read the disc transported with the patient. This results in further delays in definitive care and avoidable exposure of the patient to ionizing radiation.
Early communication with the receiving trauma surgeons can streamline the transfer process and satisfies one of the EMTALA requirements for transfer.

12. Trauma System Committee Deliverables Status Review Green = completed; Orange = Active; Red = Not Initiated
EMS
Advocate for EMS as essential service
Psychological Support
Identified priority patients will have access to psychological support during their definitive and stabilization care to include but not limited to access to PTSD screening and intervention
Rehabilitation
Rehabilitation will be integrated into the trauma system.
Utilize State Trauma Registry
Review requested reports from state trauma registry to define opportunities for improvement.
BPG
Define BPG for standardization

13. EMS As Essential Service
Collaboration
EMS Committee
Air Medical Committee
Medical Directors Committee
GETAC Council

14. Psychological Support
Define current status of psychological support
Survey Monkey
Level I, II, III
PTSD – screening and intervention
Suicide - screening and intervention
Substance Abuse – screening and intervention
Partner Violence – screening and intervention
SBRT – already in place

15. Rehabilitation
Current data initiative
Need Input

16. State Trauma Registry Data – All Patients
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

17. State Trauma Registry Data – All Mortality By Level of TC and ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

18. State Trauma Registry Data – All with BP >90 on Arrival at TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

19. State Trauma Registry Data – All with BP >90 with Mortality at TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

20. State Trauma Registry Data – All with BP >90 Transferred TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

21. Same Data Reflected Trauma Region
State Trauma Registry Data – All with BP >90 with Transfer - Mortality at TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

22. State Trauma Registry Data – All with BP >90 Second Transfer TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

23. Same Data Reflected Trauma Region
State Trauma Registry Data – All with BP >90 with 2nd Transfer - Mortality at TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

24. State Trauma Registry Data – All with Identified TBI by Level of TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

25. State Trauma Registry Data – All with TBI Mortality at Level of TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

26. Same Data Reflected Trauma Region
State Trauma Registry Data – All Patients with with TBI Transferred by Level of TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

27. Same Data Reflected Trauma Region
State Trauma Registry Data – All with TBI Transferred - Mortality at Level of TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

28. Same Data Reflected Trauma Region
State Trauma Registry Data – All Patients with with TBI 2nd Transfer by Level of TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

29. Same Data Reflected Trauma Region
State Trauma Registry Data – All with TBI 2nd Transfer - Mortality at Level of TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

30. Hemorrhage
Tourniquet Application
Tracking in the Trauma Registry

31. State Trauma Registry Data – All with SCI on Arrival at TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

32. Same Data Reflected Trauma Region
State Trauma Registry Data – All with Spinal Cord Injury - Mortality at TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

33. Same Data Reflected Trauma Region
State Trauma Registry Data – All Patients with SCI Transferred by Level of TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

34. Same Data Reflected Trauma Region
State Trauma Registry Data – All with SCI Transferred - Mortality at Level of TC by ISS
TC Level
ISS 1-9
10-15
16-24
25 or Greater
Total
Level I
Level II
Level III
Level IV
Non-TC
Same Data Reflected Trauma Region

35. State Trauma Registry Request all reports Age Breakdown
Transfers – Acute Care Hospitals

36. Best Practice Guidelines
Priority Patients
ACS
TACEP
AAST
STN
ENA
Engagement
TTCF
TETAF
N. & S. Chapters of ACS
GETAC Committees

37. System Performance Improvement
Revise current State System Trauma PI Plan

38. Improve Trauma Registry Data
TTCF / TETAF
EMS
ICD.10 Training
Injury Scoring Class Access
Data submission

39. Data Management Taskforce
Data Management Taskforce Purpose
Utilize data available through the state trauma registry, EMS registry data, vital statistics, stroke data, and cardiac data available to define meaningful reports and data to assist the GETAC efforts of advancing the trauma and emergency health care system and improving outcomes.
Data Management Taskforce Chairs
Jorie Klein, RN, BNS
Data Management Taskforce Members
Selected GETAC committee will appoint a member to the taskforce with the goal of defining data needs that assists their committee in meeting the objectives assigned to their committee through the Texas Emergency Healthcare System Strategic Plan.
EMS Committee
Medical Directors Committee
Education Committee
Trauma System Committee
Pediatric Committee
Stroke Committee
Cardiac Committee
Injury Prevention Committee
Developing Perinatal Committee

40. Data Management Taskforce
Data Management Taskforce Deliverables
Define the data reports necessary to review the performance, activity and utilization with in the Texas trauma and emergency health care system.
Define the reports requested for the following GETAC committee meetings.
Identify barriers in data submission and utilization of data from the existing data bases and define workgroup solutions.
Provide recommendations to improve data validation, accuracy and timeliness of data.
Data Management Taskforce Procedures
The taskforce will conduct its business in a respectful, organized, productive manner.
Workgroup meetings are open meetings.
The date, time and location of all scheduled taskforce meetings will be posted a minimum of ten (10) days prior to the meeting on the DSHS website.
The taskforce will meet during the GETAC meetings and has the option of scheduling additional meetings or conference call to address the deliverables.
Agendas and minutes are the responsibility of the co-chairs.
Sign-in sheets will define member’s present and taskforce guest.
Minutes and activities will be reported to GETAC committee by assigned liaisons.

41. Trauma Registrar Workgroup
Irene Lopez, BSN, CSTR

42. Trauma Medical Director’s Workgroup
NAS National Trauma System Plan – Position Paper
Mission Zero Act
Defense Re-Appropriations Act
Trauma System PI Plan Templates For RACS

43. Burn Center Workgroup Brian Eastridge, MD, FACS Jeff Beeson, DO
Kevin Cunningham, EMT-P

44. Texas TQIP Collaborative
TQIP Level III
TQIP Pediatrics

45. Stop the Bleed Coalition
Trauma System Committee
Education Committee
Broad Stakeholders and Community
Statewide Stop The Bleed Coalition
Tuesdays After TTCF and Before TETAF
State Level Organizations

46. Stop the Bleeding Coalition of Texas
Aim:
Zero Preventable Death from External Hemorrhage
Mission
Train Texans to assist the prehospital and hospital teams save lives by recognizing life- threatening bleeding and take actions to stop the bleeding.

47. Stop the Bleeding Coalition of Texas
Vision
All government buildings, law enforcement agencies, school systems, and community groups will have Stop the Bleeding equipment on site with training individuals ready to respond by December 2018.

48. Palliative Care
Deferred to November

49. Liaison Reports Committee Member Stakeholder Reports
GETAC Council Region VI American College of Surgeons/Committee on Trauma (ACS/COT) (Eastridge) Texas Trauma Coordinator's Forum (R. Garza/K. Rogers) Level IV Trauma Centers (Jorie Klein) Level III Trauma Centers (Kathy Rodgers;) Level II Trauma Centers (Lori Boyett) Level I Trauma Centers (Eastridge, Gandhi) Pediatric Trauma Centers (Lori Vinson, Ian Mitchell, MD) Texas EMS/Trauma Foundation (TETAF) Trauma Division (Dinah Welch ) Emergency Medical Services (EMS) (Kevin Cunningham) Texas Hospital Association (Elizabeth Sjoberg) Emergency Nurses Association (Sally Snow)

50. Trauma System Committee
General Public Comment
May National Trauma Awareness Month
Share Your Story
Announcements
Priorities for Next Meeting
Continuing Strategic Plan –
Legislative Priorities
Trauma Centers per TSA
Trauma System Plan Revisions
Other

51. Thank You
Be An Advocate