1. State of Texas: American College of Surgeons Trauma Systems Consultation Site Visit Team Christoph Kaufmann, MD, MPH, FACS (Team Leader) Jane Ball, RN, DrPH Alasdair Conn, MD, FACS Ted Delbridge, MD, FACEP Rajan Gupta, MD, FACS Gerry Pratsch, RN, MPH Drexdal Pratt, CEM Nels Sanddal, MS, REMT-B Jolene Whitney, MPA Holly Michaels, ACS Staff

2. State of Texas: American College of Surgeons Trauma Systems Consultation Site Visit Team Christoph Kaufmann, MD, MPH, FACS (Team Leader) Jane Ball, RN, DrPH Alasdair Conn, MD, FACS Ted Delbridge, MD, FACEP Rajan Gupta, MD, FACS Gerry Pratsch, RN, MPH Drexdal Pratt, CEM Nels Sanddal, MS, REMT-B Jolene Whitney, MPA Holly Michaels, ACS Staff

3. Consultative, not verification Multi-disciplinary structure Independently derived recommendations Consensus-based process Basis = Inclusive and integrated trauma system Basis = best interests of the patient American College of Surgeons COMMITTEE ON TRAUMA Consultation Program for Trauma Systems American College of Surgeons COMMITTEE ON TRAUMA Consultation Program for Trauma Systems

4. ACS Consultation Objective:  To help promote a sustainable effort in the graduated development of an inclusive and integrated trauma system for Texas Mission / Objectives

5. Texas

6. “Texas: It’s Like a Whole Other Country”

7. Lone Star State 268,601 square miles; 80% rural Population – 25 million 35% growth 1990-2005; 12.7% 2000-2006 Largest rural population in the U.S. (3.6 million) 6% of state public health and EMS monies spent on undocumented persons 32 trauma deaths every day in Texas Texas

8. Fatalities per 100 Million Vehicle Miles

9. Current Status 249 designated trauma facilities 15 Level I trauma centers, 9 Level II, 42 Level III, and 183 Level IV 22 RACs Huge geographic area to cover

13. Advantages & Assets Enabling legislation Longstanding RAC structure Trauma center verification process/criteria Multiple funding sources  red light camera, tobacco endowment, 911 surcharge, DUI/DWI convictions, state traffic fines, driver responsibility Support by lead Level III facilities Some of the best trauma centers in the world Care provider expertise Liability protection for all health care personnel

14. Advantages & Assets Strong confidentiality statute Early consideration of integrated emergency care system Disaster planning and response capability is outstanding GETAC advisory at gubernatorial level Dedicated injury epidemiologist Recognized need for a trauma data system Strong academic centers Capable and invested State and RAC staff

15. Challenges and Vulnerabilities: Exclusive system design No statewide trauma registry data or EMS data No trauma system performance improvement Funding never secure Poor communication about patient flow and care between RACs Inadequate system research Rising proportion of uninsured and undocumented persons EMS not an essential service Some areas not covered by EMS

16. Opportunities for Change: Timing is right for system change and to develop and implement a more inclusive and integrated trauma system throughout the state Embrace the concept of the inclusive and integrated trauma system Educate the legislature and the public about trauma, a public health crisis The legislature has asked for a report regarding the status of trauma care in Texas Health care reform may offer opportunities Extremely committed stakeholders at all levels

17. Key Recommendations “get a plan” get a registry (or two) get data get people get system PI get (more) money

18. Key Recommendations - Plan Update the Strategic Plan for the Texas EMS/Trauma System and formally revisit it on a scheduled basis, e.g. every 3 years.

19. Key Recommendations - Data Comply with the Texas Code 773.113 regarding the development of a statewide trauma reporting and analysis system. Continue to actively pursue the purchase, installation and roll-out of a trauma registry (NTDS compliant) and an EMS information system (NEMSIS compliant). Commit necessary resources to ensure development and maintenance of a reliable statewide EMS information system.

20. Key Recommendations - Data Coordinate meetings between the state Office of EMS and Trauma, the Regional Advisory Committees, and the state Office of Prevention and Preparedness injury epidemiologist to evaluate and explore existing datasets to generate trauma data and to describe the patterns of injury in the state.

21. Key Recommendations - Personnel Re-establish the position and hire a full-time trauma system program manager. Designate a state EMS medical director through an appointment or contractual relationship. The state EMS medical director role should be to advise DSHS staff, provide strategic direction, and serve as a resource for regional and local EMS medical directors and system administrators in the State. Establish a state trauma medical director position or consultant and clearly define this individual’s role.

22. Key Recommendations - PI Develop a statewide trauma system performance improvement plan and implement it. Require all RACs to complete a regional assessment with a facilitator using the same set of indicators selected by the state from the HRSA Model Trauma System Planning and Evaluation document. Establish minimum state performance improvement audit filters to adequately evaluate the trauma process and outcomes statewide, including filters for special populations (pediatric, burns, SCI, TBI, geriatric). Collate RAC information to identify instances of failed or delayed interfacility transfer for all trauma patients with an emphasis on special populations (pediatric, burns, SCI, TBI, geriatric)

23. Key Recommendation - Funding Develop a vision and strategy to identify and capitalize on all available revenue resources to support, enhance, and sustain the trauma system.

24. Focus Questions

25. 1. Houston-Galveston capacity 2. Improve: 1.care for special populations 2.rehabilitation 3.injury prevention 4.system evaluation 3. Performance improvement 4. Trauma registry

26. Site Visit Team – Closing Comments Christoph Kaufmann, MD, MPH, FACS (Team Leader) Jane Ball, RN, DrPH Alasdair Conn, MD, FACS Ted Delbridge, MD, FACEP Rajan Gupta, MD, FACS Gerry Pratsch, RN, MPH Drexdal Pratt, CEM Nels Sanddal, MS, REMT-B Jolene Whitney, MPA Holly Michaels, ACS Staff

27. Thank You ! American College of Surgeons COMMITTEE ON TRAUMA Consultation Program for Trauma Systems American College of Surgeons COMMITTEE ON TRAUMA Consultation Program for Trauma Systems