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Building Kentuckys Trauma System

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Title: Building Kentuckys Trauma System


1
Building Kentuckys Trauma System
  • Julia F. Costich, J.D., Director
  • Kentucky Injury Prevention and Research Center

2
Definitions
  • Trauma patient Seriously injured person at high
    risk for death or disability in the absence of
    timely diagnosis and treatment by a team of
    professionals supported by specialized resources
  • Trauma center Hospital designated (verified)
    by the American College of Surgeons that has
    surgeons and other specialists committed to
    treating trauma patients

3
Trauma system
  • Organized, coordinated effort
  • in a defined geographic area
  • that delivers the full range of services
  • to all trauma patients
  • and is integrated with the public health system
    for injury prevention and surveillance
  • Benefits
  • Increase survival of seriously injured
  • Reduce burden of trauma-related death and
    disability
  • Improve efficiency of system components

4
Example of system goals (MD)
  • Monitor the states population-based occurrence
    of injury
  • Assure integration and coordination of trauma
    system through effective partnerships
  • Assure secure and adequate financing
  • Monitor and track patient outcomes including
    death and disability as well as system
    performance
  • Coordinate emergency and disaster preparedness
    with responsible state agencies

5
Fundamental components
  • Injury prevention and surveillance
  • Community-based and within system
  • Pre-hospital care
  • Scene, EMS, emergency department
  • Acute care
  • Post-hospital care
  • Outpatient follow-up, rehabilitation, secondary
    prevention

6
Barriers to trauma system
  • Competition among providers (EMS, hospitals)
  • High cost of resources (surgeons, other hospital
    staff, imaging and other equipment)
  • High proportion of patients with low-paying (or
    no) coverage
  • Maldistribution of resources in relation to risk
    of injury (particularly rural areas)
  • Inadequate attention to and funding for injury
    prevention and surveillance

7
Trauma Center Verification Levels
  • I Tertiary care center with leadership role in
    system development, care, education and research.
    UK, UL
  • II Definitive care center, principal community
    hospital. None in Kentucky
  • III Commitment to general trauma care,
    stabilizes major trauma patient for transfer, in
    community lacking Level I or II center. Russell
    County Hospital
  • IV Initial care provider, stabilizes for
    transfer. None in Kentucky

8
Trauma system development funding in Kentucky
  • HRSA funding for plan development 1994
  • Withdrawn in 1996
  • State trauma plan never enacted
  • Recurrent small (45K) grants in 2001,
  • 2002-2005, 2006-?
  • Entire program terminates in current version of
    2007 federal budget
  • Issue how to fund trauma registry?

9
Special problems in rural state
  • Distance to definitive care
  • Road conditions
  • Lack of education
  • Higher prevalence of poverty
  • Lower quality of vehicles and safety devices
  • Lower rate of seat belt use
  • HIGHER RATE OF INJURY IN A CRASH

10
Impact of trauma in Kentucky
  • Unintentional injury is the leading cause of
    death for Kentuckians aged 1-34
  • Motor vehicle crashes (57), falls (14) and
    suicides (9) are the three leading causes of
    major trauma in Kentucky

11
CINCINNATI
TRAUMA CENTERS SERVING KENTUCKY
HUNTINGTON
TC
TC
TC
KNOXVILLE
VANDERBILT
12
The Golden Hour
Early trauma deaths can be impacted by rapid
evaluation and resuscitation
13
Motor Vehicle Crash Fatality Rate,
1998-2002 Source Kentucky Transportation Center
Crash Analysis, Table 7
Fatalities per 100 million miles traveled state
mean1.6
1.0 and under
1.0-1.5
1.6-2.5
Campbell
Boone
Kenton
Over 2.5
Gallatin
Bracken
Pendleton
Carrll
Grant
Mason
Trimble
Owen
Greenup
Robertson
Lewis
Henry
Harrison
Oldham
Fleming
Nicholas
Boyd
Carter
Scott
Franklin
Jefferson
Rowan
Shelby
Bourbon
Bath
Elliott
Lawrence
Fayette
Woodford
Montgomery
Spencer
Anderson
Bullitt
Meade
Menifee
Clark
Jessamine
Morgan
Johnson
Powell
Mercer
Hancock
Nelson
Martin
Breckinridge
Henderson
Madison
Daviess
Estill
Magoffin
Wolfe
Washington
Hardin
Garrard
Boyle
Union
Lee
Larue
Webster
Mclean
Marion
Breathitt
Floyd
Lincoln
Jackson
Ohio
Pike
Grayson
Owsley
Rockcastle
Crittenden
Taylor
Knott
Casey
Hart
Hopkins
Perry
Edmonson
Green
Muhlenberg
Clay
Livingston
Caldwell
Laurel
Pulaski
Leslie
Letcher
Adair
Ballard
Mccracken
Metcalfe
Lyon
Russell
Barren
Warren
Carlisle
Marshall
Christian
Knox
Harlan
Logan
Cumberland
Todd
Trigg
Wayne
Simpson
Allen
Graves
Bell
Whitley
Clinton
Hickman
Mccreary
Monroe
Calloway
Fulton
Prepared by Julia F. Costich, Kentucky Injury
Prevention Research Center

14
Trauma system assessment benchmarks (HRSA 2006)
  • Thorough description of the jurisdictions injury
    epidemiology
  • N.b. unintentional injury is leading cause of
    death in Kentuckians ages 1-34
  • Established trauma management information system
    for surveillance and system performance assessment

15
Trauma system assessment benchmarks (HRSA 2006)
  • System resource assessment completed and
    regularly updated
  • Emergency preparedness assessment completed and
    coordinated with emer-gency management agency,
    PH, EMS
  • System assesses and monitors its value,
    cost-benefit, societal investment

16
Policy benchmarks
  • Comprehensive state statutory authority and
    administrative rules for trauma system
    infrastructure, planning, oversight, and future
    development.
  • Collaborative evaluation including governmental,
    medical, professional, citizen organizations.

17
Policy benchmarks (HRSA 2006)
  • Comprehensive written trauma system plan
  • Developed in collaboration with community
    partners and stakeholders
  • Integrates trauma system with EMS, public health,
    emergency preparedness, and incident management.
  • Trauma, public health, emergency preparedness
    systems closely linked

18
Policy benchmarks
  • Sufficient resources, including those both
    financial and infrastructure related, support
    system planning, implementation, and maintenance
  • Data collected and used to evaluate system
    performance and develop public policy

19
Policy benchmarks
  • Lead agency informs state, regional, local
    constituencies and policy makers to foster
    cooperation for system enhancement and injury
    control
  • Nature and identification of lead agency critical
    to entire development process

20
Assurance benchmarks (HRSA 2006)
  • Management information system for ongoing
    assessment of performance, including cost-benefit
  • Support of EMS system including
  • communications,
  • medical oversight,
  • prehospital triage,
  • transportation
  • well-integrated trauma system, EMS system, public
    health agency

21
Assurance benchmarks
  • Efficient, inclusive acute care network
  • Lead agency monitors system performance and
    prevention effectiveness in cooperation with
    other stakeholders
  • Lead agency
  • ensures that trauma system plan is integrated
    with and
  • complements comprehensive mass casualty plan for
    both natural and manmade incidents (all hazards
    approach)

22
Assurance benchmarks
  • Lead agency ensures that trauma system
    demonstrates prevention and medical outreach
    activities within its defined service area
  • Each hospital works to improve trauma care as
    measured by patient outcomes to maintain its
    state, regional, or local designation.

23
Assurance benchmarks
  • Lead agency ensures adequate rehabilitation
    facilities have been integrated into trauma
    system and made available to all populations
    requiring them
  • Financial aspects integrated into overall
    performance improvement system for fine-tuning
    and cost-effectiveness

24
Assurance benchmarks
  • Lead agency ensures competent workforce
  • Lead agency protects public welfare by enforcing
    relevant laws, rules, regulations
  • Assumes lead agency has enforcement powers!

25
Stakeholder conferences
  • November 11-13, 2001
  • June 25-26, 2003
  • June 23, 2004
  • January 23-24, 2005
  • March 7-8, 2006

26
KENTUCKY
KENTUCKY EMSC FUNDED CONTINUOUSLY SINCE
1996 EDUCATION PARTNERSHIP
27
Definitive care pediatric facilities
  • All emergency departments should be capable of
    providing stabilization to injured children
  • Trained staff
  • Pediatric equipment
  • Separate area
  • Family-centered support
  • Communication linkages
  • Transport agreements

28
SWOT analysis strengths
  • Good coverage for air medical scene response
  • Quality and commitment of EMS, RNs, MDs
  • De facto trauma system in urban areas
  • KIPRC resources for data analysis

29
SWOT analysis weaknesses
  • Missing EMS, Emergency Department data
  • Poor understanding of trauma system by state
    residents (survey)
  • Lack of funding for true system development
  • HRSA funding ceases in 2007
  • MDs increasingly unwilling to care for trauma
    patients and take ED call (particularly surgeons)
  • Low socioeconomic status of much of state

30
SWOT analysis opportunities
  • KBEMS
  • Building on infrastructure for disaster
    preparedness and response
  • Potential for regionalization of services
  • Statewide initiative to build epidemiological
    capacity

31
SWOT analysis threats
  • Shortages of all health care providers in rural
    areas
  • Mid-size hospitals lack resources for trauma
    care, verification
  • Reimbursement, professional liability
  • County political boundaries for EMS coverage
  • Discoverability of quality assurance materials in
    litigation

32
Kentucky Hosp. Assn Survey
  • ED Physician Certification
  • 74 ACLS, 37 ATLS, 46 PALS
  • 46 require board certification or eligibility
  • Major Problems with Trauma Care
  • 64 cited lack of specialists
  • 36 cited delays in transport to other facilities
    due to terrain or weather
  • 31 cited lack of knowledge of doctors, nurses
    and EMS for trauma care
  • 15 cited uncompensated care

33
Support for Kentucky trauma care
  • Representative sample of 800 Kentuckians surveyed
    by phone in 2005 (117 counties)
  • Over 78 stated unequivocal support for trauma
    care funding
  • Four of five respondents supported assessments on
    traffic fines
  • Four of five respondents supported trauma system
    legislation
  • Complete report in December 2005 KMA Journal

34
Funding options for trauma care
  • Motor vehicle fees and fines (DUI, speeding)
  • Auto insurance or registration surcharge (not as
    popular)
  • Cigarette tax
  • Lottery revenues

35
Why funding is needed
  • Health professional education
  • Assist facilities with cost of achieving
    verification status
  • Injury prevention initiatives
  • State trauma coordinator
  • Maintenance of trauma registry and related
    research
  • Support for unfunded care and transfers
  • Continued support for stakeholder meetings

36
Next steps
  • Implementing legislation
  • Including dedicated funding source
  • Assistance to facilities for voluntary
    participation
  • Estimated 40-60,000 for initial status plus
    ongoing costs
  • Serious need for broader accessibility
  • Consensus on triage protocols, EMS coordination,
    resource allocation
  • Very difficult in all states that have addressed
    issues

37
Discussion topics
  • Missing elements
  • Prioritization and sequencing
  • Identification of lead agency
  • Obstacles/challenges
  • Communicating with policymakers to develop
    successful legislative initiative

38
(No Transcript)
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