North Central Regional Trauma Council Salina Regional Health Center

May 26, 2010 1:00pm – 4:30pm

Call to Order, Welcome and Open Remarks Emma Doherty, chairperson, called the meeting to order at 1:00pm. She “thanked” Salina Regional Health Center for hosting the meeting, welcomed Members, and asked everyone to complete their evaluation throughout the meeting. Member introductions were made. Trauma Center Care in an Organized System Dr. William Waswick presented the presentation. His presentation included information on past and present trauma systems, field triage guidelines, interfacility transfer indicators and responsibilities, and a case study presentation. Click here to view his presentation. Update on Public Health in Kansas Dr. Jason Eberhart-Phillips presented the presentation. His presentation included information on HINI, KDHE legislative activities, and other KDHE initiatives. Click here to view his presentation. Trauma System Development Rosanne Rutkowski presented the presentation. She provided an update on the Kansas Trauma System including information on past achievements, current projects and future goals. Click here to view her presentation Interpreting Trauma Registry Data Dee Vernberg provided the presentation. Her presentation provided trauma registry data for the NC region and included information on trauma registry inclusion criteria, over and under triage, and data on the receipt of EMS patient care reports. Salina Regional Health Center Level III Designation Status Rachelle Giroux, Salina Regional Health Center’s Trauma Program Coordinator, provided the update. She advised that Salina Regional Health Center has made progress in becoming a level III designated trauma center. Progress highlights:

o Medical staff and Board of Directors have endorsed the designation process

o Site visit conducted with Dr. Chris Bandy & Darlene Whitlock, Stormont Vail Hospital

o Contracted with Darlene Whitlock to assist with the designation process o General surgeons support designation process o Sheree Baker, trauma registrar, has been hired o Require trauma team nurses to be credentialed in TNCC o Trauma room equipped and ready to go

Goals

o Begin trauma activation on August 2, 2010 o Conduct ACS site visit early 2011 o Become a ATLS hub for the region

Business Meeting Reports from Subcommittees Education/Prevention Report

Education-2009 funding PHTLS Salina Fire & EMS Held class in August 2009

Smith County EMS Held class in March 2010

TNCC Clay County Hospital Held class in October 2009 Salina Regional Health Center Held class in May 2009

RTTDC Memorial Hospital-Abilene Held class in December 2009 Ellsworth County Medical Center Held class in September 2009 Smith Center Memorial Hospital Held class in August 2009 ATLS Refresher Course Provided sponsorship for the February 2010 ATLS refresher course at Mitchell County Hospital ATLS scholarships Provided 4 scholarships to: Smith County Hospital Salina Regional Health Center Mitchell County Hospital

EMD Provided scholarships to the following: Ottawa County Sheriff-provided sponsorship for 2

dispatchers to attend APCO training Osborne County Sheriff-provided sponsored for 6

dispatchers to attend APCO training

Education-2010 funding The executive committee met prior to the general membership meeting. The following Kansas Rural Health Options Project (KRHOP) and Regional Trauma Council trauma education grants were awarded: PHTLS: Ellsworth County EMS ($1,000.00 KRHOP funds) TNCC: Cloud County Health Center ($1,000.00 KRHOP funds)

Ellsworth County Hospital ($500.00 KRHOP funds, $500.00 RTC funds) Jewell County Hospital ($1,000.00 RTC funds) Republic County Hospital ($1,000.00 RTC funds)

RTTDC: Mitchell County Hospital ($1,500.00 KRHOP funds)

Prevention Fall Prevention Grants awarded to:

Clay County Medical Center North Central-Flint Hills Area on Aging

Teen Driving

Provided sponsorship to the KDOT Safe Teen Driving Program

Bylaws (action) The bylaws were mailed to all general membership members for review prior to the general membership meeting and were included in the meeting packets. The change highlighted included the addition of fiscal agent language. After discussion, Charlie Grimwood made the motion to approve the bylaws as presented. Ron Bender seconded the motion. The motion passed.

Elections (action) Due to Dr. Kris Canfield’s resignation from the executive committee, his physician seat is open. Dr. Cayle Goertzen, Republic County Hospital, was nominated for the seat. Emma opened the floor for physician nominations. No other nominations were made form the floor. Dr. Cayle Goertzen was elected to the open seat.

Election of Officers The following officer nominations were made: Chairperson: Don Lieb Vice-chairperson: Mary Gray Secretary: Emma Doherty Treasurer Dr.Cayle Goertzen, Patrick Eastes Election of Officers Voting Results After voting by ballot, the following officers were elected for 2010: Chairperson: Don Lieb Vice-chairperson: Mary Gray Secretary: Emma Doherty Treasurer Dr.Cayle Goertzen, Other discussion A suggestion was made to inquire with Dr. Jody Neff, Salina Regional Health Center, if he would consider chairing a Field Triage Guidelines subcommittee. Charlie Grimwood volunteered to follow up with him. Emma Doherty asked for volunteers for co-chair and committee members of the subcommittee. In closing Emma thanked everyone for attending and thanked Salina Regional Health Center for hosting the meeting. She reminded everyone to sign the sign-in roster and complete certificate of attendance and evaluation. Adjournment Meeting adjourned at 4:35pm.

Trauma Center Care in Trauma Center Care in an Organized Systeman Organized System

North Central Regional Trauma Council North Central Regional Trauma Council General Membership MeetingGeneral Membership Meeting

May 26, 2010May 26, 2010

William Waswick, MD, FACSWilliam Waswick, MD, FACS

ObjectivesObjectives

Review the NCRTC Trauma SystemReview the NCRTC Trauma System Review the importance of accurate field Review the importance of accurate field

triagetriage Identify patients for interfacility transfersIdentify patients for interfacility transfers Review guidelines for transferring patientsReview guidelines for transferring patients

YesterdayYesterday’’s Trauma Systems Trauma System

TodayToday’’s Trauma Systems Trauma SystemRural EMS & Hospitals

Prehospital

• First Responders

•Local EMS

•Air Medical

Hospitals

•Critical Access

•Regional Referral Centers

•Trauma Centers

The Golden HourThe Golden Hour-- In emergency medicine, the In emergency medicine, the Golden Hour Golden Hour refers to a refers to a

time period lasting from a few minutes to several time period lasting from a few minutes to several hours following traumatic injury being sustained by a hours following traumatic injury being sustained by a casualty, during which there is the highest likelihood casualty, during which there is the highest likelihood that prompt medical treatment will prevent death.that prompt medical treatment will prevent death.

Dr. R Adams Cowley Dr. R Adams Cowley –– The Father Trauma CareThe Father Trauma Care "There is a golden hour between life and death. If you "There is a golden hour between life and death. If you

are critically injured you have less than 60 minutes to are critically injured you have less than 60 minutes to survive. You might not die right then; it may be three survive. You might not die right then; it may be three days or two weeks later days or two weeks later ---- but something has but something has happened in your body that is irreparable.happened in your body that is irreparable.

The Platinum 10The Platinum 10 For critically For critically

injured patients, injured patients, initiate transport initiate transport to the closest to the closest appropriate facility appropriate facility within 10 minutes within 10 minutes of arrival on sceneof arrival on scene

10

Platinum10 minutes

Golden Period / Golden hour

Prehospital

Page 11 Source: American Customer Satisfaction Index, Oct. 4, 2008 – Jan. 31, 2009

The American College of Surgeons-Committee on Trauma (ACS-COT) developed guidelines to designate “trauma centers” in 1976 - Set standards for personnel, facilities, and processes necessary

for the best care of injured persons

Studies showed mortality reduction in regions with trauma centers

History of the Decision Scheme

Page 12 Source: American Customer Satisfaction Index, Oct. 4, 2008 – Jan. 31, 2009

CDC Field Triage Scheme

Step 3: 2006 ChangesStep 3: 2006 Changes

AddedAdded Vehicle telemetry data consistent with high risk of injuryVehicle telemetry data consistent with high risk of injury

Time OutTime Out

What is vehicle telemetry?What is vehicle telemetry? Combination of telematics and computingCombination of telematics and computing

Integration of vehicleIntegration of vehicle’’s electrical s electrical architecture, cellular communication, GPS architecture, cellular communication, GPS systems, and voice recognitionsystems, and voice recognition Can notify of exact location of crashCan notify of exact location of crash

Can enable communication with occupantsCan enable communication with occupants

Can provide key injury information to Can provide key injury information to providers regarding force, mechanics, providers regarding force, mechanics, and energy of a crash that may help and energy of a crash that may help predict severity of injurypredict severity of injury

For more information, visit:

www.cdc.gov/FieldTriage

Interfacility TransfersInterfacility Transfers

Essential part of the trauma systemEssential part of the trauma system Develop in advance of needDevelop in advance of need Communications is criticalCommunications is critical Define which patients should be Define which patients should be

transferred and the process of doing sotransferred and the process of doing so

Minimizing transfer times can equal Minimizing transfer times can equal positive outcomes for patientpositive outcomes for patient

CommunicationsCommunicationsInterfacility TransfersInterfacility Transfers

Criteria for Criteria for Consideration of TransferConsideration of Transfer

Critical Injuries to Level I or HIGHEST regional trauma centerCritical Injuries to Level I or HIGHEST regional trauma center

Carotid or vertebral arterial injuryCarotid or vertebral arterial injury Torn thoracic aorta or great vesselTorn thoracic aorta or great vessel Cardiac ruptureCardiac rupture Bilateral pulmonary contusion with PaO2 to FIO2 ration less thanBilateral pulmonary contusion with PaO2 to FIO2 ration less than 200200 Major abdominal vascular injuryMajor abdominal vascular injury Grade IV or V liver injuries requiring >6 U RBC transfusion in 6Grade IV or V liver injuries requiring >6 U RBC transfusion in 6 hourshours Fracture or dislocation with loss of distal pulsesFracture or dislocation with loss of distal pulses

Interfacility TransfersInterfacility TransfersCriteria for Criteria for

Consideration of TransferConsideration of Transfer

LifeLife--threatening injuries to Level I or Level II trauma centerthreatening injuries to Level I or Level II trauma center

Penetrating injury or open fracture of the skullPenetrating injury or open fracture of the skull Glasgow Coma Scale score <14 or lateralizing neurologic Glasgow Coma Scale score <14 or lateralizing neurologic

signssigns Spinal fracture or spinal cord deficitSpinal fracture or spinal cord deficit >2 unilateral rib fractures or bilateral rib fractures with >2 unilateral rib fractures or bilateral rib fractures with

pulmonary contusionpulmonary contusion Open long bone fractureOpen long bone fracture Significant torso injury with advanced comorbid diseaseSignificant torso injury with advanced comorbid disease

Interfacility TransfersInterfacility TransfersGuidelines for Transferring PatientsGuidelines for Transferring Patients

Transferring physician responsibilitiesTransferring physician responsibilities Identify patients needing transferIdentify patients needing transfer Initiate the transfer process by direct contact with Initiate the transfer process by direct contact with

the receiving trauma surgeonthe receiving trauma surgeon Initiate resuscitation measures within the Initiate resuscitation measures within the

capabilities of the facilitycapabilities of the facility Determine the appropriate mode of transportation Determine the appropriate mode of transportation

in consultation with the receiving surgeonin consultation with the receiving surgeon Transfer all records, test results, and radiologic Transfer all records, test results, and radiologic

evaluations to the receiving facilityevaluations to the receiving facility

Interfacility TransfersInterfacility TransfersGuidelines for Transferring PatientsGuidelines for Transferring Patients

Receiving physician responsibilitiesReceiving physician responsibilities Ensure the resources are available at the receiving Ensure the resources are available at the receiving

facilityfacility Provide consultation regarding specifics of the Provide consultation regarding specifics of the

transfer, additional evaluation, or resuscitation before transfer, additional evaluation, or resuscitation before transporttransport

Once transfer of the patient is established, clarify Once transfer of the patient is established, clarify medical controlmedical control

Identify a performance improvement and patient Identify a performance improvement and patient safety process for transportation, allowing feedback safety process for transportation, allowing feedback from the receiving trauma surgeon to the transport from the receiving trauma surgeon to the transport team directly or at least to the medical direction for team directly or at least to the medical direction for the transport the transport teamteam

Interfacility TransfersInterfacility TransfersGuidelines for Transferring PatientsGuidelines for Transferring Patients

Management during transportManagement during transport Qualified personnel and equipment should be available during Qualified personnel and equipment should be available during

transport to meet anticipated contingenciestransport to meet anticipated contingencies Sufficient supplies should accompany the patient during Sufficient supplies should accompany the patient during

transport, such as intravenous fluids, blood, and medications, atransport, such as intravenous fluids, blood, and medications, as s appropriateappropriate

Vital signs should be monitored frequentlyVital signs should be monitored frequently Vital functions should be supported, for example, ventilation, Vital functions should be supported, for example, ventilation,

hemodynamics, central nervous system, and spinal protectionhemodynamics, central nervous system, and spinal protection Records should be kept during transportRecords should be kept during transport Communication should be maintained with online medical Communication should be maintained with online medical

direction during transportdirection during transport

Interfacility TransfersInterfacility TransfersGuidelines for Transferring PatientsGuidelines for Transferring Patients

Trauma system responsibilitiesTrauma system responsibilities Ensure prompt transport once a transfer decision is madeEnsure prompt transport once a transfer decision is made Review all transfers for performance improvement and patient Review all transfers for performance improvement and patient

safetysafety Ensure transportation commensurate with the patientEnsure transportation commensurate with the patient’’s severity s severity

of injuryof injury

Interfacility TransfersInterfacility TransfersGuidelines for Transferring PatientsGuidelines for Transferring Patients

Patient information to accompany the patientPatient information to accompany the patient Patient demographicsPatient demographics Nature of injuryNature of injury--injuries indentifiedinjuries indentified Prehospital patient care reportPrehospital patient care report Summary of care provided at referring facilitySummary of care provided at referring facility Laboratory test resultsLaboratory test results Radiologic evaluationsRadiologic evaluations PatientPatient’’s response to treatments response to treatment Amount of fluids/blood infusedAmount of fluids/blood infused Chronologic record of patientChronologic record of patient’’s vital signss vital signs Medical history, current medications, allergiesMedical history, current medications, allergies

Case Study 1Case Study 1

WhatWhat’’s the trauma plan for the s the trauma plan for the North Central Regional Trauma North Central Regional Trauma

Council?Council?

Thank you!

Questions?

WhatWhat’’s the trauma plan for the s the trauma plan for the North Central Regional Trauma North Central Regional Trauma

Council?Council?

It is a work in progress---Just keep at it!!!

Public Health UpdateNorth Central Regional Trauma Council

General Membership Meeting

Jason Eberhart-Phillips, MD, MPH

Kansas State Health Officer and

Director of Health, KDHE

What is Public Health?

• Public health is the science and art of preventing disease, prolonging life and promoting health through the organized efforts of society

• Collective action for the common good

It’s Forward-Looking• It is about changing

the conditions at the root of most diseases

• Public health aims to create environments where all people can enjoy optimal health– Physical environments

– Social environments

• ‘Upstream’ thinking

Factors That Affect Health

2009 Swine-Origin Influenza

• A new pandemic flu virus– Derived by re-assortment

between two pre-existing swine influenza viruses

– North American swine H1N2 virus and Eurasian H1N1 swine lineage virus

– Not clear if the novel virus first appeared in humans or in pigs, or where it emerged

A World Caught by Surprise

• First detected in Mexico in April, as first confirmed cases were identified in California and Texas– May have been circulating

as early as late 2008

• First cases away from the border detected in KS– Man who returned from

Mexico and infected wife

Situation Update

• Activity is low in Kansas and nationwide– No new confirmed cases

since mid-April in Kansas

• 2009 H1N1 still detected throughout the world– B strains now dominant in

Europe and East Asia

– Southern Hemisphere is just entering its flu season

The ‘Third Wave’ Never Came

The Toll of H1N1 Flu

• By mid-March in the US– 60 million cases

– 270,000 hospitalizations

– >12,000 deaths

• A far smaller impact than we had first feared– 100 times less deadly

than the 1918 virus

– But 5 times more lethal than seasonal flu to <65

Breaking Down the Numbers

Why Were Older Folks Spared?• As we suspected…

– Previous exposure to the descendents of the 1918 virus induced antibodies

– These have cross-reacted with the 2009 virus

• Polysaccharides blocking the target site began to appear in the 1940s– These sugars are absent

from the 2009 virus!

The Largest Response Ever

• Surveillance– Lab, hospital, ILI sites

– Rapid expansion in KS

• Public Information– Social distancing

– Guidance to schools, businesses, physicians

– Constant messaging on hand washing, cough etiquette, staying home

Unprecedented Vaccine Drop

• Nearly 900,000 doses delivered to every KS community in ~90 days– More than 655,000 doses

now documented as given

– Includes 68,000 2nd doses

– >1000 private providers in every county in Kansas

• Local health departments in the lead in each county

Early Survey Results

• With reports back from 102 of 105 counties:– 99 conducted mass public vaccine clinics

– In total, 1276 clinics were held in Kansas

– In total, 306568 doses were distributed via these clinics (>50 percent of all doses given)

– Sites included schools, churches, shopping centers, meeting halls

– 81 conducted school-based clinics for students

– In total, 986 school-based clinics were held

– 61 said that >20% of pupils vaccinated this way

A Monumental Effort

• Just looking at the LHD responses (N=102)– More than 3,000 people

participated in the local KS pandemic response

– This included• Nearly 1900 community

volunteers (MRC, others)

• >500 nurses

• >300 admin support staff

• >300 epis, lab, planners

Kansas Vaccine Uptake

Vaccine Coverage• Through January, 2010

– KS coverage exceeded the US: 27.5% vs 23.9%

– Better than average for• Persons 6m to 17y: 39.4%

• Persons >18y: 21.0%

• Initial target groups: 34.5%

• 25-64y not targeted: 16.0%

• Persons >65y: 26.2%

– Worse than average for• 25-64y at high risk: 18.9%

Vaccine Issues

• Overall, a remarkable feat given time frame– But predictions of supply

were overly optimistic

– Up to 160 million doses expected by October 31

– In reality, just 30 million

– Used poorest producing vaccine strain ever

– 0.2 to 0.6 doses/egg

Vaccine Safety

• Public concerns grew as disease incidence fell

• In reality, the vaccine was as safe as predicted

• Monitored very carefully– Clinical trials (N > 15,000)

– 10 different post-marketing surveillance systems used to measure pre-specified diagnoses, compare rates

KDHE Evaluation

• A formal after-action process, now underway– Surveys and interviews

with key partners

– Includes hospitals, ILI providers, local health departments, emergency managers, news media

– Contractor preparing report; will disseminate

This Time We Were Lucky

• We’ve had the mildest pandemic strain ever– So far the viral genome

lacks key markers that are linked to virulence

– Antiviral resistance has been rare so far

– The viral genome has been relatively stable, and a good match for the vaccine

What’s Next?

• Our message is clear– H1N1 is here to stay

– Rebound likely in the fall

– Everyone should get the 2010-11 vaccine

– New: Fluzone high-dose

– H1N1 vaccination can be beneficial even now

– This virus may still send us many more surprises

A Stellar Year in Legislature

• Despite the gloom and doom of the poor economy

• Remarkable success in achieving key public health wins– Tobacco

– Childhood obesity

– Motor vehicle injuries

Statewide Clean Indoor Act

• Kansas is now the 40th

state protecting non-smokers from ETS in nearly all public places– Implementation is now

underway for July 1

– Educating businesses, clubs and other venues

– KsSmokeFree.Org has all the details

Primary Seat Belt Law• HB 2130 – one of the

last bills enacted before the legislature adjourned

• Permits enforcement of state’s seat belt laws as a primary offence– Adults only, front seat

– Fine only $5 as of 7/2010

– >$10 M one-time federal incentive helped passage

Texting Ban

• H Sub for SB 300– Bans use of devices

for writing or reading written communication while operating vehicle

– A few exceptions OK

– Talking on phone OK

– Warning citations only until January, 2011

– Fine will then be $60

Tuberculosis and HIV• SB 62 implements new

standard TB screening process in all post-secondary educational institutions in Kansas

• Also implements an “opt out” process for universal screening of pregnant women for HIV infection

Infant Mortality• SB 488: Authorizes

research on causes of infant mortality using birth certificates– Recommended by the

Blue Ribbon Panel

• Also allows criminal background checks – For KDHE staff with

access to sensitive birth and death data

A Revolution in Child Care• HB 2356 requires every

child care facility in the state to be inspected for health and safety on an annual basis– Also sets new standards

for child supervision

– Creates an on-line data system for parents

– Funded by a new fee on child care providers

Junk Food in Schools

• SB 499 would set high standards for healthy foods in public school vending machines– Was heard in Senate

Education Committee

– Adopted nearly in full by the state board of education, to take effect statewide in Aug 2010

Menu Labeling

• SB 505 received an ‘informational hearing’– Heard by the Senate

Public Health and Welfare Committee

• Similar requirements were included in the national health care reform legislation – Will take effect in 2012

throughout the USA

Radon Certification

• SB 531 establishes a certification program for radon gas contractors – Ensures that those who

measure radon gas and provide remediation meet professional standards

– Requires completion of specified training, exams

– New standards for labs

Lead Paint

• HB 2596 would have limited regulations for contractors who repair or renovate houses built before 1978– Compromise was

achieved, resulting in modifications to the regulations, so that the bill did not go forward

– Public safety protected

What Didn’t We Get?• Tobacco tax

– Nearly 3,000 KS kids become addicted to smoking each year

– Each 10% hike in price reduces the youth smoking rate by 6-7%

– Greatest deterrent among poor

• Sugar-sweetened beverage tax– Single largest driver of obesity

– Would have allowed the state to recover costs imposed by industry

Thank You For Listening!

To Protect the Health and Environment of all Kansans To Protect the Health and Environment of all Kansans by Promoting Responsible Choicesby Promoting Responsible Choices

www.kdheks.gov

Our Vision - Healthy Kansans living in safe and sustainable environments

NC Regional Trauma Council General Membership Meeting

Our Vision - Healthy Kansans living in safe and sustainable environments

2010 State Update

Rosanne Rutkowski, RN, MPHKansas Trauma Program Directorrrutkowski@kdheks.gov785-296-1210

Our Vision - Healthy Kansans living in safe and sustainable environments

Welcome & Thank You!

Update on State Priority projects Level IV

Federal Trauma Care & Health Care Reform

Regional Education Regional Trauma Plan

Our Vision - Healthy Kansans living in safe and sustainable environments

Progress continues to be made!Size of Kansas Trauma Registry:Patients Arrival Dates by Quarter

0

5000

10000

15000

20000

25000

30000

35000

1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th

Nu

mb

er o

f R

eco

rds

2001 2002 2003 2004 2005

Our Vision - Healthy Kansans living in safe and sustainable environments

Goals of the Kansas Trauma System

Reduce the number of preventable deaths Improve outcomes for traumatic injuries Encourage provider preparation and response to

trauma Reduce medical costs through appropriate use of

resources Increase public awareness & prevention Design an inclusive and comprehensive system Develop trauma education resources

Kansas Trauma Plan 2001

Our Vision - Healthy Kansans living in safe and sustainable environments

State Trauma Program: Infrastructure

KDHE: Lead Agency Regional Trauma Councils Advisory Committee on Trauma Trauma Registry Trauma Center designation

Advisory Committee on Trauma Appointed by the Governor's office

Regional Trauma Councils Hospitals- administrators, physicians, nurses EMS Public Health Departments

Our Vision - Healthy Kansans living in safe and sustainable environments

State Projects: 2009

Level III trauma center grants Developed Level IV criteria Updated Regional Trauma Plans Updated Data Benchmark Report 2009 Annual Report & newsletter 1st State EMS Medical Director’s Conf. Listserv and Report Writer Training

Our Vision - Healthy Kansans living in safe and sustainable environments

Our Vision - Healthy Kansans living in safe and sustainable environments Our Vision - Healthy Kansans living in safe and sustainable environments

State Designated Trauma Centers:

Level I Trauma Centers University of Kansas Hospital Via Christi- St. Francis Wesley Medical Center

Level II Trauma Centers Overland Park Regional Medical Center Stormont Vail Regional Health Center

Level III Trauma Centers Labette Health Via Christi- Pittsburg

Our Vision - Healthy Kansans living in safe and sustainable environments Our Vision - Healthy Kansans living in safe and sustainable environments

State Projects 2010

Update the BIS assessment Update regulations to include Level IV

trauma center Cont. Level III trauma center grants Update state trauma registry system On-line training

Develop interface EMS/trauma Data Awarded CDC Funding for field triage

Our Vision - Healthy Kansans living in safe and sustainable environments

Proposed Level IV criteria:

Trauma Team Education requirements Physician- ATLS ER Nurse- TNCC

Trauma Team Activation Plan On call schedule Equipment for resuscitation Quality improvement program Transfer protocol

Our Vision - Healthy Kansans living in safe and sustainable environments

Level IV Trauma Center Criteria

Our Vision - Healthy Kansans living in safe and sustainable environments

Special Projects & Federal Update

EMS/trauma interface CDC Field Triage Guidelines Health Care Reform

Our Vision - Healthy Kansans living in safe and sustainable environments

Trauma/EMS Interface

Board of EMS & KTP awarded a grant from KDOT to support interface

6-8 months completion EMS Data will be downloaded into the

trauma registry 2 data elements will be provided back

to EMS

Our Vision - Healthy Kansans living in safe and sustainable environments

Trauma/EMS Data Interface

Our Vision - Healthy Kansans living in safe and sustainable environments

CDC Field Triage Implementation Project

Awarded funding from CDC Kansas, Massachusetts, Michigan

Goal: Pilot Field Triage Guidelines in state/region

Leadership team to Atlanta SE Regional Trauma Region will serve

as pilot area

Our Vision - Healthy Kansans living in safe and sustainable environments Our Vision - Healthy Kansans living in safe and sustainable environments

Field Triage Decision

Scheme: The National

Trauma Triage Protocol

Our Vision - Healthy Kansans living in safe and sustainable environments Our Vision - Healthy Kansans living in safe and sustainable environments

Transport Times to Level I/II Trauma Center

A=30G=90

A=27G=115

A=32G=115

A=34G=115

A=35G=100

A=27G=70

A=19G=65

A=14G=42

A=24G=70

A=9G=30

A=12G=40

A=29G=95

Our Vision - Healthy Kansans living in safe and sustainable environments

Federal: Health Care Reform

Our Vision - Healthy Kansans living in safe and sustainable environments

Health Care Reform

Emergency & Trauma Care Systems Support regionalized, coordinated and

accountable emergency care Funds appropriated FY11 for research in

emergency medicine & regionalized emergency care systems

Mandate & fund integrated trauma system development Establishes new trauma center program to

strengthen ED & trauma center capacity

Our Vision - Healthy Kansans living in safe and sustainable environments

Regional Projects

Education Funding

Our Vision - Healthy Kansans living in safe and sustainable environments

Training & Education:

Establish min. standards for trauma care Prehospital PHTLS

Nurses TNCC

Physicians ATLS

Hospitals Rural Trauma Team Development (RTTDC)

Our Vision - Healthy Kansans living in safe and sustainable environments

Trauma Education Needs Survey

Trauma Education Funding Sources: Kansas Rural Health Options Project (KRHOP) Regional Trauma Councils Christopher & Dana Reeves Foundation Grant-

applied for

KRHOP Funds: RTTDC, ATLS, PHTLS, TNCC $1,500 RTTDC $1,000 PHTLS $1,500 TNCC $1,000 ATLS scholarships ( 20)

Outcome?

Our Vision - Healthy Kansans living in safe and sustainable environments

PHTLS TNCC RTTDC ATLSSC 35 22 41 5

SE 20 36 14 2

SW 39 25 13 3

NE 32 43 38 16

NC 25 14 62 12

NW 18 45 0 16

RTC- Trauma Education 2009

Our Vision - Healthy Kansans living in safe and sustainable environments

Response Totals by Region

Region

# of EMS Services*

Response Rate

% of All Respond‐ingTotal Respond‐ing

NC 17 17 100.0% 10.6%

NE 41 38 92.7% 23.8%

NW 20 19 95.0% 11.9%

SC 49 48 98.0% 30.0%

SE 20 19 95.0% 11.9%

SW 20 19 95.0% 11.9%

Total 167 160 95.8% 100.0%

Response Totals by Region

Region

# of Hospitals

Response Rate

% of All Respond‐ingTotal* Respond‐ing

NC 13 13 100.0% 10.2%

NE 33 33 100.0% 26.0%

NW 18 18 100.0% 14.2%

SC 31 31 100.0% 24.4%

SE 14 14 100.0% 11.0%

SW 18 18 100.0% 14.2%

Total 127 127 100.0% 100.0%

*Represents all Critical Access Hospitals, and acute care facilities providing trauma services.

EMS/Hospital Survey Response

Our Vision - Healthy Kansans living in safe and sustainable environments

# Needing ATLS Training

51

188

48 37 49

127

0

50

100

150

200

250

300

NC NE NW SC SE SW

% Needing ATLS Training

63.0%54.5%

63.2%

41.6%

60.5%50.2%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

NC NE NW SC SE SW

Need for ATLS

MD, PA, ARNP providing ED coverage as primary care provider: Total Number 81# w/ ATLS:30, #needing ATLS:51 ( 63% need ATLS)

Our Vision - Healthy Kansans living in safe and sustainable environments

ATLS Requirement NC

13 Hospitals: NC

69%31%

YES:4 NO: 9

Our Vision - Healthy Kansans living in safe and sustainable environments

# Needing TNCC Training

91 83

166136

65

297

0

50

100

150

200

250

300

NC NE NW SC SE SW

% Needing TNCC Training

32.3%48.7%

28.6%34.9%31.7%

45.0%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

NC NE NW SC SE SW

Need for TNCC

RN, LPN providing care in ED, Total 202# w/ TNCC:111, # needing: 91 ( 45% need TNCC)

Our Vision - Healthy Kansans living in safe and sustainable environments

TNCC Requirement: NC

13 Hospitals:NC

62%38%

YES: 8 NO: 5

Our Vision - Healthy Kansans living in safe and sustainable environments

# Needing PHTLS Training

1146

294192

784

308303

0

200400

600800

10001200

1400

NC NE NW SC SE SW

% Needing PHTLS Training

80.8% 77.4%

60.3% 61.5%51.8%70.0%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

NC NE NW SC SE SW

PHTLS Results

Attendants( 1st responders, EMTs, Paramedics) providing care in your service Total:375# needing PHTLS:303, # w/ PHTLS;72 ( 81% need PHTLS)

Our Vision - Healthy Kansans living in safe and sustainable environments

Regional Trauma Council Funding2009

54%

26%

1%15%

4%

0%

Education: Prevention: Meetings: PI: Administration EMD

Our Vision - Healthy Kansans living in safe and sustainable environments

NC Regional Trauma Council 2009

Education: 52%

Prevention: 22%

Meetings: 2%

Admin: 18%

EMD:6%

Education: $14,470 Prevention: $6,072 Meetings: $585Administrative: $5,000 EMD: $1,742

Our Vision - Healthy Kansans living in safe and sustainable environments

NC RTC Budget: 2010

Education: $9,200Admin. : $5,000Prevention: $3,000Meetings: $1,050PI: $1,750

Total: $20,000

Our Vision - Healthy Kansans living in safe and sustainable environments

Regional Trauma Plans

Regional Plans Reviewed & Updated:2005, 2007, 2009

2009 Recommendations Tailor & adopt CDC field triage guidelines Support trauma education assessment Injury prevention based on trauma data Identify a legislative liaison in ea. region Include executive summary in future

plans

Our Vision - Healthy Kansans living in safe and sustainable environments

Regional Trauma Councils

Cornerstone of the state system An opportunity for input into the state system Opportunity to become involved at regional level Responsible for assessing regional resources Responsible for identifying educational needs and

then providing education Responsible for community prevention efforts

Our Vision - Healthy Kansans living in safe and sustainable environments

Advisory Committee on Trauma 24 member committee

6 members RTC representatives

4 Legislative representatives

Nominated by organization Appointed by the Governor Represent urban & rural Advise KDHE on state’s

trauma system Meet at least 4 x year

Our Vision - Healthy Kansans living in safe and sustainable environments

Kansas Trauma Program

Web site: www.kstrauma.org ACT Regional Trauma Council Education Regulations Publications Contact information Newsletter

Our Vision - Healthy Kansans living in safe and sustainable environments

Kansas Trauma Program StaffRosanne Rutkowski, RN, MPHProgram Director

Dan Robinson, MBAAssistant Program Coordinator

Dee Vernberg, PhD, MPHTrauma Epidemiologist

Jeanette ShipleyRegional Trauma Coordinator

Dan RussellDatabase Administrator

Our Vision - Healthy Kansans living in safe and sustainable environments

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