South East Regional Trauma Coordinating Committee Report

1
South East Regional Trauma Coordinating Committee
Report

• Raul Coimbra, MD, PhD, FACS
• The Monroe E. Trout Professor of Surgery
• Chief, Division of Trauma, Surgical Critical
  Care, and Burns
• University of California San Diego School of
  Medicine

2
Region 5 Interim Regional Trauma Coordinating
Committee
Planning Members Kathi Ayers, RN. MSN, Trauma
Program Manager, Sharp San Diego Bruce Barton,
Agency Director, Riverside EMS Raul Coimbra,
Chief Division of Trauma/Burns UCSD Medical
Center (Lead) Brent Eastman, Chief Medical
Officer Scripps Health Les Gardina, QA Specialist
San Diego EMS Chris Van Gorder, President and CEO
Scripps Health Virginia Hastings, Executive
Director, Inland Counties EMS Agency Dorothy
Kelley, Trauma Services Director Scripps Mercy
Hospital Ryan Kelley, Agency Director, Imperial
County Cynthia Marlin-Stoll, Riverside County
Department of Public Health Sue Cox, Director of
Trauma Services, Radys Childrens
Hospital Sharon Pacyna, RN, MPH, Trauma Program
Manager, UCSD Facilitators Bonnie Sinz, Chief
EMS Systems Division EMSA Johnathan Jones, State
Trauma Coordinator, EMSA
3
Structure

• Steering Committee
• Triage Subcommittee
• Performance Improvement Subcommittee
• Repatriation Subcommittee
• Funding Subcommittee

4
Achievements

• Monthly Conference Calls
• Steering Committee
• Two Regional Summit Meetings
• Temecula, January 2009
• Palm Springs, June 2009
• Loma Linda planned for February 2010

5
Regional Representation

• All Trauma Centers (Level I, II, IV, Pediatric)
• 4 LEMSAs
• Pre-hospital Agencies (Ground and Aeromedical)
• Fire Agencies
• State of California Department of Corrections and
  Rehabilitation
• CHP
• Hospital Associations
• Registrars

6
Triage

• TAKE TO A TRAUMA CENTER
• PHYSIOLOGY
• GCS lt 14
• SBP lt 90
• RR lt10 gt30

STEP1

• Special Age Consideration
• gt70 y/o SBP lt100
• lt 1 y/o RR lt20

• ANATOMICAL INJURIES
• Penetrating injury to head, neck or torso,
  extremities
• proximal to elbow/knee.
• Amputation proximal to wrist/ankle
• 2 or more proximal long bone fractures
• Crushed, degloved or mangled extremity
• Open or depressed skull fracture
• Paralysis

STEP2
7
Triage continued

• IF PATIENT DOES NOT MEET ANY OF THE ABOVE
• CONSIDER TAKING TO A TRAUMA CENTER
• Falls gt 20 ft
• Peds fall gt 10 feet or 3 times height of child
• High risk auto crash
• Intrusion gt 12 driver side, gt18 any side
• Death in same passenger compartment
• Auto vs pedestrian/cyclist thrown or run over w/
  
• significant impact, gt20mph

STEP3
8
Triage continued

• SPECIAL CONSIDERATIONS
• Very young / very old
• Adults gt 70 years
• Peds consider a pediatric trauma center
• Anticoagulation therapy (Plavix, ASA, Coumadin)
• Time sensitive extremity injury
• Pregnancy gt 20 weeks
• Burns
• With trauma to a trauma center
• Without trauma to a burn center

STEP4
9
PI Successes and Challenges

• Successes
• Consensus to submit trauma data to CEMSIS
• Examine consistency of intra-county data element
  definitions
• Conduct intra-county data collection
• Challenge
• Time required to participate in a constructive
  manner

10
PI Goals

• Apply audit filters to compare intra-county
  outcomes and practice patterns
• Interfacility Transfer Survey process
  obstacles/facilitators
• Develop Practice Guidelines for Open Fractures
  (adult/pediatric)
• Develop Fracture Decision Tree

11
Repatriation Goals

• Identify 5 primary placement/repatriation
  barriers
• Define categories of difficult placement
  patients (e.g. dialysis, behavior problem,
  non-documented, homeless etc.)
• Develop a survey for SE RTCC trauma centers to
  identify current repatriation practices and
  tracking processes for difficult placement
  patients
• Identify Trauma Center fiscal and discharge
  planning representatives for participation on
  redesigned committee focused on patient placement

12
Repatriation Successes

• Developed a Survey and distributed it to all SE
  RTCC Trauma Centers. Questionnaire targeted
  current methods of identifying and tracking
  difficult to place trauma patients.
• Contacted Trauma Centers fiscal personnel and
  discharge planners for inclusion in Repatriation
  subcommittee activities.

13
Repatriation Challenges

• Identify and overcome system barriers to
  placement in Long Term Care facilities
• Quantify difficult placement patients in
  subcategories (e.g. dialysis, behavior problem,
  non-documented, homeless etc.)
• Create a collective vision for alternative
  solutions to regional repatriation issues
• Obtain cooperation of Trauma Centers to share
  financial information to track patient costs

14
Funding Task Force

• Bruce Barton, Administrator
• Riverside County EMS Agency
• Virginia Hastings, Executive Director
• Inland Counties EMS Agency
• Ryan Kelley, Administrator
• Imperial County EMS Agency
• Marcy Metz, Administrator
• San Diego County EMS Agency

15
Funding

• Funding for hospitals and physicians may be a key
  factor in successful regionalization of trauma
  systems
• A complete discussion of funding must include
  repatriation opportunities/responsibilities
• Traditional funding sources for uncompensated
  care generally come through counties
• Any reappropriation of county funding must be
  approved by our various Boards of
  Supervisors/Governing Boards

16
Funding Goals and Objectives

• Work with county budget analysts to discuss
  current revenue streams that are generally used
  to pay for MIA/indigent/uncompensated care
• Using trauma registries, identify patients that
  cross county/state lines
• Identify payor source for those patients
• Identify county/state/country of incident when
  possible
• Aggregate patient charges when available
• Collect and analyze trauma financial data that
  can be utilized to garner funding in the
  legislature
• Develop blueprint for integrated, well developed
  trauma systems.

17
Funding Challenges

• SURPRISE !!!
• OBSTACLES
• WE ALL DO THINGS DIFFERENTLY !

18
Overall Goals

• Establish a Region-Wide QI Meeting
• Interface with other RTCCs
• Disaster Planning

19
How our region can foster Californias State
Trauma System

• Identifying and Standardizing Best Practices
• Developing Region-Wide QI Meeting
• Establishing Inter-County Communication Channels