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Understanding why Georgia needs a trauma system
now

• Trauma basics
• Definitions, statistics and survivors
• Trauma in GA
• The current situation and the issues
• The Solution
• What needs to be done, what is being done and
  what you can do

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Trauma basics Definitions

• What is trauma?
• A serious injury or shock to the body
• Caused by an accident or violence
• Number one killer of Americans between the ages
  of one and 44
• Number three cause of death across all age groups

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Trauma basics Definitions

• What is the golden hour?
• The hour immediately following injury
• Chances of survival increase dramatically.
• Rapid EMS response is critical.
• Distance to a trauma center is critical.

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Trauma basics Definitions

• What is a trauma center?
• A specialized hospital
• Doctors, nurses, equipment available immediately
• Most hospitals with an ER are not
  trauma centers
• In GA, only 15 of 152 hospitals
• To be a designated trauma center in GA
• Hospitals voluntarily meet guidelines
• State DHR
• ACSCT (American College of Surgeons Committee on
  Trauma)

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Trauma basics Definitions

• What do Trauma Center levels mean?
• Level I full range 24-hour service, ER,
  surgical suite, ICU, imaging, residency, trauma
  research
• Level II full range, but not the degree of
  research
• Level III continuous general surgical and
  orthopedic coverage, but may lack subspecialties
• Level IV initial evaluation and assessment, most
  patients transferred

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Trauma basics Definitions

• What is Emergency Medical Services (EMS)?
• The front line of trauma care
• Emergency medical technicians
• Ground and air ambulances
• Advanced life support equipment
• Provide critical pre-hospital services
• Rapid transportation
• Immediate medical assistance and stabilization
• Triage, determine appropriate facility,
  level of care

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Trauma basics Definitions

• What is a trauma system?
• An organized approach to managing trauma
• Universal/rapid access to pre-hospital care
• Rapid transport to the definitive
  treatment facility
• Prompt surgical intervention when required
• Availability of critical care
  medicine/nursing skills
• Rehabilitation as needed
• Data analyzed, used to improve performance
• Prevention programs

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Trauma basics Definitions

• What are the benefits of a trauma system?
• Fewer deaths US studies show 10-30 reduced risk
  of death
• Potential ROI is productive lives, saved
• Fewer, less severe disabilities
• More productive working years
• Lower cost of initial treatment,
  continued rehab
• Typically shorter hospital stays
• Reduced uncompensated care

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Trauma basics Statistics

• Causes of trauma in GA
• Nine main causes of 91.9 of trauma
• Motor vehicle crashes (39.1)
• Falls (21.2)
• Gunshot wounds (8.1)
• Motorcycle crashes (5.3)
• Pedestrian incidents (5.1)
• Assaults (4.2)
• Accidents (3.4)\
• Stab wounds (3.0)
• All-terrain vehicle crashes (2.5)

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Trauma basics Statistics

• Trauma victims in GA
• All ethnic groups
• Caucasian (54.4)
• African American (33.6)
• Hispanic/Latino (8.8)
• Asian (.8)
• Men (68.4) women (31.6)

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Trauma basics Statistics

• EMS and trauma care
• 14,000 licensed EMS professionals in GA
• GA has 263 licensed ambulance providers
• 2,300 vehicles licensed as ambulances
• Five air ambulance services based in GA
• 72 of patients reach trauma centers in GA by
  ground ambulance
• 19 reach a trauma center by helicopter

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Trauma basics Statistics

• Trauma centers in GA
• Only 15 of the states 152
  acute-care hospitals
• Four are Level I
• Nine are Level II
• Two are Level IV
• No Level III

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Trauma basics Statistics

• GAs trauma centers
• 1. Grady Memorial Health (Atlanta) L1
• 2. Medical Center of Central Georgia (Macon) L1
• 3. Medical College of Georgia (Augusta) L1
• 4. Memorial Health University
• Medical Center (Savannah) L1
• 5. Archbold Memorial Hospital (Thomasville) L2
• 6. Atlanta Medical Center (Atlanta) L2
• 7. Childrens Healthcare of Atlanta, Egleston
  L2P
• 8. Childrens Healthcare of Atlanta, Scottish
  Rite L2P
• 9. Floyd Medical Center (Rome) L2
• 10. Gwinnett Medical Center (Lawrenceville) L2
• 11. Hamilton Medical Center (Dalton) L2
• 12. N. Fulton Regional Hospital (Roswell) L2
• 13. The Medical Center (Columbus) L2
• 14. Morgan Memorial Hospital (Madison) L4
• 15. Walton Regional Medical Center (Monroe) L4

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Trauma basics Survivors

• Survivor Steve Charron
• Home Lilburn, in Gwinnett County
• Date of trauma Sunday, April 2, 2006
• Age at time of trauma 49
• Trauma incident Riding Harley hit Ford
  Expedition at 45 mph
•  Trauma response Helicopter to Atlanta Medical
  Center, a Level II broken facial bones, bulging
  cervical discs, lung contusions and a broken left
  wrist
• Status Eight weeks after, back at job two
  hours/day 

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Trauma basics Survivors

• Survivor
• Steve Charron
• The trauma care difference We believe that
  Steves inpatient stay was shorter and his
  outcome was better because of the care he
  received at a trauma center.
• -Wife, Nancy Charron

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Trauma basics Survivors

• Survivor Mike Keown
• Home Coolidge, in Thomas County
• Date of trauma August 6, 2005
• Age at time of trauma 51
• Trauma incident Fell 20 feet off a ladder
• Trauma response Thomas County EMS took Keown to
  Archbold Medical Center, a Level II dislocated
  shoulder, pelvic fracture, open wound
• Status Fully recovered by end of January

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Trauma basics Survivors

• Survivor Mike Keown
• The trauma care differenceEveryone needs access
  to a trauma center comparable to Archbold. The
  emergency care I received was essential to my
  recovery.
• -Mike Keown
• (Keown, a Republican, represents part of Grady
  and part of Thomas Counties (District 173) in the
  Georgia House of Representatives.)

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Trauma basics Survivors

• Survivor Jeremiah Matlock
• Home Buchanan, in Haralson County
• Date of trauma Friday, July 30, 2005
• Age at time of trauma 21
• Trauma incident Swerved pickup to avoid vehicle
  on his side of the road, overturned
• Trauma response Ambulance To Atlanta Medical
  Center, a Level II. Broken pelvis, severed
  artery 25 days in coma
• Status Limited return to work

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Trauma basics Survivors

• Survivor Jeremiah Matlock
• The trauma care difference I have no doubt that
  if Jeremiah had not been transported to Atlanta
  Medical Center, he would have bled to death from
  the severed artery or died from complications
  with his lungs.
• - Mother, Laura Matlock

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Trauma basics Survivors

• Survivor Ben Shuman
• Home Morganton, in Fannin County
• Date of trauma April 9, 2006
• Age at time of trauma 22
• Trauma incident Truck ran stop sign and hit
  Shumans Chevy S10 pickup at 50 mph
• Trauma response LifeNet helicopter transport to
  Grady, a Level I immediate
  craniotomy
• Status Outpatient occupational/ speech
  therapy

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Trauma basics Survivors

• Survivor Ben Shuman
• The trauma care difference Bens evaluation at
  a trauma center gave him the edge for survival.
  If he had not been initially evaluated at a
  trauma center, its questionable if he would have
  survived his injuries.
• - Mother, Sherry Shuman

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Trauma basics Survivors

• Survivor Regina Purvis
• Home Tucker, in DeKalb County
• Date of trauma October 9, 2004
• Age at time of trauma 16
• Trauma incident Head-on collision with Ford
  Explorer no air bags
• Trauma response Ambulance to Gwinnett MC, Level
  II damage to vena cava, kidneys, liver, ribs,
  lungs, broken femur, 19 seizures, 106 temp
• Status Played high school fast-pitch senior
  year May 2006 Parkview grad. Enrolled American
  Intercontinental U.

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Trauma basics Survivors

• Survivor Regina Purvis
• The trauma care difference I would have lost my
  daughter without the best trauma care. How do you
  tell a parent that their child is dead because
  they did not have the doctors or equipment to
  provide the best care for trauma?
• - Mother, Debbie Murphy

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Trauma in Georgia The current situation

• GA does not have a comprehensive statewide trauma
  system.
• GA has a few components of a system.
• The state monitors and designates
  trauma centers.
• The state licenses EMS services.
• Designated trauma centers contribute
  data to registry.

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Trauma in Georgia The current situation

• GA needs 25-30 trauma centers.
• Particular need in areas not covered
• Inadequate public funding for trauma services
• Lack a comprehensive trauma infrastructure
• Pre-hospital care
• Rapid transport
• Availability of critical care medicine and
  nursing
• Rehabilitation

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Trauma in Georgia The current situation

• Why GA Needs a Trauma System Now?
• Statewide systems save lives.
• Our families and friends can get trauma care.
• Essential for emergency preparedness
• Essential for homeland security

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Trauma in Georgia The current situation

• Why GA Needs a Trauma System Now?
• GAs trauma death rate is significantly higher
  than the national average.
• GA 63 of every 100,000 people
• National average 56 per 100,000
• If GAs death rate improved to the national
  average, it would mean a difference of as many as
  700 more lives saved every year.

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Trauma in Georgia The Issues

• Only 15 of GAs 152 acute-care hospitals are
  designated trauma centers.
• GA should have 25-30 designated
  trauma centers.
• They should be in strategic locations.
• The 15 current centers are in ten counties.
• Large areas are not adequately served.
• Millions are two hours away from trauma care.
• Of 40,000 cases of major trauma only 10,000 are
  treated in designated trauma centers.

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Trauma in Georgia The Issues

• Why dont more hospitals start trauma centers?
• Most cant afford the financial losses.
• GA hospitals are reimbursed through
• Private health insurance
• Patient payments
• Government programs (Medicare/Medicaid)
• They do not come close to covering the cost of
  uncompensated care about 275 million a
  year for hospitals, physicians, and EMS.

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Trauma in Georgia The Issues

• Why dont more hospitals start trauma centers?
• Two-thirds of GAs hospitals
  are in the red.
• Increase in uninsured patients
• Reductions in Medicare/Medicaid reimbursement
• Increases in malpractice coverage.
• The 15 current trauma centers are at risk.
• In 2002, five of 19 trauma centers closed.
• In 2007 DeKalb Medical resigned.
• Additional funds are needed.

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Trauma in Georgia The Issues

• Other major challenges
• Staffing
• GA faces a shortage of medical
  personnel.
• Stress, low wages, workload and
  liability concerns
• Drives personnel away from trauma care
• Hard to recruit EMS personnel in rural
  areas

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Trauma in Georgia The Issues

• Other major challenges
• Pre-hospital communications network
• Integrated with EMS, emergency disaster
  preparedness systems.
• The first step is 911.
• Several GA counties do not have a 911 emergency
  system.

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Trauma in Georgia The Issues

• Other major challenges
• Medical oversight and coordination
• Shortages of physicians particularly physicians
  trained in emergency medicine
• Result is lack of oversight
• Trauma care often not uniformly coordinated

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The SolutionWhat needs to be done?

• In 2006, the Georgia Legislature began a study of
  the infrastructure and funding mechanisms needed.
• In 2007 lawmakers passed Senate Bill 60 and
  created the Georgia Trauma Care Network
  Commission to continue the work.
• But the specific infrastructure and funding
  solutions remain unresolved.

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The SolutionWhat needs to be done?

• Funding. Joint Comprehensive State Trauma
  Services Study Committee suggested options.
• Workforce development and training. Recruit and
  train enough EMTs, paramedics, physicians and
  nurses.
• Develop a pre-hospital communications network.
• Enhanced EMS medical direction
• Creation of triage and transport system
• Minimize practice of hospital diversion

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The SolutionWhat needs to be done?

• Unless the state agrees to subsidize the high
  cost of trauma care in some way, it is a virtual
  certainty that several of the state's 15 trauma
  care hospitals -- a number already insufficient
  -- will be forced to shut down their services for
  financial reasons Walking away now without
  acting would be like an emergency medical
  technician walking away from the scene of an
  accident
• OUR OPINION State can't neglect trauma
  funding - Atlanta Journal-Constitution, April
  20, 2007
•  
• One of the most critical issues facing the
  health of the state is the failing,
  stitched-together system of trauma hospitals.
  Lawmakers are aware of the crisis, but for some
  reason they believe the participating hospitals
  will continue to absorb the costs.
• Editorial Lawmakers ignoring trauma
  crisis - Macon Telegraph, April 10, 2007

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The SolutionWhat needs to be done?

• Call it bureaucratic triage Georgia's
  trauma system needs to be healed, and lawmakers
  need to act as if all Georgians' lives depend on
  it Because they do.
• Editorial Traumatized health care - Augusta
  Chronicle, January 7, 2007
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• if you're headed to a south Georgia farming
  community, you'd better drive safely The state's
  emergency care network simply does not offer
  rural Georgians the same quality of treatment
  available in urban centers such as Atlanta,
  Augusta, Macon or Savannah That needs to
  change.
• Editorial Rescue trauma centers - Savannah
  Morning News, September 25, 2006

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The SolutionWhat is being done?

• Status of legislation
• In 2006, a bill that mandated formation of Trauma
  Study Committee was approved.
• Committee reported its findings in late 2006.
• In 2007 the Legislature passed Senate Bill 60.
• Established a nine-member Georgia Trauma Care
  Network Commission.
• But specific infrastructure and funding solutions
  remain unresolved.

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The SolutionWhat is being done?

• Other states also have trauma funding problems.
  
• South Carolina
• General Assembly (May 2004) established
  infrastructure for statewide trauma care system.
• May 2005 Assembly provided 4 million in state
  funding to cover trauma care for
  Medicaid-eligible.
• But study showed 38.7 million need
• One in four patients at Level I or II does not
  pay.

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The SolutionWhat is being done?

• Arizona uses funds from a tax on cigarettes.
• Illinois assesses a 100 fee on DUI and a 20 fee
  on traffic infractions, which generates 34
  million for trauma. The state also has added a
  100 surcharge on firearms violations and a 100
  surcharge for drug-related convictions.
• Maryland uses a 13.50 surcharge on motor vehicle
  registrations.

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The SolutionWhat is being done?

• Mississippi charges a 5 fee per moving
  violation, which generates about 8 million for
  trauma centers.
• Texas passed a motor vehicle surcharge that is
  expected to generate 300 million in two years
  for trauma centers. Texas also allocates the
  interest on tobacco settlement funds to trauma
  centers, which is expected to generate 4
  million.
• Washington uses a 5 surcharge on moving
  violations and a 6.50 surcharge per change in
  motor vehicle registration.

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The SolutionWhat is being done?

• GAs effort to establish a statewide system
• Led by
• Georgia hospitals
• Emergency Medical Services (EMS)
• Emergency physicians, trauma surgeons
  and nurses
• Formed Georgia Statewide Trauma Action Team
  (GSTAT) coalition
• Deliver a unified proposal to the
  study committee

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The SolutionWhat is being done?

• GSTAT will
• Launch a trauma awareness campaign.
• Make the public, local elected officials and
  business people aware of the issues and the need
  for a statewide trauma system.

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The SolutionWhat can you do?

• Join with hospital administrators, physicians,
  nurses, and EMS providers
• There are several ways
• Fill in a postcard and mail it in.
• Or,  Go to www.GeorgiaItsAboutTime.com to
• learn more
• sign the e-petition
• join the coalition

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