Marylands Emergency Medical Trauma System

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Marylands Emergency Medical /Trauma System
Presenter Mary Beachley, MS, RN, CNAA

• Maryland Institute for
• Emergency Medical Services Systems

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Objectives

• Describe the Maryland EMS/Trauma System
• Discuss the current operations
• Discuss future plans from the current EMS Plan

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Creation of the System

• The history of the Maryland Trauma/EMS System
  begins with the initial Federal initiatives to
  develop EMS systems in the US

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EMSS Act of 1972
Arkansas Arizona California Florida Illinois Ohio

Maryland was one of the original 7 states that
were federally funded as demonstration projects
for the development of model EMS/Trauma Systems
under the EMSS Act of 1972
Maryland
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The Vision

• The Maryland System was created by the vision
  and leadership of Dr. R Adams Cowley

He was one of the authors of the landmark white
paper- Accidental Death and DisabilityThe
Neglected Disease of Modern Society (1966)
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Findings of White Paper

• Needs identified to improve care
• Training for EMS personnel and lay public
• Standards for ambulance services
• Communication between ambulances EDs
• Emergency department and ICU accessibility (24
  hrs.)
• Mechanism for categorization of EDs

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White Paper Findings

• Development of trauma registries
• Formation of hospital trauma committees
• Studies on trauma rehabilitation
• Replace lay coroners with medical examiners
• Autopsy of injured victims
• Multiple casualty disaster plans
• Research in trauma

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Components of an Optimal Trauma Care System
Ongoing

• Prevention
• Training

• Evaluation
• Communication

All Injured Patients
Major Trauma Patients
Prehospital

• EMS Response
• Triage
• Transport
• Medical Control

• Recognition / Discovery
• Notification / EMS access
• EMS dispatch

Trauma Center
Interfacility Transfer
Non-trauma Center

• Most Severely Injured

• Other Injured Patients

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Public Support for Trauma Centers

• 1973 -Governor Mandel issued an Executive Order
  to create the Maryland Institute of
  EmergencyMedicine
• 1977- Senate Bill 852 combined the DEMS and MIEM
  to create one agency known as MIEMS
• 1978 - Dr. Cowley added Systems to the MIEMS
  now known as MIEMSS

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Specialty Referral Centers

• Specialty Referral Centers were included in the
  Maryland EMS System - 1970

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Specialty Centers Designated

• 1969 - Hyperbaric Medicine Center - STC
• 1970 - Burn Center - Balto. City Hospital
• 1971 - Peds Trauma - JHH
• 1975 - Raymond M. Curtis Hand Center
• 1979 - Maryland Eye Trauma Centers
  (Wilmer _at_ JHH Georgetown)
• 1980 - Neurotrauma - STC
• 1983 - Perinatal Program - JHH UMMS

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Areawide Trauma Centers

• 1978- The Echelons Care set standards for
  Areawide Trauma Centers
• The first three hospitals to be designated
  Suburban Hospital Prince Georges
  Hospital Peninsula General Hospital

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Final Stage of System DevelopmentCompleting the
Continuum of Care

• 1982 A comprehensivetrauma rehabilitation
  unit opened at Montebello Center

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Reorganization of the System

• 1993- House Bill 1222 changed the system
  governance. The R Adams Cowley Shock Trauma
  Center was separated from MIEMSS.
• EMS Board was given regulatory authority
• MIEMSS established as the lead agency for the
  Maryland EMS/Trauma system

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The Renaissance of EMS/Trauma System 1993 EMS Law

• EMS Plan to establish goals for trauma system and
  set priorities for MIEMSS
• - Develop criteria for the designation of trauma
  and specialty centers
• - Provisions for the evaluation and monitoring
  of the system

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MIEMSS Organizational Structure
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Unique EMS System
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Baltimore City
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• Organization - independent state agency
• State managed communication system
• MSP helicopter multi mission
• State-wide protocols

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Maryland EMS Regions
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The Golden HourThe Probability of Survival
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Survival Is Related To Severity and Duration
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Survival
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90
Minutes
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Maryland EMS System
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Baltimore City
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Areawide Trauma Centers Specialty Referral
Centers Hospitals Central Alarms EMSTel Telephone
Network Medical Command Consultation Centers
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Maryland Trauma Centers
Johns Hopkins Bayview Medical Center
R Adams Cowley Shock Trauma Center
Sinai Hospital
Johns Hopkins Hospital
Washington County Hospital
Johns Hopkins Pediatric Trauma Center
Suburban Hospital
Western Maryland Health System, Memorial Hospital
Childrens National Pediatric Trauma Center
Prince Georges Hospital Center
Peninsula Regional Medical Center
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Maryland State Police Med-Evac Bases
Allegany
Washington
Cecil
5
Harford
Garrett
Carroll
Frederick
Baltimore
3
1
Howard
Montgomery
Kent
Queen Annes
8
Anne Arundel
6
2
Caroline
Talbot
Prince Georges
Baltimore Trooper 1 Washington Trooper
2 Frederick Trooper 3 Salisbury Trooper
4 Cumberland Trooper 5 Centerville Trooper
6 Southern MD Trooper 7 Norwood Trooper 8
Charles
Dorchester
Wicomico
4
St. Marys
Worcester
7
Somerset
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Continuum of Care
Emergency Incident
Citizen Access 911
Dispatch Units
Dispatch
Information
Pre-arrival Information
Fire BLS ALS Specialty Unit
Medical Consultation
Patient Assessment
Transport
Ambulance Medic Helicopter
Hospital Emergency Department or Specialty Center
Rehabilitation
Return to Society
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Components of an Optimal Trauma Care System
Ongoing

• Prevention
• Training

• Evaluation
• Communication

All Injured Patients
Major Trauma Patients
Prehospital

• EMS Response
• Triage
• Transport
• Medical Control

• Recognition / Discovery
• Notification / EMS access
• EMS dispatch

Trauma Center
Interfacility Transfer
Non-trauma Center

• Most Severely Injured

• Other Injured Patients

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EMS Patient Distribution
Specialty Referrals
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Areawide Trauma Centers
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Local ED
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Trauma / Specialty Care System
PARC
Burn
Level I
Eye
Level II
Hand
Level III
Head and Spine
Hospital Emergency Depts from 49 Hospitals
EMS System
Hyperbaric
Pediatric
Perinatal
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EMS PLAN Public Health Model

• Regionalization of Health Care Services
• Health Care Work Force Issues
• Improvements in Safety and Quality of Care
• Health Care Financing and Safety Net Resources

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Current and Future Development

• State-wide Primary Stroke Centers
• State-wide STEMI Centers
• Evaluation of appropriate aeromedical transport
• Evaluation of trauma triage tool
• Improving data collection systems
• Adequate Funding

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Institute of Medicine Report Emergency Medical
Services at the Crossroads- 2006

• Future of EMS/Trauma Systems
• Improving Coordination Communication
• Regionalization
• Treatment-Triage-Transport
• Accountability
• National Performance Indicators

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Contact Information

• WWW.MIEMSS.org
• EMS Plan
• Annual Report
• Program information