North Dakota Trauma Systems Consultation Report

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Introduction
If a disease were killing our children at the
rate unintentional injuries are, the public would
be outraged and demand that this killer be
stopped. C. Everett Koop, MD, ScDC. ScD Former
US Surgeon General Former General Chairman, The
National SafeKids Campaign
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Introduction

• Injury is a major public health problem
• Leading cause of death in 1st 4 decades of life
• Leading cause of loss of productivity
• Over 300 million injuries, 4 million deaths
  worldwide
• Despite obvious magnitude little public focus
• Has been the neglected disease since 1966
• Significant progress in individual patient care
• Trauma systems shown to save lives
• Few stable solutions at the public health level

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Introduction

• A comprehensive system of trauma care is an
  essential part of the public safety net.
• Lives and productive years are being lost
• Injury is a problem that affects everyone
• This is a problem that can be solved
• Public awareness
• Legislative support
• Appropriate framework and system-level view
• Dedicated system of providers

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Causes of Death
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Deaths by Age and MechanismNTDB Annual Report
2005
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A MODEL TRAUMA SYSTEM
Rehabilitation
Severe Injuries
Moderate Injuries
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Acute Care
TRAUMA SYSTEMS
Minor Injuries
Prehospital Care
Prevention
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State of AlaskaTrauma Systems ConsultationSite
Visit Team

• Reginald A. Burton, MD FACS Team Leader, Trauma
  Surgeon
• Jane Ball, RN, DrPH ACS Consultant
• Samir M. Fakhry, MD FACS Trauma Surgeon
• Holly Michaels ACS Program Coordinator
• Drexdal Pratt, CEM State EMS Director
• Nels Sanddal, PhDc, REMT-B ACS
  Consultant
• James D. Upchurch, MD Emergency Physician

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Objective

• To help promote a sustainable effort in the
  graduated development of an inclusive trauma
  system for Alaska

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American College of Surgeons COMMITTEE ON
TRAUMA Consultation Program for
Trauma Systems

• Consultation, not verification
• Multi-disciplinary team, tailored to state needs
• Data collected through
• Review of state questionnaire
• Review of other available data
• Interactive session with stakeholders

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American College of Surgeons COMMITTEE ON
TRAUMA Consultation Program for
Trauma Systems

• Consensus-based process
• Recommendations derived independently
• Standard is an inclusive trauma system based on
  public health model
• Our priority is the best interest of the patient

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Alaska

• Largest state in the nation
• Area about 586, 412 square miles
• Population about 626, 932
• Trivia
• Nickname The Last Frontier ,
• Motto "North To The Future"
• State land mammal Moose
• State fish King Salmon
• State fossil Woolley Mammoth
• State sport Dog mushing

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Trauma Impact

• 2nd highest death rate from trauma in the
  country.
• Leading cause for Alaskans under 44
• Leading cause overall Alaska natives all ages.
• 4000 trauma admissions /year around the state

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ALASKA The Great Land
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Current Status

• Twentyfour hospitals in Alaska
• Verified / Certified
• 1 level II center - ANMC
• 4 level IV centers- NSH -MEH - YKHC SCH
• 9 other reviews or consultations.
• Non-Verified
• 2 centers providing care for multiple trauma
  patients
• 6 centers that provide surgical capabilities
• 2 military hospitals

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Advantages Assets

• Very committed individuals who use their time and
  expertise every day to serve Alaska citizens.
• Extensive networks for transport.
• 3 large medical centers with extensive
  subspecialty expertise within the state
• Large Level I trauma center in Seattle which
  freely accepts adult and pediatric trauma
  patients.

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Advantages Assets

• One center maintaining ACS Level II verification
  standards and others obtaining consultations and
  working toward verification.
• Alaska Trauma Registry with all 24 acute care
  hospitals providing data.
• Injury prevention activities are well
  established.
• Initial efforts at legislative change

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Challenges and Vulnerabilities

• Geography / Weather / Remote and isolated
  communities
• No trauma system plan
• No trauma standards for scene trauma triage or
  trauma inter-facility transfers
• Trauma system issues have limited visibility
  within the DHSS
• Public not aware of trauma system issues
• Limited human resources
• There are two healthcare systems for trauma care
• Few incentives for hospitals to participate
• No statewide evaluation of system performance
• Trauma registry data entry lag time

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Public Health Model
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Themes

• You are closer than you think many of the
  components are already in place.
• Alaska is a unique environment different from
  anywhere else
• You have developed innovative solutions to your
  unique challenges.
• Despite differences amongst stakeholders all
  agree with the need for a consensus developed and
  integrated trauma system.

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Executive Summary
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Statutory Authority

•  
• Enact legislation to expand the membership of the
  ACEMS to include the following members appointed
  as follows
• One member, appointed by the Governor, shall
  represent the Alaska Chapter of the American
  College of Surgeons Committee on Trauma.
• One member, appointed by the Governor, shall be a
  general surgeon who routinely participates in the
  care of injured patients
• One member, appointed by the Governor, shall
  represent the Alaska Chapter of the American
  Academy of Pediatrics.
• One member shall be appointed by the Alaska
  Legislature upon the recommendation of the
  Speaker of the House of Representatives.
• One member shall be appointed by the Alaska
  legislature upon the recommendation of the
  President of the Senate.Legislation should
  empower the ATAC under DHSS as the lead agency
  with the responsibility and authority, as well as
  provide the human and financial resources to
  accomplish this purpose.
•       

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System Leadership

• Task the Alaska Trauma Advisory Committee (ATAC)
  with providing the ACEMS with recommendations
  regarding the following functions data systems,
  trauma system planning, system-wide performance
  improvement and patient safety, trauma education
  (ATLS, TNCC, PHTLS, etc), trauma center review
  and certification, injury prevention and control,
  public policy, and research.

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Coalition Building and Community Support

• Develop and disseminate public information about
  the challenges in providing trauma care and the
  status of trauma system in the state for all
  Alaskans.

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Lead Agency and Human Resources within Lead Agency

• Develop a job description for a full-time,
  permanent trauma system manager (an experienced
  healthcare provider with the administrative
  skills and clinical understanding necessary to
  support trauma system development)

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Trauma System Plan

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• Develop a comprehensive trauma system strategic
  plan consistent with HRSA Model Trauma System
  Planning and Evaluation document.

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System Integration

• Ensure that the section of IPEMS is engaged in
  planning with disaster preparedness, emergency
  management, and public health functions for
  integration of the trauma system.

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Financing

• Provide state funding to hire a fulltime trauma
  system manager.
• Determine a method of providing financial support
  for hospitals designated/certified by the state
  as trauma centers to assist with uncompensated
  care and the cost of readiness.

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Emergency Medical Services

• Develop a central coordination center for
  statewide air medical resources that will
  maintain an updated registry of all medical
  aircraft to include medical services and flight
  characteristics (ie. load capacity, instrument
  rating, landing requirements, etc) and to
  monitor the availability and location of air
  resources in near real-time.

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Definitive Care Facilities

• Establish, as soon as practical, a second Level
  II Trauma Center in Anchorage in accordance with
  ACS COT verification criteria to meet the
  existing volume and acuity demands.
• Mandate participation of all acute care hospitals
  in the trauma system within a 2 year time frame
  with trauma center designation appropriate to
  their capabilities.
• Study pediatric trauma care needs and establish
  one or more in-state centers of excellence in
  pediatric trauma care.
• Determine a method of providing financial support
  for hospitals designated/certified by the state
  as trauma centers to assist with uncompensated
  care and the cost of readiness.

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System Coordination and Patient Flow

• Implement standardized prehospital triage and
  trauma activation protocols customized to the
  three response areas (Anchorage, Southeast, and
  the bush).
•  
•  

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Disaster Preparedness

• Integrate all components of the trauma system
  into state and local disaster planning
  activities.

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System-Wide Evaluation and QA.

• Develop an initial set of 3-5 statewide system
  performance indicators from among the list
  provided in the PRQ.  

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Trauma Management Information Systems

• Ensure that all elements considered essential to
  system development, evaluation and performance
  improvement in Alaska are included and functional
  in the new trauma registry and are consistent
  with the NTDS definitions.

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Next Steps

• Focus questions have been addressed and will be
  included in final report.
• All sections will be edited and integrated into
  report.
• Report will be sent back to the state to check
  accuracy of information before finalization
  within 5 6 weeks.
• Report finalized and returned to state in 7 8
  Wks.

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Thank You !
American College of Surgeons COMMITTEE ON
TRAUMA Consultation Program for
Trauma Systems