HRSA Model Trauma Systems Planning

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HRSA Model Trauma Systems Planning Evaluation

• July 24, 2008
• Gail Cooper

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Common Names

• HRSA Model Trauma Systems Planning Evaluation
  (MTSPE)
• Model Trauma Plan
• National Trauma Plan

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HRSA Model Trauma Plan

• Do you fit?
• Sure, with a little tweaking here there all
  States fit one way or another
• Its not a prescriptive document, it is a guide!

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HRSA Model Trauma Plan

• How does California fit?
• By identifying resources already at work in
  California to reduce trauma death disability
  (Assessment)
• Working to close the gaps in service delivery
  (Policy Development)
• Measuring results, morbidity mortality
  (Assurance)

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HRSA Model Trauma Plan

• What does it mean?
• Change Toward more universal statewide coverage

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Looking Back The Need for Change

• New Plan/New Model
• Move away from components
• Toward inclusive, integrated, evidence based
• Develop Trauma System Planning and Evaluation A
  Public Health Approach
• Planning Guide
• Integrates essential elements of the model trauma
  system plan using a public health approach
• Incorporates new information on Systems
  Development
• Self-evaluation document
• BIS (Benchmarks, Indicators, Scoring)

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Process for Future TraumaSystem Development

• Funded by HRSA
• Use the village approach
• Solicit comments frequently
• Incorporate ideas from key trauma leaders
• Build consensus among stakeholders
• Repeatedly educate stakeholders about the public
  health approach to trauma care

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Why Public Health

• Gives credibility to trauma as a public health
  problem
• Reasonable, methodical approach recommended by
  the IOM
• Grounds trauma in a theoretical base
• Incorporates trauma injury within the framework
  of public health
• Allows trauma to be more competitive for funding

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The Process

• Review
• 1992 Draft Model Trauma Care System Plan
• Trauma System Agenda for the Future
• HRSA Evaluation instrument
• ACS/COT Trauma system consultation manual
• Literature review
• Skamania conference
• Literature since Skamania conference

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Leaders Task Groups

• Key Framers of New Document
• Use ACS/COT as entity to produce new document

• The Village people

• ACEP
• STN
• NASEMSP
• NASEMSO

• HRSA
• ACS/COT
• CDC
• NHTSA

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Trauma System Planning Evaluation A Public
Health Approach

• the public health approach is simply a proven,
  systematic method of problem identification
  problem solving it provides a conceptual
  framework for trauma system development,
  management ongoing performance improvement

Draft, DHHS/HRSA, Feb 2003, p. 5
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Trauma System Planning Evaluation Guide

• Fresh approach to trauma system planning
• Focus around 3 Core Functions of Public Health
  (A, PD, A)
• Use Trauma Agenda for the Future components
  (NHTSA)
• Provide practical information
• Include updated version of HRSA Trauma System
  evaluation tool (BIS self evaluation)
• Incorporate NACCHO Standards for Public Health
  Offices where applicable

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Public Health Goals

• Prevent epidemics spread of disease
• Protect against environmental hazards
• Prevent Injuries
• Promote and encourage healthy behaviors
• Respond to disasters assist communities in
  recovery
• Assure the quality accessibility of Health
  Services

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Mission of Public Health

• Assuring conditions in which people can be
  healthy
• Substance of Public Health Organized community
  efforts aimed at the prevention of disease the
  promotion of health

IOM, 1988
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Trauma System Goals

• Decrease the incidence and severity of trauma
• Ensure optimal, equitable accessible care for
  all persons sustaining trauma
• Prevent unnecessary deaths disabilities from
  trauma
• Contain costs while enhancing efficiency
• Implement quality performance improvement of
  trauma care through out the system
• Ensure certain designated facilities have
  appropriate resources to meet the needs of the
  injured

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Mission of the Trauma System

• Prevent injuries while ensuring that the right
  patient gets to the right hospital in the right
  amount of time

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Benefits to the Trauma System

• Access to a well-established accepted
  conceptual model for health care system
  assessment, planning, intervention, evaluation.
• Potential communications infrastructure
  (notification systems)
• Access to all-hazards information
• Population-based data
• Resources for disaster preparedness
• Opportunity to integrate the trauma system into
  other community health efforts to promote overall
  health
• A more precise identification of populations at
  risk a targeting of specific issues based on
  these data
• Framework for injury prevention strategies

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Benefits to the Public Health System

• Access to all-hazards information
• Access to a well-established health system
  infrastructure
• Health system response that differentiates
  facilities by level of resource availability
• Existing protocols and guidelines for the care
  process
• Access to patient outcome data
• Existing performance improvement process
• Additional resources for injury prevention
  efforts
• Resources to provide all-hazards care
• Recognition that injury continues to be a public
  health problem despite significant efforts at
  trauma system development

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Why a public health approach?

• Assure consistency with the Trauma System Agenda
  for the Future
• Begin looking at outcomes rather than just the
  structure process
• Give credibility to trauma as a public health
  problem
• Improve dialogue between trauma/EMS
  professionals, public health professionals
  policy-makers

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Why a public health approach ?

• Reasonable, methodical approach recommended by
  the Institute of Medicine
• Enhance integration of trauma systems into public
  health disaster planning bioterrorism response
  planning
• Allow trauma EMS to be more competitive for
  funding
• Grounds trauma system in theoretical base
• Incorporates both EMS trauma within a public
  health system

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Supporting the Model

• Recent IOM report on the Future of Emergency
  Medical Services
• ACS/COT Systems Consultation Guide
• Regional Trauma Systems Optimal Elements,
  Integration, Assessment
• Key Trauma System Leadership, National, State
  Local

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Vision for the Future of Emergency Care

• Emergency Care System
• Coordinated,
• Regionalized,
• Accountable

IOM, 2005
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Key Problems

• Fragmentation
• Lack of coordination between local service
  providers between EMS and public safety
  between EMS air medical services
• Uncertain Quality
• Little or no performance data lack of national
  standards for training credentialing.
• Disaster Preparedness
• Inadequate training, equipment, funding.
• Evidence Base
• limited understanding of effectiveness

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Key Recommendations

• Communications
• Improve data communications systems
  interoperability between EMS agencies, hospitals,
  public health departments.
• State regulation of air medical providers with
  respect to communications, dispatch, transport
  protocols.

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Workforce Standards

• Improve the quality consistency of EMS by
  encouraging states to
• Require national accreditation of paramedic
  education programs.
• Accept national certification as a prerequisite
  for state licensure.
• Establish a common scope of practice for EMS
  personnel across states, with state licensing
  reciprocity.

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Research

• Study to examine the gaps in emergency and trauma
  care research.
• Development of a research strategy.
• Increased funding for prehospital EMS research,
  emphasizing systems outcomes research.

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Disaster Preparedness

• Elevation of emergency care to a position of
  parity with other public safety entities in
  disaster planning operations.
• Increase in funding for EMS-related disaster
  preparedness through dedicated funding streams.
• Incorporate disaster preparedness training into
  EMS professional training continuing education.

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CA Model Trauma System

• The HRSA Model Trauma System Planning and
  Evaluation (MTSPE) document provides a guide for
  states in enhancing trauma care.
• The guide provides a structure for further
  developing the statewide system
• MTSPE guide is one tool for states to use in
  developing an inclusive trauma system
• ACS/COT Systems Consultation guide
• Public Health and Trauma System both focus on
  risk reduction
• Trauma continues to be a leading cause of death
  in California

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Conclusion Californias Direction

• Use the MTSPE guide to evolve a statewide system
• Continue developing the regional approach to
  trauma care within California using the BIS as a
  guide to improvement
• Rely on data to assist in setting standards,
  guidelines and benchmarks that may be unique to
  California
• Incorporate the COT Systems Consultation Guide
  (Regional Trauma Systems Optimal Elements,
  Integration, and Assessment)

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Conclusion Californias Direction

• Leadership in Trauma Systems
• State, Regional, Local,
• Many Benchmarks Indicators already achieved
• Statutes, Regulations, Funding available
• It will never be enough!
• The timing is right to move California to the
  next level of trauma system development

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JUST DO IT

• Build on the synergy cooperative spirit of this
  summit