Minnesota Statewide Trauma System

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Minnesota Statewide Trauma System

Tribes Transportation Conference Walker,
Minnesota October 17, 2006
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Navigating the Trauma System

• Emergency Trauma Care - The Forth E
• Goals
• Governance System
• Hospital Designations
• Data
• Case Review
• What Next?

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The Forth TZD E

• Engineering
• Enforcement
• Education
• Emergency Trauma Care
• (Statewide Trauma System)

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Serious Trauma Only

• Not bumps, bruises, or medical conditions
• Small population of total trauma patients

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Minnesota Trauma Facts

• Trauma is the leading cause of death for ages 1
  to 44
• Overall, trauma is the third leading cause of
  death
• On average, more than 2,400 Minnesotans die from
  trauma each year

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Motor Vehicle Crashes

• 2005
• _______________________
• 559 fatalities
• 70 of the fatal crashes were in rural areas
• Economic cost of MVC fatalities was 631,670,000
• Based on the National Safety
• councils economic cost figures

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Benefits

• 9 decrease in MVC deaths
• 15 to 20 increase survival of seriously injured
  patients
• Increase in productive working years

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Benefits

• Decrease second trauma
• Decrease transfers
• Improve disaster preparedness

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Minnesotas New Trauma System

• Legislation to enact a statewide trauma system
  was passed July 2005
• Commissioner of Health charged to implement this
  initiative
• The state trauma program is located in the Office
  of Rural Health and Primary Care

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Goals

• Match patient to resources
• Quick, confident decision-making
• Shorten time to definitive care
• Data-driven QA/QI system

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Governance
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System Design

• Four designation levels
• Indicates resources available (not quality of
  care)
• Voluntary participation
• ACS levels I, II
• State process for levels III IV
• Trauma registry
• EMS triage transport guidelines

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Level III Overview

• 24/7 surgeon response capability (ED ICU)
• Surgeon involvement in program, QA/QI
• MD to ED w/in 15 minutes
• ICU
• Injury prevention activities

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Level IV Overview

• No surgery requirement
• No ICU requirement
• MD, NP or PA to ED w/in 30 minutes

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General Criteria

• Trauma Team activation protocol
• Trauma program manager/ coordinator
• Trauma program medical director/advisor

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General Criteria

• 24-hour ED
• Lab
• Blood bank
• Standard analysis
• Typing/cross matching
• Transfer
• Protocol
• Agreements

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General Criteria

• Physicians
• Board certified in GS or EM ATLS/CALS once
• Not boarded in GS or EM Current ATLS/CALS
• RNs Trauma education if caring for trauma
  patients
• CALS, TNCC, etc.
• In-house training that meets state objectives

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General Criteria

• Formal QA/QI policy
• Minimum filters prescribed
• Peer review w/ all physicians involved in trauma
  care
• Multidisciplinary trauma review (level III)

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General Criteria

• Data submission via trauma registry
• Web based
• No cost
• Small data set
• TBI/SCI submission
• Benchmark against aggregate data
• NTR data submission

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Linked Databases
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EMS Implications
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Transportation Requirements

• Major trauma patients
• to highest designated trauma hospital w/in
• 30 minutes
• Bypass of undesignated hospitals
• Compromised airways to nearest designated trauma
  hospital
• No bypass of Level II for Level I
• Local/regional resources may necessitate
  deviations

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EMS Triage Transport Guideline

• Develop by July 1, 2009
• Consistent with Statewide Trauma System
  criteria
• Influenced by local hospital resources
• Approved by EMSRB
• Identify Pts to be transferred upon arrival at
  scene
• Aeromedical lt15 minutes away ? wait
• Aeromedical gt15 minutes away ? transport, meet
  chopper at hospital

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Illustrative Case Study



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Level IV Case Study

• 37 year old
• Head-on collision
• Unrestrained driver
• Trauma team at level IV trauma hospital activated
  at 0651
• Patient arrives at 0702

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Level IV Trauma Hospital Course

• Confused, GCS 14 unequal pupils
• Hypertensive, tachycardic
• Respiratory distress
• Considerable chest pain
• Obvious L femur fracture

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Emergency Department

• Transfer ordered immediately
• Protocol in place
• Transfer agreement previously established with a
  Level I facility
• Rapid sequence intubation
• Chest, pelvis, C-spine X-rays
• Chest tube placed
• Foley, NG tube placed
• Antibiotics, analgesics administered

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Diagnosis at time of transfer

• Closed head injury
• R pneumothorax
• Bilateral pulmonary contusions
• Multiple rib fractures
• Multiple pelvic fractures
• Open L femur fracture
• Clavicle fracture
• Transferred via
• helicopter at 0835

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Level I Trauma Hospital Course

• Arrives at 0857
• Primary and secondary exams repeated
• CT scan
• Head, chest, abdomen negative
• Neurosurgery evaluation
• Irrigation and debridement of open femur fracture
• Discharged home on day 10

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Level III Case Study

• 16 year old
• ATV roll-over
• Pinned beneath ATV briefly
• Rural EMS response
• Trauma team at level III trauma hospital
  activated at 1748
• Pt arrives at 1815
• Surgeon arrives at 1822

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Level III Trauma Hospital Course

• Awake and alert
• Critically hypotensive, tachycardic
• Abdominal pain
• Neck pain
• Obvious femur fracture

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Emergency Department

• Primary and secondary exams
• C-spine, chest, pelvic X-rays negative
• FAST exam/ultrasound showed free fluid in the
  abdomen
• Blood transfusion begun
• Typed and cross matched blood ordered
• Critically low blood pressure persisted
• RSI
• Transfer ordered
• To the OR

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Operating Room Course

• Spleen removed/bleeding controlled
• Abdomen packed and left open
• Transferred via
• helicopter at 2020

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Level II Trauma Hospital Course

• Arrives at 2050
• CT of head, neck, chest negative
• Abdomen re-explored then closed
• Typed and crossed blood running
• Surgical fixation of leg fracture on day 2
• Discharged home at day 7.

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Where do we go from here?
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Grants

• Consider/prepare for application
• Expenses incurred
• Staff training
• Equipment purchases
• Other
• 5000
• Download from Web site

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Current Status

• MNTrauma up running
• Applications being processed
• RTAC development
• Grants being awarded

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www.health.state.mn.us/traumasystem

• Tim Held
• State Trauma System Coordinator
• [phone]
• tim.held_at_health.state.mn.us
• Chris Ballard
• Designation Coordinator
• [phone]
• chris.ballard_at_health.state.mn.us