Overview • The what’s and why’s of trauma system development • History of trauma system development in Minnesota • Phoenix of the Minnesota Trauma System • Details of proposed system components • Questions and answers
What’s and Why’s of Trauma Systems • What is a trauma system?
What’s and Why’s of Trauma Systems • What is a trauma system? A trauma system is an organized approach to facilitating multidisciplinary system response to severely injured patients.
What’s and Why’s of Trauma Systems • A trauma system includes: • Injury prevention • EMS interventions • Emergency department interventions • Intensive and surgical in-hospital care • Rehabilitation • Social services
What’s and Why’s of Trauma Systems • Why do we need a trauma system?
National Trauma Facts • Traumatic injury is the leading cause of death for persons age 1 to 44 years old. • In 1995 alone, injuries were responsible for 147,891 deaths, 2.6 million hospital admissions, and more than 36 million emergency department visits nationwide. Source: Health Resources & Services Administration
National Trauma Facts • Injury is America’s most expensive disease process, costing nearly $180 billion/year. • Trauma causes more than 300,000 permanent disabilities annually. • An estimated 25,000 trauma deaths annually are preventable. Source: Health Resources & Services Administration
National Trauma Facts • Each year, nearly 25% of all Americans sustain an injury requiring medical attention. • The death rate from unintentional injury is more than 50% higher in rural areas than in urban areas. Source: Health Resources & Services Administration
Minnesota Trauma Facts • What is the incidence of trauma in Minnesota?
Minnesota Trauma Facts • Between 1995 and 1999, MN has averaged 610 motor vehicle crash deaths each year. • Between 1995 and 1999, MN has averaged 31,000 injury crashes each year. • Estimated economic impact of $1.5 billion each year Source: Minnesota Department of Public Safety, Office of Traffic Safety
Minnesota Trauma Facts • On an average day in 2000: • 283 crashes • 1.7 deaths • 122 people injured • $4.591 million average daily cost Source: Minnesota Department of Public Safety, Office of Traffic Safety
Minnesota Trauma Facts • The leading causes of injury-related death in MN are: motor vehicle crashes, falls, and firearms (self-inflicted). • The leading causes of injury-related hospitalization in MN are: falls, motor vehicle crashes, falls, and poisonings (self-inflicted). • The leading causes of injury-related emergency department treatment in MN are: unintentional falls, contusions, and lacerations. Source: Minnesota Department of Health, Injury and Violence Prevention Unit
What’s and Why’s of Trauma Systems • Why do we need a trauma system in Minnesota?
Why do we need a trauma system in Minnesota? • Assuming a 15% reduction in all trauma deaths, 9,222 lives saved from 1990 – 1999 (61,480 injury-related deaths total). • Assuming a 9% reduction in motor vehicle crash deaths, 515 lives saved from 1990 – 1999 (5,726 motor vehicle-related deaths total). Source: Minnesota Department of Health, Injury and Violence Prevention Unit
Why do we need a trauma system in Minnesota? • 43 other states have at least some elements of a trauma system • Extensive data demonstrate: • average 15% reduction in trauma deaths • 9% reduction in MV trauma deaths • 15% reduction in hospital costs Even Iowa has a statewide trauma system!
Why do we need a trauma system in Minnesota? • Coordinated and upgraded prehospital care (EMS) • Improved treatment and transport guidelines • Better coordinated health care • Faster delivery of patient to definitive care • Faster return of patient to local community for follow-up care or full rehabilitation
Why do we need a trauma system in Minnesota? • Costs savings • Decreased hospital, disability and long term care costs (data show 15% reduction in hospital care costs) • Decreased years of productive life lost • Better outcomes through improved care and injury prevention • Lives will be saved due to better education, faster delivery to appropriate care, and program review for quality improvement (data show decreased death rates up to 20%)
Why is a trauma system even more important in rural Minnesota? • In 2000, 70% of traffic crashes in Minnesota occurred in urban areas, but 71% of the state’s fatal crashes occurred in rural Minnesota. • Increased time for ambulance response and before arrival to hospital in rural Minnesota add to the urgency. Source: Minnesota Department of Public Safety, Office of Traffic Safety
National Trauma Facts Each day in the US, the equivalent number of people die from trauma as if a fully loaded 757 crashed everyday. Total 243 passengers First Class 12 passengers Economy Class 231 passengers
National Trauma Facts • We would never tolerate this in airline performance; why do we put up with it in our everyday lives? • Why a trauma system in Minnesota? • To decrease death and disability in Minnesota
What’s and Why’s of Trauma Systems • What might a trauma system in Minnesota look like?
BREAK • (15 minutes)
History of Trauma System Development in Minnesota • 1990-1991 • 101st Congress passed the Trauma Care Systems Planning and Development Act of 1990, providing grant funding for states to develop trauma systems. • Minnesota Emergency Medical Services Advisory Council (MEMSAC) established Trauma Care Work Group.
History of Trauma System Development in Minnesota • 1992 - 1993 • Trauma Registry Alliance was awarded an EMS special project grant to demonstrate the feasibility of a statewide trauma registry. • EMS section of the Minnesota Department of Health received federal grant to modify State EMS Plan to incorporate trauma. • MEMSAC’s Trauma Care Work Group produced Minnesota Comprehensive Trauma System outlining a proposed trauma system.
History of Trauma System Development in Minnesota • 1995 - MEMSAC’s Trauma Care Task Force produced the following: • Model Criteria for Trauma Stabilization Facilities and Community Trauma Facilities • Trauma Stabilization Facility: Model Protocols for Triage and Transfer of the Trauma Patient
History of Trauma System Development in Minnesota • 1996 • Emergency Medical Services Regulatory Board was created by the Legislature as a free-standing state agency, responsible for serving as the lead agency for EMS. • Minnesota Statutes, 144E.01, subd. 6(b)(3) “Duties of board... create, in conjunction with the department of public safety, a statewide injury and trauma prevention program…”
Phoenix of the Minnesota Trauma System • April 2002, meeting convened by: • Minnesota Chapter of American College of Surgeons • Minnesota Chapter of American College of Emergency Physicians • June 2002, EMSC Supplemental Grant of $45,000 awarded to the EMSRB for: • Trauma system development • Conduct statewide trauma system/bioterrorism needs assessment
Details of Proposed Systems Components • Facility categorization and verification • Triage and transport guidelines • Statewide trauma registry
Goals • An inclusivesystem allowing participation from all hospitals • Voluntary self selection of level of institutional trauma care (to be verified by state process or ACS) • Reciprocity with border state hospitals
Guiding principles for hospital self selection • Four (possibly five) levels of trauma care will be established through a participatory rule-making process. • Levels of care will likely resemble the American College of Surgeons, Committee on Trauma (ACS COT) criteria and the 1993 Minnesota recommendations.
Guiding principles for hospital self selection • Level of care selection • Each hospital will decide on the level of trauma care they want/are able to provide. • State resources (as they become available) will be used to support the development of levels III and IV centers.
Guiding principles for hospital self selection • Verification • Levels I and II centers will likely be verified by the ACS COT system. • Levels III and IV (possibly V) centers will be verified by a state system. • To include a self reporting system • Site visits may occur (resource dependent) • The state will aspire to act as a consultant to hospitals to enhance trauma care.
Guiding principles for hospital self selection • Using the system • Ambulance will take patient to hospital most appropriately equipped and staffed to handle the injury, as defined by regional guidelines. • System will encourage transfer back to local hospital for recovering and rehabilitating patients after appropriate treatment at levels I or II facility. • Funding for trauma team activation/ trauma care at all levels will be sought through legislation and payers.
ACS COT Levels Level I trauma center Regional resource trauma center that has the capacity of providing leadership and total care for every aspect of injury from prevention through rehabilitation
ACS COT Levels Level II trauma center Hospital that provides initial definitive trauma care regardless of the severity of injury, but may not be able to provide the same comprehensive care as a Level I trauma center and does not have trauma research as a primary objective
ACS COT Levels Level III trauma center Hospital that provides assessment, resuscitation, emergency surgery, and stabilization while arranging for transfer to a Level I or Level II facility that can provide further definitive surgical care
ACS COT Levels Level IV trauma center Medical facility that provides the stabilization and treatment of severely injured patients in remote areas where no alternative care is available
ACS COT Levels Trauma receiving facility A clinic or small hospital located in sparsely populated area and often associated with a long term care facility - No surgical capabilities - Frequently staffed by PA or NP - Has basic lab and x-ray services - Initial assessment and resuscitation prior to transfer of injured patient