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Insert name of presenters & date here. Understanding why Georgia needs a trauma system now. Trauma basics Definitions, statistics and survivors Trauma in GA The current situation and the issues The Solution What needs to be done, what is being done and what you can do.

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  1. Insert name of presenters & date here

  2. Understanding why Georgia needs a trauma system now • Trauma basics • Definitions, statistics and survivors • Trauma in GA • The current situation and the issues • The Solution • What needs to be done, what is being done and what you can do

  3. Trauma basics: Definitions What is trauma? • A serious injury or shock to the body • Caused by an accident or violence • Number one killer of Americans between the ages of one and 44 • Number three cause of death across all age groups

  4. Trauma basics: Definitions What is “the golden hour”? • The hour immediately following injury • Chances of survival increase dramatically. • Rapid EMS response is critical. • Distance to a trauma center is critical.

  5. Trauma basics: Definitions What is a trauma center? • A specialized hospital • Doctors, nurses, equipment available immediately • Most hospitals with an ER are not trauma centers • In GA, only 15 of 152 hospitals • To be a “designated” trauma center in GA • Hospitals voluntarily meet guidelines • State DHR • ACSCT (American College of Surgeons’ Committee on Trauma)

  6. Trauma basics: Definitions What do Trauma Center levels mean? • Level I: full range – 24-hour service, ER, surgical suite, ICU, imaging, residency, trauma research • Level II: full range, but not the degree of research • Level III: continuous general surgical and orthopedic coverage, but may lack subspecialties • Level IV: initial evaluation and assessment, most patients transferred

  7. Trauma basics: Definitions What is Emergency Medical Services (EMS)? • The “front line” of trauma care • Emergency medical technicians • Ground and air ambulances • Advanced life support equipment • Provide critical “pre-hospital” services • Rapid transportation • Immediate medical assistance and stabilization • Triage, determine appropriate facility, level of care

  8. Trauma basics: Definitions What is a trauma system? • An organized approach to managing trauma • Universal/rapid access to pre-hospital care • Rapid transport to the definitive treatment facility • Prompt surgical intervention when required • Availability of critical care medicine/nursing skills • Rehabilitation as needed • Data analyzed, used to improve performance • Prevention programs

  9. Trauma basics: Definitions What are the benefits of a trauma system? • Fewer deaths: US studies show 10-30% reduced risk of death • Potential “ROI” is productive lives, $ saved • Fewer, less severe disabilities • More productive working years • Lower cost of initial treatment, continued rehab • Typically shorter hospital stays • Reduced uncompensated care

  10. Trauma basics: Statistics Causes of trauma in GA • Nine main causes of 91.9% of trauma • Motor vehicle crashes (39.1%) • Falls (21.2%) • Gunshot wounds (8.1%) • Motorcycle crashes (5.3%) • Pedestrian incidents (5.1%) • Assaults (4.2%) • Accidents (3.4%)\ • Stab wounds (3.0%) • All-terrain vehicle crashes (2.5%)

  11. Trauma basics: Statistics Trauma victims in GA • All ethnic groups • Caucasian (54.4%) • African American (33.6%) • Hispanic/Latino (8.8%) • Asian (.8%) • Men (68.4%); women (31.6%)

  12. Trauma basics: Statistics EMS and trauma care • 14,000 licensed EMS professionals in GA • GA has 263 licensed ambulance providers • 2,300 vehicles licensed as ambulances • Five air ambulance services based in GA • 72% of patients reach trauma centers in GA by ground ambulance • 19% reach a trauma center by helicopter

  13. Trauma basics: Statistics Trauma centers in GA • Only 15 of the state’s 152 acute-care hospitals • Four are Level I • Nine are Level II • Two are Level IV • No Level III

  14. Trauma basics: Statistics GA’s trauma centers 1. Grady Memorial Health(Atlanta)L1 2. Medical Center of Central Georgia (Macon) L1 3. Medical College of Georgia (Augusta) L1 4. Memorial Health University Medical Center (Savannah) L1 5. Archbold Memorial Hospital (Thomasville) L2 6. Atlanta Medical Center(Atlanta)L2 7. Children’s Healthcare of Atlanta, Egleston L2P 8.Children’s Healthcare of Atlanta,Scottish Rite L2P 9. Floyd Medical Center (Rome)L2 10. Gwinnett Medical Center (Lawrenceville)L2 11. Hamilton Medical Center (Dalton) L2 12. N. Fulton Regional Hospital (Roswell)L2 13. The Medical Center(Columbus)L2 14. Morgan Memorial Hospital (Madison)L4 15. Walton Regional Medical Center (Monroe) L4

  15. Trauma basics: Survivors • Survivor: Steve Charron • Home: Lilburn, in Gwinnett County • Date of trauma: Sunday, April 2, 2006 • Age at time of trauma: 49 • Trauma incident: Riding Harley; hit Ford Expedition at 45 mph • Trauma response: Helicopter to Atlanta Medical Center, a Level II; broken facial bones, bulging cervical discs, lung contusions and a broken left wrist • Status: Eight weeks after, back at job two hours/day 

  16. Trauma basics: Survivors • Survivor: Steve Charron • The trauma care difference: “We believe that Steve’s inpatient stay was shorter and his outcome was better because of the care he received at a trauma center.” -Wife, Nancy Charron

  17. Trauma basics: Survivors • Survivor: Mike Keown • Home: Coolidge, in Thomas County • Date of trauma: August 6, 2005 • Age at time of trauma: 51 • Trauma incident: Fell 20 feet off a ladder • Trauma response: Thomas County EMS took Keown to Archbold Medical Center, a Level II; dislocated shoulder, pelvic fracture, open wound • Status: Fully recovered by end of January

  18. Trauma basics: Survivors • Survivor: Mike Keown • The trauma care difference:“Everyone needs access to a trauma center comparable to Archbold. The emergency care I received was essential to my recovery.” -Mike Keown (Keown, a Republican, represents part of Grady and part of Thomas Counties (District 173) in the Georgia House of Representatives.)

  19. Trauma basics: Survivors • Survivor: Jeremiah Matlock • Home: Buchanan, in Haralson County • Date of trauma: Friday, July 30, 2005 • Age at time of trauma: 21 • Trauma incident: Swerved pickup to avoid vehicle on his side of the road, overturned • Trauma response: Ambulance To Atlanta Medical Center, a Level II. Broken pelvis, severed artery; 25 days in coma • Status: Limited return to work

  20. Trauma basics: Survivors • Survivor: Jeremiah Matlock • The trauma care difference:“I have no doubt that if Jeremiah had not been transported to Atlanta Medical Center, he would have bled to death from the severed artery or died from complications with his lungs.” - Mother, Laura Matlock

  21. Trauma basics: Survivors • Survivor: Ben Shuman • Home: Morganton, in Fannin County • Date of trauma: April 9, 2006 • Age at time of trauma: 22 • Trauma incident: Truck ran stop sign and hit Shuman’s Chevy S10 pickup at 50 mph • Trauma response: LifeNet helicopter transport to Grady, a Level I; immediate craniotomy • Status: Outpatient occupational/ speech therapy

  22. Trauma basics: Survivors • Survivor: Ben Shuman • The trauma care difference:“Ben’s evaluation at a trauma center gave him the edge for survival. If he had not been initially evaluated at a trauma center, it’s questionable if he would have survived his injuries.” - Mother, Sherry Shuman

  23. Trauma basics: Survivors • Survivor: Regina Purvis • Home: Tucker, in DeKalb County • Date of trauma: October 9, 2004 • Age at time of trauma: 16 • Trauma incident: Head-on collision with Ford Explorer; no air bags • Trauma response: Ambulance to Gwinnett MC, Level II; damage to vena cava, kidneys, liver, ribs, lungs, broken femur, 19 seizures, 106 temp • Status: Played high school fast-pitch senior year; May 2006 Parkview grad. Enrolled American Intercontinental U.

  24. Trauma basics: Survivors • Survivor: Regina Purvis • The trauma care difference: “I would have lost my daughter without the best trauma care. How do you tell a parent that their child is dead because they did not have the doctors or equipment to provide the best care for trauma?” - Mother, Debbie Murphy

  25. Trauma in Georgia: The current situation • GA does not have a comprehensive statewide trauma system. • GA has a few components of a system. • The state monitors and designates trauma centers. • The state licenses EMS services. • Designated trauma centers contribute data to registry.

  26. Trauma in Georgia: The current situation • GA needs 25-30 trauma centers. • Particular need in areas not covered • Inadequate public funding for trauma services • Lack a comprehensive trauma infrastructure • Pre-hospital care • Rapid transport • Availability of critical care medicine and nursing • Rehabilitation

  27. Trauma in Georgia: The current situation Why GA Needs a Trauma System Now? • Statewide systems save lives. • Our families and friends can get trauma care. • Essential for emergency preparedness • Essential for homeland security

  28. Trauma in Georgia: The current situation Why GA Needs a Trauma System Now? • GA’s trauma death rate is significantly higher than the national average. • GA: 63 of every 100,000 people • National average: 56 per 100,000 • If GA’s death rate improved to the national average, it would mean a difference of as many as 700 more lives saved every year.

  29. Trauma in Georgia: The Issues • Only 15 of GA’s 152 acute-care hospitals are designated trauma centers. • GA should have 25-30 designated trauma centers. • They should be in strategic locations. • The 15 current centers are in ten counties. • Large areas are not adequately served. • Millions are two hours away from trauma care. • Of 40,000 cases of major trauma only 10,000 are treated in designated trauma centers.

  30. Trauma in Georgia: The Issues Why don’t more hospitals start trauma centers? • Most can’t afford the financial losses. • GA hospitals are reimbursed through: • Private health insurance • Patient payments • Government programs (Medicare/Medicaid) • They do not come close to covering the cost of uncompensated care: about $275 million a year for hospitals, physicians, and EMS.

  31. Trauma in Georgia: The Issues Why don’t more hospitals start trauma centers? • Two-thirds of GA’s hospitals are in the red. • Increase in uninsured patients • Reductions in Medicare/Medicaid reimbursement • Increases in malpractice coverage. • The 15 current trauma centers are at risk. • In 2002, five of 19 trauma centers closed. • In 2007 DeKalb Medical resigned. • Additional funds are needed.

  32. Trauma in Georgia: The Issues Other major challenges • Staffing • GA faces a shortage of medical personnel. • Stress, low wages, workload and liability concerns • Drives personnel away from trauma care • Hard to recruit EMS personnel in rural areas

  33. Trauma in Georgia: The Issues Other major challenges • Pre-hospital communications network • Integrated with EMS, emergency disaster preparedness systems. • The first step is 911. • Several GA counties do not have a 911 emergency system.

  34. Trauma in Georgia: The Issues Other major challenges • Medical oversight and coordination • Shortages of physicians – particularly physicians trained in emergency medicine • Result is lack of oversight • Trauma care often not uniformly coordinated

  35. The Solution:What needs to be done? • In 2006, the Georgia Legislature began a study of the infrastructure and funding mechanisms needed. • In 2007 lawmakers passed Senate Bill 60 and created the Georgia Trauma Care Network Commission to continue the work. • But the specific infrastructure and funding solutions remain unresolved.

  36. The Solution:What needs to be done? • Funding. Joint Comprehensive State Trauma Services Study Committee suggested options. • Workforce development and training. Recruit and train enough EMTs, paramedics, physicians and nurses. • Develop a pre-hospital communications network. • Enhanced EMS medical direction • Creation of triage and transport system • Minimize practice of hospital diversion

  37. The Solution:What needs to be done? “Unless the state agrees to subsidize the high cost of trauma care in some way, it is a virtual certainty that several of the state's 15 trauma care hospitals -- a number already insufficient -- will be forced to shut down their services for financial reasons… Walking away now without acting would be like an emergency medical technician walking away from the scene of an accident…” “OUR OPINION: State can't neglect trauma funding” - Atlanta Journal-Constitution, April 20, 2007 “One of the most critical issues facing the health of the state is the failing, stitched-together system of trauma hospitals. Lawmakers are aware of the crisis, but for some reason they believe the participating hospitals will continue to absorb the costs.” Editorial: “Lawmakers ignoring trauma crisis” - Macon Telegraph, April 10, 2007

  38. The Solution:What needs to be done? “Call it bureaucratic triage… Georgia's trauma system needs to be healed, and lawmakers need to act as if all Georgians' lives depend on it… Because they do.” Editorial: “Traumatized health care” - Augusta Chronicle, January 7, 2007 “…if you're headed to a south Georgia farming community, you'd better drive safely… The state's emergency care network simply does not offer rural Georgians the same quality of treatment available in urban centers such as Atlanta, Augusta, Macon or Savannah… That needs to change.” Editorial: “Rescue trauma centers” - Savannah Morning News, September 25, 2006

  39. The Solution:What is being done? Status of legislation • In 2006, a bill that mandated formation of Trauma Study Committee was approved. • Committee reported its findings in late 2006. • In 2007 the Legislature passed Senate Bill 60. • Established a nine-member Georgia Trauma Care Network Commission. • But specific infrastructure and funding solutions remain unresolved.

  40. The Solution:What is being done? • Other states also have trauma funding problems. • South Carolina • General Assembly (May 2004) established infrastructure for statewide trauma care system. • May 2005 Assembly provided $4 million in state funding to cover trauma care for Medicaid-eligible. • But study showed $38.7 million need • One in four patients at Level I or II does not pay.

  41. The Solution:What is being done? • Arizona uses funds from a tax on cigarettes. • Illinois assesses a $100 fee on DUI and a $20 fee on traffic infractions, which generates $34 million for trauma. The state also has added a $100 surcharge on firearms violations and a $100 surcharge for drug-related convictions. • Maryland uses a $13.50 surcharge on motor vehicle registrations.

  42. The Solution:What is being done? • Mississippi charges a $5 fee per moving violation, which generates about $8 million for trauma centers. • Texas passed a motor vehicle surcharge that is expected to generate $300 million in two years for trauma centers. Texas also allocates the interest on tobacco settlement funds to trauma centers, which is expected to generate $4 million. • Washington uses a $5 surcharge on moving violations and a $6.50 surcharge per change in motor vehicle registration.

  43. The Solution:What is being done? GA’s effort to establish a statewide system • Led by • Georgia hospitals • Emergency Medical Services (EMS) • Emergency physicians, trauma surgeons and nurses • Formed Georgia Statewide Trauma Action Team (GSTAT) coalition • Deliver a unified proposal to the study committee

  44. The Solution:What is being done? • GSTAT will: • Launch a trauma awareness campaign. • Make the public, local elected officials and business people aware of the issues and the need for a statewide trauma system.

  45. The Solution:What can you do? • Join with hospital administrators, physicians, nurses, and EMS providers • There are several ways: • Fill in a postcard and mail it in. • Or,  Go to www.GeorgiaItsAboutTime.com to: • learn more • sign the e-petition • join the coalition

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