1. The Central RTCC James W. Davis MD, FACS Chief of Trauma, CRMC Professor of Clinical Surgery UCSF/Fresno

2. The Credit Belongs to Everyone • Some deserve special recognition: • Lynn Bennink – CRMC Fresno • Linda Diaz – Merced EMS • Debbie Becker – Fresno EMS • Chuck Baucom – Merced EMS • Clarence Teem – Tuolumne EMS

3. The Request • Regional Representation • Short and Long term goals • Successes and Challenges • How Central Region can foster California State Trauma System

4. The Central Region • Central California covers approximately 32,000 sq miles or 20% of California. • Rural in nature with large areas of agriculture • Bounded by the Sierra Nevada mountain range • The region serves a population of approximately 3.5 million or 10% of California population. • consists of 12 counties (25% of the counties in California), • 5 LEMSA’s (2 regional and 3 single counties), • 1 level I Trauma Center • 3 level II Trauma Centers

5. The Central Region Modesto-two level II Trauma Centers Fresno-one level 1 Trauma Center Kern-one Level II Trauma Center

6. CRTCC History and Process • August 2008, Meeting • All interested parties from the State Summit • Executive Steering Committee formed • Early Decision: Process Driven • Bylaws • Mission & Vision • Goals • Membership

7. CRTCC Bylaws • Guiding Principles: • Inclusive, not exclusive • Collaborative • KISS • Bulk of efforts from EMS Administrators • Clarence Teem • Chuck Baucom

8. Mission Statement, CRTCC • To participate in the development of standardized regional trauma care, as well as the establishment and maintenance of a coordinated regional trauma system to promote optimal trauma care for all people within the region.

9. Vision • All inclusive system of trauma care throughout the central region of California • Pre-hospital • Destination criteria • Uniform standards of care • Facility • Adequate numbers and quality of trauma centers • Rehabilitation • Education and Prevention • Region-wide performance improvement

10. Accomplishments • Bylaws completed and approved • Formal regional response to EMSA draft on Intensive Care Services for the Pediatric Trauma Patient • Gap analysis completed • General Membership meeting held with diverse representation • Subcommittees formed with goals established for each • Presentation to the Hospital Council CEO group

11. Goals • Prehospital subcommittee • Standardized triage and destination criteria • Ambulance utilization • Facility subcommittee • Gap analysis • Work with prehospital subcommittee on destination criteria

12. Goals (cont.) • Education/Prevention subcommittee • Website • Prevention consortium to look at available resources • PI subcommittee • Peer review • Benchmark data • Quality indicators • To meet Semi-annually/quarterly

13. Challenges • We have had GREAT collaboration but we lack Legislative Authority • This is VOLUNTARY buy-in • $$$$$$$$$$$$$$$$ • Large region, face to face meetings are hard • Teleconferencing • Lack of adequate number of trauma centers and physicians • the San Joaquin Valley has 51% fewer specialists than the rest of the state

14. How we can foster a statewide system • Collaboration with other regions • Only region in the state that borders every region • Standardized destination and triage criteria • Transfer agreements and arrangements • Address gaps in trauma care (gap analysis) • Rural trauma course • telemedicine • Participate in statewide trauma registry

15. William Butler Yeats (1919)The Second Coming Turning and turning in the widening gyre The falcon cannot hear the falconer; Things fall apart; the centre cannot hold; Mere anarchy is loosed upon the world, The blood-dimmed tide is loosed, and everywhere The ceremony of innocence is drowned; The best lack all conviction, while the worst Are full of passionate intensity.

16. Conclusion • Californians deserve and must have an effective state-wide trauma system • This Center will hold • Anarchy in trauma care will NOT be loosed upon the world (or state)