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					                               Office of Trauma Report
                              First Quarter Report 2011
                 Contact Susan McDevitt, R.N., Director, Office of Trauma,
                       Division of Emergency Medical Operations,
                     (850) 245-4440 ext. 2760, for further information


INTRODUCTION OF NEW STAFF
Brittney Aucutt, PMP has joined the Office of Trauma as the new project manager for the
Next Generation Trauma Registry (NGTR) project. A graduate of the University of Iowa (B.A.
in Communication), Ms. Aucutt is a certified Project Management Professional (PMP) with
more than a decade of combined project management, business management, and
customer service experience, most recently with the Department of Health’s Division of
Information Technology as a senior project manager. Ms. Aucutt will coordinate and
manage all aspects of the NGTR project and will serve as the primary contact person for
this project. She will also prepare the weekly status reports for this project. She may be
contacted at (850) 245-4440, ext. 2482 or via email at Brittney_Aucutt@doh.state.fl.us.

Scott Brannon has joined the Office of Trauma as the new business analyst for the NGTR
project. An honors graduate of the University of Georgia with a B.B.A. in Management
Science, Mr. Brannon has over 20-years of experience in the IT industry across multiple
business sectors including government, IT services, non-profits, manufacturing, aerospace,
telecom, finance, publishing, and music/entertainment. Mr. Brannon will complete the
analysis and documentation of business and technical requirements for the NGTR and
assist us in finalizing the new NGTR data dictionary. He may be contacted at (850) 245-
4440, ext. 2777 or via e-mail at Scott_Brannon@doh.state.fl.us.

Our previous project manager/business analyst, Deniz Franck, remains on the NGTR project
team part-time as a business analyst consultant. We are tremendously grateful to Ms.
Franck for the strong foundation she has prepared over the past year to enable the NGTR
project to move forward. We would like to thank Jean Kline, Director, Division of
Emergency Medical Operations, and Susan McDevitt, Director, Office of Trauma, for their
support in making the addition of these new project staff possible.


ASSOCIATION OF FLORIDA TRAUMA AGENCIES/TRAUMA AGENCY
UPDATES
Association of Florida Trauma Agencies (AFTA): AFTA held a conference call on March 25,
2011. The participants were the Palm Beach, Broward and Hillsborough agencies. The
discussion was centered on budgets, the constraints for the FY 2011-2012, and the
relocation of the agency in the Hillsborough County office. The members discussed the
upcoming EMS Advisory Council’s conference call scheduled for March 28, 2011 and the
recent TSA Analysis.

If you have any questions concerning the Association of Florida Trauma Agencies, contact:
Sandra Smith, President, at sasmith@hcdpbc.org or Barbara Uzenoff, Secretary/Treasurer, at
UzenoffB@HillsboroughCounty.ORG



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Hillsborough Trauma Agency Update: In January, the Office of Trauma completed the
review of the Hillsborough Trauma Agency Trauma Transport Protocols. Outcome:
Approved as submitted.

The Office of Trauma completed the review of the agency’s five-year plan in January 2011
and the agency was given a preliminary approval based on s. 395.50, F.S. and Rule 64J-
2.009 Trauma Agency Plan Approval and Denial Process. Next Step: The agency will
present the plan to the Board of County Commissioners for approval. The Board is
scheduled to review the plan as a consent agenda item during the April 20, 2011 meeting.

DISASTER PLAN
Ms. Susan McDevitt, Director, Office of Trauma, continues to work closely with the ESF-8
partners to better define roles and responsibilities after evacuations, and to prepare for the
2011 Hurricane Season. The ESF-8 Manual was reviewed and revised to include the updated list
of current licensed ALF providers, skilled nursing facilities, dialysis centers, outpatient
chemotherapy / radiotherapy centers, durable medical equipment centers, acute care hospitals,
hospice, home health providers, and blood bank centers. Outcome: The document was reviewed,
approved, and implemented with minor changes in December 2010. In May, the list will be
reviewed again for additional revisions prior to the beginning of the 2011 Hurricane Season.

If you have any questions concerning the Florida Disaster Plan, please contact Susan McDevitt,
Director, Office of Trauma, Florida Department of Health, (850) 245-4440, ext. 2760,
susan_mcdevitt@doh.state.fl.us


TRAUMA CENTER UPDATES
Trauma Center Application Process Update: The following acute care hospitals have
submitted an application to apply for Level I trauma center status by the April 1, 2011
deadline:

   •   Delray Medical Center.
   •   St. Mary’s Medical Center

The following acute care hospital has submitted an application to apply for Level II trauma
center status by the April 1, 2011 deadline:

   •   Bay Medical Center, and has requested an extension of 18-months pursuant to 64J-
       2.013, F.A.C. The 18-month extension will be up on October 1, 2012.

Dr. Larry Reed, a trauma surgeon from Clarian Methodist Hospital Indianapolis, Dr. John
Kendall, an emergency physician from Denver Health Medical Center and Dr. Pam Pieper,
from Shands Hospital Jacksonville joined Susan McDevitt and Bernadette Behmke to review
the April 2011, trauma center applications,

Trauma Center Site Survey Schedule: The following trauma center site surveys were
conducted during the reporting period:
Baptist Hospital
Level II
January 10, 2011

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St. Mary’s Medical Center
Level II
February 7, 2011

Delray Medical Center
Level II
February 8, 2011
Lawnwood Regional Medical Center
Level II
March 14, 2011

The following site surveys are scheduled for the next reporting period:

Lakeland Regional Medical Center
Level II
April 18, 2011

Memorial Regional Hospital
Level I
May 9 and 10, 2011

Broward General Medical Center
Level I
May 11 and 12, 2011

If you have any questions concerning the letter of intent, application, or site survey processes,
please contact Bernadette Behmke, Office of Trauma at 850-245-4440 ext. 2756, or via email at
bernadette_behmke@doh.state.fl.us

Trauma Center Funding: The first quarter of Calendar Year (CY) 2011 Red-Light Running Bill and
associated legislation payout totaling approximately $1.4 million has been completed. The new
red-light camera ticket revenue from the 2010 Red-Light Camera Bill is now representing an
increase in funding of $150,000 to approaching $ 350,000 per quarter. This is expected to
continue to grow each quarter as these fines become more operational. It should be noted that
revenue from the regular red-light law enforcement issued ticket pool has declined by over 20
percent during CY 2010. Therefore, the new red-light camera bill revenue is helping to
replace the downward trend in law enforcement issued red light tickets.

It should be noted that HB 4087/SB 672 filed and heard in committees during the 2011 state
legislature proposes the repeal the red-light camera legislation passed in 2010. It appears to
have gained significant public and legislative support. Therefore, the continuation of the
red light camera funding of trauma is dependent on this legislation not passing.

For information regarding Red-Light Running Legislation and other revenue sources/budget issues,
please contact Tom Weaver, Trauma Business Manager at: tom_weaver@doh.state.fl.us.

Trauma Center Quality Improvement Update: Carma, Susan, and Michael, with the Office of
Trauma, held a pre-PI Committee conference call with Michele Ziglar and Lianne Brown,
who were representing the trauma program managers to discuss issues for the April 8, 2011
conference call. Discussion ensued regarding the performance indicators definition which
the state collects.

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For questions regarding the Trauma System Performance Improvement Committee, please contact
Carma Harvey, Registry Data Analyst and Performance Improvement Coordinator at ext. 2731 or
via email at carma_harvey@doh.state.fl.us

TRAUMA GRANTS UPDATE
Hand Surgery Triage Training Program Grant: Copies of the Hand Emergencies DVD hand
surgery triage training program are still available. If you or a facility would like a copy of
this DVD, please contact Shelly Hyde at 850-245-4440, ext. 2795. This project will be
reevaluated by the Systems Planning Team in 2011.

Florida Department of Transportation (FDOT) Motorcycle Safety Grant: The Office of Trauma
received a $107,000 grant from the FDOT for a statewide motorcycle safety education project
through Florida’s trauma centers. Dr. Patricia Byers and Susan McDevitt finalized the deliverables
of Phase I of the grant in August 2010.

In September 2010, the Office of Trauma received from the FDOT, a $250,000 continuation grant
for the Motorcycle Education and Injury Prevention Program, Phase II. Phase II develops
improved training materials for trauma center and emergency room staff, as well as training
materials for EMTs/paramedics regarding improved care techniques for motorcycle accident injury
patients in the field. Additional researching of motorcycle injuries by use of trauma registry data
and zip code location will help pin-point highest risk geographic areas and assist in concentrating
new motorcycle injury prevention materials in areas with high motorcycle accident rates.

There has been IRB approval for the research at two of the three sites, so far preliminary
educational materials were developed for pre-hospital care, trauma care/initial resuscitation, as
well as patient and family education. Survey instrument tool to evaluate the impact for pre- and
post test is developed and will be implemented the third quarter.

Second Quarter Status: The grant deliverables are 100 percent in compliance. A FDOT
grant compliance monitoring visit will be held in late April.

If you would like more information about this project, please contact Susan McDevitt, Director of
the Office of Trauma at (850) 245-4440, ext. 2760, or via email at:
Susan_McDevitt@doh.state.fl.us.



HRSA (Health Resources and Services Administration/ASPR - Office of
the Assistant Secretary for Preparedness and Response) Grants
Burn Care and Burn Capacity Grants (2003 – 2009)

Florida currently has 22 verified trauma centers (including verified Pediatric level trauma centers),
and three burn units that total 60 beds statewide. Current burn bed occupancy rate is 98 percent.
In an emergency, the number of burn beds capacity can be increased (including beds in trauma
centers), to 270, in 2004, 660 in 2005, 880 in 2006-2009, and 910 in 2010.

Accomplishments:

The trauma and burn care initiative accomplishments have included the following:


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 •   21 trauma centers and 264 EMS providers have received the burn care curriculum

 •   21 burn care contracts for supplies and education have been executed

 •   Program evaluation implemented November 2004, February 2005, February 2006, February
     2007, February 2008, December 2008, 2009 and 2010
 •   Gap analysis and resource evaluation was completed in December 2009 and December
     2010. Gap analysis is being conducted with the verified Burn Care Centers to identify
     psychosocial needs of the patients and families in the ICU, rehabilitation unit and
     reintegration into the community. Outcome: This analysis is to include clinical needs,
     identified psychosocial problems, and staffing (social worker) per center. The goal is to have
     this project scheduled for completion by May 2011.

 •   Inventory of supplies for 21 trauma centers and three burn care centers was completed
     December 2009 and December 2010

 •   Follow-up contract monitoring for burn care supplies and equipment, operating room and
     intensive care unit supplies was completed in December 2009 and in December 2010

2006-2010 HRSA Hospital Preparedness Grant recipient of $20 million for Trauma and Burn Care:
The FYs 2006-2007, and 2007-2010, HRSA grant was implemented for non-trauma center
hospitals. The following is a breakdown of burn care dollars to be received by non-trauma acute
care hospitals.

Trauma Carts: Trauma carts were developed based on ATLS guidelines for the ability to surge to
50 patients per center. A total of $800,000 was allocated at $26,998.80 per community non-
trauma center acute care hospital.

Burn Care Supplies and Equipment: The list of burn care supplies and equipment was approved
by the Burn Care Task Force, and Burn Care chair. The statewide advisory committee allocated
$4.7 million for burn supplies and equipment and burns training. Of this, $3,600,000 was allocated
for burn care supplies and equipment. Each community non-trauma center acute care hospital
received an offer of $120,000. Most accepted and the burn care supplies and equipment are now
in place.

The contract managers from the division’s Administrative Services Unit continue to monitor the
burn care supplies and equipment and trauma crash carts. The monitoring began in December
2009 and is ongoing. Annual Status: The burn care task force reviewed and made
recommendations for the 2010-2011 burn care supplies and medications to the Hospital Surge
Committee effective 6/1/2010. This request was implemented in October 2010.

Operating Room Supplies and Equipment (2008 and 2010): $5.3 million was given to the Level I
trauma centers and Sacred Heart Level II Trauma Center for operating room supplies and
equipment to improve surge capacity in the event of a bomb, burn or blast incident. The recent
release of the 2010 program funding provided another $3 million to provide enhanced operating
room supplies in order to improve surge capacity at Level II and Pediatric trauma centers in the
event of bombs, burns and blast. These supplies and equipment either are now in place or are
being placed at the participating centers.

Disaster Training Program for Physicians and Nurses (2008-2011): $110,000 was provided for
education and training on disaster preparedness, triage, resuscitation and treatment for trauma


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surgeons and emergency room nurses. As of April 2010, a total of 14 educational training
programs were conducted, educating approximately 450 health care providers from the 21 trauma
centers and approximately 19 other hospitals.

Disaster Management and Emergency Preparedness (DMEP) Courses: Three courses have
been held so far this Fiscal Year at Jacksonville, Melbourne and Tallahassee. Eighty
physicians and trauma nurses have completed the program. At least four – five more
courses are planned before the end of June 2011.

Pensacola (March 2011) – Sacred Heart Hospital – Leanne Brown (coordinator)

Jacksonville (March2011) – Shands Trauma One – Chad McIntyre (coordinator)

Tallahassee (#2) – (April 30th tentatively) – Tallahassee Memorial Hospital– Pattie Stadler
(coordinator)

Tampa (#2) – (May) – Tampa General – John Armstrong MD (lead instructor)

On May 21, 2010, the Office of Public Health Preparedness submitted the Hospital Preparedness
Program Cooperative Agreement Application for FY 2010 -11 to ASPR on May 21, 2010. The
application was funded to include $59,000 for face-to-face courses and $121,000 to work with the
American College of Surgeons’ (ACS), Chicago office, to develop an electronic version of the
course. However, since that time, the ACS has decided to fund the development of an electronic
version, without the funding from the state of Florida. Therefore, Bureau of Preparedness and
Response, withdrew $100,000 from this grant for redirection to other priority grants allowing us to
keep $20,000 for additional face-to-face courses in FY 2010 and to test the ACS electronic
course if it is completed before the end of the FY 2010.

A request to fund 3-4 face-to-face courses in FY 2011 and to fund some slots for the
electronic version in FY 2011 has been submitted. However, at this time the funding
decision is uncertain.

2006 - 2007 and 2008 - 2010 HRSA Grant Implemented for Trauma Centers: Twenty-one trauma
centers received $252,000 for ICU surge capacity. Trauma carts developed for the ability to surge
to 50 patients per center and are now in place.

Burn Care Second Edition DVD: The DVD was sent to Florida’s trauma centers, 60 non-trauma
centers, 262 EMS providers, and 60 flight programs. The DVD has been distributed to the 50
states and two territories from 9/2007 and requests for the DVD are ongoing. Year-to-date: A
total of 50,000 pre-hospital and 28,000 health care providers have been educated on burn care.
Copies of this DVD are available. At the Strategic Planning Oversight Team meeting in March
2010, a request for $250,000 to update the Burn Care 2nd Edition DVD to include blast injuries was
submitted. Funding has been granted to redevelop and update the Burn Care CD to also include
training on crush injuries and revised burn care poster by June 2011. With a very compressed
time frame turn around, the project is underway with Dr. David Mozingo at the University of
Florida, Gainesville serving as lead subject matter expert working with the Burn Care Task Force
and other trauma physicians to determine changes and new material to add to a revised edition of
the DVD.
The ASPR grant for Bombs, Burns, and Blasts SME sought clinical curriculum technical
assistance on CD educational development, implementation and program evaluation.


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Outcome: Literature search is being conducted to review methodologies for program
evaluation of the curriculum. Completion date was February 17, 2011.

Mass Casualty Traumatic Brain Injury DVD: At the March 2010 Strategic Planning Oversight Team
meeting, a request for $125,000 in funding was requested to update the Mass Casualty TBI DVD
to include blast injuries. With a very compressed time frame turn around, the project is
underway with Dr. Marda, University of Florida Gainesville, serving as the lead subject matter
expert.
Nationally recognized neurosurgeon Dr. David Okonkwo, Director Neurotrauma, Associate
Professor, University of Pittsburg and Principal Investigator for $ 25 M TBI grant. He has
agreed to assist the SME and his core team with the development of ASPR grant funded TBI
project. Outcome: Review of the literature has begun and contact with the military for
surgical techniques being used in Iraq and Afghanistan.

HRSA – Phase II - Advanced Burn Training Program for Trauma Surgeons and Trauma Nurses:
The $1.57 million HRSA grant to develop a highly specialized, advanced burns training program for
Florida trauma surgeons and trauma nurses has been completed, peer reviewed and delivered.
The program is designed to provide advanced triage and patient-care scenario training related to
victims of bombs, burn and blast who are received at trauma centers without burn centers or who
are being triaged and treated at the scene. The development is completed and the program is
functional now as a stand alone program of the University of Florida.

HRSA – Phase III - Burn Care Grant ($585,000): Phase III of the Burn Care Physician Training
Program is now completed. The operational burns advanced education program was approved
initially for the FY 2007-2008 HRSA Grant Program. The web-based training program, developed
by the DOH and the University of Florida/360ed project team (lead by Dr. David Mozingo), known
as “Burn Center” is a video game that is a medically accurate, web-based interactive six-eight hour
presentation with up to 40 different patient scenarios, which upon completion can earn continuing
medical education units for trauma surgeons and continuing education units for trauma nurses.
The Burn Center simulates surgical procedures specific to injuries received from bombs, burns and
blast incidents.

The web-based training program went active in mid-October 2008 for web beta testing and is now
fully operational. Participant nominations were solicited from the trauma medical directors and
trauma program managers of each state verified trauma center earlier. Over 260 trauma
physicians, residents/fellows and trauma nurses have been provided access codes to the web-
based training program. The DOH funded portion of the program closed out in November 2009.
However, under an agreement with the University of Florida, the Office of Trauma continues to be
able to provided access to a limited number of new trauma surgeons and new trauma nurses over
the next year. Surgeons and trauma staff that have already been granted access are strongly
encouraged to complete the training program within the next 90-120 days. Additionally, the
program will now be made available to other physicians and out of state trauma personnel through
the University of Florida. Additionally, a tailored version developed and presented for EMTs and
paramedics over the next two years, is a goal in the project. The DOH involvement in the basic
program development is now over. However, this program continues to be ongoing on an
individual enrollee process through the vendor for the University of Florida. The tailored version for
EMTs and paramedics still needs to be developed in the future. The basic on-line training
program for physicians and nurses is now functional as a free-standing program of the
University of Florida through a private provider.
This quarter the web based training program for trauma physicians, residents/ fellows,
medical students and trauma nurses has reached over 150 participants. This program

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continues to be ongoing on an individual enrollee process. The curriculum is a video game
that is medically accurate, web-based interactive six-eight hour presentations with up to 40
different scenarios, which upon completion can earn continuing medical education units for
trauma surgeons and continuing education units for trauma nurses. The program simulates
surgical procedures specific to injuries received from bombs, burns, and blasts. Since the
inception of this program in 2009, over 650 medical personnel have been trained and 300
trauma nurses.

Trauma & Disaster Telemedicine Project: On May 21, 2010, the Office of Public Health
Preparedness submitted the Hospital Preparedness Program Cooperative Agreement Application
for FY 2010-11 to ASPR on 5/21/2010. The application included the request for $300,000 for
Phase III of the telemedicine project to expand telemedicine to additional trauma centers and rural
hospitals. The Phase III request for the FY 2010-11 grant to continue the expansion of the Trauma
Telemedicine Network was approved at a higher amount of over $630,000. This is allowing the
state to bring on Holmes Regional Medical Center Trauma Center and Tallahassee Memorial
Hospital Trauma Center, with at least one distant/rural facility connected to each, plus providing
modest sustainment funds to current mini-hubs and funds to add at least one more distant/rural
facility at most of the current mini-hubs. Unfortunately one trauma center scheduled as a new
hub for FY 2011 was unable to participate. However, one additional distant/rural emergency
facility is also being added to the Tallahassee project, to the Sacred Heart Telemedicine
hub, and to the Orlando Telemedicine hub that was established in FY 2010.

Phase IV (FY 2011) of the Trauma Telemedicine Project, which could add one or two
additionally strategically located trauma centers and several more rural/distant emergency
facilities has been submitted for funding consideration. The Trauma Telemedicine Project
is now integrated into a more overall hospital communications large project to meet revised
national objectives for submitting projects for funding.



TRAUMA LEGISLATIVE AND RULE PROMULGATION UPDATES
2011 Legislative Session Update: During the 2011 Legislative Session, the Office of Trauma
staff reviewed and/or analyzed 27 of the 61 bills assigned to the Division of Emergency
Medical Services and covered these bills during House and Senate committee and session
meetings. Each week prior to, during and after the session, the Office of Trauma provides
weekly updates on the progress of trauma related legislation in the weekly Traumacomm
Newsletter. An end of the session report will be included in the second quarter Office of
Trauma Report.

Rule Promulgation Update: On January 4, 2011, the Governor signed Executive Order 11-01.
Section 3 of this order suspended all state agency rule promulgation activities for a three
month period until the Office of Fiscal Accountability and Regulatory Reform has been
established and an analysis of the state agencies rules has been completed. Due to this
order, the Office of Trauma cancelled the February 16 hearing scheduled for Rule 64J-2.010,
F.A.C. and withdrew the Notice of Proposed Rulemaking. All other rule promulgation
activities were also placed on hold until the suspension is lifted by the Governor’s Office.

The Office of Trauma distributed rule and statute surveys via the Traumacomm to obtain
stakeholder input on whether the rules and statutes needed revisions. The Office of Trauma
staff and attorney conducted a rule and statute review pursuant to the Executive Order
utilizing responses to the Office of Trauma’s rule and statute surveys. The analysis was

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completed and submitted to the Office of Fiscal Accountability and Regulatory Reform
(OFARR). The Office of Trauma is in the process of developing a rulemaking plan for 2011
to resume rule development activities to make revisions to the Trauma rules based on our
rule analysis that do not require statutory revisions. All rulemaking activities must now
have approval by OFARR prior to the Notice of Rule Development and prior to the Notice of
Proposed Rulemaking if the intent of the rule revisions change after rule development is
completed.

Documentations regarding the rule development workshops and hearings that were
pending at the time of the Executive Order are posted on the Office of Trauma web site at
the following link: http://doh.state.fl.us/demo/Trauma/notices.htm.

Trauma related rule notices are published in the Florida Administrative Weekly, posted in the Office
of Trauma list service: Traumacomm, and on the Office of Trauma “Statute and Rules“ webpage
at: http://doh.state.fl.us/demo/Trauma/statutes.htm.

To subscribe to Traumacomm, visit: http://ww7.doh.state.fl.us/mailman/listinfo/office_of_trauma

For information regarding rule promulgation activities of the Office of Trauma, please contact Janet
Collins, Program Administrator, Office of Trauma at (850) 245-4440, ext. 2775 or via email at:
janet_collins@doh.state.fl.us or Priscilla Davidson, Governmental Analyst I, Office of Trauma at
(850) 245-4440, Ext. 2483 or via email at Priscilla_Davidson@doh.state.fl.us.



TRAUMA SYSTEM 2010 ANNUAL REPORT

It is time again to begin preparing the 2010 Florida Trauma System Annual Report. The
Office of Trauma staff began work on the 2010 Final Florida Trauma System Strategic Plan
Update to close out the 2006-2010 Florida Trauma System Strategic Plan for inclusion in the
2010 annual report. Conference calls will be scheduled for early May with the trauma
centers, burn care centers and the trauma agencies to go over the layout for the next report
and guidelines for preparation and submission of the respective sections of the report. The
due date for submission of the annual reports for the trauma centers and burn care centers
is June 15, 2011. We have extended the submission date for the trauma agency reports
from May 1 to June 15, 2011.



TRAUMA SYSTEM STRATEGIC PLAN UPDATE
Florida Trauma System Plan Advisory Committee (FTSPAC) Activities and Outcomes: Due to
state travel restrictions and budget limitations, the department and the Division of
Emergency Medical Operations made the decision to look for other alternatives to complete
the valuable work done by the department’s advisory councils and committees through the
use of video/teleconferencing. The March Florida Trauma System Plan Advisory Committee
meeting was cancelled. The Office of Trauma is planning the next meeting via video/
teleconferencing for mid-June. As soon as the date is finalized, information regarding this
meeting will be posted in the Florida Administrative Weekly, the Traumacomm Weekly
Newsletter, and on the Office of Trauma, “Florida Trauma System Plan Advisory
Committee” web page.


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For a copy of previous minutes of the Florida Trauma System Plan Advisory Committee meetings
or if you have questions regarding the committee’s 2010-2011 strategic planning activities, contact
Janet Collins, Program Administrator, Office of Trauma at (850) 245-4440, ext. 2775 or via email
at: janet_Collins@doh.state.fl.us

For future trauma related meeting and other notices and events, please visit the Office of Trauma
web site at http://doh.state.fl.us/demo/Trauma/committee.htm and subscribe to the Office of
Trauma List Service: “Traumacomm,” which is a weekly newsletter which informs and updates the
trauma system continuum of care partners of state and national news and events.

To subscribe to Traumacomm, visit: http://ww7.doh.state.fl.us/mailman/listinfo/office_of_trauma


Trauma System Planning Teams – 2011 Activities and Outcomes

GOAL 1 – Leadership Planning Team
Department Leadership:          Shairi Turner, M.D., M.P.H., Deputy Secretary for Health
                               Jean Kline, Director, Division of Emergency Medical Operations
Planning Team Lead:            Susan McDevitt, Director, Office of Trauma
State Trauma Medical Director: Dr. Karanbir Gill
State Trauma Medical Advisor:  Dr. Patricia Byers
Florida Trauma System Plan Committee Leadership:
Chair: Dr. Rodney Durham
Vice-Chair: Dr. Laurie Romig
Trauma Planning Team Leads

Activities and Outcomes:
   •   The director of the Office of Trauma position (Executive Community Health Nursing
       Director, within the DOH, Division of Emergency Medical Operations) has been re-
       advertised in People First. If you are interested in applying for this position, please
       visit the following link at http://jobs.myflorida.com/viewjob.html?refnode=1930550.

       If you know others that might be interested, please forward this notice and link to
       them. Please note that the closing date is May 13, 2011.

   •   During the first quarter, the Office of Trauma worked closely with the department
       leadership to request authority to conduct a preliminary special study to develop
       evidenced-based guidelines to be used by the department in the determination of
       new trauma center locations. In addition to the special study, the department budget
       and legislative staff also worked with the Budget Committees to draft proviso
       language to request budget authority to utilize the Trauma portion of the EMS Trust
       Fund to provide funding to conduct another Comprehensive Assessment of the
       Florida Trauma System in accordance with Goals 1 and 8 of the Florida Trauma
       System Strategic Plan.

   •   Based on 2010 revisions to s. 20.43(6), F.S., all advisory councils and committees not
       specifically established in a separate statute, must be established and appointments
       made by the DOH, State Surgeon General. During the second quarter, the Office of
       Trauma will be working closely with the Leadership Planning Team to reorganize the
       Trauma System Advisory Committee to comply with the revisions to this statutory
       revision. A call for individuals interested in serving on the new trauma advisory

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       council will be released in May. We hope to have the new committee appointed by
       July 1, 2011.

   •   In January, the Office of Trauma staff updated the Florida Trauma System Fact Sheet.
       The fact sheet was utilized by the Florida Chapter of the American College of
       Surgeons and the Florida Committee on Trauma members during the 2011
       Legislative Day at the Capitol. The purpose of this event was to educate the trauma
       centers respective legislators about Florida’s trauma centers and Florida’s inclusive
       continuum-of-care system. The updated fact sheet is available on the Office of
       Trauma website under “Trauma Awareness.”

   •   Susan McDevitt attended and participated in the Association of Florida Trauma
       Coordinators’ meeting on March 3 and the Florida Committee on Trauma meeting on
       March 4 to provide an update on the Office of Trauma activities.

   •   Trauma Awareness Day: Dr. Karanbir Gill, Chair of the Florida Committee on
       Trauma, partnered with the Office of Trauma to sign the 2011 Proclamation
       designating May 18, 2011 as Trauma Awareness Day. The proclamations will be
       distributed to the continuum-of care providers, in early May 2011.


GOAL 2 – Prevention Planning Team
Lead: Dr. Olumide Sobowale
Staff Liaisons: Susan McDevitt and Michael Lo (Office of Trauma)
                Lisa Vanderwerf-Hourigan (Office of Injury Prevention)

Activities and Outcomes:

Strategic Planning:

The Prevention Planning Team face-to-face meeting scheduled for March was cancelled due
to state budget and travel restrictions. There were no conference calls held for this
planning team during the first quarter. The Planning Team is scheduled to hold a
conference call on May 6 from 10:00 – 11:30 a.m. Eastern Time (9:00 – 10:30 Central) to
review and approve the team’s action plans for 2011-2012 and begin the implementation of
the Goal 2 strategies included in the new five-year strategic plan. The agenda and
conference call number will be posted in Traumacomm.

The following are status reports on other injury prevention projects:

Florida Motorcycle Safety Coalition/Florida Department of Transportation(FDOT) Motorcycle Safety
Grant: Dr. Patricia Byers, Susan McDevitt and Michael Lo attended the Department of
Transportation Motorcycle Coalition meeting held in Tampa on January 13-14, 2011. Copies
of the 2010 Florida Trauma System Annual Report and the 2011-2015 Florida Trauma
System Strategic Plan were distributed to the coalition members. Dr. Byers and Susan
presented an update on the Office of Trauma activities, including the motorcycle safety
education grant from the Florida Department of Transportation.

During the first quarter, the Motorcycle Safety Grant team developed grant deliverables in
the areas of EMS educational materials for transfer of the patient to the nearest trauma



Page 11 of 26                                                                      Revised 05/02/11
center. For information regarding the status of this grant, please see the “Trauma System
Grants” section of this report.

Michael Lo, Office of Trauma Epidemiologist, networked with faculty researchers at the
Center for Urban Transportation Research at the University of South Florida to discuss a
possible collaboration on a motorcycle crash data linkages project involving the Florida
Trauma Registry. Michael appeared before a panel of in-state, out-of-state, and federal
stakeholders in Orlando on March 15 as a panel discussant on motorcycle safety data and
analysis issues.

If you would like more information about this project, please contact Susan McDevitt, Director of
the Office of Trauma at (850) 245-4440, ext. 2760, or via email at:
Susan_McDevitt@doh.state.fl.us.

Gang Violence Project The assistant director of the Office of Minority Health, Monica Hayes, has
identified the need to work with the Office of Trauma in identifying areas throughout the state that
are high risk for gang violence. This endeavor will include building on the gang violence project
that the FSU nursing students completed in 2009. These students completed a needs
assessment, survey instrument tool and literature review. This documentation of the literature was
placed on the Office of Trauma web-site, “Injury Prevention” web page at the following link:
http://doh.state.fl.us/demo/Trauma/index.html. During the first quarter of 2011, the CDC’s new
web site link “Youth Violence: STRYVE to Prevent Youth Violence” was added to the “Injury
Prevention” web page.

In addition to the partnership regarding gang violence, the Office of Trauma has agreed to work as
a collaborative partner with the DOH Office of Minority Health to assist in the development of
partnerships with faith and community-based programs, college and university entities,
professional associations, law enforcement, and other agency partners. This partnership will bring
together government, healthcare providers, and institutions of higher learning with a common goal
– to eliminate disparities in health care. This coordination between the Office of Minority Health
and the Office of Trauma staff will include the development of training and educational materials to
educate communities on gang violence and the signs and symptoms of traumatic injuries.

On October 9, 2010, Ms. Hayes provided an acknowledgement of partnership between the Office
of Trauma and the Office of Minority Health to implement the pilot plan on gang violence to
address the reality of increasing gang violence and the resulting consequences to the Gadsden
County communities, workforce, educational and the healthcare delivery systems. The pilot is
designed to do the following:
       •   Conduct a model that includes the following components infused with cultural and
           linguistic competency;
       •   Provide training in cultural and linguistic competency for all involved in the pilot;
       •   Enhance curriculum for elementary and middle school students to include: positive self-
           esteem, good decision-making, self-control, and anger management;
       •   Coordinate faith and community-based work with parents of school children to support
           and promote sound parenting practices;
       •   Coordinate efforts between trauma center personnel and the community in response to
           gang violence; and
       •   Develop internships for Masters Level Social Work students to provide support for
           clinical staff of the Tallahassee Memorial HealthCare ER on evening and weekend
           hours to facilitate the patient, parental, and community interface.


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       Anticipated Outcomes:
                •   Address the systemic issues leading to membership and participation in gang
                    violence;
                •   Identify the mechanism for injuries to gang violence patients;
                •   Track and trend quarterly by number of patients seen with gang violence signs
                    and symptoms, and transferred from Gadsden Community Hospital to
                    Tallahassee Memorial Hospital;
                •   Ensure appropriate follow-up of trauma services provided to address both the
                    physical and emotional aftermath for victims of gang violence; and
                •   Identify community resources available and guidelines for sharing with case
                    managers and social workers.

       The ultimate goal is to replicate this pilot in other trauma centers throughout the state to
       decrease incidents of traumatic injuries due to gang violence and the resulting disruption of
       lives and community.

Florida Injury Prevention Advisory Council Meeting: Due to current travel restrictions, the
Florida Injury Prevention Advisory Council met by conference call and WebEx on April 6,
2011. Susan McDevitt and Michael Lo presented stakeholder updates from the Office of
Trauma. Cindy Magnole, RN, Injury Prevention Coordinator at Jackson Memorial Hospital,
was the featured speaker and presented an in-service on human trafficking.

University of Florida Public Health Student Intern/Trauma Center Injury Prevention Program
Classification: The Office of Injury Prevention hosted a Master of Public Health student
intern from the University of Florida, Joseph Watson, during the spring 2011 semester
beginning in January. In addition to completing a special injury epidemiology research
project, Joseph assisted the Office of Injury Prevention, the Office of Trauma, and the
Prevention Planning Team to systematically classify each trauma center-based injury
prevention effort reported in the 2009 Florida Trauma System Annual Report as an
“activity,” “project” or “program” according to definitions developed by the Office of Injury
Prevention and the Florida Injury Prevention Advisory Council. He also assisted in the
development of a statewide injury prevention tracking tool to be used by trauma centers to
report their 2010 injury prevention efforts appropriately as an “activity,” “project” or
“program.” Use of these common definitions will enable the valid evaluation of these
efforts.

A copy of the inventory of trauma center-based injury prevention efforts, which includes
information about the injury prevention activities, projects and programs conducted by
Florida’s trauma centers in 2009, and the Injury Prevention Classification and Definitions
Guide can be obtained from the Office of Trauma Injury Prevention web page at:
http://doh.state.fl.us/demo/Trauma/InjuryPrevention.htm



GOAL 3 – Disaster Response Planning Team: Emergency/Disaster Preparedness
Response
Co-Chairs: Dr. John Armstrong, Dr. Eric Frykberg, Dr. David Mozingo, Dr. Mauricio Lynn,
Dr. Antonio Marttos
Staff Liaisons: Susan McDevitt and Janet Collins




Page 13 of 26                                                                          Revised 05/02/11
Activities and Outcomes:

The Disaster Response Planning Team face-to-face meeting scheduled for March was
cancelled due to state budget and travel restrictions. There were no conference calls held
for this planning team during the first or second quarter. The planning team is scheduled to
hold a conference call on May 17 from 1:00 – 2:30 p.m. to develop the team’s action plans
for 2011-2012 and begin the implementation of the Goal 3 strategies included in the new
five-year plan. The agenda and conference call number will be posted in Traumacomm.

The following are status reports on other projects of the Disaster Response Planning Team in
2010:

Protocol for Utilization of Tourniquets: Dr. John Armstrong developed a protocol for use in the
trauma centers and for EMS providers for the proper utilization of a tourniquet. He presented the
protocol in the joint planning team meeting during the January 28, 2009 meeting and with the EMS
medical directors on January 28, 2009 for their review and comments. Dr. Armstrong has
incorporated suggestions for improvement to the protocol and presented the revised draft to the
EMS medical directors during their June 2009 meeting. The protocol was reviewed for final
approval at the EMS Advisory Council meeting in October 2009. The protocol was approved for
implementation at the January 2010 EMS Advisory Council meeting. Mandatory education and
training is ongoing.

Mass Casualty Incident (MCI) Plan: The MCI plan was developed and approved by the Mass
Casualty Task Force. Dr. Mauricio Lynn presented the MCI plan to the Florida Committee on
Trauma members. The committee approved the plan as written on July 9, 2008. During the third
quarter of 2008, a draft action plan, including timelines, was developed for program
implementation. Two conference calls were held during the third quarter of 2008 relating to the
mass casualty plan, as well as the action plan. The MCI plan and action plan was reviewed and
discussed during the Trauma Medical Consultants’ Disaster Response Planning Team meeting,
and the Florida Trauma System Plan Committee meetings held January 28, 2009. On March 16,
2009, members of the Disaster Response Planning Team participated in a conference call with the
director and staff of the DOH Office of Public Health Preparedness, the Office of Emergency
Medical Operations, and the director of the Office of Trauma, to discuss and further refine the Mass
Casualty Incident Plan and Action Plan. A basic MCI action plan was developed and the initial part
of the project completed. The next step is further refinement and scaling of the MCI plan to various
size facilities.

At present, this part of the project is on the approved list, but funds are not available at this time to
continue the development. The Office of Trauma staff is in the process of developing a task force,
in conjunction with the Florida Committee on Trauma, which will include representatives of the
Office of Public Health Preparedness and the Office of Emergency Operations. The purpose of the
task force is to further refine the mass casualty incident plan to include acute care, critical access,
and rural hospitals.

Trauma & Disaster Telemedicine Project: The Office of Public Health Preparedness submitted the
Hospital Preparedness Program Cooperative Agreement Application for FY 2010-11 to ASPR on
5/21/2010. The application included the request for $300,000 for Phase III of the Telemedicine
Project to expand telemedicine to additional trauma centers and rural hospitals. The request to
continue the expansion of the Trauma Telemedicine Network was approved at a higher amount of
over $630,000. This will allow the bringing on of one Level II trauma center, Tallahassee
Memorial Hospital, with two distant/rural facilities connected and adding an additional
distant/rural facility at Sacred Heart, Orlando and Miami telemedicine hubs. Additionally,

Page 14 of 26                                                                             Revised 05/02/11
modest sustainment funds were provided to current hubs facilities. See the Grant section above
for a more detailed update. Phase IV (FY 2011) funding has been requested to further expand
the systems connections.



GOAL 4 – Prehospital and Transport Planning Team
Co-Leads:       Dr. Laurie Romig, Dr. Joe Nelson, Dr. Andrew Kerwin
Staff Liaisons: Susan McDevitt, Janet Collins (Office of Trauma
                Roy Pippin, Melissa Keahey (Bureau of EMS)

Activities and Outcomes:

Strategic Planning:

The Pre-Hospital and Transport Planning Team face-to-face meeting scheduled for March
was cancelled due to state budget and travel restrictions. There were no conference calls
held for this planning team during the first quarter. The Planning Team is scheduled to hold
a conference call on May 17, 2011 from 3:30 – 5:00 p.m. Eastern Time (2:30 – 4:00 p.m.
Central) to review and approved the team’s action plans for 2011-2012 and begin the
implementation of the Goal 4 strategies included in the new five-year plan. The agenda and
conference call number will be posted in Traumacomm.

Rule Reviews (Pre-Hospital, Adult and Pediatric Trauma Criteria, and Trauma Transport
Protocols): Due to the Governor’s Executive Order 11-01, Section 3 – Suspension of
Rulemaking, the rule development activities regarding the rules regarding pre-hospital and
transport of trauma patients has been suspended until further direction from the Governor’s Office
of Accountability and Regulatory Reform and the suspension on rulemaking is lifted.

Once the suspension is lifted, this planning team will work closely with the Legislative Committee of
the EMS Advisory Council, EMS and Trauma constituent groups, and the Trauma Triage Work
Group to review these rules to identify revisions needed to improve the quality of services provided
to trauma patients.

Trauma Triage Work Group Update

Goal

The CDC released updated recommendations for trauma triage from a national perspective. The
State of Florida Department of Health, Florida Committee on Trauma, the Pre-hospital and
Transport Planning Team, and the trauma program managers group requested a cross comparison
and analysis of the current state criteria with the CDC recommendations.

Actions

   •   A group of interested trauma system experts was developed to review and provide
       expertise at determining which criteria needed revision, elimination, or addition. Bi-monthly
       conference calls were conducted during the third and fourth quarters of 2010 and the first
       quarter of 2011 to help design the plan and future recommendations.




Page 15 of 26                                                                          Revised 05/02/11
   •   A comprehensive research of outcomes studies and national systems was conducted and
       reviewed among the members. A survey was posted to assist in aggregation opinions of the
       work group and finalize recommendations and next steps in the process.

Ongoing/Current

   In January and February 2011. The group reviewed the survey results and the team
   discussed recommendations for a future study on the effectiveness of the triage
   methodology. The focus would be on formulating how to measure effective outcomes of
   triage, scope of over triage and acceptable margins for both over and under triage. A
   secondary goal would be looking at BSCIP markers for transport to correct facilities
   from the scene of the accidents.

   The work group completed the primary review and recommendations and a draft
   summary report was reviewed and final recommendations were incorporated. An
   updated system wide education CD was a primary recommendation. No significant
   changes to the state triage criteria have been defined at this time. Elder criteria and
   severity of pelvic trauma remain under consideration. A summary report of findings and
   recommendations will be presented during the Pre-Hospital and Transport Planning
   Team conference call scheduled for May 17, 2011.


GOAL 5 – Trauma Centers Planning Team
Co-Leads:       Dr. Patricia Byers and Dr. Ernest Block
Staff Liaisons: Susan McDevitt, Bernadette Behmke, and Janet Collins

Activities and Outcomes:

The Trauma Center Planning Team face-to-face meeting scheduled for March was cancelled
due to state budget and travel restrictions. There were no conference calls held for this
planning team during the first quarter. The Planning Team is scheduled to hold a
conference call on May 16, 2011 from 10:30 – Noon, Eastern (11:30 – 1:00, p.m. Central), to
develop the Team’s action plans for 2011-2012 to begin the implementation of the Goal 5
strategies included in the new five-year plan.

The following is a status report on other activities of the Trauma Center and Standards Planning
Team during 2011:

Rule Activities Assigned to the Trauma Center Planning Team:

       •   Rule 64J-2.011 – 2.017, F.A.C. – Trauma Center Requirements, etc. During the
           June 28 meeting, the planning team agreed to move forward with a rule
           development workshop to begin the review of surgical and non-surgical
           specialist requirements for trauma centers. The workshop was held on August
           17, 2010 and comments were received during and after the workshop. Based on
           comments received after the workshop, the Office of Trauma decided to hold
           another rule development workshop on December 9, 2010. Due to the Governor’s
           Executive Order 11-01, no additional rule development activities on these rules
           were held during the first quarter of 2011. See the Rule Promulgation Update
           section within this report for further details regarding the December 9 workshop
           and the Governor’s Executive Order.


Page 16 of 26                                                                        Revised 05/02/11
Electronic Pre- Survey Questionnaire (EPSQ):
In an effort to streamline the preparation and document accumulation for site surveys, an electronic
pre-site survey document was created.

Actions:

Ongoing/Current:

Congratulations to Lee Memorial Hospital, St. Mary’s Medical Center, Delray Medical Center,
Lakeland Regional Medical Center, Broward General Hospital, and Memorial Regional Hospital for
completing the first e-PSQ used by a DOH and ACS survey team. The process was seamless for
the survey team and reduced redundant copies and paper product use. These hospitals provided
excellent insight into form revisions that will be utilized in future surveys.

The pilot team continues to provide advice on revisions to the initial concept. The DOH Team has
monitored recommendations, changes and alignment with regulatory standards.


Statewide Interagency Work Group on Trauma Informed Care

The Statewide Interagency Work Group is a trauma informed care network that includes a group of
health care professionals with backgrounds in social work, mental health, as well as sexual and
domestic violence counselors, and representations from alcohol and drug abuse counselors. Dr.
Jane Streit has been working with the Office of Trauma staff related to initiation of psychosocial
support groups at the respective trauma centers. The director of the Office of Trauma attends and
participates in the quarterly Interagency Trauma Team meetings. A work group meeting was
held in January to continue discussion and work on the psycho-social support needs of
trauma patients and the development of a strategic plan.

Presented the 2010-2015 Florida Trauma System Strategic Plan goal specific to
Rehabilitation and psychosocial support. Outcome: A task force is being formed to do an
analysis of the 22 trauma centers.

If you have any suggestions that you would like the planning team to consider regarding the above
projects, please provide your comments to

Dr. Patricia Byers (pbyers@med.miami.edu)
Susan McDevitt (Susan_McDevitt@doh.state.fl.us) or
Bernadette Behmke (Bernadette_behmke@doh.state.fl.us)



GOAL 6 – Rehabilitation Planning Team: Medical Rehabilitation for Trauma Patients
Co-Leads:       Dr. Gillian Hotz, Dr. Cynthia Beaulieu, and John Kuluz
Staff Liaisons: Susan McDevitt, Janet Collins (Office of Trauma)
                Thom DeLilla, Bill Reineking (Bureau of Brain and Spinal Cord Injury)

Activities and Outcomes:

Strategic Planning:



Page 17 of 26                                                                           Revised 05/02/11
The Rehabilitation Planning Team face-to-face meeting scheduled for March was cancelled
due to state budget and travel restrictions. There were no conference calls held for this
planning team during the first quarter. The Planning Team is scheduled to hold a
conference call on May 17, 2011 from 3:30 – 5:00 p.m. to develop the Team’s action plans
for 2011-2012 to begin the implementation of the Goal 6 strategies included in the new five-
year plan.

Pediatric Rehabilitation Study: No funding has been identified to being the prospective
pediatric rehabilitation investigation; however, the study team continues to conduct the
retrospective investigation.

Ventilator-Dependent Pilot Project and Diaphragmatic Pacing Pilot:

       •   The Diaphragm Pacing Project Indicator, included in the January 2010, Trauma
           Center Standards Pamphlet 150-9 became effective on April 20, 2010. During the
           first quarter of 2011, the Office of Trauma staff continued to work closely with the
           trauma centers and the BSCIP to implement the Diaphragm Pacing Project
           Indicator to track the number of patients that received the surgery, are 100
           percent weaned from the ventilator and have been reintegrated into the
           community. Several meetings were held by the Office of Trauma and BSCIP staff
           during the first quarter to map the Diaphragm Pacer Program referral process.
           The group will continue to meet during the second quarter to finalize the process
           map, which will presented to the Rehabilitation and the Trauma Center Planning
           Teams for their approval during the second or third quarters of 2011.
       •   Clinical annual review of Ventilator Rehabilitation Standards by AHCA, Hospice
           and Florida Healthcare Association was completed this quarter. No major
           changes were made specific to administration, multidisciplinary roles and
           responsibilities, medical record documentation or community reintegration.
           Recommended changes were identified for the rehabilitation flow sheet,
           coordination of training and education specific to the preventative decubitus
           ulcer program and rehabilitation for the SCI pediatric patient. There is an
           identified need for psychosocial and family support groups for the TBI and the
           abused pediatric patient.

       •   Since the inception of the Diaphragm Pacer Pilot Program, there have been 13
           diaphragm pacer surgeries performed in Florida as of March 2011. Ten of these
           patients have been 100 percent weaned from the ventilator and have been
           reintegrated into the community. Two patients have been weaned for 18 hours
           per day, and one patient for 12 hours per day. There are six potential patients
           that have been identified from Broward Home for Children through consultation
           with Dr. Onders.

Decubitus-Ulcer for SCI Patient Population Colloquium: The purpose is to reduce prevalence and
incidence of decubitus in the spinal cord injury population within trauma centers, acute hospitals,
skilled nursing facilities, and for patients in their homes.

Action Steps:

 •   Increase knowledge about reducing decubitus ulcer in the spinal cord injury population
     across the continuum of care.



Page 18 of 26                                                                         Revised 05/02/11
    •    Implement and evaluate a statewide pressure ulcer prevention program for spinal cord injury
         patients in trauma centers, skilled nursing facilities, and palliative care centers.

Outcomes:

•       The Brain and Spinal Cord Injury (BSCI) Advisory Council made the following
        recommendations:

•       The BSCIP Standards for the PUP were implemented in April 2009, and evaluation process for
        2010.

•       Trauma rule promulgation was initiated on December 1, 2009 to add the PUP standards to the
        Trauma Center Standards Pamphlet 150-9 (incorporated by reference in Rules 64J-2.011,
        F.A.C.), which would require all trauma centers to have written policies and procedures for a
        preventive ulcer program. Rule 64J-2.011, F.A.C. was filed with the Department of State on
        March 31 and became effective on April 20, 2010. Mandatory statewide reporting for
        decubitus as implemented in June 2010 to present.

•       Fourth quarter statistics in 2010: The implementation of the PUP for trauma and the BSCIP
        patients indicated a 10 percent decrease in pressure ulcers of spinal cord injured patients.



GOAL 7 – Quality Improvement Planning Team
Lead:           Lianne Brown
Staff Liaisons: Dianna Liebnitzky, Michael Lo and Carma Harvey

Activities and Outcomes:

Strategic Planning:

The Quality Improvement (QI) Planning Team face-to-face meeting is tentatively scheduled
for March was cancelled due to state budget and travel restrictions. There were no
conference calls held for this planning team during the first quarter. The Planning Team is
scheduled to hold a conference call during the week of May 23, 2011 to develop the team’s
action plans for 2011-2012 to begin the implementation of the Goal 7 strategies included in
the new five-year plan.

The following is a status report on other activities of the Quality Improvement Planning Team
members and staff liaisons during the first quarter of 2011related to quality improvement efforts:

Trauma Registry Data Compliance Reports: Performance Improvement (PI) Committee
Conference Call: The PI Committee did not meet with all members this quarter; however,
Office of Trauma held a pre-call with Lianne Brown and Michele Ziglar to discuss issues for
the April 8, 2011 call.

Quality Improvement (QI) Indicator Report Summaries: In December 2010, the Office of Trauma
completed and sent a summary of the 2009 trauma center quality improvement (QI) indicator
reports back to each of the trauma centers, providing comparison data on each of the state QI
indicators (deaths, readmissions, and unplanned admissions/readmissions to ICU) between the
different trauma center designation levels, to maximize the use of the QI indicators reported
quarterly by each trauma center in a state-level trauma system QI process. These summaries

Page 19 of 26                                                                             Revised 05/02/11
were discussed during the December 3, 2010 Performance Improvement Committee conference
call, during which helpful suggestions for improvement were received. Dr. Karan Gill, State Trauma
Medical Director, also provided suggestions for improving a state-level trauma system QI process
during his visit to the Office of Trauma on December 13.

First Quarter 2011 Update: Trauma Registry Data Compliance Reports and QI Indicator
Report Summaries for 2010 will be prepared during second and third quarter 2011 after all
2010 data submissions and resubmissions are received and accepted.
As requested by the state trauma medical director, Dr. Gill, Michael Lo is working on an
analysis of trauma registry data to calculate mortality rates by trauma center level for the
following five injury indicators: grade IV liver lacerations, grade IV spleen lacerations,
ruptured aorta, complex pelvic fractures, and C2-C3 spinal cord injuries. Dr. Gill will share
the results of this analysis at the Florida Committee on Trauma meeting in Orlando on
March 4, 2011.


Goal 8 – System Evaluation Planning Team: Pre-Hospital Care Integration -
Transport, Regional Approaches – Trauma Agencies, Medical Specialists approaches to
establish regional Centers of Excellence, Regional Evaluation and Improvement of Trauma Access
to Care).
Co-Chairs:      Dr. Rodney Durham, Dr. Larry Lottenberg, Dr. Karan Gill, & Dr. Winston Richards
Staff Liaisons: Susan McDevitt, Janet Collins,

Activities and Outcomes:

Strategic Planning:

The System Evaluation Planning Team face-to-face meeting scheduled for March was
cancelled due to state budget and travel restrictions. There were no conference calls held
for this planning team during the first quarter. The Planning Team is scheduled to hold a
conference call on May 24, 2011 from 10:30 – Noon Eastern Time (9:30 – 11:00 a.m. Central)
to review and approve the draft action plans for 2011-2012 to begin the implementation of
the Goal 8 strategies included in the new five-year plan.

The following is a status report on the activities of the System Evaluation Planning Team:

Florida Trauma System Studies:

       •   Florida Trauma Service Area Analysis 2000-2009 Final Research Project Report,
           January 2011. On March 14, 2011, the Office of Trauma distributed this research
           project report, to the trauma community via the Traumacomm. This study was
           completed by Drs. Barbara Orban and Etienne Pracht from the University of
           South Florida. The study was based on criteria utilized in the 1990-1999 analysis
           of the TSAs and in accordance with the criteria included in s. 395.402, F.S. A
           population analysis will be conducted as updated U.S. Census data of Florida is
           available at http://doh.state.fl.us/demo/Trauma/forms.htm.

           In addition to this study, the Office of Trauma has requested permission from the
           State Surgeon General to request approval from the Governor’s office to conduct
           a special study. The purpose of the study is to develop evidenced-based
           guidelines to be used by the Department of Health Office of Trauma in the


Page 20 of 26                                                                         Revised 05/02/11
           determination of new trauma center locations. When approved, the Office of
           Trauma will initiate the study and will provide updates on the progress of the
           study through the Traumacomm weekly newsletter and in the Office of Trauma
           quarterly reports.

•      Comprehensive Assessment of the Florida Trauma System: Goal 8 of the new 2001-
       2015 Florida Trauma System Plan includes an objective and strategies to request
       funding to conduct another comprehensive assessment of the Florida Trauma
       System based on the 2004 Comprehensive Assessment, the Western-Bazzoli Criteria
       and other criteria identified by the department. This objective was approved by the
       Florida Trauma System Plan Advisory Committee and recommended by the Florida
       Committee on Trauma in 2010.


Update:

To implement Goal 8, Objective 1, the Office of Trauma prepared draft proviso language to
request approval from the State Surgeon General and the Governor’s Planning and
Budgeting Office to work with the 2011 Budget Committee and Conference Committee to
allocate budget authority to the DOH to utilize funding from the EMS Trust Fund, Trauma
Special Projects Category to conduct a new comprehensive assessment of the Florida
Trauma System. When the budget authority is allocated and approval to conduct the study
is received, the Office of Trauma will initiate the contract(s) for the study and provide
updates on the progress of the assessment through the Traumacomm weekly newsletter
and in the Office of Trauma quarterly reports.


Diversion Subcommittee Update: The subcommittee activities have been put on hold until the
implementation of the DOH Communication and Patient Tracking Solution and the state’s Health
and Medical Interoperable Communications Initiative (HMICI) Project. See below updates on
these projects.
Communications and Patient Tracking System:
Scott Tomaszewski, Bureau of Preparedness and Response

Update:

1. Multiple system use was a current obstacle that our trauma docs were faced with: The
Communications and Patient Tracking System (CPTS) (sometimes referred to as EMSystems,
EMTrack or EMResource) is focused on mitigating this issue by means of interfaces. ESS is the
number one priority for the system to incorporate the functionality within CPTS. Mitigations of
duplicative data entry is a current priority.

2. Trauma Doctors are anxious to see progress with the system but have not had the exposure to
the system to define business requirements and determine how to best leverage the system
modules (EMResource and EMTrack). The administrators are focused on operations and keeping
the doors open for business. Appropriate navigation of the environment is needed to preserve the
fragile support and foster stronger acceptance throughout the trauma center workforce.

Action Plan:




Page 21 of 26                                                                       Revised 05/02/11
1. Capture and document the standards of Trauma service as building block requirements for
Trauma Center View within CPTS (EMResource and EMTrack). [Owner: Trauma Center]

2. Provide Trauma center standards of service list to the Lead Agencies to start the discussions of
including Trauma Center representatives within the planned EMTrack exercises slotted over the
next few months. Scott to report back to Trauma with findings [Owner: Scott once number 1 is
provided by Trauma].

3. Alabama [Arkansas]has a good model in use that might benefit Florida's Trauma Center to get
exposure to. It was requested that we get our Trauma Center community exposed to the Alabama
installation of their trauma system to assist in Florida's adoption. [Owner: Scott Tomaszewski].

4. Determine the best approach to capture the every day functionality needed by the Trauma
doctors and staff for long term plans of EMResource and EMTrack. [ Owner: TBD]

The Office of Trauma has asked Scott to provide an update on this project during the May Systems
Planning Team and the Disaster Planning Team conference calls.


Health and Medical Interoperable Communications Initiative (HMICI) Project:
Michael Jacobs, Bureau of Preparedness and Response

Mike McHargue, Director of the Office of Emergency Operations, has assigned Mike Jacobs to
assist the Director of the Office of Trauma (Dianna Liebnitzky-Clinical Consultant) with the
implementation of this communications initiative. The following is a summary and status of the
project:

   •   The HMICI Project was created as a solution to the interoperable communications gap for
       health and medical agencies in Florida as identified by the Regional Domestic Security
       Task Forces (RDSTF).

   •   Designed to provide a means of voice communications concurrently between multiple
       hospitals, and between hospitals and other public safety agencies, the HMICI will allow for
       improved communication capabilities for Florida’s first responders, daily and during times of
       disaster.

   •   The HMICI project will interface with the existing Florida Interoperable Network (FIN) and
       will provide each hospital with the ability to communicate via the SUNCOM network and
       internet to any other hospital, public safety agency, or emergency operation center (local,
       state or federal), which is also connected into FIN. FIN was designed to be redundant and
       sustainable, and can function even if other means of communications (phone, two-way
       radio,) have failed.

   •   There are three beta test sites, Shands (Gainesville), Tampa General, and Holmes
       Regional (Melbourne)

   •   Two of the sties Shands and Tampa have the SUNCOM and HMICI systems installed and
       are operational, awaiting training prior to conducting the 30 and 60 day tests

   •   Holmes is having a wiring difficulty and is working to get this resolved prior to becoming
       operational


Page 22 of 26                                                                          Revised 05/02/11
   •   The pilot/beta test will be conducted as a “talk-around” drill once the SUNCOM lines and all
       equipment is installed, and all staff have received training.

   •   The overall project is part of a multi-faceted comprehensive State Communication Plan.

Hand Surgery Centers of Excellence Subcommittee Report: In 2009, Dr. Winston Richards, Hand
Surgery Subcommittee Chair, completed his study on hand surgeries in Florida, which has been
published in the January 2010 Edition of Journal of Trauma. The purpose of the study was to
determine the hospitals that perform replantations to determine their interest in serving as a center
of excellence. The study found that these hospitals were not interested in serving as a sole facility
for these surgeries; but expressed that this responsibility should be spread out over several
hospitals throughout the state.

This is an issue that many states are experiencing. In April 2010, Dr. Richards responded to a
national survey conducted by the American Society of Surgery of the Hand and the American
College of Surgeons. The purpose of the survey was to assess hand trauma care in Level I
trauma centers in an effort to provide optimal patient care. The survey dealt with issues related to
unnecessary referrals to Level I centers, the availability of hand and micro vascular care 24/7, 365
days a year; and hospital support in Level I centers are critical issues that will define the
opportunity to create regional centers of hand care excellence based on this survey. When the
results of this national survey are released, Dr. Richards will keep the trauma community informed.

A Rural Trauma Care Program presentation has been funded and scheduled for May to train
emergency room personnel from the Florida Keys and rural areas of south central Florida in
the latest protocols for care of extensive trauma injuries. It also addresses how to prepare
a severe trauma case for air transport to their nearest trauma center.

The Bombs, Burns, and Blast supplies project to equip selected trauma centers and key
emergency facilities with appropriate mass casualty supplies and equipment is underway.
Additionally, the Rural Trauma Project, which is in contract development, will supply a
modest amount of specialized equipment, such as pelvic stabilizers and fluid warmers
among other items, to key rural emergency facilities. Most do not have the appropriate
trauma equipment to stabilize a serious trauma case prior to transport to a trauma center.
This project will improve the care of the serious trauma patient. Coupled with this is a
separate Rural Trauma Training Course Program specifically designed to improve trauma
care at small rural hospitals.



GOAL 9 – Trauma Registry Planning Team
Co-Leads:             Dr. Joseph Tepas, Dr. Drew Mikulaschek, and Dr. Carl Schulman
Data Validation Team: Dr. Barbara Orban, Dr. Etienne Pracht, and Dr. Pam Pieper
Staff Liaisons:       Michael Lo, , and Carma Harvey

Activities and Outcome:

Strategic Planning:

The Research and Registry Planning Team face-to-face meeting scheduled for March was
cancelled due to state budget and travel restrictions. There were no conference calls held
for this planning team during the first quarter. The Planning Team is scheduled to hold a


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conference call on May 26, 2011 from 3:00 – 4:30 p.m. Eastern Time (2:00 – 3:30 Central) to
review the draft action plans for 2011-2012 to begin the implementation of the Goal 9
strategies included in the new five-year plan.

The following is a status report on other activities of the Trauma Registry/Research
Planning Team and Office of Trauma staff liaisons during the first quarter related to Goal 9:

Florida Trauma Service Area Analysis, 2000 to 2009: Using Florida hospital discharge data from
the Agency for Health Care Administration, Drs. Etienne Pracht and Barbara Orban have
completed a ten-year (2000-2009) retrospective analysis of nucleus and feeder counties that
define Florida’s trauma service areas based on rates of retention of trauma patients, defined by
section 395.402(1), F.S. as patients with an Injury Severity Score of nine or greater, by county of
residence. This analysis is important to identify priority counties for review of new trauma centers.
A draft report was completed and submitted to the Office of Trauma in August 2010.

First Quarter Update: The Office of Trauma completed their final review of the report in
January and requested minor revisions. The analysis report was released on March 10,
2011 and a copy of the study can be obtained from the Office of Trauma Forms and Reports
web page at: http://doh.state.fl.us/demo/Trauma/forms.htm.


Next Generation Trauma Registry Project: As reported in the weekly status updates on this project
by Brittney Aucutt, Project Manager, this project actually consists of three concurrent efforts to
address (1) how to immediately fix the current state of the trauma registry; (2) developing an
interim solution; and (3) developing a long-term solution. Updates on each effort are as follows:

(1) Current State: Test files have been received from Lancet Technology and Clinical Data
Management, vendors of Trauma One and TraumaBase software, respectively, that would enable
the immediate standardization of all files submitted by trauma programs using these software
products, thereby enabling easier integration and analysis of these files by the Registry Unit.

Fourth Quarter Update: This effort is currently in full swing. Standardization efforts are being
coordinated between the vendors of Trauma One, TraumaBase, and NTRACS software and their
respective trauma center customers. The Office of Trauma held several software-specific user
group conference calls during December 2010 to facilitate this standardization process.

First Quarter 2011 Update: This effort continues to be in full swing. Resubmissions of 2010
data files from some trauma centers have been requested to complete the standardization.

(2) Interim Solution: Review of the new Florida Trauma Registry Manual that will be implemented
as part of the Next Generation Trauma Registry Project has been completed with input from the
Trauma Data Group and will be implemented via the rulemaking process in January 2011 after
development of an electronic data submission format (XML schema) that is compliant with this new
manual. Extract, transform, and load (ETL) processes have been developed for importing each file
format submitted by trauma programs into an enterprise data warehouse and are currently being
tested.

Fourth Quarter Update: This effort is also currently in full swing. Initial review of the new Florida
Trauma Registry Manual was completed in October 2010 with input from the Trauma Data Group.
Due to the temporary suspension of rulemaking by state agencies ordered by Governor Rick Scott
in January 2011, implementation of this new manual is on hold. The XML schema continues to be
under development. The project team has identified and implemented an online project

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management tool, Comindwork, to manage the NGTR project, and facilitate project
communication. Project team members have begun testing files being imported into the data
warehouse via the ETL process.

First Quarter 2011 Update: NGTR project team members have imported all NTRACS data
files for 2010 via the ETL process except for the _USE table. Digital Innovations has
provided a fix for the _USE table which is currently being tested. The project team is
working to import all remaining file formats into the data warehouse by May 31, 2011.

(3) Long-term Solution: The Office of Trauma issued a Request for Information (RFI) in July 2010,
to which six trauma registry software vendors responded. On the basis of these responses, four
vendors were invited to present product demonstrations of their software to Office of Trauma staff
in July and August 2010. On the basis of these demonstrations, technical requirements will be
developed for a Request for Proposals (RFP) that will be issued in January 2011 to procure a
commercial off-the-shelf (COTS) package via the Intent to Negotiate (ITN) process as a long-term
solution for the trauma registry. In the meantime, the business case and project management plan
are currently being developed for approval by the Department of Health’s Division of Information
Technology.

Fourth Quarter Update: Project Manager Deniz Franck is currently drafting the Next Generation
Trauma Registry System Analysis and Business Case. She will also conduct a gap analysis
between a “build” versus “buy” option for the long-term NGTR application. The infrastructure
architecture and costs of hosting the long-term NGTR application remain to be resolved.

First Quarter 2011 Update: Brittney Aucutt and Scott Brannon were hired this quarter as the
new Project Manager and Business Analyst, respectively, to replace Deniz Franck, who
remains on the project team on a part-time basis. Ms. Aucutt and Mr. Brannon will resume
work on the business case and gap analysis during second quarter 2011.

If you have any questions concerning the NGTR project, please contact Ms. Aucutt at (850)
245-4440, ext. 2482 or via email at Brittney_Aucutt@doh.state.fl.us.

Research Web Page: In 2010, the Office of Trauma created a new web page, which provides
information regarding the research projects conducted by Florida’s verified trauma centers and
contains a list of the projects and publications. This web site will be updated with research
projects and publications conducted in 2010 once these are compiled for the 2010 Florida
Trauma System Annual Report. The web site link is as follows:
http://doh.state.fl.us/demo/Trauma/ResearchProjects.htm.

If you would like to review the full draft of the objectives and strategies for the Registry/Research
Planning Team, please contact Michael Lo, Trauma Registry/Research Planning Team Staff
Liaison, at (850) 245-4440, ext. 3286, or via email at Michael_Lo@doh.state.fl.us.

For information regarding the State Trauma System Five-Year Strategic Plan and Implementation,
please contact: Susan McDevitt, Director, Office of Trauma at (850) 245-4440, Ext. 2760, email:
susan_mcdevitt@doh.state.fl.us or Janet Collins, Program Administrator, Office of Trauma at (850)
245-4440, ext. 2775, email: janet_collins@doh.state.fl.us.




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TRAUMA TRANSPORT PROTOCOLS
The Office of Trauma Director reviewed and approved 62 trauma transport protocols for
EMS providers along with the licensure renewal process from January – March 2011. There
have been no adverse outcomes thus far in 2011. Technical advice was given to 50 EMS
providers in updating uniform TTPs.

If you have questions concerning Florida’s trauma transport protocols, please contact Susan
McDevitt, Director, Office of Trauma, Florida Department of Health, (850) 245-4440, ext. 2760, or
via email at: susan_mcdevitt@doh.state.fl.us




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