EMS in the FLEX Program 2008-2010 Trauma System Assessment and Development
Trauma is the leading cause of death for Americans 35 years of age and younger. 60% of the 160,000 annual US trauma deaths occur in rural areas, where only 20% of the population lives. In addition, trauma contributes 40,000,000 emergency department visits and $200 billion in economic consequences annually. Rural trauma patients are more likely to be older and more likely to die at the scene from less severe injuries than their urban counterparts are. An organized Trauma and EMS system has been proven to reduce the incidence of death and long-term disability from traumatic injury. Establishing a formal process for State designation of trauma centers is the keystone for developing a more cohesive and effective State trauma and EMS system through which trauma-related morbidity and mortality can be mitigated. The most recent (2006) version of the American Colleges of Surgeons book titled: “Resources for Optimal Care of the Injured Patient” describes an inclusive trauma system in which all acute care facilities play a role in the management of the injured patient. In some cases, this “management” will involve the immediate resuscitation, temporizing stabilization and immediate transfer to a larger trauma center according to a preestablished set of criteria and transfer protocols. States are in different places in the trauma-system development process and many states have overlooked the absolute necessity of including Critical Access Hospitals in the treatment of persons injured in rural environments. Suggested Activities: 1. Utilization of HRSA’s Model Trauma System Planning and Evaluation (MTSPE) benchmark, indicator and scoring (BIS) system (Trauma-BIS). 2. Application of the American College of Surgeons (ACS) Facilitated Trauma System Consultation program. Overview of Activities Trauma-BIS In 2006, the Health Resources and Services Administration published the “Model Trauma System Planning and Evaluation Guide.” That watershed document represented a paradigm shift in two major areas. First, it describes an “inclusive” trauma system that has a substantive role for all acute care facilities. Second, it discusses the trauma system in a public health framework. As part of the description of a public health framework for trauma, the MTSPE document includes a series of Benchmarks, Indicators and Scoring criteria that are a common measure within public health. The Benchmark, Indicators and Scoring (BIS) tool, consists of benchmarks for each of the core public health functions (assessment, policy development and assurance). A series of indicators with further definition is assigned to each benchmark. How well a system is developed is measured by indicators. Each indicator is scored according to completion steps, using a 0-5 scale. The BIS is designed to be a self-assessment tool. By using it, a system can identify its own strengths and weaknesses, select quality improvement activities, create a strategic plan and measure its own progress over time. It is not designed to, and cannot be used to, benchmark one system against another – each system is benchmarked against an ideal state trauma system attributes.
The Trauma-BIS self-assessment tool allows states to stratify indicators by score, but it is not intended to replace strategic decision-making processes that state rural health or EMS offices use to prioritize future initiatives. Those decisions will require internal deliberation about other factors such as urgency of need, resource availability, feasibility of achieving results, and stakeholder interests. States may benefit from consulting colleagues in other states that have piloted this evaluation (early pilots included Utah, Virginia, Texas, and Montana). This strategic planning process fits the second program goal. Trauma System Consultation The American College of Surgeons Committee on Trauma developed a trauma-system consultation process based on HRSA’s Model Trauma Care System Plan. The consultation can be delivered to a regional or statewide system at any phase in its development, but is most beneficial to states that have made a clear commitment to improving trauma care. The consultation is typically performed by an expert team of outside experts consisting of two trauma surgeons, an emergency medicine physician, a trauma coordinator and a state EMS director or trauma system administrator. The evaluation is preceded by a pre-review questionnaire that is completed by the trauma coordinator (along with other stakeholders), followed by an evaluation conducted over a 3 day period. The evaluation consists of participants and stakeholders in the trauma system briefing and interviewing with the evaluation team on the status of system components. The consultation team provides an analysis of the system and recommendations for improvement. What to Fund - Who Does Them States that are more mature in their trauma system development, or have already completed an ACS facilitated consultation are more likely to benefit from a Trauma-BIS assessment. States that are new (but committed) to trauma system development are more likely to benefit from the facilitated consultation. States with CAHs that have not yet been credentialed at a trauma center level would benefit from designating CAHs as trauma centers. The state EMS director and trauma coordinator must be engaged in and support any of these efforts. Trauma-BIS Year 1: Conduct a statewide or one or more regional Trauma-BIS assessment(s). While the tool is a self-assessment tool, there will be meeting costs and staff time to assimilate results. The Trauma-BIS assessment should be followed by a facilitated strategic planning process. TraumaBIS facilitators, should they be desired, are available through the American College of Surgeons Trauma Systems Planning and Evaluation Committee. The cost of the BIS facilitation process typically runs between $10,000 and 15,000. Year Two and Three: Use the results of strategic planning to implement trauma improvement activities. Trauma System Consultation The trauma system consultation is available through the American College of Surgeons. The cost varies depending on travel and meeting facility costs, but is typically around $40,000.
FLEX EMS Measure Facilitated Trauma-BIS Assessment Year One: The number of facilitated BIS assessments conducted. Years 2 and 3: the number of quality improvement activities implemented. A reassessment of BIS scores compared to the baseline score for that system. Trauma System Consultation The number of Trauma System Consultations performed in year one. The number of quality improvement activities directly linked to consultation report recommendations in years two and three. Resources and Information Trauma-BIS Complete description of the Trauma-BIS Model: http://www.hrsa.gov/trauma/model.htm Model Trauma System Planning and Evaluation Document: ftp://ftp.hrsa.gov/hrsa/trauma/traumamodel.pdf Trauma-BIS Self-Assessment Tool: ftp://ftp.hrsa.gov/hrsa/trauma/Self-Assessment_Tool.pdf ACS Trauma-BIS Facilitation: Holly Michaels, 312-202-5340 or hmichaels@facs.org Facilitated Trauma System Development Trauma System Consultation: http://www.facs.org/trauma/traumasystems.html Trauma Systems Consultation Fact Sheet: http://www.facs.org/trauma/factsheet.pdf ACS Trauma System Consultation: Holly Michaels, 312-202-5340 or hmichaels@facs.org