Advisory Committee on Trauma AGENDA

Date: May 13, 2020 Location: GoToWebinar

*Audio is only available through conference call 1-866-620-7326 Conference Code: 785 296 0613

Time: 10:00 a.m. - 12:00 p.m.

HOUSEKEEPING ITEMS: Meeting Purpose: Quarterly Meeting Call to Order: Approval of Minutes February 2, 2020

Attendees: Apologies:

STATUS REPORTS: Provided by: Items: Summary

Dr. Kimberly Molik ACS-COT Region 7 Update

Wendy O’Hare Program Update

Ren Morton Trauma Center Update

Brittney Nichols EMSC Update

Jill Cavender Registry Update

Danielle Sass Epidemiologist Update

Joe House KBEMS Update

Ron Marshall KHA Update

Topic: Regional Trauma Council Updates

NEKRTC: NCKRTC: NWKRTC: SCKTR: SEKRTC: SWKRTC:

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Action Item(s) Person Responsible

Deadline

WORKING AGENDA: Topic COVID-19 Discussion

Discussion Summary:

ATLS/TNCC/PHTLS Courses

Decision: Action Item(s) Person

Responsible Deadline

Topic Firearm Sub-committee

Discussion Summary:

The subcommittee met and developed a position statement (included in the meeting packet)

Decision: Motion: Action Item(s) Person

Responsible Deadline

Topic Legislative Update

Discussion Summary:

Wendy will provide an update on the legislative package for the current session.

Decision: Motion: Action Item(s) Person

Responsible Deadline

Topic Wesley Medical Center

Discussion Summary:

Trauma patient feedback process update

Decision: Motion: Action Item(s) Person

Responsible Deadline

Topic Promotional Materials

Discussion Summary: Decision:

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Motion: Action Item(s) Person

Responsible Deadline

OTHER TOPICS RAISED: Issue Raised By Summary To Be Discussed At

PUBLIC COMMENT: Issue Raised By Summary To Be Discussed At

NEXT MEETING: Date: August 5, 2020 Time: 10:00am - 3:00pm Location: KaMMCO, 623 SW 10th Avenue, Topeka Date: November 4, 2020 Time: 10:00am - 3:00pm Location: KaMMCO, 623 SW 10th Avenue, Topeka

2020 EVENTS: Statewide Symposium October 7, 2020

Wesley Medical Center, Wichita

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Advisory Committee on Trauma AGENDA

Date: February 5, 2020 Location: Kansas Medical Society

623 SW 10th Avenue Topeka, Kansas

Time: 10:00 a.m. - 3:00 p.m.

HOUSEKEEPING ITEMS: Meeting Purpose: Quarterly Meeting Call to Order: 10:03 a.m. by Dr. Craig Concannon Approval of Minutes November 6, 2019

1st: Dr. Jake Breeding 2nd: Janet Kemmerer November 6, 2019 minutes approved.

Attendees: Members: Dr. Craig Concannon, Dr. Kimberly Molik, Dr. Jake Breeding, Larry Salmans, Darlene Whitlock, Janet Kemmerer, Carol Perry, Tina Pendergraft, Ron Marshall, Dr. Michael Machen (via conference call), James Higgins, Representative Monica Murnan Support: Kendra Baldridge, Joe House KDHE Staff: Wendy O’Hare, Danielle Sass, Ren Morton, Brittney Nichols, Jill Cavender

STATUS REPORTS: Provided by:

Items: Summary

Dr. Kimberly Molik

ACS-COT Region 7 Update

Doug Gann passed away unexpectedly. Region 7 made a donation in his name through the Committee on Trauma to the Future Trauma Leaders. Steve Barnes (Missouri) has taken a different position in the ACS. Dr. Stepheny Berry will be a new vice-chair in the spring. Dr. Molik will be attending a meeting March 11-13th in Chicago. Dr. Molik will have more information about the CDC field triage guidelines possibly changing after the Rural Trauma Team meets on March 12th. She is expecting a lot of good information about firearm safety coming from that spring meeting as well.

Wendy O’Hare

Program Update

Wendy introduced new KDHE Trauma program staff, Jill Cavender (Registry Coordinator) and Brittney Nichols (EMS for Children Coordinator). Wendy explained the trauma program was included in the governor’s budget proposal for $150,000. Due to cost saving measures taken by staff, the current funding should be extended through FY2023 rather than initially projected end of FY 2020. Wendy asked the committee to think about other potential funding opportunities for the program as the amount in governor’s budget will not be sufficient. Fines and fees have been discouraged within the agency. Ideas assistance from insurance companies and possible grant funding, There was robust discussion about how to publicize the importance of the trauma system. Ideas included educational offerings to regional partners, increasing help to struggling trauma centers, finding the means to host a strategic planning session with Dr. Todd Maxson, having an in-person meeting with Dr. Norman, educating the legislature, highlighting the halo effect of being a trauma center, etc.

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Digital Innovation, Inc. was purchased by ESO. If anyone is having issues, please let Jill know, but the transition has been relatively seamless thus far. In the last quarter, Kansas increased the number of Stop the Bleed instructors from 765 to 811 and 12,375 individuals were trained, up from 11,523.

Ren Morton

Trauma Center Update

Ren Morton: We currently have 34 Level IV facilities. One new one, they just completed their initial site survey, they did well, then it’s up to the secretary for final approval. 3 facilities pending site surveys, 5 facilities in the PRQ stage, 7 facilities have expired, merged, or declined to pursue designation/re-designation. Tammy Newberry was a recent guest for TPM podcast PI in Real Time event. Walked through PIPS process, over 30 people on that call, great discussion, TPMs offered resources to post on website after as well. More TPM events forthcoming. Would like to develop one on compassion fatigue for providers. There was discussion about how to assist hospitals in becoming or continuing Level IV designation which included continuing Thrive, TPM workshops; assist hospitals with succession plans for staff turnovers; buddy a facility with a higher level trauma center; educate administration to the importance of designation; mentoring support between providers; future discussion about a Level V designation, request online TNCC renewal

Brittney Nichols

EMSC Update

Brittney will be doing outreach at the KEMTA Conference in Dodge City, and travel to Minneapolis, MN for the HECC which will be focusing on pediatric emergency care coordination in hospitals. She hopes to come back with a lot of good feedback. Brittney is planning a pediatric transfer workshop, March 18th in Salina. The NEDARC EMS survey is open through March 31st. An 80% compliance rate is required, we are currently at 71%, our goal is 100% compliance. Goals for the program include getting to know the EMSC Advisory Committee, management of pediatric patients, developing the Family Advisory Network, creating more materials, education, child passenger safety for healthcare workers.

Danielle Sass

Registry Update

Danielle asked the committee to discuss the possibility of formalizing the Policy Group. Not everyone understands who is supposed to be involved in the policy group. We need to determine who needs to be attending meetings, and how the information is supposed to be brought back to everyone’s individual teams/facilities/etc. The policy group meets quarterly with an open attendance policy. There will still be an open attendance policy but would like to formalize positions within the group. A survey was sent out to get feedback to over 55 people who have been registered for policy group for past 3 meetings to receive their feedback. We had 23 respondents, 2 that did not support the formalization, but those 2 also mentioned they didn’t understand who was supposed to be involved in the group. 90% support formalization. There was discussion on the wording of clinical guidance. It is intended to have the clinical expertise on how to guide us forward. Recommendations on that language would be great. Would like to see officers such as chair, vice chair, and secretary, Mandating involvement from various levels/regions has also been discussed. In addition to clinicians, maybe registrars can help facilitate the involvement of other clinicians by way of invitation to the group. There would be no budgetary requirements for this group and it was agreed all levels of trauma centers should be involved. The

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group would still make recommendations to the ACT. Tina Pendergraft moved to develop the Policy Committee. Dr. Machen seconded. After discussion, Pendergraft amended her motion to require the Policy Committee to report to the ACT on a quarterly basis. Dr. Machen concurred with this and the motion carried.

• The 2020 registry update is expected to launch in February. We do not have final documentation as of yet.

• Sass: Field Airway Data Presentation – Power Point. • Dr. Concannon: It might be too many choices. What is the goal of taking

this info and what are you going to do with this information? What is the point of collecting so much detail?

• Sass: Following change in practice guidelines. Secondary information would be medication information.

• Dr. Concannon: I think all you really want to know is whether or not the patient was intubated, not 10 different options. Joe [House]?

• Joe House: Our system is charting – so we have to have all choices in there. We have 45 choices in ours, so 10 doesn’t seem like that much.

• Whitlock: What was purpose of this? What might cause a delay in transfers?

• Sass: No. We are looking at the change in outcomes. • Sass: This is why we still want to have registrars attend still to help close

the loop, see why the data matters and how it informs policy change. • O’Hare: We also have several facilities that do not report at all. • Dr. Concannon: What can we do for facilities not reporting? • O’Hare: Letters, phone calls, letters from the governor’s office. • Sass: Some facilities who are not reporting are not trauma centers, so

there is some lack of understanding there. • Kemmerer: The registry not easy. User errors have caused problems with

their facilities compliance. • Pendergraft: Issues with website delayed our data. • O’Hare: These timeliness reports will be provided on a regular basis. • Kemmerer: Knowing what you don’t know will help. • Dr. Breeding: Maybe focus education on completing the circle of life, if you

don’t enter in registry, we cannot justify the trauma program to legislature. We need data to justify our existence.

Joe House KBEMS Update

The Board of EMS meeting is this Thursday and Friday, there is not much on agenda which is typical during legislative session. ACT has been looking through trauma system plan and trying to revise it. We are working off 1998 plan, although it was updated with only slight changes in 2001. Dr. Allen, John, Larry, and Dennis were assigned to review. They put together a revised EMS portion for review and provide feedback. Should will have final draft for next ACT.

Ron Marshall

KHA Update

CMS does not recognize trauma centers as being closest appropriate centers. Focusing on Midwest to reduce payments for EMS services. Problematic for patients if closest facility per CMS is bypassed. Some resources being used to determine most appropriate facility is incomplete and does not provide the whole picture. Planning to develop a joint statement (KMS and KHA) for recommendation to CMS. EMS crews need to know prior to transfer what resources hospitals have. Hospitals are hesitant to spend the time needed to locate specific resources of larger hospitals which they may transfer to on any particular day. Physician education on proper documentation may be needed. Use of an app may help but Wi-Fi isn’t available in all areas of the state.

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Ron Marshall reported CMS will be doing a tour of rural KS sometime this summer – representatives coming from Baltimore. They want to meet with physicians, hospitals, EMS, chamber of commerce, etc. at 3 sites in June.

WORKING AGENDA: Topic 2020 Focus Areas: Danielle and Ren already touched on.

Discussion Summary:

A survey was sent to all committee members to gauge interest in topics which will be the focus each quarter in 2020

Decision: A summary of the poll is included in the meeting packet Action Item(s) Person Responsible Deadline Determine guest speaker for each ACT meeting in 2020

Trauma Staff/ACT Members

ASAP

Topic Legislative Update

Discussion Summary:

Wendy provided an update on the program’s legislative package for the current session. HB 2527 removes the sunset provisions for provider protection during Peer Review activities. Testimony provided to legislature. There was no neutral or opposition testimony given.

Action Item(s) Person Responsible Deadline Wendy will continue to keep everyone posted as the bill progresses through.

Wendy O’Hare Unknown

Topic Firearm Sub-committee

Discussion Summary:

The Firearm Subcommittee met and developed a position statement (included in the meeting packet) for ACT to consider.

Decision: After much discussion, Darlene Whitlock agreed to make the necessary revisions for the committee to approve at the next meeting.

Action Item(s) Person Responsible Deadline Agreed upon changes will be made, electronic draft will be included in the next meeting packet.

Darlene & rest of the subcommittee.

May 2020 ACT meeting

Topic Supply Shortage and how TCs respond

Discussion Summary:

Trauma staff were notified there is a shortage of O negative blood and hospitals are having difficulty keeping it in stock. Trauma staff were also notified there is a shortage of OR gowns and this is leading to delays or postponements in surgeries. Due to a contamination issue, there is a shortage in isolation gowns, not surgical.

Decision: The instructions to the Level IVs are to keep this as a PI issue.

Topic Regional Trauma Council Updates NEKRTC: Working on project of suicide prevention, beginning w/ firearm safe storage. Looking at

CO project and what KS could do similarly. Next meeting is tomorrow.

NCKRTC: Last meeting was in January. Discussed the strength of existing trauma system and some potential areas of focus. 5 trauma centers in NC serving 12 counties, facilities w/out blood and facilities w/out providers available at all times, facilities that don’t have trauma training or lack of knowledge of where trauma resources are, EMS challenges, resources being used for non-emergencies, elective transport vs. emergency. Dr. Breeding announced he is moving to Wyoming and his last day at Salina Regional will be June 1st. Congratulations offered from all in attendance.

NWKRTC: Last meeting was in January and was spent prioritizing regional activities: critical barriers to engagement in regional system, lack of understanding of role of trauma continuum. Training is local rather than regional. Regional decline in EMS staff. Not

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much money offered to EMS volunteers. The executive committee members could offer personal invitations to others to attend meetings.

SCKTR: The region is revisiting its reimbursement policy in 2020 to set a few more parameters. They’ll be focusing on disaster preparedness as a way to engage all stakeholders in the trauma region. A subcommittee was formed to develop preparedness resources and activities that can reinforce the designation process. Ron Marshall asked why the trauma region has disaster preparedness as a focus. It was discussed that the region wants to help connect and engage more with the rest of the regional trauma system and EMS is leading this initiative.

SEKRTC: The region has a fall prevention focus. They’ve identified several system issues and needs like more instructors and more availability of courses, more regional connectivity, and more resources. They will have a table top exercise which will work like a QI project. This will be piloted at the facility furthest from regional resources. Labette Health has a new injury prevention coordinator who will present at regional symposium.

SWKRTC:

The region did a QI brainstorming activity and will focus on two areas: burden on staff, limited trauma system understanding. Discussion was held regarding engagement of St. Catherine’s in Garden City.

Action Item(s) Person Responsible Deadline Symposiums start 3/1 and end 4/15 Each Region

TOPICS IN TRAUMA: Presentation Presenter Summary Kansas EMS – A Look into Intubation and Other Advanced Airway Devices

Joe House

Addressing questions brought up by policy group. EMS side has 44 different gradations in KEMSIS. 98% of call volume in KS being reported into that system. Pulled anything less than 5 runs due to data agreements. Baseline data submission slide. Endotracheal intubations. RSI/MAI: topline # of attempts, bottom line # of times it was MARKED that procedure was successful. Meds used for RSI/MAI. All equally used across entire 4-year span. Supraglottic devices. Single Lumen devices slide. Top 5 primary impressions – not specific to trauma. We are seeing a definite upswing of single lumen airways. Intubation attempts in KS are more successful than in our surrounding states.

PUBLIC COMMENT: Raised By Summary Darlene Whitlock

Dr. Norman said he’d be glad to meet with people. Darlene feels uncomfortable presenting her opinion to Norman as to what needs to be on budget. Plan developed with several people to ask for money for some specific pools. Personal priority was to have someone from out of state come and get money for that. Also money for critical access hospital to gain Level IV. Disappointed that TPM program is so expensive and doesn’t offer CE for RN’s. That will be discussed w/ Dr. Norman. Concannon said he would like to come to the meeting. My concern today is that we barely have a quorum. I feel like we have lost our way. We have 3 members awaiting Governor appointment.

Tracy McDonald

This is Tracy’s last week at University of KS. She has enjoyed attending this committee. The committee offered congratulations on Tracy’s new endeavor.

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NEXT MEETING: Date: May 13, 2020 [February 5, 2020 meeting adjourned 2:30 pm] Time: 10:00am - 3:00pm Location: KaMMCO, 623 SW 10th Avenue, Topeka Date: August 5, 2020 Time: 10:00am - 3:00pm Location: KaMMCO, 623 SW 10th Avenue, Topeka Date: November 4, 2020 Time: 10:00am - 3:00pm Location: KaMMCO, 623 SW 10th Avenue, Topeka

2020 EVENTS: Level IV Workshop February 20, 2020 KHP Training Center, Salina EMSC Workshop March 18, 2020 (tentative) Webster Conference Center, Salina Statewide Symposium October 7, 2020 Wesley Medical Center, Wichita

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Division of Public Health , Curtis State Office Building

l 000 SW Jackson St., Suite 340 Topeka, KS 66612-1365

Lee A. Norman, M.D., Secretary

NOTICE Extension of Trauma Center Designation Deadlines

May 1, 2020

WHAT:

Phone: 785-296-1200 Fax: 785-559-4247

www.kdheks.gov/olrh

Laura Kelly, Governor

The Kansas Trauma Program is extending designation expiration dates for one year for facilities:

1. Who would have an on-site survey in the spring of 2020

2. Whose designation will expire in 2020

WHY: The physicians, nurses, and auxiliary staff involved in the individual trauma programs, as well as, the physicians and trauma program managers who conduct the on-site surveys are redirected into emergency

preparedness efforts at this time.

HOW: Facilities who have already submitted the designation renewal application materials will NOT need to submit a new PRQ. Simply update, as needed, credential cards, benchmark repmis, and supplemental materials with attention to on-call schedules when you have been notified with an on-site survey date.

If the submitted PRQ required an improvement plan, facilities will have until the new designation expiration date to address the noted criteria deficiencies. In the event of an improvement plan, a new PRQ will need to be submitted.

Facilities with trauma designation expirations in 2020 are now extended for one year. Facilities will be notified individually of their new expiration date. Designation application materials will be due by this new date.

If you have any questions, please don't hesitate to contact Wendy O'Hare, state trauma program director,

at Wendy.0Hare@ks.gov or 785-296-1210.

We would like to thank all our Kansas Trauma Centers for their continued pariicipation in and suppmi of the state's trauma system. We trust that designated trauma centers will continue to offer the appropriate

level of trauma care during this time and the quality of service provision will not be impacted by this delay.

Sincerely,

Lee A. Norman, M.D. Secretary

Kansas Depariment of Health and Environment

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Facility ID Facility Name % Timely170122 Ascension Via Christi - St. Francis 100.00%170131 F.W. Huston Medical Center - Winchester 100.00%170191 Great Bend Campus - Univ. Of KS Health System 100.00%171377 Great Plains of Smith County 100.00%170082 Greeley County Hospital - Tribune 100.00%171313 Kearny County Hospital - Lakin 100.00%170101 Lindsborg Community Hospital 100.00%170137 Lawrence Memorial Hospital - LMH 100.00%170015 Mitchell County Hospital - Beloit 100.00%170057 Nemaha Valley Community Hospital - Seneca 100.00%170001 Newman Regional Health Center 100.00%170084 Norton County Hospital 100.00%170027 Pratt Regional Medical Center 100.00%170023 St. Catherine Hospital - Garden City 100.00%170076 Washington County Hospital 100.00%170123 Wesley Medical Center - Wichita 100.00%171306 Wichita County Health Center - Leoti 100.00%170086 Stormont Vail Healthcare - Topeka 99.77%170020 Hutchinson Regional Medical Center 99.21%170006 Ascension Via Christi - Pittsburg 98.80%170040 The University of Kansas Hospital 97.96%170017 Susan B. Allen Memorial Hospital - El Dorado 96.15%170146 Providence Medical Center 95.97%170012 Salina Regional Health Center 95.93%170143 Neosho Memorial Regional Medical Center 95.45%170143 Overland Park Regional Medical Center 95.45%170013 Hays Medical Center 93.75%170019 William Newton Hospital - Winfield 91.18%171309 Jewell County Hospital - Mankato 87.50%170116 Allen County Hospital - Iola 85.71%170120 Labette Health - Parsons 83.05%170104 Shawnee Mission Medical Center 82.00%170035 Anderson County Hospital - Garnett 81.82%171311 Rooks County Health Center - Plainville 80.00%171338 Sabetha Community Hospital 80.00%170032 Greenwood County Hospital - Eureka 77.78%170009 St. John Hospital - Leavenworth 76.19%170112 Clara Barton Hospital - Hoisington 70.00%170004 Hiawatha Community Hospital 68.75%170126 Ottawa County Health Center - Minneapolis 66.67%170061 Phillips County Hospital - Phillipsburg 55.56%170182 Menorah Medical Center 52.00%171310 Cheyenne County Hospital - St. Francis 50.00%171332 Great Plains of Kiowa County - Greensburg 50.00%

2019 Q4 % of Submissions within 60 days of Discharge DateReport Date: 3/9/2020

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171303 Lane County Hospital - Dighton 50.00%170102 Medicine Lodge Memorial Hospital 50.00%170089 Stevens County Hospital - Hugoton 50.00%170025 St. Lukes South Hospital - Overland Park 46.67%170045 Community HealthCare Systems - Onaga 44.44%170052 Kingman Community Hospital 44.44%170068 Southwest Medical Center - Liberal 38.78%170051 Rice County District Hospital - Lyons 38.46%170041 Osborne County Memorial Hospital 33.33%170056 Lincoln County Hospital 28.57%171307 Rawlins County Health Center - Atwood 28.57%170014 Advent Health Ransom Memorial 26.09%170022 Atchison Hospital 22.22%170054 Clay County Medical Center 21.43%170098 Girad Medical Center 20.00%170128 Wamego Health Center 20.00%170115 Herington Municpal Hospital 18.18%171326 Logan County Hospital - Oakley 16.67%170105 McPherson Hospital 13.04%170113 Community Memorial Healthcare - Marysville 12.50%170114 Memorial Health System - Abilene 11.11%170145 Coffeyville Regional Hospital 10.34%170095 Cloud County Health Center - Concordia 10.00%170088 Ellsworth County Medical Center 7.14%170077 Trego C. Lemke Memorial Hospital - WaKeeney 7.14%170018 Fredonia Regional Hospital 6.25%171352 Decatur Health System - Oberlin 3.85%170008 Citizens Medical Center - Colby 0.00%171312 Comanche County Hospital - Coldwater 0.00%170133 Cushing Memorial Hospital - Leavenworth 0.00%171301 Ellinwood District Hospital 0.00%170074 Geary Community Hospital - Junciton City 0.00%170097 Goodland Regional Medical Center 0.00%170080 Gove County Medical Center - Quinter 0.00%170031 Graham County Hospital - Hill City 0.00%170090 Hodgeman County Health Center - Jetmore 0.00%170160 Holton Community Hospital 0.00%170197 Kansas Medical Center - Andover 0.00%170034 Minneola District Hospital 0.00%170070 Morris County Hospital - Council Grove 0.00%170066 Ness County Hospital District 2 0.00%170049 Olathe Medical Center 0.00%171345 Pawnee Valley Community Hospital - Larned 0.00%170024 Republic County Hopsital - Belleville 0.00%171356 St. Luke Hospital and Living Center 0.00%170139 Satanta District Hospital 0.00%170085 Scott County Hospital 0.00%

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170063 Sheridan County Health Complex - Hoxie 0.00%170150 South Central KS Regional Med Ctr - Arkansas City 0.00%170038 Stafford District Hospital 0.00%170117 Stanton County Health Care Facility - Johnson City 0.00%171329 Sumner County District 1 Hospital 0.00%170039 Sumner Regional Medical Center - Wellington 0.00%170016 The Univ. of KS Health System St. Francis - Topeka 0.00%170073 Wilson Medical Center - Neodesha 0.00%

170142 Ascension Via Christi Manhattan177122 Ascension Via Christi St. Joseph170200 Ascension Via Christi St. Teresa171304 Ashland Health Center170110 Bob Wilson Memorial Grant County Hospital173300 Children's Mercy South170094 Coffey County Hospital179045 Community Healthcare System - St. Mary's170072 Edwards County Hospital171300 Grisell Memorial Hospital 170079 Hamilton County Hospital171365 Hanover Hospital170026 Hillsboro Community Hospital170067 Horton Community Hospital171331 Kiowa District Hospital170055 Meade District Hospital170075 Mercy Hospital171308 Mercy Hospital Columbus170109 Miami County Medical Center170166 Morton County Hospital170103 Newton Medical Center171346 Patterson Health Center170119 Rush County Memorial Hopsital170030 Russell Regional Hospital171318 Sedan City Hospital170192 Wesley Woodlawn Hospital170175 Western Plains Medical Complex

Facilities that did not submit/did not report "no qualifying cases" as of 3/9/20

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Kansas Advisory Committee on Trauma

Position Statement on Firearm Safety and Injury Prevention

Background

1. Firearm injury in the United States is a public health challenge and is also of great concern in Kansas.

2. The Advisory Committee on Trauma (ACT) feels a responsibility to assist in developing policies that will reduce the incidence of firearm injury and deaths

3. The ACT is composed of experienced trauma care providers who recognize that a part of their mission should include injury prevention

4. The ACT believes injury prevention strategies that are evidence based should be used whenever possible. Proposed funding of Centers for Disease Control (CDC) and National Institutes of Health (NIH) gun violence research should be used when available.

5. It is the position of the ACT that active partnerships rather than adversarial relationships should be developed with gun owners to reduce firearm injury. Kansas should develop strategies as other states have done for safe and secure storage in special situations.

6. It is recognized that 67%* of deaths from firearms in Kansas are self-inflicted and that most non-fatal injuries are assaults more commonly occurring in the higher densely populated areas

7. The CDC notes that suicide rates are higher in rural America than in urban America. Overall, suicide death rates for rural counties (17.32 per 100,000 people) were higher than medium/small metropolitan counties (14.86) and large metropolitan counties (11.92).

Firearm Injury Prevention Strategies 1. Support evidence-based Firearm Safety Education programs for safe use of firearms 2. Support statewide improvement of behavioral health resources 3. Provide resources for injury prevention including firearm safety. 4. Support general safe storage strategies. 5. Support high school students receiving education on the safe response and initial care of severe

bleeding injuries such as Stop the Bleed, You Are The Help and Civilian Response to Active Shooter trainings.

6. Support programs that address the long-term consequences of firearm injuries to the individual, their families and friends, and the healthcare providers who care for them.

*Data source: 2015 Kansas Violent Death Reporting Systems (KS-VDRS, Bureau of Health Promotion, Kansas Department and Environment)

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References Proceedings from the Medical Summit on Firearm Injury Prevention: A Public Health Approach to Reduce Death and Disability in the US, Journal of the American College of Surgeons Consensus statement at the end…..Really good with all the other organizations that are involved https://www.journalacs.org/article/S1072-7515(19)30339-4/fulltext The American College of Surgeons statement on Firearm Injuries https://www.facs.org/about-acs/statements/12-firearm-injuries Reminder that it has been 1 year since “This is Our Lane” national conversation American Academy of Pediatrics’ top priorities in federal gun violence prevention advocacy https://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/Pages/AAPFederalGunViolencePreventionRecommendationstoWhiteHouse.aspx Reducing Firearm Injuries and Deaths in the United States: A Position Paper From the American College of Physicians Annals of Internal Medicinehttps://annals.org/aim/fullarticle/2709820/reducing-firearm-injuries-deaths-united-states-position-paper-from-american American Hospital Association, The Public Health Approach to Addressing Gun Violence https://www.hhnmag.com/articles/8178-the-public-health-approach-to-addressing-gun-violence Governor Kelly’s Public Safety views on passing common sense gun legislation https://www.laurakellyforkansas.com/issues/public-safety/ Statement of American Psychological Association, Gun Violence: Prediction, Prevention, and Policy https://www.apa.org/pubs/info/reports/gun-violence-prevention American Nurses Association, Declaration to Enact meaningful gun control legislation https://www.nursingworld.org/news/news-releases/2018/stop-the-madness-end-the-violence/ Emergency Nurses Association Firearm Safety and Injury Prevention Position Statement https://www.ena.org/docs/default-source/resource-library/practice-resources/position-statements/firearm-safety-and-injury-prevention.pdf?sfvrsn=f1318020_8 Quick search for EMS showed that NAEMT was listed on the summit groups in the Journal of the American College of Surgeons. The other references related more to violence against EMS. Would love to know if others found something. Gun Violence More Health Problem Than Criminal Justice Issue, American College of Emergency Physicians 2019 Scientific Assembly in Denver. https://www.medscape.com/viewarticle/921619?nlid=132718_544&src=WNL_mdplsfeat_191126_mscpedit_emed&uac=93561DZ&spon=45&impID=2182586&faf=1#vp_2

Hunter Education https://ksoutdoors.com › Services › Education › Hunter Hunter / Education / Services / KDWPT – KDWPT Anyone born on or after July 1, 1957 must be certified by an approved course in hunter education before they can hunt in Kansas, except that anyone 15 years old or younger may hunt without hunter education certification provided they are under the direct supervision of an adult of an adult 18 years old or older. https://www.google.com/search?ei=qUvTXZPFDI22swXxpoHABA&q=kansas+law+for+hunter+safety+course&oq=kansas+law+for+hunter+sa&gs_l=psy-

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ab.1.1.33i22i29i30l10.81723.90417..92111...1.2..0.120.3525.46j2......0....1..gws-wiz.....6..0i71j0j0i22i30j0i67j0i131j0i362i308i154i357j0i273j0i131i67.yNaL353Daag NRA Explore, Firearms Training https://explore.nra.org/interests/firearms-training/

Suicide, Guns, and Public Health, Harvard School of Public Health https://www.hsph.harvard.edu/means-matter/

Suicide in Rural America https://www.cdc.gov/ruralhealth/Suicide.html

Safe, Secure Gun Storage Options Available In Colorado https://denver.cbslocal.com/2019/08/30/gun-storage-mental-health-suicide/ KansasAgStress.org offers resources and support for Kansas agriculture community https://agriculture.ks.gov/news-events/news-releases/2019/12/09/new-website-to-assist-kansans-coping-with-ag-related-stress Congress agrees on historic deal to fund $25 million in gun violence research https://abcnews.go.com/Health/congress-approves-unprecedented-25-million-gun-violence-research/story?id=67762555 Patient-reported Outcomes at 6 to 12 Months Among Survivors of Firearm Injury in the United States https://journals.lww.com/annalsofsurgery/Abstract/publishahead/Patient_reported_Outcomes_at_6_to_12_Months_Among.94713.aspx From Dr. Molik Pending legislation

H.B.2415: Regulating the practice of medicine and surgery regarding inquiries about a patient's firearm ownership. Rep. Blake Carpenter Derby AN ACT concerning health and healthcare; regulating the practice of medicine and surgery; prohibiting certain inquiries regarding patient firearm ownership. April 2019 Committee on Health and Human Services SB 8, AN ACT concerning the purchase of firearms; establishing a three-day waiting period, background check on purchaser, Retailer by Oletha Senator Faust-Goudeau. Wichita January 2019 Committee on Federal and State Affairs H.B.2234: Creating the voluntary gun safety act. AN ACT concerning firearms; relating to protective orders; enacting the voluntary gun safety act. House Committee Rep Jarrod Ousley 2-11-19 H.B.2129: Creating the gun safety red flag act. AN ACT concerning firearms; relating to protective orders; enacting the gun safety red flag act. KS Rep. James "Jim" Ward (D-KS-086), KS Whip Jim Gartner (D-KS-053), KS Rep. Freda Warfield (D-KS-058) 2-4-19 1-23-2020 Safe Storage law proposed Pre-Filed December 2019 HB 2425 AN ACT enacting the Kansas anti-red flag act; prohibiting the enactment or enforcement of extreme risk protection orders against individuals regarding firearms; establishing criminal penalty for violation.

ACT Meeting Packet 5/13/2020 16

ACT Meeting Packet 5/13/2020 17

You live in a

TRAUMA REGIONA trauma region is a designated set of counties that coordinate community injury prevention activities, emergency medical services, hospitals, trauma centers, and rehabilitation services to improve patient care. Six Kansas Trauma Regions work together to form the Kansas Trauma System.

Traumatic Injury EMS Trauma Center Rehabilitation & Survival

Not all hospitals are TRAUMA CENTERS.Where you go for care matters.Go to the Emergency Room for: Go to a Trauma Center for:• Possible broken bones• Mild Burns• Signs of Heart attack• Shortness of breath• Fainting• Loss of consciousness• Signs of Stroke• Severe stomach pain• Severe or persistent vomiting or diarrhea• Drug Overdose

• Vehicle Crashes• Gunshot Wounds• Stab Wounds• Severe Burns• Serious falls• Brain injuries • Blunt Trauma• Near Drownings

Resources Available: Resources Available:

• Located in a hospital• Staffed by Emergency Department physicians

and nurses • Patients are triaged, life-threatening conditions

seen first• Stabilize patients for further care

• Located within the hospital’s ER• Staffed by specially trained trauma surgeons,

emergency physicians, advanced practitioners, and nurses

• Patients with severe injuries are treated immediately

• Proven to increase survival rates

Take me to a KANSAS TRAUMA CENTER

Level I Trauma Centers provide the highest level of care for patients. These facilities have a full range of specialists and equipment available 24 hours a day. These facilities also offer teaching and research components. Specialists

Level II Trauma Centers provide the same services as Level I facilities without the research component. Level II facilities may not have specialists on-hand 24/7, but they have them on call. Specialists

LEVEL IIILevel III Trauma Centers do not have the full availability of specialists Level I and Level II centers do, but they do have resources for emergency surgery and intensive care. In some cases, the facility might have to transfer patients. Surgery Transfer

LEVEL IVLevel IV Trauma Centers provide initial evaluation, stabilization and diagnostic capabilities but will likely have to transfer the patient to a trauma care center with a higher designation. Evaluation Stabilize Diagnostic Transfer

HOSPITALSNon-trauma center emergency rooms can typically stabilize most traumatic injuries before transferring to a trauma center.

Stabilize Transfer

Department of Healthand Environment

For more information, visit www.kstrauma.org.

ResearchTeaching

LEVEL II

LEVEL I

Teaching