Texas Trauma SystemOverview

Tuesday, May 18th, 2010

Jane Guerrero, RN, DirectorOffice of EMS/Trauma Systems CoordinationTexas Department of State Health Services

PURPOSE

Senate Bill 1, Rider 90 required the department to conduct a study of the state’s trauma facilities and assess the need for additional Level I and Level II trauma facilities.

Governor’s EMS and Trauma Advisory Council (GETAC) recommended an assessment of the need for additional Level I and Level II trauma facilities, as well as a review of the trauma system as a whole.

The Challenge

Geographic size and population

Total square miles: 268,581 Total population: 24,782,302 (2009 est.)

Data Source: U.S. Census Bureau

Geographic Size and Population

Total Square Miles: 268,581 Population: 25,000,000

Texas EMS/Trauma System

Trauma Service Areas (TSA): geography

Regional Advisory Councils (RAC): people

Terms are used interchangeably:

RACs = TSAs

Map 1: RAC E and RAC P

The population of RAC E (5,487,477) is equivalent to the population of Wisconsin. RAC P (1,980,877) is equivalent to the population of New Mexico.

New Mexico

Wisconsin

Map 2: RAC A and RAC B

The population of RAC A and RAC B combined (848,044) is equivalent to that of Delaware (873,092).

Wisconsin

New Mexico

Delaware

Map 3: RACs C, D, and E

The population of RAC C, RAC D, and RAC E combined (6,006,125) is equivalent to that of Tennessee (6,214,888).

New Mexico

TennesseeDelaware

Map 4: RACs L, M, N, and O

The population of RAC L, RAC M, RAC N, and RAC O combined (2,292,105) is equivalent to that of Nevada (2,600,167).

Tennessee

New Mexico

Delaware

Nevada

Map 5: RACs T, U, and V

The population of RAC T, RAC U, and RAC V combined (1,737,961) is equivalent to that of Nebraska (1,783,432).

Map 6: RACs F, G, and H

The population of RAC F, RAC G, and RAC H combined (1,338,701) is equivalent to that of Maine (1,316,456).

Map 7: RACs I, J, and K

The population of RAC I, RAC J, and RAC K combined (1,210,516) is equivalent to that of Hawaii (1,288,198). The square mileage (59,286) is equivalent to that of Georgia.

Map 8: RACs Q, R, and S

The population of RAC Q, RAC R, and RAC S combined (5,455,497) is equivalent to that of Minnesota (5,220,393).

Texas EMS/Trauma System History

In 1970 a registry for EMS personnel was established under the name Division of Emergency Medical Services.

Texas EMS/Trauma System History The 1973 EMS Act, Vernon’s Texas Civil

Statutes, provided for:

1. the development of a state plan,

2. the establishment of EMS delivery areas with at least one hospital designated as a trauma center,

3. the identification of all public and private agency EMS stakeholders,

4. plan for an interagency communication system.

Texas EMS/Trauma System History

In 1983 the EMS Act of 1973 was amended requiring:

1. two certified EMS personnel aboard an ambulance,

2. personnel certification and vehicle permits, and

3. the establishment of the Bureau of Emergency Management.

Texas EMS/Trauma System History

In 1989 legislation directed the department to establish a statewide trauma system and create the Trauma Technical Advisory Committee (TTAC). However, no resources were allotted.

Texas EMS/Trauma System History

On January 11, 1990, TTAC met for the first time and was charged with:

1. the development of a trauma registry,

2. the development of the medical and technical aspects of a trauma system, and

3. recommending rules and regulations for a trauma system.

Texas EMS/Trauma System History 1993 marked the first trauma facility

designation, and ongoing development of trauma regional advisory councils (RACs). North Texas RAC C was recognized first. University Medical Center in Lubbock was the

first designated trauma facility. Eleven (11) RACs were recognized by the

department.

Texas EMS/Trauma System History

By 1995 RACs had been established in all 22 trauma service areas. All participation was voluntary; no funding was allotted.

1997 legislation created the first funding: an EMS/Trauma System Fund of $4 million for the 1998/1999 biennium.

Texas EMS/Trauma System History

In 2000 funding available for trauma system grants increased to approximately $9.5 million.

In 2003 the 78th Legislative Session increased funding to approximately $20 million.

Texas EMS/Trauma System History

Appropriations continued to increase in 2007. Funding rose to approximately $55 million.

Texas EMS/Trauma System Today

Eighty four million dollars ($84,000,000) is appropriated for Fiscal Year 2010. Ninety-seven percent (97%) of the funds are disbursed to eligible entities (hospitals, EMS providers, and RACs) that participate in the trauma system.

Texas EMS/Trauma System Today

Designated Trauma Facilities

Level I 16 Level II 8 Level III 45 Level IV 185

“In active pursuit” 18

RAC Assessment of EMS Coverage, 2009

Trauma Death Rates

Data Source: http://soupfin.tdh.state.tx.us/death10.htmData Source: http://soupfin.tdh.state.tx.us/death10.htm

Texas Relative to USATexas Relative to USA1979-20061979-2006

United States Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Office of Analysis, Epidemiology, and Health Promotion (OAEHP), Compressed Mortality File (CMF) compiled from CMF 1968-1988, Series 20, No. 2A 2000, CMF 1989-1998, Series 20, No. 2E 2003 and CMF 1999-2001, Series 20, No. 2G 2004 on CDC WONDER On-line Database.

35% reduction

6,720 lives

Focus Question 1 Given the size of Texas, what is the

recommended number and distribution of Level I and Level II trauma centers in the state?

Particular consideration should be given to the Houston-Galveston area and to the role that Level III trauma facilities play in Texas.

Focus Question 2 Given the view of our system, the size of the

state and the heterogeneous nature of the state’s RACs, what strategy could the trauma system use to:

strengthen the system in relation to trauma care for special populations (i.e., children and geriatric)?

Focus Question 2 Given the high level view of our system, the size

of the State and the heterogeneous nature of the state’s RACs, what strategy could the trauma system use to:

strengthen incorporation of rehabilitation entities/principles into the system?

Focus Question 2 Given the high level view of our system, the size

of the State and the heterogeneous nature of the state’s RACs, what strategy could the trauma system use to:

assure that appropriate, data-driven injury prevention activities are integrated into the system?

Focus Question 2 Given the high level view of our system, the size

of the State and the heterogeneous nature of the state’s RACs, what strategy could the trauma system use to:

further evaluate ourselves, including recommendations on how to best proceed (i.e., individual RAC evaluations or groups of RAC evaluations) in the future?

Focus Question 3

How can we strengthen our regional and statewide performance improvement activities?

Focus Question 4 Our state trauma registry has been problematic,

and we are currently working to replace it. Given the diversity and size of the state, we are interested in your assessment of how we could:

rebuild a registry that the stakeholders can support?

Focus Question 4 Our state trauma registry has been problematic,

and we are currently working to replace it. Given the diversity and size of the state, we are interested in your assessment of how we could:

utilize our trauma registry and other databases more effectively, with an emphasis on obtaining outcome data?