REGION III RTAC
Region III Trauma Plan
July 2016
Bill Kunkle
7/14/2016
APPROVED by GTC August 18, 2016
Region III Trauma Plan July 2016
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Table of Contents Mission ............................................................................................................................................ 2
Vision .............................................................................................................................................. 2
Authority ......................................................................................................................................... 2
Region Board .................................................................................................................................. 3
Bylaws............................................................................................................................................. 4
Regional Demographics .................................................................................................................. 4
Injury Epidemiology ....................................................................................................................... 7
Prevention and Education............................................................................................................ 7
EMS ................................................................................................................................................ 8
Air Medical ............................................................................................................................... 12
Trauma Care Protocols and Medical Direction ......................................................................... 13
Patient Triage and Destination Determination .......................................................................... 14
Method of Transport Determination ......................................................................................... 14
Educational and Training Standards ............................................................................................. 15
Definitive Care Facilities .............................................................................................................. 16
Trauma Centers ......................................................................................................................... 16
Specialty Resource Centers ....................................................................................................... 17
Pediatrics ................................................................................................................................... 17
System Flow .............................................................................................................................. 18
Rehabilitation ................................................................................................................................ 19
Communications ........................................................................................................................... 19
Disaster Preparedness ................................................................................................................... 20
Evaluation and Improvement ........................................................................................................ 21
Research ........................................................................................................................................ 22
Appendix ....................................................................................................................................... 22
Appendix A ............................................................................................................................... 23
Appendix B ............................................................................................................................... 24
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Mission
To promote, develop, maintain, and
further a comprehensive EMS, trauma
and acute care system that will meet
the needs of all patients through fact
based analysis and improvement
methods.
Vision
To provide a comprehensive and unified trauma system that provides top level care
for the community and serves as a leader for the State of Georgia.
Authority
In 2007, Senate Bill 60 was passed by the Georgia Legislature creating the Georgia
Trauma Commission. This bill authorized the newly created commission to create a
trauma system for Georgia and to be accountable and distribute funds provided by the
state for the purpose of improved trauma care.
In 2009 the Georgia Trauma Commission approved a strategic plan providing
guidance for the future of trauma care in the state. An aspect of this plan was to
create Regional Trauma Councils to coincide with the State EMS Regions. Noting
that each region of the state is different in their capabilities and needs, each region
was tasked with creating their respective RTACS.
Each RTAC is then assigned the task of completing a trauma plan. This plan begins
with an assessment of the needs of the region, followed by the creation of the
document. The plan should then be written following guidance given by the
Regional Trauma System Planning Framework document approved by the Trauma
Commission in October of 2009.
The plan should be approved at the local level then presented to the Georgia Trauma
Commission for final approval. Following this go ahead, the final plan should be
used as a template for improving trauma care within the region.
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Region Board
The system leadership is tasked with the responsibility of improving trauma
management within Region III.
The Region Board and Committee Chair Positions will consist of the following
positions and the respective person for each position.
Board of Directors Officer
Chair Dr. Jeffrey Nicholas
Vice Chair Dr. Barry Renz
Historian Dr. John Harvey
Treasurer Greg Pereira
RTAC Coordinator Billy Kunkle
Committee Committee Chair
Air Medical Jim Sargent & Dr Isakov
EMS Lee Oliver
Pediatrics Dewayne Joy
Prevention and Education Elizabeth Williams
Disaster Preparedness
System Performance
Improvement Gina Solomon
Trauma Center Gina Solomon
Rehabilitation
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Bylaws
The organization’s operations shall be governed utilizing by laws approved by the
general membership.
Regional Demographics
Region 3 is composed of eight counties to include the City of Atlanta and the
Metro Atlanta area. These eight counties consist of just four percent of the
landmass for the State of Georgia, but account for thirty nine percent of the
population. The population of this region exceeds the population of 24 of the 50
states.
County Square Miles Population
Clayton 142 267,542
Cobb 340 730,981
Dekalb 268 722,161
Douglas 200 138,776
Fulton 527 996,319
Gwinnett 430 877,922
Newton 272 103,675
Rockdale 130 87,754
Region III Total 2,309 3,925,130
Percentage of Georgia 4% 39%
Georgia 57,513 10,097,343
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Atlanta, known by many as the capital of the south is a financial, tourist, and travel
hub for the southeastern United States. The many facets
of this region make it a destination point of people from
all round the globe.
The Hartsfield –Jackson Airport is the busiest in the world. This 4,700 acre
complex is home to Delta Airlines. In 2014 the airport saw over 860,000 aircraft
operations and serviced 96 million passengers. The airport is the largest
employment venue in the state offering jobs to more than 55,000 people. There are
several additional regional airports as well as Dobbins Air Reserve Base.
As a financial leader, 7 of the Fortune 100 companies have their headquarters in
Atlanta. In addition to Delta there is also Coca Cola, Home Depot, United Parcel
Service, AT&T and Newell Rubbermaid. These companies and the many other
industries keep the residents of Region III during the workday and also attract
individuals from other regions providing for a higher workday population.
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Entertainment also draws large crowds into the Region. The Atlanta Braves,
Falcons, Hawks and the Georgia Tech Yellow Jackets all call this region home. In
addition Atlanta hosts other large venues such as the NCAA basketball finals, and
the Chick Fil A Bowl. The Atlanta Dome, Turner Stadium, and Phillips Arena all
provide for these events as well as others such as concerts and other mass
gatherings. Additional crowds of people are drawn to entertainment venues such
as Six Flags over Georgia, Whitewater Water Park, and Stone Mountain.
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Injury Epidemiology
The Region III RTAC Board of Directors and membership have made a
commitment to acquire meaningful data to provide information for decision
making utilizing the state trauma registry, GEMSIS, T-QIP and other various
resources. The board will benchmark these statistics against other areas of the
nation with similar demographics and will publish the results annually for the
benefit of its membership, community stakeholders, and the general public.
Prevention and Education
Traumatic injuries of all mechanisms collectively have a significant impact on the
public health of our community. Therefor the trauma system should grasp the role
of injury prevention as a part of the complete trauma system.
The trauma council will utilize data collected by the trauma system to develop
evidence based programs in an attempt to reduce the impact of trauma on the
residents and transients of Region III and beyond. The programs developed will
look to make changes that can prove to have measurable outcomes.
A prevention and education council will be
established within the RTAC whose role will be
charged with leading these initiatives with the
backing of the various level care providers in the
region. This position should also work with the
various stakeholders in the region to include
industry, healthcare providers, the media, and the
general public to advance this program.
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.
EMS
This section of the Region III Trauma Plan
will consider the pre-hospital portion of
trauma care. Pre-hospital providers are often
times the first providers of care and have a
tremendous impact on patient outcomes
based upon indicators such as response time,
care provided, and transport to the most appropriate facility. In this the pre-
hospital portion of this trauma plan will consider the following:
1. Pre-hospital resources available in Region III
2. Considerations for resources outside of Region III to be utilized during
times of need.
3. Establishing common tenets for protocols of trauma care within the
region based upon mutual understanding between the care providers, the
medical directors, and the trauma centers.
4. Identify best practices for destination determination for the transport of
the trauma patient within Region III.
5. Develop guidelines for the determination of transportation type within
the region.
6. Considerations for the dispatch protocols for emergency services.
7. Identify training standards for the 911 provider.
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Georgia’s Region III is the most populace region in the state and easily outnumbers
many other states based upon considerations such as:
1. Annual EMS responses
2. Trained emergency medical responders
3. Response vehicles
The Region consists of the following counties and their respective emergency
service providers.
Clayton
Clayton County Fire and Emergency Services
7810 Highway 85
Riverdale, GA 30272
770-473-7833
Forest Park Department of Fire and Emergency Services
4539 Jonesboro Rd
Forest Park, GA 30297
404-608-2383
Morrow Fire Department
1500 Morrow Road
Morrow, GA 30260
770-961-4008
Cobb
Metro Atlanta Ambulance Service Puckett EMS
595 Armstrong Street 3760 Tramore Point
Marietta, GA 30060 Austell, GA 30106
770-693-8460 770-222-1988
Douglas
Douglas County Fire Department
6856 West Broad Street
Douglasville, GA 30134
770-942-8626
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Dekalb
Dekalb County Fire and Rescue AMR
1950 W Exchange Place 1380-D Beverage Drive
Tucker GA 30084 Stone Mountain GA 30083
678-406-7750 678-537-6851
Fulton
Atlanta Fire Department Grady EMS
Office of Airport Operations 745 Memorial Drive SE
720 Doug Davis Drive Atlanta GA 30316
Hapeville, GA 30354 404-616-6396
404-382-1080
Hapeville Fire Department Rural Metro of Georgia
3468 North Fulton Avenue 250 Hembree Park Drive Suite 112
Hapeville, GA 30354 Roswell, GA 30076
404-669-2174 678-473-1990
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Gwinnett
Gwinnett County Fire and Emergency Services
75 Langley Drive Lawrenceville, GA 30046
770-822-8000
Newton
Newton County EMS
5126 Hospital Drive NE
Covington, GA 30014
770-786-7053
Rockdale
National EMS
1060 Culpepper Drive
Conyers Ga 30094
770-922-9278
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In addition to the licensed 911 providers, Region III has a multitude of responders
who routinely respond to calls for help within the region. A comprehensive listing
of these agencies would be difficult to list and maintain, however a few services
need to be mentioned for their specialty services.
Pediatrics
Children’s Healthcare of Atlanta Transport Services
1405 Clifton Rd
Atlanta, GA 30329
404-785-7778
Air Medical
Air Evac Lifeteam
Emergency Dispatch 1-800-242-3822
AirLife GA
1035 South Hill Street
Griffin, GA 30224
770-227-3206
Emergency Dispatch: 1-888-763-1010
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Trauma Care Protocols and Medical Direction
The 2009 ACS study of the Georgia Trauma System recommends “The EMS
system medical director must have statutory authority to develop protocols…must
work closely with the trauma system medical director to ensure that that protocols
and goals are mutually aligned.. .must also have interaction with EMS agency
medical directors as local levels…”
The State OEMS&T does maintain a set of treatment protocols that are updated on
a regular basis as needed. Region III has a great deal of diversity. There are high
rise urban areas within a few minutes of trauma centers, peach orchards in our
more rural areas that are an hour from such care, and then the sub-urbans,
somewhere in between. Due to this diversity, and Georgia Code allowing for
“local rule”, each EMS agency has their respective treatment protocols. There
have been several past attempts to move to a one size fits all approach to place at
least the Metro Atlanta agencies on a standardized protocol system. These
attempts have failed due to the reasons noted above.
To then work within this framework, it will be imperative that EMS directors, the
local medical directors, and the trauma center directors come together to establish
identified best practice tenets in their respective local protocols. These standards
should be evidence based and reviewed on a regular basis to keep maintain
currency for best practices.
In this same discussion can be brought up the topic of medical direction. Again
each agency maintains their own medical director who develops their specific
protocols and policies and procedures based upon local rule. In this system,
communication between the physicians at each level could resolve and prevent
future problems and ultimately lead to better patient care. The Region III RTAC
will facilitate such discussions on an annual basis to ensure that the right
information is getting to the medical directors of each agency.
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Patient Triage and Destination Determination
It is well noted in literature and studies the benefits
of transporting the EMS patient to the “right
facility the first time”. This has become even
more so with the specialization of medical centers
such as cardiac and stroke care. Correct decision
making in the transport of the trauma patient is
essential to ensure timely and accurate care. The
State Trauma Commission has identified and
published “Georgia Trauma System Primary
Triage Decision Scheme” (Appendix A) based
largely on the National Trauma Triage Protocol of the US Department of Health
and Human Services. This set of guidelines utilizes four assessment steps
(physiology, anatomy, mechanism of injury, and special considerations) to assist
the provider in determining the most appropriate facility to transport the patient to.
Region III has accepted this guideline as a best practice for the transport of the
trauma patient and will monitor transported patients to be reported as part of the
CQI process.
Method of Transport Determination
Few topics in EMS have drawn as much attention as the need for use of medical
aircraft. The most comprehensive study to date completed by the University of
Rochester shows that patients transported by air, although not as critical as those
transported by ground services, fare better than those transported by ground EMS.
(Boynton, 2011) With this information though also comes the desire to do what is
best for the trauma patient. Air medical transport, with its benefits, also comes at a
significant transportation cost.
Knowing this the practitioner should make decisions with the best use of
information available such as:
1. Patient needs
a. Surgical
b. Neurological
c. Specialty such as pediatrics or burns
d. Advanced airway management
2. Time
a. Time for arrival of air medical
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b. Time of transport to a trauma center by air vs by ground
c. Access time for patient
i. Entrapped
ii. Stranded away from ground transport units
Noting that this resource is utilized for patients with significant illness or injury,
and that time is a significant factor, consideration for air medical transport should
occur as early as possible. Protocols should be in place to allow for either the
emergency dispatcher or the responding units to request air medical response as
part of the initial response and prior to arrival of first responders. This
consideration is no different than the response of other emergency resources that
may later be cancelled if not needed.
Due to the potential of severity of the patient, the cost of utilization of this resource
and the relative infrequency of its use, it is recommended that every chart for a
patient flown undergo a CQI review by the EMS agency.
Educational and Training
Standards
The ACS assessment of the state reported:
“It is critical that trauma system leaders
work to ensure that prehospital care
providers at all levels attain and maintain
competence in trauma care. Maintenance
of competence should be ensured by requiring standards for credentialing and
certification and specifying continuing educational requirements for all
prehospital personnel involved in trauma care.”
The state requires that each prehospital care provider receive 40 hours of training
every recertification cycle (2 years) of which 4 hours must be dedicated to trauma.
The RTAC will support this and encourage additional training by working together
to provide educational opportunities such a PHTLS, ABLS, and pediatric trauma.
As part of the CQI process, medical directors, service managers, and trauma team
staff should look for recurring disparities in trauma care that might indicate a need
for additional education. Trauma leaders should also consider emerging treatment
modalities that should be taught to the target audience. With the current abilities of
modern technology, reaching the masses of pre-hospital care providers is easier
than ever before. The RTAC will look to take advantage of these abilities to
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educate the pre-hospital provider for the betterment of the treatment for patients we
serve.
The RTAC will also assist with, as able and appropriate, the delivery of Trauma
Nurse Core Course (TNCC) and Advanced Trauma Life Support (ATLS). These
two courses provide the educational backbone of care within the trauma system
Keeping the staff educated and informed will provide great dividends to the trauma
patient by ensuring the most up to date and comprehensive knowledge base.
Definitive Care Facilities
Trauma Centers
Region III has a total of 7 designated trauma centers within its boundaries. These
include three Level 1trauma facilities (one of which is a pediatric) and four Level II
facilities (one of which is pediatric). In addition there is a certified burn center.
Adult Facility Level
Atlanta Medical Center I
Grady Memorial Hospital I
Gwinnett Medical Center II
North Fulton Hospital II
WellStar Kennestone Hospital II
Pediatric Facilities
Egleston Children's Healthcare of Atlanta I
Scottish Rite Children's Healthcare of Atlanta-Level II II
Burn Facilities
Grady Memorial Hospital
Certified Burn
Center
Joseph M Still Burn Center
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The Region III RTAC will complete a needs assessment annually to identify gaps in
trauma care in the region and will then work towards
resolving these gaps. A facility working towards trauma
certification in an identified “gap” area will be assisted by
the RTAC in working towards their goal of achieving
certification. Facilities undergoing this process will be
identified for their trauma care capabilities as “in active
pursuit” on the trauma plan and in the region.
Specialty Resource Centers
Specialty Resource Centers such as pediatric facilities and burn centers provide care
above and beyond for certain demographics of trauma patients. They should be
utilized as followed.
Pediatrics
All pediatrics meeting Georgia Trauma System Entry Criteria (Appendix A) should be
transported to a pediatric trauma facility. For the purpose of the trauma patient in
Region III, a pediatric is defined as age 14 and below. At the time of this writing the
sole provider of pediatric trauma care is Children’s Healthcare of Atlanta (CHOA) at
either Egleston or Scottish Rite. The EMS provider should call in the patient report to
the CHOA Communications Center and identify that they are transporting a trauma
patient. The CHOA
Communications Team
will take into
consideration destination
choice, distance, and
facility surgical abilities to
identify the destination
facility for the EMS
provider.
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System Flow
Trauma diversion is defined as routing EMS agencies transporting trauma patients to
another facility due to a temporary inability to provide adequate trauma care. Each
facility is responsible for developing their policy for diversion which should include:
1. Criteria for diversion
2. Person or persons responsible for making diversion decision
3. Method and responsibility of notifying EMS of diversion status
4. Record keeping and performance improvement of diversions status.
The RTAC will develop and maintain a memorandum of understanding (MOU)
between the RTAC and the trauma centers regarding trauma diversion. This MOU
should be developed by the Trauma Center Council and approved by the voting
members of the RTAC to be added to this trauma plan at a later date.
Patient transfers are also a point of concern for the flow of trauma patients. Patients
are frequently transferred from within the region or into the region from areas with no
or limited trauma services. The Trauma Center Council should develop a policy to be
added to this plan regarding the following criteria:
1. Destination choice
a. Distance
b. Level of care
c. Specialty resource care needed
2. Method of transport
a. Air
b. Ground
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Rehabilitation
Rehabilitation is the process of
helping a patient adapt to a disease or
disability by teaching them to focus
on their existing abilities. Within a
rehabilitation center, physical therapy,
occupational therapy, and speech
therapy can be implemented in a
combined effort to increase a person’s ability to function optimally within the
limitations placed upon them by disease or disability. To uphold the continuum of
care from illness to health and offer a high-level of service, rehabilitation is a
critical service offered within TSA-E through hospital-based programs and private
organizations. Transfer protocols for rehabilitation facilities are determined by
individual facilities.
Communications
In any disaster and during every day operations, communications is a vital aspect of
the trauma care system. Due to the diversity of the region, a one size fits all model of
communication is not practical and therefore makes communications during large
scale events difficult. Also the transition of many agencies to the use of cellular
technology creates a dilemma during times of disaster due to the system becoming
overwhelmed. The Region III RTAC will be involved in establishing regional
communications policies to identify and resolve these and addition communications
issues.
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Also in the discussion of communications are the less emergent, but none the less
important messages that need to be sent. A great plan is of little use if all of the
players do not know what the plan is. It will be incumbent upon the Region III RTAC
to distribute trauma plans and policies to the providers of Region III and further as
necessary. The RTAC may utilize additional resources such as the EMS Council and
the GTCNC website as available. The Region III RTAC will track and ensure that
important notices and communications are received by the appropriate individuals at
the appropriate facilities.
Part of the charge for the RTAC as given by the GTCNC was to address in this plan,
connectivity with the Georgia Trauma Communications Center. In 2016, the Trauma
Communications ceased operations, therefor this operation is not addressed further.
Disaster Preparedness
The emergency response system within Region III incorporates all emergency support
functions (ESF) indicated in the National Response Framework, and is incorporated
within state and local plans. Regional ESF-8 (Health and Medical) response to
incidents and emergencies, in which response is localized, is
typically managed by individual hospitals, EMS agencies, and
with minimal involvement by supporting local health departments
and jurisdictional emergency management officials. However,
additional regional resources must be used when these incidents
exceed local capacity and local jurisdictions are required in order
to achieve a satisfactory response.
As reflected in the state of Georgia Emergency Operations Plan (GEOP) all
emergencies are considered a local responsibility. Therefore legal responsibility for
provision of support for emergencies is placed on the senior elected official within the
affected jurisdiction. Response entities such as hospitals and EMS agencies must work
through these officials when resource needs cannot be met by local assets only.
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Many resources have been placed
within Region III by participation
in a number of Federal and State
programs designed to enhance local
and regional ESF-8 readiness.
These programs include:
- Georgia Regional Hospital
Coordinating Program through which area hospitals work together to achieve a
more fluid and balanced response to disaster.
- Jurisdictional participation through health departments and local emergency
preparedness. These programs prepare jurisdictions, their supporting local health
departments, and partnering health and medical professional for epidemiological
intervention and biological events, including Strategic National Stockpile (SNS)
preparations.
- Georgia Emergency Management Agency (GEMA) Area 7
Evaluation and Improvement
The System Performance Improvement (SPI) Committee reviews aggregate data and
specific case reviews in Region III. This review process analyzes the aggregate data
generated by sources such as T-QUIP, GEMSIS and the Trauma Registry. The
committee is composed of defined members of the RTAC and defines the guidelines
and processes for review. The committee will have 2 charges:
1. To consider specific cases for review. An agency may recommend a case
for trauma care review where the SPI committee will review each aspect of
care and offer fact based recommendations regarding future operations. The
SPI Committee can then forward the cases to the Board with
recommendations for action. Actions may include
a. Refer to Region III Council
b. Consider altering existing RTAC policies or creating new to
positively affect patient care outcomes.
2. To review data, both individual and aggregate, with the intent to identify
process and system changes that will positively affect patient care outcomes.
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a. The SPI committee should identify key performance indicators (KPI)
for each discipline of care within the trauma system. These KPI’s
should be based upon sound scientific and protocol driven criteria.
b. These KPI’s should be reviewed annually to ensure continued
relevance within the trauma system.
c. The SPI Committee shall compare the appropriate data with the KPI’s
regularly and a minimum of on an annual basis. This review will be
to assess to operations of agencies and the regional system as a whole.
The intent will be to improve care for the trauma patient.
The committee should establish key performance indicators for each discipline of care
within the trauma system. These KPI’s should be based upon sound scientific and
protocol driven criteria. The committee will use the information gained to make
recommendations for changes in policy. In cases of negligence and continual non-
compliance with policy, the SPI committee will advise the Board, who may then
choose to refer the issue to the Region III Office of EMS and Trauma.
Research
The Region III RTAC participates in system research on an ad hoc basis. The Board of
Directors is responsible for governance and release of the data.
Appendix Appendix A- Georgia Trauma System Primary Triage Decision Scheme
Appendix B-Guidelines for Trauma Center Destination
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