HRSA Model Trauma Systems HRSA Model Trauma Systems Planning & EvaluationPlanning & Evaluation

July 24, 2008July 24, 2008Gail CooperGail Cooper

Common NamesCommon Names

HRSA Model Trauma Systems HRSA Model Trauma Systems Planning & Evaluation (MTSPE)Planning & Evaluation (MTSPE)

Model Trauma PlanModel Trauma Plan ““National Trauma Plan”National Trauma Plan”

HRSA Model Trauma PlanHRSA Model Trauma Plan

Do you fit?Do you fit? Sure, with a little tweaking here & Sure, with a little tweaking here &

there all States fit one way or there all States fit one way or anotheranother

It’s not a prescriptive document, it It’s not a prescriptive document, it is a guide!is a guide!

HRSA Model Trauma PlanHRSA Model Trauma Plan

How does California fit?How does California fit? By identifying resources already at work By identifying resources already at work

in California to reduce trauma death & in California to reduce trauma death & disability (Assessment)disability (Assessment)

Working to close the gaps in service Working to close the gaps in service delivery (Policy Development)delivery (Policy Development)

Measuring results, morbidity & mortality Measuring results, morbidity & mortality (Assurance) (Assurance)

HRSA Model Trauma PlanHRSA Model Trauma Plan

What does it mean?What does it mean?

Change; Toward more universal Change; Toward more universal statewide coveragestatewide coverage

Looking Back: The Need for ChangeLooking Back: The Need for Change

New Plan/New Model Move away from components

Toward inclusive, integrated, & evidence based Develop Trauma System Planning and

Evaluation: A Public Health Approach Planning Guide

Integrates essential elements of the model trauma system plan using a public health approach

Incorporates new information on Systems Development

Self-evaluation document BIS (Benchmarks, Indicators, & Scoring)

Process for Future TraumaProcess for Future TraumaSystem DevelopmentSystem Development

Funded by HRSAFunded by HRSA Use the village approach Use the village approach Solicit comments frequentlySolicit comments frequently Incorporate ideas from key trauma Incorporate ideas from key trauma

leadersleaders Build consensus among stakeholdersBuild consensus among stakeholders Repeatedly educate stakeholders about Repeatedly educate stakeholders about

the public health approach to trauma the public health approach to trauma carecare

Why Public HealthWhy Public Health

Gives credibility to trauma as a Gives credibility to trauma as a public health problempublic health problem

Reasonable, methodical approach Reasonable, methodical approach recommended by the IOMrecommended by the IOM

Grounds trauma in a theoretical baseGrounds trauma in a theoretical base Incorporates trauma & injury within Incorporates trauma & injury within

the framework of public health the framework of public health Allows trauma to be more Allows trauma to be more

competitive for fundingcompetitive for funding

The ProcessThe Process Review:Review:

1992 Draft Model Trauma Care System 1992 Draft Model Trauma Care System PlanPlan

Trauma System Agenda for the FutureTrauma System Agenda for the Future HRSA Evaluation instrumentHRSA Evaluation instrument ACS/COT Trauma system consultation ACS/COT Trauma system consultation

manualmanual Literature review:Literature review:

Skamania conferenceSkamania conference Literature since Skamania conferenceLiterature since Skamania conference

Leaders & Task GroupsLeaders & Task Groups

The Village people:The Village people: ACEPACEP STNSTN NASEMSPNASEMSP NASEMSONASEMSO

Key Framers of New DocumentKey Framers of New Document Use ACS/COT as entity to produce new Use ACS/COT as entity to produce new

documentdocument

HRSAHRSA ACS/COTACS/COT CDCCDC NHTSA NHTSA

Trauma System Planning & Evaluation: A Public Health Approach

… the public health approach is simply a proven, systematic method of problem identification & problem solving; it provides a conceptual framework for trauma system development, management & ongoing performance improvement

Draft, DHHS/HRSA, Feb 2003, p. 5

Trauma System Planning & Trauma System Planning & Evaluation GuideEvaluation Guide

Fresh approach to trauma system planning Fresh approach to trauma system planning Focus around 3 Core Functions of Public Focus around 3 Core Functions of Public

Health (A, PD, A)Health (A, PD, A) Use Trauma Agenda for the Future Use Trauma Agenda for the Future

components (NHTSA)components (NHTSA) Provide practical information Provide practical information Include updated version of HRSA Trauma Include updated version of HRSA Trauma

System evaluation tool (BIS self System evaluation tool (BIS self evaluation)evaluation)

Incorporate NACCHO Standards for Public Incorporate NACCHO Standards for Public Health Offices where applicableHealth Offices where applicable

Public Health GoalsPublic Health Goals

Prevent epidemics & spread of diseasePrevent epidemics & spread of disease Protect against environmental hazardsProtect against environmental hazards Prevent InjuriesPrevent Injuries Promote and encourage healthy behaviorsPromote and encourage healthy behaviors Respond to disasters & assist Respond to disasters & assist

communities in recoverycommunities in recovery Assure the quality & accessibility of Assure the quality & accessibility of

Health ServicesHealth Services

Mission of Public HealthMission of Public Health

Assuring conditions in which people Assuring conditions in which people can be healthycan be healthy

Substance of Public Health; Substance of Public Health; Organized community efforts aimed Organized community efforts aimed at the prevention of disease & the at the prevention of disease & the promotion of healthpromotion of health

IOM, 1988IOM, 1988

Trauma System GoalsTrauma System Goals Decrease the incidence and severity of traumaDecrease the incidence and severity of trauma Ensure optimal, equitable & accessible care Ensure optimal, equitable & accessible care

for all persons sustaining traumafor all persons sustaining trauma Prevent unnecessary deaths & disabilities Prevent unnecessary deaths & disabilities

from traumafrom trauma Contain costs while enhancing efficiencyContain costs while enhancing efficiency Implement quality & performance Implement quality & performance

improvement of trauma care through out the improvement of trauma care through out the systemsystem

Ensure certain designated facilities have Ensure certain designated facilities have appropriate resources to meet the needs of appropriate resources to meet the needs of the injuredthe injured

Mission of the Trauma SystemMission of the Trauma System

Prevent injuries while ensuring Prevent injuries while ensuring that the right patient gets to the that the right patient gets to the right hospital in the right right hospital in the right amount of timeamount of time

Benefits to the Trauma System:Benefits to the Trauma System: Access to a well-established & accepted Access to a well-established & accepted

conceptual model for health care system conceptual model for health care system assessment, planning, intervention, & evaluation.assessment, planning, intervention, & evaluation.

Potential communications infrastructure Potential communications infrastructure (notification systems)(notification systems)

Access to all-hazards informationAccess to all-hazards information Population-based dataPopulation-based data Resources for disaster preparednessResources for disaster preparedness Opportunity to integrate the trauma system into Opportunity to integrate the trauma system into

other community health efforts to promote overall other community health efforts to promote overall healthhealth

A more precise identification of populations at risk A more precise identification of populations at risk & a targeting of specific issues based on these & a targeting of specific issues based on these datadata

Framework for injury prevention strategiesFramework for injury prevention strategies

Access to all-hazards informationAccess to all-hazards information Access to a well-established health system Access to a well-established health system

infrastructureinfrastructure Health system response that differentiates Health system response that differentiates

facilities by level of resource availabilityfacilities by level of resource availability Existing protocols and guidelines for the care Existing protocols and guidelines for the care

processprocess Access to patient outcome data Access to patient outcome data Existing performance improvement processExisting performance improvement process Additional resources for injury prevention effortsAdditional resources for injury prevention efforts Resources to provide all-hazards careResources to provide all-hazards care Recognition that injury continues to be a public Recognition that injury continues to be a public

health problem despite significant efforts at health problem despite significant efforts at trauma system developmenttrauma system development

Benefits to the Public Health System:Benefits to the Public Health System:

Public Health Core Functions Trauma System Components

CORE FUNCTION ESSENTIAL SERVICE

1992 CORE COMPONENT

SUBCOMPONENTS

Assessment Monitor heathDiagnose & investigate

Evaluation Needs assessmentData collection

Research

Policy Development Inform, educate, & empower

Mobilize partnerships

Public information and

education

Injury preventionTrauma system committee

Develop policies LegislationRegulations

Trauma system planning and operations

Regulations and rules

Assurance Enforce laws State Lead Agency

Ensure links to or provision of care

Prehospital care CommunicationsTriage and transport, medical direction, & treatment protocols

Definitive care Facility designation, interfacility transfer, &

rehabilitation

Ensure competent workforce

Human resources Workforce resources & educational preparation

Evaluation Evaluation Data collection Research

Interdisciplinary Review Committee

Why a public health approach? Why a public health approach?

Assure consistency with the Trauma Assure consistency with the Trauma System Agenda for the FutureSystem Agenda for the Future

Begin looking at outcomes rather than just Begin looking at outcomes rather than just the structure & process the structure & process

Give credibility to trauma as a public Give credibility to trauma as a public health problemhealth problem

Improve dialogue between trauma/EMS Improve dialogue between trauma/EMS professionals, public health professionals professionals, public health professionals & policy-makers & policy-makers

Why a public health approach ?Why a public health approach ?

Reasonable, methodical approach Reasonable, methodical approach recommended by the Institute of Medicinerecommended by the Institute of Medicine

Enhance integration of trauma systems Enhance integration of trauma systems into public health disaster planning & into public health disaster planning & bioterrorism response planningbioterrorism response planning

Allow trauma & EMS to be more Allow trauma & EMS to be more competitive for fundingcompetitive for funding

Grounds trauma system in theoretical Grounds trauma system in theoretical basebase

Incorporates both EMS & trauma within a Incorporates both EMS & trauma within a public health systempublic health system

Supporting the ModelSupporting the Model

Recent IOM report on the Future of Emergency Medical Services

ACS/COT Systems Consultation Guide Regional Trauma Systems: Optimal

Elements, Integration, & Assessment Key Trauma System Leadership,

National, State & Local

Vision for the Future of Vision for the Future of Emergency CareEmergency Care

Emergency Care System Coordinated, Regionalized, Accountable

IOM, 2005

Key ProblemsKey Problems Fragmentation: Fragmentation:

Lack of coordination between local service Lack of coordination between local service providers; between EMS and public safety; & providers; between EMS and public safety; & between EMS & air medical servicesbetween EMS & air medical services

Uncertain Quality: Uncertain Quality: Little or no performance data; lack of national Little or no performance data; lack of national

standards for training & credentialing.standards for training & credentialing. Disaster Preparedness: Disaster Preparedness:

Inadequate training, equipment, funding.Inadequate training, equipment, funding. Evidence Base: Evidence Base:

limited understanding of effectiveness limited understanding of effectiveness

Key RecommendationsKey Recommendations

CommunicationsCommunications Improve data & communications systems Improve data & communications systems

interoperability between EMS agencies, interoperability between EMS agencies, hospitals, & public health departments.hospitals, & public health departments.

State regulation of air medical providers State regulation of air medical providers with respect to communications, with respect to communications, dispatch, & transport protocols.dispatch, & transport protocols.

Workforce StandardsWorkforce Standards

Improve the quality & consistency of Improve the quality & consistency of EMS by encouraging states to:EMS by encouraging states to: Require national accreditation of Require national accreditation of

paramedic education programs.paramedic education programs. Accept national certification as a Accept national certification as a

prerequisite for state licensure.prerequisite for state licensure. Establish a common scope of practice for Establish a common scope of practice for

EMS personnel across states, with state EMS personnel across states, with state licensing reciprocity.licensing reciprocity.

ResearchResearch

Study to examine the gaps in Study to examine the gaps in emergency and trauma care emergency and trauma care research.research.

Development of a research strategy.Development of a research strategy. Increased funding for prehospital EMS Increased funding for prehospital EMS

research, emphasizing systems & research, emphasizing systems & outcomes research.outcomes research.

Disaster PreparednessDisaster Preparedness

Elevation of emergency care to a Elevation of emergency care to a position of parity with other public safety position of parity with other public safety entities in disaster planning & entities in disaster planning & operations.operations.

Increase in funding for EMS-related Increase in funding for EMS-related disaster preparedness through dedicated disaster preparedness through dedicated funding streams.funding streams.

Incorporate disaster preparedness Incorporate disaster preparedness training into EMS professional training & training into EMS professional training & continuing education. continuing education.

CA & CA & Model Trauma System Model Trauma System

The HRSA The HRSA Model Trauma System Planning Model Trauma System Planning and Evaluationand Evaluation (MTSPE) document (MTSPE) document provides a guide for states in enhancing provides a guide for states in enhancing trauma care.trauma care.

The guide provides a structure for further The guide provides a structure for further developing the statewide systemdeveloping the statewide system

MTSPE guide is one tool for states to use MTSPE guide is one tool for states to use in developing an inclusive trauma systemin developing an inclusive trauma system

ACS/COT Systems Consultation guideACS/COT Systems Consultation guide Public Health and Trauma System both Public Health and Trauma System both

focus on risk reductionfocus on risk reduction Trauma continues to be a leading cause of Trauma continues to be a leading cause of

death in Californiadeath in California

Conclusion: California’s DirectionConclusion: California’s Direction

Use the MTSPE guide to evolve a statewide Use the MTSPE guide to evolve a statewide systemsystem

Continue developing the regional Continue developing the regional approach to trauma care within California approach to trauma care within California using the BIS as a guide to improvementusing the BIS as a guide to improvement

Rely on data to assist in setting standards, Rely on data to assist in setting standards, guidelines and benchmarks that may be guidelines and benchmarks that may be unique to California unique to California

Incorporate the COT Systems Consultation Incorporate the COT Systems Consultation Guide (Regional Trauma Systems: Optimal Guide (Regional Trauma Systems: Optimal Elements, Integration, and Assessment)Elements, Integration, and Assessment)

Conclusion: California’s DirectionConclusion: California’s Direction

Leadership in Trauma SystemsLeadership in Trauma Systems State, Regional, Local,State, Regional, Local,

Many Benchmarks & Indicators already Many Benchmarks & Indicators already achievedachieved

Statutes, Regulations, Funding availableStatutes, Regulations, Funding available It will never be enough!It will never be enough!

The timing is right to move California to The timing is right to move California to the next level of trauma system the next level of trauma system developmentdevelopment

JUST DO ITJUST DO IT

Build on the synergy & cooperative spirit of this summit