In 1989, the Texas Legislature passed legislation which led to the formation of 22 Trauma Service Areas and the creation of the 22 Regional Advisory Councils (RACs) to develop comprehensive regional trauma care systems. RACs are 501(c)(3) organizations that unite competing medical providers for the best interests of the multi-county regions they serve. RACs’ initial purpose was to develop a strong trauma care system within their respective regions.

RACs have grown substantially and now are recognized for bringing together all regional providers across the emergency healthcare spectrum to share best practices and collaborate on life-saving emergency medical protocols. Multiple emergency medicine initiatives – including stroke, cardiac and perinatal care – now are effectively addressed by RACs under contract with the Department of State Health Services (DSHS).

• TRAUMA CARE. RACs play a key role in promoting a system of care that depends upon a network of EMS agencies and designated trauma hospitals. RACs are the “traffic control” for regional resources and the uniting body for competing providers. EMS agencies rely on best practices to assess and stabilize each patient and to select and communicate with the most appropriate designated trauma hospital. This system of care and ongoing training have led to a trauma fatality rate far below the national average, yet trauma remains the leading cause of death for Texans 44 years of age and under.

• STROKE EMERGENCY CARE. RACs bring value to their regions through public education and data collection that helps identify opportunities to improve medical care. For instance, multiple RACs now track the timely administration of the clot-busting drug tPA. By ensuring tPA administration within published treatment time guidelines, the majority of strokes can be treated effectively. Stroke patients have better outcomes and healthcare costs are minimized.

• CARDIAC EMERGENCY CARE. RACs work with their regional EMS agencies and hospitals to examine ways to shave minutes off normal treatment processes. For patients with a blockage, EMS and hospital teams work together in advance of patient arrival at a hospital so that heart catheterizations can occur within 90 minutes. RACs have supported DSHS actions to collect statewide data to improve care for patients experiencing cardiac events in urban, suburban and rural settings.

• PERINATAL CARE. In 2013, the Texas Legislature established perinatal care regions to improve outcomes for pregnant women and newborns. Because of the success of the existing trauma regional approach, these regions were incorporated into the RACs. In coordination with DSHS, RACs are responsible for ensuring providers in the region collaborate to provide the best care possible for mothers and babies.

• DISASTER PREPAREDNESS AND EMERGENCY RESPONSE. RACs lead the medical component of preparedness planning and response using federal Hospital Preparedness Program funding distributed through DSHS. Among other duties, RACs assess the availability of beds in each hospital, ensure that resources are wisely allocated, and conduct training and joint exercises of all stakeholders as a team. RACs foster strong partnerships among local government officials and state and federal disaster response agencies. Recognizing the need for an ability to share manpower and resources during disasters, RACs developed the Emergency Medical Task Force (EMTF). This system deploys equipment and specially trained emergency personnel to respond to disasters such as hurricanes, large scale flooding, wildfires, explosions, mass shootings and high conse-quence infectious diseases when local resources are insufficient to respond.

THE EMERGENCY MEDICAL TASK FORCE (EMTF) was formed by RACs after realizing that the state needed a way to formally share manpower and assets in the wake of disasters such as hurricanes, large scale flooding, wildfires, explosions, mass shootings and high consequence infectious diseases. Through EMTF, equipment and specially trained emergency personnel come to the aid of Texans when local resources are depleted or are insufficient given the magnitude of the response effort needed.

Contractual agreements between RACs and first responders and hospitals enabled the formation of eight EMTF regions in 2008. DSHS supports the program and authorizes deployments. The program is unique in the nation and has been recognized as a best practice by FEMA and the U.S. Department of Health and Human Services.

Deployment of EMTF resources may include ambulance buses, nurse strike teams, ambulance strike teams, mobile medical units and a mobile morgue, among others. RACs have used federal funds to purchase special equipment, like ambulance buses (Ambuses), and human resources usually are employed within a responding health system,

Since disasters don’t follow geographic boundaries, EMTF allows first responders to be moved to the portion of the state where they are needed and minimizes duplicate purchases by encouraging the sharing of resources across the state when disasters occur. EMTF-based planning, training and relationship building has enhanced disaster response statewide.

TRAUMA REGIONALADVISORY COUNCILSLeading Emergency Planning and Response That Saves Lives

EMTF is self-governed by an eight-member executive committee comprised of RAC executives from each of the eight EMTF regions. Every RAC in Texas donates a portion of its federal funding to create and support the EMTF, and DSHS distributes the funds to the lead RACs through Hospital Preparedness Program contracts.

EMTF continues to evolve to serve the needs of the state. However, EMTF is dependent on unreliable federal funding. A state appropriation to support this program will insure that Texas always stands ready to respond to the next disaster, whether natural or man-made.

22 RACs combined resources to form EMTF regions

Scene of 2017 mass shooting in Sutherland Springs, 30 miles east of San Antonio

Hurricane Harvey rain-triggered flooding in Houston, 2017

Ambulance buses used in Hurricane Harvey response, 2017

TRAUMA REGIONAL ADVISORY COUNCILS

Bringing Providers Together to Share Best Emergency Medical Practices, Use Resources Wisely,

Coordinate Disaster Response and Save Lives

RAC A: Panhandle RAC has presented numerous educational conferences focus-ing on stroke/STEMI, pediatrics and trauma. RAC A also hosted a multi-regional disaster exercise to prepare area providers. RAC A has provided “Stop the Bleed” public education including the use of tourniquets. The RAC includes 17 hospitals and 48 EMS provid-ers covering 26,000 square miles. Visit www.panhandlerac.org.

RAC F: Northeast Texas RAC is a leader in the use and training of WebEOC© Northeast Texas. Hospitals, EMS agencies, first respond-ers and law enforcement representatives participate in monthly trainings on this and other emergency communication systems. NETRAC houses and maintains the majority of the response assets of EMTF 4, including Zumro and Western Shelter mobile medical units. Visit www.netrac.org.

RAC K: Concho Valley Regional Advisory Council works with hospitals and EMS to improve trauma care in a 14-county region. With grant funding, RAC K works with Safe Kids to prevent injuries and to distribute car seats and helmets in all the region’s counties. The RAC provides continuing education and training to all hospitals and EMS, includ-ing a trauma symposium and a cardiac and stroke symposium free to all attendees. RAC K houses a regional cache of supplies and equipment for disaster situations. RAC K also is focusing on tourniquet distribution and training for fire department and law enforce-ment personnel with plans to support public education. RAC K has placed an automated external defibrillator in each county for public use. Visit www.cvrac.org.

RAC L: Central Texas RAC includes six counties and has supported responses to the hospital explosion in Gatesville and the hos-pital full power outage in Killeen. RAC injury prevention actions cover geriatric falls, child passenger safety and educational billboards for chest pain, stroke, “Turn Around/Don’t Drown” and distracted driving. RAC L is very involved with EMTF mobile medical units and nurse strike teams. The RAC also coordinates “Stop the Bleed” activities in its services area. Visit www.tsa-l.com.

RAC M: The Heart of Texas RAC and its “Stop the Bleed” work help not only school districts and first responders but also the gen-eral public with training and supplies to control life-threatening bleeding. HOTRAC continues to partner with the American Heart Association in cardiac and stroke awareness campaigns such as the “Go Red Luncheon.” HOTRAC also works with the emergency healthcare community to enhance response and treat-ment activities through regional performance improvement. Visit www.hotrac.org/.

RAC N: The Brazos Valley RAC includes seven counties, and is dedicated to the de-velopment and implementation of regional emergency medical services and a trauma system plan to provide optimal care of the injured or ill patient. Committees include pre-hospital, hospital care and manage-ment, the Brazos Valley healthcare coalition, systems quality improvement, education, perinatal and injury prevention. Visit www.bvrac.com.

RAC O: Capital Area RAC has focused on the development of stroke and cardiac regional treatment/transport guidelines and encouraged data collection between hos-pital/EMS providers to validate patient out-comes. CATRAC has participated in “Stop the Bleed” tourniquet training/distribution for regional partners. CATRAC has been a major participant in statewide hospital peri-natal designation level initiatives. Regional exercises and deployment for disaster/emergency preparedness events including the use of mobile medical units have been conducted. CATRAC initiated a radio project allowing communication with more than 30 regional hospitals. Visit www.catrac.org.

RAC B: BRAC focuses on quality trauma, cardiac, stroke, pediatric and perinatal care through transport and transfer guidelines and monitoring of data indicators for process improvement and patient safety. Injury pre-vention activities have included “Shattered Dreams” programs, car seat clinics and child abuse education. Evidence-based education and case reviews are provided for RAC mem-bers. BRAC leads active disaster management and regional preparedness with strike teams, an ambulance bus and a mobile medical unit with frequent training and disaster drills across 22 counties. Visit www.b-rac.org.

RAC C: North Texas RAC covers 10 counties and leads collaboration among hospitals, EMS, air medical and other first responders with meetings focused on trauma, stroke, cardiac, pediatric and perinatal care. A regional trauma plan which includes trauma transfer protocols has been implemented. NTRAC is involved in public education, offering programs including car seat clinics, distracted driving, “Stop the Bleed,” bicycle safety,”CarFit” for elderly drivers and “Shattered Dreams.” NTRAC presents an annual trauma conference and provides various continuing education op-portunities. Disaster management training is a current focus. Visit www.ntrac.org.

RAC D: Big Country RAC facilitates the use of EMS and hospital protocols for 16 counties that are home to a Level III desig-nated hospital, two primary stroke centers and a perinatal hospital. In addition to host-ing health fairs, RAC D provides “Project Rescue Me” identifying tags for the young and old, thermometers to monitor the heat index in a car and STROKE magnets that describe warning signs of a stroke. RAC D provides continuing education on numerous topics including pediatric trauma. Visit www.bigcountryrac.org.

RAC E: North Central Texas RAC has been a “go-to” EMS and trauma hospital resource for Gulf hurricane response and evacuations, the Ebola public health emergency, West explosion and Texas’ frequent storm/tornado recovery efforts. The RAC invested in four community-based EMTF ambulance buses and hosts a 22,800-square foot emergency medical resources warehouse. RAC members coordinate patient destination, E.D. satura-tion, diversion and free-standing ER center challenges. The RAC verified and recognized 13 HEARTSafe Communities and has helped train more than 15,000 people through the “Stop the Bleed” initiative. Visit www.NCTTRAC.org

RAC G: Piney Woods RAC partners are teaching “Stop the Bleed” classes to local schools, participating in tabletop emergency planning exercises and disaster drills for sur-gery centers for Medicare-approved facilities and providing community disaster prepared-ness awareness region-wide trainings. EMTF 4 has continued to partner with its hospitals and first responder agencies to further develop and improve the region’s capabilities to re-spond to medical emergencies and disasters by offering education, training and joint exer-cises. EMTF 4 deployed personnel and assets along with other EMTF regions in response to Hurricane Harvey in a collaborative effortto help all Texans in a time of crisis. Visit https://www.rac-g.org/.

RAC H: Deep East Texas RAC includes eight hospitals, 10 EMS agencies and a rotor-winged air ambulance service. The RAC has three designated trauma hospitals which also are certified chest pain centers; two of these hospitals are primary stroke centers. The board leads committees focused on trauma and injury prevention; perinatal care; emergency, stroke and cardiac care; and free-standing emergency centers. Challenges include limited volunteer manpower, limited physician availability for meetings and limited funds. Visit: www.detrac.org.

RAC I: BorderRAC provides coordination for hospital and EMS response to emergency and disaster situations and hosts EMTF 9. Agencies optimize protocols to improve care and decrease mortality. Prevention and com-munity education focus on “Stop the Bleed,” signs and symptoms of heart attack and stroke, prevention of shaken baby and unsafe sleeping positions, and underage drinking with high school poster contests and coor-dination of “Shattered Dreams” programs. The RAC provides professional education for physicians, nurses and EMS providers. Visit http://borderrac.org/.

RAC J: Texas J RAC leads collaboration among hospitals, EMS services, law enforce-ment and behavioral health providers in 17 counties. Its focus areas include child safety seat distribution and education, trauma delivery and public education in rural settings, bicycle safety, and education on DWI and distracted driving. Other educational topics include stroke, STEMI and perinatal care, as well as a “Stop the Bleed” campaign for tourniquet use and public education. Visit www.texasjrac.org.

RAC P: Southwest Texas RAC leads a 24/7 trauma transfer and regional disaster response coordination center and an elec-tronic patient medical record system with more than one million records. STRAC hosts a trauma, cardiac and stroke registry with 100,000 patient records to support regional quality improvement initiatives. STRAC hosts annual 500+ patient disaster exercise drills for hospitals and EMS to practice response to terrorism, infectious disease and mass casualty incidents. Visit www.strac.org.

RAC Q: Southeast Texas RAC includes 30 designated trauma hospitals serving a population that rivals the 18th largest state. During Hurricane Harvey, SETRAC’s medi-cal operations center coordinated care for a 25-county region. Emergency stroke, cardiac, trauma and perinatal care are top focuses. The national journal Stroke published a study crediting SETRAC for uniting hospitals and improving outcomes, saving the system more than $3.6 million annually. SETRAC holds an annual awards banquet and an annual disas-ter symposium. Visit www.setrac.org.

RAC R: East Texas Gulf Coast RAC is the creator of the original mobile medical unit. To improve trauma care, RAC R provides hundreds of hours of free trauma education to its members. RAC R also has championed the “Stop the Bleed” campaign. While its primary focus is on trauma, RAC R also works to identify best practices for cardiovascular and perinatal care. Visit www.rac-r.com.

RAC S: Golden Crescent RAC focuses on getting resources to providers caring for patients, from education for trauma, cardiac, stroke or emergency preparedness to equip-ment and supplies. GCRAC is recognized though the American Heart Association as a Mission: Lifeline STEMI and Cardiac Resusci-tation System of Care. Visit www.gcrac.org.

RAC T: The Seven Flags RAC includes three counties with a population of 270,000 people served by two acute-care hospitals. The region is relatively large in square miles but has few incorporated areas. Trauma care and response times are a significant focus, which has led to improved communication systems among hospitals and first responders. Contact www.sevenflagsrac.org.

RAC U: Coastal Bend RAC unites health-care providers in regional disaster planning, preparedness activities and exercises. Trauma and acute-care committees address regional protocols designed for best patient out-comes. Data show that transport plans are enabling improved stroke and heart attack outcomes in the region. The RAC provides specialized, professional education to its stakeholders and public education on topics such as “Stop the Bleed” and injury preven-tion. Annually, its EMTF mobile medical units support the naval air stations during the Wings over South Texas Air Shows, providing a medical component for these large-scale planned events. Visit www.cbrac.org

RAC V: TRAC-V covers Hidalgo, Cameron, Starr and Willacy counties in the Rio Grande Valley. Goals include the development of collaborations between hospitals and EMS providers and the provision of educational opportunities to TRAC-V members and community stakeholders. A healthcare conference focusing on trauma, stroke, cardiac and perinatal topics is held annu-ally at South Padre Island with participants from the Rio Grande Valley, other cities and states, and Mexico. “Stop the Bleed” work-shops have been provided at various school districts throughout the region. Cardiac, stroke, trauma and perinatal committees meet regularly for sharing of information, coordination and data reporting. Visit http://www.tracv.org/.

Texas Trauma Service Areas(Led by RACs)