Ohio Trauma Legislation: How’s it Going?: Ohio Trauma Legislation: How’s it Going? Fall 2003 Mike Glenn, RN State Trauma Coordinator Ohio Public Safety - EMS Division www.ohiopublicsafety.com


Slide2: “How’s it Going” depends on “What you Measure” Promulgation of Rules? Issuance of Guidelines? Compliance with ORC & OAC? Implementation of Policies? How about Saving Lives & Decreasing Disabilities? Ohio Trauma Legislation: How’s it Going?


Slide3: Promulgation of Rules All rules required by HB 138 have been promulgated by the state EMS Board Trauma Triage ……………………………….…… ✔ DONE Trauma Registry Risk Adjustment Standards … ✔ DONE EMS/Trauma Grant Program …………………..…✔ DONE Minimum Qualifications for EMS Med Directors . ✔ DONE Ohio Trauma Legislation: How’s it Going?


Slide4: Issuance of Guidelines Board required to issue guidelines for The Operation of Air Medical Services …………….. ✔ DONE EMS Trauma Care Guidelines ………………….….. ✔ DONE EMS Peer Review and PI Program …………..…….. ✔ DONE The Operation of Ambulance & EMS Organizations. ✘ ONGOING Ohio Trauma Legislation: How’s it Going?


Slide5: Compliance with ORC/OAC EMS Board Expand with two additional members ………….. ✔ DONE Conduct 7 Special Studies………………………. ✘ ONGOING Reports due on 11/03/03 Ohio Dept of Health Convene Two Special Commissions ……………. ✘ ONGOING Injury Prevention & Post Critical Care, Reports due 11/3/03) Ohio Trauma Legislation: How’s it Going?


Slide6: Compliance with ORC/OAC Ohio Hospitals Adopt Trauma Protocols ……………....…………. ✘ ONGOING Emergency Care, Transfers and Trauma PI Trauma Centers Verified by the ACS …………... ✘ ONGOING Participate in Ohio Trauma Registry ………...…. ✘ ONGOING >100,000 records have been submitted Ohio Trauma Legislation: How’s it Going?


Slide7: Compliance with ORC/OAC Ohio EMS Agencies Participate in Incident Reporting System….……. ✘ ONGOING This is not specific to the Trauma Legislation Implement Trauma Peer Review & PI………..…. ✘ ONGOING Must be in place 11/3/03 Ohio Trauma Legislation: How’s it Going?


Slide8: Saving Lives? Reducing Disabilities? Difficult to measure at present “Trauma System” is still very young Ohio Trauma Registry and EMS Incident Reporting System Length of Stay by ISS for Injury Helicopter activations and hospital discharge within 24 hours. Over and Under Triage rates Distribution of Trauma Care Resources Ohio Trauma Legislation: How’s it Going?


Triage Protocols: Triage Protocols Ohio Revised Code 4756.40(A)(2) “Require a trauma patient to be transported directly to an adult or pediatric trauma center that is qualified to provide appropriate adult or pediatric trauma care” Qualified = ACS Verified or Ohio Provisional Appropriate = trauma center capabilities (ACS level) example - Not all level 3 TC have neurosurgical capabilities. It may be appropriate to bypass a level 3 TC enroute to a level 1 or 2 TC with a patient that has a severe head injury.


Triage Exceptions : Triage Exceptions Exceptions for Trauma Triage Protocols 1. It is medically necessary to transport to another hospital for initial assessment and stabilization. 2. It is unsafe or medically inappropriate due to adverse weather conditions or excessive transport times. 3. Would cause a shortage of local EMS resources. 4. No trauma center is able to receive patient and provide care with out undue delay. 5. Before transport begins, if the patient or parent request transportation to a particular hospital.


Regional Triage Protocols: Regional Triage Protocols Regional Trauma Triage Protocols Two Sections EMS Approved Variations to State Triage Protocol Anatomic and/or Physiologic Criteria Mechanism of Injury or Special Considerations. Use of, or additional detail applied to the 5 exceptions to trauma triage Enforceable like Ohio Administrative Code (OAC) Regional Guidelines Trauma protocols other than the variations listed above NOT approved by the EMS Board Adopted/used by the region on a consensus basis. NOT enforceable like OAC MAY establish a regional standard of care.


Slide12: Delaware Madison Union Licking Fairfield Pickaway Fayette Clark Champaign Logan Hardin Allen Hancock Wyandot Marion Crawford Huron Richland Ashland Morrow Knox Coshocton Tuscarawas Carroll Harrison Belmont Guernsey Muskingum Monroe Noble Perry Morgan Washington Athens Hocking Meigs Gallia Vinton Jackson Lawrence Scioto Adams Pike Ross Highland Shelby Miami Montgomery Greene Darke Preble Mercer Auglaize Van Wert Paulding Defiance Williams Putnam Henry Fulton Wood Lucas Ottawa Sandusky Seneca Erie Lorain Cuyahoga Medina Wayne Holmes Lake Geauga Ashtabula Trumbull Portage Summit Stark Mahoning Columbiana Jefferson Clinton Brown Clermont Warren Butler Hamilton Franklin Franklin 1 2 3 4 5 6 7 8 9 10


Triage Protocols: Triage Protocols Trauma Triage and Air Medical Services How, When and Why you should call for a helicopter….


Triage Protocols: Triage Protocols Air Medical Services How, When and Why you call a helicopter…. When your standing orders direct you to


Triage Protocols: Triage Protocols Air Medical Services How, When and Why you call a helicopter…. When your standing orders direct you to do so When on-line medical control instructs you to


Triage Protocols: Triage Protocols Air Medical Services How, When and Why you call a helicopter…. When your standing orders direct you to do so When on-line medical control instructs you to do so When in your opinion it is in the patients best interests


Slide17: Hospitals are recognized as a Trauma Center if: Verified by the ACS (all levels, adult & pediatric)  Designated as level 2 pediatric TC by ODH 12/31/2004  Hospital outside Ohio licensed or designated by that state as being capable of providing specialized trauma care  Hospitals functioning as a Provisional Trauma Center Trauma Center Definition


Trauma Center Provisional Designation: Trauma Center Provisional Designation Hospitals may self-designate as a provisional Trauma Centers if: Complete an ACS Trauma Center consultation visit  CEO/CMO certifies in writing that hospital is capable  Board of Trustees adopts a resolution that hospital is capable and will seek ACS verification  Hospital creates a written plan and time table for achieving ACS verification 18 months to obtain ACS verification If unsuccessful, must wait 2 years to try again


Trauma Center Definition: Trauma Center Definition ACS Verification vs. State Designation The ACS “Verifies” that a hospital meets their standards. A State Agency “Designates” a hospital as a Trauma Center Ohio has Verification, but not Designation


Ohio Trauma Legislation: How’s it Going?: Ohio Trauma Legislation: How’s it Going?


Slide21: Delaware Madison Union Licking Fairfield Pickaway Fayette Clark Champaign Logan Hardin Allen Hancock Wyandot Marion Crawford Huron Richland Ashland Morrow Knox Coshocton Tuscarawas CARROLL Harrison Belmont Guernsey Muskingum MONROE NOBLE PERRY MORGAN Washington Athens Hocking MEIGS Gallia VINTON Jackson Lawrence Scioto Adams Pike Ross Highland Shelby Miami Montgomery Greene Darke PREBLE Mercer Auglaize Van Wert Paulding Defiance Williams PUTNAM Henry Fulton Wood Lucas Ottawa Sandusky Seneca Erie Lorain Cuyahoga Medina Wayne Holmes Lake Geauga Ashtabula Trumbull Portage Summit Stark Mahoning Columbiana Jefferson Clinton Brown Clermont WARREN Butler Hamilton Franklin Franklin = Non trauma center hospital = Helicopter 7 13 3 Counties in RED CAPITALS have NO hospital No 9-1-1 service EMS/Trauma Map Updated 9/02/03 H I = EMS Region 4 5 4 In counties with multiple non trauma center hospitals, a bold number next to a hospital icon indicates that number of non trauma center hospitals in that county VI VII X VIII V I II III IV IX H H H H H H H H H H H H H H H (Parkersburg WV) (Huntington WV) (Ashland, KY) (Wheeling WV) (Covington, KY) = Level 3 Trauma Center = Level 2 Trauma Center = Level 1 Trauma Center The icon SHAPE indicates the trauma center level The icon COLOR indicates Status: ACS or Ohio Provisional & Adult or Pediatric = ACS Adult = ACS Pediatric = Ohio Provisional Adult = ACS Adult + Pediatric = Ohio Provisional Pediatric 4 H (Ft. Wayne, IN) (Pittsburgh, PA) (Erie, PA) LEGEND


EMS/Trauma Data: EMS/Trauma Data Ohio Trauma Registry Data collection began Jan 1999 Collect Data from; All hospitals (175)  County Coroners  Inpatient Rehab Facilities 04 Nursing Homes 05 Over 100,000 records Web enabled 2003 EMS Incident Reporting System Data collection began Jan 2002 All EMS services required to report Over 850,000 records from over 800 services to date


Trauma Grant Funding: Trauma Grant Funding EMS/Trauma Grants Priorities describe in ORC 1st - EMS Training & Equipment………..$4,700,000 2nd - Injury Prevention……………………...$300,000 3rd - Trauma Rehabilitation & Retraining..…$250,000 4th - Medical Procedures for trauma……...…$150,000 Priority 1 funds must go to EMS departments Priorities 2, 3 & 4 are open to groups and organizations other than EMS departments


Trauma Grant Funding: Trauma Grant Funding EMS/Trauma Grants Rehabilitation Grants Substance Use Disorders Following Traumatic Brain Injury Predictive Relationship of ISS/AIS to WeeFIM in pediatric and adolescent trauma patients Psychological Effects of Non lethal Gun Shot Incidents on Law Enforcement Personnel The Impact of Acute Stress Disorder following Traumatic Trauma Medical Procedures


Trauma Grant Funding: Trauma Grant Funding EMS/Trauma Grants Trauma Medical Procedures Teaching Paramedic ETT on Human Patient Simulators Effects of a Focused Paramedic Educational Intervention on the Acquisition and Retention of Airway Management Skills in the pediatric trauma patient Field Trial of the LMA by pre-hospital personnel Do No Further Harm (airway training techniques)


Seven Special Studies: Seven Special Studies Role of Non Trauma Center Hospitals. Status and Needs of EMS/Trauma Re: Pediatrics Status and Needs of EMS/Trauma Re: Geriatrics. Causes and Impact of Trauma on Minorities. Methods to Increase Trauma Education. Methods to ensure Autopsies are performed Feasibility of use of handheld PC’s to report data to the state trauma registry.


Making it Work...: Making it Work... Peer Review Performance Improvement Trauma Specific Peer Review & PI required All EMS Organizations All Hospitals (Trauma and Non Trauma centers)