x0000x0000 147Health and Wellness for all Arizonans148Page - PDF document

1 �� “Health and Wellne
�� “Health and Wellness for all Arizonans”Page of Bureau Of Emergency Medical Services & Trauma System150 N. 18th Avenue, Suite 540Phoenix, Arizona 85007 raumaand EMS Performancemprovement(TEPI) tandingommittee DateMarch 14, 2019Time9:00 hrs LocationAZ Department of HealthServices, 150 N. 18Ave, Via computer with call back: azgov.webex.com, meeting code 808 555 950passwordEPI201(telephone only: dial 2400879, meeting code AGENDA Call to OrderJosh Gaither, , Chair Roll Call III.Chairman’s ReportJosh Gaither, Attendance report (Attachment III.a.)New Members: Carey Lewis, CPNP; Nirav Patel, MD; Raymond Proa, NREMTP; Laura Smith, DNP; and James Cesolini, CEP IV.Bureau ReportTerry Mullins, Bureau Chief Rules UpdateData Linkage Update Ben Fisher, MPA, NRPPremier EMS Agency Program Update Ben Discussion and Action Items Discuss, amend, and approve TEPI meeting minutes ofNovember 15(Attachment V.a.)Discuss creating list of topics f ) Review and recommend changes for a future updateof the Air Ambulance Utilization Report (Attachment V.c.) VI.Progress Reports Workgroup for Pediatric Resuscitation Elements in the Cactus Data Set Gail Bradley, MD EMS Registry UsersGroup (EMSRUG) RaymondProa, NREMTTrauma Registry Users Group (TRUG) Melissa Moyer, CSTR �� “Health and Wellness for all Arizonans”Page of Trauma Program Manager Workshops Heather MillerBSN, VII.Agenda tems to be considered for the next eeting VIII.Call to the Public A public body may make an open call to the public during a public meeting, subject to reasonable time, place and manner restrictions, to allow individuals to address the public body on any issue within the jurisdiction of the public body. The Board may askstaff to review a matter, or may ask that a matter b

2 e put on a future agenda. Members of the
e put on a future agenda. Members of the public body shall not discuss or take legal action on matters raised during an open call to the public unless the matters are properly noticed for discussion and legal action. A.R.S. § 38431.01 (G).Persons with disabilities may request reasonable accommodations such as a sign language interpreter, by Angie McNamara(angie.mcnamara@azdhs.gov3156; State TDD Number 18939; or Voice Relay Number 711. Request should be made as early as possible to allow time to arrange accommodations IX.Summary of Current Events April 8, 2019 Arizona EMS Resiliency, Wellness and Safety Summit 2019 Phoenix May 13 National Association of State EMS Officials (NASEMO)Annual Meeting Salt Lake City, Utah June 12, 2019 PEDSAPLENTY Phoenix June 13 EMS Odyssey Conference Phoenix June 27 outhwest Regional Trauma Conference Tucson Next Meeting July 18@ 09:00 hrs, Arizona Department of Health Services, 150 N. 18th Ave, Rooms 215A & B, Phoenix, AZ 85007 XI.Adjournment aechanism of Injury IEaS Transport % Call 26.0% aVT - hccupant 25.8% Struck .y/Against 8.0% hther Land Transport 7.8% /ut/tierce 5.5% aVT - aotorcyclist 4.9% Cirearm 4.3% aV bon - Tra�c 4.2% aVT - tedestrian 2.1% hther Speci�ed, /lassi�able 2.1% The top three mechanisms of injury for HEMS transports were Falls, Motor Vehicle Traffic - Occupant and Struck By/Against. This corresponds to the top three mechanisms of injury for all trauma patients in Arizona 2 . Table 4: tercent of IEaS transports by aechanism of Injury, ASTw 2008 - 2017 Injury Severity Score Length of Stay The percent of HEMS transports with ISS greater than 15 have increased from 26% in 2008 to 30% in 2017 (Table 3). The percent of HEMS transports w

3 ith length of stay �24 hours also
ith length of stay �24 hours also increased from 68% in 2008 to 74% in 2017. The increase in mortality among HEMS transports from 2008 (3.8%) to 2017 (6.0%) also suggests that more severely ill patients are transported using HEMS. Cigure 4: tercent of IEaS transports by Injury Severity Score (ISS) , ASTw 2008 - 2017 Table 3: tercent of IEaS transports with an Injury Severity Score (ISS) greater than 15, a hospital Length of Stay (LhS) more than 24 hours, and mortality, ASTw 2008 - 2017 aechanism of Injury Cigure 5: tercent of IEaS transports with a hospital Length of Stay (LhS) more than 24 hours, ASTw 2008 - 2017 2. .ureau of EaS and Trauma System, 2018 STA. Annual weport, h�ps://www.azdhs.gov/preparedness/emergency - medical - services - trauma - system/#data - quality - assurance - reports 2008 - 2017 Total air transports ISS >15 LhS >24 hours aortality b b % b % b % 2008 6,128 1,580 26.2% 4,184 68.2% 235 3.8% 2009 5,448 1,422 26.5% 3,678 67.5% 225 4.1% 2010 4,840 1,248 26.4% 3,151 65.1% 197 4.0% 2011 4,384 1,152 26.8% 2,925 66.7% 190 4.3% 2012 4,215 1,132 27.4% 2,842 67.4% 190 4.5% 2013 3,987 1,063 27.2% 2,741 68.7% 175 4.3% 2014 3,728 1,003 27.3% 2,611 70.0% 171 4.5% 2015 3,572 982 27.9% 2,591 72.5% 161 4.5% 2016 3,703 1,020 28.2% 2,697 72.8% 211 5.6% 2017 3,502 1,038 30.1% 2,588 73.9% 211 6.0% /ounty topula�on 2017 IEaS Transports U�liza�on wate per 100,000 tima 1,026,099 117 11 aaricopa 4,221,684 557 13 aohave 209,792 36 17 tinal 427,603 370 87 Yuma 221,648 203 92 Santa /ruz 51,507

4 67 130 Dreenlee 10,961 16 14
67 130 Dreenlee 10,961 16 146 /oconino 144,057 223 155 /ochise 128,383 201 157 Yavapai 225,364 424 188 Draham 38,275 73 191 Apache 72,713 146 201 bavajo 111,266 381 342 La taz 21,598 78 361 Dila 54,947 404 735 Statewide 6,965,897 3,502 50 In 2017, the state HEMS transport utilization rate was 50 per 100,000 residents. The utilization rates were higher in Arizona ’s rural counties as compared to urban counties. Pima County and Maricopa County reported the lowest rates of HEMS transports while La Paz County and Gila County reported the highest rates. Cigure 3: IEaS transport rate per 100,000 Arizona wesidents by county, ASTw 2017 Table 2: IEaS transport rate per 100,000 Arizona wesidents by county, ASTw 2017 Volume Table 1: Volume of IEaS transports by county of injury and year, ASTw 2008 - 2017 Year 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Statewide 6,128 5,448 4,840 4,384 4,215 3,987 3,728 3,572 3,703 3,502 Apache 160 189 150 115 127 104 105 140 118 146 /ochise 274 275 255 262 261 237 170 209 174 201 /oconino 208 222 210 201 221 208 223 197 204 223 Dila 476 498 480 433 419 381 431 403 401 404 Draham 107 101 84 80 84 78 77 78 72 73 Dreenlee 38 29 38 30 34 28 20 27 26 16 La taz 65 45 74 73 57 83 87 102 102 78 aaricopa 1,382 1,245 1,072 936 885 888 863 647 716 557 aohave 23 11 22 28 30 18 25 23 43 36 bavajo 348 378 378 312 323 330 301 342 361 381 tima 341 284 266 219 209 165 123 113 143 117 tinal 771

5 752 814 677 732 633 458 442
752 814 677 732 633 458 442 409 370 Santa /ruz 124 119 90 70 86 70 71 59 66 67 Yavapai 364 427 416 463 347 415 362 343 381 424 Yuma 125 155 168 186 166 168 202 195 241 203 /ounty wate Air Transport Trauma Report Arizona State Trauma Registry (ASTR) 2008-2017 .UwEAU hC EaEwDEb/Y aEDI/AL SEwVI/ES AbD TwAUaA SYSTEa Helicopters are an integral component of a state trauma system, especially in states like Arizona with vast geographical areaseparating patients from trauma centers. The primary goal of Helicopter Emergency Medical Services (HEMS) transport is to ensure that patients with potentially severe injuries reach a definitive care facility within an intervention window when not possible with ground EMS transport. Optimizing the use of HEMS transport is important as there is a significant cost associatwith this important resource. This report analyzes ten years of trauma data to describe the use of HEMS transport in Arizona. In the past 10 years, the volume of patients transported by HEMS has decreased by 43% from a total of 6,128 HEMS transports in 2008 to a total of 3,502 HEMS transports in 2018. Over this period the largest decrease in HEMS transports volume has occurred in Maricopa County followed by Pinal County and Pima County; whereas the volume has remained consistent over the years in the other counties . Cigure 1: IEaS transports volume by year, ASTw 2008 ImportanceThis report uses data from the Arizona State Trauma Registry (ASTR) for the years 2008 to 2017 and consists of patients with at least one HEMS transport from a trauma scene. The rate of HEMS transports were calculated by county for the most recent year of data (2017) using the 2017 population denominators from the Arizona Health Sta

6 tus and Vital Statistics database. An In
tus and Vital Statistics database. An Injury Severity Score (ISS) greater than 15 was used to define trauma patients with severe injury. aethods Trend1. Arizona Department of Iealth Services, topula�on Iealth and Vital Sta�s�cs. topula�on Denominators: 2016. h�p://pub.azdhs.gov/healthstats/menu/info/pop/index.php Cigure 2: IEaS transports volume by year and county of injury, ASTw 2008 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 0 500 1000 1500 2000 2500 3000 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Other counties Maricopa Pima Pinal Section Notice eetings Standing ittee members hall tified ten (10) days n advance ll Standing ittee meetings. A yearly chedule gular Standing ittee eetings hall ade vailable Standing ittee members January. Minutes he previous eeting n agenda or the upcoming eeting hould be vailable members en (10) days n advance tanding Committee meeting. Section Attendance Regulaattendance is expecteof all Committee membersIf a member fails tattend twconsecutive meetingsinquiry shall be made by the BureaLiaisof that membeconcerning their continueparticipatithe Boathe results of the inquiry shall be forwardeto the Medical irector, Committee aiand BureaChief for a cision on the member's tatus. Section uorum onsists imple majority (50% plus one) of ntire embership, whether the positiis illed or vacant, present in person or via lectronic edia. Article VI: ParliamentarAuthorityThe les ontainein the current dition of Robert’s rder Newly vised shall overn the Standing ittee in all ases o whicthey pplicable in which they nconsistent with these laws. Article VII: Open eeting Law The Arizona pen Meeting Law .S. 38-431-A.R.S38-431.09) shall pply o meetings Standing itte

7 e. Article VIII: Minutes Minutes ach St
e. Article VIII: Minutes Minutes ach Standing ittee eeting ill cordeand the tanding ittee hall have ights view nd correction of inutes ll eetings fore ication and distribution. Article X: Motions All otions ssed by his tanding Committee ill be orwarded tthe tatutory ils review actiat their next gularly scheduled meeting. Article : Amendments These laws an be amended at gular meeting tanding mittee ajority vote ntire embershipprovided that he mendment een submittethe embers n written form en (10) days n advance he meeting. Bylaws ill evieweat inimum, very hree years.Revised & Approved by TEPI 11/16/2017 A member of the State Trauma Advisory Board A member of the Medical Direction Commission A member of the Emergency Medical Services Council Section 2: Terms of Membership There is no specific term of membership, however, the Medical Director, Standing Committee Chair and Bureau Chief , under the advice of the Bureau Liaison , shall periodically review member attendance (Article V, Section 4) an d if necessary, remove a member due to failure to meet the attendance requirement. Section 3: Compensation Standing Committee members shall not be eligible to receive compensation. Section 4: Voting Each member of the Standing Committee shall be enti tled to one vote when present in person or via electronic media at a meeting of the Standing Committee. No individual member shall cast more than one vote on the Standing Committee. Voting by proxy and/or alternate voter shall not be permitted. Section 5 : Vacancies Standing Committee vacancies shall be filled through appointment by the Medical Director, under the advice of the Standing Committee Chair , Bureau Chief and the Bureau Liaison, with consideration given to individuals

8 with expertise consistent with the Sta
with expertise consistent with the Standing Committee purpose. The Bureau Liaison shall be responsible for informing the Medical Director , Standing Committee Chair and Bureau Chief of vacancies. Article IV: Officers Chair : The Standing Committee Chairs shall be chosen as follows: Education Standing Committee – EMS Council Protocols Medications and Devices Standing Committee – MDC T rauma and EMS Performance Improvement Standing Committee – STAB Vice Chair : The Vice Chair of the Standing Committee shall be filled through appointment by the Medical Director, Standing Committee Chair and Bureau Chief, under the advice of the Bureau Liaison, and shall serve as the Standing Committee Chair in his/her absence. On resignation a new Vice Chair shall be sel ected by the next regular meeting. Article V : Meetings Section 1: Regular Meetings: The regular meetings of the Standing Committee shall be held, at a minimum, three times per year at a time and place designated by the Chair and Bureau. Section 2: Sp ecial Meetings Special meetings and/or telephone meetings may be called by the Chair in agreement with the Bureau Liaison , or by written request of five (5) members of the Standing Committee and must comply with the Open Meeting laws. BYLAWS Standing Committee Title: Trauma and EMS Performance Improvement Standing Committee Standing Committee Acronym: TEPI Article I: Purpose The Trauma and EMS Performance Improvement (TEPI) Standing Committee is formed to assist the Statutory Councils (State Trauma Advisory Board, Emergency Medical Services Council and Medical Direction Commission) and the Bureau in carrying out the duties described in statute and rule relating to quality improvement of the Stateâ€

9 ™s EMS and trauma system. This is accomp
™s EMS and trauma system. This is accomplished by aiding the Bureau’s Data and Quality Assurance Program in the development of guidelines, reports, and recommendations to the Statutory Councils. Importantly, TEPI’s review of provider level data is limited to routine system performance indicator analysis and cannot be used for regulatory purposes. Specifically, TEPI shall: 1.Provide recommendations to the Bureau for the development of system performanceindicators relating to the emergency care system inclusive of dispatch, first response,transport, emergency department, in-patient and rehabilitative care.2.Review and suggest changes to Bureau developed reports based upon system performanceindicators3.Recommend to the Statutory Councils specific system performance enhancements to theState’s emergency care system.4.Review and consider evidence-based research dealing with emergency care system and makerecommendations to the Statutory Councils for possible changes in system practice.5.Periodic review and recommendations for changes in the data-sets pertaining to emergencycare system registries. Article II: Committee Liaison The intent of this article is to provide for the timely and appropriate exchange of information between the Standing Committee and the three Statutory Councils. All Standing Committees shall, therefore, have a minimum of one member from each of the three Statutory Councils in their membership to serve as liaisons. The Chief of the Bureau of Emergency Medical Services and Trauma System, or designee, shall also attend and support the timely and appropriate exchange of information between the Standing Committee and the three Statutory Councils and to provide staff support and technical support to the Standing Committee including notification of pending actions or issues

10 which may be within the scope of the St
which may be within the scope of the Standing Committees’ purpose. Article III: Members Section 1: Committee Membership Membership of the TEPI shall consist of no more than 25 members from a diverse representation of individuals from throughout the state. There will be Standing Committee members selected from each of the four EMS Regions. The Medical Director, Standing Committee Chair and Bureau Chief, under the advice of the Bureau Liaison, shall solicit and appoint members. The following members are required: ��“Health and Wellness for all Arizonans”age 3 of 3 VII.Agenda items to be considered for the next eeting No responses VIII.Call to the Public responses. IX.Summary of Current Events As presented on agenda. Dr. Harden added the Traffic Incident Management class info andthe PHTLS free training inf Next Meeting March 14, 2019 @ 09:00 hrs, Arizona Department of Health Services, 150 N. 18th Aveooms 215A & B, Phoenix, AZ XI.Adjournment The meeting ended at 09:40 hrs. Draft ��“Health and Wellness for all Arizonans”Pag2 of 3 IV.Bureau Report – Terry Mullins, Bureau Chief a.Rules UpdateChief Mullins reported on the changes for Drug Tables, revisions for the AdministrativeMedical Direction and Base Hospital rules, and is soliciting for suggested updates to AirAmbulance rules via a survey.Data Linkage Update – Ben Fisher, MPA, NRPMr. Fisher reported on the AZ-PIERS/TraumaOne linking project and the AZ-PIERS/HIE linking project.Follow-up and Activities following EMS Council action on Premier EMS Agency, AZ-PIERS, and the Cactus Data Set – Ben Fisher, MPA, NRPMr. Fisher reported on the Cactus Data Set recently approved by EMS Council, touchedon the year-long process for adapting suggestions to the set, and indicated the need

11 forthe pediatric resuscitation elements
forthe pediatric resuscitation elements to be identified. Discussion and Action Items Discuss, amend, and approve TEPI meeting minutes of July 19Motion to approve the minutes made by Dr. Bradley, seconded by Dr. Gemar. With noamendments and no opposition, the minutes were approvedb.Discuss and approve forming a workgroup to identify a data set for proposed PremierEMS Agency pediatric reportingMr. Fisher explained that during the Cactus Data Set edits, the workgroup tabled thepediatric reporting section and suggested having a workgroup look at the data elements.Motion to create workgroup wmade by Dr. Bradley, seconded by Dr. Gemar. Withno opposition, the workgroup was created.Volunteers include Dr. Woolridge, Ms.McDonald.c.Discuss role of the TEPI Committee/Committee Members and potential futureCommittee involvement in statewide performance improvement effortsChief Mullins gave background on the role of the TEPI committee. Reports that theBureau must generate and provide: Trauma Registry reports to the facilities that submit tothe Trauma Registry; EMS registry reports to the agencies have been related to timesensitive illness and injury topics; reports have also been generated from requests bystatutory boards (STAB, EMS Council, MDC) using the perspective of systemlevelperformance.Chief Mullins added that there is opportunity to identify educational initiatives toaddress quality improvement processSome EMCTs have come through the NationalRegistry process and recertify through National; some use the State process. With thechanges, National Registry is asking states to identify practice issues locally and developcurriculumaround that in addition to asking medicaldirectorsto identify current needs atthe agency level. This committee has an opportunity to provide assistance toadministrative med

12 ical directors by looking at data to ide
ical directors by looking at data to identify educational needs.The group discussed areas of interest for this committee’s work. Dr. Bradley addedthere is also a need to clarify and set the timeframes and steps for the process to reviewactus/PEAP elements moving forward. VI.Progress Reports a.EMS Registry UsersGroup (EMSRUG)No one available to give a report.Trauma Registry Users Group (TRUG)No one available to give a report.c.Trauma Program Manager Workshops Heather Miller, RNMs. Miller reported updates from the last meeting. Draft ��“Health and Wellness for all Arizonans”age 1 of 3 Bureau Of Emergency Medical Services & Trauma System150 N. 18th Avenue, Suite 540 Phoenix, Arizona 85007-3248 602-364-3150 Trauma and EMS Performance Improvement (TEPI) tanding Committee DateNovember 15, 2018 - Time09:00 hrs LocationAZ Department of HealthServices, 150 N. 18 Ave, Rooms 215 A+B, Phoenix, AZ 85007 Via computer with call back: azgov.webex.com, meeting code 283 884 692, password TEPI2018 (telephone only: dial 240-454-0879, meeting code 283 884 692 #) raft Minutes Call to Order – Josh Gaither, , Chair The meeting was called to order at 09:10 hrs. Roll Call – Shelley Bissell (25 Members, 13 required for quorum) Quorum was present. Present Absent Eric Merrill, NRP Gail Bradley, MDHeather Miller, RN*Jill McAdoo, RNJosh Gaither, MDMichelle Guadnola, RNPam Noland, RN* Paul Geimer, DO*Pamela Goslar, PhD* *indicates teleconference Mary McDonald, RN* Rebecca Haro, NREMT-P Ralph Zane Kelly, DO*Corbin King, FPDale Woolridge, MD*Garth Gemar, MDTiffiny Strever, RN* Paul Dabrowski, MD* Darlene Herlinger , RN, MSN Danielle Stello, RNMelissa Moyer, CSTRChris Salvino, MD III.Chairman’s Report – Josh Gaither, Attendance reportAs presented on the hand

13 out.Vacancy reportDr. Gaither reported f
out.Vacancy reportDr. Gaither reported four roles are currently vacant: Law Enforcement Representativith Involvement in EMS, State Designated Level I Trauma Center Program Manager,Pediatric Representative (MD or RN), and EMS Registry Group MemberTo applyrward a letter of interest and to Shelley Bissell. Draft r aumaImprovementCommitt PresentTeleAbsentPamelaGoslarIPACRepresentative PaulDabrowskiTraumaSurgeon PaulGeimerRehabilitationSpecialist RalphZaneKelleyStateDesignatedLevelTrauma RebeccaHaroEMSCouncilLiaison TiffinyStreverStateDesignatedLevel Attendance r aumaImprovementCommitt e PresentTeleAbsentCorbinKingAirAmbulancePremierEMS 11/15/2018 DaleWoolridgeInjuryResearcher 7/20/2017 11/16/2017 3/15/2018 7/19/2018 11/15/2018 DanielleStelloPreEMSCoordinator 7/20/2017 11/16/2017 3/15/2018 7/19/2018 11/15/2018 DarleneHerlingerPreEMSCoordinator 7/20/2017 11/16/2017 3/15/2018 7/19/2018 11/15/2018 MerrillGroundAmbulance 7/20/2017 11/16/2017 3/15/2018 7/19/2018 11/15/2018 BradleyMDCLiaison 7/20/2017 11/16/2017 3/15/2018 7/19/2018 11/15/2018 GarthGemarEMSMedicalDirector 7/20/2017 11/16/2017 3/15/2018 7/19/2018 11/15/2018 HeatherMillerWesternArizonaCouncil 7/20/2017 r aumaPerformanceCommitt e PresentTeleAbsentHeatherMillerWesternArizonaCouncilEmergency 3/15/2018 7/19/2018 11/15/2018 JillMcAdooGroundAmbulanceResponder 7/20/2017 11/16/2017 3/15/2018 7/19/2018 11/15/2018 JoshGaitherChair,EMSResearcher 7/20/2017 11/16/2017 3/15/2018 7/19/2018 11/15/2018 MaryMcDonaldPrehospitalEMS 7/20/2017 11/16/2017 3/15/2018 7/19/2018 11/15/2018 MelissaMoyerRepresentativeRegistry 7/20/2017 11/16/2017 3/15/2018 7/19/2018 11/15/2018 MichelleGuadnolaStateDesignatedCenter 7/20/2017 11/16/2017 3/15/2018 7/19/2018 11/15/2018 NolandStateDesignatedTraumaCente 7/20/2017 11/16/2017 3/15/2018 7/19/2018 11/15/2018 PamelaGoslarIPACRep