Statewide Trauma Tour Indiana State Department of Health - PowerPoint Presentation

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Statewide Trauma Tour Indiana State Department of HealthDivision of Trauma and Injury Prevention

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State Government LeadershipGovernorMike PenceState Health CommissionerJerome M. Adams, MD, MPHDeputy CommissionerJennifer Walthall, MD, MPH

Chief of StaffEric Miller

Assistant Commissioner, Health & Human Services Commission

Arthur L. Logsdon, JD

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Division of Trauma and Injury Prevention StaffKatie HokansonDirectorJessica SkibaInjury Prevention EpidemiologistMurray Lawry

INVDRS Coroner Records Coordinator

Ramzi Nimry

Manager,

Performance Improvement

Camry Hess

Data Analyst

Rachel Kenny

INVDRS EpidemiologistJohn O’BoyleINVDRS Law Enforcement Records Coordinator

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Division of Trauma and Injury PreventionMission:To develop, implement and provide oversight of a statewide comprehensive trauma care system

that:P

revents injuries.

Saves lives.

Improves

the care and outcomes of trauma

patients.

Vision

:Prevent injuries in Indiana.4Slide5

Trauma TourTrauma tour events will be held in all 10 Public Health Preparedness Districts June through August.5

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Trauma Tour - GoalsUpdate on the developments of the trauma system.Clarify what an inclusive trauma

system is.

Clarify the levels of trauma centers in Indiana.

Clarify state rules.

Describe

the National Violent Death Reporting System (NVDRS) project from the CDC and ISDH’s involvement with the grant.

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Indiana’s Trauma SystemNeed to evaluate the entire trauma system – continuum of trauma patient care7

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DefinitionsTrauma: Severe injury or injuries requiring rapid evaluation and transport to specific hospitals with trauma care capabilities.“Worst of the worst”.Trauma

system

: Organized approach to treating patients with acute injuries.

Trauma

registry

:

Repository of

data on patients who receive hospital care for certain types of

injuries.8Slide9

What is Injury?Injuries are NOT accidents!Accident: An unexpected occurrence, happening by chanceInjury: A definable, correctable event, with specific risks for occurrenceInjuries affect all regardless of age, race, or economic status

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Cause of Injury CategoriesCut/PierceDrowning/Submersion*FallFire/Burn

Fire/FlameHot object/substance

Firearm

Machinery

Motor Vehicle Traffic

Pedal Cyclist, Other

Pedestrian

, Other

Transport, OtherNatural/EnvironmentalBites and StingsOverexertionPoisoning*

Struck By, againstSuffocation*

* Not considered Traumatic Injury

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U.S. Trauma FactsFor every trauma death in the United States:Approximately 10 people are hospitalized and transferred to specialized medical care. 178 people are treated and released from hospital emergency departments.Problems posed by injury are most acute in our rural areas:

60% of all trauma deaths occur in areas of the United States where only 25% of the population lives

.

Reference: World Health Organization (WHO

), 2010:

http://

www.who.int

American College of Surgeons – Committee on Trauma – Rural Trauma Team Development

Course: http://www.facs.org/trauma/rttdc/ 11Slide12

Injuries in IndianaLeading cause of death among persons age 1-44 years.Unintentional injuries leading cause of Years of Potential Life Lost.Fifth leading cause of death overall, contributes to nearly 7% of all deaths in Indiana.

Nearly 32,000

hospitalizations for all injuries in

2013.

Source: Indiana State Department of Health,

Epidemiology Resource Center, Data Analysis Team.

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Trauma Lessons LearnedWhen trauma patients are transported, by ground or air, to trauma centers:The preventable death rate DROPS by up to 25%.There are significant reductions of chronic disabilities and overall community care costs.

Reference: MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national Evaluation of the effect

of trauma-center care on mortality. N Engl J Med 2006; 354:366-378.

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Trauma Lessons LearnedOregon’s trauma system, for example has:Reduced mortality by more than 25%.Reduced morbidity by more than 40%.Reduced health care costs.Another study showed that the costs of trauma in states with integrated trauma systems dropped 9%.

Reference: Sasser

, S., Hunt, R., Sullivent

, E., et al. Guidelines for Field Triage of Injured Patients Recommendations of the National Expert Panel on Field Triage. MMWR

. January 23, 2009 / 58(RR01);

1-35.

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2004 - Trauma System Advisory Task Force formed.2006 - IC 16-19-3-28 (Public Law 155) named the State Health Department the lead agency for statewide trauma system.Indiana’s Journey

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2008 - American College of Surgeons conducted an evaluation and provided a set of recommendations for further development of Indiana’s trauma system.2009 – Governor Daniels created by executive order the Indiana State Trauma Care Committee (ISTCC)Indiana’s Journey

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2011 - ISDH created the Trauma and Injury Prevention Division.2012 – EMS Commission adopted the Triage and Transport Rule.Indiana’s Journey17

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The most seriously injured patients should go to a trauma center no matter how long it takes to get them there. http://www.cdc.gov/fieldtriage/pdf/decisionscheme_poster_a.pdf

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Triage & Transport RuleThe most seriously injured patients should go to a trauma center no matter how long it takes to get them there.EMS Commission’s rule offers two qualifications to this:If the patient’s life is in danger.If the nearest trauma center is more than 45 minutes away.Competent patients always have the right to decide where to be taken.19

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Trauma Center Access in Indiana (January 2013)20Slide21

Trauma Center Access in Indiana(August 2014)

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Indiana’s “In The Process” Process@INDTraumaSlide23

In the Process - TipsIf you are unsure – ASK.

Become close friends with Trauma program.

Check the ACS website to ensure you schedule your Consultation/Verification visits in

time.

As of

August

2015:

Applications must be submitted 12 months in

advance.

Currently

accepting site visit

applications

to be scheduled starting in May 2016.

Please note: Visits scheduled

after

July 1, 2015 will be reviewed under the Resources 2014 manual (Orange Book)

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2013:•Governor Pence signs the Trauma Registry Rule.Indiana’s Journey24

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Trauma Registry RuleRule that requires these providers to report data to the trauma registry:EMS providers.All hospitals with EDs.

Rehabilitation hospitals.

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Trauma Registry RuleRule that requires these providers to report data to the trauma registry:EMS providers.National EMS Information System (NEMSIS) Silver.

15th of the month.

All hospitals with

EDs.

National Trauma Data Standard (NTDS

).

Quarterly.

Rehabilitation

hospitals.CMS – Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI).

Quarterly.

Rule also permits ISDH to grant any person involved in a legitimate research activity to request access to confidential

information.

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•The ISDH hosted the first statewide EMS Medical Director’s Conference.•IU Health Arnett Hospital and IU Health Ball Memorial Hospital became the state’s first ACS verified level III trauma centers.•The ISDH received $1.4 million from the Centers for Disease Control and Prevention (CDC) to gather critical data on violent deaths using the National Violent Death Reporting System (NVDRS).

Indiana’s

Journey - 2014

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Indiana Violent Death Reporting System (INVDRS)28

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32 States Funded in 2014

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INVDRSIndiana Violent Death Reporting System

Database to

monitor and track trends of violent

deaths in Indiana

Data for informing

local prevention

efforts

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What is a Violent Death?SuicideHomicide

Undetermined Intent

Unintentional Firearm

Death

Legal Intervention

Terrorism

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Four Primary ObjectivesCreate

and update a plan to implement INVDRS in

Indiana

Collect and abstract comprehensive data on violent deaths from:

Death Certificates

Coroner reports

Law enforcement records

Optional Modules:

*Child Fatality Review*

Intimate Partner Violence

Drug Overdose/Poisonings

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Four Primary Objectives, Cont’dDisseminate aggregate INVDRS

data

to stakeholders, the public, and CDC’s multi-state

database

Explore

innovative methods of collecting, reporting, and sharing data

Improve

timeliness and greater utilization of data for prevention

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The ISDH hosted the first statewide injury prevention conference.New state law requiring reporting of data to ISDH – SEA 406.Creating an Injury Prevention Resource Guide.Indiana’s Journey - 2015

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Overdose intervention drugsSEA406—“Naloxone bill”Allows for broader distribution of Naloxone (which reverses the effects of opioid overdoses).Can be prescribed directly to someone at-risk of opioid overdose or to their family/friends or by standing order and be immune from civil liability.

Dispensing of

Naloxone must be registered with the state trauma registry.

ISDH is developing a protocol for registration.

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Injury Prevention Resource Guide36Create a document that can provide easily accessible and understandable data and information on the size and scope of specific injury problems in Indiana.Highlight

evidence-based solutions to the problem of injury

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Where is Indiana?Indiana does not have an integrated statewide trauma system—one of only 6 states without one.Indiana has components of a system:Emergency

medical services (EMS)

providers.Trauma centers.

Verified by ACS.

A

trauma

registry.

Rehabilitation facilities.

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Verified vs. DesignatedVerified:National process.Levels I, II, III.Refer to kinds of resources available in a trauma center.

Designated:

State process (not yet promulgated):

Indiana’s

designation requirements will go hand-in-hand with the national verification

requirements.

Additional, unique

criteria.

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Verified Trauma Centers in IndianaLevel I Trauma Centers:Eskenazi.IU Health Methodist.IU

Health Riley.

Level II Trauma

Centers:

Deaconess.

Lutheran.

Memorial Hospital

South Bend.

Parkview Regional Medical Center.

St. Mary’s

Evansville.

St. Vincent

Indianapolis.

Level III Trauma Centers:

IU Health

Arnett.

IU Health Ball

Memorial.

As of: 06/23/2015

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Trauma Centers in IndianaLevel I ACS Verified Trauma Centers:Eskenazi.IU Health Methodist.IU

Health

Riley.

Level II

ACS Verified Trauma Centers:

Deaconess.

Lutheran.

Memorial Hospital

South Bend.Parkview Regional Medical Center.

St. Mary’s

Evansville.

St. Vincent

Indianapolis.

Level III ACS Verified Trauma Centers:

IU Health

Arnett.

IU Health Ball

Memorial.

“In

the

Process of ACS Verification” Level III Trauma Centers:

St

. Elizabeth –

East.

St. Vincent

– Anderson.

Community Hospital of Anderson.

Good Samaritan Hospital.

Methodist Northlake Campus.

Community Health – East.

Community Health – North.

Community Health – South.

As of: 06/23/2015

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Level I ACS Verified Trauma CentersCapable of providing total care for every aspect of injury – prevention through rehabilitation.Associated with a school of medicine:Facilitates research.Provides

teaching opportunities to direct new advances in trauma

care.

24 hour in-house coverage

by

general

surgeons:

Prompt availability of care in

specialties.Receives patients from all levels of care.Provides leadership in injury prevention.

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Level I ACS Verified Trauma Centers (continued)Maintains a comprehensive Performance Improvement and Patient Safety (PIPS) program.Program for substance abuse screening and patient intervention.Meets minimum requirement for annual volume of severely injured patients (1200 patients / year

).

Level I Trauma

Centers:

Eskenazi Health.

IU Health – Methodist Hospital.

Riley Hospital for Children.

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Level II ACS Verified Trauma CentersSame as a level I trauma center:EXCEPT:Not associated with a school of medicine.

Does not have a general surgery residency training

program.

Does not do

research.

Level II Trauma

Centers:

Deaconess Hospital.

Lutheran Hospital.Memorial Hospital South Bend.

Parkview

Trauma Centers.

St. Mary’s of Evansville.

St. Vincent Indianapolis Hospital.

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Level III ACS Verified Trauma Centers24 hour immediate coverage by emergency medicine physicians.Prompt availability of coverage by general surgeons and anesthesiologists.

Not required to have neurosurgeons.

Transfer agreements for patients requiring more comprehensive care at a Level I or II trauma

center.

Level III Trauma

Centers:

IU Health

Arnett.

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Indiana’s Trauma System RulesTriage and Transport Rule (EMS Commission)Right patient, right place, right time.“In the process of ACS verification”.

Trauma Registry

RuleEMS

,

hospitals

and

rehabilitation hospitals must

report data to

ISDH.Designation Rule (yet to be promulgated)State approval process of trauma centers.45

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EMS Registry WebsiteWeb-based software:NEMSIS (Silver & Gold) compliant.Will be NEMSIS Version 3 compliant.

Secure, encrypted

site.

Unique username &

password.

Integrates data with Indiana trauma

registry.

Website:

https://indianaems.isdh.in.gov

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EMS Registry TimelineSummer 2012: ISDH internal discussions of an EMS Registry. The CDC Preventive Health Block Grant funds utilized for this one-time purchase.January 2013: Installed EMS database.

February 2013: Pilot project begins.

November 24, 2013: Trauma Registry Rule.

July 1, 2015: Hand over EMS registry and responsibilities to IDHS

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ISDH Trauma Registry WebsiteCompliant with ACS National Trauma Data Bank.Accessible with internet connection.

Customizable user interface, easy to

use.

Capable of electronic data transfer from hospital’s existing

registries.

HIPAA

compliant.

Website:

https://indianatrauma.isdh.in.gov

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Blue Sky ProjectFaster, easier way to report trauma cases to trauma registry.Utilizes Application Programming Interface (API) to share Electronic Medical Record (EMR) data with ISDH.Currently, accepts XML files.In the future, HL7 files.49

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Questions?Contact Us:Email: indianatrauma@isdh.in.govWebsite: https://indianatrauma.org

Division Director, 317-234-2865

Find us on Twitter @

INDTrauma

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