It`s about Time: Why Georgia Needs a Trauma System Now

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Understanding why Georgia
needs a trauma system now
> Trauma basics
>Definitions, statistics and survivors
> Trauma in GA
>The current situation and the issues
> The Solution
>What needs to be done, what is being
done and what you can do
Trauma basics: Definitions
What is trauma?
> A serious injury or shock to the body
> Caused by an accident or violence
> Number one killer of Americans between
the ages of one and 44
> Number three cause of death across all
age groups
Trauma basics: Definitions
What is “the golden hour”?
> The hour immediately following injury
> Chances of survival increase dramatically.
> Rapid EMS response is critical.
> Distance to a trauma center is critical.
Trauma basics: Definitions
What is a trauma center?
> A specialized hospital
> Doctors, nurses, equipment available
immediately
> Most hospitals with an ER are not
trauma centers
> In GA, only 15 of 152 hospitals
> To be a “designated” trauma center in GA
> Hospitals voluntarily meet guidelines
> State DHR
> ACSCT (American College of Surgeons’ Committee on Trauma)
Trauma basics: Definitions
What do Trauma Center levels mean?
> Level I: full range – 24-hour service, ER,
surgical suite, ICU, imaging, residency,
trauma research
> Level II: full range, but not the degree of
research
> Level III: continuous general surgical and
orthopedic coverage, but may lack
subspecialties
> Level IV: initial evaluation and assessment,
most patients transferred
Trauma basics: Definitions
What is Emergency Medical Services (EMS)?
> The “front line” of trauma care
> Emergency medical technicians
> Ground and air ambulances
> Advanced life support equipment
> Provide critical “pre-hospital” services
> Rapid transportation
> Immediate medical assistance and stabilization
> Triage, determine appropriate facility,
level of care
Trauma basics: Definitions
What is a trauma system?
> An organized approach to managing trauma
> Universal/rapid access to pre-hospital care
> Rapid transport to the definitive
treatment facility
> Prompt surgical intervention when required
> Availability of critical care
medicine/nursing skills
> Rehabilitation as needed
> Data analyzed, used to improve performance
> Prevention programs
Trauma basics: Definitions
What are the benefits of a trauma system?
> Fewer deaths: US studies show 10-30%
reduced risk of death
> Potential “ROI” is productive lives, $ saved
> Fewer, less severe disabilities
> More productive working years
> Lower cost of initial treatment,
continued rehab
> Typically shorter hospital stays
> Reduced uncompensated care
Trauma basics: Statistics
Causes of trauma in GA
> Nine main causes of 91.9% of trauma
> Motor vehicle crashes (39.1%)
> Falls (21.2%)
> Gunshot wounds (8.1%)
> Motorcycle crashes (5.3%)
> Pedestrian incidents (5.1%)
> Assaults (4.2%)
> Accidents (3.4%)\
> Stab wounds (3.0%)
> All-terrain vehicle crashes (2.5%)
Trauma basics: Statistics
Trauma victims in GA
> All ethnic groups
>Caucasian (54.4%)
>African American (33.6%)
>Hispanic/Latino (8.8%)
>Asian (.8%)
> Men (68.4%); women (31.6%)
Trauma basics: Statistics
EMS and trauma care
> 14,000 licensed EMS professionals in GA
> GA has 263 licensed ambulance providers
> 2,300 vehicles licensed as ambulances
> Five air ambulance services based in GA
> 72% of patients reach trauma centers in
GA by ground ambulance
> 19% reach a trauma center by helicopter
Trauma basics: Statistics
Trauma centers in GA
> Only 15 of the state’s 152
acute-care hospitals
> Four are Level I
> Nine are Level II
> Two are Level IV
> No Level III
Trauma basics: Statistics
GA’s trauma centers
1.
2.
3.
4.
Grady Memorial Health (Atlanta) L1
Medical Center of Central Georgia (Macon) L1
Medical College of Georgia (Augusta) L1
Memorial Health University
Medical Center (Savannah) L1
5. Archbold Memorial Hospital (Thomasville) L2
6. Atlanta Medical Center (Atlanta) L2
7. Children’s Healthcare of Atlanta, Egleston L2P
8. Children’s Healthcare of Atlanta, Scottish Rite L2P
9. Floyd Medical Center (Rome) L2
10. Gwinnett Medical Center (Lawrenceville) L2
11. Hamilton Medical Center (Dalton) L2
12. N. Fulton Regional Hospital (Roswell) L2
13. The Medical Center (Columbus) L2
14. Morgan Memorial Hospital (Madison) L4
15. Walton Regional Medical Center (Monroe) L4
Trauma basics: Survivors
> Survivor: Steve Charron
> Home: Lilburn, in Gwinnett County
> Date of trauma: Sunday, April 2, 2006
> Age at time of trauma: 49
> Trauma incident: Riding Harley; hit Ford
Expedition at 45 mph
> Trauma response: Helicopter to Atlanta
Medical Center, a Level II; broken facial
bones, bulging cervical discs, lung
contusions and a broken left wrist
> Status: Eight weeks after, back at job two
hours/day
Trauma basics: Survivors
> Survivor:
Steve Charron
> The trauma care
difference: “We
believe that Steve’s
inpatient stay was shorter
and his outcome was
better because of the care
he received at a trauma
center.”
-Wife, Nancy Charron
Trauma basics: Survivors
> Survivor: Mike Keown
> Home: Coolidge, in Thomas County
> Date of trauma: August 6, 2005
> Age at time of trauma: 51
> Trauma incident: Fell 20 feet off a ladder
> Trauma response: Thomas County EMS
took Keown to Archbold Medical Center, a
Level II; dislocated shoulder, pelvic
fracture, open wound
> Status: Fully recovered by end of January
Trauma basics: Survivors
> Survivor: Mike Keown
> The trauma care
difference:“Everyone
needs access to a trauma
center comparable to
Archbold. The emergency
care I received was
essential to my recovery.”
-Mike Keown
(Keown, a Republican, represents part of
Grady and part of Thomas Counties (District
173) in the Georgia House of
Representatives.)
Trauma basics: Survivors
> Survivor: Jeremiah Matlock
> Home: Buchanan, in Haralson County
> Date of trauma: Friday, July 30, 2005
> Age at time of trauma: 21
> Trauma incident: Swerved pickup to
avoid vehicle on his side of the road,
overturned
> Trauma response: Ambulance To Atlanta
Medical Center, a Level II. Broken pelvis,
severed artery; 25 days in coma
> Status: Limited return to work
Trauma basics: Survivors
> Survivor:
Jeremiah Matlock
> The trauma care
difference: “I have no
doubt that if Jeremiah
had not been transported
to Atlanta Medical Center,
he would have bled to
death from the severed
artery or died from
complications with his
lungs.”
- Mother, Laura Matlock
Trauma basics: Survivors
> Survivor: Ben Shuman
> Home: Morganton, in Fannin County
> Date of trauma: April 9, 2006
> Age at time of trauma: 22
> Trauma incident: Truck ran stop sign and
hit Shuman’s Chevy S10 pickup at 50 mph
> Trauma response: LifeNet helicopter
transport to Grady, a Level I;
immediate craniotomy
> Status: Outpatient occupational/
speech therapy
Trauma basics: Survivors
> Survivor: Ben Shuman
> The trauma care
difference: “Ben’s
evaluation at a trauma
center gave him the edge
for survival. If he had not
been initially evaluated at a
trauma center, it’s
questionable if he would
have survived his injuries.”
- Mother, Sherry Shuman
Trauma basics: Survivors
> Survivor: Regina Purvis
> Home: Tucker, in DeKalb County
> Date of trauma: October 9, 2004
> Age at time of trauma: 16
> Trauma incident: Head-on collision with
Ford Explorer; no air bags
> Trauma response: Ambulance to
Gwinnett MC, Level II; damage to vena
cava, kidneys, liver, ribs, lungs, broken
femur, 19 seizures, 106 temp
> Status: Played high school fast-pitch
senior year; May 2006 Parkview grad.
Enrolled American Intercontinental U.
Trauma basics: Survivors
> Survivor: Regina Purvis
> The trauma care
difference: “I would
have lost my daughter
without the best trauma
care. How do you tell a
parent that their child is
dead because they did
not have the doctors or
equipment to provide
the best care for
trauma?”
- Mother, Debbie Murphy
Trauma in Georgia:
The current situation
> GA does not have a comprehensive
statewide trauma system.
> GA has a few components of a system.
>The state monitors and designates
trauma centers.
>The state licenses EMS services.
>Designated trauma centers contribute
data to registry.
Trauma in Georgia:
The current situation
> GA needs 25-30 trauma centers.
> Particular need in areas not covered
> Inadequate public funding for trauma services
> Lack a comprehensive trauma infrastructure
> Pre-hospital care
> Rapid transport
> Availability of critical care medicine and nursing
> Rehabilitation
Trauma in Georgia:
The current situation
Why GA Needs a Trauma System Now?
> Statewide systems save lives.
> Our families and friends can get
trauma care.
> Essential for emergency preparedness
> Essential for homeland security
Trauma in Georgia:
The current situation
Why GA Needs a Trauma System Now?
> GA’s trauma death rate is significantly
higher than the national average.
> GA: 63 of every 100,000 people
> National average: 56 per 100,000
> If GA’s death rate improved to the
national average, it would mean a
difference of as many as 700 more
lives saved every year.
Trauma in Georgia: The Issues
> Only 15 of GA’s 152 acute-care hospitals are
designated trauma centers.
> GA should have 25-30 designated
trauma centers.
> They should be in strategic locations.
> The 15 current centers are in ten counties.
> Large areas are not adequately served.
> Millions are two hours away from trauma care.
> Of 40,000 cases of major trauma only 10,000
are treated in designated trauma centers.
Trauma in Georgia: The Issues
Why don’t more hospitals start trauma centers?
> Most can’t afford the financial losses.
> GA hospitals are reimbursed through:
>Private health insurance
>Patient payments
>Government programs (Medicare/Medicaid)
> They do not come close to covering the cost
of uncompensated care: about $275 million
a year for hospitals, physicians, and EMS.
Trauma in Georgia: The Issues
Why don’t more hospitals start trauma centers?
> Two-thirds of GA’s hospitals
are in the red.
> Increase in uninsured patients
> Reductions in Medicare/Medicaid reimbursement
> Increases in malpractice coverage.
> The 15 current trauma centers are at risk.
> In 2002, five of 19 trauma centers closed.
> In 2007 DeKalb Medical resigned.
> Additional funds are needed.
Trauma in Georgia: The Issues
Other major challenges
> Staffing
>GA faces a shortage of
medical personnel.
>Stress, low wages, workload and
liability concerns
>Drives personnel away from trauma care
>Hard to recruit EMS personnel in
rural areas
Trauma in Georgia: The Issues
Other major challenges
> Pre-hospital communications network
>Integrated with EMS, emergency
disaster preparedness systems.
>The first step is 911.
>Several GA counties do not have a 911
emergency system.
Trauma in Georgia: The Issues
Other major challenges
> Medical oversight and coordination
>Shortages of physicians – particularly
physicians trained in emergency
medicine
>Result is lack of oversight
>Trauma care often not uniformly
coordinated
The Solution:
What needs to be done?
> In 2006, the Georgia Legislature
began a study of the infrastructure
and funding mechanisms needed.
> In 2007 lawmakers passed Senate Bill
60 and created the Georgia Trauma
Care Network Commission to continue
the work.
> But the specific infrastructure and
funding solutions remain unresolved.
The Solution:
What needs to be done?
> Funding. Joint Comprehensive State Trauma
Services Study Committee suggested options.
> Workforce development and training.
Recruit and train enough EMTs, paramedics,
physicians and nurses.
> Develop a pre-hospital communications
network.
> Enhanced EMS medical direction
> Creation of triage and transport system
> Minimize practice of hospital diversion
The Solution:
What needs to be done?
“Unless the state agrees to subsidize the high cost of
trauma care in some way, it is a virtual certainty that
several of the state's 15 trauma care hospitals -- a number
already insufficient -- will be forced to shut down their
services for financial reasons… Walking away now without
acting would be like an emergency medical technician
walking away from the scene of an accident…”
“OUR OPINION: State can't neglect trauma funding” - Atlanta Journal-Constitution, April 20, 2007
“One of the most critical issues facing the health of the
state is the failing, stitched-together system of trauma
hospitals. Lawmakers are aware of the crisis, but for some
reason they believe the participating hospitals will continue
to absorb the costs.”
Editorial: “Lawmakers ignoring trauma crisis” - Macon Telegraph, April 10, 2007
The Solution:
What needs to be done?
“Call it bureaucratic triage… Georgia's trauma system
needs to be healed, and lawmakers need to act as if all
Georgians' lives depend on it… Because they do.”
Editorial: “Traumatized health care” - Augusta Chronicle, January 7, 2007
“…if you're headed to a south Georgia farming community,
you'd better drive safely… The state's emergency care
network simply does not offer rural Georgians the same
quality of treatment available in urban centers such as
Atlanta, Augusta, Macon or Savannah… That needs to
change.”
Editorial: “Rescue trauma centers” - Savannah Morning News, September 25, 2006
The Solution:
What is being done?
Status of legislation
> In 2006, a bill that mandated formation of Trauma
Study Committee was approved.
> Committee reported its findings in late 2006.
> In 2007 the Legislature passed Senate Bill 60.
> Established a nine-member Georgia Trauma Care
Network Commission.
> But specific infrastructure and funding solutions
remain unresolved.
The Solution:
What is being done?
> Other states also have trauma funding
problems.
> South Carolina
> General Assembly (May 2004) established
infrastructure for statewide trauma care system.
> May 2005 Assembly provided $4 million in state
funding to cover trauma care for Medicaid-eligible.
> But study showed $38.7 million need
> One in four patients at Level I or II does not pay.
The Solution:
What is being done?
> Arizona uses funds from a tax on cigarettes.
> Illinois assesses a $100 fee on DUI and a $20
fee on traffic infractions, which generates
$34 million for trauma. The state also has
added a $100 surcharge on firearms
violations and a $100 surcharge for drugrelated convictions.
> Maryland uses a $13.50 surcharge on motor
vehicle registrations.
The Solution:
What is being done?
> Mississippi charges a $5 fee per moving violation,
which generates about $8 million for trauma
centers.
> Texas passed a motor vehicle surcharge that is
expected to generate $300 million in two years for
trauma centers. Texas also allocates the interest
on tobacco settlement funds to trauma centers,
which is expected to generate $4 million.
> Washington uses a $5 surcharge on moving
violations and a $6.50 surcharge per change in
motor vehicle registration.
The Solution:
What is being done?
GA’s effort to establish a statewide system
> Led by
> Georgia hospitals
> Emergency Medical Services (EMS)
> Emergency physicians, trauma surgeons
and nurses
> Formed Georgia Statewide Trauma Action
Team (GSTAT) coalition
> Deliver a unified proposal to the
study committee
The Solution:
What is being done?
> GSTAT will:
>Launch a trauma awareness campaign.
>Make the public, local elected officials
and business people aware of the issues
and the need for a statewide trauma
system.
The Solution:
What can you do?
> Join with hospital administrators,
physicians, nurses, and EMS providers
> There are several ways:
> Fill in a postcard and mail it in.
> Or, Go to www.GeorgiaItsAboutTime.com to:
>learn more
>sign the e-petition
>join the coalition

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