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Indiana Epidemiology Newsletter
Charlene Graves, M.D.
Susan Perkins, R.N.
A trauma system is an organized, coordinated effort to deliver the full range of care to injured patients, including pre-hospital assessment, hospital emergency department (ED) evaluation and care, hospitalization (often with surgical intervention), and rehabilitation.
Until March 2006, Indiana was one of two states without any state legislation or state government programming that addressed a statewide trauma system. Trauma refers to people who sustain severe injuries and, thus, need rapid evaluation by pre-hospital providers and transport to specific trauma center hospitals with trauma care capabilities. These trauma center hospitals provide comprehensive medical and surgical services that are available at all times. While trauma center hospitals have EDs that are well staffed and well equipped to care for Hoosiers who receive severe or extensive injuries, not all hospital EDs are trauma centers, which is contrary to popular belief.
The goal of a statewide trauma system is to prevent injuries and coordinate care of injured patients in order to accomplish decreased death and disability of Indiana residents related to traumatic injuries. Injuries are the leading cause of death for Hoosiers ages 1-34 years both in Indiana and in the United States. Indiana hospital discharge data for 2002 show that injuries account for 33 percent (one third) of hospital ED visits and 12.5 percent of hospital discharges.
Major contributors to the toll of severe traumatic injuries include motor vehicle crashes (MVC), falls, and assaults. A recent response to a request to Indiana hospital trauma centers for data on MVC demonstrates that MVCs account for an average of 27 percent of all trauma cases treated in five trauma centers that were able to submit these data, illustrating that MVCs have a significant impact on the number and severity of trauma cases treated at Indiana’s trauma centers.
In 2002, a national assessment by the Trauma-Emergency Medical Services Program of the federal Health Resources and Services Administration (HRSA) demonstrated that emergency medical services (EMS) resources are well developed in Indiana. In sharp contrast, no trauma system existed, according to the criteria used in this assessment.
Indiana’s situation related to the deficiency of a statewide trauma system greatly improved when the state legislature passed Senate Bill 284 this year. This legislation provides a starting point for development of a statewide trauma system by designating the Indiana State Department of Health (ISDH) as the lead state agency for trauma system development. It sets the stage for future work that is needed in Indiana by denoting the ability to develop rules pertinent to a state trauma registry and a designation process for various levels of trauma care that can be rendered by hospitals. With rule-making authority, the ISDH and the Advisory Task Force for Trauma System/Emergency Preparedness (Task Force) can proceed with developing the necessary components of a system, which generally include: (1) a trauma registry, (2) standards and procedures for designation of levels of trauma care provided by hospitals, and (3) guidelines or protocols for patient transport and trauma care. This developmental process will take several years to complete.
The ISDH Task Force, with over 50 members, has been meeting regularly since May 2004 to address trauma system issues. This Task Force has representation from all 10 Indiana Public Health Preparedness Districts and from the state Emergency Medical Services Department, part of the Indiana Department of Homeland Security. The participants come from a variety of hospitals and health professions and also include administrators and several legislators. Organizations involved include the Indiana Hospital & Health Association, the Indiana Rural Health Association, the Indiana State Medical Association, the Indiana Trauma Network, and representation from the Indiana Chapters of the American College of Emergency Physicians, the Emergency Nurses Association, and the American College of Surgeons. Task Force meetings, held quarterly, have attendance of 30 or more members, and lively discussions on a wide range of issues are evident.
Seven Indiana hospitals have undergone a comprehensive review process to meet the stringent American College of Surgeons Committee on Trauma criteria to accomplish verification as Level I or Level II trauma centers able to provide comprehensive trauma care: Wishard Memorial Hospital, Clarian Methodist Hospital, and Riley Hospital for Children in Indianapolis; Deaconess Hospital and St. Mary’s Hospital in Evansville; Memorial Hospital in South Bend; and Parkview Hospital in Fort Wayne. In addition, there is growing interest in trauma center development from a hospital system in Northwest Indiana.
Although these seven hospitals collect and analyze data from their trauma centers, there is no systematic examination of trauma care provided across Indiana. The implementation of an Indiana State Trauma Registry, slated for May 2007, will help to remedy this problem. The State Trauma Registry will initially collect data from the seven trauma center hospitals and gradually expand to other hospitals in Indiana.
Subcommittees of the Task Force continue to address the development of a hospital designation process, financing, system development and maintenance, protocols, information management, and education. A short educational DVD entitled “When Minutes Matter,”developed by St. Mary’s Hospital and based on a similar DVD from the American Trauma Society, is available. “When Minutes Matter” graphically portrays what trauma centers and a trauma system accomplish, presenting the true story of a child severely injured in a MVC in Evansville.
Indiana does a respectable job of managing trauma care, but many people working in the delivery of medical care are aware of situations where appropriate or timely evaluation and patient care were not provided. A statewide trauma system will help to examine such circumstances, assess hospital capabilities across Indiana, and determine ways to improve the system.
Establishment of a program at the ISDH to accomplish a statewide trauma system will promote work on the important public health and health care delivery issue of trauma, which has a major impact on the lives of Hoosiers.
For further information on trauma system development in Indiana, contact Susan Perkins, R.N., Trauma System Manager, by e-mail at sperkins@isdh.IN.gov or by calling 317.234.2890