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Indiana Trauma System Advisory Task Force
The Indiana State Department of Health Trauma System Advisory Task Force, organized in May, 2004 as a stakeholder group, critically needed to work on all aspects of trauma system development and maintenance. The Task Force has broad representation from numerous organizations and individuals interested in developing a statewide trauma care system, with more than 100 people currently involved. Issues being considered by the Task Force include: leadership and authority for a statewide trauma system, policies, legislation and financing needed for such a system, system design (based on data and needs assessments), education of policy-makers, health professionals and the public, information management and quality of care indicators, collaboration, and resources to support a statewide system. Task Force conclusions so far:
· The goal of a statewide trauma system is preventing injuries and coordinating care of injured patients to accomplish decreased death and disabilities due to trauma.
· It is desirable for all Indiana hospitals to eventually be part of a statewide trauma system, based on the level of care each hospital is able to provide.
· System participation by hospitals would be voluntary.
· Collaboration between emergency medical services, hospitals, rehabilitation facilities and public health is needed.
· A statewide trauma registry is necessary because it provides a proven mechanism to examine trauma patient care data on a confidential basis.
· All hospitals participating in the system must provide data to the state trauma registry.
· There should be a legislatively identifiable and sustainable source of financing.
· Widespread education is needed to inform numerous constituencies (legislators, hospitals, and the public) about a statewide trauma system and that trauma is an important public health and health care delivery issue because of its major impact on the lives and health of Hoosiers.
Some states with trauma systems have a review process to designate hospitals according to the level of care that can be provided to injured patients – ranging from emergency department evaluation and stabilization in smaller hospitals to the most comprehensive levels of care provided in hospitals verified by the American College of Surgeons Committee on Trauma (ACS-COT). Indiana has the seven hospitals listed above with Level I or Level II trauma centers as verified through a strenuous review process by the ACS-COT.
After two years of study, the Task Force decided to pursue a consultation agreement with the Committee on Trauma of the American College of Surgeons, a non-biased, nationally-recognized organization. This consultation team would evaluate the resources, legislation, trauma care delivery, trauma registries/data analysis, performance improvement, interagency cooperation/communication, professional/community education, and injury prevention and control currently in Indiana. The trauma system consultation team would also provide knowledge and experience from other states which will help Indiana as trauma system development proceeds. This consultation requires intensive advance preparation, a four-day visit from the College, and the consultation team includes professionals from surgery, emergency medicine, trauma nursing and emergency medical services.
On December 14 – 17, 2008, the ACS-COT site visit team conducted a trauma system assessment for the State of Indiana. Below are a few of their findings and the priority recommendations (12 of 86 total) for the Task Force:
Priority Recommendations from ACS-COT Trauma System Consultation Team
1. Statutory Authority and Administrative Rules:
Amend PL 155-2006, trauma system law, to include establishment of a Governor appointed state trauma advisory board (STAB) that is multidisciplinary to advise the Department of Health in developing, implementing and sustaining a comprehensive statewide trauma system.
2. System Leadership:
Develop an Office of Emergency Care within the Department of Health that includes both the trauma program and EMS.
3. Lead Agency and Human Resources:
Hire sufficient staff based on the recommendations identified in the trauma system plan.
4. Trauma System Plan:
Develop a plan for statewide trauma system implementation using the broad authority of the 2006 trauma system legislation.
5. Financing:
Develop a detailed budget proposal for support of the infrastructure of the state system within the trauma system plan.
6. Definitive Care:
Perform a needs assessment to determine the number and level of trauma hospitals needed within the state
7. Emergency Medical Services:
Recruit and hire a qualified State Trauma/EMS Medical Director who will provide clinical expertise, oversight, and leadership for the state's Trauma and EMS systems.
8. System Coordination and Patient Flow:
Develop, approve, and implement prehospital trauma triage guidelines as well as inter-facility transfer criteria.
9. Disaster Preparedness:
Involve the State Trauma/EMS Medical Director in statewide disaster planning initiatives.
10. System-wide Evaluation and Quality Assurance:
Create a PI Subcommittee to develop a trauma system performance improvement plan.
Develop a PI process template as a resource tool for all trauma centers and participating hospitals.
Standardize a subset of trauma PI activities for each trauma center and participating hospital. Implement regional PI processes that feed into the statewide trauma PI processes.
11. Trauma Management Information Systems:
Amend or create a Statute with specific language to protect the confidentiality and discoverability of the Trauma Registry and of trauma system performance improvement activities.
Create and implement a Trauma System Information Management Plan.
ACS-COT Full Report for Indiana
ACS-COT Final Presentation for Indiana
