Statewide Trauma Tour Indiana State Department of Health

Statewide Trauma Tour Indiana State Department of Health Division of Trauma and Injury Prevention @INDTrauma 1 State Government Governor Leadership Mike Pence State Health Commissioner Jerome M. Adams, MD, MPH

Deputy Commissioner Jennifer Walthall, MD, MPH Chief of Staff Eric Miller Assistant Commissioner, Health & Human Services Commission Arthur L. Logsdon, JD 2 Division of Trauma and Injury Prevention Staff Katie Hokanson Director Jessica Skiba

Injury Prevention Epidemiologist Murray Lawry INVDRS Coroner Records Coordinator Ramzi Nimry Manager, Performance Improvement Camry Hess Data Analyst Rachel Kenny INVDRS Epidemiologist John OBoyle INVDRS Law Enforcement Records Coordinator 3

Division of Trauma and Injury Prevention Mission: To develop, implement and provide oversight of a statewide comprehensive trauma care system that: Prevents injuries. Saves lives. Improves the care and outcomes of trauma patients. Vision: Prevent injuries in Indiana. 4 Trauma Tour Trauma tour events will be held in all 10 Public Health Preparedness Districts June

through August. @INDTrauma 5 Trauma Tour - Goals Update 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 ISDHs involvement with the grant. @INDTrauma 6

Indianas Trauma System Need to evaluate the entire trauma system continuum of trauma patient care @INDTrauma 7 Definitions Trauma: 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. 8 What is Injury? Injuries are NOT accidents! Accident: An unexpected occurrence, happening by chance Injury: A definable, correctable event, with specific risks for occurrence Injuries affect all regardless of age, race, or economic status @INDTrauma 9 Cause of Injury Categories

Cut/Pierce Drowning/Submersion* Pedal Cyclist, Other Pedestrian, Other Fall Fire/Burn Transport, Other Natural/Environmental Fire/Flame Hot object/substance Firearm Machinery Motor Vehicle Traffic @INDTrauma

Bites and Stings Overexertion Poisoning* Struck By, against Suffocation* 10 * Not considered Traumatic Injury U.S. Trauma Facts For 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/ 11 Injuries in Indiana Leading 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. 12 Trauma Lessons Learned When 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. @INDTrauma

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. 13 Trauma Lessons Learned Oregons 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%. @INDTrauma 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. 14 Indianas Journey 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. @INDTrauma 15 Indianas Journey 2008 - American College of Surgeons conducted an evaluation and provided a

set of recommendations for further development of Indianas trauma system. 2009 Governor Daniels created by executive order the Indiana State Trauma Care Committee (ISTCC) @INDTrauma 16 Indianas Journey 2011 - ISDH created the Trauma and Injury Prevention Division. 2012 EMS Commission adopted the Triage and Transport Rule. @INDTrauma 17

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 @INDTrauma 18 Triage & Transport Rule The most seriously injured patients should go to a

trauma center no matter how long it takes to get them there. EMS Commissions rule offers two qualifications to this: If the patients 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. @INDTrauma 19 Trauma Center Access in Indiana (January 2013) 20

Trauma Center Access in Indiana (August 2014) 21 Hospital A Appp plliic caati tioon n nn iissiioo c

c e D De Homeland Security Recommendation Recommendation Indianas In The Process Process State Health Commissioner (Dr. Adams)

State Department of Health R Reec coom m @INDTrauma Application Application EMS Commission n tio

a c pli Ap m mee nnd daat tiioon n Indiana State Trauma Care Committee In the Process - Tips If 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) 23 Indianas Journey 2013: Governor Pence signs the Trauma Registry Rule.

@INDTrauma 24 Trauma Registry Rule Rule that requires these providers to report data to the trauma registry: EMS providers. All hospitals with EDs. Rehabilitation hospitals. @INDTrauma 25 Trauma Registry Rule

Rule 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. @INDTrauma 26 Indianas Journey 2014 The ISDH hosted the first statewide EMS Medical Directors Conference. IU Health Arnett Hospital and IU Health Ball Memorial Hospital became the states 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). @INDTrauma

27 Indiana Violent Death Reporting System (INVDRS) @INDTrauma 28 32 States Funded in 2014 29 INVDRS Indiana Violent Death Reporting System Database to monitor and track trends of

violent deaths in Indiana Data for informing local prevention efforts @INDTrauma 30 What is a Violent Death? Suicide

Homicide Undetermined Intent Unintentional Firearm Death Legal Intervention Terrorism @INDTrauma 31 1. 2. Four Primary Objectives Create 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 @INDTrauma 32

Four Primary Objectives, Contd 3. 4. Disseminate aggregate INVDRS data to stakeholders, the public, and CDCs multistate database Explore innovative methods of collecting, reporting, and sharing data Improve timeliness and greater utilization of data for prevention efforts @INDTrauma 33 Indianas Journey 2015

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. @INDTrauma 34 Overdose intervention drugs SEA406Naloxone bill Allows for broader distribution of Naloxone (which reverses the effects of opioid overdoses).

Can be prescribed directly to someone atrisk 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 35 registration. @INDTrauma Injury Prevention Resource Guide Create 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

@INDTrauma 36 Where is Indiana? Indiana does not have an integrated statewide trauma systemone 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. @INDTrauma

37 Verified vs. Designated Verified: National process. Levels I, II, III. Refer to kinds of resources available in a trauma center. Designated: State process (not yet promulgated): Indianas designation requirements will go hand-in-hand with the national

verification requirements. Additional, unique criteria. @INDTrauma 38 Verified Trauma Centers in Indiana Level I Trauma Centers: 1. Eskenazi. 2. IU Health Methodist. 3. IU Health Riley.

Level II Trauma Centers: 1. Deaconess. 2. Lutheran. 3. Memorial Hospital South Bend. 4. Parkview Regional Medical Center. 5. St. Marys Evansville. 6. St. Vincent Indianapolis. @INDTrauma Level III Trauma Centers: 1. IU Health Arnett. 2. IU Health Ball Memorial.

39 As of: 06/23/2015 Trauma Centers in Indiana Level I ACS Verified Trauma Centers: 1. Eskenazi. 2. IU Health Methodist. 3. IU Health Riley.

Level II ACS Verified Trauma Centers: 1. Deaconess. 2. Lutheran. 3. Memorial Hospital South Bend. 4. Parkview Regional Medical Center. 5. St. Marys Evansville. 6. St. Vincent Indianapolis. @INDTrauma Level III ACS Verified Trauma Centers: 1. IU Health Arnett. 2. IU Health Ball Memorial.

In the Process of ACS Verification Level III Trauma Centers: 1. St. Elizabeth East. 2. St. Vincent Anderson. 3. Community Hospital of Anderson. 4. Good Samaritan Hospital. 5. Methodist Northlake Campus. 6. Community Health East. 7. Community Health North. 8. Community Health South. As of: 06/23/2015 40 Level I ACS Verified Trauma Centers Capable 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. @INDTrauma 41 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. @INDTrauma 42

Level II ACS Verified Trauma Centers Same 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: @INDTrauma

Deaconess Hospital. Lutheran Hospital. Memorial Hospital South Bend. Parkview Trauma Centers. St. Marys of Evansville. St. Vincent Indianapolis Hospital. 43 Level III ACS Verified Trauma Centers 24 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. IU Health Ball Memorial. @INDTrauma 44 Indianas Trauma System Rules 1. Triage and Transport Rule (EMS Commission) Right patient, right place, right time. In the process of ACS verification. 2. Trauma Registry Rule EMS, hospitals and rehabilitation hospitals must report data to ISDH.

3. Designation Rule (yet to be promulgated) State approval process of trauma centers. @INDTrauma 45 EMS Registry Website Web-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 @INDTrauma 46 EMS Registry Timeline Summer 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. @INDTrauma 47 ISDH Trauma Registry Website Compliant with ACS National Trauma Data Bank. Accessible with internet connection. Customizable user interface, easy to use. Capable of electronic data

transfer from hospitals existing registries. HIPAA compliant. Website: https://indianatrauma.isdh.in.gov @INDTrauma 48 Blue Sky Project Faster, 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.

@INDTrauma 49 Questions? Contact Us: Email: [email protected] Website: https://indianatrauma.org Division Director, 317-234-2865 Find us on Twitter @INDTrauma @INDTrauma 50

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