Achieving Zero Preventable Deaths: Building a National Trauma Care System

and Research Action Plan

Alan H. Tyroch, MD, FACS, FCCM

Professor & Founding Chair of Surgery

Paul L. Foster School of Medicine

Texas Tech University Health Sciences Center

Chief of Surgery & Trauma Medical Director

UMC of El Paso

OPERATIONAL CHALLENGES

Overview Trauma System

Challenges

& Changes

Military Relationship

TRAUMA SERVICE AREA

Level I Trauma Centers: Distance

• Albuquerque 268

• Tucson 315

• Phoenix 445

• Lubbock 343

• San Antonio 552

• Austin 577

• Fort Worth 606

• Temple 618

• Dallas 635

• Tyler 733

• Houston 745

• Galveston 796

Trauma System

Trauma Service Area

• 39K square miles

• 1.2M individuals in TX & NM

• El Paso County

• 824K

• El Paso City

• 674K

El Paso’s Trauma Centers

• UMC-El Paso (Level I)

• HCA System

• Level II

• Level III

• Tenet System

• Four Level IVs

• WBAMC (Level III)

Military Relationship

Fort Bliss WBAMC

Military Relationship Benefits

HSC & Trauma Center

• Combined Military & civilian orthopedic residency program

• 3rd year medical student rotations

• 1st & 2nd year medical student preceptorships

WBAMC

• OMFS rotation

• Pediatric Surgery rotation

• Emergency Medicine NP fellowship

Impediments

• Frequent leadership change • Lack of institutional memory

• Frequent deployments • Granting of faculty appointments • Educating new providers of LCME & GME requirements

• Licensing and credentialing frustrations (goes both ways) • Fingerprinting & federal background check of students

• Military won’t accept the background checks done by the HSC

• Paperwork process is slow with inflexibility & lots of red tape (HSC & Military) • May require above approval above the chain of command at WBAMC or Fort Bliss

Civilian and Military institutions do NOT speak the same language

Challenges and Change

Bureaucracy is the death of all sound work.

(Albert Einstein)

GOVERNMENT

FEDERAL

COUNTY STATE

An Opportunity Lost

An Opportunity Lost

ADVANTAGES

• Clinical expertise

• Free labor

• Another surgeon in call schedule

• Opportunity for current SICU attendings to have time for: • Elective practice • Scholarly activity

DISADVANTAGES

• Can’t bill for their work

• May be deployed

• May be called back to WBAMC

• Malpractice concerns

Federal Tort Claims Act Title 28

U.S. Code, Section 2679

Military staff are immunized from individual tort liability.

Trauma Center Proliferation

• HCA

• Converting a Level III TC to a second Level II TC

• Tenet

• Converting Level IV TCs to Level III TCs & possibly upgrading to a Level II TC

• WBAMC

• Upgrading to a Level II TC

ACS-COT Needs Based Assessment o f Trauma Systems Too l No need for addi t iona l t rauma centers in E l Paso

Trauma Center Proliferation

WBAMC

• Low volume

• Location will not enhance increase

in patient catchment

• Lack of specialist support

• Neurosurgery

• Cardiothoracic

• Improve clinical skills/readiness?

Level I & Level II Trauma Centers

• Financial impact to both TCs

• Financial impact to the HSC

• Educational impact to the HSC

• Hinder the volume requirement for Level I TC verification

• Improve or hinder the Trauma System?

0

500

1000

1500

2000

2500

3000

3500

Total 2226 2495 2657 2619 2541 2350 2629 2844 2756 3027 2909

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Trauma Registry Patients

ISS > 15

0

100

200

300

400

500

600

700

Total 504 649 618 602 631 485 552 610 653 404 438

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

A strong relationship benefits the Injured