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