florida trauma / ems system california 58 counties population: 36.5m size: 158,706 sq miles florida...
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Florida Trauma / EMS Florida Trauma / EMS SystemSystem
California• 58 counties• Population: 36.5M• Size: 158,706 sq
miles
Florida• 67 counties• Population: 18m• Size: 58,664 sq
miles
Florida Trauma / EMS Florida Trauma / EMS SystemSystem
• 266 licensed EMS providers
• 3800 permitted BLS/ALS ground units• 21 rotor wing providers, 61 helicopters• 19 fixed wing providers, 59 airplanes• Boats?
• 3,200,000 EMS calls per year
Florida Trauma / EMS Florida Trauma / EMS SystemSystem
• Active:– EMT 28,131– Paramedics 21,238
• Inactive:– EMT 7,694– Paramedic 1,605
Florida Trauma Center HistoryFlorida Trauma Center History
• 1982 Certification of trauma centers began.
• During the 1980’s, as many as 48 approved trauma centers existed.
• 26 trauma centers closed during the 1980’s.
• 2 trauma centers closed during the 1990’s.
• There are currently 20 approved trauma centers.
Level I: 7Level II: 6Level II & Pediatric: 5Pediatric: 2Total: 20 Trauma Centers
Florida Adult and Pediatric Trauma Center LocationsFlorida Adult and Pediatric Trauma Center Locations
Trauma Care RegulationTrauma Care Regulation
• Chapter 395, Hospital Licensing and Regulation, Part II: Trauma
• 64E-2, Florida Administrative Code
• DOH Pamphlet 150-9,
Trauma Center and Pediatric
Trauma Center Approval
Standards
Secretary of Health/Surgeon General
Director, Emergency Medical
Operations
Bureau of Emergency
Medical Services
Office of Trauma Public Health Preparedness
Costs of Trauma CenterCosts of Trauma CenterReadiness 2002Readiness 2002
Focused on four areas:• Physician on-call coverage• Periodic recertification• Outreach and prevention programs• Other extraordinary and non-
chargeable costs
(Average median annual cost)
* The study omitted several significant types of costs: start-up, cost of uninsured/underinsured patients, and many indirect facility costs associated with being prepared to treat trauma patients
• $2,080,102• $124,120• $56,543• $811,274
$2,706,510
2003-20082003-2008Funding ExamplesFunding Examples
• $4 Million 2003 HRSA Burn Care Grant• $11 Million 2004 HRSA Burn Care Grant• $16 Million 2005 HRSA Burn Care Grant• $5 Million 2006 HRSA Burn Care Grant• $6.5 Million 2007 HRSA Burn Care Grant• $4.5 Million 2008 HRSA Burn Care Grant
2003-2007 Total: $42.5 Million
HB 497, HB 1697 – Red light running – $12.4m over 21 months distributed to trauma centers
Adult Trauma Criteria
CATEGORY 1(Any 1)
CATEGORY 2(Any 2)
AGE >55 years old
AIRWAY Active airway assistance Respiratory rate >30
CONSCIOUS BMR <5, paralyis, cordinjury, GCS <12
BMR 5
CIRCULATION No radial pulse ANDheart rate >120, SBP <90 mmHg
Sustained heart rate>120
Adult Trauma Criteria
CATEGORY 1(Any 1)
CATEGORY 2(Any 2)
FRACTURE 2 or more long bonefracture sites
Single long bone fracturesustained in MVC or fall>10 feet
CUTANEOUS Amputation; 15%TBSA burn; penetratinginjury to head/neck/torso
Major degloving; majorflap avulsion; GSW toextremities
MECHANISMOF INJURY
Ejection from motorvehicle; steering wheeldeformity
PARAMEDIC JUDGEMENT*
Pediatric Trauma Criteria
CATEGORY 1(Any 1)
CATEGORY 2(Any 2)
SIZE 11 Kg, <1 yo, Broslowred/purple
AIRWAY Intubated or manualopening
CONSCIOUS Altered MS, coma,paralyis, cord injury
Amnesia or reliable LOC
CIRCULATION Nonpalpable radial orfemoral pulse, SBP < 50mmHg
Central pulses palp,peripheral not; SBP 50-90; cap refill >3 seconds
Pediatric Trauma Criteria
CATEGORY 1(Any 1)
CATEGORY 2(Any 2)
FRACTURE Open long bone fracture;multiple fracture sites ordislocations; pelvic fx
Single closed long bonefracture
CUTANEOUS Major tissue disruption;amputation; 10%TBSA burn; penetratinginjury to head/neck/torso
EJECTION*
PARAMEDIC JUDGEMENT*
Miami-Dade County
Uniform Trauma Transport Protocols
System participants:
City of Coral Gables Fire-Rescue Department
City of Hialeah Fire-Rescue Department
Miami-Dade County Fire-Rescue Department
City of Miami Fire-Rescue Department
City of Miami Beach Fire-Rescue Department
Village of Key Biscayne Fire-Rescue Department
American Ambulance Service
American Medical Response
Florida Medi-Van Ambulance
Medics Ambulance Service
Miami-Dade Ambulance
Lifeflight (Miami Children’s Hospital)
LifeNet Air Medical Services
Out-of-County Indigent Patients
• County resident
• Funded
• Trauma Center – Outside County agreements
• HCRA funding – millage tax
• Repatriation