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The Trauma System In Georgia

J. Michelle Turner

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J. Michelle Turner

Master of Public Health Student

Health Policy and Management

Provisionally Certified in Public Health (CPH)

The National Board of Public Health Examiners (NBPHE)

Bachelor of Science in Family and Consumer Sciences

Consumer Economics

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THe Golden HourThe “Golden Hour” is a term used to describe the first hour after a traumatic injury has occurred in which trauma patients will have better outcomes if they receive definitive care.

The “golden hour” concept is the justification for the current trauma system in the United States.

Out-of-hospital care concepts such as scoop and run, aeromedical transport, and trauma center designations with trauma teams in place are, in part, predicated on the idea that time is a critical factor in the management of injured patients.

Detrimentally, many Georgians live outside of the "golden hour" radius of 150 miles or less that experts say is critical to saving lives.

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Facts and Statistics

As of February 2011, Georgia has 18 trauma centers.

Georgia should have 30 designated trauma centers, strategically placed throughout the state to, address trauma and emergency preparedness needs.

Georgia’s trauma death rate is significantly higher than the national average: 63 of every 100,000 people compared to the national average of 56 per 100,000.

If Georgia’s death rate improved to the national average, it would mean a difference of as many as 700 more lives saved every year.

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Facts and Statistics

Trauma effects:

Leading cause of death among children and adults under the age of 45, and is the 4th leading cause of death for all ages.

Accounts for approximately 170,000 deaths each year and over 400 deaths per day.

Kills more Americans than stroke and AIDS combined.

Leading cause of disability.

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Traumatic Injury

A traumatic injury is a blunt force or penetrating physical injury that requires surgical and other medical specialists to consult, observe or perform surgery in order to optimize recovery.

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Trauma Center

A trauma center is a specialized hospital distinguished by the immediate availability of specialized personnel, equipment and services to treat most severe and critical injuries.

This includes ready-to-go teams that perform immediate surgery and other necessary procedures for people with serious or life-threatening injuries, for example, due to a car crash, bad fall, or gun shot wounds.

The mission of a trauma center is to ensure continuity and quality of care for injured patients from the scene of injury through treatment at the trauma center and ultimately physical rehabilitation.

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Trauma System

A trauma system involves the coordination of trauma care delivery among trauma centers, ambulances, helicopters, state and local governments and other healthcare resources. Currently, only 8 states have matured trauma systems.

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Emergency Care vs. Trauma Care

All Trauma Care is Emergent but Not All Emergency Care is Trauma

Trauma centers are designed to handle severe, life-threatening injuries, including blunt force and penetrating trauma.

Emergency rooms are to treat the ill and injured.

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Trauma Center Designations I-IV

The levels that classify a trauma center are based upon the care provided, staff qualifications, and the amount and type of equipment.

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Level I

Has a full range of specialists and equipment available 24-hours a day

Admits a minimum required annual volume of severely injured patients

Has a research program

Is a leader in trauma education and injury prevention, and is a referral resource for communities in neighboring regions

Has a required program for substance abuse screening and provides brief intervention to patients

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Level II

Works in collaboration with a Level I center usually but may be the only resource in a rural state

Provides comprehensive trauma care and supplements the clinical expertise of a Level I institution

Provides 24-hour availability of all essential specialties, personnel and equipment

No minimum volume requirements

Provides an injury prevention program, as well as conduct substance screening, but not required to have an ongoing program of research or a surgical residency program

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Level III

Has resources for the emergency resuscitation, stabilization, emergent surgery, and intensive care of most trauma patients

Has transfer agreements with Level I and/or Level II trauma centers to assure back-up resources for the care of patients with severe injuries

Has an injury prevention program

Does not have the full availability of specialists except surgery and orthopedics in most states.

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Level IV

Provides initial evaluation, emergency resuscitation and stabilization of trauma patients, but most patients will require transfer to higher level trauma centers

Has 24-hour emergency coverage by a physician.

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Who Designates Trauma Centers?

In Georgia, the Department of Human Resources designates the assigned trauma center level classification.

The American College of Surgeons, while not designating trauma centers, “verifies” trauma centers.

This verification is to confirm the “presence of resources that are listed in the book, Resources for Optimal Care of the Injured Patient.”

This verification program is to aid hospitals in the improvement and evaluation of care.

According to the American College of Surgeons, this verification process, “provides an objective, external review of a trauma center’s resources and performance.”

Verification by the American College of Surgeons is not required to be designated as a trauma center, and, as yet, no trauma center in Georgia has received this verification.

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The Importance of Trauma Centers

Researchers from the Medical College of Wisconsin have found, evidence demonstrating the effectiveness of trauma systems comes from decreased mortality in states with mature systems.

The same study also found that better patient outcomes, even among minimally injured patients, may exist between lower tiered or undesignated centers and higher tiered centers, particularly among penetrating trauma patients.

Several other studies have found that the higher the level of trauma center designation, the better the outcome for the patient, and significantly reduced mortality in a large number of cases.

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Areas Within 60 Minutes of a LEVEL I or II Trauma Center

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On May 11, 2007, Georgia Governor Sonny Perdue signed Senate Bill 60 and the Georgia Trauma Care Network Commission became and effective entity July 1, 2007.

SB 60/Act 7:

To amend Title 31 of the Official Code of Georgia Annotated, relating to health, so as to establish the Georgia Trauma Care Network Commission; to provide for its composition, membership, duties, and responsibilities; to create the Georgia Trauma Trust Fund and provide for its management and use; to provide for related matters; to repeal conflicting laws; and for other purposes.

Under the Act, the duties and responsibilities of the Georgia Trauma Care Network Commission are to create a trauma system for the State of Georgia and to act as the accountability mechanism for distribution of trauma system funds appropriated each fiscal year by the legislature.

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Five-Year Plan

In February 2009, the Georgia Trauma Commission created a vision for the Georgia Trauma System that required identified steps through a five-year plan.

Based on the American College of Surgeon’s Trauma System Consultation Program, the Georgia Trauma Commission discerned a need for a comprehensive state trauma system plan that defines the system, its subsystems and structure, and establishes procedures and standards for implementation, monitoring and system performance improvement.

According to the five-year plan, by 2014, the Georgia Trauma System will be comprised of regional systems and plans with a centralized and statewide Trauma Communications Center as the common component of a state trauma system.

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Facility City CountyLEVEL IGrady Memorial Hospital Atlanta FULTONMedical Center of Central Ga. Inc. * Macon BIBBMedical College of Georgia * Augusta RICHMOND Memorial Health Univ. Medical Center * Savannah CHATHAM

LEVEL IIAthens Regional Medical Center Athens CLARKE Atlanta Medical Center Atlanta FULTONFloyd Medical Center Rome FLOYDGwinnett Medical Center Lawrenceville GWINNETTHamilton Medical Center Dalton WHITFIELD John D. Archbold Memorial Hospital Thomasville THOMASMedical Center-Columbus Columbus MUSCOGEENorth Fulton Regional Hospital Roswell FULTON

LEVEL IIIWalton Regional Medical Center Monroe WALTON

LEVEL IVLower Oconee Community Hospital Glenwood WHEELERMorgan Memorial Hospital Madison MORGANTaylor Regional Hospital Hawkinsville PULASKI

Pediatric Trauma Centers (Designated Under Level II Criteria)Childrens Healthcare of Atlanta@ Egleston Atlanta DEKALBChildrens Healthcare of Atlanta @ Scottish Rite Atlanta FULTON

Designated Adult Level 1 Trauma Centers with Pediatric Commitment

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SR 277 - Amendment 2

On November 2, 2010, Georgia citizens had the opportunity to increase the funding to Georgia’s trauma centers by voting “yes” on Amendment 2.

Expected revenue from the $10 fee on vehicle tags was expected to be around $80 million.

Amendment 2 appeared on the ballot as follows: (  )  YES Shall the Constitution of Georgia be (  )  NO amended so as to impose an annual $10.00 trauma charge on certain passenger motor vehicles in this state for the purpose of funding trauma care?

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Failure

Amendment 2 was defeated with 52.6% of voters (1,342,555 votes) in opposition.

47.4% (1,207,836 votes) were in favor of the amendment.

Taxed Again!

“We have trauma centers!”

Where is the Super-Speeder money?

Trust?

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An informational campaign to encourage Georgia voters to pass Amendment 2 on the November 2, 2010 ballot.

The Yes 2 Save Lives Coalition was composed of concerned citizens and businesses in Georgia, hospitals, organizations representing first responders, and the Georgia Chamber of Commerce.

Fundraising came from medical and emergency medical services (EMS) groups, businesses, Georgia citizens, trauma hospitals, and the Georgia Chamber of Commerce.

The $1 million dollar informational ad campaign aimed at Georgia voters consisted of rallies around the state, lapel stickers, bumper stickers, yard signs, informational brochures, sixty-second radio ads, a four-page Pro-Amendment 2 direct mailer, and television advertisements.

While in progress, random polling of voters found a gradual increase of favorable opinions about the amendment.

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A certain percentage of the Georgia Insurance Premium Tax that would be diverted into the Georgia Trauma Care Fund.

An additional $5.00 surcharge on motor vehicle registrations.

An increase of $1.16 in the monthly cell phone surcharge.

An additional surcharge on rental and leased cars.

An additional add-on charge to fines for certain motor vehicle moving violations, such as the offense of DUI.

A check box on the individual Georgia Income Tax form that would allow Georgia citizens to contribute 5 percent of their tax refund or $5.00 to the Georgia Trauma Care Fund.

$10 fee from tags, but from existing fees, not additional ones.25

Other Funding Ideas

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Questions?