trauma and ems performance improvement (tepi) … · bureau of emergency medical services &...

Persons with disabilities may request reasonable accommodations such as a sign language interpreter, by contacting Donna

Meyer, Program Project Specialist II, 602-364-3158; State TDD Number 1-800-367-8939; or Voice Relay Number 711. Request

should be made as early as possible to allow time to arrange accommodations.

“Health and Wellness for all Arizonans”

of 2

Bureau Of Emergency Medical Services & Trauma System

150 N. 18th Avenue, Suite 540

Phoenix, Arizona 85007-3248

602-364-3150

TRAUMA AND EMS PERFORMANCE IMPROVEMENT (TEPI)

STANDING COMMITTEE

Date: November 17, 2016 - Time: 9:00 AM

Location: 150 N. 18th

Avenue, Conference Rooms 215A & 215B (2nd

Floor)

Conference Call: 1-888-205-5513 Code: 486276#

iLinc URL: https://azdhsems.ilinc.com/register/zvhkcxs You must register prior to the meeting to join the web conference session.

AGENDA

I. Call to Order - Chris Salvino, MD, Chair

II. Roll Call – Tammy Gagnon (25 Members, 13 required for quorum)

III. Chairman’s Report - Chris Salvino, MD, Chair

a. Attendance report (Attachment III.a.)

IV. Bureau Report – Terry Mullins

a. Medical Director recognition program

b. Opportunity to discuss and comment on proposed stroke rules

V. Discussion and Action Items

a. Discuss, amend, and approve TEPI meeting minutes of July 21, 2016 (Attachment V.a.)

b. Discuss and identify workgroup members: EMS Dashboard Workgroup

c. Discuss and identify workgroup members: Improving Trauma Triage Data

VI. Progress Reports

a. EMS Registry Users Group (EMSRUG) - Robert Corbell

b. Trauma Registry Users Group (TRUG) - Melissa Moyer

c. Trauma Program Manager Workshops - Noreen Adlin

d. Registry Data In Action

i. AZ-PIERS Report- Anne Vossbrink

Naloxone Administration Form

Medication Administration Report–(Attachment VI.a) – Anne Vossbrink

https://urldefense.proofpoint.com/v2/url?u=https-3A__azdhsems.ilinc.com_register_zvhkcxs&d=AwMFAg&c=7xsdzXc1VkZyGw_71SwgiP92fiZryvVSehvDkp0td30&r=ELv1BjwLxGjsVTcZWE5NinntXQB6GMKxJMIv3bmAd5o&m=xO35U0X7Jb8h0CM1fa30hfgp6Owwpayy-iH0KI2OKLY&s=G0CBZvfA-oLJBLI43E4cNVmF_2Nl8VsxZdnW4cyncWU&e=

Persons with disabilities may request reasonable accommodations such as a sign language interpreter, by contacting Donna

Meyer, Program Project Specialist II, 602-364-3158; State TDD Number 1-800-367-8939; or Voice Relay Number 711. Request

should be made as early as possible to allow time to arrange accommodations.

“Health and Wellness for all Arizonans”

of 2

ii. 2015 EMS Annual Report – (Attachment VI.b) - Vatsal Chikani, Robyn Blust

iii. ASTR - Mary Benkert

iv. County Trauma Report – (Attachment VI.c) Robyn Blust

v. 2016 STAB Report – (Attachment VI.d)

http://azdhs.gov/documents/preparedness/emergency-medical-services-trauma-

system/reports/2016-stab-annual-report.pdf - Robyn Blust

VII. Agenda Items for Next Meeting

VIII. Call to the Public: A public body may make an open call to the public during a public meeting,

subject to reasonable time, place and manner restrictions, to allow individuals to address the

public body on any issue within the jurisdiction of the public body. At the conclusion of an open

call to the public, individual members of the public body may respond to criticism made by those

who have addressed the public body, may ask staff to review a matter, or may ask that a matter be

put on a future agenda. Members of the public body shall not discuss or take legal action on

matters raised during an open call to the public unless the matters are properly noticed for

discussion and legal action. A.R.S. § 38-431.01 (G).

Members of the public body may present a brief summary of current events. Members of the

public body shall not propose, discuss, deliberate, or take legal action on matters raised during a

summary of current events unless the matters are properly noticed for discussion and legal action.

IX. Summary of Current Events

a. February 5, 2017 – Tackle Trauma 5K RUN/WALK –

http://www.aztracc.org/TACKLETRAUMA5K/

X. Next Meetings: March 16, 2017 @ 9:00 AM, 150 N. 18th Ave. Rooms 215 A & B

XI. Adjourn

http://azdhs.gov/documents/preparedness/emergency-medical-services-trauma-system/reports/2016-stab-annual-report.pdf


http://www.aztracc.org/TACKLETRAUMA5K/

Bureau of Emergency Medical Services and Trauma System

2017 Statutory/Standing Committee Meetings

Date

Time

Meeting Conference Room

January 19, 2017 9:00 a.m. State Trauma Advisory Board

250 N. 17th Avenue, Lab

Auditorium (Igloo)

January 19, 2017 10:30 a.m. Emergency Medical Services


Auditorium (Igloo)

January 19, 2017 12:00 p.m. Medical Direction Commission


Auditorium (Igloo)

March 16, 2017 9:00 a.m.

Trauma and EMS Performance

Improvement (TEPI) 215A & 215B – 2nd Floor

150 Bldg

March 16, 2017 10:30 a.m. Education Committee 215A & 215B – 2nd Floor

150 Bldg

March 16, 2017 12:00 p.m.

Protocols, Medications and Devices

Committee 215A & 215B – 2nd Floor

150 Bldg

May 18, 2017 9:00 a.m. State Trauma Advisory Board 215A & 215B – 2nd Floor

150 Bldg

May 18, 2017 10:30 a.m. Emergency Medical Services Council 215A & 215B – 2nd Floor

150 Bldg

May 18, 2017 12:00 p.m. Medical Direction Commission 215A & 215B – 2nd Floor

150 Bldg

July 20, 2017 9:00 a.m.



150 Bldg

July 20, 2017 10:30 a.m. Education Committee 215A & 215B – 2nd Floor

150 Bldg

July 20, 2017 12:00 p.m.



150 Bldg

September 28, 2017 9:00 a.m. State Trauma Advisory Board 215A & 215B – 2nd Floor

150 Bldg

September 28, 2017 10:30 a.m. Emergency Medical Services Council 215A & 215B – 2nd Floor

150 Bldg

September 28, 2017 12:00 p.m. Medical Direction Commission 215A & 215B – 2nd Floor

150 Bldg

November 16, 2017 9:00 a.m.



150 Bldg

November 16, 2017 10:30 a.m. Education Committee 215A & 215B – 2nd Floor

150 Bldg

November 16, 2017 12:00 p.m.



150 Bldg

DISCLAIMER: “Meeting schedule subject to change upon the request of the Governor’s Office or the

Office of the Director. Should this occur, the Bureau will make all reasonable efforts to contact the affected

members as soon as feasible.”

10/26/16

TRAUMA AND EMS PERFORMANCE IMPROVEMENT (TEPI)

STANDING COMMITTEE

Date: July 21, 2016 Time: 9:00 A.M.

Draft Meeting Minutes

I. Call to Order – Chris Salvino, MD, called the meeting to order at 9:07 AM.

II. Roll Call – Tammy Gagnon (25 Members, 13 required for quorum.) A quorum was present.

Members Present: Members Absent:

Bill Ashland, RN

Brian Bowling

Darlene Herlinger*

Gail Bradley, MD

Garth Gemar, MD*

Jeffery Schaff, RN,

CEN

Jill McAdoo, RN*

Josh Gaither, MD

Mary McDonald

Melissa Moyer, CSTR

Michelle Guadnola,

RN*

Pamela Goslar, PhD*

Paul Dabrowski, MD*

Ralph Zane Kelley

Rebecca Haro

Robert Corbell

Chris Salvino, MD

Dale Woodridge, MD

Danielle Stello, RN

Eric Merill

Heather Miller

Pam Noland

Robert Djergaian,

MD*

Summer Magoteaux,

RN

Tiffiny Strever, RN

* indicates member participated telephonically

III. Chairman’s Report - Chris Salvino, MD, Chair

a. Attendance report (Attachment III.a.)

IV. Bureau Report - Rogelio Martinez

a. Medical Director recognition program

b. Trauma registry update

V. Discussion and Action Items

a. Discuss, amend, and approve TEPI meeting minutes of March 17, 2016 (Attachment

V.a.) Motion carries to approve.

b. Discuss STEMI 2015 Year in Review – Mary McDonald (Attachment V.b.)

VI. Progress Reports

a. EMS Registry Users Group (EMSRUG) - Robert Corbell

b. Trauma Registry Users Group (TRUG) - Melissa Moyer -6 months into ICD-10

c. Trauma Program Manager Workshops - Noreen Adlin-August 19th Flagstaff

Attachment V.a.

Registry Data In Action

i. AZ-PIERS - Anne Vossbrink

2014 EMS Annual Report – (Attachment VI.d.i.) - Vatsal Chikani,

Robyn Blust

ii. ASTR - Mary Benkert

Motor Vehicle Trauma (Attachment VI.d.ii.) - Vatsal Chikani, Robyn

Blust

VII. Agenda Items for Next Meeting

VIII. Call to the Public: A public body may make an open call to the public during a public meeting,

subject to reasonable time, place and manner restrictions, to allow individuals to address the

public body on any issue within the jurisdiction of the public body. At the conclusion of an open

call to the public, individual members of the public body may respond to criticism made by those

who have addressed the public body, may ask staff to review a matter, or may ask that a matter be

put on a future agenda. Members of the public body shall not discuss or take legal action on

matters raised during an open call to the public unless the matters are properly noticed for

discussion and legal action. A.R.S. § 38-431.01 (G).

Members of the public body may present a brief summary of current events. Members of the

public body shall not propose, discuss, deliberate, or take legal action on matters raised during a

summary of current events unless the matters are properly noticed for discussion and legal action.

IX. Summary of Current Events

a. 27th Annual Southwest Trauma Conference, Presented by the University of Arizona and

Banner- University Medical Center August 4 – 5, 2016 – JW Marriott Starr Pass, Tucson

https://www.facebook.com/swtrauma/posts/1712960188984114

b. November 10 – 11, 2016 – 8th Annual Southwest Trauma and Acute Care Symposium

http://www.aztracc.org/symposium/

c. November 3 – 4, 2016 Emergency Pediatric Interdisciplinary Care Conference

www.epiccaz.org

X. Next Meetings: November 17, 2016 @ 9:00 AM in Rooms 215A&B, 150 N. 18th Ave.

XI. Adjourn 10:24am

https://www.facebook.com/swtrauma/posts/1712960188984114

http://www.aztracc.org/symposium/

http://www.epiccaz.org/

AZ‐PIERS EMS Medications Given by Year

Medication 2013 2014 2015 2016

Oxygen 28778 38557 40226 38495

Normal Saline 20372 26016 28351 17927

Ondansetron (Zofran) 5421 9228 10758 12531

Fentanyl 2535 4656 6393 9429

Nitroglycerin 5746 7280 8163 8488

Aspirin (ASA) 4659 6008 6987 8081

Morphine Sulfate 5397 7237 7916 6646

Albuterol 2965 4300 4841 5970

Naloxone (Narcan) 1512 2405 3006 3759

Epi 1:10,000 3130 4548 4845 3744

Ipratropium 0 0 399 3066

Methylprednisolone (Solu‐Medrol) 1325 1732 1921 2352

Midazolam (Versed) 711 1323 1702 2043

Epi 1:1,000 181 200 412 2036

Dextrose 1433 2095 2139 1678

Atrovent 2025 2947 3007 1233

Lorazepam (Ativan) 303 607 535 779

Glucose 500 MG/ML Injectable Solution 0 0 75 710

Benadryl 365 507 589 683

Epinephrine 0 4 106 637

Adenosine 301 424 559 610

Glucose 0 0 79 577

DuoNeb (0.5 Atrovent/3.0 Albuterol) 134 255 587 469

Diltiazem (Cardizem) 149 304 388 461

Atropine 220 279 306 414

Glucose (Oral) 601 892 935 412

Magnesium Sulfate 89 160 232 396

Diazepam (Valium) 325 449 449 391

Lactated Ringers 267 569 450 369

Glucagon 196 296 297 356

Amiodorone 151 271 303 274

sodium chloride 0.9 % Injectable Solu 0 0 42 272

Thiamine 101 179 219 207

Succinylcholine (Anectine) 35 87 82 157

Furosemide (Lasix) 98 126 127 148

Etomidate 34 90 86 143

Ketamine 0 0 3 132

Sodium Bicarbonate 128 125 135 123

Lidocaine 66 118 159 111

Dopamine 18 50 43 70

Activated Charcoal 52 37 52 53

Vasopressin 45 102 110 43

Heparin 2 15 21 35

Potassium Chloride 3 10 13 33

Adenine / Glucose 0 0 0 32

Vancomycin 0 0 4 32

1 of 3

Attachment V.I.a


Medication 2013 2014 2015 2016

Propofol (Interfacility Transports) 0 0 7 24

Verapamil (Isoptin) 0 0 13 21

Phenylephrine HCl (Neo‐Synephrine) 2 9 4 19

Adenocard 0 0 0 16

Combivent 0 0 0 16

Glucose 50 MG/ML Injectable Solution 0 0 2 16

Insulin (Interfacility Transports) 0 2 5 14

Calcium Chloride 13 11 21 13

Parlodel 0 0 0 12

Epi‐Pen Adult 5 10 20 11

Levophed 0.1 % Injectable Solution 0 0 1 9

Cefoxitin 0 0 1 8

Nitronox (Nitrous Oxide) 7 8 14 8

Ativan 0 0 0 6

Oxytocin (Pitocin) 3 3 1 6

Piperacillin 0 0 1 6

Acetaminophen 8 11 21 5

Alanine / Arginine / Glucose / Glycin 0 0 0 4

Azithromycin 0 0 3 3

Hydromorphone (Dilaudid) 5 14 18 3

Metronidazole 0 0 0 3

Norepinephrine 0 0 4 3

Rocuronium Bromide (Zemuron) 4 2 8 3

Amyl NItrate 0 0 2 2

ertapenem 0 0 0 2

Levofloxacin 0 0 1 2

Normal Saline (Respiratory Use) 2 4 10 2

Racemic Epinephrine 1 1 1 2

sterile water 1 0 1 2

Unasyn 0 0 0 2

½ Normal Saline ‐ 0.45% 8 10 12 1

Alteplase 0 0 0 1

Dexamethasone 2 1 2 1

Epi‐Pen Junior 0 5 2 1

factor IX / factor VII / factor X / P 0 0 0 1

Lasix 0 0 0 1

Lidocaine Hydrochloride 20 MG/ML 0 0 0 1

Plasma‐lyte 148 0 0 0 1

aminosalicylate 0 0 1 0

Calcium Gluconate 0 1 0 0

Dobutamine 1 0 1 0

Epinephrine Infusion 0 1 0 0

Eptifibatide (Integrilin) 2 0 0 0

Haloperidol (Haldol) 0 1 0 0

Isoproterenol 1 0 0 0

Ketorolac (Toradol) 0 1 1 0

2 of 3


Medication 2013 2014 2015 2016

Labetolol 1 1 1 0

Lidocaine Drip 1 0 0 0

Mannitol (Osmitrol) 0 0 1 0

meropenem 0 0 1 0

Metoprolol (Lopressor) 0 0 1 0

Nitroprusside 1 2 0 0

Parenteral Nutrition (TPN/PPN) 0 165 182 0

Prednisone 0 0 1 0

Promethazine HCl (Phenergan) 1 2 1 0

Vecuronium (Norcuron) 0 0 3 0

3 of 3

Cara M. Christ, MD, Director

Terry Mullins, MBA, Bureau Chief

Bentley J. Bobrow, MD, Medical Director

Emergency Medical Services

2015 Annual Report

Attachment VI. b

Table of Contents

EMS Council Advisory Committee Membership ............................................................... i

Medical Direction Commission Advisory Committee Membership ................................ ii

Trauma & EMS Performance Improvement Standing Committee Membership ......... iii

Introduction ........................................................................................................................... 1

Map of Current Participating Agencies .............................................................................. 3

Submitting Agencies .............................................................................................................. 4

2014 Data EMS Annual Report ........................................................................................... 6

List of Tables & Figures ............................................................................................... 7

Purpose & Methodology .............................................................................................. 8

Total EMS Runs ............................................................................................................ 9

Treated & Transferred/Transported Population ..................................................... 16

Pediatric Population ................................................................................................... 20

Geriatric Population ................................................................................................... 25

Mortality ...................................................................................................................... 30

i.

Emergency Medical Services Council Advisory Committee Membership

Bentley Bobrow, MD

Chair

Arizona Department of Health Services– Medical

Director

Rebecca Haro, NREMT-P

Statewide Fire District Association Representative (TEPI

liaison)

North County Fire & Medical

Brian Smith

Emergency Medical Technician

Flagstaff Medical Center - Flagstaff, AZ

Chris Salvino, MD

Trauma Surgeon

Havasu Regional Medical Center - Lake Havasu City, AZ

Bob Ramsey

Ambulance Service Corporation

Dale Woolridge, MD

Public Member

Dan Millon

Department of Public Safety

Daniel Spaite, MD

Emergency Medicine Physician—Southeaster Region

Gene McDaniel

Prehospital Emergency Medical Training Program

Phoenix Fire Department

Glenn Kasprzyk

Public Member/Vice Chair

American Medical Response

Howard Reed

Ambulance Service Corporation

James Hayden, CEO

Public Member

Sara Perotti

Local EMS Coordinating System—Southeastern

Region

John Karolzak

Three Largest Employers of EMCTs

American Medical Response

Jonathan Maitem, DO

Emergency Medicine Physician—Central Region

Joseph Gibson

Local EMS Coordinating System—Central Region

Laura Baker

Three Largest Employer of EMCTs

Tucson Fire Department

Michele Preston, MD

Emergency Medicine Physician—Western Region

Nathan Lewis, RN

Public Member

Patricia Coryea-Hafkey, RN

Professional Nurse

Tyler Matthews, CEP

Public Member

Riane Page, MD

Emergency Medicine Physician—Northern Region

Robert Costello

Public Member

Rodney Reed

Local EMS Coordinating System—Western Region

Jim Dearing, DO

Hospital Administrator (Population >500K)

Todd Harms

Three Largest Employer of EMCTs

Alberto Gutier

Governor’s Office of Highway Safety

Christopher Baker, RN

Hospital Administrator (Population <500K)

ii.

Bentley Bobrow, MD

Chair

Arizona Department of Health Services– Medical

Director

Gail Bradley, MD

Physician Specializing in Cardiac Care/Vice Chair

Education Liaison

Daniel Spaite, MD

Emergency Medicine Physician—Southeastern

Region

Frank Walter, MD

Physician Specializing in Toxicology

Jonathan Maitem, DO

Emergency Medicine Physician—Central Region

Kevin Foster, MD

Physician Specializing in Trauma Surgery

Michele Preston, MD

Emergency Medicine Physician—Western Region

Nicholas Theodore, MD

Physician Specializing in Acute Head Injury/Spinal

Cord Care

Phillip Richemont

Physician with Full-Time Practice in a Rural Area

Riane Page, MD

Emergency Medicine Physician—Northern Region

(TEPI Liaison)

Toni Gross, MD

Physician Specializing in Pediatric Medicine (PMD

Liaison)

James Hayden, CEO

Public Member

Jim Dearing, DO

Hospital Administrator (Population >500K)

Medical Direction Commission Advisory Committee Membership

iii.

Trauma and EMS Performance Improvement Standing Committee Membership

Chris Salvino, MD, MS, FACS

Chair

Havasu Regional Medical Center - Lake Havasu City, AZ

Ralph Zane Kelly, MD

State Designated Level III Trauma Center Program Manager

Tuba City Regional Health Care Corporation - Tuba City, AZ

Bill Ashland, RN

Vice Chair/State Designated Level I Trauma Center Trauma

Program Manager


Summer Magoteaux, RN

Pediatric Representative (MD or RN)

Phoenix Children’s Hospital - Phoenix, AZ

Brian Bowling, BS, FP-C

Air Ambulance Premier EMS Agency Quality Improvement

Native Air Ambulance - Tempe, AZ 85282

Jill McAdoo, RN

Ground Ambulance or First Responder Premier EMS Agency –

Quality Improvement Officer (NAEMS/WACEMS), Life Line

Ambulance Service, AZ

Gail Bradley, MD

Medical Direction Commission Liaison

Peoria, Sun City, and Goodyear Fire Departments - EMS

Medical Director

Mary McDonald, RN, BSN

Prehospital EMS Manager – (SAEMS/AEMS), Tucson Fire

Department, Tucson, AZ

Robert Corbell, EMT-P

EMS Registry Group Member

Northwest Fire District

Tucson, AZ

Eric Merrill, EMT-P

Ground Ambulance or First Responder Premier EMS Agency,

Quality Improvement Officer (SAEMS/AEMS)

Rio Verde Fire Department, Rio Verde, AZ

Paul Dabrowski, MD

Trauma Surgeon, Banner Good Samaritan Medical Center,

Phoenix, AZ

Heather Miller

Western Arizona Council of Emergency Services

Kingman Regional Medical Center

Robert Djergaian, MD

Rehabilitation Specialist

Banner Good Samaritan Hospital - Phoenix, AZ

Melissa Moyer, CSTR

Representative of the Trauma Registry Users Group

John C. Lincoln North Mountain Hospital

Phoenix, AZ

Josh Gaither, MD

EMS Researcher (AEMRC)

University Medical Center Base Hospital

Tucson, AZ

Pam Noland, RN

State Designated Level IV Trauma Center Program Manager

Northern Cochise Community Hospital

Willcox, AZ

Garth Gemar, MD

EMS Medical Director of a Premier EMS Agency

Rural/Metro-Southwest Ambulance, Glendale Fire Dept.,

Surprise Fire Dept. and Banner Healthcare - Phoenix, AZ

Jeffrey Schaff, RN, CEN

ACS Verified Level I Trauma Program Manager

Banner University Medical Center - Tucson, AZ

Pamela Goslar, PhD

IPAC Representative

St. Joseph’s Hospital & Medical Center

Phoenix, AZ

Danielle Stello, RN

Prehospital EMS Coordinator - Base Hospital (NAEMS/

WACEMS)

Havasu Regional Medical Center, Lake Havasu City, AZ

Michelle Guadnola, RN

State Designated Level I Trauma Center Trauma Program

St. Joseph’s Hospital & Medical Center - Phoenix, AZ

Tiffiny Strever, RN

State Designated Level I Trauma Center – Trauma Program

Representative - West Valley Hospital – Goodyear, AZ

Rebecca Haro, NREMT-P

EMS Council Liaison

Sun City West Fire District - Phoenix, AZ

Dale Woolridge, MD

Injury Researcher

University of Arizona Department of Emergency Medicine

Tucson, AZ

Darlene Herlinger, RN, MSN

Prehospital EMS Coordinator (SAEMS/AEMS)

University of Arizona South Campus

Tucson, AZ

1

Introduction

On behalf of the Data and Quality Assurance team, we are pleased to present the 2015 EMS Annual

Report. Much like the State Trauma Advisory Board Annual Report,1 this document should serve as a record

of system-level EMS activity for the 2014 reporting year. In order to document changes over time, this report

will maintain a consistent focus with additional content being added through time.

EMS is undergoing many changes. The Patient Protection and Affordable Care Act contains several

sections that apply directly or indirectly to the provision of EMS. Most of these sections focus on the

importance of EMS data collection, data analysis and the use of data in driving performance improvement

initiatives. Additionally, the EMS Compass (www.emscompass.org), a nationwide initiative funded through

the National Highway Traffic Safety Association (NHTSA) Office of EMS, has developed performance

measures and will continue to develop more.

This past year the Bureau of EMS and Trauma System successfully provided EMS agencies with

access to outcome data after linking the Arizona State Trauma Registry, the Hospital Discharge Database, and

the Cardiac Event Data and Reporting system (CEDaR). EMS has long considered accessing outcome data as

the gold standard for targeted and timely performance improvement initiatives. This is an expansion similar to

the long-standing success found in the Save Hearts in Arizona Registry & Education2 and the Excellence in

Prehospital Injury Care (EPIC).3

Arizona is fortunate to have medical directors, performance improvement officers, and chief executives

that value the importance of data collection, data analysis, and the continuous quality improvement processes.

In fact, Arizona’s EMS providers have helped shape the provision of out-of- hospital and in-hospital cardiac

arrest care around the world. More recently, the work of some of Arizona’s 9-1-1 dispatch centers has shown

dramatic results for bystander CPR. The Journal of the American Medical Association published a report on

Arizona’s success this month.4 Lastly, your work in adopting and reporting data on the traumatic brain injury

care in EPIC is also promising dramatic improvements in patient outcomes.

http://www.emscompass.org

2

With the assistance of the Trauma and EMS Performance Improvement standing committee,5 several

EMS performance improvement resources and activities are now in place including the EMS Performance Im-

provement Manual,6 the EMS Registry Users Group, and numerous EMS registry training opportunities each

year.

As you review this report, we hope that you will share any ideas that you have for our next report. We

extend our sincerest thanks and gratitude to the 18,000 EMCTs in Arizona who respond to the requests for

EMS at all times. Your work makes a positive difference in the lives of all Arizonans.

In the future, we expect to see Community Integrated Paramedicine, which includes Treat and Refer

initiatives, as new models for the use of EMS personnel in our healthcare system. Being able to collect, ana-

lyze and use these data to improve care is vital to ensuring that these systems deliver the promised benefits.

The flow of data from Health Information Exchanges (HIE),7 with Arizona’s very own Health-e Connection,

will help shape the way organizations obtain outcome data and medical history data in the future.

Sincerely,

Terry Mullins Bentley Bobrow

Bureau Chief Medical Director

1http://azdhs.gov/documents/preparedness/emergency-medical-services-trauma-system/reports/2015-stab-annual-report.pdf 2http://azdhs.gov/preparedness/emergency-medical-services-trauma-system/save-hearts-az-registry-education/index.php 3http://www.epic.arizona.edu/ 4Bobrow BJ, Spaite DW, Vadeboncoeur TF, et al. Implementation of a Regional Telephone Cardiopulmonary Resuscitation Program and Outcomes

After Out-of-Hospital Cardiac Arrest. JAMA Cardiol. Published online May 04, 2016. doi:10.1001/jamacardio.2016.0251. 5http://azdhs.gov/documents/preparedness/emergency-medical-services-trauma-system/advisory/STAB/TEPImembership.pdf

6http://www.azdhs.gov/documents/preparedness/emergency-medical-services-trauma-system/data/users/ems-performance-improvement-plan.pdf 7http://www.azhec.org/


http://azdhs.gov/preparedness/emergency-medical-services-trauma-system/save-hearts-az-registry-education/index.php

http://www.epic.arizona.edu/

http://cardiology.jamanetwork.com/article.aspx?articleid=2518761

http://cardiology.jamanetwork.com/article.aspx?articleid=2518761

http://azdhs.gov/documents/preparedness/emergency-medical-services-trauma-system/advisory/STAB/TEPImembership.pdf

http://www.azdhs.gov/documents/preparedness/emergency-medical-services-trauma-system/data/users/ems-performance-improvement-plan.pdf

http://www.azhec.org/

3

The EMS agencies highlighted here submitted 2014 data to the AZ-PIERS Annual Report.

4

Action Medical Svc. - Ganado

Action Medical Svc. - Winslow

Aerocare Med. Transport-AeroMed

Air Evac Svcs.

Alpine Fire Dist.

American Ambulance

American Comtrans

Arivaca Fire Dist.

Arizona State University Student EMS

Arrowhead Mobile Healthcare

Avondale Fire & Medical Department

Beaver Dam-Littlefield Fire District

Black Canyon Fire Dept.

Buckeye Valley Rural Vol. Fire Dist.

Bullhead City Fire Dept. Ambulance Svc.

Camp Verde Fire District

Central Yavapai Fire Dist.

Chandler Fire Dept.

Clarkdale Fire Dist.

Classic Lifeguard Aeromedical Svc.

Congress Fire Dist.

Cottonwood Fire Dept.

Eloy Fire District Ambulance Svc.

Fort McDowell Yavapai Nation Fire Department

Fort Mojave Mesa Fire District

Golder Ranch Fire District

Green Valley Fire Dist.

Guardian Air (Flagstaff)

Guardian Medical Transport

Healthcare Innovations

High Country Fire Rescue

Holbrook EMS

Kord's Southwest

Lake Havasu City Fire Department

Life Line Ambulance Svc.

LifeNet (Arizona)

LifeStar EMS

Maricopa County Sheriff's Office (MCSO)

Maricopa Fire Dept.

Mayer Fire & Rescue

Mohave Valley Fire Dept. Ambulance Svc.

Montezuma-Rimrock Fire District

Native American Air Ambul. - OMNI Flight

Navajo Nation EMS - Fort Defiance

Navajo Nation EMS - Red Mesa

North County Fire & Medical District

Northwest Fire Rescue Dist.

PMT- Professional Medical Transport

Peoria Fire Dept.

Pine/Strawberry Fire Dept.

Queen Creek Fire Dept.

REVA

Rio Rico Fire District

Rio Verde Fire Dist.

River Medical Inc.

Rural Metro Corp. (Pinal) - TRI-CITY MED

Rural/Metro Corp. (Pima)

Rural/Metro Corp. (Yuma)

Rural/Metro Corp. - AMT (Maricopa)

Sacred Mountain Medical Svc.

San Juan Regional Air Care (New Mexico)

Scottsdale Fire Dept.

Southwest Ambulance & Rescue of AZ

Southwest Ambulance (Maricopa)

Southwest Ambulance of Casa Grande

Southwest Ambulance of Safford

Sun Lakes Fire District

Superstition Fire and Medical District

Surprise Fire Dept.

Tonopah Valley Fire Dist.

Tri-Valley Ambulance Svc.

Tubac Fire District Ambulance Svc.

Twin Arrows EMS

Verde Valley Ambulance Co.

Verde Valley Fire District

Williamson Valley Fire Dist.

Yarnell Fire Dist.

Yuma Fire Department

Submitting Agencies Thank you to all our 2014 submitters! This report would not be possible without you!

5

This Page Intentionally Left Blank

6

Arizona Department of Health Services


Prepared by:

Vatsal Chikani, MPH, BHMS, Bureau Statistician

Robyn Blust, MPH, Bureau Epidemiologist

Anne Vossbrink, MS, EMS Registry Manager

Paula Brazil, MA, SHARE Program Coordinator

Rogelio Martinez, MPH, Data & Quality Assurance Section Chief

Terry Mullins, MBA, EMS & Trauma System Bureau Chief

Bentley Bobrow, MD, EMS & Trauma System Medical Director

2014 Data

Emergency Medical Services

Annual Report

7

Total EMS Runs ........................................................................................................................................ 9

Graph 1: Age distribution of EMS runs and Arizona population .......................................... 9

Table 1: EMS run volume by age ............................................................................................... 9

Graph 2/Table 2: EMS run rate per 100,000 Arizona residents by age ............................... 10

Graph 3/Table 3: EMS run rate per 100,000 Arizona residents by county ......................... 11

Graph 4: EMS run volume by race .......................................................................................... 12

Table 4: EMS run volume by gender, race and ethnicity ...................................................... 12

Graph 5/Table 5: Incident Disposition of total EMS runs ..................................................... 13

Graph 6/ Table 6a: Provider primary impression (Top 10) .................................................. 14

Table 6b/Table 6c: Provider primary impression (Next 11-20) and (Next 21-30) .............. 15

Treated & Transferred/Transported Population ................................................................................ 16

Graph 7/Table 7: Provider primary impression (Top 10) of transported EMS patients .... 16

Table 8: Hospital principal diagnosis (Top 10) of transported EMS patients ..................... 17

Graph 8/Table 9: Payer source for transported EMS patients ............................................. 18

Graph 9/Table 10: Hospital discharge status of transported EMS patients ........................ 19

Pediatric Population ............................................................................................................................... 20

Graph 10: Age-specific pediatric EMS run rate per 100,000 Arizona residents ................. 20

Table 11: Pediatric EMS run volume by age .......................................................................... 20

Graph 11/Table 12: Provider primary impression (Top 10) for pediatric EMS runs ........ 21

Graph 12/Table 13: Incident disposition for pediatric EMS runs ........................................ 22

Table 14: Hospital principal diagnosis (Top 10) for pediatric EMS runs ............................ 23

Graph 13/Table 15: Hospital discharge status for pediatric EMS runs ............................... 24

Geriatric Population ............................................................................................................................... 25

Graph 14/Table 16: Age-specific geriatric EMS run rate per 100,000 Arizona residents .. 25

Graph 15/Table 17: Provider primary impression (Top 10) for geriatric EMS runs ......... 26

Graph 16/Table 18: Incident disposition for geriatric EMS runs ......................................... 27

Table 19: Hospital principal diagnosis (Top 10) for geriatric EMS runs ............................. 28

Graph 17/Table 20: Hospital discharge status for geriatric EMS runs ................................ 29

Mortality .................................................................................................................................................. 30

Graph 18/Table 21: On scene and in-hospital mortality by age and gender ....................... 30

Table 22a: Provider primary impression (Top 10) for on scene mortality .......................... 31

Table 22b: Provider primary impression (Top 10) for in-hospital mortality ...................... 31

Table 23: Hospital principal diagnosis (Top 10) for in-hospital mortality ........................... 31

List of Tables & Figures

8

Purpose:

The purpose of this report is to systematically describe EMS calls occurring in Arizona. We have synthesized

data from the Arizona Prehospital Information & EMS Registry System (AZ-PIERS) and the Hospital

Discharge Database (HDD) to provide stakeholders with key information on Arizona’s EMS patients.

Methodology:

The AZ-PIERS is a free electronic Patient Care Records (ePCRs) registry that allows EMS agencies to collect

and transmit to the State. The primary purpose of the AZ-PIERS is to optimize prehospital care through a data

driven, quality assurance approach. In 2014, about 65 EMS agencies were submitting data to the AZ-PIERS;

these agencies cover approximately 63% of Arizona’s area and 97% of Arizona’s population. The database

includes both required and optional reporting elements and data are validated to meet National EMS

Information System (NEMSIS) standards. The AZ-PIERS captures agency information, patient demographics,

response times, incident location, and prehospital treatment.

A total of 484,265 EMS runs were submitted to AZ-PIERS from January 1, 2014, to December 31, 2014. We

used the 2014 population denominators, from the Arizona Health Status and Vital Statistics database, to

calculate EMS run rates per 100,000 Arizona residents. These data were analyzed using SAS software, version

9.4 (SAS Institute, Cary, NC).

In order to obtain the final hospital outcome for EMS runs with an incident disposition of Treated &

Transferred or Treated & Transported (n = 394,007), a deterministic linkage between AZ-PIERS and the

Hospital Discharge Database (HDD) was performed. Of the 394,007 treated/transported EMS runs, 290,902

(74%) qualified for linkage. Runs not qualifying for linkage consisted of patients who were transported to

facilities not reporting to the HDD, facilities outside of Arizona, or had missing data on all linkage variables.

Following linkage, 252,580 (87%) EMS runs were successfully matched to their respective records in the

HDD.

If a single patient is treated by more than one EMS agency, AZ-PIERS will collect that patients information

from all the corresponding agencies, leading to multiple records for the same patient. In order to report the

information from the HDD at the patient level, duplicate runs were removed. After removing the duplicates, a

total of 209,066 linked patient level records were available from the HDD. This patient level information was

used when reporting information from the HDD.

Purpose and Methods

9

EMS Annual Report | 2015

EMS Run Volume by age

Total EMS Runs

There were 484,265 EMS

runs reported to AZ-PIERS

from January 1, 2014, to

December 31, 2014.

As age increases, the

proportion of patients

utilizing EMS services

begins to exceed the

proportion of Arizona's

population (Graph 1). For

example, 5.2% of the

population is 1 to 4 years

old; while this group makes

up only 1.3% of EMS runs.

Conversely, 1.7% of the

population is 85 years or

older; while this group

makes up 10.2% of EMS

runs.

About half of all EMS runs

involved individuals over

55 years of age (Table 1)

Table 1: EMS run volume by age

Count %

Total EMS runs 484,265 100.0%

Age (years)

51,562 10.6% Missing

< 1 4,078 0.8%

1-4 6,565 1.3%

5-14 12,829 2.6%

15-24 37,524 7.7%

25-34 40,773 8.4%

35-44 39,773 8.2%

45-54 52,978 10.9%

55-64 59,461 12.2%

65-74 64,600 13.3%

75-84 64,293 13.2%

> 85 49,829 10.2%

Graph 1: Age distribution of EMS runs and Arizona population

10


EMS run rate by age

Total EMS Runs

An EMS run rate allows for

comparisons among groups

despite differences in

population makeup.

The EMS run rate per

100,000 Arizona residents

increases with age.

Individuals aged 85 years

and older have the highest

EMS run rate in the state

with 41,545 runs per

100,000 Arizona residents.

Table 2: EMS run rate per 100,000 Arizona residents by age

EMS runs Run Rate Arizona

population

Total EMS runs 484,265 — 6,667,241

Age (years)

51,562 — — Missing

< 1 4,078 4,835 84,342

1-4 6,565 1,875 350,065

5-14 12,829 1,392 921,419

15-24 37,524 3,987 941,262

25-34 40,773 4,596 887,233

35-44 39,773 4,764 834,861

45-54 52,978 6,297 841,342

55-64 59,461 7,607 781,612

65-74 64,600 10,880 593,726

75-84 64,293 20,664 311,439

> 85 49,829 41,545 119,940

Data source: AZ-PIERS 2014

Graph 1: Age-specific EMS run rate per 100,000

4,835

1,875

1,392

3,987

4,596

4,764

6,297

7,607

10,880

20,644

41,54585+

75-84

65-74

55-64

45-54

35-44

25-34

15-24

5-14

1-4

<1

Graph 2: EMS run rate per 100,000 Arizona residents by age

11


The EMS run rate allows

for comparisons on the use

of EMS in counties despite

differences in population.

Given that not all EMS

agencies submit data to

AZ-PIERS, the rates for

some counties may be

underestimated.

Only 2% of EMS runs

involved incidents

occurring outside of

Arizona.

EMS run rate by county

Total EMS Runs

Table 3: EMS run rate per 100,000 Arizona residents by county

Count % Rate

County of Incidence

8,493 1.7% — Missing

Apache 2,729 0.5% 3,797

Cochise 4,194 0.8% 3,235

Coconino 6,700 1.4% 4,807

Gila 3,124 0.6% 5,762

Graham 3,685 0.7% 9,618

Greenlee 139 0.0% 1,327

La Paz 4,235 0.8% 19,972

Maricopa 243,005 51.2% 6,062

Mohave 35,055 7.3% 17,184

Navajo 9,194 1.9% 8,421

Pima 66,435 14.0% 6,596

Pinal 35,413 7.4% 8,937

Santa Cruz 2,170 0.4% 4,379

Yavapai 33,113 6.9% 15,376

Yuma 16,488 3.4% 7,777

Outside of Arizona 9,141 1.8% —


Graph : County-specific EMS run rate per 100,000

3,797

3,235

4,807

5,762

9,618

1,327

19,972

6,062

17,184

8,421

6,596

8,937

4,379

15,376

7,777Yuma

Yavapai

Santa Cruz

Pinal

Pima

Navajo

Mohave

Maricopa

La Paz

Greenlee

Graham

Gila

Coconino

Cochise

Apache

Graph 3: EMS run rate per 100,000 Arizona residents by county

12


Race, Ethnicity and Gender

Total EMS Runs

Although race and

ethnicity are standard

medical questions, race

was missing for 42% and

ethnicity was missing for

85% of EMS runs.

The Health Research and

Educational Trust

recommends that providers

ask for ethnicity prior to

race.

Table 4: EMS run volume by gender, race and ethnicity


Graph 2: EMS run volume by race

0.1%

0.4%

2.7%

3.2%

8.4%

41.5%

43.3%

Missing

Other Race

White

Native Hawaiian/Pacific Islander

Black/African American

Asian

American Indian/Alaska Native

Graph 4: EMS run volume by race

Count %

Gender

59,419 12.2% Missing

Male 206,291 42.5%

Female 218,555 45.1%

Race

201,249 41.5% Missing

American Indian/Alaska Native 15,668 3.2%

Asian 2,244 0.4%

Black/African American 13,466 2.7%

Native Hawaiian/Pacific Islander 641 0.1%

White 210,071 43.3%

Other Race 40,926 8.4%

Ethnicity

409,754 84.6% Missing

Hispanic or Latino 11,088 2.2%

Not Hispanic or Latino 63,423 13.0%

Example:

“"We want to make sure that all

our patients get the best care

possible. We would like you to

tell us your racial/ethnic

background so that we can

review the treatment that all

patients receive and make sure

that everyone gets the highest

quality of care."

1. Do you identify yourself

as Hispanic, Latino, or of

Spanish origin?

Yes

No

Declined to answer

2. Which category best

describes your race?

American Indian/

Alaskan Native

Asian

White

Other

Declined to answer

13


Incident Disposition

Total EMS Runs

For 81% of EMS runs,

patients were either treated

and transferred between

EMS agencies or treated &

transported directly to the

hospital.

There were 2,078 (0.4%)

EMS runs with a discharge

disposition of dead at

scene.

Table 5: Incident disposition of total EMS runs


Graph 3: Incident disposition of total EMS runs

0.4%

1.1%

3.9%

4.5%

8.4%

81.3%

Dead at Scene

No Treatment Required

Patient Refused Care

Other

Treated and Released

Treated, Transferred/Transported

Graph 5: Incident disposition of total EMS runs

Count %

Treated, Transferred/Transported 394,007 81.3%

Treated and Released 41,052 8.4%

Other 22,262 4.5%

Patient Refused Care 19,202 3.9%

No Treatment Required 5,664 1.1%

Dead at Scene 2,078 0.4%

14


Provider Primary Impression

Total EMS Runs

The EMS Provider Primary

Impression was missing for

37.3% of EMS runs. When

recorded, traumatic injury,

pain, and behavioral/

psychiatric disorder were

the top three primary

impressions.

Tables 6a to 6c show the

top 30 provider primary

impressions.

Table 6a: Provider primary impression (Top 10)

Count %

Traumatic injury 29,168 10.0%

Pain 28,322 9.7%

Behavioral/psychiatric disorder 22,576 7.7%

Abdominal pain/problems 20,219 6.9%

Altered level of consciousness 19,363 6.6%

Chest pain/discomfort 18,314 6.3%

Respiratory distress 13,249 4.5%

No Apparent Illness/Injury 12,510 4.3%

Other 12,068 4.1%

Weakness 10,475 3.6%


Graph 4: Provider primary impression (Top 10)

3.6%

4.1%

4.3%

4.5%

6.3%

6.6%

6.9%

7.7%

9.7%

10.0%

Weakness

Other

No Apparent Illness/Injury

Respiratory distress

Chest pain/discomfort

Altered level of consciousness

Abdominal pain/problems

Behavioral/psychiatric disorder

Pain

Traumatic injury

Graph 6: Provider Primary Impression (Top 10)

15



Total EMS Runs

Table 6b: Provider primary impression (Next 11-20)

Count %

Unknown Problem 7,651 2.6%

Seizure 7,109 2.4%

Other Illness/Injury 5,470 1.8%

Syncope/fainting 5,017 1.7%

Nausea/Vomiting (Unknown Etiology) 4,652 1.6%

Cardiac rhythm disturbance 4,495 1.5%

Ethyl Alcohol Abuse 4,087 1.4%

Stoke/Cerebrovascular Accident 4,009 1.3%

General Malaise 3,455 1.1%

Fever 3,400 1.1%

GI = Gastro Intestinal, CNS = Central Nervous System, COPD = Chronic Obstructive Pulmonary

Disease

Table 6c: Provider primary impression (Next 21-30)

Count % Headache 3,166 1.0% Back Pain (Non-Traumatic) 3,093 1.0% Diabetic symptoms (hypoglycemia) 2,704 0.9% Cardiac Arrest 2,176 0.7% Other Abdominal/GI Problems 1,833 0.6% Unconscious 1,743 0.6% Other CNS Problem 1,697 0.5% Poisoning/drug ingestion 1,629 0.5% COPD (Emphysema/Chronic Bronchitis) 1,493 0.5% Allergic reaction 1,476 0.5% All other impressions 32,937 11.3%


16


Treated & Transferred / Transported

After linkage (See page 8

for details), 87% of

qualifying EMS runs were

successfully matched to

their respective records in

the HDD, for a total of

252,580 linked records.

The EMS provider primary

impression was missing for

30% of the linked records.

When recorded, the top

three EMS primary

impressions for transported

patients were pain,

traumatic injury, and

altered level of

consciousness.

Table 7: EMS primary impression (Top 10) of EMS runs

transported to the hospital

Count %

Pain 19,685 11.1%







Weakness 7,504 4.2%

Other 6,843 3.8%

Seizure 5,362 3.0%


Graph 5: EMS primary impression (Top 10) of EMS runstransported to hospital

3.0%

3.8%

4.2%

4.6%

5.5%

6.8%

7.4%

8.0%

10.6%

11.1%

Seizure

Other

Weakness






Traumatic injury

Pain

Graph 7: EMS primary impression (Top 10) of EMS runs



17

Hospital Primary Diagnosis


The 252,580 linked EMS

runs represent 209,066

patient level records in the

HDD (see page 8 for

details).

The top three hospital

diagnoses for patients


were chest pain, alcohol-

related disorders and

superficial injury.

Table 8: Hospital principal diagnosis (Top 10) of EMS

patients transported to the hospital

Count %

Chest pain 10,276 4.9%

Alcohol-related disorders 8,163 3.9%

Superficial injury 7,096 3.3%

Other injury 6,955 3.3%

Syncope 6,379 3.0%

Epilepsy/Copy Number Variation 6,371 3.0%

Septicemia 6,256 2.9%

Abdominal pain 5,571 2.6%

Dysrhythmia 4,548 2.1%

Sprain 4,492 2.1%

Count %

Admitted as an inpatient 70,410 33.6%

Discharged from ED 138,656 66.3%


18

Payer Source


The majority of hospital

charges incurred by

transported EMS patients

were billed to either

Medicare (49%) or

Medicaid (24%).

Note: AHCCCS = Arizona Health Care Cost Containment System, HMO = Health Maintenance

Organization, PPO = Preferred Provider Organization

Table 9: Payer source for EMS patients transported to the

hospital

Payer status Count %

Medicare/Medicare risk 102,527 49.0%

AHCCCS/Medicaid 49,345 23.6%

Commercial/HMO/PPO 35,980 17.2%

Self pay 13,865 6.6%

Other 7,349 3.5%


Graph 6: Payer source for patients transported to hospital

3.5%

6.6%

17.2%

23.6%

49.0%

Other

Self pay

Commercial/HMO/PPO

AHCCCS/Medicaid

Medicare/Medicare risk

Graph 8: Payer source for EMS patients transported to the

hospital

Total Charges

The total charges for the 209,057 patients that were treated and transported to a hospital were $5,019,777,808,

with a median charge of $9,506.


19

Of the EMS patients

transported to the

hospital, 66% (138,656)

were discharged from the

Emergency Department

(ED), and 33% (70,410)

were admitted to the

hospital.

Of those discharged from

the ED, 89% were

discharged home.

Of the admitted patients,

52% were discharged

home and 36% were

discharged to a SNF/

ALF/Rehab or long term

nursing facility. 3.4% of

admitted patients died in

the hospital.

Among the admitted

patients, the median

hospital length of stay

was 4 days.

Hospital Discharge Status


Data source: AZ-PIERS 2014 and HDD 2014

Graph 6: Hospital discharge status of transported patients

3.7%

89.3%

2.3%

3.1%

0.4%

0.0%

0.9%

1.7%

1.4%

51.8%

3.4%

5.3%

36.0%

0.1%

Transferred to Acute Care

SNF/ALF/Rehab/Long Term

Home

LMA

Expired

Hospice

Discharged with planned readmission

EDInpatient

Note: SNF = Skilled Nursing Facility, ALF = Assisted Living Facility, LMA = Left Against Medical Advice

Table 10: Hospital discharge status of transported EMS patients

Hospital discharge status Admitted as an inpatient Discharged from ED

Count % Count %

Home 36,862 52.3% 124,016 89.4%

Transferred to Acute Care 1,255 1.7% 4,498 3.2%

SNF/ALF/Rehab/Long Term 25,031 35.5% 4,915 3.5%

LMA 1,026 1.4% 3,318 2.3%

Expired 2,447 3.4% 1,339 0.9%

Hospice 3,657 5.1% 532 0.3%

Discharged w/ planned readmission 132 0.1% 38 0.0%

Total 70,410 100.0% 138,656 100.0%

Graph 9: Hospital discharge status of transported EMS patients


20

EMS run rate by age

Pediatric Population

There were 33,375 (7%)

EMS runs involving

pediatric patients under the

age of 18.

Less than one year olds had

the highest EMS run rate

with 4,835 runs per 100,000

Arizona residents.


Graph 7: Age-specific pediatric EMS run rate per 100,000

4,835

1,875

1,091

1,696

3,65615-17

10-14

5-9

1-4

<1

Table 11: Pediatric EMS run volume by age

Count %

Total pediatric cases 33,375 100.0%

Age (years)

4,078 12.2% <1

1-4 6,565 19.6%

5-9 5,052 15.1%

10-14 7,777 23.3%

15-17 9,903 29.6%

Graph 10: Age-specific pediatric EMS run rate per 100,000

Arizona residents


21



The top three primary

impressions for EMS runs

involving pediatrics were

traumatic injury,

behavioral/psychiatric

disorder, and respiratory

distress.

Table 12: Provider primary impression (Top 10) for

pediatric EMS runs

Count %




Pain 1,652 7.0%

Seizure 1,550 6.6%



Other 921 3.9%

Fever 780 3.3%

Altered level of consciousness 752 3.2%


Graph 9: Provider primary impression of all pediatric EMSruns (Top 10)

3.2%

3.3%

3.9%

5.8%

6.5%

6.6%

7.0%

7.4%

13.2%

15.2%


Fever

Other



Seizure

Pain



Traumatic injury

Graph 11: Provider primary impression (Top 10) for

pediatric EMS runs


22



For 86% of EMS runs

involving pediatrics, the

patient was either treated

and transferred between

EMS agencies or treated &

transported directly to the

hospital.

Count %

Other 218 0.6%

Dead at Scene 13 0.0%

No Treatment Required 433 1.2%




Table 13: Incident disposition for pediatric EMS runs


Graph 10: Incident disposition of all pediatric EMS runs

0.0%

1.2%

4.9%

6.8%

86.2%

Dead at Scene





Graph 12: Incident disposition for pediatric EMS runs


23

Hospital Diagnosis


Count %

Epilepsy/Copy Number Variation 1,518 10.7%


Superficial injury 906 6.3%

Mood disorders 848 5.9%

Intracranial injury 553 3.9%

Syncope 412 2.9%

Open wound head 409 2.8%

Sprain 396 2.7%

Fracture arm 383 2.7%

Other upper respiratory infection 375 2.6%

Table 14: Hospital principal diagnosis (Top 10) for

pediatric EMS runs A total of 14,162 pediatric

EMS runs were linked to

the HDD.

The top three hospital

diagnoses for the linked

cases were Epilepsy/Copy

Number Variation, Other

Injury, and Superficial

Injury.

Count %

Admitted as an inpatient 2,525 17.8%

Discharged from ED 11,637 82.1%


24




Graph 9: Hospital discharge status of pediatric population

89.1%

0.3%

6.2%

2.0%

0.6%

1.3%

0.1%

91.7%

6.5%

0.7%

0.3%

0.4%

0.0%

0.0%

Home


LMA


Expired


Hospice

InpatientED

Hospital discharge status Admitted as inpatient Discharged from ED

Count % Count %

Home 2,250 89.1% 10,675 91.7%

Transferred to Acute Care 52 2.0% 765 6.5%

SNF/ALF/Rehab/Long Term 159 6.2% 83 0.7%

LMA 8 0.3% 57 0.4%

Expired 35 1.3% 42 0.3%

Hospice 5 0.1% 9 0.0%

Discharged with planned readmission 16 0.6% 6 0.0%

Total 2,525 100.0% 11,637 100.0%

Table 15: Hospital discharge status for pediatric EMS runs

SNF = Skilled Nursing Facility, ALF = Assisted Living Facility, LMA = Left Against Medical Advice

Of the 14,162 linked

pediatric EMS runs, 18%

were admitted to the

hospital and 82% were

discharged from the ED.

The majority of pediatric

patients were discharged

home from either the ED

or after admission to the

hospital.

The inpatient mortality

for pediatric patients was

1.3% and the ED

mortality was 0.3%.

6.2% of pediatric

inpatients were

discharged to a SNF/

ALF/Rehab or to a long

term care facility.

Graph 13: Hospital discharge status for pediatric EMS runs


25

EMS run rate by age

Geriatric Population

Count % Rate per 100,000

Total geriatric cases 178,722 100.0% —

Age (years)

64,600 36.1% 10,880 65-74

75-84 64,293 35.9% 20,644

>85 49,829 27.8% 41,545

Table 16: Age-specific geriatric EMS run rate per 100,000

Arizona residents

There were 178,722 (37%)

EMS runs involving

geriatric patients 65 years or

older.

Patients over the age of 85

had the highest EMS run

rate with 41,545 runs per

100,000 Arizona residents.


Graph 11: Age-specific geriatric EMS run rate per 100,000

10,880

20,644

41,54585+

75-84

65-74

Graph 14: Age-specific geriatric EMS run rate per 100,000

Arizona residents


26



Count %

Pain 12,327 10.5%




Weakness 7,321 6.2%



Other 5,991 5.1%


Unknown Problem 3,127 2.6%

Table 17: Provider primary impression (Top 10) for

geriatric EMS runs

Pain, Traumatic Injury, and

Altered Level of

Consciousness were the top

three primary impressions

for EMS runs involving

geriatrics.


Graph 13: Provider primary impression of all geriatric EMSruns (Top 10)

2.6%

4.2%

5.1%

5.5%

6.1%

6.2%

6.7%

7.5%

8.8%

10.5%

Unknown Problem


Other



Weakness



Traumatic injury

Pain

Graph 15: Provider primary impression (Top 10) for

geriatric EMS runs


27



Count %

Not Documented 371 0.2%

Cancelled 257 0.1%

Dead at Scene 1,032 0.5%

No Patient Found 204 0.1%

No Treatment Required 1,490 0.8%




Public Assist 210 0.1%

EMS Care / Assistance 557 0.3%

Table 18: Incident disposition for geriatric EMS patients

Geriatrics were treated and

transferred/transported

more often than other age

groups (91.2%).

0.5% of runs involving

geriatrics had an EMS

discharge disposition of

dead at scene.


Graph 14: Incident disposition of all geriatric EMS runs

0.5%

0.8%

2.8%

3.6%

91.2%

Dead at Scene





Graph 16: Incident disposition for geriatric EMS patients


28

Hospital Diagnosis


Count %

Septicemia 5,344 4.7%

Chest pain 4,859 4.3%

Syncope 4,035 3.6%

Dysrhythmia 3,762 3.3%


Fracture hip 3,393 3.0%

Urinary Tract Infection 3,351 3.0%

Acute Cerebrovascular Disease 3,167 2.8%

Superficial injury 3,105 2.7%

Pneumonia 2,889 2.5%

Table 19: Hospital principal diagnosis (Top 10) for geriatric

EMS patients A total of 111,578 geriatric

EMS runs were linked to

the HDD.

Septicemia, Chest Pain, and

Syncope were the top three

hospital primary diagnoses

among geriatric patients.


29




Graph 9: Hospital discharge status of geriatric population

7.9%

84.4%

1.4%

3.6%

1.6%

0.9%

0.0%

1.5%

38.3%

7.8%

4.0%

47.4%

0.5%

0.1%



Home

Hospice

Expired

LMA


EDInpatient

Hospital discharge status Admitted as inpatient Discharged from ED

Count % Count %

Home 19,822 38.3% 50,603 84.4%

Transferred to Acute Care 826 1.5% 2,178 3.6%

SNF/ALF/Rehab/Long Term 24,474 47.4% 4,767 7.9%

LMA 277 0.5% 846 1.4%

Expired 2,106 4.0% 989 1.6%

Hospice 4,069 7.8% 553 0.9%

Discharged with planned readmission 53 0.1% 15 0.0%

Total 51,627 100.0% 59,951 100.0%

Table 20: Hospital discharge status for geriatric EMS patients

Note: SNF = Skilled Nursing Facility, ALF = Assisted Living Facility, LMA = Left Against Medical Advice

Of the 111,578 geriatric

EMS runs, 46% were

admitted to the hospital and

54% were discharged from

the ED.

The inpatient mortality for

geriatric patients was 4.0%

and the ED mortality for

geriatric patients was 1.6%.

47.4% of geriatric

inpatients were discharged

to a SNF/ALF/Rehab or to

a long term care facility.

Graph 17: Hospital discharge status for geriatric EMS patients


30

On Scene & In-hospital

Mortality

There were 2,078 runs

with an EMS discharge

disposition of dead at

scene.

There were 7,975 EMS

patients who died in the

hospital.

Among pediatrics (<18)

and geriatrics (65+), the

proportion of on scene

deaths was higher than the

proportion of in-hospital

deaths.

On Scene In-hospital

N % N % Total mortality 2,078 100.0% 7,975 100.0% Age (years)

277 13.3% 12 0.1% Missing <1 6 0.2% 25 0.3%

1-4 1 0.0% 16 0.2%

5-9 1 0.0% 11 0.1%

10-14 3 0.1% 14 0.1%

15-17 2 0.0% 7 0.0%

18-24 43 2.0% 61 0.7%

25-34 73 3.5% 117 1.4%

35-44 103 4.9% 196 2.4%

45-54 211 10.1% 417 5.2%

55-64 326 15.6% 921 11.5%

65-74 398 19.1% 1,612 20.2%

75-84 337 16.2% 2,145 26.8%

>85 297 14.2% 2,421 30.3% Gender

300 14.4% 183 2.2% Missing Male 1,143 55.0% 4,115 51.5% Female 635 30.5% 3,677 46.1%

Data source: AZ-PIERS 2014, Arizona Health Status and Vital Statistics 2014

Graph 16: EMS run mortality by age

0.9%

0.7%

1.4%

2.4%

5.2%

11.5%

20.2%

26.8%

30.3%

0.6%

2.0%

3.5%

4.9%

10.1%

15.6%

19.1%

16.2%

14.2%> 85

75-84

65-74

55-64

45-54

35-44

25-34

18-24

0-17In hospital deathOn scene death

Table 21: On scene and in-hospital mortality by age & gender

Graph 18: On scene and in-hospital mortality by age


31

Died In Hospital N % Altered level of consciousness 1,049 14.6%

Cardiac Arrest 1,033 14.4%

Respiratory distress 873 12.2%

Weakness 392 5.4%

Pain 389 5.4%

Traumatic injury 373 5.2%

Abdominal pain/problems 347 4.8%

Stoke/CVA 244 3.4%

Other 231 3.2% Chest pain/discomfort 230 3.2%

Provider Primary Impression/Hospital Primary Diagnosis

Mortality

Died On Scene N %

Obvious death 807 48.4%

Cardiac Arrest 592 35.5%

Traumatic injury 57 3.4%

Cardiac Arrest - Asystole 52 3.1%

Unconscious 43 2.5%

Other 27 1.6%

Altered level of consciousness 18 1.0%

Gun Shot Wound/Open Wound 12 0.7%

Respiratory arrest 6 0.3%

Syncope/fainting 4 0.2%

Table 22a: Provider primary impression

(Top 10) for on scene mortality

N % Septicemia 1,697 17.1%

Cardiac arrest 1,347 13.5%

Acute Cerebrovascular disease 698 7.0%

Adult respiratory failure 583 5.8%

Acute myocardial infarction 393 3.9%

Congestive heart failure; Non-hospitalist 341 3.4%

Pneumonia 299 3.0%

Intracranial injury 278 2.8%

Fracture hip 227 2.2% Aspiration pneumonia 215 2.1%

Table 22b: Provider primary impression

(Top 10) for in-hospital mortality

Table 23: Hospital principal diagnosis (Top 10) for in-

hospital mortality

The provider primary impression was missing for 20% on scene deaths, and 27% of in-hospital

deaths. The top three primary impressions for in-hospital deaths were Altered level of

consciousness, Cardiac Arrest and Respiratory Distress.

The top three principal diagnoses for EMS patients who died in the hospital were Septicemia, Cardiac Arrest

and Acute Cerebrovascular disease.

County Trauma Report

Bureau of EMS and Trauma System

Arizona, 2016

Attachment VI.c

Table of Contents Purpose and Methods ..................................................................................................................... 1

Table 1: Trauma center designation and distribution by county ........................................................... 1

Trauma Rates .................................................................................................................................. 2

Figure 1/ Table 2: County-specific trauma rate per 100,000 Arizona residents .................................... 2

Figure 2/ Table 3: County-specific severe trauma rate per 100,000 Arizona residents ......................... 3

Race/Ethnicity ................................................................................................................................. 4

Figure 3: County-specific trauma rate per 100,000 Arizona residents by race/ethnicity ...................... 4

Table 4: County-specific trauma rate per 100,000 Arizona residents by race/ethnicity ....................... 5

Age-specific ..................................................................................................................................... 6

Figure 4: County-specific trauma rate per 100,000 Arizona residents by age ....................................... 6

Table 5: County-specific trauma rate per 100,000 Arizona residents by age ........................................ 7

Mechanism of Injury ........................................................................................................................ 8

Figure 5: County-specific trauma rate/100,000 Arizona residents by top six mechanisms of injury .... 8

Table 6: County-specific trauma rate/100,000 Arizona residents by top six mechanisms of injury...... 9

Intent of Injury .............................................................................................................................. 10

Figure 6: County-specific trauma rate per 100,000 Arizona residents by intent of injury................... 10

Table 7: County-specific trauma rate per 100,000 Arizona residents by intent of injury .................... 11

Trauma Mortality .......................................................................................................................... 12

Figure 7/Table 8: County-specific crude trauma mortality rate per 100,000 Arizona residents ......... 12

Trauma Charges ............................................................................................................................ 13

Table 9: Hospital trauma charges by county ........................................................................................ 13

Payer Source ................................................................................................................................. 14

Figure 8: Proportion of traumatic injury by primary payer source ...................................................... 14

Table 10: Proportion of traumatic injury by primary payer source ..................................................... 15

Alcohol and Drug Use .................................................................................................................... 16

Figure 9: Alcohol related trauma proportion by county ...................................................................... 16

Figure 10: Drug related trauma proportion by county ......................................................................... 16

Table 11: Alcohol and Drug related trauma by county ........................................................................ 17

Restraint Use ................................................................................................................................. 18

Figure 11/Table 12: Seat belt use among motor vehicle occupants by county ................................... 18

Appendix A.: Map of designated trauma centers by level and county .................................................. 19

1

Purpose:

The purpose of this report is to describe traumatic injury in each of Arizona’s 15 counties using the Arizona State Trauma Registry (ASTR). The intent is to identify county-specific areas of need in order to develop and strengthen local injury prevention programs.

Methods:

In 2015, the ASTR captured 42,351 cases of traumatic injury from forty-two healthcare facilities including ten Level I trauma centers, seven Level III trauma centers, twenty-three Level IV trauma centers, and two non-designated hospitals (Appendix A.). The ASTR captures a subset of injuries that meet the trauma inclusion criteria*. For the purpose of this report trauma patients were stratified by county based on the injury location. The table below depicts the distribution of reporting healthcare facilities in each of Arizona’s 15 counties based on their level of designation:

Purpose & Methods

Table 1: Distribution of reporting healthcare facilities by designation

The county of injury was either missing or located outside of Arizona in 2.8% (n = 1,189) of trauma cases which were excluded from this analysis. Trauma rates were calculated per 100,000 Arizona residents using the 2015 population denominators from the Arizona Health Status and Vital Statistics database. Non-zero trauma counts less than 10 were suppressed along with their corresponding rates.

Limitations:

The data are limited to hospitals participating in the ASTR; therefore, information on patients treated at non-participating hospitals is not included. Additionally, Yuma Regional Medical Center submitted only a fraction of their trauma cases in 2015. Therefore their rate/proportion is underestimated and unreliable.

*http://azdhs.gov/documents/preparedness/emergency-medical-services-trauma-system/data/ASTR/astr-2015-inclusion-criteria.pdf

County Level I Level III Level IV Non-Designated Total

Apache 2 2

Cochise 1 3 4

Coconino 1 1 1 3

Gila 2 2

Graham 1 1

Greenlee 0

La Paz 1 1

Maricopa 8 4 4 1 17

Mohave 1 1 2

Navajo 2 2

Pima 1 2 3

Pinal 1 1

Santa Cruz 0

Yavapai 3 3

Yuma 1 1

Total 10 7 23 2 42

http://azdhs.gov/documents/preparedness/emergency-medical-services-trauma-system/data/ASTR/astr-2015-inclusion-criteria.pdf

2

Trauma Rate Figure 1: County-specific trauma rate per 100,000 Arizona residents

Data source: Arizona State Trauma Registry 2015

County-specific trauma rates per 100,000

125

354443

565 580

720 721

898948

1,1331,177

1,2601,347 1,352

2,037

0

500

1,000

1,500

2,000

Ra

te p

er

100,0

00

Yum

a

Santa C

ruz

Pim

a

Maricopa

Pinal

Greenlee

Mohave

Cochise

Yavapai

La Paz

Graham

Navajo

Coconino

Apache

Gila

Statew ide

By county

Injury County Total Trauma Cases Rate per 100,000 (95%CI)

Yuma 268 125 [110, 140]

Santa Cruz 178 354 [302, 406]

Pima 4,470 443 [430, 456]

Maricopa 23,037 565 [558, 572]

Pinal 2,359 580 [557, 604]

Greenlee 76 720 [558, 882]

Mohave 1,484 721 [685, 758]

Cochise 1,160 898 [847, 950]

Yavapai 2,064 948 [907, 989]

La Paz 240 1,133 [990, 1,276]

Graham 453 1,177 [1,069, 1,286]

Navajo 1,382 1,260 [1,194, 1,327]

Coconino 1,907 1,347 [1,286, 1,407]

Apache 976 1,352 [1,267, 1,436]

Gila 1,108 2,037 [1,917, 2,156]

Table 2: County-specific trauma rate per 100,000 Arizona residents

CI= Confidence interval

County-specific trauma rates were calculated based on the county of injury. In 2015, the rate of traumatic

injury in Arizona was 627 per 100,000 Arizona residents. Urban counties like Maricopa, Pima and Pinal had

lower trauma rates than most of the rural counties.

3

Severe Trauma Rate Figure 2: County-specific severe trauma rate per 100,000 Arizona residents


County-specific severe trauma (ISS>15) rates per 100,000

3943 44

5257

6265

7176

8084

121

136142

193

0

50

100

150

200

Ra

te p

er

100,0

00

Yum

a

Mohave

Santa C

ruz

Graham

Pim

a

Pinal

Maricopa

Cochise

Greenlee

La Paz

Yavapai

Coconino

Apache

Navajo

Gila

Statew ide

By county

Injury County Total Trauma Cases with ISS>15 Rate per 100,000 (95%CI)

Yuma 83 39 [30, 47]

Mohave 88 43 [34, 52]

Santa Cruz 22 44 [25, 62]

Graham 20 52 [29, 75]

Pima 577 57 [52, 62]

Pinal 251 62 [54, 69]

Maricopa 2,664 65 [63, 68]

Cochise 92 71 [57, 86]

Greenlee 8 76 [23, 128]

La Paz 17 80 [42, 118]

Yavapai 184 84 [72, 97]

Coconino 171 121 [103, 139]

Apache 98 136 [109, 163]

Navajo 156 142 [120, 165]

Gila 105 193 [156, 230]

Statewide 4,634 69 [67, 71]

The severe trauma rate was calculated in order to remove patients with minor injuries who may have been

transported to a trauma center for convenience. Severe trauma patients are defined as having an Injury Severity

Score (ISS) greater then 15.

Table 3: County-specific severe trauma rate per 100,000 Arizona residents

4

Data source: Arizona State Trauma Registry 2015 Trauma rates were not calculated when trauma volume was <10

Race/ethnicity specific trauma rates per 100,000 by injury county

StatewideWhiteHispanicBlack/AAAsian/PIAI/AN

Rate

pe

r 100,0

00

YumaYavapaiSanta CruzPinalPima

NavajoMohaveMaricopaLa PazGreenlee

GrahamGilaCoconinoCochiseApache

0

1000

2000

3000

4000

0

1000

2000

3000

4000

0

1000

2000

3000

4000

Figure 3: County-specific trauma rate per 100,000 Arizona residents by race/ethnicity

Race/Ethnicity

5

Injury county AI/AN Asian/PI Black/AA Hispanic White

N Rate N Rate N Rate N Rate N Rate

Apache 442 844 U U U U 48 1,046 449 3,197

Cochise U U U U 19 324 345 773 754 1,017

Coconino 912 2,434 44 1,578 25 987 127 646 755 954

Gila 334 3,881 U U 13 2,766 58 568 688 1,985

Graham 70 1,399 U U U U 119 962 247 1,236

Greenlee U U U U U U 20 407 49 957

La Paz 23 896 U U U U 37 679 169 1,327

Maricopa 710 967 328 187 1,407 620 4,447 360 15,501 655

Mohave 49 1,051 14 460 27 905 78 240 1,299 799

Navajo 699 1,453 U U U U 67 549 576 1,228

Pima 281 1,055 57 177 199 513 1,413 388 2,427 443

Pinal 296 1,454 20 220 71 365 335 282 1,601 671

Santa Cruz U U U U U U 109 262 59 741

Yavapai 48 1,306 29 1,149 32 1,440 173 559 1,739 975

Yuma U U U U U U 106 80 135 187

Statewide 3,976 1,385 533 228 1,866 606 7,857 380 27,093 702

U: Trauma rates are unstable and not calculated when trauma volume is <10 cases

Table 4: County-specific trauma rate per 100,000 Arizona residents by race/ethnicity

The distribution of race/ethnicity-specific trauma rates varied by county. Statewide, American Indian/Alaska

Natives had the highest rate of traumatic injury followed by White people and Black/African Americans.

6

Figure 4: County-specific trauma rate per 100,000 Arizona residents by age


Age specific trauma rates per 100,000 by injury county

Statewide65+45-6425-4415-24<15

Rate

pe

r 100,0

00




0

1000

2000

3000

4000

0

1000

2000

3000

4000

0

1000

2000

3000

4000

Age-Specific

7

Injury county <15 15-24 25-44 45-64 65+

N Rate N Rate N Rate N Rate N Rate

Apache 128 730 86 779 317 1,942 211 1,198 234 2,408

Cochise 89 293 69 625 299 881 285 21 418 10

Coconino 201 778 167 507 810 2,363 429 1,306 300 1,913

Gila 84 903 73 1,278 386 3,990 269 1,767 296 2,043

Graham 83 909 62 1,029 215 2,053 64 789 29 613

Greenlee U U 16 1,072 27 946 18 700 U U

La Paz 17 551 12 615 74 2,217 57 1,102 80 1,047

Maricopa 2,640 310 1,536 272 7,562 675 4,536 464 6,763 1,198

Mohave 95 302 115 550 423 1,068 269 461 582 1,051

Navajo 144 566 127 818 586 2,421 283 1,041 242 1,398

Pima 437 238 362 226 1,810 757 1,085 439 776 433

Pinal 207 249 166 344 721 665 491 525 774 1,056

Santa Cruz 15 128 20 270 65 606 40 320 38 479

Yavapai 232 754 162 736 567 1,449 505 782 598 976

Yuma 46 98 24 69 73 141 44 99 81 217

Statewide 4,747 350 3,123 329 14,272 820 8,788 536 11,421 1,062

Table 5: County-specific trauma rate per 100,000 Arizona residents by age


Older adults 65 and above had the highest rate of traumatic injury in Arizona followed by 25-44 year olds.

8

Figure 5: County-specific trauma rate per 100,000 Arizona residents by top six mechanisms of injury


Top six mechanisms of trauma rates per 100,000 by injury county

StatewideStruck By/AgainstOther Land TransportMV TrafficFirearmFallCut/Pierce

Rate

pe

r 100,0

00




0

200

400

600

800

0

200

400

600

800

0

200

400

600

800

Mechanism of Injury

9

Injury county Cut/Pierce Fall Firearm MV Traffic Other Land Transport Struck By/Against

N Rate N Rate N Rate N Rate N Rate N Rate

Apache 46 64 409 566 22 30 208 288 84 116 116 161

Cochise 33 26 537 416 18 14 292 226 88 68 69 53

Coconino 79 56 472 333 31 22 645 456 149 105 293 207

Gila 58 107 418 768 U U 241 443 93 171 142 261

Graham 17 44 66 172 U U 186 483 75 195 43 112

Greenlee U U 13 123 U U 26 246 23 218 U U

La Paz 12 57 71 335 U U 75 354 29 137 22 104

Maricopa 971 24 9,384 230 677 17 7,496 184 1,010 25 1,598 39

Mohave 20 10 614 298 22 11 507 246 147 71 56 27

Navajo 79 72 335 305 27 25 507 462 129 118 172 157

Pima 254 25 982 97 149 15 1,723 171 339 34 421 42

Pinal 85 21 1,001 246 37 9 657 162 177 44 194 48

Santa Cruz U U 72 143 U U 43 86 16 32 20 40

Yavapai 45 21 721 331 35 16 747 343 235 108 105 48

Yuma U U 100 47 U U 85 40 23 11 17 8

Statewide 1,733 26 15,580 231 1,053 16 13,758 204 2,787 41 3,377 50

Table 6: County-specific trauma rate per 100,000 Arizona residents by injury mechanism


Statewide, falls are the leading mechanism of trauma with 231 falls per 100,000 Arizona residents, followed

by Motor Vehicle Traffic traumas. Falls and Motor Vehicle Traffic were also the top two mechanisms of

trauma in most counties.

10

Figure 6: County-specific trauma rate per 100,000 Arizona residents by intent of injury


Intent of trauma rates per 100,000 by injury county

StatewideHomicideSuicideUnintentional

Rate

pe

r 100,0

00




0

500

1000

1500

0

500

1000

1500

0

500

1000

1500

Intent of Injury

11

Table 7: County-specific trauma rate per 100,000 Arizona residents by injury intent


Injury county Homicide Suicide Unintentional

N Rate N Rate N Rate

Apache 131 181 U U 830 1,149

Cochise 41 32 22 17 1,088 843

Coconino 328 232 39 28 1,531 1,081

Gila 174 320 16 29 908 1,669

Graham 48 125 U U 396 1,029

Greenlee U U 0 0 72 682

La Paz 25 118 U U 209 987

Maricopa 1,980 49 366 9 20,437 501

Mohave 61 30 18 9 1,399 680

Navajo 260 237 20 18 1,091 995

Pima 572 57 115 11 3,755 372

Pinal 194 48 54 13 2,092 515

Santa Cruz U U U U 167 332

Yavapai 51 23 29 13 1,962 901

Yuma 19 9 U U 242 113

Statewide 3,976 59 702 10 37,260 551

In all 15 counties, the rate of Unintentional trauma was the highest followed by Homicide and Suicide.

12

Trauma Mortality

Data source: Arizona State Trauma Registry 2015 Trauma fatality rates w ere not calculated w hen fatality countw as <5

County-specific trauma fatality rates per 100,000

10 1113 13

15 16 16 17

20

46

0

10

20

30

40

Ra

te p

er

100,0

00

Graham

Greenlee

La Paz

Santa C

ruz

Yum

a

Mohave

Pinal

Pim

a

Cochise

Maricopa

Yavapai

Navajo

Apache

Coconino

Gila

Statew ide

By county

Figure 7: County-specific crude trauma mortality rate per 100,000 Arizona residents

Injury County Total Trauma Deaths Rate per 100,000 (95%CI)

Mohave 21 10 [6, 15]

Pinal 43 11 [7, 14]

Pima 127 13 [10, 15]

Cochise 17 13 [7, 19]

Maricopa 608 15 [14, 16]

Yavapai 34 16 [10, 21]

Navajo 18 16 [9, 24]

Apache 12 17 [7, 26]

Coconino 29 20 [13, 28]

Gila 25 46 [28, 64]

Graham U U

Greenlee U U

La Paz U U

Santa Cruz U U

Yuma U U

Statewide 962 14 [13, 15]

Table 8: County-specific crude trauma mortality rate per 100,000 Arizona residents

CI= Confidence interval Note: Deaths were not displayed when the count was <5 and rates were considered unstable

Statewide, the crude trauma mortality rate was 14 per 100,000 Arizona residents. The ASTR is limited to

deaths that occurred within reporting healthcare facilities; therefore, these rates only show a portion of the true

trauma mortality rate in Arizona.

13

Trauma Charges

Table 9: Hospital trauma charges by county

Trauma charges in Arizona totaled almost $1.7 billion in 2015. The median hospital charge for a trauma

patient was $22,026.

Injury county Total hospital charges Median hospital charges

Apache $23,013,865 $18,020

Cochise $28,997,164 $14,771

Coconino $51,237,060 $12,015

Gila $25,743,756 $5,165

Graham $5,002,685 $27,346

Greenlee $1,969,392 $27,944

La Paz $9,930,745 $31,173

Maricopa $1,029,553,546 $26,713

Mohave $46,757,410 $18,235

Navajo $45,202,120 $17,204

Pima $173,939,591 $19,099

Pinal $78,358,654 $18,872

Santa Cruz $7,711,991 $23,761

Yavapai $71,800,511 $14,253

Yuma $18,432,141 $32,820

Statewide $1,667,301,074 $22,026

14

Figure 8: Proportion of trauma cases by county and primary payer source

Payer Source


Trauma proportion by injury county and Payor mix

StatewideWorkers CompOtherMedicarePrivateAHCCCS/GovtSelf pay

Pe

rce

nt




0

10

20

30

40

50

0

10

20

30

40

50

0

10

20

30

40

50

15

Injury county

AHCCCS/Other

Government Medicare Other Private Self pay

Workers

Comp

N Percent N Percent N Percent N Percent N Percent N Percent

Apache 453 47.6% 206 21.6% 21 2.2% 230 24.2% 22 2.3% 18 1.8%

Cochise 321 30.9% 319 30.7% 75 7.2% 223 21.4% 73 7.0% 27 2.6%

Coconino 835 44.0% 293 15.4% 14 0.7% 598 31.5% 113 5.9% 44 2.3%

Gila 394 39.5% 263 26.3% 2 0.2% 235 23.5% 90 9.0% 13 1.3%

Graham 207 45.6% 29 6.4% 13 2.8% 149 32.8% 49 10.8% 6 1.3%

Greenlee 20 26.3% 10 13.1% 2 2.6% 29 38.1% 8 10.5% 7 9.2%

La Paz 65 27.7% 64 27.3% 5 2.1% 66 28.2% 30 12.8% 4 1.7%

Maricopa 6,795 30.2% 5,193 23.0% 250 1.1% 7,832 34.8% 1,957 8.7% 466 2.0%

Mohave 284 19.1% 444 29.9% 248 16.7% 356 24.0% 130 8.7% 21 1.4%

Navajo 732 53.0% 218 15.8% 30 2.1% 345 25.0% 36 2.6% 18 1.3%

Pima 1,614 36.1% 810 18.1% 188 4.2% 1,215 27.2% 503 11.2% 133 2.9%

Pinal 714 30.2% 749 31.7% 9 0.3% 592 25.0% 251 10.6% 44 1.8%

Santa Cruz 43 24.1% 32 17.9% 32 17.9% 39 21.9% 22 12.3% 10 5.6%

Yavapai 522 25.4% 521 25.3% 172 8.3% 627 30.5% 163 7.9% 48 2.3%

Yuma 99 36.9% 60 22.3% 2 0.7% 79 29.4% 21 7.8% 7 2.6%

Statewide 13,544 32.6% 9,387 22.6% 1,085 2.6% 13,003 31.3% 3,607 8.6% 880 2.1%

Table 10: Proportion of trauma cases by county and primary payer source

The highest proportion of trauma charges were billed to the Arizona Health Care Cost Containment System

(AHCCCS)/Other Government followed by Private insurance and Medicare.

16

Alcohol & Drug Use Figure 9: Confirmed/Suspected alcohol related trauma proportion by county


Alcohol related trauma proportion

23.9%

9.7%

29.8%

22.5%

18.5%

16.6%17.1%

12.2%11.3%

30.7%

18.8%

14.4%

7.3%

11.3%

8.2%

0.0%

10.0%

20.0%

30.0%

Pe

rce

nt

Apache

Cochise

Coconino

Gila

Graham

Greenlee

La Paz

Maricopa

Mohave

Navajo

Pim

a

Pinal

Santa C

ruz

Yavapai

Yum

a

Statew ide

By county

Figure 10: Confirmed/suspected drug related trauma proportion by county


Drug related trauma proportion

12.6%

10.2%

8.6%

15.4%

12.6%12.1%12.5%13.4%

6.9%

16.3%17.4%

13.9%

8.4% 8.5%

10.4%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Pe

rce

nt

Apache

Cochise

Coconino

Gila

Graham

Greenlee

La Paz

Maricopa

Mohave

Navajo

Pim

a

Pinal

Santa C

ruz

Yavapai

Yum

a

Statew ide

By county

17

Table 11: Proportion of confirmed/suspected drug and alcohol use by county

Suspected/Confirmed

Alcohol Use

Suspected/Confirmed

Drug Use

Injury county Total trauma N % N %

Apache 976 225 23.9% 119 12.6%

Cochise 1,160 109 9.7% 115 10.2%

Coconino 1,907 567 29.8% 165 8.6%

Gila 1,108 222 22.5% 152 15.4%

Graham 453 67 18.5% 46 12.6%

Greenlee 76 11 16.6% 8 12.1%

La Paz 240 41 17.1% 30 12.5%

Maricopa 23,037 2,809 12.2% 3,102 13.4%

Mohave 1,484 168 11.3% 103 6.9%

Navajo 1,382 414 30.7% 221 16.3%

Pima 4,470 817 18.8% 755 17.4%

Pinal 2,359 339 14.4% 327 13.9%

Santa Cruz 178 13 7.3% 15 8.4%

Yavapai 2,064 234 11.3% 177 8.5%

Yuma 268 22 8.2% 28 10.4%

Statewide 42,351 6,107 14.8% 5,419 13.1%

Statewide, 14.8% of traumas involved the suspected or confirmed use of Alcohol and 13.1% of trauma

involved the suspected or confirmed use of drugs.

Navajo county had the highest proportion of alcohol related trauma and Pima county had the highest

proportion of drug related trauma.

18

Restraint Use

Car restraint use

Injury county Total MV traffic occupants N %

Santa Cruz 30 15 50.0%

Graham 134 70 52.2%

Apache 171 95 55.5%

Gila 179 103 57.5%

Greenlee 19 11 57.8%

Navajo 420 264 62.8%

Yuma 56 36 64.2%

Pinal 477 319 66.8%

Coconino 552 384 69.5%

Cochise 230 163 70.8%

Maricopa 5,001 3,598 71.9%

Pima 1,158 859 74.1%

La Paz 60 45 75.0%

Mohave 396 313 79.0%

Yavapai 567 449 79.1%

Statewide 9,533 6,760 70.9%

Table 12: Seat belt use among motor vehicle occupants by county

Statewide, 70.9% of trauma patients were wearing some form of safety restraint (lap belt, shoulder belt or car

seat) when involved in a motor vehicle traffic accident.

Figure 11: Safety restraint use among motor vehicle occupants by county


Seat belt use among MV occupants involved in MV traffic accidents

50.0

%

52.2

%

55.5

%

57.5

%

57.8

%

62.8

%

64.2

%

66.8

%

69.5

%

70.8

%

71.9

%

74.1

%

75.0

%

79.0

%

79.1

%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Pe

rce

nt

Santa C

ruz

Graham

Apache

Gila

Greenlee

Navajo

Yum

a

Pinal

Coconino

Cochise

Maricopa

Pim

a

La Paz

Mohave

Yavapai

Statew ide

By county

19

Appendix A.

This Report is Provided

as Required by A.R.S. § 36-2222(E)(4) This Report is Provided as Required by

A.R.S. § 36-2222(E)(4)

Cara M. Christ, MD, Director

Terry Mullins, MBA, MPH, Bureau Chief

Bentley J. Bobrow, MD, Medical Director

State Trauma Advisory Board

2016 Annual Report

Agenda Item #VI. d .

State Trauma Advisory Board Membership .............................................................................. i.

Trauma and EMS Performance Improvement Standing Committee Membership .............. ii.

Annual Report to the Director .................................................................................................iii-v

List of Arizona State Designated Trauma Centers ..............................................................vi-vii

Map of Designated Trauma Centers ........................................................................................ viii

2016 Arizona State Trauma Registry Annual Report .......................................................... 1-33

Appendix A: Arizona State Trauma Registry Participating Hospitals ............................. 34-35

Appendix B: Arizona State Trauma Registry Inclusion Criteria ...................................... 36-37

Table of Contents

i


Listed below are the dedicated professionals and citizens who serve the State of Arizona as members of the State Trauma

Advisory Board and the Trauma and EMS Performance Improvement Standing Committee by giving their time,

expertise, and invaluable guidance to the Arizona trauma system. On behalf of the Arizona Department of Health

Services and the citizens of Arizona, we thank them for their many contributions.

Bentley J. Bobrow, MD, Chairman Medical Director Bureau of EMS and Trauma System - Phoenix, AZ

Debbie Johnston, Vice President, Policy Development

Statewide Hospital Association Representative Arizona Hospital and Healthcare Association - Phoenix, AZ

Bill Ashland, RN Regional EMS Council - Northern Region Representative Flagstaff Medical Center - Flagstaff, AZ

Jennefer Kieran, MD, FACS Federal Indian Health Services Organization Representative Phoenix Indian Medical Center - Phoenix, AZ

Laura Baker, Assistant Chief Fire Department - County with a Population of Five Hundred Thousand Persons or More - Representative

City of Tucson Fire Department - Tucson, AZ

Daniel Millon Department of Public Safety Representative Department of Public Safety - Phoenix, AZ

Judy Baum, PT, MSHA Statewide Rehabilitation Facility Representative Mountain Valley Regional Rehabilitation Hospital Prescott Valley, AZ

David Notrica, MD, FACS, FAAP Statewide Pediatric Organization Representative Phoenix Children’s Hospital - Phoenix, AZ

Vicki Bennett, MSN, RN Society of Trauma Nurses Representative Banner University Medical Center - Phoenix, AZ

Scott Petersen, MD, Vice Chair American College of Surgeons Representative St. Joseph’s Hospital and Medical Center - Phoenix, AZ

Herman Butler Tribal Health Organization Representative Tuba City EMS Field Office - Tuba City, AZ

Rodney A. Reed, NREMT-P

Regional EMS Council - Western Region Representative Executive Director of WACEMS - Yuma, AZ

Franco Castro-Marin, MD National Organization of Emergency Physicians Representative Scottsdale Emergency Associates - Scottsdale, AZ

Roy Ryals, CEP Regional EMS Council – Central Region Representative

Southwest Ambulance - Mesa, AZ

Bill Daniell Statewide Ambulance Association Representative Mesa Fire and Medical Department- Mesa, AZ

Chris Salvino, MD, MS, FACS Trauma Center Representative - Havasu Regional Medical

Center - Lake Havasu City, AZ

Jeff Farkas, NREMT-P Statewide Fire District Association Representative Timber Mesa Fire and Medical District - Show Low, AZ

Jeffrey Schaff, RN, CEN Regional EMS Council - Southeastern Region Representative Banner University Medical Center - Tucson, AZ

Iman Feiz-Erfan, MD Statewide Neurosurgical Society Representative Maricopa Medical Center - Phoenix, AZ

Jordan Smith, MD National Association of Orthopaedic Trauma Representative University of Arizona - Tucson, AZ

Garth Gemar, MD National Association of Retired Persons Representative Rural/Metro-Southwest Ambulance, Glendale Fire Dept., Surprise Fire Dept. and Banner Healthcare, AZ

Andrew Tang, MD, FACS Trauma Center Representative Banner University Medical Center - Tucson, AZ

Philip Johnson, MD Rural ALS Base Hospital not a Trauma Center Representative Summit Healthcare Regional Medical Center - Show Low, AZ

Laurie Wood, RN Urban Advanced Life Support Base Hospital not a Trauma

Center Representative Banner Thunderbird Medical Center - Glendale, AZ

ii

Trauma and EMS Performance Improvement Standing Committee Membership

Chris Salvino, MD, MS, FACS Chair Havasu Regional Medical Center - Lake Havasu City, AZ

Ralph Zane Kelly, DO State Designated Level III Trauma Center Program Manager Tuba City Regional Health Care Corporation - Tuba City,

AZ

Bill Ashland, RN Vice Chair/State Designated Level I Trauma Center Trauma

Program Manager


Summer Magoteaux, RN Pediatric Representative (MD or RN) Maricopa Medical Center - Phoenix, AZ

Brian Bowling, BS, FP-C Air Ambulance Premier EMS Agency—

Quality Improvement Officer

Native Air Ambulance - Tempe, AZ 85282

Jill McAdoo, RN Ground Ambulance or First Responder Premier EMS Agency

– Quality Improvement Officer (NAEMS/WACEMS), Life

Line Ambulance Service, Prescott AZ

Gail Bradley, MD Medical Direction Commission Liaison Peoria, Sun City, and Goodyear Fire Departments - EMS

Medical Director

Mary McDonald, RN, BSN Prehospital EMS Manager – (SAEMS/AEMS)

Tucson Fire Department - Tucson, AZ

Robert Corbell, EMT-P EMS Registry Group Member Northwest Fire District Tucson, AZ

Eric Merrill, EMT-P Ground Ambulance or First Responder Premier EMS

Agency, Quality Improvement Officer (SAEMS/AEMS) Rio Verde Fire Department-Rio Verde, AZ

Paul Dabrowski, MD Trauma Surgeon

Banner University Medical Center-Phoenix, AZ

Heather Miller Western Arizona Council of Emergency Services Kingman Regional Medical Center-Kingman, AZ

Robert Djergaian, MD Rehabilitation Specialist Banner University Medical Center -Phoenix, AZ

Melissa Moyer, CSTR Representative of the Trauma Registry Users Group John C. Lincoln North Mountain Hospital Phoenix, AZ

Josh Gaither, MD EMS Researcher (AEMRC) Banner University Medical Center Base Hospital-Tucson,

AZ

Pam Noland, RN State Designated Level IV Trauma Center Program Manager Northern Cochise Community Hospital Willcox, AZ

Garth Gemar, MD EMS Medical Director of a Premier EMS Agency Rural/Metro-Southwest Ambulance, Glendale Fire Dept.,

Surprise Fire Dept. and Banner Healthcare - Phoenix, AZ

Jeffrey Schaff, RN, CEN ACS Verified Level I Trauma Program Manager Banner University Medical Center - Tucson, AZ

Pamela Goslar, PhD IPAC Representative St. Joseph’s Hospital & Medical Center Phoenix, AZ

Danielle Stello, RN Prehospital EMS Coordinator - Base Hospital (NAEMS/

WACEMS) Havasu Regional Medical Center, Lake Havasu City, AZ

Michelle Guadnola, RN State Designated Level I Trauma Center Trauma Program

Representative St. Joseph’s Hospital & Medical Center - Phoenix, AZ

Tiffiny Strever, RN State Designated Level I Trauma Center – Trauma Program

Representative - West Valley Hospital – Goodyear, AZ

Rebecca Haro, NREMT-P EMS Council Liaison Sun City West Fire District - Phoenix, AZ

Dale Woolridge, MD Injury Researcher University of Arizona Department of Emergency Medicine Tucson, AZ

Darlene Herlinger, RN, MSN Prehospital EMS Coordinator (SAEMS/AEMS) Banner University Medical Center-South Campus Tucson, AZ

iii

Introduction & Highlights

Trauma remains a significant public health problem in Arizona, the details of which are

included in this report. In 2015, Arizona’s trauma centers treated 43,351 people, including 22,142

(52%) under the age of 45 and 4,747 (11%) under the age of 15.

Arizona’s proportion of mortality is at or below the national average on four of the six leading

mechanisms of injury measurements. This is a testament to the quality of Arizona’s trauma system.

Even so, 965 (2.27%) people died from their injuries in 2015. including 393 deaths for people under

the age of 45 years, and 28 deaths under the age of 15 years.

Overall, the top six causes of traumatic injuries in Arizona are; Falls (37%), Motor Vehicle

Traffic related injury (33%), Struck By/Against (8%), Other Land Transport (7%), Cut/Pierce (4%),

and Firearm (3%).While vehicle restraint use has been found to save lives, it was least practiced among

people aged 5 to 44 years.

Arizona’s Native American population suffers disproportionally from injury compared to all

other race and ethnicities; 3,976 were treated at Arizona’s trauma centers (1,385 per 100,000).

Because an unknown number of Native Americans received trauma care in neighboring states, this

number is likely an underestimate of the injury rate.

Trauma also exacts an enormous financial burden on the state. Trauma center charges in 2015

were $1.6 B., and the median charge to care for a trauma patient was $22,026. The average

reimbursement rate for trauma care in Arizona was 16.4% for this reporting period.

Drug and alcohol use continue to be prevalent and are both strongly correlated with injury.

Among young adults aged 18 to 24, 23% and 22% were found to be under the influence of drugs and

alcohol, respectively. Among teens aged 15 to 17, 13% and 6% were found to be under the influence

of drugs and alcohol, respectively.

Annual Report to the Director

iv

State Trauma System Development

Trauma Center Growth: Two new Level III Trauma Centers received provisional designation in

2015. Canyon Vista Medical Center in Sierra Vista was designated in May and Havasu Regional

Medical Center in Lake Havasu City was designated in November. As of September 13, 2016, there

are ten Level I Trauma Centers, seven Level III Trauma Centers, and twenty-two level IV Trauma

Centers in Arizona.

Revised Resources for the Optimal Care of the Injured Patient: Trauma Centers that chose to be

designated via a verification assessment by the American College of Surgeons must meet criteria

outlined in the American College of Surgeon’s, “Resources for the Optimal Care of the Injured

Patient.” A long-anticipated revision of this document was released in 2014, and many of Arizona’s

Trauma Centers have been working hard to prepare for these new standards.

Rule Updates: In late 2015, the Department of Health Services received approval from the

Governor’s office to move forward with a limited update to the trauma system rules. An invitation to

participate in the rule making process was distributed to Arizona’s trauma stakeholder community on

September 12, 2016. The Office of Administrative Council has set a target of October 2017 to

complete the process.

Public Health Reports

Arizona Injury and Trauma Mortality Report: This report highlights a 29% reduction in the

trauma mortality rate between the years 2006 and 2014 and a 16% decrease in the injury mortality

rate over the same period. This positive change may be “due to improvements in clinical care,

engineering of safer roads and cars, injury prevention initiatives, and the expansion of trauma centers

into rural Arizona.”

http://azdhs.gov/documents/preparedness/emergency-medical-services-trauma-system/data/quality-assurance/special/trauma-mortality-report.pdf

v

Looking Forward

Technical Assistance: Bureau of EMS and Trauma System staff prioritize technical assistance to rural

trauma centers. Because a significant number of rural hospitals are now Level IV Trauma Centers,

Bureau staff now focuses on supporting key regional hospitals that have expressed interest in Level III

Trauma Center designation.

Three of four rural regions now have rural Level III Trauma Centers - Tuba City Regional Health

Care Corporation in the north, Havasu Regional Medical Center in the west, and Canyon Vista Medical

Center in the south. The Bureau is optimistic that one or two more facilities that are rural will join the

Level III ranks.

Conclusion: In the past 8 years, Arizona has seen a dramatic decline in its injury and trauma death rate.

While we still lag behind the nation, our progress suggests that our efforts are paying dividends. These

past years, our focus has not been on individual Trauma Centers. Instead, the focus has been placed on

the trauma system as a whole, working collaboratively with other trauma stakeholders to assure that

injured Arizonans, and visitors to our state, received optimal, timely care.

Our system growth has been extraordinary, and our current rules are inadequate for a system of

this size. Over the next year, we have the opportunity to create a regulatory framework that will support

our continued efforts to further reduce the burden of injury in Arizona.

On behalf of the State Trauma Advisory Board, September 15, 2016

_______________________ _______________________ Bentley J. Bobrow, Chair Terry Mullins Bureau Medical Director Bureau Chief

vi

Arizona State Designated Trauma Centers

Health Care Institution Address Effective

Date

Expiration Date

Level I Trauma Centers

Abrazo West Campus 13677 W. McDowell Road, Goodyear, AZ 85395 10/1/15 6/30/18

Banner - University Medical Center Phoenix 925 E. McDowell Rd., Phoenix, AZ 85006 11/19/14 11/18/17

Banner University Medical Center – Tucson

Campus 1501 N. Campbell Ave., Tucson, AZ 85724 11/11/15 11/11/17

Dignity Health, dba Chandler Regional

Medical Center 1955 W. Frye Rd., Chandler, AZ 85224 10/1/15 07/1/18

Flagstaff Medical Center 1200 N. Beaver St., Flagstaff, AZ 86001 05/27/14 05/27/17

HonorHealth John C. Lincoln Medical Center 250 E. Dunlap Ave., Phoenix, AZ 85020 04/24/14 04/24/17

HonorHealth Scottsdale Osborn Medical

Center 7400 E. Osborn, Scottsdale, AZ 85251 10/25/14 10/25/17

Maricopa Medical Center 2601 E. Roosevelt, Phoenix, AZ 85008 12/20/15 12/19/17

Phoenix Children’s Hospital 1919 E. Thomas Rd., Phoenix, AZ 85016 08/31/16 08/31/18

St. Joseph’s Hospital & Medical Center 350 W. Thomas Rd., Phoenix, AZ 85013 11/20/13 11/20/16

Level III Trauma Centers

Banner Baywood Medical Center 6644 E. Baywood Ave., Mesa, AZ 85206 02/25/15 02/25/17

Banner Del E. Webb Medical Center (Provisional Designation)

14502 W. Meeker Blvd, Sun City West, AZ 85375 02/01/16 08/01/17

Canyon Vista Medical Center (Provisional Designation)

5700 E. Highway 90, Sierra Vista, AZ 85635 05/1/15 11/1/16

Havasu Regional Medical Center (Provisional Designation)

101 Civic Center Ln., Lake Havasu City, AZ 86403 11/11/15 5/11/17

HonorHealth Deer Valley Medical Center 19829 N. 27th Ave., Phoenix, AZ 85027 06/09/14 4/08/17

Mountain Vista Medical Center 1301 S. Crismon Rd., Mesa, AZ 85209 7/23/14 7/26/16

Tuba City Regional Health Care Corp. P.O. Box 600, 167 Main St., Tuba City, AZ 86045 4/07/15 12/10/17

Level IV Trauma Centers

Banner Boswell Medical Center 10401 W. Thunderbird Blvd., Sun City, AZ 85351 12/17/15 12/17/18

Banner Estrella Medical Center 9201 W. Thomas Road, Phoenix, AZ 85037 08/30/15 08/30/18

Banner Gateway Medical Center 1900 N. Higley Road, Gilbert, AZ 85234 01/02/16 01/02/19

Banner Ironwood Medical Center 37000 N. Gantzel Rd., San Tan Valley, AZ 85140 10/11/15 10/11/18

Banner Page Hospital 501 N. Navajo, Page, AZ 86040 11/05/14 11/05/17

Banner Payson Medical Center 807 S. Ponderosa Street, Payson, AZ 85541 11/22/13 11/22/16

Banner University Medical Center – South Campus

2800 E. Ajo Way, Tucson, AZ 85713 08/13/13 08/13/16

vii

Health Care Institution Address Effective

Date

Expiration Date

Level IV Trauma Centers

Chinle Comprehensive Health Care Facility P.O. Drawer PH, Chinle, AZ 86503 09/09/13 09/09/16

Cobre Valley Regional Medical Center 5880 S. Hospital Dr., Globe, AZ 85501 11/26/15 11/26/18

Copper Queen Community Hospital 101 Cole Ave., Bisbee, AZ 85603 12/01/15 12/01/18

Kingman Regional Medical Center 3269 Stockton Hill Rd., Kingman, AZ 86409 10/15/15 10/15/18

La Paz Regional Hospital 1200 W. Mohave Rd., Parker, AZ 85344 06/02/15 06/02/18

Little Colorado Medical Center 1501 N. Williamson Blvd, Winslow, AZ 86047 6/22/15 6/22/18

Mt. Graham Regional Medical Center 1600 S. 20th Ave., Safford, AZ 85546 03/20/14 03/20/17

Northern Cochise Community Hospital 901 W. Rex Allen Dr., Willcox, AZ 85643 12/04/14 12/04/17

Oro Valley Hospital 1551 East Tangerine Road, Oro Valley, AZ 85755 4/18/16 4/18/19

Summit Healthcare Regional Medical Center 2200 Show Low Lake Rd., Show Low, AZ 85901 08/12/14 08/12/17

Verde Valley Medical Center 269 S. Candy Ln., Cottonwood, AZ 86326 08/18/14 08/18/17

White Mountain Regional Medical Center 118 S. Mountain Ave., Springerville, AZ 85938 06/18/15 06/18/18

Wickenburg Community Hospital 520 Rose Ln., Wickenburg, AZ 85390 08/08/14 08/08/17

Yavapai Regional Medical Center – West Campus

1003 Willow Creek Road, Prescott, AZ 86301 01/10/14 01/10/17

Yavapai Regional Medical Center – East

Campus 7700 E. Florentine, Prescott Valley, AZ 86314 6/24/14 6/24/17

Arizona Department of Health Services


Prepared by:

Vatsal Chikani, MPH, BHMS, Bureau Statistician

Robyn Blust, MPH, Bureau Epidemiologist

Mary Benkert, Trauma Registry Manager

Paula Brazil, MA, SHARE Program Coordinator

Terry Mullins, MBA, EMS & Trauma System Bureau Chief

Bentley Bobrow, MD, EMS & Trauma System Medical Director


2016 Annual Report

The Arizona Department of Health Services’ Bureau of Emergency Medical Services and Trauma

System (BEMSTS) wishes to acknowledge the continued hard work and dedication of all the

individuals involved in working to understand, prevent, and treat traumatic injury.

Special thanks are extended to the members of the State Trauma Advisory Board, Trauma and

EMS Performance Improvement Committee, participating trauma centers, medical directors,

program managers, and registrars. Their dedication to continuously improving data collection

makes it possible to fully evaluate and advance Arizona’s trauma system.

Acknowledgements

Purpose and Methods .............................................................................................................................. 1

Table 1: Trauma center designation and distribution by region ............................................................. 1

Trauma Patient Demographics ............................................................................................................... 3

Figure 1/ Table 2: Trauma rate per 100,000 Arizona residents by year ................................................. 3

Figure 2/ Table 3: Gender and age-specific trauma rate per 100,000 Arizona residents ........................ 4

Figure 3/ Table 4: Race-specific trauma rate per 100,000 Arizona residents ......................................... 5

Injury Characteristics: Mechanism of Injury ....................................................................................... 6

Table 5: Mechanism-specific trauma and mortality proportion ............................................................. 6

Figure 4: Gender-specific trauma proportion by top six mechanisms .................................................... 6

Figure 5/ Table 6: Trauma rate per 100,000 Arizona residents by top six mechanisms and year .......... 7

Injury Characteristics: Intent of Injury ................................................................................................ 8

Table 7: Intent-specific trauma and mortality proportion ....................................................................... 8

Figure 6: Gender-specific trauma proportion by intent .......................................................................... 8

Figure 7/ Table 8: Trauma rate per 100,000 Arizona residents by intent and year ................................ 9

Figure 8: Top six mechanisms of unintentional trauma........................................................................ 10

Figure 9: Top six mechanisms of homicide/assault trauma injury ....................................................... 10

Figure 10: Top six mechanisms of suicide/self-inflicted trauma .......................................................... 10

Injury Characteristics: Injury Severity Score .................................................................................... 11

Figure 11: Trauma proportion by Injury Severity Score ...................................................................... 11

Table 9: Trauma and mortality proportion by Injury Severity Score ................................................... 11

Trauma Mortality .................................................................................................................................. 12

Table 10: Age-specific trauma and mortality proportion ..................................................................... 12

Figure 12/ Table 11: Age-specific trauma mortality rate per 100,000 Arizona residents .................... 13

Figure 13/ Table 12: Gender-specific trauma mortality rate per 100,000 Arizona residents ............... 14

Figure 14/ Table 13: Race-specific trauma mortality rate per 100,000 Arizona residents ................... 14

Figure 15/ Table 14: Age-adjusted trauma mortality rate per 100,000 Arizona residents by year:

Trauma center deaths vs. Statewide trauma deaths ............................................................................. 15

List of Tables and Figures

Trauma Charges .................................................................................................................................... 16

Figure 16: Trauma proportion by primary payment source by year ..................................................... 16

Table 15: Trauma charges and reimbursement by primary payment source ........................................ 16

Table 16: Trauma charges and reimbursement by year ........................................................................ 17

Table 17: Trauma charges and reimbursement by mechanism of injury .............................................. 17

Trauma Risk Factors: Drugs & Alcohol .............................................................................................. 18

Figure 17: Age-specific trauma proportion by drug and alcohol use ................................................... 18

Figure 18: Race-specific trauma proportion by drug and alcohol use .................................................. 18

Figure 19: Intent-specific trauma proportion by drug and alcohol use ................................................. 19

Figure 20: Mechanism-specific trauma proportion by drug and alcohol use ....................................... 19

Trauma Risk Factors: Safety Equipment ............................................................................................ 20

Figure 21: Age-specific proportion of restraint use among motor vehicle traffic occupants ............... 20

Figure 22: Age-specific proportion of helmet use among pedal-cyclists ............................................. 20

Figure 23: Age-specific proportion of helmet use among motorcyclists .............................................. 21

Figure 24: Age-specific proportion of helmet use among off-road vehicle occupants ......................... 21

Access to Trauma Care ......................................................................................................................... 22

Table 18: Injury to ED arrival time for Injury Severity Score > 15: Urban vs. Rural .......................... 22

Table 19: Injury to ED arrival time for inter-facility transfers with an Injury Severity Score > 15:

Urban vs. Rural ..................................................................................................................................... 22

Figure 25: Mode of transport to trauma center by Injury Severity Score ............................................. 22

Region-Specific Trauma ........................................................................................................................ 23

Figure 26/ Table 20: Region-specific trauma rate per 100,000 Arizona residents ............................... 23

Figure 27/ Table 21: Region-specific trauma mortality rate per 100,000 Arizona residents ............... 24

Figure 28: Region-specific trauma proportion by Injury Severity Score ............................................. 24

Figure 29/ Table 22: Region-specific trauma rate per 100,000 Arizona residents by top six

mechanisms ........................................................................................................................................... 25

Figure 30/ Table 23: Region-specific trauma rate per 100,000 Arizona residents by intent ................ 26

Trauma Center Designation .................................................................................................................. 27

Table 24: Trauma and mortality proportion by trauma center designation .......................................... 27

Table 25: Trauma charges and reimbursement by trauma center designation ...................................... 27

Figure 31: Injury Severity Score by trauma center designation ........................................................... 27

Arizona vs. National ............................................................................................................................... 28

Figure 32: Trauma proportion by top six mechanism: Arizona vs. National ....................................... 28

Figure 33: Trauma mortality proportion by top six mechanism: Arizona vs. National ........................ 28

Figure 34: Trauma proportion by intent: Arizona vs. National ............................................................ 29

Figure 35: Trauma mortality proportion by intent: Arizona vs. National ............................................. 29

Figure 36: Trauma proportion by Injury Severity Score: Arizona vs. National ................................... 30

Figure 37: Trauma mortality proportion by Injury Severity Score: Arizona vs. National ................... 30

Traumatic Brain Injury ........................................................................................................................ 31

Table 26: Age-specific Traumatic Brain Injury and mortality proportion ........................................... 31

Figure 38: Proportion of Traumatic Brain Injury by mechanism ......................................................... 32

Table 27: Age-specific Traumatic Brain Injury and mortality proportion by Glasgow Coma Score ... 32

Discharge to Rehab ................................................................................................................................ 33

Table 28: Discharge to rehab by Injury Severity Score and primary payment source ......................... 33

Table 29: Discharge to rehab proportion by region .............................................................................. 33

1

Purpose:

The purpose of this report is to describe Arizona’s trauma system through the Arizona State Trauma

Registry (ASTR). The ASTR is dedicated to capturing information on severely injured patients in Arizona and

collects data from all state designated trauma centers, as well as participating non-designated hospitals.

Methods:

In 2015, the ASTR captured 42,351 cases of traumatic injury from forty-two (42) participating

healthcare facilities including ten (10) Level I trauma centers, seven (7) Level III trauma centers, twenty-three

(23) Level IV trauma centers, and two (2) non-designated hospitals.

All Level I trauma centers in Arizona are located in urban areas of the state, including eight in

Maricopa County, one in Coconino County and one in Pima County. Level III and Level IV trauma centers

are located primarily in rural areas of the state.

Arizona’s Trauma System is divided into four distinct regions based on Arizona’s 15 counties:

Western (Mohave, La Paz and Yuma Counties), Northern (Yavapai, Coconino, Navajo and Apache Counties),

Southeastern (Pima, Santa Cruz, Graham, Cochise and Greenlee Counties) and Central (Maricopa, Gila and

Pinal Counties). The table below depicts the distribution of trauma centers by region:

1 http://www.facs.org/trauma/ntdb/pdf/ntdb-annual-report-2012.pdf

Injury Region Level I Level III Level IV Non-Designated Total

Western 0 1 4 1 5

Northern 1 1 7 0 9

Southeastern 1 1 5 0 8

Central 8 3 8 1 20

Statewide 10 6 24 2 42

Table 1: Trauma center designation and distribution by region

Level I and III trauma centers are required to submit the full ASTR data set while Level IV trauma

centers and non-designated facilities have the option to submit either the full or reduced data set. The ASTR

contains a validation tool that checks more than 800 state and national rules. Validation is run at the hospital

and at the state level. Inconsistencies are flagged and returned to hospitals for review or correction. In addition

to this check, a statewide Inter Rater Reliability assessment is performed each year.

This report analyzed cases for patients with an Emergency Department/Hospital Arrival Date between

January 1, 2015, and December 31, 2015. Population denominators were derived from the Arizona Health

Status and Vital Statistics database and death records were derived from the Vital Statistics Information

Management System – Electronic Death Registry System (EDR). When comparing to national trauma data, the

ASTR was restricted by admission, transfer, and outcome status in order to match the inclusion criteria of the

National Trauma Data Bank (NTDB).1 The 2015 data were compared with the 2013 and 2014 two-year median

as opposed to the five-year median used in the 2014 annual report. Each year the number of designated trauma

centers in Arizona has increased. From 2013 to 2015, there was not much change in the total number of

designated trauma centers making it meaningful to compare the 2015 data with the two-year median.

Purpose and Methods

2

Group Rate per 100,000 (95% CI)

A 437 (430, 443)

B 435 (425, 444)

C 871 (841, 902)

All trauma rates were calculated per 100,000 Arizona residents using the 2015 population

denominators from the Arizona Health Status and Vital Statistics database. A 95% Confidence Interval (CI)

was calculated along with all rate estimates. CIs provide a range of values that describe the uncertainty

surrounding an estimate and may be used to assess statistical significance. When comparing trauma rates

within a table, if the range of the CIs for two rates do not overlap, the rates are considered statistically

significant (p < 0.05). If the range of the CIs do overlap, then the difference is not significant.

Example:

In the table above, there is no statistically significant difference in rate between group A and group B.

This is because the CIs for groups A and B share a range of values (430-443). There is however, a statistically

significant difference in rate between group A and group C and between group B and group C. In both cases,

the ranges of the CIs do not overlap.

Analyses were performed using SAS Version 9.4 (SAS Institute, Cary, NC).

Geo-Population:

Arizona is 400 miles long and 310 miles wide, with a total area of 114,006 square miles. Arizona’s

topography is a blend of deserts, mountains, and plateaus. Arizona’s population increased by 1.4% from 2014

to 2015, and the number of individuals living in Arizona in 2015 totaled 6,758,2512. Arizona is divided into

15 counties, the urban counties (Maricopa, Pima, Pinal, and Yuma) make-up 84.4% of the population, the

remaining counties (Apache, Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Mohave, Navajo, Santa

Cruz, and Yavapai) account for 15.6% of the population. There are twenty-two (22) federally recognized

American Indian tribes in Arizona with a total population of 287,001 in 2015.

2 http://azdhs.gov/plan/menu/info/pop/index.php

http://azdhs.gov/plan/menu/info/pop/index.php

3

Trauma Patient Demographics

In 2015, a total of 42,351 trauma cases were reported to the Arizona State Trauma Registry; Arizona’s

trauma rate was 627 per 100,000 Arizona residents.

Since 2010, the rate of traumatic injury has increased from 418 to 627 traumas per 100,000 Arizona

residents. This increase may be due in part to the maturation of Arizona’s trauma system and the

increasing number of designated trauma centers.

Year Total Trauma cases Rate per 100,000 (95%CI)

2010 26,688 418 [413, 423]

2011 28,721 446 [441, 451]

2012 31,246 481 [475, 486]

2013 34,275 521 [515, 526]

2014 39,373 591 [585, 596]

2015 42,351 627 [621, 633]

Figure 1: Trauma rate per 100,000 Arizona residents by year

Table 2: Trauma rate per 100,000 Arizona residents by year

Data source: Arizona State Trauma Registry 2010-2015

Trauma rate by year

418

446

481

521

591

627

2010 2011 2012 2013 2014 20150

200

400

600

Rate

per

100,0

00

4

In 2015, Males had significantly higher trauma rates than Females in all age categories except 65+.

Overall, the rates of traumatic injury in 2015 were higher than the two-year median with the exception

of the <15 age category.

Figure 2: Gender & age-specific trauma rate per 100,000 Arizona residents


Gender Age Total Trauma Cases Rate per 100,000 (95%CI)

Female Total 16,994 500 [492, 507]

<15 1,814 273 [260, 286]

15-19 1,137 512 [482, 542]

20-44 4,409 404 [392, 416]

45-64 3,251 386 [372, 399]

65+ 6,383 1,099 [1,072, 1,126]

Male Total 25,356 755 [746, 764]

<15 2,933 425 [409, 440]

15-19 1,986 847 [810, 884]

20-44 9,862 864 [847, 881]

45-64 5,537 695 [677, 714]

65+ 5,038 1,018 [990, 1,047]

Table 3: Gender & age-specific trauma rate per 100,000 Arizona residents

5

Figure 3: Race-specific trauma rate per 100,000 Arizona residents

The rate of traumatic injury among American Indian/Alaskan Natives was two times higher than that of

Whites. Asian/Pacific Islanders, Blacks, and Hispanics had lower trauma rates as compared to Whites.


Race-specific trauma rates per 100,000

0

250

500

750

1,000

1,250

Rat

e p

er 1

00,0

00

Asian/PI Black

Indian

American Hispanic White

Median 2013-2014

2015

CI= Confidence interval, PI=Pacific Islander

Race/ethnicity Total Trauma Cases Rate per 100,000 (95%CI)

Asian/PI 533 228 [209, 247]

Black 1,866 606 [579, 634]

American Indian 3,976 1,385 [1,342, 1,428]

Hispanic 7,857 380 [371, 388]

White 27,093 702 [693, 710]

For more information on trauma rates among Arizona American Indians please visit: http://www.azdhs.gov/bems/data/

quality-assurance-reports.php?pg=county-regional

Table 4: Race-specific trauma rate per 100,000 Arizona residents

http://www.azdhs.gov/preparedness/emergency-medical-services-trauma-system/index.php#data-quality-assurance-reports

http://www.azdhs.gov/preparedness/emergency-medical-services-trauma-system/index.php#data-quality-assurance-reports

6

In 2015, the top six mechanisms

of traumatic injury were Fall,

Motor Vehicle Traffic, Struck

by/Against, Other Transport,

Cut/Pierce and Firearm.

The overall trauma mortality

was 2.27%. The mechanisms

with the highest mortality

proportions were Suffocation

(18.6%), Firearm (16.7%), and

Drowning (16.1%).

Injury Characteristics: Mechanism of Injury

Mechanism Count Percent Deaths Mortality Proportion

Overall 42,351 100.00% 965 2.27%

Fall 15,580 36.78% 252 1.61%

MV Traffic 13,758 32.48% 373 2.71%

Struck By/Against 3,377 7.97% 19 0.56%

Other Land Transport 2,787 6.58% 33 1.18%

Cut/Pierce 1,733 4.09% 28 1.61%

Firearm 1,053 2.48% 176 16.71%

Other Pedal Cyclist 983 2.32% 5 0.50%

Other Specified 610 1.44% 7 1.14%

Not Specified 524 1.23% 28 5.34%

Natural/Environmental 449 1.06% 2 0.44%

Not Elsewhere Classifiable 308 0.72% 4 1.29%

Machinery 240 0.56% 0 0.00%

Other Pedestrian 212 0.50% 4 1.88%

Hot Object/Scald 157 0.37% 0 0.00%

Other Transport 145 0.34% 1 0.68%

Overexertion 125 0.29% 1 0.80%

Fire/Flame 119 0.28% 5 4.20%

Suffocation 118 0.27% 22 18.64%

Drowning 31 0.07% 5 16.12%

Poisoning 24 0.05% 0 0.00%

Not documented 18 0.04% 0 0.00%

Table 5: Mechanism-specific trauma and mortality proportion, ASTR 2015

Almost half of all traumas

among females were falls.

Females had higher rates of Fall

and Motor Vehicle Traffic

trauma as compared to Males,

while Males had higher rates of

Cut/Pierce, Firearm and Stuck

By/Against.

Figure 4: Gender-specific trauma proportion by top 6 mechanisms


Top mechanisms of injury incidence by gender

31.1%30.4%

10.5%7.3%

5.5%3.6%

46.1%

34.4%

5.4% 4.2%1.9% 0.6%

Cut/Pie

rce

Fall

Firearm

MV

Tra

ffic

Oth

er

Land T

ransport

Str

uck

By/A

gain

st

Cut/Pie

rce

Fall

Firearm

MV

Tra

ffic

Oth

er

Land T

ransport

Str

uck

By/A

gain

st

0.0%

10.0%

20.0%

30.0%

40.0%

Pe

rce

nt

MaleFemale

7

Figure 5: Trauma rate per 100,000 Arizona residents by top 6 mechanism of injury and year


Top mechanisms of injury rate per 100,000

Fall MV Traff ic

By/Against

Struck

Transport

Other Land Cut/Pierce Firearm0

50

100

150

200

Ra

te

201520142013

Year Mechanism of injury Total Trauma

Cases Rate per 100,000 (95%CI)

2013 Fall 10,443 159 [156, 162]

MV Traffic 12,349 188 [184, 191]

Struck By/Against 3,283 50 [48, 52]

Other Land Transport 2,087 32 [30, 33]

Cut/Pierce 1,670 25 [24, 27]

Firearm 1,022 16 [15, 16]

2014 Fall 13,541 203 [200, 207]

MV Traffic 13,169 198 [194, 201]



Cut/Pierce 1,678 25 [24, 26]

Firearm 990 15 [14, 16]

2015 Fall 15,580 231 [227, 234]

MV Traffic 13,758 204 [200, 207]



Cut/Pierce 1,733 26 [24, 27]

Firearm 1,053 16 [15, 17]

In 2015, Falls and Motor Vehicle Traffic made up 70% of traumatic injuries in Arizona. From 2013 to

2015, the rate of Fall related trauma increased from 159 to 231 per 100,000 Arizona residents and the

rate of Motor Vehicle Traffic related trauma increased from 188 to 204 per 100,000 Arizona residents.


Table 6: Trauma rate per 100,000 Arizona residents by top 6 mechanism of injury and year

8

Table 7: Intent-specific trauma and mortality proportion, ASTR 2015

In 2015, 88% of Arizona’s traumas were Unintentional, 9% were Homicide/Assault and 2% were

Suicide/Self-Inflicted.

Legal Intervention*, and Suicide/Self-Inflicted traumas had the highest mortality proportions.

Injury Characteristics: Intent of Injury

Intent Count Percent Deaths Mortality Proportion

Overall 42,351 100.00% 965 2.27%

Unintentional 37,260 87.97% 709 1.90%

Homicide/Assault 3,976 9.38% 109 2.74%

Suicide/Self-Inflicted 702 1.65% 113 16.09%

Undetermined 277 0.65% 14 5.05%

Legal Intervention 118 0.27% 20 16.94%

Not documented 18 0.04% 0 0.00%

Figure 6: Gender-specific trauma proportion by intent

The distribution of trauma, by intent, was similar between Males and Females; however, Females had a

slightly higher proportion of Unintentional traumas while Males had a higher proportion of intentional

traumas such as Homicide/Assault and Suicide/Self-Inflicted.


Intent of injury incidence by gender

83.8%

12.7%

2.0% 0.7%0.3%

94.0%

4.3%1.0% 0.4%0.1%

Unin

tentio

nal

Suic

ide

Hom

icid

e

Legal I

nte

rventio

n

Undete

rmin

ed

Unin

tentio

nal

Suic

ide

Hom

icid

e

Legal I

nte

rventio

n

Undete

rmin

ed

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Pe

rce

nt

MaleFemale

*Legal Intervention: injury to a person caused by police or other law enforcement officer while in the line of duty

9

Figure 7: Trauma rate per 100,000 Arizona residents by intent of injury and year

The rate of Unintentional trauma has increased from 446 per 100,000 in 2013, to 535 per 100,000 in

2015. The rates of Homicide, Suicide, and Legal Intervention have not changed significantly since

2013.



Ijury rate per 100,000 by intent and year

Unintentional Homicide Suicide Legal Intervention0

100

200

300

400

500

Ra

te

201520142013

Year Intent of injury Total Trauma Cases Rate per 100,000 (95%CI)

2013 Unintentional 29,319 446 [440, 451]

Homicide/Assault 3,971 60 [58, 62]

Suicide/Self-Inflicted 601 9 [8, 10]

Legal Intervention 100 2 [1, 2]

2014 Unintentional 34,384 516 [510, 521]




2015 Unintentional 36,179 535 [530, 541]




Table 8: Trauma rate per 100,000 Arizona residents by intent of injury and year

10

Figure 8: Top six mechanisms of Unintentional trauma (n=36,179)


Unintentional trauma mechanisms

41.66%

36.92%

7.38%

3.41%2.63%1.47%

Cut/Pierce Fall MV Traff ic

Cyc

Other Pedal

Transport

Other Land

By/Against

Struck0.00%

10.00%

20.00%

30.00%

40.00%

Pe

rce

nt


Homicide/assault related trauma mechanisms

51.65%

21.37%

14.36%

5.18%3.21%3.11%

Cut/Pierce Firearm

By/Against

Struck Other Spec NEC

Specif ied

Not0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

Pe

rce

nt

Figure 9: Top six mechanisms of Homicide/Assault trauma (n=3,897)

Falls and Motor Vehicle Traffic

made-up nearly 80% of all

Unintentional trauma in Arizona.

More than half of Homicide/

Assault trauma were Struck By/

Against, followed by Cut/Pierce

and Firearm.

Figure 10: Top six mechanisms of Suicide/Self-inflicted trauma (n=700)

Cut/Pierce made-up the largest

proportion of Suicide/Self-Inflicted

trauma in Arizona, followed by

Firearm and Suffocation.


Suicide/self-inflicted trauma mechanisms

43.16%

20.51%

13.81%

7.83%

5.69%4.70%

Cut/Pierce Fall Firearm Suffocation Other Spec NEC0.00%

10.00%

20.00%

30.00%

40.00%

Pe

rce

nt

NEC: Not Elsewhere Classifiable


11

Figure 11: Trauma proportion, by Injury Severity Score

The Injury Severity Score (ISS) is a system for numerically stratifying injury severity. The ISS ranges in

value from 1 to 75, with a higher score indicating greater injury severity and increased risk of death. This

report categorizes ISS 1-8 as Minor, 9-15 as Moderate, 16-24 as Serious, 25-75 as Severe.

In 2015, the majority of trauma patients had an ISS between 1 and 8, indicating Minor severity.

Mortality increased significantly from 3.3% among Serious trauma to 32% among Severe trauma.

Injury Characteristics: Injury Severity Score


ISS proportion

62.91%

22.08%

7.27%

3.77%

1-8 9-15 16-24 25-750.00%

20.00%

40.00%

60.00%

Pe

rce

nt

Table 9: Trauma and mortality proportion by Injury Severity Score

Injury Severity Score Count Percent Deaths Mortality Proportion

1-8 26,647 62.91% 146 0.54%

9-15 9,354 22.08% 163 1.74%

16-24 3,083 7.27% 102 3.30%

25-75 1,597 3.77% 515 32.24%

*Missing/NA/ND 1,670 3.94% 39 2.33%

12

Table 10: Age-specific trauma and mortality proportion, ASTR 2015

Of the 42,351 trauma cases reported to the ASTR, 965 (2.27%) were fatal.

Patients 75 to 84 years of age had the highest mortality proportion, while those 10 to14 years of age

had the lowest mortality proportion.

Age Count Percent Deaths Mortality Proportion

Total 42,351 100.00% 965 2.27%

<1 440 1.03% 3 0.68%

1-4 1,326 3.13% 16 1.20%

5-9 1,350 3.18% 5 0.37%

10-14 1,631 3.85% 4 0.24%

15-19 3,123 7.37% 45 1.44%

20-24 3,824 9.02% 84 2.19%

25-34 6,081 14.35% 137 2.25%

35-44 4,367 10.31% 99 2.26%

45-54 4,478 10.57% 120 2.67%

55-64 4,310 10.17% 116 2.69%

65-74 4,080 9.63% 125 3.06%

75-84 4,052 9.56% 126 3.10%

85+ 3,289 7.76% 85 2.58%

Trauma Mortality

13

Figure 12: Age-specific trauma mortality rate per 100,000 Arizona residents



Age-specific trauma mortality rates per 100,000

0

10

20

30

Mo

rta

lity

ra

te p

er

10

0,0

00

<15 15-19 20-44 45-64 65+ Overall

Median 2013-2014

2015

Age Total Trauma Deaths Rate per 100,000 (95%CI)

<15 28 2 [1, 3]

15-19 45 10 [7, 13]

20-44 320 14 [13, 16]

45-64 236 14 [13, 16]

65+ 336 31 [28, 35]

Overall 965 14 [13, 15]

Older adults (65+) had the highest trauma mortality rate, while pediatrics (< 15) had the lowest trauma

mortality rate.

Table 11: Age-specific trauma mortality rate per 100,000 Arizona residents

14

Figure 13: Gender-specific trauma mortality rate per 100,000 Arizona residents

Data Source: Arizona State Trauma Registry, 2015 CI= Confidence interval

The trauma mortality rate among

Males was more than twice as

high as the trauma mortality rate

among Females.


Gender specific mortality rate per 100,000

8.0

20.6

Female Male0

5

10

15

20

Mo

rta

lity

ra

te p

er

10

0,0

00

Gender Total Trauma Deaths Rate per 100,000 (95%CI)

Female 272 8 [7, 9]

Male 693 21 [19, 22]


Race/ethnicity specific mortality rate per 100,000

21.6

5.1

17.9

8.5

15.8

Indian

American Asian/PI Black Hispanic White0

5

10

15

20

Mo

rta

lity

ra

te p

er

10

0,0

00

Figure 14: Race-specific trauma mortality rate per 100,000 Arizona residents

Race/ethnicity Total Trauma Deaths Rate per 100,000 (95%CI)

American Indian 62 22 [16, 27]

Asian/PI 12 5 [2, 8]

Black 55 18 [13, 23]

Hispanic 175 8 [7, 10]

White 609 16 [15, 17]

Data Source: Arizona State Trauma Registry, 2015 CI= Confidence interval

American Indian/Alaska Natives

had the highest trauma mortality

rate in Arizona.

Although Blacks had a lower

trauma rate than Whites (Figure

3), they had higher trauma

mortality.

Table 12: Gender-specific trauma mortality rate per 100,000 Arizona residents

Table 13: Race-specific trauma mortality rate per 100,000 Arizona residents

15

Figure 15: Age-adjusted trauma mortality rate per 100,000 Arizona residents by year: Trauma

center deaths vs. Statewide trauma deaths


The Electronic Death Registry (EDR) captures all deaths in the state of Arizona, including those that

occur outside of the hospital, while the deaths in ASTR are limited to those that occur at designated

trauma centers and participating hospitals.

Data source Year Total Trauma Deaths Rate per 100,000 (95%CI)

ASTR 2013 828 12.3 [11.5, 13.2]

2014 871 12.5 [11.7, 13.3]

2015 965 13.6 [12.8, 14.5]

EDR 2013 3,159 46.5 [44.9, 48.1]

2014 2,905 41.2 [39.7, 42.7]

2015 3,268 45.6 [44.0, 47.1]

Data sources: Arizona State Trauma Registry 2013-2015, Arizona Electronic Death Registry,2013-2015

Trauma related age-adjusted mortality rate per 100,000

12.3 12.513.6

46.5

41.2

45.6

ASTR EDR0

10

20

30

40

Mo

rta

lity

ra

te p

er

10

0,0

00

201520142013

Table 14: Age-adjusted trauma mortality rate per 100,000 Arizona residents by year: Trauma

center deaths vs. Statewide trauma deaths

Trauma Center Deaths vs. Statewide Trauma Deaths: ASTR and EDR 2013-2015

16

Figure 16: Primary payment source of traumatic injuries by year

Trauma charges in 2015 totaled over $1.6 billion, with a reimbursement rate of only 16.4%. Workers

Compensation and Private insurance had the highest reimbursement rates, while self-pay had the

lowest. AHCCCS/Government had the highest total charges, and Medicare had the highest median

charges.

Trauma Charges

Data source: Arizona State Trauma Registry 2013-2015, Other includes: No fault auto, Not bil led,and Other insurance

Primary payment source proportion1

8.4

%

11

.6%

8.5

%

27

.9%

29

.5%

31

.7%

29

.3%

30

.8%

30

.7%

16

.5% 19

.7%

22

.1%

3.6

%

4.1

%

2.4

%

2.0

%

2.1

%

2.0

%

Self pay AHCCCS/Govt Private Medicare Other

Comp

Workers0.0%

10.0%

20.0%

30.0%

201520142013

Since 2013, the proportion of hospital trauma care billed to government and private payers has

increased while self-pay has decreased (dropping from 18.4% in 2013 to only 8.5% in 2015).

Table 15: Trauma charges and reimbursement by primary payer source

AHCCCS = Arizona Health Care Cost Containment System

Primary payer Total Charges Median Charges Total Reimbursement Reimbursement Percent

AHCCCS/Government $572,452,601 $20,863 $63,899,959 11.1%

Medicare $395,038,753 $25,093 $59,786,260 15.1%

Not documented $766,319 $12,361 $35,262 4.6%

Other $29,267,573 $16,359 $2,812,115 9.6%

Private $537,603,624 $23,010 $132,507,571 24.6%

Self pay $100,230,618 $19,056 $5,424,062 5.4%

Workers Comp $31,941,586 $22,711 $10,494,024 32.8%

$1,667,301,074 $22,026 $274,959,253 16.4%

17

Table 17: Trauma charges and reimbursement by mechanism of injury

Motor Vehicle Traffic trauma and Falls made-up 72% of total trauma charges in 2015. The

mechanisms with the highest median charges were Drowning, Non-traffic Pedestrian, and Firearm.

Reimbursement rates were low regardless of injury mechanism.

Mechanism Total Charges Median Charges Total Reimbursement Reimbursement Percent

MV Occupant $655,407,048 $23,451 $102,761,620 15.60%

Fall $551,011,780 $22,494 $93,593,288 16.90%

Other Land Transport $102,123,428 $21,413 $19,828,035 19.40%

Struck By/Against $93,174,828 $18,237 $14,295,200 15.30%

Firearm $65,527,405 $27,238 $10,494,553 16.00%

Cut/Pierce $52,690,487 $21,635 $8,218,053 15.50%

Other Pedal Cyclist $29,601,951 $17,963 $5,650,353 19.00%

Other Spec $29,363,312 $17,227 $4,714,115 16.00%

Not Specified $24,300,508 $24,224 $3,640,169 14.90%

Natural/Environmental $13,841,844 $18,643 $2,293,349 16.50%

Other Pedestrian $11,656,972 $27,631 $1,766,440 15.10%

Not Elsewhere Classifiable $9,533,820 $21,595 $1,731,162 18.10%

Machinery $5,658,055 $19,518 $1,583,931 27.90%

Other Transport $5,401,454 $16,040 $1,026,761 19.00%

Fire/Flame $4,895,776 $9,866 $584,170 11.90%

Suffocation $4,348,196 $18,846 $551,634 12.60%

Overexertion $3,574,317 $18,247 $903,195 25.20%

Drowning $2,499,554 $28,959 $645,826 25.80%

Hot Object/Scald $2,106,575 $7,435 $547,320 25.90%

Poisoning $176,380 $9,468 $35,112 19.90%

Missing $407,384 $20,555 $94,966 23.30%

$1,667,301,074 $22,026 $274,959,253 16.4%

Year Total Charges Median Charges Total Reimbursement Reimbursement Percent

2013 $1,483,095,430 $24,144 $227,865,343 15.3%

2014 $1,602,920,471 $23,497 $261,156,506 16.2%

2015 $1,667,301,074 $22,026 $274,959,253 16.4%

From 2013 to 2015, the overall trauma reimbursement rate increased from 15.3% to 16.4%.

Table 16: Trauma charges and reimbursement by year

18

Trauma Risk Factors: Drug & Alcohol


Age specific alcohol and drug use

0.4

%

0.0

%

2.5

%

0.8

%

12

.9%

6.3

%

23

.3%

21

.7%

22

.7%

26

.6%

14

.6%

19

.1%

3.1

% 4.4

%

<10 10-14 15-17 18-24 25-44 45-64 65+0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Pe

rce

nt

AlcoholDrug

Figure 17: Age-specific trauma proportion by drug and alcohol use


Race specific alcohol and drug use

14.9%13.2%

11.1% 10.7%

19.2%

45.7%

20.9%

15.0%

8.8% 9.5%

Hispanic White

Native

Indian/Alaska

American

American

Black/African

Islander

Asian/Pacif ic0.0%

10.0%

20.0%

30.0%

40.0%

Pe

rce

nt

AlcoholDrug

Figure 18: Race-specific trauma proportion by drug and alcohol use

In 2015, 13% (n=5,466) of all trauma patients had confirmed or suspected drug use and 15% (n=6,190)

had confirmed or suspected alcohol use at the time of trauma.

18-24 year olds and 25-44 year

olds had the highest proportions of

trauma involving Drug and/or

Alcohol use.

Among those less than 25 years

old, the proportion of trauma

involving Drug use was higher

than the trauma involving Alcohol

use.


had the highest proportion of

trauma involving Alcohol use,

while Blacks had the highest

proportion of trauma involving

Drug use.

Almost half of all traumas among


involved Alcohol use. Trauma

involving Drug use was also high

among American Indian/Alaska

Natives, as well as Blacks.

19

Figure 19: Intent-specific trauma proportion by drug and alcohol use

Figure 20: Mechanism-specific trauma proportion by drug and

alcohol use

Suicide/Self-Inflicted and Legal

Intervention had a higher


Drug use, while Homicide/Assault

had a higher proportion of trauma

involving Alcohol use.

Firearm had the highest


Drug use, while Cut/Pierce had

the highest proportion of trauma

involving Alcohol use.

Firearm and Motor Vehicle

Traffic had a higher proportion of

trauma involving Drug use.


Intent of injury and alcohol and drug use

10.5% 11.1%

34.5%

29.8%31.4%

45.0%

34.7%

25.4%

Unintentional Suicide Homicide Legal Intervention0.0%

10.0%

20.0%

30.0%

40.0%

Pe

rce

nt

AlcoholDrug


Mechanism of injury and alcohol and drug use

27

.1%

34

.8%

5.8

% 8.3

%

33

.0%

24

.6%

16

.0%

14

.3%

12

.5% 15

.5%

20

.1%

31

.9%

Cut/Pierce Fall Firearm MV Traff ic

Transport

Other Land

By/Against

Struck0.0%

10.0%

20.0%

30.0%

Pe

rce

nt

AlcoholDrug

20

Trauma Risk Factors: Safety Equipment

Figure 22: Age-specific proportion of helmet use among pedal-cyclists

In 2015, 70% of Motor Vehicle

Traffic occupants involved in

traumas were using some form of

safety restraint (Lap Belt,

Shoulder Belt, or Child Car Seat)

at the time of the accident.

The age categories with the lowest

restraint use were 15-17 and 18-

24.

Figure 21: Age-specific proportion of restraint use among Motor

Vehicle Traffic occupants


Age specific car restraint use

81.4%

67.8% 66.8%

59.4% 60.7%

66.9%

76.5%

81.9%

0.0%

20.0%

40.0%

60.0%

80.0%

Pe

rce

nt

<5 5-8 9-14 15-17 18-24 25-44 45-64 65+

Overall

Age specific


Age specific helmet use among pedal cyclist

18.1%

14.4%

19.0%17.8%

24.0%24.7%

30.3%

40.2%

0.0%

10.0%

20.0%

30.0%

40.0%

Pe

rce

nt

<5 5-8 9-14 15-17 18-24 25-44 45-64 65+

Overall

Age specific

Overall, helmet use among pedal-

cyclists was low; only 26.7% of

pedal-cyclists were wearing a

helmet when involved in a trauma.

The proportion of helmet use

increases after age 45.

Motor Vehicle Traffic Occupants

(n = 9,868)

Pedal-Cyclists (n = 1,528)

21

Figure 23: Age-specific proportion of helmet use among motorcyclists

Helmet use among off-road

vehicle occupants was higher than

that of Pedal-cyclists but lower

than Motorcyclists; 36% of off-

road vehicle occupants were

wearing a helmet when involved

in a trauma.

The highest proportion of helmet

use was reported for the 9-14 age

category and the lowest proportion

was reported for the 65+ age


Age specific helmet use among Motorcyclist

57.8%

76.3%

63.8%

51.3%

45.7%

55.3%

0.0%

20.0%

40.0%

60.0%

80.0%

Pe

rce

nt

9-14 15-17 18-24 25-44 45-64 65+

Overall

Age specific

Figure 24: Age-specific proportion of helmet use among off-road

vehicle occupants


Age specific helmet use among all-terrain or other off-road vehicles

33.3%

22.5%

48.7%

40.8%

37.1%

34.4%33.3%

17.1%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

Pe

rce

nt

<5 5-8 9-14 15-17 18-24 25-44 45-64 65+

Overall

Age specific

Motorcyclists had a higher

proportion of helmet use than

Pedal-cyclists; 53% of

Motorcyclist were wearing a

helmet when involved in a trauma.

The highest proportion of helmet

use was reported for the 15-17 and

18-24 age categories. The lowest

proportion of helmet use was

reported for the 45-64 age

category.

Off-Road Vehicle Occupants

(n = 1,380)

Motorcyclists (n = 2,026)

22

Access to Trauma Care

Injury

location

ISS>15: Injury to ED Arrival Time (Minutes)

N Median

time

25th

percentile

75th

percentile

Injury time

missing (n)

Rural 518 86 55 124 101

Urban 1,796 46 34 66 947

Statewide 2,314 50 36 80 1,048

Injury

location

Inter-facility Transfer to Level I & ISS>15:

Injury to ED Arrival Time (Minutes)

N Median

time

25th

percentile

75th

percentile Injury time missing (n)

Rural 252 345 250 536 88

Urban 475 335 239 511 303

Statewide 727 336 240 515 391


Mode of transport by Injury Severity Score

5.9

%

68

.4%

25

.6%

10

.7%

73

.6%

15

.5%

19

.3%

69

.9%

10

.6%

25

.2%

71

.6%

3.0

%

1-8 9-15 16-24 25-750.0%

20.0%

40.0%

60.0%

Pe

rce

nt

POVGroundAir

Figure 25: Mode of transport to trauma center by Injury Severity Score

Table 18: Injury to ED arrival time for trauma patients with an

Injury Severity Score > 15: Urban vs. Rural

Table 19: Injury to ED arrival time for inter-facility transfer patients

with an Injury Severity Score > 15: Urban vs. Rural

The majority of patients were

transported to a trauma center by

ground ambulance.

The proportion of patients

transported to a trauma center by

air ambulance increased with

Injury Severity Score, while the

proportion of patients transported

by Personally Owned Vehicle

(POV) decreased with Injury

Severity Score.

Overall, there were 3,362 patients

with an ISS >15. Of these, 31%

did not have an injury time

documented and were removed

from this analysis.

The median injury to ED arrival

time for trauma patients with an

ISS > 15 was 50 minutes.

Rural injury location was

associated with a longer injury to

ED arrival time than Urban injury

location.

The median injury to ED arrival

time for inter-facility transfer

patients with an ISS > 15 was 336

minutes.

23

The Northern Region had the highest trauma rate in 2015, with 1,169 traumas per 100,000 Arizona

residents.

Table 20: Region-specific trauma rate per 100,000 Arizona residents

Region-Specific Trauma


Injury Region Total Trauma Cases Rate per 100,000 (95%CI)

Western 1,992 451 [431, 471]

Northern 6,329 1,169 [1,140, 1,198]

Southeastern 6,337 512 [499, 525]

Central 26,504 584 [577, 591]

Statewide 42,351 627 [621, 633]

Yuma Regional Medical Center only submitted data to the ASTR for the year 2014.


Region-specific trauma rates per 100,000

451

512

584

1,169

0

200

400

600

800

1,000

1,200

Ra

te p

er

10

0,0

00

Western Southeastern Central Northern

Statewide

By region

Figure 26: Region-specific trauma rate per 100,000 Arizona residents

24

The Northern region had the highest trauma mortality rate in the state, followed by the Central and

Southeastern regions.

Table 21: Region-specific trauma mortality rate per 100,000 Arizona residents

Yuma Regional Medical Center only submitted data to the ASTR for the year 2014. CI= Confidence interval


Trauma mortality by region

7

12

15

17

0

5

10

15R

ate

pe

r 1

00

,00

0

Western Southeastern Central Northern

Statewide

By region

Injury Region Total Trauma deaths Rate per 100,000 (95%CI)

Western 32 7 [5, 10]

Northern 93 17 [14, 21]

Southeastern 150 12 [10, 14]

Central 676 15 [14, 16]


ISS by Region

63

.8%

68

.3%

69

.2%

68

.2%

24

.3%

21

.8%

20

.6%

19

.7%

7.6

%

7.4

%

7.3

%

7.5

%

4.1

%

2.4

%

2.7

%

4.3

%

1-8 9-15 16-24 25-750.0%

20.0%

40.0%

60.0%

Pe

rce

nt

Southeastern RegionNorthern RegionWestern RegionCentral RegionInjury severity was comparable

between the four regions. The

Central and Southeastern regions

had a slightly higher proportion of

Severely injured patients.

Figure 28: Region-specific trauma proportion by Injury Severity Score

Figure 27: Region-specific trauma mortality rate per 100,000 Arizona residents

25

Figure 29: Region-specific trauma rate per 100,000 Arizona residents, by top 6 mechanisms

Data source: Arizona State Trauma Registry 2015, MV=Motor vehic le

Top mechanisms of injury rate per 100,000

Cut/Pierce Fall Firearm MV Traff ic

Transport

Other Land

By/Against

Struck

0

100

200

300

400

Ra

te p

er

10

0,0

00

StatewideWesternSoutheasternNorthernCentral

Table 22: Region-specific trauma rate per 100,000 Arizona residents, by top 6 mechanisms

Region Mechanisms Total Trauma Cases Rate per 100,000 (95%CI)

Central Cut/Pierce 1,114 25 [23, 26]

Fall 10,803 238 [234, 243]

Firearm 722 16 [15, 17]

MV Traffic 8,394 185 [181, 189]



Northern Cut/Pierce 249 46 [40, 52]

Fall 1,937 358 [342, 374]

Firearm 115 21 [17, 25]

MV Traffic 2,107 389 [373, 406]

Other Land Transport 597 110 [101, 119]

Struck By/Against 686 127 [117, 136]

Southeastern Cut/Pierce 310 25 [22, 28]

Fall 1,670 135 [128, 141]

Firearm 176 14 [12, 16]

MV Traffic 2,270 183 [176, 191]



Western Cut/Pierce 39 9 [6, 12]

Fall 785 178 [165, 190]

Firearm 32 7 [5, 10]

MV Traffic 667 151 [139, 162]



CI= Confidence interval Yuma Regional Medical Center did not submitted data to the ASTR for the year 2013 and 2015.

In the Central and Western

regions, the highest trauma

rates were reported for

Falls, while in the

Southeastern and Northern

regions the highest rates

were reported for Motor

Vehicle Traffic. The

Northern region had the

highest rates of trauma

across all six mechanisms

of injury.

26

Figure 30: Region-specific trauma rate per 100,000 Arizona residents by intent

The Northern region reported the highest trauma rates across all injury intents, followed by the Central

and Southeastern regions. Unintentional trauma had the highest rate in all four regions.

Region Intent Total Trauma Cases Rate per 100,000 (95%CI)

Central Unintentional 23,437 517 [510, 523]




Northern Unintentional 5,414 1,000 [974, 1,027]


Homicide/Assault 770 142 [132, 152]


Southeastern Unintentional 5,478 443 [431, 454]




Western Unintentional 1,850 419 [400, 438]






Trauma rate per 100,000 by intent

Unintentional Suicide Homicide Legal Intervention

0

200

400

600

800

1,000R

ate

pe

r 1

00

,00

0

StatewideSoutheastern Region

Northern RegionWestern RegionCentral Region

Table 23: Region-specific trauma rate per 100,000 Arizona residents by intent

27

Trauma Center Designation

Table 24: Trauma and mortality proportion by trauma center designation, ASTR 2015

Trauma Center Designation Count Percent Deaths Mortality Proportion

Level I 27,489 66.14% 854 3.10%

Level III 5,835 14.03% 42 0.71%

Level IV 8,237 19.81% 58 0.70%

Trauma Center

Designation Total Charges

Median

Charges

Total

Reimbursement

Reimbursement

Percent

Level I $1,350,432,541 $27,939 $225,587,866 16.7%

Level III $180,871,907 $17,881 $25,763,856 14.2%

Level IV $115,361,818 $10,258 $19,656,580 17.0%

$1,646,666,266 $22,196 $271,008,302 16.4%

Table 25: Trauma charges and reimbursement by trauma center designation, ASTR 2015

Figure 31: Injury Severity Score by trauma center designation

The majority of trauma patients in Arizona went to Level I trauma centers, 20% went to Level IV

trauma centers and 14 % went to Level III trauma centers.

The median charges for trauma patients were $27,939 at Level I trauma centers, $17,881 at Level III

trauma centers and $10,258 at Level IV trauma centers.

Trauma patient’s level of care increased with injury severity, with Level I trauma centers treating a

larger proportion of patients with Moderate to Severe trauma and a lower proportion of patients with

Minor trauma, as compared to Level III and IV trauma centers.


ISS by Level of designation

60

.1%

72

.5% 78

.4%

24

.7%

22

.6%

17

.3%

9.5

%

3.6

%

3.5

%

5.4

%

1.0

%

0.6

%

1-8 9-15 16-24 25-750.0%

20.0%

40.0%

60.0%

80.0%

Pe

rce

nt

Level IVLevel IIILevel I

28

The National Trauma Data Bank (NTDB) is the largest aggregation of trauma registry data in the

United States; a total of 746 hospitals submitted data to the NTDB in 2014. For the purpose of this

comparison, the ASTR data were modified to match the NTDB inclusion criteria (n = 28,751).

Figure 32: Trauma proportion by top six mechanisms of injury,

Arizona vs. National


Figure 33: Trauma mortality proportion by top six mechanisms of

injury, Arizona vs. National

Arizona had a similar distribution

of trauma, by injury mechanism,

when compared to national data.

Arizona had a higher proportion of

Firearm mortality but a lower

proportion of Fall mortality when

compared to national data.

Data source: Arizona State Trauma Registry 2014-2015, National Trauma Data Bank 2014

Top mechanisms of injury proportion: ASTR vs. NTDB

41

.7%

39

.6% 43

.4%

26

.0%

26

.8%

25

.9%

8.3

%

8.4

%

6.6

%

5.7

%

5.9

%

4.4

%

4.6

%

4.8

%

4.2

%

3.0

%

3.1

%

4.0

%

Fall MV Traff ic

By/Against

Struck

Transport

Other Land Cut/Pierce Firearm0.0%

10.0%

20.0%

30.0%

40.0%

Pe

rce

nt

NTDB 2014ASTR 2014ASTR 2015


Top mechanisms of injury mortality: ASTR vs. NTDB

2.0

%

2.2

%

4.3

%

4.9

%

4.6

%

4.6

%

0.7

%

0.7

%

1.3

%

1.9

%

1.8

%

2.3

%

2.0

%

1.9

%

2.0

%

20

.1%

20

.4%

15

.3%

Fall MV Traff ic

By/Against

Struck

Transport

Other Land Cut/Pierce Firearm0.0%

5.0%

10.0%

15.0%

20.0%

Pe

rce

nt


29

Figure 34: Trauma proportion by intent of injury, Arizona vs.

National

Figure 35: Trauma mortality proportion by intent of injury,


Arizona had a similar distribution

of trauma, by intent, when

compared to national trauma data.

Arizona had a higher mortality

proportion for Suicide and Legal

Intervention trauma as compared

to national trauma data but a lower

proportion of Unintentional, and

Homicide mortality.


Intent of injury proportion: ASTR vs. NTDB

86

.6%

86

.0%

86

.5%

10

.1%

10

.7%

9.8

%

2.0

%

2.1

%

1.5

%

0.8

%

0.8

%

0.4

%

0.3

%

0.3

%

0.1

%

Unintentional Suicide Homicide

Intervention

Legal Undetermined0.0%

20.0%

40.0%

60.0%

80.0%P

erc

en

t



Intent of injury mortality: ASTR vs. NTDB

2.8

%

2.7

%

3.9

%

3.7

%

3.8

%

5.1

%

19

.4%

17

.4%

17

.5%

5.6

% 7.0

%

10

.0%

20

.8%

25

.3%

10

.7%

Unintentional Suicide Homicide

Intervention

Legal Undetermined0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Pe

rce

nt


30

Figure 36: Trauma proportion by Injury Severity Score, Arizona vs.

National

Figure 37: Trauma mortality proportion by Injury Severity Score,


Arizona’s trauma patients had a

lower Injury Severity Score as

compared to national data.

The mortality proportion for

Arizona trauma patients with an

ISS of 25-75 was higher than

national data. However, the

mortality proportion was lower for

all other ISS categories.


Trauma proportion by ISS: ASTR vs. NTDB

52

.1%

51

.1%

46

.1%

31

.4%

31

.8%

31

.7%

10

.7%

10

.7%

13

.7%

5.6

%

6.2

%

7.6

%

1-8 9-15 16-24 25-750.0%

10.0%

20.0%

30.0%

40.0%

50.0%

Pe

rce

nt



Trauma mortality by ISS: ASTR vs. NTDB

0.9

%

0.8

%

1.1

%

1.8

%

1.4

%

2.6

%

3.3

%

3.3

% 5.5

%

32

.4%

31

.7%

27

.8%

1-8 9-15 16-24 25-750.0%

10.0%

20.0%

30.0%

Pe

rce

nt


31

Of the 42,351 trauma patients reported to the ASTR, 9,094 (22%) sustained a Traumatic Brain Injury

(TBI); 12% had a Major TBI and 10% had a Minor TBI.

Infants (< 1) had the highest proportion of TBIs. More than half of trauma patients < 1 year old

sustained a TBI; 31% had a Major TBI and 23% had a Minor TBI. Two infants died as a result of TBI.

Adults 25 to 34 years of age had the highest TBI mortality proportion, with 15% mortality among

Major TBI patients.

Traumatic Brain Injury

*Major TBI **Minor TBI

Age Overall N Percent Mortality Mortality Percent N Percent Mortality Mortality Percent

Total 42,351 4,959 11.70% 507 10.22% 4,495 10.61% 16 0.35%

<1 440 136 30.90% 2 1.47% 99 22.50% . .

1-4 1,326 166 12.51% 10 6.02% 156 11.76% . .

5-9 1,350 88 6.51% 4 4.54% 131 9.70% . .

10-14 1,631 122 7.48% 1 0.81% 270 16.55% . .

15-19 3,123 248 7.94% 22 8.87% 526 16.84% 1 0.19%

20-24 3,824 324 8.47% 45 13.88% 526 13.75% . .

25-34 6,081 483 7.94% 71 14.69% 759 12.48% 1 0.13%

35-44 4,367 413 9.45% 53 12.83% 490 11.22% 1 0.20%

45-54 4,478 482 10.76% 69 14.31% 477 10.65% 2 0.41%

55-64 4,310 596 13.82% 63 10.57% 417 9.67% 1 0.23%

65-74 4,080 636 15.58% 63 9.90% 326 7.99% 5 1.53%

75-84 4,052 700 17.27% 74 10.57% 201 4.96% . .

85+ 3,289 565 17.17% 30 5.30% 117 3.55% 5 4.27%

*Major TBI is defined as a Type I TBI on the Barell Matrix or an AIS with a head injury severity ≥ 3.

**Minor/Moderate TBI defined as a Type II TBI or a Type III TBI on the Barell Matrix or an AIS with a head injury

severity < 3.

Table 26: Age-specific Traumatic Brain Injury and mortality proportion

32

TBI- GCS<9 TBI- GCS 9-12 TBI- GCS 12-15

Age Overall N Percent Mortality Mortality

Percent N Percent Mortality

Mortality

Percent N Percent Mortality

Mortality

Percent

Total 42,351 1,028 2.42% 422 41.05% 392 0.92% 30 7.65% 7,852 18.54% 65 0.82%

<1 440 11 2.50% 2 18.18% 9 2.04% . . 204 46.36% . .

1-4 1,326 30 2.26% 10 33.33% 19 1.43% . . 257 19.38% . .

5-9 1,350 14 1.03% 4 28.57% 15 1.11% . . 187 13.85% . .

10-14 1,631 33 2.02% 1 3.03% 15 0.91% . . 335 20.53% . .

15-19 3,123 78 2.49% 23 29.48% 26 0.83% . . 666 21.32% . .

20-24 3,824 120 3.13% 44 36.66% 34 0.88% . . 684 17.88% 1 0.14%

25-34 6,081 193 3.17% 68 35.23% 58 0.95% 1 1.72% 984 16.18% 1 0.10%

35-44 4,367 122 2.79% 51 41.80% 37 0.84% . . 740 16.94% 3 0.40%

45-54 4,478 138 3.08% 65 47.10% 40 0.89% 1 2.50% 768 17.15% 5 0.65%

55-64 4,310 115 2.66% 49 42.60% 31 0.71% 5 16.12% 850 19.72% 9 1.05%

65-74 4,080 79 1.93% 46 58.22% 34 0.83% 5 14.70% 821 20.12% 16 1.94%

75-84 4,052 62 1.53% 40 64.51% 44 1.08% 9 20.45% 765 18.87% 23 3.00%

85+ 3,289 33 1.00% 19 57.57% 30 0.91% 9 30.00% 591 17.96% 7 1.18%


Trauma mechanisms and TBI Incidence

36.45%

33.15%31.27%

29.50%

26.41%26.23%

23.98%23.80%22.21% 21.42%

FallOther Pedal Cyc

Other Land Transport

Struck By/Against

NECNot Specif ied

MVT-M

otorcyclist

MVT-Pedal Cyclist

MVT-Pedestrian

MVT-O

ther

0.00%

10.00%

20.00%

30.00%

Pe

rce

nt

Figure 38: Proportion of Traumatic Brain Injury by mechanism

Table 27: Age-specific Traumatic Brain Injury and mortality proportion by Glasgow Coma Score

GCS: Glasgow Coma Score

More than 20% of trauma patients with Motor Vehicle Traffic, Fall, Struck By/Against and other

transport related mechanisms of injury sustained TBIs.

TBI patients are classified based on their Glasgow Coma Score (GCS), a neurological assessment of a

patients level of consciousness following head injury. Overall, a lower GCS was associated with a higher

mortality proportion among TBI patients, and 41% of TBI patients with a GCS < 9 died. Older adults 65+

had the highest mortality proportion regardless of GCS.


33

Of the 24,996 patients admitted to the hospital, 6.44% were discharged to Rehab. Medicare had the

largest proportion of patients discharged to Rehab, followed by Private insurance. A higher proportion

of patients with an ISS > 15 were discharged to Rehab, regardless of primary payment source.

Discharged to Rehab

Table 28: Discharge to rehab by Injury Severity Score and primary payment source

Total Patient

Admitted

Discharged to

Rehab

ISS <=15 and

Discharged to Rehab

ISS >15 and

Discharged to Rehab Primary Payer

N % N % N % N %

AHCCCS 7,965 31.86% 324 4.06% 127 1.95% 195 15.42%

Medicare 6,440 25.76% 664 10.31% 504 9.57% 155 14.35%

Not Documented 254 1.01% 13 5.11% 12 5.12% 1 25.00%

Other 326 1.30% 9 2.76% 6 2.14% 3 6.52%

Private 8,312 33.25% 574 6.90% 308 4.51% 263 19.65%

Self-pay 1,699 6.79% 27 1.58% 13 0.91% 14 5.71%

Total 24,996 100.00% 1,611 6.44% 970 4.73% 631 15.86%

Region Total Patients Admitted Discharged to Rehab

N % N %

Missing Region 701 2.8% 38 5.4%

Central Region 17,734 70.9% 1,126 6.3%

Western Region 849 3.3% 52 6.1%

Northern Region 2,698 10.7% 160 5.9%

Southeastern Region 3,014 12.0% 235 7.7%

Statewide 24,996 100.0% 1,611 6.4%

Table 29: Discharge to rehab proportion by region

The proportion of trauma patients discharged to Rehab was comparable between the four EMS regions.

34

Hospitals Submitting Data to the ASTR in 2015

Level I Trauma Centers (Full Data Set)

Abrazo West Campus

Banner University Medical Center—Phoenix

Banner University Medical Center—Tucson

Chandler Regional Medical Center

Flagstaff Medical Center

HonorHealth John C. Lincoln Medical Center

HonorHealth Scottsdale Osborn Medical Center

Maricopa Medical Center

Phoenix Children's Hospital

St. Joseph's Hospital and Medical Center

Level III Trauma Centers (Full Data Set)

Banner Baywood Medical Center

Havasu Regional Medical Center

HonorHealth Deer Valley Medical Center

Mountain Vista Medical Center

Tuba City Regional Health Care Corporation

Canyon Vista Medical Center

Appendix A.

35

Level IV Trauma Centers (Reduced Data Set)

Banner Page Hospital

Banner Payson Medical Center

Benson Hospital

Chinle Comprehensive Health Care

Cobre Valley Regional Medical Center

Copper Queen Community Hospital

La Paz Regional Hospital

Mt. Graham Regional Medical Center

Northern Cochise Hospital

Oro Valley Hospital

Summit Healthcare Regional Medical Center

White Mountain Regional Medical Center

Wickenburg Community Hospital

Yavapai Reg Med Center - East

Yavapai Regional Medical Center

Little Colorado Medical Center

Non-designated Trauma Centers

Banner Desert Medical Center/Cardon Children's (Full Data Set)

Yuma Regional Medical Center (Reduced Data Set)

Level IV Trauma Centers (Full Data Set)

Banner Boswell Medical Center

Banner Del E Webb Medical Center

Banner Estrella Medical Center

Banner Gateway Medical Center

Banner Ironwood Medical Center

Banner University Medical Center South

Kingman Regional Medical Center

Verde Valley Medical Center

36

Appendix B.

trauma and ems performance improvement (tepi) … · bureau of emergency medical services &...

Documents