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Committee on Trauma: History and Future Direction

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Committee on Trauma: History and Future Direction Committee on Trauma: History and Future Direction Ronald M. Stewart, MD October 12, 2015 National Association of State EMS Officials The Problem • 180,000 lives lost each year • 1 million disabled • 10 million lives worldwide • One of the two most expensive health care problems in the US • Leading cause of death world wide 2020 35% reduction 6,720 lives United States Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Office of Analysis, Epidemiology, and Health Promotion (OAEHP), Compressed Mortality File (CMF) compiled from CMF 1968-1988, Series 20, No. 2A 2000, CMF 1989-1998, Series 20, No. 2E 2003 and CMF 1999-2001, Series 20, No. 2G 2004 on CDC WONDER On-line Database. !"##$%&'()*+',#-.%/-)0)1)*2' •! 3"45&4'-2-*#&'$#6#1%.&#/*')-'-%&#(+4*' 5/)75#')/'*+#'8%/*#&.%"4"2'9:' •! ;6)$#/8#$'04-#$'-#1<=>%6#"/4/8#' –!!"##$%&'4/$',#-.%/-)0)1)*2' –!?%$#1'<%"')&."%6)/>'%"'-%16)/>'&%-*'%<'%5"' &4@%"'."%01#&-' "Freedom, however, is not the last word. Freedom is only part of the story and half of the truth!In fact, freedom is in danger of deteriorating!unless it is lived in terms of responsibleness.” Viktor Frankl, MD A6#"6)#(' •! BC:'?%$#1'<%"'D#41*+'C4"#'E&."%6#&#/*' •! 3+#'B&#")84/'C%11#>#'%<':5">#%/-'C%&&)F##' %/'3"45&4' –! G+%' –! G+4*'' –! G+#/' –! G+#"#' –! G+2' –! D%(' •! !5*5"#':*"4*#>)8'H)"#8I%/'4/$'J#('K"%>"4&-' The ACS Model for Health Care Quality • Set appropriate standards • Insure the right infrastructure • Use the right data • Verify Pioneered and Developed by COT “One may long, as I do, for a gentler flame, a respite, a pause for musing. But perhaps there is no other peace for the arst than what he finds in the heat of combat. "Every wall is a door," Emerson correctly said. Let us not look for the door, and the way out… Instead, let us seek the respite where it is- in the very thick of bale. For in my opinion…it is there.” Albert Camus Robert K. Greenleaf; Larry C. Spears. Servant Leadership: A Journey into the Nature of Legimate Power and Greatness 25th Anniversary Edion Overview • ACS Model for Health Care Improvement • The American College of Surgeons Commiee on Trauma – Who – What – When – Where – Why – How • Strategic Overview of the COT • Your Leadership • Responsibility and Direcon Who? A Muldisciplinary Group of Professionals • Surgeons and physicians • Nurses • EMS • Public Health and EMS Officials • ACS Commiee on Trauma The Scarce Resource [Today]—aer 500 years or so—the scarcest, most valuable resource in business is no longer financial capital. It’s talent. —Geoffrey Colvin, senior editor at large, Fortune Magazine Pearson, Chrisne; Porath, ChrisIne (2009-05-22). The Cost of Bad Behavior. What? • Developed the concept of and the criteria for a trauma center • Developed the concept of and the criteria for an inclusive trauma system • Expanding the concept to disaster response and other emergency condions When? • The past century • 1913 • 1950 • 2014 1913 ;6#/*-'%<'nkno' •! nq*+'B&#/$&#/*'r'E/8%&#'34m' •! G%&#/h-':5i"4>#'?%6#&#/*'jnk*+'B&#/$&#/*'nk^gl' •! K4/4&4'C4/41')-'8%&.1#*#$' •! U)/8%1/'D)>+(42')-'8%&.1#*#$'j'E=sgl' •! !%"$'%.#/-'&%6)/>'4--#&012'1)/#' •! ,]',#2/%1$-')/*"%$58#-'S"-*'.48V4>#$'8)>4"#F#'jC4&#1l' •! ,)8+4"$'J)m%/O',%-4'K4"V-O'])&&2'D%i4'4/$'M)/8#' U%&04"$)'(#"#'0%"/' •! B&#")84/'C%11#>#'%<':5">#%/-'(4-'<%5/$#$' Wikipedia 2014 1913 Approximates of Mortality 1913 • Open Femur Fracture: 70% • GSW to Abdomen: 70- 90% • Burn LA50: 30% • Major and significant disability from untreated problems July 24, 1950 Status in Civilian Pracce 1950 • No trauma system • Almost no automobile safety systems • No EMS system – Ambulances operated by funeral homes • No established hospital criteria or treatment guidelines for trauma • No intensive care units • No special surgical teams – Much of surgical care provided by praconers straight out of medical school – Much preventable death and morbidity – Not a lot had changed since 1913 1950: The American College of Surgeons Renames the Commiee on Trauma Sets the stage for the transformaon of trauma care in the Country 1960’s Major Advancements • Naonal Academy of Sciences: Accidental Death and Disability: The neglected disease of modern society leads to: – EMS – Emergency medicine – Trauma Surgeons – Trauma centers and systems • Public Hospitals 1976: Trauma Centers • Public Teaching Hospitals as de facto Trauma Centers • 1976 - ACS COT Reports in the Bullen: Opmal Hospital Resources for Care of the Seriously Injured • Leads to the ACS-COT Verificaon Program for Trauma Centers 1980-2000 Trauma Systems Emerge Highlights • 1981 - Virginia - Statewide Trauma System - Volunteer System • 1987 - ACS COT - Instuted Verificaon / Consultaon Program • 1989 – Texas enabling legislaon for trauma system • 1992 HRSA Model Trauma Systems Plan – (Kaufman, C, et al) • 1996– ACS COT- Trauma System Consultaon Program (Eastman, B) • 2000s More trauma system legislaon and bills to address unreimbursed trauma care – aim to improve access September 11, 2001 • Need for Public Health and Emergency/Trauma Systems to work collaboravely • Integraon of disaster response with trauma system • Further development of the public health model for trauma system development • Applicaon of a trauma system model to two Theatres of War and Verificaon of an internaonal DOD Trauma Center Market Changes 2000 - 2015 • Individual States address uncompensated trauma care • Affordable Care Act of 2010 • Emergence of robust hospital systems • Trauma as a profitable service line • Compeon in the marketplace Where? • United States • Canada • Europe • Lan America • Joint Trauma System • The developing world Why? • To improve the care of the injured paent • To reduce complicaons and death from trauma of paents and cizens in a given region • To improve response to wide scale events such as disasters How? • ACS COT model for trauma center verificaon • Muldisciplinary professionals meeng, discussing, defining and redefining criteria for a trauma system –standards developed by consensus • Professional Model – the criteria, rules and standards developed with the explicit statement that the paent’s needs come before the surgeon, the hospital or the organizaon • Partnering with state health agencies/States • Evidenced based self governance How? • ACS COT model for trauma center verificaon • Muldisciplinary professionals meeng, discussing, defining and redefining criteria for a trauma system –standards developed by consensus • Professional Model – the criteria, rules and standards developed with the explicit statement that the paent’s needs come before the surgeon, the hospital or the organizaon • Partnering with state health agencies/States • Evidenced based self governance :5&&4"2'%<'D%(a' •! :#*'"#1#64/*'+)>+'-*4/$4"$-'04-#$'%/'*+#'/##$-'%<'*+#'.4I#/*' 4-'$#*#"&)/#$'02'81)/)841'#m.#"*-'5-)/>'*+#'0#-*'#6)$#/8#Q' •! R5)1$'4/$')/-5"#'*+#'")>+*')/<"4-*"58*5"#'4)&#$'4*')&."%6)/>' 7541)*2'4/$'"#$58)/>'&%"*41)*2Q' •! K#%.1#' •! !48)1)I#-' •! ,#-%5"8#-' •! U#4$#"-+).' •! ,#75)"#'*+#'8%11#8I%/'4/$'5-#'%<'")-V'4$@5-*#$':=-&-:*=(4*$*(<%"' .#"<%"&4/8#')&."%6#&#/*' •! E&.1#&#/*'4'M#")S84I%/'K"%8#--'02')/$#.#/$#/*O'."48I8)/>' 81)/)841'#m.#"*-' The COT Quality Model G+4*'D46#'R##/'*+#'A5*8%&#-a' •! :)>/)S84/*'"#$58I%/-')/'8%&.1)84I%/-'4/$' $#4*+-' •! E&."%6#$'488#--'*%'*"45&4'84"#')/'&%-*'4"#4-' •! E/8"#4-#$'-%.+)-I84I%/'%<'*"45&4'-2-*#&-' •! E/8"#4-#$'<5/$)/>'<%"'*"45&4'-2-*#&-'4/$' *"45&4'8#/*#"-' 35% reduction 6,720 lives United States Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Office of Analysis, Epidemiology, and Health Promotion (OAEHP), Compressed Mortality File (CMF) compiled from CMF 1968-1988, Series 20, No. 2A 2000, CMF 1989-1998, Series 20, No. 2E 2003 and CMF 1999-2001, Series 20, No. 2G 2004 on CDC WONDER On-line Database. Pillars of a Modern Trauma System • Prevention • Acute Care – Communications systems – EMS – Trauma Centers Requires timely, structured • Rehabilitation cooperation and communication. • Framework for Disaster Preparedness • Framework for other time sensitive diseases Strengths of the COT • Parcipaon • Professional – what we profess – Paents’ interests come first • Solving Problems not just studying them • Proven Performance improvement process • Passionate • Paence • Perseverant What next? • Development and extension of current projects – Educaon • ATLS • RTTDC • ASSET • ATOM • DMEP – Quality • Verificaon • TQIP • PIPS – Trauma system development • Domesc and Internaonal – Advocacy • Federal • State International Verification based on Process ACS Structure Approach Lock Step Outcomes Verification Optimal Process Integration Resources No for Care Standards Standards !! The Future Trauma Leaders/Mentoring Excellence in Trauma Surgery initiatives !! Needs Based Assessment of Trauma Systems Position Statement and Policy Direction !! ATLS iBook/eBook and the introduction of m-Learning !! Update on Hemorrhage Control Policy and Education— Hartford Consensus III! !! The Future Trauma Leaders (FTL) program is a unique way for the American College of Surgeons Committee on Trauma (COT) to offer an in-depth training and mentoring opportunity for junior trauma and acute care surgeons (those who are less than five years out from fellowship completion). Applications: Completed for this year. Applications currently being reviewed. For more information about the COT, visit www.facs.org/quality-programs/trauma. !! Adding nursing liaisons
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