REGIONAL TRAUMA SYSTEMS: OPTIMAL ELEMENTS, INTEGRATION, AND ASSESSMENT SYSTEMS CONSULTATION GUIDE COMMITTEE ON TRAUMA AMERICAN COLLEGE OF SURGEONS TRAUMA SYSTEM EVALUATION AND PLANNING COMMITTEE Regional Trauma Systems: Optimal Elements, Integration, and Assessment, American College of Surgeons Committee on Trauma: Systems Consultation Guide is intended as an instructive and evaluation tool to assist surgeons, health care institutions, and public health agencies in improving trauma systems and the care of injured patients. It is not intended to replace the professional judgment of the surgeon or health care administrator in individual circumstances. Th e American College of Surgeons and its Committee on Trauma cannot accept, and expressly disclaim, liability for claims arising from the use of this work. Copyright © 2008 American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611-3211 All rights reserved. ISBN 978-1-880696-33-0 E C EDITOR IN CHIEF A. Brent Eastman, MD, FACS Avery B. Nathens, MD, PhD, FACS Chief Medical Offi cer Canada Research Chair in Trauma Systems N. Paul Whittier Chair of Trauma, SMH LJ Development Scripps-Health Division Head General Surgery and Director of Trauma San Diego, CA St Michael’s Hospital Martin R. Eichelberger, MD, FACS Toronto, ON Professor of Pediatrics and Surgery CONTRIBUTORS George Washington University School of Medicine Director, Trauma & Burn Service In Alphabetical Order Children’s National Medical Center Jane W. Ball, RN, DrPH Washington, DC Trauma Systems Consultant Th omas J. Esposito, MD, FACS ACS Trauma Systems Evaluation and Planning Chief, Section of Trauma Committee Department of Surgery Gaithersburg, MD Loyola University Medical Center Reginald A. Burton, MD, FACS Maywood, IL Trauma Director Alberto Esquenazi, MD Bryan LGH Medical Center Chair Department of Physical Medicine & Lincoln, NE Rehabilitation & Chief Medical Offi cer Sridhara Channarayapatn, MD Moss Rehab & Albert Einstein Medical Center Moss Rehab Hospital & Albert Einstein Medical Director Gait & Motion Analysis Laboratory and Center Regional Amputee Center Elkins Park, PA Philadelphia, PA David L. Ciraulo, DO, FACS, MPH Mary Sue Jones, RN, MS Associate Professor Department of Surgery Trauma System Coordinator Surgical Associates Delaware Health & Social Services, Division of Public Portland, ME Health, Offi ce of EMS Dover, DE Arthur Cooper, MD, FACS Professor of Surgery Christoph Robert Kaufmann, MD, FACS Director, Trauma and Pediatric Surgical Services Associate Medical Director, Trauma Service Columbia University Affi liation at Harlem Hospital Legacy Emanuel Hospital Center Portland, OR New York, NY Jon R. Krohmer, MD, FACEP Gail F. Cooper Deputy Chief Medical Offi cer Trauma Systems Consultant US Department of Homeland Security ACS Trauma Systems Evaluation and Planning Washington, DC Committee El Cajon, CA Editor & Contributors iii Linda Laskowski-Jones, RN, MS, APRN, BC, Nels D. Sanddal, MS, REMT-B CCRN, CEN President Vice President, Emergency, Trauma & Aeromedical Critical Illness and Trauma Foundation Services Trauma Systems Consultant Christiana Care Health System ACS Trauma Systems Evaluation and Planning Newark, DE Committee Bozeman, MT Robert C. Mackersie, MD, FACS Professor of Surgery in Residence Heather A. Soucy San Francisco General Hospital Program Support Specialist San Francisco, CA Rural EMS & Trauma Technical Assistance Center Bozeman, MT N. Clay Mann, PhD, MS Associate Director for Research Shelly D. Timmons, MD, PhD, FACS Intermountain Injury Control Research Center Chief of Neurotrauma Division University of Utah School of Medicine Department of Neurosurgery Salt Lake City, UT University of Tennessee Health Science Center Memphis, TN J. Wayne Meredith, MD, FACS Medical Director, ACS Trauma Programs Jolene R. Whitney, MPA Richard T. Myers Professor and Chair, Department of Assistant Director General Surgery Bureau of Emergency Medical Services Division of Surgical Sciences Utah Department of Health Wake Forest University School of Medicine Salt Lake City, UT Winston-Salem, NC Michelle Wielgosz Holly Michaels Program Coordinator, Trauma Systems Consultation Program Coordinator, Trauma Systems Consultation American College of Surgeons American College of Surgeons Carol Williams Richard Mullins, MD, FACS Manager, Trauma Department Professor of Surgery American College of Surgeons Director, Trauma Service Robert J. Winchell, MD, FACS Oregon Health & Science University Head, Division of Trauma and Burn Surgery Portland, OR Maine Medical Center Avery B. Nathens, MD, PhD, FACS Portland, ME Canada Research Chair in Trauma Systems Development Division Head General Surgery & Director of Trauma St Michael’s Hospital Toronto, ON Michael F. Rotondo, MD, FACS Chair, ACS Trauma Systems Evaluation and Planning Committee Professor of Surgery and Vice Chairman for Clinical Aff airs Chief, Trauma & Surgical Critical Care East Carolina University School of Medicine Greenville, NC iv Regional Trauma Systems: Optimal Elements, Integration, and Assessment T C Contributors ............................................................................................................................................ iii Preamble ..................................................................................................................................................vii Section 1: Trauma System Assessment Injury Epidemiology .......................................................................................................................... 1 Indicators as a Tool for System Assessment ........................................................................................ 2 Section 2: Trauma System Policy Development Statutory Authority and Administrative Rules ...................................................................................5 System Leadership ............................................................................................................................. 6 Coalition Building and Community Support .................................................................................... 7 Lead Agency and Human Resources Within the Lead Agency ........................................................... 8 Trauma System Plan .......................................................................................................................... 9 System Integration ........................................................................................................................... 10 Financing ........................................................................................................................................ 11 Section 3: Trauma System Assurance Prevention and Outreach ................................................................................................................. 13 Emergency Medical Services ............................................................................................................ 14 Defi nitive Care Facilities .................................................................................................................. 17 System Coordination and Patient Flow ............................................................................................ 20 Rehabilitation .................................................................................................................................. 22 Disaster Preparedness....................................................................................................................... 23 System-wide Evaluation and Quality Assurance ...............................................................................24 Trauma Management Information Systems ..................................................................................... 26 Research .......................................................................................................................................... 27 Table of Contents v Section 4: Postconsultation Measures Postconsultation Measures ............................................................................................................... 31 Assessment ...................................................................................................................................... 31 Policy Development ........................................................................................................................ 32 Assurance ........................................................................................................................................ 34 Suggested Reading .............................................................................................................................. 37 Appendix A: Glossary of Terms, Acronyms, and Abbreviations............................................... 43 Appendix B: Prereview Questionnaire (PRQ) ................................................................................ 49 vi Regional Trauma Systems: Optimal Elements, Integration, and Assessment P Th e earliest organized systems of trauma care had 2 History of the American College components: (1) a concentration of care at centers of Surgeons Trauma System dedicated to the care of injured patients; and (2) Consultation Process prehospital bypass such that severely injured patients were transported not to the closest facility, but to Historically, in the United States, care of injured trauma centers. Th e focus on transport and defi nitive patients focused on trauma centers, not trauma care facilities,