Cara M. Christ, MD, Director BUREAU OF EMERGENCY MEDICAL SERVICES AND TRAUMA SYSTEM STATE TRAUMA ADVISORY BOARD 2019 ANNUAL REPORT This Report is Provided as Required by A.R.S. § 36-2222(E)(4) PREPARED BY Bureau of Emergency Medical Services and Trauma System Terry Mullins, MBA, MPH, Bureau Chief Gail Bradley, MD, Medical Director Benjamin Fisher, MPA, NRP, Services Section Chief Vatsal Chikani, MPH, BHMS, Epidemiological Data and Quality Assurance Manager Sri Vidya Mahankali, MS,BDS, Senior Epidemiologist Mary Benkert, Trauma Data Administrator Anne Vossbrink, MS, EMS Data Administrator Page 2 STATE TRAUMA ADVISORY BOARD MEMBERSHIP 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. Gail Bradley, MD, Chairperson Debbie Johnston, Vice President, Policy Development ADHS BEMSTS Medical Director Statewide Hospital Association Representative Phoenix, AZ Phoenix, AZ Shawn Bowker, RN , BSN Jennefer Kieran, MD, FACS Local Regional EMS Coordinating Council - Northern Region Federal Indian Health Services Organization Representative Representative Phoenix, AZ Flagstaff, AZ Mike Garcia Neil Williamson, NRP Fire Department in a County with a Population > 500,000 Department of Public Safety Representative Representative Phoenix, AZ Tucson, AZ Judy Baum, PT, MSHA David Notrica, MD, FACS, FAAP Statewide Rehabilitation Facility Representative Statewide Pediatric Organization Representative Prescott Valley, AZ Phoenix, AZ Vicki Bennett, RN, MSN Nirav Patel, MD, FACS Society of Trauma Nurses Representative Statewide Organization Representing a National College of Phoenix, AZ Surgeons for Trauma Services Phoenix, AZ Herman Butler Rodney A. Reed, NREMT-P Tribal Health Organization Representative Local Regional EMS Coordinating Council - Western Region Representative Tuba City, AZ Yuma, AZ Franco Castro-Marin, MD Roy Ryals, CEP National Organization of Emergency Physicians Representative Local Regional Coordinating EMS Council – Central Region Representative (PMD Liaison) - Scottsdale, AZ Phoenix, AZ Brent Burgett, NRP Chris Salvino, MD, MS, FACS Statewide Ambulance Association Representative Trauma Center Representative Mesa, AZ Lake Havasu City, AZ Jeff Farkas, CEP Melissa Anderson, RN, MSN Statewide Fire District Association Representative Local Regional EMS Coordinating Council - Southeastern Region Show Low, AZ Representative Tucson, AZ Iman Feiz-Erfan, MD Clifford Jones, MD Statewide Neurosurgical Society Representative National Association of Orthopedic Trauma Representative Phoenix, AZ Phoenix, AZ Garth Gemar, MD Andrew Tang, MD, FACS National Association of Retired Persons Representative Trauma Center Representative / Vice Chair Phoenix, AZ Tucson, AZ Philip Johnson, MD Tara Johnson, MSN, CCRN Rural ALS Base Hospital that is not a Trauma Center Representative Urban Advanced Life Support Base Hospital that is not a Trauma Center Show Low, AZ Representative Chandler, AZ Page 3 TRAUMA & EMS PERFORMANCE IMPROVEMENT STANDING COMMITTEE MEMBERSHIP Josh Gaither, MD Ralph Zane Kelly, DO EMS Researcher (AEMRC)/Chair State Designated Level III Trauma Center Program Manager Tucson, AZ Tuba City, AZ Melissa Moyer, CSTR Carey Lewis, CPNP-AC/PC Representative of the Trauma Registry Users Group/Vice Chair Pediatric Representative (MD or RN) Phoenix, AZ Phoenix, AZ Corbin King, FP-C Tom Flanagan, NRP Air Ambulance Premier EMS Agency Ground Ambulance or First Responder Premier EMS Agency – Quality Quality Improvement Officer Improvement Officer (NAEMS/WACEMS) Gilbert, AZ Prescott, AZ Danielle Stello, RN Nirav Patel, MD, FACS Prehospital EMS Coordinator - Base Hospital (NAEMS/WACEMS) State Trauma Advisory Board Liaison Lake Havasu City, AZ Phoenix, AZ Raymond Proa, NREMT-P James Cunningham, V, RN, NREMT –P EMS Registry Group Member Ground Ambulance or First Responder Premier EMS Agency, Quality Fort Mohave, AZ Improvement Officer (SAEMS/AEMS) Mesa, AZ Paul Dabrowski, MD Heather Miller, BSN, RN, CEN, TCRN Trauma Surgeon Western Arizona Council of Emergency Services Phoenix, AZ Kingman, AZ Candyce Williams, MD Tiffiny Strever, RN Rehabilitation Specialist State Designated Level I Trauma Center or Trauma Program Phoenix, AZ Representative Phoenix, AZ Dale Woolridge, MD Pam Noland, RN Injury Researcher (AEMRC) State Designated Level IV Trauma Center Program Manager Tucson, AZ Willcox, AZ Garth Gemar, MD James Cesolini, CEP, EMT-T, DMT EMS Medical Director of a Premier EMS Agency Law Enforcement Representative with Active Involvement in EMS Phoenix, AZ Mesa, AZ Pamela Goslar, PhD Julie Augenstein, MD IPAC Representative Medical Direction Commission Liaison Phoenix, AZ Phoenix,AZ Michelle Guadnola, RN Laura Smith, DNP, RN, CEN State Designated Level I Trauma Center Trauma Program State Designated Level I Trauma Center Trauma Program Representative Representative Phoenix, AZ Glendale, AZ Rebecca Haro, NREMT-P EMS Council Liaison Phoenix, AZ Amber Prince, RN Prehospital EMS Coordinator (SAEMS/AEMS) Tucson, AZ Page 4 BUREAU OF EMS AND TRAUMA SYSTEM REPORT Director Christ: We are honored to submit the State Trauma Advisory Board 2018 Annual Report. This report, required by A.R.S.§36-2222(E)(4), summarizes data collected by all Arizona trauma centers. This report has been reviewed and approved by the members of the State Trauma Advisory Board during the January 23, 2020 board meeting. Several events of note occurred this year: To assist injury prevention efforts of trauma centers, base hospitals and EMS providers, the Data and Quality Assurance Section now includes zip-code level injury and demographic information in new quality assurance reports. This enhancement will help providers with limited injury prevention resources to target specific communities of interest. The Data and Quality Assurance Section created and launched an externally-facing dashboard allowing the public to review and create reports from injury data collected by Arizona’s 40+ trauma centers. To improve access to quality improvement data for Arizona’s trauma centers, base hospitals and EMS agencies, the Bureau worked with ADHS IT to launch an agency-specific reports portal. This is a significant improvement from past practices, where Bureau staff individually sent secure emails to each hospital and EMS agency each time a report was created. Using CMS grant funds supplied by AHCCCS, the Bureau was able to accomplish a key goal - linking the state’s EMS registry with the single state health information exchange. While this is not a trauma-specific activity, it will help to improve all EMS care, including the care provided by EMS for injured patients. In short, this linkage will provide EMS agencies with timely outcome and disposition data to drive their quality improvement initiatives and it will provide hospitals with a copy of the EMS report more quickly than before. More work needs to be done to improve system operation, but this step puts Arizona at the forefront of EMS quality improvement in the U.S. Lancet Technology, the trauma registry vendor used by Arizona, experienced a significant work flow issue, delaying the import and download of trauma records into the Arizona State Trauma Registry, and subsequently, the development of this report by 4 months. In December, Lancet Technology and several other EMS and trauma registry vendors were acquired by ESO. The Bureau will monitor Lancet’s performance closely during this transition. On behalf of the members of the State Trauma Advisory Board, we appreciate the opportunity to provide you with a summary of Arizona’s trauma activities this past year. Sincerely, ___________________________________ ___________________________________ Gail Bradley, MD FACEP FAEMS, Medical Director Terry Mullins, MBA, MPH, Bureau Chief Page 5 EXECUTIVE SUMMARY Traumatic injury is a tremendous health concern in the United States. In the last decade, trauma deaths increased by 22.8%,1 making them the leading cause of years of potential life lost.1,2 For those who survive, trauma can lead to lifelong physical suffering and places a substantial economic burden on the health system. In Arizona, the rate of traumatic injury continues to increase. In 2018, Arizona’s trauma centers treated 54,273 people, of whom 1,227 (2.26%) died. In 2017, Arizona’s age-adjusted injury mortality rate was 81 per 100,000, while the national rate was 72 per 100,000, putting Arizona at 32nd place compared to other states.2 Traumatic injury exacts a significant financial burden on the state. In Arizona for the year 2018, trauma centers charges totaled $2.6 billion, with a median charge per patient of $28,068. Falls resulted in over one trillion dollars in charges in 2018. Hospital reimbursement has remained consistently low, around 14.3%. Unintentional injuries account for the majority of all traumas in Arizona and nationally.4 The top three mechanisms were Falls (43.28%), Motor Vehicle Traffic, MVT (21.7%), and Struck by/Against (6.92%), which made up 72% of all traumas in Arizona. Firearms and MVT-Pedestrian accounted for less than 2.5% of trauma individually but both had a disproportionately higher mortality of 17.62% and 11.51% respectively as compared to other traumas. Although trauma affects all people, males and individuals