2. Planning Members Kathi Ayers, RN. MSN, Trauma Program Manager, Sharp San Diego Bruce Barton, Agency Director, Riverside EMS Raul Coimbra, Chief Division of Trauma/Burns UCSD Medical Center (Lead) Brent Eastman, Chief Medical Officer Scripps Health Les Gardina, QA Specialist San Diego EMS Chris Van Gorder, President and CEO Scripps Health Virginia Hastings, Executive Director, Inland Counties EMS Agency Dorothy Kelley, Trauma Services Director Scripps Mercy Hospital Ryan Kelley, Agency Director, Imperial County Cynthia Marlin-Stoll, Riverside County Department of Public Health Sue Cox, Director of Trauma Services, Rady’s Children’s Hospital Sharon Pacyna, RN, MPH, Trauma Program Manager, UCSD Facilitators: Bonnie Sinz, Chief EMS Systems Division EMSA Johnathan Jones, State Trauma Coordinator, EMSA Region #5 – Interim Regional Trauma Coordinating Committee

3. Structure Steering Committee – Triage Subcommittee – Performance Improvement Subcommittee – Repatriation Subcommittee – Funding Subcommittee

4. Achievements Monthly Conference Calls Steering Committee Two Regional Summit Meetings Temecula, January 2009 Palm Springs, June 2009 Loma Linda – planned for February 2010

5. Regional Representation All Trauma Centers (Level I, II, IV, Pediatric) 4 LEMSAs Pre-hospital Agencies (Ground and Aeromedical) Fire Agencies State of California Department of Corrections and Rehabilitation CHP Hospital Associations Registrars

6. Triage TAKE TO A TRAUMA CENTER: PHYSIOLOGY GCS < 14 SBP < 90 RR 30 Special Age Consideration: >70 y/o SBP <100 < 1 y/o RR <20 ANATOMICAL INJURIES Penetrating injury to: head, neck or torso, extremities proximal to elbow/knee. Amputation proximal to wrist/ankle 2 or more proximal long bone fractures Crushed, degloved or mangled extremity Open or depressed skull fracture Paralysis

7. Triage continued IF PATIENT DOES NOT MEET ANY OF THE ABOVE CONSIDER TAKING TO A TRAUMA CENTER Falls > 20 ft – Peds* fall > 10 feet or 3 times height of child High risk auto crash – Intrusion > 12” driver side, >18” any side – Death in same passenger compartment – Auto vs pedestrian/cyclist thrown or run over w/ significant impact, >20mph

8. Triage continued SPECIAL CONSIDERATIONS Very young / very old – Adults > 70 years – Peds – consider a pediatric trauma center Anticoagulation therapy (Plavix, ASA, Coumadin) Time sensitive extremity injury Pregnancy > 20 weeks Burns – With trauma to a trauma center – Without trauma to a burn center

9. PI Successes and Challenges Successes Consensus to submit trauma data to CEMSIS Examine consistency of intra-county data element definitions Conduct intra-county data collection Challenge Time required to participate in a constructive manner

10. PI Goals Apply audit filters to compare intra-county outcomes and practice patterns Interfacility Transfer Survey – process obstacles/facilitators Develop Practice Guidelines for Open Fractures (adult/pediatric) Develop Fracture Decision Tree

11. Repatriation Goals Identify 5 primary placement/repatriation barriers Define categories of “difficult placement patients” (e.g. dialysis, behavior problem, non-documented, homeless etc.) Develop a survey for SE RTCC trauma centers to identify current repatriation practices and tracking processes for difficult placement patients Identify Trauma Center fiscal and discharge planning representatives for participation on redesigned committee focused on patient placement

12. Repatriation Successes Developed a Survey and distributed it to all SE RTCC Trauma Centers. Questionnaire targeted current methods of identifying and tracking difficult to place trauma patients. Contacted Trauma Center’s fiscal personnel and discharge planners for inclusion in Repatriation subcommittee activities.

13. Repatriation Challenges Identify and overcome system barriers to placement in Long Term Care facilities Quantify “difficult placement patients” in subcategories (e.g. dialysis, behavior problem, non- documented, homeless etc.) Create a collective vision for alternative solutions to regional repatriation issues Obtain cooperation of Trauma Centers to share financial information to track patient costs

14. Funding Task Force Bruce Barton, Administrator Riverside County EMS Agency Virginia Hastings, Executive Director Inland Counties EMS Agency Ryan Kelley, Administrator Imperial County EMS Agency Marcy Metz, Administrator San Diego County EMS Agency

15. Funding Funding for hospitals and physicians may be a key factor in successful regionalization of trauma systems A complete discussion of funding must include repatriation opportunities/responsibilities Traditional funding sources for uncompensated care generally come through counties Any reappropriation of county funding must be approved by our various Boards of Supervisors/Governing Boards

16. Funding Goals and Objectives Work with county budget analysts to discuss current revenue streams that are generally used to pay for MIA/indigent/uncompensated care Using trauma registries, identify patients that cross county/state lines Identify payor source for those patients Identify county/state/country of incident when possible Aggregate patient charges when available Collect and analyze trauma financial data that can be utilized to garner funding in the legislature Develop blueprint for integrated, well developed trauma systems.

17. Funding Challenges SURPRISE !!! OBSTACLES WE ALL DO THINGS DIFFERENTLY !

18. Overall Goals Establish a Region-Wide QI Meeting Interface with other RTCCs Disaster Planning

19. How our region can foster California’s State Trauma System Identifying and Standardizing Best Practices Developing Region-Wide QI Meeting Establishing Inter-County Communication Channels