TIME CRITICAL DIAGNOSIS November 2015

OBJECTIVE TCD Background TCD Overview Bureau of Hospital Standard’s Role TCD Designation Process Transport Protocol Questions

BACKGROUND

BACKGROUND More than 400 partners from health care and emergency response organizations from across Missouri have been working for the past several years to create the Time Critical Diagnosis System. A task force met regularly to develop recommendations for the system. The effort was led by the Missouri Department of Health and Senior Services and the Missouri Foundation for Health. The Missouri Department of Health and Senior Services developed the regulations and will provide administrative oversight for the system.

Missouri’s Time Critical Diagnosis System

MISSOURI’S TCD SYSTEM Missouri’s Time Critical Diagnosis System is a new statewide system that brings together the 911 emergency phone system, ambulance services, and hospitals in a coordinated way to provide quicker and higher-quality treatment. The system will help increase the survival and recovery rate of people suffering a traumatic injury, stroke, or heart attack.   The new system builds on Missouri’s existing trauma system, which indentifies specific hospitals as trauma centers specially equipped for the treatment of serious injuries. The Time Critical Diagnosis System includes hospitals that are designated as specially equipped to treat stroke and heart attack, particularly STEMI, a specific type of heart attack.

MISSOURI’S TCD SYSTEM Missouri is the first state in the nation to enact legislation authorizing the creation of a statewide system of care for stroke and STEMI patients that is modeled after the trauma center system. Hospitals participating in the system must meet certain requirements to be designated as a trauma, stroke and/or STEMI center. Those requirements include having specialized medical teams and services available 24 hours a day, seven days a week. Each designation is granted separately, based on a hospital’s ability to meet the requirements for each type of emergency treatment.

BUREAU OF HOSPITAL STANDARDS AN OVERVIEW

BUREAU OF HOSPITAL STANDARDS (BHS) Trauma Regulations began on February 28, 1999. Those facilities that submitted application for trauma designation were surveyed under the Bureau of Emergency Medical Services. In December 2012, BHS became responsible for implemention and oversight of the Time Critical Diagnosis (TCD) program, which includes trauma, stroke, and STEMI. The Stroke/STEMI Regulations went into effect on June 30, 2013.

BUREAU OF HOSPITAL STANDARDS (BHS), continued There are 32 designated Trauma centers. The Trauma centers renew every 5 years. There are 48 designated Stroke centers. The Stroke centers renew every 4 years. 56 STEMI applications have been received and BHS is currently in the process of designating the facilities. The STEMI centers renew every 3 years.

Designated Centers Level I centers are receiving centers staffed 24/7 and equipped to provide total care for every aspect of trauma, stroke or STEMI care, including care for those patients with complications, that also functions as a resource center for the hospitals within that region, and conducts research. Level II centers are receiving centers staffed and equipped to provide care for a large number of patients within the region.

Designated Centers, cont. Level III centers are a referral center staffed and equipped to provide prompt assessment and sometimes intervention to the patient. A level III center may keep or transfer patients to a higher level care center as necessary. Level IV centers are a referral center in an area considered rural or where there are insufficient hospital resources to serve the patient population requiring TCD care. A level IV center provides prompt assessment, indicated resuscitation, appropriate emergency care, and arranges an expedites transfer to a higher level of care center as needed.

DESIGNATION PROCESS Applications for trauma, stroke, &/or STEMI must be complete and accepted prior to scheduling on-site reviews. All reviews will be conducted by a team of contracted reviewers which includes three physicians, a program manager, and members of DHSS. Information on the application, regulations, and the designation process can be found on the DHSS TCD website or by contacting a TCD Program Coordinator. Regulations: Trauma 19 CSR 30-40.430 Stroke 19 CSR 30-40.730 STEMI 19 CSR 30-40.760 http://health.mo.gov/living/healthcondiseases/chronic/tcdsystem/regsforms.php

CURRENT LOCATION OF DESIGNATED TRAUMA AND STROKE CENTERS

Minutes Matter. Call 911.

MISSOURI’S TCD SYSTEM The primary goal of the Time Critical Diagnosis System is to provide the right care at the right place at the right time for trauma, stroke and heart attack patients.   Because calling 911 is key to the emergency response system, health officials have developed a new public education campaign, “Minutes Matter. Call 911.”

MINUTES MATTER “Minutes Matter. Call 911.” urges Missourians to call 911 for emergency medical help for trauma, stroke and heart attack. Too often Missourians do not call 911 and instead drive themselves or family members or friends to the hospital or they wait too long to call for emergency help, which reduces the patient’s chance for survival or a full recovery.

MINUTES MATTER More information on the Minutes Matter campaign can be found at: www.health.mo.gov/tcdsystem (this will take you to the MO TCD Website) Then go to: TCD Public Education Materials

Transport protocol

TRANSPORT PROTOCOL On March 23, 2015, the Bureau of EMS began the enforcement of Section 190.243.1, RSMo. (Cum.Supp.2013), which provides that “patients who suffer a stroke, as defined by Section 190.100, shall be transported to a stroke center”. 19 CSR 30-40.790 establishes protocols for all ground and air ambulances to follow when transporting suspected stroke patients. However, Section 190.200.3, RSMo. (Cum.Supp.2013) provides that these regulatory requirements relevant to the transport of stroke patients may be waived by the proper submission and approval of a “community-based or regional transport plan”. It is important to understand that a waiver is not available to any service until the community-based or regional transport plan has been approved as indicated in 19 CSR 30-40.770. In the absence of an approved plan, compliance with the requirements set out in Section 190.243 RSMo and 19 CSR 30-40.790 will be required.

QUESTIONS?

CONTACT INFORMATION Donya Lowrie, RN, BHS Administrator Email: Donya.Lowrie@health.mo.gov Phone: 573-751-6303 Nicole Gamm, RN, TCD Program Coordinator Email: Nicole.Gamm@health.mo.gov Phone: 573-751-6357 Arlinda Kinkead, RN, TCD Program Coordinator Email: Arlinda.Kinkead@health.mo.gov Phone: 573-526-0723 Peggy Huddleston, Administrative Assistant TCD Registry Administrator Email: Peggy.Huddleston@health.mo.gov Phone: 573-526-1969