our emerging vision georgia trauma care network commission
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February 2009
Dear Georgia Trauma & EMS Community,
On behalf of the Georgia Trauma Care Network Commission, I am pleased to present the Five Year Georgia Trauma System Strategic Plan that we have prepared to guide the full development of the Georgia Trauma System. It will initially be used to support sustainable trauma system funding from the State Legislature in this session, which as you know will be very challenging.
!"#$"%&"'"#()&*#+%,-#."/"0(*#()"#(."1"-234*#53.6#1,-7#38#734#),'"#03-240("2#()&*#2"0,2"#&-#advocating for an effective trauma and EMS system throughout Georgia. This includes those who worked with the Legislature’s Joint Comprehensive State Trauma Services Study in 2006, which led to the formation of the Commission and last year’s $59 million in initial funding, as well as in the recent American College of Surgeons Trauma System Consultation.
!"#$"%&"'"#()&*#+%,-#."/"0(*#()"#-""2*#38#9"3.:&,;#$"*(#+.,0(&0"*#8.31#,.34-2#()"#-,(&3-;#,-2#innovative concepts many of you have offered to make it a model for the nation. It is entitled <=4.#>1".:&-:#?&*&3-@#$"0,4*";#5&()#734.#)"%+;#&(#5&%%#03-(&-4"#(3#"'3%'"#,-2#$"#."A-"2#(3#meet Georgia’s needs. We are proposing a robust stakeholder structure to assure strong participation at the local and regional level, as well as statewide. We welcome your comments and ideas, and invite you send them through Jim Pettyjohn, GTCNC Administrator, at Jim@ lacueva.com.
We also believe Georgia has the opportunity to not only catch up with the rest of the country in trauma care with a stateoftheart trauma system, but help lead the nation by developing a new public service that assures emergent, high quality care throughout the state for the seriously injured, stroke and heart attack victims, and adults and children needing emergency surgery. 9"3.:&,-*#:"-".,%%7#(,6"#+3%&0"#,-2#A."#*".'&0"*#83.#:.,-("2B#&(#&*#(&1"#83.#9"3.:&,-*#(3#),'"#the same expectation of its trauma and emergency services!
We hope that our hard work matches your commitment and expectations. Your help will be more critical than ever in obtaining the needed support from the State of Georgia to make a stateoftheart trauma system a reality in Georgia. We look forward to working with you to make this happen.
Sincerely,
Dennis Ashley, M.D., ChairGeorgia Trauma Care Network Commission
OUR EMERGING VISION
Georgia Trauma Care Network Commission
A New Public Service for Georgia
20092014 GTCNC STRATEGIC PLAN
OUR EMERGING VISION
20092014 GTCNC STRATEGIC PLAN
TRAUMA & EMERGENCY CARE: A NEW PUBLIC SERVICE FOR GEORGIA
Georgia Trauma Care Network Commission
In 2008, Georgia provided $59 million to the Georgia Trauma Care Network Commission to stabilize the state’s trauma system. It worked as
intended and substantially strengthened the remaining trauma centers. Several trauma centers were contemplating dropping out of the system, and
the stabilization worked. This level of funding needs to be continued for the existing trauma centers, as well as for physicians and EMS. In addi
tion to determining the appropriate distribution of the $59 million, the Commission also developed over the last few months a vision for the Georgia
Trauma System to be achieved over 5 years:
Immediate Objectives 200910
1. Obtain Permanent Trauma System FundingWithout a permanent funding mechanism, trauma system development cannot proceed and it will be impossible to recruit any new trauma
centers into the Georgia trauma system.
2. Maintain and Expand Georgia’s Trauma Centers, Focusing On South Georgia!"#$%&'()'$*#+%#&,-$.(+/0+1$*(%$%"#0&$'++('2$23,,$0+$"'2.$'+/$4',$,(.5*0#+%$.3&$%"#)$%3$)'0+%'0+$%"#0&$,%'%(,6$!"#$73))0,,03+$*3+/(*%#/$discussions with hospitals that have a potential for becoming designated as Level II & III trauma centers, with a focus on South Georgia
where the need is greatest. These discussions indicated that 46 Level II & III trauma centers could be developed in 20092010 if they are
',,(&#/$,(,%'0+'82#$.(+/0+1$'+/$'$%&'+,.#&$,9,%#)$%3$)'+'1#$%"#$:34$3.$%&'()'$;'%0#+%,63. Strengthen Emergency Medical Services Focusing On Rural Regions
Due to the integral relationship between EMS and trauma care, the Commission has placed a major emphasis on strengthening EMS. Major
0+0%0'%0<#,$0+*2(/#$,(;;3&%$.3&$&#'/0+#,,=$&#,3(&*#,$%'&1#%#/$'%$&(&'2$g+,=$*3+,320/'%03+$3.$>?@$A0,%&0*%,$%3$;&3)3%#$#.5*0#+*9=$'$BC@DE(%3)'%0*$F#"0*2#$G3*'%3&$@9,%#)=$'+/$'0&$)#/0*'2$%&'+,;3&%6$!"0,$,"3(2/$1&34$3<#&$%0)#$0+%3$'$.(229$0+%#1&'%#/$>?@D!&'()'$,9,%#)$%"'%$assures high quality emergency care for all, regardless of their type of injury or illness.
4. Develop Statewide Trauma Transfer SystemE$%&'()'$%&'+,.#&D*3))(+0*'%03+,$*#+%#&$%"'%$*33&/0+'%#,$%&'()'$;'%0#+%$%&0'1#=$%&'+,.#&$'+/$%&'+,;3&%$4022$8#$8(02%$%3$',,(&#$%"'%$0+H(&#/$patients are quickly transported to the most appropriate trauma facility. This state’s 4 Level I trauma centers would take on this responsibility.
5. Build Trauma System Infrastructure Under Department of Health The Commission asked for an external, “warts and all” American College of Surgeon’s Trauma System Consultation, and they were stunned
by the lack of state support for trauma system infrastructure in Georgia. In order to build an effective state trauma system, an effective and
fullystaffed Division of EMS & Trauma under the Department of Health will be essential.
6. Establish Mechanisms To Assure Exceptional AccountabilityIn 20092010, the Trauma Commission will develop a performance improvement and accountability system to assure optimum performance
by all trauma system components. This approach will assure the best possible value for Georgia’s investment in its trauma system.
5 Year Objectives
!" C023%DI(02/$!&'()'$!#2#)#/0*0+#$@9,%#)!" >+"'+*#$C#/0'%&0*$!&'()'$@(8,9,%#)!" @%&#+1%"#+$C"9,0*0'+$@(;;3&%$J3&$!&'()'$7'&#$K+$L(&'2$B#3&10'!" >M;'+/$@9,%#)$!3$L#"'8020%'%03+=$I(&+$7'&#=$N$K+%#&,%'%#$!&'+,.#&,$!" E,,0,%$K+$K+0%0'%0<#,$!3$L#/(*#$!&'()'%0*$K+H(&9$!" K+%#1&'%#$!&'()'$@9,%#)$O0%"$A0,',%#&D!#&&3&$C&#;'&#/+#,,!" Expand System To Acute Emergency Care Needs
Organizational Objectives
!" A#<#23;$!&'()'$@9,%#)$L#103+'20P'%03+$K+$B#3&10'!" 73+%0+(#$A#<#23;0+1$!&'()'$@9,%#)$C320*9D@%'Q#"32/#&$@%&(*%(&#
A New Public Service
Georgia has the opportunity to not only catch up with the rest of the country in trauma care, but help lead the nation by developing a new public
service that assures emergent, high quality care throughout the state for the seriously injured, stroke and heart attack victims, and adults and
children needing emergency surgery. This vision for the Georgia Trauma System will bring a high value to everyone. Georgia generally takes police
'+/$5&#$,#&<0*#,$.3&$1&'+%#/=$'+/$0%$0,$%0)#$.3&$%"#$,%'%#$%3$"'<#$%"#$,')#$#M;#*%'%03+$3.$0%,$%&'()'$'+/$#)#&1#+*9$,#&<0*#,6
The Best Way To Fund The Georgia Trauma System
While there are a variety of funding sources for trauma care in the nation, the best practice is one that is trauma related, is a sustainable source
of funding, and expands with population growth. Half of trauma injuries result from motor vehicle crashes, so an added fee on annual vehicle

,%&'%03+,$5%,$%"0,$;&352#$;#&.#*%296$E$RST$.##$;#&$<#"0*2#$
,%&'%03+$43(2/$&'0,#$RUV$)02203+$'++('229=$%"#$';;&3M0)'%#$')3(+%$+##/#/$%3$,(,%'0+$a fully developed Georgia trauma system and new public service.
!"#"$%&'()'*'+,--.'/"0"-(1"2'34*,5*'6.&%"5''The return on Georgia’s investment in trauma will include a reduced death rate from injury, especially in the “corridor of death” along I75 in
@3(%"$B#3&10'=$#M*#;%03+'2$%&'()'$*'&#$%"&3(1"3(%$%"#$,%'%#=$*3,%$,'<0+1,$0+$;'%0#+%$%&#'%)#+%=$%"#$#*3+3)0*$8#+#5%,$3.$,'<0+1$20<#,$3.$93(+1#&=$;&3/(*%0<#$;#3;2#=$'+/$,;0+W3..$8#+#5%,$%3$#)#&1#+*9$*'&#$'+/$/0,',%#&D%#&&3&$;&#;'&#/+#,,6
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20092014 GTCNC STRATEGIC PLAN 20092014 GTCNC STRATEGIC PLAN20092014 GTCNC STRATEGIC PLAN
OUR EMERGING VISION
OUR EMERGING VISION: A NEW PUBLIC SERVICE FOR GEORGIA
J#8&('&9$XTTY$
Georgia is experiencing a crisis in trauma care that has placed at risk anyone who is seriously injured in the state.
The Governor, Lieutenant Governor and Speaker of the House responded in 2008 by appointing the Georgia Trauma
Care Network Commission (GTCNC), and providing initial funding of $59 million to stabilize and strengthen the state’s
remaining trauma centers and help support trauma patient care and transport by Emergency Medical Services.
This strategy worked as intended, and with sustainable funding, the Georgia trauma system will not only remain intact, it
will both be strengthened and expanded to meet the needs in the state.
The Georgia Trauma Commission has pursued an aggressive assessment and planning process, which included
reviewing the extensive record of stakeholder input over the past several years, a review of the Georgia trauma system
by the American College of Surgeon’s Trauma System Consultation program, economic analysis by Georgia State
Z+0<#&,0%9-,$B#3&10'$[#'2%"$C320*9$7#+%#&=$'+/$%&'()'$,9,%#)$*3+,(2%0+1$,(;;3&%$;'&%0'229$.(+/#/$89$%"#$[#'2%"*'&#$B#3&10'$J3(+/'%03+6
This has enabled the Georgia Trauma Commission to outline a vision for the Georgia Trauma System for the decades
'"#'/=$'+/$/#5+#,$'$*3,%W#..#*%0<#$;2'+$.3&$)3<0+1$'*"0#<#)#+%$3.$%"0,$<0,03+$.3&4'&/$3<#&$'$5<#$9#'&$;#&03/=$8#%4##+$2009 and 2014. The silver lining of the cloud of Georgia’s previously poorly supported trauma system is that today‘s
technology is much better and more cost effective, and other states now offer best practices on issues Georgia faces.
In addition, Georgia has a unique capability for innovation on trauma care due to the high level interest and commitment
to developing the best system possible by trauma care providers, philanthropic and academic organizations, hospital,
physician and EMS stakeholders, and the highest levels of state government. As a result, Georgia is now poised to
build a model trauma system for the nation.
A major feature of this emerging vision is a statewide system built to optimize trauma care that also strengthens inter
related state systems and sectors for:
!" Emergency Medical Services
!" A0,',%#&D!#&&3&$C&#;'&#/+#,,!" Emergent cardiac, stroke and other emergency surgery cases
!" >)#&1#+%$;'%0#+%$:34$%3$'+/$.&3)$'22$"3,;0%'2,$\#616=$>A$/0<#&,03+$,32(%03+,]!" Georgia’s healthcare safety net
This approach will produce the best possible value for Georgia’s investment in a trauma system. It will coalesce
the fragmented components of trauma and emergency care into a new public service that will assure that should
anyone need acute emergency care, no matter where they are in the state, they will be transported professionally
and expeditiously to a reasonably close facility fully capable of providing the necessary treatment. Georgia generally
%'Q#,$;320*#$'+/$5&#$,#&<0*#,$.3&$1&'+%#/=$'+/$0%$0,$%0)#$.3&$%"#$,%'%#$%3$"'<#$%"#$,')#$#M;#*%'%03+$3.$0%,$%&'()'$'+/$emergency services.
GEORGIA TRAUMA CARE NETWORK COMMISSION
Dennis Ashley, M.D. Chairman
Linda Cole, R.N.
Leon Haley, M.D.
Ben Hinson, EMTP
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Rhonda Medows, M.D.
Bill Moore
Joe Sam Robinson, M.D.
Kurt Stuenkel
Kelli Vaughn, R.N.
20092014 GTCNC STRATEGIC PLAN
OUR EMERGING VISION
20092014 GTCNC STRATEGIC PLAN
FIVE YEAR GEORGIA TRAUMA SYSTEM STRATEGIC PLAN OUTLINE
The objectives of the 20092014 plan, with short term objectives in bold, are as follows:
1. Obtain Permanent Trauma System Funding2. Maintain & Expand Georgia’s Trauma Centers Focusing On South Georgia3. Strengthen Emergency Medical Services Focusing On Rural Regions4. Develop Statewide Trauma Transfer System5. Pilot/Build Trauma Telemedicine System6. Enhance Pediatric Trauma Subsystem7. Strengthen Physician Support For Trauma Care In Rural Georgia8. Expand System To Rehabilitation, Burn Care & Interstate Transfers 9. Assist In Initiatives To Reduce Traumatic Injury 10. Integrate Trauma System With Disaster/Terror Preparedness11. Expand System To Acute Emergency Care Needs 12. Develop Trauma System Regionalization In Georgia13. Continue Developing Trauma System Policy/Stakeholder Structure14. Build Trauma System Infrastructure Under Department of Health15. Establish Mechanisms To Assure Exceptional Accountability
!"#$%%&'(")'&%*+,'-"),'"&"./*"(*&'"01&2"34&3"&##$'*#"*))*536/*"6%01*%*23&36,2"&27")$11"#(#3*%"accountability is attached. The Five Year 20092014 Trauma System Strategic Plan is as follows:
1. OBTAIN PERMANENT FUNDINGWithout a permanent funding mechanism, trauma system development cannot proceed and it will be impossible to recruit any new trauma centers into the Georgia trauma system.
2. MAINTAIN & EXPAND GEORGIA’S TRAUMA CENTERS FOCUSING ON SOUTH GEORGIA The initial 2008 funding has stabilized and strengthened Georgia’s remaining 13 Level I & II trauma centers. They received $36 million to help with the added costs they incur due to their trauma center status, and passed on another $12 million to their trauma medical staff. A grant program of $4.2 million also supported additions of critical equipment purchases at the state’s trauma centers.
The Commission surveyed these trauma centers to establish a baseline for measuring progress in strengthening Georgia’s trauma centers and performance of them. For example, the average score for the challenge Level II trauma centers faced in maintaining support of major trauma specialties in 2007 was 3.2 (on 14 scale with 4 indicating extreme problem). In 2008 this had declined to 2.8, 0',/67628"&2"*&'1("62765&36,2",)"34*"6%0&53",)"34*"#3&3*9#".2&256&1"#$00,'3:"
;*("%*&#$'*#",)"3'&$%&"5*23*'"0*'),'%&25*"+611"<*"*#3&<16#4*7"3,"$26),'%1("%,263,'"7*.2*7"=$&163("indicators. These indicators may include:
>" Number of hours of “diversion” (i.e., denying access to injured patients) >" Quality of trauma care assessments conducted monthly at each trauma center>" Regional and statewide quality of trauma care reviews>" ?'&$%&"5*23*'"7*#682&36,2"'*/6*+#"5,27$53*7"<("34*"@).5*",)"ABCD?'&$%&"3,"&##$'*"&74*'*25*"
to trauma center requirements
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20092014 GTCNC STRATEGIC PLAN 20092014 GTCNC STRATEGIC PLAN20092014 GTCNC STRATEGIC PLAN
OUR EMERGING VISION
By 2014, based upon this plan and national trends, we anticipate the state’s trauma centers will have taken on added responsibilities in acute emergency care, including regional transfer system management and a broader role in emergency surgery.
The Commission has conducted discussions with hospitals that have the potential for becoming designated as Level II and Level III trauma centers, with a focus on South Georgia where the need is greatest. These discussions indicate that 4 to 6 Level II and Level III trauma centers may be developed between 2009 and 2011 under the following conditions:
1. New trauma centers would receive sustainable funding at the level trauma centers received in 2008. (They are being asked to make a long term commitment.)
2. !"#3&3*+67*"3'&$%&"3'&2#)*'"#(#3*%"34&3")&56163&3*#"34*"E,+",)"3'&$%&"0&36*23#"'*=$6'628"&"4684*'"level of care to trauma centers, and when appropriate with low severity patients, requires they remain in their local hospital for care.
3. The startup of several trauma centers to assure a new trauma center is not overburdened with volume due to pent up demand in its greater region.
The key initial measure of performance for them to obtain funding is whether they can meet stringent trauma center requirements. Thereafter, the trauma centers’ performance would be measured with the same system used for all Georgia trauma centers.
3. STRENGTHEN EMERGENCY MEDICAL SERVICES FOCUSING ON RURAL REGIONSF$*"3,",</6,$#"2**7#"&%,28"G*,'86&9#"%&2("&27"/&'6*7"A%*'8*25("B*765&1"C*'/65*#"0',8'&%#H"34*"623*8'&1"'*1&36,2#460"<*3+**2"ABC"&27"3'&$%&"5&'*H"&27"<*#3"0'&5365*#"62",34*'"#3&3*#H"34*"I,%%6##6,2"4&#"3&-*2",2"#6826.5&23"'*#0,2#6<6163("),'"#3'*2834*2628"ABC:"?46#"#4,$17"8',+",/*'"36%*"623,"&")$11("623*8'&3*7"ABCD?'&$%&"62636&36/*"34&3"&##$'*#"4684"=$&163("*%*'8*25("5&'*"),'"&11H"regardless of the type of injury or illness they present.
Readiness Support?,"&##$'*"34&3"ABC"6#"0'*0&'*7"3,"%**3"34*"2**7#",)"3'&$%&"5*23*'"0&36*23#H"63"6#"2*5*##&'("3,"#$00,'3"ABC"'*&762*##"),'"&11"*%*'8*25("5&#*#:"?4*"%,#3"5,#3J*))*536/*"&13*'2&36/*"3,"4*10"7,"#,"6#"3,"3'&2#)*'"3'&$%&")$27#"3,"B*765&67"3,"$#*H"5,$01*7"+634")*7*'&1"%&354628")$27#H"3,"'&6#*"B*765&67"'*6%<$'#*%*23"),'"&11"ABC"B*765&67J*1686<1*"3'&2#0,'3#:"?4*'*"#4,$17"<*"&"8$&'&23**"34&3"ABC"reimbursement would not then be cut, essentially wasting the trauma funds.
GPS & Automatic Vehicle Locator SystemThis system will continue to be developed in conjunction with the statewide trauma transfer system and disaster and preparedness systems in Georgia. No state trauma funds are being requested in 200910.
Advocacy On Behalf of EMSABC"62"G*,'86&"6#"&")'&8%*23*7"&27"$27*'J'*#,$'5*7"#(#3*%H"&27"#625*"63"6#"*##*236&1"3,"&2"*))*536/*"trauma system, the Commission has advocated for its needs and will continue to do so. This includes 34*"6%01*%*23&36,2",)"34*"'*5,%%*27&36,2#",)"34*"C*2&3*"C3$7("I,%%633**",2"ABC"K*5'$63%*23H"Retention, and Training in Georgia.
Incentivize Consolidation of EMS Districts!#"&"#(#3*%"ABC"6#"4627*'*7"<("63#")'&8%*23&36,2"<*3+**2"34*"#3&3*9#"4684"2$%<*'",)"#%&11"5,$23("jurisdictions. As is happening in other states, Georgia must move towards a regionalized structure for ABC"#(#3*%"7*#682"3,"#*'/*"34*"%,#3"0&36*23#"62"34*"%,#3"*))*536/*"&27"*).56*23"%&22*':"B&2("'$'&1"ABC",'8&26L&36,2#"62"G*,'86&"#4,$17"<*"5,%<62*7"3,"5'*&3*"'*86,2&1"ABC"76#3'653#H"8*,8'&04(H"&27"0&36*23"E,+"0&33*'2#:"
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20092014 GTCNC STRATEGIC PLAN
OUR EMERGING VISION
20092014 GTCNC STRATEGIC PLAN6
?4*#*"1&'8*'"ABC"76#3'653#"+,$17"0',/67*"%,'*"#3&<6163("3,"ABC"*%01,(**#H"*24&25*7",00,'3$2636*#"for training, and the overall challenges of recruitment and retention would be lessened. In addition, )*+*'"&%<$1&25*#"+,$17"<*"2**7*7"&',$27"34*"51,5-"7$*"3,"%,'*"*).56*23"$#*",)"#5&'5*"&%<$1&25*"resources. The capability for equipment replacement would be enhanced again due to better use of resources. The bottom line would be to provide faster response times with personnel that provide &"4684*'"=$&163(",)"5&'*:"?46#"5&2"<*"&55,%016#4*7"34',$84"&"'*86,2&1"ABCD3'&$%&"62)''$53$'*"offering economic incentives based on performance improvement.
Air Medical Transport ImbalanceThere are apparently more than enough air medical helicopters in north Georgia and none southwest ,)"B&5,2:"?46#"6%<&1&25*"0'*#*23#"0',<1*%#"62"3*'%#",)"34*"36%*1("3'&2#0,'3",)"5'6365&11("62M$'*7"patients. Georgia is beginning to regulate air medical providers, and to optimize the role of air transport within the emerging Georgia Trauma System, a coordinated approach by air medical 0',/67*'#"3,"&##$'*")$11"5,/*'&8*",)"G*,'86&"#4,$17"<*"6%01*%*23*7:"?4*".'#3"#3*0"+,$17"<*"&"5,11&<,'&36/*"01&22628"0',5*##"34&3"*28&8*#"<,34"ABC"&27"&6'"%*765&1"3'&2#0,'3"5,%0&26*#"62"determination of solutions.
!"#$%&'()*+&'$,-*.&/&0$1/$#2&+34+$%&.3(5'6$7&&0'NOOP")$27628"6251$7*7"&"5&063&1"8'&23#"0',8'&%"),'"ABC"3,"0$'54&#*"2*+"&%<$1&25*#"34&3"#4,$17"<*"5,2362$*7:"?4*#*"8'&23#"+611"<*"3&'8*3*7"<&#*7"$0,2"2**7H"+634"0'6,'63("86/*2"3,"ABC"0',8'&%#"serving regions with long transport times to trauma centers.
4. DEVELOP STATEWIDE TRAUMA TRANSFER SYSTEMSerious injuries in Georgia often trigger a time consuming search for a trauma center that has room to accept new patients for treatment, and they may not end up at the appropriate hospital. A transfer control/communications center that coordinates trauma patient triage, transfer and transport can be built to streamline the process and assure that injured patients quickly get to where they need to go. It can redirect patients throughout the state should one or more facilities become saturated, and will also serve to keep patients with minor injuries in their own community for care at less cost. It can &1#,"#$00,'3"0&36*23"#3&<616L&36,2"&27"7*.2636/*"5&'*"62"1,5&1"*%*'8*25("7*0&'3%*23#"&27"5,%%$263("hospitals.
?4*"'*86,2&16L*7"#(#3*%"<$613"&',$27"1*&7"3'&$%&"5*23*'#"34',$84,$3"B6##6##6006"&27"62",34*'"#3&3*"systems will be used as the working model for Georgia. This state’s four Level I trauma centers would take on this responsibility and lead the process for collaboratively determining patient transfer protocols among all hospitals within their regions. This system will be integrated statewide and +634"ABC"'*86,2#"&27"&11"4,#063&1#H"&27"&1#,"$#*"#3&3*J,)J34*J&'3"3*542,1,8("#3&3*+67*"3,",036%6L*"*).56*25(:"
System development will start with system planning and the organization of a collaborative process within each region. The Commission requests support for planning and adding appropriate infrastructure to pursue regionalization. Federal funding will be pursued as well for future development.
It is important to recognize that this system will coordinate/enhance the operational relationships <*3+**2"3'&$%&"5*23*'#H"ABC"'*86,2#H"ABC"0',/67*'#H"&27"&11"&5$3*"5&'*"4,#063&1#H"+4654"+611"62"3$'2"open up added opportunities to optimize emergency care beyond trauma care. This Transfer Control/Communication System will also be developed in conjunction with a concurrent initiative led by the Georgia Hospital Association to mitigate and resolve the broader emergency department diversion problem.
20092014 GTCNC STRATEGIC PLAN 20092014 GTCNC STRATEGIC PLAN20092014 GTCNC STRATEGIC PLAN
OUR EMERGING VISION
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5. PILOT/BUILD TRAUMA TELEMEDICINE SYSTEMTelemedicine is a decade old concept to bring the doctor remotely to the patient, and the time has come for its use to support trauma specialty care in rural Georgia. While the need for telemedicine has escalated, barriers to its effective use such as cost, technology, reimbursement, liability, and physician participation have lessened, but continue to exist. Best practice models for the use of telemedicine in trauma care have been developed in other states. In Georgia, there is experience 62"$#628"3*1*%*76562*"Q*:8:H"I*23*'"),'"?*1*JR*&134"&3"34*"B*765&1"I,11*8*",)"G*,'86&S"&#"+*11"&#"a developing statewide infrastructure to support it (e.g., Georgia Partnership for TeleHealth, Inc.) that may be used in collaboration with the Georgia Trauma System to pilot and develop trauma telemedicine.
In trauma care, telemedicine would bring specialty surgeon expertise to rural hospitals to help direct treatment when unstable patients cannot be transported. In addition, it also serves to help determine whether low severity patients can remain in their own community for treatment at their local hospital which is more cost effective and convenient for injured patients and their families.
The shortage of pediatric neurosurgeons provides an excellent opportunity to pilot trauma telemedicine. Instead of transporting a child with a suspected head injury to a pediatric trauma center, the child could be evaluated remotely at the local community hospital by a neurosurgeon based at the pediatric trauma center.
Telemedicine promises to enhance and expedite care of children with serious injuries, and ultimately &7$13#H"&27"&1#,"<*2*.3#"'$'&1"3'&$%&"5&'*"0',/67*'#"+4,"&'*"62"#4,'3"#$001(H"&#"+*11"&#"$'<&2"surgical specialists.
"A $500,000 USDA federal grant for telemedicine support to rural areas will be pursued in collaboration with the Georgia Partnership for TeleHealth, Inc. The grant award will support equipment purchases to launch two pilot programs in rural trauma telemedicine. Additional support for technical assistance in the development of a successful rural trauma telemedicine initiative for Georgia will be needed.
6. ENHANCE PEDIATRIC TRAUMA SUBSYSTEMGeorgia enjoys an exceptionally strong array of pediatric trauma centers that are well located to care for seriously injured children under age 15. They account for 12% of trauma center patients and require a different system than adults due to their specialized needs. The pediatric trauma facilities are collaborating on a model trauma subsystem plan for pediatrics that includes:
>" A statewide pediatric patient transfer system that functions as part of the overall system.>" ?4*"0',/6#6,2#",)"0*76&3'65"*%*'8*25("5&'*"3'&62628"&27"*=$60%*23"),'"ABC:>" F*/*1,0%*23",)"04(#656&2"*T3*27*'"',1*#"#0*56.5"3,"0*76&3'65"3'&$%&"5*23*'#:>" B&623*2&25*",)"#$'8*"5&0&563("3,"54617'*2"'*8&'7628"76#*'D3*'','"*/*23#:>" Support for prevention of childhood injury in collaboration with other organizations.>" Telemedicine program development to enable local hospitals to effectively evaluate possible head
injuries in children. >" Expansion of the pediatric trauma care system to pediatric emergency care.
The components of this pediatric trauma subsystem will be fully integrated with the overall Georgia Trauma System, and the transfer system and telemedicine components will actually be piloted within this pediatric trauma subsystem.
The result will be the nation’s stateoftheart model for delivering high quality care to children who are seriously injured, as well as those needing emergency surgery due to causes other than injury.
20092014 GTCNC STRATEGIC PLAN
OUR EMERGING VISION
20092014 GTCNC STRATEGIC PLAN
7. STRENGTHEN PHYSICIAN SUPPORT FOR TRAUMA CARE IN RURAL GEORGIAThe essential challenge facing Georgia is strengthening trauma medical staff support in the face of a nationwide trend of declining numbers of surgical specialists interested in trauma care. The following strategies to both expand and leverage scarce trauma physician resources will be pursued:
>" Develop corps of trauma physician “extenders”, perhaps including nurse practitioners, physician &##6#3&23#H"'*86#3*'*7"2$'#*".'#3"&##6#3#H"&27D,'"3'&$%&"2$'#*"#0*56&16#3#:
>" Expand trauma surgeon training and retraining to augment the supply of trauma surgical specialists in rural Georgia.
>" B&623&62"G*,'86&9#"#3',28"16&<6163("0',3*536,2"),'"3'&$%&"04(#656&2#:
>" Facilitate fair compensation of trauma physicians in terms of their emergent response (like we pay 01$%<*'#S"&27"34*"#&5'6.5*#"34*("%&-*"62"3&-628"3'&$%&"5&11:"
>" B&2&8*"3'&$%&"0&36*23"E,+"+634"&2"*))*536/*"3'&2#)*'"#(#3*%:
>" Develop community call systems for high demand, low supply trauma specialties (hand, eye, etc.) to engage as many surgeons as possible in trauma and emergency call.
>" Use of telemedicine to leverage scarce trauma physician resources and enable effective evaluation of patients, in regards to the necessity of transfer to a higher level of care.
>" Technical assistance on best practices for building sustainable trauma hospitalbased practices for trauma physicians.
For 200910, collaborative planning with a variety of partners will be conducted, including the Level I trauma centers and their medical school partners, nursing schools, the Georgia Board for Physician U,'-),'5*H"&27"34*"B*765&1"!##,56&36,2",)"G*,'86&:
8. EXPAND SYSTEM TO REHABILITATION, BURN CARE & INTERSTATE TRANSFERSThese will be important steps as the Georgia trauma system matures:
Uninsured Access to RehabilitationG*,'86&9#"3'&$%&"5*23*'#"'*0,'3"3'&2#)*''628"B*765&67D$262#$'*7"0&36*23#"3,"'*4&<6163&36,2")&561636*#"6#"generally impossible since such care is not funded. This requires the trauma centers to keep such 0&36*23#"62"*T0*2#6/*"&5$3*"5&'*"#*33628#H"+4654"&77#"$22*5*##&'("5,#3#"&27"62&00',0'6&3*1(".11#"scarce hospital beds. The patients, who tend to recover and become productive citizens, would be better off in the lower cost rehab facility. Approaches to resolving this dilemma can require creativity and collaboration rather than funding.
Burn CentersG*,'86&9#"3+,"<$'2"5*23*'#H"1,5&3*7"&3"G'&7("B*%,'6&1"R,#063&1"&27"F,53,'#"R,#063&1",)"!$8$#3&H"provide burn care to patients in a multistate region. An assessment of their capabilities in relation to Georgia’s longterm needs will be appropriate in the future, and they should be integrated into the trauma transfer/control system.
8
20092014 GTCNC STRATEGIC PLAN 20092014 GTCNC STRATEGIC PLAN20092014 GTCNC STRATEGIC PLAN
OUR EMERGING VISION
9
Stability of Interstate Trauma Transfers Some regions in Georgia rely on trauma centers located in adjacent states due to proximity (e.g., Tennessee, Florida), and the stability of these resources are essential to a stable Georgia Trauma C(#3*%:"V,'"*T&%01*H"A'1&28*'"B*765&1"I*23*'"62"I4&33&2,,8&H"?*22*##**"3'*&3#"&"#$<#3&236&1"amount of the major trauma patients treated by all Georgia trauma centers. In addition, four Georgia 3'&$%&"5*23*'#"J"B*%,'6&1"R*&134"W26/*'#63("B*765&1"I*23*'"62"C&/&22&4H"X,42"F:"!'54<,17"B*%,'6&1"R,#063&1"62"?4,%&#/611*H"B*765&1"I,11*8*",)"G*,'86&"62"!$8$#3&H"&27"B*765&1"I*23*'JI,1$%<$#"J"serve patients from neighboring states. Regional and interstate collaboration is materializing on such issues and this will need to be addressed. In the short run, such transfers will need to be incorporated into the transfer control system.
In 200910, the Commission will conduct basic planning on these issues.
9. ASSIST IN INITIATIVES TO REDUCE TRAUMATIC INJURYFire departments are a great example of a public service that broadened its mission to provide a 4684*'"/&1$*"3,"34*"0$<165"<("+,'-628"3,"0'*/*23".'*#"'&34*'"34&2"M$#3"*T3628$6#4"34*%:"?'&$%&"5*23*'"personnel, driven by the carnage they witness, are uniquely motivated and credible for work on preventing injury, but are rarely given resources to do the job.
Each trauma center can serve as a “Community Focal Point on Injury”, which incorporates the following functions:
1. Identify injury causes in the community that are subject to intervention.2. F*.2*"#,1$36,2#"34&3"4&/*"0',/*2"*))*536/*"62"#6%61&'"56'5$%#3&25*#:3. V,5$#"%*76&"&33*236,2"&27"5,%%$263("'*#,$'5*#",2"34*"#0*56.5"5&$#*",)"62M$'(:4. Foster and coordinate the development of interventions.5. A/&1$&3*"34*"*))*536/*2*##",)"#0*56.5"0'*/*236,2"0',8'&%#:
The Georgia Trauma System can use this same approach statewide in a collaborative role that assists established injury prevention organizations. In 200910 the Commission will ask members of the Trauma Advisory Council to form a committee to identify and assess feasible opportunities for injury prevention as the best means of reducing the tremendous costs of serious injury. Advocacy for a federally funded Injury Prevention Center will also be conducted.
10. INTEGRATE TRAUMA SYSTEM WITH DISASTER/TERROR PREPAREDNESSTrauma care is already integrated with disaster and terror preparedness in Georgia. Trauma centers need to be able to amass resources needed to respond to mass casualties by scaling up their */*'(7&(",0*'&36,2#:"@28,628"'*1&36,2#460#"+634"ABC"&27",34*'"4,#063&1#"'*#$13"62"'&067"0&36*23"3'6&8*"and treatment decisions in community crises of all types.
Y*5&$#*"Z*/*1"["3'&$%&"5*23*'#"4&/*"1&'8*'"5&0&5636*#H"$26=$*"#3&).28H"&27"*24&25*7"3'&62628"0',8'&%#H"34*("&'*",)3*2"34*"1,865&1"<&#*"Q62"5,11&<,'&36,2"+634"'*86,2&1"ABC"&27"4,%*1&27"7*)*2#*"personnel) to coordinate hospital response to terror and disaster events. This has proven to be the case in North Carolina, Texas and Oklahoma where strong regional trauma systems have been built, and is emerging as a strong trend in other states.
20092014 GTCNC STRATEGIC PLAN
OUR EMERGING VISION
20092014 GTCNC STRATEGIC PLAN10
As the regionalized Georgia trauma system materializes, its infrastructure will enhance trauma care’s involvement in local, regional, and state disaster preparedness planning. The emerging transfer control/communication system may prove to be a major asset to Georgia’s disaster/terror 0'*0&'*72*##"#*53,'"7$*"3,"63#"0,3*236&1"3,"*).56*231("%,263,'"&27"',$3*"*%*'8*25("%*765&1"3'&2#0,'3#"to acute care facilities throughout the state and greater region.
In 20092010, the Commission will collaborate with the Georgia Hospital Association and the Georgia A%*'8*25("B&2&8*%*23"!8*25("QGAB!S",2"4,+"34*"3'&$%&"#(#3*%"5&2"<*#3"*24&25*"76#*'Dterror preparedness in Georgia.
11. EXPAND SYSTEM TO ACUTE EMERGENCY CARE NEEDS!"%&M,'"<*2*.3")',%"5,2#3'$53628"&"',<$#3H"#3&3*+67*"3'&$%&"5&'*"62)''$53$'*"&27"#(#3*%"6#"34&3"it can be expanded to address broader emergency care service issues. This enables a highly costeffective approach to strengthening the entire problematic emergency care safety net. This is already being accomplished in some respects. Assuring adequate coverage for surgery, neurosurgery, orthopedic surgery, etc. for care of trauma patients also assures the same specialties will be available to care for nontrauma patients requiring their services.
An expansion to other time sensitive emergency health care issues such as strokes and heart attacks is feasible since they require the same systems approach and components required for trauma care. Before progress can be made in this regard, the trauma system must be substantially complete.
While this expansion to supporting broader emergency care functions promises to be an important return on the state’s investment in trauma care, in 20092010 the Commission will focus on building the core trauma system.
12. DEVELOP TRAUMA SYSTEM REGIONALIZATION IN GEORGIAKey lessons from other states in building a strong and effective infrastructure to support trauma and emergency care include:
>" Build a statewide system that incorporates all local and regional stakeholders and integrate them into a regionalized network.
>" F*.2*"'*86,2#"<("0&36*23"'*)*''&1"0&33*'2#"3,"*2&<1*"participants within traditional catchment areas to work together with the major referral hospital.
>" Provide technical assistance and basic operational funding to help regional groups organize.
>" Build it for the long term and make it expandable to emergency care and related functions.
>" Foster a grassroots network that generates statewide public support.
G*,'86&"&1'*&7("4&#"\O"*#3&<16#4*7"ABC"'*86,2#"+4654"provide a base to build upon for development of trauma regions.
20092014 GTCNC STRATEGIC PLAN 20092014 GTCNC STRATEGIC PLAN20092014 GTCNC STRATEGIC PLAN
OUR EMERGING VISION
11
FOUR LEVEL I TRAUMA REGIONSRegional Trauma System Development
STATE OF GEORGIADEPARTMENT OF HEALTH
Physicians, Trauma Centers, EMS Agencies, Hospitals, First Responders
GEORGIA TRAUMA CARE NETWORK COMMISSION
Planning, Policy, Oversight, Advocacy
LOCAL EMS REGIONS Local Trauma System Development
Seriously Injured Patients
STATEWIDE STAKEHOLDER GROUP
OFFICE OF EMS/TRAUMATrauma System Implementation,
Operations, Oversight
!#"G*,'86&"5,2#67*'#"'*86,2&16L628"63#"3'&$%&"#(#3*%H"34*".'#3"#3*0"6#"3,"7*.2*"3'&$%&"'*86,2#:"Presently, Georgia has four well positioned Level I trauma centers. If they were to serve as a ),5&1"0,623"),'"3'&$%&"'*86,2#"34&3"625,'0,'&3*"*T6#3628"ABC"'*86,2#H"34*"%&0"&<,/*"0',/67*#"&2"example of how trauma regions could be designed. In the event that additional regional trauma centers develop, it is important to note that the determination of trauma regions may be dynamic to &55,%%,7&3*"54&28*#"62"3'&$%&"5*23*'"'*#,$'5*#"&27"3'&$%&"0&36*23"E,+"0&33*'2#:"
13. CONTINUE DEVELOPING TRAUMA SYSTEM POLICY/STAKEHOLDER STRUCTUREG*,'86&"*2M,(#"#3',28"1*&7*'#460"),'"3'&$%&"&27"ABCH"&27"4&#"*#3&<16#4*7"&"#$55*##)$1"?'&$%&"Commission, composed of key stakeholders to guide the development of the Georgia Trauma System. The next step will be to extend this developing structure to the Level I trauma regions 7*#5'6<*7"&<,/*"&27"3,"625,'0,'&3*"1,5&1"ABC"'*86,2#:"?4*"),11,+628"54&'3",$3162*#"34*"*%*'8628"policy development structure for Georgia:
3789:8'6;63<:'=>?@A;'/<B<?>=:<C3'6379A397<
In essence, local and regional trauma stakeholder groups will provide input to the Commission based upon trauma patient and provider experiences and needs. The Commission will formulate 0,165(H"+4654"+611"<*"6%01*%*23*7"<("34*"@).5*",)"ABCD?'&$%&:"!"#3&3*+67*"#3&-*4,17*'"8',$0"+611"be formed by the Commission with broad representation from Governor/Lt. Governor, Speaker of 34*"R,$#*H"C3&3*"Z*86#1&3$'*H"G*,'86&"R,#063&1"!##,56&36,2H"G*,'86&"!##,56&36,2",)"ABCH"B*765&1"Association of Georgia, the business community, media, etc. to provide input and support the work of the Commission.
?4*"I,%%6##6,2"+611"'*8$1&'1("'*&54",$3"3,"#3&-*4,17*'#"),'"620$3H"6251$7628"ABC"&8*256*#H"3'&$%&"centers, local hospitals, County government, injury prevention partners, community groups, local legislators, burn care, air medical transport and other interested and participating stakeholders.
20092014 GTCNC STRATEGIC PLAN
OUR EMERGING VISION
20092014 GTCNC STRATEGIC PLAN
This coalescing of collaborative leadership locally, regionally and statewide, will strengthen the Commission’s ability to quickly move this conceptual plan to reality throughout Georgia. In turn, this structure will reinforce the Commission’s role of planning, policymaking, oversight and advocacy.
14. BUILD TRAUMA SYSTEM INFRASTRUCTURE UNDER DEPARTMENT OF HEALTHThe Commission asked for a thorough, expert, “warts and all” review of Georgia’s trauma system by 34*"!%*'65&2"I,11*8*",)"C$'8*,29#"?'&$%&"C(#3*%"I,2#$13&36,2"0',8'&%H"+4654",55$''*7",2"X&2$&'("]J^H"NOO_:"U461*"34*6'".27628#"+*'*"2,3"#$'0'6#628H"34*("$27*'#5,'*7"34*")&53"34&3"5'6365&1"5,%0,2*23#"of the Georgia Trauma System infrastructure are either missing or largely unsupported. They include:
>" Establishment by State statute of the trauma system lead agency’s authority and provision for promulgation of clear system regulation and rules.
>" I,%0'*4*2#6/*"3'&$%&"#(#3*%"01&2"7*.2*#"34*"#(#3*%H"63#"#$<#(#3*%#"&27"#3'$53$'*H"&27"establishes procedures and standards for implementation, monitoring and system performance improvement, and is supported by promulgated rules and regulations.
>" C3&).28"),'"34*"C3&3*",)"G*,'86&"3,"<$617"&27",0*'&3*"3'&$%&"&27"ABC"#(#3*%#:"
These critical needs are addressed in detail by the ACS Trauma System Consultation report. In order 3,"<$617"&2"*))*536/*"#3&3*"3'&$%&"#(#3*%H"&2"*))*536/*"&27")$11(J#3&))*7"@).5*",)"ABC"`"?'&$%&"$27*'"the Department of Health will be essential.
15. ESTABLISH MECHANISMS TO ASSURE EXCEPTIONAL ACCOUNTABILITY!88'*##6/*"&##*##%*23#",)"=$&163(",)"5&'*"&27"#(#3*%"0*'),'%&25*"&'*"5,'*"#3'*2834#",)"34*".*17"of trauma care in part because it was founded based upon such assessments. Stateoftheart performance improvement standards and accountability measures will be included in the Georgia trauma system, such as the following:
>" Time trauma centers are on diversion and deny access to injured patients.>" Percent of state’s trauma patients (by severity) who reach trauma centers.>" ?6%*",)"ABC"3'&2#0,'3")',%"5&11"3,"#5*2*H"&27")',%"#5*2*"3,"3'&$%&"5*23*':>" The “preventable” death rate for each trauma center and overall system.>" Severityadjusted trauma center length of stay/costs compared to national/state norms.>" Reductions in injuries targeted by injury prevention measures.
In 200910 the Commission will develop a performance improvement and accountability system to assure optimum performance by all trauma system components.
In addition to the accountability system described above, the Trauma Commission will arrange a followup visit from the American College of Surgeons Trauma Systems Review program at a time determined by the GTCNC. A return visit will assess Georgia’s progress on implementing '*5,%%*27&36,2#"%&7*"<("34*"!IC"7$'628"34*"5,$'#*",)"63#"#63*"/6#63"62"X&2$&'("NOO_:"
12
20092014 GTCNC STRATEGIC PLAN 20092014 GTCNC STRATEGIC PLAN20092014 GTCNC STRATEGIC PLAN
OUR EMERGING VISION
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or
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ve
n s
ucce
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pe
ratio
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l.
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rove
d p
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nt
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re.
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l p
lan
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nts
fo
r E
MS
fo
r
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o o
ptim
ize
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ho
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ita
l ca
re
of childre
n.
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is is c
urr
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ully im
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ph
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nd
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, in
jury
pre
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ed
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etc
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ntin
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d
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me
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l im
ple
me
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lan
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ill le
ad
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r str
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e:
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n
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gie
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o b
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20
12
14
.
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pa
rtn
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clu
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rn c
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ters
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n f
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y
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ts a
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om
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rtn
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de
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um
a s
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nd
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pre
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ns
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jor
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e
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s
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n.
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e n
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tio
n o
f tr
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ma
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to G
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inju
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