Activities

1. Employment of HRSA's BIS approach for Trauma and EMS systems (State or regional) assessment(s);
1. The 2006 HRSA "Model Trauma System Planning and Evaluation" (MTSPE) document, outlined under The Trauma-EMS System Program and supported under the FLEX program, addresses state trauma system self-assessment and broader strategic planning. The MTSPE at the HRSA Web site
2. The BIS assessment approach outlined in the MTSPE are clearly intended to be a living tool that will evolve and be refined as the BIS are used across a variety of settings. The intent of the tool is to allow an individual trauma system to identify its own strengths and weaknesses, prioritize activities, and measure progress against itself over time. It is not intended to compare one system to another or to be used to determine funding awards.
3. States which use the process, described in the MTSPE, provide the state leaders with a comprehensive assessment of the status of trauma system development within the state (the scoring is not designed to be used in interstate trauma system comparisons). The MTSPE self- assessment tool allows states to stratify indicators by score, but is not intended to replace strategic decision-making processes that a state rural health or EMS office uses to prioritize future initiatives. Those decisions will require internal deliberation about other factors such as urgency of need, resource availability, feasibility of achieving results, and stakeholder interests. States may benefit from consulting colleagues in other states that have piloted this evaluation (early pilots included Utah, Virginia, Texas, and Montana).
4. Once the MTSPE results are available, stakeholders should discuss development or enhancement of the state's trauma plan. State FLEX coordinators may choose to integrate the State trauma plan with the State Rural Health Plan and may utilize the BIS assessment to establish dual priorities.
2. Conduct State strategic planning and systems development to address weaknesses identified by the BIS assessment, including trauma designations for CAHs
1. An organized Trauma and EMS system is indispensable in reducing the incidence of death and long-term disability from traumatic injury. Establishing a formal process for State designation of trauma centers is the keystone for developing a more cohesive and effective State trauma and EMS system through which trauma-related morbidity and mortality can be mitigated. States are in different places in this process.
2. Small rural hospitals are crucial to the success of the system but almost half of the States do not designate any level III, IV or V trauma centers. The development and use of a statewide trauma system plan is important for CAHs for the following reasons:
1. Provides guidance on comprehensive system development;
2. Allows for local trauma system variations based on assessment results (e.g. rural versus urban needs and resources);
3. Demonstrates an all-encompassing, inclusive methodology, ranging from injury prevention activities to pre-hospital trauma care, acute care facilities, and post-acute rehabilitation; and
4. It is increasingly required in order to be eligible for some Federal funding opportunities.
3. The MTSPE is a valuable resource because it provides:
1. A process for collaboration between the public health system and the trauma care system;
2. BIS mechanism for regional and State trauma system self-assessment;
3. The necessary structured tool to identify system gaps;
4. A planning mechanism to promote and guide future development of State trauma care systems and;
5. An opportunity for improved injury care outcomes.
4. Funds can be used for:
1. HRSA encourages the use of FLEX program funds to supplement and integrate the efforts discussed in the MTSPE, most specifically by encouraging the designation of CAHS to the appropriate level throughout the State.
2. The American College of Surgeons' Trauma Systems Planning and Evaluation Committee (TSPEC) is a valuable resource to assist States with these activities. The ACS TSPEC has programs to assist with the facilitation of the BIS process and a consultation program to identify the next steps in the maturation of the state's trauma system, regardless of its stage of development. Funds may be, used to support either the ACS BIS facilitation process or the more comprehensive trauma system consultation visit.
5. How will we measure?
1. Changes in benchmark scores over time (measured against self)
2. Revisions in trauma system development activities to include all levels of acute care facilities.
3. Changes in numbers of CAH verified or credentialed as trauma centers at any level (III, IV, and V).
6. Additional Resources:
1. ACS Web site (Not a U.S. Government Web site) Consultation for Trauma Systems (Acrobat/PDF)
   
3. Support CAH's interested in Rural Trauma Team Development or in Comprehensive Advanced Life Support team training.
1. While Advance Trauma Life Support (ATLS) remains the required standard for Trauma System compliance, there are other courses emerging that hold promise in providing educational support for rural and non-urban ED practices. Of particular interest is the American College of Surgeons' Rural Trauma Team Development Course.
2. The Rural Trauma Team Development Course (RTTDC) has been developed by the Rural Trauma Subcommittee of the Committee on Trauma, American College of Surgeons to help rural hospitals with development of their trauma teams. HRSA encourages the use of State FLEX funds in coordinating access to the course as a quality improvement activity designed to develop a timely, organized, rational response to the care of the trauma patient and a team approach that addresses the common problems in the initial assessment and stabilization of the injured.
3. The basic premise of the course is the assumption that, in most situations, rural hospitals can provide three individuals to form the core of a trauma team consisting of a Team Leader - physician or physician extender, Team Member One - a nurse and Team Member Two - an additional individual who could be a nurse, aide, technician, prehospital provider or clerk. Therefore, the rural hospital should have those individuals such as respiratory, radiology and laboratory technicians, additional nurses, prehospital personnel, etc. who might be involved in supportive roles to the trauma team.
4. The course is designed to be given either in one day of approximately 8 hours or can be given in four separate modules of 1.5 - 2 hours each or combination of modules. The rural hospital, in conjunction with the presenting instruction team, will decide how the course is to be presented. RTTDC is taught by Surgeons, Emergency Physicians and Nurses who are experienced trauma care providers and trauma course instructors. The American College of Surgeons Committee on Trauma Chairperson for your state, or his/her designee, is responsible for the selection of the RTTDC Instructor teams and the quality management of the courses and can identify rural hospitals without this training.
5. FLEX program funds may also be used to support critical response team development in rural communities through the Comprehensive Advance Life Support course (CALS). The primary focus is to train medical personnel to anticipate, recognize and treat life-threatening emergencies. The emphasis is on a team approach since the success of caring for critically ill or injured patients is dependent on the overall knowledge and skills of the entire advanced life support team.
6. Additional Resources: further information.
1. Rural Trauma Team Development
   http://www.facs.org/trauma/rttdc/index.html (Not a U.S. Government Web site)
2. Comprehensive Advanced Life Support
   http://www.calsprogram.org/ (Not a U.S. Government Web site)
4. Improving EMS Medical Direction
1. EMS medical oversight (medical direction) may be "direct" (on-line) or "indirect" (off-line). Direct medical oversight is the provision of medical authority by a physician or physician-designee to the EMT in the field by radio, telephone or other device (or when physically on-scene). Indirect medical oversight is provided by the physician who is responsible for the overall medical care provided by the EMS service or system.
2. What can we fund?
1. Funding may be used to support participation medical oversight personnel in on-line or in-person training using the materials developed/promoted by the National Association of EMS Physicians and Critical Illness and Trauma Foundation, along with state level training requirements to create effective medical oversight networks consistent with statewide EMS system design;
2. Funds may also be used to recruit and retain rural and frontier physicians to serve as EMS medical directors.
3. How will we measure?
1. The number trained or recruited.
4. Additional Resources:
1. National Association of State EMS Physicians
   www.naemsp.org (Not a U.S. Government Web site)
2. Critical Illness and Trauma Foundation
   www.citmt.org (Not a U.S. Government Web site)
5. Implement mechanisms to support EMS agencies in efforts of recruitment/retention, reimbursement and restructuring.
1. Recruitment/Retention
1. Promote the replication of evidence-based recruitment and retention programs such as those evident in the commonwealth of Virginia and the state of Wisconsin.
2. Reimbursement
1. Support personnel in establishing comprehensive budget processes through training in the use of the REMSTTAC budget model and other financial tools.
2. Encourage the use of group purchase and billing processes such as those available through the North Central EMS Cooperative and the Western EMS Network
3. Restructuring
1. Support EMS agencies in developing short and long-term plans through community planning processes or EMS BIS processes.
1. This process is similar to those described in the trauma system development section 1.C. above except that it focuses on local or regional EMS systems and promotes horizontal integration
2. The tool for this process was developed by and is available through the Critical Illness and Trauma Foundation.
2. Support EMS agency leadership by promoting the training of EMS managers using the EMS Manager's Awareness Guide, Rural and Frontier EMS Agenda for the Future - Service Chief's Guide, from REMSTTAC and participation in other formal EMS manager training programs provided by individual states or national agencies and organizations.
3. In collaboration with the state level EMS agency, promote the exploration of community health-based models of care.
4. What can we fund?
1. Regional or statewide programs for recruitment and retention patterned after promising models in Virginia and Wisconsin
2. Training workshops in budget development and rural ambulance fiscal management
3. Membership in North Central EMS Cooperative, Western EMS Network or similar purchasing cooperatives
4. Facilitation of BIS processes for EMS at the local and regional level.
5. Training and support of rural EMS managers by awareness training or participation or in more formal/comprehensive management training.
6. Pilot programs to better utilize prehospital care personnel in meeting the health care needs of rural communities.
1. Any programs that expand, change or refocus the scope of practice, duties of focus of prehospital care providers must be closely coordinated with the State EMS Office
2. All pilot programs must be based on a formal needs assessment process and thoroughly evaluated.
5. How will we measure?
1. Count the number of personnel trained.

Additional Resources:

Recruitment and Retention http://www.vdh.state.va.us/OEMS/Locality_Resources/Recruitment_Retention.asp (Not a U.S. Government Web site)
http://www.wisconsinems.com/ (Not a U.S. Government Web site)

Reimbursement
www.remsttac.org (Not a U.S. Government Web site)
www.ncemsc.org (Not a U.S. Government Web site)
www.wemsn.org (Not a U.S. Government Web site)

Restructuring
www.citmt.org (Not a U.S. Government Web site)
www.remsttac.org (Not a U.S. Government Web site)
www.ircp.ncemsi.org (Not a U.S. Government Web site)

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