STATE OF OHIO EMERGENCY MEDICAL SERVICES BOARD

TRAUMA COMMITTEE MEETING MINUTES

March 10, 2004

Chaired by: Joseph W. Luria, MD

Date & Location: March 10, 2004 at Ohio Department of Public Safety, Columbus, Ohio

Name	Attendance	Name	Attendance
Nancie Bechtel, RN,	Present	Greg Nemunaitis, MD	Absent
Melody Cambell, RN	Present	Jennifer Piccione, RN	Present
Guillermo Chacon, DDS	Absent	Jane Riebe	Present
John Crow, MD	Present	Michael Shannon, MD	Present
William Crum	Absent	Anthony Stallion, MD	Absent
Dan Ellenberger, EMT-P	Present	Karen Weaver, RN	Present
William Emery, MD	Present	Howard Werman, MD	Present
Kathy Haley, RN	Present	Bruce Ziran, MD	Present
Becky Hall, RN	Absent	Virginia Haller, MD*	Present
Lynn V. Horner	Present	Mike Glenn, RN^‡	Present
Jay Johannigman, MD	Present	Heather Reed^‡	Present
Jason Kinley, EMT-P	Present
F. Barry Knotts, MD*	Absent	JD Polk, DO*	Absent
Joseph Luria, MD	Present	Tim Erskine, EMT-P ^‡	Present
Michael Mackan, MD	Present	Carol MacDowell, RHIT^‡	Present
Sidney Miller, MD	Absent
		* = Non-Voting Committee member ^‡= Non-Voting ODPS/DEMS Staff

Others in Attendance:

An audience sign-in sheet is on file in the Division of EMS office.

CALL TO ORDER:

Welcome and Introductions - Dr. Luria called the meeting to order at 10:05 am. A quorum is present. Dr. Luria announced that Defiance Hospital had received their ACS trauma center verification as a level 3 adult trauma center. Unfortunately, this means that Karen Weaver no longer meets the minimum qualifications for seat on trauma committee (representative of a non-trauma center hospital) Karen submitted her resignation from the committee several weeks ago. Dr. Luria thanked Karen for her dedication and work with the committee, as one of the original appointees; she has been a great asset to the committee. D. Luria presented Karen with a certificate of appreciation.

Review of January 22, 2004 Minutes

Dr. Luria asked the committee members to review the January minutes and note any corrections that might be needed.

MOTION: Approve the January 22, 2004 meeting minutes, pending the addition of a summary of the notes taken by Heather Reed, made by Shannon, with a second.

DISCUSSION: none

VOTE: all in favor, no against, no abstention. Motion approved

Review of March 10, 2004 Agenda

The committee members reviewed the agenda. Add Discussion of Guidelines for Operation of EMS draft document to old business. Add Regional Triage protocol submission process to new business.

SUBCOMMITTEE & WORK GROUP REPORTS.

REGIONAL PHYSICIAN ADVISORY BOARDS - Carol Macdowell

The RPABs are all active in requesting data from EMSIRS for review at the local and region level. Seven regions have opted to participate in the regional PI project grants offering. A variety of projects are proposed, form development of a regional web site to EMS PI seminars, to traveling airway CE programs. Dr. Polk is resigning as state medical director. He is being reassigned to a new position in NASA. The RFQ for a new medical director is being sent out, for more information; contact Carrie Rhonemus, Division of EMS (614) 728-7357

OHIO DEPARTMENT OF HEALTH - Dr. Haller

A recent national meeting of burn care professionals, Dr. Miller had heard that some of the HRSA bioterrorism funds could be used for burn and trauma centers. Dr. Haller was asked to look into this. At present this is an optional benchmark in the grant and Ohio has opted to focus it’s funding on the required benchmarks, because many of the required benchmarks are very basic aspects to preparation, and Ohio had many needs in this area.

EMS BOARD - Dr. Groner

The EMS Board Retreat was held Jan 21-23 and a regular Board Meeting on Feb 18. JD Polk, state EMS medical director, is resigning due to military and NASA commitments. The EMS board executive director job will soon be filled, as the “finalists” are being interviewed. The Board was updated on data submission to the OTR, delays continue mostly due to software issues. Currently, there are 172 hospitals reporting and 113,248 patient records in the system. Mike Burgess reported 231 people attended an information session on EMS grants. The board discussed HB 321, which provides summary suspension, subpoena powers (this bill is yet to be introduced), and HB 421, which makes 16-18 year olds “pseudo-EMTs” by creating a new level of certification. The EMS board is against the bill, feeling that 16-18 year olds are too young to go on EMS runs. The BMV and Highway patrol are also opposed. The “Guidelines for the Operation of EMS organizations” was presented to the EMS board, but it needs to be revised and re-presented. At the January retreat, it was decided that the Medical Oversight Committee would write a position paper on the Surgeon’s role in EMS education. Surgeons are “mandated” to participate in EMS trauma education by a line in the Ohio Code. Finally, three board members are working on developing a course on handgun safety for EMS providers. The course was inspired by the “conceal carry law,” which takes effect In April.

OHIO DEPARTMENT OF PUBLIC SAFETY -

No Report

TRAUMA REGISTRY ADVISORY SUBCOMMITTEE – Mike Glenn

The meeting was held on February 17, 2004.  A quorum was present.

Updates on the EMSIRS and OTR were given by Tim Erskine.  Information sessions for the upcoming REHAB database are scheduled for March. Hospitals were sent a “heads up” notification concerning the < 48 hr LOS project. The OTR data validation project should be close to having a vendor selected and under contract. The 2004 data dictionary has had some 2004 updates proposed. Trauma Committee should review these in preparation for presentation to the EMS Board in April.

INCIDENT REPORTING SYSTEM ADVISORY COMMITTEE - Tim Erskine

IRSAC met in February for the first time since November. The primary topics of discussion were: 1) the upcoming SWOT analysis (strengths, weaknesses, opportunities, threats) and strategic planning session, facilitated by NEDARC (National EMSC Data Analysis Resource Center), 2) the adoption/adapting of the new national EMS data set and its potential impact on local EMS agencies, and 3) the creation of a statewide EMS Casualty Database to track job-related injuries among EMS workers.

Will present report on the 10th

REGIONAL ISSUES WORKGROUP - Dr. Luria

The draft report chapters are being reviewed by Dr. Luria. This has been delayed due to the need to complete the Trauma System PI document for the Board. A final draft of this document should be ready for the May trauma committee meeting and will be circulated to committee members prior to the meeting.

STATE TRAUMA PI WORKGROUP - Dr. Luria

The PI work group will not be meeting. The project, drafting a list of potential system indicators is complete. The trauma committee as a whole will address further development of the system PI process.

EMS OPERATIONS WORKGROUP - Jason Kinley

The final draft document was sent to the EMS Board in February. The Board has asked the workgroup to address a number of concerns with the document.

AIR MEDICAL SUBCOMMITTEE – Howie Werman

The air medical subcommittee is scheduled to meet Friday, March 19, 2004, 9:30 am at the Ohio medical transportation board offices, 1952 W. Broad St. to discuss development of draft QI indicators for air medical transport. 

EMS Operations Workgroup - Jason Kinley

See new business

OLD BUSINESS

OTR Data Validation Project – Mike Glenn

Mike updated the committee on the status of the project. The RFQ have been reviewed, KJ Consulting was selected as the vendor. It is anticipated that the contract will be signed by the end of the month and meetings with the vendor will begin in March/April. The project is scheduled for completion by September 2004.

< 48 hour LOS Data Collection Project – Mike Glenn

Mike updated the committee on the status of the project and the revised time lines. General discussion was held and the following items emerged.

1. A pro-active, educational effort should accompany the planned informational updates to hospitals. Emphasis on the importance of this data should be highlighted. If possible, create an estimate, for each hospital, of what their increased workload will be for reporting the additional patients.
2. Ask the TRAS to consider extending the data submission deadlines for these reporting periods.

EMS Trauma Scenarios Manual Project – Mike Glenn

Mike updated the committee on the status of this project and thanked the members of the committee who helped review the draft materials. There was interest expressed in making all or part of this document a power point presentation, to increase its use in educational offerings. Mike Glenn and Mike Mackan will share these thoughts with ACEP. The final production of the manual is under way and this initial production is a hard copy, soft cover spiral bound manual. A copy will be provided to the program coordinator at all accredited EMS schools and approved CE sites. Additional copies will be available for purchase from Ohio ACEP.

NEW BUSINESS

ODH Commission Reports – Dr. Luria

Dr. Luria introduced John Corrigan, Ph.D. Dr. Corrigan served as the chair of the Post Critical Trauma Care (PCTC) Commission. Dr. Corrigan distributed a copy of the PCTC final report to committee members. A PDF version of this is available on the EMS web site. Dr. Corrigan reviewed the Commissions recommendations and discussed. There was consensus expressed that the PCTC was an exceptional document and Dr. Corrigan was praised for his leadership of this effort. A number of questions were raised;

Q. What actually happens to this document after it is presented to the Governor?

1. There is no legislated “home” or agency designated to follow-up on this document. It is hoped that the Trauma Committee will identify aspects of this report that the EMS Board and/or Division of EMS can support.

17. There are number of serious concerns with basic access to rehabilitation services, and barriers at the state level. How can we address these?

1. This is a complex problem and the report does not offer any easy to implement solutions, but rather is advocates that state level leadership within a designated agency to be given authority to lead efforts to address these types of concerns.

Dr. Luria asked if rehabilitation related indicators could be identified for purposes of state trauma system PI. Dr. Corrigan agreed to give this some thought.

Mike Glenn asked the committee to consider what they could do to identify specific aspects of this report and educate/advocate for them with the EMS Board. There are a number of recommendations that have clear connections with the EMS/Trauma grant priority #3. There may also be aspects within these recommendations that would require or benefit from changes to ORC, and will the Board be in a position to support or advocate for these changes. Additionally the committee was asked to consider the possible fragmentation of response/support for any recommendations. The Rehab database is overseen by the TRAS, the rehab grants overseen by the Grants committee. Close coordination and communication is essential to prevent a fragmented, piece-meal response. What can the committee do to prevent or minimize this?

Guidelines for the Operation of EMS Organizations - Dr. Luria

The EMS Board has asked the EMS Operations workgroup to revisit the draft document. The Board cited a number of specific issues that they would like the workgroup to address prior to the Boards final review of this document.

1. Add clear headings for ALS vs. BLS equipment recommendations

2. Add disclaimers covering the fact that these are guidelines only

3. Eliminate references to “required” equipment

4. Add additional content in the disaster planning section.

In addition to these, the committee suggested that an executive summary, with the rationale for the creation of the document, referenced to ORC, etc. be added. An appendix, formatted as a checklist is added for EMS services to use in comparing their equipment/services to those in the guidelines.

Mike Glenn will work with Jason Kinley and Heather Reed on #1, 2 and 3, as well as EMA staff for #4. A draft will be re-circulated prior to the May meeting.

System PI - Dr. Luria

The revised draft of trauma system PI indicators was reviewed by the committee. It was suggested that EMS indicators i, ii and iii be tabled until appropriate cohorts can be created/identified. This is important so that “apples to apples” comparisons of data can be made. Cohort considerations, paid vs. volunteer, ALS vs. BLS, urban vs. rural, etc. Attempts to define urban, suburban and rural have been disappointing. No clear, nationally recognized definitions exist, that are easily used EMS. Some definitions are limited, such as the absence of suburban definitions. Others are extremely complex and require data that is not available as part of the current database (i.e. use of metropolitan statistical areas). Additional review will be done on use of census tract info and use of county population density. Committee members asked the staff to review the draft Rural /Frontier EMS agenda for the Future document and the NAEMSMD book for additional options. A draft proposal and staff recommendations will be presented at the next committee meeting. The remaining PI indicators were reviewed without changes (see attachment 1)

MOTION: Approve the PI indicator document as revised above, made by Bechtel, with a second.

DISCUSSION: none

VOTE: all in favor, no against, no abstention. Motion approved

Seven Special Studies Recommendations to the Board – Dr. Luria

Draft recommendations were circulated to committee members prior to the meeting, each recommendation was reviewed and some revisions were made. These will be presented to the Board in April (See attachment 2)

MOTION: To send to the revised recommendations to the EMS Board made by Bechtel with a second

DISCUSSION: No additional discussion was held.

VOTE: All in favor, none against, Motion approved

Trauma Triage Protocol Submission Process – Dr. Luria

The EMS Board did not approve region 5’s trauma triage protocols, citing a number of concerns. These included need for specific formatting changes (i.e. a header) and correction of a typo. The Board also expressed a need for “more formality”. Based upon this request, Mike Glenn has drafted changes to the regional trauma triage variation submission process. These were circulated to the committee prior to the meeting. There was consensus from the committee members that these are appropriate and should address the concerns raised by the Board. These will be presented to the Board in April.

MOTION: Approve proposed revisions to the regional trauma triage protocol submission process and recommend its use to the EMS Board. Motion made by Ellenberger with a second

DISCUSSION: No additional discussion was held.

VOTE: All in favor, none against, Motion approved

Meeting adjourned by Dr. Luria at 1:00 p.m.

ATTACHMENT 1

Revisions in Red veranda font

Quarterly State Trauma System Report

Confidentiality information

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