region iii trauma plan july 2016 · region iii trauma plan july 2016 3 region board the system...

REGION III RTAC

Region III Trauma Plan

July 2016

Bill Kunkle

7/14/2016

APPROVED by GTC August 18, 2016

Region III Trauma Plan July 2016

1

Table of Contents Mission ............................................................................................................................................ 2

Vision .............................................................................................................................................. 2

Authority ......................................................................................................................................... 2

Region Board .................................................................................................................................. 3

Bylaws............................................................................................................................................. 4

Regional Demographics .................................................................................................................. 4

Injury Epidemiology ....................................................................................................................... 7

Prevention and Education............................................................................................................ 7

EMS ................................................................................................................................................ 8

Air Medical ............................................................................................................................... 12

Trauma Care Protocols and Medical Direction ......................................................................... 13

Patient Triage and Destination Determination .......................................................................... 14

Method of Transport Determination ......................................................................................... 14

Educational and Training Standards ............................................................................................. 15

Definitive Care Facilities .............................................................................................................. 16

Trauma Centers ......................................................................................................................... 16

Specialty Resource Centers ....................................................................................................... 17

Pediatrics ................................................................................................................................... 17

System Flow .............................................................................................................................. 18

Rehabilitation ................................................................................................................................ 19

Communications ........................................................................................................................... 19

Disaster Preparedness ................................................................................................................... 20

Evaluation and Improvement ........................................................................................................ 21

Research ........................................................................................................................................ 22

Appendix ....................................................................................................................................... 22

Appendix A ............................................................................................................................... 23

Appendix B ............................................................................................................................... 24



2

Mission

To promote, develop, maintain, and

further a comprehensive EMS, trauma

and acute care system that will meet

the needs of all patients through fact

based analysis and improvement

methods.

Vision

To provide a comprehensive and unified trauma system that provides top level care

for the community and serves as a leader for the State of Georgia.

Authority

In 2007, Senate Bill 60 was passed by the Georgia Legislature creating the Georgia

Trauma Commission. This bill authorized the newly created commission to create a

trauma system for Georgia and to be accountable and distribute funds provided by the

state for the purpose of improved trauma care.

In 2009 the Georgia Trauma Commission approved a strategic plan providing

guidance for the future of trauma care in the state. An aspect of this plan was to

create Regional Trauma Councils to coincide with the State EMS Regions. Noting

that each region of the state is different in their capabilities and needs, each region

was tasked with creating their respective RTACS.

Each RTAC is then assigned the task of completing a trauma plan. This plan begins

with an assessment of the needs of the region, followed by the creation of the

document. The plan should then be written following guidance given by the

Regional Trauma System Planning Framework document approved by the Trauma

Commission in October of 2009.

The plan should be approved at the local level then presented to the Georgia Trauma

Commission for final approval. Following this go ahead, the final plan should be

used as a template for improving trauma care within the region.



3

Region Board

The system leadership is tasked with the responsibility of improving trauma

management within Region III.

The Region Board and Committee Chair Positions will consist of the following

positions and the respective person for each position.

Board of Directors Officer

Chair Dr. Jeffrey Nicholas

Vice Chair Dr. Barry Renz

Historian Dr. John Harvey

Treasurer Greg Pereira

RTAC Coordinator Billy Kunkle

Committee Committee Chair

Air Medical Jim Sargent & Dr Isakov

EMS Lee Oliver

Pediatrics Dewayne Joy

Prevention and Education Elizabeth Williams

Disaster Preparedness

System Performance

Improvement Gina Solomon

Trauma Center Gina Solomon

Rehabilitation



4

Bylaws

The organization’s operations shall be governed utilizing by laws approved by the

general membership.

Regional Demographics

Region 3 is composed of eight counties to include the City of Atlanta and the

Metro Atlanta area. These eight counties consist of just four percent of the

landmass for the State of Georgia, but account for thirty nine percent of the

population. The population of this region exceeds the population of 24 of the 50

states.

County Square Miles Population

Clayton 142 267,542

Cobb 340 730,981

Dekalb 268 722,161

Douglas 200 138,776

Fulton 527 996,319

Gwinnett 430 877,922

Newton 272 103,675

Rockdale 130 87,754

Region III Total 2,309 3,925,130

Percentage of Georgia 4% 39%

Georgia 57,513 10,097,343



5

Atlanta, known by many as the capital of the south is a financial, tourist, and travel

hub for the southeastern United States. The many facets

of this region make it a destination point of people from

all round the globe.

The Hartsfield –Jackson Airport is the busiest in the world. This 4,700 acre

complex is home to Delta Airlines. In 2014 the airport saw over 860,000 aircraft

operations and serviced 96 million passengers. The airport is the largest

employment venue in the state offering jobs to more than 55,000 people. There are

several additional regional airports as well as Dobbins Air Reserve Base.

As a financial leader, 7 of the Fortune 100 companies have their headquarters in

Atlanta. In addition to Delta there is also Coca Cola, Home Depot, United Parcel

Service, AT&T and Newell Rubbermaid. These companies and the many other

industries keep the residents of Region III during the workday and also attract

individuals from other regions providing for a higher workday population.



6

Entertainment also draws large crowds into the Region. The Atlanta Braves,

Falcons, Hawks and the Georgia Tech Yellow Jackets all call this region home. In

addition Atlanta hosts other large venues such as the NCAA basketball finals, and

the Chick Fil A Bowl. The Atlanta Dome, Turner Stadium, and Phillips Arena all

provide for these events as well as others such as concerts and other mass

gatherings. Additional crowds of people are drawn to entertainment venues such

as Six Flags over Georgia, Whitewater Water Park, and Stone Mountain.



7

Injury Epidemiology

The Region III RTAC Board of Directors and membership have made a

commitment to acquire meaningful data to provide information for decision

making utilizing the state trauma registry, GEMSIS, T-QIP and other various

resources. The board will benchmark these statistics against other areas of the

nation with similar demographics and will publish the results annually for the

benefit of its membership, community stakeholders, and the general public.

Prevention and Education

Traumatic injuries of all mechanisms collectively have a significant impact on the

public health of our community. Therefor the trauma system should grasp the role

of injury prevention as a part of the complete trauma system.

The trauma council will utilize data collected by the trauma system to develop

evidence based programs in an attempt to reduce the impact of trauma on the

residents and transients of Region III and beyond. The programs developed will

look to make changes that can prove to have measurable outcomes.

A prevention and education council will be

established within the RTAC whose role will be

charged with leading these initiatives with the

backing of the various level care providers in the

region. This position should also work with the

various stakeholders in the region to include

industry, healthcare providers, the media, and the

general public to advance this program.



8

.

EMS

This section of the Region III Trauma Plan

will consider the pre-hospital portion of

trauma care. Pre-hospital providers are often

times the first providers of care and have a

tremendous impact on patient outcomes

based upon indicators such as response time,

care provided, and transport to the most appropriate facility. In this the pre-

hospital portion of this trauma plan will consider the following:

1. Pre-hospital resources available in Region III

2. Considerations for resources outside of Region III to be utilized during

times of need.

3. Establishing common tenets for protocols of trauma care within the

region based upon mutual understanding between the care providers, the

medical directors, and the trauma centers.

4. Identify best practices for destination determination for the transport of

the trauma patient within Region III.

5. Develop guidelines for the determination of transportation type within

the region.

6. Considerations for the dispatch protocols for emergency services.

7. Identify training standards for the 911 provider.



9

Georgia’s Region III is the most populace region in the state and easily outnumbers

many other states based upon considerations such as:

1. Annual EMS responses

2. Trained emergency medical responders

3. Response vehicles

The Region consists of the following counties and their respective emergency

service providers.

Clayton

Clayton County Fire and Emergency Services

7810 Highway 85

Riverdale, GA 30272

770-473-7833

Forest Park Department of Fire and Emergency Services

4539 Jonesboro Rd

Forest Park, GA 30297

404-608-2383

Morrow Fire Department

1500 Morrow Road

Morrow, GA 30260

770-961-4008

Cobb

Metro Atlanta Ambulance Service Puckett EMS

595 Armstrong Street 3760 Tramore Point

Marietta, GA 30060 Austell, GA 30106

770-693-8460 770-222-1988

Douglas

Douglas County Fire Department

6856 West Broad Street

Douglasville, GA 30134

770-942-8626



10

Dekalb

Dekalb County Fire and Rescue AMR

1950 W Exchange Place 1380-D Beverage Drive

Tucker GA 30084 Stone Mountain GA 30083

678-406-7750 678-537-6851

Fulton

Atlanta Fire Department Grady EMS

Office of Airport Operations 745 Memorial Drive SE

720 Doug Davis Drive Atlanta GA 30316

Hapeville, GA 30354 404-616-6396

404-382-1080

Hapeville Fire Department Rural Metro of Georgia

3468 North Fulton Avenue 250 Hembree Park Drive Suite 112

Hapeville, GA 30354 Roswell, GA 30076

404-669-2174 678-473-1990



11

Gwinnett

Gwinnett County Fire and Emergency Services

75 Langley Drive Lawrenceville, GA 30046

770-822-8000

Newton

Newton County EMS

5126 Hospital Drive NE

Covington, GA 30014

770-786-7053

Rockdale

National EMS

1060 Culpepper Drive

Conyers Ga 30094

770-922-9278



12

In addition to the licensed 911 providers, Region III has a multitude of responders

who routinely respond to calls for help within the region. A comprehensive listing

of these agencies would be difficult to list and maintain, however a few services

need to be mentioned for their specialty services.

Pediatrics

Children’s Healthcare of Atlanta Transport Services

1405 Clifton Rd

Atlanta, GA 30329

404-785-7778

Air Medical

Air Evac Lifeteam

Emergency Dispatch 1-800-242-3822

AirLife GA

1035 South Hill Street

Griffin, GA 30224

770-227-3206

Emergency Dispatch: 1-888-763-1010



13

Trauma Care Protocols and Medical Direction

The 2009 ACS study of the Georgia Trauma System recommends “The EMS

system medical director must have statutory authority to develop protocols…must

work closely with the trauma system medical director to ensure that that protocols

and goals are mutually aligned.. .must also have interaction with EMS agency

medical directors as local levels…”

The State OEMS&T does maintain a set of treatment protocols that are updated on

a regular basis as needed. Region III has a great deal of diversity. There are high

rise urban areas within a few minutes of trauma centers, peach orchards in our

more rural areas that are an hour from such care, and then the sub-urbans,

somewhere in between. Due to this diversity, and Georgia Code allowing for

“local rule”, each EMS agency has their respective treatment protocols. There

have been several past attempts to move to a one size fits all approach to place at

least the Metro Atlanta agencies on a standardized protocol system. These

attempts have failed due to the reasons noted above.

To then work within this framework, it will be imperative that EMS directors, the

local medical directors, and the trauma center directors come together to establish

identified best practice tenets in their respective local protocols. These standards

should be evidence based and reviewed on a regular basis to keep maintain

currency for best practices.

In this same discussion can be brought up the topic of medical direction. Again

each agency maintains their own medical director who develops their specific

protocols and policies and procedures based upon local rule. In this system,

communication between the physicians at each level could resolve and prevent

future problems and ultimately lead to better patient care. The Region III RTAC

will facilitate such discussions on an annual basis to ensure that the right

information is getting to the medical directors of each agency.



14

Patient Triage and Destination Determination

It is well noted in literature and studies the benefits

of transporting the EMS patient to the “right

facility the first time”. This has become even

more so with the specialization of medical centers

such as cardiac and stroke care. Correct decision

making in the transport of the trauma patient is

essential to ensure timely and accurate care. The

State Trauma Commission has identified and

published “Georgia Trauma System Primary

Triage Decision Scheme” (Appendix A) based

largely on the National Trauma Triage Protocol of the US Department of Health

and Human Services. This set of guidelines utilizes four assessment steps

(physiology, anatomy, mechanism of injury, and special considerations) to assist

the provider in determining the most appropriate facility to transport the patient to.

Region III has accepted this guideline as a best practice for the transport of the

trauma patient and will monitor transported patients to be reported as part of the

CQI process.

Method of Transport Determination

Few topics in EMS have drawn as much attention as the need for use of medical

aircraft. The most comprehensive study to date completed by the University of

Rochester shows that patients transported by air, although not as critical as those

transported by ground services, fare better than those transported by ground EMS.

(Boynton, 2011) With this information though also comes the desire to do what is

best for the trauma patient. Air medical transport, with its benefits, also comes at a

significant transportation cost.

Knowing this the practitioner should make decisions with the best use of

information available such as:

1. Patient needs

a. Surgical

b. Neurological

c. Specialty such as pediatrics or burns

d. Advanced airway management

2. Time

a. Time for arrival of air medical



15

b. Time of transport to a trauma center by air vs by ground

c. Access time for patient

i. Entrapped

ii. Stranded away from ground transport units

Noting that this resource is utilized for patients with significant illness or injury,

and that time is a significant factor, consideration for air medical transport should

occur as early as possible. Protocols should be in place to allow for either the

emergency dispatcher or the responding units to request air medical response as

part of the initial response and prior to arrival of first responders. This

consideration is no different than the response of other emergency resources that

may later be cancelled if not needed.

Due to the potential of severity of the patient, the cost of utilization of this resource

and the relative infrequency of its use, it is recommended that every chart for a

patient flown undergo a CQI review by the EMS agency.

Educational and Training

Standards

The ACS assessment of the state reported:

“It is critical that trauma system leaders

work to ensure that prehospital care

providers at all levels attain and maintain

competence in trauma care. Maintenance

of competence should be ensured by requiring standards for credentialing and

certification and specifying continuing educational requirements for all

prehospital personnel involved in trauma care.”

The state requires that each prehospital care provider receive 40 hours of training

every recertification cycle (2 years) of which 4 hours must be dedicated to trauma.

The RTAC will support this and encourage additional training by working together

to provide educational opportunities such a PHTLS, ABLS, and pediatric trauma.

As part of the CQI process, medical directors, service managers, and trauma team

staff should look for recurring disparities in trauma care that might indicate a need

for additional education. Trauma leaders should also consider emerging treatment

modalities that should be taught to the target audience. With the current abilities of

modern technology, reaching the masses of pre-hospital care providers is easier

than ever before. The RTAC will look to take advantage of these abilities to



16

educate the pre-hospital provider for the betterment of the treatment for patients we

serve.

The RTAC will also assist with, as able and appropriate, the delivery of Trauma

Nurse Core Course (TNCC) and Advanced Trauma Life Support (ATLS). These

two courses provide the educational backbone of care within the trauma system

Keeping the staff educated and informed will provide great dividends to the trauma

patient by ensuring the most up to date and comprehensive knowledge base.

Definitive Care Facilities

Trauma Centers

Region III has a total of 7 designated trauma centers within its boundaries. These

include three Level 1trauma facilities (one of which is a pediatric) and four Level II

facilities (one of which is pediatric). In addition there is a certified burn center.

Adult Facility Level

Atlanta Medical Center I

Grady Memorial Hospital I

Gwinnett Medical Center II

North Fulton Hospital II

WellStar Kennestone Hospital II

Pediatric Facilities

Egleston Children's Healthcare of Atlanta I

Scottish Rite Children's Healthcare of Atlanta-Level II II

Burn Facilities

Grady Memorial Hospital

Certified Burn

Center

Joseph M Still Burn Center



17

The Region III RTAC will complete a needs assessment annually to identify gaps in

trauma care in the region and will then work towards

resolving these gaps. A facility working towards trauma

certification in an identified “gap” area will be assisted by

the RTAC in working towards their goal of achieving

certification. Facilities undergoing this process will be

identified for their trauma care capabilities as “in active

pursuit” on the trauma plan and in the region.

Specialty Resource Centers

Specialty Resource Centers such as pediatric facilities and burn centers provide care

above and beyond for certain demographics of trauma patients. They should be

utilized as followed.

Pediatrics

All pediatrics meeting Georgia Trauma System Entry Criteria (Appendix A) should be

transported to a pediatric trauma facility. For the purpose of the trauma patient in

Region III, a pediatric is defined as age 14 and below. At the time of this writing the

sole provider of pediatric trauma care is Children’s Healthcare of Atlanta (CHOA) at

either Egleston or Scottish Rite. The EMS provider should call in the patient report to

the CHOA Communications Center and identify that they are transporting a trauma

patient. The CHOA

Communications Team

will take into

consideration destination

choice, distance, and

facility surgical abilities to

identify the destination

facility for the EMS

provider.



18

System Flow

Trauma diversion is defined as routing EMS agencies transporting trauma patients to

another facility due to a temporary inability to provide adequate trauma care. Each

facility is responsible for developing their policy for diversion which should include:

1. Criteria for diversion

2. Person or persons responsible for making diversion decision

3. Method and responsibility of notifying EMS of diversion status

4. Record keeping and performance improvement of diversions status.

The RTAC will develop and maintain a memorandum of understanding (MOU)

between the RTAC and the trauma centers regarding trauma diversion. This MOU

should be developed by the Trauma Center Council and approved by the voting

members of the RTAC to be added to this trauma plan at a later date.

Patient transfers are also a point of concern for the flow of trauma patients. Patients

are frequently transferred from within the region or into the region from areas with no

or limited trauma services. The Trauma Center Council should develop a policy to be

added to this plan regarding the following criteria:

1. Destination choice

a. Distance

b. Level of care

c. Specialty resource care needed

2. Method of transport

a. Air

b. Ground



19

Rehabilitation

Rehabilitation is the process of

helping a patient adapt to a disease or

disability by teaching them to focus

on their existing abilities. Within a

rehabilitation center, physical therapy,

occupational therapy, and speech

therapy can be implemented in a

combined effort to increase a person’s ability to function optimally within the

limitations placed upon them by disease or disability. To uphold the continuum of

care from illness to health and offer a high-level of service, rehabilitation is a

critical service offered within TSA-E through hospital-based programs and private

organizations. Transfer protocols for rehabilitation facilities are determined by

individual facilities.

Communications

In any disaster and during every day operations, communications is a vital aspect of

the trauma care system. Due to the diversity of the region, a one size fits all model of

communication is not practical and therefore makes communications during large

scale events difficult. Also the transition of many agencies to the use of cellular

technology creates a dilemma during times of disaster due to the system becoming

overwhelmed. The Region III RTAC will be involved in establishing regional

communications policies to identify and resolve these and addition communications

issues.



20

Also in the discussion of communications are the less emergent, but none the less

important messages that need to be sent. A great plan is of little use if all of the

players do not know what the plan is. It will be incumbent upon the Region III RTAC

to distribute trauma plans and policies to the providers of Region III and further as

necessary. The RTAC may utilize additional resources such as the EMS Council and

the GTCNC website as available. The Region III RTAC will track and ensure that

important notices and communications are received by the appropriate individuals at

the appropriate facilities.

Part of the charge for the RTAC as given by the GTCNC was to address in this plan,

connectivity with the Georgia Trauma Communications Center. In 2016, the Trauma

Communications ceased operations, therefor this operation is not addressed further.

Disaster Preparedness

The emergency response system within Region III incorporates all emergency support

functions (ESF) indicated in the National Response Framework, and is incorporated

within state and local plans. Regional ESF-8 (Health and Medical) response to

incidents and emergencies, in which response is localized, is

typically managed by individual hospitals, EMS agencies, and

with minimal involvement by supporting local health departments

and jurisdictional emergency management officials. However,

additional regional resources must be used when these incidents

exceed local capacity and local jurisdictions are required in order

to achieve a satisfactory response.

As reflected in the state of Georgia Emergency Operations Plan (GEOP) all

emergencies are considered a local responsibility. Therefore legal responsibility for

provision of support for emergencies is placed on the senior elected official within the

affected jurisdiction. Response entities such as hospitals and EMS agencies must work

through these officials when resource needs cannot be met by local assets only.



21

Many resources have been placed

within Region III by participation

in a number of Federal and State

programs designed to enhance local

and regional ESF-8 readiness.

These programs include:

- Georgia Regional Hospital

Coordinating Program through which area hospitals work together to achieve a

more fluid and balanced response to disaster.

- Jurisdictional participation through health departments and local emergency

preparedness. These programs prepare jurisdictions, their supporting local health

departments, and partnering health and medical professional for epidemiological

intervention and biological events, including Strategic National Stockpile (SNS)

preparations.

- Georgia Emergency Management Agency (GEMA) Area 7

Evaluation and Improvement

The System Performance Improvement (SPI) Committee reviews aggregate data and

specific case reviews in Region III. This review process analyzes the aggregate data

generated by sources such as T-QUIP, GEMSIS and the Trauma Registry. The

committee is composed of defined members of the RTAC and defines the guidelines

and processes for review. The committee will have 2 charges:

1. To consider specific cases for review. An agency may recommend a case

for trauma care review where the SPI committee will review each aspect of

care and offer fact based recommendations regarding future operations. The

SPI Committee can then forward the cases to the Board with

recommendations for action. Actions may include

a. Refer to Region III Council

b. Consider altering existing RTAC policies or creating new to

positively affect patient care outcomes.

2. To review data, both individual and aggregate, with the intent to identify

process and system changes that will positively affect patient care outcomes.



22

a. The SPI committee should identify key performance indicators (KPI)

for each discipline of care within the trauma system. These KPI’s

should be based upon sound scientific and protocol driven criteria.

b. These KPI’s should be reviewed annually to ensure continued

relevance within the trauma system.

c. The SPI Committee shall compare the appropriate data with the KPI’s

regularly and a minimum of on an annual basis. This review will be

to assess to operations of agencies and the regional system as a whole.

The intent will be to improve care for the trauma patient.

The committee should establish key performance indicators for each discipline of care

within the trauma system. These KPI’s should be based upon sound scientific and

protocol driven criteria. The committee will use the information gained to make

recommendations for changes in policy. In cases of negligence and continual non-

compliance with policy, the SPI committee will advise the Board, who may then

choose to refer the issue to the Region III Office of EMS and Trauma.

Research

The Region III RTAC participates in system research on an ad hoc basis. The Board of

Directors is responsible for governance and release of the data.

Appendix Appendix A- Georgia Trauma System Primary Triage Decision Scheme

Appendix B-Guidelines for Trauma Center Destination



23



24



25


region iii trauma plan july 2016 · region iii trauma plan july 2016 3 region board the system...

Documents