The Central RTCCThe Central RTCC

James W. Davis MD, FACSJames W. Davis MD, FACS

Chief of Trauma, CRMCChief of Trauma, CRMC

Professor of Clinical Surgery Professor of Clinical Surgery UCSF/Fresno UCSF/Fresno

The Credit Belongs to EveryoneThe Credit Belongs to Everyone

Some deserve special recognitionSome deserve special recognition::– Lynn Bennink – CRMC FresnoLynn Bennink – CRMC Fresno– Linda Diaz – Merced EMSLinda Diaz – Merced EMS– Debbie Becker – Fresno EMSDebbie Becker – Fresno EMS– Chuck Baucom – Merced EMSChuck Baucom – Merced EMS– Clarence Teem – Tuolumne EMSClarence Teem – Tuolumne EMS

The RequestThe Request

Regional RepresentationRegional Representation

Short and Long term goalsShort and Long term goals

Successes and ChallengesSuccesses and Challenges

How Central Region can foster California How Central Region can foster California State Trauma SystemState Trauma System

The Central RegionThe Central Region

Central California covers approximately 32,000 sq Central California covers approximately 32,000 sq miles or 20% of California. miles or 20% of California. – Rural in nature with large areas of agricultureRural in nature with large areas of agriculture– Bounded by the Sierra Nevada mountain rangeBounded by the Sierra Nevada mountain range

The region serves a population of approximately The region serves a population of approximately 3.5 million or 10% of California population.3.5 million or 10% of California population.consists of 12 counties (25% of the counties in consists of 12 counties (25% of the counties in California), California), 5 LEMSA’s (2 regional and 3 single counties),5 LEMSA’s (2 regional and 3 single counties), 1 level I Trauma Center1 level I Trauma Center3 level II Trauma Centers3 level II Trauma Centers

The Central RegionThe Central Region

KERN

TULARE

KINGS

FRESNO

MADERA

MARIPOSA

MERCED

STANISLAUS

ALPINE

TUOLUMNE

CALAVERAS

AMADOR

Fresno-one level 1 Trauma Center

Modesto-two level II Trauma Centers

Kern-one Level II Trauma Center

CRTCC History and ProcessCRTCC History and ProcessAugust 2008, Meeting August 2008, Meeting – All interested parties from the State SummitAll interested parties from the State Summit

Executive Steering Committee formedExecutive Steering Committee formed

Early Decision: Process DrivenEarly Decision: Process Driven– BylawsBylaws– Mission & VisionMission & Vision– GoalsGoals– MembershipMembership

CRTCC BylawsCRTCC Bylaws

Guiding Principles:Guiding Principles:– Inclusive, not exclusiveInclusive, not exclusive– CollaborativeCollaborative– KISSKISS

Bulk of efforts from EMS AdministratorsBulk of efforts from EMS Administrators– Clarence TeemClarence Teem– Chuck BaucomChuck Baucom

Mission Statement, CRTCCMission Statement, CRTCC

To participate in the development of To participate in the development of standardized regional trauma care, as well standardized regional trauma care, as well as the establishment and maintenance of as the establishment and maintenance of a coordinated regional trauma system to a coordinated regional trauma system to promote optimal trauma care for all people promote optimal trauma care for all people within the region.within the region.

VisionVision All inclusive system of trauma care All inclusive system of trauma care throughout the central region of Californiathroughout the central region of California– Pre-hospitalPre-hospital

Destination criteriaDestination criteria

Uniform standards of careUniform standards of care

– FacilityFacilityAdequate numbers and quality of trauma centersAdequate numbers and quality of trauma centers

Rehabilitation Rehabilitation

– Education and PreventionEducation and Prevention– Region-wide performance improvementRegion-wide performance improvement

AccomplishmentsAccomplishments

Bylaws completed and approvedBylaws completed and approved

Formal regional response to EMSA draft on Formal regional response to EMSA draft on Intensive Care Services for the Pediatric Trauma Intensive Care Services for the Pediatric Trauma PatientPatient

Gap analysis completedGap analysis completed

General Membership meeting held with diverse General Membership meeting held with diverse representationrepresentation

Subcommittees formed with goals established for Subcommittees formed with goals established for eacheach

Presentation to the Hospital Council CEO groupPresentation to the Hospital Council CEO group

GoalsGoalsPrehospital subcommitteePrehospital subcommittee– Standardized triage and destination criteriaStandardized triage and destination criteria– Ambulance utilizationAmbulance utilization

Facility subcommitteeFacility subcommittee– Gap analysisGap analysis– Work with prehospital subcommittee on Work with prehospital subcommittee on

destination criteriadestination criteria

Goals Goals (cont.)(cont.)

Education/Prevention subcommitteeEducation/Prevention subcommittee– WebsiteWebsite– Prevention consortium to look at available resourcesPrevention consortium to look at available resources

PI subcommitteePI subcommittee– Peer reviewPeer review– Benchmark dataBenchmark data– Quality indicatorsQuality indicators– To meet Semi-annually/quarterlyTo meet Semi-annually/quarterly

ChallengesChallengesWe have had GREAT collaboration but we We have had GREAT collaboration but we lack Legislative Authoritylack Legislative Authority– This is VOLUNTARY buy-in This is VOLUNTARY buy-in

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$– Large region, face to face meetings are hardLarge region, face to face meetings are hard– TeleconferencingTeleconferencing

Lack of adequate number of trauma Lack of adequate number of trauma centers and physicians centers and physicians – the San Joaquin Valley has 51% fewer specialists the San Joaquin Valley has 51% fewer specialists

than the rest of the statethan the rest of the state

How we can foster a statewide system How we can foster a statewide system

Collaboration with other regionsCollaboration with other regions– Only region Only region in the state that borders every in the state that borders every

regionregionStandardized destination and triage criteriaStandardized destination and triage criteria

Transfer agreements and arrangementsTransfer agreements and arrangements

Address gaps in trauma care Address gaps in trauma care (gap analysis)(gap analysis)– Rural trauma courseRural trauma course– telemedicinetelemedicine

Participate in statewide trauma registryParticipate in statewide trauma registry

   William Butler Yeats (1919)William Butler Yeats (1919)

The Second ComingThe Second ComingTurning and turning in the widening gyre Turning and turning in the widening gyre

The falcon cannot hear the falconer; The falcon cannot hear the falconer;

Things fall apart; Things fall apart; the centre cannot holdthe centre cannot hold; ;

Mere anarchy is loosed upon the world, Mere anarchy is loosed upon the world,

The blood-dimmed tide is loosed, and everywhere The blood-dimmed tide is loosed, and everywhere

The ceremony of innocence is drowned; The ceremony of innocence is drowned;

The best lack all conviction, while the worst The best lack all conviction, while the worst

Are full of passionate intensity. Are full of passionate intensity.

ConclusionConclusion

Californians deserve Californians deserve and must have an and must have an effective state-wide effective state-wide trauma systemtrauma system

This This CenterCenter will hold will hold

Anarchy in trauma Anarchy in trauma care will NOT be care will NOT be loosed upon the world loosed upon the world (or state)(or state)