State Trauma Advisory Council (STAC)

Meeting Minutes

December 6, 2006

Sheraton Hotel, Madison, WI

10:30 - 12:30am

 Members Absent

Karen Brasel (Excused)

1.      Introductions - Dr. Randy Szlabick (Chair) 

Randy Szlabick called the meeting to order at 10:30AM with introductions around the

room.  After introductions, Marianne Peck reminded the group that STAC is    

appointed by the Secretary of DHFS as an advisory group to the State staff.  Marianne requested that STAC members discuss the topic first and then the STAC Chair shall

open up discussions to the audience as appropriate and the audience shall raise their

hands to be recognized. 

2.  Approval of October Meeting Minutes

Motion made by Barb Larson with a second by Ray Georgen to approve the minutes as written.  Unanimous approval, motion carried.

3.  Bureau of LHS and EMS Updates - Dan Williams

Dan Williams clarified the EMS Section funding concerns.  The First Responder’s position funding has been cut.  There is potential of further funding cuts through the Prevention Block Grant.  The Medical Director position will continue as a contract position at $25,000 rather than $50,000.  The Medical Director’s workload will be prioritized and reduced to match the cut in funding.  Dr. Wesley reassured STAC that he will continue to commit as much time towards the trauma system as he has in the past.  It was also mentioned that there is a deficient of $135,000 within the Division of Public Health. 

Dan Williams announced his resignation as the section chief, but emphasized it was not related to the funding issue. 

The Ambulance Run (WARDS) reporting system has been live since April 2006 with approximately 20% of services using the system.  Many of the obstacles from the third party vendors for cross-over of data have been reduced.  Bridges for moving data from these software applications to WARDS will be available for use after the first of the year.  

There is an effort in the Division of Public Health to map CASEPOINT (Coroners data system), Trauma Registry, Hospital Discharge and WARDS to work toward entering data once.  Dan explained that the Data Sharing (Integration) Group, charged with this task and led by Debi Peters, is identifying the gaps so all can have access to the data. 

Randy thanked Dan for his efforts and emphasized that he will be missed.

4.  EMS Advisory Board Updates - Cal Lintz

Cal Lintz mentioned that Dan Williams will continue to support and advocate for EMS. 

EMS Management and EMS System Development subcommittees are identifying their new charges.  Joe Covelli is leading the EMS System Development group to create a common message about EMS.  The Education Board completed the EMT Basic courses and revisions.  Disaster Management is a new committee working with the disaster trailers and making use of universal triage tags.

Steve Bane and Cal Lintz met with the Secretary’s (DHFS) office yesterday.  They left with the impression that the EMS section is not being eliminated and that DHFS considers EMS important to the health care system and public health within DHFS. 

5.  HRSA Update - Dennis Tomczyk - See Attachment

6.  Strategic Planning Meeting

DHFS has requested a strategic planning committee with STAC.  The purpose of this meeting is for STAC to renew/revise its purpose and mission.  There is not enough time for this be accomplished during the regularly scheduled STAC meetings.

Joe Covelli was introduced.  He has been involved with EMS for 20 years and will facilitate the strategic planning session.  He emphasized that it is important to recognize past successes and where STAC would like to go.

Discussion among STAC resulted in a decision to hold the planning session March 27.  Time and place will be announced.  Dr. Wesley recommended having a place where members can arrive the night before rather than drive the day of the meeting.  The site will be Stevens Point or Wausau. 

There will be a regularly scheduled February STAC meeting. 

7.  Waiver-ATLS-Board Certified Surgeons

The new ACS (American College of Surgeons) Resource Manual has changed the ATLS surgeon requirements.  The new requirements state that a general surgeon only needs to take ATLS once if they are currently board certified.  The Trauma Medical Director is exempt from this rule and must take the training every four years (whether board certified or not).  If a surgeon is not board certified, the surgeon must continue to take ATLS every four years.  Cecile D'Huyvetter made a motion to recommend that DHFS waive Wisconsin’s current rule requirements in favor of the new ACS guidelines.  The motion was second by Ray Georgen.  Unanimous approval, motion carried.

If Trauma Coordinators need the dates of their surgeons’ ATLS training, they can contact Freddie at ACS. 

Final discussions occurred at both the working subcommittee and STAC regarding continuous surgical coverage at multiple trauma care facilities. DHFS legal counsel was present at the working subcommittee discussion and agreed with the conclusions. The far west and northwest part of Wisconsin has multiple facilities self-designated as Level III’s that share a surgeon with no back-up surgical coverage.  After discussions, the following clarification shall be Wisconsin’s Level III surgical coverage expectations based on the ACS, which Wisconsin has adopted as it’s guidelines for designation.  Continuous surgical coverage is required to maintain a Level III designation.  If a surgeon shares call at multiple facilities then there must be a back-up surgeon for each facility.  If two facilities share a surgeon, there should be a back-up; if both the primary and back-up are in a surgical procedure, the transfer policy should be instituted.  This is in agreement with the ACS guidelines and has been confirmed with ACS personnel by trauma care participants. 

There is a concern this will require all trauma care facilities in the above mentioned regions to be Level IV’s. 

Education and discussion among the RTAC trauma care facilities is essential to resolve this issue.  The ideal solution is for the RTAC to pool its resources and determine which facility(s) could function as a Level III and monitor the results at the PI process in the RTAC.  RTACs should consider their length of time to their verified trauma center (some greater than 20 to 30 minutes) and other factors.  Randy Szlabick emphasized the goal should be at least one Level III in every RTAC.  A solid transfer policy is also essential.   

If any facilities decide to change their Level III designation to a Level IV due to the above reason, the trauma facility does not need to fill out the application again.  A letter from the facility’s CEO stating that the level will change from a Level III to a Level IV is adequate.  A trauma facility should not continue to advertise itself as a Level III if in fact it is not functioning as a III.  The State requests the trauma care facility that chooses to change their level to a IV, send the above mentioned letter to Marianne Peck by April 1, 2007.  That is not to preclude a hospital from changing it's level from a III to a IV even the morning of the site review before April.  However, if a facility requests to change from a Level IV to a Level III they must fill out the application again and this must be done a minimum of three months in advance of their site review

8.  Approval of the Regional PI Template - Randy Szlabick

Randy emphasized the template is dynamic.  There was discussion regarding the pre-hospital run sheet availability.  While the run sheet is a part of the medical record, there is not a statement in the administrative rule that gives a time frame in which the receiving facility should have the record in its possession.  If the patient is transferred, and the original facility does not have the run record then the secondary facility will not have the information it needs upon patient arrival.  There is an effort underway to create a single sheet that contains the critical elements that should resolve this issue of receiving facilities having the information they need.  The Bureau of EMS is currently looking and revising the EMS administrative rules, including the pre-hospital run sheet requirements.

Barb Larson and Ray Georgen moved and seconded the acceptance of the PI template.  Unanimous approval, motion carried.  PI template accepted for RTAC usage.

9.  Site Review Process - Cecile D'Huyvetter

Training for Wisconsin’s site reviewers was held in LaCrosse November 3 and 4^th by experienced site reviewers from Texas. 

Texas offers consultation visits for their hospitals prior to their site reviews.  STAC discussed if this could and should happen and how.  There was a concern expressed regarding the time and workload required for some trauma coordinators at verified trauma centers.  After discussion it was decided that facilities may consult their RTAC and/or their regional verified Level I or II trauma center(s) in their RTAC for assistance on site reviews.  If the trauma program manager is unable to assist the facility, Marianne Peck will have a list of site reviewers willing to perform consultative visits, however, the person performing the consultative visit cannot also do the site review at the same facility.  The consultation visit will occur between the site reviewer and the trauma care facility and the State will have no involvement whatsoever, except to supply the list of site reviewers willing to serve as a consultant.  It is up to the verified trauma center program manager to determine their ability to assist the Level III and IV facilities and whether they feel they are unable to meet the needs for the inquiring facility.

The information from the consultative visit would not be available to the State.  The American College of Surgeons also provides consultative visits and that information is available to the State.  The facility will determine which type of consultation would be most helpful and will pick the site reviewer they would like to do the consultative visit (as long as it is not their "official" site reviewer).

Cecile reported that the designation subcommittee has accomplished its work including the development of forms and training of site reviewers.  Committee members were recognized by Cecile (Chair); Kelly Jung, Lynne Sears, John Folstad, John Walsh, Tom Ellison and Marianne Peck.  Facilities will be requested and receive an evaluation form to be completed after the site visit in order to improve this new process.  There will be two chart review tools reviewers can use, or they can use their own to help organize their chart reviews.   There will be an introductory and exit template and a rating score form to be filled out on-line which shall be available for the State and then the Designation Review Committee (DRC) (when DHFS is able to get it available on the website).

From this point forward any changes requested will be a part of the DRC’s charge.  The rating form has been approved.  The exit interview template includes the fact that the review findings will not be available on the day of the site review.  Marianne Peck will receive the report, and submit to the DRC who will then review and make recommendations to DHFS. 

STAC will not receive a report of Wisconsin’s site reviews.  Issues, however, will be submitted to STAC.  The site reviewer does not have to attend the Designation Review Committee meetings, however, he/she may be contacted for any clarification.  The reviewer must be clear on the ratings and the reasons for that rating.

There being no further business a motion was made to adjourn by Barb Larson with a second by Jeff Grimm.  Unanimous approval, motion carried with adjournment at 12:25 pm.

Next Meeting:   February 7, 2007 from 10:30am to 12:30pm at the Sheraton on John Nolen Drive in Madison.

HRSA Hospital Disaster Preparedness Up-Date

December 2006

I.      HICS IV

A program to “Train the Trainer” on HICS IV (Hospital Incident Command System) is being scheduled for the 1^st quarter of 2007.The new HICS IV is now available on-line at www.emsa.ca.gov. The Program will also sponsor a separate series of workshops for non-hospital healthcare facilities, e.g. nursing homes, assisted living facilities, etc.

II.      “Patient At Risk”

The “Patient At Risk” program will allow providers and emergency planners to have access to information to attend to the medical needs of those persons, listed in the “Patient at Risk” database so as to better serve them when there is a medical emergency, whether that be an individual patient emergency or a disaster situation. It is anticipated that hospitals desiring to sponsor this program will make their decision known by January 5, 20007.

III.      State Expert Panel on Radiation Emergencies

This Panel will meet next on December 12, 2006.The Panel is close to completing its work. The Panel will provide guidance for hospitals, Emergency Departments, EMS and physician offices for managing patients, exposed to radiological agents.

IV.      State Expert Panel on Mechanical Ventilation

The panel has completed the draft of its plan and anticipates that it will provide all hospitals with >60 ventilator days per year with a ventilator in Phase I. Phase II will involve providing additional ventilators to hospitals that serve a greater number of ventilator-dependent patients. The Technical Colleges will be responsible for the training of Respiratory Therapist with one common curriculum.

V.      State Expert Panel on Disaster Ethics

The first meeting is scheduled for January 4, 2007.The intent is to produce a “Guidance Document” on ethical issues and then involve clinicians and also the general public in a discussion about these issues.

VI.      State Expert Panel on Human Resources

The panel has a first draft of a policy for the deployment of volunteers at hospitals and local health departments. It is anticipated that the panel will complete is work in the spring of 2007.

VII.      State Expert Panel on Materials Management

The panel is focusing on assisting hospitals in a disaster to procure the necessary supplies and equipment when inventories are falling short. The panel has developed 7 different options for obtaining supplies. It is working with Distributors at the present time to determine which of these options will be the most feasible.

VIII.      WI Trac

This is a web-based system to track bed and resource capacity. A trainer has been hired to help all users take advantage of the full uses of this system. Intended users are hospitals, EMS, physician offices, public health, emergency management, fire departments, and law enforcement.

IX.      State Expert Panel on Healthcare Facilities

The workplan for healthcare facilities has been completed. A Baseline Survey is being completed with a deadline of December 31, 2006. The survey is available on-line for all healthcare facilities (except hospitals) to complete.

X.      Patient Tracking

The specifications for this system are being developed.

XI.      Wisconsin Ambulance Run Data System (WARDS)

The Bureau of EMS has purchased, through a grant from the HRSA Hospital Preparedness Program, the WARDS Hospital Interface Module, which will allow hospitals to look at the ambulance run data for their hospital.

XII.      Billing and Coding

The Program is collecting billing and coding issues that may arise in a disaster incident. Any questions or issues about billing and coding should be forwarded to Anne-Marie Gates (see contact information below)

XIII.      State Expert Panel on Dispatch

The panel met for the first time on November 8, 2006 and was successful in developing a first draft of a statewide protocol for all Dispatch to follow in a mass casualty incident. The panel will meet again in January 20067 to refine this first draft.

XIV.      PEPP Training

Pediatric Education for Pre-Hospital Professionals is being offered through the Hospital; Disaster Preparedness Program for up to two persons from each EMS and First Responder Service. Application and information about PEPP can be obtained through your local RTAC.

Trauma Educational Offerings 2006

Trauma Educational Offerings 2007

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