State Trauma Advisory Council (STAC)

Meeting Minutes

February 9, 2005

Holiday Inn

Madison, WI

Members Present DHFS Staff

James Austad Cathy Etter

Cecile D’Huyvetter Bruce Gordon

John Folstad Marianne Peck

Ray Georgen Dennis Tomczyk

Jeff Grimm Dan Williams

Barb Larson

Ed Mishefske

Aimen Shaaban (11am)

Steve Stroman

Randy Szlabick

Members Absent

Pat Ten Haaf

Others in Attendance

Joe Ketarkus Meriter, Madison

Liz Elsen Schlender Sauk Prairie Memorial, Prairie Du Sac

Judy Jones N/NW RTAC Coordinator

John Walsh Mercy Medical Center, Oshkosh

Neil Neinast St. Joseph’s, Marshfield

Robert Nack Fox Valley RTAC Coordinator

Holly Hepp Froedtert Hospital, Milwaukee

Michelle Ziemba St. Joseph’s, Marshfield

Jennifer Gerdmann St. Vincent’s, Green Bay

Dan Diamon Lake Superior RTAC

Jesse Tischer Mercy Hospital, Janesville

Lynne Sears UW Hospital, Madison

Ann Younger Crandall Theda Clark, Neenah

Kelly Stanislaus Theda Clark, Neenah

Carol Immermann Franciscan Skemp, LaCrosse

Gretchen Aschoff Aspirus Wausau Hospital

Joe Immermann SW RTAC Coordinator

1. Introductions

Randy Szlabick, Chair, began the meeting at 1010AM with introductions around the room. A special welcome to the newest member, James Austad EMT-P, from the Oshkosh Fire Department.

2. Approval of January Meeting Minutes

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

3. DHFS Updates

A. Bureau and DPH – Cathy Etter has filled the position of the ALS Coordinator and Brian Litza has filled the position of the Intermediate Coordinator at the Bureau of EMS. The Bureau is now fully staffed.

EMS Advisory Board – Steve Bane has been selected as Chair and Cal Lintz will be Co-Chair. Steve will fill the Board position on STAC beginning in March. The EMS Advisory Board has 10 days to approve the Wisconsin EMS Emergency Preparedness Plan (WEEPP).
HRSA Grant Objectives and the RTAC Coordinator’s meeting (see attached minutes). STAC has been requested to hold their meetings from 9am to 11am so the RTAC Coordinators could meet afterwards. STAC has agreed and from now on STAC meetings will be 9AM to 11AM.

D. Marketing – No report

State Trauma Registry – Digital Innovation has received the Purchase Order and the Bureau is awaiting a conference call to be set up by Digital Innnovation Staff.

4. Homeland Security Council

Senator Ron Brown has requested STAC to address the Homeland Security Council. Possible dates include March 2 or March 23. There was a discussion on what topics should be covered, how to do it and who should do it. Suggestions were to have a variety of disciplines address the Council for a few minutes each. Possible speakers include either Randy Szlabick or Ray Georgen (trauma surgeons), Cecile D”Huyvetter (Nurse and Trauma Program Manager), Steve Stroman (ED Physician) and Ed Mishefske and Dan Williams ( EMS and Fire). More questions need clarification – who is the audience, what is the message? Ed Mishefske will discuss with Senator Brown and let Marianne Peck know so she can disperse the information to STAC.

5. PI Discussion

Led by Cecile D’Huyvetter, the group discussed the proposed PI language for protection from civil liability and discoverability. The group felt that the language was inclusive and fulfilled RTAC needs. Dan Williams will confirm with the DHFS lawyers that the language does not prevent or preclude the Bureau from doing it’s own investigations. Jeff Grimm made a motion with a second by John Folstad to approve the language as written and to send it forward through DHFS to Senator Brown to be introduced as a Bill. Dan Williams and Marianne Peck will follow through with the next steps.

6. Review and confirm STAC’s goals for 2005

STAC reviewed the goals (see the minutes from January). It was suggested to make the goals more measurable and to include the educational component for providers, policy makers and the public as an essential component. Barb Larson will attempt to revise the goals with that in mind.

7. Questions on Level III and IV criteria for trauma designation (see attachment).

8. RTAC Reports – due to time constraints the reports will be deferred until the March STAC meeting.

9. Other Business – Lynne Sears shared a Public Service Announcement (PSA) that has been aired on the Madison area radio stations. It features Mary Reinhart (who spoke at the Surgeon General’s conference a couple of years ago) and Lynne has offered it to others if they would like to use it. Lynne also questioned STAC if they had a chance to review the EMSC packets that were distributed at the January STAC meeting. STAC agreed it was an excellent packet and for EMSC to move forward with them.

10. Next Meeting – March 2 at the Holiday Inn in Madison from 9AM to 11AM.

Respectfully submitted,

Marianne Peck

State Trauma Care System Coordinator

Comments/Questions regarding Level III and IV Trauma Designation Criteria

1. Clarification:

For the Trauma Service Director: The recommendation is for a general surgeon to

serve in this capacity. However, this is not required and may be an Emergency

Department Physician who cares for the trauma patients.

2. Question: Which physicians are required to be ATLS certified other than ED Physicians?

Answer: Note: Footnote 5 states that “physicians involved in the care of the trauma patients shall take the ATLS Course……..” This includes surgeons and ED Physicians because both groups lead the initial resuscitation of major trauma patients. Please also note that in Footnote 13 it states – “The ED physicians will have three years from the Trauma Care Facility’s (TCF) classification date or from the date of the ED physician joining the trauma team at the TCF to successfully complete this course.” This will also hold true for the general/trauma surgeons and physicians who “moonlight” for the ED and will be involved in leading the initial resuscitation of the major trauma patient.

3. Question: What staff is required to be on the Trauma Multidisciplinary Committee?

Answer: Some of the recommendations from the American College of Surgeons (upon which the criteria for Level III and IV is based) is:

Trauma Service Director
ED Medical Director
ED Physicians
Surgeons
Trauma Program Coordinator (Manager)

It will depend on your facility and your capabilities. It is up to the hospital to determine the makeup as long as it includes those who directly care for the major trauma patient.

4. Question: What are the formal continuing education program requirements?

Answer: It is up to the institution to select the trauma education that will most help prepare the staff to care for the major trauma patients. Some of the recommendations include:

TNCC
ENPC
PHTLS
TNS
CATN

There are others and your RTACs can help inform you about what exists and what the

above mentioned courses include.

5. Clarification:

“On-Call and promptly available” – is up to the hospital to determine what is appropriate. This should be tracked in your PI process. Obviously there are limits to this – for example – a surgeon not responding for an hour would not be “promptly available” – but some facilities have surgeons that respond in 5 minutes, for others it may be 15 to 20 minutes. The standard to be physically present is not more than 30 minutes. Timing of the response should be from the time they are notified per phone or pager.

6. Clarification:

If your facility desires to be a Level III Trauma Care Facility but is not able to have surgical coverage, per the criteria, that facility would not meet the Level III criteria and would not be eligible for Level III State Designation. The surgeon would be required for the initial resuscitation.

7. Clarification:

For Anesthesia – see footnote 14 – anesthesia must be immediately available for airway or operative management – must be available to immediately care for the patient that has an airway situation and that response should also be evaluated in the PI process.

8. Clarification:

Arterial catheters are required for Level III – this is not saying you have to put them in on your major trauma patients, just that you should have the equipment and the capability if needed.

9. Clarification:

Hospitals are asked to determine what their State Designation (what resources) is as of July 2005, not what you hope to be in the future. (In other words, what level are you functioning at now)? You may at any time change your level of designation as long as you complete the required application process and are approved by the Department of Health and Family Services.

10. There has been discussion regarding how the State Designation will affect EMS.

There are statewide-approved Triage and Transport Guidelines in effect throughout

Wisconsin that are in place to assist EMS with this determination. This is a local and

regional issue that should be brought forth to each RTAC for discussion among the

various partners involved.