Members Absent

Randy Szlabick

Others in Attendance

Neil Neinast                                                                St. Joseph's Hospital, Marshfield

Dan Diamon                                                               Lake Superior RTAC Coordinator

Bob Nack                                                                    Fox Valley RTAC Coordinator

Greg Friese                                                                  North Central RTAC Coordinator     

Judy Jones                                                                   North/Northwest RTAC Coordinator

Michelle Ziemba                                                         St. Joseph's Hospital, Marshfield

Joseph Immermann                                                     Southwest RTAC Coordinator

Kelly Jung                                                                   Theda Clark, Neenah

Ann Younger-Crandall                                                Theda Clark, Neenah

Lynne Sears                                                                 UW Hospital, Madison

Holly Hepp                                                                    Froedtert Hospital, Milwaukee

Todd Van Langen                                                        West Bend Fire Dept.

Tammi Hovde                                                              West Central RTAC Coordinator

Fred Hornby                                                                 Bell Ambulance

Amy McCray                                                                Southeast RTAC Coordinator 

Gretchen Aschoff                                                         Aspirus, Wausau

Joe Baasch                                                                    LifeStar EMS

Rebecca Long                                                               Aurora Healthcare

Dean Becker                                                                 Orange Cross Ambulance

Andrea Winthrop                                                          Southeast RTAC Chair

Tom Brazelton                                                              UW Children's Hospital and EMSC

Cinda Werner                                                                Children's Hospital of WI

Kim Krueger                                                                   Milwaukee County EMS

Lee Faucher                                                                    UW Madison Hospital and Clinics                                                               

1. Introductions - Dr. Steve Stroman (Vice-Chair)

Dr. Stroman began the meeting at 9:10 am with introductions around the room.  Dr. Stroman started with Merrilee Carlson, the newest STAC member.

2. Approval of April Meeting Minutes - STAC

Steve Stroman asked for review of the April meeting minutes.  John Folstad made a motion to approve the minutes as read, with a second from Barbara Larson.  Unanimous approval, motion carried.

3. DHFS Updates

1. Bureau and DPH - Dan Williams

Dan Williams announced Emergency Rule HFS 113 Public Hearings to take place June 27 - check the website (http://dhfs.wisconsin.gov/ems) for further information.  The rule enables First Responders to give epinephrine for anaphylaxis and to use a non-visualized airway.  The Emergency Rule went into effect June 6.  Starting June 6, the public has 150 days to respond to the emergency rule including at the public hearings.  Then on day 151 the Emergency Rule goes into effect becoming final rule.  First responders must file an operational plan and work with medical control and their ambulance service.

The Request for Purchase (RFP) for the EMS Data Base is nearly completed.

2. HRSA Grant Objectives (WEEPP) - Dennis Tomczyk

Dennis Tomczyk updated the group about the Wisconsin EMS Emergency Preparedness Plan (WEEPP) roll-out and will be handing out the DVD's of the presentation to the RTAC Coordinators at their meeting. 

Dennis encouraged EMS to explore the Office of Justice Assistance monies available for EMS that many do not know about.  He suggested RTAC coordinators go back to their regions and encourage EMS services to apply for the grant money available.  The funding from OJA is shared among, and tends to go to, Law Enforcement and Fire. 

Dennis also provided a handout titled, FY 2005 HRSA Grant Budget for September 2005 to August 2006, and discussed the future funding with the group including communications, completing the WEEPP and disaster exercises required in each region. There is an existing Communication Plan which comes out of the Bureau of LHS & EMS. 

Dealing with mass burn injuries will also be a component.  Dr. Lee Faucher, trauma and burn surgeon, has been working with Dennis on burn issues, and stated that President Bush met with the American Burn Association President to discuss how to prepare the country for massive burn casualties.  There will be a National Disaster Burn Plan that can assist Wisconsin with the necessary HRSA objectives.

The Strategic National Stockpile strategically placed at various locations will include Cipro, Doxycycline and Amoxicillin for treating biological exposure.  Chem packs include, among other supplies, chemical nerve agent antidote.  70% will go to EMS and 30% to hospitals.

 The State Preparedness Conference will be taking place Sept. 12 and 13 at the Hyatt in Milwaukee, and includes a speaker from Israel on their trauma preparedness for mass casualty.  The conference will be webcast

live. 

Joe Immermann - gave a synopsis on Triage Tuesday which has proven to be valuable.  Triage Tuesday is an activity designed towards familiarizing EMS and hospital personnel with disaster triage, particularly the patient tags, which classifies each patient's treatment urgency by their level of severity.  Every Tuesday the ambulance transport services will triage all patients using START, even if the pt. is not a trauma victim.  This enables practice for EMS services regularly.  This exercise flows into the ER where hospital personnel also get a chance to review usage and interpretation of triage tags.  Many issues have come to light doing this review, including the treatment flow and tracking of patients and their families, security, census and documentation, among others.

                 C.   State Registry - Marianne Peck

Marianne Peck thanked Neil Neinast from St. Joseph's, Carol Immermann from Franciscan Skemp and Vicki Tegtman from St. Vincents for participating in the finalization of the data elements with Digital Innovation.  Digital Innovation (Collector), the state trauma registry, is nearing completion for reviewing the data elements on a screen.  The current plan is to have Level III and IV's put in data on patients they keep and the Level I and II's to put in the data on the patients transferred while allowing III and IVs access to their data on transferred patients up to the point of transfer.  Those details, however, are still being worked out with Digital Innovation.  The timeline is still on track to collect data from Level I and IIs beginning October 2005.

1.      Hospital Designation - Marianne Peck

·        Criteria issues

Discussion centered on urban areas where flight and other EMS crews may arrive at the hospital that is transferring the patient before the surgeon arrives.  STAC's recommendation is that no matter what, the surgeon in a Level III must always be called in and respond to a major trauma patient activation alert.  If for some reason EMS did not arrive timely or the patient needed a sudden operative procedure, the surgeon must be there to respond.  The issues with this scenario should be reviewed in the Performance Improvement (PI) process.  There was agreement among the group that the trauma surgeon is key for the trauma system to work.

Anesthesia should be available within 30 minutes same as the surgeon while the Emergency Physician and Respiratory Therapy can give immediate airway control.  

There was an extensive open discussion on what criteria should be used to define a major trauma patient for purposes of activating a trauma alert for hospitals.  The group agreed that our trauma system must not use less than the ACS gold book standards, therefore the following recommendations were made by STAC:

·        It is up to the hospital to define major trauma but must include at a minimum the following:  The trauma system Administrative Rules, Chapter 118 definition - "major or severe injuries to more than one system of a person's body or major injury to a single system of the body that has the potential of causing death or major disability.  Hospitals should also be familiar with, and consider incorporating, the EMS criteria definition of trauma. 

·        Confirmed Blood pressure less than 90 at any time in adults and age specific hypotension for children;

·        Respiratory compromise/obstruction and/or intubation;

·        Transfer patients from other hospitals receiving blood to maintain vital signs;

·        Emergency physician's discretion;

·        Gunshot wounds to the abdomen, neck or chest and,

·        GCS less than 8 with mechanism attributed to trauma.

                                      To reiterate, the above is the minimum that a trauma care facility

                                      should use to activate their trauma alert..

                                  2.  ATLS availability -

ED physicians and surgeons have three years to complete ATLS.  There is a concern if there will be enough courses available to accomplish this.  There have been several ATLS classes cancelled across the state due to low enrollments.   ATLS website has lists of available classes.  The group asked each RTAC subcommittee to do a needs assessment to determine ATLS course needs.  Verified trauma centers may need to consider having more ATLS classes.

D.     Regional trauma plan template – STAC 

            This item was placed on hold due to time constraints.

E.      Marketing presentation and discussion - Lynne Sears

Lynne Sears introduced Danny Mager and Marianne King from Staples Marketing Communications.  Danny and Marianne went over The Statewide Trauma Care System Educational Program Outline that was developed.  Handouts were provided.  (See attachment)

F.      RTAC reports (as time permits) - RTAC Coordinators –Time did not permit this agenda item.

1.      Northeast                            F.  Southeast

2.      North Central                     G.  South-central

3.      North/Northwest                H.  Lake Superior

4.      West Central                       I.   Fox Valley

5.      Southwest

G.     Other Business

John Folstad spoke to the group regarding the issue of when there is no Verified Trauma Center in a region and how that works with the Triage and Transport Guidelines.  The group agreed the EMS medical director will have the final say about where to send the patients, and of course, patient choice is first.  Discussion included possible reasons why a hospital may no longer have it's verification.  Ray Georgen stated that STAC should be involved in the future when a hospital loses its verifications for any reason.  Further discussion on hold due to time constraints.

After a discussion STAC agreed on the following:

STAC meeting times will be expanded from 9am to 1130am.

There will be an October STAC meeting.

Future STAC meetings are:  September 7, October 12 and November 2.  There will be no December STAC meeting scheduled at this time.

The Wisconsin Division of the American Trauma Society conference will be held November 4 and 5 at the Plaza in Wausau and will be honoring Senator Brown for his devotion to the trauma system and trauma patients. 

Motion to adjourn by Steve Stroman with a second by Aimen Shaaban.  Meeting adjourned at 11:22AM.

       There is no July or August STAC meeting.  Next meeting is September 7, 2005 at

       the Holiday Inn on East Washington from 9AM to 11:30AM.  There will be an   

       RTAC Coordinators meeting following STAC. 

Respectfully submitted,

Helen Pullen/Marianne Peck