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State Trauma Advisory Council (STAC)

Meeting Minutes

March 2, 2005

Holiday Inn

Madison, WI

Members Present                                                                                    

 DHFS Staff

James Austad                                                                                            
Cathy Etter

Steve Bane                                                                                                 
Bruce Gordon

Cecile D'Huyvetter                                                                                     
Marianne Peck

John Folstad                                                                                              
  Meg Taylor

Ray Georgen                                                                                            
   Dennis Tomczyk

Jeff Grimm                                                                                                 
Dan Williams

Barb Larson

Aimen Shaaban

Steve Stroman

Randy Szlabick

Members Absent

Ed Mishefske

Pat Ten Haaf    

Others in Attendance

Neil Neinast                                                     St. Joseph's Hospital, Marshfield

Dan Diamon                                                    Lake Superior RTAC Coordinator

John Walsh                                                       Mercy Medical Center, Oshkosh

Bob Mack                                                         Fox Valley RTAC Coordinator

Jennifer Gerdmann                                           St. Vincent Hospital, Green Bay

Greg Friese                                                       North Central RTAC Coordinator     

Judy Jones                                                        North/Northwest RTAC Coordinator

Michelle Ziemba                                              St. Joseph's Hospital, Marshfield

Carol Immermann                                              Franciscan Skemp, LaCrosse

Joseph Immermann                                          Southwest RTAC Coordinator

Kelly Stanislaus                                               Theda Clark, Neenah

Ann Younger-Crandall                                    Theda Clark, Neenah

Joe Ketarkus                                                     Meriter Hospital, Madison

Andrea Winthrop                                             Southeast RTAC, Children's Hospital of WI

Cinda Werner                                                   Children's Hospital of WI

Lynne Sears                                                     UW Hospital, Madison

Holly Hepp                                                        Froedtert Hospital, Milwaukee

Dave Chase                                                      Wisconsin PHTLS

Tammy Wetherall                                            Wisconsin PHTLS


 
1.      Introductions

Randy Szlabick, Chair, began the meeting at 9:10am with introductions around the room. 

2.      Approval of February Minutes

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

3.      DHFS Updates

  1. Meg Taylor - The purchase order for the Statewide Trauma Registry did go out to Digital Innovation.  Meg was asked whether there was a plan to hire a registrar?  There is no funding at this time but there is a plan to work with other Bureaus including the Bureau of Health Information, to utilize resources they have for data collection and analysis. 

John Folstad brought up the issue of liability for the fiscal agent if something happens to the RTAC Coordinator while he/she is performing her RTAC duties.  Dennis Tomczyk suggested looking over the contracts he passed out at the beginning of the year, and to spend some of the $50,000 allocated for hiring the Coordinator to talk with a lawyer about these concerns.  The fiscal agent can write whatever is necessary in the contract that may help alleviate these concerns.  Something similar to "release of risk and responsibility."  The chance of the fiscal agent being held liable is a remote possibility but the concern still remains.

  1. Dan Williams - The Wisconsin EMS Emergency Preparedness Plan (WEEPP) has been approved by the EMS Advisory Board.  The Board is looking at educational issues for EMS.  The Secretary of DHFS has been requested to look at issues of recruitment and retention of EMS and whether the current educational requirements are too stringent especially for rural EMS.
  2. Dennis Tomczyk - RTAC Coordinators will meet this afternoon.  The focus will be on training for EMS transport services. (See attachment for minutes)
  3. Marianne Peck - DHFS continues to work on the selection of a marketing vendor.  There will be a conference call with Web-Collector (Digital Innovation) next week including staff from Collector, the EMS Bureau, DOIT (Dept. of Informational Technology -which will house the software) and Neil (Trauma Registrar from St. Joseph's in Marshfield).

E.   Summary of discussion on trauma system hospital designation:

·        Regarding ATLS for Emergency Room Physicians:  If the physician's  Emergency Medicine Board Certification expires, they will then need to take ATLS every four years.  Only Emergency Room Physicians who are current with their Board Certification may take ATLS only once.

·        Transfer agreements:  Level III and IV trauma care facilities need to have transfer agreements with at a minimum their Level I or II ACS Verified Trauma Centers in their region.  It is up to the hospital to decide which hospitals they will have transfer agreements with depending on where their trauma patients referral and transfer patterns exist.

·        On-call for Surgeons in Level III and IV trauma care facilities:  Regarding footnote 11 of the criteria;  as recommended by STAC and other trauma experts in the state:  when the surgeon is paged for a major trauma patient, he/she must respond to the ER regardless of the decision to transfer the patient out. The surgeon may need to give operative control of hemorrhage or other necessary treatment prior to transfer. The footnote states "For all trauma patients requiring surgical care, upon notification the surgeon shall respond to the ED."  It is the surgeon who would need to determine if that surgical care is needed or not.  Surgical may not always mean "operative care" either.  In addition it may take the EMS more time than expected to arrive at the transferring facility.

·         Footnote 4 of criteria - Clarification - "Any inpatients admitted to a Level IV TCF shall not have injuries requiring major surgical or surgical specialty care."  This is referring to major trauma patients, not the single limb or hip fracture or other less traumatic injuries.

4.      RTAC Reports - RTAC Coordinators

  1. Southcentral - Lynne Sears - Still confusion over the triage and transport guidelines.  There will be a forum on March 14 to discuss the guidelines and the hospital designation.  There are now billboards up around the area sponsored by the SCRTAC regarding a "Life-Wreck," the elected words to describe the consequence of traumatic injuries.
  2. Northeast - Jennifer Gerdmann - At their recent meeting they elected a new Executive Council and will be adding two new positions - Critical Care transport and an ER Physician.  NE will be having a forum on March 18 for hospitals to discuss hospital designation.  Hospitals still raise the concern of losing patients due to the trauma system.
  3. North Central - Greg Friese - Will start having conference calls alternating with face-to-face meetings for their RTAC.  Continue to educate on Triage and Transport Guidelines.  Have 8 on Executive Council.  March attendees primarily hospital-based.  100% sign-off of Medical Directors on Triage and Transport Guidelines.  Currently working on PI project - collecting data from hospitals regarding # of major trauma patients (denominator) and # of major trauma patients that arrived at hospital by ALS service (numerator).
  4. North/Northwest - Judy Jones - continual issues with triage and transport guidelines - medical directors of EMS services remain skeptical and non-participatory in that area.  Issues of liability for the fiscal agent regarding the RTAC Coordinator is a concern.
  5. West Central - no representation.
  6. Southwest - Joe Immermann - Working on communication issues, preparing a website - new address - www.swrtac-wi.org
  7. Southeast - Andrea Winthrop - This RTAC took a hiatus for many months - did meet once in November.  Last meeting was February 16.  Good attendance and working on reinvigorating the group.  Will start meeting after the HRSA 7 regional meetings the 4th Tuesday of the month and will rotate sites.  Working on streamlining communications.  They also have issues with Triage and Transport guidelines.  Working on educating hospitals on the benefits of a registry. Hope to have an RTAC Coordinator in place in the next couple of weeks.
  8. Lake Superior - Dan Diamon - meet the 4th Thursday of the month.  Triage and Transport Guidelines - 100% compliance.  Had a forum to discuss the designation at the last meeting and went well.
  9. Fox Valley - Robert Nack - meet the 2nd Wednesday of every month.  One position open on the Executive Council.  88% completion on the Triage and Transport Guidelines.  March 16 there will be a forum to discuss the hospital designation.  There is approximately  40% rural and 60% urban services that participate in the RTAC.

5.      STAC Goals - Barb Larson (see attached goals)

Reminder - the goals are dynamic and will be changed as the system matures. Ray Georgen made a motion to approve the goals as read with a second by Steve Stroman.  Unanimous approval and motion carried.

6.      Approval of Level III and IV data elements - Group

There was an agreement to add "other drugs" and "work/job related" to the Level I and II data elements.  Discussion began with a reminder that for Level III and IV facilities, major trauma patients will be a very small portion in relation to other illnesses.  The question was raised on whether Level III and IV's should even put in the patients that they would be transferring because the Level I and II's would be putting them in.  Consider having Level III and IV's only put the patients they keep into the database. Due to time constraints this discussion was tabled until the April STAC meeting.

7.      Summary of the legislature - Cecile D'Huyvetter, Randy Szlabick and Steve Stroman will be addressing the following this afternoon:

Senate portion of the Homeland Security

Senator Darling's staff

Representative Kaufert

Joint Finance Committee Chair - Fitzgerald

8.      Other Business

Meg Taylor - President Bush deleted funding for Trauma/EMS, EMS-C and Prevention Block Grant (CDC) upon which many positions are funded in the Division of Public Health and the Bureau of LHS and EMS, and drastically cut Rural AED funding.

Marianne Peck will not be available in May for STAC.  STAC meeting has been cancelled for May.

      John Folstad made a motion to adjourn the meeting with a second by Jeff Grimm,

      unanimous approval and meeting adjourned at 11:10am.

Respectfully submitted,

Marianne Peck

ADDENDUM:  STAC meetings are open to anyone and conducted in an open forum.   If you have a particular subject you would like to have discussed at STAC, call or email me with your requests and you can be put on the agenda.