State Trauma Advisory Council (STAC)

Meeting Minutes

February 7, 2007

Sheraton Hotel, Madison, WI

10:30am - 12:30pm

Members Absent

Karen Brasel

James Austad

Cal Lintz   

1. Introductions - Dr. Randy Szlabick (Chair)

Randy Szlabick called the meeting to order at 10:35 with introductions around the room.

      2.  Approval of December Meeting Minutes - (STAC)

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

      3.  Bureau of LHS and EMS Updates - (Larry Gilbertson)

Dan Williams, EMS Section Chief, resigned in December.  His position is being advertised with a deadline of February 20^th.  Interviews in March with a hire planned for April. 

The EMS section is funded by numerous sources (GPR, Federal and DOT).  Funding for two positions were recently lost; First Responders and Ambulance Run Data System, however, the position themselves were not lost, therefore they can be filled if new funds are found.  The Prevention Block Grant funded the second position and even with the same level funding, there is not enough money to support that second position.  There was a $131,000 deficient for this year due to salary increases and costs.  Travel costs must be carefully monitored.  Funding from the Department of Transportation covers Marianne Peck's, (State Trauma Coordinator) position, including salary and benefits.  This funding of $80,000 is also meant to cover all her travel expenses and STAC meetings and travel expenses.  DHFS's request for additional funding was denied.   

Funding continues to be an issue for STAC and the trauma system every year, but the group has not had the opportunity to educate the decision-makers enough.  Often the emphasis is not noticed until there is personal tragedy.  Larry reminded people that the funding decisions are made by the legislature and the governor.

An EMS section staff retreat was conducted several weeks ago to determine how to cross-train staff and to discuss how staff can increase their work load due to the lost positions.  There is confidence that the operations can continue even without these positions being filled.  There is an effort to integrate more data systems to reduce paperwork and increase efficiency.

Dr. Wesley’s contract had to be reduced by 50% and thereby decreasing some responsibilities, however, he is committed to the trauma system. 

The governor announced a proposal to split DHFS into two departments with one focusing on Children and Families.  The advantage is that there would be a remaining department that focuses on health issues with a cabinet position.  Welfare reform serves as an example having been a major issue in past years, putting health issues on the back-burner.  The benefit to STAC is that it's issues will not be “muddled in” with other family services.  There is a need to educate the decision makers responsible for splitting the department.  Suggestions for STAC and audience members to write or call the Secretary’s Office, and monitor the formal process.  There has been no mention of moving EMSC to the Children and Family Services Department.  There was an effort to “tweak” the programs to improve the structure.  One of the suggestions was to move EMSC to EMS.

The funding for the site reviews and RTACs is critical for the Trauma System.  The funding for these purposes must be reviewed to ensure this funding is not lost. 

4.  EMS Advisory Board

 No representative to give a report.

5.  Trauma Registry Update - (Debi Peters)

There has been a tremendous response and cooperation for submitting the records.  We have over 7,000 records since July.   Reports will be available in the next week or so.

An example of the Completeness Report was distributed.  It shows the current completeness for Injury Severity Score and GCS total.

Several registry workshops are scheduled throughout the State.  Some RTACs are combining to hold workshops together.  Debi Peters will be attending some as requested.

The Ad Hoc Registry Committee will work on the inclusion/exclusion criteria in preparation for the rules to be opened.  Some of the issues are falls, whether there should be a minimum hospital stay, and whether we should expand beyond major trauma.

6.  Update and Discussion of January Site Reviews  - (Site Reviewers)

Site reviews have gone well so far.  Reviewers are having facilities activate a trauma alert.  The visits were positive, well prepared and people were available.  The use of a trauma flowsheet is encouraged.  It was suggested that several examples of flowsheets be provided so facilities can design their own.  Encourage facilities to brag about their trauma program during the visit.

According to Marianne the reviewers were gracious and set a good tone for the visit. 

What do the reviewers need to see for ATLS proof in 2008?  It was suggested that either a list of the ATLS dates for the staff, an ATLS certificate or card. 

Tissue review under the essential criteria is referring to appropriate pathology for removed organs such as spleen etc.  For example, did the pathologist findings on a removed spleen review match the injury. Tissue review does not refer to organ donation. 

TOPIC course being held on Friday (2/9/07) for Levels 3 and 4.  Kelly Jung, Trauma Coordinator at Theda Clark in Neenah was acknowledged for all her work in bringing this course to Wisconsin.

The question has come up whether a trauma coordinator who oversees multiple hospitals can represent those hospitals at the RTAC meetings.  If the hospitals are getting the information they need and are able to prepare for site review visits this should be okay.  However, facilities must consider if having one trauma coordinator work at various facilities can produce one facility being unjustly underrepresented.  The site reviewers may request proof that information is being shared from minutes or other communications among the facilities.  The quality of the work by the coordinator should be taken into consideration.  Are they involved and active?  Is there a formal reporting structure so the right people are receiving the message?

7.  Regional PI Issues/Questions for STAC

This has not been underway to determine issues yet.  Need a copy of the rules for each meeting.

8.  Other Business

The RTAC objectives for this year include the beginning development of the regional trauma plans.  There is no template at the moment because most of the requirements for the plan has already been done.  Some of the requirements include listing your EMS Services, hospitals and their trauma designation level, Executive Council members, etc. RTAC coordinators should review objectives and be familiar with requirements.   RTAC Coordinators will begin the conversation to prepare for next years objectives, which should include further training on the registry, especially coding issues, at their next RTAC Coordinator meeting.

The issue of capturing the GCS for out-of-hospital and hospitals is becoming quite noticeable with the development of the trauma registry and WARDS.  There is some national "talk" on whether the GCS serves the purpose needed for information that the hospital needs.  There are many issues regarding this topic and needs to be addressed at the regional level.  There is some beginning education regarding this topic at some of the RTACs.  RTAC members should bring this up at their RTAC meetings. 

There is a survey going out to EMS regarding EMS technology levels throughout the state.  That information will be gathered and reviewed at the EMS Section. 

The STAC strategic planning meeting will be March 27, 2007 (10-3:00) in Weston at St. Clare's Hospital, Boardroom.

It was recommended that RTAC coordinators check the website for notes and minutes of other RTAC meetings.

The EMS runsheet is necessary for the Trauma Registry.  The opening of the rules is our opportunity to improve this process legislatively.  A minimum report is being considered, requiring a time period.

EMS requested that STAC provide the minimum information that must be left at the hospital.  HIPAA concerns are being addressed under the EMS Education Workgroup. 

9.  Next Meeting - April 4, 2007 from 10:30am to 12:30pm at the Sheraton on John Nolen Drive in Madison.

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