HomeMy WebLinkAboutMINUTES - 11031987 - 1.46 ®46
To. BOARD OF SUPERVISORS
FRONT: Phil Batchelor C=tra
County Administrator �,,},�
Costa
DATE: October 26, 1987
SUBJECT: Resolution from San Diego County
re: Trauma Programs
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
RECOMMENDATION•
Endorse attached Resolution from the County of San Diego to the
CSAC Annual Meeting calling for State funding of trauma programs.
Instruct the County' s representative to the CSAC Annual Meeting
to vote in favor of San Diego County' s Resolution.
BACKGROUND: -
-The Chief Administrative Officer of the County of San Diego has
written to Contra Costa County asking for this County' s
assistance in obtaining passage of a Resolution at the CSAC
Annual Meeting calling on the State to provide funding to insure
the viability of regional trauma systems: The Resolution notes
that the cost of uncompensated care to indigents . makes trauma
care difficult to maintain . in some communities. In addition,
there is the cost of developing, designating, certifying and
monitoring emergency medical service systems which either must be
paid for by the County or reimbursed by the trauma center through
a fee which is paid to the County to offset the costs of
performing these, services. Having the State. pay for, or
otherwise provide a mechanism to ' cover the cost of these
services, would be a great benefit to the County..
We are,. therefore, recommending that the Board of Supervisors
.support. San.Diego County's Resolution.
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CONTINUED ON ATTACHMENT. X YES SIGNATURE:
_X RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER.
SIGNATURE S : _
ACTION OF BOARD ON ____.--N.avPmhPr .1. l9a7 APPROVED AS RECOMMENDED _ OTHER
..VOTE OF SUPERVISORS
C HEREBY CERTIFY THAT THIS IS A TRUE
X UNANIMOUS (ABSENT ) AND CORRECT COPT' OF AN ACTION TAKEN
AYES: . _ NOES: _ AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT:_ ABSTAIN: OF SUPERVISORS ONTHE
t�DATE SHOWN.
CC: County Administrator ATTESTED NOV d 17e87
Health Services Director
County Administrator, San Diego County PHIL BATCHELOR, CLERK OF THE BOARD OF
Board Members SUPERVISORS AND COUNTY ADMINISTRATOR
BY
M382/7-83 _,DEPUTY
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BEFORE THE
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GENERAL ASSEMBLY OF THE
COUNTY SUPERVISORS ASSOCIATION OF CALIFORNIA
Resolution Concerning the )
Provision of State funds ) RESOLUTION PROPOSED BY
to Support Trauma Programs ) SAN DIEGO COUNTY
WHEREAS, accidental injury is the leading cause of death among persons
between the ages of 1-44 years; and
WHEREAS, the development of emergency medical services , systems, and
designation of trauma systems and trauma hospitals, has proven to have a major
positive impact upon the mortality and morbidity rates of critically ill or
injured patients; and
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WHEREAS, counties throughout the State are experiencing significant
difficulties because of the impact of uncompensated care on the fiscal
- viability of emergency medical services and trauma care systems; and
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WHEREAS, indigent persons are potentially at great risk of being denied j
access to trauma resources due to the high number and cost of uncompensated
cases; and j
WHEREAS, failure to address the issue of uncompens<lted trauma care can
have disastrous results for critically ill and injured patients who may no
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longer benefit from sophisticated systems of emergency medical and trauma care;
and
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WHERFAS, counties cannot easily generate sufficient local revenues to 1
cover the costs of developing and • mon•i.toring emergency medical services and `
trauma care systems, certifying personnel , and designating trauma centers ;
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NOW THEREFORE, BE IT RESOLVED that the County Supervisors Association of
California support legislation that would provide State reimbursement to
emergency medical and trauma care providers for the costs of uncompensated care
to indigent trauma victims, and to counties for the costs of development,
designation, certification, and monitoring of emergency medical services and
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trauma care systems.
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ADOPTED this day of November, 1987, by the General "Assembly of the
County Supervisors Association of California.
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KAY CENICEROS, PRESIDENT
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The National Sahety [mmci | asserts that accidents are the
' leading cause of
death ammny persons between the ages of 1 '44 years and the third leading cause
� of death in the Uni1,d States. Thc Ctu1c of [a| ifurnia recognized the
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magnitude of this problem through Lhe addition of Article 2' 5 to Division 2.6
of the [uliFornia Health and Safety [ode. The legislature thus declared itc
intent to include regional trauma systems within the statewide system for
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emergency medical services
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| The. implementation of emergency medical services and regional trauma systems
' hat significantly reduced unnecessary mortality and morbidity of critically �ll
or injured patients. The effectiveness of this system is evidenced by the
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reduction of preventable trauma-related deaths from 13.6% /prior to trauma
system implementation) to \% in Sun Diego County' (Sap Diego County Trauma
Sy�tem Annual Report, January, '
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However, this success is not without its own system costs. The impact of
uncompensated care is seriously affecting the continued operation of trauma
centers and the fiscal viability of emergency medical services and regional
trauma systems statewide. Without state support, these advanced and
sophisticated systems of care are at risk of succumbing to fiscal hardship' As
more trauma centers withdraw from the regional systems, increasing numbers of
all critically ill and injured patients will no longer have access to
sophisticated emergency medical services and trauma care resources'
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EXECUTIVE SUFMAKY
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7 h� keo`�rc �or tho �ccond op�raLing year o�� the San Diego County
�rau;na V tem r.2 flncts 1he effectiveness of a matured , regionalized trauma
V11 s� ccm The reducLion in prcvcntab]e deaths accomVlished during the firs�
sys tem ycar continues to be maintaiTied throughout the second year. The
competidon for designation has now passed and the public-private partner-
ships betwee n the transporting providers , designated trauma hospital , and
the County continue to improve.
Event,,- and data which may be of particular interest are summarized below.
Further discussion of these items, as well as additional areas of analysis ,
are found in the body of this report'
HIGHLIGHTS
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, Four �housand three hundred seventy-four (4,]74) victims of accident�-
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or assaults were transported to designated trauma hospit-als during
the period July l,. 1985 through June 30, 1986'
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� Of those 4,374 who were taken to trauma facilities, three hundred
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forty-three (343) patients - whose chance of surviving their traumatic
� injuries was lessthan 50 percent - are alive today due to theSan
� Diego County Trauma System. If we assume that 75 percent of this
population achieves its productive earning power, this represents
on additional 9,004 productive work years, earning $3,151,310,000
in salaries, and paying $135,005,825 in taxes'
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� The San Diego Trauma System experienced a 33 percent reduction in
preventable deaths (from 18 preventable deaths in the first year
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/ to lZ preventable deaths in the secondyear). Seven (7) of the
second year preventable deaths (58 percent) occurred in non-trauma
� facilities^nr in the prehospital environment'
- During the first system "year" /August l, 1984 - June 30, 1985\ ,
� three t�ousand two hundred eighteen (3,218) potients were admitted
� to trauma centers , representing an overage of 292 patients admitted
per month' During this some year, the system reported 755 trauma
deaths' While the second year's volume of major trauma victims
(MTV's ) has increased 36 percent /to 364 patients admitted to trauma
centers per month) , there has been a lO percent decline in the average
number of deaths per month, from 68'6 monthly, to 62'4 monthly.
- Of the 749 MTV' s who expired during the second year, seven hundred
six (706 - 94' 2 percent) are considered non-preventable deaths .
This rote compares favorably with the non-preventable death rate
of the first year (93'9 percent) . The remaining 43 deaths were
considered either potentially salvageable (28 deaths - 4.0 percent)
-or frankly preventable ( }2 deaths - l percent) , wiUh three of the
deaths undetermined at this time.
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- i'n rauma system recorded Lwo hundred chir(cn ( Zl3) survivors
of major rraomn ,j o ha(I pe.nanenisabiliies and an addit'onal
onc Lhnusund eighc hundred sixcy-S-� x ( l .D66) who we re tamporariIy
disab|ed
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Total traumatic deaths in San Diego County was seven hundred forty--
nine (749) during the year. Of these deaths , two hundred ninety-eight
(298) occurred in trauma centers , one hundred seven ( 107) occurred
/ in non-trauma centers , and three hundred forty-four ( 344 - 45.9
percent) died of their injuries before they reached a hospital '
| - Motor vehicle accidents continue to constitute 64 percent of the
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� reported MTV's. Some 93 percent of these 2,787 patients survived
� their vehicle occident'
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� Gunshot incidents (3O6 ' patients) , stabbings (375patients) , and
other assaults ( lhh patients) represent 19' 5 percent of � the total
trauma cases. While gunshot victims experienced o 78 percent survival
rate, stabbing victims survived 96 percent of their assaults.
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� The block population constitutes 5'6 percent of the San Diego County
population (based upon 1980 census data) ; they experience 20 percent
of the gunshot incidents, 23' 1 percent of all stabbings , and 21. I
percent of other assaults. Similarly, the Hispanic population
constitutes 14'8 percent of the County population; they represent
25'2 percent of the gunshot victims , 34'8 percent of all stabbings ,
and 23' 1 percent of other assaults.
- Males continue to represent a disproportionate share of major trauma
victims, increasing to 77 percent of all major trauma cases from
the previous year's rate of 71 percent'
- Some 83 percent of all identified trauma patients were transported
to trauma centers by advanced life support providers' The overall
average transport time for MTV' s was 11'0 minutes'
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- Approximately 170 trauma patients (less than 4 percent) were "walk-
ins" (brought by non-ambulance , non-emergency vehicles) '
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Of the drivers and passengers who died as a result of motor vehicle
accidents for whom complete data was available ( llG deaths) , 67
persons ( 57 percent) were not wearing seat belts, as compared to
17 persons ( 14 percent) who were restrained.
- Overall , sixty-one percent (6l%) of. the drivers and passengers in
motor vehicle accidents were not wearing seat belts when injured ,
compared to 14 percent who were. A large number of these cases
( 25 percent) had no restraint status documented.
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a area Coit and tr ns o r ted C, lis ;)a ti en s durin(] the second
Year, '35 per-cent of whom were zraufila vlcti(11 .
Approximately 90 percent of all l•ilV ' s were transported to designated
trauma centers , while 5. 7 'percent were taken to non-trauma renters
and 4. 4 percent were transported to other hospitals .
Of the 4,374 patients brought to trauma centers , 1,537 (35. 1 percent)
required immediate operative procedures.
Discharge data reflect a 28 percent increase in the number of patients
whose Injury Severity Score ( ISS) was greater than or equal to 10
(from 148 monthly to 173 monthly) .
The multi-disciplinary, multi-institutional Medical Audit Committee
reviewed 4,655 trauma cases during the second year. These cases
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included all deaths: at trauma centers , at non-trauma ;hospitals ,
or death on scene.
Some 83.5 percent of all major trauma patients sustained blunt in-
juries.
SIGNIFICANCE OF MAJOR TRAUMA
Excerpts from Injury in America , A Continuing Public Health Problem, 1985)
Accidental injuries are the most frequent cause of death for Americans
during their most productive years (ages 1-44) .
More than 140,000 people in the United States die each year from
injuries.
More than 80,000 people in the United States become permanently
disabled due to injury of the brain and or spinal cord each year,
and multitudes of others suffer permanent dismemberment or disfigure-
ment due to traumatic injury.
Traumatic injuries constitute one of the most expensive health pro-
blems which exist today, with an approximate annual cost between
$75 and 100 billion dollars . These traumatic injuries contribute
to loss of productive life more than any other injury or condition
in the United States.
One of every eight (8) hospital beds is occupied ' by an injured pa-
tient.
Injury causes almost half the deaths of children ages 1-4 and more
than half the deaths of children aged 5-14.
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- Injury greatly surpasses all onj.or- r, sense groups as a cause of
premature death.
- Each year over 4 million years or future worklife are lost to injury
compared to 2. 1 million to heart disease and 1.7 million to cancer.
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[N-PRODUCTION
The trauma system in San Diego County has completed two years of opera-
tion. During this time the system has transported approximately 7_,600
injured persons , who were identified in the prehospital setting,
as having been potential victims of major trauma.
This report is reflective of the success that system participants con-
tinue to achieve in the reduction of unnecessary death and disability
due to accidental injury. The following analysis, primarily of the
second system year, utilizes data compiled from multiple sources , each
covering a different aspect of the system. The implementation of the-
computerized Trauma Management Information System (TRAMIS) qas enabled
staff to provide more comprehensive , comparative information on system
performance, than found in previous reports.
System effectiveness continues to be measured by outcome. The primary
public policy question examined by this report are: "What difference
did the regional trauma system make in the lives of San Diego residents
and visitors? How effective has the system been in reducing unnec-
essary deaths?". We have prioritized this report to reflect outcome
r"irst, followed by other system descriptions , including:
The Epidemiology of Trauma
Trauma System Overview, and
Financial Impact
The majority of this second year Annual Report attempts to quantify the
data from the. trauma program and demonstrate it's effectiveness. For
this review, comparisons are made between the first year and second
year data. Second year data presented represent patients transported
from July 1, 1985 through June 30, 1986.
The designated trauma hospitals , the base hospitals, fire departments,
Life Flight and Sheriff' s ASTREA, and other County support divisions
continue to make significant improvements, which enhance the success
of the trauma program. As a component of this report , system providers
were given the opportunity to describe their own system participation
and plans for future activities. The following trauma system parti-
cipants have provided direct input to this Annual Report:
General Services/Conrmunicat ion
Sheriff' s Department/Station Y
County Coroner-
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Trauma Research and Education Foundation
(representing the six designated 'hospitals )
Life Flight
The Hospital Council of San Diego and imperial Counties
Last year, the Annual Report was dedicated to all those who contributed
so much in the planning and implementation stage of trauma regionaliza-
tion in San Diego County. Certainly, the success of this program con-
tinues to rest on the maturing public - private partnerships developing
between the County staff and service providers. Once again , this
report is dedicated to the prehospital and hospital personnel and
County staff who continue to give their best to maintain one of the _
finest trauma systems in the country.
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NORMAN W. HICKEY
Chief Administrative Officer
County of San Diego January, 1987
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