HomeMy WebLinkAboutMINUTES - 04221986 - 2.4 c ,
THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Adopted this Order on April 22, 1986 , by the following vote:
AYES: Supervisors Fanden, McPeak, Torlakson, Powers
NOES: None
ABSENT: Supervisor Schroder
ABSTAIN: None
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SUBJECT: Trauma Center Designation
The Baord received a memorandum dated April 7, 1986 from
Mark Finucane, Health Services Director, transmitting the "Staff
Report on Trauma Center Designation" (copy attached hereto and by
reference incorporated herein) , recommending designation of John Muir
Memorial Hospital as the County' s trauma center and outlining the
actions necessary to implement the trauma system.
IT IS BY THE BOARD ORDERED that receipt of the aforesaid
report is ACKNOWLEDGED.
cc: County Administrator
Health Services Director
hereby certify that this is a true and correct copy of
an action taken and entered on the minutes of the
Board of Supervisors on the date shown.
ATTESTED: oR.20 Aft
PHIL BATCHELOR, Cleric of the Board
of Supervisors and County Administrator
By �l.�.C.. ��a .w�,o" Deputy
P h►
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r 2-004
CONTRA COSTA COUNTY
HEALTH SERVICES DEPARTMENT
To: Board of Supervi s rs Date: April 7, 1986
via Phil Bach or
From:Mark Fi nucane Subject: County Trauma System
Health Services Director
Attached, for your information, is the "Staff Report on Trauma Center
Designation" recommending designation of John Muir Memorial Hospital as the
County's Trauma center and containing recommendations from the Proposal and Site
Review Team for both John Muir and the County. Under the process established by
your Board in the Trauma System Plan for Contra Costa County, designation of the
trauma center is made by the Health Services Department subject to your Board' s
approval and execution of a contract between the County and John Muir Memorial
Hospital . Actual implementation of the trauma system is to be within 90 days of
designation. and will require approval by County EMS to assure that all key agen-
cies are prepared.
The following steps will need to occur before the trauma system is implemented:
1. John Muir Hospital must comply with recommendations indicated for implemen-
tation prior to starting trauma services ("Staff Report on Trauma Center
Designation", recommendation #3) .
2. Orientation and training sessions for hospital and prehospital personnel
must be held by the County with assistance from Base hospital personnel .
These sessions are being scheduled throughout the County and will be repre-
sented several times for various groups.
3. Protocols for helicopter transport of critical trauma patients under cer-
tain conditions must be developed by EMS.
4. A contract for trauma center services must be executed between the County
and John Muir Memorial Hospital .
5. EMS will convene a meeting of the key agencies (fire, ambulance, hospital )
within each area of the County prior to initiating the trauma system in
that area.
AL:MF:je
cc: William Walker, M.D. , County Health Officer
Art Lathrop, EMS Director
A-41 3/81
CONTRA COSTA COUNTY
HEALTH SERVICES DEPARTMENT
EMERGENCY MEDICAL SERVICES
APRIL 3, 1986
STAFF REPORT ON TRAUMA CENTER DESIGNATION
RECOMMENDATIONS
EMS staff have reviewed the "Report and Recommendations of the
Contra Costa Trauma Proposal Review Team" and concur with the
recommendations of the panel; namely, that:
1. John Muir Hospital be designated a Level II Trauma
Center on a probationary basis subject to re-evaluation
after its first year of operation in accordance with
the process established in the Trauma System Plan for
Contra Costa County, and subject to applicable
conditions set forth in the recommendations below;
Z . Consideration to be given by the County and John Muir
Hospital to establishing a plan to phase in trauma center
services over a period of weeks in order to allow for an
orderly transition to a high volume of critical trauma
patients.
3 . Prior to initiation of service as a trauma center,
John Muir comply with the following requirements :
a. Enhance notification procedures for anesthesia
in order to assure availability when needed for
critical trauma' patients .
b. Develop, consistent with County policy, protocols
for critical trauma patients to by-pass the trauma
center when the center is unable to handle such
patients,
C. Establish signed transfer agreements for the
transfer of critical trauma patients which the
center is unable to handle,
d. Establish policies and procedures to insure
clearance.,by. radiology of cervical spine films
for emergency department patients,
e. Establish criteria for obtaining neurosurgical
consultation for patients with. moderate head injuries .
f . Provide documentation that emergency department '
physician staff credentials are in accordance with
County requirements with respect to Board
certification;
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4 . Prior to or during its early phases of operation, John Muir
Hospital undertake the following actions :
a. Establish procedure to include Coroner 's reports
in hospital Morbidity and Mortality Conferences,
b. Review physician coverage in the intensive care
unit and consider use of the in-house trauma surgeon
to provide backup coverage when necessary during
such times as the emergency department physician and
the patient's physician of record are not immediately
available.
c. Establish a quality assurance mechanism to review
charts of trauma patients presenting in the
emergency department who are not triaged as meeting
trauma center criteria,
d. Conduct periodic focused prehospital audits concentrating,
for example, on all patients triaged with a specific
mechanism of injury not meeting score criteria, in
order to determine if evaluation of those patients in
the prehospital setting was appropriate,
e. Expand patient data collection conducted as part of
the hospital 's existing trauma registry to include
morbidity and mortality information that can be used
to evaluate the care of the major trauma patient in
John Muir Hospital,
f . Participate in comparative evaluations of patient
probability of survival such as the American College
of Surgeons ' Committee on Trauma national data base
conducted by George Washington Hospital under the
guidance of Howard Champion as well as the bi-county
trauma audit process being proposed with Alameda County,
g. Review the format currently being used for the trauma log
book to determine if a format similar to that used for
'..the Emergency Department log book would be easier to
track trauma patients and . insure that both logs are
current,
h. Assure that John Muir Hospital fulfills its responsibility
to the community in providing public education regarding
the trauma system,
i. Demonstrate a commitment to providing clinical and
continuing education opportunities to paramedics and
EMT-1 's in areas related to trauma care;
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5 . The County conduct, as part of its ongoing monitoring of the
trauma system, a special on-site review of John Muir 's trauma
center operation after six months or after 100 critical trauma
cases with an appropriate neurosurgical mix, the purpose of
this review being to determine (1) the extent to which the
Hospital has met the above recommendations , (2) the Hospital 's
ability to manage the increased number of critical trauma
patients, and (3) the standard of care provided trauma patients
at John Muir Hospital .
6 . During its first year of operation, the County closely
monitor the following:
a. The ability of John Muir Hospital to maintain its
existing standards and commitment to trauma care
in the face of a major increase in the volume of
critical trauma cases and a shift in payor mix to
include significantly higher proportion of Medi-Cal
and uncompensated care patients ,
b. The ability of the hospital 's intensive care unit
to handle increased patient volume attributed to
the trauma program and the cardiac program.
c. Nurse charting to assure that the existing high
standard is maintained as the volume of trauma
patients increases,
d. Transfer of trauma patients to the trauma center to
insure that transfers meet County established criteria
for critical trauma patients and that nontrauma
patients not be transferred under the trauma guidelines
for transfer,
e. . Response of drthopedic surgeons and anesthesiologists
to trauma patient care .
f . The training of prehospital personnel to give focused
radio reports for trauma patients ,
g. The ability of the hospital 's Trauma Committee to
function effectively in addressing operational issues
given its large membership; and
7 . The County undertake the following:
a. Provide for the integration of helicopter services
into the trauma system in areas where helicopter
transport would significantly reduce transport time .
b. Establish policies for rapid transfer of critical
trauma patients from other facilities to the trauma
center,
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C. Establish by-pass and transfer agreements with
adjacent county trauma system,
d. Establish a pediatric trauma protocol to transport
children with critical trauma to the closer of
the trauma center or Children 's Hospital,
e. Insure that the communication system available
to ambulance personnel for obtaining base hospital
direction is adequate to meet the requirements
imposed by the trauma system for increased base
hospital direction, particularly in those areas
subject to long transport times .
EMS staff further recommends that:
1 . A contract be prepared for execution by John Muir Hospital
and the County in accordance with the Request for Proposals;
2 . The terms of the contract provide for implementation of
the trauma system within 90 days of designation, or
earlier by written agreement of both John Muir Hospital
and the County; and
3 . Prior to execution of a contract by the County, John Muir
should satisfy to EMS staff that requirements under
Recommendation #3 , above, have been met and that signed
transfer agreements for burn and spinal cord injury
patients are in effect.
THE REVIEW PROCESS
In accordance with the "Trauma System Plan for Contra Costa
County" approved by the Board of Supervisors , November 19 , 1985 ,
a"Request for Proposals for Designation of the Trauma Center"
(RFP) was issued by the Health Services Department on January 3, 1986 ,
and distributed to all eligible hospitals within the County. This
RFP detailed the requirements for trauma center designation and
the process to be followed by the County for designation. A
proposer 's conference was held on January 17, 1986 , to answer any
questions regarding the RFP. Proposals were due by February 17 , 1986 .
The proposal from John Muir Hospital was the sole application for
trauma center designation. This proposal was reviewed by EMS staff
for completeness . While the proposal was found to be substantially
complete, 11 specific items were identified as missing, incomplete,
or otherwise not in conformity with the RFP. These were identified
in a letter dated March 7, 1986 , to John Muir .Hospital, and the
Hospital was to respond to these during the site review.
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'The evaluation of the proposal and the facility was carried out by
an ad hoc Proposal Review Team composed of experts from outside
the County experienced in the implementation and operation of
Trauma Services . This panel was appointed by the Health Services
Department and included a trauma surgeon, a neurosurgeon, a
trauma hospital administrator, an emergency physician, a trauma nurse,
and an EMS administrator from an existing trauma system. Panel
members were provided copies of the Contra Costa County Trauma System
Plan, the Request for Proposal for Trauma Center Designation, and
John Muir Hospital 's Trauma Center proposal in advance of their
arrival for the site visit.
The formal review process was carried out on March 20 and 21, 1986 .
The first day included orientation of panel members by County staff,
a review by the Panel of the written proposal, and identification
of specific areas to be covered during the on-site inspection.
The second day included the on-site inspection of John Muir Hospital
followed by a period for Panel members to dictate their findings
and a debriefing session for Panel with County staff .
The on-site inspection was conducted over a period of five and
one-half hours and consisted of an opening session for introduction
of the Panel and a presentation by the Hospital, the site review,
and a summation conference during which the Panel summarized its
key findings to the Hospital . During the site review, Panel members
toured the facility, interviewed hospital staff, and reviewed
trauma patient case records and other documents concerning quality
assurance and administration of the trauma program. EMS staff
accompanied the Panel during the site review as observers .
Following the site review, a report of the recommendations and
findings of the Panel was made to the Health Services Department.
DESIGNATION AND IMPLEMENTATION
The County 's Trauma System Plan provides for designation of a
trauma center by the Department of Health Services and approval
by the Board of Supervisors of a three year contract. The contract,
which includes a one year probationary period, is to take effect
within 90 - days of designation.
Prior to implementation of the trauma system, the following ta9ks
need to be completed:
1. Implementation by John Muir Hospital of recommendations
to be carried out prior to initiation of trauma services ;
2 . Orientation to trauma transport protocols for hospital
and .field personnel;
3. Completion of trauma triage training for EMT-ls .
4 . Adoption by the county of patient transfer protocols for
the transfer of critical trauma patients from receiving
hospitals to the trauma center.
5. Execution of contract between County and John Muir Hospital.
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The following system issues are currently being dealt with by EMS
staff, however, their resolution need not delay implementation of
the trauma system:
1 . Helicopter Transport - CALSTAR currently responds when called
by public safety personnel on the scene of a medical
emergency. Policies and procedures are being developed to
more fully integrate helicopter transport into the system.
2 . Communications - EMS is currently evaluating the use of
cellular telephone units to augment the county 's MEDARS
communication system used by paramedic units to obtain base
hospital direction.
3. Trauma Audit Mechanism - EMS will begin setting up the
formal trauma audit mechanism following designation of the
trauma center.
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