Alabama Acute Health Care System Alabama Acute Health Care System System Information/Education.

Alabama Acute Alabama Acute Health Care Health Care

SystemSystemSystem Information/Education System Information/Education

Speaker’s DisclaimerSpeaker’s DisclaimerNo Representation is made that the quality of the presentation services to be performed today is greater that the quality of presentation services

performed by other speakers.

I do not have any conflicts of interest nor am I receiving compensation from Mobile Infirmary Medical Center or any company affiliated with the conference.

I am employed by the University of South Alabama with a contract with the Alabama Department of Public Health.

Speaker’s DisclaimerSpeaker’s Disclaimer

No Representation is made that the quality of the presentation services to be performed today is greater that the quality of

presentation services performed by other speakers.

I do not have any conflicts of interest nor am I receiving compensation from Mobile Infirmary Medical Center or any

company affiliated with this conference.

I am employed by the University of South Alabama with a contract with the Alabama Department of Public Health.

OBJECTIVESOBJECTIVES Understand the need for an Alabama Acute Understand the need for an Alabama Acute

Health Care System (AAHCS)Health Care System (AAHCS) Be Aware of the AAHCS Components Be Aware of the AAHCS Components Understand the Functions of the AAHCS Understand the Functions of the AAHCS

Components Components Understand the Legal Status of the AAHCSUnderstand the Legal Status of the AAHCS Be Able to Apply the Primary Triage Be Able to Apply the Primary Triage

CriteriaCriteria Be Aware of the Secondary Triage ProcessBe Aware of the Secondary Triage Process Be Aware of the Problems/Pitfalls of ATCCBe Aware of the Problems/Pitfalls of ATCC Be Aware of the QI ProcessBe Aware of the QI Process

Trauma Law / RulesTrauma Law / Rules

Alabama Legislative Act 299 – 2007Alabama Legislative Act 299 – 2007

Alabama Code 22-11D-1Alabama Code 22-11D-1(Amended in 2012 to include acute health care)(Amended in 2012 to include acute health care)

Alabama State Board of HealthAlabama State Board of Health

Chapter 420-2-2Chapter 420-2-2

Alabama Statewide Trauma SystemAlabama Statewide Trauma System

Why Develop a State-Why Develop a State-wide System?wide System?

Trauma is the number one killer between Trauma is the number one killer between one year and forty-four years of age!one year and forty-four years of age!

Cardiovascular is the number one cause Cardiovascular is the number one cause of death.of death.

Stroke is the third leading cause of death.Stroke is the third leading cause of death.

How the Acute Health How the Acute Health Care System saves livesCare System saves lives

Correctly identifies Correctly identifies the patients who the patients who need care need care

Anticipates the Anticipates the resources needed to resources needed to treat the patientstreat the patients

Locates the Locates the available needed available needed resourcesresources

How the Acute Health How the Acute Health Care System saves livesCare System saves lives

Routes the patient “right” the first time Routes the patient “right” the first time to reduce time to appropriate careto reduce time to appropriate care

Trauma – Four Levels of CareTrauma – Four Levels of Care Stroke – Four Levels of CareStroke – Four Levels of Care STEMI – Four Levels of CareSTEMI – Four Levels of Care

Determined by each HospitalDetermined by each Hospital Volunteer participation by HospitalsVolunteer participation by Hospitals Hospitals can change level status as neededHospitals can change level status as needed

How the Acute Health How the Acute Health Care System saves livesCare System saves lives

How Acute Health Care Systems save lives :How Acute Health Care Systems save lives :

Arranges inter-facility transfers if Arranges inter-facility transfers if needed to reduce time to appropriate needed to reduce time to appropriate care care Average EMTALA transfer time is 6.5 hoursAverage EMTALA transfer time is 6.5 hours Average ATS transfer time is less than 15 Average ATS transfer time is less than 15

minutes.minutes.

Volunteer Participation for Volunteer Participation for HospitalsHospitals

Hospital chooses to not participate in Hospital chooses to not participate in the system. the system.

ATCC will not route patient to this ATCC will not route patient to this hospital. hospital.

EMTALA applies!EMTALA applies!

AlabamaAlabamaTraumaTraumaSystemSystem

Trauma Center LevelsTrauma Center Levels

Level OneLevel One

All trauma care specialty services All trauma care specialty services are available “in-house”.are available “in-house”.

Level One Trauma Level One Trauma CentersCenters

University of South Alabama Medical University of South Alabama Medical CenterCenter

Sacred Heart Hospital, PensacolaSacred Heart Hospital, Pensacola

Trauma Center LevelsTrauma Center Levels

Level TwoLevel Two

All trauma care available except All trauma care available except neurosurgery. neurosurgery.

Physicians may be called in as Physicians may be called in as needed.needed.

Level Two Trauma CenterLevel Two Trauma Center

Baptist Hospital, PensacolaBaptist Hospital, Pensacola

Trauma Center LevelsTrauma Center Levels

Level ThreeLevel Three

General surgery available for General surgery available for emergent trauma care. emergent trauma care.

Majority of care provided by the Majority of care provided by the emergency physician.emergency physician.

Level Three Trauma Level Three Trauma CentersCenters

Providence HospitalProvidence Hospital

Mobile Infirmary Medical CenterMobile Infirmary Medical Center

Springhill Medical CenterSpringhill Medical Center

North Baldwin Infirmary North Baldwin Infirmary

South Baldwin Medical CenterSouth Baldwin Medical Center

Thomas HospitalThomas Hospital

D. W. McMillan HospitalD. W. McMillan Hospital

Atmore HospitalAtmore Hospital

Monroe County HospitalMonroe County Hospital

Grove Hill HospitalGrove Hill Hospital

Trauma Center LevelsTrauma Center Levels

Level FourLevel Four

No surgeon available. No surgeon available.

ATCC will not route patient to this ATCC will not route patient to this hospital. hospital.

Hospital should be part of the Hospital should be part of the system for emergent transfers.system for emergent transfers.

Community Trauma Community Trauma CentersCenters

Evergreen Medical CenterEvergreen Medical Center

Washington County HospitalWashington County Hospital

Jackson HospitalJackson Hospital

AlabamaAlabamaStrokeStrokeSystemSystem

Stroke Center LevelsStroke Center Levels

Level OneLevel One

Comprehensive Stroke Center Comprehensive Stroke Center (Joint Commission Stoke Center (Joint Commission Stoke Center

Classification) or equivalent.Classification) or equivalent.

Stroke Center LevelsStroke Center Levels

Level TwoLevel Two

Primary Stroke Center (Joint Primary Stroke Center (Joint Commission Stoke Center Commission Stoke Center

Classification) or equivalent.Classification) or equivalent.

Primary Stroke CentersPrimary Stroke Centers

Mobile Infirmary Medical CenterMobile Infirmary Medical Center

University of South Alabama Medical University of South Alabama Medical CenterCenter

Providence HospitalProvidence Hospital

Stroke Center LevelsStroke Center Levels

Level ThreeLevel Three

Acute Stroke Center Acute Stroke Center

Majority of care provided by the Majority of care provided by the emergency physician. emergency physician.

Must be willing to administer tPa.Must be willing to administer tPa.

Stroke Center LevelsStroke Center Levels

Level FourLevel Four

Community Stroke CenterCommunity Stroke Center

Care provided by emergency Care provided by emergency physician without tPa physician without tPa

administration.administration.

AlabamaAlabamaSTEMISTEMISystemSystem

STEMI Center LevelsSTEMI Center Levels

Level OneLevel One

Percutaneous Coronary Intervention Percutaneous Coronary Intervention (PCI) capable. (PCI) capable.

In-house cardiac surgery In-house cardiac surgery availability.availability.

STEMI Center LevelsSTEMI Center Levels

Level TwoLevel Two

Percutaneous Coronary Intervention Percutaneous Coronary Intervention (PCI) capable. (PCI) capable.

STEMI Center LevelsSTEMI Center Levels

Level ThreeLevel Three

Cardiac stabilization in emergency Cardiac stabilization in emergency department by emergency medicine department by emergency medicine

physician. physician.

Must be willing to administer Must be willing to administer fibrinolytic. fibrinolytic.

STEMI Center LevelsSTEMI Center Levels

Level Four: Community Level Four: Community

Care provided by emergency Care provided by emergency physician without fibrinolytic physician without fibrinolytic

administration.administration.

AGEMSS Hospitals - AGEMSS Hospitals - Trauma Trauma

University of South University of South Alabama Medical Alabama Medical CenterCenter

Sacred Heart Hospital, Sacred Heart Hospital, Pensacola, FLPensacola, FL

Baptist Hospital, Baptist Hospital, Pensacola, FLPensacola, FL

Providence HospitalProvidence Hospital

Mobile Infirmary Medical Mobile Infirmary Medical CenterCenter

Springhill Medical Springhill Medical CenterCenter

North Baldwin Infirmary North Baldwin Infirmary

South Baldwin Medical South Baldwin Medical CenterCenter

Thomas HospitalThomas Hospital

D. W. McMillan HospitalD. W. McMillan Hospital

Atmore HospitalAtmore Hospital

Monroe County HospitalMonroe County Hospital

Grove Hill HospitalGrove Hill Hospital

Evergreen Medical CenterEvergreen Medical Center

Washington County Washington County HospitalHospital

Jackson HospitalJackson Hospital

AGEMSS Hospitals - AGEMSS Hospitals - StrokeStroke

AGEMSS Hospitals - AGEMSS Hospitals - STEMISTEMI

Evidence of System Evidence of System ImprovementImprovement

Alabama Department Pubic Health,Alabama Department Pubic Health,

Alabama Hospital Association, Alabama Hospital Association,

Alabama Department of Alabama Department of TransportationTransportation

conducted a study on vehicle trauma in conducted a study on vehicle trauma in 2011 2011

which demonstrated the trauma system which demonstrated the trauma system has has

reduced mortality by 34% reduced mortality by 34% on on highways.highways.

AAHCS COMPONENTSAAHCS COMPONENTS

911 Pre - notice on incident 911 Pre - notice on incident EMS Response & CareEMS Response & Care EMS Transport ( ground or air )EMS Transport ( ground or air ) ATCC patient routing with center ATCC patient routing with center

availability linkageavailability linkage QI Process (System-wide)QI Process (System-wide) Follow-up on all Level ONE & TWO Follow-up on all Level ONE & TWO

patients – feedback to EMSPpatients – feedback to EMSP

AAHCS LEGAL STATUS AAHCS LEGAL STATUS

Triage standards part of ADPH/OEMS Protocols Triage standards part of ADPH/OEMS Protocols

Plan adopted by Regional Advisory Council Plan adopted by Regional Advisory Council /State Trauma & Health Systems Advisory /State Trauma & Health Systems Advisory Council / Alabama Committee of Public HealthCouncil / Alabama Committee of Public Health

EMSP EMSP SHALLSHALL follow as the standard of care follow as the standard of care and EMS rules and EMS rules

Protects the EMSP & HOSPITAL when followed Protects the EMSP & HOSPITAL when followed

TRIAGE TRIAGE Prioritizes patient statusPrioritizes patient status

Currently 12-14 % of all Currently 12-14 % of all trauma patientstrauma patients

Currently high volume of Currently high volume of over triage in stroke and over triage in stroke and STEMI systemSTEMI system

Changes to stop under Changes to stop under triage & over triage triage & over triage

Entry Criteria - TraumaEntry Criteria - Trauma

1. Physiological1. Physiological2. Anatomical2. Anatomical3. Mechanism of Injury3. Mechanism of Injury4. EMS Personnel Discretion4. EMS Personnel Discretion

Entry Criteria - StrokeEntry Criteria - Stroke

Any positive finding on the FAST Any positive finding on the FAST exam.exam.

Entry Criteria - STEMIEntry Criteria - STEMI

Positive indications on assessment Positive indications on assessment and ECG.and ECG.

Secondary Triage (Patient Secondary Triage (Patient Routing )Routing )

Based upon patient Based upon patient vitals, entry criteria, vitals, entry criteria, hospital availability, hospital availability, transport time transport time

ATCC and EMSP ATCC and EMSP make the decision make the decision

Best chance the Best chance the patient has is TX to patient has is TX to the right hospital the right hospital the first timethe first time

Secondary Triage (Patient Secondary Triage (Patient Routing )Routing ) No airway – Closest ERNo airway – Closest ER

Hemodynamically Hemodynamically unstable; no IV Closest unstable; no IV Closest ERER

Uncontrollable Bleeding- Uncontrollable Bleeding- Closest ERClosest ER

Alabama Trauma Alabama Trauma Communication CenterCommunication Center

Computer linkage Computer linkage of all trauma of all trauma

centerscenters

OPERATIONS- INTRA -OPERATIONS- INTRA -NETNET

Patient’s RightsPatient’s Rights

Patient information is used to Patient information is used to determine patient routing decisiondetermine patient routing decision

Decisions made with patients rights Decisions made with patients rights always consideredalways considered

ATCCATCC

Call the Alabama Trauma Call the Alabama Trauma Communication CenterCommunication Center

Cellular PhoneCellular Phone Southern LincSouthern Linc NextelNextel DispatchDispatch

ATS CARDATS CARD Every EMS unit Every EMS unit

has an ATS card has an ATS card for trauma, stroke, for trauma, stroke, and STEMI and STEMI

All triage factors All triage factors All communication All communication

methodsmethods All information All information

neededneeded

Quality ImprovementQuality Improvement QI at regional level QI at regional level Patient entry by Emergency Medicine @ hospitalPatient entry by Emergency Medicine @ hospital Inter - facility transfersInter - facility transfers Improper action by ATCCImproper action by ATCC

ATS WebsiteATS Website

www.adph.org/www.adph.org/emsems

Stroke System in AGEMSS Stroke System in AGEMSS RegionRegion

Target Date: September 1, 2015Target Date: September 1, 2015

Currently hospitals are completing Currently hospitals are completing applicationsapplications

Site VisitsSite Visits

Approval processApproval process

QUESTIONS QUESTIONS

Thank You!Thank You!

600 Clinic Drive, Suite 400 Mobile, AL 36688-0002 600 Clinic Drive, Suite 400 Mobile, AL 36688-0002

Office: 461-1832 Cell: 472-7810 Office: 461-1832 Cell: 472-7810 [email protected]