Trauma Plan - Medical Oversight

Updated October 2008

The predominant character of TSA-C is that of a rural area.  There exist a diversity of trauma facilities, ranging from the lead provider which functions at a Level III capability, while the remainder are designated Level IV.  There exists a wide variety of EMS providers and first responder organizations with  equally varied governance and accountability structures. There exists no single region-wide EMS medical director.

Currently, medical oversight is provided by EMS and first responder medical directors within a framework of existing off-line protocols and infrequent on-line direction.  While adequate, there is an opportunity to improve the existing framework and provide a robust regional approach to medical oversight which relies on a regional training, assessment, and communication infrastructure which is quickly emerging.

TSA-C, has advanced the organization of a region-wide agreement amongst providers to adopt region-wide medical protocols.

The TSA-C RAC has undertaken to develop, in partnership with both hospital , first responder agencies, and EMS providers,  off-line medical and transport protocols within the region.  Ensuring consistency of care, limiting excessive transport delays and overall improvement of patient outcomes are major expectations of this effort.


As part of the development of a concensus around implementation of regional medical control capabilities, it is expected that agreements around appropriate development and utilization of both off-line protocols and on-line medical direction will result in  appropriate, predictable and timely care to injured patients within the region.

It is recognized that the development of a region-wide medical control structure will require substantial improvements in  communication, quality improvement, and training infrastructures.  The current timeline for achievement of the infrastructural changes required to support regionalization of the medical control function anticipates a two year development process.
 
Regional Medical Control

1. Off-Line Medical Control

The Physicians' Committee (or a Medical Director's subcommittee) shall adopt standardized pre-hospital trauma protocols for regional use. These should establish a minimum level of care for trauma patients, and may be eventually extended to include regional protocols for the care of medical patients as well (cardiac, respiratory, pediatric, obstetric, etc.).
Short-term and long-term goals:
a)  Adoption of protocols -  defining means and methods
b)  Establishing mechanisms for insuring the participation of all providers
c)  Developing protocols for volunteer services/services without a medical director
d)  Dealing with EMS providers unwilling to participate in regional protocols ( should be a condition of NTRAC membership)
e) Developing CQI for protocol usage and implementation

Currently, NTRAC is actively advising all entities involved to incorporate the TDH-approved portions of the trauma system plan in their local protocols.  Also, the Nortex Regional EMS Provider’s Association is actively involved in creating a standardized protocol for off line medical control, with the collaboration of local medical directors.  These may ultimately be the common protocols utilized by all NTRAC Medical Directors, but it is anticipated that all NTRAC Medical Directors will adopt NTRAC protocols as at least a minimum standard.

The Medical Executive Officer (MEO) of the NTRAC as per its bylaws is available to be the medical director for volunteer providers and first responders, as long as no fees are charged to their patients.

2.  Provider Identification

Identification of all providers, their medical directors, their service/response areas.
Short-term and long-term goals:
a)  Provider coverage of unincorporated areas
b)  Medical Control for overlapping jurisdictions
c)  Listing communications frequencies
d)  Standardized picture identification tags for all First Responders not readily identifiable by uniform or other method.

3. Regional On-Line Medical Control: (no mechanism for this currently exists)
At this time, having a single On-Line Medical Control in the NTRAC is difficult, especially because of the enormous terrain and inability to call a centralized location from most of the areas of the TSA-C.

Short-term and long-term goals:

1. Identification of services with, and procedures for utilizing on-line control.
2. Utilizing on-line control in relation to the lead trauma facility.
3. Development of a regional communications system to allow centralized medical control.

Locally, each hospital should designate their Emergency Department Physician to be the on-line Medical Control.

Current Needs:

a) List of on-line control physicians and qualifications.
b) Accessing on-line control when primary service control unavailable (emergency situations/disasters)
c) Education/training of medical control physicians
d) Accessing on-line control at lead/receiving trauma facility when bypass/diversion protocols activated
e) Regional guidelines for insuring continuous availability of on-line control in some form.
f)  On-line physician access to provider certification/licensure levels, advanced skills status of individual providers, and service level capabilities (i.e. Basic v. ALS v. MICU).

System Quality Management (CQI)

1.Information Gathering:

Goals:

a) Identification of quality measurement criteria: "What to measure?"

(1) CQI Committee standards
(2) Medical directors reports - monthly
(3) Hospital CQI committees - monthly

(1) TDH Service Trauma Data (EMS PHP's)
(2) TDH Trauma Database (Hospitals)
(3) Regional Trauma Data
(4) Service Run Reports (EMS PHP's)