History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman...

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History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange, California

Transcript of History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman...

Page 1: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

History of Trauma System Development in California

David Hoyt, MD, FACSProfessor and Chairman Department of Surgery

University of California, IrvineOrange, California

Page 2: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

18th &19th Century Health Care Delivery

House calls No rapid

treatments Kitchen table

surgery

Page 3: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

18th & 19th Century Hospitals

All admissions needed approval Patients were refused

admission: Incurable

Cancer Epilepsy

Contagious Smallpox

Could not pay Paupers sent to ‘almshouse’

Not ‘worthy of admission’ Conditions of immorality

Prostitution/STDs Alcoholism Unwed mothers

Page 4: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Where Did Emergency Patients Go?

The Receiving Hospital A hospital that would ‘receive’ all emergency

patients Los Angeles City Receiving Hospital System

Received ‘ambulance cases’ Transferred to County General or other Hospitals

Page 5: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Early Hospital Emergency Care

‘Emergency Room’ or ‘Accident Room’ Cared for people who “had no place else

to go”

Page 6: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Admission log - Los Angeles City Receiving Hospital

April - June 1908 7.3 patients/day

Page 7: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

The Patients & Situations of 1908 Trauma

Pedestrian vs. Streetcar Traumatic arrest

Horses Bites, kicks “Horse fell on him”

Bar fights Knifes, bottles, fists

Automobiles? Minor cuts bruises

Industrial injures Cuts, crush, amputation Burns - nitrate movie film

Page 8: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

The Patients & Situations of 1908 Social problems:

Child abuse “Hit by father with board”

Spouse abuse “Beaten by husband”

Suicide GSW head, chest Potassium permanganate

Page 9: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

The Patients & Situations of 1908

Abortion “Refused to give

doctor’s name” Addictions:

Alcohol H.B.D. H.B.D.V.M.

Opiates (morphine) Tx = Coffee (caffeine)

into gastric tube

Page 10: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

The Patients & Situations of 1908 Asthma

Tx = Chloral Hydrate & Strychnine (stimulant)

Cardiac arrestTx = Adrenaline

Sexuality issues: Gonorrhea “suppression of

urine” “Injury to perineum”

“Slipped on apple” “How injured: masturbation”

“Treatment: Bedrest”

Page 11: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Early Hospital Emergency Care

Hospital ‘Emergency rooms’ staffed by: Doctors without a practice Doctors working ‘overtime’

Emergency Medicine - 1971

Page 12: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Emergency Nursing

“Triage” - emergency nursing

Page 13: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

The Hoover Commission 1923 -Secretary of

Commerce Reviewed the mortality

crisis with the automobile 20,000 deaths/year

Results Sweeping recommendations

Roads, traffic safety, licensing No call for care systemsNo call for care systems

Page 14: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Ambulances & Emergency Transport

Began in War Time

Walt Disney served in WW I - France

Page 15: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

The Early Ambulance Experience

Earliest focus was on safe, comfortable trip Why Rush to the hospital?

No emergency treatment on arrival

No defibrillation or trauma surgery

1920s California Vehicle Code: “After a collision . . . transport

the injured in whichever vehicle still operates . . .”

Page 16: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Who Operated Most Ambulance Services?

Adopted by Funeral Services Had a vehicle that could transport a body

in a supine position Could gain goodwill in community

Page 17: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,
Page 18: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,
Page 19: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Who Operated Our Ambulances?Some Los Angeles area companies

Page 20: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Local California Dispatch

1969 Automobile club study 70 different

‘ambulance phone numbers’ servicing a 26 mile section of San Diego freeway

Page 21: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

California’s Original Minimum Ambulance Training Requirements

One crewman must have Red Cross Advanced first aid card

Other attendant (within 15 days of employment); Enrolled in basic first aid class Complete advanced first aid class within 90 days.

Page 22: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Ambulance Documentation & Billing Most documentation related to

costs/charges Taxi meters would assure accurate fees

Page 23: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Mass Casualty Incident - Pre-EMS

August 1, 1966 University of Texas

Austin Sniper - Charles

Whitman fired from top of 27 story clock tower 15 killed 31 wounded

Six funeral homes sent 13 ambulances

Page 24: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Trauma Magnitude of the Problem

1966 -“The “The neglected neglected epidemic”epidemic”

Page 25: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

What Changed

A pre-hospital curriculum

Pre-hospital Care became a profession

1970-72

Page 26: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Emergency

In 1972 the TV show Emergency debuted

The Jack Webb creation

Page 27: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

1970-1980

Developing local Trauma Systems: Los Angeles EMS Orange EMS San Diego EMS Santa Clara EMS

Page 28: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

1980 Development of

California’s State EMS Leadership State law added

Division 2.5 of the Health & Safety Code

Established the Emergency Medical Services Authority

LEMSA Model Started

Page 29: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

1983 Trauma Systems

added to the Health & Safety Code Allow, but not require,

development of local trauma care systems

System based upon a series of local, optional trauma care systems

Page 30: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

1986

Trauma care regulations established California Code of Regulations, Title

22, Division 9, Chapter 7 Trauma Care Systems Promulgated to provide minimum

standards for local trauma systems & locally designated trauma centers

Page 31: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Trauma SystemA Public Private Partnership

Scripp’s Memorial

Scripp’s Mercy

UCSD Medical Center

Sharp Memorial

County Health EMS

Palomar Medical Center

Children’s Hospital

Page 32: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

#Y

#Y

#Y

#Y

#Y

#Y

Palomar MedicalCenter

Scripps MemorialHospital, La Jolla

Children's Hospitaland Health CenterSharp Memorial

Hospital

University of California,San Diego Medical Center

Scripps Mercy Hospitaland Health CenterTrauma Catchment Areas

MercyPalomarScrippsSharpUCSD

N

TRAUMA CATCHMENT AREASCounty of San Diego

Children's Hospital'scatchment area services

the entire countySource: County of San Diego, Health and

Human Services Agency, Division of EmergencyMedical Services, August 2001

10 0 10 20 Miles

Page 33: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Trauma CenterCommitment

ALL departments Trauma Surgeon Other physicians

Critical care Neurosurgery Orthopedics Plastics and ENT Anesthesia Radiology

Nurses Every other staff member

Page 34: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Trauma Center Standards

Trauma Center

Designation standards

Data collection Quality

improvement protocols

Page 35: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

San Diego County

CNS & Non CNS- 1982 12/90 Preventable Deaths

(Amherst Study)

System--------------1984

1984 3/112 (3m) Preventable

1986 11/541 Preventable

Current rate < 1%

Page 36: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Significant Accomplishments

Paramedic Training Regional EMS systems 911 ATLS Trauma Care standards Verification National Trauma Data

Bank

Disease Management Model

Page 37: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

The Infrastructure

Page 38: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Started 2005

Page 39: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

The Evidence

All measurement techniques:

8-10% mortality reduction

Page 40: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

The National Study on Costs and Outcomes of Trauma Center Care

NSCOTNSCOT

25% - Mortality Reduction <55

Page 41: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

The LEMSA Model – A Story of Great Success

Page 42: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Why Not Everywhere

Page 43: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

▲ Level I & II ● Level III-V

Trauma Centers in the United States – All LevelsTrauma Centers in the United States – All Levels

Plotted by Hospital ZIP CodeWhy not

everywhere ?

Challenges ???

Page 44: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Percent of ISS > 15 Adult PatientsTreated at a Level I/II Center

# Level I/II per Pop’n

% of ISS>15 Treated at a Level

I/II

Florida 1.1 56%

California 1.2 55%

North Carolina

1.1 66%

Maryland 1.3 78%

Pennsylvania 2.0 63%

New York 2.4 69%

Illinois 4.9 77%

Missing Patients

Page 45: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

1987 Assembly Office of Research described

California’s trauma care system: Medical & financial emergency, pointing to

financial losses experienced by trauma centers & a need to financially stabilize trauma care systems

Some hospitals (particularly in Los Angeles) dropped trauma center designation, citing financial losses.

Page 46: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

1980’s-1990’s Closure or threatened closure of trauma

centers in several areas of the state resulted in media attention & policy initiatives to increase state subsidies or develop alternative funding sources

Physicians & hospitals indicated the root problem of emergency & trauma care issues was uncompensated care

Page 47: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

System Finance

Page 48: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Threats to Trauma Care

0

10

20

30

40

50

Main ReasonAll Reasons

Page 49: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

DespiteLegislative Support

Trauma Systems Reauthorization Federal Agenda

Inconsistent

Page 50: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

1980’s-1990’s

Several legislative proposals to provide funding for trauma care surfaced – most failed

Page 51: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

1987 The Legislature enacted Chapter 1240,

Statutes of 1987 Allowed counties to establish a Maddy

Emergency Medical Services Fund (Maddy Fund) Compensate health care providers

(hospitals and physicians) for emergency services for the uninsured & compensate medically indigent

Ensure the population has continued access to emergency care.

Page 52: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

August 1999

California Regulations were updated

Page 53: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

1999

EMSA Vision Implementation Project begun

Page 54: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

2001

AB 430 (Cardenas) established Chapter 171 Statutes created the Trauma Care

Fund & a formula for distribution of funds to local EMS agencies for designated trauma centers

Page 55: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

2001

California Statewide Trauma Planning: Assessment & Future Direction begun

Page 56: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

October 2003 Vision Implementation

Project Final Report Acknowledged System

Status Provided Standards &

direction for California Statewide Trauma Planning: Assessment & Future Direction

Page 57: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Process

Trauma Advisory Committee started to develop a statewide trauma system plan in concept

Page 58: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Problem

California state law allows for, but does not require, development of local trauma systems

Page 59: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Problem

State contains 58 counties divided into 31 local EMS agencies

Local trauma systems based on state regulations - not mandated

State EMS Authority Responsible for developing statewide

standards for trauma care systems and trauma centers

Page 60: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Challenges

We still lack a coordinated statewide trauma care system that provides: Universal access to essential trauma care Coordination of resources amongst local

trauma systems A statewide trauma registry to insure

consistent information Consistent dedicated infrastructure

funding

Page 61: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Other Challenges

Large geographic area of the state Variations in terrain Population density Ethnic diversity EMS cultures Weather System and financial resources

Page 62: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

EMS Authority 2003-2006

Did Federal and ACS assessment of current state system

Federal – Public Health Model

ACS – Systems Consultation Process

Published California

Statewide Trauma Planning: Assessment & Future Direction

Page 63: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

September 2006 Governor

Schwarzenegger signed California Statewide

Trauma Planning: Assessment & Future Direction

Page 64: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

EMSA 2008 Draft

Implementation Plan Leadership Data Funding

Synthesis of Trauma Advisory Committee and EMS Authority

Page 65: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,
Page 66: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Regional Structural Development

It is proposed the state be divided into trauma regions with responsibilities to include creating access for underserved areas, balancing resources, and leveraging academic resources.

Page 67: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Humboldt

SiskiyouModoc

LassenShastaTrinity

Tehama

Plumas

Sierra

Butte

Glenn

Nevada

Placer

Colusa

Mendocino

Lake

Sonoma

Napa

Yolo

Su

tter

Yub

a

El Dorado

Amador

Alpine

Mono

Tuolumne

Sacr

amen

to

SanJoaquin

Solano

ContraCosta

Marin

San Francisco

San Mateo

Santa Cruz

Alameda

SantaClara

Stanislaus

Merced

Mariposa

Madera

SanBenito

Monterey

Fresno

Inyo

Kings

Tulare

KernSan Luis Obispo

Santa Barbara

VenturaLos Angeles

San Bernardino

RiversideOrange

San DiegoImperial

Calaveras

DelNorte

Regional EMS Agencies

Single County EMS Agencies

Local EMS Agencies

Page 68: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

California Disaster Regions

Region I (Los Angeles EMS)

Region II (Contra Costa EMS)

Region III (Northern California EMS)

Region VI (Inland Counties EMS)

Region IV (San Joaquin EMS)

Region V (Kern County EMS)

DelNorte

Humboldt

Siskiyou Modoc

LassenShastaTrinity

TehamaPlumas

SierraButte

Glenn

Nevada

Placer

Colusa

Mendocino

Lake

Sonoma Napa Yolo

Su

tter

Yub

a

El Dorado

Amador AlpineMono

Tuolumne

Sacr

amen

to

SanJoaquin

Solano

ContraCosta

Marin

San Francisco

San Mateo

Santa Cruz

Alameda

SantaClara

Stanislaus

Merced

Mariposa

Madera

SanBenito

Monterey Fresno

Inyo

KingsTulare

Kern

San Luis Obispo

Santa Barbara

VenturaLos Angeles

San Bernardino

Riverside

Orange

San DiegoImperial

Calaveras

Page 69: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Mapping of Regions

Three regions Four regions Five regions Six regions

Page 70: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Humboldt

SiskiyouModoc

LassenShastaTrinity

Tehama

Plumas

Sierra

Butte

Glenn

Nevada

Placer

Colusa

Mendocino

Lake

Sonoma Napa

Yolo

Su

tter

Yub

a

El Dorado

Amador

Alpine

Mono

Tuolumne

Sacr

amen

to

SanJoaquin

Solano

ContraCosta

Marin

San Francisco

San Mateo

Santa Cruz

Alameda

SantaClara

Stanislaus

Merced

Mariposa

Madera

SanBenito

Monterey

Fresno

Inyo

Kings

Tulare

Kern

San Luis Obispo

Santa Barbara

Ventura

Los Angeles

San Bernardino

Riverside

Orange

San Diego

Imperial

Calaveras

DelNorte

Northern California Region

North Coast EMS Agency

NorCal EMS Agency

Sierra-Sacramento EMS Agency

Sacramento County EMS Agency

ElDorado County EMS Agency

Coastal Valleys EMS Agency

Solano County EMS Agency

Central Region

Contra Costa County EMS Agency

San Francisco County EMS Agency

San Mateo County EMS Agency

Alameda County EMS Agency

Santa Clara County EMS Agency

Santa Cruz County EMS Agency

San Benito County EMS Agency

Monterey County EMS Agency

Marin County EMS Agency

Inland Counties EMS Agency (partial)

Central California EMS Agency

San Joaquin County EMS Agency

Mountain Valley EMS Agency

Merced County EMS Agency

Tuolumne County EMS Agency

Southern Region

San Luis Obispo County EMS Agency

Kern County EMS Agency

Santa Barbara County EMS Agency

Ventura County EMS Agency

Los Angeles County EMS Agency

Orange County EMS Agency

Riverside County EMS Agency

San Diego County EMS Agency

Imperial County EMS Agency

Inland Counties EMS Agency (partial)

Page 71: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Humboldt

SiskiyouModoc

LassenShastaTrinity

Tehama

Plumas

Sierra

Butte

Glenn

Nevada

Placer

Colusa

Mendocino

Lake

Sonoma Napa

Yolo

Su

tter

Yub

a

El Dorado

Amador

Alpine

Mono

Tuolumne

Sacr

amen

to

SanJoaquin

Solano

ContraCosta

Marin

San Francisco

San Mateo

Santa Cruz

Alameda

SantaClara

Stanislaus

Merced

Mariposa

Madera

SanBenito

Monterey

Fresno

Inyo

Kings

Tulare

Kern

San Luis Obispo

Santa Barbara

Ventura

Los Angeles

San Bernardino

Riverside

Orange

San Diego

Imperial

Calaveras

DelNorte

Northern California Region

North Coast EMS Agency

NorCal EMS Agency

Sierra-Sacramento EMS Agency

Sacramento County EMS Agency

ElDorado County EMS Agency

Coastal Valleys EMS Agency

Solano County EMS Agency

Marin County EMS Agency

Central Region

Contra Costa County EMS Agency

San Francisco County EMS Agency

San Mateo County EMS Agency

Alameda County EMS Agency

Santa Clara County EMS Agency

Santa Cruz County EMS Agency

San Benito County EMS Agency

Monterey County EMS Agency

Marin County EMS Agency

Inland Counties EMS Agency (partial)

Central California EMS Agency

San Joaquin County EMS Agency

Mountain Valley EMS Agency

Merced County EMS Agency

Tuolumne County EMS Agency

Southern Region

San Luis Obispo County EMS Agency

Kern County EMS Agency

Santa Barbara County EMS Agency

Ventura County EMS Agency

Los Angeles County EMS Agency

Orange County EMS Agency

Southeast Region

Inland Counties EMS Agency (partial)

Riverside County EMS Agency

San Diego County EMS Agency

Imperial County EMS Agency

Page 72: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Humboldt

SiskiyouModoc

LassenShastaTrinity

Tehama

Plumas

Sierra

Butte

Glenn

Nevada

Placer

Colusa

Mendocino

Lake

Sonoma Napa

Yolo

Su

tter

Yub

a

El Dorado

Amador

Alpine

Mono

Tuolumne

Sacr

amen

to

SanJoaquin

Solano

ContraCosta

Marin

San Francisco

San Mateo

Santa Cruz

Alameda

SantaClara

Stanislaus

Merced

Mariposa

Madera

SanBenito

Monterey

Fresno

Inyo

Kings

Tulare

Kern

San Luis Obispo

Santa Barbara

Ventura

Los Angeles

San Bernardino

Riverside

Orange

San Diego

Imperial

Calaveras

DelNorte

Northern California Region

North Coast EMS Agency

NorCal EMS Agency

Sierra-Sacramento EMS Agency

Sacramento County EMS Agency

ElDorado County EMS Agency

Coastal Valleys EMS Agency

Marin County EMS Agency

Eastern California Region

Inland Counties EMS Agency

Riverside County EMS Agency

San Diego County EMS Agency

Imperial County EMS Agency

Bay Area Region

Solano County EMS Agency

Contra Costa County EMS Agency

San Francisco County EMS Agency

San Mateo County EMS Agency

Alameda County EMS Agency

Santa Clara County EMS Agency

Santa Cruz County EMS Agency

San Benito County EMS Agency

Monterey County EMS Agency

Central California Region

San Joaquin County EMS Agency

Mountain Valley EMS Agency

Merced County EMS Agency

Central California EMS Agency

Tuolumne County EMS Agency

Southern Region

San Luis Obispo County EMS Agency

Kern County EMS Agency

Santa Barbara County EMS Agency

Ventura County EMS Agency

Los Angeles County EMS Agency

Orange County EMS Agency

Page 73: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Humboldt

SiskiyouModoc

LassenShastaTrinity

Tehama

Plumas

Sierra

Butte

Glenn

Nevada

Placer

Colusa

Mendocino

Lake

Sonoma Napa

Yolo

Su

tter

Yub

a

El Dorado

Amador

Alpine

Mono

Tuolumne

Sacr

amen

to

SanJoaquin

Solano

ContraCosta

Marin

San Francisco

San Mateo

Santa Cruz

Alameda

SantaClara

Stanislaus

Merced

Mariposa

Madera

SanBenito

Monterey

Fresno

Inyo

Kings

Tulare

Kern

San Luis Obispo

Santa Barbara

Ventura

Los Angeles

San Bernardino

Riverside

Orange

San Diego

Imperial

Calaveras

DelNorte

Northern OES Region III

NorCal EMS Agency

Sierra-Sacramento EMS Agency (partial)

Southern OES Region VI

Inland Counties EMS Agency

Riverside County EMS Agency

San Diego County EMS Agency

Imperial County EMS Agency

Coastal OES Region II

Solano County EMS Agency

Contra Costa County EMS Agency

San Francisco County EMS Agency

San Mateo County EMS Agency

Alameda County EMS Agency

Santa Clara County EMS Agency

Santa Cruz County EMS Agency

San Benito County EMS Agency

Monterey County EMS Agency

North Coast EMS Agency

Marin County EMS Agency

Coastal Valleys EMS Agency

Valley OES Region V

Merced County EMS Agency

Central California EMS Agency

Kern County EMS Agency

Southern OES Region I

San Luis Obispo County EMS Agency

Santa Barbara County EMS Agency

Ventura County EMS Agency

Los Angeles County EMS Agency

Orange County EMS Agency

Inland OES Region IV

Mountain Valley EMS Agency

ElDorado County EMS Agency

Sierra-Sacramento EMS Agency (partial)

Sacramento County EMS Agency

San Joaquin County EMS Agency

Tuolumne County EMS Agency

Page 74: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

DelNorte

CaliforniaTrauma Centers

Page 75: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Humboldt

SiskiyouModoc

LassenShastaTrinity

Tehama

Plumas

Sierra

Butte

Glenn

Nevada

Placer

Colusa

Mendocino

Lake

Sonoma Napa

Yolo

Su

tter

Yub

a

El Dorado

Amador

Alpine

Mono

Tuolumne

Sacr

amen

to

SanJoaquin

Solano

ContraCosta

Marin

San Francisco

San Mateo

Santa Cruz

Alameda

SantaClara

Stanislaus

Merced

Mariposa

Madera

SanBenito

Monterey

Fresno

Inyo

Kings

Tulare

Kern

San Luis Obispo

Santa Barbara

Ventura

Los Angeles

San Bernardino

Riverside

Orange

San Diego

Imperial

Calaveras

DelNorte

Proposed Regional Committees

Page 76: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Region #1Patient flow

Page 77: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Region #1

Page 78: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Region #2

Page 79: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Region #3Central

Region #3Patient flow

Page 80: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Region #3Region #3

Page 81: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Region #4Patient flow

Page 82: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Region #4Region #4

Page 83: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Region #5Patient flow

Page 84: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Region #5

Page 85: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

California State Trauma System Implementation 2. Develop

Statewide Trauma Registry Data submission

from local EMS agencies

Generate information fo Future Policy Decisions

Standard Data Definitions

Page 86: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

California State Trauma System Implementation

Data system Current grant to

get started Data definitions

complete Entry criteria

complete

Page 87: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Funding

A stable source of funding is needed

A recent Harris poll suggests 90% of Americans are willing to pay for trauma resources

Systematic review of funding options will be explored

Page 88: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Funding possibilities

Local property tax License tax High risk behavior tax Vehicular insurance

fees Local government

ballot measures State ballot initiatives Supplemental payment

(Medicare/MediCal match)

Homeland Security funding

State user surcharge fees User fees on arms and

ammunition New construction fees Mitigation fees Broad provider

involvement (pay or play) Individual citizen taxation

Page 89: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

California State Trauma System Implementation Trauma System

Local Assistance Funding Local

administration Enhancements of

trauma care Uncompensated

care

Page 90: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

Summary Much work has been done by the

Trauma Advisory Committee and the EMSA

A plan for state organizational structure, regional structural development, data systems, and funding has been developed

This meeting is aimed at starting the implementation process

Page 91: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,
Page 92: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

July Summit Regions for RTCCs defined Local Committees started Goals first year

Create Regional committee governance Create template for quality improvement

and data use Identify gaps in coverage and issues for

region This is our landmark first meeting

Page 93: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,
Page 94: History of Trauma System Development in California David Hoyt, MD, FACS Professor and Chairman Department of Surgery University of California, Irvine Orange,

California Trauma System

We have all done great things in California

We are constantly in search of putting ourselves out of a job

Lets go to the next level with our system


Hoyt Manual - 2013

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Resuscitation: Past and Present David B. Hoyt, MD FACS Executive Director American College of Surgeons Chicago, IL.

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2002 Compound Manual-Hoyt

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HOYT DEFLECTION CHART (Original Version Courtesy … · HOYT DEFLECTION CHART (Original Version Courtesy of Hoyt Thompson) Year Bow/Riser Limbs MDW# Draw Length Cams Limb Deflection

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BORATE DEPOSITS IN VENTURA COUNTY, CALIFORNIA · PDF fileBORATE DEPOSITS IN VENTURA COUNTY, CALIFORNIA. By HOYT S. GALE. INTRODUCTION. Colemanite, a borate of lime, was first found

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2014 Hoyt Compound Owners Manual

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