Current Trauma Status Report - Southern Nevada Health District

SOUTHERN NEVADA
CURRENT
TRAUMA
STATUS
REPORT
2004

Southern Nevada
Current Trauma Status Report
April 2004
Prepared for:
Clark County Health District
Prepared by:
The Abaris Group
700 Ygnacio Valley Road, Suite 270
Walnut Creek, CA 94596
Tel: 888.367.0911
Fax: 925.946.0911
abarisgroup.com

Table of Contents
Executive Summary_____________________________________________________________ 7
Introduction to the Study ________________________________________________________11
Purpose _____________________________________________________________________11
Methods _____________________________________________________________________11
Trauma Development ___________________________________________________________13
Trauma System versus Trauma Center_____________________________________________13
Elements of a Trauma System ___________________________________________________13
National Overview____________________________________________________________14
National Future of Trauma _____________________________________________________16
Trauma Care in Southern Nevada __________________________________________________17
Overview___________________________________________________________________17
Statewide Trauma Efforts ______________________________________________________18
Nevada Trauma Centers _______________________________________________________18
Population in Southern Nevada____________________________________________________19
Trauma Stakeholder Interview Results _______________________________________________24
Interview Synopses ___________________________________________________________24
Hospitals with EDs _________________________________________________________________ 24
UMC Trauma Center ________________________________________________________________ 25
EMS Providers _____________________________________________________________________ 26
Insurers/Payers ____________________________________________________________________ 26
Ranked Questions____________________________________________________________27
Town Hall Meeting Comments ___________________________________________________ 30
Inventory of Resources __________________________________________________________31
Prehospital Care _____________________________________________________________31
Communication ____________________________________________________________________ 31
Dispatch __________________________________________________________________________ 31
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Provider Agencies___________________________________________________________________ 31
Prehospital Data____________________________________________________________________ 32
EMS Activity _______________________________________________________________________ 33
EMS Quality Improvement ___________________________________________________________ 33
Transport of Trauma Patients_________________________________________________________ 33
Triage Criteria______________________________________________________________________ 34
Transport Agencies _________________________________________________________________ 34
Emergency Preparedness ____________________________________________________________ 34
UMC Trauma Center_________________________________________________________ 35
Southern Nevada Trauma Patient _____________________________________________________ 35
Hospital Resources__________________________________________________________ 49
ED Diversion_______________________________________________________________________ 53
Information Systems _________________________________________________________ 54
State Trauma Registry _______________________________________________________________ 54
Specialty Physician Coverage___________________________________________________ 55
Rehabilitation ______________________________________________________________ 56
Injury Prevention____________________________________________________________ 57
Evaluation_________________________________________________________________ 58
Research__________________________________________________________________ 58
Appendix ___________________________________________________________________ 59
Map of Emergency Care Facilities in Clark County ___________________________________ 59
Trauma Center Standards by Level_______________________________________________ 60
Nevada Trauma Registry Submission Requirements __________________________________62
Trauma Center Capacity Benchmark Data _________________________________________ 64
Survey of Other Freestanding Trauma Centers ______________________________________ 65
ED Diversion Hours by Hospital ________________________________________________ 66
Town Hall Meeting Comments _________________________________________________ 67
Trauma Center Funding Comparison Study ________________________________________ 78
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Chronology of Trauma Care in Southern Nevada _____________________________________82
List of Trauma System Assessment Study Participants________________________________ 86
Trauma Glossary____________________________________________________________ 89
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Table of Exhibits
Exhibit 1 – Status of Trauma System Components in Southern Nevada ______________________ 9
Exhibit 2 – Number of US Trauma Centers ___________________________________________16
Exhibit 3 – Nevada Trauma Registry Patients __________________________________________18
Exhibit 4 – Population Estimates for US, Nevada and Clark County _________________________19
Exhibit 5 – Population Distribution for Las Vegas Region by TAZ, 2003_______________________20
Exhibit 6 – Population Estimates for Clark County & Incorporated Cities _____________________20
Exhibit 7 – Population Projections for US, Nevada and Clark County ________________________21
Exhibit 8 – Projected Population Change, 2003-2010 by Traffic Analysis Zone (TAZ)_____________22
Exhibit 9 – Clark County Population Projections by Age __________________________________23
Exhibit 10 – Trauma System Components Ranked for All Hospitals _________________________27
Exhibit 11 – Trauma System Components Ranked for EMS Providers ________________________28
Exhibit 12 – Trauma Triage Criteria Ranking___________________________________________28
Exhibit 13 – Nevada Trauma Registry________________________________________________29
Exhibit 14 – Clark County EMS Providers _____________________________________________32
Exhibit 15 – Southern Nevada EMS Responses and Transports ___________________________ 33
Exhibit 16 – Trauma Cases ______________________________________________________ 36
Exhibit 17 – Trauma Statistics Percent Change________________________________________ 36
Exhibit 18 – Trauma Utilization Rate for Southern Nevada _______________________________ 37
Exhibit 19 – Trauma Patients by Type of Injury________________________________________ 37
Exhibit 20 – Trauma Patients by Age _______________________________________________ 38
Exhibit 21 – Trauma Patients by Sex________________________________________________ 39
Exhibit 22 – Trauma Patients by Race/Ethnicity _______________________________________ 39
Exhibit 23 – Trauma Patients by ISS________________________________________________ 40
Exhibit 24 – Trauma Patients by Mode of Transport____________________________________ 40
Exhibit 25 – Trauma Response Times _______________________________________________41
Exhibit 26 – Trauma Transport Times _______________________________________________41
Exhibit 27 – Trauma Ground Transport Times Greater than 30 Minutes ______________________42
Exhibit 28 – Trauma Patients by Average Length of Stay_________________________________ 43
Exhibit 29 – Trauma Patients by Top 20 ICD-9 Code Diagnoses ___________________________ 43
Exhibit 30 – Trauma Patients by Top 20 E Codes ______________________________________ 44
Exhibit 31 – Trauma Patients by State of Residence ____________________________________ 45
Exhibit 32 – Trauma Patients by Day and Hour of Arrival ________________________________ 46
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Exhibit 33 – Map Displaying Trauma Volume for the Las Vegas Metro Area __________________ 47
Exhibit 34 – Map Displaying Trauma Patients by Zip Code_______________________________ 48
Exhibit 35 – List of Clark County EDs and Trauma Center________________________________ 49
Exhibit 36 – ED Volume by Hospital _______________________________________________ 49
Exhibit 37 – Hospital and ED Statistics _____________________________________________ 50
Exhibit 38 – ED Volume by Hospital ________________________________________________51
Exhibit 39 – ED Visits per ED Treatment Station _______________________________________51
Exhibit 40 – Hospital Capacity Summary _____________________________________________52
Exhibit 41 – Total ED Diversion Hours by Month ______________________________________ 53
Exhibit 42 – Nevada Trauma Registry Patients ________________________________________ 55
Exhibit 43 – Specialty Physician Coverage ___________________________________________ 56
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Executive Summary
Overview
A trauma system is a critical component of a community’s health care system. By providing a resource
continuum dedicated to the prevention, treatment, and study of trauma, the system plays a major role
in preventing needless death and disability.
Recognizing this significance, the Clark County Health District, at the request of the Nevada State
Health Division, has undertaken an assessment of the Southern Nevada trauma system. This trauma
system assessment consists of both a consultative visit by the American College of Surgeons (ACS)
and a needs assessment by The Abaris Group.
There is currently one designated trauma center in Southern Nevada, University Medical Center
(UMC). Two other hospitals, Sunrise Hospital and Medical Center and St. Rose Dominican-Siena,
have indicated an interest in becoming a designated trauma center for Southern Nevada.
The Current Trauma Status Report is The Abaris Group’s assessment of the trauma system as it exists
today. A second report by The Abaris Group will provide more refined input on this assessment and
make recommendations on the future needs of the Southern Nevada trauma system. The second
report will also analyze the new trauma center interests and the impact of their potential addition on
the current trauma center and future trauma system.
Trauma Chronology
The following is an abbreviated summary of the trauma chronology in Southern Nevada. A more
detailed chronology can be found in the appendix.
• UMC underwent its first ACS consultation review for a Level II designation in January 1988
• Sunrise Hospital received Level III designation in October 1989
• UMC was verified in December 1989
• UMC did not receive full ACS verification for Level II during their site visit in December 1992
• UMC appeals ACS survey in January 1993 and the appeal is granted, extending their verification as
a Level II trauma center
• Nevada Board of Health provided a “provisional trauma designation” to UMC in January 1993 to
permit UMC to continue to serve the community as a trauma center
• UMC was re-verified as a Level II trauma center in May 1993
• Sunrise Hospital’s health facility certificate was issued without notation of a Level III trauma
center in January 1995
• UMC trauma center closed for a 10-day period in July 2002 due to issues with medical staff
malpractice concerns
• In October 2003, Sunrise Hospital and St. Rose Dominican Hospital notified the Nevada State
Health Division of their interest in becoming trauma centers (Level II and Level III, respectively)
• The Nevada State Health Division asked the Clark County Health District in November 2003 to
facilitate a trauma system needs assessment, leading to the engagement of The Abaris Group to
assist with the study and ACS to conduct a trauma system consultation visit
• The Clark County Health District Board of Health created a Citizen’s Trauma Task Force in January
2003 to make recommendations regarding trauma in Southern Nevada
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• From January through April 2004, four Citizens Trauma Task Force meetings were held and six
Town Hall meetings were also held
• In March 2004, Sunrise Hospital had a consultation by ACS for Level II trauma center designation,
which led Sunrise to request a “provisional” trauma center designation from the Nevada State
Health Division because ACS informed them that they needed to observe and review actual trauma
cases at Sunrise
Current Status
Southern Nevada (or Clark County) is an area with a growing population and 41.4 million visitors a
year (includes Las Vegas, Mesquite and Laughlin). The region is served by the UMC trauma center, a
freestanding Level I trauma center that is one of two trauma centers in the state. Injured patients are
transported to UMC from more than a dozen public and private EMS providers by ground and air
ambulance. Twelve area emergency departments (ED) are also available to treat less severe injuries.
There are four rehabilitation hospitals in Southern Nevada as well.
The Nevada State Health Division is designated by state statute as having primary authority over
emergency medical services (EMS) for the entire state, except in Clark County, and for trauma
throughout the state. This authority includes trauma center designation, which is based on ACS
verification. The Clark County Health District is designated by state statute to oversee the EMS system
in Clark County. This role includes the prehospital component of trauma in Southern Nevada.
However, it is important to note that neither the State of Nevada nor Clark County have a formal
trauma system or trauma plan. It is the intent of this study to recommend the elements of a trauma
system be created for Southern Nevada and the state as a whole.
Trauma Care Components
The National Highway Traffic Safety Administration (NHTSA) has identified the components of a
trauma system in their publication Trauma System Agenda for the Future 1 . These are:
• Injury Prevention
• Prehospital Care
• Acute Care Facilities
• Rehabilitation
• Leadership
• Professional Resources
• Education and Advocacy
• Information Management
• Finances
• Research
• Technology
• Disaster Preparedness and Response
The American College of Surgeons Consultation for Trauma Systems 2 document, in general, mirrors
the NHTSA model trauma system components but specifies important details on such topics as
system development and legislation. This document additionally outlines credentialing steps needed
to identify progress and the status of each of the key trauma system components.
1
Trauma System Agenda for the Future, National Highway Traffic Safety Association, Washington DC, 2002
2 Consultation for Trauma Systems , American College of Surgeons , Chicago, IL, 1996
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The trauma system components identified by these documents form the backbone of any quality
trauma system in the country. Southern Nevada has portions of some of the trauma system
components in place and others that need to be completely addressed.
The following table provides a preliminary indication by The Abaris Group on the current status of
trauma system development in Southern Nevada. Further refinement to this assessment will be
provided in the final needs assessment report.
Exhibit 1 – Status of Trauma System Components in Southern Nevada
Status of Trauma System Components in Southern Nevada
Trauma System Component: Definition: In Place Partially Not in Place
Fundamental
Injury Prevention
Prehospital Care
Acute Care Facilities
Rehabilitation
Infrastructure
Leadership
Professional Resources
Education and Advocacy
Information Management
Finances
Research
Technology
Establishing an injury prevention program/coalition that will help
reduce morbidity, mortality and costs associated with trauma.
Addressing issues faced by rural EMS providers (being farther away
from trauma centers and having fewer resources) and urban EMS
provider issues like diversion, triage and ED overcrowding.
Assessing resources in and for trauma centers, establishing
process improvement within the system and making sure adequate
volume is available to maintain trauma center skills.
Helping ensure trauma patients have access to affordable, long
term care.
Establishing an agency that has the authority, responsibility, and
resources to lead the development, operations, and evaluation of a
trauma system in their area.
Addressing shortages in the number of trauma care professionals.
Addressing the education of the public about injury and advocating
for trauma.
Establishing viable databases and information management
systems to be used in assessing a trauma system.
Identifying stable funding sources to ensure a viable, long-term
system.
Identifying a consensus on trauma research priorities.
Continuing to expand the availability of technology used in trauma,
but with an efficient and cost effective focus.
Disaster Preparedness and Response Preparing and coordinating responses to disasters and terrorisms.
Source: Trauma System Components as identified by NHTSA, Trauma System Agenda for the Future, 2002, with The Abaris Group assessment of status.
X
X
X
X
X
X
X
X
X
X
X
X
Stakeholders during this study were asked which trauma system components were most important.
The top five components by ranking are as follows:
1. Acute care facilities (trauma centers)
2. Professional resources (staffing)
3. Prehospital care
4. Leadership
5. Finances
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Clearly trauma center staffing and capability, configuration and stability are valued by the community
as important resources. Stakeholders were very conscious of the quality of care and the importance of
the trauma center resource at UMC. Some stakeholders believe that having only one trauma center is
a detriment given the growing population, increased demand and the need for more resources in the
event of a major emergency.
There was predominant input by stakeholders that any additional trauma centers should be
geographically placed to reflect growing populations and thus trauma cases. There were however
stakeholders that believe new trauma centers should be located at the hospitals with the best
resources and commitment. There were some stakeholders who could not share an opinion as they
were not sure of what characteristic should be valued most.
Key issues that are impacting the EMS and trauma system in the region are ambulance diversion and
access to subspecialty care in the EDs. This is creating an increased burden on the current trauma
center for patients that do not meet defined trauma triage standards but are perceived to be part of the
scope of a trauma center due in part to the limitation of resources in many community EDs in Clark
County.
Conclusion
The Southern Nevada trauma care program has many strengths but cannot be described as an
integrated trauma system as contemplated by national authorities on the subject. There are a number
of complex challenges facing trauma care in general and the development of trauma systems
specifically. An understanding of the current status of the system is essential to ensuring its success in
the future. The Abaris Group’s report on trauma system needs will address trauma system
components and challenges and will make recommendations on the trauma system configuration for
the future.
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Introduction to the Study
The Abaris Group was retained by the Clark County Health District to perform an assessment of the
need for a trauma system in Southern Nevada. This assessment has included conducting an inventory
of the trauma components currently in place in Southern Nevada and will also include a set of
recommendations to develop and implement a comprehensive trauma system for the future. The
study has involved extensive trauma stakeholder and public input via one-on-one interviews, focus
groups and town hall meetings, as well as an in-depth analysis of data provided by the hospitals, EMS
providers and the UMC trauma registry. Supportive to and in addition to the work of The Abaris
Group, the ACS is conducting a consultative review of the trauma system in Southern Nevada.
In order to assure an objective and unbiased approach to the study, the Clark County Health District
Board of Health created a Citizens Trauma Task Force. The task force is comprised of business and
community leaders in the Las Vegas region.
The ACS and The Abaris Group studies will dovetail into a set of recommendations, which will be
presented to the Clark County Health District Board of Health through the Citizen’s Trauma Task
Force. The Clark County Health District Board of Health will then present its recommendations to the
Nevada State Health Division Administrator.
Purpose
The purpose of this document is to provide a “snapshot” of trauma care as it exists today in Southern
Nevada. This report discusses each of the NHTSA components, as well as the history of trauma
systems and specific concerns such as diversion and physician specialty coverage. In addition,
summaries are provided of the many comments and input provided by system stakeholders. The
Southern Nevada Current Trauma Status Report will be used as a springboard for The Abaris Group’s
recommendations for the system as a whole.
Methods
As part of the Southern Nevada Trauma Assessment study, The Abaris Group conducted site visits at
the UMC Trauma Center, all 12 adult emergency departments (EDs), and the 2 pediatric EDs. The
purpose of the site visit was to meet with each hospital’s ED management team to obtain baseline
inventory and resource data on each facility and to obtain input on the needs of the trauma system.
In addition to the site visits, The Abaris Group also interviewed greater than 100 key stakeholders in a
variety of venues to obtain their input. These stakeholders included:
• air ambulance providers
• ambulance providers
• fire departments
• hospital CEOs
• insurance payers
• Nevada State Health Division staff
• Trauma Institute staff
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A series of focus groups was also conducted. The purpose of the focus groups was to obtain
information in a group setting and to help cull out ideas and allow the exchange of different
perspectives. The following focus groups were held:
• Clark County Health District staff
• ED medical directors
• ED nurse managers
• EMS supervisors (two held)
• Hospital CEOs
And finally, a series of Town Hall meetings was also held. The purpose of these meetings was to
enable the public to learn about the study and provide input. Town Hall meetings were held in:
• Boulder City
• Clark County
• Henderson
• Las Vegas
• Mesquite
• North Las Vegas
Using these several avenues (interviews, surveys, Town Hall Meetings, etc.), The Abaris Group was
able to inventory the resources relevant to trauma in Southern Nevada.\
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Trauma Development
Trauma System versus Trauma Center
A trauma system is a multidisciplinary effort by a region to respond to the risk and occurrence of injury
by coordinating resources throughout the trauma care spectrum. Such a system often involves,
amongst other elements, the participation of the local public health system, EMS, designated trauma
centers, and efforts at injury prevention and rehabilitation.
According to the NHTSA document Trauma System Agenda for the Future, the true value of a trauma
system is derived from the seamless transition between each phase of care, integrating existing
resources to achieve improved patient outcomes. Success of a trauma system is largely determined by
the degree to which it is supported by public policy. Further, regionalized trauma systems make
efficient use of health care resources. They are based on the unique requirements of the population
served, such as rural, inner-city, urban, or Native American communities.
Trauma systems are developed with an expectation that these efforts will lead to significant reductions
in morbidity and mortality.
A trauma center is an important component of a trauma system. It is where the injured person
receives the majority of their care. There are four different levels of trauma centers authorized by state
statute, Levels I through IV, with the most advanced level being a Level I. The major difference among
the levels is the type of injury the center can care for – the most severely injured are treated at a Level I
or II, less severe injuries are treated at a Level III or IV. Level I trauma centers are required to have
residency and research programs on trauma. Within a trauma system there can be as few as one
trauma center to many trauma centers. The number of trauma centers and their level depends on the
region’s needs and designation methods.
Finally, a trauma center differs from an ED in that trauma centers consistently have 24 hour resources
to care for the more severely injured patients (e.g. serious car crash), while an ED would treat those
people with less severe injuries.
Elements of a Trauma System
NHTSA has identified 12 components of a trauma system. The Trauma System Agenda for the Future
identifies key issues in addressing four fundamental components of the trauma care system and eight
key infrastructure elements that are critical to trauma system success. The four fundamental
components of a trauma care system are:
• Injury Prevention
• Prehospital Care
• Acute Care Facilities
• Rehabilitation
In addition to the fundamental operational components of the trauma system, the following key
infrastructure elements must be in place to support any comprehensive trauma care system:
• Leadership
• Professional Resources (shortages of trauma care professionals)
• Education and Advocacy (education about trauma injuries)
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• Information Management
• Finances
• Research
• Technology
• Disaster Preparedness and Response - Conventional & Unconventional
National Overview
It has only been in the past 20 years that trauma systems have existed at all. The need for improved
emergency treatment was reported in research as early as the late 1950s. 3 Additionally, the benefits of
immediate treatment of injuries had become apparent from the experience of treating injured soldiers
during the Korean and Vietnam wars. However, the first major step toward the development of trauma
systems came in 1966, when the National Academy of Sciences and National Research Council
published a white paper entitled Accidental Death and Disability: The Neglected Disease of Modern
Society. 4 This report identified significant deficiencies in the provision of care for injured patients in
this country, and it was instrumental in spurring the development of systems of trauma care. That
same year, the 1966 Highway Safety Act was enacted, reinforcing the states' authority to set standards,
regulate EMS and implement programs designed to reduce injury.
In the early planning years urban hospitals affiliated with medical schools had the staffing resources to
provide timely treatment of injuries, but others did not. Illinois was a leader with the establishment of
designated trauma centers in both urban and rural areas. In the following years, Maryland established
the Maryland Institute for Emergency Medical Services Systems (MIEMSS) and the first statewide
trauma system.
In 1973, the Emergency Medical Services Act (P.L. 93-154) was enacted to stimulate the development
of regional EMS systems. This Act contributed significantly to the growth of EMS infrastructure.
Fifteen program components were recognized as essential elements of an EMS system, including the
clear identification for the need of trauma systems. In 1981 this program ended and was folded into
the Preventive Health and Human Services (PHHS) Block Grant Program. Studies done in the late
1970s revealed high rates of preventable injury deaths. In 1983 West, Cales, et al, conducted a
comparison of preventable death rates pre- and post-trauma system implementation and found a
reduction from 73 percent to 9 percent. 5 Numerous additional studies by others have supported these
conclusions.
In 1985, the National Research Council and Library of Medicine published another white paper entitled
Injury in America—A Continuing Public Health Problem. 6 The report concluded that a great deal still
needed to be done for injury control. The report advocated increased resources for injury prevention
and led to the creation of an injury prevention center under the Centers for Disease Control (CDC).
Additional Injury Control Research Centers have since been established throughout the country.
After much debate and planning, The Trauma Care Systems Planning and Development Act of 1990
(P.L.101-590) was passed. The Act encourages state governments to develop, implement and improve
regional trauma systems. The primary focus of the Act is the development by each state of a trauma
care plan that takes into account national standards for the designation of trauma centers and for
3 Root GT, Christensen BH: Early surgical treatment of abdominal injuries in the traffic victim. Surg Gynecol Obstet 105:264, 1957; Van Wagoner FH:
Died in a hospital—A three year study of deaths following trauma. J Trauma 1:401, 1961.
4 National Academy of Sciences and National Research Council, Accidental Death and Disability: The Neglected Disease of Modern Society.
Washington, DC, 1966.
5 West JG, Cales RH, Gazzaniga AB: Impact of regionalization—The Orange County experience. Arch Surg 118:740, 1983.
6 National Research Council and Library of Medicine. Injury in America—A Continuing Public Health Problem. Washington, DC, National Academy
Press, 1985.
Page 14

patient triage, transfer and transportation policies. Additionally, the Act created a Division of Trauma
and EMS (DTEMS) under the Health Resources and Services Administration (HRSA). Funding was
suspended in FY1995 but returned in FY2001. Two important achievements of the DTEMS were the
development of a Model Trauma Care System Plan and establishment of competitive planning grants
for statewide trauma system development. 7 The Model Trauma Care System Plan was instrumental in
establishing guidelines for trauma system development throughout the country.
In 1999, the Institute of Medicine published Reducing the Burden of Injury: Advancing Prevention and
Treatment , which found evidence of progress in preventing and treating injury, but advocated
increased federal funding for greater improvements. 8 At the trauma center level, the American College
of Surgeons Committee on Trauma (ACSCOT) has played a key role in establishing guidelines. The
ACSCOT published the first guidelines for the designation of trauma centers in 1976, in a publication
entitled Optimal Hospital Resources for Care of the Seriously Injured. 9 These guidelines have been
periodically updated and were most recently published in 1999 as Resources for Optimal Care of the
Injured Patient . 10 In 1987, the ACSCOT also began a program in which the American College of
Surgeons (ACS) provides evaluation of trauma centers, and it recently published Consultation for
Trauma Systems, a set of guidelines for evaluation and improvement of trauma systems. 11
Other important guidance on trauma systems has come from the American College of Emergency
Physicians (ACEP) and the National Highway Traffic Safety Administration (NHTSA). In 1987, ACEP
published Guidelines for Trauma Care Systems, which provides guidance on all elements of trauma
system care. 12 The NHTSA established the Statewide Technical Assessment Program, through which
“technical assistance teams” were invited to review the EMS and trauma systems of states across the
country. In addition, the Development of Trauma Systems course was established to further assist the
states.
In 1987, West, Williams, et al ., defined eight trauma system components and conducted a nationwide
survey of trauma system development. 13 The components were: legal authority to designate trauma
centers, a formal process for designation, use of ACS standards for trauma centers, out-of-area survey
teams for trauma center designation, designation based on need, written triage criteria, ongoing
monitoring of trauma centers, and full state coverage by trauma centers. The survey found that only
Maryland and Virginia had all components including statewide coverage, 19 states and the District of
Colombia lacked one or more of the components for a trauma system and 29 states had not yet begun
any process for trauma system development. In a 1993 survey, Bazzoli, Madura, et al, found that the
number of states with complete trauma systems had increased to five, 14 and a 1998 survey conducted
by Bass, Gainer, et al, found that in addition to the 5 states meeting all 8 criteria, 28 states met 6 to 7
component criteria, another 10 had less than 5, and 8 states had no trauma system components. 15
Based on a recent inventory of trauma centers and trauma systems published in the Journal of the
American Medical Association in 2003, there are now 1,154 trauma centers throughout the country 16 .
7 Health Resources and Services Administration. Model Trauma Care System Plan. Rockville, MD, Health Resources and Services Administration,
1992.
8 Committee on Injury Prevention and Control, Institute of Medicine. Reducing the Burden of Injury: Advancing Prevention and Treatment.
Washington, DC, National Academy Press, 1999.
9 American College of Surgeons Committee on Trauma: Optimal hospital resources for care of the seriously injured. Bulletin of the American College
of Surgeons, 61:15-22, 1976.
10 American College of Surgeons Committee on Trauma: Resources for Optimal Care of the Injured Patient. Chicago, American College of Surgeons,
1998.
11 American College of Surgeons Committee on Trauma: Consultation for Trauma Systems . Chicago, American College of Surgeons, 1998.
12 American College of Emergency Physicians: Guidelines for Trauma Care Systems. Ann Emerg Med 16:459, 1987.
13 West JG, Williams MJ, Trunkey DD, Wolferth CC: Trauma systems: Current status —Future Challenges. JAMA 259:3597, 1988.
14 Bazzoli GJ, Madura KJ, Cooper GF, et al: Progress in the Development of Trauma Systems in the United States. JAMA 273:395, 1995.
15 Bass RR, Gainer PS, Carlini AR: Update on Trauma System Development in the United States. J Trauma 47:S15, 1999.
16 MacKenzie EJ, Hoyt DB, Sacra JC, et al.: National Inventory of Hospital Trauma Centers. JAMA 289:12 2003.
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(This study did not attempt to measure variation in capacity of these trauma centers or associated
capacity per capita.) There were 70 trauma centers in 15 states with no formal trauma system.
Exhibit 2 – Number of US Trauma Centers
Number of US Trauma Centers
Level I 190
Level II 263
Level III 251
Level IV and V 450
Total 1,154
Source: JAMA, 3/26/03 - Vol 289, No. 12
National Future of Trauma
Looking towards the future, trauma systems continue to be developed and improved across the
country. The Trauma System Agenda for the Future, published by NHTSA in 2002, envisions further
integration of injury prevention, acute care and rehabilitation programs in order to achieve an
understanding of all trauma care needs throughout the care continuum and how they can be met.
Continued research, improved technology, and the application of what is already known are helping
make this goal possible. Federal funding for this national initiative continues to be a challenge as the
overall Federal budget is adjusted for the changes in the economy and priority programs. However, the
threat of terrorism has created renewed interest in a national trauma system network and may add
additional momentum for system development.
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Trauma Care in Southern Nevada
Overview
Currently there is one trauma center in Southern Nevada, the University Medical Center (UMC), which
is a State designated and American College of Surgeons (ACS) verified Level I trauma center. In the fall
of 2003, two hospitals in Southern Nevada notified the Nevada State Health Division that they would
like consideration for designation (Sunrise Hospital and Medical Center is seeking a Level II
designation and St. Rose Dominican-Siena is seeking a Level III designation). If these two hospitals
are to be approved as a trauma center, they must first obtain verification by ACS and then be
designated by the Nevada State Health Division Administrator, the state agency that has the
responsibility for designation of trauma centers.
Under Nevada Revised Statutes (NRS 450B, et seq), the responsibility for establishing the trauma
program for the treatment of trauma and for designation rests with the Nevada Board of Health. The
oversight of this process for the trauma center application, designation and monitoring process is
performed by the Nevada State Health Division through its EMS Section. The Nevada State Health
Division’s role is set by statute to include developing and monitoring the:
• Trauma center application process
• Trauma verification and designation meeting ACS standards
• Trauma center monitoring
• Trauma patient destination policies
• Statewide Trauma Registry
Under state statute (NRS 450B.077), the EMS personnel and clinical supervision of the prehospital
system for Clark County has been delegated to the Clark County Health District. The District is
governed by a 13-member policy making board composed of representatives from each of the region’s
six governmental entities, as well as a physician member at-large. As such, it represents a unique
consolidation of the public health needs of Boulder City, Las Vegas, North Las Vegas, Mesquite,
Henderson, and Clark County into one regulating body. The Clark County Health District Board of
Health, through policy development and direction to staff, identifies public health needs and, as
mandated by County Ordinance 163, establishes priorities on behalf of local taxpayers, residents,
tourists/visitors, and the commercial service industry, "to establish and conduct a comprehensive
program of health to prolong life and promote the well-being of the people of Clark County"
(subsection b of Section 6).
The District has no official role with trauma except as it interfaces with its authority on prehospital care
policy. However, the Nevada State Health Division asked the Clark County Health District to conduct
an assessment of the trauma system in the Las Vegas region. This assessment is being conducted
partially by a system consultation visit by the ACS and through a needs assessment being conducted
by The Abaris Group, a consulting firm that specializes in assessing trauma systems.
In order to assure an objective and unbiased approach to the study, the Clark County Health District
Board of Health created an 11-member Citizens Trauma Task Force. The task force is comprised of
business and community leaders in the Las Vegas area. Once the ACS and The Abaris Group’s
assessment have been completed, the Task Force will make recommendations to the Clark County
Health District Board of Health regarding the future trauma system and its configuration. The Clark
Page 17

County Health District Board of Health will present its findings and recommendations to the Nevada
State Health Division Administrator for the ultimate decision.
Statewide Trauma Efforts
An EMS-Trauma Stakeholders Group was established in 2000 in response to the federal funding from
the Health Resources and Services Administration (HRSA) for their Trauma-EMS Systems Program.
This is a 14-member group assembled to provide advice on the key goals of the HRSA grant project.
The EMS-Trauma Stakeholder’s Group reports to the Trauma Institute, which is a freestanding nonprofit
organization based in Las Vegas with a primary focus on injury research. While trauma system
planning is an area of interest for this committee and for the State, there are significant resource
limitations that have hindered the progress of this group towards developing momentum on statewide
planning and monitoring of a trauma system.
This Southern Nevada trauma assessment will culminate in a series of recommendations regarding
trauma in the region. At this time, Southern Nevada does not have a formal trauma system or plan.
However, it is anticipated that a recommendation will be made to establish a formal trauma plan and
system.
Nevada Trauma Centers
In addition to UMC, the other trauma center in Nevada is Washoe Medical Center in Reno, a Statedesignated
and ACS-verified Level II trauma center. The following comparative data is from the most
current Nevada Trauma Registry report published in November 2003.
Exhibit 3 – Nevada Trauma Registry Patients
Nevada Trauma Registry Patients, 2000-2002
Percent
Change
2000-01
Percent
Change
2001-02
Trauma Center 2000 2001 2002
University Medical Center 3,117 3,570 3,714 14.5% 4.0%
Washoe Medical Center 2,123 2,120 2,520 -0.1% 18.9%
Other 1 329 654 672 98.8% 2.8%
Total Trauma Cases 5,569 6,344 6,906 13.9% 8.9%
1
Other: All other Nevada counties, unknown in Nevada, out of state, and unknown.
Source: Center for Health Data & Research, Bureau of Health Planning & Statistics, NV State Health Div., 5/04
Page 18

Population in Southern Nevada
Nevada, and specifically Clark County, has experienced significant population growth over the years.
For example, the nationwide population grew at an average annual rate of 1.0 percent from 2000-
2003. In Nevada, the average annual growth rate during that period was 4.3 percent, while in Clark
County; growth was even faster at 4.7 percent.
Exhibit 4 – Population Estimates for US, Nevada and Clark County
U.S. Population Estimates, 2000-2003
Year U.S. Percent Change
2000 282,177,754 -
2001 285,093,813 1.0%
2002 287,973,924 1.0%
2003 290,809,777 1.0%
Average % Change - 1.0%
Source: U.S. Census Bureau
Nevada Population Estimates, 2000-2003
Year Nevada Percent Change
2000 2,023,378 -
2001 2,132,498 5.4%
2002 2,206,022 3.4%
2003 2,295,391 4.1%
Average % Change - 4.3%
Source: Nevada State Demographer's Office
Clark County Population Estimates, 2000-2003
Year Clark County Percent Change
2000 1,428,690 -
2001 1,498,279 4.9%
2002 1,578,332 5.3%
2003 1,641,529 4.0%
Average % Change - 4.7%
Source: Southern Nevada Consensus Population Estimate
Clark County Population Growth from 2000 - 2003
1,700,000
1,650,000
1,600,000
1,578,332
1,641,529
1,550,000
1,500,000
1,450,000
1,400,000
1,350,000
1,428,690
1,498,279
1,300,000
2000 2001 2002 2003
In addition to the resident population, another significant factor impacting Las Vegas is the number of
visitors to the community during its recent history. For example, Las Vegas has been host to over 35
million visitors every year since 2000. In 2003, the number of visitors was just over 35.5 million. Based
Page 19

on an average length of stay of 3.4 nights per visitor, this adds 331,059 visitors to the annual
population of Las Vegas. Mesquite and Laughlin also play host to a large number of visitors. In 2003
Mesquite had 1.7 million visitors, while Laughlin had 4.2 million visitors. This equates to a total visitor
population of 41.4 million to Clark County.
A source of projected population data at a smaller geographic area than the county is at the traffic
analysis zone (TAZ). Population projections by TAZ are calculated by the Southern Nevada Regional
Transportation Commission. The following map shows population concentrations in the greater Las
Vegas area for 2003 by TAZs. Currently, the data show that the population in the Las Vegas region is
denser in the western region.
Exhibit 5 – Population Distribution for Las Vegas Region by TAZ, 2003
US 95
Population Distribution
Within Traffic Analysis Zones
< 500
500 – 1000
1,000-2500
2,500-5,000
> 5,000
I 215
I 15
Source: Southern Nevada Regional Transportation Commission
The resident populations in the Clark County incorporated cities are also growing. The city with the
largest growth from 2002 to 2003 was North Las Vegas.
Exhibit 6 – Population Estimates for Clark County & Incorporated Cities
Draft Population Estimates for Clark County and Incorporated
Cities, 2002 - 2003
Percent
Geographic Area 2002 2003 Change
Boulder City 14,842 14,934 0.6%
Henderson 209,486 217,448 3.8%
Las Vegas 514,640 528,617 2.7%
Mesquite 13,216 13,895 5.1%
North Las Vegas 135,967 146,005 7.4%
Unincorporated Area 661,507 699,850 5.8%
Clark County Total 1,549,657 1,620,748 4.6%
Source: Nevada State Demographer, released December 2003.
Page 20

The most current projected population for Clark County is from the Center for Business and Economic
Research at UNLV and shows an increase of 4 percent for the next two years. While the growth rate is
projected to continue to grow, it will slow reaching 2.6 percent in 2012. The tables below show the
projected population and change for the US, Nevada and Clark County.
Exhibit 7 – Population Projections for US, Nevada and Clark County
U.S. Population Projections, 2004-2012
Year U.S. Percent Change
2004 292,558,251 0.9%
2005 295,226,301 0.9%
2006 297,918,684 0.9%
2007 300,635,620 0.9%
2008 303,377,333 0.9%
2009 306,144,051 0.9%
2010 308,936,000 0.9%
2011 311,523,191 0.8%
2012 314,132,049 0.8%
Source: U.S. Census Bureau, released March 2004
Nevada Population Projections, 2004-2012
Year Nevada Percent Change
2004 2,373,543 3.3%
2005 2,442,116 2.9%
2006 2,503,286 2.5%
2007 2,558,363 2.2%
2008 2,607,574 1.9%
2009 2,651,018 1.7%
2010 2,690,078 1.5%
2011 2,725,929 1.3%
2012 2,758,635 1.2%
Source: Nevada State Demographer's Office, released
April 2002
Draft Clark County Population Projections, 2004-2012
Year Clark County Percent Change
2004 1,709,449 4.1%
2005 1,777,291 4.0%
2006 1,843,451 3.7%
2007 1,908,139 3.5%
2008 1,971,102 3.3%
2009 2,032,378 3.1%
2010 2,092,013 2.9%
2011 2,150,075 2.8%
2012 2,206,118 2.6%
Source: Center for Business & Economic Research at UNLV,
released March 2004.
As noted above, TAZ data projections are computed by the Southern Nevada Regional Transportation
Commission. Current projections show that the majority of the growth in the Las Vegas region from
2003 to 2010 is expected in the south. A map depicting the projected population growth by TAZ is
provided on the following page. The tables show the absolute change in projected population for TAZs
with a projected growth of 1,000 people or more.
Page 21

Exhibit 8 – Projected Population Change, 2003-2010 by Traffic Analysis Zone (TAZ)
Change 2003
TAZ
to 2010
13 1,940
33 2,052
44 1,076
57 1,075
68 1,052
72 1,796
80 1,744
Total 10,734
Change 2003
TAZ
to 2010
118 1,278
1149 1,171
Total 2,449
Change 2003
TAZ
to 2010
104 1,019
199 2,162
255 2,158
256 2,215
260 1,427
261 1,585
263 1,400
264 1,039
265 2,019
270 1,212
272 1,108
273 1,870
274 1,206
275 1,617
277 2,331
278 2,051
595 3,083
715 1,608
Total 30,091
Change 2003
TAZ
to 2010
870 4,036
871 1,853
873 3,356
885 3,703
954 3,898
955 2,089
960 1,559
1114 3,961
1116 2,159
Total 26,613
I 215
Source: Southern Nevada Regional Transportation Commission
;
I 15
US 95
UMC
Population Change (2003 - 2010)
Within Traffic Analysis Zones
> 2500
1,000 to 2,499
300 to 999
0 to 299
-300 to 0
Change
2003 to
TAZ
2010
304 1,513
434 1,341
Total 2,854
Change 2003
TAZ
to 2010
823 1,173
827 2,080
938 1,561
988 1,273
989 1,865
1030 1,083
1032 1,521
1033 1,267
1037 1,995
1081 2,685
1082 1,564
1083 1,660
1084 1,765
1088 1,801
1089 1,587
1090 1,393
1091 1,472
1129 2,192
1130 4,370
1132 1,975
1134 4,943
1135 5,964
1174 2,442
1179 2,344
1203 1,777
1205 1,773
1206 1,170
Total 56,691
Page 22

According to the National Center for Health Statistics, in 2001 unintentional injury was the leading
cause of death for persons aged 1 – 34 and was the second leading cause of death for those aged 35 –
44 in the United States.
While the age cohorts for persons aged 50 and older are expected to have the largest growth rate from
2005 to 2010 in Clark County, the growth of those aged 0 – 49 accounts for almost 60 percent of the
total growth in absolute change.
Exhibit 9 – Clark County Population Projections by Age
Clark County Population Projections by Age Cohort
Age Cohort 2005 2010
Absolute
Change
Percent
Change
0 - 9 255,986 289,832 33,846 13.2%
10 - 19 242,792 266,833 24,042 9.9%
20 - 29 261,375 278,723 17,347 6.6%
30 - 39 267,292 289,402 22,110 8.3%
40 - 49 256,465 280,606 24,141 9.4%
50 - 59 205,307 238,217 32,910 16.0%
60 - 69 143,715 174,577 30,862 21.5%
70 - 79 88,506 101,468 12,962 14.6%
80 Plus 40,175 49,690 9,515 23.7%
Total 1,761,614 1,969,348 207,734 11.8%
Source: Nevada State Demographer's Office.
Clark County Population Projections
Absolute Change from 2005 to 2010
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
-
0 - 9 10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 Plus
Page 23

Trauma Stakeholder Interview Results
The Abaris Group conducted greater than 100 interviews with trauma stakeholders in Southern
Nevada. This included one-on-one interviews and a series of focus groups. The following are brief
synopses of each type.
Interview Synopses
All synopses are presented in the stakeholder aggregate (all EMS providers were aggregated, all
hospitals with EDs, etc.) except for UMC Trauma Center.
Hospitals with EDs
The most commonly reported strength of the trauma system among ED respondents was the quality
of care at the UMC trauma center, which was described with words such as excellent, well-located, well
known, respected, and possessing committed resources and efficient and high quality care.
Respondents also cited as strengths UMC’s location and the fact there is no confusion in the
community about where to take trauma patients. The triage criteria were also cited as strengths by
some respondents (see triage criteria effectiveness survey results).
The most commonly reported weakness of the trauma system was acceptance of transfers at UMC -
mostly those patients that did not meet defined trauma triage criteria but that UMC was perceived to
have the resources to treat. Other weaknesses reported during some interviews were the community’s
sole reliance on UMC and a lack of competition, collaboration, or back up system due to UMC being
the only trauma center. There was also concern that growth had overwhelmed the system and that
UMC was an overly political or politically-connected institution. Over-triage was a reported concern as
well.
There are at least two hospitals willing to be added as trauma centers in the community. There is the
possibility of others in the future as the new hospitals mature and their product line needs become
identified. Of the original two new hospitals, their perspective is that their individual locations provide
the ideal site for a new trauma center.
All hospitals are impacted by capacity problems and subsequent ambulance diversions. There was a
level of frustration from the EDs and in some cases a belief that the EDs had done all they could to
improve flow and capacity but that not all had been done throughout the hospital to solve the
problems. Four hospitals admitted during the inventory process that they did not have a written
diversion policy. Several hospitals, though, were implementing an “adopt a boarder” program to assist
with ED flow which is considered to be a best-practice inpatient flow strategy.
Hospital CEOs expressed concerns about the on-call specialist challenge in the community with the
number of subspecialty issues varying from hospital to hospital. At the time of the interview one
hospital had no on call orthopedic coverage, one did not have general surgical coverage and many had
issues with neurosurgeons, ENTs, plastic and hand surgery coverage. The CEOs in general expressed
an interest in further studying this issue and coming up with common solution strategies.
Responses varied as to the need and preferred location of additional trauma centers. Sunrise Hospital
and Medical Center and St. Rose Dominican-Siena were the hospitals suggested most often, although
there was concern about the location of Sunrise from a traffic standpoint and whether St. Rose
Page 24

Dominican-Siena could effectively manage the associated increased demands. There were also
concerns raised by many of the hospital staff interviewed that both Sunrise and St. Rose had current
capacity problems with ED diversion and ambulance offload times and that the addition of a trauma
center would increase this problem at their hospitals.
Additional recommendations generally included adding a trauma center in the east side of town in the
Desert Springs/Sunrise area; in the north and southern parts of town; in the south; in the northeast
and in the south; and in North Las Vegas. A minority did not think there should be any additional
trauma centers.
A prevalent comment was the feeling of risk that by having only one trauma center the community
would be vulnerable. The history of UMC closing for 10 days during July of 2002 due to malpractice
issues significantly increased the concern that the hospitals have as to the lack of back up and the risk
that their ED might need to act as the backup trauma center again.
Some respondents felt governance should be at the state level, while others felt it should be at the
local level. Among those who favored local governance, Clark County Health District was the most
preferred agency, although there was some concern about Clark County Health District perceived as
being “political” or “tied” to UMC. Another suggestion was that the State govern in conjunction with
the Medical Advisory Board. Some respondents suggested that the governance design should be
based on what works best elsewhere.
Regarding a special trauma committee, a common recommendation was that the a multidisciplinary
committee be created with trauma center representatives, Medical Advisory Board (MAB), Facility
Advisory Board (FAB) representatives, fire representative, ambulance representatives, and possibly a
community representative. There was much concern that the leadership entity not be politically based,
and it was suggested that it not include elected officials and that it be independent from the MAB. It
was also suggested that Clark County Health District participate. Expertise was mentioned as a desired
trait, and it was suggested that the membership include trauma surgeons. Another suggestion was
that the trauma committee be independent of the stakeholders in Las Vegas, for example ACS or
retired trauma surgeons.
Concern about the trauma registry was expressed by some respondents. Data collection was reported
to be time consuming given a lack of electronic data, the data were reported to be understated, and
the registry reports were reported to not be timely.
UMC Trauma Center
UMC reported that strengths of the trauma system include broad support of administrative and
medical staff, physical plant, and demonstrated high quality care due to solely dedicated resources.
Reported weaknesses of the trauma system include the statewide medical liability climate,
uncompensated care, concerns about the potential for exacerbation of over-triage with
implementation of new triage criteria (April 1, 2004), and longer transport times from the growing
southern regions and northwest.
Regarding additional trauma centers, UMC reported that they view growth as an important and
needed consideration, because the current catchment area is stretched, especially in the south. It is
believed that a new trauma center is needed and but must be strategically placed. They reported that
the mountains act as a natural barrier so that there will be limited east/west growth, and the growth is
mostly in the south. UMC recommended a Level III facility in the southeast within the next two to
Page 25

three years, and felt that a Level III in the northwest will likely be needed within the next four to five
years. It was also felt that both of these facilities could work their way up to Level II status.
UMC recommended that governance should come from Nevada State Health Division with local
oversight by the Clark County Health District, with the UMC Level I trauma center taking the lead on
the trauma committee.
EMS Providers
EMS providers reported favorable opinions of the UMC trauma center, saying it is efficient and
accessible. Its helicopter landing pad was praised. It was reported that there is good rapport with the
physicians and that they are receptive to EMS.
However, multiple providers expressed concern about increased transport times to the trauma center
caused by traffic delays, highway construction and the growing populations outside Las Vegas. It was
also suggested that over-triage was causing overload and that risk of closure at UMC was a concern.
Although the helipad was praised, there was concern that there is only one and it is not at ground
level.
An additional trauma center or centers was desired by most of the prehospital providers interviewed.
The providers were varied as to the location of the new trauma center based primarily on the perceived
need for access, including recommendations on locations in Mesquite, Henderson (St. Rose
Dominican-Siena suggested), the north, the south, the northwest, and the southwest or southeast.
Most EMS providers did not see the value of adding another central downtown trauma center from an
access standpoint. It was suggested that data on response times be analyzed to determine where an
additional trauma center would best be located.
A sentiment that pervaded all EMS provider interviews was the concern and frustration on ED
saturation, ambulance diversion and the long off load times for ambulances even when the EDs are
open. Even if the ED is open, the average offload time today is approximately 50 minutes. In their
opinion the problem has gotten worse over the years and the providers are skeptical of new solutions
being proposed and the level of commitment from the hospitals to truly resolve the problem. Most
EMS providers echoed the concern that Sunrise and St. Rose-Siena have current problems with ED
diversion and ambulance offload times and were not clear on how they could operate a trauma center
with existing capacity problems.
Most respondents felt that the preferred form of governance would be local governance by the Clark
County Health District or a special committee. However, at least one respondent suggested state
governance. Some respondents indicated that they were not sure or did not have an opinion.
EMS providers supported a trauma oversight committee that would be inclusive, representative, fair,
and not political. A trauma MAB was suggested. One respondent felt that the current MAB was too
political. It was suggested that everyone with an interest in trauma be included, including hospital,
EMS, Clark County Health District, and trauma center representatives.
Insurers/Payers
Insurance payers demonstrated considerable interest on the trauma center topic as evidenced by their
substantial interest with representation during the interview process (five interviews) and extensive
comments.
Page 26

All payers indicated a significant concern about quality of care and their desire to play a role in the
system design and issue resolution. Of clear concern to these payers was the current ED saturation,
ambulance diversion and long ambulance off-load times which the payers were surprisingly
knowledgeable about. One payer indicated an interest in providing financial support to further study
the problem and provide best practice interventions to mitigate the problem.
Among the insurer/payer trauma center/system comments were suggestions that surgeons should be
employees of hospitals because of the medical malpractice issue, and that funding should come from
community taxes (like fire and police). It was felt by at least one insurance payer that over-triage is an
issue.
As for the location of an additional trauma center or centers, one respondent commented that an
additional trauma center should be in the south, at St. Rose Dominican-Siena or de Lima, rather than
at Sunrise. Others did not have an opinion.
It was recommended that governance be provided by the ACS or the State and to seek the governance
characteristics of independence and objectivity. At least one respondent was skeptical of the concept
of self-government.
Ranked Questions
Three questions were asked that required all participants to provide a numerical ranking. The following
are the results in the aggregate for all hospitals (including UMC Trauma Center and hospitals with
EDs) and all EMS providers (fire, ambulance, air).
One of the questions asked participants to rank the importance of the National Highway Traffic Safety
Administration (NHTSA) trauma system components identified in their publication Trauma System
Agenda For The Future. Each component was ranked from one to five (where one was least important
and five was critical).
The hospitals stakeholder group ranked Professional Resources (staffing resources) as the most
important component, followed by Acute Care Facilities and then Finances. The component ranked
least important was Injury Prevention.
Exhibit 10 – Trauma System Components Ranked for All Hospitals
Trauma System Components - Average Rated
Importance by Rank for All Hospitals
Component All Hospitals Rank
Professional Resources 4.91 1
Acute Care Facilities 4.89 2
Finances 4.59 3
Leadership 4.53 4
Pre-Hospital Care 4.48 5
Education and Advocacy 4.30 6
Rehabilitation 4.27 7
Disaster Preparedness and Response 4.18 8
Information Management 4.03 9
Research 3.92 10
Technology 3.92 10
Injury Prevention 3.74 12
Notes: Importance was rated on a scale of 1 (least important) to 5
(most important). All hospitals includes UMC Trauma Center.
Source: Interviews with The Abaris Group.
Page 27

EMS providers ranked Acute Care Facilities and Pre-Hospital Care most important, followed by
Leadership and Professional Resources (staffing resources). Injury Prevention was again ranked last.
Exhibit 11 – Trauma System Components Ranked for EMS Providers
Trauma System Components - Average Rated
Importance by Rank for EMS Providers
Component
EMS
Providers Rank
Acute Care Facilities 4.86 1
Pre-Hospital Care 4.86 1
Leadership 4.57 3
Professional Resources 4.57 3
Disaster Preparedness and Response 4.46 5
Finances 4.43 6
Education and Advocacy 4.21 7
Rehabilitation 4.00 8
Research 3.86 9
Technology 3.86 9
Information Management 3.79 11
Injury Prevention 3.50 12
Note: Importance was rated on a scale of 1 (least important) to 5
(most important).
Source: Interviews with The Abaris Group.
Respondents were asked to rank three aspects of the trauma triage criteria. These criteria determine
which patients are directed to the trauma center for specialized trauma care. First, respondents rated
the overall appropriateness of the criteria. Second, they rated the effectiveness of the criteria at limiting
over-triage (patients unnecessarily categorized as trauma). Third, respondents rated the effectiveness
of the criteria at limiting under-triage (patients not categorized as trauma when they should have
been).
The overall “Appropriateness of the Criteria” (prior to April 1, 2004 change) was ranked similarly by
hospitals and EMS providers, at 3.64 and 3.50, respectively. Hospitals had a less favorable view of the
“Effectiveness of the Criteria to Minimize Over-triage” (2.70), while EMS providers rated it the same as
the criteria’s overall “Appropriateness” (3.50). Both hospitals and EMS providers felt the triage criteria
were better at “Ensuring Minimum Under-Triage” than “Minimum Over-Triage”, with under-triage
ratings of 3.30 for hospitals and 3.86 for EMS providers.
Exhibit 12 – Trauma Triage Criteria Ranking
Trauma Triage Criteria
Average Ratings by Provider Type
Component
All
Hospitals
EMS
Providers
Overall 3.64 3.50
Minimum Over-Triage 2.70 3.50
Minimum Under-Triage 3.30 3.86
Notes: Rated on a scale of 1 (least effective) to 5 (most effective);
based on triage criteria prior to 4/1/04.
Source: Interviews with The Abaris Group.
Page 28

Hospitals rated the Nevada Trauma Registry a 3.15 in terms of effectiveness of evaluation. The other
categories were ranked lower, with “Used to Define Future Needs” being ranked last. This means that
the hospitals believe the Nevada Trauma Registry does a relatively weak job of guiding the future
needs of trauma in Nevada.
Exhibit 13 – Nevada Trauma Registry
Trauma Registry
Average Ratings for All Hospitals
All
Component
Hospitals
Evaluation 3.15
Reporting in compliance 2.73
Producing reports 2.07
Future needs 1.82
Notes: Rated on a scale of 1 (least effective) to 5 (most
effective); based on triage criteria prior to 4/1/04.
Source: Interviews with The Abaris Group.
Page 29

Town Hall Meeting Comments
A series of six Town Hall meetings were held in Southern Nevada over a three month period. The
meetings were held in Boulder City, North Las Vegas, Henderson, Mesquite, Las Vegas, and
unincorporated Clark County.
All Town Hall meetings were consistently attended by Clark County Health District, Sunrise, St. Rose,
UMC, and some representation from prehospital care (fire and/or ambulance). Attendance by other
trauma stakeholders and the public varied (Clark County had no public or prehospital stakeholders
attend and the meeting was cancelled).
A list of questions was developed to encourage discussion. Below is a brief overview of the general
comments made during the Town Hall meetings. Please refer to the Appendix for the comments and
input from each meeting.
Prevention and public outreach were thought to be important for the public’s role in a trauma system.
Generally there was knowledge of a trauma center in Southern Nevada, and it was felt that it had good
capability and people tended to know that it was at UMC. There seemed to be agreement that another
trauma center(s) was needed and that the location(s) should be based on geography and the growth
in the region. There was wide variation on where the trauma center(s) should be located. Current and
future clinical staffing was discussed as a concern. It was felt that data analysis should be used to help
create the trauma system. There was general agreement that there should be some form of
governance for the trauma system. Finally, there does not appear to be a strong appetite for a tax
initiative to fund the trauma system. (A list of alternative funding systems is provided in the appendix.)
Page 30

Inventory of Resources
Prehospital Care
The EMS Department is a section of the Clark County Health District. They regulate prehospital care
as provided in Nevada Revised Statutes Chapter 450B and in the EMS regulations for Clark County
Health District. EMS in the other counties in Nevada is overseen by the Nevada State Health Division.
Communication
The prehospital communication network includes a universal access number through the use of E-9-1-
1, except for cell phone calls and a few telephone companies that do not subscribe to the enhanced
service. They have prioritized dispatch and post dispatch instructions provided by all dispatch centers.
State regulation requires all dispatchers to be Emergency Medical Dispatch (EMD) certified.
Communication between dispatch and the ambulance is provided by the 800-megahertz link for fire
departments and by UHF for private ambulances. Similarly, ambulance to ambulance communication
is provided by the 800 megahertz for fire departments and by UHF for private ambulances. VHF
provides ambulance to hospital communication, and within six months there will be hospital-tohospital
communication through the use of the 800 megahertz system. Air ambulances also are able
to communicate with ground ambulances.
Dispatch
Following a traumatic injury, access to medical care is most often achieved through a request to the
Enhanced (E) 9-1-1 system, which is available throughout the region except for calls received from cell
phones and a limited area served by telephone companies that do not subscribe to the enhanced
service.
There are six first responders and three private transport-only agencies in Clark County. Dispatch is
accomplished primarily by two Public Safety Answering Points (PSAPs). One is Fire Alarm Operations
(FAO) for the North Las Vegas, Las Vegas and Clark County Fire Departments, which transfers calls to
AMR and Southwest Ambulance for transport. The other main PSAP is in Henderson and dispatches
Henderson’s fire and police. Mesquite also has its own dispatch. The dispatch centers have monthly
quality improvement meetings to discuss dispatcher quality improvement. They are currently working
on including a physician for QI of prehospital communication issues. The records for dispatch do not
link with the trauma registry except by manual entry by the trauma centers.
Provider Agencies
All of the first responders transport except for Clark County Fire Department and North Las Vegas Fire
Department. Las Vegas Fire & Rescue has both transport and non-transport units. By agreement, Las
Vegas Fire & Rescue responds with a transport unit for all motor vehicle crashes (MVC). For all other
calls, including non-MVC trauma, they send a non-transport unit, which is then supported by a private
ambulance transport.
The primary air ambulance transport is provided by Mercy Air and they have two stations in Clark
County. There are 11 volunteer fire departments who serve the rural areas of the county. Both the two
major ground providers are accredited by the Commission on Accreditation of Ambulance Services
Page 31

(CAAS) and the air ambulance provider is also accredited by the Commission on Accreditation of Air
Medical Services (CAAMS). These accreditation standards are incorporated into the processes that
form the basis for prehospital patient care decisions, treatments and transfer protocols. The following
table lists the Southern Nevada prehospital agencies.
Exhibit 14 – Clark County EMS Providers
Clark County EMS Providers
Clark County Agencies (6)
Boulder City Fire Dept.
Clark County Fire Dept.
Henderson Fire Dept.
Las Vegas Fire and Rescue
Mesquite Fire and Rescue
North Las Vegas Fire Dept.
Private Provider Agencies (3)
American Medical Response (AMR) - Las Vegas
AMR - Laughlin
Southwest Ambulance
Air Ambulance Services (3)
Mercy Air Service, Inc. (Helicopter)
Life Guard International, Inc. (Fixed Wing)
Med Flight Air Ambulance, Inc. (Fixed Wing)
Special Purpose Ambulance Agencies (4)
Las Vegas Motor Speedway
Specialized Medical Services, Inc.
Motorsports Medical Services (Volunteer Agency)
So. Nev. Vol. First Aid & Rescue Assn. (SNVFARA)
CCFD Rural Volunteer Ambulance Agencies (11)
Prehospital Data
Currently the fire departments capture the prehospital care reports in an electronic format initiated
based on the Clawson protocols for dispatching, while the ambulance providers provide the
prehospital care report in hard copy format. Both types of stakeholders retain their records and data
linkage is inadequate.
In accordance with NRS 450B.810, NAC 450B.620, NAC 450B.645, and NAC 450B.766, the Nevada
State Health Division EMS section, in cooperation with the Clark County Health District EMS Office,
has adopted standards for prehospital data collection. Computer software and a web-based server
have been provided for collecting and storing prehospital run reports and data obtained from all
Nevada EMS/Fire agencies.
While not every agency is required to install and utilize the provided software, each will soon be
required to submit the required data elements in a format that will allow uploading to the web-based
server. Las Vegas Fire & Rescue and local ambulance providers are expected to adopt a new software
system, called Roam IT, allowing for a standardized electronic reporting of the prehospital care report
to be in place by April 2004. The rollout of the new data collection and reporting system, utilizing the
web-based server, is scheduled for July 2004.
Data from prehospital care does not currently link with any trauma center data except by manual entry
by the trauma center at UMC and with other hospitals reporting.
Page 32

EMS Activity
The Abaris Group contacted each EMS provider for their total EMS responses and transports. The oneyear
growth between 2002 and 2003 for responses and transports was 9.6 percent and 6.5 percent,
respectively.
Exhibit 15 – Southern Nevada EMS Responses and Transports
Southern Nevada EMS Responses & Transports, 2002 and 2003
2002 2003
EMS EMS EMS EMS
EMS Provider
Responses Transports Responses Transports
Percent
Change
Responses
Percent
Change
Transports
Clark County Fire Department 1 60,778 - 66,078 - 8.7% -
Las Vegas Fire and Rescue Department 56,986 3,907 64,876 3,661 13.8% -6.3%
North Las Vegas Fire Department 1 13,654 - 15,402 - 12.8% -
Boulder City Fire Department 1,299 801 1,289 805 -0.8% 0.5%
Mesquite Fire Department 2 1,244 - 1,385 - 11.3% -
Henderson Fire Department 10,865 7,116 12,175 8,192 12.1% 15.1%
AMR 114,545 74,972 122,942 78,822 7.3% 5.1%
Southwest Ambulance 61,206 40,806 67,341 44,419 10.0% 8.9%
Mercy Air Ambulance 3 1,352 658 1,335 644 -1.3% -2.1%
Total 321,929 128,260 352,823 136,543 9.6% 6.5%
1
Does not transport.
2 Did not collect the data. Began collecting in 2004.
3 These data are for trauma requests and trauma transports only.
Source: Indvidiual EMS provider agencies.
EMS Quality Improvement
The EMS Quality Improvement Directors Committee consists of a director from each of the provider
agencies and meets monthly to evaluate safety and compliance issues related to prehospital care and
provide input to protocol development and clinical performance measures. The committee reports
system-wide issues to the Medical Advisory Board (MAB). The committee only completes chart review
as part of specific studies. However, concerns or complaints regarding a particular instance of patient
care are reported to the Clark County Health District EMS agency, and if the EMS agency finds that
protocol revision may be necessary, the issue is brought before the committee.
Transport of Trauma Patients
There are system-wide regulations that that define the categories and criteria for transporting injured
patients. These are set by State regulations and also adopted by Clark County Health District EMS for
statewide consistency. They are written to align with the ACS published standards for prehospital
trauma triage.
Unstable critical trauma patients (airway compromised, etc.) are transported directly to the trauma
center if they are within ten minutes of the trauma center. Otherwise they are taken to the closest ED.
All other trauma patients that are within 30 minutes of the trauma center are taken directly to the
trauma center. If the patient is more than 30 minutes from the trauma center, they are to be
transported to the nearest facility. The decision to utilize air transportation is not defined in any
guideline but is the decision of the paramedic on scene. They notify Fire Alarm Operations (FAO) to
dispatch as necessary.
Page 33

Triage Criteria
The determination of whether an injured patient needs to be transported to a trauma center is made
based on specific triage criteria. These are enumerated in the Clark County Health District’s trauma
patient destination protocol, a new version of which was implemented on April 1, 2004. The new
version exactly matches the protocol described in the Nevada Administrative Code (NAC 450B.770),
whereas the previous Clark County Health District protocol had contained slight differences.
Among the changes, the new protocol reduces the speed with which a pedestrian needs to be hit to be
transported to a trauma center from 20 miles per hour to 6 miles per hour and adds the requirement
stipulated in the NAC that patients be transported to the highest level trauma center available within
30 minutes. The new protocol originally called for motor vehicle crash patients traveling at a speed of
at least 20 miles per hour to be transported to a trauma center, as stated in the NAC. (Previously the
threshold in Clark County had been 40 miles per hour.) However, the Clark County Health District has
received a variance with the State Board of Health to have this changed back to 40 miles per hour,
given concerns of over-triage with the 20 mile per hour threshold.
Transport Agencies
There are an adequate number of ambulances for timely transport of patients to the appropriate
facilities, but a major impact on the resources for ambulance services is the lengthy delays incurred at
the hospitals to off load their patients. There may be as many as 5-6 ambulances backed up at any one
hospital waiting for the hospital to assume responsibility and care for the patient. Delays average 50
minutes and recent data suggests that 90 percent of the time it takes 70 minutes for the hospital to
assume care of the patient . This leaves an ambulance out of service for hours.
Clark County Health District has implemented EMSystem software to track hospital closures and
ambulance backup. The problem has been evaluated at various committees for years as well as the QI
Committee but a long-term workable solution has not been developed. The community is now pilot
testing eliminating the “emergency department closure” protocol for 90 days. Initial results are
positive.
Mutual aide agreements exist between EMS providers in Southern Nevada. There is also an Automatic
Aide System established for the region. Through the use of a satellite GPS system, the closest unit will
be dispatched to the scene, which may take the unit out of their designated service area. Agreements
are not maintained or supervised by the EMS Office but are kept at the provider agencies.
Emergency Preparedness
While there is no separate EMS Disaster Plan, EMS is part of the area wide plan for mass casualty
disaster, which includes plans for terrorist incidents and hazardous materials management. There has
been extensive disaster and bioterrorism planning for the region. The area wide planning includes
EMS, local government, the private sector and acute care facilities. They are all members of the Local
Emergency Planning Committee (LEPC). The last update of the Mass Casualty Plan was completed in
June 2003.
Page 34

UMC Trauma Center
The UMC trauma center is unique in that it is a stand alone trauma center. That is, the trauma
resuscitation bays, trauma ORs, trauma computed tomography (CT) scan and trauma ICU beds are
separate and distinct from the hospital and the trauma center staff do not rely on the hospital to
support those areas on a daily basis. There are only four other freestanding trauma centers in the
country. Please see the Appendix for a survey of the other four freestanding trauma centers in the US.
Typically, a trauma center’s ED and resuscitation area is contained within a hospital’s ED. During
1992, the UMC trauma center moved from the ED to its own building. The 18,000 square-foot Trauma
Center includes 11 resuscitation beds (or trauma treatment areas), 3 dedicated trauma operating
suites, a 14-bed trauma intensive care unit as well as state-of-the-art rapid sequence CT scanner and
an angiography suite. Adjacent to the building is a helipad for air transport of trauma patients.
There are 10 trauma surgeons staffing the trauma center as well as 8 neurosurgeons, 20 emergency
medicine physicians, 15 anesthesiologists, a trauma fellow, many surgical residents and medical
students, and several registered nurses trained in trauma care.
UMC also has a robust trauma research program. Linked to the UMC Trauma Center is the Trauma
Institute, an organization dedicated to research on a wide variety of trauma topics. In addition, the
Trauma Center works closely with the UMC’s Rancho Rehabilitation Center, UMC’s burn and wound
care center and provides replantation services.
UMC is the only trauma center in Southern Nevada . It was originally verified by the ACS as a Level II
trauma center in 1989 and became a Level I in 1999. UMC was last re-verified in 2002, with verification
set to expire in 2005. The hospital will be undergoing the re-verification process during or before
December 2004.
UMC treated 3,899 patients who met trauma activation criteria in 2003. Most of these are from within
30 miles of the hospital, but they also see patients from outlying areas including California, Arizona
and Utah. The majority of trauma patients treated at UMC are there as a result of a motor vehicle
crash.
Southern Nevada Trauma Patient
The UMC trauma registry includes patients who are activated based on trauma field triage criteria, all
admitted patients regardless of activation or trauma consult status, all transfers in from referring
facilities and all deaths. The trauma registry does not include minor trauma patients that were brought
to the trauma center and treated by the emergency medicine physician staff. During 2003, there were
an additional 8,390 minor trauma patients brought to the trauma center as well.
Page 35

With the exception of the year 2000, the total number of patients at UMC has been increasing for the
past five years .
Exhibit 16 – Trauma Cases
UMC Trauma Patient Statistics, 1998 - 2003
Type 1998 1999 2000 2001 2002 2003
Total Patients 9,573 10,018 9,947 11,439 11,600 12,289
Meeting Trauma Criteria 3,461 3,518 3,114 3,573 3,711 3,899
Admitted 2,788 2,829 2,719 3,009 3,069 3,089
ISS >= 15 719 653 639 686 835 902
Source: UMC Trauma Registry.
From 2002 to 2003 the growth in total patients was 5.9 percent and 5.1 percent for patients meeting
the trauma triage criteria.
Exhibit 17 – Trauma Statistics Percent Change
UMC Trauma Patient Statistics, 1998 - 2003
Percent
Change
Percent
Change
Percent
Change
Percent
Change
Percent
Change
Type
1998 - 1999 1999 - 2000 2000 - 2001 2001 - 2002 2002 - 2003
Total Patients 4.6% -0.7% 15.0% 1.4% 5.9%
Meeting Trauma Criteria 1.6% -11.5% 14.7% 3.9% 5.1%
Admitted 1.5% -3.9% 10.7% 2.0% 0.7%
ISS >= 15 -9.2% -2.1% 7.4% 21.7% 8.0%
Source: UMC Trauma Registry.
Page 36

The trauma utilization rate was 237.5 trauma cases per 100,000 population excluding the visitor
population in 2003. When the visitor population is factored into the resident population in the Las
Vegas region, the utilization rate drops to 197.7 for the same time period.
Exhibit 18 – Trauma Utilization Rate for Southern Nevada
Trauma Registry Patients by Various Statistic
Clark
County
Population
Trauma
Rate per
100,000
Population
Nights
Stayed in
Las
Vegas
Average
Annualized
Visitor
Population
Clark
County
Population
+ Visitors
Rate per
100,000
Population
+ Visitors
Calendar Trauma Monthly Percent
Visitors to Las
Year Activations Average Change
Vegas
1998 3,461 288 - 1,246,193 277.7 30,605,128 3.3 276,704 1,522,897 227.3
1999 3,519 293 1.7% 1,321,319 266.3 33,809,134 3.7 342,723 1,664,042 211.5
2000 3,114 260 -11.5% 1,428,690 218.0 35,849,691 3.7 363,408 1,792,098 173.8
2001 3,573 298 14.7% 1,498,279 238.5 35,017,317 3.6 345,376 1,843,655 193.8
2002 3,713 309 3.9% 1,578,332 235.2 35,071,504 3.4 326,693 1,905,025 194.9
2003 3,899 325 5.0% 1,641,529 237.5 35,540,126 3.4 331,059 1,972,588 197.7
Source: UMC Trauma Registry, Southern Nevada Consensus Population Estimate, Las Vegas Convention & Visitor's Bureau, & The Abaris Group.
300.0
250.0
200.0
150.0
100.0
50.0
Trauma Utilization Rate per Year
for Clark County and Clark County + Visitors
Trauma UR Pop
Only
Trauma UR Pop
+ Visitors
0.0
1998 1999 2000 2001 2002 2003
Almost 80 percent of all trauma registry patients in 2003 were treated for blunt trauma.
Exhibit 19 – Trauma Patients by Type of Injury
Trauma Registry Patients by Type of Injury,
2003
Type of Injury Frequency Total
Blunt 3,097 79.4%
Penetrating 801 20.5%
Burn 1 0.0%
Total 3,899 100.0%
Source: UMC Trauma Registry
The average age of the trauma patient treated at UMC was 33.
Page 37

Exhibit 20 – Trauma Patients by Age
Trauma Registry Patients by Age, 2003
Percent of
Years
Frequency Total
0-4 84 2.2%
5-9 77 2.0%
10-14 174 4.5%
15-19 470 12.1%
20-24 616 15.8%
25-34 840 21.5%
35-44 682 17.5%
45-54 471 12.1%
55-64 259 6.6%
65-74 138 3.5%
75+ 88 2.3%
Total 3,899 100.0%
Average 33 -
Median 30 -
Std. Deviation 17 -
Minimum 0 -
Maximum 94 -
Source: UMC Trauma Registry
Trauma by Age, 2003
900
800
700
600
500
400
300
200
100
-
0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75+
Page 38

Males accounted for almost three-quarters of all trauma patients in 2003.
Exhibit 21 – Trauma Patients by Sex
Trauma Patients by Sex, 2003
Trauma Registry Patients by Sex,
2003
Sex Frequency
Percent of
Total
Female 1,041 26.7%
Male 2,858 73.3%
Total 3,899 100.0%
27%
Female
Male
Source: UMC Trauma Registry
73%
In 2003, the majority of trauma patients were white, with Hispanics being the second most common
rate/ethnicity.
Exhibit 22 – Trauma Patients by Race/Ethnicity
Trauma Patients by Race/Ethnicity, 2003
3%
10%
Trauma Registry Patients by Race/Ethnicity, 2003
Race
Frequency Percent of Total
Asian 128 3.3%
Black 398 10.2%
Hispanic 817 21.0%
Other 10 0.3%
White 2,546 65.3%
Total 3,899 100.0%
Source: UMC Trauma Registry
66%
0%
21%
Asian
Black
Hispanic
Other
White
Page 39

The following chart shows that about half of all trauma patients in 2003 had an injury severity score
(ISS) in the range of 1 to 8, while 23.5 percent of the trauma patients had an ISS of 9 to 15. Just over 23
percent of the Southern Nevada trauma patients had injury severity scores greater than 15. The average
ISS was 10.2 and the median ISS was 8.
Exhibit 23 – Trauma Patients by ISS
Trauma Registry Patients by Injury Severity
Score, 2003
Injury Severity
Score Range Frequency
Percent of
Total
1 - 8 2,073 53.2%
9 - 14 916 23.5%
15 - 20 354 9.1%
21 - 30 308 7.9%
31 - 40 110 2.8%
41 - 50 90 2.3%
51 - 60 10 0.3%
61 - 70 5 0.1%
71 - 75 29 0.7%
Not recorded 4 0.1%
Total 3,899 100.0%
ISS >= 15 906 23.2%
Average ISS
Median ISS
10.2
8
Source: UMC Trauma Registry
Trauma Patients by Injury Security Score, 2003
2,500
2,000
1,500
1,000
500
-
1 - 8 9 - 14 15 - 20 21 - 30 31 - 40 41 - 50 51 - 60 61 - 70 71 - 75
In 2002, 79.4 percent of trauma registry patients arrived by ground ambulance. The table below shows
the distribution of all modes of transport.
Exhibit 24 – Trauma Patients by Mode of Transport
Trauma Registry Patients by Mode of Transport
Percent of
Mode of Transport Frequency Total
Ground Ambulance 2,944 79.4%
Helicopter 492 13.3%
ALS/Helicopter 125 3.4%
Walk 72 1.9%
Private Vehicle 56 1.5%
Fixed Wing 19 0.5%
Police 2 0.1%
Total 3,710 100.0%
Source: Southern Nevada Trauma Registry
Page 40

Response times and transport times for trauma registry patients in 2002 are shown below.
Exhibit 25 – Trauma Response Times
2002 Response Times (n=2,509)
350
300
250
200
150
100
50
0
0
3
6
9
12
15
18
21
24
27
30
33
36
39
42
45
48
51
54
57
60
Note: Response times up to 60 minutes shown; 10 cases (0.40%) had longer reported response times.
Source: UMC Trauma Registry
Exhibit 26 – Trauma Transport Times
2002 Transport Times (n=2,509)
200
180
160
140
120
100
80
60
40
20
0
0
3
6
9
12
15
18
21
24
27
30
33
36
39
42
45
48
51
54
57
60
Note: Transport times up to 60 minutes shown; 9 cases (0.36%) had longer reported transport times.
Source: UMC Trauma Registry
The map on the following page shows the occurrence of ground transport times greater than 30
minutes to the UMC trauma center in 2002.
Page 41

Exhibit 27 – Trauma Ground Transport Times Greater than 30 Minutes
CACTUS SPRINGS
INDIAN SPRINGS
COLD CREEK
LEE CANYON
MT. CHARLESTON
RED ROCK
&
15 Transports from the west of
The Las Vegas Valley via BLUE
Blue Diamond Rd DIAMOND
SANDY VALLEY
&
&
&
MOUNTAIN SPRINGS
&
&&
&
GOODSPRINGS
&
&&&&&&
& &&&
&
&
&
PRIMM
6 Transports from Northwest of
the Las Vegas Valley via US95
&
&
&
&
&
&
JEAN
&
&
&
&
&
&
&
&
&&
&&
&
&
&
&
&
&
&
&
&
&
&
&
&
& &
&
&
& &
& &
&
&
&
&
&
&
&
&
3 Transports from Southest of
the Las Vegas Valley via I 15
&
&
&
&
&
&
& &&&&&&
&
&
MOAPA
NELSON
&
GLENDALE
13 Transports from Northwest of
the Las Vegas Valley via I 15
1 Transports from Southwest of
the Las Vegas Valley via US95
VALLEY OF FIRE
&
BUNKERVILLE
&
MOAPA VALLEY
(LOGANDALE/OVERTON)
MESQUITE
Number of Transports
Number of Transports
Ground Transportation to UMC Trauma Center
200
100
0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 54 58
Minutes
30 minutes
95.6% of patients arrive in 30 minutes or less
2056 Transports, Mean Transport Time = 15 minutes-Standard Deviation = 8
Ground Transportation to UMC Trauma Center
20
10
0
30.00 34.00 38.00 42.00 46.00 51.00 56.00
32.00 36.00 40.00 44.00 48.00 54.00
Minutes
Ground Transport 30 minutes or greater to UMC Trauma Center
115 transport - 37 Minutes Mean - Standard Deviation = 7
2002 Ground Transport
times greater than
30 minutes to
UMC Trauma Center
Clark County, Nevada
G
I
S
Legend
Transport Locations
TRANS
& 30 - 60
& 61 - 107
Colorado River
10 Mile Radius from UMC
Dirt Road
Highway / Freeway
Major Road
Collector
Residential Streets
Ramps
50 Meter Contours
Count Total Number of Records Submitted Percent Processed
2826 Submitted
786 Not Used 27.18
395 No Transport times 13.98
249 Incomplete Addresses 8.81
124 To Be Researched 4.39
Total 27.18
SEARCHLIGHT
CAL NEV ARI
2058 Match and plotted 72.82
1608 00:00 to 00:19 78.13
332 00:20 to 00:29 16.13
75 00:30 to 00:39 3.64
43 00:40 & Greater 2.1
Total 100
1 inch equals 37,000 feet
LAUGHLIN
Vicinity Map - No Scale
This information is for display purposes only. No liability is
assumed as to the accuracy of the data delineated herein.
Page 42

The average length of stay (LOS) for trauma patients is 2 days in the ICU and 6 total days in the
hospital.
Exhibit 28 – Trauma Patients by Average Length of Stay
Trauma Registry Patients
Average Length of Stay, 2003
ICU Days
Average 2
Median 0
Count (n) 3,824
Not Included 75
Total Records 3,899
Hospital Days
Average 6
Median 2
Count (n) 3,815
Not Included 84
Total Records 3,899
Source: UMC Trauma Registry
Note: Excludes DOAs and deaths before
admission; hospital LOS for patients not
admitted is reported as 1.
The ICD-9 codes allow diagnoses to be categorized by type of injury. The following table presents the
top 20 diagnoses for UMC’s trauma registry patients. A trauma patient may have more than one
diagnosis documented.
Exhibit 29 – Trauma Patients by Top 20 ICD-9 Code Diagnoses
Trauma Registry Patients by Top 20 ICD-9 Code Diagnoses, 2003
ICD-9 Code Description of Diagnosis
Frequency
Percent of
Total
805 Fracture of vertebral column without mention of spinal cord injury 703 7.6%
802 Fracture of the face bones 611 6.6%
854 Inracranial injury of other and unspecified nature 533 5.7%
873 Other open wound of head 523 5.6%
860 Traumatic pneumothorax and hemothorax 447 4.8%
807 Fracture of rib(s), sternum, larynx, and trachea 437 4.7%
861 Injury to heart and lung 428 4.6%
852 Subarachnoid, subdural, and estradural hemorrhage, following injury 378 4.1%
808 Fracture of pelvis 332 3.6%
823 Fracture of tibia and fibula 325 3.5%
813 Superficial injury of elbow, forearm, and wrist 213 2.3%
864 Injury to liver 206 2.2%
916 Superficial injury of hip, thigh, leg, and ankle 205 2.2%
865 Injury to spleen 197 2.1%
847 Sprains and strains of other and unspecified parts of back 191 2.1%
863 Injury to gastrointestinal tract 187 2.0%
821 Fracture of other and unspecified parts of femur 187 2.0%
800 Fracture of vault of scull 173 1.9%
850 Concussion 156 1.7%
922 Contusion of trunk 155 1.7%
- Subtotal 6,587 70.7%
- Other 2,724 29.3%
- Grand Total 9,311 100.0%
Note: A trauma patient may have more than one diagnosis documented.
Source: UMC Trauma Registry
Page 43

E codes enable the classification of environmental events, circumstances, and conditions as the cause
of injury, poisoning, and other adverse effects. Crashes involving motor vehicles accounted for 62.9
percent of the E Codes for the 2003 trauma activations at UMC.
Exhibit 30 – Trauma Patients by Top 20 E Codes
Trauma Registry Patients by Top 20 E Codes, 2003
E Code E Code Description Frequency
Percent of
Total
812 Other motor vehicle traffic crash involving collision w/ motor vehicle 898 23.0%
816 Motor vehicle traffic crash due to loss of control, w/out collision on highway 858 22.0%
814 Motor vehicle traffic crash involving collision w/ pedestrian 345 8.8%
966 Assault by cutting and piercing instrument 345 8.8%
965 Assault by firearms and explosives 338 8.7%
821 Nontraffic crash involving other off-road motor vehicle 167 4.3%
813 Motor vehicle traffic crash involving collision w/ other vehicle 149 3.8%
968 Assault by other and nonspecified means 118 3.0%
882 Fall into hole or other opening in surface 89 2.3%
881 Fall on or from ladders or scaffolding 63 1.6%
884 Other fall from one level to another 52 1.3%
956 Suicide and self-inflicted injury by cutting and piercing instrument 47 1.2%
826 Pedal cycle crash 41 1.1%
815 Other motor vehicle traffic crash involving collision on the highway 35 0.9%
955 Suicide and self-inflicted injury by firearms and explosives 32 0.8%
920 Accidents caused by cutting and piercing instruments or objects 30 0.8%
916 Struck accidentally by falling object 29 0.7%
917 Striking against or struck accidentally by objects or persons 28 0.7%
880 Fall on or from stairs or steps 24 0.6%
885 Fall on same level from collision, pushing, shoving, by or w/ other person 22 0.6%
- Other 189 4.8%
Total - 3,899 100.0%
Source: UMC Trauma Registry
Page 44

The vast majority of trauma patients treated at UMC come from Nevada (3,156 patients). California
ranks second with 300 patients. Out of town trauma patients comprised 18.8 percent of all trauma
patients.
Exhibit 31 – Trauma Patients by State of Residence
Trauma Registry Patients by State of
Residence, 2003
State Frequency Rank
NV 3,156 1
CA 300 2
AZ 185 3
UT 40 4
Out of Country 31 5
TX 19 6
FL 19 6
WA 15 7
CO 13 8
NY 10 9
OR 9 10
IL 8 11
MI 8 11
VA 7 12
WI 6 13
HI 5 14
ID 5 14
NJ 5 14
OH 5 14
MD 4 15
MT 4 15
NM 4 15
GA 3 16
AK 2 17
AL 2 17
KS 2 17
ME 2 17
MO 2 17
NC 2 17
NE 2 17
PA 2 17
LA 1 18
MA 1 18
MS 1 18
NH 1 18
OK 1 18
SC 1 18
SD 1 18
TN 1 18
WV 1 18
Subtotal 3,886 -
Not Recorded 3 -
Total 3,889 -
Aggregate Frequency
Percent of
Total
In Nevada 3,156 81.2%
Out of Nevada 730 18.8%
Source: UMC Trauma Registry
Page 45

The day of the week with the greatest amount of trauma is Saturday. By hour of day, trauma arrivals
peak between 18:00 and 19:00.
Exhibit 32 – Trauma Patients by Day and Hour of Arrival
Injury by Day of Week by Hour of Day, 2003
Hour Sun Mon Tue Wed Thu Fri Sat Total
0:00 40 19 21 13 23 12 31 159
1:00 40 38 17 18 19 18 44 194
2:00 30 12 11 18 10 12 39 132
3:00 30 20 7 15 10 9 30 121
4:00 17 16 8 12 7 15 19 94
5:00 16 9 7 14 8 17 13 84
6:00 22 19 10 9 12 16 18 106
7:00 20 10 7 14 14 15 13 93
8:00 15 20 14 12 13 18 19 111
9:00 19 11 15 16 10 12 21 104
10:00 9 18 17 19 13 19 27 122
11:00 25 14 16 15 12 14 37 133
12:00 25 17 14 22 18 25 18 139
13:00 25 22 25 18 19 18 33 160
14:00 29 13 18 21 22 31 29 163
15:00 30 27 30 18 26 29 35 195
16:00 29 33 29 26 33 26 41 217
17:00 35 30 29 34 23 42 41 234
18:00 34 33 22 32 37 38 52 248
19:00 39 30 36 31 22 30 27 215
20:00 39 31 22 25 27 33 39 216
21:00 45 25 35 44 24 38 32 243
22:00 48 28 30 19 32 29 48 234
23:00 17 22 21 26 24 29 33 172
Total 678 517 461 491 458 545 739 3,889
Note: ED arrival day and hour was used to approximate injury day and hour.
Source: UMC Trauma Registry
Injury by Day of Week, 2003
800
700
600
500
400
300
200
100
-
Sun Mon Tue Wed Thu Fri Sat
Injury by Hour of Day, 2003
300
250
200
150
100
50
-
0:00
2:00
4:00
6:00
8:00
10:00
12:00
14:00
16:00
18:00
20:00
22:00
Page 46

The following map depicts 2002 UMC trauma case volume (n = 2,515) that had an identified geographic location of the injury address for the
metro area. Also displayed are the major roads. Each dot represents a location where a trauma patient was injured. (Note: In total, there were
3,710 UMC Trauma Registry patients in 2002. 519 patients were injured outside of Clark County and 676 patients did not have a recorded
injury location that could be mapped. The remaining 2,515 are represented in the map below.)
Exhibit 33 – Map Displaying Trauma Volume for the Las Vegas Metro Area
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Source: UMC Trauma Registry
St. Rose - Siena
Page 47

A different view of the 2002 trauma data is presented below. This map shows trauma case volume by density for all zip codes in Clark County.
(Note: The map below reflects the 2,515 patients with injury locations within Clark County that could be mapped as well as proportional
distribution of the 676 patients who did not have a recorded injury location that could be mapped. The 519 patients injured outside of Clark
County are not represented.)
Exhibit 34 – Map Displaying Trauma Patients by Zip Code
US 95
I 15
I 215
•
UMC
Sunrise
•
St. Rose - Siena
Trauma Case Volume (2002)
Within Zip Codes (n=3191)
150 to 401
75 to 149
25 to 74
1 to 24
No Cases
Source: UMC Trauma Registry
Page 48

Hospital Resources
There are 12 hospitals in Clark County, all of which have emergency departments, and one of which
has a trauma center.
Exhibit 35 – List of Clark County EDs and Trauma Center
Clark County Emergency Departments &
Trauma Center
Emergency Departments
Boulder City Hospital
Desert Springs Hospital
Lake Mead Hospital
Mountain View Hospital
Southern Hills Hospital (Opening 3/1/04)
Spring Valley Hospital
St. Rose Dominican Hospital - Rose de Lima
St. Rose Dominican Hospital - Siena
Summerlin Hospital
Sunrise Hospital
University Medical Center
Valley Hospital Medical Center
Trauma Center
University Medical Center
Please see the Appendix for a map displaying the 12 hospital s and the trauma center in Clark County.
Due to population growth, four new hospitals recently opened in the region (Summerlin, Spring Valley,
St. Rose Dominican-Siena Campus and Southern Hills). Three new hospitals are also being built: a
UHS hospital on the northwest side of Las Vegas is scheduled to open in 2005, Mountain View
Hospital in Mesquite is expected to open during the summer of 2004, and in 2006, St. Rose
Dominican-St. Martin Campus will open. In addition, many hospital EDs are undergoing expansion.
This facility expansion has increased the pressure to hire hospital personnel.
The volume of visits to the ED for each hospital in the Clark County region is presented below. This
data was provided by the Nevada Division of Health Care Financ ing and Policy. From 1999 to 2001 the
total volume rose by 2.3 percent increase for 2000 and 7.7 percent increase for 2001. However, in
2002 the overall growth rate was flat.
Exhibit 36 – ED Volume by Hospital
ED Volume by Hospital in Clark County, 2000-2002
Hospital 2000
Percent
Change 2001
Percent
Change 2002
Percent
Change
Boulder City Hospital 4,818 -4.5% 4,791 -0.6% 4,858 1.4%
Desert Springs Hospital 33,127 -12.3% 35,211 6.3% 34,901 -0.9%
Lake Mead Hospital Medical Center 31,826 15.7% 30,827 -3.1% 30,485 -1.1%
Mountain View Hospital 29,407 10.6% 38,163 29.8% 38,096 -0.2%
Saint Rose Dominican Hospital - de Lima 27,007 -11.0% 25,792 -4.5% 26,258 1.8%
Saint Rose Dominican Hospital - Siena 9,178 - 27,356 198.1% 31,680 15.8%
Summerlin Hospital Medical Center 23,192 19.8% 26,310 13.4% 27,096 3.0%
Sunrise Hospital and Medical Center 1 73,936 2.3% 70,066 -5.2% 67,840 -3.2%
University Medical Center 1 99,845 -3.0% 104,109 4.3% 104,027 -0.1%
Valley Hospital Medical Center 32,905 -6.3% 30,921 -6.0% 28,737 -7.1%
Total 365,241 2.3% 393,546 7.7% 393,978 0.1%
1
Includes adult and pediatric ED volume.
Note: Spring Valley Hospital and Southern Hills Hospital opened in 2003 and 2004, respectively.
Source: Nevada Division of Health Care Financing and Policy
Page 49

As part of The Abaris Group’s trauma system assessment study, each hospital’s ED management team was visited on site. Part of the visit
included a request for general information about the hospital and ED. Two EDs did not participate in the survey and Southern Hills Hospital
and Medical Center did not open until March 2004. The following table presents the data submitted.
Hospital and Emergency Department Statistics
Desert
Springs
Hospital
Medical
Center
Lake
Mead
Hospital
Medical
Center
Exhibit 37 – Hospital and ED Statistics
St. Rose
Dominican
Hospital
- de Lima
St. Rose
Dominican
Hospital
- Siena
Statistic
Boulder
City
Hospital
MountainView
Hospital
Sunrise Hospital
and Medical Center
University
Medical Center
Hospital Information
Hospital Admissions, 2002 - - 8,757 14,763 8,714 13,504 Opened 3/04 36,856 30,176 30,176 19,416
Hospital Admissions, 2003 - - 8,383 14,932 8,681 15,643 Opened 3/04 36,188 30,223 30,223 20,327
Licensed Beds 20 385 198 199 138 214 130 701 544 544 406
Available Beds 20 385 198 199 138 214 130 669 544 544 382
ICU Beds 2 34 10 24 10 26 22 Did not Did not
116 84 84 50
25 (ICU participate. participate.
Other critical care (define) - 27 (IMC) 10 (IMC) 36 (IMC/HCU) 20 (IMC) 34 (IMC) Stepdown) 25 (IMC) 47 IMC 47 IMC 28 IMC
PICU Beds - - - 0 0 6 0 13 14 14 -
Med/Surg Beds 16 120 98 108 66 96 58 96 290 290 139
OR Suites 2 9 6 10 6 8 8 24 25 25 11
Southern
Hills
Hospital
and
Medical
Center
Spring
Valley
Hospital
Medical
Center
Summerlin
Hospital
Medical
Center
ED Information Adult ED Pediatric Adult ED Pediatric
ED Volume, 2002 4,858 34,897 25,634 33,714 27,990 33,188 Opened 3/04 44,676 29,169 67,824 28,507 28,737
ED Volume, 2003 5,950 35,768 25,511 37,957 29,106 36,643 Opened 3/04 46,840 25,809 70,735 30,869 30,767
ED Treatment Stations 6 32 20 22 21 28 30 48 21 50 22 44
ED Admissions to OR, 2002 - 422 - - 213 299 Opened 3/04 - - - - 162
Did not Did not
ED Admissions to OR, 2003 - 85 - - 194 354 Opened 3/04 - - - - 152
participate. participate.
ED Admissions to Hospital, 2002 878 9,585 4,919 9,578 6,110 7,852 Opened 3/04 18,012 2,624 14,903 2,686 9,327
ED Admissions to Hospital, 2003 824 9,612 4,421 10,046 6,549 8,476 Opened 3/04 19,276 2,993 15,453 2,546 10,585
ED Transfers, 2002 165 708 - 606 591 601 Opened 3/04 690 0 908 31 1,224
ED Transfers, 2003 196 799 - 677 685 472 Opened 3/04 879 0 736 60 1,199
ED Diversion Hours, 2002 0 1,212 360 1,146 514 1,565 Opened 3/04 Opened 10/03 462 1,610 0 1,122 0 856
ED Diversion Hours, 2003 0 1,431 678 1,801 775 2,601 Opened 3/04 460 1,138 865 0 1,321 0 991
Notes:
A dash indicates a value was not reported or not applicable.
In the category of other critical care beds, IMC stands for Intermediate Care and HCU stands for High Care Unit.
Valley
Hospital
Medical
Center
Individual hospital notes:
Boulder City Hospital Lake Mead Hospital Medical Center St. Rose Dominican Hospital - Siena University Medical Center
Available beds assumed = licensed beds Available beds assumed = licensed beds Available beds assumed = licensed beds 2002 and 2003 hospital admissions are fiscal year
Also has 47 long term beds MountainView Hospital Sunrise Hospital and Medical Center Available beds assumed = licensed beds
Also has 2 overflow med/surg beds OR suites are 7 general, 1 cysto, and 2 open heart Beds include 12 PIMC, 46 total pediatric inpatient beds Hospital beds include 29 pediatric beds
Desert Springs Hospital Medical Center St. Rose Dominican Hospital - de Lima Available beds = Licensed minus 32 closed Main OR is 18 suites; endoscopy is 4; trauma is 3
Available beds assumed = licensed beds Available beds assumed = licensed beds ED transfers include those to mental health facilities
ED treatment stations reported as 32 with 6 hold beds Also has Critical Care Overflow with 8 beds
Valley Hospital Medical Center
28 ED tx stations in '03; 44 as of 3/04; 55 as of 6/04
Source: Individual hospitals; diversion data from CCHD
Page 50

The Abaris Group extracted two variables from the table above, ED volume and ED treatment stations.
During 2003, the hospitals reported an overall increase in ED visits of 6.4 percent for the 11 reporting
EDs.
Exhibit 38 – ED Volume by Hospital
ED Volume by Hospital in Clark County, 2002 and 2003
Hospital 2002 2003
Percent
Change
Boulder City Hospital 4,858 5,950 22.5%
Desert Springs Hospital Medical Center 34,897 35,768 2.5%
Lake Mead Hospital Medical Center 25,634 25,511 -0.5%
Mountain View Hospital 33,714 37,957 12.6%
St. Rose Dominican Hospital - de Lima 27,990 29,106 4.0%
St. Rose Dominican Hospital - Siena 33,188 36,643 10.4%
Southern Hills Hospital and Medical Center 1 - - -
Spring Valley Hospital Medical Center 2 - - -
Summerlin Hospital Medical Center 2 - - -
Sunrise Hospital and Medical Center, Adult 44,676 46,840 4.8%
Sunrise Hospital and Medical Center, Pediatric 23,185 25,809 11.3%
University Medical Center, Adult 67,824 70,735 4.3%
University Medical Center, Pediatric 28,507 30,869 8.3%
Valley Hospital Medical Center 28,737 30,767 7.1%
Total 353,210 375,955 6.4%
1 Opened in March 2004.
2 Did not participate in the survey.
Note: The 2002 ED volumes reported by the individual hospitals vary in some cases from
those reported by the Nevada Division of Health Care Financing and Policy. The discrepancy
is due to minor differences in inclusion criteria between the two sources.
Source: Individual hospitals
The following table presents the number of ED treatment stations or ED beds by hospital and the ratio
of visits per ED treatment station. It is interesting to note that the national average for the number of
patients per ED treatment station is 1,700 to 2,000. All reporting hospitals were below this average in
2003.
Exhibit 39 – ED Visits per ED Treatment Station
ED Visits per Treatment Station by Hospital
Hospital
2003
ED Visits ED Stations
Visits/ED
Stations
Boulder City Hospital 5,950 6 992
Desert Springs Hospital Medical Center 35,768 32 1,118
Lake Mead Hospital Medical Center 25,511 20 1,276
Mountain View Hospital 37,957 22 1,725
St. Rose Dominican Hospital - de Lima 29,106 21 1,386
St. Rose Dominican Hospital - Siena 36,643 28 1,309
Southern Hills Hospital and Medical Center 1 - 30 -
Spring Valley Hospital Medical Center 2 - - -
Summerlin Hospital Medical Center 2 - - -
Sunrise Hospital and Medical Center, Adult 46,840 48 976
Sunrise Hospital and Medical Center, Pediatric 25,809 21 1,229
University Medical Center, Adult 70,735 50 1,415
University Medical Center, Pediatric 30,869 22 1,403
Valley Hospital Medical Center 3 30,767 28 1,099
Total 375,955 328 1,146
1 Opened in March 2004.
2 Did not participate in the survey.
3 28 ED treatment stations during 2003; 44 as of 3/04; 55 as of 6/04
Source: Individual hospitals
Page 51

The table below summarizes the key capacity statistics from Exhibit 32 – Hospital and ED Statistics.
Exhibit 40 – Hospital Capacity Summary
Hospital and Emergency Department Capacity Statistics
Desert
Springs
Hospital
Medical
Lake
Mead
Hospital
Medical
St. Rose
Dominican
Hospital
St. Rose
Dominican
Hospital
Statistic
Boulder
City
Hospital Center Center
MountainView
Hospital - de Lima - Siena Center Center Center
Sunrise Hospital
and Medical Center
University
Medical Center
Licensed Beds 20 385 198 199 138 214 130 701 544 544 406
Available Beds 20 385 198 199 138 214 130 669 544 544 382
ICU Beds 2 34 10 24 10 26 22 116 84 84 50
25 (ICU Did not Did not
Other critical care (define) - 27 (IMC) 10 (IMC) 36 (IMC/HCU) 20 (IMC) 34 (IMC) Stepdown) participate participate
25 (IMC) 47 IMC 47 IMC 28 IMC
Med/Surg Beds 16 120 98 108 66 96 58 96 290 290 139
Southern
Hills
Hospital
and
Medical
Spring
Valley
Hospital
Medical
Summerlin
Hospital
Medical
ED Treatment Stations 6 32 20 22 21 28 30 48 (adult)
Notes:
A dash indicates a value was not reported or not applicable.
In the category of other critical care beds, IMC stands for Intermediate Care and HCU stands for High Care Unit.
21
(pediatric)
50 (adult)
Valley
Hospital
Medical
Center
22
(pediatric) 44
Individual hospital notes:
Boulder City Hospital Lake Mead Hospital Medical Center St. Rose Dominican Hospital - Siena University Medical Center
Available beds assumed = licensed beds Available beds assumed = licensed beds Available beds assumed = licensed beds Available beds assumed = licensed beds
Also has 47 long term beds MountainView Hospital Sunrise Hospital and Medical Center Hospital beds include 29 pediatric beds
Also has 2 overflow med/surg beds OR suites are 7 general, 1 cysto, and 2 open heart Beds include 12 PIMC, 46 total pediatric inpatient beds
Desert Springs Hospital Medical Center St. Rose Dominican Hospital - de Lima Available beds = Licensed minus 32 closed Valley Hospital Medical Center
Available beds assumed = licensed beds Available beds assumed = licensed beds 28 ED tx stations in '03; 44 as of 3/04; 55 as of 6/04
ED treatment stations reported as 32 with 6 hold beds Also has Critical Care Overflow with 8 beds
Source: Individual hospitals
Page 52

ED Diversion
Like the rest of the country, ED diversion has been a significant concern for the EMS and hospital
system in the Las Vegas region. Diversion hours increased by 36 percent from 2002 to 2003. Even
when a hospital was not on diversion, the average off load time for a patient from an ambulance to the
hospital bed was 70 minutes. Previous efforts by the community health care providers to resolve this
problem have had short term impacts but eventually the problem has grown worse. However, a pilot
test was recently implemented to eliminate diversion.
The chart below shows the region’s monthly diversion hours for 2002 and 2003. There are additional
hours when the hospital is open only because it has been forced open by the diversion protocol. It
should be noted that the trauma center at UMC does not divert patients meeting trauma destination
criteria.
System-wide, EDs were on diversion for over 900 hours per month during ten months in 2003.
December 2003 spiked with 1,606 hours.
Exhibit 41 – Total ED Diversion Hours by Month
ED Diversion by Month for Clark County
Month 2002 2003
Percent
Change
Jan 978 1,147 17.3%
Feb 1,059 867 -18.1%
Mar 1,418 962 -32.2%
Apr 917 972 6.0%
May 563 830 47.6%
Jun 446 767 72.0%
Jul 613 912 48.6%
Aug 589 919 56.0%
Sep 605 1,102 82.1%
Oct 440 861 95.7%
Nov 464 1,115 140.1%
Dec 754 1,606 112.9%
Total 8,846 12,061 36.3%
Source: CCHD
Clark County ED Diversion Hours, 2002-2003
1,800
1,600
1,400
1,200
1,000
800
600
400
200
-
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Source: CCHD
2002
2003
Monthly diversion hours for each hospital for 2002 and 2003 can be found in the Appendix.
Page 53

All EMS and ED stakeholders appear frustrated about the problem. The FAB and MAB, in conjunction
with the Clark County Health District, have agreed to test eliminating the “emergency department
closure” protocol and initiated a 90-day pilot on April 1, 2004. During this period, hospitals will not be
able to close for one hour as previously allowed under the protocol. Instead, all patients are to be
transported to the facility of their choice or to the closest facility, with the exception of trauma and
burn patients. EMS providers will utilize the EMSystem EMS Offload Advisory levels to advise patients
about the status of waiting times at the emergency departments when the patient is choosing a facility.
Although this pilot project prohibits diversion, if a facility declares an internal disaster, all EMS traffic
including inter-facility transfers to that facility will stop. Early indications are that the pilot test is
having a positive impact.
Information Systems
There are two main components that make up a trauma information system: a trauma registry and
prehospital data. In the case of Southern Nevada there are two trauma registries, one maintained by
the Nevada State Health Division and another registry maintained by UMC. The registry kept by UMC
captures more data than what is required by the State.
With respect to prehospital data, each provider maintains their own database. The fire providers
maintain electronic databases, while the ambulance providers maintain paper databases.
In accordance with NRS 450B.810, NAC 450B.620, NAC 450B.645, and NAC 450B.766, State EMS, in
cooperation with Clark County Health District EMS office, have adopted standards for prehospital data
collection. Computer software and a web-based server have been provided for collecting and storing
prehospital run reports and data obtained from all Nevada permitted EMS/Fire agencies.
While not every agency is required to install and utilize the provided software, each will be required to
submit the required data elements in a format that will allow uploading to the web-based server. The
rollout utilizing the web-based server is scheduled for July 2004. Las Vegas Fire and Rescue and local
ambulance providers are expected to adopt a new software system called Roam IT allowing for a
standardized electronic reporting of the prehospital care report to be in place by April 2004.
ED data reporting is voluntary and not conc lusive. However, State regulation does require the
reporting by all hospitals of any trauma care provided. While it is mandatory that hospitals report
trauma cases to the Nevada Trauma Registry, the reality is that many hospitals find it difficult to meet
the requirement due to staffing issues and thus the registry suffers. The data the State does receive is
published in an annual report. In addition to the mandatory trauma reporting, all hospitals must
submit the Uniform Billing 92 Hospital Discharge data set.
Other data sources exist, but there is not a data warehouse for EMS/trauma data in Southern Nevada.
State Trauma Registry
All hospitals are required by NAC (NRS 450B.120 and 450B.238) to submit data to the State on trauma
patients. The State provides the definitions on patient types and data fields for inclusion in the trauma
registry. Hospitals must submit quarterly reports to the Nevada State Health Division within 60 days
after the end of the quarter. The Nevada State Health Division then publishes an annual report by July
1 for the previous calendar year. The most current report was published on November 12, 2003 and
provides data for 2000 through 2002.
Page 54

The following table presents the trauma patients reported by Clark County hospitals for 2000 through
2002.
Exhibit 42 – Nevada Trauma Registry Patients
Nevada Trauma Registry Patients Reported by Hospital in Clark County, 2000 - 2002
Hospital 2000 2001 2002
Boulder City Hospital - - -
Desert Springs Hospital 8 1 18
Lake Mead Hospital 20 53 97
Mountain View Hospital - - 10
St. Rose Dominican Hospital - de Lima 13 26 -
St. Rose Dominican Hospital - Siena 7 4 9
Spring Valley Hospital - - -
Summerlin Hospital - - -
Sunrise Hospital 38 26 9
UMC 3,117 3,570 3,714
Valley Medical Center 38 57 96
Total 3,241 3,737 3,953
Note: Dashes indicate the value was zero or not reported.
Source: Center for Health Data & Research, Bureau of Health Planning & Statistics, NV State Health Div., 5/04
While the intent of the Nevada Trauma Registry is to capture all data on patients who meet the State’s
trauma criteria, the reality is that several hospitals have difficulty meeting this requirement. These
difficulties primarily include not having the staff to collect and submit the data and an understanding
about what qualifies as a trauma patient for the registry.
A summary of the statutorily required data set can be found in the Appendix.
Specialty Physician Coverage
On-call coverage to the EDs by physician specialists was identified as a major concern by the
hospitals. This can impact the trauma center as there is a community expectation that the trauma
center act as the “safety net” for those injury cases that may not meet trauma center criteria but need
specialist care.
ED managers at each of the Las Vegas region hospitals (adult and pediatric) and the trauma center
were surveyed about whether they have had problems maintaining specialty physician coverage for
their facility, and if so which types of coverage present problems. Eleven responses were received.
As indicated in the table below, four respondents said they have no problems with on call specialists at
all, three respondents reported occasional problems and four reported frequent problems. The
greatest number of problems were with hand and plastics (reported by four respondents), followed by
neurology, orthopedics and pediatrics coverage (each indicated by three respondents).
Page 55

Exhibit 43 – Specialty Physician Coverage
Southern Nevada Specialty Physician Coverage Survey
Frequency of Problems
No
Problems
Occasional
Problems
Frequent
Problems
Total
Responses
Total
Reporting
Problems
Overall 4 3 4 11 7
Hand 4 0 4 8 4
Plastics 4 1 3 8 4
Neurology 5 0 3 8 3
Orthopedics 5 1 2 8 3
Pediatrics 5 1 2 8 3
ENT 6 0 2 8 2
Neurosurgery 6 0 2 8 2
Cardiology 7 1 0 8 1
General Surgery 8 0 0 8 0
Internal Medicine 8 0 0 8 0
Primary Care 8 0 0 8 0
Source: Survey of Las Vegas region ED managers by The Abaris Group
The following additional comments were made by individual hospitals:
• More and more physicians want to be paid for on call coverage and it's very expensive.
• As a result of the change in the EMTALA rule, physicians can take call at more than one hospital,
which has increased physician specialty coverage challenges.
• On the whole at this time things are good. However, orthopedics can be a challenge.
• As of this date there are no problems, but that could change.
• There are rare problems with orthopedics only.
• Overall we have pretty good on call specialty coverage.
• If we had coverag e, we wouldn't have to transfer.
• Not having neurosurgery, neurologists and gastroenterologists is a big problem.
Rehabilitation
There are four rehabilitation hospitals in Southern Nevada:
• Healthsouth Rehabilitation Hospital, Las Vegas
• Healthsouth Rehabilitation Hospital, Henderson
• Sunrise Hospital & Medical Center Rehabilitation Unit
• UMC Rancho Rehabilitation Center
While there is no coordinated regional rehabilitation mechanism in place, the directors of the different
rehabilitation hospitals work together informally.
In addition, the UMC Trauma Center interacts closely with the UMC Rancho Rehabilitation Center. For
example, representatives from trauma and rehabilitation meet monthly. In addition, the Director of
Physical Medicine and Rehabilitation organizes a rotation of community physiatrists through the
trauma center. Physiatrists also conduct rounds in the trauma ICU. Typically a physiatrist will work
with a patient in the trauma center and then continue that care with the patient in the Rancho
Rehabilitation Center.
Page 56

Injury Prevention
There is no formalized system-wide injury control coalition. However, there are two community
coalition programs in Clark County – the Clark County Safe Kids Coalition and the Clark County Safe
Communities.
In addition to these injury prevention coalition programs, UMC has several trauma programs
including Traumaroo, ENA ENCARE, Take Care, Buckle Up Bear, Learning to Care, and Child
Passenger Safety.
A key participant in the trauma injury prevention arena is the Trauma Institute. It is a freestanding
non-profit organization that is associated with the University of Nevada School of Medicine
Department of Surgery. The Trauma Institute receives private funding and applies for grant awards to
develop population based studies of injuries and their presentation. They have completed many
research projects and have several they are currently investigating. These include:
• CODES (Crash Outcome Data Evaluation System) 10/97-07/03
• Domestic Violence 9/97-9/01
• Suicide Prevention Research Center 10/98-09/04
• EMS-C 3/98-2/06
• Trauma – EMS System 9/02-9/05
As well, the Henderson Fire Department has a program called Risk Watch sponsored by the National
Fire Protection Association that addresses car safety, fire, poison, bicycle safety, fire arms, water,
suffocation and falls.
The Clark County Safe Kids program is in the process of developing a strategic plan for its
organization. One of the goals of the strategic plan will be to focus on broader coalition development
and funding.
Data
While there is no central injury prevention data repository for Clark County, there are several sources
of injury data including: the State’s Injury Data Surveillance Project maintained by the Nevada State
Health Division, motor vehicle crash data collected by the Nevada Department of Transportation, and
all hospitals must submit Uniform Billing 92 data on hospital discharges.
In addition, the Trauma Institute engaged in a multiyear CODES (Crash Outcome Data Evaluation
System) study from 10/97-07/03 designed to link various injury databases together within the state.
The State maintains a trauma registry that includes data not only from the two trauma centers, but
from all hospitals in the state which must report cases that meet the trauma patient criteria. UMC
maintains a very robust trauma registry on all trauma patients treated in the trauma center, the State
EMS section maintains the Nevada Electronic EMS Data System (NEEDS), and the Office of Vital
Records collects vital statistics.
Databases specific to Clark County include a pediatric drowning database maintained by the Clark
County Health District and a traffic crash and assault database maintained by the Las Vegas
Metropolitan Police Department.
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Clark County Health District has identified a significant problem with drownings of children aged 1 - 4,
motor vehicle crashes and suicides. All three high-risk groups have prevention programs in place that
were identified through data screening processes using various existing databases.
Evaluation
The Clark County Health District is responsible for the prehospital component of care in Clark County
and the Nevada State Health Division’s EMS section has the responsibility of overseeing trauma.
There are mechanisms in place for evaluation of trauma in Southern Nevada that include the ACS
verification process UMC must complete every three years, the EMS training requirements set forth in
state law, and the oversight provided by the Medical Advisory Board (members of the MAB are
representatives from all hospitals, prehospital providers, the Nevada Division of Mental Health and
Development Services, and the Clark County Health District).
There is no overall quality improvement committee for the current trauma program. However, UMC
does have a trauma center focused quality improvement committee that meets weekly. The UMC
quality improvement committee focuses on deaths and other serious adverse events. All deaths are
reviewed by the trauma center peer review/performance improvement committee and if necessary are
presented to a monthly multidisciplinary committee at UMC, then to the hospital performance
improvement committee. If the case involves a prehospital component, then it is forwarded to the
Clark County Health District EMS Department. The UMC trauma registry is used to help direct process
improvement by reviewing data generated from the registry. For example, trauma treatment protocols
have been developed based on identified trends in the trauma registry and recommendations for the
trauma activation criteria have been made based on data contained in the trauma registry. In addition
to the oversight provided by UMC, the MAB provides oversight for the EMS portion of trauma.
Research
UMC conducts a vast amount of research as part of its level I trauma center requirements. Their
trauma registry is used to research topics identified by surgery residents, resulting in numerous
posters and presentations. In addition, the surgery residents participate in the ACS Committee on
Trauma annual Residents Trauma Paper Competition.
Another significant research entity of trauma in Southern Nevada is the Trauma Institute, which was
established with private funding in 1997. The Trauma Institute obtains its data from several sources.
Its primary source is the Uniform Billing 92 Hospital Discharge data set collected by the Nevada State
Health Division. The Trauma Institute also has a working agreement with a local EMS transport
agency to obtain prehospital data. Funding for the Trauma Institute is obtained via grant funding from
several entities including: the National Highway Transportation Safety Administration (NHTSA),
Nevada Attorney General’s Office, Centers for Disease Control, Health Resources and Services
Administration (HRSA), and Emergency Medical Services for Children (EMSC). The Trauma Institute
also receives private funding.
Page 58

Appendix
Map of Emergency Care Facilities in Clark County
The following map depicts the emergency departments, trauma center, and air ambulance stations in
the Southern Nevada region.
Page 59

Trauma Center Standards by Level
The standards are based on the ACS Optimal Care document. The Nevada Administrative Code (NAC)
states the following requirements, under authority of Nevada Revised Statutes (NRS) 450B.120 and
450B.237:
Level I center requirements for designation (NAC 450B.838):
To be designated as a level I center for the treatment of trauma, a licensed general hospital must:
1. Meet all of the criteria for a level I center for the treatment of trauma set forth in chapters 16 and
23 and Appendix D of Resources for Optimal Care of the Injured Patient.
2. Receive verification from the American College of Surgeons, or an equivalent medical organization
approved by the board, that confirms that the center meets the standards for a level I center for
the treatment of trauma.
Pediatric regional resource center requirements for designation (NAC 450B.845):
To be designated as a pediatric regional resource center for the treatment of trauma, a licensed
general hospital or licensed medical-surgical hospital must:
1. Meet all of the criteria for a pediatric regional resource center for the treatment of trauma set forth
in chapters 5, 10, 16 and 23 of Resources for Optimal Care of the Injured Patient.
2. Meet the minimum criteria for a level I center for the treatment of trauma and demonstrate a
commitment to the treatment of persons who are less than 15 years of age in accordance with
chapters 10 and 23 of Resources for Optimal Care of the Injured Patient.
3. Receive a verification from the American College of Surgeons, or an equivalent organization
approved by the board, that confirms that the center meets the standards for a pediatric regional
resource center for the treatment of trauma.
Level II center requirements for designation (NAC 450B.852):
To be designated as a level II center for the treatment of trauma, a licensed general hospital must:
1. Meet all of the criteria for a level II center for the treatment of trauma set forth in chapters 16 and
23 and Appendix D of Resources for Optimal Care of the Injured Patient.
2. Receive a verification from the American College of Surgeons, or an equivalent organization
approved by the board, that confirms that the center meets the standards for a level II center for
the treatment of trauma.
Level III center requirements for designation (NAC 450B.866):
To be designated as a level III center for the treatment of trauma, a licensed general hospital must:
1. Be located more than 30 minutes from a designated level I or II center for the treatment of trauma.
2. Operate a service for the treatment of trauma or maintain a multidisciplinary committee to provide
for the implementation of the requirements of NAC 450B.780 to 450B.875, inclusive.
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3. Comply with all of the criteria for a level III center for the treatment of trauma set forth in chapters
16 and 23 and Appendix D of Resources for Optimal Care of the Injured Patient.
4. If the hospital is applying for the renewal of a designation as a level III center for the treatment of
trauma, receive a verification from the American College of Surgeons, or an equivalent medical
organization approved by the board, that confirms that the center complies with the standards for
a level III center for the treatment of trauma.
Level IV center requirements for designation (NAC 450B.871):
To be designated as a level IV center for the treatment of trauma, a licensed general hospital must:
1. Be located more than 30 minutes from a designated level I, II or III center for the treatment of
trauma.
2. Meet all of the criteria for a level IV center for the treatment of trauma set forth in chapters 16 and
23 and Appendix D of Resources for Optimal Care of the Injured Patient.
3. Ensure that a nurse with experience and training in the care of patients with trauma is present at
the hospital at all times.
4. Ensure that there are an adequate number of physicians with experience and training in the
treatment of patients with trauma who will be immediately available to provide medical treatment
to the patients in the hospital.
5. Have the ability to perform computer axial tomography (CAT) scans or otherwise assess the
patient’s traumatic injuries and determine the medical center to which the patient will be
transferred.
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Nevada Trauma Registry Submission Requirements
1. Each hospital shall submit to the health division quarterly reports which comply with the criteria
prescribed by the health division and which contain at least the following information for each
patient treated for trauma by the hospital:
(a) The date and time the patient arrived in the emergency department or the receiving area or
operating room, or both.
(b) The patient’s revised trauma score upon arrival in the emergency department or receiving area
and upon discharge or transfer from the emergency department, if he is discharged or
transferred less than 1 hour after his time of arrival.
(c) The method of arrival at the hospital. If the patient arrived by ambulance or air ambulance, the
information required by subsection 3 of NAC 450B.766 must also be submitted.
(d) The time the surgeon or the trauma team was requested.
(e) The time the surgeon arrived at the requested location.
(f) The patient’s vital signs, including:
1. Blood pressure
2. Pulse rate
3. Respiratory rate
4. Temperature
(g) The results of diagnostic blood alcohol or drug screening tests, or both, if obtained.
(h) Other clinical signs which are appropriate to determine the patient’s revised trauma score,
including the patient’s score on the Glasgow Coma Scale and, if appropriate for a pediatric
patient, the patient’s score on the modified Glasgow Coma Scale.
(i) The date and time the initial surgery began and the surgical procedures that were performed
during the period in which the patient was anesthetized and in an operating room.
(j) The number of days the patient was in the hospital.
(k) The number of days the patient was in the intensive care unit, if applicable.
(l) Any complications which developed while the patient was being treated at the hospital.
(m) Information concerning the patient’s discharge from the hospital, including:
1. The diagnosis of the patient.
2. The patient’s source of payment .
3. The severity of the injury as determined by the patient’s injury severity score.
4. The condition of the patient.
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5. The disposition of the patient.
6. Information concerning the transfer of the patient, if applicable.
7. If the reporting hospital is a center for the treatment of trauma or a pediatric regional
resource center for the treatment of trauma, the amount charged by the hospital, including
charges for the treatment of trauma.
8. If the hospital is not a center for the treatment of trauma or if the patient was transferred
from a center for the treatment of trauma to another center for the treatment of trauma,
pediatric regional resource center for the treatment of trauma or other specialized facility:
(I)
(II)
(III)
The revised trauma score of the patient at the time his transfer was requested.
The date and time the center for the treatment of trauma, pediatric regional
resource center for the treatment of trauma or other specialized facility was
notified.
The time the patient left the receiving hospital or center for the treatment of
trauma for a center for the treatment of trauma, pediatric regional resource
center for the treatment of trauma or other specialized facility.
(n) The patient’s residential code assigned pursuant to the Federal Information Processing
Standards, or the city or county and the state of his residence.
Page 63

Trauma Center Capacity Benchmark Data
The table below provides a trauma center capacity comparison among the following metropolitan
statistical areas (MSAs): Salt Lake City, New Orleans, Memphis and Las Vegas. Specifically, it shows
the number of trauma centers in the MSA, the number of trauma resuscitation beds, the number of
trauma centers per 1,000,000 population (based on 2002 MSA population estimates), and the
number of resuscitation beds per 1,000,000 population.
The MSA with the highest rate of trauma centers per capita is Salt Lake City (3.0 per 1,000,000
population), while the MSA with the lowest rate is Las Vegas (0.6). Looking at the utilization rate in
terms of trauma resuscitation beds per 1,000,000 population, Salt Lake City again ranks highest with
12. Las Vegas ranks second with 7 trauma resuscitation beds per 1,000,000.
Factoring in the visitor population to the cities lowers the rate of trauma centers per capita, as well as
the resuscitation bed rate per capita.
Although several studies have provided inventories of the number of trauma centers nationwide, they
have not attempted to measure capacity and compare capacity with population.
Trauma Center Capacity Benchmark Data
Trauma
Metropolitan
Number
of
Trauma
Centers per
Number of
Trauma
Trauma
Resuscitation
Beds per 2002
2002
Average Annualized MSA
Trauma
Centers per
Resuscitation
Beds per
1,000,000
Statistical Area Trauma 2002 MSA 1,000,000 Resuscitation 1,000,000 Annual Nights Visitor Population 1,000,000 Pop +
(MSA)
Centers Population Population Beds Population Visitors Stayed Population + Visitors Pop + Visitors Visitors
Salt Lake City, UT 1 3 997,197 3.0 12 12 8,000,000 N/A N/A N/A N/A N/A
New Orleans, LA 1 1 1,315,254 0.8 3 2 8,500,000 3.4 79,178 1,394,432 0.7 2.2
Memphis, TN 2 2 1,230,554 1.6 5 4 8,000,000 3 65,753 1,296,307 1.5 3.9
Las Vegas, NV 1 1 1,578,332 0.6 11 7 35,071,504 3.4 326,693 1,905,025 0.5 5.8
Notes:
1 Only Level I trauma center(s).
2
One Level I (a stand alone trauma center) and one Level II.
N/A: Not available
Source: Individual State trauma stakeholders, individual Convention & Visitor Bureaus, State Data Centers, & US Census Bureau.
Page 64

Survey of Other Freestanding Trauma Centers
The freestanding trauma center at UMC is one of only a few freestanding trauma centers in the nation.
For the purpose of learning about the experiences of other freestanding trauma centers The Abaris
Group contacted the following:
• Elvis Presley Memorial Trauma Center at The Med in Memphis, Tennessee
• R Adams Cowley Shock Trauma Center at the University of Maryland in Baltimore, Maryland
• Ryder Trauma Center at the University of Miami/Jackson Memorial Medical Center in Miami,
Florida
• Martin Luther King/Drew Medical Center in Los Angeles, CA
Of the four, the first two agreed to be interviewed. Their responses are presented below.
Survey of Other Freestanding Trauma Centers
Trauma Center
Elvis Presley Memorial Trauma Center
R Adams Cowley Shock Trauma Center
at The Med
Location Memphis, TN Baltimore, MD
Designation Level Level I Level I+
On-call coverage in excess of ACS standards for Level I
Affiliation University of Tennessee University of Maryland
Configuration of Center Adjacent to ED but separate and with own ICU Stand alone
Trauma System
State system has 12 trauma centers; six Level I centers; two
Level II centers; and four Level III centers
State system has 9 trauma centers: the Shock Trauma
Center, which is known as a Primary Adult Resource Center
(PARC); one Level I center; two Level II centers; and five
Level III centers
Catchment Area
Memphis also has a Level II, but this is the only Level I
center in West Tennessee; the catchment area has a radius
of 175 miles, and transfers come from other states including
Arkansas and Mississippi
Primary catchment area is approximately 50 miles, but the
trauma center takes patients from farther if they think the
patient can make it; patients also are transported from
Pennsylvania, Delaware, Virginia, and West Virginia; and
transfers arrive from all over
Governance Tennessee EMS Division Maryland Institute for EMS Systems (MIEMSS)
Works Well Governance structure; also, true dedication to trauma Good relationship with EMS at all levels; also, utilization of
state medivac helicopters run by police with paramedics on
board - they transport the whole spectrum of patients, and
the paramedics are truly active
Presents Challenge
Diversion
The way transfers are received, i.e. dumping - need to Trauma patients receive care from a wide spectrum of
provide education on what constitutes a Level I patient providers, from BLS volunteers to full-time ALS paramedics,
so it is a challenge to maintain the same level of quality and
monitoring at all levels
Only when all ORs are full, which is very rare; probably
occurred for 5 hours or less in 2003 - a summer day would
be when it might happen
Try not to go on diversion; the "trauma line" will sometimes
ask for details of a patient from the field and potentially
refer the patient to the Level I center
Capacity
Resuscitation Bays 5 10
ORs
4 on the weekend; overflow available to 8-12 elective surgery
6
ORs on weekdays
ICU Beds
23 beds in the trauma-only ICU: 8 neuro and 8 surgery
intensive care beds, plus a trauma stepdown unit of 7 beds
24 critical care beds and 24 intermediate care beds (which
can still handle ventilators)
in which 4 can by ICU
Hospital beds (licensed) 330 36 acute care beds; 118 total beds at the trauma center; 650
beds at University Hospital, where patients are occasionally
sent
Annual Trauma Volume, 2003
Trauma Arrivals 20,000 6,000
Transfers Portion 1,500 (by helicopter) 1,000
Trauma Activations 1,874 Level I activations 6,000
Trauma Inpatient Admissions 4,500 (the Level I activations and approximately 2,600 6,000 (all are admitted, and about half stay over 24 hours)
Level II and III cases)
Sources: Interviews by The Abaris Group; Tennessee trauma system information from state web site
Page 65

ED Diversion Hours by Hospital
ED Diversion Hours by Hospital, 2002
Hospital Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total
Desert Springs Hospital Medical Center 139 159 187 127 47 79 90 78 70 55 84 97 1,212
Lake Mead Hospital Medical Center 29 66 94 17 59 9 12 13 8 10 28 16 360
MountainView Hospital 139 120 114 85 108 64 55 92 119 64 87 99 1,146
St. Rose Dominican Hospital - de Lima 55 77 106 75 44 32 25 26 14 20 11 29 514
St. Rose Dominican Hospital - Siena 102 137 236 125 131 88 111 80 159 107 68 220 1,565
Summerlin Hospital Medical Center 85 87 155 36 0 1 4 26 17 11 10 29 462
Sunrise Hospital and Medical Center: Adult ED 257 213 231 234 53 76 171 118 57 54 41 106 1,610
University Medical Center: Adult ED 86 88 123 105 80 71 98 109 118 64 76 105 1,122
Valley Hospital Medical Center 87 114 172 113 40 24 48 47 44 55 59 53 856
Total 978 1,059 1,418 917 563 446 613 589 605 440 464 754 8,846
ED Diversion Hours by Hospital, 2003
Hospital Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total
Desert Springs Hospital Medical Center 153 118 158 75 67 77 111 108 165 71 128 199 1,431
Lake Mead Hospital Medical Center 58 55 65 68 52 21 46 55 41 36 61 120 678
MountainView Hospital 178 110 118 140 141 123 137 179 155 145 183 193 1,801
Spring Valley Hospital Medical Center 1 - - - - - - - - - 105 147 208 460
St. Rose Dominican Hospital - de Lima 69 89 57 68 66 31 50 48 43 69 87 100 775
St. Rose Dominican Hospital - Siena 207 165 248 294 186 204 201 223 285 203 173 211 2,601
Summerlin Hospital Medical Center 116 77 54 57 51 44 124 113 150 77 96 180 1,138
Sunrise Hospital and Medical Center: Adult ED 171 88 114 53 44 64 52 39 63 18 40 118 865
University Medical Center: Adult ED 99 113 83 109 128 111 121 86 91 105 130 145 1,321
Valley Hospital Medical Center 97 53 65 108 94 92 71 67 109 32 70 131 991
Total 1,147 867 962 972 830 767 912 919 1,102 861 1,115 1,606 12,061
1 Spring Valley Hospital Medical Center opened in October 2003
The following facilities had no ambulance diversion during 2002-2003:
Boulder City Hospital
Southern Hills Hospital and Medical Center (opened 3/04)
Sunrise Hospital and Medical Center Pediatric ED
University Medical Center Pediatric ED
University Medical Center Trauma Center
Source: CCHD
Page 66

Town Hall Meeting Comments
Boulder City Town Hall Meeting
The following comments, input, questions and answers were provided during the Boulder City Town
Hall meeting on trauma in Southern Nevada held on February 12, 2004. People attending the Town
Hall included residents of Boulder City plus various stakeholders like Boulder City Fire Department,
Clark County Health District, University Medical Center, Sunrise, St. Rose Dominican.
Public Education/Involvement:
• The public should be involved via injury prevention.
• The public needs to understand the difference between trauma centers and emergency
departments.
• Educating the public as to the different types of trauma centers and systems is important.
• UMC does a good job now. They reach out to the public.
• Until you need it, you don’t know about it.
• The community fabric is fragile and trauma systems are a part of this fabric. The public should
expect/demand the care.
• We need to educate the public, but injury prevention only works to a certain degree.
Trauma Resources/Policy/Configuration:
• Boulder City Hospital is supportive of the expansion of EMS and trauma. We need it.
• Transportation issues are very important.
• We need to consider whether the trauma system is serving our region appropriately Do we have
enough resources (EDs, EMS, etc.) Do we need to expand What about in the case of surges
• We need help in determining the direction and policies of the trauma system. Once we know that,
it will help determine the number of trauma centers.
• We are experiencing a unique opportunity right now.
• We need another trauma center and we would support any new trauma center. Proximity to
Boulder City would be our preference.
• EMTALA requires all hospitals to treat all patients who come to them and only two hospitals
receive county funds.
• St. Rose will carefully consider the study reports. If the study does not call for a level III hospital,
they will pull back.
• Q. Is Boulder City going to become a trauma center A. Not right now, but maybe in the future.
• Q. What is the difference between level I and II A. They provide the same level of care, but a level I
also do research and typically teaches. UMC also provides care for burns and replantation.
Funding:
• We should fund the trauma system with private and public funding.
• Trauma centers have the substantial fixed cost of being prepared 24/7. Currently, UMC receives
some County funds and reimbursement from insurance companies.
• UMC does cost shifting to pay for those patients with no insurance. This means we average our
bills.
• A level III is less expensive to maintain than a level I or II.
• Sunrise’s current trauma center business plan does not rely on any public assistance. Sunrise will
also support its sister hospitals as a trauma center.
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• This region would not pass a tax to support the trauma system.
• The City of Henderson voted twice against a police/fire initiative.
• People aren't aware of what a trauma center can do for you, a tax will never pass.
• Q. Can trauma centers be a public or private facility A. Yes.
• Q. How are trauma center's normally funded A. Primarily from taxes/fees and insurance
reimbursement.
• Q. How much is trauma going to cost A. That depends on many factors.
Patient Care/Access:
• Trauma centers provide a higher level of care to the public.
• There needs to be access for everyone in the community.
• Patient care is also a key component, not just how long it takes us to unload a patient.
Data Analysis:
• We need to anal yze the data to determine where we need a trauma center(s).
• When UMC closed, it showed us that we need more trauma centers. There should be 2.2 trauma
centers per 1,000, 000 people.
• Need to look at capacity and volume criteria in determining the number of trauma centers.
• We need to review data. The argument for more trauma centers is like building fire stations. One
on every corner is good, but is it feasible
• UMC does an excellent job. We need to expand our infrastructure. UMC and Sunrise are the only 2
hospitals who could be a level I and II.
• In order to determine where the trauma centers will go, it must be data driven.
• We also need to consider traffic patterns.
• We need to consider the huge number of visitors to Las Vegas each year. Other models won't work
here because of that.
• We need to determine where trauma patients coming from.
• Hospitals in the region have continued to expand and grow. We need to look at the data, especially
by geography.
Clinical Staffing:
• Physician call specialists are an issue.
• One issue is physician specialist coverage and finding the staff to work at a trauma center.
Governance:
• I think the Clark County Health District should govern the trauma system. The State is up north
and is not responsive to our needs.
• Q. Does the federal government provide any oversight for a trauma system A. No.
Other:
• Q. When will this study be finished A. A draft report will be available in April 2004 with final
recommendations to the State in June.
Page 68

Henderson Town Hall Meeting
The following comments, input, questions and answers were provided during the Henderson Town
Hall meeting on trauma in Southern Nevada held on April 12, 2004. People attending the Town Hall
included residents of Henderson plus various stakeholders like Henderson Fire Department, Clark
County Health District, University Medical Center, Sunrise, St. Rose Dominican.
Public Education/Awareness:
• A trauma patient is someone who has received injuries incompatible with life or limb.
• A trauma system starts from the reporting of the incident all the way through to getting the patient
to the trauma center.
• UMC is a Level I trauma center.
• A trauma center provides rapid access to surgical care, requires that specific equipment be on
hand, and increased staffing levels.
• The public should wear their seatbelts and sell their motorcycles.
• Prevention should be key to working with the public.
Trauma Resources/Policy/Configuration:
• The Clark County Health District protocols define a trauma center.
• It's really everything from the accident to discharge and then after discharge if a patient needs
rehabilitation.
• We should start by preventing the incidents.
• One problem is placement of the uninsured in rehabilitation after discharge.
• A trauma center requires specific clinical people, equipment and facility.
• We do need another trauma center, maybe even a third trauma center. Any additional hospital
resources are a good thing for our community.
• Turn-around-time and coverage in the operating room is critical. We need to determine if trauma
centers can get trauma surgeons on board. Will the staff be adequately trained and will the
ancillary services that are needed be set up.
• A trauma center needs to create a contingency plan to respond to a multi-casualty incident. We are
already at 90 percent capacity; what are they going to do.
• Trauma is all about over supply for staffing and equipment.
• Q. Why can't a trauma center be everything to all people A. That's for the community to decide
and it mostly centers around cost.
• Q. What can politically be done to help get a trauma system A. The community can ask its
legislators to change the malpractice laws and make it more attractive for physicians to practice
here.
Funding:
• We need to find funding and then continue the support for that funding.
• How are you going to fund the trauma center It's very expensive.
• Funding a trauma system is a tough question.
• I think private entities and municipalities should fund the trauma system. It should be a
collaboration of funding.
• Sunrise isn't expected to ask for government funds and we are expecting to break even.
• Visitors could help fund the trauma system via a tax or a fee.
• No tax initiative would pass. The culture in Nevada doesn't allow for it. People are generally
against all taxes.
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• Instead of calling it a tax, we could call it a user fee, but the community would still probably not go
for it.
• Clark County is the default emergency department for other counties in Nevada and even Arizona.
These people need to pay their share.
• Q. Just what needs to be funded Is it the building and or operations A. Probably both.
• Q. How much does being a trauma center cost UMC A. UMC breaks even.
Patient Care/Access:
• It is important for the trauma center to have the ability to communicate with prehospital EMS.
• Henderson Fire Department has never been denied access to UMC. There are some geographic
issues with traffic delays, but we have access to Mercy Air too.
• It takes us about 25-30 minutes to get from Henderson to UMC.
• Sometimes ground ambulances can beat the time for air ambulances.
• Diversion is an issue in our EDs. All EDs are overwhelmed with patients.
• The mentally ill are also jamming up our EDs and the trauma center.
• Reliability is key. We must have access 24/7.
• UMC makes it very clear that there is a difference between trauma patients and ED patients. But
there can be problems with the ED and trauma center.
• We've never been turned away from UMC.
• UMC can triage on the radio and this is a real benefit.
Data Analysis:
• We need to look at what the market will bear to determine how many trauma centers are needed.
Clinical Staffing:
• A key consideration is staffing and will a trauma center impact the ED I recommend that the
trauma center and ED be separate and that there be appropriate resource allocation and back up.
• Staffing issues are important. What about clinical shortages
• There is no way the current level of physicians in the Las Vegas region could staff another trauma
center.
• Physician coverage is a huge problem. If we add more trauma centers then these issues will pose a
greater problem at UMC.
• I don't understand, everyone else is moving to Las Vegas, why not physicians
Governance:
• The governance of the trauma system needs to come from many areas. It needs to be a
partnership in the community and based on collaboration.
• Henderson Fire Department has an excellent relationship with St. Rose-Dominican Hospitals. We
think it’s a model.
• Governance needs to be made up of several stakeholders including: hospitals, administrators,
physicians, Clark County Health District, public members and patients, etc.
• I don’t think the governance structure should be bureaucratic needing quorums, rules, etc.
Other:
• What does homeland security have to do with trauma Isn't trauma already taken care of
Page 70

• I had a heart attack and Henderson Fire Department and St. Rose saved my life. I wouldn’t be here
right now if it weren’t for them.
• We need health care for the people.
• We need assistance programs for younger people. There is low unemployment, but a large number
of uninsured.
• There are three things that need to be addressed: 1. Reform the tort laws to help physicians; 2.
Address the uninsured issue. At St. Rose 18 cents out of every dollar is paid for by someone else;
and 3. Address staffing issues. We need to attract and keep them.
• Q. How has malpractice played into this A. [A physician in the audience responded] We had a
$15,000 increase in our malpractice insurance bill. Has the new legislation helped No.
• Q. Would tort reform help the situation A. Yes.
Page 71

Mesquite Town Hall Meeting
The following comments, input, questions and answers were provided during the Mesquite Town Hall
meeting on trauma in Southern Nevada held on April 13, 2004. People attending the Town Hall
included residents of Mesquite plus stakeholders from the following: Mesquite Fire Department, Mesa
View Hospital (set to open on July 6, 2004), Clark County Health District, University Medical Center,
Sunrise Hospital and Medical Center, St. Rose-Dominican Hospital.
Public Education/Awareness:
• Education and outreach are needed in the trauma system.
Trauma Resources/Policy/Configuration:
• I don't have a preference where the trauma center is located.
• I think bed availability is critical. I also think it's critical that the trauma center stay open, we have
problems when UMC won't accept patients.
• Mesquite has a role in Clark County's EMS system; we have place on the Medical Advisory Board
and one of our councilwomen sits on the Clark County Health District Board of Health.
• We are diverse and it does not matter to us what the EMS protocols are.
• We would like a quality improvement (QI) feedback loop. For example, something that would tell
us how we are doing intubations, but HIPAA has put up a wall on QI since it's inception.
• We need accountability in the trauma system. It's not just about protocols, but we need an
organization that can do QI and provide feedback.
Funding:
• Clark County has an indigent fund and only Las Vegas area hospitals have access to it.
• There is probably some funding in property taxes that could be diverted to trauma.
• We would not support any new taxes
• Maybe with a focus on terrorism we could get some federal funding, especially for the rural cities
that are gateways to large metropolitan areas.
• What about going after funding from the Department of Transportation and Commercial
Transport. The Transport Efficiency Act of the 21st Century has $228 billion to use.
• The culture of Nevada is no taxes. People live here because there is no state tax.
Patient Care/Access:
• We generally like to take patients to St. George, Utah. However, if they are seriously injured we will
fly them to Las Vegas. Sometimes we meet the helicopter between mile marker 93 to 100.
• Mesquite used to have a helicopter based here. It was great. Only lasted for about one year. It just
wasn't feasible.
• It's complicated to give a family driving directions to St. Rose or Sunrise, and very easy to give
driving directions to UMC.
• Geographic isolation needs to be considered.
• Mesquite definitely exceeds the 30 minute rule.
• Access is key. We should set up something so that you only need to make one phone call for
medical direction and to transfer/transport a patient. Like the EMS system in Seattle with their 800
#.
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Governance:
• Governance should be at the county level because there are lots of differences between the
northern and southern portions of the state.
Other:
• Our new hospital in Mesquite, Mesa View Hospital, will be eventually requesting a Level III
designation.
• Mesa View Hospital's perspective is we want to do what's right for the patient.
• Mesa View Hospital is started out with 25 inpatient beds and then we expect to expand to 40 then
90. Our ED will be open 24/7 and will have 4 treatment stations. We do not have 24 hour
radiation, but we do have CT and MRI. We do not have ortho or neuro coverage at this time.
• Mesquite's population is approximately 17,000. Our greater area is around 35,000.
• Here in Mesquite we don't have the "golden hour", but the "golden day."
Page 73

North Las Vegas Town Hall Meeting
The following comments, input, questions and answers were provided during the North Las Vegas
Town Hall meeting on trauma in Southern Nevada held on March 11, 2004. People attending the
Town Hall included residents of North Las Vegas plus stakeholders from the following: North Las
Vegas Fire Department, Southern Nevada Citizen Trauma Task Force, Lake Mead Hospital, Clark
County Health District, University Medical Center, Sunrise Hospital and Medical Center, St. Rose-
Dominican Hospital.
Public Education/Awareness:
• The public is familiar with the concept of a trauma center, but not necessarily that it's UMC.
• The public probably doesn't know that the trauma center is UMC, but they do know that there is a
trauma center.
• The public sees trauma as dialing 9-1-1 and then leaving it up to the responders.
• The public knows that UMC is it. Just watch the news at night.
• The public knows that there is a trauma center, but not necessarily that it's UMC.
• The public should support the trauma centers and have some say in the trauma system.
• Public education is needed because it is expensive to operate a trauma center.
• The public does not know how much tax money goes to UMC. If they knew, it would increase
public involvement and interest.
• This process should increase the public's awareness and protect what's there.
Trauma Resources/Policy/Configuration:
• The community is growing and needs to develop a system that best meets the needs of the
growing population. Trauma Centers are needed in the north and south areas of the region.
• Determining the levels of the trauma center is very important. A gun shot wound does not
necessarily have to go to a Level I, it could go to a lower level trauma center.
• Southern Nevada needs a trauma system and I think this discussion among the hospitals is very
helpful. We need different levels of trauma centers to feed into the Level I trauma center.
• There is a system of care in Southern Nevada, but it is not formalized. UMC does a great job.
• The Nevada trauma center standards are based on the American College of Surgeons standards.
• We've moved from a needs assessment to a location assessment. A new trauma center needs the
desire and drive to become a trauma center. No one else but Sunrise has this capability.
• We have our trauma care placed in one basket. We need another one incase it closes again.
• Geographic considerations are important in developing a trauma system.
• Q. Is designation going to be mandatory or voluntary A. It depends on what type of trauma
system developed.
• Q. How will Clark County Health District implement the recommendations A. Clark County
Health District won't be implementing the recommendations because it is the responsibility of the
State to oversee trauma.
Funding:
• How to fund a trauma system or center is a good question. I guess we should increase taxes.
• A tax initiative to fund the trauma system would not pass.
• What about establishing a special license plate to support the trauma system
• We could get funding from the legislature.
• Let's add $1 to every hotel bill.
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• I think the public would support the need for more funding, but it would be tough. We would have
to be very creative on how it was sold to them.
• I don't see the public supporting a new tax. Who would be the champion No legislator would
sponsor it.
• Taxes won't fly here.
• You won't find any politicians to take on the funding issue.
• We want a trauma system, but we can't have it all if we can't afford it.
• Q. Where does trauma system and trauma center funding come from A. UMC primarily gets its
funding from the patient's insurance programs.
• Q. Does trauma always need subsidies A. It depends on the system and how it is set up.
• Q. How is Sunrise funding their trauma center Do they need public assistance A. No.
Patient Care/Access:
• It's hard to have a trauma system with only one trauma center, but people know, when you are
hurt, go to UMC.
• The North Las Vegas community knows that UMC is the trauma center and that it's a teaching
hospital.
• Each time we bring a patient to UMC they take care of us. UMC makes it happen.
• The area needs another trauma center, but geography and location is key. Henderson and
southwest Las Vegas needs a trauma center.
Data Analysis:
• The location of injury in the future should be extrapolated based on population growth and area.
Governance:
• Some level of governance is needed. Do not leave it up to the hospitals themselves. Clark County
Health District should govern. It would help eliminate confusion. And who ever governs needs too
have some "teeth."
• Clark County Health District would be a great fit. Not all board members would agree and that
would generate lots of discussion, that's the beauty of government.
• The trauma system needs checks and balances. The governance piece should be unbiased.
• I think it should be a public agency, local would be preferred. There is a difference between north
and south Nevada and northern Nevada may not understand our issues.
• I think the trauma center should fund the governance structure.
• The Nevada State Health Division could bring trauma under EMS at Clark County Health District.
That would create lots of opportunities.
Other:
• UMC does an excellent job. Sunrise is doing everything it can to compliment the trauma center
and work with them to create a system. Sunrise intends to be a Level II trauma center. McKenzie
and associates say there should be 2.2 trauma centers per 1,000,000 population and Las Vegas
only has one.
• There are ratios for everything. I don't know where they get the 2.2 trauma centers per 1,000,000
population and I can't hazard a guess.
• Q. What is the time frame of the study A. We expect a set of draft recommendations to be
presented in May with the final recommendations going to the Board of Health in June.
Page 75

Las Vegas Town Hall Meeting
The following comments, input, questions and answers were provided during the City of Las Vegas
Town Hall meeting on trauma in Southern Nevada held on March 8, 2004. People attending the Town
Hall meeting included stakeholders from the Las Vegas Fire Department, Clark County Health District,
University Medical Center, Sunrise Hospital and Medical Center, St. Rose-Dominican Hospitals and a
neurosurgeon. The Abaris Group categorized the comments for easier reviewing purposes.
Trauma Resources/Policy/Configuration:
• An informal poll of Las Vegas Fire Department staff on where they would like another trauma
center indicated a preference for the northwest
• More trauma centers for the system would be good if appropriate based on volume
• I am not opposed to more than one, but they have seen systems with multiple centers in which
some had to close.
• We need more, but now we are paying for duplication in some places We have hospitals with
resources. Maybe we should share rather than stretch.
• Medic courses should be less expensive. I left medic training because it was too expensive.
• Some hospitals are short on beds, others are short on staff, but there is no sharing of resources.
Funding:
• A trauma tax would be unrealistic. License fees, fees at the airport or a room tax would be more
feasible.
• The system should pursue homeland security funding.
• The idea of funding a for-profit hospital’s trauma center, or any hospital choosing to have a
trauma center, with tax revenue is a concern.
Clinical Staffing:
• I am concerned about staffing for additional trauma centers.
• Are physicians available for additional trauma centers
• A medic shortage is expected based on experience at recent conferences.
Patient Care/Access:
• The Las Vegas Fire Department has experienced rapid patient care and faster turnaround for EMS
at the UMC trauma center.
• ED wait times creates a nightmare in coordinating care, which goes back to the question of
appropriate care and moving patients to the appropriate hospital. 5-6 people have probably died in
the last year as a result of waiting. However, the trauma center at UMC works very well. Trauma is
just one component of a bigger issue. Location is not the issue – it’s knowing where you can take a
patient.
• The community will be trying no diversion. The role of EMS is getting the patient to care as quickly
as possible. It doesn’t make sense to bypass one hospital to wait at another.
• Work is being done on redirecting patients who don’t need ED care, approximately 10,000-20,000
per year, who are impacting the system. There is a question of whether some EMS patients could
be redirected to urgent care, but then that may result in not getting reimbursed.
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Governance:
• A local system would make sense.
• I would lean away from state.
Other:
• Emergency department waits are a big issue.
• A neurosurgeon in attendance reported he was from a neurosurgery group that takes 60-70
percent of ED call in addition to trauma and on-demand care. He additionally reported that there
are only 3,100 neurosurgeons nationwide, down from 3,400 a few years ago. Malpractice insurance
has increased to $156,000 from $50,000 a few years ago. He is concerned about putting the
political discussion before the care discussion. He said that it is an apparent reality that we need a
trauma system and that we need to look at care that can be provided based on what is available
now rather than what might be in the future, and we need to improve everything including EMS.
He suggested expanding the UMC trauma center or adding a trauma center or centers, adding
that he trained in Houston, where there are two Level I centers next door, and that a system needs
that collaboration.
• This forum is a good opportunity for discussion. We need to have a great EMS system for
residents and visitors. The question isn’t how many but how they respond to make the best
system for the community.
Page 77

Trauma Center Funding Comparison Study
Introduction
Providing a stable source of funding for trauma centers has been an ongoing issue since the early
development of trauma systems in the country. Changes in funding sources, particularly insurance
payers, have created instability over the years. 18,19,20 Improving revenue cycle management and payer
contracting has helped, but in some communities these efforts have not been substantial enough to
stabilize their trauma system.
Below, The Abaris Group provides an overview of identified funding sources for trauma care.
State Funding Sources
Many states provide funding for the administration of their state’s trauma system at the state level.
However, there are only four states that provide ongoing funding to support their trauma centers:
Illinois, Mississippi, Oklahoma, and Washington. California had a one-time funding program that
expired in 2003.
Arizona
During November 2002 the state voted to approve doubling the state’s tobacco tax on cigarettes to
$1.18 a pack and use the $150 million strictly for the trauma centers. The measure passed two to one.
California
During the 2001 legislative session, the California Legislature passed AB1430, The Trauma Fund Act,
which encouraged the development of a statewide network of trauma centers and established a one
time source of funds for trauma centers in the state. The $20 million allocated from this bill was
renewed during 2002 and provided support to the trauma centers through 2003. The funding was
allocated on a fixed and volume basis. Each trauma center received a fixed amount according to their
designation level (e.g. $150,000) and then an allocation based on volume of patients as determined by
trauma registry entries.
Illinois
The State of Illinois established a fund for uncompensated trauma care in 1993. The funding comes
from a $5 fee placed on every moving violation over $55. In 1994 a $30 fine from each DUI conviction
or order of suspension was added. Since 1993, they have expended approximately $20.4 million. The
amount of funding each hospital receives depends on the number of trauma patients treated.
Additionally, funding is provided to those hospitals that care for Medicaid trauma patients. There is no
funding for physicians.
Mississippi
In 1998 the State of Mississippi began allocating between $8.0 – 8.5 million annually for
uncompensated trauma care. The funds come from revenue generated by Mississippi’s Tobacco
Settlement principal ($6.0 million) and from moving traffic violations ($2.5 million). There are seven
18 Trauma Care: Saving Lives Despite Setbacks, Zoller, M. Medical World News, June 1988.
19 Trauma Collapse, Can the system be saved, Williams, MJ. California Hospitals, October 1999.
20 Trauma Care: “Lifesaving System Threatened by Unreimbursed Costs and Other Factors”, GAO, May 1991.
Page 78

trauma regions, each receiving $85,000 thousand for administration purposes. The remaining portion
is divided among participating hospitals and surgeons (orthopedic, general and neuro). In addition,
Level IV trauma centers that transfer a trauma patient also receive 20 percent of the reimbursable
amount. In order to receive compensation, the patient must meet the trauma criteria and not have any
ability to pay the charges.
Oklahoma
The State of Oklahoma’s uncompensated trauma care fund was established in 1999. It is generated
from a $1 per person driver’s license renewal fee. The fund’s balance is $2.6 million, with 10 percent
going to the Department of Health for administration of the trauma system and the remainder divided
among trauma centers and prehospital providers. There is no compensation for physicians.
Washington
In 1997 the State of Washington passed a law creating the Trauma Fund to provide funding for
uncompensated trauma care. The Trauma Fund expends approximately $31.0 million every two years.
The funds are generated from a surcharge on motor vehicle infractions ($5 of every fine) and the
licensing of new and used vehicles ($4 per vehicle). The sources generate roughly $30 million
annually. The remaining $8.0 million comes from federal Medicaid matching funds. To qualify for
reimbursement the patient must have an Injury Severity Score (ISS) of 9 or greater and be eligible for
medical assistance (Medicaid). The State provides funding for prehospital providers, hospitals,
physicians and rehabilitation facilities. The state hired Arthur Anderson in 1992 to help them
determine the level of uncompensated care. Washington has a relatively stable state trauma fund.
Some funds go to trauma centers, with extra going to those treating DHS patients (through
participation grants), plus additional reimbursement for patients with a specific ISS.
Other Public Funding
Alameda County, CA
Alameda County has a special EMS and trauma tax district called the Alameda County EMS District. It
was formed in the mid 1980s to support EMS providers and to develop the trauma system. The fund
assesses all parcels at $23.94 per parcel. The trauma portion of that equates to about $8 per parcel.
The fund was established for the EMS Agency, EMS providers and the trauma centers (2 adult and 1
pediatric trauma centers). The trauma centers are subsidized approximately $10 million per year based
on uncompensated care. The tax was developed under the Special Benefit Assessment District law of
California that allowed the Board of Supervisors or the electorate to provide a simple majority for
approval of these assessments. The County chose to obtain voter approval, and it was approved by in
excess of 80 percent of the voters. When the Benefit Assessment statute was overturned five years
ago, the Tax District was re-voted on with another landslide approval percentage. The EMS Agency is
called “The EMS District” and it controls all funds which have been authorized for the District.
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Los Angeles County, CA
Los Angeles County has funded trauma centers for nearly 15 years through a combination of general
fund and tobacco tax funds. The reduction of tobacco tax dollars over recent years put the trauma
network in crisis, which along with serious County budget shortfalls put the entire Los Angeles County
public hospital system at risk. A ballot measure introduced to provide for $168 million in funding was
approved by a 73 percent vote in November 2002. Measure B raised property taxes by three cents, or
about $42 for a 1,400 square foot home. In addition to funding trauma centers and emergency
departments the money was proposed to be used for bio-terrorism. The funding is going to be heavily
used to stave off the closing of Harbor-UCLA Medical Center, a Level I trauma center, and Olive View-
UCLA Medical Center, an acute care hospital. There is some hope that these funds will help entice
hospitals that used to be trauma centers in the Pomona and Antelope Valleys to come back in as
trauma centers. There are three public (LA County Department of Health) and ten private trauma
centers in the county. It is not clear how much of these funds will be available to support the private
trauma centers once the public hospital needs are met. This was the first countywide increase in
property taxes in Los Angeles County since 1978.
Palm Beach County, FL
The Palm Beach County, Florida funding mechanism is an independent taxing district authorized
through the state for Palm Beach County. The tax district charges a property tax of about $1 per $1,000
assessed value. It generates over $100 million in revenue annually, with $24 million budgeted for
trauma. The remaining funds go to other indigent care, school nurses in the public schools, etc. Of the
$24 million budgeted for trauma, two trauma centers each receive $6 million per year, with on-call
physicians receiving about $8 million and an air medical program taking up the balance. Funding to
the hospitals has remained fairly static. The funds had been allocated to the trauma hospitals in
grants, but currently the County is using a formula based on percentage of uncompensated charges. In
addition to paying for on-call coverage, the fund also pays some malpractice insurance costs for the
trauma physicians.
Other Initiatives
There are other trauma funding tax activities in Florida. Dade County uses a half cent sales tax to fund
their one trauma center. Broward County has two taxing districts for funding indigent care including
the indigent care for trauma center patients. The tax revenue goes to reimbursing hospitals and their
physicians for trauma care at Medicare rates. Lee County, FL authorities proposed a trauma center
sales tax to raise $35 million for their single trauma center and multiple emergency departments but
the initiative failed. Five million was earmarked for the trauma center. 57 percent of the voters voted
against the measure.
California has under taken several other emergency department and trauma center funding activities.
A couple of years ago, Senator Gloria Romero (D-Los Angeles) proposed a “nickel a drink” tax (SB108)
to support the emergency departments and trauma systems in the state. During February 2003, the
Los Angeles County Board of Supervisors voted to ask the State Legislature for permission to levy a
similar alcohol tax in the county.
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Other Potential Sources
Surcharges
One approach is increasing or adding surcharges or fees to products or activities that frequently
contribute to the need for trauma care services. Consideration of adding additional surcharges for
traffic fines is often a challenge as courts levying such fines may not be willing to add to the
surcharges or to see those funds go outside the criminal justice system.
Some states (Oregon, Washington) have attached surcharges to the fee for each motor vehicle license
registration issued in the state, including motorcycles. Automobile collisions are growing as the
number of miles traveled annually increases. Similar proposals in other states have added a $5
surcharge on motor vehicle registrations, with estimates that this would generate an estimated $100
to $150 million per year.
Another option is to establish a surcharge to automobile insurance policies. Pennsylvania has
implemented this approach to supplement funding. Another consideration is to require automobile
insurance policies to provide $50,000 in personal injury protection for trauma care, with the auto
policy coverage paying the trauma center costs first, and health insurance being a secondary payer.
This is common practice in some states (Connecticut and Oregon) with higher than average health
coverage on their auto policies and state statutes that require the auto insurance policy to be the first
source of payment for auto collision injuries.
Another option is to provide an assessment on the illegal discharge and/or sale of firearms and
ammunition. The State of Illinois has in the past introduced legislation to levy a fine on the illegal
discharge of firearms and add a tax to the sale of firearms, which in 1997 would have resulted in $5
million in annual revenue. Such fines and taxes were proposed in an effort to offset trauma costs
associated with violent crimes. There is significant opposition that would need to be overcome for this
concept to be successful.
Another concept would be to add to the 9-1-1 surcharge on phone bills in the state. This could be a
potent revenue source as the number of telephone lines and cell phone lines increase.
Page 81

Chronology of Trauma Care in Southern Nevada
January 1988
September 1, 1988
First American College of Surgeons (ACS) consultation review at UMC as a
Level II trauma center.
Certificate for Level II trauma center issued to UMC. Expiration date
December 31, 1988.
January 1, 1989 Certificate to UMC for Level II trauma center expiring December 31, 1989.
September 1989
October 19, 1989
December 13, 1989
December 22, 1989
October 15, 1991
November 8, 1991
November 25, 1991
December 17, 1991
April 2, 1992
October 23, 1992
November 3, 1992
Site verification visit conducted by ACS at UMC.
Certificate for Level III trauma center issued to Humana Hospital Sunrise.
Expiration date October, 18, 1991.
Letter from ACS verifying UMC as a Level II trauma center. Effective December
7, 1989 through December 7, 1992.
Humana Hospital Sunrise contracts with the Nevada State Health Division to
provide Level III trauma center for two years. Contract was later amended to
extend one month. Expiration of contract, January 22, 1992.
Verification survey conducted by ACS at Humana Hospital Sunrise. The
reviewers unanimously recommend that a certificate of verification be withheld
at this time and that a focused review be accomplished in six to twelve months
or sooner if requested by the hospital for the purpose of correcting the major
criteria deficiencies.
Certified letter to Allan Stipe, Humana Hospital Sunrise, from Myla Florence,
Administrator, Nevada State Health Division. Letter informs that application
for renewal as a Level III trauma center is denied. Expiration date remains
December 22, 1991.
Hand delivered letter from Humana Hospital Sunrise to Myla Florence. Letter
cites numerous inconstancies relating to regulations and ACS standards.
Request is made that Nevada State Health Division reconsider application for
renewal as a level III trauma center.
Certificate renewal issued to Humana Hospital Sunrise for Level III trauma
center. Expiration date January 22, 1992.
Humana Hospital Sunrise renews Level III trauma center. Expiration date April
1, 1995.
UMC re-verification of Level II trauma center site visit.
Humana Hospital Sunrise files name change. Name of facility is now listed as
Sunrise Hospital. Level III trauma center remains in place. Expiration date
April 1, 1995.
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December 15, 1992
January 10, 1993
January 19, 1993
January 21, 1993
January 22, 1993
February 3, 1993
March 20, 1993
May 21, 1993
June 11, 1993
January 1, 1995
February 15, 1996
April 10, 1996
February 3, 1997
June 10, 1998
December 15, 1998
Letter from ACS to UMC lists major criteria deficiencies. ACS recommends
UMC undergo extensive focused review within the next six to twelve months
after the deficiencies have been corrected and the committee’s
recommendations have been implemented.
Contract amendment between UMC and Nevada State Health Division. UMC
is to provide services for a Level II center for treatment of trauma for
designation period from September 1, 1990 through January 25, 1993, not to
exceed three years.
Carson City Nevada Appeal newspaper article – “Trauma units at UMC and
Washoe Medical Center fail review by ACS.” Nevada Board of Health initiates
steps to give the two hospitals “provisional trauma designation” for up to one
year.
Letter from UMC to ACS – formal notice to appeal conclusions relative to the
October 23, 1992 survey.
Letter from ACS to UMC and Washoe Medical Center – ACS to honor appeal
and schedule re-review for April 1993. Verifications as Level II trauma center
automatically extended until appeal process is complete.
Contract for designation as Level II trauma center is signed by UMC and
Nevada State Health Division. UMC agrees to provide service as a Level II
center for treatment of trauma from January 25, 1993 until UMC and Nevada
State Health Division are notified by ACS of decision on UMC appeal.
Verification survey conducted by ACS for UMC.
Letter from ACS to UMC – indication of passing re-verification as a Level II
trauma center.
Letter from Nevada State Health Division to UMC designating as Level II
trauma center.
Health Facility certificate issued to Sunrise Hospital without notation of Level
III trauma center.
Appointment of John Fildes, MD as trauma medical director for UMC.
UMC requests nine-month extension of Level II trauma center designation.
UMC receives ACS re-verification as Level II trauma center. The site visit was
conducted on December 19-20, 1996.
UMC request Level I trauma center verification site visit by ACS. Review
scheduled for December 14-15, 1998.
ACS conducts verification visit at UMC for Level I trauma center.
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January 22, 1999
December 10, 2001
January 31, 2002
July 3-13, 2002
October 9, 2003
October 30, 2003
November 2003
December 5, 2003
January 2004
January 2004
January 13, 2004
February 9, 2004
February 12, 2004
March 8, 2004
March 11, 2004
March 28-29, 2004
April 1, 2004
UMC receives verification as a Level I trauma center from ACS, effective dates
February 1, 1999 through February 1, 2002.
ACS conducts re-verification visit at UMC for Level I trauma center.
UMC receives ACS re-verification as Level I trauma center with expiration date
of February 1, 2005.
UMC trauma center closes due to issues with medical staff malpractice
concerns.
Sunrise Hospital meets with the Nevada State Health Division and expresses
its intent to develop a trauma center.
St. Rose Dominican Hospital submits a letter to Nevada State Health Division
stating interest in becoming a Level III trauma center.
The Nevada State Health Division asks the Clark County Health District to
facilitate a needs assessment for Southern Nevada.
The Clark County Health District engages The Abaris Group to assist in
conducting a needs assessment for Southern Nevada.
The Clark County Health District engages ACS to conduct a trauma system
consultation visit.
The Clark County Health District establishes a Citizen’s Trauma Task Force to
make recommendations to the Clark County Health District Board of Health
on a trauma system for Southern Nevada. The Task Force’s recommendations
will be presented to the Board of Health on June 24, 2004. The Clark County
Health District Board of Health will then make its recommendations to the
Administrator of the Nevada State Health Division.
The first meeting of the Citizen’s Trauma Task Force is held.
The Citizen’s Trauma Task Force meets.
A Boulder City Town Hall meeting is held.
The Citizen’s Trauma Task Force meets and the City of Las Vegas Town Hall
meeting is held.
A North Las Vegas Town Hall meeting is held.
Sunrise Hospital has ACS conduct a consultative review to become a Level II
trauma center.
Sunrise Hospital informed the Nevada State Health Division of its request for
a provisional trauma center designation, effective August 2004. The request is
made because during the ACS consultation, ACS stated that in order to obtain
Page 84

final verification, they must observe and review actual trauma cases at Sunrise
Hospital.
April 12, 2004
April 13, 2004
April 14, 2004
The Citizen’s Trauma Task Force meets and the Henderson Town Hall
meeting is held.
Mesquite Town Hall meeting is held.
Clark County Town Hall meeting is scheduled. However, no public members
attend and the meeting is cancelled.
Page 85

List of Trauma System Assessment Study Participants
Southern Nevada
Trauma System Assessment Study Participants
Name Title Affiliation
Mike Alastuey Lobbyist Clark County
Andrea Anderson City Council Member City of Boulder City
Veronica Arechederra Hall Member Clark County Health District Citizen's Trauma Task Force
Ken Armstrong Chief Executive Officer Southern Hills Hospital
Renato V Baciarelli Chief Operating Officer St Rose Dominican Hospital - de Lima
John Bailey President Law Offices of John R Bailey
Michael Bass, MD, MBA Associate Administrator Sunrise Hospital & Medical Center
Harold Begley Resident/Boulder City None
Gloria Begley Resident/Boulder City None
Philis Beilfuss, RN Health Care Coordinator North Las Vegas Fire Department
Mike Bernstein Health Educator Clark County Health District
Greg Bishop President Bishop & Associates
Bobbette Bond Benefits Specialist Culinary Workers Health Fund
Susan Bowmer Chief Nurse Executive Spring Valley Hospital Medical Center
Greg Boyer CEO Valley Hospital Medical Center
Mary Ellen Britt EMS QI Coordinator Clark County Health District
Steve Brown Resident/North Las Vegas None
Richard Bunker Member Clark County Health District Citizen's Trauma Task Force
Jon Bunker President, Managed Care Division Sierra Health Services
Bob Caldwell Chief Executive Officer Lake Mead Hospital
Jenifer Campbell, RN Emergency Department Clinical Instructor Summerlin Hospital Medical Center
Dale Carrison, DO, ED Medical Director University Medical Center
Roy Carroll Operations Manager American Medical Response
Jim Cavalieri Fire Chief Henderson Fire Department
Rory Chetelat, MA, EMT-P EMS Manager Clark County Health District
Juanita Clark Member Charleston Neighborhood Preservation
Connie Clemmons-Brown, RN, MBA, CEN Director, Trauma/Emergency Services University Medical Center
JaNell Cook Member Clark County Health District Citizen's Trauma Task Force
Jeanne Cosgrove Director Safe Kids Coalition
Derek Cox Supervisor American Medical Response
Susie Cram Chief Operating Officer Sunrise Hospital & Medical Center
Kim Crandall Administrator Boulder City Hospital
Tim Crowly Battalion Chief Las Vegas Fire & Rescue
Debra Dailey Paramedic Supervisor Southwest Ambulance
David Daitch, DO ED Medical Director Boulder City Hospital
Jeff Davidson, MD, FACEP ED Medical Director Valley Hospital Medical Center
Ben Davis Trauma Surgeon Sunrise Hospital & Medical Center
Rod Davis President/CEO St Rose Dominican Hospital
Virginia DeLeon, RN ED Nurse Manager St Rose Dominican Hospital - Siena
Max Doubrava, MD Member Clark County Health District Citizen's Trauma Task Force
Dennis Dufak, RN ED Nurse Manager University Medical Center
Susan Eiselt Senior Administrative Assistant Clark County Health District
Robert Eliason Councilman North Las Vegas City Council
William Elsaesser, MD ED Medical Director Lake Mead Hospital
Michael Evans Trauma Registrar Sunrise Hospital & Medical Center
Donna Fairchild Councilwoman/City of Mesquite City of Mesquite
Robert Ferraro Mayor City of Boulder City
John Fildes, MD, FACS, FCCM Chair, Department of Trauma University Medical Center
Paul Fischer, MD ED Medical Director Sunrise Hospital & Medical Center
Roger Fontes, MD Physician St. Rose Dominican Hospital/University Medical Center
Robert Forbuss Co-chair Clark County Health District Citizen's Trauma Task Force
Lynn Fulstone Sunrise Hospital Lobbyist Lionel Sawyer & Collins
Gregg Fusto, RN ED Nurse Manager University Medical Center
Merlinda Gallegos Member Clark County Health District Citizen's Trauma Task Force
Santana Garcia Inter-Governmental Relations Specialist City of Henderson
Parmod Garg Chief Financial Officer St Rose Dominican Hospital
Julian Genilla Supervisor Southwest Ambulance
Betsy Gilbertson Director Strategic Planning Culinary Union
Patti Glavan ED Nurse Manager Boulder City Hospital
Kay Godby Bio-Preparedness Planner Clark County Health District
Peter Gruman, RN Charge Nurse St. Rose Dominican Hospital - Siena
Alex Haartz Deputy Administrator Nevada Department of Human Resources Division of Health
Denell Hahn Lobbyist Sunrise Hospital & Medical Center
Brent Hall EMS Supervisor Clark County Fire Department
Lee Haney Associate Restrepo Consulting Group
Steve Hanson Deputy Chief/EMS Coordinator Clark County Fire Department
Joe Hardy, MD Assemblyman/Boulder City Nevada State Legislature & CCHD BOH Member
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Southern Nevada
Trauma System Assessment Study Participants
Name Title Affiliation
Nancy Harland, RN ED Nurse Manager Sunrise Hospital Pediatric Emergency Department
Gerry Hart Director of Operations American Medical Response
Lee Wayne Haynes Resident City of Henderson
Joseph Heck, DO, FACOEP, FACEP EMS Operational Medical Director Clark County Health District
Richard Henderson, MD ED Medical Director St Rose Dominican Hospital - Siena
Mary Henson Luera Trauma Program Manager University Medical Center
Steve Hill Member Clark County Health District Citizen's Trauma Task Force
Mike Hillerby Chief of Staff Governor Kenny C Guinn
Marcia Holmberg Asst. Administrator, Intergovernmntl. Relations University Medical Center
Jim Holtvoigt, RN ED Nurse Manager UMC Pediatric Emergency Department
EP Homansky, MD ED Medical Director Valley Hospital Medical Center
Mark Howard Chief Executive Officer Mountain View Hospital
Randy Howell Division Chief Henderson Fire Department
Lou Huff, RN ED Nurse Manager Desert Springs Hospital
Derek Hughes Fire Chief Mesquite Fire & Rescue
Melinda Hursh, RN Trauma Program Coordinator Sunrise Hospital & Medical Center
Trent Jenkins EMS Coordinator Clark County Fire Department
Brenda Johnson Assistant to City Manager City of North Las Vegas
Stephen Jones, MD Chief Medical Officer St Rose Dominican Hospital
Lisa Jones, MPA, REHS Health Facilities Surveyor IV Nevada Department of Human Resources Division of Health
Sam Kaufman Chief Operating Officer Desert Springs Hospital
Jack Kim Dir., Legislative Prog., Gvt. Affairs & Special Proj. Sierra Health Services
Sonya King Health Facilities Surveyor III State of Nevada Bureau of Licensure & Certification
Jon Kingma EMS Coordinator Boulder City Fire Department
Kathy Kopka, RN ED Nurse Manager Sunrise Hospital & Medical Center
Matt Koschmann Dir. Business Development/Strategic Planning St Rose Dominican Hospital
Marcy Krieger, RN ED Nurse Manager Lake Mead Hospital
Deborah Kuhls, MD Surgeon UMC
Donald Kwalick, MD, MPH Chief Health Officer Clark County Health District
Jennifer Lances Policy & Analytical Services Manager Clark County
Fergus Laughridge Supervisor, Emergency Medical Services Health
Bradford Lee, MD, JD, MBA State Health Officer Health
Vince Leist Senior Vice President, Development Sunrise Hospital & Medical Center
Morgan Levi Organizer Service Employees International Union
Vickie Lewis Critical Care Director Mesa View Regional Medical Center
Ann Lynch Vice President, Community Services Sunrise Hospital & Medical Center
Jackie Mador, RN, BS, CEN Emergency Services Manager Summerlin Hospital Medical Center
Tony Marinello Assistant Administrator Desert Springs Hospital
Rose McKinney-James Co-chair Clark County Health District Citizen's Trauma Task Force
Kay McMillan, MD ED Physician Spring Valley Hospital Medical Center
Michael Metzler, MD, FACS, FCCM Director of Trauma Services Sunrise Hospital & Medical Center
Mike Meyers Assistant Chief Las Vegas Fire & Rescue
Rose Ann Miele Public Information Officer City of Boulder City
Shawna Miller, RN Chief Flight Nurse/Medical Manager Mercy Air
Dean Mollburg Chief Boulder City Fire Department
Patti Monczewski System Administrator Sunrise Hospital & Medical Center
Tad Moorley Chief Operating Officer Mountain View Hospital
Karl Munninger Director of Administrative Services Clark County Health District
Danny Musgrove Lobbyist Clark County
Andy North Advocate St Rose Dominican Hospital
Tim Oleary Associate Bishop & Associates
James Osti Librarian/Grant Writer Clark County Health District
Frank Pape, MD ED Medical Director Summerlin Hospital Medical Center
Ed Pasimio, MD Rehabilitation Director University Medical Center
Karla Perez CEO Spring Valley Hospital Medical Center
Dave Petersen Division Chief Mesquite Fire & Rescue
Craig Preston CEO Lake Mead Hospital
Otto Ravenholt, MD Member Clark County Health District Citizen's Trauma Task Force
Don Reisch, MD ED Medical Director Desert Springs Hospital
Richard Resnick Captain, EMS Coordinator Mesquite Fire & Rescue
Ken Riddle Deputy Chief Las Vegas Fire & Rescue
Brian Rogers Managing Director Southwest Ambulance
Sandy Rush Chief Nursing Officer St Rose Dominican Hospital
Rebecca Rych Foundation Director Boulder City Hospital
Chris Salm Research & Special Projects Director Service Employees International Union
Lawrence Satkoviak, MD Medical Director UMC Pediatric Emergency Department
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Southern Nevada
Trauma System Assessment Study Participants
Name Title Affiliation
Jennifer Schomburg, MHA, MA Assistant Administrator Summerlin Hospital Medical Center
Natalie Seaber, RN ED Nurse Manager Mountain View Hospital
Wade Sears, MD ED Medical Director Southern Hills Hospital
Syd Selitzky Medical Services Officer Henderson Fire Department
Davette Shea, RN ED Nurse Manager Southern Hills Hospital
Tom Shires, MD Director Nevada Trauma Institute
Jane Shunney, RN, MS Assistant to the Chief Health Officer Clark County Health District
Jennifer Sizemore Public Information Officer Clark County Health District
Patrick Smith Account Executive Rogich Communications
Stephanie Smith Councilwoman/City of North Las Vegas City of North Las Vegas
Mary Jo Solon Chief Nursing Officer Southern Hills Hospital
Doug Stevens Deputy Chief Henderson Fire Department
Allan Stipe President/Chief Executive Officer Sunrise Hospital & Medical Center
JJ Straight Member Service Employees International Union
James Swift, MD Medical Director Sunrise Hospital Pediatric Emergency Department
Yvonne Sylva State Health Administrator Health
Terri Tarbett Assistant Fire Chief North Las Vegas Fire Department
Vicki Taylor Assistant to City Manager City of Henderson
Jacqueline Taylor Chief Administrative Officer University Medical Center
Lacy Thomas CEO University Medical Center
Danny Thompson Member Clark County Health District Citizen's Trauma Task Force
Dave Tonelli Public Information Specialist Clark County Health District
Melissa Trammell Assistant Bunker & Associates
Kelley Tucky Executive Director of Benefits Mirage Resorts
Pam Turner, RN ED Nurse Manager Valley Hospital Medical Center
Tim VanDuzer, MD ED Medical Director Mountain View Hospital
Ben Venger, MD Neurosurgeon Western Regional Center for Brain & Spine Surgery
Helen Voss Vice President, Patient Services Mountain View Hospital
Paul Waalkes Resident Boulder City
Pilar Weiss Lobbyist Culinary Union
John Wilson Executive Partner Southwest Ambulance
Gail Yedinak Management Analyst University Medical Center
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Trauma Glossary
Source: Trauma System Agenda for the Future (NHTSA) and The Abaris Group
bypass – transport of an EMS patient past a normally used EMS receiving facility to a designated
medical facility for the purpose of accessing more readily available or appropriate medical care
citizen access – the act of requesting emergency assistance for a specific event
communications system – a collection of individual communication networks, a transmission system,
relay stations, and control and base stations capable of interconnection and interoperation that are
designed to form an integral whole. The individual components must serve a common purpose, be
technically compatible, employ common procedures, respond to control, and operate in unison.
designation – formal recognition of hospitals as providers of specialized services to meet the needs of
the severely injured patient; usually involves a contractual relationship and is based on adherence to
standards
disaster – any occurrence that causes damage, ecological destruction, loss of human lives, or
deterioration of health and health services on a scale sufficient to warrant an extraordinary response
from outside the affected community area
dispatch – coordination of emergency resources in response to a specific event
dry runs – the number of calls for an emergency medical services provider that are cancelled en route
to a scene
emergency medical services for children (EMS-C) – an arrangement of personnel, facilities and
equipment for the effective and coordinated delivery of emergency health services to infants and
children that is fully integrated within the emergency medical system of which it is a part
emergency medical services system (EMS) – a system that provides for the arrangement of personnel,
facilities, and equipment for the effective and coordinated delivery of health care services in
appropriate geographical areas under emergency conditions
EMS diversion – occurs when a hospital’s emergency department cannot accept any additional
patients from ambulances. The ED goes on “divert” and the ambulance must take the patient to an
ED not on divert.
EMS provider – ambulance providers and fire departments (same as pre-hospital provider)
Emergency Medical Treatment and Labor Act (EMTALA) – (Source: American College of Emergency
Physicians (ACEP)) A federal law enacted by Congress in 1986 as part of the Consolidated Omnibus
Budget Reconciliation Act (COBRA) of 1985 (42 U.S.C. §1395dd). Referred to as the "anti-dumping"
law, it was designed to prevent hospitals from refusing to treat patients or transferring them to charity
or county hospitals because they were unable to pay or had Medicaid coverage. In effect, EMTALA
designated emergency departments as one of America's most important health care safety nets.
Under the law, patients with similar medical conditions must be treated consistently. The law applies
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to hospitals that accept Medicare reimbursement, and to all their patients, not just those covered by
Medicare.
Congress has made aggressive enforcement of EMTALA a priority, with almost as much money
assessed in penalties in 2000 ($1.17 million) than in the first 10 years (about $1.8 million) of the
statute's existence, according to the Office of Inspector General (OIG). Nevertheless, in the past 2
years, EMTALA fines declined. Approximately $300,000 in fines was collected from 10 hospitals
between October 1, 2002 and March 21, 2003, but no physician settlements were reported.
Hospitals have three basic obligations under EMTALA. First, they must provide all patients with a
medical screening examination to determine whether an emergency medical condition exists. Second,
where an emergency medical condition exists, they must either provide treatment until the patient is
stabilized, or if they do not have the capability, transfer the patient to another hospital. Third, hospitals
with specialized capabilities are obligated to accept transfers if they have the capabilities to treat them.
Medical care cannot be delayed by questions about methods of payment or insurance coverage.
Emergency departments must post signs that notify patients and visitors of their rights to a medical
examination and to receive treatment.
field categorization (classification) – a medical emergency classification procedure for patients that is
applicable under conditions encountered at the site of a medical emergency
first responder – fire department personnel who are typically trained at the EMT-Paramedic level to
assess and provide the initial care to an injured person. First responders do not typically transport the
patient, they only treat. If transport is necessary, an ambulance will be dispatched.
inclusive trauma care system – a trauma care system that incorporates every health care facility in a
community in a system in order to provide a continuum of services for all injured persons who require
care in an acute care facility; in such a system, the injured patient's needs are matched to the
appropriate hospital resources
injury – the result of an act that damages, harms, or hurts; unintentional or intentional damage to the
body resulting from acute exposure to thermal, mechanical, electrical or chemical energy or from the
absence of such essentials as heat or oxygen
injury control – the scientific approach to injury that includes analysis, data acquisition, identification
of problem injuries in high risk groups, option analysis and implementing and evaluating
countermeasures
injury prevention – efforts to forestall or prevent events that might result in injuries
injury rate – a statistical measure describing the number of injuries expected to occur in a defined
number of people (usually 100,000) within a defined period (usually 1 year). Used as an expression of
the relative risk of different injuries or groups
lead agency – an organization that serves as the focal point for program development on the local,
regional or state level
level I trauma center – the highest level of care. They also conduct research and maintain volume
performance standards.
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level II trauma center – is the same as a level I but does not have the volume standards or research
level III trauma center – can stabilize and perform emergency surgery and then transfers to the nearest
level I or II. Typically serves communities that do not have access to a level I or II
level IV trauma center – provides stabilization and then transfers the patient to the nearest level I, II or
III
major trauma – that subset of injuries that encompasses the patient with or at risk for the most severe
or critical types of injury and therefore requires a systems approach in order to save life and limb
mechanism of injury – the source of forces that produce mechanical deformations and physiologic
responses that cause an anatomic lesion or functional change in humans
medical control – physician direction over prehospital activities to ensure efficient and proficient
trauma triage, transportation, and care, as well as ongoing quality management morbidity - the relative
incidence of disease
mortality rate – the proportion of deaths to population
off-line medical direction – the establishment and monitoring of all medical components of an EMS
system, including protocols, standing orders, education programs, and the quality and delivery of online
control
on-line medical direction – immediate medical direction to prehospital personnel in remote locations
(also know as direct medical control) provided by a physician or an authorized communications
resource person under the direction of a physician
overtriage – directing patients to trauma centers when they do not need such specialized care.
Overtriage occurs because of incorrect identification of patients as having severe injuries when
retrospective analysis indicates minor injuries.
pre-hospital provider – ambulance providers and fire departments (same as EMS provider)
protocols – standards for EMS practice in a variety of situations within the EMS system
quality improvement – a method of evaluating and improving processes of patient care which
emphasizes a multidisciplinary approach to problem solving, and focuses not on individuals, but
systems of patient care which might be the cause of variations
quality management – a broad term which encompasses both quality assurance and quality
improvement, describing a program of evaluating the quality of care using a variety of methodologies
and techniques
regionalization – the identification of available resources within a given geographic area, and
coordination of services to meet the needs of a specific group of patients
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ehabilitation – services that seek to return a trauma patent to the fullest physical, psychological,
social, vocational, and educational level of functioning of which he or she is capable, consistent with
physiological or anatomical impairments and environmental limitations
responses – the number of calls a prehospital provider receives. Transports differ from responses in
that responses include all calls, some calls do not generate a transport. The number of responses is
generally a higher number that transports.
response time – the time lapse between when an emergency response unit is dispatched and arrives
at the scene of the emergency
risk factor – a characteristic that has been statistically demonstrated to be associated with (although
not necessarily the direct cause of) a particular injury. Risk factors can be used for targeting
preventative efforts at groups who may be particularly in danger of injury.
rural – those areas not designated as metropolitan statistical areas (MSAs)
service area (catchment area) – that geographic area defined by the local EMS agency in its trauma
care system plan as the area served by a designated trauma center
specialty care facility – an acute care facility that provides specialized services and specially trained
personnel to care for a specific portion of the injured population, such as pediatric, burn injury, or
spinal cord injury patients
surveillance – the ongoing and systematic collection, analysis, and interpretation of health data in the
process of describing and monitoring a health event
trauma – a term derived from the Greek for "wound"; it refers to any bodily injury (see injury)
trauma activation – activation of the trauma team based on predefined triage criteria (see triage and
trauma team)
trauma care system – an organized approach to treating patients with acute injuries; it provides
dedicated (available 24 hours a day) personnel, facilities, and equipment for effective and coordinated
trauma care in an appropriate geographical region
Trauma Care Systems Planning and Development Act of 1990 - The law that amended the Public
Health Service Act to add Title XII - Trauma Programs. The purpose of the legislation is to assist State
governments in developing, implementing and improving regional systems of trauma care, and to
fund research and demonstration projects to improve rural EMS and trauma
trauma center – a specialized hospital facility distinguished by the immediate availability of specialized
surgeons, physician specialists, anesthesiologists, nurses, and resuscitation and life support
equipment on a 24 hour basis to care for severely injured patients or those at risk for severe injury
trauma registry – a collection of data on patients who receive hospital care for certain types of injuries.
Such data are primarily designed to ensure quality trauma care and outcomes in individual institutions
and trauma systems, but have the secondary purpose of providing useful data for the surveillance of
injury morbidity and mortality
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trauma team – the multidisciplinary group of professionals who have been designated to collectively
render care for trauma patients in a particular trauma care system
triage – the process of sorting injured patients on the basis of the actual or perceived degree of injury
and assigning them to the most effective and efficient regional care resources, in order to insure
optimal care and the best chance of survival
triage criteria – measures or methods of assessing the severity of a person's injuries that are used for
patient evaluation, especially in the prehospital setting, and that use anatomic and physiologic
considerations-and mechanism of injury
transports – when an ambulance provider transports a patient to a hospital. Transports differ from
responses in that responses include all calls, some calls do not generate a transport.
uncompensated care – care for which no reimbursement is made
undertriage – directing fewer patients to trauma centers than is warranted because of incorrect
identification of patients as having minor injuries when retrospective analysis indicates severe injuries
verification – review of a trauma center by an outside team of experts but not legally binding for
determining designation status. Typically this function is performed by the American College of
Surgeons (see designation)
9-1-1 – a three-digit telephone number to facilitate the reporting of an incident or situation requiring
response by a public safety agency
enhanced 9-1-1 – a telephone system that includes automatic number identification, automatic
location identification, and (optimally) selective routing, to facilitate appropriate public safety
response
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