Current Trauma Status Report - Southern Nevada Health District

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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
Page 1 and 2: SOUTHERN NEVADA CURRENT TRAUMA STAT
Page 3 and 4: Table of Contents Executive Summary
Page 5 and 6: Chronology of Trauma Care in Southe
Page 7 and 8: Exhibit 33 - Map Displaying Trauma
Page 9 and 10: • From January through April 2004
Page 11 and 12: Clearly trauma center staffing and
Page 13 and 14: A series of focus groups was also c
Page 15 and 16: • Information Management • Fina
Page 17 and 18: (This study did not attempt to meas
Page 19 and 20: County Health District Board of Hea
Page 21 and 22: on an average length of stay of 3.4
Page 23 and 24: Exhibit 8 - Projected Population Ch
Page 25: Trauma Stakeholder Interview Result
Page 29 and 30: EMS providers ranked Acute Care Fac
Page 31 and 32: Town Hall Meeting Comments A series
Page 33 and 34: (CAAS) and the air ambulance provid
Page 35 and 36: Triage Criteria The determination o
Page 37 and 38: With the exception of the year 2000
Page 39 and 40: Exhibit 20 - Trauma Patients by Age
Page 41 and 42: The following chart shows that abou
Page 43 and 44: Exhibit 27 - Trauma Ground Transpor
Page 45 and 46: E codes enable the classification o
Page 47 and 48: The day of the week with the greate
Page 49 and 50: A different view of the 2002 trauma
Page 51 and 52: As part of The Abaris Group’s tra
Page 53 and 54: The table below summarizes the key
Page 55 and 56: All EMS and ED stakeholders appear
Page 57 and 58: Exhibit 43 - Specialty Physician Co
Page 59 and 60: Clark County Health District has id
Page 61 and 62: Trauma Center Standards by Level Th
Page 63 and 64: Nevada Trauma Registry Submission R
Page 65 and 66: Trauma Center Capacity Benchmark Da
Page 67 and 68: ED Diversion Hours by Hospital ED D
Page 69 and 70: • This region would not pass a ta
Page 71 and 72: • Instead of calling it a tax, we
Page 73 and 74: Mesquite Town Hall Meeting The foll
Page 75 and 76: North Las Vegas Town Hall Meeting T
Page 77 and 78:
Las Vegas Town Hall Meeting The fol
Page 79 and 80:
Trauma Center Funding Comparison St
Page 81 and 82:
Los Angeles County, CA Los Angeles
Page 83 and 84:
Chronology of Trauma Care in Southe
Page 85 and 86:
January 22, 1999 December 10, 2001
Page 87 and 88:
List of Trauma System Assessment St
Page 89 and 90:
Southern Nevada Trauma System Asses
Page 91 and 92:
to hospitals that accept Medicare r
Page 93 and 94:
ehabilitation - services that seek
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