Current Trauma Status Report - Southern Nevada Health District

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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
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 and 26: Trauma Stakeholder Interview Result
Page 27 and 28: three years, and felt that a Level
Page 29 and 30: EMS providers ranked Acute Care Fac
Page 31 and 32: Town Hall Meeting Comments A series
Page 33: (CAAS) and the air ambulance provid
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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Current Trauma Status Report - Southern Nevada Health District

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