Purpose and Rationale
Trauma system integration is essential for the daily care of injured people and includes such services as mental health, social services, child protective services, and public safety. The trauma system should use the public health approach to injury prevention to contribute to reducing the entire burden of injury in a state or region. This approach enables the trauma system to address primary, secondary, and tertiary injury prevention through closer integration with community health programs and mobilizing community partnerships. The partnerships also include mental health, social services, child protection, and public safety services. Collaboration with the public health community also provides access to health data that can be used for system assessment,
development of public policy, and informing and educating the community.
Integration with EMS is essential because this system is linked with the emergency response and communication infrastructure and transports severely injured patients to trauma centers. Triage protocols should exist for treatment and patient delivery
decisions. Regulations and procedures should exist for online and off -line medical direction. In the event of a disaster affecting local trauma centers, EMS would have a major role in evacuating patients from trauma centers to safety or to other facilities or to make beds available for patients in greater need.
The trauma system is a significant state and regional resource for the response to mass casualty incidents (MCIs). The trauma system and its trauma centers are essential for the rapid mobilization of resources during MCIs. Preplanning and integration of the trauma system with related systems (public health, EMS, and emergency
preparedness) are critical for rapid mobilization when a disaster or MCI occurs. The extensive impact of disasters and MCIs on the functioning of trauma centers and the EMS and public health systems within the affected region or state must be considered, and joint planning for optimal use of all resources must occur to enable a coordinated response to an MCI. Trauma system leaders need to be actively involved in emergency management planning to ensure that trauma centers are integrated into the local, regional, and state disaster response plans.
Optimal Elements
I. The state lead agency has a comprehensive written trauma system plan based on national guidelines. The plan integrates the trauma system with EMS, public health, emergency preparedness, and incident management. The written trauma system plan is developed in collaboration with community partners and stakeholders. (B-203)
a. The trauma system plan has established clearly defined methods of integrating the trauma system plan with the EMS, emergency, and public health
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II. The trauma, public health, and emergency preparedness systems are closely linked.
(B-208)
Current Status
The Trauma System Strategic Plan for 2011-2015 was completed with broad
stakeholder input. Integration with EMS and emergency and public health preparedness plans is evident and ongoing with active communication between agencies and
representation on each other’s committees and working groups. The recent DOH reorganization has the Division of Emergency Preparedness and Community Support which facilitates the integration of emergency preparedness, EMS, and the Trauma Program. Plans are underway to integrate the Trauma Program and the Injury
Prevention Program. With support from the newly formed Health Information and Policy Analysis Program, data acquisition and sharing between all these programs should be greatly facilitated.
Integration with EMS occurs at many levels including planning, operations, evaluation, and performance improvement. Established routines include feedback provided to EMS regarding any patient admitted to the intensive care unit when performance
improvement issues related to prehospital care are applicable. EMS conducts a variety of injury prevention and outreach activities, and these are coordinated with the Injury Prevention Program. Information about these activities is shared with the Trauma Program.
Florida has 19 TSAs. In a few TSAs, a local multidisciplinary operational unit, called a trauma agency, is in place which provides an opportunity for local collaboration among agencies involved in trauma care. In the locales where the trauma agencies exist, they seem to be providing a useful function. Florida also has 7 Regional Domestic Security Task Force Regions.
Integration with disaster planning is evident. The State Emergency Response Team (SERT) is composed of agency-appointed Emergency Coordination Officers (ECOs) and staff from state agencies, and representatives from volunteer and non-
governmental organizations that operate under the direction and control of the Governor and State Coordinating Officer (SCO). The SERT is grouped into 18 Emergency
Support Functions (ESFs) that carry out coordination and completion of response and recovery activities in the State Emergency Operation Center (SEOC) during an
emergency or disaster. These ESFs are grouped by function rather than agency, with each ESF headed by a primary state agency and supported by additional state
agencies. The trauma system is integrated into the Florida Incident Command System through ESF-8, the Health and Medical function.
Standards exist for trauma centers to have written policies and protocols to provide mental health services, child protective services, and emotional support to trauma patients and their families. Trauma centers are also required to provide community injury prevention programs.
40 Recommendations
Use the Regional Domestic Security Task Force Regions (RDSTFR) as the TSA
regions.
o Develop a strong regional structure based on the 7 RDSTFR that enables
the integration of trauma centers with EMS, disaster preparedness, and other regional activities.
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