2010 – 2011 Annual Report
PREPARE. SUPPORT. RESPOND.
2010 Texas Department of State Health Services
Outstanding RAC Award Recipient!
TABLE OF
CONTENTS
Message from the Board Chair 1
Message from the Executive Director 2
Board of Directors 3
Executive Summary 5
Financial Overview 6
Emergency Healthcare System Grants 8
Programs Supported with the Tobacco Endowment
EMS County Assistance “Pass-through” Funds 9
Funding Details
2011 EMS County Assistance Fund Expenditure by Type
FY 2011 Uncompensated Trauma Care Fund Distribution for Hospitals 10
Background Information
FY 2011 Uncompensated Trauma Care Disbursement
Local Projects Grants 11
FY2011 LPG Recipients from TSA-E
REG*E 12
REG*E EMS and Trauma Centers Data Progress
Acute Care Facility Designation 13
Trauma Stroke Cardiac
Hospital Preparedness Program 15
HPP Funding
Funding Distribution
HPP Expenditures by Activity NCTTRAC Programmatic Support
Use of Hospital Reimbursement Allocation Subrecipient Hospital Planning for Response
Decontamination and Personal Protective Equipment (PPE)
Training & Exercises 19
Hazard Vulnerability Analysis (HVA) Super Bowl XLV & Regional Exercise Jericho Packaged Exercises
HPP Year 9 Exercise “Recap” Regional Training
MMU Training & Maintenance Videos
Data and Information Systems 24
In Support of TSA-E Support Requests Uptime Report
Redundancy and Back-up
Crisis Applications 26
E*TRACS
WebEOC Integration WebEOC
Emergency Medical Task Force 27
Team Development
Emergency Medical Operations Center 29
Interoperable Communications
TDVR/ESAR-VHP (Medical Reserve Corps) Partnership/Coalition Building
1
Message from the Board Chair
I am excited to be the new Chair of the North Central Texas Trauma Regional Advisory Council (NCTTRAC). Over the past twelve years, I have seen our RAC grow from a small cubicle at the Dallas-Fort Worth Hospital Council in Las Colinas to filling most of the ground floor of the Centerpoint III Building in Arlington. The RAC has always been driven to develop the best pre-hospital and hospital emergency healthcare system in the state. Since our creation, it has provided hospitals, EMS providers, first responders, and medical personnel a venue for communicating issues and concerns that impact this region.
The RACs were first created to help organize and coordinate trauma activities in trauma service areas. Our trauma service area (Trauma Service Area-E) is the largest in the state with a population of over $6 million in our nineteen counties. We receive more
funding from the state and the federal government than any of the 22 RACs located in Texas, and our RAC has more Level I and Level II trauma designated hospitals and more ALS and MICU EMS providers as well. I am proud of what the RAC has accomplished over the years and look forward to improving the RAC’s ability to advance patient care for our citizens.
During my seven years as Program Director for NCTTRAC, the Board of Directors has always been comprised of volunteers who actively worked to move the RAC forward. This group of individuals worked long and hard to develop a trauma system that served not only North Texas but across the state. Over time, the Hospital
Preparedness Program was moved to the RAC from the Dallas-Fort Worth Hospital Council and emphasis on stroke and cardiac care were also added as key components to regional emergency healthcare planning. While the funding for Hospital Preparedness took our organization from a $500,000 to over $7 million annual budget, the RAC grew exponentially with personnel and additional hospitals. Even though hospitals receiving preparedness funds were not required to be RAC members, many joined and began to participate in RAC activities. The RAC has transitioned from a trauma focus to a comprehensive emergency healthcare system including emergency
preparedness, cardiac, stroke, and trauma. All RACs in Texas focus on these key components under the direction of the Texas Department of State Health Services.
Today, the RAC Board of Directors and committees are still comprised of volunteers, and they continue to work diligently for the benefit of the patient. One example is an emphasis on a regional trauma registry program to provide patient information for data-driven decision making, allowing this RAC to focus on projects having the most impact on patient outcomes.
I am excited and proud to be the Chair for this RAC for the next two years and see it as a chance for NCTTRAC to continue to move forward as a RAC leader in this state. I am acutely aware that it will take a lot of work from all RAC committees and members to make the RAC the best it can be. I encourage all of our RAC members to get involved in a committee of the RAC that interests you and start making a difference in the delivery of patient care in the pre-hospital and hospital setting. I look forward to meeting and working with you to move this RAC forward in the years to come. Thanks for all you do and, remember, the RAC is only a strong leader as long as you are willing to get involved!
Jimmy Dunn
2
Message from the Executive Director
"You've come a long way, baby, …"
Many of us (definitely not all) are old enough to remember the advertisement from way back when, "You've come a long way, baby, to get where you got to today … " Hey, let's not dwell on its having been a marketing ad of the times, but rather its catchy and appropriate parallel in describing NCTTRAC's dramatic changes over the past few years!
Quite often our leadership and members have shared that "not enough people know what the RAC does" and have expressed frustration in knowing the good works of the membership, as a group, go somewhat unnoticed outside of the membership itself. In recent strategic planning efforts of the RAC's Board of Directors this was addressed, even through the means of investing its own unrestricted reserve funds toward the proposals and activities that did yield a degree of success, if not enough to be self-sustaining. With lessons learned and resources considered, we've come to produce the document you are now reading in an on-going commitment to "spread the word" about NCTTRAC's continued growth and success. It is intended to make an illustrated accounting of what's been accomplished by the RAC over the year that's passed … a "yearbook" of sorts.
Before continuing, our RAC's history reaches back, as our long-contributing Trauma / EMS leaders and equally dynamic supporting members can attest, many years before the crafting of this, our first comprehensive Annual Report. To them, we should be exceedingly grateful for the foundation of pure commitment to improving systems of care … for the patients' sake alone. These committed professionals, and volunteers, gave of their time and expertise before there was regionally contracted money to spend on system development, before the State provided Tobacco money, before EMS "pass-through", before it provided Hospital Preparedness Program funds … but rather, because it was the right thing to do … to systematically improve patient care and outcomes.
To each of you … those no longer as well as those still actively involved … a huge debt of thanks!
Now turning to the pages ahead, you'll see a "home-grown" effort … our first NCTTRAC Annual Report … produced and published entirely by the NCTTRAC employee staff to outline and provide overview of programmatic projects undertaken and summarized value derived. Fruits of our labor, so to speak, spanning the past fiscal year in review … from ad-hoc event coordination and relationships with community partners to the more formally expected deliverables of Department of State Health Services contracts. With
this document, we want to not only account to you what your RAC has been engaged with, but we also hope to stimulate interest and engagement by you in your RAC's continued progress toward being an organization that makes a difference! A difference resulting in improved facility and agency preparedness … a difference resulting in improved support to providers and receivers alike … a difference resulting in improved response capabilities by the RAC itself and its members … but simply and most importantly -- a difference resulting in fewer people becoming trauma and acute care patients and better outcomes for those who do!
NCTTRAC's current and "official" mission statement and philosophies follow, but first let me please encourage you to contact me, directly, at 817-607-7001 or [email protected] with any questions, comments, criticisms … or even compliments … that you may have with regard to your RAC. Your awareness, your support, your leadership, and dynamic followership … exemplified by your active participation … are all essential to system development and improved patient outcomes. Thanks again to you, in advance, for your continued and future commitment to the regional emergency healthcare system of both this Trauma Service Area and the State of Texas!
Hendrik J. (Rick) Antonisse
3
Board of Directors
FY 11 Board Position
Name Organization FY 12 Board Position
Name Organization Chair Carrie Hecht JPS Health
Network
Chair Jimmy Dunn PHI Air Medical
Vice Chair Jimmy Dunn PHI Air Medical Vice Chair Dr. Rajesh Gandhi
JPS Health Network
Secretary Robert Knappage Sachse Fire Rescue
Secretary Amy Atnip Medical Center of Plano
Treasurer Wes Dunham Methodist Health System
Treasurer Wes Dunham Methodist Health System Air Medical Committee Dr. Bob Simonson Physician Emergency Care Association Air Medical Committee
Rick Thurman Medical Center of Plano
(in FY 11 part of Systems Development) Cardiac Committee
Karen Yates Methodist Mansfield Med Center
EMS Committee Jodie Harbert Collin County College
EMS Committee Jodie Harbert Collin County College
Finance Committee
Ricky Reeves Lewisville FD Finance Committee
Ricky Reeves Lewisville FD
Pediatric Committee
Lori Vinson Children’s Med Center Dallas
Pediatric Committee
Lori Vinson Children’s Med Center Dallas Physician’s Advisory Group Liaison Dr. Bob Simonson Physician Emergency Care Association Physician’s Advisory Group Liaison Dr. Bob Simonson Physician Emergency Care Association Professional Development Committee Courtney Edwards Parkland Professional Development Committee Courtney Edwards Parkland Pub Ed/Injury Prevention Committee Mary Ann Contreras JPS Health Network Pub Ed/Injury Prevention Committee Mary Ann Contreras JPS Health Network Regional Emergency Preparedness Committee
Donna Glenn Texoma Medical Center
Regional Emergency Preparedness Committee
Donna Glenn Texoma Medical Center
(in FY 11 part of Systems Development) Stroke Committee
Sharon Eberlein Plaza Med Center of Fort Worth
SPI Committee Dwayne Howerton
CareFlite SPI Committee Dwayne Howerton
CareFlite
Systems Development Committee
Sharon Eberlein Plaza Med Center of Fort Worth
(for FY12 replaced by Cardiac, Stroke, and Trauma Committees )
(in FY 11 part of Systems Development) Trauma Committee
Jorie Klein Parkland
Zones
Representative
Scott Vetterick Frisco FD Zones
Representative
5
Executive Summary
We are pleased to provide this annual report to our members and partners and the region at large. The North Central Texas Trauma Regional Advisory Council (NCTTRAC) is an organization designed to facilitate the development, implementation, and operation of a
comprehensive trauma care system based on accepted standards of care to decrease morbidity and
mortality. The Trauma Service Area (TSA-E) for NCTTRAC is comprised of 19 counties of North Central Texas that include: Collin, Cooke, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, and Wise. NCTTRAC is the largest Trauma Service Area in the state serving a population equal to 25% of the population of the State of Texas and approximately 2% of the population of the United States.
During Fiscal Year 2011, NCTTRAC has been proactive in building awareness among regional partners in many ways.
The regional emergency healthcare patient data collection registry (REG*E) moved into the implementation phase as hospitals throughout the region signed agreements and began actively
submitting data to the trauma registry. During 2011, stroke and submersion applications were purchased to enhance the registry with implementation of data submission expected to begin in mid-2012.
NCTTRAC served as the Hospital Preparedness Program (HPP) regional contractor for the 4th year in 2011. With 135 TSA-E hospitals participating in the program, NCTTRAC and its subrecipient hospitals represent the largest Texas regional healthcare coalition.
The 2010 World Series and Super Bowl XLV provided NCTTRAC and regional partners the opportunity to showcase healthcare delivery resources and support local, regional, state, and federal agencies. These activities are just the first steps toward building the healthcare coalition and refocusing HPP toward regional capacity building.
Implementation of the Emergency Medical Task Force (EMTF) initiative in 2011 provided NCTTRAC the opportunity to partner with Trauma Service Areas C and D (Wichita Falls and Abilene, respectively) in the coordination of EMTF-2. The EMTF Steering Group, consisting of representatives from Abilene, Wichita Falls, and the NCTTRAC Regional Emergency Preparedness Committee, has been developed to guide the project.
A number of significant emergency medical response assets were purchased in 2011 to improve both regional and state-wide disaster response. These assets, including the first two of four ambulance buses, refrigerated transport trailers, and a mobile medical unit were set up in a static display at the GeneralMembership Meeting held in September 2011 for members and regional partners to experience firsthand. These assets will be transferred to members and
jurisdictions throughout the region.
Through deliberate planning and coalition development, NCTTRAC leadership continues to work toward the fulfillment of our mission to support and improve all emergency healthcare through prevention, education, advocacy, research, preparedness, and response. The NCTTRAC Board of Directors and staff are proud of the work accomplished in 2010 - 2011 and dedicated to continue the organization’s progress in 2012 and beyond.
6
Financial Overview
The Statement of Activities for the Fiscal Year Ended August 31, 2011 reflects NCTTRAC’s financial activity for the last fiscal year. NCTTRAC receives funding through contracts and grants from DSHS as well as revenue from unrestricted organizational activities that are not related to the DSHS contracts and grants.
Contract and grant funding sources for the Fiscal Year ended August 31, 2011 include the following:
EMS/Regional Advisory Councils (EMS/RAC)
–
The purpose of these funds is to assist in the enhancement and delivery of patient care in the EMS and Trauma Service Care System. Administrative supportfunctions are the principal activities supported by this contract with the intent to enhance and improve delivery of EMS and trauma patient care in the nineteen county region served by NCTTRAC.
Tobacco/RAC – The purpose of these funds is to assist in maintaining and improving the Texas EMS/Trauma System to reduce morbidity and mortality due to injuries. These funds support programmatic functions related to the NCTTRAC Regional Patient Registry (REG*E) as well as provide educational programs and materials for members.
ASPR/HPP – The purpose of these funds is to enhance the ability of particpating hospitals and healthcare facilities to improve surge capacity and enhance community and hospital preparedness for public health emergencies by conducting activities at the local and regional level related to areas designated by the Office of the Assistant Secretary of Preparedness and Response.
Local Projects Grant (LPG) – The purpose of these funds it to conduct EMS program activities to develop, upgrade, or expande emergency medical services systems. The funds received during Fiscal Year 2011 were used to purchase the submersion module for REG*E and to purchase life vests for regional partners to distribute at public education events related to water safety and drowning,
EMS/County Assistance – The of these funds is similar to the EMS/RAC funds, to assist in the
enhancement and delivery of patient care in the EMS and rauma care system. The primary difference is that these funds are paid directly to qualifying EMS Providers to support supplies, education and training, communications equipment , and vehicles.
Unrestricted funds are orginzational and are not related to the contracts described above. Sources of these funds include membership dues, donations and sponsorships, and interest on investments. The Board of Directors is responsible for oversight and direction of unrestricted funds. According to Board directed policy, all contractual programs contained in the annual operating budget are required to balance. As such, total anticipated contract revenue must equal budgeted expenditures for each
contract. As a result, unrestricted funds are not used to offset expenditures related to DSHS contracts.
All contracts require that any funds remaining unobligated or unspent at the end of the contract period be returned to DSHS. For the second consecutive year, NCTTRAC has utilized 100% of the funding available from DSHS contracts resulting in $0 being returned to DSHS at the end of the fiscal year. While we expect that future funding through DSHS contracts and grants may be affected by current economic conditions, the Board of Directors and staff continue to strive to manage all NCTTRAC financial resources meet our mission to support and improve the emergency healthcare system within TSA-E through prevention, education, preparedness and response.
7 E M S /R A C T O B A C C O A S P R /H P P Y R 9 * A S P R /H P P Y R 1 0 * * L P G E M S /C O U N T Y A S S IS T A N C E U N R E S T R IC T E D T O T A L R e v e n u e St a te o f T X - D SH S 2 4 6 ,1 0 8 2 8 3 ,7 8 1 5 ,9 5 4 ,5 0 5 9 5 5 ,7 3 4 3 6 ,4 9 8 3 6 6 ,9 6 0 7 ,8 4 3 ,5 8 6 H PP O b lig a te d n o t R e q u e s te d 4 8 6 ,9 0 0 4 8 6 ,9 0 0 M e m b e rs h ip D u e s 4 6 ,0 7 7 4 6 ,0 7 7 In te re s t o n I n v e s tm e n ts 2 ,6 5 0 2 ,6 5 0 O th e r 8 ,5 0 0 115 8 ,6 1 5 Pu b li c R e la ti o n s & D e v e lo p m e n t Sp o n s o rs h ip s 2 ,3 0 6 2 ,3 0 6 M e e ti n g s & Ev e n ts 3 ,4 6 2 3 ,4 6 2 A w a re n e s s C a m p a ig n s Ed u c a ti o n a l R e g is tra ti o n 199 199 In -Ki n d D o n a ti o n s T o ta l R e v e n u e 2 4 6 ,1 0 8 2 9 2 ,2 8 1 5 ,9 5 4 ,5 0 5 1 ,4 4 2 ,6 3 4 3 6 ,4 9 8 3 6 6 ,9 6 0 5 4 ,8 0 9 8 ,3 9 3 ,7 9 5 E x p e n d itu re s A ir M e d ic a l EM S 8 ,8 2 8 3 6 6 ,9 6 0 3 7 5 ,7 8 8 Ex e c u ti v e 1 8 3 ,8 5 6 1 5 4 ,6 2 7 4 2 ,6 0 7 3 8 1 ,0 9 0 F in a n c e 6 2 ,2 5 2 3 8 ,6 5 8 5 ,0 7 3 1 0 5 ,9 8 3 Pe d ia tri c 1 ,7 4 5 1 ,7 4 5 Pro fe s s io n a l D e v e lo p m e n t 2 4 ,3 9 7 2 4 ,3 9 7 Pu b lic Ed u c a ti o n 2 1 ,2 9 5 2 3 ,9 9 8 4 5 ,2 9 3 R EP C 5 ,9 5 4 ,5 0 5 3 1 5 ,3 2 1 6 ,2 6 9 ,8 2 6 Sy s te m D e v e lo p m e n t Sy s te m PI 4 2 ,7 3 1 1 2 ,5 0 0 5 5 ,2 3 1 T o ta l Ex p e n d it u re s 2 4 6 ,1 0 8 2 9 2 ,2 8 1 5 ,9 5 4 ,5 0 5 3 1 5 ,3 2 1 3 6 ,4 9 8 3 6 6 ,9 6 0 4 7 ,6 8 0 7 ,2 5 9 ,3 5 2 Pe n d in g O b lig a ti o n s 9 4 8 ,2 7 2 9 4 8 ,2 7 2 T o ta l Ex p e n d it u re s a n d O b lig a ti o n s 2 4 6 ,1 0 8 2 9 2 ,2 8 1 5 ,9 5 4 ,5 0 5 1 ,2 6 3 ,5 9 3 3 6 ,4 9 8 3 6 6 ,9 6 0 4 7 ,6 8 0 8 ,2 0 7 ,6 2 4 R e v e n u e s O v e r/ (U n d e r) Ex p e n d it u re s a n d O b lig a ti o n s 1 7 9 ,0 4 1 7 ,1 2 9 1 8 6 ,1 7 1 Be g in n in g U n re s tri c te d N e t A s s e ts 2 9 1 ,1 8 5 2 9 1 ,1 8 5 En d in g T e m p R e s tri c te d N e t A s s e ts 1 7 9 ,0 4 1 1 7 9 ,0 4 1 En d in g U n re s tri c te d N e t A s s e ts 2 9 8 ,3 1 4 2 9 8 ,3 1 4 En d in g N e t A s s e ts 1 7 9 ,0 4 1 2 9 8 ,3 1 4 4 7 7 ,3 5 5 * A SP R /H PP Y R 9 - T w e lv e M o n th s En d e d J u n e 3 0 , 2 0 1 1 ** A SP R /H PP Y R 1 0 - T w o M o n th s En d e d A u g u s t 3 1 , 2 0 1 1 N C T T R A C S T A T E M E N T O F A C T IV IT IE S F O R T H E T W E L V E M O N T H S E N D E D A U G U S T 3 1 , 2 0 1 1
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Emergency Healthcare System Grants
The Emergency Healthcare System of Trauma Service Area-E receives funding from the Texas Department of State Health Services (DSHS) through several funding streams including “Red Light” camera enforcement, the state’s tobacco settlement endowment, 911 surcharges, and various dangerous driving fines.
Programs Supported with the Tobacco Endowment
Maintaining support for training and operations for the REG*E project(our regional patient registry).
Consulting services fees for legal services as well as required independent audits.
Maintaining the Regional Communication Center Trauma Hotline. Supporting member and partner endeavors with donations and
marketing items for events such as “Shattered Dreams” and safety fairs. Items included bike helmets, safety drawstring sport packs, and items with prevention messages.
Supporting educational programs such as the Association for the Advancement of Automotive Medicine (AAAM) Injury Scaling Course for trauma programs, hosting an EMS legal seminar, and for continuing education offerings at the General Membership Meetings.
Purchasing EMS patient backboards for a new pilot regional NCTTRAC backboard program.
Continuing support of NCTTRAC Newsletter development and other means of communication with membership such as our website and social media.
Meeting support for Board of Director, Committee, and General Membership quarterly RAC meetings.
Support of travel to regional and state meetings for appropriate staff and Committee Chairs.
Portions of the costs related to personnel, lease space, office expenses and equipment, training directly related to conducting RAC business, and internet support.
FUNDING NOTES
LEGISLATIVE SOURCE
The Tobacco Endowment Fund was established in the Texas Government Code §403.106 to provide the means for the Department of State Health Services to assist RACs in “maintaining and improving the Texas Emergency Medical Services (EMS)/Trauma System to reduce morbidity and mortality due to injuries.”
FY 2011 TOTAL FUNDING
9 Supplies, $95,461 Op Expense, $39,603 Ed & Trg, $47,092 Equip, $158,160 Vehicles, $23,029 Comm Equip, $3,615
Across 56 EMS Providers
EMS County Assistance “Pass-through” Funds
Funding Details
NCTTRAC received $366,960 in EMS County Assistance funds for distribution to 56 “911” EMS Providers through a
reimbursement process. Licensed EMS Providers must fill both DSHS requirements for data submission, as well as local RAC participation requirements to be able to submit eligible receipts for reimbursement. RAC participation includes a Board approved application and dues, a minimum number of attended meetings, and participation in system performance improvement activities, if requested. EMS Providers were verified to have “active participation” status for their September 2008 through August 2009 membership period.
Items range from EMS supplies such as medication, bandages, and airway equipment to some very unique items. Some of the more interesting expenditures include language translation devices or training for EMS personnel, a four-wheel vehicle for response in off-road situations, recognition awards for EMS personnel, and safety officer training and travel.
2011 EMS County Assistance Fund
Expenditure by Type
The purpose of these funds, originating from the same base sources as the Tobacco Allocation funds, are to assist in the enhancement and delivery of patient care in the EMS and trauma care system.
FUND USE RESTRICTIONS
According to DSHS guidance, the funds in this program can only be used for the following:
Supplies
Operational Expenses
Education and Training
Equipment
Vehicles
Communication SystemsEMS COUNTY ASSISTANCE
“PASS-THROUGH” FUNDS
County No. Providers Amount Per Provider County No. Providers Amount Per Provider Collin 7 $ 3,278 Hunt 1 $ 12,378 Cooke 1 $ 10,118 Johnson 4 $ 2,560 Dallas 21 $ 6,733 Kaufman 2 $ 5,648Denton 12 $ 2,051 Palo Pinto 4 $ 2,338
Ellis 2 $ 6,976 Parker 1 $ 10,460 Erath 4 $ 2,742 Rockwall 2 $ 1,167 Fannin 1 $ 8,767 Somervell 1 $ 1,864 Grayson 1 $ 12,475 Tarrant 18 $ 3,011 Hood 2 $ 3,158 TSA-E Total $ 366,960
10 $872,359
$848,862 $539,766
Uncompensated Trauma Fund Distribution
Across 256 State of Texas Hospitals
3588 Monies 1131 Monies 911 Monies $17,755,191 $3,187,923 $606,744
Uncompensated Trauma Fund Distribution
Across 32 TSA-E Hospitals
3588 Monies Red Light Monies 911 Monies
FY 2011 Uncompensated Trauma Care Fund
Distribution for Hospitals
The Texas Department of State Health Services (DSHS) Office of EMS & Trauma Systems Coordination announced an Uncompensated Trauma Care Fund distribution during the week of September 12th, 2011.
$872,359 from the Designated Trauma Facility and Emergency Medical Services (DTF\EMS) Account (3588 Monies) was distributed to 268 eligible hospitals around Texas. The grand total distributed to eligible hospitals since the inception of this funding source is approximately $382,665,152.
$848,862 from the Emergency Medical Services, Trauma Facilities, and Trauma Care Systems Account (1131 Monies), and $539,766 from the Emergency Medical Services and Trauma Care Systems Account (911 Monies) was distributed to 256 eligible hospitals.
Background Information
Texas Health and Safety Code §780.004 directs DSHS to use 96% of funds in the DTF/EMS Account (3588 monies) to fund a portion of uncompensated trauma care provided at hospitals designated as state trauma facilities or a hospital meeting “in active pursuit” requirements.
Texas Health and Safety Code §780.004 directs DSHS to use 27% of funds in the Emergency Medical Services, Trauma Facilities, and Trauma Care Systems Account (1131 Monies) and 27% of funds in the Emergency Medical Services and Trauma Care Systems Account (911 Monies) to fund a portion of uncompensated trauma care provided at hospitals designated as state trauma facilities.
FY 2011 Uncompensated Trauma Care Disbursement
DISBURSEMENT METHODOLOGY
Uncompensated trauma care charges from2009, as reported by eligible hospitals on the Fiscal Year (FY) 2011 Uncompensated Trauma Care Fund Application (Hospital Allocation), were used in the funding formula.
Fifteen percent (15%) of the total amount of funds available was divided equally among all eligible applicants.
The remaining eighty-five percent (85%) was distributed to eligible applicants based on the percentage of uncompensated trauma care a hospital provided in relation to the total amount.11
Local Projects Grants
The Department of State Health Services Office of Emergency Medical Services Trauma Systems Coordination offers Local Project Grants (LPG) awards to eligible agencies for the funding of projects in support of EMS
initiatives. For FY11, there were 85 applicants across Texas awarded funds totaling $1.3 million dollars. Of these, ten recipients from Trauma Service Area-E, including NCTTRAC, received a total of $130,283.
This was the second straight year that NCTTRAC received a grant from this program. Continuing the theme of the previous year’s award, NCTTRAC received $36,500 to partially fund an injury prevention initiative including life jackets for distribution by EMS agency members, as well as a submersion registry module for the regional patient care registry.
FY2011 LPG Recipients from TSA-E
AGENCY TOWN MEMBER STATUS AMOUNT
Bonham FD Bonham Member $ 1,572 Bridgeport VFD Bridgeport *Non-Member $ 8,592 College Mound VFD Terrell *Non-Member $ 9,447 Cooke County EMS Gainesville Active Participant $ 22,500 Glenn Heights EMS Glenn Heights *Non-Member $ 1,600 Greenwood Rural VFD Weatherford Member $ 2,547 Keene Fire Rescue Keene Active Participant $ 7,500 Kennedale Fire Rescue Kennedale Member $ 35,000 Roanoke FD Roanoke Active Participant $ 5,025 *Membership is not required to receive LPG but qualifies the agency for additional points when
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REG*E
REG*E is the regional emergency healthcare patient data collection registry by the North Central Texas Trauma Regional Advisory Council (NCTTRAC) serving Trauma Service Area – E (TSA-E); thus “REG*E.”
The Board of Directors approved funding and grant requests to purchase REG*E with the purpose of collecting regional patient data using recognized national data sets. Robust reporting features then provide feedback to our participating stakeholders to help decrease morbidity and mortality for the populations of North Texas through professional and public education and system performance improvement. It is through the use of metrics we can drive best practices to reduce, and in some cases eliminate, trauma-related deaths.
FY 2011 began with an implementation process which had stalled due to agreement concerns by some of our members. However, this was soon addressed through cooperative leadership
on both sides and a strategy of helping hospital systems effect agreements for all of their system hospitals. This proved a successful strategy by the end of the fiscal year.
Additionally, FY 2011 saw the acquisition of the stroke application add-on with Texas Department of State Health Services Tobacco Grant funds and the notification that NCTTRAC would be receiving funds to purchase the cardiac add-on, as well, with DSHS Local Projects Grants (LPG) funding. LPGs provided $13,500 in FY 2011 and $75,000 over three total years of matching grants, including the EMS and submersion injury components of REG*E.
REG*E EMS and Trauma Centers Data Progress
It has been an exciting year for the registry! NCTTRAC has witnessed substantial growth not only in participation as demonstrated by executed agreements to participate but with data submissions as well. Since April 2011, agreements signed by trauma centers have grown by 55 percent and EMS provider participation by 35 percent.
Data submissions also increased significantly. In April, there were 10,437 data file submissions in REG*E. Since April that number has increased to 23,231 and is climbing. This is an extraordinary increase that will aide both EMS providers and hospital systems around the region to identify areas of greatest need for resources, education, and manpower allocation.
The REG*E team continues the implementation phase for hospital and EMS patient registry modules. Several healthcare systems are working with NCTTRAC to sign one agreement which will allow all system facilities access to
REG*E. While some agreements are pending for internal approval, there has been 100% success migrating data from all of the hospital trauma and EMS registry vendors in TSA- E.
EMS providers and hospital personnel have access to several REG*E training
classes each month. These are specifically designed to focus on the functionality of REG*E and the robust nature of the reporting system.
REG*E staff is preparing for the roll-out of submersion, cardiac, and stroke components. Staff is also reporting monthly metrics on participation and data submissions to NCTTRAC’s Board of Directors and as well as trauma specific related metrics to its stakeholders. The limits to this exciting regional capabilityare now only limited by the amount of data entered by the participants!
METRICS: SUBMISSIONSQuarterly data submissions from EMS Providers and Trauma Centers for Fiscal Year 2010.
0 4,918 1,235 5,412 1,653 6,363 2,188 6,538 EMS Trauma
SEPT 2010 - NOV 2010 DEC 2010 - FEB 2011 MAR 2011 - MAY 2011 JUN 2011 - AUG 2011
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Acute Care Facility Designation
As the largest Trauma Service Area in the state, NCTTRAC also has a high percentage of trauma and acute care designated hospitals. While this RAC does not designate or certify facilities, NCTTRAC staff plays a significant role in a facility’s ability to meet designation requirements. All Texas Department of State Health Services (DSHS) designations require that the applicant show they are “active participants” in the system of care in which they seek designation. NCTTRAC staff not only keeps running totals of this participation, but also supports a structure where this participation is meaningful to regional patient outcomes. Facilities can meet criteria for participation through regional performance improvement opportunities, liaison activities with EMS Providers, public education and injury prevention activities, regional patient care data analysis, and other critical components of the designated facility’s service to the region through NCTTRAC participation.
Trauma
Trauma designation, by level, has the longest history, with the trauma system in Texas turning twenty years old during 2011. Trauma facilities are designated by DSHS at four different levels:
Level I – Comprehensive Trauma Facility Level II – Major Trauma Facility
Level III – Advanced Trauma Facility Level IV – Basic Trauma Facility All four levels are critical to the trauma system, with Level III and IV facilities serving as treatment and stabilization centers. Level III and IV hospitals not only have protocols for those responsibilities but also have efficient pathways to transfer the most critical patients to a Level I or II trauma center. There is also a NCTTRAC Regional Trauma System Plan and regional guidelines, both adopted by NCTTRAC’s general membership, which provide guidance for transporting directly to a Level I or II trauma center when it is in the best interest for patient care. Level I and II trauma centers are surveyed according to American College of Surgeons Committee on trauma criteria with nationally recognized teams. Level III and IV centers are surveyed by the Texas EMS Trauma and Acute Care Foundation (TETAF) according to DSHS standards. The current list of designated trauma facilities in Texas is available at:
http://www.dshs.state.tx.us/emstraumasystems/E trahosp.shtm
TRAUMA CENTERS
LEVEL
BAYLOR UNIVERSITY MEDICAL CENTER I CHILDRENS MEDICAL CENTER OF DALLAS I JOHN PETER SMITH HOSPITAL I PARKLAND MEMORIAL HOSPITAL I COOK CHILDRENS MEDICAL CENTER II MEDICAL CENTER OF PLANO II METHODIST DALLAS MEDICAL CENTER II TEXAS HEALTH HARRIS METHODIST FORT WORTH II DENTON REGIONAL MEDICAL CENTER III HUNT REGIONAL MEDICAL CENTER GREENVILLE III TEXOMA MEDICAL CENTER III TEXAS HEALTH HARRIS METHODIST HEB III (IP) TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO III
DALLAS REGIONAL MEDICAL CENTER IV ENNIS REGIONAL MEDICAL CENTER IV GLEN ROSE MEDICAL CENTER IV LAKE GRANBURY MEDICAL CENTER IV LAKE POINTE MEDICAL CENTER IV MEDICAL CENTER OF ARLINGTON IV MUENSTER MEMORIAL HOSPITAL IV NAVARRO REGIONAL HOSPITAL IV NORTH TEXAS COMMUNITY HOSPITAL IV NORTH TEXAS MEDICAL CENTER IV PALO PINTO GENERAL HOSPITAL IV RED RIVER REGIONAL HOSPITAL IV TEXAS HEALTH HARRIS METHODIST CLEBURNE IV TEXAS HEALTH HARRIS METHODIST AZLE IV TEXAS HEALTH HARRIS METHODIST STEPHENVILLE IV TEXAS HEALTH PRESBYTERIAN ALLEN IV TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN IV WEATHERFORD REGIONAL MEDICAL CENTER IV WISE REGIONAL HEALTH SYSTEM IV
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Stroke
Stroke care facilities have been designated by various agencies over recent years, with the most common being The Joint Commission, which also accredits hospitals and other specialty areas of care. There are two recognized levels of stroke designations in Texas:
Level II – Primary Stroke Facility Level III – Support Stroke Facility
Level II facilities are certified by The Joint Commission and then designated by DSHS. There is no Level III certification process from Joint Commission, so DSHS has recently developed and is coordinating those surveys
with TETAF according to DSHS standards as well. These designation levels are considered in the NCTTRAC Regional Stroke System Plan, adopted by the General Membership, to assist with the decision on the best facility to receive a pre-hospital patient suspected of having a stroke. The current list of designated stroke facilities in Texas is available at:
http://www.dshs.state.tx.us/emstraumasystems/ etrastroke.shtm.
Cardiac
There are no current state designation requirements for cardiac hospitals, although TSA-E has many facilities that are recognized by the Society of Chest Pain Centers. The proposed NCTTRAC Regional Acute Coronary Syndrome Plan is in a final draft stage and considers these types of cardiac center capabilities for patient destination decisions. NCTTRAC staff and committee members are also actively participating with other regional cardiac initiatives such as the American Heart Association and the Caruth Grant project in Dallas.
STROKE FACILITIES
LEVEL
BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE II BAYLOR UNIVERSITY MEDICAL CENTER II DOCTORS HOSPITAL AT WHITE ROCK II JOHN PETER SMITH HOSPITAL II MEDICAL CENTER OF ARLINGTON II MEDICAL CENTER OF MCKINNEY II MEDICAL CENTER OF PLANO II MEDICAL CITY DALLAS HOSPITAL II METHODIST DALLAS MEDICAL CENTER II METHODIST RICHARDSON MEDICAL CENTER II METHODIST CHARLTON MEDICAL CENTER II NORTH HILLS HOSPITAL II PARKLAND MEMORIAL HOSPITAL II PLAZA MEDICAL CENTER OF FORT WORTH II TEXOMA MEDICAL CENTER II TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL II TEXAS HEALTH HARRIS METHODIST HEB II TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH II TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS II TEXAS HEALTH PRESBYTERIAN WILSON N. JONES II UT SOUTHWESTERN UNIVERSITY HOSPITAL II
CHEST PAIN CENTERS
LEVEL
BAYLOR MEDICAL CENTER AT CARROLLTON II BAYLOR MEDICAL CENTER AT GARLAND III w/pci
BAYLOR MEDICAL CENTER AT IRVING II w/pci BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE II w/pci
CENTENNIAL MEDICAL CENTER III DENTON REGIONAL MEDICAL CENTER III DOCTORS HOSPITAL AT WHITE ROCK II
HEART HOSPITAL BAYLOR PLANO III w/pci LAS COLINAS MEDICAL CENTER II w/pci MEDICAL CENTER OF LEWISVILLE II MEDICAL CENTER OF MCKINNEY II w/pci
MEDICAL CENTER OF PLANO III w/pci MEDICAL CENTER DALLAS HOSPITAL III w/pci METHODIST MANSFIELD MEDICAL CENTER III w/pci METHODIST RICHARDSON MEDICAL CENTER III w/pci NORTH HILLS HOSPITAL III w/pci PLAZA MEDICAL CENTER OF FORT WORTH III TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL III w/pci
TEXAS HEALTH HARRIS METHODIST HEB III w/pci TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE III TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH III w/pci
TEXAS HEALTH HARRIS METHODIST SOUTHWEST III TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS III w/pci TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON II w/pci TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO III w/pci TEXAS HEALTH PRESBYTERIAN WILSON N. JONES III w/pci WISE REGIONAL HEALTH III w/pci
15 22% 21% 19% 31% 7% PROGRAM OVERARCHING LEVEL 1 LEVEL 2 PHER
Hospital Preparedness Program
NCTTRAC continued its leadership role in pre-hospital and hospital preparedness efforts by again serving as the Hospital Preparedness Program (HPP) regional contractor for the Texas Department of State Health Services. Of the state’s 664 hospitals, 135 of TSA-E’s hospitals participated in the program making NCTTRAC, and its
subrecipient hospitals, the largest Texas regional healthcare coalition. Demonstrating region-wide improvements in medical surge capacity, NCTTRAC, participating hospitals, and area EMS agencies showcased health care delivery preparedness while supporting local, regional, state, and federal agencies during both the 2010 World Series and Super Bowl XLV. These efforts became the springboard for enhancement of the healthcare coalition and future refocusing of the Hospital Preparedness Program toward regional capacity and capabilities building.
HPP Funding
Contract Award
NCTTRAC received $5,254,505 in baseline HPP funding for the period July 1, 2010 – June 30, 2011. This represented 18.3% of the federal $28,701,403 award received by Texas. Supplemental funding for the
development of an Emergency Medical Task Force ($250,000) and Public Health Emergency Response (PHER) improvement ($450,000) boosted program funding to $5,954,505.
Funding Distribution
HPP expenditures promoted the growth of the healthcare coalition and hospital readiness during Year 9 through a prioritized spending approach of Overarching, Level 1, and Level 2 Sub-Capabilities.
HPP CAPABILITY SPENT
PROGRAM IMPLEMENTATION $1,355,315 OVERARCHING REQUIREMENTS $1,290,734 LEVEL 1 SUB-CAPABILITIES $1,130,896 LEVEL 2 SUB- CAPABILITIES $1,727,560 PHER PROJECT $450,000 TOTAL $5,954,505
HPP YEAR 9 OVERVIEW
Contract Period July 1, 2010 – June 30, 2011
HPP Year 9 Award Total Funding: $5,954,505 HPP Award: $5,254,505 EMTF Award: $250,000 PHER Award: $450,000
Participating Hospitals Start: July 2010: 126 End: June 2011: 135
Funding Per ParticipatingHospitals: $5,500
Per Capita Funding(Population 6,776,660): $0.673120 HPP $5,254,505 PHER $450,000 EMTF $250,000
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HPP Expenditures by Activity
NCTTRAC and hospital expenditures prioritized and supported 14 of 17 program activities in HPP Year 9. Work within the three remaining requirement areas was accomplished at no cost.
NCTTRAC Programmatic Support
NCTTRAC provided logistical support to regional preparedness and coalition building by implementing major procurement contracts. Primary regional projects included support of the LiveProcess hospital incident management system for all subrecipient hospitals, the provision of commercial and amateur band radios to hospitals, procurement of personal protective and decontamination equipment for new subrecipients, two ambulance buses, and ten refrigerated support trailers.
Use of Hospital Reimbursement Allocation
NCTTRAC procured the LiveProcess hospital incident management system for all subrecipient hospitals, and implemented within that platform a system by which those hospitals were able to file an expenditure plan and appropriate documents supporting their expenses. Based upon a regionally-approved formula that gives more credit to hospitals that most contribute to regional healthcare delivery in a mass casualty situation, hospital allocations totaled $1,294,276, and ranged from $3,130 for the smallest non-acute care facility to $26,841 for the largest trauma centers.
HPP CAPABILITY ACTIVITY EXPENDITURES
OVERARCHING NATIONAL INCIDENT MANAGEMENT SYSTEM (NIMS) $1,121,698
EDUCATION AND PREPAREDNESS $115,949 EXERCISES, EVALUATIONS, AND CORRECTIVE ACTIONS $40,673 NEEDS OF AT RISK POPULATIONS $40,673
LEVEL 1 SUB-CAPABILITY INTEROPERABLE COMMUNICATIONS $959,103
FATALITY MANAGEMENT $483,952 MEDICAL EVACUATION / SHELTER IN PLACE $135,786 PARTNERSHIPS AND COALITIONS $2,054 BED TRACKING AND REPORTING $0 EMERGENCY SYSTEMS FOR ADVANCED REGISTRATION OF VOLUNTEER
HEALTH PROFESSIONALS (ESAR-VHP) $0
LEVEL 2 SUB-CAPABILITY MOBILE MEDICAL ASSETS $1,275,345
PERSONAL PROTECTIVE EQUIPMENT (PPE) $282,246 DECONTAMINATION EQUIPMENT $65,651 CRITICAL INFRASTRUCTURE PROTECTION $32,745 ALTERNATE CARE SITES $3,215 PHARMACEUTICAL CACHES $387 MEDICAL RESERVE CORPS $0
PROJECT SUPPORTED SPENT
LIVEPROCESS ALL SUBRECIPIENT HOSPITALS $1,105,962
AMBULANCE BUSES EMERGENCY MEDICAL TASK FORCE $1,048,371
REFRIGERATED SUPPORT TRAILERS REGIONAL HEALTHCARE COALITION $450,000
SUBRECIPIENT HOSPITAL RADIOS ALL SUBRECIPIENT HOSPITALS $116,080
PPE AND DECON EQUIPMENT ALL SUBRECIPIENT HOSPITALS $36,011
17 Final 101 Draft 28 No Plan 4 Final Mass Fatality Plans Of the $1.294 million allocation, hospitals requested reimbursement for $615,189. A second reimbursement phase was implemented which provided another $553,438 to 29 hospitals. NCTTRAC applied the remaining
unclaimed $125,649 to regional projects and, following a contract amendment, awarded a purchase order for two ambulance bus chassis for use by Emergency Medical Task Force-2.
Subrecipient Hospital Planning for Response
The Hospital Preparedness Program sets benchmarks by which subrecipient hospital planning and readiness may be measured. These benchmarks include the development of plans for mass human fatalities, pandemic influenza response, medical evacuation and sheltering in place, pharmaceutical cache distribution, and medical evacuation / shelter in place planning. Subrecipient hospitals are also required to establish and maintain the capability to perform decontamination and use personal protective equipment.
Mass Fatality Planning
Each subrecipient hospital was expected to complete a final mass fatality plan that includes a process for handling deceased remains of up to 5% of their licensed bed capacity for 24-hours. NCTTRAC supported this goal by providing each hospital the BioSeal fatality response system. BioSeal is capable of supporting Biosafety Level 4 containment of deceased remains.
Pandemic Influenza Response Planning
Each subrecipient hospital was expected to have a final Pandemic Influenza Response Plan that addresses development and operation of Alternate Care Sites (ACS), triage of the ill, science-based triggers for action, use of personal protective equipment, just-in-time training of staff, education of the workforce, education of ill individuals and their caregivers, and equipment and supplies. These plans should continue to develop and improve ACS plans and concept of operations for providing supplemental surge capacity to the healthcare system. Initial Reimbursements 47% End of Year Reimbursements 43% Reassigned to Regional Projects 10%Hospital Reimbursement
Allocation Usage
Final 64 Draft 11 No Plan 2 Pandemic Influenza Response Plans18
Pharmaceutical Cache Planning
Each subrecipient hospital was expected to complete a final pharmaceutical cache plan that provided for the distribution of broad spectrum prophylaxis for hospital staff and hospital-based EMS, and their families, for a period of 72 hours. Plans addressed the continued purchase, rotation, and maintenance of antibiotic and antiviral caches and vendor relationships in lieu of direct purchase.
Medical Evacuation / Shelter in Place
Planning
Subrecipient hospitals were expected to have the ability to receive emergent shelter-in-place notifications and institute appropriate shelter-in-place plans including notifications within the facility, communication internally and externally, and institute measures to preserve facility
infrastructure and to sustain such operations for at least 48 hours. Supporting facility evacuation, all subrecipient hospitals were required to have a final plan detailing vertical and horizontal evacuation within the facility, out of the facility but within the local area, and out of the facility and out of the local area.
Decontamination and Personal Protective Equipment (PPE)
Hospitals must ensure that adequateamounts of appropriate personal protective and decontamination equipment is in place to protect current and additional trained healthcare personnel expected in support of response to hazardous events. Acute care hospitals have a minimum requirement of 12 sets of Level C personal protective equipment. Non-acute care facilities are expected to have at least six sets of Level C PPE. NCTTRAC provides initial PPE and decontamination equipment to hospitals joining the program. Hospitals with existing stocks
of PPE and decontamination equipment are expected to use the reimbursement system to maintain and sustain these minimum levels. The amount and type of PPE and decontamination equipment held by hospitals is dictated by the facility’s Hazard Vulnerability Assessment.
Final 76
Draft
17 No Plan 7
Final Pharmaceutical Cache Plans
Level C Partially Achieved Not Reported
Level C PPE Achieved
Acute Care Non-acute Care 13 6 22 14 62 16 Final 98 Draft 24 No Plan 11
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Training & Exercises
Throughout the Hospital Preparedness Program (HPP) contract year, NCTTRAC provides regional training courses, drills, and exercises designed and implemented in support of ESF- 8 (Emergency Support Function #8) Public Health and Medical Services. Training courses are identified through workgroups, regional recommendations, and exercise After Action Reports. Once identified for the upcoming program year, hands-on training, classroom-based informative sessions, and regional functional-level exercises are submitted to the Department of State Health Services (DSHS) within a cumulative document referred to as the Multi-year Training & Exercise Plan or MYTEP. The purpose of the MYTEP is to allow multiple organizations, within a trauma service area and across the state, to coordinate training courses and exercises in an effort to reduce or eliminate duplicated efforts. All NCTTRAC training and exercise efforts are consistent with identified regional and state priorities through a standardized implementation program, the Homeland Security Exercise and Evaluation Program.
While the overarching sub-capabilities for training and exercises are directed from DSHS, regionally identified hazards and threats specific to North Central Texas are analyzed annually. Based on a systematic process for ranking hazards (i.e., tornados, hurricanes, terrorism), training courses and exercises are designed and
implemented to address regional hazards. During HPP Year 9, a workgroup designated specifically for creating a regional Hazard Vulnerability Analysis (HVA) was established in order to both complete a required regional HVA for NCTTRAC and to guide in the development of future training and exercise needs for the region.
Hazard Vulnerability Analysis (HVA)
Under the direction of the Regional Emergency Preparedness Committee (REPC), the HVA Workgroup was formed with the distinct purpose of creating a regional report that captured, through a survey assessment tool, hospital and public health hazards. Volunteers were solicited and quickly gathered momentum through REPC members’ participation. This workgroup included representation from several major trauma facilities within the metroplex with Chris Noah, from Parkland Hospital in Dallas, serving as workgroup lead.
A standardized methodology for gathering hospital data was identified and the survey assessment tool was implemented region-wide. Hospitals accredited by The Joint Commission are required to conduct or review their respective HVA annually, and the workgroup recognized that a wide-array of HVA assessment tools would be in
53 36 26 19 18 18 17 10 7 3
HVA Results Reported Fall 2011
Tornado Severe Weather Ice Storm Electrical Failure IT Failure Mass Casualty Epidemic / Disease Outbreak
Water Supply Failure Large-scale Terrorism Miscellaneous Results Not Displayed: 41%
Total of Completed Surveys: 69 Total Number of Hazards: 357
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use. Next steps included evaluation and use of a standardized HVA tool along with data analysis and assessment of the results. With NCTTRAC staff support, the HVA Workgroup surveyed hospitals within the North Central Texas region for their top HVA results using a standardized tool. Ranking of top priorities and hazards are shown above.
Super Bowl XLV & Regional Exercise Jericho
The North Central Texas region has successfully managed many large-scale planned and unplanned events in its past but none greater in scale than the planning and preparation for Super Bowl XLV (SBXLV). Advanced exercise planning began as early as March of 2009 during which NCTTRAC supplemented wage-offset costs for hospital staff who were actively involved in training and exercises in preparation for the February 2011 event. Throughout the months leading up to SBXLV, NCTTRAC staff was also heavily involved in regional planning efforts to support the readiness of public health and medical services through the facilitation of regional planning sessions and through staff attendance of regional meetings, as well.
Leading up to the Super Bowl, NCTTRAC staff participated in planning committees, workgroups, specialized training, and various levels of response exercises. Under mobilization order by DSHS, NCTTRAC staff was assigned as an agency representative for medical services as one of the ESF-8 liaisons serving in support of the combined Disaster District Committees (DDCs) in our region from January 27 to February 6, 2011. The Trauma Service Area – E Medical Operations Center (TSA-E MOC) was also activated during this time with staff support throughout the game.
In preparation for the Super Bowl and the Regional Exercise (REGEX) Jericho, which was held in January in preparation for the SBXLV, NCTTRAC staff improved the use of a tracking tool through WebEOC to allow for the regional tracking of patients in a mass casualty incident (MCI). The final product, referred to as the MCI Toolkit,
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was used by all hospital exercise participants during REGEX Jericho. Jericho was designed around a scenario-simulated act of terrorism at a major sporting event, resulting in a potential “perfect storm” for a mass casualty incident.
REGEX Jericho was designed to test the regional strengths and weaknesses of response elements related to patient triage, transport, transfer, and tracking. The exercise was conducted during evening hours while also running concurrently with a real event, the 2011 ATA&T Cotton Bowl Classic. The atypical timing of a regional exercise during the evening hours along with the alignment during the Cotton Bowl game demonstrated regional planning, training, and exercise commitment by participants in support of SBXLV preparation.
REGEX Jericho served as the first steps for regional testing of preparedness efforts in patient tracking and transfer in advance of Super Bowl XLV. Nearly one hundred organizations from within the North Central Texas region were involved which allowed for a significant “proof of concept” testing of the new MCI Toolkit. Prior to the exercise, discussion and planning sessions with local EMS agencies and hospitals were conducted to maximize the use of this computer-based tracking tool during field triage.
With the nod of approval from our participating EMS partners that the tool could potentially serve to assist with a regional patient transfer / tracking system during a mass casualty incident, the first test of the system was conducted. For the hospitals and partnering agencies participating during the exercise, the MCI Toolkit was used for the transfer of over 2,000 simulated patients. These simulated patients were entered, tracked, and/or transferred throughout the region within the exercise duration of 4 hours.
This bank of simulated patients included fictitious first and last names, dates of birth, gender, and triage categories. Simulated patients were received and transported within WebEOC in a system of waves, as shown above. With the exception of minor adjustments following the exercise, the MCI Toolkit showed great promise for its utilization as a successful resource for tracking patients during a large scale emergency.
Packaged Exercises
Over the course of three HPP program years, NCTTRAC has provided several regional functional-level exercises that meet requirements set forth by DSHS, the National Incident Management System (NIMS), the Homeland Security Exercise & Evaluation Program (HSEEP), and The Joint Commission. By providing regional exercises at the functional level, NCTTRAC assists hospitals with fulfilling their exercise requirements to test their Emergency Operations Plans, Hospital Incident Command System, and Hospital Command Centers.
NCTTRAC now offers these past exercises as a “packaged deal” that allows hospitals to conduct one of the regional, NCTTRAC staff-developed exercises to assist hospitals with continuing to meeting their exercise requirements or serving as a re-test opportunity for any corrective action items that were identified during previous training or exercises. The packaged exercises being provided by NCTTRAC include all supporting and required HSEEP and DSHS exercise documentation including the After Action Report template, the Exercise Evaluation Guide, and the Master Scenario Events List. With the provision and support of our regional exercise packages, it is just one more way that NCTTRAC staff is continuing to support hospitals’ successful training and exercise activities!
22 56% 26% 5% 5% 4% 4% Hospital Other Fire Public Health EMS County
HPP Year 9 Exercise “Recap”
Exercise Scenario: The North Central Texas region was impacted by an act of terrorism with partial structural collapse of a major venue during a high-profile sporting event. As first responders coordinated patient triage and transportation, hospitals’ mass casualty plans were activated in preparation for overwhelming patient surge, patient discharge / transfers, and coordination activities.
Exercise Scenario: The North Central Texas region was impacted by an act of terrorism involving an aerosolized biological weapon. This incident affected a significant portion of the population. Public health officials began efforts to minimize the outbreak by operating Points of Dispensing Sites for treating the general public within the region. Regional Exercise Red Cloud was conducted simultaneously and in collaboration with Operation Bluebonnet conducted by DSHS Health Service Region 2/3.
Regional Training
Each year, training courses are provided to address areas of concern from either vulnerabilities identified within the regional HVA, overarching sub-capabilities and requirements, hospital liaison recommendations, and
deficiencies trending from exercise After Action Reports. During the time that NCTTRAC has managed the Hospital Preparedness Program for Trauma Service Area-E, training courses have ranged from the operational functionality of hospital decontamination team
members to those in need of critical incident stress management for mental health situations. In HPP Year 9, NCTTRAC provided new courses for our region including a Healthcare Facility Evacuation Training Course, Internal HAZMAT Spill Course, and DECON Refresher training.
This year, training was again provided on hospital campuses across North Central Texas in a continued effort to bolster the readiness level of hospital decontamination teams. The capability for hospital emergency departments to provide mass patient decontamination is vital. The course of instruction covers the required precautionary measures as identified by the Occupational Safety and Health Administration (OSHA) for first receivers in healthcare facilities.
The benefit of conducting training at hospital locations is allowing staff the familiarity of their provided equipment and the footprint of operations. A component of the on-site vendor training that hospitals receive is the added value of having a subject matter expert available to provide recommendations of practices that have worked best at other locations.
As each hospital is unique in geographic location, access points, emergency department, and ambulance bay entrances, staging of equipment and the response process varies widely. Instructors share these lessons learned and best practice methods throughout the course of instruction. Trained team leaders and team members then
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serve as a force multiplier throughout their own hospitals and the region as their expertise is shared from NCTTRAC supported training initiatives and beyond!
MMU Training & Maintenance Videos
During the eighth year of the Hospital Preparedness Program, funding was allocated for the creation of a training video that explained the deployment, operational functionality, nomenclature, and reconstitution of the Base X model Mobile Medical Units. The purpose of the training video was to provide a “just in time” tool for asset deployment while also being used as an introductory training aid. The availability of expedient training is vital to the operational direction NCTTRAC is heading toward with the development and implementation with the Emergency Medical Task Force. As several Base-X model MMUs have been forward placed in anticipation of an event, annual competency training is a must.
Over the past year, a second video was created to provide training on the maintenance of the entire unit. This includes the main sections of the asset, as well as the ancillary equipment such as generators, inflator boxes, and HVAC units. Both videos are available for viewing on the NCTTRAC homepage.
1. HVA Page: http://www.ncttrac.org/Committees/RegionalEmergencyPreparedness/RegionalHVAWorkgroup/tabid/325/Default.aspx 2. Packaged Exercises: http://www.ncttrac.org/TEPIEDUC/DrillsExercise/PackagedExercises/tabid/328/Default.aspx 3. Regional Training: http://www.ncttrac.org/TEPIEDUC/TrainingandEducation/tabid/67/Default.aspx 4. MMU Training Video:
http://www.ncttrac.org/TEPIEDUC/TrainingandEducation/MMUDeploymentTraining/tabid/271/Default.aspx 5. MMU Maintenance Videos:
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Data and Information Systems
NCTTRAC’s Data and Information Systems Division has made extraordinary progress over the last 12 months. There are always further opportunities ahead in the coming year, which we look forward to tackling with dedication and optimism. This portion of the report provides you with a summary of the DIS Division’s goals and objectives as well as our successes.
The mission of the Data and Information Systems Division is to provide superior crisis application systems and customer service to support the mission of NCTTRAC and its partners.
In Support of TSA-E
Being consistent with our mission statement, a goal to build and provide a comprehensive online support system for our end users. That system was launched in late May 2011.
The scope of the potential for end user support is demonstrated in the chart to the right. While many of the accounts are duplicated in the different systems, there are variations for a number of reasons. The largest of these reasons is the agencies and users in E*TRACS for TSA-C and D in direct support of Emergency Medical Task Force-2.
Support Requests
Since the deployment of the online support system, the DIS Division has responded to 1,600 support tickets and had 4 live support chats. That averages out to about 9 tickets a day with an initial response time of 4 hours. Our goal is to have a response time of less than 6 hours for any ticket.
The following table outlines how the requests come to the support helpdesk. Level 1 Support handles all the tickets first for resolution. If resolution cannot occur, the ticket gets escalated to Level 2 Support. The RAC Internal Group is a section set up for internal staff to route tickets to the support helpdesk. Items in this group are website or distribution list updates. REG*E Support is a group specifically dedicated to the support of the regional patient registry. 519 462 402 1270 1168 1030
E*TRACS WebEOC EMResource
Agency and User Counts
Agencies UsersTICKET SOURCE GROUP TOTAL WEB EMAIL
LEVEL 1 SUPPORT 842 123 714
LEVEL 2 SUPPORT 2 0 2
RAC INTERNAL 650 647 3
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99.999% 99.999% 99.999%
99.996%
99.999%
E*TRACS WebEOC REG*E Tandberg Email
Uptime
Uptime Report
The world of data management is measured in the time it is accessible to the end user. The expectation in the social world is that data systems are available and “up” at all times. This is all the more important in the world of emergency management. While email and websites are important, to NCTTRAC and our partners, our crisis applications take precedence. The critical applications we host are:
E*TRACS WebEOC REG*E
Tandberg Video Conferencing Email and Listserv
This chart shows the availability (uptime) of each of the above crisis or critical applications we host at the NCTTRAC. We maintain a 99.999% available status on all our major systems, including the network which is up 99.99999% of the time.
In perspective, this translates into being unavailable for about 5.3 minutes over the course of last 365 days. The causes of that unavailability were by updates to the system. In the past year, we did not encounter any unplanned outages.
Redundancy and Back-up
In the emergency management community, redundancy and back-up are terms that are applied to several theories. In the data management community these terms mean very specific things.
Redundancy is having a real-time, ready to take over, duplicate of the system. In this past year, we established a contract with the Southwest Texas Regional Advisory Council (STRAC) to share and host a redundant system for our crisis applications. In return, we are hosting a backup copy of their critical data. That link was established four months ago, and we are working to improve the connection between us for a solid fail-over redundant solution.
Back-up is a capture of data at a point in time and producing a copy in case of a failure. We back-up all data on a nightly schedule. This back-up is hosted locally. We are currently testing the Southwest Texas Regional Advisory Council and others for a secondary backup location. We expect the resolution of this project by the end of the calendar year 2011.
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Crisis Applications
E*TRACS
E*TRACS is the acronym for TSA-E Tracking Resources, Alerting, and Capabilities System. It is a web-based database software that provides tools for coordinated preparedness and response by the health and medical sectors of our area.
It was developed by ImageTrend (same developer for our patient registry software) specifically to track bed, inventory and resource availability from all designated agencies within the area as well as providing for allocation of these resources to support surge capacity needs. Agency diversion status, EMS resources, resource requests, and alert notifications are supported in real time.
There has been substantial growth in the E*TRACSproduct in the past year. We started in March 2011 reporting bed information and using the notification system for alerts and advisories. We also started uploading the RAC specific documents into the Knowledgebase for easy access by facilities.
WebEOC Integration
A large advancement this past year has been the integration of WebEOC Medical Dashboard information into E*TRACS.
We have integrated all the bed types to populate from WebEOC to E*TRACS and vice-versa. This advancement has given us the opportunity to allow for 75% more time for the hospitals to gather bed information and report it. The reason for this is because of the dynamic and quick reporting capabilities we have in E*TRACS versus what is available for reporting in WebEOC.
WebEOC
WebEOC is a web-enabled, user-friendly, and locally-configurable incident and event management system. With access to the Internet, authorized emergency managers and first responders, regardless of location, can enter and view incident information in WebEOC status boards. NCTTRAC uses WebEOC to collaborate through situational awareness and a common operating picture with regional and state partners.
As mentioned in the Training and Exercises section, a significant tool was added to the WebEOC arsenal in response to an identified need for patient tracking and transfer in support of the Super Bowl. In February 2011, we deployed
