Florida Trauma / EMS Florida Trauma / EMS SystemSystem

California• 58 counties• Population: 36.5M• Size: 158,706 sq

miles

Florida• 67 counties• Population: 18m• Size: 58,664 sq

miles

Florida Trauma / EMS Florida Trauma / EMS SystemSystem

• 266 licensed EMS providers

• 3800 permitted BLS/ALS ground units• 21 rotor wing providers, 61 helicopters• 19 fixed wing providers, 59 airplanes• Boats?

• 3,200,000 EMS calls per year

Florida Trauma / EMS Florida Trauma / EMS SystemSystem

• Active:– EMT 28,131– Paramedics 21,238

• Inactive:– EMT 7,694– Paramedic 1,605

Florida Trauma Center HistoryFlorida Trauma Center History

• 1982 Certification of trauma centers began.

• During the 1980’s, as many as 48 approved trauma centers existed.

• 26 trauma centers closed during the 1980’s.

• 2 trauma centers closed during the 1990’s.

• There are currently 20 approved trauma centers.

Level I: 7Level II: 6Level II & Pediatric: 5Pediatric: 2Total: 20 Trauma Centers

Florida Adult and Pediatric Trauma Center LocationsFlorida Adult and Pediatric Trauma Center Locations

Trauma Care RegulationTrauma Care Regulation

• Chapter 395, Hospital Licensing and Regulation, Part II: Trauma

• 64E-2, Florida Administrative Code

• DOH Pamphlet 150-9,

Trauma Center and Pediatric

Trauma Center Approval

Standards

Secretary of Health/Surgeon General

Director, Emergency Medical

Operations

Bureau of Emergency

Medical Services

Office of Trauma Public Health Preparedness

Trauma Center Verification

– ACS versus State DOH

– New trauma center

Costs of Trauma CenterCosts of Trauma CenterReadiness 2002Readiness 2002

Focused on four areas:• Physician on-call coverage• Periodic recertification• Outreach and prevention programs• Other extraordinary and non-

chargeable costs

(Average median annual cost)

* The study omitted several significant types of costs: start-up, cost of uninsured/underinsured patients, and many indirect facility costs associated with being prepared to treat trauma patients

• $2,080,102• $124,120• $56,543• $811,274

$2,706,510

2003-20082003-2008Funding ExamplesFunding Examples

• $4 Million 2003 HRSA Burn Care Grant• $11 Million 2004 HRSA Burn Care Grant• $16 Million 2005 HRSA Burn Care Grant• $5 Million 2006 HRSA Burn Care Grant• $6.5 Million 2007 HRSA Burn Care Grant• $4.5 Million 2008 HRSA Burn Care Grant

2003-2007 Total: $42.5 Million

HB 497, HB 1697 – Red light running – $12.4m over 21 months distributed to trauma centers

Data and Outcomes

• EMS Tracking and Recording System (EMSTARS) (CEMSIS)

• State trauma registry

Adult Trauma Criteria

CATEGORY 1(Any 1)

CATEGORY 2(Any 2)

AGE >55 years old

AIRWAY Active airway assistance Respiratory rate >30

CONSCIOUS BMR <5, paralyis, cordinjury, GCS <12

BMR 5

CIRCULATION No radial pulse ANDheart rate >120, SBP <90 mmHg

Sustained heart rate>120

Adult Trauma Criteria

CATEGORY 1(Any 1)

CATEGORY 2(Any 2)

FRACTURE 2 or more long bonefracture sites

Single long bone fracturesustained in MVC or fall>10 feet

CUTANEOUS Amputation; 15%TBSA burn; penetratinginjury to head/neck/torso

Major degloving; majorflap avulsion; GSW toextremities

MECHANISMOF INJURY

Ejection from motorvehicle; steering wheeldeformity

PARAMEDIC JUDGEMENT*

Pediatric Trauma Criteria

CATEGORY 1(Any 1)

CATEGORY 2(Any 2)

SIZE 11 Kg, <1 yo, Broslowred/purple

AIRWAY Intubated or manualopening

CONSCIOUS Altered MS, coma,paralyis, cord injury

Amnesia or reliable LOC

CIRCULATION Nonpalpable radial orfemoral pulse, SBP < 50mmHg

Central pulses palp,peripheral not; SBP 50-90; cap refill >3 seconds

Pediatric Trauma Criteria

CATEGORY 1(Any 1)

CATEGORY 2(Any 2)

FRACTURE Open long bone fracture;multiple fracture sites ordislocations; pelvic fx

Single closed long bonefracture

CUTANEOUS Major tissue disruption;amputation; 10%TBSA burn; penetratinginjury to head/neck/torso

EJECTION*

PARAMEDIC JUDGEMENT*

Miami-Dade County

Uniform Trauma Transport Protocols

System participants:

City of Coral Gables Fire-Rescue Department

City of Hialeah Fire-Rescue Department

Miami-Dade County Fire-Rescue Department

City of Miami Fire-Rescue Department

City of Miami Beach Fire-Rescue Department

Village of Key Biscayne Fire-Rescue Department

American Ambulance Service

American Medical Response

Florida Medi-Van Ambulance

Medics Ambulance Service

Miami-Dade Ambulance

Lifeflight (Miami Children’s Hospital)

LifeNet Air Medical Services

Out-of-County Indigent Patients

• County resident

• Funded

• Trauma Center – Outside County agreements

• HCRA funding – millage tax

• Repatriation