Amended Trauma Service Area Assessment
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1 Amended Trauma Service Area Assessment Florida Department of Health Bureau of Emergency Medical Oversight Health Information and Policy Analysis Program Date: March 24, 2014
2 Contents Data Sources... 3 Glossary of Terms... 3 Review of the Assignment of the 67 Counties to Trauma Service Areas... 5 Trauma Center Funding... 6 Trauma Service Areas... 7 Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Trauma Service Area Conclusion... 26
3 Data Sources The hospital discharge dataset is collected by the Agency for Health Care Administration (AHCA). It is a comprehensive set of all hospitalizations in the state. Records used for this report are for The Florida Emergency Medical Services Tracking and Reporting System (EMSTARS) collects incident-level information on millions of EMS incidents every year, for benchmarking and quality improvement initiatives. EMSTARS currently contains over nine million records. The EMSTARS data used for this report is for The Florida Trauma Registry collects patient-level data from the state s verified and provisional trauma centers, as authorized by section (1), Florida Statutes. Verified and provisional trauma centers must maintain a comprehensive database of those injured patients treated within the hospital. The records used for this report are , the three most recent years available. The data regarding severely injured patients was derived from the AHCA hospital discharge database for US Census Data was used to determine TSA demographics. Population is based on 2012 estimates. Glossary of Terms 1) Acute Care Hospital An acute care hospital is defined by the Agency for Health Care Administration as a facility type that is equal to a hospital with acute care bed capacity. Acute care hospitals include trauma centers. 2) Statutory Trauma Center Patient Volume Defined by section (1), Florida Statutes. Florida counties with a population of more than 500,000 are Duval, Brevard, Miami-Dade, Hillsborough, Lee, Orange, Palm Beach, Pinellas, and Polk. 3) Annual Trauma Patient Volume Trauma patient volume is derived from the state trauma registry for records submitted by provisional and verified trauma centers for No inclusion criteria were applied to the self-reported volumes. 4) ICISS: International Classification Injury Severity Score, ICISS is derived using the Agency for Health Care Administration discharge database. Probability of Survival (SRR=Survival Risk Ratio): ratio of the number of patients with that injury code who have survived to the total number of patients diagnosed with that code Age is included as a predictor variable with the SRR 5) Severely Injured Patient A patient with injuries as defined in the National Trauma Data Standard Patient Inclusion criteria with an ICISS score of <.85, excluding a length of stay of less than 24 hours or isolated hip fractures. 3
4 6) Severely Injured Patients Discharged from Acute The number of severely injured patients that were discharged from an acute care hospital (excluding trauma centers) as reflected by the AHCA database of ) Annual Percent of Patients Discharged from Acute The total number of severely injured patients discharged from acute care hospitals (excluding trauma centers) divided by total number of severely injured patients. 8) Rotor Wing Aircraft Rotor Wing Aircraft includes all rotary winged aircraft permitted by the Department. The total number of aircraft per TSA is derived from the Customer Oriented Medical Practitioner Administration System (COMPAS). Aircraft such as jets or airplanes are considered fixed wing aircraft and are not included in this measure. This is a static look at the COMPAS database for a specific time period and does not differentiate between active and inactive aircraft. Aircraft represented in this assessment may service multiple TSAs. 9) Permitted EMS Ground A vehicle that is permitted by the department to perform Basic Life Support or Advanced Life Support and transport patients to a receiving facility. The total number of permitted EMS ground vehicles per TSA is derived from a static look from the COMPAS database and does not differentiate between active and inactive vehicles. EMS ground vehicles represented in this assessment may service multiple TSAs. 10) EMS Ground Vehicle to The total number of permitted ground vehicles, regardless of transport or non-transport status, to a population of 10,000 residents. (Total number EMS Ground /Population)*10,000 11) EMS Ground Vehicle to The total number of permitted ground vehicles, regardless of transport or non-transport status, to 100 square miles. (Total number EMS ground /)*100 12) Median Transport Time The median EMS transport time is derived from the Emergency Medical Services Tracking and Reporting System (EMSTARS). All patients transported to a hospital licensed as a verified trauma center are included regardless of illness or injury. EMS transport time is the difference between the time the unit left the scene and the time the EMS unit arrived at the hospital. Transport time includes all EMSTARS records submitted from 2009 to 2012 with a Type of Service Requested equal to 911 scene or intercept. Records that had a median transport time of greater than two hours were excluded. 4
5 Review of the Assignment of the 67 Counties to Trauma Service Areas Since 1990, Florida's 67 counties have been assigned to 19 trauma service areas (TSAs) pursuant to section , Florida Statutes. As required by legislative amendments to the trauma statutes in 2004, the assignment of counties to TSAs is to be reviewed annually. The first such review occurred on February 1, 2005, when the Department released A Comprehensive Assessment of the Florida Trauma System which was conducted by the University of South Florida. The 2005 assessment considered transforming Florida's TSAs so that the boundaries of the TSAs would be identical to the boundaries of the Regional Domestic Security Task Forces (RDSTFs), thus realigning counties and reducing the number of TSAs to seven. While the assessment determined it may be possible to transform the TSAs into areas that coincide with the RDSTFs, it noted that regional trauma agencies would need to be developed in each of the larger geographical areas in order to make the transformation feasible. As part of this assessment, the Department again evaluated the possibility of altering the current county assignments to establish TSAs that are identical to the RDSTFs. At this time, Florida has just one regional trauma agency and three local trauma agencies. None of the regional or local trauma agencies have boundaries that are identical to the RDSTFs. Neither the one regional trauma system plan in existence nor the state trauma system plan recommend realignment of counties into the RDSTFs for allocation purposes. While the RDSTFs present opportunities for planning and performance improvement, the RDSTFs are too large of a geographic area to ensure the even distribution of trauma centers throughout Florida. Without the existence of regional trauma agencies in each of the trauma regions, the allocation of trauma centers throughout the state should continue to be guided by the more geographically compact TSAs. Also as part of this assessment, the Department evaluated the current county assignments to TSAs. The existing TSAs have been used to guide trauma center development in Florida since 1990 and are familiar to all stakeholders of the trauma system. On review, the Department has determined that none of the current county assignments require realignment at this time. The most appropriate alignment of counties is described in section (4)(a), Florida Statutes. 5
6 Trauma Center Funding As noted by the American College of Surgeons in its Trauma System Consultation Report, "Florida is fortunate to have several funding sources to support the trauma program." The Florida Legislature provides funding for existing trauma centers through portions of the revenue from the vehicle registration taxes and red light camera fines. The funding provided to existing trauma centers has increased significantly in the past two years as a result of the installation of red light cameras throughout Florida. For example, funds distributed to trauma centers in calendar year 2011 totaled $5,163,848.64, and in 2012, that number more than doubled with distributions to trauma centers totaling $12,683, The current funding methodology is prescribed by section , Florida Statutes, and uses trauma patient volumes to disburse funds. As part of its Trauma System Consultation Report, the American College of Surgeons system consultation team recommended changes to Florida's current funding methodology. As the needs of the Trauma Program and trauma system change, the Trauma Program should consider revising the statutes and rules governing the trauma fund to ensure that designated trauma centers receive levelappropriate support for the "cost of readiness." In addition, distribution of funds should focus on the deliverables established by the Trauma Program rather than volume and acuity exclusively. The Department concurs with the assessment of the system consultation team. 6
7 Trauma Service Areas Trauma Service Area 1 # Verified Level I Trauma 0 # Verified Level II Trauma 2 # of Acute 11 Statutory Patient Volume 1,000 Annual Trauma Patient 2,544 # of Severely Injured Patients 447 Annual # of Severely Injured Patients 93 Discharged from Acute Annual % of Severely Injured 20.8% Patients Discharged from Acute # of Rotor Wing Aircraft 2 # of Permitted EMS Ground 87 EMS Ground Vehicle to 1.23:10,000 EMS Ground Vehicle 2.4:100 to Median Transport Time 00:14:00 Population 708,892 Population Density Year Population 13.7% Median Age 37.9 % Persons 65 & Over 13.2% % Persons Under % 3,635 sq Miles 7
8 Trauma Service Area 2 # Verified Level I Trauma 0 # Verified Level II Trauma 1 # of Acute 5 Statutory Patient Volume 500 Annual Trauma Patient 363 # of Severely Injured Patients 137 Annual # of Severely Injured Patients 137 Discharged From Acute Annual % of Severely Injured 100% # of Rotor Wing Aircraft 0 # of Permitted EMS Transport 35 EMS Ground Vehicle to 1.51:10,000 EMS Ground Vehicle to 1.47:100 Population 232,317 Population Density Year Population 15.5% Median Age 39.8 % Persons 65 & Over 11.3% % Persons Under % 2,384 sq Miles Median Transport Time 00:39:00 8
9 Trauma Service Area 3 # Verified Level I Trauma 0 # Verified Level II Trauma 1 # of Acute 9 Statutory Patient Volume 500 Annual Trauma Patient 1,292 # of Severely Injured Patients 289 Annual # of Severely Injured Patients 32 Discharged From Acute Annual % of Severely Injured 11.1% # of Rotor Wing Aircraft 3 # of Permitted EMS Transport 95 EMS Ground Vehicle to 1.90:10,000 Population 500,675 Population Density Year Population 14.8% Median Age 30.2 % Persons 65 & Over 5.9% % Persons Under % 6,982 sq Miles EMS Ground Vehicle to 1.36:100 Median Transport Time 00:33:00 9
10 Trauma Service Area 4 # Verified Level I Trauma 1 # Verified Level II Trauma 0 # of Acute 10 Statutory Patient Volume 1,000 Annual Trauma Patient 2,745 # of Severely Injured Patients 537 Annual # of Severely Injured Patients 63 Discharged From Acute Annual % of Severely Injured 11.7% # of Rotor Wing Aircraft 4 # of Permitted EMS Transport 96 EMS Ground Vehicle to 1.68:10,000 Population 575,041 Population Density Year Population 14.5% Median Age 38.1 % Persons 65 & Over 9.4% % Persons Under % 6,856 sq Miles EMS Ground Vehicle to 1.40:100 Median Transport Time 00:51:00 10
11 Trauma Service Area 5 # Verified Level I Trauma 1 # Verified Level II Trauma 0 # of Acute 13 Statutory Patient Volume 1,000 Annual Trauma Patient 3,433 # of Severely Injured Patients 776 Annual # of Severely Injured Patients 358 Discharged From Acute Annual % of Severely Injured 46.1% # of Rotor Wing Aircraft 4 # of Permitted EMS Transport 252 EMS Ground Vehicle to 1.84:10,000 Population 1,377,850 Population Density Year Population 22.7% Median Age 40.4 % Persons 65 & Over 12.8% % Persons Under % 3,201 sq Miles EMS Ground Vehicle to 7.87:100 Median Transport Time 00:09:00 11
12 Trauma Service Area 6 # Verified Level I Trauma 0 # Verified Level II Trauma 0 # of Acute 8 Statutory Patient Volume 0 Annual Trauma Patient 80 # of Severely Injured Patients 216 Annual # of Severely Injured Patients 216 Discharged From Acute Annual % of Severely Injured 100% # of Rotor Wing Aircraft 2 # of Permitted EMS Transport 78 EMS Ground Vehicle to 1.19:10,000 Population 647,907 Population Density Year Population 27.6% Median Age 48 % Persons 65 & Over 28.2% % Persons Under % 2,639 sq Miles EMS Ground Vehicle to 2.96:100 Median Transport Time 00:22:00 12
13 Trauma Service Area 7 # Verified Level I Trauma 0 # Verified Level II Trauma 1 # of Acute 8 Statutory Patient Volume 500 Annual Trauma Patient 1,936 # of Severely Injured Patients 369 Annual # of Severely Injured Patients 99 Discharged From Acute Annual % of Severely Injured 26.8% # of Rotor Wing Aircraft 4 # of Permitted EMS Transport 73 EMS Ground Vehicle to 1.22:10,000 Population 595,309 Population Density Year Population 20.7% Median Age % Persons 65 & Over 22.8% % Persons Under % 1,586 sq Miles EMS Ground Vehicle to 4.60:100 Median Transport Time 00:12:05 13
14 Trauma Service Area 8 # Verified Level I Trauma 1 # Verified Level II Trauma 0 # of Acute 21 Statutory Patient Volume 1,000 Annual Trauma Patient 4,223 # of Severely Injured Patients 1,093 Annual # of Severely Injured Patients 430 Discharged From Acute Annual % of Severely Injured 39.3% # of Rotor Wing Aircraft 4 # of Permitted EMS Transport 315 EMS Ground Vehicle to 1.36:10,000 Population 2,325,294 Population Density Year Population 37.0% Median Age 43.9 % Persons 65 & Over 14.6% % Persons Under % 4,025 sq Miles EMS Ground Vehicle to 7.83:100 Median Transport Time 00:13:00 14
15 Trauma Service Area 9 # Verified Level I Trauma 0 # Verified Level II Trauma 2 # of Acute 19 Statutory Patient Volume 1,500 Annual Trauma Patient 3,977 # of Severely Injured Patients 937 Annual # of Severely Injured Patients 608 Discharged From Acute Annual % of Severely Injured 64.9% # of Rotor Wing Aircraft 0 # of Permitted EMS Transport 129 EMS Ground Vehicle to 0.92:10,000 Population 1,391,710 Population Density 1, Year Population 9.9% Median Age 43.9 % Persons 65 & Over 21.9% % Persons Under % 1,021 sq Miles EMS Ground Vehicle to 12.64:100 Median Transport Time 00:12:08 15
16 Trauma Service Area 10 # Verified Level I Trauma 1 # Verified Level II Trauma 1 # of Acute 12 Statutory Patient Volume 2,000 Annual Trauma Patient 4,788 # of Severely Injured Patients 949 Annual # of Severely Injured Patients 160 Discharged From Acute Annual % of Severely Injured 16.9% # of Rotor Wing Aircraft 2 # of Permitted EMS Transport 193 EMS Ground Vehicle to 1.51:10,000 Population 1,277,746 Population Density 1, Year Population 27.9% Median Age 36.4 % Persons 65 & Over 12.4% % Persons Under % 1,020 sq Miles EMS Ground Vehicle to 18.92:100 Median Transport Time 00:13:00 16
17 Trauma Service Area 11 # Verified Level I Trauma 0 # Verified Level II Trauma 1 # of Acute 10 Statutory Patient Volume 1,000 Annual Trauma Patient 1,413 # of Severely Injured Patients 409 Annual # of Severely Injured Patients 103 Discharged From Acute Annual % of Severely Injured 25.2% # of Rotor Wing Aircraft 2 # of Permitted EMS Transport 83 EMS Ground Vehicle to 1.12:10,000 Population 741,800 Population Density Year Population 24.0% Median Age 46.3 % Persons 65 & Over 20.0% % Persons Under % 3,452 sq Miles EMS Ground Vehicle to 2.40:100 Median Transport Time 00:21:00 17
18 Trauma Service Area 12 # Verified Level I Trauma 0 # Verified Level II Trauma 1 # of Acute 9 Statutory Patient Volume 1,000 Annual Trauma Patient 1,657 # of Severely Injured Patients 359 Annual # of Severely Injured Patients 137 Discharged From Acute Annual % of Severely Injured 38.2% # of Rotor Wing Aircraft 1 # of Permitted EMS Transport 67 EMS Ground Vehicle to 0.97:10,000 Population 687,874 Population Density Year Population 16.8% Median Age 48.2 % Persons 65 & Over 23.0% % Persons Under % 1,519 sq Miles EMS Ground Vehicle to 4.41:100 Median Transport Time 00:11:00 18
19 Trauma Service Area 13 # Verified Level I Trauma 0 # Verified Level II Trauma 1 # of Acute 8 Statutory Patient Volume 500 Annual Trauma Patient 890 # of Severely Injured Patients 458 Annual # of Severely Injured Patients 458 Discharged From Acute Annual % of Severely Injured 100% # of Rotor Wing Aircraft 1 # of Permitted EMS Transport 77 EMS Ground Vehicle to 1.02:10,000 EMS Ground Vehicle to 3.98:100 Population 754,754 Population Density Year Population 21.3% Median Age 49.9 % Persons 65 & Over 27.4% % Persons Under % 1,936 sq Miles Median Transport Time 00:16:00 19
20 Trauma Service Area 14 # Verified Level I Trauma 0 # Verified Level II Trauma 1 # of Acute 6 Statutory Patient Volume 500 Annual Trauma Patient 1,174 # of Severely Injured Patients 272 Annual # of Severely Injured Patients 87 Discharged From Acute Annual % of Severely Injured 32.0% # of Rotor Wing Aircraft 2 # of Permitted EMS Transport 79 EMS Ground Vehicle to 1.67:10,000 Population 472,150 Population Density Year Population 32.9% Median Age 46.7 % Persons 65 & Over 21.9% % Persons Under % 1,884 sq Miles EMS Ground Vehicle to 4.19:100 Median Transport Time 00:09:00 20
21 Trauma Service Area 15 # Verified Level I Trauma 0 # Verified Level II Trauma 1 # of Acute 9 Statutory Patient Volume 1,000 Annual Trauma Patient 2,080 # of Severely Injured Patients 644 Annual # of Severely Injured Patients 190 Discharged From Acute Annual % of Severely Injured 29.5% # of Rotor Wing Aircraft 3 # of Permitted EMS Transport 118 EMS Ground Vehicle to 1.36:10,000 Population 858,296 Population Density Year Population 36.4% Median Age 56.8 % Persons 65 & Over 25.6% % Persons Under % 3,424 sq Miles EMS Ground Vehicle to 3.45:100 Median Transport Time 00:23:00 21
22 Trauma Service Area 16 # Verified Level I Trauma 1 # Verified Level II Trauma 1 # of Acute 14 Statutory Patient Volume 2,000 Annual Trauma Patient 3,117 # of Severely Injured Patients 786 Annual # of Severely Injured Patients 238 Discharged From Acute Annual % of Severely Injured 30.3% # of Rotor Wing Aircraft 2 # of Permitted EMS Transport 204 EMS Ground Vehicle to 1.51:10,000 Population 1,356,545 Population Density Year Population 19.9% Median Age 43.6 % Persons 65 & Over 22.1% % Persons Under % 1,970 sq Miles EMS Ground Vehicle to 10.36:100 Median Transport Time 00:08:00 22
23 Trauma Service Area 17 # Verified Level I Trauma 0 # Verified Level II Trauma 0 # of Acute 4 Statutory Patient Volume 0 Annual Trauma Patient 0 # of Severely Injured Patients 154 Annual # of Severely Injured Patients 154 Discharged From Acute Annual % of Severely Injured 100% # of Rotor Wing Aircraft 1 # of Permitted EMS Transport 33 EMS Ground Vehicle to 0.98:10,000 Population 332,427 Population Density Year Population 32.2% Median Age 48 % Persons 65 & Over 28.1% % Persons Under % 1,998 sq Miles EMS Ground Vehicle to 1.65:100 Median Transport Time 00:15:51 23
24 Trauma Service Area 18 # Verified Level I Trauma 2 # Verified Level II Trauma 1 # of Acute 16 Statutory Patient Volume 3,000 Annual Trauma Patient 5,294 # of Severely Injured Patients 913 Annual # of Severely Injured Patients 273 Discharged From Acute Annual % of Severely Injured 29.9% # of Rotor Wing Aircraft 4 # of Permitted EMS Transport 277 EMS Ground Vehicle to 1.55:10,000 EMS Ground Vehicle to 22.90:100 Population 1,815,137 Population Density 1, Year Population 11.8% Median Age 40.0 % Persons 65 & Over 14.6% % Persons Under % 1,210 sq Miles Median Transport Time 00:10:00 24
25 Trauma Service Area 19 # Verified Level I Trauma 1 # Verified Level II Trauma 1 # of Acute 29 Statutory Patient Volume 2,000 Annual Trauma Patient 6,745 # of Severely Injured Patients 1,579 Annual # of Severely Injured Patients 837 Discharged From Acute Annual % of Severely Injured 53.0% # of Rotor Wing Aircraft 7 # of Permitted EMS Transport 463 EMS Ground Vehicle to 1.75:10,000 P opulation Ratio Population 2,665,844 Population Density Year Population 14.3% Median Age 42.7 % Persons 65 & Over 14.6% % Persons Under % 2,881 sq Miles EMS Ground Vehicle to 16.07:100 Median Transport Time 00:13:01 25
26 Conclusion Based upon available data and the reliability of the data, the Department has determined that the following criteria should be used to evaluate the number and level of trauma centers needed to serve the population in a defined trauma service area: 1. Population 2. Median Transport Times 3. Community Support 4. Severely Injured 5. The Existence of A Level I Trauma Center 6. Number of Severely Injured Patients 26
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