State Trauma Advisory Council Inaugural Meeting Monday, December 5, 2005 1-4 p.m.
MDH Snelling Office Park - Mississippi Room
Members Present: John Bowar, M.D., J. Kevin Croston, M.D., Robert Dahm, Jane Gisslen, R.N., William Heegaard, M.D., Tom Hock, R.N., P.A., Mark Larkins, M.D., Timothy LeMieur, M.D., Mark Lindquist, M.D., Dennis Miley, Gary Pearson, Jeffrey Schiff, M.D., Marc Swiontkowski, M.D., Linda Vogel, R.N., Mike Wilcox, M.D.
MDH Consultants: Kirstie Bingham, R.N., David Larson, M.D.
MDH Staff: Cirrie Byrnes, Tim Held, Mark Kinde, Mark Schoenbaum, Carol Woolverton
Audience: Heidi Altamirano, Brenda Anderson, Leslie Becker, Paula Chambers, Brian Clarkowski, M.D., Becca Clements, Vicki Costello, O.J. Doyle, Chris Fransen, R. J. Frascone, M.D., Curtis Fraser, Lisa Job, Val Kriegler, Buck McAlpin, Pat McCauley, Art Ney, M.D., Molly O’Brien, Mike Parrish, Karie Pearce, Mark Phillips, Darel Radde, Jon Roesle, Janice Schade, Kelly Spratt, Deb Syverson, Marlys Tanner, Karen Thorp-Talbot, David Waltz
Call to Order, Welcome and Introductions – Dr. Kevin Croston, Chair, called the meeting to order at 1:10 p.m. He welcomed everyone to the meeting, noting the importance of this historic first meeting of the State Trauma Advisory Council (STAC). Introductions of STAC members and the audience were conducted. Mr. Held mentioned his deep gratitude for and recognition of former Minnesota Department of Health (MDH) Assistant Division Director, Wayne Carlson for his significant leadership in developing the state trauma plan, and in passing the trauma legislation.
Assistant Commissioner’s Remarks – Assistant Commissioner Carol Woolverton addressed the STAC on behalf of Commissioner Mandernach, who was unable to attend due to a late request from the Governor to speak in Washington D.C. Ms. Woolverton expressed her (and Commissioner Mandernach’s) understanding of the importance of rural trauma care and the need for rural providers to have the system and training in place to handle trauma efficiently in their facilities. Ms. Woolverton concluded her remarks by highlighting the importance for the STAC to be able to measure its work. Commissioner Mandernach hopes to be free to attend the next meeting.
Chair’s Remarks – Dr. Croston gave a brief historical background of the development of the trauma system. He stated that the vision for the Statewide Trauma System includes improving the care and transport of trauma patients across the state even with the limited resources faced by many hospitals. Dr. Croston spoke about the desire for all hospitals to participate, thereby making it a truly networked system.
Dr. Croston acknowledged audience members O.J. Doyle (EMS Consultant), Mike Parrish (Chair of the EMSRB), and Buck McAlpin (President of the Minnesota Ambulance Association) for their efforts in passing this year’s the trauma legislation.
Staff Report –
Mark Schoenbaum, Director of the Office of Rural Health and Primary Care (ORHPC): Mr. Schoenbaum explained that the new state Trauma Program has been organizationally placed in the ORHPC. He described how the approaches and similarities of both make this a natural fit. One example he gave is that the ORHPC designates critical access hospitals (CAHs) throughout the state—around 80 by year end. He stressed that he will do whatever he can to assist the trauma program in succeeding.
Tim Held, MDH Trauma System Coordinator: Trauma Legislation: The trauma legislation defines the purpose and role of the new statewide trauma system and of the STAC. Mr. Held summarized the trauma legislation as a whole, and highlighted specific sections for emphasis. It is important to note that hospital participation in the system is voluntary. The immediate focus for the system to get up and running will be to designate Level III and IV hospitals.
Mr. Held further spoke about the purpose and significance of the “rule exemption” that the legislature granted until July 1, 2009, and how this allows the STAC the freedom to get the system fully implemented in a timely manner.
Purpose and Responsibilities: The STAC is a policy group, so detail work will be done through ad hoc or regularly named committees or workgroups. Regional trauma advisory committees (RTACs) may form, to advise, consult with, and make recommendations to the STAC on suggested regional modifications to the statewide trauma criteria to accommodate specific regional needs. In the absence of regional modifications, the broad state-level criteria are required.
State Trauma Plan: Mr. Held highlighted portions of the Comprehensive Statewide Trauma System Plan. As a result of the rules exemption mentioned earlier, changes to the plan (including the data and designation requirements) may be made, but how to go about doing this has to be determined. However, since the Plan was developed and accepted by such a large number of trauma stakeholders and related associations, STAC is encouraged to concentrate on implementing the plan, and cautioned against making too many changes, especially to the data elements and the designation criteria.
Funding: A brief discussion occurred regarding the funding of the system. Mr. Held explained that participation in the system is voluntary for hospitals, but increased license fees to pay for it is not voluntary. To change this would require a statutory change, which would also need to ensure that a replacement funding mechanism is adopted.
The majority of the funding will support expenses related to the site survey teams and providing and supporting a Web-based trauma registry (the next point of discussion) at no additional cost to the hospitals. Related to this funding discussion is the fact that participating hospitals are eligible to bill a new trauma team activation charge.
Trauma Registry: After a comprehensive and technical Request for Proposal (RFP) process, ImageTrend was chosen as the vendor to develop the Web-based statewide trauma registry. There were two finalists, but ImageTrends superior reference checks and significant costs reductions set them apart. Mr. Kinde mentioned that this registry will allow required trauma data to be reported to the MDH in a secure fashion. One of Mr. Kinde’s primary roles is to ensure the integrity and accurate reporting of the data. The Trauma Registry is scheduled to “go-live” on April 15, 2006.
Housekeeping: Completed expense reimbursement forms should be sent to Cirrie Byrnes. Mr. Held will provide clarification on whether or not parking stubs must be submitted for reimbursement.
After a brief discussion about the funding level for the state trauma system, Mr. Held suggested that council members waive the $55 per diem for participation at meetings. This does not include expense reimbursement (e.g., mileage, food, overnight stays). Mr. Miley moved to waive the per diem. MSP.
Guest Speakers – Dr. Croston introduced Dr. Arthur Ney and Dr. R.J. Frascone as men who have been trauma system advocates and leaders in Minnesota for years. Dr. Frascone spoke on the EMS community’s long-time efforts to develop and pass statewide trauma legislation, and expressed how pleased he was to see that the final product resembled the work from previous efforts. Dr. Ney expressed his pleasure at having the trauma system funded and ready to move forward. He acknowledged that many challenges are ahead, but it is good to have this system, and many individuals are eager to make it a success.
20 Minute Break
Work Plan Development – Council Operating Procedures
Member Terms: Dr. Croston opened the discussions by asking the group about self imposed term limits. He clarified that following these initial one- and two-year appointments, each consecutive appointment is for four years, and that there is no statutory limit on the number of terms. It was recognized that a member seeking reappointment still needs to reapply through the state Open Appointments Process and that the Commissioner decides whether to reappoint or appoint someone new.
Attendance: Overall, some parameters are preferred, but allowances must be made.
Vice-chair: Dr. Croston discussed the need to appoint a vice-chair to oversee STAC meeting in his absence and to participate in relevant time-sensitive discussions that may arise between STAC meetings, Nominations were made for Mr. Miley and Dr. Schiff. Dr. Schiff declined his nomination. Mr. Miley was agreeable to his nomination, but wanted a more thorough discussion and explanation of the expectations. There was general agreement for Mr. Miley as vice-chair, but no vote was taken.
Executive Committee: There was some interest expressed for forming an Executive Committee. It was decided that further discussion is necessary on this issue.
Quorum: All members agreed that a quorum should be a simple majority (8 members).
Meeting Schedule: It was agreed to initially follow a quarterly meeting format, which puts the next meeting into March 2006. Video or teleconferencings are options for members too. Members are encouraged to contact Mr. Held if they are interested in either of these options. Mr. Held will poll council members via email to determine the March meeting date.
Ad Hoc Committee: Mr. Dahm, Mr. Miley, Dr. Croston and Dr. LeMieur will work with Mr. Held to develop a set of draft operating procedures based on these discussions for the STAC to respond to at the next meeting.
Work Plan Development – Designating Hospitals
Dr. Croston expressed that the STAC needs to move forward in designating hospitals, and that work needs to take place on developing these processes before the next STAC meeting. An Ad Hoc Trauma Designation Workgroup was established, with Linda Vogel, R.N., as Chair. Dr. Croston accepted volunteers from the trauma program coordinators in the audience, along with a pediatric designee from Dr. Schiff. The Ad Hoc Workgroup was asked to report on its work at the next STAC meeting.
- Dr. Ney brought up some procedural issues surrounding the designation of Level III and IV hospitals.
- Vicki Costello mentioned that the National Foundation for Trauma Care is offering a trauma center designation course and a site surveyor workshop in June 2006. Regions Hospital in St. Paul will host these events. Mr. Held said that he has some money set aside from a federal grant to provide tuition assistance for the workshop.
- Deb Syverson mentioned that the North Dakota trauma system surveys usually take 2-3 hours, and that several sites within close proximity can be completed in one day.
- Dr. Schiff requested that Mr. Held bring a formalized communication plan to the next STAC meeting. The plan should outline how STAC will get information out to interested people and organizations.
The meeting adjourned at 4:10 p.m.