coverage at designated hospitals. The fee would be set at a level below what it would cost to have hospitals manage their on-call coverage problems individually.

Accountability

The initiative includes the development of a countywide quality assurance program under which all hospitals would submit certain data elements for assessment. It is unclear at this time how far this system would go toward public disclosure of system performance.

San Diego County, California

San Diego County has a regionalized trauma system that is characterized by a strong public–private partnership between the county and its five adult and one children’s trauma centers. Public health, assessment, policy development, and quality assurance are core components of the system, which operates under the auspices of the state EMS Authority.

Coordination

A countywide electronic system (QA Net) provides the real-time status of every trauma center and ED in the county, including the reason for diversion status, ICU bed availability, and trauma resuscitation capacity. The system has been in place for over 10 years and is a critical part of the coordination of emergency and trauma care in the county.

A regional communications system serves as the backbone of the emergency and trauma care system for both day-to-day operations and disasters. It includes an enhanced 9-1-1 system and a countywide network that allows all ambulance providers and hospitals to communicate. The network is used to coordinate decisions on EMS destinations and bypass information, and allows each hospital and EMS provider to know the status of every other hospital and provider on a real-time basis. Because the system’s authority comes from the state to the local level, all prehospital and emergency hospital services are coordinated through one lead agency. This arrangement provides continuity of services, standardized triage, treatment and transport protocols, and an opportunity to improve the system as issues are identified.

Regionalization

The county is divided into five service areas, each of which has at least a level II trauma center. Adult trauma patients are triaged and transported to



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