hospitals answered it. This is how the NCHS produced its estimate that U.S. hospitals diverted more than 500,000 ambulances in 2003. Since then, McCaig said, high nonresponse rates for this particular survey item have precluded the NCHS from updating its estimate. As a result, the NCHS cannot determine whether diversions are increasing or decreasing in frequency.

GENERAL AUDIENCE DISCUSSION

Following the opening presentation, Mary Jagim, client engagement manager for Intelligent InSites and 2006 IOM committee member, facilitated a general discussion of how federal policy affects emergency care at the community level. This was the first opportunity for the audience to engage each other. Jagim asked audience members to consider the role that the federal trauma program, administered for many years by the Health Resources and Services Administration (HRSA), played in establishing and maintaining state and local trauma programs.

Robert Bass, executive director of Maryland’s state emergency medical services (EMS) agency, said the HRSA program had an impact in a couple different ways. First, it helped states that had not been able to get trauma systems up and running. It provided a small amount of funding, but this was sufficient for states to hire someone to run the program, begin to collect data, and provide a forum for trauma-related activities. Second, in those states that had functioning trauma systems, the federal program helped them to mature. These states were able to develop statewide bypass protocols, conduct additional data analysis, and perform other functions. However, Bass noted that since the HRSA program was eliminated 3 years ago, progress has stopped.

Nels Sanddal, of the Critical Illness and Trauma Foundation and a technical consultant to the American College of Surgeons (ACS) Trauma System Planning and Evaluation Committee, said that even though only about $40,000 a year was going out to certain states to assist with trauma system planning and development, many states had been able to hire a part-time, or in some cases, a full-time staff member with that money. Trauma surgeon Jerry Jurkovich, with the American Association for Surgery and Trauma, added that this was the person whose job it was to see the trauma system-building effort through to the end. Sanddal said the absence of those HRSA funds, and more importantly the loss of structured leadership at the state level, has hurt trauma efforts substantially. Finally, Sanddal noted that the termination of HRSA’s program meant the loss of two technical assistance centers devoted to trauma system planning and development nationwide.

John Fildes, chief of the Division of Trauma & Critical Care at the University of Nevada School of Medicine and chair of the Committee on



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