Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page R1
Regionalizing Emergency Care: Workshop Summary
FUTURE OF EMERGENCY CARE
REGIONALIZING EMERGENCY CARE
Workshop Summary
Ben Wheatley, Rapporteur
Board on Health Care Services
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
OCR for page R2
Regionalizing Emergency Care: Workshop Summary
THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W.
Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This study was supported by Contract No. HHSP233200800008T, Task Order #21 between the National Academy of Sciences and the Emergency Care Coordination Center, part of the Office of the Assistant Secretary for Preparedness and Response in the Department of Health and Human Services; other contributors include the American College of Emergency Physicians and the Society of Academic Emergency Medicine. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the workshop participants and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
International Standard Book Number-13: 978-0-309-15151-1
International Standard Book Number-10: 0-309-15151-1
Additional copies of this report are available from the
National Academies Press,
500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.
Copyright 2010 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
Suggested citation: IOM (Institute of Medicine). 2010. Regionalizing Emergency Care: Workshop Summary. Washington, DC: The National Academies Press.
OCR for page R3
Regionalizing Emergency Care: Workshop Summary
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
OCR for page R4
Regionalizing Emergency Care: Workshop Summary
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.
www.national-academies.org
OCR for page R5
Regionalizing Emergency Care: Workshop Summary
PLANNING COMMITTEE ON REGIONALIZING EMERGENCY CARE WORKSHOP1
ARTHUR KELLERMANN (Chair), Professor and Associate Dean for Health Policy,
Emory University School of Medicine
ROBERT BASS, Executive Director,
Maryland Institute for Emergency Medical Services Systems
DREW DAWSON, Director,
Office of Emergency Medical Services,
National Highway Traffic Safety Administration,
Department of Transportation
A. BRENT EASTMAN, Chief Medical Officer and Chair of Trauma Services,
Scripps Health
MICHAEL HANDRIGAN, Acting Director,
Emergency Care Coordination Center,
Office of the Assistant Secretary for Preparedness and Response,
Department of Health and Human Services
JON KROHMER, Principal Deputy Assistant Secretary and Chief Medical Officer,
Department of Homeland Security
JEFFREY S. UPPERMAN, Director of Trauma,
Children’s Hospital Los Angeles
Study Staff
BEN WHEATLEY, Program Officer
ASHLEY McWILLIAMS, Senior Program Assistant
ROGER HERDMAN, Board Director
1
IOM planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.
OCR for page R6
Regionalizing Emergency Care: Workshop Summary
This page intentionally left blank.
OCR for page R7
Regionalizing Emergency Care: Workshop Summary
Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report:
BRENT ASPLIN, Chair, Department of Emergency Medicine, Mayo Clinic College of Medicine
MARY JAGIM, Client Engagement Manager, Intelligent Insites
RICARDO MARTINEZ, Executive President of Medical Affairs, The Schumacher Group
JOSEPH WAECKERLE, Chief Medical Officer, Office of Homeland Security, State of Missouri
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by MEGAN McHUGH, Health Research and Educational Trust. Appointed by the Institute of Medicine, she was responsible for making certain that
OCR for page R8
Regionalizing Emergency Care: Workshop Summary
an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the author and the institution.
OCR for page R9
Regionalizing Emergency Care: Workshop Summary
Contents
OVERVIEW
1
WORKSHOP INTRODUCTION
7
1
REGIONALIZED TRAUMA CARE: PAST, PRESENT, AND FUTURE
11
Emergency Care Regionalization in the 1970s,
11
The States’ Perspective,
12
Centralized Authority,
13
Trauma System Lessons,
14
Audience Discussion,
15
2
EMERGING MODELS OF REGIONALIZATION
25
Acute STEMI Care,
25
Considerations in Regionalizing Cardiac Arrest,
26
The Emergence of Stroke as an Emergency,
27
A Hub-and-Spoke Wheel Model for Children,
28
Audience Discussion,
29
3
LESSONS FROM OTHER SYSTEMS
37
Regionalization in the Department of Veterans Affairs,
37
The U.S. Armed Forces Joint Theater Trauma System,
41
Accountable Care Organizations,
44
Audience Discussion,
46
References,
49
OCR for page R10
Regionalizing Emergency Care: Workshop Summary
4
REGIONALIZATION: POTENTIAL AND PITFALLS
51
Financing a Regional Hospital from a Local Tax Base,
51
Regionalizing Rural Prehospital Care,
53
Diluting Paramedic Experience,
54
Addressing Suburban Access Challenges,
55
Distribution of Services to Outlying Areas,
56
A Surgical Specialist’s Perspective,
58
Audience Discussion,
59
Reference,
64
5
GOVERNANCE AND ACCOUNTABILITY
65
Regionalization in the Marketplace of Ideas,
65
The State’s Role in Regionalization,
68
Operation Regionalization,
69
What’s in It for Us?,
70
Building “Systemness,”
71
Audience Discussion,
73
References,
81
6
FINANCING
83
Safety Net Hospitals,
83
Network of Community Hospitals,
84
A Revised Model for EMS Reimbursement,
85
Trauma Care Resources,
86
A Health Plan’s Perspective,
87
Audience Discussion,
88
7
DATA AND COMMUNICATIONS
95
EMS Communications Challenges,
96
Standardizing EMS Data Collection,
98
Linking with Automatic Crash Notification,
99
The Birmingham Alabama Regional System,
100
Audience Discussion,
102
Reference,
108
8
PREPAREDNESS
109
Linking Daily Emergency Care and Disaster Preparedness,
110
Regionalization and Preparedness for Catastrophic Events,
111
Catastrophic Medicine Operations in Texas,
112
A Culture of Preparedness,
115
Audience Discussion,
116
Reference,
121
OCR for page R11
Regionalizing Emergency Care: Workshop Summary
9
WRAP-UP DISCUSSION WITH FEDERAL PARTNERS
123
Win-Win Regionalization,
125
Envisioning a Congressional Action Plan,
126
The Role of a Federal Lead Agency,
127
Building a Unified System,
129
Liability Reform,
130
APPENDIXES
A
Workshop Agenda
131
B
Workshop Presenters and Participants
141
C
The Future of Emergency Care: Key Findings and Recommendations from 2006 Study
149
OCR for page R12
Regionalizing Emergency Care: Workshop Summary
This page intentionally left blank.
OCR for page R13
Regionalizing Emergency Care: Workshop Summary
List of Figures and Boxes
FIGURES
3-1
Care delivery in the military’s joint theater trauma system,
43
5-1
A more inclusive regionalization model,
68
7-1
Core elements of emergency medical services systems,
97
8-1
Regionalized response to catastrophic events in Texas: lessons learned,
114
BOXES
3-1
Challenges Related to Regionalization,
40
3-2
Lessons from Previous Regionalization Experience,
41
5-1
Lessons Learned in North Carolina,
72
OCR for page R14
Regionalizing Emergency Care: Workshop Summary
This page intentionally left blank.
