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NCTTRAC 600 Six Flags Drive Suite 160 Arlington TX 76011 817-608-0390 www.ncttrac.org 2014 -2015 Annual Report NCTTRAC Annual Report 1 Contents Message from Outgoing Board Chair..2 Message from Incoming Board Chair..3 Executive Summary..5 Board of Directors FY15...7 Financial Overview8 Emergency Healthcare System.9 EHS Professional Development..14 Hospital Preparedness Program............16 Emergency Medical Task Force - 2.20 NCTTRAC Logistics and Transportation...23 Data and Information Systems Division24 NCTTRAC Staff.30 2014-2015 2 Message from the Outgoing Board Chair Dear NCTTRAC Members It has been my pleasure and honor to serve as the Chair for the RAC for the past three and a half years. As I leave the post to Ricky Reeves I know that the future of the RAC is in good hands under the Chair of Ricky as well as Rick Antoinesse. Over the last three and a half years we have accomplished quite a bit. 1. We have been able to raise dues to allow for some security of our staff and the function of the RAC as we continue in these difficult economic times. 2. We have been able to get a registry and start using that registry to get data and the use of that data has proved to be very interesting. 3. We have expanded our HPP and our ability to get hospital participation especially the C suite and participation from numerous institutions. 4. We have made major inroads in TETAF as well as GETAC meetings and as a RAC shown our leadership within the Texas Regional Advisory Council System. 5. We have increased our advocacy presence. There are numerous other collective achievements that we have done as a group over the past three and a half years however the above are just some of the highlights. All these achievements would not have been possible without the cooperation of every member of the RAC. Each member is important for the functioning of the entire RAC. Just as a car needs all the parts and pieces to work in and of itself and work as a team in order for the motor to work in order for the electronics to assist the motor and be part of the entire system each of you are part of our functioning motor. The complexity of our system has increased over time as well and shall continue to increase due to the medical legal administrative and other systemic issues that we now encounter that we had not encountered previously. Even with all of the economic medical legal and other challenges I feel secure that the RAC will prevail and that the RAC system will ensure every Texan has access to trauma care as well as stroke cardiac pediatric and neonatal care. The RAC system has come a long way from beginning as a system for trauma to becoming a system for trauma and acute care and has expanded into many areas. As we progress we need to keep an open mind regarding innovation that will come about as well as perpetuating the system that we have created and built together. I thank you all for your support these past years and appreciate that you will continue to support the next chair as he takes the mantle on for the next two years. It has been my sincere honor and pleasure to be the Chair of the RAC and I appreciate what each of you do every day for all of our patients. Respectfully Raj Gandhi NCTTRAC Annual Report 3 Message from the Incoming Board Chair As your new chair I want to thank you for allowing me the privilege to lead NCTTRAC. I want to also thank Dr. Gandhi for his tenure as the past chair and wish him continued success. I want to welcome Jorie Klein Vice Chair Amy Atnip Secretary and Derrick Cuenca Treasurer as your newly elected Executive Committee. Over the past couple of years I have had the pleasure of watching NCTTRAC truly grow as one of the lead RACs in the state. While the environment of our organization remains a very challenging one I have seen our organization come together and show resilience determination and a shared sense of purpose working effectively as a unified voice. I hope to continue that energy in the future months. For the first time in years Texas has a new governor lieutenant governor and chairs of the House and Senate health committees. This legislative session proved to be a very challenging session but I feel with the help of our members we have educated our legislative body of the importance of the funding needed to sustain a trauma system in Texas. Because of your hard work and that of TETAF House Speaker Joe Straus issued the House Interim Charge for an interim study and it was issued to the House Appropriations Committee and House Public Health Committee. The charge is to Study the trauma system in the State of Texas including financing service delivery planning and coordination among Emergency Medical Services providers Trauma Service Area Regional Advisory Councils the Emergency Medical Task Force and hospitals. Determine strengths and weaknesses including challenges for rural areas of the state. Make recommendations to reduce any duplicated services improve the coordination of services and advance the delivery of trauma services in Texas. I believe your voice was heard loud and clear but the challenge still exists to actually receive funding. The 84th Legislature directed significant changes that reorganized the Health and Human Service HHSC system including transferring some functions of DSHS to the HHSC. Several public hearings are schedule across Texas to discuss the transformation of the HHSC system. NCTTRAC was also awarded several new contracts including the DSHS Health Promotion and Chronic Disease Prevention Section related to heart attack and stroke patients. It is still in its infancy stages and there will be more to come with this contract. The other contract awarded to NCTTTRAC is the Ebola Preparedness and Response contract which requires us to develop a regional transport plan for highly infectious disease incidents and to interface with public health and emergency response partners. These are in addition to the other contracts we have. 2014-2015 4 Our Committee Chairs are busy continuing to keep our membership apprised of changes within their respective committees. We have added the ED Operations workgroup to provide input on all aspects of the clinical and operational issues that impact Emergency Departments in our RAC. We welcome input from this new group. We continue to build practice and educate to the community of our Emergency Medical Task Force and all of its components. This year we traveled to the Hotter N Hell event in Wichita Falls and provided exceptional care to the needs of attendees and participants in the event. As we near the holidays please be safe and continue to keep our military family in your prayers. Your leadership commitment and support are essential to the continued development of our RAC system and improving patient outcomes. Thank you for allowing me to be a part of this journey. Sincerely Ricky Reeves NCTTRAC Annual Report 5 Executive Summary We are pleased to provide the fifth consecutive NCTTRAC Annual Report to our members partners and the regional Healthcare Coalition. This annual report reflects activities of the RAC and Coalition members over the period July 1 2014 through August 31 2015. NCTTRAC supports the development implementation and operation of a comprehensive trauma care system based on accepted standards of care to decrease morbidity and mortality within Trauma Service Area TSA-E. The Trauma Service Area is comprised of 19 North Central Texas counties including Collin Cooke Dallas Denton Ellis Erath Fannin Grayson Hood Hunt Johnson Kaufman Navarro Palo Pinto Parker Rockwall Somervell Tarrant and Wise. NCTTRAC is the largest Trauma Service Area in the state serving 27 of the entire population of Texas and approximately 2.3 of the population of the United States. The TSA-E Healthcare Coalition was challenged with a wide variety of public health and healthcare delivery events over the last year. In addition to drought flash floods and tornados TSA-E was in the forefront of national and international scrutiny as it responded to the nations first outbreak of Ebola Virus Disease. In October 2014 a Coalition hospital received a patient with Ebola the first incident of this disease in the United States. The region mobilized as did the whole nation resulting in critical reviews and improvements in pre-hospital and hospital environments. NCTTRACs Emergency Medical Coordination Center EMCC played a vital role in supporting EMS hospital city and county authorities and provided staff members as liaison officers within both state and local government command centers. Deemed a risk area for another high consequence disease outbreak NCTTRAC received a special grant to prepare the region should another case occur. NCTTRAC hosted a regional Mobile Integrated Healthcare and Community Paramedicine Symposium aimed at educating and supporting the Healthcare Coalition in improving individual patient outcome and reducing operational costs among Coalition members. Dr. Rajesh Gandhi outgoing Chairman of the Board of Directors receives recognition from incoming Chair Chief Ricky Reeves 2014-2015 6 Improvement in patient outcomes remained the focus of Coalition members participating in the Cardiac Committee which culminated a yearlong project introducing the Heart Safe Community project to the Trauma Service Area. This program through public education and involvement by many physicians and nurses has had a positive influence in cardiac care within the region. Similarly the Stroke Committee has seen great improvement in recognition of and the provision of treatment of patients that have experienced a stroke. With emphasis on pre- hospital and hospital protocols the Stroke Physicians Advisory Group leads the region in supporting stroke treatment protocols and designation of stroke centers. Emergency Medical Task Force - 2 played a crucial role in disaster response. Ambulance Strike Teams and Ambulance Buses deployed to tornado-stricken communities and Medical Incident Support Team M-IST personnel supported county and city officials in a local tornado incident. During the Ebola crisis M-IST personnel provided critical support within state and county command centers. Through continued Coalition development NCTTRAC and its members fulfill the mission to improve emergency healthcare through prevention education advocacy research preparedness and response. EMTF-2s Mobile Medical Unit prepares to deploy to support the annual Hotter N Hell event in Wichita Falls NCTTRAC Annual Report 7 Board of Directors FY15 FY15 Board Position Name Organization Chair Dr. Rajesh Gandhi John Peter Smith Health Network Vice Chair Ricky Reeves Lewisville Fire Department Secretary Amy Atnip Medical Center of Plano Treasurer David Orcutt Weatherford Regional Medical Center Air Medical Committee Mike Eastlee Air Evac LifeTeam AE67 Cardiac Committee Karen Yates Methodist Mansfield Medical Center EMS Committee Kevin Cunningham Cedar Hill Fire Department Finance Committee Derrick Cuenca Lake Granbury Medical Center Pediatric Committee Melinda Weaver Cook Childrens Medical Center Physicians Advisory Group Liaison Dr. Bob Simonson Physician Emergency Care Association Professional Development Committee Shawn White Parkland Memorial Hospital Public Education Injury Prevention Committee Mary Ann Contreras John Peter Smith Health Network Regional Emergency Preparedness Committee J.J. Jones John Peter Smith Health Network Stroke Committee Sharon Eberlein Plaza Medical Center of Fort Worth SPI Committee Dwayne Howerton Emergency Physicians Advisory Board Trauma Committee Jorie Klein Parkland Memorial Hospital Zones Representative Martha Headrick Air Evac Lifeteam-North Texas 2014-2015 8 Financial Overview EMSRegional Advisory Councils EMSRAC The purpose of these funds is to assist in the enhancement and delivery of patient care in the EMS and Trauma Service Care System. Administrative support functions are the principal activities supported by this contract with the intent to enhance and improve delivery of EMS and trauma patient care in the nineteen county region served by NCTTRAC. TobaccoRAC The purpose of these funds is to assist in maintaining and improving the Texas EMS and Trauma Service Care System to reduce morbidity and mortality due to injuries. These funds support programmatic functions related to the NCTTRAC Regional Patient Registry REGE as well as provide educational programs and public education materials for members. EMSCounty Assistance The purpose of these funds is similar to the EMSRAC funds to assist in the enhancement and delivery of patient care in the EMS and Trauma Service Care System. The most significant difference is that these funds are paid directly to qualifying EMS Providers to support supplies education and training communications equipment and vehicles. Hospital Preparedness Program and Ebola Preparedness and Response Program The purpose of these funds is to enhance the ability of participating hospitals and healthcare facilities to improve surge capacity and enhance community and hospital preparedness for public health emergencies. This is achieved at the local and regional level through designated capabilities and benchmarks designated by the Office of the Assistant Secretary of Preparedness and Response and the Centers for Disease Control and Prevention. HPP YR 13 began July 1 2014 and runs through June 30 2015 HPP YR 14 began July 1 2015 and runs through June 30 2016 EBOLA YR 1 began August 1 2015 and runs through June 30 2016 EMSRAC TOBACCO HPP YR 13 EMSCOUNTY ASSISTANCE EBOLA YR 1 UNRESTRICTED DEVELOPMENT TOTAL Revenue State of TX - DSHS 242529 296438 3125508 304749 38587 - 4427273 Program Income - - - - - - - Membership Dues - - - - - 418400 418400 Interest on Investments - - - - - 2271 2271 Other - - - - - - - Sponsorships - - - - - 4700 4700 Educational Registration - - - - - 21340 21340 In-Kind Donations - - - - - - - Total Revenue 242529 296438 3125508 304749 38587 446711 4873983 Expenditures Salaries 134602 193105 805579 - 10426 165930 1460285 Fringe Benefits 44926 42003 207755 - 2325 33328 376757 Travel - - 24931 - - 29233 58714 Equipment - - - - - - - Supplies - - 173239 - 1938 - 192016 Contractual - - 950898 304749 - - 1261798 Other 56451 54960 750251 - 1142 134822 1089578 Indirect 6550 - 212855 - 2924 23042 284383 Unobligated - 6370 - - - - 6370 Total Expenditures 242529 296438 3125508 304749 18756 386354 4729900 Revenues Over Under Expenditures - - - - 19832 60356 144083 Beginning Unrestricted Net Assets - - - - - 375452 375452 Ending Temp Restricted Net Assets - - - - 19832 - 83727 Ending Unrestricted Net Assets - - - - - 435808 435808 Ending Net Assets - - - - 19832 435808 519535 NCTTRAC Annual Report 9 Emergency Healthcare System EHS The Emergency Healthcare System of Trauma Service Area - E receives financial support from the Texas Department of State Health Services DSHS through several funding streams. These include Red Light camera enforcement the states tobacco settlement endowment 911 surcharges and various dangerous driving fines. Programs Supported with the Tobacco Endowment Maintaining support for training and operations for the REGE project the regional patient registry. Consulting services fees for legal services as well as required independent audits. Maintaining the Regional Communication Center Trauma Hotline to assist with in-RAC trauma transfers. Supporting member and partner endeavors with donations and marketing items for events. Items included mood cups and pencils flying discs and draw string bags all imprinted with the NCTTRAC name and logo along with the campaign motto. Supporting educational programs in the region and offering continuing education at the General Membership Meetings. Continuing support of the quarterly NCTTRAC Newsletter development and other means of communication with membership such as our website and social media. Meeting support for Board of Director Committee and General Membership RAC meetings. Support of travel to regional and state meetings for appropriate staff and Committee Chairs. Portions of the costs related to personnel lease space office expenses and equipment training directly related to conducting RAC business and internet support. Tobacco Funding Notes The Tobacco Endowment Fund was established in the Texas Government Code 403.106 to provide the means for the Department of State Health Services to assist RACs in maintaining and improving the Texas Emergency Medical Services EMSTrauma System to reduce morbidity and mortality due to injuries. FY15 NCTTRAC received 288238 Disbursements are based on a formula which includes a calculation of the trauma related death rate in the Trauma Service Area TSA. 2014-2015 10 EMS County Assistance Pass-through Funds NCTTRAC received 304749 in EMS County Assistance funds for distribution to fifty-six 911 andor emergency transport providers through a reimbursement process. The purpose of these funds is to assist in the enhancement and delivery of patient care in the EMS and trauma care system. Licensed EMS Providers must fulfill DSHS requirements for data submission participation in system performance improvement activities as requested and utilization of the RACs regional trauma plan protocols. Beyond that providers are required to meet local RAC participation requirements in order to submit eligible receipts for reimbursement. RAC participation includes a Board approved application and dues a minimum data set submission to the regional registry REGE. FY15 EMS Pass-through funds were distributed to all 56 eligible agencies and were expended as indicated below EMS County Assistance Pass-through Funds County No. of Providers Amt. per Provider Collin 13 1923 Cooke 1 8537 Dallas 22 4539 Denton 17 1343 Ellis 4 2986 Erath 1 10013 Fannin 1 8119 Grayson 3 3989 Hood 2 2592 Hunt 1 8522 Johnson 4 2557 Kaufman 2 4786 Palo Pinto 2 4267 Parker 2 4780 Rockwall 3 842 Somervell 1 1810 Tarrant 17 2467 Wise 2 4303 Total 304749 Fund Use Restrictions DSHS guidance permits these funds to be used only for the following purposes Supplies Operational Expenses Education and Training Equipment Vehicles Communication Systems Supplies 112703 Op Expense 30241Ed Trg 33234 Equip 87645 Vehicles 28508 Comm Equip 12418 FY 15 EMS Pass-through Expenditures by Category NCTTRAC Annual Report 11 Acute Care Designations in TSA-E Both Texas Department of State Health Services DSHS designations in Trauma and Stroke require that the hospital applicant show they are active participants in the RACs system of care in which they seek designation. NCTTRAC General Membership has set this standard to include requirements that these hospitals must be approved members of the RAC participate in any performance improvement initiative requested and submit their relevant patient data to the emergency patient healthcare regional registry REGE. NCTTRAC has all levels of Trauma Designation throughout the nineteen counties there is at least one designated or in active pursuit facility in each TSA-E county. There are four Trauma level designations I IV all Trauma-designated facilities treat and provide the most efficient system of treatment to the most critical Trauma patients. Level I and II Trauma Centers are surveyed according to American College of Surgeons Committee on Trauma criteria by nationally recognized teams. Level III and IV centers are surveyed by the Texas EMS Trauma and Acute Care Foundation TETAF according to DSHS standards. Stroke care facilities may be recognized by various agencies including Joint Commission Det Norske Veritas DNV Healthcare the Healthcare Facility Accreditation Program HFAP and the Texas EMS Trauma and Acute Care Foundation TETAF. Facilities complete a designation application to the Texas Department of State Health Services DSHS which uses the information from these approved agencies to determine a facilitys designation level. These designation levels are considered in the NCTTRAC Regional Stroke System Plan as reviewed annually by the NCTTRAC Stroke Committee with the input of other clinically oriented committees such as EMS and System Performance Improvement SPI. Any changes are then presented to the NCTTRAC General Membership for adoption to provide guidance with the decision on the best facility to receive a pre- hospital patient with stroke signs and symptoms. As of September 30 2015 there were 137 designated stroke facilities in Texas with 40 in this RACs nineteen counties. 2014-2015 12 Acute Care Designations Stroke Facilities Trauma Centers Level I Comprehensive Stroke Facilities Level I Trauma Centers Medical Center Of Plano Baylor University Medical Center Medical City Dallas Hospital Childrens Medical Center Of Dallas Plaza Medical Center of Fort Worth John Peter Smith Hospital UT Southwestern University Hospital Methodist Dallas Medical Center Level II Primary Stroke Facilities Parkland Memorial Hospital Baylor All Saints Medical Center at Fort Worth Level II Trauma Centers Baylor Medical Center at Garland Cook Childrens Medical Center Baylor Medical Center at Irving Medical Center Of Plano Baylor Regional Medical Center at Grapevine TH Harris Methodist Hospital Fort Worth Baylor Regional Medical Center at Plano Level III Trauma Centers Baylor University Medical Center Baylor All Saints Medical Center Fort Worth Centennial Medical Center Denton Regional Medical Center Columbia Medical Center of McKinney Medical Center Of Arlington Dallas Regional Medical Center Texoma Medical Center Denton Regional Medical Center TH Harris Methodist HEB Doctors Hospital at White Rock Lake Wilson N. Jones Regional Medical Center John Peter Smith Hospital TH Presbyterian Hospital Plano Methodist Dallas Medical Center Level IV Trauma Centers Las Colinas Medical Center Ennis Regional Medical Center Medical Center of Arlington Glen Rose Medical Center Medical Center of Lewisville Hunt Regional Medical Center Methodist Charlton Medical Center Lake Granbury Medical Center Methodist Dallas Medical Center Lake Pointe Medical Center Methodist Mansfield Medical Center Medical Center Of Lewisville Methodist Richardson Medical Center Medical City Dallas Hospital North Hills Hospital Muenster Memorial Hospital Parkland Memorial Hospital Navarro Regional Hospital Texas Health Arlington Memorial Hospital North Hills Hospital Texas Health Harris Methodist Hospital Fort Worth North Texas Medical Center Texas Health Harris Methodist Hospital HEB Palo Pinto General Hospital Texas Health Presbyterian Hospital of Dallas TH Harris Methodist Hospital Azle Texas Health Presbyterian Hospital Denton TH Harris Methodist Cleburne Texas Health Presbyterian Hospital Plano TH Harris Methodist Hospital Stephenville Texoma Medical Center TH Presbyterian Hospital Allen Wilson N. Jones Regional Medical Center TH Presbyterian Hospital Kaufman Wise Regional Health System TMC Bonham Hospital Level III Support Stroke Facilities Weatherford Regional Medical Center North Texas Medical Center Wise Regional Health System Texas Health Harris Methodist Hospital Azle Texas Health Presbyterian Hospital Of Kaufman TMC Bonham Hospital NCTTRAC Annual Report 13 FY15 Hospital Uncompensated Trauma Care Fund Distribution The Texas Department of State Health Services DSHS Office of EMS Trauma Systems Coordination announced Uncompensated Trauma Care Fund distributions during the month of August 2015 for FY 2015. A total of 14451200 from the Designated Trauma Facility and Emergency Medical Services DTFEMS Account 3588 Monies was distributed to 39 TSA-E hospitals designated as trauma facilities or meeting in active pursuit requirements. This amount is 24 of the 54720091 distributed to 293 facilities across Texas. FY15 Uncompensated Trauma Care Disbursement Systems of Care Committees The NCTTRAC Trauma Emergency Medical Services EMS Stroke and Cardiac committees along with supporting Physician Advisory Groups continued to make advances and improvements in Emergency Health Care Systems within TSA-E. This year the EMS committee updated the regional field triage and transport guidelines affecting all three acute care committees. On June 9 2015 NCTTRACs Board of Directors approved these revised Trauma Triage Transport Guidelines. Beginning with the FY16 membership renewals the Board of Directors requested an acknowledgment of the Providers adherence to RAC regional protocols plans and guidelines regarding patient care and transportation by requesting signatures from Hospital members Trauma Stroke and Cardiovascular medical directors. This acknowledgement has been a practice for EMS agencies. Disbursement Methodology Uncompensated trauma care charges from Calendar Year 2013 as reported by eligible hospitals on the Fiscal Year FY 2015 Uncompensated Trauma Care Fund Application Hospital Allocation were used in the funding formula for both allocations. Fifteen percent 15 of the total amount of funds available was divided equally among all eligible applicants. The remaining eighty-five percent 85 was distributed to eligible applicants based on the percentage of uncompensated trauma care a hospital provided in relation to the total uncompensated trauma care provided by all eligible applying hospitals. 9475985 2348736 1651103 784313 191064 Level 1 5 eligible Level 2 3 eligible Level 3 7 eligible Level 4 20 eligible In Active Pursuit 4 eligible - 5000000 10000000 Uncompensated Trauma Fund Allotment Designation by Level 2014-2015 14 EHS Professional Development Trauma Registrar Specific ICD-10 Training Course The International Statistical Classification of Diseases and Related Health Problems 10th Revision ICD-10 is a coding of diseases signs and symptoms abnormal findings complaints social circumstances and external causes of injury or diseases as classified by the World Health Organization WHO. Current health plan systems and health care providers are required by the Health Insurance Portability and Accountability Act HIPAA to use a standard code set to indicate diagnoses and procedures on transactions. Unlike the usual annual updates of ICD-9 codes the ICD-10 codes are markedly different from their predecessors. ICD-9 codes were used in almost every clinical and administrative process in a health care setting. Therefore substantial system and procedural changes have been necessary to implement and correctly use the new codes. The updated code sets require significant changes in the way health plans reimburse services and in the way coverage of services is determined. As the new compliance effective date of October 1 2015 original was October 2014 was approaching NCTTRAC hosted the Trauma Registrar Specific ICD-10 Training course provided by Pomphrey Consulting. Class was held on August 13- 14 2015 and was open to all Level I-IV Trauma Centers in TSA-E. NCTTRAC contributed 50 200 of the course fee to all 22 attendees. March 2015 General Membership Educational Session Many questions and concerns have been circulating among EMS and hospital personnel regarding the use of cuffed versus uncuffed tracheal tubes for pediatric patients. NCTTRAC Pediatric Committee Chair Melinda Weaver RN requested the expertise of Dr. Gavin Fine MBBCh Department of Anesthesiology at Cook Childrens Medical Center. Dr. Fine presented To Cuff or Not to Cuff. That is the Question for NCTTRACs March 2015 General Membership Educational Session. Dr. Fine delivered an excellent presentation focusing on new developments and recommendations for cuffed and uncuffed tracheal tubes in the pediatric population. Discussion included history of endotracheal tubes traditional teaching risks complications advantages and future requirements in facilitating pediatric airway management. Cook Childrens Medical Center Department of Education provided two hours of continuing education. Attendees found Dr. Fines educational offering to be very informative and valuable for practical application in the health care setting. NCTTRAC Annual Report 15 Community Integrated Mobile Healthcare Symposium Improving Patient Outcomes and Reducing Costs Across the nation EMS agencies of all sizes and types are partnering with hospitals primary care physicians nurses and mental health and social services providers in leading-edge programs through Mobile Integrated Healthcare and Community Paramedicine MIH-CP. These programs are expanding and transforming the care being provided in the community by improving patient outcomes creating healthcare system efficiencies lowering costs and reducing avoidable patient admissions and readmissions. MIH-CP is being discussed at every turn and NCTTRAC wanted to be a part of that conversation. On Friday April 24 2015 NCTTRAC held the regions first Community Integrated Mobile Healthcare Symposium Improving Patient Outcomes and Reducing Costs at the Uptown Theater in Grand Prairie Texas. Dr. Raj Gandhi JPS Health Network and NCTTRAC Chairman of the Board served as Master of Ceremonies. The keynote speakers included Matt Zavadsky MedStar Mobile Healthcare Kristin Jenkins DFW Hospital Council and Dr. Sharon Malone EMS Medical Director for Grand Prairie Sherman and Denison Fire Departments. Jack Ayres of Ayres Law Office P.C. provided legal information and also created a Legal Guide to MIH-CP for Texas EMS Providers. Chief Norman Seals Dallas Fire-Rescue DFR and Dr. Marshal Isaacs Medical Director Dallas Fire-Rescue presented on Dallas MIH- CP program. Dr. Liz Fagan Community Health Paramedicine Director McKinney Fire Department delivered her presentation on McKinneys outstanding MIH-CP program. Daniel Frey co-creator of the McKinney program was also a presenter. Josh Clouse Community Paramedicine Coordinator of Plano Fire-Rescue Chris Weinzapfel Director of Emergency Medical Services for Rowlett Fire Department and Dawn Zieger Executive Director of Access and Integration JPS Health Network each spoke to their agencies critical roles and programs that are improving healthcare in their communities. Joseph Schmider Texas EMS Director attended the symposium and graciously made an appearance on stage and addressed the audience with regard to the Department of State Health Services DSHS support for EMS and the MIH-CP programs. The symposium sponsors included ImageTrend BEST EMS Abbott Point of Care Emergicon Grainger Hanger Clinic Infor and Physio-Control. Mobile Integrated Healthcare and Community Paramedicine MIH-CP programs represent a new direction in pre-hospital care and will continue to emerge as progressive EMS systems look to improve patient outcomes and reduce healthcare cost. 2014-2015 16 Hospital Preparedness Program 2014 Hazard Vulnerability Analysis The Regional Hazard Vulnerability Analysis Report was a product created in Year 13 of the Hospital Preparedness Program and is a vital tool for the advancement of the Healthcare Coalition. This report details the cumulative hazard results provided by hospital coalition members and yields quantitative analysis of the hazards that are a threat to the region. These findings define training exercise and planning initiatives for disaster preparedness in TSA-E. 71 52 50 48 45 42 41 38 32 30 0 10 20 30 40 50 60 70 80 Tornado SevereThunderstorm ChemicalExposureExternal ElectricalFailure IceStorm TerrorismChemical MassCasualtyIncident medicalinfectious MassCasualtyIncidenttrauma Small-MediumSizedInternalSpill TerrorismBiological Top Ten HVA Results N 875 Total Entries 6 6 5 2 2 2 3 3 3 13 10 9 3 3 3 20 15 13 24 22 20 0 10 20 30 Tornado Chemical Exposure External Mass Casualty Incident Zone 1 Severe Thunderstorm Tornado Hostage Situation Zone 2 Ice Storm Tornado Mass Casualty Incident Zone 4 Tornado Terrorism Chemical Severe Thunderstorm Zone 5 Severe Thunderstorm Tornado Small-Medium Sized Zone 6 Tornado Ice Storm Severe Thunderstorm Zone 7 Tornado Electrical Failure Severe Thunderstorm Zone 8 Top Three HVA Results by Zone N 875 Total Entries NCTTRAC Annual Report 17 HPP Capability Measures Percentage Completion Status The Hospital Preparedness Program HPP has completed budget period three BP3 and initiating work in budget period four BP4 of the five year contract period. The contract and program are scheduled to continue through June 2017. The HPP requires work in eight federally defined capabilities each capability delineates several functions and resource elements. The Healthcare Coalition has focused on completing objectives related to all eight capabilities. Below you will find the current status of each of the programs eight capabilities. HPP Capability Measures Percentage Completion Status as of September 2015 75 50 31 20 36 33 30 18 80 83 84 80 64 70 50 18 80 100 100 100 85 80 50 100 0 10 20 30 40 50 60 70 80 90 100 Capability 1 Healthcare System Preparedness Capability 2 Healthcare System Recovery Capability 3 Emergency Operations Coordination Capability 5 Fatality Management Capability 6 Information Sharing Capability 10 Medical Surge Capability 14 Responder Safety and Health Capability15 Volunteer Management Percentage Complete As of March 2014 Percentage Complete As of January 2015 Percentage Complete As of June 2015 2014-2015 18 HPP Training and Exercise During Hospital Preparedness Program HPP Year 13 NCTTRAC worked to provide training that strengthen HPP core capabilities and organizational operations. Training needs and gaps were identified in the 2014 2015 multi- year training and exercise plan MYTEP and HPP YR 13 EOY Assessment. Some of the recognized needs included training and experience in mass fatality decontamination and appropriate use of personal protective equipment. NCTTRAC hosted the Centers for Disease Control and Prevention CDC as they facilitated the Personal Protective Equipment for Biological Events course and successfully trained 116 students. Students were also trained in Critical Incident Stress Management and Psychological Simple Triage and Rapid Treatment PsySTART in order to increase responder health and safety with the Healthcare Coalition. Other courses provided include Basic Disaster Life Support Advanced Disaster Life Support and Medical Management of Chemical Biological Radiological Events facilitated by the Texas AM Engineering Extension Services. NCTTRAC Training and Exercise finished the year with 11 total trainings of which 352 students were trained in an assortment of core focused training opportunities. NCTTRAC Annual Report 19 Communications and Information Sharing NCTTRACs continuing commitment to regional preparedness presented the RAC with the opportunity to move some of the cache of communications equipment out into the hands of the EMTF - 2 first responders. NCTTRAC has strategically placed five Mobile Satellite MSAT communications kits and five ambulance strike team VHF radio communications kits out into the region in the hands of the strike team leaders. This process decreases deployment time by eliminating the need for the teams or team leaders to have to travel to south Arlington to obtain equipment. NCTTRAC also created 5 portable HAM Radio kits to increase the com This year NCTTRAC has created more than 250 new crisis application users in WebEOC EMResouce and ETRACS as training in these crisis applications has been moved into high gear. NCTTRAC is now training small groups thru WebEx online meetings. By offering training via WebEx we have eliminated the need for members to travel to the NCTTRAC office to be trained in the crisis applications. Classes are also being adjusted to meet the needs of the audience and not just a one size fits all curriculum. We are tailoring the classes to meet the needs of the Emergency Room RN the EMS professional and continue to train users in the training center at least once a quarter. We are committed to making these drills available to the healthcare region to test their redundant communications systems including satellite phone commercial radio and amateur radio on a continuing basis. Staff looks forward to increasing participation in the monthly drills and will be glad to help troubleshoot systems as the needs arise to ensure preparedness. 45 60 32 74 0 20 40 60 80 Fourth Quarter Third Quarter Second Quarter First Quarter HPP YR 13 Redundant Communications Drill Participation Number of Hospitals 2014-2015 20 Emergency Medical Task Force 2 Texas EMTF - 2 The Texas Emergency Medical Task Force TXEMTF is funded a part of the Hospital Preparedness Program and is administered through eight lead participating RACs with the mission of creating State-deployable medical teams regionalized for rapid mobilization and readiness. The EMTF program provides a well-coordinated response rapid professional medical assistance to emergency operation systems during large scale incidents and immediately available resources such as Ambulance Bus AMBUS Mobile Medical Units Ambulance Strike Teams RN Strike Teams Medical Incident Support Teams and Staging Managers. Teamwork. Training. Experience. Dedication. These words describe what makes the regional Emergency Medical Task Force a success. EMTF2 demonstrated great success this year by building upon partnerships with many private agencies and jurisdictions and demonstrating the capability to support disaster health care delivery. A special Thank You to all of the individuals that come together to make this program possible. Partnering Agencies Acadian Travis County East Texas Medical Center EMS Irving FD Prosper FD Acadian North Texas Division Euless FD Krum FD Questcare DFW Air Evac Life Team Farmers Branch FD Lake Granbury Medical Center Richardson FD Allegiance Ambulance Ferris FD Lewisville FD Rowlett FR Argyle Fire District Flower Mound FD Life Med Sacred Cross Cannefax Consulting Frisco FD Little Elm FD Sherman FD Careflight Garland FD Lonestar Ambulance Inc. South Taylor EMS Cedar Hill FD Giatros Holdings Mansfield Fire Rescue Stephenville FD Celina FD GrahamYoung County EMS Mckinney FD Texas Vital Care EMS City of Ft Worth Grapevine FD Murphy Fire Rescue Van Alstyne FD Cook Childrens Medical Center Hardeman County EMS North Richland Hills FD Vernon FireEMS Cooke County EMS HCA North Texas Division Possum Kingdom Lake Vol EMS Wise County EMS Coppell FD Highland Village FD Pottsboro FD Wylie FD Denton FD NCTTRAC Annual Report 21 Bataan Memorial Death March On March 22 2015 EMTF - 2 participated in this years Bataan Memorial Death March an annual event sponsored by the U.S. Army at White Sands Missile Range New Mexico. The event is a challenging 26.2 mile march through the high desert terrain of White Sands Missile Range conducted in honor of service members who defended the Philippine Islands during World War II. EMTF Regions One and Nine mobilized their Mobile Medical Unit MMU assets to establish a minor and advanced care treatment center. The MMU consisted of a total of five Zumro 860s three Zumro Quads and one awning on a 53 trailer it was the largest MMU footprint for this event to date. Of the 5500 persons who participated in this years march approximately 555 of those participants received medical treatment in the MMU. The care provided ranged from minor foot care due to blister formation to more advanced therapy resulting from dehydration and heat exhaustion. This year all eight EMTF regions across the state were represented at this event. Participating and representing NCTTRAC and EMTF Region 2 were Dr. Sharon Malone Jacob Johnson and Jeremy Rountree with HCA North Texas and Jim Dickerson Emergency Healthcare Systems Director from NCTTRAC. These individuals served in multiple support roles throughout the event including initial deployment and set up patient triage and treatment command coordination and support and incident demobilization. Foot Care - 298 43 Meds Only - 35 5 IV Therapy - 108 15 Orth Injury - 112 16 Other - 145 21 Bataan Memorial Death March Patients Treated 2014-2015 22 Tornado Response Van Bridgeport Operational Deployments During the severe weather events in early May 2015 EMTF- 2 was issued two State Mission Assignments. The assignment for each was to roster and deploy an Ambulance Strike Team and two Medical Incident Support Team M-IST personnel. This was done successfully and no needs were unmet. A formal AAR was created and important experience was developed. On Sunday May 10 the State of Texas activated a small EMTF footprint to assist with response to the Tornado that touched down in Van Texas. The Palestine AMBUS EMTF 4 was sent on mutual aid early on and the EMTF SCO kept very close conversation with the SMOC staff. It was decided that a second AMBUS and one Ambulance Strike Team would be activated to join the 10-20 local resources already on the ground. Initial reports of flattened homes a second tornado and the fact that it was still dark were concerns leading to this decision. The closest region was EMTF-2 since EMTF-4 was in the path of the weather system producing the tornadoes. EMTF-2 resources were activated including the Cedar Hill AMBUS and one ambulance strike team. As EMTF resources were getting close to Van the IC and local Public Health authority made the decision to cancel those resources. However due to multiple tornadoes in the area watches in the forecast and the uncertainty of the darkness the Disaster District Committee DDC State Medical Operations Center SMOC and State Operations Center SOC made the decision to stage those resources in Canton until first light. Victor Wells and Brent Smith EMTF-4 were also activated as M-IST to provide support to the DDC and serve as staging personnel for state resources. As of 0200 Van had no unmet needs. All EMTF resources were requested to meet up with Victor and stage until morning pending any new mission assignments. On Tuesday May 19 just before midnight the SMOC and the SOC requested activation of one 1 Ambulance Strike Team one 1 AMBUS and two 2 Medical Incident Support Team M-IST personnel to respond to the Decatur DDC to stage in support of response operations following multiple tornadoes that touched down in the area. Initial reports included damaged homes trapped individuals and several injuries. High water heavy rain and hail hampered response efforts and darkness and power outages made size-up difficult. As a result EMTF-2 activated the resources requested by the SOC. MedStarFt. Worth provided both the AMBUS and Ambulance Strike Team. M-IST personnel from EMTF-2 included Jacob Johnson HCA NTX and Curtis Poovey Richardson FD. The SOCDPS Captain initially requested an ambulance strike team and AMBUS in anticipation of more casualties as storms entered Denton Wise and Parker counties. Local assets managed to handle the event without further need for state activated resources and EMTF-2 assets were demobilized accordingly. NCTTRAC Annual Report 23 NCTTRAC Logistics and Transportation Division NCTTRAC Emergency Medical Warehouse 4408 Barnett Blvd Arlington TX 76017 Open Wednesdays and By Appointment Only Warehouse Facts Manages over 5.2 million in inventory Radiological detection and identification cache Medical Evacuation equipment cache Mass Fatality equipment cache Over 150000 N95 masks 21 trailers and generators with 2 prime mover trucks 39 ventilators 45 suction units 4 AEDs 12 Mobile Satellite communications kits HAM and public safety radios and antennas Licensed by Texas Department of State Health Services as a Non pharmaceutical and Medical Device Distributor with medical gas license Personal Protective Equipment PPE and Decontamination Equipment 2014-2015 24 Data and Information Systems Division Remote Worksite Redundancy This year signified the completion of the remote worksite functionality at the NCTTRAC emergency medical warehouse. NCTTRAC staff can remotely work as if they are sitting at their desk from the Warehouse location in South Arlington. We can operate from laptops and manipulate network data send files to network printers scan documents to email and access email while being connected to a network port or the integrated wireless network. Staff also has the ability to reach regional crisis applications while outside of the main office. We were also able to implement remote viewing multi camera video security system with recording to make sure the warehouse inventory is accounted for and safe. This gives NCTTRAC staff the opportunity to operate from the emergency medical warehouse in the event that regional assets are needed to be stage or deployed and know that this process is seamless. Taking the Region to the Cloud This year was focused on migrating NCTTRACs current regional IT infrastructure into the newly designed virtual cloud datacenter. The implementation goals were to increase efficiency reliability and redundancy within the regional crisis applications and member support functionality for Trauma Service Area E. We were able to successfully migrate ETRACS REGE NCTTRAC websitesupport site and member list servs. These applications being in the cloud datacenter gives us the flexibility to address the regions demands in a moments notice. We have the ability to add new server infrastructure increase application performance and address growth requirements on the fly which is very important during region wide events that would put more demand on the infrastructure and its usability. The cloud datacenter also signifies the redundancy needed during such an event due to the level of multiple internet providers backup power and cooling and redundant generators. We even have the ability to virtually migrate of infrastructure to a datacenter on the East Coast if we were to have a region wide infrastructure outage. This coming year we will plan to move the Regional WebEOC instance as well as a few other internal applications for site redundancy and performance. NCTTRAC Annual Report 25 REGE Over the past year several additional hospitals and EMS agencies began participating and contributing data on a quarterly basis to REGE. We are excited to see a dedication in data contributions. Several exciting changes have occurred. We are proud to announce that REGE has its own webpage On the REGE webpage a variety of materials can be found including quarterly data submissions annual benchmark reports MAVEN annual reports the data submission schedule guides presentations and important links. The REGE webpage can be found at ncttrac.orgDepartmentsDataInformationSystemsREGE In addition REGE now has the capability of importing and exporting Stroke and Trauma ICD-10 codes. As always for any REGE questions or assistance please create a REGE helpdesk ticket in the NCTTRAC Support Site at support.ncttrac.org. 2014-2015 26 Crisis Applications EMResource This year EMResource proved to be one of the regions most beneficial communication resource. Several new advancements were made to the regional default screen making the tool easier to navigate and view real-time information. During the early winter seasons the pediatric community experienced extreme saturation and PICUNICU beds quickly became a scarcity. External transfers became a harsh reality to some of the larger pediatric facilities in Trauma Service Area -E prompting the need for state wide visibility on available bed information. Supporting a request from local partners NCTTRAC partnered with SETRAC Houston and HOTRAC Waco to initiate an EMResource NICUPICU query to help aid some pediatric transfer decisions. The tool allowed for hospital users in all three RACs to update their available bed counts on one page every few hours. This tool became so valuable that it is now configured as a permanent feature and can be activated whenever the need arises. More advancements in this application included strengthening the regions ability to receive and provide emergent information and expanding the Hospital Preparedness Programs coalition audience. The Texas Department of State Health Services partnered with the Texas Department of Aging and Disability Services to create a Long Term Care view inside EMResource. This list included assisted living facilities nursing homes and Intermediate Care Facilities for Individuals with Intellectual Disabilities ICF IID. The region alone has 1000 DADS facilities bringing the coalition to the largest it has ever been. Having the ability to communicate with and receive real time information from these facilities further strengthens the regional response capability and helps improve overall emergency healthcare connectivity. NCTTRAC Annual Report 27 ETRACS ETRACS saw another year of advancement in YR 13 and remained the sleekest and most flexible of the crisis applications. Between major exercise usage training opportunities new module additions and real-event support ETRACS saw over 420 logins and gained 630 new users. The Patient Tracking module that was added in 2013 continued to build traction this year lending support to 15 exercises around the region and four real life events. This tool was purchased to provide better accountability for patient movement during Mass Casualty Incidents. Because of ease and intuitive navigation over 100 coalition members were trained on this process inching the region that much closer to being fully prepared to respond to multi-victim incidents andor hurricane coastal evacuations. ETRACS was also utilized to meet the DSHS no-notice bed requests that occur monthly in the HPP environment. Hospitals can now login select the drop down boxes for every HAvBED category and upload timely bed availability information that can be communicated all the way to the federal level. This proved to be a timely and valuable resource during the October 2014 Ebola event. State Health Commissioner Dr. David Lakey requested daily bed reporting to assist with the impact of the Ebola crisis. With help and participation from surrounding hospitals NCTTRAC was able put the needed information into the hands of Dr. Lakey while he was serving in the Dallas County EOC allowing for clear regional perspectives and better response decision making. The newest module launched this year is an incident management tool dubbed Command Center. This module provides a scalable chat room for incident management document sharing bulletin information updates event tracking and single or group conversation. Hospital users now have the flexibility to start a chat room with everyone in their department everyone in their facility everyone in their hospital system or even everyone in the region with just a few easy clicks. This process was built to be in line with incidents that start local and gradually grow larger as the needs begin to outweigh the resources. 2014-2015 28 WebEOC WebEOC was the go-to resource this year during the Ebola event which used a regionally fused incident between all regional servers McKinney Fort Worth NCTTRAC Dallas County and Plano and was tied to the state operations center. NCTTRAC worked with the regional administrators to agree upon the use of one WebEOC board Texas EF-8 Events to share all incident related information. Regional and state representatives from the Department of State Health Services Texas Division of Emergency Management and Dallas County Health and Human Services all posted situational reports throughout the duration of the event making this information available to everyone with a WebEOC login. WebEOC was also utilized during the May 2015 EMTF deployments to Van and Decatur. The entire EMTF program from around the state had access to all incidents details and were able to track personnel and resources to and from the events. Responders at the scene were also able to capture needed incident information by logging in from the Incident Command post to follow along with progress and potential response orders. The NCTTRAC Emergency Medical Coordination Center EMCC was able to provide incident coordination updates to state representatives broad communication to coalition members as well as situational awareness and geographical information to those on scene. NCTTRAC Annual Report 29 2014-2015 30 NCTTRAC Staff Contact Information Contact Phone Number Executive Director 817-607-7001 Director Healthcare Coalition HCC Preparedness Programs 817-607-7002 Plans Capabilities Supervisor 817-607-7003 Infectious Disease Coordinator 817-607-7024 Logistics Transportation Supervisor 817-607-7005 Training Exercise Coordinator 817-607-7018 Director Emergency Healthcare Systems EHS 817-607-7017 EHS Support Supervisor 817-607-7011 EHS Development Manager 817-607-7022 EMTF Coordinator 817-607-7015 Emergency Medical Response Coordinator 817-607-7010 Crisis Communications Administrator 817-607-7016 Director Data Information Systems 817-607-7007 Product Solutions Engineer 817-607-7014 Data Information Systems Manager 817-607-7006 Data Information Systems Administrator 817-607-7004 Comptroller 817-607-7019 Staff Accountant 817-607-7012 Office Manager 817-607-7009 The North Central Texas Trauma Regional Advisory Council NCTTRAC is an organization designed to facilitate the development implementation and operation of a comprehensive trauma care system based on accepted standards of care to decrease morbidity and mortality. The Mission of the North Central Texas Trauma Regional Advisory Council is to promote and coordinate a system of quality trauma and emergency healthcare and preparedness in North Central Texas At the North Central Texas Trauma Regional Advisory Council We PREPARE Through research education injury and illness prevention and emergency management We SUPPORT Through protocol development resources communications and advocacy We RESPOND To the needs of the emergency healthcare community partners and the State of Texas Connect with us at www.ncttrac.org