History of Trauma in Indiana
Trauma is an important public health and health care delivery issue because of its major impact on the lives and health of Hoosiers.
Trauma refers to people who have sustained severe injuries, requiring rapid evaluation and transport to specific hospitals with trauma care capabilities, staffed and equipped to provide the comprehensive care needed. All hospital emergency departments are not trauma centers; only 8 Indiana hospitals are American College of Surgeons – verified as trauma centers.
A trauma system is an organized, coordinated effort in a geographic area that delivers the full range of care to all injured patients. Until March 2006, Indiana was among a handful of states with no laws or regulations granting oversight authority for trauma care. Proper oversight is a necessary element of any trauma system. Public Law 155, enacted in 2006 with support from resolutions by the Indiana State Medical Association and the Indiana Emergency Nurses Association, changed that. This legislation designated the Indiana State Department of Health (ISDH) as the lead agency for a state trauma care system with goals of preventing injuries and coordinating care for injured patients in order to reduce death and disability. No funding was appropriated with this legislation; in fact, of all the states, Indiana appropriates the lowest per capita funding for public health programs. This lack of focus on public health programs is one reason Indiana lags behind many states in trauma system development.
Indiana’s Trauma Timeline
Click on a date to display the events that took place during that year in the development of the statewide trauma system.
Trauma Care Task Force was first organized. One hundred people were involved at various times during the early years. The Task Force came to the following conclusions about the design of Indiana’s trauma system:
- It’s desirable for all hospitals to eventually be part of the statewide system.
- Creating a statewide trauma system will mean necessary collaboration between Emergency Medical Services (EMS), hospitals, rehabilitation facilities and public health
- Legislation will be necessary to create an identifiable and sustainable source of funding for the trauma system.
- Injury prevention data collection and “best practices” along with widespread public education about trauma and injury will be important parts of the system.
A one-year Health Resources and Services Administration (HRSA) grant from the federal government was obtained for the trauma program at the Indiana State Department of Health (ISDH).
A three-year HRSA trauma/EMS grant was awarded, but the office was defunded in 2006.
Governor Daniels signs Public Law 155 (now codified at I.C. 16-19-3-28) ordering the ISDH to develop, implement and oversee a statewide comprehensive trauma care system. Sen. Tom Wyss (R., Ft. Wayne) led the effort to get the law passed.
IC 16-19-3-28: State department designated as lead agency of a statewide trauma care system; rule making authority
Sec. 28:
- (a) The state department is the lead agency for the development, implementation, and oversight of a statewide comprehensive trauma care system to prevent injuries, save lives, and improve the care and outcome of individuals injured in Indiana.
- (b) The state department may adopt rules under IC 4-22-2 concerning the development and implementation of the following:
- (1) A state trauma registry.
- (2) Standards and procedures for trauma care level designation of hospitals.
As added by P.L.155-2006, SEC.2.
In April, the ISDH hired a trauma system manager.
Federal funding from the National Highway Transportation Safety Administration (NHTSA 408) for the state trauma registry was received from the Indiana Criminal Justice Institute (ICJI). A contract with a trauma registry software vendor (ImageTrend) was completed and a trauma system retreat was held.
Note: The ICJI funding continues today.
Senate Bill 249, sponsored by Sen. Wyss, passes giving the Department of Homeland Security the authority to adopt EMS triage and transportation protocols.
In September, the ISDH hired its first state trauma registry manager.
In December, the American College of Surgeons (ACS) conducted a consultation visit during which it commented on those aspects of a trauma system in place and recommended a list of actions the state should take to improve its trauma system.
In February, the ACS issued their consultation visit recommendations.
In November, Governor Daniels signed an Executive Order creating the Indiana Trauma Care Committee, which serves as an advisory body to the ISDH on all issues involving trauma.
Presentation to the Indiana Rural Health Association.
Presentation to the Indiana Emergency Nurses Association Symposium.
In February, the ISDH reported that there were 17,000 records in the trauma registry. The goal of 20,000 records “is now within reach.” NOTE: As of May 2012, there are now more than 70,000 records in the Indiana trauma registry.
In October, the first meeting of the Indiana Trauma Care Committee (previously the Trauma Care Task Force) was held.
In April, the Indiana Department of Homeland Security reconsider a Triage and Transport rule, fulfilling the intent of Sen. Wyss’ bill (Senate Bill 249) of 2008.
In August, the ISDH hired a trauma and injury prevention division director, prioritizing trauma as a division within the agency.
In November, the EMS Commission adopted a rule governing Triage and Transport of injured patients. NOTE: Due to process issues with the original vote, the Commission had to reconsider the rule; the rule has not changed substantively.
In January, the ISDH hired three additional staff members: a Trauma Registry manager, Trauma Registry data analyst and an injury epidemiologist, expanding the trauma and injury prevention division’s expertise.
In May the EMS Commission re-adopted the Triage and Transport rule. In August, the Triage and Transport rule was published.
In January, Governor Pence re-issued Governor Daniels' original Executive Order creating the Indiana Trauma Care Committee, which serves as an advisory body to the ISDH on all issues involving trauma.
