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; currently 23 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. The ISDH has successfully acquired and used federal funding to development and implementation of a statewide trauma system. Trauma system development is currently funded by grants from the Indiana Criminal Justice Institute (ICJI), which administers the NHTSA 408 traffic records grant, monies from the federal Centers for Disease Control and Prevention (CDC) Preventive Health and Health Services block grant, CDC National Violent Death Reporting System (NVDRS) grant, CDC Overdose Data 2 Action (OD2A) grant, the Substance Abuse and Mental Health Services Administration (SAMHSA) First Responder Comprehensive Addiction and Recovery Act (FR CARA) grant, Bureau of Justice Administration (BJA) Comprehensive Opioid Abuse Program (COAP) grant and BJA Student, Teachers and Officers Preventing (STOP) School Violence and Prevention grant.
Indiana’s Trauma Timeline
- 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.
IC 16-19-3-28: State department designated as lead agency of a statewide trauma care system; rule making authority
- (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.
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.
- Presentation to the Indiana Rural Health Association.
- Presentation to the Indiana Emergency Nurses Association Symposium.
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. On January 9, 2017, Governor Holcomb re-issued Governor Daniels' original Executive Order creating the Indiana State Trauma Care Committee. A link to the full text of the re-issued order can be found here.
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 2018, there are 255,680 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 reconsidered 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 did not change 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.
From June through September, the ISDH completed their first Trauma Tour around the state.
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.
In March, the ISDH and IDHS EMS Commission worked together to approve "In the process of ACS verification" trauma centers for purposes of the Triage and Transport Rule, which will greatly increase the number of trauma centers in Indiana.
In April and May, the ISDH completed their second Trauma Tour around the state.
In June and July, the ISDH completed their Training Tour around the state.
In November, the Trauma Registry Rule was published. It requires all pre-hospital (EMS) transport providers, hospitals with emergency departments and the State's seven rehabilitation hospitals to report trauma cases to the ISDH trauma registry. The rule became effective November 24, 2013. The rule was preliminarily adopted by the ISDH Executive Board in January 2013 and a public hearing was held July 29, 2013. The full text of the Trauma Registry rule can be found here.
In January, the ISDH hosted the first statewide EMS Medical Director's Conference. The ISDH also hired an additional staff member: an ISDH EMS Registry manager.
In February and March, the ISDH completed their Trauma Registry Training Tour around the state.
In August, IU Health Arnett Hospital and IU Health Ball Memorial Hospital became the state's first ACS verified level III trauma centers.
Note: As of August 2016, the state has 12 verified trauma centers.
In October, the ISDH received $1.4 million from the Centers for Disease Control (CDC) to gather critical data on violent deaths using the National Violent Death Reporting System (NVDRS).
In March, the ISDH hosted the first statewide Injury Prevention Conference. The ISDH also hired an additional staff member: an Indiana Violent Death Reporting System (INVDRS) Epidemiologist.
In May, the ISDH hired an additional staff member: an Indiana Violent Death Reporting System (INVDRS) Law Enforcement Records Coordinator.
During the months of June through August, the ISDH completed their 2015 Trauma Tour around the state.
In August, the ISDH hosted the second annual EMS Medical Director's Conference.
In September, the ISDH hired two additional staff members: an Injury Prevention Program Coordinator and an Indiana Violent Death Reporting System (INVDRS) Records Consultant.
In February, the ISDH hired an Events Project Coordinator and a Prescription Drug Overdose (PDO) and INVDRS records consultant)..
In March, the ISDH received $3.2 million from the CDC to support enhancements to INSPECT, the Indiana prescription drug monitoring program at the Indiana Professional Licensing agency, improve opioid prescribing practices, support prevention efforts at the state and community levels to address new and emerging problems related to prescription drug overdoses and a partnership with the IU Fairbanks School of Public Health to evaluate opioid prescribing practices in Indiana.
In April, the ISDH hired a Prescription Drug Overdose Community Outreach Coordinator, PDO Records Consultant and PDO Epidemiologist.
In September, the ISDH received $1.9 million from the CDC to further support enhancements to improving opioid prescribing practices and support prevention efforts at the state and community levels to address new and emerging problems related to prescription drug overdoses.
In October, the ISDH received a Public Health Associate through the CDC's Public Health Associate Program (PHAP). This associate is with the Division of Trauma and Injury Prevention for two years. In October, the ISDH hired an injury prevention coordinator.
In January, Governor Holcomb 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.
In March, the ISDH hired two additional PDO Records Consultants, and an additional PDO Community Outreach Coordinator.
In June, the ISDH hired an overdose surveillance educator epidemiologist.
In July, the ISDH hired a registry coordinator, a PDO epidemiologist, and two PDO and INVDRS records consultants.
In September, the ISDH hired a PDO community outreach coordinator.
In October, the ISDH received a Public Health Associate through the CDC's Public Health Associate Program (PHAP). This is the second CDC associate who will be with the Division of Trauma and Injury Previontion for two years.
In November, the ISDH hired a PDO and INVDRS record consultant.
As of November 2017, the state had 20 ACS verified trauma centers.
As of April 2018, the state had 22 ACS verified trauma centers.
As of June 2019, the state had 23 ACS verified trauma centers.
American College of Surgeons Consultation in 2008
After two years of study, the Indiana Trauma Task Force reached a consultation agreement with the Committee on Trauma of the American College of Surgeons, a non-biased, nationally-recognized organization. This consultation team would evaluate the resources, legislation, trauma care delivery, trauma registries/data analysis, performance improvement, interagency cooperation/communication, professional/community education, and injury prevention and control currently in Indiana. The trauma system consultation team would also provide knowledge and experience from other states to help Indiana develop a trauma system. This consultation required intensive advance preparation, and a four-day visit from the College. The consultation team included professionals from surgery, emergency medicine, trauma nursing and emergency medical services.
The ACS-COT site visit team conducted a trauma system assessment for the State of Indiana on December 14–17, 2008.
ACS-COT Full Report for Indiana:
ACS-COT Final Presentation for Indiana:
Indiana Pre-Review Questionnaire:
Indiana Presentation for ACS: