Trauma and Injury Prevention Section Newsletter - August 2007, Vol 11, #2
Letter from the Chair
Mark Sochor, MD, FACEP
Hope everyone’s summer is going great! The last few months have been semi-turbulent as the Trauma Care and Injury Control Committee (TCIC) was disbanded and spread among other committees such as EMS and Public Health. The disbanding of the TCIC committee will put more emphasis for expertise and trauma advocacy on the section. Please refer to the newsletter article for more details.
On the brighter side, the TIP Section was awarded a section grant to study emergency department directors’ knowledge and opinions on trauma and alcohol use. The principal investigator is Dr. Rebecca Cunningham and a task force has been assembled to develop a questionnaire, which will be sent to ED directors by both mail and email. Way to go Rebecca! As this is our third year in trying to secure a grant for the section with two previously failed attempts this one tastes sweet. The section e-list had an announcement which invited any and all section members to participate in the formulation of the questions and interpretation of the results. If you missed the blanket e-mail or ignored it and would like to participate please see the article which describes the grant in the newsletter.
P.L. 110-23: Trauma Care Systems Planning and Development Act of 2007 has finally passed and monies will be available for much needed research. Be sure to thank Rep. Gene Green of Texas who introduced the bill. The particulars:
||In General- The Secretary shall, with respect to trauma care—
||conduct and support research, training, evaluations, and demonstration projects;
||foster the development of appropriate, modern systems of such care through the sharing of information among agencies and individuals involved in the study and provision of such care;
||collect, compile, and disseminate information on the achievements of, and problems experienced by, State and local agencies and private entities in providing trauma care and emergency medical services and, in so doing, give special consideration to the unique needs of rural areas;
||provide to State and local agencies technical assistance to enhance each State's capability to develop, implement, and sustain the trauma care component of each State's plan for the provision of emergency medical services;
||sponsor workshops and conferences; and
||promote the collection and categorization of trauma data in a consistent and standardized manner.
||Grants, Cooperative Agreements, and Contracts- The Secretary may make grants, and enter into cooperative agreements and contracts, for the purpose of carrying out subsection (a).
||In General- The Secretary may make grants to public and nonprofit private entities for the purpose of carrying out research and demonstration projects with respect to improving the availability and quality of emergency medical services in rural areas—
||by developing innovative uses of communications technologies and the use of new communications technology;
||by developing model curricula, such as advanced trauma life support, for training emergency medical services personnel, including first responders, emergency medical technicians, emergency nurses and physicians, and paramedics—
||in the assessment, stabilization, treatment, preparation for transport, and resuscitation of seriously injured patients, with special attention to problems that arise during long transports and to methods of minimizing delays in transport to the appropriate facility; and
||in the management of the operation of the emergency medical services system;
||by making training for original certification, and continuing education, in the provision and management of emergency medical services more accessible to emergency medical personnel in rural areas through telecommunications, home studies, providing teachers and training at locations accessible to such personnel, and other methods;
||by developing innovative protocols and agreements to increase access to prehospital care and equipment necessary for the transportation of seriously injured patients to the appropriate facilities;
||by evaluating the effectiveness of protocols with respect to emergency medical services and systems; and
||by increasing communication and coordination with State trauma systems.
What about the money? $12,000,000 authorized for 2008 without the requirement that states match dollar for dollar. However, 2009 has $10,000,000 and the dollar for dollar state match goes into effect. 2010 has $8,000,000 with dollar for dollar state match. 2011 and subsequent years have $8,000,000 per year available with a $1 federal for $2 state match. Finally some money to study trauma!!! Please see bill H.R. 727 for more details and good luck on securing some of that grant money.
The Virginia Tech shootings were a tragic event in which our docs were on the front lines receiving those injured. As always emergency medicine was up to the task! I feel strongly about the need to control who can buy a handgun. I still don’t think there are enough safeguards. I would like to form a task force to propose a resolution about ACEP’s position on gun control and would like to see a stronger stance on it. Perhaps we should invite the public health section and tactical medicine section to the conversation for different perspectives on a very difficult topic. However, our medical partners (pediatricians and trauma surgeons) have officially endorsed anti-gun positions as evidenced by being listed on the NRA website as "National Organizations with Anti-Gun policies." Pediatricians are very nice and collegial people, while trauma surgeons are a little more rough and tumble. I always envisioned Emergency Medicine taking the positive attributes from these established fields of medicine and blending the best to achieve the "Emergency Physician." It never occurred to me that EPs were lacking a backbone. During the Virginia Tech Massacre who was on the front lines, who would be the ones to render care and save lives from this horrific tragedy? You guessed it. Emergency Medicine would be there to stabilize and comfort the victims but EPs won’t voice an opinion on a device that has ruined countless lives. We’re quick to tell someone with COPD they shouldn’t smoke or that children should be in car seats or if they’ve consumed too much alcohol. We even sometimes have the nerve to ask about guns but only when we are working up the psych patient. Should we advocate trigger locks out of the ED? Should we tell people to stop storing guns? We tell parents to put helmets on their kids and chastise the children and parents while we are sewing up the head lac after a simple bike accident. We ask about smoke detectors. Why not ask if there are guns in the house? If they answer yes, hand the family a pamphlet on just how dangerous that is. Like it or not, we are physicians and we need to advocate for the health of our fellow men and women. We need stronger statements coming from the College than just the regular party line that doesn’t offend anyone. From my perspective, the party line on the recent Virginia Tech tragedy was to evaluate whether the ED receiving these victims was overwhelmed so an ED crowding spin could be put on this tragedy. We EPs should have been vocalizing how the control of handguns failed in this instance and how every gun should be accounted for and locked up. There are those who would argue that our "right to bear arms" protects us from governmental takeover. If American citizens are to match weaponry with the US government we citizens would need a nuclear arsenal to battle successfully. Barring this occurrence, the fact that Americans are armed to the teeth does not provide security or peace of mind. The guns are in the hands of the criminals or are about to be when they use your own gun on you. I propose a task force is formed out of the TIP Section which will draft a resolution with some TEETH that will get ACEP on the NRA black list. If you are interested in joining the task force or have comments please email me c/o email@example.com
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Letter from the Chair-elect
Ernest E. Sullivent, III, MD
Are You Ready for Bombing Casualties?
We hate to think about it, but we all know that some day a large scale terrorist bombing on U.S. soil is quite possible. On the front lines in such an incident will be prehospital providers and emergency physicians. Are you ready?
Bombings: Injury Patterns and Care is a new course designed to provide the latest clinical information regarding blast-related injuries from terrorism. The course is supported by the CDC’s Terrorism Injuries Information, Dissemination and Exchange (TIIDE) Project. TIIDE was established through a cooperative agreement to link acute care and emergency medical services to state and local injury prevention programs for terrorism preparedness and response. Bombings: Injury Patterns and Care was developed by a team of experts from the following TIIDE grantee organizations:
- American College of Emergency Physicians (ACEP)
- American Medical Association (AMA)
- American Trauma Society (ATS)
- National Association of EMS Physicians (NAEMSP)
- National Association of EMTs (NAEMT)
- National Association of State EMS Officials (NASEMSO)
- National Native American EMS Association (NNAEMSA)
- Background on Terrorism and Explosive Devices
- Bombing Events
- Blast Injuries: Primary, Secondary, Tertiary, Quaternary
- Crush Injuries and Compartment Syndrome
- Military Experience
- Special Considerations
- Psychological Issues
Download the Course
The course is available in a one-hour module and a three-hour seminar. Each has a PowerPoint presentation as well as a curriculum guide in Word format. A CD-ROM/Web-based interactive course planned for release later in 2007. To download any of the following course components go to: http://www.bt.cdc.gov/masscasualties/bombings_injurycare.asp
A CD-ROM of the course is currently being distributed free of charge to first responders and others interested in blast injury care and management. To place an order for a free CD-ROM, visit the American College of Emergency Physicians website at www.acep.org/blastinjury.
In addition, a new CDC report to address system-wide and discipline-specific issues from terrorism has just been released. In a Moment’s Notice: Surge Capacity for Terrorist Bombings examines the challenges that are likely to confront both the general emergency response and the health care system in the aftermath of a bombing event. The document also recommends easible and affordable strategies for individual communities to manage large numbers of bombing casualties within the current hospital emergency care environment.
In collaboration for more than two years with partner organizations and other federal agencies, CDC developed In a Moment’s Notice to:
- Help health care communities across the nation to identify issues and develop strategies to care for large numbers of injured persons in the event of a terrorist bombing or other mass casualty event;
- Serve as an impetus for hospital administrators and policymakers to begin thoughtful, aggressive planning to maximize emergency health care within their jurisdictions; and
- Provide stand-alone templates that can be used by a variety of communities to address surge capacity issues within nine different health care disciplines.
You can view and download the report for free at http://www.bt.cdc.gov/masscasualties/pdf/surgecapacity_cover.pdf. Visit www.bt.cdc.gov/masscasualties/ for additional resources to prepare for and respond to mass casualty events.
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Trauma Care and Injury Control Committee Disbanded
Mary Pat McKay, MD, MPH, FACEP
Linda Lawrence, ACEP’s President Elect, has made a decision to disband the Trauma Care and Injury Control Committee. She told me her thinking was that much of the work fit better into either the EMS Committee or the Public Health Committee, both of which will continue. This was presented to me and to the rest of the Committee members as a "fait accompli" rather than a topic for discussion. Linda specifically requested that she be the one to inform the committee members and did so via email.
When the issue of combining the TCIC with another committee was initially discussed several years ago, I spoke strongly against the concept as the then-Chair of the TIP Section. I believed then and continue to believe that ACEP needs to have a strong Trauma presence, and that a piece of ACEP’s message to the rest of the world about the importance of Trauma and Injury Control in our profession is to have a standing committee focused on those topics. Having been the Chair of the TCIC Committee for the past three years, I admit I have been frustrated by the inability to achieve consensus and actively push the issues we believe are important to the top of the agenda at ACEP.
What’s interesting is that this occurred at a time when the TIP Section is more active than ever, with an active Section Grant, increasing membership demonstrating increasing interest in the topic from throughout the College. I have high hopes that in Spring of 2008 many of you will ask to be placed on either the EMS Committee or the Public Health Committee to support the interests of trauma and injury control in ACEP. Help keep our issues and ideas alive at leadership levels!
Finally, many, many thanks to all the Committee members who have worked with me over the last several years. Thanks for your time at meetings and during conference calls, hard work tackling tough issues, and for your boundless support.
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Coalition for Fire-Safe Cigarettes Update
As of May 2007, 25 states have filed legislation since the beginning of the year. So far six have signed it into law and two await governor signatures. You can check out the map to see how things are shaping up. Right now, 35.6% of the country is or will soon be covered by this technology. ACEP is a member of this coalition.
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The CPH Update -- Summer 2007
A Publication of the Campaign for Public Health
SENATE STAFF TOUR THE CDC’S ATLANTA FACILITIES
With the generous support of more than a dozen partner organizations, CPH completed its second congressional staff tour of the CDC’s Atlanta headquarters at the end of May.
Ten of the participating Senate staff were based in Washington, DC, and represented members who sit on several key committees. These include the Budget Committee; the Appropriations Committee and the LHHS Subcommittee; the Health, Education, Labor and Pensions (HELP) Committee; Homeland Security; Special Aging and several others. An additional three congressional staff joined the tour from local offices of the Georgia congressional delegation.
As on the House staff tour CPH led in 2006, this two-day Senate staff visit included lectures from dozens of the CDC’s top scientists on a wide range of public health topics. Participants were also guided through the CDC’s emergency response center, the Health Marketing center and the Chamblee Campus environmental health laboratories-including the CDC’s smoking research facility. Staff also enjoyed a rare tour inside a newly constructed Bio-Security Level 4 laboratory that will be certified for use (and closed to visitors) in the near future. At the end of the first day, participating partner groups joined Senate staff at a reception and dinner. During the reception, Dr. Gerberding called the group from overseas to welcome them to the CDC.
CONGRESSIONAL STUDY GROUP ON PUBLIC HEALTH
The new congressional caucus founded by Representatives McGovern (D-MA), Granger (R-TX) and Roybal-Allard (D-CA) to explore a wide range of public health topics held its third and fourth congressional briefings this summer. In June the broad topic of vector-borne disease was covered by experts from the CDC, Yale University and the Environmental Protection Agency. In early July a briefing on workplace wellness was held in partnership with the Prevention Caucus, the U.S. Chamber of Commerce, the American College of Preventive Medicine and Partnership for Prevention. Speakers for this event included senior representatives from the CDC, Dow Chemical Company, Wegmans Food Markets and the American Medical Association. Material from these events will be made available on the Campaign for Public Health’s web site.
Additional briefings on immunizations and global health are on the Congressional Study Group on Public Health’s agenda between now and the fall.
NEW Pro-CDC ADVERTISEMENT HAILS 73 SUPPORTING ORGANIZATIONS
The Campaign for Public Health’s pro-CDC advertisement originally listed 21 national organizations when it was released in February. Since that time, several dozen additional organizations requested to join our effort to highlight the importance of this agency. The ad was recently re-crafted by Ogilvy Public Relations and now lists 73 groups and coalitions. A flier highlighting the ad will be sent to all Congressional offices in the near future. Partner groups are encouraged to distribute the ad to legislators as well -particularly between now and September.
CPH ORGANIZES PUBLIC HEALTH MEETING WITH SPEAKER NANCY PELOSI
Speaker Nancy Pelosi and her senior health and appropriations staffers met with CPH leaders and public health experts on May 10. Former members of Congress John Edward Porter and Paul G. Rogers were joined by CPH Board members Dr. Georges Benjamin and Jennifer Luray. Dr. Michael McGinnis of the Institute of Medicine and CPH executive director Karl Moeller also attended the meeting. The group detailed the real declines in the CDC’s budget since FY02 and impressed upon her the negative impact an erosion of core CDC programs would have on our nation’s health.
FACT SHEETS & POWERPOINTS BOLSTER WEB SITE
A new issue-specific area of CPH’s web site is making partner handouts, relevant PowerPoints and materials from past Study Group meetings available to the public. Partner and CDC materials from the May trip to Atlanta are already available - benefiting Hill staff who were not able to attend the Atlanta tour. Partner groups with concise CDC-related fact sheets are encouraged to contact Kristen Latona at KristenL@FundCDC.org so these materials can be considered for this new section. Additional public health topics will be added as material becomes available. Also of note: CPH web site traffic has nearly doubled since last summer and has exploded by a factor of ten since the summer of 2005.
* Groups that supported the staff trip to Atlanta: Arthritis Foundation, American Diabetes Association, American Heart Association, American Public Health Association, American Red Cross, Home Safety Council, March of Dimes, National Alliance of State & Territorial AIDS Directors, National Association of Chronic Disease Directors, National Association of County and City Health Officials, National Safety Council, Partnership for Prevention and Research!America.
CONGRESS MOVES FORWARD ON FY08 SPENDING BILLS...
July 2007 promises to be a busy month for the Labor, Health and Human Services and Education Appropriations bill. Both the House and Senate have produced a version of the LHHS bill, though the House bill includes $2 billion more in overall funding than the Senate bill. This bill funds the CDC and most other health agencies and programs. As of press time, the House of Representatives expects a vote on the bill in the full House by mid-month. The Senate’s Committee-passed bill looks promising for the CDC, but the Senate leadership has yet to set a date to consider the Senate bill. Consideration of the bill by the full Senate is said to be set for late July-just prior to the August congressional recess.
The Senate bill (S.1710) currently provides the CDC’s core programs with $6.585 billion, while the House number is slightly less - giving the agency’s core budget lines $6.447 billion. In both cases this figure includes pandemic flu funding, although the Senate bill is less complicated in this regard. Its bill does not mix flu dollars in with core CDC program lines but instead proposes to transfer $158 million in flu funding to the CDC from the Public Health and Social Services Emergency Fund after passage of the bill. The Senate’s flu funding mechanism is in line with CPH requests to clearly account for such funding as these ever-changing amounts complicate year-to-year comparisons across core program budget lines.
Both the House and Senate bills are a tremendous step in the right direction for the CDC. While the agency’s budget kept up with inflation from FY02 to FY05, years of cuts or level funding of the agency since that time has eaten away the CDC’s core programs. While neither of the proposals replace all the ground lost to inflation since 2005, CPH is pleased both the House and Senate bills move the agency in a very positive direction.
... BUT - BUSH THREATENS VETO
Should these dollar figures and dates hold, Congress will return late in the summer to conference the House and Senate bills together into one measure. That bill would then be sent to President Bush. It is still unclear what type of reception the LHHS bill will have upon arrival at the White House as Democrats in Congress have provided more funds to the CDC (and other such agencies) than the White House requested. In May, Office of Management and Budget Director Rob Portman sent a letter to Congress threatening that the President will veto any appropriations bill that exceeds his request until Congress demonstrates a sustainable path that keeps discretionary spending within the President’s topline of $933 billion and ensures that the Department of Defense has the resources necessary to accomplish its mission. The Senate provided the LHHS bill alone with $10 billion more than the President requested while the House budget allocation is higher still. This is part of the reason that Congress has been able to overturn his proposed cuts to the CDC in their bills.
Still, during a meeting in a senior Republican appropriations committee member’s office, CPH staff was told that Republican willingness to stand with the President and sustain a veto of this popular health funding bill will depend greatly on the President’s popularity at the time-and current trends are not good for the President. Another factor, of course, would be the popularity of the legislation itself. To this point, Democrats in Congress are working to shore-up support for the LHHS bill early in the process-making a veto threat all that much more uncomfortable for the President and Republicans in Congress. Unlike the President, all House members will face a reelection effort in 2008 - and the LHHS bill has always provided good sound bites for campaign commercials.
OTHER CPH NEWS
The American Medical Association's House of Delegates adopted a resolution on Wednesday, June 27 that pledged to "Support National Coalitions that Advocate for Increased Federal Funding for the Centers for Disease Control and Prevention." Introduced by the American College of Preventive Medicine, Resolution 441 points to the work of CPH specifically and resolves "that our AMA support the Campaign for Public Health." CPH is extremely pleased that this important national organization has pledged to help CPH advance the work of the CDC.
Jennifer M. Luray of Abbott Laboratories - a former Hill staff member and extremely knowledgeable advocate for health, agreed to join the Board of the Campaign for Public Health in March of 2007. Also of note, CPH is currently undergoing our annual audit and will publish a 2006 Annual Report soon after the audit is completed.
THANKS TO OUR NON-PROFIT PARTNERS
Voluntary donations to the Campaign for Public Health from unaffiliated non-profit partners are almost three times higher than they were in all of 2006. Such support helped CPH run our partner advertisement and ensured that congressional staff members saw the CDC’s work first hand.
While there is much more to do, CPH wishes to thank our contributing non-profit partners. We have accomplished a great deal with their help and support
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National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary
On June 29, 2007 the CDC released its most recent annual report measuring health care utilization in emergency departments nationwide. The 2005 Emergency Department Summary report details the most current nationally representative data on visits to hospital and emergency departments in the United States. The statistics show that during 2005, one or more ED visits were made by approximately one-fifth of the population of the United States and this report breaks down the visits in to selected trends and data in terms of hospital, patient, and visit characteristics. A few highlights from the report:
- A total of 115.3 million visits were made to hospital EDs in 2005
- Avg of 30,000 visits per ED in 2005 vs. 23,000 in 1995
- Of those visits, 41.9 million were injury-related (36 percent)
- 36.9 percent of ED visits were made to hospitals designated as trauma centers
- Patients with Medicaid or SCHIP comprised 24.9 percent of all visits with Medicare patients at 16.6 percent
- 12 percent of ED visits resulted in hospital admission
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Federal Affairs Director
While the Trauma Care Systems program (P.L. 110-23) was reauthorized in May 2007, no funding has been appropriated as yet. The Senate Appropriations Committee cleared S. 1710, the FY 2008 Labor-HHS-Education Appropriations Act, on June 21 and the House Appropriations Committee marked-up its rendition of the bill on July 11. ACEP has been working with the American College of Surgeons, the American Association of Orthopaedic Surgeons and Advocates for EMS to secure funding for the Trauma/EMS program. We hope to add funding for this program when the Senate debates S. 1710 and then press for inclusion of the money during the House-Senate conference negotiations.
Medicare Physician Fee Schedule Draft Contains SGR Cuts for 2008
In addition to the predicted 9.9% cut in the fee schedule, CMS also included in the just-released proposed regulation a slight reduction in emergency medicine practice expenses for two of a four-year phase in on practice expense methodology. When combined with a few other adjustments to achieve budget neutrality, the total reduction will result in cuts close to 12% for emergency medicine.
Key policy makers on Capitol Hill are concerned about the scheduled 9.9% cut and have been working with the physician community to develop a legislative proposal that would, in essence, avert a cut for the next several years. This would allow Congress additional time to develop a comprehensive SGR fix. Legislation could reach the floor of the House of Representatives before the August recess or sometime in September.
EM has historically low practice expense values and ACEP has provided financial support for the AMA-sponsored survey of practice costs that is in the field now. Please complete this survey if you are randomly selected. CMS also proposed to use the $1.5 billion Congress set aside in the last year's bill, P.L. 109-432 to extend the physician quality reporting program (PQRI) into 2008 instead of using the funds to help pay for an SGR fix. We will seek your help in the coming weeks as we lobby congress to block this -9.9% cut in the payment update.
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This publication is designed to promote communication among emergency physicians of a basic informational nature only. While ACEP provides the support necessary for these newsletters to be produced, the content is provided by volunteers and is in no way an official ACEP communication. ACEP makes no representations as to the content of this newsletter and does not necessarily endorse the specific content or positions contained therein. ACEP does not purport to provide medical, legal, business, or any other professional guidance in this publication. If expert assistance is needed, the services of a competent professional should be sought. ACEP expressly disclaims all liability in respect to the content, positions, or actions taken or not taken based on any or all the contents of this newsletter.