Accidental Death and Disability. The Neglected Disease of Modern Society. White paper from the National Academy of Sciences and National Research Council. Accidental Death and Disability. The Neglected Disease of Modern Society. Washington DC, Division of Medical Sciences, National Academy of Sciences, National Research Council. September 1966.
First US Civilian Trauma Unit
Cook County, Chicago
Designation of Trauma Centers first established by US state law.
Optimal Resources for the Care of the Seriously Injured (USA)
Published by the American College of Surgeons Committee on Trauma
Injury in America—A Continuing Public Health Problem
Published by National Academy of Sciences re-examining the paper of 1996. Washington D.C. National Academy of Sciences, 1985.
NHTSA conducts an assessment of Michigan’s EMS Systems. First organizational meetings were held in November to create the Michigan Trauma Coalition (MTC). In December, the Michigan Trauma coalition (MTC) was formed.
The MTC organizes, recruits stakeholders, incorporates, develops consensus on mission, vision and goals, and develops sources of funding. The MTC works with MDPH to submit and secure a $162,905 HHS grant for Trauma Systems Development to develop, implement, and monitor modifications to the trauma care component of Michigan’s EMS plan.
Using grant support, and membership dues, the MTC meets monthly to research how other states deliver trauma care; consider what works/doesn’t work; develops consensus among stakeholders regarding the basics of a trauma system; develops a “Vision 2000″ document to define the common direction of the MTC; compiles a “Trauma Care in Michigan” data manual; and provides support to University of Michigan in conducting a NHTSA-funded Rural Preventable Mortality Study. The MTC works with MDPH to submit and secure an $182,327 HHS grant for continued Trauma Systems Development.
The MTC continues to guide stakeholder agreements on key guidelines, criteria, protocols, and definitions of the state trauma system. The coalition next provides $150,000 funding for the development of four pilot networks in the West Central, Southwest, Upper Peninsula, and Flint regions to implement, test and coordinate trauma system development at the local and regional levels. During this period, the MTC continues work on the Rural Preventable Mortality Study, and works with MDPH to submit and secure a $127,620 HHS grant for continued Trauma Systems Development.
The MTC continues its support of the four regional pilot trauma Networks, and works with developing networks in the Southeast (Detroit) and North-Central regions as they organize and seek funding support. At this time, MTC member organizations attempt to establish and link regional trauma registries and develop information about injury prevention programs. Federal support for state trauma system development ends.
1996 and 1997
MTC member organizations continue to fund trauma system development activities including provision of staff support for existing regional networks; assisting new network development attempts in the Lansing, North Central, and Saginaw-Bay City regions; linking regional registries to the state level; developing state and regional data use and access policies; targeting regional injury prevention problems; and developing a coordinated, statewide fundraising program that links MTC injury prevention activities with health insurers in Michigan.
In 1998, the MTC joined with Michigan SafeKids to establish the Safe Michigan Partnership. The Partnership created a coordinated state-wide injury prevention program providing the following:
- A toll-free injury prevention “Hotline” for information or brochures;
- Discounts on injury prevention products at local stores;
- Distribution 592,731 injury prevention brochures on Helmet, Home Fire, Car Seat, and Home Safety;
- Mail-order sale of discounted car seats, protective helmets, smoke/CO detectors, and first aid kits; and
- Safety demonstrations at local safety events and health fairs.
In February 1998, the MTC Legislative Committee begins serious discussions with representatives of Michigan’s Departments of Community Health and Consumer and Industry Services about the need for Michigan trauma system legislation. By the fall of 1998, a structure for ongoing discussions with the state, and mechanisms for ensuring the board input of all trauma care providers was established and implemented. The committee met throughout the winter of 1998-99 to discuss and draft trauma system amendments to pending EMS legislation (S.B. 404), scheduled for introduction in the spring.
In the spring of 1999, Senator Shugars introduced S.B. 404 to amend the State Health Code concerning EMS provider training, education, certification, and liability. In April of 1999, House Bill 4596 was introduced by Representative Paul DeWeese (as an identical House Bill to Senate Bill 404). During October, House Bill 4596 was amended with language that would establish a Statewide Trauma Care Commission. House Bill 4596 (with the Trauma Commission amendment) was approved by unanimous vote on November 11th.
2000 and 2001
In the spring of 2000, S.B. 404 was passed by the Senate, and sent to the House where it was amended to reduce certain liability exemptions. The amended version of the bill was passed by the House and sent back to the Senate. The bill was referred to a Senate Conference Committee, where it remained until the “lame duck” session of the Legislature in the fall of 2000. At that time a compromise was reached, and SB 404 was passed on December 5th, followed by passage of HB 4596 on December 14th 2000. The Governor signed the Trauma Care Commission bill on January 9, 2001, as Public Act 440 of 2000. The Commission was charged with the following responsibilities:
- Assess the status of trauma care in Michigan;
- Hold public hearings throughout the State to gather public opinion about the status of trauma care in Michigan. The Commission was required to hold at least one public hearing in each of the State’s eight health planning areas;
- Obtain information on trauma care systems in other states;
- File a report, including recommendations, by July 1, 2002, with the Governor, the Legislature, the Director of the Department of Consumer and Industry Services, and the Emergency Medical Services Coordination Committee.
Nine public hearings were held between October 22, 2001 and January 16, 2002, and the Commission’s report was released in the fall of 2002. The Commission’s findings were categorized as follows:
- Issues involving oversight, administration, coordination, assessment, and evaluation of trauma care delivery.
- Issues related to the lack of an adequate infrastructure to support expansion of the trauma system, i.e., lack of trauma facilities in certain areas of the state and lack of appropriate transportation vehicles for the state’s geography and inclement weather.
In July 2003, the Michigan Department of Consumer and industry Services contracted with the MTC to convene a Trauma Care Planning Committee comprised of its membership, members of the former Michigan Statewide Trauma Care Commission, and other interested parties to: (a) develop a Model Trauma System Plan; and (b) develop an Implementation Plan for the establishment of a statewide trauma system in Michigan. The goal of the Trauma Care Planning Committee was to:
- Use the Trauma Care Commission’s trauma report and the “Model Trauma System Plan” to develop a Michigan Model Trauma System Plan
- Develop a Trauma System Implementation Plan; and
- In November, of 2003, the Michigan Trauma System Plan to guide establishment of a statewide trauma care system was completed and distributed to the Emergency Medical Services Coordination Committee and stakeholder organizations for their formal support. Both the State Emergency Medical Services Coordination and the Michigan Trauma Coalition have supported the Michigan Trauma System Plan.
After a year-long effort, trauma system legislation was finalized and passed by the Michigan legislature in the fall of 2004, and signed by the governor on December 30, 2004.
In March of 2005, the governor appointed members to the new Trauma Advisory Subcommittee (STAC). This group spent most of the 2005 meeting to oversee the development of rules associated with implementation of the Model Trauma Systems Plan. In addition, the STAC began to identify potential sources for long-term funding of the statewide trauma system in the face of a state budget deficit.
The STAC, and caucus groups from the STAC and EMSCC met regularly to oversee the development of rules associated with implementation of the Model Trauma Systems Plan. In the spring, these groups sent the final version of the administrative rules to the full EMSCC for review and approval in May. At the same time, the MTC continued to work with the STC to identify potential sources for long-term funding for the statewide trauma system.
Implementation of Michigan’s trauma system continues to be a high MDCH priority for 2007; however, the Department is awaiting final action on the State’s budget. The MTC staff continued to meet with State legislators and the governor’s office to garner support for the creation of a dedicated funding stream for the trauma system.
Early in the year, Michelle Mora RN, EMT-P was appointed as the State Trauma Coordinator. The MTC and other statewide organizations concerned with trauma held a State Trauma Conference in August to discuss how other states and regional trauma systems have been funded. Although Michigan has adopted administrative rules for the trauma system, there was no funding source for the system. The MDCH and the MTC worked to develop a grass root push for funding support as a priority for 2009. The MDCH and MTC staff worked to develop “talking points” for a grass roots effort to educate State lawmakers about the need for funding a Michigan Trauma system. This effort was coordinated with related efforts by stakeholders in the areas of Homeland Defense, stroke prevention, childcare, and injury prevention. The STAC continued to meet, despite the absence of funding.
MTC severed ties with the previous management firm. An external accounting firm conducted a financial evaluation. The MTC books were moved to the MTC Treasurer’s office. New bylaws were drafted and approved. Members supported the contracting of a lobbyist to secure state trauma system funding. The website was redesigned with a member’s only page.
Membership increased from 23 to 34 hospitals. Phone and web conferencing was implemented for meetings. The MTC continued working with a lobbyist group on trauma related legislation. The MTC secured a consistent centralized meeting facility at Lansing Community College West Campus, 5708 Cornerstone Drive, Lansing Michigan. Mitrauma.com was redesigned with a member’s only section. Members participated in the Annual Injury Prevention Symposium. Financial position was secured to allow support of all MTNC and Registrar meetings and supported a AAAM-AIS Course for members. MTC transitioned to a calendar fiscal year beginning with 2012.
The First Annual Michigan Pediatric Trauma Conference was held in June with over 200 attendees. MTC continued working with MHSA (Muchmore Harrington Smalley & Associates, Inc) on trauma related legislation. To assist with the growth of MTC, a part-time administrative assistant was hired. The MTC was able to financially support the AAAM-AIS and ATS course for members. MTC collaborated with the Michigan Committee on Trauma (MCOT) to promote trauma education, research, and public policy.
The MTC continued to provide programs to educate its members’ staff and to promote leadership for trauma centers, as well as injury prevention and various public policy initiatives. Its support was both financial and through the volunteerism of many MTC members.
The MTC continued working with its lobbyist to secure collection of funds to support Michigan’s state-wide trauma system. In October of 2014, we celebrated an important event: Governor Rick Snyder signed legislation to continue funding for coordination of statewide trauma services designed to improve emergency care in Michigan. In a press release, Governor Snyder said, “This support allows Michigan to develop a regionalized, coordinated and accountable trauma system, which delivers the right resources to the right patient at the right time.” House Bill 4915, sponsored by state Rep. Matt Lori, extended the sunset date for fees from the Crime Victim’s Rights Fund for the trauma system until Oct. 1, 2018. Original legislation to fund this system was passed in 2010, but a technical issue in the legislation led to a delay in fee collection, requiring more time to collect the revenue needed to implement the statewide trauma system. It is now Public Act 299 of 2014. For more information on legislation, visit: http://legislature.michigan.gov.
New endeavors for MTC during this period included more robust marketing and legislative activities. The Marketing Committee linked with our lobbyist to advance specific goals related to the ongoing need for a state-wide trauma system. Their activities were aimed at educating the public and our legislators regarding funding for the Michigan trauma system, as our funding was due to sunset in fall of 2018. The committee developed a brochure aimed at educating legislators and a video-format public service announcement called “Lost Minutes Cost Lives.” In June of 2018, the governor, Rick Snyder, signed House Bill 5901 to secure trauma funding for 3 more years.
Across the state, trauma programs rolled out STOP THE BLEED education, under the aegis of the American College of Surgeons standardized curriculum. A highlight of this training occurred in April 2018, when STOP THE BLEED was offered at the state capital, to legislators and staff. The capital was a sea of red, as all volunteers and participants wore red T-shirts bearing STOP THE BLEED information. The house subsequently passed House Resolution 320 naming April 26 ‘Stop the Bleed Day.”
Other committees continued to advance the MTC mission of improving trauma outcomes through education, leadership, collaboration, and legislative action. Specifically, this included the financial support of both an annual pediatric trauma conference and an annual injury prevention conference. The MTC also underwrites education for trauma registrars, trauma program managers/coordinators, and other trauma program staff, by offering training programs at significant discounts. These programs include the AIS/AAAM course, Trauma Registrar training course, and TOPIC course, to name a few.
In summer of 2019 we learned that we would have to update our website to make it consistent with new security standards. The Website Workgroup added representative members from MTC committees, selected a new website template, and by September of 2019 we had a new website! MTC also invested in online meeting software, to allow our members to attend and participate in meetings remotely. The MTC Bylaws were updated in fall of 2019, to better reflect our practices. The Bylaws also added a Treasurer-Elect. SurveyMonkey was used for member voting of new officers and for the bylaws and budget, to enhance voting security. MTC invested in ‘cloud’ storage of e-documents, to better archive our history and preserve and retain our important documents. During 2019, there was a push to record practices in the form of written policies and procedures, and to store these in our online document archive.
In early 2020, we held two strategic planning sessions (a full day plus a half-day) with an outside facilitator, Stephanie Czuhajewski, MPH, CAE, President & CEO of Agentis Management. The sessions were held by our full Leadership Council, consisting of the officers, committee chairs, and physician-at-large members. The brainstorming resulted in updated language for our mission-vision-values as well as a 2-year plan built around our four pillars: Education, Advocacy/Legislation, Quality/Data, and Engagement/Leadership.
As MTC leaders began implementing our new strategic plan in early 2020, we were confronted with the challenges of the COVID-19 pandemic. The pandemic caused the Executive Board and Leadership Council to re-prioritize its goals for the year. In particular, our educational programs and General Membership Meetings were moved from in-person sessions in Lansing to a virtual platform. The Executive Board reassessed its objectives and activities throughout 2020, as the pandemic waxed and waned. MTC invested in a permanent virtual platform with GoToMeeting and GoToWebinar. This investment merged our organizational needs related to the pandemic and our educational and marketing/outreach goals from the strategic planning sessions. In addition, MTC conducted an educational survey with SurveyMonkey, to determine the educational needs of our members. This led to planning more breakout sessions with our General Membership Meetings, and the scheduling of routine trauma webinars for our members.
The year 2021 began with a message of hope, as COVID-19 vaccine was now available to front-line workers that included many of our MTC member hospitals. With social distancing and masking indoors still in place, and with an ongoing shortage of front-line workers to care for COVID patients, 2021 was a challenging year for providing trauma education. Many regional and national trauma meetings were either conducted virtually or with the option of virtual or in-person attendance. MTC offered the virtual platform for the majority of its educational offerings and meetings, including the Basic Registrar’s Course, the ICD-10 Coding Course for Trauma, the Optimal Course, the TARP Course, the TOPIC Course, and the AIS course. However, both the Annual MTC Pediatric Trauma Conference and the MTC Injury Prevention Symposium were successfully offered in person with social distancing.
In September, MTC asked its members to rally support for HB 5094, a bill that would continue funding Michigan’s Trauma System for another 3 years from the Crime Victims’ Fund. Without this extension, Michigan’s funding for the Trauma System would have been cut in half beginning October 1, 2021. MTC’s Legislative, Advocacy, and Outreach Committee had worked with a marketing firm to create both a brochure and video describing the need for Michigan’s statewide trauma system and the essential work that it does. These marketing materials were used by our lobbyist and our members to promote the legislation. However, there was considerable opposition from the domestic violence coalition in Michigan, and ultimately legislators passed the funding extension from the Crime Victims’ Fund for just one more year. But legislators did promise to work with the MDHHS to include trauma funding as a part of Michigan’s annual general budget going forward.
2022 continued to be a challenging year for providing trauma education. Many regional and national trauma conferences were conducted either virtually or with the option of virtual or in-person attendance. MTC offered four (4) education scholarships to attend one of these national or regional conference. MTC continued to offer a virtual platform for the majority of its educational offerings and meetings, including the following courses: Basic Registrar’s Course, ICD-10 Refresher Course for Trauma, Rural Trauma Outcomes and Performance Improvement, and the Injury Prevention Coordinator Course (IPCC). However, both the Annual MTC Pediatric Trauma Conference and the MTC Injury Prevention Symposium were successfully offered in person.
MDHHS and MTC continue to work with Michigan’s legislators to include permanent trauma funding as a part of Michigan’s annual general budget, going forward.
The Michigan legislature funded Michigan’s Statewide Trauma System for the 2023 fiscal year with 3.5 million dollars of State General Fund Dollars. The total funding for the MDHHS statewide budget was $6 million: $3.5 million for Trauma and $3 million for stroke and STEMI. MTC’s Legislative-Advocacy-Outreach Committee is working to maintain this funding for fiscal year 2024. They have also been working to re-introduce a Bleeding Control Education Bill.