SENATE BILL REPORT

SB 6191

BYSenators West, Kreidler, Johnson, Anderson, Gaspard, Niemi, McMullen, Murray, Wojahn, Conner, Patrick, Stratton and Smith

Establishing the Washington state trauma care system.

Senate Committee on Health & Long-Term Care

Senate Hearing Date(s):January 11, 1990; January 23, 1990

Majority Report:  That Substitute Senate Bill No. 6191 be substituted therefor, and the substitute bill do pass and be referred to Committee on Ways & Means.

      Signed by Senators West, Chairman; Smith, Vice Chairman; Amondson, Johnson, Niemi, Wojahn.

Senate Staff:Scott Plack (786-7409)

                  January 24, 1990

Senate Committee on Ways & Means

Senate Hearing Date(s):February 15, 1990; February 23, 1990

Majority Report:  That Substitute Senate Bill No. 6191 as recommended by Committee on Health & Long-Term Care be substituted therefor, and the substitute bill do pass.

      Signed by Senators McDonald, Chairman; Craswell, Vice Chairman; Amondson, Bailey, Bauer, Bluechel, Cantu, Fleming, Gaspard, Johnson, Lee, Moore, Newhouse, Niemi, Owen, Smith, Talmadge, Warnke, Williams, Wojahn.

Senate Staff:Randy Hodgins (786-7715)

                  February 24, 1990

AS REPORTED BY COMMITTEE ON WAYS & MEANS, FEBRUARY 23, 1990

BACKGROUND:

Trauma is the number one cause of death from age one to age 44.  Nearly 40 percent of trauma-related deaths occur within the first hour (the golden hour) following the injury.  Experts believe that 30 to 40 percent of deaths occurring within the golden hour can be prevented if the injured patient has quick access to appropriate medical care.  The presence of an effective and well-coordinated trauma care system has been shown to reduce trauma-related deaths and disability by reducing the amount of time between the injury and definitive tertiary care.  People in many areas of the state lack timely access to trauma care services due to the lack of a statewide trauma care system.

The Legislature created the Trauma Advisory Committee in 1988 to assess the current provision of trauma care in the state, identify the components needed for a statewide trauma care system, and design a statewide trauma care system that meets current needs including a plan for phased-in implementation.  The Trauma Advisory Committee presented its report to the Legislature in January 1990.  The report included detailed recommendations regarding the structure of a statewide trauma care system and standards for the system components and patient care.

SUMMARY:

The Washington State Trauma Care System is created.  The Department of Health is designated as the state administrating and oversight agency.  The trauma care system is integrated with the existing emergency medical services system to form a unified statewide system of emergency medical services and trauma care.  It will be implemented over a three-year period.

The state Trauma Care Steering Committee is renamed the Emergency Medical Services and Trauma Care Steering Committee.  The committee will advise the department on emergency medical services and trauma care needs, review regional plans and recommend changes to the department, and review applicable proposed departmental rules.  The members are appointed by the Governor. 

The state Emergency Medical Services Committee is renamed the Emergency Medical Services Licensing and Certification Advisory Committee.  The committee will review rules relating to the credentialing of emergency medical services personnel and to provide assistance to the department with regard to its credentialing responsibilities.  The 11 members are appointed by the department.

The Department of Health, in consultation with the Emergency Medical Services and Trauma Care Steering Committee, is directed to establish statewide minimum standards for trauma care and emergency medical services and establish patient care protocols and outcome measures for trauma services provided in health care facilities and for pre-hospital trauma care providers.

Statewide minimum standards will be established by the department for trauma care services, pediatric trauma care services, and trauma-related rehabilitative services.  Standards will also be established for verification of pre-hospital providers, emergency medical communications, emergency medical services transportation, personnel training and quality assurance programs to monitor trauma and emergency medical services. 

The Department of Health is directed to initially utilize standards adopted in the report of the Trauma Advisory Committee but may modify such standards if public health considerations, efficiencies in the delivery of trauma care or federal or other state laws warrant modifications.

The department is directed to establish emergency medical services and trauma care regions throughout the state.  It will create a statewide trauma care registry, prepare a statewide emergency medical services and trauma care plan from approved regional plans, establish criteria for determining the number and type of designated trauma care services, coordinate and monitor the statewide emergency medical services and trauma care system, develop and coordinate trauma prevention programs and conduct a special study on trauma related charity care and monitor such charity care on an ongoing basis.

The department shall designate hospitals and other health care facilities to provide trauma services.  Designations shall be based upon the need for services identified in the state emergency medical services and trauma care plan.  Facilities applying for designation shall be inspected to assure compliance with standards.

Any pre-hospital provider may provide pre-hospital trauma care services upon application to the department if minimum statewide standards required for verification are met.  The need for pre-hospital providers shall be established by the regional councils in the regional plans.  The department may inspect pre-hospital trauma care providers to assure compliance with standards.

The department may suspend or revoke a facility's designation to provide trauma care service or a pre-hospital provider's authority to provide pre-hospital trauma service if found out of compliance with state standards.

Regional and local emergency medical services and trauma care councils are created.  The regional councils are directed to prepare and submit to the department regional emergency medical services and training plans which will include an assessment of equipment, personnel and facility needs in the region; the number and level of care of training facilities to be designated and pre-hospital training providers to be verified, and a regional budget and plan of implementation.

The existing state grant program for development and implementation of emergency medical services is expanded to include trauma system development and implementation and emergency medical services and trauma care system maintenance.

Pre-hospital providers are granted immunity for acts conducted in good faith while providing services in compliance with regional plans.  Immunity is not granted for any act which constitutes willful or wanton misconduct.

EFFECT OF PROPOSED SUBSTITUTE:

The secretary is granted explicit authority to adopt procedures to enforce provisions regulating emergency medical service providers.  Limited confidentiality is provided for records and other information generated from the quality assurance programs and the onsite inspection of facilities seeking designation to provide a trauma service.

Appropriation:    none

Revenue:    none

Fiscal Note:      available

Effective Date:The bill contains an emergency clause and takes effect immediately.

Senate Committee - Testified: HEALTH & LONG-TERM CARE:  L. H. Pinkers, Washington State Medical Assoc. (pro); Urean Florin (pro); Emma Florin (pro); John Sinclair, Firefighter (pro); Jack T. Pinza, Firefighter (pro)

Senate Committee - Testified: WAYS & MEANS:  Featherstone Reid, Office of the Governor (pro); Sheryl Robinson, Washington State Trauma Committee (pro); Steve Hubbard, Washington State Trauma Committee (pro); Susie Tracy, WSMA (pro); Jim Nania, M.D. (pro); Janet Griffin, Washington State Trauma Committee (pro); Otto Jensen, Washington State Association of Fire Chiefs (pro); Roger Ferris, Washington Fire Commissioners Association (pro)