Trauma in Georgia : analysis of 2003 trauma system data

T G RAUMA IN EORGIA
ANALYSIS of TRAUMA SYSTEM DATA
2003
DEPARTMENT OF HUMAN RESOURCES DIVISION OF PUBLIC HEALTH
OFFICE OF EMERGENCY MEDICAL SERVICES/TRAUMA

Trauma in Georgia 1
Trauma in Georgia
Analysis of 2003 Trauma System Data
Prepared by Georgia Department of Human Resources
Division of Public Health Office of Emergency Medical Services/Trauma
Operations Research & Analysis Section December 17, 2004

Trauma in Georgia 2
ABSTRACT This document provides a basic statistical characterization of trauma in Georgia utilizing data collected from the 14 hospitals participating in the statewide trauma system. The primary data source is National Trauma Registry American College of Surgeons (NTRACS) data for 2003. The tables and illustrations in this document have been prepared to provide consistency with the American College of Surgeons, National Trauma Data Bank (NTDB) 2003 publication. This publication provides a baseline for the examination, comparison and improvement of the trauma system in Georgia.

Trauma in Georgia 3
TABLE OF CONTENTS Abstract ........................................................................................................................... 2 Table of Contents............................................................................................................ 3 Preface............................................................................................................................. 6
A message from the State Office of Emergency Medical Service/Trauma (OEMS/T) ........................................................................................................... 6 Acknowledgements......................................................................................................... 9 Introduction................................................................................................................... 11 Objectives ......................................................................................................... 11 What is Trauma? ............................................................................................... 11 Definition of Trauma ........................................................................................ 11 Emergency Room vs. Trauma Center Contrasting Illustrations of Injuries..... 12 What is a Trauma System? ............................................................................... 13 Benefits of a Trauma System............................................................................ 13 Illustration: Trauma System............................................................................. 14 Understanding the Impact of Trauma in Georgia ............................................. 14 Georgia Acute Care Hospitals By Size............................................................. 15 What is the status of Georgia's Trauma System? ............................................. 15 Georgia Designated Trauma Centers 2003 ..................................................... 16 The Importance of Emergency Medical Services to Trauma Care................... 16 Illustration: Open Repair of Descending Aorta Injury .................................... 17 Trauma System Development....................................................................................... 19 Georgia Trauma Centers on a State Map with 10 EMS Regions ..................... 19 Medical Review Committee ............................................................................. 20 Georgia Committee for Trauma Excellence ..................................................... 20 Georgia Trauma System Development Committee .......................................... 20 Emergency Medical Services Advisory Council .............................................. 20 Regional Emergency Medical Services Program Directors.............................. 21 Working Towards Injury Prevention ................................................................ 21 The Impact of Trauma on Georgia................................................................................ 22 Economic Pressures .......................................................................................... 22 The Cost of Traumatic Injury ........................................................................... 22 Understanding Other Related Health Care Issues............................................. 23 Traumatic Brain Injury (TBI) ........................................................................... 23 Post-Traumatic Stress. ...................................................................................... 24 Organ Donation Awareness .............................................................................. 25 Trauma Care & Homeland Security ................................................................. 26 Atlanta Centennial Park Bombing, 1996 .......................................................... 26 Analysis of Statewide Trauma Data ............................................................................. 27 Relative Distribution of Trauma Patients Among the 14 Centers .................... 27 Trauma Patients by Gender & Age................................................................... 28 Trauma by Gender ............................................................................................ 28 Trauma Patients by Ethnic Representation ....................................................... 29 Bar Chart of Trauma Patient Ethnic Representation......................................... 29 Blunt vs. Penetrating Trauma ........................................................................... 30 Most Common Mechanisms of Injury .............................................................. 30

Trauma in Georgia 4
Mechanisms of Injury All Coded Categories................................................. 31 Where Injury Occurred ..................................................................................... 32 Riding Position in Street & Highway Related Injuries..................................... 32 ED Trauma Patient Volume by Month 2003 ................................................. 33 Transportation to Trauma Center...................................................................... 34 Air Ambulance Services in Georgia ................................................................. 35 Admitting Service Volume ............................................................................... 36 Five Most Frequent Initial Medical Procedures................................................ 36 Injury Severity Scores (Percent %)................................................................... 37 Pediatric Injury Severity Scores (Percents %) .................................................. 38 Emergency Department Disposition ................................................................. 38 Average ISS, Days in ICU and Length of Stay (LOS) ..................................... 39 Trauma Center Deaths All Patients................................................................ 40 Trauma Center Deaths Adults Centers .......................................................... 40 Trauma Center Deaths Pediatric Centers....................................................... 41 Trauma Deaths vs. Organ Donations 2003 .................................................... 42 Demographic Characteristics of Trauma Death Organ Donors........................ 42 Trauma Center Profiles ................................................................................................. 43 John D. Archbold Memorial Hospital............................................................... 44 Atlanta Medical Center ..................................................................................... 45 Children's Healthcare of Atlanta Egleston and Scottish Rite........................ 46 DeKalb Medical Center .................................................................................... 47 Floyd Medical Center ....................................................................................... 48 Grady Health System ........................................................................................ 49 Gwinnett Medical Center.................................................................................. 50 Hamilton Medical Center.................................................................................. 51 Medical Center of Central Georgia................................................................... 52 Medical College of Georgia Health System ..................................................... 53 Memorial Health University Medical Center ................................................... 54 North Fulton Regional Hospital........................................................................ 55 The Medical Center Columbus ...................................................................... 56 Appendix A: Georgia 2003 Trauma Statistical Tables ................................................ 57 Table 1, Summary of Georgia Designated Trauma Centers ............................. 57 Table 2, Summary of Georgia Acute Care Hospitals by Size........................... 57 Table 3, Summary of Trauma Registry Records by Center.............................. 58 Table 4, Georgia Trauma Registry Records Ordered by Patient Counts....... 58 Table 5, Georgia Trauma Registry Records Bar Chart..................................... 59 Table 6, 2003 Patient Gender............................................................................ 60 Table 7, 2003 Patient Gender Bar Chart........................................................... 60 Table 8, Trauma Patient Ethnic Representation ............................................... 61 Table 9, Trauma Patient Ethnic Representation Bar Chart............................... 61 Table 10, Georgia Trauma Center Patients by NTDB Age Groups ................. 62 Table 11, Georgia Trauma Center Patients by NTDB Age Groups Bar Chart. 62 Table 12, Georgia Trauma Patient Age Descriptive Statistics ......................... 63 Table 13, Georgia Trauma Patients Represented by NTDB Age Groups, Sorted by Frequency of Presentation............................................................................ 63

Trauma in Georgia 5
Table 14, Georgia New Driver Trauma Patient Representation ....................... 64 Table 15, New Drivers * Riding Position Crosstabulation............................... 64 Table 16, Ethnicity * Gender Cross tabulation................................................. 65 Table 17, Gross Mechanism of Injury .............................................................. 66 Table 18, Gross Mechanism of Injury Bar Chart.............................................. 67 Table 19, Mechanisms of Injury - Alphabetical ............................................... 68 Table 20, Bar Chart of Patients by Mechanism of Injury (Frequency) ............ 69 Table 21, NTDB Age Group * Selected Mechanisms of Injury Vehicles..... 70 Table 22, NTDB Age Group * Selected Mechanisms of Injury - Violence ..... 72 Table 23, Riding/Running/Position .................................................................. 74 Table 24, Riding/Running/Position Bar Chart.................................................. 74 Table 25, Where Injury Occurred ..................................................................... 75 Table 26, Where Injury Occurred Bar Chart .................................................... 75 Table 27, ED Trauma Patient Volume by Month ............................................. 76 Table 28, Transportation to ER......................................................................... 76 Table 29, Transportation to ER Bar Chart ........................................................ 77 Table 30, ED Disposition (SPSS Raw Output)................................................. 77 Table 31, Admitting Service Frequency & Percentage .................................... 78 Table 32, ISS Range All Patients................................................................... 78 Table 33, ISS Range Adult Facilities Only.................................................... 79 Table 34, ISS Range Pediatric Facilities Only............................................... 79 Table 35, Average ISS, Days in ICU & LOS ................................................... 80 Table 36, Top 5 Initial Medical Procedures...................................................... 80 Table 37, Average Length of Stay by Admitting Service................................. 81 Table 38, Average Length of Stay by Mechanisms of Injury........................... 82 Table 39, Place of Injury vs. Gross Mechanism of Injury Adults ................. 83 Table 40, Place of Injury vs. Gross Mechanism of Injury Pediatrics ............ 83 Table 41, EMS Regional Summary Trauma Centers Treatments of Injury .. 84 Table 42, Georgia Trauma Centers on a State Map with 10 EMS Regions ..... 85 Table 43, Examples of Injury Severity Scores (ISS) ........................................ 86 Table 44, Trauma Deaths All Trauma Centers .............................................. 87 Table 45, Deaths Adult Trauma Centers Only............................................... 87 Table 46, Deaths Pediatric Trauma Centers Only ......................................... 87 Table 47, Final Patient Disposition................................................................... 88 Table 48, Organ Donors vs. Trauma Deaths..................................................... 89 Table 49, Organ Donors by Gender & Race Georgia Trauma Centers ......... 89 Appendix B: Georgia Demographics........................................................................... 90 Georgia Age Demographics: 2002-2003 .......................................................... 90 Georgia Ethnic Demographics: 2002-2003 ...................................................... 91 Georgia Household Demographics: 2002-2003................................................ 91 Appendix C: State Office of EMS/Trauma Contacts................................................... 92 Appendix D: State Trauma Center Contacts................................................................ 93 Appendix E: Georgia Regional EMS Offices.............................................................. 95 Appendix F: Trauma System Development Committee.............................................. 97 Appendix G: Medical Review Committee................................................................... 99

PREFACE

Trauma in Georgia 6

A message from the State Office of Emergency Medical Service/Trauma (OEMS/T)

The State Office of EMS/Trauma is primarily a regulatory department; however, improving statewide emergency preparedness to include EMS, bioterrorism, and trauma requires the development of new ways to collect, link, and analyze data. An understanding of our ability to treat and prevent traumatic injury is fundamental to all of these efforts.
R. David Bean, Director OEMS/T
(Pictured Left)

Expansion of the Georgia Trauma System requires the development of an effective and efficient statewide infrastructure including data collection, reporting, evaluation and quality improvement initiatives. Understanding the nature of trauma in Georgia and establishing a viable system of trauma care benefits all Georgia citizens.
Ej Dailey, Deputy Director OEMS/T
(Pictured Right)

During the 1960's, the National Research Council labeled trauma as the neglected disease of the modern society. Since that time, published studies have demonstrated that as much as one third of trauma deaths occurring in areas without an organized trauma care system were preventable. The Georgia Department of Human Resources, Division of Public Health recognizes the importance of developing an organized trauma system in Georgia, which includes both prevention and treatment. In today's modern society, governmental programs are influenced by data. In 2001, a state budget appropriation of $740,000 allowed for the collection of trauma data. The data is collected quarterly from the designated trauma centers and managed by the Office of Emergency Medical Services/Trauma (OEMS/T). A plan for the development of the Georgia Trauma System has been written and is in the process of being adopted. The data collected will contribute to the success of the future Georgia Trauma System.

Trauma in Georgia 7
Efforts to establish a statewide trauma system so that all seriously injured patients
have access to optimal care without regard to socioeconomic status or geographic
location in the state began over a decade ago. The publication of this 2003 data marks a
major milestone; it is the first publication of trauma data by the State of Georgia
summarizing information from the Georgia Trauma Registry. Additionally, it marks
Georgia's ability for the first time to participate in submitting data to the National
Trauma Data Bank (NTDB).
The mission of the Georgia trauma system is to save lives and provide the best
possible outcomes through improved trauma care and injury prevention. Understanding
the nature and cause of trauma in Georgia establishes an important knowledge base for
legislative policy makers, medical practitioners, public health, law enforcement and
emergency management. With this information, Georgia possesses a distinct ability to
identify risk factors, foster interventions to prevent injuries and understand how the
integrated delivery of optimal resources for patients who need acute care ultimately
affects patient outcomes. It also supports evaluation of the statewide demands for trauma
care and forms the basis for disaster preparedness.
James P. O'Neal, M.D. currently serves as the EMS Medical Director for the Georgia Office of EMS/Trauma. Since 2000, he has been influential in many facets of EMS, Emergency Preparedness, and Bioterrorism for the Department of Human Resources, Division of Public Health. Dr. O'Neal earned his medical degree from Tulane University School of Medicine in 1968 and finished his formal education as a flight surgeon while serving in the United States Air Force in Vietnam in l971. Dr. O'Neal retired from DeKalb Medical Center after 29 years of service. He was the Medical Director for the Emergency Department and the Vice-Chairman for the Trauma Committee at that facility. He served as the Medical Director for DeKalb EMS for 16 years and Medical Director for EMS Region III for 7 years. He served on the Region III Trauma Advisory Committee, the Region III Prehospital Care/Medical Direction Committee, the Region III Medical Audit Committee, the Region III EMS Council, and the Greater Atlanta Cardiac Coalition for several years. Dr. O'Neal served as Affiliate Faculty for the American Heart Association's Advanced Cardiac Life Support courses for over ten years and has been a member of the American College of Emergency Physicians for 30 years.

Trauma in Georgia 8
One of the first steps that the OEMS/T undertook for the development of the Georgia Trauma System was the implementation of a statewide trauma registry. This system provides a foundation for the collection of accurate and reliable information regarding the nature of trauma in Georgia.
During 2002, the Georgia Trauma Registry was established. The Georgia Trauma Registry is based on NTRACS software. NTRACS is a commercial microcomputerbased software package for the collection, storage, analysis and reporting of trauma patient information on an individual, regional and state level. The development of the NTRACS software was funded by the American College of Surgeons. The American College of Surgeons, founded in 1913, is committed to the development of improved standards of care for the trauma patient. In addition, the American College of Surgeons maintains a close professional, working relationship with other medical organizations and with government and regulatory bodies such as Health Resources and Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
The OEMS/T has a strong commitment of keeping pace with the NTRACS based trauma data registry. In connection with this commitment, the OEMS/T submitted data to the NTDB for the first time in its history in 2004. Submittal of this data and participation in the NTDB marked major operating milestones for the trauma program.
The ongoing goal of the Georgia Trauma Registry is to provide data that supports improvements in the care of the injured patient. The publication of these data is a beginning towards a data-driven, statewide trauma system. The Georgia Trauma Registry offers participating hospitals the opportunity to collect and analyze the critical data pertinent to their respective trauma experience on a daily basis. The NTRACS software allows for these participating centers to submit data on a quarterly basis. Once received, data is merged, accumulated, and studied on a state, regional, and local level. Aggregated data from the trauma registry have identified a number of strategic considerations where additional focus is needed in order to benefit all citizens of Georgia.

Trauma in Georgia 9
ACKNOWLEDGEMENTS
The Trauma in Georgia - 2003 Publication Team. Pictured front from left to right: Marie Probst, State Trauma Registrar; Dr. J. Patrick O'Neal, State Medical Director Office of EMS/Trauma; Indrani Daseupta, Statistical Analysist; Fred Grant, Manager Operations Research & Analysis, OEMS/T and the Principal Investigator for this publication. Not pictured: Renee Morgan, State Trauma Program Manager
In August 2003, the OEMS/T set a goal to develop the information capabilities necessary to publish the Georgia Trauma Registry data in 2004. Through diligence and hard work this goal has been attained. No exercise of this scope, complexity or magnitude could have been completed without the hard work and selfless contributions of numerous persons. No attempt to recognize or thank all of those who participated in the development of this publication is adequate. Many who provided the benefits of their thoughts and experience will remain unnamed; however, all who participated and those who are taking the plan forward are playing a strategic role in improving the system of care in Georgia.
Emergency Medical Services (EMS) and medical professionals from the Georgia Department of Human Resources representing all of the ten EMS Regions of the state, along with trauma coordinators and registrars from the participating trauma centers provided information that has been utilized in this publication. The input from each of these groups represented the accumulation of hundreds of years of EMS and medical trauma care experience.
Within the OEMS/T, it is acknowledged that the Operations, Analysis and Research Section (OARS) personnel provided the overall framework for accomplishing the writing, analysis and processing, and presentation of this data. Information technology is one of the most critical tools for taking the trauma system to the "next level" as a public health entity.1 Data and information permeate every aspect of EMS and
1 F. J. Grant, MBA, CDP, Manager Operations, Analysis & Research, Office of EMS/Trauma is the identified principal investigator of this publication.

Trauma in Georgia 10
trauma care. The building of state infrastructure recognizes that people, process and technology must all play a role. Fundamentally sound strategic governance is also essential for trauma system development.
To all who participated--thank you.

INTRODUCTION

Trauma in Georgia 11

Objectives The objectives of this publication are threefold: 1. Provide an operating description of the Georgia statewide trauma system and related programmatic areas. 2. Establish a context for understanding the 2003 trauma system statistics and information presented from the NTRACS Georgia Trauma Registry. 3. Provide an overview of some of the issues associated with trauma in Georgia that can drive the future strategic alignment of program areas, technology and public health initiatives consistent with enhancing trauma prevention and optimizing the care of injured patients.

What is Trauma?
When most people hear the word "trauma" they think of very serious injuries-very serious, unplanned injuries that fundamentally threaten life or quality of life. But trauma is more than this.

Definition of Trauma
trauma (tr m , trou -) n. pl. traumas or traumata (-m -t )2 1. A serious injury or shock to the body, as from violence or an accident. 2. An emotional wound or shock that creates substantial, lasting damage to the psychological development of a person, often leading to neurosis. 3. An event or situation that causes great distress and disruption.
As shown in the illustration below, there is a significant difference between the severity and type of injuries treated in an emergency room and those requiring treatment at a trauma center. But having said this, many typical emergency room injuries can also
2 Source: Dictionary.com (2004).

Trauma in Georgia 12
represent traumatic injury. Traumatic injury is not always obvious and does not always immediately manifest itself.

Emergency Room vs. Trauma Center Contrasting Illustrations of Injuries

Patients cannot diagnose their injuries; therefore, it is important to differentiate

between the level of care provided at Emergency Departments vs. Trauma

Centers. Below are a few examples:

Emergency Room

Trauma Center

Minor Wrist fracture Cut or Laceration
Minor Back Sprain
Potential Loss of Life Bleeding Head Injury/Concussion Time is of the essence. Injuries may or may not be life threatening.

Multiple Fractures Major Laceration
Amputations Back Injury with New Onset
Paralysis Potential Loss of life Fractured Skull/Brain Injury Time is of the essence. Death or the inability to recover may result if not treated within certain time parameters, e.g., the "Golden
Hour".

For trauma registry purposes, the American College of Surgeons has established a very specific clinical definition of trauma; this definition is complex, not well understood by laypersons and can vary by state.3 But in the final analysis, experts agree that traumatic injuries cover a broad number of categories and should be treated as very serious disease.

3 The criteria for entry into the NTDB include all patients with at least one injury (ICD-9 diagnosis code between 800.00 and 959.9, including some types of burn injuries 940-949). ICD 905-909, late effects of injuries are excluded, as are 910-924 blisters, contusions, abrasions, and insect bites, 930-939 foreign bodies. Those who were admitted to the Operating Room, who died after receiving any evaluation or treatment, were dead on arrival at the hospital, or who transferred into or out of a hospital are also included in the registry. The Georgia criteria for trauma includes admissions over 48 hours and additionally recognizes those who were admitted to the ICU regardless of length of stay or were readmitted within 72 hours of initial admission. The Georgia criteria does not include isolated burn injuries.

Trauma in Georgia 13
Trauma, as a disease, can be prevented or avoided through behavior modification and the use of safety equipment. And when not prevented, it may be successfully treated--if a systematic approach is taken.
What is a Trauma System?
A trauma system is a strategically organized approach to injury prevention, EMS prehospital response, hospital-based acute care and post hospital rehabilitation that is fully integrated within a state's public health system. According to the National Foundation for Trauma Care, consolidating major injury patients into hospitals--trauma centers--that have a high level of expertise and the specialized resources required for optimum care is highly effective in saving lives. The presence of a trauma system means that there is systematic coordination between injury prevention, EMS (including air and ground medical transports) and regional referring hospitals. It also means that there is a systematic integration of the care provided to the very seriously injured at all stages of their treatment. The resources required for each component of a trauma system are clearly identified, deployed and studied to ensure that all injured patients gain access to the appropriate level of care in a timely, coordinated and cost-effective manner.
Trauma systems possess the distinct ability to identify risk factors and related interventions to prevent injuries as well as maximize the integrated delivery of optimal resources for patients who need acute trauma care. Trauma systems also address the daily demands of prehospital response. Trauma systems form the basis for disaster preparedness.
Benefits of a Trauma System
Trauma systems can reduce the preventable death rate by 10 - 30 percent; some say even up to 50 percent. Studies of trauma systems in the United States where the most severely injured patients are directed to specialized trauma centers show that the benefit of an organized system of trauma care can reduce the risk of death significantly among

Trauma in Georgia 14
seriously injured trauma patients. As an added benefit, these survivors have shorter hospital stays, freeing up resources for other needs.4

Illustration: Trauma System
Injury Prevention

Policies & Procedures

Pre-hospital Care

Data Analysis

Discharge - Home Rehab SNF Death

Hospitals

Understanding the Impact of Trauma in Georgia In 2003, the number of Georgians affected by trauma can only be estimated and
sized in relative terms. Based upon an analysis of 2003 NTRACS data, relative to the total number of acute care hospitals in Georgia, it is probable that the volume and impact of trauma in Georgia has been significantly underestimated. The data presented by the 14 participating trauma centers provides representative data on 9,612 patients which met the Georgia Trauma Registry criteria for 2003.
4 For additional information see the American Trauma Society (2003) publication "When it matters most" as retrieved from http://www.amtrauma.org/uploads/1083595747675.PDF

Trauma in Georgia 15
According to the Georgia Hospital Association, there are approximately 152 acute care hospitals in Georgia. Based upon an analysis of various demographic and geographic data sources, Georgia's death rate from trauma is currently estimated to be 65 per 100,000 while the national average is 56 per 100,000.5 If we did nothing other than improve to the level of the national average, we would save approximately 624 additional lives annually.6 Out of approximately 35,000 to 45,000 cases of trauma occurring each year in Georgia, only 9,612 patients were treated by the fourteen designated trauma centers and met the Georgia trauma registry criteria.

Georgia Acute Care Hospitals By Size

Bed Size Range 0 - 49 50 - 99
100 - 199 200 - 299 300 - 399
400+ Total

Hospitals 47 39 28 12 9 17 152

Licensed Beds 1558 2869 3981 3027 2993 8949 23,377

What is the status of Georgia's Trauma System?
As shown on the table below, 14 trauma centers were designated in Georgia in 2003.
Efforts to further develop Georgia's trauma system are actively being made; however, many additional trauma centers are needed to insure optimal health care for all seriously injured patients.
A truly "inclusive" trauma system for Georgia would involve all acute care hospitals in some manner. Informed discussions among trauma system stakeholders have suggested that Georgia should have approximately 30 designated trauma centers in strategic locations in order to address Georgia's trauma care and emergency preparedness needs.
5 Based upon this study's analysis of data, the 2002 NTDB percentage rate for 2002 was 5.2%. Georgia's computed percentage for 2003 is 7.6%. 6 Source: Georgia Trauma Plan (Draft) 2004.

Trauma in Georgia 16

Georgia Designated Trauma Centers 20037

Trauma Center (Listed Alphabetically) Archbold Memorial Hospital Atlanta Medical Center Children's Healthcare of Atlanta - Egleston Children's Healthcare of Atlanta - Scottish Rite DeKalb Medical Center Floyd Medical Center Grady Memorial Health Gwinnett Medical Center Hamilton Medical Center Medical Center of Central Georgia Medical College of Georgia Memorial Health University Medical Center N. Fulton Regional Hospital The Medical Center Columbus TOTALS

Level of Regular

Pediatric

Designation Beds ICU Beds Beds

2

224

14

0

2

460

36

0

2 Pediatric

0

21

235

2 Pediatric

0

21

181

3

525

32

0

2

252

24

28

1

1000

80

56

2

175

20

8

2

244

18

20

1

637

54 32, ICU-12

1

632

104

60

1

435

60 51, ICU-10

2

167

28

0

2

413

32

35

5164

544

728

The Importance of Emergency Medical Services to Trauma Care Emergency Medical Services (EMS) represents the "front line" of trauma care.
The injury clock begins to tick the moment a traumatic event occurs--whether it is a car crash, fall, gunshot wound, or any other serious injury. Many traumatic events will be followed by activation of pre-hospital personnel. In Georgia, the response time may range from 3 minutes to 45 minutes depending on the geographical location of the patient. An additional 10 minutes to 60 minutes may lapse before the patient reaches a medical facility. Even then, the destination may not necessarily be the appropriate facility for optimal care. Factor in that the patient may transfer from one facility to another and it could be 8 to 10 hours before the appropriate level of care is rendered. Participation in a statewide trauma system assures quality of care, promptness of response, and performance improvement of overall patient care.
7 Source: Georgia Trauma Center Coordinators (2004).

Trauma in Georgia 17
Illustration: Open Repair of Descending Aorta Injury
An inclusive system of trauma care has provisions for treating this type of injury. Those who have a full-thickness arterial tear from a car crash or other injury and are hemodynamically unstable may also be unstable from hemorrhages from other organs, such as a liver or spleen injury. Hemorrhage control remains a primary priority in these patients. Specialized care is required for this type of injury. A trauma system provides all levels of care from minor to major.
Source: Trauma.org
Emergency Medical Services (EMS) is an "umbrella term" for a continuum of prehospital care activities involving personnel, equipment, procedures, systems and community programs.8 In Georgia, EMS represents a broad and complex collection of private, community and governmental organizations, services and environments providing prehospital health care related services. Accordingly, EMS includes the full spectrum of emergency care from prevention to recognition of the emergency, prehospital medical treatment, and patient transportation to a definitive care facility. EMS also includes a number of specialized topical areas such as:
1. Community health care (prevention) education 2. Emergency Medical Services for Children (EMSC) 3. Emergency Medical Technician (EMT) training and certification 4. Ambulances and specialized equipment including Automated External
Defibrillators (AEDs) 5. The planning for emergency medical responses to disasters including natural
or man-made disease out-breaks and other catastrophes 6. The planning for the provision of emergency medical coverage at mass
gatherings
8 Source: GAO, 2001, p. 4

Trauma in Georgia 18
7. Interfacility transfers of patients 8. The longitudinal study of trauma from incident to outcome.
From an EMS perspective, Georgia has many factors that set it above other states. The overall quality of Georgia's pre-hospital care is excellent. The skill level and training of rescue, first responders, EMS and air medical service personnel is ranked among the highest in the nation. The commitment of many hospitals, physicians, surgeons, nursing and other support staff involved in Georgia's trauma system is unsurpassed. Many facilities not currently participating in the organization of an inclusive system are still rendering excellent care to the citizens of Georgia.
Collectively, these services and programs comprise the EMS gateway to healthcare and certain types of medical emergency preparedness for the public in Georgia. EMS is an important function within Public Health.

Trauma in Georgia 19
TRAUMA SYSTEM DEVELOPMENT
Interest in establishing a statewide trauma system began in Georgia more than twenty years ago. Georgia designated its first trauma center in 1981. Twenty-two years later in 2003, Georgia had fourteen designated trauma centers. The first re-designation evaluations were completed in 2001. In connection with this, several key committees and individuals with statewide representation play a key role in developing Georgia's trauma system.
Georgia Trauma Centers on a State Map with 10 EMS Regions
Shown left: Red circles indicate Level 1 centers, Yellow circles indicate Level 2 centers, the Green circle indicates the only Level 3 center, Violet circles indicate Level 2 Pediatric centers, and the Aqua dashed circles indicate the potential Level 4 centers.

Trauma in Georgia 20
Medical Review Committee The Medical Review Committee, established in 2002, has the responsibility to
review and evaluate all aspects of patient care and make recommendations for appropriate system-wide quality improvement.
Georgia Committee for Trauma Excellence The Georgia Committee for Trauma Excellence (GCTE) is comprised of trauma
coordinators and trauma registrars who meet to discuss trauma guidelines and policy and procedures, as well as the educational needs and opportunities within the facilities they represent and across the state. Their participation is fundamental and provides the foundation for both the need for and substantive discussion of trauma data collection.
Georgia Trauma System Development Committee The Georgia Trauma System Development Committee (GTSDC) is a group of
stakeholders from across the state with a mission to develop and implement a statewide, patient-focused trauma initiative. The committee fosters the development of policies, procedures, and practices which assure that injuries are prevented when possible. When prevention has not been successful, the goal is then that all injured individuals receive the best possible pre-hospital, emergency and definitive care. The role of the GTSDC is to develop an integrated, inclusive, regionalized trauma system for Georgia, which without regard to socioeconomic status permits optimal care to the injured patient, family and community. This statewide committee was established in 2001 and has a multidisciplinary representation of healthcare professionals and various community representatives.
Emergency Medical Services Advisory Council Emergency Medical Services Advisory Council (EMSAC) is an advisory council
established pursuant to the provisions of O.C.G.A, Section 50-4-4 and Georgia Department of Human Resources Administrative Order No. 9, the purpose of which is to

Trauma in Georgia 21 advise the Department in matters essential to its operations with respect to emergency medical services.9
Regional Emergency Medical Services Program Directors The Program Directors in each of the ten regional EMS offices are an extension of
the OEMS/T. They are responsible for developing specific goals and objectives for the systematic implementation and evaluation of a comprehensive EMS and Trauma System at the local level. Program Directors utilize laws, rules, regulations, policies and procedures to provide direct oversight of regional data in the assessment of the prevailing health status and emergency healthcare needs of a community.
Working Towards Injury Prevention Injury prevention needs to be integrated into the strategic focus of trauma system
development. Community-based injury prevention programs have been demonstrated to decrease injury-related morbidity and mortality and to reduce health care costs. On a national basis, prevention programs are often not targeted or evaluated in a systematic review of actual injury data. In Georgia, the OEMS/T provides its analysis of injury data upon request to other state agencies. This forms the basis for data driven responses to community public health.
9 Source: Rules and Regulations Chapter 290-5-30-.02,ii. The rules and regulations also state that any variance from the guidelines for designated trauma centers must be approved by the department based on recommendations from the Emergency Medical Services Advisory Council (EMSAC).

Trauma in Georgia 22
THE IMPACT OF TRAUMA ON GEORGIA
Economic Pressures
Georgia is facing a very serious situation. The ability of hospitals to participate in Georgia's trauma system has never been more important; yet, financial and other constraints are actually diminishing the abilities of hospitals to participate.10
Recent statistics indicate that approximately two-thirds of Georgia's hospitals are operating in the "red". The recent economic downturn has accentuated an alreadysignificant problem for hospitals. The tremendous increase in uninsured patients and reductions in Medicare/Medicaid reimbursement are bringing about the closure of some hospitals and a significant reduction in services at others. The increased penetration of managed care and the escalating costs of malpractice coverage for hospitals and individual practitioners are additional economic challenges. Is it any wonder that hospitals find it difficult to make the costly commitment that trauma center designation requires or that many physicians resist participation at trauma centers?
The Cost of Traumatic Injury
It is estimated that traumatic injury is producing approximately $170 million of uncompensated hospital care annually in Georgia. This uncompensated care is being provided by a healthcare system that is already fragile fiscally and in danger of collapse. The cost of "shoring up" the system is high, but the potential yield is worth the expenditure in productive lives and dollars saved.
Some well-designed, integrated, statewide trauma systems have shown as much as a 500% return on investment.11 Dollars spent on a well-designed, integrated, statewide trauma system, though large on the front end, can provide an even larger yield on the back end where lives are saved and productive capabilities are maintained.
It is anticipated that with appropriate funding, these goals can be obtained.
10 According to the U. S. Department of Health & Human Services (2002, p. 39.) National Assessment of State Trauma System Development, finance was the category cited as the top threat to the continued viability of state trauma systems. 11 Source: Dr. O'Neal (2004) unpublished notes supporting the Trauma Plan.

Trauma in Georgia 23
Understanding Other Related Health Care Issues
There are many types of injuries and syndromes that are closely related to trauma. It is important to recognize what these related health care issues are because they affect the long-term quality of life of many people in Georgia.
Many of the injuries that are classified as trauma are preventable. Even those that are not preventable, stand to have a better outcome if high quality care is rapidly available. The prevention of traumatic injury is an area that is still understudied on a nationwide basis. In particular, traumatic brain injury and post-traumatic stress syndromes have high frequencies of occurrence and warrant efforts of prevention.
Traumatic Brain Injury (TBI)
There are a number of possible consequences for the head injured person with brain injury. Physically, damage to parts of the brain can result in gait, balance, and coordination problems. Head injured persons may be unaware of one-half of their vision field, also known as "visual neglect." Some are left with double vision (diplopia) and other visual disturbances. Motor problems occur such as paralysis and an inability to use a limb. The cognitive changes can be significant and include deficits in short-term memory, decreased problem-solving ability, and coordination of eye-hand movements, problems attending to multiple things occurring at the same time. The survivor may have a shallow awareness of their own deficit areas and thus not benefit from verbal feedback or may not learn from experience and end up repeating mistakes.12
TBI is associated with a host of physical, cognitive, personality, emotional, interpersonal, social, and recreational consequences that can greatly impact both the head injured person and that person's family. Because these consequences often last over a period of months and sometimes years, changes occur in the family to adjust to the changes in the head-injured person. TBI represents an opportunity of greater utilization of data as the system matures.
TBI is unlike some other medical problems such as bone fractures or systematic illnesses like the flu, in that recovery from head injury takes a very prolonged period of

Trauma in Georgia 24
time, and in more severe cases, the problem does not fully remit. During the period of recovery, the family and/or spouse of the head-injured person are left with the task of coping, managing, and enduring the stresses and burdens that caring for the individual requires. Emotional and behavioral changes will often be very stressful to family members. Some survivors of severe injuries may experience minimal psychological disturbance while others may exhibit serious post-traumatic stress symptoms after a slight accident.
These consequences can linger long after the physical wounds have been treated and healed. Symptoms of post-traumatic stress are believed to have a high prevalence among survivors. There are many variations to the problems that become stressors to family members and can lead to changes in the family system.
On a national basis, TBI is often described as the leading cause of disability in children, but data to support this assertion are lacking. It is known that each year an estimated 3,000 children and youth die from TBI; 29,000 are hospitalized; and 400,000 are treated in hospital emergency departments.13 Currently, no population-based studies of the outcomes of TBI among children and youth exist to provide national estimates of TBI-related disability and document the need for services. In Georgia, TBI remains understudied as well.
Post-Traumatic Stress. Many factors appear to increase an individual's risk for post-traumatic stress
following an injury, including a history of psychiatric disorder, previous trauma, substance abuse, parental divorce and separation from parents, and physical or sexual abuse. Individual "patient variables" help explain why one person may develop posttraumatic stress disorder while another person experiencing the same trauma may not.
12 Source: TBI Foundation Public Education Materials (2003). 13 Source: CDC (2000). Traumatic Brain Injury in the United States: Assessing Outcomes in Children. Expert Working Group, Atlanta, GA. Department of Health and Human Services.

Trauma in Georgia 25
Organ Donation Awareness
When a traumatic event occurs that results in death, there is a positive effect that can follow. This positive effect begins with the individual's or family's consent for organ donation. The act of "Giving the Gift of Life" is respected and accepted by many people in the United States regardless of their faith. In the first quarter of 2004, there were 3,422 donors resulting in 6,542 transplants being performed.14 While this may sound like an accomplishment for our country, the national Organ Procurement and Transplant Network (OPTN) database shows there are still 86,121 candidates awaiting a single or multiple organ transplant as of July 9, 2004. Like a traumatic event, the diseases that result in the need for an organ transplant do not differentiate between age, gender, ethnicity, economic or social status. In Georgia, there are an estimated 1465 patients waiting for a transplant.15 If one is not received, the disease may cause the patient to die or become disabled resulting in more loss of life and loss of productive years.
Based on the 2003 trauma registry data, there were 59 recorded organ donors out of the 768 trauma deaths. These numbers reveal a need for education in our communities, churches and hospitals to increase the awareness of Georgia's need for organ donors. There are professional organizations available to train and educate the appropriate staff and/or individuals to facilitate organ donations.
"Awareness is no longer the public issue: the issue is action family discussion regarding organ and tissue donation. Even if you have the organ donor label on your driver's license, to ensure your wishes are carried out, discuss your intentions to be a donor with your family. Regardless of written intentions, your family's decision is important because family consent is part of the donation process".16 It is noted that The Honorable Sonny Perdue, Governor of the State of Georgia, signed a proclamation supporting organ donation and designated the month of April as the "Donate Life Month in Georgia".
14 Source: www.optn.org (2004). As retrieved July 9, 2004. 15 Source: www.lifelinkfound.org (2004). As retrieved July 9, 2004. 16 Source: LifeLink of Georgia (2004).

Trauma in Georgia 26 Trauma Care & Homeland Security
Looking at recent events, Georgians, like all Americans, recognize that the world has entered a new age--an age of terrorism. An effective trauma system is an essential part of Georgia's emergency preparedness efforts. Most terrorism against the U.S. has involved conventional trauma. A trauma system can be key infrastructure in our preparedness efforts not only for the unnatural acts of terrorism, but also for those natural disasters such as tornadoes, floods, hurricanes, and newly emerging infectious challenges such as Severe Acute Respiratory Syndrome (SARS). An integrated, statewide trauma system is fundamentally important in our efforts to improve Homeland Security.
Atlanta Centennial Park Bombing, 1996
Source: http://www.cnn.com/US/9607/27/sights.so unds/lay.hurt.lg.jpg
Today, the threat of terrorism requires the activities of preparedness and response to minimize harm and resulting fear and panic. Preparedness to deal with terrorism is now within the domain of Public Health, and trauma systems are a resource with which to strengthen capabilities to prepare for and respond to terrorism.17
17 Source: Jacobs, L. M. (2003). Terrorism: A Public Health Threat with a Trauma System Response. The Journal of Trauma, Vol 55, No 6. p. 1014 1021.

Trauma in Georgia 27
ANALYSIS OF STATEWIDE TRAUMA DATA
The Georgia Trauma Registry (GTR) for 2003 contains 9,612 patient records from 14 participating trauma centers. - The illustration below shows the relative distribution of trauma patients reported by the 14 Georgia designated trauma centers. - 9,612 patient records represent approximately 20-30% of the trauma patients that are treated in Georgia. Because there are only 14 participating hospitals in the Georgia trauma system, the exact number of trauma patients is unknown. - The 9, 612 patient records analyzed meet the strict American College of Surgeons trauma registry criteria.18 A less strict definition of trauma, based upon an analysis of Georgia's local conditions, would significantly increase the number of seriously injured patients reported by these centers.

Relative Distribution of Trauma Patients Among the 14 Centers

7% 2% 5% 11%
7% 9%
2% 6%

10% 6% 4% 5% 4%
22%

Archbold MC Atlanta MC Columbus MC Dekalb MC Egleston P2 Floyd Grady Gwinnett Hamilton MCCG MCG Memorial N. Fulton Scottish Rite

18 See The American College of Surgeons definition of trauma.

Trauma in Georgia 28
Trauma is the number one killer in the 1-44 year age group and the 3rd highest cause of death for all age groups. - The loss of life, disability and rehabilitation increasingly place tremendous hardships not only on society but also on the entire economic stability of Georgia's healthcare system. - The mean age for trauma patients in Georgia is 34.2 years.

Trauma Patients by Gender & Age

1400 1200 1000
800 600 400 200
0

Female

Male

A. <1 B. 1 - 4 C. 5 -9 D. 10 - 14 E. 15 - 19 F. 20 - 24 G. 25 - 34 H. 35 - 44 I. 45 - 54 J. 55 - 64 K. 65 - 74 L. 75 - 84 M. 85 - 89 N. 90 >

Trauma is a disease that impacts both genders. Females represent 31.8% of the trauma patient records; males represent 68.2%.
Trauma by Gender

Male Female Uncoded Total

Frequency 6553 3056 3 9612

Percent 68.2 31.8 .0
100.0

Trauma is a disease that impacts all ethnic groups.

Trauma in Georgia 29

Trauma Patients by Ethnic Representation

Caucasian African American Hispanic/Latino Asian American Indian Other Not Available Not Reported Total19

Frequency Percent

5174 3274
801 70 7
139 138
9 9612

53.8 34.1
8.3 .7 .1
1.4 1.4
.1 100.0

Bar Chart of Trauma Patient Ethnic Representation

Frequency

6,0 0 0 5 ,0 0 0 4,000 3 ,0 0 0 2,000 1,000
0

E th n ic it y

Caucasian

African AmericanHispanic/Latino Other

Not Available Asian

E th n ici ty

Not Reported American Indian

19 Not Available and Not Recorded are standard default options in the NTRACS database for the data element, Race.

Trauma in Georgia 30

From a medical perspective, the gross mechanisms of traumatic injury can be divided into two general categories: blunt and penetrating mechanisms. The majority of trauma, approximately 86% is the result of blunt injury. Approximately 14% is the result of penetrating mechanisms of injury.
Blunt vs. Penetrating Trauma
14%

86%

Blunt Penetrating

Another way of understanding trauma is to examine the major categories of specific injuries in more detail. Nine mechanisms account for 91.9% of trauma.

Most Common Mechanisms of Injury

Mechanism

Frequency

Percent

Cumulative Percent

1

Motor Vehicle Crash

(MVC)

3654

38.0

38.0

2

Fall

1976

20.6

58.6

3

Gun Shot Wound

(GSW)

4

Motorcycle

5

Pedestrian

6

Assault

7

Accident

8

Stab Wound

9

All Terrain Vehicle

(ATV)

819

8.5

67.1

580

6.0

73.1

540

5.6

78.7

407

4.2

83.0

387

4.0

87.0

276

2.9

89.9

193

2.0

91.9

Trauma in Georgia 31

Mechanisms of Injury All Coded Categories

3% 2% 4% 1%
0% 6%
1%

0% 4%

2% 2%
1%

38%

21%
0% 9% 6%

Abuse Accident Aircraft Animal Assault ATV Bicycle Burn Electrical Fall Fight/Brawl GSW Hanging Machine Motorcycle MVC Not Available Not Recorded Pedestrian Rape Sports Stab Wound Struck

Motor vehicle crashes20 (MVC) are a predominate mechanism of injury and represent 38% of all traumatic injury reported.
Falls represent 20.6% of mechanisms of injury. Falls are the second highest cause of injury after MVCs.
Gunshot wounds (GSW) represent 8.5% of mechanisms of injury. GSWs represent the third highest cause of injury after MVCs and falls.
Motorcycle crashes represent 6%. ATVs account for 2%.
Most traumatic injuries occurred on streets and highways (52.2%).

Trauma in Georgia 32 Where Injury Occurred

E-Codes E849.5 - Street/Highway E849.9 - Unspecified Place
E 849.0 Home E849.4 - Recreation & Sports Location E849.3 - Industrial Place E849.8 - Other Specified Place
E849.6 - Public Building E849.7 Residential E849.1 Farm Total

Frequency 5021
1881
1494
364
287
252
174 101
38 9612

Percent 52.2
19.6
15.5
3.8
3.0
2.6
1.8 1.1
.4 100.0

Within E-Code 849.5, Street & Highway, motor vehicle drivers and passengers were the most frequently injured.

Riding Position in Street & Highway Related Injuries21

4% 1% 8% 10%
23%

52%

Motorvehicle-D Motorvehicle-P Pedestrian Motorcycle-D Unspecified Pedal Cyclist Motorcycle-P Other Specified Rider-Animal

20 Motorcycle and ATV crashes are not included in this number and are reported separately. 21 D represents Driver, P represents Passenger

Trauma in Georgia 33
Trauma can strike any month or season of the year. July (9.6%) is the month with the most number of visits to the Emergency Department for a traumatic injury that met the inclusion criteria for the trauma registry.

ED Trauma Patient Volume by Month 2003

2003 Trauma Patient Volume by Month
To tal Reco rds = 9612

1000 800 600

716 796 885 854 926 894 902 870 783 747 642 597

400

200

0

JanuaryFebruary

arch M

April

ay M

June

JulyAugSuespttember OctobNeorvembeDrecember

Trauma in Georgia 34 73% of patients reach a trauma center by ground ambulance.
- Georgia has 263 licensed ambulance providers. - Georgia has approximately 2300 vehicles licensed as ambulances. - There are approximately 12,300 licensed EMS professionals in Georgia.
Transportation to Trauma Center
2% 9%
16% Ambulance Helicopter Walk in Police Not Available
73%
- 9% of trauma patients "walk-in" to trauma centers. - 16.3% of patients reach a trauma center by helicopter. Helicopters and air
transportation represent unregulated emergency transportation in Georgia.22
22 It is noted that in 2002 The Georgia General Assembly passed legislation to amend Chapter 11, Title 31 of the OCGA so as to provide for the licensure and regulation of air ambulance services.

Trauma in Georgia 35 Five air ambulance services are based in Georgia 23
(Air Med (Augusta), Children's Response Air, Emory Flight/LifeNet Georgia, Life Star One, and Rescue Air 1) - Air transportation can also originate outside of Georgia. - Air ambulance services play a major role in pre-hospital trauma care. - Some areas of Georgia are not yet covered.
Air Ambulance Services in Georgia
23 Other Helicopter services not on the map include: Aero Medical Transport Services and Skycare 1. Their services may vary from the air ambulance services on the map. The source of the map is Flight Services Atlas and has been revised to reflect the current air ambulance services.

Trauma in Georgia 36
No matter how patients arrive at the trauma center, they are usually admitted by the trauma service.

63%

Admitting Service Volume

3% 7% 3%
15%

Emergency Medicine Gen Surgery Neurosurgery Not Available Orthopedic Surg Other Med Other Surg Peds Plastics Thoracic Trauma

The most frequent medical procedures initially performed are imaging techniques to help determine severity of injury.

Five Most Frequent Initial Medical Procedures24

10% 15%

34%

17% 24%

CAT Scan NEC
CAT Scan Head
CAT Scan Abdomen Ultrasound Abdomen Skin Closure NEC

24 Note: The term NEC (Not Elsewhere Classifiable) is used as standard terminology by NTDB. NOS (Not Otherwise Specified) is more commonly used in Georgia among trauma stakeholders.

Trauma in Georgia 37

Trauma patients are given an Injury Severity Score (ISS). ISS is a numerical value from 1 to 75. The higher the number the more severe the overall injuries. This score is the sum of the squares of the Abbreviated Injury Scale (AIS) scores of the three most severely injured body regions.25 This scoring system is widely accepted in trauma literature.

Injury Severity Scores (Percent %) (All Centers Adults and Pediatrics)

30 25 20 15 10
5 0 ISS 1-4

ISS 5-9

10-15 ISS

16-24 ISS

>=25 ISS

Not Done

Impact of age on Injury Severity Scores. Age can be an important variable in relationship to injury severity. It is well documented that older patients will have a higher probability of unfavorable outcome than a healthy younger person given the same injury severity. However, very young children may be similarly worse off.

25 There is a relationship between ISS length of hospital stay and long-term patient outcome. Source: The Abbreviated Injury Scale (1990), Association for the Advancement of Automotive Medicine.

Trauma in Georgia 38

Pediatric Injury Severity Scores (Percents %)

60 50 40 30 20 10
0
ISS 1-4

ISS 5-9 ISS 10-15 ISS 16-24 ISS >= 25 Not Done

From the Emergency Department, 31% of patients require treatment in an Intensive Care Unit (ICU) and 37% are taken to standard hospital rooms for additional care.

Emergency Department Disposition

22%

2% 2% 3%

1%

37%

31%

2%

DOA/Death in ED Floor Home ICU Not Available OR Telemetry Transfer

Trauma in Georgia 39
Average ISS, days in ICU and length of stay are all factors which have bearing on overall patient outcomes. In studies, it is important to break out adult and pediatric data.

Average ISS, Days in ICU and Length of Stay (LOS)

14 12 10
8 6 4 2 0
Avg ISS Avg Days in Avg Days ICU Hospital LOS

All Adult Pediatric

Trauma in Georgia 40 Total trauma-related deaths reported by the 14 participating centers equaled 768.
These deaths include DOA (Dead on Arrival)26, deaths in the ED (Emergency Department), and deaths after admission.
Trauma Center Deaths All Patients

5%

62%

33%

DOA's
ED Deaths
Deaths After Admission

Causes of death after admission vary by patient. Trauma Center Deaths Adults Centers
5%

62%

33%

DOA's
ED Deaths
Deaths After Admission

26 Some trauma centers do not recognize the DOA category, i.e., an effort is made to resuscitate all patients that arrive at the center.

Trauma in Georgia 41
Pediatric Trauma Centers reported zero DOAs in 2003; an effort was made to resuscitate all pediatric patients.
Trauma Center Deaths Pediatric Centers 0% 21%

79%

DOA's
ED Deaths
Deaths After Adm is s ion

Analysis of the death statistics indicates that Georgia trauma centers have an 8.0% death rate. These statistics indicate that Georgia trauma center patients have an excellent chance for survival after they are admitted to a trauma center.27

27 At this time no equivalent data is available for comparisons of Georgia Trauma Centers against national averages except on a category by category basis. The OEMS/T will be conducting a follow-on study of Trauma Deaths in Georgia in 2005.

Trauma in Georgia 42
Georgia organ donations for trauma death numbered 59. Only 7.7% of deceased patients donated organs. 92.3% were not organ donors.28

Trauma Deaths vs. Organ Donations 2003 (Numbers of Patients)

768 800 700 600 500 400 300 200 100
0 Trauma Deaths

59 Organ Donors

Organ donors from trauma deaths represented all ethnic groups and both genders.

Demographic Characteristics of Trauma Death Organ Donors (Numbers of Donors by Characteristic)

Not Available White Other
Hispanic Black Asian
0

Female Male

5

10 15 20 25

28 For additional information regarding the Georgia Organ Donors Program, see www.lifelinkfound.org.

Trauma in Georgia 43 TRAUMA CENTER PROFILES
Georgia Trauma Centers (In Alphabetical Order)
Source: http://www.gwinnetthealth.org/programs/trauma/trauma.asp

John D. Archbold Memorial Hospital

Trauma in Georgia 44

John D. Archbold Memorial Hospital P.O. Box 1018 Thomasville, Georgia, 31799-1018 229-228-2000 http://www.archbold.org
Trauma Medical Director Gregory K. Patterson, MD, FACS, CWS
Trauma Coordinator Kelli Vaughn, RN, BSN, CEN
Highlights of Trauma Program: John D. Archbold Memorial Hospital has provided trauma care to the surrounding area since its initial trauma center designation in 1986. Upgraded to a Level II Trauma Center in 2002, Archbold continues to offer optimal resources to traumatically injured patients by providing acute care, rehabilitation, and injury prevention services.
Description of facility: John D. Archbold Memorial Hospital is a not-for-profit, 264-bed hospital accredited by the Joint Commission on Accreditation of Healthcare Organizations. It is the anchor of an 800-bed regional network comprising five hospitals, four nursing homes, and primary and specialty clinics, serving 15 counties in south Georgia and north Florida. Archbold provides comprehensive cancer care, a multi-site inpatient and outpatient rehabilitation program, home health, dialysis, behavioral care, and outreach to underserved populations.

Mission: Archbold Medical Center is committed to providing high quality, compassionate, cost-effective healthcare for our patients. Vision: The vision of John D. Archbold Memorial Hospital is to be a regional health system recognized for healthcare excellence and exceptional service to our patients. Values: Compassion fostering a caring environment in which the patient comes first Integrity conducting ourselves in an ethical and honest manner. Commitment We are committed to our patients, employees, medical staff, and community. Excellence Meeting and exceeding expectations of those we serve. We value continuously improving everything we do to achieve excellence in performance. Teamwork Achieving a cooperative spirit among employees, medical staff, volunteers, and the community. Effectiveness Providing value-added, costeffective care and appropriate services.

Atlanta Medical Center

Trauma in Georgia 45

Atlanta Medical Center 303 Parkway Drive N.E. Atlanta, GA 30312-1212 (404) 265-4000 www.atlantamedcenter.com
Trauma Medical Director Dr. Vernon Henderson, MD, FACS Trauma Coordinator Rochella Mood, RN, MSN
Highlights of Trauma Program: Since 1997, Atlanta Medical Center (AMC) has been
a key player in trauma care in the state. Our Level II trauma center is committed to excellence in the care of trauma patients from admission through rehabilitation. Our medical center has committed the resources to meet the demands of staffing, specialty services and surgical capabilities required 24 hours a day, seven days a week. Last year AMC treated over 1,250 critically injured trauma patients.
Despite the growing financial challenges facing designated trauma centers in Georgia, Atlanta Medical Center has remained committed to caring for trauma victims. AMC is a regional referral center for facilities that are not equipped to deal with significantly injured patients and accepts patients from around the state. Last year more than 20% of AMC's patients were transfers from other facilities. AMC uses the latest technologies available, combined with skill and compassion to ensure that patients have the best possible recovery.
Description of facility: Since its founding in 1901, Atlanta Medical Center
(AMC) has been serving the medical needs of the community and the region. The 460-bed tertiary care hospital, which is part of Tenet Georgia, is located at 303 Parkway Drive in Atlanta, Ga. Specialties include advanced surgery, cardiology, neurology, oncology, women's health, orthopedics, trauma and rehabilitation.

The level II trauma center is supported by aeromedical services providing immediate transportation to critical patients throughout the state.
The hospital campus also comprises a comprehensive cancer center, a Diabetes Metabolic Center, Sheffield HealthCare, a neighborhood community health center, as well as the Wellness Center, which houses the Highland Athletic Club, Atlanta Surgical Weight Loss Center and outpatient rehabilitation program.
Atlanta Medical Center is accredited by the Joint Commission on the Accreditation of Healthcare Organizations, the nation's oldest and largest hospital accreditation agency. To learn more about Atlanta Medical Center, visit www.atlantamedcenter.com.
Mission: Atlanta Medical Center has a twofold mission: First of all, to meet the healthcare needs of the community in which we are located. Secondly, to serve as a tertiary referral hospital for the Southern Crescent of the Atlanta area. Services are provided to all patients for whom the capability exists within the hospital to render those services in a quality, cost-efficient manner.
Vision: "Extraordinary Service by Extraordinary People". This vision gives meaning to the work of all of our people employees, physicians, and volunteers. It is a purpose toward which we can all strive and aspire. The vision describes where we are going as an organization. It is what we stand for.
Values: Quality is the cornerstone of everything we do. It is our passion to provide exceptional care to every patient we serve. We value this commitment to quality and service. We value the rights of every patient to be treated with skill, dignity and respect.

Trauma in Georgia 46 Children's Healthcare of Atlanta Egleston and Scottish Rite

Children's Healthcare of Atlanta at Egleston 1405 Clifton Road NE Atlanta, GA 30322-1062 404-325-6000
Trauma Medical Director Paul Parker, MD
Trauma Program Coordinator Mary Shepherd, RN, CCRN Trauma Registrar Dana Burrell
Children's Healthcare of Atlanta at Scottish Rite
1001 Johnson Ferry Road NE Atlanta, GA 30342-1605 404-785-5252
Trauma Medical Director John Bleacher, MD
Trauma Program Coordinator Teresa Fox-Paone, RN, BS, BSN Trauma Registrar
Pamela Jones-Jackson, C.C.B.S.
http://www.choa.org
Highlights of Trauma Program: Level II Pediatric Trauma Center Treats over 19,900 trauma related injuries/year Trauma Resource and Trauma Specialist Program All services provided from prevention to rehab Wide variety of trauma education offerings

Hospital Mission: To enhance the lives of children through excellence in patient care, research and education. Vision: To be the model for addressing children's health needs by defining, then providing or advocating for: accessible, innovative and excellent patient care; integrated teaching and research; and partnerships in wellness and prevention programs. Values: -- Integrity: Being honest, ethical and committed to all we do. Respect: Appreciating all people, work and ideas. Nurturing: Fostering the care, growth and development of the individual. Excellence: Delivering the highest level of care and service. Teamwork: Working together to achieve our goals. Trauma Mission: The mission of the Trauma Program at Children's Healthcare of Atlanta is to provide excellent clinical care, education, research, and to maintain designation as a Level II Pediatric Trauma Center with campus specific capabilities.
Description of facility: 58 ED beds/ 42 PICU beds 4 trauma rooms/ 4 helipads ECMO capabilities / CV Surgery Comprehensive Inpatient Rehabilitation Children's Response Transport Team: Ground,
Helicopter, Fixed wing. 1-800-325-6540 Child Life, Child Injury Prevention and
Advocacy Program

DeKalb Medical Center

Trauma in Georgia 47

Address 2701 N. Decatur Road Decatur, GA 30033 Main hospital telephone # 404-501-1000 Website address www.dekalbmedicalcenter.org
Trauma Medical Director William R. Hardcastle, M.D. 404-296-0148 Trauma Coordinator Kelly Nadeau, R.N., M.N. 404-501-5651 Trauma Registrar Karen Johnson 404-501-5663

Mission: Our mission is to improve lives through the delivery of excellent health and wellness services in partnership with our physicians.
Vision: DeKalb Medical Center will be the recognized leader in clinical and service excellence and employee satisfaction.
Values: Diversity Respect Healing Service

Highlights of Trauma Program:

Description of facility:

DeKalb has been designated as a Level 3 Trauma Center since 1990. We are the primary trauma care provider for DeKalb County and are proud of our close relationship with DeKalb Fire and Rescue Services for prehospital care. Seven general/trauma surgeons provide trauma coverage with subspecialists available for consult. A monthly trauma lecture series is offered to any health care provider with an interest in trauma care. Trauma Nursing Core Courses and the Course in Advanced Trauma Nursing are offered regularly. Advanced Trauma Life Support courses are planned for 2005.

DeKalb Medical Center is a not-forprofit hospital system that includes three hospitals: the 525 bed DeKalb Medical Center, the 102 bed DeKalb Medical Center at Decatur, and DeKalb Medical Center at Hillandale, a new 100 bed hospital scheduled to open in fall 2005. A leader in progressive medical technology delivered by a highly qualified and caring staff, the hospital system serves approximately 500,000 patients, including 75,000 emergency and trauma patients, and provides the community with more than $40 million in free care.

Floyd Medical Center

Trauma in Georgia 48

304 Turner McCall Blvd Rome, Ga 30165 706-509-5000
Trauma Medical Director Louis Dinatti, MD, FACS
Trauma Coordinator Tifani Kinard, RN
Trauma Registrar Cindy Holman

qualified personnel ...are encouraged and supported to reach their maximum potential through education, and are recognized for a job well done ...are provided an environment of open communication, participation in planning, and respect for each employee's contribution to our mission. Floyd's Medical Staff ...are our valued customers as well as partners in health care ...are provided an environment that attracts and maintains high caliber physicians ...are involved in the direction of the hospital community.

Mission: Floyd's mission is to be responsive to the communities we serve with a comprehensive and technologically advanced health care system committed to the delivery of care that is characterized by continually improving quality, accessibility, affordability and personal dignity.
Vision: Floyd's vision is to be the regional health care provider of choice and the employer of choice, to deliver patient and family centered care that is compassionate, sensitive and respectful of each individual's needs.
Values: Floyd Patients ...are our highest priority ...are provided high quality, state-of-the-art health care ...are treated with respect and dignity, and treated equally ...are provided education and information for themselves and their families.
Floyd Employees ...are our most valuable asset ...are offered an environment that attracts and retains highly

Description of facility: A 304-bed full-service, acute care hospital and regional referral center, Floyd provides sophisticated medical services and the latest technology to support centers of excellence in trauma and emergency care, as well as women and infants, pediatrics, inpatient and outpatient rehabilitation specialties, inpatient and outpatient surgery, cancer, diabetes, home care and hospice, neurosciences, orthopedics and cardiology.
Highlights of the Trauma Program: Floyd Medical Center is a state-designated Level II Trauma Center treating 56,000 people each year in our Emergency Care Center. Highlights of the program include: Community wide injury prevention program seeing over 2000 students/year, EMS of the year three times, most recently in 2003, and hospital wide trauma education.

Grady Health System

Trauma in Georgia 49

80 Jesse Hill Jr Drive Atlanta, GA 30303-3050 Main hospital telephone # 404-616-4307 Website address http://www.gradyhealthsystem.org
Trauma Medical Directors Grace S. Rozycki, MD FACS Emory University School of Medicine
L. Leon Dent, MD FACS Morehouse School of Medicine
Trauma Coordinator Fran H. Lewis, RN MS
Highlights of Trauma Program: Grady Health System is one of the largest public hospitals in the Southeast -- and includes the 900+ bed Grady Memorial Hospital, Hughes Spalding Children's Hospital, 10 neighborhood and airport health centers and the only level one trauma center within a 100-mile radius.
Description of facility: Grady is an internationally recognized teaching hospital, staffed exclusively by physicians from Emory and Morehouse schools of medicine, many who could be categorized as some of the leading doctors in the country. Twenty-five percent of all physicians practicing medicine in Georgia received some or all of their training at Grady. Grady maintains its historic commitment to the health needs of those most vulnerable and offers a broad range of state-of-the-art services and medical expertise to all segments of the greater metropolitan area and beyond. Grady shields other Atlanta hospitals from a massive burden of uncompensated care. Grady is also one of Atlanta's largest downtown employers, generating more than $1.6 billion for the Atlanta economy.

Mission: The Grady Health System is a comprehensive health services delivery system that includes affiliations with public health organizations, medical education programs, and community advocates to provide quality, costeffective and customer-focused health care to all residents of metropolitan Atlanta, and citizens of the state of Georgia. The Grady Health System maintains its commitment of offering medical services to the underserved, including governmentally sponsored populations. Grady's services will be provided in a compassionate, respectful and dignified manner to all its customers.
Vision: The Grady Health System will continue to be a world-renowned leader in health services through its commitment to quality care, medical education and research.
Values: Our core values (compassion, excellence, teamwork, integrity, and commitment) are critical to achieving the mission of the Grady Health System. All employees, physicians, affiliated staff members, volunteers and the Fulton-Dekalb Hospital Authority Board of Trustees accept and embrace these five Core Values.

Gwinnett Medical Center

Trauma in Georgia 50

1000 Medical Center Blvd. Lawrenceville, GA 30045 678-442-4321 www.gwinnettmedicalcenter.org
Trauma Medical Director Barry Renz, MD Trauma Coordinator Deb Battle MS, RN, CEN, CCNS Trauma Registrar Mary Lou Dennis

Mission: We exist to provide quality health services to our community. Vision: To be the Health System of choice in our community by enhancing the health of our patients and other customers. Values: The customer is first and foremost. Respect for the individual. The pursuit of excellence. The promotion of positive change. Service to the community.

Highlights of Trauma Program: Gwinnett Medical Center is designated by
the Georgia State Office of EMS & Trauma as a Level II adult trauma center Gwinnett Medical Center is the only trauma center in Gwinnett County In addition to providing inpatient care to trauma patients, we also provide: continuing trauma education to EMS,
hospital and medical staff injury prevention education to the
community community trauma web page at
www.gwinnetthealth.org

Description of Medical Center: Gwinnett Medical Center is part of Gwinnett Hospital System, a 479-bed not-for-profit healthcare network providing high quality facilities and services to Gwinnett and the surrounding area. Gwinnett Medical Center offers state-of-the-art inpatient, outpatient and intensive care, maternity services and comprehensive specialty care, including orthopedics and neuroscience.

Hamilton Medical Center

Trauma in Georgia 51

Address: 1200 Memorial Drive Dalton, GA 30720
Main hospital telephone #: (706) 272-6000
Website address: www.hamiltonhealth.com
Trauma Medical Director Richard Fromm MD FACS Trauma Coordinator Jennie Banks RN CEN EMT-P Trauma Registrar Byron Wynkoop

Mission: Hamilton Medical Center is dedicated to quality health care that serves the needs of area residents without discrimination. Working in partnership with trustees, professional staff and the medical community, Hamilton Medical Center will be the region's leading provider of a continuum of health care services that are high in quality, that promote effectiveness and efficiency, and that advance the quality and dignity of life. As a not-forprofit organization, Hamilton Medical Center will manage its resources with integrity and in a manner which ensures continued financial viability.

Description of facility:

Vision: Hamilton Medical Center will achieve

Centered in the heart of the Hamilton Health outstanding customer satisfaction and clinical

Care System is Hamilton Medical Center, a excellence in all of its services and build a

282-bed hospital dedicated to providing premier reputation throughout northwest

premium health care. Twice named one of the Georgia for selected specialty services.

Top 100 Hospitals in the United States by

HCIA and Mercer Consulting, Hamilton Guiding Principles: Hamilton Medical

Medical Center continually receives the Center's staff is committed to these guiding

maximum 3-year accreditation by the Joint principles: Customer Centered Care;

Commission on Accreditation of Healthcare Competent Care; Compassionate Care and

Organizations (JCAHO). Hamilton's Cost Effective Care.

technologically advanced diagnostic facility

includes a fully-accredited laboratory, a Highlights of Trauma Program: The state-

magnetic resonance imaging center and designated Level II trauma center, among the

outpatient neurodiagnostic center. The medical state's busiest, provides outstanding immediate

center is also home to an advanced computer and ambulatory emergency care. Hamilton

radiology system and outpatient women's remains a dedicated resource for all aspects of

pavilion featuring mammography, ultrasound truama care, such as prevention, access, pre-

and bone densitometry capabilities.

hospital evaluation, acute hospital care,

surgical and critical care, as well as,

rehabilitation services.

Medical Center of Central Georgia

Trauma in Georgia 52

Address: 777 Hemlock Street Macon, GA 31201
Main hospital telephone #478-633-1000 Website address: www.MCCG.org
Trauma Medical Director Dennis W. Ashley, MD, FACS Trauma Program Manager Debra Kitchens, RN, CEN, NREMT-P Trauma Registrar Brenda Norris, NCMA
Highlights of Trauma Program: In June of 1993, the trauma attending began staying inhouse in order to provide efficient, expedient care to the most critically injured trauma patients. This marked the birth of the first organized Trauma Service at MCCG. In October of 1998, the Medical Center became designated as a Level One Trauma Center. There are currently 8 trauma surgeons on service in addition to Dr. Ashley with a designated attending on call each night and weekends. The Trauma Service admits approximately 1500 trauma patients a year.
Description of the facility: MCCG is a tertiary-level referral hospital serving the residents of central and south Georgia. It's a licensed capacity is 637 beds, including medical-surgical, obstetric, pediatric, psychiatric, cardiac surgery intensive care. The Medical Center performs approximately 31,800 surgical procedures and 3,000 deliveries per year. It is the major provider of open-heart surgery procedures in the region and has more than 29,000 inpatient admissions and 400,000 outpatient visits per year.

Mission: To enhance the health status of those we serve in partnership with medical staff and community organizations by providing wellness services, health education and training, and access to safe, high quality health care. Vision: To be a national leader in providing the safest, highest quality community-centered health care and wellness services through our highly skilled, diverse, and valued workforce to meet the changing needs of those we serve. Values: We are a national healthcare leader committed to the following values:
Excellence: We continually strive to provide the highest quality Service at the lowest possible cost, with the best utilization of our resources. Integrity We act honestly and ethically in all relationships.
Diversity: We value and respect the uniqueness and dignity of all individuals. Service We responsibly anticipate the needs of our community and cooperatively work with our medical staff and community entities to provide a safe and seamless continuum of care.
Integrity: We act honestly and ethically in all relationships.
Compassion: We respond through a caring environment to the holistic needs of those we serve.

Medical College of Georgia Health System

Trauma in Georgia 53

Address: 1120 15th Street Augusta, GA 30809

Mission: To Care, To Serve, To Educate, To Discover

Main Hospital Telephone #: 706-721-0211
Website Address: MCGHealth.org
Trauma Medical Director: Michael L. Hawkins, MD, FACS Director: Trauma/Critical Care Service Professor of Surgery, Anesthesiology and Emergency Medicine
Trauma Coordinator: Regina S. Medeiros, RN, MHSA, CCRN
Trauma Registrars: Sandra Lowe Melissa Brown
Highlights of Trauma Program: MCG Health System's trauma team specializes in the treatment of traumatic, critical care injuries 24-hours a day, seven days a week. Designated in 1981 as Georgia's first Level I trauma center, MCG also houses a pediatric trauma center located in the Children's Medical Center. The physicians and nurses in the trauma center serve a 13-county region including Augusta. With the recent addition of helicopter transport, the center also treats trauma patients beyond the 13-counties. The trauma center coordinates care for more than 1,500 trauma victims each year by following them through their hospital stay and coordinating their care after leaving MCG. The center includes a 12-bed shock/trauma intensive care unit and a specialized trauma resuscitation area within the emergency department. The specialized team includes a trauma nurse coordinator, trauma clinical nurse specialist, trauma registrar and one of the most highly trained physician teams in the Southeast. The interdisciplinary team also includes many other health care professionals from pastoral care to pharmacy services. The goal is to provide comprehensive care to ensure the best possible outcomes for trauma victims and their families.

Vision: To achieve excellence in compassionate patient care, life-long learning, dedicated public service and leading edge research.
Values: We are committed to the following values:
Respect Service Communication Quality Collaboration Cost Efficiency
Description of facility: MCG Health System is composed of three separate organizations -- MCG Health, Inc. and the clinical services offered by the faculty employees of the Medical College of Georgia and the members of the Physicians Practice Group. The physicians of MCG Health System are community physicians and faculty employees of the Medical College of Georgia and the Physicians Practice Group, not employees of MCG Health Inc. MCG Health, Inc. is a not-for-profit corporation operating the MCG Medical Center, MCG Children's Medical Center, the MCG Sports Medicine Center, MCG Ambulatory Care Center, the Georgia Radiation Therapy Center and related clinical facilities and services. MCG Health, Inc. was formed to support the research and education mission of the Medical College of Georgia and to build the economic growth of the CSRA, the state of Georgia and the Southeast by providing an environment for faculty employees of the Medical College of Georgia and the Physicians Practice Group and community physicians to deliver the highest level of primary and specialty health care. For more information, please visit www.MCGHealth.org.

Memorial Health University Medical Center

Trauma in Georgia 54

Memorial Health 4700 Waters Avenue Savannah, GA 31404 (912) 350-8000
Trauma Medical Director M. Gage Ochsner, MD, FACS
Trauma Services Manager Daisy Gantt, RN, MS

Mission: We help people feel better.
Vision: We will be the healthcare partner of choice, empowering people to achieve physical, emotional, and spiritual well-being.
Values: Trust, Respect, World-Class, Enjoyment, My Memorial

Trauma Registrar Kim Clark
Highlights of Trauma Program: Memorial Health University Medical Center has been a designated Level I Trauma Center since 1980. There are five physicians who have been specially trained in trauma surgery and surgical critical care who provide 24/7 coverage. Each of these physicians has membership in numerous national trauma associations and is often sought out for their expertise in the care of the injured patient. Additionally, Memorial Health operates MedStarOne, a ground ambulance service serving the majority of Chatham County and LifeStarOne, emergency helicopter service. The Trauma Services Department consists of Trauma Department Manager, Trauma Nurse Coordinator, Social Worker, Registrar and Administrative Coordinator. The Department is involved in community injury prevention programs within Chatham County.

Description of facility: Memorial Health University Medical Center opened in October 1955 as a 300 bed general hospital dedicated in honor of the nation's war dead. MHUMC has grown into a two-state corporation, including 530 licensed beds in the medical center providing tertiary care for residents in 35 counties in southeast Georgia and southern South Carolina. MHUMC is a regional referral center for cancer care, trauma, rehabilitation, high-risk obstetrics, neonatology, pediatrics and cardiac care. Memorial Health has a strong relationship with Mercer University School of Medicine providing medical rotations to junior and senior medical school students. Memorial Health also has a General Surgery residency program with 3 residents at each year level for a total of 15 residents. Residents from Eisenhower Army Medical Center at Fort Gordon rotate through the facility for training in trauma and surgical critical care.

North Fulton Regional Hospital

Trauma in Georgia 55

North Fulton Regional Hospital 3000 Hospital Blvd Roswell, GA 30076 (770) 751-2500 (770) 751-2912 www.northfultonregional.com

Mission: "North Fulton Regional Hospital, in partnership with our medical staff, will provide quality, cost effective healthcare to our patients in a kind, caring, and respectful environment."

Trauma Medical Director John Harvey, M.D.
Trauma Coordinator Judy McDaniel, RN

Vision: Our Commitment to Quality consists of a comprehensive set of initiatives that address issues surrounding patient safety and reporting, physician excellence, nursing excellence and patient throughput.

Values: NFRH's core values are an organizational focus on: Service, Quality, People, Growth and Cost.

Highlights of Trauma Program: North Fulton Regional Hospital is a designated Level II Trauma Center. This designation was first obtained in the mid 80's. North Fulton meets the standards set forth by the State of Georgia and in many instances exceeds these standards. They take pride in serving their community.

Description of facility: North Fulton Regional Hospital (NFRH), opened in 1983, is a 167-bed, acute-care community hospital located on Highway 9 (Alpharetta Highway) in Roswell, Georgia. NFRH serves North Fulton and surrounding counties through its team of over 1000 employees, 450 affiliated physicians and 250 volunteers. North Fulton Regional Hospital is proud to be celebrating its twenty-year anniversary serving North Georgia. More information on services offered at North Fulton Regional Hospital can be found at www.northfultonregional.com

The Medical Center Columbus

Trauma in Georgia 56

710 Center Street Columbus, Georgia 31901 (706) 571-1000
columbusregional.org
Trauma Medical Director R. Scott Hannay, MD Trauma Coordinator Cathy Maxwell, RN, CCRN Trauma Registrar Imogene Willis
Highlights of Trauma Program: Located in West Central Georgia, The Medical Center is the only state designated trauma center within a 90 mile radius. The Trauma Program provides care to trauma patients from 19 counties in Georgia and Alabama and is dedicated to excellence in care for all patient. 6 trauma surgeons from a single practice (Surgical Associates) direct care on the trauma service and provide oversight to residents. The Trauma Program also strives to serve the community through education, outreach and injury prevention activities.

Mission: Columbus Regional will be the region's leader in providing quality health-care services, caring for those we serve compassionately and with respect for their needs, dignity and the quality of their lives. Vision: We envision serving a community and region where the people are strong and healthy. We envision a health-care system focused solely and completely on excellence, care and compassion. We will build a workforce, manage our resources and develop collaborative relationships in our community to ensure this vision is realized. Values: We value life and we value people. We strive for excellence in all we do. We are ethical, professional and dedicated to serving our community and our region. We value diversity, innovation and creativity in our employees.
Description of facility: The Medical Center offers highly specialized acute care services, many of which are available nowhere else in the region. These include the John B. Amos Cancer Center, the region's only advanced maternity services and neonatal intensive care unit, a dedicated pediatric service and pediatric intensive care unit and a dedicated trauma center and highly regarded emergency services for children and adults.

Trauma in Georgia 57 APPENDIX A: GEORGIA 2003 TRAUMA STATISTICAL TABLES

Table 1, Summary of Georgia Designated Trauma Centers

Trauma Center (Listed Alphabetically) Archbold Memorial Hospital Atlanta Medical Center Children's Healthcare of Atlanta Egleston Children's Healthcare of Atlanta Scottish Rite DeKalb Medical Center Floyd Medical Center Grady Memorial Health Gwinnett Medical Center Hamilton Medical Center Medical Center of Central Georgia Medical College of Georgia Memorial Health University Medical Center N. Fulton Regional Hospital The Medical Center Columbus TOTALS

Level of Designation
2 2 2 Pediatric 2 Pediatric 3 2 1 2 2 1 1 1 2 2

Regular Beds 224 460 0 0 525 252 1000 175 244 637 632 435 167 413 5164

ICU Beds
14 36 21 21 32 24 80 20 18 54 104 60 28 32 544

Pediatric Beds 0 0 235 181 0 28 56 8 20
32, ICU-12 60
51, ICU-10 0 35
728

Table 2, Summary of Georgia Acute Care Hospitals by Size

Georgia Acute Care Hospitals By Size

Bed Size Range 0 - 49 50 - 99
100 - 199 200 - 299 300 - 399
400+ Total

Hospitals 47 39 28 12 9 17 152

Licensed Beds 1558 2869 3981 3027 2993 8949 23377

Trauma in Georgia 58 Table 3, Summary of Trauma Registry Records by Center

Alphabetic List by Name Level Designation

1

Archbold MC 2

2

Atlanta MC 2

3

Columbus MC 2

4

Dekalb MC 3

5

Egleston - P2

6

Floyd 2

7

Grady 1

8

Gwinnett MC 2

9

Hamilton 2

10 MCCG 1

11 MCG 1

12 Memorial 1

13 N. Fulton MC 2

14 Scottish Rite - P2

Total

Number of Trauma Registry
Records (n = ) 242 918 578 392 495 356 2124 573 178 875 679 1069 469 664 9612

Percent
2.5 9.6 6.0 4.1 5.1 3.7 22.1 6.0 1.9 9.1 7.1 11.1 4.9 6.9 100.0

Table 4, Georgia Trauma Registry Records Ordered by Patient Counts

Ranked by Patient Counts Grady 1 Memorial - 1 Atlanta MC - 2 MCCG 1 MCG 1 Scottish Rite - P2 Columbus - 2 Gwinnett MC - 2 Egleston - P2 N. Fulton - 2 Dekalb MC - 3 Floyd 2 Archbold - 2 Hamilton - 2 Total

Frequency 2124 1069 918 875 679 664 578 573 495 469 392 356 242 178 9612

Percent 22.1 11.1 9.6 9.1 7.1 6.9 6.0 6.0 5.1 4.9 4.1 3.7 2.5 1.9
100.0

Cumulative Percent 22.1 33.2 42.8 51.9 58.9 65.8 71.9 77.8 83.0 87.8 91.9 95.6 98.1
100.0

Trauma in Georgia 59

Table 5, Georgia Trauma Registry Records Bar Chart

Frequency

Trauma C enter N ame

2,500

2,000

1,500

1,000

500

0

Grady

-

1MemoriaAl -tla1nta

MCCG Med Ctr

-

MCG 1
2

-

1 Sc otti sh

RCiotelu-mPb2uGs

w- i2nnettEMgCles-t2onN- .PF2ultonD-e2kalb

Floyd MC - 3

-

2ArchboldH- a2milton

-

2

Trauma Center Name

Table 6, 2003 Patient Gender

Trauma in Georgia 60

Female Male Uncoded Total

Frequency 3056 6553 3 9612

Percent 31.8 68.2 .0
100.0

Cumulative Percent 31.8
100.0 100.0

Table 7, 2003 Patient Gender Bar Chart

Frequency

7,000 6,000 5,000 4,000 3,000 2,000 1,000
0

Gender

Female

Male
Gender

Uncoded

Trauma in Georgia 61

Table 8, Trauma Patient Ethnic Representation

Asian African American Hispanic/Latino American Indian Other Not Reported Caucasian Not Available Total29

Frequency 70
3274 801 7 139 9
5174 138
9612

Percent .7
34.1 8.3 .1 1.4 .1
53.8 1.4
100.0

Cumulative Percent .7 34.8 43.1 43.2 44.6 44.7 98.6 100.0

Table 9, Trauma Patient Ethnic Representation Bar Chart

Frequency

6,000 5,000 4,000 3,000 2,000 1,000
0

Ethnicity

Asian

African

AmericHanispanic/LatinAomerican

Other Indian

Not Reported Caucasian

Not Available

Ethnicity

29 Not Available and Not Recorded are standard default options in the NTRACS database for the data element, Race.

Trauma in Georgia 62

Table 10, Georgia Trauma Center Patients by NTDB Age Groups

A. < 1 B. 1 - 4 C. 5 - 9 D. 10 - 14 E. 15 - 19 F. 20 - 24 G. 25 - 34 H. 35 - 44 I. 45 - 54 J. 55 - 64 K. 65 - 74 L. 75 - 84 M. 85 - 89 N. 90 > Total

Number (n = ) 275 486 554 529 896 1032 1623 1477 1146 686 396 369 95 48 9612

Percent 2.9 5.1 5.8 5.5 9.3
10.7 16.9 15.4 11.9
7.1 4.1 3.8 1.0
.5 100.0

Cumulative Percent 2.9 7.9 13.7 19.2 28.5 39.2 56.1 71.5 83.4 90.6 94.7 98.5 99.5 100.0

Table 11, Georgia Trauma Center Patients by NTDB Age Groups Bar Chart

Frequency

2 ,0 0 0

NTD B A ge Groups

1 ,5 0 0

1 ,0 0 0

500

0

A. < 1 B. 1 - C . 5 - D. 10 - E. 15 - F . 20 - G. 25 - H . 35 - I. 45 - J. 55 - K. 65 - L. 75 M . 85 - N. 90

4

9

14

19

24

34

44

54

64

74

-84

89

>

NTDB Age Groups

Trauma in Georgia 63

Table 12, Georgia Trauma Patient Age Descriptive Statistics

N

Valid

Missing

Mean

Std. Error of Mean

Median

Mode

Std. Deviation

Variance

Skewness

Std. Error of Skewness

Kurtosis

Std. Error of Kurtosis

Range

Minimum

Maximum

9497 115
34.297 .2162
31.600 .0
21.0737 444.099
.543 .025 -.274 .050 103.3
.0 103.3

Count

1,500
1,000
500
0 A. < B. 1 -C. 5 - D. 10E. 15F. 20G. 25H. 35 I. 45 J. 55 K. 65 L. 75 M. 85N. 90 1 4 9 - 14 - 19 - 24 - 34 - 44 - 54 - 64 - 74 -84 - 89 >
NTDB Age Groups

Table 13, Georgia Trauma Patients Represented by NTDB Age Groups, Sorted by Frequency of Presentation

Ranked Order G. 25 - 34 H. 35 - 44 I. 45 - 54 F. 20 - 24 E. 15 - 19 J. 55 - 64 C. 5 - 9 D. 10 - 14 B. 1 - 4 K. 65 - 74 L. 75 -84 A. < 1 M. 85 - 89 N. 90 > Total

Frequency 1623 1477 1146 1032 896 686 554 529 486 396 369 275 95 48 9612

Percent 16.9 15.4 11.9 10.7 9.3 7.1 5.8 5.5 5.1 4.1 3.8 2.9 1.0 .5
100.0

Cumulative Percent 16.9 32.3 44.2 54.9 64.2 71.4 77.1 82.6 87.7 91.8 95.7 98.5 99.5
100.0

Trauma in Georgia 64

Table 14, Georgia New Driver Trauma Patient Representation

A. 0 - 15.4 (Not of Age/Passengers)
B. 15.5 - 18 New Drivers Group (See related crosstabulations)
C. 19 - 21 (See related crosstabulations)
D. 22 64
E. 65 >
Total

Number (n = )
1906

Percent 19.8

631

6.6

634
5533 908
9612

6.6
57.6 9.4
100.0

Table 15, New Drivers * Riding Position Crosstabulation

(Extracted from variable crosstabulations)

B. 15.5 - 18 (New Drivers)

Count
% within Riding Position % of Total Trauma (n/9612)

Motorcycle Driver 18
4.2%
.2%

Motorcycle Passenger
3
6.0%
.0%

Motorvehicle Driver 226
8.7%
2.4%

Motorvehicle Passenger
144
12.1%
1.5%

C. 19 - 21

Count
% within Riding Position % of Total Trauma (n/9612)

22 5.1%
.2%

3 6.0%
.0%

222 8.5% 2.3%

90 7.6%
.9%

Trauma in Georgia 65

Table 16, Ethnicity * Gender Cross tabulation

Ethnicity

Asian
African American Hispanic/Latino
American Indian Other
Not Reported
Caucasian
Not Available

Count
% within Ethnicity % within Gender % of Total
Count
% within Ethnicity % within Gender % of Total
Count
% within Ethnicity % within Gender % of Total
Count
% within Ethnicity % within Gender % of Total
Count
% within Ethnicity % within Gender % of Total
Count
% within Ethnicity % within Gender % of Total
Count
% within Ethnicity % within Gender % of Total
Count
% within Ethnicity % within Gender % of Total

Female 37
52.9%
1.2% .4% 870
26.6%
28.5% 9.1% 150
18.7%
4.9% 1.6%
6 85.7%
.2% .1%
39 28.1%
1.3% .4% 3
33.3%
.1% .0% 1893 36.6%
61.9% 19.7%
58 42.0%
1.9% .6%

Gender Male 33
47.1%

Uncoded 0
.0%

.5%

.0%

.3%

.0%

2404

0

73.4%

.0%

36.7%

.0%

25.0%

.0%

651

0

81.3%

.0%

9.9%

.0%

6.8%

.0%

1

0

14.3%

.0%

.0%

.0%

.0%

.0%

100

0

71.9%

.0%

1.5%

.0%

1.0%

.0%

6

0

66.7%

.0%

.1%

.0%

.1%

.0%

3281

0

63.4%

.0%

50.1% 34.1%
77 55.8%

.0% .0%
3 2.2%

1.2% .8%

100.0% .0%

Total 70
100.0%
.7% .7% 3274 100.0%
34.1% 34.1%
801 100.0%
8.3% 8.3%
7 100.0%
.1% .1% 139 100.0%
1.4% 1.4%
9 100.0%
.1% .1% 5174 100.0%
53.8% 53.8%
138 100.0%
1.4% 1.4%

Trauma in Georgia 66

Table 16, Ethnicity * Gender Cross tabulation

Total30

Count
% within Ethnicity % within Gender % of Total

Female 3056
31.8%
100.0% 31.8%

Gender Male 6553
68.2%

Uncoded 3
.0%

100.0% 68.2%

100.0% .0%

Total 9612
100.0%
100.0% 100.0%

Table 17, Gross Mechanism of Injury

Blunt Burn31 Not Available Penetrating Total

Frequency 8230 49 7 1326 9612

Percent 85.6 .5 .1 13.8 100.0

Cumulative Percent 85.6 86.1 86.2 100.0

30 Not Available and Not Recorded are standard default options in the NTRACS database for the data
element, Race. 31 In general, the Georgia Trauma Registry does not track burn patients.

Trauma in Georgia 67 Table 18, Gross Mechanism of Injury Bar Chart

Frequency

1 0,00 0 8,0 0 0 6,0 0 0 4,00 0 2,00 0 0

G ro s s M ec h a n is m o f In ju ry

B lu n t

P e n etr a tin g

B u rn

G ro s s M e c h a n is m o f In ju ry

N o t A v ai la b le

Trauma in Georgia 68

Table 19, Mechanisms of Injury - Alphabetical

Alphabetical Listing Abuse Accident Aircraft Animal Assault ATV Bicycle Burn Electrical Fall Fight/Brawl GSW Hanging Machine Motorcycle MVC Not Available Not Recorded Pedestrian Rape Sports Stab Wound Struck Total

Frequency 49 387 4 90 407 193 168 47 4
1976 18 819 9 80 580
3654 48 1 540 5 112 276 145
9612

Percent .5 4.0 .0 .9 4.2 2.0 1.7 .5 .0
20.6 .2 8.5 .1 .8 6.0
38.0 .5 .0 5.6 .1 1.2 2.9 1.5
100.0

Cumulative Percent .5 4.5 4.6 5.5 9.7 11.8 13.5 14.0 14.0 34.6 34.8 43.3 43.4 44.2 50.3 88.3 88.8 88.8 94.4 94.5 95.6 98.5 100.0

P a ti e n t s b y M e c h a n i s m o f In ju r y P a tie n ts b y M e c h a n is m o f In ju ry

Trauma in Georgia 69 Table 20, Bar Chart of Patients by Mechanism of Injury (Frequency)

Not Recorded Electrical Aircraft Rape Hanging Fight/Brawl Burn Not Available Abuse Machine Animal Sports Struck Bicycle ATV Stab Wound Accident Assault Pedestrian Motorcycle GSW Fall MVC

4 ,0 0 0 3 ,0 0 0 2 ,0 0 0 1 ,0 0 0
0

Frequency

Trauma in Georgia 70

Table 21, NTDB Age Group * Selected Mechanisms of Injury Vehicles

NTDB Age Groups

A. < 1

Count

B. 1 - 4 C. 5 - 9 D. 10 - 14 E. 15 - 19 F. 20 - 24 G. 25 - 34 H. 35 - 44 I. 45 - 54

% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count

ATV Bicycle Motorcycle

3

0

15

1.6%

.0%

.0%

.0%

15

12

7.8%

7.1%

.2%

.1%

20

42

10.4% 25.0%

.2%

.4%

42

46

21.8% 27.4%

.4%

.5%

36

16

18.7%

9.5%

.4%

.2%

12

4

6.2%

2.4%

.1%

.0%

39

9

20.2%

5.4%

.4%

.1%

14

10

7.3%

6.0%

.1%

.1%

8

16

2.6%
.2% 3
.5%
.0% 15
2.6%
.2% 21
3.6%
.2% 44
7.6%
.5% 76
13.1%
.8% 156
26.9%
1.6% 125
21.6%
1.3% 74

MVC 70
1.9%
.7% 89
2.4%
.9% 116
3.2%
1.2% 97
2.7%
1.0% 488
13.4%
5.1% 485
13.3%
5.0% 643
17.6%
6.7% 542
14.8%
5.6% 450

Trauma in Georgia 71

Table 21, NTDB Age Group * Selected Mechanisms of Injury Vehicles

Total

J. 55 - 64 K. 65 - 74 L. 75 -84 M. 85 - 89 N. 90 >

% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total

ATV Bicycle Motorcycle

4.1%

9.5%

12.8%

.1%

.2%

.8%

3

11

29

1.6%

6.5%

5.0%

.0%

.1%

.3%

1

2

13

.5%

1.2%

2.2%

.0%

.0%

.1%

0

0

7

.0%

.0%

1.2%

.0%

.0%

.1%

0

0

1

.0%

.0%

.2%

.0%

.0%

.0%

0

0

1

.0%

.0%

.2%

.0%

.0%

.0%

193

168

580

100.0% 100.0%

100.0%

2.0%

1.7%

6.0%

MVC 12.3%
4.7% 299
8.2%
3.1% 188
5.1%
2.0% 151
4.1%
1.6% 23
.6%
.2% 13
.4%
.1% 3654
100.0%
38.0%

Trauma in Georgia 72

Table 22, NTDB Age Group * Selected Mechanisms of Injury - Violence

NTDB A. < 1 Age Groups
B. 1 - 4
C. 5 - 9
D. 10 - 14
E. 15 - 19
F. 20 - 24
G. 25 - 34
H. 35 - 44

Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury

Fight

Stab

Abuse Assault Brawl GSW Rape Wound

30

7

0 24

0

4

61.2% 1.7% .0% 2.9% .0% 1.4%

.3% 17
34.7%
.2% 0
.0%
.0% 0

.1% .0% .2% .0%

0

1

4

1

.0%

5.6%

.5%

20.0 %

.0% .0% .0% .0%

1

0

9

2

.2%

.0% 1.1%

40.0 %

.0% .0% .1% .0%

3

2 12

0

.0% 4
1.4%
.0% 1
.4%
.0% 4

.0%

.7% 11.1% 1.5% .0% 1.4%

.0%

.0% .0% .1% .0%

.0%

0

22

6 97

1

16

.0%

5.4% 33.3%

11.8 %

20.0 %

5.8%

.0%

.2% .1% 1.0% .0%

.2%

0

33

0 198

0

46

.0%

8.1%

.0%

24.2 %

.0%

16.7%

.0%

.3% .0% 2.1% .0%

.5%

0

83

3 231

0

93

.0%

20.4% 16.7%

28.2 %

.0%

33.7%

.0%

.9% .0% 2.4% .0% 1.0%

0

128

4 131

1

60

.0%

31.4% 22.2%

16.0 %

20.0 %

21.7%

Trauma in Georgia 73

Table 22, NTDB Age Group * Selected Mechanisms of Injury - Violence

Total

I. 45 - 54 J. 55 - 64 K. 65 - 74 L. 75 -84 M. 85 - 89 N. 90 >

% of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total
Count
% within Patients by Mechanism of Injury % of Total

Abuse .0% 0

Assault 1.3% 94

Fight Brawl
.0%
2

GSW 1.4%
67

Rape .0% 0

Stab Wound
.6%
34

.0% 23.1% 11.1% 8.2% .0% 12.3%

.0% 1.0% .0% .7% .0%

.4%

0

21

0 24

0

6

.0% 5.2% .0% 2.9% .0% 2.2%

.0%

.2% .0% .2% .0%

.1%

0

8

0

9

0

8

.0% 2.0% .0% 1.1% .0% 2.9%

.0%

.1% .0% .1% .0%

.1%

1

4

0 11

0

0

2.0% 1.0% .0% 1.3% .0%

.0%

.0%

.0% .0% .1% .0%

.0%

0

3

0

2

0

0

.0%

.7% .0% .2% .0%

.0%

.0%

.0% .0% .0% .0%

.0%

1

0

0

0

0

0

2.0%

.0% .0% .0% .0%

.0%

.0%

.0% .0% .0% .0%

.0%

49

407

18 819

5

276

100.0 %

100.0%

100.0 %

100. 0%

100. 0%

100.0%

.5% 4.2% .2% 8.5% .1% 2.9%

Trauma in Georgia 74

Table 23, Riding/Running/Position

Valid

Motorvehicle-D Motorvehicle-P Pedestrian Motorcycle-D Unspecified Pedal Cyclist Motorcycle-P Other Specified Rider-Animal N/A Total

Frequency 2599 1190 508 428 219 74 50 35 3 4506 9612

Percent 27.0 12.4 5.3 4.5 2.3 .8 .5 .4 .0 46.9 100.0

Cumulative Percent 73.9 86.3 91.6 96.0 98.3 99.1 99.6 100.0 100.0 46.9

Table 24, Riding/Running/Position Bar Chart

Frequency

5,000 4,000 3,000 2,000 1,000
0

R iding/R unning/P osition
Not AvailableMotorvehicleM-DotorvehicleP-Pedestrian Motorcycle-DUnspecified Pedal CyclisMt otorcycle-POther SpecifRieidder-Animal
R id in g/Ru n n in g/P o sition

Trauma in Georgia 75

Table 25, Where Injury Occurred

E-Code (Numerical Order) E849.5 - Street/Highway E849.9 - Unspecified Place
E 849.0 - Home E849.4 - Recreation & Sports Location E849.3 - Industrial Place E849.8 - Other Specified Place E849.6 - Public Building E849.7 - Residential E849.1 - Farm Total

Frequency Percent

5021

52.2

1881

19.6

1494

15.5

364

3.8

287

3.0

252

2.6

174 101 38 9612

1.8 1.1 .4 100.0

Cumulative Percent 52.2 71.8 87.3
91.1
94.1
96.7
98.6 99.6 100.0

Table 26, Where Injury Occurred Bar Chart

Frequency

6,0 0 0 5 ,0 0 0 4 ,0 00 3 ,0 0 0 2 ,0 00 1 ,0 0 0
0

W h ere Inju ry O ccu rred

E849.5

-

Street/EH8ig4h9.w9a-y

Uns

peEcif8ie4d9.P0l-acHeomeE849.4 -
W h ere In

E849.3 Recreation &

-

S

ju ry O

IpcnodrutcsstLEruoia8cl4aPr9l.ra8ce-eOdther

SEp8e49ci.f6ie-dPPulabcliceEB8u4il9d.i7ng-

Res

E849.1 idential

-

Farm

Trauma in Georgia 76

Table 27, ED Trauma Patient Volume by Month

Month JAN 2003 FEB 2003 MAR 2003 APR 2003 MAY 2003 JUN 2003 JUL 2003 AUG 2003 SEP 2003 OCT 2003 NOV 2003 DEC 2003 Total

Frequency 642 597 716 796 885 854 926 894 902 870 783 747 9612

Percent 6.7 6.2 7.5 8.3 9.2 8.9 9.6 9.3 9.4 9.0 8.1 7.8
100.0

Table 28, Transportation to ER

Ranked by Frequency
Ambulance Helicopter Walk in Other Police Not Available Not Recorded Total

Frequency 6961 1564 861 6 3 206 11 9612

Percent 72.4 16.3 9.0 .1 .0 2.1 .1 100.0

Cumulative Percent 72.4 88.7 97.6 100.0 100.0 99.8 99.9

Table 29, Transportation to ER Bar Chart

Trauma in Georgia 77

Frequency

7,000 6,000 5,000 4,000 3,000 2,000 1,000
0

Transportation to ER

Ambulance

Helicopter

W alk in

Not Available

Not Recorded Other

Police

Transportation to ER

Table 30, ED Disposition (SPSS Raw Output)

Death DOA (Death) Floor Home ICU Not Available OR Telemetry Transfer Total

Percent 2.6 0.4 36.8 2.2 31.2 0.8 22.2 1.5 2.3 100

Frequency 252 40 3540 214 3000 78 2130 141 217 9612

Trauma in Georgia 78

Table 31, Admitting Service Frequency & Percentage

A dm itting Service Frequency Percentage

B u rn

2

0.0%

C ardiology

1

0.0%

ENT

27

0.3%

Em ergency M edicine

234

2.4%

G en Surgery

265

2.8%

H and

14

0.1%

M edicine

105

1.1%

N euro

634

6.6%

N ot A vailable

282

2.9%

O phtha

35

0.4%

O rtho

1409

14.7%

O ther M ed

77

0.8%

O ther Surg

218

2.3%

Peds

105

1.1%

P la stic s

153

1.6%

T h o racic

5

0.1%

Traum a

6023

62.6%

U rology

14

0.1%

V ascular

9

0.1%

9612

100.0%

Table 32, ISS Range All Patients

ISS Range ISS 1 - 4 ISS 5 - 9 ISS 10 - 15 ISS 16 - 24 ISS >= 25 Not Done

Freqency 2394 2770 1465 1566 1264 153

Percentage 24.9% 28.8% 15.2% 16.3% 13.2% 1.6%

Table 33, ISS Range Adult Facilities Only

ISS Range ISS 1 - 4 ISS 5 - 9 ISS 10 - 15 ISS 16 - 24 ISS >= 25 Not Done

Frequency 1800 2419 1406 1483 1201 144

Percentage 21.29% 28.62% 16.63% 17.54% 14.21% 1.70%

Trauma in Georgia 79

Table 34, ISS Range Pediatric Facilities Only

ISS Range ISS 1 - 4 ISS 5 - 9 ISS 10 - 15 ISS 16 - 24 ISS >= 25 Not Done

Frequency 594 351 59 83 63 9

Percentage 51.25% 30.28% 5.09% 7.16% 5.44% 0.78%

Table 35, Average ISS, Days in ICU & LOS

Trauma in Georgia 80

14

12

10

8

6

4

2

0

Avg ISS Avg Days in Avg Hospital

ICU

LOS

All Adult Pediatric

Table 36, Top 5 Initial Medical Procedures

Procedure CAT Scan NEC CAT Scan Head Abdomen CAT Scan Abd & Retroperitoneal US Skin Closure NEC

Count 3292 2304 1685 1516 998

Trauma in Georgia 81

Table 37, Average Length of Stay by Admitting Service

(LOS in Days)

Medical Service Burn Cardiology ENT Emergency Medicine General Surgery Hand Maxillo/Facial Medicine Neurosurgery Not Available Ophthalmology Orthopedic Surgery Other Med Other Surg Pediatrics Plastics Thoracic Trauma Urology Vascular

Average LOS Days 21 1 4 0 7 4 12 5 6 1 2 4 11 9 4 3 8 9 2 5

Trauma in Georgia 82

Table 38, Average Length of Stay by Mechanisms of Injury

(LOS in Days)

Injury Mechanism ATV Abuse Accident Aircraft Animal Assault Bicycle Burn Electrical Fall Fight/Brawl GSW Hanging MVC Machine Motorcycle Not Available Not Recorded Pedestrian Rape Sports Stab Wound Struck

Average LOS Days 6 6 9 12 3 6 4 2 5 5 3 9 3 8 6 7 7 1 8 6 2 5 4

Trauma in Georgia 83

Table 39, Place of Injury vs. Gross Mechanism of Injury Adults

Total

Place of Injury

Count Blunt Penetrating Burn

E849.0 - Home

1077 761

289

27

E849.1 - Farm

33 32

1

0

E849.3 - Industrial Place

285 253

29

3

E849.4 - Place of Recreation and

Sports

190 183

7

0

E849.5 - Street & Hwy

4736 4600 134

2

E849.6 - Public Building

97 65

32

0

E849.7 - Residential Institution 100 82

18

0

E849.8 - Other Specified Place 232 165

64

3

E849.9 - Unspecified Place

1703 1010 677

14

Total 8453 7151 1251

49

Not Available
0 0 0
0 0 0 0 0 2 2

Table 40, Place of Injury vs. Gross Mechanism of Injury Pediatrics

Injury Site

Count Blunt Penetrating Burn

E849.0 Home

417 365

52

0

E849.1 Farm

5 5

0

0

E849.3 - Industrial Place

2 1

1

0

E849.4 - Place of Recreation and

Sports

174 168

5

0

E849.5 - Street & Hwy

286 286

0

0

E849.6 - Public Building

77 75

2

0

E849.7 - Residential Institution

1 1

0

0

E849.8 - Other Specified Place

20 19

1

0

E849.9 - Unspecified Place

177 160

13

0

Total 1159 1080

74

0

Not Available
0 0 0
1 0 0 0 0 4 5

Trauma in Georgia 84

Table 41, EMS Regional Summary Trauma Centers Treatments of Injury32

1

ATV

13

ABUSE

0

ACCIDENT

16

AIRCRAFT

0

ANIMAL

10

ASSAULT

6

BICYCLE

3

BURN

8

ELECTRICAL

1

FALL

133

FIGHT

2

GSW

30

HANGING

1

MVC

233

MACHINE

10

MCC

22

NOT

AVAILABLE

1

NOT RECORDED 0

PEDESTRIAN

19

RAPE

0

SPORTS

6

SW

7

STRUCK

14

TOTAL

535

23 0 79 0 40 0 267 01 0 52 0 268 0 126 03 01 0 1343 06 0 529 04 0 1762 0 53 0 393
0 12 01 0 350 02 0 83 0 168 0 92 0 5635

4 5 6 7 8 9 10 TOTAL

0 29 17 10 9 36 0

193

0010080

49

0 12 19 16 16 42 0

388

0110010

4

0 4 4 1 4 15 0

90

0 36 21 24 9 43 0

407

0 10 7 2 2 18 0

168

0 8 1 3 0 24 0

47

0100010

4

0 116 52 82 81 169 0

1976

0600220

18

0 69 53 55 9 73 0

818

0010030

9

0 421 392 292 83 472 0

3655

0627200

80

0 51 37 20 9 48 0

580

0 0 5 23 3 4 0

48

0000000

1

0 49 36 31 3 52 0

540

0001020

5

0831370

111

0 29 27 10 5 30 0

276

0 19 0 0 2 18 0

145

0 875 679 578 242 1068 0

9612

32 Note: Some EMS Regions do not have a designated trauma center within their geographies.

Trauma in Georgia 85
Table 42, Georgia Trauma Centers on a State Map with 10 EMS Regions
Shown left: Red circles indicate Level 1 centers, Yellow circles indicate Level 2 centers, the Green circle indicates the only Level 3 center, Violet circles indicate Level 2 Pediatric centers, and the Aqua dashed circles indicate the potential Level 4 centers.

Trauma in Georgia 86

Table 43, Examples of Injury Severity Scores (ISS)

ISS Range Example

1 - 4

1

Ankle sprain

Description

2

Cornea laceration, closed nose fracture, superficial scalp laceration

Superficial penetrating abdominal injury, superficial penetrating

thorax injury, superficial penetrating upper and lower extremity

3

injury

4

Cerebral concussion

5 -9

5 Tibia and fibula fracture, chest wall abrasion

Cerebral concussion, superficial facial laceration, closed nose

6

fracture, upper and lower extremity abrasion

Simple liver laceration, major neck laceration, major upper

8

extremity laceration

9

Open ulna fracture, closed radius fracture

10 - 15

10 Brachial plexus contusion, superficial face avulsion, scalp contusion, unknown length of unconsciousness with neurological deficit
11 Basilar fracture, cervical spine disc fracture without cord contusion, cornea contusion, facial abrasion, facial bone fracture, shoulder contusion, unconsciousness known to be less than 1 hour.

16 - 24 > or = 25

Closed nose fracture, closed orbit fracture, closed ulna fracture, talus fracture, chest wall contusion, contusion of abdomen skin, 12 unconsciousness known to be less than 1 hour.
Basilar fracture, compound vault fracture, subdural and 16 pneumocephalus hematoma of cerebrum 17 Unilateral lung contusion, cerebral concussion, hand fracture
Lower extremity amputation, open femur fracture, flail chest, 19 abrasions on the face and abdomen
Subdural cerebrum hematoma, lumbar spine fracture, rib fracture, 21 scalp laceration
Thoracic aorta injury, kidney laceration, liver laceration, closed 24 pelvis fracture, thoracic cavity injury with hemo/pneumothorax 25 Cerebrum hematoma, unilateral lung contusion
Diffuse axonal cerebrum injury, vault fracture, tibia shaft fracture, 30 superficial facial laceration
Massive destruction, crush injury of brain stem, massively depressed 75 vault fracture

Trauma in Georgia 87

Table 44, Trauma Deaths All Trauma Centers

Total

DOA's

40

ED Deaths

252

Deaths After Admission 476

Total

768

Not

Blunt Penetrating Burn Available

23

16

0

1

159

91

2

0

391

85

0

0

573

192

2

1

Table 45, Deaths Adult Trauma Centers Only

Total

DOA's

40

ED Deaths

246

Deaths After Admission 454

Total

740

Not

Blunt Penetrating Burn Available

23

16

0

1

153

91

2

0

370

84

0

0

546

191

2

1

Table 46, Deaths Pediatric Trauma Centers Only

Total

DOA's

0

ED Deaths

6

Deaths After Admission 22

Total

28

Blunt Penetrating Burn

0

0

0

6

0

0

21

1

0

27

1

0

Not Available
0 0 0 0

Trauma in Georgia 88

Table 47, Final Patient Disposition

Disposition DOA Death Home Home Health Incomplete Treatment/AMA Jail Nursing Home Rehab Transfer to Other Hospital Transfer to Other Trauma Center Not Available

Number of Patients 40 728 6836 109 53 108 189 956 465 119 9 9612

Table 48, Organ Donors vs. Trauma Deaths

768 800 700 600 500 400 300 200 100
0 Trauma Deaths

59 Organ Donors

Trauma in Georgia 89

Table 49, Organ Donors by Gender & Race Georgia Trauma Centers33

Gender Male Female Totals

Asian

Black 0 1 1

Hispanic Other

10

6

3

2

13

8

Not

White Available Total

2

23

1

42

0

10

1

17

2

33

2

59

33 Not Available is the NTRACS default option for the data element, Race.

Trauma in Georgia 90 APPENDIX B: GEORGIA DEMOGRAPHICS

Georgia Age Demographics: 2002-2003

Total Population: Sex & Age Male Female
Under 5 years 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 to 34 years 35 to 44 years 45 to 54 years 55 to 59 years 60 to 64 years 65 to 74 years 75 to 84 years 85 years and over
Median age(years)
18 years and over Male Female
21 years and over 62 years and over 65 years and over
Male Female

Number
8,186,453
4,027,113 4,159,340
595,150 615,584 607,759 596,277 592,196 1,299,256 1,353,508 1,079,992 375,651 285,805 435,695 261,723 87,857
33.4
6,017,219 2,915,524 3,101,695 5,646,535
948,821 785,275 311,231 474,044

Source: http://georgia.usl.myareaguide.com/census.html

Percent
100.0 %
49.2 % 50.8 %
7.3 % 7.5 % 7.4 % 7.3 % 7.2 % 15.9 % 16.5 % 13.2 % 4.6 % 3.5 % 5.3 % 3.2 % 1.1 %
N/A
73.5 % 35.6 % 37.9 % 69.0 % 11.6 % 9.6 % 3.8 % 5.8 %

Trauma in Georgia 91

Georgia Ethnic Demographics: 2002-2003

Race White Black or African American American Indian and Alaska Native Asian Native Hawaiian and Other Islander Some other race Hispanic or Latino

5,412,371 2,393,425
53,197 199,812
9,689 241,298 435,227

67.0 % 29.6 % 0.7 % 2.5 % 0.1 % 3.0 % 5.3 %

Source: http://georgia.usl.myareaguide.com/census.html

Georgia Household Demographics: 2002-2003

Total Population In households Householder Spouse
Child Own child under 18 years
Other relatives Under 18 years
Non-relatives Unmarried partner
In group quarters Institutionalized population Non-institutionalized population
Source: http://georgia.usl.myareaguide.com/census.html

8,186,453 7,952,631 3,006,369 1,548,800 2,439,098 1,899,303
522,651 218,208 435,713 145,743 233,822 126,023 107,799

100.0 % 97.1 % 36.7 % 18.9 % 29.8 % 23.2 % 6.4 % 2.7 % 5.3 % 1.8 % 2.9 % 1.5 % 1.3 %

Trauma in Georgia 92 APPENDIX C: STATE OFFICE OF EMS/TRAUMA CONTACTS34

Name and Title David Bean, EMS Director
Ej Dailey Deputy EMS Director
James P. O'Neal, MD EMS Medical Director
Fred Grant Operations Analysis Manger

Address 2 Peachtree Street NW Suite 13.202 Atlanta, Georgia 30303 2600 Skyland Drive Lower Level Atlanta, Georgia 30319 2 Peachtree Street NW Suite 13.203 Atlanta, Georgia 30303 2600 Skyland Drive Lower Level Atlanta, Georgia 30319

Renee Morgan Trauma Program Manager

2 Peachtree Street NW Suite 13.205 Atlanta, Georgia 30303

Marie Probst Trauma Consultant
Jennifer Benoskie Budget /Contract Specialist

2600 Skyland Drive Lower Level Atlanta, Georgia 30319 2600 Skyland Drive Lower Level Atlanta, Georgia 30319

Rhonda Griffin Executive Secretary

2 Peachtree Street NW Suite 13.204 Atlanta, Georgia 30303

Contact Information
rdbean@gdph.state.ga.us O: 404-657-2596 F: 404-651-8036
ejdailey@gdph.state.ga.us O: 404-679-0547 F: 404-679-0526 jponeal@gdph.state.ga.us O: 404-463-0799 F: 404-651-8036 fjgrant@gdph.state.ga.us O: 404-679-0521 F: 404-679-0526
rwmorgan@gdph.state.ga.us O: 404-657-6717 F: 404-651-8036
mprobst@gdph.state.ga.us O: 404-679-0524 F: 404-679-0526 jlbenoskie@gdph.state.ga.us O: 404-679-0527 F: 404-679-0526
rlgriffin@gdph.state.ga.us O: 404-657-2594 F: 404-651-8036

34 Appendixes C, D, E, F, and G are current as of September 2004.

Trauma in Georgia 93 APPENDIX D: STATE TRAUMA CENTER CONTACTS

Trauma Center

Trauma Coordinator

Trauma Registrar

Archbold Memorial Hospital Gordon Avenue at Mimosa PO Box 1018 Thomasville, Ga 31792
Atlanta Medical Center 303 Parkway Drive, NE Box, 408 Atlanta, Ga 30312
Children's Healthcare of Atlanta at Egleston 1405 Clifton Road, NE Atlanta, Ga 30322
Children's Healthcare of Atlanta at Scottish Rite 1001 Johnson Ferry Road Atlanta, Ga 30342

Kelli Vaughn kvaughn@archbold.org O: 229-228-8087 P: 229-225-0685 F: 229-228-8390 Rochella Mood rochella.mood@tenethealth.com O: 404-265-6577 P: 404-866-4940 F: 404-265-3954 Mary Shepherd mary.shepherd@choa.org O: 404-785-6530 P: 404-225-3633 F: 404-785-1495 Teresa Fox-Paone Teresa.Fox-Paone@choa.org O: 404-785-4955 P: 404-225-0246 F: 404-785-4942

Dana Burrell dana.burrell@choa.org
O: 404-785-1921
Pamela Jones-Jackson pamela.jonesjackson@choa.org O: 404-785-4956

Columbus Regional Medical Center 710 Center Street Columbus, Ga 31902

Cathy Maxwell cathy.maxwell@crhs.net O: 706-571-1225 P: 706-320-1542 F: 706-571-1744

Imogene Willis Imogene.willis@crhs.net O: 706-571-1524

DeKalb Medical Center 2701 N Decatur Road Decatur, Ga 30033

Kelly Nadeau knadeau@dkmc.org O: 404-501-5651 P: 404-837-6069 F: 404-501-1631

Karen Johnson
Johnson_Karen@dkmc.org
O: 404-501-5663

Floyd Medical Center 304 McCall Blvd Rome, Ga 30162

Tifani Kinard tkinard@floyd.org O: 706-509-6135 P: 770-773-1244 F: 706-292-4747

Cindy Holman
cholman@floyd.org
O: 706-509-6135 F: 706-509-4750

Trauma in Georgia 94

Trauma Center

Trauma Coordinator

Grady Memorial Hospital 80 Jessie Hill Jr. Drive, SE Atlanta, Ga 30335

Fran Lewis FLEWIS@gmh.edu O: 404-616-4584 P: 404-619-3457
F: 404-616-7333

Gwinnett Medical Center 1000 Medical Center Blvd Lawrenceville, Ga 30045
Hamilton Medical Center 1200 Memorial Drive PO Box 1168 Dalton, Ga 30722 Medical Center of Central GA 777 Hemlock Street, Box 103 Macon, Ga 31201
Medical College of GA Health System 1120 15th Street, Room BA 4411 Augusta, Ga 30912

Deb Battle dbattle@ghsnet.org O: 678-442-3742 P: 404-743-3133 F: 678-442-3282 Randy Casteel rcasteel@hhcs.org O: 706-272-6154 F: 706-272-6557 Debra Kitchens Kitchens.debra@mccg.org O: 478-633-1584 P: 478-326-7634 F: 478-633-6195 Regina Medeiros rmedeiro@mail.mcg.edu O: 706-721-3153 P: 706-721-7243, # 1155 F: 706-721-6271

Memorial Health University Medical Center 4700 Waters Avenue PO Box 23089 Savannah, Ga 31404 North Fulton Regional Hospital 3000 Hospital Blvd Roswell, Ga 30075

Trauma CNS Brendell Collins, RN O: 706-721-3153 Daisy Gantt Trauma Program Manager O: 912-350-5902 F: 912-350-3122
Judy McDaniel
Judy.mcdaniel@tenethealth.com
O: 770-751-2758 P: 770-388-5367 F: 770-410-4209

Trauma Registrar
Mary Lou Dennis mldennis@ghsnet.org O: 678-442-3291 F: 678-442-3282
Byron Wynkoop bwynkoop@hhcs.org O:706-272-6154 F:706-272-6648 BJ Norris at Medical
Norris.Brenda@mccg.org
O: 478-633-6194
P: 478-633-3487
Melissa Brown
mebrown@mail.mcg.edu
O: 706-721-3153
Sandra Lowe slowe@mail.mcg.edu O: 706-721-3153

Trauma in Georgia 95 APPENDIX E: GEORGIA REGIONAL EMS OFFICES

Regional Emergency Medical Services Offices

Name and Title

Address

Contact Information

Region 1 David Loftin EMS Program Director
James Cutcher EMS Training Coordinator

Northwest Georgia Region 1 EMS Northwest Georgia Regional Hospital 1305 Redmond Circle Bldg 614 Rome, Georgia 30165-1391

cdloftin@gdph.state.ga.us jlcutcher@gdph.state.ga.us O: 706-295-6175 F: 706-802-5292

Region 2

North Georgia Region 2 EMS

Earl McGrotha

1280 Athens Street

EMS Program Director Gainesville, Georgia 30507-7000

B. Jack Mundy EMS Training Coordinator

ehmcgrotha@gdph.state.ga.us bjmundy1@gdph.state.ga.us O: 770-535-5743 F: 770-535-5958

Region 3 Marty Billings EMS Program Director
Bill Harvey EMS Training Coordinator

Region 3 EMS 2600 Skyland Drive Upper Level Atlanta, Georgia 30319

wmbillings@gdph.state.ga.us harv100@aol.com O: 404-248-8995 F: 404-248-8948

Region 4 Billy Watson EMS Program Director
Russ McGee EMS Training Coordinator

West Georgia Region 4 EMS 122 Gordon Commercial Drive Suite A LaGrange, Georgia 30240-5740

brwatson@gdph.state.ga.us ramcgee@gdph.state.ga.us O: 706-845-4035 F: 706-845-4309

Region 5

Central Georgia Region 5 EMS

Chris W. Threlkeld 158-1 Sammons Industrial Pkwy

EMS Program Director Eatonton, Georgia 31024

Kristal Claxton EMS Training Coordinator

cwthrelkeld@gdph.state.ga.us oconeeemsc@yahoo.com O: 706-484-2993 F: 706-484-2994

Trauma in Georgia 96

Regional Emergency Medical Services Offices

Name and Title

Address

Contact Information

Region 6 Lawanna Mercer-Cobb EMS Program Director
Wes Simonds EMS Training Coordinator

East Central Georgia Region 6 EMS 1916 North Leg Road Augusta, Georgia 30309-4402

lmcobb@gdph.state.ga.us wgsimonds@gdph.state.ga.us O: 706-667-4336 F: 706-667-4594

Region 7 Sam R. Cunningham EMS Program Director
Darrell R. Enfinger EMS Training Coordinator

West Central Georgia Region 7 EMS 2100 Comer Avenue Post Office Box 2299 Columbus, Georgia 31902-2299

srcunningham@gdph.state.ga. us drenfinger@gdph.state.ga.us O: 706-321-6150 F: 706-321-6155

Region 8 Robert D. Vick EMS Program Director
Region 9 Shirley Starling Acting EMS Program Director

Southwest Georgia Region 8 EMS Post Office Box 3637 319 North Main Street Moultrie, Georgia 31776-3637 Southeast Georgia Region 9 EMS Post Office Box 1877 Brunswick, Georgia 31521

rdvick@dhr.state.ga.us O: 229-891-7034 F: 229-891-7031
sdstarling@gdph.state.ga.us O: 912-262-3035 F: 912-264-2504

Region 10

Northeast Georgia Region 10 EMS ehmcgrotha@gdph.state.ga.us

Earl McGrotha

1551 Jennings Mill Road

O: 706-583-2862

EMS Program Director Bogart, Georgia 30622-2565

F: 706-227-7960

Trauma in Georgia 97

APPENDIX F: TRAUMA SYSTEM DEVELOPMENT COMMITTEE

Trauma System Development Committee

Name
Dennis Ashley, MD Jennie Banks, RN Deb Battle, RN Ken Beverly
Chad Black, EMT-P Chris Bonham Phillip Coule, MD Robert Cox, MD
Sam Cunningham
Darrell Enfinger
Lance B. Duke Jane Garbish
William Hardcastle, MD
John Harvey, MD
Michael Hawkins, MD Gail Helmly, EMT-P, R
Vernon Henderson, MD Glen Henry
George Houlditch, MD Arthur Kellerman, MD
Zsolt Koppanyi, MD, MPH. Jeff Linzer, MD

Department or Title

Company

Trauma Medical

Director

Medical Center of Central Georgia

Trauma Coordinator Hamilton Medical Center

Trauma Coordinator Gwinnett Medical Center

CEO, Archbold

Georgia Hospital Association and

Memorial Hospital CEO at John D. Archbold

Memorial Hospital

Flight Paramedic

Emory Flight

Chief Executive Officer Morgan Memorial Hospital

Emergency Physician Medical College of Georgia

Emergency Physician Spalding Regional Hospital

West Central Georgia Region 7

EMS Program Director EMS

EMS Training

West Central Georgia Region 7

Coordinator

EMS

Columbus Regional Medical

Chief Executive Officer Center

First Responder

Trauma Medical

Director

DeKalb Medical Center

Trauma Medical

Director

North Fulton Regional Hospital

Trauma Medical

Director

Medical College of Georgia

Flight Nurse

Emory Flight

Trauma Medical

Director

Atlanta Medical Center

Transport Team

Children's Healthcare of Atlanta

Program Manager

EMS Regional

Medical Director

North Georgia Medical Center

Department of

Emory University

Emergency Medicine

District Health Director Georgia Division of Public Health

Emergency Pediatric Children's Healthcare of Atlanta at

Group

Egleston

Trauma in Georgia 98

Trauma System Development Committee

Name
Isiah Lineberry
Regina Medeiros, RN Dan Miears
Wendell Myers Gage Ochsner, MD
Stanley Payne Nancy Peed
William G. Pike Wayne Reece Grace Rozycki, MD
Doug Skelton, MD Kurt Stuenkel
Kelli Vaughn, RN Robert D. Vick Arthur Yancey, II, MD

Department or Title

Company

Rural and Critical Office of Rural Health

Access Hospital

Coordinator

Trauma Coordinator Medical College of Georgia

Regional Marketing Shepherd Center

Manager

Consumer Advocate

Trauma Medical

Memorial Health University

Director

Medical Center

Region I EMS Council Floyd Medical Center EMS

Administrator

Peach Regional Medical Center

Chief Operations

Officer

Rescue Air

Attorney at Law

Reece and Associates

Director of Trauma and Grady Memorial Hospital

Surgical Critical Care

District Health Director Georgia Division of Public Health

Chief Executive Officer Floyd Medical Center

John D. Archbold Memorial

Trauma Coordinator Hospital

EMS Program Director Southwest Georgia Region 8 EMS

Department of

Emory University School of

Emergency Medicine Medicine

Trauma in Georgia 99 APPENDIX G: MEDICAL REVIEW COMMITTEE

Name

Department or Title

Organization

Chad Black, EMT-P Flight Paramedic

Emory Flight

Vernon Henderson, MD Trauma Medical Director Atlanta Medical Center

Tifani Kinard, RN Trauma Coordinator

Floyd Medical Center

Natalie Lane, MD

Department of Emergency

Medicine

Medical College of Georgia

East Central Georgia Region 6 Lawanna Mercer-Cobb EMS Program Director EMS

Greg Patterson, MD Trauma Medical Director Archbold Memorial Hospital

Doug Skelton, MD District Health Director Georgia Division of Public Health

Chris Threlkeld

EMS Program Director Central Georgia Region 5 EMS

Larry Vandegriff

EMS Educator

Department of Emergency Emory University School of

Arthur Yancey, MD Medicine

Medicine

The Georgia Emergency Medical Services Information System (GEMSIS) is supported in part by grant H33 MC00125 from the Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. DPH 04.313H.
For additional information or copies of this publication, please write to: The Department of Human Resources Division of Public Health Office of Emergency Medical Services and Trauma Operations, Analysis, and Research Section 2600 Skyland Drive, Lower Level Atlanta, Georgia 30319