State Trauma Advisory Council Meeting
March 8, 2016
12:30-3:30 p.m.
Minnesota Department of Health
Shoreview Community Center, Shoreview
Minutes
Members Present
Aaron, Burnett, M.D.
Dan DeSmet
John Fossum
Ron Furnival, M.D.
Members Absent
Peter Cole, M.D.
MDH Staff
Chris Ballard
Cirrie Byrnes
Craig Henson, M.D.
John Hick, M.D.
Carol Immermann, R.N.
Alan Johnson, PA-C
Matt Langer, Colonel
Steven Lockman, M.D.
Sharon Moran, M.D.
Mark Paulson, M.D.
Robert Roach, M.D.
Gayle Williams, R.N.
Marty Forseth
Tim Held
Mark Kinde
Mark Schoenbaum
MDH Staff Absent
Tammy Peterson
Call to Order, Welcome and Introductions
Chairman Furnival called the meeting to order at 12:35 p.m. Dr. Furnival introduced and
welcomed new STAC members: Sharon Moran, M.D., from Essentia Health St. Mary’s Medical
Center in Duluth as the new Level 1 or 2 Trauma Surgeon; Craig Henson, M.D., from Lakewood
Health Systems in Staples as the new Rural General Surgeon; and Alan Johnson, PA-C, from RC
Hospital in Olivia as the new Rural Nurse Practitioner or Physician Assistant. Both State Trauma
Advisory Council (STAC) and audience members introduced themselves.
Approve Agenda and December 8, 2015 Minutes
Dr. Paulson moved to accept the agenda and the December minutes as printed. Dr. Burnett
seconded; the motion carried.
Oath of Office and Annual Conflict of Interest Acknowledgement
Mr. Ballard asked STAC members to sign and return their individual Oath of Office and Annual
Conflict of Interest forms.
Staff Reports
Mr. Held reported that neither of the trauma system’s two legislative initiatives—the change to
the Level 4 designation process and the change in eligibility for the STAC Pediatrician seat—have
met with any opposition to date. He also reported that the trauma system’s traditional funding
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sources are declining so funding is likely to become much tighter. Mr. Held then introduced
Marty Forseth, the new trauma designation coordinator.
Mr. Ballard reported that the Level 4 Work Group is still accepting volunteers for membership.
The work group will review the current Level 4 criteria and determine if it still represents a
reasonable balance between demands and resources, adding that the criteria haven’t been
reviewed since the inception of the system for ten years. He anticipates that the first meeting
will take place sometime in May with subsequent meetings occurring regularly for at least a year.
Mr. Ballard mentioned that the Trauma Program Manager 101 and MNTrauma 101 classes
planned for April have been cancelled due to the lack of funding. He encouraged stakeholders to
attend PI Forum, Part 1 on March 24, which is sponsored by the Southern Minnesota Regional
Trauma Advisory Committee (SMARTAC). He also mentioned that an RTAC Summit originally
scheduled for April will occur on June 6 as a cost-saving measure.
MHA Small Rural Hospital Subcommittee Meeting Report
Mr. Fossum reported that the subcommittee met on January 8 to discuss how the trauma
system is functioning in small and rural hospitals, particularly in terms of operations and cost. He
noted that some rural hospitals struggle to appreciate the value of the designation when
considering the resources needed. He also noted that some attendees gained a new
understanding of the association between the trauma system and the EMS Regulatory Board
(EMSRB), which are two distinct state agencies. Mr. Fossum also pointed out that distance and
travel times remain a significant issue for patients in the rural areas.
EMS Regulatory Board Update
Mr. Spector reported that the EMSRB’s Data Policy Standing Advisory Committee will soon be
discussing the statewide implementation plan for conversion from National Emergency Medical
Services Information System (NEMSIS) version 2.0 to version 3.0. Mr. Spector then highlighted
the recommendations of the Post-Transition Education Standards Work Group highlighting
Emergency Medical Responder education requirements. He also mentioned that the state’s eight
EMS regions must now file an audit with the EMSRB and that the portion of regions’ funding
from seatbelt fines has been declining because there are fewer convictions for the offense.
Applicant Review Committee Report
Mr. Ballard reported that Mayo Clinic Hospital Saint Mary’s Campus, Rochester and Mayo
Eugenio Litta Children’s Hospital, Rochester were re-verified as a Level 1 trauma center and Level
1 Pediatric trauma center, respectively, by the American College of Surgeons and will be
designated as such by the commissioner.
Mr. Ballard further reported that the Applicant Review Committee (ARC) recommends the
following hospitals for re-designation: Level 3—Avera Marshall Regional Medical Center; Level
4—CentraCare Health System-Monticello; District One Hospital, Faribault; Fairview Northland
Medical Center, Princeton; and Sanford Thief River Falls.
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Dr. Hick moved to recommend the designations noted above. Dr. Paulson recused himself from
voting on the Sanford Thief River Falls recommendation and Mr. DeSmet recused himself from the
Avera Marshall Regional Medical Center. Dr. Paulson then seconded the motion. The motion
carried unanimously.
Mr. Ballard then reported that the ARC recommends the extension of Riverwood Healthcare
Center, Aitken.
Dr. Hick moved to recommend the extension for the hospital noted above. Mr. DeSmet seconded;
the motion carried unanimously.
Mr. Ballard then referenced the Level 4 Post-Site Visit Reports that were distributed by email and
solicited comments from the STAC: Community Memorial Hospital, Cloquet; Ely-Bloomenson
Community Hospital; Essentia Health Ada; Granite Falls Hospital; Lake View Memorial Hospital,
Two Harbors; Mahnomen Health Center; Mercy Hospital, Moose Lake; Pipestone County Medical
Center; Ridgeview Emergency Department at Two Twelve Medical Center, Chaska; Sanford Tracy
Medical Center; Sanford Westbrook Medical Center; and Sleepy Eye Medical Center.
Re-designation Applications for Discussion
Ms. Immermann reviewed the duties of the Applicant Review Committee and reported that the
ARC evaluated the site visit reports from St. John’s Hospital, St. Josephs’ Hospital or Woodwinds
Hospital and noted three essential criteria continued to be outstanding issues over the course of
the last six years: 1) lack of surgeon response within the prescribed timeframe to the trauma
bay; 2) lack of participation by surgeons to admitted trauma patients as determined by lack of
surgeon documentation in patient records; and 3) lack of loop closure on previous
recommendations. The ARC did not recommend the three HealthEast hospitals for redesignation.
HealthEast representatives spoke to each of the three issues, recognizing that changes must be
made. After critical analysis, several organizational changes have been implemented, which were
highlighted. They noted that Woodwinds Hospital could not meet the surgeon response
requirements and would like to reapply as a Level 4 trauma hospital. Dr. Hick moved to not
recommend Woodwinds Hospital as a Level 3, but to allow them to re-apply for a Level 4
designation. After some discussion, this motion was withdrawn.
Ms. Immermann moved that the STAC not recommend the re-designation of Woodwinds Hospital
as a Level 3 trauma hospital. Dr. Hick seconded; the motion passed unanimously.
Dr. Burnett strongly suggested that any consideration of extending current designations include
a requirement for regular progress reports to the STAC.
After further discussion, Dr. Hick moved to extend the current Level 3 designation for St. Joseph’s
Hospital for 12 months in order to allow them to address and correct the issues based on the
ARC’s review and recommendations. Dr. Paulson seconded; the motion passed unanimously.
Dr. Paulson moved to extend the current Level 3 designation for St. John’s Hospital for 12 months
in order to allow them to address and correct the issues based on the ARC’s review and
recommendations. Mr. Johnson seconded; the motion passed unanimously.
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Break—15 minutes
Safe Kids Recommendations & the Role of STAC in Best Practices
Due to time limitations, this agenda item was deferred to June 2016 STAC meeting.
Data Work Group Report
Ms. Immermann reviewed each of the six Data Work Group charges, noting that the Proposed
Trauma Registry Inclusion Criteria and Proposed ICD-10 Data Set address charges two and three.
Many proposed changes to the inclusion criteria are clarifications. The salient changes are 1) the
inclusion of shaken baby syndrome; 2) the elimination of isolated minor injuries (e.g., abrasions
and contusions); 3) the inclusion of any case admitted from trauma care regardless of length of
stay. The work group proposed to reduce the data set by 35 data elements to 66. There was
general consensus to collect stakeholder comments about the proposals and re-visit the
proposal at the June 2016 meeting.
Adjourn/Next Meeting
The next STAC meeting is scheduled for June 7, 2016, from 12:30-3:30 p.m., at the Shoreview
Community Center, 4580 Victoria Street North, Shoreview. With no further business, Dr. Furnival
adjourned the meeting at 3:42 p.m.
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