History of Trauma in Indiana
Trauma is an important public health and health care delivery issue because of its major impact on the lives and health of Hoosiers.
Trauma refers to people who have sustained severe injuries, requiring rapid evaluation and transport to specific hospitals with trauma care capabilities, staffed and equipped to provide the comprehensive care needed. All hospital emergency departments are not trauma centers; currently 23 Indiana hospitals are American College of Surgeons – verified as trauma centers.
A trauma system is an organized, coordinated effort in a geographic area that delivers the full range of care to all injured patients. Until March 2006, Indiana was among a handful of states with no laws or regulations granting oversight authority for trauma care. Proper oversight is a necessary element of any trauma system. Public Law 155, enacted in 2006 with support from resolutions by the Indiana State Medical Association and the Indiana Emergency Nurses Association, changed that. This legislation designated the Indiana State Department of Health (ISDH) as the lead agency for a state trauma care system with goals of preventing injuries and coordinating care for injured patients in order to reduce death and disability.
No funding was appropriated with this legislation; in fact, of all the states, Indiana appropriates the lowest per capita funding for public health programs. This lack of focus on public health programs is one reason Indiana lags behind many states in trauma system development. The ISDH has successfully acquired and used federal funding to development and implementation of a statewide trauma system. Trauma system development is currently funded by grants from the Indiana Criminal Justice Institute (ICJI), which administers the NHTSA 408 traffic records grant, monies from the federal Centers for Disease Control and Prevention (CDC) Preventive Health and Health Services block grant, CDC National Violent Death Reporting System (NVDRS) grant, CDC Overdose Data 2 Action (OD2A) grant, the Substance Abuse and Mental Health Services Administration (SAMHSA) First Responder Comprehensive Addiction and Recovery Act (FR CARA) grant, Bureau of Justice Administration (BJA) Comprehensive Opioid Abuse Program (COAP) grant and BJA Student, Teachers and Officers Preventing (STOP) School Violence and Prevention grant.
Indiana’s Trauma Timeline
- It’s desirable for all hospitals to eventually be part of the statewide system.
- Creating a statewide trauma system will mean necessary collaboration between Emergency Medical Services (EMS), hospitals, rehabilitation facilities and public health
- Legislation will be necessary to create an identifiable and sustainable source of funding for the trauma system.
- Injury prevention data collection and “best practices” along with widespread public education about trauma and injury will be important parts of the system.
IC 16-19-3-28: State department designated as lead agency of a statewide trauma care system; rule making authority
- (a) The state department is the lead agency for the development, implementation, and oversight of a statewide comprehensive trauma care system to prevent injuries, save lives, and improve the care and outcome of individuals injured in Indiana.
- (b) The state department may adopt rules under IC 4-22-2 concerning the development and implementation of the following:
- (1) A state trauma registry.
- (2) Standards and procedures for trauma care level designation of hospitals.
As added by P.L.155-2006, SEC.2.
In April, the ISDH hired a trauma system manager.
Note: The ICJI funding continues today.
Senate Bill 249, sponsored by Sen. Wyss, passes giving the Department of Homeland Security the authority to adopt EMS triage and transportation protocols.
In September, the ISDH hired its first state trauma registry manager.
In December, the American College of Surgeons (ACS) conducted a consultation visit during which it commented on those aspects of a trauma system in place and recommended a list of actions the state should take to improve its trauma system.
In February, the ACS issued their consultation visit recommendations.
- Presentation to the Indiana Rural Health Association.
- Presentation to the Indiana Emergency Nurses Association Symposium.
In November, Governor Daniels signed an Executive Order creating the Indiana Trauma Care Committee, which serves as an advisory body to the ISDH on all issues involving trauma. On January 9, 2017, Governor Holcomb re-issued Governor Daniels' original Executive Order creating the Indiana State Trauma Care Committee. A link to the full text of the re-issued order can be found here.
In February, the ISDH reported that there were 17,000 records in the trauma registry. The goal of 20,000 records “is now within reach.”
Note: As of March 2020, there are 326,588 records in the Indiana trauma registry.
In October, the first meeting of the Indiana Trauma Care Committee (previously the Trauma Care Task Force) was held.
In April, the Indiana Department of Homeland Security reconsidered a Triage and Transport rule, fulfilling the intent of Sen. Wyss’ bill (Senate Bill 249) of 2008.
In August, the ISDH hired a trauma and injury prevention division director, prioritizing trauma as a division within the agency.
In November, the EMS Commission adopted a rule governing Triage and Transport of injured patients. NOTE: Due to process issues with the original vote, the Commission had to reconsider the rule; the rule did not change substantively.
In January, the ISDH hired three additional staff members: a trauma registry manager, trauma registry data analyst and an injury epidemiologist, expanding the trauma and injury prevention division’s expertise.
In May the EMS Commission re-adopted the Triage and Transport rule. In August, the Triage and Transport rule was published.
From June through September, the ISDH completed their first Trauma Tour around the state.
In January, Governor Pence re-issued Governor Daniels' original Executive Order creating the Indiana Trauma Care Committee, which serves as an advisory body to the ISDH on all issues involving trauma.
In March, the ISDH and IDHS EMS Commission worked together to approve "In the process of ACS verification" trauma centers for purposes of the Triage and Transport Rule, which will greatly increase the number of trauma centers in Indiana.
In April and May, the ISDH completed their second Trauma Tour around the state.
In June and July, the ISDH completed their Training Tour around the state.
In November, the Trauma Registry Rule was published. It requires all pre-hospital (EMS) transport providers, hospitals with emergency departments and the State's seven rehabilitation hospitals to report trauma cases to the ISDH trauma registry. The rule became effective November 24, 2013. The rule was preliminarily adopted by the ISDH Executive Board in January 2013 and a public hearing was held July 29, 2013. The full text of the Trauma Registry rule can be found here.
In January, the ISDH hosted the first statewide EMS Medical Director's Conference. The ISDH continues to host this conference annually.
In February and March, the ISDH completed their Trauma Registry Training Tour around the state.
In August, IU Health Arnett Hospital and IU Health Ball Memorial Hospital became the state's first ACS verified level III trauma centers.
In October, the ISDH received $1.4 million from the Centers for Disease Control (CDC) to gather critical data on violent deaths using the National Violent Death Reporting System (NVDRS).
In March, the ISDH hosted the first statewide Injury Prevention Conference. The ISDH hired an INVDRS epidemiologist.
In May, the ISDH hired an INVDRS records coordinator.
During the months of June through August, the ISDH completed their 2015 Trauma Tour around the state.
In September, the ISDH hired an injury prevention program coordinator and an INVDRS records consultant.
The ISDH published and released “Preventing Injuries in Indiana: A Resource Guide” an application on iOS and Android platforms.
In February, the ISDH hired an additional records consultant.
In March, the ISDH received $3.2 million from the CDC for the Prescription Drug Overdose: Prevention for States grant. This three and a half year grant was to support enhancements to INSPECT, the Indiana prescription drug monitoring program at the Indiana Professional Licensing agency, improve opioid prescribing practices, support prevention efforts at the state and community levels to address new and emerging problems related to prescription drug overdoses and a partnership with the IU Fairbanks School of Public Health to evaluate opioid prescribing practices in Indiana.
In April, the ISDH hired a Drug Overdose Prevention (DOP) Community Outreach Coordinator, another records Consultant and a DOP Epidemiologist.
In July, the ISDH started to receive $250,000 per year in the state budget bill for naloxone kit distribution to local health departments.
In September, the ISDH received $1.9 million from the CDC for the Enhanced State Surveillance of Opioid-Related Morbidity & Mortality grant. This two year grant was to further support enhancements to improving opioid prescribing practices and support prevention efforts at the state and community levels to address new and emerging problems related to prescription drug overdoses.
In October, the ISDH received a Public Health Associate through the CDC's Public Health Associate Program (PHAP). This associate was with the Division of Trauma and Injury Prevention for two years.
In January, Governor Holcomb re-issued Governor Daniels' original Executive Order creating the Indiana Trauma Care Committee, which serves as an advisory body to the ISDH on all issues involving trauma.
In March, the ISDH hired two additional records consultants and an additional DOP community outreach coordinator.
In April, the ISDH received $800,000 from Indiana Family and Social Services Administration (FSSA) for the 21st Century Cures Act grant to distribute naloxone kits to local health departments for the next two years.
In July, the ISDH hired a registry coordinator and a records consultant.
In September, the ISDH hired a third DOP community outreach coordinator. The ISDH also received $3.2 million from Substance Abuse and Mental Health Services Administration (SAMHSA) through the first responder comprehensive addiction and recovery act (FR CARA) grant to 1) provide resources through the Indiana Naloxone Kit Distribution Program for First Responders for emergency treatment of known or suspected opioid overdoses in rural communities; 2) train first responders on carrying and administering naloxone; and 3) expand the Indiana Recovery and Peer Support Initiative for referral to appropriate treatment and recovery communities. This is a five year grant.
In October, the ISDH received a Public Health Associate through the CDC's Public Health Associate Program (PHAP). This was the second CDC associate who was with the Division of Trauma and Injury Previontion for two years.
As of November 2017, the state had 20 ACS verified trauma centers.
In December, the ISDH hired a naloxone program manager.
As of April 2018, the state had 22 ACS verified trauma centers.
In June, the ISDH received $1 million over three years from the Administration for Community Living (ACL) through the Traumatic Brain Injury (TBI) grant to maximize health outcomes and reduce disability following TBI. The division is partnering with the Rehabilitation Hospital of Indiana to carry out the work of this grant.
In July, the ISDH compiled a list of certified stroke centers per IC 16-31-2-9.5 requirements. Also, the ISDH no longer requires firework injury reporting per IC 35-4-7-7.
In September, the ISDH received $1 million over three years from the Bureau of Justice Administration (BJA) through the STOP School Violence Prevention and Mental Health Training Program grant to expand in-school services and prevention education of school personnel, mental health professionals, students and families; increase the collection and data timeliness of aggregate school violence, bullying and adolescent mental health reporting; and operate a crisis intervention team that will coordinator law enforcement agencies and school personnel. The ISDH also received $1 million over three years from the BJA through the Comprehensive Opioid Abuse Site-based Program grant to fund the current toxicology program for coroners, expand current efforts to test all suspected overdoses in emergency departments (fatal and non-fatal) and link data between INSPECT (state’s prescription drug monitoring program), Coroner Case Management System and toxicology program.
The ISDH rolled out the coroner toxicology program which requires all coroners to submit toxicology screens for suspected drug overdose deaths and report the findings to the ISDH.
As of June 2019, the state had 23 ACS verified trauma centers.
In September, the ISDH hired a DOP program director. The ISDH received $21 million over three years from the CDC for the overdose data to action grant to undertake multiple strategies that leverage high quality, comprehensive, and timely data surveillance to drive state and local drug overdose prevention efforts. The DTIP plans on accomplishing the following with the awarded grant funding:
1) Collect, analyze, and disseminate timely syndromic emergency department (ED) data on suspected all drug, all opioid, heroin, and all stimulant overdoses. Increase timeliness of hospital/billing ED discharge data.
2) Collect and disseminate descriptions of drug overdose death circumstances for all unintentional or undetermined intent drug overdose deaths. Participate in the State Unintentional Drug Overdose Reporting System (SUDORS) optional activity to collect preliminary opioid overdose death counts within a month of decedent date of death from a subset of interested high burden counties.
3) Conduct several innovative surveillance projects that will include tracking public health risk of the illicit opioid drug supply, linking overdose data from different sources within the same jurisdiction, linking Prescription Drug Monitoring Program (PDMP) data to other data systems, and conducting innovative morbidity/mortality data surveillance.
4) Enhance and maximize Indiana’s PDMP.
5) Integrate state and local prevention and response efforts by partnering with the Marion County Public Health Department, implementing the Indiana Communities Advancing Recovery Efforts Extension for Community Healthcare Outcomes, and partnering with the Indiana Department of Education and the Indiana United Ways to implement school-based drug prevention programs.
6) Establish linkages to care for those with opioid use disorder by partnering with the Indiana Family and Social Services Administration to build infrastructure and service systems to support transportation costs, and partnering with PACE, Inc. to staff harm reduction sites with peer recovery coaches.
7) Provide support to providers and health care systems by creating and implementing online opioid-prescribing dentistry courses and working with EDs to implement post-overdose protocols.
8) Enhance public safety partnerships by providing harm reduction training to law enforcement officials and building collaborations among public health and public safety through the annual Public Safety and Public Health Opioid Conference.
9) Empower individuals to make safer choices by partnering with the Indianapolis Colts to advertise CDC’s RxAwareness campaign, maintaining the OptIN website, which connects substance users to naloxone and treatment resources, and collecting data on adverse childhood experiences through the Behavioral Risk Factor Surveillance System.
10) Propose an innovative project focused on decreasing the rates of Hepatitis C in high-risk populations by training inmates as peer educators.
11) Serve as a peer-to-peer learning mentor for other states attempting to implement overdose fatality review teams.
American College of Surgeons Consultation in 2008
After two years of study, the Indiana Trauma Task Force reached a consultation agreement with the Committee on Trauma of the American College of Surgeons, a non-biased, nationally-recognized organization. This consultation team would evaluate the resources, legislation, trauma care delivery, trauma registries/data analysis, performance improvement, interagency cooperation/communication, professional/community education, and injury prevention and control currently in Indiana. The trauma system consultation team would also provide knowledge and experience from other states to help Indiana develop a trauma system. This consultation required intensive advance preparation, and a four-day visit from the College. The consultation team included professionals from surgery, emergency medicine, trauma nursing and emergency medical services.
The ACS-COT site visit team conducted a trauma system assessment for the State of Indiana on December 14–17, 2008.
ACS-COT Full Report for Indiana:
ACS-COT Final Presentation for Indiana:
Indiana Pre-Review Questionnaire:
Indiana Presentation for ACS: