Item N08
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
*TIME APPROPRIATE REQUESTED *
Meeting Date: Wednesday, October 20.2004
Division: BOCC
Bulk Item: Yes
No XX
Department: Commissioner Rice. District 4
AGENDA ITEM WORDING: Presentation of Report of the Trauma System Study Group,
prepared by the Health Council of South Florida, regarding their study of County-wide trauma
care system.
ITEM BACKGROUND: The Trauma System Study Group was approved by the BOCC on
August 20, 2003 to study the existing trauma care deliyery system serving the Middle and Lower
Keys and make recommendations to the Board for enhancement of the system for this area into
the long-term future.
PREVIOUS RELEVANT BOCC ACTION:
CONTRACT/AGREEMENT CHANGES:
STAFF RECOMMENDATIONS:
TOTAL COST:
BUDGETED: Yes
No
COST TO COUNTY:
SOURCE OF FUNDS:
REVENUE PRODUCING: Yes
No
AMOUNT PER MONTH_ Year
APPROVED BY: County Arty _ OMBlPurchasing _ Risk Management _
DMSION DIRECTOR APPROVAL: ~
(David P. Rice, Commissioner, District 4)
DOCUMENTATION:
Included XX To Follow_ Not Required
DISPOSITION:
AGENDA ITEM #-Li
Revised I/03
Monroe County Trauma Study
Group
INTERIM REPORT
Prepared by:
Health Council of South Florida, Inc.
For:
The Monroe County Board of County Commissioners
October 2004
\\UOc//
~Q""
c:z:: ...::\ .' ....;
-..r-a ~ ~
~ -$.
\~
" ~,\\\
'____"_'__"__'_"_"_"__'_"_"_.'_"____u_.__u__._.._u_.._.._.._.__.._.___________..____..____.._.._.__..--.-..__.__.___________._.__.._.._.__.__.__..____..__.-----.----..-.-____.._.__u_.__..__._.__.._.__.__..__._
' .
ACKNOWLEDGEMENTS
Kim Bassett, Lower Keys Medical Center
Mayor Clyde Burnett, Key Colony Beach
Cheryl Cottrell, Upper Keys Health Care Taxing District Advisory Board
Kathleen Fischer, Layton
Brian Haff, Key West Emergency Medical Services
Yvonne Harper, Layton
Commissioner Peter Hines, Key Colony Beach
Susie Martenson, Fisherman's Hospital
Sylvia Murphy, Upper Keys Health Care Taxing District Advisory Board
Michael Puto, Marathon
Captain Tom Strobel, Islamorada Fire Department
Chief Hans Wagner, Marathon Fire Department
Chief William Wagner III, Islamorada Fire Department
Chief Billy Wardlow, Key West Fire Department
Leonard Yeager, Key West Emergency Medical Services
Consultants
Brenda Beckmann, Upper Keys Health Care Taxing District
Matt Cordell, Monroe County Sheriff s Office- Aviation
Dr. Mike Klitenick, Lower Florida Keys Health System
Chief Clark Martin, Monroe County Fire Rescue
Lt. Mike Pando I, Monroe County Sheriff s Office- Aviation
Co!. Rick Ramsay, Monroe County Sheriff s Office
Bureau Chief Mike Rice, Monroe County Sheriff s Office- Administration
George Schaffer, Department of Health (Bureau of EMS)
Dr. Sandra Schwemmer, Monroe County Medical Director
James Ward, Retired Chief
!_u_u_u_u_u_ -:.- _.._u_ -- _"_U__._U_U_ ._U_U__._.._.._.._.._.._u_.._. _.'_h_.._.._ __'_'._n_.._.__._ __.._ _ __.._ __._.._..__ _. _. _..____ ._.._ __._ .__._.._ .____.._ ._ '_'._ ._ __
TABLE OF CONTENTS
1. GLOSSARY
II.
INTRODUCTION
1
III.
BACKGROUND
2
IV.
STUDY GROUP ACTIVITIES
2
A. Aviation Committee
B. Finance Committee
C. Structure/Operations
3
4
4
V.
STUDY GROUP CONCLUSIONS AND RECOMMENDATIONS
8
VI. APPENDICES
Appendix I:
Florida Trauma Center Locations and 30 Minute Helicopter
Service Area
Appendix II:
Monroe County Hospital Emergency Room Departments
Appendix III:
Monroe County Trauma System Study Group Membership
Appendix IV:
Finance Committee Budget
Appendix V:
Trauma Star Transport Data - Ryder Trauma Center
. Monroe County Trauma Study Group Interim Report
October 2004
GLOSSARY
Inter-facility Transfer
The transfer of a patient between facilities licensed under Florida Statutes, Chapter 395.
Trauma Agency
A Department of Health approved agency established and operated by one or more
counties, or a Department of Health approved entity with which one or more counties
contract, for the purpose of administering an inclusive regional trauma plan.
Trauma Alert Victim'
A person who has incurred a single or multisystem injury due to blunt or penetrating
means or burns, who requires immediate medical intervention or treatment, and who
meets one or more of the adult or pediatric scorecard criteria established by the
Department of Health by rule.
Trauma Center
A hospital verified by the Department of Health to be in substantial compliance with the
requirements in Florida Statutes 395.4025 and has been approved by the Department of
Health to operate as a Level I trauma center, Level II trauma center, or pediatric trauma
center. This facility provides highly specialized medical care (e.g., neurosurgery, burn
care) to trauma alert victims.
Trauma Scorecard
A statewide methodology adopted by the Department of Health by rule under which a
person who has incurred a traumatic injury is graded as to the severity of his or her
injuries or illness and which methodology is used as the basis for making destination
decisions.
Trauma Transport Protocol
A document which describes the policies, processes, and procedures governing the
dispatch of vehicles, the triage, prehospital transport, and inter-facility trauma transfer of
trauma victims.
Trauma Victim
Any person who has incurred a single or multisystem injury due to blunt or penetrating
means or burns and who requires immediate medical intervention or treatment.
Sources: American College of Surgeons
Florida Statutes, 395.4001
Monroe County Trauma Study Group Interim Report
October 2004
INTRODUCTION
An important feature in a community's emergency medical services (EMS) system is the
capability to transport severely injured victims of trauma in a timely manner to the appropriate
medical care facility. Some communities may vary in their ability to make available the needed
scope of services to readily transport trauma patients over large distances due to unique
challenges.
For Monroe County, the lack of a local trauma center and its unique geography are significant
factors that impact the rural county's operation of a coordinated trauma transport system. The
absence of a trauma center in Monroe County can be attributed to the high cost associated with
the operation and maintenance of a trauma center in addition to the low volume of trauma alerts
which does not meet the annual minimum number of patients (500) recommended under Florida
Statute 395.402 to establish a facility. The geography of Monroe County, largely comprised of a
chain oflow-lying islands (Florida Keys), further compounds the trauma transport situation. The
majority of Monroe County's population (79,589) resides on the Florida Keys that extend from
the southwestern tip of the Florida peninsula into the Gulf of Mexico. Monroe County's total
land area is slightly less than 1,000 square miles and except for the main1~d, no point in the
county is more than four miles from the water. Only a 112-mile highway connect the keys which
poses a limitation in providing timely ground transport for appropriate care because of potential
road hazards, distance and traffic congestion. Under the Florida Department of Health's (DOH)
Bureau of EMS Trauma Transport Protocols (TIPs) Manual, Section Five, it is stated that:
"All trauma alert patients must be transported to a State Approved Trauma Center
(SATC) or State Approved Pediatric Trauma Referral Center (SAPTRC) nearest the .
location of the incident if the incident is within 30 minutes by ground or air transport or
within 50 miles by air transport. The medical director shall identify any exceptions to
this standard in the EMS provider's or trauma agency's TTPs with explanation and
justification. "
Due to the linear expanse of the keys from the Florida mainland, attaining optimal trauma
transport time required by DOH to the nearest trauma centers in Miami-Dade County becomes
more difficult for EMS providers located in the Middle and Lower Keys (See Appendix I).
Three acute care hospitals exist in Monroe County that have the resources to stabilize injured
patients (See Appendix 11); however, they do not provide trauma care services and other
specialized services (e.g., cardiac catheterizations).
1
Monroe County Trauma Study Group Interim Report
October 2004
BACKGROUND
Monroe County illUstrates an example of many rural communities in Florida that face challenges
in having timely access to trauma care. DOH has been striving for the last 20 years to meet the
needs of trauma victims by establishing a statewide trauma system. Its State Trauma System
Plan December 2000 - December 2005, states:
"National research has documented that regional trauma systems are the most effective
means for planning and providing trauma care. Florida's trauma system design
incorporates the regional concept as the basic framework for the system and a
commitment has been made to broaden the system design to be inclusive in nature. This
means that the needs of all trauma victims will be considered, not just the most severely
injured. "
Recognizing the efforts in the development of the state trauma system and the existing
challenges of trauma transport from Monroe County, the Monroe County Sheriff's Department
provided a UH-I class surplus helicopter (valued at $326,000) to the Monroe County Fire
Rescue .for trauma services. Monroe County Fire Rescue utilized the aircraft to create a
successful trauma transport flight program (Trauma Star) which was initiated in February 2002.
In the summer of 2003, there was concern among members of the Monroe County Board of
County Commissioners and administrators of the Trauma Star program to sustain the air service
because of the limited availability of replacement aircraft parts and the United States military
planning the termination of equipment support for the UH-l class aircraft. Additionally, the
Trauma Star program administrators observed within the civil and commercial industries the
increased trend of upgrading the existing aircraft model which had exacerbated the already small
supply of replacement parts.
An informal Study Group was created in the fall of 2003 to outline the issues associated with air
trauma transport system maintenance and improvement: The Study Group was comprised of
officials from municipalities in the Upper and Middle Keys, representatives of local acute care
hospitals, EMS representatives from the Lower and Middle Keys, and representatives of the
Upper Keys Taxing District (See Appendix III).
STUDY GROUP ACTIVITIES
The Study Group convened eight meetings between October 2003 and September 2004 and
Commissioner David Rice, PhD, facilitated all of the meetings. The goal of the Study Group
was to design a plan that would prevent a decrease in the current level of air trauma transport
service. Throughout the meetings, the Study Group discussed and reviewed issues regarding the
operation, organization of flight staff, funding, and evaluation of Monroe County's emergency
medical air transport service.
The Study Group identified early in the planning process that the two definitive operations
carried out by Trauma Star were inter-facility transfer of critical care patients and trauma alert
transports. The Group also acknowledged the Upper Keys region of Monroe County has an
2
Monroe County Trauma Study Group Interim Report
October 2004
advantage for air transport of trauma patients by being geographically closer to a trauma center
and having an established trauma district for financing medical care that is supported by its
communities through past taxation.
Throughout the meetings, Study Group members deliberated on the options of purchasing an
aircraft, leasing an aircraft, or contracting with a commercial vendor (out of county) to station
equipment and provide trauma transport service for the Middle and Lower Keys. To examine the
areas of operation, organization of medical staff, funding, and service evaluation, the Study
Group created three working committees to gather information and report to the.Study Group for
further discussion.
The three working committees were the Aviation Committee, Finance Committee, and
Structure/Operations Committee. The working committees held public meetings advertised
accordingly to meet the provisions of Florida's Sunshine Law under Florida Statute 286.011.
Aviation Committee
The Aviation Committee was created with the purpose of selecting the appropriate aircraft and
assisting the Finance Committee detennine costs of operational elements (e.g., crew equipment,
training, etc.). The committee met on several occasions and conducted a needs assessment for
selection of an appropriate aircraft to maintain trauma transport services. The criteria utilized for
aircraft selection were:
. Multi-mission role capability (i.e., EMS, Fire Rescue, Search and Rescue)
. Range
. Speed
. Capacity of patient and medical personnel
. Single engine versus twin engine specifications
Other factors researched by the committee regarding aircraft models were the scope of
manufacturers' service and support programs, manufacturer responsiveness, availability of parts,
warranty policies, maintenance and insurance programs, and hidden costs associated with
selecting a used helicopter versus a new aircraft.
Committee members also met with EMS providers utilizing EMS airframes of the helicopter
models to determine "real world" performance and conducted test flights. The committee
recommended the Bell 430 ($4.5M to $5M) to the Study Group for consideration as the
appropriate aircraft, should the option of purchasing an aircraft be considered. The Bell 430 was
chosen due to its lower operational cost and a new aircraft was endorsed by the committee to
allow for customization of the airframe to EMS specifications. Other justifications for the
selection of the new aircraft were that air service program administrators would have a stronger
service and support program and would be able to easily project the maintenance cost for
operation. Elements for cost of operations were provided to the Finance Committee.
3
Monroe County Trauma Study Group Interim Report
October 2004
Finance Committee
The Finance Committee was created to determine operating costs of an improved air service and
explore finance options. Committee members attended the meetings of the other committees to
determine necessary elements to include in a working draft budget. The budget created reflected
the leasing of a factory refurbished Bell 430 aircraft for 10 years with an annual operating budget
of $2.5M for 534 flight hours per year (See Appendix IV). Purchasing the aircraft at the end of
the term was an available option. The creation of a trauma district was identified as a possible
funding source collecting ad valorem tax funds (See Appendix IV).
Structure/Operations Committee
The Structure/Operations Committee was created to develop options on how to provide air
trauma transport services. The committee also had a medical subcommittee to address medical
staffing issues of the helicopter service. Committee members conducted several meetings
between November 2003 and June 2004 discussing the challenges for trauma transport,
physician/hospital acceptance for inter-facility transfers, and countywide evaluation of trauma
care servIces.
Committee members representing the Lower Keys Medical Center, Fisherman's Hospital,
Mariner's Hospital, Upper Keys Taxing District, and staff of the Monroe County Fire Rescue
coalesced into a Data Collection Subcommittee (under quality assurance meetings) to
retrospectively (March 1, 2002 - January 10, 2004) gather trauma transport data from their
respective organizations. The trauma transport data elements collected were: 1) mile marker of
incident/origination; 2) destination hospital; 3) trauma vs. medical; 4) patient age; 5) patient
residency (in-county vs. visitor); 6) mode of transportation; and 7) method of payment.
The Data Collection Subcommittee encountered several hurdles during the data collection and
compilation process which involved the laborious tasks of refining collected data, minimizing
duplication of patient data, and addressing omitted/missing information as identified within the
desired data elements. The subcommittee members were confident that prospective data
collection on the desired elements would reveal a clearer understanding on trauma transports and
inter-facility transfers.
Data on a total of 1,472 transfers were shared with the Structure/Operations Committee at its
February and March meetings. These data indicated 93.7% (1,379) of the collected patient
transfer data were inter-facility transfers from acute care hospitals. The remaining 6.3% (93)
represented trauma transports sent from the scene of injury to a trauma center (See Figure I).
The largest share of inter-facility transfers was from the Lower Keys Medical Center (LKMC)
(694) followed by Mariner's Hospital (521) and Fisherman's Hospital (164).
The Data Collection Subcommittee noted that some trauma patients (an estimated 221 patients or
15.0% of the collected 1,472 transfer data) were transported from Monroe County through inter-
facility transfers via air services operated by Baptist Aeromed, Trauma Star, Metro Miami-Dade
Air Rescue, Miami Children's Air, and Air Trek. Hospital representatives of the Data Collection
Subcommittee were not able to retrospectively verify the trauma status of inter-facility transfers.
4
Monroe County Trauma Study Group Interim Report
October 2004
Figure I: Inter-Facility Transfers
(March 1, 2002 - January 10, 2004)
Transferring Agency
6.3%
47.2%
~ On Scene
lSl Fishermens
. Mariners
B LKMC
Source: Structure/Operations Committee - Data Collection Subcommittee
From the review of collected data of trauma transports airlifted from the scene of injury to
Mi~i-Dade County, the Data Collection Subcommittee indicated that most (90 transports or
96.8%) of the estimated 93 transports were sent to the Ryder Trauma Center with the remaining
transports (3) arriving at Miami Children's Hospital. Overall, most of the "On Scene" air
transports were from the Middle and Upper Keys area (See Figure II). Trauma Star was
identified as the air carrier taking most (55 transports or 61.1 %) of the transports from the scene
of injury to Ryder with Metro Miami-Dade Air Rescuel taking the remaining 35 transports from
the scene.
Upon examination of Trauma Star's transport data2 provided by Ryder Trauma Center (service
period from February 2002 to September 2003), Monroe County residents accounted for 57%
(31) of the verified trauma alert patients originating from Monroe County (54) (See Appendix
V). The leading mechanism of injury was motor vehicle crashes (MY A; 23) followed by motor
cycle crashes (MCC; 8). The locations of most of the injuries transported by Trauma Star
occurred in the Middle and Lower Keys area. Retrospective data requested from Miami
Children's Hospital were not available due to trauma registry technical problems that were being
repaired.
I Metro Miami-Dade Air Rescue is a helicopter program of Miami-Dade County Fire Rescue that provides service
for the Upper Keys of Monroe County.
2 Trauma Star operation temporarily ceased during winter 2003 to early January 2004 due to routine repairs and
inspection.
5
Monroe County Trauma Study Group Interim Report
October 2004
Figure II: On Scene Air Trauma Transports to Miami-Dade County
(March 1, 2002 - January 10, 2004)
On Scene Air Trauma Transports by Mile Marker
21
18
15
12
9
6
3
o
~~ ~~ ~~ ~~ ~~ ~~ ~~ ~~ ~~ ~~ ~~ ~'?J *-0~ 0ii- ,3.~~
~/,r;;:j /rfl ",n;,r;;:j ",n;,CfJ r:tCfJ ~"CfJ r;;;;roCfJ (y~CfJ ~CfJ f;:jr;>JC!J ..........~ ~ol.:-v ~0 fl).~<<? p.f'
....." I), n;, ~ ~ Cij "'\ <<B ~ ~(y....\ ~o r!f o..ov
'" <:)' ... 0 v
Location
Source: Structure/Operations Committee - Data Collection Subcommittee
When hospital representatives of the Data Collection Subcommittee reviewed the payer source of
the 1,472 transfer data, approximately 55.8% (822 transfers) of the collected data could readily
indicate a payer source. The Data Collection Subcommittee showed that 83.2% or 684 of the
reportable transfer data had insurance coverage for payment (Commercial [304], Medicare [280],
and Medicaid [100]) (See Figure III). The Upper Keys Trauma District financed the medical
care of 16 (1.9%) ofthe reportable transfers and the remaining 122 (14.8%) transfers were "Self-
Pay".
Figure III: Payer Source of Transfers
(March 1, 2002 - January 10, 2004)
Transfers by Payer Source
1.90/0
14.80/0
. Commercial
III Medicaid
m Medicare
_Self-Pay
ImITrauma Dist
37.00/0
34.10/0
Source: Structure/Operations Committee - Data Collection Subcommittee
6
Monroe County Trauma Study Group Interim Report
October 2004
As the Committee was briefed on the challenges in obtaining data, Committee members
observed the benefits (e.g.,authority to collect standardized confidential data, protection from
discovery for any civil legal actions) of a trauma agency in collecting countywide data from
various agencies for systematic quality management (QM) and quality assurance (QA) functions
of trauma care services.
From estimations developed from the available data gathered, the Structure/Operations
Committee recommended for the Study Group to consider the following:
. include an appropriate role and set standards for conducting inter-facility transfers of
critical patients within trauma transport air services to offset operational costs through
funding provided by insurance billing under Federal Aviation Administration's (FAA)
regulation, Part 135 (if an aircraft is leased/purchased);
. have the flight staff be comprised of a flight nurse/paramedic and a paramedic for inter-
facility transfers and two paramedics for transport from the incident scene (if an aircraft
is leased/purchased);
. designate the Middle and Lower Keys as the primary service area and providing
secondary support to the Upper Keys;
. place the current Trauma Star helicopter as a backup resource to the newly acquired
aircraft (if an out of county provider is selected or if an aircraft is leased/purchased);
. endorse the stationing of an aircraft in Marathon and inclusion of air trauma transport
services (if an out of county provider is selected orif an aircraft is leased/purchased);
. explore (through long range planning) the designation of a trauma agency to improve
data collection and quality assurance of the provision of trauma care; and
. identify a finance model (similar to Upper Keys) to fund trauma care services.
7
Monroe County Trauma Study Group Interim Report
October 2004
STUDY GROUP CONCLUSIONS AND RECOMMENDATIONS
From review of the information provided by the working committees, the Study Group
concluded that three options should be considered when deliberation is made by the Monroe
County Board of County Commissioners (BOCC) on maintaining the current level of air trauma
transport services. The options were:
1) Purchase a helicopter;
2) Develop a public-private partnership for rendering air trauma transport services; or
3) Seek the private operation of an air trauma transport service.
The Study Group acknowledged the advantages and disadvantages associated with each of the
options under consideration (See Table I). For Option 1, the primary disadvantage of bearing the
full burden of purchasing an aircraft (estimated $4.5M) overshadowed the identified advantage
of having full authority and control of air transport operations.
Under Option 2, the advantage of having joint operational control through a public-private
partnership was considered promising by the Study Group. The financial burden would be
mitigated through the sharing of operational costs and the combined expertise of two
organizations would help streamline planning and assist in delineating organizational
responsibilities. The private vendor would provide the aircraft and collect net revenues from
charges to appropriate insurance companies and patients for services rendered. The County
would furnish pilots, storage infrastructure, maintenance personnel, and medical staff.
A fully privately owned and operated air ambulance service in Monroe County was entertained
as Option 3. The chief advantage is the community's need for air trauma transport services
would be met at no cost to the public. The concerns shared by Study Group members were the
history of few companies expressing interest in establishing local-based service and the lack of
control over the tenure of local service rendered by a private company.
Table I: Options for Maintaining Air Trauma Transport
Options
Purchase
Helico ter
Advantage County retains full
control/authority
Establish Public-Private
Partnershi
County maintains some
level of control through a
contractual arrangement
Seek Private
o eration
No burden of cost
borne by County;
service need is
addressed
No control over
Ion evit of service
Disadvantage
Some level of cost borne by
CountZ
8
Monroe County Trauma Study Group Interim Report
October 2004
To determine the viability of Options 2 and 3, a request for proposal (RFP) was developed and
advertised in June 2004 (per approval by the BOCC in May 2004). Vendor requirements
included two essential criteria. First, the applicant must be an FAA approved Part 135 air
ambulance operator and secondly, have a minimum of five continuous years as a certified
Florida air ambulance helicopter service provider.
In July 2004, one vendor responded and submitted a proposal that was similar to Option 2. In
September 2004, the Study Group convened to discuss the vendor's response and the
recommendation of the appropriate option to the BOCC. At the September meeting, the Study
Group identified several positive elements of the vendor's proposal, which included a revenue
sharing arrangement (conditional on the level of excess profits), a five-year service term,
coverage of maintenance service costs, and the provision of an aircraft. The proposal also
included Part 135 training for pilots and the assumption of all risks for billing, collections, and
non-payment of services.
Recommendations
The Study Group agreed that Option 2 (public-private partnership) was the most viable strategy
for the County Commission to consider for further development. The Study Group identified
two key features as considered highly important for consideration during the contract
negotiations process with any vendor under this option. These features were: a) the financial
stability of the vendor and b) acquiring an aircraft for long-term service that can accommodate
two patients in addition to a two member patient care crew.
Staffing and logistical recommendations endorsed by the Study Group were to:
· Hire and train a flight staff comprised of a) a flight nurse and a paramedic for inter-
facility transfers and b) two paramedics for trauma transport from the incident scene;
· Develop appropriate standards and procedures for conducting inter-facility transfers of
critical patients within trauma transport air services;
· Designate the Middle and Lower Keys as the primary service area and provide secondary
support to the Upper Keys due to its closer vicinity to a trauma center;
· Place the current Trauma Star helicopter on back-up status as a resource to the newly
acquired aircraft;
· Station the aircraft in Marathon;
· Explore (through long range planning) the designation of a trauma agency to improve
data collection and quality assurance mechanism for the provision of trauma care; and
· Review possible funding sources for trauma care services for the Middle and Lower
Keys.
The Study Group acknowledged that further meetings would be needed to determine possible
methods for funding trauma care for the uninsured and indigent trauma patients transported to a
trauma center from the Middle and Lower Keys. It was concluded that having a contractual
relationship with an experienced air ambulance operator would provide the best opportunity to
ensure the local EMS system will continue to provide timely, quality air transport services for
residents and guests of Monroe County who are critically injured.
9
...__.__.__.____.._.._.._.._.._.__d_.__.___.__.__._.__.__.._n_n_.._.._U_.__..__._.._.._____._.._..__.__._U_.._.._.___._.._.._.._.._u_.._n_.._.._U__._U_.__..____.._.._.._..____.._.._.._.._.._n_.._.______._.__.__
Appendices
Appendix I
Florida Trauma Center Locations and
30 - Minute Helicopter Service Radius
Florida Trauma Center Locations and
30- Minute Helicopter Service Radius
Map not to Scale
Source: Sumnuuy of Department of Health 1999 Report. "Timely Accas to TraUm/l. Que"
Appendix II
Monroe County Hospital Emergency Room
Departments
Monroe County
Hospital Emergency Room Departments
and
Trauma Service Area 19 Trauma Centers
~Q\\unc//
-
a:: ~
~ .:::-
;tf/I? ~-
,~
II ",\\
Prepared by:
Legend
Lower Keys Medical Center - College "R' State Approved Trauma Center
19,219 ER Visits. I!JJ
181 State Approved Pediatric Trauma Referral Center
[8] Hospital Emergency Room Departments
_ Monroe County
Lm~.._..__j Miami-Dade County
* District 11 Hospital Utilization Report - Calendar Year 2003,
Health Council of South Florida, Inc.
Appendix III
Monroe County Trauma System Study Group
Monroe County Trauma System Study Group
Members
Kim Bassett, Lower Keys Medical Center
Mayor Clyde Burnett, Key Colony Beach
Cheryl Cottrell, Upper Keys Health Care
Taxing District Advisory Board
Kathleen Fischer, Layton
Brian Haff, Key West Emergency Medical Services
Yvonne Harper, Layton
Commissioner Peter Hines, Key Colony Beach
Susie Martenson, Fisherman's Hospital
Michael Puto, Marathon
Chief Hans Wagner, Marathon Fire Department
Sylvia Murphy, Upper Keys Health Care
Taxing District Advisory Board
Captain Tom Strobel, Islamorada Fire Department
Chief William Wagner ill, Islamorada Fire Department
Chief Billy Wardlow, Key West Fire Department
Consultants
Brenda Beckmann, Upper Keys Health Care Taxing District
Matt Cordell, Monroe County (Me) Sheriff's Office- Aviation
Chief Clark Martin, MC Fire Rescue
Lt. Mike Pandol, MC Sheriff's Office- Aviation
Co\. Rick Ramsay, MC Sheriff's Office
Bureau Chief Mike Rice, MC Sheriff's Office- Administration
George Schaffer, Dept. of Health (Bureau of EMS)
Dr. Sandra Schwemmer, MC Medical Director
James Ward, Retired Chief
Monroe County Government
Commissioner David P. Rice, PhD
Commissioner Rice Staff
Tamara Lundstrom
Health Council Staff
Troy Johnson
Appendix IV
Finance Committee Budget
C.
::l
e
C)
>-
"
::l
-
en
ca
E
::l
e
~
~
C
::l
0
(J
ep
e
C
0
:!i
ep
ep
=
'E
E
0
(J
ep
It) U
T- CO r--. CO C) 0 C\I C
I T- ca
C\I T- T- T- C
u:
CD
U
...
::l
0
tn
t/)
CD
t/) - '-
CD c: CD CD
U CD C) C.
Q. '0
IE x ::l 0
0 W al .2
C/) '0 C) Q)
CD c: t/) ::z:
= x ;: .~ '-
'i: u: cu .e
ep Q) ~ 15 t/)
.c - "1:1' '0 CD c: t/) .~
tn CD Q c: C) Q. <( (;j ~
en Q cu '0 0 0 15
""C/)N CD :J c: U 0 CD
al U) g c: t/) t/)
C ::l ep ~ :0 ::E <( "0 c:
cam-II) cu C) 'Ci) C> ..lo:: CD .~
~_::lN .;:: .S W .S t/) cu Q.
u">- ~ ~ ~ '5 1U '- CD X 15
C 'i: CD ca c- ~ '- W r::
'- al
::l-.c:!i CD c: u CD t/) <(
- :J <( r:: t/) en
o .!!! U 0 0. 0.
oetn;;; 0 0 0 cu ~ > 0
~ u '- '- :J
CDcao! CD ~ 0 CD cu
cu t/) - CD 0.
e E x ca 5:: CD 0. :0 - :c ::l .E
E 0 0 c: E r::
C::lepc. E .;:: '- .2 cu .~ ~
oe"! CD c: Q) .;:: 1U .2' x
:J L:. 0 ~ CD cu
:!i1-.5o.. U) U) ::E :c a.. u:: e::: ~
III
CD
III
C
CD
C.
><
W
"C
CD
II) ><
i: ii:
'C "C
CD..C.
=: CD tIS 0
".. aI CD 0
"Cl"C-N
C ::J ~ _
arID_1O
.i:'..:;N
c.g>i;'
g:!o:E
o Q ~i:j
CD tIS tIS !
e E E tIS
c::JEC.
o l! ::J !
:IE ... UHL
CD
Co)
8
.....
CD
en
tIS
D.
~ t-- to N It) 0 It)OT"" It) t-- 0 co
C') C') Q) ~ T"" It) C') NtOCO to to C'\l Q)
Z It) t-- Q) 0 t-- It) C')~Q) t-- t-- It) N
10 ri N N ai .q: ~rici ai <<i ~
CD ~ C') ~ T"" T"" Q) 0 C'\l
C') q It) co ~ T"" N ~ co
U) T"" N N
cC
~ t-- to t-- 0 Q) It)OT"" It) 0 U) Q)
0 C') Q) ~ It) 0 C') NtOtO ~ Q) ~ N
It) t-- Q) N 0 Q) C')~C'\l q t-- 0 t--
C') ri N cO ri M ~riri an .q:
. N
~ C') N 0 T"" 0 ~ C'\l
a; O~ It) It) T"" T"" C') U)
ID T"" N N
a;
"C
o
:E
"-
CD
..
C.
o
.!:!
a;
:r:
+
o
CD
....
U)
t!
~
(i.)
~
C')
It)
~
:;,
o
:I:
-
..c
.21
u:
ir.i
...
U)
o
o
Q
W
)(
ii:
t--
C>>
t--
ri
~
q
T""
I/)
CI)
I/)
c:
CD
c.
x
W
Cl
c:
:;::l
f!
CD
Q.
o
CI)
o
~
I/)
==
'C
CI)
..c
(J)
to
~
Q)
N
C')
It)
I/)
CI)
I/)
c:
CI)
C.
x
W
~
c:
:;,
o
()
CD
e
c:
o
~
o
co
.....
N
.....
Q)
-
~
tV
~
o
.....
-
m
:;,
c:
c:
<C
'E
CI)
E
>.
tV
Q.
-
.c
CD
o
N
N
Q)
ai
co
~
N
I/)
en
o
()
"C
CI)
X
u:
S
~
N
to
to
.q:
....
::l
o
:I:
-
..c
.21
u:
....
CI)
Q.
J!J
I/)
o
U
"C
CI)
X
u:
t--co~
co~Q)
1t)C')T""
~rian
T"" co
T"" C')
ir.i
...
U)
o
o
W
...I
ID
cC
it:
~
CI)
o
III c:
- tV
c: c:
tV II)
0_
- 'C c:
CI) ..c .-
:;, ::l tV
l.L.-1~
-
....
:;,
o
J::
CI)
..c
-
>.
.c
....
II)
:!:
o
a.
-
Q)
N
.....
ci
co
~
I/)
-
I/)
o
U
CI)
:c
tV
'E:
~
m
~
Q)
Q)
co
....
::l
o
:I:
1:
.21
u:
....
CI)
Q.
I/)
-
I/)
o
U
II)
:c
tV
'E:
tV
>
C'\l
U)
o
0)
co
C)
N
.....
to
It)
~
....
:;,
o
:I:
rn
to-
rn
o
o
..J
~
e
-
..c
.21
u:
....
II)
Q.
J!J
I/)
o
U
m
'0
I-
Gl ..
CJ Gl
IE C)
o 'g
U) en
&:: Cl)
'C .5
Gl......'Olt
,cCDl!O
en C) Gl 0
'C "0 Q. N
C := 0 ~
raen.~
~OGl>-
c't:CJra
:=-;;E:e
0._ 0
00 i:;
GlralllGl
oE!E~
"':='-c.
~l!~f
:el-tnD..
Gi
c
c
o
~
Gl
D..
o
o
o
N
(')
C\/
10
J!3
.Q
a::
o
"
o
..,f
'V
.....
(,)
'E
t1l
.r:.
(,)
0)
~
(')
'V
C'!.
.....
.....
0> .....
....... CO
~~
..... C\/
NIO
>-
t1l
Q..
>-
t1l
:2
'0
J:
~
o
(')
10
cO
0.....
~@
CO_
'C
....... Gl
@E
<( .~
u-
u::&
o
CO
CO
cO
10
.r:.
-
C
o
E
-..
o
0>
.......
EI7
@
Gl
(,)
C
t1l
....
::l
Ul
.E
.r:.
-
1ii
Gl
J:
co
'V
C'l
.....
C
o
=
t1l
Ul
C
0)
a.
E
o
U
-[!?
0)
~
....
o
~
.....
'0
C
t1l
Ul
-
.Q
'0.
N
'0
C
t1l
t>
'C
U;
is
t1l
E
::I
E
I-
0)
.r:.
-
>-
D
'0
0)
'0
C
.a
~
t1l
(,)
'E
t1l
.r:.
(,)
Gl
E
.....
'0
C
t1l
J!3
..Q
'0.
10
Ul
Gl
E
::I
Ul
Ul
"!-
00
COO
0> CO
(')-~
I
.r:.
-
C
o
E
G; )(
Q.t1l
lOll..
It) '0
@!ij
Ul Ul
Gl 0)
C C
,g;:j
Q.. 0)
(,)
-:e:
<30
It)
It)
N
I
:J
U)
o
11.
N
CD
C)
ra
D..
LO
.......
.....
Qj
C
C
o
Ul
....
Gl
a.
Gl
(,)
C
t1l
C
Gl 0
'E 0 0
'm 0 ci
ELOLOIriOOO
'O)()(CO~ON
COO)(~IriQj
t1l00..... coGl
[!?IriIriO)X)(LL
GlCOCOUl..........1ii
DUlJ!3~_-3=
EU;Ul(,)~l3Gl
(I)GlGl....,o_c
EI-I-o.-a.&
3=.~E';,8::1_
(I)'OOc<(3=t1l
t5 .g -g :;; 1ii,g E
=Gl~O)ooc
<(Q......I-D..LL<(
:=
'-
o
~
LL
CO?
Q)
en
CIS
D..
..
0 Ocor--OO 00 ON 0 0 I.C) 0
0 O~O)I.C)O O~ ~ co 0 ~ I.C) I.C)
0 I.C)NI.C)~~ o co C'1N C") N ~
0 N NN lOcO ~ ai' 0 ri ri
N ~ ~ COI.C) co N
C")
E
l!
e
a..
~
:g
Q)
E
e
~
..
.e
1ft
Q)
Q)
u..
c
E
::::lI
1ft
C
o
o
-
Co)
'C
-
(II
c
CIS
E
::::lI
l!
....
"
c
CIS
It:
'C
Q)
.c
U)
c
Q)
CD
!
m
.c
C.c
0_
.ES
co E
~(;)
COO)
C")~
!@)
~ CD
~Cl
.Q m CD III
o.~IIlCD
1;i:gm=a.
.,..f!!"O~ 0.
.." _ C >-,~
01!:-m't:w
.C~""CDCD
oCD.Bo.Co)
CDCDmO=
jjj~~Q:O
~
U)
.!l
(II
o
o
..
.e
o
.!:!
a;
J:
c
o
Q)
Co)
c
l!
=
1ft
.5
-
III
CD
III
o
e-
~
0.
0.
~
~
Co)
m
.rJ
....
mS
--
0.....
gs
.- (J)
Q) m
:I:E
~ 16
z.=
:s
CIS
:i
"
c
m
CD
l!
CD
>
o
o
-=
J:
ci
C")
~
Q)
a:l
m
....
S
CD
'0
~
e-
m
C
o
"0
CD
III
m
.rJ
~
m
III
-
III
g
CD
Co)
C
f!!
~
III
C
;-
CD
Co)
c
l!
::::lI
(II
.5
iii
c
o
';;
(II
J!!
e
D..
N
CO
NN
CO~
~@)
(,)
@)'c
m
.!}.c
!2frl
ii:~
I.C)~
1ft
CD
U
c
!
oS!
c
o
o
"
c
ca
1ft
:c
2!
CIl
.rJ
E
CIl
:E
iii
c
o
iii
III
oS!
e
D..
~
'c
m
.!} .c
!2 frl
ii: ~
r-- N
... ....
S S
Cl 01
C C
'c 'c
.~ .~
.... ....
m m
~ ~
C C
~ ~
....
.E
Cl
C
'c
~
-
III
III
CD
....
01
W
"0
CO
mo
-lri
~CO
.- ~
~@)
en III
Qio
.....=
ma..
~r--
III
-
!2
'Ci.
C
CD
ii
III
...
.E
E
CD.....
:;SX
....
CDO
0.1.C)
"O~
ffi@)
1) ~
~~
.... .-
t-<t
...
'iij
GI
a::
'tJ
c
ell
GI
c.>
C
ell
C
GI
-
c
'iii
:E
.....
00
.....-
~
III
;:::
l.l!
~
-
o
c:
o
~
cv
U
-=
:e
GI
U
~
-
c:
.Q
<<i
U
-=
:e
0)
u
o
o
C\l
-<i
o
Ol
~
N
III
t::
CV
0.
-
c:
0)
E
0)
U
cv
C.
~
c:
::l
en
0)
-
Z
III >.
0) cv
="t:l
.2>.
U cv
Cl"t:l
c: 0
~;
=2
o cv
0.-
ui~
01 .
cvB
... 0)
li.$
0) c:
3: 0)
>
.215
0. III
o
.r.
III
~
0) 0)
.l!i~g
c: .- cv
O)=C:
~(/)2
0) 'E .~
CD .- cv
Q~~
o
o
10
.r. III
g 2 m
III E ':5
m -0)1i;
01.$ -5 ..0
'E ~ ui (ij'
0) > 0) ..,...
EO)Clu
o.:!::-o8.
._ - 'C (/)
::l3:t:: _
g~~!!!
_uC\l~
~:Eou
.~ .Ql u. ~
::l I;:: III ...
en-o~~
_C:CVtV
~~~3:
lfi~lfi-c:i
ElfiEQ
0) III 0)
UIIlUa;
~cv]!,o
0. 0. 0. co .
0) III 0) o.'s
O::cvO::(/)O)
000000
OOC\lIOOO~
~~~""'0C\l
cria>"":criri
-
c
Q)
E
GI
U
.!!!
3:
~<O
3: U ><
~ 1"-0
U xo
..... ~ 01&0
;o3:,.,~~
0).....~ij)00)
"'u><u...13E
.....u"OO;
li;C>><.....c:.r.
o.>lIl><cv...
~zCl)inffi.E
III = > 0) 0) en
-.- 0> Cl...J
'S 3: Ol;;; := c...
en - >< ,u LL. I-
0) CI) .~
-s,EEc:g,g
i:E~~~~Jj
w
~
...
o
III
C
o
~
ell
:;
~
"t:l
C
ftI
III
'iii
:J
C
ftI
:E
Q)
c.>
C
ftI
C
.!
c
'iij
:E
III -in
(ij~~
:::I ~ 0)
c: 0- ....
cv '5 .S
E ~ 0)
C 01=
Q)t:: .~ c
c .-
:::I .- <(
ul.l!<(
"t:l-u..
~ ~ 0)
.- o..c:
::l._ _
gffi"t:l
... > C
-EtV
o 0 III
Q) ... ...
U - ~
~~.a
c cv U
2.r.~
c U :::I
'm -g ~
~ cv E
~
GI
01
ftI
Q.
(/)
c:
o
~
cv III
'3c
010
GI~
... ell
10 .2
~:lS
:::I
t::o.
tV-
0.0
~~
@
~
-
c:
~
"t:l ...
c: :::I
cv U
~g>
~ .;::
tV .-
(/) g..
'0 ~
II)
G)
C)
Cll
ll.
0 OO)oq- ...... N CO It) 0 0 0 r0-
O) en......oq- N ...... CO en 0 0 0 at
...... ...... C") ......- It) 0) 0 C!. ro-
...... N ...... M
..,
~
....
o
~
......
N
C")
~
f!!
00.0
80~=
ocio);~o
~en"""""cO
:$10";;;11 ~~
1O~58~(I)
::lCll;l '~.o
cECllen ::l
co '3~\5a.
E C Ol~:;:l C
.0 CO (I) CO 0
CO() :;:l ... ~ ">- ._
COCCO 'ij
cEo.cco.-
CO ... .- () "t:l >
COm_coCO
CO'E'-CON'
'E - > C '1: ~
"-(I)<COCD.-
CO -C m t5 'S E
~~~m~~
<C .!:: co co 0 0-
u..<Cu........u
CD
()
~
G)
II)
:S
u:
...
G)
.c
-
Cll
~
~
G)
'1:
m
-
,g
ii:
.!S
o
'i:
o
S
G)
:E
o
~
co
co
......
....
II
(I)
.c
-
C
o
E
N
....
><
o
o
0)
~
.....
~
.9
CO
"t:l
ffi iii
...:::E 5
.9Et;
() 0 co
8. tt: fir
(I) Cl .5:
.5: u 10 ~
m I:; ::l 0
() 0 C 'ii)
'CCC(I)
.J:OCO~
~:;seo
-~j!D..~
~ :g ~~ ~
~a.0..!..1t)
'-I:;() 0
ClloomCO
~:;:l - Ol~
.9 ~~'>1O
co '1:; (I) co ~
-oO::lCCI)
ffi=:;-oD..C
~ffiffi~~
E
f
e
...
S
()
!
is
G)
u
c
Cll
c
S
c
n;
::E
ll.
~
co
CD
u..
m
~
I:;
co
tt:
10
::l
C
I:;
<C
(I)
'ii)
>-
m
C
<C
o
s
C
CI)
"t:l
"u
C
C)
C
0..
a.
:c
rn
II)
Gl
II)
C
Gl
a.
><
w
C)
c
;:
f
Gl
C.
o
~
-
GI
'"
GI 1::11
U ::l
E ID
o g'
III ;:i
I: 1!
'C GI
GI _ Co...
~ &0 g
1::II1::IIU)N
C ::l:E -
I'II~W~
~U~>-
c'C C I'll
5]i 5:E
UOU1::ll
GI I'll GI GI
o EO jij
"::l"Co
S 1! S l!!
:EI-:Ea..
III
II
III
C
II
a.
)(
w
B
~
OONO",,"
ClOO(')",," I'--
'<:tCO...,.COCD
cD
It)
00000
0000"""
'ooooco
N-Ll'i"":uio
.....-vCD
(')01'--00
COOIt)OO
"""O,,,,"ON
Ll'iorio"":
ClOCO C')
.....
000
ooco
'CDOCD
riri
.
. .
. . .
III
II
III
C
II
a.
)(
w
DI
C
'C
..
::l
~
a::
I
c
o
z
&:l ~gg
N 000
ri t6"":1li
""" .........
III
31
c
8-
)(
W
DI
C
'C
"-
::II
U
II
a::
OOOOONON
l~g~~g~~m
riri ri
.....
o
o
'0
N
00
0"""
oco
00
MCD
(')01'--00
COOIt)OO
""'O",,"ON
t6orio"":
coco C')
.....
II)
c.
:2
(!!
CD
.Ll
E
CD
::!:
Q)
..... u
,g ~
Ul v c:
~ l!! $
(I) is c:
C:'(ij c:
&l iii::!: - .Q
"C ~ Q):Q, ~
~ ! CDl!! ~ ~~~
~ !:!;.u. c: iBEu
~l'lI ~~~~ ~ II) ~a:2
~"'c:l'lI-c:CD CD .Ll~CD
00 ~ .~ is ~ (l)Cl- CDE :gl'll Ul 'E. ~ Iff:::-
Ul =CD~", II) (l)c. ~~
~ RU)a..~SCD~ ~ -~ ~l'lIl'lI~.
"C ~ iii"C '(ij ~~"C ~ Cl 2:00 .g 'S '5 tl ~
~ooo~c:::!:a..c:~ c:~~g' a..OO~_
tsiii I1ll'll (I) -~ Cll'll:!aOO_ ---00
1!l'lIl!!~b~>~~ .~1i~1! J~~uo
--cc: ~o~C.c:->_CDIIlOC.C.X~
a..OCD01!CD~.CD~."C~C.l'lIOl'lll1lrol'll
C').....~UI->a..a::a::a..~~OO~IDU0~a..
co
II
DI
lIS
a..
co
...
'CJI
N
CO)
10
N
llCI
N
Q
llCI
0'
It)
I'--
ri
(')
~
~
(I)
E
c.
'S
er
(I)
1:
Cl
;;:
"C
c:
l'lI
...
CD
CD
N
10
....
~~
CD
N~
~~
-- U
III l'lI
(I) (I)
~-
III c:
.!a (I)
c:[
CD .-
E ~
.Q. as
~-
erO
Q) III
iiio;
:EU)..;
.~ Q ~
O';!:~
o Cl E
~'B 8
~.!2"t:J
l'lI C. c:
~l!!l'lIc:
_ c: e l'lI
~ &.~ ~
~ E III
Q)"C~=
:SQ)......CO
o !G ~ E
_.Ll~1Il
(!! .!a 0 ~
Q).,.,-o
~1IlJ2-
c.8c.~
CD Cl.a Ul
c: CD l'lI
~.;:: III ~
"C5iiit?
-5~:e~
1: a:: t= :
. ..
Ul
-e
~
ro
a..
l'lI
E
~
1!
I-
...
o
u..
1::
o
III
Q)
a::
B
o
I-
CD
u
E fI)
o .;
fI) >0-
ft: ii
'C: C
CD_<"'lt
.cCDCQ
U)QOQ
'tJ"g;:;N
C :S'in -
ftl lZL_ ~
~_ :s....
..- u cr >-
c 'C U ftl
:S-<:::l!ii:
o .f! ..
OC,Si:i
CD ftl Cl. !
oEOftl
:: :s.!:! Cl.
of';!
::E...:I:Q.
-
fI)
o
o
C
o
;:;
.;
'S
U
<
.!
C
CD
E
ftl
Q.
ii
:s
C
c
<
..
.!
C
CD
E
ftl
Q.
:c
-
C
o
:IE
o
co
-
N
-
en
II)
-
Q
U;
,....
c
~
E
co
....:
.c
-
c
o
E
-
@)
+
o
CD
,....
en
.....
CD
Q
ftl
Q.
,....
II)
N
U;
N
II)
N
-
Q
N
'''It
co
II)
II)
co
fIi"
'''It
co
CD
-
o
,....
c:
o
:p
ro
.!:
E
lD
-
-
ro
-
::J
g,
::J
.0
c
~
'S
II)
~
.....
ER-
L:
-
.~
<fl-
It) ..:
C'! lD
(t')c..
co 8
~~
roL:
~'O
- lD
roL:
Q.en
'0 :0
"2 :s
::J'Q)
E l-
I- ~
ro 0
~t)
~J:!!
ro ro
en en
lD lD
E E
::J ::J
en en
en en
<e:t
.. ..
C
~
's
N
....:
..
..
.c
-
C
o
E
-
@)
Q
M
'''It
';
m
.c
-
C
o
E
-
@)
C")
Z
II)
CD
M
o
W
~
!
5..8
IE ID:=
o .g~
III = ~
a:lDoE
";: ~.III
1D;:;1ii~
J::1II00
t/)I,;"o
"CID""N
c: oQ. Ol -
ea c: ."
~..;:;N
c: .~ e ~
=..ID_
o III Q. "'"
ui5~i:i
IDea_I!!
eE.gea
c: =.- Q.
o ea ~ ID
::E'=~&:
E
e
Ol
e
D.
~
=
o
:r:
ID
J::
..
>-
.c
....
;
o
D.
J::
..
"i
..
III
o
U
Ol
c:
;:;
e
ID
Q.
o
4::
e
e
<i
@~
:a'"
o
~
4::
e
u
~
<i
ii
=
c:
c:
c(
~
.s
Q.
o
uC')
ez
=."
WCD
c:C')
eaU
uW
"t:
ID
E
c(
o
C')
~
Qi
lD
+
U
CD
....
t/)
~
e
o
.:.::
(i)
..
III
o
U
Ol
c:
;:;
e
ID
Q.
o
4::
e
e
<i
~
ea
ID
>-
~
ID
D.
!!
=
o
:r:
o
o
cO
......
N
~
o
o
ai
o
N
~
......0:::
;;::c:c
oit;-
r--r--r--
cccc~
t/) t/) Ul
~~~
000
VVV
,- @~
@o~
ccC')cc
r--VC')
(/)a:lu
W
...
:c
:;:.
en
o
U
Q)
::l
u..
o
o
cO
......
N
~
co
co ~
v N
cO N
~ N
-
co
co ~
'<t N
cO N
~ N
-
....
r-- N
N Iti
cO ....
~ N
-
Q)
.a
-
o
~
o
C')
en
c:
~
'1:
.c
::l
-J
~
..
.c
=
t/)
o
o
Iti
~
."
-
o
o
cO
CD
."
-
o
o
~
co
CD
-
..
III
o
U
~
::I
o
:r:
ID
J::
..
>-
.c
~
;
o
D.
Q)
a:l
c:
o ..:
c: 0
... .1:
~.$
o .5:
l.)rJJ
'O~
c:w
en CD
~:5
"0 en CD
c: ell g>
i!!J::':<:
a.l.)l.)
O::lell
""ilia.
v.!!l~
c: '2
Q) ~ .2
a:lo>
.!i a. ell
oE"O
Z 8 f6
>.
"2
o
~
~
o
l.)
...
::l rn
o-
J:: 53
CD c:
:58.
.c>- E
o
lD l.)
:= .5:
8.:
$ ~
a. '1:
0"0
~-g
::l ell
W CD
a; .5:
o~
zw
." co ."
N .... N
a) Iti Iti
N ~ CD
.... 0 ....
Q N a)
co N !
: :
co
~
...:
CD
....
-
co
~
ci
en
....
-
....
N
a)
en
:
-
...
0
'C
.$
.E
rJJ
~ >-
~ "2
0
ll:: c:
::l .~
:I: 1ii -
a:l I: c:
a. 0 0
- "0 -
t/) "0 Cl
0 ell
U c:
CD W
Cl "0 "0
c: ::l
:;::l C3 c:
CD
e .5 .$
CD '0
a. "0
0 I: I:
S en CD
CD_
0 0 0
I- 0 Z
co
CD
Ol
ea
D.
CD
u
E
o
III
t:
'C III
eIl..ii..,.
,cell >0,0
(l)Q-O
'O'DasN
C~C;_
asa:a<sn
....N
~U.e>-
C'ClItca
~1iiC::E
SO!..
eIlll:~
OEcca
"~eIla.
6!"ii!
::EI-ll.a..
s~~~ ~
~ N M
M~COlO ..,.
o ~ N
6-
CD
en
MCON......
9 ~
Ol
~
M..,.......CI)
o ~
-l.
::I
-,
M~OCl)
9 N
e:
::I
-,
M""~CO
9 N
>.
III
::i:
M lOCO CO
o ~
.!.
Co
<
MCI)~"""
o N
.!.
III
::i:
M lO...... co
o N
I
.c
CD
u.
MM......CO co
o N M
C
III
-,
NMlO~~O
o ~ N
~
C
NMMCO ..,.
o N M
>
o
Z
NM..,...,. ~
o ~ N
is
o
III
C
ca
E l!!
... CJ CD
CD c~-
,c::E'CSJ!l
.!!!~::!OO
LL....J_ I-
lO
N
tI)
1ii
::=
Co .
tI).!Q
.2~
CD Co
CD tI)
... 0
.c .c
; E
=.g
-
o l!!
~'*
o c:
E l!!
.gi
;;-
c,g
o e:
E
... .Q
CD::=
o.::g
l!! III
~.!;;;
tI) CD
e: "-
III III
.::. 'E
~ .~
o::i:
M 0
o~
~~
III tI)
"- c:
g? l!!
<l-
e: CD
III c:
CD CD
... U
~~
~o
CD CD
~~
o
M
o
M
M
M
~
M
......
M
o
..,.
"s
~co
=
E-o
III
..
.!l
a
..
Eo< ::i:
i::i:::i: ~
_y::i: 0 0
rnoNM
~~ I I
I ~ ~
O~N
lOCI)
o
N
MlOCl)""""
::i:::i:::i:::i:::i:
::i:::i:::i:::i:::i:
CI)CI)CI)CI)CI)
~,.U?coto;-
~oooo
M..,. lO co......
lO
N
COCX)NM~NlO
~~
::i: [G Q; III
::i:::i:::i: ~~~~
::i:::i:~5~c:l6
~~'7I-~m~
-T...LO~OUO
as~~C:I:OCC
Gl
ell
CD
II
a..
CI)
..,.
CU
u
IE
o
en
ft:
'C
CU c
.c1)~~
rn ClOg
'C'C'CN
C ::::I ~ _
lISmllSlI)
>-_!N
t: .~ m ~
::S'tije!:E
o ._ _
OCo'i:;
CUllS::!:!
eE-lIS
c::::l.ca..
oe~e
:E~LLD.
e!
::s
o
::I:
en
CU
E
i=
-
.c
.2'
i:i:
e!
::s
o
::I:
-
.c
.21
i:i:
NO,....
CC!..-..-
..- ..- ..-
en
-
.c
.21
i:i:
ii
::s
-
u
<(
c
o
..c
-
ea
....
ea
~
c
o
..c
~
ea
:2:
>->-
.Dt:
CU ::s
C 0
00
C CU
-oe.e
c
o
:!:
c
g C
~ 0
U..c
ea-
. ~
I ea
II)~
~I
~ C
.... 0
~~
o ea
...J ...,
I
C
o
II)
~
u
ea
.
I
II)
>-
Q)
~
>-
-
;:
C
lIS
::::I
a
....
Q)
a.
a.
::>
II)
1::
o
c.
en
c
e
~
lIS
E
::::I
lIS,
...
~
I
C C C
000
..c ..c ..c
- --
ea ea ea
.... .... ....
ea ea ea
~:2::2:
...... co to
LO N N
000
LOOO
~OcO
NN..-
<f!.<f!.<f!.
000
LOCOCO
0) LO 0
'V N N
C/) C/) C/)
>->->-
Q) Q) Q)
~~~
.... Q) ....
Q)-Q)
c..:g ~
c...- 0
::>~....J
..-
..-
..-
~
ea
E
::::I
ea
....
I-
eu
15
I-
CONCO
OlL()N
N
000
CONCO
NcOo;
MNM
..-
'#.'#.-oe.
000
"OtCOCO
N,....M
CO"OtM
N
en
1::
o
c.
en
c
e
~
~
'u
lIS
LL
~
CU
-
C
C/) II) II)
>->->-
Q) Q) Q)
~~~
.... Q) ...
Q)'C~
0."'C ;>
0..- 0
:J:2:...J
M
,....
M
o
LO
N
co
M
o
LO
C/)
....
~
c
ea
....
I-
eu
~
en
-
.c
.21
i:i:
CU
u
C
lIS
C
S
c
.;
:E
o
...
CU
Cl
lIS
a.
~
CO')
&I)
e!
::s
o
::I:
-
.c
.21
i:i:
ii
-
o
~
CP
U
g
III
fE
...
CP..III~
':CPCPo
0"'1110
,,"CN
C=!, ~
l'lIm~~
~U w >-
C'C . l'lI
=..111:5
O.lt! >
(JQllloij
!! l'lI ! l!!
I:::: E C l'lI
c:=CPICI.
o 1! t l!!
:5~a=D..
"
"
III
Gl
=
C
CP
>
Gl
a=
Gl
::a
j
'0
u
0>1l)~
co'~ co
OcOM
COMO>
COCOIl)
~aSo
0>0>0>
III
Gl
=
C
Gl
>
&
S
o
~
MO~
CO N CO
c-JIriM
O>O>N
CON~
ririN
NC">N
..... ..... .....
'"
.:
.2'
i!
...
CP
D..
."
~
iii
lOCO 0>
CO......."<l;
cci..:t.....
IOCOIl)
OCOCO
lOCO.......
III
..
.:
.2'
i!
100CO
NN.....
III
CP
=
C
g!
CP
a=
o
t:: 0 0 0
0>.>'>.
o.Q)Q)Q)
~~~~
tO~Q)~
~Q)-Q)
I- o.:g ~
to 0..- 0
E::>:E...J
::s
~
I-
COOCO
O>MIO
..:t..:tcci
COlON
O>.......N
00;0;
~100
..... ..... 0>
COMO
CONM
..:tccicO
<O~.......
CO 0> CO
16,..:0;
CO CO CO
..........q
.....
10<00>
CO.......~
cci..:t~
10 CO 10
o COCO
lOCO.......
MCOO
MN~
.....
~
o
0.000
0>.>.>.
C Q) CP Q)
E!!~~~
I-~Q)~
~Q)-Q)
= o.:g ~
'13 0..- 0
to=:l~...J
't:
Q)
.:s
III
CP
=
c
!
a=
~
~
.....
CO
cO
.......
CO
o
0>
~.
.....
-
COO
MO
Iri~
~CO
00>
16"':
Nil)
10 Il)
N-
CO
q
.....
o
.....
ri
o
~
.....
1i
en
-"
0=
~rD
_III
;ire
l'lI CP
....:
00
u..c:
-'-
III C
CP 0
III:Z;:
C U
CP =
ICI."
~ CP
Wr:t:
-III
~=
~...J
.......
.......
iii
GO
.....
ur
~
...
...
Gl
."
l'lI
D.
-
III
III
o
...I
li'
E
o
u
.5
a;
z
~ Co
g,:J
co e
o.C)
C >.
0"0
"0 :J
~cn
co E
lD Q)
!Iii
~CJ'J
E!! to
"0 E
.- :J
.~ ~
"01-
Q)~
E C
~ 5
2(,)
C Q)
o e
:2 6
[::E
~&:-
o C
lF5
c(,)
E!! Q)
- e
~6
~~
.!. E
~ e
c....
;::l!?
o Q)
~'t;;
lb fii
CO ~
"01-
fiio
o ~
15 .~
Co C: .
0CP~
!Ii c :> g.
$ ~O N
E!! ;1"f
"0 E -.....
'cu ::s E.J:
~ gO!:!
Q) of: CO
E06::E
~ ~ ~ al
2 ....... E iii
0~"O
C Q).E-
o E.6;; ~
"0 :JcpE
~ lZ!:!:J
to -t ::s "
$D : ~.g
CD
u
IE
o
Ul
&::
'C
CD_
.cCD .
fI) aI g
'C'CtnN
C ::I'Uj _
C'lSaJ>oan
>-_iiN
C'~ c >-
::I_<C~
o .!!! ...
(JC~i:i
CDC'lSc.e
e E E C'lS
::I - a.
S l! = e
:iE1-1-Q.
M 10 Il) N CO I"-
I"-N""'I"-NN
CO ('I) I"-'<t 10 0
Lt'i ....: 0 M '<t- ~
CO.....Il)'<t'<tCO
10 '<t....."!.CO
..-
rfl.rfl.rfl.rfl.rfl.?fl.
CO'<t'<t'<tCOCO
..-('1)..- ('I)N
c:i
Ul
CD
::I
ii
>
>0
t:
CD
a.
e
Q.
CD
:is
C'lS
>C
C'lS
I-
M
o
o
N
N('I)COIOIOO')
100,...,0..-0
o'<t..-C"') 1"-1"-
'<t- ....: ai N M ....:
'<tIOI"-NCO..-
OOO')I"-I"-Il)
Lt'ic!5~c!5"":0
CO('l)C")IOCOIl)
CO '<t'<tenl"-
..- ....: MN
...
>-
-
C
::I
o
,L:; C)
(.) Q)
ltl 0
Q) ....
0) C
ltl ;>. 0
~ C5Ul:i:
oc,g~~i
EOm'-'>(ti
ltl>.....;>.;>.....
'iiSltlltlQ)Q) 0
-...J:i:~~ l?;
000008
;>. ;>. ~ ;>. ;>..E
~~._~::: c
()()C)()u::::>
N
co
C"')_
N
en
o
Lt'i
o
10
o
..-
...
CD
01
'C
::I
rD
ii
-
o
I-
NIOO
IO'<tN
0010
en- Lt'i as
CONN
en lOCO
N- N N-
+
(J
Ul
to-
rn
>0 0 M
~MZ
l!!.1C
~-~
._ CD rn
rnrD<C
o
o
o
o
o
...
tit-
...
CD
Q.
-
tn
o
(J
..
..
CD
1;
ar:::
CD
aI
.!!!
:i
Ul
CD
::I
ii
>
~
CD
a.
e
Q.
CD
:is
C'lS
>C
~
M
o
o
N
NOI"-
CO..-O
C"')('I)O')
N as CO.
O')'<ten
00 en
Lt'iOM
o'<to
Il)COCO
oaSaS
..-
Ul
CD
'C
C'lS
'C
C
::I
o
CD
-
u
'C
-
Ul
i5
ii
:;::
c
~
Q.
c
o
-
;>.
ltl
...J
0)
c
'5
::I
U
><
W
ltl ltl
'0 '0
ltl ltl
.... ....
o 0
E E
ltl ltl
]i]i
00
:5:5:5
::I ::I ::I
000
cncncn
ltl .... ....
'000
CO........
.... Q) Q)
00l0l
E CO ltl
co--
~~~
N
...
CD
01
C'lS
Q.
m
'0
CO
....
o
E
CO
~
o
Q)
Ol
.!!!
:>
Q)
,L:;
-
....
o
,L:;
-
::I
o
Ul
Ul
ltl
Q)
....
CO
'0
Q)
-
~ ..:
o Q)
l?;a.
o 0
C,) .Q
.E a;
C,L:;
::10
Q)C"')
:5'<t
....=
o Q)
....0)
13 CO
.20
ltl C
> 0
~;;
Q) ~
a.Q)
~ g-
0.'0
Q) C
::c ltl
~ ~
ltl CO
~~
,L:; Q)
-,L:;
Ul-
- Ul
55 Q)
UlQ) E
.... ::I
a.Ul
Q) Ul
o::::t
... ...
Appendix V
Trauma Star Transport Data -
Ryder Trauma Center
Trauma Star Transports- Ryder Trauma Center
2002 - 2003
Count Admission Date Date of DIC Disposition Mechanism Trauma Criteria Location Me Resident
1 02/27/02 04/23102 Rehab Explosion 2 lono bone MM 48-Fish Y
2 03106102 03/14/02 Transfer MVA 2 lona bone MM42 N
3 03106/02 04120/02 Transfer MVA Aae steerina wheel MM42 N
4 03107/02 04/05/02 SNF MVA GCS < 12 MM 25.5 y
5 03126/02 03128/02 Home MVA GCS < 12 Kev Colonv y
6 03/26/02 04/02/02 Home MVA GCS < 12 Kev Colonv y
7 03131/02 04/19/02 Home MVA GCS < 12 MM53 y
8 04115/02 04115/02 Home MVA Hiah susoicion MM 19.5 y
9 05/01/02 05/02/02 Expired MCC GCS < 12 MM29 Unk
10 05/06/02 05/18/02 SNF GSW Penetr + Ace N
11 06/04102 07/12/02 Rehab FALL GCS < 12 MM10 y
12 07/12/02 08/05/02 Home GSW Penetr trunk Fishennans y
13 07117102 07/18/02 Home ASSAULT GCS < 12 Fishermans y
14 08/01/02 08/03/02 Home MVA Hiah susoicion MM74 N
15 08/08102 08116/02 Home BOAT PROP None Islamorada N
16 08/25/02 08/27/02 Home MVA GCS < 12 MM83 Y
17 09/08102 09108/02 Home MVA GCS < 12 Mariners N
18 09/10/02 10116/02 Home GSW Penetr head N
19 09/15/02 09130/02 Home MCC 2 lona bone MM86 N
20 10/07/02 10/09/02 Expired PHBC GCS < 12 MM28 y
21 10/08102 10/30/02 Transfer MVA GCS < 12 MM 57.5 y
22 10/19/02 10/20/02 Home FALL GCS < 12 MM 65-Fish N
23 10/24/02 10/25/02 Home MVA Hiah susoicion MM65 N
24 11/09/02 11/14/02 Home FALL (para) RR>30 Marathon Aimort N
25 11/09/02 11/15/02 Home FALL (oara) Hiah suspicion Marathon Airoort N
26 11/15/02 12/07/02 Home MVA Hiah susoicion MM52 y
27 11/22102 11/26/02 Home MVA GCS < 12 MM56 Y
28 12/07/02 12/16/02 Home MCC GCS < 12 MM 27-Fish y
29 12/29/02 01/02/03 Home GSW Penetr trunk Bia Pine Y
30 01/03103 01/03/03 AMA FALL Paralvsis ?Kev Y
31 01/03103 01/11/03 Home PHBC Hiah suspicion Boca Chica Bridcie N
32 01/22/03 01/25/03 Home MVA Soinal cord MM 19.5 Y
33 02/10103 02/10/03 Home FALL GCS < 12 MM78 N
34 03/06103 08107/03 Home MVA GCS < 12 MM41 N
35 03/09/03 04/04/03 Home MVA SBP <90 MM24 y
36 03109/03 03/09/03 Home MVA Hiah suspicion MM36 N
37 03/14/03 03115/03 Home BURN Bum Fishermans N
38 03/19/03 03/21103 VAH MVA GCS < 12 MM 61-Fish N
39 03121/03 04/07103 Expired MVA GCS < 12 MM47 N
40 03121/03 06105103 Nursing home FALL GCS < 12 Fishennans y
41 03/26/03 03/28/03 Home Hiah susDicion Fishennans y
42 04/28/03 06/10/03 Vent facility MCC GCS < 12 MM10 y
43 04/28/03 05/05103 Home MCC GCS < 12 MM10 Y
44 05/04103 05/15/03 Home MVA GCS < 12 Y
45 05/08/03 05/14/03 Home MVA GCS < 12 Deer Kev y
46 05/03103 MCC MM82.5
47 05108/03 05/21/03 Home CRUSH Hiah suspicion y
48 05/09/03 05/13/03 Home PENETRATING Penetr trunk Y
49 05/09/03 05/10/03 Home ASSUALT Hiah suspicion
50 0511 0/03 05/15/03 Home GCS < 12 Y
51 05/25/03 OS/29/03 Home MVA N
52 06/05/03 07/11/03 Home MCC AMPUTATION Y
53 07/05/03 08/29/03 Home MCC 2 lona bone MM27 y
54 09/23/03 10/02/03 Home Bike None y
Source: Ryder Trauma Center
\ \ " n t /;
~
-...,
cc:
...-'
~
~
~
r
RECEIVED-..~.~.'....".
~i.
OCT , j 2004 .;
f
September 30, 2004
Jim L. Roberts, County Administrator
Monroe County Government
5100 College Road, Wing II, Room 212
Key West, Fl33040
COUNTY ADMINISTRATOR
Re: Monroe County Trauma System Study Group Continued Staff Support
Dear Mr. Roberts:
The Health Council of South Florida (Council) is interested in continuation of its
providing staff support to the Monroe County Trauma System Study Group. The
total funding requested for staff support activities is $7,343.
As described in the Study Group's Interim Report, members have been actively
involved in identifying the best strategy to maintain local air trauma transport
service for the Middle and Lower Keys. From their recent meeting held on
September 22, 2004, the Study Group decided to convene additional meetings to
determine possible ways of funding trauma care provided to uninsured and
indigent patients of the Middle and Lower Keys. The Study Group
recommended the Health Council continue in its technical support role to the
members as they pursue the development of strategies and interventions to
improve the regional trauma system.
The Council recognizes the dedication of Study Group members and is
submitting this proposal in support of the Study Group's extended activities. The
following information briefly describes the proposed scope of work, projected
timelines, and the budget.
Scope of Work
The Council proposes to continue attending and recording minutes for five
scheduled monthly meetings, distribute meeting minutes to the study group's
voting members and technical experts, conduct secondary research on areas (e.g.,
Health Care Responsibility Act [HCRA] funds, taxing district funds) identified
by the Trauma System Study Group, and develop a final report of the Trauma
System Study Group's findings and recommendations. Monroe County has
expressed interest to continue scheduling and noticing the meetings.
Our mission is to engage in
community-based planning
that improves health and
promotes wellness in
Miami-Oade and Monroe
Counties.
8095 NW 12 Street
Suite 300
Miami, FL 33126
Tel 305592.1452
Fax 305.592.0589
www.healthcouncil.org
e-mail hcsf@healthcouncilorg
Officers
Max B. Rolhman, JD, U M.
Ch~ir
Liz K8rn, R.N
Vice Chair
Albert Collazo
Treasurer
Debbie Premaza, R N , B SN
SerrelC1ry
Board Mem bers
Castell Vauglm Bryan!. rdD
Tllomas L Garvin, MD.
Paul Gluck. M.D
Charles Gray
Kerry ShellJY CPA
Ana Rila Velazquez, SeD.
Executive Director
Sonya R. Albury
An Equal OpportufJlfy Emplove!
JJ-Cj
Timeline
Activity Date
Trauma Study Group monthly meeting November 2004 - April 2005
participation and meeting minutes distribution
(5 meetings)
Research/Pinal Report Development December 2004 - April 2005
Pinal Report Submission May 13, 2005
Budget
Activity Funding Source
Monroe County Trauma Total Monroe County Monroe County SOCC Health Council
System Study Group Cost SOCC In-Kind Support In-Kind Support
Personnel
Executive Director $1,200 $720 $480
Health Planner $5,600 $5.400 $200
Administrative Assistant $500 $500
Subtotal Personnel $7,300 $6,620
Operating Expenses
Staff Travel $500 $500
Printing, Duplication & Mailing $223 $223
Telephone $100 $100
Subtotal Expenses $823 $723
Total $fJ,123 $7,343 $780
The proposed funding is requested in two installments of $3,671.50 on December 15, 2004 and March 15,
2005. The Council is thankful to be considered as the organization of choice to assist the Study Group
improve the delivery of trauma care services for residents in the Lower and Middle Keys. I appreciate
your consideration of this proposal. Please feel free to contact me or Troy Johnson, Health Planner, if
there any questions.
Thank you.
Sincerely, R: ad
~~~. 7
Sonya R. Albury
Executive Director