TRAC V SYSTEM ACCESS

Basic 911

Basic 911 is a regional system providing dedicated trunk lines, which allow direct routing of emergency calls. Routing is based on the telephone exchange area, and not municipal boundaries.  Automatic number identification (ANI) and   Automatic   location (ALI) are not provided with Basic 911.  There are no basic 911 systems within the Rio Grande Valley 911 Emergency Communications Plan.

Enhanced 911

Enhanced 911 is a system, which automatically routes emergency calls to a pre-   selected answering point based upon the geographical location from where the call originated.  A caller dialing the digits 9-1-1 is routed to the local telephone company central office or CO. The telephone number or ANI is then sent to the public safety answering point (PSAP). With automatic location identification and selective routing, the call is sent to the CO and the computer (9-1-1 database) assigns an address to the phone number, then routes the call to the designated PSAP.

In TSA-V, the primary emergency Communication System for public access is enhanced 911. The emergency   communications   system   was   implemented   providing   citizen’s   access   to emergency communications to municipalities and counties.

ANI is a system capability that enables an automatic display of the seven-digit number of the telephone used to place a 911 call.  ALI is a system that enables the automatic display of the calling party’s name, address and other information.

Alternative Routing (AR) is a selective routing feature, which allows 911 calls to be routed to     a designated alternative location of all incoming 911 lines, are busy of the central system (PSAP) closed down for a period of time.

Selective Routing (SR) is a telephone system that enables 911 calls from a defined geographical area to be answered at a pre-designated PSAP.

Communications Network

The “Cameron County 911” administers the lower Rio Grande Valley Emergency Medical Services Emergency Communications systems for the county. The communications systems include the following cities: Brownsville, Harlingen, Los Fresnos, South Padre Island and Port Isabel.

The Lower Rio Grande Valley Development Council administers the 911 System for all of Hidalgo County and Willacy   County.

 

TRAC V COMMUNICATIONS

 Communication/Dispatch Centers in Trauma Service Area V

 

Center Location	Level of Resources	Radio Frequencies	Contact      Information	Phone Number
Brownsville Fire EMS Brownsville	911 Certified Dispatch PD	800 MHz Trunking Digital System	Sam Ortega, EMT-P	Sam@brownsvilletx.gov (956) 564-3195
SPI Fire EMS South Padre Island	911 Certified PD Dispatched	800 MHz Trunking Digital System	Oziel Garcia, EMT-P	ozielg@myspi.org (956) 761-6465
P.I. EMS Port Isabel	911 Police PD Dispatched	800 MHz Trunking Digital System	Charlie Wood, EMT-P	cwood@copitx.com (956) 943-2029
L. F. EMS Los Fresnos	911 Police PD Dispatched	800 MHz Trunking Digital System	Gene Daniels, EMT-P	lfems@yahoo.com (956) 640-7240
STEC EMS Harlingen	911 EMD Certified In-House Dispatched	800 MHz Trunking Digital System	Rene Perez, LP	rperez@stec-ems.org (956) 364-2711
Willacy County EMS Raymondville	911 EMD Certified In-House Dispatched	800 MHz Trunking Digital System	Frank Torres, EMT-P	willems@prontonet.net (956) 689-5456
Mercedes Fire EMS Mercedes	911 Certified Mid-Valley Dispatched	800 MHz Trunking Digital System	Javier Campos, EMT-P	jcampos@cityofmercedes.com (956) 565-7755
Weslaco Fire EMS Weslaco	911 Certified Mid-Valley Dispatched	800 MHz Trunking Digital System	Antonio Lopez, LP	anlopez@weslacotx.gov (956) 447-3415
Pharr EMS Pharr	911 Certified PD Dispatched	800 MHz Trunking Digital System	Kenneth Ennis	kennith.ennis@pharr-tx.gov (956) 207-8787
Med Care EMS McAllen	911 EMD Certified In-House Dispatched	800 MHz Trunking Digital System	Mack Gilbert	mgilbert@medcare-ems.com (956) 369-0911
Palmview EMS Palmview	911 Certified PD Dispatched	800 MHz Trunking Digital System	Gerardo Alaniz	jalaniz@palmview.us (956) 432-0371
Starr County Memorial Hospital EMS Starr County	911 Dispatch Multi-Agency Dispatched	800 MHz Trunking Digital System	Rolando Ramirez	rolando.ramirez@starrcountyhospital.com (956) 500-2998

Communication for Multi-Agency Scene Personnel

All Counties in the TRAC are covered by enhanced 911. Emergency calls are routed through the 911 system.

Communications varies from county to county.  Not all EMS systems in the TRAC utilize certified medics for dispatch.   The   larger   communications   centers   are   staffed with EMD personnel and provide pre-arrival instructions.

Programs and refer to the flip charts (manual or computerized) when needed. Many systems have calls routed through various other agencies, such as local law enforcement office.

One weakness that has been observed in the TRAC is that some private providers operate on leased business radio frequencies making communications difficult in the event of a major disaster. All of the major 911 EMS providers in the TRAC have the capability to communicate with other responding EMS agencies.

TRAC-V faces difficulties found only along the Border. Radio interference from transmissions in Mexico have long been a problem. The new communications systems are designed to alleviate this problem. Additionally, numerous Federal Agencies to include the U. S. Border Patrol, Customs Service, Coast Guard and the DEA operate in the area.   There are hundreds     of radios operated by these agencies. Border Patrol is able to communicate direct or by landline to the Emergency response agencies.

Our goal is to improve communications throughout the TRAC. Due to vast expanse of the area and the fact that the TRAC is comprised of Counties along the Border, designing a system         to service the length and breadth of the area will require multiple towers and transmission sites at a very high cost. The TRAC is taking the lead in evaluating solutions to these difficult problems.

Conclusion:

Alternatives presently in place for communicating between multiple agencies:

1. Valley wide fire frequency for fire and EMS
2. Texas EMS and Hospital Frequency 340
3. Brownsville & Harlingen has the capability of VHF/UHF trunking PATCH
4. Cell phones

Communications between TRAC members and the office is accomplished by fax, phone, and email (cindy@tsav.org) as well as the newly developed EMSystem.

AIR MEDICAL ACTIVATION GUIDELINES

Air Medical Activation Plan

 Purpose: These Air Medical Provider (AMP) activation guidelines are intended to provide a standardized method for ground emergency medical service providers to request a scene response by an AMP, to reduce delays in providing optimal care for severely ill or injured patients, and to decrease mortality and morbidity. AMP resources should be utilized in accordance with the regional trauma plan.

Guidelines for Activation & Selection of AMP:

1. The EMS provider should comply with TRAC-V approved triage criteria to activate AMP transport should be considered.

 

Factors that should be considered are:
A. Location of incident	E. Weather /Visibility at the scene	I. Diversions
B.  Number of patientsC.  Age of patientsD.  Scene / LZ Obstructions	F.  If any other AMP was requestedG.  Response time of AMP(s) ***H.  Distance to AMI/Stroke Centers	J. MCI event

*** The total AMP response time (response time + scene time + transport time) will result in delivery of the patient(s) to the most appropriate trauma designated facility faster than transport by ground ambulance.

If the patient requires an airway and patient requires Rapid Sequence intubation ((RSI) and is not available with ground EMS, AMP activation should be considered.

Other considerations: Trauma patients meeting criteria for AMP dispatch should be transported to the nearest appropriate Trauma designated facility.

AMP Selection Considerations: The following parameters may be considered in the development of TRAC-V AMP activation criteria when more than one AMP provides service in the Trauma Service Area (TSA):

1. The AMP should meet the minimum TRAC -V participation standards in the TRAC in their primary service area;
2. The AMP should participate as requested in TRAC-V performance improvement activities;
3. The AMP utilized for patient treatment and transport should be the AMP that best meets the patient’s care and transport needs, including:
4. Performance criteria (dispatch + response time + scene time + transport time) Clinical capabilities• Operational interface and safety. AMP should demonstrate safe operations at all times. Safe operations standards include safety standards such as those endorsed by the Federal Aviation Administration, the National Association of EMS Pilots, National Association of Air Medical Services and the Committee on Accreditation of Air Medical Transportation.• Clinical and operational performance improvement (PI) practices.

Diversion Policy

Subject: Diversion of Ambulance Traffic from Emergency Facilities

Purpose: To develop a standardized diversion policy that identifies area specific trauma resources and assures continual access to the appropriate trauma facility for each trauma patient.

Statements: System hospital facilities, both Trauma Center and non-Trauma centers, should request diversion activation only when the resources and capabilities of that facility have been exhausted to the point that further ambulance traffic would jeopardize the care and treatment of patients at that facility as well as any subsequent patient transported by an ambulance.

It is recognized in advance that no diversion strategy can guarantee total compliance with these guidelines and it is likely that ambulances will deliver patients to hospitals which have requested diversion activation. It is further understood that a request for diversion activation is honored as a courtesy by the local EMS system. All Requests for Diversion are for CODE 1 Status Patients Only.

Diversion requests DO NOT apply to those patients with extremely life-threatening conditions (e.g. cardiac or respiratory compromise, Cardiac Arrest, lack of airway control or other problems that must be immediately addressed by a physician).

Procedure:

1. Each facility will develop procedures for their facility to be placed on diversion status and procedures for implementation of these guidelines including regional notification

 A.  Suggested reasons for facility diversion for Provisional requests might       include, but not limited to:

• Trauma Surgeon/General surgeon/Orthopedic Surgeon/Neurosurgeon is not available
• Inoperable CT Scanner
• Multiple Critical Patients in the ED or Numerous ED Hold

B.  Priority Requests might include, but not limited to:

Physical Plant Failure/Structural Compromise Disaster Activation Response

C.  Detailed Requests

No in-house bed availability

(ICU, Pediatrics, Telemetry, Med/Surg)

2.  Each facility shall designate a person responsible for decisions regarding diversion status. The Trauma Medical Directors in conjunction with the Emergency Department physician shall be notified in cases of Trauma

3.  Each facility must have a Local Mass Casualty plan and know how to activate the other resources within the TSA-V if

4.  Each facility must have policies and procedures in place to open critical beds in the event of a mass casualty.

5.  Communication of Diversion Status:

A representative from hospital administration must notify EMResourse, an online medical           direction source.

6.  Time Period for diversion status:

Diversion request will be in allotments up to eight (4) hours of four hours with updates in             EMResource every four hours. A hospital may deactivate a diversion request at any time.

7.  EMS shall inform the patient and or family of the diversion status of this facility and the               distance to the next closest facility. EMS may override the family’s request if it is deemed             necessary to transport to said facility in order to obtain the level of care necessary for                   treating the patient. Online medical control should be notified if the patient or family                     request the diverted facility or severity of the patient warrants EMS to transport there for             stabilization. Section 1867 does not obligate the ambulance service to transport the patient         to that Hospital.

8.  Each EMS system will be requested to document and report to the TSA “V” QI Committee             those situations where a diversion request has not been honored.

HCFA Division of Health Standards and Quality Bureau (HSCB) Section 1867 (c) (2). Social Security Act 1867 defines “Appropriate Transfer”.

EXAM AND TREATMENT FOR EMERGENCY MEDICAL CONDITIONS AND WOMEN IN LABOR

TRAC – V TRAUMA FACILITY BYPASS PLAN

 GOAL: Trauma patients who are medically unstable, unconscious, or at high risk for multiple and/or severe injuries will be quickly identified and transported to an appropriate trauma system hospital.

Decision Criteria:

Transportation protocols must ensure that patients who meet triage criteria as outlined in the TRAC-V Triage Decision Scheme Bypass Protocols will be transported directly to an appropriate trauma facility rather than the nearest hospital except under the following circumstances.

1. If unable to establish and/or maintain an adequate airway, or in the case of traumatic cardiac arrest.

 

2. A Level IV facility may be appropriate if the expected transport time to Level III trauma center is excessive (>20min) and there is a qualified physician at the Level IV Facility’s Emergency

 

3. Medical control (EMS Medical Director) may wish to order bypass in any of the above situation as appropriate, such as when a facility is unable to meet hospital or when there are patients in need of specialty care

 

4. If expected transport time to the nearest facility is excessive (>30 min) or if prolonged extrication time is expected, the EMS crew or medical control may consider activation of air transportation resources if they are available within the area. Refer to air medical evacuation guidelines.

TRAC V REGIONAL MEDICAL CONTROL

Currently, each provider utilizes their medical control through their unit radios or hand-helds.  All 911 providers are on 800 Trunked Analog/Digital Frequencies; however, there are a few non- 911 providers that are still on VHF. If the radio communications are down, the providers do have cellular and digital telephones as well as a Microwave communications system that are available to them.

Currently, the enhanced 911 system is available in every county. Currently all providers are dispatched by 911 call centers. The 3 private services that are contracted by the cities to provide their 911 service have enhanced 911 system located at their facility. The remaining private providers that provide 911 service are dispatch through the enhanced 911 service provided by that County.

TRAC V FACILITY TRIAGE CRITERIA

 Purpose:

The purpose of the Regional Facility Triage Criteria Scheme is:

1. To categorize patients for determination of facility transport and/or transfer
2. To specify facility action plans for transfer of patients
3. To include pediatric and burn criteria for patient transport and/or

Description of the Facility Triage Action Plan:

The Triage decision scheme is an algorithmic approach to differentiating patient categories as well as mechanism of injury for stabilization and determination for transfer to a higher level of care facility.

Patient categories define the severity of the patients according to critical and urgent. Critical patients meet criteria for instability of hemodynamic and neurological functions, as well as specific anatomical injury patterns that place them at a high suspicion for significant risk. These patients generally meet the requirement for trauma code activation. Urgent categorized patients are those that are evaluated for evidence of mechanism of injury, high energy impact and age or disease specific history and in most cases, meet the activation of trauma alert activation.

The facility triage action plan is included below to assist the facilities in determining where a trauma patient should be transferred. General guidelines for admission service and guidelines for transport, to ensure “the right patient gets to the right facility, in the right amount of time”.

Rio Grande Valley Trauma Regional Advisory Committee Facility Triage Action Plan

 

Patient Arrives At	Critical Adult Patient	Urgent Adult Patient	Critical or Urgent Pediatric Patient	Critical or Urgent Burn Patient
Level III	Assess patient & Stabilize. If specialists available may admit or consider transport to nearest higher level of care.	Assess patient & Stabilize. If Specialist available may Admit or consider transport To nearest higher level of care.	Assess patient & Stabilize. For Critical patients consider transfer to Pediatric facility ASAP.	Assess patient & Stabilize. For critical patients Consider transfer to Pediatric Facility ASAP.
Level IV	Stabilize and transfer ASAP	Stabilize and transfer ASAP	Assess patient & Stabilize. Transfer To Pediatric Facility ASAP.	Stabilize and transfer ASAP.

 

TRAC V INTER VALLEY HOSPITAL TRANSFERS

Inter-valley trauma transfers will adhere to the EMTALA guidelines and will be carried out in accordance with the individual hospitals transfer policies and procedures, including but not limited to the MOT, notification process and transportation arrangements.

It is essential that trauma patients presenting to any of the facilities, who will require transfer to a higher level of care, or for services not available are identified expeditiously. This process will be monitored by the hospitals Quality Assurance/Performance Improvement process for appropriate completion of transfer arrangements and rapid transport to an appropriate facility.

To provide the highest quality of trauma care and in accordance with Department of State Health Services Guidelines any required communication or Performance Improvement information will be exchanged between trauma coordinators/managers. All information utilized for performance improvement purposes is considered confidential and non-discoverable.

Any system or care issue identified will be discussed with the trauma coordinator/manager or trauma medical director, if no resolution is obtained, information may be forwarded to the Trauma Regional Advisory Council Quality Assurance Committee for review.

Each individual facility is required to maintain a trauma database in order to meet the minimum requirements for designation and is required to upload their data to the state on a quarterly basis. Since all of the hospitals have been designated, they now have the ability to perform this function.

Texas Trauma Registry: injury.web@dshs.state.tx.us (512) 776-7268

Each facility has also determined and implemented a method to determine which patients meet their criteria for inclusion into their facilities database according to the definitions developed by the Texas Department of Health and the American College of Surgeons.

BYPASS PROTOCOL FOR MAJOR TRAUMA

COVID-19 EMERGENCY MEDICAL NON-TRANSPORT GUIDANCE EMS TRANSPORTING

CONFIRMED OR SUSPECTED COVID 19 PATIENTS

BYPASS PROTOCOL FOR MAJOR TRAUMA

TRAC V Regional Education

Regional Education falls under two categories. Improving public awareness of the Trauma Regional Advisory Council and its mission and to provide quality educational events to the health care providers in the region. To accomplish these tasks the Trauma Regional Advisory Council utilizes the Injury Prevention/Public Education/Special Populations, Allied Health and Stroke committees.  Health care provider education is accomplished in a variety of ways. The Trauma Regional Advisory Council is committed to providing one massive educational event per year. This event is known as the South Padre Island Trauma Symposium. Participants from across the Valley and State participate in the event and presenters from around the county are invited to speak.

Another method used to facilitate trauma education in the region is local resources. The Rio Grande Valley offers a wide variety of educational resources for all levels of health care providers from pre- hospital employees to trauma surgeons.

Currently, South Texas College, Texas State Technical College and the University of Texas Brownsville offer a wide variety of topics for Pre-Hospital Providers. Hospitals in the region have become active educators through collaboration with the trauma coordinator.

Courses offered regularly in the Rio Grande Valley, by prehospital providers, health care and educational institutions include but are not limited to: CPR &BLS, PHTLS (Pre-Hospital Trauma Life Support), ACLS (Advanced Cardiac Life Support), PALS (Pediatric Advanced Life Support), PEPP (Pediatric Education Pre-Hospital Provider), ENPC (Emergency Nurses Pediatric Course), TNCC (Trauma Nursing Core Course) and ATLS (Advanced Trauma Life Support).

TRAC V SYSTEM QUALITY MANAGEMENT PROGRAM

Quality Assurance/Performance Improvement

CASE APP REVIEW

Quality Assurance/Performance Improvement Committee Case Review Request

 Instructions: You may submit any issue you define as a performance improvement issue that needs review. The QA/PI Committee, however, may decide the issue is not appropriate for system discussion and recommend that it is managed internally in your facility or agency. The QA/PI Committee meets monthly. You will be notified when your case is up for review. If you have any questions, please call 956-364-2022.

1. Please fill out the attached Quality Assurance/Performance Improvement Committee Case Review Request
2. Please FAX or email with a cover sheet to (956) 364-2022 cindy@tsav.org
3. Please include your contact information to ensure we are able to reach you for any questions about the

What happens to my submission?

Once your request has been received, you will receive confirmation within one business day from the TRAC QA/PI that your submission is being

1. Your request will be forwarded to the QA/PI Committee Chair, Co-Chair, and the TRAC Executive Director for review.
2. The QA/PI Committee Chair, Co-Chair, and TRAC Executive Director will make the determination if the case warrants presentation at Trauma QA/PI
3. All parties involved will be
4. If the case will be reviewed at System QA/PI Committee, TRAC will compile any associated documents and/or recordings necessary to provide to the QA/PI
5. All parties will be notified when the case is up for review and invited to the
6. Results of the review will be available on request to the involved

Confidentiality:

This document may contain CONFIDENTIAL

• All proceedings and records of the LRGV Regional Advisory Council on Trauma TRAC) Performance Improvement Committee are confidential. All professional review actions and communications made to or from the TRAC Quality Assurance/Performance Improvement Committee are privileged communications under Texas and federal law. TEX. OCC. CODE ANN. Chps. 151 and 160; Tex. Health and Safety Code § 161.032; and 42 USC §
• Your signature below indicates you understand that you are not to discuss any committee business outside of the committee, to include any/all written information, discussions, verbal testimony, etc. You also understand that failure to uphold these laws may result in criminal charges.

Signature                                                                     Date

Print Name:                                                                               

All proceedings and records of the LRGV Trauma Regional Advisory Council Performance Improvement Committee are confidential. All professional review actions and communications made to or from the LRGV Trauma Regional Advisory

 

Council Performance Improvement Committee Case Review Request

 Today’s date:                                                                                                         Your Name and Title:                                                  

Name

Title

Name and Title of Person                                           Referring the case: Name

(if different)                                                                 Title

Your Facility or Agency

Name:                                                                         

Date of Event:                                                                                                                          Your Contact Phone

Number and Email:                                                   

Phone Number

Email

Note: the QA/PI Committee reviews system issues. You may submit any issue you define as a system issue that needs review. The QA/PI Committee, however, may decide the issue is not appropriate for system discussion and recommend that it is managed internally in your facility or agency. The QA/PI Committee will meet monthly.

Please describe the event:

 

What actions have you taken to address the problem? (Example: contacted agency PI person and requested run sheet/chart; talked with PI person and informed them of issue, etc.)

All proceedings and records of the LRGV Trauma Regional Advisory Council Performance Improvement Committee are confidential. All professional review actions and communications made to or from the LRGV Trauma Regional Advisory

 Initial Review by QA/PI Chair

 Date reviewed:                            

Regional System Issue Determination: regional issue, appropriate for QA/PI Committee

    non-regional issue between the involved entities

    trend that should be reviewed by QA/PI Committee

Recommendation:

(check all that apply)

__ Refer to QA/PI Committee

__ More in-depth information is required

      Do not refer to QA/PI Committee

Chair or designee will discuss with referring agency or facility to obtain Hospital or Facility Name

Names and specifics.

Hospital or Facility Name:     ________________________________________

EMS or Agency Name: ______________________________________________

Other Committee Review: __________________________________________

Date referred to QA/PI Committee:                                                                     

Summary of Discussion:                                                              

Determination:

         regional system issue

          regional system issue but requires review by committee due to a trend

          not a regional system issue and will be referred back for internal review

 

Determination:    System related    Disease Related     Provider related cannot be determined

Preventability: Non-preventable Non-preventable with opportunity for improvement Potentially preventable Preventable Cannot be determined

Corrective Actions:    Unnecessary    Trend    Education     Guideline / Protocol Counseling Peer-review presentation Resource Enhancement Process Improvement Privilege/credentialing action Other

All proceedings and records of the LRGV Trauma Regional Advisory Council Performance Improvement Committee are confidential. All professional review actions and communications made to or from the LRGV Trauma Regional Advisory Council Performance Improvement Committee are privileged communications under Texas and federal law. TEX. OCC. CODE ANN. Chps. 151 and 160; Tex. Health and Safety Code § 161.032; and 42 USC § 11101.

 

 Corrective Action(s):

 

          Requires written communication from TRAC in the form of:

          Recommendations for improvement

1. _____________________________________________
2. _____________________________________________
3. _____________________________________________

          Education on:

          One-on-one discussion between:

And                                                                                                   

          Referral to home RAC (if outside TSA-V)

          Requires verbal communication

          Communication is unnecessary

          Communication is inappropriate

Person(s) responsible for taking corrective action(s):

Date to be completed:                                          

Completion Date:                                                 

Signature of QA/PI Chair

Date of Signature

 

All proceedings and records of the LRGV Trauma Regional Advisory Council Performance Improvement Committee are confidential. All professional review actions and communications made to or from the LRGV Trauma Regional Advisory Council Performance Improvement Committee are privileged communications under Texas and federal law. TEX. OCC. CODE ANN. Chps. 151 and 160; Tex. Health and Safety Code § 161.032; and 42 USC § 11101.