Maine EMS Trauma System
Welcome from the TAC Chair
Welcome, and thanks for visiting the Maine Trauma System’s web page.
This site has been created by the Maine EMS Trauma Advisory Committee (the TAC) as a general guide and reference for Maine trauma care providers at every level. We hope that it will become a useful tool for sharing knowledge and experience among your community of colleagues, from prevention through rescue, resuscitation, recovery, and rehabilitation.
Trauma (physical injury) can be an especially difficult, time-sensitive, and unforgiving disease; and optimal, systematic trauma care in Maine presents its own unique challenges. Ours is a very rural state, with diverse geography and climate, and diffuse clinical resources. Although trauma is conventionally thought of as a disease of the young, Maine’s injury patterns reflect our aging population, complete with comorbidities and chronic medications. And where urban trauma systems see high rates of penetrating injuries (mostly discrete, easily identified, and surgery-friendly), Maine trauma patients overwhelmingly suffer blunt mechanisms (multi-system, diagnostically challenging, and operatively unpredictable).
Although most of the basic principles of trauma care are global, some do not cleanly translate to these unique circumstances. Indeed, Maine has learned (or devised) special responses and practices which serve as models for other rural systems. From our voluntary, inclusive state trauma system, to our focused trauma system triage algorithm, to our experience-driven regionalization, award-winning critical care transport systems, robust performance improvement, ground-breaking outreach programs, and state-of-the-art technologies, Maine offers much to learn from and be proud of.
The Consensus Guidelines are produced and listed here to assist Trauma System Hospitals with their trauma clinical decision-making and practices and to establish System-wide practice expectations. The Trauma Technical Assistance Program materials describe a program available, at no charge, to Trauma System Hospitals. It is recommended that Trauma System Hospitals utilize this program no less frequently than every five years to make sure that their clinical decision-making process for trauma meets contemporary standards of care.
Please explore and enjoy the site, and know that the TAC appreciates any constructive advice on how to make this site more useful, informative, or interesting for its audience.
Thanks.
Preston R. “Pret” Bjorn, RN
Chair, MEMS-TAC
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Contact Information
The following is contact information for general administrative purposes, and for the purpose of consulting Trauma Center staff for the care and possible referral of trauma patients.
General Administrative Contacts:
Maine EMS Trauma System Manager (for Trauma Technical Assistance Program, Trauma Advisory Committee, and other statewide Trauma System issues):
Regional Trauma Coordinators
(For trauma service matters at their respective Regional Trauma Centers, outreach visits, feedback on referred patients, and trauma data for facilities in that general Trauma Center region):
- Doris Laslie, RN, Central Maine Medical Center - see contact information below
- Pret Bjorn, RN, Eastern Maine Medical Center - see contact information below
- Tammy Lachance, RN, Maine Medical Center - see contact information below
Regional Trauma Centers: Consultation and Transfer Contacts
(Including administrative, patient follow-up and other purposes as specified below):
In contacting any of the three regional trauma centers for clinical consultation or patient transfer, you should contact the “one call” numbers listed below to request the trauma service or other service as specified:
- Central Maine Medical Center:
- For consult or transfer, call “CMMC Connect” at 1-877-366-7700 to be connected with a trauma surgeon.
- For feedback or administrative issues, call Trauma Director: 795-2869, or Regional Trauma Coordinator: 795-2869 (ask for Doris Laslie, RN)
- Eastern Maine Medical Center
- For consult or transfer, call 207-973-9000
- For feedback or administrative issues:
- Maine Medical Center:
- For consult or transfer call “MMC One Call” at 866-662-6632.
- For feedback or administrative issues, call Trauma Medical Director: 774-2381 (ask for Dr. Rob Winchell - winchr@mmc.org) or Regional Trauma Coordinator: 774-2381 extension 316 (ask for Tammy Lachance - lachat@mmc.org)
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Maine EMS Trauma System - Purpose, History and Organization
Purpose
Since 1992, the Maine EMS (MEMS) Trauma Advisory Committee (TAC) has developed an organized System of trauma care to reduce morbidity and mortality from the most serious injuries and assure equally appropriate care for all other injuries. To accomplish this, the Maine Trauma System promotes efficient and effective prehospital and hospital clinical-decision-making to treat and route patients to the most appropriate source of care for the type and severity of their injury. Such decision-making provides the trauma patient with definitive emergency care resources from the statewide System, including those organized for the System in other areas of New England. All Maine hospitals which treat injury patients serve as portals to that System.
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History & Organization
By the end of the Vietnam War, it had become apparent that war trauma mortality and morbidity was significantly impacted by the military’s organized system of trauma care. Soon these principles were adapted for civilian trauma care systems. Organized regional trauma systems in Maryland and Orange County California demonstrated significantly lower morbidity and mortality for trauma victims. These successes led to the first Federal funding of formal trauma system development in the late 1970's and early 1980's.
The trauma systems that developed relied on processes of designating regional trauma centers that limited such designations to larger medical centers. As a result, smaller community hospitals and other institutions that provided a significant amount of care to the injured were left out of the evolving systems. With publicly advertised “Regional Trauma Center” designations, Regional Trauma Centers became overburdened with minor trauma cases that could have been cared for at local hospitals. Because of these and other difficulties, trauma system development stagnated.
Preventable death and morbidity did not abate. Rural areas in particular had higher morbidity and
mortality due to long transport times, and lack of organized trauma care. In the early 1990's,
Congress began to appreciate that rural areas could also benefit from organized trauma systems.
In 1992, Congress funded trauma system planning grants. Special consideration was given to
rural areas that lacked organized trauma systems.
In early 1992, Maine Emergency Medical Services, (MEMS), established a Trauma Advisory
Committee, (TAC), to create a statewide trauma plan. In September 1992, MEMS received a
Federal Trauma Planning grant to assist in that effort. The TAC, which has since been formalized by Maine Statute (5 MSRA §12004-I, sub-§49-B), has assisted MEMS in the establishment, implementation and management of a comprehensive Trauma System for the state. TAC members have been drawn from around the state. Membership includes surgeons, emergency physicians, nurses, prehospital care providers, hospital administrators representing the Maine Hospital Association, and concerned citizens. Leaders of the American College of Surgeons' Maine Committee on Trauma, Maine Chapter of the American College of Emergency Physicians, and the Emergency Nurses Association have all been actively involved, as have EMS system leaders.
The TAC worked to build a comprehensive, state-wide trauma system for Maine. Having learned from the missteps of earlier, national trauma system development efforts, and having seen national Regional Trauma Center designation processes expanded only marginally to include additional hospitals, Maine EMS’ TAC elected a different course. It chose to create a system which emphasized the inclusion of every acute care, emergency department equipped hospital in the state as either a Trauma System Hospital or a Regional Trauma Center. The TAC and MEMS’ Medical Direction and Practice Board (MDPB), which governs prehospital medical practices, added to this approach specific protocols and procedures for the stabilization of patients at the scene of injury and their movement to, and treatment at, hospitals most appropriate to the type and severity of injuries suffered.
Approximately 80% of these injured patients can be treated at hospitals closest to the scene of injury, and often closest to the patient’s home and family. Others may require stabilization at that hospital and then movement to another hospital in the System for care by surgical, rehabilitation and other specialty experts. Still others may need to be transported by ground or by air directly to Regional Trauma Centers with comprehensive services to treat major trauma.
Since under the Maine Trauma System, every hospital in the state is important to the functioning of the system, every hospital wishing and able to participate is eligible to be designated a Trauma System Hospital by Maine EMS. Those making the commitment to staff, equip, organize and operate to effectively treat the most severe and complex trauma patients are eligible to be designated as Maine EMS Regional Trauma Centers.
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Trauma System Hospitals
The responsibility and the challenge for every Trauma System Hospital is to provide effective and efficient clinical decision-making and trauma care, assure appropriate consultation and, when required, effect appropriate transfer to other facilities. The commitment of the Trauma System Hospital is to participate in the TAC Trauma Technical Assistance Program, and develop its own "Guide to Trauma Care in the Emergency Department" (with the assistance of MEMS staff to the Program) at least once every five years. It will also commit to participate in Regional Trauma Center outreach programs when they are offered. The reward for participation will be inclusion in a coordinated, approved system of care, patient outcome analysis, performance-based continuing education, and community recognition as a portal to a statewide System of trauma care resources. Other features of this commitment include:
- A functioning Emergency Department staffed with physicians or physician-extenders who regularly participate in trauma care continuing education, and participate effectively in the Maine EMS system of prehospital medical direction;
- Communication technology enabling effective and efficient medical direction of EMS personnel, and communications with specialty transport and trauma consulting resources (including tele-trauma systems when they are made available);
- A person designated as the primary Trauma System Hospital contact to work with the Maine EMS Regional Trauma Coordinator and State Trauma System Manager; and
- A commitment to Trauma System integration, participation in outreach educational and performance improvement programs and allowing quality improvement review of process and outcome of patient clinical interactions.
Hospitals Eligible for Trauma System Hospital Designation and Their Designation Status
The dates listed below are for the most recent designation as Trauma System Hospital following a Technical Assistance visit. A “1995” designation is the original designation and no Technical Assistance visit has been requested by the facility. Facilities in bold highlights are designated Trauma System Hospitals as of 2010.
- Aroostook Medical Center - 2006
- Blue Hill Memorial Hospital - 2004
- Bridgton Hospital -2012
- C.A. Dean Memorial Hospital - 2004
- Calais Regional Hospital - 2004
- Cary Medical Center - 1995
- Down East Community Hospital - 2012
- Franklin Memorial Hospital - 2003
- Goodall Hospital - 1995
- Houlton Regional Hospital - 2004
- Inland Hospital - 1995
- Maine Coast Memorial Hospital - 2009
- Maine General Hospital – Augusta Campus - 2012
- Maine General Hospital – Waterville Campus - 2010
- Mayo Regional Hospital - 2012
- Mercy Hospital - 1995
- Mid-Coast Hospital - 2010
- Miles Memorial Hospital - 2006
- Millinocket Regional Hospital - 1995
- Mount Desert Island Hospital - 2004
- Northern Maine Medical Center - 2005
- Parkview Hospital - 2006
- Penobscot Bay Medical Center - 2002
- Penobscot Valley Hospital - 2008
- Redington-Fairview General Hospital - 2006
- Rumford Community Hospital - 1995
- Saint Andrew's Hospital - 2004
- Saint Joseph’s Hospital - 1995
- St. Mary’s General Hospital - 1995
- Sebasticook Valley Hospital - 2005
- Southern Maine Medical Center - 1995
- Stephens Memorial Hospital - 2009
- Waldo County General Hospital - 2009
- York Hospital - 1995
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Regional Trauma Centers
Hospitals committed and able to provide a comprehensive array of trauma care and Trauma System support resources may elect to be designated as a Regional Trauma Center. A major requirement is institutional and medical staff commitment to trauma management, with an institutionally-recognized, surgeon-led trauma service. Specific features of this commitment include:
- Current verification as an American College of Surgeons (ACS) Level I or level II trauma center and maintenance of the resources as described in the Hospital Resource Table (below);
- Staffing with at least one full time equivalent trauma nurse coordinator, who will serve as a Maine EMS Regional Trauma Coordinator for the general catchment area of the RTC, to provide clinical, educational, and data/analytic services, and support of the Maine Trauma System;
- Participation in a statewide standardized system of trauma patient feedback to referring TSH and EMS staff, and a standardized method of regional and statewide reporting of System activity and outcomes;
- Facilitation of a system of outreach programs to TSHs in the RTC general catchment area, and active participation by staff in TAC Technical Assistance Program activities for TSHs; and,
- General support and reasonable funding of the development and maintenance of the Trauma System, locally, regionally, and statewide.
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Designated Maine EMS Regional Trauma Centers:
- Central Maine Medical Center, Lewiston
- Eastern Maine Medical Center, Bangor
- Maine Medical Center, Portland
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