Trauma System Report Released with Recommendations

July 31, 2019

To:                   Chief Executive Officers, Chief Operating Officers, and Government Affairs Representatives

From:              Lauren McDonald, Policy Director, Health Access | (206) 277-1821

Subject:          Trauma System Report Released with Recommendations


On July 25, the Department of Health (DOH) released a long-anticipated report on the status of Washington’s trauma system. The report was conducted by the American College of Surgeons Committee on Trauma as part of their Trauma System Consultation Program. The recommendations made by the Committee will likely spark debate about future funding, trauma level designation, data needs, new or updated regulations, and supports to ensure Washington has a strong trauma system that is able to meet the needs of a growing population.


This report makes recommendations to modernize the trauma system to meet the needs of Washington’s growing population into the future.  The findings in the report will be of interest to many hospitals, as each hospital plays an important part of the state’s trauma system. Future funding decisions and changes to the regulations governing the system will impact all acute care hospitals in Washington state.


  • Review the report to understand the vulnerabilities identified impacting trauma care in your community.
  • Reach out to Lauren McDonald if the report sparks specific concerns for your hospital.
  • Be on the lookout for additional communications from WSHA regarding next steps that the state will be taking to address the challenges and recommendations included in the report.
  • Secretary Wiesman of DOH has indicated that he will hold four stakeholder meetings across the state to gather feedback on the report. WSHA will communicate about these meetings once specific dates and times are announced. Hospitals should plan on attending.

Key Findings from the Report

The American College of Surgeons Committee on Trauma, which conducted the report, includes a multidisciplinary panel of nationally-recognized experts in the field of trauma care. Their report includes an assessment of strengths of Washington’s trauma system, in addition to challenges and recommendations to address vulnerabilities.

The report noted the ability of local communities to use creative methods to help them make good use of the funds available, engagement from both long-time, seasoned EMS medical directors and the state’s leadership, and a strong state template for triage and destination protocols as just a few of the assets of Washington’s trauma system (more are listed on pages 9-11 of the report).

Overarching challenges to our state’s trauma system identified in the report include:

  • “Funding has not scaled with population growth to take the system to the next level of development.
  • There has been a decentralization of responsibility within the system, with an imbalance between delegation of responsibilities and resources distributed to regions.
  • Regions are significantly under-resourced for their contractual responsibilities.
  • There is a lack of strong public, community, and legislative engagement within the system.
  • There is a lack of surge capacity within the system.
  • The system is at a good point to reassess its vision and future direction.”

In addition to the overall findings, the following “priority recommendations” that may be of interest to hospitals include that the state:

  • Perform a formal data-based gap analysis of the Washington State Trauma System.
  • Ensure that EMS assets are strategically placed and sufficient in number to meet the needs of the state’s population, including air and critical care ground transport.
  • Establish a clear and transparent process for calculation of minimum/maximum numbers for trauma centers in each region, based on a uniform statewide approach with potential for regional adjustment.
  • Re-evaluate the purpose and function of the Level I trauma center role and adjust requirements as necessary.
  • Seek additional and sustainable system-wide funding to support the EMS, Trauma, Cardiac and Stroke Care System.
  • Realign the composition of the eight EMS and Trauma Regional Councils with that of the State EMS and Trauma Care Steering Committee to ensure adequate representation of all stakeholders in regional systems planning and oversight.
  • Mandate that all EMS agencies submit data into the WEMSIS system, and develop data linkages with the trauma registry.
  • Ensure trauma destination protocols are consistently followed by EMS agencies.
  • Establish an objective and standardized statewide process to revise the Minimum and Maximum criteria for the number of EMS agencies in the system.
  • Develop a regional contingency plan and system redundancy plan in the event Level I and II centers become incapacitated.
  • Develop a master plan for system performance improvement at the state and regional levels to implement and complete data-driven performance improvement initiatives.

Additional priority recommendations are included on pages 16-17 of the report.

Overview of Washington’s Trauma System

The state’s EMS and Trauma Care System is led by the Department of Health, which has responsibility for enacting regulatory statues, operate the grant program for designated trauma care services and provides leadership and oversight to the System. Washington also has local and regional Emergency Medical Services and Trauma Care Councils that oversee local and regional system development. This structure was passed by the legislature in 1990. Since then, there have been changes to the system, but no additional funding.

Next Steps

WSHA staff is conducting a more complete analysis of the trauma report and is communicating with DOH staff regarding their next steps and anticipated actions in response to the report. WSHA members can expect to receive updates when information is available regarding steps that the DOH and legislature may take to address the recommendations in the report.

Background and References

WSHA’s 2019 New Law Implementation Guide

Please visit WSHA’s 2019 implementation guide online, where you will find a list of the high priority laws that WSHA is preparing resources and information on to help members implement the new laws, as well as links to resources such as this bulletin. In addition, you will find the Government Affairs team’s schedule for release of upcoming resources on other laws and additional resources for implementation.


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