State to Update Trauma, Emergency System Rules
By Patrick McDaid

For the first time in 20 years, the Texas Department of State Health Services (DSHS) is updating the state’s emergency medical system and trauma care rules.  

The Texas Medical Association working with health officials to ensure a set of rules that “promote a stable, statewide trauma system that fosters safe, timely, and appropriate emergency medical services and trauma care throughout the state.” 

That was the gist of a comment letter TMA submitted in February to the state in response to DSHS’ proposed rules, which have garnered thousands of comments throughout the lengthy revision process. There is currently no timetable for implementing the proposed revisions. 

While applauding DSHS for its “collaborative, transparent approach to the rulemaking process,” TMA weighed in with robust suggestions and concerns ranging from the very definitions of trauma care and how trauma facilities earn their designations, to transfer processes and rural versus non-rural considerations, among other topics. 

Since revisions were last made, trauma care has advanced – in effective ways – and medicine is eager to see the updated rules reflect that, says Alan Tyroch, MD. The trauma medical director and chair of surgery at Texas Tech University Health Sciences Center El Paso is a consultant to TMA’s Committee on Emergency Medical Services and Trauma (CEMST), which helped draft TMA’s comments. 

For example, one area where he sees changes for better is in the ability to properly treat trauma patients in nonoperative ways, “which means we have upped our game with respect to critical care.”  

Dr. Tyroch is optimistic the forthcoming rule changes will assist not only physicians but all levels of trauma care. 

“We want to provide cutting-edge care during an injured patient’s entire path through trauma system; from the pre-hospital setting to the acute-care phase in the hospital, all the way to their rehabilitation. It is so much more than just the surgeon. I tell people all the time: Trauma is a team sport, and you need all those people there in the [emergency department].”  

Houston emergency physician Hilary Fairbrother, MD, who chairs CEMST, adds the regulations are important for establishing a base of care for patients. 

“In Texas, whether it is urban or rural, we are looking to elevate the standards of trauma care in a very patient-centered way. [Physicians] do not want to regulate simply for regulatory purposes,” said Dr. Fairbrother, associate professor at McGovern Medical School at UTHealth. 

Also among the emphases of TMA’s comments are streamlining the definitions of trauma care and trauma patient, as well as the impact the regulations will have on level IV trauma centers, “which is what most of Texas trauma centers are,” said committee member and Athens emergency medicine physician  J. Lane Schnell, MD, medical and trauma director at UT Health Athens and immediate past system medical director of the 10 emergency departments in the UT Health East Texas system. 

He also hopes DSHS considers the quality-of-care measures necessary at level IV trauma centers in rural areas.  For instance, UT Health Athens, where he works, is a 45-minute transport to Tyler, the closest level I trauma center.  

“In Athens, we are it. We resuscitate and stabilize following trauma guidelines and require transport to our level I Center in Tyler, so that EMS transport time can really add up,” he said. 

Robert Greenberg, MD, a committee consultant who sits on the Governor's EMS and Trauma Advisory Council (GTAC) with Dr. Tyroch, acknowledges the shared frustrations with the extensive rulemaking process, which, as of this writing, did not have a clear end in sight.   

Nevertheless, he is encouraged by the physician involvement in the modernization process.  

“At the end of this, [the goal is] to align Texas medicine with national standards, which is a good thing,” said Dr. Greenberg, vice president and chief medical officer of emergency services for Baylor Scott and White Health’s central Texas division. “These rules cannot fix access to care, staffing issues, and time-sensitive issues. But they will hopefully put us in the best position to treat patients.”