THE NORTH CAROLINA TRAUMA SYSTEM

NC TRAUMA CENTERS	LOCATION	DESIGNATION
UNC Health Care System	Chapel Hill	I
Duke University Medical Center	Durham	I
Wake Forest University Baptist Medical Center	Winston-Salem	I
University Health Systems of Eastern North Carolina	Greenville	I
Carolina’s Medical Center	Charlotte	I
Wake Med	Raleigh	I
New Hanover Health System	Wilmington	II
Mission St. Joseph’s Health System	Asheville	II
Moses Cone Health System	Greensboro	II
North East Medical Center	Concord	III
Cleveland Regional Medical Center	Shelby	III
High Point Regional Health System	High Point	III

North Carolina Rules and Regulations
Governing Ambulance Service and Trauma Systems

G.S. 131-162

History/Background

In 1993 the State Emergency Medical Services Advisory Council convened a Trauma Task Force that was charged with designing a state trauma system. After two years, the Task Force drafted a set of rules and regulations. The Rules and Regulations Governing Ambulance Service and Trauma Systems (G.S. 131-162) were revised after input from each acute care hospital in North Carolina, from-out-of-hospital services, and from other interested parties, including professional health care organizations. Prior to finalizing the proposed Rules and Regulations, three public meetings were held in March 1996.

The proposed North Carolina Trauma System Rules and Regulations address four major areas. These areas include: specification of three levels of trauma centers, the processes to be followed for initial and renewal designation, related enforcement procedures, and the basic design for an inclusive state and regional trauma system.

The basic building blocks of the proposed new trauma system are the Regional Advisory Committees (RACs), groups representing trauma care providers and communities that will be affiliated with a Level I or II trauma center. RACs will plan, establish and maintain a coordinated regional system. Each hospital will choose its RAC affiliation, and the RAC will then implement prehospital triage, and air medical protocols and transfer agreements and regional plans for education, training, prevention outreach and quality assessment.

The Notice of Rule-making Proceedings appeared in the December 15, 1995 issue of the North Carolina Registrar in order to allow individuals to submit written comments within the 60-day comment period. At the March 14, 1997 Medical Care Commission meeting, the Commission adopted the recommendation from the Regulatory Committee to allow staff to proceed with rule-making in order that the full Commission could consider the rules at the September 12, 1997 meeting.

At the Public Hearing held on September 12, 1997, the Commission approved the Trauma System Rules published in the North Carolina Register with minor recommendations. The Rules and Regulations were then submitted to the NC Rules Review Board and were introduced to the Legislative Oversight Committee during the 1998 Summer Session where they were approved and made effective August 1, 1998.

Purpose/Benefits

The purpose of a statewide trauma system in North Carolina is to reduce death and disability from injury by providing both effective triage of patients to appropriate facilities and better treatment. It has been estimated that one in five major injury victims die because they do not have access to an organized trauma system. Multiple studies have shown that regionalization of trauma care can decrease death rates from 30% to as low as 4 to 5%. The North Carolina Rules and Regulations mentioned above have been designed to facilitate and coordinate an inclusive trauma system to provide timely response to severely injured patients.

The benefits of such a system are substantial. First of all, many lives can be saved by an improved trauma system and substantial savings can accrue by decreasing disability. Prevention is critical for reducing 50% of the deaths from injury. Currently it is estimated that injuries cost North Carolinians over 4 billion dollars per year. The decrease in unnecessary death and disability could lower these costs significantly. The new system would essentially improve communication between hospitals, as well as improving pre-hospital triage. The enhanced Quality Assurance mechanisms and Outreach Programs would improve the care in smaller facilities as well as in designated Trauma Centers. Education of health care professionals would be promoted and prevention efforts could be refined. This system has worked well in other states (e.g. Pennsylvania, Maryland, Virginia) and would serve to strengthen the current system in North Carolina. Studies indicate that in the majority of Trauma Centers where Trauma Services have been properly organized, there appears to be a halo effect, with improvement in the care of other life-threatening emergencies.

The NC Trauma System Today (2006)

The NC Trauma System evolved dramatically after the events of September 11, 2001. Now, not only does each RAC coordinate regional trauma care, but also regional disaster preparedness. Currently, there are eight RACs in the state that tie together each hospital and EMS system within the state. Each RAC has a State Medical Assistance Team (SMAT II Team), which is a pivotal part of North Carolina’s disaster preparedness. These teams can staff alternate care facilities, assist at hospitals to address surge capacity, and can set up and staff mass immunization sites, and are trained to perform decontamination procedures. Below are current maps showing the RACs, and their Hospital and EMS System affiliations.