About Us

Piney Woods Regional Advisory Council (RAC-G)

Trauma Service Area G (TSA-G)

OUR PURPOSE

The purpose of developing and participating in the Piney Woods Regional Trauma Plan is to facilitate coordination of patient care for critically injured patients through TSAG and other surrounding counties.The Plan has been developed under the direction of the Texas Department of Health Bureau of Emergency Management’s procedures and standards for implementation of a comprehensive statewide Emergency Medical Services (EMS) Trauma System as mandated in the Health and Safety Code, chapter 773, 81-90. Healthcare volunteers whose sole purpose is to develop a mechanism to enhance the care rendered to critically injured patients in TSA-G developed and annually review the Regional Trauma Plan.

Each patient is a unique individual, and each patient’s medical condition will be equally unique. Scenarios for his or her care will almost always vary because of the unique nature of each person and the conditions causing the injury, even in the same geographical area or institution.

These guidelines are suggestions only. It is our intention to enhance patient care and maximize the number of clinical outcomes possible. The actual treatment of any patient is the responsibility of the caregivers, both before and during hospitalization. Clinical decisions must be made based on the specific medical condition of the individual, what is believed best for him or her and the patient’s choice, if known.

This document is not intended to establish a legal standard of care for treatment of any medical condition or services rendered by any emergency medical technician, hospital, physician or patient. This is an aid to decision making in general clinical scenarios. It does not constitute medical advice for or to any individual.

The purpose of participation in the Regional Trauma Plan is to facilitate coordination of a regional system for trauma patient care. Nothing contained in this plan, and no acts by a participant under the Regional Trauma Plan, shall be construed as creating the relationship of a joint venture, partnership, principal/agent or employer/employee between or among any of its participants.

Each and every participant in the Regional Trauma Plan is solely responsible for its own activities, and each shall indemnify and hold harmless all other participants in the Regional Trauma Plan, including but not limited to, Trauma Directors, Trauma Nurse Coordinators and Project Medical Directors that participants function under, from any loss, costs of defenses or settlement arising out of its own negligence or wrongful acts.

ABOUT THE REGION

Trauma Service Area-G (TSA-G) extends from the prairies of the Blackland Belt in its westernmost region to the heavily wooded eastern Pine Belt area at its eastern border. The region is a 19-county, 13,609.2 square-mile area of East Texas spanning three different natural geographic regions. A larger percentage of TSA-G lies within the Pine Belt of eastern Texas. This area includes the counties of Marion, Harrison, Panola, Rusk, Shelby, Trinity, Gregg, Upshur, Cherokee, Freestone, Houston and the eastern portions of Anderson, Henderson, Smith, Wood and Camp counties. The western portions of the latter five counties are in the Post Oak Belt, a transitional region between the highly forested Pine Belt and the Blackland Belt.

Franklin County, which is the northernmost county in TSA-G, crosses both the Post Oak Belt in the southern two-thirds of the county and the Blackland Belt in its upper one-third. Rains and Van Zandt Counties also cross two different regions, with the western portion of the counties in the Blackland Belt and the eastern portions in the Post Oak Belt.

TSA-G has an abundant water supply, containing tributaries of some of the major rivers in Texas and many lakes of varying sizes. The Pine Belt region is the source for almost all of Texas’ large commercial timber production. A great oil field, discovered in Gregg, Rusk and Smith counties in 1931, has contributed heavily to the economic growth in the area, especially during the first half of the Twentieth Century. In addition to oil, gas, natural gas, lignite, clay and coal mining, along with sand and gravel production, are active industries in the area. This area also contributes to the beef, dairy cattle and poultry industries. Major crops produced include hay, peaches, pecans, peanuts and sweet potatoes. Due to the number of lakes throughout the region there is an abundance of water sports, including swimming, fishing and various boating activities.

The population of TSA-G is presently estimated at 845,706. With the exception of Smith, Harrison, Henderson and Gregg counties, the remainder of TSA-G is primarily rural, with a population of 379,835 inhabiting a 9581.5 square-mile area. The two largest cities in TSA-G are Tyler in Smith County, with a population of 83,650, and Longview in Gregg County, with a population of 73,344.

Data provided by the Texas Department of Health in 1998 indicated that TSA-G had the third highest death rate from trauma of the 22 Trauma Service Areas in Texas.

Data specific to 1992 indicates that 12 of the 19 counties in TSA-G had a higher per-capita death rate than Dallas County. Fourteen of the 19 counties had an overall higher death rate when compared to the overall rate for the state of Texas (page 9). The total number of deaths due to causes listed by ICD-9 codes 800 through 999 decreased in TSA-G from 551 in 1993 to 326 in 2001, representing a 41% decrease in the number of deaths during that time. There was a desperate need for regionalization of trauma services and the development of an organized systems approach to trauma care in order to improve outcomes in Trauma Service Area G.) The Piney Woods Regional Advisory Council’s long-term goal of organizing the Regional Trauma System and decreasing the mortality rate for trauma patients in TSA-G has been recognized.

In response to the Texas Department of Health’s establishment of trauma facility criteria, the first meeting of trauma care professionals in Trauma Service Area G was held on October 27, 1992. Every effort was made to involve all EMS agencies, hospitals, surgeons and emergency department physicians in TSA-G. A Bylaws Ad Hoc Committee was appointed which presented a draft of TSA-G bylaws to the Steering Committee on November 18, 1992. These bylaws were presented to the entire group of trauma care professionals on December 2, 1992, and were ratified. Officers were elected in January, 1993.

On December 4, 1992, a request was mailed to Mr. Gene Weatherall, Chief, Bureau of Emergency Management, for recognition of the Regional Advisory Council of Trauma Service Area G. The TSA-G Regional Advisory Council was officially recognized on April 23, 1993.

Franklin, Houston, Freestone, Trinity and Shelby Counties subsequently requested realignment into Trauma Service Area G. Realignment was approved by a majority vote of the Regional Advisory Council Administrative Council, bringing the total counties in TSA-G to nineteen.

Standing committees were established, and on May 5, 1993, the committee members were appointed and chairpersons were elected. On March 16, 1995, a Trauma System Planning Ad Hoc Committee was convened at the request of the Chairman of the Regional Advisory Council. Original membership included all Chairpersons of the Standing Regional Advisory Council Committees and two or three other members of each committee. Meetings were held in March, May, July and October of 1995 and February and June, 1996.

In addition, at the April, 1995, meeting of the Administrative Council of the Regional Advisory Council, the Chairman requested that any other participants interested in participating in the development of the trauma plan to so request. This request resulted in the final members comprising the Trauma System Planning Ad Hoc Committee.

The Trauma Service Area G Trauma Plan was completed by the Trauma System Planning Ad Hoc Committee on June 20, 1996. The plan was presented to the Administrative Council and was approved on June 26, 1996. The Regional Trauma Plan is reviewed and updated annually as needed.

As of the year 2005 there is one Level I, one Level II, five Level III’s and 13 Level IV hospitals designated as trauma centers. This has not only improved care for the trauma patients at each hospital but also has provided valuable data from a systems perspective through the regional quality improvement process and the regional trauma registry. There are currently four non-designated facilities in our RAC.

There are presently 24 EMS agencies and over 150 first responder agencies in TSA-G. One achievement of the Piney Woods Regional Advisory Council is to develop a mechanism whereby these groups can arrive at a common set of protocols so that the level of the pre-hospital care becomes constant throughout the region.

There is an organized disaster plan for TSA-G that has been activated once since its inception. We have developed a basic model to guide EMS care during any incident which exceeds normal operating capabilities of any EMS system. This plan can serve as a guideline for those EMS systems or areas of TSA-G which presently have no organized disaster preparedness plan. While each county and many cities in TSA-G have disaster plans in place, our goal was to assist in standardizing the EMS response to any disaster throughout our area in coordination with other emergency response agencies (such as law enforcement and fire rescue). Our ultimate goal over the next two years is to further develop this comprehensive disaster plan specific for TSA-G through the Pre-Hospital Care and Transportation Committee of the Piney Woods Regional Advisory Council. One of the first steps in realizing this goal was the addition of the SMART TAG System that unifies all pre-hospital providers with the same disaster triage system.

Another challenge is the relationship between trauma patient flow and managed care contracts. Although the Piney Woods Regional Advisory Council is a volunteer organization, we hope that through our efforts appropriate triage decisions can be made based on sound medical decisions rather than merely financial allegiance.

Finally, the Piney Woods Regional Advisory Council will need to address the issue of patient flow from surrounding counties outside of TSA-G into hospitals within TSA-G. While historical referral patterns should be honored, there needs to be a mechanism whereby quality of care issues can be addressed in this group of patients from a system perspective. The mechanism for reviewing these patients is contact with the Trauma Coordinator at each hospital. The hospitals outside of TSA-G are not required to participate in any of the Piney Woods Regional Advisory Council activities or the Performance Improvement process.

In the year 1998 the Piney Woods Regional Advisory Council saw the realization of some funding for the trauma system in Texas. This important step has furthered efforts at organized trauma care in TSA-G. The long-term goal of the Piney Woods Regional Advisory Council is to utilize these funds to achieve the greatest system impact and to monitor this impact, specifically as it relates to our death rate.

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