Posts Tagged ‘Tucson’

Building a World-Class Trauma System

March 1st, 2013

 Four years ago- AZ didn’t really have a trauma system.  We had 7 Level I (high-end) Trauma Centers…  but that’s it.  After 4 years and a full court press- we now have a decent trauma system that includes 31 trauma centers, (8 Level I, 4 Level III, and 19 Level IV (16 of the Level IVs are in rural Arizona).  Over the past few years I’ve blogged about the progress we have made.  Our next goal is to develop a world-class trauma system. 

To help us get there we asked the American College of Surgeons to review today’s AZ Trauma System and make recommendations areas for improvement.   So, what’s in the report?  For one, traumatic injury in rural AZ still has room for improvement.  For another, trauma care in the urban areas of Phoenix and Tucson is solid…  and we want to make sure that we keep it that way and improve even further where we can.  That means redoubling our focus on preventing injury from happening in the first place, continuing to focus on building out our rural trauma system, ensuring that trauma patients get high quality and timely care in the field, helping our Level III and IV trauma centers implement performance improvement practices in their facilities, and identifying 3 or 4 hospitals to become Level III trauma centers in rural AZ.

We don’t have the statutory authority to implement a designation moratorium for additional Level I Trauma Centers as the report recommends- but we do recognize the importance of having sufficient patient volume to support the necessary resources and provider expertise required by the highest level Trauma Centers.  As a next step, we’ll be getting a group of experts to examine the data in our trauma registry in detail and come up with evidence-based criteria for determining need for the addition of future Trauma Center(s) in Arizona. These criteria may eventually serve as a substantive policy statement for us, guiding us as we review all future Level I Trauma Center applications. 

We’ll also be engaging with our stakeholders (State Trauma Advisory Board, EMS Council, Medical Direction Commission and the four EMS Regions) in the coming months to develop priorities and a plan for our future trauma system development.  We put together a set of frequently asked questions that shed some light on where we plan on going from here.  I also talked about it for a few minutes on Wednesday night’s Horizon.  I’m excited to think about what additional progress we continue to move the needle on trauma in Arizona- contributing to ”Health and Wellness for all Arizonans”.

UA College of Public Health Info Sessions

February 25th, 2013

The UA College of Public Health Phoenix location has new options for students interested in the Master of Public Health (Public Health Practice Concentration) and the Graduate Certificate in Health Administration.  They also have several online graduate certificate programs and many other degree options at the Tucson campus.  

The College is hosting information sessions in Phoenix, Tucson, and online for interested prospective students.   Most of the programs have upcoming deadlines of March 1…  but the MPH in Public Health Practice (Phoenix) and the MD/MPH programs have deadlines of May 1.  Contact Kim Barnes at for more info.


AZ’s Trauma System: Moving to the Next Level

December 3rd, 2012

Injuries are the leading cause of death for Arizonans from age 1 to 44.  That means for the majority of the young and the middle-aged injury is more lethal than cancer, heart disease, hypertension and influenza combined.  The effectiveness of a State’s pre-hospital and Trauma System makes the difference when it comes to saving lives (and quality of life) from injuries.  That’s why we invited the American College of Surgeons to assess AZ’s Trauma System back in 2007…  to evaluate the effectiveness of our trauma system and to make recommendations.  

The main 2007 recommendations were to improve trauma care in the rural parts of the state by recruiting Level IV trauma centers in rural AZ, strengthen the State’s trauma registry, and to assess our system and make necessary updates to our state trauma plan.  We have.  

Over the last 3 ½ years, our EMS and Trauma System team has been able to recruit 17 rural hospitals (up from 0) into our trauma system.  For the first time, Arizona’s rural trauma patients have timely access to good trauma care.  Our State Trauma Registry has been strengthened by undergoing validation checks and audits and is now one of the best in the country, allowing us to conduct all kinds of research to improve care across the state.  Arizona’s trauma system today bears little resemblance to our system 4 years ago, and like any system, it’s important to re-assess how we’re doing and set new priorities to maximize our effectiveness.  

That’s why we invited the American College of Surgeons back last week…  to evaluate our system- to take a look at the progress we have made over the last several years and give us feedback on the best way to move forward- both in rural and urban Arizona.  The ACS met with our team and our EMS and hospital trauma Stakeholders- and we had great participation. 

The ACS had about a dozen nuts and bolts recommendations and 3 larger recommendations regarding AZ’s Trauma System in their report-out presentation. Their written report (in about 6 weeks) will recommend (among other things):

  1. A moratorium on new trauma center designations in the Valley and Tucson and at the same time recommending that the Department explore the statutory authority to have a “needs based” system for designation.
  2. During the moratorium (if we have one)- they recommend that we put together a destination protocol for the Valley for ambulance providers.
  3. Their report will recommend that we explore more effective ways to use the Prop 202 money that currently only goes to Level I Centers. 

We’ve just begun to explore the who, what, when, where, and how their initial recommendations. Once the actual written report comes in 5 or 6 weeks we’ll be in a better position to evaluate the recommendations. 

Finally…  three cheers for Dan Didier, Noreen Adlin, Donna Meyer, and Betty Yunick for preparing for this week’s evaluation.  To get ready, they had to respond to a detailed trauma system pre-review questionnaire; identify, copy and scan approximately 400 pages of trauma system reports developed over the past 5 years; and coordinate hotel and meeting room space for approximately 80 participants. Thanks!

Thanksgiving, ASH & the Territorial Cup

November 21st, 2012

Our Arizona State Hospital (ASH) and the U of A share a birthday.  Both were established by the 13th Territorial Legislature in 1885.  The City of Tucson had wanted ASH (it came with a $100K appropriation) but their delegation got to Prescott (the Territorial Capitol) late because the Salt was flooded…  and Tucson ended up getting the U of A instead (which only carried a $25K appropriation).  ASH opened its doors in 1887 and the U of A held their first classes in 1891. 

The UA football team played their first games in 1899 as the U of A “Varsity”… and the first Big Game between the Varsity and the Tempe “Normals” (ASU) was played on Thanksgiving in 1899 at Carillo Gardens field in Tucson in front of 300 fans. The U of A met the Normals at the Tucson train station and the teams had a post-game Thanksgiving feast.  I don’t think they do that anymore—  or we’d probably have to test the food in advance at our Lab.   The local newspaper reported that this was U of A’s first game and that “… the Normal squad was physically larger and better conditioned”, with the Normals winning 11 to 2.  The Territorial Cup is the trophy that’ll be awarded again to the winner of Friday’s Duel in the Desert (in Tucson this year)…   it’s the oldest Trophy of its kind.

Working Together

September 24th, 2012

I’ve written many times about how important it is that we work with our partners to protect the health and safety of the people of Arizona.  It’s our responsibility to take advantage of opportunities to teach and practice what we preach.  It’s nice when someone outside acknowledges when someone goes above and beyond which is just what one of our new Tucson licensees did about our staff.  Congratulations to our Behavioral Health leaders – Tammy, Ann &  Dianne.

Our New e-Public Health Classroom

September 6th, 2012

I’ve mentioned in previous posts about how I’d like to build more bridges between the Arizona’s academic public health infrastructure and Arizona’s public health system.  After all- our goal is to use evidence-based practices to drive our interventions- and the U of A’s expertise at the Mel & Enid Zuckerman College of Public Health is a key resource within AZ’s public health system to accomplish those goals. 

We reached an important milestone this week when we turned the key on our new electronic public health classroom- in Room 411 in the 1740 Building.  The on-line learning center will allow our employees (and staff from the local health departments) to continue their education and obtain a degree in Public Health or complete advance degrees.  In addition, we’ll be working to develop distance learning classes on specific areas such as Quality Improvement to help us gain the knowledge and skill necessary to become accredited and assist our local public health departments as well.  The possibilities are unlimited. I’ll kick off the use of the classroom next week by using it for a lecture on Environmental and Occupational Health for students in Tucson. 

My blog post from March has more information about the host of career training and development opportunities available through the U of A’s College of Public Health.  You can book the new classroom with America Coles.  We’re also planning to have it on the Intranet/e-mail system to reserve room like all the other conference rooms- along with its own web page which will include a calendar of events.

Dispatch Interventions

June 25th, 2012

About a year ago Ben Bobrow, MD (our EMS Medical Director) came into my office with a great idea to set up a program to train 911 dispatchers in better ways to coach callers through CPR instructions so callers can do a better job before the paramedics get there.  The problem was money.  So I sent him over to our chronic disease prevention team that controls a 2002 voter approved fund which places tobacco tax revenue into a prevention and early detection fund.  Ben got with Wayne Tormala and his team funded and put together the intervention.  

Our team put together and executed training for 911 dispatchers so they can guide the bystander in starting CPR quicker and better.  Led by Dr. Ben Bobrow & CPR Dispatch Program Manager Micah Panczyk, the ADHS Telephone-Assisted CPR program trains 911 dispatch staff on how to guide a caller on the delivery of chest-compression-only CPR. That’s real important- because survival drops by 10% for every minute delay in starting CPR- and the typical wait time for an ambulance is between 5 and 8 minutes.  

Our built in measurement tools suggest that (once implemented statewide) we can expect to save 660 lives every year in AZ with this intervention alone.  It just goes to show you that public health can save lives in unusual ways if you have creative and energetic folks that work together.  

By the way- the national survival rate for cardiac arrest is between 5 and 8%.  Not here.  Because of interventions like this one, Arizona’s (witnessed) cardiac arrest survival rate is 32%- 4 to 5 times better than the national average.  Some of our efforts got some great media coverage in the Arizona Republic and on KVOA in Tucson.

Medical Marijuana Continuing Medical Education Opportunity

March 13th, 2012

The University of California, San Francisco (UCSF) School of Medicine and the U of A College of Nursing are sponsoring a Continuing Medical Education Conference on April 27–28, at the Loews Ventana Canyon Resort in Tucson.  The Conference is called “The Endocannabinoid System: Clinical Implications for Health Care (Course #MMJ12106)”.

AZ Smallpox Outbreak

February 6th, 2012

Smallpox broke out in southeast Arizona almost exactly 100 years ago last week (co-incident with the Statehood activities).  The first cases were in Tucson and Douglas with a few dozen cases and several deaths… and there were a few additional cases in Nogales and Globe.  Of course, all the cases were among folks that hadn’t been vaccinated.  The public health interventions of the time were much like what we would do today- case contact follow up with targeted vaccinations of folks that had contact with cases. 

For example, Dr. Chenoweth (Santa Cruz County Superintendent of Health) implemented an aggressive targeted vaccination effort following the Nogales case.  From the 1912 records, we know that Dr. Chenoweth immediately began a “house-to-house vaccination campaign, vaccinating every person within a radius of six or seven miles of the case under quarantine, except one person who secreted herself and escaped vaccination, but developed smallpox instead.”  These two cases were the only ones reported from Santa Cruz County. 

As the outbreak progressed in the following months, the State Board of Health weighed in on the public health response that had been undertaken in the various counties.  The 1912 State Board of Health minutes stated that: “In our opinion this (contact and ring vaccination campaigns) is not sufficient, as there is no one to keep check on the patient or guardian to see that vaccination is done.  Our public health law should be amended to read:  In addition to the above stated section, no principal, teacher or superintendent shall permit any person to attend school, unless they have been vaccinated.  A large per cent of the children of Arizona have not been vaccinated and will not as long as they are allowed to attend school without first having been vaccinated. 

So, the February 1912 Smallpox outbreak in SE AZ was that spark that triggered the debate about whether and how to require vaccination as a prerequisite for attending school.  You can check out our pre-school and school resource page to find out more about today’s school vaccination requirements.

Valley Fever Week

November 4th, 2011

This is Valley Fever Awareness Week- an annual event to provide awareness  of coccidioidomycosis (also known as Valley Fever)- the second most commonly reported infectious disease in Arizona.  Events for the general public include a “Learn about Valley Fever – Ask the Doctor Your Questions” held in Tucson on Sunday, Nov. 6 and the Walk for Valley Fever in Sun City West on Sunday, Nov. 6.  Healthcare providers can receive continuing medical education in Tucson on Saturday, Nov. 5:  “Coccidioidomycosis for the PCP” and “Advanced Clinical Aspects of Coccidioidomycosis”.  To find out more about valley fever awareness week events visit:

Our epidemiology staff work closely with the Valley Fever Center for Excellence to promote education and awareness.  The Center is based at the U of A and will be opening a center in Phoenix in January.  Check out our home-grown video that’s designed help people understand the disease and how to talk to their doctors about it. To read more about valley fever and what has been done during past valley fever awareness weeks, please visit my blog.  I also wrote a piece about the effects that the large dust storms may have on valley fever, which by the way, we’re still investigating…