Table 1

Guiding principles and recommendations for Washington State trauma system implementation

Guiding principles	Recommendation
System needs to engage the continuum of trauma care	Set standards and designation requirements for prehospital agencies, acute care hospitals, and rehabilitation centers Make injury prevention activities a priority in the regions
System needs to be inclusive to allow access to care in rural regions	Designation of adult facilities levels I through V Pediatric centers levels I to III, IV, and V centers designed for stabilization and transfer
Trauma care personnel are the most valued trauma care resource	Financial support needs to be provided to the regions to implement a comprehensive trauma care education plan
Flexibility is needed in implementation to meet the varying needs across the state	Use existing EMS regions to establish regional implementation plans to be approved by the DOH and EMS and Trauma Steering Committee
All providers and organizations need representation in the governance of the system	Establish an EMS and Trauma Steering Committee with all stakeholders at the table and the DOH as the lead agency
Continuous system and quality improvement needs to be based on high-quality data	Establish a statewide trauma registry with mandatory reporting by all designated facilities Establish regional QI committees with protection from discovery for QI activities
Distribution of trauma centers and prehospital agencies should be based on defined population need	Each region will establish minimum and maximum numbers for designation of each level of trauma center, and for prehospital agencies modifications to min/max numbers need to be justified by population need
The system needs dedicated trauma system funding to maintain operations and address gaps in reimbursement of undercompensated care	Create and allocate a source of funding for a dedicated trauma system fund

DOH, Department of Health; EMS, emergency medical service, QI, quality improvement.