Trauma Update Info Sheet 9-30-19

Ballad Health Trauma System Update:

Implementation Effective October 1

TOP TAKEAWAYS:
1. Ballad Health has implemented plans to create a fully integrated and highly coordinated regional
trauma and emergency care system to better meet the needs of Northeast Tennessee and
Southwest Virginia.
• Our goal is to save lives and improve quality of life for those we serve.
• The regional system will better integrate our highly-skilled trauma experts in Johnson City,
Kingsport and Bristol with EMS and emergency rooms across the region to ensure
assessment and rapid transport of patients to the center most appropriate for the patient’s
needs.

2. A physician-led trauma steering committee worked thoughtfully to develop implementation plans,

in conjunction with leadership at the hospitals.

3. We worked closely with regional EMS leaders to develop our timeline for effective
implementation.
• Holston Valley Medical Center is transitioning to a level III trauma center on October 1, 2019.
• Bristol Regional Medical Center’s level II trauma center is expected to transition to level III in
2021.
• The timing for each location was determined by factors related to staffing, input from the
physician-led trauma committee, and ongoing enhancements at Johnson City Medical Center.

4. Holston Valley will continue to offer highly specialized treatment for serious medical emergencies
such as heart attack and stroke, and will also maintain its high acuity neurosurgery, orthopedic
surgery and general surgery programs.

A NEW APPROACH FOR REGIONAL TRAUMA AND EMERGENCY CARE

» Our regional trauma and emergency system will include our three trauma centers (Johnson City
Medical Center, Holston Valley Medical Center and Bristol Regional Medical Center). Our system
is closely connected with our emergency rooms in every Ballad Health acute care hospital and
will leverage a new medical call center that provides real-time, system-wide coordination with
seamless and timely transport.
• Our improvements reflect Ballad Health’s commitment to create a strong health system that
brings excellent care to the people we serve and makes the best use of our resources and
the skills of our physicians and team members.

» We have moved forward with this change to ensure the best possible patient care. Research
shows that when a greater number of high-acuity trauma patients are served in one single
location, patient outcomes improve.
• The Ballad Health service region does not the support the number of specialists needed to
maintain two level I and a level II trauma center, and we have had challenges maintaining
sufficient physician coverage for a number of years.
Trauma Update Info Sheet 9-30-19

» Beginning October 1, Johnson City Medical Center (JCMC) will serve as the region’s level I trauma
center, as it was already the busiest trauma center in our region, treating more than 60% of the
region’s trauma cases and a majority of our high severity cases.
• For most cases, the coverage provided at our three trauma centers will not change –
Johnson City Medical Center, Holston Valley Medical Center and Bristol Regional Medical
Center will continue to provide full general surgical, orthopedic and neurosurgery coverage
for trauma.

» The trauma capacity in our region will continue to exceed most in the nation. Most of our service
area is within a one-hour ground transport time to reach one of our three trauma centers, while a
majority of residents are within 30 minutes. “Major trauma” cases are more often transported by
helicopter, but even in the event they are transported by ambulance, accessibility to trauma and
emergency services will remain among the best in the country.

» As a reminder, this decision impacts far less than 1% of emergency cases in our region – only
the most serious trauma injuries – which will be treated at Johnson City Medical Center. While
“major trauma” cases will be transported to JCMC, most cases will continue to be served in the
trauma center closest to the patient.

» The term “trauma” only applies to medical emergencies that involve an injury. Coverage for other
serious medical emergencies such as heart attack and stroke will not be affected by changes to
the trauma system. Holston Valley and Bristol Regional will continue to offer highly specialized
heart procedures, orthopedics and neurosurgery.

» We are also working to make several enhancements to Johnson City Medical Center’s emergency
department. These improvements are designed to help us serve patients needing emergency
and trauma care faster and as effectively as possible.
• We’ve considered making these changes for a number of years because the needs of our
patients have continued to shift, emergency care best practices have evolved, and we are
always considering opportunities to enhance our resources and facilities to better serve our
community. Making these improvements will also best position JCMC to serve as the region’s
level I trauma center once that transition occurs.
• We’ve worked to ensure these renovations ultimately provide expanded services for high-
acuity patients, improved traffic flow and access for our EMS and air medical professionals
so patients can get the care they need faster, and more convenient parking options for
patients and families needing emergency services.
• The renovations to the JCMC ED are anticipated to be completed by late Spring 2020. These
improvements will occur over several phases during the next year, and we are committed to
doing everything we can to ensure a smooth process for both patients and caregivers.

WHERE WE ARE TODAY AND NEXT STEPS

» Since we shared our vision for this new system last fall, a physician-led steering committee has
been working thoughtfully to develop implementation plans. We have received input from
regional EMS leaders and have developed a timeline for the transition, taking a phased approach
to ensure a smooth transition.
• Holston Valley Medical Center will transition to a level III trauma center on Oct. 1, 2019.
o We are pleased with the progress underway and the work of our physician-led steering
committee to create a safe and deliberate transition plan. We agree transitioning HVMC
first is what’s best for patient care.
Trauma Update Info Sheet 9-30-19

o Further reinforcing this decision, recent staffing changes among our trauma surgeons at
HVMC have made it imperative that we stick to the October 1 time frame. We are working
to ensure we have the necessary trauma physician and team coverage in place at HVMC
in the meantime to reinforce patient safety.
• Bristol Regional Medical Center’s level II trauma center is expected to transition to level III in
2021. In order to ensure a smooth transition and strong foundation for our regional trauma
system, our physician leaders have recommended that we take this phased approach.
• Both level III trauma centers will retain key trauma program elements, including trauma
program manager, trauma medical director, trauma nurses, and trauma clinics for follow-up
care after an injury.

» For our team members and physicians, importantly, no jobs or positions are being eliminated as
part of this transition.
• Holston Valley Medical Center: As we proceed with this transition, we will continue to provide
updates to our team. We are also committed to providing appropriate staffing and resources
to ensure the team is supported and patient care remains top priority.
• Bristol Regional Medical Center: Nothing changes today. As we move into 2020, we will
continue to provide updates as we have them on the timeline to transition BRMC’s trauma
level.

» We are working closely with EMS teams and community partners to provide updates and ensure
all EMS teams in our region have the information and support they need.