Report 2013-116 Recommendation 4 Responses

Report 2013-116: Los Angeles County: Lacking a Comprehensive Assessment of Its Trauma System, It Cannot Demonstrate That It Has Used Measure B Funds to Address the Most Pressing Trauma Needs (Release Date: February 2014)

Recommendation #4 To: Los Angeles County

To determine whether its trauma system is appropriately designed and serving the needs of residents in underserved areas and the needs of the most at-risk populations, the board should use Measure B funds to engage the College of Surgeons by July 2014 to perform a comprehensive assessment of the trauma system and then make the results available to the public. To the extent the assessment identifies weaknesses in the trauma system, the board should develop strategies to address those weaknesses where feasible. Specifically, the board should ask the College of Surgeons to do the following: analyze how EMS might better use the data it collects to evaluate, improve, and report continuously on its trauma system.

Agency Response*

Los Angeles County highly values objective, rigorous external input from knowledgeable experts with respect to continuous improvement of its trauma system. Such input is regularly obtained from the LA County Trauma Hospital Advisory Committee, the State EMS Authority, and the LA County EMS Commission. LA County acknowledges the suggestion to engage the American College of Surgeons (ACS) in an analysis of the trauma system. However, LA County is already taking a multitude of steps and will be working with the American College of Surgeons, as described in its response, to improve the trauma system for all County residents and visitors.

For example, LA County has been notified that the State EMS Authority, the preeminent subject matter expert in California trauma and emergency services planning, has scheduled a review of the State trauma system in March 2016. It should be noted that the EMS Authority has already contracted with the American College of Surgeons for this review. LA County plans to fully participate in this review. The results of the review and any recommendations or comments relevant to LA County will be thoroughly evaluated internally and through its committee process.

LA County, through its EMS Agency, has included trauma system data in the Annual EMS System Data Report which is available to the public. A more comprehensive report with the focus on the trauma system, including evaluation, improvement and specific areas of high risk is being developed and will be issued on an annual basis. This report will be the foundation to a more comprehensive and targeted trauma prevention program under development and for approval by LA County.

  • Response Type†: Annual Follow Up
  • Response Date: September 2015

California State Auditor's Assessment of Status: Will Not Implement


Agency Response*

LA County highly values objective, rigorous external input from knowledgeable experts with respect to continuous improvement of its trauma system. Such input is regularly obtained from the Trauma Hospital Advisory Committee, the State EMS Authority, and the EMS Commission. Although the suggestion to engage the American College of Surgeons (ACS) in an analysis of the trauma system is reasonable, LA County is already taking the obvious steps needed to improve the trauma system for all County residents.

  • Response Type†: 1-Year
  • Response Date: February 2015

California State Auditor's Assessment of Status: Will Not Implement

We stand by our recommendation the the board should engage the College of Surgeons to analyze how EMS might better use the data it collects to evaluate, improve, and report continuously on its trauma system. As we reported, the director of EMS acknowledged that Los Angeles has not conducted an evaluation of its trauma system to demonstrate it has fulfilled the intent of Measure B. Further, we reported that Los Angeles' current monitoring efforts do not enable it to examine whether its trauma system serves residents, such as those in underserved areas and at-risk population groups, equitably. We believe the College of Surgeons can provide insights to EMS on how to use the data it collects to evaluate, improve, and report continuously on its trauma system.


Agency Response*

LA County highly values objective, rigorous external input from knowledgeable experts with respect to continuous improvement of its trauma system. Such input is regularly obtained from the Trauma Hospital Advisory Committee, the State EMS Authority, and the EMS Commission. Although the suggestion to engage the American College of Surgeons (ACS) in an analysis of the trauma system is reasonable, LA County is already taking the obvious steps needed to improve the trauma system for all County residents. Several of these steps are described in the response to other recommendations.

  • Response Type†: 6-Month
  • Estimated Completion Date:
  • Response Date: August 2014

California State Auditor's Assessment of Status: Will Not Implement

We stand by our recommendation the the board should engage the College of Surgeons to analyze how EMS might better use the data it collects to evaluate, improve, and report continuously on its trauma system. As we reported, the director of EMS acknowledged that Los Angeles has not conducted an evaluation of its trauma system to demonstrate it has fulfilled the intent of Measure B. Further, we reported that Los Angeles' current monitoring efforts do not enable it to examine whether its trauma system serves residents, such as those in underserved areas and at-risk population groups, equitably. We believe the College of Surgeons can provide insights to EMS on how to use the data it collects to evaluate, improve, and report continuously on its trauma system.


Agency Response*

The benefits of having ACS analyze how EMS collects its data are unclear.

  • Response Type†: 60-Day
  • Estimated Completion Date: TBD
  • Response Date: April 2014

California State Auditor's Assessment of Status: No Action Taken


All Recommendations in 2013-116

†Response Type refers to the interval in which the auditee is providing the State Auditor with their status in implementing recommendations made in an audit report. Auditees must submit a response regarding their progress in implementing recommendations from our reports at three intervals from the release of the report: 60 days, six months, and one year or subsequent to one year.

*Agency responses received after June 2013 are posted verbatim.


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