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specialty care referrals for primary care patients needing specialists in a timely manner. Othermore comprehensive reforms are needed to address the uninsurance problem but traumacenters have a direct interest in taking steps to minimize the effects of the current system.More work is needed to study the problems of patients with mental health needs anddetermine an appropriate response with more precise resources. Best practice models need tobe developed for treating these patients in the ED and making transfers to appropriate settingsfor follow-up care.An evaluation of the appropriateness of the new organizational structure of TDSHS andwhether it is meeting the needs of the public and private stakeholders in emergency and traumacare should be conducted to ensure the State’s oversight is adequate and appropriate. Thelevel of responsiveness and responsibility should be benchmarked with other states and bestpractices should be identified to ensure that needed day-to-day infrastructure exists as well asthe ability to ramp up activities to meet crises like bioterrorism threats and natural disastersA review of lessons learned from hurricanes Katrina and Rita should be performed and amodel of active cooperation and collaboration developed. The role of multiple agencies of theState need to be examined in light of the need for improved coordination and response. TheState’s different regions for disaster areas, pubic health and TSAs may be creating anunnecessary barrier for communication and response. After the storms, disaster coordinatorswere obligated to work with multiple public health regions and trauma regional advisory councilswere required to work with several disaster coordinators. Standardization of regionalsubdivisions should be explored to improve efficiencies in planning, communication andresponsiveness.It is clear from our review that much remains to be done for Texas to become a leader inregionalized emergency and trauma care systems. Some of the challenges are symptomatic ofmuch larger issues – the growing un-insurance problem, bioterrorism, natural disasters – butefforts must continue to be made to shore up the system through funding mechanisms,oversight and infrastructure development.ReferencesaJones L, Johnson K, Hellsten J, Mathabela B. Overview of injury in Texas and the role of theEMS/Trauma Registry, November 2004, Texas Department of State Health Services, Austin.bNathens AB, Fabrice PB, Maier RV. 2004. Development of trauma systems and effect onoutcomes after injury. The Lancet, Vol. 363, 1794-1801.chttp://www.techproservices.net/history.php.dMullins, RJ. A historical perspective of trauma system development in the United States.Journal of Trauma. 1999;47 (3 suppl):S8-14.eKing, B,, Jatoi, I. The mobile army surgical hospital (MASH): a military and surgical legacy.Journal of the National Medical Association. 2005; 97:648-656.G-15