Committee intelligence: STAC and Nassau RTAC decision profiles now include current NYS STAC members, Nassau REMSCO/RTAC representation, minutes signals, and Mount Sinai South Nassau opposition analysis.
Mercy focus row: 710 all injury-coded inpatient proxy discharges; 276 ED-origin injury-coded inpatient discharges; 1600 assigned institutional capacity units. Use registry and EMS imports before formal submission claims.
Strategy Options
| Priority | Hypothesis | Status | Public data | STAC fit | South Nassau vulnerability | Recommended use | Caveat |
|---|---|---|---|---|---|---|---|
| 1 | Geriatric fracture/TBI readiness | lead candidate; needs internal validation | 4 | 5 | 3 | Lead with geriatric injury readiness, transfer discipline, and safe transitions. | Do not overclaim this as major-trauma volume; it is a readiness and care-pathway argument. |
| 2 | Institutional-origin and care-transition burden | strong secondary candidate; needs origin proof | 4 | 4 | 3 | Frame as institutional injury continuity and transitions support. | Institutional capacity is exposure, not proof of actual EMS origin. |
| 3 | EMS routing clarity and bypass discipline | private strategy spine; public only after simulation | 3 | 5 | 2 | Make high-acuity bypass and transfer triggers central. | This is a governance argument, not a public-data volume win. |
| 4 | South Nassau opposition-response map | opposition response only; do not lead | 3 | 3 | 5 | Use as an opposition-response map focused on specific facilities and safeguards. | This is not proof Mercy improves the whole trauma network. |
| 5 | Equity and high-friction access | supporting context; do not lead alone | 3 | 3 | 3 | Use high-friction access as context beneath a clinical/governance argument. | Socioeconomic friction alone does not justify trauma designation. |
Literature Evidence
Literature read: supports a narrow geriatric fall/fracture/TBI Level III pathway with transfer discipline; does not support a broad Mercy-versus-South Nassau trauma-volume claim.
| Domain | Source | Type | Supports | Limit / counterpoint |
|---|---|---|---|---|
| NYS/ACS fit | 10 NYCRR 405.45 Trauma Centers | official requirement | Supports a Mercy argument only if it is built around capability, stabilization, transfer agreements, registry participation, and regional affiliation rather than market demand. | This does not prove Mercy should receive designation; it defines the threshold Mercy would have to meet. |
| NYS/ACS fit | About the ACS Verification, Review, and Consultation Program | official guideline | Directly supports a narrow Level III trauma center role for appropriate lower-acuity geriatric injury and stabilization cases. | ACS emphasizes communities lacking timely Level I/II access; Mercy must explain why a role is still needed near South Nassau. |
| Geriatric fracture/TBI readiness | ACS Trauma Quality Programs Best Practices Guidelines | official guideline | Supports building Mercy's proposal around named protocols: geriatric trauma, TBI, imaging, orthopedic trauma, PIPS, and transfers. | Guidelines support clinical design and quality review; they do not prove a local designation need by themselves. |
| Geriatric fracture/TBI readiness | Elderly adults with isolated hip fractures: orthogeriatric care versus standard care | official guideline | Supports a Mercy geriatric hip-fracture pathway with orthopedics, medicine/geriatrics, anesthesia, rehab, and discharge planning. | Hip-fracture pathway evidence is not the same as broad trauma-center need or major-trauma routing. |
| Geriatric fracture/TBI readiness | Management of Hip Fractures in Older Adults | official guideline | Supports packaging Mercy around a geriatric fracture pathway with measurable timeliness and complication metrics. | This is orthopedic pathway evidence; it does not prove trauma-system geography or EMS routing advantage. |
| Geriatric fracture/TBI readiness | Implementation of a Multidisciplinary Preoperative Protocol for Geriatric Hip Fractures Improves Time to Surgery at a Level III Trauma Center | peer-reviewed | Shows a Level III trauma center can use protocol design to improve a geriatric fracture process measure. | Single-center retrospective evidence; it supports a pathway hypothesis, not Mercy designation on its own. |
| Geriatric fracture/TBI readiness | Improved outcomes following implementation of a multidisciplinary care pathway for elderly hip fractures | peer-reviewed | Reinforces that older-adult fracture outcomes depend on multidisciplinary pathway reliability, not just destination label. | Level I pathway evidence may not transfer directly to Mercy's resources without local capability proof. |
| Institutional-origin falls | Facts About Falls | official epidemiology | Supports the clinical plausibility of a fall/fracture/TBI niche for older adults near Mercy. | National epidemiology does not prove Mercy's local EMS-origin stream or designation need. |
| Institutional-origin falls | A review of falls and injuries of nursing home residents presenting to the emergency department | peer-reviewed | Supports treating nursing-home fall traffic as a plausible institutional-origin stream worth testing locally. | Irish single-hospital data may not generalize to Nassau County; it does not prove Mercy origin or outcomes. |
| EMS triage and undertriage | Undertriage in geriatric trauma: insights from a multicentre cohort study | peer-reviewed | Supports a Mercy pathway only if it makes older-adult triage clearer and safer. | Undertriage evidence can also support bypass to higher-level centers; it does not automatically support routing to Mercy. |
Local Population Opportunity
| Place | ZCTA | Age 65+ | Age 75+ | Poverty % | No-vehicle HH % | Institutional capacity |
|---|---|---|---|---|---|---|
| Hempstead | 11550 | 8466 | 3779 | 14.0 | 22.8 | 731 |
| East Meadow | 11554 | 8010 | 3595 | 6.4 | 6.8 | 538 |
| Freeport | 11520 | 6726 | 2653 | 7.3 | 9.4 | 380 |
| Valley Stream | 11580 | 7774 | 2559 | 4.1 | 5.6 | 120 |
| Oceanside | 11572 | 6880 | 3011 | 3.0 | 3.0 | 120 |
| Rockville Centre | 11570 | 5637 | 1952 | 4.8 | 10.0 | 367 |
| Baldwin | 11510 | 6028 | 2487 | 6.4 | 5.6 | 0 |
| Uniondale | 11553 | 4113 | 1710 | 9.6 | 8.1 | 869 |
| Lynbrook | 11563 | 4410 | 2091 | 6.8 | 8.1 | 738 |
| Garden City | 11530 | 4913 | 2144 | 3.4 | 4.6 | 170 |
Angle Finder
| Priority | Angle | Recommended use | Caveat |
|---|---|---|---|
| 1 | Hempstead high-friction older-adult access wedge | Lead with localized, high-friction older-adult access in Hempstead/Rockville Centre/Uniondale/Valley Stream. | Do not describe this as broad Nassau dominance or proof that Mercy improves the whole trauma network. |
| 2 | Emergency/ED-origin injury plausibility, separated from elective-coded rows | Use as the honest acute public-data denominator before requesting trauma registry and ePCR validation. | Do not cite the 710 all-injury proxy as acute trauma volume. |
| 3 | Geriatric fracture/TBI protocol market | Package as geriatric fall, anticoagulated head-injury, hip-fracture, and safe-SNF-transition readiness. | This supports a monitored Level III geriatric pathway, not an unrestricted major-trauma diversion claim. |
| 4 | South Nassau opposition-response map | Use as an opposition-response / localized-access argument focused on specific facilities and transfer rules. | Not proof Mercy improves the whole network; nearest-current-trauma model remains unfavorable overall. |
| 5 | Institutional exposure is real but second-tier regionally | Frame as a local South Shore institutional-access niche rather than a densest-area claim. | St. John's, Flushing, Plainview, Elmhurst, NUMC, Queens, South Nassau, and St. Catherine rank higher in this benchmark. |
| 6 | Current trauma-center access remains the main objection | Make transfer criteria and high-acuity bypass protections central to any pitch. | This is the reason the Mercy case must be narrow, monitored, and facility-specific. |
Acute Plausibility Split
| Metric | Value | % of all injury proxy | Shareability |
|---|---|---|---|
| All injury-coded inpatient proxy discharges | 710 | 100.0 | Use as a broad injury-coded inpatient proxy only; not acute trauma volume. |
| ED-origin injury-coded inpatient discharges | 276 | 38.9 | Closest public-data acute entry signal because the encounter had an emergency department indicator. |
| Emergency-admission injury-coded inpatient discharges | 277 | 39.0 | Admission-type view of acute/emergent inpatient injury demand. |
| Emergency admission with ED-origin overlap | 276 | 38.9 | Best conservative public-data acute plausibility cut; still not a trauma-registry activation count. |
| Elective/non-ED injury-coded inpatient rows | 428 | 60.3 | Likely contains planned/post-acute orthopedic or coded injury rows; keep out of acute trauma-volume claims. |
| Urgent injury-coded inpatient rows | 4 | 0.6 | Small residual category; not a core story. |
Institutional Niche Benchmark
| Hospital | NH beds | Adult-care capacity | Combined | NH beds within 15 min % |
|---|---|---|---|---|
| ST JOHN'S EPISCOPAL HOSPITAL AT SOUTH SHORE | 4401 | 1749 | 6150 | 100.0 |
| FLUSHING HOSPITAL MEDICAL CENTER | 3400 | 247 | 3647 | 100.0 |
| PLAINVIEW HOSPITAL | 1451 | 1001 | 2452 | 100.0 |
| ELMHURST HOSPITAL CENTER | 1400 | 862 | 2262 | 100.0 |
| NASSAU UNIVERSITY MEDICAL CENTER | 971 | 1200 | 2171 | 100.0 |
| QUEENS HOSPITAL CENTER | 1722 | 239 | 1961 | 100.0 |
| MOUNT SINAI SOUTH NASSAU | 1209 | 683 | 1892 | 100.0 |
| ST CATHERINE OF SIENA HOSPITAL | 460 | 1190 | 1650 | 100.0 |
| MERCY MEDICAL CENTER | 1281 | 319 | 1600 | 100.0 |
| GOOD SAMARITAN HOSPITAL MEDICAL CENTER | 925 | 439 | 1364 | 100.0 |
| NS/LIJ HS HUNTINGTON HOSPITAL | 586 | 721 | 1307 | 100.0 |
| NEW YORK-PRESBYTERIAN/QUEENS | 860 | 423 | 1283 | 100.0 |
Nearby Comparator Injury Signal
| Hospital | Miles from Mercy | Injury discharges | Age 70+ | IPPS trauma proxy |
|---|---|---|---|---|
| MERCY MEDICAL CENTER | 0.0 | 710 | 320 | 76 |
| MOUNT SINAI SOUTH NASSAU | 2.44 | 1204 | 772 | 575 |
| NASSAU UNIVERSITY MEDICAL CENTER | 4.74 | 995 | 424 | 139 |
| LONG ISLAND JEWISH MEDICAL CENTER | 6.06 | 877 | 497 | 877 |
| NORTH SHORE UNIVERSITY HOSPITAL | 7.22 | 2479 | 1595 | 1688 |
| CHSLI ST JOSEPH HOSPITAL | 8.42 | 0 | 0 | 212 |
| ST FRANCIS HOSPITAL - THE HEART CENTER | 8.44 | 0 | 0 | 896 |
| ST JOHN'S EPISCOPAL HOSPITAL AT SOUTH SHORE | 8.89 | 0 | 0 | 17 |
| QUEENS HOSPITAL CENTER | 9.22 | 126 | 65 | 0 |
| JAMAICA HOSPITAL MEDICAL CENTER | 9.76 | 1369 | 423 | 143 |
| PLAINVIEW HOSPITAL | 10.03 | 462 | 355 | 217 |
| FLUSHING HOSPITAL MEDICAL CENTER | 10.75 | 153 | 94 | 12 |
| NEW YORK-PRESBYTERIAN/QUEENS | 11.04 | 0 | 0 | 613 |
| NORTHWELL HOSPITAL GLEN COVE | 12.76 | 0 | 0 | 117 |
Reference Trauma Centers
| Center | Level | County | Miles from Mercy | Source note |
|---|---|---|---|---|
| Mount Sinai South Nassau | Level II | Nassau | 2.44 | Hospital page describes state-designated and ACS-verified Level II trauma center. |
| NYU Langone Hospital-Long Island | Level I Adult and Pediatric | Nassau | 3.82 | NYS Health Profiles Level I Adult and Pediatric Trauma Center list includes NYU Langone Hospital-Long Island. |
| Nassau University Medical Center | Level I Adult | Nassau | 4.74 | NYS Health Profiles Level I Adult Trauma Center list includes Nassau University Medical Center. |
| North Shore University Hospital | Level I Adult and Pediatric | Nassau | 7.22 | NYS Health Profiles Level I Adult and Pediatric Trauma Center list includes North Shore University Hospital. |
| Huntington Hospital | Level III | Suffolk | 17.38 | Northwell public page describes Huntington as an ACS-verified Level III trauma center. |
| South Shore University Hospital | Level I | Suffolk | 20.59 | Northwell public page describes South Shore University Hospital as a Level 1 trauma center. |
| Stony Brook University Hospital | Level I Adult and Pediatric | Suffolk | 31.0 | NYS Health Profiles Level I Adult and Pediatric Trauma Center list includes Stony Brook University Hospital. |
| NYU Langone Hospital-Suffolk | Level II Adult | Suffolk | 34.77 | NYU Langone page describes the Suffolk trauma center as Level 2 Adult. |
Mount Sinai South Nassau Scrutiny
| Metric | Mercy | South Nassau | Read |
|---|---|---|---|
| South Nassau current role | Candidate Level III planning site | Current Level II trauma center | Most likely opposition and closest existing high-level South Shore trauma reference. |
| Conservative inpatient injury discharges | 710 | 1204 | 494 |
| Age 70+ injury discharges | 320 | 772 | 452 |
| SNF discharge after injury admission | 165 | 504 | 339 |
| Medicare IPPS trauma-proxy discharges | 76 | 575 | 499 |
| Assigned institutional capacity | 1600 | 1892 | 292 |
| Beds where Mercy is faster than South Nassau | 13532 | 23078 | 58.6% of analyzed nursing-home beds; bed-weighted saving 2.2 minutes |
| Beds where South Nassau is faster than Mercy | 9546 | 23078 | 41.4% of analyzed nursing-home beds; supports a credible opposition argument against broad Mercy diversion claims. |
Mercy vs South Nassau Nursing-Home Advantage
| Nursing home | City | Beds | Mercy min | South Nassau min | Minutes saved |
|---|---|---|---|---|---|
| SANDS POINT CENTER FOR HEALTH AND REHABILITATION | PORT WASHINGTON | 180 | 24.5 | 29.1 | 4.6 |
| Nassau Rehabilitation & Nursing Center | HEMPSTEAD | 280 | 4.4 | 8.9 | 4.5 |
| TOWNHOUSE CENTER FOR REHABILITATION & NURSING | UNIONDALE | 280 | 5.6 | 9.9 | 4.3 |
| HEMPSTEAD PARK NURSING HOME | HEMPSTEAD | 251 | 5.6 | 9.9 | 4.3 |
| GLEN COVE CENTER FOR NURSING AND REHABILITATION | GLEN COVE | 154 | 26.9 | 31.2 | 4.3 |
| EMERGE NURSING AND REHABILITATION AT GLEN COVE | GLEN COVE | 102 | 26.9 | 31.2 | 4.3 |
| SUNHARBOR MANOR | ROSLYN HEIGHTS | 266 | 16.7 | 20.9 | 4.2 |
| GLENGARIFF HEALTH CARE CENTER | GLEN COVE | 262 | 28.2 | 32.4 | 4.2 |
| FULTON COMMONS CARE CENTER INC | EAST MEADOW | 280 | 8.8 | 12.5 | 3.7 |
| NORTHWELL HEALTH STERN FAMILY CENTER FOR REHAB | MANHASSET | 256 | 18.3 | 22.0 | 3.7 |
| PARKER JEWISH INSTITUTE FOR HEALTH CARE & REHAB | NEW HYDE PARK | 527 | 16.5 | 20.1 | 3.6 |
| THE GRAND REHABILITATION AND NURSING AT GREAT NECK | GREAT NECK | 214 | 22.0 | 25.6 | 3.6 |
Nursing-Home Transport Advantage
| Nursing home | City | Beds | Mercy min | Nearest current trauma center | Current min | Minutes saved |
|---|---|---|---|---|---|---|
| Nassau Rehabilitation & Nursing Center | HEMPSTEAD | 280 | 4.4 | NYU Langone Hospital-Long Island | 6.0 | 1.6 |
| TOWNHOUSE CENTER FOR REHABILITATION & NURSING | UNIONDALE | 280 | 5.6 | Nassau University Medical Center | 5.9 | 0.3 |
| HEMPSTEAD PARK NURSING HOME | HEMPSTEAD | 251 | 5.6 | Nassau University Medical Center | 5.7 | 0.1 |
| MAYFAIR CARE CENTER | HEMPSTEAD | 200 | 4.7 | Mount Sinai South Nassau | 7.1 | 2.4 |
| GARDEN CARE CENTER | FRANKLIN SQUARE | 150 | 8.6 | NYU Langone Hospital-Long Island | 9.2 | 0.6 |
| NORTH SHORE - L I J ORZAC CTR FOR REHABILITATION | VALLEY STREAM | 120 | 8.4 | Mount Sinai South Nassau | 11.3 | 2.9 |