RIVERSIDE COUNTY

EMERGENCY MEDICAL

SERVICES

TRAUMA SYSTEM UPDATE

2015

Daved van Stralen, MD, Medical Director

Bruce Barton, BSEd, Director

Shanna Kissel, MSN, RN, Trauma Coordinator

Riverside County 2015

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TABLE OF CONTENTS

I. Trauma System Summary…………………………………………………………………….….. 2

II. Changes in Trauma System……………………………………………………………………… 3

III. Number and Designation Level of Trauma Centers ……………………………………………. 7

IV. Trauma System Goals and Objectives……………………………………………………............ 8

V. Changes to Implementation Schedule…………………………………………………………… 10

VI. System Performance Improvement ……………………………………………………………... 10

VII. Progress on Addressing EMS Authority Trauma System Plan Comments…………………….. 11

VIII. Other Issues ………………………………………..…………………………………………… 11

IX. Appendix………………………………………………………………………………………… 12

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I. SUMMARY OF THE PLAN

The Riverside County EMS Agency (REMSA) Trauma Care System Plan was developed in compliance

with Section 1798.160, et seq., Health and Safety Code. REMSA’s organized system of the care for

trauma patients has been in place since 1994 with approval by the California EMS Authority, (EMSA) in

1995. The plan was last updated in 2013.

Riverside County’s jurisdiction includes four Level II Trauma Centers, one of which is a Level II

Pediatric Trauma Center (PTC). The PTC is located geographically towards the western region of the

County, but centrally within the majority of the County’s population. All four trauma centers are

distributed evenly within their population density. Catchment areas have remained the same, although

population has increased throughout the County (see Trauma Center Population map below).

REMSA uses Digital Innovations Collector® Trauma Registry CV 5 for data entry for the identified

trauma patient.

Trauma Center Population Map

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REMSA Trauma Volume Trend

II. Changes in Trauma System

1. Contracts

2. Inter-county Agreements

3. Patient Registry

4. Helicopter Utilization and Review, Helicopter EMS and Continuous Quality Improvement

(HEMS CQI)

5. Policy Revisions and Additions

6. Education

7. Tranexamic Acid (TXA) Trial Study

1. Contracts

Trauma centers are continually being monitored for compliance with the standards as outlined in the

contracts. Effective July 2015, each hospital will have a pre-hospital receiving center agreement and the

designation as a trauma center will be an annex to this agreement. This will include an agreement for PTC

designation for Riverside County Regional Medical Center (RCRMC), will also be included in this

document. The American College of Surgeons - Committee on Trauma (ACS-COT) updated their

resource manual emphasizing the Trauma System as a whole. With this system wide approach, the trauma

center contracts will include criteria as mentioned in Title 22 and the ACS-COT 2014 resource manual.

Trauma site evaluations will take place concurrently with the ACS site surveys every three years.

(Appendix A: Trauma Center Review Form)

ACS- COT site verification or consultation continues to be a contractual requirement. Three trauma

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Tota

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REMSA Trauma Volume Trend 2000 - 2013

Total Trauma Pts

Adult (age >= 15 yrs)

Peds (age, < 15 yrs)

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centers will have achieved the consultative visit by the end of the current contract term; one trauma center

has successfully achieved verification. Site verification will continue to be a requirement in future

contracts. The following is the ACS verification status for each trauma center:

A. Riverside County Regional Medical Center (RCRMC) received their second ACS Level II

verification in April 2014. Their goal is to become a Level I trauma center. (Appendix B:

RCRMC ACS Level II verification letter)

B. Riverside Community Hospital (RCH) is tentatively scheduling a consultation visit for June

2016 and plans to schedule the site verification in July 2017.

C. Desert Regional Medical Center (DRMC) is scheduling a consultation visit before the end of

2016.

D. Inland Valley Medical Center (IVMC) is scheduling a consultation visit before the end of 2016.

2. Inter-county Agreements

Trauma patients are occasionally transported from the scene across county borders between Riverside and

San Bernardino Counties. REMSA and Inland Counties Emergency Medical Agency (ICEMA) both have

agreements regarding the acceptance of these trauma patients. Both counties will work collaboratively to

assure that care delivered will be optimal and in the best interest of the patients. Any EMS issues

identified in association with the transports between the two counties will be reviewed by the LEMSA’s

and presented in Trauma Audit Committee (TAC). (Appendix C: Inter- County agreements)

3. Patient Registry

The current registry Digital Innovations (DI CV5) has been in place since January 1, 2013. This is a

California EMS Information Systems (CEMSIS) and National Trauma Data Bank (NTDB) compliant

registry that is web and Windows based. Data submission will be Health Insurance Portability and

Accountability Act (HIPAA) compliant. (Appendix D: Patient Registry Data Elements) The data elements

were updated in January 2015 to reflect any changes made to the National Trauma Databank Data

Dictionary. Registry inclusion criteria includes at least one ICD-9 diagnostic code for any injury within

the following range 800-959.9 and “seen by” Trauma Services.

Any trauma related surgical service includes the following as listed in the ACS-COT FAQ for resources

for Optimal Care of the Injured Patient 2006:

General surgery

Neurosurgery

Orthopaedics

Urology

Plastics

ENT

Ophthalmology

Burns

Vascular

Surgical critical care

Pediatric surgery

Trauma

Emergency general surgery

Death due to injury

Transferred for higher level of care

Transferred to trauma services after

admission

Beginning March 2015, DI has developed hospital dashboards with trauma indicators that both the

hospital and REMSA central site can access.

4. HEMS Continuous Quality Improvement (CQI)

The HEMS CQI committee, established in 2009, identified and discussed the concerns between EMS

stakeholders regarding appropriate use of the HEMS resources. Airship scene calls were scored using the

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revised scoring matrix of indicators until June, 2014. The HEMS CQI committee was able to prove that

Riverside County is appropriate is appropriately utilizing airships on 9-1-1 calls. There has been

restructuring of the committee and beginning July 2015, HEMS providers will be tracked with quarterly

reports on specific data elements (Appendix E: HEMS Data Elements). HEMS meetings will no longer

focusing on call review, the focus will be in integration and communication of all air providers into the

EMS system. The quarterly total call data will be presented at REMSA’s Pre-hospital Medical Advisory

Committee (PMAC).

5. Policy Revisions and Additions

All trauma patient treatment policies are routinely reviewed and updated for current standards of care.

The Trauma Continuation of Care policy (#5302) currently in place is being revised in order to ensure

trauma patients are transferred to the most appropriate hospital in a timely manner. This policy update

will include recommendations from the Regional Trauma Coordinating Committee (RTCC) as well as an

analysis of the trauma data. Quarterly monitoring of the patients coded as continuation of care is included

in the Performance Improvement Plan (PIP). REMSA and ICEMA are working together to have a similar

continuation of care policy while keeping it county specific as both counties potentially have patients

crossing over county lines. A poster is being developed that includes contact phone numbers for hospitals

in both counties for specialty care centers. The following policies are those that have been updated for the

2015 Policy Manual:

REMSA Policy # 4102- Universal Patient

Mechanical spinal immobilization criteria was updated from 2014 to include the NSAID

assessment tool to patient care. Manual spinal immobilization was changed to

“Cervical spine stabilization as clinically indicated by mechanism of injury with any of

the following indicators:

Neuro deficit

Spinal Tenderness

Altered mental status

Intoxication

Distracting Injury

http://www.remsa.us/policy/4102.pdf

REMSA Policy # 4301- Shock Due to Trauma

For the patient in traumatic arrest, the following was added to the policy:

“Perform bilateral needle chest decompression for: cardiac arrest with known/suspected

torso trauma.”

http://www.remsa.us/policy/4301.pdf

REMSA Policy # 5301- Critical Trauma Patient (CTP)

This was updated to the 2011 guidelines for field triage of injured patients as identified by the

Center for Disease Control. The CTP criteria will be up to date and consistent with ACS-COT

Resources for Optimal Care of the Injured Patient 2014. (Appendix F: Policy #5301).

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REMSA Policy #5801- Tranexamic Acid (TXA) - Trial Study

REMSA is participating in a trial study with ICEMA for the administration of TXA by the ground

paramedics in the prehospital setting. This policy identifies the inclusion criteria,

contraindications, procedure, and documentation requirements. The trial study will begin June 1,

2015 and will be conducted over the course of 18 months or until the necessary number of patients

is reached, whichever comes first. (Appendix G: Policy #5801)

REMSA Policy #7306- Performance Standard: Needle Chest Decompression

The following was added to the policy:

“Confirm one of the indications for bilateral needle chest decompression:

Cardiac arrest with known/suspected torso trauma

Cardiac arrest with a presentation suggesting spontaneous pneumothorax”

“Identify and aseptically mark the appropriate side(s), approach (es), and insertion site(s):

Left, right, or bilateral

o The side(s) requiring needle chest decompression

Anterior approach:

o Second intercostal space at the midclavicular line immediately above the

third rib

(2 ICS @ MCL)

o Third intercostal space at the midclavicular line immediately above the

fourth rib

(3 ICS @ MCL)

Anterolateral approach:

o Fourth intercostal space at the anterior axillary line immediately above

the fifth rib

(4 ICS @ AAL)

o Fifth intercostal space at the anterior axillary line immediately above the

sixth rib

(5 ICS @ AAL) Lateral approach:

o Fourth intercostal space at the midaxillary line immediately above the

fifth rib

(4 ICS @ MAL)

o Fifth intercostal space at the midaxillary line immediately above the sixth

rib

(5 ICS @ MAL)

Note: Inability to positively identify the insertion site is a contraindication to needle chest

decompression.”

http://www.remsa.us/policy/7306.pdf

6. Education

REMSA contract requires all RN’s caring for trauma patients to have taken Trauma Nursing Core Course

(TNCC), Advanced Trauma Care for Nurses (ATCN), or Trauma Care After Resuscitation (TCAR). One

trauma center has a hospital specific education course that incorporates TCAR into the education, which

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has been reviewed and approved by REMSA in place of TCAR. REMSA’s Trauma Coordinator is

involved with hospital education at one of the trauma centers by being an Advanced Trauma Life Support

(ATLS) coordinator.

TNCC ATCN TCAR

DRMC Quarterly X Bi-annually

IVMC Bi- annually X REMSA approved critical care course

with TCAR components

RCH Every 3 months X Annually

RCRMC Bi- annually Bi-annually X

REMSA also actively participates in educational opportunities among the pre-hospital agencies and

hospitals. This includes policy updates, involvement with Advanced Trauma Life Support courses, Mass

Casualty Incident (MCI) and Active Shooter Drills.

7. Tranexamic Acid (TXA) Trial Study

REMSA and ICEMA are collaborating on a trial study for the pre-hospital administration of TXA. The

purpose of this study is to determine if pre-hospital administration of TXA in trauma patients with signs

of hemorrhagic shock decreases mortality, blood product usage and total blood loss. The arm of the study

that REMSA is involved in has a total of 200 patients, being the Paramedic Group. The entire study

includes:

A. Hospital Group: patients will receive both doses of TXA upon arrival to the hospital (200 pts)

B. Air transport Group: First dose of TXA given by the flight staff and second dose will be given in the

hospital (200 pts)

C. Paramedic Group: First dose given by licensed paramedics and second dose will be given in the

hospital (400 pts)

D. Control Group: Patients chosen randomly from the previous five years of the trauma registry (200 pts)

The study will be conducted over an 18 month period with monthly CQI of the patients. These patients

will also have a thorough case review at TAC. Frequent updates of the trial study will be reviewed and

submitted to EMSA on the approved schedule.

III. Number and Designation Level of Trauma Centers

Level II Trauma Centers: REMSA has four Level II Trauma Centers: RCH, in the City of Riverside,

RCRMC, in Moreno Valley, DRMC, in Palm Springs, and IVMC, in the City of Wildomar.

Pediatrics: RCRMC is the designated Pediatric Trauma Center, (PTC). This center has a California

Children's Services, CCS conditional approval of their Pediatric Intensive Care Unit.

Level I trauma center: Loma Linda University Medical Center, in San Bernardino County, is both an adult

and pediatric ICEMA designated Trauma center.

Scheduled changes: There are no scheduled changes to the Trauma centers at this time.

System changes: REMSA does not anticipate the need for any additional trauma centers at this time. The

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transfers out for higher level of care have increased from 2013 to 2014. These patients are being

monitored to ensure the patients are being treated at the most appropriate facility.

RCRMC has expressed interest in becoming a Level I Trauma Center within the next three years.

REMSA will work with them to explore the need and additional regulatory and/or ACS-COT

requirements.

2013-14 Trauma Center Data

*Qualified ICD 9 Dx EMS Transports Transfer to Higher Level of Care

2013 Totals 95.5% 83.3% 6.3%

2014 Totals 98.7% 81.6% 10.2%

*Qualified ICD 9 Dx: at least one Dx in 800-959.9 range

- Excludes single injuries in the 905- 924.9, 930-939.9 Dx ranges

- EMS Transport: via air or ground from scene of injury

- Transfer to higher level of care: ED or Hospital disposition = Acute care facility

IV. Trauma System Goals and Objectives

REMSA has developed the following goals and objectives for the Trauma System:

Goal #1: Review identified trauma cases on a quarterly schedule

Objectives to

Achieve Goal

Key Work Metric Target Date Status

TAC will review

identified trauma

cases on a

quarterly basis

Work in

collaboration with

ICEMA for peer

review indicators

# of Unanticipated

mortality needing 3rd

level of review

# of IFT’s with referral

hospital door-in to door-

out time > 30 min

# of All ground level

falls, > 65 years old on

anti-coagulants with an

unanticipated mortality

and/ or complication

Patients who received

TXA in the field

May 13, 2015

September 23,

2015

Ongoing

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Goal #2: Become more involved with continuing education

Objectives to

Achieve Goal

Key Work Metric Target Date Status

The Trauma

Coordinator will

be actively

involved with

education to pre-

hospital and

hospital agencies

REMSA will be

present and

participate in MCI/

Active Shooter

Drills

# of MCI drills and

active shooter drills in

Riverside County

attended by REMSA

October 21,

2014

May 19, 2015

Completed

Pending

Trauma Coordinator

will work

collaboratively with

hospitals as an

Advanced Trauma

Life Support

(ATLS) Coordinator

# of ATLS courses

offered in Riverside

County attended by

REMSA Trauma

Coordinator involved

September 26

& 27, 2015

Trauma

Coordinator

attended 1

in 4th

Quarter

2014.

Goal #3: Develop trauma policies that are data driven and evidence based

Objectives to

Achieve Goal

Key Work Metric Target Date Status

Use education,

current research and

evidence based

studies in policy

development to

improve patient

outcomes

Policies are

continuously

reviewed and

updated with the

most recent

standards of care

# of patients meeting

trauma continuation of

care

# of patients receiving

TXA in the field

# of trauma patients

admitted, transferred

or died

Quarterly

December 1,

2016

Quarterly

Ongoing

100 % PI

of all

patients

Ongoing

Goal #4: Participate in Trial Studies with other LEMSA’s

Objectives to

Achieve Goal

Key Work Metric Target Date Status

REMSA will

participate in a

countywide trial

study to evaluate if

traumatic

hemorrhagic shock

outcomes will

improve after

receiving TXA in

the pre-hospital

setting

REMSA and

ICEMA are

participating in a

trial study over the

course of 18

months or 200

patient cap per

county. Each case

will be reviewed

in depth on the

agency and system

levels

# of patients enrolled

in the TXA study

December 1,

2016

Ongoing

through

duration

of the trial

study or

pt. count

is met

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Goal #5: Encourage all four trauma centers to have ACS verification

Objectives to

Achieve Goal

Key Work Metric Target Date Status

Hospital contracts

state that they will

have ACS

consultation/

verification during

the term of the

contract. Once the

consultation visit is

complete, this

requirement will

change to

verification only.

Provide support to

those trauma

centers that are not

ACS verified

# of non- verified

trauma centers

designated as trauma

centers in Riverside

County

June 2016

Pending

Incorporate the

ACS PIP

suggestions into

the REMSA’s PIP

# of ACS suggestions

incorporated into

REMSA’s PIP

December 31,

2015

Perform

evaluations of the

trauma system in

collaboration with

ACS site visits,

every three years

# of ACS site visits

# of ACS site visits to

trauma centers in

Riverside County that

were attended by

REMSA’s Trauma

Coordinator

2016

V. Changes to Implementation Schedule

No scheduled changes to report

VI. System Performance Improvement

System- wide Performance Improvement (PI) is monitored via several methods. With any system change,

a PI measure is placed at the trauma center with reporting to REMSA. Contracts and policies are

monitored for compliance via reports and system review.

Trauma patient care is monitored through each trauma center’s trauma committee and through the

REMSA/ICEMA Trauma Audit Committee (TAC). Each trauma center reviews patient care in

compliance to their REMSA approved Performance Improvement Plan (PIP). (Appendix H: REMSA PIP)

TAC audit filters are reviewed for any system trends, American College of Surgeons-Committee on

Trauma (ACS-COT) changes and/or individual requests in the Trauma Program Managers meeting.

(Appendix I: Trauma Audit Committee Schedule)

The 2015 Peer Review Indicators for TAC:

1. Unanticipated mortality needing third level review

2. All IFT’s with ISS > 9, with referral hospital door-in to door – out time > 30 min (was this missed

Trauma Continuation of Care?)

3. All ground level falls (ICD 885.9), > 65 y.o. on anticoagulants with unanticipated mortality and/or

complications identified.

4. All patients receiving Tranexamic Acid (TXA) in the pre-hospital setting, both in San Bernardino and

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Riverside Counties.

VII. Progress on Addressing EMS Authority Trauma System Plan Comments

Response to EMSA letter dated November 12, 2013:

Trauma System Goals and Objectives from 2013 update:

Goal Goal met (Y/N) Status

1. Maintain a viable trauma

system

Yes 1. Trauma patient registry policy

in place for non-trauma centers

2. TAC and TPM are involved in

all processes

2. Grow into ACS verification No 1. IVMC upgraded to a Level II

trauma center

2. ACS site visits planned for

DRMC, IVMC, and RCH in

2016.

3. Develop measurable PI

standards

Yes partially, when Inland

Valley became Level II

1. Trauma center review matrix

developed

4. Include Injury Prevention

coordination between trauma

centers and DOPH

Partially met 1. RCRMC and REMSA attend

and participate in Child Death

Review

2. REMSA participates in

Domestic Violence/ Elder abuse

team

5. PTC Contract No 1. RCRMC has been a designated

PTC without a contract in place

VIII. Other Issues

REMSA is involved in activities on both the state and county level. The Trauma Coordinator is involved

in the Trauma Managers Association of California, Trauma System Advisory Committee

(TSAC) and TAC. Both agencies have been developing similar system policies and criteria to have

consistency with patient care which are presented at TSAC. Riverside will also be looking into

developing a tracking system with Orange, San Bernardino and San Diego counties to track those patients

originating in Riverside County and are transferred out of county from the scene.

REMSA hosts a quarterly Trauma Registrar and Trauma Manager meeting to discuss any changes in the

trauma data dictionary and other issues identified pertaining to the database on the hospital level. This

meeting provides support to the registrars as well as networking between the four trauma centers.

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X. Appendix

A. Trauma Center Review form …………………………………………………………………........... 13

B. RCRMC ACS Verification letter …………………………………………………………………… 22

C. Inter- county agreements ……………………………………………………………………………. 23

D. Patient Registry Data Elements ……………………………………………………………………. 25

E. HEMS Data Elements ……………………………………………………………………………… 44

F. REMSA Policy #5301- Critical Trauma Patient (CTP) ……………………………………………. 45

G. REMSA Policy #5801- Tranexamic Acid (TXA) Trial Study ……………………………………… 46

H. REMSA Trauma PIP ………………………………………………………………………………. 48

I. Trauma Audit Committee Schedule………………………………………………………………… 49

J. References …………………………………………………………………………………………. 51

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Appendix A: Trauma Center Review Form

California Trauma Center Criteria

California Code of Regulations

Title 22, Chapter 7-Trauma Care System

E = essential (Title 22), D = desired

Level II Level II Level II Level II

TRAUMA CENTER IVMC DRMC RCH RCRMC

INSTITUTIONS/ORGANIZATION

1 A Trauma Center must demonstrate substantial

medical, administrative and financial

commitment for the level of designation

requested.

D D D D

2 Commitment must be demonstrated and include

documentation from the hospital's:

D D D D

3 Administration D D D D

4 Medical Staff D D D D

5 Nursing D D D D

6 JCAHO Accreditation, or AOA Sec.100248 E E E E

7 Proof of licensure as a general acute care

hospital in the State of California 100259 (a)

E E E E

Level I Trauma Center shall have: Section

100260 Does not apply

8 a minimum of 1200 trauma program hospital

admissions, OR

9 a minimum of 240 trauma patients per year

whose Injury Severity Score (ISS) is >15, OR

10 an average of 35 trauma patients with an ISS

of >15 per trauma program surgeon per year

11 a trauma research program

12 An ACGME approved surgical residency

program

Requirements for all level trauma centers as

indicated: Section 100259, 100263, 100264

13 Trauma Program Medical Director E E E E

Qualifications are:

14 Board Certified Surgeon E E E E

15 Qualified Specialist (*Surgical)

Responsibilities include but are not limited to:

16 recommending trauma team physician

privileges

E E E E

17 working with nursing & administration to

support needs of trauma patients

E E E E

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18 developing trauma treatment protocols E E E E

19 determining appropriate equipment and

supplies

E E E E

20 ensuring development of policies/procedures

for domestic violence, elder/child abuse/neglect

E E E E

21 having authority & accountability for QI peer

review process

E E E E

22 correct deficiencies in trauma care/exclude

team members that don't meet standards

E E E E

23 coordinating with local and State EMS

agencies

E E E E

24 coordinating pediatric trauma care with other

hospitals/professional services

E E E E

25 assisting with the coordination of budgetary

processes for trauma program

E E E E

26 Identify representatives from neurosurgery,

orthopedic surgery, emergency medicine,

pediatrics and other appropriate disciplines to

assist in identifying physicians from their

disciplines who are qualified to be members of

the trauma program.

E E E E

27 Trauma Nurse Coordinator/Manager E E E E

Qualifications are:

28 Registered Nurse E E E E

29 Provide evidence of educational preparation,

clinical expertise in care of adult & pediatric

trauma patient, & administrative responsibilities

E E E E

Responsibilities include but are not limited to:

30 Organizing services and systems necessary

for multidisciplinary care

E E E E

31 Coordinating day-to-day clinical process &

performance improvement of nursing and

ancillary personnel

E E E E

32 Collaborating with trauma program medical

director to carry out educational, clinical,

research, administrative and outreach activities

of the trauma program

E E E E

33 Trauma Service E E E E

Which will provide:

34 implementation of requirements as specified

& provide for coordination with the local EMS

agency

E E E E

Trauma Team

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35 A multidisciplinary team responsible for the

initial resuscitation and management of the

trauma patient

E E E E

Responsibilities include but are not limited to:

36 capability of providing immediate initial

resuscitation/management of trauma patient

E E E E

37 capability of providing prompt assessment,

resuscitation & stabilization of patient

38 ability to provide treatment or arrange for

transportation to higher level trauma center

E E E E

SURGICAL DEPARTMENT(S),

DIVISION(S), SERVICE(S), SECTION(S):

Which includes at least the following surgical

specialties & staffed by qualified specialists:

39 General E E E E

40 Orthopedic E E E E

41 Neurologic (* transfer agreement) E E E E

42 Obstetric/Gynecologic E E E E

43 Ophthalmologic E E E E

44 Oral/maxillofacial or head and neck E E E E

45 Plastic E E E E

46 Urologic E E E E

NON-SURGICAL DEPARTMENT(S),

DIVISION(S), SERVICE(S), SECTION(S):

47 Which includes at least the following non-

surgical specialties & staffed by qualified

specialists:

E E E E

48 Anesthesiology E E E E

49 Internal Medicine E E E E

50 Pathology E E E E

51 Psychiatry E E E E

52 Radiology E E E E

53 Emergency Medicine, immediately available E E E E

QUALIFIED SURGICAL SPECIALIST(S):

available as follows

54 General Surgeon capable of evaluating &

treating adult and pediatric trauma patients

E E E E

55 immediately for trauma team activation and

promptly available for consultation;

E E E E

56 Requirements may be fulfilled by supervised

senior residents as defined in Section 100245

Title 22

E E E E

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57 Senior Resident must be capable of assessing

emergent situations in their respective specialty,

and shall be able to provide overall control and

surgical leadership including surgical care if

needed, and staff trauma surgeon with

experience in trauma care shall be on-call &

promptly available

E E E E

58 Staff trauma surgeon shall be advised of all

trauma patient admissions, participate in major

therapeutic decisions, & be present in the ED for

major resuscitations & in the OR for all trauma

operative procedures

E E E E

59 General Surgeon capable of evaluating &

treating adult and pediatric trauma patients

promptly for trauma team activation and

promptly available for consultation

60 Who is/are qualified Surgical Specialist(s) E E E E

61 Regularly involved in care of the injured

patient

E E E E

Qualified Surgical Specialists on-call and

promptly available:

62 Neurologic (*transfer agreement) E E E E

63 Obstetric/Gynecologic E E E E

64 Ophthalmologic E E E E

65 Oral/maxillofacial or head and neck E E E E

66 Orthopedic E E E E

67 Plastic E E E E

68 Level I Re-plantation/microsurgery capability

- *may be provided through a written agreement

69 Urologic E E E E

Surgical services

70 Available for consultation for adult &

pediatric trauma patients

E E E E

71 Burn Care - May be provided by

transfer agreement

E E E E

72 Cardiothoracic - Must be promptly

available (Section 100260)

73 Pediatric Level I Section 100260,

Level II *May be provided by transfer

agreement (Sec 100259)

*E *E *E *E

74 Re-plantation/microsurgery - Must be

promptly available (Section 100260)

75 Spinal cord injury - May be provided

by transfer agreement

E E E E

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QUALIFIED NON-SURGICAL

SPECIALIST(S):

76 Emergency Medicine, in-house and immediately

available

E E E E

77 Qualified Specialist in emergency medicine E E E E

78 Emergency medicine physicians boarded in

other specialties, required current ATLS

certification

E E E E

79 Anesthesiology E E E E

Responsibilities include but are not limited to:

80 Available and in-house 24 hours/day

81 Senior Resident/CRNA in-house with Staff

Anesthesiologist promptly available & present

for surgery

E E E E

82 On-call and promptly available with a

mechanism to ensure presence when patient

arrives in OR

E E E E

Radiology

83 On-call and promptly available E E E E

Available for consultation:

84 Cardiology E E E E

85 Gastroenterology E E E E

86 Hematology E E E E

87 Infectious Diseases E E E E

88 Internal medicine E E E E

89 Nephrology E E E E

90 Neurology E E E E

91 Pathology E E E E

92 Pulmonary Medicine E E E E

SERVICE CAPABILITIES:

Radiological Service (Available 24 hours/day)

93 immediately available a technician for

general radiological procedures & computer

tomography

E E E E

94 promptly available a radiological technician

for angiography & ultrasound services

E E E E

Clinical laboratory Service

95 comprehensive blood bank or access to

community central blood bank

E E E E

96 clinical laboratory services immediately

available

E E E E

97 clinical laboratory services promptly

available

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98 Surgical Services E E E E

99 Shall have an operating suite available or being

utilized for trauma patients and has:

E E E E

100 Operating staff, immediately available, and

back-up staff that are promptly available unless

operating on trauma patients. (Section 100260)

101 Operating staff, promptly available & back-

up staff that are promptly available unless

operating on trauma patients. (* Back up staff

not required but desirable)

E E E E

102 Appropriate surgical equipment and supplies

which have been approved by the Trauma

Medical Director (* EMS Agency)

E E E E

103 Cardiopulmonary bypass - Section 100260

104 Operating microscope - Section 100260

105 Basic or comprehensive emergency services

with special permits

E E E E

106 Designate emergency physician to be

member of trauma team

E E E E

107 Provide emergency services to adult and

pediatric patients

E E E E

108 Appropriate equipment and supplies for adult

and pediatric patients as approved by the

director of emergency medicine an in

collaboration with the trauma program medical

director

E E E E

Intensive Care Service

109 Qualified specialist in-house 24 hours/day

immediately available to care for the trauma

ICU patient

110 Qualified specialist promptly available to

care for trauma patients ICU

E E E E

111 Qualified specialist may be a resident with

2 years of training who is supervised by staff

intensivist or attending surgeon who participates

in all critical decision making

E E E E

112 Qualified specialist shall be a member of the

trauma team

E E E E

113 Appropriate equipment and supplies

determined by physician responsible for

intensive care service and the trauma program

medical director.

E E E E

114 Burn Center - In House or Transfer Agreement E E E E

Physical Therapy Service

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115 personnel trained in physical therapy E E E E

116 equipped for acute care of critically injured

patient

E E E E

117 Rehabilitation Center - May be provided by

written transfer agreement

E E E E

118 personnel trained in rehabilitation care E E E E

119 equipped for acute care of critically injured

patient

E E E E

Respiratory Care Service

120 personnel trained in respiratory therapy E E E E

121 equipped for acute care of critically injured

patient

E E E E

122 Acute Hemodialysis Capability E E E E

Occupational Therapy Service

123 personnel trained in occupational therapy E E E E

124 equipped for acute care of critically injured

patient

E E E E

Speech Therapy Service

125 personnel trained in speech therapy E E E E

126 equipped for acute care of critically injured

patient

E E E E

127 Social Service E E E E

Trauma Centers shall have the following

services and programs (special license or permit

not required)

Pediatric Service:

128

In addition to requirements in Div. 5 of Title 22

an in-house pediatric service shall have

E E E E

129 PICU approved by CCS or a written transfer

agreement with an approved PICU

E E E E

130 Hospitals without a PICU shall establish and

utilize written criteria for consultation and

transfer of pediatric patients needing intensive

care

E E E E

131 A multidisciplinary team to manage child

abuse and neglect

E E E E

132 Acute spinal cord injury - In-House or Transfer

Agreement

E E E E

133 Organ donor protocol (as described in Div. 7,

Chapter 3.5 of California Health and Safety

Code)

E E E E

134 Outreach program to include: E E E E

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135 telephone and on-site physician consultations

with physicians in the community and outlying

areas

E E E E

136 trauma prevention for general public E E E E

137 Written interfacility transfer agreements with

referring and specialty hospitals

E E E E

Continuing Education in Trauma Care for:

138 staff physicians E E E E

139 staff nurses E E E E

140 staff allied health personnel E E E E

141 EMS personnel E E E E

142 other community physicians and health care

personnel

E E E E

Performance Improvement (Section 100265)

143 Shall have a quality improvement process in

place which includes structure, process and

outcome evaluations

E E E E

144 Must have improvement process in place to

identify root causes of problems

E E E E

145 Must have interventions to reduce or

eliminate the causes

E E E E

146 Must take steps/actions to correct the

problems identified

E E E E

147 In addition the process shall include:

148 A detailed audit of all trauma -related deaths,

major complications and transfers

E E E E

149 A multidisciplinary trauma peer review

committee that includes all members of the

trauma team

E E E E

150 Participation in the trauma data management

system

E E E E

151 Participation in the local EMS Agency

trauma evaluation committee

E E E E

152 Have a written system in place for patients,

parents of minor children who are patients, legal

guardians of children who are patients, and or

primary care givers of children who are patients

to provide input and feedback to hospital staff

regarding the care provided to the children

E E E E

Interfacility transfer of Trauma Patients

(Section 100266)

153 Patients may be transferred between and from

trauma centers providing that:

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154 Transfers shall be medically prudent as

determined by the trauma surgeon of record

E E E E

155 Shall be in accordance with the local EMS

Agency interfacility transfer policies

E E E E

156 Written transfer agreements exist with

receiving trauma centers

E E E E

157 Shall have written criteria for consultation

and transfer of patients needing a higher level of

care

E E E E

158 Hospitals which have repatriated trauma patients

from a designated trauma center will provide the

trauma center with all required information for

the trauma registry, as specified by local EMS

policy.

E E E E

159 Hospitals receiving trauma patients shall

participate in system and trauma center quality

improvement activities for those trauma patients

they have transferred.

E E E E

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Appendix B- RCRMC ACS Site Verification document

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Appendix C: REMSA and ICEMA inter-county agreements

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Appendix D- Patient Registry Data Elements

1. DEMOGRAPHIC SECTION OLD

DATABASE REMSA NTDB CEMSIS PG#

Record Created Date / Time 3

Record Created By 4

Initial Location D-01 5

Facility D-02 6

Trauma Registry Number X D-03 7

Patient Arrival Date X D-04 8

Patient Arrival Time X D-05 9

Medical Record Number X D-06 10

Account Number X 11

Patient Name X D-07 CA-04,05 12

Patient Origin D-08 13

Inclusion Source D-09 14

NTDB X 15

REMSA D-10 16

Name / Alias D-11 17

SSN (last four digits) X D-12 CA-06 18

Date of Birth X D-13 D-07 D-07 19

Age X D-14 D-08 D-08 20

Age Units X D-15 D-09 D-09 21

Gender X D-16 D-12 D-12 22

Race X D-17 D-10 D-10 23

Ethnicity X D-18 D-11 D-11 24

Patient Home Zip Code X D-19 D-01 D-01 25

Homeless Status D-20 26

Patient Home Address X D-21 27

Patient Home City X D-22 D-05 D-05 28

Patient Home State X D-23 D-03 D-03 29

Patient Home County X D-24 D-04 D-04 30

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Patient Home Country X D-25 D-02 D-02 31

1. DEMOGRAPHIC SECTION (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

Patient Alternate Home Address D-26 D-06 D-06 32

Patient Telephone 33

Relative / Guardian Relationship to Patient 34

Guardian to Patient 35

Relative / Guardian Name 36

Relative / Guardian Address Info 37

Relative / Guardian Home Zip Code 38

Relative / Guardian Home Address 39

Relative / Guardian Home City 40

Relative / Guardian Home State 41

Relative / Guardian Home County 42

Relative / Guardian Home Country 43

Relative / Guardian Telephone 44

Demographic Section Notes X 45

2. INJURY INFORMATION SECTION 47

Injury Date X I-01 I-01 I-01 49

Injury Time X I-02 02 02 50

Place of Injury E849 X I-03 I-08 I-08 51

Place of Injury ICD10 I-04 I-09 I-17 52

Specify Memo Field X I-05 53

Incident Location Zip Code X I-06 I-12 I-09 54

Incident Location Address X I-07 55

Incident Location City X I-08 I-16 I-13 56

Incident Location State X I-09 I-14 I-11 57

Incident Location County X I-10 I-15 I-12 58

Incident Location Country X I-11 I-13 I-10 59

Work Related X I-12 I-03 I-03 60

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Domestic Violence I-13 61

2. INJURY INFORMATION SECTION (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

Report of Physical Abuse I-36 I-20 I-18 62

Investigation of Physical Abuse I-37 I-21 I-19 63

Occupation X I-14 I-05 I-05 64

Occupational Industry X I-15 I-04 I-04 65

Restraints X I-16 I-17 I-14 66

Airbag Deployment X I-17 I-19 I-16 67

Child Specific Restraints X I-18 I-18 I-15 68

Equipment X I-19 I-17 I-14 69

Primary E-Code – ICD-9 X I-20 I-06 I-06 70

Secondary E-Code – ICD-9 X I-21 I-10 I-08 71

Tertiary E-Codes – ICD-9 I-22 72

Cause of Injury Memo Field X I-23 73

Position in Vehicle I-24 74

Impact Location I-25 75

Injury Type X I-26 76

Activity E-Code I-27 77

Specify Activity Memo Field I-28 78

Injury Mechanism I-29 79

Disaster Casualty I-30 80

Casualty Event I-31 81

Primary E-Code ICD-10 (2014) I-32 I-07 I-20 82

Secondary E-Code ICD-10 (2014) I-33 I-11 I-21 83

Tertiary E-Codes ICD-10 (2014) I-34 84

Cause of Injury Memo Field ICD-10 (2014) I-35 85

Injury Section Notes X 86

3. PRE-HOSPITAL SECTION 87

POV / Walk-In X P-01 P-07 P-07 89

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Inclusion Source D-09 90

3. PRE-HOSPITAL SECTION (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

Extrication P-02 91

Extrication Time P-03 92

Fluid Amount P-04 93

Trauma Alert Called by EMS Date P-05 94

Trauma Alert Called by EMS Time P-06 95

Transport Mode X P-07 P-07 P-07 96

Transport Mode - Additional (Other) X P-08 P-08 P-08 97

Transport P-09 98

Agency ID Number P-10 99

Agency Unit P-11 100

Role P-12 101

Scene EMS Report X P-13 102

PCR Number X P-14 103

EMS Call Dispatched Date X P-15 P-01 P-01 104

EMS Call Dispatched Time X P-16 P-02 P-02 105

Rendezvous Pickup Location P-17 106

EMS Unit Arrived at Location Date X P-18 P-03 P-03 107

EMS Unit Arrived at Location Time X P-19 P-04 P-04 108

EMS Unit Departed Location Date X P-20 P-05 P-05 109

EMS Unit Departed Location Time X P-21 P-06 P-06 110

EMS Unit Arrived Destination Date X P-22 111

EMS Unit Arrived Destination Time X P-23 112

Scene Time Elapsed P-24 113

Transport Time Elapsed P-25 114

Trauma Center Criteria X P-26 P-18 P-18 115

Vehicular, Pedestrian, Other Risk Injury P-26 P-19 P-19 116

Prehospital Vitals Recorded Date X P-27 117

Prehospital Vitals Recorded Time X P-28 118

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Vitals / Procedures / Meds Agency / Unit X P-10 119

3. PRE-HOSPITAL SECTION (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

Prehospital Paralytic Agents X P-29 120

Prehospital Initial Vitals Sedated X P-30 121

Prehospital Initial Vitals Eye Obstruction X P-31 122

Prehospital Intubated X P-32 123

Prehospital Intubation Method P-33 124

Prehospital Respirations Assisted X P-34 125

Prehospital Respiration Assistance Type P-35 126

Prehospital SBP X P-36 P-09 P-09 127

Prehospital DBP P-37 128

Prehospital Pulse Rate X P-38 P-10 P-10 129

Prehospital UnAssist. Resp. Rate X P-39 P-11 P-11 130

Prehospital Assist. Resp. Rate X P-40 131

Prehospital 02 Sat X P-41 P-12 P-12 132

Prehospital Supplemental 02 P-42 133

Prehospital GCS Eye X P-43 P-13 P-13 134

Prehospital GCS Verbal X P-44 P-14 P-14 135

Prehospital GCS Motor X P-45 P-15 P-15 136

Prehospital GCS Total X P-46 P-16 P-16 137

Pediatric Trauma Score - Weight 138

Pediatric Trauma Score - Airway 139

Pediatric Trauma Score - Skeletal 140

Pediatric Trauma Score - Cutaneous 141

Pediatric Trauma Score - Consciousness 142

Pediatric Trauma Score - Pulse Palp 143

Pediatric Trauma Score - Total 144

Prehospital Procedure X P-47 145

Prehospital Medication P-48 146

Prehospital Section Notes X 147

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4. REFERRING FACILITY SECTION OLD

DATABASE REMSA NTDB CEMSIS 149

Immediate Referring Facility Transfer Status X RH-01 P-17 P-17 151

Immediate and Additional Referring Facility X RH-02 152

Immediate and Additional Referring Facility Arrival Date X RH-03 153

Immediate and Additional Referring Facility Arrival Time X RH-04 154

Immediate and Additional Referring Facility Departure Date X RH-05 155

Immediate and Additional Referring Facility Departure Time X RH-06 156

Immediate and Additional Referring Facility Length of Stay RH-07 157

Immediate and Additional Referring Facility Mode of Arrival X RH-08 158

Immediate and Additional Referring Facility Transfer Rationale X RH-09 159

Immediate and Additional Referring Facility Transfer Rationale

By RH-10 160

Immediate and Additional Referring Facility Late Referral X RH-11 161

Immediate and Additional Referring Facility Vitals Recorded

Date RH-12 162

Immediate and Additional Referring Facility Vitals Recorded

Time RH-13 163

Immediate and Additional Referring Facility Temperature RH-14 164

Immediate and Additional Referring Facility Temperature Route RH-15 165

Immediate and Additional Referring Facility Temperature Unit RH-16 166

Immediate and Additional Referring Facility Paralytic Agents RH-17 167

Immediate and Additional Referring Facility Sedated RH-18 168

Immediate and Additional Referring Facility Eye Obstruction RH-19 169

Immediate and Additional Referring Facility Intubated RH-20 170

Immediate and Additional Referring Facility Intubation Method RH-21 171

Immediate and Additional Referring Facility Resp. Assisted. RH-22 172

Immediate and Additional Referring Facility Resp. Assistance

Type RH-23 173

Immediate and Additional Referring Facility SBP RH-24 174

Immediate and Additional Referring Facility DBP RH-25 175

Immediate and Additional Referring Facility Pulse Rate RH-26 176

Immediate and Additional Referring Facility UnAssist. Resp.

Rate RH-27 177

Immediate and Additional Referring Facility Assist. Resp. Rate RH-28 178

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Immediate and Additional Referring Facility 02 Sat RH-29 179

4. REFERRING FACILITY SECTION (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

Immediate and Additional Referring Facility Supplemental 02 RH-30 180

Immediate and Additional Referring Facility GCS Eye RH-31 181

Immediate and Additional Referring Facility GCS Verbal RH-32 182

Immediate and Additional Referring Facility GCS Motor RH-33 183

Immediate and Additional Referring Facility GCS Total RH-34 184

Immediate Referring Facility Alcohol Use Indicator RH-35 ED-17 ED-1715 185

Immediate Referring Facility ETOH / BAC Level RH-36 186

Immediate Referring Facility Drug Use Indicator RH-37 ED-18 ED-23 187

Immediate Referring Facility Tox Screen Results RH-38 188

Immediate Referring Facility Clinician Administered RH-39 189

Immediate Referring Facility If Other Tox Memo Field RH-40 190

Immediate and Additional Referring Facility Procedures /

Medications RH-02 191

Immediate and Additional Referring Facility Procedure ICD9

Code X RH-41 192

Immediate and Additional Referring Facility Procedure Start

Date RH-42 193

Immediate and Additional Referring Facility Procedure Start

Time RH-43 194

Immediate and Additional Referring Facility Procedure

Diagnostic Results RH-44 195

Immediate and Additional Referring Facility Procedure

Anatomic Region RH-45 196

Immediate and Additional Referring Facility Procedure Memo

Field RH-46 197

Immediate and Additional Referring Facility Medication Codes RH-47 198

Immediate and Additional Referring Facility Provider Vitals RH-02 199

Intra-facility POV / walk-In RH-48 200

Intra-facility Transport Mode RH-49 201

Intra-facility Transport Mode if Other Memo Field RH-50 202

Intra-facility Transport Agency RH-51 203

Intra-facility Transport Unit RH-52 204

Intra-facility Transport Role RH-53 205

Intra-facility Transport Scene EMS Report RH-54 206

Intra-facility Transport PCR Number RH-55 207

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Intra-facility Transport Call Dispatched Date RH-56 208

4. REFERRING FACILITY SECTION (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

Intra-facility Transport Call Dispatched Time RH-57 209

Intra-facility Transport Rendezvous Pick-up Location RH-58 210

Intra-facility Transport Arrived at Location Date RH-59 211

Intra-facility Transport Arrived at Location Time RH-60 212

Intra-facility Transport Departed Location Date RH-61 213

Intra-facility Transport Departed Location Time RH-62 214

Intra-facility Transport Arrived Destination Date RH-63 215

Intra-facility Transport Arrived Destination Time RH-64 216

Intra-facility Transport Scene Time Elapsed. Transport Time

Elapsed

RH-65

RH-66 217

Intra-facility Transport Paralytic Agents RH-67 218

Intra-facility Transport Sedated RH-68 219

Intra-facility Transport Eye Obstruction RH-69 220

Intra-facility Transport Intubated RH-70 221

Intra-facility Transport Intubation Method RH-71 222

Intra-facility Transport Resp. Asst. RH-72 223

Intra-facility Transport Resp. Assistance Type RH-73 224

Intra-facility Transport SBP RH-74 225

Intra-facility Transport DBP RH-75 226

Intra-facility Transport Pulse Rate RH-76 227

Intra-facility Transport Unassisted. Resp. Rate RH-77 228

Intra-facility Transport Assist. Resp. Rate RH-78 229

Intra-facility Transport 02 Sat RH-79 230

Intra-facility Transport Supplemental 02 RH-80 231

Intra-facility Transport GCS Eye RH-81 232

Intra-facility Transport GCS Verbal RH-82 233

Intra-facility Transport GCS Motor RH-83 234

Intra-facility Transport GCS Total RH-84 235

Intra-facility Transport Agency / Transport Unit RH-51

RH-52 236

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Intra-facility Transport Procedure RH-85 237

4. REFERRING FACILITY SECTION (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

Intra-facility Transport Medications RH-86 238

Referring Facility Section Notes X 239

5. ED RESUSCITATION SECTION 241

Direct Admit Status X ED-01 243

ED Arrival Date X ED-02 ED-01 ED-01 244

ED Arrival Time X ED-03 ED-02 ED-02 245

ED Departure or Admission Date X ED-04 ED-21 ED-19 246

ED Departure or Admission Time X ED-05 ED-22 ED-20 247

Time in ED ED-06 248

Mode of Arrival X ED-07 P-07 P-07 249

Response Level X ED-08 250

Revised Response Level ED-09 251

Post ED Disposition X ED-10 ED-19 ED-17 252

Admitting Service X ED-11 253

Post OR Disposition X ED-12 254

Signs of Life PM_01 ED_0220 ED_18 255

Response Activation Date X ED-13 256

Response Activation Time X ED-14 257

Response Activation Elapsed Time ED-15 258

Revised Response Activation Date ED-16 259

Revised Response Activation Time ED-17 260

Revised Response Activation Elapsed Time ED-18 261

Admitting Physician X 262

Medications 263

Warming Measures 264

Arrival / Admission CPR ED-22 265

Arrival / Admission CPR Duration ED-23 266

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Arrival / Admission Initial & Additional Vitals Recorded Date X ED-24 267

5. ED RESUSCITATION SECTION (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

Arrival / Admission Initial & Additional Vitals Recorded Time X ED-25 268

Arrival / Admission Initial & Additional Vitals Temperature X ED-26 ED-05 ED-05 269

Arrival / Admission Initial & Additional Vitals Temperature

Unit ED-27 270

Arrival / Admission Initial & Additional Vitals Temperature

Route ED-28 271

Arrival / Admission Initial & Additional Vitals Weight ED-29 ED-16 ED-21 272

Arrival / Admission Initial Weight Units ED-30 273

Arrival / Admission Initial & Additional Vitals Height ED-31 ED-15 ED-22 274

Arrival / Admission Initial Height Units ED-32 275

Arrival / Admission Initial & Additional Vitals Paralytic

Agents X ED-33 ED-14 ED-14 276

Arrival / Admission Initial & Additional Vitals Sedated X ED-34 ED-14 ED-14 277

Arrival / Admission Initial & Additional Vitals Eye Obstruction X ED-35 ED-14 ED-14 278

Arrival / Admission Initial & Additional Vitals Intubated X ED-36 ED-14 ED-14 279

Arrival / Admission Initial & Additional Vitals Intubation

Method ED-37 280

Arrival / Admission Initial & Additional Vitals Resp. Asst. X ED-38 ED-07 ED-07 281

Arrival / Admission Initial & Additional Vitals Resp.

Assistance Type ED-39 282

Arrival / Admission Initial & Additional Vitals SBP X ED-40 ED-03 ED-03 283

Arrival / Admission Initial & Additional Vitals DBP ED-41 284

Arrival / Admission Initial & Additional Vitals Pulse Rate X ED-42 ED-04 ED-04 285

Arrival / Admission Initial & Additional Vitals UnAssist. Resp.

Rate X ED-43 ED-06 ED-06 286

Arrival / Admission Initial & Additional Vitals Assist. Resp.

Rate X ED-44 287

Arrival / Admission Initial & Additional Vitals 02 Sat X ED-45 ED-08 ED-08 288

Arrival / Admission Initial & Additional Vitals Supplemental

02 X ED-46 ED-09 ED-09 289

Arrival / Admission Initial & Additional Vitals GCS Eye X ED-47 ED-10 ED-10 290

Arrival / Admission Initial & Additional Vitals GCS Verbal X ED-48 ED-11 ED-11 291

Arrival / Admission Initial & Additional Vitals GCS Motor X ED-49 ED-12 ED-12 292

Arrival / Admission Initial & Additional Vitals GCS Total X ED-50 ED-13 ED-13 293

ABGs ED-51 294

ABG pH ED-52 295

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PaO2 ED-53 296

5. ED RESUSCITATION SECTION (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

PaCO2 ED-54 297

Base Deficit ED-55 298

Hematocrit ED-56 299

INR ED-57 300

Initial Alcohol Use Indicator X ED-58 ED-17 ED-1715 301

ETOH / BAC Level X ED-59 CA-02 302

Initial Drug Use Indicator X ED-60 ED-18 ED-23 303

Initial Tox Screen Results X ED-61 304

Initial Tox Screen Clinician Administered ED-62 305

Initial Tox Screen Results Other ED-63 306

Assessment Type ED-64 307

ED Resus Section Notes X 308

6. PATIENT TRACKING SERVICE 309

Location of Pt. 311

Location of Pt. Arrival Date X 312

Location of Pt. Arrival Time X 313

Location of Pt. Departure Date 314

Location of Pt. Departure Time 315

Location of Pt. Elapsed Time 316

Location Tracking Details 317

ICU Days X O-05 O-01 O-01 318

Step-Down / IMC Days 319

Service / Consult 320

Service / Consult Start Date 321

Service / Consult Start Time 322

Service / Consult Stop Date 323

Service / Consult Stop Time 324

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Service / Consult Elapsed Time 325

6. PATIENT TRACKING SERVICE (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

Service Tracking Details 326

Ventilator Start Date 327

Ventilator Start Time 328

Ventilator Stop Date 329

Ventilator Stop Time 330

Ventilator Elapsed Time 331

Total Ventilator Days X O-06 O-02 O-02 332

Blood Product PT-06 333

Blood Volume PT-07 334

Blood Units PT-08 335

Blood Location PT-09 336

Blood Time Period PT-10 337

Clinical Management Code / Intervention 338

Clinical Management Intervention Start Date 345

Clinical Management Intervention Stop Date 346

Patient Tracking Section Notes 347

7. PROVIDERS SECTION 349

Resus Team Type / In-House Consult X PR-01 350

Resus Team Provider / In-House Consult X PR-02 351

Resus Team / In-House Consult Called Date X PR-03 352

Resus Team / In-House Consult Called Time X PR-04 353

Resus Team / In-House Consult Responded Date X PR-05 354

Resus Team / In-House Consult Responded Time X PR-06 355

Resus Team / In-House Consult Arrived Date X PR-07 356

Resus Team / In-House Consult Arrived Time X PR-08 357

Resus Team Timeliness X PR-09 358

In-House Consult Timeliness X PR-10 359

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Resus Team / In-House Consult Notes 360

7. PROVIDERS SECTION (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

Provider Section Notes X 361

8. PROCEDURES SECTION 363

ICD9 Procedure Code X HP-01 HP-01 HP-01 365

Procedure Location X HP-02 368

Operation Number X HP-03 369

Procedure / Operation Start Date X HP-04 HP-03 HP-02 370

Procedure / Operation Start Time X HP-05 HP-04 HP-03 371

Procedure / Operation Stop Date X HP-06 372

Procedure / Operation Stop Time X HP-07 373

Procedure / Operation Diagnostic Result 374

Procedure / Operation Anatomic Region 375

Procedure / Operation Service HP-10 376

Procedure / Operation Physician 377

ICD9 Procedure Narrative X HP-12 378

ICD10 Procedure (2014) HP-13 HP-02 HP-04 379

Procedure Section Notes X 380

9. DIAGNOSES SECTION 381

AIS Version X DG-01 IS-04 IS-04 383

ISS X DG-02 IS-05 IS-05 384

NISS 385

TRISS X DG_13 386

ICD9 Diagnosis Narrative X DG-03 DG-02 DG-02 387

ICD9 Diagnosis Code X DG-04 388

ICD9 Diagnosis Predot X DG-05 IS-01 IS-01 389

AIS Severity X DG-06 IS-02 IS-02 390

ISS Body Region X DG-07 IS-03 IS-03 391

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ICD-10 Diagnosis Code DG-08 DG-03 DG-03 392

9. DIAGNOSES SECTION (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

Non-Trauma Diagnosis ICD9 DG-09 393

Non-Trauma Diagnosis ICD-10 (2014) DG-10 394

Co-Morbidities Code X DG-11 DG-01 DG-01 395

Pre-Hospital Cardiac Arrest P-49 P-20 P-20 396

Co-Morbidities Note DG-12 397

Diagnosis Section Notes 398

10. OUTCOME SECTION 399

Discharge Status X O-01 401

Discharge Condition O-02 402

Discharge / Death Date X O-03 O-03 O-03 403

Discharge / Death Time X O-04 O-04 O-04 404

Total ICU Days X O-05 O-01 O-01 405

Total Ventilator Days O-06 O-02 O-02 406

Total Hospital Days X O-07 407

Discharging Physician 408

Discharged Destination X O-08 O-05 O-05 409

Caregiver at Discharge O_38 I_22 I-22 410

Discharge Destination Specify O-09 411

Initial Transferred Discharge Facility X O-10 412

Initial Discharge Destination Other X O-11 413

Initial Discharge Transfer Rationale X O-12 CA-01 414

Initial Discharge Transfer Rationale By O-13 415

Impediment to Discharge X O-14 416

Ready For Discharge Date O-15 417

Impediments to Discharge Delay Days O-16 418

Disabilities - Pre-Existing / Upon Discharge O-17 419

Disabilities Qualifiers O-18 420

Disabilities - Totals O-19 421

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Rehabilitation Potential O-20 422

10. OUTCOME SECTION (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

Death Location O-21 423

Death Manner (Suspected) O-22 424

Death Cause O-23 425

Autopsy Status X O-24 426

Medical Examiner 427

Autopsy Number O-25 428

Autopsy Memo X O-26 429

Organ Donation Request Status O-27 430

Organ Donation Request Permission O-28 431

Organs Procured X O-29 432

Organ Procured Specify Other X O-30 433

Organ Non-Procurement Reason O-31 434

Organ Donor Status O-32 435

Organ Procurement Date O-33 436

Organ Procurement Time O-34 437

Billing Account Number X 438

Total Hospital Charges Billed X O-35 CA-03 439

Diagnosis Billing DRG 440

Diagnosis Billing MS-DRG 441

Primary Payor / Additional Payor X O-36 F-01 F-01 442

Primary Payor / Add. Payor Collected Amount 443

Primary Payor / Add. Payor Collected Date 444

Billing Specify 445

Total Charges Collected X 446

Last Date Charges Collected 447

Outcomes Section Notes X 448

11. QA TRACKING SECTION 449

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ACS Questions X Q-01 451

11. QA TRACKING SECTION (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

QA Item Occurrence Date 453

QA Item Occurrence Response 454

QA Item Occurrence Tracking 455

QA Item Occurrence Notes 456

NTDB Complications X Q-02 Q-01 Q-01 457

NTDB Complications Date 459

NTDB Complications QA Tracking 460

QA Item 461

QA Item Occurrence Location 462

QA Item Occurrence Service 463

QA Item Occurrence Date Opened 464

QA Item Occurrence Date Loop Closed 465

QA Item Occurrence Provider 466

QA Item Occurrence Section Notes 467

QA Item Occurrence Reviewer 468

QA Item Occurrence Reviewed Date 469

QA Item Occurrence Reviewed Comment 470

QA Item Occurrence Contributing Factors 471

QA Item Occurrence Determination - System/Disease/Provider 472

QA Item Occurrence Determination Qualifier - OFI Status 473

QA Item Occurrence Determination Grade 474

QA Item Occurrence Determination Care Given Status 475

QA Item Occurrence Corrective Action 476

QA Item Occurrence Corrective Action Status 477

QA Item Occurrence Memo Field 478

12. TQIP SECTION 479

NTDB Enable Fields X 481

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NTDB Lock Record X 482

12. TQIP SECTION (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

TQIP Exclusion X 483

TQIP Head Injury Criteria X 484

TQIP Blood Product Criteria 485

TQIP Withdrawal Of Care PM_02 PM-26 I-23 486

TQIP Withdrawal Date PM_03 PM-27 I-24 487

TQIP Withdrawal Time PM_04 PM-28 I-25 488

TQIP Venous Thromboembolism X PM-07 489

TQIP Prophylaxis Date X PM-08 490

TQIP Prophylaxis Time X PM-09 491

TQIP / TBI Highest Total GCS Within 24 Hrs. PM-01 492

TQIP / TBI GCS Motor Component X PM-02 493

TQIP / TBI GCS Qualifiers X PM-03 494

TQIP / TBI Cerebral Monitor Type X PM-04 495

TQIP / TBI Cerebral Monitor Date X PM-05 496

TQIP / TBI Cerebral Monitor Time X PM-06 497

TQIP / BLOOD Lowest ED SBP PM_26 498

TQIP / BLOOD Transfusion Blood 4hrs PM_10 499

TQIP / BLOOD Transfusion Blood 24hrs PM_11 500

TQIP / BLOOD Transfusion Blood Measurements PM_12 501

TQIP / BLOOD Transfusion Blood Conversion PM_13 502

TQIP / BLOOD Transfusion Plasma 4hrs PM_14 503

TQIP / BLOOD Transfusion Plasma 24 Hrs. PM_15 504

TQIP / BLOOD Transfusion Plasma Blood Measurements PM-16 505

TQIP / BLOOD Transfusion Plasma Blood Conversion PM-17 506

TQIP / BLOOD Transfusion Platelets 4hrs PM_18 507

TQIP / BLOOD Transfusion Platelets 24 Hrs. PM_19 508

TQIP / BLOOD Transfusion Platelets Blood Measurements PM_20 509

TQIP / BLOOD Transfusion Platelets Blood Conversion PM_21 510

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TQIP / BLOOD Cryoprecipitate 4hrs PM_22 511

12. TQIP SECTION (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

TQIP / BLOOD Cryoprecipitate 24 Hrs. PM_23 512

TQIP / BLOOD Cryoprecipitate Measurements PM_24 513

TQIP / BLOOD Cryoprecipitate Conversion PM_25 514

TQIP / BLOOD Embolization Site PM_28 515

TQIP / BLOOD Surgery For Hemorrhagic Control PM_31 516

TQIP / BLOOD Surgery Date PM_32 517

TQIP / BLOOD Surgery Time PM_33 518

TQIP / BLOOD Angiography PM_27 519

TQIP / BLOOD Angiography Date PM_29 520

TQIP / BLOOD Angiography Time PM_30 521

APPENDIX and OTHER REFERRENCES 523

1. NTDB Patient Inclusion Criteria 525

2. REMSA Trauma Registry Inclusion Criteria 526

3. CEMSIS Trauma Patient Inclusion Criteria 528

4. Classification of Patient Without Zip Code 530

5. List of Services 531

6. Patient's Occupation 532

7. Patient's Occupational Industry 536

8. ICD9 Activity Codes 539

9. List of Potential Mass Casualty Events 543

10. Prehospital Procedures 544

11. List of Medications 545

12. List of Procedures 549

ICD9 Procedure Codes 551

13. Patient Location / Destination / Disposition 555

14. Day Calculator 556

15. NTDB Co-Morbidities 557

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16. NTDB Complications 568

APPENDIX (con’t) OLD

DATABASE REMSA NTDB CEMSIS PG#

17. ACS Questions 581

18. GCs – Eye / Verbal / Motor / Total 582

19. California Penal Code for Child Abuse 584

OSHPD Hospital ID# Riverside / San Bernardino Counties 585

OSHPD Long Term Care Facility ID# Riverside County 587

Riverside County Zip Codes & Communities 590

Body Mass Index Table / Obesity Chart 592

GSW Velocity 593

Pediatric Trauma Score 594

CDC Injury Matrix 596

Vehicle Impact Location 599

Burns Rule of Nine 600

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Appendix E: HEMS Scoring Matrix

Your Agency Name / Unit #:

Date of Service

Scene or IFT

Incident location

Number of pts

Specific Reason for Air Utilization

If other: free text reason

Flight Number

Dispatch Time

1st Responder Agency / Unit #

Hospital Contact Time

Name of Hospital

Lift Off Time

Skids down @ LZ Time

Patient contact Time

Special Procedures:

Pt transport from scene to LZ Time

Skids up Time

Arrived to destination Time

Destination

Was another Hospital overflown?

Name of facility overflown

Ground ETA to closest Hospital

Delay Reason (if any)

Cancellation Reason (if any)

Comments, concerns

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Appendix F: Policy 5301- Critical Trauma Patient (CTP)

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Appendix G: Policy 5801- Tranexamic Acid (TXA) Trial Study

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Appendix H: REMSA PI Plan

Appendix I: Trauma Center Audit Schedules

PI Jan Feb March April May June July Aug Sept Oct Nov Dec

Under-triage % X X X

Non-surgical admit % X X X

Hospital PIPS X X

SICU call panel X X X

TAC attendance X X X

Disaster Plan- hospital drills 2

times a year

Chart submission X X X

Continuation of Care X X X

Annual PI

TMD active member in in

regional or national trauma X

Copy of trauma activation criteriaX

Copy of protocols for

Orthopaedic emergencies X

Copy of agreements for

transfers to specialty care

centers X

Year- end Injury Prevention report X

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2015 Trauma Audit Committee (TAC) Meeting Schedule:

February 25, 2015

May 13, 2015

September 23, 2015

TAC Chart rotation:

The goal for chart rotation is have both counties review charts from trauma centers outside of their

LEMSA.

15-Feb 15-May 15-Sep

DRMC ARMC LLUMC-P LLUMC-A

RCRMC LLUMC-P DRMC ARMC

RCH IVMC LLUMC-A LLUMC-P

IVMC LLUMC-A ARMC RCH

LLUMC-P DRMC IVMC RCRMC

LLUMC-A RCRMC RCH IVMC

ARMC RCH RCRMC DRMC

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Appendix J: References

Committee on Trauma, American College of Surgeons. (2014). Resources for Optimal Care of the Injured

Patient.

Riverside County EMS Agency 2015 Policy Manual. Retrieved from http://www.remsa.us/policy/.

End of document