Date of Adoption: December 14, 2001.

     Purpose: The purpose of the rule change is to gather prehospital data through designated trauma hospitals, to improve the completeness and accuracy of all data collected, and to improve the availability and delivery of prehospital and hospital trauma care services.

     Citation of Existing Rules Affected by this Order: Amending WAC 246-976-330, 246-976-420, and 246-976-430.

     Statutory Authority for Adoption: RCW 70.168.060 and 70.168.090.

      Adopted under notice filed as WSR 01-22-065 on November 1, 2001.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 3, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 3, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 3, Repealed 0.
     Effective Date of Rule: Thirty-one days after filing.

December 26, 2001

Nancy Ellison

for Mary Selecky

Secretary

OTS-5232.2

AMENDATORY SECTION(Amending WSR 00-08-102, filed 4/5/00, effective 5/6/00)

WAC 246-976-330   Ambulance and aid services -- Record requirements.   (1) Each ambulance and aid service must maintain a record of:

     (a) Current certification levels of all personnel;

     (b) Make, model, and license number of all vehicles; and

     (c) Each patient contact with at least the following information:

     (i) Names and certification levels of all personnel;

     (ii) Date and time of medical emergency;

     (iii) Age of patient;

     (iv) Applicable components of system response time as defined in this chapter;

     (v) Patient vital signs;

     (vi) Procedures performed on the patient;

     (vii) Mechanism of injury or type of illness;

     (viii) Patient destination;

     (ix) For trauma patients, other data points identified in WAC 246-976-430 for the trauma registry.

     (2) Transporting agencies must provide an initial written report of patient care to the receiving facility at the time the patient is delivered. For patients meeting the state of Washington prehospital trauma triage (destination) procedures, as described in WAC 246-976-930(3), the transporting agency must provide additional trauma data elements described in WAC 246-976-430 to the receiving facility within ten days.

     (3) Licensed services must make all records available for inspection and duplication upon request of the department.

[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-330, filed 4/5/00, effective 5/6/00. Statutory Authority: RCW 43.70.040 and chapters 18.71, 18.73 and 70.168 RCW. 93-01-148 (Order 323), § 246-976-330, filed 12/23/92, effective 1/23/93.]

     (a) Provide data for injury surveillance, analysis, and prevention programs;

     (b) Monitor and evaluate the outcome of care of major trauma patients, in support of state-wide and regional quality assurance and system evaluation activities;

     (c) Assess compliance with state standards for trauma care;

     (d) Provide information for resource planning, system design and management;

     (e) Provide a resource for research and education.

     (2) Confidentiality: It is essential for the department to protect information regarding specific patients and providers. Data elements related to the identification of individual patient's, provider's, and facility's care outcomes shall be confidential, shall be exempt from RCW 42.17.250 through 42.17.450, and shall not be subject to discovery by subpoena or admissible as evidence.

     (a) The department may release confidential information from the trauma registry in compliance with applicable laws and regulations. No other person may release confidential information from the trauma registry without express written permission from the department.

     (b) The department may approve requests for trauma registry data from qualified agencies or individuals, consistent with applicable statutes and rules. The department may charge reasonable costs associated with such requests.

     (c) The data elements indicated as confidential in Tables E, F and G below are considered confidential.

     (d) The department will establish criteria defining situations in which additional registry information is confidential, in order to protect confidentiality for patients, providers, and facilities.

     (e) This paragraph does not limit access to confidential data by approved regional quality assurance programs established under chapter 70.168 RCW and described in WAC 246-976-910.

     (3) Inclusion criteria:

     (a) The department will establish inclusion criteria to identify those injured patients that ((providers)) designated trauma services must report to the trauma registry.

     (((a) For all licensed prehospital providers these criteria will include injured patients:

     (i) Who were dead at the scene;

     (ii) Who died enroute; or

     (iii) Who met the criteria of the prehospital trauma triage (destination) procedures.

     (b) For designated trauma services)) These criteria will include:

     (i) All patients who were discharged with ICD diagnosis codes of 800.0 - 904.99, 910 - 959.9 (injuries), 994.1 (drowning), 994.7 (asphyxiation), or 994.8 (electrocution) and:

     (((i))) (A) For whom the hospital trauma resuscitation team was activated; or

     (((ii))) (B) Who were dead on arrival at your facility; or

     (((iii))) (C) Who were dead at discharge from your facility; or

     (((iv))) (D) Who were transferred by ambulance into your facility from another facility; or

     (((v))) (E) Who were transferred by ambulance out of your facility to another acute care facility; or

     (((vi))) (F) Adult patients (age fifteen or greater) who were admitted as inpatients to your facility and have a length of stay greater than two days or forty-eight hours((.

     (c))); or

     (G) Pediatric patients (ages under fifteen years) who were admitted as inpatients to your facility, regardless of length of stay; or

     (ii) All patients who meet the requirements of the state of Washington prehospital trauma triage procedures described in WAC 246-976-930(3);

     (b) For all licensed rehabilitation services, these criteria will include all patients who were included in the trauma registry for acute care.

     (4) Other data: The department and regional quality assurance programs may request data from medical examiners and coroners in support of the registry.

     (5) Data linking: To link data from different sources, the department will establish procedures to assign a unique identifying number (trauma band number) to each trauma patient. All providers reporting to the trauma registry must include this trauma number.

     (6) Data submission: The department will establish procedures and format for providers to submit data electronically. These will include a mechanism for the reporting agency to check data for validity and completeness before data is sent to the registry.

     (7) Data quality: The department will establish mechanisms to evaluate the quality of trauma registry data. These mechanisms will include at least:

     (a) Detailed protocols for quality control, consistent with the department's most current data quality guidelines.

     (b) Validity studies to assess the timeliness, completeness and accuracy of case identification and data collection. The department will report quarterly on the timeliness, accuracy and completeness of data.

     (8) Registry reports:

     (a) Annually, the department will report:

     (i) Summary statistics and trends for demographic and related information about trauma care, for the state and for each EMS/TC region;

     (ii) Outcome measures, for evaluation of clinical care and system-wide quality assurance and quality improvement programs.

     (b) Semiannually, the department will report:

     (i) Trends, patient care outcomes, and other data, for each EMS/TC region and for the state, for the purpose of regional evaluation;

     (ii) On all patient data entered into the trauma registry during the reporting period;

     (iii) Aggregate regional data to the regional EMS/TC council, excluding any confidential or identifying data.

     (c) The department will provide:

     (i) Provider-specific raw data to the provider that originally submitted it;

     (ii) Periodic reports on financial data;

     (iii) Registry reports to all providers that have submitted data;

     (iv) For the generation of quarterly reports to all providers submitting data to the registry, for the purpose of planning, management, and quality assurance.

[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-420, filed 4/5/00, effective 5/6/00. Statutory Authority: RCW 43.70.040 and chapters 18.71, 18.73 and 70.168 RCW. 93-01-148 (Order 323), § 246-976-420, filed 12/23/92, effective 1/23/93.]

     (2) ((All trauma care services must submit required data to the trauma registry in an approved format.

     (3))) All trauma care providers must protect the confidentiality of data in their possession and as it is transferred to the department.

     (((4))) (3) All trauma care providers must correct and resubmit records which fail the department's validity tests described in WAC 246-976-420(6). You must send corrected records to the department within three months of notification.

     (((5))) (4) Licensed prehospital services that transport trauma patients must:

     (a) Assure personnel use the trauma ID band.

     (b) Report data as shown in Table E for trauma patients defined in WAC 246-976-420. Data is to be reported to the receiving facility in an approved format within ten days.

     (((c) Report incidents occurring in a calendar quarter by the end of the following quarter. The department encourages more frequent data reporting.

     (6))) (5) Designated trauma services must:

     (a) Assure personnel use the trauma ID band.

     (b) Report data elements shown in Table F for all patients defined in WAC 246-976-420.

     (c) Report patients discharged in a calendar quarter in an approved format by the end of the following quarter. The department encourages more frequent data reporting.

     (((7))) (6) Designated trauma rehabilitation services must:

     (a) Report data on all patients who were included in the trauma registry for acute care.

     (b) Report either:

     (i) Data elements shown in Table G; or

     (ii) If the service submits data to the uniform data set for medical rehabilitation, provide a copy of the data to the department.

TABLE E: Prehospital Data Elements for the Washington Trauma Registry
Type of patient	((Pre-Hosp No-Trans))	Pre-Hosp Transport	Inter-Facility
Data Element
Note: (C) identifies elements that are confidential. See WAC 246-976-420 (2)(c).
Incident Information
Agency identification number (C)	((X))	X	X
Date of response (C - day only)	((X))	X	X
Run sheet number (C)	((X))	X	X
((Agency incident number (C)	X	X	X))
First agency on scene identification number (C)	((X))	X
((Transporting agency identification	X	X))
Level of ((transporting agency)) personnel	((X))	X	X
Mode of transport	((X))	X	X
Incident county code	((X))	X
((Incident Zip Code	X	X))
Incident location (type)	((X))	X
Incident response area type	((X))	X
Patient Information
Patient's trauma identification band number (C)	((X))	X	X
Name (C)	((X))	X	X
Date of birth (C), or Age	((X))	X	X
Sex	((X))	X	X
((If patient died at scene: Patient home Zip Code	X	X))
Mechanism of injury	((X))	X
((Illness/Injury type code	X	X))
Safety restraint or device used	((X))	X
Transportation
Transported from (code) (C - if hospital ID)		X	X
((Transported to (code) (C - if hospital ID)		X	X
If rendezvous, assisting agency ID number		X	X))
Reason for destination decision		X	X
Times
((Call received	X	X	X))
Transporting agency dispatched	((X))	X	X
((Code Response to scene?	X	X	X))
Transporting agency arrived at scene	((X))	X	X
Transporting agency departed from scene		X	X
((Code response to destination?		X	X
Arrival at destination		X	X))
First)) Vital Signs
Time	((X))	X	X
Systolic blood pressure	((X))	X	X
Respiratory rate	((X))	X	X
Pulse	((X))	X	X
Glasgow coma score (three components)	((X))	X	X
Pupils		X	X
Vitals from 1st agency on scene?		X
Trauma Triage Criteria
Vital signs, consciousness level	((X))	X
Anatomy of injury	((X))	X
Biomechanics of injury	((X))	X
Other risk factors	((X))	X
Gut feeling of medic	((X))	X
Prehospital trauma system activation?	((X))	X
Other Severity Measures
((Blunt/Penetrating injury	X	X))
Respiratory ((effort)) quality	((X))	X
Consciousness	((X))	X
Time (interval) for extrication	((X))	X
Treatment: EMS interventions	((X))	X	X

     Identification of reporting facility (C);

     Date and time of arrival at reporting facility (C - day only);

     Unique patient identification number assigned to the patient by the reporting facility (C);

     Patient's trauma identification band number (C);

Patient Identification

     Name (C);

     Date of birth (C - day only);

     Sex;

     Race;

     Social Security number (C);

     Home zip code;

Prehospital Incident Information

     Date and time of incident (C - day only);

     Prehospital trauma system activated?;

     First agency on-scene ID number;

     Arrival via EMS system?;

     Transporting (reporting) agency ID number;

     Transporting agency run number (C);

     Mechanism of injury;

     ((City and county of incident;

     If transfer in, facility patient was transferred from (C);))

     Respiratory quality;

     Consciousness;

     Incident county code;

     Incident location type;

     Response area type;

     Occupational injury?;

     Safety restraint/device used;

Earliest Available Prehospital Vital Signs

     Time;

     Systolic blood pressure;

     Respiratory rate;

     Pulse rate;

     Glasgow coma score (three components);

     Pupils;

     Vitals from 1st on-scene agency?;

Extrication time over twenty minutes?;

Prehospital procedures performed;

Prehospital Triage

     Vital signs/consciousness;

     Anatomy of injury;

     Biomechanics of injury;

     Other risk factors;

     Gut feeling of medic;

Transportation Information

     Time transporting agency dispatched;

     Time transporting agency arrived at scene;

     Time transporting agency left scene;

     Transportation mode;

     Personnel level;

     Transported from;

     Reason for destination;

ED or Admitting Information

     Time ED physician called;

     ED physician called "code"?;

     Time ED physician available for patient care;

     Time trauma team activated;

     Level of trauma team activation;

     Time trauma surgeon called;

     Time trauma surgeon available for patient care;

     Vital Signs in ED

          Patient dead on arrival at your facility?;

          First and last systolic blood pressure;

          First and last temperature;

          First and last pulse rate;

          First and last spontaneous respiration rate;

          Lowest systolic blood pressure;

          Glasgow coma scores (eye, verbal, motor);

     Injury Severity scores

          Prehospital Index (PHI) score;

          Revised Trauma Score (RTS) on admission;

          For pediatric patients:

               Pediatric Trauma Score (PTS) on admission;

               Pediatric Risk of Mortality (PRISM) score on      admission;

               Pediatric Risk of Mortality - Probability of      Survival (PRISM P(s));

               Pediatric Overall Performance Category (POPC);

               Pediatric Cerebral Performance Category (PCPC):

     ED procedures performed;

     ED complications;

     Time of ED discharge;

     ED discharge disposition, including

          If admitted, the admitting service;

          If transferred out, ID of receiving hospital

Diagnostic and Consultative Information

     Date and time of head CT scan;

     Date of physical therapy consult;

     Date of rehabilitation consult;

     Blood alcohol content;

     Toxicology screen results;

     Drugs found;

     Co-morbid factors/Preexisting conditions;

Surgical Information

     For the first operation:

          Date and time patient arrived in operating room;

          Date and time operation started;

          OR procedure codes;

     For later operations:

          Date of operation

          OR Procedure Codes

Critical Care Unit Information

     Date and time of admission for primary stay in critical care unit;

     Date and time of discharge from primary stay in critical care unit;

     Length of readmission stay(s) in critical care unit;

Other procedures performed (not in OR)

Discharge Status

     Date and time of facility discharge (C - day only);

     Most recent ICD diagnosis codes/discharge codes, including nontrauma codes;

     E-codes, primary and secondary;

     Glasgow Score at discharge;

     Disability at discharge (Feeding/Locomotion/Expression)

Discharge disposition

     If transferred out, ID of facility patient was transferred to (C)

     If patient died in your facility

          Date and time of death (C - day only);

          Was an autopsy done?;

          Was case referred to coroner or medical examiner?

          Did coroner or medical examiner accept jurisdiction?

          Was patient evaluated for organ donation?

Financial Information (All Confidential)

     For each patient

          Total billed charges;

          Payer sources (by category);

          Reimbursement received (by payer category);

     Annually, submit ratio-of-costs-to-charges, by department.

     Facility ID (C)

     Facility Code

     Patient Code

     Trauma tag/identification Number (C)

     Date of Birth (C - day only)

     Social Security Number (C)

     Patient Name (C)

     Patient Sex

Care Information

     Date of Admission (C - day only)

     Admission Class

     Date of Discharge (C - day only)

     Impairment Group Code

     ASIA Impairment Scale

Diagnosis (ICD-9) Codes

     Etiologic Diagnosis

     Other significant diagnoses

     Complications/comorbidities

     Diagnosis for transfer or death

Other Information

     Date of onset

     Admit from (Type of facility)

     Admit from (ID of facility)

     Acute trauma care by (ID of facility)

     Prehospital living setting

     Prehospital vocational category

     Discharge-to-living setting

Functional Independence Measure (FIM) - One set on admission and one on discharge

     Self Care

     Eating

     Grooming

     Bathing

     Dressing - Upper

     Dressing - Lower

     Toileting

     Sphincter control

     Bladder

     Bowel

     Transfers

     Bed/chair/wheelchair

     Toilet

     Tub/shower

     Locomotion

     Walk/wheelchair

     Stairs

     Communication

     Comprehension

     Expression

     Social cognition

     Social interaction

     Problem solving

     Memory

Payment Information (all confidential)

     Payer source - primary and secondary

     Total Charges

     Remitted reimbursement by category

     Facility ID (C)

     Patient number (C)

     Trauma tag/identification Number (C)

     Social Security Number (C)

     Patient Name (C)

Care Information

     Date of Admission (C - day only)

Impairment Group Code

Diagnosis (ICD-9) Codes

     Etiologic Diagnosis

     Other significant diagnoses

     Complications/comorbidities

Other Information

     Admit from (Type of facility)

     Admit from (ID of facility) (C)

     Acute trauma care given by (ID of facility) (C)

     Inpatient trauma rehabilitation given by (ID of facility) (C)

     Discharge-to-living setting

Payment Information (all confidential)

     Payer source - primary and secondary

     Total Charges

     Remitted reimbursement by category

[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-430, filed 4/5/00, effective 5/6/00. Statutory Authority: RCW 43.70.040 and chapters 18.71, 18.73 and 70.168 RCW. 93-01-148 (Order 323), § 246-976-430, filed 12/23/92, effective 1/23/93.]

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