Iowa Trauma Patient Data Dictionary January 2017 Iowa Department of Public Health (IDPH) Bureau of Emergency and Trauma Services (BETS) 321 E. 12th Street Des Moines, Iowa 50319-0075 1 Contents Introduction ................................................................................................................................................ 10 Definition .................................................................................................................................................... 10 Trauma Registry Inclusion Criteria .............................................................................................................. 10 Data Submission and Forms ........................................................................................................................ 11 HIPAA Statement ........................................................................................................................................ 14 Acknowledgements ..................................................................................................................................... 16 Software ...................................................................................................................................................... 16 Demographic Information........................................................................................................................... 17 ImageTrend Registry Number ................................................................................................................. 18 Account Number ..................................................................................................................................... 20 Medical Record Number ......................................................................................................................... 21 Injury Date............................................................................................................................................... 22 Injury Time .............................................................................................................................................. 23 Last Name ............................................................................................................................................... 24 Patient’s First Name ................................................................................................................................ 25 Middle Initial ........................................................................................................................................... 26 Date of Birth ............................................................................................................................................ 27 Age (at date of incident) ......................................................................................................................... 28 Age Units ................................................................................................................................................. 29 Race ......................................................................................................................................................... 30 Ethnicity .................................................................................................................................................. 31 Gender .................................................................................................................................................... 32 Address ................................................................................................................................................... 33 Country ................................................................................................................................................... 34 Postal Code ............................................................................................................................................. 35 Alternate Residence ................................................................................................................................ 36 Injury Information ....................................................................................................................................... 37 Injury Location-ICD 10 ............................................................................................................................. 38 Place of Injury ......................................................................................................................................... 39 Injury Location-Postal Code .................................................................................................................... 40 Injury Location-Country .......................................................................................................................... 41 2 Injury Description .................................................................................................................................... 42 Cause of Injury-ICD 10 ............................................................................................................................. 43 Intentionality ........................................................................................................................................... 44 Trauma Type ........................................................................................................................................... 45 Vehicle Position ....................................................................................................................................... 46 Airbag Present ......................................................................................................................................... 47 Child Restraint ......................................................................................................................................... 48 Lap Belt ................................................................................................................................................... 49 Shoulder Belt ........................................................................................................................................... 50 Personal Flotation ................................................................................................................................... 51 Eye Protection ......................................................................................................................................... 52 Helmet ..................................................................................................................................................... 53 Protective Clothing ................................................................................................................................. 54 Protective Non-Clothing Gear ................................................................................................................. 55 Safety Equipment-Other ......................................................................................................................... 56 Pre-Hospital Information ............................................................................................................................ 57 Patient Arrived From ............................................................................................................................... 58 Transported To Your Facility By (Transport Mode) ................................................................................ 59 EMS Triage Information-Vehicular, Pedestrian, Other Risk Injury ......................................................... 60 Trauma Center Criteria ........................................................................................................................... 62 EMS Run Number .................................................................................................................................... 64 EMS PCR Number .................................................................................................................................... 65 EMS Service ............................................................................................................................................. 66 EMS Unit Notified/Dispatched Date ....................................................................................................... 67 EMS Unit Notified/Dispatched Time ....................................................................................................... 68 EMS Unit Arrived at Scene (or Transferring Facility) .............................................................................. 69 Time EMS Unit Left/Departed Scene or Transferring Facility ................................................................. 70 EMS Unit Arrived at Hospital .................................................................................................................. 71 Triage Destination Protocol .................................................................................................................... 72 Triage Criteria .......................................................................................................................................... 73 Pre Hospital Cardiac Arrest ....................................................................................................................