Penetrating
injury of head, neck, torso, groin
Two
or more body regions with potential life or limb threat
Combination
trauma with >= 20% TBSA Burn
Amputation
above wrist or ankle
Limb
paralysis and/or sensory deficit above the wrist and ankle
Flail
chest
Two
or more proximal long bone fractures
Category II Pick
List:
Ejection
from motor vehicle
Death
in same passenger compartment
Fall
> 20 feet (Peds - falls >= three time body length of child)
Pregnancy
>= 24 weeks
Registry Section: CATEGORY
TEMPLATE
Field Name: CATEGORY -
LOCATION OF TRAUMA ACTIVATION
Data Field Name:
CATACTLOCATE
Accessible by IDPH:
YES
Max. Length of Field: 5
Type of Field:
CODE (V)
Value Range: TRH, PRH, ED, ICU, STP, FLR,
RAD, OTH, UNK, NA
Definition: The initial location of the patient when the trauma criteria
was met.
Value: TRH - Transfer
Hospital
PRH -
Pre-Hospital
ED -
Emergency Department
ICU -
Intensive/Coronary Care Unit
STP -
Step Down Unit / Intermediate Care Unit
FLR -
Floor
RAD -
Radiology
OTH -
Other
UNK -
Unknown
NA - Not Applicable
Registry Section: CATEGORY
TEMPLATE
Field Name: CATEGORY - INITIAL
DATE/TIME TRAUMA ACTIVATION DECLARED
Data Field Name:
CATACTDATE/TIME
Accessible by IDPH:
YES
Max. Length of Field: 2, 2, 4 / 2, 2
Type of Field:
DATE/TIME
Value Range: 01-12, 01-31, 1991 TO PRESENT /
00-23, 00-59, UNK, NA ^
Definition: The initial date/time when the patient met the trauma
criteria. Enter the date in MM/DD/YYYY
format. Use military time format 00:00 to 23:59.
Registry Section: CATEGORY
TEMPLATE
Field Name: CATEGORY - TRAUMA
CATEGORY CHANGE
Data Field Name:
CATACTCHG
Accessible by IDPH:
YES
Max. Length of Field: 5
Type of Field:
CODE (V)
Value Range: I, II, NA
Definition: This field indicates the category trauma grade change. Patients may be upgraded at any time during
ED treatment. The trauma surgeon’s
response time requirements begin at the time of the upgrade. Once a patient has been assigned a Category I
or II status that patient cannot be downgraded until the trauma surgeon or
appropriate sub-specialist evaluates the patient. Enter NA if the patient’s trauma grade did
not change.
Value: I - Category I
II - Category II
NA
- Not Applicable
Registry Section: CATEGORY
TEMPLATE
Field Name: CATEGORY -
DATE/TIME OF TRAUMA CATEGORY GRADE CHANGE
Data Field Name:
CATACTCHGDATE/TIME
Accessible by IDPH:
YES
Max. Length of Field: 2, 2, 4 / 2, 2
Type of Field:
DATE/TIME
Value Range: 01-12, 01-31, 1991 TO PRESENT /
00-23, 00-59, UNK, NA ^
Definition: The initial date/time the patient’s
trauma category criteria assessment changed.
Enter the date in MM/DD/YYYY format.
Use military time format 00:00 to 23:59.
>>>>>>>>>>>>>> FUNCTIONAL INDEPENDENCE MEASURE TEMPLATE*
<<<<<<<<<< ******Not applicable in children <
7 years old****
Registry Section: FIMS TEMPLATE
Field Name: EXPRESSION
CAPABILITY AT ADMIT/DISCHARGE
Data Field Name:
EXPRESSADM/DC
Accessible by IDPH:
YES
Max. Length of Field: 5
Type of Field:
CODE (V)
Value Range: 1 - 4, 8, 9
Definition: The measure of the patient’s expression of verbal or
nonverbal language at time of admission (use pre-injury capability)/or
discharge (actual capability).
Value: 4 -
Independent
3 -
Independent with device
2 -
Dependent - partial help required
1 -
Dependent - total help required
8 -
Unknown
9 -
Not Applicable (age< 7)
Registry Section: FIMS TEMPLATE
Field Name: FEEDING
CAPABILITY AT ADMIT/DISCHARGE
Data Field Name:
FEEDADM/DC
Accessible by IDPH:
YES
Max. Length of Field: 5
Type of Field:
CODE (V)
Value Range: 1 - 4, 8, 9
Definition: The measure of the patient’s feeding ability at time of
admission (use pre-injury status)/discharge.
This includes using utensils to bring food to the mouth, chewing, and
swallowing.
Value: 4 -
Independent
3 -
Independent with device
2 -
Dependent - partial help required
1 -
Dependent - total help required
8 -
Unknown
9 - Not Applicable (age< 7)
Registry Section: FIMS TEMPLATE
Field Name: LOCOMOTION
CAPABILITY AT ADMIT/DISCHARGE
Data Field Name:
LOCOADM/DC
Accessible by IDPH:
YES
Max. Length of Field: 5
Type of Field:
CODE (V)
Value Range: 1 - 4, 8, 9
Definition: The measure of the patient’s locomotion ability at time of
admission (use pre-injury status)/discharge.
This includes walking once in a standing position, or using a
wheelchair, once in a seated position.
Value: 4 -
Independent
3 -
Independent with device
2 -
Dependent - partial help required
1 -
Dependent - total help required
8 -
Unknown
9 - Not Applicable (age< 7)
>>>>>>>>>>
DO NOT RESUSCITATE / ORGAN DONOR TEMPLATE
<<<<<<<<<<<<<<
Registry Section: DNR / ORGAN DONOR TEMPLATE
Field Name: DO NOT
RESUSCITATE (DNR) ORDER
Data Field Name:
DNR
Accessible by IDPH:
YES
Max. Length of Field: 1
Type of Field:
CHAR
Value Range: Y, N, UNK, NA
Definition: The patient does not authorize cardiopulmonary
resuscitation. The patient acknowledges
that cardiopulmonary resuscitation (CPR) will not be performed if breathing or
heart beat stops.
Registry Section: DNR
/ ORGAN DONOR TEMPLATE
Field Name: ORGAN DONOR
Data Field Name:
ORGANDONOR
Accessible by IDPH:
YES
Max. Length of Field: 1
Type of Field:
CHAR
Value Range:
Y, N, U
Definition: Indicates if the patient is an organ donor.
Value: Y - Yes, organs were donated
N - No, organs were not
donated
U- Unknown
Registry Section: DNR / ORGAN DONOR TEMPLATE
Field Name: NOT AN ORGAN
DONOR
Data Field Name:
NOTORGANDONOR
Accessible by IDPH:
YES
Max. Length of Field: 5
Type of Field:
CODE (V)
Value Range: NR, REF, UNS, UNK, NA
Definition: If the Organ Donor field is ‘N’, this field will indicate
why the patient is not an organ donor.
Value: NR - Not
Requested for donation
REF -
Refused donation
UNS -
Unsuitable for donation
UNK -
Patient expired but unknown if organ(s) were donated
NA -
Patient survived
Registry Section: DNR / ORGAN DONOR TEMPLATE
Field Name: ORGANS DONATED
Data Field Name:
ORGANSDONATED
Accessible by IDPH:
YES
Max. Length of Field: 5
Type of Field:
CODE (V)
Value Range:
PICK ALL THAT APPLY
Definition: If the Organ Donor field is ‘Y’, this field will indicate
the organs or tissue donated by the patient. PICK ALL that apply.
Value: Heart Liver Kidney
Cornea Pancreas Lung
Skin Bone Other
Registry Section: PATIENT
DEMOGRAPHY
Field Name: HOSPITAL NUMBER
Data
Field Name: HOSPITALNO
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE (V) -
INTERNAL
Value
Range: 10001 -99999
Definition: The
5 digit numeric code assigned to your Hospital.
Hospital Numbers are assigned by the Illinois Department of Public
Health. (Automatically entered in the registry.)
Value: Appendix
5.c.i.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: TRAUMA HOSPITAL DESIGNATION
Data
Field Name: HOSPTRDESIGN
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: CODE (V) -
INTERNAL
Value
Range: 1, 1P, 2, 2P
Definition:
Trauma Center
Designation criteria are listed in the Supplemental Documentation, Section
515.2030 to 515.2045 of the Illinois Administrative Code. This value is based on the hospital number
and taken the Facility File Listing (Appendix 5.c.i.).
Value: Appendix
5.c.i.
Value
Interpretation:
1 -
Level I Trauma Center
Designation
1P - Level I Pediatric Trauma
Center Designation
2 -
Level II Trauma Center
Designation
2P - Level II Pediatric Trauma
Center Designation
0 -
Non Trauma center
Registry Section: PATIENT
DEMOGRAPHY
Field Name: EMS REGION
Data
Field Name: EMSREGION
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: CHAR, INTERNAL
Value
Range: 01 - 11
Definition:
The two digit number code assigned to the Trauma
Center’s geographic regional
location by the Illinois Department of Public Health as listed in the Appendix
5.c.i., and is based on the hospital number, taken from the Facility File
Listing. (Auto-generated)
Value: Appendix
5.c.i.
Value Interpretation:
01 - Region 1
02 - Region 2
03 - Region 3
04 - Region 4
05 - Region 5
06 - Region 6
07 - Region 7
08 - Region 8
09 - Region 9
10 - Region 10
11 - Region 11
Registry Section: PATIENT
DEMOGRAPHY
Field Name: REGISTRY NUMBER
Data
Field Name: REGISTERNO
Accessible
by IDPH: YES
Max. Length of Field:
10
Type
of Field: INTEGER, INTERNAL
Value
Range: 0000000001 - 9999999999
Definition:
Auto-generated sequential unique number assigned by the program that identifies
the patient record.
Value: Auto-generated
Registry Section: PATIENT
DEMOGRAPHY
Field Name: DATA ENTRY USER ID
Data
Field Name: USERID
Accessible
by IDPH: NO
Max. Length of Field:
20
Type
of Field: CHAR - INTERNAL
Value
Range: NONE
Definition: User
ID of the data entry person. The system
will update the field based on the user ID of the person that created or
updated the record. This is a security
access field.
Value: Assigned by the facility.
Auto-generated.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: LAST DATA ENTRY UPDATE
Data
Field Name: LASTUPDATE
Accessible
by IDPH: YES
Max. Length of Field:
2,2,4
Type
of Field: DATE (TIMESTAMP),
INTERNAL
Value
Range: 01-12, 01-31, 1991- present
Definition:
The date of the last data entry update.
Value: This
date should be set to the current system date at the time record data is added
or changed within the system. Auto-generated.
Registry Section: PATIENT
DEMOGRAPHY - Patient Header Info
Field Name: PATIENT BILLING ACCOUNT NUMBER
Data
Field Name: CONTROLNO
Accessible
by IDPH: NO
Max. Length of Field:
10
Type
of Field: CHAR
Value Range: Free Text
Definition:
Identifier assigned by facility for patient billing and accounting services.
Registry Section: PATIENT
DEMOGRAPHY Patient Header Info
Field Name: PATIENT MEDICAL RECORD NUMBER
Data
Field Name: MEDRECNO
Accessible
by IDPH: YES
Max. Length of Field:
15
Type
of Field: CHAR
Value Range: Free Text
Definition:
The medical record number of the patient.
Registry Section: PATIENT
DEMOGRAPHY Patient Header Info
Field Name: EMERGENCY DEPARTMENT ARRIVAL DATE/TIME
Data
Field Name: EDDATE/TIME
Accessible
by IDPH: YES
Max. Length of Field:
2, 2, 4 / 2, 2
Type
of Field: DATE/TIME
(TIMESTAMP)
Value
Range: 01-12, 01-31, 1991 TO PRESENT / 00-23, 00-59
Definition:
The date/time the patient arrived at your hospital. Enter the date in MM/DD/YYYY format. Use military time format 00:00 to 23:59.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: SYSTEM ENTRY
Data
Field Name: DESIGNABY
Accessible
by IDPH: YES
Max. Length of Field: 1
Type
of Field: CODE(V)
Value
Range: 1 - 5, 8, 9
Definition: How
the patient arrived at your institution- method of transportation. (Your choice
determines which screens will appear in the record.)
Value: 1 Prehospital: use for ambulance or
helicopter
2 Emergency Department: use for walk-in,
drop off, private vehicle, police, or other nonmedical mode of transportation.
3 Transfer in from another medical
facility without prehospital (scene) info
4 Transfer in with prehospital (scene)
info (Does not include the transporting vehicle/agency run sheet between the
two facilities.)
6. Direct Admit
8 Unknown
Registry Section: PATIENT
DEMOGRAPHY
Field Name: Trauma
Team Activation
Def: Where the
patient was initially categorized as a Trauma Patient.
1. Field
Cat. I or II
2. ED
Cat. I or II
3. In-house
(Trauma Surgeon) Consult
4. Transfer
In- Cat. I or II
5. Retrospective
review: this is intended as a QA indicator for over/under triage; e.g.
identified later in trauma committee that the patient should have been
categorized as a I or II but wasn’t.
6. Unknown
7. N/A: Any other reportable pt. that is not a Cat. I
or II. E.g. isolated injury
Registry Section: PATIENT
DEMOGRAPHY Patient Information
Field Name: PATIENT LAST NAME
Data
Field Name: LASTNAME
Accessible
by IDPH: YES
Max. Length of Field:
100
Type
of Field: CHAR, UNK
Value
Range: Free Text
Definition:
The patient’s legal last name.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: PATIENT FIRST NAME
Data
Field Name: FIRSTNAME
Accessible
by IDPH: YES
Max. Length of Field:
20
Type
of Field: CHAR, UNK
Value Range: Free Text
Definition:
The patient’s legal first name.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: PATIENT MIDDLE INITIAL
Data
Field Name: MI
Accessible
by IDPH: YES
Max. Length of Field:
20
Type
of Field: CHAR, UNK
Value Range: Free Text
Definition:
The initial of the patient’s legal middle name. Leave this section blank if
no middle initial known.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: HOME STREET
ADDRESS
Data
Field Name: ADDRHOME
Accessible
by IDPH: YES
Max. Length of Field:
100
Type
of Field: CHAR
Value
Range: NONE
Definition:
The number and street name where the patient most often resides. If the patient is homeless or a transient,
enter “homeless” in the field. May enter P.O. Box if that is only available
address.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: HOME
CITY
Data
Field Name: CITYHOME
Accessible
by IDPH: YES
Max. Length of Field:
50
Type
of Field: CHAR
Value
Range: NONE
Definition:
The name of the city where the patient most often resides.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: HOME ZIP CODE
Data
Field Name: ZCODEHOME
Accessible
by IDPH: YES
Max. Length of Field:
10, 4
Type
of Field: CHAR
Value
Range: 00000 - 99999, UNK, NA ^
Definition:
The zip code where the patient most often resides.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: FIPS HOME STATE/COUNTY CODE
Data
Field Name: FIPSHOME
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V)
Value
Range: 01000-56045, UNK, NA ^
Definition: **
The Federal Information Processing Standard (FIPS) state and county code where
the patient most often resides. The
first two digits of the code signify the state and the last three digits
signify the county. **Note: this is a table validation field. If error message
on this screen, correct/check this section first.
Value: Appendix 5. c.ii.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: HOME
STATE
Data
Field Name: STATEHOME
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: CODE(V) -
DISPLAYED
Value
Range: OFFICIAL U.S.
POST OFFICE ABBREVIATION, DEFAULT IL
Definition:
The abbreviation of the state where the patient most often resides. This value is displayed based on the value
entered in the FIPSHOME field.
Value: Appendix 5.c.ii.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: HOME COUNTRY
Data
Field Name: COUNTRYHOME
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V)
Value
Range: IDPH COUNTRY CODES
Definition:
The country where the patient most often resides.
Value: Appendix 5.c.vi
Registry Section: PATIENT
DEMOGRAPHY
Field Name: PATIENT DATE OF BIRTH
Data
Field Name: BIRTHDATE
Accessible
by IDPH: YES
Max. Length of Field:
2,2,4
Type
of Field: DATE
Value
Range: 01-12, 01-31, 1880- present, UNK
Definition:
The patient’s date of birth.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: PATIENT AGE
Data
Field Name: AGE
Accessible
by IDPH: YES
Max. Length of Field:
6
Type
of Field: DECIMAL(6,2) -
INTERNAL CALCULATION
Value
Range: 000.01 - 999.99, (* )
Definition:
The patient’s age on the date of arrival to the hospital. IDPH Emergency Medical Services for Children
defines pediatric as 0-15 years of age. For the purposes of the registry, 0-59
days old will equal 1 month old.
Value:
The difference between the patient’s date of birth and the date of
arrival to the hospital. Automatically
calculated if both dates are entered.
The field is displayed as (*) if the field cannot be calculated.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: PATIENT GENDER
Data
Field Name: GENDER
Accessible
by IDPH: YES
Max. Length of Field:
1
Type
of Field: CODE(V)
Value
Range: M, F, U, O
Definition:
The patient’s gender on the hospital arrival date. It is expected that “Other” will not be used
frequently. It is included for cases of
sex change surgery. U may be used for pts. injured beyond recognition, etc.
Value: M
- Male
F - Female
U - Unknown
O
- Other
Registry Section: PATIENT
DEMOGRAPHY
Field Name: RACE
Data
Field Name: RACE
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: CODE(V)
Value
Range: 10, 20, 30, 31-38, 3A, 3B, 40-43, 80, 99
See Note below
Definition:
The patient’s race using the IDPH UNIFORM DATA CODING STANDARD. This is a requirement of IDPH Legal
Department and cannot be modified at this time- please just be as accurate as
possible.
Value: 10
- White
20 - Black
30 - Asian or Pacific Islander
31 - Chinese
32 - Japanese
33 - Hawaiian
34 - Filipino
35 - Korean
36 - Asian Indian
37 - Vietnamese
38 - Other
3A - Guamanian
3B - Samoan
40 - Native American
41 - American Indian
42 - Alaska
Native
43 - Aleut
80 - Other
99 - Unknown
Registry Section: PATIENT
DEMOGRAPHY
Field
Name:
ETHNICITY-Hispanic
Data Field Name: ETHNICITY
Accessible by IDPH: YES
Max. Length
of Field: 2
Type of Field: CODE(V)
Value
Range: 00, 11-14, 18, 19, 99
Definition: The patient’s Hispanic Ethnicity using
the IDPH UNIFORM DATA CODING STANDARD.
Value: 00 - Not of Hispanic Origin
11
- Mexican
12
- Puerto Rican
13
- Cuban
14
- Central or South American
18
- Other Hispanic
19
- Unknown, Hispanic
99
- Unknown, Not Classified
Registry Section: PATIENT
DEMOGRAPHY
Field Name: INJURY DATE/TIME
Data
Field Name: INJDATE/TIME
Accessible
by IDPH: YES
Max. Length of Field:
2, 2, 4 / 2, 2
Type
of Field: DATE/TIME
(TIMESTAMP)
Value
Range: 01-12, 01-31, 1991 TO PRESENT / 00-23, 00-59 - UNK, NA
Definition:
The date/time of the patient’s injury.
Enter the date in MM/DD/YYYY format.
Use military time format 00:00 to 23:59.
Use best estimate, and UNK as last case scenario.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: TRANSPORT MODE
Data
Field Name: TRANSMODE
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V)
Value
Range: NONE
Definition: The
level of care/type of transportation used to move the patient from the scene of
injury or the initial hospital to the receiving hospital. E.g. if transported
under BLS even though the agency is capable of ALS, use BLS.
Value: 01 - ALS Ground Ambulance
02 - ILS Ground Ambulance
03 - BLS Ground Ambulance
04 - Helicopter
05 - Boat
06 - Fixed Wing
07 - Police
08 - Private Vehicle
97 - Other
98 - Unknown
99 - Not Applicable
Registry Section: PATIENT
DEMOGRAPHY Injury Location
Field Name: SCENE STREET
ADDRESS
Data
Field Name: ADDRSCENE
Accessible
by IDPH: YES
Max. Length of Field:
100
Type
of Field: CHAR
Value
Range: NONE
Definition:
The number and street name where the patient’s injury occurred.
Registry Section: PATIENT
DEMOGRAPHY Injury Location
Field Name: SCENE
CITY
Data
Field Name: CITYSCENE
Accessible
by IDPH: YES
Max. Length of Field:
50
Type
of Field: CHAR
Value
Range: NONE
Definition:
The name of the city where the patient’s injury occurred.
Registry Section: PATIENT
DEMOGRAPHY Injury Location
Field Name: SCENE ZIP CODE
Data
Field Name: ZCODESCENE
Accessible
by IDPH: YES
Max. Length of Field:
10, 4
Type
of Field: CHAR
Value
Range: 00000 - 99999, UNK, NA ^
Definition:
The zip code where the injury occurred.
Registry Section: PATIENT
DEMOGRAPHY Injury Location
Field Name: FIPS SCENE
Data
Field Name: FIPSSCENE
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V)
Value
Range: 01000- 56045, UNK, NA ^
Definition:
The Federal Information Processing Standard (FIPS) state and county code where
the injury occurred. The first two
digits of the code signify the state and the last three digits signify the
county.
Value: Appendix 5.c.ii.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: SCENE
STATE
Data
Field Name: STATESCENE
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: CODE(V) -
DISPLAYED
Value
Range: OFFICIAL U.S.
POST OFFICE ABBREVIATION, DEFAULT IL
Definition:
The abbreviation of the state where the patient’s injury occurred. This value is not currently displayed.
Value: Appendix 5.c.ii.
Registry Section: PATIENT
DEMOGRAPHY Injury Codes
Field Name: ETIOLOGY CODE
Data
Field Name: Principle ECODE
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V) - REPEAT
FIELD 2 TIMES
Value
Range: E800.0 - E999.9
Definition:
The ICD-9-CM external cause of injury code for the event or circumstances that
was/were most responsible for the principle anatomic injury to the
patient. Enter the principle external
injury code first. Two different
codes may be entered for the injury. The second Ecode is not mandatory, but
gives the ability in cases of mixed mechanisms of injury to add a second ecode,
such as shot and stabbed or mvc and burn.
Value: Appendix
5.c.iii.
Registry Section: PATIENT DEMOGRAPHY
Field Name: Principle Ecode Status:
Data Field Name:
BLTPEN
Accessible
by IDPH: YES
Max. Length of Field:
1
Type
of Field: CHAR - INTERNAL
FROM ICD-9-CM TABLE
Value
Range: B, P, N
Definition:
The type of injury which corresponds to the principle Etiology Code (ICD-9-CM)
entered for the patient injury. If the principle E-Code entered does not have a
blunt or penetrating injury type assigned to it, use N for NA.
Value: Appendix
5.c.iii.
Value Interpretations:
B - Blunt
P - Penetrating Injury
N - Not Applicable (e.g. burns, drowning,
hypothermia, heat exhaustion)
Registry Section: PATIENT
DEMOGRAPHY Injury Details
Field Name: PLACE OF INJURY
Data
Field Name: INJPLACE
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V) DISPLAY
DESCRIPTION
Value
Range: 849.0 - 849.9
Definition:
The type of place where the injury occurred.
Use ICD-9-CM 849 ecodes.
Value: 849.0 - Home
849.1 - Farm
849.2 - Mine and quarry
849.3 - Industrial place and premises
849.4 - Place for recreation and sport
849.5 - Street and Highway
849.6 - Public
Building
849.7 - Residential Institution
849.8 - Other Specified place
849.9 - Unspecified Place
Registry Section: PATIENT
DEMOGRAPHY
Field Name: WORK RELATED INJURY
Data
Field Name: INJWORK
Accessible
by IDPH: YES
Max. Length of Field:
3
Type
of Field: CHAR
Value
Range: Y, N, UNK
Definition:
Work related place of injury.
Value: Y - Yes injury was work related
N - No, injury was not work related
Unk - Unknown if injury was work related
Registry Section: PATIENT
DEMOGRAPHY
Field Name: SCHOOL RELATED INJURY
Data
Field Name: SCHINJURY
Accessible
by IDPH: YES
Max. Length of Field:
3
Type
of Field: CHAR
Value
Range: Y, N, UNK
Definition: School
related place of injury. Include school
sports, etc.
Value: Y - Yes injury was school related
N - No, injury was not school related
Unk - Unknown if injury was school related
Registry Section: PATIENT
DEMOGRAPHY
Field Name: MISCELLANEOUS INJURY ACTIVITY
Data
Field Name: MISCACT
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V)
Value
Range: 1 - 9
Definition:
Indicates the miscellaneous mechanism of injury, to further qualify nonspecific
ecodes.
Value: 1 Child caught in car window
2.
Motor vehicle backs over child
3
Motor scooter
4
Motorbike/dirt bike
5 ATV
6 In-line Skates
7 Skateboard
8 Trampoline
9 Other (e.g. snowmobile)
10 Unknown
11 Not Applicable
Registry Section: PATIENT
DEMOGRAPHY
Field Name: SAFETY EQUIPMENT
Data
Field Name: SAFETYEQUIP
Accessible
by IDPH: YES
Max. Length of Field:
1
Type
of Field: CODE(V)
Value
Range: PICK ALL THAT APPLY
Definition: The
safety devices in use or worn by the patient at the time of the injury. PICK ALL that apply or None, Unknown or Not
Applicable.
Value: Safety Belt/ Harness Protective Helmet
Infant /Child Seat Other
Protective Device
Padding/Protective
clothing None
Window Bars/Guards Unknown
Airbag Not
Applicable
Note: Field will appear based on Principle Ecode
inserted
Registry Section: PATIENT
DEMOGRAPHY
Field Name: VEHICLE SEAT POSITION
Data
Field Name: VEHSEATPOSN
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V)
Value
Range: D, F, R, U, N
Definition: Patient
placement in the vehicle.
Value: D
- Driver
F -
Front Seat Passenger
R -
Rear Seat Passenger
O -
Other
U -
Unknown
Note: Field will appear based on Principle Ecode inserted
Registry Section: PATIENT
DEMOGRAPHY
Field Name: EJECTION FROM VEHICLE
Data
Field Name: VEHEJECTION
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V)
Value
Range: Y, N, UNK, NA
Definition: Patient
ejection from the vehicle.
Value: Y -
Patient ejection from Vehicle
N -
Patient NOT ejected from vehicle
UNK - Unknown if patient ejected from vehicle
Note: Field will appear based on Principle Ecode inserted
Registry Section: PATIENT
DEMOGRAPHY
Field Name: DEMOGRAPHY Comments
Data
Field Name: DEMOMEMO
Accessible
by IDPH: NO
Max. Length of Field:
Variable
Type
of Field: VARCHAR(254) -
FREE TEXT FIELD
Value
Range: NONE
Definition:
Free text format for storage of demography related information. Number of
characters limited.
XXXXXXXXXXXXX
TRANSFER SCREEN
XXXXXXXXXXXXXXXXXXXXXX
Registry Section: TRANSFER SCREEN
Field Name: TRANSFERRING/REFERRAL HOSPITAL NUMBER
Data
Field Name: TRANSINHOSPNO
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE (V)
Value
Range: 10001 - 99999
Definition:
The 5 digit hospital number assigned to the facility that transferred the
patient to your trauma center. Hint: if not an Illinois hospital, choose N and
search for “nonspecific hospital” by state. (97000+)
Value: Appendix 5.c.i.
Registry Section: TRANSFER SCREEN
Field Name: TRANSFERRING/REFERRAL HOSPITAL LEVEL
OF CARE
Data
Field Name: TRANSINHOSPLEV
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: CODE(V) -
INTERNAL
Value
Range: 1, 1P, 2, 2P, NA
Definition:
The Illinois trauma center designation of the sending facility. Auto-generated.
Value: Appendix
5.c.i.
Value Interpretation:
1 - Level I Trauma Center Designation
1P - Level I Pediatric Trauma Center
Designation
2 -
Level II Trauma Center Designation
2P
- Level II Pediatric Trauma Center Designation
NA-
Other or Non-Trauma Center (includes free standing emergicenters)
Registry Section: TRANSFER SCREEN
Field Name: DATE/TIME ARRIVED AT
TRANSFERRING/REFERRAL HOSPITAL
Data
Field Name: TRANSINDATE/TIME
Accessible
by IDPH: YES
Max. Length of Field:
2, 2, 4 / 2, 2
Type
of Field: DATE/TIME
Value
Range: 01-12, 01-31, 1991
TO PRESENT / 00-23, 00-59 - UNK, NA ^
Definition:
The date/time the patient arrived at the original (transferring/referral)
facility. This applies to all patients
transferred from another hospital or treatment center. Enter the date in MM/DD/YYYY format. Use military time format 00:00 to 23:59.
Registry Section: TRANSFER SCREEN
Field Name: TRANSFERRING VEHICLE PROVIDER NUMBER
Data
Field Name: TRANSVEHNO
Accessible
by IDPH: YES
Max. Length of Field:
6
Type
of Field: CODE(V)
Value
Range: 000001 - 999999
Definition:
The four digit numeric code assigned to the EMS vehicle that transported the
patient from the transferring/referral hospital. This numeric code is usually documented in
the upper left hand corner of the run sheet.
Value: Appendix 5.c.iv.Registry Section: TRANSFER SCREEN
Field Name: TRANSFERRING/REFERRAL VEHICLE HIGHEST
LEVEL OF CARE
Data
Field Name: TRANSVEHLEVEL
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V) -
INTERNAL
Value
Range: BLS, B/D, ILS, ALS
Definition: Highest
level of care provided by the transporting agency from the original
hospital/facility.
Information:
Each ambulance will be staff as required on all emergency calls:
BLS &
B/D - minimum 2 EMT's, pre-hospital RNs, or Physicians.
(BLS - Basic Life
Support)
(B/D - Basic Life
Support with external Defib.)
ILS - minimum 1 EMT-I,
pre-hospital RN or Physician; and 1 other EMT,
pre-hospital RN, or
physician.
(ILS - Intermediate
Life Support)
ALS - minimum 1 EMT-P,
pre-hospital RN or physician; and one other
EMT, pre-hospital RN,
or physician.
(ALS - Advanced Life
Support)
UNK
N/A
Value: Appendix 5.c.iv.
Field Name: Transport
Mode:
Definition: The level of
care/transport mode used to transfer patient to accepting facility.
Value:
01
ALS
02
ILS
03
BLS ground
04
helicopter
05
Fixed wing
06
Air: non-ambulance
07 Police
08
Private vehicle
09
Boat
97
Other
Field Name: Reason
for Transfer:
Definition: Primary reason
for transferring the patient from the first facility. If specialty-driven
transfer, please indicate the specialty needed.
Value:
1. Pt.
request
2. Insurance
request
3. Higher
level of trauma care (e.g. nontrauma center to trauma center or Level II->I
for multi-system trauma)
4. Pediatrics/PICU
5. Neurosurgery
(includes pediatric NS)
6. OB
care
7. Cardio
thoracic care
8. Orthopedic
care
9. Urology
10. Ophthalmology
11. Oral/dental
care services
12. ENT
13. Plastics/maxillofacial
services
14. Burn Unit
15. Replantation
16. Spinal Cord
Injury Management
17. Other
specialty not available- (if not specifically listed e.g. Radiology)
O- Other reason
N- Not applicable
U- unknown
Registry Section: TRANSFER SCREEN Initial Pt Vital info
Field Name: INITIAL TOTAL GLASGOW COMA SCORE
AT TRANSFERRING/REFERRAL HOSPITAL -
ADULT
Data
Field Name: TRANSGCSTOTADULT
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: NUMERIC
Value
Range: 3 - 15, UNK, NA
Definition:
The sum of the three scores of the adult (>= 16 years) patient’s first Glasgow
Coma Scale components (EYE + VERBAL +
MOTOR) at the transferring/referral hospital as documented in the
transfer records.
Registry Section: TRANSFER SCREEN
Field Name:
INITIAL TOTAL GLASGOW COMA SCORE AT
TRANSFERRING/REFERRAL HOSPITAL - PEDIATRIC
Data
Field Name: TRANSGCSTOTPED
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: NUMERIC
Value
Range: 3 - 15, UNK, NA ^
(BASED ON AGE)
Definition: The
sum of the three scores of the pediatric (<= 15 years) patient’s first
Glasgow Coma Scale components (EYE +
VERBAL + MOTOR) at the transferring/referral hospital as documented in
the transfer records.
Registry Section: TRANSFER SCREEN
Field Name: INITIAL PULSE AT TRANSFERRING/REFERRAL
HOSPITAL
Data
Field Name: TRANSPULSE
Accessible
by IDPH: YES
Max. Length of Field:
3
Type
of Field: NUMERIC
Value
Range: 000 - 300, UNK, NA
Definition: The
patient’s initial pulse at the transferring/referral hospital as
documented in the transfer records
Registry Section: TRANSFER SCREEN
Field Name: INITIAL SYSTOLIC PRESSURE AT
TRANSFERRING/REFERRAL HOSPITAL
Data
Field Name: TRANSSYSTOLIC
Accessible
by IDPH: YES
Max. Length of Field:
3
Type
of Field: NUMERIC
Value
Range: 000 - 300, UNK, NA
^
Definition:
The patient’s initial systolic blood pressure at the transferring/referral
hospital as documented in the transfer records
Registry Section: TRANSFER SCREEN
Field Name: INITIAL RESPIRATORY RATE AT
TRANSFERRING/REFERRAL HOSPITAL
Data
Field Name: TRANSRESPRATE
Accessible
by IDPH: YES
Max. Length of Field:
3
Type
of Field: NUMERIC
Value
Range: 000 - 150, UNK, NA
^
Definition:
The initial, unassisted respiratory rate at the transferring/referral hospital as
documented in the transfer records.
Registry Section: TRANSFER SCREEN
Field Name: INITIAL TEMPERATURE AT TRANSFERRING/REFERRAL
HOSPITAL
Data
Field Name: TRANSTEMP
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: DECIMAL(4,1)
Value
Range: 25.0 - 110.0, UNK,
NA ^
Definition:
Initial patient temperature at the transferring/referral hospital as
documented in the transfer records.
Registry Section: TRANSFER SCREEN
Field Name: INITIAL TEMPERATURE SCALE AT
TRANSFERRING/REFERRAL HOSPITAL
Data
Field Name: TRANSTEMPSCALE
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V)
Value
Range: C, F, U, N
Definition:
The thermometric scale used to indicate initial temperature at the
transferring/referral hospital as documented in the transfer record.
Value: C
- Celsius
F - Fahrenheit
U - Unknown
N - Not Applicable
Registry Section: TRANSFER SCREEN
Field Name: INITIAL TEMPERATURE METHOD/ROUTE AT
TRANSFERRING/REFERRAL HOSPITAL
Data
Field Name: TRANSTEMPROUTE
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V)
Value
Range: 1-5, 7-9
Definition:
The method used to measure the initial temperature of the patient at the
transferring/referral hospital as documented on the transfer sheet.
Value: Appendix
5.c.xi.
Registry Section: TRANSFER SCREEN
Field Name: INITIAL REVISED TRAUMA SCORE AT
TRANSFERRING/REFERRAL HOSPITAL -ADULT
Data
Field Name: TRANSREVTS
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: NUMERIC -
INTERNAL CALCULATION IF POSSIBLE
Value
Range: 0 - 12, (*)
Definition:
The initial Revised Trauma Score at the transferring/referral hospital is the
sum of the values of the Glasgow Coma Score, Systolic blood pressure, and
Respiratory rate as documented in the transfer records.
Value:
The field is displayed as (*) if the field cannot be calculated.
Registry Section: TRANSFER SCREEN
Field Name: INITIAL PEDIATRIC TRAUMA SCORE AT
TRANSFERRING/REFERRAL HOSPITAL
Data
Field Name: TRANSPEDTS
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: NUMERIC
Value
Range: -6 TO 12, UNK, NA ^
Definition: The
initial Pediatric Trauma Score at the transferring/referral hospital as
documented in the transfer records.
The Pediatric Trauma Score is primarily designed to function as a
checklist. Each component can be
assessed by basic physical examination.
Airway evaluation is designed to reflect intervention required for
effective care. An open fracture is
graded -1 for Fx and -1 for cutaneous injury.
As clinical observation and diagnostic evaluation continue, further
definition and reassessment will establish a trend that predicts severity of
injury and potential outcome. Use for
pediatric (<= 15 years) patients.
(See Trauma Assessment screen)
Field Name: Procedure
Codes at Transferring Hospital- see template
Field Name Category
Level at Transferring Hospital- see template
Registry Section: TRANSFER SCREEN
Field Name: ADMISSION/SURGERY AT
TRANSFERRING/REFERRAL HOSPITAL
Data
Field Name: TRANSCARE
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V)
Value
Range: 1 - 4 , 8, 9
Definition:
Indicates if the patient had been admitted or had undergone surgery at the
original facility before transfer as
documented in the transfer record.
Value: 1
- Admission
2 - Surgery
3 - Admission and Surgery
4 - Not Admitted
8 - Unknown
9
- Not Applicable
Registry Section: TRANSFER SCREEN
Field Name: DATE/TIME DISCHARGED FROM
TRANSFERRING/REFERRAL HOSPITAL
Data
Field Name: TRANSDCDATE / TIME
Accessible
by IDPH: YES
Max. Length of Field:
2, 2, 4 / 2, 2
Type
of Field: DATE/TIME
Value
Range: 01-12, 01-31, 1991
TO PRESENT / 00-23, 00-59, UNK, NA ^
Definition:
The date/time of the patient’s discharge from the original facility as
documented in the transfer records.
Enter the date in MM/DD/YYYY format.
Use military time format 00:00 to 23:59.
Value: Appendix 5.c.i.
Hint: all of the above information should be documented in
the medical records accompanying the patient from the sending facility.
Registry Section: TRANSFER SCREEN
Field Name: TRANSFER MEMO
Data
Field Name: TRANSMEMO
Accessible
by IDPH: NO
Max. Length of Field:
VARIABLE
Type
of Field: VARCHAR(254) -
FREE TEXT FIELD
Value
Range: NONE
Definition:
Free text format for storage of transfer/referral information. Characters
limited to 254.
XXXXXXXXXXXXXXXXXXXX
PRE-HOSPITAL FIELDS XXXXXXXXXXXXXXXX
Registry Section: PRE-HOSPITAL
SCREEN
Field Name: PRE-HOSPITAL RUN SHEET AVAILABILITY
Data
Field Name: PHRUNSHEET
Accessible
by IDPH: YES
Max. Length of Field:
3
Type
of Field: CHAR
Value
Range: Y, N, UNK, NA
Definition: This
field is used to indicate if a run sheet is available. A Run Sheet is a form completed by the
pre-hospital provider to document the care given to the patient from the time
the provider was dispatched until the patient arrived at the hospital.
Value: Y
- Yes, if run sheet was available
and filled out completely.
N - No, if run sheet was not available or
not filled out completely.
UNK - Unknown (Do not use)
NA - Not Applicable (Do not use)
Hint: If no run sheet- every field must still be filled in
to clean the screen. Consider building default template with UNK in each field
for date and time.
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL RECORD NUMBER
Data
Field Name: PREHOSPNO
Accessible
by IDPH: YES
Max. Length of Field:
10
Type
of Field: CHAR
Value
Range: 0000000001 -
9999999999, UNK, NA
Definition:
The preprinted ambulance litho code number on the Illinois Prehospital Care
Report, (or the run number on the run sheet.)
Registry Section: PRE-HOSPITAL SCREEN
Field Name: CRASH RECORD NUMBER
Data
Field Name: CRASHNO
Accessible
by IDPH: YES
Max. Length of Field:
10
Type
of Field: CHAR
Value
Range: 0000000001 -
9999999999, UNK, NA
Definition: Enter
the 7-digit bar code control number located in the upper right hand corner of
the Illinois Traffic Crash Report Form from the Illinois Department of
Transportation. This number can also be
found on the Illinois Pre-Hospital Care Report (Run Sheet). Be sure to enter leading “O’s” to complete
the field.
Hint: If
crash record number not available and the pt. was involved in a mvc, use UNK.
If not involved in a mvc, use NA.
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL VEHICLE Provider
Data
Field Name: PHVEHNO
Accessible
by IDPH: YES
Max. Length of Field:
4
Type
of Field: CODE(V)
Value
Range: 00001 - 99999
Definition:
The four digit numeric code assigned to the EMS provider that transported the
patient from the injury scene to the hospital.
Value: Appendix 5.c.iv.
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL VEHICLE HIGHEST LEVEL OF
CARE
Data
Field Name: PHVEHLEVEL
Accessible
by IDPH: YES
Max. Length of Field:
3
Type
of Field: CODE(V) -
INTERNAL
Value
Range: BLS, B/D, ILS, ALS,
UNK, NA
Definition:
Level of care provided by EMS in prehospital setting.
Information:
Each ambulance will be staffed as required on all emergency calls:
BLS &
B/D - minimum 2 EMT’s, pre-hospital RN's, or Physicians.
(BLS - Basic Life
Support)
(B/D - Basic Life
Support with external Defib.)
ILS - minimum 1 EMT-I,
pre-hospital RN or Physician; and 1 other EMT,
pre-hospital RN, or
physician.
(ILS - Intermediate
Life Support)
ALS - minimum 1 EMT-P,
pre-hospital RN or physician; and one other
EMT, pre-hospital RN,
or physician.
(ALS - Advanced Life
Support)
Value: BLS - Basic
Life Support
B/D
- Basic Life Support with external
defibrillator (BLS/D)
ILS -
Intermediate Life Support
ALS -
Advanced Life Support
UNK
- Unknown
NA
- Not Applicable
Hint: The level of care is available in the look up for
the vehicle provider number.
Registry
Section: PRE-HOSPITAL
SCREEN
Field Name: Vehicle
Number-
Definition: Rig
number
Registry Section: PRE-HOSPITAL SCREEN Transport Time Info
Field Name: PRE-HOSPITAL DATE/TIME RECEIVED CALL
Data
Field Name: PHCALLDATE/TIME
Accessible
by IDPH: YES
Max. Length of Field:
2, 2, 4 / 2, 2
Type
of Field: DATE/TIME
Value
Range: 01-12, 01-31, 1991
TO PRESENT / 00-23, 00-59, UNK, NA
Definition:
The date/time the initial call for assistance was received by the dispatch
center as documented on the Illinois Pre-Hospital Care Report (runsheet). Enter the date in MM/DD/YYYY format. Use military time format 00:00 to 23:59.
Hint: If information is not available, use UNK.
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL DISPATCH TIME
Data
Field Name: PHDISPATCHTIME
Accessible
by IDPH: YES
Max. Length of Field:
2, 2
Type
of Field: TIME
Value
Range: 00-23, 00-59, UNK,
NA ^
Definition:
The time EMS personnel/vehicle were notified by the dispatcher to respond to
the call as documented on the Illinois Pre-Hospital Care Report (runsheet). Use military time format 00:00 to 23:59.
Hint: If information is not available, use UNK.
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL EN ROUTE TIME
Data
Field Name: PHENROUTETIME
Accessible
by IDPH: YES
Max. Length of Field:
2, 2
Type
of Field: TIME
Value
Range: 00-23, 00-59, UNK,
NA ^
Definition:
The time EMS personnel/vehicle departed its location and began responding to
the call as documented on the Illinois Pre-Hospital Care Report (runsheet). Use military time format 00:00 to 23:59.
Hint: If information is not available, use UNK.
.
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL SCENE ARRIVAL TIME
Data
Field Name: PHSCNARVLTIME
Accessible
by IDPH: YES
Max. Length of Field:
2, 2
Type
of Field: TIME
Value
Range: 00-23, 00-59, UNK,
NA ^
Definition:
The time the EMS personnel/vehicle arrived at the emergency scene as documented
on the Illinois Pre-Hospital Care Report (runsheet). Use military time format 00:00 to 23:59.
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL CONTACT TIME
Data
Field Name: PHCONTACTIME
Accessible
by IDPH: YES
Max. Length of Field:
2, 2
Type
of Field: TIME
Value
Range: 00-23, 00-59, UNK,
NA ^
Definition:
The time the EMS personnel made actual verbal or physical contact with the
patient. Use military time format 00:00 to 23:59. To determine the actual
patient contact time, add the scene arrival time and the patient contact
minutes as documented on the Illinois Pre-Hospital Care Report (runsheet).
Value: 00-23,
00-59, UNK, NA
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL SCENE DEPART TIME
Data
Field Name: PHSCNDEPARTIME
Accessible
by IDPH: YES
Max. Length of Field:
2, 2
Type
of Field: TIME
Value
Range: 00-23, 00-59, UNK,
NA
Definition:
The time the EMS personnel/vehicle departed the emergency scene as documented
on the Illinois Pre-Hospital Care Report (runsheet). Use military time format 00:00 to 23:59.
Value: 00-23, 00-59, UNK, NA ^
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL MINUTES FOR RESPONSE
Data
Field Name: PHRESPONMINS
Accessible
by IDPH: YES
Max. Length of Field:
4
Type
of Field: NUMERIC -
INTERNAL CALCULATION
Value
Range: 0000 - 9999, (*)
Definition: The
minutes between the initial call for assistance was received by the dispatch
center and the time the EMS personnel/vehicle departed its location to respond
to the call. This field is automatically calculated if an appropriate entry is
entered in both of the above fields.
Value: The
difference between the time of the initial call for assistance was received
(PHCALLTIME) and the time the EMS personnel responded to the call
(PHENROUTETIME). The field is displayed
as (*) if the field cannot be calculated
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL SCENE MINUTES
Data
Field Name: PHSCNMINS
Accessible
by IDPH: YES
Max. Length of Field:
4
Type
of Field: NUMERIC -
INTERNAL CALCULATION
Value
Range: 0000 - 9999, (*)
Definition:
The total number of minutes spent at the scene by the EMS provider. This field will be automatically calculated
if the pre-hospital scene arrival time and the pre-hospital scene departure
time is appropriately entered.
Value: The difference between the scene
arrival time (PHSCNARVLTIME) and the scene depart time (PHSCNDEPARTIME). The field is displayed as (*) if the field
cannot be calculated.
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL TRANSPORT MINUTES
Data
Field Name: PHTRANSPORTMINS
Accessible
by IDPH: YES
Max. Length of Field:
4
Type
of Field: NUMERIC -
INTERNAL CALCULATION
Value
Range: 0000 - 9999, (*)
Definition: The
total number of minutes it took the EMS provider to get from the scene of the
incident to the hospital. This field will be automatically calculated if the
pre-hospital scene departure time and the ED arrival time is appropriately
entered.
Value: The difference between the scene
depart time (PHSCNDEPARTIME) and the ED arrival date/time (EDDATE/TIME). The field is displayed as (*) if the field
cannot be calculated.
Registry Section: PRE-HOSPITAL SCREEN Patient Information
Field Name: PRE-HOSPITAL INITIAL PULSE
Data
Field Name: PHPULSE
Accessible
by IDPH: YES
Max. Length of Field:
3
Type
of Field: NUMERIC
Value
Range: 000 - 300, UNK, NA
Definition: The
patient’s initial pulse recorded by the pre-hospital provider as documented on
the Illinois Pre-Hospital Care Report (runsheet).
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL INITIAL SYSTOLIC PRESSURE
Data
Field Name: PHSYSTOLIC
Accessible
by IDPH: YES
Max. Length of Field:
3
Type
of Field: NUMERIC
Value
Range: 000 - 300, UNK, NA
^
Definition:
The patient’s initial systolic blood pressure recorded by the pre-hospital
provider as documented on the Illinois Pre-Hospital
Care Report (runsheet).
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL INITIAL RESPIRATORY RATE
Data
Field Name: PHRESPRATE
Accessible
by IDPH: YES
Max. Length of Field:
3
Type
of Field: NUMERIC
Value
Range: 000 - 150, UNK, NA
^
Definition:
The initial, unassisted respiratory rate recorded by the pre-hospital provider as
documented on the Illinois
Pre-Hospital Care Report (runsheet).
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL INITIAL GLASGOW COMA
SCORE - ADULT
Data
Field Name: PHGCSTOTAL
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: NUMERIC
Value
Range: 3 - 15, UNK, NA ^
(BASED ON AGE)
Definition:
The sum of the 3 scores of the adult (>= 16 years) patient’s Glasgow Coma
Scale components (Eye + Verbal + Motor)
as documented on the Illinois Pre-Hospital Care Report (runsheet). If a
prehospital gcs is not specifically documented, use UNK; the only exception- it
is acceptable to use ‘15’ if the pt. is documented to be alert and oriented x3.
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL INITIAL TOTAL GLASGOW COMA SCORE - PEDIATRIC
Data
Field Name: PHGCSTOTALPED
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: NUMERIC (BASED ON
AGE)
Value
Range: 3 - 15, UNK, NA ^
Definition: The
scores of the pediatric (<= 15 years) patient’s Glasgow Coma Scale
components ( EYE + VERBAL + MOTOR) upon arrival of the first responders as
documented on the Illinois Pre-Hospital Care Report (runsheet). If a
prehospital gcs is not specifically documented, use UNK; the only exception- it
is acceptable to use ‘15’ if the pt. is documented to be alert and oriented x3.
Registry Section: PRE-HOSPITAL SCREEN
Field Name: PRE-HOSPITAL INITIAL REVISED TRAUMA
SCORE - ADULT
Data
Field Name: PHREVTS
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: NUMERIC
Value
Range: 0 - 12, UNK, NA ^
(BASED ON AGE)
Definition:
The Revised Trauma Score is the sum of the adult (>= 16 years) Glasgow Coma
Score, Systolic blood pressure, and Respiratory rate as documented on the
Illinois Pre-Hospital Care Report (runsheet).
Value: Supplemental
Documentation
Registry Section: PRE-HOSPITAL
SCREEN
Field Name: PRE-HOSPITAL INITIAL TRAUMA SCORE TOTAL
- PEDIATRIC
Data Field Name:
PHPEDTSTOT
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: NUMERIC
Value
Range: -6 TO 12, UNK, NA ^
Definition:
The initial Pediatric Trauma Score as documented on the Illinois Pre-Hospital
Care Report (runsheet). The Pediatric
Trauma Score is primarily designed to function as a checklist. Each component can be assessed by basic
physical examination. Airway evaluation
is designed to reflect intervention required for effective care. An open fracture is graded -1 for Fx and -1
for cutaneous injury. Use for pediatric (<= 15 years) patients. (See Trauma
Assessment screen)
PEDIATRIC TRAUMA SCORE
Value:
|
COMPONENT
|
+2
|
+1
|
-1
|
|
Size
|
Child/adolescent, >20kg
>20
kg
|
Toddler, 11-20 kg
10-20
kg
|
Infant, <10 kg
<10
kg
|
|
Airway
|
Normal
Normal
|
Assisted 02 , mask, cannula
Maintainable
|
Intubated; ETT, EOA, Crico.
Not maintainable
|
|
Consciousness
|
Awake
Awake
|
Obtunded; lost consciousness
Obtunded/LOC
|
Coma; unresponsive
Coma/decerebrate
|
|
Systolic blood pressure
|
>90 mm Hg; good peripheral
pulses, perfusion
>90
mm Hg
|
51-90 mm Hg; peripheral pulses,
pulses palpable
50-90
mm Hg
|
<50 mm Hg; weak or no pulses
<50 mm Hg
|
|
Fracture
|
None seen
or suspected
None
|
Single closed Fx anywhere
Closed Fx
|
Open, multiple Fx
Open/multiple Fx
|
|
Cutaneous
|
No visible injury
None
|
Contusion,
abrasion; laceration <7 cm; not through fascia
Minor
|
Tissue loss; any GSW/Stab;
through fascia
Major/penetrating
|
NOTE: Draft
ITR data dictionary values (as of June 2005) are noted in black font.
Traditional PTS values are in bold/red font.
Field Name: see
Procedure Code Template for prehospital
Field Name: see
Category Level Template for field activation
Registry Section: PRE-HOSPITAL
SCREEN
Field Name: PRE-HOSPITAL Comments
Data Field Name:
PHMEMO
Accessible
by IDPH: NO
Max. Length of Field: VARIABLE
Type
of Field: VARCHAR(254) -
FREE TEXT FIELD
Value
Range: NONE
Definition: Free
text format for storage of pre-hospital information.
XXXXXXXXXXXXX
EMERGENCY DEPARTMENT
XXXXXXXXXXXXXXXXXXXX
>>>>>>>>>>>>> Physicians information
<<<<<<<<<<<<<<
Registry Section: EMERGENCY
DEPARTMENT SCREEN Responding
Physicians
Field Name: PHYSICIAN RESPONSE IDENTIFICATION
NUMBER
Data
Field Name: PHYIDRESPONSE
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V) - GENERIC
CONVERSION
Value
Range: 10000 - 90000
Definition: The
identification numbers of the physicians responsible for the emergency care of
the trauma patient. The choices include
ED physician, Trauma Surgeon, Neurosurgeon, Consultant.... Enter as many
choices as necessary to identify physicians participating with the trauma team
response. Can include consults generated in the Emergency Department for in-
hospital care of the patient. (Physicians contacted later in the hospital
course should be listed under Visiting Physician on the Hospitalization
Screen.)
Consultants
may include but are not limited to:
Cardiology
ENT
Family/Internal
Medicine
Obstetrics
Ophthalmology
Orthopedics
Oral
Maxillofacial Surgeon
Pediatrician/Pediatric
Surgeon
Plastic
Surgeon
Urology/Nephrology
Cardio/Vascular/Thoracic
Surgeon
Value: Appendix
5.c.ix.
Registry Section: EMERGENCY
DEPARTMENT SCREEN
Field Name: PHYSICIAN NOTIFICATION DATE/TIME
Data
Field Name: PHYNOTIFYDATE/TIME
Accessible
by IDPH: YES
Max. Length of Field:
2, 2, 4 / 2, 2
Type
of Field: DATE/TIME
Value
Range: 01-12, 01-31, 1991
TO PRESENT / 00-23, 00-59, UNK, NA ^
Definition: The
date/time of the physician was notified of the need to evaluate the patient.
HINT: It’s
not necessary to insert “/” or “:” in
date/time, program will insert
Registry Section: EMERGENCY
DEPARTMENT SCREEN
Field Name: PHYSICIAN RESPONSE DATE/TIME
Data
Field Name: PHYRESPONSDATE/TIME
Accessible
by IDPH: YES
Max. Length of Field:
2, 2, 4 / 2, 2
Type
of Field: DATE/TIME
Value
Range: 01-12, 01-31, 1991
TO PRESENT / 00-23, 00-59, UNK, NA ^
Definition: The
date/time of the physician’s response.
Enter the date in MM/DD/YYYY format.
Use military time format 00:00 to 23:59.
HINT: It’s
not necessary to insert “/” or “:” in
date/time, program will insert
Registry Section: EMERGENCY
DEPARTMENT SCREEN
Field Name: PHYSICIAN ARRIVAL DATE/TIME
Data
Field Name: PHYARRIVALDATE/TIME
Accessible
by IDPH: YES
Max. Length of Field:
2, 2, 4 / 2, 2
Type
of Field: DATE/TIME
Value
Range: 01-12, 01-31, 1991
TO PRESENT / 00-23, 00-59, UNK, NA ^
Definition: The
date/time of the physician’s arrival in the emergency department. Enter the date in MM/DD/YYYY format. Use military time format 00:00 to 23:59.
HINT: It’s
not necessary to insert “/” or “:” in
date/time, program will insert
Registry Section: EMERGENCY
DEPARTMENT SCREEN
Field Name: PHYSICIAN INITIAL PATIENT CONTACT
DATE/TIME
Data
Field Name: PHYCONTACTIME
Accessible
by IDPH: YES
Max. Length of Field:
2,2
Type
of Field: TIME
Value
Range: 00-23, 00-59, UNK,
NA ^
Definition: The
date/time the physician makes actual verbal or physical contact with the
patient. Use military time format 00:00
to 23:59.
HINT: It’s
not necessary to insert “/” or “:” in
date/time, program will insert
Field Name: see
Procedure Code Template
Field Name: see
Category Template
Registry Section: EMERGENCY DEPARTMENT SCREEN Initial Pt. Vital Info
Field Name: ED INITIAL PULSE
Data
Field Name: EDPULSE
Accessible
by IDPH: YES
Max. Length of Field:
3
Type
of Field: NUMERIC
Value
Range: 000 - 300, UNK, NA
^
Definition: The
patient’s initial pulse in the Emergency Department. The patient’s initial (first) pulse recorded
in the Emergency Department or as a direct admission to the hospital.
Hint: A patient’s initial
vitals signs are to be placed in the ED vitals section regardless of where they
entered the hospital for scoring calculation purposes.
Registry Section: EMERGENCY DEPARTMENT SCREEN
Field Name: ED INITIAL SYSTOLIC PRESSURE
Data
Field Name: EDSYSTOLIC
Accessible
by IDPH: YES
Max. Length of Field:
3
Type
of Field: NUMERIC
Value
Range: 000 - 300, UNK, NA
^
Definition:
The patient’s initial (first) systolic blood pressure recorded in the Emergency
Department, or as a direct admission to the hospital; may be measured by
palpation, auscultation, Doppler or machine.
Registry Section: EMERGENCY DEPARTMENT SCREEN
Field Name: ED INITIAL RESPIRATORY RATE
Data
Field Name: EDRESPRATE
Accessible
by IDPH: YES
Max. Length of Field:
3
Type
of Field: NUMERIC
Value
Range: 000 - 150, UNK, NA
^
Definition:
The patient’s first respiratory rate (expressed
as number per minute) recorded in the
Emergency Department, or as a direct admission to the hospital. If the patient
respirations were being assisted, e.g. by Bag-valve-mask, note that fact in the
respiratory qualifier section.
Registry Section: EMERGENCY DEPARTMENT SCREEN
Field Name: ED INITIAL RESPIRATORY STATUS -
INITIALLY VENTILATED, INTUBATED (QUALIFIER)
Data
Field Name: EDRESPQUALIFY
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V)
Value
Range: T, TP, S, L, U, ML
Definition: Was patient breathing on his/her own or did he have
assisted ventilations on ED arrival? (Note: this is
NOT what interventions occurred in the ED.)
Value: T - Patient Intubated when initially
assessed in ED
TP - Patient Intubated and Paralytic: pt.
was intubated and chemically paralyzed when first assessed in the ED
S - Patient Chemically Sedated when
first assessed in the ED
L - Legitimate Values: the initial resp.
rate is a legitimate value if without intervention such as RSI and intubation;
(i.e. pt. is breathing on their own, unassisted at that time.)
ML Manually ventilated (“bagged”)
U Unknown- not documented
Registry Section: EMERGENCY DEPARTMENT SCREEN
Field Name: ED RESPIRATORY MEDICATION / PARALYTIC
SEDATION
Data
Field Name: EDRESPMED
Accessible
by IDPH: YES
Max. Length of Field:
50
Type
of Field: CHAR
Value
Range: NONE
Definition:
The medications used in the ED in conjunction with respiratory
intubation (sedation) entered in free text format.
Registry Section: EMERGENCY DEPARTMENT SCREEN
Field Name: ED INITIAL TEMPERATURE
Data
Field Name: EDTEMP
Accessible
by IDPH: YES
Max. Length of Field:
3
Type
of Field: DECIMAL(4,1)
Value
Range: 25.0 - 110.0, UNK,
NA ^
Definition:
Initial patient temperature in the Emergency Department, or as a direct admit
to the hospital.
Registry Section: EMERGENCY DEPARTMENT SCREEN
Field Name: ED INITIAL TEMPERATURE SCALE
Data
Field Name: EDTEMPSCALE
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE(V)
Value
Range: C, F, N
Definition:
The thermometric scale used to indicate the initial temperature.
Value: C
- Celsius
F - Fahrenheit
N - Not Applicable
U- Unknown (avoid using)
Registry Section: EMERGENCY
DEPARTMENT SCREEN
Field Name:
