Texas EMS & Trauma Registries - Frequently Asked Questions

The Texas Emergency Medical Services and Trauma Registries (EMSTR) is an online reporting system that collects legislatively mandated data on all EMS runs, traumatic brain injuries, spinal cord injuries, submersions, and other traumatic injuries based on a specified criterion.

The purpose of the EMSTR is to monitor and analyze the EMS and trauma care systems. The EMSTR incorporates national EMS and hospital data standards in addition to Texas custom questions to analyze the EMS and trauma care systems and to benchmark Texas within its 22 trauma service areas and between other states. Data is used to perform epidemiological investigations to identify public health issues and support injury prevention projects to ultimately improve the efficiency and quality of care patients receive in Texas.

As stated in the Texas Administrative Code Title 25, Part 1, Chapter 103, Rule 103.4; the following are the responsible entities required to report to the EMSTR:

• EMS Providers
• Hospitals
• Acute or Post-Acute Rehabilitation Facilities
• Justice of the Peace
• Medical examiners
• Physicians

If the above-listed professionals or organizations choose to notify a local or regional health authority to respond on their behalf, the local or regional health authority must report to the EMSTR within ten business days.

• Health and Safety Code, Title 2, Chapter 92, Subchapter A Section 92.003;
• Texas Administrative Code Title 25, Part 1, Chapter 103, section 103.5 – EMS Providers;
• Section 103.6 –Physicians, Medical Examiners, and Justices of the Peace;
• Section 103.7 –Hospitals; and
• Section 103.8 –Acute or Post-Acute Rehabilitation Facilities.

EMS
All runs, as defined in the Texas EMSTR EMS Data Dictionary, must be submitted electronically to the Texas Department of State Health Services (DSHS) online EMSTR. 

Texas Administrative Code, Title 25, Part 1, Chapter 103, Rule 103.5

A run is a resulting action from a call for assistance where an EMS provider is dispatched to, responds to, provides care to, or transports a person. That includes trauma and medical, emergency and non-emergency, transport and non-transport runs.

Texas Administrative Code, Title 25, Part 1, Chapter 103, Rule 103.2 

Hospitals
Hospitals shall submit all traumatic injuries where the patient died or arrived dead, was admitted for more than 48 hours, was transferred into the hospital, or was transferred out to another hospital. Hospitals also submit all traumatic brain injuries, traumatic spinal cord injuries, and submersions. Refer to the definitions on the following link for more details on case inclusion. 

EMS and Trauma Registries Reporting Rules

Texas Administrative Code Title 25, Part 1, Chapter 103, Rule 103.7  

Acute or Post-Acute Rehabilitation Facilities
Long Term Acute Care facilities shall report all Traumatic brain injuries (TBIs). TBI is defined as an acquired injury to the brain, including brain injuries caused by anoxia due to submersion incidents. The following International Classification of Diseases 10th Revision Clinical Modification (ICD-10-CM) diagnostic codes are to be used to identify cases of traumatic brain injury: S06 and S02.The ICD-10-CM diagnostic code to be used to identify traumatic brain injury caused by anoxia due to submersion incidents is G93.1 or T75.1XXA. 

Facilities shall report all Spinal cord injuries (SCIs). SCI is defined as an acute, traumatic lesion of the neural elements in the spinal canal, resulting in any degree of sensory deficit, motor deficits, or bladder/bowel dysfunction. The following International Classification of Diseases 10th Revision Clinical Modification (ICD-10-CM) diagnostic codes are to be used to identify cases of traumatic spinal cord injury: S12, S14, S22, S24, S32, or S34) and S14, S24, or S34.

EMS & Trauma Registries Reporting Rules
Texas Administrative Code, Title 25, Part 1, Chapter 103, Rule 103.8

Justice of the Peace
Justices of the Peace (JPs) shall report any submersion injuries. Submersions are defined as the process of experiencing respiratory impairment from submersion or immersion in liquid. 

JPs shall report all Traumatic brain injuries (TBIs). TBI is defined as an acquired injury to the brain, including brain injuries caused by anoxia due to submersion incidents. The following International Classification of Diseases10th Revision Clinical Modification (ICD-10-CM) diagnostic codes are to be used to identify cases of traumatic brain injury: S06 and S02. The ICD-10-CMdiagnostic code to be used to identify traumatic brain injury caused by anoxia due to submersion incidents is G93.1 or T75.1XXA. 

JPs shall report all Spinal cord injuries (SCIs). SCI is defined as an acute, traumatic lesion of the neural elements in the spinal canal, resulting in any degree of sensory deficit, motor deficits, or bladder/bowel dysfunction. The following International Classification of Diseases 10th Revision Clinical Modification (ICD-10-CM) diagnostic codes are to be used to identify cases of traumatic spinal cord injury: S12, S14, S22, S24, S32, or S34) and S14, S24, or S34. 

EMS & Trauma Registries Reporting Rules
Texas Administrative Code, Title 25, Part 1, Chapter 103, Rule 103.6

Medical Examiners
Medical Examiners (MEs) shall report all submersion injuries. Submersion is defined as the process of experiencing respiratory impairment from submersion or immersion in liquid. 

MEs shall report all Traumatic Brain Injuries (TBIs). TBI is defined as an acquired injury to the brain, including brain injuries caused by anoxia due to submersion incidents. The following International Classification of Diseases10th Revision Clinical Modification (ICD-10-CM) diagnostic codes are to be used to identify cases of traumatic brain injury: S06 and S02. The ICD-10-CMdiagnostic code to be used to identify traumatic brain injury caused by anoxia due to submersion incidents is G93.1 or T75.1XXA. 

MEs shall report all Spinal Cord Injuries (SCIs). SCI is defined as an acute, traumatic lesion of the neural elements in the spinal canal, resulting in any degree of sensory deficit, motor deficits, or bladder/bowel dysfunction. The following International Classification of Diseases 10th Revision Clinical Modification (ICD-10-CM) diagnostic codes are to be used to identify cases of traumatic spinal cord injury: S12, S14, S22, S24, S32, or S34) and S14, S24, or S34. 

EMS & Trauma Registries Reporting Rules
Texas Administrative Code, Title 25, Part 1, Chapter 103, Rule 103.2

Physicians
Physicians shall report all submersion injuries. Submersion is defined as the process of experiencing respiratory impairment from submersion or immersion in liquid. 

Physicians shall report all Traumatic Brain Injuries (TBIs). TBI is defined as an acquired injury to the brain, including brain injuries caused by anoxia due to submersion incidents. The following International Classification of Diseases10th Revision Clinical Modification (ICD-10-CM) diagnostic codes are to be used to identify cases of traumatic brain injury: S06 and S02. The ICD-10-CM diagnostic code to be used to identify traumatic brain injury caused by anoxia due to submersion incidents is G93.1 or T75.1XXA. 

Physicians shall report all Spinal Cord Injuries (SCIs). SCI is defined as an acute, traumatic lesion of the neural elements in the spinal canal, resulting in any degree of sensory deficit, motor deficits, or bladder/bowel dysfunction. The following International Classification of Diseases 10th Revision Clinical Modification (ICD-10-CM) diagnostic codes are to be used to identify cases of traumatic spinal cord injury: S12, S14, S22, S24, S32, or S34) and S14, S24, or S34. 

Note: A physician is exempt from reporting if a hospital or acute or post-acute rehabilitation facility admitted the patient and fulfilled the reporting requirements as stated in rule 103.7 of this title (relating to Reporting Requirements for Hospitals) or rule 103.8 of this title (relating to Reporting Requirements for Acute or Post-Acute Rehabilitation Facilities).

The professionals or organizations listed in this section must send all reports of injuries and events listed in this section to the EMS and Trauma Registries. If the above listed professionals or organizations choose to notify a local or regional health authority to respond on their behalf, the local or regional health authority must report to the Registry within ten business days.

EMS and Trauma Registries Reporting Rules
Texas Administrative Code, Title 25, Part 1, Chapter 103, Rule 103.6

EMS
EMS providers should include all of the required data fields listed in the EMS Data Dictionary, in the file format described in the data dictionary. The link to the EMS Data dictionary can be found at dshs.texas.gov/injury-prevention/ems-trauma-registries/ems-reporting-requirements. 

Hospitals
For trauma hospitalizations, hospitals should include all of the required fields listed in the Hospital Data Dictionary and in the file format described in the data dictionary. For submersions, all requested fields should be included in the web-data entry. 

dshs.texas.gov/injury-prevention/ems-trauma-registries/hospital

EMS
All data should be transmitted to EMSTR within 90 days of the run (call for assistance); monthly electronic data submissions are recommended. 

Texas Administrative Code Title 25, Part 1, Chapter 103

Hospital
All data should be transmitted to EMSTR within 90 days of discharge from the facility; monthly electronic data submissions are recommended. 

Hospitals must submit a No Reportable Data (NRD) form to the online system of any given month that the hospital did not treat or document a required reportable event.

EMS
Data shall be submitted within 90 days from the date of call for assistance. EMSTR recommends EMS providers and third party billers submit data monthly. 

When there is no data for a month, the EMS provider should submit a No Reportable Data (NRD) form using the online system. 

Hospital
Data shall be submitted within 90 days from the date of discharge from their facility. EMSTR recommends hospitals and third party billers submit data monthly. 

When there is no data for a month, the hospital should submit a No Reportable Data (NRD) form using the online system.

Entities need to submit their data electronically via web services, web-data entry, or file upload. Each entity will establish an account with EMSTR and use the online system for submitting data. Entities may use their own software or the free online system for entering data. Submersion data shall be sent using the web-data entry method by logging into EMSTR.

Yes, EMS and hospital providers can submit data through a third party. However, it is the individual EMS and hospital providers' responsibility to make sure its data is reported to EMSTR. Each provider must have a Business Associate Agreement (BAA) on file with EMSTR before using a third party.

Once the DSHS Regulatory Licensing Unit issues a license and verification of the license has been received by the entity, an email should be submitted to the EMSTR Registry Operations Support Team at injury.web@dshs.texas.gov or you may call the toll-free number at 1-800-242-3562. For either email or phone messages, please provide the entity name, a contact name, a phone number, and reason for request. The toll-free number is a recording to receive messages. The number is not a real person; however, a response will be made to requests received in three to five business days.

There are two methods in which an account manager account can be created:

1. The first method is a systematic process through the Registration Portal. Through this process an account manager can be identified and assigned a login name and password. 
2. The second method is if there is already an existing account manager, the account manager can create and assign a second account manager.

If an account manager has not been established in the EMSTR for the entity, an administrative representative of the entity may send a request to the EMSTR Registry Operations Support Team email address injury.web@dshs.texas.gov.

The account manager(s) can add a user to an entity’s account. The account manager may send a request to the EMSTR Registries Operations Support Team customer service email address injury.web@dshs.texas.gov.

Each entity has a system-generated number which is used as the DSHS personal identifier (ID) in the EMSTR system. This may or may not match the license number received from regulatory.

Each entity is issued a license number when they were registering their facility with the DSHS Regulatory Licensing Unit. This number may or may not match the license number received from regulatory. For any questions regarding licensing, visit the DSHS Online Licensing Help Center Division Consumer Protection webpage.

For patient data security, DSHS IDs are not posted on an open website. An email can be sent to injury.web@dshs.texas.gov requesting your DSHS ID. Your DSHS ID can also be accessed by logging in to your entity’s account and following these steps:

1. On the main page, click on search for an existing record.
2. In the “Search Event” section under the Search criteria, look for the “Record Type” drop-down and select the appropriate entity type.
3. Click on the “Search” button; the name of the entity will be displayed on the right side of the Search Event, under the “Search Results”.
4. Double click on the name of the entity and the “Record Summary” page will be displayed.
5. The DSHS ID will be seen under the “Basic Information” and subheading “Notifications”.

To request deletion of a duplicate or invalid record, submit an email to injury.web@dshs.texas.gov. Specify the data or record ID to be deleted. You should expect a three-to-five-day turnaround to delete a record.

To request data, send an email to injury.web@dshs.texas.gov providing specifics on the data being sought.

DSHS will reach out to discuss the request. To request a Public Use Data File (PUDF), complete the Public Use Data Usage Agreement form on the website (dshs.texas.gov/injury-prevention/ems-trauma-registries/data-requests/) and email it to injury.web@dshs.texas.gov.

• For web-data entry, records are submitted the moment the user clicks “save.” To confirm the total number of records submitted for your entity, send an email to injury.web@dshs.texas.gov.
• For file upload, a submission status display will be shown when the file is uploaded. It will show the status as processed or unprocessed. When the file is processed, a link will be provided. Click the “result” link to see the status. Or check the status in the Question Package by clicking the “Submission Status” line. This method may also be used to verify the records submitted when an entity uses a third party vendor to submit data. 

Please note, the program is currently reviewing the Business Associate Agreement (BAA) process and drafting an updated policy to allow for the submission of affidavits. When this new policy and affidavit have completed review and are available, stakeholders will be informed, and this FAQ will be updated accordingly. 

A BAA should be uploaded to the entities’ account, and then an email is sent to injury.web@dshs.texas.gov to inform DSHS staff that a BAA has been uploaded and ready for review and approval. Once DSHS reviews and approves the BAA, DSHS will give the entity's account access to the identified third party agency who can then submit data on behalf of the entity. An email will be sent to the entity informing them of the access granted. 

Each entity is responsible for monitoring the submission of its data even though they use a third party agency.

Sample BAA

All BAAs must include:

• Name of entity
• Name of the third party agency
• Effective date
• Signatures of both parties (entity and third party billing agency)

Sample BAA

Entity account managers must log on to the EMSTR system and upload their BAA. If having trouble uploading a BAA, contact injury.web@dshs.texas.gov.

Submersion data at this time can only be reported via web-data entry. View details on how to do web-data entry.

• An account manager in the EMSTR system has access to add, edit, and inactivate users along with permissions to upload Business Associates Agreements (BAAs) for all entities they have been granted access. They may also submit data for their entity.
• A user only has permissions to submit data for their entity.

• A required element can accept Null Values (i.e., Not Applicable or Not Known / Not Recorded).
• A mandatory element must be answered with a correct value; if a correct value is not answered for a mandatory field, the record will be rejected from the system (i.e., entering a value for first name).