Texas EMS & Trauma Registries - Frequently Asked Questions

The Texas Emergency Medical Services and Trauma Registries (EMSTR) is an online reporting system collecting legislatively mandated data on all EMS runs, traumatic brain injuries (TBIs), spinal cord injuries (SCIs), submersions, and other traumatic injuries based on specific criteria.

EMSTR monitors and analyzes the Texas EMS and trauma care systems by incorporating National EMS Information System (NEMSIS) Version 3.5 and National Trauma Data Bank (NTDB) / International Trauma Data Exchange (ITDX) 2020 and 2023 hospital data standards in addition to Texas custom questions. EMSTR uses data collected from 22 Texas trauma service areas / regional advisory councils to benchmark and compare Texas with other states and perform epidemiological investigations to identify public health issues. By identifying public health issues, stakeholders can use data to support injury prevention projects and ultimately improve the efficiency and quality of care patients receive in Texas.

dshs.texas.gov/injury-prevention/ems-trauma-registries/emstr-platform-resources

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

• EMS providers;

• Hospitals (both designated trauma facilities and non-designated facilities);

• Acute rehabilitation facilities (long-term acute care or LTAC);

• Post-acute rehabilitation (rehab) facilities;

• Justices of the peace;

• Medical examiners; and

• Physicians.

Note – If these professionals or entities choose to notify a local or regional health authority to respond on their behalf, the local or regional health authority must report to EMSTR within ten business days of receiving the notification from the professional or entity.

Definitions:

• LTAC – a health facility providing immediate and short-term treatment for patients meeting the traumatic brain injury (TBI) and spinal cord injury (SCI) inclusion criteria.

• Rehab – a health facility providing continued recovery for patients meeting the TBI and SCI inclusion criteria.

• Spinal cord injury (SCI) – 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.

• Submersion injury – the fatal or non-fatal process of experiencing respiratory impairment from submersion/immersion in liquid.

• Trauma – an injury or wound to a living body caused by the application of an external force, including but not limited to violence, burns, poisonings, submersion incidents, traumatic brain injuries, traumatic spinal cord injuries, and suffocations.

• Traumatic brain injury (TBI) – an acquired injury to the brain, including brain injuries caused by anoxia due to submersion incidents.

Pertinent reporting requirements and rules:

• 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.

Professionals or entities listed in this section must send all injury and traumatic event reports electronically to the Texas Department of State Health Services (DSHS) EMSTR online application.  

Texas Administrative Code, Title 25, Part 1, Chapter 103, Rule 103.4.

EMS Providers
All EMS providers must submit all runs, as defined in the EMSTR Quick Reporting Guide, electronically to the DSHS EMSTR online application. 

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

Hospitals
Hospitals must submit all acute traumatic injuries meeting the National Trauma Data Bank (NTDB) / International Trauma Data Exchange (ITDX) case inclusion criteria electronically to the DSHS EMSTR online application. This includes patients who pass away during hospital care, arrive deceased, were admitted for more than 48 hours, were transferred into the hospital, or were transferred out to another hospital.

Hospitals must also submit all traumatic brain injuries (TBIs), traumatic spinal cord injuries (SCIs), and submersions. Refer to the definitions in the following links for more details on case inclusion, as well as the 2020 or 2023 NTDB and ITDX inclusion criteria.

EMSTR New Platform Resources | Texas DSHS

Hospital Requirements | Texas DSHS

Traumatic Brain Injury (TBI) / Spinal Cord Injury (SCI) Data Dictionary

Submersion Data Dictionary

EMS and Trauma Registries Reporting Rules:
Texas Administrative Code Title 25, Part 1, Chapter 103, Rule 103.7  

Long-Term Acute Rehabilitation Facilities
Long-term acute care (LTAC) facilities must report all traumatic brain injuries (TBIs) and spinal cord injuries (SCIs) with any relevant data electronically to the DSHS EMSTR online application.

LTAC facilities should use the International Classification of Diseases 10th Revision Clinical Modification (ICD-10-CM) diagnostic codes to identify TBI and SCI. LTACs should include all requested data entry fields which can be found in the TBI / SCI data dictionary using the link below.

Traumatic Brain Injury (TBI) / Spinal Cord Injury (SCI) Data Dictionary

Texas Administrative Code, Title 25, Part 1, Chapter 103, Rule 103.8

Rehabilitation Facilities
Rehabilitation (rehab) facilities must report all traumatic brain injuries (TBIs) and spinal cord injuries (SCIs) with any relevant data electronically to the DSHS EMSTR online application. Rehabs should include all requested data dictionary fields which can be found in the TBI / SCI data dictionary using the link below.

Traumatic Brain Injury (TBI) / Spinal Cord Injury (SCI) Data Dictionary

Texas Administrative Code, Title 25, Part 1, Chapter 103, Rule 103.8

Justices of the Peace
Justices of the peace (JPs) must report any traumatic brain injuries (TBIs), spinal cord injuries (SCIs), and submersion occurrences as defined by the appropriate data dictionaries not already reported by a medical examiner electronically to the DSHS EMSTR online application. Submersion is defined as the process of experiencing respiratory impairment from submersion or immersion in liquid. 

JPs should refer to the corresponding TBI / SCI or submersion data dictionaries for more details on case inclusion.

Traumatic Brain Injury (TBI) / Spinal Cord Injury (SCI) Data Dictionary

Submersion Data Dictionary

Texas Administrative Code, Title 25, Part 1, Chapter 103, Rule 103.6

Medical Examiners
Medical examiners (MEs) must report any traumatic brain injuries (TBIs), spinal cord injuries (SCIs), and submersion occurrences electronically to the DSHS EMSTR online application. Submersion is defined as the process of experiencing respiratory impairment from submersion or immersion in liquid. 

If available, MEs should use the International Classification of Diseases 10th Revision Clinical Modification (ICD-10-CM) diagnostic codes to identify traumatic TBI, SCI, or submersion cases. Refer to the corresponding TBI / SCI or submersion data dictionaries for more details on case inclusion.

Traumatic Brain Injury (TBI) / Spinal Cord Injury (SCI) Data Dictionary

Submersion Data Dictionary

Texas Administrative Code, Title 25, Part 1, Chapter 103, Rule 103.6

Physicians
Physicians must report all traumatic brain injuries (TBIs), spinal cord injuries (SCIs), and submersion injuries not already reported by a hospital or rehabilitation facility electronically to the DSHS EMSTR online application. Submersion is defined as the process of experiencing respiratory impairment from submersion or immersion in liquid. 

Physicians should use the International Classification of Diseases 10th Revision Clinical Modification (ICD-10-CM) diagnostic codes to identify TBI, SCI, or submersion cases. Refer to the corresponding TBI / SCI or submersion data dictionaries for more details on case inclusion.

Traumatic Brain Injury (TBI) / Spinal Cord Injury (SCI) Data Dictionary

Submersion Data Dictionary

Note – A physician is exempt from reporting if a hospital or acute/ post-acute rehabilitation facility admitted the patient and fulfilled the reporting requirements as stated in rule 103.7 of the Texas Administrative Code (related to hospital reporting requirements) or rule 103.8 of the Texas Administrative Code (related to acute or post-acute rehabilitation facility reporting requirements).

EMS Providers
EMS providers should include all required data elements listed in the version 3.5 NEMSIS Data Dictionary using the file format described within.

Hospitals
Non-designated hospitals and trauma-designated hospitals should include all required data elements and follow the inclusion criteria listed in either the 2020 or 2023 National Trauma Data Bank (NTDB) / International Trauma Data Exchange (ITDX) data dictionaries using the file format described within. For traumatic brain injuries (TBIs), spinal cord injuries (SCIs), and submersions; hospitals must include all requested data dictionary fields which can be found in the Traumatic Brain Injury (TBI) / Spinal Cord Injury (SCI) and Submersion data dictionaries using the links below.

Traumatic Brain Injury (TBI) / Spinal Cord Injury (SCI) Data Dictionary

Submersion Data Dictionary

Long-Term Acute Care Rehabilitation Facilities

Long-term acute care (LTAC) facilities should include all required data elements for traumatic brain injuries (TBIs) and spinal cord injuries (SCIs). LTACs should include all requested data dictionary fields which can be found in the TBI / SCI data dictionary using the link below.

Traumatic Brain Injury (TBI) / Spinal Cord Injury (SCI) Data Dictionary

Rehabilitation Facilities
Rehabilitation (rehab) facilities should include all required data elements for traumatic brain injuries (TBIs) and spinal cord injuries (SCIs). Rehabs should include all requested data dictionary fields which can be found in the TBI / SCI data dictionary using the link below.

Traumatic Brain Injury (TBI) / Spinal Cord Injury (SCI) Data Dictionary

Justices of the Peace
Justices of the peace (JPs) should include all required data elements for traumatic brain injuries (TBIs), spinal cord injuries (SCIs), and submersions not already reported by a medical examiner. Please refer to the JP data dictionary using the link below.

Justice of the Peace Requirements | Texas DSHS

Medical Examiner
Medical examiners (MEs) should include all required data elements for traumatic brain injuries (TBIs), spinal cord injuries (SCIs), and submersions. Please refer to the ME data dictionary using the link below.

Medical Examiner | Texas DSHS

EMS Providers
EMS providers must submit data within 90 days from the call for assistance date. EMSTR recommends EMS providers or third-party billers/vendors submit data monthly. 

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

Hospitals
Hospitals must submit data within 90 days from their facility’s discharge date or once per quarter. EMSTR recommends hospitals or third-party billers/vendors submit data monthly. 

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

Long Term Acute Care Facilities
Long term acute care (LTAC) facilities must submit data within 90 days from the discharge date. EMSTR recommends LTACs or authorized business associates submit data monthly. 

When there is no data for a month, the LTAC should submit a No Reportable Data (NRD) entry using the EMSTR online application.

Rehabilitation Facilities
Rehabilitation (rehab) facilities must submit data within 90 days from the discharge date. EMSTR recommends rehabs or authorized business associates submit data monthly.

When there is no data for a month, the rehab facility should submit a No Reportable Data (NRD) entry using the EMSTR online application. 

Justices of the Peace
Justices of the peace (JPs) must submit data not already reported by a medical examiner within 90 days from identification of a required reportable event. EMSTR recommends JPs or authorized business associates submit data monthly using the EMSTR online application.

Medical Examiners
Medical examiners (MEs) must submit data within 90 days from identification of a required reportable event. EMSTR recommends MEs or authorized business associates submit data monthly using the EMSTR online application.

If the listed professionals or entities choose to notify a local or regional health authority to respond on their behalf, the local or regional health authority must report to EMSTR within ten business days of receiving the notification from the professional or entity.

Entities new to the EMSTR system will need the following to set up their accounts:

1. Entity name; 

2. Organizational administrator; 

3. Contact information (email, address, phone); and

4. Tax ID number (TIN).

Once the account is created, the EMSTR online application will assign the entity a DSHS ID number to link all patient care records to the entity. The DSHS ID number may or may not match the license number received from DSHS EMS/Trauma Systems Licensing Unit. For any questions regarding licensing, visit the DSHS Consumer Protection Division Online Licensing Help Center webpage.

An entity who previously had an account within Maven (the old EMSTR reporting platform) should have received an activation link from the Texas Health and Human Services (HHS) Identity and Access Management (IAM) to set up and activate their account in the new EMSTR online application. If the entity did not receive an activation email, the organizational administrator will need to email [email protected] with the information below:  

1. Entity name; 

2. Organizational administrator; 

3. DSHS ID; 

4. Contact information (address, phone); and

5. Tax ID number (TIN).

If the organizational administrator does not remember the DSHS ID, please reach out to [email protected].   

Please contact [email protected] to coordinate updating the account. Based on the nature of the name or facility ownership change, instructions may vary and can take up to 30 days to implement.

An organizational administrator (account manager) can take one of two methods to create an account:

1. Through the Identity and Access Management (IAM) Online application, a user can create a new account and request access to EMSTR. The EMSTR team must approve the request prior to receiving an account administrator activation link.

For more information visit How to Register a New Facility with EMSTR.

2. For an existing organizational administrator, the IAM Online application allows the administrator to assign a second account manager by approving the new user’s request as a Level 3 user.

For more information visit How to Request an EMSTR Account as an Additional User and DSHS EMSTR Organization Administrative Users Training (slides 4-62).

If an organizational administrator is not established in the EMSTR online application for the facility, the entity’s administrative representative may send a request to the EMSTR team at [email protected].

Additional users need to request an account associated with the entity. Contact EMSTR ([email protected]) to confirm the entity’s name as it appears in the EMSTR online application.

Note – The entity name must match what is on the registry account exactly for the linkage to work. The additional user must follow the steps outlined in the How to Request an EMSTR Account as an Additional User guide.

EMSTR Level 1 users are end-users who need limited application access.

EMSTR Level 2 users are entity users who submit data for their facility but are not facility administrators.

EMSTR Level 3 users are organizational administrators.

EMSTR supports three electronic submission types – web services, manual entry, and file upload. Each entity must establish an account with Texas Health and Human Services (HHS) Identity and Access Management (IAM) and the EMSTR online application to use the online system for submitting data. Entities may use their own (National EMS Information System [NEMSIS] or National Trauma Data Bank [NTDB] Compliant) software or the free online state system for entering data.

Entities should submit traumatic brain injuries (TBIs), spinal cord injuries (SCI), and submersions data manually by logging into IAM, clicking on the EMSTR tile, and selecting the appropriate TBI / SCI / submersion patient type.

Note – DSHS will not accept paper submissions.

EMS providers can submit data through a third-party vendor. However, it is the individual EMS provider’s responsibility to make sure its data is reported to EMSTR. Each provider must have a signed, approved Business Associate Agreement (BAA) with the third-party vendor on file with EMSTR before using the third-party vendor data submitting services.

Currently, hospitals are unable to use third-party vendors for data submission. However, a facility can designate an agency, billing company, or RAC to submit on their behalf. IAM and EMSTR may still require a BAA to set up this service. Contact EMSTR at [email protected] for more information.

All entities must have a valid Business Associate Agreement (BAA) in place and EMSTR must review, approve, and have a copy on file.

NOTE: EMSTR will not accept BAAs with an effective date over 5 year old as the system needs to verify and track organization and vendor changes.

Step 1: Gather all BAA components:

• Entity name;

• Third-party biller/vendor agency name;

• Effective date; and

• Signatures of both parties (entity and third-party / billing agency) on the BAA.

Sample BAA

Step 2: Send the complete, signed BAA to [email protected].  

Step 3: The EMSTR team will review the BAA and approve or deny it. If approved, EMSTR will upload the BAA into the EMSTR online application.

Step 4: The third-party biller/vendor account manager must request the BAA association through IAM for approval.

Step 5: The EMSTR team will approve or deny the request.

             Note – If a BAA is not on file, the EMSTR team will deny the request.

Step 6: The EMSTR team will inform the requesting entity that access was granted and inform the third-party biller/vendor they can begin submissions.

             Note – Each entity is responsible for monitoring the data submission even though they use a third-party biller/vendor agency.

Access EMSTR Technical Guide for Webservices for detailed instructions.

The user can verify the entity’s data was submitted by doing one of the following:

1. Run an EMSTR online application Feedback Report (file uploads);

2. Use the EMSTR Reports tile and navigate to Additional Reports; or

3. Complete a patient record search.

The EMSTR team is unable to provide this information to you through the online application. An entity can find the National Provider Identifier (NPI) number for any Texas facility or practitioner using the following link:

npiregistry.cms.hhs.gov/search.

Each entity has a system-generated number used as the DSHS personal identifier (DSHS ID) in the EMSTR online application. For patient data security, DSHS IDs are not posted on an open website. Users can find this information via the Entity Reference Code Report.

On the main menu of the EMSTR application, users should select Reports -> Additional Reports which will unlock a drop-down menu. Please select the Entity Reference Code List. It is worth noting multiple facilities can be included in one report.

Please see the EMSTR Reports – State Health Analytics and Reports Platform (SHARP) Reporting Guide (March 2024) (pgs. 52-54) for further instruction.

1. A required element can accept Null Values (i.e., Not Applicable or Not Known / Not Recorded).

2. A mandatory element must be answered with a correct value. You cannot select a Null value (i.e., Not Applicable or Not Known / Not Recorded) for this field. If a correct value is not answered for a mandatory field, the system will reject the record. Values can be numerical, alphabetical, or both. Please refer to the associated data dictionary for the complete list of accepted values.

1. Not including the National Trauma Data Bank (NTDB) /International Trauma data Exchange (ITDX) version in the hospital electronic patient care record (ePCR) schematron uploads.
   If a hospital chooses to upload patient records via an .XML upload, it is mandatory the NTDB/ITDX version be included in the file. If this element is left blank, the file upload will fail.

Example: <ItdxRecords ItdxVersion="Itdx_v2020"> 

Please see the File Upload Guide for additional detail.

2. Not entering the record linkage type and software information in the ITDX Record Control Question Package.
   The record linkage information is a mandatory field per the ITDX data dictionary to link trauma patient records to any other existing multiple standardized records.

Examples:

• EMS ePCR;

• Hospital interfacility transfer; and

• Rehabilitation facility.

3. Not using the Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) calculator.
   Within each hospital ePCR, the EMSTR online application provides an ISS calculator for the user. The ISS score is based on the AIS version the user selected. The only versions available are AIS 05, Update 08, and AIS 15. Before entering the body regions affected, the user must select the AIS version used. 
   
   If the user feels the ISS score populated by the provided calculator is wrong, the user should review the rules provided by the Association for the Advancement of Automotive Medicine (AAAM). The most common errors faced by system users pertain to the following rules (version AIS 15) outlined by the AAAM:
   
   -  When an anatomic structure involves two or more AIS regions, see index to identify all possible regions and code according to the specific location of injury.
   
   -  If there are multiple injuries in the same body region, the highest score is considered. 
   
   -  Code conservatively. If there is any question about the severity of an injury based upon all available documented information, assign it to the less severe of the two AIS codes being considered.

4. Not using the correct Glasgow Coma Scale (GCS) standards.
   Hospital users should only submit a GCS in the GCS-15 or GCS-40 standard. If users send GCS values in both formats it may result in a submission error. If GSC-15 is Not Known/Not Recorded, users must complete the GCS-40 and vice versa. Find additional information in the 2023 NTDB Data Dictionary.

1. Submitting too many records at one time. Record submission file uploads are limited to 10 megabytes (MB) through web services. The EMSTR online application will reject a file upload over 10 MB.

2. Not providing a complete username. If the user or submitter receives a “–3 error” after attempting to upload, this is commonly due to an incomplete username. The username should be in the following format: WS_EMSTR_#######@partner.hhs.texas.gov.
   
   If the user or submitter uses the complete username and still experiences this error, the user or submitter should reach out to the EMSTR team at [email protected] and provide a screenshot of the error.

3. There is a discrepancy with dAgency.01 and dAgency.02. If the user or submitter receives a “–4 error” after attempting to upload, this could be due to a discrepancy with dAgency.01 and dAgency.02.
   
   For the National EMS Information System (NEMSIS) mapping submission purposes, dAgency.01 and dAgency.02 MUST be the Texas Department of State Health Services Identification number (DSHS ID) given to the facility by the DSHS EMSTR online application. If the user or submitter is unsure of the facility’s corresponding DSHS ID with the EMSTR online application, they can run an EMSTR online application Entity Reference Code Report.

The Texas Wristband Project will electronically link pre-hospital to hospital patient records throughout the continuum of care and resolve any extenuating circumstances with patient accountability during disaster-related incidents, mass casualties, and evacuations.

The EMS patient record fields used to collect the Texas Wristband will be eOutcome.03 and eOutcome.04. Use the following format when entering the patient’s wristband number:

Name:  Texas EMS Wristband (ePatient.03 and ePatient.04)

1. Serialization:  TX + Vendor Initial + six (6) alpha or numeric characters (includes any spaces).

2. Exclude letters “I” as in “India”, “O” as in “Oscar”, and “S” as in “Sierra”.

Example:  TXP1A2B3C or TXPA1B2C3

For more information about the Texas EMS Wristband Project, please contact your Regional Advisory Council.

Regional Advisory Councils | Texas DSHS

Yes. Users can find all resources on the EMSTR New Platform Resources. EMSTR recorded webinars detailing the integration with Health and Human Services Identity and Access Management (IAM) online platform on the EMSTR Webinars and Presentations page.