1. Guidance for the 2012 Texas EMS/Trauma Registry Drowning Event Report Form
February 29, 2012

2. 2012 Drowning Event Report Form Guidance – 02/29/2012
The revised Drowning Event Report Form (#EF ) should be used for all drowning events occurring on or after January 1, The Texas Department of State Health Services (DSHS) Texas EMS/Trauma Registry has created a new Drowning Event Report Form, with additions and improvements based on the Registry Solution Workgroup’s (RSWG) recommendations and stakeholder feedback. These slides provide information and guidance on the major changes to the 2012 Drowning Event Report Form (#EF ).
2012 Drowning Event Report Form Guidance – 02/29/2012
2012 Drowning Event Report Form Guidance – 02/29/2012

3. Section 1 – Reporting Entity Information
2012 Drowning Event Report Form Guidance – 02/29/2012

4. 2012 Drowning Event Report Form Guidance – 02/29/2012
Questions 1 – 5
This section has been expanded to collect more complete information on who is submitting the 2012 Drowning Report Form
Items in this section include the reporter’s name and phone number, the reporting entity’s name and EMS/Trauma Registry number (as assigned by DSHS), and entity type
This information will help us follow-up if there are questions about the case, and to communicate with all stakeholders who report drowning events to DSHS
Hospitals’ EMS/Trauma Registry numbers can be located by hospital name* or by county*. Select either link to open a list of hospital ID numbers.
*The lists of hospital EMS/Trauma Registry numbers are frequently updated as hospital
information is added or changed. Please use these links when looking up registry numbers to
ensure information is accurate and up-to-date.
2012 Drowning Event Report Form Guidance – 02/29/2012

5. Section 2 – Demographics
2012 Drowning Event Report Form Guidance – 02/29/2012

6. 2012 Drowning Event Report Form Guidance – 02/29/2012
Questions 9 – 10
Race and ethnicity have been separated into two data elements
In addition to the patient’s race, the patient’s ethnicity may be identified as either Hispanic/Latino or Non-Hispanic/Latino
2012 Drowning Event Report Form Guidance – 02/29/2012

7. Section 4 – Administrative
2012 Drowning Event Report Form Guidance – 02/29/2012

8. 2012 Drowning Event Report Form Guidance – 02/29/2012
Questions 15 – 15d
Additional EMS information is collected, including the EMS provider’s EMS/Trauma Registry number (as assigned by DSHS) and EMS call time information
EMS providers’ EMS/Trauma Registry numbers can be located by EMS provider name* or by county*. Select either link to open a list of EMS provider ID numbers.
*The lists of EMS provider EMS/Trauma Registry numbers are frequently updated as EMS
provider information is added or changed. Please use these links when looking up registry
numbers to ensure information is accurate and up-to-date.
2012 Drowning Event Report Form Guidance – 02/29/2012

9. 2012 Drowning Event Report Form Guidance – 02/29/2012
Questions 16 – 16d
Items regarding treatment and hospitalization have been updated to allow for more accurate collection of patient treatment information
The Drowning Event Report Form asks if the patient was treated at the hospital, and if the patient was either admitted or treated and released only
The form also collects the date and time of arrival at the hospital, instead of the date of admission
Discharge information has been moved to the Assessment Information section, under Disposition, questions 37-39
2012 Drowning Event Report Form Guidance – 02/29/2012

10. Section 5 – Drowning Event Information
2012 Drowning Event Report Form Guidance – 02/29/2012

11. Section 5 – Drowning Event Information
Several additions have been made to this section in order to collect more complete information that can be used to guide prevention efforts, including:
Kind of swimming pool
Entrapment
Nature of incident
Expanded scene locations, barriers at scene, and supervision information
2012 Drowning Event Report Form Guidance – 02/29/2012

12. 2012 Drowning Event Report Form Guidance – 02/29/2012
Question 19
To indicate the place of the drowning event, select the appropriate category and answer all applicable questions within that category
The three Event Place categories are:
Pool and Hot Tub/Spa/Jacuzzi
Natural Bodies of Water (including Ditch/Canal)
Other/Miscellaneous (including Bathtub, Toilet, and Bucket
Select only ONE answer from either category A, B or C to indicate the place the drowning event occurred
2012 Drowning Event Report Form Guidance – 02/29/2012

13. A. Pool and Hot Tub/Spa/Jacuzzi Question A1
If the drowning event occurred in a swimming pool, indicate if the pool was a:
Wading pool (less than 2 feet deep)
Above ground pool
In-ground pool
2012 Drowning Event Report Form Guidance – 02/29/2012

14. A. Pool and Hot Tub/Spa/Jacuzzi Questions A2 – A2a
The new Entrapment portion of the form allows reporters to indicate if the event was an entrapment, and if so, what type (e.g. torso, limb, mechanical, etc.)
Entrapment victims:
Source: Pool Safety Council,
2012 Drowning Event Report Form Guidance – 02/29/2012

15. A. Pool and Hot Tub/Spa/Jacuzzi Questions A3 – A5
Fencing, pool alarm, and barrier items have been expanded to capture more specific information regarding fencing, gates or other barriers at the scene
Indicate if any fences and gates were present and operational at the time of the incident
Indicate if a pool alarm was present and operational at the time of the incident
2012 Drowning Event Report Form Guidance – 02/29/2012

16. A. Pool and Hot Tub/Spa/Jacuzzi Questions A6 – A7
Event location information has been expanded to include locations such as municipal pools, neighborhood/subdivision pools, and community centers
Separates specific location (e.g. multi-family dwelling, single-family dwelling, etc.) from type of residence (e.g. patient residence or other residence), when applicable
2012 Drowning Event Report Form Guidance – 02/29/2012

17. B. Natural Bodies of Water (including Ditch/Canal) Question B1
If the drowning event occurred in a lake/pond, bay/bayou or river/creek, indicate the name of the body of water
2012 Drowning Event Report Form Guidance – 02/29/2012

18. B. Natural Bodies of Water (including Ditch/Canal) Question B2
Event location information has been expanded to include locations such as uninhabited private property and national, state, county or city parks
2012 Drowning Event Report Form Guidance – 02/29/2012

19. 2012 Drowning Event Report Form Guidance – 02/29/2012
C. Other/Miscellaneous (including Bathtub, Toilet, & Bucket) Question C2
Event location information has been expanded to include locations such as farm/ranch/non-residential
2012 Drowning Event Report Form Guidance – 02/29/2012

20. 2012 Drowning Event Report Form Guidance – 02/29/2012
Question 23
This new item is used to record whether or not the patient knew how to swim
2012 Drowning Event Report Form Guidance – 02/29/2012

21. 2012 Drowning Event Report Form Guidance – 02/29/2012
Question 24
Another new item, this is used to indicate if the nature of the incident was non-intentional or intentional (either self-inflicted or inflicted by another)
2012 Drowning Event Report Form Guidance – 02/29/2012

22. 2012 Drowning Event Report Form Guidance – 02/29/2012
Questions 26 – 26c
These items should be answered only for patients younger than 15 years of age
Improved supervision items include expanded answer options for who was supervising the patient at the time of the drowning event, such as:
Friend/neighbor
Lifeguard
Other relative
Parent intimate partner (i.e. unmarried partner of patient’s parent)
New items also ask for:
Age (if the supervisor was younger than 18 years of age)
If supervisor was aware child was engaged in water activity at time of drowning event
If supervisor saw child fall into or begin struggling in water
2012 Drowning Event Report Form Guidance – 02/29/2012

23. Section 6 – Assessment Information
2012 Drowning Event Report Form Guidance – 02/29/2012

24. Section 6 – Assessment Information
All questions regarding the assessment of the patient after the drowning event have been consolidated into one section, including improved patient alcohol and/or drug use items
2012 Drowning Event Report Form Guidance – 02/29/2012

25. 2012 Drowning Event Report Form Guidance – 02/29/2012
Question 29
Indicate if the diagnoses codes being used are either ICD-9 or ICD-10 codes
2012 Drowning Event Report Form Guidance – 02/29/2012

26. 2012 Drowning Event Report Form Guidance – 02/29/2012
Questions 32 – 33a
Patient alcohol and/or drug use may now be indicated as:
No (not suspected)
No (laboratory confirmed)
Suspected (not confirmed)
Yes (laboratory confirmed)
Blood alcohol level test results are recorded in milligrams per deciliter (mg/dL)
List any positive drug use test results
2012 Drowning Event Report Form Guidance – 02/29/2012

27. 2012 Drowning Event Report Form Guidance – 02/29/2012
Question 34
This item should only be answered for patients younger than 15 years of age
Indicate if the patient’s supervisor at the time of the drowning event was suspected of using drugs or alcohol
2012 Drowning Event Report Form Guidance – 02/29/2012

28. 2012 Drowning Event Report Form Guidance – 02/29/2012
Questions 35a – 35b
Record any vital signs collected at the scene and during initial assessment at hospital
Oxygen saturation information is now collected in addition to pulse and respiration rate
Facilities receiving a patient transferred from another facility should, when possible, record the vital signs from the scene of the drowning event under Question 35a
It is important for the receiving hospital to include this information in order to decrease missing information in the EMS/Trauma registry, as the transferring facility may fail to include this information or submit its own Drowning Event Report Form
2012 Drowning Event Report Form Guidance – 02/29/2012

29. 2012 Drowning Event Report Form Guidance – 02/29/2012
Question 36
Indicate if the outcome of the drowning event was:
Death
Morbidity
No morbidity
Select no morbidity if the patient was not diagnosed with any physical and/or mental deficits
2012 Drowning Event Report Form Guidance – 02/29/2012

30. 2012 Drowning Event Report Form Guidance – 02/29/2012
Question 37
Indicate the location the patient was transferred/discharged to
Please use the following descriptions to determine the appropriate facility or service type:
Intermediate care facility (ICF) – a facility providing a level of medical care that is less than the degree of care and treatment that a hospital or skilled nursing facility is designed to provide but greater than the level of room and board
Home health service – a certified service approved to provide care received at home as part-time skilled nursing care; speech, physical or occupational therapy; and/or part-time services of home health aides
Hospice – an organization which is primarily designed to provide pain relief, symptom management, and support services for the terminally ill and their families
Skilled nursing care – daily nursing and rehabilitative care that is performed only by or under the supervision of skilled professional or technical personnel. Skilled care includes administering medication, medical diagnosis, and minor surgery.
Source: National Trauma Data Bank (NTDB) 2012 Data Dictionary, p. 155,
available at
2012 Drowning Event Report Form Guidance – 02/29/2012

31. 2012 Drowning Event Report Form Guidance – 02/29/2012
Questions 37a – 37b
If the patient was transferred to another entity for further treatment, enter the entity’s name as well as the entity’s EMS/Trauma Registry number (as assigned by DSHS)
Record the date and time of the patient’s transfer or discharge
Hospitals’ EMS/Trauma Registry numbers can be located by hospital name* or by county*. Select either link to open a list of hospital ID numbers.
*The lists of hospital EMS/Trauma Registry numbers are frequently updated as hospital
information is added or changed. Please use these links when looking up registry numbers to
ensure information is accurate and up-to-date.
2012 Drowning Event Report Form Guidance – 02/29/2012

32. 2012 Drowning Event Report Form Guidance – 02/29/2012
Questions 38 – 39
Record the date and time of the patient’s transfer or discharge
2012 Drowning Event Report Form Guidance – 02/29/2012