Q1 Contact Information

Q1 Contact Information Answered: 7 Skipped: 0 ANSWER CHOICES Hospital Name of Person Completing Survey Email RESPONSES 100.00% 7 100.00% 7 100.00% 7 # HOSPITAL DATE 1 Saint Luke's Hospital of Kansas City 9/24/2018 4:50 PM 2 Mercy South/ St. Anthony's Medical Center 9/21/2018 11:51 AM 3 St. Louis Children's Hospital 9/20/2018 5:54 PM 4 Freeman Health system 9/20/2018 3:01 PM 5 Western Missouri Medical Center 9/20/2018 12:29 PM 6 Truman Medical Center 9/20/2018 12:07 PM 7 Lake Regional Health System 9/20/2018 12:02 PM # NAME OF PERSON COMPLETING SURVEY DATE 1 Joann Paul 9/24/2018 4:50 PM 2 Tiffany Placke 9/21/2018 11:51 AM 3 Michele Herndon, MSN, RN 9/20/2018 5:54 PM 4 Christine M. Hoag-Apel RN, TNS 9/20/2018 3:01 PM 5 Patricia Richey 9/20/2018 12:29 PM 6 Teresa Lienhop 9/20/2018 12:07 PM 7 Mariah Swinker 9/20/2018 12:02 PM # EMAIL DATE 1 jpaul@saint-lukes.org 9/24/2018 4:50 PM 2 Tiffany.placke@Mercy.net 9/21/2018 11:51 AM 3 michele.herndon@bjc.org 9/20/2018 5:54 PM 4 cmhoag-apel@freemanhealth.com 9/20/2018 3:01 PM 5 prichey@wmmc.com 9/20/2018 12:29 PM 6 teresa.lienhop@tmcmed.org 9/20/2018 12:07 PM 7 mswinker@lakeregional.com 9/20/2018 12:02 PM 1 / 22

Q2 Does your facility use the state registry for trauma or a national registry? Answered: 7 Skipped: 0 State National 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ANSWER CHOICES State National RESPONSES TOTAL 7 2 / 22

Q3 If national, which one? Answered: 4 Skipped: 3 # RESPONSES DATE 1 National TRauma Databank 9/24/2018 4:50 PM 2 Collector V5 9/21/2018 11:51 AM 3 Collector from Digital Innovations 9/20/2018 12:07 PM 4 N/A 9/20/2018 12:02 PM 3 / 22

Q4 Which survey program does your facility use to get your program designated by the state? Answered: 7 Skipped: 0 State National Both 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ANSWER CHOICES State National Both RESPONSES 0.00% 0 14.29% 1 Total Respondents: 7 4 / 22

Q5 If your program is nationally designated, which national program do you use? Answered: 2 Skipped: 5 # RESPONSES DATE 1 American College of Surgeons 9/20/2018 5:54 PM 2 N/A 9/20/2018 12:02 PM 5 / 22

Q6 Which data elements are essential to have in order to evaluate quality performance? Check all that apply. Answered: 7 Skipped: 0 Patient's home zip/postal code Patient's home country Patient's home state Patient's home country Patient's home city Alternate home residence Date of birth Age Age Units Race Ethnicity Sex Injury incident date Injury incident time Work-related Patient's occupational... Patient's occupation ICD-10 primary external cau... 6 / 22

ICD-10 place of occurrenc... ICD-10 additional... Incident location... Incident country Incident state Incident county Incident City Protective devices Child specific restraint Airbag deployment Report of physical abuse Investigation of physical... Caregiver at discharge EMS dispatch date EMS dispatch time EMS unit arrival date... EMS unit arrival time... EMS unit departure da... EMS unit departure ti... Transport mode Other transport mode 7 / 22

field systolic blo... field pulse rate field respiratory... field oxygen... field GCS - eye field GCS - verbal field GCS - motor field GCS - total field GCS 40 - eye field GCS 40 - verbal field GCS 40 - motor Inter-facility transfer Trauma center criteria Vehicular, pedestrian,... Pre-hospital cardiac arrest ED/hospital arrival date ED/hospital arrival time ED/hospital... ED/hospital... ED/hospital... 8 / 22

ED/hospital... ED/hospital... ED/hospital... ED/hospital... ED/hospital... ED/hospital... ED/hospital... ED/hospital... ED/hospital... ED/hospital... ED/hospital... ED/hospital... ED/hospital... ED/hospital... Drug screen Alcohol screen Alcohol screen results ED discharge disposition Signs of life ED discharge date ED discharge time ICD-10 9 / 22

ICD-10 hospital... Hospital procedure st... Hospital procedure st... Advanced directive... Alcohol use disorder Angina pectoris Anticoagulant therapy Attention deficit... Bleeding disorder Cerebral Vascular... Chronic Obstructive... Chronic Renal Failure Cirrhosis Congenital anomalies Congestive heart failur... Current smoker Currently receiving... Dementia Diabetes mellitus Disseminated cancer Functionally dependent... 10 / 22

Hypertension Mental/personal ity disorders Myocardial Infarction (MI) Peripheral Arterial... Prematurity Steroid use Substance abuse disorder ICD-10 injury diagnoses AIS predot code AIS severity AIS version Acute kidney injury (AKI) Acute respiratory... Alcohol withdrawal... Cardiac arrest with CPR Catheter-Associ ated urinary... Central line-associa... Deep surgical site infection Deep vein thrombosis Extremity compartment... Myocardial infarction (MI) 11 / 22

Organ/space surgical sit... Osteomyelitis Pulmonary embolism (PE) Pressure ulcer Severe sepsis Stroke/CVA Superficial incisional... Unplanned admission to... Unplanned intubation Unplanned return to th... Ventilator-asso ciated... Total ICU length of stay Total ventilator days Hospital discharge date Hospital discharge time Hospital discharge... Primary method of payment Highest GCS total Highest GCS motor GCS assessment qualifier... Highest GCS 40 - motor 12 / 22

- motor ED/hospital... Midline shift Cerebral monitor Cerebral monitor date Cerebral monitor time Venous thromboembol... Venous thromboembol... Venous thromboembol... Transfusion blood (4 hours) Transfusion blood... Transfusion blood... Transfusion plasma (4... Transfusion plasma... Transfusion plasma... Transfusion platelets (4... Transfusion platelets... Transfusion platelets... Cryoprecipitate (4 hours) Cryoprecipitate Measurement Cryoprecipitate conversion Lowest 13 / 22

Lowest ED/hospital... Angiography Embolization site Angiography date Angiography time Surgery for hemorrhage... Surgery for hemorrhage... Surgery for hemorrhage... Withdrawal of life support... Withdrawal of life support... Withdrawal of life support... Antibiotic therapy Antibiotic therapy date Antibiotic therapy time National provider... 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ANSWER CHOICES Patient's home zip/postal code Patient's home country Patient's home state Patient's home country Patient's home city Alternate home residence Date of birth RESPONSES 14 / 22

Age Age Units Race Ethnicity Sex Injury incident date Injury incident time Work-related Patient's occupational industry Patient's occupation ICD-10 primary external cause code ICD-10 place of occurrence external cause code ICD-10 additional external cause code Incident location zip/postal code Incident country Incident state Incident county Incident City Protective devices Child specific restraint Airbag deployment Report of physical abuse Investigation of physical abuse Caregiver at discharge EMS dispatch date EMS dispatch time EMS unit arrival date at scene or transferring facility EMS unit arrival time at scene or transferring facility EMS unit departure date from scene or transferring facility EMS unit departure time from scene or transferring facility Transport mode Other transport mode field systolic blood pressure field pulse rate 14.29% 1 14.29% 1 15 / 22

field respiratory rate field oxygen saturation field GCS - eye field GCS - verbal field GCS - motor field GCS - total field GCS 40 - eye field GCS 40 - verbal field GCS 40 - motor Inter-facility transfer Trauma center criteria Vehicular, pedestrian, other risk injury Pre-hospital cardiac arrest ED/hospital arrival date ED/hospital arrival time ED/hospital systolic blood pressure ED/hospital pulse rate ED/hospital temperature ED/hospital respiratory rate ED/hospital respiratory assistance ED/hospital oxygen saturation ED/hospital supplemental oxygen ED/hospital GCS - eye ED/hospital GCS - verbal ED/hospital GCS - motor ED/hospital GCS - total ED/hospital GCS assessment qualifiers ED/hospital GCS 40 - eye ED/hospital GCS 40 - verbal ED/hospital GCS 40 - motor ED/hospital height ED/hospital weight Drug screen Alcohol screen Alcohol screen results 16 / 22

ED discharge disposition Signs of life ED discharge date ED discharge time ICD-10 hospital procedures Hospital procedure start date Hospital procedure start time Advanced directive limiting care Alcohol use disorder Angina pectoris Anticoagulant therapy Attention deficit disorder/attention deficit hyperactivity disorder Bleeding disorder Cerebral Vascular Accident (CVA) Chronic Obstructive Pulmonary Disease (COPD) Chronic Renal Failure Cirrhosis Congenital anomalies Congestive heart failure (CHF) Current smoker Currently receiving chemotherapy for cancer Dementia Diabetes mellitus Disseminated cancer Functionally dependent health status Hypertension Mental/personality disorders Myocardial Infarction (MI) Peripheral Arterial Disease (PAD) Prematurity Steroid use Substance abuse disorder ICD-10 injury diagnoses AIS predot code AIS severity 100.00% 7 100.00% 7 14.29% 1 17 / 22

AIS version Acute kidney injury (AKI) Acute respiratory distress syndrome (ARDS) Alcohol withdrawal syndrome Cardiac arrest with CPR Catheter-Associated urinary tract infection (CAUTI) Central line-associated blood stream infection (CLABSI) Deep surgical site infection Deep vein thrombosis Extremity compartment syndrome Myocardial infarction (MI) Organ/space surgical site infection Osteomyelitis Pulmonary embolism (PE) Pressure ulcer Severe sepsis Stroke/CVA Superficial incisional surgical site infection Unplanned admission to ICU Unplanned intubation Unplanned return to the operating room Ventilator-associated pneumonia (VAP) Total ICU length of stay Total ventilator days Hospital discharge date Hospital discharge time Hospital discharge disposition Primary method of payment Highest GCS total Highest GCS motor GCS assessment qualifier component of highest GCS total Highest GCS 40 - motor ED/hospital pupillary response Midline shift Cerebral monitor 18 / 22

Cerebral monitor date Cerebral monitor time Venous thromboembolism prophylaxis type Venous thromboembolism prophylaxis date Venous thromboembolism prophylaxis time Transfusion blood (4 hours) Transfusion blood measurement Transfusion blood conversion Transfusion plasma (4 hours) Transfusion plasma measurement Transfusion plasma conversion Transfusion platelets (4 hours) Transfusion platelets measurement Transfusion platelets conversion Cryoprecipitate (4 hours) Cryoprecipitate Measurement Cryoprecipitate conversion Lowest ED/hospital systolic blood pressure Angiography Embolization site Angiography date Angiography time Surgery for hemorrhage control type Surgery for hemorrhage control date Surgery for hemorrhage control time Withdrawal of life supporting treatment Withdrawal of life supporting treatment date Withdrawal of life supporting treatment time Antibiotic therapy Antibiotic therapy date Antibiotic therapy time National provider identification (optional) 14.29% 1 14.29% 1 14.29% 1 0.00% 0 14.29% 1 Total Respondents: 7 19 / 22

Q7 How do you currently loop other stakeholders into data outcomes to make quality changes? Answered: 7 Skipped: 0 Quality meetings Routine reports Third Party (i.e. ESO) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ANSWER CHOICES Quality meetings Routine reports Third Party (i.e. ESO) RESPONSES 100.00% 7 Total Respondents: 7 20 / 22

Q8 If third party, which one? Answered: 2 Skipped: 5 # RESPONSES DATE 1 EXO 9/24/2018 4:50 PM 2 ESO 9/20/2018 12:02 PM 21 / 22

Q9 Comments Answered: 1 Skipped: 6 # RESPONSES DATE 1 Any state created registry needs to have very specific specifications and definitions for any data point requested. Somehow the registry would need to remain consistent with current evidencedbased practices. The state registry should also align with the national registries which can then provide risk adjusted metrics for evaluating a trauma program. 9/24/2018 4:50 PM 22 / 22