Regulations, Forms & Resources


Missouri has enacted laws that create the Time Critical Diagnosis System through which emergency medical care is provided for patients who experience trauma, stroke, or STEMI, a potentially fatal form of heart attack. All of these conditions require quick assessment, diagnosis and treatment by a facility that can provide timely, definitive care to minimize risk for preventable complications and death.

The Time Critical Diagnosis System and a sustained effort by partners throughout the state will improve health outcomes for Missourians who suffer acute trauma, stroke, or ST-segment elevation myocardial infarction through the Time Critical Diagnosis system.


Fact Sheet
Frequently Asked Questions
Work Groups
Stroke and STEMI Implementation

Resources and Publications

TCD Conference 1-23-13 Presentation by Samar Muzaffar
Presentation Resources
EMTALA Presentation-06-13-2012
Missouri Emergency Medical Care System Time Critical Diagnosis Resources
Stroke Reviewers Education - 2013

Emergency Medical Services

Mars Active Data Elements


The DHSS Bureau of Hospital Standards is pleased to announce that the date for Missouri Time Critical Diagnosis (TCD) Stroke Center application acceptance has been determined. All Stroke Centers that wish to become designated as a TCD Stroke Center may submit theircompleted application and documentation beginning Thursday, August 15, 2013. This may be accomplished by mailing, faxing, or emailing the application and accompanying documents. Once received, the application(s) will be reviewed. If an application contains any omissions, the Stroke Center will be contacted regarding the missing information. After an application has been confirmed as complete, the Stroke Center will be contacted to arrange a date for the review.

All applications and correspondence should be sent care of Nicole Gamm at Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102 or

Chapter 190 - Emergency Services

Current Trauma Regulations

STEMI Regulations (Final Effective 6-30-2013)
STEMI Data Elements
STEMI Definitions (Final Effective 6-30-2013)
STEMI Center Application and Instructions (Final Effective 6-30-2013)
Recommendations for Counting PCIs (added 3-19-2010) (Guidelines only, not for regulations)

Stroke Regulations (Final Effective 6-30-2013)
Stroke Data Elements
Stroke Definitions (Final Effective 6-30-2013)
Stroke Center Application and Instructions (Final Effective 6-30-2013)
Stroke Center Application - Fillable

Transport Protocol for Stroke and STEMI Patients (Final)
Definitions for Stroke and STEMI Transport Protocols (Final)
Community Plan for Emergency Medical Services, Trauma, STEMI and Stroke (Final)

Comments or questions should be forwarded to the Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102 or by e-mail, care of