National EMS Information System by 6edh0EpV

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									NEMSIS: The Project
  and the Center
         Paige Nielsen, BS
  NEMSIS Technical Assistance Center
             Overview
• Need for standardized data

• NEMSIS
  – Two primary objectives for ONE PURPOSE
  – Where we are today

• Elements NEMSIS collects related to
  Stroke victims
     Why is EMS Data Collection
             Difficult?
                                     Mark
                   Antonia Marie Pilaski Bess
                   Alias:
      Antonia Pilaski         Toni Pilaski
                                     Work
                              Marie PilaskiAddress:
                   Address: Marie Pilaski
                    Antonia                     24 6 Montgomery Street Salt Lake City, UT
                    Alias:
      Trauma Center Address:33 Prince Regent Street Salt Lake City, UT
                  450 1st Avenue, Salt LakeAntonia Pilaski
                               Toni Marie City, UT
                    Response Address:
                               the residence
        9-1-1 call place from Prince Regent Street Salt Lake City, UT
                            39
                                         First Hospital Address:
                                                     245 Chipeta Way, Murray, UT
                   EMS responds to neighbour's house

              Marie is transported to nearest hospital
15 hours later, Marie transferred to a trauma center
          A domestic dispute with fiancée arrested at work
                      Who Know’s Marie’s
                           Story?
           Status Among States
                                  W
                                  A
                                                    M            N                                                                  ME
                                                    T            D                                                             V
                                                                              M
                              O
                                                                              N                                                 T N
                              R           ID                     S                                MI
                                                                                           W                               NY     H
                                                                                                                                  MA
Marianas                                                W        D                                                               C R
                                                                                           I
 Islands                                                Y                                                                        T I
                                      N                          N                IA                                    PA    N
                                                                                                           O
                                      V                          E                         I                                  D
                                                                                                                              J
 Guam                                                                                                      H
                                               U             C                             L     IN                           E
                          C                                                                                    W                       District of
                                               T             O       K                 M                                VA
                          A                                                                                    V                       Columbia
American                                                             S                 O              KY
 Samoa                                                                                                              NC
                                           A                                                     TN
                                                                         OK            A
                                           Z                                                                    SC
                                                        NM                             R
                                                                                                  A        GA
                                                                                           MS     L
                                                                 TX                    L
                                                                                       A
                     AK
                                                                                                                   FL



                                                                                  Puerto Rico


                                                   HI                              U.S. Virgin
                  KEY:                                                              Islands

           Active Data System

           No Active Data System

           Did Not Respond to Survey
                                                                                               Source: NEMSIS TAC
                                                                                               Capability Survey, 2006
                       The Need
• EMS Education
   – Curriculums
   – Local Education

• EMS Outcomes
   – Something other than death
   – System evaluation

• EMS Research
   – Generate hypothesis
   – Evaluate cost-effectiveness
   – Identify problems and target issues

• EMS Reimbursement
   – National fee schedule and reimbursement rates
                                                                                                                     EMS Performance Improvement Resource Center
                                                                                                                             EMS Response by Chronology



                                                                                                                                                            Cultural/
                                                                                                                                                            Religious      Alcohol/
                                                                                                                                                                                            Event                                                          Recognition/Action
                                                                                                                                                 Geography/                 Drugs Demographics
                                                                                                                                                                                                                                                                  Community                                                               Correct
                                                                                                                                                 Topography                                                                                                                                                        Knowledge
                                                                                                                                                                                                                                                                  Education                                                               Activation
                                                                                                                                                                                                                                                                                   Public               Phone
                                                                                                                                         Community                                                                         Medical Experience                                     Education             Access          Motivation
                                                                                                                                                                                                                                                         Knowledge
                                                                                                                                              Public Education          Educational     Medical
                                                                                                                                                                                                                                                           History
                                                                                                                                                                          Level         History                            Public                                                                                                                Capability
                                                                                          Pre-Event                                   Definition/Acuity
                                                                                                                                                                                                                       Knowledge
                                                                                                                                                                                                                                                     Motivation
                                                                    Personnel Level

                                                                  Scheduling
                                                                                              Utilization
                                                                                                                                                                                                                                                                         Fear/
                                                                                                                                                                                                                                                                     Responsibility
                                                                                                                                                                                                                                                                                         Liability
                                                                                                                                                                                                                                                                                                                                                                PSAP Notification
                                                                                      Availability
                                                                                                                                 Seasonal                   Location                                                                             Non-Healthcare
                                            Information System                          (Time)
                                                                                                                         Gated Variations                                                                                                          Facilities
                                                                                                                                                            Boundaries/                                                                                       Auto-Notification                                                                               Access     Language
                                        Deployment/                                                                   Communities,                                                                                                   Nursing Homes
                                                                                                                          etc.                              Access                                                                                                                Lifeline                                                                                Barriers
                                                                                                                                                                                                                                                                                                                                                                                      Non-Verbal
                                          Capability                                                                                Weather
                                                                                                                                                          Public/Private
                                                                                                                                                                                                                                          Social Services                                                                             Functioning Phone
                                                     Configuration                                                                                                                                                                                                                    Other          Schools
                                                                                       Geography         Tiered                                                                                                                           Community Center
                                                      Deployment Plan                                   Response                                                  Environment                                                    Healthcare                                                                                    Communication
                                                                                                                                   Transport
                                                                                        System Status Plan                                          Roads
                                                          Demand vs. Supply                                                          Weather                                                           Public Health              Interface                       Other
                                                                                                                                                                                                            vs.
                                                                               System                  Motivation/         Technology Infrastructure                                                    Healthcare                                               Physician Offices   Poison                                                                   Drive By          Telematics
                                                                                                                                                                           Transport Only                                             Mutual Aid
                                                                            Understanding             Commitment                                              Medical                                                                                         DayOp Centers         Control                                                                              Lifeline             Alarms
                                                                                                                                                                                            Accidental                                                                                                                                              Walk-In
                                                                  Numbers                         Buy in                                                        vs.                                                                                        Free Standing ED’s
                                                                                                                                                                                                vs.
                                                                                                                                                              Trauma
                                                                                                                                                                                            Intentional                                      Healthcare Facilities                                                                 Alternative
                                                              Staffing                                                                                                                                                                                                        Witnesses/
                                                                                                                                                    Event Type                                                                                                                Bystanders                 Geographic              Communication
                                                                                                                                                                                                                                                                                                          Location                                                     Caller               Location
                                                                       Fatigue                                                                                                                                                                                   Weather
                                                                                    Satisfaction           Culture                                                                                                                                                                                                                                                              Primary    Awareness
                                                                                                                                                            Single                             Weapons
                                                                                               Compensation
                                                                                                                                                              vs.               Adult             Of              Natural                     Environment                                                                                                 Proximity                Secondary            Knowledge
                                                                                                     Analysis                                            Mass Casualty           vs.        Mass Destruction        vs.                                                                                                                                                             Tertiary
                                                                                       Pre-Plan                 Reconfiguratiion                                               Pediatric                         Man Made                                                             Religeon                    Race/
                                                                    Policy and
                                                                                                                   Performance                                                                                                                                                                                   Ethnicity              Level of Information
                                                                    Procedure                                                                                                                                                                                          Language                      Tradition
                                                                                                                   Improvement                                                                                                                                                                                                                                         Confidentiality              Receiver
                                                            Planning                                                                                                    Scene/                                          Event                    Special Needs/                                                                                                                 Language Barriers Performance
                                                                                                                                                                     Incident Size             Patient Numbers         Numbers
                                                                         Future Planning       Exercise/Training
                                                                                                                                                      Size/                                                                                     Cultural Barriers
                                                                                                                                                                                                                                                                                                                                                                                               Resource
                                                                                                                                                                                                                                                                                         Special        Fear Empowerment/                                                   Event             Allocations
                                                                                                      Perceived Value                                Volume                                                                                                          Impairment
                                                                                                                                                                                                                                                                                                                                                                          Confusion
                                                                          Socio-Economic                                    Geography/                                                                                                                                                   Needs                 Custody                                                                                                  Time
                                                                                                                                                                                                                                                                                                                                                                                         Order
                                                                                                   Tax base/funding          Density                                                             Seasonal         Geography                                                                                      Equipment                                                               Triage              Staffing    Of
                                                                            Expectations                                                                                                                                                                                                     PAD                                                       Multiple Rings/Hold                                              Day
                                                                                                                                                                                                            Access          Safety                                                                                           AED                                                        Accuracy
                                                                                                                                                                                     Weather                                                                                                           First Aid
                                                                      Community                                                                                                                                                                                                     CPR                                       Other
                                                                                                                                                                                                                                                                                                                                                         Multiple
                                                                             Knowledge/                                                                                                                                                                               First Aid
                                                                              Education                Public Perception     Cultural/Religious                      Environment                                                                                                                                                                       Notifications                                          Knowledge
                                                                                                                                  Issues                                                                                                                                           Formal                 Education            Fear/
                                                                               Experience                             System                                                                                                                                                                                                                                                         Unknown Location         Of Access
                                                                                                                                                                                                                                                                              Non-EMS Response                               Motivation
                                                                                                                     Knowledge                                                                                                                                                                                                                                                                                        Identifiers
                                                                                                                                                                                                      Locating the Event                                                                                                                                          Event Location ID
                                                                                                                                                                                                                                                                                                     Patient Safety          Bystander Safety                                                       Awareness           Locators
                                                                                         Readiness                                                                             Location                                                                                           Personal Safety                Incident Security                             Location
                                                                                                                                                                                                                                                                                                                                                                                                                        Location of Call
                                                                                            Vehicle Ready
                                                                                                                Equipment Ready
                                                                                                                                    People Ready
                                                                                                                                                                                                                                                                                  Safety                                                                                             Inaccurate
                                                                                                                                                                                                                                                                                                                                                                                    Information     Dispatch Error
                                                                                                                                                                                                                                                                                                                                                                                                                        vs.
                                                                                                                                                                                                                                                                                                                                                                                                                        Location of Scene             EMS
                                       Initial
                                                          Delay      Volume
                                                                                 Staffing
                                                                                         Motivation
                                                                                                   Hardware                                                       Location ID
                                                                                                                                                                                                                                     Confirmation
                                                                                                                                                                                                                                                       Routing
                                                                                                                                                                                                                                                                     Patient
                                                                                                                                                                                                                                                                            Directions

                                                                                                                                                                                                                                                                  Information
                                                                                                                                                                                                                                                                                         Clarity
                                                                                                                                                                                                                                                                                                                       Unable
                                                                                                                                                                                                                                                                                                                         To
                                                                                                                                                                                                                                                                                                                       Locate
                                                                                                                                                                                                                                                                                                                                         Not
                                                                                                                                                                                                                                                                                                                                        Marked
                                                                                                                                                                                                                                                                                                                                                        Not
                                                                                                                                                                                                                                                                                                                                                       Mapped                         Geography
                                                                                                                                                                                                                                                                                                                                                                                                        Access          Vertical       Wilderness
                                                                                                                                                                                                                                                                                                                                                                                                                                                    Response
                                                                                                                         Cell Communications/            Policed
                                    Ring/Answer                                                                                 Location                Boundaries
                                                                                                                                                                                                                  Communication                                                                                                                                                                   Weather           Hazmat           Crowd
                                                                         Software                      Language
                                                Distractions/
                                                                                                                      GIS Capabilities        Interoperability                                                      Exchange                                                                                Address
                                                                                      Disaster Mode
                                            Other Responsibilities                                                                                                                                                                             Physiologic                    Accuracy in                                                                                       Environment
                                                              Handoffs           Training                                          Training                                                                              Location                          Activity Level      Reporting
                                          Coordination                                                                                                                                                                                                                                                                                                                                                   Access                    Isolated
                                                                                                                                                                                                                                       Home
                                                                            Drops         Misinformation                                                          Technology                                                                                Time of Day                                                   Weather         Hazmat       Crowd                                 Unknown                Entrapment
                                                                                                                                                                                                                                           Station            Fatigue
                           Relays-Levels                                                                              Manual         Telematics                                                              Personnel                                                                                                                                                           Location
                                                                                                                       vs.                                                                                                                            Traffic        Functional Vehicle
                                                                                                                                                                                                                                                                                                       Environment                                                                     Language              Religeon
                                          Language            See                                                    Computer
                                                     Initial Ring/Answer                                                                                                                                                            AVC              Control          And Equipment
                                                                                                                                                                              See Call Processing                                                    Systems                                                                                                                                        Ethnic                 Family
                                                             Above       Repetition-                                                                                                                                                                                                                                                         Demographics
                                                                         Time DelayCaller Frustration/
                                                                                                                                                         Inter-operability/   Initial Ring-Answer           Equipment/                                                                                               Geography
                                                                                                                                                                                                                                                                                                                                                                            Cultural
                                                                                                                           Decision Point                  Coordination                And
                                                                     Motivation      Cooperation                              (Send)                                             Relays-Levels              Technology        Time Based Events                                                          Alcohol/               Public Response/
                                        Training                                        Work                                                Mode Selection                                                                                Traffic                       Map Book                          Drugs                        Aid                                                    Patient         Personnel
                                                           Scheduling               Environment                                                                                                                                            Roads
                                                                                                                 Technology                                                                                                                                       Mapping                     Community                                                                     Safety
                         Personnel/                                                                                                                                                                                        Knowledge         Weather
                                                                                                                  (Method)                                                                                                                     Train
                           Staffing                                                                                                                                                                       Navigation
                                                                                                                                                                                                                                                                                                                                                                                             Multiple Types
                                            Personal Relations             Satisfaction                                 Contingency Plan                                                                                                                                                                  Gated          Roads        Restricted Access                                                   High Angle
                                                                                                                                                                                                                                                                                                                                                                                           Others
                                                                                                                                                                                                                                                                                                                                                                                                            Swift Water
                                                                                                                                         Business Plan           Hardware Back
                                                                                                                                                                                                                   Restricted Access           Gated Communities                                                                                                  Rescue/
                             Protocol      Policy              Education Performance                                                                                                                         Location                                                                         Access                                                              Access
                                                    Documentation        Improvement                             Fail Safe                                                                                   (Scene)                                                                                                                                                        Number
                                                                                                                                                                                                                                                                                                                                                                                        Resources
             Automated Action/                                                                                                                                                                                                            Hazmat                                                                                                                              Of                   Power
                                                                                                                            Redundant Notification            Exercise/Training                                         Weather           Incident          Crowd
Process or Decision Algorhythm                                                                                                                                                                                                                                                                             Patient              Personnel                                   Patients
                                                                                                                                                                                                                                                                                                                                                                                                    Water
                                                                                                                                                                                                                                                                                                                                                                                                              Density
                                          Recall/Review       Decision Automation
                                                                                                                             Equipment
                                                                                                                                                     People
                                                                                                                                                                       Vehicle                      Environment                                                                                                                                               Mass Care
                                                                                                                                                    (Staffing)
                                                            Quality
                                                                                                                                                                      Availability                                                                                                        Safety                                                                         Control       Communications
                                 Yes/No                   Management      Performance                                                                                                                              Time Limits                Protocol                                                                                                                                                     Law
                                            Application                   Improvement             Capacity or Backlog                                                                                                                                                                                                                                                    Decontamination               Enforcement

                       EMD                                                                                                                    Airtime                Volume                 Policy/Procedure                                                                                                                                                     Alcohol/
                                                                                                                                                                                                                                                                                                                                                                                     Special   Ethnicity
                                                                                                                                                                                                                                                                                                                                                                  Drugs
                                                               Cards                                                                                                                                                                                                                                                                                                                 Needs Fear
                           Implementation                                  Politics                                                                                                                              Black Box          Verbal        Response
                                              Personnel         vs.
                                                                                                                                Acknowledgement                   Personnel
                                                                                                                                                                                                                                                                                                                                                     Patient
                                                              Computer
                                              Education                                                                                                                                                                                                                                                                                            Cooperation
                                                                                                                                                  Status Change                            Truck In Motion                                                                                                                                                               Language
                                                                                                                  Confirmation
                                                              Call Process                                                                                                                                                                                                                                                                                                                    At Patient
                                                                                                                                                                                                                 Safety
                                                                                                                                                                                                                                                                                                                             At Scene
                                                                                                                                                    Call Dispatch

                                                                                                                                                                                                                                             Response




                                                                                                                                                                                                                                                                                                                                                                                                                                                       12/09/2004
     NEMSIS Purposes
• Compose a Uniform Dataset
  – Demographic dataset (EMS System)
  – EMS dataset (EMS Event)

• Ensure the Portability of Data
  – XML (eXtensible Markup Language )
  – XSD (XML Schema Definition)
NEMSIS Overview
         Patient Care Report Software

                    Patient
                     Care
                    Report

           Agency A’s Software


                    Patient
                     Care
                    Report


 911      Agency B’s Software
Center

                    Patient
                     Care
                    Report


           Agency C’s Software
Where are we?
States Using the NHTSA Standard
                           W
                           A
                                             M              N                                                                  ME
                                             T              D                                                             V
                                                                         M
                       O
                                                                         N                                                 T N
                       R           ID                       S                                MI
                                                                                      W                               NY     H
                                                                                                                             MA
 Marianas                                        W          D                                                               C R
                                                                                      I
 Islands                                         Y                                                                          T I
                               N                            N                IA                                    PA    N
                                                                                                      O
                               V                            E                         I                                  D
                                                                                                                         J
 Guam                                                                                                 H
                                        U             C                               L     IN                           E
                   C                                                                                      W                       District of
                                        T             O         K                 M                                VA
                   A                                                                                      V                       Columbia
American                                                        S                 O              KY
 Samoa                                                                                                         NC
                                    A                                                       TN
                                                                    OK            A
                                    Z                                                                      SC
                                                 NM                               R
                                                                                             A        GA
                                                                                      MS     L
                                                            TX                    L
                                                                                  A
            AK
                                                                                                              FL



                                                                             Puerto Rico


                                            HI                               U.S . Virgin
                                                                               Islands



                                                            KEY
                 100% Data Dictionaries 100% Compliant with 2.2 Standard
                 EMS of the EMS Data Dictionary Uses Using the NHTSA NHTSA 2.2
                 Not 100% of Dictionaries not 100% Compliant
                 EMS Data the EMS Data Dictionary Using the NHTSA 2.2 Standard
                                                          or No Answer
                 States not Reporting
                  Did Not Respond to Survey
    National EMS Database
                        W
                        A
                                          M             N                                                                   ME
                                          T             D                                                              V
                                                                      M
                    O
                                                                      N                                                 T N
                    R           ID                      S                                 MI
                                                                                   W                               NY     H
                                                                                                                          MA
Marianas                                      W         D                                                                C R
                                                                                   I
Islands                                       Y                                                                          T I
                            N                            N                IA                                    PA    N
                                                                                                   O
                            V                            E                         I                                  D
                                                                                                                      J
 Guam                                                                                              H
                                     U             C                               L     IN                           E
                C                                                                                      W                       District of
                                     T             O         K                 M                                VA
                A                                                                                      V                       Columbia
American                                                     S                 O              KY
 Samoa                                                                                                      NC
                                 A                                                       TN
                                                                 OK            A
                                 Z                                                                      SC
                                              NM                               R
                                                                                          A        GA
                                                                                   MS     L
                                                         TX                    L
                                                                               A
           AK
                                                                                                           FL



                                                                          Puerto Rico


                                         HI                               U.S . Virgin
                                                                            Islands



                                                       KEY
                                Submitting in 2006

                                Reporting as Capable of Submitting in 2007

                                Reporting a Date After 2007 or Unknown

                                Did Not Respond to Survey
           NEMSIS TAC
• To facilitate the collection of EMS data
  from States and Territories to create the
  National EMS Database.
  – Two campuses
  – Ten staff
  – NEDARC is offering assistance
  – Small grant opportunities
www.nemsis.org
        Funds Available !
• Money provided by NHTSA ($255,000)
  – Uses:
  – To aid states over the hurdle of submitting
    data to the National EMS Repository
    • Additional programming
    • Software modifications
    • Needed consensus meetings
• Section 408 funds
Facilitate a Focused Effort
• Strategic Plan built around a one-month
  timeline:
  – Full dedication of the NEMSIS Team
     • Designed to built momentum and relationships
   Collected Elements Related to
           Stroke Victims
• E03_01: Complaint Reported by Dispatch
  – 480 – Fall Victim
  – 550 – Unconscious/Fainting
  – 535 – Stroke/CVA
• E09_12: Chief Complaint Organ System
  – 1355 – CNS/Neuro
  – 1385 – Psych
• E09_13: Primary Symptom
  – 1415 – Change in responsiveness
  – 1460 – Menta/Psych
   Collected Elements Related to
       Stroke Victims (cont.)
• E09_14:Other Associated Symptoms
  – 1415 – Change in responsiveness
  – 1460 – Mental/Psych
• E09_15: Providers Primary Impression
  – 1730 – Stroke/CVA
• E09_16: Providers Secondary Impression
  – 1730 – Stroke/CVA
   Collected Elements Related to
       Stroke Victims (cont.)
• E23_09: Research Survey Field
  – Allows states to add on additional variables


• E23_02: Potential Registry Candidate
  – Can be an additional fields for state data
    systems to flag patients for specific registries
             Conclusion
• The NEMSIS Standard is here to stay

• The efforts of the EMS community (plus
  the standards) will improve patient care

• Data collection and evaluation are the first
  steps in continuous improvement
T
H
A   Y
    O
N   U
K
      Available Resources



Paige Nielsen    Michael Ely
(801) 581-7373   (801) 585-9761

								
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