National EMS Database by elc18177

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									  National EMS
   Database



       Greg Mears, MD FACEP
         Principal Investigator
 North Carolina EMS Medical Director
University of North Carolina-Chapel Hill
 The Project:
 National EMS Information
 System
   Long Term Goals
                                                                                                                                             EMS Performance Improvement Resource Center



 Electronic EMS Data
                                                                                                                                                     EMS Response by Chronology



                                                                                                                                                                                    Cultural/                       Event                                                          Recognition/Action




 Standard EMS
                                                                                                                                                                                    Religious      Alcohol/
                                                                                                                                                                         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




  Dataset
                                                                                                                                                  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                                                                    vs.        Mass Destruction        vs.                                                                                                                                                             Tertiary




 Data Systems
                                                                                                                                                                                 Mass Casualty
                                                                                                               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




    Local
                                                                                                                                                                                                                                                                                                                             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                                                                                                                      Access                    Isolated




    State
                                                                  Coordination                                                                                                                                                                                 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




    National EMS
                                                                                                                                                                 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




     Database
                                                                      Personnel         vs.
                                                                                                                                                        Acknowledgement                   Personnel
                                                                                                                                                                                                                                                                                                                                                                             Patient
                                                                                      Computer
                                                                      Education                                                                                                                                                                                                                                                                                            Cooperation
                                                                                                                                                                          Status Change                            Truck In Motion                                                                                                                                                               Language
                                                                                                                                          Confirmation
                                                                                      Call Process                                                                                                                                                                                                                                                                                                                    At Patient
                                                                                                                                                                                                                                         Safety
                                                                                                                                                                                                                                                                                                                                                     At Scene
                                                                                                                                                                            Call Dispatch




 Data Drives EMS
                                                                                                                                                                                                                                                                     Response




    System
                                                                                                                                                                                                                                                                                                                                                                                                                                                                               12/09/2004




    Personnel
    Clinical Care
The Team
NASEMSD
   Project Management
   Regional Meetings
   Operational Support
Greg Mears, MD
   Principle Investigator
NEDARC
   Clay Mann, PhD, Co-Investigator
   Mike Dean, MD, Co-Investigator
   Technical Assistance

State Data-Managers
The Money
NHTSA
   EMS Division (Primary)
HRSA
   Trauma and EMS
   EMS-C
American Heart Association
   Support for EMS Software Development
The Consensus
    Professional Organizations          Federal Partners

   AAA                             CDC
   AAMS                            FEMA
   ACEP                            HRSA-EMSC
   ACS-COT (NTDB)                  HRSA-EMSC/NEDARC
   AHA (NRCPR)                     HRSA-EMSC/NRC
   EMSOP                           HRSA-ORHP
   IAFC                            HRSA-Trauma/EMS
   IAFF                            NHTSA
   NAEMD
   NAEMSP
   NASEMSD
   NENA
The National EMS Information
          System
                    National

                    State

                    Local System
The Data Sources
                          Dispatch
                Linkage               Incident


     Medical
                                                 Patient
     Device



  Domestic                NHTSA
  Terrorism
                                                    Trauma
                           2.0



                                                 Cardiac
     Outcomes
                                                  Arrest

                Quality
                Manage-               System
                 ment
                          Personnel
The Truth about NEMSIS
Macroscopic
 Public education and
  drive policy
 Identify national trends   Reality
 Drive education             Business structure and
 Prioritize needs and         management
  funding                     Improve reliability and
 Benchmarking                 efficiency
 Solidify EMS in the         Reduce errors
  Healthcare family           Determine effectiveness of
                               systems and patient care
Microscopic
 Outcomes
 EMS Research
  hypothesis
 Promote research
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
GAO
Emergency Medical
Services
Reported Needs Are Wide-
Ranging, With a Growing Focus
on Lack of Data
GAO Results…..
The extent and impact of the reported
 needs is difficult to ascertain, however,
 because there is little standard and
 quantifiable information that can be
 used across systems. Most of the
 available information about the effect of
 unmet needs is localized and
 anecdotal.
Local Pulse
Data collection is important
     Medical record keeping
     Local data analysis
     Decision making
     Do not detract from patient care
     Short time frame of documentation
Local: Where we are
Very little information on local EMS
 data collection
Most systems are paper based but are
 discussing or transitioning to electronic
Many systems use paper and scan into
 databases or do manual entry
Local: Where we are
Few systems are compliant with the
 NHTSA dataset definitions
Several models for data collection, but
 no uniformity or consistency across
 systems
In general, there is an absence of data
 to drive reimbursement and policy
 decisions
Local: Where we want to be
 Electronic data collection    The health care
 Uniform dataset with           components are linked
  definitions                          Hospital
     Patient care                     Dispatch
     Technician                       Public Health
     System                           Public Safety
 Workflow oriented               Quality Improvement
 No dual entry                   Benchmarking
 Data comes from the source      Community based
     CAD                         Information is passed to the
     Medical Devices              State office of EMS for
                                   finance and policy decisions
Local: How to get there
Technical Assistance
Model administrative and/or statutory
 language
Standards for data collection and definitions
Attach to EMS Education Agenda and local
 training programs
National job description for EMS providers
Medical and communication device
 transmission standards
National Performance Standards
State Pulse
There is no data for:
   Resource planning
   Budget justification
   System-wide
    evaluation
   Injury prevention
    programs
   Target support and
    assistance
State: Where we want to be
State EMS database on every EMS
 patient encounter
Electronic data transmission
Privacy and confidentiality protection
   System and patient
Statutory authority
State: Where we want to be
System wide Quality Improvement
Benchmarking of compliance and public
 health indicators
Disaster Management
Bioterrorism Surveillance
Support and Assistance Resources
Annual Report for policy makers
Provide data to the National EMS Database
State: How to get there
Identify resources for a state EMS database
Technical Assistance
Model templates and database schema’s
Model quality improvement reports
Support to the state EMS office
Uniform Dataset and definitions
Peer Review Model Legislation
Promote Research
National Pulse

 Asystole
National: Where we are
EMS Agenda for the Future
Monographs, Trade journals
Surveys
National: Where we want to be
National EMS
 Database
NASEMSD lead the
 charge
Revision of the
 NHTSA Dataset
Multidisciplinary
 approach
What will we do with it?
 Public education and        Outcomes
  drive policy                Solidify EMS in the
 Identify national trends     Healthcare family
 Benchmarking                Drive education
 Reduce errors               Prioritize needs and
 Business structure and       funding
  management                  Determine
 EMS Research                 effectiveness of
  hypothesis                   systems and patient
 Promote research             care
NEMSIS Project
Dataset
XML
Business Model
Pilot Project
Outreach/PR
Software Development
The Progress
    Completed            In Progress
 NHTSA Version 2    Pilot National EMS
  Dataset             Database
    EMS                Mississippi
    Demographic        North Carolina
 XSD Standard          4 others
 Business Model     Business Logic
                        Record
                        Component
                        Data Element
                     Database Validity
                     EMS Data Collection
                      Software
Data Dictionary
 Name                        Data Element Use
 Definition                     Medical Record
                                 Quality Management
 Variable Definitions
                              Report Types Possible
 Single or Multiple Entry
                              Collected by Whom
 Relationship to other
  Data Elements               Relationship to Other
                               Datasets
 Null Values
                                 NHTSA Version 1
 National EMS
  Database Element               NFIRS
                                 Utstein
Data Dictionary: XML
Data Type
   Integer, String, Date/Time, Number
Relationship
   One to One
   Many to One
Required in XML
Minimal Entry Constraint
Maximal Entry Constraint
Formatting
Pilot Project
 Demonstration          Key Components
  National EMS
                        National Dataset
  Database
                        XML
 States Participating
                        Physical Database
    Minnesota
                         for Storage
    Mississippi
    North Carolina     Web Based
    Others as possible  Reporting to the
                         public
 Timeline
    May, 2005
The State of the States
2003 Rural EMS Survey
Collection of Statewide EMS Data
                                               States     Territori
                                                             es

No and Nothing is Planned                      2 (4%)     2 (33%)
No, But a System is Being Planned              6 (12%)       0
No, But a System is Being Developed            9 (18%)    3 (50%)
Yes, <50% of EMS Events are Being Collected    5 (10%)       0
Yes, >50% of EMS Events are Being Collected   20 (40%)       0
Yes, 100% of EMS Events are Being Collected    8 (16%)    1 (17%)


Total States Reporting on EMS Data            50 (100%)   6 (100%)
2003 Rural EMS Survey

Submission of EMS Data to the State
                                            States     Territories
No, No Plan to Require Data                 3 (6%)      4 (67%)

No, Plan to Require Data in the Future     12 (24%)     1 (17%)

Yes, Data is Required through Regulation   35 (70%)     1 (17%)
or Law


Total States Reporting on EMS Data         50 (100%)   6 (100%)
Submission
2003 Rural EMS Survey

Authority to Collect Patient Identifiers
                                      States     Territorie
                                                     s
Yes                                  38 (76%)    3 (50%)
No                                   10 (20%)    2 (33%)
Unknown                               2 (4%)     1 (17%)


Total States Reporting on EMS Data   50 (100%)   6 (100%)
Identifiers
2003 Rural EMS Survey

Peer Review Protection
                                         States     Territories
Yes                                     23 (46%)        0

No                                      21 (42%)     2 (33%)

Unknown                                  6 (12%)     4 (67%)


Total States Reporting on Peer Review   50 (100%)   6 (100%)
Protection
2003 Rural EMS Survey

2002 EMS Patient Transports
                                        States     Territories
Minimum EMS Patient Transports/state    27,463       4,000
Maximum EMS Patient Transports/state   1,502,000     84,000
Average EMS Patient Transports/state   331,153       54,595
Median EMS Patient Transports/state    130,000       75,785


Total EMS Patient Transports           6,954,211    163,785


Total States Reporting EMS Patient     21 (42%)     3 (50%)
Transports
NEMSIS 2005 - 2006
 Limited Implementation of the National EMS Database
 Establishment of a NEMSIS Resource and Technical
  Assistance Center
 Documentation
    Compliance
    Data Validity
    Measurement of progress across states
 Increased use support and software developer interaction
 Software
      Database schema
      XML test cases
      Data entry software
      Scripted reports
 Other?

								
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