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TRAC-IT Data Elements Matrix

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TRAC-IT Data Elements Matrix Powered By Docstoc
					                                                     Reference Material

The data elements referenced in this document are to be used as reference material only for the purpose of discussion with the MTG
Consultants during their interview sessions throughout the state of Texas. The document reflects the data collected by TRAC-IT as
 well as the National EMS Information System (NEMSIS) data elements silver compliance, and the data elements collected by the
 National Trauma Data Bank (NTDB). This document also includes the desired data elements for gathering information on stroke,
          cardiac events, spinal cord injury, traumatic brain injury, and submersion (drowning and near-drowning) injuries.

 MTG is interested in obtaining information on data requirements and other data collection activities from data submitters and data
                                                             users.
                                                                             TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                      * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                        Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                NEMSIS DATA DICTIONARY                                                          NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                            Submerssion
                                                                                                                                                                                   Cardiac /
                                                                                                                                                                                    Stroke
   Data Element                                           Element                                                                         Element




                                                                                                                                                                                                      SCI
                                                                                                                                                                                                TBI
                  Mandate / Rule     Data Element Name                                 Definition                    Data Element Name                                Definition
      Name                                                Number                                                                          Number


                  H&S 92.003                                 No                                                                              No
Data Set ID       H&S 773.0613 No Translation                        No Translation                                No Translation                    No Translation
                                                         Translation                                                                     Translation
                  TAC 103.1
                                                                     The unique number automatically assigned by
                  H&S 773.0613
                                                                     the EMS agency for each patient care report                             No
Run Report ID     TAC 103.4    Patient Care Report No.    E01_01                                                   No Translation                    No Translation                   X          X    X
                                                                     (PCR). This is a unique number to the EMS                           Translation
                  TAC 103.6
                                                                     agency for all of time.

                  H&S 92.003
Medical Record                                               No                                                                              No
                  H&S 773.0613 No Translation                        No Translation                                No Translation                    No Translation                              X    X        X
Number                                                   Translation                                                                     Translation
                  TAC 103.1


                  H&S 92.003
                                                                     The state-assigned provider number of the                               No
Firm Number       H&S 773.0613 EMS Agency Number          E02_01                                                   No Translation                    No Translation                   X
                                                                     responding agency                                                   Translation
                  TAC 103.1


                  H&S 773.113                                No                                                                              No
Facility Number                    No Translation                    No Translation                                No Translation                    No Translation                   X                        X
                  TAC 103.4                              Translation                                                                     Translation


                                                             No                                                                              No
Vehicle Type                       No Translation                    No Translation                                No Translation                    No Translation                   X
                  H&S 92.003                             Translation                                                                     Translation
                  H&S 773.0613
                  TAC 103.1                                  No                                                                              No
Date of Call                       No Translation                    No Translation                                No Translation                    No Translation                   X
                                                         Translation                                                                     Translation




          May 28th, 2009                                                              Please note cover on first worksheet.                                                                     Page 2
                                                                                       TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                                * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                                  Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                          NEMSIS DATA DICTIONARY                                                              NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                          Submerssion
                                                                                                                                                                                                 Cardiac /
                                                                                                                                                                                                  Stroke
   Data Element                                                     Element                                                                             Element




                                                                                                                                                                                                                    SCI
                                                                                                                                                                                                              TBI
                   Mandate / Rule      Data Element Name                                          Definition                       Data Element Name                                Definition
      Name                                                          Number                                                                              Number


                   H&S 92.003                                          No                                                                                  No
Data Set ID        H&S 773.0613 No Translation                                 No Translation                                   No Translation                     No Translation
                                                                   Translation                                                                         Translation
                   TAC 103.1
                                                                               Indicates that the reason for the EMS encounter
                                                                               was related to an injury or traumatic event. This
                   H&S 773.0613                                                data element provides documentation to classify                             No
Call Type                       Possible Injury                     E09_04                                                       No Translation                    No Translation                   X
                   TAC 103.2                                                   the EMS Reason for Encounter as either injury or                        Translation
                                                                               non-injury related based on mechanism and not
                                                                               on actual injury




                                                                               The type of service or category of service
                   H&S 773.0613                                                                                                                            No
Run Type                        Type of Service Requested           E02_04     requested of the EMS service responding for this No Translation                     No Translation                   X
                   TAC 103.2                                                                                                                           Translation
                                                                               specific EMS incident

                                                                       No                                                                                  No
Mutual Aid                          No Translation                             No Translation                                   No Translation                     No Translation                   X
                   H&S 92.003                                      Translation                                                                         Translation
                   H&S 773.0613
                   TAC 103.1                                                   Type of disposition treatment and/or transport of                           No
Response Type                       Incident/Patient Disposition    E20_10                                                       No Translation                    No Translation                   X
                                                                               the patient                                                             Translation

                   H&S 92.002
Patient Contact    H&S 92.003                                          No                                                                                  No
                                    No Translation                             No Translation                                   No Translation                     No Translation                   X
Location           TAC 103.2                                       Translation                                                                         Translation
                   TAC 103.8

Patient Contact                                                        No                                                                                  No
                               No Translation                                  No Translation                                   No Translation                     No Translation                   X
Location Comments H&S 92.003                                       Translation                                                                         Translation
                  H&S 773.0613
                  TAC 103.1




             May 28th, 2009                                                                     Please note cover on first worksheet.                                                                         Page 3
                                                                                  TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                           * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                             Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                     NEMSIS DATA DICTIONARY                                                                       NTDB DATA DICTIONARY                                                     Data Sets




                                                                                                                                                                                                                                                  Submerssion
                                                                                                                                                                                                                         Cardiac /
                                                                                                                                                                                                                          Stroke
   Data Element                                                Element                                                                                      Element




                                                                                                                                                                                                                                            SCI
                                                                                                                                                                                                                                      TBI
                     Mandate / Rule      Data Element Name                                   Definition                          Data Element Name                                        Definition
      Name                                                     Number                                                                                       Number
                     H&S 92.003
                     H&S 773.0613
                     H&S 92.003                                   No                                                                                           No
Data Set ID          TAC 103.1
Location ID          H&S 773.0613 No Translation
                                  No Translation
                                                                  No      No Translation
                                                              Translation No Translation
                                                                                                                              No Translation
                                                                                                                              No Translation
                                                                                                                                                               No      No Translation
                                                                                                                                                           Translation No Translation                                       X
                     TAC 103.1                                Translation                                                                                  Translation


                                                                          The street address (or best approximation) where
Street Address of    H&S 92.003                                                                                                                                No
                                      Incident Address         E08_11     the patient was found, or, if no patient, the    No Translation                              No Translation                                       X                        X
Occurrence           TAC 103.8                                                                                                                             Translation
                                                                          adddress to which the unit responded

                                                                          The city or township (if applicable) where the                                               The city or township where the patient was
                     H&S 92.003
City of Occurrence                    Incident City            E08_12     patient was found or to which the unit responded Incident City                      I_13     found or to which the unit responded (or best        X                        X
                     TAC 103.8
                                                                          (or best approximation)                                                                      approximation)
Zip Code of          H&S 92.003
                                      Incident Zip Code        E08_15     The Zip Code of the incident location               Incident Location Zip Code      I_09     The Zip Code of the incident location                X                        X
Occurrence           TAC 103.8
County of            H&S 92.003                                           The county or parish where the patient was found                                             The county or parish where the patient was
                                      Incident County          E08_13     or to which the unit responded (or best          Incident County                    I_12     found or to which the unit responded (or best        X          X    X        X
Occurrence           TAC 103.8
                                                                          approximation)                                                                               approximation)
GPS Latitude of      H&S 92.003
Occurrence           TAC 103.8                                                                                                                                 No
                                      Scene GPS Location       E08_10     The GPS coordinates associated with the Scene No Translation                                 No Translation                                       X
                                                                                                                                                           Translation
GPS Longitude of     H&S 92.003
Occurrence           TAC 103.8

                   H&S 92.003                                             The date/time the phone rings (911 call to PSAP
                                                                                                                                                               No
Call Received Time H&S 773.0613 PSAP Call Date/Time            E05_02     or other designated entity) requesting EMS      No Translation                               No Translation                                       X
                                                                                                                                                           Translation
                   TAC 103.1                                              services


                                                                                                                                                                       The date the unit transporting to your hospital
                                                                                                                              EMS Dispatch Date              P_01
                     H&S 92.003                                                                                                                                        was notified by dispatch
                                  Unit Notified by Dispatch               The date/time the responding unit was notified by
Dispatch Time        H&S 773.0613                              E05_04                                                                                                                                                       X
                                  Date/Time                               dispatch
                     TAC 103.1




          May 28th, 2009                                                                    Please note cover on first worksheet.                                                                                                     Page 4
                                                                                  TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                           * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                             Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                     NEMSIS DATA DICTIONARY                                                                     NTDB DATA DICTIONARY                                                     Data Sets




                                                                                                                                                                                                                                                Submerssion
                                                                                                                                                                                                                       Cardiac /
                                                                                                                                                                                                                        Stroke
   Data Element                                                Element                                                                                    Element




                                                                                                                                                                                                                                          SCI
                                                                                                                                                                                                                                    TBI
                     Mandate / Rule    Data Element Name                                     Definition                         Data Element Name                                       Definition
      Name                                                     Number                                                                                     Number
                     H&S 92.003
                                  Unit Notified by Dispatch               The date/time the responding unit was notified by
Dispatch Time        H&S 773.0613
                     H&S 92.003                                E05_04                                                                                                                                                     X
                                  Date/Time                       No      dispatch                                                                           No
Data Set ID          TAC 103.1
                     H&S 773.0613 No Translation                          No Translation                                    No Translation                           No Translation transporting to your hospital
                                                                                                                                                                     The time the unit
                                                              Translation                                                   EMS Dispatch Time            Translation
                                                                                                                                                            P_02
                     TAC 103.1                                                                                                                                       was notified by dispatch



                     H&S 92.003
                                                                          The date/time the unit responded, that is, the time                                No
En Route Time        H&S 773.0613 Unit En Route Date/Time      E05_05                                                         No Translation                         No Translation                                       X
                                                                          the vehicle started moving                                                     Translation
                     TAC 103.1



                     H&S 92.003
                                                                  No                                                                                         No
Hour of Dispatch     H&S 773.0613 No Translation                          No Translation                                     No Translation                          No Translation
                                                              Translation                                                                                Translation
                     TAC 103.1


                     H&S 92.003
                                                                  No                                                                                         No
Minute of Dispatch   H&S 773.0613 No Translation                          No Translation                                     No Translation                          No Translation
                                                              Translation                                                                                Translation
                     TAC 103.1




                                                                                                                             EMS Unit Arrival On Scene               The date the unit transporting to your hospital
                                                                                                                                                           P_03
                                                                                                                             Date                                    arrived on the scene


                   H&S 92.003                                             The date/time the responding unit arrived on the
                                Unit Arrived on Scene
Arrival Scene Time H&S 773.0613                                E05_06     scene, that is, the time the vehicle stopped                                                                                                    X
                                Date/Time
                   TAC 103.1                                              moving




          May 28th, 2009                                                                    Please note cover on first worksheet.                                                                                                   Page 5
                                                                                 TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                          * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                            Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                  NEMSIS DATA DICTIONARY                                                                       NTDB DATA DICTIONARY                                                     Data Sets




                                                                                                                                                                                                                                               Submerssion
                                                                                                                                                                                                                      Cardiac /
                                                                                                                                                                                                                       Stroke
   Data Element                                             Element                                                                                      Element




                                                                                                                                                                                                                                         SCI
                                                                                                                                                                                                                                   TBI
                   Mandate / Rule   Data Element Name                                          Definition                   Data Element Name                                          Definition
      Name                                                  Number                                                                                       Number
                   H&S 92.003                                            The date/time the responding unit arrived on the
                                  Unit Arrived on Scene
Arrival Scene Time H&S 773.0613                             E05_06       scene, that is, the time the vehicle stopped                                                                                                    X
                   H&S 103.1      Date/Time
                   TAC 92.003                                  No        moving                                                                             No
Data Set ID        H&S 773.0613 No Translation                           No Translation                                   No Translation                            No Translation
                                                           Translation                                                                                  Translation
                   TAC 103.1
                                                                                                                                                                    The time the unit transporting to your hospital
                                                                                                                            EMS Unit Arrival On Scene
                                                                                                                                                          P_04      arrived on the scene (the time the vehicle
                                                                                                                            Time
                                                                                                                                                                    stopped moving)




                  H&S 92.003
Hour of Scene                                                  No                                                                                           No
                  H&S 773.0613 No Translation                          No Translation                                       No Translation                          No Translation
Arrival                                                    Translation                                                                                  Translation
                  TAC 103.1


                  H&S 92.003
Minute of Scene                                                No                                                                                           No
                  H&S 773.0613 No Translation                          No Translation                                       No Translation                          No Translation
Arrival                                                    Translation                                                                                  Translation
                  TAC 103.1



                  H&S 92.003
Patient Contact                Arrived at Patient                        The date/time the responding unit arrived at the                                   No
                  H&S 773.0613                              E05_07                                                          No Translation                          No Translation                                       X
Time                           Date/Time                                 patient's side                                                                 Translation
                  TAC 103.1




                                                                                                                            EMS Unit Scene Departure                The date the unit transporting to your hospital
                                                                                                                                                          P_05
                                                                                                                            Date                                    left the scene


                  H&S 92.003
                                                                         The date/time the responding unit left the scene
Depart Scene Time H&S 773.0613 Unit Left Scene Date/Time    E05_09                                                                                                                                                       X
                                                                         (started moving)
                  TAC 103.1



          May 28th, 2009                                                                   Please note cover on first worksheet.                                                                                                   Page 6
                                                                                   TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                            * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                              Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                      NEMSIS DATA DICTIONARY                                                                      NTDB DATA DICTIONARY                                                     Data Sets




                                                                                                                                                                                                                                                  Submerssion
                                                                                                                                                                                                                         Cardiac /
                                                                                                                                                                                                                          Stroke
   Data Element                                                 Element                                                                                     Element




                                                                                                                                                                                                                                            SCI
                                                                                                                                                                                                                                      TBI
                      Mandate / Rule     Data Element Name                                    Definition                           Data Element Name                                      Definition
      Name                                                      Number                                                                                      Number
                  H&S 92.003
                                                                     The date/time the responding unit left the scene
Depart Scene Time H&S 773.0613 Unit Left Scene Date/Time  E05_09                                                                                                                                                            X
                  H&S 92.003                                 No      (started moving)                                                                          No
Data Set ID       TAC 103.1
                  H&S 773.0613 No Translation            Translation
                                                                     No Translation                                             No Translation
                                                                                                                                                           Translation
                                                                                                                                                                       No Translation
                  TAC 103.1
                                                                                                                                                                       The time the unit transporting to your hospital
                                                                                                                                EMS Unit Scene Departure
                                                                                                                                                             P_06      left the scene (the time the vehicle started
                                                                                                                                Time
                                                                                                                                                                       moving)




                    H&S 92.003
Hour of Leaving the                                                No                                                                                          No
                    H&S 773.0613 No Translation                            No Translation                                       No Translation                         No Translation
Scene                                                          Translation                                                                                 Translation
                    TAC 103.1


                      H&S 92.003
Minute of Leaving                                                  No                                                                                          No
                      H&S 773.0613 No Translation                          No Translation                                       No Translation                         No Translation
the Scene                                                      Translation                                                                                 Translation
                      TAC 103.1


Destination Arrival
Date
                                                                                                                                ED/Hospital Arrival Date    ED_01      The date the patient arrived to the ED/hospital
Date of Arrival
                                       Patient Arrived at                  The date/time the responding unit arrived with the
                      TAC 103.8                                 E05_10                                                                                                                                                      X          X    X        X
Arrive Destination                     Destination Date/Time               patient at the destination or transfer point
Time
                                                                                                                                ED/Hospital Arrival Time    ED_02      The time the patient arrived to the ED/hospital

Time of Arrival




           May 28th, 2009                                                                    Please note cover on first worksheet.                                                                                                    Page 7
                                                                                 TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                          * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                            Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                    NEMSIS DATA DICTIONARY                                                                NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                      Submerssion
                                                                                                                                                                                             Cardiac /
                                                                                                                                                                                              Stroke
   Data Element                                               Element                                                                               Element




                                                                                                                                                                                                                SCI
                                                                                                                                                                                                          TBI
                      Mandate / Rule     Data Element Name                                     Definition                      Data Element Name                                Definition
      Name                                                    Number                                                                                Number


                      H&S 92.003                                 No                                                                                    No
Data Set ID           H&S 773.0613 No Translation
                          92.003                                         No Translation                                     No Translation                     No Translation
                                                             Translation
                                                                 No                                                                                Translation
                                                                                                                                                       No
Month of Arrival      H&S 773.0613 No Translation
                      TAC 103.1                                          No Translation                                     No Translation                     No Translation
                                                             Translation                                                                           Translation
                      TAC 103.1


                      H&S 92.003
                                                                 No                                                                                    No
Day of Arrival        H&S 773.0613 No Translation                        No Translation                                     No Translation                     No Translation
                                                             Translation                                                                           Translation
                      TAC 103.1


                      H&S 92.003
                                                                 No                                                                                    No
Year of Arrival       H&S 773.0613 No Translation                        No Translation                                     No Translation                     No Translation
                                                             Translation                                                                           Translation
                      TAC 103.1


                      H&S 92.003
                                                                 No                                                                                    No
Hour of Arrival       H&S 773.0613 No Translation                        No Translation                                     No Translation                     No Translation
                                                             Translation                                                                           Translation
                      TAC 103.1


                      H&S 92.003
                                                                 No                                                                                    No
Minute of Arrival     H&S 773.0613 No Translation                        No Translation                                     No Translation                     No Translation
                                                             Translation                                                                           Translation
                      TAC 103.1



                      H&S 92.003                                         The date/time the unit was back in service and
Return to Service                  Unit Back in Service                                                                                                No
                      H&S 773.0613                            E05_11     available for response (finished with call, but not No Translation                    No Translation                   X
Time                               Date/Time                                                                                                       Translation
                      TAC 103.1                                          necessarily back in home location)


                      H&S 92.003                                                                                                                       No
Patient's Last Name                    Last Name              E06_01     Patient's last name                                No Translation                     No Translation                   X                        X
                      TAC 103.8                                                                                                                    Translation




           May 28th, 2009                                                                  Please note cover on first worksheet.                                                                          Page 8
                                                                                   TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                           * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                             Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                     NEMSIS DATA DICTIONARY                                                      NTDB DATA DICTIONARY                                     Data Sets




                                                                                                                                                                                                                 Submerssion
                                                                                                                                                                                        Cardiac /
                                                                                                                                                                                         Stroke
   Data Element                                                Element                                                                     Element




                                                                                                                                                                                                           SCI
                                                                                                                                                                                                     TBI
                    Mandate / Rule     Data Element Name                                         Definition           Data Element Name                                    Definition
      Name                                                     Number                                                                      Number


                    H&S 92.003
                    H&S 92.003                                    No                                                                          No
Data Set First Name H&S 773.0613 No Translation
Patient's ID                     First Name                    E06_02 No Translation
                                                                          Patient's first name                     No Translation                     No Translation                       X                        X
                    TAC 103.8                                 Translation                                                                 Translation
                    TAC 103.1
Patient's Middle    H&S 92.003                                                                                                                No
                                 Middle Initial/Name           E06_03     Patient's middle name (if any)           No Translation                     No Translation                       X                        X
Initial             TAC 103.8                                                                                                             Translation

                    H&S 92.003
Date of Birth       H&S 773.0613 Date of Birth                 E06_16     Patient's date of birth                  Date of Birth            D_07      Pt's date of birth                   X          X    X        X
                    TAC 103.1

                    H&S 92.003
Patient's Social                                                                                                                              No
                    H&S 773.0613 Social Security Number        E06_10     Patient's social security number         No Translation                     No Translation                       X
Security Number                                                                                                                           Translation
                    TAC 103.1

                                                                  No                                                                          No
Month of Birth                       No Translation                       No Translation                           No Translation                     No Translation
                    H&S 92.003                                Translation                                                                 Translation
                    H&S 773.0613
                    TAC 103.1                                     No                                                                          No
Day of Birth                         No Translation                       No Translation                           No Translation                     No Translation
                                                              Translation                                                                 Translation


                    H&S 92.003
                                                                  No                                                                          No
Year of Birth       H&S 773.0613 No Translation                           No Translation                           No Translation                     No Translation
                                                              Translation                                                                 Translation
                    TAC 103.1


                    H&S 92.003
Patient's Drivers                                                                                                                             No
                    H&S 773.0613 Driver's Lic. Number          E06_19     Patient's driver's license nunber        No Translation                     No Translation                       X
License Number                                                                                                                            Translation
                    TAC 103.1


Street Address of   H&S 92.003                                                                                                                No
                                     Patient's Home Address    E06_04     Mailing or street address                No Translation                     No Translation                       X                        X
Patient's Residence TAC 103.8                                                                                                             Translation




           May 28th, 2009                                                                     Please note cover on first worksheet.                                                                  Page 9
                                                                                   TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                            * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                              Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                      NEMSIS DATA DICTIONARY                                                            NTDB DATA DICTIONARY                                                  Data Sets




                                                                                                                                                                                                                                     Submerssion
                                                                                                                                                                                                            Cardiac /
                                                                                                                                                                                                             Stroke
   Data Element                                                 Element                                                                          Element




                                                                                                                                                                                                                               SCI
                                                                                                                                                                                                                         TBI
                    Mandate / Rule     Data Element Name                                      Definition              Data Element Name                                          Definition
      Name                                                      Number                                                                           Number


City of Patient's   H&S 92.003
                    H&S 92.003                                     No                                                                               No
Data Set ID         H&S 773.0613 No Translation City
                                 Patient's Home                 E06_05 No Translation
                                                                           Home city or township of residence      No Translation City
                                                                                                                   Patient's Home                  D_05     No Translation
                                                                                                                                                            Pt's city (or township, village) of residence      X                        X
Residence           TAC 103.8                                  Translation                                                                      Translation
                    TAC 103.1
Zip Code of         H&S 92.003
                                     Patient's Home Zip Code    E06_08     Home Zip code of residence              Patient's Home Zip Code        D_01       Pt's home Zip code of primary resid.              X                        X
Patient's Residence TAC 103.8


County of Patient's H&S 92.003
                                     Patient's Home County      E06_06     Home county or parish of residence      Patient's Home County          D_04       Pt's county (or parish) of residence              X          X    X        X
Residence           TAC 103.8




                    H&S 92.003
Sex                                  Gender                     E06_11     Patient's gender                        Sex                            D_12                          The pt's sex                   X                        X
                    TAC 103.8




                    H&S 92.003
Race / Ethnicity                     Race                       E06_12     Patient's race as defined by OMB        Race                           D_10       The pt's race                                     X          X    X        X
                    TAC 103.8
                  H&S 92.003
Motor Response at                                                  No                                                                                        First recorded Glasgow Coma Score (Motor)
                  H&S 773.0613 No Translation                              No Translation                          Initial Field GCS - Motor       P_15                                                        X                        X
Scene                                                          Translation                                                                                   measured at the scene of injury.
                  TAC 103.1

                   H&S 92.003
Verbal Response at                                                 No                                                                                        First recorded Glasgow Coma Score (Verbal)
                   H&S 773.0613 No Translation                             No Translation                          Initial Field GCS - Verbal      P_14                                                        X                        X
Scene                                                          Translation                                                                                   measured at the scene of injury.
                   TAC 103.1

                  H&S 92.003
Eye Opening                                                        No                                                                                        First recorded Glasgow Coma Score (Eye)
                  H&S 773.0613 No Translation                              No Translation                          Initial Field GCS - Eye         P_13                                                        X                        X
Response at Scene                                              Translation                                                                                   measured at the scene of injury.
                  TAC 103.1



           May 28th, 2009                                                                     Please note cover on first worksheet.                                                                                     Page 10
                                                                                TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                         * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                           Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                   NEMSIS DATA DICTIONARY                                                                    NTDB DATA DICTIONARY                                                        Data Sets




                                                                                                                                                                                                                                                Submerssion
                                                                                                                                                                                                                       Cardiac /
                                                                                                                                                                                                                        Stroke
   Data Element                                              Element                                                                                   Element




                                                                                                                                                                                                                                          SCI
                                                                                                                                                                                                                                    TBI
                    Mandate / Rule      Data Element Name                                  Definition                     Data Element Name                                          Definition
      Name                                                   Number                                                                                    Number
                    H&S 92.003
Eye Opening                                                     No                                                                                                First recorded Glasgow Coma Score (Eye)
                    H&S 773.0613 No Translation                         No Translation                                 Initial Field GCS - Eye           P_13                                                             X                        X
Response at Scene   H&S 92.003                              Translation
                                                                No                                                                                        No      measured at the scene of injury.
Data Set ID         TAC 103.1
                    H&S 773.0613 No Translation             Translation
                                                                        No Translation                                 No Translation
                                                                                                                                                      Translation
                                                                                                                                                                  No Translation
                    TAC 103.1
                    H&S 92.003                                                                                                                                    First recorded respiratory rate in the pre-
Respiration Rate at                                                     The patients respiratory rate expressed as a   Initial Field Respiratory
                    H&S 773.0613 Respiratory Rate            E14_11                                                                                      P_11     hospital setting (palpated or auscultated),             X                        X
Scene                                                                   number per minute                              Rate
                    TAC 103.1                                                                                                                                     expressed as a number per minute

                    H&S 92.003
                                                                No                                                                                        No
Pulse at Scene      H&S 773.0613 No Translation                         No Translation                                 No Translation                             No Translation                                                                   X
                                                            Translation                                                                               Translation
                    TAC 103.1

                    H&S 92.003
Systolic Blood                   SBP (Systolic Blood                                                                   Initial Field Systolic Blood               First recorded systolic blood pressure in the pre-
                    H&S 773.0613                             E14_04     The patient's systolic blood pressure                                           P_09                                                              X
Pressure at Scene                Pressure)                                                                             Pressure                                   hospital setting
                    TAC 103.1

                                                                No                                                                                        No
Date of Occurrence TAC 103.5         No Translation                     No Translation                                 No Translation                             No Translation                                          X          X    X
                                                            Translation                                                                               Translation


Date of Injury                       Incident or Onset                  The date/time the injury occurred, or the      Injury Incident Date              I_01     The date the injury occurred                                                     X
                    TAC 103.8                                E05_01
                                     Date/Time                          date/time the symptoms or problem started
Time of Injury                                                                                                         Injury Incident Time              I_02     The time the injury occurred                                                     X

                    H&S 92.003
                                                                No                                                                                        No
Month of Injury     H&S 773.0613 No Translation                         No Translation                                 No Translation                             No Translation
                                                            Translation                                                                               Translation
                    TAC 103.1


                    H&S 92.003
                                                                No                                                                                        No
Day of Injury       H&S 773.0613 No Translation                         No Translation                                 No Translation                             No Translation
                                                            Translation                                                                               Translation
                    TAC 103.1




           May 28th, 2009                                                                 Please note cover on first worksheet.                                                                                                    Page 11
                                                                                TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                        * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                          Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                  NEMSIS DATA DICTIONARY                                                                 NTDB DATA DICTIONARY                                                   Data Sets




                                                                                                                                                                                                                                       Submerssion
                                                                                                                                                                                                              Cardiac /
                                                                                                                                                                                                               Stroke
   Data Element                                             Element                                                                                Element




                                                                                                                                                                                                                                 SCI
                                                                                                                                                                                                                           TBI
                   Mandate / Rule      Data Element Name                                    Definition                        Data Element Name                                  Definition
      Name                                                  Number                                                                                 Number


                   H&S 92.003                                  No                                                                                     No
Data Set ID        H&S 773.0613 No Translation
                       92.003                                          No Translation                                       No Translation                    No Translation
                                                           Translation
                                                               No                                                                                 Translation
                                                                                                                                                      No
Year of Injury     H&S 773.0613 No Translation
                   TAC 103.1                                           No Translation                                       No Translation                    No Translation
                                                           Translation                                                                            Translation
                   TAC 103.1


                   H&S 92.003
                                                               No                                                                                     No
Hour of Injury     H&S 773.0613 No Translation                         No Translation                                       No Translation                    No Translation
                                                           Translation                                                                            Translation
                   TAC 103.1


                   H&S 92.003
                                                               No                                                                                     No
Minute of Injury   H&S 773.0613 No Translation                         No Translation                                       No Translation                    No Translation
                                                           Translation                                                                            Translation
                   TAC 103.1




                   H&S 92.002
                                                                       The category of the reported/suspected external
Cause of Injury    TAC 103.2        Cause of Injury         E10_01
                                                                       cause of the injury
                   TAC 103.8

                                                                                                                                                              E-Code used to describe the mechanism (or
                                                                                                                            Primary E-Code           I_06                                                        X          X    X        X
                                                                                                                                                              external factor) that caused the injury event


                   N/A              Intent of Injury        E10_02     The intent of the individual inflicting the injury


                    H&S 92.003
                                                                       The mechanism of the event which caused the
Mechanism of Injury H&S 773.0613 Mechanism of Injury        E10_03
                                                                       injury
                    TAC 103.1




           May 28th, 2009                                                                  Please note cover on first worksheet.                                                                                          Page 12
                                                                                 TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                          * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                            Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                    NEMSIS DATA DICTIONARY                                                             NTDB DATA DICTIONARY                                                     Data Sets




                                                                                                                                                                                                                                       Submerssion
                                                                                                                                                                                                              Cardiac /
                                                                                                                                                                                                               Stroke
   Data Element                                               Element                                                                            Element




                                                                                                                                                                                                                                 SCI
                                                                                                                                                                                                                           TBI
                       Mandate / Rule   Data Element Name                                  Definition                       Data Element Name                                  Definition
      Name                                                    Number                                                                             Number


                       H&S 92.003
                       H&S 92.003                                No                                                                                 No
Place of ID
Data SetInjury         H&S 773.0613 No Translation                       No Translation                                   No Translation                    No Translation
                       H&S 773.0613 Incident Location Type   Translation The kind of location where the incident happened Location E-Code
                                                              E08_07                                                                            Translation E-Code used to describe the place/site/location
                                                                                                                                                   I_07                                                          X                        X
Occurrence             TAC 103.1                                                                                                                            of the injury event (E849X)
                       TAC 103.1

Place of Injury        H&S 92.003
                                                                 No                                                                                 No
Occurrence             H&S 773.0613 No Translation                       No Translation                                  No Translation                     No Translation                                       X                        X
                                                             Translation                                                                        Translation
Comments               TAC 103.1

Injury Type 1
Injury Type 2          H&S 92.003
                                                                 No                                                                                 No
Injury Type 3          H&S 773.0613 No Translation                       No Translation                                  No Translation                     No Translation                                       X
                                                             Translation                                                                        Translation
Injury Type 4          TAC 103.1
Injury Type 5
Injury Body Location
1
Injury Body Location
2
                     H&S 92.003
Injury Body Location                                             No                                                                                 No
                     H&S 773.0613 No Translation                         No Translation                                  No Translation                     No Translation                                       X
3                                                            Translation                                                                        Translation
                     TAC 103.1
Injury Body Location
4
Injury Body Location
5
Patient Safety
Device Use 1
Patient Safety
Device Use 2
                       H&S 92.003
                                                                 No                                                                                 No
                       H&S 773.0613 No Translation                       No Translation                                  No Translation                     No Translation                                       X
                                                             Translation                                                                        Translation
                       TAC 103.1


           May 28th, 2009                                                                 Please note cover on first worksheet.                                                                                           Page 13
                                                                                TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                         * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                           Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                   NEMSIS DATA DICTIONARY                                                             NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                  Submerssion
                                                                                                                                                                                         Cardiac /
                                                                                                                                                                                          Stroke
   Data Element                                              Element                                                                            Element




                                                                                                                                                                                                            SCI
                                                                                                                                                                                                      TBI
                     Mandate / Rule     Data Element Name                                  Definition                      Data Element Name                                Definition
      Name                                                   Number                                                                             Number

                     H&S 92.003
                     H&S 92.003
Patient Safety                                                  No                                                                                 No
Data Set ID          H&S 773.0613 No Translation
                     H&S 773.0613                                       No Translation                                  No Translation                     No Translation                   X
Device Use 3                                                Translation                                                                        Translation
                     TAC 103.1
                     TAC 103.1
Patient Safety
Device Use 4
Patient Safety
Device Use 5




                                                                        The primary sign and symptom presented in the                              No
                                      Primary Symptom        E09_13                                                     No Translation                     No Translation
                                                                        patient or observed by EMS personnel                                   Translation
                      H&S 92.003
 Suspected Illness   H&S 773.0613                                                                                                                                                           X
                      TAC 103.1


                                                                        The EMS personnel's impression of the patient's
                                      Providers Primary                 primary problem or most significant condition                              No
                                                             E09_15                                                      No Translation                    No Translation
                                      Impression                        which led to the management given to the patient                       Translation
                                                                        (treatments, medications, or procedures)


                                      Other Associated                  Other symptoms identified by the patient or                                No
                                                             E09_14                                                     No Translation                     No Translation
                                      Symptoms                          observed by EMS personnel                                              Translation
                     H&S 92.003
Suspected Illness 2 H&S 773.0613                                        The EMS personnel's impression of the patient's                                                                     X
                     TAC 103.1 Providers Secondary                      secondary problem or which led to the                                      No
                                                             E09_16                                                     No Translation                     No Translation
                                 Impression                             management given to the patient (treatments,                           Translation
                                                                        medications, procedures)




          May 28th, 2009                                                                  Please note cover on first worksheet.                                                                      Page 14
                                                                                   TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                            * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                              Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

    TRAC-IT DATA DICTIONARY                                     NEMSIS DATA DICTIONARY                                                            NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                    Submerssion
                                                                                                                                                                                           Cardiac /
                                                                                                                                                                                            Stroke
   Data Element                                                 Element                                                                           Element




                                                                                                                                                                                                              SCI
                                                                                                                                                                                                        TBI
                         Mandate / Rule   Data Element Name                                   Definition                     Data Element Name                                Definition
      Name                                                      Number                                                                            Number


                    H&S 92.003                                     No                                                                                No
Data Set ID         H&S 773.0613 No Translation
                        92.003                                             No Translation                                  No Translation                    No Translation
                                                               Translation
                                                                   No                                                                            Translation
                                                                                                                                                     No
                    H&S 773.0613 No Translation
Suspected Illness 3 TAC 103.1                                              No Translation                                  No Translation                    No Translation                   X
                                                               Translation                                                                       Translation
                    TAC 103.1


                    H&S 92.003
                                                                   No                                                                                No
Suspected Illness 4 H&S 773.0613 No Translation                            No Translation                                  No Translation                    No Translation                   X
                                                               Translation                                                                       Translation
                    TAC 103.1


                    H&S 92.003
                                                                   No                                                                                No
Suspected Illness 5 H&S 773.0613 No Translation                            No Translation                                  No Translation                    No Translation                   X
                                                               Translation                                                                       Translation
                    TAC 103.1


                         H&S 92.003
Suspected Illness                                                  No                                                                                No
                         H&S 773.0613 No Translation                       No Translation                                  No Translation                    No Translation                   X
Comments                                                       Translation                                                                       Translation
                         TAC 103.1

Prior Illness 1
Prior Illness 2          H&S 92.003
                                                                   No                                                                                No
Prior Illness 3          H&S 773.0613 No Translation                       No Translation                                  No Translation                    No Translation                   X
                                                               Translation                                                                       Translation
Prior Illness 4          TAC 103.1
Prior Illness 5

                         H&S 92.003
                                                                   No                                                                                No
Prior Illness Text       H&S 773.0613 No Translation                       No Translation                                  No Translation                    No Translation                   X
                                                               Translation                                                                       Translation
                         TAC 103.1

Aid Prior to Arrival -
By 1
                         H&S 92.003
                                                                           The type of individual who performed the care                             No
                         H&S 773.0613 Prior Aid Performed By    E09_02                                                     No Translation                    No Translation                   X
                                                                           prior to the arrival of this unit                                     Translation
                         TAC 103.1

            May 28th, 2009                                                                   Please note cover on first worksheet.                                                                     Page 15
                                                                                  TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                           * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                             Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

    TRAC-IT DATA DICTIONARY                                    NEMSIS DATA DICTIONARY                                                             NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                    Submerssion
                                                                                                                                                                                           Cardiac /
                                                                                                                                                                                            Stroke
   Data Element                                                Element                                                                            Element




                                                                                                                                                                                                              SCI
                                                                                                                                                                                                        TBI
                         Mandate / Rule   Data Element Name                                  Definition                      Data Element Name                                Definition
      Name                                                     Number                                                                             Number

                       H&S 92.003
Aid Prior to Arrival - H&S 92.003
Data Set ID
                                                                  No      The type of individual who performed the care                              No
                       H&S 773.0613 No Translation
                       H&S 773.0613 Prior Aid Performed By     E09_02 No Translation                                      No Translation                     No Translation                   X
By 2                                                          Translation prior to the arrival of this unit                                      Translation
                       TAC 103.1
                       TAC 103.1
Aid Prior to Arrival -
By 3
Aid Prior to Arrival -
Type 1 to Arrival -
Aid Prior              H&S 92.003
                                                                          Any care which was provided to the patient prior                           No
Type 2                 H&S 773.0613 Prior Aid                  E09_01                                                      No Translation                    No Translation                   X
                                                                          to the arrival of this unit                                            Translation
Aid Prior to Arrival - TAC 103.1
Type 3
                         H&S 92.003
                                                                  No                                                                                 No
Extrication              H&S 773.0613 No Translation                      No Translation                                  No Translation                     No Translation                   X
                                                              Translation                                                                        Translation
                         TAC 103.1

                         H&S 92.003
Extrication                                                       No                                                                                 No
                         H&S 773.0613 No Translation                      No Translation                                  No Translation                     No Translation                   X
Comments                                                      Translation                                                                        Translation
                         TAC 103.1

BLS/ALS Treatment
1
BLS/ALS Treatment
2
BLS/ALS Treatment
3
BLS/ALS Treatment
4
BLS/ALS Treatment
5                 H&S 92.003
                                                                                                                                                     No
                  H&S 773.0613 Procedure                       E19_03     The procedure performed on the patient          No Translation                     No Translation                   X
                                                                                                                                                 Translation
                  TAC 103.1




              May 28th, 2009                                                                Please note cover on first worksheet.                                                                      Page 16
                                                                               TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                        * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                          Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                  NEMSIS DATA DICTIONARY                                                              NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                  Submerssion
                                                                                                                                                                                         Cardiac /
                                                                                                                                                                                          Stroke
   Data Element                                             Element                                                                             Element




                                                                                                                                                                                                            SCI
                                                                                                                                                                                                      TBI
                    Mandate / Rule   Data Element Name                                    Definition                       Data Element Name                                Definition
      Name                                                  Number                                                                              Number
                   H&S 92.003
                                                                                                                                                   No
                   H&S 773.0613 Procedure                   E19_03 The procedure performed on the patient               No Translation                     No Translation                   X
                   H&S 92.003                                  No                                                                              Translation
                                                                                                                                                   No
BLS/ALS ID
Data Set Treatment TAC 103.1
                   H&S 773.0613 No Translation                         No Translation                                   No Translation                     No Translation
6                                                          Translation                                                                         Translation
                   TAC 103.1
BLS/ALS Treatment
7
BLS/ALS Treatment
8
BLS/ALS Treatment
9
BLS/ALS Treatment
10

                    H&S 92.003
BLS/ALS                                                        No                                                                                  No
                    H&S 773.0613 No Translation                        No Translation                                   No Translation                     No Translation                   X
Comments                                                   Translation                                                                         Translation
                    TAC 103.1


                    H&S 92.003
                                                                       The type of destination the patient was delivered                           No
Patient Destination H&S 773.0613 Type of Destination        E20_17                                                       No Translation                    No Translation                   X
                                                                       or transferred to                                                       Translation
                    TAC 103.1


                    H&S 92.003                                         The code of the destination the patient was
                                 Destination/Transferred                                                                                           No
Destination ID      H&S 773.0613                            E20_02     delivered or transferred to, if present and      No Translation                     No Translation                   X
                                 To, Code                                                                                                      Translation
                    TAC 103.1                                          available


                    H&S 92.003
                                                               No                                                                                  No
Loaded Mileage      H&S 773.0613 No Translation                        No Translation                                   No Translation                     No Translation                   X
                                                           Translation                                                                         Translation
                    TAC 103.1




          May 28th, 2009                                                                 Please note cover on first worksheet.                                                                       Page 17
                                                                             TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                      * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                        Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                NEMSIS DATA DICTIONARY                                                    NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                      Submerssion
                                                                                                                                                                             Cardiac /
                                                                                                                                                                              Stroke
   Data Element                                           Element                                                                   Element




                                                                                                                                                                                                SCI
                                                                                                                                                                                          TBI
                    Mandate / Rule   Data Element Name                                Definition               Data Element Name                                Definition
      Name                                                Number                                                                    Number


                    H&S 92.003                               No                                                                        No
Data Set ID         H&S 773.0613 No Translation
                        92.003                                       No Translation                          No Translation                    No Translation
Respiration Rate at                                      Translation
                                                             No                                                                    Translation
                                                                                                                                       No
                    H&S 773.0613 No Translation
                    TAC 103.1                                        No Translation                          No Translation                    No Translation                   X
Destination                                              Translation                                                               Translation
                    TAC 103.1


                     H&S 92.003
                                                             No                                                                        No
Pulse at Destination H&S 773.0613 No Translation                     No Translation                          No Translation                    No Translation                   X
                                                         Translation                                                               Translation
                     TAC 103.1


Systolic Blood      H&S 92.003
                                                             No                                                                        No
Pressure at         H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation                   X
                                                         Translation                                                               Translation
Destination         TAC 103.1


                    H&S 92.003
Care Provider                                                No                                                                        No
                    H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
Training Level                                           Translation                                                               Translation
                    TAC 103.1


                    H&S 92.003
Care Provider                                                No                                                                        No
                    H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
Training Level 2                                         Translation                                                               Translation
                    TAC 103.1


Additional Care     H&S 92.003
                                                             No                                                                        No
Provider Training   H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
                                                         Translation                                                               Translation
Level               TAC 103.1




          May 28th, 2009                                                              Please note cover on first worksheet.                                                              Page 18
                                                                               TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                        * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                          Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                  NEMSIS DATA DICTIONARY                                                             NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                 Submerssion
                                                                                                                                                                                        Cardiac /
                                                                                                                                                                                         Stroke
   Data Element                                             Element                                                                            Element




                                                                                                                                                                                                           SCI
                                                                                                                                                                                                     TBI
                    Mandate / Rule     Data Element Name                                  Definition                      Data Element Name                                Definition
      Name                                                  Number                                                                             Number


                    H&S 92.003                                 No                                                                                 No
Data Set ID
Additional Care     H&S 773.0613 No Translation
                        92.003                                         No Translation                                   No Translation                    No Translation
                                                           Translation
                                                               No                                                                             Translation
                                                                                                                                                  No
Provider Training   H&S 773.0613 No Translation
                    TAC 103.1                                          No Translation                                   No Translation                    No Translation
                                                           Translation                                                                        Translation
Level 2             TAC 103.1


                    H&S 92.003
                                                               No                                                                                 No
Test Record         H&S 773.0613 No Translation                        No Translation                                   No Translation                    No Translation
                                                           Translation                                                                        Translation
                    TAC 103.1


                                                                       The name of the software vendor by whom the                                No
                                     Software Creator       E01_02                                                      No Translation                    No Translation
                                                                       data collection software was developed                                 Translation

                    H&S 92.003
Software                                                               The name of the software package with which the                            No
                    H&S 773.0613 Software Name              E01_03                                                     No Translation                     No Translation                   X
Identification                                                         data was collected by the agency                                       Translation
                    TAC 103.1

                                                                       The version of the software used by the agency                             No
                                     Software Version       E01_04                                                      No Translation                    No Translation
                                                                       to collect the data                                                    Translation

EMS Research
Field 1
                    H&S 92.003
EMS Research                                                   No                                                                                 No
                    H&S 773.0613 No Translation                        No Translation                                   No Translation                    No Translation                   X
Field 2                                                    Translation                                                                        Translation
                    TAC 103.1
EMS Research
Field 3
Hospital Research
Field 1
                    H&S 92.003
Hospital Research                                              No                                                                                 No
                    H&S 773.0613 No Translation                        No Translation                                   No Translation                    No Translation
Field 2                                                    Translation                                                                        Translation
                    TAC 103.1




           May 28th, 2009                                                               Please note cover on first worksheet.                                                                       Page 19
                                                                              TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                      * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                        Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                               NEMSIS DATA DICTIONARY                                                     NTDB DATA DICTIONARY                                   Data Sets




                                                                                                                                                                                                        Submerssion
                                                                                                                                                                               Cardiac /
                                                                                                                                                                                Stroke
   Data Element                                          Element                                                                    Element




                                                                                                                                                                                                  SCI
                                                                                                                                                                                            TBI
                     Mandate / Rule
                     H&S 92.003     Data Element Name                                  Definition              Data Element Name                                  Definition
      Name                                               Number
                                                            No                                                                      Number
                                                                                                                                       No
                     H&S 773.0613 No Translation                      No Translation                         No Translation                      No Translation
                                                        Translation                                                                Translation
                     TAC 103.1
Hospital Research    H&S 92.003                             No                                                                         No
Data Set ID          H&S 773.0613 No Translation                    No Translation                           No Translation                    No Translation
Field 3                                                 Translation                                                                Translation
                     TAC 103.1
RAC Research Field
1
                   H&S 92.003
RAC Research Field                                          No                                                                         No
                   H&S 773.0613 No Translation                      No Translation                           No Translation                    No Translation                     X
2                                                       Translation                                                                Translation
                   TAC 103.1
RAC Research Field
3
Miscellaneous
Research Field 1
                     H&S 92.003
Miscellaneous                                               No                                                                         No
                     H&S 773.0613 No Translation                    No Translation                           No Translation                    No Translation                     X
Research Field 2                                        Translation                                                                Translation
                     TAC 103.1
Miscellaneous
Research Field 3

                     H&S 92.003
                                                            No                                                                         No
Ejection             H&S 773.0613 No Translation                    No Translation                           No Translation                    No Translation                     X
                                                        Translation                                                                Translation
                     TAC 103.1


                     H&S 92.003
                                                            No                                                                         No
Patient Position     H&S 773.0613 No Translation                    No Translation                           No Translation                    No Translation                     X
                                                        Translation                                                                Translation
                     TAC 103.1


                     H&S 92.003
                                                            No                                                                         No
Exposure Type        H&S 773.0613 No Translation                    No Translation                           No Translation                    No Translation                     X
                                                        Translation                                                                Translation
                     TAC 103.1




           May 28th, 2009                                                              Please note cover on first worksheet.                                                               Page 20
                                                                               TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                        * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                          Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                  NEMSIS DATA DICTIONARY                                                    NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                        Submerssion
                                                                                                                                                                               Cardiac /
                                                                                                                                                                                Stroke
   Data Element                                             Element                                                                   Element




                                                                                                                                                                                                  SCI
                                                                                                                                                                                            TBI
                      Mandate / Rule   Data Element Name                                Definition               Data Element Name                                Definition
      Name                                                  Number                                                                    Number


Procedure Attempt H&S 92.003
Data Set ID
                                                               No                                                                        No
1                 H&S 773.0613 No Translation              Translation
                                                                       No Translation                          No Translation
                                                                                                                                     Translation
                                                                                                                                                 No Translation
                  TAC 103.1
Procedure Attempt
2
                  H&S 92.003
Procedure Attempt                                              No                                                                        No
                  H&S 773.0613 No Translation                          No Translation                          No Translation                    No Translation                   X
3                                                          Translation                                                               Translation
                  TAC 103.1
Procedure Attempt
4
Procedure Attempt
5

                      H&S 92.003
Time of 1st                                                    No                                                                        No
                      H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation                   X
Defibrilation Shock                                        Translation                                                               Translation
                      TAC 103.1


                    H&S 92.003
                                                               No                                                                        No
Joules of 1st Shock H&S 773.0613 No Translation                        No Translation                          No Translation                    No Translation                   X
                                                           Translation                                                               Translation
                    TAC 103.1


                     H&S 92.003
                                                               No                                                                        No
Extrication Position H&S 773.0613 No Translation                       No Translation                          No Translation                    No Translation                   X
                                                           Translation                                                               Translation
                     TAC 103.1


                  H&S 92.003
Air EMS Contacted                                              No                                                                        No
                  H&S 773.0613 No Translation                          No Translation                          No Translation                    No Translation                   X
Date                                                       Translation                                                               Translation
                  TAC 103.1




          May 28th, 2009                                                                Please note cover on first worksheet.                                                              Page 21
                                                                              TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                       * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                         Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                 NEMSIS DATA DICTIONARY                                                    NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                       Submerssion
                                                                                                                                                                              Cardiac /
                                                                                                                                                                               Stroke
   Data Element                                            Element                                                                   Element




                                                                                                                                                                                                 SCI
                                                                                                                                                                                           TBI
                     Mandate / Rule   Data Element Name                                Definition               Data Element Name                                Definition
      Name                                                 Number                                                                    Number


                  H&S 92.003                                  No                                                                        No
Data Set ID       H&S 773.0613 No Translation
                      92.003                                          No Translation                          No Translation                    No Translation
Air EMS Contacted                                         Translation
                                                              No                                                                    Translation
                                                                                                                                        No
                  H&S 773.0613 No Translation
                  TAC 103.1                                           No Translation                          No Translation                    No Translation                   X
Time                                                      Translation                                                               Translation
                  TAC 103.1


                     H&S 92.003
Air EMS Arrival at                                            No                                                                        No
                     H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation                   X
Scene Time                                                Translation                                                               Translation
                     TAC 103.1


                  H&S 92.003
Air EMS Departure                                             No                                                                        No
                  H&S 773.0613 No Translation                         No Translation                          No Translation                    No Translation                   X
from Scene Time                                           Translation                                                               Translation
                  TAC 103.1


                     H&S 92.003
                                                              No                                                                        No
Trauma Criteria      H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation                   X
                                                          Translation                                                               Translation
                     TAC 103.1


                     H&S 92.003
Trauma System                                                 No                                                                        No
                     H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation                   X
Activated                                                 Translation                                                               Translation
                     TAC 103.1


                     H&S 92.003
                                                              No                                                                        No
Burn Percentage      H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation                   X
                                                          Translation                                                               Translation
                     TAC 103.1




          May 28th, 2009                                                               Please note cover on first worksheet.                                                              Page 22
                                                                              TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                       * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                         Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                 NEMSIS DATA DICTIONARY                                                             NTDB DATA DICTIONARY                                                   Data Sets




                                                                                                                                                                                                                                  Submerssion
                                                                                                                                                                                                         Cardiac /
                                                                                                                                                                                                          Stroke
   Data Element                                            Element                                                                            Element




                                                                                                                                                                                                                            SCI
                                                                                                                                                                                                                      TBI
                     Mandate / Rule   Data Element Name                                Definition                Data Element Name                                          Definition
      Name                                                 Number                                                                             Number


                     H&S 92.003                               No                                                                                 No
Data Set ID          H&S 773.0613 No Translation
                         92.003                                       No Translation                          No Translation                             No Translation
                                                          Translation
                                                              No                                                                             Translation
                                                                                                                                                 No
EMS Diverted         H&S 773.0613 No Translation
                     TAC 103.1                                        No Translation                          No Translation                             No Translation                                     X
                                                          Translation                                                                        Translation
                     TAC 103.1


                     H&S 92.003
Facility Diverted                                             No                                                                                 No
                     H&S 773.0613 No Translation                      No Translation                          No Translation                             No Translation                                     X
From                                                      Translation                                                                        Translation
                     TAC 103.1


                     H&S 92.003
                                                              No                                                                                 No
Facility Divert Time H&S 773.0613 No Translation                      No Translation                          No Translation                             No Translation                                     X
                                                          Translation                                                                        Translation
                     TAC 103.1


                     H&S 92.003
                                                              No                                                                                 No
Alcohol Level Test   H&S 773.0613 No Translation                      No Translation                          No Translation                             No Translation                                                              X
                                                          Translation                                                                        Translation
                     TAC 103.1


                     H&S 92.003
                                                              No                                                                                 No
Alcohol Level        H&S 773.0613 No Translation                      No Translation                          No Translation                             No Translation                                                              X
                                                          Translation                                                                        Translation
                     TAC 103.1


                     H&S 92.003
Systolic Blood                                                No                                              Initial ED/Hospital Systloic               First recorded systolic blood pressure in the
                     H&S 773.0613 No Translation                      No Translation                                                          ED_03
Pressure                                                  Translation                                         Blood Pressure                             ED/hospital.
                     TAC 103.1




           May 28th, 2009                                                              Please note cover on first worksheet.                                                                                         Page 23
                                                                              TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                       * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                         Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                 NEMSIS DATA DICTIONARY                                                          NTDB DATA DICTIONARY                                                        Data Sets




                                                                                                                                                                                                                                    Submerssion
                                                                                                                                                                                                           Cardiac /
                                                                                                                                                                                                            Stroke
   Data Element                                            Element                                                                         Element




                                                                                                                                                                                                                              SCI
                                                                                                                                                                                                                        TBI
                   Mandate / Rule     Data Element Name                                Definition                Data Element Name                                       Definition
      Name                                                 Number                                                                          Number


                   H&S 92.003                                 No                                                                              No
Data Set ID        H&S 773.0613 No Translation
                       92.003                                         No Translation                          No Translation                          No Translation
Diastolic Blood                                           Translation
                                                              No                                                                          Translation
                                                                                                                                              No
                   H&S 773.0613 No Translation
                   TAC 103.1                                          No Translation                          No Translation                          No Translation
Pressure                                                  Translation                                                                     Translation
                   TAC 103.1


                   H&S 92.003
                                                              No                                              Initial ED/Hospital                     First recorded respiratory rate in the ED/hospital
Respiration Rate   H&S 773.0613 No Translation                        No Translation                                                       ED_06                                                                                       X
                                                          Translation                                         Respiratory Rate                        (expressed as a number per minute).
                   TAC 103.1


                   H&S 92.003                                                                                                                         First recorded pulse rate in the ED/hospital
                                                              No                                              Initial ED/Hospital Pulse
Pulse              H&S 773.0613 No Translation                        No Translation                                                       ED_04      (palputated or ausculated), expressed as a                                       X
                                                          Translation                                         Rate
                   TAC 103.1                                                                                                                          number per minute.


                   H&S 92.003
                                                              No                                              Initial ED/Hospital GCS -               First recorded Glasgow Coma Score (Motor) in
Motor Response     H&S 773.0613 No Translation                        No Translation                                                       ED_12                                                              X                        X
                                                          Translation                                         Motor                                   the ED/hospital.
                   TAC 103.1


                   H&S 92.003
                                                              No                                              Initial ED/Hospital GCS -               First recorded Glasgow Coma Score (Verbal) in
Verbal Response    H&S 773.0613 No Translation                        No Translation                                                       ED_11                                                              X                        X
                                                          Translation                                         Verbal                                  the ED/hospital.
                   TAC 103.1


                   H&S 92.003
Eye Opening                                                   No                                              Initial ED/Hospital GCS -               First recorded Glasgow Coma Score (Eye) in
                   H&S 773.0613 No Translation                        No Translation                                                       ED_10                                                              X                        X
Response                                                  Translation                                         Eye                                     the ED/hospital.
                   TAC 103.1


Glasgow Coma                                                  No                                              Initial ED/Hospital GCS -               First recorded Glasgow Coma Score (total) in
                   TAC 103.8        No Translation                    No Translation                                                       ED_13                                                              X          X    X        X
Score at Admission                                        Translation                                         Total                                   the ED/hospital.




          May 28th, 2009                                                               Please note cover on first worksheet.                                                                                           Page 24
                                                                               TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                        * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                          Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                  NEMSIS DATA DICTIONARY                                                        NTDB DATA DICTIONARY                                                  Data Sets




                                                                                                                                                                                                                             Submerssion
                                                                                                                                                                                                    Cardiac /
                                                                                                                                                                                                     Stroke
   Data Element                                             Element                                                                       Element




                                                                                                                                                                                                                       SCI
                                                                                                                                                                                                                 TBI
                    Mandate / Rule     Data Element Name                                Definition               Data Element Name                                     Definition
      Name                                                  Number                                                                        Number


                    H&S 92.003                                 No                                                                            No
Data Set Coma
Glasgow ID          H&S 773.0613 No Translation
                        92.003                             Translation
                                                                       No Translation                          No Translation
                                                                                                                                         Translation
                                                                                                                                                     No Translation
                                                               No                                                                            No
Score for Revised   H&S 773.0613 No Translation
                    TAC 103.1                                          No Translation                          No Translation                        No Translation                                    X
                                                           Translation                                                                   Translation
Trauma Score        TAC 103.1


                     H&S 92.003
Respiratory Rate for                                           No                                                                            No
                     H&S 773.0613 No Translation                       No Translation                          No Translation                        No Translation                                    X
Trauma Score                                               Translation                                                                   Translation
                     TAC 103.1


Systolic Blood      H&S 92.003
                                                               No                                                                            No
Pressure for        H&S 773.0613 No Translation                        No Translation                          No Translation                        No Translation                                    X
                                                           Translation                                                                   Translation
Trauma Score        TAC 103.1


                    H&S 92.003
Revised Trauma                                                 No                                                                            No
                    H&S 773.0613 No Translation                        No Translation                          No Translation                        No Translation                                    X
Score                                                      Translation                                                                   Translation
                    TAC 103.1


Patient Discharged                                             No                                                                            No
                   TAC 103.8         No Translation                    No Translation                          No Translation                        No Translation                                    X
To                                                         Translation                                                                   Translation


Condition on                                                   No                                                                            No
                    TAC 103.8        No Translation                    No Translation                          No Translation                        No Translation                                    X          X    X
Discharge                                                  Translation                                                                   Translation


Date of Discharge   TAC 103.7                                  No                                                                                    The date the patient was discharged from the
                                     No Translation                    No Translation                          Hospital Discharge Date     O_03                                                        X                        X
or Death            TAC 103.8                              Translation                                                                               hospital.




          May 28th, 2009                                                                Please note cover on first worksheet.                                                                                   Page 25
                                                                               TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                        * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                          Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                  NEMSIS DATA DICTIONARY                                                        NTDB DATA DICTIONARY                                                  Data Sets




                                                                                                                                                                                                                             Submerssion
                                                                                                                                                                                                    Cardiac /
                                                                                                                                                                                                     Stroke
  Data Element                                              Element                                                                       Element




                                                                                                                                                                                                                       SCI
                                                                                                                                                                                                                 TBI
                    Mandate / Rule     Data Element Name                                Definition               Data Element Name                                     Definition
     Name                                                   Number                                                                        Number


                   H&S 92.003                                  No                                                                            No
Data Set ID        H&S 773.0613 No Translation
                       92.003                                          No Translation                          No Translation                        No Translation
Month of Discharge                                         Translation
                                                               No                                                                        Translation
                                                                                                                                             No
                   H&S 773.0613 No Translation
                   TAC 103.1                                           No Translation                          No Translation                        No Translation
or Death                                                   Translation                                                                   Translation
                   TAC 103.1


                    H&S 92.003
Day of Discharge or                                            No                                                                            No
                    H&S 773.0613 No Translation                        No Translation                          No Translation                        No Translation
Death                                                      Translation                                                                   Translation
                    TAC 103.1


                    H&S 92.003
Year of Discharge                                              No                                                                            No
                    H&S 773.0613 No Translation                        No Translation                          No Translation                        No Translation
or Death                                                   Translation                                                                   Translation
                    TAC 103.1


Time of Discharge                                              No                                                                                    The time the patient was discharged from the
                    N/A              No Translation                    No Translation                          Hospital Discharge Time     O_04                                                        X
or Death                                                   Translation                                                                               hospital.


                    H&S 92.003
Hour of Discharge                                              No                                                                            No
                    H&S 773.0613 No Translation                        No Translation                          No Translation                        No Translation
or Death                                                   Translation                                                                   Translation
                    TAC 103.1


                    H&S 92.003
Minute of Discharge                                            No                                                                            No
                    H&S 773.0613 No Translation                        No Translation                          No Translation                        No Translation
or Death                                                   Translation                                                                   Translation
                    TAC 103.1


                   H&S 92.003
Patient Discharged                                             No                                                                            No
                   H&S 773.0613 No Translation                         No Translation                          No Translation                        No Translation                                    X
To Facility Number                                         Translation                                                                   Translation
                   TAC 103.1




          May 28th, 2009                                                                Please note cover on first worksheet.                                                                                   Page 26
                                                                                TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                          * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                            Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                   NEMSIS DATA DICTIONARY                                                          NTDB DATA DICTIONARY                                                      Data Sets




                                                                                                                                                                                                                                    Submerssion
                                                                                                                                                                                                           Cardiac /
                                                                                                                                                                                                            Stroke
   Data Element                                              Element                                                                         Element




                                                                                                                                                                                                                              SCI
                                                                                                                                                                                                                        TBI
                     Mandate / Rule     Data Element Name                                  Definition               Data Element Name                                         Definition
      Name                                                   Number                                                                          Number


                     H&S 92.003                                 No                                                                              No
Data Set ID          H&S 773.0613 No Translation
                         92.003                                         No Translation                           No Translation                         No Translation
                                                            Translation
                                                                No                                                                          Translation
                                                                                                                                                No
Length of Stay       H&S 773.0613 No Translation
                     TAC 103.1                                          No Translation                           No Translation                         No Translation                                        X
                                                            Translation                                                                     Translation
                     TAC 103.1


                   H&S 92.003
                                                                No                                                                                        The total number of days in any ICU (including
ICU Length of Stay H&S 773.0613 No Translation                          No Translation                           Total ICU Length of Stay     O_01                                                            X
                                                            Translation                                                                                   all episodes).
                   TAC 103.1

Diagnosis 1
Diagnosis 2          H&S 92.002
                                                                No
Diagnosis 3          TAC 103.2        No Translation                    No Translation                           Injury Diagnosis            DG_02        Diagnosis related to all indentified injuries.      X          X    X        X
                                                            Translation
Diagnosis 4          TAC 103.8
Diagnosis 5

Abbreviated Injury
Scale for Injury 1


Abbreviated Injury
Scale for Injury 2


Abbreviated Injury   H&S 773.113                                No                                                                              No
                                      No Translation                                     No Translation                No Translation                                       No Translation                    X
Scale for Injury 3   TAC 103.2                              Translation                                                                     Translation


Abbreviated Injury
Scale for Injury 4




          May 28th, 2009                                                                 Please note cover on first worksheet.                                                                                         Page 27
                                                                                TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                         * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                           Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.
                 H&S 773.113
   TRAC-IT DATA DICTIONARY                                      No
                                                             NEMSIS DATA DICTIONARY Translation                                                 No
                                                                                                                                              NTDB DATA DICTIONARYNo Translation                                  Data Sets
                                      No Translation                              No                                  No Translation                                                                     X
                 TAC 103.2                                  Translation                                                                     Translation




                                                                                                                                                                                                                               Submerssion
                                                                                                                                                                                                      Cardiac /
                                                                                                                                                                                                       Stroke
   Data Element                                              Element                                                                         Element




                                                                                                                                                                                                                         SCI
                                                                                                                                                                                                                   TBI
                     Mandate / Rule     Data Element Name                                Definition                Data Element Name                                      Definition
      Name                                                   Number                                                                          Number


                     H&S 92.003                                 No                                                                              No
Data Set ID Injury
Abbreviated          H&S 773.0613 No Translation                        No Translation                          No Translation                          No Translation
                                                            Translation                                                                     Translation
Scale for Injury 5   TAC 103.1

Procedures 1
Procedures 2
                                                                No                                                                                      Operative or essential procedures conducted
Procedures 3         TAC 103.8        No Translation                    No Translation                          Hospital Procedures          HP_01                                                       X
                                                            Translation                                                                                 during hospital stay.
Procedures 4
Procedures 5

                                                                No                                              Hospital Procedures Start               The date operative and essential procedures
                     N/A              No Translation                    No Translation                                                       HP_02
                                                            Translation                                         Date                                    were performed.


                                                                No                                              Hospital Procedures Start               The time operative and essential procedures
                     N/A              No Translation                    No Translation                                                       HP_03
                                                            Translation                                         Time                                    were performed.

Pre-existing
Condition 1
Pre-existing
Condition 2
                     H&S 92.003
Pre-existing                                                    No                                                                              No
                     H&S 773.0613 No Translation                        No Translation                          No Translation                          No Translation                                   X
Condition 3                                                 Translation                                                                     Translation
                     TAC 103.1
Pre-existing
Condition 4
Pre-existing
Condition 5

                                                                No                                                                                      The Abbreviated Injury Scale (AIS) predot
                     N/A              No Translation                    No Translation                          AIS Predot Code               IS_01
                                                            Translation                                                                                 codes that reflect the patient's injuries.




          May 28th, 2009                                                                 Please note cover on first worksheet.                                                                                    Page 28
                                                                             TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                      * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                        Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                NEMSIS DATA DICTIONARY                                                       NTDB DATA DICTIONARY                                                       Data Sets




                                                                                                                                                                                                                               Submerssion
                                                                                                                                                                                                      Cardiac /
                                                                                                                                                                                                       Stroke
   Data Element                                           Element                                                                      Element




                                                                                                                                                                                                                         SCI
                                                                                                                                                                                                                   TBI
                  Mandate / Rule     Data Element Name                                Definition                Data Element Name                                    Definition
      Name                                                Number                                                                       Number


                  H&S 92.003                                 No                                                                           No
Data Set ID       H&S 773.0613 No Translation                No      No Translation                          No Translation                       No Translation
                  N/A          No Translation            Translation No Translation                          AIS Severity             Translation The Abbreviated Injury Scale (AIS) severity
                                                                                                                                        IS_02
                  TAC 103.1                              Translation                                                                              codes that reflect the patient's injuries.


                                                             No                                                                                   The Injury Severity Score (ISS) body region
                  N/A              No Translation                    No Translation                          ISS Body Region            IS_03
                                                         Translation                                                                              codes that reflects the patient's injuries.


                                                             No                                                                                   The software (and version) used to calculate
                  N/A              No Translation                    No Translation                          AIS Version                IS_04
                                                         Translation                                                                              Abbreviated Injury Scale (AIS) severity codes.


Injury Severity   H&S 773.0613                               No                                                                                   The Injury Severity Score (ISS) that reflects the
                               No Translation                        No Translation                          Locally Calculated ISS     IS_05                                                            X
Score             TAC 103.2                              Translation                                                                              patient's injuries.


                                                             No                                              Primary Method of
Payor Category    TAC 103.8        No Translation                    No Translation                                                     F_01      Primary source of payment for hospital care.           X          X    X        X
                                                         Translation                                         Payment


                  H&S 773.115
                  H&S 773.122
Billed Hospital   H&S 780.002                                No                                                                           No
                                   No Translation                    No Translation                          No Translation                       No Translation                                         X                        X
Charges           TAC 157.125                            Translation                                                                  Translation
                  TAC 157.130-
                  132

                  H&S 773.115
                  H&S 773.122
Total             H&S 780.002                                No                                                                           No
                                   No Translation                    No Translation                          No Translation                       No Translation                                         X
Reimbursement     TAC 157.125                            Translation                                                                  Translation
                  TAC 157.130-
                  132




           May 28th, 2009                                                             Please note cover on first worksheet.                                                                                       Page 29
                                                                               TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                        * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                          Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                  NEMSIS DATA DICTIONARY                                                              NTDB DATA DICTIONARY                                                       Data Sets




                                                                                                                                                                                                                                        Submerssion
                                                                                                                                                                                                               Cardiac /
                                                                                                                                                                                                                Stroke
   Data Element                                             Element                                                                             Element




                                                                                                                                                                                                                                  SCI
                                                                                                                                                                                                                            TBI
                      Mandate / Rule   Data Element Name                                 Definition                   Data Element Name                                       Definition
      Name                                                  Number                                                                              Number


                      H&S 92.003                               No                                                                                  No
Data Set ID           H&S 773.0613 No Translation
                          92.003                                       No Translation                              No Translation                          No Translation
Glasgow Coma                                               Translation
                                                               No                                                                              Translation First record Glasgow Coma Score (total)
                      H&S 773.0613 No Translation
                      TAC 103.1                                        No Translation                              Initial Field GCS - Total      P_16                                                            X                        X
Score at Scene                                             Translation                                                                                     measured at the scene of injury.
                      TAC 103.1


                      H&S 92.003
                                                                       The state-assigned provider number of the                                   No
TDH Firm Number       H&S 773.0613 EMS Agency Number        E02_01                                                 No Translation                          No Translation
                                                                       responding agency                                                       Translation
                      TAC 103.1


                      H&S 92.003
                                                               No                                                                                          Was the patient transferred to your facility from
Is this a Transfer?   H&S 773.0613 No Translation                      No Translation                              Inter-Facility Transfer       P_17                                                             X
                                                           Translation                                                                                     another acute care facility?
                      TAC 103.1


                      H&S 92.003
First Hospital                                                 No                                                                                  No
                      H&S 773.0613 No Translation                      No Translation                              No Translation                          No Translation                                         X
Number                                                     Translation                                                                         Translation
                      TAC 103.1


                      H&S 92.003
Date of Arrival to                                             No                                                                                  No
                      H&S 773.0613 No Translation                      No Translation                              No Translation                          No Translation                                         X
First Hospital                                             Translation                                                                         Translation
                      TAC 103.1


                      H&S 92.003
Month of Arrival to                                            No                                                                                  No
                      H&S 773.0613 No Translation                      No Translation                              No Translation                          No Translation
First Hospital                                             Translation                                                                         Translation
                      TAC 103.1




           May 28th, 2009                                                               Please note cover on first worksheet.                                                                                              Page 30
                                                                                TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                         * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                           Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                   NEMSIS DATA DICTIONARY                                                    NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                         Submerssion
                                                                                                                                                                                Cardiac /
                                                                                                                                                                                 Stroke
   Data Element                                              Element                                                                   Element




                                                                                                                                                                                                   SCI
                                                                                                                                                                                             TBI
                       Mandate / Rule   Data Element Name                                Definition               Data Element Name                                Definition
      Name                                                   Number                                                                    Number


                       H&S 92.003                               No                                                                        No
Data Set ID            H&S 773.0613 No Translation
                           92.003                                       No Translation                          No Translation                    No Translation
Day of Arrival to                                           Translation
                                                                No                                                                    Translation
                                                                                                                                          No
                       H&S 773.0613 No Translation
                       TAC 103.1                                        No Translation                          No Translation                    No Translation
First Hospital                                              Translation                                                               Translation
                       TAC 103.1


                       H&S 92.003
Year of Arrival to                                              No                                                                        No
                       H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
First Hospital                                              Translation                                                               Translation
                       TAC 103.1


                       H&S 92.003
Time of Arrival to                                              No                                                                        No
                       H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation                   X
First Hospital                                              Translation                                                               Translation
                       TAC 103.1


                       H&S 92.003
Hour of Arrival to                                              No                                                                        No
                       H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
First Hospital                                              Translation                                                               Translation
                       TAC 103.1


                       H&S 92.003
Minute of Arrival to                                            No                                                                        No
                       H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
First Hospital                                              Translation                                                               Translation
                       TAC 103.1


                       H&S 92.003
Date of Departure                                               No                                                                        No
                       H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation                   X
from First Hospital                                         Translation                                                               Translation
                       TAC 103.1




           May 28th, 2009                                                                Please note cover on first worksheet.                                                              Page 31
                                                                               TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                        * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                          Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                  NEMSIS DATA DICTIONARY                                                    NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                        Submerssion
                                                                                                                                                                               Cardiac /
                                                                                                                                                                                Stroke
   Data Element                                             Element                                                                   Element




                                                                                                                                                                                                  SCI
                                                                                                                                                                                            TBI
                      Mandate / Rule   Data Element Name                                Definition               Data Element Name                                Definition
      Name                                                  Number                                                                    Number


                    H&S 92.003                                 No                                                                        No
Data Set ID         H&S 773.0613 No Translation
                        92.003                                         No Translation                          No Translation                    No Translation
Month of Departure                                         Translation
                                                               No                                                                    Translation
                                                                                                                                         No
                    H&S 773.0613 No Translation
                    TAC 103.1                                          No Translation                          No Translation                    No Translation
from First Hospital                                        Translation                                                               Translation
                    TAC 103.1


                      H&S 92.003
Day of Departure                                               No                                                                        No
                      H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
from First Hospital                                        Translation                                                               Translation
                      TAC 103.1


                      H&S 92.003
Year of Departure                                              No                                                                        No
                      H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
from First Hospital                                        Translation                                                               Translation
                      TAC 103.1


                      H&S 92.003
Time of Departure                                              No                                                                        No
                      H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation                   X
from First Hospital                                        Translation                                                               Translation
                      TAC 103.1


                      H&S 92.003
Hour of Departure                                              No                                                                        No
                      H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
from First Hospital                                        Translation                                                               Translation
                      TAC 103.1


                    H&S 92.003
Minute of Departure                                            No                                                                        No
                    H&S 773.0613 No Translation                        No Translation                          No Translation                    No Translation
from First Hospital                                        Translation                                                               Translation
                    TAC 103.1




           May 28th, 2009                                                               Please note cover on first worksheet.                                                              Page 32
                                                                              TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                       * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                         Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                 NEMSIS DATA DICTIONARY                                                    NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                       Submerssion
                                                                                                                                                                              Cardiac /
                                                                                                                                                                               Stroke
   Data Element                                            Element                                                                   Element




                                                                                                                                                                                                 SCI
                                                                                                                                                                                           TBI
                     Mandate / Rule   Data Element Name                                Definition               Data Element Name                                Definition
      Name                                                 Number                                                                    Number


                     H&S 92.003                               No                                                                        No
Data Set ID          H&S 773.0613 No Translation
                         92.003                                       No Translation                          No Translation                    No Translation
Trauma Team                                               Translation
                                                              No                                                                    Translation
                                                                                                                                        No
                     H&S 773.0613 No Translation
                     TAC 103.1                                        No Translation                          No Translation                    No Translation                   X
Activation                                                Translation                                                               Translation
                     TAC 103.1


                     H&S 92.003
Time of Trauma                                                No                                                                        No
                     H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation                   X
Team Activation                                           Translation                                                               Translation
                     TAC 103.1


                     H&S 92.003
                                                              No                                                                        No
Blunt Injury         H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
                                                          Translation                                                               Translation
                     TAC 103.1


                     H&S 92.003
                                                              No                                                                        No
Burn Injury          H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
                                                          Translation                                                               Translation
                     TAC 103.1


                     H&S 92.003
                                                              No                                                                        No
Penetrating Injury   H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
                                                          Translation                                                               Translation
                     TAC 103.1


                     H&S 92.003
                                                              No                                                                        No
Direct Admit         H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
                                                          Translation                                                               Translation
                     TAC 103.1




           May 28th, 2009                                                              Please note cover on first worksheet.                                                              Page 33
                                                                             TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                      * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                        Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                NEMSIS DATA DICTIONARY                                                                 NTDB DATA DICTIONARY                                                   Data Sets




                                                                                                                                                                                                                                     Submerssion
                                                                                                                                                                                                            Cardiac /
                                                                                                                                                                                                             Stroke
   Data Element                                           Element                                                                                Element




                                                                                                                                                                                                                               SCI
                                                                                                                                                                                                                         TBI
                    Mandate / Rule   Data Element Name                                  Definition                     Data Element Name                                       Definition
      Name                                                Number                                                                                 Number


                    H&S 92.003                               No                                                                                     No
Data Set ID
Emergency           H&S 773.0613 No Translation
                        92.003                                       No Translation                                  No Translation                         No Translation
                                                         Translation
                                                             No                                                                                 Translation The date the patient was discharged from the
Department          H&S 773.0613 No Translation
                    TAC 103.1                                        No Translation                                  ED Discharge Date            ED_19
                                                         Translation                                                                                        ED.
Discharge Date      TAC 103.1


Emergency           H&S 92.003
                                                             No                                                                                             The time the patient was discharged from the
Department          H&S 773.0613 No Translation                      No Translation                                  ED Discharge Time            ED_20
                                                         Translation                                                                                        ED.
Discharge Time      TAC 103.1


Emergency           H&S 92.003
                                 Emergency Department                The known disposition of the patient from the                                          The disposition of the patient at the time of
Department          H&S 773.0613                          E22_01                                                     ED Discharge Disposition     ED_17                                                                                 X
                                 Disposition                         Emergency Department (ED)                                                              discharge from the ED
Disposition         TAC 103.1


Emergency           H&S 92.003
                                                             No                                                                                     No
Department Stay     H&S 773.0613 No Translation                      No Translation                                  No Translation                         No Translation
                                                         Translation                                                                            Translation
Over 2 Hours        TAC 103.1


                    H&S 92.003
Transfer to Lower                                            No                                                                                     No
                    H&S 773.0613 No Translation                      No Translation                                  No Translation                         No Translation
Level Facility                                           Translation                                                                            Translation
                    TAC 103.1


                    H&S 92.003
                                                             No                                                                                     No
CPR Performed       H&S 773.0613 No Translation                      No Translation                                  No Translation                         No Translation
                                                         Translation                                                                            Translation
                    TAC 103.1




          May 28th, 2009                                                               Please note cover on first worksheet.                                                                                            Page 34
                                                                             TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                      * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                        Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                NEMSIS DATA DICTIONARY                                                    NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                      Submerssion
                                                                                                                                                                             Cardiac /
                                                                                                                                                                              Stroke
   Data Element                                           Element                                                                   Element




                                                                                                                                                                                                SCI
                                                                                                                                                                                          TBI
                    Mandate / Rule   Data Element Name                                Definition               Data Element Name                                Definition
      Name                                                Number                                                                    Number


                  H&S 92.003                                 No                                                                        No
Data Set ID       H&S 773.0613 No Translation
                      92.003                                         No Translation                          No Translation                    No Translation
Airway Management                                        Translation
                                                             No                                                                    Translation
                                                                                                                                       No
                  H&S 773.0613 No Translation
                  TAC 103.1                                          No Translation                          No Translation                    No Translation
Type                                                     Translation                                                               Translation
                  TAC 103.1


                    H&S 92.003
                                                             No                                                                        No
EMS Run Report      H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
                                                         Translation                                                               Translation
                    TAC 103.1


                    H&S 92.003
Prehospital                                                  No                                                                        No
                    H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
Essential Data                                           Translation                                                               Translation
                    TAC 103.1


Documentation of    H&S 92.003
                                                             No                                                                        No
Trauma Team         H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
                                                         Translation                                                               Translation
Activation          TAC 103.1

Trauma Team
                     H&S 92.003
Response Time                                                No                                                                        No
                     H&S 773.0613 No Translation                     No Translation                          No Translation                    No Translation
Over 10 Minutes - In                                     Translation                                                               Translation
                     TAC 103.1
House

Trauma Team
                    H&S 92.003
Response Time                                                No                                                                        No
                    H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
Over 30 Minutes -                                        Translation                                                               Translation
                    TAC 103.1
On call




          May 28th, 2009                                                              Please note cover on first worksheet.                                                              Page 35
                                                                            TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                     * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                       Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                               NEMSIS DATA DICTIONARY                                                    NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                     Submerssion
                                                                                                                                                                            Cardiac /
                                                                                                                                                                             Stroke
   Data Element                                          Element                                                                   Element




                                                                                                                                                                                               SCI
                                                                                                                                                                                         TBI
                   Mandate / Rule   Data Element Name                                Definition               Data Element Name                                Definition
      Name                                               Number                                                                    Number


                   H&S 92.003                               No                                                                        No
Data Set ID
Documentation of   H&S 773.0613 No Translation
                       92.003                                       No Translation                          No Translation                    No Translation
                                                        Translation
                                                            No                                                                    Translation
                                                                                                                                      No
Trauma Team        H&S 773.0613 No Translation
                   TAC 103.1                                        No Translation                          No Translation                    No Translation
                                                        Translation                                                               Translation
Response Times     TAC 103.1


                  H&S 92.003
                                                            No                                                                        No
Trauma Flow Sheet H&S 773.0613 No Translation                       No Translation                          No Translation                    No Translation
                                                        Translation                                                               Translation
                  TAC 103.1


                   H&S 92.003
                                                            No                                                                        No
Assessments        H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
                                                        Translation                                                               Translation
                   TAC 103.1


                   H&S 92.003
                                                            No                                                                        No
Interventions      H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
                                                        Translation                                                               Translation
                   TAC 103.1


                   H&S 92.003
Responses to                                                No                                                                        No
                   H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
Interventions                                           Translation                                                               Translation
                   TAC 103.1


                    H&S 92.003
Hourly Recording of                                         No                                                                        No
                    H&S 773.0613 No Translation                     No Translation                          No Translation                    No Translation
Vital Signs                                             Translation                                                               Translation
                    TAC 103.1




          May 28th, 2009                                                             Please note cover on first worksheet.                                                              Page 36
                                                                             TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                      * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                        Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                NEMSIS DATA DICTIONARY                                                    NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                      Submerssion
                                                                                                                                                                             Cardiac /
                                                                                                                                                                              Stroke
   Data Element                                           Element                                                                   Element




                                                                                                                                                                                                SCI
                                                                                                                                                                                          TBI
                    Mandate / Rule   Data Element Name                                Definition               Data Element Name                                Definition
      Name                                                Number                                                                    Number


                    H&S 92.003                               No                                                                        No
Hourly Recording of H&S 773.0613 No Translation
Data Set ID             92.003                                       No Translation                          No Translation                    No Translation
                                                         Translation
                                                             No                                                                    Translation
                                                                                                                                       No
Glasgow Coma        H&S 773.0613 No Translation
                    TAC 103.1                                        No Translation                          No Translation                    No Translation
                                                         Translation                                                               Translation
Score               TAC 103.1


                    H&S 92.003
Hourly Recording of                                          No                                                                        No
                    H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
Intake & Output                                          Translation                                                               Translation
                    TAC 103.1


                    H&S 92.003
Resuscitation                                                No                                                                        No
                    H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
Protocols                                                Translation                                                               Translation
                    TAC 103.1


                    H&S 92.003
                                                             No                                                                        No
Treatment Protocols H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
                                                         Translation                                                               Translation
                    TAC 103.1


                    H&S 92.003
                                                             No                                                                        No
Standards of Care   H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
                                                         Translation                                                               Translation
                    TAC 103.1


                    H&S 92.003
Required                                                     No                                                                        No
                    H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
Equipment Available                                      Translation                                                               Translation
                    TAC 103.1




          May 28th, 2009                                                              Please note cover on first worksheet.                                                              Page 37
                                                                            TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                     * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                       Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                               NEMSIS DATA DICTIONARY                                                    NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                     Submerssion
                                                                                                                                                                            Cardiac /
                                                                                                                                                                             Stroke
  Data Element                                           Element                                                                   Element




                                                                                                                                                                                               SCI
                                                                                                                                                                                         TBI
                  Mandate / Rule    Data Element Name                                Definition               Data Element Name                                Definition
     Name                                                Number                                                                    Number


                  H&S 92.003                                No                                                                        No
Data Set ID       H&S 773.0613 No Translation
                      92.003                                        No Translation                          No Translation                    No Translation
                                                        Translation
                                                            No                                                                    Translation
                                                                                                                                      No
Physician Notes   H&S 773.0613 No Translation
                  TAC 103.1                                         No Translation                          No Translation                    No Translation
                                                        Translation                                                               Translation
                  TAC 103.1


                  H&S 92.003
CT of Head                                                  No                                                                        No
                  H&S 773.0613 No Translation                       No Translation                          No Translation                    No Translation
Receoived                                               Translation                                                               Translation
                  TAC 103.1


                   H&S 92.003
Comatose Patient                                            No                                                                        No
                   H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
Airway Established                                      Translation                                                               Translation
                   TAC 103.1


Admitted Under    H&S 92.003
                                                            No                                                                        No
Care of Non-      H&S 773.0613 No Translation                       No Translation                          No Translation                    No Translation
                                                        Translation                                                               Translation
Surgeon           TAC 103.1


                  H&S 92.003
Gunshot Managed                                             No                                                                        No
                  H&S 773.0613 No Translation                       No Translation                          No Translation                    No Translation
Non-Operatively                                         Translation                                                               Translation
                  TAC 103.1


                  H&S 92.003
Laparotomy Over 1                                           No                                                                        No
                  H&S 773.0613 No Translation                       No Translation                          No Translation                    No Translation
Hour                                                    Translation                                                               Translation
                  TAC 103.1




          May 28th, 2009                                                             Please note cover on first worksheet.                                                              Page 38
                                                                            TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                     * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                       Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                               NEMSIS DATA DICTIONARY                                                    NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                     Submerssion
                                                                                                                                                                            Cardiac /
                                                                                                                                                                             Stroke
  Data Element                                           Element                                                                   Element




                                                                                                                                                                                               SCI
                                                                                                                                                                                         TBI
                   Mandate / Rule   Data Element Name                                Definition               Data Element Name                                Definition
     Name                                                Number                                                                    Number


                  H&S 92.003                                No                                                                        No
Data Set ID       H&S 773.0613 No Translation
                      92.003                                        No Translation                          No Translation                    No Translation
Laparotomy Over 4                                       Translation
                                                            No                                                                    Translation
                                                                                                                                      No
                  H&S 773.0613 No Translation
                  TAC 103.1                                         No Translation                          No Translation                    No Translation
Hours                                                   Translation                                                               Translation
                  TAC 103.1


                  H&S 92.003
Craniotomy Over 4                                           No                                                                        No
                  H&S 773.0613 No Translation                       No Translation                          No Translation                    No Translation
Hours                                                   Translation                                                               Translation
                  TAC 103.1


                   H&S 92.003
Debridement Over 8                                          No                                                                        No
                   H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
Hours                                                   Translation                                                               Translation
                   TAC 103.1


                  H&S 92.003
Abdominal Surgery                                           No                                                                        No
                  H&S 773.0613 No Translation                       No Translation                          No Translation                    No Translation
Over 24 Hours                                           Translation                                                               Translation
                  TAC 103.1


                   H&S 92.003
Thoracic Surgery                                            No                                                                        No
                   H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
Over 24 Hours                                           Translation                                                               Translation
                   TAC 103.1


                   H&S 92.003
Vascular Surgery                                            No                                                                        No
                   H&S 773.0613 No Translation                      No Translation                          No Translation                    No Translation
Over 24 Hours                                           Translation                                                               Translation
                   TAC 103.1




          May 28th, 2009                                                             Please note cover on first worksheet.                                                              Page 39
                                                                             TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                      * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                        Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                NEMSIS DATA DICTIONARY                                                    NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                      Submerssion
                                                                                                                                                                             Cardiac /
                                                                                                                                                                              Stroke
   Data Element                                           Element                                                                   Element




                                                                                                                                                                                                SCI
                                                                                                                                                                                          TBI
                   Mandate / Rule    Data Element Name                                Definition               Data Element Name                                Definition
      Name                                                Number                                                                    Number


                   H&S 92.003                                No                                                                        No
Data Set ID        H&S 773.0613 No Translation
                       92.003                                        No Translation                          No Translation                    No Translation
Cranial Surgery                                          Translation
                                                             No                                                                    Translation
                                                                                                                                       No
                   H&S 773.0613 No Translation
                   TAC 103.1                                         No Translation                          No Translation                    No Translation
Over 24 Hours                                            Translation                                                               Translation
                   TAC 103.1


Non-fixation of    H&S 92.003
                                                             No                                                                        No
Femoral Diaphyseal H&S 773.0613 No Translation                       No Translation                          No Translation                    No Translation
                                                         Translation                                                               Translation
Fracture           TAC 103.1


                     H&S 92.003
Re-intubation Within                                         No                                                                        No
                     H&S 773.0613 No Translation                     No Translation                          No Translation                    No Translation
48 Hours                                                 Translation                                                               Translation
                     TAC 103.1


                   H&S 92.003
                                                             No                                                                        No
Delays of Injury   H&S 773.0613 No Translation                       No Translation                          No Translation                    No Translation
                                                         Translation                                                               Translation
                   TAC 103.1


                   H&S 92.003
Admitted Without                                             No                                                                        No
                   H&S 773.0613 No Translation                       No Translation                          No Translation                    No Translation
Physician                                                Translation                                                               Translation
                   TAC 103.1


                   H&S 92.003
Transferring EMS                                             No                                                                        No
                   H&S 773.0613 No Translation                       No Translation                          No Translation                    No Translation
Provider Number                                          Translation                                                               Translation
                   TAC 103.1




           May 28th, 2009                                                             Please note cover on first worksheet.                                                              Page 40
                                                                                TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                         * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                           Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                   NEMSIS DATA DICTIONARY                                                        NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                             Submerssion
                                                                                                                                                                                    Cardiac /
                                                                                                                                                                                     Stroke
   Data Element                                              Element                                                                       Element




                                                                                                                                                                                                       SCI
                                                                                                                                                                                                 TBI
                     Mandate / Rule     Data Element Name                                 Definition                  Data Element Name                                Definition
      Name                                                   Number                                                                        Number


                     H&S 92.003                                 No                                                                            No
Data Set ID          H&S 773.0613 No Translation
                         92.003                                         No Translation                              No Translation                    No Translation
Air EMS Activation                                          Translation
                                                                No                                                                        Translation
                                                                                                                                              No
                     H&S 773.0613 No Translation
                     TAC 103.1                                          No Translation                              No Translation                    No Translation
Date                                                        Translation                                                                   Translation
                     TAC 103.1


                     H&S 92.003
Air EMS Activation                                              No                                                                            No
                     H&S 773.0613 No Translation                        No Translation                              No Translation                    No Translation
Time                                                        Translation                                                                   Translation
                     TAC 103.1


                     H&S 92.003
                                                                No                                                                            No
Air EMS Arrival Date H&S 773.0613 No Translation                        No Translation                              No Translation                    No Translation
                                                            Translation                                                                   Translation
                     TAC 103.1


                     H&S 92.003
Air EMS Arrival                                                 No                                                                            No
                     H&S 773.0613 No Translation                        No Translation                              No Translation                    No Translation
Time                                                        Translation                                                                   Translation
                     TAC 103.1


                     H&S 92.003
Air EMS Provider                                                No                                                                            No
                     H&S 773.0613 No Translation                        No Translation                              No Translation                    No Translation
Number                                                      Translation                                                                   Translation
                     TAC 103.1


                                                                        The state-assigned provider number of the                             No
                     N/A              EMS Agency Number      D01_01                                                 No Translation                    No Translation
                                                                        responding agency                                                 Translation


                                                                                                                                              No
                     N/A              EMS Agency Name        D01_02     The formal name of the agency               No Translation                    No Translation
                                                                                                                                          Translation




          May 28th, 2009                                                                 Please note cover on first worksheet.                                                                  Page 41
                                                                                TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                         * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                           Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                   NEMSIS DATA DICTIONARY                                                                 NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                      Submerssion
                                                                                                                                                                                             Cardiac /
                                                                                                                                                                                              Stroke
  Data Element                                               Element                                                                                Element




                                                                                                                                                                                                                SCI
                                                                                                                                                                                                          TBI
                 Mandate / Rule      Data Element Name                                      Definition                         Data Element Name                                Definition
     Name                                                    Number                                                                                 Number


                 H&S 92.003                                     No                                                                                     No
Data Set ID      H&S 773.0613 No Translation                            No Translation                                  No Translation                 No      No Translation
                 N/A          EMS Agency State              Translation The state in which the Agency provides services No Translation
                                                             D01_03                                                                                Translation No Translation
                 TAC 103.1                                                                                                                         Translation


                                                                        The county(s) for which the agency formally                                    No
                 N/A              EMS Agency County          D01_04                                                         No Translation                     No Translation
                                                                        provides service                                                           Translation


                                                                                                                                                       No
                 N/A              Primary Type of Service    D01_05     The primary service type provided by the agency No Translation                         No Translation
                                                                                                                                                   Translation


                                                                        The other service type(s) which are provided by                                No
                 N/A              Other Types of Services    D01_06                                                         No Translation                     No Translation
                                                                        the agency                                                                 Translation


                                                                        The highest credentialed personnel's level of
                                                                        service which the agency provides for every EMS
                                                                                                                                                       No
                 N/A              Level of Service           D01_07     encounter if requested. In a                         No Translation                    No Translation
                                                                                                                                                   Translation
                                                                        tiered response system, this is the highest level of
                                                                        service which could be sent to any specific call.


                                                                        The organizational structure from which EMS                                    No
                 N/A              Organizational Type        D01_08                                                           No Translation                   No Translation
                                                                        services are delivered (fire, hospital, county, etc.)                      Translation

                                                                        The primary organizational status of the agency.
                                                                                                                                                       No
                 N/A              Organizational Status      D01_09     The definition of Volunteer or Non-Volunteer is No Translation                         No Translation
                                                                                                                                                   Translation
                                                                        based on state or local terms.

                                                                                                                                                       No
                 N/A              Statistical Year           D01_10     The year to which the information pertains          No Translation                     No Translation
                                                                                                                                                   Translation




          May 28th, 2009                                                                   Please note cover on first worksheet.                                                                         Page 42
                                                                                  TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                          * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                            Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                    NEMSIS DATA DICTIONARY                                                               NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                     Submerssion
                                                                                                                                                                                            Cardiac /
                                                                                                                                                                                             Stroke
  Data Element                                                Element                                                                              Element




                                                                                                                                                                                                               SCI
                                                                                                                                                                                                         TBI
                 Mandate / Rule      Data Element Name                                       Definition                       Data Element Name                                Definition
     Name                                                     Number                                                                               Number


                 H&S 92.003                                      No      All other EMS or First Responder Agencies,                                   No
Data Set ID      H&S 773.0613 No Translation In Area                     No Translation                                     No Translation            No      No Translation
                 N/A          Other Agencies                 Translation which are in the service area or are available for No Translation
                                                              D01_11                                                                              Translation No Translation
                 TAC 103.1                                                                                                                        Translation
                                                                         mutual aid




                                                                         The total square miles in the agency's service                               No
                 N/A              Total Service Size Area     D01_12                                                       No Translation                     No Translation
                                                                         area                                                                     Translation




                                                                         The total population in the agency's service area
                                                                         based on year 2000 census data (if possible).
                                  Total Service Area                                                                                                  No
                 N/A                                          D01_13     This number does not                              No Translation                     No Translation
                                  Population                                                                                                      Translation
                                                                         include population changes associated with daily
                                                                         work flow or seasonal movements




                                                                         The number of 911 EMS calls for the calendar                                 No
                 N/A              911 Call Volume Per Year    D01_14                                                       No Translation                     No Translation
                                                                         year                                                                     Translation




          May 28th, 2009                                                                   Please note cover on first worksheet.                                                                        Page 43
                                                                             TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                     * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                       Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                 NEMSIS DATA DICTIONARY                                                            NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                               Submerssion
                                                                                                                                                                                      Cardiac /
                                                                                                                                                                                       Stroke
  Data Element                                             Element                                                                           Element




                                                                                                                                                                                                         SCI
                                                                                                                                                                                                   TBI
                 Mandate / Rule      Data Element Name                                  Definition                      Data Element Name                                Definition
     Name                                                  Number                                                                            Number


                 H&S 92.003                               No                                                                                    No
Data Set ID      H&S 773.0613 No Translation                      No Translation                                No Translation                          No Translation
                                                      Translation                                                                           Translation
                 TAC 103.1    EMS Dispatch Volume Per             The number of EMS dispatches for the calendar                                 No
                 N/A                                   D01_15                                                   No Translation                          No Translation
                              Year                                year                                                                      Translation




                                  EMS Transport Volume               The number of EMS transports for the calendar                              No
                 N/A                                       D01_16                                                    No Translation                     No Translation
                                  Per Year                           year.                                                                  Translation




                                  EMS Patient Contact                The number of EMS patient contacts for that                                No
                 N/A                                       D01_17                                                    No Translation                     No Translation
                                  Volume Per Year                    calendar year.                                                         Translation




                                  EMS Billable Calls Per             The number of EMS patient encounters which                                 No
                 N/A                                       D01_18                                                    No Translation                     No Translation
                                  Year                               are billable for the calendar year                                     Translation


                                                                                                                                                No
                 N/A              EMS Agency Time Zone     D01_19    The time zone for the EMS Agency                No Translation                     No Translation
                                                                                                                                            Translation


                                  EMS Agency Daylight                Indicate if the EMS Agency conforms to Daylight                            No
                 N/A                                       D01_20                                                    No Translation                     No Translation
                                  Savings Time Use                   Savings Time                                                           Translation




          May 28th, 2009                                                              Please note cover on first worksheet.                                                                       Page 44
                                                                                 TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                          * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                            Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                    NEMSIS DATA DICTIONARY                                                              NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                    Submerssion
                                                                                                                                                                                           Cardiac /
                                                                                                                                                                                            Stroke
  Data Element                                                Element                                                                             Element




                                                                                                                                                                                                              SCI
                                                                                                                                                                                                        TBI
                 Mandate / Rule     Data Element Name                                       Definition                       Data Element Name                                Definition
     Name                                                     Number                                                                              Number


                 H&S 92.003                                    No                                                                                    No
Data Set ID      H&S 773.0613 No Translation
                                                                       TheTranslation
                                                                       No National Provider Identifier associated with    No Translation                     No Translation
                                                           Translation National Provider System (NPS) and used in all                            Translation
                                                                                                                                                     No
                 N/A
                 TAC 103.1    National Provider Identifier D01_21                                                         No Translation                     No Translation
                                                                       standard HIPAA transactions                                               Translation
                                                                       such as electronic claim filing.

                                  Agency Contact Last                                                                                                No
                 N/A                                          D02_01     The Last Name of the agency's primary contact    No Translation                     No Translation
                                  Name                                                                                                           Translation


                                  Agency Contact Middle                  The Middle Name or initial of the agency's                                  No
                 N/A                                          D02_02                                                      No Translation                     No Translation
                                  Name/Initial                           primary contact                                                         Translation


                                  Agency Contact First                                                                                               No
                 N/A                                          D02_03     The First Name of the agency's primary contact   No Translation                     No Translation
                                  Name                                                                                                           Translation


                                                                         The Agency contact's location or physical                                   No
                 N/A              Agency Contact Address      D02_04                                                      No Translation                     No Translation
                                                                         address                                                                 Translation


                                                                                                                                                     No
                 N/A              Agency Contact City         D02_05     The city of the Agency contact's mailing address No Translation                     No Translation
                                                                                                                                                 Translation


                                                                                                                                                     No
                 N/A              Agency Contact State        D02_06     The state of the Agency contact's mailing address No Translation                    No Translation
                                                                                                                                                 Translation


                                                                         The ZIP code of the Agency contact's mailing                                No
                 N/A              Agency Contact Zip Code     D02_07                                                      No Translation                     No Translation
                                                                         address                                                                 Translation




          May 28th, 2009                                                                   Please note cover on first worksheet.                                                                       Page 45
                                                                              TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                       * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                         Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                  NEMSIS DATA DICTIONARY                                                            NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                Submerssion
                                                                                                                                                                                       Cardiac /
                                                                                                                                                                                        Stroke
  Data Element                                              Element                                                                           Element




                                                                                                                                                                                                          SCI
                                                                                                                                                                                                    TBI
                 Mandate / Rule     Data Element Name                                    Definition                      Data Element Name                                Definition
     Name                                                   Number                                                                            Number


                 H&S 92.003                                No                                                                                    No
Data Set ID      H&S 773.0613 No Translation Telephone Translation No Translation
                              Agency Contact                                                                  No Translation                     No      No Translation
                 N/A                                    D02_08 The primary phone number of the Agency contact No Translation                 Translation No Translation
                 TAC 103.1    Number                                                                                                         Translation


                                  Agency Contact Fax                                                                                             No
                 N/A                                        D02_09    The primary fax number of the Agency contact     No Translation                    No Translation
                                  Number                                                                                                     Translation


                                  Agency Contact Email                                                                                           No
                 N/A                                        D02_10    The primary email address of the Agency contact No Translation                     No Translation
                                  Address                                                                                                    Translation


                                  Agency Contact Web                  The primary website address (URL) of the                                   No
                 N/A                                        D02_11                                                     No Translation                    No Translation
                                  Address                             agency                                                                 Translation


                                  Agency Medical Director                                                                                        No
                 N/A                                        D03_01    The Last Name of the agency's primary contact    No Translation                    No Translation
                                  Last Name                                                                                                  Translation


                                  Agency Medical Director             The Middle Name or initial of the agency's                                 No
                 N/A                                        D03_02                                                     No Translation                    No Translation
                                  Middle Name/Initial                 primary contact                                                        Translation


                                  Agency Medical Director                                                                                        No
                 N/A                                        D03_03    The First Name of the agency's primary contact   No Translation                    No Translation
                                  First Name                                                                                                 Translation


                                  Agency Medical Director             The Agency contact's location or physical                                  No
                 N/A                                        D03_04                                                     No Translation                    No Translation
                                  Address                             address                                                                Translation


                                  Agency Medical Director                                                                                        No
                 N/A                                        D03_05    The city of the Agency contact's mailing address No Translation                    No Translation
                                  City                                                                                                       Translation




          May 28th, 2009                                                                Please note cover on first worksheet.                                                                      Page 46
                                                                                 TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                         * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                           Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                   NEMSIS DATA DICTIONARY                                                                  NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                       Submerssion
                                                                                                                                                                                              Cardiac /
                                                                                                                                                                                               Stroke
  Data Element                                               Element                                                                                 Element




                                                                                                                                                                                                                 SCI
                                                                                                                                                                                                           TBI
                 Mandate / Rule      Data Element Name                                      Definition                          Data Element Name                                Definition
     Name                                                    Number                                                                                  Number


                 H&S 92.003                                     No                                                                                      No
Data Set ID      H&S 773.0613 No Translation Director
                              Agency Medical                            No Translation                                    No Translation                No      No Translation
                 N/A                                        Translation The state of the Agency contact's mailing address No Translation
                                                             D03_06                                                                                 Translation No Translation
                 TAC 103.1    State                                                                                                                 Translation


                                  Agency Medical Director               The ZIP code of the Agency contact's mailing                                    No
                 N/A                                         D03_07                                                          No Translation                     No Translation
                                  Zip Code                              address                                                                     Translation


                                  Agency Medical Director                                                                                               No
                 N/A                                         D03_08     The primary phone number of the Agency contact No Translation                           No Translation
                                  Telephone Number                                                                                                  Translation


                                  Agency Medical Director                                                                                               No
                 N/A                                         D03_09     The primary fax number of the Agency contact         No Translation                     No Translation
                                  Fax Number                                                                                                        Translation


                                  Agency Medical Director                                                                                               No
                 N/A                                         D03_10     The primary email address of the Agency contact No Translation                          No Translation
                                  Email Address                                                                                                     Translation


                                  Agency Medical Director               The primary website address (URL) of the                                        No
                 N/A                                         D03_11                                                          No Translation                     No Translation
                                  Web Address                           agency                                                                      Translation


                                  State Certification                   All of the potential levels of certification/licensure                          No
                 N/A                                         D04_01                                                            No Translation                   No Translation
                                  Licensure Levels                      for EMS personnel recognized by the state                                   Translation

                                                                        The EMS unit number used to dispatch and
                                                                        communicate with the unit. This may be the same                                 No
                 N/A              EMS Unit Call Sign         D04_02                                                     No Translation                          No Translation
                                                                        as the EMS Unit/Vehicle                                                     Translation
                                                                        Number in many agencies




          May 28th, 2009                                                                   Please note cover on first worksheet.                                                                          Page 47
                                                                                   TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                           * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                             Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                     NEMSIS DATA DICTIONARY                                                                 NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                        Submerssion
                                                                                                                                                                                               Cardiac /
                                                                                                                                                                                                Stroke
  Data Element                                                 Element                                                                                Element




                                                                                                                                                                                                                  SCI
                                                                                                                                                                                                            TBI
                 Mandate / Rule      Data Element Name                                        Definition                         Data Element Name                                Definition
     Name                                                      Number                                                                                 Number


                 H&S 92.003                                       No                                                                                     No
Data Set ID      H&S 773.0613 No Translation                              No Translation zones used by an agency to
                                                                          The geographic                                      No Translation                     No Translation
                                                              Translation                                                                            Translation
                 TAC 103.1                                                divide the service area into smaller geographic
                                                                          components. These zones can                                                    No
                 N/A              Zones                        D04_03                                                         No Translation                     No Translation
                                                                          be defined locally using any method which will                             Translation
                                                                          allow easy assignment of locations to their
                                                                          respective zone


                                                                          A list of all procedures that the agency has                                   No
                 N/A              Procedures                   D04_04                                                         No Translation                     No Translation
                                                                          implemented and available for use                                          Translation


                                  Personnel Level Permitted               All Personnel Levels which are permitted to use                                No
                 N/A                                           D04_05                                                         No Translation                     No Translation
                                  to Use the Procedure                    the associated procedure                                                   Translation


                                                                          A list of all medications the agency has                                       No
                 N/A              Medicationgs Given           D04_06                                                         No Translation                     No Translation
                                                                          implemented and available for use                                          Translation


                                  Personnel Level Permitted               All personnel levels which are permitted to use                                No
                 N/A                                           D04_07                                                         No Translation                     No Translation
                                  to Use the Medication                   the associated medication                                                  Translation


                                                                          A list of all of the medical treatment protocols that
                                                                          the agency has in place and available for use.
                                                                                                                                                         No
                 N/A              Protocol                     D04_08     Specific Adult or Pediatric                           No Translation                   No Translation
                                                                                                                                                     Translation
                                                                          Protocols should be mapped to one of these
                                                                          topics if possible.


                                  Personnel Level Permitted               All personnel levels which are permitted to use                                No
                 N/A                                           D04_09                                                         No Translation                     No Translation
                                  to Use the Protocol                     the associated Protocol                                                    Translation




          May 28th, 2009                                                                     Please note cover on first worksheet.                                                                         Page 48
                                                                                  TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                          * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                            Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                    NEMSIS DATA DICTIONARY                                                                 NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                       Submerssion
                                                                                                                                                                                              Cardiac /
                                                                                                                                                                                               Stroke
  Data Element                                                Element                                                                                Element




                                                                                                                                                                                                                 SCI
                                                                                                                                                                                                           TBI
                 Mandate / Rule      Data Element Name                                       Definition                         Data Element Name                                Definition
     Name                                                     Number                                                                                 Number


                 H&S 92.003                                      No                                                                                     No
Data Set ID      H&S 773.0613 No Translation                             No Translation                                      No Translation                     No Translation
                 N/A          Billing Status                 Translation Indication of whether the EMS agency routinely
                                                              D04_10                                                         No Translation
                                                                                                                                                        No
                                                                                                                                                    Translation No Translation
                 TAC 103.1                                               bills for any segment of the patient population                            Translation


                                                                         A list of all the hospitals the agency transports to                           No
                 N/A              Hospitals Served            D04_11                                                          No Translation                    No Translation
                                                                         or from                                                                    Translation


                                                                         The state assigned licensure number (code) for                                 No
                 N/A              Hospital Facility Number    D04_12                                                         No Translation                     No Translation
                                                                         each Hospital Served (D04_11)                                              Translation


                                                                         A list of all destinations other than hospitals which                          No
                 N/A              Other Destinations          D04_13                                                           No Translation                   No Translation
                                                                         an agency transports to or from                                            Translation


                                  Destination Facility                   The state assigned licensure number (code) for                                 No
                 N/A                                          D04_14                                                         No Translation                     No Translation
                                  Number                                 each Other Destination (D04_13)                                            Translation


                                                                         The type of facility associated with the Other                                 No
                 N/A              Destination Type            D04_15                                                         No Translation                     No Translation
                                                                         Destination (D04_13)                                                       Translation


                                  Insurance Companies                    A list of insurance companies which are prevalent                              No
                 N/A                                          D04_16                                                       No Translation                       No Translation
                                  Used                                   in the Agencies service area                                               Translation


                                                                         The Vendor or Company associated with the                                      No
                 N/A              EMD Vendor                  D04_17                                                         No Translation                     No Translation
                                                                         EMD Card set and algorithms                                                Translation


                                                                                                                                                        No
                 N/A              Station Name                D05_01     Name of the agency's station                        No Translation                     No Translation
                                                                                                                                                    Translation




          May 28th, 2009                                                                    Please note cover on first worksheet.                                                                         Page 49
                                                                                 TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                          * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                            Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                    NEMSIS DATA DICTIONARY                                                             NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                   Submerssion
                                                                                                                                                                                          Cardiac /
                                                                                                                                                                                           Stroke
  Data Element                                                Element                                                                            Element




                                                                                                                                                                                                             SCI
                                                                                                                                                                                                       TBI
                 Mandate / Rule      Data Element Name                                       Definition                     Data Element Name                                Definition
     Name                                                     Number                                                                             Number


                 H&S 92.003                                      No                                                                                 No
Data Set ID      H&S 773.0613 No Translation                             No Translation                                  No Translation             No      No Translation
                 N/A          Station Number                 Translation ID number of the agency's station
                                                              D05_02                                                     No Translation         Translation No Translation
                 TAC 103.1                                                                                                                      Translation


                                                                         The geographic zone or location of the agency's                            No
                 N/A              Station Zone                D05_03                                                     No Translation                     No Translation
                                                                         station                                                                Translation


                                                                                                                                                    No
                 N/A              Station GPS                 D05_04     The GPS coordinate for the agency's station     No Translation                     No Translation
                                                                                                                                                Translation


                                                                                                                                                    No
                 N/A              Station Address             D05_05     Address of the agency's station                 No Translation                     No Translation
                                                                                                                                                Translation


                                                                                                                                                    No
                 N/A              Station City                D05_06     City of the agency's station                    No Translation                     No Translation
                                                                                                                                                Translation


                                                                                                                                                    No
                 N/A              Station State               D05_07     State of the agency's station                   No Translation                     No Translation
                                                                                                                                                Translation


                                                                                                                                                    No
                 N/A              Station ZIP                 D05_08     ZIP Code of the agency's station                No Translation                     No Translation
                                                                                                                                                Translation


                                                                                                                                                    No
                 N/A              Station Telephone Number    D05_09     The telephone number of the agency's station    No Translation                     No Translation
                                                                                                                                                Translation

                                                                         The unique ID number of the unit which is
                                                                                                                                                    No
                 N/A              Unit / Vehicle Number       D06_01     specific for each vehicle; typically the VIN    No Translation                     No Translation
                                                                                                                                                Translation
                                                                         associated with the vehicle




          May 28th, 2009                                                                    Please note cover on first worksheet.                                                                     Page 50
                                                                                    TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                            * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                              Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                     NEMSIS DATA DICTIONARY                                                                  NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                         Submerssion
                                                                                                                                                                                                Cardiac /
                                                                                                                                                                                                 Stroke
  Data Element                                                 Element                                                                                 Element




                                                                                                                                                                                                                   SCI
                                                                                                                                                                                                             TBI
                 Mandate / Rule      Data Element Name                                         Definition                         Data Element Name                                Definition
     Name                                                      Number                                                                                  Number


                 H&S 92.003                                       No                                                                                      No
Data Set ID      H&S 773.0613 No Translation                              No Translation                                        No Translation            No      No Translation
                 N/A          Vehicle Type                    Translation Vehicle type of unit (ambulance, fire, truck, etc.)
                                                               D06_03                                                           No Translation        Translation No Translation
                 TAC 103.1                                                                                                                            Translation


                                  State Certification /                    The personnel certification/licensure level of the                             No
                 N/A                                           D06_04                                                           No Translation                    No Translation
                                  Licensure Levels                         vehicle crew member                                                        Translation


                                  Number of Each Personnel                 The number of each personnel level associated                                  No
                 N/A                                           D06_05                                                           No Translation                    No Translation
                                  Level on the Vehicle Crew                with the vehicle crew                                                      Translation



                                                                           The initial cost of the vehicle excluding all medical
                                                                           and other equipment not associated with the
                                                                                                                                                          No
                 N/A              Vehicle Initial Cost         D06_06      vehicle operation. This cost                          No Translation                   No Translation
                                                                                                                                                      Translation
                                                                           should be inclusive of all sources of funding
                                                                           including grants, donations, and any other capital



                                                                           The year the vehicle was manufactured. This is
                                                                           defined by the year of the VIN, understanding                                  No
                 N/A              Vehicle Model Year           D06_07                                                           No Translation                    No Translation
                                                                           that some parts of the vehicle                                             Translation
                                                                           may not be original


                                  Year Miles / Hours                                                                                                      No
                 N/A                                           D06_08      The year the Hours and miles were accumulated No Translation                           No Translation
                                  Accrued                                                                                                             Translation


                                                                           The number of hours the vehicle was in service                                 No
                 N/A              Annual Vehicle Hours         D06_09                                                           No Translation                    No Translation
                                                                           for the agency for the defined year                                        Translation




          May 28th, 2009                                                                      Please note cover on first worksheet.                                                                         Page 51
                                                                                    TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                             * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                               Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                       NEMSIS DATA DICTIONARY                                                                 NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                          Submerssion
                                                                                                                                                                                                 Cardiac /
                                                                                                                                                                                                  Stroke
  Data Element                                                   Element                                                                                Element




                                                                                                                                                                                                                    SCI
                                                                                                                                                                                                              TBI
                 Mandate / Rule      Data Element Name                                          Definition                         Data Element Name                                Definition
     Name                                                        Number                                                                                 Number


                 H&S 92.003                                         No                                                                                     No
Data Set ID      H&S 773.0613 No Translation Miles
                                                                            TheTranslation miles the vehicle accumulated in
                                                                            No number of                                       No Translation              No      No Translation
                 N/A          Annual Vehicle                    Translation service for the agency for the defined year
                                                                 D06_10                                                        No Translation          Translation No Translation
                 TAC 103.1                                                                                                                             Translation
                                                                            (Odometer Reading)

                                  Personnel's Agency ID                                                                                                    No
                 N/A                                             D07_01     Local agency ID number for personnel               No Translation                      No Translation
                                  Number                                                                                                               Translation


                                  State / Licensure ID                      The state certification/licensure ID number                                    No
                 N/A                                             D07_02                                                        No Translation                      No Translation
                                  Number                                    assigned to the crew member                                                Translation


                                  Personnel's Employment                                                                                                   No
                 N/A                                             D07_03     Personnel's Employment Status for this Agency      No Translation                      No Translation
                                  Status                                                                                                               Translation


                                                                                                                                                           No
                 N/A              Employment Status Date         D07_04     The date that the employee status was assigned No Translation                          No Translation
                                                                                                                                                       Translation

                                  Personnel's Level of
                                                                            Personnel's level of certification in this agency in                           No
                 N/A              Certification/Licensure for    D07_05                                                          No Translation                    No Translation
                                                                            the associated year                                                        Translation
                                  Agency

                                  Date of Personnel's
                                                                            The date that the Certification/Licensure was                                  No
                 N/A              Certification or Licensure     D07_06                                                        No Translation                      No Translation
                                                                            achieved                                                                   Translation
                                  for Agency

                                  EMS Personnel's Last                                                                                                     No
                 N/A                                             D08_01     Last Name of personnel                             No Translation                      No Translation
                                  Name                                                                                                                 Translation


                                  EMS Personnel's Middle                                                                                                   No
                 N/A                                             D08_02     Middle name or initial of personnel                No Translation                      No Translation
                                  Name / Initial                                                                                                       Translation




          May 28th, 2009                                                                      Please note cover on first worksheet.                                                                          Page 52
                                                                                TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                         * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                           Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                   NEMSIS DATA DICTIONARY                                                          NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                               Submerssion
                                                                                                                                                                                      Cardiac /
                                                                                                                                                                                       Stroke
  Data Element                                               Element                                                                         Element




                                                                                                                                                                                                         SCI
                                                                                                                                                                                                   TBI
                 Mandate / Rule     Data Element Name                                      Definition                   Data Element Name                                Definition
     Name                                                    Number                                                                          Number


                 H&S 92.003                                     No                                                                              No
Data Set ID      H&S 773.0613 No Translation First
                              EMS Personnel's                           No Translation                                No Translation            No      No Translation
                 N/A                                        Translation First name of personnel
                                                             D08_03                                                   No Translation        Translation No Translation
                 TAC 103.1    Name                                                                                                          Translation


                                  EMS Personnel's Mailing               Street or PO Box of the personnel's mailing                             No
                 N/A                                         D08_04                                                   No Translation                    No Translation
                                  Address                               address                                                             Translation


                                  EMS Personnel's City of                                                                                       No
                 N/A                                         D08_05     City of personnel's mailing address           No Translation                    No Translation
                                  Residence                                                                                                 Translation


                                                                                                                                                No
                 N/A              EMS Personnel's State      D08_06     State of personnel's mailing address          No Translation                    No Translation
                                                                                                                                            Translation


                                  EMS Personnel's ZIP                                                                                           No
                 N/A                                         D08_07     ZIP code of personnel's mailing address       No Translation                    No Translation
                                  Code                                                                                                      Translation


                                  EMS Personnel's Work                                                                                          No
                 N/A                                         D08_08     Work phone number of the personnel            No Translation                    No Translation
                                  Telephone                                                                                                 Translation


                                  EMS Personnel's Home                                                                                          No
                 N/A                                         D08_09     Home phone number of the personnel            No Translation                    No Translation
                                  Telephone                                                                                                 Translation


                                  EMS Personnel's Email                                                                                         No
                 N/A                                         D08_10     Primary email address of the personnel        No Translation                    No Translation
                                  Address                                                                                                   Translation


                                  EMS Personnel's Date of                                                                                       No
                 N/A                                         D08_11     The EMS personnel's date of birth             No Translation                    No Translation
                                  Birth                                                                                                     Translation




          May 28th, 2009                                                                  Please note cover on first worksheet.                                                                   Page 53
                                                                                   TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                            * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                              Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                       NEMSIS DATA DICTIONARY                                                                NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                         Submerssion
                                                                                                                                                                                                Cardiac /
                                                                                                                                                                                                 Stroke
  Data Element                                                   Element                                                                               Element




                                                                                                                                                                                                                   SCI
                                                                                                                                                                                                             TBI
                 Mandate / Rule      Data Element Name                                         Definition                         Data Element Name                                Definition
     Name                                                        Number                                                                                Number


                 H&S 92.003                                         No                                                                                    No
Data Set ID      H&S 773.0613 No Translation Gender                         No Translation                                      No Translation            No      No Translation
                 N/A          EMS Personnel's                   Translation The EMS personnel's gender
                                                                 D08_12                                                         No Translation        Translation No Translation
                 TAC 103.1                                                                                                                            Translation


                                                                           The EMS personnel's race as defined by the                                     No
                 N/A              EMS Personnel's Race           D08_13                                                         No Translation                    No Translation
                                                                           OMB (US Office of Management and Budget)                                   Translation


                                                                           The EMS personnel's ethnicity as defined by the                                No
                 N/A              EMS Personnel's Ethnicity      D08_14                                                    No Translation                         No Translation
                                                                           OMB (US Office of Management and Budget)                                   Translation


                                  State EMS Certifcation                                                                                                  No
                 N/A                                             D08_15    The personnel's State EMS Certification level        No Translation                    No Translation
                                  Licensure Level                                                                                                     Translation


                                  National Registry                        Indication of National Registry Credential for the                             No
                 N/A                                             D08_16                                                         No Translation                    No Translation
                                  Credentialed                             level of Certification/Licensure in D08_15                                 Translation


                                  State EMS Current                                                                                                       No
                 N/A                                             D08_17    The date of the personnel's current certification    No Translation                    No Translation
                                  Certification Date                                                                                                  Translation


                                  Initial State Certification              The certification date of personnel's current State                            No
                 N/A                                             D08_18                                                        No Translation                     No Translation
                                  Date                                     certification                                                              Translation

                                                                           The personnel's total length of active EMS
                                                                           service at any level in years. Please do not                                   No
                 N/A              Total Length of Service        D08_19                                                         No Translation                    No Translation
                                                                           include time periods not working in                                        Translation
                                                                           EMS




          May 28th, 2009                                                                      Please note cover on first worksheet.                                                                         Page 54
                                                                                 TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                          * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                            Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                    NEMSIS DATA DICTIONARY                                                             NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                   Submerssion
                                                                                                                                                                                          Cardiac /
                                                                                                                                                                                           Stroke
  Data Element                                                Element                                                                            Element




                                                                                                                                                                                                             SCI
                                                                                                                                                                                                       TBI
                 Mandate / Rule      Data Element Name                                     Definition                       Data Element Name                                Definition
     Name                                                     Number                                                                             Number


                 H&S 92.003                                      No                                                                                 No
Data Set ID      H&S 773.0613 No Translation Service
                              Date Length of                             No Translation                                  No Translation                     No Translation
                 N/A                                         Translation The date which the length of EMS service was
                                                              D08_20                                                     No Translation
                                                                                                                                                    No
                                                                                                                                                Translation No Translation
                 TAC 103.1    Documented                                 documented                                                             Translation


                                                                         The unique manufacturer's serial number                                    No
                 N/A              Device Serial Number        D09_01                                                     No Translation                     No Translation
                                                                         associated with a medical device                                       Translation


                                                                         The local number or configurable ID/Name of the                            No
                 N/A              Device Name or ID           D09_02                                                     No Translation                     No Translation
                                                                         medical device                                                         Translation


                                                                                                                                                    No
                 N/A              Device Manufacturer         D09_03     The manufacturer of the medical device          No Translation                     No Translation
                                                                                                                                                Translation


                                                                         The specific manufacturer's model number                                   No
                 N/A              Model Number                D09_04                                                     No Translation                     No Translation
                                                                         associated with medical device                                         Translation


                                                                         The date the device was placed in service by the                           No
                 N/A              Device Purchase Date        D09_05                                                      No Translation                    No Translation
                                                                         EMS agency                                                             Translation


                                                                         The incident number assigned by the 911                                    No
                 N/A              Incident Number             E02_02                                                     No Translation                     No Translation
                                                                         Dispatch System                                                        Translation

                                                                         The internal EMS response number which is
                                  EMS Unit (Vehicle)                                                                                                No
                 N/A                                          E02_03     unique for each EMS unit's (vehicles) responses No Translation                     No Translation
                                  Response Number                                                                                               Translation
                                                                         to an incident within an agency
                                                                         The primary role of the EMS service which was                              No
                 N/A              Primary Role of the Unit    E02_05                                                     No Translation                     No Translation
                                                                         requested for this specific EMS incident                               Translation




          May 28th, 2009                                                                  Please note cover on first worksheet.                                                                       Page 55
                                                                                   TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                           * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                             Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                     NEMSIS DATA DICTIONARY                                                                 NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                        Submerssion
                                                                                                                                                                                               Cardiac /
                                                                                                                                                                                                Stroke
  Data Element                                                 Element                                                                                Element




                                                                                                                                                                                                                  SCI
                                                                                                                                                                                                            TBI
                 Mandate / Rule     Data Element Name                                         Definition                         Data Element Name                                Definition
     Name                                                      Number                                                                                 Number


                 H&S 92.003                                       No                                                                                     No
Data Set ID      H&S 773.0613 No Translation Delay                        No Translation                                      No Translation                     No Translation
                 N/A          Type of Dispatch                Translation The dispatch delays, if any, associated with the
                                                               E02_06                                                         No Translation
                                                                                                                                                         No
                                                                                                                                                     Translation No Translation
                 TAC 103.1                                                dispatch of EMS unit to the patient encounter                              Translation


                                                                          The response delays, if any, of the unit                                       No
                 N/A              Type of Response Delay       E02_07                                                         No Translation                     No Translation
                                                                          associated with the patient encounter                                      Translation


                                                                          The scene delays, if any, of the unit associated                               No
                 N/A              Type of Scene Delay          E02_08                                                         No Translation                     No Translation
                                                                          with the patient encounter                                                 Translation


                                                                          The transport delays, if any, of the unit associated                           No
                 N/A              Type of Transport Delay      E02_09                                                          No Translation                    No Translation
                                                                          with the patient encounter                                                 Translation

                                                                          The turn-around delays, if any, associated with
                                                                                                                                                         No
                 N/A              Type of Turn-Around Delay    E02_10     the EMS unit associated with the patient            No Translation                     No Translation
                                                                                                                                                     Translation
                                                                          encounter

                                                                          The unique physical vehicle number of the                                      No
                 N/A              EMS Unit/Vehicle Number      E02_11                                                         No Translation                     No Translation
                                                                          responding unit                                                            Translation

                                                                          The EMS unit number used to dispatch and
                                  EMS Unit Call Sign (Radio               communicate with the unit. This may be the                                     No
                 N/A                                           E02_12                                                         No Translation                     No Translation
                                  Number)                                 same as the EMS Unit/Vehicle Number in many                                Translation
                                                                          agencies

                                                                          The station (or hospital) name representing the
                                                                                                                                                         No
                 N/A              Vehicle Dispatch Location    E02_13     geographic location of the vehicle at the time of   No Translation                     No Translation
                                                                                                                                                     Translation
                                                                          dispatch




          May 28th, 2009                                                                     Please note cover on first worksheet.                                                                         Page 56
                                                                               TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                        * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                          Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                  NEMSIS DATA DICTIONARY                                                              NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                  Submerssion
                                                                                                                                                                                         Cardiac /
                                                                                                                                                                                          Stroke
  Data Element                                              Element                                                                             Element




                                                                                                                                                                                                            SCI
                                                                                                                                                                                                      TBI
                 Mandate / Rule     Data Element Name                                     Definition                       Data Element Name                                Definition
     Name                                                   Number                                                                              Number


                 H&S 92.003                                    No                                                                                  No
Data Set ID      H&S 773.0613 No Translation Zone                      No Translation                                   No Translation                     No Translation
                 N/A          Vehicle Dispatch             Translation The Geographic zone representing the location of No Translation
                                                            E02_14
                                                                                                                                                   No
                                                                                                                                               Translation No Translation
                 TAC 103.1                                             the responding vehicle at the time of dispatch                          Translation


                                  Vehicle Dispatch GPS                 The GPS coordinates associated with the EMS                                 No
                 N/A                                        E02_15                                                      No Translation                     No Translation
                                  Location                             unit at the time of dispatch                                            Translation

                                  Beginning Odometer                   The mileage (odometer reading) of the vehicle at
                                                                                                                                                   No
                 N/A              Reading of Responding     E02_16     the beginning of the call (when the wheels begin No Translation                     No Translation
                                                                                                                                               Translation
                                  Vehicle                              moving)

                                  On-Scene Odometer
                                                                       The mileage (odometer reading) of the vehicle                               No
                 N/A              Reading of Responding     E02_17                                                      No Translation                     No Translation
                                                                       when it arrives at the patient                                          Translation
                                  Vehicle

                                  Patient Destination
                                                                       The mileage (odometer reading) of the vehicle                               No
                 N/A              Odometer Reading of       E02_18                                                      No Translation                     No Translation
                                                                       when it arrives at the patient's destination                            Translation
                                  Responding Vehicle

                                  Ending Odometer
                                                                       The mileage (odometer reading) of the vehicle (at                           No
                 N/A              Reading of Responding     E02_19                                                       No Translation                    No Translation
                                                                       time back in service)                                                   Translation
                                  Vehicle

                                                                       Indication whether or not lights and/or sirens                              No
                 N/A              Response Mode to Scene    E02_20                                                      No Translation                     No Translation
                                                                       were used on the vehicle on the way to the scene                        Translation


                                  Complaint Reported by                The complaint dispatch reported to the                                      No
                 N/A                                        E03_01                                                      No Translation                     No Translation
                                  Dispatch                             responding unit                                                         Translation


                                                                       Indication of whether EMD was performed for this                            No
                 N/A              EMD Performed             E03_02                                                      No Translation                     No Translation
                                                                       EMS event                                                               Translation




          May 28th, 2009                                                                 Please note cover on first worksheet.                                                                       Page 57
                                                                                  TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                          * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                            Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                    NEMSIS DATA DICTIONARY                                                                  NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                        Submerssion
                                                                                                                                                                                               Cardiac /
                                                                                                                                                                                                Stroke
  Data Element                                                Element                                                                                 Element




                                                                                                                                                                                                                  SCI
                                                                                                                                                                                                            TBI
                 Mandate / Rule      Data Element Name                                       Definition                          Data Element Name                                Definition
     Name                                                     Number                                                                                  Number


                 H&S 92.003                                      No      TheTranslation number reported by dispatch,                                     No
Data Set ID      H&S 773.0613 No Translation                             No EMD card                                        No Translation               No      No Translation
                 N/A          EMD Card Number                Translation consisting of the card number, dispatch level, and No Translation
                                                              E03_03                                                                                 Translation No Translation
                 TAC 103.1                                                                                                                           Translation
                                                                         dispatch mode

                                                                         The State Certification/Licensure ID number                                     No
                 N/A              Crew Member ID              E04_01                                                          No Translation                     No Translation
                                                                         assigned to the crew member                                                 Translation


                                                                         The role of the crew member during transport of
                                                                         this call [lengthly definitions for "Driver", "Primary
                                                                         Patient Caregiver", "Secondary Patient                                          No
                 N/A              Crew Member Role            E04_02                                                            No Translation                   No Translation
                                                                         Caregiver", and "Third Patient Caregiver". See                              Translation
                                                                         this element's definition on page 155 of NEMSIS
                                                                         data dictionary v. 2.2.1]


                                                                         The functioning level of the crew member during                                 No
                 N/A              Crew Member Level           E04_03                                                     No Translation                          No Translation
                                                                         this EMS patient encounter                                                  Translation


                                  Dispatch Notified                      The date/time dispatch was notified by the 911                                  No
                 N/A                                          E05_03                                                          No Translation                     No Translation
                                  Date/Time                              call taker (if a separate entity)                                           Translation


                                  Transfer of Patient Care               The date/time the patient was transferred from                                  No
                 N/A                                          E05_08                                                    No Translation                           No Translation
                                  Date/Time                              this EMS agency to another EMS agency for care                              Translation


                                                                                                                                                         No
                 N/A              Unit Cancelled Date/Time    E05_12     The date/time the unit's call was cancelled          No Translation                     No Translation
                                                                                                                                                     Translation




          May 28th, 2009                                                                    Please note cover on first worksheet.                                                                          Page 58
                                                                                TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                        * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                          Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                  NEMSIS DATA DICTIONARY                                                                NTDB DATA DICTIONARY                                                       Data Sets




                                                                                                                                                                                                                                          Submerssion
                                                                                                                                                                                                                 Cardiac /
                                                                                                                                                                                                                  Stroke
  Data Element                                              Element                                                                               Element




                                                                                                                                                                                                                                    SCI
                                                                                                                                                                                                                              TBI
                 Mandate / Rule      Data Element Name                                     Definition                      Data Element Name                                      Definition
     Name                                                   Number                                                                                Number


                 H&S 92.003                                    No                                                                                    No
Data Set ID      H&S 773.0613 No Translation                           No Translation                                 No Translation                         No Translation
                                                           Translation The date/time the responding unit was back in                             Translation
                 TAC 103.1                                             their service area. In agencies who utilized
                              Unit Back at Home                                                                                                      No
                 N/A                                        E05_13 Agency Status Manaagement, home location           No Translation                         No Translation
                              Location Date/Time                                                                                                 Translation
                                                                       means the service area as assigned through the
                                                                       agency status management protocol

H&S 92.003                                                             Home state, territory, province, or DC, where
                 N/A              Patient's Home State      E06_07                                                      Patient's Home State       D_03      Stete (territory, province, DC) where pt. resides                 X    X        X
TAC 103.8                                                              patient resides
H&S 92.003
                 N/A              Patient's Home Country    E06_09     Country of citizenship                           Patient's Home Country     D_02      The country where pt. resides
TAC 103.8

                                                               No                                                                                            Documentation of the type of patient without a
                 N/A              No Translation                       No Translation                                   Alternate Home Address     D_06
                                                           Translation                                                                                       home zip code.

H&S 92.003
                 N/A              Ethnicity                 E06_13     Patient's ethnicity as defined by OMB            Ethnicity                  D_11      The pt's ethnicity
TAC 103.8
H&S 92.003                                                             Patient's age (either calculated from DOB or best                                     Pt's age at the time of injury (best
                 N/A              Age                       E06_14                                                       Age                       D_08                                                                        X    X        X
TAC 103.8                                                              approximation                                                                         approximation)
                                                                       Units which age is documented in (Hours, Days,                                        Units used to document pt's age (Years,
                 N/A              Age Units                 E06_15                                                    Age Units                    D_09
                                                                       Months, Years)                                                                        Months, Days, Hours)

                                  Primary or Home                                                                                                    No
                 N/A                                        E06_17     Patient's home or primary telephone number       No Translation                       No Translation
                                  Telephone Number                                                                                               Translation


                                  State Issuing Driver's                                                                                             No
                 N/A                                        E06_18     The state that issued the driver's license.      No Translation                       No Translation
                                  License                                                                                                        Translation




          May 28th, 2009                                                                  Please note cover on first worksheet.                                                                                              Page 59
                                                                                   TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                           * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                             Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                     NEMSIS DATA DICTIONARY                                                              NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                     Submerssion
                                                                                                                                                                                            Cardiac /
                                                                                                                                                                                             Stroke
  Data Element                                                 Element                                                                             Element




                                                                                                                                                                                                               SCI
                                                                                                                                                                                                         TBI
                 Mandate / Rule      Data Element Name                                         Definition                     Data Element Name                                Definition
     Name                                                      Number                                                                              Number


                 H&S 92.003                                       No                                                                                  No
Data Set ID      H&S 773.0613 No Translation of
                              Primary Method                              No Translation                                    No Translation                    No Translation
                 N/A                                          Translation The primary method of payment or type of
                                                               E07_01                                                       No Translation
                                                                                                                                                      No
                                                                                                                                                  Translation No Translation
                 TAC 103.1    Payment                                     insurance associated with this EMS encounter                            Translation


                                  Certificate of Medical                  Indication of whether a certificate of medical                              No
                 N/A                                           E07_02                                                       No Translation                    No Translation
                                  Necessity                               necessity is present                                                    Translation


                                  Insurance Company                       The ID number of the patient's insurance                                    No
                 N/A                                           E07_03                                                       No Translation                    No Translation
                                  ID/Name                                 company                                                                 Translation


                                  Insurance Company Billing               The billing priority or order for the insurance                             No
                 N/A                                           E07_04                                                       No Translation                    No Translation
                                  Priority                                company                                                                 Translation


                                  Insurance Company                                                                                                   No
                 N/A                                           E07_05     The mailing address of the insurance company      No Translation                    No Translation
                                  Address                                                                                                         Translation


                                                                                                                                                      No
                 N/A              Insurance Company City       E07_06     The insurance companies city or township          No Translation                    No Translation
                                                                                                                                                  Translation


                                                                          The insurance companies state, territory, or                                No
                 N/A              Insurance Company State      E07_07                                                       No Translation                    No Translation
                                                                          province, or District of Columbia                                       Translation


                                  Insurance Company Zip                                                                                               No
                 N/A                                           E07_08     The insurance companies Zip Code                  No Translation                    No Translation
                                  Code                                                                                                            Translation


                                                                          The ID number or name of the patient's insurance                            No
                 N/A              Insurance Group ID/Name      E07_09                                                      No Translation                     No Translation
                                                                          group                                                                   Translation




          May 28th, 2009                                                                     Please note cover on first worksheet.                                                                      Page 60
                                                                                     TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                             * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                               Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                       NEMSIS DATA DICTIONARY                                                                     NTDB DATA DICTIONARY                                                      Data Sets




                                                                                                                                                                                                                                                   Submerssion
                                                                                                                                                                                                                          Cardiac /
                                                                                                                                                                                                                           Stroke
  Data Element                                                   Element                                                                                    Element




                                                                                                                                                                                                                                             SCI
                                                                                                                                                                                                                                       TBI
                 Mandate / Rule      Data Element Name                                           Definition                          Data Element Name                                    Definition
     Name                                                        Number                                                                                     Number


                 H&S 92.003                                         No                                                                                         No
Data Set ID      H&S 773.0613 No Translation ID
                              Insurance Policy                              No Translation                                        No Translation               No      No Translation
                 N/A                                            Translation The ID number of the patient's insurance policy
                                                                 E07_10                                                           No Translation           Translation No Translation
                 TAC 103.1    Number                                                                                                                       Translation


                                                                            The last (family) name of the person insured by                                    No
                 N/A              Last Name of the Insured       E07_11                                                           No Translation                       No Translation
                                                                            the insurance company                                                          Translation


                                                                            The first (given) name of the person insured by                                    No
                 N/A              First Name of the Insured      E07_12                                                           No Translation                       No Translation
                                                                            the insurance company                                                          Translation


                                  Middle Initial/Name of the                The middle name, if any, of the person insured by                                  No
                 N/A                                             E07_13                                                       No Translation                           No Translation
                                  Insured                                   the insurance company                                                          Translation


                                                                            The relationship of the patient to the primary                                     No
                 N/A              Relationship to the Insured    E07_14                                                           No Translation                       No Translation
                                                                            insured person                                                                 Translation

                                                                            Indication of whether or not the injury is work                                            Indication of whether the injury occurred during
                 N/A              Work-Related                   E07_15                                                           Work-Related                I_03
                                                                            related                                                                                    paid employment
                                  Patient's Occupational                                                                          Patient's Occupational               The occupational industry associated with the
                 N/A                                             E07_16     The occupational industry of the patient's work                                   I_04
                                  Industry                                                                                        Industry                             patient's work environment
H&S 92.003       N/A              Patient's Occupation           E07_17     The occupation of the patient                         Patient's Occupation        I_05     The occupation of the patient

                                  Closest Relative/ Guardian                The last (family) name of the pt's closest relative                                No
                 N/A                                             E07_18                                                         No Translation                         No Translation
                                  Last Name                                 or guardian                                                                    Translation


                                  First Name of the Closest                 The first (given) name of the pt's closest relative                                No
                 N/A                                             E07_19                                                           No Translation                       No Translation
                                  Relative/Guardian                         or guardian                                                                    Translation




          May 28th, 2009                                                                       Please note cover on first worksheet.                                                                                                  Page 61
                                                                                    TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                            * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                              Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                     NEMSIS DATA DICTIONARY                                                                  NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                         Submerssion
                                                                                                                                                                                                Cardiac /
                                                                                                                                                                                                 Stroke
  Data Element                                                 Element                                                                                 Element




                                                                                                                                                                                                                   SCI
                                                                                                                                                                                                             TBI
                 Mandate / Rule      Data Element Name                                         Definition                         Data Element Name                                Definition
     Name                                                      Number                                                                                  Number


                 H&S 92.003                                       No                                                                                      No
Data Set ID      H&S 773.0613 No Translation
                              Middle Initial/Name of the                  No Translation                                        No Translation                    No Translation
                 N/A                                          Translation The middle name/initial, if any, of the closest
                                                               E07_20                                                           No Translation
                                                                                                                                                          No
                                                                                                                                                      Translation No Translation
                 TAC 103.1    Closest Relative/Guardian                   relative or guardian                                                        Translation


                                  Closest Relative/Guardian                The home address of the pt's closest relative or                               No
                 N/A                                           E07_21                                                           No Translation                    No Translation
                                  Street Address                           guardian                                                                   Translation


                                  Closest Relative/Guardian                The home city of the patient's closest relative or                             No
                 N/A                                           E07_22                                                           No Translation                    No Translation
                                  City                                     guardian                                                                   Translation


                                  Closest Relative/Guardian                The home state of the patient's closest relative or                            No
                 N/A                                           E07_23                                                          No Translation                     No Translation
                                  State                                    guardian                                                                   Translation


                                  Closest Relative/Guardian                The home Zip Code of the patient's closest                                     No
                 N/A                                           E07_24                                                           No Translation                    No Translation
                                  Zip Code                                 relative or guardian                                                       Translation


                                  Closest Relative/Guardian                The home or other phone no. of the patient's                                   No
                 N/A                                           E07_25                                                           No Translation                    No Translation
                                  Phone Number                             closest relative or guardian                                               Translation


                                  Closest Relative/Guardian                The relationship of the patient's closest relative or                          No
                 N/A                                           E07_26                                                            No Translation                   No Translation
                                  Relationship                             guardian                                                                   Translation


                                                                                                                                                          No
H&S 92.003       N/A              Patient's Employer           E07_27      The name of the patient's employer                   No Translation                    No Translation
                                                                                                                                                      Translation


                                  Patient's Employer's                                                                                                    No
                 N/A                                           E07_28      The street address of the patient's employer         No Translation                    No Translation
                                  Address                                                                                                             Translation




          May 28th, 2009                                                                      Please note cover on first worksheet.                                                                         Page 62
                                                                                   TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                            * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                              Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                      NEMSIS DATA DICTIONARY                                                           NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                   Submerssion
                                                                                                                                                                                          Cardiac /
                                                                                                                                                                                           Stroke
  Data Element                                                  Element                                                                          Element




                                                                                                                                                                                                             SCI
                                                                                                                                                                                                       TBI
                 Mandate / Rule      Data Element Name                                        Definition                    Data Element Name                                Definition
     Name                                                       Number                                                                           Number


                 H&S 92.003                                        No                                                                               No
Data Set ID      H&S 773.0613 No Translation                               No Translation                                 No Translation            No      No Translation
                 N/A          Patient's Employer's City        Translation The home city of the patient's employer
                                                                E07_29                                                    No Translation        Translation No Translation
                 TAC 103.1                                                                                                                      Translation


                                                                                                                                                    No
                 N/A              Patient's Employer's State    E07_30     The home state of the patient's employer       No Translation                    No Translation
                                                                                                                                                Translation


                                  Patient's Employer's Zip                                                                                          No
                 N/A                                            E07_31     The home Zip Code of the patient's employer    No Translation                    No Translation
                                  Code                                                                                                          Translation


                                  Patient's Work Telephone                                                                                          No
                 N/A                                            E07_32     The patient's work telephone no.               No Translation                    No Translation
                                  Number                                                                                                        Translation


                                                                           The urgency in which the EMS agency began to                             No
                 N/A              Response Urgency              E07_33                                                  No Translation                      No Translation
                                                                           mobilize resources                                                   Translation


                                                                                                                                                    No
                 N/A              CMS Service Level             E07_34     The CMS service level for this EMS encounter   No Translation                    No Translation
                                                                                                                                                Translation


                                                                           The condition codes are used to better describe
                                                                           the service & patient care delivery by an EMS
                                                                                                                                                    No
                 N/A              Condition Code Number         E07_35     service. Please consult CMS documentation for No Translation                     No Translation
                                                                                                                                                Translation
                                                                           detailed descriptions of these condition codes &
                                                                           their uses.




          May 28th, 2009                                                                     Please note cover on first worksheet.                                                                    Page 63
                                                                                    TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                             * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                               Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                       NEMSIS DATA DICTIONARY                                                               NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                        Submerssion
                                                                                                                                                                                               Cardiac /
                                                                                                                                                                                                Stroke
  Data Element                                                   Element                                                                              Element




                                                                                                                                                                                                                  SCI
                                                                                                                                                                                                            TBI
                 Mandate / Rule      Data Element Name                                          Definition                       Data Element Name                                Definition
     Name                                                        Number                                                                               Number


                 H&S 92.003                                         No                                                                                   No
Data Set ID      H&S 773.0613 No Translation                                No Translation                                   No Translation                      No Translation
                                                                Translation The ICD-9 Code assigned by CMS for the                                   Translation
                 TAC 103.1    ICD-9 Code for the                            condition code documented in E07_35. Please                                  No
                 N/A                                             E07_36                                                      No Translation                      No Translation
                              Condition Code No.                            consult CMS documentation for detailed                                   Translation
                                                                            descriptions of the Condition Codes & their uses


                                                                            The CMS Condition Code Modifier is used to
                                                                            better describe the EMS ground or air medical
                                                                                                                                                         No
                 N/A              Condition Code Modifier        E07_37     services response & service delivery. Please       No Translation                    No Translation
                                                                                                                                                     Translation
                                                                            consult CMS documentation for detailed
                                                                            descriptions of these modifiers & their use


                                  Other EMS Agencies at                     Other EMS agencies that were at the scene, if                                No
                 N/A                                             E08_01                                                        No Translation                    No Translation
                                  Scene                                     any                                                                      Translation


                                                                                                                                                         No
                 N/A              Other Services at Scene        E08_02     Other services that were at the scene, if any      No Translation                    No Translation
                                                                                                                                                     Translation

                                  Estimated Date/Time Initial               The date/time differential between the initial
                                                                                                                                                         No
                 N/A              Responder Arrived on           E08_03     responder and the EMS unit arriving on the         No Translation                    No Translation
                                                                                                                                                     Translation
                                  Scene                                     scene, if applicable
                                  Date/Time Initial                         The time that the initial responder arrived on the                           No
                 N/A              Responder Arrived on           E08_04                                                        No Translation                    No Translation
                                                                            scene, if applicable                                                     Translation
                                  Scene
                                  Number of Patients at                     Indicator of how many total patients were at the                             No
                 N/A                                             E08_05                                                        No Translation                    No Translation
                                  Scene                                     scene                                                                    Translation




          May 28th, 2009                                                                       Please note cover on first worksheet.                                                                       Page 64
                                                                                   TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                           * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                             Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                     NEMSIS DATA DICTIONARY                                                               NTDB DATA DICTIONARY                                                   Data Sets




                                                                                                                                                                                                                                        Submerssion
                                                                                                                                                                                                               Cardiac /
                                                                                                                                                                                                                Stroke
  Data Element                                                 Element                                                                              Element




                                                                                                                                                                                                                                  SCI
                                                                                                                                                                                                                            TBI
                 Mandate / Rule      Data Element Name                                        Definition                       Data Element Name                                  Definition
     Name                                                      Number                                                                               Number


                 H&S 92.003                                       No      Indicator if this event would be considered a                                No      Additional E-Code used to describe, for
Data Set ID      H&S 773.0613 No Translation Incident                     No Translation                                    No Translation                     No Translation
                 N/A          Mass Casualty                   Translation mass casualty incident (overwhelmed existing
                                                               E08_06                                                       Additonal E-Code       Translation example, a mass casualty evnet, or other
                                                                                                                                                      I_08
                 TAC 103.1                                                EMS resources)                                                                       external cause

                                                                          The state or regulatory number (code) associated
                                                                                                                                                       No
                 N/A              Incident Facility Code       E08_08     with the facility if the incident is a Healthcare No Translation                     No Translation
                                                                                                                                                   Translation
                                                                          Facility

                                                                          Geographic zone representing the location of the                             No
                 N/A              Scene Zone Number            E08_09                                                      No Translation                      No Translation
                                                                          scene                                                                    Translation

                                                                                                                                                               The country where the patient was found or to
                                                                  No
                 N/A              No Translation                          No Translation                                    Incident Country          I_10     which the unit responded (or best
                                                              Translation
                                                                                                                                                               approximation).

                                                                          The state, territory, or province where the patient                                  The state, territory, or province where the
                 N/A              Incident State               E08_14     was found or to which the unit responded (or best Incident State            I_11     patient was found or to which the unit                        X    X        X
                                                                          approximation)                                                                       responded (or best approximation)

                                                                          What was the outcome or result of the care                                   No
                 N/A              Outcome of the Prior Aid     E09_03                                                       No Translation                     No Translation
                                                                          performed prior to the arrival of this unit?                             Translation


                                                                          The statement of the problem by the patient or                               No
                 N/A              Chief Complaint              E09_05                                                       No Translation                     No Translation
                                                                          the history provider inone or two words                                  Translation


                                  Duration of Chief                                                                                                    No
                 N/A                                           E09_06     The time duration of the chief complaint          No Translation                     No Translation
                                  Complaint                                                                                                        Translation


                                  Time Units of Duration of               The time units of the duration of the patient's                              No
                 N/A                                           E09_07                                                       No Translation                     No Translation
                                  Chief Complaint                         chief complaint                                                          Translation




          May 28th, 2009                                                                     Please note cover on first worksheet.                                                                                         Page 65
                                                                                     TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                             * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                               Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                       NEMSIS DATA DICTIONARY                                                               NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                        Submerssion
                                                                                                                                                                                               Cardiac /
                                                                                                                                                                                                Stroke
  Data Element                                                   Element                                                                              Element




                                                                                                                                                                                                                  SCI
                                                                                                                                                                                                            TBI
                 Mandate / Rule      Data Element Name                                          Definition                       Data Element Name                                Definition
     Name                                                        Number                                                                               Number


                 H&S 92.003                                         No                                                                                   No
Data Set ID      H&S 773.0613 No Translation
                              Secondary Complaint                           No Translation                                    No Translation                     No Translation
                 N/A                                            Translation The narrative of the patient's secondary
                                                                 E09_08                                                       No Translation
                                                                                                                                                         No
                                                                                                                                                     Translation No Translation
                 TAC 103.1    Narrative                                     complaint                                                                Translation


                                  Duration of Secondary                                                                                                  No
                 N/A                                             E09_09     The duration of the secondary complaint           No Translation                     No Translation
                                  Complaint                                                                                                          Translation


                                  Time Units of Duration of                 The time units of the duration of the patient's                              No
                 N/A                                             E09_10                                                       No Translation                     No Translation
                                  Secondary Complaint                       secondary complaint                                                      Translation


                                  Chief Complaint Anatomic                  The primary anatomic location of the chief                                   No
                 N/A                                             E09_11                                                       No Translation                     No Translation
                                  Location                                  complaint as identified by EMS personnel                                 Translation


                                                                            The primary organ system of the patient injured
                                  Chief Complaint Organ                     or medically affected. This is to be completed by                            No
                 N/A                                             E09_12                                                       No Translation                     No Translation
                                  System                                    EMS personnel with a minimum of an EMT-                                  Translation
                                                                            Paramedic level of credentialing


                                                                            The kind of risk factor predictors associated with                           No
                 N/A              Vehicular Injury Indicators    E10_04                                                        No Translation                    No Translation
                                                                            the vehicle involved in the incident                                     Translation


                                  Area of the Vehicle                                                                                                    No
                 N/A                                             E10_05     The area or location of impact on the vehicle     No Translation                     No Translation
                                  Impacted by the Collision                                                                                          Translation

                                                                            The seat row location of the patient in vehicle at
                                  Seat Row Location of                                                                                                   No
                 N/A                                             E10_06     the time of the crash with the front seat numbered No Translation                    No Translation
                                  Patient in Vehicle                                                                                                 Translation
                                                                            as 1




          May 28th, 2009                                                                       Please note cover on first worksheet.                                                                       Page 66
                                                                                     TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                              * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                                Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                       NEMSIS DATA DICTIONARY                                                                       NTDB DATA DICTIONARY                                                     Data Sets




                                                                                                                                                                                                                                                    Submerssion
                                                                                                                                                                                                                           Cardiac /
                                                                                                                                                                                                                            Stroke
   Data Element                                                  Element                                                                                      Element




                                                                                                                                                                                                                                              SCI
                                                                                                                                                                                                                                        TBI
                     Mandate / Rule      Data Element Name                                       Definition                          Data Element Name                                     Definition
      Name                                                       Number                                                                                       Number


                     H&S 92.003                                     No                                                                                           No
Data Set ID          H&S 773.0613 No Translation in the
                                  Position of Patient                       No Translation                                        No Translation                         No Translation
                     N/A                                        Translation The position of the patient in seat of the vehicle at No Translation
                                                                 E10_07
                                                                                                                                                                 No
                                                                                                                                                             Translation No Translation
                     TAC 103.1    Seat of the Vehicle                       the time of the crash                                                            Translation


                                                                                                                                                                         Protective devices (safety equipment) in use or
Protective Devices   N/A                                                                                                          Protective Devices            I_14                                                          X
                                      Use of Occupant Safety                 Safety equipment in use by the patient at the time                                          worn by the patient at the time of the injury
                                                                 E10_08
                                      Equipment                              of the injury
                                                                                                                                                                         Child Care Seat/Infant Car Seat/Child Booster
                     N/A                                                                                                          Child Specific Restraint      I_15
                                                                                                                                                                         Seat
                                                                             Indication of Airbag deployment during the motor                                            Indication of Airbag deployment during the
                     N/A              Airbag Deployment          E10_09                                                       Airbag Deployment                 I_16
                                                                             vehicle crash                                                                               motor vehicle cras

                                                                             The distance in feet the patient fell, measured                                     No
                     N/A              Height of Fall             E10_10                                                         No Translation                           No Translation
                                                                             from the lowest point of the patient to the ground                              Translation


                                                                             Indication of the presence of a cardiac arrest at                                   No
                     N/A              Cardiac Arrest             E11_01                                                           No Translation                         No Translation
                                                                             any time associated with the EMS event                                          Translation


                                                                             Indication of the etiology or cause of the cardiac                                  No
                     N/A              Cardiac Arrest Etiology    E11_02                                                           No Translation                         No Translation
                                                                             arrest (classified as cardiac, non-cardiac, etc.)                               Translation

                                                                             Indication of an attempt to resuscitate the patient
                                                                                                                                                                 No
                     N/A              Resuscitation Attempted    E11_03      who is in cardiac arrest (attempted, not attempted No Translation                           No Translation
                                                                                                                                                             Translation
                                                                             due to DNR, etc.)

                                                                             Indication of who the cardiac arrest was                                            No
                     N/A              Arrest Witnessed By        E11_04                                                           No Translation                         No Translation
                                                                             witnessed by                                                                    Translation




          May 28th, 2009                                                                        Please note cover on first worksheet.                                                                                                  Page 67
                                                                                   TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                           * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                             Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                     NEMSIS DATA DICTIONARY                                                                  NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                         Submerssion
                                                                                                                                                                                                Cardiac /
                                                                                                                                                                                                 Stroke
  Data Element                                                 Element                                                                                 Element




                                                                                                                                                                                                                   SCI
                                                                                                                                                                                                             TBI
                 Mandate / Rule      Data Element Name                                         Definition                         Data Element Name                                Definition
     Name                                                      Number                                                                                  Number


                 H&S 92.003                                       No                                                                                      No
Data Set ID      H&S 773.0613 No Translation Rhythm of
                              First Monitored                             No Translation                                   No Translation                         No Translation
                 N/A                                          Translation Documentation of what the first monitored rhythm No Translation
                                                               E11_05
                                                                                                                                                          No
                                                                                                                                                      Translation No Translation
                 TAC 103.1    the Patient                                 which was noted                                                             Translation

                                                                          Indication whether or not there was any return of
                                  Any Return of                                                                                                           No
                 N/A                                           E11_06     spontaneous circulation at any time during the    No Translation                        No Translation
                                  Spontaneous Circulation                                                                                             Translation
                                                                          EMS event

                                                                          The level of cerebral performance of the patient
                                  Neurological Outcome at                 at the time of discharge from the Hospital:                                     No
                 N/A                                           E11_07                                                           No Translation                    No Translation
                                  Hospital Discharge                      [multiple options in definition see page 283 of                             Translation
                                                                          NEMSIS data dictionary v. 2.2.1]

                                                                          The length of time the patient was down
                                  Estimated Time of Arrest                                                                                                No
                 N/A                                           E11_08     (estimated) before the responding unti arrived at No Translation                        No Translation
                                  Prior to EMS Arrival                                                                                                Translation
                                                                          the patient

                                  Date/Time Resuscitation                 The date/time the CPR was discontinued (or                                      No
                 N/A                                           E11_09                                                           No Translation                    No Translation
                                  Discontinued                            could be time of death)                                                     Translation


                                  Reason for CPR                          The reason that CPR or the resuscitation efforts                                No
                 N/A                                           E11_10                                                           No Translation                    No Translation
                                  Discontinued                            were discontinued                                                           Translation


                                  Cardiac Rhythm on Arrival               The patient's cardiac rhythm upon delivery or                                   No
                 N/A                                           E11_11                                                           No Translation                    No Translation
                                  at Destination                          transfer to the destination                                                 Translation

                                                                          Indication of whether or not there were any
                                                                                                                                                          No
                 N/A              Barriers to Patient Care     E12_01     patient specific barriers to serving the patient at   No Translation                    No Translation
                                                                                                                                                      Translation
                                                                          the scene




          May 28th, 2009                                                                     Please note cover on first worksheet.                                                                          Page 68
                                                                                 TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                          * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                            Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                    NEMSIS DATA DICTIONARY                                                                 NTDB DATA DICTIONARY                                                    Data Sets




                                                                                                                                                                                                                                          Submerssion
                                                                                                                                                                                                                 Cardiac /
                                                                                                                                                                                                                  Stroke
  Data Element                                                Element                                                                                Element




                                                                                                                                                                                                                                    SCI
                                                                                                                                                                                                                              TBI
                 Mandate / Rule      Data Element Name                                       Definition                         Data Element Name                                  Definition
     Name                                                     Number                                                                                 Number


                 H&S 92.003                                      No                                                                                     No
Data Set ID      H&S 773.0613 No Translation Medical
                              Sending Facility                           No Translation                                    No Translation                       No Translation
                 N/A                                         Translation The medical record number of the medical facility No Translation
                                                              E12_02
                                                                                                                                                        No
                                                                                                                                                    Translation No Translation
                 TAC 103.1    Record Number                              who is transferring care to EMS                                            Translation


                                  Destination Medical                    The patient's medical record number at the                                     No
                 N/A                                          E12_03                                                        No Translation                      No Translation
                                  Record Number                          patient's receiving facility                                               Translation


                                  First Name of Patient's                                                                                               No
                 N/A                                          E12_04     The first name of the patient's primary practitioner No Translation                    No Translation
                                  Primary Practitioner                                                                                              Translation


                                  Middle Name of Patient's               The middle name of the patient's primary                                       No
                 N/A                                          E12_05                                                        No Translation                      No Translation
                                  Primary Practitioner                   practitioner                                                               Translation


                                  Last Name of Patient's                                                                                                No
                 N/A                                          E12_06     The last name of the patient's primary practitioner No Translation                     No Translation
                                  Primary Practitioner                                                                                              Translation

                                                                         The presence of a valid form of living will
                                                                                                                                                        No
                 N/A              Advanced Directives         E12_07     document directing end of life or healthcare       No Translation                      No Translation
                                                                                                                                                    Translation
                                                                         treatment decisions

                                                                                                                                                        No
                 N/A              Medication Allergies        E12_08     The patient's medication allergies                 No Translation                      No Translation
                                                                                                                                                    Translation


                                  Environmental/Food                     The patient's known allergies to food or                                       No
                 N/A                                          E12_09                                                        No Translation                      No Translation
                                  Allergies                              environmental agents                                                       Translation

                                                                         The patient's pre-existing medical and surgical                                        Pre-existing co-morbid factors present beflore
                 N/A              Medical/Surgical History    E12_10                                                        Co-Morbid Conditions     DG_01
                                                                         history of the patient                                                                 patient arrival at the ED/hospital




          May 28th, 2009                                                                   Please note cover on first worksheet.                                                                                             Page 69
                                                                                TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                         * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                           Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                   NEMSIS DATA DICTIONARY                                                              NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                   Submerssion
                                                                                                                                                                                          Cardiac /
                                                                                                                                                                                           Stroke
  Data Element                                               Element                                                                             Element




                                                                                                                                                                                                             SCI
                                                                                                                                                                                                       TBI
                 Mandate / Rule     Data Element Name                                       Definition                      Data Element Name                                Definition
     Name                                                    Number                                                                              Number


                 H&S 92.003                                     No                                                                                  No
Data Set ID      H&S 773.0613 No Translation Obtained
                              Medical History                           No Translation                                    No Translation            No      No Translation
                 N/A                                        Translation Type of person medical history obtained from
                                                             E12_11                                                       No Translation        Translation No Translation
                 TAC 103.1    From                                                                                                              Translation


                                                                        The type of immunization the patient has                                    No
                 N/A              Immunizatkion History      E12_12                                                       No Translation                    No Translation
                                                                        received                                                                Translation


                                                                                                                                                    No
                 N/A              Immunization Date          E12_13     The date of the associated immunization type      No Translation                    No Translation
                                                                                                                                                Translation


                                                                                                                                                    No
                 N/A              Current Medications        E12_14     The medications the patient currently takes       No Translation                    No Translation
                                                                                                                                                Translation


                                                                        The numeric dose or amount of the patient's                                 No
                 N/A              Current Medication Dose    E12_15                                                       No Translation                    No Translation
                                                                        current medication                                                      Translation


                                  Current Medication                    The dosage unit of the patient's current                                    No
                 N/A                                         E12_16                                                       No Translation                    No Translation
                                  Dosage Unit                           medication                                                              Translation


                                  Current Medication                    The administration route (po, SQ, dtc.) of the                              No
                 N/A                                         E12_17                                                       No Translation                    No Translation
                                  Administration Route                  patient's current medication                                            Translation


                                                                        Indication of the presence of the Emergency
                                  Presence of Emergency                                                                                             No
                 N/A                                         E12_18     Information Form associated with patient's with   No Translation                    No Translation
                                  Information Form                                                                                              Translation
                                                                        special healthcare needs




          May 28th, 2009                                                                  Please note cover on first worksheet.                                                                       Page 70
                                                                                       TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                               * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                                 Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                        NEMSIS DATA DICTIONARY                                                                    NTDB DATA DICTIONARY                                                     Data Sets




                                                                                                                                                                                                                                                  Submerssion
                                                                                                                                                                                                                         Cardiac /
                                                                                                                                                                                                                          Stroke
  Data Element                                                    Element                                                                                   Element




                                                                                                                                                                                                                                            SCI
                                                                                                                                                                                                                                      TBI
                 Mandate / Rule      Data Element Name                                            Definition                          Data Element Name                                  Definition
     Name                                                         Number                                                                                    Number


                 H&S 92.003                                          No                                                                                        No
Data Set ID      H&S 773.0613 No Translation
                              Alcohol/Drug Use                               No Translation                                        No Translation                      No Translation
                 N/A                                             Translation Indicators for the potential use of Alcohol or
                                                                  E12_19                                                           No Translation
                                                                                                                                                               No
                                                                                                                                                           Translation No Translation                                                                X
                 TAC 103.1    Indicators                                     Drugs by the patient                                                          Translation


                                                                              Indication of the possibility by the patient's history                           No
                 N/A              Pregnancy                       E12_20                                                             No Translation                    No Translation
                                                                              of current pregnancy                                                         Translation


                                                                                                                                                               No
                 N/A              Run Report Narrative            E13_01      The narrative of the run report                      No Translation                      No Translation
                                                                                                                                                           Translation


                                  Date/Time Vital Signs                                                                                                        No
                 N/A                                              E14_01      The date/time vital signs taken                      No Translation                      No Translation
                                  Taken                                                                                                                    Translation

                                                                              Indicates that the information which is
                                  Obtained Prior to this Units                                                                                                 No
                 N/A                                              E14_02      documented was obtained prior to the EMS unit's No Translation                           No Translation
                                  EMS Care                                                                                                                 Translation
                                                                              care creating this patient care report

                                                                              The initial cardiac rhythm of the patient as                                     No
                 N/A              Cardiac Rhythm                  E14_03                                                           No Translation                      No Translation
                                                                              interpreted by EMS personnel                                                 Translation


                                  DBP (Diastolic Blood                                                                                                         No
                 N/A                                              E14_05      The patient's diastolic blood pressure               No Translation                      No Translation
                                  Pressure)                                                                                                                Translation


                                  Method of Blood Pressure                                                                                                     No
                 N/A                                              E14_06      Indication of method of blood pressure procedure No Translation                          No Translation
                                  Measurement                                                                                                              Translation

                                                                                                                                                                       First recorded pulse rate in the pre-hospital
                                                                              The patients pulse rate, palpated or auscultated,
                 N/A              Pulse Rate                      E14_07                                                        Initial Field Pulse Rate     P_10      setting (palpated or auscultated), expressed as
                                                                              expressed as a number per minute
                                                                                                                                                                       a number per minute




          May 28th, 2009                                                                         Please note cover on first worksheet.                                                                                               Page 71
                                                                              TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                      * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                        Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                NEMSIS DATA DICTIONARY                                                                    NTDB DATA DICTIONARY                                                     Data Sets




                                                                                                                                                                                                                                          Submerssion
                                                                                                                                                                                                                 Cardiac /
                                                                                                                                                                                                                  Stroke
  Data Element                                            Element                                                                                   Element




                                                                                                                                                                                                                                    SCI
                                                                                                                                                                                                                              TBI
                 Mandate / Rule      Data Element Name                                    Definition                        Data Element Name                                     Definition
     Name                                                 Number                                                                                    Number


                 H&S 92.003                                  No      TheTranslation                                                                    No
Data Set ID      H&S 773.0613 No Translation Rate                    No patient's heart rate as recorded by an          No Translation                 No      No Translation
                 N/A          Electronic Monitor         Translation electronic monitoring device (ECG, pulse
                                                          E14_08                                                        No Translation             Translation No Translation
                 TAC 103.1                                                                                                                         Translation
                                                                     oximetry, etc.)

                                                                                                                        Initial Field Oxygen                   First recorded oxygen saturation in the pre-
                 N/A              Pulse Oximetry          E14_09     The patient's oxygen saturation                                                 P_12
                                                                                                                        Saturation                             hospital setting (expressed as a percentage)


                                                                     The clinical rhythm of the patient's pulse (regular,                              No
                 N/A              Pulse Rhythm            E14_10                                                          No Translation                       No Translation
                                                                     irregular, etc.)                                                              Translation


                                                                                                                                                       No
                 N/A              Respiratory Effort      E14_12     The patient's respiratory effort                   No Translation                         No Translation
                                                                                                                                                   Translation


                                                                                                                                                       No
                 N/A              Carbon Dioxide          E14_13     The patient's end-tidal or other CO2 level         No Translation                         No Translation
                                                                                                                                                   Translation


                                                                                                                                                       No
                 N/A              Blood Glucose Level     E14_14     The patient's blood glucose level                  No Translation                         No Translation
                                                                                                                                                   Translation

                                  Glasgow Coma Score -                                                                                                         First recorded Glasgow Coma Score (Eye) in
                 N/A                                      E14_15     The patient's Glasgow Coma Score eye opening Initial Field GCS-Eye              P_13
                                  Eye                                                                                                                          the pre-hospital setting
                                  Glasgow Coma Score -                                                                                                         First recorded Glasgow Coma Score (Verbal) in
                 N/A                                      E14_16     The patient's Glasgow Coma Score verbal            Initial Field GCS-Verbal     P_14
                                  Verbal                                                                                                                       the pre-hospital setting
                                  Glasgow Coma Score -                                                                                                         First recorded Glasgow Coma Score (Motor) in
                 N/A                                      E14_17     The patient's Glasgow Coma Score motor             Initial Field GCS-Motor      P_15
                                  Motor                                                                                                                        the pre-hospital setting
                                                                                                                                                               Documentation of factors potentially affecting
                                  Glasgow Coma Score -               Documentation of factors which make the GCS        Initial ED/Hospital GCS
                 N/A                                      E14_18                                                                                    ED_14      the first assessment of GCS upon arrival in the
                                  Qualifier                          score more meaningful                              Assessment Qualifiers
                                                                                                                                                               ED/hospital




          May 28th, 2009                                                                Please note cover on first worksheet.                                                                                                Page 72
                                                                             TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                      * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                        Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                NEMSIS DATA DICTIONARY                                                                   NTDB DATA DICTIONARY                                               Data Sets




                                                                                                                                                                                                                                   Submerssion
                                                                                                                                                                                                          Cardiac /
                                                                                                                                                                                                           Stroke
  Data Element                                            Element                                                                                  Element




                                                                                                                                                                                                                             SCI
                                                                                                                                                                                                                       TBI
                 Mandate / Rule     Data Element Name                                    Definition                         Data Element Name                                  Definition
     Name                                                 Number                                                                                   Number


                 H&S 92.003   Total Glasgow Coma             No                                                                                       No
Data Set ID      N/A 773.0613 No Translation              E14_19 No Translation                                         No Translation                        TheTranslation
                                                                                                                                                              No recorded Glasgow Coma Score (Total) in
                 H&S          Score                      Translation The patient's total Glasgow Coma Score             Initial Field GCS-Total      P_16
                                                                                                                                                  Translation the pre-hospital setting
                 TAC 103.1
                                                                     The patient's body temperature in degrees                                        No
                 N/A              Temperature             E14_20                                                        No Translation                        No Translation
                                                                     celsius/centigrade                                                           Translation


                                                                     The method used to obtain the patient's body                                     No
                 N/A              Temperature Method      E14_21                                                        No Translation                        No Translation
                                                                     temperature                                                                  Translation


                                                                                                                                                      No
                 N/A              Level of Response       E14_22     The patient's level of response                    No Translation                        No Translation
                                                                                                                                                  Translation


                                                                     The patient's indication of pain from a scale of 0 -                             No
                 N/A              Pain Scale              E14_23                                                          No Translation                      No Translation
                                                                     10                                                                           Translation


                                                                     The patient's Los Angeles or Cincinnati Stroke                                   No
                 N/A              Stroke Scale            E14_24                                                        No Translation                        No Translation
                                                                     Scale Results                                                                Translation


                                                                     The results of the patient's Thrombolytic Screen                                 No
                 N/A              Thrombolytic Screen     E14_25                                                        No Translation                        No Translation
                                                                     for potential Thrombolytic use                                               Translation

                                                                     The patient's total APGAR score (0 - 10).
                                                                                                                                                      No
                 N/A              APGAR                   E14_26     Recommended to be taken at 1 and 5 minutes         No Translation                        No Translation
                                                                                                                                                  Translation
                                                                     after the infant's birth

                                                                                                                                                      No
                 N/A              Revised Trauma Score    E14_27     The patient's Revised Trauma Score                 No Translation                        No Translation
                                                                                                                                                  Translation




          May 28th, 2009                                                               Please note cover on first worksheet.                                                                                          Page 73
                                                                                   TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                            * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                              Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                      NEMSIS DATA DICTIONARY                                                               NTDB DATA DICTIONARY                                     Data Sets




                                                                                                                                                                                                                           Submerssion
                                                                                                                                                                                                  Cardiac /
                                                                                                                                                                                                   Stroke
  Data Element                                                  Element                                                                              Element




                                                                                                                                                                                                                     SCI
                                                                                                                                                                                                               TBI
                 Mandate / Rule     Data Element Name                                          Definition                       Data Element Name                                  Definition
     Name                                                       Number                                                                               Number


                 H&S 92.003                                        No                                                                                   No
Data Set ID      H&S 773.0613 No Translation Score                         No Translation                                 No Translation                No      No Translation
                 N/A          Pediatric Trauma                 Translation The Trauma Score for patients age 12 and under No Translation
                                                                E14_28                                                                              Translation No Translation
                 TAC 103.1                                                                                                                          Translation


                                  MHTSA Injury Matrix                      Type of Injury indentified and associated with the
                 N/A                                            E15_01
                                  External/Skin                            external body/Skin (including burns)

                                                                           Type of Injury indentified and associated with the
                 N/A              NHTSA Injury Matrix Head      E15_02     Head (excluding face, neck, cervical spine, and
                                                                           ear)
                                                                                                                                                        No
                                                                           Type of Injury indentified and associated with the     No Translation                                 No Translation
                 N/A              NHTSA Injury Matrix Face      E15_03                                                                              Translation
                                                                           Face (including ear)
                                                                           Type of Injury indentified and associated with the
                 N/A              NHTSA Injury Matrix Neck      E15_04
                                                                           Neck

                                  NHTSA Injury Matrix                      Type of Injury indentified and associated with the
                 N/A                                            E15_05
                                  Thorax                                   Thorax (excluding the thoracic spine)


                                  NHTSA Injury Matrix                      Type of Injury indentified and associated with the
                 N/A                                            E15_06
                                  Abdomen                                  Abdomen (excluding the lumbar spine)

                                                                           Type of Injury indentified and associated with the
                 N/A              NHTSA Injury Matrix Spine     E15_07
                                                                           Spine
                                  NHTSA Injury Matrix Upper                Type of Injury indentified and associated with the
                 N/A                                            E15_08                                                                                  No
                                  Extremities                              Upper Extremities                                      No Translation                                 No Translation
                                                                                                                                                    Translation
                                                                           Type of Injury indentified and associated with the
                 N/A              NHTSA Injury Matrix Pelvis    E15_09
                                                                           Pelvis
                                  NHTSA Injury Matrix Lower                Type of Injury indentified and associated with the
                 N/A                                            E15_10
                                  Extremities                              Lower Extremities




          May 28th, 2009                                                                     Please note cover on first worksheet.                                                                            Page 74
                                                                                 TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                         * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                           Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                   NEMSIS DATA DICTIONARY                                                                 No
                                                                                                                                                  NTDB DATA DICTIONARYNo Translation                  Data Sets
                                                                                                                               No Translation
                                                                                                                                                Translation




                                                                                                                                                                                                                   Submerssion
                                                                                                                                                                                          Cardiac /
                                                                                                                                                                                           Stroke
  Data Element                                               Element                                                                             Element




                                                                                                                                                                                                             SCI
                                                                                                                                                                                                       TBI
                 Mandate / Rule     Data Element Name                                       Definition                     Data Element Name                                 Definition
     Name                                                    Number                                                                              Number


                 H&S 92.003   NHTSA Injury Matrix               No      Type of Injury indentified and associated with                              No
Data Set ID      N/A 773.0613 No Translation
                 H&S                                         E15_11 No Translation                                       No Translation                     No Translation
                              Unspecified                   Translation Unspecified                                                             Translation
                 TAC 103.1
                                                                        The patient's body weight in kilograms, either                              No
                 N/A              Estimated Body Weight      E16_01                                                      No Translation                     No Translation
                                                                        measured or estimated                                                   Translation


                                                                                                                                                    No
                 N/A              Broselow/Luten Color       E16_02     The Broselow/Luten Color as taken from the tape No Translation                      No Translation
                                                                                                                                                Translation


                                                                        The date/time assessment was made on the                                    No
                 N/A              Date/Time of Assessment    E16_03                                                      No Translation                     No Translation
                                                                        patient                                                                 Translation


                                                                        The assessment of the patient's skin on                                     No
                 N/A              Skin Assessment            E16_04                                                      No Translation                     No Translation
                                                                        examination                                                             Translation


                                                                        The assessment of the patient's face on                                     No
                 N/A              Head/Face Assessment       E16_05                                                      No Translation                     No Translation
                                                                        examination                                                             Translation


                                                                        The assessment of the patient's head & neck                                 No
                 N/A              Neck Assessment            E16_06                                                      No Translation                     No Translation
                                                                        area on examination                                                     Translation


                                                                        The assessment of the patient's chest on                                    No
                 N/A              Chest/Lungs Assessment     E16_07                                                      No Translation                     No Translation
                                                                        examination                                                             Translation


                                                                        The assessment of the patient's heart on                                    No
                 N/A              Heart Assessment           E16_08                                                      No Translation                     No Translation
                                                                        examination                                                             Translation




          May 28th, 2009                                                                   Please note cover on first worksheet.                                                                      Page 75
                                                                                  TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                          * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                            Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                    NEMSIS DATA DICTIONARY                                                             NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                   Submerssion
                                                                                                                                                                                          Cardiac /
                                                                                                                                                                                           Stroke
  Data Element                                                Element                                                                            Element




                                                                                                                                                                                                             SCI
                                                                                                                                                                                                       TBI
                 Mandate / Rule     Data Element Name                                        Definition                     Data Element Name                                Definition
     Name                                                     Number                                                                             Number


                 H&S 92.003                                      No                                                                                 No
Data Set ID      H&S 773.0613 No TranslationUpper
                              Abdomen Left                               No Translation                                  No Translation                     No Translation
                 N/A                                         Translation The assessment of the patient's left upper
                                                              E16_09                                                     No Translation
                                                                                                                                                    No
                                                                                                                                                Translation No Translation
                 TAC 103.1    Assessment                                 abdomen on examination                                                 Translation


                                  Abdomen Left Lower                     The assessment of the patient's left lower                                 No
                 N/A                                          E16_10                                                     No Translation                     No Translation
                                  Assessment                             abdomen on examination                                                 Translation


                                  Abdomen Right Upper                    The assessment of the patient's right upper                                No
                 N/A                                          E16_11                                                     No Translation                     No Translation
                                  Assessment                             abdomen on examination                                                 Translation


                                  Abdomen Right Lower                    The assessment of the patient's right lower                                No
                 N/A                                          E16_12                                                     No Translation                     No Translation
                                  Assessment                             abdomen on examination                                                 Translation


                                                                         The assessment of the patient's GU area on                                 No
                 N/A              GU Assessment               E16_13                                                     No Translation                     No Translation
                                                                         examination                                                            Translation


                                                                         The assessment of the patient's back-cervical on                           No
                 N/A              Back Cervical Assessment    E16_14                                                      No Translation                    No Translation
                                                                         examination                                                            Translation


                                                                         The assessment of the patient's back-thoracic on                           No
                 N/A              Back Thoracic Assessment    E16_15                                                      No Translation                    No Translation
                                                                         examination                                                            Translation


                                  Back Lumbar/Sacral                     The assessment of the patient's back-                                      No
                 N/A                                          E16_16                                                     No Translation                     No Translation
                                  Assessment                             lumbar/sacral on examination                                           Translation


                                  Extremities-Right Upper                The assessment of the patient's right upper                                No
                 N/A                                          E16_17                                                     No Translation                     No Translation
                                  Assessment                             extremities on examination                                             Translation




          May 28th, 2009                                                                   Please note cover on first worksheet.                                                                      Page 76
                                                                                  TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                          * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                            Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                    NEMSIS DATA DICTIONARY                                                             NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                   Submerssion
                                                                                                                                                                                          Cardiac /
                                                                                                                                                                                           Stroke
  Data Element                                                Element                                                                            Element




                                                                                                                                                                                                             SCI
                                                                                                                                                                                                       TBI
                 Mandate / Rule      Data Element Name                                       Definition                     Data Element Name                                Definition
     Name                                                     Number                                                                             Number


                 H&S 92.003                                      No                                                                                 No
Data Set ID      H&S 773.0613 No Translation Lower
                              Extremities-Right                          No Translation                                  No Translation                     No Translation
                 N/A                                         Translation The assessment of the patient's right lower
                                                              E16_18                                                     No Translation
                                                                                                                                                    No
                                                                                                                                                Translation No Translation
                 TAC 103.1    Assessment                                 extremities on examination                                             Translation


                                  Extremities-Left Upper                 The assessment of the patient's left upper                                 No
                 N/A                                          E16_19                                                     No Translation                     No Translation
                                  Assessment                             extremities on examination                                             Translation


                                  Extremities-Left Lower                 The assessment of the patient's left lower                                 No
                 N/A                                          E16_20                                                     No Translation                     No Translation
                                  Assessment                             extremities on examination                                             Translation


                                                                         The assessment of the patient's left eye on                                No
                 N/A              Eyes-Left Assessment        E16_21                                                     No Translation                     No Translation
                                                                         examination                                                            Translation


                                                                         The assessment of the patient's right eye on                               No
                 N/A              Eyes-Right Assessment       E16_22                                                     No Translation                     No Translation
                                                                         examination                                                            Translation


                                                                         The assessment of the patient's mental status on                           No
                 N/A              Mental Status Assessment    E16_23                                                      No Translation                    No Translation
                                                                         examination                                                            Translation


                                                                         The assessment of the patient's neurological                               No
                 N/A              Neurologica Assessment      E16_24                                                     No Translation                     No Translation
                                                                         status on examination                                                  Translation


                                                                         The protocol used by EMS personnel to direct the                           No
                 N/A              Protocols Used              E17_01                                                      No Translation                    No Translation
                                                                         clinical care of the patient                                           Translation


                                  Date/Time Medication                   The date/time medication administered to the                               No
                 N/A                                          E18_01                                                     No Translation                     No Translation
                                  Administered                           patient                                                                Translation




          May 28th, 2009                                                                   Please note cover on first worksheet.                                                                      Page 77
                                                                                 TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                          * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                            Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                    NEMSIS DATA DICTIONARY                                                              NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                    Submerssion
                                                                                                                                                                                           Cardiac /
                                                                                                                                                                                            Stroke
  Data Element                                                Element                                                                             Element




                                                                                                                                                                                                              SCI
                                                                                                                                                                                                        TBI
                 Mandate / Rule      Data Element Name                                      Definition                       Data Element Name                                Definition
     Name                                                     Number                                                                              Number


                 H&S 92.003       Medication Administered        No      Indicates that the medication administration                                No
Data Set ID      H&S 773.0613     No Translation                         No Translation                                    No Translation            No      No Translation
                 N/A              Prior to This Units EMS    Translation which is documented was administered prior to
                                                              E18_02                                                       No Translation        Translation No Translation
                 TAC 103.1                                                                                                                       Translation
                                  Care                                   this EMS unit's care

                                                                                                                                                     No
                 N/A              Medication Given            E18_03     The medication given to the patient               No Translation                    No Translation
                                                                                                                                                 Translation


                                  Medication Administred                 The route that the medication was administered                              No
                 N/A                                          E18_04                                                       No Translation                    No Translation
                                  Route                                  to the patient                                                          Translation


                                                                         The dose or amount of medication given to the                               No
                 N/A              Medication Dosage           E18_05                                                       No Translation                    No Translation
                                                                         patient                                                                 Translation


                                                                                                                                                     No
                 N/A              Medication Dosage Units     E18_06     The units of medication dosage given to patient   No Translation                    No Translation
                                                                                                                                                 Translation


                                                                                                                                                     No
                 N/A              Response to Medication      E18_07     The patient's response to the medication          No Translation                    No Translation
                                                                                                                                                 Translation

                                                                         Any complication (abnormal effect on the patient)
                                                                                                                                                     No
                 N/A              Medication Complication     E18_08     associated with the administration of the         No Translation                    No Translation
                                                                                                                                                 Translation
                                                                         medication to the patient by EMS

                                  Medication Crew Member                 The statewide assigned ID numberr of the EMS                                No
                 N/A                                          E18_09                                                       No Translation                    No Translation
                                  ID                                     crew member giving the treatment to the patient                         Translation


                                                                                                                                                     No
                 N/A              Medication Authorization    E18_10     The type of treatment authorization obtained      No Translation                    No Translation
                                                                                                                                                 Translation




          May 28th, 2009                                                                   Please note cover on first worksheet.                                                                       Page 78
                                                                                   TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                           * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                             Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                     NEMSIS DATA DICTIONARY                                                                NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                       Submerssion
                                                                                                                                                                                              Cardiac /
                                                                                                                                                                                               Stroke
  Data Element                                                 Element                                                                               Element




                                                                                                                                                                                                                 SCI
                                                                                                                                                                                                           TBI
                 Mandate / Rule      Data Element Name                                        Definition                        Data Element Name                                Definition
     Name                                                      Number                                                                                Number


                 H&S 92.003                                       No                                                                                    No
Data Set ID      H&S 773.0613 No Translation
                                                                          TheTranslation of the authorizing physician
                                                                          No last name                                        No Translation                    No Translation
                              Medication Authorizating        Translation ordering the medication administration if the order                       Translation
                                                                                                                                                        No
                 N/A
                 TAC 103.1                                     E18_11                                                         No Translation                    No Translation
                              Physician                                   was provided by any manner other than protocol                            Translation
                                                                          (standing order) in E18_10

                                  Date/Time Procedure                     The date/time the procedure was performed on                                  No
                 N/A                                           E19_01                                                        No Translation                     No Translation
                                  Performed Successfully                  the patient                                                               Translation

                                                                          Indicates that the procedure which was
                                  Procedure Performed Prior                                                                                             No
                 N/A                                           E19_02     performed and documented was performed prior No Translation                           No Translation
                                  to this Unit's EMS Care                                                                                           Translation
                                                                          to this EMS unit's care

                                  Size of the Procedure                   The size of equipment used in the procedure on                                No
                 N/A                                           E19_04                                                        No Translation                     No Translation
                                  Equipment                               the patient                                                               Translation


                                  Number of Procedure                     The number of attempts taken to complete a                                    No
                 N/A                                           E19_05                                                        No Translation                     No Translation
                                  Attempts                                procedure or intervention regardless of success                           Translation


                                                                          Indication of whether or not the procedure                                    No
                 N/A              Procedure Successful         E19_06                                                        No Translation                     No Translation
                                                                          performed on the patient was successful                                   Translation


                                                                          Any complication associated with the                                          No
                 N/A              Procedure Complication       E19_07                                                        No Translation                     No Translation
                                                                          performance of the procedure on the patient                               Translation


                                                                                                                                                        No
                 N/A              Response to Procedure        E19_08     The patient's response to the procedure            No Translation                     No Translation
                                                                                                                                                    Translation




          May 28th, 2009                                                                     Please note cover on first worksheet.                                                                        Page 79
                                                                                    TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                            * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                              Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                       NEMSIS DATA DICTIONARY                                                                NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                         Submerssion
                                                                                                                                                                                                Cardiac /
                                                                                                                                                                                                 Stroke
  Data Element                                                   Element                                                                               Element




                                                                                                                                                                                                                   SCI
                                                                                                                                                                                                             TBI
                 Mandate / Rule      Data Element Name                                          Definition                        Data Element Name                                Definition
     Name                                                        Number                                                                                Number


                 H&S 92.003                                         No      TheTranslationassigned ID numberr of the EMS                                  No
Data Set ID      H&S 773.0613 No Translation Member
                              Procedure Crew                                No statewide                                        No Translation            No      No Translation
                 N/A                                            Translation crew member performing the procedure on the
                                                                 E19_09                                                         No Translation        Translation No Translation
                 TAC 103.1    ID                                                                                                                      Translation
                                                                            patient

                                                                                                                                                          No
                 N/A              Procedure Authorization        E19_10    The type of procedure authorization obtained         No Translation                    No Translation
                                                                                                                                                      Translation

                                                                           The last name of the authorizing physician
                                  Procedure Authorizing                    ordering the procedure, if the order was provided                              No
                 N/A                                             E19_11                                                      No Translation                       No Translation
                                  Physician                                by any manner other than protocol (standing                                Translation
                                                                           order)

                                                                           The location of the IV site (if applicable) on the                             No
                 N/A              Successful IV Site             E19_12                                                         No Translation                    No Translation
                                                                           patient                                                                    Translation


                                                                           Endotracheal Tube placement verification at the                                No
                 N/A              Tube Confirmation              E19_13                                                         No Translation                    No Translation
                                                                           time the airway procedure was done                                         Translation


                                  Destination Confirmation of              Endotracheal Tube location verification on arrival                             No
                 N/A                                             E19_14                                                       No Translation                      No Translation
                                  Tube Placement                           at the Destination (if applicable)                                         Translation


                                  Destination/Transferred                  The destination the patient was delivered or                                   No
                 N/A                                             E20_01                                                         No Translation                    No Translation
                                  To, Name                                 transferred to                                                             Translation


                                                                           The street address of the destination the patient                              No
                 N/A              Destination Street Address     E20_03                                                         No Translation                    No Translation
                                                                           was delivered or transferred to                                            Translation




          May 28th, 2009                                                                      Please note cover on first worksheet.                                                                         Page 80
                                                                                    TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                            * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                              Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                      NEMSIS DATA DICTIONARY                                                                NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                        Submerssion
                                                                                                                                                                                               Cardiac /
                                                                                                                                                                                                Stroke
  Data Element                                                  Element                                                                               Element




                                                                                                                                                                                                                  SCI
                                                                                                                                                                                                            TBI
                 Mandate / Rule      Data Element Name                                         Definition                        Data Element Name                                Definition
     Name                                                       Number                                                                                Number


                 H&S 92.003                                        No                                                                                    No
Data Set ID      H&S 773.0613 No Translation                               No Translation                                      No Translation                    No Translation
                 N/A          Destination City                 Translation The city name of the destination the patient was
                                                                E20_04                                                         No Translation
                                                                                                                                                         No
                                                                                                                                                     Translation No Translation
                 TAC 103.1                                                 delivered or transferred to                                               Translation


                                                                           The destination State in which the patient was                                No
                 N/A              Destination State             E20_05                                                         No Translation                    No Translation
                                                                           delivered or transferred to                                               Translation


                                                                           The destination County in which the patient was                               No
                 N/A              Destination County            E20_06                                                         No Translation                    No Translation
                                                                           delivered or transferred to                                               Translation


                                                                           The destination zip code in which the patient was                             No
                 N/A              Destination Zip Code          E20_07                                                       No Translation                      No Translation
                                                                           delivered or transferred to                                               Translation


                                                                           The destination GPS coordinates to which the                                  No
                 N/A              Destination GPS Location      E20_08                                                         No Translation                    No Translation
                                                                           patient was delivered or transferred to                                   Translation


                                                                           The zone number of the destination the patient                                No
                 N/A              Destination Zone Number       E20_09                                                         No Translation                    No Translation
                                                                           was delivered or transferred to                                           Translation


                                  How Patient was Moved to                 The method the patient was moved to the                                       No
                 N/A                                            E20_11                                                         No Translation                    No Translation
                                  Ambulance                                ambulance from the scene                                                  Translation


                                  Position of Patient During               The position of the patient during transport from                             No
                 N/A                                            E20_12                                                         No Translation                    No Translation
                                  Transport                                the scene                                                                 Translation

                                  How Patient Was
                                                                           The method the patient was moved from the                                     No
                 N/A              Transported From              E20_13                                                         No Translation                    No Translation
                                                                           ambulance to the destination                                              Translation
                                  Ambulance




          May 28th, 2009                                                                     Please note cover on first worksheet.                                                                         Page 81
                                                                                 TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                         * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                           Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                   NEMSIS DATA DICTIONARY                                                               NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                    Submerssion
                                                                                                                                                                                           Cardiac /
                                                                                                                                                                                            Stroke
  Data Element                                               Element                                                                              Element




                                                                                                                                                                                                              SCI
                                                                                                                                                                                                        TBI
                 Mandate / Rule      Data Element Name                                      Definition                       Data Element Name                                Definition
     Name                                                    Number                                                                               Number


                 H&S 92.003                                     No                                                                                   No
Data Set ID      H&S 773.0613 No Translation From
                              Transport Mode                            No Translation                                     No Translation                    No Translation
                 N/A                                        Translation Indication whether or not lights and/or sirens
                                                             E20_14                                                        No Translation
                                                                                                                                                     No
                                                                                                                                                 Translation No Translation
                 TAC 103.1    Scene                                     were used on the vehicle while leaving scene                             Translation


                                  Condition of Patient at                                                                                            No
                 N/A                                         E20_15     The condition of the patient after care by EMS     No Translation                    No Translation
                                  Destination                                                                                                    Translation


                                  Reason for Choosing                   The reason the unit chose to deliver or transfer                             No
                 N/A                                         E20_16                                                        No Translation                    No Translation
                                  Destination                           the patient to the destination                                           Translation


                                                                        The time of the event recorded by the device's                               No
                 N/A              Event Date/Time            E21_01                                                        No Translation                    No Translation
                                                                        internal clock                                                           Translation


                                  Medical Device Event                  The type of event documented by the medical                                  No
                 N/A                                         E21_02                                                        No Translation                    No Translation
                                  Name                                  device                                                                   Translation


                                                                        The type of waveform file stored in Waveform                                 No
                 N/A              Waveform Graphic Type      E21_03                                                        No Translation                    No Translation
                                                                        Graphic (E21_04)                                                         Translation


                                                                                                                                                     No
                 N/A              Waveform Graphic           E21_04     The graphic waveform file in a PDF or JG format No Translation                       No Translation
                                                                                                                                                 Translation

                                                                        The mode of operation the device is operating in
                                  AED, Pacing, or CO2                   during the defibrillation, pacing, or rhythm                                 No
                 N/A                                         E21_05                                                      No Translation                      No Translation
                                  Mode                                  analysis by the device (if appropriate for the                           Translation
                                                                        event)




          May 28th, 2009                                                                   Please note cover on first worksheet.                                                                       Page 82
                                                                                TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                         * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                           Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                  NEMSIS DATA DICTIONARY                                                                  NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                      Submerssion
                                                                                                                                                                                             Cardiac /
                                                                                                                                                                                              Stroke
  Data Element                                              Element                                                                                 Element




                                                                                                                                                                                                                SCI
                                                                                                                                                                                                          TBI
                 Mandate / Rule     Data Element Name                                       Definition                         Data Element Name                                Definition
     Name                                                   Number                                                                                  Number


                 H&S 92.003                                    No                                                                                      No
Data Set ID      H&S 773.0613 No Translation
                                                                       TheTranslation
                                                                       No lead or source which the medical device            No Translation            No      No Translation
                 N/A          ECG Lead                     Translation used to obtain the rhythm (if appropriate for the
                                                            E21_06                                                           No Translation        Translation No Translation
                 TAC 103.1                                                                                                                         Translation
                                                                       event)

                                                                        The interpretation of the rhythm by the device (if                             No
                 N/A              ECG Interpretation        E21_07                                                           No Translation                    No Translation
                                                                        appropriate for the event)                                                 Translation


                                                                        The energy form used by the device for the                                     No
                 N/A              Type of Shock             E21_08                                                           No Translation                    No Translation
                                                                        defibrillation (if appropriate for the event)                              Translation


                                                                        The energy used for the shock or pacing event (if                              No
                 N/A              Shock or Pacing Energy    E21_09                                                        No Translation                       No Translation
                                                                        appropriate for the event)                                                 Translation

                                                                        The number of times the patient was defibrillated,
                                  Total Number of Shocks                                                                                               No
                 N/A                                        E21_10      if the patient was defibrillated during the patient No Translation                     No Translation
                                  Delivered                                                                                                        Translation
                                                                        encounter

                                                                        The rate the device was calibrated to pace during                              No
                 N/A              Pacing Rate               E21_11                                                        No Translation                       No Translation
                                                                        the event, if appropriate                                                  Translation


                                                                        The heart rate electronically obtained by the                                  No
                 N/A              Device Heart Rate         E21_12                                                           No Translation                    No Translation
                                                                        device (if appropriate for the event)                                      Translation


                                                                        The pulse rate as measured from the pulse
                                                                                                                                                       No
                 N/A              Device Pulse Rate         E21_13      oximeter, non-invasive pressure, or invasive        No Translation                     No Translation
                                                                                                                                                   Translation
                                                                        pressure transducers (if appropriate for the event)




          May 28th, 2009                                                                   Please note cover on first worksheet.                                                                         Page 83
                                                                                  TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                           * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                             Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                     NEMSIS DATA DICTIONARY                                                               NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                      Submerssion
                                                                                                                                                                                             Cardiac /
                                                                                                                                                                                              Stroke
  Data Element                                                 Element                                                                              Element




                                                                                                                                                                                                                SCI
                                                                                                                                                                                                          TBI
                 Mandate / Rule      Data Element Name                                       Definition                        Data Element Name                                Definition
     Name                                                      Number                                                                               Number


                 H&S 92.003                                       No                                                                                   No
Data Set ID      H&S 773.0613 No Translation                              No Translation                                    No Translation                     No Translation
                                                              Translation The Systolic Blood Pressure as measured either                           Translation
                 TAC 103.1    Device Systolic Blood                       through non-invasive blood pressure, invasive                                No
                 N/A                                           E21_14                                                       No Translation                     No Translation
                              Pressure                                    blood pressure monitor 1, or invasive blood                              Translation
                                                                          pressure monitor 2 (if appropriate for the event)


                                                                          The Diastolic Blood Pressure as measured either
                                  Device Diastolic Blood                  through non-invasive blood pressure, invasive                                No
                 N/A                                           E21_15                                                       No Translation                     No Translation
                                  Pressure                                blood pressure monitor 1, or invasive blood                              Translation
                                                                          pressure monitor 2 (if appropriate for the event)


                                                                          The Respiratory Rate as calculated from the
                                                                                                                                                       No
                 N/A              Device Respiratory Rate      E21_16     device through one of the various monitoring      No Translation                     No Translation
                                                                                                                                                   Translation
                                                                          parameters (if appropriate for the event)


                                                                          The Oxygen Saturation as measured from the                                   No
                 N/A              Device Pulse Oximetry        E21_17                                                        No Translation                    No Translation
                                                                          pulse oximeter in % (if appropriate for the event)                       Translation

                                                                          The Carbon Dioxide or end-tidal Carbon Dioxide
                                                                                                                                                       No
                 N/A              Device CO2 or ETCO2          E21_18     as measured from the device transducers (if    No Translation                        No Translation
                                                                                                                                                   Translation
                                                                          appropriate for the event)

                                                                          The Units of Carbon Dioxide, end-tidal Carbon
                                  Device CO2, ETCO2, or
                                                                          Dioxide, invasive pressure monitor 1, or invasive                            No
                 N/A              Invasive Pressure Monitor    E21_19                                                       No Translation                     No Translation
                                                                          pressure monitor 2 as measured from the device                           Translation
                                  Units
                                                                          transducers (if appropriate for the event)




          May 28th, 2009                                                                    Please note cover on first worksheet.                                                                        Page 84
                                                                               TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                       * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                         Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                 NEMSIS DATA DICTIONARY                                                                 NTDB DATA DICTIONARY                                                    Data Sets




                                                                                                                                                                                                                                       Submerssion
                                                                                                                                                                                                              Cardiac /
                                                                                                                                                                                                               Stroke
  Data Element                                             Element                                                                                Element




                                                                                                                                                                                                                                 SCI
                                                                                                                                                                                                                           TBI
                 Mandate / Rule      Data Element Name                                     Definition                        Data Element Name                                 Definition
     Name                                                  Number                                                                                 Number


                 H&S 92.003                                   No                                                                                     No
Data Set ID      H&S 773.0613 No Translation                          No Translation                                      No Translation                     No Translation
                                                          Translation The Invasive Pressure Mean as calculated either                            Translation
                 TAC 103.1    Device Invasive Pressure                through the invasive pressure monitor 1 or the                                 No
                 N/A                                       E21_20                                                         No Translation                     No Translation
                              Mean                                    invasive pressure monitor 2 (if appropriate for the                        Translation
                                                                      event)

                                                                      Indication of how the patient was dispositioned      Hospital Discharge                The disposition of the patient when discharged
                 N/A              Hospital Disposition     E22_02                                                                                  O_05                                                                     X    X        X
                                                                      from the hospital, if admitted                       Disposition                       from the hospital
                                                                      The unique number associated with the law
                                  Law Enforcement/Crash                                                                                              No
                 N/A                                       E22_03     enforcement or crash report which can be used        No Translation                    No Translation
                                  Report Number                                                                                                  Translation
                                                                      for linkage at a later date

                                                                      The unique number associated with the local or
                                                                                                                                                     No
                 N/A              Trauma Registry ID       E22_04     state trauma registry which can be used for          No Translation                    No Translation
                                                                                                                                                 Translation
                                                                      linkage at a later date

                                                                      The unique number associated with the fire
                                  Fire Incident Report                                                                                               No
                 N/A                                       E22_05     incident report which can be used for linkage at a No Translation                      No Translation
                                  Number                                                                                                         Translation
                                                                      later date

                                                                      The unique number associated with the patient
                                  Patient ID Band/Tag                 ID band agency. This is used by a few states as                                No
                 N/A                                       E22_06                                                     No Translation                         No Translation
                                  Number                              a universal linkage between healthcare data                                Translation
                                                                      agencies

                                                                      Indication of whether the form needs review by                                 No
                 N/A              Review Requested         E23_01                                                          No Translation                    No Translation
                                                                      anyone                                                                     Translation


                                  Potential Registry                  An indication if the patient may meet the entry                                No
                 N/A                                       E23_02                                                          No Translation                    No Translation
                                  Candidate                           criteria for a injury or illness specific registry                         Translation




          May 28th, 2009                                                                  Please note cover on first worksheet.                                                                                           Page 85
                                                                                 TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                          * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                            Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                                     NEMSIS DATA DICTIONARY                                                              NTDB DATA DICTIONARY                                 Data Sets




                                                                                                                                                                                                                     Submerssion
                                                                                                                                                                                            Cardiac /
                                                                                                                                                                                             Stroke
  Data Element                                                 Element                                                                             Element




                                                                                                                                                                                                               SCI
                                                                                                                                                                                                         TBI
                 Mandate / Rule      Data Element Name                                       Definition                       Data Element Name                                Definition
     Name                                                      Number                                                                              Number


                 H&S 92.003                                       No                                                                                  No
Data Set ID      H&S 773.0613 No Translation
                              Personal Protection
                                                                          TheTranslation
                                                                          No personal protective equipment which was       No Translation             No      No Translation
                 N/A                                          Translation used by EMS personnel during the EMS patient
                                                               E23_03                                                      No Translation         Translation No Translation
                 TAC 103.1    Equipment Used                                                                                                      Translation
                                                                          contact

                                  Suspected Intentional, or              Suspicion of the listed multi-casualty or domestic                           No
                 N/A                                           E23_04                                                       No Translation                    No Translation
                                  Unintentional Disaster                 terrorism causes                                                         Translation

                                  Suspected Contact With
                                                                         Indication of unprotected contact with blood or                              No
                 N/A              Blood/Body Fluids of EMS     E23_05                                                      No Translation                     No Translation
                                                                         body fluids                                                              Translation
                                  Injury or Death

                                  Type of Suspected
                                                                         The type of exposure or unprotected contact with                             No
                 N/A              Blood/Body Fluid Exposur,    E23_06                                                     No Translation                      No Translation
                                                                         blood or body fluids                                                     Translation
                                  Injury, or Death


                                                                         The EMS personnel who was/were exposed to                                    No
                 N/A              Personnel Exposed            E23_07                                                      No Translation                     No Translation
                                                                         unprotected contact wth blood or body fluids                             Translation


                                  Required Reportable                    The presence of any condition which is reportable                            No
                 N/A                                           E23_08                                                      No Translation                     No Translation
                                  Condition                              based on federal or state regulations                                    Translation


                                                                         A customizable field to be used by local agencies                            No
                 N/A              Research Survey Field        E23_09                                                      No Translation                     No Translation
                                                                         for additional documentation or research                                 Translation

                                                                         The statewide assigned ID number of the EMS
                                  Who Generated This                                                                                                  No
                 N/A                                           E23_10    crew member which completed this patient care     No Translation                     No Translation
                                  Report?                                                                                                         Translation
                                                                         report




          May 28th, 2009                                                                   Please note cover on first worksheet.                                                                        Page 86
                                                                            TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                     * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                       Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                               NEMSIS DATA DICTIONARY                                                                    NTDB DATA DICTIONARY                                                      Data Sets




                                                                                                                                                                                                                                          Submerssion
                                                                                                                                                                                                                 Cardiac /
                                                                                                                                                                                                                  Stroke
  Data Element                                           Element                                                                                   Element




                                                                                                                                                                                                                                    SCI
                                                                                                                                                                                                                              TBI
                 Mandate / Rule     Data Element Name                                  Definition                       Data Element Name                                        Definition
     Name                                                Number                                                                                    Number


                 H&S 92.003                                 No                                                                                        No
Data Set ID      H&S 773.0613 No Translation Field
                              Research Survey                       No Translation                                    No Translation                          No Translation
                 N/A                                    Translation A customizable field to be used by local agencies No Translation
                                                         E23_11
                                                                                                                                                      No
                                                                                                                                                  Translation No Translation
                 TAC 103.1    Title                                 for additional documentation or research                                      Translation


                                                            No                                                                                                The mode of transport delivering the patient to
                 N/A              No Translation                    No Translation                                   Transport Mode                 P_07
                                                        Translation                                                                                           your hospital.

                                                                                                                                                              All other modes of transport used during patient
                                                            No                                                                                                care event (prior to arrival at your hospital),
                 N/A              No Translation                    No Translation                                   Other Transport Mode           P_08
                                                        Translation                                                                                           except the mode delivering the patient to the
                                                                                                                                                              hospital.

                                                            No                                                       Initial ED/Hospital                      First recorded temperature (in degrees Celcius
                 N/A              No Translation                    No Translation                                                                 ED_05
                                                        Translation                                                  Temperature                              [centigrade]) in the ED/hospital.

                                                                                                                                                              Determinatoin of respiratory assistance
                                                            No                                                       Initial ED/Hospital
                 N/A              No Translation                    No Translation                                                                 ED_07      associated with the initial ED/hospital
                                                        Translation                                                  Respiratory Assistance
                                                                                                                                                              respiratory rate.

                                                            No                                                       Initial ED/Hospital Oxygen               First recorded oxygen saturation in the
                 N/A              No Translation                    No Translation                                                                 ED_08
                                                        Translation                                                  Saturation                               ED/hospital (expressed as a percentage).


                                                                                                                                                              Determination of the presence of supplemental
                                                            No                                                       Initial ED/Hospital
                 N/A              No Translation                    No Translation                                                                 ED_09      oxygen during assessment of initial ED/hospital
                                                        Translation                                                  Supplemental Oxygen
                                                                                                                                                              oxygen saturation level.


                                                            No
                 N/A              No Translation                    No Translation                                   Alcohol Use Indicator         ED_15      Use of alcohol by the patient.                                                 X
                                                        Translation




          May 28th, 2009                                                              Please note cover on first worksheet.                                                                                                  Page 87
                                                                            TRISA Data Documentation Reference Material



 * Green - Indicates that the * Yellow - Indicates that the
                                                                     * Grey - Indicates Required National
data element exists in TRAC- data element exists in two of
                                                                       Data Element for NEMSIS Silver
     IT, NEMSIS & NTDB        the three data dictionaries.

   TRAC-IT DATA DICTIONARY                               NEMSIS DATA DICTIONARY                                                       NTDB DATA DICTIONARY                                                      Data Sets




                                                                                                                                                                                                                             Submerssion
                                                                                                                                                                                                    Cardiac /
                                                                                                                                                                                                     Stroke
  Data Element                                           Element                                                                      Element




                                                                                                                                                                                                                       SCI
                                                                                                                                                                                                                 TBI
                 Mandate / Rule     Data Element Name                                Definition                Data Element Name                                    Definition
     Name                                                Number                                                                       Number


                 H&S 92.003                                 No                                                                           No
Data Set ID      H&S 773.0613 No Translation                No      No Translation                          No Translation                       No Translation
                 N/A          No Translation            Translation No Translation                          Drug Use Indicator       Translation Use of drugs by the patient.
                                                                                                                                       ED_16                                                                                    X
                 TAC 103.1                              Translation


                                                            No                                                                                   The type of death incurred while the patient was
                 N/A              No Translation                    No Translation                          ED Death                   ED_18
                                                        Translation                                                                              in the ED.

                                                                                                                                                 The total number of patient days spent on a
                                                            No
                 N/A              No Translation                    No Translation                          Total Ventilator Days      O_02      mechanical ventilator (excluding time in the
                                                        Translation
                                                                                                                                                 OR).

                                                            No                                                                                   Any medical complication that occurred during
                 N/A              No Translation                    No Translation                          Hospital Complications     Q_01
                                                        Translation                                                                              the patient's stay at your hospital.




          May 28th, 2009                                                             Please note cover on first worksheet.                                                                                      Page 88
                                                    TRISA Data Documentation Reference Material


                                                      Heart Attack, Heart Failure and Stroke
                                                            Quality of Care Elements
                                                                Trauma Registry
Condition        Elements                              Description                        Count                               Reporter

Heart Attack
HA – 1           Aspirin at arrival                     Acute myocardial infarction (AMI) patients No. of eligible            Hospital
                                                        without aspirin contraindications who      patients
                                                        received aspirin within 24 hours before or
                                                        after hospital arrival.                    No. of patients
                                                                                                   treated

                                                                                                      % of patients treated

HA – 2           Aspirin at discharge                   AMI patients without aspirin                  No. of eligible         Hospital
                                                        contraindications who were prescribed         patients
                                                        aspirin at hospital discharge.
                                                                                                      No. of patients
                                                                                                      prescribed

                                                                                                      % of patients
                                                                                                      prescribed
HA – 3           ACE inhibitor or ARB for left          AMI patients with left ventricular systolic   No. of eligible         Hospital
                 ventricular systolic dysfunction       dysfunction (LVSD) and without                patients
                                                        angiotensin converting enzyme inhibitor
                                                        (ACE inhibitor) contraindications or          No. of patients
                                                        angiotensin receptor blocker (ARB)            prescribed
                                                        contraindications who are prescribed an
                                                        ACE inhibitor or an ARB at hospital           % of patients
                                                        discharge.                                    prescribed
HA - 4           Beta Blocker at discharge              AMI patients without beta-blocker             No. of eligible         Hospital
                                                        contraindications who were prescribed a       patients
                                                        beta-blocker at hospital discharge.
                                                                                                      No. of patients
                                                                                                      prescribed



May 28th, 2009                                           Please note cover on first worksheet.                                           Page 89
HA - 4           Beta Blocker at discharge              AMI patients without beta-blocker                                          Hospital
                                                        contraindications who were prescribed a
                                                        beta-blocker at hospital discharge.
                                                    TRISA Data Documentation Reference Material



                                                                                                       % of patients
                                                                                                       prescribed
HA - 5           Fibrinolytic medication received          AMI patients receiving fibrinolytic therapy No. of eligible             Hospital
                 within 30 minutes of hospital arrival     during the hospital stay and having a time patients
                                                           from hospital arrival to fibrinolysis of 30
                                                           minutes or less                             No. of patients
                                                                                                       treated

                                                                                                           % of patients treated

HA – 6           PCI Received Within 90 Minutes Of         AMI patients receiving Percutaneous             No. of eligible         Hospital
                 Hospital Arrival                          Coronary Intervention (PCI) during the          patients
                                                           hospital stay with a time from hospital
                                                           arrival to PCI of 90 minutes or less.           No. of patients
                                                                                                           treated

                                                                                                           % of patients treated

HA - 7           Smoking cessation advice/counseling       AMI patients with a history of smoking       No. of eligible            Hospital
                                                           cigarettes, who are given smoking cessation patients
                                                           advice or counseling during a hospital stay.
                                                                                                        No. of patients
                                                                                                        counseled

                                                                                                           % of patients
                                                                                                           counseled
Heart Failure
HF - 1           Evaluation of left ventricular systolic   Heart failure patients with documentation in    No. of eligible         Hospital
                 (LVS) function                            the hospital record that an evaluation of the   patients
                                                           left ventricular systolic (LVS) function was
                                                           performed before arrival, during                No. of patients
                                                           hospitalization, or is planned for after        evaluated
                                                           discharge.
                                                                                                           % of patients
                                                                                                           evaluated



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                                                    TRISA Data Documentation Reference Material


HF - 2           ACE inhibitor or ARB for left          Heart failure patients with (LVSD) and        No. of eligible         Hospital
                 ventricular systolic dysfunction       without angiotensin converting enzyme         patients
                 (LVSD)                                 inhibitor (ACE inhibitor) contraindications
                                                        or angiotensin receptor blocker (ARB)         No. of patients
                                                        contraindications who are prescribed an       prescribed
                                                        ACE inhibitor or an ARB at hospital
                                                        discharge.                                     % of patients
                                                                                                       prescribed
HF - 3           Discharge instructions                 Heart failure patients discharged home with No. of eligible           Hospital
                                                        written instructions or educational material patients
                                                        given to patient or care giver at discharge or
                                                        during the hospital stay addressing all of the No. of patients w/
                                                        following: activity level, diet, discharge     discharge instruct.
                                                        medications, follow-up appointment, weight
                                                        monitoring, and what to do if symptoms         % of patients with
                                                        worsen.                                        discharge instruct.

HF - 4           Smoking cessation advice/counseling    Heart failure patients with a history of      No. of eligible         Hospital
                                                        smoking cigarettes, who are given smoking     patients
                                                        cessation advice or counseling during a       No. of patients
                                                        hospital stay.                                counseled
                                                                                                      % of patients
                                                                                                      counseled
Acute Stroke
DSC – AS - 1     Deep Vein Thrombosis prophylaxis       Stroke patients had DVT prophylaxis           No. of eligible         Hospital
                                                        initiated by end of hospital day 2            patients

                                                                                                      No. of patients
                                                                                                      treated

                                                                                                      % of patients treated

DSC - AS - 2     Antiplatelet/antithrombotics           Stroke patients had antithrombotic therapy No. of eligible            Hospital
                 prescribed at discharge                prescribed at discharge                    patients

                                                                                                      No. of patients
                                                                                                      prescribed


May 28th, 2009                                           Please note cover on first worksheet.                                           Page 91
DSC - AS - 2     Antiplatelet/antithrombotics       Stroke patients had antithrombotic therapy                               Hospital
                 prescribed at discharge            prescribed at discharge
                                                TRISA Data Documentation Reference Material



                                                                                                     % of patients
                                                                                                     prescribed
DSC – AS - 3     Atrial Fibrillation Therapy         Stroke patients with atrial fibrillation were   No. of eligible         Hospital
                                                     prescribed anticoagulation therapy at time      patients
                                                     of hospital discharge
                                                                                                     No. of patients
                                                                                                     prescribed

                                                                                                  % of patients
                                                                                                  prescribed
DSC – AS - 4     IV Thrombolytic Therapy             Stroke patients that received IV             No. of eligible            Hospital
                 Administered (Texas – Tissue        thrombolytic therapy at this hospital during patients treated
                 plasminogen activator               the present hospitalization
                 (tPA)considered - IV, IA and                                                     No. of patients
                 Mechanical therapy)                                                              treated


                                                                                                     % of patients treated


                                                                                                     (Texas – No. and
                                                                                                     percentage of
                                                                                                     patients provided IV,
                                                                                                     IA and/or mechanical
                                                                                                     thrombolytic therapy)


DSC – AS - 5     Antithrombotic medication           Stroke patients that had antithrombotic     No. of eligible             Hospital
                 Administered within 48 hours        therapy administered by the end of hospital patients
                                                     day two.
                                                                                                 No. of patients
                                                                                                 treated

                                                                                                     % of patients treated




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                                                   TRISA Data Documentation Reference Material


DSC – AS - 6     Cholesterol Reducing Therapy           Stroke patients were prescribed cholesterol   No. of eligible   Hospital
                 Prescribed at Discharge (Texas - Lipid reducing drugs at discharge:                  patients
                 Profile Order during hospitalization)
                                                        Was the patient on cholesterol reducing       No. of patients
                                                        therapy prior to this hospitalization?        prescribed

                                                         The patient’s LDL level was > 100 mg/dl in % of patients
                                                         the first 48 hours of hospitalization      prescribed




DSC – AS - 7     Dysphagia Screening                     Stroke patients were screened for dysphagia No. of eligible    Hospital
                                                         before being given any oral intake,         patients
                                                         including food, fluids or medications.
                                                                                                     No. of patients
                                                                                                     screened

                                                                                                      % of patients
                                                                                                      screened
DSC – AS - 8     Stroke Education Provided               Stroke patients given education on:          No. of eligible   Hospital
                                                                                                      patients

                                                           Need for activation of EMS system if       No. of patients
                                                           signs occur                                educated
                                                           Need for continuing medical care after
                                                           discharge
                                                           Medication addressed                       % of patients
                                                                                                      educated
                                                           Personal risk factors for stroke
                                                           Warning signs and symptoms of stroke

DSC – AS - 9     Smoking Cessation Counseling            Stroke patients with a history of smoking    No. of eligible
                                                         during the prior year given smoking          patients
                                                         cessation advice of counseling during
                                                         hospital stay.                               No. of patients
                                                                                                      counseled




May 28th, 2009                                            Please note cover on first worksheet.                                    Page 93
DSC – AS - 9     Smoking Cessation Counseling         Stroke patients with a history of smoking
                                                      during the prior year given smoking
                                                      cessation advice of counseling during
                                                  TRISA Data Documentation Reference Material
                                                      hospital stay.


                                                                                                   % of patients
                                                                                                   counseled
DSC – AS - 10    Assessed for Rehabilitation Services   Stroke patients were assessed for or       No. of eligible       Hospital
                                                        received rehabilitation services           patients

                                                                                                   No. of patients
                                                                                                   assessed or treated

                                                                                                   % of patients
                                                                                                   assessed or treated

Admissions
Ad               Admissions (from DSC info)             All patients:                              No. of patients       Hospital and EMS
                                                         Date of arrival to hospital
                                                         Time of arrival
                                                         Admission date
                                                         Admission Source
                                                         Birthdate
                                                         (Case Identifier)
                                                         Comfort Measures
                                                         Discharge Date
                                                         Discharge Status
                                                         Hispanic Ethnicity
                                                         ICD9 – CM Principal Diagnosis
                                                         Race
                                                         Report period
                                                         Sex

EMS
EMS              Calls Received and Responded to by     Time patients made and received assistance No. of patients and   EMS and Hospital
                 EMS                                    from EMS for signs and symptoms of heart times for response
                                                        attack or stroke:

                                                          Calls received by EMS
                                                          Time from call to scene
                                                          Time on scene



May 28th, 2009                                          Please note cover on first worksheet.                                               Page 94
                 EMS                                                                             times for response


                                                  TRISA Data Documentation Reference Material


                                                          Time from scene to hospital
                                                          Admitted to hospital


Data Sources     Entity                                 Measures                                 Evidence
Heart Attack     Centers for Medicare/Medicaid Required Hospital Process of Care Measure Set     Every year, about one million people suffer a heart
                 Data Elements                                                                   attack (acute myocardial infarction or AMI). AMI is
                                                                                                 among the leading causes of hospital admission for
                                                                                                 Medicare beneficiaries, age 65 and older.
                                                                                                  Scientific evidence indicates that the following
                                                                                                 process of care measures represent the best practices
                                                                                                 for the treatment of AMI.

Heart Failure    Centers for Medicare/Medicaid Required Hospital Process of Care Measure Set     Heart failure is the most common hospital admission
                 Data Elements                                                                   diagnosis in patients age 65 or older, accounting for
                                                                                                 more than 700,000 hospitalizations among Medicare
                                                                                                 beneficiaries every year. It is associated with severe
                                                                                                 functional impairments and high rates of mortality and
                                                                                                 morbidity. Substantial scientific evidence indicates
                                                                                                 that the following process of care measures represent
                                                                                                 the best practices for the treatment of heart failure.

Acute Stroke     Joint Commission Primary Stroke Center Disease Specific Care Program            Each year about 700,000 people experience a new or
                                                                                                 recurrent stroke. With advances in diagnosis and
                                                                                                 treatment, the stroke death rate has fallen over the
                                                                                                 years, however it still remains the No. 3 cause of death
                                                                                                 in the U.S. and Texas. Once a stroke has occurred, all
                                                                                                 attempts should be made to decrease the time from
                                                                                                 symptom onset to stroke treatment. Initial diagnosis if
                                                                                                 important for treatment and disease management.
                                                                                                 Research has identified and clinical practice guidelines
                                                                                                 include recommended processes of care based on the
                                                                                                 best evidence and clinical opinion available at this
                                                                                                 time.




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                                                              The performance measures presented have been
                                                              selected with reference to the process of care described
                                                              in current clinical practice guidelines.




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Variable Label                                Variable Name         Missing Code   Format Type      Length
Age                                           AGE                        999       Numeric            8
Case Identification                           CASEID                     N/A       Numeric            8
County of Injury                              CNTYINJ                    999       Numeric            8
County of Residence                           CNTYRES                    999       Numeric            8
Date of Admission                             DOADM                   99999999     Character/Text     8
Date of Birth                                 DOB                     99999999     Character/Text     8
Date of Death                                 DOD                     99999999     Character/Text     8
Date of Discharge                             DODC                    99999999     Character/Text     8
Date of Injury                                DOINJ                   99999999     Character/Text     8
Diagnosis Codes                               ICD1-ICD36              99999999     Character/Text     6
Discharge Disposition                         DCDISP                       9       Numeric            8
External Cause of Injury Codes                ECODE1-ECODE5            999999      Character/Text     6
Event                                         EVENT                      N/A       Character/Text     8
Hispanic                                      HISPANIC                     9       Numeric            8
Payment Source                                PAYER1 PAYER2                9       Numeric            8
Preadmission Death / Hospital Size            PAD_HOSP                   N/A       Numeric            8
Race                                          RACE                         9       Numeric            8
Sex                                           SEX                          9       Numeric            8
State of Injury                               STATEINJ                    99       Numeric            8
State of Report                               STATERPT                   N/A       Numeric            8
State of Residence                            STATERES                   N/A       Numeric            8
Type of Care                                  TYPECARE                     9       Numeric            8
Work-Relatedness                              WORKRLTD                     9       Numeric            8
Year                                          YEARRPT                    N/A       Numeric            8

                                          TBI Extended Variables
Variable Label                                Variable Name      Missing Code      Format Type      Length
Abbreviated Injury Scale Score - Head         AISHEAD                  9           Numeric            8
Glasgow Coma Scale Score                      GCS                     99           Numeric            8
Glasgow Outcome Scale Score                   GOS                      9           Numeric            8
Intercranial Lesion                           ICLESION                 9           Numeric            8
Level of Consciousness                        LOC                      9           Numeric            8
Length of Time Unconscious - Added            TIMEUCON                 9           Numeric            8
Skull Fracture                                SKULLFX                  9           Numeric            8
                                                                                                      8
                                          Sci Extended Variables
Variable Label                                Variable Name      Missing Code      Format Type      Length
Abbreviated Injury Scale Score - Spine        AISSPINE                 9           Numeric            8
Spinal Cord Injury Extent                     SCIEXTNT                 9           Numeric            8
Spinal Cord Injury Level                      SCILEVEL                 9           Numeric            8

                                      TBI and SCI Extended Variables
Variable Label                                Variable Name       Missing Code     Format Type      Length
Abstract                                      ABSTRACT                 N/A         Numeric            8
Blood Alcohol Concentration                   BAC                      999         Numeric            8
Event-Revised                                 EVENTREV                99999        Numeric            8
External Cause of Injury Code 1 - Revised     ECODERV1               999999        Character/Text     6
External Cause of Injury Code 2 - Revised -
Added                                         ECODERV2               999999        Character/Text     6



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Motor Vehicle Position                         MVPOS                          9    Numeric               8
Patient's Living Status                        LIVESTAT                      99    Numeric               8
Personal Protective Equipment                  PPE1, PPE2, PPE3               9    Numeric               8

Preadmission Death / Hospital Size - Revised   PADHREV                       N/A   Numeric               8
Sports and Recreation - Modified               SPORTREC                      99    Numeric               8
Sports and Recreation SPECIFY - Added          S_R_SPEC                      N/A   Character/Text       20
Sample Flag                                    SAMPLE                        N/A   Numeric               8


Note : SCI records are identified in the TRAC-IT system as those with DIAGNOSIS codes of 806.0 through
806.9 or 952.0 through 952.9

Note: TBI records are identified in the TRAC-IT system as those with DIAGNOSIS codes of 800.0 through
801.99, 803.0 through 804.99, 850.0 through 854.99, and 959.01




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 Number                     Data Element Name                       Type                                   Description
   1      LAST NAME OF PERSON COMPLETING FORM                       Text     The last name of the person who is completing this form
   2      FIRST NAME OF PERSON COMPLETING FORM                      Text     The first name of the person completing this form
   3      MIDDLE INITIAL OF PERSON COMPLETING FORM                  Text     The middle initial of the person completing this form
   4      PHONE NUMBER OF PERSON COMPLETING THIS FORM               Text     The direct phone number of the person completing this form
                                                                             including the extension, if applicable
    5     ENTITY NAME                                              Text      The name of the entity you represent
    6     ENTITY TYPE                                             Numeric    The type of entity you represent
    7     TRAUMA REGISTRY / HOSPITAL FACILITY NUMBER              Numeric    The unique number assigned by the registry software program or
                                                                             registrar.
    8     PATIENT’S LAST NAME                                      Text      The patient’s legal last name
    9     PATIENT’S FIRST NAME                                     Text      The patient’s legal first name
   10     PATIENT’S MIDDLE INITIAL                                 Text      The patient’s legal middle initial
   11     DATE OF BIRTH                                          Date/Time   The patient’s date of birth
   12     SEX                                                     Numeric    The patient's sex at injury date (if patient is in the middle of a
                                                                             gender change, use original sex)
   13     PATIENT’S AGE                                           Numeric    The patient’s age in years
   14     ESTIMATED AGE                                           Numeric    The patient’s estimated age group
   15     RACE                                                    Numeric    The patient's race
   16     ETHNICITY                                               Numeric    The patient's ethnicity
   17     PATIENT ADDRESS – STREET NUMBER                          Text      The Street Number of the patient’s address at the time of this
                                                                             incident
   18     PATIENT ADDRESS – STREET NAME                             Text     The Street Name of the patient’s address at the time of this incident

   19     PATIENT ADDRESS – CITY                                   Text    The city the patient lived in at the time of this incident
   20     PATIENT ADDRESS – STATE                                  Text    The state the patient lived in at the time of this incident
   21     PATIENT ADDRESS – COUNTY                                Numeric  The county the patient lives in at the time of this incident
   22     PATIENT ADDRESS – ZIP CODE                               Text    The zip code the patient lived in at the time of this incident; enter
                                                                           only 5 digits
   23     DATE OF INCIDENT                                       Date/Time Date of submersion
   24     TIME OF INCIDENT                                       Date/Time The time the patient was injured; use military time Ex: 00:00 is
                                                                           midnight
   25     DAY OF THE WEEK THE INCIDENT OCCURRED                   Numeric The day of the week the patient was injured.
   26     CHECK IF SAME AS PATIENT ADDRESS                          Bit    Check this if the incident occurred at the patient’s home address

   27     ADDRESS OF INCIDENT – STREET NUMBER                       Text     The street number where this incident occurred
   28     ADDRESS OF INCIDENT – STREET NAME                         Text     The street name where this incident occurred



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   29       ADDRESS OF INCIDENT – CITY                                Text      The city where this incident occurred
   30       ADDRESS OF INCIDENT – STATE                               Text      The state where this incident occurred
   31       ADDRESS OF INCIDENT – COUNTY                             Numeric    The county where this incident occurred
   32       ADDRESS OF INCIDENT – ZIP CODE                            Text      The zip code where this incident occurred ; enter as #####
   33       WAS PATIENT TREATED AT HOSPITAL                          Numeric    Was the patient treated (seen) at a hospital
   34       IF TREATED                                               Numeric    If the patient was seen at the hospital, what type treatment was
                                                                                received?
   35       DATE OF ARRIVAL                                         Date/Time   If the patient was treated at admitted to the hospital, enter the date
                                                                                they arrived at your facility
   36       DATE DISCHARGED                                         Date/Time   Enter the date the patient was transferred/discharged
   37       MEDICAL RECORD NUMBER                                     Text      If the patient was treated at the hospital, enter the medical record
                                                                                number that is specific to this particular visit
38,39,40,4 ICD-9 DIAGNOSIS CODES                                       Text     Enter the diagnosis codes for this patient for this particular incident.
 1,42,43                                                                        Enter the MOST SEVERE ICD-9 FIRST, then the less severe (up to
                                                                                6 different codes). Include the decimal point for those codes with a
                                                                                suffix.
 44,45,46 ICD-9 E-CODES                                                Text     Enter the E-Codes (Cause of Injury codes ) for this patient for this
                                                                                particular incident. Include the decimal point for those codes with a
                                                                                suffix.
 47,48,49   METHOD OF PAYMENT                                        Numeric    How was the patient’s bill paid? (May choose up to 3)
    50      METHOD OF PAYMENT – OTHER                                 Text      Describe other location of incident
    50      HOSPITAL CHARGES                                         Numeric    Enter the patient bill amount (round to the nearest dollar).
    51      LOCATION INCIDENT OCCURRED                               Numeric    Where did the incident occur?
    52      LOCATION INCIDENT OCCURRED – OTHER LOCATION               Text      Describe other location of incident
    53      TYPE OF POOL                                             Numeric    If the incident occurred in a swimming pool, describe the type of
                                                                                pool
   54       KIND OF POOL                                             Numeric    If the incident occurred in a swimming pool, describe the kind of
                                                                                pool
   55       BARRIER AT TIME OF INCIDENT - FENCE                      Numeric    Was there a fence around the swimming pool and was it
                                                                                operational, i.e. upright and intact
   56       FENCE TYPE                                               Numeric    What type of fence was it
   57       BARRIER AT TIME OF INCIDENT - GATE                       Numeric    Was there a gate leading to the swimming pool and was it open or
                                                                                closed
   58       BARRIER AT TIME OF INCIDENT – POOL ALARM                 Numeric    Was there a pool alarm
   59       BARRIER AT TIME OF INCIDENT – OTHER BARRIER               Text      Describe any other barrier
   60       NAME OF WATER BODY                                        Text      If the incident occurred in a bay, bayou, lake, pond ,river, creek or
                                                                                other, enter the name of the water body



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   61     WAS THIS AN ENTRAPMENT                                 Numeric Ensnared on pool/spa drain or drain cover, usually by suction or
                                                                         entangled hair
   62     LIFE GUARD ON DUTY                                     Numeric Was there a lifeguard on duty at the time the incident occurred
   63     LOCATION DESCRIPTION                                   Numeric What is the setting of the incident
   64     DWELLING TYPE                                          Numeric Did the incident occur at the patients home or at another person’s
                                                                         home?
   65     PATIENT ACTIVITY                                       Numeric What activity was the patient doing at the time of this incident?
   67     PATIENT ACTIVITY – OTHER                                Text   Did the patient know how to swim?
   66     SWIMMER                                                Numeric Describe the activity not listed.
   68     CRASH RELATED                                          Numeric Was this incident a result of a motor vehicle crash?
   69     WEATHER RELATED                                        Numeric Did weather conditions , e.g. rain, wind, fog, flash flood, contribute
                                                                         to this incident?
   70     CLOTHING TYPE                                          Numeric Describe the type of clothing the patient was wearing at the time of
                                                                         the incident.
   71     CLOTHING TYPE – OTHER                                   Text   Describe other clothing worn by the patient at time of the incident

   72     PERSON SUPERVISING                                     Numeric If the patient was under age 15, who was supervising the patient at
                                                                         time of the incident ?
   73     PERSON SUPERVISING – OTHER                              Text   Describe other person not listed who was supervising the child at
                                                                         time of the incident
   74     PERSONAL FLOTATION DEVICE                              Numeric Was the patient using a personal flotation device at the time of the
                                                                         incident?
 75,76,77 PERSONAL FLOTATION DEVICE - TYPE                       Numeric What type of flotation device was being used at the time of the
                                                                         incident?
   78     TYPE OF PERSONAL FLOTATION DEVICE – OTHER               Text   Describe other flotation device used by the patient at time of the
                                                                         incident
   79     PATIENT UNCONSCIOUS                                    Numeric Was the patient unconscious at any time during the incident?
   80     ESTIMATED TIME SUBMERGED                               Numeric Estimate the time this patient was submerged under water
   81     TYPE OF RESCUE ASSISTANCE AT SCENE                     Numeric What was the primary type of rescue assistance given at the scene
                                                                         of the incident?
   82     TYPE OF RESCUE ASSISTANCE AT SCENE– OTHER               Text   Describe other type of rescue assistance provided at the scene.

   83     WHO PROVIDED ASSISTANCE                                Numeric If rescue assistance was provided, who provided the assistance?

   84     WHO PROVIDED ASSISTANCE AT SCENE– OTHER                 Text   Describe other who provided rescue assistance at the scene.
   85     CONTRIBUTING MEDICAL FACTORS                           Numeric Did any of the following conditions contribute to this incident?




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   86     CONTRIBUTING MEDICAL FACTORS– OTHER                          Text     Describe other type of rescue assistance provided at the scene.

   87     ALCOHOL USE                                                Numeric    Was alcohol use suspected or confirmed?
   88     ALCOHOL LEVEL                                              Numeric    What is the result of the test for alcohol?
   89     DRUG USE                                                   Numeric    Was drug use suspected or confirmed?
   90     DRUG LEVEL                                                 Numeric    What is the result of the test for drugs?
   91     TRANSPORTED TO HOSPITAL BY EMS                             Numeric    Was the patient transported to your facility by an EMS provider?

   92     FIRM NAME                                                    Text  Enter ther name or DSHS number of the EMS provider that
                                                                             transported this patient to your facility
   93     VITAL SIGNS AT THE SCENE - PULSE                           Numeric What was the patient’s pulse at the scene of the incident?
   94     VITAL SIGNS AT THE SCENE - RESPIRATIONS                    Numeric What was the patient’s respiration rate at the scene of the incident?

   95     GLASCOW COMA SCORE AT THE SCENE - EYE                      Numeric    Enter the patient’s GCS Eye score at the scene
   96     GLASCOW COMA SCORE AT THE SCENE - VERBAL                   Numeric    Enter the patient’s GCS Verbal score at the scene
   97     GLASCOW COMA SCORE AT THE SCENE - MOTOR                    Numeric    Enter the patient’s GCS Motor score at the scene
   98     VITAL SIGNS AT THE HOSPITAL (INITIAL) - PULSE              Numeric    What was the patient’s pulse the first time it was taken at the
                                                                                hospital?
   99     VITAL SIGNS AT THE HOSPITAL (INITIAL) - RESPIRATIONS       Numeric    What was the patient’s respiration rate the first time it was taken at
                                                                                the hospital?
   100    GLASCOW COMA SCORE AT THE HOSPITAL - EYE                   Numeric    Enter the patient’s GCS Eye score at the hospital
   101    GLASCOW COMA SCORE AT THE HOSPITAL - VERBAL                Numeric    Enter the patient’s GCS Verbal score at the hospital
   102    GLASCOW COMA SCORE AT THE HOSPITAL - MOTOR                 Numeric    Enter the patient’s GCS Motor score at the hospital
   103    OUTCOME                                                    Numeric    Enter the patient’s outcome upon leaving the hospital
   104    STATUS AT TRANSFER/DISCHARGE                               Numeric    Enter the patient’s status when they were transferred to another
                                                                                facility or discharged from your facility
   105    TRANSFERRED/DISCHARGED TO                                  Numeric    Where was the patient transferred to or discharged to?
   106    FACILITY NAME                                               Text      If the patient was discharged to another hospital, a nursing home, a
                                                                                rehab facility, or other facility, enter the name of the facility

   107    DATE TRANSFERRED                                          Date/Time Enter the date the patient was transferred/discharged
   108    DESCRIBE ANY OTHER CIRCUMSTANCE THAT MAY HAVE               Text    Enter any circumstances that you feel we might want to know about
          CONTRIBUTED TO THIS INCIDENT                                        concerning this incident




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